Acute Decompensation 急性失代偿 Concurrently with these events, the situation within the home became increasingly strained and difficult. The fights and arguments were frequent and increasingly intense. Gloria would engage in long and drawn-out discussions with her father. In these discussions she seemed unable to accept her father's point of view, but at the same time was unwilling to settle for anything else. She would keep the argument going by continuing to ply him with questions and by offering objections and counterarguments. The father—on his side—could not back away from the argument until he felt that Gloria had in fact accepted his point of view. The overall effect was to prolong the arguments almost interminably. 与此同时，家庭内部的情况变得越来越紧张和困难。打架吵架频繁而且越来越激烈。格洛里亚会和她父亲进行长时间的讨论。在这些讨论中，她似乎不能接受父亲的观点，但同时又不愿接受其他任何事情。她会不断地向他提出问题，提出反对意见和反驳意见，使论点继续下去。在格洛里亚实际上接受了他的观点之前，他的父亲无法从争论中抽身。其总体效果是几乎无休止地延长了争论。 The most difficult relationship, however, was with her mother. Mrs G.—as we shall see more in detail when we turn to the consideration of the family dynamics—was a rather depressed woman who felt very resentful when things did not go her way. This was particularly true when it came to the management of the household. She tended to be a somewhat sloppy housekeeper. Gloria would come out of her room from time to time and would do some bit of cleaning or other housework. Inevitably it was done in a manner that her mother did not approve of. Usually an argument would develop in which the mother would insist on Gloria's doing things her way or else minding her own business. Gloria in her turn would criticize her mother and constantly badger her about being lazy and not keeping the house as she should. It was clear that Gloria knew this to be a sensitive area for her mother and that her criticism and badgering had a provocative quality. Mrs.G. became increasingly exasperated with Gloria's behavior. She began pushing for Gloria to be hospitalized, but Mr.G. resisted this move. He could not bring himself to put his daughter in a hospital. The parents argued a fair amount over this issue. 然而，最困难的是和她母亲的关系。G.夫人——当我们谈到家庭动力学的时候，我们将会看到更多的细节——是一个相当沮丧的女人，当事情没有按照她的意愿发展时，她感到非常气愤。在家庭管理方面尤其如此。她是个有点邋遢的主妇。格洛丽亚会时不时地走出她的房间，做一些清洁或其他家务。不可避免地，她做这件事的方式是她母亲不赞成的。通常会有一场争论，母亲会坚持格洛里亚按照她的方式做事，或者管好她自己的事。格洛丽亚反过来也会批评她的母亲，不断地纠缠她，说她懒惰，不把房子收拾得井井有条。很明显，格洛丽亚知道这对她母亲来说是一个敏感的领域，她的批评和纠缠具有挑衅性。G.夫人对格洛丽亚的行为越来越恼火。她开始催促格洛里亚住院治疗，但G.先生反对此举。他不忍心把女儿送进医院。父母在这个问题上争论得很激烈。 The tension and level of conflict continued to rise. Finally, about a month before Gloria was to be admitted to the hospital, a rather critical episode occurred. I have found such episodes to play a significant part in the precipitation of the more acute phase of a paranoid process. It seems to represent an event that crystallizes the developing paranoid delusion and provides a sort of irrefutable proof to the validity of the paranoid claim. Patients will continually refer back to such an event in the course of subsequent therapy, as if making an appeal to a convincing experimentum crucis that verifies the paranoid delusion. Such indeed was the case with Gloria and this event. The details were a long time in emerging, but the events went something like this. Gloria was in her room cleaning around dinner time. Her mother had served the dinner and called Gloria to come to the table. Gloria did not come until several minutes later when the family was