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酷刑、大规模侵犯人权行为及难民创伤的心理社会影响:构建一个综合概念框架

The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework.

作者信息

Silove D

机构信息

The Psychiatry Research & Teaching Unit, School of Psychiatry, University of New South Wales, Liverpool Hospital, Australia.

出版信息

J Nerv Ment Dis. 1999 Apr;187(4):200-7. doi: 10.1097/00005053-199904000-00002.

Abstract

Torture is a complex trauma that often occurs within the context of widespread persecution and human rights violations. In addition, the nature of modern warfare is such that whole populations are at risk of suffering extensive trauma, injustices, loss, and displacement. Refugees, in particular, experience sequential stresses that may compound each other over prolonged periods of time. The present overview examines whether contemporary notions of trauma, and especially a focus on the category of posttraumatic stress disorder (PTSD), are adequate in assessing the multiple effects of such experiences. Recent studies are reviewed to indicate the strengths and limitations of current research approaches. Rates of PTSD in such studies have varied with relatively low rates being found in recent epidemiologic studies undertaken on refugee populations. It is suggested that a focus on intervening psychosocial adaptive systems may assist in delineating more clearly the pathways that determine whether traumatized persons achieve psychosocial restitution or are at risk of ongoing psychiatric disability. A model is proposed which suggests that torture and related abuses may challenge five core adaptive systems subserving the functions of "safety," "attachment," "justice," "identity-role," and "existential-meaning." It is argued that a clearer delineation of such adaptive systems may provide a point of convergence that may link research endeavors more closely to the subjective experience of survivors and to the types of clinical interventions offered by trauma treatment services.

摘要

酷刑是一种复杂的创伤,常常发生在广泛迫害和侵犯人权的背景之下。此外,现代战争的性质使得全体民众都面临遭受广泛创伤、不公正待遇、损失和流离失所的风险。尤其是难民,会经历一系列的压力,这些压力可能在很长一段时间内相互叠加。本综述探讨当代的创伤观念,特别是对创伤后应激障碍(PTSD)这一类别关注,是否足以评估此类经历的多重影响。回顾近期研究以指出当前研究方法的优势与局限。此类研究中PTSD的发生率各不相同,在近期针对难民群体开展的流行病学研究中发现的发生率相对较低。有人认为,关注干预心理社会适应系统可能有助于更清晰地勾勒出决定受创伤者能否实现心理社会恢复或面临持续精神残疾风险的途径。本文提出一个模型,该模型表明酷刑及相关虐待行为可能会对服务于“安全”“依恋”“正义”“身份角色”和“存在意义”功能的五个核心适应系统构成挑战。有人认为,对此类适应系统进行更清晰的描述可能提供一个汇聚点,使研究工作能更紧密地与幸存者的主观体验以及创伤治疗服务所提供的临床干预类型联系起来。

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