克恩伯格:人格是什么?
时间:2016年07月13日|2722次浏览|1次赞

WHAT IS PERSONALITY?人格是什么?

Otto F. Kernberg, MD 奥托·克恩伯格

mints译

Journal of Personality Disorders, Volume 30(2), 145-156, 2016

The concept of personality, in my view (Kernberg & Caligor, 2005; Posneret al, 2003), refers to the dynamic integration of the totality of a person’s subjective experience and behavior patterns, including both (1) conscious,concrete, and habitual behaviors, experiences of self and of the surrounding world, conscious, explicit psychic thinking, and habitual desires and fears and (2) unconscious behavior patterns, experiences and views, and intentional states. It is a dynamic integration insofar as it implies an organized, integrated association of multiple traits and experiences that influence each other, the final outcome of the coordination of multiple dispositions. In this regard, personality represents a much more complex and sophisticated entity than simply the sum of all its component features.

人格的概念,在我看来(Kernberg & Caligor, 2005; Posner et al, 2003),是一个人的主观经验和行为模式的动态整合,包括两个方面(1)对周围的世界,意识,明确的精神思维,和习惯性的欲望与恐惧之有意识的、具体的、以及习惯性行为、体验。以及(2)无意识的行为模式、经验和观点,以及有意识的状态。它是一个动态的整合,因为它是一种有组织的,相互影响的多样性状与经验的整体一体化的综合体,是多重气质协调的最终结果。在这一点上,人格代表了其所有组元特征的简单综合的更复杂和更微妙的实体。

Personality derives from the human organism’s capacity to experience subjective states that reflect the internal condition of the body as well as the perception of the external environment within which this body functions. It includes discrete psychic functions, such as affects, perception, cognition, and instrumental as well as declarative memory, and various levels of self-reflective functions, from relatively simple mirroring of perceived and intended motor movements and perceived sensory experiences to complex self-reflective evaluation of cognitive and affective states.

人格源于人类有机体对主观状态体验的能力,这种状态,即反映了身体的内部状态,也反映了在此外部环境之中这个身体功能的感知。它包括一些分离的心理功能,例如情感、知觉、认识,以及和陈述性记忆一样的工具性,以及各种层次的自我反思功能,从相对简单的镜像知觉,和预期的运动原的运动,以及知觉的感官体验,到复杂的认知和情感状态的自我反思评价。

The combination of the scientific advances in the area of genetic determination of neurotransmitters that activate and regulate various affective states, the observation of interacting relationships between baby and caregiver from birth on, and the observation of psychological functioning throughout early development and into adulthood is gradually facilitating an integrated view of the determinants of personality. The study of brain structures related to affect activation and control, instrumental and declarative development of memory, and cognitive capacities and the psychodynamic study of the intrapsychic relationships among behaviors, motivational states,fantasy, and registration of psychosocial reality are slowly finding contact boundaries. The study of the sociology of small groups and the psychological influence of educational and cultural mores and the study of specific types of organic and personality pathology jointly permit, I believe, establishing a general frame of reference regarding the dominant features of the personality and their harmonious or disharmonious functioning in health and illness.

激活和调节各种情感状态的神经递质的遗传性测定,对照顾者和婴儿从出生开始的交互关系的观察,以及从早期发展到成年的心理功能的观察,这些领域的科学进展的结合,逐步推动了人格决定因素的综合观。与对情感的激活与控制,工具性和陈述性的记忆发展的大脑结构的研究,以及对行为、动机、幻想和心理现实反映的认知能力与心理动力学的研究,都正在慢慢的寻找彼此接触的边界。我相信,小团体的社会学研究,教育和文化习俗的心理学影响,特定类型的有机体的研究,人格病理学共同的许可,这些都正在建立了一个关于人格及其在健康与疾病中的和谐与不和谐功能的主导特征的整体框架。

Probably all personality researchers and experts would agree that personality is codetermined by genetic and constitutional dispositions, on the one hand, and interaction of the individual with environmental, particularly psychosocial, features in the course of psychological development, on the other. However, enormous differences remain in the views of researchers in the relevant fields regarding the key determinants of the personality, their mutual influences, and assessment (Korner, 2010; Widiger & Mullins-Sweat, 2005). I believe that the main obstacle to progress in this general area of human knowledge is the temptation for a radical reductionism in the development of theoretical frames that, in turn, then influences the development of corresponding approaches and instruments to the study of personality, which may lead to apparently incompatible frames of reference.

可能所有的人格研究者和专家们都会同意,人格一方面是由基因以及本质的气质共同决定的,另一方面又决定于个体与环境的互动,尤其是社会心理的互动,心理发展过程之中的面貌。然而巨大的差异仍旧存在于关于决定人格的关键因素、他们的相互影响,以及评估领域的研究者的看法之中。我相信在促进这一人类知识的一般领域中的主要障碍是,在这些理论框架的发展中的激进的简化论的诱惑,进而,接下来会影响相应方法的发展,也会影响人格研究的工具,这些都可能会导致与参考框架明显不符。

For example, the psychoanalytic studies of personality constellations in the clinical practice of psychoanalytic investigation have permitted the description of major personality disorders, such as the narcissistic personality disorders (Akhtar, 1992), and, in fact, have provided major advances in the description of the constellation of features characterizing the entire field of personality disorders. At the same time, however, the neglect of neurobiological determinants of motivational systems and intentional states, and of the environmental determinants of personality features, has made any efforts to construct a satisfactory, purely psychoanalytically informed theory of personality and personality disorders clearly inadequate. By the same token, a radical reduction of personality studies to the descriptive mapping of personality traits and factor analytic evaluation of clusters of epidemiologically predominant characterological traits, an approach that treats across various “normal” populations, considers all traits as equivalent, and neglects deeper structures of organization of behavior, appears to be equally inadequate (Kernberg, 2012a). This is reflected in the problematic efforts to relate such a trait psychology to specific neurobiological structures and functions, without considering the complexity of the internal psychological organization of behavior that gives the same traits a completely different meaning in the context of different underlying structural dynamics. A simplistic model of traits determined by neurobiological features reflecting specific genetic determinants seems as inadequate as a simplistic psychodynamic model based on unconscious conflict constellations. The same criticism, I believe, could be directed at other theoretical approaches to personality that neglect the complexity of the neurobiological and intrapsychic structures involved, such as a simplistic model of normal or pathological psychosocial adaptation.

