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concept-breakdown-deadness

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崩溃、死寂与绝望（breakdown, deadness, despair）

类型: concept
创建时间: 2026-08-29
最后更新: 2026-08-29
主来源: eshel-withness

摘要

在奥芙拉·埃谢尔（Ofra Eshel）的框架中，崩溃（breakdown）不是有待消除的病理，而是有待被经验与诠释的文本——博拉斯（Christopher Bollas）在 Govrin 的评述中被如此概括：看似精神崩溃的东西，可能是心灵最精致的沟通尝试。埃谢尔加进温尼科特（Donald Winnicott）的时间悖论：崩溃早已发生，但因患者当时「不在场」，它尚未「发生」；唯一的「记得」方式是在移情中第一次经历它。

本页的核心区分是受苦（suffering）vs 感受痛苦（feeling pain），源自费德恩（Paul Federn）、比昂（Wilfred Bion）与米特拉尼（Judith Mitrani）：受苦是自我的主动功能——把致痛事件纳入自我疆界之内并消化之，因而被自我转化并转化自我；感受痛苦则是疼痛反复撞击自我边界，每次都以同样强度产生创伤效应。治疗转化发生在从感受痛苦到受苦这一步——需要能代为受苦的他者。

长案例 P.（恋物—受虐倒错，四次／周）显示：倒错崩解后，死亡本身成为其实存核心，分析师须与之同在到死亡本身，而非仅止于对死亡的恐惧。

一、崩溃作为「文本」：博拉斯的立场

Govrin 把博拉斯对濒临崩溃之患者的取向概括为一次对常规精神病学的根本挑战：

Bollas’s approach to patients on the verge of breakdown fundamentally challenges conventional psychiatric wisdom. What appears as mental collapse, he suggests, may actually constitute the psyche’s most sophisticated attempt at communication—a desperate effort to make known what has never been mentally represented. The breakdown becomes not pathology to be eliminated but text to be interpreted, not a failure to function but the beginning of a profound conversation that has been waiting decades to occur.

— Govrin, Interpretation，第七章第三节「Crisis as Communication—The Radical Promise of Breakdown」

其推论是：常规精神科把崩溃当作需要抑制的病理，从而否定了崩溃的转化潜能：

By treating collapse as pathology requiring suppression rather than communication requiring understanding, conventional psychiatric responses negate the breakdown’s transformative potential.

— Govrin, Interpretation，第七章第三节

在这一取向中，抱持环境本身即起诠释之作用：

the analyst’s freedom enables complete devotion to creating a holding environment for patients whose psychic organization is collapsing, with this devoted containment itself functioning as interpretation.

— Govrin, Interpretation，第七章第三节

二、温尼科特的时间悖论：崩溃已经发生，但患者当时不在场

这是整个崩溃理论的时间骨架。埃谢尔在结论部分完整引出：

The breakdown has already happened, near the beginning of the individual’s life… but… this thing of the past has not happened yet because the patient was not there for it to happen to. The only way to “remember” in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference. This past and future thing then becomes a matter of the here and now, and becomes experienced by the patient for the first time.

— Eshel, Withness，「CONCLUDING THOUGHTS: UNLESS THE BOTTOM HAS BEEN REACHED」（引 Winnicott, 1974, p. 105）

温尼科特随即补充了那句支撑长期艰苦工作的判断：

“All this is very difficult, time-consuming and painful, but it at any rate is not futile” (Winnicott 1974, p. 105).

— Eshel, Withness，「CONCLUDING THOUGHTS」

同一逻辑被明确扩展到空虚（emptiness）——空虚也是患者正试图去经验的一种过去状态：

This also applies to emptiness: “Emptiness occurring in a treatment is a state that the patient is trying to experience, a past state that cannot be remembered except by being experienced for the first time now” (Winnicott 1974, p. 106).

