用成癮藥物治療悲傷會危及社會聯繫
Treating Grief with Addiction Drug Jeopardizes Social Connections
一篇新文章批評了精神病學中的一項運動，將復雜的悲傷理解為一種成癮並用納曲酮治療。
A new article critiques a movement in psychiatry to understand complicated grief as an addiction and treat it with naltrexone.
阿什利波巴克，MS-2022 年 6 月 13 日
Ashley Bobak, MS -June 13, 2022
發表在《人文心理學雜誌》上的一篇新文章 批評了一項研究，該研究將長期悲傷視為一種成癮形式，並使用阿片類藥物拮抗劑納曲酮來“治療”它。作者討論了這種方法如何最大限度地減少死者與死者之間關係的重要性，並可能破壞社會聯繫，這可能會對邊緣化社區產生重大影響。他們還強調了社會聯繫對康復的重要性，並推薦了側重於與他人一起康復的干預措施。
A new article published in the Journal of Humanistic Psychology critiques a research study that frames prolonged grief as a form of addiction and uses the opioid antagonist naltrexone to “treat” it. The authors discuss how this approach minimizes the significance of the relationship between the bereaved and deceased and could be potentially harmful in disrupting social connections, which may significantly impact marginalized communities. They also emphasize the importance of social connection to healing and recommend interventions that focus on healing with others.
該研究提案由 Gang 等人撰寫。(2021) 與美國國立衛生研究院 (NIH) 和美國國家癌症研究所 (NCI) 合作。剛等人。（2021）表明，在長期悲傷中對親人的渴望類似於對成癮的渴望。
The research proposal was authored by Gang et al. (2021) in collaboration with the National Institutes of Health (NIH) and the National Cancer Institute (NCI). Gang et al. (2021) suggest that longing for loved ones in prolonged grief is similar to cravings in addiction.
他們提供納曲酮，它已被證明可以減少社會聯繫的感覺，並且通常用於治療阿片類藥物成癮，作為“治療”長期悲傷的一種方式。他們認為，納曲酮會減少與死者的社會聯繫，從而減少失去親人的孤獨感和情感痛苦。
They offer naltrexone, which has been shown to reduce feelings of social connection and is commonly used in treating opioid addiction as a way to “treat” prolonged grief. They theorize that naltrexone will reduce social connectedness with the deceased, resulting in less loneliness and emotional suffering for the bereaved.
當前文章的作者，由亞利桑那州立大學喪親家庭彈性育兒項目的 Kara Thieleman 領導，作者寫道：
The authors of the current article, led by Kara Thieleman of the Resilient Parenting for Bereaved Families program at Arizona State University, write:
“用納曲酮治療悲傷者進一步將心理健康產業綜合體擴展到喪親之痛的領域，在這種情況下，親人去世時的悲傷被視為另一種可以用藥物治療的病理形式，而沒有考慮到發生何種悲傷，包括與死者的關係、圍繞死亡的環境、關係的歷史和質量，或對死者的依戀程度。”
“Treating grievers with naltrexone further expands the mental health industrial complex into the realm of bereavement, where grief at the death of a loved one is viewed as just one more form of pathology to be treated with pharmaceutical agents, with no consideration of the context in which grief occurs, including the relationship to the person who died, the circumstances surrounding the death, the history, and quality of the relationship, or the degree of attachment to the person who died.”
在他們的提議中，Gang 等人。(2021) 參考 Inagaki 等人的工作。（2016）證明使用納曲酮有目的地破壞社會聯繫是合理的。然而，稻垣等人。(2016) 將社會紐帶的干擾確定為納曲酮的不利影響，並強調社會支持和紐帶對恢復過程的重要性——蒂勒曼及其同事認為，這對於喪親之痛同樣重要。
In their proposal, Gang et al. (2021) reference the work of Inagaki et al. (2016) to justify the use of naltrexone to disrupt social connections purposefully. However, Inagaki et al. (2016) identify disturbances in social bonds as an adverse effect of naltrexone and emphasize the importance of social support and bonding to the recovery process – which Thieleman and colleagues argue is just as crucial to bereavement.
