Family Studies 家庭研究 One of the most interesting and fruitful areas of study, which has shed considerable light on the mechanisms and genesis of mental disease, has been studies in family dynamics. However, the major focus in such studies has been on the role of family relationships and patterns of interaction in the production of schizophrenia. These studies have been exhaustively reviewed and criticized elsewhere(Meissner,1964; Mishler and Waxler,1966; Lidz, Fleck, and Cornelison,1965; and Boszormenyi-Nagy and Framo,1965). 家庭动力学研究是最有趣和最有成果的研究领域之一，它对精神疾病的机制和成因有相当大的启发。然而，此类研究的主要焦点一直是家庭关系和相互作用模式在精神分裂症产生中的作用。这些研究已经在其他地方得到了详尽的回顾和批评(Meissner,1964;Mishler Waxler, 1966;Lidz, Fleck和Cornelison,1965;Boszormenyi-Nagy和Framo,1965年)。 Few of these studies, unfortunately, have distinguished the paranoid dynamics within the broader focus of schizophrenia. In an attempt to describe the sociological aspects of the background of paranoia, Bonner(1960) describes the strictness, harshness, and domination of the patient's early pattern of family life. He remarks that the paranoid's opportunities for mastering the world around him or for promoting his own growth to maturity are often either reduced or eliminated, and that ultimately, the paranoid finds himself both despising the world and being despised by it. Goodman's (1968) study of the influence of parental figures found that paternal figures are more valent than maternal figures for paranoid schizophrenics but that the relationship was reversed for nonparanoid schizophrenics. Paranoids responded more quickly on the response latency measure when they were influenced by father figures, and correspondingly nonparanoids responded more quickly when influenced by maternal figures. Sletten and Ballous(1967) investigated the paranoid delusional system to try to determine which parent was the most fear-inspiring for the patient. They found that when the father was the most fear-inspiring parent, the subject had delusional ideas which concerned men only. But when the mother was the most fear-inspiring parent, the subjects tended to have delusions which involved both men and women, but in which women predominated. Thus they felt that the content of persecutory delusions was related to premorbid fears that were primarily influenced by the most threatening parent. 不幸的是，这些研究中很少有在精神分裂症更广泛的关注范围内区分偏执动力学。为了描述偏执症背景的社会学方面，邦纳(1960)描述了病人早期家庭生活模式的严格性、严酷性和支配性。他指出，偏执者掌控周围世界或促进自身成长成熟的机会往往要么减少，要么消失，最终，偏执者发现自己既鄙视世界，又被世界鄙视。古德曼(1968)对父母形象影响的研究发现，对于偏执型精神分裂症患者来说，父亲形象比母亲形象的影响更大，但对于非偏执型精神分裂症患者，这种关系正好相反。当偏执者受到父亲形象的影响时，他们在反应延迟测量上的反应速度更快;相应地，非偏执者受到母亲形象的影响时，他们的反应速度也更快。Sletten和Ballous(1967)研究了偏执妄想系统，试图确定哪个父母对病人最恐惧。他们发现，当父亲是最让人害怕的家长时，受试者会产生只与男性有关的错觉。但当母亲是最让人害怕的家长时，受测者往往会产生错觉，这种错觉包括男性和女性，但女性占主导地位。因此，他们认为被害妄想症的内容与主要受最具威胁性父母影响的疾病前恐惧有关。 While such family studies have shed a great deal of light on our understanding of schizophrenia, they have not contributed a great deal to the understanding of paranoia beyond the indication of the importance of the child's relationship to the parents and the management of hostility in that relationship. It must be remembered, however, that investigation of schizophrenia is an exploration into a level of life adjustment or the development of the internal structure and personality functioning. Paranoia, however, is related more to questions of style of adaptation and living. The paranoid style of adaptation can be found at all levels of personality development and at all degrees of psychopathology, from the minimally neurotic to the intensely psychotic. 虽然这些家庭研究为我们对精神分裂症的理解带来了大量的启发，但除了指出孩子与父母的关系的重要性以及在这种关系中控制敌意之外，它们并没有对偏执症的理解做出很大的贡献。然而，必须记住，对精神分裂症的调查是对生活适应水平或内部结构和人格功能发展的探索。然而，偏执症更多地与适应和生活方式的问题有关。偏执风格的适应可以在人格发展的各个水平上找到，也可以在精神病理的各个层面上找到，从轻微的神经质到严重的精神病。 Studies in this area have not been greatly rewarding. Goldstein and Carr(1956) tried to study maternal attitudes toward child behavior of mothers of schizophrenics. Their effort was directed at testing out Arieti's suggestion that catatonics had been criticized for their actions as children while paranoids were criticized for their intentions. Their findings did not upport this suggestion. Studies of patterns of interaction within families, which have focused primarily on schizophrenia as an entity have shown that generalized styles of interaction and generalized family norms appear to be more dominant than role differentials within family structure. Family resemblances have been found in psychological and biological traits, cognitive styles, value systems, and even political views. Investigators have found a strain toward consistency which requires and supports certain behaviors within the family and which creates an apparent similarity in styles of interaction within it. 在这方面的研究没有得到很大的回报。Goldstein和Carr(1956)试图研究精神分裂症母亲对孩子行为的母亲态度。