荣格:精神病内容

THE CONTENT OF THE PSYCHOSES
精神病的内容
Carl Jung 卡尔 荣格
320 Psychiatry is a stepchild of medicine. All the other branches
of medicine have one great advantage: the scientific method. In all other branches there are things that can be seen and touched, physical and chemical methods of investigation to be followed. The microscope reveals the dreaded bacillus, the surgeon’s knife halts at no anatomical difficulty and gives us glimpses into the most vital and inaccessible organs. Psychiatry, the art of healing the soul, still stands at the door, seeking in vain to weigh and measure as in the other departments of science. We have long known that we have to do with a definite organ, the brain; but only beyond the brain, beyond the anatomical substrate, do we reach what is important for us-the psyche, as indefinable as ever, still eluding all explanation, no matter how ingenious.

精神病是医学的继子。医学的所有的其他分科都拥有一个很大的优点:科学的方法。在所有其他的分科,有些东西能够被看见,被碰触到,生理或化学的研究方法能够被遵循。显微镜显示可怕的杆菌,外科医生的手术刀面对解剖,并无任何困难,并且让我们瞥见最具有生命力与无法接近的器官。精神病学,治疗灵魂的艺术,则是依旧站在门边,白费力气地尝试衡量与测量,如同在科学的其他部门。我们长久以来就知道,我们必须处理明确的器官,脑。但是仅有在超越脑之外,超越解剖的次级层面之外,我们才获得对于我们是重要的东西—心灵,像以往一样无法被定义,依旧逃避所有的解释,无论是多么聪明的解释。

321 Former ages, endowing the soul with substance and personi-
fying every incomprehensible occurrence in nature, regarded mental illness as the work of evil spirits; the patient was looked upon as one possessed, and the methods of treatment were such as befitted this conception. It is not unknown for this medieval view to find credence and expression even today. A classic example is the expulsion of the devil which was successfully per¬formed by the elder Pastor Blumhardt in the famous case of the Dittus sisters. 1 To the honour of the Middle Ages be it said that there were also early evidences of a sound rationalism.

以前的时代,赋予灵魂具有物质,并且让每一个无法被理解的自然的事件具有人格化。以前的时代将精神疾病视为是邪恶精灵的运作:病人被看待作为是被鬼魂著魔。治疗的方法是如此合适于这个观念。中世纪的观点并非不知道如何找到即使在今天的可信度与表达。古典的例子就是将恶魔驱除出去。这个驱魔出去由年长的牧师布伦哈特执行。在著名的狄塔斯姐妹的个案。中世纪的令人推崇之处,我们不妨说,它也具有健全的理性主义的证据。

Thus, in the sixteenth century at the Julius Hospital in Wiirzburg, mental patients were already being treated side by side with the physically sick, and the treatment seems to have been really humane. With the opening of the modern era and the dawn of the first scientific ideas, the original barbaric personification of unknown powers gradually disappeared; a change arose in the conception of mental disease in favour of a more philosophic moral attitude. The ancient view that every misfortune was the vengeance of offended gods returned in a new guise to suit the times. Just as physical diseases can, in many cases, be traced back to some frivolous self-injury, so mental diseases were believed to be due to some moral injury, or sin. Behind this conception, too, lurks the angry deity.

因此,在十六世纪,在维兹伯格的朱利斯医院,精神病人已经被治疗,跟生理疾病的病人并排一块。这种治疗在当时似乎确实合乎人性。随着现代的时代的开始,与科学的观念的开始,原先的野蛮的将未知的力量予以拟人化,逐渐就消失。精神疾病的观念产生改变,以赞同更加具有哲学的道德的态度。古代的观念认为,每个不幸都是众神受到冒犯产生的报复。这个古老的观点回转过来,具有新的伪装,以符合新的时代。正如在许的的个案里,生理的疾病能够被追踪,回到某个任意的自我的伤害。精神疾病也被相信是由于某个道德的伤害,或原罪。在这个观念的背后,也潜藏著愤怒的神祗。

