죄 진단을 위한 기독교 병리학 체계와 치료적 함의

김규보 한국실천신학회 2021 신학과 실천 Vol.- No.76

이 연구는 죄에 대한 기독교 병리학적 접근을 제안하고 치료적 함의를 논한다. 하 나님의 창조를 믿는 입장에서 인간 병리에 대한 이해는 하나님의 말씀을 중심으로 이 루어져야 한다. 이에 본고는 성경 계시를 중심으로 기독교 전통을 진지하게 탐구하며 현대 심리학의 합리적인 발견들을 창조은혜 안에서 비평적으로 또한 건설적으로 활용 하는 인간 병리에 대한 전인적 진단체계로서 기독교 병리학을 소개하고, 죄의 범주를 탐구한다. 죄 문제에 대해 기독교 병리학은 원죄, 죄 행위, 사회문화적 죄를 구분한다. 원죄는 인간 병리의 근원이며, 원죄로부터 기인한 죄성은 전인에 영향을 미친다. 원죄 와 죄성에 대한 기독교 병리학의 진단은 궁극적으로 마음의 우상을 드러낸다. 죄 행 위에 대한 진단은 죄 행위의 주체와 객체를 구분하고, 행하는 죄와 행하지 않는 죄를 구분하여 적용한다. 이 진단은 내담자와 상담사를 분리하기보다 함께 자기 죄를 성찰 하고 서로 짐을 나눔으로 그리스도께 나아가는 실천을 촉구한다. 또한 기독교 병리학 의 진단은 내담자가 속한 사회문화에 깃든 죄의 역동을 탐색하고 성경적 개혁을 추구한다. 죄 진단에 대한 기독교 병리학은 다음과 같은 치료적 함의를 갖는다. 첫째, 죄 진단은 타락한 현실에 대한 공감적 회개를 야기한다. 둘째, 죄 행위의 주체에 대한 탐 색은 자기 죄 인식과 책임 있는 변화를 촉구한다. 셋째, 죄 행위의 객체 구분을 통해 내담자가 타인의 죄로 인한 피해자인 경우, 위로와 회복, 불필요한 거짓 죄책으로부터 자유함의 기회를 제공한다. 넷째, 내담자의 삶은 사회문화적 죄를 탐색하는 일종의 프 리즘으로 기능하며, 이에 기독교 상담사는 선지자적 역할을 해야 할 공적 사명이 있 다. 궁극적으로 죄를 진단하는 기독교 병리학의 목적은 결코 내담자를 정죄함이 아닌 죄에 대해 함께 애통하고 함께 그리스도께로 나아감이다. This study proposes a Christian pathological approach to sin and discusses its therapeutic implications. In the framework of Christian pathology, counselors, based on God’s word, can diagnose human pathology with respect to theological tradition, and using rational discoveries of modern psychology critically and constructively in terms of creation grace. Regarding sin, Christian pathology distinguishes original sin, sinful acts, and sociocultural sin. Original sin is the source of human pathology, and it affects all over the creation, including human nature. The diagnosis of original sin ultimately reveals the idol of the mind. The diagnosis of a sinful act shall be applied separately from the subject and object of it, and the sin-committed and the sin-omitted. This diagnosis calls for the practice of reflecting on one's sins and moving toward Christ by sharing burdens with one another. The diagnosis of sociocultural sin uncovers the distortion of sociocultural contexts around the counselees and seeks to reform them in faith. This diagnosis of sin in Christian pathology has the following therapeutic implications: First, the diagnosis of guilt leads to sympathetic repentance of the reality of corruption. Second, the practice of considering the subject of a sinful act encourages the person to recognize one’s sin and engage in a responsible change. Third, the practice of considering the object of a sinful act provides the person with opportunities for comfort, recovery, and freedom from unnecessary false guilt. Fourth, regarding sociocultural sins around the counselee, Christian counselors have a prophetic calling for public ministry. Finally, the purpose of Christian pathology, which diagnoses sin, is not condemning others, but to lament together for the fallen state of humanity and move together toward Christ, the only Savior from our sins.

