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  • Actually, the main selection criterion for a TEDx talk

    事實上,你必須得有些瘋狂

  • is that you have to be slightly crazy.

    才能符合TED演講的主要評選標準

  • I distinctly remember that I wanted to say something important about it,

    我很清楚地記得,我當時想說一些很重要的事情

  • but I'm getting a little bit confused because ...

    但接下來我的思緒變得有點混亂,因為…

  • You, sir. I saw you touching your glasses just now,

    就是你,先生。我看見你正在碰觸你的眼鏡

  • whilst at the same time,

    同時

  • the lady over there was distinctly scratching her nose.

    那邊的那位小姐很明顯地正在抓她的鼻子

  • I saw you!

    我看見妳囉!

  • (Laughter)

    (觀眾的笑聲)

  • And there is something going on between the two of you, some sort of ...

    你們之間好像正在上演著甚麼事情,像是在…

  • (Laughter)

    (觀眾的笑聲)

  • communication.

    溝通

  • And I distinctly get the impression that you want to ruin my TED talk.

    接著,我很明顯地感受到你們試圖破壞我的TED演講

  • (Laughter)

    (觀眾的笑聲)

  • Is that true?

    這是真的嗎?

  • So, maybe some of you start to worry a little bit about my mental health.

    也許在你們之中,有些人開始有些擔憂我的身心健康狀況

  • Maybe after my TED talk,

    也許當我結束這場TED演講

  • you want to take me to the local hospital for a psychiatric assessment.

    你想帶我去當地的醫院,進行精神科的評估

  • Let's imagine, I tell the psychiatrist

    我們假設,我告訴精神科醫生

  • that apart from these delusional thoughts, I'm also hearing voices,

    我除了有這些妄想的念頭,我還會聽見聲音

  • and that I haven't been functioning very well for the last six months.

    而且過去六個月以來,我的身心狀況一直不是很好

  • By telling this, I will meet likely criteria

    經由我這麼一說,我可能得到的診斷結果

  • for one of these so-called "schizo" diagnoses.

    其中一項即是所謂的「精神分裂症患者」

  • Let's say I meet criteria for schizophrenia

    我們假設我的診斷結果就是「精神分裂症」

  • which is the prototypical diagnostic formulation for "madness."

    而它即是「瘋狂」的典型病症

  • Now, my family, by this time, will be notified of this diagnosis.

    此時,我的家人們被告知我的診斷結果

  • Since they don’t know what it is,

    由於他們不知道這是甚麼疾病

  • they will start looking on the Internet, what this condition actually is.

    他們會開始在網路上搜尋此疾病究竟是甚麼

  • They'll look in the most prestigious scientific journals,

    他們會閱讀最具權威性的科學期刊

  • and they find that I have a devastating genetic brain disease,

    然後發現我得了一種非常嚴重的腦部遺傳疾病

  • or a debilitating neurological disorder.

    或者是一種神經系統疾病

  • So now they start to be really worried,

    現在他們開始非常憂心

  • and they start looking for information about my likely prognosis.

    開始尋找關於我病情可能的預後推估

  • And they find that my prognosis is bad.

    然後他們發現我的預後並不樂觀

  • I am totally disabled for the remainder of my lifetime.

    完全喪失我人生剩餘時日的自主能力

  • Wow! That’s scary, isn’t it?

    天啊!聽起來很嚇人,可不是嗎?

  • But you will note, that there is nothing in this terminology

    但是你會發現,僅以這一個醫學術語

  • that actually allows them to understand what is the matter with me.

    無法使我的家人們真正地瞭解我究竟怎麼了

  • The information is disconnected from anything that we can understand

    我們完全無法理解此醫學術語所提供的資訊

  • as a mental function.

    與心理功能絲毫沒有連結

  • What is offered is a stereotype consisting of three things:

    這個醫學術語只呈現由以下三點所構成的既定印象:

  • a mystifying Greek name,

    一個令人困惑的希臘名詞

  • an unproven hypothesis of a genetic brain disease,

    一個沒有經過證實的假設:腦部遺傳疾病

  • and a hopeless view of outcome.

    以及沒有任何希望的後果

  • Meet my cousin, Elizabeth.

