Sadomasochism—Identification with the Victim 受虐狂——与被害者的认同 These aspects of the inner self of the paranoid patient reflect the dynamics at work in the world of significant objects which surrounds him. In all of these cases the patient's parents enact the drama of sadomasochism, with varying degrees of intensity and decisiveness, often varying the roles so that their relationship comes to be mutually victimizing, and perhaps victimizing in different areas, in different ways, to different degrees—with an almost endless capacity for variation and subtlety. It is this drama and mutual interaction of victim and victimizer that the paranoid patient has internalized. He carries it on within himself and carries it on against himself. 偏执患者内在自体的这些方面反映了在他周围的重要客体的世界中工作的动力。在所有这些病例下，病人的父母制定受虐狂的戏剧，以不同程度的强度和果断，往往变换角色，使得他们的关系是相互迫害，也许是在不同的地方，以不同的方式，不同的程度迫害——以几乎无穷无尽的变化和微妙的能力。偏执症患者正是内化了这种受害者与迫害者的戏剧和相互作用。他在内心进行着，也在对抗着自己。 I think it is worth making a point that, while there may be a more or less generalizable pattern, what is more significant in the development of the pathology is that the parents are somehow or other caught up in a complex interaction which involves sadomasochistic components of victimizing and being victimized. From our previous discussion it would be clear that the quality of the introjects depends not so much on the separate introjections from parental figures as on the combination of introjective elements that derive in fact from the ambivalent quality of the patient's relationship to both parental figures. 我认为值得指出，虽然可能是一个或多或少可概括的模式，在病理学的发展中更重要的是，父母莫名其妙地卷入复杂的互动，这互动包含了加害和受害的受虐狂元素。从我们之前的讨论中我们可以清楚地看到，内摄物的性质并不依赖于从父母形象中独立的内摄，而是依赖于内摄元素的组合，这些元素实际上源自于患者与父母形象之间关系的矛盾的性质。 The significance which this so-called "identification with the victim" can play in the dynamics of paranoia can readily be seen. It is precisely this introjected victimized object, which has been internalized and has been incorporated into the self, which the patient must struggle to defend and protect. It is this aspect of himself which the patient sees as weak, helpless, dependent, ineffectual, deficient, defective, and inadequate. For some patients the issue is weakness and defectiveness, but for others the issue is spelled out in more explicitly sadomasochistic terms of vulnerability. The defensive characteristics of the paranoid state which we have observed in so many of these patients wraps itself around this inner core of introjective deficit. 这种所谓的“对受害者的认同”在偏执症的动力学中所起的作用显而易见。正是这种内摄的受害客体，已经内化并融入了病人必须努力捍卫和保护的自体。病人认为自己的这一方面是软弱的、无助的、依赖的、无效的、有缺陷的、有问题的和不胜任的。对一些患者来说，这个问题是软弱和缺陷，但对另一些患者来说，这个问题被更明确地用受虐狂的术语解释为脆弱。我们在很多患者身上观察到的偏执症状态的防御特征，都是围绕着内摄的缺陷这个内部核心。 However, just as in ambivalence there is always another side, so too in the victimizing process there is another side. If there is a victim, there must be a victimizer. If the drama of victimization is internalized, there is also internalized a victimizer. It is this aspect of the patient's development which Anna Freud has described in terms of "identification with the aggressor" (A. Freud, 1936). It is this aspect of the introjective process which is usually thought of as more closely allied with the formation of superego precursors and finally of the superego itself. In our sicker patients, this victimizing introjective aspect of the inner organization of the psyche manifests itself in quite explicit terms: there is a powerful, destructive evil, and hurtful monster that lurks inside of them which is ready to leap out and unleash destruction on any and all objects around them. The description of this monster is most graphic and dramatic in Clare, but it is also seen in its own style in all of these patients. Here again the monstrousness and autonomy of the primary process presence is more predominant and well delineated in the more primitive patients. 然而，正如在矛盾心理中总是有另一方面一样，在加害过程中也有另一方面。如果有受害者，就一定有迫害者。如果受害的戏剧内化了，那么也就内化了一个迫害者。安娜·弗洛伊德(Anna Freud)用“对攻击者的认同”(A. Freud, 1936)来描述病人发展的这一方面。内摄过程的这一方面通常被认为是与超我初期形式的形成以及超我自身的形成更为密切相关的。在我们较严重的病人中，这个心理的内部组织的加害性的内摄方面，以相当明确的形式表现出来：有一个强大的、破坏性的邪恶的并伤人的怪物，它潜伏在他们体内，准备好随时跳出来，并发泄毁灭在周围所有的客体上。克莱尔对这个怪物的描述是最生动和戏剧性的，但在所有这些病人中也可以看到其自己的风格。在这里，基本过程存在的可怕性和自主性在更原始的患者中更为突出和清晰。 It should be noted that the intensity of the destructive affect which gives the monster its evil, poisonous, and destructive potentiality is precisely what prevents the introjective assimilation from the object from being more generally metabolized and integrated with other psychic structures. The more primitive and intense the aggressive component of the ambivalence to the object, therefore, the more destructive, monstrous, and potentially hurtful is this aspect of the introject felt to be. 应该指出的是，使怪物具有邪恶、毒害和破坏性潜能的破坏性情感的强度，恰恰是阻止来自客体的内摄同化与其他心理结构进行更普遍的代谢和整合的原因。因此，对客体的矛盾心理中的攻击性成分越原始、越强烈，内摄物的这一方面感觉到的破坏性、怪物性和潜在的伤害性就越大。 This is the aspect of the paranoid pathology which is perhaps most difficult to elicit and define. This is the aspect of the patient which he is most anxious to keep in check, to keep out of view, to withhold from expression. It is that part of himself which he feels is not only most destructive and hurtful, but which is most despicable and hateful to others. It is his fear, for example, in therapy, that any inkling that he might give the therapist of this inner lurking evilness and monstrosity would drive the therapist away, would destroy his fragile relationship with the therapist, and would bring the therapy to a halt. The monstrous rage which such patients feel boiling inside them, which is somehow sensed without being in explicit awareness, is what inhibits them from the more productive and useful expression of aggression, even when it seems reasonable and appropriate. This is a fundamental therapeutic issue for all paranoid patients. In the treatment process, it is closely related to the issue of trust, for it is only on the basis of a well-developed and firm sense of trust in the therapist and to some extent in themselves that patients can begin to reveal this inner evilness and destructiveness. 这是偏执症病理中也许最难引起和界定的方面。这是病人最急于控制、不被人注意、忍住不表达的方面。他觉得自己的这一部分不仅最具破坏性和伤害性，而且对别人来说也是最卑鄙和可恨的。例如，在治疗中，他担心自己可能给治疗师的任何关于这种内心潜伏的邪恶和畸形的暗示都会把治疗师赶走，会破坏他与治疗师的脆弱关系，会使治疗陷入停顿。这类病人感到内心沸腾的滔天怒火，在某种程度上是在没有明确意识到的情况下被感觉到的，正是这种怒火抑制了他们更有成效、更有用的攻击性表达，即使这种表达似乎是合理的、恰当的。这是所有偏执症患者的基本治疗问题。在治疗过程中，它与信任问题密切相关，因为只有在对治疗师以及在某种程度上对自己有良好的、坚定的信任感的基础上，患者才能开始揭示这种内在的邪恶性和破坏性。