DENIAL 否认 The mechanism of denial undoubtedly plays a role in paranoid distortion, but it is not altogether clear that it is a distinct mechanism for projection, or whether it forms a component part of the projective mechanism. In Waelder's(1951) reconsideration of the structure of paranoid ideas, he places denial at the heart of the process. The essential aspect of delusional ideas, he feels is their resistance to correction by experience. Any excessive concentration of instinctual derivatives on an object, whether aggressive or libidinal, and whether the object is external or has been internalized, distorts the ego's sense of reality. He sees paranoid ideas as resting on an unsuccessful denial. 否认机制无疑在偏执扭曲中发挥了作用，但它究竟是一种独特的投射机制，还是构成投射机制的组成部分，目前还不十分清楚。在Waelder(1951)对偏执思想的结构的重新思考中，他把否认放在了这个过程的核心。他认为，妄想想法的本质是他们对经验纠正的抗拒。本能衍生物在一个客体上的过度集中，无论是攻击性的还是力比多性的，无论这个客体是外在的还是已经内化的，都会扭曲自我对现实的感觉。他认为偏执的想法是建立在不成功的否认之上的。 Freud (1911) has indicated the role of denial in his formulation of the four classic forms of paranoia. Each formula began with the statement of denial; "I do not love him." The statement of denial is then followed by a contradictory claim characteristic of the respective forms. Denial is thus a way of dealing not only with external events of a threatening or painful nature, but also with internal instinctual derivatives. The frustrating event or instinctual drive is denied, but what has been so denied can return in a distorted form. What is disclaimed may then return in the form of a claim or an assertion. The knowledge of the essential truth of the statement may account for its inaccessibility to influence. Waelder appeals to an isomorphism of symptom and defense: if the defense is denial, the return of the denied takes the form of a claim. The model is that of neurotic repression and the return of the repressed. 弗洛伊德(1911)指出了否认在他的四种典型偏执形式的形成中的作用。每一个公式都以否定的陈述开始; “我不爱他。” 在否认声明之后，接着是各形式的相互矛盾的声称。因此，否认不仅是处理具有威胁性或痛苦性质的外部事件的一种方式，而且是处理内在本能衍生物的一种方式。令人沮丧的事件或本能冲动被否认，但被如此否认的东西可能会以一种扭曲的形式回归。然后，被否认的东西可能以声称或断言的形式回归。对该声明的基本事实的了解可以解释其无法施加影响的原因。Waelder求助于症状和防御的同构性:如果防御是否认，那么被否认物的回归将以声称的形式出现。其模式是神经症的压抑和被压抑内容的返回。 In a similar vein, Rycroft's(1960) attempt to establish contradiction as the basic mechanism of paranoia does not effectively establish contradiction as a separate mechanism. He describes a paranoid patient with many hysterical features whose defenses were organized around massive contradiction of wishes and fears. The notion of contradiction, as he develops it, implies construction of an organized pattern of behavior and thinking which is based on a number of defense mechanisms including denial and projection. It is not clear that contradiction is a mechanism, so much as a complex ego state or position, which derives from defense mechanisms like denial. Defense mechanisms operate at an unconscious level and should not be confused with conscious derivatives. 同样，Rycroft(1960)试图将矛盾建立为偏执的基本机制，但并没有有效地将矛盾建立为一种独立的机制。他描述了一个偏执的病人，他有许多癔症的特征，他的防御是围绕着愿望和恐惧的巨大矛盾而组织起来的。正如他所发展的那样，矛盾的概念意味着建立一种有组织的行为和思维模式，这种模式基于包括否认和投射在内的一系列防御机制。矛盾作为一种机制，我们并像清楚复杂的自我状态或心位(源于否认等防御机制)那样清楚它。防御机制是在无意识的水平上运作的，不应该与有意识的衍生物混淆。 Denial, along with projection, is one of the primitive narcissistic defenses of the ego. Denial constitutes a basic unconscious unwillingness to perceive. It is a primitive technique for avoidance of what is painful or intolerable. While projection can operate at many levels of psychic integration and can even, as we have seen, function in the service of adaptive and self-sustaining needs, denial remains limited to primitive levels of defense.I would think it preferable here to follow Waelder and regard denial as closely linked to psychotic distortion. In some sense every defense involves an element of denial and distortion of reality, but to use the terms in that context seems only to dilute them to a point of reducing their usefulness. Similarly, to describe the common phenomenon of not acting in response to significant and acknowledged realities—e.g., traveling by airplane even though planes can and do crash(Moore and Fine,1967)—as a form of denial, is to violate the meaning of defense mechanisms. Reality can be ignored without its being denied. Traveling by airplane reflects a realistic evaluation of comparative risks and need not in any sense involve a denial of reality. Denial, in the sense we are using it here, involves an unconscious avoidance of reality in which the reality is not acknowledged as existing at all. 