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Bessel van der Kolk sat cross—legged on an oversize pillow in the center of a smallish room overlooking the Pacific Ocean in Big Sur. He wore khaki pants, a blue fleece zip-up and square wire-rimmed glasses. His feet were bare. It was the third day of his workshop, "Trauma Memory and Recovery of the Self," and 30 or so workshop participants — all of them trauma victims or trauma therapists — lined the room's perimeter. They, too, sat barefoot on cushy pillows, eyeing van der Kolk, notebooks in hand. For two days, they had listened to his lectures on the social history, neurobiology and clinical realities of post-traumatic stress disorder and its lesser-known sibling, complex trauma. Now, finally, he was about to demonstrate an actual therapeutic technique, and his gaze was fixed on the subject of his experiment: a 36-year-old Iraq war veteran named Eugene, who sat directly across from van der Kolk, looking mournful and expectant.
從不大的房間望出去，大瑟爾地區(qū)太平洋的風(fēng)光盡收眼底。貝塞爾·范德科爾克(Bessel van der Kolk)盤腿坐在房間中央的超大號靠枕上。他戴著方形金絲眼鏡，身穿藍色拉鏈?zhǔn)浇q頭織物衫和卡其布褲子，赤著腳。這天是他主辦的“創(chuàng)傷記憶與自我恢復(fù)”(Trauma Memory and Recovery of the Self)研討會的第三天，約30名研討會參與者（均為創(chuàng)傷受害者或創(chuàng)傷治療師）沿著房間的四壁圍成一圈。他們也都赤腳坐在舒適的靠枕上，手里拿著筆記本，眼睛盯著范德科爾克。兩天來，他們聆聽他講解了創(chuàng)傷后應(yīng)激障礙(post-traumatic stress disorder, PTSD)及其鮮為人知的同類——復(fù)雜創(chuàng)傷(complex trauma)的社會歷史、神經(jīng)生物學(xué)和臨床現(xiàn)狀?，F(xiàn)在，他終于將向他們演示實際的治療技術(shù)。范德科爾克將目光落在自己的實驗對象尤金(Eugene)的身上。這是一名36歲的伊拉克戰(zhàn)爭退伍軍人，此刻他正坐在范德科爾克的對面，面帶悲傷，又充滿期待。
Van der Kolk began as he often does, with a personal anecdote. "My mother was very unnurturing and unloving," he said. "But I have a full memory and a complete sense of what it is like to be loved and nurtured by her." That's because, he explained, he had done the very exercise that we were about to try on Eugene. Here's how it would work: Eugene would recreate the trauma that haunted him most by calling on people in the room to play certain roles. He would confront those people — with his anger, sorrow, remorse and confusion — and they would respond in character, apologizing, forgiving or validating his feelings as needed. By projecting his "inner world" into three-dimensional space, Eugene would be able to rewrite his troubled history more thoroughly than other forms of role-play therapy might allow. If the experiment succeeded, the bad memories would be supplemented with an alternative narrative — one that provided feelings of acceptance or forgiveness or love.
像過去一樣，范德科爾克的治療從講述自己的親身經(jīng)歷開始?！拔业哪赣H對我毫無教養(yǎng)和疼愛之心，”他說?！暗覅s能讓自己體會到在她關(guān)愛和撫育下成長的全部感受，并讓它們成為我的‘記憶'?！币驗樗鲞^一項非常特別的練習(xí)，他解釋道，而這也正是現(xiàn)在尤金將要嘗試的。具體的做法是這樣的：在場的人們將應(yīng)尤金的要求扮演各種特定的角色，從而幫助他重現(xiàn)那段深深困擾他的創(chuàng)傷。他將對著這些人表露他的憤怒、悲傷、悔恨和迷茫，而他們則將依據(jù)所扮演的角色對他作出相應(yīng)的回應(yīng)，或道歉、或?qū)捤。部梢哉J同他的感受。通過將自己的“內(nèi)心世界”投射到三維空間，尤金將得以重塑自己最不堪回首的經(jīng)歷，而且效果會比其他形式的角色扮演治療更加徹底。如果實驗?zāi)軌虺晒?，那些悲慘的回憶將可以通過另一種方式——一種可以獲得認可、寬恕或愛的方式來重新描述。
The exercise, which van der Kolk calls a "structure" but which is also known as psychomotor therapy, was developed by Albert Pesso, a dancer who studied with Martha Graham. He taught it to van der Kolk about two decades ago. Though it has never been tested in a controlled study, van der Kolk says he has had some success with it in workshops like this one. He likes to try it whenever he has a small group and a willing volunteer.
這種做法被范德科爾克稱為“構(gòu)造”(structure)，它還有個名字叫做精神運動療法(psychomotor therapy)。舞蹈演員艾伯特·佩索(Albert Pesso)創(chuàng)立了該療法，并在大約20年前教給了范德科爾克。盡管這種療法未在對照研究中接受過檢驗，但范德科爾克稱，在幾次類似的研討會中，他們已經(jīng)有過若干成功的先例。無論何時何地，只要他身邊聚集了一小群人，而且有人愿意站出來，他都喜歡嘗試一下這種療法。
With some gentle prodding from van der Kolk, Eugene told us how he came to be a specialist in the United States Army, how he spent a full year stationed in Mosul, the largest city in northern Iraq, and how his job involved disposing of exploded bombs. It was a year of dead bodies, he said. He saw, touched, smelled and stepped in more bodies than he could possibly count. Some of them were children. He was only 26.
