Initial Contact 最初的联系 I first came into contact with Fred when he was brought to the hospital for admission by the police. He was just twenty-two years old, a student at one of the local universities. The police had apprehended him the previous night, standing in the middle of a highway brandishing a crowbar at the passing cars in the road, thus obstructing traffic and causing a considerable disturbance. He was arrested, spent the night in jail, and then was sent by the judge to the hospital for psychiatric evaluation due to his obviously disorganized and bizarre behavior. 我第一次接触弗雷德是在他被警察带到医院住院的时候。他只有22岁，是当地一所大学的学生。警察在前一天晚上逮捕了他，当时他站在高速公路中央，向路上过往的车辆挥舞撬棍，从而阻碍了交通，造成了相当大的骚乱。他被逮捕，在监狱里呆了一夜，然后被法官送到医院进行精神评估，因为他明显混乱和怪异的行为。 When I first spoke to Fred, he seemed somewhat tense, apprehensive, anxious, and rather agitated. He spoke readily and even eagerly, but with acertain degree of pressure behind his flow of speech. He seemed easily distractible and unable to follow a line of thought for very long. His mind would shoot off in tangential directions which gave the distinct impression of a loosening of his thought processes. He tried to affect a rather casual and self-assured facade, but at the same time gave the distinct impression of being inwardly uncertain, frightened, and insecure. His thoughts seemed almost obsessively preoccupied with questions of politics, human rights, freedom, individual expression, racial justice, social justice, etc. He would episodically break out into angry tirades about these subjects in a manner which reflected his intense rage and anger at the fact that unfortunate people in the world were taken advantage of and were powerless in the face of the heartless and cold, inhuman forces which controlled their lives. 当我第一次和弗雷德谈话时，他似乎有些紧张、忧虑、焦虑，而且相当激动。他说得很爽快，甚至很急切，但在他滔滔不绝的讲话背后却有一定程度的压力。他似乎很容易分心，不能长时间地思考一个问题。他的思想会向一些不相干的方向发散，这给人一种明显的印象，即他的思维过程放松了。他试图装出一副相当随意和自信的样子，但同时又给人一种内心不确定、害怕和缺乏安全感的截然不同的印象。他的思想似乎痴迷于政治、人权、自由、个人表达、种族正义、社会正义等问题。他会时不时地就这些话题发表愤怒的长篇大论，这反映了他对世界上不幸的人被利用，在无情、冷酷、不人道的力量控制他们生活时无能为力的强烈愤怒。 From time to time he would refer to his own special powers and sensitivities which made him an extraordinarily valuable person. He felt that he had special powers which enabled him to read people's minds or which enabled him to make himself invisible. He felt that he had a special understanding of other cultures and other people which made it possible for him to be politically successful and astute. He expressed rather vague, yet definite, delusions of persecution. The identity of the persecutors was not very well defined—he spoke loudly of the government, or the university administration, or the FBI, or the "establishment," etc. It seemed that the purpose of all these forces was to thwart the patient and frustrate his ambitions of obtaining goals—such as financial success, or academic success, or success in the political area—that he felt he deserved. He even hinted vaguely at delusions of total world chaos and destruction, with hostile and powerful forces vying with each other and destroying each other in an attempt to take over the world. 他有时会提到自己的特殊能力和敏感，这使他成为一个非常有价值的人。他觉得自己有一种特殊的能力，能够读懂别人的心思，或者使自己隐形。他觉得他对其他文化和其他人有一种特殊的理解，这使他有可能在政治上取得成功和精明。他含糊而明确地表达了遭受迫害的错觉。迫害者的身份并不是很明确——他大声地指责政府、大学行政部门、联邦调查局或“建制派”等等。似乎所有这些力量的目的都是挫败患者，挫败他实现目标的雄心壮志——比如经济上的成功，学术上的成功，或者政治上的成功——他认为自己应得的。他甚至模糊地暗示了世界混乱和毁灭的错觉，敌对和强大的力量相互竞争，相互摧毁，试图接管世界。 Fred was at first fairly cooperative, despite his delusions and preoccupations. Even so, he would from time to time during the course of the examination make peremptory demands that questions of his be answered to his satisfaction. His attitude was one of suspicion and distrust. For example, he demanded to know what the function of the opthalmoscope was and why the doctor would want to look into his eyes with it. He was not satisfied and would not let the examination continue until the doctors had given him a rather lengthy explanation—even though he was obviously in no condition to absorb or appreciate the explanation given. As time wore on, however, despite increasing doses of phenothiazines, he became increasingly tense and agitated, and began to break out into angry shouting tirades. He also began to threaten other patients and staff with physical violence so that it became necessary to restrain him and restrict his activities. He seemed to quiet down on high doses of phenothiazines, but continued to have difficulty in restraining and controlling his angry impulses. 弗雷德一开始还算配合，尽管他有妄想和成见。即便如此，在检查的过程中，他还是会不时地提出专横的要求，要求对他提出的问题作出令他满意的回答。他的态度是怀疑和不信任。例如，他要求知道眼检镜的功能是什么，为什么医生要用它来观察他的眼睛。他不满意，直到医生给了他一个相当长的解释，他才让检查继续进行——尽管他显然没有能力接受或欣赏医生的解释。然而，随着时间的推移，尽管服用了越来越多的吩噻嗪，他却变得越来越紧张和激动，并开始愤怒地大喊大叫。他还开始用身体暴力威胁其他病人和工作人员，因此有必要约束他并限制他的活动。服用大剂量的吩噻嗪后，他似乎平静下来了，但仍然难以抑制和控制自己的愤怒冲动。 This was particularly true in the ward community meetings. In these meetings, it was the custom for matters of general concern to the patients to be discussed, but Fred seemed to respond to them as though they were political gatherings that he felt it necessary to harangue and exhort politically. On one such occasion, he jumped up in the middle of the meeting and interrupted the proceedings with an impassioned, intensely angry, and provocative tirade which had to do with the violation of patients' rights by the establishment and by the hospital, the staff and doctors, and an exhortation to the patients to revolt and take over the hospital. It was delivered in an intensely furious, angry, foot-stomping, shouting tirade that wound up with the patient throwing a chair on the floor and breaking it. This behavior was obviously very disruptive, and Fred had to be removed from the meeting—with, of course, a physical struggle to accomplish this. Gradually, as the medication took hold, he began to quiet down and to gain some better degree of control over his behavior, although the delusional content of his thought and the loosened and tangential quality of his thought processes remained disorganized for several weeks. 在病房社区会议上尤其如此。在这些会议上，讨论病人普遍关心的问题是一种习惯，但弗雷德似乎对这些会议的反应就像政治集会一样，他觉得有必要在政治上进行长谈和劝告。有一次，他在会议进行到一半时突然站起来，用一段热情洋溢的、极其愤怒的、挑衅性的长篇大论打断了会议的进行，这篇长篇大论是关于当局、医院、工作人员和医生侵犯了病人的权利，并劝告病人反抗并接管医院。这是一种含有强烈暴怒、愤怒、跺脚、大喊大叫的长篇大论，最后患者把一把椅子扔到地板上，把它打碎了。这种行为显然非常具有破坏性，弗雷德必须被赶出会场——当然，要做到这一点，得付出身体上的努力。渐渐地，随着药物开始起作用，他开始安静下来，并能够更好地控制自己的行为，尽管他的思想内容仍然充满妄想，思维过程仍然散漫且离题，这种状态持续了几周。