Homicide 杀人 The overlap between paranoid symptomatology and homicidal threats is considerable. In Macdonald's (1963) study of one hundred patients admitted to the hospital specifically for homicidal threats, paranoid delusions were present in thirty-five. Some of these showed considerable sadism in their histories, and even boasted of sadistic exploits, taking pleasure in such triumphs. Private armories with lethal weapons, including revolvers, pistols, shotguns, etc. were not infrequent. Such patients were often hypersensitive and easily provoked to angry outbursts. Even more passive-aggressive or passive-dependent personalities would experience outbursts of violent impulses—impulses such as were characteristically defended against. Pathological jealousy was a significant contributing factor to homicidal threats. Suspicions of marital infidelity often reached delusional proportions. Paranoid husbands with latent homosexual conflicts would often directly or indirectly encourage their wives to have affairs—and then react with great outrage. The victims in this series as well were family members—predominantly wives and husbands. The homicidal threats usually came in the context of intense sadomasochistic relationships. Macdonald remarks on the extraordinary reluctance on the part of relatives to seek advice or protection against the imminent threat of harm. Despite obvious signs of homicidal inclincations and preoccupations, relatives would often do nothing to effectively protect themselves or intervene in the process until forced to by physical assault or third-party interventions. 偏执症状学和杀人威胁之间有相当大的重叠。在麦克唐纳(1963)对100名专门因为杀人威胁而入院的病人的研究中，偏执妄想在其中35人身上有表现。其中一些人在他们的历史中表现出相当严重的施虐狂，甚至吹嘘自己的施虐行为，并以此为乐。拥有包括左轮手枪、手枪、猎枪等致命武器的私人兵工厂并不少见。这类病人常常是敏感的，容易发怒。甚至更多的消极攻击或消极依赖人格也会经历暴力冲动的爆发——这种冲动是典型的防御冲动。病态嫉妒是杀人威胁的一个重要因素。对婚姻不忠的怀疑常常达到妄想的程度。有潜在同性恋冲突的偏执丈夫通常会直接或间接地鼓励他们的妻子有外遇，然后做出愤怒的反应。这个系列的受害者也是家庭成员——主要是妻子和丈夫。杀人威胁通常来自于强烈的施虐受虐关系。麦克唐纳指出，在面临迫在眉睫的伤害威胁时，亲属们极不情愿地寻求建议或保护。尽管有明显的杀人倾向和先占观念的迹象，亲属往往不采取任何有效的措施保护自己或干预这一过程，直到受到身体攻击或第三方干预的强迫。 The study of homicidal adolescents suggests that the threat to kill the parents or the actual killing of the parents has a significant relationship to the degree of parent brutality(Duncan and Duncan,1971). Similar patterns of parental brutality have also been identified in adult murderers(Duncan et al.,1958; Satten et al.,1960). There is some evidence also to suggest that similar dynamics are operative in cases of child abuse—suggesting that violence breeds violence (Silver et al.,1969). Part of the mechanism operating in such cases unquestionably involves identification with the aggressor—but it is clear from our own study of paranoid dynamics that the aggression need not be in the form of physical assault or brutality. 对有杀人倾向的青少年的研究表明，杀害父母的威胁或实际杀害父母的行为与父母暴力的程度有显著的关系(Duncan and Duncan,1971)。在成年杀人犯身上也发现了类似的父母暴力模式(Duncan et al.，1958;Satten et al ., 1960)。也有一些证据表明，类似的动力学也在虐待儿童的案例中起作用，这表明暴力会滋生暴力(Silver et al.，1969)。毫无疑问，这些案例的部分机制涉及到对侵略者的认同——但从我们自己对偏执动力学的研究中可以清楚地看到，这种侵略不一定是以身体攻击或暴力的形式出现。 