The Emerging Psychosis 出现精神病 During this period she developed a variety of symptoms. She began to hear voices talking about her—when there was no one there. She began to have anxiety attacks, feeling cold, clammy, tense, and frightened. She described a number of visual illusions—everything seemed as though it were made out of gold, and things seemed smooth and round. Everything lookedsmall and distant. Her desk at work looked like a miniature. The people around her looked stiff and lifeless—like stick figures. She also described several depersonalization phenomena. At times she felt that she was part of the desk—she would feel cold and lifeless, like an inanimate object. She felt at times that her arms and legs were not attached to her body and that they didn't belong to her. She began to feel that her body was turned inside out and that she could not stand up straight. Her thinking became increasingly disorganized and bizarre, and her capacity to function at work completely deteriorated. One night she ran away from home in a panic, and this precipitated her first hospital admission. She was just twenty years old. 在此期间，她出现了各种症状。她开始听到有人在谈论她——当时那里一个人也没有。她开始焦虑不安，感到寒冷、潮湿、紧张和害怕。她描述了许多视觉上的错觉——所有的东西都好像是金子做的，而且看起来又光滑又圆。一切都显得那么渺小和遥远。她工作时的书桌看起来像一个微型模型。她周围的人看起来僵硬而毫无生气。她还描述了几种人格解体的现象。有时她觉得自己是桌子的一部分——她会感到寒冷和没有生命，就像一个没有生命的物体。她时常感到她的胳膊和腿没有连在她的身体上，也不属于她。她开始觉得自己的身体被翻了个底朝天，站不直了。她的思维变得越来越混乱和怪异，她在工作中的能力也完全退化了。一天晚上，她惊慌失措地离家出走，这使她第一次住进了医院。当时她才二十岁。 During this hospitalization Ann began treatment with a new doctor. She continued to see this doctor for a period of over two years, and formed an intense and highly eroticized transference with him. The intensity of this relationship was evidenced by the fact that after several months of treatment the doctor had to cancel one appointment. In response Ann ingested a bottle of Excedrin tablets and had to be rehospitalized. For some time, her symptoms had been primarily depressive. She had been quite apathetic and somewhat disorganized, but otherwise functioning reasonably well. She impressed several interviewers during this period as being neither psychotic nor paranoid, but as a case of chronic and acute depression of a more neurotic sort. During the hospitalization following this ingestion, however, her behavior became increasingly bizarre and her thought patterns—whileremaining quite depressed in content—became increasingly delusional. For example, she became somewhat friendly with an older male patient who subsequently died. Ann became quite depressed after this event, and complained that she could feel his coffin lying on top of her when she lay down. Then she began to feel that his coffin was inside her stomach. 在住院期间，安娜开始接受一位新医生的治疗。她在两年多的时间里继续看这位医生，对他形成了强烈的、高度色情化的移情。经过几个月的治疗，医生不得不取消一次预约，这证明了这种关系的强度。作为回应，安服用了一瓶埃克塞德林药片[止痛片，用于治疗偏头痛]，不得不再次住院治疗。一段时间以来，她的症状主要是抑郁。她一直相当冷漠，有点杂乱无章，但在其他方面运作得相当好。在此期间，她给几位访谈者留下的印象是，她既不是精神病患者，也不是偏执者，而是一种更神经质的慢性严重抑郁症患者。然而，在这之后的住院治疗中，她的行为变得越来越奇怪，她的思维模式——同时在内容上相当抑郁——变得越来越妄想。例如，她对一位后来去世的老年男性病人变得有些友好。这件事发生后，安娜变得非常沮丧，她抱怨说她躺下时能感觉到他的棺材躺在她身上。然后她开始觉得他的棺材在她的肚子里。 The impression that she gave at this stage of her ilness was one of severe depression—yet with occasional expressions of intense inner turmoil and distress. She was a sad and withdrawn figure on the ward. She complained of the fact that she was not going steady, that all of her friends were working or getting married and she could not, that she felt lifeless andhopeless and saw the world around her as inanimate. She was utterly confused about her own identity—not knowing who or what she was. She felt that there were no boundaries between herself and other people, or between herself and things near her. She continued to hear voices telling her she was no good, cheap, dirty, worthless. She talked about her fear of becoming a mental patient for the rest of her life, but felt helpless because she could do nothing about her mother who was always intruding in her life and trying to make her sick. 在她身体虚弱的这个阶段，她给人的印象是一种严重的抑郁——但偶尔也会表现出强烈的内心骚动和痛苦。她在病房里是一个忧郁、孤僻的人。她抱怨自己没有稳定下来，她所有的朋友都在工作或结婚，而她却不能，她感到毫无生气和希望，觉得周围的世界毫无生气。她对自己的身份完全感到困惑——不知道自己是谁，也不知道自己是什么。她觉得自己和别人之间没有界限，自己和身边的事物之间也没有界限。她不断听到有人说她不好，不值钱，肮脏，毫无价值。她谈到了她害怕成为一个精神病人度过余生，但感到无助，因为她对母亲无能为力，她的母亲总是闯入她的生活，试图让她生病。 