在范德科爾克溫和的鼓勵下，尤金向我們講述了他的故事：他怎樣成為美國陸軍的技術(shù)兵；他在伊拉克北部最大的城市摩蘇爾駐扎的那一整年時間，是如何度過的；以及他的工作怎么會涉及處置已爆炸的炸彈。那一年都在和尸體打交道，他說。他目睹、觸摸、嗅聞乃至踏過的尸體簡直不可勝數(shù)，其中有些還是兒童。而尤金當(dāng)時只有26歲。
People turn to grease when they explode, he told us, because their fat cells burst open. He witnessed multiple suicide bombings. Once, he accidentally stepped in an exploded corpse; only the legs were still recognizable as human. Another time, he saw a kitchen full of women sliced to bits. They'd been making couscous when a bomb went off and the windows shattered. He was shot in the back of the head once. He was also injured by an improvised explosive device.
尤金告訴我們，當(dāng)人被炸碎時，脂肪細胞都會爆裂開，于是人就變成了一大團動物油脂。他曾目擊過多起自殺式炸彈襲擊事件。有一次，他不小心踩在一具爆炸后的尸體上——只有腿部還勉強有點人型。還有一次，他看到一個廚房里，到處散落著女人身體四分五裂的殘片——她們正在做古斯米時，一枚爆炸的炸彈震碎了窗戶。尤金曾經(jīng)頭部后側(cè)中彈，也曾經(jīng)因土制的爆炸裝置受傷。
But none of those experiences haunted him quite as much as this one: Several months into his tour, while on a security detail, Eugene killed an innocent man and then watched as the man's mother discovered the body a short while later.
但這些經(jīng)歷對他的困擾，與下面這件事相比，只是小巫見大巫：在任職幾個月后，尤金在一次安保任務(wù)中殺死了一名無辜的男子，然后他還眼看著那名男子的母親在不久之后發(fā)現(xiàn)了兒子的遺體。
"Tell us more about that," van der Kolk said. "What happened?" Eugene's fragile composure broke at the question. He closed his eyes, covered his face and sobbed.
“請講得再詳細一些，”范德科爾克說，“發(fā)生了什么事？”簡單的問題打破了尤金強忍著的鎮(zhèn)定。他閉上眼睛，用手遮住臉，開始抽泣。
"The witness can see how distressed you are and how badly you feel," van der Kolk said. Acknowledging and reflecting the protagonist's emotions like this — what van der Kolk calls "witnessing" them — is a central part of the exercise, meant to instill a sense of validation and security in the patient.
“見證人看得出你有多么痛心和難過，”范德科爾克說。范德科爾克像這樣承認事件主人公的情緒，并對其情緒做出反應(yīng)，他把這個過程稱為“見證”，這是練習(xí)的核心部分，旨在向患者灌輸受到認可的感覺以及安全感。
Eugene had already called on some group members to play certain roles in his story. Kresta, a yoga instructor based in San Francisco, was serving as his "contact person," a guide who helps the protagonist bear the pain the trauma evokes, usually by sitting nearby and offering a hand to hold or a shoulder to lean on. Dave, a child-abuse survivor and small-business owner in Southern California, was playing Eugene's "ideal father," a character whose role is to say all the things that Eugene wished his real father had said but never did. They sat on either side of Eugene, touching his shoulders. Next, van der Kolk asked who should play the man he killed. Eugene picked Sagar, a stand-up comedian and part-time financial consultant from Brooklyn. Finally, van der Kolk asked, Who should play the man's mother?
在此之前，尤金已經(jīng)拜托了一些小組成員來扮演他故事中的角色。居住在舊金山的瑜伽教練克雷斯塔(Kresta)擔(dān)任他的“聯(lián)絡(luò)人”，就像是一個向?qū)?，幫助主人公承受回憶喚起的?chuàng)傷。聯(lián)絡(luò)人通常就坐在主人公的身旁，在需要時提供一只支持的手臂或一個可以依靠的肩膀。戴夫(Dave)是虐待兒童案件的幸存者，現(xiàn)在是南加州的一個小企業(yè)主。在這里，他扮演的角色是尤金的“理想父親”，他的任務(wù)是對尤金說一些尤金一直期盼能從自己真正的父親口中聽到，但真正的父親從來沒有說過的話。這兩個人分別坐在尤金的兩側(cè)，手搭在他的肩膀上。接下來，范德科爾克詢問尤金希望由誰來扮演那名被自己殺害的人。尤金選擇了塞格爾(Sagar)，來自紐約布魯克林區(qū)的脫口秀笑星及兼職財務(wù)顧問。最后，范德科爾克問道，誰來扮演那男子的母親？
Eugene pointed to me. "Can you do it?" he asked.
