南京大学马克思主义社会理论研究中心
教育部人文社会科学重点研究基地

神经症和精神病

NEUROSIS AND PSYCHOSIS(1924) 
神经症和精神病 
作者 Sigmond Freud 
译者 M.Andre 
In my recently published work, The Ego and the Id(1923b), I have proposed a differentiation of the mental apparatus, on the basis of which a number of relationships can be represented in a simple and perspicuous manner. As regards other points - for instance, in what concerns the origin and role of the super-ego - enough remains obscure and unelucidated. Now one may reasonably expect that a hypothesis of this kind should prove useful and helpful in other directions as well, if only to enable us to see what we already know from another angle,to group it differently and to describe it more convincingly. Such an application of the hypothesis might also bring with it a profitable return from grey theory to the perpetual green of experience. 
在我最近出版的书《本我和自我》中,我提出了一种对精神结构的区分,在这个基础上,许多关系可以以明确而简要的方式表现出来。然而在其他一些观点上,比方说,关于足够超我的位置和其起源方面仍然是晦暗不明且未得到阐释的。如果这个假设仅仅能帮助我们从其他角度看到我们早已知道的事物,并且以一种不同的方式将其聚集到一起,更准确地描述它,那么人们就有理由期待这种假设能在其他方向也被证明是有用且有效的。这个假设的运用也许可以带来一个有益的转变,从那灰暗的理论进入经验的长青之处。 
In the work I have mentioned I described the numerous dependent relationships of the ego, its intermediate position between the external world and the id and its efforts to humour all its masters at once. In connection with a train of thought raised in other quarters, which was concerned with the origin and prevention of the psychoses, a simple formula has now occurred to me which deals with what is perhaps the most important genetic difference between a neurosis and a psychosis: neurosis is the result of a conflict between the ego and its id, whereas psychosis in the analogous outcome of a similar disturbance in the relations between the ego and the external world. 
在我所提到的那些著作中,我已经描述了大量的自我的依赖关系,它处于外界世界和本我的中间地带,并且它的作用是立刻满足其所有的主人。一连串的思想在其他角落出现了,这些思想关系到精神病的起源和持续,一个简单的公式现在已经在我心里出现了,这个公式可以解释神经症和精神病可能是最重要的本质区别:神经症是自我和本我之间冲突的结果,同样精神病也是一种类似混乱的结果,这种类似的混乱存在于自我和外界世界的关系中。 
There are certainly good grounds for being suspicious of such simple solutions of a problem. Moreover, the most that we may expect is that this formula will turn out to be correct in the roughest outline. But even that would be something. One recalls at once, too, a whole number of discoveries and findings which seem to support our thesis. All our analyses go to show that the transference neuroses originate from the ego’s refusing to accept a powerful instinctual impulse in the id or to help it to find a motor outlet, or from the ego’s forbidding that impulse the object at which it is aiming. In such a case the ego defends itself against the instinctual impulse by the mechanism of repression. The repressed material struggles against this fate. It creates for itself, along paths over which the ego has no power, a substitutive representation (which forces itself upon the ego by way of a compromise) - the symptom. The ego finds its unity threatened and impaired by this intruder, and it continues to struggle against the symptom, just as it fended off the original instinctual impulse. All this produces the picture of a neurosis. It is no contradiction to this that, in undertaking the repression, the ego is at bottom following the commands of its super-ego - commands which, in their turn, originate from influences in the external world that have found representation in the super-ego. The fact remains that the ego has taken sides with those powers, that in it their demands have more strength than the instinctual demands of the id, and that the ego is the power which sets the repression in motion against the portion of the id concerned and which fortifies the repression by means of the anticathexis of resistance. The ego has come into conflict with the id in the service of the super-ego and of reality; and this is the state of affairs in every transference neurosis. 
