Ambivalence and Disillusionment 矛盾和幻灭 The depressive position is the more evolved and more difficult in that it implies at least a minimal capacity to tolerate ambivalence. The same object is both loved and hated. It is the presence of a loving relation within the ambivalence which makes the depressive position so difficult and which creates the regressive pressures for retreat to a paranoid stance. The depressive position is in this sense a healthier and developmentally more advanced position. Perhaps more than anyone else, Searles (1965) has pointed to the presence of loving ambivalence and its importance in many of the sicker patients. The basic feelings which structure the pathological relation between mother and child are feelings of fondness, adoration, compassion, solicitude, loving loyalty, and dedication. The illness is generated not merely out of mutual hatred and rejection, but out of a genuine love in the relation. The hostility serves as an unconscious and mutual denial of deeply repressed and loving feelings. Searles describes graphically how an outburst of murderous rage in a paranoid patient stemmed not only from the depression of murderous feelings, but from ambivalent feelings, both tender and solicitous as well as murderous, which derived from the patient's early relation to her mother(1965,p.353). Love feelings are held as threatening and destructive and are repressed in a relatively primitive and poorly differentiated form. Love feelings are in fact poorly differentiated from primitive feelings of dependency and murderously destructive rage. This undifferentiated feeling complex occasionally breaks through repressive barriers in a frighteningly primitive form so that loving feelings must be avoided and repressed. The need is operative on both sides of the mother-child relation. The paranoid patient's libidinal impulses, therefore, both heterosexual as well as homosexual, carry with them these murderously ambivalent affects which threaten both the patient and his loved objects. 抑郁心位是更进化和更困难的，因为它意味着至少有最小的容忍矛盾心理的能力。同一个客体既爱又恨。正是在这种矛盾心理中存在着一种爱的关系，才使得抑郁心位变得如此艰难，才造成了回归到偏执状态的退行压力。从这个意义上说，抑郁心位是一种更健康、发展上更高级的心位。Searles(1965)指出了爱的矛盾心理的存在及其在许多病情较重的患者中的重要性。构成母亲与孩子病态关系的基本情感是喜爱、崇拜、怜悯、关怀、爱的忠诚，以及奉献。这种病不仅产生于相互的仇恨和拒绝，而且产生于关系中的真爱。这种敌意是一种对被深深地压抑和爱的感觉的无意识的、相互的否定。Searles生动地描述了偏执型患者的暴怒不仅来自于对谋杀感觉的压抑，而且来自于既温柔又关切，同时也谋杀的矛盾感觉，这源于患者与母亲的早期关系(1965年，第353页)。爱的感觉被认为是具有威胁性和破坏性的，并被以一种相对原始和不充分分化的形式压抑着。事实上，爱的感觉未能与依赖、谋杀性毁灭暴怒这些原始感觉充分分化开来。这种未分化的感觉复合体有时会以一种可怕的原始形式冲破压抑的藩篱，因此爱的感觉必须被避免和压抑。这种需要对母子关系的双方都是有效的。因此，偏执患者的力比多冲动，无论是异性恋力比多还是同性恋力比多，都带有这种充满杀气的矛盾情感，其对患者和他所爱客体都构成威胁。 Searles points out that the paranoid position serves the function of masking and denying intense dependency needs which are devouring and destructive. The devouring quality of these needs leads the patient to feel that his loving dependency will destroy its object, or else that he will take in so much of the object that he will be engulfed himself. The paranoid surrounds himself with threatening and rejecting objects and thus circumvents the dangers of dependency and closeness. The paranoid mobilizes scorn, cynicism, hostility, and distrust in a constant effort to defend himself from these underlying positive affects. Searles describes a sense of disillusionment in these patients which is quite apt. Disillusion normally involves a series of steps—the object is first seen as wholly good, then with the emergence of undesirable characteristics as wholly bad, and these two sides are finally integrated into some more realistic appraisal of the person. The paranoid is more or less fixed at the second stage. For the paranoid, the disillusioning experiences came too early or with too great intensity for him to be able to integrate them. He could not work through the feelings