1940 Mourning and its Relation to Manic-Depressive States
作者: . Int. J. Psycho-Ana / 5850次阅读 时间: 2009年10月27日
标签: Klein Mourning
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)|#YXL{/`"B}8KQ01940 Mourning and its Relation to Manic-Depressive States心理学空间'_!C1ggF.U

r]#|.IzPa g&FzS01940 Mourning and its Relation to Manic-Depressive States. Int. J. Psycho-Anal., 21:125-153 (IJP)
X iw6NLg0Mourning and its Relation to Manic-Depressive States1心理学空间'e;YD K4\Nx\
Melanie Klein心理学空间x5m ODv
An essential part of the work of mourning is, as Freud points out in 'Mourning and Melancholia', the testing of reality. He says that 'in grief this period of time is necessary for detailed carrying out of the behest imposed by the testing of reality, and ?by accomplishing this labour the ego succeeds in freeing its libido from the lost object', 2 And again: 'Each single one of the memories and hopes which bound the libido to the object is brought up and hyper-cathected, and the detachment of the libido from it accomplished. Why this process of carrying out the behest of reality bit by bit, which is in the nature of a compromise, should be so extraordinarily painful is not at all easy to explain in terms of mental economics. It is worth noting that this pain seems natural to us.'3 And, in another passage: 'We do not even know by what economic measures the work of mourning is carried through; possibly, however, a conjecture may help us here. Reality passes its verdict梩hat the object no longer exists梪pon each single one of the memories and hopes through which the libido was attached to the lost object, and the ego, confronted as it were with the decision whether it will share this fate, is persuaded by the sum of its narcissistic satisfactions in being alive to sever its attachment to the non-existent object. We may imagine that, because of the slowness and the gradual
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1This paper was read originally before the Fifteenth International Psycho-Analytical Congress, Paris, 1938. It was subsequently revised and enlarged with a view to its inclusion in the Ernest Jones Sixtieth Birthday Number of this JOURNAL, Vol. XX, Parts 3 and 4, 1939.
p3yb k&Tf02Collected Papers, Vol. IV, p. 163.
D @4Zvr0\03Collected Papers, p. 154.
q C~+}GEt*j04Collected Papers, p. 166.
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5p^.G&a,Ndi#n t0way in which this severance is achieved, the expenditure of energy necessary for it becomes somehow dissipated by the time the task is carried through.'4
g%_ rj_k r0In my view there is a close connection between the testing of reality in normal mourning and early processes of the mind. My contention is that the child goes through states of mind comparable to the mourning of the adult, or rather, that this early mourning is revived whenever grief is experienced in later life. The most important of the methods by which the child overcomes his states of mourning, is, in my view, the testing of reality; this process, however, as Freud stresses, is part of the work of mourning.心理学空间!e Nf.OV
In my paper 'A Contribution to the Psychogenesis of Manic-Depressive States', 5 I introduced the conception of the infantile depressive position, and showed the connection between that position and manic-depressive states. Now in order to make clear the relation between the infantile depressive position and normal mourning I must first briefly refer to some statements I made in that paper, and shall then enlarge on them. In the course of this exposition I also hope to make a contribution to the further understanding of the connection between normal mourning, on the one hand, and abnormal mourning and manic-depressive states, on the other.
0T:a:X]'C,O'U(W0I said there that the baby experiences depressive feelings which reach a climax just before, during and after weaning. This is the state of mind in the baby which I termed the 'depressive position', and I suggested that it is a melancholia in statu nascendi. The object which is being mourned is the mother's breast and all that the breast and the milk have come to stand for in the infant's mind: namely, love, goodness and security. All these are felt by the baby to be lost, and lost as a result of his own uncontrollable greedy and destructive phantasies and impulses against his mother's breasts. Further distress about impending loss (this time of both parents) arises out of the Oedipus situation, which sets in so early and in such close connection with breast frustrations that in its beginnings it is dominated by oral impulses and fears. The circle of loved objects who are attacked in phantasy and whose loss is therefore feared widens owing to the child's心理学空间7^rs N!G h/W(GS

&f3{P#MR6QA05This JOURNAL, Vol. XVI, 1935. The present paper is a continuation of that paper, and much of what I have now to say will of necessity assume the conclusions I arrived at there.心理学空间*jo!K Iys5E5v
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ambivalent relations to his brothers and sisters. The aggression against phantasied brothers and sisters, who are attacked inside the mother's body, also gives rise to feelings of guilt and loss. The sorrow and concern about the feared loss of the 'good' objects, that is to say, the depressive position, is, in my experience, the deepest source of the painful conflicts in the Oedipus situation, as well as in the child's relations to people in general. In normal development these feelings of grief and fears are overcome by various methods.
VD1`~"eWs H0Along with the child's relation, first to his mother and soon to his father and other people, go those processes of internalization on which I have laid so much stress in my work. The baby, having incorporated his parents, feels them to be live people inside his body in the concrete way in which deep unconscious phantasies are experienced梩hey are, in his mind, 'internal' or 'inner' objects, as I have termed them. Thus an inner world is being built up in the child's unconscious mind, corresponding to his actual experiences and the impressions he gains from people and the external world, and yet altered by his own phantasies and impulses. If it is a world of people predominantly at peace with each other and with the ego, inner harmony, security and integration ensue.心理学空间cr[6Q|"s0Umf~D
There is a constant interaction between anxieties relating to the 'external' mother梐s I will call her here in contrast to the 'internal' one梐nd those relating to the 'internal' mother, and the methods used by the ego for dealing with these two sets of anxieties are closely inter-related. In the baby's mind, the 'internal' mother is bound up with the 'external' one, of whom she is a 'double', though one which at once undergoes alterations in his mind through the very process of internalization; that is to say, her image is influenced by his phantasies, and by internal stimuli and internal experiences of all kinds. When external situations which he lives through become internalized梐nd I hold that they do, from the earliest days onwards梩hey follow the same pattern: they also become 'doubles' of real situations, and are again altered for the same reasons. The fact that by being internalized, people, things, situations and happenings梩he whole inner world which is being built up梑ecome inaccessible to the child's accurate observation and judgement, and cannot be verified by the means of perception which are available in connection with the tangible and palpable object-world, has an important bearing on the phantastic nature of this inner world. The ensuing doubts, uncertainty and anxieties act as a continuous incentive to the young child to
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6Here I can only refer in passing to the great impetus which these anxieties afford to the development of interests and sublimations of all kinds. If these anxieties are over-strong, they may interfere with or even check intellectual development. (Cf. Klein, 'A Contribution to the Theory of Intellectual Inhibition', this JOURNAL, Vol. XII, 1931.)心理学空间9I"SDd/V)CkCy
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&bWt)_8Es3k:AF0observe and make sure about the external object-world, 6 from which this inner world springs, and by these means to understand the internal one better. The visible mother thus provides continuous proofs of what the 'internal' mother is like, whether she is loving or angry, helpful or revengeful. The extent to which external reality is able to disprove anxieties and sorrow relating to the internal reality varies with each individual, but could be taken as one of the criteria for normality. In children who are so much dominated by their internal world that their anxieties cannot be sufficiently disproved and counteracted even by the pleasant aspects of their relationships with people, severe mental difficulties are unavoidable. On the other hand, a certain amount even of unpleasant experiences is of value in this testing of reality by the child if, through overcoming them, he feels that he can retain his objects as well as their love for him and his love for them, and thus preserve or re-establish internal life and harmony in face of dangers.心理学空间7h)i`%G5|"kC
All the enjoyments which the baby lives through in relation to his mother are so many proofs to him that the loved object inside as well as outside is not injured, is not turned into a vengeful person. The increase of love and trust, and the diminishing of fears through happy experiences, help the baby step by step to overcome his depression and feeling of loss (mourning). They enable him to test his inner reality by means of outer reality. Through being loved and through the enjoyment and comfort he has in relation to people his confidence in his own as well as in other people's goodness becomes strengthened, his hope that his 'good' objects and his own ego can be saved and preserved increases, at the same time as his ambivalence and acute fears of internal destruction diminish.
