The military had little to offer. "They are not even trying to help," he would tell friends and relatives. "You say, ‘I have horrible diarrhea, and I can't stop going to the bathroom.' And they say, ‘Stop going to the bathroom.' Or you say, ‘I have a horrible time with the subway; the noise just terrifies me.' And they say, ‘Well, New York is pretty noisy.' " One doctor prescribed an anti-anxiety medication, but it was so strong that Eugene started walking into walls. He tried talk therapy and group therapy. Neither did anything to relieve the uncomfortable tingling up his spine or the constant feeling that he was about to be attacked from behind.
軍隊幫不上什么忙?！八麄兩踔粮緵]有嘗試過提供幫助，”他這樣告訴親戚朋友們。“你跟他們說，‘我腹瀉很嚴重，簡直離不開衛生間。'結果他們回答，‘那就別去衛生間。'你跟他們抱怨，‘我很怕乘地鐵；那些噪音讓我驚恐萬分。'他們卻說，‘沒錯，紐約是怪嘈雜的。'”曾有一位醫生給他開了些抗焦慮的藥物，可是那藥效果太過猛烈，以至于尤金開始犯迷糊，走著走著都會撞到墻上。他也嘗試過談話治療和團體治療。但這些都未曾緩解他不安的驚懼，也沒能消除他總感覺隨時會被人背后偷襲的那種恐慌。
He was nearly a full decade into this private war by the time he came to sit across from van der Kolk in the room overlooking the Pacific and to tell a group of strangers how he killed an innocent man.
在這場“與自己的戰爭”中，他幾乎已經孤軍奮戰了整整10年，直到此刻——他來到這個俯瞰太平洋的小房間里，坐在范德科爾克的對面，向一群陌生人坦承，自己怎樣殺死了一個無辜的人。
Mosul reminded Eugene of a movie, he said: an old western in which the bad guys take over some small town, and all the townsfolk hide indoors and tumbleweed blows across the screen. In this movie, though, the bad guys were crazy terrorists who not only fired on Eugene and his team constantly but also strapped explosives to themselves, wandered into residential areas and detonated.
在摩蘇爾的經歷讓尤金想起了一部電影，那是個很老的西部片，他說，壞人們占據了小鎮，所有的居民都躲在屋里，關門閉戶，銀幕上只有大風卷著草團吹過。不過，在尤金的故事里，壞人們是瘋狂的恐怖分子，他們不僅不斷地朝尤金和他的隊伍開槍，還會往自己身上綁上炸藥，潛入居民區然后引爆。
Eugene was on the security detail for a bomb patrol when a man drove up without yielding for inspection. Eugene signaled to him to stop, but the man kept his foot on the gas. Eugene signaled a second time, and a third.
當時尤金正在一個炸彈巡邏隊中執行安保任務，一名男子駕車而來，卻拒絕接受檢查。尤金做手勢叫他停車，但該男子仍舊將腳踩在油門上。尤金第二次對他示意，然后是第三次。
Stop. Stop. Stop.
停車。停車。停車！
The man kept driving. So Eugene opened fire. His team searched the car afterward but found no bombs. As Eugene left the scene, he saw the man's mother. She ran over to the car, distraught.
但那名男子仍在向前開。于是尤金開槍了。事后，他的小隊搜查了那輛車，卻沒有發現炸彈。正當尤金要離開現場時，他看到了那名男子的母親。她向汽車跑去，悲痛欲絕。
As he told us this, Eugene stared into the empty space between him and van der Kolk. His face was red and contorted, and it was easy to imagine that he was not so much remembering what happened as reliving it. I wondered what torments had led him to submit to such an experiment. I wondered how it could possibly work.
講到這里，尤金的目光落在他和范德科爾克之間的虛空里。他臉色通紅表情扭曲，很容易想象，他在回顧那段情節時，記憶并不十分清晰。我暗想要怎么樣的痛苦，才會迫使他愿意參加這么一項實驗，更好奇這種治療到底怎么能產生效果。
"What do you want the mother to know?" van der Kolk asked. Again, Eugene covered his face and broke into loud sobs.
“你想讓那位母親知道些什么？”范德科爾克問道。尤金再次捂住了臉，大聲哭泣起來。
"I'm sorry," he said. "I'm so, so sorry. There are not words for how sorry. . . ." He buried his face in his hands again. "Do you want to look at her?" van der Kolk asked. Eugene couldn't seem to speak, but he lifted his head and squinted at me with one eye. It was too much. He tucked his chin into his chest, wracked by sobs.
