Depression 抑郁 As these resistances were gradually worked through, Gloria's provocative struggles with the staff diminished. She became more cooperative and was able to settle into the ward routine in a relatively comfortable manner. As she relinquished her paranoid struggles, however, she entered into a deeper and deeper depression. Over the course of several months she became increasingly depressed. Whole therapy hours would be spent in anguished and tearful silence. She felt herself to be evil, degraded, worthless, and totally useless. She felt that she was completely unworthy of any love, that she was without value or any redeeming quality. She felt sad and quite anxious. She spoke repeatedly during this period of her sense of inner hopelessness and despair. She felt as though she were in a dark pit and that there was no way out of it. She was doomed to spend the whole of her life in it. There was no glimmer of hope. She began to have thoughts that her father and mother and sisters were going to die. She developed a delusional conviction that her father would have to die because—as she said—he was the only one in the family who had not suffered. After his death, she was convinced that the anguish that enveloped her and the torments that had plagued her family would come to an end. She saw it almost as an expiatory sacrifice to the gods. 随着这些抵抗逐渐被克服，格洛丽亚与工作人员之间的挑衅性斗争减少了。她变得更加合作，能够以一种相对舒适的方式适应病房的日常生活。然而，当她放弃偏执的挣扎时，她陷入了越来越深的抑郁。几个月后，她变得越来越沮丧。整个治疗时间将在痛苦和含泪的沉默中度过。她觉得自己是邪恶的，堕落的，无价值的，完全无用的。她觉得自己完全不配得到任何爱，她没有价值，没有任何可取之处。她感到悲伤和焦虑。在她内心感到无望和绝望的这段时间里，她反复地说着话。她觉得自己好像在一个黑暗的坑里，没有出路。她注定要在里面度过她的一生。没有一丝希望的微弱之光。她开始想到她的父亲、母亲和姐妹们都要死了。她产生了一种妄想性的信念，认为她的父亲将会死去，因为——正如她所说——他是家里唯一没有遭受痛苦的人。他死后，她确信，笼罩着她的痛苦和折磨她的家庭的折磨将会结束。她几乎把它看作是对诸神的赎罪祭。 As her depression deepened she became increasingly suicidal. She thought about it, talked about it increasingly in her therapy hours, and even dreamed about it. Her dreams—infrequently reported—were overloaded with themes of death, murderous attacks, violent accidents, and suicide. She seemed to walk in a world in which she was wrapped in a shroud of death. In the previous phase of her treatment, her provocative rage had challenged and confronted the staff and me. So too, her intense depression and despair challenged us once again, but in a more profound and difficult way. The staff made heroic efforts to maintain contact with her and to engage her in a variety of ways. This was extremely difficult since Gloria tended to isolate herself and withdraw from any contacts. It was difficult to talk with her since she was almost always tearful and morose. She was a painful person to be with, but the continuing effort to reach her and sustain communicationwas essential. Her suicidal preoccupations made it necessary also to keep ourselves as informed as possible of her state of mind. At several points the risk of suicide was felt to be very great and she had to be watched closely. She came close to a suicidal attempt on several occasions—saving pills, hiding razor blades, etc.—but on none of these occasions did she actually come to the point of making the intended attempt. 随着她的抑郁加深，她越来越想自杀。她思考这个问题，在她的治疗时间里越来越多地谈论这个问题，甚至梦到了这个问题。她的梦——很少被报告——充斥着死亡、杀人袭击、暴力事故和自杀的主题。她似乎走在一个世界里，她被裹在死亡的裹尸布里。在她接受治疗的前一阶段，她那挑衅性的愤怒挑战了工作人员和我。同样，她强烈的抑郁和绝望再次挑战着我们，但是以一种更深刻、更艰难的方式。工作人员作出了英勇的努力，与她保持联系，并以各种方式与她接触。这是非常困难的，因为格洛丽亚往往孤立自己，不与任何人接触。和她说话很困难，因为她几乎总是泪流满面，郁郁寡欢。和她在一起很痛苦，但必须不断努力与她取得联系并保持沟通。她的自杀倾向也使我们有必要尽可能地了解她的精神状态。有几次自杀的危险被认为是非常大的，她必须被密切监视。有几次她差点想自杀，比如吃药、藏剃须刀片等等，但她都没有真正达到想要自杀的地步。 Therapy with Gloria during this phase was difficult. She would come into my office, sit down, and start crying, sometimes for a whole hour. Sometimes she would seem lost in thought for long periods of time; she would sit with her head down or staring out the window, apparently oblivious to me and the world around her. My strategy was to allow her to bear the pain and the anguish—and to be simply there with her during the bearing of it. When she expressed her feelings of pain and anguish,I attempted nothing more than acknowledging her feelings, emphasizing only that they were feelings and that they must be very hard for her to bear. Actually her intense depression made the treatment difficult for me as well. The long silences, Gloria's lack of responsiveness, the marked blocking and retardation of her thought processes, and her own painful feelings made her therapy hours almost intolerable. During the long silences, I would occasionally offer her comments or leading questions or gentle attempts of many sorts to get the ball rolling a little bit. Sometimes she would respond to these initiatives, but often she would not. I found myself working very hard in the therapy to keep anything going. I also found myself resenting the fact that she made me work so hard. 