耐受窗狭窄的幸存者们
《心理韧性》耐受窗狭窄的幸存者们,页面无弹窗的全文阅读!
我们这些有过儿童期不良经历的人都是幸存者。但在身心系统发展的重要阶段，我们也形成了一些非常根深蒂固的神经生物学模式。这种神经生物学方面的特征来自具有大量非稳态负荷的幸存者拥有的一些独特的优势和劣势。
按照这种模式生活的人可能会表现出极强的韧性和适应力，他们简直就是超人，能够经受住逆境的冲击，完成具有挑战性的任务。实际上，他们的身心系统在高度应激唤醒的状态下形成了一种能运作良好甚至繁荣发展的能力，即一种适应极端压力环境的反应力。这样的身心系统会无意识地渴望危机。
然而，按这种方式生活的人的适应力通常相当脆弱，这是因为他们的身心系统默认的高度应激状态与任何无须高度应激的环境，也就是大多数日常生活是不匹配的。讽刺的是，他们的自我满足可能会加重痛苦，这可能会孤立他们，使他们难以寻求支持或帮助。
那些并非成长于这种环境的人很难理解为什么有人会不断将自己投入危险的工作环境，维持虐待关系，保持臃肿的身材，用成瘾行为毁掉自己的生活，甚至犯下暴力罪行。我们会从一个自己一无所知的角度去判断他们的作为，因为这么做十分方便，但我们却没有充分认识到我们每个人都有可能在适当的条件下做出相同的行为。我们所有人越是否认他们行为中可被我们理解的缘由，越是对他们的行为加以谴责，就越是会将他们困在当前的行为模式中，扼杀他们改变的努力。
本章的证据清楚地表明，儿童期遭遇的贫困、虐待、冷落、创伤和暴力行为对我们的耐受窗宽度会产生终生影响。尽管童年经历并不能决定我们的命运，但我们早期的社会环境的确深深影响了我们耐受窗的发展轨迹。在神经生物学方面，我们有确切的理由来解释为何来自富有挑战性的成长环境的人更难以做出明智的决定，控制冲动，调节情绪，形成支持性的人际关系，以及从压力中恢复过来。
对我们这些在这种环境中成长起来的人来说，理解我们今天为什么会受到伤害和出现失调问题（也就是将我们从童年开始到现在的点滴经历都联系在一起）并不能让我们的痛苦消失或治愈我们的失调问题。然而，这么做可以帮助我们平息我们的自我批判、自我厌恶，对自己的身心健康状况、上瘾问题及其他应对行为的羞耻感。实际上，这些约束性的想法和情绪只能让我们在早期的生活压力下形成过度反应和失调的应对程序，而我们采取的这些应对机制今天已不再适用。例如，这种羞耻感和自我批判助长了溜溜球式节食[43]、暴饮暴食式的锻炼、极端的拖延、最后期限前的赶工，以及用其他新方法来应对压力的“走走停停”式的尝试。
这就是勇士的智慧和勇气品质对我们有所助益的原因。智慧帮助我们理解自己的神经生物学属性在儿童时期如何形成，以及它为何具有适应性。它有助于我们认识到自己的神经生物学特征具有独特的优点和缺点。尽管早期压力和创伤给了我们其他人无法形成的力量，但我们在生活方式的选择上并没有多少余地。和那些在童年时期业已形成较宽的耐受窗的人相比，我们总是更容易受到失调、炎症和非稳态负荷的影响。而我们就是这样被塑造出来的。意识到并接受这个关于自己的真理，我们就能开启改变的可能。有了这样的认识，我们就可以鼓起勇气，做出经过深思熟虑的行为，重新连接那些神经生物学上的结构，拓宽我们的耐受窗。我们可以尝试使用新的内外部工具来扩大压力期间的适应性反应范围。我们可以学着打破生存脑的默认程序，以及我们在童年时期习得的应对习惯。
最后，我们可以记住，今天我们固有的狭窄耐受窗也可能成为明天的宽广耐受窗。童年不幸中的一线希望也有可能让我们形成最为宽阔的耐受窗。
在开始下一章之前，请花一些时间回想一下你在缩小耐受窗的第一种途径方面的经历。在你的笔记中，你可能会回顾祖辈和父辈的生活经历、他们的依恋模式及他们的耐受窗宽度。你也可能会回顾父母和其他照料者在你童年时期所要应对的生活压力源，特别是他们是否应对过任何未得到解决的创伤或损失。
接下来，你也可以进行儿童期不良经历测试，计算你的ACE得分，这些测试可以在网上找到。[44]如前所述，ACE得分并未涵盖所有可能对身心系统产生持久影响的童年慢性压力和创伤来源。鉴于此，以下是一些可能会让你在童年时期缩小自己耐受窗的潜在压力与创伤事件，供你在回忆时参考。
■ 早产（特别是30周之前的）或难产。
■ 儿科手术、长期住院治疗、紧急医疗事件（自己或兄弟姐妹的）。
■ 频繁的身体虐待。
■ 频繁的情感虐待。
■ 霸凌。
■ 性骚扰、性虐待或强奸。
■ 贫困或长期处于饥饿状态。
■ 无家可归。
■ 种族主义。
■ 父母感情不和、父母分居或离异。
■ 家庭暴力。
■ 父母、兄弟姐妹或其他重要照料者的死亡。
■ 领养。
■ 寄养、拘禁于少管所、监禁。
■ 目睹家庭成员遭遇虐待、攻击或杀戮。
■ 家庭成员患有心理疾病，包括抑郁症、创伤后应激障碍或焦虑症等。
■ 家人试图自杀或自杀身亡。
■ 家人酗酒或吸毒。
■ 家庭成员犯下重罪或被监禁。
■ 因为破产、父母失业、赌博、战争或自然灾害而失去住所或财产。
■ 自己或家庭成员经历过自然灾害、战争、恐怖袭击、种族屠杀、大规模枪击、事故或其他灾难。
■ 被迫逃离家园或寻求政治庇护。
■ 遭遗弃或被迫与家人长期分离。
最后，你可以回顾一下本章讨论的儿童不良经历产生持久影响的机制，写下那些符合你情况的机制。你还可以回想一下自己小时候是如何应对压力和创伤的，以及在今天感到压力时，你是否还会依赖这些应对习惯。
