Personal History

What Science Knows About Grief

关于悲伤,科学知道些什么
After my husband’s death, I had never been more pliable, tender, open, or raw. It was then that I tried E.M.D.R. therapy.
丈夫去世后,我从未如此柔顺、脆弱、敞开、生疼。正是在那时,我尝试了EMDR疗法。
Large eye with a woman grieving in the foreground.
Illustration by Jillian Tamaki

In 1967, Leonard Cohen released “So Long, Marianne,” a requiem for a love affair that was unravelling, or at least transforming in some critical way. The song is romantic—the Marianne of its title was Cohen’s girlfriend and muse in the nineteen-sixties—but its fourth verse contains what I’ve always thought was a profound articulation of grief:

1967年,莱昂纳德·科恩(Leonard Cohen)发行了《再见,玛丽安》(So Long, Marianne),这是一首为一段正在瓦解——或至少正在发生某种关键转变——的恋情所作的挽歌。这首歌很浪漫——歌名中的玛丽安是科恩在六十年代的女友兼缪斯——但它的第四段歌词,我一直认为是对悲伤极为深刻的表达:

Your letters, they all say that you’re beside me now
Then why do I feel so alone?
I’m standing on a ledge and your fine spiderweb
Is fastening my ankle to a stone.

你的来信,都说你就在我身旁 / 那我为何还感到如此孤单?/ 我站在悬崖边,你纤细的蛛网 / 正把我的脚踝系在一块石头上。

I listened to “So Long, Marianne” dozens, possibly hundreds, of times after my husband experienced two catastrophic seizures and died, in the summer of 2022. The spiderweb—the object of my grief—became both a tether to and a protection from danger. The night of his death, I left the emergency room in the gauzy predawn hours, carrying our thirteen-month-old daughter. I was alone, stupefied with shock, mentally replaying a scene in Joan Didion’s “The Year of Magical Thinking” in which a hospital social worker gestures toward Didion and asks, “Is this the wife?” I had not been assigned a social worker. Maybe that meant my husband wasn’t dead. I felt hot and weightless, as if my feet weren’t making full contact with the ground. A nurse had offered my daughter a little package of crayons, but she was too young to use them, and now I was clutching them in one hand. I woke up my sister, who was living in New England. Her voice was tight but steady on the phone. I must have sounded insane. I let her assume the controls: Buckle the baby into the car seat. Is she safe? Are you sure? Get in. Put on your seat belt. Start the ignition. Are the headlights on? Can you drive? Are you sure? It felt as though I were a dazed passenger attempting to land a nose-diving airplane. I tried not to think about the clatter and thud of his body being slid into a refrigerated compartment. My parents lived fifteen minutes from the hospital; they were standing in the driveway when I pulled in. Had I phoned them? The horizon was a soft and murky pink. Did I open the car door and fall out? Did my mother get the baby? I don’t know. My husband and I met as teen-agers, and married in our late twenties. Later that morning, I called his family. I called his boss. I called our friends. Most of them answered the phone cheerfully.

2022年夏天,我丈夫经历了两次灾难性的癫痫发作后去世。在那之后,我把《再见,玛丽安》听了几十遍,可能上百遍。那蛛网——我悲伤的对象——既成了与危险相连的绳索,也成了抵御危险的屏障。他去世那晚,我在薄雾般的破晓时分离开急诊室,抱着我们十三个月大的女儿。我孤身一人,震惊到麻木,脑海里不断重放着琼·狄迪恩(Joan Didion)《奇想之年》(The Year of Magical Thinking)里的一个场景:医院社工朝狄迪恩示意,问道:“这位是妻子吗?”没有社工被指派给我。也许这意味着我丈夫没有死。我感到灼热而失重,仿佛双脚没有完全踩实地面。一位护士曾给我女儿一小包蜡笔,但她太小了,还不会用,此刻我一只手紧紧攥着它们。我叫醒了住在新英格兰的姐姐。电话里,她的声音紧绷但平稳。我当时听起来一定像疯了一样。我让她来掌控一切:把宝宝扣进安全座椅。她安全吗?你确定?上车。系好安全带。发动引擎。车灯开了吗?你能开车吗?你确定?我感觉自己像一个晕头转向的乘客,正试图让一架俯冲的飞机着陆。我努力不去想他的身体被滑入冷藏柜时发出的哐当声和闷响。我父母住在离医院十五分钟车程的地方;我把车开进车道时,他们已经站在那儿了。我给他们打过电话吗?地平线是一片柔和朦胧的粉色。我打开车门,是摔出去的吗?我妈妈抱走了宝宝吗?我不知道。我和丈夫十几岁时相识,快三十岁时结婚。那天上午晚些时候,我给他家人打了电话。给他的老板打了电话。给我们的朋友打了电话。他们大多接起电话时,语气是欢快的。

My daughter and I stayed with my parents for a couple of months. When I went back home for the first time, to collect some toys and clothes, I cleaned streaks of my husband’s dried blood off the floorboards and threw up in the kitchen sink. Then I cleaned that up, too. I put his eyeglasses, still cloudy with fingerprints, into a drawer. It seemed impossible that he didn’t need them anymore. When I was presented with a rendering of my husband’s headstone, after pawing through a binder of unhinged-seeming designs (did he want an etching of the Buffalo Bills logo?), it felt like a gag gift, something that friends might have mocked up for his birthday. It suddenly seemed so easy to disappear. “Media vita in morte sumus,” someone said at the funeral. In the midst of life we are in death.

我和女儿在我父母家住了几个月。当我第一次回家,去取一些玩具和衣服时,我擦掉了地板上丈夫干涸的血迹,然后在厨房水槽里吐了。接着,我把那也清理干净了。我把他的眼镜放进抽屉,镜片上还蒙着指纹的雾气。他再也不需要它们了,这似乎不可能。当我翻阅了一本充满疯狂设计(他想要一个水牛比尔队标志的蚀刻吗?)的活页夹后,看到丈夫墓碑的效果图时,那感觉像是一个恶作剧礼物,像是朋友们可能为他的生日恶搞出来的东西。消失,突然间显得如此容易。“Media vita in morte sumus,”葬礼上有人说道。生命之中,我们身处死亡。

My situation was, on some level, achingly ordinary. People die all the time. Or worse things happen. My father lost his father when he was a toddler. My mother lost her sister when she was a teen-ager. My husband lost both his parents. After a while, a sort of austere survival instinct kicked in for me. My existential panic was subsumed by more pragmatic concerns. When a death is quick, and the practical ramifications are both vast and immediate, any platitudes associated with “good” grieving feel like luxurious fantasies. There was no time for grace. I was astounded—fixated, on some level—by the irresolvable mathematics of my scenario. My household income had been halved, and my domestic responsibilities had doubled. I was now a single mother, with a slate of grisly and endlessly regenerating administrative chores, most of which concluded with the faxing of a death certificate to an institution, accompanied by a deranged note saying “Thanks!” I returned a car that we had bought a few days prior to his death, sitting in the exact same stiff, faux-leather chair at the dealership, trying to explain to the very smiley salesperson that my husband, whom he’d recently shaken hands with, was not alive anymore and I didn’t need two cars. He was flummoxed, then horrified. My parents had to finish the paperwork. Between grief-induced insomnia and waking in the night to care for my baby daughter, I was feral with exhaustion. The tiniest decisions were paralyzing. Was the trash full enough to take out? Was her fever high enough to call the pediatrician? What was for dinner?

我的处境,在某种程度上,平凡得令人心痛。人总在死去。或者更糟的事情也在发生。我父亲在他蹒跚学步时就失去了他的父亲。我母亲在她十几岁时失去了她的姐姐。我丈夫失去了双亲。过了一段时间,一种近乎严酷的求生本能在我体内启动。我存在的恐慌被更实际的忧虑所淹没。当死亡来得迅速,而实际后果既巨大又紧迫时,任何与“好的”悲伤相关的陈词滥调都感觉像是奢侈的幻想。没有时间优雅。我在某种程度上,对自己处境中那无解的算术感到震惊——甚至痴迷。我的家庭收入减半,而我的家庭责任加倍。我现在是一个单身母亲,面对着一系列可怕且不断再生的行政琐事,其中大多数都以将死亡证明传真给某个机构告终,并附上一张写着“谢谢!”的疯癫字条。我退还了一辆我们在他去世前几天刚买的车,坐在经销店里同一张硬邦邦的假皮椅上,试图向那位笑容满面的销售员解释,我丈夫——他最近才和他握过手——已经不在了,我不需要两辆车。他先是困惑,然后是惊骇。我父母不得不帮我完成剩下的文书工作。在悲伤导致的失眠和夜间醒来照顾幼女之间,我疲惫得近乎疯狂。最微小的决定都让我瘫痪。垃圾桶满到该倒了吗?她的烧高到该给儿科医生打电话了吗?晚饭吃什么?

