演講MP3+雙語文稿:治療抑郁與焦慮的"社會處方" ,不吃藥也能輕松告別抑郁癥

聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學(xué)習(xí)使用。本文主要內(nèi)容為演講MP3+雙語文稿:治療抑郁與焦慮的"社會處方" ,不吃藥也能輕松告別抑郁癥，希望你會喜歡！

【演講者及介紹】Johann Hari 記者

哈里畢業(yè)于劍橋大學(xué)，最高學(xué)位，雙學(xué)位，社會科學(xué)和政治學(xué)。他在倫敦長大，父親是一位瑞士司機，而蘇格蘭母親則在一家家庭暴力受害者收容所工作。今天，他有半年的時間住在倫敦，他每年的另一半時間都在旅行去研究他的書。

【演講主題】這可能是你抑郁或焦慮的原因

【中英文字幕】

翻譯者 psjmz mz 校對者 Jiasi Hao

00:14

For a really long time, I had two mysteries that were hanging over me. I didn't understand them and, to be honest, I was quite afraid to look into them. The first mystery was, I'm 40 years old, and all throughout my lifetime, year after year, serious depression and anxiety have risen, in the United States, in Britain, and across the Western world. And I wanted to understand why. Why is this happening to us? Why is it that with each year that passes, more and more of us are finding it harder to get through the day? And I wanted to understand this because of a more personal mystery.

一直以來 有兩個迷團一直困擾著我。我無法理解它們，而且說實話，我害怕深究它們。第一個謎團是，我40歲了，在我一生中，年復(fù)一年，嚴重的抑郁和焦慮癥狀 在美國，英國等國家 不斷浮現(xiàn)出來，橫掃整個西方世界。我想要搞清楚為什么。為什么這開始發(fā)生在我們身上？ 為什么過去的每一年里，我們越來越多人發(fā)現(xiàn) 更難以度過每一天？ 我想要理解這個是因為 一個很私人的謎團。

00:56

When I was a teenager, I remember going to my doctor and explaining that I had this feeling, like pain was leaking out of me. I couldn't control it, I didn't understand why it was happening, I felt quite ashamed of it. And my doctor told me a story that I now realize was well-intentioned, but quite oversimplified. Not totally wrong. My doctor said, "We know why people get like this. Some people just naturally get a chemical imbalance in their heads -- you're clearly one of them. All we need to do is give you some drugs, it will get your chemical balance back to normal."

當我還是10來歲時，我記得有一次去看醫(yī)生，說我總覺得渾身疼痛。我不能控制它，我不理解為什么它會出現(xiàn)，并且感到非常羞恥。醫(yī)生告訴我了一個 現(xiàn)在我意識到是出于好意的故事，但太過于簡化。并非全錯。我醫(yī)生說，“我們知道 人們?yōu)槭裁磿@樣。有些人的大腦很自然地 會發(fā)生一些化學(xué)失衡—— 你顯然是其中一個。我們要做的就是給你開一些藥，它就會把你的化學(xué)平衡 恢復(fù)正常。”

01:29

So I started taking a drug called Paxil or Seroxat, it's the same thing with different names in different countries. And I felt much better, I got a real boost. But not very long afterwards, this feeling of pain started to come back. So I was given higher and higher doses until, for 13 years, I was taking the maximum possible dose that you're legally allowed to take. And for a lot of those 13 years, and pretty much all the time by the end, I was still in a lot of pain. And I started asking myself, "What's going on here? Because you're doing everything you're told to do by the story that's dominating the culture -- why do you still feel like this?"

所以我開始服用帕羅西汀 或類似的藥物。一個東西在不同國家 有不同的名字。然后我感覺好了很多，也受到了很大的鼓舞。但隨后不久，這種疼痛的感覺回來了。所以我使用越來越高的劑量，直到后來的13年，我都在服用法律允許的最高劑量。在這13年的大部分時候，差不多一直到最后，我仍然很痛苦。我開始問自己，“這是怎么回事？” 因為你按照主導(dǎo)文化所說的 做了所有的事情—— 為什么你仍然會有這樣的感受？

02:03

So to get to the bottom of these two mysteries, for a book that I've written I ended up going on a big journey all over the world, I traveled over 40,000 miles. I wanted to sit with the leading experts in the world about what causes depression and anxiety and crucially, what solves them, and people who have come through depression and anxiety and out the other side in all sorts of ways. And I learned a huge amount from the amazing people I got to know along the way.

