親人離世後,如何面對活着的創傷
TALKING with my 88-year-old mother, four and a half years after my father died from a brain tumor, I was surprised to hear her questioning herself. "You'd think I would be over it by now,” she said, speaking of the pain of losing my father, her husband of almost 60 years. "It's been more than four years, and I'm still upset."
我的父親死於腦瘤已是四年半前的事情了。但如今和我88歲的母親談起失去我父親這個事情時，我很驚訝地發現她還在懷疑自己：“你大概以爲我早看開了吧”。她談起失去她共度幾乎六十年生命的丈夫時，依然沉浸在痛苦中，“已經四年多了，但我還是很難過。”I'm not sure if I became a psychiatrist because my mother liked to talk to me in this way when I was young or if she talks to me this way now because I became a psychiatrist, but I was pleased to have this conversation with her. Grief needs to be talked about. When it is held too privately it tends to eat away at its own support.
我不知道我成爲精神科醫生的動機，是否緣於我母親在我小的時候就喜歡這麼講話，或者是因爲現在我是個精神科醫生了，她才這麼跟我交談。但我很高興可以和她談起這個話題。我們需要談論痛苦。如果痛苦深埋在個人心底，它將會蠶食掉個人的心理支撐。"Trauma never goes away completely," I responded. "It changes perhaps, softens some with time, but never completely goes away. What makes you think you should be completely over it? I don't think it works that way." There was a palpable sense of relief as my mother considered my opinion.
“心靈創傷永不會消失殆盡。”我回答，“也許它會有變化，有時隨着時間可以逐漸淡化，但它永不可能完全消失。你爲什麼會覺得你應該看開了呢？我覺得不是這麼回事。”我的母親思考着我的看法，如釋重負。
"I don't have to feel guilty that I'm not over it?" she asked. "It took 10 years after my first husband died," she remembered suddenly, thinking back to her college sweetheart, to his sudden death from a heart condition when she was in her mid-20s, a few years before she met my father. "I guess I could give myself a break."
“我不用因爲還沒看開而內疚了？”她問，“我第一任丈夫去世時，我花了10年才走出來。”她突然又想起來她大學裏的愛人。當她20多歲時，她的愛人由於心臟問題突然去世，多年後才又遇到我的父親，“我覺得自己終於能透口氣了。”I never knew about my mother's first husband until I was playing Scrabble one day when I was 10 or 11 and opened her weather-beaten copy of Webster's Dictionary to look up a word. There, on the inside of the front cover, in her handwriting, was her name inscribed in black ink. Only it wasn't her current name (and it wasn't her maiden name). It was another, unfamiliar name, not Sherrie Epstein but Sherrie Steinbach: an alternative version of my mother at once entirely familiar (in her distinctive hand) and utterly alien.
在我10歲還是11歲之前，我對我母親的第一任丈夫毫無所知。直到有一天我在玩猜字遊戲時，爲了查找單詞，我翻開了她那本飽經風霜的韋伯詞典。書的扉頁上有我母親的筆跡，用黑墨水寫着她的名字。但那姓氏並不是她現在的姓氏，也不是她未婚前的姓氏。那是另一個我不熟悉的名字：雪莉·施泰因巴赫(Sherrie Steinbach)，而不是她現在的名字雪莉·艾普斯坦(Sherrie Epstein)。這是我母親的另一面，她獨特的手跡立刻讓我覺得無比熟悉，但這個名字又讓我感得十分遙遠。"What's this?" I remember asking her, holding up the faded blue dictionary, and the story came tumbling out. It was rarely spoken of thereafter, at least until my father died half a century later, at which point my mother began to bring it up, this time of her own volition. I'm not sure that the trauma of her first husband's death had ever completely disappeared; it seemed to be surfacing again in the context of my father's death.
