加害者創傷壓力

加害者創傷壓力（perpetration-induced traumatic stress，縮寫為PITS）是一類當創傷後壓力症候群是因為自己犯下殺生或其他相似暴行所引起時，所會出現的狀況。

加害者創傷壓力和道德傷害（Moral injury）相似但並不完全相同，道德傷害更多指的是個人認知上自己犯下的道德罪惡所會造成的各種心理、文化和精神層面的影響。

作為心理疾病

狀態

DSM-5在關於創傷後壓力症候群的定義的討論下，討論了主動參與作為心理創傷的可能原因，並列舉了「軍事人員成為加害者、目睹暴行、殺害敵人」等事項，作為可能的肇因。

目前已有一些關於退伍軍人、^[1]^[2]^[3]^[4]^[5]執行死刑或酷刑的人、執行勤務時開槍的警察、犯下殺人罪的人、從事墮胎工作的人和其他人的加害者創傷壓力的研究出現。^[1]

嚴重性

所有考慮到加害者創傷壓力的嚴重性的研究都指出比起其他原因造成的心理創傷，曾經殺生的人的心理創傷症狀往往更加嚴重。一項利用美國政府的越戰老兵資料庫^[6]的研究指出，^[7]那些說自己曾經殺人的老兵的症狀，和那些說自己沒有殺人的老兵的症狀有不同之處，侵入性思維（做夢、閃回、不想要的想法等）和突發性的憤怒在有殺人的老兵身上更常出現，而專注力和記憶問題較少出現；此外，在那些回答說自己曾殺人的老兵身上，過度警覺、社會孤立感以及不屬於創傷後壓力症候群症狀的崩解感（sense of disintegration）也更加常見，酒類濫用（英語：Alcohol abuse）和可卡因濫用似乎也更加普遍。

夢中的情景

出現加害者創傷壓力的人夢中的情景，和因為自身受害經驗而出現心理創傷的人相較，有不同之處。盡管出現加害者創傷壓力的人和因為自身受害經驗而出現心理創傷的人，在夢中都會出現影像性的片段，不斷地以影像的方式重複回憶造成創傷的事件，其他的一些情景更常出現在出現加害者創傷壓力的人的夢中。^[1]^[8]^[9]其中一種常見的夢境是雙方角色互換，自己被受害人給殺掉，或者在如此情境中變得非常脆弱；另一個情景是受害者指控做夢的人為何他要有如此舉措；另一個可能性是自我一分為二，殺人的那個自己變成另一個人。

治療

一些已知對加害者創傷壓力可能有效的療法有團體心理治療、眼動身心重建法、^[10]時間觀療法^[11]以及讓患者了解這種問題有多麼普遍等等，^[12]很多因為社會期望而參與暴行的患者發現說，認知到自己的行為是對不正常情境的正常反應、而非自己特別膽小或瘋狂這點，是有幫助的；此外諸如贖罪、寬恕和作為見證人等傳統的作法也是經時間考驗確實有幫助的作法。^[13]對於這類的建議，需要更多研究來證實，而傳統的創傷後壓力症候群療法，也尚未在受害者與加害者的區別方面，做出完整的調查。

其他已被提出的療法已被證實是無效的。就目前的狀況來看，讓患者在受控情境中反覆地暴露在會喚起對相關情境回憶的情境中，以期減低患者對相關情境的敏感程度的長時間暴露治療（prolong exposure therapy，PE）並不是一個好方法，這種作法在心理創傷的來源是因自己的暴行而起時，會招致反效果；^[14]此外，有助多數心理受創的人緩解心理創傷的表達性寫作，反倒會增加有加害者創傷壓力士兵的憤怒感；^[15]另外，對於在治療中可能有效的各種藥物，其在對心理機制方面的影響的不同處，依舊是未知的。

