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トラウマは人を孤独にする

 「花はただ咲いているだけ」の次の記事を書こうと3日間奮闘したものの、うまくまとめることができずにいます。頭の中にはアイデアが断片的に浮かんでいても、それをつなげることができないんですね。

 6月の下旬に、看護学生さんたちに、「燃え尽き(バーンアウト)症候群」のビデオを見てもらいました。その中で取り上げられていたのがベテラン看護師さんの例で、一生懸命に仕事に打ち込んでいた人が、次第に疲弊しある朝とうとう起きられなくなり、仕事に対する興味も意欲も全くなくなってしまう、というストーリーでした。

 今の私は、かなりこれに近い状態です。今まで意欲的に取り組んでいたはずのカウンセリングという仕事が、多少重荷になってきています。朝目が覚めるとものすごい不安が襲ってきて、全身がだるく起きあがるのに時間を要します。

 それでも、仕事にはきちんと行っています。ケースの数を減らしてもゼロにすることはできません。今すぐに対応しなければならない人をのぞいては、少し待ってもらうようにお願いするのが今の私にできる精一杯のことかもしれません。

 私は今、2つのトラウマを抱えていて、完全にfull PTSD(つまり医学的にPTSDと診断できる状態)にあります。一つは配偶者にまつわること、もう一つは仕事上のことです。後者は、前者の連鎖反応として起こったことで、一応解決は見ているのですが、私の信念を揺さぶるようなショックを受けました。

 そうして、PTSDの二次的な問題として、うつ状態に陥っています。

 PTSDは、一般の人が考えているよりはるかに深刻な問題を引き起こします。トラウマのすべてがそうだというわけではありませんが、単にショックを受ける以上の衝撃的なできごとを体験すると、脳は機能不全の状態に陥ってしまうのです。

 思い出したくないのに、繰り返し思い出す、夢に見る、思い出すと感情も身体反応も全くそのときと同じ状態に戻ってしまうといった「侵入的再体験」、思い出させるような刺激に近寄らない「回避」、異常に用心深くなったり、音や刺激などの普通なら気にならないことにも敏感に反応し、不眠や不快な身体症状を示す「過覚醒症状」は、説明をすることも、理解することもそれほど難しくはありません。

 しかし、現実感がなくなり、周りの世界と自分が切り離されたような感覚になる、いわゆる「解離症状」は、なかなか説明が難しく、単にぼーっとしているだけ、と見られることが多いです。

 これがものすごく辛い症状であることを、想像できる人はそれほど多くないと思います。

 私自身を例に挙げると、近くのスーパーに買い物に行くために横断歩道を歩いていて、自分が歩いているという感覚がなく、周りにある信号や並木道、行き過ぎる通行人や走っている車といったものも現実感が全くなく別世界にいるような感覚になるのです。時々なぜ歩いているのかすら分からなくなることがあります。当然ながら、時間の感覚もあいまいになります。過去と未来と現在がつながらなくなるのです。

 またそばに人がいても、たとえその人が親しい人であっても、自分だけが切り離されてしまったような、人とのつながりがなくなってしまったように感じるのです。何をしていてもどこにいても、たとえようのない孤独感を感じてしまうのです。

 さらに人によっては、自分が外から自分を眺めているような感覚(離人感)が出てきます。

 解離症状にまで至らなくても、トラウマは人を孤独にします。ショッキングなできごとを体験してから最初の1週間〜10日くらいの間、人はできごとを積極的に話そうとします。体験から日が浅いこともあって、話を聞く方もある程度協力的になれるため、この時期にきちんと話を聞いてもらうことができ、安心感を持てれば回復は早いです。

 しかし10日をすぎると、人は逆に体験を話せなくなってしまうのです。話すことは否応にでもできごとについて思い出させてしまうからです。話せないけれどもまだいろんな気持ちを抱えている状態になるのです。できごとが起こってから時間がたつにつれ、その傾向は強まります。体験をした当事者以外の多くの人にとっては、できごとは時間とともに過去のこととして捉えられるので、当事者がまだトラウマによる様々な問題を抱えていることに対し、「過ぎた事は早く忘れなさい」「いつまでも引きずっていないで元気出して」などとつい励ましてしまいます。

