加害者创伤压力

加害者创伤压力（perpetration-induced traumatic stress，缩写为PITS）是一类当创伤后压力症候群是因为自己犯下杀生或其他相似暴行所引起时，所会出现的状况。

加害者创伤压力和道德伤害（Moral injury）相似但并不完全相同，道德伤害更多指的是个人认知上自己犯下的道德罪恶所会造成的各种心理、文化和精神层面的影响。

作为心理疾病

状态

DSM-5在关于创伤后压力症候群的定义的讨论下，讨论了主动参与作为心理创伤的可能原因，并列举了“军事人员成为加害者、目睹暴行、杀害敌人”等事项，作为可能的肇因。

目前已有一些关于退伍军人、^[1]^[2]^[3]^[4]^[5]执行死刑或酷刑的人、执行勤务时开枪的警察、犯下杀人罪的人、从事堕胎工作的人和其他人的加害者创伤压力的研究出现。^[1]

严重性

所有考虑到加害者创伤压力的严重性的研究都指出比起其他原因造成的心理创伤，曾经杀生的人的心理创伤症状往往更加严重。一项利用美国政府的越战老兵资料库^[6]的研究指出，^[7]那些说自己曾经杀人的老兵的症状，和那些说自己没有杀人的老兵的症状有不同之处，侵入性思维（做梦、闪回、不想要的想法等）和突发性的愤怒在有杀人的老兵身上更常出现，而专注力和记忆问题较少出现；此外，在那些回答说自己曾杀人的老兵身上，过度警觉、社会孤立感以及不属于创伤后压力症候群症状的崩解感（sense of disintegration）也更加常见，酒类滥用（英语：Alcohol abuse）和可卡因滥用似乎也更加普遍。

梦中的情景

出现加害者创伤压力的人梦中的情景，和因为自身受害经验而出现心理创伤的人相较，有不同之处。尽管出现加害者创伤压力的人和因为自身受害经验而出现心理创伤的人，在梦中都会出现影像性的片段，不断地以影像的方式重复回忆造成创伤的事件，其他的一些情景更常出现在出现加害者创伤压力的人的梦中。^[1]^[8]^[9]其中一种常见的梦境是双方角色互换，自己被受害人给杀掉，或者在如此情境中变得非常脆弱；另一个情景是受害者指控做梦的人为何他要有如此举措；另一个可能性是自我一分为二，杀人的那个自己变成另一个人。

治疗

一些已知对加害者创伤压力可能有效的疗法有团体心理治疗、眼动身心重建法、^[10]时间观疗法^[11]以及让患者了解这种问题有多么普遍等等，^[12]很多因为社会期望而参与暴行的患者发现说，认知到自己的行为是对不正常情境的正常反应、而非自己特别胆小或疯狂这点，是有帮助的；此外诸如赎罪、宽恕和作为见证人等传统的作法也是经时间考验确实有帮助的作法。^[13]对于这类的建议，需要更多研究来证实，而传统的创伤后压力症候群疗法，也尚未在受害者与加害者的区别方面，做出完整的调查。

其他已被提出的疗法已被证实是无效的。就目前的状况来看，让患者在受控情境中反复地暴露在会唤起对相关情境回忆的情境中，以期减低患者对相关情境的敏感程度的长时间暴露治疗（prolong exposure therapy，PE）并不是一个好方法，这种作法在心理创伤的来源是因自己的暴行而起时，会招致反效果；^[14]此外，有助多数心理受创的人缓解心理创伤的表达性写作，反倒会增加有加害者创伤压力士兵的愤怒感；^[15]另外，对于在治疗中可能有效的各种药物，其在对心理机制方面的影响的不同处，依旧是未知的。

暴力循环

一些加害者创伤压力的症状会导致其他的暴力行为，^[1]^[16]愤怒的爆发，会导致家庭暴力和街头犯罪；而情感上的麻木（emotional numbing）、分离（Emotional detachment）和与他人的隔阂（estrangement）以及对更多战斗活动的参与或对他人暴行的冷漠等，也都可能会对此有影响；另外心理创伤导致的药物滥用也可能和暴力行为有关。