[ gh\l$}U"V0Unpleasant experiences and the lack of enjoyable ones, in the young child, especially lack of happy and close contact with loved people, increase ambivalence, diminish trust and hope and confirm anxieties about inner annihilation and external persecution; moreover they slow down and perhaps permanently check the beneficial processes through which in the long run inner security is achieved.
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%U"B)?&AP Ea.h*|0In the process of acquiring knowledge, every new piece of experience has to be fitted into the patterns provided by the psychic reality which prevails at the time; whilst the psychic reality of the child is gradually influenced by every step in his progressive knowledge of external reality. Every such step goes along with his more and more firmly establishing his inner 'good' objects, and is used by the ego as a means of overcoming the depressive position.心理学空间?+C-Tm^sxS
In other connections I have expressed the view that every infant experiences anxieties which are psychotic in content, 7 and that the infantile neurosis8 is the normal means of dealing with and modifying these anxieties. This conclusion I can now state more precisely, as a result of my work on the infantile depressive position, which has led me to believe that it is the central position in the child's development. In the infantile neurosis the early depressive position finds expression, is worked through and gradually overcome; and this is an important part of the process of organization and integration which, together with his sexual development, 9 characterizes the first years of life. Normally the child passes through his infantile neurosis, and among other achievements arrives step by step at a good relation to people and to reality. I hold that this satisfactory relation to people depends upon his having succeeded in his struggles against the chaos inside
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~$lvG#q Bi7H07The Psycho-Analysis of Children, 1932; in particular, Chapter VIII.心理学空间/Gaj;jgn
8In the same book (p. 149), referring to my view that every child passes through a neurosis differing only in degree from one individual to another, I added: 'This view, which I have maintained for a number of years now, has lately received valuable support. In his book, Die Frage der Laienanalyse (1926), Freud writes: "Since we have learnt to see more clearly we are almost inclined to say that the occurrence of a neurosis in childhood is not the exception but the rule. It seems as though it is a thing that cannot be avoided in the course of development from the infantile disposition to the social life of the adult" (S. 61).'心理学空间3e? \Sv/|7dKV
9At every juncture the child's feelings, fears and defences are linked up with his libidinal wishes and fixations, and the outcome of his sexual development in childhood is always interdependent with the processes I am describing in this paper. I think that new light will be thrown on the child's libidinal development if we consider it in connection with the depressive position and the defences used against that position. It is, however, a subject of such importance that it needs to be dealt with fully, and is therefore beyond the scope of this paper.
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l)Vl Wo%L sjwf0him (the depressive position) and having securely established his 'good' internal objects.心理学空间6?z Mm8{}RM
Let us now consider more closely the methods and mechanisms by which this development comes about.
%tT W\wV5|0In the baby, processes of introjection and projection, since they are dominated by aggression and anxieties which reinforce each other, lead to fears of persecution by terrifying objects. To such fears are added those of losing his loved objects; that is to say, the depressive position has arisen. When I first introduced the conception of the depressive position I put forward the suggestion that the introjection of the whole loved object gives rise to concern and sorrow lest that object should be destroyed (by the 'bad' objects and the id), and that these distressed feelings and fears, in addition to the paranoid set of fears and defences, constitute the depressive position. There are thus two sets of fears, feelings and defences, which, however varied in themselves and however intimately linked together, can in my view, for purposes of theoretical clearness, be isolated from each other. The first set of feelings and phantasies are the persecutory ones, characterized by fears relating to the destruction of the ego by internal persecutors. The defences against these fears are predominantly the destruction of the persecutors by violent or secretive and cunning methods. With these fears and defences I have dealt in detail in other contexts. The second set of feelings which go to make up the depressive position I formerly described without suggesting a term for them. I now propose to use for these feelings of sorrow and concern for the loved objects, the fears of losing them and the longing to regain them, a simple word derived from everyday language梟amely the 'pining' for the loved object. In short梡ersecution (by 'bad' objects) and the characteristic defences against it, on the one hand, and pining for the loved ('good') object, on the other, constitute the depressive position.
1Z~ Fkl8Q0When the depressive position arises, the ego is forced (in addition to earlier defences) to develop methods of defence which are essentially directed against the 'pining' for the loved object. These are fundamental to the whole ego-organization. I formerly termed some of these methods manic defences, or the manic position, because of their relationship to the manic-depressive illness.10心理学空间0e ge`8M6[-Pu
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10'A Contribution to the Psychogenesis of Manic-Depressive States', this JOURNAL, Vol. XVI, 1935.
