心理疾患的身體療法:把舊日傷痛"演"出來

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，大瑟爾地區太平洋的風光盡收眼底。貝塞爾·範德科爾克(Bessel van der Kolk)盤腿坐在房間中央的超大號靠枕上。他戴着方形金絲眼鏡，身穿藍色拉鍊式絨頭織物衫和卡其布褲子，赤着腳。這天是他主辦的“創傷記憶與自我恢復”(Trauma Memory and Recovery of the Self)研討會的第三天，約30名研討會參與者（均爲創傷受害者或創傷治療師）沿着房間的四壁圍成一圈。他們也都赤腳坐在舒適的靠枕上，手裏拿着筆記本，眼睛盯着範德科爾克。兩天來，他們聆聽他講解了創傷後應激障礙(post-traumatic stress disorder, PTSD)及其鮮爲人知的同類——複雜創傷(complex trauma)的社會歷史、神經生物學和臨牀現狀。現在，他終於將向他們演示實際的治療技術。範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歲的伊拉克戰爭退伍軍人，此刻他正坐在範德科爾克的對面，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，範德科爾克的治療從講述自己的親身經歷開始。“我的母親對我毫無教養和疼愛之心，”他說。“但我卻能讓自己體會到在她關愛和撫育下成長的全部感受，並讓它們成爲我的‘記憶'。”因爲他做過一項非常特別的練習，他解釋道，而這也正是現在尤金將要嘗試的。具體的做法是這樣的：在場的人們將應尤金的要求扮演各種特定的角色，從而幫助他重現那段深深困擾他的創傷。他將對着這些人表露他的憤怒、悲傷、悔恨和迷茫，而他們則將依據所扮演的角色對他作出相應的迴應，或道歉、或寬恕，也可以認同他的感受。通過將自己的“內心世界”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。如果實驗能夠成功，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.

這種做法被範德科爾克稱爲“構造”(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)創立了該療法，並在大約20年前教給了範德科爾克。儘管這種療法未在對照研究中接受過檢驗，但範德科爾克稱，在幾次類似的研討會中，他們已經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羣人，而且有人願意站出來，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.

在範德科爾克溫和的鼓勵下，尤金向我們講述了他的故事：他怎樣成爲美國陸軍的技術兵；他在伊拉克北部最大的城市摩蘇爾駐紮的那一整年時間，是如何度過的；以及他的工作怎麼會涉及處置已爆炸的炸彈。那一年都在和屍體打交道，他說。他目睹、觸摸、嗅聞乃至踏過的屍體簡直不可勝數，其中有些還是兒童。而尤金當時只有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，當人被炸碎時，脂肪細胞都會爆裂開，於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後的屍體上——只有腿部還勉強有點人型。還有一次，他看到一個廚房裏，到處散落着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。尤金曾經頭部後側中彈，也曾經因土製的爆炸裝置受傷。

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：在任職幾個月後，尤金在一次安保任務中殺死了一名無辜的男子，然後他還眼看着那名男子的母親在不久之後發現了兒子的遺體。

"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，”範德科爾克說，“發生了什麼事？”簡單的問題打破了尤金強忍着的鎮定。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麼痛心和難過，”範德科爾克說。範德科爾克像這樣承認事件主人公的情緒，並對其情緒做出反應，他把這個過程稱爲“見證”，這是練習的核心部分，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，尤金已經拜託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)擔任他的“聯絡人”，就像是一個嚮導，幫助主人公承受回憶喚起的創傷。聯絡人通常就坐在主人公的身旁，在需要時提供一隻支持的手臂或一個可以依靠的肩膀。戴夫(Dave)是虐待兒童案件的倖存者，現在是南加州的一個小企業主。在這裏，他扮演的角色是尤金的“理想父親”，他的任務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，手搭在他的肩膀上。接下來，範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的脫口秀笑星及兼職財務顧問。最後，範德科爾克問道，誰來扮演那男子的母親？

Eugene pointed to me. "Can you do it?" he asked.

尤金指着我。“可以拜託你嗎？”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.

“我願意扮演被害人的母親，”我學着其他人的樣子宣佈承擔這個任務，然後把自己的靠枕搬到了房間的中央，面對着尤金，挨着範德科爾克。

"O.K.," van der Kolk said. "Tell us more about that day. Tell us what happened."

