Nightmares and Paranoia 噩梦和偏执症 A relevant question in regard to the problem of nightmares is whether there is any intrinsic relationship between the nightmare experience as such and the development of paranoid mechanisms (Mack, 1969). In his meta-psychological supplement to the theory of dreams, Freud (1917) commented on the resemblance of projection in dreams to paranoid projection. Certainly a case in point is the Wolf-Man, whose childhood nightmare we have discussed and who later developed a paranoid psychosis. Six years after he had completed his analysis with Freud, the Wolf-Man resumed treatment because of a paranoid psychosis with acute delusions of persecution (Brunswick, 1928; Gardner, 1971). Both the content and structure of his psychosis were related to the childhood nightmare. The psychosis seemed to have resulted from an unresolved homosexual transference to Freud, so that similar conflicts to those that were expressed in childhood dream permeated his awareness and diminished his capacity to test reality. The nightmare may well have been a form of infantile psychosis. 关于噩梦问题的一个相关问题是，噩梦经验本身和偏执机制的发展之间是否有任何内在的关系（Mack，1969）。弗洛伊德(1917)在其对梦的理论的元心理学补充中，评论了梦中的投射与偏执投射的相似性。当然，狼人就是一个典型的例子，我们已经讨论过他的童年噩梦，后来他发展成了偏执型精神病。在他完成与弗洛伊德的分析六年后，狼人因为偏执性精神病与急性迫害妄想而恢复了治疗（Brunswick，1928；Gardner，1971）。他的精神病的内容和结构都与童年的噩梦有关。精神病似乎是由于对弗洛伊德的同性恋移情未解决而导致的，因此与童年梦境中表达的类似冲突渗透到他的意识中，削弱了他检验现实的能力。梦魇很可能是一种婴儿精神病的形式。 One is indeed struck by the phenomenological similarity between nightmares and acute psychotic states. The terror is striking. The individual feels himself to be weak, helpless, and totally vulnerable to the attack of powerful external forces, which strive to destroy or annihilate him. Characteristically, the danger in the nightmare reflects more immediately the world of childhood fears and dangers—biting animals, snakes, monsters, spiders, or creatures of the child's world of fantasy or storybook or even television characters. Persecuting figures in a paranoid psychosis, however, are more likely to be either the subject's personal enemies or elements drawn from the patient's world of experience. 人们确实被噩梦和急性精神病状态在现象上的相似性所震撼。恐怖是惊人的。个体感到自己是软弱的、无助的、完全容易受到强大的外在力量的攻击，这些力量试图摧毁或消灭他。特点是，噩梦中的危险更直接地反映了童年的恐惧和危险世界--咬人的动物、蛇、怪兽、蜘蛛，或儿童幻想世界或故事书中的生物甚至电视人物。然而，在偏执型精神病中的迫害人物，更可能是主体的个人敌人或来自患者经验世界的元素。 In both states, the dreamer or the psychotic feels helpless and vulnerable to the violent attack that he feels is directed against him. The nightmare victim loses his grasp on reality not only in the dream but also sometimes even for a short period afterward. The reality testing of the psychotic also fails him during the period of his acute decompensation. The underlying conflicts and particularly the use of projective mechanisms are quite similar in both states. 在这两种状态下，做梦者或精神病患者都会感到无助，容易受到他认为是针对他的暴力攻击。噩梦患者不仅在梦中，有时甚至在梦后短时间内失去对现实的把握。精神病患者的现实检验也在他的急性失代偿期失效。在这两种状态下，潜在的冲突，特别是投射机制的使用是相当相似的。 It is striking, in this regard, that some patients find it difficult to draw the line between the persecutory and threatening experiences of the nightmares and their experiences in the waking state. Thus, little Fred F. was terrified by the rabid foxes of his nightmares, but also developed a severe phobic state in which he fantasied rabid foxes under his bed and prowling the woods where he played, ready to pounce on him and to bite him. Similarly Gloria G. lived in a dream world, in which she was constantly under attack from malicious forces and murderous individuals who attack and kill her. But her living and waking world was filled with the same fears and threats. It was as if the dream and reality for her were one. 在这方面，令人注目的是，有些患者很难在噩梦的迫害性和威胁性体验 与 清醒状态下的体验 之间划清界限。因此，小弗雷德被噩梦中的疯狐吓坏了，但同时也产生了严重的恐惧症状态，他幻想着疯狐在他的床下，在他玩耍的树林里徘徊，随时准备扑上去咬他。同样，格洛丽亚也生活在梦境中，在梦境中，她不断受到恶势力和凶徒的攻击，对她进行攻击和杀害。但她的生活世界和清醒的世界却充满了同样的恐惧和威胁。对她来说，仿佛梦境和现实是一体的。 