“對不起，”他說?！拔艺娴姆浅?，非常抱歉。我無法用語言來表達我的歉意……”他又把臉埋在掌心里?！澳阆肟粗龁幔俊狈兜驴茽柨擞謫?。尤金一時說不出話來，但他還是抬起頭，用一只眼睛飛快地瞟了我一眼。只是這已經超出了他所能承受的限度。他埋下頭，哭得不能自已。
"The witness sees how truly sorry and how upset you are," van der Kolk said. I kept my eyes focused on Eugene, so I didn't see van der Kolk's face. But Kresta would later tell me that watching him was like watching a wizard or a magician or a superfast computer. She could see him tracking Eugene's facial expressions, tone of voice and changes in posture and responding to each in microseconds, posing a question or remarking "the witness sees."
“你真心的悔恨和難過，見證人都看到了，”范德科爾克說。我一直凝視著尤金，所以我看不到范德科爾克的表情。但后來克雷斯塔告訴我，看著他，就好像是看著一個巫師或魔法師，又或者像一臺超高速電腦。她留意到，他一直密切關注著尤金的面部表情、語調和姿勢中的變化，并在幾微秒內就對它們作出相應的反應，時而提出問題，時而旁白“見證人看到了”。
Van der Kolk instructed me in a low, steady voice. "Tell him that you forgive him," he said. "Tell him you understand that it was a crazy time, and you know that he didn't mean to do what he did. He was very young, and both of you were trapped in the same hell. Tell him you forgive him. And that you are O.K. now." I repeated the words. I tried to make them sound genuine. I found myself hoping, fervently, that Eugene could hear me.
范德科爾克以低沉平穩的聲音指示我。“告訴他，你原諒他，”他說。“告訴他你明白那時候是非常時刻，你知道他不是故意的。他還很年輕，你們都同樣被困在地獄中飽受折磨。告訴他你原諒他，你現在已經沒事了?！蔽抑貜椭@些話，盡力讓它們聽起來發自肺腑。我發現自己熱切地盼望尤金能夠把我的話聽進心里。
For a man who speaks to more than 15,000 people a year, van der Kolk has a surprisingly hard time projecting his voice. His thick Dutch accent is easy enough to decipher if you're sitting right next to him, but it is difficult to penetrate from even a few feet away. As is often the case, the first audience comment at a recent lecture he gave in Philadelphia was "We can't hear you!" Van der Kolk asked a sound technician to turn up the volume and promised the 200 or so attendees that he would speak as loudly as he could. There were some grumbles, even from people in the front row, who still couldn't hear him. But van der Kolk is effusively charming and, as usual, managed to win the group over quickly.
說起來令人難以置信，作為一個每年聽眾總數可達1.5萬以上的人，范德科爾克并不擅長演講。他帶著厚重的荷蘭口音，如果你就坐在他旁邊的話倒是也不難聽懂，但哪怕只隔開幾英尺遠，你就會覺得不知所云了。所以情況經常會像他在費城的最近一次講座這樣，聽眾們對他的第一條評論是：“我們聽不清！”范德科爾克請求音效師幫他調高音量，并向與會的200來人承諾，他會盡可能地大聲。但還是有聽眾們聽不到他在說什么，即使有些人已經是在前排，于是頗有些抱怨的聲音。但范德科爾克總是那么熱情洋溢，令人傾倒。與往常一樣，他很快就征服了聽眾。
"Everybody hunch their backs forward and droop their heads, like this," he said, demonstrating. "Now try saying: ‘Oh, I'm feeling great! I'm very happy today!' " The audience laughed. "See, it's impossible to feel happy in that position." To drive the point home, he asked us to do the opposite: sit upright, assume cheerful expressions and then try to feel bad.
“請大家弓起后背并低頭，就像這樣，”他一邊說一邊親身示范?！艾F在請試著說：‘哦，我感覺好極了！我今天非常開心！' ”場下出現了笑聲?！澳憧?，在這種姿勢下，你是不可能感到幸福的?！睘榱藦氐妆砻髯约旱挠^點，他讓我們擺出相反的姿勢：坐直身子，展現歡快的表情，然后試著去感覺難過。
The mind follows the body, he said.