The incidence of homicide in relationship to paranoia is not at all unusual. A recent newspaper account came to my attention describing a fifty-eight-year-old man who had been waging a long battle with city authorities over the cluttering of his yard. The man lived alone and had few friends. He kept the yard of his home cluttered with junk and garbage which was quite unsightly and disturbing to the neighbors. For eighteen months he waged a battle with officials, who finally obtained a court order allowing them to clean up his yard as being a public nuisance. When the sanitation department workers arrived and began cleaning the yard, the owner, armed with a twelve-gauge shotgun, killed two of them. The police arrived and a gun battle ensued, during which this rather disturbed man shot himself with his own gun. A handwritten note was found in the grass beside his body. It read: "How can they abuse me anymore?" 杀人案的发生与偏执症的关系一点也不罕见。最近报纸上的一篇报道引起了我的注意，它描述了一位58岁的老人，他一直在与市政当局就自家院子里的杂物进行一场旷日持久的斗争。这个人独自生活，几乎没有朋友。他让他的院子里堆满了破烂和垃圾，这非常不雅观和干扰邻居。在十八个月的时间里，他与官员们展开了一场斗争，最终，官员们获得了一项法庭命令，允许他们清理他的院子，因为这是一种妨害公众的行为。当环卫处的工作人员到达并开始打扫院子时，店主拿着一支12口径的猎枪打死了其中两人。警察来了，接着发生了枪战，在枪战中，这个精神失常的人用自己的枪自杀了。在他尸体旁边的草丛里发现了一张手写的纸条。上面写着:“他们怎么能再虐待我?” The Wagner Case. Another fascinating example—the Wagner case—has been reported by Hilde Bruch (1967). On the night of September 4, 1913, a series of fires awakened the people of Mulhausen, then in southwest Germany. They ran into the street and there were confronted by a man whose face was covered by a black veil and who carried two pistols. He began firing and in a few minutes had killed eight men and one girl and had severely wounded twelve more people. He was then overpowered and found to be a man who had been a schoolteacher in the village more than ten yearsago. He then confessed that on the preceding night he had quietly killed his wife and four children. He said that he had come to the town to take revenge on the men of the town for their scorn and disdain of him. On the day of the murders he had mailed a series of letters to the largest newspaper in Stuttgart completely confessing all of his crimes. 瓦格纳案例。另一个有趣的例子(瓦格纳案例)是Hilde Bruch(1967)报道的。1913年9月4日晚，在德国西南部的穆豪森，一连串的大火惊醒了当地的人们。他们跑到街上，迎面遇到一个人，他脸上蒙着黑纱，手里拿着两支手枪。他开始射击，几分钟内就打死了八名男子和一个女孩，还重伤了十二人。他被制服了，原来是十多年前村里的一名教师。然后他承认在前一天晚上他悄悄地杀死了他的妻子和四个孩子。他说他到镇上来是为了报复镇上的人对他的蔑视和鄙视。在谋杀案发生的那天，他给斯图加特最大的报纸寄去了一系列的信件，完全坦白了他所有的罪行。 The amazement at this destructive outburst was increased by the fact that, prior to it, Wagner had been an exemplary man. He was described as an admirable citizen, dignified, quiet. The contrast to the horrible, carefully and deliberately calculated mass murder was overwhelming. The fateful chain of events began with a sodomistic act that had occurred in the summerof 1901. He shrouded this experience in strong and persistent secretiveness, and thus the suspicion existed that these experiences were not real but delusional. In any case his sexual and masturbatory urges stood in irrevocable opposition to his high and rather rigid moral standards and ethical concepts. He had a deep sense of guilt over these impulses. 在此之前，瓦格纳一直是一个模范人物，这一事实更增加了人们对这种毁灭性的爆发的惊讶。他被描述为一个可敬的公民，有尊严，文静。这与恐怖的、精心策划的大规模屠杀形成了强烈的对比。这一系列致命的事件始于1901年夏天发生的鸡奸行为。他以强烈而持久的隐秘来掩盖这种体验，因此怀疑这些体验不是真实的，而是妄想。无论如何，他的性冲动和自慰冲动与他的崇高而相当严格的道德标准和伦理观念是完全对立的。他对这些冲动深感内疚。 