The "Exceptions" 例外 A particularly interesting manifestation of paranoid pathology is the process of narcissistic fixation in connection with bodily defects. Physical deformity can become a significantly pathogenic element in the formation and preservation of narcissistic disturbances. In discussing character types, Freud (1916) described what he called the "exceptions." These were patients in whom congenital anomalies or physical malformations had occurred early in life and who consequently refused to accept the regulation or limitation imposed by reality. These defects were often minor or hidden imperfections, but they became the vehicle for the expression of often intense narcissism. Such patients often manifest the residues of an unresolved narcissistic injury(Bing and Marburg,1962). The unresolved narcissistic injury may result in compensatory narcissistic grandiosity or increased aggression, often expressed in temper tantrums or outbursts of rage. Such patients frequently entertain fantasies of revenge along with fantasies of birth and rebirth. The themes of omnipotence and immortality are often woven through the fabric of such fantasies. Patients will cling to a fantasy of invulnerability and invincibility with a persistence and tenacity which assume almost delusional intensity. This characteristic is often found in creative or artistic personalities who attribute to their creative activities a quality of great significance or timelessness(Niederland,1965). 偏执病理的一个特别有趣的表现是与身体缺陷相关的自恋固着的过程。身体畸形可以成为自恋障碍形成和保持的重要致病因素。在讨论性格类型时，弗洛伊德(1916)描述了他所谓的“例外”。这些患者的先天性畸形或身体畸形发生在生命早期，因此他们拒绝接受现实强加的规则或限制。这些缺陷往往是微小的或隐藏的缺陷，但它们成为往往是强烈的自恋表达的工具。这些患者常常表现为未解决的自恋伤害的残留(Bing和Marburg,1962)。未解决的自恋伤害可能导致补偿性自恋夸大或增加的攻击性，通常表现为发脾气或勃然大怒。这类患者经常怀有复仇的幻想，以及出生和重生的幻想。全能和不朽的主题经常被编织在这些幻想的织物中。病人会抱着坚不可摧和不可战胜的幻想，坚韧不拔，不屈不挠，几乎到了妄想的程度。这一特点经常出现在创造性或艺术性人格中，他们认为他们的创造性活动具有重要意义或永恒的品质(尼德兰，1965)。 Often the defect is cloaked with a secrecy and a context of magical connotations and may be concealed in the course of analysis until the second year or even later. As we have noted, this area of the patient's traumatized narcissism is often shrouded in secrecy and hidden from the attention or inquiry of the analyst. There is often a linkage of secrets and a keeping of secrets to this secret defect. This, as we can recall, was a significant aspect of the pathology in our patient Jim. The heart defect, for which he was operated on at the age of five, was kept as a terrible and powerful—even magical—secret, which formed a special bond between himself and his mother. As a child, and even later into his young adult years, the emphasis on secrets and the significance of secrets as a vehicle of maintaining his contact with his mother and the sense of narcissistic investment he derived from her were significant aspects of his family involvement. The secrets inevitably had to do with the ultimate secret of his defectiveness and the link that it established to his specialness as her defective baby who needed to be cared for and protected. While there were Oedipal elements in this yearning for closeness and special relationship with his mother, the determinants were to a significant degree also pregenital. His inner defect became a special focus and highly cathected core of his narcissistic disorder. Beyond the defect, there was the hidden aspect of things that were powerful and magical and overburdened with sadistic destructiveness. The anal implications of such material were transparent. To keep the defect a secret, as to hide his feces, represented a narcissistic empowerment to Jimmy, and represented the grandiose and fantasied power which lay behind and was cloaked by the special magical quality of his defectiveness. Thus the narcissistic trauma was magically undone. 