Depression 抑郁 The interplay of depressive and paranoid elements is a constant feature of all of these patients. When the predominance of paranoid defenses, and particularly projection, fails or is altered by therapy, the depressive aspects of the illness emerge—often with surprising intensity. Similar neurasthenic and depressive manifestations are clinically familiar in the usual course of patients with acute schizophrenic episodes (Roth, 1970). These patients often show a progression in phases of their illness. There is an initial phase of prepsychotic turmoil followed by the acute psychotic breakdown. This is followed, usually during hospitalization, by a phase of compensated transition which is relatively short, but which then passes into a more prolonged phase of depression and neurasthenia. The latter phase may last for months, and hopefully leads to a resolution of the depression and therapeutic improvement. The underlying mechanisms in these cases of postschizophrenic depression seem to bear some similarity to what is often observed in paranoid patients. There is some overlap, of course, in that the rate of conjunction between paranoid features and schizophrenia is high. 抑郁和偏执因素的相互作用是所有这些患者的一个不变的特征。当偏执防御的优势，特别是投射，失败或被治疗改变时，疾病的抑郁方面就会出现——通常以令人惊讶的强度出现。类似的神经衰弱和抑郁表现在急性精神分裂症发作患者的通常病程中是临床常见的(Roth, 1970)。这些患者往往表现出病情的阶段性进展。先是一个精神病前混乱的初始阶段，然后是急性精神崩溃。跟着的是，通常在住院期间，一个相对较短的代偿过渡阶段，但随后进入一个较长时间的抑郁和神经衰弱阶段。后一个阶段可能会持续数月，并有望导致抑郁症的解决和治疗的改善。这些精神分裂后抑郁病例的潜在机制似乎与在偏执患者身上经常观察到的情况有些相似。当然，这与 偏执特征和精神分裂症之间的关联率很高 也有一些重叠。 The schizophrenic's inner world can be seen not merely in terms of its relative disorganization and fragmentation, but also in terms of its organization around highly ambivalent and relatively fragmented introjections which are relatively undifferentiated—at least in the acute phase of the illness—and which are highly susceptible to regressive pulls. Introjects can function at nearly any level of psychic integration and organization—anywhere from the primitive levels of psychic dysfunction to highly structuralized levels of neurotic organization. The paranoid process can function anywhere along this continuum. The interplay of introjective and projective mechanisms is also found in paranoid patients—at whatever level of functioning—even as they are found in more severely disturbed schizophrenics. The differences have to do with the degree of regressive liability of the introjects and the extent of their de-differentiation. 精神分裂症患者的内心世界不仅可以从其相对的混乱和分裂来看，还可以从其围绕高度矛盾和相对碎片化的内摄物的组织来看，这些内摄物相对来说是未分化的——至少在疾病的急性期是这样的——而且非常容易受到退行拉力的影响。内摄物几乎可以在任何层次的精神整合和组织中发挥作用——从精神功能障碍的原始层次到高度结构化的神经组织。偏执过程可以在这个连续体的任何地方发挥作用。内摄和投射机制的相互作用在偏执患者中也有发现——无论功能水平如何——甚至在更严重的精神分裂患者中也有发现。差异 与内摄物的退行程度及其去分化程度 有关。 The depression in these cases relates to a predominance of introjective mechanisms in the patient's defensive posture. His breakdown had signaled the failure of projective defenses. His capacity to externalize became mitigated and internalized aggression predominated. The destructive elements formed around the introjects that made up the basic structure of his personality and his inner world. He became both victim and victimizer—both helpless and vulnerable victim of destructive urges and at the same time the brutal and destructive aggressor. The drama of the interplay of these introjects would have played itself out in his own suicide—an internalization and an acting out of the fantasies of murderous destructiveness that he had experienced in relation to his parents. In suicide he would have intensified and completed his assimilation of both—he would become both murdered victim and murderous aggressor. 这些病例中的抑郁与患者防御姿态中内摄机制的主导有关。他的崩溃标志着投射防御的失败。他的外化能力减弱，内化的攻击性占主导地位。破坏性元素围绕着构成他人格和内心世界基本结构的内摄物形成。他成了既是受害者，也是加害者——既是破坏性冲动的无助和脆弱的受害者，同时又是残暴和破坏性的攻击者。这些内摄物的相互作用会在他自己的自杀中表现出来——这是对 他在与父母的关系中所体验到的谋杀性破坏幻想 的内化和行动化。在自杀的过程中，他将加强并完成他对两者的吸收——他将同时成为被谋杀的受害者和凶残的攻击者。