1 Bresler, “Kulturhistorischer Beitrag zur Hysterie” (1897); Zlindel, Pfan’er J. C. Blumhardt (1880). [Also Cal”ter, Pastor Blumhardt.-EDIToRs.]
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THE CONTENT OF THE PSYCHOSES
322 Such views played a great role right up to the beginning of
the last century, especially in German psychiatry. In France, however, at about the same time, a new idea was appearing, des¬tined to sway psychiatry for a hundred years. Pinel, whose statue fittingly stands at the gateway of the Salpetriere in Paris, re¬moved the chains from the insane and thus freed them from the stigma of the criminal. In this way he gave the most effective expression to the humane and scientific conceptions of modern times. A little later Esquirol and Bayle made the discovery that certain forms of insanity ended in death after a relatively short time, and that regular changes in the brain could be demon¬strated post mortem.2 Esquirol had discovered general paralysis of the insane (or, as it was popularly called, “softening of the brain”), a disease which is always accompanied by chronic in¬flammatory shrinkage of the cerebral tissue. Thus was laid the foundation of the dogma which you will find repeated in every text-book of psychiatry: “Mental diseases are diseases of the brain.”

这些观点扮演重要的角色,一直到上个世纪的开始,特别是在德国的精神病学。可是,在法国,大约在同时,一个新的观念正在出现,注定会影响精神病学,有百年之久。皮内尔的雕像恰如其分地站立在巴黎的萨培瑞尔医院的大门。他将锁链从疯狂者身上移开开,因此解放他们,免疫罪犯的标志。用这个方式,他给予最有效的表达,对于现代的人性与科学的观念。后来,耶斯奎洛与巴尔发现到:某些疯狂的形式结果造成死亡,经过比较短暂的时期。根据死后解剖,脑部的规律的改变能够被证明。耶斯奎洛曾经发现到疯狂者的通常的麻痹)或者,如它通俗被称为是“脑部的软化”),这一个疾病总是伴随着脑细胞组织的慢性的发炎的萎缩。因此,这个信条的基础被奠定下来。你将会发现这个信条被重复,在精神病的每一本教科书上:「精神疾病就是脑的疾病」。

323 Further confirmation of this view was furnished about the
same time by the discoveries of Gall, who traced partial or com¬plete loss of the power of speech-a psychic faculty-to a lesion in the region of the lower left frontal convolution. Later this view proved to be exceedingly fruitful. Innumerable cases of extreme idiocy and other serious mental disorders were found to be caused by tumours of the brain. Towards the end of the nine¬teenth century Wernicke (recently deceased) localized the speech-centre in the left temporal lobe. This epoch-making dis¬covery raised hopes to the highest pitch. It was expected that the time was not far off when every characteristic and every psychic activity would be assigned its place in the cortical grey matter. Gradually, more and more attempts were made to trace the primary mental changes in the psychoses back to parallel changes in the brain.

这个观点的更进一步的被证实,大约同时间,由嘉尔的发现所提供。嘉尔追踪心灵的能力,也就是,言说的力量的部分或完全的丧失,回溯到左下方的前面迴旋的地区的病变。后来,这个观点证明是极端有成果的。无数的极端白痴与其他严重的精神疾病的个案,被发现是脑的肿瘤所引起。将近十九世纪的末期,温米克(最近生病了)找出言说中心的位置,在左边的脑的颞页。这个创世纪的发现,将希望提升到最高度。大家期望,在这个表皮的灰色的物质,每个具有特效,每个心灵的活动,将会被指明它的位置,这个时机为时不远了。逐渐地,越来越多的企图被从事,为了追踪精神病这的原初的精神的改变,回归到脑部的并行的改变。
2 [For these and other historic medical personages mentioned in this volume, cf. ZiIboorg and Hemy, History of Medical Psychology, index, S.V.-EDITORS.]
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THE PSYCHOGENESIS OF MENTAL DISEASE

Meynert, the famous Viennese psychiatrist, pro¬pounded a regular system in which the alteration of the blood-supply to certain areas of the cortex was to play the chief role in the origin of the psychoses. Wernicke made a similar but far more ingenious attempt at an anatomical explanation of psychic’ disturbances. One visible result of this tendency can be seen in the fact that nowadays even the smallest and most out of the way asylum has its anatomical laboratory, where cerebral sections are cut, stained, and examined under the microscope. Our numerous psychiatric journals are full of morphological con¬tributions, investigations on the path of the fibres in the brain and spinal cord, on the structure and distribution of cells in the cerebral cortex, and the various ways they are destroyed in dif-ferent mental diseases.

