Influences on Self-esteem and Autonomy 对自尊和自主权的影响 We have pointed out that influences which undercut the child's sense of self-esteem and autonomy are closely related to the genesis of paranoia. Allport (1958) reviewed studies of the development of prejudice which, as we have seen, is a subvariant of the paranoid process. He concluded that the manner of a child's upbringing had a significant impact on the development of prejudice. Mothers of prejudiced children far more frequently express authoritarian and repressive attitudes, emphasizing the importance of obedience, compliance to parental demands, and repression of the child's spontaneous activity. Such mothers are more likely to punish the child for masturbation, while mothers of unprejudiced children tend to ignore it. The family atmosphere is suppressive, harsh, and critical. The parent's word is law. 我们已经指出，削弱孩子的自尊和自主感的影响与偏执症的成因密切相关。Allport(1958)回顾了偏见发展的研究，正如我们所见，偏见是偏执过程的一种亚型。他的结论是，孩子的教养方式对偏见的发展有重大影响。有偏见的孩子的母亲往往表现出专制和压抑的态度，强调听话重要性、服从父母的要求的重要性 和 压制孩子自发活动的重要性。这样的母亲更有可能因为孩子手淫而惩罚他们，而没有偏见的孩子的母亲往往会忽视这一点。家庭氛围是压抑的、严厉的、批判的。父母的话就是法律。 Allport concludes that the effect on the child is to put him on guard against his own impulses. Because of them he suffers both punishment and withdrawal of love—leaving him alone, exposed, and desolate. The child learns that the parents have the power to withhold love so that their power and will become decisive influences on him. The balance in his object-relations is shifted to a base in power and authority and away from trust and tolerance. The child comes to mistrust his own inner impulses, to mistrust himself and the evil in him, and by projection to fear the evil impulses in others. The world becomes threatening and not to be trusted. The incidence of prejudicial attitudes is related to rejective, neglectful, or inconsistent styles of training. Family backgrounds marked by quarreling, violence, or divorce are frequent. Rejection of the child by one or both parents is the rule. Anti-Semitic attitudes, for example, are not taught specifically by parents but seem to be taken in by the child from the infected family atmosphere (Allport, 1958). Allport的结论是，这对孩子的影响是让他提防自己的冲动。因为这些冲突，他承受着惩罚和爱的收回——扔下他一个孤独、暴露、凄凉。孩子知道父母有不给爱的能力，这样父母的能力和意愿就对他有决定性的影响。他的客体关系的平衡从信任和宽容转向了权力和专制的基础。孩子开始怀疑自己内心的冲动，怀疑自己和自己内心的邪恶，并通过投射来害怕别人内心的邪恶冲动[孩子将自己内心的邪恶投射到他人，成为他人的邪恶，并害怕他人的这种邪恶]。世界变得充满威胁，不值得信任。偏见态度的发生率与拒绝、忽视或不一致的训练方式有关。以争吵、暴力或离婚为特征的家庭背景是常见的。孩子被父母中的一方或双方拒绝是规则。例如，反犹太主义的态度并不是由父母专门教导的，而是由受感染的家庭氛围中的孩子所接受的(Allport, 1958)。 Conversely, tolerant children seem to come from homes in which there is a calm and permissive atmosphere. They feel welcome, accepted and loved, whether they are good or bad. Punishment is neither harsh nor inconsistent, so that the child does not have to be constantly on guard against evil impulses. Strategies of control using threat are relatively missing, so that the atmosphere which surrounds the child is one of security and acceptance. Consequently, the child is better able to accept himself and his impulses and to maintain a sense of his own value. Self-esteem is a by-product of parental acceptance and comfort with the child's impulsiveness and spontaneous expression of feelings. Since the parents do not feel the need to repress and control the child, the issues of his upbringing are not power or obedience rigidly enforced. There is room for the child to develop a sense of self-control without shame or doubt, and the sense of autonomy can follow its normal developmental course. 