Enuresis 尿床 We have taken note in passing of the prominence of enuretic symptoms in a number of these patients and of its role in their developmental experience. In all of these cases it is apparent that the parents used shaming as a form of disciplinary regulation. Thus the shaming experience based on persistent enuresis and its regressive determinants became a focus for the emerging sense of self as shameful and defective that played such a prominent role in the pathology of these patients. Enuresis is not significant in this development, except as a focus by which the shaming tendencies of the parents could be expressed and by which the child could elicit and channel the parent's shaming tendency. 我们已经注意到，在这些病人中，有许多人表现出明显的遗尿症状，并注意到遗尿症状在他们的发展过程中所起的作用。在所有这些案例中，很明显，家长将羞辱作为一种纪律约束的形式。因此，基于持续遗尿和它的退行决定因素，羞辱经历成了正在出现的自我意识的一个焦点，自我意识把自我感知为丢脸的和有缺陷的，这在这些患者的病理学中发挥了如此突出的作用。遗尿在这一发展过程中并不重要，除了作为父母的羞辱倾向得以表达的焦点，以及孩子引导父母羞辱倾向的焦点。 It is well known in general that enuresis is a not uncommon and highly multidetermined symptom. Often it is associated with situations which induce regression in the child—such as disappointments, rejections, abandonments, losses, birth of siblings, etc. The regressive loss of control over bladder functions offers the potentiality for shameful experience. But the pathogenic impact of it depends on the manner of the parent's shaming attack on the child, as well as upon the extent to which the child is forced to resort to the eliciting of shame in the context of interaction with the parents. What is apparent is not merely that the shaming inflicts a narcissistic injury on the child, but the latter in many ways invests himself in eliciting such injury. There is often a defiant quality to this, something to which Winnicott (1958) has called attention in terms of the "nuisance value of the symptoms." 众所周知，遗尿是一个不罕见的和高度多因素决定的症状。它通常与引起儿童退行的情况有关——如失望、拒绝、抛弃、失去、兄弟姐妹的出生等。对膀胱功能的退行性失控，有可能带来可耻的经历。但它的致病影响取决于父母对孩子的羞辱攻击的方式，以及在与父母互动的情况下，孩子被迫诉诸引出羞耻的程度。显而易见的是，这种羞耻感不仅会对孩子造成自恋式的伤害，而且后者在很多方面也会给自己带来这种伤害。这通常带有一种挑衅的性质，温尼科特(1958)在“症状的讨厌价值”方面引起了人们的注意。 The important points that need to be made at this juncture are the following: first, that the enuresis serves to elicit a shaming response from the parents; second, that the shaming activity on the part of the parent carries the potentiality for narcissistic injury; third, that the pathogenic impact of the shaming is a function of the extent to which the enuresis carries the connotation of parental failure or ineptitude which serves to make it a narcissistic defeat for the parents; fourth, that the effects of shaming are complexly related to aspects of parental psychopathology, often involving narcissistically susceptible areas of the parents' own personalities, which are projected onto the child and condemned and devalued and shamed in him; fifth, the shame experience together with the context of parental projection, often sets off a chain of contextual responses by which the child internalized the parental shaming attitude and sets about achieving a verification of the parental shaming attitude by prolonging the shame-inducing situation or by substituting other shame-producing symptoms or behaviors. 在这个节骨眼需要强调以下几点:第一，遗尿会引起父母的羞辱反应;第二，父母的羞辱行为具有自恋伤害的潜在性;第三，羞辱的致病影响是遗尿带有父母失败或无能的内涵程度的函数，它们对父母构成自恋失败;第四，羞辱的影响与父母的精神病理方面有着复杂的联系，通常涉及父母自身人格中自恋易感的部分，这些部分投射到孩子身上，在孩子身上受到谴责、贬低和羞耻感;第五,羞耻体验结合父母投射，常常引发一连串的相关的反应，通过这些反应，孩子内化父母的羞辱态度，开始通过延长招致羞辱的情境，或者做其他产生羞辱的症状或行为，来证实父母的羞辱态度。 Finally, it should be noted that shaming is a variant of blaming which we have identified as so closely involved in the paranoid process. We have already noted the role of blaming in setting the cognitive style as well as the defensive style in the family context. We will have more to say about this later, but the relationship of shaming to blaming should not be allowed to pass unnoticed. We will return to this subject later in connection with the development of delinquency or antisocial tendencies. 最后，应该指出的是，羞辱是责备的一种变体，我们已经确认它与偏执的过程密切相关。我们已经注意到责备在家庭环境中形成认知风格和防御风格的作用。关于这一点，我们以后会有更多的讨论，但是我们不应该忽视羞辱和责备之间的关系。我们将在以后谈到犯罪或反社会倾向的发展时再讨论这个问题。