例如,在精神分析研究的临床实践中的人格类型的精神分析之中,已经使得对于例如自恋型人格障碍(Akhtar,1992)这样的主要人格障碍的描述成为了可能,而且,事实上,在描述人格障碍的整个领域特征的类型特征之中提供了重大的进展。然而,与此同时,对动机系统和刻意状态的神经神学因素,以及人特特征的环境决定因素的忽略,已经使得任何对建构一个满意的、纯粹的精神分析式地了解人格和人格障碍的努力明显缺乏信心。同理,对描述性的绘制人格特征和流行病学主要性格特征因素的分析评估的人格研究地图的缩减,在各种“正常”的人群中的治疗方法,认为所有的特征是相同的,以及忽略了行为组织中更深层次结构,似乎都是同样的不足 (Kernberg, 2012a)。这反映了与诸如特定的神经结构与功能有关的一种心理特征的有问题的努力,不考虑在给定的不同潜在的结构动力学背景之中的一个完全不同意义的内部心理组织的复杂性。反映着具体的遗传因素的神经生物学特征所决定的过于简单的特征模型,似乎与一个基于无意识冲突类型的心理动力学模型一样是不足以胜任的。我认为同样的指责也可以针对其他的人格理论方法,这些方法忽略了神经生物学和心灵内部结构的复杂性,例如包括,过于简单化的正常或病理心理社会适应模型。

What follows is an effort to approach the organizational structure of the personality from a multiplicity of viewpoints that corresponds to the collaborative work of the Personality Disorders Institute at Weill Cornell Medical College over the past 30 years. The main findings of this group on identity and identity disturbances now have a fundamental organizing place in the classification of personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013). It needs to be stressed that what follows certainly is not assumed to be the only or definitive way to integrate our presently evolving knowledge regarding personality structure, development, and pathology, but an approach that attempts to do justice to the various fundamental scientific developments now available for our evolving understanding of this field.

以下对人格组织结构的探讨来自于过去的30年里,威尔康奈尔医学院的人格障碍研究所协同工作的对应的多样性的观点。对这一群体的身份和身份困扰的主要的发现,在《精神障碍诊断与统计手册》第五版(DSM-5;美国精神病协会,2013)中有了一个基本的规划。需要强调的是,接下来可以肯定的, 对整合我们目前关于人格结构、发展和病理学不断发展的知识的方法的假设,不是唯一和最终的,而是一种试图公平的对待现在有利于我们理解这一领域的各种基础科学发展的方法。

THE COMPONENTS OF THE PERSONALITY 人格的组成部分

Our fundamental proposal considers personality as an umbrella organization that includes a small number of major component systems: temperament, object relations, character, identity, ethical value systems, and cognitive capability (intelligence).

我们的基本构想认为,作为伞型组织的人格所包括的少数主要组成系统是:气质、客体关系、性格、认同、道德价值体系,和认知能力(智力)。

TEMPERAMENT 气质

I consider temperament as the fundamental constitutive structure of the personality, represented by the general psychological reactivity of the organism, particularly psychomotor, cognitive, and affective reactivity (Kernberg, 1992; Panksepp, 1998). Affective reactivity is the fundamental aspect of the organism’s psychic operation, in terms of constituting the primary motivational system, relating the individual to the environment in terms of positive, rewarding, or negative, aversive affective states reflected, particularly, in peak affect state activation.Neurobiological affective systems are activated in response to organismic requirements that trigger alternative or combined activation of some of these systems. I am referring, particularly, to the attachment-separation panic system, the fight-flight system, the playbonding system, the erotic system, the feeding system, and the agentic panic system (Panksepp, 1998; Wright & Panksepp, 2012). Each of these systems’ response to organismic needs of the individual is constituted by a combined activation of specific brain structures and neurotransmitters, particularly specific neuropeptide and neuro-amine affective neurotransmitters, the serotonergic, dopaminergic, and noradrenergic systems.

我认为作为人格基本构成结构的气质,由有机体的一般心理现实、尤其是精神运动、认知和情感反应所代表(Kernberg, 1992; Panksepp, 1998)。情感反应是机体的心理运作的基本方面,在构成主要动力系统方面,与个体对环境中积极的、令人满意的、或消极的,厌恶的情感状态的反射相关,尤其和在高峰情感状态的激活相关。神经生物学情感系统在触发这些系统中的某些选择或组合活化的有机体组织需要的反应中被激活。我尤其是指,依恋—分离恐慌系统,战斗—逃跑系统,游戏—粘连系统,性欲系统,给食系统,以及代理恐慌系统(Panksepp, 1998; Wright & Panksepp, 2012)。这些系统中的每个系统对个体有机体需求的反应是由一个组合的激活反应构成,包括,对特定的大脑组织结构和神经递质、特别是特定的神经肽和神经胺情感递质,5-羟色胺、多巴胺,和去甲肾上腺素能系统的激活。

Of central relevance in early development is the attachment-separation panic system. It motivates the baby’s search for mother’s breast and mother’s bodily contact and represents the prototype of the establishment of relations with significant others (“object relations”). This system determines the establishment of internalized representations of these interactions with mother in the form of dyadic, affective memory units constituted by representations of self and representations of the “object,” within the context of a determined, dominant positive or negative primary affect.

在早期发展中关联的核心是依恋—分离恐慌系统。它激发了婴儿对母亲乳房和母亲的身体接触的搜索,并代表与重要他人(“客体关系”)建立关系的原型。这一系统决定了以二元的形式与母亲的相互作用构成了内化的建立,以及在一个确定的,占主导地位的积极或消极的主要影响的背景下,由自我和“客体” 表征构成情感记忆单位的建立。

CHARACTER AND EGO IDENTITY 性格与自我同一性

These internalized affective memory traces constitute the building blocks of internal representation of relationships with significant others (Kernberg, 1976). The repetitive activation of both extremely pleasurable and extremely unpleasurable and potentially traumatic affective experiences determines the primary motivation toward and away from an object. Within contemporary attachment theory, these motivational structures constitute internal models of behavior. Within psychoanalytic theory, these primary “ideal” and “all bad” internalized object relations will become organized into two major, mutually dissociated segments of “idealized” and feared or “persecutory” segments of earliest experience. Out of these internalized representations of relations with significant others—internal models of behavior—will derive habitual behavior patterns that, in their dynamic integration, eventually will constitute character, that is, the dynamically integrated structure of habitual behavior pattern. At the same time, in the gradual consolidation of all the integrated representations of self, surrounded, so to speak, by an integrated set of representations of significant others, ego identity or, rather, self-identity crystalizes, as the overall, integrated view of oneself and the nature of one’s habitual relations with significant others.

