First Contact 首次联系 My first contacts with Ellen were memorable—although I later learned that the whole flavor of my experience with her were fairly typical of her manner of behaving and relating to other people. She was quite agitated and intensely angry. She acted in a manner to suggest total impatience and irritation with everything that was asked of her. She kept saying, "Let's get going and get this whole thing over with!" She was intensely suspicious of everything that was done or asked of her. During the first interview she would suddenly burst out into frightened tears that reflected her inner turmoil and distress. Then she would quickly turn from tears to an attitude of angry attack, shouting obscenities (she had developed a rich vocabulary that would make a truck driver blush) and venting her spleen on me or on the nurses or on a variety of other people who she felt were out to get her and were making things tough for her. The content of these outbursts were highly paranoid and was accompanied by extreme agitation and excitement. 我与埃伦的第一次接触是难忘的——尽管后来我了解到，我与她相处的全部经历都是她行事和与人相处典型的的方式。她非常激动，非常生气。她对别人要求她做的每件事都表现出完全的不耐烦和恼怒。她不停地说，“我们走吧，把这整件事做完!” 她对别人对她做的或要求她做的每件事都非常怀疑。第一次会面时，她会突然吓哭，这反映了她内心的混乱和痛苦。然后她会很快从眼泪转向一种愤怒攻击的态度,下流地叫喊着(她开发了一套能让卡车司机脸红的丰富词汇)，并对我、对护士或其他她觉得企图伤害她或正在为难的人发泄她的脾气。这些爆发的内容是高度偏执的，并伴有极端的激动和兴奋。 Her behavior on admission to the hospital and for several days thereafter was extremely provocative and assaultive. Her general mode of behavior suggested a high degree of tension and inner turmoil. She would remain relatively quiet, keeping very much to herself and talking to no one, and then suddenly she would lash out at someone—usually one of the nurses who happened to be passing by, or occasionally one of the patients. Almost always the victim was a female. The suddenness and unpredictability of these apparently unprovoked attacks made it necessary to restrict her, and this move provoked additional attacks and angry accusations against the staff which had a highly paranoid cast. 她入院时的行为，以及此后几天的行为，都极具挑衅性和攻击性。她的一般行为模式显示出高度的紧张和内心的混乱。她会保持相对的安静，非常安静，不跟任何人说话，然后突然她会对某个人大发脾气——通常是路过的护士，或者偶尔是病人。几乎所有的受害者都是女性。这些显然是无缘无故的攻击的突然性和不可预测性使得有必要对她加以限制，而这一举动又激起了对那些被高度偏执投射的工作人员的进一步攻击和愤怒指控。 But the admission procedure was particularly memorable for me! It was part of the admitting physician's responsibilities to complete a physical examination of the patient. After the initial interview with her, we went to the examining room. A nurse helped her to undress and prepare for the examination. Ellen's attitude was one of irritation and reluctant resentment, but she was nonetheless by and large cooperative. She continued the "let's get it over with" attitude here, too. The examination was unquestionably sexually stimulating for her. As it progressed she made several comments about how doctors got their kicks out of examining female patients, and expressed some of her resentment at such treatment. When we came to the pelvic examination, however, her anxiety reached a crescendo. She cooperated to a point—but only to a point. With some gentle reassurances from me and from the nurses standing by, we were able to proceed to the point of beginning to introduce some vaginal lubricant for the speculum examination. At this point Ellen began to writhe on the table, began screaming excitedly at the top of her voice that I was raping her. This outburst was soagitated and intense that I was really frightened by it, and decided that the physical examination was at that point finished. Discretion seemed to dictate an immediate retreat. Ellen calmed down as soon as I made my escape, and then proceeded to attack the nurse who was attending her. I confess that the whole episode had shaken me. 但是入院手续对我来说却特别难忘!完成病人的体格检查是收治医生职责的一部分。和她初次见面后，我们去了检查室。一位护士帮她脱掉衣服，准备检查。埃伦的态度是恼怒和不情愿的怨恨，但总的来说，她还是很配合的。她在这里也继续着“让我们把这件事做完”的态度。检查对她来说无疑是性刺激的。随着时间的推移，她对医生如何从检查女性病人中获得乐趣发表了几句评论，并表达了她对这种治疗的一些不满。然而，当我们来到盆腔检查时，她的焦虑达到了顶峰。她合作到了一定程度，但只是到了一定程度。在我和站在一旁的护士们的温柔的安慰下，我们终于可以开始为窥镜检查引入一些阴道润滑剂了。这时埃伦开始在桌子上扭来扭去，扯着嗓门兴奋地尖叫起来，说我在强奸她。这次爆发是如此激动和强烈，我真的被它吓坏了，并决定在那个时候体检已经结束。谨慎似乎决定了立即撤退。我一逃跑，埃伦就平静下来，然后开始攻击照顾她的护士。我承认这整件事使我很震惊。 We can sense in these events the pugnacious and assaultive character of Ellen's paranoia. It is worth noting that our patients seem to vary between this aggressive "fight" stance against the threatening persecutors and a more phobic "flight" pattern of reaction in the face of mounting persecutory anxiety. The patterns may take characteristic forms, as in this case, or may vary from one circumstance to another. 在这些事件中，我们可以感觉到爱伦偏执性的好斗和攻击性。值得注意的是，我们的病人在面对威胁的迫害者时表现出的好斗的“战斗”姿态和面对日益增长的迫害焦虑时表现出的更为恐惧的“逃跑”反应模式之间似乎存在差异。模式可以采取特征形式，就像在本例中一样，也可以随环境的不同而变化。