癔症研究05

癔症研究05
IV
第四章

THE PSYCHOTHERAPY OF
HYSTERIA 257
癔症的心理治疗

(FREUD)
弗洛伊德

Consequently, the psychical mechanism revealed by the ‘Pre-
liminary Communication 5 could not be pathognomonic for
hysteria. Nor could I resolve, merely for the sake of preserving
that mechanism as a criterion of it, to lump all these other
neuroses in with hysteria. I eventually found a way out of all
these emerging doubts by the plan of treating all the other
neuroses in question in the same way as hysteria. I determined
to investigate their aetiology and the nature of their psychical
mechanism in every case and to let the decision as to whether
the diagnosis of hysteria was justified depend upon the outcome
of that investigation.

结果,初步沟通所显示的心理机制,无法成为癔症的确定诊断。我也无法决定,仅是为了保持那个作为它的标准的机制,要将所有这些其他的神经症跟癔症堆积一块。我最后找到一个方法避开所有这些出现的怀疑,凭借计划将所有受到置疑的其他神经症,跟癔症一样,用相同方式来处理。我决定研究他们的病因学,与他们在每个情况的心理机制的特性。并且让这个决定,关于癔症的诊断是否自圆其说,依靠那个研究的结果来做决定。

Thus, starting out from Breuer’s method, I found myself
engaged in a consideration of the aetiology and mechanism of
the neuroses in general. I was fortunate enough to arrive at
some serviceable findings in a relatively short time. 1 In the first
place I was obliged to recognize that, in so far as one can speak
of determining causes which lead to the acquisition of neuroses,
their aetiology is to be looked for in sexual factors. There fol-
lowed the discovery that different sexual factors, in the most
general sense, produce different pictures of neurotic disorders.

因此,从布鲁尔的方法开始,我发现我自己从事考虑一般的神经症的病因学与心理机制。我足够幸运地在相当短的时间内,获得某些可供服务的发现。首先,我不得不承认,就我们所能够谈论到导致神经症的罹患的决定的原因,他们的病因学应该被寻找,在性的因素。跟随而来的是这个发现:不同的性的因素,从最通俗的意义来说,产生不同的神经症的疾病的画面。

And it then became possible, in the degree to which this
relation was confirmed, to venture on using aetiology for the
purpose of characterizing the neuroses and of making a sharp
distinction between the clinical pictures of the various neuroses.
Where the aetiological characteristics coincided regularly with
the clinical ones, this was of course justified.

因此,这变得可能,这个关系被证实的程度,为了大胆使用病因学作为表现神经症的特性,并且明显地区别各种的神经症的临床画面。以病因学作为特性,规律地跟临床的特性不谋而合。这当然能够自圆其说。

In this manner I found that neurasthenia presented a mon-
otonous clinical picture in which, as my analyses showed, a
‘psychical mechanism’ played no part. There was a sharp
distinction between neurasthenia and ‘obsessional neurosis’, the
neurosis of obsessional ideas proper. In this latter one I was
able to recognize a complicated psychical mechanism, an
aetiology similar to that of hysteria and an extensive possibility
of reducing it by psychotherapy. On the other hand, it seemed
to me absolutely necessary to detach from neurasthenia a com-
plex of neurotic symptoms which depend on a quite different
and indeed at bottom a contrary aetiology.

以这种方式,我发现,脑神经衰弱呈现一个单调的临床画面。依照我的分析显示,在这个临床画面,“心理的机制”并没有任何角色。在脑神经衰弱与“妄想症神经症”,妄想症本体的观念的神经症,他们之间的区别非常明显。在妄想症的神经症,我能够体认出一种复杂的心理机制,一种类似癔症的病因学的病因学。它具有广泛的可能,凭借心理治疗化简它。在另一方面,我觉得绝对有这个必要,将神经症的症状的情结,跟脑神经衰弱区隔开来。神经症的症状依靠完全不同,而且确实追根究底是相反的病因学。

The component
symptoms of this complex are united by a characteristic which
has already been recognized by Hecker (1893). For they are
either symptoms or equivalents and rudiments of manifestations
of anxiety and for this reason I have given to this complex
which is to be detached from neurasthenia the name of ‘anxiety
neurosis’.

这个情结的组成的症状凭借赫克(1893)已经体认出来的特性,作为统合。因为这些症状要就是焦虑展示的症状,要不就是焦虑的展示的相等与初级阶段。因为这个理由,我给予这个情结,“焦虑神经症”的名字。这个情结应该跟神经衰弱症区隔开来。

I have maintained [Freud 1895] that it arises from
an accumulation of physical tension, which is itself once more
of sexual origin. This neurosis, too, has no psychical mech-
anism, but it invariably influences mental life, so that ‘anxious
expectation 5 , phobias, hyperaesthesia to pains, etc., are among
its regular manifestations. This anxiety neurosis, in my sense
of the term, no doubt coincides in part with the neurosis which,
under the name of ‘hypochondria’, finds a place in not a few
descriptions alongside hysteria and neurasthenia. But I cannot
regard the delimitation of hypochondria in any of the works in
question as being the correct one, and the applicability of its
name seems to me to be prejudiced by the fixed connection of
that term with the symptom of ‘fear of illness’. 1

我曾经主张(弗洛伊德 1895),这个情结是由于生理的紧张的累积而产生。这个生理上的紧张再次是出于性的起源。这个神经症也没有心理的机制,但是它一成不变地影响到精神的生活。所以,“焦虑的期待,恐惧症,对于痛苦的过度敏感症,等等,都是它的规律的展示的症状。从我对术语的理解,这个焦虑神经症无可置疑地,部分跟”忧郁症“这个名称之下找到一席之地的神经症不谋而合。在癔症与神经衰弱症之外的许多描述里。但是,我无法将任何受到置疑的研究里的忧郁症的除掉限制,认为就是正确的除掉限制。我觉得,忧郁症的名称的应用似乎是一种偏见,那个术语跟”对于疾病的恐惧“的症状固定地联接一块,产生的偏见。

雄伯译
32hsiung@pchome.com.tw
https://springhero.wordpress.com

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