这些内化的情绪记忆痕迹构成了与重要他人关系的内在表征的积木 (Kernberg, 1976)。极端愉快与极端不愉快的重复激活和潜在地创伤性情感体验决定了主要的动机趋向,并远离一个客体。在当代依恋理论中,这些动机结构构成了行为的内部模型。在精神分析理论中,这些主要的“理想的”和“所有的坏的”内化的客体关系将成为组织成两个主要的,相互分离的“理想化”的碎片和早期体验中的“被迫害的”的碎片。由于这些与重要他人关系的内化表征——行为的内部模型——将衍生出习惯的行为模式,也就是,在他们的动力性整合中,最终将会形成性格。与此同时,逐渐使的自我和周围的表征结合成为整体,可以这么说,通过对那些重要他人、自我认同,以及甚至作为整体的自体认同结晶,自我的整合观点以及与那些重要他人的习惯关系的本质逐渐得到巩固。

In summary, so far, all these processes might be subsumed under the statement that temperament reflects the motivation for activation of interpersonal behavior, and the resulting internalized object relations will determine the development of character and identity: character as the objective, individualized integration of habitual behavior patterns, and identity as the subjective correspondent of character in terms of the integration of self-perception and experience and the experience of significant others. Identity and character are mutually complementary expressions of the organization of psychic life. Character traits, the behavioral expression of the internal models of behavior derived from internalized self and object representation units, express the reflection of past experience on present, mostly automatized, functioning modes of reaction. These traits, however, may depend in varying degrees on temperamental predispositions that influence past affective gratification or frustration of the person’s own needs and desires in the context of adaptive relations with significant others.

In addition, character traits may represent protective reactions against the expression of deeper needs felt to be risky or unacceptable in the interpersonal field. In other words, character traits may serve a defensive purpose, sometimes directed against impulses opposite to the behavior expressed in the character trait.

总之,到目前为止,可以将所有这些过程纳入以下的论述,气质反映人际行为激活的动机,而且,由此产生的内化客体关系将决定性格和认同的发展:作为客体,个体化的习惯行为模式的整合的性格,以及作为以自我感知体验和重要他人经验的整合所表示的性格的主观通讯的的认同。 同一性与性格是精神生活组织相互补充的表达。性格特征,内在行为模式的行为表达来自于内化的自体和客体表征单元,表达了基于当前的过去的经验的反射,反应模式的功能大部分是自动化的。然而,这些特征可能在不同程度上依赖于以下的气质诱因,影响与那些重要他人的适应性关系之背景下的这个人自己的需求与欲望的过去的情感满足或挫折。此外,性格特征可能代表了对人际交往领域中感觉是危险的或不可接受的更深层次的需求表达的保护反应。换言之,性格特征可以起到防御的目的,有时是针对与性格特征中与行为表达相反的冲动行为。

For example, habitual timidity may be an expression of a defensive reaction against projected aggressive trends, the projection onto others of intense negative affective experiences that are considered risky to express in the environment. But timidity, to stay with this example, may also express a defensive reaction against exhibitionistic impulses expressing erotic wishes that, equally, cannot be tolerated consciously. In general terms, character traits may serve defensive purposes against intolerable primitive aggressive and erotic impulses linked to early infantile and childhood experiences that can no longer be freely expressed in later developmental stages of the personality (Kernberg & Caligor, 2005).

例如,习惯性胆怯可能是对投射性攻击趋势的防御反应的一种表达,将紧张的消极情感体验投射到他人身上,是认为在环境中去表达是冒险的。但是,在这个例子中,胆怯也可能表达了一个对暴露癖式色情愿望的冲动表现的防御性反应,这个色情的愿望同样是不能被意识所容忍的。在一般条件下,性格特征可以起到防御的目的,对无法忍受的原始的攻击性和色情冲动的防御,这些攻击性和冲动与婴儿早期和童年的经历之中不能够再次在人格的以后发展阶段自由地表达有关(Kernberg & Caligor, 2005)。

Defensive characterological traits are characterized by their rigidity, that is, by their habitual activation, whether they are adaptively indicated at a certain point or not, leading to rigidification of the personality that is characteristic of personality disorders. They may signal inhibition within certain areas of affective expression, typically of a sexual or aggressive origin, or else, in a paradoxical mode, reactions against feared instinctual impulses may lead to exaggerated counter-phobic behaviors. In short, defensive character traits may be inhibitory, exaggerated, or “reaction formations,” and, particularly in the case of severe personality disorder, a contradictory combination of inhibitory and reactive formations that conveys a chaotic nature to the character structure so typical for these disorders.

As mentioned before, some traits may reflect non-conflictual, dominant temperamentally based dispositions, particularly introversion or extraversion. Characterological traits may reflect vicissitudes of the major neurotransmitters that influence the activation of primary affective systems, such as, for example, the accentuation of intensity of negative affects derived from decrease in the functioning of the serotonergic system and genetically determined hyper-reactivity of the amygdala to aversive perceptions.

防御的人格生物学特质以其刚性为特点,也就是说,无论他们是否在某一点上显示为自适应,通过他们习惯性的活化,导致了人格障碍的特征的人格的僵化。他们可能显著的抑制在一定区域内的情感表达、通常情况下,以性或攻击性的起源为代表,抑或,以一种矛盾的方式,对恐惧的本能冲动的反应会导致夸张的反惊恐行为。总之,风行的性格特征可能是抑制、夸张或“反向的形式”,而且,特别是在严重人格障碍的病例之中,抑制的矛盾组合,以及混乱本质的反应形式传达了这些障碍的如此典型的性格结构。如前所述,某些特征可能反映了非冲突、基于气质的主导性格,优势是内向或外向的的性格。人格生物学特质可能反应了主要的神经递质的变迁,这些神经递质影响了主要情感系统的活化,比如,例如,源自于血清素系统功能减少的 消极情感强度的亢进,以及基因决定的杏仁核对厌恶感知的高反应性。

To this point, I have related character traits to the behavioral activation of internalized models of behavior represented by dyadic units of self and object representations under the dominance of certain affects, particularly peak affect states. However, significant learning, of course, gradually occurs more and more under conditions of activation of low affective states, when direct perception and cognitive elaboration of the perceived environment permit cognitive learning relatively uninfluenced by the expression of organismic needs reflected in affect activation. Character formation, in other words, does not depend exclusively on peak affect states. Basic affective states, however, correspond to basic motivational tendencies that, in turn, are ultimately activated by the basic neurobiological systems geared to express the instinctual needs related to attachment, feeding, self-protection, peer bonding, and sexuality.