例子

目前已有纳粹大屠杀、^[17]印尼反共屠杀、^[18]红色高棉大屠杀、^[19]南非种族隔离^[20]等暴行的施暴者身上，以及屠宰场员工身上的加害者心理创伤的纪录。^[21]^[22]在提到美国士兵在伊拉克战争当中的经验时，心理学家罗伯特·杰伊·利夫顿（Robert Jay Lifton）在哈迪塞屠杀事件发生之后，做出了以下的叙述：

在伊拉克发生的罪行，就像美莱村屠杀一样，都是我所谓的‘产生暴行的情境’的例子，这类的暴行不管在军事或心理方面，都高度地结构化，以致普通人，也就是不比你我还要来得好或来得差的男男女女，在其中都可能犯下令人发指的暴行。导致这些暴行的一个主要因素，是美军士兵的心理状态，在其中，他们深受因自己的同袍被不可见的敌人所杀所产生的悲愤所影响，同时他们对于找出所谓的‘敌人’，产生了迫切的需要。^[23]^[24]

拉亚·莫拉格（Raya Morag）是最早对加害者创伤压力以及在21世纪的新型态恐怖主义战争的情境中对受害者和加害者之间区别提出理论的心理学家之一，而她在在2013年的文章当中引述了对“产生暴行的情境”的定义。^[25]根据莫拉格的理论，作为道德创伤一种的加害者创伤压力，在参与第一次巴勒斯坦大起义的以色列士兵，以及在伊拉克和阿富汗作战的美军士兵身上都有记录到；^[26]探讨创伤后压力症候群的期刊作者，也在屠宰场员工身上记录到加害者创伤压力，他们提到说“这些人被雇用来杀死猪或牛之类性情温和的动物，而要执行这样的任务，这些员工就必须从他们的所作所为，以及站在他们面前的动物是甚么当中抽离开来；而这种情感上的不一致，会导致家庭暴力、社会抽离、焦虑、药物和酒类滥用，以及创伤后压力症候群等问题。”^[27]