心隨體轉，他說。
Trauma victims, van der Kolk likes to say, are alienated from their bodies by a cascade of events that begins deep in the brain with an almond-shaped structure known as the amygdala. When faced with a threat, the amygdala triggers a fight-or-flight response, which includes the release of a flood of hormones. This response usually persists until the threat is vanquished. But if the threat isn't vanquished — if we can't fight or flee — the amygdala, which can be thought of as the body's smoke detector, keeps sounding the alarm. We keep producing stress hormones, which in turn wreak havoc on the rest of our bodies. It's similar to what happens in chronic stress, except that in traumatic stress, the memories of the traumatic event invade patients' subconscious thoughts, sending them back into fight-or-flight mode at the slightest provocation. Therapists and patients refer to this as being "reactivated." In the short term, patients avoid the pain it causes by "dissociating." That is, they take leave oftheir bodies, so much so that they often cannot describe their own physical sensations. This happens a lot in therapy, van der Kolk says.
范德科爾克總喜歡說，創傷受害者的精神與身體脫節了，而這是由大腦深處被稱為杏仁核的結構開始的級聯反應造成的。在遇到威脅時，杏仁核會激發出“戰或逃”反應，其中涉及大量激素的釋放。這種反應通常會持續到威脅消除為止。但如果威脅一直沒有消失——如果我們不能反抗也不能逃跑——那么杏仁核這個“人體的煙霧探測器”就會不停地拉響警報。于是我們就不斷地制造應激激素，進而大肆破壞我們身體的其余部分。這與慢性應激的過程非常相似，區別只在于在創傷應激中，關于創傷事件的記憶侵入了患者的潛意識中，哪怕是最輕微的刺激都會令他們回到“戰或逃”模式。治療師和患者將其稱為被“激發”。短期內，患者會通過“游離于世外”的方式來回避它所引發的痛苦。也就是說，他們會將自己的精神從軀體上抽離開，以至于無法準確地描述自己的身體感覺。這在治療中屢見不鮮，范德科爾克說。
In the long term, they become experts in self-numbing. They use food, exercise, work — or worse, drugs and alcohol — to stifle physical discomfort. The longer they do this, the more difficult it becomes to remain present in any given moment. "That's why the guy at the end of ‘The Hurt Locker' is so utterly incapable of playing with his kid," van der Kolk says.
長此以往，他們往往會成為自我麻木的高手，用食物、運動、工作——或者是更糟糕的毒品和酒精——來遏殺身體上的不適。這樣做的時間越長，他們就越難以在哪個時刻不游離。“這就是電影《拆彈部隊》(The Hurt Locker)結尾時那人根本無法與自己的孩子一起玩耍的原因，”范德科爾克說。
The goal of treatment should be to resolve this disconnect. "If we can help our patients tolerate their own bodily sensations, they'll be able to process the trauma themselves," he says. In his own patients, particularly those suffering from treatment-resistant PTSD, yoga has proved an especially good way to do this. So has emotional freedom technique, or tapping. With a therapist's guidance, the patient taps various acupressure points with his or her own fingertips. If done correctly, it can calm the sympathetic nervous system and prevent the patient from being thrown into fight-or-flight mode. Ultimately, van der Kolk supports almost any therapy that involves paying careful attention to patients' physiological states, like psychomotor therapy, or getting up and moving around through theater, dance and even karate. For patients with acute PTSD from isolated traumatic memories (think car accidents or single-episode assaults), van der Kolk is a fan of eye movement desensitization and reprocessing, or E.M.D.R., in which a therapist wiggles fingers back and forth across the patient's field of vision and the patient tracks the fingers while "holding in mind" the traumatic memory. Proponents say the technique enables patients to process their traumas so that they pass into memories and stop invading the present. Van der Kolk likes to point out that he came to the technique as a skeptic. "It's this weird treatment," he said. "You ask people to remember what happened to them, and you wiggle your finger in front of their eyes and have them follow it. Crazy." More than 60,000 therapists around the world have now been certified in E.M.D.R., though the practice remains controversial, with critics and supporters debating the validity of each new study. Van der Kolk places his faith in what he sees in his own patients, he says. For them, E.M.D.R. has been a godsend.
