Chapter 1 The Development of Theoretical Perspectives 第1章 理论方面的发展 The concept of paranoia was bequeathed to modern psychiatry in its Kraepelinian form. Kraepelin tried to distinguish paranoia from paraphrenia and paranoid dementia praecox. He described it as an insidiously developing, relatively unchanging delusional system which involved no hallucinations and could exist side by side with clear and orderly thinking. One of the basic problems in dealing with paranoia is that it usually is compounded with schizophrenic manifestations. Freud himself recognized this and still felt that there were grounds for distinguishing paranoia on dynamic bases. The specificity that he wished to retain seemed to have been based on the specific psychodynamic ideology that he defined in the now famous Schreber case. Sullivan on the other hand imagined them as imaginary poles of a clinical continuum. The imaginary poles stood apart and were rarely, if ever, in fact realized. He felt that every schizophrenic has some paranoid feelings and can be led to express them from time to time, and that conversely, every paranoid person also has some period of schizophrenic adjustment in his history(Sullivan,1956). 偏执症的概念以Kraepelin[德国精神病专家，与弗洛伊德同年生]的形式遗留给了现代精神病学。Kraepelin试图将偏执症与妄想痴呆和偏执型早发性痴呆区分开来。他将其描述为一种不知不觉中发展起来的、相对不变的妄想系统，它不涉及幻觉，可以与清晰有序的思维并存。处理偏执症的一个基本问题是，它通常与精神分裂症的表现相混合。弗洛伊德自己也意识到了这一点，并且仍然认为在动力学的基础上区分偏执症是有道理的。他希望保留的特性似乎是基于他在如今著名的史瑞伯案例中定义的特定的精神动力观念。另一方面，沙利文把它们想象成一个临床连续统的假想极点。想象中的两极是分开的，很少能真正实现。他认为每个精神分裂症患者都有一些偏执的感觉，并且可以被引导着不时地表达出来，相反，每个偏执的人在他的历史上也有一段精神分裂症的调适期(Sullivan,1956)。 The trend, however, has been in the direction of using the concept of paranoia with greater flexibility and with greater applicability. It is used not only as a diagnostic category but also as a descriptive personality trait which is characterized by isolation, hypersensitivity, guardedness, suspiciousness, and the use of projection as a defense. It has also been extended to include concepts of paranoid traits, or a paranoid attitude or outlook (Schwartz,1963). In the present review we will be using the concept "paranoia" in its broader meaning as applying both to paranoid traits, paranoid mechanisms, or paranoid styles of life that can apply with varying degrees of intensity and pathology from severely disturbed psychotic states to relatively innocuous and more or less adaptive life-styles in relatively normal individuals and cultural institutions. 然而，目前的趋势是更灵活和更适用地使用偏执症的概念。它不仅被用作一种诊断类别，而且还被用作一种描述性人格特征，其特征是孤立、过于敏感、警惕、多疑，并使用投射作为防御。它还被扩展到包括偏执的特征，或偏执的态度或观点(施瓦茨，1963)。在当前的回顾中，我们将在更广泛的意义上使用“偏执”这个概念，将其应用到偏执的特征，偏执的机制，或偏执风格的生活，偏执风格可以应用于不同程度的强度和病理，从严重混乱的精神病状态到相对无害或多少适应性的生活方式，后者存在于相对正常的个人和文化习俗之中。