Paranoid Indices 偏执表征 It becomes relatively difficult, therefore, to think in terms of subtle and often very "soft"indicators which might reflect the operation of the paranoid process at rather minimal levels. The difficulty, of course, is that such minimal indicators shade over into levels of normal functioning—but that after all is one of the major points of significance of the present study.　Such early indicators are extremely subtle, for the most part, and may often present themselves in quite muted forms in the organization of the patients'　behavior. When patients present the clinician with relatively patent paranoid concerns—as for example a concern with secrecy and confidentiality, a guardedness and suspiciousness of manner, with identifiable ideas of references, etc.—clinical judgment and awareness is a simple and straightforward matter. But the case is not always so clear-cut. Moreover, we have a presumption and a right as clinicians to examine our patients in the light of potential psychopathology. However, when we approach the nonclinical sphere of broader social involvements and cultural manifestations, the question of paranoid manifestations becomes considerably more difficult and nuanced. 因此，用可能反映偏执过程在相当低的水平上的运作的微妙和往往非常“软”的指标来思考是比较困难的。当然，困难在于这些最小的指标逐渐过渡到正常功能的水平，但这毕竟是本研究的主要意义之一。这些早期的指标在很大程度上是非常微妙的，而且在病人行为的组织中经常以非常隐晦的形式出现。当病人向临床医生表现出相对明显的偏执式的担忧时——例如，对保密性的担忧、对行为的警惕和怀疑、对引用会被认出的想法[心理学家在写作时，会引用自己治疗过的案例，虽然会匿名处理，但病人仍有这方面的担心]等等——临床判断和察觉是一件简单而直接的事情。但情况并不总是如此明确。此外，作为临床医生，我们有权利根据潜在的精神病理学检查我们的病人。然而，当我们接触到更广泛的社会参与和文化表现的非临床领域时，偏执表现的问题就变得相当困难和微妙。 One manifestation of the paranoid process which enjoys a considerable spectrum of expression is what Bullard (1960) has referred to as "centrality."　The notion of centrality expresses the patient's notion of somehow being in the center of interest or attention from other people. Such a state of mind can present itself in the most normal of ways, and may be taken for granted as a natural state of mind for one who has come into the focus of psychiatric interest—for whatever reason. But the feelings of centrality may also serve as a subtle expression of the patient's feelings of impingement by outside forces, of a sense of being a passive recipient of external influences to which he is somehow subjected and over which he may feel he has little or no control. 偏执过程具有相当广泛的表现形式，其中一种就是布拉德(1960)所说的“中心性”[以自我为中心]。中心性的概念表达了病人以某种方式成为他人兴趣或注意力的中心的想法。这种精神状态可以以最正常的方式表现出来，并且可以被认为是一个人出于某种原因而成为精神病学兴趣焦点的一种自然的精神状态。但是中心的感觉也可以作为病人受外部力量影响的感觉的一种微妙的表达，一种被动接受外部影响的感觉——他在某种程度上受到了这种外部影响，他可能觉得自己几乎或根本无法控制这种影响。 Hypersensitivity is another subtle indicator of an underlying paranoid process. The patient may seem to be more than unusually reactive to the comments or opinions of other people, may have a feeling of being slighted or wronged or mistreated. This again falls well within the spectrum of normal behaviors, and may indeed have considerable justification in reality; nonetheless, the astute clinician needs to be aware of the potentiality of early and minimal paranoid manifestations. A nother curious manifestation is the facade of self-sufficiency which patients often present to the clinician. One can discern beneath such apparent self-sufficiency a sense of vulnerability and susceptibility which is countered by the "adequate" facade. 超级敏感是潜在的偏执过程的另一个微妙指标。病人似乎对别人的评论或意见异常反应过度，可能有一种被轻视、受委屈或不公平对待的感觉。这也属于正常行为的范畴，在现实中可能确实有充分的理由;尽管如此，敏锐的临床医生需要意识到早期和最小程度偏执表现的可能性。另一种奇怪的表现是病人经常向临床医生呈现的自给自足的假象。在这种明显的自给自足的表象下，人们可以觉察到一种被“胜任的”假象所抵消的脆弱感和易感性。 