精神病学、疯人院、精神疾病、电休克疗法、脑白质切除术、弗洛伊德与荣格

The following is a conversation with Andrew Scull, a historian of psychiatry and mental health.

以下是与精神病学和心理健康历史学家安德鲁·斯卡尔的对话。

00:00 He has authored many books that I highly recommend including Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine and Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness.

他写了很多我强烈推荐的书，包括《文明中的疯狂：从圣经到弗洛伊德、从疯人院到现代医学的疯狂文化史》和《绝望的补救措施：精神病学对治疗精神疾病的动荡探索》。

Andrew Scull has spent decades studying how societies have understood madness, how psychiatry rose to authority, and how often that authority was used with false confidence and catastrophic consequences.

安德鲁·斯卡尔花了数十年的时间研究社会如何理解疯狂、精神病学如何上升为权威，以及这种权威如何经常被错误地自信和灾难性后果所利用。

In this conversation we’ll trace the long arc from the asylum era to eugenics, from lobotomy and insulin coma therapy to electroconvulsive therapy, psychoanalysis, antipsychotics, antidepressants and the modern crisis of mental health.

在这次对话中，我们将追溯从庇护时代到优生学、从脑白质切除术和胰岛素昏迷治疗到电休克治疗、精神分析、抗精神病药物、抗抑郁药物和现代心理健康危机的漫长弧线。

00:52 It is in part a story about the terrifying history of bad ideas in medicine, but it is also about the fascinating mystery of the human mind and about the difficult journey to understand it.

这个故事在一定程度上讲述了医学上糟糕想法的可怕历史，但它也讲述了人类心灵的迷人奥秘以及理解它的艰难旅程。

This is a Lex Fridman podcast.

这是莱克斯·弗里德曼的播客。

To support it, please check out our sponsors in the description where you can also find links to contact me, ask questions, give feedback, and so on.

为了支持它，请在描述中查看我们的赞助商，您还可以在其中找到联系我、提出问题、提供反馈等的链接。

And now, dear friends, here’s Andrew Scull.

现在，亲爱的朋友们，这是安德鲁·斯卡尔。

01:20 Is it fair to characterize your view on psychiatry and mental illness as that there’s a crisis in modern psychiatry?

将您对精神病学和精神疾病的看法描述为现代精神病学存在危机是否公平？

We have made some progress- …

我们已经取得了一些进展——……

over the past century, but mostly we still are not good at treating mental illness either via the drugs or talk therapy, meaning psychopharmacology or psychotherapy, or as you put it, the brain or the mind route.

在过去的一个世纪里，但大多数时候我们仍然不擅长通过药物或谈话疗法（即精神药理学或心理疗法，或者正如你所说的，大脑或思维途径）来治疗精神疾病。

01:48 So let’s start at the end of our story.

那么让我们从故事的结尾开始吧。

Let’s start at where we stand before we go into the rich history that you so eloquently write about.

在我们深入探讨您雄辩地描述的丰富历史之前，让我们先从我们所处的位置开始。

So psychiatry is a profession that tries to deal with an enormously complicated thing: the human mind, the human emotions, the human ability to attempt to understand the world.

因此，精神病学是一个试图处理极其复杂的事情的专业：人类的思想、人类的情感、人类尝试理解世界的能力。

01:56 And in particular, obviously, it focuses on people where our common sense approach to the world seems to break down—people whose emotional life is filled with turmoil, people whose ability to relate to others is badly damaged, people who see things in the world that the rest of us simply think aren’t there.

显然，它特别关注的是那些我们对世界的常识似乎被打破的人——情感生活充满混乱的人，与他人交往的能力严重受损的人，看到世界上我们其他人认为不存在的事物的人。

02:38 They’re illusions, they’re hallucinations, they’re delusions.

它们是幻觉，它们是幻觉，它们是妄想。

And this is a subject that has occupied some very clever minds over the years, and there’s no question that in the course of at least the last three quarters of a century there has been some limited progress in dealing with the problems that mental illness creates.

多年来，这个话题一直占据着一些非常聪明的头脑，毫无疑问，至少在过去四分之三个世纪的过程中，在处理精神疾病造成的问题方面取得了一些有限的进展。

Some of that is confined to the milder forms of mental distress; the more serious forms of psychosis and breakdown of emotional control, those are areas where I think again there’s been some progress, but it’s easy to overstate how much of that there’s been.

其中一些仅限于较轻微的精神困扰；我认为在更严重的精神病形式和情绪控制崩溃方面，这些领域已经取得了一些进展，但很容易夸大其中的进展。

As we’ll see probably later in our conversation today, the advent of modern psychopharmacology, which occurred in the early nineteen fifties, was a serendipitous event.

正如我们在今天的谈话中可能会看到的那样，发生在十九世纪五十年代初的现代精神药理学的出现是一个偶然事件。

It wasn’t planned for.

这不是计划好的。

03:40 It happened almost by accident, and it did mark in some ways an advance over some of the things that psychiatry had engaged in before that.

这几乎是偶然发生的，它确实在某些方面标志着精神病学比之前从事的一些事情取得了进步。

And no question, for some people that revolution and a parallel revolution in the psychotherapeutic realm have created some advance for patients, and we should not minimize that.

毫无疑问，对于某些人来说，这场革命和心理治疗领域的并行革命为患者带来了一些进步，我们不应该低估这一点。

What we have available to us are symptomatic treatments, not cures.

我们所能提供的只是对症治疗，而不是治愈方法。

We don’t have a psychiatric penicillin for any of the conditions we’re gonna be talking about.

我们没有针对我们将要讨论的任何病症的精神科青霉素。

04:20 That doesn’t mean we can’t do some things that help, but the help is quite limited, and it’s important to understand both the ways in which we have progressed and the limits of that progress, and also to understand that when we treat something, sometimes we create new problems—what we call iatrogenic problems, things caused by the interventions that we use.

这并不意味着我们不能做一些有帮助的事情，但帮助是相当有限的，重要的是要了解我们取得进展的方式和进展的局限性，还要了解当我们治疗某些东西时，有时我们会产生新的问题——我们所说的医源性问题，是由我们使用的干预措施引起的问题。

That’s true of some psychotherapeutic interventions and most certainly true of the drugs we use to treat mental illness these days.

对于一些心理治疗干预措施来说是这样，对于我们现在用来治疗精神疾病的药物来说也是如此。

So for example, in treating PTSD, we often get patients to confront the episode– the trauma which provoked their distress, and that is often a very, very fraught process, and for many patients it actually makes things worse.

例如，在治疗创伤后应激障碍（PTSD）时，我们经常让患者面对这一事件——引发他们痛苦的创伤，这通常是一个非常非常令人担忧的过程，对许多患者来说，这实际上让事情变得更糟。

For some patients it makes them better.

对于一些患者来说，这会让他们的病情好转。

05:23 So that’s a situation where you could see problems.

所以在这种情况下你可能会看到问题。

With both antipsychotics and antidepressants, the two main classes of psychotropic drugs that we use, they’re at best partially effective and they don’t work for a significant fraction of patients who are given them.

对于我们使用的两类主要精神药物，抗精神病药和抗抑郁药，它们至多只能部分有效，而且对很大一部分服用它们的患者不起作用。

And one of the big problems psychiatry faces is that psychiatrists don’t know in advance who’s gonna respond well to the drugs, who’s gonna respond badly, for which group of patients in the middle the side effects and the main effects, if that’s what we wanna call them, the therapeutic effect, are finely balanced, and making those judgment calls about what to do is very, very difficult.

精神病学面临的一个大问题是，精神科医生事先不知道谁会对药物反应良好，谁会对药物反应不好，对于哪一组患者来说，副作用和主要作用（如果这就是我们想要称之为的治疗效果）是否得到了很好的平衡，而做出关于该做什么的判断是非常非常困难的。

06:15 Now in terms of the crisis psychiatry faces at the moment, as I see it, there are a number of strands that point to this.

就精神病学目前面临的危机而言，在我看来，有很多方面都表明了这一点。

Psychiatry’s diagnostic system that is still used– I mean, the fundamental basis of, of psychiatric diagnosis today was really first formulated in, in 1980 with the third edition of The Diagnostic and Statistical Manual of a Profession-

仍在使用的精神病学诊断系统——我的意思是，今天精神病学诊断的基本基础实际上是在 1980 年第三版《专业诊断和统计手册》中首次制定的——

DSM-III

帝斯曼-III

…

……

06:45 DSM-III, and then there’s been DSM-III-R, DSM-IV, DSM-IV-TR, and now DSM-5, finally not with a Roman numeral but with an Arabic numeral.

DSM-III，然后是 DSM-III-R、DSM-IV、DSM-IV-TR，现在是 DSM-5，最后不再使用罗马数字，而是使用阿拉伯数字。

So they thought with DSM-5 when they needed to modify it it would be like a piece of software.

因此，他们认为当需要修改 DSM-5 时，它就像一个软件。

You have Windows 10, Windows 11, and so on, right?

您有 Windows 10、Windows 11 等等，对吗？

Now that diagnostic system came into being because psychiatrists had a very hard time agreeing with one another about what was wrong with somebody, and that became embarrassingly clear in — first in the professional literature which outsiders didn’t read, and then via a very famous study that’s a scientific fraud by David Rosenhan called On Being Sane in Insane Places where he claimed to have sent in pseudo patients to the hospital and they all were diagnosed as schizo.

现在，诊断系统的出现是因为精神科医生很难就某个人的问题达成一致，这一点变得令人尴尬地清楚——首先是在外人不读的专业文献中，然后通过大卫·罗森汉的一项非常著名的科学欺诈研究，名为《在疯狂的地方保持理智》，他声称将假病人送到医院，他们都被诊断为精神分裂症。

07:42 All but one of them diagnosed as schizophrenic, the other as somebody with bipolar disorder, and they were fake patients.

除了一名患者外，其他人都被诊断为精神分裂症患者，另一名则被诊断为双相情感障碍患者，而且他们都是假病人。

So almost in a panic after that study appeared in Science and because there was an abundant professional literature from the 1960s showing the same thing, that diagnosis was a very erratic process, the DSM-III task force led by Robert Spitzer, who was then at Columbia, was explicitly set up to try to create a sort of tick the boxes approach to deciding which box a patient belonged in.

因此，在这项研究发表在《科学》杂志上之后，几乎陷入了恐慌，而且由于 20 世纪 60 年代有大量专业文献表明了同样的事情，诊断是一个非常不稳定的过程，当时在哥伦比亚大学的罗伯特·斯皮策 (Robert Spitzer) 领导的 DSM-III 工作组明确成立，试图创建一种勾选框的方法来确定患者属于哪个框。

Were you schizophrenic?

你患有精神分裂症吗？

Were you this type of schizophrenic or that type of schizophrenic?

你是这种类型的精神分裂症患者还是那种类型的精神分裂症患者？

Were you manic depressive or bipolar?

您患有躁狂抑郁症或躁郁症吗？

Did you have various forms of depression?

您是否患有各种形式的抑郁症？

08:32 And to construct those boxes, what they relied upon was a list of symptoms, and if you had more than a certain number– if you had more than six of ten, six or ten or more symptoms of a certain sort, you could be diagnosed with major depression, for example.

为了构建这些盒子，他们依赖的是一系列症状，如果你的症状超过一定数量，例如，如果你有超过十种、六种或十种或更多某种症状中的六种，你可能会被诊断为重度抑郁症。

So that system came into being.

于是这个制度就应运而生了。

It was partially embedded because it appealed to drug companies who were developing drugs to treat these various disorders.

它之所以被部分嵌入，是因为它吸引了正在开发药物来治疗这些不同疾病的制药公司。

It appealed to insurance companies ’cause it gave them a stable base to look at.

它对保险公司很有吸引力，因为它给了他们一个稳定的基础。

It appealed to, as diagnosis always does, to patients and their families who are scrambling to deal with these enormous upsets in the mental life of either themselves or a family member.

正如诊断始终所做的那样，它吸引了那些正在努力应对自己或家人精神生活中巨大困扰的患者及其家人。

So provided some sense of certainty around diagnosis.

因此为诊断提供了一些确定性。

09:33 But that was always based simply on symptoms in the way an eighteenth century doctor might diagnose dropsy or diagnose some other kind of disor— fever, for example.

但这总是简单地基于症状，就像十八世纪医生诊断水肿或其他疾病（例如发烧）的方式一样。

Well, fever and other diseases they talked about in the eighteenth century are really a constellation of very different things under one label.

嗯，他们在十八世纪谈论的发烧和其他疾病实际上是同一个标签下的一系列截然不同的事物。

And I think that’s what is turning out to be true of the DSM labels.

我认为这就是帝斯曼标签的真实情况。

But that approach was really all that psychiatry could come up with if it wanted to make sure whether you were in Walla Walla or New York or San Francisco or Atlanta, you reached the same conclusion faced by the same patient, that you had a reliable diagnostic system.

但如果精神病学想确定无论你是在瓦拉瓦拉、纽约、旧金山还是亚特兰大，你都能得出同一个病人所面临的相同结论，那就是你有一个可靠的诊断系统，那么这种方法实际上就是精神病学所能想到的全部方法。

That didn’t mean necessarily it was a valid diagnostic system, if you understand the distinction between validity and reliability.

如果您了解有效性和可靠性之间的区别，这并不一定意味着它是一个有效的诊断系统。

10:29 Reliability means you and I faced with the same sets of facts reach the same conclusion, but that conclusion may or may not reflect the underlying reality of things, right?

可靠性意味着你和我面对相同的事实得出相同的结论，但这个结论可能反映也可能不反映事物的根本现实，对吗？

So you had this diagnostic system, and it went through various iterations.

所以你有了这个诊断系统，并且它经历了各种迭代。

Each time it went through an iteration, the number of possible psychiatric disorders you could get grew and grew and grew, and it became difficult to believe in some of those categories, shall we say, that they were really illnesses rather than some kinda social construct.

每次经历一次迭代，你可能患上的精神疾病的数量就会越来越多，我们很难相信其中一些类别，容我们说，它们真的是疾病，而不是某种社会建构。

But beyond that, psychiatrists wanted to be more like other medical doctors, to root their diagnoses in an understanding of the underlying pathology of the disorder.

但除此之外，精神科医生希望更像其他医生，将他们的诊断植根于对这种疾病的潜在病理学的理解。

What was it that caused people to become schizophrenic?

是什么导致人们患上精神分裂症？

11:30 The sense was if we could grasp that we’d have a better handle on how to attack it, how to treat it.

其意义在于，如果我们能够掌握，我们就能更好地掌握如何攻击、如何治疗它。

And when DSM-5 was mooted, the fifth edition in the early two thousands, NIMH, then under the leadership of Steven Hyman who’s at Harvard now and succeeded by Thomas Insel who ruled NIMH for about thirteen years, the two of them had pushed psychiatry and psychiatric research in a very particular direction: on the one hand towards understanding the genetics of mental illness, and on the other to looking at what the new discipline of neuroscience could contribute to understanding things.

当 DSM-5 被提出时，即 2000 年初的第五版，NIMH 的领导者是史蒂文·海曼 (Steven Hyman)，他现在在哈佛大学，托马斯·英塞尔 (Thomas Insel) 接替了他，他统治了 NIMH 约 13 年。他们两人将精神病学和精神病学研究推向了一个非常特殊的方向：一方面了解精神疾病的遗传学，另一方面研究神经科学的新学科可以为理解事物做出哪些贡献。

Both of them were heavily invested in the idea that mental illness was brain disease.

他们两人都坚信精神疾病就是脑部疾病。

12:28 And if it was brain disease, then the question was what was making the mechanism here go awry?

如果是脑部疾病，那么问题是什么导致这里的机制出现问题？

What was causing people’s emotions or their cognitive skills or their sense of the world to become so disordered?

到底是什么原因导致人们的情绪、认知能力、世界观变得如此紊乱？

And they invested a lot of money in that approach.

他们在这种方法上投入了大量资金。

When Insel stepped down he gave an interview actually to somebody at MIT, and he’s repeated it since in a– in a book he wrote about his experiences where he said, “Well, you know, as I look back on my thirteen years, I funded an enormous amount of scientific…

当英塞尔卸任时，他实际上接受了麻省理工学院某人的采访，他在一本关于自己经历的书中重复了这一点，他说：“嗯，你知道，当我回顾我的十三年时，我资助了大量的科学......

really cool scientific research.

非常酷的科学研究。

I funded geneticists and I funded neuroscientists and they did a lot of really interesting science.

我资助了遗传学家和神经科学家，他们做了很多非常有趣的科学研究。

And after spending twenty billion dollars, the lot of the mentally ill has improved not one bit, right?”

而且花了二十亿之后，精神病人的境遇也没有丝毫好转吧？”

Wow!

哇！

Which was a pretty devastating statement, I thought.

我认为这是一个相当具有毁灭性的声明。

And NIMH is National Institute of Mental Health.

NIMH 是国家心理健康研究所。

National Institute of Mental Health, yes, I shouldn’t resort to jargon.

国家心理健康研究所，是的，我不应该诉诸行话。

13:27 But the National Institute of Mental Health had been founded in the late nineteen forties with the goal of improving, doing basic research, training people in the field, advancing the care of the mentally ill, and producing obviously cures and advances.

但国家心理健康研究所成立于十九世纪四十年代末，其目标是改进、开展基础研究、培训该领域的人员、推进对精神病患者的护理，并产生明显的治疗方法和进步。

And its mission has varied widely over the years since, but starting in the in the nineteen nineties –the period when the first George Bush declared the decade of the brain— NIMH increasingly focused on the idea that mental illness was purely a brain disease, and there’s something to that and there’s also some mistake in thinking about it that way.

从那以后的几年里，它的使命发生了很大的变化，但从 20 世纪 90 年代开始——也就是第一任乔治·布什宣布大脑十年的时期——NIMH 越来越关注精神疾病纯粹是一种大脑疾病的观点，这种想法有一定的道理，但这样思考也存在一些错误。

This is, by the way, as we will talk about this distinction between seeing mental health, the maladies of the human mind – As a problem of the brain like neurobiology Neuroscience versus the problem of the mind which is more in the cognizant psychotherapy these more less amenable to scientific rigor So I think whats appealing About studying the brain and your biology Your sciences theres data Yes It’s more rigorous You can do science

顺便说一句，这就是我们将讨论的心理健康与人类心灵疾病之间的区别——作为大脑的问题，如神经生物学，神经科学与心灵的问题，后者更多地在认知心理治疗中，这些更不符合科学严谨性所以我认为研究大脑和你的生物学有什么吸引力你的科学有数据是的，它更严格你可以做科学

It’s the kind of thing that really appealed to medical school deans because once NIH and the drug companies too were funding basic research on neurobiology and basic research on genetics the moneys flooded in and psychiatry Which had been Something of an orphan Became much more popular

这种事情真正吸引了医学院的院长，因为一旦美国国立卫生研究院和制药公司也资助神经生物学和遗传学的基础研究，资金就会涌入，曾经孤儿的精神病学变得更受欢迎

and we should say That This Is something you write A Lot about There are all These Factors To consider So Theres cultural Elements Political public Policy elements Then At Certain Point Drug Companies Insurance Companies Come In Of course All Human Beings Around Somebody Who suffering With mental health issue So Family factors Thats Connected Cultural Stuff

我们应该说，这是你写的很多东西，有所有这些因素需要考虑，所以有文化因素，政治公共政策因素，然后在某个时候，制药公司保险公司介入，当然，所有患有心理健康问题的人周围的人，所以家庭因素与文化因素有关

it’s a very complicated area and oversimplification is a real problem I think.

这是一个非常复杂的领域，我认为过于简单化是一个真正的问题。

15:35 and I think even that dichotomy you just drew between the brain and the social Or psychological Some mix of those Things I Think in someways thats category Mistake thats mistaken Way looking World Because Brain You have today Not Born With Human brains Are remarkably Plastic Things Develop response Environment Social Psychological Embedded Our brains Rigid separation Saying One Other No Abundant evidence From epidemiology That social factors Play important role Development Illness

我认为，即使你刚刚在大脑和社会或心理之间做出的二分法，这些东西的混合，我认为在某种程度上，这是类别错误，这是错误的方式看待世界，因为你今天拥有的大脑不是与人类大脑一起出生的，是非常可塑的东西，发展反应环境社会心理嵌入我们的大脑严格的分离互相说没有来自流行病学的大量证据表明社会因素发挥着重要作用发展疾病

Nevertheless history Psychotherapy Example Subfields Human Mind Complicated All Factors Say Anything Helpful Have Simplify Freud famously simplified Lot Towards Particular View Human mind Mm-hmm That simplification Actually Talk about Its Correct Deeper Sense Productive

尽管如此，历史心理治疗示例子领域人类思维复杂化所有因素说任何有帮助的话简化弗洛伊德著名的简化很多朝向特定观点人类思维嗯嗯，这种简化实际上谈论其正确的更深层次的意义富有成效

yes in fact whenever you’re trying to deal with a very complicated set of issues you have to simplify you have to make heuristic decisions about what you’re going to neglect and what you’re gonna emphasize but what im trying to say well you asked me about the crisis in psychiatry and the simplest way for me to encapsulate the issue and the problem as i see it that’s arisen —one of the problems—is a quote by Leon Eisenberg who had a very long career at Harvard and Eisenberg said towards the end of his career He Said When Entered Psychiatry Was Brainless Psychiatry Leaving It mindless Psychiatry Yeah sums Up Way Field Large Degree Moved Process Insights Lost Though Ways Other Being Gained Freudians tended Neglect Biological Suggest Brain as a biological organism was not something we

是的，事实上，每当你试图处理一系列非常复杂的问题时，你就必须简化，你必须做出关于你要忽略什么和你要强调什么的启发式决定，但我想说的是，你问我关于精神病学危机的问题，以及我概括这个问题和我所看到的问题的最简单方法——其中一个问题——是莱昂·艾森伯格的一句话，他在哈佛有很长的职业生涯，艾森伯格在他的职业生涯 他说，当进入精神病学时，他是无脑精神病学，离开它是无脑精神病学 是的，总结道领域大程度移动过程洞察力通过其他方式获得弗洛伊德倾向于忽视生物学表明大脑作为一种生物有机体不是我们的东西

18:22 needed to worry about.

需要担心。

We worried at the level of a psychological model of how our minds work.

我们担心我们的思维如何运作的心理模型。

And all too often, not exclusively because some of the psychiatrists I’m friends with are very sophisticated men and women and do grasp that you can’t move in these bipolar directions.

很多时候，不仅仅是因为我的一些朋友的精神科医生都是非常老练的男人和女人，他们确实知道你不能朝这些两极方向发展。

You’ve got to meet somewhere in the middle.

你们必须在中间的某个地方见面。

But that sort of got lost, I think, in all the enthusiasm for neuroscience.

但我认为，这种迷失在对神经科学的热情中。

I mean, when antipsychotic drugs were discovered in the early 1950s, we had no clue of how they worked.

我的意思是，当抗精神病药物在 20 世纪 50 年代初被发现时，我们不知道它们是如何起作用的。

And one of the things that they helped us spawn as people began to say, “Well, why did these drugs work?

当人们开始说：“好吧，为什么这些药物有效？

19:14 What did they do?” Was to begin to understand that the brain wasn’t just a set of electrical signals, as had been thought in the first half of the 20th century and before.

他们做了什么？是开始了解大脑不仅仅是一组电信号，正如 20 世纪上半叶及之前人们所认为的那样。

But rather there was this very interesting chemical soup running around in our brains with neurotransmitters that help the brain work the way it did and perhaps explained why it went awry.

相反，我们的大脑中存在一种非常有趣的化学汤，其中含有神经递质，可以帮助大脑正常工作，也许可以解释为什么会出错。

19:40 So it was one of the many factors that gave rise to neuroscience.

所以它是催生神经科学的众多因素之一。

The first neuroscience conventions were in the 1970s, and they attracted a few hundred people.

首届神经科学大会于 20 世纪 70 年代举行，吸引了数百人参加。

Now it’s tens of thousands of neuroscientists.

现在有数以万计的神经科学家。

It’s a huge enterprise.

这是一个巨大的企业。

So diagnosis has come under threat.

因此诊断受到了威胁。

The categories that we have all become familiar with, that we’re told are real diseases like bipolar disorder, schizophrenia, major depression, are beginning to falter, and we’re beginning to worry about whether those diagnoses are real ways of thinking about the world and may in fact mislead us.

我们都熟悉的类别，我们被告知的真实疾病，如双相情感障碍、精神分裂症、重度抑郁症，开始动摇，我们开始担心这些诊断是否是思考世界的真正方式，实际上可能会误导我们。

20:20 Because if we think there’s something called schizophrenia or the schizophrenias, as the inventor of that term put it, if we think there’s something like that and we try to research where it comes from, but that’s not really what’s going on, obviously we’re probably gonna not make the progress we could be making if we had a better diagnostic system.

因为如果我们认为有一种叫做精神分裂症的东西，或者正如该术语的发明者所说的那样，如果我们认为有类似的东西，并且我们试图研究它的来源，但事实并非如此，显然，如果我们有更好的诊断系统，我们可能不会取得我们可以取得的进展。

And that’s what DSM-V thought it was gonna be able to do and discovered it couldn’t.

这就是 DSM-V 认为它能够做到的事情，但发现它做不到。

So it stayed basically with the symptomatic approach.

所以基本上还是采取对症治疗的方法。

If we can just really brief – …

如果我们能简单地介绍一下——……

20:51 I would love to talk a little bit more about the DSM, but just to give a history here, looking it up on Perplexity, DSM One in 1952 was a 32 page pamphlet- ..with 106 diagnoses heavily influenced by psychodynamic concepts- ….and etiology using broad, often vague categories like reactions.

我很想多谈谈 DSM，但只是为了在这里介绍一下历史，在 Perplexity 上查找它，1952 年的 DSM One 是一本 32 页的小册子 - ......其中 106 种诊断深受心理动力学概念的影响 - ......以及使用广泛且通常模糊的类别（例如反应）的病因学。

DSM Two in 1968 expanded to 185 diagnoses, still psychodynamically flavored and reliability poor, but added more attention to childhood disorders and later removed homosexuality as a disorder in 1974 printing.

1968 年的 DSM 2 期扩大到 185 种诊断，仍然具有心理动力学特征且可靠性较差，但增加了对儿童障碍的更多关注，并在 1974 年印刷时删除了同性恋作为一种障碍。

Then to the revolution, as you mentioned, the DSM Three in 1980 introduced explicit symptom-based diagnostic criteria, a multi axial assessment system, and an officially atheoretical stance about causes aiming to improve reliability and research utility.

然后是革命，正如您所提到的，1980 年的 DSM 3 引入了明确的基于症状的诊断标准、多轴评估系统以及旨在提高可靠性和研究实用性的关于原因的官方非理论立场。

21:49 And then DSM Three R in 1987 revised criterion expanded to around two 97 diagnoses.

然后 DSM Three R 在 1987 年修订了标准，扩大到大约 2 97 个诊断。

DSM Four in ’94 and DSM Four TR in 2000 focused on literature driven empirical revisions,- …..added and deleted some disorders, increased coordination with ICD ten and goes on.

94 年的《DSM 4》和 2000 年的 DSM 4 TR 侧重于文献驱动的实证修订，-……添加和删除了一些疾病，增加了与 ICD 10 的协调，并继续进行。

And then finally in 2013 DSM Five came out which eliminated the multiaxial system, integrated most information into a single nonaxial diagnostic list than separate notations for psychological and medical factors.

最后在 2013 年，DSM 5 版问世，它消除了多轴系统，将大部分信息整合到一个非轴诊断列表中，而不是对心理和医学因素进行单独的标记。

It reorganized chapters, e.g., neurodevelopmental, obsessive compulsive related, trauma and stress related disorders, introduced new and refined entities, and so on.

它重新组织了章节，例如神经发育、强迫相关、创伤和压力相关疾病，引入了新的和完善的实体等等。

22:41 But big picture trajectory conceptually, the DSM moved from cause focused and psychoanalytical to symptom based, theoretical, and reliability driven over time.

但从概念上看，DSM 从以原因为中心和精神分析为基础，逐渐转向以症状为基础、理论化和可靠性驱动的概念。

There has been growth in the number of granularity of categories, closer alignment with ICD, ongoing controversy over medicalization validity and the balance between categorical and dimensional approaches.

类别的粒度数量不断增加，与 ICD 更加一致，关于医疗有效性的持续争议以及类别和维度方法之间的平衡。

Yes, it feels like that description doesn’t necessarily fully get to the core of why the DSM five doesn’t quite get the full scope of the problem.

是的，感觉这样的描述不一定完全触及为什么 DSM 5 没有完全了解问题的全部范围的核心。

You invest a ton of money.

你投入了大量资金。

23:22 You invest- …

您投资-...

$20 billion– More than $20 billion in a particular approach.

200 亿美元——某种特定方法的价值超过 200 亿美元。

And at the time you’re constructing this you say finally because of all the work that’s being done in genetics we now have decoded the human genome.

当你构建这个时，你说“最后”，因为在遗传学方面所做的所有工作，我们现在已经解码了人类基因组。

23:40 We have PCR so we can chop it up and we can look at bits of it.

我们有 PCR，所以我们可以将其切碎并查看其中的一些部分。

We have a lot more understanding of the role of neurotransmission in the brain.

我们对大脑中神经传递的作用有了更多的了解。

Surely we’re going to be able to recast our diagnostic system based on underlying pathology so that we won’t be worrying about symptoms anymore.

当然，我们将能够根据潜在的病理学重塑我们的诊断系统，这样我们就不会再担心症状了。

We’ll be looking at the actual underlying pathological changes that have taken place.

我们将研究已经发生的实际的潜在病理变化。

But in the event, it turned out they couldn’t do that.

但事实证明他们做不到。

By about 2008 they had thrown up their hands and said, no, we’re going to have to continue to refine, rely upon the same basic approach that we developed in 1980.

到 2008 年左右，他们举手表示，不，我们必须继续改进，依赖于我们在 1980 年开发的相同基本方法。

24:30 And when that document came out, and there’d been a lot of criticism, some of it from Robert Spitzer, who had been largely in control of DSM-III and DSM-IIIR, and then his successor Allen Frances, who’d run DSM-IV, they both were fiercely critical about what was going on and said it was being done in the dark and it was done in secrecy and it wasn’t scientific.

当这份文件发布时，引起了很多批评，其中一些批评来自罗伯特·斯皮策(Robert Spitzer)，他主要控制着DSM-III和DSM-IIIR，然后是他的继任者艾伦·弗朗西斯(Allen Frances)，他负责DSM-IV，他们都对正在发生的事情提出了强烈批评，并表示这是在黑暗中进行的，是在秘密的情况下进行的，不科学。

And when it was about to come out, Thomas Insel and Steven Hyman, the two then existing at the preceding director of the National Institute of Mental Health, denounced the document as unscientific and useless.

当该文件即将发布时，托马斯·英塞尔和史蒂文·海曼（两人当时担任国家心理健康研究所前所长）谴责该文件不科学且无用。

So if you’re talking about a crisis, that’s a crisis for the field.

因此，如果你谈论的是危机，那就是该领域的危机。

If its diagnostic system is being dissed by leading figures like that, what else was a problem?

如果它的诊断系统被这样的领导人物所嘲笑，那还有什么问题呢？

25:25 The difficulties with the drug existing therapies particularly had become more and more manifest.

尤其是现有药物疗法的困难已经变得越来越明显。

To make matters worse, partly because Big Pharma had sometimes behaved, shall we say, rather unethically.

更糟糕的是，部分原因是大型制药公司的行为有时相当不道德。

Sometimes with these drugs it had hidden things that undercut their claims, it had manufactured studies, it had manipulated data, and it got caught out and it paid billions of dollars in damages for some of the tricks it had got up to.

有时，在这些药物中，它隐藏了削弱其主张的东西，它制造了研究，它操纵了数据，它被抓了，它为它的一些伎俩支付了数十亿美元的赔偿金。

Not just in psychiatry—I mean Vioxx, for example, the painkiller, was another huge scandal and it was a five billion dollar settlement—but the drug companies had suffered some reputational damage.

不仅仅是在精神病学领域——我的意思是止痛药万络（Vioxx）是另一起巨大丑闻，而且赔偿金额达 50 亿美元——但制药公司的声誉也受到了一些损害。

Beyond that, they didn’t have any real clues.

除此之外，他们没有任何真正的线索。

Unfortunately neuroscience hadn’t thrown up new targets for different forms of drug development, and they decided they could make

不幸的是，神经科学并没有为不同形式的药物开发提出新的目标，他们决定可以制造

26:31 more money with spending their money on research on other diseases, not mental illness.

更多的钱花在其他疾病的研究上，而不是精神疾病上。

A crisis was you were stuck with a set of drugs that Steve Hyman says aren’t really any advance on the ones by accident we found in the fifties, mm-hmm, and there isn’t new research, unless it’s small startups, going on to develop new ones.

一场危机是你被困在一系列药物中，史蒂夫·海曼说这些药物与我们在五十年代偶然发现的药物相比并没有任何进步，嗯嗯，而且没有新的研究，除非是小型初创公司，正在开发新的药物。

So, you have an increasing sense your diagnostic process is falling apart, your drug treatments’ limitations are becoming more manifest, and as well, for people with serious mental illness, public policy has screwed things up badly.

因此，你越来越感觉到你的诊断过程正在崩溃，你的药物治疗的局限性变得更加明显，而且，对于患有严重精神疾病的人来说，公共政策已经把事情搞砸了。

So, if you, a person with serious mental illness, you will die, on average, fifteen to twenty-five years before the rest of us.

所以，如果你是一个患有严重精神疾病的人，你平均会比我们其他人早十五到二十五年去世。

That gap has been growing rather than diminishing.

这种差距一直在扩大而不是缩小。

So, that’s not a good thing.

所以，这不是一件好事。

It’s not something I want to lay entirely at the door of psychiatry, so

我不想把这完全归咎于精神病学，所以

27:41 Don’t get me wrong.

别误会我的意思。

I think a lot of this is public policy that has really abandoned treatment for the seriously mentally ill, and you see it on the streets of our cities.

我认为这很大程度上是公共政策真正放弃了对严重精神病患者的治疗，你在我们城市的街道上看到了这一点。

You see the sidewalk psychotics.

你会看到人行道上的精神病患者。

You see people who are cycling between brief periods of inpatient care, the gutter, or the flop house, and the jail.

你会看到人们在短暂的住院治疗、阴沟、破房子和监狱之间骑自行车。

So the three largest centers of inpatient psychiatric care, if you can call it that, in the United States today are the Los Angeles County Jail, Cook County Jail in Chicago, and Rikers Island in New York.

因此，当今美国最大的三个住院精神科护理中心（如果可以这样称呼的话）是洛杉矶县监狱、芝加哥的库克县监狱和纽约的赖克斯岛监狱。

That’s shockingly because, by their very nature, of course, prisons aren’t equipped to deal with serious mental illness.

