Klein 克莱因 The relationship between paranoia and depression had been noted by Freud in his early treatments of paranoia. He regarded paranoia as a defense against feelings of self-reproach, but he never developed this idea further in his later writings on the subject. It was not until Melanie Klein's contributions that the relation between paranoia and depression became a central concern of psychoanalytic thinking. She based her consideration on the vicissitudes of infantile sadism. The infant's sadism is initially directed against the mother's breast and body, wishing to bite, devour, and destroy them. The mother's breast is a prototype of the good and bad objects which the infant introiects from the beginning. The breast is good when he has it and it satisfies him; it is bad when it fails him. The breast is bad not only because it frustrates the child's wishes, but also because the child projects his own aggressive impulses onto it—with the result that breast becomes "bad" and objects become persecuting. The persecuting objects are feared as threatening to destroy him even as he wished to destroy the mother's breast. The sadism has thus become projected and redirected against the self. By the operation of projection and introjection, these persecutors are internalized and must be again defended against by projection and expulsion. 弗洛伊德在其早期对偏执的治疗中就已经注意到了偏执和抑郁之间的关系。他认为偏执是对自我谴责的一种防御，但在他后来关于这个主题的著作中，他从未进一步发展这个观点。直到梅兰妮·克莱因的贡献，偏执和抑郁之间的关系才成为精神分析思维的中心关注点。她以婴儿施虐的变迁为基础来考虑问题。婴儿的施虐最初是针对母亲的乳房和身体，希望咬，吞食，并摧毁他们。母亲的乳房是婴儿从一开始就内化的好客体和坏客体的原型。乳房是好的，当他拥有它并且它满足了他；乳房是坏的，当它辜负了他。乳房是坏的，不仅因为它挫败了孩子的愿望，还因为孩子把自己的攻击冲动投射到乳房上——结果乳房变成了“坏的”，客体变成了迫害者。迫害性客体令人害怕，它们威胁要毁灭他，就像他想要毁灭母亲的乳房一样。施虐因此被投射出去，并重定向到自体[本来是婴儿恨乳房，现在成了乳房恨婴儿]。通过投射和内摄的操作，这些迫害者被内化了，必须再次通过投射和驱逐来防御。 The ego also gains a loving relation to good objects together with a feeling of guilt for sadistic impulses. There is a need to try to preserve the good object against persecutors and a sadness related to the expectation of loss. The ego's unconscious knowledge of the presence of hate along with love, as well as the anxiety that the hate might gain the upper hand and so destroy the loved object, gives rise to the feelings of guilt and sorrow which underlie depression. As long as the ego can deal with part objects, the hate for bad objects and the love for good objects can be kept separate. But when the ego is able to integrate its experience to the level of dealing with whole objects, the same object becomes the object of both hate and love—and this ambivalence is central to the depressive position. The paranoid in Klein's view is unable to introject a good object or, if he does, cannot maintain it since the inherent sadism will turn it into a persecutor. The whole relation to objects is colored by the early experience of part objects as persecutors, which prevents his relating to real, whole objects. 自我也获得了对好客体的爱的关系，以及对施虐冲动的愧疚感。我们有必要保护好的客体，对抗迫害者，以及与损失预期相关的悲伤。自我对恨与爱一起存在的无意识认知，以及对恨可能占上风从而摧毁所爱客体的焦虑，导致了作为抑郁基础的内疚和悲伤的感觉。只要自我可以处理部分客体，对坏客体的恨与对好客体的爱就可以分离。但是当自我能够将自己的经验整合到能处理整个客体的层面时，同一个客体就变成了既恨又爱的客体——这种矛盾心理是抑郁心位的核心。克莱因认为，偏执不能内摄好的客体，如果他这么做了，也不能保持它，因为固有的施虐会把它变成一个迫害者。部分客体作为迫害者的早期经历影响了与客体的整体关系，阻碍了他与真实的整体客体的关系。 The paranoid cannot bear the additional anxieties for a loved object or the guilt and remorse of the depression. The availability of projection is also limited in the depressive position since he runs the double risk of expelling good objects and of injuring good external objects by the projection. Thus the paranoid retreats from depression—even though, and, in a sense, to the extent that, the potentiality for depression remains. Klein writes: 偏执者无法忍受对所爱客体的额外焦虑，也无法忍受抑郁带来的内疚和悔恨。投射的可用性在抑郁心位下也是有限的，因为他冒着通过投射驱逐好客体和伤害好的外部客体的双重风险。这样，偏执者就会从抑郁中撤退——即使在某种程度上，抑郁的可能性依然存在。克莱因写道: Thus we see that the sufferings connected with the depressive position thrust him back to the paranoiac position. Nevertheless, though he has retreated from it, the depressive position has been reached and therefore the liability to depression is always there. This accounts, in my opinion, for the fact that we frequently meet depression along with severe paranoia as well as in milder cases(1964,p.292). 由此可见，与抑郁心位相关的痛苦将他推回到偏执心位。然而，虽然他已经退出，抑郁心位已经达到，因此抑郁的责任总是存在。在我看来，这解释了我们经常会遇到抑郁伴随严重偏执以及轻度偏执的事实(1964年，第292页)。 Whether or not one accepts Klein's formulation of the infantile development of the paranoid and depressive states, it seems clear that the dynamics of paranoia and depression are closely connected in adult patients. While there are many difficulties with her views on infantile sadism, there can be little doubt that these issues are quite relevant to the dynamics of adult paranoia. Paranoia serves as an important defense against depression. When paranoid patients can be induced to give up their paranoid stance, they do so only at the risk of clinical depression. Klein has also pointed to the important interplay of projection and introjection in both these states. 无论人们是否接受克莱因的偏执和抑郁状态的婴儿期发展的说法，似乎很明显，偏执和抑郁的动力学在成年患者身上是密切相关的。虽然她对婴儿施虐的观点有很多困难，但毫无疑问，这些问题与成年偏执的动力学相当相关。偏执是对抗抑郁的重要防御手段。当偏执患者可以被诱导放弃他们的偏执立场，他们这样做只有有临床抑郁症的风险。克莱因还指出了在这两种状态下投射和内摄的重要相互作用。