Presenting Picture 呈现的画面 Dr. B was brought to the hospital one quiet Sunday morning in a state of acute disorganization and turmoil. He was intermittently struggling violently, so that it required several hefty policemen to restrain him. When attempts were made to reassure him, he would lapse into a tense and constrained silence only to burst out screaming and struggling a few moments after. He would scream that he was God, that he didn't want to die. He repeatedly asked the doctor whether he was God, and when told the doctor was not God but a doctor, then asked whether he himself was going to die. At one point in all this turmoil, he broke away from the police and rushed over to a pretty young nurse. We all jumped, expecting violence, but instead he put his arms around her and asked, "Can I fuck you?" After these initial struggles, and with the aid of a moderate amount of phenothiazine, he stopped struggling and became quite compliant. 在一个宁静的周日上午，罗伯特医生被送到医院，当时他的状态非常混乱和动荡。他断断续续地剧烈挣扎，以至于需要几名彪悍的警察才能制住他。当有人试图安抚他时，他就会陷入紧张而拘谨的沉默，但片刻后就会爆发出尖叫和挣扎。他会大喊他是上帝，他不想死。他反复问医生他是不是上帝，当被告知医生不是上帝而是医生时，又问他自己是不是要死了。在这些混乱中，有一次，他挣脱了警察，冲向一个年轻漂亮的护士。我们都跳了起来，以为会发生暴力事件，但他却搂着她问："我可以操你吗？" 经过这些最初的挣扎，在适量酚噻嗪的帮助下，他停止了挣扎，变得很听话。 Within a few days the psychotic disorganization of the patient's thought processes began to abate, and little by little we began the long process of piecing together what had brought him to this state. The patient's recompensation at this point was remarkable. He seemed to be almost visibly struggling to pull himself together and to reengage himself with reality. In a relatively short time he was able to reconstitute himself and all marks of the psychosis had disappeared. This pattern was so noteworthy—the acuteness of his decompensation and the rapidity of his reconstitution—that the diagnostic issue was clouded. In many ways his behavior seemed to resemble the acute traumatic stress reactions so often seen in the military, in which acute disruption and disorganization take place in the face of battlefield stress, but then disappears with sedation in a brief period of time. These patients appear notoriously schizophrenic, but in act are experiencing the effects of severe panic. Often they recover quickly and go back to the field of action and are able to function adequately. 几天之内，病人思维过程中的精神紊乱开始减弱，我们一点一点地开始了漫长的拼凑过程，拼凑出使他陷入这种状态的原因。这时病人的重新恢复能力是很显著的。他似乎几乎明显地在努力振作起来，重新与现实接触。在相对较短的时间内，他就能重新振作起来，精神病的所有痕迹都消失了。这种模式是如此值得注意——他失代偿的急性和他重建的快速性——以至于诊断问题变得模糊不清。在许多方面，他的行为似乎与军队中经常见到的急性创伤性应激反应相似，即在面对战场压力时，会出现急性的混乱和无组织状态，但在短时间内随着镇静剂的使用而消失。这些病人看起来是众所周知的精神分裂症，但在行为上却是经历了严重的恐慌影响。通常他们很快就会恢复，回到战场上，并能正常工作。 Bob's pattern was quite similar to this—at least in its early stages. The signs of his psychosis disappeared quickly and he was released from the hospital within a few weeks and was able to return to his rather responsible and arduous duties. At the time he was completing a residency training in surgery. He was able to return to his service, and functioned adequately until the completion of his training. To flash ahead in the story, after the completion of his formal training he became increasingly apathetic and lethargic over a period of months. He became more and more deeply depressed, developed suicidal ideation, and finally after nearly six months out of the hospital had to be rehospitalized. He remained in a neurasthenic, and at times almost catatonic, state for almost a year—and then only slowly was he able to tolerate increasing periods out of the hospital. The acute pattern was by that time in progress of verging into a more chronic pattern. As we shall see, this clinical progression reflects the stage of an inner struggle Bob was waging to gain and preserve his sense of self against the powerful forces within. 鲍勃的模式与此颇为相似——至少在早期阶段是如此。他的精神病迹象很快就消失了，几周内他就出院了，并能回到他那颇具责任感和艰巨性的工作岗位上。当时他正在完成外科住院医师培训。他能够回到自己的岗位上，并且在完成培训之前都能充分地发挥作用。作为后边故事的超前叙述[flash-ahead也叫flash-forward，超前叙述：一种在一系列按时间顺序发生的事件中插入未来事件的文学或电影的表现手法]，在完成正式培训后，他在几个月的时间里变得越来越冷漠和昏昏欲睡。他的抑郁症越来越深，出现了自杀的念头，最后在出院近半年后不得不重新住院。他在近一年的时间里一直处于神经衰弱的状态，有时几乎是紧张性的状态——然后才慢慢能够忍受越来越长的出院时间。急性模式在那个时候已经逐渐接近于慢性模式。正如我们将看到的，这种临床进展反映了鲍勃为了获得和维护他的自体感，对抗内心强大的力量而进行的内心斗争的阶段。