Placeholder Image

字幕列表 影片播放

  • What does it mean to be normal?

    譯者: Lilian Chiu 審譯者: Helen Chang

  • And what does it mean to be sick?

    正常是什麼意思?

  • I've asked myself this question from the time I was about seven,

    生病又是什麼意思?

  • when I was diagnosed with Tourette syndrome.

    我從七歲開始, 就在問我自己這個問題,

  • Tourette's is a neurological disorder

    那時我被診斷出妥瑞氏症。

  • characterized by stereotyped movements I perform against my will, called tics.

    妥瑞氏症是一種神經性失調,

  • Now, tics are technically involuntary,

    特徵就是我非刻意 也會做出刻板的動作,

  • in the sense that they occur without any conscious attention

    稱為抽搐。

  • or intention on my part.

    技術上來說,抽搐並不是自願的,

  • But there's a funny thing about how I experience tics.

    也就是,抽搐發生時

  • They feel more unvoluntary than involuntary,

    我並不會意識到, 我也沒有意圖要這麼做。

  • because I still feel like it's me moving my shoulder,

    但我對於抽搐的體驗 有一點十分有趣。

  • not some external force.

    覺得比較像是不由自主 而不是無意識的,

  • Also, I get this uncomfortable sensation, called premonitory urge,

    因為我仍然感覺得到我在動肩膀,

  • right before tics happen,

    並不是外力造成的。

  • and particularly when I'm trying to resist them.

    此外,就在抽搐發生之前,

  • Now, I imagine most of you out there understand what I'm saying,

    我會有一種不舒服的感覺, 叫做前驅性衝動,

  • but unless you have Tourette's, you probably think you can't relate.

    特別是當我試圖抗拒時。

  • But I bet you can.

    我相信在座大部分的人 都懂我所說的,

  • So, let's try a little experiment here and see if I can give you

    但除非你也有妥瑞氏症, 不然你可能會認為你無法體會。

  • a taste of what my experience feels like.

    但我敢說你可以。

  • Alright, ready?

    咱們來做個小實驗,看看我能否

  • Don't blink.

    讓各位嚐到我的體驗是什麼滋味。

  • No, really, don't blink.

    準備好了嗎?

  • And besides dry eyes, what do you feel?

    別眨眼。說真的,不要眨眼。

  • Phantom pressure?

    除了眼睛很乾之外, 你還感覺到什麼?

  • Eyelids tingling?

    不知哪來的壓力?

  • A need?

    眼瞼刺痛?

  • Are you holding your breath?

    有需求?

  • (Laughter)

    你有在憋氣嗎?

  • Aha.

    (笑聲)

  • (Laughter)

    啊哈。

  • That's approximately what my tics feels like.

    (笑聲)

  • Now, tics and blinking, neurologically speaking, are not the same,

    我的抽搐大約就是這種感覺。

  • but my point is that you don't have to have Tourette's

    就神經學上來說, 抽搐和眨眼是不一樣的,

  • to be able to relate to my experience of my premonitory urges,

    但我的重點是, 你不用得妥瑞氏症,

  • because your brain can give you similar experiences and feelings.

    也能夠感受我的前驅性衝動體驗,

  • So, let's shift the conversation from what it means to be normal versus sick

    因為你的大腦會給你 類似的體驗和感覺。

  • to what it means that a majority of us are both normal and sick.

    咱們把話題從 「正常和生病是什麼意思」

  • Because in the final analysis, we're all humans

    轉到「我們大部分人 既正常又生病是什麼意思」。

  • whose brains provide for a spectrum of experiences.

    因為到頭來,我們都是

  • And everything on that spectrum of human experiences

    大腦提供經驗光譜的人類。

  • is ultimately produced by brain systems

    在人類經驗光譜上的一切

  • that assume a spectrum of different states.

    最終都是由大腦系統所產生,

  • So again, what does it mean to be normal,

    這些系統假設存在不同狀態的光譜。

  • and what does it mean to be sick,

    倘若生病位於正常光譜的最尾端,

  • when sickness exists on the extreme end of a spectrum of normal?

    那麼正常是什麼意思,

  • As both a researcher who studies differences in how individuals' brains

    生病又是什麼意思呢?

  • wire and rewire themselves,

    身為研究者,我研究個人的大腦

  • and as a Touretter with other related diagnoses,

    在自我串接和重新串接上的差異。

  • I have long been fascinated by failures of self-regulation

    同時我也是個妥瑞氏症患者, 具有其他相關的診斷結果。

  • on the impulsive and compulsive behavioral spectrums.

