导言:重新思考创伤
当我思考创伤时,真正的大问题是:大多数人如何应对我们所认为的创伤事件?我倾向于使用“潜在创伤”或“潜在创伤性事件”这个词。这是因为事件本身并非创伤,它们只是具有创伤的可能性。但大多数人是如何应对的呢?我们知道有些人会患上创伤后应激障碍(Post-Traumatic Stress Disorder, PTSD:指个体在经历或目睹创伤性事件后出现的严重、持续的心理障碍),但大多数人,他们是如何反应的?当我们能看清这一点时,我们就能追问,为什么人们会有某些特定的反应方式?这正是我整个职业生涯都在探究的问题。
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The big question, really, when I think about trauma is how do most people respond to the things that we think of as traumas? I tend to use the word potential trauma or potentially traumatic event. And that's because events are not traumatic, they're potentially traumatic, but how do most people respond? We know that some people get PTSD, but what do most people, how do most people react? And when we can see that, then why is it that people react certain ways? This is the question really that's occupied my career.
我的名字是乔治·博南诺,是哥伦比亚大学的临床心理学教授。我最近的一本书名为《创伤的终结:韧性的新科学如何改变我们对创伤后应激障碍的看法》。我因识别并记录了人类在面对基本上可以说是人生中最糟糕的事情时所表现出的心理韧性而闻名。
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My name is George Bonanno. I'm a professor of clinical psychology at Columbia University. My most recent book is titled "The End of Trauma: How the New Science of Resilience "is Changing How We Think About PTSD." I'm known for identifying and documenting human resilience in the face of, basically, the worst things that happen to people.
第一章:人类的韧性能力
我很难只挑出一个我想揭穿的迷思,因为我想揭穿的是一大堆。关于创伤,目前至少存在三个相互关联的普遍误解。其一,任何非常困难、不愉快、艰辛的事情都可能导致创伤,或者其本身就是一种创伤。其二,任何我们认为是创伤的事件,都会造成持久的情感伤害。第三个误解则非常有害,它认为存在一些隐藏的创伤,我们像携带创伤后应激障碍一样将它们带在身上,它们对我们是隐藏的,却持续地伤害我们,给我们的生活制造困难。
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It's difficult for me to identify one myth that I'd like to debunk 'cause I'd like to debunk a bunch of them. There are at least three very much interrelated misconceptions about trauma right now. One is that anything very difficult and unpleasant, hard, can cause trauma or is a trauma. Another is that anything that we consider a trauma has lasting emotional damage. And the third, which is very pernicious, is that there are hidden traumas that we're carrying around PTSD like traumas in us somewhere, and they're hidden from us, yet they are continuing to harm us and to cause difficulties in our life.
坦白说,即使只是说出这些话,也让我感觉很奇怪。因为作为一名科学家,当你说“我们携带着隐藏的创伤”时,我想问:“它们在哪里?”因为我们的身体里并没有承载这些东西的机制。长久以来,我们倾向于将创伤本质化,认为创伤是自然存在的,创伤后应激障碍也是自然存在的。我们不是构想出它,而是发现了它。这是普遍的看法。同理,韧性也存在于自然之中,我们只是发现了它。因此,这些东西似乎是既定事实,人们要么会受到创伤,要么会具有韧性,这仅仅取决于他们是谁。
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Even saying that, I have to confess, even saying that makes me feel funny because as a scientist, when you say, "we carrying around with us hidden traumas," I want to say, "where are they?" Because we don't have mechanisms for those things in our bodies. We have for a long time; we tend to essentialize trauma. We think that trauma exists in nature. PTSD exists in nature. We didn't think it up. We discovered it. That's the way it's viewed. And by the same token, resilience exists in nature and we discover it. So these things just are, and people therefore are either going to be traumatized or they're going to be resilient just because of who they are.
然而,这些说法实际上没有一个是真实或准确的,但这导致了一种对真实情况缺乏探究的现象。为什么有些人会发展出创伤后应激障碍?为什么其他人不会?这才是我们必须深入探讨的问题。
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None of that is actually true or accurate, but it leads to a kind of an absence of inquiry into what's really going on. Why is it that some people develop PTSD? Why is it other people don't? And that's really the question we have to get at.
我大约在1991年开始研究这些现象。当时,韧性的概念已经为人所知,主要体现在那些面对恶劣环境的儿童身上,比如在长期虐待和贫困中长大的孩子,或身处内战中的人们。这些环境都极度消耗、苛刻且有害。但当涉及到潜在的创伤性事件时,人们的假设是,那太超负荷了。因为这些事件如此急剧、强烈、集中,很少有人能应对。对于丧失和悲伤,人们也曾持有同样的想法。
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I began studying these phenomena around 1991, and at that time, resilience was known. It was largely seen in children faced with really caustic environments, children going up with, you know, chronic abuse and poverty or people in Civil War. Things were really draining, demanding caustic environments. When it came to potentially traumatic events, the assumption was that that's just too much. That's overwhelming because they're so acute, so intense, so focused that very few people can deal with that. The same was actually thought about loss, about grief as well.
因此,当我们的研究开始识别并展示出,看,人们实际上对这些事件是有韧性的,很多人都是,大多数人都是。最初,这并没有引起太多的反驳,更多的是冷漠。我当时很年轻,是一名新研究员,使用了一些不同于以往的方法,所以人们的假设是,我肯定哪里做错了。要么是这样,要么就是,这不可能是真的。
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So when in our research we began to identify and show that, look, people are actually resilient to these events. A lot of people are. Most people are. It was met initially with not really much of a rebuttal, more of indifference. I was young, I was a new investigator, I was using some different methods that had been used, and the assumption was, I must be doing something wrong. Either that or I'm, you know, this can't be true.
起初,很多偏向临床领域的人会告诉我,这完全是错的。我不知道你在做什么。你可能是个好研究员,但这根本不是真的。这种反应与其说是反对,不如说是直接忽视这个想法。当我刚开始发表这些论文时,我和我的同事们一起发表,但他们不希望我使用“韧性”这个词,因为这个词似乎太具挑衅性了。
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And initially a lot of people on the more clinical end of things would tell me, that's just plain wrong. I don't know what you're doing. You're probably a good researcher, but that's just not true. And that kind of lack of the reason, it wasn't so much pushback as much as simply just ignoring the idea. And when I first began to publish these papers, I published these papers with my colleagues. My colleagues didn't want me to use the word resilience because that seemed too provocative to use that word.
我17岁时离开了家,那是一个相当,怎么说呢,不太光彩的家,一个充满暴力的家庭。我17岁时独自一人闯荡,身无分文,无人支持。大约19岁时,我设法到了亚利桑那州,找到了一份兼职工作。当时我似乎不需要太多钱。我搭便车去了亚利桑那州中部,那里有很多印第安保留地,也就是美洲原住民的土地。
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I left home when I was 17, and I left a fairly, for lack of a better word: unsavory home. It was a violent home. And I left, I sat out on my own at 17 with no money, nobody in my corner. Around the age of 19, I had made my way to Arizona and I had a part-time job. At the time, I didn't seem to need a lot of money, and I hitchhiked to Central Arizona where there's a lot of Indian reservation, Native American lands.
黄昏时分,我到达了盐河峡谷。我决定走进去露营。我看到有一条河穿过盐河。那里有个牌子,如果我没理解错的话,大概意思是:这里是阿帕奇保留地。如果你进入这个峡谷,你就得靠自己了。我们这里人不多,没人会来救你。诸如此类的话。那是很久以前的事了,50年前,所以我只是在转述。
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And I reached the Salt River Canyon at dusk. I decided to walk in and camp. I saw that there was a river going through the Salt River. There was a sign that basically said, if I can translate this, this is Apache Reservation Land. If you go in this canyon, you're on your own, basically. No one's gonna come get you. There aren't many of us here. Something like that. It was a long time ago, 50 years ago. So I'm paraphrasing.
那里有一些关于山洪的警告标志,我完全没有注意到。我当时年轻,对沙漠知之甚少。我徒步进入峡谷一段路,直到小径消失,然后爬上一个离水面大约10到15英尺的岩架,搭起帐篷就睡了。
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There were a number of warning signs of flash floods that I was, I just simply did not pick up on those. I was young, I didn't know that much about the desert. I hiked into the canyon aways until the trail disappeared, climbed up to a ledge about 10, 15 feet above the water, pitched my tent and went to sleep.
半夜里,开始下雨了,我听到水流声。我担心这可能会损坏我的帐篷,于是拉开防雨罩,用手电筒照出去,发现河水已经涨到了我帐篷所在的高度,并且湍急地流过,河面上升了大约10到15英尺。我惊慌失措。
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So in the middle of the night, it began to rain, and I heard the water running by. I thought this may be damaging my tent, so I pulled up the rain flight, stuck up my flashlight, and the river had risen to where my tent was and was rushing by, it'd risen about 10, 15 feet. I panicked.
我迅速起身,雨还在下,我尽可能快地收起帐篷,把它卷起来,环顾四周。现在,这条河比之前宽了很多,水流湍急地从我身边经过,拍打着我刚才所在的地方。我非常恐慌,尽力集中思绪。我向上又爬了大约15英尺,到了一个非常小的岩架上,安顿下来。最终,我的狗也爬了上来,我为此感到非常高兴。
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Got up quickly, it was raining now, pulled my tent out as fast as I could, gathered it up, looked around me. And there's this now river that's much wider than it was before, running by me quite fast. Lapping at the very spot where I was. I was panicking, I was focusing my thoughts as best I could. I climbed up about another 15 feet to a very tiny ledge and got myself there. Eventually, my dog made his way up. I was very happy about that.
我不知道河水会不会随着峡谷的侵蚀而冲走我所在的岩架。我栖息在那个岩架上很长时间,不知道自己会怎么样。我脑海里不断回想着一个事实:我睡觉的地方现在已经被水淹没了。如果我没有在那个时候醒来,我就会被卷走,基本上是装在一个巨大的尼龙袋里——我的帐篷,我肯定会以最可怕的方式溺水身亡。
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I didn't know the river would take my ledge with me as it withered away to canyon. And I sat perched on that ledge for a long time, wondering what was going to happen to me. I was running in my mind all the realization that where I was sleeping is now underwater. Had I not woken when I did, I would've been swept away essentially in a big plastic, big nylon bag that was my tent, and I would've surely drowned the most horrific death.
直到多年后,我开始研究人们如何应对创伤和丧失,并开始看到人们是多么有韧性。起初我想,为什么我没有经历过类似的事情?所有这些人都经历了这些可怕的事件,为什么我没有经历过?然后我开始回忆,我想起了那件事,还想起了我经历过的许多其他事件,这些事件都符合创伤或潜在创伤的标准,但当时它们只是令人心酸、不安、困难,却并非创伤。
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It wasn't until years later when I began to study people coping with trauma and loss, and I began to see how resilient people were. And at first I thought, why have I not gone through anything like this? All these people go through these horrific events, why have I not gone through one of these events? And then I began to remember, I remembered that event and I remembered all these other events, many other events that I'd gone through that would qualify as traumas or potential traumas that were just simply poignant, disturbing at the time, difficult but not traumas.
我以一种相当简单的方式定义创伤。我的定义很像1980年创伤后应激障碍成为一种诊断时的最初定义:它是一件超出正常人类经验范围的事件。所以它是一种不寻常的事件,具有暴力性和/或危及生命。最典型的例子是,你可能在事件中死亡、受重伤或遭受性侵犯。这是一个更广泛的核心。当然,符合这个标准的事件有很多例外和不同类型。
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I defined trauma in a fairly simple way. I defined trauma a lot, like the way it was first defined in 1980 when PTSD became a diagnosis. It's an event out of the range of normal human experience. So it's an unusual event that is violent and or life-threatening. And the most archetypal examples, the most typical prototypical examples are something that in an event in which you could die, be seriously injured or endure sexual violation. That's kind of the broader nexus. And there are a lot of exceptions and the kind of events that fit that rubric.
有些事件也可能具有潜在的创伤性,如果我们将其想象为暴力或危及生命,即使它们发生在别人身上,我们也可以想象它们发生的方式,从而让我们感到创伤。但大多数情况下,有很多非常不愉快的事件,它们并不是创伤性事件或潜在的创伤性事件。这其中有很好的理由,因为它们会引发不同的反应。
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Some events can also be potentially traumatic if we imagine them as violent or life-threatening in a way that even if they're happening to somebody else, we can imagine them happening, you know, in such a way that might allow us to feel traumatized by that. But for the most part, there are a lot of really unpleasant events that are just not traumatic events or potential traumatic events. And there's very good reason for that because they inculcate different reactions.
比如说,一场毁灭性的金融危机,一段毁灭性的关系,一段关系的结束,或者发生了一些以非常负面的方式改变你生活的事情。这些都是非常不愉快的事件,它们可能造成心理伤害,但它们不是创伤性事件或潜在的创伤性事件。这是因为它们产生的反应看起来不同,感觉不同,并且有不同的组合。我们的大脑会做不同的事情。至少,如果我们想理解这些事件,我们需要非常清楚地知道这些不同类型的事件是如何发展的。
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So say in, you know, a devastating financial crisis. A devastating relationship. The end of a relationship. Something that happens that just changes your life in a very negative way. Those are very unpleasant events. They can cause psychological harm, but they're not traumatic events or not potentially traumatic events. And that's because the reactions that they create look different, feel different, and have a different constellation. Our brains do different things. At least if we wanna understand these events, we need to be really clear about how these different events play out, different types of events.
韧性是一种结果。我们倾向于认为人要么有韧性,要么没有,但当我们试图研究和理解这一点时,这种说法站不住脚。我们只能在与某件事相关联时谈论韧性。一个人对发生的事情有韧性。因此,当我们思考时,在这种情况下,我们可以看到潜在的创伤性事件,也可以看到更广泛的事件类别,比如那些让人沮丧或焦虑的事情。
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Resilience is an outcome. We tend to assume that people are resilient or not resilient, but that just doesn't hold up when we try to investigate that, when we try to understand it. We can only talk about resilience in relation to something. A person is resilient to this thing that happened. So when we think about, and in this case, we can look at potentially traumatic events, we can look at broader categories of events too, things that depress people or make people anxious.
我们可以对任何这些可怕、困难、费力或不愉快的事件表现出韧性。如果我们能在这些事件发生时,大部分时间里继续保持稳定的健康功能轨迹,那么我们就是有韧性的。这意味着我们能够承受这些事件,并在之后继续相对正常地运作。这并不意味着我们没有感到不安。大多数人在坏事发生时都会感到非常不安,这是自然的。事实上,我们的应激反应只有在我们感到压力时才会起作用;我们必须触发那个反应才能应对它。
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We can be resilient to any of these horrific events or difficult events, taxing events, unpleasant events. And we are resilient if when one of these events happens, for the most part, we continue on a stable trajectory of healthy functioning. So we're able to endure one of these events and continue to function relatively normally afterwards. That doesn't mean we didn't get upset. Most people do get pretty upset when bad things happen. That's natural. In fact, our stress response only works when we feel stress. We have to trigger that response in order to cope with it.