already seated at the table eating. When she walked into the dining room, her mother made a sarcastic remark about her coming to the table when she pleased rather than when the dinner was ready. Gloria became very angry at that point and launched into a verbal atack on her mother. The youngest sister, Glenda, who was just fourteen years old and who turned out to be a paranoid schizophrenic in her own right, became extremely upset at Gloria's attack on her mother. She leaped up and began to strike Gloria. Gloria fought back. The father and mother jumped up and tried to separate the struggling sisters. The father restrained Glenda while the mother tried to restrain Gloria. In the course of the struggle the mother slapped Gloria, apparently in an attempt to stop her hysterical screaming. The whole scene was an outbreak of violent and angry feelings, particularly on the part of the two sick daughters. The third daughter, Gladys, kept out of the fight. 紧张局势和冲突的程度持续上升。最后，在格洛丽亚被送进医院的前一个月，发生了一件非常严重的事情。我发现这样的情节在偏执过程的急性阶段的诱发中起着重要的作用。它似乎代表了一个事件，使得发展中的偏执妄想成形，并提供了一种无可辩驳的证据，证明偏执主张的有效性。在随后的治疗过程中，患者会不断地回想起这样的事件，就好像是在求助于一个令人信服的关键实验，以验证偏执妄想。歌洛莉亚和这件事就是这样。细节的出现需要很长时间，但事情是这样的。晚饭时间，格洛丽亚正在打扫房间。她母亲已经准备好了晚餐，叫格洛里亚过来吃饭。格洛丽亚直到几分钟后才来，那时全家人已经坐在桌旁吃饭了。当她走进饭厅时，她母亲对她说了一句挖苦的话，说她是高兴时才来吃饭，而不是晚饭准备好时。格洛丽亚听了非常生气，开始对母亲进行言语攻击。最小的妹妹格伦达(Glenda)只有14岁，她自己也是一个偏执型精神分裂症患者。格伦达对格洛里亚攻击母亲的行为感到极为不满。她跳起来开始打歌洛莉亚。格洛丽亚进行反击。父亲和母亲跳了起来，试图把这对正在打斗的姐妹分开。父亲约束格伦达，母亲则试图约束格洛丽亚。在搏斗过程中，母亲打了格洛丽亚一巴掌，显然是想制止她歇斯底里的尖叫。整个场面爆发出暴力和愤怒的情绪，尤其是两个生病的女儿。第三个女儿格拉迪斯没有参加打斗。 Gloria was convinced from that moment on that her family was trying to kill her. She attributed this intention particularly to her mother. She would come back again and again to this episode and assert that the family had tried to kill her then. On each occasion that she would return to it, she would refer to it with obvious and intense anger. The episode was severely upsetting to the rest of the family as well. After it the second daughter, the twenty-year-old Gladys, decided to move out of the house. She gave as her reason that she could no longer tolerate the tension and conflict that Gloria was creating at home. The parents had the same feelings of growing intolerance of Gloria's more or less provocative and paranoid behavior. The deteriorating situation at home and finally the urging of the therapist made them determine to do something about the problem. 从那一刻起，格洛丽亚确信她的家人想要杀了她。她把这一意图特别归因于她母亲。她会一遍又一遍地回到这段情节中，声称当时她的家人试图杀死她。每次当她回到这个话题时，她都会带着明显而强烈的愤怒提及它。这件事也让家里其他的人非常难过。之后，二女儿，二十岁的格拉迪斯，决定搬出房子。她给出的理由是，她再也不能忍受格洛丽亚在家里制造的紧张和冲突了。家长们对格洛里亚多少有些挑衅性和偏执的行为也有同样的感觉，越来越不能容忍。不断恶化的家庭状况，以及最后治疗师的敦促，使他们决定做些什么来解决这个问题。 Gloria's complaint at the time of her hospitalization was that she was a being made the victim of her family's problems. Conversely, the family's complaint was that they were being made the victim of Gloria's problem. This pattern of dealing with problems by blaming was to prove significant in the understanding of Gloria's illness. But there was in fact an element of truth in both claims. Gloria was indeed victimized by her parents' problems to a significant degree, and it was also demonstrable that her illess had the effect of making them victims. It was an interlocking process of victimizing and being victimized. 格洛丽亚住院时的抱怨是，她成了家庭问题的受害者。相反，这家人的抱怨是，他们成了格洛里亚问题的受害者。这种通过责备来处理问题的模式被证明对理解格洛丽亚的病情很重要。但事实上，双方说法都有一定的道理。格洛丽亚确实在很大程度上是她父母的问题的受害者，这也表明她的病使他们成了受害者。这是一个相互关联的加害和被害的过程。