The Origin of Delusion 妄想的起源 The course of the development of this paranoid delusion was gradual and progressive. We can immediately see that the content of the active delusional system was a form of restitutive defense against all of the patient's underlying concerns and feelings of weakness and vulnerability. His wish to become chief resident, for example, was translated into the delusional system and was satisfied by the delusional power to assume the identity of chief resident at will. We shall see that the other elements in the delusional content similarly reflected Bob's underlying fears and uncertainties and wishes. 这种偏执妄想的发展过程是循序渐进的。我们马上就能看到主动妄想系统的内容是一种恢复性防御的形式，用来对抗病人潜在的担忧以及虚弱和脆弱的感觉。例如，他想成为总住院医师的愿望被转化为妄想系统，并被妄想的权力，即可以随心所欲地承担总住院医师的身份，所满足。我们将看到妄想内容中的其他元素同样反映了鲍勃潜在的恐惧、不确定和愿望。 The development of these acute symptoms presents an interesting course of emergence. The pattern is much like a deep root that is clearer and more defined near the surface, but becomes more widely spread and diffuse as it plunges deeper into the soil. We can thus trace Bob's illness and his symptoms back into his history, but as we so do they become all the more vague and diffuse—but, I think, still recognizable. At the beginning of his residency it was clear that his attitude was marked by intense competitiveness and phallic striving. He made it evident, even at that stage, that he felt that he had to prove something—something that he could not presume or feel comfortable in already possessing. Moreover, what he needed to prove could only be demonstrated by putting down his colleagues and proving that he was better than they were. Little by little a pattern of social exclusion, rivalry, jealousy, and gradually suspicions of a conspiratorial effort to undermine him became more evident. These feelings of jealous rivalry and suspiciousness came to a more marked intensity when Bob was denied the position as chief resident. His thinking at this point had a markedly paranoid flavor. The confrontation with the chief resident over the transfusion and the subsequent events which culminated in his having to extend his program provided a consummatory insult and injury to Bob's rather intense narcissism. His underlying feelings of inadequacy and inferiority were stirred and his defenses against those feelings were intensified. 这些急性症状的发展呈现出一个有趣的出现过程。这种模式很像一个深根，靠近表面时更清晰、更清晰，但当它深入土壤时，就会变得更广泛和扩散。因此，我们可以将鲍勃的疾病和症状追溯到他的历史，但随着我们这样做，它们变得更加模糊和扩散——但我认为，仍然可以识别。在他住院的开始，很明显，他的态度是激烈的竞争和阳具期抗争。即使在这个阶段，他也清楚地表明，他觉得他必须证明一些东西——一些他在已经拥有之物里不能假设或感到舒服的东西。此外，他需要证明的东西只能通过贬低他的同事，证明他比他们更优秀来证明。渐渐地，一种社会排斥、竞争、嫉妒，以及渐渐地开始怀疑有人在阴谋削弱他的模式越来越明显。当鲍勃被拒绝担任总住院医师时，这种嫉妒的竞争情绪和怀疑的情绪变得更加明显。在这一点上，他的想法明显带有偏执的味道。与住院总医师在输血问题上的对抗以及随后发生的事件，最终导致他不得不延长他的治疗计划，这对鲍勃相当强烈的自恋心理造成了极大的侮辱和伤害。他内心深处的不足和自卑的感觉被激起了，他对这些感觉的防御也被加强了。 The delusional system resolved his perplexity and confusion. It also served to allay and respond to his underlying fears and frustrated wishes. The emergence of the delusion, therefore, seemed to have followed a pattern of gradual emergence which could be traced back for several months and years. The elements were drawn together and intensified and crystallized in a relatively short time in the face of specific disappointments and losses. Further, the acute formation of the delusional content occurs in the context of an environmental stimulatory situation. If we try to look back further into Bob's history, we can begin to appreciate to what extent the delusion served a defensive function in responding to and countering his deepest anxieties. 妄想系统解决了他的不知所措和困惑。这也有助于减轻和回应他潜在的恐惧和受挫的愿望。因此，这种错觉的出现似乎遵循了一种逐渐出现的模式，可以追溯到几个月甚至几年之前。在面对特定的失望和损失时，这些因素在相对较短的时间内被集中起来、强化和结晶化。此外，妄想内容的急性形成发生在环境刺激情境的背景下。如果我们试着更深入地回顾鲍勃的历史，我们就可以开始理解这种错觉在多大程度上起到了防御功能，以回应和对抗他最深的焦虑。