此外，納曲酮不能針對特定的社會紐帶，因此可能會減少社會聯繫。研究表明，它可能會對其他領域的慾望產生負面影響，例如食物。
Further, naltrexone cannot target specific social bonds and, therefore, could reduce social connection. Research suggests that it may negatively affect desire in other domains, such as food.
鑑於感知到的社會支持，尤其是動物支持，對於悲傷的個體至關重要，並與更好的生活質量相關，並能防止複雜的悲傷、創傷後應激障礙和抑鬱症，故意破壞個人的社會紐帶可能對雙方的痛苦都造成毀滅性的打擊個人以及他們的親人。
Given that perceived social support, especially animal support, is crucial to grieving individuals and is associated with better quality of life and protects against complicated grief, posttraumatic stress disorder, and depression, intentionally disrupting an individual’s social bonds could be potentially devastating to both the suffering individual as well as their loved ones.
損害社會紐帶不僅會影響心理健康，而且孤獨已被證明會導致喪親之痛的死亡風險增加。切斷福利和尋求社會支持的動力可能會加劇這個問題。
Not only could impairing social bonds affect psychological health, but loneliness has been shown to lead to increased risk for mortality in bereavement. Cutting off the benefits and the drive for social support could worsen this problem.
此外，由於長期悲傷障礙 (PGD) 的一個重要症狀是難以與他人建立聯繫，因此目前尚不清楚破壞社會紐帶將如何使那些經歷複雜悲傷的人受益。
Moreover, as a significant symptom of Prolonged Grief Disorder (PGD) is a struggle to feel connected to others, it is unclear how disrupting social bonds would benefit those experiencing complicated grief.
減少社會聯繫可能會對邊緣化和受壓迫人群產生負面影響，包括黑人、土著和有色人種 (BIPOC) 社區以及性和性別少數群體。儘管喪親之痛的研究往往集中在老年人、白人、順性別者和異性戀者身上，但對邊緣化群體的現有研究已經證明了社會聯繫和支持在這些人群中的重要性。用納曲酮剝奪社會紐帶可能會不成比例地影響邊緣化人群，他們往往更多地依賴非正式形式的支持。
Reducing social connectedness could negatively impact marginalized and oppressed populations, including Black, Indigenous, and People of Color (BIPOC) communities and sexual and gender minorities. Although research on bereavement tends to focus on elderly, White, cisgender, and heterosexual individuals, available research on marginalized groups has demonstrated the importance of social connection and support in these populations. Stripping away social bonds with naltrexone could disproportionately affect marginalized populations who tend to rely more on informal forms of support.
此外，由於歧視性的醫療實踐和經驗，邊緣化社區普遍存在對醫療保健系統的不信任。因此，BIPOC 社區傾向於更多地依賴自然癒合實踐，並強調祖先的癒合實踐來解決世代創傷。
Additionally, distrust in the health care system is prevalent in marginalized communities, fueled by discriminatory healthcare practices and experiences. As a result, BIPOC communities tend to rely more on natural healing practices and emphasize ancestorial healing practices to address generational trauma.
以社區為基礎的康復模式，包括康復和殘疾正義，強調需要承認壓迫和不平等是康復的關鍵。他們還主要關注社區聯繫，以使受壓迫的個人能夠努力實現系統性變革。因此，通過使用藥物削弱社會聯繫並不能反映具有文化能力的護理，並可能導致醫學界對邊緣化群體的進一步不信任。
Community-based modes of healing, which include healing and disability justice, stress the need for recognition of oppression and inequality as being key to recovery. They also focus primarily on community connection to empower oppressed individuals to work towards systemic change. Therefore, blunting social connection through the use of drugs is not reflective of culturally competent care and could cause further distrust of the medical community in marginalized groups.
