Bob's earliest memories of sexual interests related to his experiences in the family. When he was very young his mother used to bathe him with his sisters. He recalled his interest in his sisters' genitals and his embarrassment in showing them his own. He felt at such times that it was wrong for him to want to look at them and was afraid that his mother would catch him at it. His fear was that she would do something terrible to him if she knew that he was curious about his sister's sexual parts. He remembered that on frequent occasions, starting when he was about five or six years old, he would play with the girls in the neighborhood. They would go into the cellar and undress and play games with each other. He recalled that these games were exciting and he was always fearful of being caught. As he grew somewhat older he remembered thoughts and fantasies of having intercourse with his sister. He knew that these were "bad thoughts" and felt guilty about them, but also was afraid of what his parents would think of him or do to him if they knew that he had such evil ideas. 鲍勃最早的性兴趣记忆与他在家庭中的经历有关。在他很小的时候，他的母亲常常给他和他的姐妹们一起洗澡。他回忆起自己对姐妹们的生殖器感兴趣，却又尴尬地向她们展示自己的生殖器。在这种时候，他觉得自己不该去看它们，害怕被母亲抓住。他担心的是，如果她知道他对他妹妹的性器官感到好奇，她会对他做出可怕的事来。他记得，从五六岁开始，他经常会和邻居家的女孩们一起玩。他们会走进地窖，脱下衣服，互相玩游戏。他回忆说，这些游戏很刺激，他总是害怕被抓住。随着年龄的增长，他想起了和妹妹性交的想法和幻想。他知道这些是“不好的想法”，并为此感到内疚，但他也害怕如果父母知道他有这样的坏想法，他们会怎么想他或对他做什么。 In his adolescent years Bob began to experiment sexually with many different girls. It was very important to him to have intercourse with as many of the girls he took out as possible. He had to prove that he could get them into bed and screw them; otherwise he was falling short of the performance that would be expected of a man. As time went on, through his college years and after, this pattern of intense sexuality persisted. He had a strong need for physical contact and a unique ability to draw women to him. With rare exceptions he was able to get them to go to bed with him. He described his feelings of warmth and closeness in the sexual embrace. He felt safe and secure with his penis in the woman's vagina, and anything short of that was fraught with anxiety and feelings of uncertainty and precariousness. He described the act of intercourse as "getting inside" a woman where you could finally feel safe and protected. The fantasy seemed to reflect an infantile wish to enter into the woman and find security and protection within her womb—a fantasy of return to the maternal matrix, the safe harbor of symbiosis. 鲍勃在青春期开始与许多不同的女孩发生性关系。对他来说，和尽可能多的他带出来的女孩发生关系是非常重要的。他必须证明他能把她们骗上床，搞她们；否则，他就没有达到人们期待的一个男人应有的水平。随着时间的推移，在他的大学时代和之后，这种强烈的性模式持续存在。他对身体接触有强烈的需求，并且有一种独特的能力来吸引女人。除了极少数例外，他能让他们和他上床。他描述了自己在性拥抱中感受到的温暖和亲密。当他的阴茎插在女人的阴道里时，他感到很安全，很有安全感，除此之外的一切都充满了焦虑、不确定和不稳定的感觉。他将性交行为描述为“进入”一个女人，在那里你最终会感到安全和受保护。这种幻想似乎反映了一种婴儿的愿望，即进入妇女体内，在她的子宫内找到安全感和保护——一种回到母性母体的幻想，一种共生的安全港湾。 