Grief mangles cognition and memory in ways that can make even banal tasks feel surreal, if not impossible. When a bank clerk asked me for my daughter’s birth date—I was attempting to add her name to our savings account—it felt as though I’d been charged with solving a math equation. I did my best. I boxed up and donated my husband’s jeans and sweaters. I took his toothbrush out of the holder and threw it in the garbage. I ordered a new sofa. I thought that if the room looked different I could begin to resolve some of the dissonance of sudden loss. I indulged in my share of magical thinking. The question that hounded me the most that fall was: Where did he go? Perhaps that’s why the word “lost” is so synonymous with death—it can feel as if your person is simply misplaced.

悲伤对认知和记忆的摧残,能让哪怕最平庸的任务都变得超现实,甚至不可能完成。当一位银行职员问我女儿的出生日期——我正试图把她的名字加到我们的储蓄账户上——我感觉自己像是被要求解一道数学方程式。我尽力了。我把丈夫的牛仔裤和毛衣装箱捐掉了。我把他的牙刷从杯子里拿出来,扔进了垃圾桶。我订了一张新沙发。我想,如果房间看起来不一样了,我也许就能开始消解一些因骤然失去而产生的不协调感。我纵容了自己那份“奇想”。那年秋天,最纠缠我的问题是:他去哪儿了?也许这就是为什么“失去”这个词与死亡如此同义——它感觉就像你那个人只是被放错了地方。

I went back to work. People marvelled at this, as though it were a choice, but I needed money, and I needed to engage some cooler, steadier portion of my brain. Unfortunately, I found music largely unlistenable—an inconvenient development for a professional pop critic. The emotional circuit that my favorite songs lit up inside me was too vivid; music felt overwhelming, if not revolting. There were a few things I could stand: Nick Cave and the Bad Seeds’ “Ghosteen,” P. J. Harvey’s “Stories from the City, Stories from the Sea,” Paul Simon’s “Graceland,” anything by Leonard Cohen. Some Nina Simone, some Miles Davis. Listening to most records felt shaky, ominous, like reintroducing food after a stomach bug. What could I receive without retching? Somewhat serendipitously, I was already in the midst of reporting a Profile of Metallica, a band famously preoccupied by death. (Metallica’s bassist Cliff Burton died in a ghastly bus accident in 1986, when he was twenty-four, an event that haunts even the current iteration of the group.) I now found the singer and guitarist James Hetfield’s clenched-fist articulations of despair wildly comforting. Death was interesting to him. These songs both normalized pain and made it beautiful. Understanding that this was even possible—that grief could shape-shift into something less ugly, less weak—kept me going.

我回去工作了。人们对此表示惊叹,好像这是一种选择,但我需要钱,而且我需要调动大脑中某个更冷静、更稳定的部分。不幸的是,我发现音乐基本上听不下去了——对一个职业流行乐评人来说,这是个麻烦的发展。我最喜欢的歌曲在我体内点亮的情感回路太过鲜明;音乐感觉令人难以承受,甚至令人作呕。有几样东西我能忍受:尼克·凯夫与坏种子乐队(Nick Cave and the Bad Seeds)的《幽灵之子》(Ghosteen),P·J·哈维(P. J. Harvey)的《城与海的故事》(Stories from the City, Stories from the Sea),保罗·西蒙(Paul Simon)的《恩赐之地》(Graceland),以及莱昂纳德·科恩的任何作品。一些妮娜·西蒙(Nina Simone),一些迈尔斯·戴维斯(Miles Davis)。听大多数唱片都感觉摇摇欲坠,不祥,就像肠胃感冒后重新开始进食。我能接受什么而不至于作呕?有点巧合的是,我当时已经在为金属乐队(Metallica)写一篇人物特写,这支乐队以痴迷死亡而闻名。(金属乐队的贝斯手克利夫·伯顿(Cliff Burton)在1986年死于一场可怕的巴士事故,年仅二十四岁,这件事至今仍萦绕着乐队的现阵容。)我现在发现,主唱兼吉他手詹姆斯·海特菲尔德(James Hetfield)那紧握拳头式的绝望表达,给了我极大的安慰。死亡对他来说是件有趣的事。这些歌曲既将痛苦常态化,又使其变得美丽。理解到这一点是可能的——悲伤可以变形为不那么丑陋、不那么软弱的东西——支撑着我走下去。

Appearing steady around my subjects was hard. (One afternoon, while watching the indie-rock band the National rehearse at its airy, sunlit studio space in Hudson, New York, I had a fairly sizable breakdown in the bathroom, stifling my sobs with a mitten.) But I was grateful for the sense of control I felt when writing. The real work of nonfiction, and of profile writing especially, is in making a series of arbitrary and disconnected events legible. The best profiles force a coherent arc from a string of mostly random occurrences: of course it all happened just like that. Writing was a corrective to my reality, which felt incoherent.

在我的采访对象面前显得镇定是困难的。(一天下午,在纽约哈德逊市独立摇滚乐队国民乐队(the National)那通风、阳光明媚的工作室里看他们排练时,我在洗手间里相当严重地崩溃了,用一只连指手套捂住嘴,压住啜泣。)但我很感激写作时感受到的那种掌控感。非虚构写作,尤其是人物特写,真正的工作在于让一系列任意且不连贯的事件变得清晰可辨。最好的特写能迫使一串大多随机的事件形成一条连贯的弧线:当然,事情就是这样发生的。写作是对我现实的修正,我的现实感觉支离破碎。

The rawness and terror of that first year was so visceral and embodied. “And grief still feels like fear,” C. S. Lewis wrote, in 1961. His wife, Joy, had recently passed away, of cancer, at age forty-five. “Perhaps, more strictly, like suspense. Or like waiting; just hanging about waiting for something to happen.” I was locked in a kind of defensive crouch. My daughter surely sensed the hum of my heartbreak, though I tried to be soft, even joyful, in her presence. I was toggling maniacally between otherworldly love for her and anguish that her father was dead and she would have no memory of him. During nap time, I’d tiptoe out to the driveway, sit in my parked car, place the baby monitor in my lap, and weep into the hood of my sweatshirt. Part of me wanted her to know that grief is a reasonable reaction to a devastating occurrence, but mostly I just wanted her to remain connected, in the way children are, to the ecstasy and wonder of existence, without any premature knowledge of its concomitant pain.

第一年的那种生涩与恐惧是如此发自肺腑,深入骨髓。“而悲伤仍然感觉像恐惧,”C·S·刘易斯(C. S. Lewis)在1961年写道。他的妻子乔伊(Joy)最近因癌症去世,年仅四十五岁。“也许,更严格地说,像悬念。或者像等待;只是无所事事地等待着什么事情发生。”我陷入了一种防御性的蜷缩姿态。我女儿肯定感觉到了我心碎的嗡鸣,尽管我努力在她面前表现得柔和,甚至快乐。我在对她超凡的爱与对她父亲去世、她将对他毫无记忆的痛苦之间疯狂切换。午睡时间,我会蹑手蹑脚走到车道上,坐在停着的车里,把婴儿监视器放在腿上,对着运动衫的帽子哭泣。我一部分想让她知道,悲伤是对毁灭性事件的合理反应,但大多数时候,我只想让她保持孩子那种与存在的狂喜和惊奇的联系,而不要过早了解与之相伴的痛苦。

I got very good at sensing when the heft and finality of the loss was making someone uncomfortable. I found this both relatable (I surely wouldn’t have known what to say, either) and alienating. Grief can’t be “fixed”—death is famously irreversible—so conversations about it require both parties to abandon problem-solving and accept a kind of unpleasant stasis. When well-intentioned friends or colleagues asked me how I was doing, I felt dread. What I wanted to say was This feels exactly as bad as you think it feels. What I usually said was Yeah, I’m O.K.