所以,大多数人确实会感到非常不安,但韧性就是能够以一种基本健康的方式继续运作。用最简单的话来说,这意味着有能力集中注意力,专注于生活中需要做的事情,无论是工作还是其他,并且能够与他人保持亲密关系。事实证明,当我们长期研究人们时,大多数人都表现出那种韧性模式。我们称之为“韧性轨迹”(resilience trajectory)。
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So most people do get pretty upset, but resilience then is being able to kind of continue functioning in a way that we would that is basically healthy. And in the simplest terms, that means having the capacity to concentrate, to focus, and do what you need to do in life. One's job or whatever that might be, and to be close and intimate with other people. And it turns out when we study people over time, the majority of people show that resilient pattern. We call it the resilience trajectory.
大多数人会经历一个非常令人厌恶、极端不愉快的事件,一个潜在的创伤性事件,但仍然能够像以前一样,继续相对正常、健康地运作。这个比例略有不同,平均而言,大约三分之二的经历过这些事件的人会表现出这种模式。所以大多数人是有韧性的,但这仍然意味着有很多人会因为经历这些负面事件而遭受某种持久的痛苦。
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The majority of people will endure a highly aversive, a very extremely unpleasant event, a potentially traumatic event, and still be able to continue functioning relatively normally, relatively in a healthy way as they had before. The range varies a little bit on average, it's around two-thirds of the people exposed to these events will show that pattern. So most people are resilient, but that still leaves many people who will suffer in some lasting way from exposure to one of these aversive events.
通过长期追踪人们,我们已经能够识别出几种不同的模式。一种反应是变得非常沮丧,并在更长的时间内以一种更费力、更困难的方式挣扎,然后逐渐恢复到正常的水平,逐渐回到对那个人来说健康的运作状态。这可能需要一年,有时甚至更长。我们称之为恢复模式。我们确实看到了这种情况,有相当多的人表现出这种模式。
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And we've been able to identify several different patterns by tracking people over time. One response is to become very upset and struggle in a much more, say, demanding and difficult way for a longer period of time. And then gradually return to a kind of a normative level. Gradually return to the kind of functioning that seems to that person healthy. And it could take a year for that to happen, sometimes even longer. We call that a recovery pattern. And we do see this, we see quite a few people showing this pattern.
换句话说,与表现出韧性模式的人相比,他们在事件发生后的一段时间内,在某种程度上更加失衡、更加困扰、更加痛苦,但他们最终也会康复,回到自己的正常范围。我们看到的另一种模式是,有些人挣扎的程度超出了他们的预期,而且情况没有好转,反而在恶化。他们的症状逐渐增多,事情开始像滚雪球一样发展,然后他们逐渐出现高水平的症状,真的在挣扎,需要专业帮助。
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So in other words, they are in a way more disequilibrated, more disturbed, more distressed by the event over time than someone who was showing that resilient pattern, but they are going also to recover and get back to their normal range. Another pattern we see are some people who are struggling more than they expected to and then they're not getting better. They're getting worse. And they gradually suffer more symptoms, things begin to steamroll, and then gradually they get into high levels of symptoms and they're really struggling and they need professional help.
这种情况可能由多种原因引起。可能是他们经历的事件有一些挥之不去的后果,比如他们受伤了,遭受了很多痛苦。也可能是事件导致了他们生活中的巨大动荡,而这种动荡现在继续给他们带来困难。还可能是他们因为情况没有好转而感到沮丧和失望,并因此变得抑郁。这背后有很多不同的原因。这是一种延迟模式,但它始于挣扎,然后逐渐恶化。
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That could happen for many different reasons. It could be that whatever event they went through has some lingering consequence, maybe they were injured and they suffer a lot of pain. Maybe the event result in a lot of upheaval in their life. And so that upheaval is now continuing make difficulties for them. It may be they're upset and disappointed that they're not getting better and they're getting depressed about not getting better. There are many different reasons for that. That's a kind of a delayed pattern, but it begins with struggling and then getting gradually worse.
然后,我们看到的第三种模式,在那些没有韧性的人当中,我们称之为基本上是慢性痛苦或慢性症状。这是一个被事件严重创伤的人,如果不是潜在的创伤性事件,他们也会感到非常深刻的痛苦。他们会持续挣扎很长时间,这种伤害是无情的,是持久的。这很不幸,非常不幸,但它是真实存在的。这种情况通常发生在不到10%的人身上,但确实时有发生。
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Then another pattern we see, the third pattern among those people who aren't resilient is what we call basically chronic distress or chronic symptomatology. And that's a person who is really seriously traumatized by the event, really deeply upset if it's not a potential traumatic event. And they continue to struggle for a long time. And there's really kind of relentless and it's long lasting harm. And that's unfortunate, very unfortunate, but it's real. It happens in less than 10% usually, but it does happen quite a bit.
我创造了“韧性盲点”这个词,用来描述一个我多年来观察到的现象。我在纽约市9/11袭击后所做的研究中看到了这一点。当时我就在纽约市。最近,在COVID-19大流行期间,我又非常清楚地看到了这一点。韧性盲点最明显的时候是在大规模灾难中,因为很多人都受到了影响,并且在许多人中存在一种共同的焦虑、痛苦、担忧和不安。
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I coined this phrase, "the resilience blind spot" to capture a phenomenon that I've seen now for many years. I saw this in the research I did after the 9/11 attacks in New York City. I was in New York City at the time. I've saw it again recently with the COVID-19 pandemic very clearly. What happens with the resilience blind spot is it's most apparent with a large scale disaster because many people are affected and there is a kind of a shared anxiety, distress, concern, upset among many people.
这里面有一点社会传染的因素。我们倾向于看到别人不安,然后我们自己也感到不安,我们更加担心。像9/11、COVID-19大流行、几年前纽约市的超级风暴桑迪、日本的海啸,这些事件都非常令人不安。它们发生过,将来还会发生。当人们感到不安时,我们的大脑就是这样运作的:我们很难相信这种感觉不会持续,很难相信这只是一个短暂的现象。
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And there's a little bit of social contagion there. We tend to see other people being upset and then we feel upset. We worry more. These events that 9/11, COVID-19 pandemic, the super storm Sandy that was in New York City a number of years ago, the tsunami in Japan. Lots of these events, they happen, they're going to happen again. They're very, very disturbing. And when people are upset, it's just a way our minds work. It's very hard for us to believe that that won't last, that that's a short-lived phenomenon.
这可以追溯到我的朋友兼同事、哈佛大学的丹·吉尔伯特(Dan Gilbert)曾就此谈到过的“情感预测”(affective forecasting:指人们预测未来情绪状态的倾向)。当我们感受到一种情绪时,很难想象它是短暂的。很难想象我们不会永远或很长一段时间都这样感觉。所以,当我们因为一场灾难、一场群体性事件而感到不安时,这种情绪会被所有的关注、媒体、与他人的交谈以及我们所知的情况所加剧。
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This goes all the way back to my friend and colleague Dan Gilbert at Harvard had talked about this in terms of affective forecasting. When we're feeling emotion, it's hard to imagine that it's ephemeral. It's hard to imagine we won't feel this way forever or for a long time. So when we are upset because of a disaster, a mass event that's fed by all the attention it gets, it's fed by the media, it's fed by conversations we have with other people, it's fed by what we know is happening.
这种不安如此强烈,以至于我们戴上了像马戴的眼罩一样的“遮眼罩”,或者像我们眼睛里的盲点一样,对“这一切会过去,我们会好起来的”这个想法视而不见。
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And it's so upsetting that we live blinders like a horse wears blinders or a blind spot like we have a blind spot in our eye for the idea that this will pass, that we'll be okay.
当我们暴露于潜在的创伤性事件时,我们的大脑里发生了什么?坦白说,我们并不知道完整的细节,因为我们无法做到。我们不能把人放进实验里去创伤他们。所以我们所知的大部分,是基于我们对如何应对极端压力的深入了解而进行的延伸。
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So what is happening in our brains when we're exposed to a potentially traumatic event? To be perfectly honest, we don't know the story in full detail because we can't. We can't put people in experiments and traumatize them. So most of what we know is kind of extending what we do know very well about how we respond to extreme stress.
我们从这项研究中得知,我们拥有一种非凡的应激反应。在我看来,它简直是宏伟的。它是多方面的,多阶段的。它可以持续很短的时间,也可以持续很长时间,并且可以管理不同级别和不同类型的挑战。最初发生的事情,我们过去称之为“战斗或逃跑反应”,这个词是20世纪初由伟大的生理学家沃尔特·坎农(Walter Cannon)创造的。他没有我们现在拥有的工具,所以我们已经将这个想法发展得更远了。
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And what we know from this research is that we have a kind of a remarkable stress response. It's magnificent, actually, in my mind. It's magnificent. It's multifaceted. It's multiphasic. It can last for a very short time or a long time, and it can manage different levels and different kinds of challenges. What happens initially, which we used to know is the fight or flight response, that phrase was coined in the early 20th century by the great physiologist Walter Cannon. He didn't have the tools we have now, and so we've taken that idea a lot further.
但基本上,当我们的感觉器官向大脑发送信号时,通常是中脑,这些信号会经过一些处理。如果它们与某些预设或我们学到的东西相匹配,它们就会被转移到另一个结构——杏仁核,然后杏仁核可能会把它转移到下丘脑。所有这些结构都在进行过滤,几乎就像小型二进制计算机一样,判断这是否是威胁?这是否危险?
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But, essentially, what happens is when our sensory organs send signals to the brain, typically the midbrain, they get shuffled around a little bit. If they match some presets or some things we've learned, they get shuffled to another structure, the amygdala, and that may shuffle it over to hypothalamus. All of these structures are kind of filtering almost like little computers, binary computers, is this something threatening? Is this dangerous?
它不需要完全验证,只需要匹配可能的威胁的基本最低水平,这就会在我们全身引发一连串的生物反应。我们的大脑协调着我们身体的运作。正常情况下,它通过让事物升降来维持一个精妙的平衡,使我们身体的一切都保持良好、平衡和功能正常。
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It doesn't have to be fully verified. It all it needs to do is match the kind of the basic minimum level of a possible strap, and that will send a cascade of biological responses throughout our body. Our brain orchestrates how our body functions. And it does this normally by keeping it in a nice delicate balance of, you know, things ramping up and ramping down so that everything stays kind of nice and balanced, and functional in our bodies.
当那个威胁警报响起,当那些大脑结构说现在有非常危险的事情正在发生时,它就会打破那个平衡。我们最需要的东西会被加强。所以血液被泵送得更多,我们泵送更多的血液到四肢。我们产生更多的葡萄糖,也输送到四肢,因为我们会需要它。我们呼吸更重,我们的瞳孔放大,这样我们就能接收更多的信息。而一些不必要的东西则被关闭。我们不需要其他一些身体功能,暂时让它们下线。
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When that threat alarm goes off, when those brain structures say there's something really dangerous going on right now, it shifts that balance. The things that we need most get ramped up. So blood gets pumped up. We pump more blood, it goes to the extremities. We produce more glucose. That goes to the extremities too. We're gonna need that. We breathe more heavily, our eyes, our pupils dilate. So we take in more information and some of the things that are not necessary kind of gets shut down. We don't need some of these other bodily functions, take them offline temporarily.
与此同时,我们大脑的运作方式也发生了转变,从反思性、深思熟虑的处理过程——就像我现在正在做的这样——转变为更直接、几乎是自动驾驶、习惯性和自动化的处理过程,旨在应对大脑认为正在发生的事情。这对我们体验和记忆这些事件的方式也有影响,因为它只关注那些与我们生存最相关的信息片段。它不关心更广泛的背景,不关心更广泛的叙事线索。它只关心我们需要知道的事情:这个东西移动得多快?这个东西有多锋利?如果我摔倒了会有多糟?所有这些信息片段。
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At the same time, there's a shift in what our brains are doing from reflective, thoughtful processing, well, like what I'm doing right now, to much more immediate, almost autopilot, habitual and automatic processing designed to deal with what the brain thinks is happening. That also has consequences for how we experience and remember these events because it focuses only on the bits and pieces of information that are most relevant for our survival. It doesn't care about the broader context, the broader narrative thread. It's just the things we need to know. How fast is this moving? How sharp is this thing? How bad could this be if I fall? All these bits and pieces of information.
如果威胁持续存在,警报继续响起,就会发送更多的信号,下丘脑结构会通过血液发送信号,即神经化学信使,这些信使会到达肾上腺并释放皮质醇(Cortisol:一种由肾上腺分泌的激素,通常被称为“压力荷尔蒙”)。皮质醇早些时候就已经被释放了,但现在它做的事情不同了。它通过血液传播,当它到达大脑时,它会与一些相同的大脑结构结合,但现在它会导致这些结构发生基因和表观遗传学的变化,这样它们就能以更强大的方式做它们需要做的事情,它们会真正地加强这种应激反应。
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If the threat continues and the alarm continues to go off, that sends more signals and the structure of the hypothalamus will then send signals through our blood, neurochemical messengers through our blood that will go down to the adrenal glands and release cortisol. Cortisol has been released earlier, but it does something different now. It travels through the blood and when it reaches the brain, it bonds with some of those same brain structures only now it results in genetic change and epigenetic change in those structures so they can do what they need to do, even in a bigger way, even more powerfully, and they really ramp up this stress response.
情况不妙,所以我们需要一个更强烈的反应。与此同时,我们的长期记忆被阻断了,这非常有趣。我们无法主动回忆过去的事情,因为此时我们不需要那些信息,它只会分散注意力。我们可以记住细节,但我们无法记住叙事性的长期记忆,因为我们不需要它们。
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Things are not going well. So we need a bigger response. At the same time, there's a blockage of our long-term memory, which is really intriguing. We can't voluntarily recall things in the past very well 'cause we don't need that information at this point. It's just distracting. We can remember details, but we can't remember narrative long-term memories because we don't need them.
这种情况会发生,并且可以持续相当长的时间,长达几个小时。而这种皮质醇,它的平衡非常巧妙,内置了一种制动系统。所以有些细胞对皮质醇反应非常强烈,它们对皮质醇有很高的亲和力。因此,它们对大脑中皮质醇的存在会立即做出非常强烈的反应。
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So that's happening, and that can last for quite a long time up to a couple hours. And this cortisol, it's wonderfully balanced. It's kind of got a braking system built into it. So some cells allow cortisol to, they react very strongly to cortisol and they have kind of a what's called a high affinity for cortisol. So they respond right away very powerfully to the presence of cortisol in the brain.
其他细胞对皮质醇的亲和力较低。所以皮质醇会有一个积累的过程,然后被关闭,逐渐下降。整个过程可以持续好几个小时。在那段时间里,我们基本上处于一种另类的意识状态,因为我们的大脑以一种不同的方式集中注意力。所以,我们最初从这种习惯性的、自动化的处理方式,最终转变为一种更具反思性、目标驱动的处理方式,当后者变得必要时。这个转变过程非常有趣。
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Other cells have a low affinity of cortisol. So there's a kind of a building up of cortisol and then it gets shut down and gradually declines. And that whole arc can last a good couple hours. We're in essentially an alternative state of consciousness during that time because our brains are focused in a different way. So, initially, we've gone from this habitual automatic kind of processing, eventually, to a more reflective, goal-driven processing after time when that becomes necessary. And that sweep is very interesting.