— Eshel, Withness，「CONCLUDING THOUGHTS」

以及温尼科特那句被埃谢尔两次引用的金句——除非触及谷底，除非所恐惧之事已被经验，否则没有终结：

I think about Winnicott’s unforgettable words: “But alas, there is no end unless the bottom of the trough has been reached, unless the thing feared has been experienced” (1974, p. 105, italics in original).

— Eshel, Withness，「CLINICAL ILLUSTRATION」

三、埃谢尔的补充：为了患者能够在场并经历，分析师必须先在那里、在其内

这是温尼科特命题在埃谢尔处的转化——分析师的位置被写入了崩溃得以被经验的条件：

I emphasize that in order for the patient to be there and experience these agonizing feelings, the analyst must be there, with-in. Only then, can the deadly breakdown that has already happened be experienced and lived out t(w)ogether in the treatment.

— Eshel, Withness，「CONCLUDING THOUGHTS: UNLESS THE BOTTOM HAS BEEN REACHED」

四、★ 核心区分：受苦（suffering）vs 感受痛苦（feeling pain）

这一区分由费德恩提出、经比昂与米特拉尼扩展，是全部临床材料的解释框架。埃谢尔把它完整引在结论部分。

受苦是自我的主动功能——致痛事件被纳入自我疆界之内，其全部强度被领会、消耗并消化，因而被自我转化并反过来转化自我：

According to Federn (1952), suffering is the expression of an active function on the part of the ego in which the pain-inducing event (frustration with or loss of the object) is taken within the boundaries of the ego and the full intensity of the event is appreciated, consumed, and digested, thus undergoing transformation by the ego and, in turn, transforming the ego.

— Eshel, Withness，「CONCLUDING THOUGHTS」（引 Federn, 1952）

感受痛苦则是失败——事件无法在自我疆界内被承受与修通，疼痛只是触及自我的边界，每次复现都以同样的强度撞击，产生创伤效应，并威胁自我的完整：

Feeling pain, on the other hand, is a process in which the pain-inducing event cannot be endured and worked through within the bounds of the ego. The pain is not contained within the ego but merely touches upon the border of the ego, affecting it painfully, and with every recurrence, it meets the ego boundary with the same intensity and with traumatic effect. Therefore, such pain poses a threat to the ego’s integrity.

— Eshel, Withness，「CONCLUDING THOUGHTS」（引 Federn, 1952）

费德恩把这一不能受苦归因于自我的原发性失败；比昂则直接点名一类患者——他们感受痛苦却不愿受苦，并补充说：患者痛苦的强度本身就助长了他对受苦的恐惧：

Later, Bion (1965, 1970) related to patients who “feel the pain but will not suffer it,” and added: “The intensity of the patient’s pain contributes to his fear of suffering pain” (1970, pp. 9, 19, italics in original).

— Eshel, Withness，「CONCLUDING THOUGHTS」

米特拉尼把它放回母婴情境——母亲不能忍受去受苦她的婴儿，因此无法缓解婴儿的经验：

Mitrani (1995), following Federn and Bion, elaborates on the mother’s inability to contain: “It would seem that the baby’s painful experience has touched the mother, but has not been introjected by the mother, who, it seems, cannot bear to suffer her baby and who is therefore unable to mitigate its experience” (p. 86).

— Eshel, Withness，「CONCLUDING THOUGHTS」（引 Mitrani, 1995, p. 86）

比昂的原句给出了这一失败的原始场景——母亲本应把「孩子正在死去」的恐惧纳入自身并经验之：

From the infant’s point of view she should have taken into her, and thus experienced, the fear that the child was dying. It was this fear that the child could not contain… This patient had had to deal with a mother who could not tolerate experiencing such feelings.

— Eshel, Withness，「CONCLUDING THOUGHTS」（引 Bion, 1959, p. 104）

临床上的对应由埃谢尔自己写出——那些母亲无法纳入自身的轰炸性经验，如今在治疗中被重新活现，猛烈地轰炸着我的心理边界：

I think of my patient and what transpired during the analysis in these terms of feeling pain, catastrophe, despair, and dying—bombarding experiences that the mother could not take into herself; she could not bear to suffer her baby’s agony. Now these feelings were relived here, powerfully and desperately bombarding the boundary of my psyche.

