In the Hospital 在医院 I would like to turn now to my own experience with Gloria, an experience which has stretched itself out over several years. It has been a varied experience, including the period of her hospitalization, which lasted over sixteen months, several more years of weekly psychotherapy, and a total of three years of weekly meetings with Gloria and her family. When I first met Gloria she was in a state of utter panic and terror. She had just learned that she was to be admitted to the hospital, and the prospect terrified her. It was my responsibility to see her through the admitting procedures and get her settled on the ward. In the face of her panic, I tried to be calm, patient, and firm. As soon as her parents had left, she seemed to respond to this approach and became more compliant and cooperative with the admission procedures. She balked at only one point in all the questioning and examining that was required, when I tried to examine her breasts aspart of the physical examination. She refused to allow this part of the examination. She also refused a pelvic examination. I respected her wish and her fear. 现在我想谈谈我自己与格洛里亚的经历，这段经历已经延续了好几年。这是一次不同寻常的经历，包括她住院的那段时间(持续了16个多月)，几年时间的每周心理治疗，三年时间的每周与格洛丽亚和她的家人见面。当我第一次见到格洛丽亚时，她正处于极度的恐慌和恐惧之中。她刚刚得知自己要住院了，想到这一前景，她吓坏了。我有责任帮助她完成入院手续，让她住进病房。面对她的惊慌失措，我努力保持镇静、耐心和坚定。她的父母一离开，她似乎就对这种做法做出了回应，对入院手续变得更加顺从和配合。在所有的提问和检查中，她只在一点上退缩了，即当我试图把检查她的胸部作为体检的一部分时。她拒绝在体检中做这部分。她还拒绝接受盆腔检查。我尊重她的愿望和恐惧。 On the ward she remained quiet and made little effort to communicate with other patients. Little by little, however, the picture began to change. Over the course of several weeks she became more and more uncooperative. My original hope was that a brief hospitalization would take enough pressure off Gloria and the family to allow a more effective treatment regimen to be set up, so that treatment could continue on an outpatient basis. The hope proved futile. Gloria increasingly engaged herself in struggles with the staff. She became increasingly uncooperative. She would not do anything that was requested of her, she would not do any of the ward jobs that were assigned to her, and she began to stay in bed in the mornings and sleep until almost noontime. She would not engage herself in any of the therapeutic activities offered by the staff. As this pattern of behavior developed, Gloria and I would discuss it in her therapy sessions. Her attitude was that she had been railroaded into the hospital and she would not cooperate in anything that went on. She expressed a great deal of anger at her parents for putting her in the hospital and a great deal of anger toward me for keeping her there. She also ventilated a considerable amount of ire at the staff for trying to make her do things that she didn't want to do. 在病房里，她保持安静，几乎没有努力与其他病人交流。然而，情况开始一点一点地发生变化。几周后，她变得越来越不合作了。我最初的希望是，短暂的住院治疗能给格洛里亚和她的家人减轻足够的压力，让他们能够建立一个更有效的治疗方案，这样就可以在门诊的基础上继续治疗。事实证明，这种希望是徒劳的。格洛丽亚越来越多地参与到与工作人员的斗争中。她变得越来越不合作。她不会做任何要求她做的事情，也不会做任何分配给她的病房工作，她每天早上都要躺在床上，一直睡到中午。她不会参与工作人员提供的任何治疗活动。随着这种行为模式的发展，格洛丽亚和我将在她的治疗过程中讨论它。她的态度是，她是被强行送进医院的，无论发生什么事，她都不会配合。她对父母把她送进医院表示了极大的愤怒，对我把她留在医院表示了极大的愤怒。她还对那些试图让她做自己不想做的事情的工作人员发泄了相当大的愤怒。 Her behavior became increasingly provocative. She would deliberately flaunt ward regulations. The staff responded by imposing certain restrictive and punitive measures. It became clear that she was provoking these responses from the staff and that the whole process had an increasingly paranoid flavor to it. The inevitable escalation took place. She became disruptive and physically assaultive. The staff was forced to physically restrain her at times. Gloria saw this as an unprovoked assault on their part, and was unable to see her own role in provoking this sort of response. 