所以為了揭開這兩個謎團的謎底，為了我寫的一本書，我進行了一場環(huán)球旅行，旅途超過4萬英里。我想跟世界一流的專家坐在一起 討論是什么引發(fā)了抑郁和焦慮，并且最重要的是： 有什么治愈方法，以及那些經(jīng)歷過抑郁和焦慮的人 是如何以各種方式走出來的。我一路走來，從我認識的那些，了不起的人身上學(xué)到了很多。

02:26

But I think at the heart of what I learned is, so far, we have scientific evidence for nine different causes of depression and anxiety. Two of them are indeed in our biology. Your genes can make you more sensitive to these problems, though they don't write your destiny. And there are real brain changes that can happen when you become depressed that can make it harder to get out. But most of the factors that have been proven to cause depression and anxiety are not in our biology. They are factors in the way we live. And once you understand them, it opens up a very different set of solutions that should be offered to people alongside the option of chemical antidepressants.

但我認為 我所學(xué)到的最核心的是，目前為止，科學(xué)依據(jù)能夠證明 有9種不同的 引發(fā)抑郁和焦慮的原因。其中兩個確實是由于生理因素。你的基因會讓你 對這些問題更敏感，雖然它們不能決定你的命運。當你變得抑郁時，你的大腦會發(fā)生實質(zhì)的變化，讓你更難擺脫出來。但絕大部分被證實 引發(fā)抑郁和焦慮的因素 跟我們的生理因素無關(guān)，而主要取決于我們的生活方式。一旦你理解了它們，就能開啟一套 非常不同的解決方案，應(yīng)該和化學(xué)抗抑郁藥 一起提供給人們。

03:08

For example, if you're lonely, you're more likely to become depressed. If, when you go to work, you don't have any control over your job, you've just got to do what you're told, you're more likely to become depressed. If you very rarely get out into the natural world, you're more likely to become depressed.

比如，如果你很孤獨，你很可能會變得抑郁。如果，當你工作時，你對 自己的工作沒有控制權(quán)，你得按照吩咐去做，你就更可能變得抑郁。如果你很少接觸自然世界，你更可能變得抑郁。

03:24

And one thing unites a lot of the causes of depression and anxiety that I learned about. Not all of them, but a lot of them. Everyone here knows you've all got natural physical needs, right? Obviously. You need food, you need water, you need shelter, you need clean air. If I took those things away from you, you'd all be in real trouble, real fast. But at the same time, every human being has natural psychological needs. You need to feel you belong. You need to feel your life has meaning and purpose. You need to feel that people see you and value you. You need to feel you've got a future that makes sense. And this culture we built is good at lots of things. And many things are better than in the past -- I'm glad to be alive today. But we've been getting less and less good at meeting these deep, underlying psychological needs. And it's not the only thing that's going on, but I think it's the key reason why this crisis keeps rising and rising. And I found this really hard to absorb. I really wrestled with the idea of shifting from thinking of my depression as just a problem in my brain, to one with many causes, including many in the way we're living.

有一件事情把所有 我所知道的抑郁和焦慮 聯(lián)系在一起。不是所有，但很多。這里每個人都知道，你們都有自然的生理需求，對吧？ 顯然。你需要食物，你需要水，你需要住所，你需要干凈的空氣。如果我拿走那些東西，你們都會很快就陷入巨大的困境。但同時，每個人都有自然的心理需求，你需要有歸屬感。你需要感到 你的生活有意義和目的。你需要感到人們關(guān)注你并重視你。你需要感覺 你有一個有意義的未來。我們建立的這種文化 擅長很多事情。很多事情比過去好多了—— 我很高興生活在今天。但我們對滿足這些 深層次的心理需求 越來越不擅長了。這并不是唯一的原因，但我認為是這場危機 不斷升級的關(guān)鍵原因。我發(fā)現(xiàn)這很難理解。我真的很糾結(jié)于這個想法： 把我的抑郁癥 從一個僅僅是我大腦中的問題，轉(zhuǎn)變成一個有很多 成因的問題，包括我們的生活方式。