这令人震惊，因为就其本质而言，监狱当然不具备应对严重精神疾病的能力。

Some dark ways to return to the asylum era.

回到庇护时代的一些黑暗方式。

Yeah.

是的。

28:32 Well, you know, the asylums had acquired a very bad reputation, and I’ve written about some of the reasons why that happened.

嗯，你知道，收容所的名声很坏，我已经写过一些发生这种情况的原因。

But when asylums were founded, it was a period of enormous optimism that we were going to be able to cure these people, that we would rescue them from attics and from jail cells, and through providing a therapeutic environment, coaxing them to work, creating a system where they learn to control themselves, not necessarily to drive their demons out, but to keep them under some sort of wraps.

但是当庇护所建立时，那是一个非常乐观的时期，我们将能够治愈这些人，我们将把他们从阁楼和牢房中救出来，并通过提供治疗环境，哄骗他们工作，创建一个让他们学会控制自己的系统，不一定要赶走他们的恶魔，而是以某种方式将他们隐藏起来。

The expectation was, when the asylums came along, is that they’d not only rescue people from horrendous conditions in the prisons and the jails, but they’d actively cure them.

当庇护所出现时，人们的期望是，他们不仅能将人们从监狱和看守所的可怕条件下拯救出来，而且还能积极治愈他们。

And the earliest alienists, as they called themselves then, thought that they could cure 60, 70, 80 percent, maybe even more, of patients as long as they came in early.

最早的精神病学家（他们当时自称）认为，只要尽早治疗，他们就可以治愈 60%、70%、80%，甚至更多的患者。

And really, asylums were built out of that sense.

事实上，庇护所就是出于这种意义而建立的。

29:39 Of optimism, that sense that we, you know, that so much was environmental and so much was not exacerbating the condition by treating people like animals or treating them, you know, beating them and in other ways horrifically maltreating them, that would create a sense of cure.

乐观的感觉是，我们，你知道，很多都是环境问题，很多都没有通过像对待动物一样对待人或对待他们，你知道，殴打他们以及以其他方式可怕地虐待他们来加剧病情，这会产生一种治愈的感觉。

And really, that underlay the construction of the asylums.

事实上，这也是庇护所建设的基础。

And now having abandoned the asylums, which we did starting a little bit in the 1950s but really the late 1960s onwards, that was because there was going to be something miraculous called community care, but community care is a shell game without a pea.

现在我们放弃了收容所，我们从 20 世纪 50 年代开始，但实际上是从 1960 年代末开始，这是因为将会出现一种叫做社区护理的奇迹，但社区护理是一场没有豌豆的骗局。

It’s like one of those confidence tricks.

这就像那些自信技巧之一。

There were no substitute community facilities for dealing with the really serious mentally ill.

没有替代的社区设施来治疗真正严重的精神病患者。

So now we’re in this truly, in this crisis- …

所以现在我们真正陷入了这场危机——……

30:35 in this essentially dark ages.

在这个本质上黑暗的时代。

And in part I think our conversation, our journey through the history of psychiatry- …

在某种程度上，我认为我们的对话，我们的精神病学历史之旅……

is an exploration of some gigantic mistakes but also an exploration of where lay some hope for the future.

这是对一些巨大错误的探索，也是对未来希望所在的探索。

So we’ll talk quite a bit about this.

所以我们会详细讨论这个问题。

30:58 I was wondering if you can also just lay out what are the big categories of mental illness that we’re referring to.

我想知道您是否也可以列出我们所指的精神疾病的大类。

You’ve already hinted at them, but like levels of seriousness- …

你已经暗示过它们，但就像严肃程度一样——……

and the categories of illness- …

以及疾病的类别-...

like with psychosis and depression and so on.

比如精神病和抑郁症等等。

So going back to the early 20th century was when the German psychiatrist Emil Kraepelin, working with thousands of records in German asylums, inductively developed a distinction between two very broad categories of mental illness.

回到 20 世纪初，德国精神病学家埃米尔·克雷佩林 (Emil Kraepelin) 在研究了德国精神病院的数千份记录后，归纳出两种非常广泛的精神疾病类别之间的区别。

31:16 One he called dementia praecox or early dementia, and the other he called manic depressive illness, which was a more remitting illness that sometimes went away entirely, other times went back and forth, whereas dementia praecox was a one-way ticket down.

他将其中一种称为早发性痴呆或早期痴呆，另一种称为躁狂抑郁症，这是一种缓解性更强的疾病，有时会完全消失，有时会反复发作，而早发性痴呆是一张单程票。

Now that label was transformed by a Swiss psychiatrist, Bleuler, into the term we use today, schizophrenia, although Bleuler talked about the schizophrenias because he thought under that broad label there were a diverse group of things running around.

现在这个标签被瑞士精神病学家布洛伊勒转变为我们今天使用的术语“精神分裂症”，尽管布洛伊勒谈论精神分裂症是因为他认为在这个宽泛的标签下存在着各种各样的东西。

32:16 And I think that was an important insight that tends to get lost sometimes.

我认为这是一个重要的见解，但有时往往会被迷失。

This was jamming together people with very serious psychosis, that is, people who’d lost touch with what we like to think of as reality, whose emotional and cognitive lives were in total turmoil, who were — who lost the ability to connect with other human beings.

这是把患有非常严重的精神病的人挤在一起，也就是说，那些与我们所认为的现实脱节的人，他们的情感和认知生活完全混乱，他们失去了与其他人联系的能力。

So their social skills atrophied, their– Well, this is something contemporary psychiatrists would refer to as the positive and negative symptoms of schizophrenia.

所以他们的社交技能萎缩了，他们的——嗯，这就是当代精神病学家所说的精神分裂症的阳性和阴性症状。

But underlying the definition of schizophrenia here is a detachment from reality.

但这里精神分裂症的定义背后是脱离现实的。

32:53 So you’re hearing voices-

所以你听到了声音——

Yes

是的

…

……

33:00 you’re seeing visions.

你正在看到异象。

You’re thinking people are plotting against you.

你认为人们正在密谋反对你。

33:01 You think the television is talking directly to you.

您认为电视正在直接与您交谈。

And because of that, it has these consequences of how you’re connected to the rest of the world and what your emotional life is like, all that kind of stuff.

正因为如此，它会对你如何与世界其他地方联系以及你的情感生活是什么样的等等产生这些影响。

Yes.

是的。

33:15 Your emotional life flattens out.

你的情感生活变得平淡。

Your language capacity deteriorates.

你的语言能力下降。

Your ability to relate to other people either vanishes or becomes caught up in the web of delusions where you think people around you are plotting against you or doing terrible things to you.

你与他人交往的能力要么消失，要么陷入错觉之网，你认为周围的人正在密谋反对你或对你做可怕的事情。

And is that a different world than the world of bipolar and the world of depression?

那是一个与双相情感障碍和抑郁症世界不同的世界吗？

Yes.

是的。

33:38 The Greeks recognized and the Romans, ancient Greece and ancient Rome recognized different forms of insanity as they called it.

希腊人认识到，罗马人、古希腊和古罗马也认识到他们所说的不同形式的精神错乱。

So melancholia would have been the term the Greeks and the Romans would have used and it survived and was very much around.

因此，忧郁症本来就是希腊人和罗马人使用的术语，并且它幸存下来并且非常普遍。

And I think that is a form of depression.

我认为这是抑郁症的一种形式。

What’s happened now is major depression has become a catchall category.

现在的情况是，重度抑郁症已经成为一个包罗万象的类别。

So it embraces both what we might think of as milder forms of emotional distress along with what melancholia referred to, which was really a kind of depression that had psychotic features.

因此，它既包含了我们可能认为的较温和的情绪困扰，也包含了忧郁症，后者实际上是一种具有精神病特征的抑郁症。

This loss of contact, as it were, with everyday reality.

可以说，这种与日常现实的联系的丧失。

Something you would talk about maybe like a clinical depression.

你可能会谈论一些像临床抑郁症这样的事情。

34:28 And by the way, we should mention that this field in the 21st century is like a minefield.

顺便说一句，我们应该提到，21世纪的这个领域就像一个雷区。

Yes, very much so.

是的，非常如此。

34:37 So here’s a very strange bit of historical record.

这是一段非常奇怪的历史记录。

The other distinction, and the distinction we’re grappling with– so we have people who are– whose depression is of such a scale they’re threatening to do away with themselves.

另一个区别，也是我们正在努力解决的区别——所以我们有这样的人——他们的抑郁症严重到他们威胁要自杀。

They’ve retreated into complete, almost immobility.

他们已经完全退缩了，几乎一动不动。

They’re overwhelmed by senses of sadness and loss and they’re– If they’re religious, then they’re damned to hell and all those kinds of things.

他们被悲伤和失落的感觉压倒了，他们——如果他们有宗教信仰，那么他们就会下地狱和诸如此类的事情。

So we have this psychosis that we’ve been talking about.

所以我们就有了我们一直在谈论的这种精神病。

We have something also that the ancients recognized: dementia, the loss, really the loss of our mind, as it were.

我们也有一些古人认识到的东西：痴呆症，丧失，实际上是我们心智的丧失。

35:22 But then we also have other kinds of disturbance of our mental faculties that generally we think of as more minor, but I don’t want to make light of them because often people suffer from these things, genuinely suffer pretty badly.

但我们的心智也会受到其他类型的干扰，通常我们认为这些干扰比较轻微，但我不想轻视它们，因为人们经常遭受这些事情的痛苦，真的非常痛苦。

But those things we in the 20th and 21st centuries tend to talk about as neuroses, neurotic diseases, psychotic diseases.

但我们在 20 世纪和 21 世纪往往将这些东西称为神经症、神经症疾病、精神病。

In the 19th century, neurosis was a term that meant things rooted in the brain, as you can see from the root of the word, and psychosis was stuff that came from the mind, the psyche.

在 19 世纪，神经症是一个术语，意思是根植于大脑的东西，正如你从这个词的词根中看到的那样，而精神病是来自思想、心灵的东西。

36:04 And yet sometime in the late 19th century those things crossed over and so when we talk in the present we do tend to distinguish between the core, really the most severe forms of mental disorder, which would include things like Alzheimer’s disease and other forms of dementia, would include very serious depression, would include bipolar disorder where people oscillate either have extreme mania so they’re not getting any sleep.

然而，在 19 世纪末的某个时候，这些事情交叉了，所以当我们现在谈论时，我们确实倾向于区分核心的、真正最严重的精神障碍，其中包括阿尔茨海默病和其他形式的痴呆症，包括非常严重的抑郁症，包括双相情感障碍，人们摇摆不定，要么有极度躁狂，所以他们无法入睡。

They’re talking at an extraordinary rate.

他们说话的速度非常快。

36:41 Their behavior is very hard to tolerate, and they’re exhausting themselves, and they may even die from exhaustion if it’s not controlled.

他们的行为让人难以忍受，而且很累自己，如果不加以控制，甚至可能会累死。

And very often that alternates with periods of depression.

而且这种情况常常与抑郁时期交替出现。

So that was a category that was captured initially as manic depressive illness and later on evolved into bipolar disorder and then separating out depression and major depression separately.

因此，这一类别最初被视为躁狂抑郁症，后来演变为双相情感障碍，然后分别将抑郁症和重度抑郁症分开。

But then there are a whole bunch of other things like, for example, phobias.

但还有很多其他的事情，例如恐惧症。

People can’t go outside because they find it too frightening.

人们不敢出去，因为他们觉得外面太可怕了。

Milder phobias: “I can’t get in an airplane because it’s gonna crash,” “I can’t go to school because it’s overwhelming for me.” So school phobia emerges as a diagnosis.

较轻的恐惧症：“我不能坐飞机，因为它会坠毁”，“我不能去学校，因为这对我来说太难以承受了。”因此，学校恐惧症成为一种诊断。

A disorder that at first attracted Freud, hysteria.

一种最初吸引弗洛伊德的疾病是癔病。

And now we should say you wrote a book on hysteria.

现在我们应该说你写了一本关于歇斯底里症的书。

Oh, I did indeed, yes.

哦，我确实这么做了，是的。

You mentioned …

你提到……

37:38 I mean, hysteria, every classification we’re talking about has been used and abused by every layer of society including institutions- …including just culturally the word hysteria applied to different races disproportionately, to different, um-

我的意思是，歇斯底里，我们谈论的每一种分类都被社会各阶层使用和滥用，包括机构——……包括文化上歇斯底里这个词不成比例地应用于不同的种族，不同的，嗯——

Genders particularly, yes, yes.

尤其是性别，是的，是的。

…genders disproportionate- So we’re in this crisis of trying to figure out what to do with this super complicated human mind- …and everybody is dogmatically creating narratives that hold, take hold, and in so doing can lead to some abuses-

……性别不成比例——所以我们正处于这场危机中，试图找出如何处理这个超级复杂的人类思维——……每个人都在教条地创造一些叙事，这些叙事能够占据主导地位，这样做可能会导致一些滥用——

Yes, they do.

是的，他们确实这么做了。

38:15 Yes, they do.

是的，他们确实这么做了。

…as you document.

...正如您所记录的那样。

If you look back at the asylum era born in this period of intense optimism, and then the claims to be able to cure these vast numbers of patients were overblown.

如果你回顾一下诞生于这段强烈乐观主义时期的庇护时代，那么声称能够治愈这些大量患者的说法就有些言过其实了。

38:17 Uh, I do believe the early asylums actually did good work and that some patients did very well and recovered as a result of their stays.

呃，我确实相信早期的收容所实际上做得很好，一些病人做得很好，并因住院而康复。

But what happened, they weren’t discharging 80% of their patients.

但结果是，他们没有让 80% 的病人出院。

They were discharging 35 or 40% of their patients, and what that meant is every year left behind were a batch of chronic patients, and then the next year you repeated it.

他们让 35% 或 40% 的病人出院，这意味着每年都会留下一批慢性病人，然后第二年你又重复这样的情况。

And over time, what that means is the ratio of new patients to chronic patients gets worse and worse.

随着时间的推移，这意味着新患者与慢性患者的比例变得越来越糟。

39:02 And more and more the image of the asylum is defined by the chronic patient who hasn’t recovered and maybe spends years or decades there and only leaves in a pine box.

越来越多的精神病院的形象是由尚未康复的慢性病患者定义的，他们可能在那里度过数年或数十年，最后只能留在松木盒子里。

So the, the image of the asylum declined drastically.

于是，收容所的形象急剧下降。

As they became more and more overcrowded, conditions in them deteriorated.

随着它们变得越来越拥挤，里面的条件也恶化了。

Patients were often abused.

病人经常受到虐待。

Psychiatrists didn’t know what to do with them, and they faced a problem in the late 19th century.

精神科医生不知道该如何处理他们，他们在 19 世纪末面临着一个问题。

You’d promised 70% or 80% cures, but we’re not seeing that.

你们承诺治愈 70% 或 80%，但我们没有看到这一点。

In fact, when we calculate cures and the numbers of people in the asylum, it’s more like 10% or 12%.

事实上，当我们计算治愈率和收容所的人数时，它更像是 10% 或 12%。

That’s the way you could play with statistics ’cause that’s all the old patients mixed with the new.

这就是你可以使用统计数据的方式，因为所有的老病人都与新病人混合在一起。

But still, it looks very bad.

但看起来还是很糟糕。

How do you explain this doctor?

这位医生怎么解释呢？

39:56 You’ve promised us one thing, and you delivered something quite different.

你向我们承诺了一件事，但你却交付了完全不同的东西。

The answer came in a way of blaming the victim, in a way of saying, “Well, you know, what we didn’t understand was that mental illness is a fundamentally biological condition.

答案以指责受害者的方式出现，以某种方式说：“嗯，你知道，我们不明白的是，精神疾病本质上是一种生物学疾病。

These people are evolutionary throwbacks.” Evolution was generally thought of as a progressive onwards and upwards, but these people had fallen back into a, into a, a, a lesser form of existence.

这些人是进化的倒退。”进化通常被认为是向前和向上的进步，但这些人却退回到了一种较低的存在形式。

They’d lost their essential humanity because their brains were defective.

他们失去了基本的人性，因为他们的大脑有缺陷。

So what emerged then was the idea of degeneration, the idea that these patients were degenerates.

于是就出现了退化的观念，这些病人都是退化的观念。

They were people with an inferior biology.

他们是生理素质较差的人。

You couldn’t release them because they breed like rabbits.

你不能释放它们，因为它们像兔子一样繁殖。

They didn’t have any self-control because of their diminished humanity.

由于人性的削弱，他们没有任何自制力。

This is the narrative.

这就是叙述。

This is the narrative.

这就是叙述。

40:52 And so what it did was provide a justification for locking up people in asylums that wasn’t therapeutic at all.

因此，它所做的就是为将人们关进完全没有治疗作用的收容所提供了理由。

It was just keeping them out of the way.

这只是让他们远离。

And then it led to the justification of sterilization- ….based on the same argument.

然后它导致了绝育的合理性——……基于同样的论点。

So if maybe we can release them if we make sure they can’t breed.

因此，如果我们确保它们无法繁殖，也许我们可以释放它们。

This is the beginning of the darkness.

这是黑暗的开始。

It is the beginning of the darkness.

这是黑暗的开始。

41:12 My own state was one of the pioneers in this process, and it continued to sterilize mental patients up until about 1960.

我所在的州是这一过程的先驱之一，它一直对精神病人进行绝育，直到 1960 年左右。

By the 1960s, over 60,000 sterilizations have been performed in the US with California performing a disproportionally high number.

到 20 世纪 60 年代，美国已实施了超过 60,000 例绝育手术，其中加利福尼亚州的绝育手术数量高得不成比例。

That’s correct.

这是正确的。

41:36 But even more serious consequences could flow from these set of issues.

但这些问题可能会带来更严重的后果。

When you start talking, one, one British psychiatrist said that if his patients that were coming into the asylum had been puppies, we’d have tied them up in a sack because they were some horrible mongrel, not a purebred dog, tied them up in a sack with some lead weights, and thrown them in a pond and drowned them.

当你开始说话时，一位、一位英国精神病学家说，如果他进入精神病院的病人是小狗，我们会把它们绑在麻袋里，因为它们是一些可怕的杂种，而不是纯种狗，用一些铅重物把它们绑在麻袋里，然后把它们扔进池塘里淹死。

Man.

男人。

That kind of language is very, very dangerous.

这种语言是非常非常危险的。

42:06 And what happened, California’s law surrounding sterilization was advocated for in the West.

结果，加州关于绝育的法律在西方得到了提倡。

By that I mean North America and, and Britain and much of Europe.

我指的是北美、英国和欧洲大部分地区。

There were enough checks and balances in a democratic system that even though there were enthusiasts, the eugenicists who said, “Best get rid of these people, put them to death,” uh, that never really, that never really acquired mass support.

民主制度中有足够的制衡，即使有热衷者，优生学家也说，“最好摆脱这些人，把他们处死”，呃，从来没有真正获得过群众的支持。

But what happened in Germany once Nazi– the Nazis came to power is they seized on these notions and that the idea that the mentally ill were, as they put it, useless eaters, people consuming resources but never gonna get better, just a burden on the state.

但纳粹上台后在德国发生的事情是，他们抓住了这些观念，认为精神病患者，正如他们所说，是无用的食者，消耗资源但永远不会好起来的人，只是国家的负担。

Their lives weren’t worth living because after all, they had this serious mental illness.

他们的生活不值得过，因为毕竟他们患有这种严重的精神疾病。

43:02 So first you sterilize, and then you go, “But we’re still supporting all these people.” And so Hitler starts something called the T4 program after the street name of the house where this was concocted, Tiergartenstraße 4.

所以首先你要进行绝育，然后你说，“但我们仍然支持所有这些人。”因此，希特勒启动了一项名为 T4 计划的项目，该计划以该计划制定的房子的街道名称 Tiergartenstraße 4 命名。

And the mentally ill were the first people to suffer from the Final Solution.

而精神病患者是最先遭受“最终解决方案”折磨的人。

It was in the mass killing of the mentally ill, which may have been as many as a quarter million people, that the technology of the gas chamber was developed, and the technology of disguising the gas chamber as showers was developed.

正是在对精神病人（可能多达25万人）的大规模屠杀中，毒气室的技术得以发展，将毒气室伪装成淋浴的技术也得以发展。

And so patients were taken away to a number of psychiatric centers and systematically put to death, and they had, they had the crematoriums and the black smoke, and local people talked about the buses that were bringing them in as killing crates.

因此，病人被带到许多精神病中心并系统地处死，他们有火葬场和黑烟，当地人谈论将他们运来的巴士就像杀戮板条箱。

44:00 So they were aware of what was going on.

所以他们知道发生了什么。

Were they influenced by the narratives that were born in the United States?

他们受到美国诞生的叙事的影响吗？

Yes, absolutely.

是的，绝对是。

44:05 They-

他们——

About this kind of-

关于这种——

About that sort of thing, and lacking the checks and balances that at least until recently this country had, it was relatively easy for Hitler to do that.

对于这类事情，由于缺乏至少直到最近这个国家所拥有的制衡机制，希特勒相对容易做到这一点。

44:07 And particularly with the war looming, the idea that we’re gonna support all these useless people, let’s kill them.

尤其是随着战争迫在眉睫，我们要支持所有这些无用的人，让我们杀死他们。

And German psychiatry for the most part collaborated with that process.

德国精神病学在很大程度上参与了这一过程。

I wonder how many people throughout that whole journey in the psychiatry profession sort of were brave enough to speak up like, “Hey, maybe the sack of puppies kinda language-“

我想知道在精神病学行业的整个旅程中，有多少人有足够的勇气说出这样的话，“嘿，也许小狗的麻袋有点语言——”

Oh, yes.

哦，是的。

44:46 Oh, yes.

哦是的。

…

……

is a problem?”

有问题吗？

That’s the really nasty direction that that language could lead to.

这才是该语言可能导致的真正令人讨厌的方向。

44:48 And it was symptomatic of the kind of stigma that tends to attach itself to mental illness and this sense of hopelessness.

这是一种往往与精神疾病和绝望感联系在一起的耻辱感的症状。

So but if you’re a healing profession, if you enter psychiatry thinking, “I’m gonna do this to help people, to cure people, to make their lives better,” to just become a glorified boarding housekeeper keeping them under lock and key or in the alternative to collaborate in the sorts of awfulness that the Nazis perpetrated, that’s something from which decent human beings tend to recoil and decent psychiatrists tended to recoil.

所以，如果你是一个治疗职业，如果你进入精神病学领域，你会想：“我要做这件事是为了帮助人们，治愈人们，让他们的生活变得更好”，只是成为一名光荣的寄宿管家，把他们锁在门外，或者与纳粹所犯下的可怕罪行合作，这是正派的人类往往会退缩的事情，正派的精神病学家往往会退缩。

45:36 And so still thinking as they did by the end of the 19th century that mental illness was predominantly a biological problem, some of them began to say, “Well, maybe biology as well as being the problem could provide the solution.

因此，他们中的一些人仍然像 19 世纪末那样认为精神疾病主要是一个生物学问题，因此开始说：“好吧，也许生物学以及问题本身都可以提供解决方案。

Maybe we should look for ways to intervene in the biological systems of these people and make them better.” The same logic that applies I would say in the present- …

也许我们应该寻找方法来干预这些人的生物系统并让他们变得更好。”我想说的同样的逻辑适用于现在——……

For, for many working in the field.

对于许多在该领域工作的人来说。

But in a cruder form.

但以更原始的形式。

But in a very different form, exactly.

但确切地说，是以一种非常不同的形式。

Yeah.

是的。

46:14 If we can just speak about the Nazis a bit more, you highlight that America financially supported the German psychiatric researchers with deep Nazi ties like Ernst Rüdin who was the key architect of Hitler’s mass sterilization and extermination laws.

如果我们能多谈谈纳粹，你会强调美国在财政上支持与纳粹有深厚关系的德国精神病学研究人员，例如恩斯特·鲁丁（Ernst Rüdin），他是希特勒大规模绝育和灭绝法的关键设计师。

So it seems like the Nazis borrowed the American narratives of the psychiatrist that these are lesser biological beings and then this financial support and the ties continued.

因此，纳粹似乎借用了美国精神病学家的说法，认为这些人是低等生物，然后这种财政支持和联系仍在继续。

Yeah.

是的。

46:42 So one of the organizations that recognized that mental illness was an acute social problem, very costly to the state, inflicting all kinds of suffering on people, was The Rockefeller Foundation.

因此，洛克菲勒基金会是认识到精神疾病是一个严重的社会问题的组织之一，它给国家带来了巨大的损失，给人们带来了各种痛苦。

What we don’t realize today is that the involvement of the federal government in medical research and indeed scientific research is a World War II and post-war development, partly the Cold War and Sputnik and all of that.

今天我们没有意识到的是，联邦政府对医学研究和科学研究的参与是第二次世界大战和战后的发展，部分是冷战和人造卫星等等。

But that’s when big science and big medicine got funded-

但这就是大科学和大医学获得资助的时候——

47:21 in extravagant ways.

以奢侈的方式。

Before the war, science was an orphan.

战前，科学是一个孤儿。

It didn’t get money from the government much and medicine even more so.

它没有从政府那里得到太多资金，药品更是如此。

So to the extent medical training was reformed, that was the product of investment by The Rockefeller Foundation, enormously wealthy by the standards of the time.

因此，就医疗培训的改革而言，这是洛克菲勒基金会投资的产物，按照当时的标准，该基金会非常富有。

And come about 1930, The Rockefeller Foundation decided it needed to concentrate its resources and pick priorities for the money it was investing.

1930 年左右，洛克菲勒基金会决定需要集中资源并选择投资的优先顺序。

And it may seem a rather strange thing within the whole range of medical areas that it could choose, it chose psychiatry as the one that it was going to invest in.

在它可以选择的整个医疗领域中，它选择精神病学作为它要投资的领域，这似乎是一件相当奇怪的事情。

And I think it did so in part precisely because scientific research in psychiatry was so backward, partly because it was such a pressing public problem.

我认为这样做的部分原因是精神病学的科学研究非常落后，部分原因是它是一个如此紧迫的公共问题。

Hmm.

嗯。

And partly, and this was less public but nonetheless I think played an important role, several of the trustees of The Rockefeller Foundation had direct experience of mental illness in their families.

部分原因是，虽然这件事不太公开，但我认为发挥了重要作用，洛克菲勒基金会的几位受托人在他们的家庭中直接经历过精神疾病。

48:26 Wives who’d been institutionalized as schizophrenic.

那些因精神分裂症而被送进收容机构的妻子。

In one case, a wife who murdered the children and killed herself, leaving her husband as a major actor in The Rockefeller Foundation, berefted and of course inclined then to support research in this area.

在一个案例中，一位妻子谋杀了孩子并自杀，让她的丈夫成为洛克菲勒基金会的主要演员，她失去了亲人，当然倾向于支持这一领域的研究。

And Rockefeller spread its money very widely precisely ’cause it didn’t know where to spend most of its money.

洛克菲勒将资金分散得非常广泛，正是因为它不知道把大部分钱花在哪里。

So it did some support of psychotherapeutics.

所以它对心理治疗做了一些支持。

It supported a number of the then extant therapeutic experiments going on, and it supported work in genetics.

它支持了当时正在进行的许多治疗实验，并且支持了遗传学工作。

49:20 And one of the geneticists it supported, Ernst Rüdin in Germany, who was the leading German researcher in genetics and mental disorder.

它支持的遗传学家之一是德国的恩斯特·鲁丁（Ernst Rüdin），他是德国遗传学和精神疾病领域的领先研究员。

And Rüdin, because he’d absorbed the lessons from California about sterilization, became a very enthusiastic proponent of that, and then a supporter of murdering mental patients.

鲁丁因为吸取了加州关于绝育的教训，成为绝育的热情支持者，然后又成为谋杀精神病人的支持者。

And we should say, I mean, we’ll probably talk about the complicated nature of science- …that it sometimes can be captured by certain ideologies and- …in so doing do a lot of damage to humanity.

我们应该说，我的意思是，我们可能会谈论科学的复杂本质——……它有时会被某些意识形态所俘获——……这样做会对人类造成很大的损害。

49:42 But ultimately, the beacon of hope for the future of humanity lays in the scientific method, as flawed as it is.

但最终，人类未来的希望灯塔在于科学方法，尽管它存在缺陷。

So everything we’re talking about, we get to see how you F up- In a major dark disturbing ways throughout the 20th century- …on the– in the psychiatric profession.

所以我们所谈论的一切，我们都会看到你在整个 20 世纪以一种主要的、黑暗的、令人不安的方式——……在——精神病学行业中如何搞砸。

But that should be instructive lessons of how we proceed forward to do better and better and better.

但这应该是我们如何继续做得越来越好的指导性教训。

We can discuss a series of therapeutic experiments on people who were shut up in a double sense.

我们可以讨论一系列针对被双重关押的人的治疗实验。

50:24 They were locked away, and their voices were not heeded because it was the product of their madness.

他们被锁起来，他们的声音没有被理会，因为这是他们疯狂的产物。

And so what we see in the first five decades really of the 20th century is people with a variety of motivations including the desire to improve the lot of the mentally ill engaging in uncontrolled experiments that had terrible results.

因此，我们在 20 世纪的前 50 年看到的是，人们有着各种各样的动机，包括希望改善精神病患者的命运，从事不受控制的实验，但结果却很糟糕。

And the science behind it was shaky but nonetheless it existed.

虽然其背后的科学原理并不可靠，但它仍然存在。

It wasn’t just plucked out of the sky.

它不只是从天上掉下来的。

And yes, eventually those things break down.

是的，最终这些东西都会崩溃。

I mean, the clearest case of that because it’s the most extreme of these at least in the public imagination is lobotomy.

我的意思是，最明显的例子是脑白质切除术，因为至少在公众的想象中这是最极端的。

51:15 The idea that you are going to solve psychotic breakdowns in people by excising part of their brain initially by drilling holes in the skull and injecting alcohol or using what looks like a butter knife to break connections between the brain.

这个想法是，你要通过在头骨上钻孔并注射酒精或使用看起来像黄油刀的东西来切断大脑之间的连接来切除部分大脑来解决人们的精神崩溃。

And then later when that process seems to be too slow, the Henry Ford of lobotomy — his daughter said Walter Freeman aspired to be the Henry Ford of lobotomy, the one who could mechanize the production of it and get it done fast.

后来，当这个过程似乎太慢时，脑白质切除术的亨利·福特——他的女儿说沃尔特·弗里曼渴望成为脑白质切除术的亨利·福特，一个能够机械化生产并快速完成它的人。

He invented the ice pick lobotomy where you used an ice pick in the orbit of the eye having rendered somebody unconscious after two or three electric shocks and you banged it through the bone and wiggled it about and severed — I mean, it’s just hard to even describe.

他发明了冰锥脑叶白质切除术，用冰锥刺入眼眶，使某人在受到两三次电击后失去知觉，然后用冰锥敲击骨头，扭动它并切断——我的意思是，这甚至很难描述。

So this is from the 1930s to the 1970s?

那么这是从 1930 年代到 1970 年代吗？

Yes.

是的。

52:12 Freeman starts his work in 1936 borrowing from the work of the preceding year of a Portuguese neurologist named Egas Moniz.

弗里曼于 1936 年开始他的工作，借鉴了一位名叫埃加斯·莫尼兹 (Egas Moniz) 的葡萄牙神经学家前一年的工作。

And Moniz wins the Nobel Prize in medicine in 1949 for lobotomy.

莫尼斯因脑白质切除术于 1949 年获得诺贝尔医学奖。

So it’s important to see that.

所以看到这一点很重要。

That was 14 years of experience and yet that won a Nobel Prize.

那是14年的经验，但却获得了诺贝尔奖。

I’m sure that’s one they’d like to retract.

我确信他们想撤回这一内容。

So he popularized, Walter Freeman, the ice pick.

于是他普及了沃尔特·弗里曼（Walter Freeman）冰镐。

And his particular specialty after the war became this ice pick lobotomy because there were over half million patients in America’s mental hospitals.

战后他的特殊专长是冰镐脑白质切除术，因为美国精神病院里有超过 50 万患者。

52:42 Freeman was convinced this operation was a cure-all.

弗里曼确信这次手术是包治百病的灵丹妙药。

And so he traveled around in a camper truck which he called the Lobotomobile, and he would descend in the summer on state hospitals and he would teach them how to do this ice pick lobotomy.

于是，他开着一辆他称之为 Lobotomobile 的露营车四处旅行，夏天他会来到州立医院，教他们如何进行冰锥脑白质切除术。

This is by the way image of the tool.

顺便说一下，这是该工具的图像。

Yes, those are the tools he used.

是的，这些就是他使用的工具。

53:15 Originally, he used an actual ice pick and then he developed this-

最初，他使用的是真正的冰镐，然后他开发了这个-

This is what he developed.

这就是他开发的。

53:20 This is the state-of-the-art technology.

这是最先进的技术。

This is the state of the art with a hammer or a mallet.

这是使用锤子或木槌的现有技术。

Oh no!

哦不！

Yes, I’m sorry.

是的，对不起。

53:26 It’s very distressing.

这是非常令人痛苦的。

I don’t know-

我不知道-

You having to write about this, by the way –

顺便说一句，你必须写下这个——

Well, it’s really-

嗯，这确实是——

Is a lot.

是很多。

…very, very, very, very difficult.

……非常、非常、非常、非常困难。

53:36 I came across, for example, a picture of a woman, a naked woman being dragged away by attendants to be lobotomized, and she’s resisting with all her might, and to no avail.

比如我看到一张女人的照片，一个裸体女人被服务员拖走去做脑叶白质切除术，她极力反抗，但无济于事。

You have a picture there of Walter Freeman lobotomizing a patient in Washington State.

你有一张沃尔特·弗里曼在华盛顿州对一名病人进行脑白质切除术的照片。

Freeman was ambidextrous, and when he taught neurology, he would draw simultaneously with his left and right hand, and he could do it perfectly.

弗里曼双手灵巧，在教授神经学时，他会用左手和右手同时画画，而且可以完美地完成。

When he was performing lobotomy, when his right hand got tired, he switched to his left hand, and he sometimes would do 20 or 30 lobotomies in an afternoon.

他做脑白质切除手术时，右手累了，就换左手，有时一个下午要做20、30个脑白质切除手术。

And he boasted, he said, “You know, I could teach any damn fool to perform a lobotomy in twenty minutes, even a psychiatrist.” Because Freeman was a neurologist, and he had a lot of contempt for psychiatrists.

他还吹嘘说：“你知道，我可以在二十分钟内教任何该死的傻瓜进行脑白质切除术，甚至是精神科医生。”因为弗里曼是一名神经科医生，他对精神科医生非常蔑视。

54:33 So this was a very ugly episode.

所以这是一个非常丑陋的插曲。

How did it die away?

它是怎么消亡的？

It really took generational change.

