Manifestations 表现 If we look at the experience of the patients whom we have described, we can begin to appreciate the extent to which the paranoid construction forms a central aspect of their pathology. For all of them it forms a view of the world and of themselves which gives a specific quality to their experience. The manifestations of it vary, as might be expected. For Bob, the paranoid construction expressed itself most vividly in his acute delusional system. But that certainly seemed to have been an acute and exacerbated and highly defensively organized view of his world and his place in it. The delusional quality of this construction, as well as its defensive purposes, are not difficult to see. This is particularly true since almost every point in Bob's delusional system answered to an underlying need or defect that he felt in himself. Moreover the interpretive and constructional aspect of this cognitive organization is quite apparent. The grandiose delusional notion of belonging to an undying and powerful race of gods has obvious compensatory and restitutional components. 如果我们看一下我们所描述的病人的经历，我们就能开始理解偏执建构在多大程度上构成了他们病理的中心方面。对他们所有人来说，它形成了一种对世界和自身的看法，这种看法赋予他们的经验以特定的性质。正如所预料的那样，它的表现形式各不相同。对鲍勃来说，偏执建构在他的急性妄想系统中表现得最为生动。但这显然是对他的世界和他在其中的地位的一种尖锐的、恶化的、高度防御地组织起来的观点。这个建构妄想性质，以及它的防御目的，是不难看出的。这一点尤其正确，因为在鲍勃的妄想系统中，几乎每一点都回应他在自己身上感受到的潜在需求或缺陷。此外，这一认知组织的解释和建构方面是相当明显的。这种自己属于永恒而强大的神族的夸大妄想信念具有明显的补偿和归还成分。 However, more subtle, as well as more chronic and difficult to assess, is the paranoid construction which characterized most of his premorbid experience and adjustment. In this aspect he saw himself as weak, defective, impotent, and as a victim of forces and persons which surrounded him and constantly took advantage of and in various ways diminished him. As we have already seen, this particular organization of his experience answered to several important influences generated within his family life and particularly related to the patterns of internalization which we have described. What I wish to emphasize at this point is that this aspect of Bob's experience formed a cognitive synthesis in which these various elements were combined to provide an interpretive schema, within which he was able to define his own sense of self, as well as to elaborate a schema by which he was able to interpret the world around him and its relevance and impact upon himself. 然而，更微妙、更长期、更难以评估的是偏执建构，这是他大部分病前经历和调整的特征。在这方面，他认为自己是软弱的、有缺陷的、无能的，是那些围绕着他、不断利用他、以各种方式贬低他的力量和人的牺牲品。正如我们已经看到的，他经验的这种特殊组织回应了他家庭生活中产生的，特别是与我们已经描述的内化模式有关的几个重要影响。在这一点上，我想强调的是，鲍勃经验的这一方面形成了一种认知综合，其中将这些不同的要素结合在一起以提供一种解释性图式，在其中他可以定义自己的自体感并精化一种图式，通过这种图式，他可以解释周围的世界及其对自己的相关性和影响。 In other patients as well, the paranoid construction manifests itself in characteristic ways. For Ann, the paranoid construction, in its most flamboyant and pathological form, expressed itself as an elaborate and highly developed Communist plot—worldwide in its implications and extension—which was directed toward her humiliation and destruction. For Ann, this particular construction, delusional as it obviously was, expressed only an intensified and elaborated form of the underlying construction which permeated her whole life's experience, namely, her sense of worthlessness and humiliation and victimization, particularly at the hands of her pathogenic mother. 在其他病人身上，偏执建构也以其特有的方式表现出来。对安娜来说，偏执建构，以其最浮夸和病态的形式，表现为一种精心设计和高度发展的共产主义阴谋——其影响和外延遍及全世界——直指她的羞辱和毁灭。对于安娜来说，这个特殊的建构，虽然很明显是妄想，只是表达了渗透在她整个人生经历中的深层建构的一种强化和精化的形式，即，她的无价值感，羞辱感和受害感，尤其是在她生病的母亲手中。 