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The fluctuations between the depressive and the manic position are an essential part of normal development. The ego is driven by depressive anxieties (anxiety lest the loved objects as well as itself should be destroyed) to build up omnipotent and violent phantasies, partly for the purpose of controlling and mastering the 'bad', dangerous objects, partly in order to save and restore the loved ones. From the very beginning, these omnipotent phantasies, both the destructive and the reparative ones, stimulate and enter into all the activities, interests and sublimations of the child. In the infant, the extreme character both of his sadistic and of his constructive phantasies is in line with the extreme frightfulness of his persecutors梐nd, at the other end of the scale, the extreme perfection of his 'good' objects.11 Idealization is an essential part of the manic position and is bound up with another important element of that position, namely denial. Without partial and temporary denial of psychic reality the ego cannot bear the disaster by which it feels itself threatened when the depressive position is at its height. Omnipotence, denial and idealization, closely bound up with ambivalence, enable the early ego to assert itself to a certain degree against its internal persecutors and心理学空间X HW9b}

!p$B&{#p'|HXa$f0I011I have pointed out in various connections (first of all in 'The Early Stages of the Oedipus Complex', this JOURNAL, Vol. IX, 1928) that the fear of phantastically 'bad' persecutors and the belief in phantastically 'good' objects are bound up with each other. Idealization is an essential process in the young child's mind, since he cannot yet cope in any other way with his fears of persecution (a result of his own hatred). Not until early anxieties have been sufficiently relieved owing to experiences which increase love and trust, is it possible to establish the all-important process of bringing together more closely the various aspects of objects (external, internal, 'good' and 'bad', loved and hated), and thus for hatred to become actually mitigated by love梬hich means a decrease of ambivalence. While the separation of these contrasting aspects 梖elt in the unconscious as contrasting objects 梠perates strongly, feelings of hatred and love are also so much divorced from each other that love cannot mitigate hatred.心理学空间 xf ebya3v Q"kJ
The flight to the internalized 'good' object, which Melitta Schmideberg (in 'Psychotic Mechanisms in Cultural Development', this JOURNAL, Vol. XI, 1930) has found to be a fundamental mechanism in schizophrenia, thus also enters into the process of idealization which the young child normally resorts to in his depressive anxieties. Melitta Schmideberg has also repeatedly drawn attention to the connections between idealization and distrust of the object.
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#|3T*K7a?)K gj0against a slavish and perilous dependence upon its loved objects, and thus to make further advances in development. I will here quote a passage from my former paper:
!W9OoE+?&i$NT(zlD*k0In the earliest phase the persecuting and the good objects (breasts) are kept wide apart in the child's mind. When, along with the introjection of the whole and real object, they come closer together, the ego has over and over again recourse to that mechanism梥o important for the development of the relations to objects梟amely, a splitting of its imagos into loved and hated, that is to say, into good and dangerous ones.心理学空间c1OnPiM'G)g9k0w
One might think that it is actually at this point that ambivalence which, after all, refers to object-relations梩hat is to say, to whole and real objects梥ets in. Ambivalence, carried out in a splitting of the imagos, enables the small child to gain more trust and belief in its real objects and thus in its internalized ones梩o love them more and to carry out in an increasing degree its phantasies of restoration on the loved object. At the same time the paranoid anxieties and defences are directed towards the "bad" objects. The support which the ego gets from a real "good" object is increased by a flight-mechanism, which alternates between its external and internal good objects. [Idealization.]
6?3_p!^&~|0It seems that at this stage of development the unification of external and internal, loved and hated, real and imaginary objects is carried out in such a way that each step in the unification leads again to a renewed splitting of the imagos. But as the adaptation to the external world increases, this splitting is carried out on planes which gradually become increasingly nearer and nearer to reality. This goes on until love for the real and the internalized objects and trust in them are well established. Then ambivalence, which is partly a safeguard against one's own hate and against the hated and terrifying objects, will in normal development again diminish in varying degrees.12心理学空间mF4L_u,sY4?+HB
As has already been stated, omnipotence prevails in the early phantasies, both the destructive and the reparative ones, and influences sublimations as well as object relations. Omnipotence, however, is so closely bound up in the unconscious with the sadistic impulses with which it was first associated that the child feels again and again that his attempts at reparation have not succeeded, or will not succeed. His sadistic impulses, he feels, may easily get the better of him. The young child, who cannot sufficiently trust his reparative and constructive feelings, as we have seen, resorts to manic omnipotence. For
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12'A Contribution to the Psychogenesis of Manic-Depressive States', pp. 172?.
6f2I#vo,}#W.hT013The Psycho-Analysis of Children, pp. 170 and 278.心理学空间Z ik(RA*KMcw
14The Psycho-Analysis of Children, Chapter IX.
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this reason, in an early stage of development the ego has not adequate means at its disposal to deal efficiently with guilt and anxiety. All this leads to the need in the child梐nd for that matter to some extent in the adult also梩o repeat certain actions obsessionally (this, in my view, is part of the repetition compulsion);13 or梩he contrasting method梠mnipotence and denial are resorted to. When the defences of a manic nature fail, defences in which dangers from various sources are in an omnipotent way denied or minimized, the ego is driven alternately or simultaneously, to combat the fears of deterioration and disintegration by attempted reparations carried out in obsessional ways. I have described elsewhere14 my conclusion that the obsessional mechanisms are a defence against paranoid anxieties as well as a means of modifying them, and here I will only show briefly the connection between obsessional mechanisms and manic defences in relation to the depressive position in normal development.心理学空间9Qp(W8^d.ys~0TZ
The very fact that manic defences are operating in such close connection with the obsessional ones contributes to the ego's fear that the reparation attempted by obsessional means has also failed. The desire to control the object, the sadistic gratification of overcoming and humiliating it, of getting the better of it, the triumph over it, may enter so strongly into the act of reparation (carried out by thoughts, activities or sublimations) that the benign circle started by this act becomes broken. The objects which were to be restored change again into persecutors, and in turn paranoid fears are revived. These fears reinforce the paranoid defence mechanisms (of destroying the object) as well as the manic mechanisms (of controlling it or keeping it in suspended animation, and so on). The reparation which was in progress is thus disturbed or even nullified梐ccording to the extent to which these mechanisms are activated. As a result of the failure of the act of reparation, the ego has to resort again and again to obsessional and manic defences.