“好了，”範德科爾克說。“請告訴我們更多關於那一天的事吧，都發生了些什麼？”

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牀實踐中廣泛實施，也沒有得到臨牀研究的支持。事實上，大多數執業精神科醫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立的。但範德科爾克相信，舞者——以及樂手和演員——在促進精神創傷的癒合方面可能的確有過人之處，值得精神科醫生借鑑，這個方法雖然有些矯揉造作，但仍然值得關注。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，比如戰爭、強姦、亂倫、拷打，以及生理和心理的虐待所造成的影響，並嘗試進行治療。他撰寫了100多篇關於心理創傷的經過同行評議的文章。而且，作爲一名訓練有素的精神科醫生，他的私人診所每週都接診數十名患者——其中有些人找他看病已有多年。此外，他還負責着位於波士頓的一家名爲“創傷中心”(Trauma Center)非營利性診所，那裏還爲另外數百名患者提供診治。如果有一件事是他可以斷言的，那就是：常規的治療方法不管用。患者們仍然痛苦不堪，他們的家人也不能倖免。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.

範德科爾克尤其對創傷治療中最常用的兩種方法持有異議：認知行爲療法（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。範德科爾克把它貶斥爲“最不可能治療”創傷的方法。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：脫敏與痊癒是兩個不同的概念。他對認知行爲療法，也有類似的看法。認知行爲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繫調試不良，從而改變患者的行爲。“但創傷與認知可沒有一丁點兒關係，”範德科爾克說。“真正的問題在於，創傷改造了你的身體，讓你覺得這世界很危險。”這種改造源於我們大腦中最原始結構的深處，認知療法所無法觸及的地帶。“這不是你勸解自己說幾句就可以解決的。”這些觀點令他遊離出了精神學主流。

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.

範德科爾克並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。該療法後來被哈佛大學的心理學家理查德·麥克納利(Richard McNally)稱爲“自腦葉切除術時代以來降臨到心理健康領域的最大災難。”在當時的一系列引人注目的性虐待案件中（均與恢復受抑制的記憶密切相關），範德科爾克擔任了專家證人，作證稱遭受極端或反覆性創傷的受害者有可能——甚至普遍——會壓抑自己關於那些創傷的所有記憶，直至多年後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，他還能從醫學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潮，人們紛紛指控父母、牧師和日託服務人員犯下了恐怖的性犯罪，並聲稱，他們是在治療師的幫助下才剛剛想起來的。一時間，法官和陪審團都被範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歷。但隨着指控變得越來越稀奇古怪——譬如被外星人綁架或神祕的撒旦邪教之類——支持這一理論的聲音日漸衰弱。大多數心理學研究專家認爲，與其說是受害者自發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。隨着時間的推移，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、甚至在某些情況下整個生活，都被毀於一旦。

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.

待這場日後被稱爲“記憶之戰”的爭論塵埃落定之後，範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院(Massachusetts General Hospital)的實驗室被關停，還失去了在哈佛醫學院(Harvard Medical School)的職位。官方給出的理由是資金不足，但範德科爾克及其支持者認爲，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.

範德科爾克將自己的診所併入了一家規模更大的非營利組織中。他開始募集慈善捐款，並將關注的目標集中在創傷記憶及創傷治療之上。他仍堅信，記憶抑制是創傷應激的一個普遍特徵。範德科爾克解釋道，創傷經歷並沒有被加工成記憶，而是莫名其妙地“卡殼”了，日後纔在軀體上表現出來。精神病學的主流研究者大多都對這些理論嗤之以鼻，但範德科爾克在另一個羣體中找到了更願意接受它們的人：身體導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，並在小規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交的忠實夥伴建立起了一個新的關係網絡。

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."

這羣人秉持着一個簡潔有力的觀念：精神創傷的治療應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，以至於他們未能逃脫魔爪。如今，同樣是他們的身體屈服於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，那他們的心靈又怎麼可能會痊癒？“對於創傷受害者而言，唯一最重要的問題就是要讓自己的身體找到安全感，”範德科爾克說。“不幸的是，大多數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麼重要。”

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.' "

範德科爾克對身體感受的重視爲他贏得了背景各異的衆多粉絲。“他是一個真正的英雄，”北卡羅來納大學教堂山分校(University of North Carolina, Chapel Hill)的精神病學教授史蒂芬·波格斯(Stephen Porges)表示。“他一直表現出大無畏的態度，挑戰自己的學術圈子，並始終堅持不應簡單地認定創傷受害者存在身體症狀‘僅僅是腦筋出了問題'。”

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，範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，捧場的觀衆均遍及治療領域的方方面面：精神科醫生、心理學家、社會工作者、藝術治療師、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於這種治療、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.