A Study on Relationship between Divine Violence in the Atonement and Human Violence

김규보 개혁신학회 2019 개혁논총 Vol.49 No.-

One of the most significant practical criticisms regarding the atonement in the last decades is that the violence within traditional atonement theories seems to promote human violence. This paper argues that the acceptance of divine violence in the atonement does not promote human violence, since divine violence in the atonement is properly understood only in the context of divine love and it pertains only to God. To support the argument, this study assesses hypotheses of J. Denny Weaver, as a representative for nonviolent scholars. Weaver first assumes that within atonement theories acknowledging divine violence, God’s image is violent. Second, he supposes that the violent image of God revealed in the divine violence of the atonement has a positive correlation with human violence. He asserts, therefore, that assuming divine violence in the atonement reinforces human violence. Against Weaver, this inquiry first argues that the true image of God in the act of the atonement is that of a loving God, since the “violence” in the atonement rises only in the context of working out God’s perfect love. Second, it also argues that divine violence in the atonement is redemptive violence only pertaining to God, and therefore it eventually stifles human violence.

현대 청소년 비행의 특징과 교회의 실천적 대안에 대한 고찰

김규보 한국복음주의실천신학회 2020 복음과 실천신학 Vol.55 No.-

이 연구의 목적은 오늘날 청소년 비행의 특징을 살펴보고 그에 대한 교회의 실천적 대안을 모색하는 것이다. 본고는 사회적 파장을 일으켰 던 사례를 중심으로 현대 청소년 비행의 특징을 4가지로 분석한다. 첫 째, 현대 청소년들은 비행을 단독적으로 범하기보다 또래 집단 안에서 범하는 경향, 곧 집단성(왜곡된 타자화)이 있다. 둘째, 현대 청소년들의 비행은 성인 강력 범죄의 수준에 이를 만큼 잔혹성(악의 평범함)을 보 이곤 한다. 셋째, 현대 청소년들은 잔혹한 폭력 비행을 장난으로 삼는 놀이화(거친 자기애적 놀이)의 경향이 있다. 넷째, 현대 청소년들은 비 행 현장 혹은 결과를 인터넷 플랫폼 상에 공유하는 특성(병리적 공공 성)을 보인다. 각 특성에 대한 교회의 실천적 대안에 대해서 본고는 네 가지를 제안한다. 첫째, 집단성에 대한 대안으로 교회는 다양한 주제의 기독 공동체를 형성해야 한다. 둘째, 잔혹성에 대한 대안으로 교회는 주일학교 성경공부를 넘어 공감훈련을 통해 사랑의 질서를 회복하기에 노력해야 한다. 셋째, 놀이성에 대해 교회는 샬롬을 위한 기독 청소년 놀이를 개발하여 병리적 놀이를 대체할 하나님 나라의 놀이 문화를 형 성해야 한다. 넷째, 공유성에 대해 교회는 성경적 디지털 리터러시를 함양시킴으로써 청소년들이 왜곡된 자기애가 아닌 하나님 나라의 공적 경건을 공유하는 디지털 문화를 창조해 갈 수 있도록 인도해야 한다. The purpose of this study is to observe the characteristics of Juvenile delinquency in these days and to find out the practical way of Church’s action against these characteristics. This paper identified in 4 different characteristics of juvenile delinquency, based on analysis of major juvenile delinquency cases, which caused social ramification in recent years. First of all, Juveniles of these days commit delinquency as a peer group, rather than by himself/herself, which is called clustering. Secondly, the delinquencies of juveniles in these days are getting more ferocious, comparable enough to felony violent crime by adult offenders. Third, the adolescents tend not to take seriously committing delinquency, including brutal violence, and to treat them as a play or a game. Last, the juveniles in these days tend to share the scene or the result of the delinquency behavior on social media. Regarding each feature, this paper proposes following four practical ways of action by Church. First, concerning the tendency of clustering, Church can help to forming Christian groups in various ways by common interests and activities. Second, regarding the tendency of getting more ferocious, church can exert more effort in restoring the order of God’s love through promoting empathy beyond the typical Sunday school Bible study. Third, against the tendency of violence becoming a play for fun, Church can develop the tactics and activities for juveniles to establish as Christian play of God’s Kingdom for Shalom, which will be able to replace the pathological play committing violence just for having fun-a distorted self-love culture. Fourth, regarding the tendency of sharing their delinquency, church can improve a biblical digital literacy and lead the juveniles to create digital culture sharing public piety of God’s kingdom.