我们确实有很好的理由来怀疑这么简单的答案就能解决这个问题。不仅如此,我们期望的是这个公式能在最粗略的概括水平上成立。但是甚至这成为了某些真理。人们也会立刻想起支持我们论点的大量发现成果。我们所有的分析都指出,移情神经症起源于自我拒绝接受一种本我中强有力的本能冲动,或者拒绝为其找一个动力出口,或者自我禁止冲动投向其所指示的客体。如此自我通过压抑这种机制来抵抗本能冲动。而被压抑的材料则与这种命运相斗争,它沿着自我没有力量的那条道路,为自身创造了一个替代性的表象(以妥协的方式来进入自我中)——症状。自我发现它受到了这种侵入物的威胁和损害,于是它开始与症状作斗争,就像它与原初的本能冲动作斗争一样。这些就展示除了神经症的情况。我们并不否认在压抑过程中,自我实际上在执行超我的命令,这种命令来源于外界世界的影响,而在外界世界中已经发现了超我中的表象。事实是自我已经在拥护那些权力了,在这其中超我的需求比本我的本能需要更有力,而且自我就是这种权力,它把压抑用于与相关的本我部分斗争中,并且这部份本我通过阻抗的反精神灌注加强了这种压抑。自我与本我的斗争服从于超我和现实,这就是在每一种移情神经症那里发生的事。 
On the other side, it is equally easy, from the knowledge we have so far gained of the mechanism of the psychoses, to adduce examples which point to a disturbance in the relationship between the ego and the external world. In Meynert’s amentia - an acute hallucinatory confusion which is perhaps the most extreme and striking form of psychosis - either the external world is not perceived at all, or the perception of it has no effect whatever. Normally, the external world governs the ego in two ways: firstly, by current, present perceptions which are always renewable, and secondly, by the store of memories of earlier perceptions which, in the shape of an ‘internal world’, form a possession of the ego and a constituent part of it. In amentia, not only is the acceptance of new perceptions refused, but the internal world, too, which, as a copy of the external world, has up till now represented it, loses its significance (its cathexis) - The ego creates, autocratically, a new external and internal world; and there can be no doubt of two facts - that this new world is constructed in accordance with the id’s wishful impulses, and that the motive of this dissociation from the external world is some very serious frustration by reality of a wish - a frustration which seems intolerable. The close affinity of this psychosis to normal dreams is unmistakable. A precondition of dreaming, moreover, is a state of sleep, and one of the features of sleep is a complete turning away from perception and the external world. 
另一方面,这等于是在说,我们从这种知识中获得了精神病的机制,并且可以举出一些表明自我和外在世界关系混乱的例子。在迈内特精神错乱中——一种严重的幻觉性错乱,这可能是精神病最极端和显著的形式,要么外界世界完全被感知不到,要么对外界世界的知觉不会产生任何影响的。一般而言,外界世界以两种方式主导自我:第一,通过当前的感知经验的流动,这种经验总是在更新。第二,通过过去感知经验的记忆储存,以“内部世界”的方式形成了自我的拥有物,并且构成了一部分自我。在精神错乱中,不仅仅是对新来的感知经验进行拒绝,同样作为外部世界的复制品的内部世界也失去了其重要性(其精神灌注)。自我独断地创造了一个新的内部和外部世界;而且毫无疑问有两个事实-这个新的世界的构造符合本我的愿望冲动,而分解的动机源自于外在世界由于其愿望的现实原因成为了一个严重的挫折——一个似乎无法忍受的挫折。并且,做梦的前提是保持睡眠的状态,而睡眠的一个特征就是完全脱离感知觉和外在世界。 
We know that other forms of psychosis, the schizophrenias, are inclined to end in affective hebetude - that is, in a loss of all participation in the external world. In regard to the genesis of delusions, a fair number of analyses have taught us that the delusion is found applied like a patch over the place where originally a rent had appeared in the ego’s relation to the external world. If this precondition of a conflict with the external world is not much more noticeable to us than it now is, that is because, in the clinical picture of the psychosis, the manifestations of the pathogenic process are often overlaid by manifestations of an attempt at a cure or a reconstruction. 
我们知道精神病的其他形式,即精神分裂有种情感淡漠的倾向,也就是离开对外界世界的参与。在妄想的起源方面,许多分析都告诉我们妄想像一块补丁盖在一个地方,这里债务一开始就出现在了自我与外界世界的关系上。如果说这种冲突的前提条件之前没有现在这么令人关注,这是因为在对精神病的理解上,病理机制的分析总是被一种治愈和重构的尝试分析所遮盖了。 
The aetiology common to the onset of a psychoneurosis and of a psychosis always remains the 
same. It consists in a frustration, a non-fulfilment of one of those childhood wishes which are for ever undefeated and which are so deeply rooted in our phylogenetically determined organization. This frustration is in the last resort always an extern alone; but in the individual case it may proceed from the internal agency (in the super-ego) which has taken over the representation of the demands of reality. The pathogenic effect depends on whether, in a conflictual tension of this kind, the ego remains true to its dependence on the external world and attempts to silence the id, or whether it lets itself be overcome by the id and thus torn away from reality. A complication is introduced into this apparently simple situation, however, by the existence of the super-ego, which, though a link that is not yet clear to us, unites in itself influences coming from the id as well as from the external world, and is to some extent an ideal model of what the whole endeavour of the ego is aiming at - a reconciliation between its various dependent relationships. The attitude of the super-ego should be taken into account - which has not hitherto been done - in every form of psychical illness. We may provisionally assume that there must also be illnesses which are based on a conflict between the ego and the super-ego.Analysis gives us a right to suppose that melancholia is a typical example of this group; and we would set aside the name of ‘narcissistic psychoneuroses’ for disorders of that kind. Nor will it clash with our impressions if we find reasons for separating states like melancholia from the other psychoses. We now see that we have been able to make our simple genetic formula more complete, without dropping it. Transference neuroses correspond to a conflict between the ego and the id; narcissistic neuroses, to a conflict between the ego and the super-ego; and psychoses, to one between the ego and the external world. It is true that we cannot tell at once whether we have really gained any new knowledge by this, or have only enriched our store of formulas; but I think that this possible application of the proposed differentiation of the mental apparatus into an ego, a super-ego and an id cannot fail to give us courage to keep that hypothesis steadily in view. 