您關於自我割傷、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.

範德科爾克自己的整個人生就好像一項關於人類創傷的研究。1943年的夏天，他在海牙出生。這是德國佔領荷蘭的第三年，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裏。按照範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院，而他的第一個生日蛋糕是用鬱金香球莖做的，因爲當時基本上沒有面粉。

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.

範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，他會告訴你在故鄉城市遭受轟炸後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傷。左右的鄰居都是猶太人大屠殺的倖存者。他的母親一點也不樂意當媽媽；14歲的時候她就輟學照顧自己的父親，之後又被迫離開了自己喜愛的職業以承擔身爲人妻的責任。在家裏的第二個孩子貝塞爾懂事之前，她的性格已經變得刻薄而冷漠。範德科爾克的父親是荷蘭皇家殼牌集團(Royal Dutch Shell)的高管。儘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，範德科爾克提到，當他還是個小男孩時，曾經因爲“正常的3歲孩子都會惹的禍”而被關在地下室裏，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，他在途經一所修道院時聽到修道士們誦經的聲音，併爲之深深打動，於是請求司機讓他在那裏下車。他在那所修道院度過了當年夏天剩下的所有時間，然後是次年的復活節假期，以及之後的又一個夏天，甚至考慮要不要成爲一名修道士。修道院院長對他很有好感，並承諾如果他加入修會，他們就送他到日內瓦讀醫學院。“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勝了他對安靜冥想的嚮往，於是他選擇了夏威夷大學(University of Hawaii)。“我仍然有一些精神感應，”他說。“我相信萬事萬物都彼此關聯。但組織有序的宗教讓我渾身發毛。”

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，範德科爾克來到了美國，並先後就讀於夏威夷大學、芝加哥大學(University of Chicago)和哈佛醫學院。在這裏，他將自己關於人性中恐怖的一面，以及人類神奇的適應和恢復能力的許多問題，擺在了科學和醫學面前。“人類這個物種可真是一團糟，”他說。“我們總是一遍又一遍地犯同樣的錯誤。我真好奇這究竟是爲什麼。爲什麼我們明知道會釀成大禍，惹來不可收拾的後果，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."

離開學校後，範德科爾克的頭幾份工作裏包括在退伍軍人事務部下屬的一家波士頓診所擔任精神科醫師。他入職時正值1978年，越戰老兵洪水一般地涌來。“等候看診的隊伍足有一英里長，”他說。“診所的牆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，範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裏。即使是那些從二戰戰場上歸來的老一批的退伍軍人也常常在兩種狀態之間搖擺：或是沉溺於戰爭經歷中無法自拔，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友，就是覺得什麼都不像。彷彿是他們腦海中的投影儀被戰爭弄壞了，範德科爾克說，於是他們只能選擇把一卷影像翻來覆去地看，或者乾脆把機器徹底關掉。

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.

令範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，高風險的行爲更可能將他們拉回現實（例如，一名患者稱，每當覺得自己快要暴跳如雷或者遊離於現實之外時，他就騎着哈雷摩托車玩兒命地飆車）。範德科爾克的治療手段——也就是醫學院唯一教他做的——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，關於那些可怕的回憶、關於夢魘以及在家裏遇到的麻煩等等。但談話似乎並沒什麼幫助；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.

範德科爾克翻遍了診所的醫學圖書館中關於炮彈休克症(shell shock)和戰鬥疲勞症(combat fatigue)的書籍，尋找可能幫助他更好地瞭解患者症狀的任何信息，或者有助於他進行治療的任何提示。在那個時代，創傷後應激障礙還未被公認爲一種疾病。後來，他在哈佛的弗朗西斯·A·康特韋醫學圖書館(Francis A. Countway Library of Medicine)裏發現了一本書：《戰爭的創傷性神經官能症》(The Traumatic Neurosis of War)。該書出版於1941年，正好是在飽受炮彈休克症困擾的美國老兵從第二次世界大戰中歸來之前。在這本書中，範德科爾克找到了一些最初的靈感。這些靈感最終指明瞭他職業生涯的方向：神經官能症的核心在於軀體性神經官能症。換句話說，他認爲，日後所稱的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.