He soon began to hear slanderous remarks about himself and became unshakably convinced that his crime was known to the people of the town. He felt that he was being watched and mocked and ridiculed, and lived in a constant dread of being arrested for his crime. He then took to carrying a loaded pistol—even when he took his final examination as a teacher in 1902, and also on his wedding day in 1903. He regarded his wife as more of a servant than a wife. He was unhappy about the birth of his children, but he was unusually indulgent with them—even extravagant. He explained this later as due to the fact that he knew that they only had a short time to live. 不久，他开始听到一些关于他自己的流言蜚语，并且不可动摇地相信镇上的人都知道他的罪行。他感到自己受到监视、嘲笑和奚落，时时刻刻担心自己会因犯罪而被捕。然后他开始带着一支上膛的手枪——甚至在他1902年作为教师参加期末考试的时候，以及1903年结婚的时候。他认为他的妻子与其说是妻子，不如说是仆人。他对自己孩子的出生并不高兴，但他对他们却异常宽容——甚至放纵的。他后来解释说，这是因为他知道他们活不了多久了。 His mood was generally depressed and pessimistic, with many hypochondriacal complaints. He would occasionally experience suicidal impulses, wanting to drown himself. He lived in constant dread of public humiliation. At times he tried to accuse his persecutors, but when his accusations were denied he felt utterly helpless and had to hide his rage and shame from them. Gradually he evolved his plan for destruction and murder. He collected and hid weapons and other things needed for his plan—even practiced sharpshooting in the remote parts of the woods. He worked on his plans in elaborate detail, but again and again shrank from the actual execution of them. 他的情绪通常是抑郁和悲观的，有许多疑病症的抱怨。他偶尔会有自杀的冲动，想要淹死自己。他一直生活在公开羞辱的恐惧中。有时他试图指责迫害他的人，但当他的指控被否认时，他感到完全无助，不得不向他们隐藏自己的愤怒和羞愧。他逐渐制定了毁灭和谋杀的计划。他为他的计划收集和藏起武器和其他需要的东西——甚至在森林的偏远地区练习射击。他煞费苦心地研究他的计划，但一次又一次地回避实际执行。 He had been a devoted student of literature and developed an interest in drama. He wrote dramas of his own which he tried to get published. When he couldn't find a publisher for his plays he would have them printed at his own expense. On occasions when he would drink too much beer, his friends noted that he seemed to change his personality and became quite moody and morose, or quite grandiose and talkative. He would talk passionately about his favorite topics—God and religion, or free love, which he advocated with caustic cynicism, and his great dramas. His wife had been dissatisfying to him. He was not happy with his teaching and commented from time to time that one day he would become a famous man and would do deeds that would astound the world. His father was a peasant who had been an alcoholic and probably paranoid. His father had died when he was two years old and left his mother with nothing but debts. His mother had been promiscuous, and he was known in the village as the "widow's boy." He suffered then from depression, suicidal thoughts, and nightmares. 他一直是一个专注于文学的学生，并对戏剧产生了兴趣。他自己写剧本，并试图出版。当他找不到出版商出版他的剧本时，他就自费印刷。有时他会喝太多啤酒，他的朋友们注意到他似乎改变了自己的性格，变得非常喜怒无常、郁郁寡欢，或者非常夸大、健谈。他会热情地谈论他最喜欢的话题——上帝和宗教，或者他以刻薄的犬儒主义所倡导的自由之爱，以及他的伟大戏剧。他的妻子对他一直不满意。他对自己的教学并不满意，并不时评论说，总有一天他会成为名人，做一些震惊世界的事情。他的父亲是一个农民，曾经酗酒，可能还患有偏执。他两岁时父亲就去世了，留给母亲的只有债务。他的母亲是滥交的，他在村子里被称为“寡妇的孩子”。他那时饱受抑郁、自杀念头和噩梦的折磨。 