The Area of the Basic Fault基本缺陷区域
作者: Michael Balint 著 / 2413次阅读 时间: 2016年12月09日
来源: 陈明 译 标签: BALINT Balint 基本缺陷 退行
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The Area of the Basic Fault基本缺陷区域
)J{Y3ep HI0 Michael Balint
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Accepting theoretically the existence of the level of the basic fault, we have to ask what kind of events in the course of analytic treatment have to be considered as signals that this level has been reached. Taking a fairly normal case, let us suppose that the treatment has been proceeding smoothly for some time, patient and analyst have understood each other, while the strains and demands on either of them, but especially on the analyst, were only reasonable and, in particular, at all times intelligible. Then at some point, suddenly or insidiously, the atmosphere of the analytic situation changes profoundly. With some patients this might happen after a very short period, or even right from the start.心理学空间 eZXgv| y?VJIT E

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接受基本缺陷水平在理论上的存在,我们必须要问,在分析处理过程中,什么样的事件应当被视为触及到了这一水平的信号。我们假设在比较正常的情况下,治疗已经顺利地进行了一段时间,病人和分析师都已彼此了解,当他们之间张力与需求、尤其是分析师的张力与需求是合理的,而且,尤其在任何时候都是可以理解的。然后在某些时候,突然地或隐匿地,分析情境的氛围发生了深刻的变化。这在很短的一段时间内,甚至从一开始就可能会发生在某些病人身上。心理学空间(V J7G%QnTx|

p [/Ox,C0nqa1C0There are several aspects of what I will call the profound change of atmosphere. Foremost among them is, as discussed in the previous chapter, that interpretations given by the analyst are not experienced any longer by the patient as interpretations. Instead he may feel them as an attack, a demand, a base insinuation, an uncalled-for rudeness or insult, unfair treatment, injustice, or at least as a complete lack of consideration, and so on; on the other hand, it is equally possible that the analyst’s interpretations may be experienced as something highly pleasing and gratifying, exciting or soothing, or as a seduction; in general as an irrefutable sign of consideration, affection, and love. It may also happen that common words which until then have had an agreed conventional ‘adult’ meaning and could be used without any great consequence, become immensely important and powerful, either in a good or a bad sense. At such times, in fact, the analyst’s every casual remark, every gesture or movement, may matter enormously and may assume an importance far beyond anything that could be realistically intended.

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我称之为深刻变化的气氛有这几个方面。其中最重要的是,正如在前面的章节中讨论的,分析师给出的诠释不再被病人体验为诠释。相反,他可能觉得那些是种一攻击、一个盘问,一个基本的反唇相讥,一个无缘无故的无礼和侮辱,一种不公平的待遇,不公正的,或者,至少完全是欠考虑的,等等;另一方面,也可能是,分析师的诠释可能被体验为非常令人满意和欣慰,令人兴奋的或舒缓的东西,或者被当成了一个诱惑;一般来说,分析师的诠释被当作一个无可辩驳的照顾、情感,和爱的迹象。也许直到约定的“成人的”意味,以及被应用时不会有任何重大的后果,变得极其重要和强大,它才会被当作成一般的话语,无论是在一个好的还是一个坏的感觉之中。在这样的时候,事实上,分析师的每一个偶然的评论,每一个手势或动作,都可能关系重大,并可能承担了远超出了任何 可以是现实地意图的重要事情。

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_C*x6gR0|5C,]%o0Moreover – and this is not so easy to admit – the patient somehow seems able to get under the analyst’s skin. He begins to know much too much about his analyst.This increase in knowledge does not originate from any outside source of information but apparently from an uncanny talent that enables the patient to ‘understand’ the analyst’s motives and to ‘interpret’ his behaviour. This uncanny talent may occasionally give the impression of, or perhaps even amount to, telepathy or clairvoyance. (See Balint, M., ‘Notes on Parapsychology and Parapsychological Healing’, 1955.) The analyst experiences this phenomenon as if the patient could see inside him, could find out things about him. The things thus found out are always highly personal, in some ways always concerned with the patient, and are in a way absolutely correct and true, and at the same time utterly out of proportion, and thus untrue – at least this is how the analyst feels them.心理学空间l6dK-haX z

