Characterological Externalization 性格的外化 It is worth noting that projective mechanisms can function not only at delusional and psychotic levels, but also at the level of characterological defects which are manifestly nonpsychotic, but which form important parameters of the analytic experience. Giovacchini (1967), for example, has described patients who maintain a more or less distorted perception of the environment, such that the patient re-creates in the transference an environment based on the externalization of aspects of his inner world along with projected affects, impulses and attitudes. The structuring of his environment through such projections leads to inevitable frustration. The patient seems to have a need to construct a painful reality and attributes the trauma he experiences to his inability to cope with the external world. His environment is seen as complex, impossible to deal with by available adaptive techniques. The patient feels helpless and vulnerable and weak—a helpless baby cast into a harsh environment he is totally incapable of dealing with. I am reminded, in reading Giovacchini's description of his patients, of both Karen and Jim in the present series. For both of them it was the weak, vulnerable, and helpless little child that was the source of fear and which lay at the core of their fantasies about themselves—issuing in phobic anxieties in one case and in excessively rigid and severe coping reactions in another. Yet in less specific and often more severe ways, the same perception permeates the case material of the other and sicker patients as well. 值得注意的是，投射机制不仅可以在妄想和精神病水平上起作用，而且可以在明显的非精神病性的、但构成分析经验重要参数的性格缺陷水平上起作用。例如，Giovacchini(1967)描述了那些对环境保持着或多或少的扭曲认知的病人，这样病人在移情过程中重新创造了一个基于他内心世界的外化以及投射的情感、冲动和态度的环境。通过这种投射来建构他的环境，导致了不可避免的挫折感。患者似乎需要建构一个痛苦的现实，并将他所经历的创伤归因于他无法应对外部世界。他的环境被看作是复杂的，不可能用现有的适应性技术来处理。病人感到无助、脆弱和虚弱——一个无助的婴儿被扔到一个他完全无法应对的恶劣环境中。在阅读乔瓦奇尼对病人的描述时，我想起了本系列中的卡伦和吉姆。对他们两人来说，弱小、脆弱、无助的小孩子才是恐惧的源头，也是他们对自己幻想的核心——在一个病例中会产生恐惧症焦虑，在另一个病例中则会产生过于僵硬和严厉的应对反应。然而，在其他病人和病情较重的病人的病例材料中，也渗透着同样的观念，但不那么具体，而且往往更为严重。 Such patients tend to identify their universal experience in terms of a level of childhood involvement with early and predominantly primary objects. Giovacchini writes, in this regard, 这类患者倾向于以童年与早期和主要客体的亲密关系来确定他们的普遍经验。乔瓦奇尼就此写道： To feel secure in one's identity, one has to know where he stands in his universe. The self-image contains numerous introjects, so one perceives the self in the same way as the external objects that have been introjected. So external objects are among the first representations of reality. So one's sense of identity, if it is firm and coherent, corresponds to the environment that contributes to its formation. The early environment of patients with ego defects is different from that experienced by persons with a relatively good psychic organization. The ego of the person with the character disorder is not in resonance with any reality that differs radically from the one he knew in early childhood. The degree of difference determines how well he can master external stimuli and perceive himself as a meaningful person in an acceptable world (1967, p. 576) 要对自己的身份感到安全，就必须知道自己在宇宙中的位置。自体形象中包含了众多的内摄物，所以人对自体的感知与对外部客体的内摄方式是一样的。所以外部客体是现实的第一表征之一。所以，一个个体的身份感如果是坚定的、一致的，就与促成其形成的环境相对应。自我缺陷患者的早期环境与心理组织相对良好的人所经历的环境是不同的。性格障碍者的自我与任何与他幼年所认识的现实有根本性差异的现实都不在共鸣之中。差异的程度决定了他能在多大程度上掌握外部刺激，并在一个可接受的世界中感知自己是一个有意义的人(1967，第576页) The patient's attempt to structure the treatment situation in terms of an environment, embedded in the childhood past, can be seen as a repetition compulsion. The analyst who refuses to frustrate the patient by verifying his projection ends up frustrating him anyway. With my patient Jim, this situation in the analysis was described as a no-win situation—as he put it, "If I win, I lose; if I lose, I lose." We can remind ourselves of the "no-win" situation that we have seen in some of our paranoid families, most strikingly in the G. family. The patient's externalization structures reality in such a way that it becomes a frustrating reality. 病人试图从环境的角度来安排治疗情境，嵌入童年的过去，可以被视为一种重复的强迫症。分析师如果拒绝通过验证病人的投射来挫败他，最后还是会让他感到沮丧。在我的病人吉姆那里，分析中的这种情况被描述为不赢的局面——正如他所说，"如果我赢了，我就输了；如果我输了，我就输了"。我们可以提醒自己，我们在一些偏执家庭中看到的 "不赢 "情况，最突出的是格洛丽亚家。患者的外化结构了现实，以至于成为一个令人沮丧的现实。 Giovacchini (1967) hesitates to call this projection, since it is not the attribution of hostile wishes to a persecuting figure, but rather represents a mode of adjustment which makes interaction between self and the outer world possible. He prefers to label this externalization, although the latter, it seems, is built upon projection, since the construction of reality necessarily involves the attributing of unacceptable and particularly hostile impulses to external objects. The clinical situation which Giovacchini describes is readily verifiable, but it may not be helpful to describe the situation merely in terms of externalization. It is not clear how the externalization specifically differs from projection. Giovacchini(1967)不愿意将此称为 "投射"，因为它不是把敌意的愿望归于一个迫害性的人物，而是代表一种调整模式，使自体与外部世界之间的互动成为可能。他更倾向于将其贴上外化的标签，尽管后者似乎是建立在投射的基础上，因为现实的建构必然涉及到将不可接受的、特别是敌意的冲动归因于外部客体。Giovacchini所描述的临床情况是很容易验证的，但仅仅用外化来描述这种情况可能是没有帮助的。目前还不清楚外化与投射有什么具体区别。 It is nonetheless clear that such patients with characterological defects do indeed project, and that they construct reality to support and verify the projections. We will deal with this aspect of the paranoid process later in terms of the paranoid construction. What is at issue is the patient's need to fail. He must create an environment, both in the external world and in the analysis, in which he can feel frustrated and defeated. 尽管如此，很明显，这类有性格缺陷的患者确实会投射，而且他们会建构现实来支持和验证投射。后面我们将从偏执的建构方面来讨论偏执过程的这一方面。问题的关键在于病人对失败的需要。他必须在外部世界和分析中创造一个环境，让他感到挫折和失败。