“這是什麼？”我想起我舉着這本褪色的藍色辭典，詢問我的母親，這個故事就此翻江倒海地展現出來。之後我們很少再提起。直到我的父親在半個世紀後去世了，我的母親才又開始提起這個事情，這一次是她主動提起的。我不清楚她第一任丈夫的去世所造成的創傷，是否真的完全被撫平。我父親的去世似乎又使這個問題浮到水面。Trauma is not just the result of major disasters. It does not happen to only some people. An undercurrent of trauma runs through ordinary life, shot through as it is with the poignancy of impermanence. I like to say that if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune. Our world is unstable and unpredictable, and operates, to a great degree and despite incredible scientific advancement, outside our ability to control it.
心理創傷並不只是重大災難的後果，它的影響不侷限於受重災的人羣。心理創傷的暗流不停在日常生活中涌動，於無常的人生裏，伴隨各種辛酸經歷將我們擊垮。我可以說，我們要麼正處於心理創傷後的應激障礙裏，要麼就是正處於心理創傷前的應激障礙裏。死亡、年邁、疾病、事故、分離、失去，它們以各種方式環繞在我們所有人之間，沒有人可以逃離。我們的世界是如此的不穩定與不可預測，即使已擁有了難以置信的科學進展，這個世界依然在很大程度上，以超越我們控制的形式運行着。My response to my mother — that trauma never goes away completely — points to something I have learned through my years as a psychiatrist. In resisting trauma and in defending ourselves from feeling its full impact, we deprive ourselves of its truth. As a therapist, I can testify to how difficult it can be to acknowledge one's distress and to admit one's vulnerability. My mother's knee-jerk reaction, "Shouldn't I be over this by now?" is very common. There is a rush to normal in many of us that closes us off, not only to the depth of our own suffering but also, as a consequence, to the suffering of others.
我告訴我母親的話“心理創傷永不消失”，來自於我這些年作爲精神科醫生的認識。當我們試圖抵制心理創傷，不讓自己感受到其全部影響時，我們迫使自己脫離了事實。作爲治療師，我可以作證：讓一個人承認自己的痛苦與無能爲力是有多麼困難。我母親的自然反應“我不是應該看開了嗎？”，是非常普遍的現象。我們中的許多人會盡力恢復常態，但這使我們逃避自身的痛苦程度，也因此忽視了其他人的痛苦程度。When disasters strike we may have an immediate empathic response, but underneath we are often conditioned to believe that "normal" is where we all should be. The victims of the Boston Marathon bombings will take years to recover. Soldiers returning from war carry their battlefield experiences within. Can we, as a community, keep these people in our hearts for years? Or will we move on, expecting them to move on, the way the father of one of my friends expected his 4-year-old son — my friend — to move on after his mother killed herself, telling him one morning that she was gone and never mentioning her again?
當災難襲擊時，我們可能會迅速產生移情反應，但私底下我們總認爲自己應該恢復“正常”。波士頓馬拉松爆炸案的受害者需要數年才能恢復，士兵從戰場帶回的是其沙場中的痛苦體驗。我們作爲一個社羣，是否能夠爲這些人痛苦數年？或者我們應該向前走，也希望他們能夠向前看？我一個朋友在4歲時遭遇母親自殺，他的父親爲了讓他向前走，在一個清晨告訴他：母親已經離開，永遠也不要再提起她。當我們在希望他人往前走時，我們是否也在採用這個方式？IN 1969, after working with terminally ill patients, the Swiss psychiatrist Elisabeth Kübler-Ross brought the trauma of death out of the closet with the publication of her groundbreaking work, "On Death and Dying." She outlined a five-stage model of grief: denial, anger, bargaining, depression, acceptance. Her work was radical at the time. It made death a normal topic of conversation, but had the inadvertent effect of making people feel, as my mother did, that grief was something to do right.
1969年，瑞士精神科醫生伊麗莎白·庫伯勒·羅斯(Elisabeth Kübler-Ross)將死亡的創傷帶入她開創性工作的著作《論死亡與臨終》(On Death and Dying)裏。她闡述了悲哀的五步驟模型：否認、憤怒、談判、絕望、接受。在那個時代裏，她的工作成果非常激進。它使死亡成爲正常的談論話題，但這也無意中讓人們覺得： 應該用正確的方式來處理悲哀，這正如我母親的感覺一樣。Mourning, however, has no timetable. Grief is not the same for everyone. And it does not always go away. The closest one can find to a consensus about it among today's therapists is the conviction that the healthiest way to deal with trauma is to lean into it, rather than try to keep it at bay. The reflexive rush to normal is counterproductive. In the attempt to fit in, to be normal, the traumatized person (and this is most of us) feels estranged.
