Loss of Function 功能丧失 As suggested above, the loss of significant functions can also serve to precipitate a paranoid reaction. Fitzgerald (1970) has reported on a series of recently acutely blinded adults. A major dysphoric reaction occurred in over 90 percent of these patients. A high percentage showed depressive affect, crying, withdrawal, lowered self-esteem, suicidal ideation, insomnia, guilt, shame, self-blame. A smaller percentage showed suspicion in some form or another, or they were found to foster some form of paranoid ideation. Depression is an easily understood response to the narcissistic trauma of loss of such an important function. The fact that a substantial minority of these patients showed a paranoid reaction to the acute loss suggests that the paranoia may be serving a defensive function in these patients as well. 如上所述，失去重要的功能也会导致偏执反应。菲茨杰拉德(1970)报道了一系列近期严重失明的成年人。超过90%的患者出现严重的焦虑反应。有很高比例的人表现出抑郁、哭泣、退缩、自尊降低、有自杀念头、失眠、内疚、羞愧、自责。较小比例的人表现出某种形式的怀疑，或者他们被发现助长了某种形式的偏执观念。抑郁是一种很容易理解的对自恋创伤的反应，这种创伤是由于失去了这样一个重要的功能。事实上，这些患者中有相当多的人对急性丧失表现出偏执反应，这表明偏执可能也在这些患者中起到防御功能。 In this regard, Rochlin (1965) has reported a case of an editor who was partially blinded as a result of an eye infection. The patient's initial reaction was depression—he felt deprived, impoverished, helpless and dependent. His dependence was all the more burdensome in the face of a family ethic that no one should receive more than any other and that all should share alike. His consequent low estimation of himself was a source of severe anguish. His hatred and resentment of his family was turned against himself in the form of self-destructive wishes. He became convinced that they hated him and always had. He developed the belief that they did not want him, were all against him, and that they were contemptuous of him because he was so useless. He became suspicious of their superficially good intentions toward him. 在这方面，Rochlin(1965)报告了一个编辑由于眼部感染而部分失明的案例。病人最初的反应是抑郁——他感到被剥夺、贫困、无助和依赖。在家庭伦理面前，任何人都不应该得到比别人更多的东西，所有人都应该平等地分享，他的依赖就更加沉重了。他因此而产生的对自己的低评价使他极度痛苦。他对家庭的憎恨和怨恨以自我毁灭的愿望的形式来反对他自己。他开始相信他们恨他，而且一直恨他。他逐渐相信，他们不需要他，都反对他，他们瞧不起他，因为他那么没用。他开始怀疑他们表面上对他的好意。 The loss of vision is a loss of a functionally important part of the self, and the significance of the loss is that it amounts to a narcissistic injury. The response is in the first instance and primarily a depressive one which undermines self-esteem and increases the sense of deprivation and narcissistic loss. The paranoid reaction comes as an attempt to redeem something of what has been lost. Behind the young editor's paranoid ideas, there was the conviction that he was cleverer than the rest of his family. His competence and attainments had served him both to bolster his inner insecurity and support his self-esteem, but also to channel his considerable competitiveness and aggression. His paranoid thoughts enabled him to serve both ends once more, but in a less productive manner. 视觉的丧失是自体功能上重要部分的丧失，这种丧失的意义在于它相当于一种自恋伤害。这种反应首先是抑郁的，会破坏自尊，增加被剥夺感和自恋的失落感。这种偏执的反应是一种试图挽回失去的东西的尝试。在这位年轻编辑偏执的想法背后，有一种信念，那就是他比家里其他人都聪明。他的能力和造诣不仅增强了他内心的不安全感和自尊，而且还引导了他相当强的竞争力和侵略性。他的偏执的想法使他能够再次达到目的，但以一种低效的方式。 The nature of the precipitants of the paranoid reaction varies, but they share a common element of producing a narcissistic injury. Narcissistic deprivation is followed by a depressive response which is marked by lowered self-esteem, feelings of worthlessness, a sense of inadequacy and inferiority. The paranoid response works to redeem some of the lost narcissism and recreates a meaningful pattern of relatedness in which self-esteem can survive. Consequently, the precipitants in no way determine the paranoid character of the individual's response, but they point to the intimate relationship between the dynamics of depression and those of paranoia. The genetic conditions which lie behind the paranoid pattern of response can be expected to share many elements in common with those which give rise to depressive states. 偏执反应的诱因各不相同，但它们都有一个共同的因素，那就是造成自恋伤害。自恋被剥夺后，随之而来的是一种抑郁反应，其特征是自尊降低、觉得自己没有价值、感到不足和自卑。偏执反应可以弥补一些失去的自恋，并重建一种有意义的关联模式，让自尊得以存活。因此，这些因素并不能决定个体反应的偏执特征，但它们指出了抑郁和偏执动力学之间的密切关系。可以预期，偏执反应模式背后的发生条件与那些导致抑郁状态的因素有许多共同之处。