Breast Conservation Therapy versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23

김규보,박혜진,신경환,김진호,최두호,박원,안승도,김수산,김대용,김태현,김진희,김지영 대한암학회 2018 Cancer Research and Treatment Vol.50 No.4

Purpose The aim of this study is to compare the treatment outcomes of breast conserving surgery (BCS) plus radiotherapy (RT) versus mastectomy for patients with pT1-2N1 triple-negative breast cancer (TNBC). Materials and Methods Using two multicenter retrospective studies on breast cancer, a pooled analysis was performed among 320 patients with pT1-2N1 TNBC. All patients who underwent BCS (n=212) received whole breast RT with or without regional nodal RT, while none who underwent mastectomy (n=108) received it. All patients received taxane-based adjuvant chemotherapy. The median follow-up periods were 65 months in the BCS+RT group, and 74 months in the mastectomy group. Results The median age of all patients was 48 years (range, 24 to 70 years). Mastectomy group had more patients with multiple tumors (p < 0.001), no lymphovascular invasion (p=0.001), higher number of involved lymph node (p=0.028), and higher nodal ratio  0.2 (p=0.037). Other characteristics were not significantly different between the two groups. The 5-year locoregional recurrence-free, disease-free, and overall survival rates of BCS+RT group versus mastectomy group were 94.6% versus 87.7%, 89.5% versus 80.4%, and 95.0% versus 87.8%, respectively, and the differences were statistically significant after adjusting for covariates (p=0.010, p=0.006, and p=0.005, respectively). Conclusion In pT1-2N1 TNBC, breast conservation therapy achieved better locoregional recurrencefree, disease-free, and overall survival rates compared with mastectomy.

Frontal Sinus Lymphoma Presenting As Progressive Multiple Cranial Nerve Palsy

김규보,윤주헌,김민주,안상현,배소영,김원석 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.6

Primary frontal sinus lymphoma is a very uncommon disease. In all the previously reported cases, the presenting symptoms have been due to the tumor mass effect. We present an unusual case report of an immunocompetent patient who presented with facial palsy, and then progressively developed other cranial nerve palsies over several months. He was later diagnosed with diffuse large B cell lymphoma originating from the frontal sinus. The patient underwent chemotherapy, but eventually had to receive autologous peripheral blood stem cell transplantation. He is currently disease-free. The clinical course, diagnostic workup, and therapeutic outcome are described.

Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14)

김규보,정유리,신경환,김진호,안승도,김수산,서창옥,김용배,최두호,박원,차지혜,전미선,이동수,이선영,김진희,박혜진,정원근 대한암학회 2019 Cancer Research and Treatment Vol.51 No.4

Purpose The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement. Materials and Methods A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy. Results The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node  4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose  54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCLinvolved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients. Conclusion Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.

Selective Radiation Therapy for Ductal Carcinoma In Situ Following BreastConserving Surgery According to Age and Margin Width: Korean Radiation Oncology Group 11-04 and 16-02 Studies

김규보,김진희,김용배,서창옥,신경환,김진호,김태현,정소연,최두호,박원,안승도,김수산,예지원,강민규,김동원,김이준 한국유방암학회 2017 Journal of breast cancer Vol.20 No.4

Purpose: The optimal indications for omitting adjuvant radiation therapy (RT) after breast-conserving surgery are still controversial in ductal carcinoma in situ (DCIS) of the breast. The purpose of this study was to validate the role of postoperative RT in DCIS patients aged ≤50 years and with tumor margin widths of <1 cm, both of which have been proven to be high-risk features for recurrence in cohorts not receiving RT. Methods: Using two multicenter retrospective studies on DCIS, a pooled analysis was performed among patients aged ≤50 years and with margin widths <1 cm. All patients underwent breast-conserving surgery. Two hundred thirty-two patients received postoperative RT, while 54 did not. The median follow-up period was 77 months (range, 2–190 months) and 70 months (range, 5–166 months) in the patients who received RT and those who did not, respectively. Results: The patients who received RT had larger tumors (p<0.001), higher nuclear grade (p<0.001), closer margin width (p<0.001), and negative estrogen receptor expression (p=0.010) compared with those who did not receive RT. During the follow-up period, there were 17 ipsilateral breast tumor recurrences (IBTRs) as follows: invasive carcinoma in 10 patients and DCIS in seven. In the univariate analysis, the treatment with RT and human epidermal growth factor receptor 2 (HER2) status were significant risk factors for IBTR. The 7-year IBTR rates with and without postoperative RT were 3.6% and 13.1%, respectively (p=0.008). HER2positive tumors had a higher IBTR rate than the HER2-negative tumors (7-year rate, 13.6% vs. 3.9%; p=0.003). Conclusion: Postoperative RT following breast-conserving surgery significantly reduced the 7-year IBTR rate in the DCIS patients aged ≤50 years and with margin widths <1 cm. HER2 positivity was associated with increased IBTR in these patients.