暴力循環

一些加害者創傷壓力的症狀會導致其他的暴力行為，^[1]^[16]憤怒的爆發，會導致家庭暴力和街頭犯罪；而情感上的麻木（emotional numbing）、分離（Emotional detachment）和與他人的隔閡（estrangement）以及對更多戰鬥活動的參與或對他人暴行的冷漠等，也都可能會對此有影響；另外心理創傷導致的藥物濫用也可能和暴力行為有關。

例子

目前已有納粹大屠殺、^[17]印尼反共屠殺、^[18]紅色高棉大屠殺、^[19]南非種族隔離^[20]等暴行的施暴者身上，以及屠宰場員工身上的加害者心理創傷的紀錄。^[21]^[22]在提到美國士兵在伊拉克戰爭當中的經驗時，心理學家羅伯特·傑伊·利夫頓（Robert Jay Lifton）在哈迪塞屠殺事件發生之後，做出了以下的敘述：

在伊拉克發生的罪行，就像美萊村屠殺一樣，都是我所謂的『產生暴行的情境』的例子，這類的暴行不管在軍事或心理方面，都高度地結構化，以致普通人，也就是不比你我還要來得好或來得差的男男女女，在其中都可能犯下令人髮指的暴行。導致這些暴行的一個主要因素，是美軍士兵的心理狀態，在其中，他們深受因自己的同袍被不可見的敵人所殺所產生的悲憤所影響，同時他們對於找出所謂的『敵人』，產生了迫切的需要。^[23]^[24]

拉亞·莫拉格（Raya Morag）是最早對加害者創傷壓力以及在21世紀的新型態恐怖主義戰爭的情境中對受害者和加害者之間區別提出理論的心理學家之一，而她在在2013年的文章當中引述了對「產生暴行的情境」的定義。^[25]根據莫拉格的理論，作為道德創傷一種的加害者創傷壓力，在參與第一次巴勒斯坦大起義的以色列士兵，以及在伊拉克和阿富汗作戰的美軍士兵身上都有記錄到；^[26]探討創傷後壓力症候群的期刊作者，也在屠宰場員工身上記錄到加害者創傷壓力，他們提到說「這些人被僱用來殺死豬或牛之類性情溫和的動物，而要執行這樣的任務，這些員工就必須從他們的所作所為，以及站在他們面前的動物是甚麼當中抽離開來；而這種情感上的不一致，會導致家庭暴力、社會抽離、焦慮、藥物和酒類濫用，以及創傷後壓力症候群等問題。」^[27]

參見

道德傷害

註腳

[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頁.
[18]
Mohammed 2015，第1193頁.
[19]
Mohammed 2015，第1196-1200頁.
[20]
Mohammed 2015，第1207頁.
[21]
Dorovskikh, Anna. Killing for a Living: Psychological and Physiological Effects of Alienation of Food Production on Slaughterhouse Workers (學位論文). University of Colorado, Boulder. 2015.^{[失效連結]}
[22]
Confessions of a slaughterhouse worker. BBC News. January 6, 2020 [January 13, 2020]. （原始內容存檔於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]. （原始內容存檔於2020-01-13）.
[25]
Morag 2013，第1-32頁.
[26]
Morag 2013，第211-218頁.
[27]
The Psychological Damage of Slaughterhouse Work. PTSDJournal. [23 May 2019]. （原始內容存檔於2019-05-25）.

參考資料

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]. （原始內容存檔於2018-07-08）. |url-status=和|dead-url=只需其一 (幫助)
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.

外部連結

Bibliography（頁面存檔備份，存於互聯網檔案館）（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頁.

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

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

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

[21] [21]
Dorovskikh, Anna. Killing for a Living: Psychological and Physiological Effects of Alienation of Food Production on Slaughterhouse Workers (學位論文). University of Colorado, Boulder. 2015.^{[失效連結]}

[22] [22]
Confessions of a slaughterhouse worker. BBC News. January 6, 2020 [January 13, 2020]. （原始內容存檔於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]. （原始內容存檔於2020-01-13）.

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

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

[27] [27]
The Psychological Damage of Slaughterhouse Work. PTSDJournal. [23 May 2019]. （原始內容存檔於2019-05-25）.

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