我非常擅长察觉这种失去的沉重和终结性何时让人感到不舒服。我对此既感同身受(我肯定也不知道该说什么),又感到疏离。悲伤无法被“修复”——死亡是出了名的不可逆转——所以关于它的对话要求双方都放弃解决问题,接受一种不愉快的停滞状态。当善意的朋友或同事问我过得怎么样时,我感到恐惧。我想说的是:这感觉就和你想的一样糟。我通常说的是:嗯,我还好。
Tomato gets interrogated by police.
“We did some digging on you, Tomato. Turns out you’re not even a real vegetable.”
“我们查了查你的底细,番茄。结果发现你根本算不上真正的蔬菜。”
Cartoon by Paul Noth
Copy link to cartoon
Shop

I was having a hard time connecting with anyone who hadn’t locked eyes with a particular sort of darkness. I sought out people who felt complicated and fucked up—who were able to reckon in some way with the lunacy of human life. In 1986, a trio of social psychologists introduced an idea called terror-management theory, based on the cultural anthropologist Ernest Becker’s claim that fear of death is “the mainspring of human activity.” (Becker’s book “The Denial of Death” won the Pulitzer Prize for general nonfiction in 1974.) T.M.T. posits that civilization itself is largely a response to mortality—an elaborate system of distraction and repudiation. Because humans have a sophisticated and symbolic awareness of death, we invest aggressively in shared cultural beliefs, which “provide the universe with order, meaning, value, and the possibility of either literal or symbolic immortality.” Simply sitting with the idea that death is compulsory and irreversible is too hard. Most of us will do almost anything to forget it.

我很难与任何没有凝视过某种特定黑暗的人建立联系。我寻找那些感觉复杂、一团糟的人——那些能以某种方式理解人类生活之疯狂的人。1986年,三位社会心理学家基于文化人类学家欧内斯特·贝克尔(Ernest Becker)关于死亡恐惧是“人类活动的主要动力”的论断,提出了一个名为“恐惧管理理论”(terror-management theory)的概念。(贝克尔的书《拒斥死亡》(The Denial of Death)在1974年获得了普利策非虚构类大奖。)恐惧管理理论假定,文明本身在很大程度上是对死亡的一种回应——一个精心设计的分散注意力和否定的系统。因为人类对死亡有着复杂且象征性的意识,我们便积极地投入到共享的文化信仰中,这些信仰“为宇宙提供了秩序、意义、价值,以及获得字面或象征性永生的可能性”。仅仅是接受死亡是强制且不可逆的这个想法,就太难了。我们大多数人几乎会做任何事来忘记它。

Yet becoming a young widow was easily the most fascinating thing that has ever happened to me. In fact, it often felt like the only thing that had ever happened to me. In a 2019 conversation between Stephen Colbert and Anderson Cooper, Colbert spoke about the isolation of grief, even decades later: “Why is nobody asking me about this? My brothers died forty-five years ago, and sometimes I’ll go, ‘How come nobody is asking me about Paul?’ ” I knew what he meant. Talking about anything else felt nuts. It was hard not to think of “moving on” as a kind of annulment, a final act of severance. In this context, the whole idea of recovery seemed vaguely dehumanizing—too results-oriented, too transactional, too American. Who was I to believe that I could vanquish the ache of death?

然而,成为一个年轻的寡妇,无疑是发生在我身上最引人入胜的事。事实上,它常常感觉像是唯一发生在我身上的事。在2019年斯蒂芬·科尔伯特(Stephen Colbert)和安德森·库珀(Anderson Cooper)的一次对话中,科尔伯特谈到了悲伤的孤立感,即使在几十年后:“为什么没人问我这件事?我的兄弟们四十五年前就去世了,有时我会想,'怎么没人问我关于保罗的事?'”我懂他的意思。谈论其他任何事情都感觉疯了。很难不把“向前看”视为一种废除,一种最终的切割。在这种语境下,整个“恢复”的概念都隐约显得有点非人化——太结果导向,太交易化,太美国了。我凭什么相信自己能战胜死亡的痛楚?

I liked speaking with people who could acknowledge the enigma at the core of existence without feeling embarrassed. One afternoon, the Episcopal minister who’d performed my husband’s funeral service said to me, only half jokingly, “I guess he has all the answers now.” I found the idea that he’d suddenly been made privy to cosmic information both funny and comforting. Rare air; good for him. In 2023, Paul Simon released a thirty-three-minute album of acoustic hymns titled “Seven Psalms.” Simon spends most of the record musing about a higher power and what happens, or doesn’t happen, when we die. On “The Sacred Harp,” a gentle and circuitous song, he sings, “The Lord is my personal joke / My reflection in the window.” I repeated the phrase like a mantra.

我喜欢和那些能坦然承认存在核心之谜而不感到尴尬的人交谈。一天下午,那位主持我丈夫葬礼的圣公会牧师半开玩笑地对我说:“我猜他现在知道所有答案了。”我发现他突然获知了宇宙信息这个想法既好笑又令人安慰。稀薄的空气;对他来说挺好的。2023年,保罗·西蒙发行了一张三十三分钟的原声赞美诗专辑,名为《诗篇七首》(Seven Psalms)。西蒙在这张唱片的大部分时间里,都在沉思一种更高的力量,以及我们死后会发生什么,或不会发生什么。在《神圣竖琴》(The Sacred Harp)这首温柔而迂回的歌曲中,他唱道:“主是我个人的玩笑 / 我在窗中的倒影。”我像念咒语一样重复着这句话。

Encountering new motherhood and acute loss in quick succession was harrowing, though I eventually came to see them as deeply consonant experiences. Both required enormous amounts of selflessness, stamina, plasticity, courage, and improvisation. I reminded myself to take it day by day, or, sometimes, minute by minute. I sent a lot of weird texts to friends. I posted very personal things on Instagram. I fumbled a few relationships. I wanted to be around people all the time, but I also couldn’t bear anyone needing anything from me, including my polite participation in a social interaction. At Christmas, my daughter and I caught the flu. We stayed home by ourselves. I had a panic attack at the pediatrician’s office, triggered by the sound of a blood-pressure machine in another room, or the starchy crinkle of parchment paper on the exam table, or maybe just the ambient smell of rubbing alcohol—it was all too close. I yanked off my mask and tried to suck in just enough air not to pass out. The situation was so grim that it was almost funny; I was so sick I couldn’t stand. On Christmas Eve, I had to crawl up the stairs, one arm dragging my body, the other cradling my baby, who was ruddy with fever. At that moment, I could not imagine ever feeling good again.

接连遭遇初为人母和剧烈的丧亲之痛,是种折磨,尽管我最终开始将它们视为深度共鸣的体验。两者都需要巨大的无私、耐力、可塑性、勇气和即兴发挥。我提醒自己要一天一天地过,或者,有时,一分钟一分钟地过。我给朋友们发了很多奇怪的短信。我在Instagram上发了很多非常私人的东西。我搞砸了几段关系。我一直想和人待在一起,但我也无法忍受任何人对我有任何需求,包括我在社交互动中礼貌的参与。圣诞节时,我和女儿得了流感。我们独自待在家里。我在儿科医生的办公室里惊恐发作,触发原因可能是另一个房间血压计的声音,或是检查台上防油纸那浆硬的窸窣声,又或许只是周围弥漫的酒精气味——一切都太接近了。我扯下口罩,试图吸入足够的空气以免晕过去。情况如此严峻,几乎有点可笑;我病得站不起来。圣诞前夜,我不得不爬上楼梯,一只胳膊拖着身体,另一只胳膊搂着我的宝宝,她烧得满脸通红。在那一刻,我无法想象自己还能再好起来。

In 1999, The New Yorker ran a cartoon of two beleaguered cowboys looking out over a cliff with the caption “Hard to tell from here. Could be buzzards. Could be grief counsellors.” It’s difficult to say when grief tips from normal to pathological. It’s even more difficult to say when it might require intervention. “I don’t think that any grief is pathological, actually,” Katherine Shear, the founder and director of the Center for Prolonged Grief, at Columbia University’s School of Social Work, told me recently. “It’s a little bit analogous to pregnancy, in the sense that it’s a normal state, but it’s a high-risk state.” She continued, “The problem people have is not in the experience of grief itself. The problem is how to learn to accept the unthinkable.”