我对此感到非常兴奋,因为我认为这是一个了不起的系统,我们每个人都拥有它,作为我们基本上继承来的生物能力的一部分。
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So I get very excited about this because I think it's a marvelous system and we all have this as part of our basically inherited biological capacity.
我们看到的与极端压力水平相关的大脑活动,为我们提供了一些线索,解释了为什么有些人会发展出创伤后应激障碍,而许多人则不会。许多人不会发展出创伤后应激障碍或持久的伤害,是因为这些过程,这些大脑过程,非常非常有效。但对某些人来说,它们可能效果较差,部分原因可能是皮质醇的缺乏。有证据表明,有些人的静息皮质醇水平较低。
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The brain activity we see in relation to extreme levels of stress has some clues about why people also develop PTSD and why many people don't. Many people don't develop PTSD or lasting harm because these processes, these brain processes are very, very effective. But for some people they may be less effective and that in part may be because of a lack of cortisol, and there's some evidence to suggest that some people have lower resting cortisol.
这种情况发生的原因很复杂,目前还有很多工作在试图弄清楚。有些人还有一个更敏感的皮质醇制动系统,它会更快地关闭皮质醇,这似乎有一个表观遗传学的成分。这意味着,一些早期的生活经历可能已经使系统准备好,比如说,反应不够或者在关闭时反应过度。所有这些都很难在研究中证明,但这似乎是一个正在出现的想法。
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There are complicated reasons why that may have come about. There's still a lot of work trying to figure that out. Some people also have a more sensitive cortisol break, which shuts it down more quickly, and that that seems to have an epigenetic component meaning. Some earlier life experiences may have primed the system to be say, not reactive enough or over reactive in terms of shutting it down. All of that is hard to demonstrate in research but that seems to be an emerging idea.
当我们处于极端压力下时,我们大脑的运作方式会导致对这些事件的记忆非常零碎,只有一些片段。我认为这具有高度的适应性,因为它给了我们可以使用的通用信息。下次再发生非常困难的事情时,如果它会再次发生的话。我记得在东京海啸之后,有人给我看了一段机场被淹的录像带,我从未见过机场被淹。我从那段录像中记得的只是一些关键事件:水来了,来得有多快,以及当它与飞机相遇时发生了什么,一些东西浮了起来,另一些则没有。
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The way our brain works when we're under extreme stress results in very fragmented memories of these events. The bits and pieces. And that's, I think, highly adaptive because it gives us kind of generic information we can use. And next time something really difficult happens if it would happen again. I remember after the tsunami in Tokyo, I was shown a videotape of an airport flooding and I'd never seen an airport flooding. And what I remember from that as it just a couple key incidents, the water arriving, how fast it came, and what happened when it met with the plains, some things floated up, other things didn't.
这些都是我以前没有的信息。那段视频的其余部分我不记得了,但我记得那些零碎的片段。所以,这就是我们对大多数潜在创伤性事件的体验,一些零碎的、去情境化的信息。
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None of that was information that I had before. The rest of that video I don't remember, but I remember those bits and pieces. So that's the kind of experience we have of most potential traumatic events, bits and pieces of kind of decontextualized information.
现在,每当我们记起某件事,我们都是以一种非常有机的的方式重新记忆它。在我的领域,我们称之为“巩固”和“再巩固”。当我们记起某件事时,这是一个生物学事件。所以我们以某种方式巩固所有的大脑活动,以便我们再次回到它时能够记起。然后,当我们回到一个记忆时,我们重新激活了那些相同的生物系统,然后,在我们思考完它们之后,它们又回到了记忆中。它们被再巩固了。
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Now, whenever we remember something, we re-remember it in a very organic way. In my field, we call that consolidating and reconsolidating. When we remember something, it's a biological event. So we're consolidating all that brain activity in some way that we can remember it when we go back to it. And then when we go back to a memory, we reactivate those same biological systems and then after we're done thinking about them they go back in the memory. They get reconsolidated.
唯一的区别是,现在我们有了其他的经历,即我们记忆时的经历。所以记忆会逐渐改变。我认为,我们所认为的许多创伤记忆,就是这些零碎的信息,我们后来把它们拼凑成一个故事。这是一个非常有趣的现象,我们仍在努力理解它,但它可能变得更糟,也可能变得更好。
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Only the difference is now we have other experiences. the experiences we had when we were remembering. So the memories gradually change. And I think a lot of what we think of as memories of trauma are these bits and pieces of information that we later put together into a story. And that's a very interesting phenomenon. That's something that we're still trying to understand, but it can go for the worse or for the better.
如果我们开始告诉自己某件事有多么可怕,并开始将碎片串联成一种半虚构的叙事,情况就会变得更糟。如果我们逐渐在自己和那段记忆之间拉开一些距离,并逐渐以一种更温和的方式,或者像是在观看它们一样记住这些事件,这可能会在未来帮助我们。事实上,我们对经历过9/11袭击的人做了一些研究,这些人是9月11日当天真正在双子塔内或附近的人。
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It goes for the worse, if we then begin to tell ourselves how horrible something was and we begin to string pieces together in a kind of a quasi invented narrative. It can help us in the future if we gradually put some distance between ourselves in that memory and we gradually remember these events in a more benign way or in a way as if we were watching them. And, in fact, we did some research on people who had gone through the 9/11 attacks. People who were actually in the towers or near the towers on September 11th.
所有这些人当时都处于生命危险之中。我们发现,那些康复或表现出韧性模式的人,他们的记忆随着时间的推移而改变了。他们对那些事件的记忆变得更加温和。而那些仍然受到创伤的人,他们的记忆虽然有一些变化,但基本上仍然是一个非常令人不安的记忆。所以,我们随着时间推移思考这些事件的方式中,有一些我们尚未完全理解的东西,但它与实际发生的事情有些脱节。
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All those people were in life-threatening danger. And what we found was the people who either recovered or showed that resilient pattern had their memory changed over time. Their memory of those events became more benign. And the people who remained traumatized had pretty much, they had some variation in their memory, but it continued to be pretty much a very disturbing memory. So there's something in the way we think about these events over time that we don't fully understand yet, but it's a little bit removed from what actually happened.
那么,关于创伤后应激障碍的诊断呢?如果一个人确实患有创伤后应激障碍,被诊断出来有用吗?我认为,就我的研究而言,我们看到确实有人患有创伤后应激障碍。这个范围有所不同,但我认为,对我们真正挣扎的任何事情有一个诊断都是有用的,是有帮助的。
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So what about the diagnosis of PTSD? Is it useful to be diagnosed with PTSD if somebody is generally suffering from PTSD? And I think in terms of my research, we see that there are certainly people generally suffering from PTSD. The range varies, but I think having a diagnosis of anything that we're really struggling with is useful, is helpful.
它既能带来安慰,因为我们现在知道了我们正在挣扎的是什么,也意味着别人也知道了我们正在挣扎的是什么。如果有人诊断了我们,那就意味着我们可以了解到专门针对我们所挣扎的事情的治疗方法。但这样做的缺点是,创伤后应激障碍的诊断是有漏洞的,人们可能在实际上没有创伤后应激障碍的情况下被诊断出来。不幸的是,这种情况发生得太频繁了。
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It's both comforting because we now know what it is we're struggling with and it means that somebody else knows what it is we're struggling with. If somebody diagnoses us and it means there are treatments we can learn about that are specifically for that thing we're struggling with. The downside of that is that the PTSD diagnosis is porous and people can be diagnosed with PTSD when they actually don't have PTSD. And that does happen, unfortunately, far too often.
第二章:开发克服创伤的工具
当我们开始确信我们确实发现了一些真实的东西,也就是我所说的这种韧性轨迹时,我们已经在许多研究中证实了它。它已经在超过100项研究中被令人信服地证实,这些研究是由除我之外的许多其他人进行的。所以它是一个非常真实的东西。那么,大的问题就变成了,为什么大多数人有韧性,而有些人没有?
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When we began to become confident that we really had identified something real, this resilience trajectory I've talked about, we've identified it in many studies at this point, it's been identified convincingly in the majority and over 100 research studies by other people than myself, lots of other people. So it's very much a real thing. The big question then is why are most people resilient and why are some people not resilient?
结果发现,这个问题比我想象的要难回答。因为当我们测量与韧性相关的因素,即与韧性同时发生的因素时,我们发现了许多不同的因素。在公众中,我们看到媒体上,甚至在一些专业文献中,都存在一种迷思,认为有一些神奇的特质,比如“高韧性人群的三个特质”、“高韧性人群的五个特质”。
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That turned out to be a harder question to answer than I thought because when we measure the things that correlate with resilience, the things that co-occur with resilience, we find loss of different factors. The kind of a myth in the general public, we see it in the media, we see it in even in some professional literature, is that there are a few magic traits. The three traits of highly resilient people. The five traits of highly resilient people.
事实证明,有许多许多因素与韧性相关,但它们都具有我们所说的“小效应”。它们解释不了太多,只能解释一小部分谁会具有韧性。换句话说,如果某人有积极思维,或者他们擅长解决问题,或者他们擅长分散自己的注意力,或者他们做的任何有助于他们变得有韧性的事情,结果发现,这只能预测一小部分他们在事情发生时是否真的会有韧性。
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It turns out there are many, many factors that have been associated with resilience, but they all have what we call small effects. They don't explain very much. They only explain a little bit of who will be resilient. So in other words, if somebody says has positive thinking or they're good at problem solving or they're good at distracting themselves or whatever it is that they they do that is something that helps them to be resilient. It turns out that that only predicts a little bit of whether or not they will actually be resilient when something happens.
我称之为“韧性悖论”。我们可以识别这些因素,但矛盾的是,它们并不能真正预测下一次事情发生时谁会具有韧性。事实证明,原因在于情境变化很大,而且每件事都有成本和收益。所以,我们认为能让我们变得有韧性的这些不同因素,这些不同的行为,甚至是我们认为在试图应对逆境时会使用的首选方法,它们只在某些时候有效。
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I call that the resilience paradox. We can identify these things, but, paradoxically, they don't actually predict who will be resilient the next time something happens. And the reason for that it turns out is because situations vary a great deal, and there are cost and benefits to everything. So these different factors that we think make us resilient, these different behaviors, even the go-to things that we think we use when we are trying to cope with adversity, they only work sometimes.
它们在某些情境下有效,但在其他时候效果不佳。即使是我们认为最好的方法,也并非总是有效。所以这意味着,每当有事情发生,我们所有人都必须找出什么是最好的解决方案,什么是针对此时此刻、我所处的这个特定情境的最佳策略。我称之为“适应性灵活性”(adaptive flexibility:指根据情境需求,灵活调整应对策略以适应变化的能力)。
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They work sometimes in some situations and they don't work very well in other times. Even the things that we think are kind of our best shot don't always work. So what that means is every time something happens, all of us, we have to work out what's the best solution, what's the best strategy for this particular moment right now? This particular situation I'm in. And I call that process of doing that adaptive flexibility.
我也称之为“调节灵活性”。适应性灵活性基本上是一套技能,大多数人实际上都拥有,这是一件好事。大多数人都拥有这些技能,它们也是高度可学习的。但即使我们拥有这些技能,我们也必须使用我们拥有的技能,而这是需要努力的。为了做到这一点,我们必须有动力,我们必须相信我们能够做到,否则我们甚至不会尝试。
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I've also called it regulatory flexibility. Adaptive flexibility is basically a set of skills that most people have actually, which is a good thing. Most people have those skills, they're also highly learnable. But even if we have those skills, we have to use the skills we have and that's work. And in order to do that work, we have to be motivated, we have to believe that we'll be able to do it otherwise we won't even try.
而那种信念,那种“我最终会挺过去的”的想法——我不高兴这件事发生,这真的很糟糕,很痛苦,它正在毁掉我的生活,但我最终会挺过去的——正是我们为了做那份工作所需要的信念。我们必须以某种方式认为我们会挺过去。我们称之为“灵活性心态”(flexibility mindset)。
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And that belief, that idea that I'll get through this eventually. I'm not happy this happened, this really sucks, this is painful, it's ruining my life, but I'll get through this eventually. That's the belief that we need in order to do that work. We need to somehow think we'll get through it. We call this the flexibility mindset.
似乎有三个核心信念构成了灵活性心态。它们相互关联,相互促进。其中之一是乐观。这基本上是一种信念或确信,事情会好起来的。未来会好的,现在虽然不好,但未来会好的。你可以在体育运动中看到这一点,也可以在生活的许多其他领域看到。
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There are three core beliefs that seem to comprise the flexibility mindset. They're related and they feed off each other. One of them is optimism. That's essentially a belief or conviction that it's going to be okay. The future will be okay, this isn't good now, but it will be okay in the future. You know, you can see this in sports, you can see it in many other domains of life.
有些运动员拥有世界上所有的技能,但如果他们没有动力,没有目标感,他们就不会表现出色。你在体育运动中一次又一次地看到这种情况,我们总是需要那种动力,那种“我能挺过去,我能做到”的信念。
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There are some athletes who have all the skills in the world, but if they don't have the motivation, if they don't have the sense of purpose, they're not going to perform well. And you see this over and over in sports, we need always to have that motivation, that belief that I'll get through this. I can do it.
这些信念中的另一个是应对的信心,有时被称为应对自我效能感。这基本上是一种信念,即我有一些应对能力,而大多数人确实有。大多数人至少有一些可以使用的应对行为、应对机制。所以这是一种提醒自己“我能应对”的感觉。
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So another one of those beliefs is confidence of coping, sometimes called coping self-efficacy. And this is essentially a belief that I have some ability to cope and most people do. Most people have at least some coping that they can do some behavior, some coping mechanisms that they can use. So it's a sense of reminding ourselves, I can cope.
第三个信念,这个心态的第三个组成部分,我们称之为“挑战导向”,有时也叫“挑战评估”。这是指当我们从挑战的角度思考威胁性事件时,思考我们需要做什么来度过难关。你知道,当我们第一次面对威胁时,我们自然会评估威胁,因为我们需要知道事情有多糟糕。
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The third belief. The third component of this that appears to be part of the mindset is what we call challenge orientation. Sometimes called challenge appraisal. And that's when we think of threatening events in terms of the challenge at hand, what we need to do to get through it. You know, when we're first confronted with a threat, we naturally assess the threat because we need to know how bad something is.
但在某个时刻,我们必须从思考威胁转向思考我们需要做什么来克服它。如果我们过于专注于威胁,我们就会被它麻痹。所以挑战评估是一种感觉,“好吧,发生了什么?这里的挑战是什么?我需要做什么?”
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But that at some point we have to shift from thinking about the threat to thinking about what we need to do to get past it. If we stay too focused on the threat, we're paralyzed by that. So the challenge appraisal is a sense of, all right, what happened? What's the challenge here? What do I need to do?
我们的研究项目逐渐指向了我们现在称之为“灵活性序列”(flexibility sequence)的三个关键组成部分,三个步骤。我在我最近的书《创伤的终结》中首次将它们整合在一起,并详细阐述了它们。这三个步骤都来自我们的研究。第一步我们称之为“情境敏感性”。
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Our research program gradually began to point to three key components, three steps of what we now call the flexibility sequence. I pulled these together for the first time in my recent book, "The End of Trauma" and lay them out in some detail. The first step and all three of these come from our research. The first step we call contact sensitivity.