    我與我的表妹伊莉莎白見了面

  • Elizabeth completed two university studies and is a witty and compassionate person;

    我的表妹伊莉莎白完成了兩個學士學位,是一位非常風趣與富有同情心的人

  • quite unlike me.

    非常不像我

  • We were always close, and we both ended up in psychiatry.

    我們以前很親近,而且最終都走向精神病學之路

  • However, me, as a psychiatrist, and she, as a patient.

    差別只在於我是精神科醫生,而她是病患

  • And over the last 15 years, she has worked very hard at her recovery,

    過去15年以來,她很努力地進行復健療程

  • taking her medications, accepting numeral hospital admissions,

    服用藥物、在許多醫院進行評估

  • and receiving a range of psychiatric diagnoses,

    收到不同類型的精神疾病診斷報告

  • including several of the schizo diagnoses.

    其中包含一些精神分裂症的診斷報告

  • And then, five years ago, there was this great moment,

    接著,五年前,發生了一件振奮人心的事情

  • because she applied for a job and was accepted.

    因為她應徵了一個職缺,而且得到了這份工作

  • But, when her employer found out about her diagnosis,

    但是,當她的雇主知道關於她的診斷報告

  • he immediately tried to dismiss her.

    他立即嘗試解雇她

  • And when he found out he couldn’t,

    當他發現他無法這麼做

  • she was forced to disclose her diagnosis to the entire office.

    她被強迫將自己的診斷報告公開至整個辦公室

  • Nobody initially wanted to work with her.

    起初沒有人願意與她共事

  • But now, five years later, she has an exemplary work record.

    但是現在,五年過後,她的工作表現優異

  • But because of the extremely negative expectations associated with psychosis,

    因為人們將極端負面的預想與精神疾病聯想在一起

  • diagnosed people face an uphill struggle.

    被診斷出患有精神疾病的人們處境非常艱難

  • A very few end up in paid employment.

    僅有非常少數的精神疾病患者爭取到有薪工作

  • So, why do I tell you this?

    那麼,為何我要告訴你們這件事情呢?

  • Well, psychosis, schizophrenia,

    精神疾病、精神分裂症

  • these are conditions that typically start in adolescence.

    這些病症通常始於青春期

  • There is widespread consensus that in order to recover from psychosis,

    如果想治癒精神疾病,我們需要有一個廣泛共識

  • you need a perspective of hope, a possibility to change.

    你必須以一個抱有希望的觀點看待此事、相信改變的可能性

  • And I think it is clear that the concept or the stereotype of psychosis

    我相信,如同我剛剛所描述的,大眾對於精神疾病的概念與既定印象

  • as represented,

    已經非常的清楚

  • is devoid of exactly thatof hope and change.

    正是缺少希望與改變

  • So, can we do better?

    那麼,我們可以做些甚麼來改善這件事呢?

  • Well, a bunch of people got together,

    那就是將一群人聚集起來

  • and this was really a mixed group of patients, professionals, relatives,

    由患者、專業人士與親戚們所組成的一群人

  • and we asked ourselves the question: what do we really know about psychosis?

    接著,我們捫心自問:我們對於精神疾病真正了解了多少?

  • Is schizophrenia really best represented as this stereotype

    對於精神分裂症最貼切的解釋

  • of a devastating genetic brain disease?

    真的是既定印象中的無可救藥的腦部遺傳疾病?

  • Or is schizophrenia perhaps something

    又或者,精神分裂症

  • that is connected to a human mental function,

    與人類的心理功能有關

  • just like disorders of anxiety and depression

    就像是焦慮症或是憂鬱症

  • are connected to human emotion?

    跟人類的情緒有所關聯?

  • And if it is connected, can we reach young people

    如果有所關聯,我們可否接觸這些年輕人

  • to give them a message of hope and change?

    給予他們希望與改變的可能性?

  • So, to cut a long story short, let’s have a look at what we came up with.

    那麼我長話短說,來看看我們提出的想法

  • (Video) Psychosis experiences, everybody has them, and so do you.

    (觀看影片)精神疾病的經驗,每個人都有,你也是

  • Throughout the day, we are exposed to stimuli

    一整天下來,我們接觸到的刺激

  • that we hear, see, taste, feel and smell.

    來自聽覺、視覺、味覺、觸覺與嗅覺的刺激

  • Our brain helps us to transform this information

    我們的大腦幫助我們處理這些訊息

  • into an image of the surrounding world.

