Compliance 顺从 Bob's increasing ambivalence created a problem for him in therapy. He felt that he needed and depended on the therapist but at the same time he felt that he could not express his anger at the latter. If he were to do that, he would run the risk of rejection and loss of the therapist, and then he would be lost. The repeated attempts of his father to interfere with his treatment, to transfer him from the hospital, to change his therapist were severely threatening to Bob from one point of view, but they also played into his ambivalence from another point of view. They also intensified Bob's rage at his father for running his life, something that Bob had always resented, even as he complied with his father's wishes out of his need to please and gain the parent's approval. The process became one of choosing between his father and his therapist. It was extremely difficult for him to follow the demands of therapy and to resist the pressure from his father. In the measure that he was able to do so and to thus remain in treatment, the threat of confronting the father and of expressing his rage at him drew closer and, as it did, Bob became all the more terrified of it. 鲍勃日益增长的矛盾心理给他的治疗带来了麻烦。他觉得他需要和依赖治疗师，但同时他又觉得他无法表达他对后者的愤怒。如果他这么做，他就会冒着被拒绝和失去治疗师的风险，然后他就会迷失。他的父亲多次试图干扰他的治疗，把他从医院转走，更换他的治疗师，从某种角度来说，这对鲍勃来说是严重的威胁，但从另一个角度来看，这也加剧了他的矛盾心理。他们也加剧了鲍勃对父亲掌控他生活的愤怒，这是鲍勃一直憎恨的，即使他出于取悦和获得父母认可的需要而遵从父亲的意愿。这个过程变成了在他父亲和心理医生之间做出选择的过程。他很难按照治疗的要求去做，也很难抗拒来自父亲的压力。在他能够这样做并因此继续接受治疗的情况下，面对父亲以及向他表达愤怒的威胁越来越近了，鲍勃也因此变得更加害怕。 Bob had always been extremely compliant to his parents' wishes, but as his therapy made clear, not without considerable resentment and bitterness toward them—and especially toward his father. There was only one exception to this that stood out in his history. When he went to college Bob followed a premed course with the intention of entering medical school. It was not clear that this was really Bob's wish—neither was it clear that it was not. What was clear was that his parents held this up to him from very early in his life as a desired goal and ambition. Toward the end of his college career, he applied to a number of medical schools but was not accepted. This was a severe disappointment to him. He reacted with anger toward his parents and bitterly renounced their demands and expectations. He described himself as wild, confused, and enraged. There was a family argument in which Bob bitterly rejected their demands—particularly their professional and religious demands. His father wanted him to be a doctor and his mother wanted him to be an observant (and good) Jewish boy. Bob stormed out of the house and went to New York—where he lived for a year and did a year of graduate work. 鲍勃一直非常顺从他父母的意愿，但正如他的治疗表明的那样，他对父母——尤其是他的父亲——并非没有相当大的怨恨和痛苦。在他的历史中只有一个例外。鲍勃上大学时参加了医学预科课程，目的是进入医学院。不清楚这是否真的是鲍勃的意愿，也不清楚这是否不是鲍勃的意愿。很明显，在他很小的时候，他的父母就把这当作一个理想的目标和抱负。大学生涯接近尾声时，他申请了多所医学院，但都没有被录取。这使他非常失望。他对父母表现出愤怒，痛苦地放弃了他们的要求和期望。他把自己描述为狂野、困惑和愤怒。在一次家庭争吵中，鲍勃严厉地拒绝了他们的要求，尤其是他们的职业和宗教要求。他的父亲希望他成为一名医生，他的母亲希望他成为一名严守教规(而且好)的犹太男孩。鲍勃怒气冲冲地走出家门，去了纽约——在那里他住了一年，并完成了一年的研究生学业。 It is not at all clear what was going on in this episode. Bob's behavior was rather wild and disorganized, and one can wonder whether what was in process then was not a form of schizophrenic decompensation. In any case, the disruption was transient and there was a reconciliation with his parents. Bob himself did not know what he wanted to do, and it was in response to his father's suggestion that he applied for and was accepted in dental school. This factor became significant in his later course of treatment. Accepting father's suggestion and setting himself on the course of a dental career meant two important things to Bob. It meant first of all submission to his father's wishes, and at the same time, it meant an admission of his inadequacy, since he had to resign the goal of a career in medicine. Even in trying to satisfy his father's present wish, he was trying to satisfy a second-best wish. Even success in this new line, therefore, could not avoid the stigma of failure. 我们完全不清楚这一事件发生了什么。鲍勃的行为相当疯狂和混乱，人们会怀疑当时正在进行的事情是不是精神分裂症失代偿的一种形式。无论如何，这种分裂是短暂的，他与父母和解了。鲍勃自己也不知道自己想做什么，正是在他父亲的建议下，他申请了牙科学校，并被录取了。这一因素在他后来的治疗过程中变得非常重要。接受父亲的建议并开始做牙医对鲍勃来说有两件重要的事。这意味着首先要服从父亲的意愿，同时也意味着承认自己的能力不足，因为他不得不放弃从医的目标。即使在努力满足他父亲目前的愿望时，他也不过是在努力满足一个次好的愿望。因此，即使在这一新领域取得成功，也无法避免失败的污名。 