这是指当我们停下来,当某件事困扰我们,我们感到不安时,我们停下来反思,思考:问题是什么?现在发生了什么?问题是什么,我需要做什么?这真的是关于当下的。你知道,我们有时在被某件事真正困扰时遇到的一个困难是,我们采取了一个非常宽泛的视角。这件事发生了,它正在毁掉我的生活,这太可怕了。
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And this is where we stop and we, when something is disturbing us, we're upset. We stop and we reflect and we think, what is the problem? What's happening right now? What's the problem and what do I need to do? And this is really about the moment. You know, one of the difficulties we experience sometimes when we're really upset by something is we take a very broad perspective. This thing happened, it's ruining my life. It's horrible.
这是一个太大的问题,无法一次性解决。我们需要把它分解成小块。当前的问题是什么?此时此刻真正困扰我的问题是什么?可能是我感到焦虑。可能是我去某个地方时会变得非常焦虑,因为那里是事情发生的地方。可能是我们有的任何数量的反应,我们必须一次解决一个。
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That's too big of a problem to undo all at once. We need to take it in pieces. What's the problem at hand? What's the problem in this moment that's really bothering me? It may be that I'm feeling anxious. It may be that when I go to this one place, I get really anxious 'cause this is the place where this thing happened. It may be any number of of reactions we have and we have to take these one at a time.
当我们思考,好吧,我需要睡觉。问题是我睡不好,这让我在白天不开心,也让我难以集中注意力,然后我开始担心我的工作,诸如此类。我需要做什么?我需要专注于解决那个问题。我如何才能睡得更好?或者我需要专注于在当下感觉不那么焦虑。
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When we think about, okay, I need to sleep. The problem is I'm not sleeping well and that's making me unhappy during the day and it's making me have trouble concentrating and then I'm worried about my job, whatever that may be. What do I need to do? I need to focus on solving that problem. How do I sleep better? Or I need to focus on feeling less anxious in the moment.
一旦我们做到了这一点,我们就有了一个可以解决的明确问题。我们进入序列的第二步,我们称之为“策略库”。在这里,我们决定我们将使用哪种策略。我们称之为策略库,因为我们每个人都有一个个人策略的库,那些我们知道如何做的事情,我们过去使用过的事情,我们从那个库中选择。
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Once we've done that, we have a clear problem we can solve. We move to the second step of the sequence, which we call repertoire. And here we decide on a strategy we'll use. We call it repertoire though, because all of us have a repertoire of personal strategies, the things that we know how to do, the things we've used in the past, and we choose from that repertoire.
它就像一个工具箱。我们打开那个工具箱,然后说,好吧,我需要睡得更好,或者我现在需要感觉不那么焦虑,或者我需要找到一种方法,当我在这种情况下时,不感到受威胁。我们看着那个工具箱,决定现在使用哪种工具最好。然后我们尝试一些东西,这就带我们到了第三步,我们称之为“反馈”。
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It's kind of like a toolbox. We open up that toolbox and we say, alright, I need to sleep better or I need to feel a little less anxious now, or I need to find a way not to feel threatened when I'm in this situation. And we look in that toolbox and we decide which of these tools is going to be best to use right now? And we try something out that takes us to the third step, which we call feedback.
这基本上很简单。我们只是监控我们刚才做的事情,然后问自己,它起作用了吗?尽管这听起来很简单,但这确实是关键的一步,因为很多人在这里就放弃了。如果他们尝试了某件事,但没有用,他们就会想,我处理不了这个,我就是无法应对。我试过做这件事来分散自己的注意力,这样我就不会去想它了。我试过全身心投入到我的工作中,这对我很有帮助,但我还是不停地想着它。
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And this is basically very quite simple in a way. We just simply monitor what we just did and ask ourselves, is it working? As simple as that may sound, this is really a key step because a lot of people give up here. If they try something, it doesn't work, they think, I can't deal with this, I just can't cope with this. I tried, you know, doing this thing where I distract myself, so I won't think about it. I tried getting wrapped up in my job, which really helps me a lot and I still kept thinking about it.
所以我无法应对这个,我认为这实际上是一个非常危险的误解。因为在这种情况下,我们需要做的是,正如在灵活性序列中阐述的那样,我们回到策略库那一步,然后尝试别的东西。我们尝试另一种策略。我们可能需要继续尝试几种策略,直到有东西真正起作用。
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So I can't cope with this, and that's actually a very dangerous misconception, I think, because what we need to do in this situation is, and as it laid out in the flexibility sequence is we go back to the repertoire step and we try something else. We try another strategy. And we might have to continue trying strategies several times before something actually works.
或者,如果我们已经尝试了很多策略,那可能意味着我们必须回到最开始,用稍微不同的方式来思考问题。也许我关注得太宽泛了,我关注了错误的问题。我现在能解决的问题是什么?
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Or if we've tried many strategies, it may be that we have to go all the way back to the beginning and think about the problem in slightly different terms. What is, maybe I'm focusing too broadly, I'm focusing on the wrong problem. What's the problem that I can solve right now?
在灵活性序列的这些不同部分中,都有一个教训。因为它不仅给了我们应对这些挑战、我们经历的这些负面事件的工具,它实际上也在教导我们关于我们自己的掌控力。我们实际上可以对这些事件做些什么。我们可以随着时间的推移自己解决这些事情。它确实告诉我们,我们不需要简单地让事情发生在我们身上。
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There's a lesson in all of this in these different pieces of the flexibility sequence because not only does it give us tools for dealing with these challenges, these averse events we experience, it also essentially is teaching us about our own mastery. We can actually do something about these events. We can actually work these things out ourselves over time. And it does teach us really that we don't need to simply let things happen to us.
有句话叫“时间治愈一切”,时间确实能治愈一些东西,但时间不着急。时间需要很长时间。所以我们实际上可以介入,努力让我们自己度过这些事件,以一种我们自己做决定的方式。我们尝试一些东西。一个好的思考方式是,即使我们尝试了某件事但没有成功,我们已经尝试了,这是我们自己的选择。我们知道,好吧,这个没用,让我看看我还有什么别的办法。
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There's a phrase, "Time heals all ills" and time does heal things, but time is in no rush. Time takes a long time. So we can actually get in there and work to get ourselves through these events in a way that we're making the decisions. We're trying things out. The good way to think about this is even when we try something and it doesn't work, we've tried it, it's been our choice to try it. And we know, okay, this isn't working, let me see what else I have.
随着时间的推移,我们也开始更多地了解我们的工具。我们更多地了解我们如何感知事物,我们更多地了解我们拥有的工具,我们实际上可以想,好吧,这个工具在这种情况下效果很好,现在我知道我有这个工具了。我看到别人,我听说别人在做另一件事。也许我将来会试试那个。我会把它放进我的工具箱里。所以有很多方式,我们可以作为人成长,变得更有效能,在某种程度上更独立地使用这些工具。
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And over time we also begin to learn more about our tools. We learn more about how we perceive things, we learn more about the tools we have, and we can actually kind of think, okay, this tool worked pretty well in this situation and now I know I have this tool and I saw somebody else, I heard about somebody else doing this other thing. Maybe I'll try that in the future. I'll put that in my toolbox. So there are a lot of ways that we can grow as people and become more efficacious and more independent in a way with these kinds of tools.
我认为有一种普遍的观念,很容易让人接受,那就是有人可能会想,我受到了创伤,这真的毁了我的生活,现在我只能限制我的生活了。我对此无能为力,它就是发生在我身上了。这种想法中蕴含着很多无助感。而灵活性的概念,即我们实际上可以介入并改变我们体验世界的方式,改变事情发生在我们身上的方式,以及我们面临的挑战——我认为这给了我们更多的效能感,更多的掌控感,更多的主动性来处理这些事件。
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I think there's a kind of a general idea that it's pretty easy to latch onto that somebody might think I've been traumatized and it's really ruining my life and, you know, I just have to limit my life now. And there's nothing I can do about it. It's just happened to me. And there's a lot of helplessness built into that idea. And the flexibility notion, the sense that we can actually get in and change the way we're experiencing the world, the way things are happening to us. The challenges we face- I think gives us a lot more efficacy, a lot more mastery, a lot more sense of agency in how we deal with these events.
我创造了“统一效能谬误”这个词,因为我在人们的谈话中,以及在我自己的研究领域中都看到了这一点。这种观念认为,有一些行为、一些策略,人们可以使用,它们就像金科玉律一样。它们总是有效。它们是完美的策略,而另一些则是不健康的。它们是适应不良的。不要做这些事,这些事是不健康的。
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I coined the term the fallacy of uniform efficacy, because I see this in the way people talk, and I see this actually in my own research discipline. This idea that there's some behaviors, some strategies that people can use that are just golden. They always work. They are the perfect strategies, and then there are others that are just not healthy. They're maladaptive. Don't do these things, these things are unhealthy.
事实上,这与研究结果完全不符。所以统一效能谬误是指任何策略要么总是好的,要么总是坏的。我们发现,有一些策略是人们喜欢使用的,有一些是健康的好策略,但在某些情况下,即使是最不健康的策略也可能具有适应性。
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And in fact that doesn't hold up to the research at all. So that the fallacy of uniform efficacy is that any strategy is always good or always bad. And we find that there are strategies that people like to use. There are strategies that are healthy and good strategies to use, but in certain situations, even the most unhealthy strategy can actually be adaptive.
我称之为“丑陋地应对”。这个想法是,比如说,做一些冲动的事情并不是很健康。你知道,你应该行为得体。你不需要在这里自我毁灭。但如果你在某些情况下做一两次这样的事,它实际上可能正是你所需要做的。约翰·列侬写过一首歌,“Whatever gets you through the night”(任何能让你度过长夜的事)。这正是这种想法的体现。
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I call this coping ugly. It's the idea that say something like doing some impulsive thing is not really healthy. You know, you should behave. You don't need to be self-destructive here. If you do something that once or twice in certain situations, it's actually can be just what you need to do. John Lennon wrote a song, "Whatever gets you through the night". And that's exactly what this kind of idea embodies.
同样地,我们认为总是健康的事情,我们应该做的那些事,并非总是有效的。它们并非总是奏效。很好的例子是像正念这样的东西。正念是好东西,毫无疑问。但正念并不能总是解决问题,除非你可能是世界上那18个可以整天冥想的人之一。我们大多数人都做不到。我们大多数人是以一种日常的方式使用正念,或者任何人使用它的方式。
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By the same token, the things that we think are always healthy, we should just do these things. They're not always efficacious. They don't always work. Great examples are something like mindfulness. Mindfulness is good stuff, there's no doubt about that. But mindfulness isn't always going to solve a problem unless you are maybe one of the 18 people in the world who can meditate all day long. Most of us can't do that. Most of us use mindfulness in a kind of a daily way or however anybody uses it.
这会有很大帮助,但它不能解决所有问题。社会支持是另一个例子。向他人寻求安慰和建议在许多情况下有帮助,但并非总是如此。它并不总是能为我们提供解决特定问题所需的东西。
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That's going to help a lot, but it's not gonna solve every problem. Social support is another one. Turning to other people for comfort and advice that helps in many situations, but it doesn't always help. It doesn't always give us what we need for a particular problem.
我之所以开始进行大量关于灵活性的研究,实际上是通过研究情绪抑制。当时我正在做关于抑制的研究。有很多人开始研究这种行为,但它已经形成了一种声誉,被认为是普遍不好的,普遍是适应不良的。但有很多轶事例子表明,抑制在某些情况下可以非常有适应性。
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The way I actually got into a lot of this flexibility research was by studying emotional suppression. I was doing research on suppression at the time. There were a lot of people beginning to study this behavior, but it had developed this kind of reputation as being uniformly bad, uniformly maladaptive. And there are plenty of anecdotal examples that show that suppression can be very adaptive in some situations.
例如,在我们的9/11研究中,带着年幼孩子的父母在访谈中告诉我们,他们当时必须真正地抑制自己正在经历的所有情绪,因为他们不想吓到自己的孩子。当你身处一个极具挑战性的情境中,比如战争,有时我们必须把自己的感受压抑起来,因为我们需要保持专注于我们正在做的事情。我们需要集中注意力。
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For example, in our 9/11 research parents who are with young children told us in interviews that they had to really suppress all the emotions they were experiencing at the moment 'cause they didn't wanna frighten their children. When you're in the midst of a tremendously challenging situation like a war, for example, there are times when we have to just simply bottle up whatever we're feeling because we need to remain focused on what we're doing. We need to concentrate.
甚至有一些关于抑制积极情绪的研究。有一些研究表明,获奖的人,赢得体育比赛的人,如果获胜者表现出太多的积极情绪,其他人实际上会不喜欢他们,因为他们觉得获胜者没有考虑到失败者,那些没有赢的人。所以在许多社交场合,许多危险的情况下,我们需要抑制我们感受到的情绪。
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There's some research even about suppressing positive emotions. There have been some studies where the people winning awards, people winning sporting events if the the winners show too much positive emotion, other people actually don't like them because they feel like they're being inconsiderate of the losers; the people who didn't win. So in many social situations, many dangerous situations where we need to suppress the emotions we feel.
当然,在其他情况下,这并不具有适应性,因为在其他情况下,我们需要那些信息。我们的情绪在告诉我们什么?所以,就像我们使用的每一种策略一样,它取决于情境,取决于我们在那一刻面临的挑战。所以,这通常归结为反复试验,尝试某件事,问自己,这有用吗?如果它有用,太好了,我们继续做。如果它没用,我们需要尝试别的东西。
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Of course, in other situations that's not adaptive because in other situations we need that information. What are our emotions telling us? So like every strategy we use, it depends on the situation, it depends on the challenge we're facing in that moment. So often this simply comes down to trial and error, and trying something, asking ourselves, is this working? And if it's working great, let's keep doing it. If it's not working, we need to try something else.
适应性灵活性、灵活性心态和灵活性序列这些概念,如果我们正在思考如何应对很久以前发生的事情,比如一个确实给我们造成了持久伤害并且仍在造成伤害的潜在创伤性事件,也可能是有用的。在这种情况下,我们必须专注于像处理当前事件一样使用它。
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Adaptive flexibility and the flexibility mindset, the flexibility sequence, these concepts can also be useful if we're thinking about how to cope with something that happened some time ago as say a a potentially traumatic event that did cause us lasting harm and is still causing us lasting harm. In this case, we though have to focus on using it the way we use it for current events.
所以,如果我们想到一个真正颠覆了我们生活、我们仍在挣扎的创伤性事件,我们倾向于以一种宽泛、笼统的方式思考那个事件。我被这个事件创伤了。它改变了我的生活。我再也不能出去了。我不再做我过去做的事情了。我的关系也因为这个不再那么好了,因为我处于一种破碎的状态。
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So if we think about a traumatic event that really did upend our life that we're still struggling with, we tend to think of that event and we will tend to think of that event in a sort of broad, generic way. I was traumatized by this event. It's changed my life. I can't go out anymore. I don't do the things I used to do. My relationships are not so good anymore because of this 'cause I'm kind of in this broken state.
这是一个无法一次性解决的问题。它太大了。但我们可以做的,就像处理我们生活中当前发生的任何事情一样,是遵循灵活性序列的步骤,从当下的问题出发来思考它,思考现在发生了什么?这个问题的哪一部分正在困扰我们,我们可以解决它?
