马特(Matt)的父亲打电话给我，因为数周前马特拿着一把未上膛的发令枪，指着一位正因其扰乱秩序而试图拘捕他的警官。马特目前涉嫌严重违反枪支管理法，但他在获得保释后继续恣意胡来。他违反保释条件，出外与朋友们喝酒，有时好几天不回家。他还与人打架。身为教师的马特父母开始接受一个前景：马特可能会坐牢。
马特的父母在马特两岁时领养了他。马特的父亲告诉我，据他了解，马特幼时的生活是这样的：马特出生后不久，当时只有17岁的妈妈就带着他离开了外祖父家，最初呆在一家紧急收容所，随后就四处漂泊。马特的妈妈是位瘾君子，没有能力照顾他。营养不良、体弱多病的马特在1岁时被送进了儿童福利院。在被领养前，马特曾经被寄养在几个不同的家庭。从很小的时候起，马特就是一个不易相处、脾气倔强的孩子，正因如此，他的养父母决定不再领养其他孩子。
数天后马特来看我。他大大咧咧地坐到我对面的椅子上，开始畅谈起来。他向我说起，小区内有一对兄弟俩正想找他麻烦——这两人曾用刀捅过他认识的某人。马特的情况令人担心，但听着他的叙述，我开始注意到自己并没有特别担心的感觉。他的话音宏亮而清晰，但我发现自己很难听进去。我很容易感到神思恍惚，不由自主地考虑起自己打算在午饭时间办的一些杂事。事实上，每次我打起精神思索马特的故事，就好像在梦里爬山一样。
某人说的话与他带给你的感觉存在落差，这种情况并不少见。想想你的朋友在你情绪低落的时候给你打电话，他一副鼓励、支持的口吻，但结果让你感觉更糟糕。马特说的话完全不同于他带给我的感觉。他描述的生活很可怕，但我不担心他的安全。我一反常态地有种超然的感觉。
为了理解自己对马特的漠然和他的处境，我想象了马特幼年时的一系列场景。我看到一个婴儿在大声啼哭——我饿了，喂喂我；我尿尿了，给我换尿布；我害怕，抱抱我——而他的妈妈却对他不理不睬，没有任何反应。我认为，马特幼年经历造成的一个后果可能是，他不知道怎么让别人关心自己，因为他没有从自己的妈妈那里学到这些。他似乎从未获得我们大家都需要的一个技巧：让另一个人关心我们的能力。
马特感觉怎样？他似乎也不关心自己的处境。当我问他对自己被捕怎么看时，他回答道，“我感觉很酷，怎么了？”我再次努力道，“你似乎对自己并不是很焦虑，你当时可能会遭到枪击。”他耸了耸肩。
我开始意识到，马特不会表达自己的情感。在我们两个小时的谈话中，马特似乎要么借用我对他的情感的描述，要么从别人的行为来推断自己的情感。例如，他说自己不知道为何要拿枪指着警官，我提出他当时也许很生气。马特就回答称，“嗯，我很生气。”“当你生气时你感觉怎么样？”我问道。“你知道的，警察他们对我非常生气，父母对我非常生气，大家都对我非常生气。”他回答道。“但你感觉怎样？”我问道。他告诉我，“他们全都对我大喊大叫。”
通常来说，潜在的病人来找精神分析学家是因为自己直接感到痛苦。在这个病例中，打来电话的是马特的父亲，而非马特本人。马特在幼年时就学会麻木自己的感觉，并且不信任那些提供帮助的人。我们的这次见面并没有什么不同。马特在情感上没有感到足够的痛苦，不足以打消他的疑虑，接受下次再来的提议。
1946年，内科医生保罗•布兰德(Paul Brand)在一家麻风病疗养院工作期间发现，麻风病的“毁容”并非疾病本身造成的，而是由感染和受伤逐渐导致的，而病人之所以会感染和受伤，是因为他们感觉不到疼痛。1972年，布兰德写道：“如果可能的话，我要送给麻风病人一个礼物，这个礼物将是疼痛。”马特患上了某种心理上的麻风病：他无法感受自己情感上的痛苦，永远处于持久的、或许致命的自我伤害的危险之中。
就像有时做完一个棘手而让人怜悯的诊疗后所做的那样，马特离开办公室之后，我走到街角买上一杯咖啡，然后回到诊疗室上网，随便看一些内容，不再去想马特的问题。说实话，我们每个人都有点像马特。某些时候，我们都会努力压制自己的痛苦情感，但当我们成功地做到麻木不仁的时侯，我们也失去了明白究竟是什么让自己痛苦、以及为什么痛苦的唯一途径。
译者/君悦
http://www.ftchinese.com/story/001037924
Matt's father rang me because several weeks earlier his son had pointed an unloaded starter's pistol at a police officer who was trying to arrest him for disorderly conduct. Matt was now on bail for a serious firearms offence, and he was continuing to act recklessly. In violation of his bail, he would stay out drinking with friends, sometimes not coming home for days. He was getting into fights. His parents, both teachers, were beginning to accept that Matt would probably go to prison.