    我一直都很著迷於

  • Because so much of my own experience of my own body

    衝動性和強迫性行為光譜的 自我調節失靈。

  • and my own behavior

    因為我對於我自己身體 及自己行為的經驗當中,

  • has existed all over that map.

    有好大一部分都在 那地圖上處處可見。

  • So with the spotlight on the opioid crisis,

    所以,當大家聚焦於 鴉片類藥物的危機上時,

  • I've really found myself wondering lately:

    我發現自己在納悶:

  • Where on the spectrum of unvoluntary behavior

    要把濫用類鴉片止痛藥物或海洛英

  • do we put something like abusing opioid painkillers or heroin?

    放在不由自主行為光譜上的哪裡?

  • By now, we all know that the opioid crisis and epidemic is out of control.

    目前,我們都知道類鴉片藥物的 危機和流行已經失控了。

  • Ninety-one people die every day in this country from overdose.

    在這個國家裡,每天就有 91 人 因為用藥過量而死。

  • And between 2002 and 2015,

    在 2002 年到 2015 年之間,

  • the number of deaths from heroin increased by a factor of six.

    因為海洛英而死的 人數增加了六倍。

  • And something about the way that we treat addiction isn't working,

    我們治療成癮的方式似乎無效,

  • at least not for everyone.

    至少不是人人都有效。

  • It is a fact that people suffering from addiction

    事實就是,飽受成癮之苦的人

  • have lost free will

    已失去自由意志,

  • when it comes to their behavior around drugs, alcohol, food

    無法控制他們與藥物、

  • or other reward-system stimulating behaviors.

    酒精、食物相關的行為,

  • That addiction is a brain-based disease state

    或其他由報償系統所刺激的行為。

  • is a medical, neurobiological reality.

    成癮是以大腦為基礎的 一種疾病狀態,

  • But how we relate to that disease --

    在醫學和神經生物學上, 這都是現實。

  • indeed, how we relate to the concept of disease when it comes to addiction --

    但我們如何看待那疾病——

  • makes an enormous difference for how we treat people with addictions.

    的確,涉及成癮與疾病相關的概念

  • So, we tend to think of pretty much everything we do as entirely voluntary.

    會使我們治療成癮者的方式大大不同。

  • But it turns out that the brain's default state

    我們傾向於認為我們 所做的一切都是自願的。

  • is really more like a car idling in drive than a car in park.

    但結果發現大腦的預設狀態

  • Some of what we think we choose to do

    其實比較像是空轉的汽車,

  • is actually things that we have become programmed to do

    而不是關掉引擎的汽車。

  • when the brakes are released.

    有些我們認為是自己選擇去做的行為,

  • Have you ever joked that your brain was running on autopilot?

    其實是鬆開煞車後

  • Guess what?

    我們的內建機制讓我們去做的。

  • It probably was.

    你是否曾開玩笑說 你的大腦在「自動駕駛」?

  • OK?

    你猜怎樣?很可能是真的。

  • And the brain's autopilot is in a structure called the striatum.

    好嗎?

  • So the striatum detects emotional and sensory motor conditions

    大腦的自動駕駛是在 所謂的紋狀體結構中。

  • and it knows to trigger whatever behavior you have done most often

    紋狀體會偵測

  • in the past under those same conditions.

    情緒和感覺運動的狀態,

  • Do you know why I became a neuroscientist?

    它知道要觸發你過去

  • Because I wanted to learn what made me tick.

    在同樣的條件下最常做的行為。

  • (Laughter)

    你們知道我為什麼 會成為神經科學家嗎?

  • Thank you, thank you.

    因為我想了解是什麼讓我 做出行為(音同「抽搐」)。

  • (Laughter)

    (笑聲)

  • I've been wanting to use that one in front of an audience for years.

    謝謝,謝謝。(笑聲)

  • (Applause)

    多年來我一直想找機會 在觀眾面前用這個梗。

  • So in graduate school, I studied genetic factors

    (掌聲)

  • that orchestrate wiring to the striatum during development.

    在研究所時,我學的是基因因子

  • And yes, that is my former license plate.

    在發展過程中負責安排 紋狀體串接的因子。

  • (Laughter)

    是的,那是我之前的 車牌(紋狀體)。

  • And for the record, I don't recommend

    (笑聲)

  • any PhD student get a license plate with their thesis topic printed on it,

    鄭重聲明,我並不建議

  • unless they're prepared for their experiments not to work

    任何博士生選取和他們 論文題目一樣的車牌,

  • for the next two years.

