如何走出痛失親人的悲傷

Getting Grief Right

如何走出痛失親人的悲傷

By the time Mary came to see me, six months after losing her daughter to sudden infant death syndrome, she had hired and fired two other therapists. She was trying to get her grief right.

女兒被嬰兒猝死癥奪取生命的六個月后，瑪麗(Mary)找到了我。那時，她已經聘請并解雇了兩名心理醫(yī)師，她努力想要從悲傷中恢復過來。

Mary was a successful accountant, a driven person who was unaccustomed to being weighed down by sorrow. She was also well versed in the so-called stages of grief: denial, anger, bargaining, depression and acceptance. To her and so many others in our culture, that meant grief would be temporary and somewhat predictable, even with the enormity of her loss. She expected to be able to put it behind her and get on with her life.

瑪麗是成功的會計師，充滿斗志，很少被悲傷壓垮。她也非常清楚所謂的悲傷的各個階段：否認、憤怒、協(xié)商、沮喪和接受。對于她和我們文化中的許多其他人來說，那意味著悲傷是暫時的，在一定程度上也是可以預測的，即使是她的生命承受了如此巨大的損失。她期待著能放下痛苦，繼續(xù)自己的生活。

To look at her, she already had done so. The mask she wore for the world was carefully constructed and effective. She seemed to epitomize what many people would call “doing really well,” meaning someone who had experienced a loss but looked as if she was finished grieving. Within a few days of the death of her daughter she was back at work and seemed to function largely as before.

從表面上看，這些她都已經做到了。她戴著一張精心構造的面具來面對世界，掩飾的效果相當不錯。她似乎就是許多人所說的“很堅強”的典范，意思是雖然經歷了打擊，但看起來已經不再悲傷。在女兒夭折的幾天之后，她就回來繼續(xù)工作，言行舉止基本上和以前一樣。

The truth of her life was something else. Six months after her baby’s death she remained in deep despair. She was exhausted from acting better than she felt around co-workers, friends and family. As is so often the case, she had diagnosed her condition as being “stuck” in grief, believing that a stubborn depression was preventing her from achieving acceptance and closure.Was she in denial, she wondered. She also wondered if she was appropriately angry. The bottom line was that she knew she was depressed — a psychiatrist had prescribed an antidepressant — and that is what she wanted me to treat.

她在生活中的真實情況并非如此。寶寶去世的六個月之后，她仍然處于深深的絕望之中。為了在同事、朋友和家人面前表現(xiàn)得更堅強，她已經疲憊不堪。就像多數(shù)情況一樣，她已經察覺自己“陷入”了難以擺脫的悲傷，認為頑固的抑郁正在阻止自己實現(xiàn)接受和解脫。她想，自己是不是還處在否認的階段。她還琢磨，自己是否合理地發(fā)泄了憤怒。但最重要的是，她知道自己抑郁了，一位精神科醫(yī)生給她開了抗抑郁藥。她想讓我?guī)退委煹?，也是抑郁?/p>

Earlier in my practice, I would have zeroed in on that depression. Was there a family history? Had she been depressed before? Was the medicine helping? What were her specific symptoms? Knowing the answers might suggest why she was stuck. Or I would have reviewed the stages of grief, as she had, looking for one in which the work remained incomplete.

倘若是在我行醫(yī)的初期，我會把所有精力放在她的抑郁癥上。她有家族病史嗎?她以前抑郁過嗎?那些藥管用嗎?她有哪些具體癥狀?了解這些問題的答案可能會解釋她的狀況?；蛘撸視u估她經歷的悲傷的每一個階段，就像她所做的那樣，找出哪個階段還沒有完成。

But I had begun to operate differently by the time Mary showed up, which was 10 years after my own loss. My firstborn child had also died before he was a year old. It was why Mary had chosen me.

不過，當瑪麗前來就診時，我已經不那么做了。那時距離我自己遭受同樣的打擊，已經過去10年了。我的第一個孩子不到1歲就去世了。也是出于這個原因，瑪麗找到了我。

In our first session I put Mary’s depression aside. I asked her to tell me the story of her baby rather than describe the symptoms of her grief. Though she was resistant, she eventually started to talk.