梅内特,这位著名的维也纳精神科医生,提出一个规律的系统。在这个系统里,血液供应给脑部的某些地区的轮替,扮演主要的角色,在精神病的起源。温米克从事类似,但是更加聪明的企图,要对心灵的疾病,用解剖学来解释。这个倾向的可看见的结果,能够被看见,根据这个事实:今天,即使是最小规模或即使是最偏远的精神病院,都拥有它的解剖的实验室。在那里,脑皮层的部分被切开,被灌上药水,被检查,在显微镜下。我们的无数的精神病学的杂志充满了形态学的投稿与研究,针对脑的组织与脊椎的途径,针对大皮质心的细胞的结构与分布,以及它们被毁灭的各种的方式,在不同的精神疾病里。

Psychiatry has been charged with gross materialism. And quite rightly, for it is on the road to putting the organ, the instrument, above the function-or rather, it has long been doing so. Function has become the appendage of its organ, the psyche an appendage of the brain. In modern psychiatry the psyche has come off very badly. While immense progress has been made in cerebral anatomy, we know practically nothing about the psyche, or even less than we did before. Modern psychiatry behaves like someone who thinks he can decipher the meaning and purpose of a building by a mineralogical analysis of its stones. Let us try to form a statistical picture of the number and types of mental patients who show any clear lesions of the brain.

精神病学已经被赋予笼统的物质主义。这是相当正确的,因为精神病学正朝着前进,将器官,工具,放置在功能之上。或者说,精神病学长久以来就是这样做。功能已经变成是它的器官的附属品,心灵就是脑的附属品。在现代的精神病学,心灵已经遭受痛苦的结果。虽然在脑的解剖,已经有了重大的进展,对于心灵,我们几乎一无所知。甚至比起以前,还更加不如。现代的精神病学行为好像某个人认为他能够解释一栋建筑物的意义与目的,凭借对于建筑物的石头,从事矿物学的分析。让我们尝试形成统计学的画面,对于精神病人的人数与种类,他们显示任何的脑的病变。

In the last four years we have admitted 1,325 mental patients to Burgholzli Mental Hospital-some 331 a year-of whom 9% suffer from constitutional psychic anomalies. By this I mean an inborn defect of the psyche. Of the 9%, about a quarter are imbeciles, congenitally feeble-minded. In them we find definite cerebral changes such as congenital microcephalus, pronounced hydrocephalus, and malformation of certain parts of the brain. The remaining three quarters of the psychopathically inferior show no trace of typical findings in the brain.

在过去四年来,我们已经收容1,325位病人,到博格尔利精神病院—平均一年331位病人。他们百分之9遭受身体体质的心灵的异常症状。我说这个的意思是,心灵的天生的缺陷。在这百分之9的病人当中,大约有四方之一是低能儿,天生的心智低落。在他们身上,我们发现明确的脑的改变,譬如,天生的畸形小头,又被称为是脑水肿病,脑的某些部分的形成不良。这个低劣的畸形小头的剩余的三个部分,并没有显示任何脑的典型发现的痕迹。

Three per cent of our patients suffer from epileptic mental disturbances. In the course of epilepsy a typical degeneration of the brain gradually sets in, which I cannot describe more closely 160

329
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THE CONTENT OF THE PSYCHOSES
here. The degeneration is demonstrable only in severe cases and after the illness has lasted a long time. If the attacks have been present for a relatively short time only, not more than a few

years, as a rule nothing can be discovered in the brain.