雖然 Gang 等人。（2021）提出納曲酮長期悲傷的風險很低，蒂勒曼和他的同事們認為相反，他們指出研究表明，失去親人的人往往會感到孤立和脆弱，並且經常受到文化要求的影響，迫使他們壓製或最小化自己的情緒使周圍的人感到更舒服，以及滿足生產力的經濟需要。
Although Gang et al. (2021) present the risk of naltrexone for prolonged grief as low, Thieleman and colleagues argue otherwise, pointing to research that indicates that bereaved individuals tend to feel isolated and vulnerable and are often subjected to cultural demands that push them to repress or minimize their own emotions to make others around them feel more comfortable, as well as to meet economic needs of productivity.
他們強調了這些對失去親人的人的不合理要求如何可能因精神病學的衝動而惡化，將特定的悲傷經歷病態化，儘管研究表明一些損失會導致更持久和更強烈的悲傷。
They highlight how these unreasonable demands on bereaved individuals have likely been worsened by urges by psychiatry to pathologize specific experiences of grief, despite research suggesting that some losses result in longer-lasting and more intense grief.
雖然經歷這種悲傷的人需要支持，但治療他們並不是他們需要的那種支持。可悲的是，隨著美國精神病學協會在 2013 年將 PGD 添加到《精神疾病診斷和統計手冊》中，很可能會出現更多將悲傷病態化和醫學化的嘗試。
While individuals experiencing this type of grief need support, medicating them is not the kind of support they need. Sadly, with the American Psychiatric Association’s addition of PGD to the Diagnostic and Statistical Manual of Mental Disorders in 2013, it is likely that additional attempts to pathologize and medicalize grief will occur.
作者得出結論：
The authors conclude:
“我們認為干預措施應側重於幫助人們在與他人的關係中康復，而不是削弱社會聯繫的能力。與喪親有關的干預措施應植根於富有同情心、協調一致的支持，並允許悲傷者分享他們的故事，與意義問題作鬥爭，並建立他們承受痛苦的能力，而不是通過試圖最小化、否認或治愈他們的痛苦和悲傷. 完全活著意味著願意感受在安全條件下需要感受的東西，包括親人死亡的痛苦，而不是為了麻木痛苦而進一步疏遠自己。也許，與喪親有關的干預措施的最終目標是幫助人們認識到他們有能力成為一個完整的人，即使是心碎的人。”
“We believe interventions should focus on helping people heal in relationships with others, not on impairing the very capacity for social connectedness. Bereavement-related interventions should be rooted in compassionate, attuned support and allow grievers to share their stories, struggle with questions of meaning, and build their capacity to hold their pain, not through attempts to minimize, deny, or medicate away their pain and grief. Being fully alive means being willing to feel what needs to be felt under conditions of safety, including the pain of the death of a loved one, not further alienating oneself in an attempt to numb the pain. Perhaps, the ultimate goal of bereavement-related interventions is to help people recognize their capacity to become whole, if broken-hearted, human beings.”
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Thieleman, K.、Cacciatore, J.、Thomas, S. (2022)。損害社會聯繫：用納曲酮治療悲傷的危險。人文心理學雜誌，1-9。DOI：10.1177/00221678221093822 （鏈接）
Thieleman, K., Cacciatore, J., Thomas, S. (2022). Impairing social connectedness: The dangers of treating grief with naltrexone. Journal of Humanistic Psychology, 1-9. DOI: 10.1177/00221678221093822 (Link)
Ashley Bobak 是 Point Park 大學臨床社區心理學專業的 PsyD 學生，擁有諮詢心理學碩士學位。她對哲學、歷史和心理學的交叉點很感興趣，並利用這個交叉點作為鏡頭來檢查物質成癮。她希望開發和推廣替代方法來概念化和治療維持和尊重人類尊嚴的精神病理學。
Ashley Bobak, MSAshley Bobak is a PsyD student in Clinical-Community Psychology at Point Park University and has a Master’s degree in Counseling Psychology. She is interested in the intersections of philosophy, history, and psychology and is using this intersection as a lens to examine substance addiction. She hopes to develop and promote alternative approaches to conceptualizing and treating psychopathology that maintain and revere human dignity.