Threat to Life 对生命的威胁 Orbach and Bieber (1957) studied a group of patients who were confronted with the necessity of having a lifesaving operation. The patierts were drawn from a nonpsychiatric population of cancer patients. They were faced with the reality of a potentially lethal disease and the prospect of mutilative surgery. These patients, in the face of this narcissistic assault, showed a variety of hypochondriacal, depressive, and paranoid responses. These reactions were accompanied by extensive denial in the face of the disruption of the individual's mechanisms for maintaining a sense of mastery and personal integrity. A critical factor was the need to maintain control over the threat posed by illness and injury. The assignment of blame for this loss of control determined whether the reaction took a depressive or a paranoid form. Attribution of blame to the self produced feelings of unworthiness, badness, and guilt. Attribution of blame to others brought feelings of anger over unjust injury and paranoid feelings. In the light of our preceding discussion, the depressive response can be seen as the primary response to threatened loss and narcissistic injury, and the paranoid pattern would emerge as a restitutive attempt to salvage self-esteem and a sense of worth. Orbach和Bieber(1957)研究了一组需要进行救命手术的病人。这些病人是从非精神病的癌症患者中挑选出来的。他们面临着一种可能致命的疾病的现实和残废的手术前景。这些患者在面对这种自恋攻击时，表现出多种疑病症、抑郁和偏执的反应。面对着个人保持掌控感和个人完整的机制的破坏，这些反应伴随着广泛的否认。一个关键因素是需要保持对疾病和伤害造成的威胁的控制。这种失控的责任分配决定了反应是抑郁的还是偏执的。把责任归咎到自己身上会产生一种无价值、糟糕和内疚的感觉。将责任归咎于他人会带来不公平的伤害和偏执的感觉。根据我们之前的讨论，抑郁反应可以被看作是对损失威胁和自恋伤害的主要反应，而偏执模式将作为一种挽回自尊和价值感的尝试而出现。