‘PTSD 시대’의 고통 인식과 대응: 외상 회복의 대안 패러다임 모색
The awareness and coping of human suffering in the “PTSD era”: Searching for an alternative paradigm of trauma recovery
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초록
본 연구는 외상후 스트레스 장애(Posttraumatic stress disorder, PTSD)가 등장한 이후 현대 사회에서 외상 및 고통을 인식하고 이에 대응하는 방법을 조명하였고, 한국 사회의 외상 인식과 대응 방식을 검토하면서 외상 회복을 위한 대안 패러다임의 원칙을 제시하였다. 외상은 기억을 매개로 만성적인 고통을 야기하는 외부 스트레스 사건으로서, 미국정신의학회는 1980년 정신장애 진단 및 통계 편람에서 외상후 스트레스 장애를 공식 인정하였다. 외상후 스트레스 장애 진단의 개발은 피해자에게 도덕적 정당성을 부여하였고, 성공적인 치료 개입의 길을 열었으며, 신경생리학과 인지신경과학 분야에서 연구 성과 축적에 기여하였다. 그러나 이와 동시에, 고통에 대한 인식이 협소해졌고, 기술 개입의 한계를 넘어서는 대응 방안의 중요성이 간과되고 있다. 특히 한국사회의 분리와 부인의 역사적 맥락, 의료 및 전문가 중심 관료주의 기저에는 외상을 개인의 문제로 치환하려는 전략이 발견된다. 따라서 사회적 고통으로서 외상을 인식하고 대안 패러다임을 모색할 필요가 있다. 이 글은 진실 규명과 정의 회복, 회복 주체로서 생존자와 공동체의 책임, 최신 생물-심리학적 성과의 생태학적 적용, 그리고 회복이란 무엇인가에 관한 지속적인 논의를 중시하는 대안 패러다임의 원칙을 제시하였다.
Abstract
This study focused on the awareness and coping methods of psychological trauma and human suffering in the contemporary era after the development of posttraumatic stress disorder(PTSD) including the situations in the Korean society, and proposed principles for an alternative paradigm of trauma recovery. Trauma is defined as an ‘external’ stress causing chronic suffering mediated by memory, and the American Psychiatric Association approved PTSD in the Diagnostic and Statistical Manual of Mental Disorders in 1980. The development of PTSD empowered moral legitimacy to the victims, opened a successful way to treatment, and accomplished explosive amount of research in the area of neurobiology and cognitive neuroscience. However, this also narrowed the understanding of human suffering, and the importance of an alternative coping method which overcomes the limitations of technical intervention became overlooked. Moreover, the Korean society has an underlying mechanism of replacing the matter of trauma to a problem of an individual. This is shown among the historical context of splitting and denial, and among medicalized bureaucracy. Trauma should be acknowledged as a social suffering, and searching for an alternative paradigm is in need. This study suggested the following principles; seeking for truth and justice, survivor as the agent of recovery emphasizing the responsibility of the community, ecological adaptations of recent bio-psychological achievements, and finally putting emphasis on continuous discussions about the definition of recovery.
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