The psychology of post-traumatic stress disorder - Joelle Rabow Maletis

譯者: Lilian Chiu 審譯者: Marssi Draw

Many of us will experience some kind of trauma during our lifetime.

Sometimes, we escape with no long-term effects.

But for millions of us, those experiences linger,

causing symptoms like flashbacks,

nightmares,

許多人在一生中都有可能 會經歷到某種創傷。

and negative thoughts that interfere with everyday life.

This phenomenon, called post-traumatic stress disorder,

有時，我們能順利復原， 沒留下長期的影響。

or PTSD,

但有數百萬人會無法抹滅 那些經歷，揮之不去，

isn’t a personal failing;

rather, it’s a treatable malfunction of certain biological mechanisms

造成一些症狀，如閃回、

做惡夢，

以及負面想法，影響到日常生活。

that allow us to cope with dangerous experiences.

這種現象叫做創傷後壓力症候群，

To understand PTSD,

we first need to understand how the brain processes a wide range of ordeals,

簡稱 PTSD，

這種症候群並不是個人缺陷，

而是可以治療的疾病，

including the death of a loved one,

起因是某些我們用來處理 危險經歷的生物機制發生故障。

domestic violence,

injury or illness,

abuse,

rape,

war,

若要了解 PTSD，

car accidents,

我們首先需了解大腦 如何處理各種嚴峻考驗，

and natural disasters.

These events can bring on feelings of danger and helplessness,

包括愛人的死亡、

which activate the brain’s alarm system,

家暴、

known as the “fight-flight-freeze” response.

受傷或疾病、

虐待、

When this alarm sounds,

強暴、

戰爭、

the hypothalamic, pituitary, and adrenal systems,

車禍，

以及天然災害。

這些事件可能會帶來 危險和無助的感受，

known as the HPA axis,

work together to send signals to the autonomic nervous system.

接著會觸發大腦的警報系統，

也就是大家所知的 「戰鬥、逃跑或不動」反應。

That’s the network that communicates with adrenal glands and internal organs

當這種警報響起，

to help regulate functions like heart rate,

下視丘（H）、腦垂體（P）， 以及腎上腺（A）系統，

digestion, and respiration.

也就是所謂的 HPA 軸，

These signals start a chemical cascade

會合作發送訊號給 副交感神經系統。

that floods the body with several different stress hormones,

副交感神經系統是負責幫 腎上腺及內部器官溝通的網絡，

causing physiological changes that prepare the body to defend itself.

來協助調節一些功能，比如心跳、

Our heart rate speeds up,

breathing quickens,

消化，

以及呼吸。

and muscles tense.

這些訊號會造成一連串化學反應，

Even after a crisis is over,

讓身體充滿了數種 不同的壓力荷爾蒙，

escalated levels of stress hormones may last for days,

導致生理改變， 使身體能準備好保衛它自己。

contributing to jittery feelings,

nightmares,

and other symptoms.

我們的心跳會加速，

For most people, these experiences disappear within a few days to two weeks

呼吸會加快，

肌肉會緊繃。

即使在危機解除後，

as their hormone levels stabilize.

壓力荷爾蒙逐漸上升的狀況 可能會持續數日，

But a small percentage of those who experience trauma

造成緊張不安的感覺、

have persistent problems

作惡夢，

—sometimes vanishing temporarily only to resurface months later.

以及其他症狀。

對大多數人來說，在幾天到兩週內 他們的荷爾蒙量會穩定下來，

We don’t completely understand what’s happening in the brain,

這些感受就會消失。

but one theory is that the stress hormone cortisol

但有少數經歷過創傷的人，

may be continuously activating the “fight-flight-freeze” response

他們的問題還在，

有時會短暫消失，幾個月後又出現。

while reducing overall brain functioning, leading to a number of negative symptoms.

我們還無法完全了解 大腦中發生了什麼事，

These symptoms often fall into four categories:

但有一個理論強調 壓力荷爾蒙皮質醇

intrusive thoughts, like dreams and flashbacks,

可能會持續觸發 「戰鬥、逃跑或不動」反應，

avoiding reminders of the trauma,

negative thoughts and feelings, like fear, anger, and guilt,

同時會降低整體的大腦功能運作， 導致數種負面的症狀。

and “reactive” symptoms like irritability and difficulty sleeping.