否认和投射一样，是自我最原始的自恋防御之一。否认是一种基本的无意识的不愿意去感知。这是一种避免痛苦或无法忍受之物的原始技术。虽然投射可以在心理整合的许多层面上运作，甚至可以，如我们所见，为适应和自我维持的需要服务，否认仍然局限于原始的防御层面。我认为在这里最好是跟随韦尔德，把否认与精神扭曲紧密联系在一起。从某种意义上说，每一种防御都包含否认和歪曲事实的成分，但在这种情况下使用这些术语似乎只会冲淡它们，使它们变得毫无用处。类似地，把对重要的和公认的现实不采取行动的普遍现象——比如明知飞机会/要坠毁还要坐飞机(Moore and Fine,1967)——作为否认的一种形式，违反了防御机制的意义。现实可以被忽视而不被否认。乘飞机旅行反映了对相较而言的风险的现实评估，在任何意义上都不需要否认现实。否认，在我们这里使用它的意义上，涉及对现实的无意识的逃避，在这种逃避中，现实根本不被承认是存在的。 Denial in paranoid states is seen in its grossest and most primitive form in acute delusional states and particularly in paranoid grandiosity. The use of denial, however, shades off into a spectrum of less apparent and less intense usages which often escape notice. Paranoid states, in which the distortion is not of the magnitude or intensity of psychosis, are frequently marked by selectivity of attention. Events or bits of information, which do not fit the paranoid preconception or which cannot easily be reconciled with it, are ignored and treated as if they are nonexistent. Assiduous attention is paid to other aspects of the patient's environment, but elements which fly in the face of his paranoid system drop out of consideration. It is difficult to discriminate in such cases whether in fact the patient is unable to acknowledge the existence of the reality(denial), or whether he can acknowledge its facticity but is unwilling for defensive reasons to take it into his reconstruction or interpretation of reality. Both are possible, but the latter strategy is less primitive and in fact is often observed in normal thought processes. 偏执状态下的否认，在严重妄想状态下，尤其在偏执性夸大中，表现为最粗俗、最原始的形式。然而，否认的使用逐渐演变为一系列不那么明显和不那么强烈的用法，这些用法常常会被忽视。偏执状态通常表现为注意力的选择性，在这种状态下，扭曲的程度和强度都不像精神病那么严重。不符合偏执先入之见的事件或信息，或者不容易与之调和的信息，都被当作是不存在的。患者对环境的其他方面给予了孜孜不倦的关注，但那些与他偏执的系统相悖的因素却被抛诸脑后。在这种情况下很难区分，到底是病人不能承认现实的存在(否认)，还是他能承认现实的存在，但出于防御的原因而不愿将其纳入对现实的重建或解释之中。两种都有可能，但后一种不那么原始，实际上在正常的思维过程中经常可以观察到。 The paranoid patient's hyperalert and suspicious scrutiny of reality is pressured by the underlying need to integrate available data into a consistent system which answers to self-defensive and self-preservative ends. This pressured search for inner meaning thus can easily miss what is most obvious and most apparent to the normal mind. Suspicion will not permit anything that is obvious to be accepted at face value, until it can be reconciled with prior convictions. Thus, while the paranoid style can be acutely aware of concrete and often complex realities, it can also remain completely unaware of less complex and rather obvious aspects of situations, particularly social situations(Shapiro,1965). This selective inattention to the obvious may be one important form of denial—or, where the fact is recognized but not accepted, may pass for denial. 将得到的数据整合到一个一致的系统中(以应对自我防御和自我保护的目的)，这种根本需求造成的压力导致偏执患者对现实的高度警惕和充满怀疑的审视。这种在压力下对内在意义的搜寻很容易忽略那些在正常人看来再明显不过的东西。这种怀疑不允许任何显而易见的事情按其表面的样子被接受[偏执者认为什么事情都有“深意”——只要深挖，就能发现恶意]，除非它能与先前的信念相调和。因此，尽管偏执型风格可以敏锐地意识到具体的、往往是复杂的现实，但它也可以完全意识不到不那么复杂和相当明显的情景方面，尤其是社会情景(夏皮罗，1965)。这种选择性地忽视显而易见的事实可能是一种重要的否认形式——或者，当事实被承认但不被接受时，可能被当作否认[对应上一段最后说的两种情况]。 Denial is closely linked with other mechanisms and thus poses some difficult problems, both theoretically and clinically. As Jacobson has pointed out(1957), denial and repression are closely related. Denial is the more primitive mechanism and is seen much more prominently in borderline and psychotic patients. The resort to denial is due to a relative deficiency in the repressive capacity of the ego. Repression represents a much more highly organized and controlling defense which reflects a much higher degree of integration within the ego and a much more developed capacity to direct specific countercathexes in the interest of defense. Repression involves the mobilization of countercathectic energies against the expression of id impulses and id derivatives. The ego consequently has a much greater degree of toleration for such impulse derivatives than would be suggested in denial. Denial is more of a simple withdrawal of cathexis from such id impulses. The ego is considerably less able to tolerate them and has fewer resources to direct against them. Its reaction is one of flight, not fight. It can offer no resistance and must resort to avoidance mechanisms. 