参见

道德伤害

注脚

[1]
MacNair, R. M. (2002). Perpetration-Induced Traumatic Stress: The psychological consequences of killing. Westport, CT: Praeger Publishers
[2]
Grossman, D. (1995). On killing: The psychological cost of learning to kill in war and society. Boston: Little, Brown and Company.
[3]
Maguen, S., Metzler, T. J., Litz, B. T., Seal, K. H., Knight, S. J., & Marmar, C. R. (2009). The impact of killing in war on mental health symptoms and related functioning. Journal of Traumatic Stress, 22, 435-443.
[4]
Maguen S., Lucenko B., Reger M.A., Gahm G., Litz B., Seal K., Knight S., Marmar C.R. (2010). The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. Journal of Traumatic Stress, 23, 86-90.
[5]
Baalbaki, Zenobia S. (2010) Perpetration in combat, trauma, and the social psychology of killing: An integrative review of clinical and social psychology literature with implications for treatment. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 70(10-B), 2010, 6537
[6]
Kulka, R. A., Schlenger, W..E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam war generation: Report on the findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
[7]
MacNair, R. M. (2002). Brief Report: Perpetration-Induced Traumatic Stress in Combat Veterans. Peace and Conflict: Journal of Peace Psychology, vol. 8, no. 1, pp. 63-72.
[8]
Glover, H. (1985). Guilt and aggression in Vietnam veterans. American Journal of Social Psychiatry, 1, 15-18.
[9]
Lifton, R. J. (1990). Adult dreaming: Frontiers of form. In R. A. Neminoff & C. A. Colarusso (Eds.), New dimensions in adult development (pp. 419-442). New York: Basic Books.
[10]
Lipke, H. (2000). EMDR and psychotherapy integration. Boca Raton, FL: CRC Press
[11]
Zimbardo, P.G., Sword, R. M., & Sword, R.K.M. (2012). The time cure: Overcoming PTSD with the new psychology of time perspective therapy. San Francisco: Jossey Bass
[12]
[Yalom, I. (1995). The theory and practice of group psychotherapy. New York: Basic Books
[13]
Foa, E. B., Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-480.
[14]
Pitman, R. K., Altman, B., Greenwald, E., Longpre, R. E., Macklin, M. L., Poire, R. E., & Steketee, G. S. (1991). Psychiatric complications during flooding therapy for posttraumatic stress disorder. Journal of Clinical Psychiatry, 52, 17-20.
[15]
Munsey, C. (2009, October). Writing about wounds. Monitor on Psychology, 58-59
[16]
Silva, J. A., Derecho, D.V., Leong, G. B., Weinstock, R., & Ferrari, M. M. (2001). A classification of psychological factors leading to violent behavior in Posttraumatic Stress Disorder. Journal of Forensic Sciences, 46, 309-316.
[17]
Mohammed 2015，第1190-1191页.
[18]
Mohammed 2015，第1193页.
[19]
Mohammed 2015，第1196-1200页.
[20]
Mohammed 2015，第1207页.
[21]
Dorovskikh, Anna. Killing for a Living: Psychological and Physiological Effects of Alienation of Food Production on Slaughterhouse Workers (学位论文). University of Colorado, Boulder. 2015.^{[失效链接]}
[22]
Confessions of a slaughterhouse worker. BBC News. January 6, 2020 [January 13, 2020]. （原始内容存档于2020-07-02）.
[23]
原文：“The alleged crimes in Iraq, like My Lai, are examples of what I call an atrocity-producing situation—one so structured, psychologically and militarily, that ordinary people, men or women no better or worse than you or I, can commit atrocities. A major factor in all of these events was the emotional state of US soldiers as they struggled with angry grief over buddies killed by invisible adversaries, with a desperate need to identify an 'enemy.'”
[24]
Robert Jay Lifton. Haditha: In an ‘Atrocity-Producing Situation’ — Who Is to Blame?. Editor & Publisher. June 14, 2006 [January 13, 2020]. （原始内容存档于2020-01-13）.
[25]
Morag 2013，第1-32页.
[26]
Morag 2013，第211-218页.
[27]
The Psychological Damage of Slaughterhouse Work. PTSDJournal. [23 May 2019]. （原始内容存档于2019-05-25）.

参考资料

Morag, Raya (2012). Perpetrator Trauma and Current Israeli Documentary Cinema. Camera Obscura, 27(80): 93-133.
Morag, Raya (2013). Waltzing with Bashir: Perpetrator Trauma and Cinema. I.B. Tauris.
Morag Raya (2014). The Trauma of the Female Perpetrator and New War Cinema. In: The Horrors of Trauma in Film: Violence, Void, Visualization, eds. Michael Elm, Kobi Kabalek, Julia B. Köhne, Cambridge Scholars Publishing: 293-313.
Saira, Mohammed. Of Monsters and Men: Perpetrator Trauma and Mass Atrocity. Columbia Law Review. 2015, 115: 1157–1216 [2018-07-08]. （原始内容存档于2018-07-08）. |url-status=和|dead-url=只需其一 (帮助)
Morag, Raya (2018). On the Definition of the Perpetrator: From the Twentieth to the Twenty-First Century. Journal of Perpetrator Research, 2.1: 13-19.

外部链接

Bibliography（页面存档备份，存于互联网档案馆）（英文）

[name1-1] [1]
MacNair, R. M. (2002). Perpetration-Induced Traumatic Stress: The psychological consequences of killing. Westport, CT: Praeger Publishers

[2] [2]
Grossman, D. (1995). On killing: The psychological cost of learning to kill in war and society. Boston: Little, Brown and Company.

[3] [3]
Maguen, S., Metzler, T. J., Litz, B. T., Seal, K. H., Knight, S. J., & Marmar, C. R. (2009). The impact of killing in war on mental health symptoms and related functioning. Journal of Traumatic Stress, 22, 435-443.

[4] [4]
Maguen S., Lucenko B., Reger M.A., Gahm G., Litz B., Seal K., Knight S., Marmar C.R. (2010). The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. Journal of Traumatic Stress, 23, 86-90.