"GSKDn0When in the course of normal development a relative balance between love and hate is attained, and the various aspects of objects are more unified, then also a certain equilibrium between these contrasting and yet closely related methods is reached, and their intensity is diminished. In this connection I wish to stress the importance of triumph, closely bound up with contempt and omnipotence, as an心理学空间;q$K s.yT7m:W
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.C'OcQ~+l0element of the manic position. We know the part rivalry plays in the child's burning desire to equal the achievements of the grown-ups. In addition to rivalry, his wish, mingled with fears, to 'grow out' of his deficiencies (ultimately to overcome his destructiveness and his bad inner objects and to be able to control them) is an incentive to achievements of all kinds. In my experience, the desire to reverse the child-parent relation, to get power over the parents and to triumph over them, is always to some extent associated with the impulse towards the attainment of success. A time will come, the child phantasies, when he will be strong, tall and grown up, powerful, rich and potent, and father and mother will have changed into helpless children, or again, in other phantasies, will be very old, weak, poor and rejected. The triumph over the parents in such phantasies, through the guilt to which it gives rise, often cripples endeavours of all kinds. Some people are obliged to remain unsuccessful, because success always implies to them the humiliation or even the damage of somebody else, in the first place the triumph over parents, brothers and sisters. The efforts by which they seek to achieve something may be of a highly constructive nature, but the implicit triumph and the ensuing harm and injury done to the object may outweigh these purposes, in the subject's mind, and therefore prevent their fulfilment. The effect is that the reparation to the loved objects, which in the depths of the mind are the same as those over which he triumphs, is again thwarted, and therefore guilt remains unrelieved. The subject's triumph over his objects necessarily implies to him their wish to triumph over him, and therefore leads to distrust and feelings of persecution. Depression may follow, or an increase in manic defences and more violent control of his objects, since he has failed to reconcile, restore, or improve them, and therefore feelings of being persecuted by them again have the upper hand. All this has an important bearing on the infantile depressive position and the ego's success or failure in overcoming it. The triumph over his internal objects which the young child's ego controls, humiliates and tortures is a part of the destructive aspect of the manic position which disturbs the reparation and re-creating of his inner world and of internal peace and harmony; and thus triumph impedes the work of early mourning.
Y]J&zo illustrate these developmental processes let us consider some features which can be observed in hypomanic people. It is characteristic of the hypomanic person's attitude towards people, principles and events that he is inclined to exaggerated valuations: over-admiration心理学空间;u7w#FXOb
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(idealization) or contempt (devaluation). With this goes his tendency to conceive of everything on a large scale, to think in large numbers, all this in accordance with the greatness of his omnipotence, by which he defends himself against his fear of losing the one irreplaceable object, his mother, whom he still mourns at bottom. His tendency to minimize the importance of details and small numbers, and a frequent casualness about details and contempt of conscientiousness contrast sharply with the very meticulous methods, the concentration on the smallest things (Freud), which are part of the obsessional mechanisms.心理学空间w c1?7o-k$b%g
This contempt, however, is also based to some extent on denial. He must deny his impulse to make extensive and detailed reparation because he has to deny the cause for the reparation, namely the injury to the object and his consequent sorrow and guilt.
{ ]8G*?[ b0Returning to the course of early development, we may say that every step in emotional, intellectual and physical growth is used by the ego as a means of overcoming the depressive position. The child's growing skills, gifts and arts increase his belief in the psychical reality of his constructive tendencies, in his capacity to master and control his hostile impulses as well as his 'bad' internal objects. Thus anxieties from various sources are relieved, and this results in a diminution of aggression and, in turn, of his suspicions of 'bad' external and internal objects. The strengthened ego, with its greater trust in people, can then make still further steps towards unification of its imagos梕xternal, internal, loved and hated梐nd towards further mitigation of hatred by means of love, and thus to a general process of integration.心理学空间skf/\(N;P
When the child's belief and trust in his capacity to love, in his reparative powers and in the integration and security of his good inner world increase as a result of the constant and manifold proofs and counter-proofs gained by the testing of external reality, manic omnipotence decreases and the obsessional nature of the impulses towards reparation diminishes, which means in general that the infantile neurosis has passed.心理学空间]O A$y1y0] u
We have now to connect the infantile depressive position with normal mourning. The poignancy of the actual loss of a loved person is, in my view, greatly increased by the mourner's unconscious phantasies of having lost his internal 'good' objects as well. He then feels that his internal 'bad' objects predominate and his inner world is in danger of disruption. We know that the loss of a loved person leads to an impulse in the mourner to reinstate the lost loved object in the
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:\e;}`/W|Y5f0ego. (Freud and Abraham.) In my view, however, he not only takes into himself (re-incorporates) the person whom he has just lost, but also reinstates his internalized good objects (ultimately his loved parents), who became part of his inner world from the earliest stages of his development onwards. These too are felt to have gone under, to be destroyed, whenever the loss of a loved person is experienced. Thereupon the early depressive position, and with it anxieties, guilt and feelings of loss and grief derived from the breast situation, the Oedipus situation and all other such sources, are reactivated. Among all these emotions, the fears of being robbed and punished by both dreaded parents梩hat is to say, feelings of persecution梙ave also been revived in deep layers of the mind.心理学空间z!}#wA/J4Y Y t]
If, for instance, a woman loses her child through death, along with sorrow and pain, her early dread of being robbed by a 'bad' retaliating mother is reactivated and confirmed. Her own early aggressive phantasies of robbing her mother of babies gave rise to fears and feelings of being punished, which strengthened ambivalence and led to hatred and distrust of others. The reinforcing of feelings of persecution in the state of mourning is all the more painful because, as a result of an increase in ambivalence and distrust, friendly relations with people, which might at that time be so helpful, become impeded.