精神神经科学和精神病学的共同开端都是相同的。其包括了某种童年愿望的挫折,不满,这些愿望从未被击败而且根植于我们系统发生决定的组织当中。这种挫折最后总是仅仅外部的,但是在个案中,其总是来自于内部(超我),这个内部代替了现实需要的表征。其致病因素在于,在这种冲突的张力下,自我是否还保持其对外在世界的独立性,并且是否还对本我表示沉默,或者说自我是否让自己被本我所征服,并因此而远离现实。然而由于超我的存在,一种复杂的形式被引入了这个表面上简单的情况,尽管超我与这的联系对我们而言还不是很清楚,然而这种联合体在其来自本我的影响中和来自外界的影响中一样,在某种程度上都是解释自我的一切努力是针对什么而言的理想的模型——一种对自我的多种依赖关系的调和。在每一种精神疾病形式中,对超我的态度应该得到思考,而这是迄今为止还没有完成的。我们可以暂时假设有某种由于自我和超我冲突而产生的疾病。分析指示我们一个正确的假设,即抑郁症是这种疾病中的一种典型例子;我们要拒绝把这种疾病称为“自恋神经症”。如果我们有理由把类似抑郁症的状态与其他精神病区分开来,那么“自恋神经症”也与我们的印象不符。我们现在知道我们已经有能力完善我们最初的公式,而不是抛弃它了。移情神经症与自我和本我之间的冲突相符;而精神病,则是与自我和外界世界的冲突相符。确实,我们不能马上说我们能从这种公式中获得什么新知识,或者说丰富我们的理论;但是我认为这种对于自我,超我,本我构成的精神结构区分的应用会鼓励我们一直保持这种假设。 
The thesis that neuroses and psychoses originate in the ego’s conflicts with its various ruling agencies - that is, therefore, that they reflect a failure in the functioning of the ego, which is at pains to reconcile all the various demands made on it - this thesis needs to be supplemented in one further point. One would like to know in what circumstances and by what means the ego can succeed in emerging from such conflicts, which are certainly always present, without falling ill. This is a new field of research, in which no doubt the most varied factors will come up for examination. Two of them, however, can be stressed at once. In the first place, the outcome of all such situations will undoubtedly depend on economic considerations - on the relative magnitudes of the trends which are struggling with one another. In the second place, it will be possible for the ego to avoid a rupture in any direction by deforming itself, by submitting to encroachments on its own unity and even perhaps by effecting a cleavage or division of itself. In this way the inconsistencies, eccentricities and follies of men would appear in a similar light to their sexual perversions, though the acceptance of which they spare themselves repressions. 
神经症和精神病起源于自我与其各种控制代表的冲突——因此,这反映了那个痛苦地协调由其主人提出的各种要求的悲催自我的功能失败,这个主题需要在一个更深刻的观点上得到补充。人们想知道在什么情况下,自我能以一种怎样的方式来在这些冲突中取得成功,当然是以不陷入疾病为前提。这是研究的新领域,在这里最多变的因素开始接受检验。然而,我们立马能提出其中两个因素。第一,这种情况的结果依赖于经济原则——即两种互相冲突的趋势的相对大小。第二,自我可能在任何方向上都避免一种破碎,这可能通过重塑其自身,通过让自身屈服于那入侵其组织的侵入者,甚至通过让自身分裂或是分割。通过这种方式,人们的矛盾、怪癖和罪恶都似乎有点类似于性倒错,而前者为对后者的接受让出了他们自身的压抑。(译者注:后者被压抑得更多) 
In conclusion, there remains to be considered the question of what the mechanism, analogous to repression, can be by means of which the ego detaches itself from the external world. This cannot, I think, be answered without fresh investigations; but such a mechanism, it would seem, must, like repression, comprise a withdrawal of the cathexis sent out by the ego. 
总之,还有一个需要思考的问题就是,自我脱离于外界世界形成了一种类似于压抑的机制,那么这个机制是什么?我认为这个问题若非有新的研究则难以回答;但是这种机制一定是像压抑那样包含由自我发出的精神灌注的撤回。