Schwartz D P
Austen Riggs Center, Stockbridge, Massachusetts.
Psychiatr Clin North Am. 1990 Sep;13(3):401-14.
This article is an exploration of intrapsychic structure formation and change from the point of view of a psychoanalytic concept of action. It compares the normal development of intrapsychic structure with that involved in psychotic disorganization as individuals encounter adolescence and its developmental tasks and requirements for action. The flexible complexity of intrapsychic structure and available action in a normally developing adolescent and the contrasting fixed simplicity of intrapsychic structure and its repertory of action in psychotic patients are highlighted. Four different environmental life occasions, all of which are associated with intrapsychic change, are examined against this background. The first of these involves little initial action on the part of the ego, although lasting change does occur. The last three involve both inner and outer developmental actions that can be central to growth and may be the occasion of psychosis. The first environmental life occasion is "trauma," in which the person's action, potentialities, and intrapsychic structure are disrupted by the world's destructive action and are thereby changed. The second is "intimacy," in which newly evolved actions and interaction are sought, often with little regard for or knowledge of the accompanying necessities of intrapsychic change. In the third --"success"--new intrapsychic change and altered necessities of action can surprisingly affect both the sense of continuity within one's inner world and the nature of one's relationship to the action of the outer world. The fourth occasion is "analytic" therapy, in which the regularities of one's intrapsychic structure and its stereotypies of action are often disrupted by the very "therapeutic" processes that allow these to be observed and examined in the course of promoting progressive development. All of these exciting and dangerous occasions mark out a separate, autonomous, individual, chosen act. The attempt to explicate the role of action in intrapsychic structural change during analytic work with a psychotic patient defines the analyst's actions as interferences and disruptions of that inner structure. His actions are noted, felt, represented, and organized into a part of that reformed, newly organized inner structure. Those analytic actions are represented by the patient as "having an impact" upon the patient and do indeed affect the patient. In that regard it is asserted that for a full, psychoanalytic conception of the ego, what is required is not only a central "body ego," but the integration of action in the formation and function of that ego's intrapsychic structure--an "action ego." Clarification of the complex relationship of conceptions of "fantasy" and action are re-examined in this context.(ABSTRACT TRUNCATED AT 400 WORDS)
本文从精神分析的行动概念角度探讨了心理内部结构的形成与变化。它将心理内部结构的正常发展与个体在青春期遇到的精神病性解体所涉及的情况进行了比较，以及青春期的发展任务和行动要求。重点强调了正常发展的青少年心理内部结构和可用行动的灵活复杂性，以及精神病患者心理内部结构及其行动模式的固定简单性。在此背景下，研究了四种不同的环境生活情境，所有这些情境都与心理内部变化相关。第一种情境中自我最初几乎没有行动，尽管确实发生了持久的变化。后三种情境涉及内部和外部的发展行动，这些行动可能是成长的核心，也可能是精神病发作的契机。第一种环境生活情境是“创伤”，在这种情境中，个体的行动、潜能和心理内部结构被世界的破坏行为打乱，从而发生改变。第二种是“亲密关系”，在这种情境中，人们寻求新发展的行动和互动，往往很少考虑或了解伴随心理内部变化的必要性。第三种情境——“成功”——新的心理内部变化和行动必要性的改变会出人意料地影响个体内心世界的连续性感觉以及个体与外部世界行动的关系性质。第四种情境是“分析性”治疗，在这种治疗中，个体心理内部结构的规律及其行动的刻板模式常常被那些在促进渐进发展过程中能让这些规律被观察和审视的“治疗性”过程打乱。所有这些令人兴奋又危险的情境都标志着一个单独的、自主的、个体的、被选择的行动。在对精神病患者进行分析工作时，试图阐明行动在心理内部结构变化中的作用，这将分析师的行动定义为对那种内部结构的干扰和打乱。他的行动被注意、被感知、被表征，并被组织成经过改革的、新组织起来的内部结构的一部分。患者将那些分析行动表征为对患者“有影响”，并且确实会影响患者。在这方面，可以断言，对于完整的、精神分析的自我概念来说，不仅需要一个核心的“身体自我”，还需要行动在自我心理内部结构的形成和功能中的整合——一个“行动自我”。在这种背景下，重新审视了“幻想”概念与行动之间复杂关系的阐释。（摘要截取自400字）