這與範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，許多患者還遭受着衆多生理症狀的折磨，包括頭痛、疲勞、消化系統疾患和失眠等。當他在治療中試圖觸及他們的創傷時，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。範德科爾克表示，雖然這本書並沒有提供任何治療建議，但給了他一個起點。在接下來的20年裏，他仔細研究了他所有患者的生理症狀。1994年，就在他在哈佛的實驗室被關閉前不久，他撰寫了一篇論文總結了自己的所有發現，並發表在《哈佛精神病學評論》(The Harvard Review of Psychiatry)上。創傷應激似乎可以觸發一連串的生理性災難，幾乎影響到身體的所有主要系統。

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過半，當時正在舊金山軍事休假。海灣天氣涼爽，微風拂面；四周漫步的人們都身着風雪大衣和連帽衫。但他自己卻滿頭大汗。他一度以爲這是因爲數月來自己在沙漠中的生活，激活了某些與出汗有關的奇特基因，需要過一段時間它們纔會自行關閉。他估計慢慢就會好起來的。但事實並非如此。等他徹底退役回家時，他才發現，出汗只是個最最微不足道的問題。他出現了幻視，看到路邊堆積着屍體。他需要不停地去衛生間。他退伍後的第一份工作是在一家大銀行的總部辦公室任職，由於他去洗手間太過頻繁，他敢肯定同事們都懷疑他有毛病。