[1]Bruce E. Wexler, Brain and Culture: Neurobiology, Ideology, and Social Change(Cambridge, MA: MIT Press, 2006), 100; Pat Ogden, Kekuni Minton, and Clare Pain, Trauma and the Body: A Sensorimotor Approach to Psychotherapy(New York: Norton, 2006), chap. 6; Daniel J. Siegel, The Developing Mind:How Relationships and the Brain Interact to Shape Who We Are (New York:Guilford, 1999), chap. 8; Robert M. Sapolsky, Behave: The Biology of Humans at Our Best and Worst (New York: Penguin, 2017), chap. 7, esp. 221-222.
[2]Siegel, The Developing Mind, chap. 8; Wexler, Brain and Culture, chap. 3; K.Chase Stovall-McClough and M. Cloitre, “Unresolved Attachment, PTSD,and Dissociation in Women with Childhood Abuse Histories,” Journal of Consulting and Clinical Psychology 74, no. 2 (2006): 219-228; Ogden et al., Trauma and the Body, chap. 3; M. S. Scheeringa and C. H. Zeanah, “A Relational Perspective on PTSD in Early Childhood,” Journal of Traumatic Stress 14, no. 4 (2001) 799-815; G. N. Neigh, C. F. Gillespie, and C. B.Nemeroff, “The Neurobiological Toll of Child Abuse and Neglect,” Trauma,Violence and Abuse 10, no. 4 (2009): 389-410.
[3]P. A. Brennan et al., “Maternal Depression and Infant Cortisol: Infuences of Timing, Comorbidity and Treatment,” Journal of Child Psychology and Psychiatry 49, no. 10 (2008): 1099-1107; R. Yehuda et al., “Transgenerational Effects of Posttraumatic Stress Disorder in Babies of Mothers Exposed to the World Trade Center Attacks during Pregnancy,” Journal of Clinical Endocrinology and Metabolism 90 (2005): 4115-4118; Robert C. Scaer, The Trauma Spectrum: Hidden Wounds and Human Resiliency (New York: Norton,2005), 106-107; I. S. Yim et al., “Biological and Psychosocial Predictors of Postpartum Depression: Systematic Review and Call for Integration,’ Annual Review of Clinical Psychology 11 (2015): 99-137. 针对其他哺乳动物的精心控制研究也表明，就胎儿出生时受到的神经生物学影响而言，将怀孕的准妈妈暴露在压力或虐待环境下相当于将胎儿直接暴露在这种环境中。相关评论参见：Neigh et al., “The Neurobiological Toll of Child Abuse and Neglect”。
[4]J. Snyder et al., “Parent-Child Relationship Quality and Family Transmission of Parent Posttraumatic Stress Disorder Symptoms and Child Externalizing and Internalizing Symptoms Following Fathers Exposure to Combat Trauma,”Development and Psychopathology 28, no. 4, pt. 1 (2016): 947-969.