9p6^4mv9p4Oc0The pain experienced in the slow process of testing reality in the work of mourning thus seems to be partly due to the necessity, not only to renew the links to the external world and thus continuously to re-experience the loss, but at the same time and by means of this to rebuild with anguish the inner world, which is felt to be in danger of deteriorating and collapsing.15 Just as the young child passing through the depressive position is struggling, in his unconscious mind, with the task of establishing and integrating his inner world, so the mourner goes through the pain of re-establishing and re-integrating it.心理学空间k5[TsW+^M#pj~*D:c
In normal mourning early psychotic anxieties are reactivated; the mourner is in fact ill, but, because this state of mind is so common and心理学空间Y;?Sn;vh0f,E1vu

;f!^f'O c j(_4BV015These facts I think go some way towards answering Freud's question which I have quoted at the beginning of this paper: 'Why this process of carrying out the behest of reality bit by bit, which is in the nature of a compromise, should be so extraordinarily painful is not at all easy to explain in terms of mental economics. It is worth noting that this pain seems natural to us.'心理学空间!SBGm2ys7L$ZG
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8k$ycD O r0seems so natural to us, we do not call mourning an illness. (For similar reasons, until recent years, the infantile neurosis of the normal child was not recognized as such.) To put my conclusions more precisely: I should say that in mourning the subject goes through a modified and transitory manic-depressive state and overcomes it, thus repeating, though in different circumstances and with different manifestations, the processes which the child normally goes through in his early development.心理学空间%wCt0]un)Ms3y&E
The greatest danger for the mourner comes from the turning of his hatred against the lost loved person himself. One of the ways in which hatred expresses itself in the situation of mourning is in feelings of triumph over the dead person. I refer in an earlier part of this paper to triumph as part of the manic position in infantile development. Infantile death wishes against parents, brothers and sisters are actually fulfilled whenever a loved person dies, because he is necessarily to some extent a representative of the earliest important figures, and therefore takes over some of the feelings pertaining to them. Thus his death, however shattering for other reasons, is to some extent also felt as a victory, and gives rise to triumph, and therefore all the more to guilt.
O:Qe,s-x`F0At this point I find that my view differs from that of Freud, who stated: 'First, then: in normal grief too the loss of the object is undoubtedly surmounted, and this process too absorbs all the energies of the ego while it lasts. Why then does it not set up the economic condition for a phase of triumph after it has run its course or at least produce some slight indication of such a state? I find it impossible to answer this objection off-hand.'16 In my experience, feelings of triumph are inevitably bound up even with normal mourning, and have the effect of retarding the work of mourning, or rather they contribute much to the difficulties and pain which the mourner experiences. When hatred of the lost loved object in its various manifestations gets the upper hand in the mourner, this not only turns the loved lost person into a persecutor, but shakes the mourner's belief in his good inner objects as well. The shaken belief in the good objects disturbs most painfully the process of idealization, which is an essential intermediate step in mental development. With the young child, the idealized mother is the safeguard against a retaliating or a dead mother and against all bad objects, and therefore represents security and life
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16'Mourning and Melancholia', Collected Papers, Vol. IV, p. 166.
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itself. As we know, the mourner obtains great relief from recalling the lost person's kindness and good qualities, and this is partly due to the reassurance he experiences from keeping his loved object for the time being as an idealized one.
*[A9c8m)Wu0The passing states of elation17 which occur between sorrow and distress in normal mourning are manic in character and are due to the feeling of possessing the perfect loved object (idealized) inside. At any time, however, when hatred against the lost loved person wells up in the mourner, his belief in him breaks down and the process of idealization is disturbed. (His hatred of the loved person is increased by the fear that by dying the loved one was seeking to inflict punishment and deprivation upon him, just as in the past he felt that his mother, whenever she was away from him and he wanted her, had died in order to inflict punishment and deprivation upon him.) Only gradually, by regaining trust in external objects and values of various kinds, is the normal mourner able once more to strengthen his confidence in the lost loved person. Then he can again bear to realize that this object was not perfect, and yet not lose trust and love for him, nor fear his revenge. When this stage is reached, important steps in the work of mourning and towards overcoming it have been made.
,hC;z/B+i+t.@0To illustrate the ways in which a normal mourner re-established connections with the external world I shall now give an instance. Mrs. A., in the first few days after the shattering loss of her young son, who had died suddenly while at school, took to sorting out letters, keeping his and throwing others away. She was thus unconsciously attempting to restore him and keep him safe inside herself, and throwing out what she felt to be indifferent, or rather hostile梩hat is to say, the 'bad' objects, dangerous excreta and bad feelings.心理学空间C k'j(ECE
Some people in mourning tidy the house and re-arrange furniture, actions which spring from an increase of the obsessional mechanisms which are a repetition of one of the defences used to combat the infantile depressive position.心理学空间J4? fUp+fR&L-L
In the first week after the death of her son she did not cry much, and tears did not bring her the relief which they did later on. She心理学空间PmRA"F
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17Abraham writes of a situation of this kind: 'We have only to reverse [Freud's] statement that "the shadow of the lost love-object falls upon the ego" and say that in this case it was not the shadow but the bright radiance of his loved mother which was shed upon her son.' (Selected Papers, p. 442.)
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e Z~&WFh)v.Iu0felt numbed and closed up, and physically broken. It gave her some relief, however, to see one or two intimate people. At this stage Mrs. A., who usually dreamed every night, had entirely stopped dreaming because of her deep unconscious denial of her actual loss. At the end of the week she had the following dream:心理学空间 G}0KU d uP
She saw two people, a mother and son. The mother was wearing a black dress. The dreamer knew that this boy had died, or was going to die. No sorrow entered into her feelings, but there was a trace of hostility towards the two people.
Ot5y)n*B;N_o;k_0The associations brought up an important memory. When Mrs. A. was a little girl, her brother, who had difficulties in his school work, was going to be tutored by a school-fellow of his own age (I will call him B.). B.'s mother had come to see Mrs. A.'s mother to arrange about the coaching, and Mrs. A. remembered this incident with very strong feelings. B.'s mother behaved in a patronizing way, and her own mother appeared to her to be rather dejected. She herself felt that a fearful disgrace had fallen upon her very much admired and beloved brother and the whole family. This brother, a few years older than herself, seemed to her full of knowledge, skill and strength梐 paragon of all the virtues, and her ideal was shattered when his deficiencies at school came to light. The strength of her feelings about this incident as being an irreparable misfortune, which persisted in her memory, was, however, due to her unconscious feelings of guilt. She felt it to be the fulfilment of her own harmful wishes. Her brother himself was very much chagrined by the situation, and expressed great dislike and hatred of the other boy. Mrs. A. at the time identified herself strongly with him in these resentful feelings. In the dream, the two people whom Mrs. A. saw were B. and his mother, and the fact that the boy was dead expressed Mrs. A.'s early death wishes against him. At the same time, however, the death wishes against her own brother and the wish to inflict punishment and deprivation upon her mother through the loss of her son梫ery deeply repressed wishes梬ere part of her dream thoughts. It now appeared that Mrs. A., with all her admiration and love for her brother, had been jealous of him on various grounds, envying his greater knowledge, his mental and physical superiority, and also his possession of a penis. Her jealousy of her much beloved mother for possessing such a son had contributed towards her death wishes against her brother. One dream thought, therefore, ran: 'A mother's son has died, or will die. It is this unpleasant woman's son, who hurt my mother and brother, who心理学空间5X+s"tW6mh0g{ @2qQ
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should die.' But in deeper layers, the death wish against her brother had also been reactivated, and this dream thought ran: 'My mother's son died, and not my own.' (Both her mother and her brother were in fact already dead.) Here a contrasting feeling came in梥ympathy with her mother and sorrow for herself. She felt: 'One death of the kind was enough. My mother lost her son; she should not lose her grandson also.' When her brother died, besides great sorrow, she unconsciously felt triumph over him, derived from her early jealousy and hatred, and corresponding feelings of guilt. She had carried over some of her feelings for her brother into her relation to her son. In her son, she also loved her brother; but at the same time, some of the ambivalence towards her brother, though modified through her strong motherly feelings, was also transferred on to her son. The mourning for her brother, together with the sorrow, the triumph and the guilt experienced in relation to him, entered into her present grief, and was shown in the dream.