在我們的第一次治療中，我把瑪麗的抑郁放在了一邊。讓她對我講講她女兒的事，而不是描述自己悲傷的癥狀。盡管一開始她有些抗拒，最終還是講了起來。

Like most other things in Mary’s life, the baby, whom she named Stephanie, was planned. Mary was delighted with her pregnancy and had wonderful dreams for her daughter. After a routine delivery, Mary stayed home with Stephanie for the first three months. Returning to work had been difficult, but Mary was comfortable with the child-care arrangement, and managed to balance motherhood with her busy professional schedule.

就像瑪麗人生中的其他許多事項一樣，這個被取名斯蒂芬妮(Stephanie)的寶寶也是按計劃降生的?，旣悜焉纤浅ｉ_心，對這個女兒有很多美好的期盼。順產后的頭三個月，瑪麗待在家里照顧斯蒂芬妮。重返工作很痛苦，瑪麗把帶孩子的事安排得很好，努力平衡著母親的角色和繁忙的工作。

Then Mary told me about the Saturday when she went to check on her napping daughter and found that Stephanie wasn’t breathing. She began C.P.R. as her husband called 911. There were moments of surreal focus as she and her husband tried to save their baby. Then this woman, so accustomed to being in control, had to surrender her daughter to an emergency crew. Her husband drove as they followed the ambulance to the hospital.

然后，瑪麗給我講述了那個星期六，當她回到家想要看看正在睡覺的女兒時，卻發(fā)現(xiàn)斯蒂芬妮沒有任何氣息。她開始做心肺復蘇，丈夫撥打了911。她和丈夫試圖挽救孩子的時候，做到了異乎尋常的專注。然后，這個習慣了把所有事情納入掌控之中的女子，不得不把女兒交給了急救人員。丈夫開車帶著她，跟隨救護車駛向了醫(yī)院。

She described the waiting room in great detail, down to the color of the furniture. When the hospital chaplain walked in with the doctor she knew her baby was gone. She and her husband were taken into a room where they held the baby for the last time.

她詳細地描述了等候室的樣子，甚至包括桌椅顏色這樣的細節(jié)。當醫(yī)院牧師和醫(yī)生一起走進來時，她意識到自己的孩子已經不在了。她和丈夫被帶到了一個房間，最后一次把女兒抱在懷里。

At this point in her story Mary finally began to weep, intensely so. She seemed surprised by the waves of emotion that washed over her. It was the first time since the death that the sadness had poured forth in that way. She said she had never told the story of her daughter from conception to death in one sitting.

講到這里，她終于哭了出來，而且一發(fā)不可收拾。她似乎對這種排山倒海的情緒感到不可思議。這是孩子去世以來，她第一次以這種方式宣泄悲傷。她說，她從來沒有這樣完整地講述過女兒從孕育到去世的過程。

“What is wrong with me?” she asked as she cried. “It has been almost seven months.”

“我這是怎么了?”她哭著問。“都已經過去將近七個月了。”

Very gently, using simple, nonclinical words, I suggested to Mary that there was nothing wrong with her. She was not depressed or stuck or wrong. She was just very sad, consumed by sorrow, but not because she was grieving incorrectly. The depth of her sadness was simply a measure of the love she had for her daughter.

我非常輕柔地，用簡單的非醫(yī)學詞匯告訴瑪麗，她沒事。她既沒有抑郁，也沒有陷入悲傷無法自拔，更沒有做錯什么。她只是非常傷心，內心被悲傷填滿，不是因為她承受悲傷的方式有什么不對。她的悲傷之深，只不過是因為她愛女兒之切。

A transformation occurred when she heard this. She continued to weep but the muscles in her face relaxed. I watched as months of pent-up emotions were released. She had spent most of her energy trying to figure out why she was behind in her grieving. She had buried her feelings and vowed to be strong because that’s how a person was supposed to be.

她聽到這里時，轉變發(fā)生了。她仍然在哭泣，但面部的肌肉松弛了。我看到她壓抑了數(shù)月的情緒釋放了出來。在這之前，她用大部分精力想要弄清楚自己為什么無法擺脫悲傷。她把自己的感受埋在心里，發(fā)誓要堅強起來，因為人理當如此。

Now, in my office, stages, self-diagnoses and societal expectations didn’t matter. She was free to surrender to her sorrow. As she did, the deep bond with her little girl was rekindled. Her loss was now part of her story, one to claim and cherish, not a painful event to try to put in the past.

