Autonomy 自主性 We have already had occasion to examine the difficulties that paranoid patients have with the issue of autonomy. These patients feel themselves to be threatened continually by the inevitability of submission to forces and persons around them. This may take the form of frankly paranoid delusions, or it may take more subtle forms of feeling victimized, feeling that one is being taken advantage of, or of struggles with authority figures. The deficits in autonomy are closely related to the feeling of powerlessness and helplessness that is associated with the depressive introject. The sense of autonomy is more broadly undermined by both external and internal influences. 我们已经有机会研究过偏执症患者在自主性问题上的困难。这些病人觉得自己不断受到威胁，因为他们不可避免地要向周围的力量和人屈服。这可能采取明确的偏执妄想的形式，也可能采取更微妙的形式，即感觉自己被害，感觉自己被利用，或与权威人物斗争。自主感的缺失与抑郁性内摄物的无力感和无助感密切相关。自主感更广泛地受到外部和内部影响的破坏。 The paranoid patient is subject to external threats to his autonomy. We have seen this clearly in all of our cases. The patient in the childhood situation in relationship to the parents is thrust into a position in which compliance is exacted at the cost of either punishment or the loss of love. The parent demands compliance and submission from the child. The demands are often severe and rigid. The child is caught up in the pattern of sadomasochistic interaction which is characteristic of the relationship between his parents and more generally the relationship in the family itself. The child himself thereby becomes a victim. 偏执患者的自主性受到外部威胁。我们在所有的病例中都清楚地看到了这一点。在儿童时期与父母的关系中，病人被推到了一个以惩罚或失去爱为代价来要求服从的境地。父母要求孩子顺从和服从。这些要求往往是严厉和僵硬的。儿童陷入了施虐受虐式的互动模式，这种模式是其父母之间关系的特点，更普遍的是家庭本身的关系的特点。因此，孩子本身也成为受害者。 Part of his experience then is in reality an experience of persecution, of a demand for submission and compliance, of a violation of his autonomous rights and capacity for autonomous functioning. This was most clear, for example, in Gloria's relationship to her parents, particularly her father. Neither Gloria nor her father could rest until a point had been reached at which she was completely accepting and compliant to his point of view and wishes. Bob was also caught up in a continual interaction with his parents, particularly his father, in which he was constantly striving to live up to his father's expectations, always however with the feeling that he was never able to do it, that he was never quite good enough. 因此，他的部分经历实际上是受迫害的经历，是被要求服从和顺从的经历，是侵犯其自主权利和自主运作能力的经历。例如，这一点在格洛丽亚与父母，特别是与父亲的关系中表现得最为明显。无论是格洛丽亚还是她的父亲，在她完全接受和顺从父亲的观点和愿望之前，都不能休息。鲍勃也陷入了与父母，特别是与父亲的持续互动中，他不断地努力达到父亲的期望，但总觉得自己永远做不到，永远不够好。 It is interesting that in some of these patients the paranoid position takes the form of a rebellion against this enforcement of compliance. Ann complains that her mother is trying to kill her. Bob uses his psychosis as a way of taking himself off of the path towards success that his father had laid out for him. Ellen revolts violently against the pattern of submissive goodness which her mother continually tries to foist on her. Gloria becomes psychotically disturbed and feels that her parents are trying to kill her. From this point of view, the paranoid outbursts in these patients can be seen as an attempt to establish some individuality, to achieve some sense of independence. 有趣的是，在这些病人中的一些人，偏执心位采取了反抗这种强制遵守的形式。安娜抱怨说她的母亲要杀她。鲍勃用他的精神病作为一种方式，使自己脱离他父亲为他安排的成功之路。埃伦猛烈反抗她母亲不断试图强加给她的顺从善良的模式。格洛丽亚变得精神错乱，觉得父母要杀她。从这个角度看，这些病人的偏执发作可以看作是一种建立某种个体性、实现某种独立意识的尝试。 What is interesting is that the ordinary channels for establishing such autonomy seem cut off from them. Even as they rebel against the pressure of external compliance and submission, they assign themselves another set of persecutors — even delusional persecutors — who threaten their autonomy and independence on a new level. It is as though the fragile sense of autonomy saves itself by finding enemies against which it can struggle on some new level. Fred, for example, avoids the threat to his autonomy, which is related to his involvement with his parents, by rebelling against and rejecting their wishes and engaging himself in a new struggle in which the controlling and persecuting forces are cast in the larger framework of university and society. Yet the paradox is that, in so struggling to gain some inner sense of autonomous capacity, these patients prolong and extend the identical threat to autonomy by the projection of persecutory forces. Thus the threat to autonomy is initially introjected and carried from the external demands of the parents to the internal demands of the introjected parental objects, but then reprojected to re-create the threat to autonomy in the external sphere. 