Lidz T
Can J Psychiatry. 1979 Nov;24(7):621-32. doi: 10.1177/070674377902400706.
Many of the most significant changes in concepts of personality development and maldevelopment derive simply from belated appreciation that the child grows up in a family; and that the child requires considerable positive input from those who raise him to grow into a reasonably integrated person. Only recently have psychiatrists and psychoanalysts begun to focus on the influence of the family transactions throughout the formative years. The paper briefly presents the requisites a family must provide to assure the integrated development of its offspring and groups them under four headings: the parental nurturant functions that change with each phase of the offspring's development; the influence of the dynamic organization of the family on the offspring's intrapsychic structure, affecting self-boundaries, gender identity, superego directives, and so forth; conveying through family transactions the basic social roles and societal institutions to the child; transmitting the instrumental techniques of the culture, and particularly its language with its system of meanings and logic upon which virtually all ego functioning depends. The paper considers the evidence that the "choice of the neurosis" -- or more correctly, the choice of the psychiatric syndrome -- does not depend only upon fixation at various phases of pre-genital development, but also, and perhaps primarily, upon the panphasic influence of the intrafamilial environment. It is of particular importance to recognize that there is a very direct relationship between the family transactions, the separation-individuation process, bounary formation, the attainment of various degrees of object constancy, problems of splitting, superego directives, and what can be conscious and what need be repressed into the unconscious. The failure to recognize the import of the family has interfered with the formation of an integrated developmental theory that can unite various aspects of the developmental process that have remained more or less isolated from one another -- drive theory, object relations, ego psychology, separation-individuation, and cognitive development. Finally the question is raised if in providing guidance to parents we have been amiss in not focusing on such matters as who the parents are, how they relate to one another as well as to the child, the values they communicate by their behaviour -- matters that are fundamental and to which almost all else is secondary, but about which relatively little has been said or taught.
人格发展与发展不良概念中许多最重大的变化，仅仅源于人们迟迟才认识到孩子是在家庭中成长的；而且孩子需要抚养他的人给予大量积极的投入，才能成长为一个合理整合的个体。直到最近，精神病学家和精神分析学家才开始关注家庭互动在整个成长阶段的影响。本文简要介绍了家庭必须提供的条件，以确保其后代的整合发展，并将这些条件归纳为四个标题：随着后代发展的每个阶段而变化的父母养育功能；家庭动态组织对后代内心结构的影响，影响自我边界、性别认同、超我指令等；通过家庭互动向孩子传达基本的社会角色和社会制度；传递文化的工具性技术，特别是其具有意义和逻辑系统的语言，几乎所有自我功能都依赖于此。本文认为，“神经症的选择”——或者更准确地说，精神疾病综合征的选择——不仅取决于在前生殖器期发展的各个阶段的固着，而且也许主要取决于家庭内部环境的全阶段影响。认识到家庭互动、分离个体化过程、边界形成、不同程度客体恒常性的实现、分裂问题、超我指令以及哪些可以有意识以及哪些需要压抑到无意识之间存在非常直接的关系尤为重要。未能认识到家庭的重要性，妨碍了形成一个整合的发展理论，该理论可以将发展过程中或多或少相互孤立的各个方面——驱力理论、客体关系、自我心理学、分离个体化和认知发展——统一起来。最后提出一个问题，即在为父母提供指导时，我们是否在没有关注诸如父母是谁、他们彼此以及与孩子的关系如何、他们通过行为传达的价值观等问题上犯了错误——这些问题是根本性的，几乎所有其他问题都是次要的，但关于这些问题相对来说说得或教得很少。