Bob carried on an intense sexual life on multiple fronts. He always had several girl friends with whom he was actively sexually involved at any one time. By the time he came into treatment, he had women in nearly all parts of the country whom he would occasionally visit and sleep with. Some of these women were married and some not. In the course of his adventures, many of these women became pregnant. I say "many" because the exact number was never determined. In the course of therapy, the number kept increasing: Bob would casually mention another girl whom he got pregnant. The number mounted to the neighborhood of fifteen. Some of these women had abortions and some did not. Bob generally urged them to have abortions, but some of the women wanted to have their children—particularly the married women. On one occasion, Bob could not arrange for an abortionist and attempted the abortion himself. The abortion was successful, but the girl became very sick and had to be taken to a hospital. The event frightened Bob severely; he would often refer to this episode and accuse himself of nearly killing the girl. 鲍勃在多个方面都进行着激烈的性生活。他总是有几个女朋友，他在任何时候都积极地与她们发生性关系。当他开始接受治疗时，他几乎在全国各地都有女人，他偶尔会去拜访她们，和她们上床。这些女人有些已婚，有些未婚。在他的冒险过程中，许多这样的女人怀孕了。我说“很多”是因为确切的数字从未确定过。在治疗过程中，这个数字一直在增加：鲍勃会不经意地提到他搞大肚子的另一个女孩。这个数字增加到十五左右。这些妇女中有些人堕胎了，有些人没有。鲍勃一般都劝她们堕胎，但有些妇女想要自己的孩子——尤其是已婚妇女。有一次，鲍勃找不到打胎师，就想自己打胎。堕胎成功了，但女孩病得很重，不得不被送往医院。这件事把鲍勃吓坏了。他经常提起这件事，指责自己差点害死了那个女孩。 The incredible fact was that despite this unusual record Bob persisted in the belief that he was impotent. He felt that he was impotent because of his defective testicle, even though he had been told differently after his successful surgery, and even though he knew better from his own medical knowledge. His denial in the face of such overwhelming evidence is striking. What is also very striking in all this is that Bob had adequate knowledge and adequate access to contraceptive means. Yet he made no effort in all these instances to utilize contraceptive precautions. In part this reflected his underlying conviction of his own impotence, but at a deeper level it reflected his unconscious sadistic wish to hurt and maim the women. These sadistic impulses found their expression indirectly and in a displaced manner in the impregnation and aborting of these many women. The guilt that Bob felt so deeply in relation to these episodes was related to the underlying unconscious sadistic and destructive impulses. We have already had occasion to observe how these same sadistic impulses were transposed into his activity as a surgeon. 令人难以置信的事实是，尽管有这个不寻常的记录，鲍勃坚持认为他是阳痿的。他觉得自己阳痿是因为他的睾丸有缺陷，尽管他在成功的手术后被告知不是这样，尽管他从自己的医学知识中知道得更好。面对如此压倒性的证据，他的否认令人震惊。在所有这一切中，还有一点非常引人注目，那就是鲍勃有足够的知识和足够的途径使用避孕手段。然而，在所有这些情况下，他都没有采取避孕措施。在某种程度上，这反映了他对自己无能为力的潜在信念，但在更深层次上，这反映了他无意识的虐待欲，想要伤害和残害妇女。这些施虐的冲动在这些妇女的怀孕和流产中以一种间接和置换的方式得到了表达。鲍勃对这些事件所感到的深深的内疚与潜在的无意识的施虐和破坏性冲动有关。我们已经有机会观察到，同样的施虐冲动是如何转化为他作为外科医生的活动的。 Symbiotic Ambivalence. In working through these relationships, a primary issue was Bob's intense ambivalence in his relations with women. His yearning for closeness with them and his dependence on them had an infantile quality. He sought them out for protection, support, sympathy, warmth, and closeness. He needed them for the security, warmth, and protectiveness of their bodies. This was not simply a sexual yearning but was laden with much earlier—almost symbiotic—yearnings for closeness and protection and dependence on his mother. The descriptions and responses he gave of his sexual activity did not have a phallic