尤金指著我。“可以拜托你嗎？”他問。
I swore myself in as the others had, by saying, "I enroll as the mother of the man you killed." Then I moved my pillow to the center of the room, across from Eugene, next to van der Kolk.
“我愿意扮演被害人的母親，”我學(xué)著其他人的樣子宣布承擔(dān)這個任務(wù)，然后把自己的靠枕搬到了房間的中央，面對著尤金，挨著范德科爾克。
"O.K.," van der Kolk said. "Tell us more about that day. Tell us what happened."
“好了，”范德科爾克說?！罢埜嬖V我們更多關(guān)于那一天的事吧，都發(fā)生了些什么？”
Psychomotor therapy is neither widely practiced nor supported by clinical studies. In fact, most licensed psychiatrists probably wouldn't give it a second glance. It's hokey-sounding. It was developed by a dancer. But van der Kolk believes strongly that dancers — and musicians and actors — may have something to teach psychiatrists about healing from trauma and that even the hokey-sounding is worthy of our attention. He has spent four decades studying and trying to treat the effects of the worst atrocities we inflict on one another: war, rape, incest, torture and physical and mental abuse. He has written more than 100 peer-reviewed papers on psychological trauma. Trained as a psychiatrist, he treats more than a dozen patients a week in private practice — some have been going to him for many years now — and he oversees a nonprofit clinic in Boston, the Trauma Center, that treats hundreds more. If there's one thing he's certain about, it's that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better.
精神運動療法目前既沒有在臨床實踐中廣泛實施，也沒有得到臨床研究的支持。事實上，大多數(shù)執(zhí)業(yè)精神科醫(yī)生恐怕都不會看它第二眼。它聽起來就像做戲，而且還是由舞蹈演員創(chuàng)立的。但范德科爾克相信，舞者——以及樂手和演員——在促進精神創(chuàng)傷的愈合方面可能的確有過人之處，值得精神科醫(yī)生借鑒，這個方法雖然有些矯揉造作，但仍然值得關(guān)注。他花了40年的時間，來研究人們施加在彼此身上最慘痛的暴行，比如戰(zhàn)爭、強奸、亂倫、拷打，以及生理和心理的虐待所造成的影響，并嘗試進行治療。他撰寫了100多篇關(guān)于心理創(chuàng)傷的經(jīng)過同行評議的文章。而且，作為一名訓(xùn)練有素的精神科醫(yī)生，他的私人診所每周都接診數(shù)十名患者——其中有些人找他看病已有多年。此外，他還負責(zé)著位于波士頓的一家名為“創(chuàng)傷中心”(Trauma Center)非營利性診所，那里還為另外數(shù)百名患者提供診治。如果有一件事是他可以斷言的，那就是：常規(guī)的治療方法不管用?；颊邆?nèi)匀煌纯嗖豢埃麄兊募胰艘膊荒苄颐?。我們還需要做得更好才行。
Van der Kolk takes particular issue with two of the most widely employed techniques in treating trauma: cognitive behavioral therapy and exposure therapy. Exposure therapy involves confronting patients over and over with what most haunts them, until they become desensitized to it. Van der Kolk places the technique "among the worst possible treatments" for trauma. It works less than half the time, he says, and even then does not provide true relief; desensitization is not the same as healing. He holds a similar view of cognitive behavioral therapy, or C.B.T., which seeks to alter behavior through a kind of Socratic dialogue that helps patients recognize the maladaptive connections between their thoughts and their emotions. "Trauma has nothing whatsoever to do with cognition," he says. "It has to do with your body being reset to interpret the world as a dangerous place." That reset begins in the deep recesses of the brain with its most primitive structures, regions that, he says, no cognitive therapy canaccess. "It's not something you can talk yourself out of." That view places him on the fringes of the psychiatric mainstream.
范德科爾克尤其對創(chuàng)傷治療中最常用的兩種方法持有異議：認知行為療法（cognitive behavioral therapy，簡稱CBT）和暴露療法(exposure therapy)。暴露療法是讓患者一遍又一遍地面對最困擾他們的問題，直到他們對此變得麻木。范德科爾克把它貶斥為“最不可能治療”創(chuàng)傷的方法。它的成功率還不到一半，他說，就算“成功”了也無法提供真正的解脫：脫敏與痊愈是兩個不同的概念。他對認知行為療法，也有類似的看法。認知行為療法試圖通過一種蘇格拉底式的對話，幫助患者認識到自己的思想與情緒之間的聯(lián)系調(diào)試不良，從而改變患者的行為?！暗珓?chuàng)傷與認知可沒有一丁點兒關(guān)系，”范德科爾克說?！罢嬲膯栴}在于，創(chuàng)傷改造了你的身體，讓你覺得這世界很危險?！边@種改造源于我們大腦中最原始結(jié)構(gòu)的深處，認知療法所無法觸及的地帶?！斑@不是你勸解自己說幾句就可以解決的?！边@些觀點令他游離出了精神學(xué)主流。
It's not the first time van der Kolk has been there. In the early 1990s, he was a lead defender of repressed-memory therapy, which the Harvard psychologist Richard McNally later called "the worst catastrophe to befall the mental-health field since the lobotomy era." Van der Kolk served as an expert witness in a string of high-profile sexual-abuse cases that centered on the recovery of repressed memories, testifying that it was possible — common, even — for victims of extreme or repeated sexual trauma to suppress all memory of that trauma and then recall it years later in therapy. He'd seen plenty of such examples in his own patients, he said, and could cite additional cases from the medical literature going back at least 100 years.
