I will describe a man I saw in psychoanalytic psychotherapy with a history of serious drug abuse and violent psychotic episodes. At the start of therapy my patient had little capacity to tolerate the anxiety, depression or the inevitable frustrations involved in facing reality. Over time and with the support of the therapy he was able to increase his capacity for self observation noticing the way he withdrew from the world of shared reality into psychotic states of mind in order to avoid painful feelings of rage, humiliation and shame. In the book ‘Catch 22ʹ, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions, while the authorities maintain that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! This insight is deemed to be evidence of the individual’s sanity and consequently their plea of insanity is denied. In this paper, I will show how Mr. A’s developing capacity for reflective functioning lead to a ‘Catch 22’ as the insight he needed as part of the process of recovery threatened to overwhelm him with depressing realities about the extent of his illness.

中文翻译：

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第22集：洞察力的发炎性

我将描述我在心理分析心理治疗中看到的一个有严重吸毒和剧烈精神病发作史的人。在治疗开始时，我的患者几乎没有能力承受面对现实的焦虑，沮丧或不可避免的挫败感。随着时间的流逝，在治疗的支持下，他能够提高自我观察的能力，注意到他从共享现实世界退出到精神病状态的方式，从而避免了痛苦的愤怒，屈辱和羞辱感。约瑟夫·海勒（Joseph Heller）在《追捕22》一书中描述了希望声称精神错乱以避免致命飞行任务的飞行员的悖论，而当局坚持认为为避免自杀性任务而精神错乱的人表现出对精神错乱的理智认识。任务！这种见解被认为是个人理智的证据，因此他们的精神错乱被拒绝了。在本文中，我将展示A先生反射功能的发展能力如何导致“ Catch 22”，这是他在康复过程中所需要的见解，这可能使他对病情的严重程度感到沮丧。