相反，宽容的孩子似乎来自平静、宽容的家庭。不管他们是好是坏，他们都感到受欢迎、被接受和被爱。惩罚既不严厉也不前后矛盾，这样孩子就不必经常提防邪恶的冲动。使用威胁的控制策略相对缺失，因此围绕着孩子的氛围是安全和接受的。因此，孩子能更好地接受自己和他的冲动，并保持自己的价值感。自尊是父母对孩子冲动和自发情感表达的接受和安慰的副产品。由于父母不觉得有必要压抑和控制孩子，他的成长问题不是严格执行的权力或服从。有空间让孩子发展没有羞愧或怀疑的自我控制感，自主感可以遵循其正常的发展过程。 While these issues of power-relations, control, and autonomy are often writ large in families of paranoid patients, the same issues can also be brought to bear in subtle and insidious ways that can only be illumined by careful examination of the patterns of interaction in families. This makes the problem all the more difficult to analyze and to treat. It is interesting, for example, that the series of family studies offered by Laing and Esterson (1964) contains material from eleven families—and ten of these show clearcut patterns of paranoid dynamics. Here again even though the diagnostic focus is on schizophrenia, the mechanisms at work seem to be relevant to the paranoid process in the family. In each of these families, mechanisms are at work constantly to undercut, devalue, and repress the autonomous functioning and independence of the affected member. Laing (1965) identifies the process as "mystification," by which he means the process by which the family interaction confuses, befuddles and masks the real nature of whatever is the real issue in the family negotiation. Similar phenomena have been described in terms of double-binds (Bateson et al., 1956) or pseudomutuality (Wynne et al., 1958). All of these mechanisms have the effect of confusing and muddling thought processes and limiting the capacity for those caught up in them to adequately test reality. Their influence is therefore growth inhibiting. But I would like to emphasize that in addition, or perhaps correlatively, they serve very effectively to inhibit the differentiation between the child's emerging self and the parents' selves. There is a tendency for symbiotic modes of interaction in which repressed impulses are communicated and shared so that the child participates in the parents' anxiety over issues of control and the feeling of threat and destructive evil that becomes attached to such impulses. The mechanisms of dealing with such problems operate to effectively convince the child of his inner evilness and lack of worth and impair his growth to autonomous independence and self-government. 虽然在偏执症患者的家庭中，这些权力关系、控制和自主权的问题显而易见，但同样的问题也会以微妙而隐伏的方式存在，只有通过对家庭中相互作用模式的仔细研究才能明白这一点。这使得问题更加难以分析和处理。有趣的是，例如，Laing和Esterson(1964)提供的一系列家庭研究包含了来自十一个家庭的材料——其中十个显示了清晰的偏执动力学模式。尽管诊断的重点是精神分裂症，但其工作机制似乎与家庭中的偏执过程有关。在这些家庭中，各种机制不断地削弱、贬低和压制受影响成员的自主功能和独立性。Laing(1965)将这一过程定义为“神秘化”，他指的是家庭互动 混淆、迷惑和掩盖了 家庭协商中真正问题的本质 的过程。类似的现象也被描述为双结合(Bateson et al.， 1956)或伪相互关系(Wynne et al.， 1958)。所有这些机制的作用是使思维过程难以理解和糊涂，限制了那些陷入其中的人充分检验现实的能力。因此，它们的影响是生长抑制。但我想强调的是，除此之外，或许是相关的，它们有效地抑制了孩子的自体和父母的自体之间的分化。有一种互动的共生模式的趋势，在这种互动中，被压抑的冲动被交流和分享，这样孩子就会参与到父母对控制问题的焦虑，以及(与这种冲动相关的)威胁和破坏性的邪恶的感觉中。处理这类问题的机制有效地使孩子相信他内在的邪恶和价值的缺乏，妨碍他向自主、独立和自治的方向发展。 