Pathological Organization 病理组织 As Kernberg(1970) pointed out in the pathology of narcissistic personalities, the grandiose and coldly controlling behavior of such patients can often be seen as a defense against the projection of basically oral rage which forms a central component of the psychopathology. This aspect of narcissistic pathology points to the primarily introjective component with its primitive, destructive, and depressive aspects. This is reflected in the clinical dialectic of introjection and projection, and in the sometimes difficult-to-detect distortion in object-relations. Where the introjective aspects come to dominate the inner realm of the patient's experience, there are often strong conscious feelings of inadequacy and inferiority. Kernberg(1970)在《自恋人格的病理学》中指出，这类患者的夸大和冷漠的控制行为通常可以被看作是对基本的口腔愤怒投射的防御[口腔是指性心理发展的第一个阶段]，而口腔愤怒是精神病理学的核心组成部分。这方面的自恋病理指向主要地为内摄的成分，及其原始的，破坏性的，和抑郁的方面。这反映在临床中对内摄和投射的辩证，以及有时难以察觉的客体关系的扭曲。当内摄的方面开始主导病人体验的内心世界时，往往会有强烈的不充分和自卑的感觉。 These feelings (as has been noted), caught up as they are in the narcissistic polarization of extremes, may alternate with grandiose and omnipotent fantasies. Frequently enough the omnipotence and narcissistic grandiosity of such self-demeaning patients is long and laborious in coming to the surface. The pathological organization of such personalities may often approach a borderline constellation. They may often resort regressively to primitive defense mechanisms of splitting, denial, projection, omnipotence and idealization. Usually they are able to preserve areas of adequate social functioning, often to the point of being able to mask the underlying pathology quite effectively. In addition they often demonstrate a remarkable capacity for consistent and effective work in some areas of their life which provides them with significant amounts of narcissistic reward and gratification. 这些感觉(如前所述)，在极端的自恋两极分化中被抓住，可能与夸大和全能的幻想交替出现。这种自我贬低的病人的无所不能和自恋性夸大，往往要花很长时间，费很大功夫才能浮出水面。这类人格的病理组织常常接近边缘水平。他们通常会退行性地诉诸原始的防御机制，如分裂、否认、投射、全能和理想化。通常他们能够保留足够的社会功能区域，通常能够有效地掩盖潜在的病理。此外，他们往往在生活的某些领域表现出持续而有效的工作能力，这为他们提供了大量的自恋奖励和满足感。 Such personality organization by no means excludes creative capacity in professional fields of endeavor. They are often outstanding leaders in areas of professional and academic life and may be distinguished performers in the arts. Moreover, more often than not, their insistence on living at the extremes and the depressive impact of failure to live up to and meet the demands of their narcissistic expectations serve as a greater impediment to their professional and artistic attainment. There is a failure to integrate ego-ideal precursors and idealized self-images; consequently, the grandiose self on one hand and the unmodified and primitive aggressive aspects of the superego on the other are left relatively intact. These structures are left at a primary introjective level of integration with the result that primitive elements of aggression, both oral and anal, are highly susceptible to reprojection in the form of paranoid projections. 这样的人格组织绝不排斥专业领域的创新能力。他们通常是专业和学术领域的杰出领导者，也可能是艺术领域的杰出表演者。此外，他们往往坚持极端的生活方式，未能达到自恋预期的要求所带来的抑郁影响，对他们的专业和艺术成就构成了更大的障碍。整合理想自我前体[理想自我跟超我可认为是差不多的东西]和理想化的自我形象的努力失败;因此，一方面是夸大自体，另一方面是未经修饰和原始的具有攻击性的超我，它们相对完整。这些结构处于整合的初级内摄水平，其结果是，攻击性的原始元素，无论是口腔的还是肛门的，都非常容易以偏执投射的形式重新投射出来。 While such individuals may show a pattern of authoritarian conformity, they nonetheless see themselves as getting away with something. It is often out of this context of narcissistic grandiosity and its attendant unleashing of primitive aggressive impulses and their correlative projection to the outer world that the antisocial tendencies and conflicts with authority arise. The narcissism in such cases may take the form of the demand that recognition and reward be given them without the necessity of having to work for it or earn it, along with the resentment at the failure of the world to respond to this demand, which may then take the further form of resentment and resistance to all forms of external control. This was, for example, the difficulty with our young student radical Fred. Behind his wish to destroy contemporary institutions was the intense resentment and bitter hatred of his father. But behind both of these, there was the insatiable and demanding narcissism which dictated the terms of his disappointment and bitterness toward both of these unresponsive and uncaring institutions. 虽然这些人可能表现出一种专制的从众模式，但他们仍然认为自己侥幸逃脱了某些事情。反社会倾向和与权威的冲突往往就是在这种自恋的夸大及其伴随的原始攻击性冲动的释放及其对外部世界的相关投射的背景下产生的。自恋在这种情况下可能采取这样的形式，比如要求不必工作或挣钱，就得到认可和报酬，或者怨恨世界没有响应这种要求，这可能会采取这种形式，比如进一步的怨恨和抵制各种形式的外部控制。例如，这就是我们年轻学生激进的弗雷德遇到的困难。在他摧毁当代制度的愿望背后，是对他父亲强烈的怨恨和刻骨仇恨。但在这两者的背后，有一种贪得无厌的、苛刻的自恋，这就决定了他对这两个冷漠无情的机构的失望和痛苦。