Central Nervous System Failure in Korean Breast Cancer Patients with HER2-Enriched Subtype: Korean Radiation Oncology Group 16-15 Multicenter Retrospective Study

김규보,신경환,김진호,최두호,박원,김용배,김현주,김진희,Hyeli Park,이선영,김지영,오도훈,김인아 한국유방암학회 2019 Journal of breast cancer Vol.22 No.1

Purpose: The purpose of this study was to evaluate the risk of central nervous system (CNS) failure in Korean patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer treated with surgery followed by postoperative radiotherapy (RT). Methods: A total of 749 patients from eight institutions were enrolled in this study. All of them underwent surgery followed by postoperative RT from 2003 to 2011; 246 (32.8%) received neoadjuvant chemotherapy and 649 (81.7%) received adjuvant chemotherapy. Adjuvant trastuzumab was administered to 386 patients (48.6%). Results: The median follow-up duration was 84 (range, 8–171) months. The 7-year disease-free and overall survival rates were 79.0% and 84.2%, respectively. On multivariate analysis, mastectomy, nodal involvement, and presence of lymphatic invasion were correlated with poor overall survival (p = 0.004, 0.022, and 0.011, respectively), whereas T stage and lymphatic invasion were associated with disease-free survival (p = 0.018 and 0.005, respectively). Regarding CNS failures, 30 brain metastases, 2 leptomeningeal metastases, and 8 brain and leptomeningeal metastases were noted. The 7-year CNS relapse-free survival rates in patients receiving and not receiving trastuzumab were 91.2% and 96.9%, respectively (p = 0.005). On multivariate analysis, the administration of adjuvant trastuzumab was the only prognostic factor in predicting a higher CNS failure rate (hazard ratio, 2.260; 95% confidence interval, 1.076–4.746; p = 0.031). Conclusion: Adjuvant trastuzumab was associated with higher CNS failure rate in Korean patients with HER2-enriched breast cancer. Close monitoring and reasonable approaches such as CNS penetrating HER2 blockades combined with the current standard therapy could contribute to improving intracranial tumor control and quality of life in patients with CNS metastasis from HER2-enriched breast cancer.

중독에 대한 기독교 병리학적 진단: 죄의 범주를 중심으로

김규보 한국복음주의상담학회 2023 복음과 상담 Vol.31 No.1

Since human beings are created in the Image of God, human pathology cannot be understood, excluding God's existence and his creation order. A Christian pathology that considers the categories of sin, dis-order, and suffering enables a christian counselor to make a diagnosis in a holistic level regarding a counselee’s problem. This study proposes a christian pathology of addiction in terms of sin, and presents practical implications for biblical counseling. Addiction essentially is a state in which the ordo amoris established by God is broken. Addiction is a reality that reveals the idol of the heart derived from self-love, and which stems from the absence of true knowledge of God. The absence of the knowledge in turn leads to the loss of awe, and it causes the will for his own glory, which eventually makes people addict on a worldly thing. The primary implication of such understanding is that the ultimate help comes from Christ. Also theknowledge of God in Christ provides a cognitive interpretative framework, seeing everything with new eyes in God's order, giving emotional impression, and presenting a new way of life. This leads to a habit of piety that forms counter-addiction practices in the judgment of love. In that process, it is God’s calling that the church persistently takes care of the addicts within a redemption group and creates supportive culture wiping out the social stigma on addiction. This study is limited to the category of sin, and it is suggested that other categories of Christian pathology on addiction be addressed in subsequent studies. 인간이 하나님의 형상으로 창조되었다면 인간의 병리는 하나님의 존재와 창조질서를 배제한 채 이해할 수 없다. 죄, 장애 및 질병, 고통의 범주를 고려하는 기독교 병리학적 이해는 전인적 차원에서 호소문제에 대한 왜곡된 창조질서를 진단할 수 있게 한다. 이 연구는 기독교 병리학적 접근 가운데 죄의 범주를 중심으로 중독 문제를 이해하고 성경적 상담을 위한 실천적 함의를 제시한다. 죄의 관점에서 중독은 하나님께서 세우신 사랑의 질서가 깨어진 상태이다. 중독은 자기 사랑의 현세적 실재로 표출된 마음의 우상을 섬김이며, 이는 하나님을 아는 참 지식의 부재로부터 기인한다. 하나님을 아는 참 지식의 부재는 하나님을 향한 경외를 잃게 하고, 경외를 잃어버린 자유는 하나님의 영광이 아닌 자기의 영광과 만족을 위한 의지의 남용을 낳아 결국 중독자를 물질 혹은 행위에 집착하게 한다. 이렇게 죄의 범주에서 중독을 이해하는 기독교 병리학적 진단의 첫째 되는 함의는 중독의 궁극적인 해결이 그리스도께 있다는 신앙 고백이다. 그리스도 안에서 하나님을 아는 참 지식은 모든 것을 하나님의 창조질서와 섭리를 전제로 보게 하는 인지해석구조를 제공하고, 정서적 감화를 주며, 새로운 삶의 방향을 제시한다. 이는 사랑의 판단을 통한 중독 대항적 실천을 주의 날까지 포기하지 않는 경건의 습관을 형성하게 한다. 이 과정 가운데 교회는 구속그룹과 돌봄 문화의 형성을 통해 중독자들의 회복과 거룩을 지속적으로 지지하고 지도할 사명이 있다. 이 연구는 죄의 범주에 국한하여 논의를 전개하고 있으며, 중독에 대한 다른 범주의 기독교 병리학적 탐구는 후속연구에서 다룰 것을 제안한다.