1999年,《纽约客》刊登了一幅漫画,两个疲惫不堪的牛仔眺望着悬崖,配文是:“从这儿很难说。可能是秃鹫。也可能是悲伤辅导员。”很难说悲伤何时从正常滑向病态。更难说它何时可能需要干预。“实际上,我不认为任何悲伤是病态的,”哥伦比亚大学社会工作学院延长哀伤障碍中心(Center for Prolonged Grief)的创始人和主任凯瑟琳·希尔(Katherine Shear)最近告诉我。“这有点像怀孕,意思是它是一种正常状态,但它是高风险状态。”她接着说,“人们的问题不在于悲伤体验本身。问题在于如何学会接受那不可想象的事。”

The Center for Prolonged Grief, which was founded in 2013, is an academic institution focussed on education and research. (It is not a brick-and-mortar clinic open to the public, though in the months immediately following my husband’s death I often yearned for a place like that: something in between an urgent-care center and an A.A. meeting, where the mental and physical symptoms of bereavement are recognized, and the ebb and flow of sorrow doesn’t require explanation or apology.) The center’s work is largely supported by outside grants, though it also generates income through its clinical-training programs and workshops. Shear first studied internal medicine but then decided that she wanted to be a psychiatrist. She completed her residency at Cornell in the late nineteen-seventies, when, she said, grief was not very well understood by clinicians. “A group of colleagues who were doing depression research had started seeing people who were bereaved and thought they were depressed,” Shear said of her time as a professor at the University of Pittsburgh, in the early nineties. “The depression treatment wasn’t working, basically. Those colleagues, like almost all mental-health professionals, including myself, knew almost nothing about grief. Everybody knew that loss is important, but grief wasn’t in the curriculum.” In 2005, Shear published a paper in the Journal of the American Medical Association that demonstrated the efficacy of a treatment plan for “traumatic grief.”

延长哀伤障碍中心成立于2013年,是一个专注于教育和研究的学术机构。(它并非对公众开放的实体诊所,尽管在我丈夫去世后的几个月里,我常常渴望有那样一个地方:介于紧急护理中心和匿名戒酒会之间的某种场所,在那里,丧亲之痛的精神和身体症状被认可,悲伤的潮起潮落无需解释或道歉。)该中心的工作主要由外部资助支持,但也通过其临床培训项目和工作坊创收。希尔最初学的是内科,但后来决定成为一名精神科医生。她在七十年代末于康奈尔大学完成住院医师培训,她说,那时临床医生对悲伤的理解并不充分。“一群做抑郁症研究的同事开始接诊一些丧亲的人,并认为他们得了抑郁症,”希尔谈到九十年代初她在匹兹堡大学担任教授的那段时光时说。“抑郁症治疗基本上不起作用。那些同事,和几乎所有精神健康专业人士一样,包括我自己,对悲伤几乎一无所知。大家都知道失去很重要,但悲伤不在课程大纲里。”2005年,希尔在《美国医学会杂志》上发表了一篇论文,证明了一种针对“创伤性悲伤”的治疗方案的有效性。

In March, 2022, a revision of the Diagnostic and Statistical Manual of Mental Disorders included something called prolonged-grief disorder, which for adults is defined as debilitating, life-altering grief that is still ongoing a year after loss. Shear led a committee that lobbied for its addition. (The World Health Organization’s ICD-11, a global analogue to the DSM, gives a timeline of six months for the same condition.) According to some estimates, P.G.D. could affect about seven to ten per cent of all bereaved people. The diagnostic criteria include “intense yearning/longing for the deceased person” and “preoccupation with thoughts or memories of the deceased person.” A P.G.D. diagnosis hinges chiefly on time; clinically, at least, the difference between functional and nonfunctional grief is duration.

2022年3月,《精神障碍诊断与统计手册》(Diagnostic and Statistical Manual of Mental Disorders)的一次修订纳入了一种名为“延长哀伤障碍”(prolonged-grief disorder)的疾病,对成人而言,其定义为在失去亲人一年后,仍持续存在、令人衰弱且改变生活的悲伤。希尔领导了一个委员会,为其纳入进行了游说。(世界卫生组织的ICD-11,相当于全球版的DSM,对同一状况给出的时间线是六个月。)据一些估计,延长哀伤障碍可能影响约百分之七到十的丧亲者。诊断标准包括“对逝者强烈的渴望/思念”和“全神贯注于对逝者的思念或回忆”。延长哀伤障碍的诊断主要取决于时间;至少在临床上,功能性悲伤与非功能性悲伤的区别在于持续时间。

The inclusion in the DSM was controversial for obvious reasons—grief is not a mental disorder. The decision was preceded by several decades of fervent debate and disagreement among practitioners; detractors argued that adding the disorder was reckless, if not mercenary. A formal diagnosis means that a patient can be categorized, and that doctors can be more easily reimbursed by insurance companies for treatment. In an editorial published in The Lancet Psychiatry in 2022, the psychologists and researchers Joanne Cacciatore and Allen Frances described the decision as “a huge mistake that solves no existing problem and creates many new ones,” including the careless prescription of antidepressants or other drugs, without consideration of the immediate cause of a patient’s distress. They added, “Pathologising grief is an insult to the dignity of loving relationships—it proclaims grievers as mentally ill.” They concluded, “Grief warrants strong social support and compassionate connection, not medicalisation.”

将其纳入DSM引发争议,原因显而易见——悲伤不是一种精神障碍。这一决定之前,从业者之间进行了几十年的激烈辩论和分歧;反对者认为,增加这种障碍是鲁莽的,甚至是唯利是图的。一个正式的诊断意味着患者可以被归类,医生也能更容易地从保险公司获得治疗费用的报销。在2022年发表于《柳叶刀·精神病学》的一篇社论中,心理学家兼研究员乔安妮·卡恰托雷(Joanne Cacciatore)和艾伦·弗朗西斯(Allen Frances)将这一决定描述为“一个巨大的错误,它没有解决任何现存问题,反而制造了许多新问题”,包括在不考虑患者痛苦直接原因的情况下,轻率地开具抗抑郁药或其他药物。他们补充说:“将悲伤病理化,是对爱的关系之尊严的侮辱——它宣称哀悼者是精神病患者。”他们总结道:“悲伤需要的是强大的社会支持和富有同情心的连接,而非医疗化。”

In the book “The Other Side of Sadness,” the psychologist George Bonanno points out that the most common response among bereaved people is resilience. Grief “is something we are wired for, and it is certainly not meant to overwhelm us,” he writes. When I met with Bonanno in New York, in February—he is a professor of clinical psychology at Columbia, though he is not affiliated with the Center for Prolonged Grief—he told me, “We evolved these emotions because they’re functional. They do something very efficient from an evolutionary perspective.” He continued, “If they go on for a long time, then they become problematic. Stress is adaptive, but after about a month it goes into the realm of being maladaptive.” In our conversation, Bonanno was careful to distinguish grief from clinical depression. “Depression is objectless, and grief has an object,” he said.

在《悲伤的另一面》(The Other Side of Sadness)一书中,心理学家乔治·博南诺(George Bonanno)指出,丧亲者中最常见的反应是韧性。悲伤“是我们天生就会的,它肯定不是为了压倒我们而设计的,”他写道。今年二月,我在纽约见到博南诺时——他是哥伦比亚大学的临床心理学教授,不过他不隶属于延长哀伤障碍中心——他告诉我:“我们进化出这些情绪,是因为它们有功能。从进化的角度看,它们能非常高效地完成某些事情。”他接着说:“如果它们持续很长时间,就会成为问题。压力是适应性的,但大约一个月后,它就进入了适应不良的范畴。”在我们的谈话中,博南诺谨慎地区分了悲伤与临床抑郁症。“抑郁症是没有对象的,而悲伤是有对象的,”他说。

Ultimately, the DSM is a diagnostic tool; it doesn’t include guidelines for treatment. Though I understood the misgivings about the medicalization of grief, I also found the naming and codifying of it sort of validating—it acknowledged that the situation had gravity. Seeking out “social support and compassionate connection” is generally excellent advice, but those things aren’t always so easy to come by. Spending time with a grieving person is exhausting. It requires enormous amounts of patience and generosity. After a while, people get tired of your bottomless melancholy.