范德科爾克并不是第一次陷入這種境地。20世紀90年代初，他是記憶抑制治療(repressed-memory therapy)的一名主要的擁護者。該療法后來被哈佛大學(xué)的心理學(xué)家理查德·麥克納利(Richard McNally)稱為“自腦葉切除術(shù)時代以來降臨到心理健康領(lǐng)域的最大災(zāi)難。”在當(dāng)時的一系列引人注目的性虐待案件中（均與恢復(fù)受抑制的記憶密切相關(guān)），范德科爾克擔(dān)任了專家證人，作證稱遭受極端或反復(fù)性創(chuàng)傷的受害者有可能——甚至普遍——會壓抑自己關(guān)于那些創(chuàng)傷的所有記憶，直至多年后在治療中才回想起來。他表示，在自己的患者中見過很多這樣的例子，此外，他還能從醫(yī)學(xué)文獻中找出此類案例，至少可以回溯100年。
In the 1980s and ‘90s, people from all over the country filed scores of legal cases accusing parents, priests and day care workers of horrific sex crimes, which they claimed to have only just remembered with the help of a therapist. For a time, judges and juries were persuaded by the testimony of van der Kolk and others. It made intuitive sense to them that the mind would find a way to shield itself from such deeply traumatic experiences. But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned. Most research psychologists argued that it was much more likely for so-called repressed memories to have been implanted by suggestive questioning from overzealous doctors and therapists than to have been spontaneously recalled. In time, it became clear that innocent people had been wrongfully persecuted. Families, careers and, in some cases, entire lives were destroyed.
20世紀80年代和90年代，全美各地涌起了一股性虐訴訟的風(fēng)潮，人們紛紛指控父母、牧師和日托服務(wù)人員犯下了恐怖的性犯罪，并聲稱，他們是在治療師的幫助下才剛剛想起來的。一時間，法官和陪審團都被范德科爾克等人的證言說服了。他們直覺感到，人的心靈確實會找一種途徑來屏蔽過度痛苦的經(jīng)歷。但隨著指控變得越來越稀奇古怪——譬如被外星人綁架或神秘的撒旦邪教之類——支持這一理論的聲音日漸衰弱。大多數(shù)心理學(xué)研究專家認為，與其說是受害者自發(fā)地回憶起了這些所謂的“被壓抑的記憶”，可能性要大得多的是，過分狂熱的醫(yī)生和治療師的暗示性提問在他們的頭腦中植入了這樣的故事。隨著時間的推移，事實逐漸浮出水面：的確有無辜的人被錯誤地起訴了。他們的家庭、事業(yè)、甚至在某些情況下整個生活，都被毀于一旦。
After the dust settled in what was dubbed "the memory wars," van der Kolk found himself among the casualties. By the end of the decade, his lab at Massachusetts General Hospital was shuttered, and he lost his affiliation with Harvard Medical School. The official reason was a lack of funding, but van der Kolk and his allies believed that the true motives were political.
待這場日后被稱為“記憶之戰(zhàn)”的爭論塵埃落定之后，范德科爾克自己也付出了代價。90年代末，他在馬薩諸塞州總醫(yī)院(Massachusetts General Hospital)的實驗室被關(guān)停，還失去了在哈佛醫(yī)學(xué)院(Harvard Medical School)的職位。官方給出的理由是資金不足，但范德科爾克及其支持者認為，真正的動機是政治因素。
Van der Kolk folded his clinic into a larger nonprofit organization. He began soliciting philanthropic donations and honed his views on traumatic memory and trauma therapy. He still believed that repressed memories were a common feature of traumatic stress. Traumatic experiences were not being processed into memories, he reasoned, but were somehow getting "stuck in the machine" and then expressed through the body. Many of his colleagues in the psychiatric mainstream spurned these ideas, but he found another, more receptive audience: body-oriented therapists who not only embraced his message but also introduced him to an array of alternative practices. He began using some of those practices with his own patients and then testing them in small-scale studies. Before long, he had built a new network of like-minded researchers, body therapists and loyal friends from his Harvard days.
