Pathogenic Interaction 致病互动 Fred's mother was extremely inconstant and inconsistent in her mothering. She would at one point be overloving and hyperaffectionate—undoubtedly motivated by her own feelings of guilt and inadequacy in fulfilling her mothering role—and at another moment vindictive and highly punitive—this quite probably being related to her own inner narcissistic needs and the correspondingly high demands she placed on her favorite and firstborn son. With considerable intensity, she looked to Fred as a source of fulfillment and gratification that she was not receiving in her relationship with her husband, and at the same time striking out at him in a punitive and destructive fashion because he could not fulfill her expectations and needs. Fred was clearly the victim of her inner conflict and unresolved pathology, as well as of the unresolved tension inherent in the interaction between mother and father. 弗雷德的母亲在养育孩子方面极为反复无常，前后不一。她有时会对孩子过度溺爱，这无疑是出于她自己在履行母亲角色时的内疚感和不足感；而有时又会变得报复心强，极具惩罚性——这很可能与她内心的自恋需求和她对最喜爱的大儿子提出的相应高要求有关。她以相当大的强度将弗雷德视为一种满足和愉悦的来源，这是她在与丈夫的关系中所无法得到的，同时，由于弗雷德无法满足她的期望和需求，她又会以一种惩罚性和破坏性的方式对待他。弗雷德显然是母亲内心冲突和未解决的心理问题的受害者，也是父母之间互动中固有的未解决紧张的受害者。 Fred's relationship to his father was difficult and disappointing, in the face of the father's distance and unavailability. Fred's view of his father was one that was filled with intense yearning and longing that was subject to recurrent frustration and disappointment. The sense of frustrated longing and the wish for closeness and acceptance became mingled with an equally frustrated sense of rage and abandonment. This provided a source of recurrent and cumulative trauma that was rehearsed again and again in Fred's experience. The first episodes were framed in the context of his childish longing for his father—the never available and always retreating object. But later episodes were framed in a larger context of extrusion from the family and exile and abandonment to foreign school-prisons. Each such removal, each such abandonment, each such implied and implicit rejection reopened the old wound and drove it deeper into Fred's scarred and sensitized psyche. Each recurrence of the same theme of abandonment and rejection revivified and reinforced the string of such abandonments that stretched back to the farthest and dimmest reaches of his memory, and beyond. The sense of hurt and disappointment and inner rage could not be unleashed, because it carried with it the threat of even greater rejection. As Fred himself wrote with simple eloquence: "Afraid to a degree that I was responsible for the trouble at home and afraid that I would be sent away again, I convinced myself I had absolutely no ill feelings toward you and mother. This led consequently to a deeper fear that I would lose what little love I was able to feel between us." 弗雷德与父亲的关系十分困难，令人失望，这主要是因为父亲总是保持疏远，无法亲近。弗雷德对父亲的看法充满了强烈的渴望和期盼，然而这些情感却一再受到挫折和失望。这种受挫的期盼、对亲近和接纳的渴望，与同样强烈的愤怒和被遗弃的感觉交织在一起。在弗雷德的经历中，这种反复出现并不断累积的创伤成为了一种常态。最初的事件发生在他童年时期对父亲的渴望之中——那个永远无法触及、总是在退缩的形象。但后来的事件则发生在更大的背景下，即他被家庭排斥，被流放到国外的学校监狱中。每一次这样的分离、每一次这样的遗弃、每一次这样含蓄而隐晦的拒绝，都重新揭开了旧的伤口，使它们更深地刻入弗雷德已经伤痕累累的敏感心灵中。每一次遗弃和拒绝的主题重复出现，都重新激活并加强了这一连串的遗弃事件，这些事件一直延伸到他的记忆中最遥远、最模糊的部分，甚至更远。他内心的伤害、失望和愤怒无法释放，因为这伴随着更大的被拒绝的威胁。正如弗雷德自己以简洁而雄辩的笔触所写：“我在一定程度上害怕自己对家里的麻烦负有责任，害怕自己会被再次送走，于是我确信自己对你和母亲绝对没有任何恶意。这进而导致了我更深的恐惧，即我会失去我们之间那一点点微薄的爱。” The sense of rejection and abandonment had a more or less inevitable consequence for Fred. He began to see himself in terms of his being unworthy of his parents', and particularly his father's love. He grew up under the sting of these cumulative traumata with an inner sense of being unloved and unlovable, of being unvalued and unvaluable. The sense of disappointment and rage could not be directed against his father on this account, and it issued in a pattern of self-devaluation. He was an unworthy object of his father's love and esteem. It is worth noting that this pattern of paternal distancing and lack of rewarding closeness is a recurrent theme in the histories of male paranoids. We have seen it clearly exemplified in the cases of Bob B. and Don D. and we shall have occasion to see it again in discussing the relationship of father and son in the remaining cases. In Fred's case it obtains a particular intensity and poignancy. It has in all these cases a particular impact on the young boy; it undermines his inner sense of self-worth and value, it mobilizes considerable amounts of inner rage and resentment that cannot find adequate discharge or sublimation, and it introduces a distorting factor into the identificatory processes that guide and underlie the course of normal psychic development. 弗雷德所感受到的拒绝和遗弃，对他产生了或多或少不可避免的影响。他开始认为自己不值得父母的爱，尤其是父亲的爱。在这些累积的心灵创伤下成长，他的内心充满了不被爱、不可爱、无价值、不可能有价值的感觉。由此产生的失望和愤怒无法直接指向他的父亲，于是表现为自我贬低的模式。他觉得自己不配得到父亲的爱和尊重。值得注意的是，父爱的疏远和缺乏亲密的奖赏在男性偏执患者的病史中是一个反复出现的主题。我们在鲍勃·B和唐·D的案例中清楚地看到了这一点，在讨论其他案例中的父子关系时，我们还将有机会再次看到。在弗雷德的案例中，这种情况表现得尤为强烈和尖锐。这种情况对所有这些案例中的年幼男孩都产生了特殊的影响；它破坏了他们的自我价值和自尊感，激发了大量的内心愤怒和怨恨，这些情绪无法找到适当的发泄或升华途径，并为指导和支撑正常心理发展过程的认同过程引入了一个扭曲因素。