 そういう一つ一つの言葉が、トラウマを抱える当事者をさらに傷つけ追いつめてしまうのです。誰も思い出したくて思い出すわけでも、好んで引きずっているわけでもありません。早く忘れたいし、前に進みたい気持ちは持っています。何故回復できないのか焦りも持っています。しかし、自分の体験や気持ちを話そうとするとうまく言葉にできなかったり、話すことで相手が不快感を抱いたり自分から離れていってしまうのではないかと不安になって、話したいことが言えなくなってしまうのです。

 PTSDにうつの合併する割合が高いのは、このような孤独感の存在も理由の一つだと思います。

 トラウマを抱え孤独を感じている人に必要なのは、「共感と保証」です。

 思い出したくない、まだいろんな気持ちを抱えているけど話せない、辛い気持ちでいることを理解し、そのままでいていいと保証することは、トラウマを抱える人に安心感を与えます。孤独感から抜け出せるかどうかは、安心して自分自身でいられる感覚を取り戻せるかにかかっています。

 仕事柄、他人のケアに力を注いできましたが、「辛いよね」の一言を一番必要としているのは、自分自身だったのかもしれません。


 

 

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Comments

 身体面に症状が現れるととてもつらいですね。
 私もこの4月頃は、人間関係にまつわるショックから、買い物に行ってもなにを買いに行ったか思い出せず30分くらい、スーパーを歩き回る経験をするなど、苦しい体験をしました。ただ長続きせず、早く解消したのでよかったのですが・・・・・。続くと苦しいでしょうね。大変な時期だと思います。


 私も一時期「燃え尽き症候群」ではないかと思いましたが、今はアスペルガー症候群の二次障害、OCDであると思うようになりました。
 先日自閉症児の「応用行動分析学」の学習会をしてきましたが、自閉症の子がとるこだわり行動と私の思考、行動特性はまさに一致します。
 成人の自閉症圏の人間であることをつくづく実感しました。また、未だに舌噛みのような自傷行為をやめることができません。
 ただ、幸いにも今は自分がアスペルガー症候群であるがゆえにできることがあります。
 自分を基準にしてアスペルガー症候群の子、ADHDの子を見つけだしたり、特異な思考、行動の特性について対応できたりするなど、得をしている部分もあります。
 しかし、OCDの患者が抱える心の問題にはわたしも例外なく当てはまります。こだわりが強すぎて、また、ちょっとした事がきっかけになって過敏に反応して情緒の安定を崩すなど、困ったことも多くあります。
 最近、できないことは、はっきりと「できない」と言わないと、自分にあった良い仕事ができないと思うようになりました。
 人から見ると定型発達の人に見えるのですが、中身は、自閉圏の人間です。ですから、こだわりのある行動しかとれません。そういうことを管理職に分かってもらうよう、詳しく話すようにしています。
 そうでないと、最悪、希死念慮がうかんでくるなど不安定になってしまいます。
 マイペースを保たれて今の状況を乗り切ってください。

Posted by: aikidonotatujin | 2005.08.23 at 07:09 PM

はじめまして。かすみと申します。

本を読んで、sanaさんのブログを知りました。治療者として、情報を発信し、さらに、当事者としても、自分をオープンにされていることに、心を動かされました。

私は、精神科の心理職として働いていましたが、燃えつきから、うつ状態になり、臨床から離れています。治療者から、当事者となり、まったく、視点が変わりました。私の場合、自分が学んだ心理学だけでは、回復できませんでした。今はスピチュアルな視点で見ています。現在は、治療者、当事者、両方の経験から、何か新しいことができないかと試行錯誤しています。

私は、PTSDには詳しくなく、小西聖子さんのワークショップや「心的外傷と回復」という本などで勉強した程度です。でも、患者さんの話を聞いている中での、二次受傷の経験はあります。世界から切り離されたような恐怖、孤独感で、体の震えが止まりませんでした。初めて孤独の意味を知った気がしました。sanaさんの苦しみが分かるわけではありませんが、おつらいことだろうと思います。

「花が教えてくれる、大切なこと」などのコラム、素敵です。大事なことをふんわりやさしく、分かりやすく書かれていて、好きです。

私も、sanaさんのように、心のつらさを抱えながら、それでも、前を向いて、歩いていきたいです。自分を生かして、人の役に立てたらいいなと思います。勇気をいただきました。
長々と失礼しました。ありがとうございました。

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