有趣的是，建立这种自主性的普通渠道似乎与他们隔绝。即使在他们反抗外部顺从和服从的压力时，他们也给自己指派了另一组迫害者——甚至是妄想的迫害者——他们在新的层面上威胁着他们的自主性和独立性。仿佛脆弱的自主意识通过寻找可以在某种新的层面上与之斗争的敌人来拯救自己。例如，弗雷德就通过反抗和拒绝父母的意愿，使自己参与到新的斗争中，将控制和迫害的力量投向大学和社会这个更大的框架中，从而避免了与父母打交道有关的自主性受到威胁。然而矛盾的是，这些患者在如此挣扎以获得某种内在的自主能力感的过程中，通过迫害性力量的投射，延长和扩大了对自主性的相同威胁。因此，对自主性的威胁最初是由父母的外在要求内摄并搬运到到被内摄的父母客体的内在要求，但随后又被再投射，结果在外在领域重新制造对自主性的威胁。 But the threat to autonomy is also internal. I do not mean merely in this sense that the threatening and limiting objects are internalized—although this is a significant aspect of the internal economy of the introjects—but that the introjects themselves, by reason of their regressive potential and instability and by reason of their susceptibility to drive-dependent influences serve to undermine the patient's sense of inner autonomy. Thus the inner sense of helplessness and powerlessness is reinforced considerably. The instability and fragility of the introjects are a primary consideration in the attempts to effectively treat such patients. 但对自主性的威胁也是内在的。我的意思不仅仅是指在这个意义上，即威胁和限制性的客体被内化了——尽管这是内摄物内部经济的一个重要方面——而是指内摄物本身，由于其退行的潜力和不稳定性，以及由于其易受驱力依赖的影响的原因，起到了破坏病人的内在自主感的作用。因此，内心的无助感和无力感被大大加强。在试图有效治疗这类病人时，内摄物的不稳定性和脆弱性是一个首要考虑因素。 Patients will often complain of feelings of loss of identity, or a feeling of losing themselves in the face of external pressures and demands, or a feeling that they have no reality except in terms of their capacity to respond to the initiatives of other people. All of this is a reflection of an inner sense of impairment and susceptibility of their own inner autonomy. This is, of course, a matter of degree. In the more severely psychotic patients, where the status of the introjects is more fragmented and reflects a considerably greater regressive potential, the sense of autonomy is most severely compromised. For such patients the fear of loss of autonomy reaches cataclysmic proportions, and it often reflects itself in a paralyzing fear of death, as in the case of Bob, or in a fear of total annihilation, as was the case for Ann and Henry. 患者常常会抱怨自己的身份丧失感，或者面对外界的压力和要求有一种迷失自己的感觉，或者觉得自己除了有能力回应别人的倡议外，没有其他的现实。这一切都反映出他们内心对自己内心自主性的损害感和脆弱感。当然，这是一个程度问题。在比较严重的精神病患者中，内摄物的状态比较零散，反映出的退行潜能也大大增加，自主意识受到的损害最为严重。对这些病人来说，对失去自主性的恐惧达到了灾难性的程度，它往往反映在对死亡的麻痹性恐惧上，如鲍勃的情况，或者反映在对完全毁灭的恐惧上，如安娜和亨利的情况。 But even in our healthier patients who are able to mobilize relatively effective defenses against this feeling, there is still a sense of susceptibility or capacity to be influenced excessively, a fear of falling into positions of dependence and vulnerability, of being in control of other powerful figures which is often quite threatening to them. Thus it is often quite difficult to draw a line effectively between the instinctual dimensions of depressive or masochistic tendencies and the more ego-based issued[是不是笔误？应为issues？] of threats to autonomy. Both are relevant and these clinical phenomena undoubtedly reflect varying proportions of these respective influences. 但是，即使在我们比较健康的病人中，他们能够调动相对有效的防御来抵御这种感觉，但仍然有一种脆弱感，或被过度影响的能力，害怕陷入依赖和脆弱的境地，害怕被其他强大的人物控制，这对他们来说往往是相当大的威胁。因此，往往很难有效地在 抑郁或受虐倾向的本能层面 和 更多基于自我的对自主性的威胁 之间划清界限。两者都是相关的，这些临床现象无疑反映了这些各自影响的不同比例。 It is worth noting in this connection that the extremes of both powerlessness and powerfulness are both in their own way distortions of basic autonomy. Autonomy carries within it the connotation not only of having a sense of one's own independence and capacity, but also a capacity for accepting and recognizing the independence and individuality of other selves around one. If a sense of powerlessness undermines autonomy, from the point of view of denying the inner capacity of self, the sense of excessive powerfulness undermines the autonomy from the point of view of denying the independent capacity and autonomy of the other. Consequently, whether the paranoid patient sees himself as a threatened and helpless victim who is victimized by external persecuting forces, or whether he sees himself as a powerful, evil, and dangerously destructive monster who can victimize and hurt and destroy those around him—in either case this reflects a distortion of autonomy. 在这一点上值得注意的是，无力和有力这两个极端都是对基本自主性的扭曲。自主性的内涵不仅是具有自己的独立意识和能力，而且具有接受和承认周围其他自体的独立和个体性的能力。如果说，从否定自体内在能力的角度看，无力感破坏了自主性，那么，从否定他人的独立能力和自主性的角度看，过度的有力感则破坏了自主性。因此，不管偏执患者是把自己看成是一个受到外部迫害力量威胁的、无助的受害者，还是把自己看成是一个强大的、邪恶的、具有危险破坏性的怪物，可以伤害和毁灭周围的人——不管是哪种情况，这都反映了自主性的扭曲。