    除非他們已準備好接受自己的 實驗在接下來的兩年都不會成功。

  • (Laughter)

    (笑聲)我最終還是找出方法了。

  • I eventually did figure it out.

    我的實驗是要探討

  • So, my experiments were exploring how miswiring in the striatum

    紋狀體的錯誤串接 和強迫行為的關係。

  • relates to compulsive behaviors.

    意思就是,被你無法 有意識地抗拒的

  • Meaning, behaviors that are coerced

    不舒服衝動所強制造成的行為。

  • by uncomfortable urges you can't consciously resist.

    所以,我真的很興奮 看見我的小鼠發展出

  • So I was really excited when my mice developed

    這種強迫行為, 牠們一直在磨擦自己的臉,

  • this compulsive behavior,

    甚至弄傷自己似乎仍停止不了。

  • where they were rubbing their faces and they couldn't seem to stop,

    好吧,不該用興奮這個詞,

  • even when they were wounding themselves.

    我其實為牠們感到很難過。

  • OK, excited is the wrong word,

    我以為牠們抽搐,也就是 有紋狀體發生串接錯誤的證據。

  • I actually felt terrible for them.

    牠們是強迫性的,

  • I thought that they had tics, evidence of striatal miswiring.

    但結果,進一步的測試發現,

  • And they were compulsive,

    這些小鼠對於和其他 不熟悉的小鼠進行互動

  • but it turned out, on further testing,

    或是去認識牠們產生出反感現象。

  • that these mice showed an aversion to interacting

    這很不尋常,這是我們未預期的。

  • and getting to know other unfamiliar mice.

    這些結果意味著

  • Which was unusual, it was unexpected.

    肯定和強迫性光譜失調 有所關聯的紋狀體

  • The results implied that the striatum,

    也會影響人類的社會連結 以及我們的能力——

  • which, for sure, is involved in compulsive-spectrum disorders,

    不是人類的社會連結, 而是我們去連結的能力。

  • is also involved in human social connection and our ability to --

    所以我再深入鑽研,

  • not human social connection, but our ability to connect.

    進入到所謂社會神經科學的領域。

  • So I delved deeper,

    那是一個更新的跨學科領域,

  • into a field called social neuroscience.

    在那裡,我找到了 和紋狀體有關的報告,

  • And that is a newer, interdisciplinary field,

    不只是和小鼠的社交異常有關,

  • and there I found reports that linked the striatum

    也和人有關。

  • not just to social anomalies in mice,

    結果發現,

  • but also in people.

    在紋狀體中的社交神經化學

  • As it turns out, the social neurochemistry in the striatum

    和一些你可能已經 聽過的東西有關。

  • is linked to things you've probably already heard of.

    比如催產素,它是一種荷爾蒙,

  • Like oxytocin,

    會讓擁抱感覺起來很溫暖和柔軟。

  • which is that hormone that makes cuddling feel all warm and fuzzy.

    但這也意味著對鴉片類 藥物的接受器發出訊號。

  • But it also implicates signaling at opioid receptors.

    在你的大腦中有天然 產生的鴉片類藥物,

  • There are naturally occurring opioids in your brain

    它們和社交過程有很深的關聯性。

  • that are deeply linked to social processes.

    鈉洛酮會阻斷鴉片類藥物的 接受器,而鈉洛酮的實驗顯示

  • Experiments with naloxone, which blocks opioid receptors,

    鴉片類藥物的接受器的訊號發送

  • show us just how essential this opioid-receptor signaling is

    對於社交互動而言有多重要。

  • to social interaction.

    當對人施用鈉洛酮——它是 鹽酸烯丙羥嗎啡酮的一種成分,

  • When people are given naloxone -- it's an ingredient in Narcan,

    能逆轉鴉片類藥物過量, 以拯救性命。

  • that reverses opioid overdoses to save lives.

    但給健康的人施用時,

  • But when it's given to healthy people,

    它會干預他們感受自己和已相識

  • it actually interfered with their ability to feel connected

    且在乎的人有所連結的能力。

  • to people they already knew and cared about.

    所以,若無法和鴉片類 藥物的接受器連結,

  • So, something about not having opioid-receptor binding

    就會出於某種原因,

  • makes it difficult for us to feel the rewards of social interaction.

    讓我們很難感覺到 社交互動帶來的報償。

  • Now, for the interest of time,

    基於時間考量,我必須 省略一些科學細節,

  • I've necessarily gotten rid of some of the scientific details,

    但簡短來說,這是我們目前的進度。

  • but briefly, here's where we're at.