The last twenty-five years of his life were spent in an asylum. For several years he worked studiously on a drama which he called Wahn ("Delusion"). It was based on the life of Ludwig II of Bavaria. He was bitterly disappointed when this work, which he considered a masterpiece, was not produced. A bout the same time, a drama dealing with mental illness was produced by Franz Werfel in Stuttgart. Wagner became convinced that Werfel had stolen it from him, or that he had based it on his life. He became preoccupied with concerns of dramatic work of his having been stolen by other successful writers. He became gradually convinced that there was a Jewish conspiracy to deprive him of the rewards of his dramatic labors. 他生命的最后25年是在精神病院度过的。几年来，他一直在努力创作一部他称之为“妄想”的戏剧。它是基于巴伐利亚路德维希二世的生活的。他认为这是一部杰作，但当它没有完成时，他感到非常失望。大约在同一时间，斯图加特的弗朗茨·韦费尔创作了一部关于精神疾病的戏剧。瓦格纳开始相信是韦费尔从他那里偷来的，或者是他根据自己的生活写成的。他全神贯注于这样的担心，担心自己的戏剧作品被其他成功的作家偷走。他逐渐相信犹太人密谋剥夺他戏剧创作的报酬。 About this time political events in Germany began to catch up with him. He joined the Nazi Party in 1929, and was proud of the fact that he had been the first inmate in the hospital to do so. He followed with great enthusiasm the racial policies and persecutions of the Nazi regime, regarding them as justification for his own delusional thoughts. Wagner died finally an embittered man—embittered not because of any remorse for his murders, but because his persecutors had declared him insane and he had thus failed to find the fame that he sought as a literary figure. The Wagner case is a classic one and it illustrates, I think, the difficulty in identifying the potentially homicidal paranoid patient. The secretiveness and intelligence of the paranoid individual make it possible for him to conceal his intentions to a considerable degree. 大约在这个时候，德国的政治事件开始对他产生影响。他于1929年加入纳粹党，并为自己是医院病人里第一个加入的而自豪。他以极大的热情关注纳粹政权的种族政策和迫害，认为这证明了他自己的妄想是对的。瓦格纳最终以一个痛苦的人的身份死去——痛苦不是因为他对自己的谋杀行为有任何悔恨，而是因为迫害他的人宣布他精神失常，因此他没能获得他作为一个文学人物所追求的名声。瓦格纳案例是一个典型的案例，我认为，它说明了识别潜在的杀人偏执者的难度。偏执者的隐秘和智慧使他有可能在相当大的程度上隐藏自己的意图。 Homicidal Intent. At times however—just as in the case of suicidal intents—homicidal threats are communicated before the fatal act is undertaken. Macdonald's (1967) follow-up study of patients who had made homicidal threats indicates a number of factors related to such threats, including parental brutality, parental seduction, fire-setting, sadistic and cruel treatment of animals, previous police arrests, particularly for assault, alcoholism, and attempted suicide. However the absence of suicide attempts suggests an even greater risk of homicide. The relationship between murder and paranoid tendencies is also underlined by Lanzkron's(1963) study of 150 cases of mental patients committed to a hospital who were charged with or indicted for murder. In approximately 40 percent of this group, the homicide was directly related to, or derived from, paranoid delusions. In an additional 32.6 percent, the insane paroxysmal, homicidal outburst was associated with motives which included anger, revenge, jealousy, etc. In another 27 percent, the insanity seemed to have developed after the homicide, but the motives again included such apparently paranoid motivations as morbid jealousy, revenge, cuckolding-reaction, etc. Thus in 40 percent of the cases the paranoid process is explicit enough to warrant a labeling as one of the recognizable paranoid syndromes. In an additional 50 or