治療的目標應該是解決這種脫節問題?！叭绻覀兡軌驇椭颊吣褪茏约旱纳眢w感覺，他們就可以自己處理所受到的創傷，”范德科爾克解釋道。在他自己的患者，尤其是那些難治性PTSD患者中，瑜伽在這方面的效果被證明尤其值得稱道。情緒釋放術(emotional freedom technique)又被稱為穴位按摩，效果也不錯。在治療師的指導下，患者們使用自己的指尖點按不同的穴位。如果方法正確，它可以平復交感神經系統，防止患者陷入“戰或逃”模式。歸根結底，范德科爾克對所有密切關注患者生理狀態的療法幾乎都抱著支持的態度，如精神運動療法、起立并在劇場中漫步、舞蹈，乃至空手道。對于從孤立的創傷記憶（如車禍或一次性的襲擊）中罹患急性PTSD的病人，范德科爾克也很贊成采用眼動脫敏與再加工療法（eye movement desensitization and reprocessing，簡稱EMDR)。在這種療法中，治療師在患者的視野前來回晃動手指，并要求患者一面將“思緒停留”在創傷記憶上，一面用目光追隨著治療師的手指。支持者稱，這項技術可促使患者加工創傷事件，并將其轉化為過去的記憶，從而使它們不再侵犯當前的日常生活。范德科爾克很喜歡指明的一點是，最初接觸這項技術時，他也是滿腹狐疑?！斑@真是種古怪的治療，”他說?！澳憬倘藗冇浧鹱约旱脑庥?，還在他們的眼前晃動手指，讓他們的眼睛跟著轉。這太瘋狂了?！蹦壳埃澜绺鞯匾呀浻谐^6萬名治療師獲得了EMDR治療認證，但人們對這種療法一直存在爭議，批評者和支持者對每一項新研究正確與否都爭論不休。范德科爾克說，他更相信從自己患者身上觀察到的結果。對于他們而言，EMDR簡直是天賜的福音。
Van der Kolk's most vocal critics tend to have the same complaint: He overstates his case. There is far less evidence for therapeutic tapping or theater or massage therapy than for cognitive behavioral therapy or even exposure therapy. And while the National Institutes of Health and the Department of Defense have begun studying the benefits of yoga and E.M.D.R., van der Kolk's own studies have been criticized for a lack of rigor and small sample sizes; there were just 88 people in his 2007 study of E.M.D.R. and 64 people in his 2014 study of yoga. "Anyone is going to tell their therapist that they're doing better if they like their therapist," says Patricia Resick, a clinical psychologist and researcher in the use of C.B.T. for post-traumatic stress at Duke University. "You need an independent assessor." There is a standard in the field, Resick says, speaking broadly of his methodology. "If he wants to be taken seriously, he has to do studies that live up to that standard." (Van der Kolk points out that his E.M.D.R. and yoga studies both had blind raters.)
范德科爾克最為人詬病的地方似乎集中于一點：他過分夸大了自己病例的代表性。有關治療性穴位點按、劇院療法以及按摩療法的證據都遠遠少于認知行為療法，甚至還比不上暴露療法。雖然美國國立衛生研究院(National Institutes of Health)和國防部都已經開始研究瑜伽和EMDR的效益，但批評者指出，范德科爾克自己的研究缺乏嚴謹性，樣本也過??；他2007年的EMDR研究只涉及了88人，2014年的瑜伽研究也只入組了64人?！爸灰矚g自己的治療師，任何人都樂意告訴他們自己的感覺越來越好，”杜克大學(Duke University)的臨床心理學家、研究使用認知行為療法治療創傷應激的帕特里夏·雷斯尼克(Patricia Resick)說?！澳阈枰毩⒌脑u估?！痹谡劦椒兜驴茽柨说拇笾卵芯糠椒〞r，雷斯尼克表示，該研究領域自有其標準?！叭绻Ｍ藗儼阉敾厥聝?，他就需要完成符合這一標準的研究?！保▽Υ?，范德科爾克指出，他的EMDR和瑜伽研究均設有不知情的評價者。）
Van der Kolk has also been charged with oversimplifying neuroscience to support his clinical work. He likes to divide the brain into distinct regions — rational and emotional — that he says are "not all that connected to one another." He says the techniques he favors are capable of accessing the emotional brain, where the amygdala resides, whereas C.B.T., exposure therapy and talk therapy aren't necessarily capable of doing so. Van der Kolk has scores of fMRI scans showing that when faced with a trauma — or in the case of PTSD, with a traumatic memory — the prefrontal cortex becomes muted, the speech center becomes muted and the amygdala becomes hyperactive. But a vast majority of neurobiologists say the so-called rational and emotional brains are much more integrated than his model suggests. In fact, the two communicate regularly through a multitude of circuitous loops that researchers have only just begun to map. And the scans that van der Kolk uses offer a bird's-eye view of the brain — too sweeping to justify such detailed inferences. "He has a lot of interesting and important ideas, but the relatively weak connection to the brain detracts from his message," says Joseph LeDoux, a neuroscientist at New York University. "This happens in a lot of fields now. Everybody wants to use the brain to justify certain things. But sometimes what the brain does is more important than how it does it."
