自闭-毗连心位的防御模式
Thomas H. Ogden （1989）
Mints 译
Defences generated in an autistic-contiguous mode are directed at the re-establishment of continuity of the bounded (被容纳在…里,与…毗邻；紧密连接，成为…的边界,界限) sensory surface and ordered rhythmicity upon which the early integrity of self rests. Within the analytic hour, patients spanning the full range of psychological maturity commonly attempt to reconstitute a sensory 'floor' (Grotstein, 1987) of experience by means of activities like hair twirling, foot tapping (even while lying on the couch), stroking of the lips, cheek, or ear lobe, humming, intoning, picturing or repeating series of numbers, focusing on symmetrical geometric shapes on the ceiling or wall or using a finger to trace shapes on the wall next to the couch. Such activities can be thought of as self-soothing uses of autistic shapes.
在自闭-毗连模式中产生的这些防御旨在（directed at）重新建立紧致的感官表面和秩序的节律的连续性，早期自我的完整性休憩于此。患者在分析时间内，往往跨越了整个心理成熟序列，通过旋转头发、拍打脚（即使躺在沙发上）、抚摸嘴唇、脸颊或耳垂、哼唱、吟诵、描绘或重复一系列数字，关注天花板或墙壁上的对称几何形状，或用手指追踪沙发旁边墙上的形状等方法，尝试着重建感官体验的“地板（floor）”（Grotstein, 1987）。可以认为这样的活动是在运用各种自闭形式进行自我安慰。
Between analytic hours, patients commonly attempt to maintain or re-establish a failing sense of bodily cohesion by means of rhythmic muscular activities including long periods of bicycle riding, jogging, lap swimming, etc.; eating and purging rituals; rocking (sometimes in a rocking chair); head banging (often against a pillow); riding buses and subways or driving a car for hours; aintaining a system of numbers or geometric shapes in one's head or in computer programmes that are continually being worked on (i.e. 'perfected'), etc. The absolute regularity of these activities is so essential to the process of allaying anxiety that the individual cannot/will not allow any other activity to take precedence over them.
在两次分析的间隔期，患者通常试图通过有节奏的肌肉活动（包括长时间骑自行车、慢跑、圈泳等）；饮食和净化仪式；摇摆（有时在摇椅上）；头部撞击（通常撞击枕头）；乘坐公共汽车、地铁或开车数小时；在一个人的头脑中或者在一个不断运行（即“完美”）的计算机程序中维持一个数字或几何形状的系统等等，来维持或重建身体凝聚的衰退感。这些活动的绝对韵律对于缓解焦虑的过程至关重要，以至于个人不能/不愿允许任何的其他活动优先于它们。
Bick (1968), (1986) uses the phrase 'second skin formation' to describe the way in which the individual attempts to create a substitute for a deteriorating sense of the cohesiveness of skin surface. Often the individual attempts to use the sensory experience of adhering to the surface of the object in order to resurrect the integrity of his own surface. For example, one might attempt to adhere to an object by means of tenacious eye contact or a steady stream of chatter in a way that is 'experienced … as holding the parts of the [sensory-dominated] personality together' (Bick, 1968, p. 49).
Bick（1968, 1986）用“次级皮肤结构”这个短语来描述个体如何试图创造一种替代方式，以取代皮肤表面内聚感的日益恶化。通常，个体试图利用附着在物体表面的感官体验来恢复自身表面的完整性。例如，一个人可能会试图通过执着的眼神接触或持续的喋喋不休的方式粘附着一个客体，这种方式是“体验……将[感官主导的]人格的各个部分抱持在一起” (Bick, 1968, p. 49).。
Meltzer (Meltzer et al., 1975) has introduced the term adhesive identification to refer to the defensive adherence to the object in the service of allaying （减轻）the anxiety of disintegration. Imitation and mimicry, for instance, are utilized in an effort to make use of the surface of the object as if it were one's own. Adhesive identification is a form of identification more primitive than either introjective or projective identification in that the latter two forms of identification involve a sense of inner space into which one can project an aspect of oneself or into which one can take an aspect of the object. In an autistic-contiguous mode, one attempts to defend against the anxiety of disintegration by sticking bits of the surface of the object to one's own failing surface.