現(xiàn)在，在我的辦公室里，悲傷的各個階段、自我診斷，以及社會的期待都不重要了。她可以自由地屈服于悲傷。她和幼小的女兒之間那段深刻的聯(lián)系被重新點燃。她所承受的打擊成了她的一段故事，一個可以講述和珍藏的故事，而不是一段努力想要遺忘的苦痛經歷。

I had gone through the same process after the loss of my son. I was in my second year of practice when he died, and I subsequently had many grieving patients referred to me. The problem in those early days was that my grief training was not helping either my patients or me. When I was trained, in the late 1970s, the stages of grief were the standard by which a grieving person’s progress was assessed.

在我的兒子夭折后，我經歷了同樣的過程。那是我當上醫(yī)生的第二年，之后就有很多悲痛的患者被介紹到我這里。一開始的問題是，我的治療方法對病人和我都沒有幫助。在上世紀70年代，我接受培訓的時候，悲傷的五個階段是評估一位患者治療進展的指標。

THAT model is still deeply and rigidly embedded in our cultural consciousness and psychological language. It inspires much self-diagnosis and self-criticism among the aggrieved. This is compounded by the often subtle and well-meaning judgment of the surrounding community. A person is to grieve for only so long and with so much intensity.

這個模式仍然深刻而頑固地存在于我們的文化意識和心理話語中。它讓痛苦的人們做出了許多自我診斷和自我批評。推波助瀾的，則是周圍的人常常含蓄和善意的看法。一個人的悲傷的時間和強度，都應當適度。

To be sure, some people who come to see me exhibit serious, diagnosable symptoms that require treatment. Many, however, seek help only because they and the people around them believe that time is up on their grief. The truth is that grief is as unique as a fingerprint, conforms to no timetable or societal expectation.

當然，有些來找我尋求幫助的人顯示出了嚴重的、可以診斷的癥狀，這些癥狀需要治療。然而許多人尋求幫助只是因為他們和周圍的人認為，他們悲傷的時間該結束了。實際上，悲傷就像指紋一樣獨一無二，它不會遵照任何時間安排或者社會期待。

Based on my own and my patients’ experiences, I now like to say that the story of loss has three “chapters.” Chapter 1 has to do with attachment: the strength of the bond with the person who has been lost. Understanding the relationship between degree of attachment and intensity of grief brings great relief for most patients. I often tell them that the size of their grief corresponds to the depth of their love.

根據我自己和我的患者的經歷，我現(xiàn)在想說，失去至親的故事有三個“章節(jié)”。第一個章節(jié)與依戀程度有關：指的是你和去世者之間的關系。理解感情程度和悲傷程度的關系，會讓多數(shù)患者感到極大的寬慰。我常常告訴他們，悲傷的強度和愛的深度是相稱的。

Chapter 2 is the death event itself. This is often the moment when the person experiencing the loss begins to question his sanity, particularly when the death is premature and traumatic. Mary had prided herself on her ability to stay in control in difficult times. The profound emotional chaos of her baby’s death made her feel crazy. As soon as she was able, she resisted the craziness and shut down the natural pain and suffering.

第二個章節(jié)是死亡本身。在這個階段，失去至親的人常常會開始質疑自己的精神狀況，如果是過早死亡或創(chuàng)傷性的死亡，就尤其如此?，旣悓ψ约涸谄D難時期把控全局的能力感到自豪。她女兒的死亡導致的深度情緒混亂讓她抓狂。她會盡可能地抵制這種抓狂的狀態(tài)，抑制自然產生的痛苦和折磨。

Chapter 3 is the long road that begins after the last casserole dish is picked up — when the outside world stops grieving with you. Mary wanted to reassure her family, friends and herself that she was on the fast track to closure. This was exhausting. What she really needed was to let herself sink into her sadness, accept it.

第三個章節(jié)是從外部世界不再陪你一同悲傷的時候開始的，這是一條漫長的道路?，旣愊胍尲胰恕⑴笥押妥约合嘈?，她很快會從悲傷中走出來。這個過程讓人精疲力盡。她真正需要的是讓自己沉浸在悲傷里，然后接受它。