Pedersen Duncan, Tremblay Jacques, Errázuriz Consuelo, Gamarra Jeffrey
McGill University, 6875 LaSalle Boulevard, Montreal, Quebec, Canada.
Soc Sci Med. 2008 Jul;67(2):205-17. doi: 10.1016/j.socscimed.2008.03.040. Epub 2008 Apr 16.
In this article, we begin with a qualitative mapping of the multiple ways indigenous peoples in the Peruvian highlands construct their emotions, symptoms and specific disorders when confronted with an adverse environment of sustained political violence, multiple stressors and massive exposure to traumatic experiences. Second, we address the issue of magnitude (point prevalence) and distribution of mental health problems such as depression and anxiety, and sequelae of exposure to violence-related stressors as reported in the selected populations, by reviewing the quantitative results of a cross-sectional survey. Third, we examine the pathways and linkages between the social context (drawn from ethnography and secondary sources) and the collective experience, such as massive exodus, forced displacement, resilience and accommodation strategies for coping and survival. When assessing the overall mental health impact of exposure to protracted forms of extreme violence in civilian populations, we argue for the need to move beyond the limited notion of post-traumatic stress disorder, which is a useful but restrictive medical category failing to encompass the myriad of signals of distress, suffering and affliction, as well as other culture bound trauma-related disorders and long-term sequelae of traumatic experiences. Lastly, following the concluding remarks, we discuss some implications the results of the study may have at various levels, not only for the victims and survivors of massive exposure to traumatic events, but also their families and communities, as well as for interventions carried out by humanitarian and emergency relief organizations, and specialised agencies engaged in the promotion of social justice, prevention of human rights abuses, and mental health rehabilitation programs at both national and international levels.
在本文中，我们首先对秘鲁高地的原住民在面对持续的政治暴力、多重压力源以及大量创伤经历的不利环境时，构建其情感、症状和特定疾病的多种方式进行定性映射。其次，我们通过回顾一项横断面调查的定量结果，来探讨所选人群中抑郁症和焦虑症等心理健康问题的严重程度（点患病率）及分布情况，以及暴力相关压力源暴露的后遗症。第三，我们研究社会背景（源自人种志和二手资料）与集体经历之间的路径和联系，例如大规模外流、被迫流离失所、恢复力以及应对和生存的适应策略。在评估平民长期遭受极端暴力对心理健康的总体影响时，我们认为有必要超越创伤后应激障碍这一有限概念，该概念虽有用但具有局限性，未能涵盖痛苦、苦难和折磨的众多信号，以及其他与文化相关的创伤性疾病和创伤经历的长期后遗症。最后，在结语之后，我们讨论该研究结果可能在各个层面产生的一些影响，不仅涉及大量遭受创伤事件的受害者和幸存者，还包括他们的家庭和社区，以及人道主义和紧急救援组织以及参与促进社会正义、预防侵犯人权行为和国家及国际层面心理健康康复项目的专门机构所开展的干预措施。