04:35

And it only really began to fall into place for me when one day, I went to interview a South African psychiatrist named Dr. Derek Summerfield. He's a great guy. And Dr. Summerfield happened to be in Cambodia in 2001, when they first introduced chemical antidepressants for people in that country. And the local doctors, the Cambodians, had never heard of these drugs, so they were like, what are they? And he explained. And they said to him, "We don't need them, we've already got antidepressants." And he was like, "What do you mean?" He thought they were going to talk about some kind of herbal remedy, like St. John's Wort, ginkgo biloba, something like that. Instead, they told him a story.

直到有一天，我前去采訪一位 名叫德里克·薩莫菲爾德的 南非精神病醫(yī)生，我才真正明白了這一點。他是個很棒的人。2001年，薩莫菲爾德在柬埔寨，當時他們首次在那個國家 為人們引入化學(xué)抗抑郁藥。當?shù)氐募砥艺t(yī)生 從沒聽過這些藥物，所以，他們問“這些是什么？” 于是他解釋了。然后他們告訴他，“我們不需要它們，我們已經(jīng)有抗抑郁藥了。” 他問，“你指的是什么？” 他以為他們會談及某種草藥，比如圣約翰草，銀杏葉之類的。反之，他們告訴他一個故事。

05:15

There was a farmer in their community who worked in the rice fields. And one day, he stood on a land mine left over from the war with the United States, and he got his leg blown off. So they him an artificial leg, and after a while, he went back to work in the rice fields. But apparently, it's super painful to work under water when you've got an artificial limb, and I'm guessing it was pretty traumatic to go back and work in the field where he got blown up. The guy started to cry all day, he refused to get out of bed, he developed all the symptoms of classic depression. The Cambodian doctor said, "This is when we gave him an antidepressant." And Dr. Summerfield said, "What was it?" They explained that they went and sat with him. They listened to him. They realized that his pain made sense -- it was hard for him to see it in the throes of his depression, but actually, it had perfectly understandable causes in his life. One of the doctors, talking to the people in the community, figured, "You know, if we bought this guy a cow, he could become a dairy farmer, he wouldn't be in this position that was screwing him up so much, he wouldn't have to go and work in the rice fields." So they bought him a cow. Within a couple of weeks, his crying stopped, within a month, his depression was gone. They said to doctor Summerfield, "So you see, doctor, that cow, that was an antidepressant, that's what you mean, right?"

他們社區(qū)有個農(nóng)民在稻田里干活。有天，他踩到了 抗美戰(zhàn)爭時留下的地雷，他的腿被炸掉了。所以他們給他裝了一只假腿，不久之后他就回到稻田干活。但顯然，你帶著假腿 在水下干活非常痛疼，而且我猜他 回到腿被炸掉的地方干活 一定很痛苦。這個人開始整天哭泣，他拒絕下床，他出現(xiàn)了所有 典型的抑郁癥癥狀。柬埔寨醫(yī)生說，“就在這時 我們給他開了抗抑郁藥。” 薩莫菲爾德醫(yī)生問，“是什么藥？” 他們解釋說，他們過去跟他坐在一起。他們傾聽他。他們認識到他的痛苦合情合理—— 身處沮喪的陣痛中，他本人很難看出這一點，但確實，這是他生活中 完全可以理解的原因。其中一個醫(yī)生 和社區(qū)里的人交談，想到，“如果我們給這人買一頭奶牛，他就可以變成一個奶農(nóng)了，他就不會處在這種境地，把自己搞得如此狼狽了，他也不用去稻田里干活了?！?于是他們給他買了一頭奶牛。沒幾周，他停止了哭泣，不到1個月，他的抑郁癥消失了。他們跟薩莫菲爾德醫(yī)生說，“所以你看，醫(yī)生，那頭奶牛，就是抗抑郁藥，那是你說的藥吧？”

06:30

(Laughter)

（笑聲）

06:32

(Applause)

（掌聲）

06:35

If you'd been raised to think about depression the way I was, and most of the people here were, that sounds like a bad joke, right? "I went to my doctor for an antidepressant, she gave me a cow." But what those Cambodian doctors knew intuitively, based on this individual, unscientific anecdote, is what the leading medical body in the world, the World Health Organization, has been trying to tell us for years, based on the best scientific evidence.

