Bernstein J S
Psychoanal Rev. 1995 Apr;82(2):293-311.
In this article I have elucidated the diagnostic entity of the grandiose character, primary type. The concept of the primary grandiose character has been around for a long time but has not been formally elucidated. The primary grandiose character is contrasted to the reactive grandiose character, which is the type normally considered in the literature. The primary grandiose character is someone who was treated with such anticipation and succor by the parents that he learned to feel no way but good and to demand succor when he did not feel good. The reactive grandiose character is someone who originally moderated his primary grandiosity but re-intensified it in order to defend against later appearing pain, particularly of a narcissistic sort. The primary grandiose character develops a large array of fears and depressions as he learns little developmentally except how to demand. In the face of these increasing anxieties and depressions, he simply demands more and more. When he appears in treatment, he shows himself as an anxiety- and depression-ridden individual, with a strong need for help (succor). The analyst tries to help with the anxieties and depressions but the treatment goes round and round because the patient does not cathect the observing function of his own ego, only that of the analyst's ego: the analyst is to know what is wrong (observe it) and fix it. When the analyst does not fix it (although he might, for a while, observe it), the analysand's grandiose rage breaks through and he shows himself for what he is, a grandiose character, primary type. Now the task is clear but the treatment formidable. The analysand must come to observe that he is grandiose and that he has foresworn the observing function. This process, which comprises a major portion of the working through, is replete with grandiose rage, working through, grandiose rage, and working through. Ultimately the patient discovers the great strength that comes from decreased reliance on the observing ego of others and increased reliance on his own observing ego. A number of diagnostic entities and clinical behaviors are shown to have a primary grandiose base. And rather than some of these depending upon repression as the basic defense, it would seem that they depend on a pre-stage of repression, akin to the concept of biological irritability. The concepts of secondary grandiosity, partial grandiosity, and developmental grandiosity are natural corollaries to the concept of primary grandiosity.
在本文中,我阐明了原发性夸大性人格这一诊断实体。原发性夸大性人格的概念已存在很长时间,但尚未得到正式阐明。原发性夸大性人格与反应性夸大性人格形成对比,后者是文献中通常所考虑的类型。原发性夸大性人格的人在成长过程中受到父母如此多的期待与呵护,以至于他学会了只感觉良好,并且在感觉不好时就要求得到呵护。反应性夸大性人格的人最初克制了其原发性的夸大,但后来为了抵御出现的痛苦,尤其是自恋性的痛苦,又强化了这种夸大。原发性夸大性人格的人除了学会如何索取外,在成长过程中几乎没有什么发展,因而产生了大量的恐惧和抑郁。面对这些日益增加的焦虑和抑郁,他只是索取越来越多。当他前来接受治疗时,他表现为一个充满焦虑和抑郁的人,有着强烈的寻求帮助(呵护)的需求。分析师试图帮助他缓解焦虑和抑郁,但治疗陷入了循环,因为患者没有将自己自我的观察功能贯注其中,而只贯注于分析师自我的观察功能:分析师要知道哪里出了问题(观察到问题)并解决它。当分析师没有解决问题(尽管他可能会暂时观察到问题)时,被分析者的夸大性愤怒就会爆发,他就会展现出自己的真面目,即原发性夸大性人格。现在任务明确了,但治疗却很艰巨。被分析者必须开始观察到自己是夸大的,并且他已经放弃了观察功能。这个过程,构成了分析治疗的主要部分,充满了夸大性愤怒、分析治疗、夸大性愤怒以及分析治疗。最终,患者发现了巨大的力量,这种力量来自于减少对他人观察性自我的依赖,增加对自己观察性自我的依赖。一些诊断实体和临床行为被证明具有原发性夸大的基础。而且,这些情况似乎并非像某些情况那样依赖压抑作为基本防御机制,而是依赖于压抑的前阶段,类似于生物应激性的概念。继发性夸大、部分夸大和发展性夸大的概念是原发性夸大概念的自然推论。