For Jim, who was able to function at a much higher level of personality organization and whose pathology was solidly stabilized at much higher neurotic levels, the perception of himself as weak, defective, special, inadequate, doomed forever to be a failure in life, seen in its cognitive perspective, forms an elaborate representation of himself and his relationship to the world, and conversely of the world and its relationship to himself, which served to stabilize his own fragile sense of self and to preserve a meaningful context of interaction with that world. The meaningfulness of this interaction was determined at many levels since it provided a persistent interpretive framework in which he could relate himself to other individuals around him and to other forces in his experience, but also functioned at a highly unconscious level to preserve a meaningful context of infantile relationships by which he defined and sustained his relationship with his parents. 对于吉姆来说，他能够在人格组织的更高水平上发挥功能，他的病理学坚实地稳定在更高的神经症水平上，他觉得自己是软弱的、有缺陷的、特别的、不胜任的、在人生中永远注定失败的，从其认知角度来看，构成了一个对他和他与世界的关系，以及相反地 世界和世界与他的关系的精化表征，这种表征稳定了他脆弱的自体感，保存了与那个世界互动的有意义的背景。这种互动的意义在许多层次上是确定，因为它提供了一个持续的解释框架，在其中他会将自己与他周围的其他个体，他经历中的其他力量联系起来，同时也在高度无意识水平上起到保持一种有意义的婴儿式关系的背景的作用，在这种关系中他定义和维持他与父母的关系。 Similarly, if we look at the experience of Karen, it seems quite clear that her view of herself as susceptible and vulnerable was part of an elaborate cognitive schema which allowed her to relate to the world of her experience. The pattern which that construction assumed was highly overdetermined by multiple influences, particularly those derived from her relationships with her primary objects. But the construction worked in such a way that it permitted her to not only define her relationship to the world, but to preserve within that definition aspects of the definition of herself that had emerged in the context of her infantile relationships with parental figures. 同样地，如果我们看看卡伦的经历，很明显，她认为自己易受影响和易受伤害的观点是一个复杂的认知图式的一部分，这个图式使她能够与自己经历的世界联系起来。这个建构所假定的模式是由多重影响高度决定的，特别是那些来自她与主要客体的关系的影响。但这种建构方式使她不仅能够定义自己与世界的关系，还能在这种定义中保留她对自己定义中 那些在她与父母的婴儿式关系产生的方面。 It should be apparent that what we are describing in these patients is not something that clinicians, who deal with psychopathology on a day to day basis, have not been quite familiar with. What I am emphasizing here is the cognitive and constructional aspects of these clinical phenomena. What I have described in Jim or Karen, for example, is content which is quite familiar in our understanding of the neuroses, but I am describing it here in terms of the paranoid construction for particular purposes of this analysis. The same material can be looked at in terms of fantasy formation, or in terms of Oedipal displacements, or in a variety of other ways. The point here, however, is that the patient derives an interpretive construction, which is based primarily on internal needs and pressures and which denies or selectively distorts available evidences in reality to support the internal formulation. My purpose in describing this process in these terms is to emphasize its continuity not only with severe forms of pathological distortion, but also with relatively normal and healthy cognitive processes which characterize every human being. 很明显，我们在这些病人身上描述的，并不是那些每天都在处理精神病理学的临床医生所不熟悉的。我在这里强调的是这些临床现象的认知和建构方面。例如，我在吉姆和卡伦中所描述的内容，在我们对神经官能症的理解中，是非常熟悉的，但我在这里为了分析的特殊目的 从偏执建构的角度进行描述。同样的材料也可以用幻想形成，或者俄狄浦斯情结置换，或者其他各种方式来看待。然而，这里的要点是，患者得到了一个解释性建构，它主要基于内部需求和压力，它否认或选择性地扭曲现实中可用的证据来支持内部构想。我用这些术语描述这一过程的目的是强调它的连续性，不仅是有严重形式的病态扭曲，也有每个人都有的相对正常和健康的认知过程。