归根结底,DSM是一种诊断工具;它不包含治疗指南。尽管我理解对悲伤医疗化的疑虑,但我也发现,对它的命名和编纂在某种程度上是一种确认——它承认了这种状况的严重性。寻求“社会支持和富有同情心的连接”通常是极好的建议,但这些东西并不总是那么容易获得。陪伴一个悲伤的人很累。它需要巨大的耐心和慷慨。过了一段时间,人们会厌倦你那无底的忧郁。

The Center for Prolonged Grief used to be known as the Center for Complicated Grief. (The name was changed to align with the diagnosis in the DSM.) I told Shear that I liked the earlier name better—it felt gentler, less contingent on a schedule of recovery. “I agree,” she said. “I now think it really should be called post-loss stress disorder or post-traumatic-loss disorder.” She went on, “When I started this work, grief was defined as deep sorrow. That’s how people think of it, even today. My latest thought is that it’s a trans-diagnostic psychological state, because grief contains many emotions, not just one. You experience sadness, anxiety, anger, guilt, the whole range. Even positive emotions come up—they’re a part of grief. It’s a complex state of being.” She also felt that the diagnostic criteria could be more flexible. “Our therapists see people as early as two or three months sometimes. If you are really, really struggling, even for two months, that’s a long time to feel underwater,” she said, then paused. “I guess I don’t have to tell you. You know what it feels like. It’s very reasonable to want a little help.”

延长哀伤障碍中心以前被称为复杂哀伤中心(Center for Complicated Grief)。(改名是为了与DSM中的诊断保持一致。)我告诉希尔,我更喜欢以前的名字——它感觉更温和,不那么依赖于一个恢复的时间表。“我同意,”她说。“我现在认为它真的应该叫做'丧失后应激障碍'或'创伤性丧失障碍'。”她接着说,“当我开始这项工作时,悲伤被定义为深切的哀痛。直到今天,人们还是这么想的。我最近的想法是,它是一种跨诊断的心理状态,因为悲伤包含许多情绪,不止一种。你会体验到悲伤、焦虑、愤怒、内疚,整个范围。甚至积极的情绪也会出现——它们是悲伤的一部分。这是一种复杂的存在状态。”她也认为诊断标准可以更灵活。“我们的治疗师有时早在两三个月时就接诊了。如果你真的、真的非常挣扎,即使只有两个月,那也是一段很长的时间感觉像溺水一样,”她说着,停顿了一下。“我想我不必告诉你。你知道那是什么感觉。想要一点帮助是非常合理的。”

The center has its own recovery program, a six-part plan supported by studies from the National Institute of Mental Health. It contains elements of exposure therapy (the gradual, repeated introduction of a triggering thought or object, ideally leading to habituation), as well as a variety of established psychotherapeutic methods that encourage patients to recount and reframe their trauma. It was the first treatment for the condition to be found efficacious in a randomized controlled trial, and, in 2024, Shear received the Award for Research in Psychiatry from the American Psychiatric Association.

该中心有自己的恢复方案,一个由美国国家心理健康研究所(National Institute of Mental Health)研究支持的六部分计划。它包含了暴露疗法(逐渐、反复地引入触发性的想法或物体,理想情况下导致习惯化)的元素,以及各种已确立的心理治疗方法,鼓励患者重述和重构他们的创伤。这是首个在随机对照试验中被证明对该病症有效的治疗方法,2024年,希尔获得了美国精神病学协会(American Psychiatric Association)颁发的精神病学研究奖。

Now there are numerous emerging treatments for P.G.D. One involves the use of naltrexone, a drug previously approved to manage alcohol and opioid addiction. Some studies indicate a connection between symptoms of P.G.D. and the reward pathways responsible for addiction, suggesting that, in some way, grief requires a kind of detox. Transcranial magnetic stimulation, which uses magnetic fields to stimulate nerve cells in the brain, has also been trialled for efficacy. (T.M.S., as both an isolated and a repeated treatment, is currently approved by the Food and Drug Administration as a therapy for major depression, obsessive-compulsive disorder, smoking addiction, and migraines.) One of the more compelling developments for P.G.D. involves the monitored use of various psychedelic drugs, usually administered in conjunction with traditional therapy. Psilocybin, in particular, appears to be highly effective for helping people with terminal illnesses feel less terrified of dying. A Johns Hopkins study of fifty-one patients with cancer who had exhibited “clinically significant” signs of anxiety or depression found that a monitored dose of psilocybin resulted in “increases in ratings of death acceptance.” I was too timid to take psychedelics, though the thought of increasing my death acceptance was appealing. What is grief, after all, if not a reaction to the overwhelming perpetuity of mortality? Certain drugs seem to make the membrane between Here and There feel more permeable—maybe, by that logic, the person you lost might begin to feel a little less unreachable. A little less gone.

现在,针对延长哀伤障碍出现了许多新兴疗法。其中一种涉及使用纳曲酮(naltrexone),这是一种先前被批准用于控制酒精和阿片类药物成瘾的药物。一些研究表明,延长哀伤障碍的症状与负责成瘾的奖赏通路之间存在联系,暗示在某种程度上,悲伤需要一种“戒断”。经颅磁刺激(Transcranial magnetic stimulation),即利用磁场刺激大脑中的神经细胞,也已被试验其有效性。(无论是作为单独治疗还是重复治疗,经颅磁刺激目前已获美国食品药品监督管理局(Food and Drug Administration)批准,用于治疗重度抑郁症、强迫症、吸烟成瘾和偏头痛。)针对延长哀伤障碍,一个更引人注目的进展涉及在监控下使用各种迷幻药物,通常与传统疗法结合进行。特别是裸盖菇素(psilocybin),似乎对帮助绝症患者减轻对死亡的恐惧非常有效。约翰·霍普金斯大学一项针对五十一名表现出“临床显著”焦虑或抑郁迹象的癌症患者的研究发现,在监控下服用一剂裸盖菇素,能“提高死亡接受度的评级”。我太胆小了,不敢服用迷幻药,尽管提高死亡接受度的想法很吸引我。毕竟,悲伤是什么,如果不是对死亡那压倒性永恒性的反应?某些药物似乎能让“此处”与“彼处”之间的隔膜感觉更具渗透性——也许,按照这个逻辑,你失去的那个人可能会开始感觉不那么遥不可及。不那么彻底地消失了。

My husband had been dead for six weeks when I asked my primary-care doctor about a form of psychotherapy called E.M.D.R. I’d read that it was useful for coping with trauma and post-traumatic stress disorder. She was encouraging, though she also reminded me that I wasn’t post-anything yet. I was grieving—active verb. A month earlier, I’d reached out to the photographer Tabitha Soren; in 2021, she and her husband, the writer Michael Lewis, lost their nineteen-year-old daughter, Dixie, who was a passenger in a car that crashed in Northern California. Soren suggested that it might be helpful to think about my grief as a brain injury—to be awake, at least, to the ways in which it might manifest physically. There was a reason that the phrase “grief-stricken” had entered the lexicon. The experience was not entirely dissimilar to getting whacked in the skull.

我丈夫去世六周后,我向我的初级保健医生询问了一种叫做EMDR的心理疗法。我读到它对应对创伤和创伤后应激障碍有用。她很鼓励,但也提醒我,我还没到任何“后”阶段。我正在悲伤——进行时态的动词。一个月前,我联系了摄影师塔比瑟·索伦(Tabitha Soren);2021年,她和她的丈夫、作家迈克尔·刘易斯(Michael Lewis)失去了他们十九岁的女儿迪克西(Dixie),她当时是一辆在北加州发生车祸的汽车的乘客。索伦建议,把我的悲伤看作一种脑损伤可能会有帮助——至少要意识到它可能以何种方式在身体上显现出来。“悲痛欲绝”(grief-stricken)这个词能进入词典是有原因的。这种体验与被重击头部并非完全不同。

When I asked Shear about the biological aftermath of grief, she brought up two-person neuroscience, an emerging discipline that studies how our brains affect other brains. “Our closest relationships, especially when we’re living together—in particular, when we’re living together—have an impact on our immune system, our cardiovascular system, our sleep, our eating, probably the whole body,” she said. “I think we have to understand what happens, neurologically, when we’re with someone to really understand what happens when we lose them.” (In the three months immediately following the death of a spouse, particularly in older couples, the surviving partner’s risk of death can increase by as much as an extraordinary sixty-six per cent, a phenomenon known colloquially as the widowhood effect.)