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此外——并不能那么容易承认的是——病人似乎能够莫名其妙的钻到分析师的皮肤里。他开始太多太多的了解了他的分析师。这种了解的增加并非源于信息的任何外部来源,却显然来自于一个神秘的天才,这位天才能够使病人“理解”分析师的动机,并“解释”他的行为。这诡异的才能也许偶尔会留下一种心灵感应或透视能力的印象,这种印象也许是极少的(参见M·巴林特的‘超心理与超心理疗愈笔记’1955)。分析师体验如此的现象:似乎患者可以看到他的颞部,能够发现关于他的诸多事情。发现的事情总是高度个人化的,在某些方面总是与病人有关,并且是一种绝对正确和真实的方式,与此同时完全不成比例,因此,这种不真实——至少这是分析师对他们的感受方式。心理学空间 PQ4_ E+g9\AJ

-N'g)R Kg0If now the analyst fails to ‘click in’, that is, to respond as the patient expects him to do, no reaction of anger, rage, contempt, or criticism will appear in the transference as one would expect it at the Oedipal level. The only thing that can be observed is a feeling of emptiness, being lost, deadness, futility, and so on, coupled with an apparently lifeless acceptance of everything that has been offered. In fact everything is accepted without much resistance but nothing makes any sense.

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如果现在咨询师无法“突然明白”,即,像病人期望他去做的那样作出回应,没有在移情中出现作为生气、愤怒或批评的反应,就像一个人在俄狄浦斯水平上期待的那样。唯一可以观察到的东西就是一种空虚的感觉,失落,死寂,无用,等等,再加上显而易见地对已经提供的所有事情之死气沉沉的接纳。实际上,一切都没有在太大的阻力下所接受,但是没有任何的意义。

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&I1M.] DA]_F C h0Another reaction to the analyst’s failure to ‘click in’ might have the appearance of persecutory anxieties. Leaving on one side that in these states anxiety-in its common-sense clinical form – is usually very slight, hardly existent, the fact remains that at any frustration these patients feel that it was intentionally inflicted upon them. They cannot accept that there exists any other cause for a frustration of their desires than malice, evil intention, or at least, criminal negligence. Good things may happen by chance, but frustrations are unchallengeable proofs of evil and hostile sentiments in their environment.心理学空间frzD4FMR

({g\5C K_0另一个分析师无法“突然明白”的反应可能会有迫害焦虑的表象。撇开在这些焦虑状态中的一个面向——在常见的——临床形式的感受——通常是非常轻微的,几乎不存在,事实上,病人感受到的任何挫折是故意地强加给他们的。他们无法接受这里存在着任何其他导致他们愿望挫折的恶意,邪恶的意图,或至少,可耻的疏忽。好的事情可能是偶然发生的,但是挫折是在他们的环境之中邪恶与敌对情绪不可挑战的证明。心理学空间8F4}1_H oZ _&[9r{

9A^}:\&I TM0Remarkably, all this is simply accepted as a painful fact and it is most surprising how little anger, still less a willingness to fight, is mobilized by it. It is still more surprising that a feeling of hopelessness hardly ever develops; it seems that despair and hopelessness belong to the Oedipal level; they are probably post-depressive. Though feelings of emptiness and deadness (cf. Balint, Enid, 1963) may be very strong, behind them there is usually an earnest, quiet determination to see things through. This queer mixture of profound suffering, absence of cheap pugnacity, and an unshakeable determination to get on makes these patients truly appealing-an important diagnostic sign that the work has reached the level of the basic fault.