[5]相关评论参见：Neigh et al., “The Neurobiological Toll of Child Abuse and Neglect.”
[6]A. Chandra et al., “Children on the Homefront: The Experience of Children from Military Families,” Pediatrics 125 (2010): 16-25; J. Douglas Bremner,Does Stress Damage the Brain? Understanding Trauma-Related Disorders from a Mind-Body Perspective (New York: Norton, 2005), 152; A. C. Davidson and D. J. Mellor. “The Adjustment of Children of Australian Vietnam Veterans:Is There Evidence for the Transgenerational Transmission of the Effects of War-Related Trauma?” Australian and New Zealand Journal of Psychiatry 35,no. 3 (2001): 345-351; F. A. Al-Turkait and J. U. Ohaeri, “Psychopathological Status, Behavior Problems, and Family Adjustment of Kuwaiti Children Whose Fathers Were Involved in the First Gulf War,” Child and Adolescent Psychiatry and Mental Health 2, no. 1 (2008): 1-12; P. Lester et al., “The Long War and Parental Combat Deployment: Effects on Military Children and atHome Spouses,” Journal of the American Academy of Child and Adolescent Psychiatry 49 (2010): 310-320.
[7]保镖的名字蒂尼的原文为Tiny，在英语中有身材矮小的意思。——译者注
[8]K. J. Kim et al., “Reciprocal Influences between Stressful Life Events and Adolescent Internalizing and Externalizing Problems,” Child Development 74, no. 1 (2003) 127-143; R. D. Conger et al., “A Family Process Model of Economic Hardship and Adjustment of Early Adolescent Boys,” Child Development 63, no. 3 (1992): 526-541; M. Cui and R. D. Conger, “Parenting Behavior as Mediator and Moderator of the Association between Marital Problems and Adolescent Maladjustment,” Journal of Research on Adolescence 18, no. 2 (2008): 261-284; M. Cui et al., “Intergenerational Transmission of Relationship Aggression: A Prospective Longitudinal Study,” Journal of Family Psychology 24, no. 6 (2010): 688-697; T. J. Schofield et al., “Harsh Parenting,Physical Health, and the Protective Role of Positive Parent-Adolescent Relationships,” Social Science and Medicine 157 (2016): 18-26; R. D. Conger and K. J. Conger, “Understanding the Processes through Which Economic Hardship Infuences Families and Children,” Handbook of Families and Poverty 5 (2008): 64-78; K. A. S. Wickrama et al., “Family Antecedents and Consequences of Trajectories of Depressive Symptoms from Adolescence to Young Adulthood: A Life Course Investigation,” Journal of Health and Social Behavior 49, no. 4 (2008): 468-483.
[9]Jane Ellen Stevens, “The Adverse Childhood Experiences Study-The Largest,Most Important Public Health Study You Never Heard of—Began in an Obesity Clinic,” acestoohigh/2012/10/03/the-adverse-childhood-experiencesstudy-the-largest-most-important -public-health-study-you-never-heard-ofbegan-in-an-obesity-clinic/.
[10]V. J. Felitti et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, no. 4(1998): 245-258.
[11]我在这里用了“3分及以上”的说法，是因为芝加哥的这项研究没有具体说明4分及以上的情况。J. P. Mersky, J. Topitzes, and A. J. Reynolds,“Impacts of Adverse Childhood Experiences on Health, Mental Health and Substance Use in Early Adulthood: A Cohort Study of an Urban, Minority Sample in the U.S.,” Child Abuse and Neglect 37, no. 11 (2013): 917-925;也参见N. J. Burke et al. “The Impact of Adverse Childhood Experiences on an Urban Pediatric Population,” Child Abuse and Neglect 35, no. 6 (2011):408-413; M. E. Jimenez et al., “Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample,” AcademicPediatrics 17, пo. 4 (2017): 356-361。
[12]这项研究测量的11个类别为家庭精神疾病、父母分居或离异、家人吸毒、家人酗酒、家庭身体虐待、家庭成员被监禁、家人遭遇家庭暴力、情感虐待、性接触、被迫与他人发生性接触以及被迫发生性行为。
[13]J. R. Blosnich et al., “Disparities in Adverse Childhood Experiences among Individuals with a History of Military Service,” JAMA Psychiatry 71, no. 9(2014): 1041-1048.