    將它們轉變為周遭環境的意象

  • In other words, we translate external sensory information from our environment

    換句話說,我們將來自周遭的外部感官感覺訊息

  • into an internal mental experience.

    轉化至內部心理經驗

  • Sensory translations are highly personal.

    感官感覺的轉化非常主觀

  • For example, two people are walking through the woods at night.

    舉例來說,兩個人在黑夜中穿越樹林

  • One watched a violent horror film earlier that evening, whereas the other did not.

    其中一人在傍晚時曾看過暴力恐怖片,另一人則沒有看那部影片

  • As a result, one hears and sees rather different things compared to the other.

    如此一來,兩個人聽見與看見的事物則有所差異

  • This is because powerful negative emotions, occasioned by the film,

    這是因為那部影片所產生的強烈負面情緒

  • distort a person's interpretation of sensory perception.

    扭曲了一個人對於感官感覺的解讀方式

  • One can say, therefore, that this person is experiencing a mild psychotic event.

    也可以說這個人正經歷一件輕微的精神疾病事件

  • Childhood adversities, cannabis use, and genetic factors

    童年遭遇的不幸、吸食大麻與基因遺傳因素

  • can trigger negative interpretations.

    皆可能引發一個人以負面的方式解讀感官感覺

  • This can cause you to feel that the world is full of threats.

    這可能使你感覺世界充滿了威脅

  • For example, you may start thinking that you are being stalked,

    舉例來說,你可能開始認為有人正在跟蹤你

  • or that people on TV are talking about you.

    或者電視上的人們正在討論你

  • Such ways of thinking are called delusions.

    諸如此類的想法,被稱為妄想

  • You may also misinterpret your inner mental processes.

    你可能還會誤解你內部的心理歷程

  • For example, your thoughts can be so overpowering

    舉例來說,你的想法可能會過於強烈

  • that you interpret them as external voices, or visions.

    而你將這些想法解讀為外部的聲音或幻象

  • As a result, you may hear voices or see things that are not really there.

    如此一來,你還可能會聽見不存在的聲音或看見不存在的事物

  • These experiences are called hallucinations.

    這種經驗被稱為幻覺與幻聽

  • If perception of external environments or inner thoughts become psychotic,

    如果無法分辨外部環境的感官感覺與內部的想法

  • it is possible, with help, to learn how to modify this.

    可藉由其他人事物的幫助下,學習如何改正它

  • It's a learning process that many people with psychotic symptoms find profitable.

    許多具有精神疾病症狀的患者發現,這是一種有益的學習方法

  • PsychoseNet tries to facilitate this process.

    PsychoseNet試著促進此種學習方法

  • (Video ends)

    (影片結束)

  • (On-stage) Jim van Os: Do you notice the difference

    (演講者)Jim van Os:你注意到影片當中

  • with the presentation of the schizophrenia stereotype?

    與大眾對於精神分裂病症的既定印象的差異了嗎?

  • Yet, this is what science suggests psychosis is about.

    這就是科學對於精神疾病所提出的論點

  • There are four important points of difference here:

    有四個不同的論點:

  • What is psychosis? What is the role of the brain?

    什麼是精神疾病?大腦扮演著甚麼角色?

  • What is the role of genes? And what is the prognosis of psychosis?

    基因扮演著甚麼角色?以及精神疾病的預後是甚麼?

  • Psychosis is about, what you could say, hyper meaning.

    精神疾病是關於甚麼呢?可以說是過度解讀

  • It is about that we sometimes attach too much meaning

    我們有時對於外部環境

  • to the external environment.

    附加了過多的解讀與含義

  • And seeing signals in random noise is actually quite human.

    在雜亂無章的噪音當中取得一些訊息,其實是相當自然的

  • So, experiences of hyper meaning are quite common.

    因此,過度解讀的經驗也相當常見

  • Think about being madly in love

    想想瘋狂地墜入愛河

  • or being madly worried that your love is unfaithful,

    或者過度憂慮你的另一伴不忠誠

  • or seeing a face in the dark.

    又或者看見一張臉孔出現在黑暗之中

  • Actually, 30% of the general population,

    事實上,當人們被詢問是否有精神疾病的經驗

  • when asked, will admit to having had one or more psychotic experiences.