范德科爾克將自己的診所并入了一家規(guī)模更大的非營利組織中。他開始募集慈善捐款，并將關(guān)注的目標(biāo)集中在創(chuàng)傷記憶及創(chuàng)傷治療之上。他仍堅信，記憶抑制是創(chuàng)傷應(yīng)激的一個普遍特征。范德科爾克解釋道，創(chuàng)傷經(jīng)歷并沒有被加工成記憶，而是莫名其妙地“卡殼”了，日后才在軀體上表現(xiàn)出來。精神病學(xué)的主流研究者大多都對這些理論嗤之以鼻，但范德科爾克在另一個群體中找到了更愿意接受它們的人：身體導(dǎo)向治療師們不僅欣然接納了他的觀點，還向他介紹了一系列替代療法。他開始使用其中一些療法來嘗試治療自己的患者，并在小規(guī)模的研究中對他們加以測試。不久，他就與志同道合的研究人員、身體治療師以及他在哈佛時結(jié)交的忠實伙伴建立起了一個新的關(guān)系網(wǎng)絡(luò)。
The group converged around an idea that was powerful in its simplicity. The way to treat psychological trauma was not through the mind but through the body. In so many cases, it was patients' bodies that had been grossly violated, and it was their bodies that had failed them — legs had not run quickly enough, arms had not pushed powerfully enough, voices had not screamed loudly enough to evade disaster. And it was their bodies that now crumpled under the slightest of stresses — that dove for cover with every car alarm or saw every stranger as an assailant in waiting. How could their minds possibly be healed if they found the bodies that encased those minds so intolerable? "The single most important issue for traumatized people is to find a sense of safety in their own bodies," van der Kolk says. "Unfortunately, most psychiatrists pay no attention whatsoever to sensate experiences. They simply do not agree that it matters."
這群人秉持著一個簡潔有力的觀念：精神創(chuàng)傷的治療應(yīng)該通過身體而不是通過心理進行。很多病例中，受到嚴重侵犯的是患者的身體，是他們的身體辜負了他們的期望——腿跑得不夠快，手臂抗拒得不夠有力，呼救的聲音還不夠大，以至于他們未能逃脫魔爪。如今，同樣是他們的身體屈服于哪怕最輕微的壓力之下——一聽到汽車防盜器的鳴叫聲就會慌忙躲閃，每見到一個陌生人就覺得那是一個蓄勢待發(fā)的攻擊者。如果容納思想的軀體如此不堪重負，那他們的心靈又怎么可能會痊愈？“對于創(chuàng)傷受害者而言，唯一最重要的問題就是要讓自己的身體找到安全感，”范德科爾克說?！安恍业氖牵蠖鄶?shù)精神科專家對感官體驗都不屑一顧。他們根本就不覺得這有什么重要?！?/div>
That van der Kolk does think it matters has won him an impressive and diverse fan base. "He's really a hero," says Stephen Porges, a professor of psychiatry at the University of North Carolina, Chapel Hill. "He's been extraordinarily courageous in confronting his own profession and in insisting that we not discount the bodily symptoms of traumatized people as something that's ‘just in their heads.' "
范德科爾克對身體感受的重視為他贏得了背景各異的眾多粉絲?！八且粋€真正的英雄，”北卡羅來納大學(xué)教堂山分校(University of North Carolina, Chapel Hill)的精神病學(xué)教授史蒂芬·波格斯(Stephen Porges)表示?！八恢北憩F(xiàn)出大無畏的態(tài)度，挑戰(zhàn)自己的學(xué)術(shù)圈子，并始終堅持不應(yīng)簡單地認定創(chuàng)傷受害者存在身體癥狀‘僅僅是腦筋出了問題'?！?/div>
These days, van der Kolk's calendar is filled with speaking engagements, from Boston to Amsterdam to Abu Dhabi. This spring, I trailed him down the East Coast and across the country. At each stop, his audience comprised the full spectrum of the therapeutic community: psychiatrists, psychologists, social workers, art therapists, yoga therapists, even life coaches. They formed long lines up to the podium to introduce themselves during coffee breaks and hovered around his table at lunchtime, hoping to speak with him. Some pulled out their cellphones and asked to take selfies with him. Most expressed similar sentiments:
連日來，范德科爾克的日程表被約得滿滿的，演講地點從波士頓到阿姆斯特丹，再到阿布扎比。今年春天，我跟隨他的腳步，走遍了東海岸和全美各地。每到一站，捧場的觀眾均遍及治療領(lǐng)域的方方面面：精神科醫(yī)生、心理學(xué)家、社會工作者、藝術(shù)治療師、瑜伽治療師，乃至生活教練。在講座的中間休息時間，他們排成長隊逐一到講臺上去做自我介紹，午餐時還會在他的桌子附近徘徊，希望能和他搭話。一些人掏出手機，想要與他合影留念。很多人表達了諸如此類的觀點：
Thank you so much for what you said about this treatment, that therapy, those studies.
非常感謝您宣講了關(guān)于這種治療、療法或研究的信息。
Your research on cutting, child sexual abuse, family violence confirms what I have seen in my own patients, or experienced myself, for decades now.
您關(guān)于自我割傷、兒童期性虐待和家庭暴力的研究證實了過去幾十年來我從自己的患者或者親身經(jīng)歷中所見證的事實。
Can you help me?