在这一点上,我已经将性格特质相关于以自体和客体的二价组合为代表的行为内化模型的行为激活,这里的自体和客体的二元组合表征在一定情绪的主导之下,尤其是情绪状态的峰值之时。然而,有意义的学习在情绪状态活化的条件下,当直接的感知和认知详尽的分析知觉环境允许认知学习的比较未被在情绪活化时机体需要的表达所影响时,当然会逐渐越来越多的发生。换句话说,性格的形式,不依赖于特定地峰值情感状态。然而,紧绷的情感状态,与基本的动机倾向相一致,相应的,基本的动机倾向,最终被与依恋、进食、自我保护、同伴链接和性有关的本能需求表达连接的基本的神经生物学系统激活。

So far I have referred to dyadic relations between self and object representations. It needs to be added, at this point, that, from the beginning of life and gradually in a more articulated way, triadic internalized object relations complicate the original dyadic structures and determine more complex mechanisms of identity formation. As a child learns to accept and understand the relationship between the caretaking person and other significant adults and siblings in his or her psychosocial environment, he or she begins to evaluate interactions between significant others and to relate them, by projection, to the child’s own experiences in dyadic relations. Internalized dyadic relations now become influenced by the awareness of dyadic relations in the individual’s immediate environment in the process of identification of the self with such experienced relations between significant others: basically, the relationship of the parents.

到目前为止,我已经提到了自体和客体表征之间的二元关系。在这一点上,需要对其进行补充的是,从生命的开始,并且逐渐以更明了的方式,三元内化客体关系的内化让最初的二元结构更加的复杂,并决定了更复杂的 同一性形式的机制。作为在他或她的社会心理环境中接受和理解照料者和其他重要成人与兄弟姐妹之关系的一个儿童,他或她通过对儿童自己在二元关系中的经验的投射,开始评估重要他人以及与他们相关的人的交互关系。现在,内在的二元关系开始变得受——个体在对自己与重要的客体:基本上是父母的关系——相关的体验的认同过程中的当前环境中的二元关系的意识所影响。

In other words, triangulations emerge that lead to the significant conflicts around infantile aggression, sexuality, and dependency described in psychoanalytic developmental theory and that interest us here because such triadic relations contribute to more realistic assessment of the self and of significant others in the interpersonal and internalized world of object relations. These developments foster the emergence of idealized, as opposed to realistic, representations of self, modeled by parental demands and prohibitions, praise, and criticism. A “moralistic” assessment of one’s self, with dismantling of primitive illusions of one’s own absolute goodness, power, and righteousness, and a gradual internalization of expectations, demands, and prohibitions evolves, which creates tension between one’s desired sense of self and the realistically perceived one. The psychological structuralization of this tension represents the origin of the “superego” in psychoanalytic theory (Jacobson, 1964).

换句话说,三元关系的出现导致了在精神分析发展理论中描述的,围绕在婴儿期的攻击、性和依赖关系的重大的冲突,而且之所以让我们此的兴趣,是因为这种三元关系有助于在人际关系和客体关系内化的世界中对自我和重要他人的更现实的评估。 这些发展助长了理想化的出现,作为现实的对立面,自我表征,被父母的要求和禁止、赞美和批评所塑造。一个人自体的一个“说教”的评估,同时解构了一个人自己绝对的善良、力量、以及正义的原始幻觉,而且,一个逐渐内化的期望,需求与禁止的演变,这些在一个人的自我意识和现实感知之间创造了紧张感。这种紧张的心理结构代表了在心理动力理论中的原始“超我”(Jacobson, 1964)。

NORMAL IDENTITY AND IDENTITY DIFFUSION正常的同一性与同一性分散

As mentioned before, the subjective aspect of the dynamic organization of character is the development of identity. A major developmental process extends from the first 2 or 3 years of life to crucial developments during late childhood and then again in adolescence. I am referring to the gradual integration of the representations of the self into an integrated self-concept and the gradual integration of multiple representations of significant others. This developmental process facilitates the capacity for awareness, concern, and empathy for others. As mentioned, an early stage of development in which rewarding, pleasurable peak affective states and their corresponding internalized object relationships are completely separated, dissociated, or split off from negative, aversive peak affect states with early caretakers leads to the consolidation of two separate segments of psychic experience, one an ideal or idealized view of intrapsychic and external reality and one a frightening, threatening, potentially destructive, and catastrophic world of experience. This latter, by means of projective mechanisms, is mostly projected outside and expressed as a diffuse panic, eventually originating the construction of a fantastic, primitive, persecutory external world.

如前所述,性格的动力组织主体的面向是同一性的发展。主要的发展过程从生命中最初的2到3岁延伸到随后的儿童期的关键发展,然后再一次在青春期发展。我所指的是 ,自我表征之逐渐整合入一个整合的自我概念,以及重要他人们的多个表征的整合。这个发展的过程促进了意识的包容力,关心,以及对他人的共情能力。如前所述,在早期发展阶段 的有益的、愉悦的高峰情感状态以及与之相应的内部客体关系,从消极的、令人厌恶的高峰体验中,兼带着早期照料者导致的精神体验的两个分裂的部分,被彻底地分裂、解离,或剥落。在这两种分裂的部分中,一个是心灵内部或外部现实的理想的或现实的观点,另一个是令人恐惧的、险恶的、潜在破坏性 的,以及灾难性的经验世界。此地的后者,借助于投射机制,基本上是以一种弥散的恐慌表达来向外投射,最终创造了一个幻想的、原始的、被害型的外部世界的结构。

These two segments of experience originally represent the parallel buildup of idealized and persecutory dyadic units, linked to the separate channeling and corresponding cognitive-affective memory built up of the respective self-representation-object-representation units. Later on, primitive psychological mechanisms of protection against overwhelming fears may lead to the defensive maintenance of this split organization, resulting in reliance upon the primitive defenses of splitting, projective identification, denial, primitive idealization, devaluation, and omnipotent control as described by Melanie Klein and her school (Klein, 1946/1952, 1957). These primitive defensive operations can be observed clinically in the interpersonal behaviors of patients with severe personality disorders; under certain experimental situations, such as completely unstructured small and large study groups; and under extremely traumatic social circumstances that lead to the emergence of primitive dissociative mechanisms.

