Scurta incursiune în domeniul psihotraumatologiei

De când oamenii au legat noțiunea de suflet de prezența imaterială a vieții, dar și de aspirația la nemurire, neputând să-i excludă totuși legăturile cu corpul, i-au descris într-un limbaj comun suferințele ca și cum ar fi fost fizice, corporale, precum în cazul explicării suferințelor provocate de rănile nevindecate ale sufletului. De aici decurg azi, în limbajul științific, similitudinile dintre traumă și rană, suflet și psihic. Cu toate aceste similitudini, doar în ultimele decenii beneficiem de un studiu programatic, consacrat traumelor psihice, condițiilor în care acestea acționează, se produc și lasă consecințe imediate sau tardive, într-un cuvânt, asistăm la dezvoltarea psihotraumatologiei, un domeniu cu multiple confluențe interdisciplinare.
După J. Laplanche și J.-B. Pontalis (1994), trauma sau traumatismul psihic reprezintă un eveniment din viața subiectului care se definește prin intensitatea sa, prin incapacitatea subiectului de a-i răspunde adecvat și prin tulburările și efectele patogene durabile pe care le provoacă. Interac-țiunea cu un eveniment devine pentru un individ semnificativ-determinantă, în sens traumatic, nu numai prin felul particular în care o trăiește, dar și prin valoarea simbolică pe care i-o acordă.
Modificările psihopatologice survenite după evenimente traumatizante se definesc ca tulburări posttraumatice, din cauză că se extind dincolo de capa-citatea indivizilor de a le autocontrola. Manifestările generale ale reacțiilor traumatice pot include: amnezii lacunare, stări de depersonalizare (sentimentul de mo-dificare, pierdere a identității somatopsihice) sau de derealizare (sentimentul de înstrăinare față de realitate).
Raportat la gravitatea factorilor traumatogeni, în funcție de rezistența psihică personală și de gradul de vulnerabilitate înnăscută sau dobândită, situațiile de expunere la stres și traume psihice se împart în:

– ușoare – schimbarea mediului, conflictele cu anturajul sau familia duse până la limita acceptabilă cultural a normelor;
– medii – eșecurile în ruta educațională (repetenții, exmatriculări), bolile cronice, pierderile materiale cu modificări remediabile sau încă suportabile ale statutului social, pensionarea;
– severe – divorțul cu repercusiuni asupra încre-dințării și creșterii copiilor, graviditatea nedorită la adolescente, arestarea, moartea unor membri din familie;
– extrem de severe – abuzul sexual, agresiunea resimțită ca pericol vital, deportarea, tortura, munca forțată, maltratarea corporală sau moartea unuia dintre parteneri;
– catastrofale – moartea copilului, sinuciderea unuia dintre parteneri, situația de victimă a crimelor împotriva umanității, dezastrele naturale.
Evenimentele traumatizante pot fi:
-unice – confruntarea cu o situație violentă, neobișnuită la care este expus un individ.
-multiple și durabile în timp – cumularea lor succesivă duce la înlănțuirea și amplificarea consecințelor traumatogene asupra indivizilor.
Sunt cunoscute la copiii care au depășit vârsta de nouă luni o altă categorie de situații traumatizante, și anume cele de neglijare socială. Aceste situații pot duce la perturbarea atașamentului față de adulții care le asigură îngrijirea, manifestându-se fie printr-un comportament inhibat și detașat emoțional față de aceștia, fie prin abordarea dezinhibată a adulților necunoscuți și menținerea redusă ori absența legăturii cu persoanele care-I îngrijesc.

Tulburarea de stres posttraumatic, tulburarea acută de stres și tulburările de adaptare sunt alte posibile manifestări psihopatologice consecutive expunerii la eve-nimente traumatice sau stresante.

Dr. Mihai Ardelean, Medic Primar Psihiatru
Centrul de Sanatate Mintala Tg.-Mures

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