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地震灾后“隐形创伤”也需要心理救援

更新时间:2017/10/15 11:16:51 来源:本站原创 作者:佚名

The 'disaster psychologists' who helped after Mexico's quake
地震灾后“隐形创伤”也需要心理救援

Raquel Barrera felt nauseous and couldn't sleep or eat.

拉克尔·巴雷拉 (Raquel Barrera)感到恶心,无法睡觉和吃饭。

“I felt dizzy, too. I was scared it was going to happen again,” she said.

"我还觉得头晕。我很害怕,感觉地震还会发生,"她说。

Last week, 12-year-old Barrera had been caught in the middle of the magnitude 7.1 earthquake that hit central Mexico, killing hundreds of people and toppling many buildings. Barrera was in class at her middle school when the earthquake struck at just past 13:00 on 19 September. Her mother, Eucevia Roman, had been waiting outside to pick her up.

9月19日,12岁的巴雷拉被困在墨西哥中部地区发生的一场7.1级的地震中。这场地震导致数百人丧生,大量楼房倒塌。9月19日下午1点刚过,地震发生了,当时巴雷拉正在中学的课堂上。她的母亲尤切维亚·罗曼(Eucevia Roman)正在学校外等着接她。

Her symptoms – nausea, insomnia and a loss of appetite – didn’t require medical attention. However, in the days following the quake, the young girl’s parents decided to seek help, after hearing doctors were seeing patients affected by the disaster at a government building in downtown Xochimilco, one of Mexico City’s hardest-hit districts. The doctors referred her to a psychologist – one of many who mobilised to help the country’s children and distressed adults cope with the aftermath.

她的症状——恶心、失眠和胃口减退——并不需要治疗。然而,在地震过后数天,女孩的父母听说在墨西哥城的重灾区霍奇米尔科(Xochimilco)的政府大楼里有医生为受灾患者提供诊断,他们决定寻求帮助,而医生建议她去看心理医生。墨西哥动员了大量心理医生帮助儿童和抑郁的成年人应对灾后心理问题。

Typically, much of the mental health support that victims receive after natural disasters comes months after the event, if at all, and after basic needs are first met. But what’s changing in Mexico is that now counsellors and psychologists are moving much faster to help people immediately. Last week, hundreds of them offered free counselling in shelters at government buildings and via hotlines within hours of the quake.

通常情况下,受灾者即使能得到心理健康方面的帮助,也要等到数月后。基本需求会放在首位。但是墨西哥发生的变化是咨询师和心理学家加快了速度,立刻开始帮助受灾者。上周,数百位咨询师和心理学家在政府大楼的避难所提供了免费咨询,他们还在震后数小时内通过热线提供免费咨询。

The trauma of the event is likely to take a toll on many residents – not just those who lost loved ones, but people who were evacuated from buildings, felt an earthquake for the first time or remembered the devastation of the 1985 earthquake, as well as the hundreds of volunteers who rallied to help in the relief efforts. To cope with the aftermath of a disaster, survivors usually go through a process of disbelief, bewilderment, difficulty focusing, denial, anxiety, fear and eventually depression and sadness, according to researchers.

很多人都可能会产生灾后心理创伤——不仅是失去亲人的人,还有从建筑物中疏散出来的人,他们有的第一次经历地震,有的想起了1985年毁灭性的地震,可能产生心理创伤的还有参与救灾的志愿者们。研究者认为,幸存者通常会经过难以置信、混乱、无法集中精神、否认、焦虑、恐惧、压抑和悲伤这样一个心理过程。

Yet if the world can learn from what happened in Mexico last week, it’s that intervening faster to offer immediate mental health assistance may be key to helping people deal with trauma in the longer-term – and particularly for children like Barrera.

如果世界可以从墨西哥的地震灾难中学到什么的话,那就是较快干预并立刻提供心理健康帮助将对人们应对长期心理创伤产生重要作用——尤其是对巴雷拉这样的儿童。

Just steps from the building where Barrera had gone for a checkup, she met Adriana Chavez, a psychologist with the Women’s Institute of Mexico City, a government organisation that supports the health and safety of women in the city. The group had set up a canopy there to offer one-on-one sessions with victims of the earthquake.

就在巴雷拉进行体检的楼房不远处,她见到了墨西哥城女性研究院(Women's Institute of Mexico City)的心理学家阿德里亚纳·查维斯。该学院是支持女性健康和安全的政府组织。他们早就在那里搭了一顶帐篷,为受灾者提供一对一的咨询服务。

“She’s dealing with symptoms of post-traumatic stress as a result of the natural disaster,” according to Chavez. “We want people to understand what these concepts mean. This is the first time Barrera has ever experienced an earthquake, so I explained to her how an earthquake works, and what’s normal for people [to feel] after natural disasters: chaos, shock, fear. At the end of the day, we just lived through a traumatic experience.”