这两部分的体验最初代表了理想化和二元一体迫害的并行组合,连接着分离的通道和与之相应的认知情感记忆所建造的各自的自我表征-客体表征单元。后来,针对势不可挡 之恐惧的主要的心理保护机制可能导致这一分裂组织的防御维护,造成了对分裂、投射性认同、否认、原始理想化、贬低,和梅兰妮·克莱因及其学派 (Klein, 1946/1952, 1957)描述的的全能控制之原始防御的依赖。这种原始的防御运作可以在以下情景中观察到:在有着严重的人格障碍的患者的人际行为临床之中;在某些实验性情景中,例如,完整的非结构化的 或大或小的研究团体之中;以及在导致了原始解离机制出现的极端的社会创伤情景之中。

Under normal circumstances, however, or rather, when the strong predominance of positive experiences permits the development of basic trust in a loving and reliable world of object relations, this experience and the gradual predominance of a low affect activation learning environment facilitate the linking between positive and negative, idealized and persecutory representations of self and others. The predominance of positive experiences permits the absorption, integration, and mentalization of the negative segment of experience. Usually between the third and the fifth or sixth year of life an integrated view of self is consolidated, in the context of a more realistic, integrated view of significant others: this constitutes normal identity (Kernberg, 2012b).

在正常情况下,然而,或者更确切的说,当强大的积极体验优势允许在一个充满爱和可靠的客体关系的现实世界里基本信任的发展,这种体验和一个低情感激活环境渐进的主导 ,促进了积极与消极、理想化的与自我与他人迫害表征的连接。积极体验的主导地位允许吸收、整合和心智化消极的经验部分。通常在生命的第三与第四或第五年之间,自我 的整合观点被巩固了,在一个更现实的背景下,重要他人们的整合观:构成了正常的同一性。

The failure of this process, with persistence of a lack of integration of the concept of self and of significant others, constitutes the syndrome of identity diffusion. Here a permanent splitting of the idealized and persecutory realm of experience is established, interfering with the integration of the concept of the self and of significant others. The syndrome of identity diffusion is reflected clinically in the incapacity to convey to an observer an integrated description of self and the equal lack of capacity to convey an integrated view of significant others (Kernberg, 2012b). This incapacity is reflected, psychopathologically, in chaotic behavior patterns, severe feelings of insecurity, rapidly fluctuating self-assessments and degrees of self-regard, and uncertainty about one’s major interests and commitments. By the same token, these patients present great difficulties in commitment to work or profession and in commitment to intimate relations that integrates eroticism and tender love. They evince general instability and chaos in relations with significant others, related to the severe lack of capacity to assess others in depth and to maintain stable and intimate relations with them.

这一过程的失败,随着自我和重要他人们概念的整合缺乏的持续,构成了同一性分散的典型表现。这里,一个永久性的理想化的分裂和经验领域的迫害被建立了,干扰了自我和重要他人们之概念的整合(Kernberg, 2012b)。这里的无能力在混乱的行为模式,严重的不安全感,快速起伏的自我评估和自我欣赏程度,以及关于某人的主要兴趣和承诺的半信半疑 之中是反射的、精神病理学的。出于同样的原因,这些患者在致力于工作或职业之中呈现了很大的困难,而且,在致力于性兴奋和温柔之爱的亲密关系之中也有很大的困难。 在与重要他人的关系中,他们显示出广泛的不稳定和混乱,与深入的接近他人以及与他们保持稳定和亲密的关系之能力的严重缺乏相关。

It is this structurally fixated lack of integration of the self and of the representations of significant others that represents the main etiological feature of the corresponding chaotic lack of integration and pathological organization of characterological traits of the various prototypes of severe personality disorders. We have designated these patients as presenting “borderline personality organization.” In contrast, “neurotic personality organization” refers to those personality disorders that, while still presenting significant rigid, defensive, and pathological character traits, do not present the syndrome of identity diffusion. These patients, therefore, represent a less severe level of personality disorder.

这代表了与之相应的混乱的主要的病因性特征的整合缺乏,与严重人格障碍各种原型的人格生物学特质的病理性组织,正是这些在结构上固定的自我和代表了重要他人的整合缺乏。我们已经将这些患者命名为“边缘型人格组织”相反,“神经症性人格组织”是指那些虽然仍旧呈现着刚性的,防御的,以及病理学特征特点的,没有呈现出同一性分散特征的人格障碍。因此,这些患者,代表一个不太严重的人格障碍 层次。

Obviously, normal personality is constituted both by normal identity and by relative absence of a constellation of rigid, defensive character traits that would justify, if such defensive constellations were dominant, classifying them as the neurotic prototypes of personality disorders. From this general perspective, the proposal in the DSM-5 classification of personality disorders of identity pathology as the central criterion of severity of personality disorders, defined by the combination of lack of integration of the self and of the self’s willful self-determination and by abnormal relations with others characterized by a lack of capacity for empathy and intimacy, clearly corresponds to the syndrome of identity diffusion (Kernberg, 2012b).

显然,正常的人格是由正常的同一性和缺乏众多的刚性共同构成的,正当的防御性特征,如果这种防御丛占据了主导地位,将他们归类为神经症性原型的人格障碍。从这个角度来看,在作为严重人格障碍标准的同一性病理学的人格障碍的DSM5分类中,是由自我整合和自我意愿的自我决定的缺乏、以及通过与其他性格特征的异常关系,与缺乏认同和亲密的能力,明确对应于同一性分散的特征来综合定义的。

AN INTEGRATED SYSTEM OF ETHICAL VALUES (“SUPEREGO”) 一个整合的伦理价值体系(“超我”)

Having explored the constituent components of the personality represented by temperament, character formation, and identity, I now return to the es-tablishment of an internalized “moral” structure as reflected by an internalized commitment to ethical values and to universally valid ethical principles of relationships with significant others and in social life in general. Such value systems and ethical commitments are in contrast to and transcend the instrumental, practical requirements of direct interactions with the sur-rounding human society. This component of the personality corresponds roughly to the Freudian “Superego.” By the same token, the Freudian “Id” or “Dynamic Unconscious” corresponds to the totality of primitive aggres-sive, sexual, and dependent longings and their corresponding desired and feared primitive object relations that cannot be accepted in consciousness as ego identity consolidates. Active rejection of such intolerable desires and fears tends to eliminate them from consciousness by means of repression and other advanced defensive operations that depend on the very establishment of ego identity. The Freudian “ego,” from the viewpoint of the organization of the personality, is centered around the functions of identity, that is, it is constituted by an integrated self and its surrounding world of internalized, integrated object representations. In other words, the self and its internal world of object relations governs, in the end, the organization of character traits that permit the harmonious activation of effective, intimate, empathic, and stable relations with significant others.