[14]A. C. Iverson et al.,“Influence of Childhood Adversity on Health among Male UK Military Personnel,” British Journal of Psychiatry 191 (2007): 506511; U. A. Kelly et al., “More Than Military Sexual Trauma: Interpersonal Violence, PTSD, and Mental Health in Women Veterans,” Research in Nursing and Health 34, no. 6 (2011): 457-467; T. Woodruff, R. Kelty, and D. R. Segal, “Propensity to Serve and Motivation to Enlist among American Combat Soldiers,” Armed Forces and Society 32, пo. 3 (2006): 353-366; J.R. Schultz et al., “Child Sexual Abuse and Adulthood Sexual Assault among Military Veteran and Civilian Women,” Military Medicine 171, no. 8 (2006):723-728; L. Trent et al., “Alcohol Abuse among U.S. Navy Recruits Who Were Maltreated in Childhood,” Alcohol and Alcoholism 42, no. 4 (2007):370-375; Kathy Roth-Douquet and Frank Schaffer, AWOL: The Unexcused Absence of America's Upper Classes from Military Service-And How It Hurts Our Country (New York: HarperCollins, 2006).
[15]I. H. Stanley et al., “Career Prevalence and Correlates of Suicidal Thoughts and Behaviors among Firefighters,” Journal of Affective Disorders 187 (2015):163-171.
[16]J. Hardt and M. Rutter, “Validity of Adult Retrospective Reports of Adverse Childhood Experiences: Review of the Evidence,” Journal of Child Psychology and Psychiatry 45, no. 2 (2004): 260-273.
[17]这里指工作人员参加涉及安全或机密工作的资格。——译者注
[18]R. J. Davidson, D. C. Jackson, and N. H. Kalin, “Emotion, Plasticity, Context,and Regulation: Perspectives from Affective Neuroscience,” Psychological Bulletin 126, no. 6 (2000): 890-909; J. L. Hanson et al., “Structural Variations in Prefrontal Cortex Mediate the Relationship between Early Childhood Stress and Spatial Working Memory,” Journal of Neuroscience 32, no. 23(2012): 7917-7925; R. J. Davidson and B. S. McEwen, “Social Infuences on Neuroplasticity: Stress and Interventions to Promote Well-Being,”Nature Neuroscience 15, no. 5 (2012): 689-695; Sapolsky, Behave, 194201; S. J. Lupien et al., “Effects of Stress throughout the Lifespan on the Brain, Behaviour and Cognition,” Nature Reviews Neuroscience 10, no.6 (2009): 434-445; V. G. Carrion C. F. Weems, and A. L. Reiss, “Stress Predicts Brain Changes in Children: A Pilot Longitudinal Study on Youth Stress, Posttraumatic Stress Disorder, and the Hippocampus,” Pediatrics 119,no. 3 (2007): 509-516; F. L. Woon and D. W. Hedges, “Hippocampal and Amygdala Volumes in Children and Adults with Childhood MaltreatmentRelated Posttraumatic Stress Disorder: A Meta-Analysis.” Hippocampus 18,no. 8 (2008): 729-736.
[19]Sapolsky, Behave, 194-201.
[20]M. M. Weissman et al., “Depressed Adolescents Grown Up,” Journal of the American Medical Association 281, no. 18 (199): 1707-1713; M. M.Weissman et al., “Children with Prepubertal-Onset Major Depressive Disorder and Anxiety Grown Up,” Archives of General Psychiatry 56, no. 9 (1999) 794-801.
[21]A. C. Schermerhorn, “Associations of Child Emotion Recognition with Interparental Conflict and Shy Child Temperament Traits,” Journal of Social and Personal Relationships (2018): doi:10.1177/0265407518762606.
[22]Scaer, The Trauma Spectrum, 62-64; Pat Ogden and Janina Fisher,Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (New York: Norton, 2015), 181.
[23]Stephen W. Porges, The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation (New York:Norton 2011), chap. 16.
[24]Neigh et al., “The Neurobiological Toll of Child Abuse and Neglect.”; J. J.Mann and D. M. Currier, “Stress, Genetics and Epigenetic Effects on the Neurobiology of Suicidal Behavior and Depression,” European Psychiatry 25,no. 5 (2010): 268-271.