您可以幫助我嗎？
Van der Kolk's entire life has been a study in human trauma. He was born in The Hague in the summer of 1943, three years into the German occupation of the Netherlands and one year before the great Dutch famine, when a military blockade cut off food and fuel shipments to the country's western provinces and more than 20,000 people starved to death. His father was imprisoned in a Nazi work camp. According to van der Kolk family lore, his mother had to ride her bike to the hospital when she went into labor with him, and his first birthday cake was made of tulip bulbs because there was hardly any flour.
范德科爾克自己的整個人生就好像一項關(guān)于人類創(chuàng)傷的研究。1943年的夏天，他在海牙出生。這是德國占領(lǐng)荷蘭的第三年，次年，軍事封鎖切斷了通往荷蘭西部省份的糧食和燃料補給，導(dǎo)致逾2萬人餓死，史稱“冬季饑荒”。他的父親被囚禁在納粹集中營里。按照范德科爾克家族中的傳說，他的母親快要分娩的時候不得不自己騎自行車到醫(yī)院，而他的第一個生日蛋糕是用郁金香球莖做的，因為當(dāng)時基本上沒有面粉。
He was a weak and scrawny boy, but daring nonetheless. Ask him about his childhood, and he will tell you about playing amid the bombed-out ruins of his native city. Nearly everyone around him was deeply traumatized. His neighbors on either side were Holocaust survivors. His mother did not enjoy motherhood; she was pulled out of school at 14 to care for her father and then pulled away from a satisfying career to assume her wifely duties. By the time Bessel, her middle child, was old enough to know her, she had grown bitter and cold. His father was an executive at Royal Dutch Shell, and despite being a devout Protestant and dedicated pacifist, he suffered violent rages and inflicted them on his children. In his new book, "The Body Keeps the Score," which comes out this fall, van der Kolk mentions being locked in the basement as a little boy for what he describes as "normal 3-year-old offenses" and hating himself for being too puny to fight back.
范德科爾克是一個骨瘦如柴的孱弱男孩，但這絲毫沒有減損他的勇敢。如果問起他的童年往事，他會告訴你在故鄉(xiāng)城市遭受轟炸后的廢墟上玩耍的故事。他周圍幾乎每個人都遭受了深深的創(chuàng)傷。左右的鄰居都是猶太人大屠殺的幸存者。他的母親一點也不樂意當(dāng)媽媽；14歲的時候她就輟學(xué)照顧自己的父親，之后又被迫離開了自己喜愛的職業(yè)以承擔(dān)身為人妻的責(zé)任。在家里的第二個孩子貝塞爾懂事之前，她的性格已經(jīng)變得刻薄而冷漠。范德科爾克的父親是荷蘭皇家殼牌集團(Royal Dutch Shell)的高管。盡管他是一名虔誠的新教徒，也是忠實的和平主義者，但盛怒之下他也會在孩子們身上泄憤。在秋天將要面世的新書《身體記得》(The Body Keeps the Score)中，范德科爾克提到，當(dāng)他還是個小男孩時，曾經(jīng)因為“正常的3歲孩子都會惹的禍”而被關(guān)在地下室里，只能怨恨自己太弱小，無力反抗。
As a teenager, he began traveling on his own. He liked to hitchhike into France. On one such trip, as he passed a monastery, he heard the chanting of monks and was so taken with the sound that he asked the driver to let him off there. He spent the rest of that summer, and the following Easter break, and the summer after that, at the monastery contemplating monkhood. The abbot took a liking to him and promised that if he joined the order, they would send him to Geneva for medical school. "I seriously considered it," he told me. But in the end, a youthful thirst for adventure beat out any yearning he might have felt for quiet meditation, and he chose the University of Hawaii instead. "I still have some spiritual feelings," he says. "I believe that all things are connected. But organized religion gives me the creeps."
十幾歲的時候，他開始獨自旅行。他喜歡搭便車到法國去。在一次這樣的旅行中，他在途經(jīng)一所修道院時聽到修道士們誦經(jīng)的聲音，并為之深深打動，于是請求司機讓他在那里下車。他在那所修道院度過了當(dāng)年夏天剩下的所有時間，然后是次年的復(fù)活節(jié)假期，以及之后的又一個夏天，甚至考慮要不要成為一名修道士。修道院院長對他很有好感，并承諾如果他加入修會，他們就送他到日內(nèi)瓦讀醫(yī)學(xué)院。“我認真考慮過這個提議，”他告訴我。但最終，年輕的心對冒險的渴望戰(zhàn)勝了他對安靜冥想的向往，于是他選擇了夏威夷大學(xué)(University of Hawaii)?！拔胰匀挥幸恍┚窀袘?yīng)，”他說?！拔蚁嘈湃f事萬物都彼此關(guān)聯(lián)。但組織有序的宗教讓我渾身發(fā)毛?！?/div>
And so in 1962, he came to the United States and made his way from the University of Hawaii to the University of Chicago to Harvard Medical School, where he posed to science and medicine all of his many questions about the horrors of human nature and the miracles of human resilience. "The human species is messed up," he says. "We make the same mistakes over and over, and I'm deeply curious about why that is. Why do we keep doing things that we know are horrible and will have terrible consequences?"