在探索了以气质、性格形成,和认同为代表的人格之构成成分后,我现在回到了内化的“正常”结构的建立, 这一结构通过内化的承诺所反映,这些承诺是在和重要他人与一般社会生活中,对道德价值和普世道德原则的承诺。这样的价值体系和道德承诺对照并超越于工具,直接的相互作用于周边人类社会的现实要求。这样的人格成分大致相当于弗洛伊德的“超我”。同理,弗洛伊德的“本我”或“动态无意识”对应于原始的侵袭性的总和,性,和依赖的渴望,及其相应的欲望与对原始客体关系的恐惧,这些都不能作为自我同一性的愈合在意识中被接受。对如此无法忍受的欲望和恐惧的主动拒绝,往往倾向于通过压抑的方法和其他依赖于自我同一性的确立的高级防御操作,从意识中消除之。弗洛伊德学说中的“自我”,从人格组织的角度来看,是以同一性功能为中心的,也就是说,它是由一个整合的自我及其内化的周遭的世界、整合的客体表征所构成。换句话说,自我和其内部客体关系世界的治理,归根结蒂,性格特征的组织允许有效的,亲密的,共情的,与重要他人稳定关系的和谐活化。

The superego is a complex structure, the pathology of which is an important indicator of the severity—and the psychotherapeutic prognosis—of personality disorders. From the point of view of the corresponding internal-ization of ethical value systems, the work of Edith Jacobson (1964), it seems to me, has clarified the developmental stages of the establishment of this segment of the personality. What follows is a brief summary of her overall conclusions.

超我是一个复杂的结构,其病理的严重程度是人格障碍和心理治疗预后的一个重要指标。从相应的伦理价值系统内化角度来看,在我看来,伊迪丝·雅各布森的工作(1964),澄清了这些割裂的人格片段之形成的不同发展阶段。下面是她的总体结论的一个简短的总结。

The earliest precursor of the superego, in Jacobson’s proposal, is the internalization of the earliest prohibitions, in the parent/child interactions, signaled by mother’s clear and parental “No!,” usually a response to the ba-by’s behavior that may constitute an active danger for him or her (at least, in mother’s view). The fantastic distortions of such early prohibitions under the activation of negative peak affect states, belonging to the “persecutory” segment of early experience, derive from the combination of projective mechanisms and external frustrations. The prohibitions are amplified in terms of the baby’s misunderstanding and misinterpretations of them under the effects of such projective mechanisms. The internalization of this first, negative layer of internalized prohibitions stimulates primitive, implicitly life-threatening fantasized dangers and punishments, mostly centering around threatened abandonment under the effect of the activation of the attachment-separation panic system. The internalization of these prohibitions implies an acceptance of them as a protective mechanism against greater threats of abandonment and even annihilation. Obviously, under conditions of severe traumatic circumstances, physical abuse, sexual abuse, chronic witnessing of physical or sexual abuse, such an early negative internalized sense of basic threats to survival may become much more dominant than would be the case under ordinary circumstances.

超我最早的前身,在雅各布森的提议中,是最早期对禁止的内化,在父母/儿童的互相影响之中,通过母亲的明显信号和父母“不”,通常是对婴儿的那些可能对他或她构成的一个活跃的危险的(至少在母亲的看法) 行为的反应。这种在消极情绪状态的活化下的早期禁令的不切实际的扭曲,属于早期体验的“被害型”的割裂,来自于投射机制和外部挫折的联合体。该禁止在这样的投射机制的影响下,在婴儿对他们的曲解和错误的判断之中被放大。这第一次的内化,原初的内化禁止刺激的负性层面,暗示地生命威胁之幻想的危险和惩罚,主要是围绕在分离恐慌系统活化的情绪下的抛弃的恫吓。这些禁令的内化 ,暗示着对作为抵御抛弃甚至毁灭的更大的危险的保护机制的接受。显然,在严重创伤,身体虐待,性虐待的情况下,身体或性虐待证据的长期存在,如此的一种早期的,对生存的基本威胁消极内化感可能会变得比一般情况下的情形更具优势。

This first, most primitive level of internalized prohibitions, which al-ready begins to influence both positive and negative segments of early experience, is gradually followed by a second level of experiences, under the activation of positive peak affect states and also, in part, under conditions of low affective activation, reflecting the environmental demands for “good” behavior. The expression of appreciation of the child’s behavior, its stimulation, rewards, and gratitude on the part of the parental objects, fosters be-haviors that the baby comes to see as ideal in terms of the rewards associated with them. This layer constitutes the early “ego ideal.” It is constituted both by the internalization of the demanding and rewarding aspects of the ideally perceived images of the significant others and also by the development of more realistic “ideal” self-representations under conditions of the gradual toning down and integration of the idealized and persecutory segments of the self.

首先,最原初层次的内化禁令,在那些已经开始同时影响早期经验的正面和消极的部分之后,接踵而至的是经验的第二个层次,这一层次在积极峰值激活的影响状态下,以及在低情感激活的条件下,反映着“好”行为的环境要求。表达对孩子的行为的欣赏、其促进、奖励,以及部分的对父母客体的感恩 、养育行为,在孩子看来是和他们相联系的奖赏的理想化。这一层是早期的“理想化自我”。它同时通过以下的方式建立,对重要他人理想化感知形象的需求和奖赏的诸多面向,同时在逐步淡化和整合自我的理想化的和迫害性的碎片的条件下,对更现实的“理想化”自我表征的发展中建立。

The buildup of the ego ideal as an idealized internalized structure rein-forces a sense of security, inner goodness, and intimate relations with significant others. This structure gradually tends to neutralize the most primitive, persecutory segment of experiences within the superego referred to before. Throughout the second and third year of life a process of integration between the most primitive persecutory and the secondary idealized level of realistic and fantasized, desired and feared demands and prohibitions takes place. This neutralization of negative experiences tends to reduce projective processes under conditions of negative affect activation and facilitates the internalization of still a third level of internalized demands and prohibitions. This is what Freud described as the advanced Oedipal state of development, consolidated between approximately the fourth and sixth year of life (Freud, 1923/1961).