这确实需要一代人的变革。

Some of these lobotomists continued to operate into the sixties, even to the early seventies, but the younger generation who became acquainted with the really worst failures of that regime — the people on the back wards who were incontinent, who were basically zombies, had lost all mental power — they rebelled against this, and by then they had a different treatment in the form of antipsychotic drugs-

这些脑叶白质切除手术者中的一些人一直持续到六十年代，甚至到七十年代初，但是年轻一代逐渐熟悉了该政权真正最严重的失败——那些在后院失禁的人，基本上是僵尸，已经失去了所有的精神力量——他们对此进行了反抗，到那时他们接受了抗精神病药物形式的不同治疗——

55:16 …

……

which looked much more like what regular medicine was doing and didn’t have these horrible overtones.

这看起来更像是常规医学的作用，并且没有这些可怕的暗示。

And of course, in the popular mind, I think the probably the most famous instance of telling the public about some of these interventions was the film of Ken Kesey’s novel One Flew Over the Cuckoo’s Nest, where you see Jack Nicholson, giving I think the performance of a lifetime, who is given ECT, electroconvulsive therapy, in a very dramatic rendition of what that was — not, not really what was going on by the 1970s with ECT, but nonetheless, certainly what had been going on back in the past.

当然，在大众心目中，我认为向公众讲述其中一些干预措施的最著名的例子可能是肯·凯西的小说《飞越疯人院》的电影，在那里你可以看到杰克·尼科尔森，我认为他一生中的表演，他接受了 ECT，电休克治疗，以一种非常戏剧性的方式再现了当时的情况——不是，不是 1970 年代 ECT 所发生的事情，但尽管如此，当然是过去发生的事情。

56:06 And then finally, when ECT doesn’t smash him to bits, they lobotomize him.

最后，当电休克疗法没有把他打成碎片时，他们就对他进行了脑白质切除术。

And, and the film ends obviously with him being smothered to death ’cause Chief can’t bear to see him in, in the state that he’s in.

而且，影片的结尾显然是他被窒息而死，因为酋长不忍心看到他现在的样子。

So that fixed in the public mind some of the images of these things.

这样就在公众心中固定了这些事情的一些形象。

It is one of the things that gave electroconvulsive therapy such a bad name.

这是电休克疗法名声不佳的原因之一。

So we will actually, not to fast forward too quickly,- -…

所以我们实际上不会快进太快，- -...

56:35 let’s talk about the full journey of everything we’ve been talking about.

让我们来谈谈我们一直在谈论的一切的完整旅程。

So we mentioned the asylum era that began in the mid-nineteenth century going into twentieth, and we talked about the narratives-

所以我们提到了从十九世纪中叶开始到二十世纪的庇护时代，我们谈论了叙述——

And we talked about sterilization.

我们讨论了灭菌。

Sterilization.

灭菌。

56:53 And let’s look at the insulin shock therapy of nineteen thirty three to the ninteen sixties where you were putting patients in deep hypoglycemic comas using large doses of insulin.

让我们看看 19 世纪 33 年代到 19 世纪 60 年代的胰岛素休克疗法，使用大剂量的胰岛素使患者陷入深度低血糖昏迷。

Yeah.

是的。

57:07 So as I mentioned for psychiatrists who went into the field and were ambitious but who also wanted to think of themselves as therapeutic agents-

正如我所提到的，那些进入该领域并雄心勃勃但也想将自己视为治疗剂的精神科医生——

57:18 ….uh, to just sit there passively and contain the patients was very unattractive.

......呃，只是被动地坐在那里并遏制病人是非常没有吸引力的。

And so they looked around for ways in which perhaps biological interventions could be used to ameliorate this condition that they still saw in largely biological terms.

因此，他们四处寻找也许可以使用生物干预措施来改善这种情况的方法，而他们仍然在很大程度上从生物学角度看待这种情况。

Now in some ways, one of the crucial early ways in which this thinking went and which affected a large number of patients was this: one of the few diagnostic triumphs of psychiatry in the early nineteenth century as the profession began to emerge was that it began to distinguish a group of patients who were deemed to be suffering from something called General Paralysis of the Insane.

从某些方面来说，这种思想的早期影响之一是：十九世纪初期，随着精神病学专业的兴起，精神病学在诊断方面取得的少数胜利之一是，它开始区分出一群被认为患有“疯子全身瘫痪”的患者。

That encapsulates two things about what was going on.

这概括了正在发生的两件事。

58:13 First of all, paralysis; the gradual loss of motor control, ability to walk, ability to swallow, ability to talk.

首先是瘫痪；逐渐丧失运动控制、行走能力、吞咽能力、说话能力。

So those are primarily what we’d think of these days as neurological issues.

所以这些主要是我们现在认为的神经问题。

But those were accompanied by bizarre psychiatric symptomatology.

但这些都伴随着奇怪的精神症状。

These were people who thought they were Napoleon or Jesus Christ or the richest and sexiest man in the world-

这些人认为自己是拿破仑或耶稣基督或世界上最富有和最性感的男人 -

58:44 …or Mary the mother of God.

……或者上帝的母亲玛丽。

They were primarily men but there were also female victims.

他们主要是男性，但也有女性受害者。

At the turn of the twentieth century as many as twenty five percent of the people being admitted to asylums were suffering from General Paralysis of the Insane or GPI for short.

在二十世纪之交，被收容的人中有百分之二十五患有疯人全身瘫痪（简称 GPI）。

There have been a lot of suspicions about this being connected somehow to sex and to moral dissolution and so forth but what evolved in the early twentieth century was the discovery of the actual origins of this disorder.

人们对这种疾病是否与性和道德败坏等有某种联系有很多怀疑，但在二十世纪初，人们发现了这种疾病的实际起源。

So I’ve said psychiatry has been looking for the underlying pathology that lies behind mental diseases.

所以我说过精神病学一直在寻找精神疾病背后的潜在病理学。

This was one that at Rockefeller Institute they discovered that the organism that causes syphilis was residing in the brains of the people who were suffering from GPI.

在洛克菲勒研究所，他们发现导致梅毒的微生物存在于患有 GPI 的人的大脑中。

59:48 This was in fact tertiary stage of syphilis.

这实际上是梅毒的第三阶段。

Syphilis is still a real public health problem.

梅毒仍然是一个真正的公共卫生问题。

It was like AIDS in the late nineteenth century.

这就像十九世纪末的艾滋病。

It was everywhere.

它无处不在。

And when you first contract syphilis in the primary phase you have pain, but then it goes underground and you think it’s gone and it lurks the way chicken pox virus lurks and can surface years later, right?

当你在初级阶段第一次感染梅毒时，你会感到疼痛，但随后它就会转入地下，你认为它已经消失了，它像水痘病毒一样潜伏着，几年后就会浮出水面，对吗？

It lurks, it lurks, and it’s insidiously damaging.

它潜伏着，它潜伏着，而且具有潜在的破坏性。

Sometimes it attacks the um, heart and people drop dead of a heart attack in their forties.

有时它会攻击嗯，心脏，人们在四十多岁的时候就死于心脏病。

Ohh, he died of a r– You know, it’s natural heart attack, but in fact it was the syphilis.

哦，他死于……你知道，这是自然心脏病，但实际上是梅毒。

Or it attacks the central nervous system, the spinal column and the brain, and then you get the paralysis – Mm-hmm …and then you get also the psychiatric symptomatology.

或者它攻击中枢神经系统、脊柱和大脑，然后你就会出现瘫痪——嗯嗯……然后你也会出现精神症状。

1:00:44 So when that was discovered, that sort of suggested that mental illness might have an infectious origin.

因此，当这一点被发现时，这就表明精神疾病可能具有传染性。

Tertiary syphilis, GPI, went on to win for somebody who developed a treatment for it a Nobel Prize, one of only two awarded for psychiatric innovations.

三期梅毒（GPI）后来因开发出一种治疗方法而荣获诺贝尔奖，这是仅有的两项因精神病学创新而获奖的奖项之一。

One was a lobotomy, the other was giving people malaria to cure their syphilis.

一种是脑叶白质切除术，另一种是给人们注射疟疾来治疗梅毒。

In case people didn’t hear that- Giving people malaria- ..

万一人们没有听到这一点-给人们带来疟疾-..

1:01:08 In order to cure syphilis

为了治愈梅毒

So there was an Austrian doctor, Wagner-Jauregg, who had long thought that fever could be used to cure mental illness.

于是就有了一位奥地利医生瓦格纳-贾雷格，他很早就认为发烧可以用来治疗精神疾病。

1:01:18 And he tried rat bite fever.

他还尝试过鼠咬热。

He tried giving people typhoid vaccine that creates a fever to no avail.

他尝试给人们接种导致发烧的伤寒疫苗，但没有成功。

And towards the end of World War I, the Italians were fighting in World War I on the side of the British and the Americans and the French.

第一次世界大战即将结束时，意大利人在第一次世界大战中与英国人、美国人和法国人并肩作战。

They captured an Italian soldier who had malaria.

他们俘虏了一名患有疟疾的意大利士兵。

Malaria was endemic in those years in Italy.

那些年，疟疾在意大利流行。

And they brought him to him, and he extracted the malarial blood and injected it into a series of patients with GPI, with general paralysis of the insane, and claimed it cured them.

他们把他带到他身边，他提取了疟疾的血液，并将其注射到一系列患有 GPI 的患者体内，这些患者患有全身性瘫痪，并声称它治愈了他们。

1:02:03 We know from later on when he fessed up that those claims were wildly exaggerated, but they were widely accepted, and malarial treatment spread to Britain, it spread to Germany, it spread to the United States.

后来我们知道，当他承认这些说法被严重夸大时，但它们被广泛接受，疟疾治疗传播到了英国，传播到了德国，传播到了美国。

Sometimes it was vials of malarial blood, but very often mental hospitals had actual colonies of malarial mosquitoes.

有时是小瓶疟疾血液，但精神病院通常有真正的疟蚊群。

So imagine you’re a mental patient, and you’re put in a straitjacket, and you’re put in a room, and you can’t move, and mosquitoes are buzzing around, and they bite you, and then you develop malaria.

想象一下，你是一个精神病人，你被穿上紧身衣，被关在一个房间里，你无法动弹，蚊子在周围嗡嗡作响，它们咬你，然后你就患上了疟疾。

And he got a Nobel Prize for this?

他因此获得了诺贝尔奖？

Yes, in 1937, he got a Nobel Prize.

是的，1937年，他获得了诺贝尔奖。

1:02:42 ‘Cause this was a condition that was invariably fatal.

因为这种情况总是致命的。

And the claim was that somehow the malarial fever worked.

据称，疟疾热病以某种方式起作用了。

Now, there are two possible ways.

现在，有两种可能的方法。

Von Jauregg thought it stimulated the immune system to attack whatever it was, was causing the insanity.

冯·贾雷格认为它刺激了免疫系统攻击任何东西，从而导致了精神错乱。

But the other possibility was the following: When you have the malarial parasite in a test tube and you heat the test tube to about 105, 106 degrees, it dies.

但另一种可能性是：当你将疟疾寄生虫放入试管中并将试管加热到大约 105、106 度时，它就会死亡。

So the idea potentially was you were sort of burning the parasites out of the brain with this agent.

所以这个想法可能是用这种药剂将寄生虫从大脑中烧掉。

And because people were pretty unsophisticated about statistics and because the idea of a controlled trial had not yet come to pass, this treatment was used extensively for a couple of decades.

由于人们对统计学相当不熟悉，而且对照试验的想法尚未成为现实，这种治疗方法被广泛使用了几十年。

1:03:42 What caused it to stop, and you talk about the progress of science, was the discovery of penicillin, which was a real magic bullet.

导致它停止的原因是青霉素的发现，这是一颗真正的灵丹妙药。

1:03:51 So once you had penicillin, you weren’t gonna continue treating people with malaria, so it died away.

所以一旦你有了青霉素，你就不会继续治疗疟疾患者，所以它就会消失。

But it was the first such treatment, and here’s the other way this feeds into the narrative of these desperate remedies that develop in this period between the mid-‘teens and, say, 1950.

但这是第一次这样的治疗，而且这是对这些绝望疗法的叙述的另一种方式，这些疗法是在青少年中期到 1950 年这一时期发展起来的。

The discovery of the syphilitic origins of general paralysis of the insane occurred at a time when medicine had undergone a profound transformation.

疯子全身瘫痪的梅毒起源的发现发生在医学经历深刻变革的时代。

In the late 19th century, the work of Louis Pasteur, who was a chemist, not an MD, and the work of Robert Koch in Germany had uncovered the origins of a variety of diseases and suggested that bacteria were the reason why people sickened.

19世纪末，化学家路易斯·巴斯德（Louis Pasteur）（而非医学博士）和德国罗伯特·科赫（Robert Koch）的工作揭示了多种疾病的根源，并提出细菌是人们生病的原因。

1:04:47 And that led, of course, to a whole series of public health triumphs, because initially it didn’t lead to antibiotics.

当然，这带来了一系列公共卫生方面的胜利，因为最初它并没有带来抗生素。

But for a lot of these diseases, even viral diseases like rabies, you could develop a vaccine.

但对于许多此类疾病，甚至是狂犬病等病毒性疾病，您都可以开发疫苗。

1:05:05 And the vaccines were phenomenally effective.

这些疫苗非常有效。

And so that was one way in which the new germ theory of disease transformed medicine and tied it into the laboratory and into science in a new way.

因此，这是新的疾病细菌理论改变医学并以新的方式将其与实验室和科学联系起来的一种方式。

And the other was the adaptation of Pasteur’s theories by a British surgeon named Lister, who previously when pus developed post-surgery, people had thought that was a good sign.

另一个是英国外科医生李斯特（Lister）对巴斯德理论的改编，以前当李斯特在手术后出现脓液时，人们认为这是一个好兆头。

Lister said, “No, I don’t think so.

李斯特说：“不，我不这么认为。

This is actually these nasty germs causing this, and so we’re gonna do antiseptic surgery.” So he sprayed carbolic acid on the wounds to try to kill the microbes.

这实际上是这些讨厌的细菌造成的，所以我们要做消毒手术。”于是他在伤口上喷洒石炭酸，试图杀死微生物。

Most of his colleagues thought he was nuts.

他的大多数同事都认为他疯了。

Thought he was just– This is ridiculous, these microorganisms.

以为他只是——这太荒谬了，这些微生物。

You couldn’t even see them, you know?

你甚至看不到他们，你知道吗？

Well, you could with a…

好吧，你可以用...

But Lister prevailed.

但李斯特占了上风。

1:06:05 And eventually we moved from antiseptic surgery to aseptic surgery, which is what we have now, where you try to have a sterilized set of instruments in a sterilized environment, so you don’t infect things, right?

最终我们从防腐手术转向无菌手术，这就是我们现在所拥有的，你试图在无菌环境中使用一套经过消毒的仪器，这样你就不会感染东西，对吗？

By the way, these are definitive examples of progress in medicine.

顺便说一句，这些都是医学进步的明确例子。

Absolutely.

绝对地。

Penicillin-

青霉素-

Yes

是的

…you know, making sure there’s no germs in during surgery.

……你知道，确保手术过程中没有细菌。

Associated with wounds, yes.

与伤口有关，是的。

So these are all just refreshingly clear examples of progress.

因此，这些都是令人耳目一新、清晰的进步例子。

1:06:30 The reason I say it’s refreshingly clear that there’s progress, there’s not a refreshingly clear progress in the history of psychiatry.

我之所以说进步是令人耳目一新的，但精神病学的历史上并没有令人耳目一新的明显进展。

Maybe, maybe a few hints.

也许，也许一些提示。

Some bits, yes.

有些位，是的。

1:06:44 There haven’t been the dramatic breakthroughs that I think everybody in the field would hope for.

我认为该领域的每个人都希望没有取得重大突破。

And there’s some debate about how powerful what we have done is, and I think it’s reasonable to debate that and to also acknowledge that there is important progress, limited as it is.

关于我们所做的事情有多强大存在一些争论，我认为对此进行争论并承认取得了重要进展（尽管进展有限）是合理的。

Now you have 25% of the admits to a mental hospital actually suffering from an infectious disease.

现在精神病院收治的病人中有 25% 实际上患有传染病。

Medicine in general has now tied its fortunes to the laboratory.

医学界现在已将其命运与实验室联系在一起。

The idea that disease is caused by bacteria, we can’t yet see viruses.

人们认为疾病是由细菌引起的，但我们还看不到病毒。

1:07:28 It is a very powerful one and that notion that disease is caused by bacterial infection acquires great momentum, but it hasn’t touched psychiatry.

这是一个非常强大的观点，疾病是由细菌感染引起的这一观点获得了巨大的支持，但它还没有触及精神病学。

So medicine now has interventions that work, and sometimes quite dramatically.

因此，医学现在已经有了有效的干预措施，有时甚至效果显着。

You know, the first patient given diphtheria vaccine– Diphtheria causes a leather-like membrane to grow over your throat and you die choking to death.

你知道，第一个注射白喉疫苗的病人——白喉会导致你的喉咙上长出一层皮革状的薄膜，然后你就会窒息而死。

And if you have a child and you watch that child die like that, you will never be over it.

如果你有一个孩子，而你看着那个孩子就这样死去，你将永远无法释怀。

So when you had something that warded that off, that improved medicine’s image dramatically and improved its financial prospects dramatically, particularly as medical training became reformed and more involved with science.

因此，当你有一些东西可以阻止这种情况时，就会极大地改善医学形象并极大地改善其财务前景，特别是随着医疗培训的改革并更多地涉及科学。

So that hasn’t applied to psychiatry until syphilis comes along.

因此，直到梅毒出现之前，这才适用于精神病学。

Now we have the model that an infectious

现在我们有了一个模型，传染性

1:08:39 agent can cause people’s minds to go amok

代理可以使人们的思想变得疯狂

1:08:46 So the very person who invents the basic distinction between kinds of psychoses we still use today, schizophrenia and bipolar disorder, Emil Kraepelin, begins to think, “You know, there may be something infectious about the mental illnesses we’re treating.” And one of the people he trains is a young psychiatrist from the United States named Henry Cotton, who’s also been trained by Adolf Meyer, who is the leading American psychiatrist of the first forty years of the twentieth century.

因此，埃米尔·克雷佩林 (Emil Kraepelin) 发明了我们今天仍在使用的各种精神病（精神分裂症和双相情感障碍）之间的基本区别，他开始思考：“你知道，我们正在治疗的精神疾病可能具有传染性。”他培养的人之一是来自美国的年轻精神病学家亨利·科顿，他也曾受过二十世纪前四十年美国顶尖精神病学家阿道夫·迈耶的培养。

And when he comes back from Germany having spent a year there, Meyer secures him a position as head of the New Jersey State Mental Hospital at Trenton.

当他从德国呆了一年回来后，迈耶为他安排了新泽西州立特伦顿精神病医院院长的职位。

And Cotton is an ambitious, reforming man.

科顿是一位雄心勃勃、勇于改革的人。

He wants to bring psychiatry back to medicine.

他希望将精神病学带回医学领域。

He also wants to chuck out all the old stuff.

他还想扔掉所有旧的东西。

He doesn’t want chains in his

他不希望自己身上有锁链

1:09:44 hospital.

医院。

He doesn’t want, if he can help it, straightjackets.

如果可以的话，他不想穿紧身衣。

So that goes away, but nothing seems to change fundamentally.

这样就消失了，但似乎没有什么根本改变。

He still isn’t curing patients.

他仍然没有治愈病人。

And then he comes across this idea of focal sepsis, the idea that low-grade infections can lurk in the body, and what they do is release toxins into the bloodstream and the lymph.

然后他想到了局灶性败血症的想法，即低度感染可能潜伏在体内，它们的作用是将毒素释放到血液和淋巴液中。

And hey, imagine if those toxins get to the brain.

嘿，想象一下这些毒素是否进入大脑。

What’s it going to do?

它会做什么？

It’s gonna poison the brain, and the brain is then gonna act up.

它会毒害大脑，然后大脑就会变得异常。

1:10:19 So we don’t have antibiotics.

所以我们没有抗生素。

So what are we gonna do about this?

那么我们该怎么办呢？

Well, we can perhaps locate the bacterial infection and then we can get rid of it.

好吧，我们也许可以找到细菌感染，然后我们就可以摆脱它。

We can engage in what he calls surgical bacteriology.

我们可以从事他所谓的外科细菌学研究。

So the first obvious target here is teeth.

所以这里第一个明显的目标是牙齿。

Your teeth look close to your brain.

你的牙齿看起来离你的大脑很近。

They’re often infected.

他们经常被感染。

That infection often goes untreated for a time…

这种感染通常会在一段时间内得不到治疗……

So we pull a lot of teeth.

所以我们拔了很多牙齿。

Patients don’t get better.

病人并没有好转。

Mm, maybe the theory’s wrong?

嗯，也许这个理论是错误的？

No.

不。

Um, tonsils, well, they’re getting infected, so we’ll remove them.

嗯，扁桃体，好吧，它们被感染了，所以我们要把它们切除。

Still don’t get better.

还是没有好转。

Well, they’re swallowing the bacteria, so we remove stomachs, and we remove spleens, and we remove colons.

好吧，它们正在吞下细菌，所以我们切除了胃，切除了脾脏，并切除了结肠。

And we claim to be curing eighty percent of our patients.

我们声称可以治愈百分之八十的患者。

And rich patients come from all over America to be treated with this novel treatment.

来自美国各地的富有患者接受这种新颖的治疗方法。

Crazy

疯狂

Cotton gives a series of lectures at Princeton.

科顿在普林斯顿大学做了一系列讲座。

1:11:22 There were not some lectures which are given by Nobel Prize winners.

没有一些诺贝尔奖获得者的演讲。

There’s a very prestigious series.

有一个非常有声望的系列。

It’s published by Oxford University Press and Princeton University Press.

它由牛津大学出版社和普林斯顿大学出版社出版。

The New York Times hails it as a great breakthrough.

《纽约时报》称赞这是一个伟大的突破。

And in reality, forty-five percent of the people who get the abdominal surgery die within a year.

事实上，接受腹部手术的人中有百分之四十五会在一年内死亡。

They’re cutting out stomachs

他们正在切除胃

Yep.

是的。

1:11:47 He’s cutting out stomachs.

他正在切除胃。

He says –there’s this passage in one of his papers where he says “stomachs are like cement mixers on a construction site and could be dispensed with.” When you think oh my God.

他说——他的一篇论文中有这样一段话，他说“胃就像建筑工地上的水泥搅拌机，可以被省掉。”当你想天哪。

If you were released from Trenton and you had no teeth, people immediately knew you were an ex-patient because the word had spread.

如果你从特伦顿出院并且没有牙齿，人们会立即知道你是一名前病人，因为消息已经传开了。

And this goes on for– starting in nineteen sixteen.

这种情况一直持续下去——从十九点十六分开始。

Cotton drops dead of a heart attack in nineteen thirty-three, but he’s succeeded by three people he’s trained.

十九点三十三分，科顿因心脏病去世，但他训练的三个人接替了他。

They drop the abdominal surgery.

他们放弃了腹部手术。

They use colonic irrigation, but the teeth and the tonsils keep being pulled.

他们使用结肠冲洗，但牙齿和扁桃体不断被拉扯。

I interviewed the dentist who had come to the hospital in nineteen sixteen and must have pulled several hundred thousand teeth, and he retired in nineteen sixty, which was when

我采访了一位牙医，他在十九十六岁的时候来到医院，一定拔了几十万颗牙齿，他在十九岁六十岁退休了，也就是那时。

1:12:44 that finally stopped.

终于停止了。

And he was convinced Cotton should have won the Nobel Prize for this.

他坚信科顿应该因此获得诺贝尔奖。

Oh well.

那好吧。

Can you just give some intuition, put ourselves in that mind space, I mean, presumably these are smart human beings, why were they fraudulent in the reporting of how effective it is?

你能否给出一些直觉，将我们自己置于那个思维空间中，我的意思是，大概这些人都是聪明人，为什么他们在报告其有效性方面存在欺诈行为？

1:12:51 Why are all the people that are participating, both the doctors and general culture–

为什么所有的人都参与其中，包括医生和一般文化——

it’s extraordinary.

这是非凡的。

1:13:11 So obviously, many of the interventions I’m talking about are very powerful interventions conducted by people in white coats and stethoscopes and scalpels.

显然，我所说的许多干预措施都是由穿着白大褂、拿着听诊器和手术刀的人进行的非常有力的干预措施。

Powerful by the way by the amount of impact they have on the human body, not powerful in terms of how effective they are.

顺便说一下，它们的强大在于它们对人体的影响程度，而不是它们的有效性。

Yes, powerful as well in terms of placebo effect.

是的，安慰剂效应也很强大。

1:13:31 Look, what I am going to do to you and yes it’s gonna hurt and it’s very intimate, but it’s going to make you better.

听着，我要对你做的事，是的，这会伤害你，而且非常亲密，但它会让你变得更好。

So that’s always– this is a problem that persists in contemporary psychiatry, trying to figure out how much of the improvement we’re seeing is the placebo effect and how much of it is the active effect of whatever we’re doing.

所以这始终是当代精神病学中持续存在的一个问题，试图弄清楚我们看到的改善有多少是安慰剂效应，有多少是我们正在做的事情的积极影响。

But by the way, on that small tangent, let’s return to that perhaps often.

但顺便说一句，关于这个小切线，让我们也许经常回到这个话题。

Yes.

是的。

I for one can tell you that for me, for my mind, the placebo effect even when you tell me it’s placebo will work.

我可以告诉你，对我来说，对我的思想来说，安慰剂效应即使你告诉我它是安慰剂也会起作用。

Yes!

是的！

But now if you have combined an actual gigantic operation that is physically, mentally, in every way life changing – …

但现在，如果你结合了一个实际的巨大手术，它在身体上、精神上、在各个方面都改变了生活——……

1:14:15 everybody around you in lab coats, all of society’s telling you this is going to be life changing.

你周围的每个人都穿着实验室外套，整个社会都在告诉你这将改变你的生活。

I get it.

我得到它。

That’s like the most pure kind of placebo effect.

这就像最纯粹的安慰剂效应。

It’s placebo effect that comes from both the patient who wants to be better-

这是安慰剂效应，来自于想要变得更好的患者——

1:14:39 …

……

and wants to believe this is gonna make them, and from the person conducting.

并且想要相信这会让他们成功，并且来自指挥者。

And it’s easy to deceive yourself, to see what you want to see.

而且很容易欺骗自己，看到自己想看到的东西。

So anyway, that was one episode.

无论如何，那只是一集。

1:14:52 We talk about triumphs of medicine, so let me talk about one of the real triumphs of 20th century medicine, which is interesting to refer to because it wasn’t a cure, just like psychiatric drugs aren’t a cure for mental illness.

我们谈论医学的胜利，所以让我谈谈 20 世纪医学的真正胜利之一，提到这一点很有趣，因为它不是一种治疗方法，就像精神药物不能治愈精神疾病一样。

It was a symptomatic treatment, but it transformed lives, and that was the discovery of insulin in the 1920s.

这是一种对症治疗，但它改变了生活，这就是 20 年代胰岛素的发现。

Previously, particularly what we now call Type One or juvenile diabetes, was a death sentence.

以前，特别是我们现在所说的一型糖尿病或青少年糖尿病，是一种死刑。

You got it and whatever you did, you tried various quack remedies, you tried diet, you tried all sorts of things.

你得到了它，无论你做了什么，你尝试了各种庸医疗法，你尝试了节食，你尝试了各种各样的事情。

The inevitable thing was it killed you.

不可避免的事情是它杀了你。

And then came insulin.

然后是胰岛素。

1:15:43 Now insulin doesn’t mean you’re cured of your diabetes, but what it means is you can live a relatively normal life and your lifespan is greatly expanded.

现在有了胰岛素并不意味着你的糖尿病就被治愈了，而是意味着你可以过上相对正常的生活，并且你的寿命大大延长。

So by any measure, you have to say that’s dramatic progress.

因此，无论以何种标准衡量，你都必须说这是巨大的进步。

But insulin is something our bodies produce, we hope, unless we’re really seriously diabetic.

但我们希望胰岛素是我们身体产生的，除非我们真的患有严重的糖尿病。

Those of us with Type Two diabetes, our bodies resist insulin and we have to resort to other ways of trying to cope.

我们这些患有二型糖尿病的人，我们的身体会抵抗胰岛素，我们必须采取其他方法来应对。

But if you get too much insulin, it makes you unconscious and that’s how another one of these desperate remedies came along.

但如果你摄入过多的胰岛素，它会让你失去知觉，这就是另一种绝望疗法的出现。

A man named Sakel working in a German clinic for drug addicts, they were putting people under mild comas to help them through the withdrawal symptoms once they got over their addiction.

一位名叫萨克尔的男子在德国一家吸毒者诊所工作，他们让人们处于轻度昏迷状态，以帮助他们克服毒瘾后的戒断症状。

So he was familiar with that.

所以他对此很熟悉。

1:16:45 And when he moved to Austria, he decided he’d try this as a treatment for schizophrenia.

当他搬到奥地利时，他决定尝试用这种方法治疗精神分裂症。

And so he put people into comas, sometimes comas that would last hours, days.

所以他让人们陷入昏迷，有时昏迷会持续几个小时、几天。

They would be revived by giving them glucose, usually intravenously, sometimes not.

通过给予葡萄糖，他们可以苏醒，通常是静脉注射，有时不是。

During the time they were in comas, they often seized, had seizures.

在他们昏迷期间，他们经常癫痫发作。

He saw that as a therapeutic sign.

他认为这是一种治疗迹象。

And he claimed that this Insulin Coma Treatment cured eighty percent of his– eighty percent tends to come up again and again in these treatments as a sort of percentage that you cure.

他声称这种胰岛素昏迷治疗治愈了他百分之八十——百分之八十往往在这些治疗中一次又一次地出现，作为治愈的百分比。

And he was invited to New York and demonstrated this at the Harlem Valley Mental Hospital.

他被邀请到纽约并在哈莱姆谷精神病院展示了这一点。

It spread.

它传播开来。

This was in the thirties?

这是三十年代的事？

This was starting in nineteen thirty-three.

这是从十九点三十三分开始的。

1:17:40 The visit to America was I believe nineteen thirty-six, and Sakel ended up settling here.

我相信是在十九点三十六分访问美国，萨克尔最终定居在这里。

He had a very lucrative private practice in New York, and when he died, he left his partner I think an estate of about two million dollars, which in the early sixties was a very substantial amount of money that he’d earned from practice, right?

他在纽约有一家利润丰厚的私人诊所，当他去世时，他给他的合伙人留下了大约两百万美元的遗产，这在六十年代初是他从诊所赚到的一笔非常可观的钱，对吧？

So insulin coma therapy was widely adopted.

因此胰岛素昏迷疗法被广泛采用。

What kept it from being a large scale thing was it required an enormous amount of nursing and medical attention ’cause people were literally hovering on the brink of life and death.

阻止它成为大规模事件的原因是它需要大量的护理和医疗护理，因为人们实际上徘徊在生与死的边缘。

They could go into a permanent coma, they could just die.

他们可能会陷入永久昏迷，也可能会死去。

So vital signs had to be monitored.

因此必须监测生命体征。

They had to be brought around very quickly if need be.

如果需要的话，他们必须很快被带过来。

And there’s some evidence that the treatment killed brain cells.

有一些证据表明这种治疗会杀死脑细胞。

1:18:32 And when Sakel was told that, he said yes, that’s probably true.

当萨克尔被告知这一点时，他说是的，这可能是真的。

They’re killing the schizophrenic brain cells.

他们正在杀死精神分裂症的脑细胞。

That’s just nonsense.

那只是无稽之谈。

Of course.

当然。

That’s just nonsense, but that’s rational.

这虽然是无稽之谈，但却是有道理的。

Insulin comas weren’t subjected to a randomized controlled trial until the nineteen fifties, and when they were subjected to a controlled trial, they failed it, and so it died out, and that’s, I guess, scientific progress again in a way, but took a long time.

胰岛素昏迷直到十九世纪五十年代才接受随机对照试验，当他们接受对照试验时，他们失败了，所以它消失了，我想，这在某种程度上又是科学进步，但花了很长时间。

One of the people who received insulin coma therapy, have you seen the film A Beautiful Mind?

接受胰岛素昏迷治疗的人之一，你看过电影《美丽心灵》吗？

Mm hmm.

嗯嗯。

He did receive insulin coma therapy.

他确实接受了胰岛素昏迷治疗。

Ironically, actually at Trenton State Hospital where Cotton had been, so John Nash received– John Nash got insulin comas, and they were going to lobotomize him, and they didn’t, but he was at risk of that, we should say.

讽刺的是，实际上在科顿所在的特伦顿州立医院，约翰·纳什接受了——约翰·纳什出现了胰岛素昏迷，他们打算对他进行脑叶白质切除术，但他们没有这样做，但我们应该说，他有这样做的风险。

1:19:25 that this treatment, patients would thrash, moan, and convulse before falling into a coma.

在这种治疗中，患者在陷入昏迷之前会剧烈抽搐、呻吟和抽搐。

The treatment required a course of up to sixty comas.

治疗需要长达六十次昏迷的疗程。

It turned out to have a mortality rate of one to five percent and caused significant brain damage and obesity, yeah.

事实证明，它的死亡率为百分之一到百分之五，并造成严重的脑损伤和肥胖，是的。

Yet was hailed as a miracle cure for schizophrenia.

却被誉为治疗精神分裂症的灵丹妙药。

Yes, that’s right, performed on John Nash, one of the great

是的，没错，是在约翰·纳什身上表演的，他是伟大的音乐人之一

minds of the 20th century.

20世纪的思想。

Yes, and Nash clearly did become delusional, but that was one of the treatments he was subjected to.

是的，纳什显然确实产生了妄想，但那是他所接受的治疗之一。

1:19:55 And well represented actually in the film of A Beautiful Mind.

在电影《美丽心灵》中也得到了很好的体现。

So I mentioned seizures.

所以我提到了癫痫发作。

Also in Austro-Hungary in this period, another psychiatrist decided that you couldn’t be both schizophrenic and epileptic, that there was somehow an antagonism between the two.

同样在这个时期的奥匈帝国，另一位精神病学家认为，你不可能同时患有精神分裂症和癫痫症，两者之间存在某种对抗。

So if you had epilepsy, you didn’t have schizophrenia.

因此，如果您患有癫痫症，那么您就不会患有精神分裂症。

If you had schizophrenia, couldn’t have epilepsy.

如果您患有精神分裂症，就不可能患有癫痫症。

I should say at the outset, that’s not true, but that’s what he believed.

我首先应该说，这不是真的，但他就是这么认为的。

So then the logical next step was, “Well, if we could create an artificial epileptic seizure, maybe we would drive out the schizophrenia.” So what to do?