Matt's parents had adopted him when he was two years old. Matt's father told me what he knew of Matt's early life: shortly after his birth, Matt and his 17-year-old mother had left her parents' home, moving first to an emergency shelter and then from place to place. Matt's mother, a drug user, was incapable of caring for him. Malnourished and ill, Matt was taken into care when he was one year old. He had spent time in several different foster homes before being adopted. From early on, he was a difficult and uncompromising child, and, as a result, his parents had decided not to adopt any others.
Several days later, Matt came to see me. He flopped into a chair opposite me, and began to talk quite openly. He told me about two men, brothers, who lived in his neighbourhood and were out to get him - these men had stabbed someone he knew. Matt's situation was alarming but, as he talked, I began to notice that I didn't feel particularly alarmed. His speech was energetic and clear, but I found it difficult to get involved in his story. I was easily distracted and caught myself thinking about some errands I wanted to run at lunchtime. In fact, every attempt I made to think about Matt's story was like trying to run uphill in a dream.
Such a gap between what someone says and what he makes you feel is not uncommon - think of the friend who rings you when you're down and talks to you in an encouraging, supportive way but leaves you feeling worse. The gap between Matt's words and the feelings he provoked in me was enormous. His words described a life that was frightening, but I didn't feel frightened for him. I felt uncharacteristically disengaged.
In trying to comprehend my indifference to Matt and his situation, I imagined a series of scenes from his earliest months. I saw a small baby crying - I'm hungry, feed me; I'm wet, change me; I'm frightened, hold me - and being ignored by an unresponsive mother. I had the idea that one consequence of Matt's early experiences could be that he did not know how to make someone feel concern for him, because he did not learn this from his mother. He seemed never to have acquired a skill we all need: the ability to make another person care about us.
And what did Matt feel? He too seemed indifferent to his own situation. When I asked him what he felt about his arrest he replied, “I'm cool. Why?” I tried again. “You don't seem to be very anxious for yourself,” I said. “You could have been shot.” He shrugged.
I began to realise that Matt didn't register his own emotions. In the course of our two-hour-long conversation, he seemed either to pick up and use my descriptions of his feelings or to infer his emotions from the behaviour of others. For example, he said he didn't know why he had pointed the gun at the police officer. I suggested he might have been angry. “Yeah, I was angry,” Matt replied. “What did you feel when you were angry?” I asked. “You know, the police, they were very angry with me. My parents were very angry with me. Everyone was very angry with me,” he replied. “But what did you feel?” I asked. “They were all really shouting at me,” he told me.
Typically, what brings a potential patient to a consultation is the pressure of his immediate suffering. In this case, it was Matt's father, not Matt, who had telephoned. Matt had learnt at an early age to deaden his feelings and to distrust those who offered him help. Our encounter was no different. Matt did not feel enough emotional pain to overcome his suspicions and accept my offer to meet again.
In 1946, while working in a leprosy sanatorium, the physician Paul Brand discovered that the deformities of leprosy were not an intrinsic part of the disease, but rather a consequence of the progressive devastation of infection and injury, which occurred because the patient was unable to feel pain. In 1972, he wrote: “If I had one gift which I could give to people with leprosy, it would be the gift of pain.” Matt suffered a kind of psychological leprosy; unable to feel his emotional pain, he was forever in danger of permanently, maybe fatally, damaging himself.
After Matt left my office, I did what I sometimes do after a knotty, affecting consultation. I walked round the corner to buy a coffee and then returned to my consulting room to zone out by reading who-knows-what on the internet. The truth of the matter is this: there is a bit of Matt in each of us. At one time or another, we all try to silence painful emotions. But when we succeed in feeling nothing we lose the only means we have of knowing what hurts us, and why.
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