— Eshel, Withness，「CONCLUDING THOUGHTS」

五、长案例 P.：严重恋物—受虐倒错，四次／周

5.1 前提：倒错是精神存活的最后防线

P. 三十多岁时由精神科医师转介，多家性治疗师因严重度拒诊，药物无效且副作用奇特；他此前与心理学、精神分析毫无接触，接受分析本身即是其绝望的指标。其自述的转介理由：

He sought treatment because he knew that, in his own words, “if it goes on like this, it will end in a hospital—in a serious injury or in death.” After a few months of analysis, when he realized that I would not throw him out of treatment because of what he told me, P. said, “This is the last stop for me. Psychoanalysis. After that—it’s the graveyard.”

— Eshel, Withness，「CLINICAL ILLUSTRATION」

埃谢尔将其先前对倒错的概念化引作解释——倒错是倒错者阻止坠入深渊的最后手段：

“The perverse act seizes and clutches, preventing in its corporeality, in its actuality and intensity, a collapse into dread, psychic deadness and total internal annihilation. Perversion is the pervert’s last-ditch attempt to halt the fall into the abyss” (Eshel 2005, pp. 1078-1079).

— Eshel, Withness，「CLINICAL ILLUSTRATION」

5.2 退行至依赖（regression to dependence）

在分析倒错患者时，首要的是把倒错理解为早期母性—环境失败所造成的需求情境，而非操纵性的见诸行动：

I pointed out the fundamental function of the evolving process of therapeutic regression in Balint’s and especially Winnicott’s terms in the analysis of the perverse patient—namely, to understand it primarily as a situation of need resulting from an early maternal-environmental failure (rather than manipulative acting out), with the ensuing treatment priorities of holding, analytic reliability, and attentiveness to the patient’s need states and dependence.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

由此，分析师的相互贯通式临在所完成的是一次转化——把患者的退缩与大规模自我防御组织（此处即倒错）转化为治疗中的退行至依赖：

Thus, in Winnicottian terms of regression, the analyst’s interconnected “presencing” can be seen as enabling the transformation of the patient’s withdrawal and massive self-defensive organization—in this context, the perversion—into regression to dependence in treatment, which carries with it a new opportunity for correcting the patient’s past experiences and for emotional development (Winnicott 1954b, 1964, 1988).

— Eshel, Withness，「CLINICAL ILLUSTRATION」

5.3 第二年的关键片段：绝望与「死亡竟可以如此廉价」

分析师在假期后首次会谈中感到巨大的疲倦与厌恶并撤出、沉默；患者随即激烈躁动。分析师意识到他知道自己抛弃了他：

And I realized he sensed and knew that I had abandoned him, left him wounded and lost on the battlefield, and had gone off to save myself. Thus I returned to this despicable, despairing, and desperate place, his and mine, and said: “You are so desperate because you felt that I’d given up. And when we both give up, there’s nothing more to hold on to. It’s really very despairing, but we are going on.” He lay back quietly, tears in his eyes for the first time in analysis (perhaps in his life), and said, “Death can be so cheap. You should lock me up inside the treatment.”

— Eshel, Withness，「CLINICAL ILLUSTRATION」

「但我们继续下去（but we are going on）」是本页对绝望（despair）最精确的临床定义：绝望不是无望的情绪，而是双方都放弃、因而再无可抓握之物的结构。

5.4 倒错崩解之后：死寂与空虚

第三至四年，倒错实践停止，随之而来的是巨大的骚动、困惑与日益增长的内在空虚——恋物消失后留下一个真空：

And still, deep inside, he felt cut off and vulnerable, and an immense inner emptiness was growing and taking hold of him. It seemed that the fetish that had disappeared had left behind a vacuum and profound emptiness.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