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That's a problem that can't be solved in one go. It's too big of a problem. But what we can do, just like anything that's happening currently in our life, is we go through the steps of the sequence, the flexibility sequence, and think about it in terms of what's the problem in the moment, what's happening right now? What is a piece of this problem that's bothering us and that we can address?
我想起很久以前认识的一个人,他受到了创伤,以至于再也不出门了。他担心如果他出去,他会有闪回,会被压垮,会在公共场所陷入那种闪回、恐慌发作的状态。所以,问题就变成了:尽管我此刻感到非常脆弱、非常脆弱,我怎样才能走出去,进入这个世界?
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An example comes to mind of someone I knew long time ago who was traumatized to such a point that that person never went out anymore. They were worried that if they went out, they would have a flashback and be overwhelmed and be somewhere out in public in this sort of flashback, you know, panic attack state. So that became the problem. How can I go out into the world despite the fact that I am feeling quite vulnerable, quite fragile at the moment?
解决方案是首先识别那个问题,然后思考可能有助于解决那个特定问题的策略。这导致了一种逐渐的认识。那个人可以告诉朋友,他以前从未告诉过很多朋友他有创伤后应激障碍,他可以告诉朋友他有创伤后应激障碍,然后那些朋友就可以成为他的“安全屋”。所以那是一个步骤。试试看。效果如何?
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The solution was to first identify that problem, then to think about strategies that might help with that particular problem. And that led to a gradual kind of realization. That person could tell friends had never told a lot of friends that he had PTSD, he could tell friends he had PTSD and then those friends could be kind of safe houses for him. So that was a step. Try that out. How's that working?
然后,我们再次通过试错过程。让我们试着告诉一些朋友,我有创伤后应激障碍,然后试着出去,知道我们可以打电话给他们,他们同意了。如果我感到不安,就打电话给他们,这似乎效果很好。我前几天出去了,我试了这个,我感到有点不安。我打电话给我的朋友,我去了他那里。我没有闪回,我没有恐慌发作,但我能够感觉到如果需要,我可以去安全的地方。
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Then again, so we go through the trial and error process. Let's try telling some friends, I have PTSD and let's try then going out and knowing that we can call them, they agreed to this. That call them if I'm feeling upset, that seemed to work really well. I went out the other day, I tried this, I felt a little uneasy. I called my friend. I went over there. I didn't have a flashback, I didn't have a panic attack, but I was able to feel like I could go to safety if I needed it.
好的,那奏效了。让我们稍微扩大一下范围。那个人逐渐发展出一种重新回到世界的方式。这给了他更多对自己能在世界上做什么的信心,也让他能够处理问题的其他一些部分。所以他就是这样把它分解开来,一次解决一个,试图通过试错的方法找到解决方案,注意反馈。它奏效了吗?如果奏效了,太好了。如果没奏效,试试别的东西。这逐渐让他能够在自己的生活中给自己更多的自由。他有了解决问题各个部分的工具。
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Okay, that worked. Let's expand it a little bit. And that person gradually developed a way to get back out in the world. That gave him more confidence in what he could do out in the world that allowed him to deal with some other pieces of the problem. So he broke it down that way and took it one at a time, tried to find the solutions to the trial and error approach, paying attention to the feedback. Did it work? If it worked, great. If it didn't work, try something else. And that gradually allowed him to give himself more latitude in his life. He had tools to address the pieces of the problem.
我们可以用自言自语作为工具和提醒,来教我们如何在生活中运用灵活性的各个组成部分。自言自语是我们自然会做的事情。我们浓缩了我们脑海中正在发生的事情,而我们的思绪一直在运转,我们有时会把脑海中正在发生的事情浓缩成几句话。我们可能会大声说出来,也可能对自己说。
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We can use self-talk as both as a tool and a reminder for how to use the flexibility components in our lives. So self-talk is something we naturally do. We condense what's going on in our mind, and our minds running all the time, and we sometimes condense what's going on in our mind into a few sentences. We might say them aloud or we might say them to ourselves.
不幸的是,我们使用的很多自言自语都是负面的。我们可能会对自己说,“啊,笨蛋”或者类似的话。你为什么那么做?但它也可以被积极地使用。人们确实会自然地使用积极的自言自语。最经典的一个词是“是的”。是的。你在体育赛事中看到这个,你在其他场合也看到,人们参加考试或某些场合,这在许多不同的学科中都被利用了。
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Unfortunately, a lot of self-talk we use is negative. We might say to your ourselves, "ah, dummy" or something along those lines. Why did you do that? But it can also be used positively. And people do naturally use positive self-talk. The classic one word, "yes". Yes. You see this in sporting events, you see it in other contexts, people taking an exam or some context, and that has been harnessed in many different disciplines.
它在教育中被利用,在体育运动中被大量利用,在临床环境中也是如此。这是一种将我们的思想浓缩成短语的方式,然后我们可以用这些短语来提醒自己,并指导我们完成某些行为。所以对于灵活性心态,我们实际上可以制作一个包含这类短语的小图表。在我最近的书《创伤的终结》中,我在书的后面有一个这样的小图表,但它们都是些简单的事情。
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It's been harnessed in education. It's been harnessed to a great deal in sports and in clinical context as well. It's a way of condensing what we're thinking to phrases that we can use then to remind ourselves and guide us through some behavior. So for the flexibility mindset, we might actually make a little chart of these kinds of phrases. In my recent book, "The End of Trauma", I have a little chart of these phrases in the back, but there's simple things like
比如,对于灵活性心态,我们可以告诉自己一些事情,比如,一切都会好起来的;我有一些工具来处理这个问题。或者对于挑战评估,所以一切都会好起来,就是对此保持乐观。一切都会好起来的。未来会好的。应对的信心。那会是类似这样的话:我有一些工具。我知道如何应对。而挑战评估会是这样的话:好吧,这很糟糕。我不希望这发生。我需要做什么来度过难关?
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for the flexibility mindset, we can tell ourselves things like, it's gonna be okay; I have some tools to work with this. Or for challenge appraisals, so what's going to be okay would be being optimistic about it. It'll be okay. The future will be okay. Confidence in coping. That would be something along the lines of: I have some tools. I know how to cope. And challenge appraisal would be something like, okay, this sucks. I didn't want this to happen. What do I need to do to get through this?
对于灵活性序列,这些也相当简单。对于评估情境,我们可以对自己说,现在发生了什么?我需要做什么?这实际上相当有力量。我发现我在自己的生活中也用过这个,当我为某事挣扎并且有点困惑时。我感到不安,然后退后一秒,说,发生了什么?我在这里需要做什么?这真的帮助我们专注于问题的核心部分。我现在需要做什么?
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For the flexibility sequence, these are also quite simple for assessing the context. We can say to ourselves, what's happening now? What do I need to do? And that actually is quite powerful. I've found I've used this in my own life when I'm struggling with something and it's a little confusing. I'm feeling upset and then sort of take a second back and say, what's happening? What do I need to do here? And it really helps us focus in on a core piece of the problem. What is it that I need to do right now?
一旦我们做到了这一点,那么在策略库阶段,我们就可以说,那么我工具箱里有什么工具?我可以用什么样的事情来应对这个?这些都是简单的陈述,但它们有一种让我们思想集中的方式。当我们谈论灵活性序列时,这是一种对话。很多自言自语只是简单的陈述,比如,我会挺过去的,一切都会好的。
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Once we do that then the repertoire stage, we can just say, so what tools do I have in my toolbox? What kind of things can I use here to cope with this? These are simple statements, but they have a way of focusing our mind. And when we're talking about the flexibility sequence, this is a kind of a dialogue. A lot of self-talk are just simply statements like, I'll get through this, this'll be okay.
但是当我们谈论灵活性序列时,我们实际上是在问自己一个问题。我们正在与自己进行对话。这几乎就像我们自己在我们旁边的房间里,问我们这些问题。这既简单又容易,而且非常有效。
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But when we talk about the flexibility sequence, we're actually asking ourselves a question. We're having a dialogue with ourselves. It's almost like having ourselves in the room next to us, asking us these questions. And it's simple and easy and very effective.
有一个经常被用来总结我工作的短语,“你比你想象的更强大”。我对这个短语有点警惕,因为它带有推测性。我不知道任何人的想法,但我认为可以公平地说,现在有一种文化趋势,认为我们都非常脆弱。我认为这种情况越来越普遍。我不知道具体原因是什么。
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There's a phrase that is often used when my work is talked about, summarized as, "you are stronger than you think". I'm a little leery of that phrase because it's presumptive. I don't know what anybody thinks, but it is fair to say, I think there's a kind of a cultural trend toward thinking we're all pretty fragile right now. I think that's more and more been the case. And I don't know exactly why it all is.
这与互联网有关,它让我们关注世界现在是多么危险,多么有害,通过我们感知到的所有事物,因为这能吸引我们的注意力。但也有很多产业围绕着这个想法兴起,这个产业以我们是破碎和脆弱的想法为生。我认为这不是一个好趋势。而且我认为,正如我所说,灵活性的想法是对此的一种反击,因为它让我们重新掌握了主动权。
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It has something to do with the internet has got us focused on how dangerous, how harmful the world is right now by all the things that we perceive that we're fed because it gets our attention. But there's also a lot of industry that's sprung up around this idea, the industry that feeds off the idea that we are broken and fragile. And I think that's not a good trend. And I think, as I've said, the flexibility ideas are kind of a counter to that because it puts us back in the driver's seat.
但我认为,提醒我们自己实际上有多强大是件好事。有时,这个想法可能看起来很难让人接受,即你实际上可以度过难关,你比你此刻可能认为的更强大。但给自己一点宽容,让自己至少暂时接受那个信念,让自己深入挖掘,努力让自己的生活向前迈进,这真的很重要。
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But I think that it's good to remind ourselves of how strong we actually are. It can sometimes seem like a tough sell. This idea that you are, you can actually get through something. That you're stronger than you might think you are at the moment. But it's really important to cut yourself a little slack and to allow yourself to take on that belief for a little while at least to let yourself dig in and try to move forward with your life.
你可以提醒自己,你很强大。你也可以提醒自己,过去你所有坚强的时刻,你度过的所有难关。你知道,我喜欢做的一个小练习是,回想我自己的过去,当某件事真的让我很沮丧,让我觉得我的生活真的要走向黑暗,或者发生了什么坏事,然后我挺过来了。
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And you can remind yourself, both that you are strong. You can also remind yourself of all the times you've been strong in the past, all the things you've got to. You know, a little exercise that I like to do is to think back in my own life in the past when something had really upset me as something had led me to feel like my life was really going to take a dark turn or some bad thing had happened and then I got through it.
我多希望当时能有来自未来的人回来对我说,“嘿,你知道吗,你挺过来了,”就在我挣扎的时候。“你知道,你现在正在挣扎,但你实际上——我知道,我来自未来——你挺过来了,”但这很难。这是我们当时往往不相信的事情,我们倾向于觉得这种挣扎意味着我很软弱。
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And I would love if someone from the future could have come back to me then and said, "Hey, you know, you got through this," right when I was struggling with it. "You know, you're struggling now, "but you actually-I know I'm from the future. "You got through this," and it's hard. Something that we don't tend to believe at the time, we tend to feel like this struggle is means I am weak.
你知道,有一篇相关的文献,来自卡罗尔·德韦克(Carol Dweck)关于成长心态的精彩工作。这个想法是,如果我们认为我们身上的某种品质是固定的,那么我们倾向于放弃。如果看起来我们正在失败,那就意味着我们一定不好。如果它是固定的而我正在失败,那就意味着我一定不擅长这个。
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You know, there's a related literature from the wonderful work by Carol Dweck on growth mindset. And that's the idea that if we think that something is fixed, a quality in us is fixed, then we tend to give up. If it looks like we're failing, that means that we must not be good. If it's fixed and I'm failing, it means I must be bad at this.
但就像生活中的许多事情一样,灵活性是关于尝试,是关于使用技能和努力来度过难关。所以韧性不是固定的。韧性是一个结果,而灵活性的理念是介入,深入挖掘,努力度过难关。当我们这样做时,我们往往会度过难关。如果我们想,你知道,我做得不好,那就意味着我坏了。我们以那种态度是不会有任何进展的。我们能做的最好的事,就是给自己一个机会,相信我们会度过一个情境,而大多数时候我们会的。
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But like many things in life, flexibility is about trying, it's about using the skills and doing the work to get through something. So resilience is not fixed. Resilience is an outcome, and the idea with the flexibility is to get in there and dig in and work to get through something. And when we do that, more often than not, we do get through it. If we think, you know, I'm doing poorly, that means I'm broken. We are not going to get anywhere with that attitude. The best we can do is to just give ourselves the chance to believe we'll get through a situation, and most of the time we will.
第三章:创伤后应激障碍的历史
我们经常思考,现在的生活是否比过去更具创伤性,因为创伤这个概念现在如此普遍。我认为,要论证现在的生活比过去更具创伤性或更困难,会是一个很难赢得的论点。现在正在发生的一件事是,实际上比过去更多的是,对创伤的关注如此之多。
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We often think about whether life is more traumatic now than in the past because the idea of trauma is so ubiquitous now. I think it would be a hard argument to win to think that life is more traumatic now than in the past or more difficult. One of the things that's happening now is that more than in the past actually, is that there's so much of a focus on trauma.
我认为主要原因有几个不同的因素共同作用。一个是,我们的大脑在很大程度上被“设定”了,如果我可以用这个词的话。它们并不是真的被设定了,但它们在很大程度上被预设为会注意到危险和直接的威胁,因为从进化的角度来看,这完全合理。如果我们不小心,我们很快就会死亡。所以我们的大脑被设定为会检测环境中的那些危险。
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And I think the primary reason is there are a couple different factors that come together. One is that our brains are very much wired, if I can use that phrase. They're not really wired, but they're very much preset to pick up danger and immediate threat because for that makes perfect sense from an evolutionary perspective. We can dive very quickly if we're not careful. So our brains are set to detect those kind of dangers in our environment.
现在我们有了互联网,互联网已经从最初那个有趣的、旨在通过通信联合世界的想法,变成了一个巨大的赚钱机器。互联网上的钱,是关于抓住你的注意力。它能越多地抓住人们的注意力,就能产生越多的广告收入。现在就是这样运作的。每个人都知道这不是什么秘密。
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Now we have the internet, and the internet has become gone from this kind of interesting idea in the beginning to unite the world and communication. It's gone from that to an enormous moneymaking machine. And the money on the internet is about capturing your attention. The more it can capture people's attention, the more advertising revenues can be generated. And that's just how it works now. And everybody knows this is not a mystery.
所以,在这种背景下,用威胁性的东西,用关于危险的信息来吸引人们的注意力是很容易的。看看发生了什么。看看这里发生了什么。看看这些人,他们有多沮丧。看看这个人有多失常,多受损。所有这些东西都极大地吸引了我们的注意力。很难不去看那些东西,因为我们的大脑想知道。我们想知道危险在哪里。所以,这种情况比以往任何时候都多。
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So the more that- and in that context, it's easy to capture people's attention with threatening things, with information about dangers. Look at what happened. Look at what's happening here. Look at these people, how upset they are. Look at how unhinged, how damaged this person is. All of these things capture our attention big time. It's hard not to look at those things because our brains want to know. We want to know where the dangers are. So there's more, and more, and more of that than there's ever been before.