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.
軍隊幫不上什麼忙。“他們甚至根本沒有嘗試過提供幫助，”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，以至於尤金開始犯迷糊，走着走着都會撞到牆上。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揹後偷襲的那種恐慌。
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裏，坐在範德科爾克的對面，向一羣陌生人坦承，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，壞人們佔據了小鎮，所有的居民都躲在屋裏，關門閉戶，銀幕上只有大風捲着草團吹過。不過，在尤金的故事裏，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，潛入居民區然後引爆。
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，然後是第三次。
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。於是尤金開槍了。事後，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.
講到這裏，尤金的目光落在他和範德科爾克之間的虛空裏。他臉色通紅表情扭曲，很容易想象，他在回顧那段情節時，記憶並不十分清晰。我暗想要怎麼樣的痛苦，纔會迫使他願意參加這麼一項實驗，更好奇這種治療到底怎麼能產生效果。
"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麼？”範德科爾克問道。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。“我真的非常，非常抱歉。我無法用語言來表達我的歉意……”他又把臉埋在掌心裏。“你想看着她嗎？”範德科爾克又問。尤金一時說不出話來，但他還是擡起頭，用一隻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，”範德科爾克說。我一直凝視着尤金，所以我看不到範德科爾克的表情。但後來克雷斯塔告訴我，看着他，就好像是看着一個巫師或魔法師，又或者像一臺超高速電腦。她留意到，他一直密切關注着尤金的面部表情、語調和姿勢中的變化，並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.
範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。”我重複着這些話，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裏。
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，作爲一個每年聽衆總數可達1.5萬以上的人，範德科爾克並不擅長演講。他帶着厚重的荷蘭口音，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，聽衆們對他的第一條評論是：“我們聽不清！”範德科爾克請求音效師幫他調高音量，並向與會的200來人承諾，他會盡可能地大聲。但還是有聽衆們聽不到他在說什麼，即使有些人已經是在前排，於是頗有些抱怨的聲音。但範德科爾克總是那麼熱情洋溢，令人傾倒。與往常一樣，他很快就征服了聽衆。
"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.
“請大家弓起後背並低頭，就像這樣，”他一邊說一邊親身示範。“現在請試着說：‘哦，我感覺好極了！我今天非常開心！' ”場下出現了笑聲。“你看，在這種姿勢下，你是不可能感到幸福的。”爲了徹底表明自己的觀點，他讓我們擺出相反的姿勢：坐直身子，展現歡快的表情，然後試着去感覺難過。
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.
範德科爾克總喜歡說，創傷受害者的精神與身體脫節了，而這是由大腦深處被稱爲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爲止。但如果威脅一直沒有消失——如果我們不能反抗也不能逃跑——那麼杏仁核這個“人體的煙霧探測器”就會不停地拉響警報。於是我們就不斷地製造應激激素，進而大肆破壞我們身體的其餘部分。這與慢性應激的過程非常相似，區別只在於在創傷應激中，關於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爲被“激發”。短期內，患者會通過“遊離於世外”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，以至於無法準確地描述自己的身體感覺。這在治療中屢見不鮮，範德科爾克說。
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，他們往往會成爲自我麻木的高手，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遊離。“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，”範德科爾克說。
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。“如果我們能夠幫助患者耐受自己的身體感覺，他們就可以自己處理所受到的創傷，”範德科爾克解釋道。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)又被稱爲穴位按摩，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，範德科爾克對所有密切關注患者生理狀態的療法幾乎都抱着支持的態度，如精神運動療法、起立並在劇場中漫步、舞蹈，乃至空手道。對於從孤立的創傷記憶（如車禍或一次性的襲擊）中罹患急性PTSD的病人，範德科爾克也很贊成採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，並要求患者一面將“思緒停留”在創傷記憶上，一面用目光追隨着治療師的手指。支持者稱，這項技術可促使患者加工創傷事件，並將其轉化爲過去的記憶，從而使它們不再侵犯當前的日常生活。範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。“這真是種古怪的治療，”他說。“你教人們記起自己的遭遇，還在他們的眼前晃動手指，讓他們的眼睛跟着轉。這太瘋狂了。”目前，世界各地已經有超過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。範德科爾克說，他更相信從自己患者身上觀察到的結果。對於他們而言，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.)
範德科爾克最爲人詬病的地方似乎集中於一點：他過分誇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於認知行爲療法，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，範德科爾克自己的研究缺乏嚴謹性，樣本也過小；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。“只要喜歡自己的治療師，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)的臨牀心理學家、研究使用認知行爲療法治療創傷應激的帕特里夏·雷斯尼克(Patricia Resick)說。“你需要獨立的評估。”在談到範德科爾克的大致研究方法時，雷斯尼克表示，該研究領域自有其標準。“如果他希望人們把他當回事兒，他就需要完成符合這一標準的研究。”（對此，範德科爾克指出，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，也有人指責範德科爾克將神經科學過度簡單化，以支持自己的臨牀工作。他喜歡將大腦劃分爲理性與感性兩個截然不同的區域，用他的原話說是：“它們的相互聯繫並非那麼緊密。”他聲稱自己所熱衷的技術可以作用於杏仁核所在的“情緒腦”，而認知行爲療法、暴露療法和談話治療卻未必有這神通。範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（對於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爲，所謂的理性腦和情緒腦並非如他的模型顯示的那樣彼此孤立，而是一個更爲融合的有機體。實際上，它們經常通過衆多迂迴曲折的神經迴路彼此通訊，而科研人員在這方面的研究纔剛剛起步。範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。“他提出了很多十分有趣也非常重要的想法，但與腦部的關聯並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麼。然而有時候，大腦能做什麼比它是怎麼做的更加重要。”