    鴉片類藥物接受器的 社會連結斷絕造成的效應、

  • The effects of social disconnection through opioid receptors,

    成癮性藥物的效應,

  • the effects of addictive drugs

    以及異常神經傳遞的效應,

  • and the effects of abnormal neurotransmission

    它們對於非自願性動作 和強迫行為的影響

  • on involuntary movements and compulsive behaviors

    都會合在紋狀體當中。

  • all converge in the striatum.

    而紋狀體以及紋狀體中的 鴉片類藥物訊號

  • And the striatum and opioid signaling in it

    和寂寞有很深的關聯性。

  • has been deeply linked with loneliness.

    若沒有足夠的訊號傳送到 鴉片類藥物的接受器,

  • When we don't have enough signaling at opioid receptors,

    即使在一間房間中滿滿都是 我們在乎的人、愛的人,

  • we can feel alone in a room full of people we care about and love, who love us.

    同時也愛我們的人, 我們仍會感到孤獨。

  • Social neuroscientists, like Dr. Cacioppo at the University of Chicago,

    社會神經科學家,比如 芝加哥大學的卡奇奧波,

  • have discovered that loneliness is very dangerous.

    發現寂寞是非常危險的。

  • And it predisposes people

    它會讓人傾向

  • to entire spectrums of physical and mental illnesses.

    全部的光譜都是身體和心理疾病。

  • Think of it like this: when you're at your hungriest,

    可以這樣想: 當你在最飢餓的時候,

  • pretty much any food tastes amazing, right?

    幾乎任何食物吃起來 都是美味,對吧?

  • So similarly, loneliness creates a hunger in the brain

    同樣的,寂寞會 在大腦中創造出飢餓,

  • which neurochemically hypersensitizes our reward system.

    它會以神經化學的方式 將我們的報償系統做超增感。

  • And social isolation acts through receptors

    而社會孤立會 透過接受器而產生影響,

  • for these naturally occurring opioids and other social neurotransmitters

    讓這些自然產生的鴉片類藥物 和其他社交神經傳遞質

  • to leave the striatum in a state

    造成紋狀體進入一種狀態,

  • where its response to things that signal reward and pleasure

    它對於發送報償和愉悅訊號的事物

  • is completely, completely over the top.

    會做出完全過火的反應。

  • And in this state of hypersensitivity,

    在這種超增感的狀態中,

  • our brains signal deep dissatisfaction.

    我們的大腦會發出深深不滿的訊號。

  • We become restless, irritable and impulsive.

    我們會變得焦躁不安、 易怒,且容易衝動。

  • And that's pretty much when I want you to keep the bowl of Halloween chocolate

    那時我大概就會請你們把房間中 整碗萬聖節巧克力都留給我,

  • entirely across the room for me, because I will eat it all.

    因為我會把它們全部吃光。我會的。

  • I will.

    這就帶出了另一樣東西,

  • And that brings up another thing that makes social disconnection

    會讓社會連結斷絕變得很危險。

  • so dangerous.

    如果我們沒有建立社會連結的能力,

  • If we don't have the ability to connect socially,

    我們會非常渴望我們的社交 神經化學能夠被重新平衡,

  • we are so ravenous for our social neurochemistry to be rebalanced,

    以致於我們很可能會 從其他地方尋求出口。

  • we're likely to seek relief from anywhere.

    如果那「其他地方」是

  • And if that anywhere is opioid painkillers or heroin,

    鴉片類止痛藥物或海洛英,

  • it is going to be a heat-seeking missile for our social reward system.

    它會是我們社交報償系統的

  • Is it any wonder people in today's world are becoming addicted so easily?

    導熱飛彈。

  • Social isolation --

    有沒有人納悶

  • excuse me --

    為什麼現今世界上的人 這麼容易上癮?

  • contributes to relapse.

    社會孤立——

  • Studies have shown that people who tend to avoid relapse

    抱歉——

  • tend to be people who have broad, reciprocal social relationships

    會造成復發。

  • where they can be of service to each other,

    研究指出,比較能夠避免復發的人,

  • where they can be helpful.

    通常擁有廣闊且對等的社交關係,

  • Being of service lets people connect.

    在這些關係中,他們能互相幫忙,

  • So --

    能有所貢獻就會讓人連結。

  • if we don't have the ability to authentically connect,

    所以——

  • our society increasingly lacks this ability to authentically connect

    如果我們沒有進行真實連結的能力,

  • and experience things that are transcendent and beyond ourselves.

