Glazer M W
Psychoanal Rev. 1979 Fall;66(3):323-37.
This paper has focused on the sense of helplessness as an essential component of a depressive reaction. By inference, a sense of mastery and ability to achieve goals seems essential for a sense of well-being. Both patients presented here revealed infantile fantasies that hampered their exercising this mastery, and the path to well-being was the analysis of these fantasies. The treatment plans differed, though, in the locus of the fantasies. In an object-related depression such as Mr. Janson's, the fantasy involved the inhbition of functioning--that is, the inability to express aggression--and the treatment aimed at removing the inhibition. In a narcissistic depression such as Miss Gaynor's, the helplessness was not due to inhibited functioning per se. Rather, her goals were unrealistic, unattainable, and based on unconscious fantasies. Here the aim of treatment was the development of more reality-adapted and attainable objectives and the concommitant internalization of a more realistic sense of her own worth. Thus the common denominator in both depressive reactions was a sense of helplessness, and the path toward increased self-esteem was by way of the development of a sense of mastery and competence.
本文重点探讨了无助感作为抑郁反应的一个基本组成部分。由此推断，掌控感和实现目标的能力对于幸福感而言似乎至关重要。这里所呈现的两位患者都表现出了阻碍他们行使这种掌控力的婴儿期幻想，而通往幸福的途径就是对这些幻想进行分析。不过，两位患者的治疗方案在幻想的根源方面存在差异。在像詹森先生那样与客体相关的抑郁症中，幻想涉及功能抑制——也就是说，无法表达攻击性——治疗旨在消除这种抑制。在像盖纳小姐那样的自恋型抑郁症中，无助感并非源于功能抑制本身。相反，她的目标不切实际、无法实现，且基于无意识幻想。在此，治疗的目标是培养更适应现实且可实现的目标，以及随之而来的对自身价值更现实的内在认知。因此，两种抑郁反应的共同特征是无助感，而增强自尊的途径是培养掌控感和能力感。