如果你打小就和我一樣 思考抑郁癥，像座大多數(shù)人這樣，那聽起來像個冷笑話，對吧？ “我找醫(yī)生開抗抑郁藥，她給了我一頭奶牛?！?但那些柬埔寨人憑直覺就知道的、 基于這個個體的，不科學(xué)的軼事，是世界領(lǐng)先的醫(yī)療機構(gòu)，世界衛(wèi)生組織，多年來，基于最好的科學(xué)證據(jù)，一直試圖告訴我們的。

07:01

If you're depressed, if you're anxious, you're not weak, you're not crazy, you're not, in the main, a machine with broken parts. You're a human being with unmet needs. And it's just as important to think here about what those Cambodian doctors and the World Health Organization are not saying. They did not say to this farmer, "Hey, buddy, you need to pull yourself together. It's your job to figure out and fix this problem on your own." On the contrary, what they said is, "We're here as a group to pull together with you, so together, we can figure out and fix this problem." This is what every depressed person needs, and it's what every depressed person deserves.

如果你抑郁，如果你很焦慮，你不是脆弱，你沒有瘋，總的來說，你不是一個 零部件壞了的機器，你是個需求未被滿足的人。在這里，思考柬埔寨醫(yī)生說的 和世界衛(wèi)生組織沒說的同樣重要。他們沒跟這個農(nóng)民說，“嘿，伙計，你需要振作起來，你得自己解決和修復(fù)這個問題。” 相反，他們說的是，“我們作為一個團隊 來和你一起努力，所以一起，我們可以解決 和修復(fù)這個問題?！?這是每一個抑郁的人需要的，并且也是 每一個抑郁的人應(yīng)得的。

07:48

This is why one of the leading doctors at the United Nations, in their official statement for World Health Day, couple of years back in 2017, said we need to talk less about chemical imbalances and more about the imbalances in the way we live. Drugs give real relief to some people -- they gave relief to me for a while -- but precisely because this problem goes deeper than their biology, the solutions need to go much deeper, too.

這是為什么 有位聯(lián)合國的頂尖醫(yī)生，在2017年世界衛(wèi)生日的 官方宣言中寫到，我們要少談化學(xué)失衡，多談?wù)勎覀兩罘绞降氖Ш?。藥物對有些?有真正的緩解作用—— 它們對我有陣子也很有效—— 但因為這個問題 比他們的生物構(gòu)造更深入，解決方案也需要更為深入。

08:13

But when I first learned that, I remember thinking, "OK, I could see all the scientific evidence, I read a huge number of studies, I interviewed a huge number of the experts who were explaining this," but I kept thinking, "How can we possibly do that?" The things that are making us depressed are in most cases more complex than what was going on with this Cambodian farmer. Where do we even begin with that insight?

但當我第一次知道的時候，我記得我在想，“我能看到所有的科學(xué)證據(jù)，我閱讀了大量的研究，我采訪了很多專家來 解釋這一問題，” 但我一直在想，“我們怎么可能做到？” 讓我們抑郁的事情 在很多情況下比那個柬埔寨農(nóng)民 遠復(fù)雜得多。基于那個觀點，我們該從哪里下手呢？

08:35

But then, in the long journey for my book, all over the world, I kept meeting people who were doing exactly that, from Sydney, to San Francisco, to São Paulo. I kept meeting people who were understanding the deeper causes of depression and anxiety and, as groups, fixing them. Obviously, I can't tell you about all the amazing people I got to know and wrote about, or all of the nine causes of depression and anxiety that I learned about, because they won't let me give a 10-hour TED Talk -- you can complain about that to them.

