Vicissitudes of Aggression 攻击的变迁 She was extremely sensitive to the slightest innuendos or feelings. This was particularly true of any anger or hostility in people around her. It was particularly true in the therapeutic relationship. She often provoked feelings of impatience, anger, frustration, and irritation in me. She responded to such feelings in me, sometimes even before I was aware of them myself. I found that the most productive way to deal with such feelings was to communicate them or admit them to her, and then try to discuss the reasons for my feeling as I did and what role she might have played in making me feel that way. This sort of sensitivity is substantially an extension of the usual paranoid hypersensitivity and hyperawareness. The paranoid defense requires constant vigilance and constant scanning of the environment to detect possible sources of hostility and harm. 她对最轻微的含沙射影或感情极为敏感。在她周围的人的愤怒或敌意中尤其如此。在治疗关系中尤其如此。她常常使我感到不耐烦、生气、沮丧和恼怒。有时甚至在我自己意识到之前，她就对我的这种感觉做出了反应。我发现处理这种感觉最有效的方法是与她交流或承认，然后试着讨论我产生这种感觉的原因，以及她在让我产生这种感觉的过程中可能扮演了什么角色。这种敏感本质上是偏执超敏感和超意识的延伸。偏执防御需要持续的警惕和对环境的持续扫描，以发现可能的敌意和伤害来源。 Once again Gloria's experience calls our attention to the frequent occurrence of phobias and nightmares in paranoid patients. Most typically her fears had a decidedly paranoid cast—someone would kill her, or rape her, or, on a more moderate scale, people would criticize, ridicule, humiliate, or embarrass her. Such identifiably paranoid anxieties would often shade over into more generally phobic concerns, and the line was often difficult to draw between them. She would be terrified at the idea of riding on buses or streetcars. At times this was linked with her fear that someone might try to kill her, but often as not the fear could not be linked with anything more specific than that there might be an accident. She was afraid of streetcars particularly in that they went underground as part of their route and Gloria was frightened of being underground and frightened of being in the dark. Such phobic concerns formed the substance of her nightmares. In them she was time and again again threatened with death—men chasing her with knives to murder her(symbolic?), people trying to run her down with automobiles, etc, etc. These dreams were often more active during periods in which clinically her fears had diminished somewhat and she was functioning on a somewhat less impaired level. It seemed reasonable to me to assume that these anxiety dreams were functioning in some degree as substitute for her psychotic symptoms. 格洛丽亚的经历再次提醒我们注意偏执患者的恐惧症和噩梦的频繁发生。最典型的是，她的恐惧带有明显的偏执——有人会杀了她，或者强奸她，或者，在更温和的范围内，人们会批评、嘲笑、羞辱她，或者让她难堪。这种明显的偏执焦虑往往会逐渐演变成更普遍的恐惧症，而且往往很难在两者之间划清界限。她一想到坐公共汽车或有轨电车就会感到害怕。有时，这与她害怕有人试图杀死她有关，但通常情况下，这种恐惧与任何比可能发生意外更具体的事情都没有关系。她害怕有轨电车，尤其是因为电车是在地下行驶的，而格洛里亚害怕在地下行驶，害怕在黑暗中行驶。这种恐惧的担忧构成了她噩梦的主旨。在这些梦中，她一次又一次地受到死亡威胁——拿刀追赶她的人要杀了她(象征性的?)这些梦通常在她的临床恐惧有所减轻和她的功能受损程度有所减轻的时期更为活跃。在我看来，假设这些焦虑的梦在某种程度上代替了她的精神症状似乎是合理的。