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Ag5o z"d0值得注意的是,所有这一切只是被接受为一个痛苦的事实,并且,最令人惊讶的是,愤怒是如此之少,仍然不愿意去战斗,并被其动员起来。更令人惊讶的,绝望的感觉几乎从未形成;似乎绝望与无助属于俄狄浦斯的水平;他们可能是后抑郁症患者。空虚和死亡的感觉(参见巴林特,Enid,1963)可能是非常强烈的,他们背后通常有一个诚挚的、安静的决心去看透事物。这种奇怪的深刻痛苦的混合物、缺乏廉价的好斗和一种不可动摇的决心,使得这些病人真正的呈现出一个重要的诊断标志——咨询工作已经触及到了这个基本缺陷水平。心理学空间 V1oS1Kx|K

a]j^`Ch c6vsS.T0The analyst’s reaction also is characteristic, and is utterly different from his reaction to a resistance at the Oedipal level. I shall return to this in Parts III, IV, and V of this book; here it will suffice to say that everything touches him much more closely; he finds it rather difficult to maintain his usual attitude of sympathetic, objective passivity; in fact, he is in constant danger of subjective emotional involvement. Some analysts allow, or even elect, to be carried away by this forceful current and must then change their techniques accordingly. Others carefully and cautiously stick to their well-proven guns and consistently avoid any risk of becoming involved. There are also those who, in face of this threat, adopt – perhaps as a reaction formation against it – a somewhat omnipotent confidence, constantly reassuring themselves that their technique of interpretation is capable of dealing with any situation.心理学空间#_d+{4T[0M4B3|

&b j RU|r0分析师的反应也是独特的,并且完全不同于他对俄狄浦斯水平阻抗的反应。我将在本书的第三、四、五部分回到这一点;在这里,就足以说,触及到他的一切他更加紧密;他发现很难维持他一贯的共情、客观被动性;事实上,他持续处在客观情绪卷入的危险之中。一些分析师、甚至候选人,会被这有说服力的趋势带走,然后必定相应的改变他们的技术。其他人小心翼翼地、谨慎地遵循他们的精心证明的枪炮,并始终避免卷入任何风险。也有些人,在面对这种威胁时,采取——可能是作为一种对其敌对的方式——有点无所不能的信心,不断安慰他们自己,他们诠释技术能够处理任何的情况。

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1V.~yHg0Another important group of phenomena is centred upon what may be called appreciation of, and gratitude for, the analyst’s work. On the Oedipal level, provided the analyst’s work has been up to professional standards, these two sentiments – appreciation and gratitude – are powerful allies and, especially during bleak periods, may help considerably. At the level of the basic fault one cannot be certain at all that the patient will bear in mind, still less that he will appreciate, that his analyst was skilful and understanding in the past, whether remote or recent. One reason for this profound change is that at that level patients feel that it is their due to receive what they need. I shall return presently to this important feature.

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ot(Vi(VO.~M0另一个重要的一组现象集中出现在分析师的工作被欣赏、被感激当口。在俄狄浦斯水平上,倘若分析师的工作已经到了专业的水准,这两种情感——欣赏与感激——是强大的盟友,并且,尤其是在黯淡的时期,可能会有很大的帮助。在基本缺陷水平上,一个人根本无法确保病人会铭记所有,更不能保证他会欣赏他的分析师曾经是技艺高深和通情达理的,无论进或者远。这种深刻变化的一个原因是,在这种水平上的患者认为,这是由于他们收到的他们所需要的东西。我很快会重提这一重要特征。心理学空间4tzP${} m

5r8fL w{ruq6W0Thus, if the analyst provides what is needed, this fact is taken for granted and loses all its value as proof of professional skill, of exceptional gift, or of favour, and in due course more and more demands will be produced. In present-day analytical literature this syndrome is called greediness, or even oral greed. I have no objection to calling it greed, but strong objection to calling it ‘oral’ because this is misleading. It is not the relationship to the oral component instinct that is relevant for the understanding of this syndrome but the fact that it originates in a primitive two-person relationship which may or may not be ‘oral’. To cite the range of addictions in which ‘greediness’ is a most important feature, there are very numerous and unquestionably ‘oral’ addictions, foremost among them nicotine and alcohol; but there are many that are non-oral, such as morphinism, sniffing cocaine, and not forgetting the various forms of scratching as in pruritus.心理学空间Zd$^vG eu