然而后來，在我寫書的漫長旅途中，在全球旅行中，我不斷遇到正在那樣做的人，從悉尼，到舊金山，到圣保羅。我一直遇見理解引發(fā) 抑郁和焦慮深層原因的人，并且，作為群體，修復(fù)它們。顯然，我不能告訴你們 我認識和寫下的 所有這些讓人驚嘆的人，或者所有我所習(xí)得的引發(fā) 抑郁和焦慮的9個原因，因為他們不會讓我做一個 10小時的TED演講—— 你們可以向他們抱怨。

09:05

But I want to focus on two of the causes and two of the solutions that emerge from them, if that's alright. Here's the first. We are the loneliest society in human history. There was a recent study that asked Americans, "Do you feel like you're no longer close to anyone?" And 39 percent of people said that described them. "No longer close to anyone." In the international measurements of loneliness, Britain and the rest of Europe are just behind the US, in case anyone here is feeling smug.

但如果可以的話，我想聚焦在兩個原因，以及對應(yīng)的兩個解決方案。這是第一個。我們處于人類歷史上 最孤獨的社會。最近研究有一項研究，詢問美國人 “你感覺不再跟任何人親近了嗎？” 39%的人說這描述符合他們?！安辉俑魏稳擞H近。” 在國際孤獨測量評估中，英國和其他歐洲國家僅次于美國。以防這里有人沾沾自喜。

09:34

(Laughter)

（鼓掌）

09:35

I spent a lot of time discussing this with the leading expert in the world on loneliness, an incredible man named professor John Cacioppo, who was at Chicago, and I thought a lot about one question his work poses to us. Professor Cacioppo asked, "Why do we exist? Why are we here, why are we alive?" One key reason is that our ancestors on the savannas of Africa were really good at one thing. They weren't bigger than the animals they took down a lot of the time, they weren't faster than the animals they took down a lot of the time, but they were much better at banding together into groups and cooperating. This was our superpower as a species -- we band together, just like bees evolved to live in a hive, humans evolved to live in a tribe. And we are the first humans ever to disband our tribes. And it is making us feel awful. But it doesn't have to be this way.

我花了很多時間就孤獨問題 和世界一流的專家交流。一個非常優(yōu)秀的人，約翰·卡奇奧波教授，他在芝加哥，他的工作給我們提出了 一個問題，我想了很久。卡奇奧波教授問到，“我們?yōu)槭裁创嬖冢?我們?yōu)槭裁丛谶@兒，我們?yōu)槭裁椿钪?？?一個關(guān)鍵的原因在于 我們非洲大草原上的祖先 真的非常擅長一件事情。他們不比很多時候 他們放倒的動物高大，他們不比很多時候 他們放倒的動物跑得更快，但他們更擅長抱團 與協(xié)作。這是我們作為一個物種的超能力。我們聚集在一起，就像蜜蜂進化到住在蜂巢中一樣，人類進化到部落聚居。而我們是第一批 解散部落的人類。這讓我們感到糟糕。但事情不一定非得這樣。

10:29

One of the heroes in my book, and in fact, in my life, is a doctor named Sam Everington. He's a general practitioner in a poor part of East London, where I lived for many years. And Sam was really uncomfortable, because he had loads of patients coming to him with terrible depression and anxiety. And like me, he's not opposed to chemical antidepressants, he thinks they give some relief to some people. But he could see two things. Firstly, his patients were depressed and anxious a lot of the time for totally understandable reasons, like loneliness. And secondly, although the drugs were giving some relief to some people, for many people, they didn't solve the problem. The underlying problem. One day, Sam decided to pioneer a different approach. A woman came to his center, his medical center, called Lisa Cunningham. I got to know Lisa later. And Lisa had been shut away in her home with crippling depression and anxiety for seven years. And when she came to Sam's center, she was told, "Don't worry, we'll carry on giving you these drugs, but we're also going to prescribe something else. We're going to prescribe for you to come here to this center twice a week to meet with a group of other depressed and anxious people, not to talk about how miserable you are, but to figure out something meaningful you can all do together so you won't be lonely and you won't feel like life is pointless."