    有30%的人們會承認至少有過1次或者多次這種經驗

  • Things like hearing voices or seeing things, mind reading,

    像是聽見聲音、看見某些事物、讀心

  • thought broadcasting, having special powers.

    認為被惡意散播或者擁有特異功能等等

  • Low level, mild, but still all the things that are the hallmark of psychosis.

    即使是中低程度的精神疾病經驗,這些經驗依然都具有精神疾病的特點

  • Thirty percent!

    30%的人們都有過這些經驗!

  • So, I want you to look at the person on your left,

    現在,我要你看看你左邊的人

  • and then look at the person on your right.

    再看看你右邊的人

  • And if it's not them ...

    如果他們不是那30%

  • it is you!

    就是你!

  • (Laughter)

    (觀眾的笑聲)

  • This is not to say that the brain is not important;

    這並不意味著大腦不重要

  • the brain is very important.

    大腦非常的重要

  • But it is like learning a language.

    但是就像是學習一個語言

  • The brain provides us with the biological capacity to acquire speech.

    大腦發展出說話的能力,使我們得以說話

  • But it is the early environment that programs this capacity

    但這是因應早期環境所發展出的能力

  • so that we speak Chinese, English, French, or Dutch.

    這也是為何我們能夠說中文、英文、法文或者荷蘭語

  • And it's the same with psychosis.

    跟精神疾病之所以會發生的情況相同

  • The brain provides us with the biological capacity

    大腦提供我們獲得心理經驗的能力

  • to have mental experiences in the first place.

    使我們從一開始就擁有心理經驗

  • But it is the environment that can program this capacity

    問題在於,環境的因素造成此能力在發展的過程之中

  • towards psychotic modes of thinking.

    朝向以具有精神疾病症狀的方式思考

  • People growing up in circumstances of childhood trauma,

    如果人們的成長中曾經歷童年創傷

  • unsafety, or extreme exclusion,

    感到不安或者曾被嚴重地排擠的經驗

  • have a higher risk of developing psychotic symptoms.

    發展出精神疾病症狀的風險較高

  • This is because these environments can program our thinking

    這是因為此類環境會使我們的思考邏輯

  • towards the formation of psychotic symptoms.

    朝向具有精神疾病症狀的方式發展

  • Genes do play a role, genetic factors are important,

    基因也是其中因素之一,基因的因素至關重要

  • but their role is not nearly as dominant or as specific as is often portrayed.

    但是基因並非主導因素,或像是它經常被描述般的如此特定

  • And, importantly, genes may act in ways that are complementary to the environment,

    最重要的是,基因很有可能為了配合周遭環境,做出相應的反應

  • by making people more or less sensitive to the environments that cause psychosis.

    調整人們對於周遭可能會引起精神疾病症狀的事物的敏感度

  • And, with regard to the outcome, some people with psychotic symptoms

    確實,有些精神疾病患者的案例

  • have a very severe illness and very poor prognosis.

    情況非常嚴重,預後推估極為悲觀

  • But, this is a minority.

    但這只佔少數

  • There are also people with schizophrenia, who show complete recovery.

    還是有精神分裂症患者完全痊癒的案例

  • And, between those two extremes is a wide spectrum of variation.

    而介於此兩種極端案例之間的中間範圍,則涵蓋廣泛的可能性

  • In fact, extreme variation is the rule.

    事實上,任何情況都是有可能的

  • The notion of extremely uniform poor outcome is a myth.

    對於預後抱持極端負面態度是完全沒有根據的

  • Psychosis is something that varies from day to day,

    因為精神疾病是一種每天持續變化的疾病

  • even from moment to moment within a day.

    甚至一天之中的任何時刻都會改變

  • It is capturing this dynamic variation

    就像是為了應對動態變化的環境與情緒

  • in response to the environment and the emotions

    而做出的相應變化

  • that is key to treatment and diagnosis.

    這就是治療方法與診斷報告中的關鍵參考依據

  • So, if psychosis is all about hyper meaning varying during the day

    如果精神疾病就是一天當中,為了應對環境與情緒

  • in response to environment and emotions,

    所做出的過度解讀

  • a remarkable opportunity presents itself.