[5] [5]
Baalbaki, Zenobia S. (2010) Perpetration in combat, trauma, and the social psychology of killing: An integrative review of clinical and social psychology literature with implications for treatment. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 70(10-B), 2010, 6537

[6] [6]
Kulka, R. A., Schlenger, W..E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., & Weiss, D. S. (1990). Trauma and the Vietnam war generation: Report on the findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.

[7] [7]
MacNair, R. M. (2002). Brief Report: Perpetration-Induced Traumatic Stress in Combat Veterans. Peace and Conflict: Journal of Peace Psychology, vol. 8, no. 1, pp. 63-72.

[8] [8]
Glover, H. (1985). Guilt and aggression in Vietnam veterans. American Journal of Social Psychiatry, 1, 15-18.

[9] [9]
Lifton, R. J. (1990). Adult dreaming: Frontiers of form. In R. A. Neminoff & C. A. Colarusso (Eds.), New dimensions in adult development (pp. 419-442). New York: Basic Books.

[10] [10]
Lipke, H. (2000). EMDR and psychotherapy integration. Boca Raton, FL: CRC Press

[11] [11]
Zimbardo, P.G., Sword, R. M., & Sword, R.K.M. (2012). The time cure: Overcoming PTSD with the new psychology of time perspective therapy. San Francisco: Jossey Bass

[12] [12]
[Yalom, I. (1995). The theory and practice of group psychotherapy. New York: Basic Books

[13] [13]
Foa, E. B., Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-480.

[14] [14]
Pitman, R. K., Altman, B., Greenwald, E., Longpre, R. E., Macklin, M. L., Poire, R. E., & Steketee, G. S. (1991). Psychiatric complications during flooding therapy for posttraumatic stress disorder. Journal of Clinical Psychiatry, 52, 17-20.

[15] [15]
Munsey, C. (2009, October). Writing about wounds. Monitor on Psychology, 58-59

[16] [16]
Silva, J. A., Derecho, D.V., Leong, G. B., Weinstock, R., & Ferrari, M. M. (2001). A classification of psychological factors leading to violent behavior in Posttraumatic Stress Disorder. Journal of Forensic Sciences, 46, 309-316.

[FOOTNOTEMohammed20151190-1191-17] [17]
Mohammed 2015，第1190-1191页.

[FOOTNOTEMohammed20151193-18] [18]
Mohammed 2015，第1193页.

[FOOTNOTEMohammed20151196-1200-19] [19]
Mohammed 2015，第1196-1200页.

[FOOTNOTEMohammed20151207-20] [20]
Mohammed 2015，第1207页.

[21] [21]
Dorovskikh, Anna. Killing for a Living: Psychological and Physiological Effects of Alienation of Food Production on Slaughterhouse Workers (学位论文). University of Colorado, Boulder. 2015.^{[失效链接]}

[22] [22]
Confessions of a slaughterhouse worker. BBC News. January 6, 2020 [January 13, 2020]. （原始内容存档于2020-07-02）.

[23] [23]
原文：“The alleged crimes in Iraq, like My Lai, are examples of what I call an atrocity-producing situation—one so structured, psychologically and militarily, that ordinary people, men or women no better or worse than you or I, can commit atrocities. A major factor in all of these events was the emotional state of US soldiers as they struggled with angry grief over buddies killed by invisible adversaries, with a desperate need to identify an 'enemy.'”

[24] [24]
Robert Jay Lifton. Haditha: In an ‘Atrocity-Producing Situation’ — Who Is to Blame?. Editor & Publisher. June 14, 2006 [January 13, 2020]. （原始内容存档于2020-01-13）.

[FOOTNOTEMorag20131-32-25] [25]
Morag 2013，第1-32页.

[FOOTNOTEMorag2013211-218-26] [26]
Morag 2013，第211-218页.

[27] [27]
The Psychological Damage of Slaughterhouse Work. PTSDJournal. [23 May 2019]. （原始内容存档于2019-05-25）.

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