第四年他自己的话：

It’s amazing, amazing, how the fetish took over my entire life, and now there’s nothing, nothing.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

Everything hurls me into a world that has no center. I’m so empty inside… Feel so unreal, so unable to exist in the world of the living—and mainly, so ill.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

5.5 第五年：死亡成为实存的核心

这是全案例最黑暗的一年。患者对恋物能量给出自己的诊断——它修补死亡，而非生命：

But now this last-ditch attempt to halt the fall into the abyss had collapsed. Perversion no longer repaired death, no longer secured survival. Throughout this year, death was the very heart of his existence. It was everywhere, all the time, invading every hour with menacing forcefulness.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

“Fetishistic energy isn’t an energy of life; it’s energy that repairs death. It’s between life and death—dead-alive, more dead than alive; death-in-life,” he said.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

分析师首次在临床工作中建议服药缓解，他愤怒而苦涩地拒绝——这句话是「受苦 vs 感受痛苦」最锋利的临床文本：

How can you say that to me? I thought you were holding the hope, you and psychoanalysis. I don’t need anything else to keep my body alive; for that there’s the fetish, big time, and familiar for so many years. But I don’t exist. I’m not. There’s nothing here. I’m dead. That’s the fundamental thing—I’m dead.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

同年，童年史浮现：母亲改口「那很难过」，并说出那个没有名字的死去婴儿。分析师的解释把死亡定位为一种被注入的、代际的心理现实：

I said that a baby is born into the psyche-and-body of its mother and comes into being and grows there. And he was born to a mother who became distraught, alive-dead, and his yearning as an infant and small child to attach to and grow within her psyche and body had overwhelmed and filled him with her agonized feelings—with depression, death, a dead baby.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

5.6 早期崩溃（madness X）与湮灭

埃谢尔在此引入温尼科特的 madness X 与艾根（Michael Eigen）的 agony X：早期崩溃如此不可思考、痛苦到无法被经验，于是一个大规模的防御组织被组织起来对抗它：

This early breakdown was so unthinkable and indescribably painful that it could not be experienced, and a massive defense organization, which the patient displays as an illness syndrome, was organized against it. In my patient’s case, it was the ferocious fetishistic-masochistic perversion that turned him from a passive victim of unbearable early damage and destruction into an active “doer” of them, over and over again, while beneath it there yawned an abyss of inner death and emptiness.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

而在这些深渊之中，同时埋藏着创伤经验与去经验它的基本冲动：

in those depths of annihilation and the agony of early breakdown, or madness X, are buried both the traumatic experience and a “basic urge*”* to experience it, and thus “to be recovered in experience… remembered in the reliving of it” (1965, p. 126) in treatment.

— Eshel, Withness，「CLINICAL ILLUSTRATION」（引 Winnicott, 1965）

此刻的分析成为与一个**终结性客体（terminal object）**相遇的场所：

Analysis was now a meeting place with a terminal object (in Bollas’s sense, 1995, p. 76)—indeed, a terminal and annihilating object and the despair of his first year of life.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

博拉斯关于施受虐者的论述被引作对「近失（near-death）」结构的说明：

The sadomasochists are still trapped by their need continuously to remaster an early trauma, although they have converted the anxiety of annihilation into the excitement of its representation… These sadomasochistic alliances enact the near-death of the self, in which the child self avoids its killing but forever feels the near-hit as a kind of narrow escape.

— Eshel, Withness，「CONCLUDING THOUGHTS」（引 Bollas, 1995, pp. 209-210）

艾根对湮灭的描述被引在注释中——湮灭不是静态状态，它持续再持续：

“Annihilation is not a static state. It goes on and on and on. It’s electrifying. I don’t have the words for it. It’s like being in an electric chair with the current continuously on, or being suffocated but you never die. You keep getting more and more suffocated… I felt that this is partly what babies must feel, in their own way… screaming and screaming and then the scream fades away” (pp. 26-27).

