被父母囚禁虐待的孩子能重獲新生嗎

The California case in which 13 siblings were found imprisoned at home earlier this week is shocking, but not without precedent. Lurid cases have come to light over the years of children locked in closets and basements, held captive by parents who have crumbled under the weight of drugs, extreme religious conviction, personality disorders or their own abusive backgrounds.

本週早些時候加州發現13名兄弟姐妹被囚家中一案令人震驚，但並非沒有先例。這些年一直有兒童被關在儲藏室或地下室的駭人案件遭到曝光，孩子們被深受毒品、極端宗教信仰、人格障礙或自身虐待歷史影響而心理崩潰的父母囚禁。

The good news, trauma experts say, is that recovery is indeed possible. Victims can reclaim their lives.

但好消息是，精神創傷專家稱康復是十分可能的。受害者可以重拾自己的生活。

“The clinical data is encouraging,” said John A. Fairbank, co-director of the National Center for Child Traumatic Stress. “There are good treatments available for children seriously abused and traumatized.”

“臨牀數據是樂觀的，”美國國家兒童創傷應激中心(National Center for Child Traumatic Stress)聯席主任約翰·A·費爾班克(John A. Fairbank)說。“對受到了嚴重虐待和創傷的兒童有很好的治療方法。”

In particular, said Dr. Fairbank, a professor of psychiatry and behavioral sciences at Duke, good results have been shown with a relatively short-term cognitive behavioral therapy tailored for trauma patients, an approach developed in the early 1990s but widely disseminated in the last 15 years.

作爲杜克大學精神病學和行爲學教授的費爾班克說，尤其是相對短期的針對精神創傷病人的認知行爲療法表現出了良好成效，該療法研發於90年代早期，但在最近的15年纔得到普及。

A significant hurdle to recovery for the California siblings and children in analogous situations, said psychologists, is that their captors were not stranger-kidnappers but their parents.

但心理學家表示，對於加州的這些兄弟姐妹以及有着類似情況的兒童來說，康復過程的一個巨大障礙是，囚禁他們的並非陌生綁架者，而是父母。

“In doing the healing work, you look at what the patient’s support systems are, “ said Priscilla Dass-Brailsford, a trauma psychologist and an adjunct professor in the department of psychiatry at Georgetown University. “The biggest supports are parents and family. These kids don’t have that. The parents were the aggressors.”

“在進行康復工作時，要找出病人的支持系統是什麼，”喬治城大學(Georgetown University)精神病學系副教授、精神創傷心理學家普利西拉·達斯-佈雷斯福德(Priscilla Dass-Brailsford)說。“父母和家庭是最重要的支持。但那些孩子們沒有這些。他們的父母就是侵犯者。”

Experts interviewed for this article, who underscored that they had no direct knowledge of the California case, said that because the siblings’ primal assurance of unconditional love and safety had been ripped away, they would almost certainly struggle to trust and attach to future supportive figures.

在撰寫本文時採訪的專家強調，自己對加利福尼亞一案並非直接知情，並表示，由於這些兄弟姐妹被剝奪了無條件的愛和安全這一首要保障，他們在與未來的支持對象建立信任和親密關係時基本上肯定會遇到困難。

“The notion that this was done by parents increases a child’s helplessness and hopelessness,” said Nora J. Baladerian, a Los Angeles psychologist who often treats traumatized individuals.

“知道這是父母的行爲這一點增加了孩子的無助和絕望，”洛杉磯一名經常治療精神創傷病人的心理學家諾拉·J·貝拉戴裏安(Nora J. Baladerian)說道。

Dr. Dass-Brailsford compared the 13 siblings’ situation to that of prisoners of war, who have been deprived of food, freedom and sufficient nurturing.

達斯-佈雷斯福德拿這13個孩子的情況與被剝奪了食物、自由和足夠照料的戰俘做了比較。

“One glimmer of hope is that they did not go through this alone,” she said. “Prisoners of war are isolated as part of their torture. These children at least had each other.”

“還有一線希望，那就是他們並不是獨自經受這一切的，”她說。“作爲懲罰，戰俘是被隔離的。而這些孩子們至少還有彼此。”

Before formal therapy can begin, the siblings must be placed in a safe, nurturing environment where kind treatment will be a positive constant they can rely upon, experts said. They added that keeping as many siblings together as possible would be important, to sustain their bonds.