作为一种理想化的内在结构的自我理想的建立,增强了安全感、内在的善者,以及与重要他人的亲密关系。这种结构逐渐地趋于中和在之前提到的,在超我之中的最原始的、迫害性碎片。在生命的第二和第三年期间,一个整合的过程发生在最原始的迫害和现实与理想的、渴望的和恐惧的需求,以及禁令发生之地的第二层的理想化 层次之间。这种消极经验的中和,往往减少了在消极情绪活化的条件下的投射投射过程,同时有利于内化的需求和禁令的第三个层次悄然无声的内化。这是弗洛伊德描述的作为更高级的俄狄浦斯状态的发展,大概在生命的第四年和第六年之间得到巩固(Freud, 1923/1961)。

This third, more realistic level of internalized demands and prohibitions already contains many expectations derived from the family, reflecting the cultural expectations of the immediate social environment and their specific ethnic, social, national, religious, or racial traditions and biases. By the be-ginning of the school years (the “latency years” in traditional psychoanalytic theory), sufficient integration of these levels of internalized value systems, under the dominance of the third, more realistic and complex level, has taken place to permit the child to enter a socially shared value system. This system regulates behavior in terms of justice and concern for, and responsibility to-ward, others, as well as for one’s own behavior.

这第三个层次,更现实层面的内化的需求和禁止已经包含了很多来自于家庭的预期,反映了当前社会和他们特定的种族、社会、国家、宗教或种族传统与偏见的文化预期。在学龄前的初期(在传统的精神分析理论中的“潜伏期”),这些内在价值系统的充分整合,在更现实和更复杂的第三层主导的情况下,允许孩子进入一个社会分享的价值 体系已经开始发生了。该系统在公证的情况下规范着行为,而且关注于并负责于他人,以及自己行为。

Throughout the years leading to adolescence, a gradual process of de-personification, abstraction, and individualization of the superego takes place, in other words, an abstraction and general integration of value systems no longer linked concretely to demands or prohibitions from any particular pa-rental image (Jacobson, 1964). Now, both deep, unconscious dispositions from the early childhood years and later preconscious and conscious identifications with value systems acquired at home, school, and one’s social group characterize the pubescent child. Finally, in early adolescence, with the activation of intense sexual strivings that reactivate, deepen, and expand sexual impulses, fantasies, fears, and desires from early childhood, and the impact of the development of secondary sexual characteristics, a profound transformation takes place. Now infantile prohibitions against sexuality and aggression have to be somewhat modified to conform with the more adult demands of intimate relationships under the combined impact of instinctual desires, efforts to harmonize them with the adolescent’s identity and character formation, and the conscious and unconscious value systems reflected by the developed, integrated superego. In short, the development of an internalized set of ethical principles derives from particular aspects of internalized object relations, namely, those in which different levels of a broad spectrum of demands and prohibitions initiates the child’s identification with the moral and ethical values of his or her home and social environment.

在通向青春期的期间,一个渐进的去拟人化de-personification,抽象化和自性化的超我解构发生了,换言之,一个抽象的和普遍的整合的价值系统不再具体的与来自于任何特定的父母影像的需求与禁止相关联(Jacobson, 1964)。至此,来自于儿童早期以及随后的,在家庭、学校和一个人社会群体描述的青春期孩子的前意识和意识认同无意识规定,最终,都深刻的,与重新复活的、更深层的、以及扩张的性冲动、幻想、恐惧,和来自于婴儿早期的的愿望,以及第二性特征发展的影响之强烈的性欲望的激活, 所有这些,一个深刻的转变之解构发生了。现在紧挨着性欲和侵攻击性的婴儿期的禁令必须有所修改,在本能的欲望、青春期的同一性和性格形成的努力协调,以及通过发展和整合超我所反映的意识和无意识的价值系统的综合影响下,必须顺应于越来越多的亲密关系的成年要求。总之,内在的一套道德原则的发展源 自于内化的客体关系的诸多面向,亦即,源自于那些在不同层次的广泛的需求之中,以及在禁止启动儿童对道德和他或他家庭与社会环境的伦理价值观的认同之中。

Under pathological circumstances, different levels of severity of personality disorders may affect the integration of this internalized system of ethical values and, in turn, influence the development of different levels of psychopathology. Under the dominance of severe aggressive impulses, whether derived from genetically determined, temperamentally established predominance of negative affects and lack of cognitive control and contextualization of affects, or severely pathological attachment experiences, or a traumatic early infancy and childhood, identity diffusion may become fixed. The lack of identity integration negatively influences the integration of the different layers of the superego system. The first, persecutory superego level becomes excessively dominant by aggressive internalized object relations, and the relative weakness of the ego ideal level interferes with the integration of these two levels and brings about a persistent dominance of the first, persecutory superego level. The establishment of the third, higher level of ethical values suffers as well, a consequence of excessive projection of the negative earlier superego features. Clinically, this predisposes the individual to the activation of ego syntonic aggressive antisocial behavior.

在病理情况下,不同程度的严重人格障碍可能会影响这个内化的伦理价值体系的整合,进而影响不同层次的精神病理学的发展。在严重攻击性冲动的支配下,无论是来自基因决定的,消极情绪主导的和缺少认知控制以及情绪的情景化的神经质的建立,或严重病理学的依恋体验,或婴儿早期或儿童期的创伤,认同扩散可能成为不易改变的。同一性整合的缺乏,消极的影响了超我系统不同层次的整合。首先,通过攻击性的内化的客体关系,被害型的超我层次变得过于主导,其次,相对薄弱的自我理想的层次干扰了这两个层次的整合,并且引起了被害型超我这第一层的持久的优势。第三层的建立,更高层次的伦理价值也会遭受消极的早期超我特征的过度投射结果的影响。临床上,这会使得个体易于激活自我共振的攻击性反社会行为。

In fact, the development of antisocial behavior is the most important complication of the most severe level of borderline personality organization and signifies a poor prognosis for psychotherapeutic treatments. It causes damage to the capacity of relationships with others and to the normal modulation of affective expression of one’s own emotional needs. In contrast, under conditions when normal identity development proceeds adequately, this positively influences superego integration.  Under circumstances when normal superego integration takes place, but with a strong induction of excessive guilt feelings over instinctual impulses, the early superego level may “contaminate” the ego ideal with the development of sadistic demands for perfection.  Under these circumstances, the prohibitions against infantile sexuality during the development of the third level of superego development may appear as excessively prohibitive, even violent, so that an integrated but sadistic superego may inhibit sexual, aggressive, and dependent impulses, leading to a defensive character structure that characterizes the higher level of personality disorders (“neurotic personality organization”).