我書中，也是我生活中的一個英雄，是一個叫山姆·艾佛林頓的醫(yī)生。他是東倫敦貧民區(qū)的 一名全科醫(yī)生，我在那生活過好多年。山姆真的很不容易，因為很多病人 都帶著嚴重的抑郁和焦慮來找他。和我一樣，他不反對使用抗抑郁藥，他認為藥物對一些人有緩解作用。但他可以看到兩件事情。第一，他的病人很多時候 因為完全可以理解的理由 而抑郁和焦慮，比如說孤獨。第二，盡管藥物能給 部分人帶來一些緩解。對多數(shù)人而言，它們無法解決問題，根本性的問題。一天，山姆決定 開創(chuàng)一種不同的方法。一位女性來到他的醫(yī)療中心，她叫麗莎·坎寧安。我后來才認識的。麗莎因為嚴重的抑郁和焦慮 被隔離家中，長達7年。當她來到山姆的中心時，她被告知，“不要擔心，我們會繼續(xù)給你這些藥，但我們也會開一些其他東西。你需要每周來這個中心兩次，去見其他抑郁和焦慮的人們，不是來說你有多么不幸，而是找出一些你們可以 一起做的有意義的事情，這樣你就不會感到孤獨，或是生活沒有意義。

11:45

The first time this group met, Lisa literally started vomiting with anxiety, it was so overwhelming for her. But people rubbed her back, the group started talking, they were like, "What could we do?" These are inner-city, East London people like me, they didn't know anything about gardening. They were like, "Why don't we learn gardening?" There was an area behind the doctors' offices that was just scrubland. "Why don't we make this into a garden?" They started to take books out of the library, started to watch YouTube clips. They started to get their fingers in the soil. They started to learn the rhythms of the seasons. There's a lot of evidence that exposure to the natural world is a really powerful antidepressant. But they started to do something even more important. They started to form a tribe. They started to form a group. They started to care about each other. If one of them didn't show up, the others would go looking for them -- "Are you OK?" Help them figure out what was troubling them that day. The way Lisa put it to me, "As the garden began to bloom, we began to bloom."

這些人第一次見面時，麗莎焦慮到開始嘔吐，因為這對她而言壓力非常大。不過人們開始給她按摩，這群人開始聊天，“我們能做什么？” 這些都是和我一樣 住在倫敦東部貧民區(qū)的人，他們不懂園藝。“為什么我們不學(xué)習(xí)園藝呢？” 醫(yī)生辦公室后面有塊區(qū)域 是個灌木叢?！拔覀?yōu)槭裁床话阉?改造成花園呢？” 于是他們開始從圖書館借書，開始看YouTube視頻。他們開始把手伸進土里。他們開始學(xué)習(xí)四季的旋律。有大量的研究表明 接觸自然世界 是一種非常有效的抗抑郁藥。但他們開始做一些更重要的事情。他們開始形成部落。他們開始形成團隊。他們開始關(guān)心彼此。如果其中有個人沒出現(xiàn)，其他人會去尋找—— “你還好嗎？” 幫助他們解決 他們那天遇到的麻煩。就像麗莎向我說的，“隨著園中花朵的綻放，我們也開始綻放?！?/p>

12:45

This approach is called social prescribing, it's spreading all over Europe. And there's a small, but growing body of evidence suggesting it can produce real and meaningful falls in depression and anxiety.

這個方法被稱為社會處方，它正在整個歐洲蔓延。有一個小的，但不斷增長的證據(jù) 表明它可以真正且有意義地 緩解抑郁和焦慮。

12:56

And one day, I remember standing in the garden that Lisa and her once-depressed friends had built -- it's a really beautiful garden -- and having this thought, it's very much inspired by a guy called professor Hugh Mackay in Australia. I was thinking, so often when people feel down in this culture, what we say to them -- I'm sure everyone here said it, I have -- we say, "You just need to be you, be yourself." And I've realized, actually, what we should say to people is, "Don't be you. Don't be yourself. Be us, be we. Be part of a group."

有天，我記得站在這個 麗莎和她那些一度抑郁的 朋友建造的花園中—— 這真是個美麗的花園—— 我產(chǎn)生了這個想法，很大程度上受到 澳大利亞的休·麥凱教授的啟發(fā)。我在想，當人們 在這種文化中感到沮喪時，我們是怎么跟他們說的—— 我確信這里每個人這么說過，我也說過—— “你只要做自己，做你自己。” 我已經(jīng)意識到，其實，我們應(yīng)該跟人們說的是，“別自己一個人，不要做自己。做我們，我們一起。成為團隊的一員?！?/p>

13:30

(Applause)

（鼓掌）

13:34

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