這些症狀通常可以分為四類：

侵入性思維，比如作夢或是閃回；

Not everyone has all these symptoms,

or experiences them to the same extent and intensity.

避免會提醒創傷的人事物；

負面的想法和感受， 如恐懼、憤怒，及罪惡感；

When problems last more than a month, PTSD is often diagnosed.

以及反應性的症狀， 如易怒和難以入眠。

Genetics,

on-going overwhelming stress,

and many risk factors like preexisting mental illnesses

並不是人人都會有所有這些症狀，

如果有，感受到的程度 和強度也不盡相同。

or lack of emotional support,

likely play a role in determining who will experience PTSD.

當問題持續了超過一個月， 通常都會診斷出 PTSD。

But the underlying cause is still a medical mystery.

遺傳、

大到難以招架的強大壓力，

以及許多風險因子， 比如先前就存在的心理疾病，

A major challenge of coping with PTSD is sensitivity to triggers,

或是缺乏情緒支持，

都可能是得 PTSD 的原因。

physical and emotional stimuli

that the brain associates with the original trauma.

但背後的成因在醫學上仍是個謎。

These can be everyday sensations that aren’t inherently dangerous

處理 PTSD 的主要挑戰 是處理觸發因子的敏感度，

but prompt powerful physical and emotional reactions.

For example, the smell of a campfire

也就是會刺激身體和情緒，

could evoke the memory of being trapped in a burning house.

讓大腦聯想起原來創傷的因子。

有可能是日常的感覺， 這些感覺原本並不是危險的，

For someone with PTSD,

that memory activates the same neurochemical cascade

但會引發強大的身體和情緒反應。

as the original event.

比如，聞到營火的味道，

That then stirs up the same feelings of panic and helplessness

就可能勾起失火時 被困在房子內的記憶。

as if they’re experiencing the trauma all over again.

對於有 PTSD 的人而言，

Trying to avoid these triggers, which are sometimes unpredictable,

那樣的記憶所造成的 一連串神經化學反應，

和原本的事件不相上下。

can lead to isolation.

接著，那就會激起 同樣的痛苦和無助感，

That can leave people feeling invalidated,

ignored,

or misunderstood,

好像他們又重新經歷了一次創傷。

like a pause button has been pushed on their lives

while the rest of the world continues around them.

若試圖避免這些 有時很難預料的觸發因子，

But, there are options.

可能會導致孤立。

If you think you might be suffering from PTSD,

那就會讓人覺得自己沒有用、

the first step is an evaluation with a mental health professional

被忽視，

或被誤解，

就彷彿他們的人生被按下了暫停鍵，

who can direct you towards the many resources available.

但他們周圍的世界仍然繼續正常運作。

Psychotherapy can be very effective for PTSD,

但，有一些選擇。

helping patients better understand their triggers.

如果你認為你可能患有 PTSD，

And certain medications can make symptoms more manageable,

第一步是要找一位 心理健康專家為你做評估，

as can self- care practices, like mindfulness and regular exercise.

他能引導你取得許多資源。

對 PTSD 來說， 心理治療可能很有效，

What if you notice signs of PTSD in a friend or family member?

協助病人更了解他們的觸發因子。

Social support, acceptance, and empathy are key to helping and recovery.

且某些藥物能讓症狀較受控，

Let them know you believe their account of what they’re experiencing,

另外像自我照顧的方法，比如正念 和規律運動，也有相同的效應。

and that you don’t blame them for their reactions.

如果你注意到朋友或家人 有 PTSD 的徵兆，該怎麼辦？

If they’re open to it,

encourage them to seek evaluation and treatment.

社會支持、接納，以及同理心， 都是協助和復元的關鍵。

PTSD has been called “the hidden wound”

because it comes without outward physical signs.

讓他們知道，你相信 他們所說的體驗和感受，

But even if it’s an invisible disorder, it doesn’t have to be a silent one.

且你並不怪罪他們的那些反應。

若他們願意敞開自我，

鼓勵他們去尋求評估和治療。

PTSD 一直被稱為 「隱藏的傷口」，

因為它發生時並不會有 外在身體的徵兆。

但就算它是一種看不見的病症， 也不表示它就必須是沉默的病症。