否认与其他机制密切相关，导致理论和临床上的一些难题。正如雅各布森(1957)所指出的，否认和压抑是密切相关的。否认是一种更为原始的机制，在边缘水平和精神水平病患者中更为明显。诉诸否认是由于自我的压抑能力相对缺乏。压抑代表了一种更有组织性和控制性的防御，反映了自我内部更高程度的整合，以及为防御利益而引导特定“反精神投入”的更发达的能力[“反精神投入”是指自我或超我对本能冲动的抑制作用]。压抑包括动员“反精神投入”能量来对抗本我冲动和本我衍生物的表达。因此，自我对这种冲动衍生品的容忍程度，比否认中所暗示的要高得多。否认更多的是简单地将“精神投入”从这种本我冲动中抽离。自我对他们的容忍能力大大降低，直接针对他们的资源也更少。它的反应是逃跑，而不是战斗。它不能提供任何阻力，必须诉诸回避机制。 Thus, while denial is a more primitive type of defense, it is often found operating at more neurotic levels. As Freud (1940 [1938]) suggested, denial has to do with the withdrawal of cathexis from perceptions, where the perceptions may be either external or internal. Repression has the effect of making ideas unconscious, but denial can only erect a protective screen between the preconscious and the conscious, so that ideas which have reached the preconscious level are prevented from becoming conscious. Thus both repression and denial deal with contradictory ideas; in repression one is in consciousness but the other is in the unconscious, whereas in denial both ideas have their place in the ego. This produces a split in the ego and the perceived reality is correspondingly distorted under the influence of instinctual conflicts(Jacobson,1957). This results in a tendency for the ego to distort reality by a wish-fulfilling fantasy as a defense against an opposite, painful idea which also distorts reality. 因此，否认是一种更为原始的防御方式，在更神经症的水平上往往可以看到它在起作用。正如弗洛伊德(1940[1938])所指出的，否认与精神投入从知觉中退出有关，知觉可能是外在的，也可能是内在的。压抑具有使思想无意识的作用，而否认只能在前意识和意识之间架起一道保护屏，使达到前意识水平的思想无法成为意识。因此，压抑和否认都处理矛盾的思想;在压抑中，一个在意识中，另一个在无意识中，而在否认中，两种思想都在自我中占有一席之地。这在自我中产生了分裂，在本能冲突的影响下，感知到的现实相应地被扭曲(Jacobson,1957)。这就导致了自我倾向于通过一个实现愿望的幻想来扭曲现实，作为对一个同样扭曲现实的相反的、痛苦的想法的防御。 Denial in paranoid states is not a characteristic defense, but it is one that is frequently identifiable. Paranoid suspiciousness and guardedness tend to keep the paranoid well tuned in on his perceptual environment. The paranoid style lies not so much in denying reality as reinterpreting it in terms of the victim's own inner system. However, when projective and reinterpretive devices cannot adequately handle the challenge presented by contradictory data, the paranoid readily resorts to denial. Often it serves the interest of maintaining the paranoid system to deny one aspect of a part of the patient's experience and to modify other aspects of it by projection. Thus these mechanisms may and often do operate in conjunction. Where the paranoid distortion has reached psychotic proportions, denial seems to be an important part of the process. 否认并不是偏执状态下特有的防御，但在偏执状态下常可发现。偏执性的多疑和警惕倾向于让偏执者很好地适应他的感知环境。偏执的风格不在于否认现实，而在于根据“受害者”自身的内在系统对现实进行重新解读。然而，当投射和重新解释的方法都不能充分处理矛盾数据所带来的挑战时，偏执者很容易诉诸否认。通常，它通过否认病人一部分经验的一个方面，并通过投射修改其他方面来维持偏执系统。因此，这些机制可能并且常常同时运作。当偏执扭曲达到精神病的程度时，否认似乎是这个过程的一个重要部分。 It is important to keep in perspective that denial, however primitive and distorting of reality, is not essentially a psychotic mechanism. It is often seen in the operation of belief systems, where individuals may resort to denial(not merely negation) in the service of preserving the belief system intact. It is seen in the operation of prejudice where good and constructive aspects of the object of prejudice are not only distorted by projection but actually treated as nonexistent. In all such cases, one is confronted with a basic capacity of the human mind to rely on the security of its inner constructions and to accept only that reality which can be brought into compromise with that inner vision. This brings us to the last consideration of the mechanisms that constitute paranoid states. 重要的是要正确认识到，否认，无论多么原始和扭曲现实，本质上不是一种精神病机制。它经常出现在信仰系统的运作中，在这种情况下，为了保持信仰系统的完整，个人可能会诉诸否认(而不仅仅是否定)。在偏见的运作中，偏见对象好的和建设性的方面不仅被投射扭曲，而且实际上被当作不存在的。在所有这些情况下，人们都面临着人类心灵的一种基本能力，即依靠其内在结构的安全，只接受可以与内在想象妥协的现实。这把我们带到对构成偏执状态的机制的最后考虑面前。