在这个阶段与格洛丽亚的治疗是困难的。她会走进我的办公室，坐下来，开始哭，有时哭上整整一个小时。有时她似乎会陷入沉思很长一段时间;她会低着头坐着，或者盯着窗外，显然对我和她周围的世界视而不见。我的策略是让她忍受痛苦和苦闷，并在她忍受的时候陪在她身边。当她表达她的痛苦和苦闷时，我只是承认她的感受，只强调那是一种感受，她一定很难忍受。事实上，她的严重抑郁症也让我的治疗变得很困难。格洛丽亚长时间的沉默、缺乏反应、明显受阻和迟缓的思维过程，以及她自己的痛苦感觉，使她的治疗时间几乎无法忍受。在长时间的沉默中，我偶尔会给她一些意见或引导问题，或者是各种各样的温和尝试，让谈话开始。有时她会回应这些倡议，但通常不会。我发现自己在治疗过程中非常努力，以保持一切正常。我还发现自己对她让我如此努力工作感到不满。 I shared this feeling with her, and it came as a revelation to her that she could have that effect on me. The discussion of her own role in psychotherapy seemed helpful in that it became clearer to her that what was in question was not unquestioning submission to therapy, but that she was indeed an active participant and that if we were to get anywhere in her treatment it would require her working at it too. Somehow we passed through the deepest trough in her depression—or so it seemed—and little by little the intense depressive affect seemed to wane and recede. She seemed to gain slowly in energy and responsiveness. I was wary at this juncture and felt the need to be cautious about any suicidal intent. The frequency with which depressed patients commit suicide while apparently emerging from the deepest part of a depression is well known. But there were no mishaps; Gloria seemed to make steady progress in inching her way out of the pit of her depression. 我和她有同样的感觉，这对她来说是一个启示，她可以对我产生这样的影响。对她在心理治疗中角色的讨论似乎有用,在这种讨论中，有件事情对她变得清晰,那就是问题不是绝对的服从治疗,而是她其实是一个主动参与者,如果我们在治疗中想获得什么效果，必须有她的配合。不知怎的，我们度过了她抑郁时最深的低谷——至少表面上是这样——那种强烈的抑郁情绪似乎一点一点地消退了。她似乎慢慢恢复了精力和反应能力。我在这个节骨眼上很谨慎，觉得有必要对任何自杀意图保持谨慎。抑郁症患者在明显从最严重的抑郁状态中解脱出来后自杀的频率是众所周知的。不过没有什么意外;格洛丽亚似乎在一点点地走出抑郁的深渊方面取得了稳步的进展。 As the depression faded, Gloria was increasingly able to spend more and more time outside the hospital. She began spending nights and then weekends at home. As her capacity to function progressed, it became apparent that she was less in need of the hospital. The question then arose as to where she would go when she left. This remained a focus of argument and conflict in the family for months; it was a question around which a number of significant family issues were activated (but the discussion of these issues is better left for our consideration of family dynamics). 随着抑郁的消退，格洛丽亚越来越有能力在医院外呆上越来越多的时间。她开始晚上，然后周末都呆在家里。随着她身体机能的发展，她对医院的需求明显减少了。于是问题就来了，她离开时要去哪里。这几个月来一直是家庭内部争论和冲突的焦点;这是一个引起许多重大家庭问题的问题(但对这些问题的讨论最好留给我们对家庭动力学的思考)。 Gloria finally resolved many of the questions by getting a job on her own initiative. She decided that she would live at home with her parents. The pros and cons and alternatives were discussed in a seemingly endlessand repetitious fashion. The basic issue was one of dependency. For Gloria to go back home was equivalent to reestablishing and reasserting her dependence on her parents and her reluctance to stand on her own feet and face the world. Further, to be dependent on her parents meant to submit to them, to accept their standards and opinions, to live according to their desires and wishes, and more importantly to deny and stifle any wishes, desires, or inclinations of her own. It seemed in many respects a move toward greater infantilization, but it was not simply that, and there were compensating factors in other directions. Gloria was able to obtain a rather responsible job at a good salary. Under these terms she left the hospital and continued her therapy as an out-patient. 格洛丽亚终于通过主动找了份工作解决了这些问题。她决定和父母住在一起。对利弊和替代方案的讨论似乎没完没了、周而复始。基本问题是依赖性。对格洛丽亚来说，回家等于重新建立和重申她对父母的依赖，以及她不愿自立面对世界。此外，依赖父母意味着服从他们，接受他们的标准和意见，按照他们的期待和愿望生活，更重要的是否认和扼杀她自己的任何愿望、期待或倾向。从很多方面来看，这似乎是朝着更大程度的“婴儿化”迈出的一步，但并不仅仅是这样，还有其他方面的补偿因素。格洛丽亚能找到一份相当需要责任心的工作，薪水也不错。在这些条件下，她离开了医院，继续她的门诊治疗。