在TikTok这个社交媒体平台上,有一种现象叫做“创伤倾倒”。人们在TikTok上发布他们的创伤经历,然后有一些网站将这些内容聚集到一个地方,而这些网站的利润非常丰厚。所以,这种事情,你知道,末日刷屏,所有这些我们现在有的词,都是因为我们无法移开视线。
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On TikTok, which is everybody knows is a social media platform, there is something, a phenomenon called trauma dumping. People are posting their traumatic experiences on TikTok and then there are sites that are gathering those into one place and those are enormously profitable. So this kind of thing, you know, doom scrolling, all of these things, these words that we have now are because we can't look away.
所以在那种背景下,我们逐渐开始相信,无论我们是否意识到,我们现在看到的这个世界是一个越来越危险的地方。一个可能伤害我们的地方。我们开始将自己的失败视为所有这些伤害的结果。
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So in that context, we gradually come to believe whether we realize it or not, that we're now seeing the world as an increasingly dangerous place. A place that can harm us. And we begin to see our own failings as a result of all of this harm.
一个非常有趣的问题是,过去的创伤是什么样的?如果我们考虑到我们现在似乎更关注创伤,那么过去的人是不是没有那么多创伤?嗯,这很奇怪,因为如果我们回到过去,我们几乎看不到任何关于创伤的提及,关于创伤的症状,任何类似创伤后应激障碍的东西。当然,我们不会看到创伤后应激障碍这个概念,但真的没有任何提及人们受到创伤,做噩梦,被一个事件,一个潜在的创伤所伤害。
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A very interesting question is, what trauma was like in the past? If we think about the fact that we do seem to focus on trauma much more now, were people not traumatized in the past as much? Well, it's very curious because if we go back in time, we see hardly any references at all to trauma, to the symptoms of trauma that anything like PTSD, of course the concept of PTSD we wouldn't see, but there's really no mention really of people being traumatized, having nightmares and being harmed by an event, a potential trauma.
我们在历史文献中真的完全看不到这一点。而且,你知道,我们确实看到了大量关于悲伤的证据。我们可以一直追溯到荷马的《伊利亚特》和《奥德赛》。有很多关于士兵公开悲伤的提及。所以人们知道这一点。人们尊重这一点。所有那些血腥的战斗场面。在任何记载中,真的没有提及士兵有类似创伤后应激障碍的症状。也许这里那里有一点点暗示。
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We don't see that really at all in historical literature. And, you know, we do see plenty of evidence for grief. We can go all the way back to Homer, The Iliad and The Odyssey. There's plenty of mention of soldiers openly grieving. So people knew about that. People honored that. All those gory battle scenes. There's no mention of soldiers having PTSD like symptoms in any of the accounts, really. Maybe a little bit of a hint here and there.
当我们进入16世纪、17世纪,实际上有一些类似准记述的东西,但我们直到19世纪,直到19世纪末,才真正接触到任何关于心理创伤的全面提及。实际上是一位德国医生在19世纪末首次提到了它,称之为“创伤性神经症”。
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As we get into the 16th century, 17th century, there are actually some kind of quasi accounts, but we don't really get into any full blown mention of something like psychological trauma, until the 19th century. Until near the end of the 19th century, and it was actually a German physician who mentioned it for the first time right at the end of the 19th century called the traumatic neurosis.
然后我们当然进入了20世纪,我们有了第一次世界大战,我们现在开始,我们有了报纸,我们有了更多的文化传播,我们有了“炮弹休克”这个概念,它在第一次世界大战中流行起来。第一次世界大战是一场相当可怕的战争。现代武器已经发展到了一定程度,在某种意义上超越了战争战术,导致了大量的屠杀。
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Then we of course come into the 20th century and we have World War I and we're now beginning to, we have newspapers, we have much more cultural transmission, and we have the idea of shell shock that caught on in World War I and World War I was a pretty horrific war. Modern weaponry had advanced to the point where it, in a sense outpaced war tactics leading to a lot of carnage.
并不是说过去没有屠杀,但在第一次世界大战前后,我们开始思考这个叫做“炮弹休克”的概念。它并没有被普遍接受。事实上,许多人如果声称自己有炮弹休克,就会被认为是懦夫。在英国有一个著名的短语叫“黎明时分被枪决”,意思是如果一个士兵说他们不打了,或者因为有炮弹休克而不能回到前线,他们就会因为懦弱而被枪决。黎明时分被枪决。这种情况确实经常发生。
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Not that there wasn't carnage in the past, but in around the time of World War I, we began to think about this idea of something called shell shock. It wasn't universally accepted. In fact, many people were considered cowards if they claimed to have shell shock. And there was a famous phrase in England called, "shot at dawn", which meant that if a soldier had said they didn't, they weren't going to fight or they couldn't go back to the front because they had shell shock. They were shot for cowardness. Shot at dawn. And that really happened quite frequently.
然后有一段小小的平静期。众所周知,在20世纪的文学和事物中都有记载,一些士兵似乎被战争击垮了。然后第二次世界大战发生了,我们遇到了很多同样的情况,士兵们在心理上受到了困扰。但仍然不清楚。人们不清楚该怎么称呼那种情况。
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Then there was a little bit of a lull. It was well known. It's documented in literature and things in the 20th century that some soldiers seemed to be broken by the war. Then World War II happens and we had a lot of the same situation where soldiers were being psychologically disturbed. It still wasn't clear though. People were not clear what to call that.
这种情况直到1980年才真正改变,这是在越南战争的余波中。在那之前,早期的精神健康手册,如果它们谈到任何类似创伤的东西,它们并没有真正使用“创伤”这个词。它们更多地是从“那个人有问题”的角度来谈论它。那个人有弱点。他们有一些缺陷,让他们受到了创伤。
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That didn't really change until 1980, and this is in the aftermath of the Vietnam War. Up until that point, pretty much the early mental health manuals, if they talked about anything like trauma, they didn't really use the word trauma. And they talked about it more in terms of there's something wrong with that person. There's a weakness in that person. There some deficit in them that allowed them to be traumatized.
这种情况在1980年随着创伤后应激障碍的出现而改变。这很大程度上与越南战争有关,那是一场相当可怕的战争。战争通常都很可怕。越南战争是美国士兵在丛林中作战。所以是游击战。士兵们并没有真正为那做好准备。那是一场非常不受欢迎的战争。
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And that changed in 1980 with the advent of PTSD. A lot of it had to do with the Vietnam War where it was a pretty horrific war. Wars are generally horrific. The Vietnam War was US soldiers fighting in the jungle. So it was guerilla warfare. The soldiers were not really prepared for that. It was a very unpopular war.
当士兵们从那场战争中回家时,许多士兵为了应对那场战争而染上了毒瘾。当他们回家时,他们通常没有得到很好的对待,因为那场战争非常不受欢迎,尽管士兵们是被征召的。那是一场征兵制的战争。被征召的士兵基本上别无选择,要么去打仗,要么面临刑事指控,要么离开国家。
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When soldiers came home from that war, many soldiers developed drug addiction as a way to cope with that war. When they came home, they were not often treated very well because the war was very unpopular, even though soldiers were drafted. That was a war by draft. Soldiers who had been drafted basically had no choice but to go to the war or face criminal charges or leave the country.
所以那些士兵常常因为当过兵而受到严厉的指责,他们中的许多人自我用药。他们没有其他办法照顾自己,这导致许多治疗提供者最终在1980年将创伤后应激障碍指定为官方认可的障碍,这样他们才能真正治疗那些士兵。
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So those soldiers were often castigated for having been soldiers and many of them self-medicated. They had no other way to take care of themselves, and that led a lot of treatment providers. Finally, in 1980 to designate PTSD as an officially recognized disorder so they could actually treat those soldiers.
所以当我们思考这段历史,历史记录中创伤的缺失,这真的引出了一个问题,嗯,也许我们现在只是在编造它。我不认为那是真的,尤其是我作为治疗师与有创伤后应激障碍的人一起工作过,我很清楚有些人真的被创伤伤害了。那么,那里发生了什么?过去,人们没有受到创伤吗?
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So when we think about this history, the absence of trauma in the historical record, it really begs the question, well, maybe we're just making it up now. I don't think that's true, especially I've worked with people who have PTSD as a therapist and it's very clear to me some people really are harmed by trauma. So what's going on there? In the past, weren't people traumatized?
一个非常好的信息可以融入其中。有塞缪尔·佩皮斯的日记。塞缪尔·佩皮斯是17世纪的一位贵族。他是艾萨克·牛顿的同代人。他认识国王。我想那是英国的查理二世。佩皮斯是国王的核心圈子成员。
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A really nice piece of information to fit into that. There's a diaries of Samuel Pepys. Samuel Pepys was an aristocrat in the 17th century. He was a contemporary of Isaac Newton. He knew the king. I think that was Charles the 16th in England. And Pepys was in the inner circle of the king.
1666年伦敦大火发生时,那是一场可怕的火灾。伦敦的很大一部分在那场火灾中被烧毁。国王要求塞缪尔·佩皮斯四处评估损失并向他报告。所以佩皮斯看到了火灾的范围。他感受到了热量。他感觉自己的脚快要被鞋子烧穿了。他看到了可怕的火焰、浓烟和屠杀。他看到了整个过程。
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When the London fire happened in 1666, it was a horrific fire. Huge portion of London burned in that fire. The king asked Samuel Pepys to go around and assess the damage and report back to him. So Pepys saw the extent of it. He felt the heat. He felt like his feet were burning through his shoes. He saw horrific flames, and smoke, and carnage. He saw the whole thing.
这对他来说非常令人不安,也影响了他。现在,如果不是因为他写了大约10年的日记,我们可能不会真正了解佩皮斯。他把所有事情都写了下来。他毫无顾忌地写下了一切,很大程度上是因为他用一种他自己发明的密码写的,不是一个特别难的密码,但它是一个密码。他并不打算让任何人在他有生之年读到它。所以他觉得可以完全不受抑制、不经审查地说话。
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It was very disturbing to him and it effected him. Now, we wouldn't have really know about Pepys. It wasn't for the fact that he kept a diary for about 10 years. He wrote everything down. He wrote unabashedly, everything down and largely because he wrote it in a kind of a code he invented, not a tremendously difficult code, but it was a code. He didn't intend anybody to read it in his lifetime. So he felt free to speak completely uninhibited, uncensored.
他去世时,把他所有的书,包括那些日记,都留给了剑桥大学。大约一百年后,才有人仔细看了看它们,然后意识到里面有东西,并解码了它们,它们绝对引人入胜。它们就像窥探一个17世纪人的大脑,听他们说什么,他们如何体验世界。
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When he died, he left all his books, including those diaries to the University of Cambridge. And it was about a hundred years before anybody took a good look at them and then realized there was something there and decoded them, and they're absolutely fascinating. They're like looking into the brain of somebody in the 17th century and listening to what they say and how they experience the world.
佩皮斯谈到了那场火灾。他谈到了他对那场火灾的反应,以及他有多么困惑。几个月后,他开始做噩梦。我想大约六个月后,他在日记里写道,他无法理解为什么他因为害怕火而睡不着。害怕火,以及为什么他会做关于火的噩梦。
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And Pepys talked about that fire. He talked about his reactions to that fire and how confused he was. Months later, he was having nightmares. And I think about six months later, he wrote in his diary something to the effect that he could not understand why he couldn't sleep because of fear of the fire. Fear of fire, and why he was having nightmares about fire.
他基本上是在经历创伤后应激障碍的症状。而佩皮斯日记的有趣之处在于,他对那感到困惑。他不明白为什么他会有那些症状。现在,这是一个非常好的证据,但它只是一个证据。但它向我们表明,他正在经历真正的创伤症状,但这些症状是如此地不为人知、不为人所知,以至于他不明白那是什么,以及为什么他会有这些症状。
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He was basically having PTSD symptoms. And what's interesting about these Pepys diaries is he was confused by that. He didn't understand why he was having those symptoms. Now this is one very nice piece of evidence, but it's only one piece of evidence. But it suggests to us that he was having genuine trauma symptoms, but they were so unspoken about, unknown, that he didn't understand what it was and why it was having them.
我认为这可能是我们思考这个问题的一个更好的方式,即人们确实有创伤症状,但它们只是那种没人谈论、没人真正承认的事情。
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And I think that's probably a better way that we can think about this, that people did have trauma symptoms, but they were just kind of this thing that nobody talked about and nobody really acknowledged.
第四章:悲伤心理学
当我完成博士学位时,我希望稍微改变一下方向。我一直在研究实验临床心理学,我想变得更广泛一些,更多地进入人们日常生活的领域。我在旧金山加利福尼亚大学旧金山分校获得了一个研究丧亲之痛的职位。
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When I finished my PhD, I was looking to change directions a bit. I had been studying experimental clinical psychology and I wanted to get a little bit broader, more in the realm of what people do in their daily lives. And I was offered a position in San Francisco at the University of California in San Francisco studying bereavement. Now, I knew almost nothing about bereavement at the time, and, frankly, I wasn't interested.
当时,我几乎对丧亲之痛一无所知,坦白说,我也不感兴趣。所以我考虑了一下,查阅了相关文献,当我查阅文献时,我有点惊讶。我真的很惊讶。文献太陈旧了。它看起来像19世纪的文献。假设是每个人都会悲伤,这对每个人来说都是一件可怕的事情。几乎每个人都需要临床帮助。
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So I thought about this a bit, looked into the literature, and when I looked into the literature, I was kind of surprised. I was actually amazed. The literature was so antiquated. It looked like a literature from the 19th century. The assumption was everybody grieves, and it's a horrible thing for everybody. Everybody needs clinical help- just about everybody.
所以我认为这非常有趣。当我看到正在使用的方法时,我意识到这些也不是很现代的方法。所以我接受了旧金山的这个职位,我有很多资源可以用来研究人们如何应对配偶的死亡。我们所做的,与其说是革命性的,不如说在某种程度上是常识。
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So I thought this was very intriguing. When I looked at the methods being used, I realized these were also not very modern methods. So I took this position in San Francisco and I had a lot of resources at my disposal to study how people cope with the death of a spouse. What we did was not so much revolutionary as just common sense in a sense.
我使用了我学到的技术,我使用了我学到的研究方法,而不是获取一个临床样本,即寻求治疗的人,我们获取了一个广泛的人群,字面上是任何在那个时间点几个月内失去配偶的人,我们用我提到的技术研究他们。我学会了编码他们的面部表情,让人们通过连接着心理生理学仪器的实验,转录他们说的话,做文本分析,长期跟踪人们。
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I used the techniques I've learned, I used the research methods I've learned instead of getting a clinical sample, people looking for treatment, we got a broad range of people, literally anybody who lost a spouse within a few months of that time, and we studied them using the techniques, as it mentioned. I learned like coding their facial expressions, running people through experiments with psychophysiology attached, transcribing what they said and doing text analysis following people over time.