This became an important issue in Bob's treatment. After his acute break, he was able to finish his residency training. Then he was confronted with a decision whether to set up a practice in oral surgery or not. For a time he worked on a part-time basis in another surgeon's office, just enough to support himself. And he agonized over the decision. He was unable to make it—unable to commit himself to that course of action. He endlessly reviewed the possible alternatives, the difficulties, the locale, the opportunities—all in an obvious attempt to avoid coming to any conclusion. This process went on for months. As he was trying to make this decision—or trying not to make it—he became more and more depressed and withdrawn. Gradually he developed suicidal ideas which became sufficiently intense to warrant rehospitalization. He came back into the hospital and remained there for more than a year. 这在鲍勃的治疗中成为一个重要问题。在他的急性发作后，他能够完成住院医师培训。然后他面临着一个决定，是否要在口腔外科开设一家诊所。有一段时间，他在另一家外科医生的办公室兼职，只够养活自己。他为这个决定感到痛苦。他不能这样做——不能把自己投入到那种行动中去。他无休止地审视着可能的选择、困难、地点和机会——所有这一切显然都是为了避免得出任何结论。这个过程持续了好几个月。当他试着做这个决定——或者试着不做这个决定时，他变得越来越沮丧和孤僻。渐渐地，他产生了自杀的念头，这种念头强烈到足以使他再次住院。他回到医院，在那里住了一年多。 Bob's inability to make this important decision was multiply determined. It was from one point of view a decision to commit himself to a decisive life course—a career decision. That meant becoming adult, mature, taking responsibility. He felt himself unready, unprepared, incapable of accepting the responsibility for caring for patients, even though he had been able to perform professional duties in the supportive environment of the training program. He realized that he would have to make and take responsibility for important decisions regarding the care and treatment of his patients, and he did not feel himself man enough to do that. He made excuses of many kinds. One of the major ones was that he didn't know enough. With a sort of obsessional perfectionism he felt that he should know everything, and that if he didn't know everything he knew nothing. On occasions when he had to ask for a consult from the medical or other surgical services in the hospital, he felt inadequate because he didn't know as much about the consult's specialty as the consult. When the grandiosity and omnipotence of this extremely narcissistic position was pointed out to him, he responded that only when he knew everything could he feel secure about treating patients. He concluded that as long as he didn't know everything he was still inadequate. Moreover, he clung stubbornly to his conviction that his inability to learn everything was proof of his inadequacy and of his unsuitability for practicing oral surgery. 鲍勃不能做出这个重要的决定是多重原因造成的。从某种意义上说，这是一个决定，把自己投入到一个决定性的人生道路上——一个事业上的决定。这意味着长大成人，成熟，承担责任。他觉得自己没有准备好，没有准备好，无法承担照顾病人的责任，即使他能够在培训项目的支持性环境中履行专业职责。他意识到，他必须对有关病人的护理和治疗作出重要决定并承担责任，而他觉得自己没有足够的男子气概去做这件事。他找了各种各样的借口。其中一个主要原因是他知道的不够多。带着一种强迫性的完美主义，他觉得自己应该无所不知，如果他不知道一切，他就什么都不知道。有时，当他不得不向医院的医疗或其他外科服务部门咨询时，他感到力不从心，因为他对会诊人员的专业了解不如会诊人员多。当有人向他指出这个极度自恋的心位的夸大和全能时，他回答说，只有当他知道一切的时候，他才能对治疗病人感到安全。他的结论是，只要他不知道一切，他仍然是不够的。此外，他还固执地认为，他什么都学不会，证明了他的能力不足，不适合从事口腔外科手术。 In addition, the choice of dentistry and oral surgery had been influenced by his father's wishes. This definitive compliance with father's wish was fraught with ambivalence. Bob saw his life as an endless process of striving to please his father and living up to father's expectations. Establishing himself as a practicing oral surgeon would be complying with his father's wishes in a definitive way. Further, becoming an oral surgeon was an admission of being second best—of not having been able to become what father really wanted, a doctor. And also—the career was father's choice, not Bob's. Bob envisioned the whole process by which he came to this point in his life as an endless chase, a treadmill that never stopped and which he hated and resented. His breakdown and hospitalization were equivalently stopping the treadmill, removing himself from the endless and fruitless effort. And he did not want to get back on. He wanted in some deep and final way to frustrate and disappoint his father's wish—to make himself a decisive failure and thus deliver a final blow at his father. 此外，选择牙科和口腔外科是受他父亲意愿的影响。这种对父亲意愿的完全顺从充满了矛盾。鲍勃认为他的生活是一个无休止的过程，努力取悦他的父亲，不辜负父亲的期望。让自己成为一名执业口腔外科医生就是完全遵从他父亲的意愿。此外，成为一名口腔外科医生就等于承认自己是第二优秀的——没能成为父亲真正想要的医生。而且，这个职业是父亲的选择，不是鲍勃的。鲍勃把他走到人生这一步的整个过程想象成一场无休止的追逐，一场永不停歇、令他憎恶又怨恨的跑步机。他的崩溃和住院相当于停止了跑步机，把他从无休止的徒劳的努力中抽离出来。他不想再坐上去了。他想以某种深刻而最终的方式挫败和辜负他父亲的愿望——让自己成为一个决定性的失败者，从而给他父亲最后一击。 As we shall see, Bob's psychotic decompensation and his subsequent immobility represent a form of rebellion against his father, but also an attempt to abandon the facade of the competent, knowledgeable, capable, fearless, sexually hyperadequate, and counterphobically hyperactive professional man and entrepreneur. That facade was erected to meet the expectations of both parents—a compliance, a false self which he hated, and in his psychosis rejected and tried to destroy. 正如我们将看到的，鲍勃的精神病失代偿和随后的静止表现了一种对他父亲的反叛，但也是一种尝试，试图抛弃一个有能力、有知识、有能力、无所畏惧、性能力超强、反恐惧的高度活跃的专业男性和企业家的外表。这种假象是为了满足父母双方的期望而建立起来的——一种顺从，一种他憎恨的、在他的精神状态中拒绝并试图摧毁的虚假自体。