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因此,如果分析提供了所需之物,这一事实是理所当然的,并且失去了其所有的价值,失去了作为专业技能之证明的、特殊的礼物的、或所偏爱的、并在适当的过程中来制造出越来越多的需求的价值。在如今的分析性文献中,这种综合症被称为贪婪,甚至是口欲贪婪。我不反对称其为贪婪,但强烈反对称之为“口欲”,因为这是误导。它与理解这一综合症的口欲部分的本能没有关系,但事实是,它起源于单纯的两人关系,这一关系可能是也可也可能不是“口欲的”。引用成瘾的范围,贪婪是最重要的特征,有非常多的和毫无疑问的“口欲”成瘾,其中尼古丁和酒精是最主要的;但也有许多是非口欲的,吗啡成瘾、吸食可卡因,并且不要忘记在搔痒症中的各种形式的抓挠。

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At the Oedipal level the analyst is hardly ever tempted out of his sympathetic passivity; if he abandons his passivity at the level of the basic fault, he may start on a dangerous spiral of addiction – because of the peculiar lack of gratitude, or presence of greed; if he remains adamant either the treatment will be broken off by the patient as hopeless, or after a long forlorn struggle the patient will be forced to identify himself with the aggressor, as the analyst is felt to be, i.e. as I heard it described in one of my seminars – the patient is made to acquire an everlasting internal long-playing record. In Chapter 17 I shall have to return to this important technical problem.

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8q#Z ]M6J U0在俄狄浦斯水平之上,分析师几乎从未试探过他的共情的被动性;如果他放弃了在基本缺陷水平的他的被动性,他可能会由于特别缺少感激之情或贪婪的存在而开启一个危险的成瘾漩涡;如果他仍然坚持,要么治疗将被当作毫无希望而被病人打破,要么在一个长期的绝望斗争之后,患者将被迫承认自己是侵略者,正如分析师所感觉的,就像我上次在一个研讨会上所描述的——病人被打造以获得一个永恒的内部长期播放的唱片。在第17章,我将要回到这一重要的技术问题。

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y|zpZG0All these events belong essentially to the field of two-person psychology and are more elementary than those belonging to the three-person Oedipal level. Moreover, they lack the structure of a conflict. This was one of the reasons why I proposed to call them ‘basic’. But why fault? First, because this is exactly the word used by many patients to describe it. The patient says that he feels there is a fault within him, a fault that must be put right. And it is felt to be a fault, not a complex, not a conflict, not a situation. Second, there is a feeling that the cause of this fault is that someone has either failed the patient or defaulted on him; and third, a great anxiety invariably surrounds this area, usually expressed as a desperate demand that this time the analyst should not-in fact must not – fail him.

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\Vx.H _0所有这些事件本质上属于两个人心理学领域,比那些属于三人的恋母情结的水平更基本的。此外,他们缺乏一个冲突的结构。这是我提出要称之为“基本”的原因之一。但为什么是缺陷?首先,这正是因为许多患者用这个词来描述它。病人说,他觉得他有一个缺陷,一个必须恢复正常的缺陷。它被认为是一个缺陷,不是难懂的,不是一个冲突,更不是一个状况。其次,有一种感觉,这一缺陷的原因是,有人让病人挫败或亏欠于他;第三,一个巨大的焦虑总是围绕着这个区域,通常表示为一个迫切的需求,这个时候分析师不应该——其实绝对不能——挫败他。

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'{ g W)@vS)N0The term fault has been in use in some exact sciences to denote conditions that are reminiscent of that which we are discussing. Thus, for instance, in geology and in crystallography the word fault is used to describe a sudden irregularity in the overall structure, an irregularity which in normal circumstances might lie hidden but, if strains and stresses occur, may lead to a break, profoundly disrupting the overall structure.

