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  3. When I was a psychiatric resident, we had a faculty member who was famous for his messy office: stacks of papers and old journal

When I was a psychiatric resident, we had a faculty member who was famous for his messy office: stacks of papers and old journal

admin2009-04-27  109
问题     When I was a psychiatric resident, we had a faculty member who was famous for his messy office: stacks of papers and old journals covered every chair and table as well as much of the floor. Eventually, the faculty member had to be given another office in which to see patients.
    Not surprisingly, the psychiatric diagnostic manual does riot list "messy room" in the index. But it does mention a tantalizing symptom: inability "to discard worn-out or worthless objects even when they have no sentimental value." It comes under the diagnosis obsessive-compulsive personality disorder, an obscure cousin of the more famous obsessive-compulsive disorder(强迫性神经官能症)
    I was barely aware of the diagnosis. Every era has mental disorders that for cultural or scientific reasons become popular. In Freud’s day it was hysteria. Currently, depression has moved to center stage. But other ailments go relatively ignored, and this disorder was one.
    (46)It came with a list of additional symptoms: anxiety about spending money, excessive devotion to work to the exclusion of leisure activities, rigidity about following rules, perfectionism in doing tasks—at times to the point of interfering with finishing them.
    (47)In moderation, the symptoms seemed to fit right in with our workaholic culture—perhaps explaining the low profile of the diagnosis. Relentless work orientation and perfectionism may even be assets in rule-and-detail-oriented professions like accounting or law.
    But when the symptoms are too intense or pervasive, they become crippling. Beneath the seemingly adaptive behaviors lies a central disability. People with this diagnosis have enormous difficulty in making decisions. (48)They lack the internal sense of completion that most of us experience at the end of a choice or a task, even one as simple as throwing something out or making a purchase. In obsessive-compulsive personality disorder, this feeling occurs only after endless deliberation and revision, if at all.
    (49)The need to come up with the "correct" answer, the best purchase or the perfect proposal leads to excess rumination over each decision. It can even lead to complete paralysis. For such people, rules of all kinds are a godsend they represent pre-made decisions. Open-ended assignments, like writing papers, are nightmares.
    For such a patient or for a psychiatrist, understanding a cluster of diagnostic symptoms can be a revelation. The picture leaps out from the previously disorganized background. (50)But undoubtedly, at times we can become too reductionistic, seeing patterns where none exist: sometimes a messy room is just a messy room.

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答案要想出"正确的"答案，要买到最合适的东西，要提出完美的提议，这种需要导致患者在做每一个决定时考虑过多。
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