헤르만 바빙크(H. Bavinck)의 언약 이해와 가정사역: 성경적 가족생활교육을 위한 언약의 실천신학적 함의

김규보 한국복음주의상담학회 2019 복음과 상담 Vol.27 No.1

This paper argues that Herman Bavinck's understanding of the covenant has practical implications for Family Life Education. For Bavinck, the family is a covenantal community driven by God. According to Bavinck, the covenant is originated by the triune God from the eternity. Through Christ’s merit, his people eternally enter the covenantal relationship with God. Bavinck stresses the following characteristics of the covenant. First, the covenant has its origin only in God’s grace. Second, the covenant highlights God's sovereignty over his people. Third, the covenant in essence is unilateral, but it turns out bilaterally. Fourth, the covenant embraces the organic unity of his creation. These aspects of the covenant contain practical values on Family Life Education. First, grace is the origin of the family. Second, the owner of the family is God. Third, family members voluntarily obey one another in love, and thereby they together participate in the process of sanctification, which includes forgiveness and mortification of sin. Fourth, the family is a channel through which its members experience the kingdom of God and carry its grace and value into a broader society. These implications will be able to provide practical theological foundations for the development of a biblical Family Life Education Program. 이 연구의 목적은 개혁주의 신학자 헤르만 바빙크(Herman Bavinck, 1854-1921)의 언약 이해를 중심으로 가족생활교육의 실천신학적 함의를 살펴보는 것이다. 바빙크에 의하면, 가정은 하나님께서 세우신 언약 공동체이다. 바빙크의 언약 이해는 다음과 같다. 첫째, 언약은 본질상 인류에게 주신 하나님의 은혜이다. 둘째, 언약은 하나님의 주권을 강조한다. 셋째, 언약은 편무적으로 시작하되 쌍무적이 된다. 넷째, 언약은 그리스도 안에서 유기체적 구원을 성취한다. 이 언약은 영원 전 삼위 하나님의 작정 가운데 시작되었고, 그리스도 안에서 성취되었으며, 그분께서 다시 오실 날 완성될 영원한 하나님의 섭리이다. 언약에 대한 이와 같은 이해는 가족생활에 중요한 실천적 가치를 제공한다. 첫째, 가족은 은혜이다. 둘째, 가족의 주인은 하나님이시다. 셋째, 가족은 서로를 향한 자발적인 순종과 사랑의 섬김으로 함께 성화되어 간다. 언약 가정의 구성원들은 십자가 사랑으로 서로를 용서하고 그 사랑 안에서 스스로 죄 죽임을 실천하며 함께 하나님 형상의 온전함을 이루어 간다. 넷째, 가정은 하나님 나라를 경험하고 흘려보내는 통로이다. 이와 같은 언약의 실천적 함의는 성경적 가족생활교육 프로그램의 개발과 발전을 위한 실천신학적 기초가 된다.