当我向希尔询问悲伤的生物学后果时,她提到了“双人神经科学”(two-person neuroscience),这是一门研究我们的大脑如何影响其他大脑的新兴学科。“我们最亲密的关系,尤其当我们住在一起时——特别是,当我们住在一起时——会对我们的免疫系统、心血管系统、睡眠、饮食,可能整个身体都产生影响,”她说。“我认为我们必须理解,当我们和某人在一起时,神经层面发生了什么,才能真正理解当我们失去他们时发生了什么。”(在配偶去世后的头三个月里,尤其是在老年夫妇中,未亡伴侣的死亡风险可能增加高达惊人的百分之六十六,这种现象俗称“丧偶效应”(widowhood effect)。)

E.M.D.R., an acronym for eye-movement desensitization and reprocessing, combines elements of talk therapy, exposure therapy, and bilateral stimulation, or alternating activation of the right and left hemispheres of the brain. This is most often achieved via guided eye movements, though it can also occur through a number of benign physical sensations: a patient might tap her own shoulders, or hold a buzzer in each palm, or listen to a series of alternating tones on headphones. In the past decade, E.M.D.R. has moved from the fringes to the mainstream, both within the culture and among clinicians. In 2021, Prince Harry, who suffers from anxiety, underwent E.M.D.R. on camera for an episode of the Oprah Winfrey-produced docuseries “The Me You Can’t See”; in 2025, Miley Cyrus told the Times that the treatment had saved her life by helping her to process unresolved childhood trauma.

EMDR,是“眼动脱敏与再加工”(eye-movement desensitization and reprocessing)的缩写,它结合了谈话疗法、暴露疗法和双侧刺激(即交替激活大脑左右半球)的元素。这通常通过引导性眼球运动来实现,但也可以通过一系列良性的身体感觉来达成:患者可能会轻拍自己的肩膀,或在每个手掌中握住一个震动器,或通过耳机聆听一系列交替的音调。在过去十年中,EMDR已从边缘走向主流,无论是在文化中还是在临床医生中。2021年,患有焦虑症的哈里王子(Prince Harry)在奥普拉·温弗瑞(Oprah Winfrey)制作的系列纪录片《你看不见的我》(The Me You Can't See)的一集中,在镜头前接受了EMDR治疗;2025年,麦莉·赛勒斯(Miley Cyrus)告诉《泰晤士报》,这种疗法通过帮助她处理未解决的童年创伤,救了她的命。

I was already seeing a therapist, who’d helped me navigate a series of routine yet formidable transitions: moving out of the city, changing jobs, becoming a parent. I found our sessions useful and edifying, but she didn’t practice E.M.D.R. (Practitioners are not legally mandated to be certified beyond their country’s basic therapy-license requirement, though the E.M.D.R. International Association requires at least forty hours of training, and ten hours of direct consultation, before offering its approval.) I eventually Googled my way to a local therapist who was certified in E.M.D.R. In my introductory e-mail, I described myself as “hopeless.”

我当时已经在看一位治疗师,她帮助我应对了一系列常规但艰巨的转变:搬离城市、换工作、成为父母。我发现我们的会谈有用且有启发性,但她不施行EMDR。(法律并未强制要求从业者在其国家的基本治疗师执照要求之外获得认证,尽管EMDR国际协会(EMDR International Association)在给予批准前,要求至少四十小时的培训和十小时的直接咨询。)我最终通过谷歌搜索找到了本地一位获得EMDR认证的治疗师。在我的介绍邮件中,我形容自己“毫无希望”。

He was intelligent and compassionate. Sessions were held in a little wood cabin on his property. Sometimes a small dog nosed in the door and curled up by the space heater. I was still in the roughest and least comprehensible stage of my grief. Most of the time, driving to his office felt like an insurmountable task, but I went anyway—twice a week at first. I held a little buzzing paddle in each palm. I narrated my memories of the event. There are eight formal stages to E.M.D.R., which typically unfold over eight to twelve weeks, though it’s the fourth and the fifth stages, desensitization and installation, that feel the strangest and most crucial. In desensitization, patients repeatedly recount a traumatic event while receiving bilateral stimulation (squeezing the buzzing paddles, in my case), ideally until they are close to unperturbed by the memory. Discomfort is measured via something called the Subjective Units of Distress Scale, or SUDS. In installation, the bilateral stimulation continues, and a positive belief is added to the narration—usually some version of “But I survived.” I cried a lot during both parts. I’m not sure how to describe the experience beyond some vague sense that my pain was coalescing. For me, it happened quickly, after three or four sessions. Grief started to seem less predatory—it was no longer lurking around a dark corner, eager to pounce. It was here. I could see its contours. That felt good.

他既聪明又富有同情心。治疗在他家土地上一间小木屋里进行。有时,一只小狗会用鼻子拱开门,蜷缩在暖气片旁。我当时仍处于悲伤最艰难、最不可理解的阶段。大多数时候,开车去他办公室感觉像是一项无法完成的任务,但我还是去了——起初是一周两次。我每只手掌里都握着一个嗡嗡作响的小震动器。我叙述着我对那件事的记忆。EMDR有八个正式阶段,通常在八到十二周内展开,但第四和第五阶段,即脱敏和植入,感觉最奇怪也最关键。在脱敏阶段,患者在接收双侧刺激(就我而言,是挤压嗡嗡作响的震动器)的同时,反复讲述一个创伤事件,理想情况下,直到他们对记忆几乎不再感到不安。不适程度通过一种叫做“主观痛苦单位量表”(Subjective Units of Distress Scale,简称SUDS)来衡量。在植入阶段,双侧刺激继续,并在叙述中加入一个积极的信念——通常是某种版本的“但我活下来了”。在这两个阶段,我都哭了很多。除了某种模糊的感觉——我的痛苦正在凝聚——之外,我不知道该如何描述这种体验。对我来说,它发生得很快,三四次治疗之后。悲伤开始显得不那么具有掠夺性了——它不再潜伏在黑暗的角落,随时准备猛扑过来。它就在这里。我能看清它的轮廓。那感觉很好。
Two men watch dog splatter paint on canvas with its tail.
“His lithographs lack this spontaneity.”
“他的石版画缺少这种自发性。”
Cartoon by Harry Bliss and Steve Martin
Copy link to cartoon
Shop

The therapy was first formalized in the late eighties, when a psychologist named Francine Shapiro took a walk and found that the anguish she associated with traumatic memories was alleviated when she was also experiencing rapid and simultaneous eye movement. According to Shapiro, E.M.D.R. is designed to target specific “unprocessed” or “pathogenic” memories—which contain negative emotions, sensations, or beliefs—allowing them to be integrated and therefore defanged. In “EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma,” first published in 1997, Shapiro suggests that E.M.D.R. works “on a physiological level.” Sometimes, she writes, “the system becomes ‘stuck’—as if it was choking on trauma—and often requires assistance in order to get moving smoothly again.”

这种疗法最初是在八十年代末正式形成的,当时一位名叫弗朗辛·夏皮罗(Francine Shapiro)的心理学家在一次散步中发现,当她同时经历快速的眼球运动时,与创伤记忆相关的痛苦得到了缓解。根据夏皮罗的说法,EMDR旨在针对特定的“未加工”或“致病性”记忆——这些记忆包含负面的情绪、感觉或信念——使它们得以整合,从而被“拔掉毒牙”。在1997年首次出版的《EMDR:克服焦虑、压力和创伤的突破性疗法》(EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma)一书中,夏皮罗提出,EMDR“在生理层面”起作用。她写道,有时,“这个系统会'卡住'——就好像被创伤噎住了一样——并且常常需要帮助才能重新顺畅运转。”

Shapiro, who was born in Brooklyn in 1948, received a Ph.D. in clinical psychology from the Professional School of Psychological Studies, in San Diego. She had previously been enrolled in a Ph.D. program in English literature at New York University, and in the late seventies, while she was still living in New York, she was diagnosed with breast cancer. In 1985, Shapiro told the Los Angeles Times that she believed cancer was “a stress-related disease,” which led her to start researching alternative life styles. She eventually discovered neurolinguistic programming, a behavioral theory positing that people experience the world via a combination of three distinct perceptual systems (visual, auditory, and kinesthetic), with one becoming dominant. Being able to recognize which system a person is primarily engaging in can help strengthen relationships and communication, or, perhaps more nefariously, be used to influence decision-making. (The founders of N.L.P., Richard Bandler and John Grinder, eventually began marketing it as a business tool, selling courses in California.) N.L.P. isn’t directly associated with E.M.D.R., though Shapiro’s interest in what most consider a tawdry New Age scam—the L.A. Times once compared N.L.P. to Scientology—has been fuel for skeptics.