"她正在应对自然灾害后的创伤压力症状,"查维斯说,"我们希望人们理解这些概念的含义。这是巴雷拉第一次经历地震,所以我和她解释了地震的原理,以及在自然灾害之后人们通常的感受:混乱、惊吓、恐惧。地震只是让我们经历了一场创伤体验。"

After meeting with Chavez, Barrera felt better. “She told me to stay away from news about the earthquake and showed me breathing exercises,” Barrera says.

巴雷拉觉得在见过查维斯后感到好了一些。"她让我不要看关于地震的新闻,还向我演示呼吸练习,"巴雷拉说。

The 12-year-old’s experience is a normal way of processing trauma, Chavez says, and most people will begin to feel normal by the second week. But if left untreated, people affected by disasters can develop post-traumatic stress disorder, a condition that could last months or years marked by flashbacks, an avoidance of feelings, and anxiety or depression.

这个12岁的孩子所经历的是处理心理创伤的正常方式,查维斯说,大多数人从第二周开始会恢复正常。但是如果没有经过治疗,受灾者可能会形成创伤后遗症,有可能会持续数年或数月,主要特点是闪回、逃避情绪、焦虑或抑郁。

Research shows that up to 29% of survivors of disasters develop PTSD, and that they are significantly more likely to have a lifetime anxiety disorder and affective disorder. A survey of adults in 75 Mexico City shelters following the 1985 earthquake found that 32% were experiencing PTSD, and direct victims of the disaster reported having higher levels of anger, depression and confusion. Following the Turkey earthquake of 1999, 17% of survivors reported having suicidal thoughts.

研究表明,多达29%的幸存者患有创伤后应激障碍,他们发生终身焦虑症和情绪失调的可能性也大大提高。1985年地震后对墨西哥城75个避难所的成年人进行的一项调查发现,32%的被调查者患有创伤后应激障碍,灾难的直接受害者存在较严重的愤怒、忧郁和困惑。在1999年土耳其地震后,17%的幸存者称有过自杀的想法。

According to research, it’s after the first few days following a disaster that mental health issues manifest and need attention.

据研究,在灾难后的几天内,人们会表现出心理问题,这需要受到重视。

Across town in Colonia Roma, Rosa Inez Borga, 27, sat with her four-year-old daughter, Salma, last Thursday. They were staying at a makeshift albergue, or shelter – one of 45 that had been set up – after being evacuated from their building in nearby Colonia Doctores. Salma was in kindergarten when the earthquake hit. “I was crying,” said Salma. “The teacher told us to sit down and started singing with us.”

地震发生时,在墨西哥城的科洛尼亚罗马(Colonia Roma),27岁的罗萨·伊内兹·博尔伽(Rosa Inez Borga)和她四岁的女儿萨尔玛(Salma)坐在一起。她们先从附近的科洛尼亚多克托瑞斯(Colonia Doctores)的楼房中逃生,然后被安置在一个临时避难所,当地一共建起了45个这样的避难所。地震发生时,萨尔玛正在幼儿园里。"我当时哭了,"萨尔玛说,"老师让我们坐下,然后开始和我们唱歌。"

Borga said a psychologist had come by to see Salma, mostly to play games and distract her.

博尔伽说,有一个心理学家来看过萨尔玛,主要是和她玩游戏,分散她的注意力。

There are no set rules for how to interact with children affected by disasters, says Fernando Alvarez, a coordinator for volunteer search-and-rescue group Brigada de Rescate Topos Tlatelolco, commonly known as the Topos, Spanish for moles. “Sometimes it’s just playing games, doing activities, drawing. With each child, it varies,” he said.

关于如何与受灾儿童互动,并没有陈规,搜救志愿团Brigada de Rescate Topos Tlatelolco(通称"Topos",西班牙语里的意思是鼹鼠)的协调员费尔南多·阿尔瓦雷斯(Fernando Alvarez)说。"有时候,就是做游戏,进行一些活动,画画。每个孩子都不一样,"他说。

As part of their first aid relief work, the Topos work with volunteer psychologists who help prevent post-traumatic stress among those affected, particularly children, who are one of the most vulnerable populations. A study assessing the mental health impact of the 2011 earthquake in Japan showed that “younger children and those with parents suffering from trauma-related distress were particularly vulnerable to the onset of pediatric mental disturbances.”

Topos与志愿心理学家一起防止受灾者发生创伤后应激障碍,特别是非常容易受到影响的儿童。这是Topos救灾工作的一部分。一项研究对2011年日本地震对心理健康的影响进行了评估,发现"幼儿以及父母患有创伤后应激障碍的儿童尤其容易引发儿科心理障碍。"

The Topos had recently worked in Juchitan, Oaxaca, where a magnitude 8.2 earthquake on 7 September resulted in dozens of collapsed buildings. They provided support to about 80-100 children there. They’ve also volunteered after natural disasters hit Japan, Indonesia and Haiti.