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L U#G]P$]0术语缺陷一直在一些精确的科学中用以表示条件,这一条件让人想起我们现在讨论的。那么,比如,在地质学和晶体学之中,缺陷这个词用来描述在总体结构上不可预见的不规则,一种在正常情况下可能隐藏着的,但,如果应变和应力发生后,可能会导致断裂,深刻地破坏整体结构的不规则。

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We are accustomed to think of every dynamic force operating in the mind as having the form either of a biological drive or of a conflict. Although highly dynamic, the force originating from the basic fault has the form neither of an instinct nor of a conflict. It is a fault, something wrong in the mind, a kind of deficiency which must be put right. It is not something dammed up for which a better outlet must be found, but something missing either now, or perhaps for almost the whole of the patient’s life. An instinctual need can be satisfied, a conflict can be solved, a basic fault can perhaps be merely healed provided the deficient ingredients can be found; and even then it may amount only to a healing with defect, like a simple, painless scar.心理学空间"eb(v%ob

0W7I8[I] Fg1|"E0我们习惯于认为每一个动力在头脑中的运作的形式,要么是一个生物性的驱力,要么是一种冲突。虽然高度动力性的,源自基本缺陷的驱力既不是一种本能,也不是一个冲突。这是一个缺陷,心智中有些东西坏了,一种不足必须被更正。这些东西不是为了阻塞,这是为了找到一个更好的出路,但是有些东西现在要么找不到了,要么几乎成为了病人的生命的全部。一种本能的需求可以被满足,一种冲突是可以被解决,一个基本的缺陷或许只不过在可以找到缺乏整合的情况下被愈合;即使这样,它可能仅仅是一个有缺陷的愈合,就像简单的、不引起痛苦的疤痕。心理学空间$Q9E:QI!A_FX

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The adjective ‘basic’ in my new term not only means that it relates to simpler conditions than those characterizing the Oedipus complex, but also that its influence extends widely, probably over the whole psychobiological structure of the individual, involving in varying degrees both his mind and his body. In this way the concept of the basic fault allows us to understand not only the various neuroses (perhaps also psychoses), character disorders, psychosomatic illnesses, etc., as symptoms of the same etiological entity, but also – as the experiences of our research into general medical practice have shown-a great number of ordinary ‘clinical’ illnesses as well (Balint, M., 1957; Balint, M., & Balint, Enid, 1961; Lask, 1966; Greco and Pittenger, 1966). By this I mean that under the influence of various emotional experiences, among them medical treatment, a ‘clinical’ illness may disappear to give way to a specific psychological disorder and vice versa.心理学空间'^5O^e(v2D

,`I]vK2L1FH?0在我的术语中的形容词——“基本的”不仅意味着它与以俄狄浦斯情结为特征的这些简单的状况有关,而且它的影响范围广泛,大概超出了个人整个的精神生物学结构,在不同程度上涉及了他的心智和他的身体。基本缺陷的概念以这种方式允许我们不仅去理解各种神经症(大概还包括精神病)、性格障碍、心身疾病等等,也包括去理解——正如我们研究到的一般医疗实践业已表明的经验——大量的普通的‘临床’疾病(Balint, M., 1957; Balint, M., & Balint, Enid, 1961; Lask, 1966; Greco and Pittenger, 1966)。我的意思是,在各种的情绪体验的影响下,在他们的医疗中,一个“临床”的疾病可能会消失,以让位于一个特定的心理障碍,反之亦然。