几乎立刻,我们就看到大多数人应对得非常好。大多数人对丧失表现出韧性。我实际上没有预料到这一点,但这算是一个有趣的惊喜。然后我们做了另一项研究,发现了同样的事情。这基本上开启了我整个研究生涯,我们最终扩展到研究创伤,并且在接下来的30年里,我们一直在使用许多相同的技术。基本上,我们发现大多数人是有韧性的。
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And almost immediately we saw that most people were coping really well. The majority of people were resilient to loss. I wasn't actually expecting that, but that was kind of an interesting surprise. We then did another study and found the same thing. And that led to, basically, my entire research career, we broadened into studying trauma eventually, and we've been using a lot of those same techniques for the next 30 years. And, basically, finding that most people are resilient.
有时我称亲人的死亡为潜在的创伤性事件,仅仅是因为这个词允许一种更广泛的包容性,但悲伤和创伤确实非常不同。它们是不同类型的事件,它们导致非常不同的反应,非常不同的大脑活动,以及我们方面非常不同的长期过程。
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Sometimes I have called the death of a loved one, a potentially traumatic event, simply because that term allows for a kind of a broader inclusiveness, but grief and trauma are really very different. They are different kinds of events and they result in very different reactions, very different brain activity, very different longer term processes on our part.
一个潜在的创伤性事件是一个强烈的、危及生命的事件,它会开启各种紧急反应,并在某种程度上迫使我们重新思考生命是什么。亲人的死亡则做了非常不同的事情。亲人的死亡告诉我们的大脑,我们认为的世界,就他人而言,已经不正确了。
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A potentially traumatic event is an intense life-threatening event that turns on all kinds of emergency reactions, and that in a way forces us to rethink what life is a little bit. The death of a loved one does something very different. The death of a loved one tells our brain that what we think is the world is like in terms of other people, isn't correct anymore.
它还引入了一个存在主义的威胁,一个巨大的存在主义威胁。因为大多数时候,正如佛教徒所说,“生命是无常的”,你知道,我们不是活着的——我们只活一定的时间,这是一个我们通常不会放在意识里的事实。而当一个亲人去世时,它就摆在我们面前。我认识的那个人不再存在了。
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It also introduces an existential threat, a big existential threat. 'cause most of the time, as the Buddhists say, "Life is impermanent," you know, we don't live- we live only a certain period of time, and that's a fact that we just don't keep in our awareness very much. And when a loved one dies, it's staring us in the face. That person that I knew doesn't exist anymore.
所以这些都是非常具有挑战性的事件。这些丧亲事件非常具有挑战性。大多数人随着时间的推移都能很好地应对它们,就像其他任何事情一样,但它们仍然需要我们去度过。
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So these are very challenging events. These bereavement events are very challenging. Most people cope well with them over time like anything else, but they still require us to get through them.
当我们失去一个亲人时,发生的一件事是我们变得非常悲伤。而悲伤是高度功能性的。所有的情绪都是功能性的。它们做某件事。我们进化出情绪是有原因的,因为它们做某件事。悲伤的作用是,它将我们的注意力转向内心。与创伤相反,创伤中有一种唤醒的增加,我们处于紧张状态。
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One of the things that happens when we lose a loved one is we become very sad. And sadness is highly functional. All emotions are functional. They do something. We've evolved emotions for a reason as they do something. And what sadness does is it turns our attention inward. In contrast to trauma where there's a uptick in arousal, we're on edge.
当我们失去一个亲人时,我们的系统会慢下来。我们的心率实际上会下降。我们有点——世界慢下来了,我们从世界中退缩,更深地进入我们自己的头脑,恕我直言。这种情况发生的原因是,以及它之所以具有适应性的原因是,当我们依恋某人,任何人,当我说依恋时,我指的是最普遍的意义,即人们已经成为我们的一部分。
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When we lose a loved one, our system slows down. We actually have a decrease in heart rate. We kind of- the world slows down and we withdraw from the world some deeper into our own heads, for lack of a better word. The reason that happens is, and the reason that that's adaptive is because when we're attached to someone, anyone, and when I say attached, I mean it in the most common sense way that people have become a part of who we are.
他们在我们的脑海里。我们不在他们身边时会想到他们,他们成为我们身份的一部分,与这个人的关系。我们深深依恋的人常常不在我们此刻的生活中。生活就是这样。他们白天在别处,或者别的什么,但他们在我们的脑海里。
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They're in our minds. We think of those people when they're not there, and they become a little bit of a part of our identity, this relationship with this person. The people that we're deeply attached to are often not in our life at the moment. That's just the way life works. They're off somewhere else during the day or whatever, but they're in our minds.
当那个人去世时,我们的大脑完全被那搞糊涂了。我们的大脑不知道该如何处理那个信息,因为我们的大脑不是一个生命体。它是我们头脑里的一个器官。我们才是生命体。所以大脑需要重新校准。它需要想出一种思考世界的方式,即那个人不再活着,不再以肉体形式活着,但他们仍然可以在我们的脑海里。
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When that person dies, our brain is completely confused by that. Our brain doesn't know what to do with that information 'cause our brain is not a being. It's an organ inside our head. We are the being. So the brain needs to recalibrate. It needs to come up with a way of thinking of the world where that person is no longer living and no longer living in the fresh, but they can still be in our mind.
在旧的弗洛伊德概念中,这有点像一个问题,我想弗洛伊德用了“decathecting”(脱离情感投注)这个词,我从未完全理解那是什么意思,但它的意思有点像打破与那个人的联系。所以你不再悲伤,但我不认为我们实际上是那样做的。我们做的是,我们仍然可以在我们的脑海里依恋某人。我们仍然可以对某人有巨大的爱和感情,并希望我们能和他们在一起,但我们必须意识到他们已经死了。
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In the old Freudian concept, it was a kind of a question of, I think Freud used the word decathecting, I never fully understood what that meant, but it means to something along the lines of sort of breaking the bond with that person. So you're no longer grieving, but I don't think that's actually what we do. What we do is, we can still be attached to somebody in our minds. We can still have tremendous love and affection for somebody and wish we could be with them, but we have to realize that they're dead.
这相当困难,非常困难;我们逐渐接受它,这个新信息。有一个非常普遍的观念,主导了很多人对悲伤的看法,那就是所谓的五个阶段:否认、愤怒、讨价还价、抑郁和接受。这个观念是,我们按顺序经历这五个阶段,直到我们完成了悲伤的过程。
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It's quite difficult, very difficult; and we're gradually come into terms with it, this new information. There's a very prevalent idea that is dominated the way a lot of people thought about grief is the so-called five stages: denial, anger, bargaining, depression, and acceptance. And this idea was that we go through these five stages in sequence until we are then done with the grieving process.
不幸的是,真的没有证据。从来没有证据表明我们是这样悲伤的。当我们观察人们在做什么时,我们看不到这一点,当我们观察有韧性的人时,例如,大多数丧亲者都表现出这种韧性轨迹。他们很早就已经基本上在运作和前进了。他们似乎不太可能为了度过难关而做了一种打了类固醇的五个阶段。
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Unfortunately, there's really no evidence. There never has been that this is how we grieve. We don't see this when we look at what people are doing, when we look at resilient people, for example, that most bereaved people show this resilient trajectory. They're already basically functioning and moving on very early on. It seems highly unlikely that they did a kind of a five stages on steroids in order to get through.
他们可能只是经历了一个不同的过程。我们看到一个比大多数人经历的更不同、更具特质的过程。它非常个人化。它不是那么整洁。事实上,这五个阶段最初是在库伯勒-罗斯关于人们如何面对自己死亡的研究中提出的。对此也没有研究,原因很明显。研究人们面对自己死亡会相当困难。
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They probably just, they go through a different process. And we see a much different, much more idiosyncratic process than most people go through. It's very personal. It's not so neat and tidy. In fact, the five stages were originally formulated for in the Kubler-Ross's work on how people face their own death. And there's no research on that either, for obvious reasons. It'd be pretty hard to research people facing their own death.
但她根据她与面临自己死亡的人的临床工作,提出了那些阶段。然后另一组研究人员将那些阶段强加于丧亲之痛。所以她实际上并没有提出那些作为人们悲伤的方式。但不知何故,那成了大多数人现在思考丧失的方式。这是一个非常危险的想法。
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But she had proposed that as what based on her clinical work with people facing their own death, she had proposed those stages. And then another group of investigators foisted those stages onto bereavement. So she actually didn't propose those as the way people grieve. But somehow that became the way that most people now think of loss. It's a very dangerous idea.
它可能对一些人有帮助,因为我们确实喜欢有一个路线图。我们确实喜欢有可预测的东西。但问题是,很多人会因为他们似乎没有经历那些阶段而感到非常沮丧。或者他们生活中的其他人会告诉他们,你知道,你这样做不对,因为你现在不应该已经感觉好起来了,因为你还没有经历这个阶段。你还没有经历这个抑郁阶段或者这个否认阶段。所以你将来会有麻烦。所以这可能真的很有问题。
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It may be helpful to some people because we do like having a roadmap. We do like having something predictable. But the problem is that a lot of people will be very upset that they don't, they don't seem to be going through those stages. Or other people in their life will tell them, you know, you're not doing this right because you shouldn't be already feeling good right now because you haven't gone through this stage yet. You haven't gone through this depression stage or this denial stage. So you're going to be in trouble in the future. So it can be really problematic.
实际上,一个精彩的,虽然悲伤但精彩的例子来自脊髓损伤的文献。我做了一些关于脊髓损伤的研究,并查阅了那方面的文献,因为像往常一样,我们发现大多数人是有韧性的。遭受脊髓损伤,身体功能永久丧失的人,也表现出同样的韧性模式,即使他们在医院里。事件发生后不久,他们就会随着时间的推移表现出同样健康的心理功能。
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Actually, a wonderful, sad but wonderful example of this comes from the spinal cord injury literature. I did some research on spinal cord injury and looking at that literature because as usual, we found that most people are resilient. And people who suffer spinal cord injuries, permanent loss of bodily functioning, also show the same resilient pattern even when they're in the hospital. Soon after the event, they'll show that same healthy psychological functioning across time.
为了理解这一切,我查阅了脊髓损伤的文献。我找到了一本1960年代的书,当时那方面的文献刚刚开始兴起。那本书中的一章认为,如果一个脊髓损伤的病人不抑郁,他的医生应该让他抑郁,这样他才能经历走向康复的各个阶段。这是一个有点奇怪的想法。
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In trying to understand all that, I looked to the spinal cord injury literature. And I found a book from the 1960s when that literature was just beginning to take off. And one of the chapters in that book argue that if a spinal cord injury patient isn't depressed, their doctor should make them depressed so that they can go through the stages toward recovery. And that's a kind of a bizarre idea.
丧亲者报告的一个常见现象是,他们有这些类似幻觉的经历。他们以为在公共场合看到了某人,一个路过的人长得像他们,你发誓他们就在那里。他们在这里做什么?他们已经死了。或者人们报告,你知道,在家里,然后他们可能会听到走廊里钥匙叮当作响,如果他们住在公寓楼里,以为是他们的伴侣回家了,结果才意识到那是别人的钥匙。
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A common thing that bereaved people report is that they have these quasi hallucinations. They think they see somebody in public, a person passes by that looks like them, and you swear that there they are right there. What are they doing here? They're dead. Or people report, you know, being home, and then they might hear keys jingling in the hallway if they live in an apartment building and thinking their partners coming home only to realize that that's somebody else's keys.
那种类似幻觉的经历,是因为大脑仍然在假设他们还活着的运作。大脑是一个预测机器。大脑不断地试图预测生活是什么。接下来会发生什么?它需要经历这个过程,我们逐渐重新校准,重新配置一个没有那个人活着的世界,这需要时间。
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Those kind of quasi hallucinations. 'cause the brain is still operating on the assumption that they're still alive. The brain is a prediction machine. The brain is constantly trying to predict what life is. What will happen next? And it needs to go through this process where we gradually recalibrate, reconfigure the world without that person living, and it takes time.
所以我们深入内心。我们试图思考那个人是谁?我能以什么方式继承下去?所以这实际上是我们做的有趣的事情之一,就是我们有点像浓缩了我们对那个人的了解,在他的一生中,浓缩成一种我们可以随身携带的形式,几乎就像我们有某种有形的东西,这就是那个人。这就是他的一生。这就是我与他的关系。
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So we go deep into ourselves. We're trying to think through who was that person? What can I carry forward in a way? So this is actually one of the interesting things that we do, is that we kind of condense what we knew of the person in their life into a form that we can take with us almost as if we had something tangible that this is the person. This is their life. This is the relationship I had with them.
我们这样做的时候非常慷慨。我们倾向于在这里稍微理想化一下。不是很多,但有一点点。我们磨平了棱角。我们不一定会忘记一个人做过的一些负面的事情,但,有时有很多负面的事情我们必须面对,但我们倾向于磨平或者给他们一点宽容。
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We're very generous when we do that. We tend to idealize a little bit here. Not a tremendous amount, but a little bit. We round off the rough spots. We don't necessarily forget some of the negative things that a person did, but, and sometimes there are a lot of negative things we have to contend with, but we tend to round off or we give them a little slack.
我们在哀悼仪式中也这样做。哀悼仪式有趣地围绕着我们实际上必须经历的心理过程。所以在哀悼仪式中,人们讲述关于逝者的故事。他们讲述关于他们认识的那个人的故事。那些故事起着完全相同的作用。它们是愉快的。它们磨平了棱角,并将它浓缩成这些记忆,然后我们可以带着这个理想化的版本前进。
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We do this in mourning ceremonies as well. Mourning ceremonies are interestingly oriented around the very psychological processes that we actually have to go through. So in morning ceremonies, people tell stories about the person that's deceased. They tell stories about the person that they knew. And those stories serve the exact same function. They're pleasant. They round off the rough spots and they condense it down into these memories, and we can then carry that forward, this idealized version.
悲伤的有趣之处在于,它在人们悲伤时如此普遍,而且它是功能性的,它做了它需要做的事情。它在我们转向内心时帮助我们。但当我们转向内心时,我们是脆弱的,因为我们没有注意周围的世界。现在,如果我们在自己家里,这没问题,当然危险在于我们会停留在我们的内心世界到一定程度,以至于我们开始反复思考,这实际上可能导致更糟的结果。
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The interesting thing about sadness, it's so ubiquitous when people are grieving and it's functional, it does what it needs to do. It helps us when we turn inward. But when we turn inward, we're vulnerable because we're not paying attention to the world around us. Now, this is fine if we're in our own home, of course the danger is that we'll stay in our internal world to such an extent that we begin to ruminate and that actually can lead to a worse outcome.
但在现代世界里,这也同样危险,仅仅因为我们没有集中注意力。可能是在开车时没有集中注意力,或者在地铁里没有集中注意力。走在街上,任何数量的事情,做饭时沉浸在悲伤中而忘记了它。把炉子上的火开着。所有这些事情都相当危险。
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But it's also dangerous in the modern world simply 'cause we're not paying attention. It might be driving a car and not paying attention or in the subway and not paying attention. Walking down the street, any number of things, making a meal and getting lost in sadness and forgetting about it. Leaving a burner on the stove. All those things are quite dangerous.