因此，合乎逻辑的下一步是，“好吧，如果我们能够制造出人工癫痫发作，也许我们就能赶走精神分裂症。”那么该怎么办呢？

1:20:52 He first tries injecting camphor, a natural substance.

他首先尝试注射樟脑，一种天然物质。

Natural substances aren’t necessarily benign substances.

天然物质不一定是良性物质。

That caused abscesses, and it wasn’t very effective.

这导致了脓肿，而且效果不是很好。

He sought an alternative, and he settled on something that was called Cardiazol or Metrazol, depended which side of the Atlantic you were on.

他寻求一种替代方案，最终选择了一种叫做卡地唑（Cardiazol）或美特拉唑（Metrazol）的东西，这取决于你在大西洋的哪一边。

And injecting that into a patient usually caused a seizure, a big seizure, like a grand mal seizure where your body arcs back, your legs contract dramatically.

将其注射到患者体内通常会引起癫痫发作，一次大癫痫发作，就像大癫痫发作一样，您的身体向后弯曲，双腿急剧收缩。

You can fracture spines and hips and bones.

你可能会导致脊柱、臀部和骨头骨折。

and you ended up, yes, with fractures of vertebrae, fractures of the hip socket.

是的，你最终导致了椎骨骨折、髋关节骨折。

1:21:30 Because when muscles in the thigh contract that badly, what happens?

因为当大腿肌肉收缩得如此严重时，会发生什么？

The thigh bone is driven into the socket at such a rate that it fractures, right?

大腿骨以如此快的速度进入骨槽，以致于骨折，对吧？

So these were among the complications that Metrazol produced.

这些都是四甲唑产生的并发症之一。

More than that, he himself conceded that between the injection and the seizure, the patient felt as though he were on—or she was on—the brink of death.

不仅如此，他本人也承认，在注射和癫痫发作之间，患者感觉自己或她正处于死亡的边缘。

Now imagine, pretend you’re a mental patient.

现在想象一下，假装你是一个精神病人。

You’re brought in in a straitjacket.

你穿着紧身衣被带进来。

A man in a white coat with a big hypodermic injects something into you.

一个穿着白大褂、带有大皮下注射器的男人正在向你注射某种东西。

You feel as though you’re gonna die, and maybe that lingers for two, three, ten minutes, and then you seize with those possible fractures following

你感觉自己快要死了，这种感觉可能会持续两、三、十分钟，然后你就会抓住可能发生的骨折

violent seizures.

剧烈癫痫发作。

violent seizures.

剧烈癫痫发作。

1:22:28 It’s violent and hard to witness and is very unpredictable.

它是暴力的、难以目睹的，而且非常难以预测。

So it’s used, but people are not very happy, and that’s how we get electroconvulsive therapy, electroshock, as it’s first called.

所以它被使用了，但人们不太高兴，这就是我们如何进行电休克治疗，电击，正如它最初被称为的那样。

1:22:44 Two Italian psychiatrists, Cerletti and Bini, experiment with electricity, and they first experiment on dogs.

两位意大利精神病学家塞莱蒂和比尼进行了电实验，他们首先在狗身上进行了实验。

And they make a mistake initially: they have an electrode on the head, an electrode on the anus.

他们一开始就犯了一个错误：他们的头上有一个电极，肛门上有一个电极。

The electric current passes through the body, it stops the heart, the dogs die.

电流穿过身体，使心脏停止跳动，狗就会死亡。

So that seems a dead end.

所以这似乎是一个死胡同。

And then somebody says to them, “You know, you should go to the Rome slaughterhouse and see the pigs being slaughtered ’cause you’ll learn something very interesting.” So they go, and the pigs are dangling by their hind legs.

然后有人对他们说：“你知道，你应该去罗马屠宰场，看看猪被宰杀，因为你会学到一些非常有趣的东西。”他们就这样走了，猪的后腿悬在空中。

And as they come by, two electrodes cross their head, electroshock, they convulse, they’re

当他们经过时，两个电极交叉在他们的头上，电击，他们抽搐，他们

1:23:24 unconscious, their throats are slit, and pork arrives.

他们失去知觉，喉咙被割断，猪肉就到了。

So they try that on dogs, and current passing through the brain, it turns out, doesn’t kill them.

因此他们在狗身上进行了尝试，结果发现电流通过大脑并不会杀死它们。

So decide to try it out.

所以决定尝试一下。

They pick up a transient homeless person at the Rome train station, and they bring him in, and they try it.

他们在罗马火车站接了一个临时无家可归的人，然后把他带进来，然后尝试一下。

And at first, they don’t use enough current, and nothing very much happens.

起初，他们没有使用足够的电流，所以什么也没有发生。

And they’re very white-faced, they’re quite worried.

而且他们脸色都很白，很担心。

Off in the corner, we have descriptions of this, and they’re talking, “What should we do?” “Well, we’ll up the current,” and the patient hears that and says, “No, another one, that’s deadly.” They do it anyway, and he convulses.

在角落里，我们有对此的描述，他们在讨论，“我们应该做什么？” “好吧，我们会加大电流，”病人听到后说，“不，再来一个，那是致命的。”不管怎样，他们还是这么做了，他抽搐了。

Another grand mal seizure with the same problems of spinal fractures and hip fractures and so on.

另一种大发作同样存在脊柱骨折、髋部骨折等问题。

Not universally, obviously, but often enough.

显然，这并不普遍，但经常如此。

And he

而他

1:24:22 stops breathing.

停止呼吸。

You can imagine the scene.

你可以想象那个场景。

And then he spontaneously starts breathing again.

然后他又自发地开始呼吸。

And when he comes around, he’s in contact with reality.

当他醒过来时，他就接触到了现实。

They got this miracle cure, and it’s very easy to administer, cheap, doesn’t involve injecting things into people’s bodies.

他们找到了这种神奇的疗法，而且非常容易管理，价格便宜，不涉及将东西注射到人们的体内。

So that quickly spreads across the Atlantic and other parts of Europe.

因此，这种现象很快就蔓延到了大西洋和欧洲其他地区。

And ECT becomes a very widely used intervention.

ECT 成为一种非常广泛使用的干预措施。

Couple of things to say about this.

关于这一点有几点要说。

It turns out it’s not very useful for schizophrenia.

事实证明它对精神分裂症不是很有用。

Remember the connection between seizures and schizophrenia that was originally posited, but it seems to work in cases of depression, suicidal depression particularly,

还记得最初提出的癫痫发作和精神分裂症之间的联系，但它似乎适用于抑郁症，特别是自杀性抑郁症，

Fast forwarding to the modern day—mm-hmm—and this is something I learned by reading a bunch recently, it seems to be one of the few evidence-based, like scientifically backed, methods that actually worked for clinical depression, for serious depression.

快进到现代——嗯——嗯——这是我最近通过阅读大量书籍学到的东西，它似乎是为数不多的基于证据的、有科学支持的、真正对临床抑郁症、严重抑郁症有效的方法之一。

Um yes, if we fast forward, we’re looking at in some respects a different animal for reasons I’ll explain.

嗯，是的，如果我们快进，我们在某些方面会看到一种不同的动物，原因我会解释。

1:25:40 Okay.

好的。

This is unmodified ECT.

这是未经修改的 ECT。

Yeah, so we’re talking about unmodified ECT, which rules the roost really well into the 1950s, and some places even into the 1960s.

是的，所以我们谈论的是未经修改的 ECT，它在 20 世纪 50 年代一直占据主导地位，有些地方甚至在 1960 年代仍然占据主导地位。

1:25:49 And so it is associated with all the problems of fractures that we’ve talked about.

因此它与我们讨论过的所有骨折问题有关。

It’s also associated with memory problems.

它还与记忆问题有关。

People often lose memory.

人们常常会失去记忆。

There’s some dispute about how serious that is, but it’s pretty widely recognized that’s one of the prices you’re gonna pay for that treatment.

关于这种情况的严重程度存在一些争议，但人们普遍认为这是您为这种治疗要付出的代价之一。

The thing is, for mental hospitals in the ’40s and ’50s, ECT was much more used as a device to control people’s behavior than as a therapeutic intervention.

事实是，对于 40 年代和 50 年代的精神病院来说，ECT 更多地用作控制人们行为的设备，而不是作为治疗干预。

It was quite punitive, seen as such.

从本身来看，这是相当具有惩罚性的。

Patients didn’t wanna repeat, and so they-

患者不想重复，所以他们-

1:26:39 …

……

sort of controlled themselves a bit.

有点控制住自己了。

But yes, we don’t know why it works, but more recent work starting in probably the 1990s—and I’m gonna get in trouble with some people for saying this because you mentioned patients and psychiatrists who swear by ECT.

但是，是的，我们不知道它为什么有效，但最近的研究可能从 20 世纪 90 年代开始——我会因为这样说而给一些人带来麻烦，因为你提到了坚信 ECT 的患者和精神科医生。

There are others who swear at it.

还有其他人对此发誓。

1:27:05 Partly because of the memory problems I alluded to, and partly because of claims that it may cause brain damage.

部分是因为我提到的记忆问题，部分是因为声称它可能会导致脑损伤。

Passing an electric current through the brain is possible.

让电流通过大脑是可能的。

What changed ECT a bit, quite a bit actually, was giving muscle relaxants so that people didn’t thrash about, and the fractures were largely a thing of the past.

ECT 改变了一点，实际上改变了很多，是给予肌肉松弛剂，这样人们就不会扭动，骨折基本上已经成为过去。

When you introduce these muscle relaxers, originally they used curare, but then they used other more modern drugs to paralyze the muscles temporarily.

当你介绍这些肌肉松弛剂时，最初他们使用箭毒，但后来他们使用其他更现代的药物来暂时麻痹肌肉。

Problem is, that would also paralyze your breathing muscles, so that’s not too good.

问题是，这也会麻痹你的呼吸肌肉，所以这不太好。

So it became a more complicated procedure because you needed anesthesiologist breathing support and so forth during the procedure.

因此，这变得更加复杂，因为在手术过程中您需要麻醉师呼吸支持等。

But you did eliminate the fractures.

但你确实消除了骨折。

1:28:00 It still was a very widely disdained practice, I think, particularly when they had drugs available.

我认为，这仍然是一种受到广泛鄙视的做法，特别是当他们有药物可用时。

The thinking was that, well, we’d sooner use those, but the drugs turn out to be only partially effective and pretty ineffective very often for suicidal cases or in cases of extreme melancholia.

我们的想法是，好吧，我们应该尽快使用这些药物，但事实证明，这些药物仅部分有效，而且对于自杀病例或极度忧郁症病例，通常非常无效。

Now, a couple things to say: Very often, ECT has to be repeated at intervals, as a kind of maintenance therapy.

现在，有几件事要说：很多时候，ECT 必须每隔一段时间重复一次，作为一种维持治疗。

So it hasn’t cured things, but it temporarily alleviates the symptoms, and the temporary may be fairly lengthy, but nonetheless, very often things will recur.

所以它并没有治愈疾病，但是它暂时缓解了症状，而且暂时的时间可能相当长，但很多时候还是会复发。

The memory problems can be quite severe.

记忆问题可能相当严重。

The worries about brain damage are, I think, certainly things we have to be very cautious about.

我认为，对脑损伤的担忧当然是我们必须非常谨慎的事情。

And when we talk about treatment-resistant depression, that’s an interesting concept to me.

当我们谈论难治性抑郁症时，这对我来说是一个有趣的概念。

1:28:58 What it means is those are the patients who don’t respond to drugs.

这意味着那些对药物没有反应的患者。

They may not have a different disease, but the drugs don’t work for them, hence treatment resistant.

他们可能没有患上不同的疾病，但药物对他们不起作用，因此对治疗产生抵抗力。

And the numbers of psychiatrists who are willing to give ECT are rather small, and in many states it’s hedged around with lots of legal restrictions.

愿意提供 ECT 的精神科医生数量相当少，而且在许多州，它受到许多法律限制的限制。

In California, for example, ECT now almost can’t be given to involuntarily confined patients ’cause you have to volunteer for it.

例如，在加利福尼亚州，现在几乎不能对非自愿受限的患者进行 ECT，因为你必须自愿接受。

1:29:38 So it’s unusual in that most medical procedures aren’t hedged about by legal constraints like that.

因此，大多数医疗程序都没有受到这样的法律限制，这是不寻常的。

And there clearly is a very powerful group of people, some of them psychiatrists, many of them ex-patients, many of them other people who just are suspicious of modern medicine and science, who form a group who are very powerfully opposed to ECT.

显然有一群非常强大的人，其中一些是精神病学家，其中许多是前病人，其中许多是对现代医学和科学持怀疑态度的人，他们形成了一个非常强烈反对ECT的团体。

So although it’s fair to say there are trials now that seem to provide decent evidence that for some patients this works and that those patients are deeply distressed before the treatment, it’s also still a controversial treatment, I think it’s fair to say.

因此，尽管可以公平地说，现在有一些试验似乎提供了充分的证据，表明这对某些患者有效，并且这些患者在治疗前深感痛苦，但我认为可以公平地说，这仍然是一种有争议的治疗方法。

Like basically every single topic, treatment, problem subfield of psychiatry today.

基本上就像当今精神病学的每个主题、治疗、问题子领域一样。

Yes, yes.

是的，是的。

For everything, everything we say today, there will be at least one person upset- …and writing a letter.

对于我们今天所说的一切、一切，至少会有一个人感到不安——……并写一封信。

I think lots of people upset.

我想很多人都感到不安。

1:30:43 So if we talk about drugs, there’ll be two kinds of people who will be upset: those who think the drugs are more powerful than they are or who have been successfully treated by the drugs and go, “Well, it worked for me, so, you know, stop criticizing it ’cause it really is an effective treatment.” And then on the other side of the coin, there are those who either the drug treatment has been used and it’s failed, or they’re being left with terrible side effects that don’t go away, or they’re part of a general group of people that unfortunately is of a growing number these days who are so suspicious of medical science and of the drug companies that no amount of evidence will sway them.

因此，如果我们谈论毒品，会有两种人会感到不安：那些认为药物比它们本身更强大的人，或者那些已经通过药物成功治疗的人，然后说：“嗯，它对我有用，所以，你知道，停止批评它，因为它确实是一种有效的治疗方法。”另一方面，有些人要么已经使用了药物治疗但失败了，要么他们留下了无法消失的可怕副作用，或者他们是一个普通人群的一部分，不幸的是，这些人现在越来越多，他们对医学和制药公司如此怀疑，没有任何证据可以动摇他们。

1:31:38 They are convinced that you know, the, the drug treatments are poisonous.

他们确信你知道，药物治疗是有毒的。

The Scientologists being a very extreme example of that who they have a whole museum in Los Angeles and the title is Psychiatry Industry of Death.

山达基教徒是一个非常极端的例子，他们在洛杉矶拥有一整座博物馆，标题是“死亡精神病学产业”。

And then if you think about all the resistance, for example, that has surfaced to vaccination in contemporary US and how the trust in vaccination has been destroyed for a substantial number of people, it’s very difficult to convince them that they’re mistaken.

然后，如果你考虑一下当代美国对疫苗接种所出现的所有阻力，以及相当多的人对疫苗接种的信任是如何被摧毁的，就很难让他们相信自己错了。

And not just the trust in vaccination, consequence of that is a general distrust in science-

不仅仅是对疫苗接种的信任，其后果是对科学的普遍不信任——

A general distrust, exactly.

确切地说，是普遍的不信任。

…

……

1:32:27 and distrust in medicine and so on.

以及对医学的不信任等等。

That’s one of my great worries about our contemporary situation, that we’re only– We’re less than a year in.

这是我对我们当前处境的最大担忧之一，我们只是——我们还不到一年。

1:32:30 After four years of this, first of all, the degree of mistrust will have grown exponentially, and once trust is lost, it’s very hard to recover.

这样过了四年，首先，不信任的程度会成倍增长，一旦失去信任，就很难恢复。

Secondly, the science itself is being destroyed.

其次，科学本身正在被摧毁。

Clinical trials that were midway through were aborted, so that knowledge has been lost.

临床试验进行到一半就中止了，因此知识已经丢失。

You would have to start from square one, and that’s years of work.

你必须从头开始，这需要多年的工作。

Scientists aren’t being trained because funding has been cut.

由于资金被削减，科学家们没有接受培训。

Scientists with successful careers no longer have the funding necessary to do their work, and it takes at least six or seven years to train a scientist at the beginning of their career.

事业成功的科学家不再拥有开展工作所需的资金，而在职业生涯初期培养一名科学家至少需要六七年的时间。

1:33:30 And so if you have four years with nobody being trained, you’re talking about a decade being lost, and what’s lost is invisible- …because it’s counterfactuals.

因此，如果你有四年时间没有​​人接受培训，那么你就在谈论失去了十年，而失去的东西是看不见的——……因为这是反事实的。

We don’t know what that science will lead to or what that medical treatment might lead to, and very many times they fail.

我们不知道科学会带来什么结果，也不知道医学治疗会带来什么结果，而且很多时候它们都会失败。

That’s the nature of science.

这就是科学的本质。

It’s the nature of medicine and medical research that not every bright idea we have is going to eventuate in a breakthrough.

医学和医学研究的本质是，并非我们拥有的每一个好主意都会最终取得突破。

It would be really simple and wonderful if that was opposite were the case.

如果情况相反，那就真的很简单而且很棒了。

But the reality is we have to go down lots of blind alleys, we have to try lots of different things, and we have to take years to move from the laboratory to practical application.

但现实是我们必须走很多死胡同，我们必须尝试很多不同的事情，我们必须花费数年时间才能从实验室转向实际应用。

And when we eliminate a whole segment of that and when on top of that we diminish people’s trust-

当我们消除其中的一整部分时，除此之外，我们还会削弱人们的信任——

1:34:35 …in science, that’s a really, I think, a profoundly devastating thing that probably given my advanced age, I won’t live to see the consequences of, but my children and grandchildren will.

……在科学上，我认为这确实是一件具有深远破坏性的事情，考虑到我年事已高，我可能无法活着看到其后果，但我的子孙会。

It really is something cultural that you’ve got to build up trust.

这确实是一种文化，你必须建立信任。

1:35:00 And it can be destroyed very easily.

而且它很容易被摧毁。

So one of the things, to go back to the very first question you asked me about, is psychiatry in crisis?

那么，回到你问我的第一个问题，精神病学是否处于危机之中？

Well, genetics was supposed to provide a clear picture of the origins of various mental diseases ’cause they do seem to run in families.

嗯，遗传学应该能够清晰地描述各种精神疾病的起源，因为它们似乎确实有家族遗传性。

So the expectation was once we decoded the human genome and we could examine bits and pieces of it, that we would very quickly find a Mendelian gene or set of genes for schizophrenia, let us say.

因此，我们的期望是，一旦我们解码了人类基因组，我们就可以检查它的各个部分，我们会很快找到一个孟德尔基因或一组精神分裂症基因，比如说。

Hasn’t happened.

没有发生。

We now use gene-wide association studies, that is throwing everything in the kitchen soup into, into the picture, and then without any preconditions, seeing what relates to what.

我们现在使用全基因关联研究，即将厨房汤中的所有东西都放入图片中，然后在没有任何先决条件的情况下，看看什么与什么相关。

And if we use three hundred small variations in the genome, we can account for about ten percent of schizophrenia.

如果我们使用基因组中的三百个小变异，我们就可以解释大约百分之十的精神分裂症。

1:35:53 That’s not very powerful.

这不是很强大。

Beyond that, what psychiatric genetics has tended to throw up is something that undermines the distinctions that we’ve made based on symptomatology.

除此之外，精神遗传学往往会破坏我们根据症状学做出的区分。

So if you look, there is a great deal of overlap in the kinds of genetic abnormalities that heighten the susceptibility to bipolar disorder or schizophrenia or autism.

因此，如果仔细观察，会发现增加双相情感障碍、精神分裂症或自闭症易感性的基因异常种类有很多重叠。

There’s a lot of overlap there.

那里有很多重叠之处。

What that suggests is these aren’t distinctive entities in the way that, you know…

这表明这些并不是独特的实体，你知道……

Schizophrenia, as my friend Robin Murray, a British psychiatrist, has to say, “It really seems to be the extreme end of psychosis, the most serious.” But it’s sort of on a continuum, you know.

正如我的朋友、英国精神病学家罗宾·默里（Robin Murray）所说，精神分裂症“这似乎确实是精神病的极端情况，也是最严重的情况。”但这是一个连续体，你知道。

1:36:43 And so if psychiatry has to say in ten years, as some leading psychiatrists are speculating, that there’s no such thing as schizophrenia, there’s no such thing as bipolar disorder, that will tend, I suspect, to have pretty bad effects on people’s trust-

因此，如果精神病学在十年内必须说，正如一些领先的精神病学家推测的那样，不存在精神分裂症这样的东西，不存在双相情感障碍这样的东西，我怀疑这往往会对人们的信任产生相当糟糕的影响——

1:37:02 …in psychiatry, and yet that’s where the science may lead them.

……在精神病学领域，但这正是科学可能引导他们的地方。

So it’s a, it’s a complicated picture, but this issue of trust and its absence is vital, I think, in looking at not just what we’re talking about today, but across a whole spectrum of things, even outside the medical realm altogether.

所以，这是一幅复杂的图景，但我认为，信任及其缺失的问题至关重要，不仅考虑到我们今天所讨论的内容，而且考虑到整个范围的事物，甚至完全在医学领域之外。

If you lose trust in institutions, trust in science, trust in history.

如果你失去对机构的信任，对科学的信任，对历史的信任。

So I think more humility and less arrogance, more willingness to confess the limits of what we can do, more awareness of the dangers of enthusiasm, more skepticism when we’re told something is a breakthrough.

因此，我认为要多一点谦虚，少一点傲慢，更愿意承认我们能做的事情的局限性，更多地意识到热情的危险，当我们被告知某件事是突破时，要更多地怀疑。

One of the things I worry about is the tendency of science journalism and medical journalism to hype things, and, and then when the hype turns out to be just that, that undermines trust.

我担心的一件事是科学新闻和医学新闻倾向于炒作事情，然后当炒作事实证明是这样时，就会破坏信任。

1:38:16 You know?

你知道？

So be cautious when things come along- …

所以当事情发生时要小心——...

don’t be so sure that it represents a breakthrough.

不要太确定它代表着突破。

I’m very worried at the moment.

我现在很担心。

I see ketamine and psychedelics being propounded as a miracle cure for depression, and the evidence for that is enormously weak is the best way to put it.

我认为氯胺酮和致幻剂被认为是治疗抑郁症的灵丹妙药，但最好的说法是证据非常薄弱。

And I’ve seen this movie before too many times.

我以前看过这部电影太多次了。

You know?

你知道？

I mentioned that 80% cure for Cotton’s work, 80% cure for insulin coma therapy, 80% cure for the early asylums.

我提到过科顿的工作治愈了80%，胰岛素昏迷治疗治愈了80%，早期收容所治愈了80%。

This is overblown rhetoric, and the reality is usually progress comes in small steps.

这是言过其实的说法，现实是进步通常是小步推进的。

1:39:03 Sometimes it comes in big steps.

有时它会迈出大步。

Penicillin, I think was a huge step.

我认为青霉素是一个巨大的进步。

Uh, I was lucky enough to grow up in the era when penicillin and other antibiotics became widely available.

呃，我很幸运生长在青霉素和其他抗生素广泛使用的时代。

They hadn’t been overused by then.

那时它们还没有被过度使用。

And so if I had a strep throat, I had something that got rid of it right away.

因此，如果我患有链球菌性咽喉炎，我可以立即服用一些药物来消除它。

I didn’t run the risk of heart valve damage, which in previous times would’ve been the case.

我没有冒心脏瓣膜受损的风险，而在以前就会出现这种情况。

So you know, once in a while you do have these dramatic shifts, and maybe AI will help us in that regard, but maybe it won’t.

所以你知道，偶尔你确实会发生这些戏剧性的转变，也许人工智能会在这方面帮助我们，但也许不会。

It’s another potential double-edged sword.

这是另一把潜在的双刃剑。

I should mention that psychedelics, psilocybin in particular, has been demonized for a long time.

我应该提到迷幻药，尤其是裸盖菇素，长期以来一直被妖魔化。

1:39:46 And so there’s studies now out of Johns Hopkins- …

所以现在约翰·霍普金斯大学有研究——……

that are doing serious studies on cases where it is effective.

正在认真研究其有效的案例。

I think it’s nice to give a chance to the different treatments with the rigor of science, but with caution – …

我认为以科学的严谨性为不同的治疗提供机会是很好的，但要谨慎——……

and basically ignoring like you’re saying, science journalists who are basically hyping every new thing ’cause they have to get clicks and all- …

基本上就像你说的那样，忽略了科学记者，他们基本上在炒作每一个新事物，因为他们必须获得点击，并且所有 - ......

this kind of stuff and- …

这种东西和——……

Look at the actual science in the modern day.

看看现代的实际科学。

So the- …

所以——……

in the past, the rigor was not there.

过去没有严谨。

In the modern day, there’s more.

在现代，还有更多。

Yes.

是的。

1:40:25 We can add beyond the realm of science journalists.

我们可以在科学记者的领域之外添加内容。

I think Science and Nature make choices about what they’re gonna foreground, and they too have this tendency to look for things that make a big splash.

我认为科学和自然会选择他们要突出的东西，他们也有这种倾向寻找引起轰动的东西。

Oh, you mean the editors and the- …

哦，你是说编辑们和——……

1:40:42 the major journals.

各大期刊。

I think the editors, the major journals, that’s what they’re looking for.

我认为编辑们、主要期刊，这就是他们所寻找的。

1:40:44 As you know, I mean, negative findings are very important in science.

如你所知，我的意思是，负面发现在科学中非常重要。

They’re the things that help us avoid mistakes, but they’re not the things that are going to get you published in the journal.

它们可以帮助我们避免错误，但不能让你在期刊上发表文章。

Right.

正确的。

1:41:01 So it’s not just the surface level science journalism.

所以这不仅仅是表面层面的科学新闻。

It is also the extra journals and the conferences and the publication process.

这也是额外的期刊、会议和出版过程。

Having lots of scientists working on these problems in different sites and different places turns out to be very important, I think, as a check on enthusiasm, as a check on premature claims that turn out to be unfounded.

我认为，让许多科学家在不同的地点和不同的地方研究这些问题是非常重要的，作为对热情的检查，作为对被证明是毫无根据的过早主张的检查。

1:41:10 And also because you’re often partially right, but you’re not fully right and someone else following the same idea- …

也因为你经常是部分正确的，但你并不完全正确，而其他人也遵循同样的想法——……

is perhaps gonna be a little closer to the truth than you were.

也许会比你更接近事实。

And so it’s very helpful to have multi-centered things and not everything under one all-knowing- …

因此，拥有多中心的事物而不是一切都在一个全知之下是非常有帮助的——……

Thing.

事。

And that’s a problem with funding agencies.

这是资助机构的问题。

The maverick scientist has a hard time- …

这位特立独行的科学家过得很艰难——……

very often- …

很多时候——……

getting a hearing.

举行听证会。

And we know of lots of examples of that in history where after the fact we go “oh well yes, we should have supported that line of research, but we didn’t.”

我们知道历史上有很多这样的例子，事后我们会说“哦，是的，我们应该支持这一研究方向，但我们没有。”

Very well put.

说得很好。

1:42:12 Let us return to the origins of ECT and how it was applied.

让我们回到 ECT 的起源以及它是如何应用的。

But first, if it’s okay, a quick bathroom break.

但首先，如果可以的话，先去趟厕所。

Quick ten second thank you to our sponsors.

快十秒感谢我们的赞助商。

Check them out in the description.

在描述中查看它们。

It really is the best way to support this podcast.

这确实是支持这个播客的最佳方式。

Go to lexfridman.com/sponsors.

请访问 lexfridman.com/sponsors。

And now, dear friends, back to my conversation with Andrew Scull.

现在，亲爱的朋友们，回到我与安德鲁·斯卡尔的谈话。

Now we’re back just to talk a little bit more about ECT and One Flew Over the Cuckoo’s Nest.

现在我们回来只是想多谈谈《ECT》和《飞越疯人院》。

So what can we say about that, that little cultural moment, one of the most famous moments about psychiatry?

那么，对于这个小小的文化时刻，关于精神病学最著名的时刻之一，我们能说些什么呢？

First of all, Ken Kesey wrote this book about his own experience in a mental institution.

首先，肯·凯西写这本书是关于他自己在精神病院的经历。

Yeah, Menlo Park.

是的，门洛帕克。

1:42:55 Yes.

是的。

How representative is it of the system at the time?

它对当时的制度有多大代表性？

Mental hospitals have had a very patchy and complicated history.

精神病院的历史非常不完整且复杂。

1:43:01 He was working actually in a hospital for veterans.

他实际上在一家退伍军人医院工作。

Those were largely created after the Second World War when there were very many more psychiatric casualties among American troops than even the First World War.

这些主要是在第二次世界大战后创建的，当时美国军队中的精神伤亡人数甚至比第一次世界大战还要多。

The interesting thing is we all by osmosis know that in the First World War there was something called shell shock that afflicted the troops and that the military initially resisted recognizing and ultimately were forced to grasp.

有趣的是，我们都潜移默化地知道，在第一次世界大战中，有一种叫做炮弹休克症的现象困扰着军队，军方最初拒绝承认这一现象，最终被迫接受。

But in World War II, American psychiatric casualties among the troops were two to three times as high as in World War I, and that’s an important part of the history of psychiatry.

但在第二次世界大战中，美国军队中精神病患者的伤亡人数是第一次世界大战时的两到三倍，这是精神病学历史的重要组成部分。

1:43:54 But the upshot of that was that post-war the VA was heavily involved in, first of all, paying to train psychiatrists and even psychologists, and then had in its mental hospital system a considerable involvement with psychiatric disorders.

但其结果是，战后退伍军人事务部大量参与，首先，花钱培训精神科医生甚至心理学家，然后在其精神病院系统中大量参与精神疾病治疗。

Kesey– Well, the book is different than the film is the first thing to say.

凯西——首先要说的是，这本书与电影不同。

Obviously, the film is heavily indebted to the book, but it changes various things.

显然，这部电影很大程度上借鉴了原著，但它改变了很多事情。

If I may just go into Perplexity, “The book and the 1975 film tell the same basic story of McMurphy challenging an oppressive psychiatric ward, but they differ sharply in point of view, tone, and what the story is about.

如果我可以简单地谈谈《困惑》的话，“这本书和 1975 年的电影讲述了麦克墨菲挑战压抑的精神病房的相同基本故事，但它们在观点、基调和故事内容方面存在巨大差异。

1:44:26 The novel is weirder, more political, and more about Chief Bromden’s inner world and the combine while the film is more naturalistic, character-driven, and turns McMurphy into the central hero.”

小说更加怪异，更具政治性，更多地讲述布罗姆登酋长的内心世界和结合，而电影则更加自然主义，以角色为导向，并将麦克墨菲变成了中心英雄。”

Yes, I think that’s right.

是的，我认为这是对的。

McMurphy is the person that received ECT, played by Jack Nicholson.

麦克墨菲是接受ECT的人，由杰克·尼科尔森饰演。

Yes.

是的。

1:45:00 And you have a nurse figure in Nurse Ratched.

《拉契特护士》中有一个护士角色。

Louise Fletcher, I think, is an equally powerful performance.

我认为路易丝·弗莱彻的表演同样有力。

It’s one of the greatest films of all time who happens to be– which is unfortunate for, you know, maybe psychiatry.

这是有史以来最伟大的电影之一——这对于精神病学来说是不幸的。

Psychiatry, yes.

精神病学，是的。

1:45:14 It’s very interesting.

这很有趣。

I used to teach a class called Madness In The Movies and I didn’t just use…

我曾经教过一门叫做“电影中的疯狂”的课程，我不只是使用……

In fact, I used relatively few contemporary films, and among all the films from back then, the one almost everybody in the class had seen was One Flew Over the Cuckoo’s Nest.

其实我用的当代电影比较少，当时的电影中，班上几乎所有人都看过的就是《飞越疯人院》。

So eight, nineteen, and twenty-year-olds in two thousand and fifteen– if I showed them Alfred Hitchcock’s Spellbound, no chance they’d ever seen that, maybe one because they were a class of people interested in film.

所以，2015年的八岁、十九岁、二十岁的孩子——如果我给他们看阿尔弗雷德·希区柯克的《魔咒》，他们不可能看过，也许是因为他们是一类对电影感兴趣的人。

But everybody had seen One Flew Over the Cuckoo’s Nest.

但每个人都看过《飞越疯人院》。

On that tangent really quick, what is the greatest film on madness in your view?

很快就切线了，你认为关于疯狂的最伟大的电影是什么？

Oh, well…

哦，好吧……

Would that be One Flew Over the Cuckoo’s Nest?

那会是飞越疯人院吗？

I think One Flew Over the Cuckoo’s Nest, I think oddly a very different film appeared at about the same time was I Never Promised You a Rose Garden, which is a much more sympathetic portrait of a different kind of psychiatry, a very Freudian psychiatrist, really about Frieda Fromm-Reichmann who worked at Chestnut Lodge in Maryland and treated schizophrenia with psychotherapy rather than with drugs or other forms of physical intervention.

我认为《飞越疯人院》，我认为奇怪的是，大约在同一时间出现了一部非常不同的电影《我从未向你保证过玫瑰园》，这是对另一种精神病学的更加富有同情心的描绘，一位非常弗洛伊德式的精神病学家，实际上是关于弗里达·弗洛姆-赖希曼的，她在马里兰州切斯特纳特洛奇工作，用心理治疗而不是药物或其他形式的物理干预来治疗精神分裂症。

1:46:43 And that was a bestselling novel by a young girl who had been her patient with some fairly serious delusions and a very complicated family background.

那是一本畅销小说，作者是一位年轻女孩，她曾是她的病人，患有相当严重的妄想症，家庭背景也非常复杂。

And again the film changed a lot of things in the novel.

这部电影再次改变了小说中的很多内容。

That’s what films do.

这就是电影的作用。

My book Madhouse at one point interested Hollywood and one of the two principals said to me, “I really like this story.

我的书《疯人院》一度引起了好莱坞的兴趣，两位校长之一对我说：“我真的很喜欢这个故事。

It’s got a great first act and a great second act, but where’s the third act?” Meaning where’s the happy ending, and I had to say there wasn’t any happy ending to that story.

第一幕和第二幕都很精彩，但是第三幕呢？”意思是幸福的结局在哪里，我不得不说这个故事没有任何幸福的结局。

It was just rather grim.

只是情况相当严峻。

Madhouse: A Tragic Tale of Megalomania and Modern Medicine is the book you’re referring to.

你指的是《疯人院：狂妄自大与现代医学的悲剧故事》。

1:47:26 Yes, that’s right.

是的，没错。

Now that reminds me of Flowers for Algernon.

这让我想起了《献给阿尔吉侬的鲜花》。

That doesn’t have a happy ending, and it’s not about mental health necessarily, but it’s about the journey of an institution in relation to the health of a patient.