Such patterns of interaction apparently reach across cultural boundaries. Tseng (1969) has recently reported a Taiwan family in which eight members of the family were involved in a paranoid delusional system—a striking case of folie à famille. The family atmosphere was characterized by frequent conflicts, inhibition of anger and an inability to express angry feelings, a constant tendency for family members to blame others within and without the family as responsible for their difficulties, rigidity, argumentativeness, lack of insight, self-assertiveness and a marked fondness for preaching to others in a relentless attempt to persuade or convince them to change their perceptions. The father used what is described as a "brain-washing" technique to break down his son's resistance to the psychosis. This terribly sick and disruptively fragmented family achieved an increased sense of cohesiveness from their sharing in the delusional system. These same mechanisms of blaming and relentless convincing we have also seen in some of our clinical cases, although often the process is neither so blatant nor so generally effective as in the Taiwan family. 这种互动模式显然跨越了文化界限。Tseng(1969)最近报道了一个台湾家庭，该家庭的八名成员卷入到了一个偏执妄想症系统——这是一个典型的家庭疯狂案例。家庭气氛表现为频繁的冲突，对愤怒的抑制 和 无法表达愤怒的感情，家庭成员倾向于责怪别人(无论家里家外)要为他们的困难负责，刚性，好争辩，缺乏洞察力，自我断言 和 喜欢无情地说教他人以使对方改变他们的看法。这位父亲使用了一种被称为“洗脑”的技术来瓦解他儿子对精神病的抵抗。这个病得很重、支离破碎的家庭，通过在这个妄想的系统中共享，获得了一种增强的凝聚感。在我们的一些临床案例中，我们也看到了同样的指责和无情的说服机制，尽管这一过程通常不像台湾家庭那样明目张胆，也没有普遍的效果。 An interesting cross-cultural study was reported several years ago by Hitson and Funkenstein (1959). They studied the relationships between types of family patterns, types of personality disposition, and types of mental illness in two divergent social structures. They studied differences in depressed and paranoid patients in Boston and Burma. In Boston, they found that the dominant parent (usually the father) of the depressed patient tended to put responsibility on the child and punished him because he "ought" to have done something or known what was expected of him. But in paranoid families, there was no "ought." The child was expected simply to follow the often inconsistent rules laid down by the dominant parent without question or complaint. They conclude that depressed patients learn the moral imperative early in life, but that the paranoid as a child learns to protect himself from a hostile and unpredictable environment by denying his own responsibility and throwing the blame elsewhere. In Burma, similarly, fathers are dominant and children submissive, but "ought" is not involved. Misbehavior is justified on the grounds that children are not responsible. Correlatively, the Burmese show a strong paranoid cast and tend to see their environment as potentially harmful. Paranoid forms of illness predominate over depressive and there is a high homicidal rate. This kind of information is consistent with our previous conclusions regarding paranoid and depressive states. But it becomes apparent that patterns of child-rearing and family interaction can have significant influences on the development of these states. 几年前，Hitson和Funkenstein(1959)报道了一项有趣的跨文化研究。他们研究了两种不同社会结构中家庭模式类型、性格倾向类型和精神疾病类型之间的关系。他们研究了波士顿和缅甸抑郁和偏执患者的差异。在波士顿，他们发现，抑郁患者占主导地位的父母(通常是父亲)倾向于把责任推给孩子并惩罚他，因为他“应该”做些什么，或者知道对他的期望是什么。但在偏执家庭中，没有“应该”。他们期望孩子毫无疑问或毫无怨言地遵守占主导地位的父母制定的经常不一致的规则。他们得出的结论是，抑郁患者在很小的时候就学会了道德上的责任，而偏执患者在孩提时代就学会了通过否认自己的责任和推卸责任至他人来保护自己不受充满敌意和不可预测的环境的伤害。同样，在缅甸，父亲占主导地位，孩子们顺从，但没有“应该”。行为不当是正当的[因为没有“你应该”]，理由是孩子不应负责任。相对而言，缅甸人表现出了强大的偏执投射[此处的cast翻译为投射合适吗？]，倾向于认为他们的环境是潜在的有害的。疾病的偏执形式比抑郁形式更主导，而且有很高的杀人率。这类信息与我们之前关于偏执和抑郁状态的结论是一致的。但很明显，育儿和家庭互动的模式会对这些状态的发展产生重大影响。