我们的病人的百分之三遭受癫痫的精神疾病的痛苦。在癫痫的过程,一个典型的脑的恶化逐渐开始。我在此要最为详细描述这个脑的典型的恶化。这个恶化仅有在严重的案例里,才能够被展示,当疾病已经延续一段漫长的时间后。假如疾病的侵袭仅是出现比较短的时间,则是仅有少数的恶化。

Seventeen per cent of our patients suffer from progressive
paralysis and senile deterioration. Both diseases present char-acteristic cerebral findings. In progressive paralysis there is regu¬larly an extensive shrinkage of the brain, so that the cerebral cortex in particular is often reduced by one half. Especially the frontal portions of the brain may be reduced to a third of the normal weight. A similar destruction occurs in senile deteriora¬tion ..

我们病人的百分之十七,遭受逐渐的麻痹与衰老的恶化。两种的疾病呈现特征的脑的发现。在逐渐的脑性麻痹,脑会规律地广泛的委缩。所以,特别是脑皮质经常被减缩到一半。特别是脑的前叶的部分,可能被减缩到正常的重量的一半。同样的毁灭发生在衰老的恶化。

Fourteen per cent of the patients admitted annually suffer from poisoning, at least 13% of the cases being due to alcohol. As a rule, in milder cases nothing can be found in the brain; only in relatively few of the more severe cases is there a slight shrinkage of the cortex. The number of these severe cases amounts to less than 1 % of the yearly cases of alcoholism.

百分之十四的病人承认每年会遭受中毒的痛苦。至少百分之十三的病人是由于酒精中毒。通常,在温和的案例,在脑部,并没有发现任何东西。仅有在比较少数的严重的案例,才有脑皮质的轻微的委缩。这些严重的案例的数目总数不到百分之一,在每年的酒精中毒的案例里。

Six per cent of the patients suffer from so-called manic-de-pressive insanity, which comprises the manias and the melan¬cholias. The essence of this disease can be understood even by the layman. Melancholia is a condition of abnormal sadness with no disturbance of intelligence and memory. Mania is the opposite, the rule being an abnormally excited state with great restlessness, but without any deeper disturbance of intelligence and memory. In this disease no morphological lesions of the brain can be demonstrated.

百分之六的病人遭受所谓的躁郁与具沮丧的疯狂。这个疯狂包括躁郁症者与忧郁症者。这个疾病的本质能够被理解,即使是外行人。忧郁症是一种不正常的悲伤的情况,并没有智力与记忆的疾病。躁郁症则是恰恰相反,通常是不正常地興奋的状态,具有强烈的不安。但是并没有任何智力与记忆的更加严重的疾病。在这个疾病,并没有脑的形态学的病变能够被展示。

Forty-five per cent of the patients suffer from the authentic and common disease known as dementia praecox. The name is a very unhappy one, for the dementia is not always precocious, nor in all cases is there dementia. Unfortunately the disease is too often incurable; even in the best cases, in recoveries where the layman would notice no abnormality, one always finds some defect in the patient’s emotional life. The clinical picture is incredibly varied; usually there is some disturbance of feeling, very often there are delusions and hallucinations. As a rule there is nothing to be found in the brain. Even in cases of the most severe type, lasting for years, an intact brain is not infrequently found post mortem. Only in a few cases are slight changes to be found, which cannot yet, however, be proved to be regular.

百分之四十五的这些病人遭受真诚而普遍的疾病,众所周知的精神分裂症。这个名称是一个很不快乐的名称。因为精神分析并不总是早发性质的。在各个案例里,也没有精神分裂。不幸地,这个疾病通常是无法被治疗。即使是在最佳的案例,在外行人并没有发现异常状况的复发里。我们总是找的某个缺陷,在病人的情感的生活里。临床的画面是难以置信地各式各样。通常会有感觉的某个困扰。经常会有幻觉与幻象。通常,在脑部,并没有发析现什么。即使在最严重的种类的个案,延续两年,死后解剖后,一个完整的脑还是经常被找到。
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THE PSYCHOGENESIS OF MENTAL DISEASE
To sum up: in round figures about a quarter of our patients show more or less extensive alterations and lesions of the brain, while three-fourths have a brain which seems to be generally unimpaired or at most exhibits changes such as afford abso-lutely no explanation of the psychological disturbance.