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[27]McEwen and Lasley, The End of Stress as We Know It , 64, chap. 6.
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[29]Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Berkeley, CA: North Atlantic, 2010), 171, chaps. 13, 15.
[30]Maté, In the Realm of Hungry Ghosts, 42.
[31]Sapolsky, Behave, 197.
[32]Scaer, The Trauma Spectrum, 56; Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (New York:Penguin, 2015), 29-31; Christopher Peterson, Steven F. Maier, and Martin E. P. Seligman, Learned Helplessness: A Theory for the Age of Personal Control (New York: Oxford University Press, 1993); B. A. van der Kolk et al., “Inescapable Shock, Neurotransmitters, and Addiction to Trauma: Toward a Psychobiology of Post Traumatic Stress,” Biological Psychiatry 20, no. 3(1985): 314-325.
[33]Scaer, The Trauma Spectrum, 56-57; Sapolsky, Behave, 197; C. Anacker, K.J. O'Donnell, and M. J. Meaney, “Early Life Adversity and the Epigenetic Programming of Hypothalamic-Pituitary Adrenal Function,” Dialogues in Clinical Neuroscience 16, no. 3 (2014): 321-333; Peterson et al, Learned Helplessness.
[34]Scaer, The Trauma Spectrum, 56-57; B. A. van der Kolk, “Clinical Implications of Neuroscience Research in PTSD,” Annals of the New York Academy of Sciences 1071, no. 1 (2006): 277-293.
[35]Scaer, The Trauma Spectrum, 88; B. A. van der Kolk, “The Compulsion to Repeat the Trauma,” Psychiatric Clinics of North America 12, no. 2 (1989):389-411; Peter A. Levine, Waking the Tiger: Healing Trauma (Berkeley, CA:North Atlantic, 1997), 173.
[36]Scaer, The Trauma Spectrum, 88-95; van der Kolk, The Body Keeps the Score, 31-33; Ogden and Fisher, Sensorimotor Psychotherapy, chap. 21;Levine, Waking the Triger, chap. 13; P. Payne and M. A. Crane Godreau, “The Preparatory Set: A Novel Approach to Understanding Stress, Trauma, and the Bodymind Therapies,” Frontiers in Human Neuroscience 9, no. 178 (2015):doi:10.3389/fnhum.2015.00178; P. Payne, P. A. Levine, and M. A. CraneGodreau, “Somatic Experiencing: Using Interoception and Proprioception as Core Elements of Trauma Therapy,” Frontiers in Psychology 6, no. 93 (2015):doi:10.3389/fpsyg.2015.00093.
[37]van der Kolk, The Body Keeps the Score, 31; van der Kolk, “The Compulsion to Repeat the Trauma.”
[38]van der Kolk, “The Compulsion to Repeat the Trauma”; Scaer, The Trauma Spectrum, 89-92; T. Woodman, N. Cazenave, and C. Le Scanff, “Skydiving as Emotion Regulation: The Rise and Fall of Anxiety Is Moderated by Alexithymia,” Journal of Sport and Exercise Psychology 30, no. 3 (2008):424-433.
[39]van der Kolk, “The Compulsion to Repeat the Trauma,” 400; 也参见D. G.Dutton and S. L. Painter, “Traumatic Bonding: The Development of Emotional Attachments in Battered Women and Other Relationships of Intermittent Abuse,” Victimology: An International Journal 6, no. 1-4 (1981): 139-155;Lenore E. A. Walker, The Battered Woman Syndrome, 4th ed. (New York:Springer, 2017).
[40]Jimenez et al., “Adverse Childhood Experiences”; J. C. Spilsbury et al., “Profiles of Behavioral Problems in Children Who Witness Domestic Violence,”Violence and Victims 23, no. 1 (2008): 3-17; Burke et al, “The Impact of Adverse Childhood Experiences”; van der Kolk, The Body Keeps the Score,chap. 9.
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[43]溜溜球式节食是一种时常通过节食减轻体重的做法。虽然节食期间体重有所减轻，但一旦停止节食，体重便会反弹，因此这样的节食方式通常会造成体重的反复。这个概念最早是由凯利·布劳内尔（Keelly D. Brownell）提出的。——译者注
[44]你可以在acestudy.org/the-ace-score.html这个网页找到相关测试。