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.

本周早些時(shí)候加州發(fā)現(xiàn)13名兄弟姐妹被囚家中一案令人震驚，但并非沒(méi)有先例。這些年一直有兒童被關(guān)在儲(chǔ)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(chuàng)傷專(zhuān)家稱(chēng)康復(fù)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.”

“臨床數(shù)據(jù)是樂(lè)觀的，”美國(guó)國(guó)家兒童創(chuàng)傷應(yīng)激中心(National Center for Child Traumatic Stress)聯(lián)席主任約翰·A·費(fèi)爾班克(John A. Fairbank)說(shuō)。“對(duì)受到了嚴(yán)重虐待和創(chuàng)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.

作為杜克大學(xué)精神病學(xué)和行為學(xué)教授的費(fèi)爾班克說(shuō)，尤其是相對(duì)短期的針對(duì)精神創(chuàng)傷病人的認(rèn)知行為療法表現(xiàn)出了良好成效，該療法研發(fā)于90年代早期，但在最近的15年才得到普及。

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(xué)家表示，對(duì)于加州的這些兄弟姐妹以及有著類(lèi)似情況的兒童來(lái)說(shuō)，康復(fù)過(guò)程的一個(gè)巨大障礙是，囚禁他們的并非陌生綁架者，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(jìn)行康復(fù)工作時(shí)，要找出病人的支持系統(tǒng)是什么，”喬治城大學(xué)(Georgetown University)精神病學(xué)系副教授、精神創(chuàng)傷心理學(xué)家普利西拉·達(dá)斯-布雷斯福德(Priscilla Dass-Brailsford)說(shuō)。“父母和家庭是最重要的支持。但那些孩子們沒(méi)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(xiě)本文時(shí)采訪(fǎng)的專(zhuān)家強(qiáng)調(diào)，自己對(duì)加利福尼亞一案并非直接知情，并表示，由于這些兄弟姐妹被剝奪了無(wú)條件的愛(ài)和安全這一首要保障，他們?cè)谂c未來(lái)的支持對(duì)象建立信任和親密關(guān)系時(shí)基本上肯定會(huì)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.

“知道這是父母的行為這一點(diǎn)增加了孩子的無(wú)助和絕望，”洛杉磯一名經(jīng)常治療精神創(chuàng)傷病人的心理學(xué)家諾拉·J·貝拉戴里安(Nora J. Baladerian)說(shuō)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(dá)斯-布雷斯福德拿這13個(gè)孩子的情況與被剝奪了食物、自由和足夠照料的戰(zhàn)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(xiàn)希望，那就是他們并不是獨(dú)自經(jīng)受這一切的，”她說(shuō)。“作為懲罰，戰(zhàn)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(zhuān)家表示，在正式治療開(kāi)始之前，一定要先將這些孩子安置在一個(gè)安全并被悉心呵護(hù)的環(huán)境中，讓溫和的治療成為一個(gè)他們可以依靠的正面常態(tài)。并補(bǔ)充說(shuō)，讓盡可能多的兄弟姐妹們待在一起對(duì)維系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(xué)家丹尼爾·L·戴維斯(Daniel L. Davis)表示，沒(méi)有哪一種行為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(dāng)然，是有風(fēng)險(xiǎn)因素的，”他說(shuō)。其中可能包括虐待或家庭暴力前科，還有比如反社會(huì)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(shuō)，這些人可能會(huì)過(guò)度情緒化、難以預(yù)測(cè)、控制欲或是剝削欲過(guò)強(qiáng)。