2IN8d];CW4t/b0Let us now consider the interplay of defences as they appeared in this material. When the loss occurred, the manic position became reinforced, and denial in particular came especially into play. Unconsciously, Mrs. A. strongly rejected the fact that her son had died. When she could no longer carry on this denial so strongly, but was not yet able to face the pain and sorrow, triumph, one of the other elements of the manic position, became reinforced. 'It is not at all painful', the thought seemed to run, as the associations showed, 'if a boy dies. It is even satisfactory. Now I get my revenge against this unpleasant boy who injured my brother.' The fact that triumph over her brother had also been revived and strengthened became clear only after hard analytic work. But this triumph was associated with control of the internalized mother and brother, and triumph over them. At this stage the control over her internal objects was reinforced, the misfortune and grief were displaced from herself on to her internalized mother. Here denial again came into play梔enial of the psychical reality that she and her internal mother were one and suffered together. Compassion and love for the internal mother were denied, feelings of revenge and triumph over the internalized objects and control of them were reinforced, partly because, through her own revengeful feelings, they had turned into persecuting figures.
%\T;?D,G0In the dream there was only one slight hint of Mrs. A.'s growing unconscious knowledge (indicating that the denial was lessening) that it was she herself who lost her son. On the day preceding the dream心理学空间^2I%QP$z!C
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y0Y6~"x!\'jLy0she was wearing a black dress with a white collar. The woman in the dream had something white round her neck on her black dress.
:k {3x9f6TF$}N0Two nights after this dream she dreamt again:心理学空间CIJ2|U1g
She was flying with her son, and he disappeared. She felt that this meant his death梩hat he was drowned. She felt as if she, too, were to be drowned梑ut then she made an effort and drew away from the danger, back to life.心理学空间p'FZV8]q
The associations showed that in the dream she had decided that she would not die with her son, but would survive. It appeared that even in the dream she felt that it was good to be alive and bad to be dead. In this dream the unconscious knowledge of her loss is much more accepted than in the one of two days earlier. Sorrow and guilt had drawn closer. The feeling of triumph had apparently gone, but it became clear that it had only diminished. It was still present in her satisfaction about remaining alive梚n contrast to her son's being dead. The feelings of guilt which already made themselves felt were partly due to this element of triumph.心理学空间V/j!P-K4G4p9J
I am reminded here of a passage in Freud's 'Mourning and Melancholia':18 'Reality passes its verdict梩hat the object no longer exists梪pon each single one of the memories and hopes through which the libido was attached to the lost object, and the ego, confronted as it were with the decision whether it will share this fate, is persuaded by the sum of its narcissistic satisfactions in being alive to sever its attachment to the non-existent object.' In my view, this 'narcissistic satisfaction' contains in a milder way the element of triumph which Freud seemed to think does not enter into normal mourning.心理学空间(Z ZDXn+wv;~
In the second week of her mourning Mrs. A. found some comfort in looking at nicely situated houses in the country, and in wishing to have such a house of her own. But this comfort was soon interrupted by bouts of despair and sorrow. She now cried abundantly, and found relief in tears. The solace she found in looking at houses came from her rebuilding her inner world in her phantasy by means of this interest and also getting satisfaction from the knowledge that other people's houses and good objects existed. Ultimately this stood for re-creating her good parents, internally and externally, unifying them and making them happy and creative. In her mind she made reparation to her parents for having, in phantasy, killed their children, and by this she anticipated their wrath. Thus her fear that the death of心理学空间2~Bcy#K6me0W9i
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18Collected Papers, Vol. IV, p. 166.心理学空间+UV C)B| zn$^
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.t P#|/lo@0her son was a punishment inflicted on her by retaliating parents lost in strength, and also the feeling that her son frustrated and punished her by his death was lessened. The diminution of hatred and fear all round allowed the sorrow itself to come out in full strength. Increase of distrust and fears had intensified her feeling of being persecuted and mastered by her internal objects and strengthened her need to master them. All this had expressed itself by a hardening in her internal relationships and feelings梩hat is to say, in an increase in manic defences. (This was shown in the first dream.) If these again diminish through the strengthening of the subject's belief in goodness梙is own and others'梐nd fears decrease, the mourner is able to surrender to his own feelings, and to cry out his sorrow about the actual loss.
*\([k _2jOK*T0It seems that the processes of projecting and ejecting which are closely connected with giving vent to feelings, are held up in certain stages of grief by an extensive manic control, and can again operate more freely when that control relaxes. Through tears, which in the unconscious mind are equated to excrement, the mourner not only expresses his feelings and thus eases tension, but also expels his 'bad' feelings and his 'bad' objects, and this adds to the relief obtained through crying. This greater freedom in the inner world implies that the internalized objects, being less controlled by the ego, are also allowed more freedom: that these objects themselves are allowed, in particular, greater freedom of feeling. In the mourner's situation, the feelings of his internalized objects are also sorrowful. In his mind, they share his grief, in the same way as actual kind parents would. The poet tells us that 'Nature mourns with the mourner'. I believe that 'Nature' in this connection represents the internal good mother. This experience of mutual sorrow and sympathy in internal relationships, however, is again bound up with external ones. As I have already stated, Mrs. A.'s greater trust in actual people and things and help received from the external world contributed to a relaxing of the manic control over her inner world. Thus introjection (as well as projection) could operate still more freely, more goodness and love could be taken in from without, and goodness and love increasingly experienced within. Mrs. A., who at an earlier stage of her mourning had to some extent felt that her loss was inflicted on her by revengeful parents, could now in phantasy experience the sympathy of these parents (dead long since), their desire to support and to help her. She felt that they also suffered a severe loss and shared her grief, as they would have done had they lived. In her internal world harshness and心理学空间"B};H2AAFu
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suspicion had diminished, and sorrow had increased. The tears which she shed were also to some extent the tears which her internal parents shed, and she also wanted to comfort them as they梚n her phantasy梒omforted her.心理学空间I ?pL Q-]v
If greater security in the inner world is gradually regained, and feelings and inner objects are therefore allowed to come more to life again, re-creative processes can set in and hope return.