这没有一个美好的结局，也不一定与心理健康有关，而是与患者健康相关的机构的旅程。

Yes, Pat Barker’s trilogy of novels about World War I was turned into a film, I think it was called Regeneration and that was quite powerful.

是的，帕特·巴克（Pat Barker）关于第一次世界大战的小说三部曲被拍成了电影，我认为它叫《再生》，非常强大。

1:47:44 It was about World War I and the treatment of shell shock.

这是关于第一次世界大战和炮弹休克症的治疗。

And I thought was quite well done.

我认为做得很好。

And my friend Patrick McGrath, who’s a novelist wrote a book called Asylum.

我的小说家朋友帕特里克·麦格拉思（Patrick McGrath）写了一本名为《庇护》的书。

Patrick grew up in the grounds of Broadmoor.

帕特里克在布罗德莫长大。

Broadmoor is England’s premier hospital for the criminally insane and he was babysat by some of the patients.

布罗德莫尔医院是英格兰首屈一指的精神病罪犯医院，他负责照顾一些病人。

And when you read his novels you can see how that upbringing affected his rather macabre imagination.

当你读他的小说时，你会发现这种成长经历如何影响了他相当可怕的想象力。

1:48:29 But anyway, so One Flew Over the Cuckoo’s Nest, the poverty of the environment room that the patients were in I think fairly successfully recreates that way in which staff very often put patients down, didn’t listen to them or poke fun at them or even were physically abusive although you don’t see that.

但无论如何，在《飞越疯人院》中，我认为病人所在的病房的贫困环境相当成功地再现了工作人员经常贬低病人、不听他们说话或取笑他们，甚至对他们进行身体虐待，尽管你看不到这一点。

Those were all features of mental hospitals.

这些都是精神病院的特征。

The general boredom of life sort of there, but yeah hard to– putting boredom on the screen will turn an audience off rather fast.

生活中普遍存在的无聊感就在那里，但是很难——把无聊放在屏幕上会让观众很快就失去兴趣。

What about nurses and this kind of abusive element, you know?

护士和这种虐待行为怎么样，你知道吗？

Yeah, I think there was an abusive element in a lot of mental hospitals and it was almost inevitable.

是的，我认为很多精神病院都存在虐待成分，这几乎是不可避免的。

1:49:18 Look at who had the most contact with the patients: it was the lowest paid, least respected ward attendants, very few even RNs.

看看谁与病人接触最多：是工资最低、最不受尊重的病房服务员，甚至连注册护士也很少。

And you know, ratio of doctor to patient in the large state mental hospitals meant that patients hardly ever saw a physician, you know.

你知道，大型州立精神病院的医生与病人的比例意味着病人几乎看不到医生。

Remarkable about the film, there are many remarkable things about the film as well as its polemical edge, I think, is that chief psychiatrist that you see in the film is the real head of Oregon State Mental Hospital.

这部电影的出色之处在于，这部电影有很多值得注意的地方以及它的争议性边缘，我认为，你在电影中看到的首席精神科医生是俄勒冈州立精神病院真正的院长。

He really was, introduction to acting, and I thought he was pretty remarkable actually.

他确实是，表演入门，我认为他实际上非常出色。

Obviously there’s a lot of exaggeration there, but ECT was used in the fifties and sixties as a tool of discipline in the hospitals.

显然这有很多夸张之处，但 ECT 在五六十年代曾被用作医院的纪律工具。

1:50:28 It was also used therapeutically, but overwhelmingly it was used as a tool of discipline and control.

它也被用于治疗，但绝大多数被用作纪律和控制的工具。

And that’s true to life.

这就是生活的真相。

Lobotomy…

脑叶白质切除术…

One of the interesting things we haven’t talked about with all these treatments we’ve been discussing is that almost invariably, except for the case of the syphilitic patients, for obvious reasons men were more troubled by that condition than women, it was women that got the brunt of these experiments.

我们一直在讨论的所有这些治疗方法中，我们没有谈论的有趣的事情之一是，除了梅毒患者的情况之外，几乎总是，出于明显的原因，男性比女性更容易受到这种情况的困扰，在这些实验中首当其冲的是女性。

So Henry Cotton, about 70% of his patients who were treated were female.

亨利·科顿（Henry Cotton）接受治疗的患者中约有 70% 是女性。

Lobotomy patients, it’s hard to get overall numbers, but those of us who’ve looked at the records of a number of different hospitals again and again discover, again, 60 or 70% of the patients are female.

脑叶白质切除患者的总数很难统计，但我们这些反复查看多家不同医院记录的人发现，60%或70%的患者是女性。

ECT tends to be heavily female.

ECT 往往以女性为主。

1:51:26 That’s complicated by the fact that it’s used primarily as, as we were discussing in serious cases of depression and so-called treatment-resistant depression, and depression is a diagnosis that is more to be found among women than men.

事实上，它主要用于治疗严重的抑郁症和所谓的难治性抑郁症，而抑郁症这种诊断在女性中比男性更常见。

Not that there aren’t very many men with depression, but again, the ratio is such.

并不是说患有抑郁症的男性不多，但比例确实如此。

Men tend to get a different– they get different diagnoses.

男性往往会得到不同的结果——他们会得到不同的诊断。

Personality disorders, for example, are very, very common and are more a male diagnosis.

例如，人格障碍非常非常常见，而且更多的是男性诊断。

Um, ADHD-

嗯，多动症-

Mm

毫米

…is more male than female and so on.

……男性多于女性等等。

1:52:04 So it’s good to point that out.

所以最好指出这一点。

Uh, I think it helped end interest in ECT, except for a small handful of enthusiasts for decades, that film.

呃，我认为这有助于消除人们对《ECT》的兴趣，除了几十年来少数的狂热爱好者之外。

And probably even now it creates hesitation in people about the treatment.

也许即使是现在，人们也会对治疗产生犹豫。

So it’s one that has had a very powerful and long-lasting effect, I think.

所以我认为这是一个具有非常强大和持久影响的方法。

I think the surprising thing is I recently learned a friend of mine tried everything, about 20 years ago, tried everything with depression, and ECT is the last thing he tried, and it changed his life- …for the better.

我认为令人惊讶的是，我最近了解到我的一个朋友尝试了一切，大约 20 年前，尝试了一切与抑郁症有关的方法，而 ECT 是他尝试的最后一件事，它改变了他的生活 - ……变得更好。

That’s not an uncommon story.

这并不是一个不寻常的故事。

1:52:54 Yeah.

是的。

And then I looked online and there’s a lot of stories like this.

然后我上网查了一下，这样的故事还有很多。

1:52:57 And I– before learning of that, my, I’m embarrassed to say, knowledge of ECT was just “One Flew Over the Cuckoo’s Nest.”

而我——在得知这一点之前，我很不好意思地说，我对 ECT 的了解只是“飞越疯人院”。

It– You know, it has a terrible history- …in the, in the ’40s, ’50s and ’60s.

它——你知道，它有一段可怕的历史——……在 40 年代、50 年代和 60 年代。

1:53:11 There are lots of-

有很多——

Abuses

滥用行为

The CIA funded Ewen Cameron up in Canada, and he was giving multiple ECTs a day and reducing peoples to…

中央情报局资助艾文·卡梅伦在加拿大，他每天给予多次 ECT 并减少人们......

1:53:18 Well, they couldn’t walk, they couldn’t talk, they couldn’t feed themselves, they were incontinent, and then he built them back up, or so he claimed, but in many cases, they were left permanently damaged.

嗯，他们不能走路，他们不能说话，他们不能自己吃饭，他们大小便失禁，然后他把它们重建起来，至少他是这么声称的，但在很多情况下，他们被永久损坏了。

So I could recite lots of real horror stories about ECT, but it’s also, if you’re honest about the thing, what you just described, that is patients who were on the brink of suicide, who had long-running depressions, some of them had ECT and they describe it as lifesaving.

所以我可以背诵很多关于 ECT 的真实恐怖故事，但如果你对这件事诚实的话，你刚才所描述的，那就是那些处于自杀边缘的患者，他们患有长期抑郁症，其中一些人患有 ECT，他们将其描述为可以挽救生命。

And as I say when more controlled trials have been done recently, there’s enough evidence now that it’s hard to say, “This never works.

正如我所说，当最近进行了更多对照试验时，现在有足够的证据表明很难说：“这永远不会起作用。

1:54:17 This is just one of these desperate remedies we should consign to dark ages.” The complicating thing is we’d have no clue why it works.

这只是我们应该留给黑暗时代的绝望补救措施之一。”复杂的是我们不知道它为什么起作用。

It’s a purely empirical treatment.

这是一种纯粹的经验治疗。

Right.

正确的。

1:54:29 Right.

正确的。

And that itself I think tends to put people off.

我认为这本身就会让人望而却步。

If you have a curable form of cancer and the surgeon says, “Well, I’m gonna remove it,” and she does, that’s that.

如果你患有可治愈的癌症，外科医生说：“好吧，我要把它切除，”她就这么做了，就是这样。

But because we understand even a little bit, even if our knowledge of human biology is pretty primitive, we do understand a little bit that cancer is cells dividing uncontrollably and taking up and doing damage to the body and eventually killing you, and the fact that we can surgically remove it is a big deal.

但因为我们了解一点点，即使我们对人类生物学的了解相当原始，我们也确实了解一点点，癌症是细胞不受控制地分裂，对身体造成损害并最终杀死你，而事实上我们可以通过手术切除它是一件大事。

There are lots of disorders.

有很多障碍。

I have high blood pressure.

我有高血压。

If untreated, my blood pressure is like a 20-year-old’s thanks to treatment.

如果不治疗的话，我的血压就像20岁的人治疗后的血压一样。

It’s an ongoing thing.

这是一个持续的事情。

I take the damn pill every day and it has a few minor side effects, but for me very minor ones.

我每天都服用该死的药丸，它有一些轻微的副作用，但对我来说非常轻微。

1:55:25 And it turns what could have killed me via a stroke or a heart attack into a condition that’s very well controlled.

它把可能因中风或心脏病而杀死我的情况转变为得到很好控制的情况。

So, you know, all of these things, they’re a complicated picture.

所以，你知道，所有这些事情都是一幅复杂的图景。

It’s easy with some of these things, with lobotomy, with insulin comas, deep sleep treatments, Henry Cotton’s endeavors.

其中一些事情很容易实现，比如脑白质切除术、胰岛素昏迷、深度睡眠治疗，亨利·科顿的努力。

Those you can just say, “Well, we’ll throw them away.” And for a long time, I think ECT would have formed part of that cast of characters.

你可以直接说：“好吧，我们会把它们扔掉。”在很长一段时间里，我认为 ECT 会成为这个角色的一部分。

So when I first conceived the idea of writing Desperate Remedies, the book, it was back in 1981 and I was in London on a Guggenheim Fellowship at the Wellcome Institute.

因此，当我第一次萌生写《绝望的补救措施》这本书的想法时，那是在 1981 年，当时我正在伦敦威康研究所 (Wellcome Institute) 获得古根海姆奖学金。

1:56:13 And I hadn’t done research in detail, but I was aware there were all these things lurking about that had happened in the 1920s and ’30s and I thought that would be a very interesting thing to study.

我没有做过详细的研究，但我知道 20 世纪 20 年代和 30 年代发生的所有这些事情都潜伏着，我认为这将是一件非常有趣的研究。

And luckily I didn’t do it right away or I did it piecemeal over the years and I ended up writing a much more comprehensive look at psychiatry really from its origins to now.

幸运的是，我没有立即这样做，或者多年来我零碎地做，最终我写了一篇更全面的文章，从精神病学的起源到现在。

And I couldn’t have written that book back then, and I would’ve missed all the developments from 1980 onwards, which are very, very important to the overall picture.

那时我不可能写那本书，而且我会错过 1980 年以来的所有发展，这些发展对于整体情况非常非常重要。

So forty years later, 2022.

四十年后，2022 年。

Yes.

是的。

1:56:54 Yes, exactly.

是的，完全正确。

Your own Desperate Remedies: Psychiatry’s- …

你自己的绝望疗法：精神病学的——……

1:56:56 Turmoil in Quest to Cure Mental Illness.

寻求治愈精神疾病的混乱。

I’ve written a lot of books and along the way– part of the way, I think I’ve been productive and kept interested.

我写了很多书，一路走来——在某种程度上，我认为我一直富有成效并保持着兴趣。

1:57:00 I always had two…

我总是有两个…

at least two projects on the go at once.

至少同时进行两个项目。

You can’t simultaneously write two things, but I’d have one and I’d work on it, and if I got tired of it, I’d pick up the other one for a bit and then go back.

你不能同时写两件事，但我有一个，我会继续写，如果我厌倦了，我会拿起另一件事，然后再回去。

And it also meant when I was working on one main project, I had other things percolating in my head, and I would come across things that were relevant to them and I’d make a note and then I’d go back.

这也意味着当我从事一个主要项目时，我的脑海中会渗透出其他事情，我会遇到与它们相关的事情，我会记下来，然后再回去。

So when I finally did Desperate Remedies, I’d been thinking about those issues for forty years, and that made a big difference, I think, to the way I approached things and to what I thought.

因此，当我最终完成《绝望的补救措施》时，我四十年来一直在思考这些问题，我认为这对我处理事物的方式和我的想法产生了很大的影响。

‘Cause you just…

因为你只是...

1:57:51 You either like Thomas says, you say the same thing over and over and over again for forty years or you learn new things and you broaden what you know, and you think about things in a different way because you realize you haven’t grasped the full complexity of what you’re looking at.

你要么像托马斯说的那样，四十年来一遍又一遍地说同样的事情，或者你学习新事物，拓宽你的知识，你以不同的方式思考事物，因为你意识到你还没有掌握你所看到的事物的全部复杂性。

And so look, what I found with psychiatry is there are really a couple of fundamental things that have kept me engaged with the field.

所以看，我在精神病学方面发现确实有一些基本的事情让我一直致力于这个领域。

One, it’s an arena where there’s tremendous human suffering, and it spreads out and it’s as far as I know — and I wrote a big book called Madness in Civilization about from the ancient Greeks and ancient China to now — in every society I’ve studied they have to cope with this.

其一，这是一个人类遭受巨大痛苦的舞台，而且据我所知，它蔓延开来——我写了一本名为《文明中的疯狂》的大书，讲述了从古希腊人和古代中国到现在的故事——在我研究过的每一个社会中，他们都必须应对这一问题。

It takes different forms.

它有不同的形式。

It’s regarded in different ways.

人们以不同的方式看待它。

1:58:44 It’s treated differently, but that there are people that deviate so far from the norm of what we regard as culturally appropriate, they exist everywhere.

它的待遇有所不同，但有些人偏离了我们认为文化上适当的规范，他们无处不在。

So the suffering, the difficulty of studying it, and then the fact that it is such a complex and difficult subject to understand.

因此，痛苦，研究它的困难，以及它是一个如此复杂和难以理解的主题这一事实。

The very fact that we have such limits to our knowledge means there’s space there to examine things in a, in a very– in what needs to be a very complicated way.

事实上，我们的知识如此有限，这意味着我们有空间以一种非常复杂的方式来检查事物。

And so it’s, it’s intellectual puzzles attracted some very, very smart people, but there’s a long way to go.

因此，智力难题吸引了一些非常非常聪明的人，但还有很长的路要走。

Yeah, we have glimmers of insights about how the mind works but- ….if you look at the span of human history, we’re probably in the very early days of understanding this particular one.

是的，我们对大脑如何运作有一些见解，但是……如果你纵观人类历史的跨度，我们可能还处于理解这一特定历史的早期阶段。

1:59:45 I have to, if it’s okay-

如果可以的话我必须这么做-

Yes, of course.

是的，当然。

…so that we– we’ve been carrying multiple threads together.

……所以我们——我们一直在一起承载多个线程。

1:59:48 One of the threads that I think is really exciting to me and really important to the history of psychiatry is the psychotherapy side.

我认为对我来说真正令人兴奋且对精神病学历史真正重要的主题之一是心理治疗方面。

We have mentioned the psychopharmacology that will also– it would be nice to discuss when the two clash and there’s a revolution where psychopharmacology kinda wins over psychoanalysis for a time.

我们已经提到了精神药理学，当两者发生冲突并且出现一场精神药理学暂时战胜精神分析的革命时进行讨论会很高兴。

But let us start at, at the somewhat beginning, in the nineteenth century when talk therapy starts coming to life maybe in the religious context with Christian Science and then psychoanalysis context.

但让我们从十九世纪开始，当时谈话疗法开始在基督教科学的宗教背景下开始出现，然后是精神分析背景。

Yes.

是的。

2:00:32 So I’d mentioned late nineteenth century psychiatry, confined as it was to the mental hospital and to people incarcerated in those places, had become very biological.

所以我提到十九世纪末的精神病学，因为它仅限于精神病院和被监禁在这些地方的人，已经变得非常生物学。

But there were people experiencing mental troubles of various kinds, sadness, confusion, loss of social relationships that were troubling them, grief, all sorts of things like that, that didn’t involve time in a mental hospital but nonetheless involved a good deal of distress as they continued to do.

但有些人经历着各种各样的精神问题，悲伤、困惑、困扰他们的社会关系的丧失、悲痛，诸如此类的事情，这些并不涉及在精神病院的时间，但尽管如此，他们继续这样做会带来很大的痛苦。

And one of the things that was interesting about nineteenth century America is it spawned a number of new religions, sort of variants of Christianity.

十九世纪的美国有趣的事情之一是它催生了许多新的宗教，有些是基督教的变体。

2:01:23 So you had Seventh-day Adventists, a group that still exists, who actually spawned a sanitarium for their depressed congregants that was later taken over by two prominent members of the Adventist Church, the Kellogg family, everybody knows them through cereal.

因此，基督复临安息日会这个团体仍然存在，他们实际上为他们抑郁的会​​众建立了一个疗养院，后来被复临教会的两位著名成员凯洛格家族接管，每个人都通过麦片认识他们。

But they ran a huge sanitarium to which Abraham Lincoln’s widow went, Tarzan went, Henry Ford went, lots of very prominent industrialists and politicians and, you know, it was kind of a farm to go and recover your mental stability and health, and it was all bound up also with beliefs about diet and defecation and all sorts of things.

但他们经营着一个巨大的疗养院，亚伯拉罕·林肯的遗孀、人猿泰山、亨利·福特都去过，还有很多非常著名的实业家和政治家，你知道，那是一个农场，可以让你恢复精神稳定和健康，而且这一切都与饮食、排便和各种事情的信仰紧密相关。

There were the Mormons, or Church of Jesus Christ of Latter-day Saints, many Christians don’t believe they’re really Christian, but they think they are and call themselves such.

有摩门教徒，或耶稣基督后期圣徒教会，许多基督徒不相信他们是真正的基督徒，但他们认为自己是真正的基督徒，并自称是基督徒。

2:02:25 So you have a number of these, and one of them was Christian Science, which was the invention of a woman named Mary Baker Eddy.

所以你有很多这样的东西，其中之一是基督教科学，它是一位名叫玛丽·贝克·艾迪的女人的发明。

Developed the idea–and there are still Christian Science churches and Christian Science reading rooms all across America–that there wasn’t such a thing as disease, that it could be prayed away, that it was just a lack of sufficient faith.

提出了这样的想法——美国各地仍然有基督教科学教堂和基督教科学阅览室——不存在疾病这样的东西，它可以通过祈祷消失，这只是缺乏足够的信仰。

So faith healing tended to work, I think, better if it worked at all for psychiatric problems than it did if you had, say, cancer.

因此，我认为，如果信仰治疗对精神问题有效，那么它往往会比对患有癌症等疾病更有效。

But Christian Science achieved a considerable number of followers, disproportionately women, but not only women.

但基督教科学派拥有相当数量的追随者，其中女性比例不成比例，但不仅仅是女性。

And it began to treat many of the people suffering from what we would think of as the milder mental disorders, and it attracted both adherents and severe critics.

它开始治疗许多患有我们认为的较轻微精神障碍的人，它吸引了追随者和严厉的批评者。

2:03:37 Mark Twain, for example, was thoroughly dismissive of Mary Baker Eddy.

例如，马克·吐温就对玛丽·贝克·艾迪完全不屑一顾。

But it was very successful for a time.

但一时间却非常成功。

There were other religiously based attempts to join in, the most important of which in New England was something called Emmanuel Movement, centered around the Church of the Emmanuel in Boston, which was an attempt actually initially to bring medical and religious approaches to helping the mentally troubled.

还有其他基于宗教的尝试加入其中，其中在新英格兰最重要的是所谓的“以马内利运动”，以波士顿的以马内利教堂为中心，实际上最初是试图通过医学和宗教方法来帮助精神障碍患者。

Rather quickly, the doctors involved decided this was veering too much in the direction of medically-based therapeutics; they kind of withdrew from enterprise.

很快，参与其中的医生就认为这过于偏向基于医学的治疗方法；他们有点退出企业了。

It dispensed– there were talk therapies obviously with a strong religious component around them.

它分配了——谈话疗法显然带有强烈的宗教成分。

This was also at a time when some…

这也是在一些人……

2:04:42 guess we can call them psychiatrists they were often neurologists were beginning to get lots of patients with these kinds of difficult to treat disorders.

我想我们可以称他们为精神科医生，他们通常是神经科医生，他们开始接诊大量患有此类难以治疗的疾病的患者。

Neurology had emerged in America after the Civil War.

神经病学在内战后在美国兴起。

Civil War provided a lot of naturalistic experiments on what happens to the human brain and the human nervous system when trauma affect – I don’t mean psychological trauma I mean bullets blowing holes in your brain.

内战提供了很多关于创伤影响时人类大脑和人类神经系统会发生什么的自然主义实验——我不是指心理创伤，而是指子弹在你的大脑中炸出洞。

A group of new specialists emerged after the Civil War who claims expertise in the brain and the nervous system.

内战后出现了一群新专家，他们声称拥有大脑和神经系统方面的专业知识。

Well one of the other side parts of that is insanity because insanity is also seen as a brain disease so there is a conflict that erupts in the 1870s and ’80s between neurologists and psychiatrists.

另一方面是精神错乱，因为精神错乱也被视为一种脑部疾病，因此 20 世纪 70 年代和 80 年代神经科医生和精神病学家之间爆发了一场冲突。

But the neurologist can’t for the most part get into the asylum

但神经科医生大多无法进入疯人院

2:05:46 where the most seriously ill patients are.

病情最严重的病人在哪里。

Gradually what comes to their waiting room, along with people like multiple sclero– suffering from things like multiple sclerosis, are people with functional mental disorders.

渐渐地，与患有多发性硬化症等疾病的人一起来到他们的候诊室的是患有功能性精神障碍的人。

There’s the beginning of an outpatient practice which initially involves some drugs, the use of electricity–not ECT, but the use, for example, of static electricity because it produces obvious physiological responses.

门诊治疗开始了，最初涉及一些药物、电的使用——不是 ECT，而是使用静电等，因为它会产生明显的生理反应。

Electricity is seen as dominating the workings of the body.

电力被视为主导身体的运作。

Sometimes tonics of one sort or another.

有时是一种或另一种补品。

Most notoriously of all, something called the rest cure.

最臭名昭著的是一种叫做“休息疗法”的东西。

Silas Weir Mitchell, one of the leading lights of American neurology, develops complete bedrest, lots of calories, lots of food, complete lack of intellectual stimulation.

塞拉斯·威尔·米切尔（Silas Weir Mitchell）是美国神经病学的领军人物之一，他养成了完全卧床休息、摄入大量卡路里、大量食物、完全缺乏智力刺激的习惯。

Supposedly this is going to cure you, mainly

据说这会治愈你，主要是

2:06:53 aimed at women.

针对女性。

I feel like that’s another evidence backed technique that works well.

我觉得这是另一种有效的有证据支持的技术。

Well, you know, I’ve partaken in this and I know it has helped me.

嗯，你知道，我参与了这个，我知道它对我有帮助。

Laying in bed doing nothing, eating snacks.

躺在床上什么也不做，吃零食。

Virginia Woolf was one of the people subjected to this.

弗吉尼亚·伍尔夫就是遭受这种情况的人之一。

She claimed it practically drove her mad or made her worse, you know?

她声称这实际上让她发疯或者让她变得更糟，你知道吗？

Just to clarify, we’re talking about laying in bed eating snacks, eating lots of snacks, very high calorie.

澄清一下，我们谈论的是躺在床上吃零食，吃很多零食，热量非常高。

Okay.

好的。

Weir Mitchell wrote two popular bestsellers, self-help books suppose you’d call them in the modern genre.

威尔·米切尔（Weir Mitchell）写了两本广受欢迎的畅销书，假设你将它们称为现代类型的自助书籍。

One was called Wear and Tear.

其中一种称为“磨损”。

The pace of modern life, the telegraph, the railway was all too much.

现代生活的节奏、电报、铁路都让人难以承受。

Your nervous system was overstressed.

你的神经系统压力过大。

Either your batteries ran down, that was one analogy, or you overtaxed your system and went bankrupt.

这是一个类比，要么你的电池没电了，要么你的系统负担过重而破产。

Wear and tear, that was the problem.

磨损，这就是问题所在。

The

的

2:07:54 solution was Fat and Blood.

解决方案是脂肪和血液。

That was the title of the other book.

这是另一本书的书名。

You got scrawny, nouveau, nervous, twitchy, and what you really needed was to build back up your strength, including your nervous strength.

你骨瘦如柴、新奇、紧张、抽搐，而你真正需要的是增强你的力量，包括你的神经力量。

Isn’t it fascinating to look at that 120 years plus ago?

回顾120多年前的景象，是不是很有趣？

They’re talking about how anxiety inducing society is, how much is going on, and we in the modern day talk in exact same way about social media, the internet, all that kind of stuff.

他们谈论的是社会是如何引发焦虑的，正在发生什么，而我们现代人以完全相同的方式谈论社交媒体、互联网以及所有类似的东西。

Yeah, yeah, it is.

是啊，是啊，确实如此。

We look back on the nineteenth century and think of it in idyllic terms of a much slower pace of life, and people, they thought it was stressful in exactly the ways we do.

我们回顾十九世纪，会以田园诗般的方式思考它，生活节奏要慢得多，人们认为这和我们一样充满压力。

There was a class of potential patients.

有一类潜在的病人。

Some of them were seeking help in the neurologists and a few psychiatrists who moved out of the asylum.

他们中的一些人正在向神经科医生和一些搬出精神病院的精神科医生寻求帮助。

But there were also these mental healing groups that were religious, and they’re all around at the beginning of the 20th century.

但也有一些宗教性的心理治疗团体，它们在 20 世纪初就很普遍。

2:08:58 And in 1909, a Viennese gentleman and two of his close colleagues travel across the Atlantic on a German steamer and arrive in New York and then transport themselves up to Worcester, Massachusetts, where Clark University is celebrating its 20th anniversary.

1909 年，一位维也纳绅士和他的两位亲密同事乘坐德国轮船横渡大西洋，抵达纽约，然后前往马萨诸塞州伍斯特，克拉克大学正在那里庆祝建校 20 周年。

Clark University was then set up– It still exists, but it was set up to copy the German research university.

克拉克大学随后成立——它仍然存在，但它是模仿德国研究型大学而设立的。

The only comparable example at the time was Johns Hopkins in Baltimore, and Hopkins developed the leading medical school of the time borrowing from that German concept of mixing research and teaching and patient care.

当时唯一可比的例子是巴尔的摩的约翰·霍普金斯大学，霍普金斯大学借鉴​​了德国混合研究、教学和患者护理的理念，发展出了当时领先的医学院。

I like how you’re telling this in a cinematic way the story of Sigmund Freud and Carl Jung-

我喜欢你以电影的方式讲述西格蒙德·弗洛伊德和卡尔·荣格的故事——

2:09:53 …

……

go coming to America to give a lecture.

去美国讲学。

I like, I like how it’s like the movie opens and there yeah Yeah Well here he is You know Like How do you feel who he is?

我喜欢，我喜欢电影一开始的样子，是的，是的，他就在这里，你知道，就像你觉得他是谁？

He’s fairly obscure We should say the reason you’re actually telling it that way is America has been a really defining place for psychiatry Yes And then Freud had his own views on America and so on But this this was In terms of the history yes psychiatric medicine america as central Right Many of the in house histories of Psychiatry portray this as Freud conference Mm-hmm But it wasn’t Freud Was almost an afterthought Of the Conference The head of Clark Was a psychologist And he was interested in Freud But Actually There were about thirty speakers At the Clark conference Two Nobel Prize Winners in physics Franz Boas

他相当晦涩 我们应该说你实际上这样讲的原因是美国一直是精神病学的一个真正决定性的地方 是的 然后弗洛伊德对美国有他自己的看法等等 但这是从历史角度来看 是的 精神病学医学 美国作为中心 对 许多精神病学内部历史将其描述为弗洛伊德会议 嗯嗯 但这不是弗洛伊德 几乎是会议的事后想法 克拉克的负责人是一位心理学家他对弗洛伊德感兴趣 但实际上克拉克会议上大约有三十位发言者 两位诺贝尔物理学奖获得者 弗兰兹·博阿斯

2:10:50 Who was the leading anthropologist Of his generation And A host of other scholars Including a couple of Freuds Fierce critics One of whom Stern Was On the same boat As him And They avoided one another Like the plague But anyway Its important To see That And Freud It’s a mark of how Important german science And German Medical Science Was In the late nineteenth Early Twentieth Century Where it was THE most advanced In the world That Freud Delivered His lectures IN GERMAN AND THE AUDIENCE THAT WASNT A PROBLEM FOR THE AUDIENCE CAUSE THEYD ALL LEARNED GERMAN SO THEY COULD READ GERMAN LITERATURE ON MEDICINE So Quite An Extraordinary Thing UM William James Attends One OF FREUDS LECTURES AND HAS A CONVERSATION WITH HIM WILLIAM JAMES IS ONE OF THE PEOPLE THINKING ABOUT THE PSYCHOLOGY OF THE HUMAN

谁是他这一代的主要人类学家 还有许多其他学者 包括几位弗洛伊德 激烈的批评家 其中一位斯特恩和他在同一条船上 他们像瘟疫一样互相回避 但无论如何重要的是看到这一点和弗洛伊德 它标志着德国科学和德国医学在十九世纪末二十世纪初是多么重要 那里是世界上最先进的弗洛伊德用德语进行演讲以及听众这对观众来说不是一个问题，因为他们都学了德语，所以他们可以阅读德国医学文献，所以这是一件非同寻常的事情威廉·詹姆斯参加弗洛伊德的一场讲座并与他交谈威廉·詹姆斯是思考人类心理学的人之一

2:11:44 MIND IN INTERESTING WAYS HES NOT IMPRESSED BY FREUD AND HE ALSO HAS A BAD HEART CONDITION HE DIES NOT All that long afterwards BUT HES NOT Impressed By Freud A handful of people are Some of the neurologists And Freuds Lectures Explicitly Attack Religiously Based Psychotherapy Says psychotherapy Is like a surgical operation on the mind And Only Us Doctors Or ONLY US THOROUGHLY TRAINED People Cause ACTually He doesnt Believe That Psychoanalysis Is Only Something That Can Be Practiced by Medically Qualified But The Lecture Is On psychoanalysis YES ITS FIVE LECTURES THEYRE PUBLISHED SUBSEQUENTLY AND HE MAKES A VERY IMPORTANT Convert THERE UM James Jackson Putnam Is A Boston Brahmin One of the Upper Class Bostonians With Whos Extremely well connected and is professor of Neurology AT Harvard

有趣的是，他对弗洛伊德没有印象，他的心脏也不好，死后不久他就去世了，但他对弗洛伊德没有印象因为实际上他并不相信精神分析只是具有医学资格的人才能实践的东西，但是讲座是关于精神分析的，是的，他们随后出版了五场讲座，他在那里做出了非常重要的转变，UM詹姆斯·杰克逊·普特南是波士顿婆罗门，与他关系密切的上层波士顿人之一，是哈佛大学的神经病学教授

2:12:43 And he becomes A Freudian At that conference So Mainstream American Psychiatry Pays Very little attention TO To Freuds Arrival on the scene And When he BECOMes A bit more visible They tend to be very dismissive They uh They regard the idea of talk therapy For something They regard as a biological condition AS A ridiculous Idea Maybe Just Uh Mention A Few Things SIGMUND FREUD Of course Is widely acknowledged to be the father of psychoanalysis And UH He Has a bunch of ideas One of which is theres This unconscious Mind That is the source of many of our Uh Behaviors Exactly And Then Psychoanalysis Is a Way to delve deep into that mind And the tools he used to Do that is talking Yes Freud was trained as a neurologist himself Uh And studied under the most famous Late Nineteenthcentury Neurologist

在那次会议上他成为了弗洛伊德主义者所以美国主流精神病学很少关注弗洛伊德到达现场当他变得更加引人注目时他们往往非常不屑一顾他们呃他们认为谈话疗法的想法对于他们认为是一种生物学状况的东西是一个荒谬的想法也许只是呃提几件事西格蒙德·弗洛伊德当然被广泛认为是精神分析之父而且呃他有一堆想法其中之一就是这个无意识的心灵 那是我们许多行为的根源 正是 然后精神分析是一种深入研究心灵的方法 他用来做的工具就是说话 是的，弗洛伊德本人接受过神经科医生的培训 呃并在最著名的十九世纪末神经学家的指导下进行了研究

2:13:43 Charcot in Paris and translated Charcot into German and endeared himself to Charcot by doing that.

夏科在巴黎，并将夏科翻译成德语，从而赢得了夏科的喜爱。

That’s, um, a clever way to help your career along.

嗯，这是一个帮助你的职业生涯发展的聪明方法。

But his Viennese colleagues didn’t think much of Charcot.

但他的维也纳同事并不怎么看好夏科。

And they didn’t think much of Freud’s ideas either, so he had a bit of a hard time.

而且他们也不太重视弗洛伊德的想法，所以他过得有点为难。

But he did develop a successful practice in the sense that patients came to him.

但从病人来找他的意义上来说，他确实开展了一项成功的实践。

He was accompanied by two of his close disciples to the Clark Conference.

他在两名亲密弟子的陪同下参加了克拉克会议。

One of them, Carl Jung, was then anointed the Crown Prince.

其中一位卡尔·荣格随后被任命为王储。

He was supposed to inherit Freud’s enterprise until the men had a very serious falling out.

他本来应该继承弗洛伊德的事业，直到两人发生严重的争吵。

Mm-hmm.

嗯嗯。

Uh, just a little bit later in nineteen thirteen.

呃，就在十九点十三分​​晚些时候。

And Freud and Jung went their separate ways.

弗洛伊德和荣格分道扬镳。

That’s a complicated story.

这是一个复杂的故事。

Freud, as one of his close, uh, friends and collaborators put it, was a great hater if you fell

弗洛伊德，正如他的一位亲密的，呃，朋友和合作者所说的那样，如果你跌倒了，他是一个很大的仇恨者

2:14:49 out with Freud.