— Eshel, Withness，「CLINICAL ILLUSTRATION」注释 8（引 Eigen, 2010）

六、诠释的失效与分析师的自我批评

第五年中，任何理解与诠释的尝试都毫无意义、意义或影响：

Frequently, he would sleep during the sessions—a still, motionless, and soundless sleep.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

His words in the sessions and in the messages were full of despair, harrowing emptiness, and death, and no attempt on my part to understand and interpret had any significance, meaning, or impact.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

埃谢尔并承认，自己的话语同时也是保护自己免于那种她无以为答的暴力性重复绝望的手段：

I would reply: “These are very troubled words. Thank you for not despairing of sharing these feelings with me.” But I felt that my words were also an attempt to protect myself from the intensity of this violent, repetitive desperation to which I had no answer.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

七、转捩点：同在到「死亡本身」

分析师的自我诊断——她所经验的只是恐惧，还不是死亡本身：

I was there with these feelings, speaking about them and speaking them, thinking and understanding them, struggling to ensure survival—more and more in the grip of these feelings, but not yet there in the patient’s inmost devastation, not “unless the bottom of the trough [had]… been reached, unless the thing feared [had]… been experienced” (Winnicott 1974, p. 105, italics in original). I was experiencing the terror of breakdown, suicide, and death, but not yet death itself, until the time that I starkly took them into myself and was with the dying child-man, holding the dead body in the arms of my psyche—thinking, feeling, and “dreaming” the death (Bion 1992, p. 216; Eigen 2001; Grotstein 2007, 2009; Ogden 2004).

— Eshel, Withness，「CLINICAL ILLUSTRATION」

此前那个周一的会谈，她不再试图以协议、承诺或诠释脱身：

We’ve done things. Things have happened. We’re trying to do the best we can in this fateful encounter of ours, but we really don’t know whether we’ll succeed in crossing this huge dead place. It’s like sailing on a tiny boat in an ocean of death…

— Eshel, Withness，「CLINICAL ILLUSTRATION」

会谈中浮现的 pietà 意象——一个抱着死去的身体、侧面行走、看不见面容、四处游荡的女人：

I saw a sort of pietà—not Michelangelo’s well-known, frontal, seated pietà, but a figure of a woman walking with a dead body in her arms. I saw her from the side, did not see her face, and she was wandering about. I felt terrible distress, which changed to acceptance, and then I felt sorrow, very quiet, profound, pure sorrow—without words, even to myself. It was as if this sorrow had become all-being. I sat within this immense sorrow, in silence, until the session was over.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

结句——从感受痛苦到受苦的转化，及其可传递性：

Thereby, this desperate, attacking plea turned into suffering and profound, immense sorrow within me. It became a wordless, deep, psyche-to-psyche interconnectedness and com-passion; and the death that was taken in and became experienced and suffered for the first time by me-with-him was transformed, and could then become, within him, a different, new possibility of being and experiencing.

— Eshel, Withness，「CONCLUDING THOUGHTS」

以及全篇论点的临床落点：

And I add: there is no end unless the bottom of the trough has been reached*, un-* less the thing feared has been experienced in a compassionate holding, within the analyst’s “presencing” and interconnecting with the patient’s gripping, unbearable agony, devastation, and death. Analyst-and-patient t(w)ogether there, with-in. For me, it was a very deep moment of com-passion.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

八、之后：从「不存在」到「我真的在」

当夜，这位无法忍受人手触碰的男人，第一次经由人手完成了一次非暴力的性接触。次日清晨的留言：

I don’t remember such a real feeling or one so intense as this feeling. I think the only thing in the world I wanted when I opened my eyes this morning was to come and hide in treatment. Don’t know whether it was to hide in you or with you—it’s all the same.

— Eshel, Withness，「CLINICAL ILLUSTRATION」

以及后两年中那句最简洁的疗效陈述——「我真的在。我存在。」：

He repeated over and over, determinedly, “I want different sex. In those moments with them, I felt. I was deeply depressed, I was sad, but I was there. I really was. I existed.”