more percent of the cases, a detectable element of paranoia is recognizable. The same author has reported a number of cases of involutional paranoia in which delusions of infidelity or delusions of persecution led to murder(Lanzkron,1961). These cases seem to suggest that, when the paranoid process is operating, homicidal tendencies are operative over prolonged periods of time, since forebodings and forewarnings of homicidal intent are retrospectively identifiable for considerable periods. It is also noteworthy that such paranoid delusions and homicidal intent are usually found in males more frequently than in females—Lanzkron cites a ratio of four to one. 行凶的意图。然而，有时——就像自杀意图的情况一样——杀人威胁在采取致命行动之前就已经传达了。麦克唐纳(1967)对实施过杀人威胁的病人进行的跟踪研究表明，与这些威胁相关的因素有很多，包括父母的残暴、父母的引诱、纵火、虐待动物和虐待动物、先前的警察逮捕，特别是因为袭击、酗酒和自杀未遂。然而，自杀企图的减少意味着更大的杀人风险。Lanzkron(1963)的研究也强调了谋杀和偏执倾向之间的关系，该研究调查了150名被指控犯有谋杀罪的精神病人。在这群人中，大约有40%的人是直接因为妄想而行凶。另外32.6%中，这种疯狂的发作性、杀人性的情绪爆发与愤怒、报复、嫉妒等动机有关。另有27%的人在凶杀案后精神失常，但其动机又包括病态嫉妒、报复、绿帽反应等明显的偏执动机。因此，在40%的病例中，偏执过程足够明确，可以作为可识别的偏执症状之一。在另外50%或更多的病例中，可检测到的偏执元素被识别出。同一作者还报告了一些更年期偏执症的案例，在这些案例中，不忠的妄想或被迫害的妄想导致了谋杀(Lanzkron,1961)。这些案件似乎表明，当偏执进程起作用时，杀人倾向在很长一段时间内都在起作用，因为在相当长的一段时期内，可以追溯确定有杀人意图的预兆和警告。同样值得注意的是，这种偏执妄想和杀人意图通常在男性身上比在女性身上更常见——兰兹克伦引用的比例是四比一。 Premonitory signs are frequently available—for those who are able or willing to read them. Malmquist(1971) has studied such prodromal signs in young adolescent murderers. Behavioral and mood changes were frequent—especially self-hate and pessimism. Efforts to gain help may occur but often are met with denial, particularly from close relatives. Object losses were frequent precipitants. Threats to masculinity often came in the form of provocations to fight—often from teenage girls—usually in sadomasochistic contexts. Somatic and hypochondriacal symptoms or delusions were found. Homosexual threats seemed to raise the homicidal index. 对于那些有能力或愿意阅读先兆症状的人来说，先兆症状常常是有用的。Malmquist(1971)研究了青少年杀人犯的这种前驱症状。行为和情绪变化频繁——尤其是自我憎恨和悲观主义。他们可能会做出求助的努力，但往往遭到拒绝，尤其是来自近亲的拒绝。客体丧失是常见的诱发因素。对男子气概的威胁通常以挑衅的形式出现——通常来自十几岁的女孩——通常是在施虐受虐的情况下。躯体症状和疑病症或妄想被发现。同性恋威胁似乎提高了行凶指数。 The feeling of helplessness and hopelessness is a strong predisposing factor to acts of violence(Halleck,1967). An acute state of loss or mourning may plunge the adolescent beyond the point of no return. As we shall see, the dynamics of depression and paranoia are closely linked. In these cases of destructive and homicidal violence, it seems that the acute and intolerable exacerbation of depression precipitates the paranoid defense and its attendant solution—a paroxysmal attempt at survival and self-preservation in the face of desperate self-disintegration(Malmquist,1971; Dalman,1955). Despite the determinable role of paranoid dynamics in criminal violence, a diagnosis of paranoia has little predictive validity. The risks of prediction of criminal violence in a medicolegal framework have recently been discussed by Rubin(1972). 无助和绝望的感觉是暴力行为的一个强大的诱发因素(Halleck,1967)。一种强烈的失落或哀悼的状态可能会使青少年陷入无法回头的境地。正如我们将看到的，抑郁症和妄想症的动力学是紧密相连的。在这些破坏性和谋杀性暴力的案例中，似乎抑郁的急性和不可忍受的恶化促成了偏执的防御和随之而来的解决方案——在绝望的自我瓦解面前，一种突发性的生存和自我保护的尝试(Malmquist,1971;陶曼,1955)。尽管偏执动力学在犯罪暴力中起着确定性的作用，但对偏执的诊断几乎没有预测效度[就算你知道他是偏执，你也不能说他一定会犯罪]。Rubin(1972)最近讨论了在法医学框架下预测犯罪暴力的风险。