和弗洛伊德出去了。

It was bad news.

这是个坏消息。

Oh yeah, yeah.

哦，是的，是的。

You were excommunicated if it was Adler, but Jung especially.

如果是阿德勒，你就会被逐出教会，但荣格尤其如此。

Jung was Swiss and he worked in the major mental hospital in Zurich, and he was attracted to psychoanalysis and to Freud.

荣格是瑞士人，在苏黎世的一家大型精神病院工作，他对精神分析和弗洛伊德很感兴趣。

2:14:57 And for the first few years there, there was this obvious close alliance.

在那里的最初几年，存在着这种明显的紧密联盟。

Anyway, so Jung was a, the person who actually persuaded Freud to go to America.

不管怎样，荣格是一个真正说服弗洛伊德去美国的人。

Freud initially– Freud had very low opinion of America.

弗洛伊德最初——弗洛伊德对美国的评价很低。

He said it should be renamed Dollaría because it was only interested in the dollar.

他说它应该更名为 Dollaría，因为它只对美元感兴趣。

And American women were far too pushy and powerful, and American food was dreadful and it poisoned him, and on and on.

美国女人太咄咄逼人、太强势，美国食物太难吃了，毒害了他，等等。

Um-

嗯-

So as you said, Freud was a master hater.

正如你所说，弗洛伊德是一个仇恨大师。

Yeah, he was.

是的，他是。

2:15:35 And one of the things he hated was America, even though America brought him some fairly rich patients.

他讨厌的事情之一就是美国，尽管美国给他带来了一些相当富有的病人。

But- …

但是——……

the richest patients of all went to Jung, not to Freud.

最富有的病人都去找荣格，而不是弗洛伊德。

And I think that probably exacerbated this split.

我认为这可能加剧了这种分裂。

Let’s actually focus first before the conference on the actual ideas of psychoanalysis.

在会议开始之前，让我们首先关注精神分析的实际想法。

2:15:53 So Freud was the originator of psychoanalysis.

所以弗洛伊德是精神分析学的鼻祖。

This is 19th century.

这是19世纪。

So tell me about the original case of Anna O.

请告诉我有关安娜·O 的原始案例。

and like what is psychoanalysis?

以及什么是精神分析？

Yeah.

是的。

2:16:07 So Freud’s academic career had been failing in Vienna, and he faced a prospect of either having to emigrate to America, which he regarded with horror in the 1880s, or perhaps reviving his career by going and studying under the most famous neurologist of the era, Jean-Martin Charcot, who was then delivering lectures on hysteria in Paris.

因此，弗洛伊德的学术生涯在维也纳一直失败，他面临着要么必须移民到美国（他在 1880 年代对此感到恐惧）的前景，要么可能通过跟随当时最著名的神经学家让·马丁·夏尔科（Jean-Martin Charcot）学习来重振自己的职业生涯，夏尔科当时正在巴黎发表有关癔症的讲座。

And so Freud went and spent some months there and came back imbued with Charcot’s ideas about hysteria and found a Viennese medical establishment.

于是弗洛伊德去那里呆了几个月，回来时带着夏科关于歇斯底里症的想法，并找到了一家维也纳医疗机构。

He started a consulting career and that involved– He had a close friend named Josef Breuer.

他开始了咨询职业生涯，其中涉及——他有一个亲密的朋友，名叫约瑟夫·布洛尔(Josef Breuer)。

And Breuer was more senior, had a very large practice, and referred patients to Freud.

布洛伊尔的资历更高，拥有规模很大的诊所，并将患者转介给弗洛伊德。

And the two of them began to be interested in this problem of hysteria.

而他们两个人也开始对这个歇斯底里的问题产生了兴趣。

2:17:13 Breuer had treated a woman who’s now known as the sort of foundation patient for– the Ur patient for psychoanalysis, who was known to us as Anna O.

布洛伊尔治疗过一位女士，她现在被称为精神分析的乌尔病人的基础病人，我们称之为安娜·O。

She– We actually know she was Bertha von Pappenheim but that was hidden for a long time.

她——我们实际上知道她是伯莎·冯·帕彭海姆，但这已经被隐藏了很长时间。

There– A lot of these patients had pseudonyms because obviously the cases exposed a lot about their inner psychology and quite reasonably, even without the modern concerns about privacy, there was a reluctance to identify them.

那里——很多病人都有化名，因为显然这些案例暴露了他们的很多内心心理，而且很合理的是，即使没有现代对隐私的担忧，人们也不愿意透露他们的身份。

2:17:50 So Anna O.

所以安娜·O.

had nursed her father.

照顾过她的父亲。

She was Breuer’s patient, not Freud’s.

她是布洛伊尔的病人，而不是弗洛伊德的病人。

She’d nursed her father through an illness, and he’d ended up dying, and she developed various physical symptoms that troubled her a great deal and was also somewhat depressed.

她照顾生病的父亲，最后他去世了，她出现了各种身体症状，让她很困扰，也有些沮丧。

And Breuer and Freud dealt with that by developing a notion that what she was suffering from was repressed memories and trauma.

布洛尔和弗洛伊德通过发展一种观念来解决这个问题，即她所遭受的痛苦是压抑的记忆和创伤。

And this would become central to psychoanalysis, the idea of half-muttered memories lurking in your subconscious that emerged in distorted forms of psychological symptoms and ways of being in the world that were disruptive.

这将成为精神分析的核心，即潜意识中潜伏着半嘀咕的记忆的想法，这些记忆以扭曲的心理症状和破坏性的存在方式出现。

Freud, of course, develops a much more elaborate theory of this in years to come.

当然，弗洛伊德在未来几年对此提出了更复杂的理论。

2:18:43 Fre- and Breuer collaborate on a book called Studies in Hysteria, and they’re a series of case vignettes in there of patients Freud has treated.

弗洛伊德和布洛伊尔合作写了一本名为《歇斯底里症研究》的书，其中包含弗洛伊德治疗过的患者的一系列病例片段。

And he develops the notion that people have these ex– past experiences.

他提出了这样一种观念：人们都有这些过去的经历。

Initially, he thinks they’re real, that they’re– For example, they have been sexually assaulted as a child and that they can’t face that, and so they hide it away from themselves.

最初，他认为它们是真实的，比如，他们小时候受到过性侵犯，他们无法面对这一点，所以他们把它藏起来。

But they can’t completely, so it emerges in this tortured series of forms.

但他们不能完全做到这一点，所以它以这一系列折磨人的形式出现。

And as things develop, the notion of resistances emerges, that you can’t easily retrieve these memories, and indeed, you resist them surfacing, and you have a hard time acknowledging them.

随着事情的发展，阻力的概念出现了，你不能轻易地检索这些记忆，事实上，你抵制它们的出现，你很难承认它们。

2:19:30 And only with long and painful work will it become possible for– But as you bring them into– from the unconscious into the conscious world, you learn to cope with them in a different way, and, and your personality is transformed and you’re made better.

只有经过长期而痛苦的工作，才有可能——但当你把它们从无意识世界带入意识世界时，你学会以不同的方式应对它们，并且，你的个性会发生转变，你会变得更好。

But crucially, the stuff that happens in childhood is important.

但至关重要的是，童年发生的事情很重要。

Yes.

是的。

2:19:53 The early experiences have a dramatic effect, and I think even some biological psychiatrists would agree with that notion these days.

早期的经历产生了巨大的影响，我想即使是现在的一些生物精神病学家也会同意这个观点。

That, you know, to the extent we abolish this distinction between mind and body and, and acknowledge that they are closely tied together, traumatic experiences in childhood, various socialization experiences, loss and so on deeply mark the human psyche, I think, and, and can have long term effects that are, are very powerful.

你知道，在某种程度上，我们废除了心灵和身体之间的区别，并承认它们紧密相连，童年时期的创伤经历、各种社会化经历、损失等等深深地标记了人类的心理，我认为，并且可以产生非常强大的长期影响。

Of course, Freud added a bunch of stuff in the realm of psychosexual stages of childhood.

当然，弗洛伊德在童年的性心理阶段领域添加了很多东西。

Yes.

是的。

2:20:38 As he begins to develop his theories, he more and more comes to see at first the libido, which gets sort of transformed into the sex drive- …

当他开始发展他的理论时，他越来越多地首先看到性欲，它在某种程度上转化为性欲——……

And sexual experiences and the repression of sexuality and the modification of sexuality as people grow.

随着人们的成长，性经历、性欲压抑和性欲改变也随之而来。

Um, all of that enters the picture.

嗯，所有这些都进入了画面。

It’s one of the things that ends up dividing Freud and Jung, Jung somewhat because Jung downplays that sexual side of things after the break.

这是弗洛伊德和荣格最终分裂的原因之一，荣格在某种程度上是因为荣格在休息后淡化了事物的性方面。

2:21:11 But so Freud develops a very complicated theory of mind initially reflecting his training as a neurologist.

但弗洛伊德发展了一种非常复杂的心理理论，最初反映了他作为神经科医生接受的训练。

He tries to write an essay which survives called Project for a Scientific Psychology, and the scientific psychology is gonna tie psychology back into neurology.

他试图写一篇名为“科学心理学项目”的文章，而科学心理学将把心理学重新与神经学联系起来。

But he abandons that, and once he’s abandoned that, he goes on to develop an increasingly elaborate theory.

但他放弃了这一点，一旦他放弃了这一点，他就会继续发展一个越来越复杂的理论。

He writes The Interpretation of Dreams, for example, because he begins to regard dreams as an arena where these hidden memories, these suppressed- …

例如，他写了《梦的解析》，因为他开始将梦视为一个舞台，在那里这些隐藏的记忆，这些被压抑的记忆……

things reemerge in disguised form in your dream life.

事物以伪装的形式重新出现在你的梦想生活中。

And so that book marks an important step forward.

因此，这本书标志着向前迈出了重要的一步。

He becomes interested in things like slips of the tongue, so-called Freudian mistakes.

他对诸如口误之类的事情产生了兴趣，即所谓的弗洛伊德错误。

2:22:11 As seeing those as revealing what really is hidden from you.

将它们视为揭示了真正对你隐藏的东西。

And so there’s this very elaborate dissection of things that relies upon long extended talk therapy.

因此，对事物的细致剖析依赖于长时间的谈话治疗。

Of course underlying it he’s building a model of how this whole mind thing works.

当然，在其背后，他正在建立一个模型来展示整个思维如何运作。

2:22:26 There’s- …

有——……

three interacting parts of the personality.

人格的三个相互作用的部分。

First, the id, which is the primitive, entirely unconscious, driven by pleasure principle, seeking immediate gratification or basic drives such as sex and aggression.

首先，本我是原始的、完全无意识的，受快乐原则驱动，寻求即时满足或性和攻击性等基本驱动力。

There’s the ego, which is the rational mediator operating under reality principle, balancing the id’s demands with external reality.

自我是在现实原则下运作的理性调解者，平衡本我的要求与外部现实。

And finally, the superego, which is the internalized moral standards and ideals producing guilt or pride and striving for perfection.

最后是超我，它是内化的道德标准和理想，产生内疚或骄傲并追求完美。

So that’s the structure.

这就是结构。

Yeah.

是的。

2:23:06 That is broadly speaking the structure that Freud ends up with, and the conflicts between these entities and the ways they interact are obviously the thing that creates your mental universe, your way of being in the world and in many cases creates pathology, which through the process of psychoanalysis you can transform grotesque unhappiness into ordinary unhappiness or something like that.

从广义上讲，这就是弗洛伊德最终得出的结构，这些实体之间的冲突以及它们相互作用的方式显然是创造你的精神宇宙、你在世界上的存在方式的东西，并且在许多情况下创造了病理学，通过精神分析的过程，你可以将怪诞的不快乐转化为普通的不快乐或类似的东西。

You know?

你知道？

So- ….

所以- …。

Yes, you get that.

是的，你明白了。

And initially, Jung gets one of the heirs to the International Harvester fortune as a patient, and the McCormick family are as rich as the Rockefellers and the Carnegies and the Vanderbilts of that world.

最初，荣格以病人的身份得到了国际收割机财富的继承人之一，麦考密克家族与洛克菲勒家族、卡内基家族和范德比尔特家族一样富有。

2:24:02 This guy is a US senator who ends up committing suicide in nineteen twenty-five after a lot of treatment from Jung when he fails to win reelection to the US Senate.

这个家伙是一位美国参议员，在未能赢得美国参议院连任后，在荣格的大量治疗后最终在十九岁二十五岁自杀。

He kills himself in Washington in the interregnum.

他在空位期间在华盛顿自杀。

But he also gets another one of that brood.

但他也得到了另一窝。

One of the Rockefeller daughters, Edith Rockefeller, marries a McCormick.

洛克菲勒的女儿之一伊迪丝·洛克菲勒嫁给了麦考密克家族的人。

2:24:26 And she has a lot of psychological issues, and she tries to get Jung to move to Chicago promising him she’ll set him up in a mansion with lots of her friends as his patients, and Jung has no interest.

她有很多心理问题，她试图让荣格搬到芝加哥，向他保证她会把他安排在一座豪宅里，让她的很多朋友作为他的病人，但荣格没有兴趣。

So then she finally persuades him to come to New York and accompany her on the liner across to Zurich to be treated.

于是她终于说服他来纽约，陪她乘船前往苏黎世接受治疗。

She’s agoraphobic, and so she has a hard time being out of her little cocoon.

她有广场恐惧症，所以她很难摆脱她的小茧。

So she’s treated there as an example of how peculiar she was.

所以她在那里被视为她有多么奇特的一个例子。

I mentioned the agoraphobia.

我提到了广场恐惧症。

2:25:05 So she occupies a huge array of suites with all her servants and so on in Zurich.

因此，她和她所有的仆人等在苏黎世占据了大量的套房。

And she takes a train journey—it’s a stopping train—and her chauffeur follows the train in the Rolls Royce in case she has to jump out of the train at a station ’cause she can’t bear it anymore.

她乘坐火车旅行——这是一列停靠的火车——她的司机开着劳斯莱斯跟随火车，以防她因为无法忍受而不得不在车站跳下火车。

And she becomes a Jungian analyst, but she’s very wealthy and she writes big checks to Jung, which is the important thing.

她成为了一名荣格分析师，但她非常富有，她给荣格开了大笔支票，这是重要的事情。

And then Jung attracts Paul Mellon and his wife Mary.

然后荣格吸引了保罗·梅隆和他的妻子玛丽。

And so Jung’s works are published by Princeton University Press with a subvention from that Mellon Foundation.

因此，在梅隆基金会的资助下，荣格的作品由普林斯顿大学出版社出版。

So it’s a long-running thing.

所以这是一个长期的事情。

Freud doesn’t get patients quite that rich.

弗洛伊德并没有让病人变得那么富有。

He gets some rich Americans.

他得到了一些富有的美国人。

We should say that Freud became– Freud’s ideas became quite popular among the intellectual and artist class in the nineteen twenties in America.

应该说，弗洛伊德成为——弗洛伊德的思想在十九世纪二十年代的美国知识分子和艺术家阶层中非常流行。

And another thing happened.

还有一件事发生了。

2:26:00 World War I saw the breakdown of many soldiers from something that came to be labeled as shell shock.

第一次世界大战中，许多士兵因被称为炮弹休克症的疾病而崩溃。

The label shell shock intimates its—the first theories about its origin, which was that shells bursting near you and bombs bursting near you shook up your body and your brain and created some physical damage that then accounted for the symptoms of shell shock: your mutism, your blindism, your constant shaking, your nightmares, all of that.

炮弹休克症的标签暗示了它的起源——关于其起源的第一个理论，即在你附近爆炸的炮弹和在你附近爆炸的炸弹震动了你的身体和大脑，并造成了一些身体损伤，从而导致了炮弹休克症的症状：你的沉默，你的失明，你不断的颤抖，你的噩梦，所有这些。

But it became increasingly apparent that shell shock was actually a psychological thing.

但越来越明显的是，炮弹休克实际上是一种心理现象。

The trauma of war in significant number of cases brought about mental breakdowns.

战争的创伤在很多情况下导致了精神崩溃。

2:26:50 And in thinking about that, Freud’s ideas about the unconscious mind and trauma and its connection to symptomatology acquired a new significance for a lot of people in that period.

在思考这一点时，弗洛伊德关于无意识心理和创伤及其与症状学的联系的观点对于那个时期的许多人来说获得了新的意义。

And then after the war, you’re absolutely right among a certain smart section of society, those ideas developed a considerable purchase.

战后，你绝对是社会中某个聪明人的正确选择，这些想法引起了相当大的购买力。

Psychiatrists who were mostly stuck in the asylums dealing with psychotic patients wanted nothing to do with these ideas and this talk therapy.

大多数被困在精神病院里处理精神病患者的精神科医生不想与这些想法和谈话疗法有任何关系。

The mainstream psychotherapy which was mostly in a clinical setting, yeah, Freud’s ideas were not popular.

主流心理治疗主要是在临床环境中，是的，弗洛伊德的想法并不受欢迎。

No.

不。

2:27:36 The only partial exception to that was um, the mental hospital in Washington DC–the only federal mental hospital, St. Elizabeths.

唯一的部分例外是华盛顿特区的精神病院——唯一的联邦精神病院，圣伊丽莎白医院。

William Alanson White, who was then the superintendent, was somewhat sympathetic to Freud’s ideas and tried a bit, but you’re talking about thousands of patients and the idea of talk therapy for them is obviously out of reach, plus they are much more severely disturbed.

时任院长的威廉·阿兰森·怀特（William Alanson White）对弗洛伊德的想法有些同情，并进行了一些尝试，但你谈论的是成千上万的患者，对他们进行谈话治疗的想法显然是遥不可及的，而且他们的困扰要严重得多。

So it does happen: novelists, painters, artists, playwrights, and the audience for those elite forms of culture do tend to embrace Freudian ideas.

确实如此：小说家、画家、艺术家、剧作家和这些精英文化形式的观众确实倾向于接受弗洛伊德的思想。

Sex sells in the theater and on the movies, obviously.

显然，性在剧院和电影中很受欢迎。

But beyond that part of Freud’s appeal to everybody, it was something he lamented at one point.

但除了弗洛伊德对所有人的吸引力之外，他曾一度对这一点感到遗憾。

He said, “You know my case histories read like short stories, like works of fiction, and in that

他说：“你知道我的案例读起来就像短篇小说，就像小说作品一样，而且在这一点上

2:28:46 sense people think they lack the stamp of serious science.

有理智的人认为他们缺乏严肃科学的印记。

But I’m driven to that because that’s how I unpack what’s going on.

但我被迫这么做，因为这就是我解开正在发生的事情的方式。

Well, psychoanalysis is telling stories.

嗯，精神分析就是讲故事。

It’s getting people to recover stories, recover memories, to rebuild, right?

它让人们恢复故事、恢复记忆、重建，对吗？

Um and its elements of psychological conflict and hidden motives and so forth, naturally very appealing to people writing novels, people writing plays, people doing screenplays.

嗯，它的心理冲突和隐藏动机等等元素，自然对写小说的人、写戏剧的人、做剧本的人非常有吸引力。

And for artists of the modern sort, the idea that we can extract things from the subconscious, Surrealism and the like for example, are clearly very heavily influenced by Freudian ideas.

对于现代艺术家来说，我们可以从潜意识中提取事物的想法，例如超现实主义等，显然深受弗洛伊德思想的影响。

But it’s important to know circa 1930 there are probably three hundred psychoanalysts in North America if they each Classical psychoanalysis involving five hours a week.

但重要的是要知道，大约在 1930 年，北美可能有 300 名精神分析师，如果他们每人每周进行 5 个小时的古典精神分析。

They can’t treat

他们无法治疗

2:29:57 that many patients.

那么多病人。

A few thousand when there are hundreds of thousands in the hospitals.

当医院里有数十万人时，只有几千人。

Right.

对。

Mm-hmm.

嗯嗯。

So what changes that?

那么是什么改变了这一点呢？

Hitler starts killing off Jews and killing off psychoanalysts.

希特勒开始屠杀犹太人和精神分析学家。

The ones who can escape, some of them go to England and some come to America.

能逃出来的，有的去了英国，有的去了美国。

Uh, the most famous escapee is Freud himself and his daughter Anna.

呃,最著名的逃亡者就是弗洛伊德本人和他的女儿安娜。

Princess Bonaparte, who’s one of Freud’s great supporters, bribes the Nazis to get him out.

波拿巴公主是弗洛伊德的伟大支持者之一，她贿赂纳粹以将他救出。

And he travels by train to London, very sick with cancer of the jaw, as he has been since the mid-’20s.

他乘火车前往伦敦，自 20 世纪 20 年代中期以来，他就患有下颌癌，病情十分严重。

So he sets up shop in London, and Anna succeeds him really as one of the central figures in British psychoanalysis.

于是他在伦敦开设了商店，安娜接替了他，真正成为英国精神分析的核心人物之一。

But other analysts come here to America.

但其他分析师也来到了美国。

So the numbers of analysts probably by 1940, America’s not yet in the war, have a bit more than doubled.

因此，到 1940 年，美国尚未参战时，分析师的数量可能会增加一倍多。

And more importantly,

更重要的是，

2:31:01 psychoanalytic training has become much more organized here.

这里的精神分析培训变得更加有组织。

The institutes outside the universities control psych…

大学以外的机构控制心理……

And universities are not yet the knowledge factories they become after the war.

大学还不是战后的知识工厂。

Mm-hmm.

嗯嗯。

And that’s a crucial mistake that psychoanalysis makes.

这是精神分析所犯的一个严重错误。

It’s great because it controls its training completely.

它很棒，因为它完全控制了训练。

The bad thing is when the center of gravity moves to the university, it’s not there and either resists being incorporated or the university resists incorporating it.

糟糕的是，当重心转移到大学时，大学却不在那里，要么抵制合并，要么大学拒绝合并。

So I think that’s a structural weakness for that.

所以我认为这是一个结构性弱点。

But what really transforms things is World War II.

但真正改变事情的是第二次世界大战。

Five fifty-minute hours famously–they last fifty minutes ’cause then there’s ten minutes for analysts to recover before the next patient arrives.

著名的五个五十分钟的小时——它们持续五十分钟，因为在下一个病人到达之前，分析师有十分钟的时间恢复。

Yes.

是的。

You are free associating on the couch and gradually being

你可以在沙发上自由地交往，并逐渐变得

2:32:13 coaxed to see as material emerges what you’re hiding from yourself.

当材料出现时，你会被诱骗看到你对自己隐瞒的事情。

I mean initially they tried–this is in their early early days–they tried hypnosis, yes.

我的意思是，最初他们尝试过——这是在他们早期的早期——他们尝试过催眠，是的。

But they’ve…

但他们已经……

You know, this is where Freud took the big leap and expanded to free association.

你知道，这就是弗洛伊德迈出一大步并扩展到自由联想的地方。

Right.

对。

So I mentioned Freud training under Charcot.

所以我提到了弗洛伊德在夏科的指导下接受的训练。

Charcot hypnotized his hysterical patients.

夏科催眠了他的歇斯底里的病人。

We now know a lot of that was fakery.

我们现在知道其中很多都是伪造的。

Not–I don’t think he was conscious of the fakery, but the patients were on display over and over again and they worked their routines up very well and they deceived him and they deceived the audience.

不——我认为他没有意识到这些造假，但是病人一遍又一遍地展示，他们把自己的日常工作做得很好，他们欺骗了他，他们欺骗了观众。

But Freud came back from Paris bringing with him the idea that hypnosis was the way forward.

但弗洛伊德从巴黎回来，带来了催眠是前进之路的想法。

But after the break with Breuer–Breuer had a general medical practice and lost interest in hysteria and didn’t want anything to

但在与布洛伊尔分手后，布洛伊尔开始接受一般医学实践，对歇斯底里症失去了兴趣，并且不想做任何事情。

2:33:11 do with the revisions of Freud’s work on hysteria.

与弗洛伊德关于歇斯底里症的著作的修订有关。

After that happened, Freud, who was a very clumsy hypnotist by his own account, began to develop this alternative of free association and getting people to speak whatever came into their head without a censor.

在那之后，弗洛伊德（据他自己的说法是一个非常笨拙的催眠师）开始开发这种自由联想的替代方案，让人们在没有审查的情况下说出他们脑海中出现的任何内容。

That was the important thing, that the half-murdered memories were being hidden from you and your–uh, the constellation of psychological forces in your unconscious was squashing them down, but they were reemerging as other kinds of symptoms.

重要的是，半被谋杀的记忆对你和你的——呃，你无意识中的心理力量群正在压制它们，但它们又以其他类型的症状重新出现。

So how well does psychoanalysis work?

那么精神分析的效果如何呢？

2:33:49 How much do we understand?

我们了解多少？

We’ve talked about all these approaches that didn’t work.

我们已经讨论过所有这些行不通的方法。

How well did it work at that time?

当时效果如何？

You know, one of the things after World War II, when psychoanalysis was making great strides in America and the Rockefeller Foundation was still heavily involved in promoting psychiatry and developing what it hoped would be new tools in it, the then heads of the institute–of the funding program, Alan Gregg and Robert Morison, especially Morison, kept pressing the analysts, “Provide us proof that what you do works.” And the analysts kept resisting and resisting and resisting, saying, “It’s much more complicated than that.

你知道，二战后的一件事，当时精神分析学在美国取得了长足的进步，洛克菲勒基金会仍然大力参与推广精神病学并开发它希望成为精神病学的新工具，当时的研究所负责人——资助计划艾伦·格雷格和罗伯特·莫里森，特别是莫里森，不断向分析师施压，“向我们提供证据，证明你们所做的事情是有效的。”分析师们一直在抵制、抵制、抵制，他们说：“事情比这复杂得多。

2:34:01 There’s no easy measure because what we’re doing is reconstructing entire personalities, entire ways of being.

没有简单的衡量标准，因为我们正在做的是重建整个人格、整个存在方式。

People sense themselves, their ways of being in the world, and we don’t have easy ways to measure that.”

人们感知自己，感知自己在世界上的存在方式，但我们没有简单的方法来衡量这一点。”

To contrast that with the eighty percent promises over and over and over and over.

与此相比，百分之八十的承诺一遍又一遍。

2:34:52 Yes, yes, yes.

是的，是的，是的。

And it’s a long and complicated pro…

这是一个漫长而复杂的过程……

2:34:57 That was very important.

这非常重要。

Because another kind of psychotherapeutics is emerging in, in the aftermath, during and in the aftermath of the war, as a rival for both psychiatry and for psychoanalysis.

因为另一种心理治疗学正在战争期间、战争期间和战后出现，作为精神病学和精神分析的竞争对手。

Initially not terribly successful, but as time goes on, a more and more important part of the story.

最初并不是很成功，但随着时间的推移，故事的一部分变得越来越重要。

So to focus on the war for a minute, America’s psychiatrists went to the military brass and to the politicians before America entered the war, and it had some advance warning because America didn’t enter till Pearl Harbor, but the European war had been going on.

因此，为了集中关注这场战争，美国的精神病学家在美国参战之前就去找了军方高层和政治家，他们有一些预先警告，因为美国直到珍珠港才参战，但欧洲战争一直在进行。

2:35:44 And they said, look, if we have to fight, we’re gonna have the same problem we had in the First World War.

他们说，看，如果我们必须打仗，我们就会遇到第一次世界大战时遇到的同样问题。

We’re gonna train these soldiers, gonna equip them, we’re gonna put them in the battlefield and the psychologically vulnerable among them are gonna break down.

我们要训练这些士兵，装备他们，我们要把他们送上战场，他们当中心理脆弱的人将会崩溃。

Mm-hmm.

嗯嗯。

There’ll be shell shock all over again, so we should screen all recruits to make sure they’re not psychologically weak and susceptible.

炮弹休克症将会再次出现，因此我们应该对所有新兵进行筛查，以确保他们不会出现心理脆弱和易受影响的情况。

And they screen out one and three-quarter million people and say, “These men are not fit.” So now we won’t have the problems we had in World War I, except it quickly turns out that those problems reemerge.

他们筛选出四分之三百万人并说：“这些人不适合。”因此，现在我们不会再遇到第一次世界大战时遇到的问题，除非这些问题很快就会再次出现。

Industrial warfare exposes people to seeing things and doing things that all of us in normal life would recoil from.

工业战使人们看到和做一些我们在正常生活中都会畏缩的事情。

And when we’re forced to do them as soldiers, many of us can’t–I speak from experience

当我们作为士兵被迫这样做时，我们中的许多人都做不到——这是我的经验之谈

2:36:54 but from talking to people who’ve gone through all this, uh, many of them find the experiences and the memories those create intolerable.

但通过与经历过这一切的人交谈，呃，他们中的许多人发现这些经历和记忆令人难以忍受。

And they emerge in symptoms, and they break down.

它们会出现症状，然后就会崩溃。

So it became a huge problem for the American Army, as it did for all the armies, actually.

因此，这对美国陆军来说是一个巨大的问题，实际上对所有军队来说都是如此。

The Nazis just shot people who broke down.

纳粹只是射杀那些崩溃的人。

Bang, you’re dead, we’re not dealing with you.

邦，你死了，我们不跟你打交道。

But, um, obviously the Allies, that was not the response.

但是，嗯，显然盟军并没有做出这样的回应。

Um, and they quickly had to try to treat these troops, maybe get them back into the fighting lines, maybe get them into support positions, something to cope with the problem, which both created extraordinary morale problems among the troops, and it invited malingering, claiming you had these conditions when you didn’t.

嗯，他们很快就不得不尝试治疗这些部队，也许让他们回到战斗前线，也许让他们进入支援位置，一些东西来解决这个问题，这两者都在部队中造成了极大的士气问题，而且还引发了装病，声称你有这些条件，而你没有。

It obviously cost a lot of the fighting force.

显然，这消耗了不少战力。

In combat

战斗中

2:38:01 conditions, as much as twenty-five percent of the soldiers broke down.

在这种情况下，百分之二十五的士兵都崩溃了。

So it was a big, big problem.

所以这是一个很大很大的问题。

Before the war, there were about two thousand psychiatrists in North America, in the US.

战前，北美、美国大约有两千名精神科医生。

At the end of the war, there were more than two thousand psychiatrists in the US military.

战争结束时，美军中有两千多名精神科医生。

Okay.

好的。

So you had to train people in a hurry.

所以你必须赶紧培训人员。

Mm-hmm.

嗯嗯。

And even still, it was hard to get enough people trained.

即便如此，培训足够多的人员仍然很困难。

And it turned out that the head of the US military–not the first, but the first one died, the second one was a man named William Menninger from the Menninger Clinic in Kansas, where he and his brother ran a psychoanalytic treatment facility.

事实证明，美国军方首脑——不是第一个，而是第一个去世了，第二个是来自堪萨斯州门宁格诊所的威廉·门宁格，他和他的兄弟在那里经营一家精神分析治疗机构。

So Bill Menninger became the head of army psychiatry.

于是比尔·门宁格成为军队精神病学的负责人。

He concluded that the best treatment for these soldiers breaking down was psychotherapeutic in nature.

他的结论是，对于这些崩溃的士兵来说，最好的治疗方法就是心理治疗。

The

的

2:39:02 origin of their condition was trauma.

他们的病情源于创伤。

Uh, and so in a watered-down way, Freud’s ideas, those were the ones that the people that recruited quickly and retrained as psychiatrists absorbed.

呃，弗洛伊德的思想以一种淡化的方式被那些迅速招募并接受再培训的精神病学家所吸收。

So they formed after the war a fairly coherent group of people, separate from the psychiatrists in the state hospitals who were still very biologically oriented.

因此，他们在战后形成了一个相当团结的群体，与仍然非常注重生物学的州立医院的精神科医生分开。

Another group emerged during the war precisely because you couldn’t produce enough psychotherapists who were MDs quickly enough.

战争期间出现了另一个群体，正是因为你无法足够快地培养出足够多的心理治疗师来担任医学博士。

Psychologists were drafted in and asked to treat.

心理学家被请来并要求进行治疗。

Mm-hmm.

嗯嗯。

So what they disco– What the psychologists discovered was, “Hey, we could do this stuff too, and we really like it.” “It’s interesting-“

所以他们迪斯科——心理学家发现的是，“嘿，我们也可以做这个东西，而且我们真的很喜欢它。” “这很有趣——”

2:39:54 “…it’s challenging.

“……这很有挑战性。

We, we should do that.” So after the war, similar kind of problem.

我们，我们应该这样做。”战后，类似的问题也出现了。

Mental illness is a massive problem.

精神疾病是一个大问题。

The returning soldiers, it’s a big problem, but it’s also a problem in the, in the community.

归来的士兵，这是一个大问题，但也是社区的问题。

These guys don’t…

这些家伙不……

The, the psychiatrists don’t go and work in the mental hospital.

而且，精神科医生不会去精神病院工作。

They start outpatient treatment.

他们开始门诊治疗。

And by 1958, about 80% of psychiatrists are working in outpatient rather than in the hospitals, right?

到 1958 年，大约 80% 的精神科医生在门诊而不是在医院工作，对吧？

So the psychologists organize themselves and federal money–again, “We need you.

因此，心理学家们自行组织起来，并利用联邦资金——再次强调，“我们需要你。

We need you.

我们需要你。

We need more of you.” So the VA, the Veterans Administration, and then once the National Institute of Mental Health is established, they start providing a lot of money for training, and they train not just psychiatrists, they train psychologists.

我们需要更多的你。”因此，退伍军人管理局、退伍军人管理局，以及国家心理健康研究所成立后，他们就开始提供大量资金用于培训，他们不仅培训精神科医生，还培训心理学家。

2:40:53 So the question is: How are the psychologists gonna set up clinical training?

所以问题是：心理学家如何进行临床培训？

So what the psychologists come up with, the clinically oriented ones, is a training program where would-be clinical psychologists spend two years learning basic scientific psychology and research methods, and then they have two or three years of clinical work and experience.

所以心理学家提出的，临床导向的，是一个培训计划，未来的临床心理学家花两年时间学习基本的科学心理学和研究方法，然后他们有两到三年的临床工作和经验。

And that’s very clever because it means when they start looking for grants, they know how to do that, and the psychoanalysts don’t have a clue how to apply for federal grant money, and they don’t get any, almost.

这非常聪明，因为这意味着当他们开始寻求资助时，他们知道如何去做，而精神分析师不知道如何申请联邦资助，而且他们几乎什么也得不到。

Beyond that, these people begin to work on treating symptoms.

除此之外，这些人开始致力于治疗症状。

The psychoanalysts think to treat a symptom is to play Whac-A-Mole.

精神分析学家认为治疗症状就像玩打地鼠游戏。

2:41:47 If you don’t deal with the underlying problems of the personality, their interaction between your id ego and superego, you suppress that symptom, and another one will pop up over here.

