Assaultive Patients 喜好攻击的病人 On a lesser scale—but nonetheless significant in the management of hospital patients—the paranoid process also is related to the tendency for patients in the hospital to become assaultive. Such assaults may be deliberate, often retaliatory, but they may also be impulsive and occur in the context of loss of control. Sudden and uncontrolled explosions of rage and assaultive behavior may be quite unrelated to any identifiable provocation. Such patients are almost inevitably paranoid to one or another degree. Assaults may be provoked by the behavior of other patients or even in unconscious ways by the behavior of the hospital staff. Patients may have the feeling of helplessness in the face of staff members whom they see as powerful authority figures. 在较小的范围内——尽管在医院病人的管理中很重要——偏执过程也与病人在医院变得有攻击性的倾向有关。这种攻击可能是蓄意的，通常是报复性的，但也可能是冲动的，在失去控制的情况下发生。突然和不受控制的暴怒和攻击行为可能与任何可识别的挑衅无关。这样的病人几乎不可避免地偏执到这样或那样的程度。攻击可能是由其他病人的行为引起的，甚至可能是由医院工作人员无意识的行为引起的。病人可能会在面对他们视为权威人物的工作人员时感到无助。 In my own experience, it has generally been paranoid patients who create disturbances on the hospital wards and who become assaultive either to other patients or to the staff. Usually such patients are also psychotic—although assaultive behavior is not infrequently seen in other diagnostic categories. The most frequent exception has been acutely manic patients, for whom the expression of anger and aggressive impulses is not infrequent(Kalogerakis,1971). 根据我自己的经验，通常是偏执病人在医院病房里制造混乱，并对其他病人或工作人员产生攻击性。通常这些病人也有精神疾病——尽管攻击性行为在其他诊断类别中并不少见。最常见的例外是急性躁狂患者，他们的愤怒和攻击冲动的表达并不罕见(Kalogerakis,1971)。 The patient's impulse to violent acting-out also creates a difficulty in psychotherapy. The factors prompting such violent expression are complex and can play themselves out in a variety of ways. Frequently enough, particularly in men, the violence represents an aggressive attempt at defense against the intolerable psychic pain which may be related to the crisis of self-esteem involved in the underlying conflicts of dependency and power which are embedded in the therapeutic relationship. These conflicts may be related to homosexual issues, but frequently enough have more to do with power conflicts in the sense of pseudohomosexual conflicts. 患者暴力行为的冲动也造成了心理治疗的困难。引发这种暴力表达的因素是复杂的，可以以多种方式发挥作用。通常情况下，尤其是在男性中，暴力代表了对难以忍受的精神痛苦的一种攻击性的尝试，这种痛苦可能与自尊危机有关，涉及到依赖和权力的潜在冲突，而这种冲突根植于治疗关系中。这些冲突可能与同性恋问题有关，但往往更多地与权力冲突有关，从伪同性恋冲突的意义上说。 Often such patients reveal a fragile sense of masculine identity with a history of many failures in self-assertion, particularly in conflicts with other men. They have painful and shameful feelings about submission and passivity. The basic conflicts of power and dependency are elaborated within the transference, and thus form a threat to masculine pride and narcissism. The therapeutic intervention is regarded as a humiliating surrender. Such patients often have fairly strong paranoid dynamics: however, it is usually only in cases of frank psychosis that the threat is generally responded to by overt destructive activity. The importance of distinguishing the issues of power and dependence from true homosexuality are central to the handling of such violent crises. Any interpretations made to such patients on the basis of latent homosexuality would only serve to escalate the threat and increase the anxiety—sometimes to the point of panic(Woods,1972). 这样的病人往往显露出一种脆弱的男性认同感，他们有很多失败的自我主张的历史，尤其是在与其他男性发生冲突时。他们对顺从和被动有着痛苦和羞耻的感觉。权力和依赖的基本冲突在移情中被阐述，从而形成了对男性自尊和自恋的威胁。治疗性干预被认为是一种屈辱性的屈服。这类患者往往具有相当强的偏执动力学:然而，通常只有在明确的精神病患者中，这种威胁才会以蓄意的破坏性活动来回应。把权力和依赖的问题，与真正的同性恋区分开来，非常重要，是处理此类暴力危机的核心。对这些患者做出任何基于潜在同性恋的解释，只会加剧威胁，增加焦虑——有时会达到恐慌的程度(伍兹，1972)。