Topos最近还在墨西哥瓦哈卡(Oaxaca)的胡奇坦(Juchitan)展开工作。9月7日发生的8.2级地震导致数十栋建筑物坍塌。他们为80至100名儿童提供帮助。他们还曾在日本、印尼、海地发生自然灾害后提供志愿服务。

Alvarez says there is no other international group that brings psychological help as part of search-and-rescue relief efforts. Many groups simply don’t offer psychological relief. But the understanding and training of psychological first aid is gaining traction.

阿尔瓦雷斯说,没有任何其他国际团体把心理援助作为援救工作的一部分。很多团体根本不提供心理援助。但是对心理救助和认识和培训正在取得进展。

"We've seen that if we help at the very beginning, it really helps children avoid post-traumatic stress,” says Alvarez. “If they get the help immediately, recovery is quicker, especially among younger kids.”

"我们发现,如果我们一开始就提供帮助,的确能够帮助儿童避免创伤后应激障碍,"阿尔瓦雷斯说,"如果他们立刻得到帮助,恢复速度就会更快,尤其是年幼的孩子。"

He also points out that it’s more cost effective to provide preventative psychological help than to try to solve mental health problems en masse later on.

他还指出,预防心理疾病比之后批量治疗心理疾病的成本效率更高。

The day after the earthquake, psychology students, professors and alumni at the National Autonomous University of Mexico (UNAM) gathered to volunteer. They formed brigades of teams who took shifts visiting shelters and disaster zones across the city.

地震后第二天,墨西哥国立自治大学的心理学专业师生和校友集合到一起提供志愿服务。他们组队轮班访问整个城市的各个避难所和灾区。

“Our first aid support focuses on stabilising emotions and identifying how people can move past a traumatic experience like this,” says Silvia Morales, coordinator for training and support services at the UNAM psychology department. “It’s not that easy, especially if they’ve been hurt or lost loved ones.”

"我们的急救专注于稳定情绪并找到方法帮助人们度过创伤过程,"墨西哥国立自治大学心理系培训和支持服务协调员西尔维娅·莫拉莱斯(Silvia Morales)说,"这并不简单,尤其是当他们受伤或者有亲人去世时。"

Psychological first aid offers various methods for dealing with disaster victims: it includes a slow breathing exercise to a count of three, which helps to relax and reduce anxiety, and talking them through an imagined situation. Victims could also benefit from talking through their experience of what’s happened to them or their fears, but this method requires professional help since it could trigger negative emotions.

受灾者的心理急救有多种方法,包括从一数到三的缓慢呼吸法,这有助于放松和减少焦虑,还有为他们讲述想象的场景。受灾者讲述自己的经历或者恐惧也会有益,但是这需要专业人士的帮助,因为这可能会激发负面情绪。

Mental health support for those affected also changes over time, Morales says. “The immediate support is crisis intervention and helping people understand what’s happened. Later it will be helping people manage their emotional shock, grief and other post-traumatic feelings.”

对受灾者的心理健康服务也会随着时间而发生变化。莫拉莱斯说:"一开始是危机干预,帮助人们理解发生的事情。然后要帮助人们管理情绪冲击、悲伤和其他创伤后的应激情绪。"

About 400 volunteers have signed up through UNAM to participate in shifts. The university also has two hotlines open to provide support, with volunteers working there night and day. Francisco Martinez, who manages the helpline, said they were receiving about 100 a day.

大约400名志愿者报名参与墨西哥国立自治大学的轮班服务。大学还开设了两条热线电话以提供援助,志愿者不分昼夜展开工作。热线电话的管理者弗朗西斯科·马丁内兹(Francisco Martinez)称他们一天接到大约100个电话。

“We’ve heard a lot of calls from people who are in crisis mode. They’re anxious, wondering what’s going to happen or if there’s going to be a replica,” says Martinez. “Some people feel a shake from trucks passing the street and that triggers anxiety. Now everything draws our attention and takes us back to the earthquake. It’s fear that we won’t be safe. Our goal is to calm them down and reduce their anxiety.”

"我们接到了很多电话,发现打电话的人处于危机模式下,他们很焦虑,想知道会发生什么,会不会再发生同样的事情,"马丁内兹说,"一些人感到过路卡车的震动,就触发了焦虑。什么都会引起他们都注意,把他们带回到地震的情景。他们担心自己不安全。我们的目标是让他们平静下来,减少他们的焦虑。"

Martinez says more women have called then men, perhaps because they feel more comfortable calling in. “It has a lot to do with culture, tradition, but we want people to know we’re here. The objective of our support is the same, regardless if it’s men or women.”