如果你不处理人格的根本问题，即你的本我和超我之间的相互作用，你就会抑制这种症状，而另一种症状就会出现在这里。

The clinical psychologists go, “We’re gonna treat the symptoms of what are troubling people.

临床心理学家说道：“我们要治疗困扰人们的症状。

We’re gonna treat the symptoms, and we’re gonna develop techniques that allow people to cope with those symptoms and eliminate them.” Uh, and how are we gonna do that?

我们要治疗这些症状，我们要开发技术，让人们能够应对这些症状并消除它们。”呃，我们要怎么做呢？

We’re going to do it primarily through what initially is cognitive behavioral therapy and later interpersonal therapy and some other variants emerge.

我们将主要通过最初的认知行为疗法和后来的人际关系疗法以及其他一些变体来做到这一点。

2:42:35 But basically, what they try to do with those techniques is develop things that work relatively quickly, work specifically on one set of problems or small subset of problems, and try to get those under control.

但基本上，他们试图用这些技术做的是开发相对快速的工作，专门解决一组问题或一小部分问题，并尝试让这些问题得到控制。

And how does, how does it work?

它是如何运作的？

You’ve developed really bad habits.

你已经养成了非常坏的习惯。

You…

你……

The way you react to being socially snubbed or being ignored or you– the way you deal with your coworkers or the trouble you’re having with your disruptive child will help you see the patterns that you’ve fallen into and will give you exercises that will work to give you a better way of coping with those things that don’t produce these symptoms.

你对受到社交冷落或被忽视的反应方式，或者你与同事打交道的方式，或者你与捣乱的孩子所遇到的麻烦，都会帮助你看到你陷入的模式，并给你一些练习，让你有更好的方法来应对那些不会产生这些症状的事情。

I’m oversimplifying obviously, but basically that’s the fundamental thrust of this.

显然我过于简单化了，但这基本上就是这个的基本主旨。

And one of the other contrasting things about CBT, Cognitive Behavioral Therapy, is that it doesn’t have necessarily that heavy requirement of five hours a week.

CBT（认知行为疗法）的另一个对比之处在于，它不一定有每周五个小时的严格要求。

Exactly.

正是如此。

2:43:46 So these therapies could be packaged.

所以这些疗法可以打包。

They could be reproduced.

它们可以被复制。

They could be tested to see whether they worked, so they had an evidentiary foundation.

可以对它们进行测试，看看它们是否有效，因此它们有证据基础。

The psychoanalyst would say, “It’s gonna take us years, and it’s hard to measure.” These guys went, “Well, we’ll measure what, what happens when we treat people this way?”

精神分析师会说：“这需要我们几年的时间，而且很难衡量。”这些人说，“好吧，我们来衡量一下，当我们这样对待别人时会发生什么？”

Psychologists.

心理学家。

Yeah.

是的。

2:44:08 The symptoms are what matter, not the underlying– you know, the underlying more complex thing that psychoanalysts claimed to be treating.

重要的是症状，而不是潜在的——你知道，精神分析学家声称要治疗的潜在的更复杂的东西。

And so it’s shorter.

所以它更短。

It’s reproducible whereas psychoanalytic– You know, every patient is a new patient, with a new set of complicated things going on.

它是可重复的，而精神分析——你知道，每个病人都是一个新病人，有一系列新的复杂的事情正在发生。

Here we are.

我们到了。

We’re gonna do this.

我们要做这个。

And the key figures here is Albert Bandura, Albert Ellis, Aaron Beck.

这里的关键人物是阿尔伯特·班杜拉（Albert Bandura）、阿尔伯特·埃利斯（Albert Ellis）、亚伦·贝克（Aaron Beck）。

Yes.

是的。

2:44:40 Um, Bandura and some other psychologists launching this movement, and then later on Aaron Beck, who went by Tim Beck who just recently died at…

嗯，班杜拉（Bandura）和其他一些心理学家发起了这场运动，然后是亚伦·贝克（Aaron Beck），蒂姆·贝克（Tim Beck）最近刚刚去世……

I think he was ninety-nine.

我想他已经九十九岁了。

Extraordinary.

非凡的。

No, no, I think he crossed 100.

不，不，我想他已经超过100了。

Maybe 100.

也许 100。

2:44:59 Yeah.

是的。

Maybe 100.

也许 100。

There’s videos of him talking at that age and he’s still, he’s still killing it, so wise.

有视频显示他在那个年纪说话，他仍然，他仍然在杀人，非常明智。

Aaron Beck is, is a remarkable figure because he was also one of the first in the 1960s to look at psychiatric diagnosis and show how unreliable it was, how difficult it was to get psychiatrists to agree on what was wrong.

亚伦·贝克 (Aaron Beck) 是一位了不起的人物，因为他也是 20 世纪 60 年代第一批研究精神科诊断的人之一，并证明了精神科诊断是多么不可靠，让精神科医生就错误所在达成一致是多么困难。

So he was a psychoanalyst, right?

所以他是一位精神分析师，对吗？

He had been trained as a psychoanalyst, became disillusioned with it, and so there were two strands, two important strands that stemmed from his work.

他接受过精神分析学家的培训，但对此感到幻灭，因此他的工作产生了两条重要的线索。

2:45:26 First, this…

首先，这……

He was one of the ones within the community itself who said to his fellow psychiatrists, “You know, we’re not very good at this diagnosis business-” “…

他是社区内对他的精神科医生同行说的人之一，“你知道，我们不太擅长这个诊断业务——”“……

and maybe we need to work on that.”

也许我们需要为此努力。”

2:45:51 Okay?

好吧？

And that was very important for the movement towards DSM-III.

这对于 DSM-III 的发展非常重要。

The other side of the coin was he broke with the idea that treating symptoms was a waste of time, and joined with the psychologists who already embarked on that journey to say, “How can we develop techniques to overcome these self-destructive ways in which people are responding?

另一方面，他打破了治疗症状是浪费时间的想法，并与已经开始这一旅程的心理学家一起说：“我们如何开发技术来克服人们的这些自我毁灭性的反应方式？

How can we help with their ability to interact?” So interpersonal therapy is much– you know, much more concerned with the way in which if your relations with other people break down, that damages your emotional stability.

我们如何帮助他们提高互动能力？”因此，人际关系治疗更关注的是，如果你与他人的关系破裂，会损害你的情绪稳定性。

If you repair those relationships, that helps your emotional stability come back.

如果你修复这些关系，这有助于你的情绪恢复稳定。

So all of this develops, and Americans are unusual.

所有这一切都在发展，美国人是不寻常的。

The– most of the rest of the world has what we call socialized medicine.

世界其他大部分地区都有我们所说的社会化医疗。

2:46:57 America doesn’t have that, so we’re used to paying for medical care.

美国没有这样的条件，所以我们习惯于支付医疗费用。

And so Americans were more willing, I think, to pay for clinical psychologists, and they attacked some of the problems of everyday living, the more uh, I was gonna say minor, but these are often quite distressing things.

因此，我认为美国人更愿意为临床心理学家付费，他们解决了日常生活中的一些问题，呃，我想说的是小问题，但这些往往是相当令人痛苦的事情。

But those were the things they were most successful at doing.

但这些是他们做的最成功的事情。

If I look at the literature on CBT, for example, and its uses in cases of schizophrenia, the evidence is pretty poor that it works.

例如，如果我查看有关 CBT 的文献及其在精神分裂症病例中的应用，就会发现它有效的证据非常少。

And even the evidence for the milder conditions is a bit more ambiguous than we like…

即使条件较温和的证据也比我们希望的更加模糊……

That they like to pretend.

他们喜欢假装。

2:47:44 The Cochrane Reviews, which are a systematic attempt to assess how strong the evidence for particular approaches to disease of all sorts are, say that at best, the evidence for CBT is of low and medium confidence, you know?

Cochrane 综述是一项系统性尝试，旨在评估治疗各种疾病的特定方法的证据有多强，它说，CBT 的证据充其量只有低到中等可信度，你知道吗？

But I think, again, there are patients for whom this helps, and indeed, for the milder forms of depression, I think CBT works better than the drugs without some of the side effects that the, the drugs have.

但我再次认为，这对某些患者有帮助，事实上，对于较轻微的抑郁症，我认为 CBT 比药物效果更好，而且没有药物所具有的一些副作用。

And indeed, NICE, which is the British organization that passes on what treatments the National Health Service will support and which ones are, are sufficiently evidence-based has come to that same conclusion.

事实上，NICE 这个英国组织也得出了同样的结论，该组织以充分的证据为基础，传递了国家卫生服务将支持哪些治疗方法以及哪些治疗方法。

So I think one thing to just say about cognitive behavioral therapy, I mean, it’s– It has some elements of kind of surface level intuitive kind of things like- …

所以我认为关于认知行为疗法有一件事要说，我的意思是，它有一些表面层面的直觉元素，比如……

2:48:36 being aware of and adjusting your thought patterns, being aware of triggers that get you- …

意识到并调整你的思维模式，意识到让你——……的触发因素

down a negative spiral- …

陷入恶性循环——……

and then basic behavior changes, habit changes that lead to a healthier life.

然后是基本的行为改变、习惯改变，从而带来更健康的生活。

So I think, I think this kinda, you know, getting your life together kind of process- is, is intuitive that that would have a positive effect on some percent of the population.

所以我认为，我认为这种让你的生活融为一体的过程是直观的，这会对一定比例的人口产生积极影响。

But as you get more serious and serious into the land of mental disorders, it starts to be a little bit less conclusive.

但当你越来越认真地进入精神障碍领域时，它开始变得不那么确定了。

Yes.

是的。

2:49:24 I think that’s an accurate statement of what– the way I read the literature.

我认为这是对我阅读文献的方式的准确表述。

And it’s not a cure-all, but for some patients, this really does seem to improve things quite a lot.

这并不是包治百病的灵丹妙药，但对于一些患者来说，这似乎确实改善了很多情况。

And it, it does make sense that you have developed poor ways of responding to signals from the outside world, and they’ve become habitual, and they’ve — habits, as we know, are very hard to break.

而且，确实有道理的是，你已经养成了对外界信号作出反应的糟糕方式，并且它们已经成为习惯，而且正如我们所知，习惯很难打破。

You know, there’s a lot of homework, there’s a lot of exercises you have to do to try to reconfigure the ways you deal with the world.

你知道，有很多作业，你必须做很多练习来尝试重新配置你处理世界的方式。

And it’s not for everybody, and it doesn’t work for everybody, but there’s some set, subset of people for whom this seems to have positive effects.

它并不适合所有人，也不适合所有人，但对某些人来说，这似乎有积极的影响。

So this, this is the lay of the land.

所以这就是这片土地的情况。

2:50:14 We talked about some of the darkness.

我们谈论了一些黑暗的事情。

Lobotomies and so on.

脑叶白质切除术等。

There is some talk therapy ideas of psychoanalysis, and then there is, from the clinical psychology side, cognitive behavioral therapy.

有一些精神分析的谈话治疗思想，然后从临床心理学方面来看，有认知行为治疗。

Then starts to emerge the psychopharmacology- …that challenges this whole shebang of talk therapy, period.

然后开始出现精神药理学——……这挑战了谈话疗法的整个过程。

And can you talk about the accidental origins of psychopharmacology- …that challenges this whole thing?

您能否谈谈精神药理学的偶然起源——……这对整个事情提出了挑战？

Hardly anybody had conceived of the idea that drugs could be used to treat mental illness.

几乎没有人想到药物可以用来治疗精神疾病。

2:50:49 Drugs had been used in the mental hospitals back in the 19th and 20th centuries, but they were usually things that were used to control patients, to calm them down.

早在 19 世纪和 20 世纪，精神病院就已经使用过药物，但它们通常是用来控制病人、让他们平静下来的。

Opiates, for example, various hypnotics that would put people to sleep when they were extremely agitated and so forth.

例如阿片类药物，各种催眠药，可以让人们在极度烦躁时入睡等等。

Sometimes marijuana was experimented with, as was alcohol in the 19th century, interestingly enough, given the revival of psychedelics.

有趣的是，考虑到迷幻药的复兴，有时会尝试大麻，就像 19 世纪的酒精一样。

But the idea that a drug might be used to actually attack the underlying problem, it emerged by accident in the following kind of way.

但是，药物可以用来真正解决根本问题的想法是通过以下方式偶然出现的。

2:51:39 The drug industry in general had emerged mostly in Germany, where I’d mentioned the most advanced medicine was being practiced in the late 19th century.

总体而言，制药业主要出现在德国，我曾提到德国在 19 世纪末就开始采用最先进的医学。

From the chemical industry from, for example, refining coal tar into different substances, that’s where we got aspirin.

例如，从化学工业中，将煤焦油提炼成不同的物质，这就是我们得到阿司匹林的地方。

That’s where we got a whole bunch of drugs.

那就是我们得到一大堆毒品的地方。

And gradually, the drug companies become more organized.

渐渐地，制药公司变得更加组织化。

They differentiate themselves from all the quack remedies that are around.

它们与周围所有的庸医疗法不同。

And the war, I think, greatly accelerates– Again, World War II greatly accelerates things, not least because we discover a real magic bullet called penicillin and then the other antibiotics that we subsequently come across.

我认为，战争大大加速了——第二次世界大战大大加速了事情的发展，尤其是因为我们发现了一种真正的神奇子弹，称为青霉素，然后是我们随后遇到的其他抗生素。

2:52:31 Penicillin had been observed by Alexander Fleming, famously in his lab in some Petri dishes where bacteria had been killed.

亚历山大·弗莱明（Alexander Fleming）在他的实验室的一些培养皿中观察到了青霉素，其中细菌已被杀死。

Later was one of the co-winners of Nobel Prize and made a lot of capital out of that discovery.

后来成为诺贝尔奖的共同获得者之一，并从这一发现中赚了很多钱。

It was really Howard Florey and his team at Oxford who developed the therapeutic potential of penicillin.

确实是霍华德·弗洛里和他在牛津的团队开发了青霉素的治疗潜力。

And actually, Florey flew some of it in his jacket across the Atlantic to America, and it was Americans that solved the critical thing.

事实上，弗洛里把其中的一些放在他的夹克里飞越大西洋飞到了美国，是美国人解决了这个关键问题。

It took Florey and his team weeks to develop enough penicillin to treat a single mouse.

弗洛里和他的团队花了几周时间才开发出足够治疗一只小鼠的青霉素。

What America learned how to do was mass produce penicillin.

美国学会了如何大规模生产青霉素。

And that was critical because it was vital to the war effort, obviously.

这很重要，因为显然这对战争努力至关重要。

2:53:29 And after the war, it was vital to the civilian population because it was such an, an important breakthrough.

战后，这对平民至关重要，因为这是一个非常重要的突破。

So drugs, drug companies grew fatter on that.

因此，药品、制药公司因此而发财。

They embarked on research to try to find new substances they could use to treat things.

他们开始研究，试图寻找可以用来治疗疾病的新物质。

And a French company named Rhône-Poulenc came across a chemical that had actually been synthesized back in the 1880s in Germany.

一家名为 Rhone-Poulenc 的法国公司发现了一种实际上早在 1880 年代就在德国合成的化学物质。

It was an antihistamine, chlorpromazine.

这是一种抗组胺药，氯丙嗪。

They didn’t know what to do with it, but other kinds of antihistamines in the war had been used effectively, and they thought, “Well, let’s look and see if we can find a market for this drug.” And so they…

他们不知道如何处理它，但战争中其他种类的抗组胺药已经得到有效使用，他们想，“好吧，让我们看看是否能为这种药物找到市场。”所以他们……

The interesting thing to remember in those days is that investigating the property of new drugs was a Wild West phenomenon.

那时值得记住的有趣的事情是，研究新药的特性是一种狂野西部现象。

There were no controls.

没有任何控制。

2:54:27 You could do whatever you wanted, and you handed stuff out and said, “Why don’t you try this and see if it works?” Right?

你可以做任何你想做的事，然后你分发东西并说：“你为什么不试试这个，看看它是否有效？”对吗？

So Rhône-Poulenc did that.

所以罗纳-普朗克就这么做了。

They thought this might work as an antiemetic.

他们认为这可能起到止吐作用。

If you have a child who’s prone to car sickness, you give them an antiemetic drug.

如果你有一个容易晕车的孩子，你可以给他们服用止吐药。

So that was one possibility.

所以这是一种可能性。

Another possibility, it might work for eczema so that people didn’t scratch themselves.

另一种可能性是，它可能对湿疹有效，这样人们就不会抓伤自己。

Well, there were a number of possibilities and somebody said, “Well, maybe it will work as an anesthetic potentiator,” meaning if you gave some of these, you need to use less anesthetic, or would act like a catalyst because it tended to make you sleepy.

嗯，有很多种可能性，有人说，“嗯，也许它会起到麻醉增效剂的作用，”这意味着如果你给予其中一些，你需要使用较少的麻醉剂，或者会像催化剂一样发挥作用，因为它会让你昏昏欲睡。

If you read the leaflets on Dramamine, one of the cautions is, “It’ll make you sleepy, don’t drive,” right?

如果你读过茶苯海明的传单，其中的警告之一就是“它会让你昏昏欲睡，不要开车”，对吗？

2:55:16 So why don’t we give it to some surgeons and see if they can find a use for it?

那么我们为什么不把它交给一些外科医生，看看他们是否能找到它的用途呢？

Literally it’s like that.

从字面上看就是这样。

And one of the people who gets that drug is a lieutenant in the French Navy, Henri Laborit, and he tries it as an anesthetic potentiator, and he also gives it to some of the patients who are awaiting surgery.

获得这种药物的人之一是法国海军中尉亨利·拉博里特（Henri Laborit），他尝试将其用作麻醉增强剂，并且还将其提供给一些等待手术的患者。

Normally when you’re awaiting surgery, you’re a little bit anxious.

通常，当您等待手术时，您会有点焦虑。

These patients stop being anxious.

这些患者不再焦虑。

This was the era of lobotomies, and he wrote to one of his relatives who worked in one of the Paris mental hospitals.

那是脑叶白质切除术的时代，他写信给在巴黎一家精神病院工作的一位亲戚。

He said, “This like, this works like a chemical lobotomy.

他说：“这就像化学脑白质切除术。

These people don’t care anymore about their surgery.”

这些人不再关心他们的手术了。”

And that’s supposed to be a good thing, right?

这应该是一件好事，对吧？

Well, lobotomy hadn’t become the nasty word it, it would become in a few years.

好吧，脑白质切除术还没有成为一个令人讨厌的词，几年后它就会变得如此。

2:56:02 So one of his colleagues contacts Delay and Deniker, who work at Saint-Anne’s which is the biggest mental hospital in Paris and says, “Hey guys this might work on your psychiatric patients.

因此，他的一位同事联系了在巴黎最大的精神病院圣安妮医院工作的迪莱和德尼克，并说：“嘿，伙计们，这可能对你们的精神病患者有效。

You should give it a try.” And they do.

你应该尝试一下。”他们确实这么做了。

When it doesn’t work, they give larger dose and when it doesn’t work they give a large dose and sure enough patients stopped acting out.

当它不起作用时，他们会给予更大的剂量；当它不起作用时，他们会给予更大的剂量，果然患者停止了行动。

They stopped smashing furniture.

他们不再砸家具了。

They, they become– They’re still sorta conscious but they’re less mobile and they’re much calmer.

他们，他们变得——他们仍然有一定的意识，但他们的活动能力减弱，而且更加平静。

2:56:45 And this is why in the early stages Chlorpromazine, which becomes known as Largactil or Mighty Drug in Europe and Thorazine here, it becomes known as a major tranquilizer because it has this tranquilizing effect.

这就是为什么氯丙嗪（在欧洲被称为Largactil或Mighty Drug，在这里被称为Thorazine）在早期阶段被称为主要镇静剂，因为它具有镇静作用。

The hospitals see it as a boon because it’ll help control the patients.

医院认为这是一个福音，因为它有助于控制病人。

They’re not yet thinking of it as more than that.

他们还没有想到更多的事情。

So that’s the accidental way it’s discovered.

这就是它被发现的偶然方式。

It comes to North America via Quebec,- ….where there’s a psychiatrist up there, Heinz Lehmann, who actually works in the Protestant Hospital.

它通过魁北克来到北美，-……那里有一位精神科医生，海因茨·莱曼（Heinz Lehmann），他实际上在新教医院工作。

Québec in those days is dominated by its Anglo-speaking elite who oppressed the, the French Canadians pretty mightily.

当时的魁北克由英语精英统治，他们对法裔加拿大人进行了相当大的压迫。

But because of the French connection, he gets amounts of the drug.-

但由于与法国的联系，他获得了大量的毒品。-

2:57:50 Rhône-Poulenc has had to sell the rights to an American company.

罗纳-普朗克不得不将版权出售给一家美国公司。

In those days, American physicians don’t trust European science or European medicine- …

在那些日子里，美国医生不相信欧洲科学或欧洲医学——……

especially European medicine.

尤其是欧洲医学。

So Rhône-Poulenc sells the rights.

因此罗纳-普朗克出售了版权。

The first two drug companies it approaches say, “No thank you.

它最先接触的两家制药公司表示：“不，谢谢。

This doesn’t look very interesting to us.

这对我们来说看起来不太有趣。

I don’t think there’s much of a market.” And then SmithKline & French buys it up and within two years, two million people are taking this drug.

我认为市场不大。”然后 SmithKline & French 收购了它，两年内就有 200 万人服用这种药物。

It’s a bonanza for them right?

这对他们来说是一笔财富，对吗？

Not an accident ’cause they put their best salesman on the job of selling this and they realize the hospital psychiatrists mostly aren’t interested.

这并非偶然，因为他们让最好的推销员来销售这个产品，但他们意识到医院的精神科医生大多不感兴趣。

They haven’t yet gotten to this idea of a chemical cure or a chemical treatment.

他们还没有想到化学治愈或化学处理的想法。

So it’s the companies that wake up to this?

那么是公司意识到了这一点？

The companies wake up, they sell it to the politicians.

公司醒悟了，他们把它卖给政客。

2:58:44 They go to the state legislatures.

他们去州立法机构。

They have moving pictures of an agitated patient who turns calm, you know.

你知道，他们有一个激动的病人变得平静的动态照片。

So this is already the mechanism of big pharma?

那么这已经是大型制药公司的机制了？

Yeah.

是的。

2:59:00 So it’s starting to be big pharma.

所以它开始成为大型制药公司。

It transforms SmithKline & French from a small operator into a big company, and then of course once that’s successful, it turns out that chlorpromazine can be easily tweaked as a molecule, and so copycat drugs emerge on the scene.

它将 SmithKline & French 从一家小运营商转变为一家大公司，当然，一旦成功，氯丙嗪就可以很容易地作为分子进行调整，因此仿制药就出现了。

So this happens in America in 1954.

这就是 1954 年美国发生的事情。

The following year in 1955 we get the so-called minor tranquilizers being invented and brought to market.

次年，即 1955 年，我们发明了所谓的小型镇静剂并将其推向市场。

This is Miltown.

这是米尔敦。

Yeah, this is Miltown heavily promoted by the first major television star of the mid-’50s, Milton Berle, who calls himself Unc- Uncle Miltown and promotes the drug heavily on his show.

是的，这就是 50 年代中期第一位主要电视明星 Milton Berle 大力宣传的 Milton，他自称 Milton 叔叔，并在他的节目中大力宣传这种药物。

So these are mostly like tranquilizer type of effects?

那么这些大多类似于镇静剂类型的效果？

Those work really– They’re muscle relaxant types of things, and later on in the ’60s we get Valium and Librium coming on adding to or re-and replacing those first generation drugs.

这些确实有效——它们是肌肉松弛剂类型的东西，后来在 60 年代，我们得到了安定和利眠宁来添加或重新取代这些第一代药物。

2:59:51 So you have major tranquilizers, minor tranquilizers.

所以你有主要镇静剂和次要镇静剂。

Minor tranquilizers and guess what?

少量镇定剂，你猜怎么着？

The Freudians don’t want really anything to do with these drugs.

弗洛伊德主义者并不希望与这些药物有任何关系。

Right.

对。

3:00:13 Of course.

当然。

The hospital psychiatrist wants to wake up to the usefulness of Thorazine and its analogues do start using the drugs a lot and that’s really important, and in the early ’60s, they changed their name.

医院的精神科医生希望人们认识到氯磺嗪及其类似物的有用性，他们确实开始大量使用这些药物，这非常重要，在 60 年代初，他们更改了名称。

3:00:14 Instead of being major tranquilizers, they become antipsychotics.

它们不是主要的镇静剂，而是抗精神病药。

So that suggests they actually attack the underlying psychosis.

所以这表明他们实际上攻击了潜在的精神病。

Is there any evidence of that for them?

他们有任何证据吗？

They do change the forms of psychosis in important ways, some good and some they fail to attack.

它们确实以重要的方式改变了精神病的形式，有些是好的，有些是他们无法解决的。

3:00:45 So they reduce the agitation, they reduce the delusions and the hallucinations, the things psychiatrists call the positive symptoms of schizophrenia, those, those they help with for not every patient, but for a significant number of patients, and they’re very — That’s very important.

因此，他们减少了躁动，减少了妄想和幻觉，精神科医生称之为精神分裂症的阳性症状，他们帮助的不是每个患者，而是相当多的患者，而且它们非常——这非常重要。

Why are they called the positive?

为什么他们被称为积极的？

The positive symptoms activate things.

积极的症状会激活事物。

3:01:19 They activate the hallucinations and the delusions.

它们会激活幻觉和妄想。

Those are changing, and they’re visible usually because if somebody’s deluded or hallucinating, you know about it pretty quickly- ….right?

这些正在改变，而且它们通常是可见的，因为如果有人被欺骗或产生幻觉，你很快就会知道——……对吗？

The negative symptoms are things like apathy, loss of ability to interact with people, poverty of language, lack of initiative.

负面症状包括冷漠、丧失与人交往的能力、语言贫乏、缺乏主动性等。

All of those things are devastating.

所有这些事情都是毁灭性的。

Just to state out loud and clear that both positive and negative affects so-called by psychologists of schizophrenia are both devastating and both negative.

只是要大声明确地说，精神分裂症心理学家所谓的积极和消极影响都是毁灭性的，都是消极的。

Yes, yes.

是的，是的。

3:01:57 I think that’s right.

我认为这是对的。

In the common parlance of what negative means.

用通俗的话说，消极的意思是什么。

It’s a very strange choice of language, but it’s been there for a long time, so it’s embedded.

这是一种非常奇怪的语言选择，但它已经存在很长时间了，所以它是嵌入的。

3:02:02 Now, to the extent antipsychotics work, they work on the positive symptoms.

现在，就抗精神病药物的作用而言，它们对阳性症状起作用。

They either dull them down so you’re still hallucinating a bit and you’re still delusional, but it’s not– it’s very much less, and you are you’re somewhat pacified.

他们要么让它们变得迟钝，所以你仍然有一点幻觉，你仍然有妄想，但事实并非如此——它要少得多，而且你是有点平静的。

You’re less overtly disturbed.

你不再那么明显地受到干扰。

But the negative side of things, not so much or not at all.

但事情的消极面却没有那么多，或者根本没有。

Then on top of that, the drugs work for some people and they don’t work for others, and a significant number of psychotic patients are non-drug responders, just as a significant number of people with depression are not responsive to antidepressants.

最重要的是，这些药物对某些人有效，而对其他人无效，并且大量精神病患者是非药物反应者，就像大量抑郁症患者对抗抑郁药没有反应一样。

3:02:55 Moreover, initially in the enthusiasm for these drugs everybody neglects the fact that they have serious side effects, or many of them argue the side effects are an essential part of the treatment and you just have to put up with it.

此外，最初在对这些药物的热情中，每个人都忽视了它们具有严重副作用的事实，或者他们中的许多人认为副作用是治疗的重要组成部分，你只能忍受它。

So what are we talking about when I say there are nasty side effects?

那么，当我说有令人讨厌的副作用时，我们在谈论什么呢？

Well, among others, you may become incurably restless.

好吧，除此之外，你可能会变得无可救药地焦躁不安。

So you’re constantly in motion, you’re moving around, you’re never, never still.

所以你一直在运动，你在移动，你永远不会静止。

If you’re in the presence of somebody like that, it becomes unbearable after a fairly short while, and it’s unbearable often to the person who can’t control it.

如果你和这样的人在一起，过不了多久就会变得难以忍受，而且对于控制不住的人来说往往是难以忍受的。

Other patients develop Parkinson’s disease symptoms.

其他患者出现帕金森病症状。

3:03:47 Is an awful affliction which unfortunately affects a significant number of people each year, and we don’t have– We have through L-DOPA a means to delay its impact, but eventually that loses its efficacy and unfortunately we don’t have a cure.

这是一种可怕的疾病，不幸的是，每年都会影响很多人，而我们却没有——我们通过左旋多巴（L-DOPA）有一种方法可以延缓其影响，但最终会失去功效，不幸的是，我们没有治愈方法。

So you have those.

所以你有那些。

And then perhaps the nastiest is what’s called tardive dyskinesia.

也许最令人讨厌的是所谓的迟发性运动障碍。

Tardive because it’s late developing, it doesn’t happen right away, and dyskinesia because what it involves is jerky uncontrolled movements of the body and particularly of the facial muscles.

迟缓是因为它发育较晚，不会立即发生，运动障碍是因为它涉及身体特别是面部肌肉的不稳定的不受控制的运动。

So your tongue will protrude, you’ll make strange noises, you’ll twitch, you’ll stagger about walking.

所以你的舌头会伸出，你会发出奇怪的声音，你会抽搐，你会走路摇摇晃晃。

If somebody like that is walking down the street towards you, you will think there’s a mentally ill person and you’ll cross to the other side of the street.

如果这样的人在街上向你走来，你会认为这是一个精神病患者，然后你会穿过街道的另一边。

3:04:40 And yes, they probably are a mentally ill person but what you’re seeing is the iatrogenic effects of the drugs they’re on.

是的，他们可能是一个精神病患者，但你看到的是他们所服用的药物的医源性影响。

Okay?

好吧？

So that problem was ignored for about 20 years.

所以这个问题被忽视了大约20年。

Paper appeared in Science by George Crane, a Maryland psychiatrist, in which he said, “We as a profession have been ignoring this terrible problem.” Yes, the drugs do some good, but they’re also creating a lot of harm, and we need to focus more on that.

马里兰州精神病学家乔治·克兰 (George Crane) 在《科学》杂志上发表了一篇论文，他在文中表示：“作为一个职业，我们一直忽视了这个可怕的问题。”是的，这些药物确实有一些好处，但它们也造成了很多伤害，我们需要更多地关注这一点。

And it took a few years, but by the ’80s, I think the American Psychiatric Association was very worried by that problem.

这花了几年时间，但到了 80 年代，我认为美国精神病学协会非常担心这个问题。

And the drug companies were kind of worried about it but didn’t have any obvious solution till towards the end of the ’80s something happened.

制药公司对此有些担心，但没有任何明显的解决方案，直到 80 年代末发生了一些事情。

3:05:34 Nineteen fifty-seven, when the people were developing copycat versions of Thorazine, clozapine was developed by a small company which was subsequently bought up by a bigger company and introduced in Europe.

十九点五十七分，当人们开发氯氮平的山寨版时，氯氮平是由一家小公司开发的，后来被一家更大的公司收购并引入欧洲。

It never came to America because of two things.

由于两件事，它从未来到美国。

First, it tended not to produce tardive dyskinesia, and at that time many in the profession thought if you didn’t get those symptoms you weren’t attacking the problem.

首先，它往往不会产生迟发性运动障碍，当时许多业内人士认为，如果你没有出现这些症状，那么你就没有解决问题。

Bizarre, right?

很奇怪吧？

3:06:05 Secondly in a significant number of patients it destroyed their– the patient’s white blood cells and they died.

其次，在相当多的患者中，它破坏了患者的白细胞，导致他们死亡。

Okay?

好的？

Not, not a good outcome.

不，不是一个好的结果。

So it was quickly withdrawn from the market, and it never made it to this side of the Atlantic.

因此它很快就退出了市场，再也没有到达大西洋彼岸。

However as this tardive dyskinesia problem became more acute there was an attempt to revive clozapine, and it tends to…

然而，随着这种迟发性运动障碍问题变得更加严重，有人尝试恢复氯氮平，并且它往往......

It turns out it tends to work better in treatment resistant cases, meaning cases don’t respond to the other antipsychotics that we have.

事实证明，它在治疗耐药的病例中往往效果更好，这意味着病例对我们拥有的其他抗精神病药物没有反应。

And it could be revived but at the cost of weekly blood checks ’cause you had to be very careful if it– if your white blood cells count started to drop, you had to stop.

它可以恢复，但代价是每周进行血液检查，因为如果你的白细胞计数开始下降，你必须非常小心，你必须停止。

3:07:03 Right?

正确的？

So it came to market in the late ’80s, and very quickly other drug companies tried to find other compounds actually chemically not related to it, but that’s hardly the point.

因此它在 80 年代末进入市场，很快其他制药公司试图寻找实际上与它在化学上不相关的其他化合物，但这不是重点。

The whole class of drugs became known as second generation antipsychotics.

整个类别的药物被称为第二代抗精神病药。

So Clozapine, Risperdal-

所以氯氮平、利培酮-

Yes, those kinds of ones

是的，就那些类型的

Zyprexa.

再普乐。

Zyprexa among others.

再普乐等。

Zyprexa.

再普乐。

Yes.

是的。

3:07:34 And so there were a number of these, and they have actually — Because they are chemically quite different from each other, but they’re classed together in the public mind and – …in the professional mind.

所以有很多这样的东西，而且它们实际上——因为它们在化学上彼此完全不同，但它们在公众心目中和……在专业心目中被归为一类。

They tend to have different side effect profiles and slightly different modes of action and differing levels of efficacy, I think.

我认为，它们往往有不同的副作用，作用方式略有不同，功效水平也不同。

Of course, there’s not a real, at that time or even now, a real science of like when you have a human come to you, what is the actual protocol of how you figure out which to give.

当然，在当时甚至现在，都没有一门真正的科学，比如当你有人来找你时，你如何弄清楚该给予哪个的实际协议是什么。

Right.

正确的。

3:08:07 So in 2005 most of the– I should say once the Drugs Revolution came along increasingly the studies were funded by the drug companies who owned the data and controlled the data- …and only released what they chose to release, what was helpful for them and not what wasn’t.

因此，在 2005 年，我应该说，随着药物革命的到来，大多数研究都是由拥有数据并控制数据的制药公司资助的……并且只发布他们选择发布的内容，对他们有帮助的内容，而不是对他们没有帮助的内容。

And they were heavily marketing stuff.

他们大力推销东西。

Oh yeah, very heavily mar– And then to get FDA approval of efficacy and safety you needed two trials.

哦，是的，非常严重——然后为了获得 FDA 对功效和安全性的批准，你需要进行两项试验。

3:08:28 You might have conducted 15 trials and 13 of them had been failures but if you had two that worked, that was enough.