    我們的社會越來越缺乏 這種建立真實連結的能力,

  • We used to get this transcendence

    越來越缺乏體驗超越己身 卓越事物的能力。

  • from a feeling of belonging to our families and our communities.

    我們以前會從所屬家庭和社區的 歸屬感來得到這種超越。

  • But everywhere, communities are changing.

    但,不論在哪裡,社區都在改變。

  • And social and economic disintegration is making this harder and harder.

    而社會和經濟的崩解

  • I'm not the only person to point out

    讓它越來越困難。

  • that the areas in the country most economically hard hit,

    除了我以外還有其他人也指出,

  • where people feel most desolate about their life's meaning,

    在這個國家中最受到 經濟影響的區域,

  • are also the places

    這裡的人對於自己 生命的意義最感到淒涼,

  • where there have been communities most ravaged by opioids.

    這些區域正好也是

  • Social isolation acts through the brain's reward system

    受到鴉片類藥物蹂躪 最嚴重的社區所在的區域。

  • to make this state of affairs literally painful.

    社會孤立會透過大腦的 報償系統產生影響,

  • So perhaps it's this pain, this loneliness,

    會讓這種事情的狀態真的很痛苦。

  • this despondence

    所以,也許正是 這種痛苦、這種寂寞、

  • that's driving so many of us to connect with whatever we can.

    這種失望,

  • Like food.

    驅使許多人盡可能 去建立各種連結。

  • Like handheld electronics.

    比如食物。

  • And for too many people, to drugs like heroin and fentanyl.

    比如手持式電子裝置。

  • I know someone who overdosed, who was revived by Narcan,

    也有太多人因此轉向 海洛因和芬太奴這類藥物。

  • and she was mostly angry that she wasn't simply allowed to die.

    我認識一個人,她用藥過量, 鹽酸烯丙羥嗎啡酮讓她活過來,

  • Imagine for a second how that feels, that state of hopelessness, OK?

    她最憤怒的一點就是 她連想死都不被允許。

  • But the striatum is also a source of hope.

    想像一下,那種沒有希望的狀態 是什麼樣的感覺,好嗎?

  • Because the striatum gives us a clue of how to bring people back.

    但紋狀體也是希望的來源。

  • So, remember that the striatum is our autopilot,

    因為紋狀體給了我們一條線索, 讓我們知道要如何把人救回來。

  • running our behaviors on habit,

    所以,記住紋狀體 是我們的自動駕駛,

  • and it's possible to rewire, to reprogram that autopilot,

    根據習慣來主導我們的行為,

  • but it involves neuroplasticity.

    而且能夠把那自動駕駛 重新串接、重新編程。

  • So, neuroplasticity is the ability of brains

    但這會涉及到神經可塑性。

  • to reprogram themselves,

    神經可塑性是

  • and rewire themselves, so we can learn new things.

    讓大腦可以將自己 重新編程的一種能力,

  • And maybe you've heard the classic adage of plasticity:

    以及重新串接, 讓我們能學習新事物。

  • neurons that fire together, wire together.

    也許你們聽說過關於 可塑性的經典格言:

  • Right?

    神經元會一起發動、一起串接。

  • So we need to practice social connective behaviors

    對吧?

  • instead of compulsive behaviors, when we're lonely,

    因此,當我們寂寞時,

  • when we are cued to remember our drug.

    當我們不由自主地

  • We need neuronally firing repeated experiences

    被迫轉向藥物時,

  • in order for the striatum to undergo that necessary neuroplasticity

    反而是要練習社會連結的行為。

  • that allows it to take that "go find heroin" autopilot offline.

    我們需要不斷重覆檢視 神經元發動的經驗,

  • And what the convergence of social neuroscience, addiction

    紋狀體才能產生必要的神經可塑性,

  • and compulsive-spectrum disorders in the striatum suggests

    這種可塑性會關掉

  • is that it's not simply enough

    「去找海洛英」的自動駕駛功能。

  • to teach the striatum healthier responses to compulsive urges.

    而社會神經科學、成癮, 以及衝動性光譜失調

  • We need social impulses to replace drug-cued compulsive behaviors,

    通通在紋狀體中會合的現象,

  • because we need to rebalance, neurochemically, our social reward system.

    意味著僅僅是教紋狀體 對強迫性的慾望

  • And unless that happens,

    做出比較健康的反應是不夠的。

  • we're going to be left in a state of craving.

    我們需要用社交衝動

  • No matter what besides our drug we repeatedly practice doing.

    來取代會暗示我們 轉向藥物的強迫行為,