就這樣，1962年，范德科爾克來到了美國，并先后就讀于夏威夷大學(xué)、芝加哥大學(xué)(University of Chicago)和哈佛醫(yī)學(xué)院。在這里，他將自己關(guān)于人性中恐怖的一面，以及人類神奇的適應(yīng)和恢復(fù)能力的許多問題，擺在了科學(xué)和醫(yī)學(xué)面前?！叭祟愡@個物種可真是一團糟，”他說?！拔覀兛偸且槐橛忠槐榈胤竿瑯拥腻e誤。我真好奇這究竟是為什么。為什么我們明知道會釀成大禍，惹來不可收拾的后果，卻還是會一意孤行？”
One of van der Kolk's first jobs out of school was as a staff psychiatrist at the Veterans Affairs clinic in Boston; he arrived there in 1978, in time for the influx of Vietnam veterans. "The waiting list to see a doctor was a mile long," he says. "And the clinic's walls were pocked full of fist imprints."
離開學(xué)校后，范德科爾克的頭幾份工作里包括在退伍軍人事務(wù)部下屬的一家波士頓診所擔(dān)任精神科醫(yī)師。他入職時正值1978年，越戰(zhàn)老兵洪水一般地涌來。“等候看診的隊伍足有一英里長，”他說?！霸\所的墻上到處是被拳頭打出來的印記。”
The first thing van der Kolk noticed about his new patients was how utterly stuck in the past they were. Even the older veterans from World War II seemed to vacillate between one of two states: immersion in their wartime experiences or lifeless disengagement. In Rorschach tests, every inkblot was a dead baby, a fallen comrade or nothing at all. It was as if war had broken the projector of their imaginations, he says, and their only options were to play one reel over and over or turn the machine off altogether.
在這些新患者身上，范德科爾克首先注意到的一件事是，他們都將自己完全困在過去里。即使是那些從二戰(zhàn)戰(zhàn)場上歸來的老一批的退伍軍人也常常在兩種狀態(tài)之間搖擺：或是沉溺于戰(zhàn)爭經(jīng)歷中無法自拔，或是看破紅塵四大皆空。在羅夏測試(Rorschach test)中，他們不是把墨跡看成死去的嬰兒或倒下的戰(zhàn)友，就是覺得什么都不像。仿佛是他們腦海中的投影儀被戰(zhàn)爭弄壞了，范德科爾克說，于是他們只能選擇把一卷影像翻來覆去地看，或者干脆把機器徹底關(guān)掉。
The second thing that struck van der Kolk was how the men managed their own conditions. Almost all of them claimed that highly risky behaviors were capable of yanking them into the present in a way that no form of therapy could (one patient, for example, rode his Harley at breakneck speeds whenever he felt himself swirling into a rage or disconnecting from his surroundings). Van der Kolk's treatment — the only thing he had been taught in medical school — involved getting the men to talk. In both group and one-on-one sessions, he would ask them about their horrible memories, nightmares and troubles at home. But talking didn't seem to help; in some cases, he thought, it made things worse.
令范德科爾克感到震驚的第二件事是這些人控制自己狀況的方式。幾乎所有人都聲稱，與任何形式的治療相比，高風(fēng)險的行為更可能將他們拉回現(xiàn)實（例如，一名患者稱，每當(dāng)覺得自己快要暴跳如雷或者游離于現(xiàn)實之外時，他就騎著哈雷摩托車玩兒命地飆車）。范德科爾克的治療手段——也就是醫(yī)學(xué)院唯一教他做的——是讓這些人敞開心扉，多多交談。在小組和一對一的治療會話中，他都會詢問他們很多問題，關(guān)于那些可怕的回憶、關(guān)于夢魘以及在家里遇到的麻煩等等。但談話似乎并沒什么幫助；甚至在某些病例中，他覺得適得其反。
Van der Kolk scoured the clinic's medical library for books on shell shock and combat fatigue — anything that might help him better understand what he was seeing or give him some clue about how to treat it. Post-traumatic stress disorder was not yet a recognized condition. Then he came across a book at Harvard's Francis A. Countway medical library, "The Traumatic Neurosis of War." It was published in 1941, just before shellshocked American veterans would return from World War II. In its pages, van der Kolk found the first seeds of an idea that would ultimately shape his career: The nucleus of neurosis is physioneurosis. In other words, he thought, the root of what would eventually be called PTSD lay in our bodies.