專家表示，在正式治療開始之前，一定要先將這些孩子安置在一個安全並被悉心呵護的環境中，讓溫和的治療成爲一個他們可以依靠的正面常態。並補充說，讓儘可能多的兄弟姐妹們待在一起對維繫他們之間的紐帶是很重要的。

Daniel L. Davis, a forensic psychologist in Columbus, Ohio who has treated victims and perpetrators and evaluates children for juvenile court, said that there is not one behavioral model that adequately describes a typical parent perpetrator.

一位在俄亥俄州哥倫布市少年法庭治療受害者和施害者的司法心理學家丹尼爾·L·戴維斯(Daniel L. Davis)表示，沒有哪一種行爲模型可以完全概括出典型的父母施害者。

“There are risk factors, certainly,” he said. A list might include a prior history of abuse, domestic violence, and a cluster of personality disorders such as antisocial personality disorder, borderline personality disorder and narcissistic personality disorder. Such people, he said, might be overly emotional, unpredictable, manipulative and exploitative.

“當然，是有風險因素的，”他說。其中可能包括虐待或家庭暴力前科，還有比如反社會型人格、邊緣型人格、自戀型人格等一系列的人格障礙歷史。他說，這些人可能會過度情緒化、難以預測、控制慾或是剝削欲過強。

But like other trauma experts, Dr. Davis emphasized that children can be remarkably resilient. He treated an elementary school-age boy whose parents had kept him locked away for such a long period that the child showed significant developmental delays. “But with intensive treatment and real effort by a support team, his growth was impressive,” said Dr. Davis. “His parents were sent to prison.”

但和其他精神創傷專家一樣，戴維斯強調兒童有着驚人的適應力。他曾治療過一個被父母鎖了很長時間以至於表現出嚴重的發育遲緩的學齡男孩。“但經過支持團隊集中治療並作了十足努力後，他的成長十分出色，”戴維斯說。“他的父母被送進了監獄。”

Other examples of children locked away from society by parents do occasionally emerge. A documentary “The Wolfpack” tells the story of seven siblings isolated in a Lower East Side apartment by their father. In 2015, three siblings were found locked by their parents in a urine-and-feces infested room in Spotsylvania County, Virginia. That same year, a teenage girl in Murfreesboro, Tenn., was also discovered having been locked in her bedroom for months by her parents, who had allowed her three siblings to travel at will.

偶爾也出現過其他一些孩子被父母隔離在社會之外的案例。紀錄片《狼羣》(The Wolfpack)講述了七個兄弟姐妹被父親隔離在下東區一個公寓裏的故事。2015年，在維吉尼亞州斯波特西瓦尼亞縣發現了三個兄弟姐妹被父母鎖在一間充滿屎尿的房間裏。同一年，在田納西州默弗里斯博羅市發現了一個十多歲的女孩被父母鎖在臥室裏數月，她的父母允許她的三個兄弟姐妹隨意出行。

Dr. Davis said that while poverty is an element in many cases, it is certainly not a signature characteristic; indeed in the California case, the family lived in a middle-class neighborhood and the father, David Allen Turpin, had reportedly once been employed as an engineer. But poverty-afflicted situations may come to light more often, Dr. Davis noted, “because the perpetrators don’t have the resources to keep shielding from public scrutiny.”

戴維斯博士表示，雖然貧窮是很多案例中的一個因素，但它肯定不是標誌性特徵。事實上，在加州的這個案例中，這家人住在一箇中產階級社區，據說父親戴維·艾倫·特平(David Allen Turpin)曾做過工程師。但是，戴維斯博士指出，貧困導致的情況可能更容易被發現，“因爲犯罪者沒有足夠的資源來避免公衆監督”。

Formal treatment begins after children are placed in a secure home and assessed for trauma-related symptoms, including post-traumatic stress disorder. They may be unwilling or unable to describe their experience. Nightmares may roil them. The slightest trigger — the rattle of keys, for example — might send them into a hysterical tantrum. They may seem hyper-aroused or vigilant, ever alert and cringing, braced to flee or fight. Younger children may act out the trauma as they play; for others, the emotional pain may be so overwhelming that they seem numb.

