亲人离世后,如何面对活着的创伤

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."

我的父亲死于脑瘤已是四年半前的事情了。但如今和我88岁的母亲谈起失去我父亲这个事情时，我很惊讶地发现她还在怀疑自己：“你大概以为我早看开了吧”。她谈起失去她共度几乎六十年生命的丈夫时，依然沉浸在痛苦中，“已经四年多了，但我还是很难过。”

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.

我不知道我成为精神科医生的动机，是否缘于我母亲在我小的时候就喜欢这么讲话，或者是因为现在我是个精神科医生了，她才这么跟我交谈。但我很高兴可以和她谈起这个话题。我们需要谈论痛苦。如果痛苦深埋在个人心底，它将会蚕食掉个人的心理支撑。

"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.

“心灵创伤永不会消失殆尽。”我回答，“也许它会有变化，有时随着时间可以逐渐淡化，但它永不可能完全消失。你为什么会觉得你应该看开了呢？我觉得不是这么回事。”我的母亲思考着我的看法，如释重负。

"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."

“我不用因为还没看开而内疚了？”她问，“我第一任丈夫去世时，我花了10年才走出来。”她突然又想起来她大学里的爱人。当她20多岁时，她的爱人由于心脏问题突然去世，多年后才又遇到我的父亲，“我觉得自己终于能透口气了。”

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岁还是11岁之前，我对我母亲的第一任丈夫毫无所知。直到有一天我在玩猜字游戏时，为了查找单词，我翻开了她那本饱经风霜的韦伯词典。书的扉页上有我母亲的笔迹，用黑墨水写着她的名字。但那姓氏并不是她现在的姓氏，也不是她未婚前的姓氏。那是另一个我不熟悉的名字：雪莉·施泰因巴赫(Sherrie Steinbach)，而不是她现在的名字雪莉·艾普斯坦(Sherrie Epstein)。这是我母亲的另一面，她独特的手迹立刻让我觉得无比熟悉，但这个名字又让我感得十分遥远。

"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.

“这是什么？”我想起我举着这本褪色的蓝色辞典，询问我的母亲，这个故事就此翻江倒海地展现出来。之后我们很少再提起。直到我的父亲在半个世纪后去世了，我的母亲才又开始提起这个事情，这一次是她主动提起的。我不清楚她第一任丈夫的去世所造成的创伤，是否真的完全被抚平。我父亲的去世似乎又使这个问题浮到水面。

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.

心理创伤并不只是重大灾难的后果，它的影响不局限于受重灾的人群。心理创伤的暗流不停在日常生活中涌动，于无常的人生里，伴随各种辛酸经历将我们击垮。我可以说，我们要么正处于心理创伤后的应激障碍里，要么就是正处于心理创伤前的应激障碍里。死亡、年迈、疾病、事故、分离、失去，它们以各种方式环绕在我们所有人之间，没有人可以逃离。我们的世界是如此的不稳定与不可预测，即使已拥有了难以置信的科学进展，这个世界依然在很大程度上，以超越我们控制的形式运行着。

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.

我告诉我母亲的话“心理创伤永不消失”，来自于我这些年作为精神科医生的认识。当我们试图抵制心理创伤，不让自己感受到其全部影响时，我们迫使自己脱离了事实。作为治疗师，我可以作证：让一个人承认自己的痛苦与无能为力是有多么困难。我母亲的自然反应“我不是应该看开了吗？”，是非常普遍的现象。我们中的许多人会尽力恢复常态，但这使我们逃避自身的痛苦程度，也因此忽视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?

当灾难袭击时，我们可能会迅速产生移情反应，但私底下我们总认为自己应该恢复“正常”。波士顿马拉松爆炸案的受害者需要数年才能恢复，士兵从战场带回的是其沙场中的痛苦体验。我们作为一个社群，是否能够为这些人痛苦数年？或者我们应该向前走，也希望他们能够向前看？我一个朋友在4岁时遭遇母亲自杀，他的父亲为了让他向前走，在一个清晨告诉他：母亲已经离开，永远也不要再提起她。当我们在希望他人往前走时，我们是否也在采用这个方式？

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，瑞士精神科医生伊丽莎白·库伯勒·罗斯(Elisabeth Kübler-Ross)将死亡的创伤带入她开创性工作的著作《论死亡与临终》(On Death and Dying)里。她阐述了悲哀的五步骤模型：否认、愤怒、谈判、绝望、接受。在那个时代里，她的工作成果非常激进。它使死亡成为正常的谈论话题，但这也无意中让人们觉得： 应该用正确的方式来处理悲哀，这正如我母亲的感觉一样。

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，追悼没有时刻表。悲哀对每个人的效果并不相同，而且它并不总能轻易离开。如今精神科医生们能找到的最接近的共识是：对待心理创伤，最健康的方法是直面接近它，而不是试图去逃避。强迫恢复正常的自然反射冲动只能适得其反。当受到心理创伤的人试图融入正常人中间时（我们中大部分人是这么做的），他们只能感觉自己格格不入。

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.

虽然我们习惯认为心理创伤是巨大灾难后不可避免的结果，但我们的日常生活也充满着无休止的小心理创伤。东西打破了，别人伤害了我们的感受，蜱虫会传染莱姆病，宠物会死亡，朋友生病，甚至也会死。

"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.

“它们正在攻城掠地，”有一天，一位60岁的朋友数着亲近熟人们的各种疾病，“我们正在走下坡路。”他是对的，但这种生活带来的心理创伤并不只攻击一个年龄段。第一天上学与第一天使用生命辅助设施，有惊人的相似之处，分离与丧失摧残着每一个人。

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.

当我母亲告诉我，她花了10年时间才走出第一任丈夫去世的痛苦时，我很惊讶。我想，她开始恢复时，我已经六七岁了。我的父亲是一位富有同情心的医生，但他并没有对我母亲的问题采取措施。当母亲嫁给父亲时，她把往日的婚礼照片都交给了姐姐保管。我对此毫不知情，也从未想过要问起。但当我父亲去世后，我的母亲突然对她生命里这段非常时间毫不忌讳。这段故事一直沉睡着等待了60年，几乎从未被提起。

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.

我的母亲在处理父亲死亡的问题上，将自己摆在了与当年一样的压力下。那些早期的心理创伤决定了后来的创伤，而克服创伤的困难度只能越积越高。我非常高兴自己是一位精神科医生，也很感激自己在与母亲交谈时带着佛教的宽容倾向。在那些尽快恢复正常的无稽之谈中，我可以给她提供其他一些东西。

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.

愿意面对心理创伤的意愿是恢复的关键，无论创伤是大是小，年代久远或是昨日之事。它们也许永远无法如我们希望的那样完全消失，但也许它们并不需要这么做。心理创伤是生活中不可磨灭的一部分。正因为如此——而不是尽管如此，我们才是活生生的人。