总而言之,在园形的图形里,大约四分之一的我们的病人显示或多或少的脑的广泛轮替与病变。四分之三的我们的病人则是拥有一个似乎通常没有受到损伤的脑。或是至多,他们展示一些改变,譬如,这些改变绝的不容许用心灵的疾病来解释。

These figures offer the best possible proof that the purely anatomical approach of modern psychiatry leads-to put it mildly-only very indirectly to the goal, which is the under-standing of the psychic disturbance. In addition, it must be remembered that the mental patients who show the most strik-ing lesions of the brain die after a relatively short time: conse-quently, the chronic inmates of the asylum, who form its real population, consist of up to 70 or 80% cases of dementia prae¬cox, that is, of patients in whom anatomical changes are prac¬tically non-existent. The way to a psychiatry of the future, which is to come to grips with the essence of the matter, is therefore clearly marked out: it can only be by way of psychology. For this reason we have entirely abandoned the anatomical approach in our Zurich Clinic and have turned to the psychological in-vestigation of mental disease. Since most of our patients suffer from dementia praecox, this disease is naturally our chief prob¬lem.

这些图形提供最佳的证据:现代的精神病学的解剖的方法,温和地说,仅是间接地导致目标。这个目标就是要理解心灵的疾病。除外,我们必须记住,显示脑的明星的病变的精神病这,在比较短的时间内死亡。结果,精神病院的这些慢性的病人,形成是精神病院的主要人口。精神分裂症的个案占据百分之70到80。 换句话说,在这些病人身上,解剖的改变几乎是不存在的。到达未来的精神分裂症的途径,是要处理这个物质的本质,这个途径因此清楚地被标示出来;那就是凭借心理学的途径。因为这个理由,我们完全地放弃解剖学的途径,在我们的苏黎世的诊所,并且诉诸于精神病的心理的研究。因为大部分的我们的病人遭受精神分裂症的痛苦,这个疾病当然是我们主要的难题。

The older clinicians paid great attention to the psycho¬logical precursors of insanity, just as the lay public still does, following a true instinct. We took up this trail and care-fully investigated the previous psychological history whenever possible. Our efforts were richly rewarded, for we found sur¬prisingly often that the illness broke out at a moment of some great emotion which, in its turn, had arisen in a more or less normal manner. We also found that in the mental disease which ensued there were a number of symptoms that could not be understood at all from the anatomical standpoint. These symp-toms immediately became comprehensible when considered from the standpoint of the individual’s previous history. Freud’s pioneering investigations into the psychology of hysteria and dreams afforded us the greatest stimulus and help in our work.

老经验的临床医生会专注注意疯狂的心理的先兆,如同外行的大众现在依旧这样做。他们遵循真实的本能。我们从事这个途径,并且尽可能小心地研究先前的心理的历史。我们的努力收获非常丰盛。因为我们经常感到惊奇地发现到,这个疾病发作在强烈情感的时刻。反过来,这个强烈的情感会以相当正常的方式产生。我们也发现到,在随之而来的精神的疾病,会有许多的症状,从解剖的观点,根本就无法被理解。当它们从个人的先前的历史的观点来考虑,这些症状立即变得可以被理解。弗洛伊德的开先锋的研究癔症与梦的心理学,供应我们的工作最强大的刺激与帮助。

A few examples of the most recent departures in psychiatry will, I think, make the subject clearer than any amount of dry theory. In order to bring home to you the difference in our con-ception I shall, in each case, first describe the medical history in the older fashion, and then give the solution characteristic of the new approach.

精神分裂症最近的研究发展的几个例子,让这个主题更加清楚,比起再多的枯燥的理论的数目。为了让你们清楚明白我们的观念的差异。我将在每个个案里,首先描述古老的方式的医学的历史。然后,给予具有新的途径的特征的解决。

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

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