她的行为变得越来越挑衅。她会故意无视病房的规章制度。工作人员的反应是采取某些限制性和惩罚性措施。很明显，她是在激发工作人员的这些反应，整个过程越来越带有偏执的味道。不可避免的升级发生了。她变得具有破坏性和身体攻击性。工作人员有时被迫在身体上约束她。格洛丽亚认为这是他们无端的攻击，她不认为自己在激起这种反应中扮演了什么角色。 An important area in which this sort of struggle took place was over her staying in bed long hours in the morning. One of the ward regulations was that patients were to rise by a certain hour in the morning. Gloria ignored this regulation. The staff tried urging, coaxing, persuasion, and a variety of other approaches. Other patients in the ward began to feel resentful and angry about Gloria's behavior. It was clear to the staff that Gloria was trying to re-create on the ward the kind of conflict and struggle that she had left behind her at home. Finally, in desperation one morning, the staff decided to roll her out of bed. The effect of this was to precipitate Gloria's rage and she became severely paranoid. She saw this action of the staff as a deliberate and malicious attack. She was minding her own business and not hurting anyone, and they came along and for no reason threw her out of bed. The whole episode was a rehearsal of the episode at the family dinner table in which she became convinced that the family was out to kill her. Gloria similarly became convinced that the ward staff was out to kill her. 发生这种斗争的一个重要方面是她早晨在床上呆很长时间。病房的规定之一是病人必须在早晨某个时间起床。格洛丽亚无视这个规定。工作人员尝试了催促、哄骗、劝说和其他各种方法。病房里的其他病人开始对格洛丽亚的行为感到愤恨和愤怒。工作人员很清楚，格洛丽亚试图在病房里重现她留在家里的那种冲突和挣扎。最后，某天早上，在绝望中，工作人员决定把她从床上抱起来。这样做的结果是激起了格洛里亚的愤怒，她变得极度偏执。她认为工作人员的这种行为是蓄意和恶意的攻击。她只顾自己的事，没有伤害任何人，他们来了，无缘无故地把她从床上扔了下去。整个过程都是在家庭晚宴上那一幕的彩排，那次她确信家人要杀了她。格洛丽亚也同样确信病房的工作人员要杀了她。 I also decided that in view of her continuing and intensified paranoid symptoms medications were indicated. At first Gloria refused to take any medicines. I decided that any attempt to force the medication on her would only be playing into the same sort of game that we were anxious to avoid if possible. The nurses continued to offer her the medication on schedule, and Gloria continued to refuse it. Her reasons for doing so became a focus in therapy. She basically distrusted my medicine. She blamed me for the way she had been treated by the staff, and had to struggle with her paranoid concerns about me. She found it difficult to reconcile these with her more positive feeling toward me and with the fact that I treated her so kindly and patiently. She could not decide whether I was her benefactor or her enemy. Besides—and this played perhaps the dominant role in her thinking—if she took the medicine that would be to admit that she needed help, that she was indeed a patient, and that perhaps her parents had been right when they put her in the hospital. It took several months for these issues to be explored. From time to time Gloria would accept the medication from the nurses, but often when her ambivalence was high and her paranoid doubts activated she would refuse it. After several months she became more comfortable with the idea and began taking the medications regularly. 我还决定，鉴于她持续和加剧的偏执症状，表明需要用药。起初，格洛丽亚拒绝服用任何药物。我决定，任何试图强迫她服药的行为，只会让她陷入我们尽可能避免的那种游戏中。护士们继续按时给她提供药物，格洛丽亚继续拒绝。她这样做的原因成为治疗的焦点。她基本上不信任我的药。她因为工作人员对待她的方式而责备我，她不得不与她对我偏执的担忧作斗争。她发现很难把这些和她对我更积极的感情以及我对她如此友善和耐心的事实调和起来。她无法决定我是她的恩人还是敌人。此外——这可能在她的思维中起着主导作用——如果她吃药，那就意味着她承认自己需要帮助，承认自己确实是一个病人，承认她的父母把她送进医院时也许是对的。研究这些问题花了几个月的时间。格洛丽亚有时会接受护士的药物治疗，但通常当她的矛盾情绪高涨，偏执的怀疑情绪激活时，她会拒绝。几个月后，她对这个想法感到更舒服了，并开始按时服药。