Tragic Course 悲惨历程 Fred's depression was a prominent feature of his therapy. After his hospitalization and his relatively rapid emergence from his acute psychosis, he became increasingly depressed. He was apathetic and neurasthenic for a period of several weeks. He then seemed to mobilize himself and made struggling efforts to pull himself out of the doldrums and get himself moving. He could not altogether leave the depression behind. It clung to him and remained a more or less permanent feature of his pathology, interrupted only by angry outbursts of varying duration. In the depths of this depression, his feelings of hopelessness, guilt, shame, and self-devaluation were intense. He managed to relieve these intense feelings only by a manic immersion in external activities, particularly in the political and organizational activity related to student organizations and groups. This activity served to help him escape the depressive affects that tortured him so, and also gave him some basis for sustaining his faltering self-esteem. The paranoid thoughts, however, were never far away. When the sadness became too painful, he would begin to feel that people were looking at him, and that they could see that he was weird or crazy. How, he bemoaned, could he ever have any self-respect or self-esteem with such thoughts in his head? In such contexts—as we have already noted—the concerns about his incest, his associated feelings of worthlessness and guilt, and his paranoid fears that people would know about it would overwhelm him. 弗雷德的抑郁是他治疗过程中的一个突出特征。在他住院并从急性精神病中相对较快地康复后，他变得越来越抑郁。他有好几周都显得冷漠和神经衰弱。然后他似乎开始振作起来，努力摆脱困境，让自己行动起来。他不能完全摆脱抑郁。它依附着他，成为他病理学中或多或少的一个永久特征，只有持续时间不同的愤怒爆发才能打断它。在这种抑郁的深处，他的绝望、内疚、羞耻和自我贬低的感觉非常强烈。他设法通过狂热地投身于外部活动，特别是与学生组织和团体有关的政治和组织活动，来缓解这些强烈的感情。这种活动帮助他逃离了折磨他的抑郁情绪，也为他维持摇摇欲坠的自尊心提供了一些基础。然而，偏执的想法从未远离。当悲伤变得太痛苦时，他会开始觉得人们在看着他，而且他们能看出他很奇怪或疯了。他哀叹道，他脑子里有这样的想法，怎么可能会有自敬或自尊呢？在这样的背景下——正如我们已经注意到的——他对乱伦的担忧、他由此产生的无价值感和内疚感，以及他偏执的恐惧（担心人们会知道这件事）会将他淹没。 What I am describing in these pages is a tragic case. Fred was never able to unravel these tormenting elements. He clung stubbornly to his convictions, his resentments, his bitterness, and his anger. On countless occasions he made it clear that he would not forgive himself for the crimes of the past—particularly the incest with his mother—and moreover that he would not forgive his parents for what they had done to him. No less could he find any room for tempering his anger and resentment against the forces of evil that permeated his view of society and its institutions. He could recognize the elements of displacement from his parents and he could appreciate the intensity and infantility of his rage, but he could not give them up in any manner. He was severely distressed by the fact that these resentments played such a role in his life, but he could not surrender them. To do so in any degree was to him a betrayal of all that he had embraced and committed himself to: it meant to abandon his revolutionary convictions and his intense hatred of all authority in any of its forms. He saw himself as a revolutionary, and his continuing rage was essential to that posture—and, I believe, to the preservation of his own inner sense of identity. The therapeutic process never really had a chance. 我在这些页面中描述的是一个悲剧性的案例。弗雷德永远无法解开这些折磨人的元素。他固执地坚持自己的信念、怨恨、痛苦和愤怒。在无数场合，他明确表示，他不会原谅自己过去的罪行——尤其是与他母亲的乱伦——而且，他也不会原谅他的父母对他所做的一切。他也不可能找到任何缓和他对他眼里社会及其机构中邪恶力量的愤怒和怨恨的空间。他能认识到从父母那里置换过来的元素，也能理解自己愤怒的强烈和幼稚，但他无法以任何方式放弃它们。这些怨恨在他的生活中扮演了如此重要的角色，这让他感到非常痛苦，但他无法摆脱它们。在任何程度上这样做，都是对他所拥抱和承诺的一切的背叛：这意味着放弃他的革命信念和对一切形式权威的强烈仇恨。他把自己看作是一个革命者，而他持续的愤怒对这一立场至关重要——我相信，这对他保持自己内心的认同感也至关重要。治疗过程从来没有真正的机会。 The manner in which the treatment process and my association with this young man came to a close augured ominously for his future course. After almost three years of groping, stumbling, on-and-off, ambivalent therapy, Fred went to visit some friends in another part of the country. There he took some mescaline, in the face of the concern and opposition of his friends. He became disorganized and bizarre in his behavior. He was finally picked up again by the police and committed to the state hospital in that locality. He was at that point as agitated, uncontrolled, paranoid and psychotic as he had been as he had been when he had entered our hospital three years before. 治疗过程以及我与这个年轻人的联系 结束的方式，对他的未来预示着不祥。经过近三年的摸索、跌跌撞撞、断断续续、矛盾重重的治疗，弗雷德去了国家的另一个地方拜访一些朋友。在那里，他不顾朋友们的担心和反对，服用了一些麦斯卡林[一种致幻剂]。他的行为变得杂乱无章，古怪异常。最后，警察再次把他带走，送进了当地的州立医院。那时，他和三年前进入我们医院时一样激动、失控、偏执和精神错乱。