此外，也有人指責范德科爾克將神經科學過度簡單化，以支持自己的臨床工作。他喜歡將大腦劃分為理性與感性兩個截然不同的區域，用他的原話說是：“它們的相互聯系并非那么緊密?！彼暦Q自己所熱衷的技術可以作用于杏仁核所在的“情緒腦”，而認知行為療法、暴露療法和談話治療卻未必有這神通。范德科爾克手中有大量的功能性磁共振成像掃描資料顯示，在面對創傷時（對于PTSD患者則是面對創傷記憶時），前額葉皮層、語言中樞都沉寂下來，而杏仁核卻變得異常活躍。但絕大多數的神經生物學家都認為，所謂的理性腦和情緒腦并非如他的模型顯示的那樣彼此孤立，而是一個更為融合的有機體。實際上，它們經常通過眾多迂回曲折的神經回路彼此通訊，而科研人員在這方面的研究才剛剛起步。范德科爾克所使用的掃描圖提供的是大腦活動的概況，要是想解釋如此細節的問題，它們未免太過籠統?！八岢隽撕芏嗍钟腥ひ卜浅Ｖ匾南敕?，但與腦部的關聯并不緊密這一點是一大敗筆，”紐約大學(New York University)的神經科學家約瑟夫·勒杜(Joseph LeDoux)說。“這種現象在當今的很多領域都層出不窮。每個人都希望扯上大腦來證明些什么。然而有時候，大腦能做什么比它是怎么做的更加重要。”
Some of van der Kolk's closest colleagues have suggested that his exaggerations are by design. It's not so much that he abhors conventional therapies or thinks his own methods are ironclad. It's that he is trying to persuade people to be more open-minded. Indeed, when I pressed him on C.B.T., he acknowledged that it might have some uses, perhaps for anxiety or obsessive-compulsive disorder. And despite his contention that Prozac is less effective than E.M.D.R. at treating PTSD, he is not antimedication.
范德科爾克的一些最親密的同事指出，他的夸張其實是刻意為之。他并沒有那么厭棄傳統療法，也并不認為自己的方法無懈可擊。他只是試圖說服人們保持一種更加開通的態度。事實上，當我就認知行為療法追問他時，他承認這種療法在焦慮癥或強迫癥的治療中大概還是可以派上用場的。而且，雖然他認為百憂解(Prozac)治療PTSD的效果不如EMDR，但他并不是絕對地反對用藥。
But there is a larger issue, too. "Testing a therapeutic technique is not like conducting a drug trial," says Frank Ochberg, a professor at Michigan State University and clinical psychiatrist who specializes in PTSD. "With a drug trial, everyone gets the exact same pill or the exact same placebo. With therapy, you can't separate the tools from the person using the tools. There's no good experimental technique for measuring a therapist's kindness, wisdom or judgment."
不過，還有一個更大的問題。“測試治療技術與進行藥物試驗不同，”密歇根州立大學(Michigan State University)的教授、專門從事PTSD研究的臨床精神病學家弗蘭克·歐什博格(Frank Ochberg)說?！霸谒幬镌囼炛校惺茉囌叩玫降氖峭耆嗤乃幫杌蛲耆粯拥陌参縿６鴮τ谥委熂夹g而言，就無法將工具與使用工具的人割裂開來。目前還沒有足夠成熟的實驗技術來衡量治療師的友善程度、智慧或判斷力?！?/span>
For his part, van der Kolk says he would love to do large-scale studies comparing some of his preferred methods of treatment with some of the more commonly accepted approaches. But funding is nearly impossible to come by for anything outside the mainstream. In the wake of the Sept. 11 terrorist attacks, he says, he was invited to sit on a handful of expert panels. Money had been designated for therapeutic interventions, and the people in charge of parceling it out wanted to know which treatments to back. To van der Kolk, it was a golden opportunity. We really don't know what would help people most, he told the panel members. Why not open it up and fund everything, and not be prejudiced about it? Then we could study the results and really learn something. Instead, the panels recommended two forms of treatment: psychoanalysis and cognitive behavioral therapy. "So then we sat back and waited for all the patients to show up for analysis and C.B.T. And almost nobody did." Spencer Eth, who was then the medical director of behavioral health services at St. Vincent's Hospital in Manhattan, gathered data on the mental-health care provided to more than 10,000 Sept. 11 survivors. The most popular service by far was acupuncture. Yoga and massage were also in high demand. "Nobody looks at acupuncture academically," van der Kolk says. "But here are all these people saying that it's helped them."