Meltzer（Meltzer et al.，1975）引入了“粘附性认同（adhesive identification）”一词指的是为了减轻失整合焦虑而对客体进行粘附的防御。例如，效仿和模仿是为了努力利用客体的表面，就好像它是自己的一样。粘附性认同是一种比内摄性认同或投射性认同更原始的认同形式，因为后两种认同形式涉及一种内在空间感，人们可以在这个空间中将自己的一个方面投射到其中，也可以将客体的一个方面纳入其中。在自闭-毗连模式中，人们试图通过将客体表面的碎片粘在自己的破损表面上来抵御失整合焦虑。
Tustin (1986) correctly points out that the object utilized in 'adhesive identification' is not experienced as a separate object and therefore the term adhesive equation better describes the way in which the individual is equated with (becomes the qualities of) the surface of the object being used in this form of defence.
Tustin（1986）实事求是地指出，在“粘附性认同”中使用的客体并不是作为一个分离的物体来体验的，因此术语“粘附性等式”（adhesive equation）更好地描述了个体等同于（成为）在这种防御形式中使用的物体的表面（之品质）的方式。
Mrs R, in a regressed phase of her analysis, would spend hours at a time picking at her face. She suffered from severe insomnia in large part due to fear of nightmares that she could not recall. Over time, her face became covered with scabs at which she picked. As this 'picking' was occurring in the analytic hours, the patient was clearly in a painfully anxious state although she said that she had 'absolutely no thoughts'.
R夫人在分析中的一个退行阶段，会一次花几个小时在脸上挑刺。她的严重的失眠症在很大程度上是因为害怕那些她无法回忆的噩梦。随着时间的推移，她的脸上长满了她挑出来的血痂。由于这种“挑刺/剔除”发生在分析时间，患者显然处于痛苦的焦虑状态，尽管她说自己“完全没有想法”。
Mrs R took bits of tissue from the Kleenex box next to the couch and stuck them to the lesions she was creating on her face. (She would also take extra pieces of these tissues home with her at the end of the hour.) It did not seem to me that either self-destructive wishes or displaced hostility towards me was the core of this activity at this point （在这时）in the analysis. I said to her that I thought she must feel as if she were without skin; she did not sleep because when she was asleep she must feel psychologically defenceless to the danger of nightmares. I told her that I could understand her attempt to cover herself with my skin (tissues) since this seemed to make her feel a little less raw（皮肤破损的；擦伤的、未经处理的；未经分析的；原始的 ）.
R夫人从沙发旁边的纸巾盒中取出一些纸巾（tissue, 译注：双关语，tissue也有细胞组织的意思）贴在她在脸上弄出的损伤地方，（她也会在一节咨询结束时带上额外的纸巾回家。）在我看来，自我毁灭的愿望，或者对我的敌意的置换似乎都不是这项活动在分析中的这种时刻的核心。我告诉她，我想她一定觉得自己仿佛没有皮肤；她不睡觉是因为她一定会觉得自己在睡着的时候对这些噩梦的危险毫无心理防御。我告诉她，我可以理解她试图用我的皮肤（组织/纸巾）覆盖自己，因为这似乎让她感觉少了一点擦伤。
In the hour following this intervention, Mrs R fell asleep and slept for almost the entire session until I woke her to tell her that our time was up. In the next meeting, the patient said that even though she had not had a blanket while sleeping in my office, she had the distinct feeling when recalling that session that she had been sleeping under some sort of cover. Mrs R's capacity to sleep during her session represented an expanded and more fully symbolic（象征性符号） use of me as a second skin. She utilized me and the analytic setting as （作为） a symbolic and yet tangibly felt medium （媒介，介质，灵媒） in which to wrap herself. She felt sufficiently covered and held together to safely sleep.