马丁内兹说,打来电话的女性比男性多,可能因为她们感到打电话比较安心。"这和文化、传统有很大的关系,但是我们希望人们知道有我们在这里。我们帮助的目的是一样的,不论是男性还是女性。"

There were many other efforts by experts in the week following the earthquake. Last Thursday, a psychologist's office had set up a support session for children and their families; the office said it would be the first of many. And as part of a collaboration between a clinic in Colonia Condesa and various psychology associations, another 200-300 psychologists joined brigades to visit albergues starting Saturday. Another group was supporting victims at the Enrique Rebsamen school, where they said families were angry and in shock after hearing rumours and false news reports.

地震后的一周,专家还进行了很多其他工作。上周四,一个心理学家的办公室还设置了一个亲子支援会。该办公室还表示将来还会建立更多的支援会。周六开始,另外有200至300位心理学家组队访问避难所,这是科洛尼亚康得萨(Colonia Condesa)的诊所和多个心理学协会合作的一部分。另外有一个团体在恩里克·雷夫萨门(Enrique Rebsamen)的学校支援受灾者,他们说这里的家庭在听闻了谣言和虚假新闻报道后感到愤怒和震惊。

Martinez says the mental health of volunteers and disaster workers would also need to be addressed in the coming weeks. In a 2007 study looking at the impact of disasters on first responders, researchers found that exposed disaster workers had significantly higher rates of ASD (acute stress reaction), PTSD and depression than their counterparts who had not assisted in the same relief work. Disaster workers with ASD were also nearly four times more likely to be depressed seven months later.

马丁内兹说,未来数周还需要应对志愿者和灾害工作人员的心理健康问题。2007年的一项调查研究了灾害对先遣救援队的影响,发现灾害工作人员发生急性应激障碍(ASD)、创伤后应激障碍和抑郁的可能性比没有参与援救工作的人高很多。在七个月以后,灾害工作人员发生急性应激障碍的可能性比普通人高将近四倍。

Petra Gante, 41, was another Mexico City resident still coping with the psychological aftermath days after the quake struck. “I don’t feel well since it happened,” Gante told BBC Future last week. “I’m nervous, I’m not hungry. I see all the chaos, and it makes me more anxious. It scares me to be home.”

在地震发生数日后,41岁的墨西哥城居民佩特拉·甘特(Petra Gante)仍然在应对自己的心理问题。"地震发生后,我觉得很糟糕,"甘特上周对BBC Future表示,"我很紧张,没有胃口。我看到了混乱不堪的场面,这让我更加紧张。呆在家里我感到害怕。"

As of 26 September, Xochimilco – a neighbourhood of Mexico City – still didn’t have running water. When she visited the Instituto de las Mujeres tent, Gante was also still waiting for an assessment on the safety of her home – a fact that worries her because while her home doesn’t appear to have any damage, the home next to hers looks like it’s leaning and could fall.

9月26日,墨西哥城的霍奇米尔科区仍然没有自来水。当甘特来到女性研究院的帐篷时,她仍在等待自己家的安全评估——她之所以担心是因为邻居家的房子已经歪斜,有可能会倒塌,但是她的房子看似没有损坏。

Though her family is safe, she says she constantly thinks about what might have happened. “I started remembering the one from ‘85. The ambulances, the noise,” she says. “I was nine. I started forgetting it, but this reminded me of it because we lost water and electricity then, too. That brought back memories.”

虽然她的家人都平安无事,但是她不断的想象可能会发生的事情。"我开始回想起1985年的那次,有救护车,还有噪音,"她说,"我当时九岁,我已经开始忘记那次地震了。但是这次地震让我回想起来,因为当时我们也是断水断电。这唤醒了我的记忆。"

She says she intends to follow up with mental health support at the local office of the Women’s Institute of Mexico City.

她说,她想要前往墨西哥城女性研究院的本地办公室,继续获得心理健康方面的帮助。

A week after the earthquake, life in the city hasn’t returned to normal. Many schools haven’t yet reopened, and volunteers are still out sorting through donations and rubble. But thanks to the work by psychologists in the days since, Raquel Barrera says she’s recuperated from the post-traumatic stress symptoms she experienced. “I’m practising the exercises [Chavez] showed me,” she says. “It took a few days, but I feel fine.”

地震后一周,城市的生活秩序仍然没有恢复正常。很多学校还没有重新开放,志愿者仍然在整理捐赠品,清理碎石。不过,多亏了这些天心理学家的工作,拉克尔·巴雷拉说,她已经从创伤后应激反应的症状中恢复过来。"我在做查维斯教我的练习,"她说,"我花了几天的时间,但我觉得已经没什么问题了。"

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