*lI3Q5RiT0As we have seen, this change is due to certain movements in the two sets of feelings which make up the depressive position: persecution decreases and the pining for the lost loved object is experienced in full force. To put it in other words: hatred has receded and love is freed. It is inherent in the feeling of persecution that it is fed by hatred and at the same time feeds hatred. Furthermore, the feeling of being persecuted and watched by internal 'bad' objects, with the consequent necessity for constantly watching them, leads to a kind of dependence which reinforces the manic defences. These defences, in so far as they are used predominantly against persecutory feelings (and not so much against the pining for the loved object), are of a very sadistic and forceful nature. When persecution diminishes, the hostile dependence on the object, together with hatred, also diminishes, and the manic defences relax. The pining for the lost loved object also implies dependence on it, but dependence of a kind which becomes an incentive to reparation and preservation of the object. It is creative because it is dominated by love, while the dependence based on persecution and hatred is sterile and destructive.
!O8S6JX1q&nh0Thus, while grief is experienced to the full and despair at its height, the love for the object wells up and the mourner feels more strongly that life inside and outside will go on after all, and that the lost loved object can be preserved within. At this stage in mourning, suffering can become productive. We know that painful experiences of all kinds sometimes stimulate sublimations, or even bring out quite new gifts in some people, who may take to painting, writing or other productive activities under the stress of frustrations and hardships. Others become more productive in a different way梞ore capable of appreciating people and things, more tolerant in their relation to others梩hey become wiser. Such enrichment is in my view gained through processes similar to those steps in mourning which we have just investigated. That is to say, any pain caused by unhappy experiences, whatever their nature, has something in common with mourning. It reactivates the infantile depressive position, and encountering and心理学空间 XZo p%|{&i V
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overcoming adversity of any kind entails mental work similar to mourning.心理学空间2Y4d'GH X
It seems that every advance in the process of mourning results in a deepening in the individual's relation to his inner objects, in the happiness of regaining them after they were felt to be lost ('Paradise Lost and Regained'), in an increased trust in them and love for them because they proved to be good and helpful after all. This is similar to the ways in which the young child step by step builds up his relations to external objects, for he gains trust not only from pleasant experiences, but also from the ways in which he overcomes frustrations and unpleasant experiences, nevertheless retaining his good objects (externally and internally). The phases in the work of mourning when manic defences relax and a renewal of life inside sets in, with a deepening in internal relationships, are comparable to the steps which in early development lead to greater independence from external as well as internal objects.
N6fj ]Y2n$n0To return to Mrs. A. Her relief in looking at pleasant houses was due to the setting in of some hope that she could re-create her son as well as her parents; life started again inside herself and in the outer world. At this time she could dream again and unconsciously begin to face her loss. She now felt a stronger wish to see friends again, but only one at a time and only for a short while. These feelings of greater comfort, however, again alternated with distress. (In mourning as well as in infantile development, inner security comes about not by a straightforward movement but in waves.) After a few weeks of mourning, for instance, Mrs. A. went for a walk with a friend through the familiar streets, in an attempt to re-establish old bonds. She suddenly realized that the number of people in the street seemed overwhelming, the houses strange and the sunshine artificial and unreal. She had to retreat into a quiet restaurant. But there she felt as if the ceiling were coming down, and the people in the place became vague and blurred. Her own house suddenly seemed the only secure place in the world. In analysis it became clear that the frightening indifference of these people was reflected from her internal objects, who in her mind had turned into a multitude of 'bad' persecuting objects. The external world was felt to be artificial and unreal, because real trust in inner goodness had gone.心理学空间Dn(O S;g5BxlZ
Many mourners can only make slow steps in re-establishing the bonds with the external world because they are struggling against the chaos inside; for similar reasons the baby develops his trust in the心理学空间4j1yQ"T4gie*}
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object-world first in connection with a few loved people. No doubt other factors as well, e.g. his intellectual immaturity, are partly responsible for this gradual development in the baby's object relations, but I hold that this also is due to the chaotic state of his inner world.心理学空间-A[V6D8o
One of the differences between the early depressive position and normal mourning is that when the baby loses the breast or bottle, which has come to represent to him a 'good' helpful, protective object inside him, and experiences grief, he does this in spite of his mother being there. With the grown-up person however the grief is brought about by the actual loss of an actual person; yet help comes to him against this overwhelming loss through his having established in his early life his 'good' mother inside himself. The young child, however, is at the height of his struggles with fears of losing her internally and externally, for he has not yet succeeded in establishing her securely inside himself. In this struggle, the child's relation to his mother, her actual presence, is of the greatest help. Similarly, if the mourner has people whom he loves and who share his grief, and if he can accept their sympathy, the restoration of the harmony in his inner world is promoted, and his fears and distress are more quickly reduced.
`T#C0@N!nj O0Having described some of the processes which I have observed at work in mourning and in depressive states, I wish now to link up my contribution with the work of Freud and Abraham.心理学空间ph"H6z:d~-X&k
Following Freud's and his own discoveries about the nature of the archaic processes at work in melancholia, Abraham found that such processes also operate in the work of normal mourning. He concluded that in this work the individual succeeds in establishing the lost loved person in his ego, while the melancholic has failed to do so. Abraham also described some of the fundamental factors upon which that success or failure depends.
b,ZE w_V5i:z6w/w0My experience leads me to conclude that, while it is true that the characteristic feature of normal mourning is the individual's setting up the lost loved object inside himself, he is not doing so for the first time but, through the work of mourning, is reinstating that object as well as all his loved internal objects which he feels he has lost. He is therefore recovering what he had already attained in childhood.
