Delusional Projection 妄想性投射 The first task in this endeavor to gain theoretical precision and depth is to clarify, for our own understanding, the patterns of projection which manifest themselves in the clinical material we have been considering. I think this is particularly important, since it is often thought that projection is the basis of the paranoid delusional system. It is clear that all of our patients have been very much caught up in the process of projecting, but it is also clear that not all of them can in any way be said to have had a developed paranoid delusional system. There is in fact considerable variation in the patterns of projection. 为了获得理论上的精确性和深度，这项工作的第一个任务就是为了我们自己的理解，澄清我们一直在考虑的临床材料中所表现出来的投射模式。我认为这一点特别重要，因为人们常常认为投射是偏执妄想系统的基础。很明显，我们所有的病人都非常多地陷入了投射的过程中，但也很明显，无论如何也不能说所有的病人都有发达的偏执妄想系统。事实上，投射的模式有很大的差异。 In several of our patients we can point to a frank delusional system as such. For Ann it was the delusional belief that she was the object of a worldwide Communist conspiracy which was meant to undercut and destroy her. For Bob B., on the other hand, the delusional system which marked the acute phase of his illness centered around his belief that he belonged to a race of superhuman, godlike beings who were immune from injury and death and who were relatively omniscient and omnipotent. The persecutory aspect of Ann's delusional system is directly expressed. For Bob, however, it can only be inferred insofar as the grandiose position of power and invulnerability would seem to serve defensive intents against the implied and potential threat of attack or death. 在我们的一些病人中，我们可以指出这样一个明确的妄想系统。对安娜来说，她的妄想是认为自己是一个世界性的共产主义阴谋的目标，而这个阴谋的目的是要削弱和摧毁她。另一方面，对鲍勃来说，标志着他的疾病急性期的妄想系统围绕着他的信念，即他属于一个超人、神一样的种族，他们对伤害和死亡免疫，而且他们相对来说是全知全能的。安娜的妄想系统的迫害性直接表现出来。然而，对于鲍勃来说，它只能被推断为权力和不可侵犯的宏大地位似乎可以对隐含的和潜在的攻击或死亡威胁起到防御意图。 Moreover, for Ann the delusional belief remained a more or less fixed aspect of her pathology, even though it was not always explicit. At no point did she surrender the belief, and would repeatedly return to it at points of intensified stress. For Bob the belief was episodic and, when the psychotic process had been more or less compensated, the delusional belief was dissipated—such that he could regard it as a set of crazy ideas which were part of his psychosis and which he regarded as somehow ego-distant and alien. For Ann the projection, then, seemed to be quite direct, based on the introjection of the sadistic and persecuting mother. Consequently we can look or Ann's delusional system as a re-creation on another level of an important relationship with her mother. For Bob on the other hand what is projected is the narcissistic and defensively grandiose self-image. What stands out is the intense and delusional grandiose wish, and the threatening and persecutory aspects fade into the background, so that they are not explicitly presented. 此外，对安娜来说，妄想信念或多或少是她病态的一个固着方面，尽管它并不总是明确的。她从来没有放弃这种信念，在压力加剧时，她会一再回到这种信念。对鲍勃来说，这个信念是偶发性的，当精神病的过程或多或少得到补偿时，这个妄想的信念就消散了——因此他可以把它看成是一套疯狂的想法，这是他精神病的一部分，他认为这些想法在某种程度上是自我遥远的和陌生的。那么，对安娜来说，这种投射似乎是相当直接的，基于对虐待性和迫害性母亲的内摄。因此，我们可以把安娜的妄想系统看作是在另一个层面上与她母亲的重要关系的再创造。而对于鲍勃来说，投射的则是自恋和防御性的宏大的自体形象。突出的是强烈的、妄想的宏愿，而威胁性和迫害性的方面则消失在背景中，所以它们并没有明确地呈现出来。 For several of our other patients—and here I would include Clare, Don, Ellen, Gloria, and Henry—what we see is not so much a delusional system, as a vague conviction that people are out to get them, that they are the object of evil intentions of people around them, that they must be fearful and on guard toward hostile attacks, etc. Quite clearly in these cases the quality of the ideation is markedly paranoid and forms a relatively predominant aspect of their pathology, but the projections do not have an organized and formulated quality which would lend them to a systematic delusion. Moreover, at points of stress or decompensation, these patients do not produce systematic delusions, but rather have a marked intensification of their paranoid fears and anxieties. This is true even where the level of the patient's decompensation is clearly psychotic. 对于我们的其他几位病人——这里我会包括克莱尔、唐纳德、埃伦、格洛丽亚和亨利——我们所看到的与其说是一个妄想系统，不如说是一种模糊的信念，即人们都想惩罚或伤害他们，他们是周围人邪恶意图的目标，他们必须对敌对的攻击感到恐惧和警惕，等等。很明显，在这些情况下，思维的质量是明显的偏执，并形成了他们病理的一个相对主要的方面，但这些投射并不具有一种有组织的和制定的质量，这将使它们成为一种系统的错觉。此外，在应激或失代偿时，这些病人并不产生系统性的妄想，而是其偏执性的恐惧和焦虑明显加强。即使在病人的失代偿程度明显是精神病的情况下，也是如此。 The outcome for these patients is varied: for some it is the unleashing of aggressive and destructive attacks against themselves in the form of acute depression and suicidal attempts—this was the case for Clare, Don, and Henry particularly. But for others, like Ellen, there is a launching of a terrified and desperate counterattack which is intended to fight off and destroy the persecuting enemies. Moreover, in these cases we can clearly trace the basis for the projected attitudes. We can recognize that the destructive quality of the introjects is based primarily and in part on the sadistic, destructive, undercutting, undermining, and devaluing elements which were built into the highly ambivalent relationship with one or other or both parents. Thus for Gloria, the persecutory dread which she experienced in her most phobic and paranoid states was clearly a reflection of the sadistic, infantalizing, devaluing, and controlling aspects of her father, although the rejecting and unloving aspects of her cold and ungiving mother also played into this paranoid picture. 这些病人的结果是多种多样的：对一些人来说，是以急性抑郁症和自杀企图的形式对自己发动攻击性和破坏性的攻击——克莱尔、唐纳德和亨利的情况尤其如此。但对另一些人来说，比如埃伦，则是发起了惊恐而绝望的反击，其目的是为了击退和消灭迫害性敌人。此外，在这些病例中，我们可以清楚地追溯到被投射态度的基础。我们可以认识到，内摄物的破坏性特质主要和部分是基于与父母一方或另一方或双方高度矛盾的关系中所建立的虐待、破坏、削弱、破坏和贬低的因素。因此，对格洛丽亚来说，她在最恐惧和偏执的状态下所经历的迫害性恐惧，显然是她父亲的虐待、婴儿化、贬低和控制方面的反映，尽管她冷酷无情的母亲的拒绝和不爱的方面也在这种偏执的画面中起了作用。