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In my view the origin of the basic fault may be traced back to a considerable discrepancy in the early formative phases of the individual between his biopsychological needs and the material and psychological care, attention, and affection available during the relevant times. This creates a state of deficiency whose consequences and after-effects appear to be only partly reversible. The cause of this early discrepancy may be congenital, i.e. the infant’s biopsychological needs may have been too exacting (there are non-viable infants and progressive congenital conditions, like Friedreich’s ataxia or cystic kidneys), or may be environmental, such as care that is insufficient, deficient, haphazard, overanxious, over-protective, harsh, rigid, grossly inconsistent, incorrectly timed, overstimulating, or merely un-understanding or indifferent.心理学空间H#q;M Eb

a5Lwq4a7emc|W%m0在我看来,基本缺陷的起源可以追溯到个体的早期形成阶段中的巨大差异,在相关期间生理需求和物质以及心理呵护、关心、情感关注之间的巨大差异。这造成了一种缺乏的状态,其后果和影响似乎只能够被部分可逆。这种早期的缺乏的原因可能是先天性的,也就是说,婴儿的生理心理需求可能太难以取悦(不存在无法生活的婴儿和逐渐形成的条件,就像弗利德来氏共济失调或囊状肾),或者是环境太过苛刻,例如照顾是不够的、缺乏的、盲目的、过度焦虑的、过度保护的、苛刻、僵化、非常的反复无常、非正确同步的、过度刺激的,或者很少理解以及漠不关心的。心理学空间+Ah/B)SLG_

{\Q.jY!P`{0As may be seen from my description, I put the emphasis on the lack of ‘fit’ between the child and the people who represent his environment. Incidentally, we started with a similar lack of ‘fit’ – between the analyst’s otherwise correct technique and a particular patient’s needs; this is very likely to be an important cause of difficulties, and even failures, experienced by analysts in their practice. This will be discussed in more detail in Part V.

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~!fWSE4{BzQ1|I0从我的描述中可以看出,我所强调的是孩子与代表他环境的成人之间‘吻合’的缺乏。顺便提一下,我们开始于一个类似的“吻合”的缺乏——在分析师完全不是那么一回事的正确的技术与一个特定病人需求之间的缺乏;这很可能是导致分析师在他们的实践中所体验的困难、甚至是失败的一个重要的原因。这些将在第五部分中更详细的讨论。心理学空间YR~p s-}K(d&o

1M){CI!| r2d1y0Returning now to our main theme, I wish the reader to be aware of my personal bias, under the influence of which my description of the processes, which eventually may result in some basic fault, will be couched in terms of object relationship. In my view, all these processes happen within a very primitive and peculiar object-relationship, fundamentally different from those commonly observed between adults. It is definitely a two-person relationship in which, however, only one of the partners matters; his wishes and needs are the only ones that count and must be attended to; the other partner, though felt to be immensely powerful, matters only in so far as he is willing to gratify the first partner’s needs and desires or decides to frustrate them; beyond this his personal interests, needs, 26 desires, wishes, etc., simply do not exist. In Chapter 12 I propose to discuss in more detail this essentially two-person relationship and to differentiate it from what I have called primary object love, or primary object relationship.

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8W wa*K6QM5W s0现在回到我们的主题,我希望读者能察觉到我的个人的偏见,在我的描述过程影响之下的偏见,这一最终可能会导致一些会埋伏在客体关系之中的基本缺陷。在我看来,所有这些过程发生在一个非常原始的和特殊的客体关系之中,从根本上不同于那些通常在成年人之间所观察到的。它肯定是一种二人的关系,然而在此之中,只有一个参与者的问题;他的愿望和需求是唯一需要被照顾和被值得考虑的;另一个参与者,虽然感觉是无比强大的,但是问题只有在他愿意满足第一个参与者的需要和欲望之中以挫败他们;除此之外他个人的利益,需要、愿望,企求,等等,根本不存在。在第12章中,我提出更详细的讨论,这基本上是两个人的关系,并从我所说的主要的客体爱,或主要对象关系中区分它。

t!U [}8e-k0www.psychspace.com心理学空间网
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