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.
範德科爾克的一些最親密的同事指出，他的誇張其實是刻意爲之。他並沒有那麼厭棄傳統療法，也並不認爲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，當我就認知行爲療法追問他時，他承認這種療法在焦慮症或強迫症的治療中大概還是可以派上用場的。而且，雖然他認爲百憂解(Prozac)治療PTSD的效果不如EMDR，但他並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研究的臨牀精神病學家弗蘭克·歐什博格(Frank Ochberg)說。“在藥物試驗中，所有受試者得到的是完全相同的藥丸或完全一樣的安慰劑。而對於治療技術而言，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。”
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."
至於範德科爾克，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恐怖襲擊之後，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於治療干預的經費，於是負責人徵求他們的意見，問他們應該拿這些錢來支持哪些治療。對範德科爾克來說，這是一個千載難逢的好機會。我們確實不知道什麼方法可以最大限度地爲人們提供幫助，他對小組成員這樣說道。那我們爲什麼不徹底放開成見，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。可惜事與願違，專家小組推薦了兩種形式的治療：精神分析和認知行爲療法。“於是我們坐等患者來接受分析和認知行爲治療。結果幾乎是無人問津。”斯潘塞·艾斯(Spencer Eth)當時在曼哈頓的聖文森特醫院(St. Vincent's Hospital)行爲健康服務部門擔任醫療主任，他蒐集了關於1萬多名9·11倖存者接受心理健康醫療服務的資料。截至目前，最受歡迎的服務是鍼灸，瑜伽和按摩的呼聲也甚高。“沒人把鍼灸擡入學術的大雅之堂，”範德科爾克說。“但所有這些人都說它很有用。”
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，範德科爾克都在藉助評估自己的臨牀經驗來尋找最佳療法的蛛絲馬跡。“或許我該對尤金用EMDR，而不是構造練習，”在加州的研討會後不久，他對我說。“我不太確定它會有多大效果。”
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，範德科爾克及其同事們正投身於他信奉的下一步研究：重新定義創傷本身。“如今我們總是傾向於把什麼都貼上PTSD的標籤，”他說。“但是，我們今天所見的很多症狀都是長期、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。”範德科爾克及其同事們將這種創傷應激的慢性形式稱爲“進行性創傷障礙(developmental trauma disorder)”。2010年，他們曾經試圖遊說 《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，作爲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，最終將得償所願。來自官方的正式接受是爭取支持的關鍵，範德科爾克說。
"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倖存者的專項撥款達800萬美元以上，”範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，就在這同一座城市裏，每天都有數以萬計的兒童遭受創傷，如果把統計範圍擴展到全美，這個數字可達兩百萬，卻沒有人向他們伸出援手。”我問他認爲其中的原因何在。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於當時被稱爲“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，”範德科爾克告訴我。“我們發現了創傷。然後，當我們認識到它有多麼可怕和多麼令人爲難時，我們會轉而攻擊這個概念，並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，並解釋了歐洲和美國的軍事權威部門是如何抹黑炮彈休克症和戰鬥疲勞症的，因爲他們害怕它們會削弱戰鬥力。這是故意的失憶，他說，並且舉出了大量近期的例子。就在幾年之前，他在聯邦參議院關於寄養情況的聽證會上問詢了一批寄養兒童。“後來，我跟孩子們坐在一起，”範德科爾克說。“一名法官在出門時從我們身邊走過，他對孩子們說，‘你們做得非常棒！非常了不起！'於是我說，‘哦不，你爲什麼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。但法官並不想聽到那些，就像在戰爭結束後，我們一點也不關心士兵們究竟怎麼樣了。”
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。現在，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。在參加範德科爾克的研討會幾個月之後，我約他在上東區喝咖啡。我想知道，經過一段時間之後，他現在對“架構”練習的感覺如何。他覺得這對PTSD有效果麼？
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."
最令他着迷的，是這種練習的效果立竿見影，尤金說。範德科爾克的“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。“我很怕你，”他告訴我。然後又過了一天，範德科爾克讓我第二次對他表示原諒，那咒語才最終被打破，他終於能夠面對我，將我還原爲研討會的普通參與者而已。“這讓我想起了菲利普·塞默·霍夫曼(Philip Seymour Hoffman)主演的電影《大師》(The Master)，”他說。“埃米·亞當斯(Amy Adams)問華金·菲尼克斯(Joaquin Phoenix)，‘我的眼睛是什麼顏色？'他回答，‘綠色。'她又說，‘請把它們變成藍色，'然後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。”
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，他開着車帶着妻子沿着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。在幾個星期裏，他可以毫無障礙地駕駛汽車和乘地鐵。“就好像是我的感知功能不知怎的就給修好了，”他說。“我以前總是很疑神疑鬼——比如，就因爲候診室裏面有保安，出去看醫生都會嚇壞我。但這種念頭有一陣子沒有出現。”
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，他試圖找出是什麼觸發了復發。他認爲這可能跟自己看到的一幅畫有關。本週早些時候，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，其中大部分以士兵爲題材，只有一幅畫表現的是一名女子。尤金說她看起來很像我。他記得自己盯着它，一動也動不了。第二天，在客戶的家裏，他不知道把自己的公文包塞到哪兒去了。“簡直就像我把它從窗戶裏扔出去了似的，”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。最後他終於找到了包——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.
儘管如此，尤金表示，他還是挺樂觀的。在研討會結束時，範德科爾克還建議了其他一些可以採取的治療方法。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，他覺得一隻眼睛周圍有些麻木。自從進行了“架構”練習後，他一緊張，右眼周圍就會發麻——就是他瞟過我的那隻眼。他說自己也不知道這是怎麼了，不過他確信這與練習本身有關。“我一直在閱讀能弄到的所有資料，”他說。“它絕對管用，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。”