Marcelli D, Duché D J
Sem Hop. 1983 Dec 15;59(47):3309-14.
This paper reports the case of a female patient hospitalized twice at a twelve-year interval in the same department. During the first hospitalization at the age of fifteen clinical findings and results of projective tests had led to consider schizophrenia. The patient had been entered upon a Sakel cure. Twelve years later, this twenty-seven-year-old patient has no symptoms pointing to schizophrenia. Her mental organization and the nature of the relationships she establishes with others rather suggest pathologic personality organizations which are now better known, especially narcissic pathology. While the answers to projective tests performed at a twelve-year interval are very similar, the interpretation of these tests no longer focuses upon the same issues. This observation is especially interesting as an illustration of the developments which have taken place in the psychopathological approach and as material for an a posteriori discussion of the Sakel cure which has now been practically abandoned. Lastly, this observation clearly shows that strict focusing upon the diagnostic neurosis-psychosis alternative is an oversimplification. From this viewpoint, the wide field of conditions designated as "borderline" has led to more dynamic discussions and more subtle therapeutic choices.
本文报告了一名女性患者的病例，该患者在同一科室间隔12年住院两次。15岁首次住院时，临床检查结果和投射测试结果提示可能患有精神分裂症。患者接受了萨克治疗法。12年后，这位27岁的患者没有任何精神分裂症的症状。她的心理组织以及她与他人建立关系的性质反而提示了现在更为人熟知的病理性人格组织，尤其是自恋病理。虽然间隔12年进行的投射测试答案非常相似，但对这些测试的解读不再聚焦于相同的问题。作为精神病理学方法发展的例证以及对现已几乎被摒弃的萨克治疗法进行事后讨论的素材，这一观察结果尤其有趣。最后，这一观察结果清楚地表明，严格聚焦于诊断神经症 - 精神病的二分法是一种过度简化。从这个角度来看，被归类为“边缘性”的广泛病症领域引发了更具动态性的讨论和更微妙的治疗选择。