至于范德科爾克，他表示自己很希望能進行一些大規模的研究，將他比較偏愛的治療方法與已經獲得普遍接受的其他一些方法進行比較。只是，想要做些主流之外的事情，幾乎是不可能弄到資助的。他回憶道，在9·11恐怖襲擊之后，他曾應邀參與四五個專家小組。他們已經拿到了一筆指定用于治療干預的經費，于是負責人征求他們的意見，問他們應該拿這些錢來支持哪些治療。對范德科爾克來說，這是一個千載難逢的好機會。我們確實不知道什么方法可以最大限度地為人們提供幫助，他對小組成員這樣說道。那我們為什么不徹底放開成見，資助所有的療法呢？這樣我們就可以研究所得的結果，從中真正獲得一些知識?？上屡c愿違，專家小組推薦了兩種形式的治療：精神分析和認知行為療法。“于是我們坐等患者來接受分析和認知行為治療。結果幾乎是無人問津?！彼古巳ぐ?Spencer Eth)當時在曼哈頓的圣文森特醫院(St. Vincent's Hospital)行為健康服務部門擔任醫療主任，他搜集了關于1萬多名9·11幸存者接受心理健康醫療服務的資料。截至目前，最受歡迎的服務是針灸，瑜伽和按摩的呼聲也甚高?！皼]人把針灸抬入學術的大雅之堂，”范德科爾克說?！暗羞@些人都說它很有用。”
Van der Kolk is always evaluating his own clinical experiences for clues to what works best. "Maybe I should have done E.M.D.R. with Eugene instead of that structure," he said not long after the California workshop. "I'm not sure how much good it will do."
一直以來，范德科爾克都在借助評估自己的臨床經驗來尋找最佳療法的蛛絲馬跡?！盎蛟S我該對尤金用EMDR，而不是構造練習，”在加州的研討會后不久，他對我說?！拔也惶_定它會有多大效果?！?/span>
Back at the Trauma Center in Boston, van der Kolk and his colleagues are working on what he sees as the next step: redefining trauma itself. "We have a tendency now to label everything as PTSD," he says. "But so much of what we see is the result of long-term, chronic abuse and neglect. And that produces a different condition than one-off, acute traumatic incidents." Van der Kolk and his colleagues call this chronic form of traumatic stress "developmental trauma disorder"; in 2010, they lobbied unsuccessfully to have it listed in the Diagnostic and Statistical Manual of Mental Disorders as a condition separate from PTSD. They're hoping that with more data, they might finally prevail. Formal acceptance, van der Kolk says, is the key to getting support.
回到波士頓的創傷中心，范德科爾克及其同事們正投身于他信奉的下一步研究：重新定義創傷本身?！叭缃裎覀兛偸莾A向于把什么都貼上PTSD的標簽，”他說?！暗?，我們今天所見的很多癥狀都是長期、慢性的虐待和忽視的結果。由此產生的疾病與一次性的急性創傷事件有所不同。”范德科爾克及其同事們將這種創傷應激的慢性形式稱為“進行性創傷障礙(developmental trauma disorder)”。2010年，他們曾經試圖游說 《精神疾病診斷與統計手冊》(Diagnostic and Statistical Manual of Mental Disorders)的編制機構將其從PTSD中分離出來，作為一種單獨的疾病列入，但未能成功。他們希望在更多數據的支持下，最終將得償所愿。來自官方的正式接受是爭取支持的關鍵，范德科爾克說。
"There's a grant to give more than $8 million to help survivors of the marathon bombing," van der Kolk mentioned one afternoon. "That's psychotic. Yes, it was horrible, and yes, those people are suffering and deserve help. But we have tens of thousands of children being traumatized every day, right in the same city — a couple million across the country — and no one is offering to help them." I asked why he thought that was. He told me about Pierre Janet, a psychiatrist at the Salpêtrière Hospital in 19th-century Paris. Janet published the first book on what was then called hysteria but which we now refer to as PTSD. He, too, became enmeshed in a dispute with his peers. He, too, was forced out of his laboratory.
