Criticism 批评 Freud's formulations form the substantial basis for our modern conceptions of paranoia. Nonetheless they are subject to criticism on several grounds. First, there is no good evidence that Freud had any extensive experience with paranoid psychoses. His theories are based on written accounts of patients whom he never saw personally, or on several cases in which his contact with the patient was superficial at best. Second, the formulation of his views took the form rather of an adaptation and application of his theory of symptom formation based on the study of psychoneuroses, in particular of hysteria. This procedure was counter to his normal methodological conviction(Meissner,1971a) and seems to have been an exception to his normal pattern of clinical investigation. Third, the role of aggression in Freud's theory remained inchoate. He recognized the role of hostility in his early treatments of paranoia, but then any consideration of hostility seems to have been overwhelmed by his libidinal preoccupations. This is particularly true by the time of the writing of the Schreber case, in which hostility receives little or no mention. From our contemporary vantage point, it strikes us as strange that delusions of he end of the world could be analyzed in terms of withdrawal of libido without any mention of the obvious underlying hostility. Some hints occur as to the role of hostility in Freud's treatment of superego projections in his later writings. But these are only passing references. Freud's preoccupation throughout was with the supposed transformation of love into hate. Basing his thinking on this fixation point really forces him to the consideration of hate as a defense against libidinal involvements. It is easy to see how his theory of paranoia as a defense against repressed homosexuality fits this pattern quite well. It overlooks, however, that the basic problem to begin with may be in the management of hostility. 弗洛伊德的论述构成了我们现代偏执症概念的坚实基础。尽管如此，它们还是受到了多方面的批评。首先，没有充分的证据表明弗洛伊德对偏执型精神病有任何丰富的经验。他的理论是基于他从未亲自见过的病人的书面记录，或者是基于他与病人接触非常肤浅的几个案例。第二，他的观点的形成不是在对精神神经症，特别是歇斯底里症研究的基础上，对其症状形成理论的适配和应用。这一过程与他正常的方法学信念相悖(Meissner,1971a)，似乎是他正常的临床调查模式的一个例外。第三，攻击性在弗洛伊德理论中的作用尚不成熟。他认识到敌意在他早期治疗偏执的过程中所起的作用，但后来，任何对敌意的考虑似乎都被他对力比多的关注压倒了。这一点在写史瑞伯案例时尤为明显，在这个案例中，很少或根本没有提到敌意。从我们当代的观点来看，让我们感到很奇怪的是，世界末日的妄想可以从力比多撤回的角度来分析，却没有提及明显的潜在敌意。在弗洛伊德后期著作中有一些关于敌意作用的暗示，是在他处理超我投射的部分。但是这些只是传递在参考文献。弗洛伊德自始至终全神贯注于所谓的将爱转化为恨。把他的思想建立在这个固定的点上，确实迫使他把恨看作是对力比多卷入的一种防御。很容易看出，他的偏执症理论(即偏执是对被压抑的同性恋的防御)是如何很好地适合这个模式的。然而，它忽略了一开始的基本问题可能是对敌意的管理。