Exotic Syndromes 异国情调的症状 There are a number of rather unusual and rare conditions—at least in our own cultural setting—which have a paranoid flavor, but in which the paranoid mechanisms display themselves in unusual settings or in an unusual manner. These syndromes have been reviewed extensively elsewhere (Swanson et al, 1970; Arieti and Meth,1959), so that they need not be discussed extensively here. 有一些相当不寻常和罕见的情况——至少在我们自己的文化背景下--具有偏执的味道，但偏执机制在不寻常的环境中或以不寻常的方式显示出来。这些症候群在其他地方已经被广泛地评估过了（Swanson等人，1970年；Arieti和Meth，1959年），所以这里不需要广泛地讨论它们。 The first syndrome of interest is Cotard's syndrome—a syndrome which is known also as "the illusion of doubles." This phenomenon consists of the delusion that some other person in the patient's life is a double or an impostor who is impersonating someone. Thus the patient may feel that the person who presents himself as a doctor, and whose intentions are supposedly helpful, is in fact an impostor who really intends to do the patient harm. Arieti and Meth (1959) explain the syndrome psychodynamically—the patient cannot admit ambivalent feelings about an acquaintance and he therefore splits the friend's attributes and assigns the bad characteristics to the impostor, while retaining the good characteristics for the acquaintance. The projective aspects of this psychic mechanism would be consistent with the paranoid process. 第一个值得关注的综合症是科塔尔综合症——一种也被称为 "替身幻觉 "的综合症。这种现象包括妄想病人生活中的另一些人是替身或冒名顶替的人。因此，病人可能会觉得，那个把自己说成是医生的人，其意图应该是帮助病人的，其实是一个真正打算伤害病人的冒牌货。Arieti和Meth(1959)从心理动力学的角度解释了这个综合症——患者不能承认对熟人的矛盾感觉，因此他把朋友的属性拆分开来，把不好的特征分配给冒牌货，而把好的特征保留给熟人。这种心理机制的投射方面将与偏执过程相一致。 Cotard's syndrome is also known as a "chronic delusional state of negation." This condition is usually linked to involutional states, and is often found in women. It involves a massive delusion in which the patient feels that nothing, including the patient's self, exists. There is some controversy as to whether the syndrome actually exists as such and, if it does exist, whether it might be better described as a form of psychotic depression. The converse of the Cotard phenomenon is the autoscopic phenomena—although it too cannot be considered as specifically paranoid in nature. In this condition the subject experiences an hallucination in which he has a sensation that his own body is somehow seen outside of himself. This phenomenon has been reported in patients who also suffer from epilepsy or migraine, but it may also be seen in schizophrenics or severe depressives. One of the most fascinating and intriguing descriptions of the autoscopic phenomena, placed in a system of paranoid delusions, is the narrative of the unfortunate clerk Golyodkin which is provided in Dostoevsky's "The Double." 科塔尔综合症也被称为 "慢性妄想否定状态"。这种情况通常与渐进状态有关，常出现在妇女身上。它涉及到一种大规模的妄想，在这种妄想中，患者觉得包括患者自身在内的任何东西都不存在。对于这种综合症是否真的存在，以及如果它确实存在，是否可以更好地描述为一种精神性抑郁的形式，存在一些争议。科塔尔现象的反面是自视现象--虽然它也不能被认为是特别偏执的性质。在这种情况下，受试者体验到一种幻觉，他有一种感觉，他自己的身体以某种方式出现在自己之外。这种现象在同时患有癫痫或偏头痛的患者中也有报道，但也可能出现在精神分裂症患者或严重的抑郁症患者身上。对自视现象的最迷人和最有趣的描述之一，放在偏执妄想的系统中，是陀思妥耶夫斯基的"替身."中提供的不幸的职员戈利奥德金的叙述。 