夏皮罗1948年出生于布鲁克林,在圣地亚哥的心理研究职业学院(Professional School of Psychological Studies)获得了临床心理学博士学位。她此前曾在纽约大学攻读英国文学博士课程,七十年代末,当她仍住在纽约时,被诊断出患有乳腺癌。1985年,夏皮罗告诉《洛杉矶时报》,她相信癌症是“一种与压力相关的疾病”,这促使她开始研究替代性的生活方式。她最终发现了神经语言程序学(neurolinguistic programming),这是一种行为理论,假定人们通过三种不同感知系统(视觉、听觉和动觉)的组合来体验世界,其中一种会成为主导。能够识别一个人主要在使用哪种系统,有助于加强关系和沟通,或者,也许更危险的是,可以被用来影响决策。(神经语言程序学的创始人理查德·班德勒(Richard Bandler)和约翰·格林德(John Grinder)最终开始将其作为一种商业工具进行营销,在加州出售课程。)神经语言程序学与EMDR没有直接关联,尽管夏皮罗对大多数人所认为的俗艳新时代骗局的兴趣——《洛杉矶时报》曾将神经语言程序学比作山达基教——一直是怀疑论者的口实。

E.M.D.R. touts itself as evidence-based, and the treatment is recognized as effective for trauma by the American Psychiatric Association, the W.H.O., and the Department of Veterans Affairs. But our understanding of why it might work is limited. It’s possible that E.M.D.R. mimics aspects of REM sleep, a phase also marked by eye movement, and associated with the processing of memory. Another hypothesis, usually referred to as the working-memory theory, focusses on the way that bilateral stimulation encourages something called dual taxation, or, basically, what happens in the brain when we try to remember something while doing something else. A 2022 study asked patients with P.T.S.D. to draw a figure, solve a math problem, or play Tetris while simultaneously recalling a trauma. The study suggested that “the secondary task distracts attention away from the retrieval of memory” and has “a detrimental effect on storage.” Because the memory was now imperfectly stored, it would also be imperfectly retrieved. “The partial retrieval of these memory traces would blur their content, resulting in the reduction of vividness or the level of emotion,” the study concluded.

EMDR标榜自己是循证的,这种疗法被美国精神病学协会、世界卫生组织和美国退伍军人事务部(Department of Veterans Affairs)认可为对创伤有效。但我们对其为何可能有效的理解是有限的。一种可能性是,EMDR模拟了快速眼动睡眠的某些方面,这个睡眠阶段也以眼球运动为特征,并与记忆的加工处理有关。另一种假说,通常被称为“工作记忆理论”,侧重于双侧刺激如何促进一种叫做“双重征税”(dual taxation)的现象,或者,基本上,就是当我们试图在做其他事情的同时记住某事时,大脑中发生的情况。2022年的一项研究要求创伤后应激障碍患者在回忆创伤的同时,画一个图形、解一道数学题或玩俄罗斯方块。该研究表明,“次要任务分散了对记忆提取的注意力”,并对“存储产生了不利影响”。由于记忆现在被不完美地存储,它也将被不完美地提取。“这些记忆痕迹的部分提取会模糊其内容,导致生动性或情绪水平的降低,”该研究总结道。

In a 2007 paper, Bessel van der Kolk, the author of “The Body Keeps the Score,” which has spent almost six years on the Times best-seller list, conducted a study in which eighty-eight P.T.S.D. patients received either eight weeks of E.M.D.R., a course of fluoxetine (the generic form of Prozac), or a placebo pill; seventy-five per cent of the patients in the E.M.D.R. group who had experienced adult-onset P.T.S.D. “achieved asymptomatic end-state functioning compared with none in the fluoxetine group.” In 2012, a team of Italian researchers, led by Marco Pagani, used electroencephalogram imaging to “fully monitor neuronal activation throughout EMDR sessions,” and found that “traumatic events are processed at cognitive level following successful EMDR therapy, thus supporting the evidence of distinct neurobiological patterns of brain activations during bilateral stimulation associated with a significant relief from negative emotional experiences.” Which is to say, E.M.D.R. can help the brain to process trauma in a more adaptive way, thereby lessening its capacity to completely capsize a person.

在2007年的一篇论文中,《身体从未忘记》(The Body Keeps the Score)一书的作者巴塞尔·范德考克(Bessel van der Kolk)——该书已在《泰晤士报》畅销书榜上停留了近六年——进行了一项研究,八十八名创伤后应激障碍患者分别接受了为期八周的EMDR、一个疗程的氟西汀(fluoxetine,百忧解的通用名)或安慰剂药片;在EMDR组中,经历过成年期发病的创伤后应激障碍患者,有百分之七十五“达到了无症状的终态功能,而氟西汀组中无人达到”。2012年,由马尔科·帕加尼(Marco Pagani)领导的一个意大利研究团队,使用脑电图成像“全面监测了EMDR治疗过程中的神经元激活情况”,并发现“在成功的EMDR治疗后,创伤事件在认知层面得到处理,从而支持了双侧刺激期间存在不同神经生物学模式的大脑激活的证据,这与负面情绪体验的显著缓解相关”。也就是说,EMDR可以帮助大脑以一种更具适应性的方式处理创伤,从而降低其彻底击垮一个人的能力。

Roger Solomon, who has been practicing psychology since 1979, learned E.M.D.R. directly from Francine Shapiro, in 1990. “I think it was the second class she taught in the United States,” he recalled. Today, he teaches E.M.D.R. workshops and seminars around the world. Solomon has found the treatment transformative in its ability to shift the way we remember trauma. “With your husband dying under those circumstances, those are risk factors—the unexpectedness, the violence of it,” he told me. “You have the loss, but it’s a traumatic loss. Hopefully, what E.M.D.R. does is to reduce the trauma so that you can go through the mourning process, which is still continuing.” He went on, “It will always continue. It doesn’t stop. It evolves. We talk about trauma recovery. We do not talk about grief recovery. Grief is an adaptation process.”

罗杰·所罗门(Roger Solomon)自1979年起执业心理学,他于1990年直接从弗朗辛·夏皮罗那里学习了EMDR。“我想那是她在美国教的第二堂课,”他回忆道。如今,他在世界各地教授EMDR工作坊和研讨会。所罗门发现,这种疗法在改变我们记忆创伤的方式方面具有变革性。“你丈夫在那种情况下去世,那些都是风险因素——意外性、暴力性,”他告诉我。“你经历了丧失,但这是创伤性丧失。希望EMDR所做的是减少创伤,这样你就能经历哀悼的过程,这个过程仍在继续。”他接着说,“它会永远继续下去。它不会停止。它会演变。我们谈论创伤恢复。我们不谈论悲伤恢复。悲伤是一个适应过程。”

Therapeutic modalities are famously complicated to substantiate, and there are plenty of clinicians who think that E.M.D.R. is mostly theatre—exposure therapy bolstered by dual taxation and repackaged as something else entirely. “For trauma, the best treatment, statistically, is exposure therapy,” Bonanno told me. “It’s also the most painful and difficult for both therapist and patient. It involves reliving every moment in a traumatic event, verbally describing it to the therapist, audiotaping it, and then listening to the audiotape repeatedly.” He added, “Understanding what you went through works a lot better if you tell the story. People can’t get over a loss, convince themselves of this distorted view of what happened, that it’s somehow their fault, they did something wrong, they could’ve done more. Then, when they play the whole event through, it’s, like, Oh, it’s not my fault.”

众所周知,治疗方式的证实非常复杂,而且有很多临床医生认为EMDR主要是作秀——被“双重征税”所支持的暴露疗法,被重新包装成了完全不同的东西。“对于创伤,统计上最好的治疗方法是暴露疗法,”博南诺告诉我。“对治疗师和患者来说,它也是最痛苦、最困难的。它涉及重温创伤事件中的每一刻,向治疗师口头描述,录音,然后反复听录音。”他补充说,“如果你讲述这个故事,理解你所经历的事情会有效得多。人们无法从失去中走出来,无法说服自己接受对发生的事情的扭曲看法,认为这不知何故是他们的错,他们做错了什么,他们本可以做得更多。然后,当他们把整个事件过一遍时,就会觉得,哦,这不是我的错。”

Gerald M. Rosen, a retired clinical psychologist and professor at the University of Washington, and the author of the 2023 paper “Revisiting the Origins of EMDR,” expressed distaste for the way the therapy has been sold. “My central concern about E.M.D.R. is that it’s what we call a ‘Purple Hat Therapy,’ ” he wrote to me. “Let’s take a driving phobia that develops after a car accident. We know that imagining the event while relaxing and finding new ways to think about current threats versus recalled fears helps 99% of driving phobics. Now, we have a person practice all that while they wear a purple hat. When the person gets better, we attribute the benefits to the Purple Hat even though it didn’t do anything. We also charge an extra $250 for the hat. E.M.D.R. uses exposure plus a distracting and novel task like eye movements. We notice that the distraction helps the person stay with the imagery, so it increases exposure. See what’s happening? E.M.D.R. is a falsely packaged and trademarked therapy that isn’t helping individuals think clearly about the meaning of their loss and the ways to find restorative meaning in what remains.”