孩子們先要被安置到一個安全的家中，評估與創傷相關的症狀，包括創傷後應激障礙(PTSD)，之後纔開始正式治療。他們可能不願意或無法描述自己的經歷。噩夢可能會困擾他們。最輕微的觸動——例如，鑰匙的響聲——可能會讓他們爆發歇斯底里症狀。他們可能會極度亢奮或警覺，始終警惕而畏縮，隨時準備逃跑或對抗。年幼的孩子可能在玩耍時都會表現出創傷；另一些孩子可能遭受了巨大的情感創傷，顯得有些麻木。

“But the majority of these children can bounce back, “ said Anthony P. Mannarino, director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. “I’m not saying they’ll forget it but they can find a way to go forward.”

“不過，大多數孩子都能恢復過來，”匹茲堡阿勒格尼醫院(Allegheny General Hospital)兒童和青少年心理創傷中心(Center for Traumatic Stress in Children and Adolescents)的主任安東尼·P·曼納裏諾(Anthony P. Mannarino)說，“我不是說他們會忘記，但他們能找到前進的道路。”

Dr. Mannarino is a co-developer of trauma-focused cognitive behavioral therapy (TF-CBT). The typical treatment, he said, is 12 to 16 sessions.

曼納裏諾博士是創傷性認知行爲療法(TF-CBT)的聯合開發者。他說，治療一般需要12至16個療程。

First, a therapist works with a child to manage terrifying thoughts and feelings about the experience. Next a therapist helps the child gradually discuss the trauma.

首先，治療師幫孩子控制關於那段經歷的可怕想法和感受。接下來，治療師引導孩子慢慢討論創傷。

“Those memories are really scary,” Dr. Mannarino said. ”Maybe the parents said, ‘You deserve what you’re getting, it’s your fault,’ and the child may have internalized shame. Helping them talk and processing that distortion gives them a chance to understand that they are not to blame.”

“那些記憶真的很可怕，”曼納裏諾博士說。“也許他們的父母說，‘這是你應受的懲罰，這是你的錯’，羞恥感可能已經在孩子的心裏紮根了。幫助他們談論和處理這種扭曲的想法能讓他們有機會明白，那不是他們的錯。”

Finally, TF-CBT involves the child’s new caregivers. “We work with them to understand that the child’s behavior expresses what happened to the child, as opposed to who they really are,” said Dr. Mannarino.

TF-CBT的最後一步需要孩子新看護人的參與。“我們幫看護人們明白，孩子的行爲是他們遭遇的表現，不是他們的真實性情，”曼納裏諾博士說。

Of numerous therapies developed to address traumatized patients, TF-CBT is one of the most studied. In a 2004 randomized, multisite study published in the Journal of the American Academy of Child and Adolescent Psychiatry, 203 children between eight and 14 who had symptoms of PTSD related to sex abuse, and their caretakers, were randomly assigned to TF-CBT or “child-centered” therapy — a talk therapy model often use in rape-crisis or sex-abuse treatment centers. TF-CBT patients showed significantly more improvement in markers such as PTSD, depression and behavior.

在治療創傷患者的諸多療法中，TF-CBT是最受關注的一種。在《美國兒童和青少年精神病學會期刊》(Journal of the American Academy of Child and Adolescent Psychiatry)2004年發表的一項多地點隨機研究中，203名8至14歲具有性虐待創傷後應激障礙症狀的孩子和他們的看護人被隨機分配採用TF-CBT療法或“以兒童爲中心”的療法——後者是強姦危機中心或性虐待治療中心經常使用的一種談話療法。採用TF-CBT療法的患者在創傷後應激障礙、抑鬱和行爲等指標上的改善更爲明顯。

Dr. Baladerian hoped that not only would the California family receive sufficient services, but that “the attention will also help other victims whose cases might not have been attended to with such alacrity.”

巴拉德里安博士不僅希望那個加州家庭能得到足夠的服務，而且希望“人們的關注也能幫助那些沒有得到如此密切關注的案例的受害者”。