Another interesting phenomenon is Clerambault's syndrome. In this the patient is usually a female, and is convinced that a certain man is in love with her. The man is usually a well-known public figure—an actor or a political personage. The syndrome consists of a variety of paranoid disorder with grandiose delusions that have a decidedly erotic tinge. The patient usually is diagnostically a paranoid schizophrenic. 另一个有趣的现象是Clerambault综合症。在这种情况下，患者通常是一名女性，并确信某个男人爱上了她。这个男人通常是一个著名的公众人物——演员或政治人物。此症候群包括各种偏执障碍，带有明显的色情色彩的夸张妄想。病人通常被诊断为偏执型精神分裂症。 Another characteristic syndrome, seen predominantly in Malayan men, is the amok syndrome. The amok syndrome involves a rampage of destructive violence in patients who are either chronically delusional or acutely confused—often in connection with some form of toxic syndrome. This syndrome is similar to the outbreaks of violence in toxic psychosis. Usually the patient is someone withdrawn and schizoid, and may appear to be brooding for a period of time; then suddenly without warning he grabs a weapon—usually a knife or rock or other lethal instrument—and begins to run around wildly slashing at anyone in sight. These episodes usually terminate only in death, either when the patient is killed or manages to kill himself. If he does survive the episode, there is usually total amnesia. Among Malayans, the episode is usually associated with possession by the devil; in more developed Western cultures, there may be voices that impel the patient to his outbursts. An interesting observation is that, as the level of education among the Malayan people has risen, the amok syndrome has become increasingly rare. 另一种主要见于马来西亚男子的特征性综合症是 "阿莫克综合症"。阿莫克综合症涉及到长期有妄想症或严重精神错乱的病人的破坏性暴力狂潮——通常与某种形式的中毒综合症有关。这种综合症类似于中毒性精神病中暴力的爆发。通常病人是一个孤僻和分裂型的人，可能会在一段时间内表现出沉思，然后突然毫无征兆地拿起武器——通常是刀子或石头或其他致命的工具——开始四处狂奔，向任何看到的人乱砍。这些发作通常只以死亡结束，要么是病人被杀，要么是设法自杀。如果他能活下来，通常会完全失忆。在马来人中，这种发作通常与魔鬼附身有关；在更发达的西方文化中，可能会有一些声音促使病人爆发。一个有趣的现象是，随着马来人教育水平的提高，阿莫克综合症越来越少见。 Recent evaluations of the amok syndrome have emphasized the importance of sociopsychological variables in the precipitation of the outbreak. External factors that seem to play a significant role are younger age, role crises of various kinds, recent losses, and drunkenness (Westermeyer, 1972). The effects of such precipitants can be related to assaults on self-esteem which precipitate a violent response. The usual period of withdrawal and brooding over real or imagined wrongs preceding the attack suggests the narcissistic withdrawal and narcissistic licking of wounds. The fury of the attack is directed without discrimination. This suggests that the persecutory delusion is generalized so that the destructive wish is quite diffuse. Since the advent of court proceedings or commitment to insane asylums, the incidence of amok in certain areas of the world has decreased. There are still occasional accounts of such outbreaks in areas of Malaya, but the overall incidence has diminished. There are similar accounts of outbreaks of senseless killing in all countries and cultures with a frequency not far from that of reports of amok (Teoh,1972). Thus the amok phenomenon may not be at all culture-bound and may represent a variety of paranoid violence. In cases of apparently senseless and indiscriminate violence, as we have seen, the dynamics are usually specifically paranoid. Specific elements related to paranoid dynamics are the narcissistic injury (often seemingly trivial), the shameful affect, and persecutory fears related to supernatural powers or malevolent sorcerers. The behavior, although bizarre, serves to permit the affected individual to maintain a culturally determined role (Weidman and Sussex, 1971). 