杰拉尔德·M·罗森(Gerald M. Rosen),一位退休的临床心理学家、华盛顿大学教授,也是2023年论文《重访EMDR的起源》(Revisiting the Origins of EMDR)的作者,对这种疗法的推销方式表示反感。“我对EMDR的主要担忧是,它是一种我们称之为'紫帽子疗法'(Purple Hat Therapy)的东西,”他写信给我。“让我们以车祸后产生的驾驶恐惧症为例。我们知道,在放松的状态下想象那个事件,并找到新的方法来思考当前的威胁与被唤起的恐惧,能帮助99%的驾驶恐惧症患者。现在,我们让一个人在做所有这些练习时戴上一顶紫色的帽子。当这个人好转时,我们将益处归功于紫帽子,即使它什么也没做。我们还为这顶帽子额外收取250美元。EMDR使用暴露加上一个分散注意力的新奇任务,比如眼球运动。我们注意到,这种分散注意力有助于患者停留在意象中,因此它增加了暴露。看出问题了吗?EMDR是一种被错误包装和商标化的疗法,它无助于个体清晰地思考他们失去的意义,以及在剩余之物中找到恢复性意义的方法。”

I wasn’t sure whether the path out of grief was, as Rosen said, to “find restorative meaning” in my new life or to stop thinking so one-dimensionally about meaning itself. Mostly, it reminded me of the Fiona Apple song “Paper Bag,” in which she sings, “He said, It’s all in your head / And I said, So’s everything.”

我不确定走出悲伤的道路,是否如罗森所说,是在我的新生活中“找到恢复性意义”,还是停止如此单一维度地思考意义本身。这主要让我想起了菲奥娜·艾波(Fiona Apple)的歌《纸袋》(Paper Bag),她在其中唱道:“他说,这全在你脑子里 / 我说,万事万物不都如此。”

Grief forces a kind of radical transformation, for better or for worse. I found it to be a shockingly generative state: I’d never been more pliable, tender, open, or raw. Miracles, catastrophe—it all felt so possible in those early months. In that way, grief itself is a psychedelic journey. Shortly before the one-year mark, when I theoretically would have been qualified to seek out a P.G.D. diagnosis, the shape of my grief changed again. It began to feel less like a slowly unfolding apocalypse and more like I’d been handed an invisible shield—as if my intimacy with pain had led to a kind of immunity from it. Some days were still hard, but most days were O.K.; eventually, the hard days were aberrations. Music was listenable again, even the really sad songs, though a few still got me. (The first time I heard Zach Bryan sing “Your funeral was beautiful / I bet God heard you comin’,” I had to pull my car off the road.) I developed a new and funny admiration for the ways in which music distilled and centered emotion. I liked that songs, for the most part, took living seriously. I did, too. I found a rhythm to life as a solo parent. I got better at asking for and receiving help. I was more forgiving. The future felt sort of interesting again. Then, incredibly, the future felt almost exciting. What a bold and miraculous thing—to be alive at all.

悲伤迫使一种彻底的转变,无论好坏。我发现它是一种惊人地富有生成力的状态:我从未如此柔顺、脆弱、敞开、生疼。奇迹,灾难——在最初那几个月,一切都感觉如此可能。就那样,悲伤本身就是一场迷幻之旅。就在一周年纪念日之前不久,理论上那时我已有资格寻求延长哀伤障碍的诊断,我的悲伤形态再次改变了。它开始感觉不那么像一场缓慢展开的末日启示,而更像是我被赋予了一面无形的盾牌——仿佛我与痛苦的亲密接触,导致了对它的一种免疫力。有些日子仍然艰难,但大多数日子还好;最终,艰难的日子成了例外。音乐又可以听了,即使是那些非常悲伤的歌,尽管有几首仍然能击中我。(当我第一次听到扎克·布莱恩(Zach Bryan)唱“你的葬礼很美 / 我敢打赌上帝听到了你到来”,我不得不把车停到路边。)我对音乐提炼和聚焦情感的方式产生了一种新的、有趣的钦佩。我喜欢歌曲,在大多数情况下,它们认真对待生活。我也是。我找到了作为单亲家长的生活节奏。我更善于寻求和接受帮助了。我变得更宽容了。未来又开始显得有点意思了。然后,不可思议地,未来几乎显得令人兴奋了。能活着,这本身就是一件多么勇敢而神奇的事啊。

I was still meeting regularly with my original therapist. Our sessions became less about triage and more about integration. I told and retold the story; she repeated it back to me when I needed to hear it. Eventually, I learned to cultivate an odd kind of gratitude for my grief, and for the very modest miracle of my own survival. It’s possible that E.M.D.R., or some aspect of it, helped me claw my way back from what had seemed, at the time, like the end of my life. Ultimately, I didn’t really care about the therapy’s scientific bona fides. All I had wanted was to stop feeling as though the world was unsafe and everyone I loved was about to die. Besides, what did science really know about death, or what happens afterward?

我仍然定期与我最初的治疗师会面。我们的会谈不再那么侧重于紧急处理,而更多是关于整合。我一遍又一遍地讲述那个故事;当我需要听到它时,她会把它复述给我听。最终,我学会了对我的悲伤,以及我自己那非常微小的生存奇迹,培养出一种奇特的感激之情。有可能EMDR,或者它的某个方面,帮助我从当时看似我生命尽头的境地中爬了回来。归根结底,我并不真正在乎这种疗法的科学可信度。我想要的只是不再感觉世界是不安全的,我爱的每个人都即将死去。再说了,关于死亡,或者之后会发生什么,科学又真正知道些什么呢?

The primary thing I recall from E.M.D.R. is unrelated to the therapy itself. Often, at the beginning or the end of our session, my therapist would remind me, firmly and repeatedly, to grieve—to suffer. I can’t remember how he phrased it; possibly, it was as simple as him saying, “Let’s make sure you’re really grieving.” It felt bizarre, even sort of grating: all I was doing was grieving! Yet, in retrospect, I understand it as a remarkable kindness. Humans are instinctively averse to pain, conditioned instead to solve and strengthen and maximize, to inure ourselves to hurt. The idea of willingly spending some indeterminate amount of time feeling bad is unthinkable. But that was how I understood his counsel: feel bad. A bad thing happened, and it is reasonable to feel bad. Thrashing against it was both exhausting and fruitless. The experience reminded me of the woven bamboo finger traps I played with as a kid—the harder you tried to free your hands, the tighter and more frightening the whole thing got. To feel better, I had to find a way to value and nurture my grief. To understand it as some invisible but essential system inside me. ♦

我从EMDR中回忆起的主要事情,与疗法本身无关。通常,在我们治疗开始或结束时,我的治疗师会坚定地、反复地提醒我,要去悲伤——去承受痛苦。我记不清他是怎么说的了;可能,简单到就像他说:“让我们确保你真的在悲伤。”这感觉很奇怪,甚至有点刺耳:我明明做的所有事都是在悲伤!然而,回想起来,我理解那是一种非凡的善意。人类本能地厌恶痛苦,我们被训练成去解决、去加强、去最大化,去让自己对伤害变得麻木。自愿花一段不确定的时间去感受糟糕,这个想法是不可想象的。但我就是这么理解他的忠告的:去感受糟糕。一件糟糕的事情发生了,感到糟糕是合理的。与之对抗既筋疲力尽又徒劳无功。这种体验让我想起了小时候玩过的竹编手指陷阱——你越想挣脱双手,整个东西就变得越紧、越可怕。为了感觉好起来,我必须找到一种方式来珍视和滋养我的悲伤。去理解它,把它看作我体内某个无形但至关重要的系统。 ♦

2 free previews left — register to get 30 translations a month