— Eshel, Withness，「CLINICAL ILLUSTRATION」

⚠️ 矛盾标注
议题：面对崩溃，分析师的主导动作应当是诠释，还是超越诠释的临在／同在？
A 方立场：博拉斯（经 Govrin 转述）——崩溃是有待被诠释的文本，诠释性的抱持环境本身就构成治疗：「The breakdown becomes not pathology to be eliminated but text to be interpreted」；「with this devoted containment itself functioning as interpretation.」（Govrin, Interpretation，第七章第三节）
B 方立场：埃谢尔——在最深处，诠释完全失效：「no attempt on my part to understand and interpret had any significance, meaning, or impact.」（Eshel, Withness，「CLINICAL ILLUSTRATION」）；此时所需的不是把崩溃读作文本，而是「Thereby, this desperate, attacking plea turned into suffering and profound, immense sorrow within me.」
备注：此项可调和为阶段性差异而非原则对立：博拉斯处理的是濒临崩溃（on the verge of breakdown）的患者——此时诠释仍可及；埃谢尔处理的是崩溃已经发生、且防御（倒错）已崩解之后的患者——此时患者「不存在」，故无文本可读。但二者对「崩溃是沟通而非病理」共享同一前提，且埃谢尔明确引用博拉斯的施受虐论述与终结性客体概念。分歧的实质是临床时相之差，而非范式之差。

关键引文

  1. The breakdown becomes not pathology to be eliminated but text to be interpreted, not a failure to function but the beginning of a profound conversation that has been waiting decades to occur.
    — Govrin, Interpretation，第七章第三节「Crisis as Communication—The Radical Promise of Breakdown」

  2. The breakdown has already happened, near the beginning of the individual’s life… but… this thing of the past has not happened yet because the patient was not there for it to happen to. The only way to “remember” in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference.
    — Eshel, Withness，「CONCLUDING THOUGHTS」（引 Winnicott, 1974, p. 105）

  3. suffering is the expression of an active function on the part of the ego in which the pain-inducing event (frustration with or loss of the object) is taken within the boundaries of the ego and the full intensity of the event is appreciated, consumed, and digested, thus undergoing transformation by the ego and, in turn, transforming the ego.
    — Eshel, Withness，「CONCLUDING THOUGHTS」（引 Federn, 1952）

  4. Feeling pain, on the other hand, is a process in which the pain-inducing event cannot be endured and worked through within the bounds of the ego. The pain is not contained within the ego but merely touches upon the border of the ego, affecting it painfully, and with every recurrence, it meets the ego boundary with the same intensity and with traumatic effect.
    — Eshel, Withness，「CONCLUDING THOUGHTS」（引 Federn, 1952）

  5. I was experiencing the terror of breakdown, suicide, and death, but not yet death itself, until the time that I starkly took them into myself and was with the dying child-man, holding the dead body in the arms of my psyche—thinking, feeling, and “dreaming” the death (Bion 1992, p. 216; Eigen 2001; Grotstein 2007, 2009; Ogden 2004).
    — Eshel, Withness，「CLINICAL ILLUSTRATION」

  6. the analyst’s interconnected “presencing” can be seen as enabling the transformation of the patient’s withdrawal and massive self-defensive organization—in this context, the perversion—into regression to dependence in treatment, which carries with it a new opportunity for correcting the patient’s past experiences and for emotional development (Winnicott 1954b, 1964, 1988).
    — Eshel, Withness，「CLINICAL ILLUSTRATION」

关联

引用来源

  • eshel-withness — 本页主要来源：案例 P. 的全部临床材料、受苦／感受痛苦的区分、退行至依赖、转捩点与结论
  • govrin-interpretation — 提供博拉斯「崩溃即文本」的立场与「抱持环境本身即诠释」的表述
  • eshel-interconnectedness — 提供治疗性退行（温尼科特与巴林特意义上）与「另一个经验维度」的框架性说明

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