然而，追悼沒有時刻表。悲哀對每個人的效果並不相同，而且它並不總能輕易離開。如今精神科醫生們能找到的最接近的共識是：對待心理創傷，最健康的方法是直面接近它，而不是試圖去逃避。強迫恢復正常的自然反射衝動只能適得其反。當受到心理創傷的人試圖融入正常人中間時（我們中大部分人是這麼做的），他們只能感覺自己格格不入。While we are accustomed to thinking of trauma as the inevitable result of a major cataclysm, daily life is filled with endless little traumas. Things break. People hurt our feelings. Ticks carry Lyme disease. Pets die. Friends get sick and even die.
雖然我們習慣認爲心理創傷是巨大災難後不可避免的結果，但我們的日常生活也充滿着無休止的小心理創傷。東西打破了，別人傷害了我們的感受，蜱蟲會傳染萊姆病，寵物會死亡，朋友生病，甚至也會死。"They're shooting at our regiment now," a 60-year-old friend said the other day as he recounted the various illnesses of his closest acquaintances. "We're the ones coming over the hill." He was right, but the traumatic underpinnings of life are not specific to any generation. The first day of school and the first day in an assisted-living facility are remarkably similar. Separation and loss touch everyone.
“它們正在攻城掠地，”有一天，一位60歲的朋友數着親近熟人們的各種疾病，“我們正在走下坡路。”他是對的，但這種生活帶來的心理創傷並不只攻擊一個年齡段。第一天上學與第一天使用生命輔助設施，有驚人的相似之處，分離與喪失摧殘着每一個人。I was surprised when my mother mentioned that it had taken her 10 years to recover from her first husband's death. That would have made me 6 or 7, I thought to myself, by the time she began to feel better. My father, while a compassionate physician, had not wanted to deal with that aspect of my mother's history. When she married him, she gave her previous wedding's photographs to her sister to hold for her. I never knew about them or thought to ask about them, but after my father died, my mother was suddenly very open about this hidden period in her life. It had been lying in wait, rarely spoken of, for 60 years.
當我母親告訴我，她花了10年時間才走出第一任丈夫去世的痛苦時，我很驚訝。我想，她開始恢復時，我已經六七歲了。我的父親是一位富有同情心的醫生，但他並沒有對我母親的問題採取措施。當母親嫁給父親時，她把往日的婚禮照片都交給了姐姐保管。我對此毫不知情，也從未想過要問起。但當我父親去世後，我的母親突然對她生命裏這段非常時間毫不忌諱。這段故事一直沉睡着等待了60年，幾乎從未被提起。My mother was putting herself under the same pressure in dealing with my father's death as she had when her first husband died. The earlier trauma was conditioning the later one, and the difficulties were only getting compounded. I was glad to be a psychiatrist and grateful for my Buddhist inclinations when speaking with her. I could offer her something beyond the blandishments of the rush to normal.
我的母親在處理父親死亡的問題上，將自己擺在了與當年一樣的壓力下。那些早期的心理創傷決定了後來的創傷，而克服創傷的困難度只能越積越高。我非常高興自己是一位精神科醫生，也很感激自己在與母親交談時帶着佛教的寬容傾向。在那些儘快恢復正常的無稽之談中，我可以給她提供其他一些東西。The willingness to face traumas — be they large, small, primitive or fresh — is the key to healing from them. They may never disappear in the way we think they should, but maybe they don't need to. Trauma is an ineradicable aspect of life. We are human as a result of it, not in spite of it.
願意面對心理創傷的意願是恢復的關鍵，無論創傷是大是小，年代久遠或是昨日之事。它們也許永遠無法如我們希望的那樣完全消失，但也許它們並不需要這麼做。心理創傷是生活中不可磨滅的一部分。正因爲如此——而不是儘管如此，我們纔是活生生的人。