of hurt and painful disappointment to reach that level of compassionate acceptance which allows integration of the object as a whole but ambivalent one. Instead the disillusioning object becomes split into disparate ones, and if the trauma occurs early enough these disparate percepts never become firmly integrated. The adult fixation on the object as bad is both a reaction to unresolved disillusioning traumata in the past and an unconscious defense against positive feelings and the threat of disillusionment in the present. The paranoid's struggles with his persecutors are in effect struggles with the unmanageably painful and therefore repressed disappointments and disillusionments he has suffered from them. For, as Freud indicated in his discussion of Schreber, the person who is hated and feared as a persecutor was once loved and honored. 塞尔斯指出，偏执心位起到了掩蔽和否认强烈依赖需求的作用，而这种依赖需求是吞噬和破坏性的。这些需求的吞噬性使病人觉得他的爱的依赖会摧毁它的客体，否则他会吸收太多的客体而把自己吞没。偏执者以威胁性和拒绝性客体来包围自己，从而规避了依赖和亲近的危险。偏执者会调动起轻蔑、玩世不恭、敌意和不信任，不断努力保护自己不受这些潜在的积极影响。塞尔斯描述在这些患者中的一种幻灭，这个说法非常恰当。幻灭通常涉及一系列步骤——客体首先被视为全好,然后随着不受欢迎的特点出现而被视为全坏,这两方面最终融合为对这个人更现实的评价。偏执者或多或少固定在第二阶段。对于偏执者来说，幻灭的体验来得太早或太强烈，以至于他无法将它们融合在一起。他无法克服受伤和痛苦失望的感觉，从而达到同情的接受程度，以使客体成为一个完整但充满矛盾的整体。相反，幻灭的客体会分裂成不同的客体，如果创伤发生得足够早，这些不同的感知就永远不会牢固地融合在一起。成年人对坏客体的固着既是对过去未解决的幻灭创伤的一种反应，也是对积极情绪以及当下幻灭威胁的无意识防御。偏执者与迫害者的斗争实际上是与难以控制的痛苦斗争，从而压抑了他所遭受的失望和幻灭。正如弗洛伊德在对史瑞伯的讨论中指出的那样，作为迫害者而被憎恨和害怕的人，曾经是被爱戴和尊敬的。 These issues are profound and reach beyond pathology to the heart of human existence. It is not without reason that Schwartz (1963) could speak of paranoia and depression as an "existential"continuum. The difficulty of psychotherapy in paranoid states relates directly to this issue. The therapist must bring the patient face to face with his ambivalence and must help him to bear his depression and disillusionment—patient and therapist must move in the direction of what is most painful to each, not away from it. For many paranoid patients we cannot offer much more than human misery—without the murderous residues of infantile rage, hopefully. We hope for their capacity to love, to engage in the community of men—to share in human suffering without the torment of guilt, remorse, and hateful destructiveness. Speaking of the treatment of paranoid patients, Will has remarked: 这些问题意义深远，超出了病理学的范畴，深入到人类生存的核心。施瓦茨(1963)把偏执和抑郁称为“存在主义”的连续统，这不无道理。在偏执状态下进行心理治疗的难度与这个问题直接相关。治疗师必须让患者面对他的矛盾心理，必须帮助他忍受抑郁和幻灭——患者和治疗师必须朝着各自最痛苦的方向前进，而不是背离它。对于许多偏执患者来说，除了人类的痛苦之外，我们不能提供更多的东西——希望不带婴儿时期愤怒的谋杀残余物。我们希望他们有能力去爱，去参与到人类社会中来——去分担人类的痛苦，而不受内疚、悔恨和可恨的破坏性的折磨。谈到对偏执患者的治疗，威尔说: In this treatment procedure there is a reality that cannot be avoided, denied or talked away. There are losses that are not to be repaired; at best they can be acknowledged and the grief for them accepted. The great anxiety at separation, the haunting doubt of self, the ever-lurking fear of others, the living at the edge of loneliness—such are a part of one and may never be gone. Perhaps this is as it should be, no man being able without guilt to deny his being, or to divest himself entirely of that which has made him what he is. In psychotherapeutic work there is not a "recovery" of health, but only the gaining of strength to go on from what has been, into an unknown, with, perhaps, increased chance for both gain and loss, but with no clear prediction of the future. This courage to exist derives from some semblances of security in the past and must gain reinforcement in the present. There lies the task(1961a,p.86). 在这个治疗过程中，有一个现实是无法避免的，无法否认的，也无法用言语逃避的。有些损失是无法弥补的;他们最多只能被承认，他们的悲伤也只能被接受。分离时的巨大焦虑，对自我挥之不去的怀疑，对他人始终潜藏的恐惧，生活在孤独边缘的人——这些都是一个人的一部分，可能永远不会消失。也许这是应该的，没有人能够没有内疚地否认他的存在，或完全放弃使他成为他自己的东西。在精神治疗的工作中，没有健康的“恢复”，只有从已经发生的事情中获得继续前进的力量，走进未知，带着，也许增加了的获得和失去的机会，但没有对未来明确的预测。这种存在的勇气来自过去的一些安全迹象，必须在现在得到加强。任务就在这里(1961a，第86页)。