这种缺陷常常被隐藏在一种神秘的、具有魔力内涵的环境中，并且可能在分析过程中被隐藏起来，直到第二年甚至更晚。正如我们所注意到的，病人被创伤的自恋的这一区域常常被隐藏起来，不被分析人员注意或询问。这一秘密缺陷常常与秘密和保守秘密联系在一起。我们可以回忆起，这是我们的病人吉姆病理的一个重要方面。他在五岁时因心脏缺陷接受了手术，这一可怕而强大的——甚至是神奇的——秘密被保留了下来，这在他和母亲之间形成了一种特殊的纽带。作为一个孩子，甚至后来进入他的青年时代，对秘密的强调和秘密作为他与母亲保持联系的工具的重要性，以及他从母亲那里获得的自恋投资感，是他家庭关系的重要方面。这些秘密不可避免地与他的缺陷的终极秘密有关，并与他作为她的缺陷婴儿需要被照顾和保护的特殊性建立了联系。虽然有俄狄浦斯的因素在这种渴望与他母亲亲密和特殊的关系中，决定因素也在很大程度上是前性器。他的内在缺陷成为他自恋障碍的一个特殊焦点和高度精神投入的核心。除了这些缺点之外，还有一些隐藏的东西，它们强大而神奇，充满了施虐的破坏性。这种材料的肛门含义是显而易见的。把缺陷隐藏起来，就像把他的粪便藏起来一样，对吉米来说，这代表了一种自恋性的赋予力量，也代表了一种夸大而幻想的力量，这种力量隐藏在吉米的缺陷背后，被他缺陷的特殊的具有魔力的品质所掩盖。于是，自恋的创伤神奇地消失了。 As was evident in Jimmy's case—as also to a certain extent in Bob's where the defect was a more specifically genital defect—the narcissistic fixation and related trauma were significantly involved with the mother's pathology. This aspect of the pathology of narcissistic traumata in defective children has been focused on by Lax (1972). During pregnancy there is a marked shift of libidinal concentration on the self within the mother, so that her expanding self-representation is more intensely cathected with narcissism. This established a more or less symbiotic bond between herself and the infant-to-be. The symbiosis, nonetheless, continues after birth so that the child, even though he comes to be regarded as an object now separated from the mother's body, is nonetheless cathected with a fusion of narcissistic and object libido. 吉米的情况很明显——而鲍勃的情况在一定程度上也是如此，他的缺陷更具体地说是生殖器缺陷——自恋固着和相关的创伤与母亲的病理有显著的关系。Lax(1972)着重研究了缺陷儿童自恋性创伤病理的这一方面。在怀孕期间，母亲内在的自我有一个明显的力比多注意力的转移，因此她不断扩大的自体表征更强烈地被自恋所精神投入。这在她和即将出生的婴儿之间建立了一种或多或少的共生关系。尽管如此，这种共生关系在孩子出生后仍在继续，因此，即使他被视为一个与母亲的身体分离的客体，但他仍然被一种自恋与客体力比多的融合所精神投入。 When the child turns out to be somehow defective, the mother's worst fears during pregnancy of the child being misshapen or retarded or otherwise undeveloped are realized. The effect is a severe narcissistic trauma. The intensity and pathogenicity of this result depend on the degree of narcissistic distortion present in the mother. Since the child is a split-off portion of the mother's self, a defective child profoundly affects the mother's self-image. The impairment of the mother's self-image is followed by a sense of devaluation and feelings of evilness and worthlessness. 当孩子被证明有某种缺陷时，母亲在怀孕期间对孩子畸形、弱智或发育不全的最大恐惧就会实现。其结果是严重的自恋创伤。这个结果的强度和致病性取决于母亲自恋扭曲的程度。因为孩子是母亲自我的一部分，一个有缺陷的孩子会深刻地影响母亲的自我形象。母亲的自我形象受到损害后，随之而来的是一种贬低感和邪恶与无价值感。 These feelings are intensified to the extent that the child may come to represent a compensation for the earlier narcissistic wound involved in the little girl's lack of a penis. The more intense, therefore, the element of penis envy in such mothers, the more debilitating is the narcissistic affront. The birth of a defective child rekindles these latent, unconscious conflicts and their related resentments. The child comes to represent the mother's unconscious and infantile-damaged and deprived self. The mother is often overwhelmed with a sense of hopelessness and failure. The assault on the mother's self-esteem, and her sense of helplessness, hopelessness, and defectiveness set the stage for the operation of the mechanism of depression. The highly cathected narcissistic aspiration for the compensating and wished-for baby is confronted by the ego's disappointment, and its realization of its helplessness to achieve the object of its aspiration. The disparity between the hoped-for ideal and the reality evokes a narcissistic mortification, a depletion and impairment of the self-representation. Depression follows due to the shift in narcissistic equilibrium. 这些感觉被强化到这样一种程度:孩子可能代表着一种补偿，以弥补小女孩早期因缺少阴茎而造成的自恋创伤。因此，在这些母亲中，阴茎嫉妒的成分越强烈，自恋的冒犯就越让人虚弱。一个有缺陷的孩子的出生重新点燃了这些潜在的，无意识的冲突和他们相关的怨恨。