Another interesting manifestation that might be regarded as somewhat surprising, particularly in analytic patients, is a preoccupation with hidden meanings. This is particularly noteworthy in the context of exploratory psychotherapy or psychoanalysis, where the concern with hidden meanings is part of the therapeutic process. One can easily be misled into thinking that the patient is demonstrating a productive involvement in the treatment, when in fact the concern with hidden meanings or hidden motives may be a reflection of an underlying paranoid process. 另一个有趣的表现(可能有点令人惊讶，特别是在善于分析的患者中)是对隐藏含义的关注。这一点在探索性心理治疗或精神分析的背景下尤其值得注意，其中隐含意义的关注是治疗过程的一部分。我们很容易被误导，认为病人在治疗中表现出积极的参与，而实际上，对隐藏含义或隐藏动机的关注可能是潜在偏执过程的反映。 Another subtle and pervasive concern that relates to the functioning of the paranoid process is the concern over autonomy. The variety and heterogeneity of the concerns over autonomy is considerable and may take extremely subtle forms indeed. When a patient expresses a fear of loss of control the issue is unequivocal, but often the patient's concerns may be expressed in a variety of resistances or avoidances, or even of unexpressed and silent inner reservations which are not specifically directed to the undoing of therapeutic efforts, but which are more directly concerned with preoccupations with autonomy and the underlying fears of violation of autonomy that are so closely linked with the paranoid style. 另一个与偏执过程运作有关的微妙而普遍的担心是对自主性的担心。对自主性的担心的多样性和异质性是相当大的，而且可能采取非常微妙的形式。当病人表达对失控的害怕时，问题是明确的,但往往病人的担心往往以各种抗拒或回避的形式表达出来，甚至以不表达和沉默的内部保留的形式表达出来。这种保留，不是特定地导向对治疗努力的撤销，而是直接与对自主性和对自主性侵犯的恐惧的先占观念有关，这种恐惧与偏执风格密切相关。 Another important and subtle manifestation is the tendency to blaming. This is closely related to tendencies to externalization, the disposition of the patient to formulate and understand his difficulties in terms of external circumstances, forces, events, persons, etc. 另一个重要而微妙的表现是责备的倾向。这与外化倾向密切相关，也就是病人倾向于从外部环境、力量、事件、人物等方面来阐述和理解自己的困难。 Another set of indicators has to do with feelings of inadequacy or deficiency. Here again the manifestation is such a common part of the clinical experience that one almost hesitates to suggest that there may be important connections with the operation of the paranoid process; nonetheless such concern over inadequacy may play an important role in paranoid dynamics. This may take the expression of complaints about being too short or being too tall, may take the form of concern over genital inadequacy, or may take a more diffuse and nonspecific form as concerns about being somehow different. Some patients express an idea of somehow being an outsider, of not being a part of the social or political or cultural context in which they carry out their lives. Often there may be a quite diffuse concern over values or purposes or beliefs which might lead one to think in terms of more descriptive categories such as "identity diffusion," but these concerns may also be seen in the context of a concern over difference and separation which may reflect a paranoid modality. 另一组指示物与不胜任感和不足感有关。再一次，这种表现是临床经验中如此常见的一部分，以至于人们几乎不愿说可能与偏执过程的运转有重要联系;尽管如此，这种对不胜任的担忧可能在偏执动力学中扮演重要角色。这可能采取抱怨自己太矮或太高的表达方式，也可能采取对生殖器缺陷担心的形式，也可能采取一种更广泛和非具体的形式，比如自己与他人不同。有些病人表达了一种作为局外人，或不属于他们生活中所处的社会、政治或文化环境一部分的想法。经常会有相当模糊的对价值观、目的或信仰的担忧，这可能让人想到更具描述性的类别,如“认同混淆,”但这些担忧也可能出现在对不同和分离担忧的环境下,这可能反映了一种偏执形态。 