Her behavior at this time became quite regressed. She became quite withdrawn, spent most of her time in a fantasy world—much of which had to do with eroticized fantasies about her therapist. She was quiet and kept to herself most of the time, but whenever approached by the staff or asked to do anything, she would become quite tearful and regressed. This behavior served only to anger the staff, who felt that she was manipulating them by her regressive behavior. Any request, even for the most minor task, was met by weeping and crying and complaints of helplessness and hopelessness. The staff responded with anger and guilt feelings, fearing that their requests were making her sicker. If she were confronted in any way or if any pressure were put on her by the staff or by other patients, she would become quite angry and frankly paranoid. She would become quite upset and tearfully complain of a plot against her, that the staff wanted to hurt her and that they were part of the Communist plot to ruin her mind and damage her for life. In this context, she was finally transferred to the ward for chronic female patients. She remained on that service for over a year. Finally she went home for a visit and did not return to the hospital. She continued to see her therapist on a weekly basis as an outpatient. 她在这个时候的行为变得相当倒退。她变得相当孤僻，大部分时间都在幻想世界中度过——其中大部分时间都与对她的治疗师的色情幻想有关。她很安静，大部分时间都是一个人呆着，但每当工作人员走近她，或要求她做任何事情时，她就会变得泪流满面，很沮丧。这种行为只会激怒工作人员，他们认为她的倒退行为是在操纵他们。任何要求，即使是最微小的任务，都会遭遇抽泣、哭泣以及对无助和绝望的抱怨。工作人员的反应是愤怒和内疚，担心他们的要求会让她病情加重。如果她遇到任何情况，如果工作人员或其他病人给她施加任何压力，她会变得非常愤怒，坦率地说，她会变得偏执。她会变得非常沮丧，泪流满面地抱怨有一个针对她的阴谋，说工作人员想要伤害她，说他们是共产主义阴谋的一部分，目的是要毁掉她的思想，毁掉她的一生。在这样的背景下，她最终被转到了慢性女性患者的病房。她在那个部门待了一年多。最后，她回家探视，没有回到医院。她继续以门诊病人的身份每周去看她的治疗师。 She continued to live at home—but she remained quite withdrawn, staying in her room, talking little, doing nothing. She continued to meet with her therapist until he was drafted into the armed services. This brought the treatment to a close. This was very upsetting to Ann, and subsequently she became more and more morose and depressed, spending long hours crying and moaning, sleeping most of the day, and finally beginning to slowly decompensate again. The situation at home again became increasingly difficult until finally the mother had Ann sent back to the hospital. When Ann got to the hospital she was quite disorganized, delusional, and angry. She complained about the loss of her therapist, angrily talking about how he rejected and jilted her "for other women." She called herself a cheap, lousy whore. "Whatever I do, my life won't change... The same lousy people, people like you, are making me into a criminal, like that fourteen-year-old girl, lying on the floor in the hospital, playing with herself... You and the Communists and the rest of the cheap psychiatrists are interfering in my life, trying to hurt me, making accusations, making me feel like an animal untill die..." 她继续住在家里，但仍然很孤僻，呆在自己的房间里，很少说话，什么也不做。她继续与她的治疗师见面，直到他应征入伍。这就结束了治疗。这让安娜非常沮丧，后来她变得越来越忧郁和沮丧，长时间地哭泣和呻吟，一天的大部分时间都在睡觉，最后又开始慢慢地解压。家里的情况再次变得越来越困难，直到安娜的母亲终于把安娜送回到了医院。当安娜到医院时，她很混乱，妄想，而且很生气。她抱怨失去了她的治疗师，愤怒地谈论他如何拒绝和抛弃她，“为了其他女人”。她自称是一个廉价的坏婊子。“无论我做什么，我的生活都不会改变……同样是这些讨厌的人，像你这样的人，正在把我变成一个罪犯，就像那个十四岁的女孩，躺在医院的地板上，自个儿玩……你和共产党人，还有其他那些卑鄙的精神病医生，正在干涉我的生活，想要伤害我，指责我，让我觉得自己像个动物，直到死去……” Ann's state of mind at this point was delusionally psychotic and frankly paranoid. She saw herself as extremely vulnerable and easily hurt. She saw others around her as hard, cynical, cruel, and specifically as having ulterior motives in all that they did. These motives were directed against her—they intended to hurt her, trying to cheapen her into a sexually perverted animal, trying to ruin her mind and make her crazy. She saw herself a victim of malignant forces and persons around her from which she could not escape. Along with this strikingly paranoid core of her illness, there was an overwhelming sense of defeat and despair. She thought little of herself and harbored deep feelings of worthlessness, inadequacy, helplessness, hopelessness. It was striking that her self-accusations and self-devaluing followed a pattern set by her mother. Her accusations against herself were the accusations that her mother had always brought against her, and which the mother continued to cast in Ann's face. 此时，安娜的精神状态是一种妄想型精神病和直白的偏执。她认为自己非常脆弱，很容易受伤。她认为她周围的人都是冷酷、愤世嫉俗、残忍的，尤其是他们所做的一切都别有用心。这些动机都是针对她的——他们想要伤害她，试图把她贬低成一个性堕落的动物，试图毁掉她的思想，让她发疯。她看到自己成了邪恶势力和周围人的牺牲品，无法逃脱。伴随着她疾病中令人吃惊的偏执，还有一种压倒一切的挫败感和绝望感。她不把自己放在心上，心里有一种深深的感觉，觉得自己没有价值，没有能力，没有办法，没有希望。令人吃惊的是，她的自我指责和自我贬低遵循了她母亲的模式。她对自己的指责是她母亲一直以来对她的指责，而且母亲还在不断地对安娜进行指责。 It should be noted that the unexpected loss of her doctor was anothertraumatic abandonment which precipitated her into acute psychotic decompensation. The loss re-created the abandonment she had experienced when she lost Bobby. The transference aspects of these involvements were apparent, as we shall see. 应该指出的是，她的医生的意外离开是另一种创伤性遗弃，使她陷入急性精神失代偿。让她重新体验了被罗伯特抛弃的感觉。这些事件的移情方面是显而易见的，我们将会看到。