quality at all, but rather the quality of a frightened little child cuddling close to his mother's warm body to shield himself from the cold buffeting and demands of the outside world. It was as though, behind the facade of phallic striving and narcissistic gratification in sexual conquests, there was a much more central core of infantile yearning and dependence on the woman that was satisfied in sexual union. It was as though Bob were reuniting himself with the maternal matrix in the act of intercourse—and wanted to fold himself in it and rest there safe from the demands of growing up and functioning as a big boy. His clinging to the belief in his impotence undoubtedly served the function of preserving the inner fantasy of infantile dependence—rather than the acceptance of mature phallic potency. It also served him to deny and repress the hostility and destructive urges that raged within against the bad, punitive mother. 共生的矛盾心理。在处理这些关系的过程中，一个主要问题是鲍勃在与女性关系中强烈的矛盾心理。他渴望与她们亲近，对她们的依赖有一种孩子气。他向她们寻求保护、支持、同情、温暖和亲密。他需要她们提供安全和温暖，需要她们身体的保护。这不仅仅是一种性的渴望，而是更早的——几乎是共生的——对亲密、保护和对母亲的依赖的渴望。他对自己性行为的描述和反应完全没有生殖器崇拜的性质，而是像一个受惊的小孩紧紧依偎在母亲温暖的身体上，保护自己免受外界冰冷的冲击和要求。就好像，在性征服的阳具期抗争和自恋性满足的表象背后，有一个更核心的核心，那就是婴儿般的渴望和对女人的依赖，这些在性结合中得到满足。就好像鲍勃在性交的过程中把自己和母性母体重新结合在了一起——他想把自己裹在里面，在那里休息，远离成长和作为一个大男孩的需求。他坚持认为自己无能为力，这无疑起到了保持婴儿依赖的内在幻想的作用，而不是接受成熟的阳具力量。这也使他能够否认和压抑内心对那个坏的、惩罚人的母亲的敌意和破坏性的冲动。 Bob had successfully avoided marriage in all this activity. He talked much about the possibility in relation to his two current girl friends. He also recalled that once before he had felt that he was in love and wanted to marry. But the girls were all non-Jewish. He did not date Jewish girls and would never sleep with one. He recalled how he was always afraid of bringing his girl friends home to meet his mother, fearing that she would be angry because they were not Jewish. When he seriously considered marriage, the leading consideration in his mind was how deeply his mother would be hurt if he were to marry outside his religion. He had decided not to marry a Gentile girl because of the pain he felt it would cause his mother, and the same consideration entered into his ruminations about marrying either of the present girl friends—both of whom were non-Jewish. The Oedipal implications of this attitude were clear. He could not relinquish his symbiotic dependence on his mother—caught up in the deep ambivalence as it was. Nor could he date or sleep with Jewish girls, presumably because they were too much like mother and posed an incestuous threat. He was caught on both sides of the ambivalence: if he married a Jewish girl it would have carried the threat of incest; if he married a non-Jewish girl it would have carried the threat of an attack on mother and loss of her love. Bob could not resolve this ambivalence 在所有这些活动中，鲍勃成功地避免了结婚。他谈了很多关于他现在的两个女朋友的可能性。他还回忆说，以前有一次他觉得自己恋爱了，想要结婚。但这些女孩都不是犹太人。他从不和犹太女孩约会，也从不和犹太女孩上床。他回忆说，他总是害怕把女朋友带回家见母亲，担心她会因为她们不是犹太人而生气。当他认真考虑结婚时，他脑子里主要考虑的是，如果他和异教的人结婚，他的母亲会受到多大的伤害。他已经决定不娶一个非犹太人的女孩，因为他觉得这会给他母亲带来痛苦。同样的考虑也使他在考虑是否要娶现在的两个女朋友——她们都不是犹太人。这种态度的恋母情结很明显。他无法放弃对母亲的共生依赖——他陷入了深深的矛盾之中。他也不能和犹太女孩约会或睡觉，大概是因为她们太像母亲了，构成了乱伦的威胁。他左右为难:如果他娶了一个犹太女孩，就有乱伦的危险；如果他娶了一个非犹太女孩，就会有袭击母亲和失去她的爱的威胁。鲍勃无法解决这种矛盾心理