事实上,反社会行为的发展是大多数最严重层次的边缘性人格组织最重要的并发症,同时意味着心理治疗治疗疗法的不良预后。它会导致与他人的关系能力的损害,并且有害于自己情绪需求的情感表达的正常调节。相比之下,在正常情况下,当正常的同一性充分的发展时,这会影响积极超我的整合。在正常的超我整合发生的情况之下,却又随着强烈的罪疚感凌驾于本能冲动之上的指引,早期超我层次可能以完美无缺的虐待需求发展来“污染”自我理想。在这种情况下,对婴儿在超我发展第三层次的发展期间的禁止可能会出现过度的禁止,甚至是暴力,以至于一个整合却又施虐的超我可能会抑制性欲的,攻击性的,并且依赖的冲动,导致一种以更高层次的人格障碍为特征的防御性性格结构(“神经性人格组织”)。

One may summarize, in a simplified way, the dominant etiological features of personality disorders at different levels of severity by stating that, at the level of borderline personality organization, conflicts, whatever their origin, around aggressive impulses predominate. At a higher level of development, with the establishment of normal identity, conflicts around infantile sexuality and dependency are predominant in the pathology of neurotic personality organizations (Kernberg, 2012b). Obviously, this is a very general statement that includes a broad spectrum of variations in terms of individual history and development.

可以以一个简单的方式总结,在不同层次的严重程度的人格障碍的主要的病因特征说明,在边缘人格组织的层次,冲突,无论他们的起源,围绕着占主导地位的攻击冲动。在一个更高的发展层次中,随着正常同一性的建立,冲突围绕着婴儿期性欲,并且属于在病理学上占主导优势的神经性人格组织 (Kernberg, 2012b)。显然,这是一个非常笼统的声明,包括了在个人的历史和发展中的广泛的频谱变化。

INTELLIGENCE 智力

The final major component of the personality is the cognitive potential of the individual, intelligence, particularly expressed in the achieved level of abstraction. The level of intelligence, it now seems to be generally agreed upon, is dependent both on genetic disposition and on early experiences. The stimulation of cognitive processes and linguistic development and the explicit attention to a child’s motivations, thought processes, and fantasy development exert a fundamental influence on the development of cognitive ability. In general, a high cognitive potential facilitates an ever more realistic and subtle perception of the environment and the capacity to respond adequately to cognitive cues. The genetically determined development of the prefrontal and preorbital cortex, the anterior cortical midline structures, and the linguistic brain centers powerfully influences effortful control and participates in modulating affective response (Silbersweig et al., 2007).

人格的最后一个主要组成部分是个人的认知潜力,智力,特别是在实现层面的抽象表达。现在看来,这似乎是普遍的共识,智力的水平,依赖于基因遗传倾向和早期的经验。认知过程的刺激和语言发展,以及孩子的动机、思维过程和幻想的发展,对认知能力的发展产生了根本性的影响。在一般情况下,一个高的认知潜力有利于更现实和微妙的环境感知,以及对认知线索能力充分反映的能力。基因决定了前额叶和眶前骨皮质的发展,前皮质中线结构,和大脑语言中心强烈的影响着需要努力的控制以及参与情感反应的调节(Silbersweig et al., 2007)。

In that regard, cognitive control may mitigate the effects of a severely traumatic environment, although, by the same token, under severely pathological circumstances, intelligence even may amplify trauma by the development of complex distorted cognitive interpretations of a threatening environment. At the same time, on the negative side, cognitive systems of rationalization of pathological character traits may powerfully reinforce faulty adaptive strategies that may be encountered in severe personality disorders. In clinical practice, we find patients with very high intelligence and with very low intelligence at all levels of severity of personality disorders. Intelligence has a positive prognostic implication for the indication of psychotherapeutic treatments and, of course, also for the general level of social adaptation in terms of educational development and level of work or profession.

在这方面,认知控制可能会减轻严重创伤的环境的影响,虽然,同样的道理,在严重的病理情况下,智力甚至可能会通过对一个威胁的环境的复杂扭曲的认知解释来放大创伤的发展。与此同时,在消极方面,病理学特征合理化的认知系统可能会有力地巩固在严重的人格障碍中遇到的错误的适应策略。在临床实践中,我们在所有严重程度的人格障碍中发现,患者有着非常高的智力或非常低的智力的。智力对心理治疗的治疗指征有一个积极的预后意义,同样,就教育发展和工作或专业水平而言,智力当然对于社会适应的一般水平也有着积极的预后意义。

From the viewpoint of both the development of the normal personality and the etiology of personality disorders, we may distinguish, I believe, two general organizational levels of psychic life: first, a neurobiological level of development that determines the organization of basic neurobiological structures that find expression in psychological life, particularly the development of perception and memory, the activation of consciousness, and, fundamentally, the development of affect systems that protect homeostasis and become the primary motivator of object relations. To this basic level of psychic development has to be added a second level of organization at a purely symbolic, intrapsychic level, best formulated in terms of the gradual building up of an internal world centered around personal identity and the realistic perception and investment in a world of significant others. This internal world organizes the satisfactory expression of basic instinctual needs, autonomy, and self-affirmation and, by the same token, the relationship of gratifying and effective relations with the surrounding social world.This includes sexual and romantic intimacy, friendship and commitments, effectiveness and gratification in work, and personal creativity. The limitations in this development represented by personality disorders are now within the realm of our understanding regarding etiology, mechanisms of interactions and organization, and the potential for treatment, as well as the present limitations of our therapeutic endeavors. I believe that further progress in all these areas requires the attention to these two systems, the neurobiological and the intrapsychic, and their mutual influences in normality, pathology, and treatment.

从正常人格发展和人格障碍的病因的观点来看,我相信,我们可以区分精神生活的两大组织层次:第一,神经生物学的发展水平,确定了基本的神经生物学的结构,这些结构包括,心理生活中找到表达,尤其是知觉和记忆的发展,无意识的活化,以及,从根本上的,保护平衡和成为客体关系的原动力的情绪系统的发展。对这一精神发展的基本水平,已经在一个纯粹的象征中被添加在了组织的第二层,心灵内部的水平层次,就逐渐围绕着人格同一性和现实感知和以及重要他人投入而起来的建立于 一个内部的世界而言,是最好的构想。这个内在世界组织着基本本能需要的表达, 自主权,和自我肯定,同时,同理,也组织着与周围的社会世界的令人满意的关系和有效。这包括性和浪漫的亲密关系,友谊和承诺,工作中的有效性和满足感,以及个人创造力。,以人格障碍为代表的这些发展中的局限性,现在,处于我们理解关于病因、相互作用和组织的机制,以及资料的建立,以及除此之外的我们的医疗的努力之限制的领域之中。我相信,所有这些领域的进一步发展需要注意以下这两个系统,神经生物学和心灵内部的,以及它们之间在正常、病理及治疗中的相互影响。

标签: 人格  精神分析  克恩伯格 

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