您可能进行了 15 次试验，其中 13 次失败，但如果有两次有效，那就足够了。

That’s what you needed.

这就是你所需要的。

That was the gold standard.

那是黄金标准。

So 2005 National Institutes of Mental Health funds this drug study, not an industry study, and what it wants to look at, the first generation drugs are now out of patent and they’re cheap.

因此，2005 年美国国立心理健康研究所资助了这项药物研究，而不是行业研究，它想要看到的是，第一代药物现在已经失去专利，而且价格便宜。

The second generation are patented and are quite expensive, ten times as expensive in some cases.

第二代产品已获得专利，并且相当昂贵，在某些情况下甚至贵十倍。

So we do something called the CATIE Study, and it’s published in the New England Journal of Medicine.

因此，我们开展了一项名为 CATIE 研究的研究，该研究发表在《新英格兰医学杂志》上。

And there are two interesting findings.

还有两个有趣的发现。

3:09:20 So you have one first generation antipsychotic, one of those very early drugs, and you have four more recent drugs that you’re looking at.

因此，您有一种第一代抗精神病药物，一种非常早期的药物，还有四种您正在研究的最新药物。

3:09:31 And you ask a number of questions.

你问了很多问题。

Are the new drugs more efficacious than the old drug?

新药比旧药更有效吗？

No.

不。

Hmm.

嗯。

Were patients willing to tolerate these drugs?

患者是否愿意耐受这些药物？

And that was a finding that I thought was much underreported at the time.

我认为这一发现当时被低估了。

Between 67% and 82% of the patients, depending on which drug they were on, dropped out of the trial because either the drug wasn’t working or they couldn’t stand the side effects.

67% 到 82% 的患者退出试验，具体取决于他们服用的药物，因为药物不起作用或他们无法忍受副作用。

So that tells you, these are our best drugs, you know, there are real complications here.

这告诉你，这些是我们最好的药物，你知道，这里确实存在并发症。

And then as we delve further into it, do they have nasty side effects?

然后，当我们进一步深入研究时，它们是否有令人讨厌的副作用？

Well, less tardive dyskinesia somewhat, but a whole new set of side effects.

嗯，迟发性运动障碍有所减轻，但出现了一系列全新的副作用。

If you take these pills, you will gain in most cases a lot of weight—10, 20, 30, 40 pounds, 50 pounds.

如果您服用这些药物，大多数情况下您的体重会增加很多——10、20、30、40 磅、50 磅。

What does that do?

那有什么作用？

3:10:40 That gives you metabolic syndrome; it gives you diabetes; it gives you heart trouble.

这会导致代谢综合症；它会让你得糖尿病；它会给你带来心脏病。

So important to state when we’re looking at this ’cause there is no– There is no free lunch with medicine.

当我们研究这个问题时，声明这一点非常重要，因为世界上没有免费的药物午餐。

If you take an aspirin, it may cause your stomach to bleed sometimes enough to really put you in serious jeopardy.

如果您服用阿司匹林，有时可能会导致您的胃出血，足以真正让您处于严重危险之中。

Most of the time it’s fine.

大多数时候都很好。

Everything…

一切……

Every drug that’s brought to market has the main effect we’re looking, looking for and some side effects which may be minimal for most people but for some people maybe worse than that.

上市的每一种药物都有我们正在寻找的主要作用，以及一些副作用，这些副作用对大多数人来说可能很小，但对某些人来说可能更严重。

So we’ve got to– It’s one of these cost benefit analysis, right?

所以我们必须——这是成本效益分析之一，对吗？

You- …You’re getting some relief from your psychiatric symptoms but you’re courting these other dangers that may or may not arise and going in we don’t know where you’re gonna fall.

你——……你的精神症状得到了一些缓解，但你正在面临这些可能会或可能不会出现的其他危险，而且我们不知道你会跌倒在哪里。

3:11:48 We don’t know trial and error.

我们不知道尝试和错误。

You mean every individual that walks into the picture, they don’t know where on distribution they fall?

你的意思是每个走进图片中的人，他们都不知道自己在分布上落在哪里？

Right.

正确的。

3:11:54 And we have no biological markers at the moment that would tell us.

目前我们没有生物标记可以告诉我们。

One or two of my friends in the um, psychiatric genetics industry uh if that’s the right term for it, but you know, in that research area are saying, “Well, we haven’t done very well to find the genetic roots of mental illness, but maybe we can learn to distinguish which patients are gonna respond well to drugs and which shouldn’t be given them because they’re not going to.” Um, that’s a promissory note.

我在精神科遗传学行业的一两个朋友，呃，如果这是正确的术语的话，但你知道，在那个研究领域，他们说，“好吧，我们在寻找精神疾病的遗传根源方面做得还不够好，但也许我们可以学会区分哪些患者会对药物产生良好的反应，哪些患者不应该接受药物治疗，因为他们不会这样做。”嗯，这是一张期票。

It’s not something that they actually can do now.

这不是他们现在真正能做到的。

3:12:31 It’s just we hope we’ll be able to do this, and I hope they’re able to do it, too.

只是我们希望我们能够做到这一点，我希望他们也能够做到。

But, you know, you can’t have an enormous amount of confidence in that.

但是，你知道，你不能对此抱有极大的信心。

Maybe it’ll happen, or maybe some other mechanism will emerge that allows us to see who the responders and nonresponders are.

也许它会发生，或者也许会出现一些其他机制，让我们能够看到谁是响应者和非响应者。

Who’s gonna suffer the worst side effects if they’re put on these medications?

如果服用这些药物，谁会遭受最严重的副作用？

And the side effects do vary, so um though a lot of what I’ve described is common to this class of drugs.

而且副作用确实各不相同，所以嗯，尽管我所描述的很多内容对于此类药物来说都是常见的。

And sometimes it’s hard to describe the side effect.

有时很难描述副作用。

3:13:00 You’re talking about the human mind.

你说的是人类的思想。

Yeah, yeah.

是啊是啊。

So describing the side effects, it’s not like bleeding or like diarrhea or-

所以描述副作用，它不像出血或腹泻或-

Well, yeah.

嗯，是的。

Weight gain, that’s describable, but like the effect on your personality.

体重增加，这是可以描述的，但就像对你的性格的影响一样。

Yep, that’s much harder, much harder.

是的，这更难，更难。

3:13:15 People, you know, some of the patients who drop out, drop out because they find the richness of their mental life is completely gone and they don’t want to tolerate that.

人们，你知道，一些退出的患者之所以退出，是因为他们发现自己丰富的精神生活完全消失了，他们不想忍受这一点。

They’d sooner tolerate some hallucinations.

他们宁愿忍受一些幻觉。

That’s a hard one.

这很难。

So there’s a that that picture the SSRIs that also came to be Prozac, Zoloft, Paxil during that time.

因此，SSRI 类药物在当时也被称为百忧解 (Prozac)、左洛复 (Zoloft)、帕罗西汀 (Paxil)。

3:13:35 Yes, Paxil, all of that.

是的，帕西尔，所有这些。

Well again, they’re the second generation of antidepressants.

再说一遍，它们是第二代抗抑郁药。

Mm-hmm.

嗯嗯。

So that’s a complicated story.

所以这是一个复杂的故事。

Again, it’s an accident.

再说一遍，这是一次意外。

They’re at treating patients with advanced tuberculosis in the 1950s.

他们在 20 世纪 50 年代治疗晚期结核病患者。

Now that’s a very unpleasant thing that’s also gonna kill you.

这是一件非常不愉快的事情，它也会杀了你。

So, tuberculosis.

所以，结核病。

Very advanced cases.

非常先进的案例。

You’re coughing your lungs up.

你咳得肺都咳起来了。

You’re depressed as all get out.

当所有人都出去时，你会感到沮丧。

And here we have two new drugs, Iproniazid, we can use that maybe will treat the condition.

这里我们有两种新药，异丙烟肼，我们可以用它来治疗这种情况。

When you give it to the patients and these depressed tuberculosis patients start acting happy, dancing about, their mood changes.

当你把它给病人时，这些抑郁的肺结核病人开始表现得快乐，跳舞，他们的情绪发生了变化。

Bingo!

宾果！

We’ve got something that maybe we can use over here to treat depression.

我们这里有一些东西也许可以用来治疗抑郁症。

However, the drug companies in circa 1960 think of depression as a small market because what they’re talking

然而，大约 1960 年的制药公司认为抑郁症是一个小市场，因为他们所说的

3:14:41 about is the kind of melancholic psychotic depressions that leads people into the mental hospital.

大约是一种导致人们进入精神病院的忧郁精神病性抑郁症。

And that’s not an insignificant group, but it’s not a huge group.

这不是一个微不足道的群体，但也不是一个庞大的群体。

So, it’s really much later on that things begin to change.

所以，事情在很久以后才开始发生变化。

Right now, it’s fair to say depression is the common cold of psychiatry.

现在，可以公平地说，抑郁症是精神病学中的普通感冒。

It’s, you know, it’s abundant there.

你知道，那里资源丰富。

The depressive diagnosis probably the most commonly given among psychiatrists.

抑郁症的诊断可能是精神科医生最常给出的诊断。

So, part of that is a deeper understanding of the human mind, and a big part of that is probably the drug companies convincing the world.

因此，其中一部分是对人类思维的更深入了解，其中很大一部分可能是制药公司说服了世界。

Well, its transforming, yes.

嗯，它正在转变，是的。

3:15:19 So there were big disputes, for example, when DSM-5 was being contemplated, about whether grief, bereavement would count as a mental disorder, as count as a form of depression.

因此，例如，在考虑制定 DSM-5 时，关于悲伤、丧亲之痛是否算作精神障碍或抑郁症的一种形式，存在很大的争议。

If you lose a parent, if you lose, even worse, a child, um, it’s a deeply, how can I put it, deeply upsetting?

如果你失去了父母，如果你失去了，更糟糕的是，失去了一个孩子，嗯，我该怎么说，非常令人沮丧？

Yes.

是的。

Some psychiatrists say yes and some no, but it’s an example of what happens in psychiatry repeatedly, what I would call diagnostic creep, which is a term actually an Australian named Nick Haslam came up with.

有些精神病学家说是，有些说不是，但这是精神病学中反复发生的事情的一个例子，我称之为诊断蠕变，这个术语实际上是一个名叫尼克·哈斯拉姆的澳大利亚人提出的。

But it’s a phenomenon I described before that.

但这是我之前描述过的一个现象。

You start with a core of unambiguous deviations from the norm that are so serious that any competent member of the culture knows that’s that.

你从一个明显偏离规范的核心开始，这种偏离是如此严重，以至于文化中任何有能力的成员都知道就是这样。

3:16:42 But then it– you begin to say, “Well, there’s this penumbra,” you see, and just outside that core, there are people who are also disturbed, not perhaps as sufficiently disturbed that you actually recognize it, but it’s happening.

但然后你开始说，“嗯，有这个半影”，你看，就在那个核心之外，也有人感到不安，也许没有那么不安，以至于你实际上认识到它，但它正在发生。

And so that has tended to happen over and over again.

因此，这种情况往往会一而再、再而三地发生。

Parents with an autistic child won’t necessarily agree with what I’m about to say, but the chief editor of DSM-IV, Allen Frances, is convinced the huge increase in the number of diagnoses of autism is more driven by the fact he loosened the criteria for the diagnosis than it is because there are more actual cases.

有自闭症孩子的家长不一定会同意我要说的话，但 DSM-IV 的主编艾伦·弗朗西斯 (Allen Frances) 坚信，自闭症诊断数量的大幅增加更多是由于他放宽了诊断标准，而不是因为实际病例增多。

Autism used to be a fairly rare phenomenon, and now sadly it’s a very broad one.

自闭症曾经是一种相当罕见的现象，但遗憾的是现在它的范围非常广泛。

3:17:33 And I understand why parents react very negatively to that because the diagnosis is the key to all sorts of social supports and educational supports and all the rest, and they’re dealing with a child who is extremely difficult.

我理解为什么父母对此反应非常消极，因为诊断是各种社会支持和教育支持以及其他所有支持的关键，而他们面对的是一个极其困难的孩子。

But there is a real difference between the most severe forms of autism where people lose capacity to speak and very often any ability to interact with other people and so forth, and the other cases that are of a still serious but milder sort.

但是，最严重的自闭症与其他仍然严重但较温和的病例之间存在着真正的区别，最严重的自闭症使人们失去说话的能力，并且常常失去与他人互动的能力等。

Diagnostic creep is not driven just by psychiatric imperialism, the desire for more territory, more patients.

诊断蠕变不仅仅是由精神帝国主义、对更多领土、更多病人的渴望驱动的。

It’s driven as well by patients and people and they resist it being pushed back very often.

它也是由患者和人们推动的，他们经常抵制它被推迟。

So families have formed organizations like NAMI, but those aren’t the mentally ill.

因此，家庭成立了像 NAMI 这样的组织，但这些组织并不是精神病患者。

3:18:29 Those are the family members of the mentally ill, and there are differences in the perspectives and the interests of the family members and the patients- …

那些是精神病患者的家属，家属和患者的观点和利益存在差异——……

And that’s easy to forget.

这很容易被忘记。

I think one of the things you talk about is I mean, the quote you had was use the word madness.

我认为你谈论的一件事是我的意思是，你引用的内容是使用“疯狂”这个词。

3:18:40 But that madness or mental health maladies, if you’re suffering from them, it’s a deeply lonely experience.

但是，如果你患有这种疯狂或心理健康疾病，那将是一种非常孤独的经历。

And then if you’re around somebody suffering from it, it’s a very social experience.

如果你周围有人患有这种疾病，那是一种非常社交的经历。

Yeah.

是的。

3:19:05 Yeah, this is actually that’s a paraphrase of — I was quoting one of my friends and fellow historians of psychiatry, Michael MacDonald.

是的，这实际上是我引用的一位朋友和精神病学历史学家迈克尔·麦克唐纳的话。

The most solitary of afflictions for the sufferer and the most social of maladies for those around them.

对于患者来说，这是最孤独的痛苦；对于周围的人来说，这是最社会性的疾病。

And there’s lots of ways in which you can see that very powerfully, and that’s why I think there are a ton of people who suffer in various ways from mental disturbances of one sort and another.

你可以通过很多方式强烈地看到这一点，这就是为什么我认为有很多人以不同的方式遭受着这样那样的精神障碍。

But the effects aren’t confined to them.

但影响并不局限于他们。

They extend out to everybody else around them, and that’s really powerful.

他们扩展到周围的每个人，这真的很强大。

3:19:42 So we had this first generation, there were actually two different kinds of antidepressants: MAOIs as they’re called in the trade, and tricyclics which were called tricyclics ’cause they had a third ring of a certain element in their molecule.

所以我们有了第一代抗抑郁药，实际上有两种不同的抗抑郁药：行业中所谓的单胺氧化酶抑制剂（MAOIs）和三环类药物，之所以被称为三环类药物是因为它们的分子中含有某种元素的第三个环。

Those had as I say, a limited market, but also there were complications associated with them that it was easy to overdose and die.

正如我所说，这些药物的市场有限，但也存在与之相关的并发症，很容易过量服用而死亡。

And so depressed– giving a depressed patient a bunch of pills that if they took too many of them would kill them was tricky.

如此沮丧——给一个抑郁症患者服用一堆药，如果他们服用太多就会杀死他们，这是很棘手的。

They also could kill you another way because for example, you couldn’t– certain dietary items, cheese, cured meats, in combination with them were, were very, very health threatening, maybe even fatal.

它们也可能以另一种方式杀死你，因为例如，你不能——某些饮食项目，奶酪，腌肉，与它们结合起来，非常非常威胁健康，甚至可能致命。

3:20:36 Now, in the late ’80s, the drug companies came across a new class of antidepressants that didn’t have those side effects.

现在，在 80 年代末，制药公司发现了一种没有这些副作用的新型抗抑郁药。

As we’ll see, they had other side effects, but not those.

正如我们将看到的，它们还有其他副作用，但不是这些。

And the most famous of those was Prozac.

其中最著名的是百忧解。

There were a class of drugs called SSRIs, and again forgive the acronyms, but what it means is selective serotonin reuptake inhibitors.

有一种药物叫做 SSRIs，再次原谅这些缩写词，但它的意思是选择性血清素再摄取抑制剂。

Serotonin is something manufactured in our bodies, actually in our digestive system, and it performs a variety of functions in the body.

血清素是我们体内（实际上是我们的消化系统）产生的物质，它在体内发挥多种功能。

But it’s also one of the neurotransmitters in our brains.

但它也是我们大脑中的神经递质之一。

And the way these drugs worked was by slowing the reuptake of serotonin in the brain, which was marketed by the drug companies as the solution to depression.

这些药物的作用方式是减缓大脑中血清素的再摄取，制药公司将其作为抑郁症的解决方案进行营销。

3:21:38 That when you got depressed, it was because you didn’t have enough serotonin in your brain, and these pills solved that problem.

当你感到抑郁时，是因为你的大脑中没有足够的血清素，而这些药丸解决了这个问题。

It was like, well, Tipper Gore, Al Gore’s ex-wife, was like many politicians’ wives, depressed for reasons I fully understand or at least partially understand.

就像，阿尔·戈尔的前妻蒂珀·戈尔，就像许多政客的妻子一样，因为我完全理解或至少部分理解的原因而感到沮丧。

And she went to her psychiatrist and that was one of the things she was given, and she became one of the big public advocates for SSRIs which still are the most prescribed antidepressants.

她去看了精神科医生，这是她得到的治疗之一，她成为 SSRIs 的主要公众倡导者之一，SSRIs 仍然是处方最多的抗抑郁药。

Do they work?

它们有效吗？

3:22:15 And what are the side effects?

副作用是什么？

Yeah.

是的。

3:22:18 So here’s where we get into slippery territory.

这就是我们进入棘手领域的地方。

Every time you do a controlled study of these antidepressants, they beat placebo in a statistically significant margin, but not necessarily in a clinically significant margin.

每次对这些抗抑郁药进行对照研究时，它们都会以统计学上显着的优势击败安慰剂，但不一定在临床上显着的优势。

And this is when you see drug ads, be very careful.

当你看到药品广告时，要非常小心。

This one significantly improves X or Y.

这显着改善了 X 或 Y。

Does that mean clinically or does it mean statistically?

这意味着临床意义还是统计学意义？

Because the fact– if you — When we measure improvement with depression, we tend to use rating scales of various sorts.

因为事实上——如果你——当我们衡量抑郁症的改善时，我们倾向于使用各种评级量表。

And if you improve on one of the major scales that’s used by one or two points on a 60-point scale, it may be enough to show statistical significance.

如果您在 60 分制的主要量表中提高一两个点，则可能足以显示统计显着性。

This drugs looks a little better than placebo, but doesn’t really affect your quality of life much.

这种药物看起来比安慰剂好一点，但并不会真正影响你的生活质量。

3:23:18 And for most patients, antidepressants are marginally better than placebo, but a lot of the effect is the placebo effect.

对于大多数患者来说，抗抑郁药比安慰剂稍好一些，但很多效果都是安慰剂效应。

And they come with very difficult side effects.

而且它们会带来非常严重的副作用。

A lot of people describe them as numbing drugs.

很多人将它们描述为麻醉药物。

They-

他们——

3:23:41 …

……

flatten everything out so you can’t experience the highs and lows that normally we take as part of human experience.

把一切都扁平化，这样你就无法体验我们通常认为是人类经验一部分的高潮和低谷。

And then the numbing extends elsewhere in your body.

然后麻木感会延伸到身体的其他部位。

In particular, lots of patients find a complete loss of libido.

特别是，许多患者发现性欲完全丧失。

They…

他们……

They can’t get an erection.

他们无法勃起。

They can’t climax if they’re a woman.

如果她们是女人，她们就无法达到高潮。

Their sex life just goes away, and sometimes it doesn’t come back after you stop the drugs.

他们的性生活就消失了，有时停药后就不会再出现。

Next layer of problems, getting off the drugs for some people turns out to be hell on wheels.

下一层问题是，对某些人来说，戒毒简直就是地狱。

They get worse depression than they had before.

他们的抑郁症比以前更严重。

They get terrible feelings.

他们有可怕的感觉。

That brain is sparking; something’s wrong.

那个大脑正在闪闪发光；出问题了。

3:24:31 And so many patients find themselves trapped on those drugs for a long time, and we don’t know what the effects of that are gonna be.

许多患者发现自己长期服用这些药物，我们不知道这会产生什么影响。

So it’s a very mixed picture, you know.

所以这是一个非常复杂的情况，你知道。

That’s why I think groups like NICE in England are saying, “Use CBT as the first line, not drugs.” Um, but again, it’s also fair to say, I think what we find and there was a recent Lancet study that I think was revealing on this point.

这就是为什么我认为像英国 NICE 这样的组织会说，“使用 CBT 作为第一线，而不是药物。”嗯，但同样，公平地说，我认为我们发现了什么，最近的一项《柳叶刀》研究我认为揭示了这一点。

It’s like this with both antipsychotics and antidepressants.

抗精神病药和抗抑郁药都是这样。

You have a group of people who respond pretty well, and, and the side effects for them are bearable or even they don’t experience them.

有一群人反应很好，而且他们的副作用是可以忍受的，甚至他们没有经历过。

That’s great.

那太棒了。

You have a group of people, and it’s significant.

你有一群人，这很重要。

With depressed patients, we’re talking 40 or north of forty percent who aren’t responding.

对于抑郁症患者，我们所说的是 40% 或 40% 以上的人没有反应。

Okay?

好的？

3:25:29 So drugs aren’t doing anything for them, and they’re running a risk.

所以药物对他们没有任何作用，而且他们还面临着风险。

And then in the middle, you have a group of people who get some positive improvement, but they also get side effects, and that’s where, you know, this cost-benefit analysis, if we can call it that, comes into play, and it’s very difficult.

然后在中间，有一群人得到了一些积极的改善，但他们也受到了副作用，这就是成本效益分析（如果我们可以这样称呼的话）发挥作用的地方，这是非常困难的。

And the problem is going in, you don’t know which group you’re gonna fall in.

问题是，你不知道自己会属于哪一组。

And your, and your doctor doesn’t know which group you’re gonna fall in.

而你和你的医生都不知道你会属于哪一组。

And more importantly, one of the things the Drugs Revolution did was it moved the diagnosis and the prescribing of things away from psychiatry alone, so many of these things, particularly antidepressants, are dispensed by primary care docs, not, not psychiatrists.

更重要的是，毒品革命所做的一件事是，它使诊断和处方不再仅局限于精神病学，因此许多药物，特别是抗抑郁药，是由初级保健医生而不是精神科医生分配的。

Let’s zoom out.

让我们缩小。

3:26:23 We did say that there’s a real crisis.

我们确实说过存在真正的危机。

From an individual perspective suffering from psychosis or suffering from depression- …

从患有精神病或抑郁症的个人角度来看——……

What are you supposed to do?

你应该做什么？

What works, and what is the hope for the future in the next ten, twenty out?

在接下来的十、二十年里，什么是有效的？对未来的希望是什么？

So you probably need to try the drugs because the suffering is very intense.

所以你可能需要尝试这些药物，因为痛苦非常强烈。

3:26:43 But you need to be aware of things, and you need a clinician who’s monitoring very carefully.

但您需要注意一些事情，并且需要一位非常仔细监测的临床医生。

More generally, psychiatric research needs to broaden.

更一般地说，精神病学研究需要扩大。

We have spent all our monies on drugs, on neuroscience, and on genetics, but there are other things we could do that would improve the lives of families and patients more immediately.

我们把所有的钱都花在了药物、神经科学和遗传学上，但我们还可以做其他事情来更直接地改善家庭和患者的生活。

So we need to spend some time on the psychosocial dimensions of mental illness and to allow psychiatrists to build careers in those fields.

因此，我们需要花一些时间研究精神疾病的心理社会层面，并允许精神科医生在这些领域建立职业生涯。

One of the problems if you’re an academic psychiatrist, your whole future is dependent on you bringing in grant monies, and there aren’t grant monies available to study: Are there better ways we could cope with the problem of homelessness?

如果你是一名学术精神病学家，你的整个未来都取决于你带来的助学金，而没有可供研究的助学金，那么问题之一是：我们是否有更好的方法来应对无家可归的问题？

3:27:52 Are there better ways we could make f– ease the problem for families who are having to cope with somebody in their midst who’s hallucinating?

对于那些不得不应对其中出现幻觉的人的家庭，我们是否有更好的方法可以缓解这个问题？

That sort of thing, I think, would help.

我认为这类事情会有帮助。

What about talk therapy on both the CBT, cognitive behavioral therapy, and psychoanalysis?

CBT、认知行为疗法和精神分析的谈话疗法怎么样？

3:28:03 We left psychoanalysis in this place where society left it behind.

我们把精神分析留在了社会抛弃它的地方。

I think it’s become a niche product now.

我认为它现在已经成为一个利基产品。

3:28:14 Only, only the very wealthy can afford to do it, and some of them indeed do make use of it, and some of them claim that it helps them.

只是，只有非常富有的人才能负担得起，其中一些人确实使用了它，其中一些人声称这对他们有帮助。

Oh, do you think there’s future in it?

哦，你觉得这有未来吗？

3:28:27 I will add an extra– I would add an extra bit to that.

我会额外添加一点——我会额外添加一点。

Yes.

是的。

Carefully is with the advent and the rapid improvement of artificial intelligence systems- …that are able to communicate with individual humans and learn a lot about them, and have a conversation about the deepest secrets that you sometimes actually would even be uncomfortable telling even a therapist.

小心的是，随着人工智能系统的出现和快速改进，它们能够与人类个体进行交流并了解他们的很多信息，并就最深层的秘密进行对话，有时甚至连治疗师都不愿意告诉你这些秘密。

3:28:34 That starts to go into the realm of Freud and Jung and psychoanalysis.

这开始进入弗洛伊德和荣格以及精神分析的领域。

Well, yes, and we did see actually COVID with the isolation that it produced and the fact people couldn’t go to their therapists directly.

嗯，是的，我们确实看到了新冠病毒带来的隔离以及人们无法直接去看治疗师的事实。

3:29:05 We did see the rise of some of this distant learning of this, and some of it may indeed be mechanizable in the way you described.

我们确实看到了一些远程学习的兴起，其中一些确实可以按照您所描述的方式实现机械化。

It’s very important that psychiatrists broaden their perspective on these things, and some already have.

精神科医生拓宽对这些事情的看法非常重要，有些人已经这样做了。

I think public policy is in a mess when it comes to serious mental illness, but I’m pessimistic about fixing that ’cause it would cost bunches of money.

我认为在严重的精神疾病方面，公共政策一团糟，但我对解决这个问题持悲观态度，因为这会花费大量资金。

If we were talking about something where we could cure people, transform them from, as they used to say, tax eaters to taxpayers, there’d be incentive to do it.

如果我们谈论的事情可以治愈人们，将他们从人们常说的食税者转变为纳税人，那么就会有动力去做这件事。

But the honest answer is right now that’s not where we are.

但诚实的答案是，现在这不是我们所处的位置。

And so we face dilemmas.

所以我们面临着两难的境地。

3:30:07 I think helping people as much as we can with social supports –And, you know, social interaction is tremendously important to people’s mental health.

我认为通过社会支持尽可能地帮助人们——而且，你知道，社交互动对人们的心理健康非常重要。

If they lack it, if they’re lonely, if they’re isolated, it does bad things to people.

如果他们缺乏它，如果他们感到孤独，如果他们被孤立，就会对人们产生不好的影响。

So somehow providing that kind of support, providing some sense of agency to people who often lack it would be very helpful.

因此，以某种方式提供这种支持，为那些经常缺乏这种支持的人提供某种代理感，将会非常有帮助。

I hope somebody has a breakthrough and produces a better drug because unlike some people, I would be astonished if the major forms of mental illness didn’t have a biological component to them.

我希望有人能够取得突破并生产出更好的药物，因为与某些人不同的是，如果主要形式的精神疾病没有生物学成分，我会感到惊讶。

3:30:48 I don’t think that’s ever gonna be the whole story, but it’s going to be an important part of the story, and therefore, you know, the fact that major drug companies have abandoned research in this area, they’ve been bad actors in many ways, but the drugs have had some positive effects, and the fact that there’s no research being done by the people with the most money to develop better treatments is, well, one word for it would be depressing.

我不认为这会是故事的全部，但它将成为故事的重要组成部分，因此，你知道，大型制药公司已经放弃了这一领域的研究，他们在很多方面都是坏人，但这些药物产生了一些积极的作用，而最有钱的人没有进行研究来开发更好的治疗方法，这一事实只能用一个词来形容，这将是令人沮丧的。

You know?

你知道？

That’s not what we wanna see.

这不是我们想看到的。

So the path forward is a mix- ….of continued research on drugs, but from a patient perspective, extreme caution in use of those drugs.

因此，前进的道路是……继续对药物进行研究，但从患者的角度来看，使用这些药物时要极其谨慎。

3:31:20 Talk therapy, whether it’s CBT or psychoanalysis, further investigation research on that front.

谈话疗法，无论是CBT还是精神分析，都需要在这方面进行进一步的调查研究。

Then the psychosocial component of social family- …..people around you, less loneliness, investigating how from a cultural social perspective and from a public policy perspective, can we increase the amount of social connections that people who suffer have and all of that together?

那么社会家庭的心理社会组成部分——……你周围的人，减少孤独，从文化社会的角度和公共政策的角度调查如何，我们可以增加受苦的人所拥有的社会联系的数量以及所有这些吗？

Yes.

是的。

3:31:58 And breakthrough with people who have a very hard time making those connections or who’ve lost the ability to make them.

对于那些很难建立这些联系或失去建立这些联系的能力的人来说，这是一个突破。

If we can zoom out, looking back at this rich history of human beings, and we did look at the darkness, but I think there’s a very large number of people that want to help those who suffer.

如果我们能把目光放远，回顾人类丰富的历史，我们确实看到了黑暗，但我认为有很多人想要帮助那些受苦受难的人。

3:32:07 So looking at the history of people trying to figure out- ……how to help those who suffer, what gives you hope about our future?

因此，回顾人们的历史，试图弄清楚——……如何帮助那些受苦受难的人，是什么让你对我们的未来充满希望？

A real hope for the future of psychiatry that we can actually help people who suffer.

对精神病学未来的真正希望是我们能够真正帮助那些遭受痛苦的人。

Well, I think we have a profession with many very well-meaning people who see the suffering on a day-to-day, face-to-face basis.

嗯，我认为我们这个行业有很多善意的人，他们每天都面对面地看到苦难。

3:32:39 And I like to think that among them will be people who move this thing forward.

我认为他们当中将会有推动这件事向前发展的人。

And the fact is we have moved things forward.

事实是我们已经取得了进展。

We have tended to dwell a lot on some of the very unsavory aspects of the past and even some of the drawbacks of what we have available to us in the present.

我们倾向于过多地关注过去的一些非常令人讨厌的方面，甚至我们现在所拥有的一些缺点。

But it is important to see at times highly motivated people have been able to do very good things to help people with these conditions.

但重要的是，有时积极主动的人们能够做一些很好的事情来帮助患有这些疾病的人。

And there is, I think, hope in the future that we will see more of that than has been the case.

我认为，未来我们有望看到比以往更多的情况。

3:33:42 And that involves, in some senses, a shift in the mentality of a whole profession in a more caring kinda direction or less technocratic kind of direction, less reliance on something as simple as giving people pills, because that can help, but it’s clearly not gonna be the solution to the whole thing.

从某种意义上说，这涉及到整个职业的心态转变，转向更关心的方向或更少的技术官僚方向，减少对像给人们吃药这样简单的事情的依赖，因为这会有所帮助，但显然不会成为整个问题的解决方案。

We need a system that is aware of and catering to the suffering that people experience and finds ways, if they can’t eliminate it entirely, to ameliorate it in ways that people will sense is actually of help to them.

我们需要一个能够意识到并照顾人们所经历的痛苦的系统，如果他们不能完全消除痛苦，我们会找到方法，以人们感觉实际上对他们有帮助的方式来改善它。

It’s a, it’s a very difficult area, this one.

这是一个非常困难的领域。

3:34:35 It’s one that touches some of the most profound aspects of ourselves as human beings, and I think as difficult as this problem is, it’s very important not to be cynical.

这是一个触及我们人类最深刻的方面的问题，我认为尽管这个问题很困难，但不要愤世嫉俗非常重要。

Not to give up hope, not to deny the possibility of progress, because that’s always there.

不要放弃希望，不要否认进步的可能性，因为进步永远存在。

And has happened, and I hope will happen with increasing pace in the years ahead of us.

并且已经发生了，我希望在未来的几年里会以越来越快的速度发生。

And if you’re listening to these words and you’re right now in this moment of your life where you yourself are suffering, please know we’re with you.

如果你正在听这些话，并且你现在正处于生命中的这个时刻，你自己正在受苦，请知道我们与你同在。

3:35:09 We’re in this together.

我们在一起。

Stay strong.

坚强点。

There’s hope, legitimately, as one human to another.

作为一个人对另一个人来说，这是合理的希望。

I love you, brother, sister.

我爱你们，兄弟，姐妹。

If you’re listening to this, stay strong.

如果你正在听这个，请保持坚强。

Andrew, thank you for this incredible work of history that you do.

安德鲁，感谢您所做的这项令人难以置信的历史工作。

Incredible work of raising awareness, stepping into a difficult topic, and trying to find the wisdom, the insights in it.

这是令人难以置信的工作，它提高了人们的认识，进入了一个困难的话题，并试图从中找到智慧和见解。

And thank you for this incredible conversation today.

感谢你们今天进行的这次令人难以置信的对话。

Lex, thank you for having me, and I felt you were remarkably prepared to push me in various directions.

莱克斯，谢谢你邀请我，我觉得你已经准备好将我推向各个方向。

3:35:50 So you’d obviously done a lot of preparation to get, get this in, in the right frame.

所以显然你已经做了很多准备才能将其放入正确的框架中。

And I hope that people will get something positive from this conversation along with some of the darkness we’ve inevitably had to talk about.

我希望人们能从这次谈话中得到一些积极的东西，同时也能摆脱我们不可避免地不得不谈论的一些黑暗面。

Thank you for listening to this conversation with Andrew Scull.

感谢您收听与安德鲁·斯卡尔的对话。

3:36:17 To support this podcast, please check out our sponsors in the description, where you can also find links to contact me, ask questions, give feedback, and so on.

为了支持这个播客，请在描述中查看我们的赞助商，您还可以在其中找到联系我、提出问题、提供反馈等的链接。

And now, let me leave you with some words from Friedrich Nietzsche: “To live is to suffer, to survive is to find meaning in the suffering.” Thank you for listening, and I hope to see you next time.

现在，让我借用弗里德里希·尼采的话：“活着就是受苦，生存就是在受苦中寻找意义。”感谢您的聆听，希望下次再见。