范德科爾克翻遍了診所的醫(yī)學(xué)圖書館中關(guān)于炮彈休克癥(shell shock)和戰(zhàn)斗疲勞癥(combat fatigue)的書籍，尋找可能幫助他更好地了解患者癥狀的任何信息，或者有助于他進行治療的任何提示。在那個時代，創(chuàng)傷后應(yīng)激障礙還未被公認為一種疾病。后來，他在哈佛的弗朗西斯·A·康特韋醫(yī)學(xué)圖書館(Francis A. Countway Library of Medicine)里發(fā)現(xiàn)了一本書：《戰(zhàn)爭的創(chuàng)傷性神經(jīng)官能癥》(The Traumatic Neurosis of War)。該書出版于1941年，正好是在飽受炮彈休克癥困擾的美國老兵從第二次世界大戰(zhàn)中歸來之前。在這本書中，范德科爾克找到了一些最初的靈感。這些靈感最終指明了他職業(yè)生涯的方向：神經(jīng)官能癥的核心在于軀體性神經(jīng)官能癥。換句話說，他認為，日后所稱的PTSD的根源深埋在人類的身體之中。
This meshed perfectly with what van der Kolk was seeing in his patients. In addition to their nightmares and hallucinations, many of them had a host of physical ailments, including headaches, fatigue, digestive troubles and insomnia. When he tried accessing their traumas in therapy, they often became jittery, broke into cold sweats or shut down. The book, van der Kolk said, did not offer any suggestions for treatment, but it did give him a starting point. In the two decades that followed, he made a careful study of all his patients' physiological symptoms. And in 1994, not long before his Harvard lab was shuttered, he wrote a paper in The Harvard Review of Psychiatry summarizing all he had learned. Traumatic stress, it seemed, triggered a cascade of physiological catastrophes that affected almost every major system in the body.
這與范德科爾克在患者身上的所見所聞完全吻合。除了噩夢和幻覺，許多患者還遭受著眾多生理癥狀的折磨，包括頭痛、疲勞、消化系統(tǒng)疾患和失眠等。當(dāng)他在治療中試圖觸及他們的創(chuàng)傷時，他們往往一下子就變得如同驚弓之鳥一般，渾身冷汗涔涔或者將自己完全封閉起來。范德科爾克表示，雖然這本書并沒有提供任何治療建議，但給了他一個起點。在接下來的20年里，他仔細研究了他所有患者的生理癥狀。1994年，就在他在哈佛的實驗室被關(guān)閉前不久，他撰寫了一篇論文總結(jié)了自己的所有發(fā)現(xiàn)，并發(fā)表在《哈佛精神病學(xué)評論》(The Harvard Review of Psychiatry)上。創(chuàng)傷應(yīng)激似乎可以觸發(fā)一連串的生理性災(zāi)難，幾乎影響到身體的所有主要系統(tǒng)。
Eugene was on military leave in San Francisco, about halfway through his tour of duty, when he first realized something was wrong. The bay was cool and breezy; people were walking around in parkas and hoodies. But he was sweating profusely. He thought his months in the desert had maybe activated some weird sweat gene that needed time to turn itself off. He figured it would pass eventually. It didn't. By the time he came home for good, sweat was the least of his problems. He was seeing dead bodies on the side of the road. And he could not stop going to the bathroom. At his first post-military job in the corporate offices of a large bank, he went to the bathroom so often that he was sure his co-workers wondered what was wrong with him.
尤金第一次意識到自己出了問題時，他的服役期差不多已經(jīng)過半，當(dāng)時正在舊金山軍事休假。海灣天氣涼爽，微風(fēng)拂面；四周漫步的人們都身著風(fēng)雪大衣和連帽衫。但他自己卻滿頭大汗。他一度以為這是因為數(shù)月來自己在沙漠中的生活，激活了某些與出汗有關(guān)的奇特基因，需要過一段時間它們才會自行關(guān)閉。他估計慢慢就會好起來的。但事實并非如此。等他徹底退役回家時，他才發(fā)現(xiàn)，出汗只是個最最微不足道的問題。他出現(xiàn)了幻視，看到路邊堆積著尸體。他需要不停地去衛(wèi)生間。他退伍后的第一份工作是在一家大銀行的總部辦公室任職，由于他去洗手間太過頻繁，他敢肯定同事們都懷疑他有毛病。
| 重點單詞 | 查看全部解釋 | |||
| monastery | ['mɔnəs.teri] |
想一想再看 n. 修道院，寺院 |
聯(lián)想記憶 | |
| shell | [ʃel] |
想一想再看 n. 殼，外殼 |
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| vast | [vɑ:st] |
想一想再看 adj. 巨大的，廣闊的 |
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| therapist | ['θerəpist] |
想一想再看 n. 臨床醫(yī)學(xué)家 |
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| guilt | [gilt] |
想一想再看 n. 罪行，內(nèi)疚 |
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| resolve | [ri'zɔlv] |
想一想再看 n. 決定之事，決心，堅決 |
聯(lián)想記憶 | |
| acute | [ə'kju:t] |
想一想再看 adj. 敏銳的，劇烈的 |
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| diverse | [dai'və:s] |
想一想再看 adj. 不同的，多種多樣的 |
聯(lián)想記憶 | |
| complex | ['kɔmpleks] |
想一想再看 adj. 復(fù)雜的，復(fù)合的，合成的 |
聯(lián)想記憶 | |
| projector | [prə'dʒektə] |
想一想再看 n. 放映機(探照燈，發(fā)射裝置，設(shè)計者，制圖投射線) |
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