孩子代表了母亲无意识的、婴儿式被伤害和剥夺的自体。母亲常常被绝望和失败感压倒。对母亲自尊的打击，以及她的无助感、绝望感和缺陷感，为抑郁症机制的运作奠定了基础。对补偿性和期待的婴儿的高度精神投入的自恋渴望，遭遇了自我的失望和对达成其愿望目标的无助感的实现。所期望的理想与现实之间的差距引起了自恋的屈辱、自我表征的耗竭和损害。自恋平衡的转变导致了抑郁。 An important element in this constellation of narcissistic vicissitudes is that the magnitude or obviousness of the child's defect has little to do with the severity of the depressive reaction (Niederland, 1965). The severity of the depression depends to the extent to which the mother sees the child as an externalization of her own defective self. We can judge, for example, from the obsessional concern and preoccupation demonstrated by Bob's mother over his undescended testicle and from the anxious and concerned worry and preoccupation evinced by Jimmy's mother over his patent ductus, that the physical anatomy became quickly overburdened by the weight of the mother's projection of defectiveness and inferiority onto the child. In both cases the projection reflected the underlying narcissistic deprivation that persisted in the mother's own self-image. In both cases the impact of the child's own emerging sense of self was considerable and could hardly have had any other effect but to diminish and deplete the child's own sense of narcissistic fulfillment. 自恋变迁的一个重要因素是，孩子缺陷的大小或明显程度与抑郁反应的严重程度无关(Niederland, 1965)。抑郁的严重程度取决于母亲将孩子视为自身缺陷外化的程度。我们可以从,例如,从鲍勃的妈妈对他睾丸未沉降的强迫关心和先占观念，从吉姆的妈妈对他奇怪的导管[todo：莫非是尿道的意思，等翻译了吉姆那章后再来修正]的焦虑、担忧和先占观念中判断，生理解剖学迅速被母亲在孩子身上投射的缺陷和劣等的重量所压倒。在这两个案例下，这种投射都反映了母亲自我形象中潜在的自恋剥夺。在这两种情况下，对孩子自己形成的自我意识的影响是相当大的，除了削弱和耗尽孩子自己的自恋满足感外，几乎不会有任何其他的影响。 Patterns of interaction between such mothers and their defective children can span a wide spectrum from hypersolicitude to complete rejection. Such mothers can completely deny the child's handicap, or they can excessively emphasize and magnify the defect. Often the mother's own narcissistic vulnerability cannot tolerate the mortification derived from the impaired child figure. The child is rejected, consequently, due to its incapacity to gratify and fulfill the mother's narcissistic needs. Often in such cases the overly protective and solicitous and concerned mother overcomes her wishes to neglect and even destroy the impaired child. Such attitudes would seem to reflect unconscious inner feelings of self-hatred and self-contempt, which are projected onto the child as the representative of the mother's own self-image. 这些母亲和她们有缺陷的孩子之间的互动模式可以跨越从过分关心到完全拒绝的广泛范围。这样的母亲可以完全否认孩子的缺陷，也可以过分强调和放大孩子的缺陷。通常情况下，母亲自身的自恋弱点无法忍受受损的孩子形象带来的屈辱。因此，孩子会被拒绝，因为他无法满足母亲的自恋需求。在这种情况下，过度保护和担心和关心的母亲往往克服她忽视甚至摧毁受损的孩子的愿望。这种态度似乎反映了无意识的自我憎恨和自我轻视的内心感受，这些情绪投射到孩子身上，成为母亲自我形象的代表。 While these dynamics are dramatically displayed in the mothers of defective children, one might wonder the role that they might play in the birth of female children. To the mother who devalues herself as a woman, the birth of a female child must in some way represent something analogous to the birth of a defective child. The child does not coincide with the mother's image of the narcissistically invested, hoped-for infant. The projection of this defective self-image onto the female child may therefore form the basis of a fundamental introjection, which serves to distort the child's emerging sense of self-awareness. Thus the chain of narcissistic disappointment can be handed down from generation to generation. Solnit and Stark have also described this process in terms of a mourning process (1961). The process is easily identifiable in each of our female patients. 当这些动力学在有缺陷的孩子的母亲身上戏剧性地表现出来时，人们可能会想知道它们在女孩的出生中可能扮演的角色。对于贬低自己作为一个女人的母亲来说，一个女孩的出生一定在某种程度上代表了某种类似于一个有缺陷的孩子的出生。孩子与母亲的自恋投资的、期望中的婴儿形象并不一致。因此，将这种有缺陷的自我形象投射到女孩身上，可能会形成一种基本的内摄，从而扭曲儿童正在形成的自我意识。这样，自恋的失望之情就会代代相传。索尔尼特和斯塔克也用哀悼过程的方式描述了这一过程(1961年)。这一过程在我们的每位女性患者中都很容易识别。