R夫人在干预之后睡着了，几乎整个疗程都在睡觉，直到我叫醒她，告诉她我们的时间到了。在下一次会谈中，患者说，尽管她在我的办公室睡觉的时候没有毯子，但当她回忆起那节咨询时，她有一种明显的感觉，那就是她一直盖着柔然的东西一直睡着。R夫人在她的咨询中睡着的能力代表着她能够在更大的范围和更完整的把我作为次级皮肤的象征性符号使用。她把我和分析性设置作为一种象征性的、又能明显感受到的，把她自己包裹在里面的媒介。她觉得自己被完全遮盖住了，并且紧紧地抱在一起，可以安全地入睡。
Before concluding this section, I would like to mention briefly two forms of symptomatology where the concept of autistic-contiguous modes of defence must supplement understandings formulated in terms of defences erected （建立; 建造; 竖立，Erection勃起）in the face of anxiety resulting from conflicted sexual and aggressive wishes. First, compulsive masturbation often serves the purpose of creating a heightened experience of a sensory surface in order to ward off （避开，躲开，防止）feelings of loss of sensory cohesion. A female patient would masturbate for hours each day without conscious sexual phantasy. Orgasm was not the goal. When orgasm did occur, it was experienced as an unwelcome 'anticlimax' （令人扫兴的事）which ended the only part of the patient's day during which she felt 'alive and in one piece'.
在结束本节之前，我想简单地提到症状学（symptomatology）的两种形式，其中自闭-毗连防御模式的概念必须补充理解阐释在面对因性的冲突和攻击性愿望而导致的焦虑之时竖立起来的防御机制。首先，强迫性自慰的目的通常是为了创造一种高涨的感官表面体验，以避免抵挡（ ward off）失去感官凝聚的情绪感受。女性患者每天手淫数小时而没有性幻觉意识。高潮不是目的。当性高潮确实发生时，它被体验为一种不受欢迎的“反高潮（anticlimax）”，这种反高潮结束了患者一天中唯一感到“活着而且完整”的部分。
Secondly, painful, anxiety-producing procrastination also often serves the purpose of generating a palpable （palp触须 易于察觉的;可意识到的;明显的）sensory edge against which the patient attempts to define （画出…的线条）himself. The 'deadline' is elevated （提拔，晋升，提升）to the position of a continually felt pressure in the patient's emotional life that can be a felt presence at every moment whether or not the patient is consciously focused upon it. These patients describe the anxiety of the approaching deadline as a pressure that they hate and at the same time continually seem to create for themselves: 'A due date is something to push up against like a wall in front of me'.
其次，痛苦的、焦虑不已的拖延症通常也有助于制造可触及到的感官边界，患者试图依靠这些描述出自己的轮廓。“最后期限”在患者的情绪生活中被抬高到持续感到压力的位置，他可以在每时每刻感受到这种情绪的在场，而无论患者是否有意识地专注于这些时刻。这类患者将邻近最后期限的焦虑描述为一种他们即讨厌、同时似乎又在不断为自己制造的压力：“最后期限就像我面前的一堵需要推倒墙一样。”
A deadline that is finally met usually does not produce more than a sense of momentary relief and instead often throws the patient into a state of panic. Very frequently such patients become physically ill once the task has been completed (usually at the last possible moment prior to the deadline), experiencing such symptoms as migraine headaches, dermatitis, or somatic delusions. Such symptoms can be understood as substitute efforts at maintaining a sensory surface in the absence of the containing pressure of the deadline.
最终遇到的最后期限通常只会产生短暂的解脱感，而且经常会让患者进入惊恐状态之中。在完成任务之后（通常是在截止日期前的最后一个可能时刻），这些患者经常会出现身体疾病，体验到像偏头痛、皮炎或躯体错觉等症状。此类症状可以理解为，在缺乏涵容最后期限压力的情况下维持感官表面的替代性努力。
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