最近对阿莫克综合症的评估强调了社会心理变量对疾病爆发的重要性。似乎起重要作用的外部因素是年龄较小、各种角色危机、最近的损失和醉酒（Westermeyer，1972）。这些诱发因素的影响可能与自尊受到攻击有关，从而诱发暴力反应。攻击前通常有一段退缩期和对真实或想象中的错误的沉思，这表明自恋的退缩和自恋的舔舐伤口。攻击的愤怒是不分青红皂白的。这说明迫害性妄想是泛化的，所以破坏性的愿望是相当分散的。自从法庭诉讼或送入精神病院以来，世界上某些地区的阿姆克的发生率有所下降。在马来亚的一些地区，仍偶有这种爆发的记载，但总的发生率已经减少了。在所有国家和文化中，都有类似的无意义杀戮爆发的报道，其频率与阿莫克的报道相差无几（Teoh，1972）。因此，阿莫克现象可能根本不受文化的限制，可能代表了各种偏执暴力。正如我们所看到的，在明显的无意义和不分青红皂白的暴力事件中，动力学通常是明确偏执的。与偏执动力学有关的具体内容是自恋伤害（往往是看似微不足道的），羞愧的影响，以及与超自然力量或恶意巫师有关的迫害性恐惧。这种行为虽然怪异，但却能让受影响的人保持 一种文化决定的角色（Weidman和Sussex，1971）。 The Whitico (Windigo) psychosis is limited to certain Eskimo and Indian tribes. It is a form of possession syndrome in which the patient begins to brood and fear that he will turn into a Whitico—a giant figure made of ice who devours human beings. The patient gradually becomes increasingly delusional and begins to think that he has become a Whitico. He may in fact become murderous and cannibalistic. This is clearly a psychotic delusional state—an unusual variant of paranoid psychosis. Whitico(Windigo)精神病仅限于某些爱斯基摩人和印第安部落。这是一种附身综合症，患者开始沉思，害怕自己会变成Whitico——一个吞噬人类的冰制巨像。病人逐渐变得越来越妄想，并开始认为自己已经变成了一个Whitico。事实上，他可能会变成杀人和吃人的人。这显然是一种精神妄想状态，是偏执型精神病的一种不寻常变种。 Voodoo death is a variant of the typical paranoid fear that someone is trying to kill the patient. In Voodoo death, in fact, the patient does die—apparently as an effect of his delusional fear. A similar syndrome is the so-called Susto syndrome in which the patient is violently frightened and shows marked anxiety along with hyperexcitability and severe depression and weight loss. The patient suffers from the delusion that his soul has been absorbed by the earth and is no longer present in his body. It is a variety of persecutory delusion. Another syndrome that has received some attention is the so-called Puerto Rican syndrome which is marked by a combination of panic, violent agitation, and violence—including self-mutilation. Paranoid symptoms have been described, including paranoid jealousy and ideas of infidelity and rather bizarre delusions. Doubt was cast on the existence of the syndrome by Mehlman, who analyzed several patients given this diagnosis. Patients could be described more aptly by a variety of other psychiatric diagnoses, so that it was not felt useful to designate the syndrome as a separate entity. These patients sometimes showed delusional and paranoid characteristics (Mehlman,1961). 巫毒教死亡是典型的偏执恐惧症的一种变种，即有人试图杀死病人。事实上，在巫毒教死亡中，病人确实死了--显然是他妄想恐惧的结果。类似的综合症是所谓的Susto综合症，患者受到剧烈的惊吓，表现出明显的焦虑，同时伴有过度兴奋和严重的抑郁和体重减轻。患者患有妄想症，认为自己的灵魂已被大地吸收，不再存在于身体中。这是迫害性妄想的一个种。另一种受到关注的综合症是所谓的波多黎各综合症，它的特点是惊恐、暴力激动和暴力——包括自残。已经描述了的偏执症状，包括偏执嫉妒和不忠的想法以及相当怪异的妄想。Mehlman对该综合症的存在表示怀疑，他分析了几位被诊断为该症的患者。患者可以用其他各种精神诊断更贴切地描述，因此，人们认为将该综合症指定为一个单独的实体是没有用的。这些病人有时表现出妄想和偏执的特征（Mehlman，1961年）。