“幫助波士頓馬拉松爆炸案幸存者的專項撥款達800萬美元以上，”范德科爾克在一天下午提到。“簡直是精神錯亂！沒錯，爆炸案非常可怕，而且，那些人也的確備受煎熬，值得救助。然而，就在這同一座城市里，每天都有數以萬計的兒童遭受創傷，如果把統計范圍擴展到全美，這個數字可達兩百萬，卻沒有人向他們伸出援手。”我問他認為其中的原因何在。他對我講述了19世紀巴黎薩伯特慈善醫院(Salpêtrière Hospital)的一名精神科醫生皮埃爾·雅內(Pierre Janet)的故事。雅內出版了第一本關于當時被稱為“歇斯底里”的PTSD的著作。他也陷入了與同行的爭論之中，也被迫離開了自己的實驗室。
"There's this cycle of knowing and forgetting," van der Kolk told me. "We discover trauma. And then when we see how horrifying and how inconvenient it is, we turn on the concept and peel off the messengers." Without missing a beat, he segued from Janet to World War I and World War II, explaining how the military establishments in both Europe and the United States stigmatized shell shock and combat fatigue, for fear that they would undermine the war effort. It's willful amnesia, he said, and he had plenty of more recent examples. Just a few years ago, he interviewed a group of foster children at a United States Senate hearing on the state of foster care. "Afterward, I'm sitting with the kids," van der Kolk said. "And a judge walks past us on his way out, and he says to the kids: ‘You're all doing so great! Look how terrific you all are!' And I say, ‘Well, no, why don't you ask them how they're doing?' These are kids that have suffered significant abuse and neglect. A couple of them are suicidal. They have substance-abuse problems. One of them cuts herself. But the judge didn't want to hear about that any more than we want to hear about what really happens to soldiers when they're off at war."
“這是一種認識和遺忘的循環，”范德科爾克告訴我?！拔覀儼l現了創傷。然后，當我們認識到它有多么可怕和多么令人為難時，我們會轉而攻擊這個概念，并排斥將這個概念帶給我們的人。”他繼續不厭其詳地對我講述從雅內到第一次世界大戰再到第二次世界大戰的歷史，并解釋了歐洲和美國的軍事權威部門是如何抹黑炮彈休克癥和戰斗疲勞癥的，因為他們害怕它們會削弱戰斗力。這是故意的失憶，他說，并且舉出了大量近期的例子。就在幾年之前，他在聯邦參議院關于寄養情況的聽證會上問詢了一批寄養兒童?！昂髞?，我跟孩子們坐在一起，”范德科爾克說?！耙幻ü僭诔鲩T時從我們身邊走過，他對孩子們說，‘你們做得非常棒！非常了不起！'于是我說，‘哦不，你為什么不問問他們到底好不好？'這些都是遭受了嚴重的虐待和忽視的孩子，其中有幾個人有自殺傾向，還有人存在物質濫用的問題，一個女孩子喜歡拿刀割傷自己。但法官并不想聽到那些，就像在戰爭結束后，我們一點也不關心士兵們究竟怎么樣了?！?/span>
Before enlisting in the Army, Eugene earned a bachelor's degree in art history from the American University of Paris. Now he's an antique art dealer. He lives in Queens with his wife and 3-year-old daughter but often goes into Manhattan to meet clients and visit galleries. I met him for coffee on the Upper East Side a couple of months after van der Kolk's workshop. I wanted to know how he felt about the exercise now that some time had passed. Did he think it had any impact on his PTSD?
在從軍之前，尤金在巴黎美國大學(American University of Paris)拿到了藝術史學士學位?，F在，他是一名古董藝術品經銷商。他與妻子和3歲的女兒住在皇后區，經常到曼哈頓去見客戶或拜訪畫廊。在參加范德科爾克的研討會幾個月之后，我約他在上東區喝咖啡。我想知道，經過一段時間之后，他現在對“架構”練習的感覺如何。他覺得這對PTSD有效果么？
What intrigued him most, he said, is how well it worked in the moment. Whatever spell van der Kolk cast lingered into the next day, so that Eugene really saw me, a complete stranger, as the object of his guilt. "I was terrified of you," he told me. It wasn't until the following day, when van der Kolk had me forgive him a second time, that the spell finally broke and he was able to face me as just another workshop participant. "It reminded me of that movie ‘The Master,' with Philip Seymour Hoffman," he said. "When Amy Adams asks Joaquin Phoenix, ‘What color are my eyes?' and he says, ‘Green,' and she says, ‘Turn them blue,' and you see them change color. It really reminded me of that."
