Steiner J
Int J Psychoanal. 1987;68 ( Pt 1):69-80.
I have presented clinical material to illustrate how a pathological organization can be considered to exist in an equilibrium with the paranoid-schizoid and depressive positions. While making use of paranoid-schizoid mechanisms such as primitive splitting and projective identification, the defensive structure is highly organized and held together by narcissistic intrapsychic relationships in which perverse gratification plays an important role. This organization of defences seems to be designed to produce a place of real or illusionary safety from the anxieties experienced in the other two positions. All individuals fluctuate in the defences they employ and hence can be thought of as moving between these organizations and the other two positions. They consequently demonstrate some evidence of paranoid-schizoid level function and also of the existence of pathological organizations even if they may function in a relatively mature way at other times and in other settings. In some patients however the pathological organization dominates the personality and leads to analyses which become fixed and stuck. It is argued that a recognition of these organizations of defences enables the analyst to orient himself more accurately to the clinical material and hence to address himself to the patient at a level he can understand.
我已呈现临床资料，以说明病理组织如何被认为与偏执分裂位和抑郁位处于一种平衡状态。在运用诸如原始分裂和投射性认同等偏执分裂机制时，防御结构高度组织化，并由自恋性心理内部关系维系在一起，其中变态的满足起着重要作用。这种防御组织似乎旨在从在其他两个位所体验到的焦虑中产生一个真实或虚幻的安全场所。所有个体在他们所采用的防御方式上都会波动，因此可以被认为在这些组织和其他两个位之间移动。他们因此展现出一些偏执分裂水平功能的证据，以及病理组织存在的证据，即便他们在其他时候和其他情境下可能以相对成熟的方式运作。然而，在一些患者中，病理组织主导着人格，并导致分析陷入停滞。有人认为，认识到这些防御组织能使分析师更准确地针对临床资料确定自身方向，从而在患者能够理解的层面与患者交流。