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(chuàng)傷專(zhuān)家一樣，戴維斯強(qiáng)調(diào)兒童有著驚人的適應(yīng)力。他曾治療過(guò)一個(gè)被父母鎖了很長(zhǎng)時(shí)間以至于表現(xiàn)出嚴(yán)重的發(fā)育遲緩的學(xué)齡男孩。“但經(jīng)過(guò)支持團(tuán)隊(duì)集中治療并作了十足努力后，他的成長(zhǎng)十分出色，”戴維斯說(shuō)。“他的父母被送進(jìn)了監(jiān)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(xiàn)過(guò)其他一些孩子被父母隔離在社會(huì)之外的案例。紀(jì)錄片《狼群》(The Wolfpack)講述了七個(gè)兄弟姐妹被父親隔離在下東區(qū)一個(gè)公寓里的故事。2015年，在維吉尼亞州斯波特西瓦尼亞縣發(fā)現(xiàn)了三個(gè)兄弟姐妹被父母鎖在一間充滿(mǎn)屎尿的房間里。同一年，在田納西州默弗里斯博羅市發(fā)現(xiàn)了一個(gè)十多歲的女孩被父母鎖在臥室里數(shù)月，她的父母允許她的三個(gè)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(gè)因素，但它肯定不是標(biāo)志性特征。事實(shí)上，在加州的這個(gè)案例中，這家人住在一個(gè)中產(chǎn)階級(jí)社區(qū)，據(jù)說(shuō)父親戴維·艾倫·特平(David Allen Turpin)曾做過(guò)工程師。但是，戴維斯博士指出，貧困導(dǎo)致的情況可能更容易被發(fā)現(xiàn)，“因?yàn)榉缸镎邲](méi)有足夠的資源來(lái)避免公眾監(jiān)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(gè)安全的家中，評(píng)估與創(chuàng)傷相關(guān)的癥狀，包括創(chuàng)傷后應(yīng)激障礙(PTSD)，之后才開(kāi)始正式治療。他們可能不愿意或無(wú)法描述自己的經(jīng)歷。噩夢(mèng)可能會(huì)困擾他們。最輕微的觸動(dòng)——例如，鑰匙的響聲——可能會(huì)讓他們爆發(fā)歇斯底里癥狀。他們可能會(huì)極度亢奮或警覺(jué)，始終警惕而畏縮，隨時(shí)準(zhǔn)備逃跑或?qū)?。年幼的孩子可能在玩耍時(shí)都會(huì)表現(xiàn)出創(chuàng)傷;另一些孩子可能遭受了巨大的情感創(chuàng)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(guò)，大多數(shù)孩子都能恢復(fù)過(guò)來(lái)，”匹茲堡阿勒格尼醫(yī)院(Allegheny General Hospital)兒童和青少年心理創(chuàng)傷中心(Center for Traumatic Stress in Children and Adolescents)的主任安東尼·P·曼納里諾(Anthony P. Mannarino)說(shuō)，“我不是說(shuō)他們會(huì)忘記，但他們能找到前進(jìn)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.

曼納里諾博士是創(chuàng)傷性認(rèn)知行為療法(TF-CBT)的聯(lián)合開(kāi)發(fā)者。他說(shuō)，治療一般需要12至16個(gè)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(guān)于那段經(jīng)歷的可怕想法和感受。接下來(lái)，治療師引導(dǎo)孩子慢慢討論創(chuàng)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，”曼納里諾博士說(shuō)。“也許他們的父母說(shuō)，‘這是你應(yīng)受的懲罰，這是你的錯(cuò)’，羞恥感可能已經(jīng)在孩子的心里扎根了。幫助他們談?wù)摵吞幚磉@種扭曲的想法能讓他們有機(jī)會(huì)明白，那不是他們的錯(cuò)。”

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的最后一步需要孩子新看護(hù)人的參與。“我們幫看護(hù)人們明白，孩子的行為是他們?cè)庥龅谋憩F(xiàn)，不是他們的真實(shí)性情，”曼納里諾博士說(shuō)。

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(chuàng)傷患者的諸多療法中，TF-CBT是最受關(guān)注的一種。在《美國(guó)兒童和青少年精神病學(xué)會(huì)期刊》(Journal of the American Academy of Child and Adolescent Psychiatry)2004年發(fā)表的一項(xiàng)多地點(diǎn)隨機(jī)研究中，203名8至14歲具有性虐待創(chuàng)傷后應(yīng)激障礙癥狀的孩子和他們的看護(hù)人被隨機(jī)分配采用TF-CBT療法或“以?xún)和癁橹行?rdquo;的療法——后者是強(qiáng)奸危機(jī)中心或性虐待治療中心經(jīng)常使用的一種談話(huà)療法。采用TF-CBT療法的患者在創(chuàng)傷后應(yīng)激障礙、抑郁和行為等指標(biāo)上的改善更為明顯。

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(gè)加州家庭能得到足夠的服務(wù)，而且希望“人們的關(guān)注也能幫助那些沒(méi)有得到如此密切關(guān)注的案例的受害者”。