    那麼一個令人驚奇的機會也出現了

  • And this is because we can now diagnose psychosis

    因為現在我們可以依照精神疾病本身的程度

  • at the level of the experience itself,

    來診斷它

  • in such a way, that it becomes the first step towards treatment,

    如此一來,這即是進行療程的第一步

  • without a need to invoke the scary schizo labels.

    而不需要被貼上令人害怕的精神分裂症患者的標籤

  • And since young people are well versed in technology,

    再者,年輕人現今已經非常熟悉如何應用科技

  • why not use technology to empower them

    為何不利用科技的力量來幫助他們

  • to monitor their experiences themselves,

    監控他們自身的經歷

  • so that they can gain an insight and get a grip?

    如此一來,他們能夠深入了解自己,而且適時控制自己?

  • To this end, our group developed this simple mobile app.

    為了實踐這個想法,我們團隊研發了這個簡單的手機軟體

  • Its purpose is to allow people

    它的目的

  • to monitor their mental states and experiences in daily life,

    是讓人們能夠在日常生活當中,監測自己的心理狀態與經歷的心理經驗

  • feeding that information back to them, so that they can learn and cope.

    手機軟體會將訊息反饋給使用者,如此一來就能夠學習如何應對

  • So, this app actually works as follows.

    這個手機軟體的運作方式就是

  • At multiple random moments during the day, the app gives off a signal,

    在一天當中,此手機軟體會在多次隨機的時間點發出通知

  • and each time there is a signal, people are asked to input information,

    每一次發出通知,使用者都會被要求輸入訊息

  • less than two minutes.

    完成訊息輸入的時間不超過兩分鐘

  • Information about emotions, thoughts, context, and activities.

    訊息包含使用者的情緒、想法、所處的環境與參與的活動

  • With this information,

    有了這些訊息

  • patterns of vulnerability and resilience can actually be made visible.

    受影響的程度與適應度即可被量化為可觀察的資料

  • People then have access to the experiences of hyper meaning

    使用者能夠了解他們所經歷的過度解讀經驗

  • as they evolve in the flow of daily life, in response to emotions and environments,

    發生於日常生活當中,為了對應環境與情緒下所做出的過度解讀

  • allowing them to actually understand what is going on,

    使他們明白到底發生了甚麼事

  • and allowing them to develop better ways of coping.

    也使他們學習以更好的方式解讀這些訊息

  • In clinical practice, we find this works very well,

    在臨床實驗中,我們發現這個方法非常可行

  • particularly with people in the early stages of psychosis.

    尤其是正經歷初期精神疾病階段的患者

  • So, where does all this leave us then?

    那麼,這些訊息留給了我們甚麼呢?

  • Well, today is about reaching the impossible.

    就是將不可能變為可能

  • I think it is, in fact, much simpler.

    事實上,我認為這做起來並不困難

  • I think that nothing stands in our way

    我認為沒有任何事物阻礙著我們

  • to make today the first day we can all feel connected to psychosis,

    讓今天成為我們對精神疾病盡一份心力的第一天

  • because it is all a question of perception.

    因為這只是一個攸關感官感覺的問題

  • When we see a person with psychotic symptoms

    當我們看見一個人顯現出精神疾病的症狀

  • we can with a little effort, information, and particularly education,

    我們只需付出少許的努力、接受特定的教育宣導

  • not see the stereotype of a devastating brain disease,

    以及忽視那些認為精神疾病是嚴重的腦部遺傳疾病的既定印象

  • but instead see a person who's struggling with the way we attach meaning

    以另一種觀點看待精神疾病這件事,是一個人正苦惱該如何解讀

  • to the internal and external environment.

    來自內部與外部環境的訊息

  • And this is sometimes a difficult and painful process,

    有時這是一段艱難與痛苦的過程

  • but we are all experts.

    但是現在的我們都已經非常瞭解它了

  • Thank you.

    感謝您蒞臨此場演講

  • (Applause)

    (掌聲)

Actually, the main selection criterion for a TEDx talk

事實上,你必須得有些瘋狂

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B1 中級 中文 疾病 精神 解讀 診斷 經驗 訊息

【TEDx】一窺精神疾病的面貌 (Connecting to Madness | Jim van Os | TEDxMaastricht)

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    郭宇舜   發佈於 2017 年 01 月 22 日
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