wy$o&r b){*vt ]0In the course of his early development, as we know, he establishes his parents within his ego. (It was the understanding of the processes of introjection in melancholia and in normal mourning which, as we know, led Freud to recognize the existence of the super-ego in normal development.) But, as regards the nature of the super-ego and the心理学空间#EQy H%|"G*\1c
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@1Jc/jm$VO!E0history of its individual development, my conclusions differ from those of Freud. As I have often pointed out, the processes of introjection and projection from the beginning of life lead to the institution inside ourselves of loved and hated objects, who are felt to be 'good' and 'bad', and who are interrelated with each other and with the self: that is to say, they constitute an inner world. This assembly of internalized objects becomes organized, together with the organization of the ego, and in the higher strata of the mind it becomes discernible as the super-ego. Thus, the phenomenon which was recognized by Freud, broadly speaking, as the voices and the influence of the actual parents established in the ego is, according to my findings, a complex object-world, which is felt by the individual, in deep layers of the unconscious, to be concretely inside himself, and for which I and some of my colleagues therefore use the term 'internalized', or an internal (inner) world. This inner world consists of innumerable objects taken into the ego, corresponding partly to the multitude of varying aspects, good and bad, in which the parents (and other people) appeared to the child's unconscious mind throughout various stages of his development. Further, they also represent all the real people who are continually becoming internalized in a variety of situations provided by the multitude of ever-changing external experiences as well as phantasied ones. In addition, all these objects are in the inner world in an infinitely complex relation both with each other and with the self.心理学空间T3G ks*Fav0O&m
If I now apply this conception of the super-ego organization as compared with Freud's super-ego to the process of mourning, the nature of my contribution to the understanding of this process becomes clear. In normal mourning the individual re-introjects and reinstates, as well as the actual lost person, his loved parents梬ho are felt to be his 'good' inner objects. His inner world, the one which he has built up from his earliest days onwards, in his phantasy was destroyed when the actual loss occurred. The rebuilding of this inner world characterizes the successful work of mourning.心理学空间ADM*qk
An understanding of this complex inner world enables the analyst to find and resolve a variety of early anxiety-situations which were formerly unknown, and is therefore theoretically and therapeutically of an importance so great that it cannot yet be fully estimated. I believe that the problem of mourning also can only be more fully understood by taking account of these early anxiety situations.
Gm9Nso4p0I shall now illustrate in connection with mourning one of these anxiety-situations which I have found to be of crucial importance also
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in manic-depressive states. I refer to the anxiety about the internalized parents in destructive sexual intercourse; they as well as the self are felt to be in constant danger of violent destruction. In the following material I shall give extracts from a few dreams of a patient, D., a man in his early forties, with strong paranoid and depressive traits. I am not going into details about the case as a whole: but am here concerned only to show the ways in which these particular fears and phantasies were stirred in this patient by the death of his mother. She had been in failing health for some time, and was, at the time to which I refer, more or less unconscious.心理学空间]3r7r-Ain9q\v/^
One day in analysis, D. spoke of his mother with hatred and bitterness, accusing her of having made his father unhappy. He also referred to a case of suicide and one of madness which had occurred in his mother's family. His mother, he said, had been 'muddled' for some time. Twice he applied the term 'muddled' to himself and then said: 'I know you are going to drive me mad and then lock me up.' He spoke about an animal being locked up in a cage. I interpreted that his mad relative and his muddled mother were now felt to be inside himself, and that the fear of being locked up in a cage partly implied his deeper fear of containing these mad people inside himself and thus of going mad himself. He then told me a dream of the previous night:
+f B3za7p+P.V(q?0He saw a bull lying in a farmyard. It was not quite dead, and looked very uncanny and dangerous. He was standing on one side of the bull, his mother on the other. He escaped into a house, feeling that he was leaving his mother behind in danger and that he should not do so; but he vaguely hoped that she would get away.
?5`!S V\/j c0To his own astonishment, my patient's first association to the dream was of the blackbirds which had disturbed him very much by waking him up that morning. He then spoke of buffaloes in America, the country where he was born. He had always been interested in them and attracted by them when he saw them. He now said that one could shoot them and use them for food, but that they are dying out and should be preserved. Then he mentioned the story of a man who had been kept lying on the ground, with a bull standing over him for hours, unable to move for fear of being crushed. There was also an association about an actual bull on a friend's farm; he had lately seen this bull, and he said it looked ghastly. This farm had associations for him by which it stood for his own home. He had spent most of his childhood on a large farm his father owned. In between, there were associations about flower seeds spreading from the country and taking root in town心理学空间7\2V-hhS8B;RA
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gardens. D. saw the owner of this farm again the same evening and urgently advised him to keep the bull under control. (D. had learnt that the bull had recently damaged some buildings on the farm.) Later that evening he received the news of his mother's death.心理学空间(n h)vg P5m
In the following hour, D. did not at first mention his mother's death, but expressed his hatred of me梞y treatment was going to kill him. I then reminded him of the dream of the bull, interpreting that in his mind his mother had become mixed up with the attacking bull father梙alf dead himself梐nd had become uncanny and dangerous. I myself and the treatment were at the moment standing for this combined parent-figure. I pointed out that the recent increase of hatred against his mother was a defence against his sorrow and despair about her approaching death. I referred to his aggressive phantasies by which, in his mind, he had changed his father into a dangerous bull which would destroy his mother; hence his feeling of responsibility and guilt about this impending disaster. I also referred to the patient's remark about eating buffaloes, and explained that he had incorporated the combined parent-figure and so felt afraid of being crushed internally by the bull. Former material had shown his fear of being controlled and attacked internally by dangerous beings, fears which had resulted among other things in his taking up at times a very rigid and immobile posture. His story of the man who was in danger of being crushed by the bull, and who was kept immobile and controlled by it, I interpreted as a representation of the dangers by which he felt threatened internally.19心理学空间S;RI G)dq:L$n
I now showed the patient the sexual implications of the bull's attacking his mother, connecting this with his exasperation about the birds waking him that morning (this being his first association to the bull dream). I reminded him that in his associations birds often stood心理学空间 gu5h2HG"I LgRV
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19I have often found that processes which the patient unconsciously feels are going on inside him are represented as something happening on top of or closely round him. By means of the well-known principle of representation by the contrary, an external happening can stand for an internal one. Whether the emphasis lies on the internal or the external situation becomes clear from the whole context梖rom the details of associations and the nature and intensity of affects. For instance, certain manifestations of very acute anxiety and the specific defence mechanisms against this anxiety (particularly an increase in denial of psychic reality) indicate that an internal situation predominates at the time.
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