The Issue of Autonomy 自主权问题 We have pointed out in any number of these cases that the issue of imperiled autonomy is one that is characteristic of the paranoid forms of pathology. Karen's autonomy was a threatened and fragile autonomy. But there would seem to be room for some distinctions to be made in discussing the question of diminished autonomy in cases such as these. There were indeed many respects in which Karen's ego-functions were intact and operated with a considerable degree of autonomy. There is certainly room for a distinction between autonomy which has its reference to ego-capacities and ego-functions, and the autonomy which has its primary reference to the self. It is the latter form of autonomy that shows itself to be significantly threatened in the present instance, and which shows itself to be decisively threatened in all the cases we have considered in this study. It is also the form of autonomy that received its most pregnant description at the hands of Erik Erikson. 我们已经指出，在这些案例中，自主权受到威胁的问题，是病理学偏执形式的特征之一。卡伦的自主权是一个受到威胁的脆弱的自主权。但是，在讨论诸如此类案例中自主权减少的问题时，似乎还有一些区别的余地。卡伦的自我功能在很多方面都是完整的，并且有相当程度的自主权。当然，在涉及自我能力和自我功能的自主权与主要涉及自体的自主权之间，是有区别的。在后一种形式的自主权，在当前案例中，表现出明显的受到威胁，而且在本研究所考虑的所有案例中，表现出决定性的受到威胁。埃里克•埃里克森对这种自主权形式的描述最为深刻。 If the distinction between ego-autonomy and self-autonomy has a legitimate place, the complexities of their interrelationship would seem to demand theoretical clarification. Certainly in the more distorted forms of paranoid functioning, in which autonomy is most severely threatened, there would seem to be ample room for the consideration of both modalities of impoverished autonomy. However there are other cases, such as the present one, in which the distinction may have some validity and clinical import. It is not clear that the paranoid mechanisms represent a simple case of drive-derivative influences invading the functioning of ego-capacities. What predominates the clinical picture in the present case is Karen's sense of threatened autonomy, sense of threat to her self as an autonomously functioning self. It is this aspect of her inner functioning which is closely related to the motifs of vulnerability and victimization that played such a significant role in her psychopathology. 如果自我自主权和自体自主权之间的区别有一个合理的空间，那么它们相互关系的复杂性似乎需要理论上的澄清。当然，在偏执功能更扭曲的形式中，自主权受到最严重的威胁，似乎有足够的空间来考虑耗尽了的自主权的两种形态。然而，在其他案例中，如目前的案例中，这种区分可能具有一定的有效性和临床意义。目前还不清楚偏执的机制是否代表驱力派生物影响侵入自我能力功能的简单情况。在这个病例中占主导地位的临床表现是卡伦的受威胁的自主性，对她作为一个自主运作自体的威胁。正是她内在功能的这一方面与脆弱和受害的主题密切相关，这一主题在她的精神病理学中扮演了如此重要的角色。 We do not have far to look in determining some of the sources of Karen's sense of threatened autonomy. An important influence was the continuing incursiveness and obsessive control exercised by her mother throughout the period of her development. The struggle that Karen engaged in with her mother was in its most central core dimension a struggle for autonomy. The struggle was joined from the very beginning and presumably reached a first level of intensity over the issues of anal control and regulation. Karen emerged in a development sense from that battle with an abiding sense of willfulness and stubbornness which serves as the hallmark of an imperiled autonomy. The campaign against her mother continued to be waged throughout aspects of her analysis. It was—simply put and in all essential aspects—a battle for the establishment and preservation of Karen's autonomy. Moreover, the battle was fought largely in anal terms. Anything that Karen did that stood in opposition to her mother's will had to be interpreted as an attack on mother. Thus when Karen decided to go to graduate school, or when she decided to live with her boyfriend and postponed her decision to marry, these were taken as having been done against her mother, rather than as autonomous and self-motivated decisions. 在确定卡伦自主权受威胁感觉的某些来源方面，我们不用看太多。一个重要的影响是，她的母亲在她的整个发展过程中施加的持续不断的侵入和强迫性控制。卡伦与母亲之间的斗争，其最核心的方面是争取自主权。这场斗争从最早就开始了，大概在肛门控制和管理问题上达到了第一个高度[就是小孩如厕训练]。从发展的意义上来说，卡伦从那场斗争中获得了一种持久的任性和固执的感觉，这是自主权岌岌可危的标志。针对她母亲的战役继续在她分析的各个方面展开。简单地说，这是一场为建立和维护卡伦自主权而进行的战斗。此外，这场战争在很大程度上是一场肛门战争。卡伦所做的任何违背母亲意愿的事情都必须被理解为对母亲的攻击。因此，当卡伦决定去读研究生，或者当她决定和男友住在一起，推迟结婚的决定时，这些都被认为是对她母亲的反对，而不是自主和自我激发的决定[就是为了跟人作对而作对]。