【作者】 刘芳； 孟蕊； 谢中垚； 苏英； 徐红红； 洪炜；

【Author】 Fang Liu;Rui Meng;Zhongyao Xie;Su Ying;Xu Honghong;Hong Wei;Medical Psychology Department,PKUHSC;

【机构】 北京大学医学部医学心理学教研室；

【摘要】 对于抑郁型人格,希波克拉底创立"体液说",其中黑胆汁偏胜者具有抑郁的特质;无论是中世纪文化、文艺复兴时期的著作和中医典籍中都有许多有关抑郁型人格的记述。在DSM诊断中也提及了抑郁型人格障碍。而在临床实践中,心理动力学更倾向于从心理结构、内心体验来把握抑郁型人格。当代心理动力治疗师Mc Williams(1994)认为应从心理动力机制和心理发展水平两个维度来分析抑郁型人格,她总结前人的理论和观点,提出抑郁心理动力机制至少需要考察四方面的内容:1气质、驱力和情感2防御和适应机制3客体关系4自体体验。从人格发展的维度看,发展水平连续谱包括1健康/神经症水平2边缘性水平3精神病性水平。应注意,发展水平的概念与精神病诊断中的症状学分类不同,此处反映的是心理结构的发展状态。有关气质、驱力和情感,许多家庭史和双生子研究都支持抑郁人格具有遗传性;Freud(1917)系统地对比了哀伤和抑郁的异同,他指出,抑郁否认丧失,自我始终认同于丧失的客体(自恋型认同),客体的丧失让人知觉到的是自我中一部分内容的崩塌或枯竭。Blatt(1976)提出抑郁有两种类型,即内摄型抑郁和依靠型抑郁,内摄型的抑郁者遭遇心理冲突时常有负罪感,而依靠型的抑郁者则常感到羞愧和悲伤。有关防御和适应机制,抑郁者常使用内摄、转向自身和基于道德的理想化防御机制。Klein论详细阐述了个体发展到抑郁心位,客体关系中客体坏的方面则会被婴儿内摄为自我的一部分;Fairbairn(1952)认为,抑郁人格是儿童与父母建立联系的方式,通过内摄客体坏的部分儿童感觉到一定的可控性。有关关系模式,Mahler认为在分离个体化的和解阶段,如果母亲的接纳和’情绪理解‘显著匮乏,将促使孩子形成"抑郁的倾向"。有关自体体验,内摄型抑郁者笃信自己的本性是坏的,担心自己内部存在的毁灭性会爆发。依靠型抑郁者感到自身的不完整,虽有渴求但注定会得不到满足。根据上述特点,Mc Williams总结了心理动力治疗对抑郁型人格类型来访者工作的一些知道方针,其中包括1强调咨询师的接纳、尊重、共情、和努力理解的基本态度2识别并揭示出病人的无意识抑郁性主题3对移情进行工作和修通4如果条件允许,避免过早中止对抑郁型人格来访者的治疗。更多还原

【Abstract】 Hippocrates created the humorae theory and believed that melancholy was resulted from excess of black bile.Since then,the depressive personality were documented in a variety of medieval books,renaissance works and Chinese medical classics.It has also been recognized in the Diagnostic and StatisticalManual of Mental Disorders.However,psychodynamic therapy tends to understand the depressive personality from the aspects of mental structure and inner experience in clinical practice.Contemporary psychoanalysts Nancy Mc Williams claimed that the depressive personality should be identified from dynamic mechanism and developmental levels.Based on the overview of other psychoanalytic theories,she believed the dynamic mechanism should be approached from four aspects:(1) temperament,drive and affect;(2) defensive and adaptive processes;(3) object relations;(4) self-formation.As for the personality organization,the developmental levels spectrum was ranged from neurotic level,borderline level to psychotic level.It is important to notice that the developmental level referred to here,which reflects the developmental state of the mental structure,is different from the symptomatic classification of the psychiatry diagnosis.As for the temperament,drive and affection,accumulating evidence about the family histories twins and adoptees suggested that one can inherit a vulnerability to depression.Freud(1917) systematically compared melancholia and mourning.He contended that melancholia denied the reality of loss,and that the melancholy subject identified with the lost subject,which one could perceived as part of the ego collapsed or exhausted.Blatt(1976) proposed there were two kinds of depression:introjective depression and anaclitic depression.Introjective patients were guilt-ridden while the anaclitic patients tended to experience the feeling of shame and grieve.As to the defensive and adaptive processes,the defense mechanism used by depressive people usually introjection,turning against oneself and idealization.The introjection was the unconscious internalization of the more hateful qualities of object.(Klein,1940).According to Fairbairn(1952),depressive personality is the way for children to establish connection with their parents.They can feel the sense of control through introjecting the bad part the object.As for the object relations,during the compromise phrase of the process of separation-individuation,if the mother was deficient in acceptance and emotional comprehension,the children may form the depression tendency.As for the self-formation,introjective depressive people believed they were bad at bottom and worry they were inherently destructive.The central feelings of anacliticdepressive people,however,were helplessness,weakness and depletion.They were marked with a desperate search for satisfaction and the feeling of unable to find gratification and comfort.Based on what has been mentioned,Nancy Mc Williams summarized some therapeutic implication of the depression personality,including(1) emphasize the importance of an atmosphere of acceptance,respect and compassionate efforts to understand;(2) Identify and interpret depressive themes;(3) focus on the transference and working through;(4) Leave decisions about termination up to the depressive patients when the circumstance permit.更多还原