他们的努力是为了验证Arieti的建议，即精神紧张症患者因为他们儿童时期的行为而受到批评，而偏执者则因为他们的意图而受到批评。他们的发现并不支持这个建议。对家庭内部相互作用模式的研究主要集中在精神分裂症这一实体上，研究表明，广义的相互作用方式和广义的家庭规范似乎比家庭结构中的角色差异更具有支配性。家庭相似性在心理学和生物学特征、认知风格、价值体系甚至政治观点上都有所发现。研究人员发现，这种一致性要求并支持家庭内部的某些行为，并在家庭内部的交互方式上产生了明显的相似性。 This raises a question about the role of family styles and patterns of interaction in the generation of the paranoid style or the paranoid strategy. Wallace and Fogelson (1965), for example, have described two basic strategies which take place in schizophrenic families in which the schizophrenic, struggling to attain a total identity, strives to reduce the dissonance that he senses between his own real identity and the ideal identity. The strategies available for reducing the dissonance require either reducing the value of the ideal identity, or increasing the value of the real identity. They label these respective strategies as the withdrawal strategy and the paranoid strategy. In the withdrawal strategy, the victim sees himself as helpless, worthless, and incompetent. He feels there is no point in aspiring to anything more in life, and asks only that he be left alone. The paranoid strategy, on the other hand, allows the victim to absolve himself of blame and to feel that it is someone else who is worthless, incompetent, and even evil. The victim himself is good and competent, and well able to take care of himself. Thus his claimed identity becomes his ideal identity, and the real identity is denied and projected onto others through the paranoid defense. 这就提出了一个关于家庭风格和互动模式在产生偏执风格或偏执策略中的作用的问题。例如，华莱士和福格尔森(1965)描述了发生在精神分裂症患者家庭中的两种基本策略，精神分裂症患者努力获得一个完整的身份，努力减少他所感知到的自己的真实身份和理想身份之间的不协调。减少这种不和谐的策略要么需要降低理想身份的价值，要么需要增加真实身份的价值。他们把这两种策略分别称为退缩策略和偏执策略。在退缩策略中，受害者认为自己是无助的、毫无价值的、无能的。他觉得没有必要在生活中追求更多的东西，只要求不要打扰他。另一方面，偏执策略允许受害者为自己开脱罪责，并认为是别人没有价值，没有能力，甚至是邪恶的。受害者本身是善良的，有能力的，能够很好地照顾自己。因此，他所声称的身份成为了他的理想身份，而真实的身份被否定并通过偏执防御投射到他人身上。 The Mishler and Waxler (1968) study of patterns of interaction in schizophrenic families has provided some information about control strategies in family processes. In the context of an emphasis on power conflicts in paranoia, their findings on control strategies in schizophrenic families are of considerable interest. Strategies of attention control in normal families found clear patterns of role differentiation and a hierarchy of power and authority, without showing at the same time patterns of authoritarian or coercive control. In normal families the strategies of person-control and direct attempts at interpersonal influence are found in all members of these families, including the low-status children, and this pattern of interaction is strikingly different from that found in schizophrenic families. In male schizophrenic families, for example, they found a reversal of generational roles between fathers and sons, the patient and his mother thus holding relatively high power positions, with the father exerting little or no influence on the family system. In female schizophrenic families, the daughter is given little attention or respect and on her own part makes few attempts to influence the family proceedings. Mishler and Waxler(1968)对精神分裂症家庭相互作用模式的研究提供了一些关于家庭过程控制策略的信息。在强调偏执症中的权力冲突的背景下，他们关于精神分裂症家庭控制策略的发现是相当有趣的。在正常家庭中，注意力控制策略发现了明显的角色分化模式和权力与权威等级，但同时没有显示出专制或强制控制的模式。在正常家庭中，包括地位低下的儿童在内的所有家庭成员都有控制个人的策略和试图直接影响人际关系的行为，而且这种互动模式与精神分裂症家庭中的明显不同。例如，在男性精神分裂症家庭中，他们发现父亲和儿子之间的代际角色发生了逆转，病人和他的母亲因此拥有相对较高的权力地位，而父亲对家庭系统的影响很少或没有影响。在女性精神分裂症家庭中，女儿很少受到关注或尊重，而她自己也很少试图影响家庭的进程。 Power was exercised in various forms of control strategy in an impersonal and rather indirect manner. Moreover, the evidence suggested that these divergencies from normal power relations and control strategies within the family were more marked in situations where the schizophrenic patient was present than in situations where the patient was not. The authors comment that the dimension of power, of who has it and of how it is used, is particularly sensitive to the presence of the patient. It is unfortunate that these studies do not focus on the issue of paranoid versus nonparanoid strategies in the schizophrenic syndrome, but their findings question the extent to which such deviations from normal power interactions influence the generation of the paranoid style of thinking. It is not clear, by any means, to what extent such strategies within the family have to do with the level of personality development and integration on the one hand (the schizophrenic question), and on the other, to what extent they are concerned with styles of interpersonal interaction and defense(the paranoid question). 权力是在各种形式的控制战略中以非个人和相当间接的方式行使的。此外，有证据表明，这些与家庭内部正常权力关系和控制策略的差异，在有精神分裂症患者的情况下比没有精神分裂症患者的情况下更明显。作者评论说，权力的大小、谁拥有权力以及如何使用权力，对病人的存在特别敏感。不幸的是，这些研究并没有关注精神分裂症中偏执与非偏执的策略问题，但他们的发现质疑了这种偏离正常权力互动的行为对偏执思维方式产生的影响程度。无论如何,目前尚不清楚,一方面家庭中这些策略在多大程度上与人格发展的水平和集成有关(精神分裂问题),另一方面,在多大程度上与人际互动和防御的风格有关(偏执问题)。