在我们进化的过去,这要危险得多,因为有捕食者,还有许多其他人们必须应对的危险。所以我们似乎进化出了一种振荡式的悲伤方式。我们向内走,我们做这种悲伤的、深度的内心反思,然后我们再出来。我们再次关注我们周围的世界。我们关注我们周围的人,然后我们可能再回去。
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In our evolutionary past, it was much more dangerous because there were predators and there were lots of other dangers that people had to contend with. So we've seemed to have evolved a kind of an oscillatory way of grieving. We go inward, we do this sad, deep kind of internal reflection and then we come back out. We attend to the world around us again. We attend to the people around us and then we might go back in.
所以我们在这些阶段之间进进出出,专注于我们周围的世界和深深地向内转。这似乎是一种更具适应性的方式。我们在自己的研究中看到了这一点,当我们研究笑声和微笑时。嗯,事实证明,大多数丧亲者会表现出真正的笑声和微笑,即使他们正在挣扎,即使他们几分钟前还在哭。
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So we go in and out of these phases of, of focusing on the world around us and turning deeply inward. And that seems to be a much more adaptive way. We've seen this in our own research when we studied laughter and smiling. Well, it turns out that most bereaved people will show genuine laughter and smiling even when they're struggling, even when they were crying moments ago.
我们可以在我们的研究中通过编码面部的肌肉来做到这一点。我们在面部看到某些肌肉反应,这些反应表明了真正的积极情绪。当人们真诚地微笑和真诚地大笑时,我们看到它们。我们发现,在我们做的访谈中,人们可能正在谈论丧失和哭泣,他们的脸因痛苦而扭曲。
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We can do this in our research by coding the muscles in the face. And there's certain muscle reactions that we see in the face that are indicative of genuine positive emotion. We see them when people smile genuinely and when they laugh genuinely. And what we found is in interviews we've done, is that people might be talking about the loss and crying and their face is just contorted in pain.
几秒钟后,他们想到了一个有趣的故事,他们在讲故事时真的在笑,眼泪还在脸上流淌。他们可能会在那种状态下待三四分钟,然后他们会回到这种深度的内心状态。这是一种转向内心和转向外在。但笑声部分也是因为他们正在与周围的人进行社交联系。
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And then seconds later they're thinking of a funny story and they're actually laughing as they're telling the story, and they're still tears running down their face. And they might be in that state for three or four minutes and then they'll go back into this deep internal state. And this is a kind of a turning in and turning out. But the laughter part's also because they're connecting socially with the people that are around.
这是生活中非常重要的一部分,也是丧亲之痛中非常重要的一部分,因为我们需要其他人来帮助我们度过丧失。当我们重新与他们联系并笑的时候,笑声是会传染的。这几乎是一种给予人们东西的方式。你知道,你在照顾我,但我要和你一起笑一会儿,这让其他人感觉很好。然后我们再回去。我们在研究中多次看到这种情况,它真的似乎是我们拥有的应对生活的神奇工具集的一部分。
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And that's very important part of life is a very important part of bereavement because we need other people to help us through loss. And when we connect back with them and we laugh, laughter's contagious. It's a way of almost giving people something. You know, you're taking care of me, but I'm going to smile and laugh with you for a little bit and that makes other people feel good. And then we'll go back in. And then we've seen this many times in the research and it really seems to be again, part of the marvelous set of tools we have to cope with life.
我们有时在丧亲期间会看到愤怒。我们在丧亲期间会看到许多其他情绪。愤怒,像许多负面情绪一样,在特定的情境和特定的背景下非常有用。当丧亲期间发生愤怒时,通常是我们觉得我们正在经历的这种痛苦在某种程度上是某人的错。那可能是医疗机构。也可能是我们自己。
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We sometimes see anger during bereavement. We see lots of other emotions during bereavement. Anger is, like a lot of negative emotions, it's very useful in specific situations and specific contexts. When anger happens during bereavement, it's usually when we feel like this pain we're experiencing is in some way somebody's fault. That could be the medical establishment. It could be ourselves.
我们可以对自己生气,因为我们认为自己没有做一些本可以做的事情。人们有时会对死去的人生气,因为他们没有做那些能帮助他们生存的事情。这在一定程度上有用,因为它符合情境。如果有一个时候我们需要简单地把那件事说出来,如果你愿意的话,或者,你知道,那些是我们正在有的想法,我们想表达那些想法,那就是愤怒可以有用的时候。
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We can be angry at ourselves for we perceive not doing something we could have done. People are sometimes angry with the person that died for not doing the thing that would've helped them survive. That's useful to a point, again, as it fits the situation. If there's a time when we need this to simply sort of get that off our chest, if you will, or, you know, those are thoughts we're having, we want to express those thoughts, that's when the anger can be useful.
如果我们做得太多,如果我们一直这样做,它就会变得适应不良。就像关于灵活性的更广泛的想法中的任何其他事情一样。我们做得太多的任何事情都是适应不良的,因为我们没有注意情境。所以一些愤怒是有用的。很多愤怒是没用的。
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It becomes maladaptive if we do it a lot, if we do it all the time. Just like anything else in the broader idea about flexibility. Anything that we do too often is maladaptive 'cause we're not paying attention to the situation. So some anger is useful. A lot of anger is not useful.
有些人经历了亲人的死亡,却无法走出那份失落。他们继续受苦。他们甚至多年来都感到剧烈的痛苦,那是非常痛苦的。那非常不愉快。在许多方面都是悲剧性的。他们失去的人已经不在我们身边,而他们无法在生活中前进。
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There are some people who endure the death of a loved one who are not able to get over that loss. They continue to suffer. They continue to feel intense pain for years even, and that's horribly painful. It's horribly unpleasant. It's tragic in many ways. The person that they've lost is no longer with us and they can't move on in their life.
关于如何帮助处于那种情况的人,有很多不同的想法。有一些人们谈论过的工具和技术。其中之一实际上是与逝者进行对话,谈论他们认为发生了什么,他们认为他们的生活是什么样的,等等,那可能会让他们感到联系。也可能帮助他们把感受说出来,你知道,也许是对那个人的愤怒,或者对他们做过或没做过的事情的内疚。
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There are lots of different ideas about what can be done to help people in that situation. There are some tools and techniques people have talked about. One is actually having conversations with the deceased person and talking through what it is they think happened and what it is they think their life like, etcetera, that might make them feel connected. It might also help allow them to get feelings off their chest that, you know, maybe anger at that person or guilt at something they did or something they didn't do.
还有,走出去,进入世界,这是非常重要的。即使我们不想走出去,我们也真的需要走出去。有时仅仅是锻炼就非常重要,因为它帮助我们更好地运作,帮助我们感觉更有活力。我们有时需要回顾那个人在我们生活中的意义。如果我们高度依赖他们来处理我们生活的某个部分,那会非常困难。
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There is also, it is very important to get out into the world. Even if we don't feel like getting out in the world, we really need to get out in the world. Sometimes just exercising is very important because it helps us function better, helps us feel more alive. We sometimes need to review what that person meant in our life. If we were highly dependent on them for a certain part of our life that's very difficult.
但那样的话,我们就需要找到一种方法,在他们缺席的情况下,发展我们自己生活的那一部分。另一个重要部分,实际上是许多成功的悲伤治疗的一个组成部分,是思考我们如何概念化这个损失。我们如何解释它?而且,我不想用这个词,但通常人们有通常被称为“功能失调的信念”。
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But then we need to find a way to develop that own part of our life in their absence. Another big part of it, which is actually a component of a lot of treatments, successful treatments for grief is to think about how we're conceptualizing the loss. How are we explaining it? And often, I hate to use this word, but often people have what are typically called dysfunctional beliefs.
它们通常是错误的信念,认为我们以某种方式导致了死亡,或者我们做得不够,或者不知何故,那个人死时对我们生气,或者我们可能告诉自己的任何事情。有一些现有的治疗方法,实际上已经证明相当有效。其中许多使用认知行为疗法的组成部分,这些疗法关注这个核心部分,我们如何理解损失,以及我们如何理解损失实际上驱动了我们如何对它做出反应。
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They're often erroneous beliefs that somehow we caused the death or somehow we didn't do enough, or somehow, you know, the person died angry at us or whatever we may be telling ourselves. There are a number of existing treatments that actually have proven quite efficacious. Many of them use cognitive behavioral components, which focus on this core part, how we understand the loss and how we understand the loss actually drives how we react to it.
所以要解决那一部分,另一个相关的部分实际上涉及暴露。这意味着从头到尾谈论损失。导致它的事情,发生了什么,以及你如何反应。那一次性的过程。因为,有趣的是,当我们对一个事件感到非常痛苦,当我们对一个事件感到非常困扰时,我们倾向于不把它看作一个整体。
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So getting at that piece of it, another related part is actually involves exposure. And that means talking about the loss from beginning to end. The leading up to it, what happened, and how you reacted. That one stretch. 'Cause, interestingly, when we are really distressed by an event, when we're really disturbed by an event, we tend not to think of it as a whole piece.
我们倾向于把它看作零碎的片段,脑海中浮现的图像。不愉快的图像,某人说的话,我们说的话,一个视觉图像,一个声音。那些发生时,我们马上想把它们推开,因为它们太痛苦,太不愉快了,我们不去追寻整个故事。现在治疗做的一件事是,它们要求人们从头到尾讲述整个故事。
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We tend to think of it in little bits and pieces, images that come to mind. Unpleasant images, something somebody said, something we said, a visual image, a sound. Those happen and we right away wanna push them away 'cause they're so painful and so unpleasant, and we don't pursue the entire story. One of the things that treatments do now is they ask people to tell the whole story from beginning to end.
当你讲述那个故事时,一个失去亲人、正在挣扎的人,从头到尾对另一个人,尤其是一个我们认为是专家的人讲述,我们有点像把它摆在那里。这就是实际发生的事情。这有助于我们,有趣的是,它有助于我们理解我们是如何思考那个事件的,以及我们如何将自己置于那个故事中,通常是以一些真正没有根据的方式。比如事情通常不是一个人的错。
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When you're telling that story, a person who's lost a loved one, who's struggling from beginning to end to another person, especially a person that we assume is an expert, we're kind of laying it out there. This is what actually happened. And that helps us, interestingly, it helps us understand how we are thinking about that event and how we're placing ourselves in that story often in ways that are really not founded. Like things are usually not a person's fault.
现在,我认为重要的一件事是这个“持续的纽带”的想法,因为我们确实与某人有持续的纽带,而当人们无法走出失落时,经常使用的一个词是“渴望”。有一种感觉,我想要这个人回来,我希望他们活着,那是痛苦的。那是我们在失落初期经常经历的。
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Now, one of the things I think is important is this idea of continuing bonds because we do have a continuing bond with someone, and one of the terms of when people can't get over lost, it's often used as yearning. There's this sort of sense of I want this person back, I want them to be alive and that is painful. That's what we experience a lot in the beginning of a loss.
但我们必须有点超越那个,因为他们不会回来了。我们可以继续拥有那个纽带,但它转变成与一个不再活着,但在我们脑海里的人的纽带。我个人对在我的脑海里与死去的人有纽带感到非常自在。我不知道人死后会发生什么。我认为没人知道。如果我们知道就好了,但我们不知道。
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But we have to kind of move beyond that because they're not coming back. We can continue to have that bond, but it transforms into a bond with the person who is no longer alive, but is in our minds. And I'm personally very comfortable with having bonds with people that are dead in my mind. I don't know what happens when people die. I don't think anybody does. It'd be nice if we knew, but we don't.
我们真的不能说。所以我们有点可以随心所欲地做,抱着那个人可能在某个地方,我们在和他们说话,或者我们不知道的想法。我们可以做的一件事是,实际上给人们写信,和他们交谈。我和我父亲的关系非常复杂。他去世后,我继续在我的脑海里和他交谈,实际上比他去世前10年多得多,因为我不在他身边。
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We really can't say. So we're kind of free to do it as we wish with the idea that the person may be somewhere we're talking to them or we don't know. And one of the things we can do is actually write letters to people, have conversations with them. I had a very complicated relationship with my father. When he died, I continued to have conversations with him in my mind, actually a lot more than I did in the 10 years before he died 'cause I wasn't around him.
但我用那些对话来和他谈论过去。谈论那些困扰我的事情,真的很有帮助。谈论那些我可能误解或理解的事情。也请求他做一些作为父亲,如果他还活着,我会想问他的事情。
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But I used those conversations to actually talk about the past with him. And it was kind of really helpful to talk about the things that bothered me. To talk about the things that I may have been misunderstanding or understanding. And to also ask for him to do the things as a father that I would've liked to ask him if he were still alive.
例如,当我有了自己的孩子时,我有很多关于做父亲是什么样的问题。我问我的父亲,就好像他还活着一样,那让你能够继续那段关系,完全意识到那个人已经不在这个世界上了。现在,我在我的——我住在一栋纽约的楼里。我在电梯里做这个。那是个老电梯。我故意在电梯里做,因为门真的很慢。
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For example, when I had my own children, I had a lot of questions about what being a father is like. And I asked my father, as if he were alive, that allows you to continue that relationship fully aware that the person no longer lives in the world. Now I did this in my- I live in a New York building. I did this in the elevator. It's an old elevator. I did it in the elevator, purposefully, because the door is really slow.
所以当电梯停下时,我知道门会打开,我就可以停止对着空气说话了。所以做这些事情有点奇怪,很多人可能会觉得不舒服,但这是我们能感受到一个人存在的很好的方式之一。我们也可以思考那个人的生命对我们意味着什么。他们会希望什么?如果他们继续活着,什么会让他们开心?
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So when the elevator stopped, I knew the door was going to open and I could stop talking to the air. So it's a little odd to be doing these things and many people might feel uncomfortable with it, but it is one of the really nice ways we can have a sense of a person. We can also think about what the person's life meant to us. What would they have wanted? What would've made them happy if they continued to live?
这些实际上是与一个人在一起,并利用他们的记忆,抓住他们的记忆的很好的方式。我们也可以思考他们会希望我们做什么。我记得有一句话,我想是保罗·麦卡特尼说的。保罗·麦卡特尼曾与他的妻子琳达·麦卡特尼有过一段非常健康的婚姻。当她去世时,他在他的生活中前进了。
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These are actually very nice ways to be with a person and to use their memories to hold onto their memories. We can also think about what they would've liked us to be doing. I remember there was a quote, I think Paul McCartney said this. Paul McCartney had been married in a very healthy marriage with his wife Linda McCartney. And when she died, he moved on in his life.
我想他说她不会希望我为这段失去的婚姻、这段失去的关系而受苦和憔悴。她会希望我继续前进,而我就是要这么做。我认为我们可以那样想那个死去的人。他们在某种程度上仍然与我们同在,在精神上,我们可以思考他们会希望什么,他们会希望我们做什么,等等。
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And I think he said she wouldn't have wanted me to suffer and pine away for this lost marriage, this lost relationship. She would've wanted me to move on, and that's what I'm going to do. And I think we can think about the person that died in that way. They're still with us in a way in spirit, and we can think about what they would've wanted, what they would've wanted us to do, etcetera.
这是一件神秘的事情,我们被给予了这段时间来生活,然后就结束了,我们可以随心所欲地利用它,或者不利用。
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It's a mysterious thing we're given. This period of time we have to live and then it's over, and we can do with it what we will or not.