Depression and Paranoia 抑郁和偏执 We can turn to more specific consideration of the effect of these interactions in Clare. She demonstrated in a graphic manner the alternation between depression and paranoia that we have seen in other patients and will see again. She alternated between frankly paranoid fears and anxieties that she would be attacked or killed by some external agency and a severely depressed preoccupation with her own inner evilness and destructiveness. We have found this pattern in all of our paranoid patients. When the paranoid defensive position is given up, the patient becomes depressed—often the depression is severe. In Clare the location of the destructive and paranoid evil bounced back and forth. At times it was within her, and at other times it was located outside herself. Invariably she saw it located in some threatening male figure, never in a female, to my knowledge. This alternation between paranoid and depressive positions reflects the predominance of projective or introjective mechanisms in dealing with the intensity of her ambivalence and particularly the hostility and destructive wishes it involved. While projective mechanisms were predominant, she tended to be more guarded, suspicious, and to experience paranoid fears and anxieties. As we shall see, an important aspect of her treatment was to allow the introjective elements to predominate and to then be able to work these through. 我们可以转而更具体地考虑这些相互作用对克莱尔的影响。她以生动的方式展示了抑郁和妄想之间的交替，这种交替我们已经在其他病人身上看到了，以后还会看到。她在偏执恐惧焦虑和严重的抑郁先占观念间交替。偏执的时候，她担心自己会被某个外部机构袭击或杀害。抑郁时内心充斥着关于自己内心是邪恶的和有破坏性的先占观念。我们在所有偏执型患者身上都发现了这种模式。当偏执防御姿势被放弃时，病人就会变得抑郁——通常是严重的抑郁。在克莱尔的位置，破坏性和偏执的邪恶来回反弹。有时它在她的内心，有时它在她的外部。据我所知，她总能从某个具有威胁性的男性形象中看出这一点，而不是从女性身上。偏执和抑郁心位的交替反映了投射或内摄机制在处理她的矛盾心理(尤其是其中包含的敌意和破坏性愿望)时的主导地位。当投射机制占主导地位，但她往往更谨慎、更多疑，并经历偏执恐惧和焦虑。我们将会看到，她治疗的一个重要方面是让内摄因素占主导地位，然后才能解决这些问题。