The vital difference, however, between the nightmare and a psychotic state is that one can awaken from the nightmare and leave its terrors in the land of dreams, but for the decompensated psychotic the nightmare becomes a dream from which he does not awaken. Discussing this striking similarity, Mack writes as follows: 然而，噩梦和精神病状态的重要区别在于，一个个体可以从噩梦中醒来，并把它的恐怖留在梦境中，但对失代偿的精神病患者来说，噩梦就成了一个他不会从中醒来的梦。在论述这种惊人的相似性时，麦克写道： For the nightmare victim and the psychosis-prone individual, the immediate precipitating factors have re-evoked painful memories of abandonment by infantile love objects and conflicts over annihilation, oral incorporation, and destructiveness. Both the nightmare and the acute psychosis reflect the ego's efforts to deal with these early anxieties and conflicts through the construction of a primitive symbolic structure whose content is derived from the interweaving of the residues of day time experience and regressively revived early memories. This regressive re-evoking of fantasies of violent attack is of particular importance in the dramatic intensification of anxiety that occurs in both nightmares and acute psychosis (1970, p. 173). 对于噩梦受害者和精神病患者来说，直接的诱发因素重新唤起了被幼年所爱客体遗弃的痛苦记忆，以及关于湮灭、口并入和破坏性的冲突。噩梦和急性精神病都反映了自我通过建构一个原始的符号结构来处理这些早期的焦虑和冲突的努力，其内容来自于白天经验的残余 和 退行式复苏的早期记忆 的交织。这种暴力攻击幻想 的退行性再唤起，对于在噩梦和急性精神病中出现的焦虑的急剧强化具有特别重要的意义（1970，第173页）。 Thus the nightmares and night terrors of childhood may serve as precursors of later paranoid manifestations. One of the striking findings in the case material that we have presented is that persistent early nightmares were a predominant feature of their childhood histories. The themes and content are frequently the same: conflicts over passivity, over helplessness and vulnerability, conflicts over intense ambivalence and the yearning for love accompanied by a terror of rejection and repulsion, and the tendency to resort to projective defenses. The conflicts are rooted in intense, dependent oral longings and wishes for fusion with the parent, along with destructive hatred that is projected onto the menacing persecutor. In the dream the madness is reversible, and it can be escaped by a flight into consciousness. 因此，童年的噩梦和夜惊可能是日后偏执表现的前兆。在我们所介绍的病例材料中，一个引人注目的发现是，持续的早期噩梦是他们童年历史的主要特征。其主题和内容经常是相同的：对被动的冲突、对无助和脆弱的冲突，对强烈的矛盾心理和对爱的渴望的冲突，伴随着对拒绝和排斥的恐惧，以及诉诸投射性防御的倾向。这些冲突植根于强烈的、依赖性的 口渴望 和与父母融合的愿望，以及投射到威胁性迫害者身上的破坏性仇恨。在梦中，这种疯狂是可逆的，它可以通过飞入意识中来逃避。 And, in addition, an important aspect of the whole process—one which Mack has taken particular note of—is the manner in which the parents respond to the nightmare experience. In our case histories, and particularly in the family studies, there is apparent an inability on the part of the parents to deal with the child's anxieties in a comforting, reassuring, supportive and loving manner. It is too often in these cases as though the inner world of the parent himself were peopled with threatening objects and dangerous eventualities. What the parent communicates to these troubled children is a sense of his own insecurity and threatenedness and anxiety. What the child internalizes is the threatening and threatened aspects of the parents' inner world, around which these anxieties cluster and feed. One can at least speculate in this context that the parent's failure to assist the child to learn to discriminate between the dream and reality, between the world of fantasy and the world of real things that surrounds him, contributes significantly to the impairment in reality testing that is so frequently seen in such patients. 此外，整个过程的一个重要方面——麦克特别注意到了——是父母对噩梦经历的反应方式。在我们的病例史中，特别是在家庭研究中，父母显然没有能力以一种安慰、安抚、支持和爱的方式来处理孩子的焦虑。在这些病例中，父母自己的内心世界往往仿佛充斥着威胁的客体和危险的可能发生的坏事情。父母传达给这些问题儿童的，是他自己的不安全感、被威胁感和焦虑感。孩子内化的是父母内心世界的威胁性和被威胁性，焦虑围绕着这些威胁性和被威胁性聚集和滋生。在这种情况下，我们至少可以推测，父母没有帮助孩子学会区分梦境和现实，没有帮助孩子学会区分他周围的幻想世界和现实客体的世界，这在很大程度上造成了这类患者经常出现的现实检验的障碍。