Another significant area is the whole question of authority relations, and this type of manifestation refers back to the concern over problems of power and powerlessness which are so closely related to paranoid concerns. We discussed some of these issues in relation to the authoritarian personality, but it must be noted here that they can serve as an area of particular expression of the paranoid process. Here again we can note the generality of such manifestations, particularly in younger segments of the population. Related to this is an area in which considerable confusion can arise, but which nonetheless may serve as an expression of paranoid concerns. I am referring to feelings of righteousness, of feelings of resentment about social injustice, of dedication to causes and campaigns, and a whole host of purposeful involvements which may pass for manifestations of social conscience or social sensitivity, or a variety of constructive and valuable emphases which may also reflect the operation of the paranoid process. 另一个重要的领域是权力关系的整个问题，这种表现形式涉及到对权力和无能为力问题的担忧，而这些问题与偏执担忧密切相关。我们讨论了一些与专制人格有关的问题，但在这里必须指出，它们可以作为偏执过程的一个特殊表达领域。在这里，我们可以再次注意到这种表现的普遍性，特别是年轻人里。与此相关的是，在这个领域可能会出现相当多的混乱，但尽管如此，这仍可能成为偏执担忧的一种表达。我指的是正义感，对社会不公正的不满情绪，对事业和运动的奉献精神以及各种各样的有目的的参与，这些参与可能会体现出社会良心或社会敏感性，或各种建设性和宝贵的重点 这也可能反映了偏执过程的运行。 One can begin to sense the inherent difficulty in discussing diagnostic concerns in this whole area. The borderline between the pathological and the nonpathological becomes quickly blurred and obfuscated. The early indicators that we have suggested—while certainly not exhaustive or detailed—can be looked at in terms of the relationship to potential psychopathology in a specifically clinical context. As such they may be minimal indices of an underlying concealed paranoid process which is functioning in relatively pathological ways, so that the identification of such indicators can serve to raise the index of suspicion for a diagnosis of paranoia, or at least of paranoid mechanisms. 在讨论整个领域的诊断问题时，人们可以开始感觉到固有的困难。病理学和非病理学之间的界限很快变得模糊。我们提出的早期指示物——虽然肯定不是详尽的或详细的——可以从特定临床环境中与潜在精神病理学关系的角度来看待。因此，它们可能是一个潜在的隐藏的偏执过程的最小指标，这种偏执过程以相对病态的方式运作，因此，对这些指示物的识别可以提高诊断偏执的怀疑指数，或者至少是偏执机制的怀疑指数。 In the broader nonclinical context, however, these same indices are relatively human stuff. Who is there of us who at one time or other does not manifest one or another of these indicators of the paranoid process? One might conclude, therefore, that such indices were meaningless, or that they were of little relevance to any clinical concerns. However, one can take the opposite tack, as we are doing here, and say that such minimal indicators may indeed be reflectors of the operation of a paranoid process, and that such a process has broad implications for the understanding of human functioning and behavior even in a nonclinical and broader cultural context. 然而，在更广泛的非临床环境中，这些相同的指数相对来说是人类的东西。我们中有谁在某个时候没有表现出这些偏执过程的迹象?因此，人们可能会得出这样的结论:这些指标是没有意义的，或者它们与任何临床问题几乎没有相关性。然而,一个人可以持反对意见(正如我们在这里所做)并说这样的最低指标可能确实是偏执过程运行的反映，这样的过程对于理解非临床和更广泛的文化背景下人类功能和行为具有广泛的影响。 The argument however—it should be noted—does not rest on the identification or the generality of such minimal indicators of the paranoid process, but rests also and more specifically on the understanding of the functions of the paranoid process and its continuity with identifiably pathological forms. It is apparent, therefore, that a diagnostic concern can be quite misleading. One can easily be seduced into thinking that everyone is paranoid, or that social institutions and cultural processes are themselves pathological, but it seems to me that one could only reach this inference by reason of clinging to an older diagnostic frame of reference, rather than shifting the level of consideration to the understanding of the paranoid process. 然而，值得注意的是，这一论点并不是基于对偏执过程这些最小指标的识别或泛化，而是更具体地基于对偏执过程的功能及其与可识别的病理形式的连续性的理解。因此，很明显，诊断上的担忧可能会误导人。我们很容易被诱导而认为每个人都是偏执,或社会制度和文化过程本身就是病态的,但在我看来,只有坚持用一种较旧的诊断性参考框架推理，而非把考虑的层次转向对偏执过程的理解，才会得出这种推论。