最令他著迷的，是這種練習的效果立竿見影，尤金說。范德科爾克的“咒語”的魔力直到第二天也沒有消退，這讓尤金真的將我，一個完全的陌生人，當成了他心懷愧疚的對象?！拔液芘履悖彼嬖V我。然后又過了一天，范德科爾克讓我第二次對他表示原諒，那咒語才最終被打破，他終于能夠面對我，將我還原為研討會的普通參與者而已?！斑@讓我想起了菲利普·塞默·霍夫曼(Philip Seymour Hoffman)主演的電影《大師》(The Master)，”他說?！鞍Ｃ住啴斔?Amy Adams)問華金·菲尼克斯(Joaquin Phoenix)，‘我的眼睛是什么顏色？'他回答，‘綠色。'她又說，‘請把它們變成藍色，'然后你就看到那眼睛真的變色了。真的，這確實讓我想起了那一幕?！?/span>
For a while at least, he said, he felt better. He recalled driving down the Pacific coast with his wife the day the workshop ended and noticing how weird it was not to feel stressed out. For weeks he was able to drive and use the subway with no trouble. "It felt like it sort of repaired my perception somehow," he said. "I used to always feel paranoid — like, I'd get freaked out going to my doctor because there were all these security guards in the waiting room — and for a while that was lifted."
他說，至少有一段時間，他感覺好多了。他回憶起研討會結束那天，他開著車帶著妻子沿著太平洋海岸向南行駛，很驚異地發現自己似乎不再被壓得喘不過氣來了。在幾個星期里，他可以毫無障礙地駕駛汽車和乘地鐵?！熬秃孟袷俏业母兄δ懿恢醯木徒o修好了，”他說。“我以前總是很疑神疑鬼——比如，就因為候診室里面有保安，出去看醫生都會嚇壞我。但這種念頭有一陣子沒有出現?！?/span>
But some of those effects were starting to fade. He was having headaches and memory problems again, and he was trying to figure out what triggered the relapse. He thought it had something to do with a painting he saw. He attended an Asian art fair earlier in the week, and an Arab dealer was selling some contemporary paintings; most of them were of soldiers, but one was of a woman. She looked like me, he said. He remembered staring at it and freezing up. The next day at a client's house, he misplaced his briefcase. "It was like I threw it out the window," he said. He spent 20 frantic and embarrassing minutes searching the house in a sweaty panic before he finally found it, right where he'd left it, near a window by the door.
然而，其中的一些療效開始消退。頭痛和記憶問題再次纏上了他，他試圖找出是什么觸發了復發。他認為這可能跟自己看到的一幅畫有關。本周早些時候，他出席了一場亞洲藝術博覽會。一名阿拉伯經銷商在銷售一批當代繪畫作品，其中大部分以士兵為題材，只有一幅畫表現的是一名女子。尤金說她看起來很像我。他記得自己盯著它，一動也動不了。第二天，在客戶的家里，他不知道把自己的公文包塞到哪兒去了?！昂喼本拖裎野阉鼜拇皯衾锶映鋈チ怂频?，”他說。整整20分鐘，他狂躁而窘迫地搜索房子的每一個角落，渾身大汗，恐慌不已。最后他終于找到了包——就在他原先放的地方，門旁邊的窗戶附近。
Still, he was feeling hopeful. Van der Kolk had suggested some other possible approaches at the end of the workshop. He was planning to try E.M.D.R. next.
盡管如此，尤金表示，他還是挺樂觀的。在研討會結束時，范德科爾克還建議了其他一些可以采取的治療方法。下一步，他打算嘗試一下EMDR。
I asked him how he felt sitting across from me now. He said that he had to go to the bathroom and that his face felt numb around one eye. Ever since the exercise, the area around his right eye — the one he'd squinted at me with — went numb whenever he got nervous. He said he didn't know why exactly, but he was sure it had something to do with the exercise itself. "I've been reading everything I can get my hands on," he said. "It definitely helped, more than anything else I've tried so far. But I still have no idea what he did to me."
我問他此時此刻坐在我對面的感覺如何。他說，他還是得去趟洗手間，而且，他覺得一只眼睛周圍有些麻木。自從進行了“架構”練習后，他一緊張，右眼周圍就會發麻——就是他瞟過我的那只眼。他說自己也不知道這是怎么了，不過他確信這與練習本身有關?！拔乙恢痹陂喿x能弄到的所有資料，”他說?！八^對管用，起碼，比我之前試過的所有東西都管用。只是我還沒想通其中的玄機?！?/span>