Dr. Casey Halpern: Biology & Treatments for Compulsive Eating & Behaviors
Andrew Huberman:
安德鲁·休伯曼：
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
Today, my guest is Dr. Casey Halpern.
今天，我的嘉宾是凯西·哈尔彭博士。
Dr. Halpern is the chief of neurosurgery at the University of Pennsylvania School of Medicine.
Halpern 博士是宾夕法尼亚大学医学院神经外科主任。
His laboratory focuses on bulimia, binge eating disorder, and other forms of obsessive-compulsive behaviors.
他的实验室专注于贪食症、暴食症和其他形式的强迫行为。
Normally, when we hear about eating disorders or obsessive-compulsive disorders of other kinds, the conversation quickly migrates to pharmacologic interventions and serotonin or dopamine or talk therapy interventions, many of which can be effective.
通常，当我们听到饮食失调或其他类型的强迫症时，谈话很快就会转移到药物干预和血清素或多巴胺或谈话治疗干预，其中许多干预措施都是有效的。
The Halpern Laboratory, however, takes an entirely different approach.
然而，哈尔彭实验室采取了完全不同的方法。
While they embrace pharmacologic and behavioral and talk therapy interventions, their main focus is the development and application of engineered devices to go directly into the brain and stimulate the neurons, the nerve cells, that generate compulsions that cause people to want to eat more, even when their stomach is full.
虽然他们采用药物、行为和谈话治疗干预措施，但他们的主要重点是开发和应用工程设备，直接进入大脑并刺激神经元和神经细胞，从而产生强迫症，导致人们想要吃更多东西，即使他们的胃很饱。
In other words, they do brain surgery of various kinds, sometimes removing small bits of brain, sometimes stimulating small bits of brain with electrical current, and even stimulating the brain through the intact skull, that is, without having to drill down beneath the skull in order to alleviate and indeed sometimes cure these conditions.
换句话说，他们进行各种脑部手术，有时切除大脑的一小部分，有时用电流刺激大脑的一小部分，甚至通过完整的头骨刺激大脑，也就是说，无需钻到头骨下方即可减轻甚至有时治愈这些病症。
Today's discussion with Dr. Halpern was an absolutely fascinating one for me, because it represents the leading edge of what's happening in modification of brain circuits and the treatment of neurologic and psychiatric disease.
今天与 Halpern 博士的讨论对我来说绝对是一场令人着迷的讨论，因为它代表了脑回路改造以及神经和精神疾病治疗方面正在发生的前沿进展。
For instance, they just recently published a paper in "Nature Medicine," one of the premier journals out there, entitled "Pilot Study of Responsive Nucleus Accumbens Deep Brain Stimulation for Loss of Control Eating." The nucleus accumbens is an area of our brains that we all have, in fact, we have two of them, one on each side of the brain, that is intimately involved in the release of dopamine for particular motivated behaviors.
例如，他们最近刚刚在顶级期刊之一《自然医学》上发表了一篇论文，题为“响应性伏隔核深部脑刺激对饮食失控的试点研究”。伏隔核是我们大脑中每个人都有的一个区域，事实上，我们有两个伏隔核，大脑两侧各一个，它与特定动机行为的多巴胺释放密切相关。
And while most often we think about dopamine for the release of behaviors that we want to engage in, in this context, they are using stimulation and control of neuronal activity in nucleus accumbens to control loss of control eating.
虽然我们通常认为多巴胺可以释放我们想要进行的行为，但在这种情况下，他们正在利用刺激和控制伏隔核中的神经元活动来控制饮食失控。
Something that when people suffer from it, despite knowing they shouldn't eat, despite not even wanting to eat, they find themselves eating.
当人们遭受这种痛苦时，尽管知道自己不应该吃东西，尽管甚至不想吃，但他们发现自己在吃东西。
So again, this represents really the leading edge of where neuroscience is going, and it certainly is going to be an area of neuroscience that's going to expand in the years to come.
再说一次，这确实代表了神经科学发展的前沿，而且它肯定会成为神经科学的一个领域，在未来几年将会扩展。
And Dr. Halpern and the members of his laboratory are among a very small group of scientists in the world that are using the types of approaches that I described a minute ago, and that you're going to hear more about in today's episode, in order to resolve some of the most difficult and debilitating human conditions.
哈尔彭博士和他的实验室成员是世界上极少数科学家之一，他们正在使用我一分钟前描述的方法类型，您将在今天的节目中听到更多关于这些方法，以解决一些最困难和最令人衰弱的人类状况。
During today's discussion, you will also learn about the use of deep brain stimulation and other approaches for the treatment of movement disorders, such as essential tremor, Parkinson's disease, and various types of dystonias, which are challenges in generating particular types of movement.
在今天的讨论中，您还将了解如何使用深部脑刺激和其他方法来治疗运动障碍，例如特发性震颤、帕金森病和各种类型的肌张力障碍，这些都是产生特定类型运动的挑战。
So whether or not you or somebody that you know suffers from an eating disorder, from obsessive compulsive disorder, or from a movement disorder, today's episode is sure to teach you not only about what's happening in those arenas, but also in the arenas of neuroscience generally.
因此，无论您或您认识的人是否患有饮食失调、强迫症或运动障碍，今天的节目肯定不仅会告诉您这些领域正在发生的事情，而且还会告诉您一般神经科学领域正在发生的事情。
In fact, I would say today's episode is especially important for anyone that wants to understand how the brain works and what the future of brain modification really looks like for all of us.
事实上，我想说今天的节目对于任何想要了解大脑如何工作以及大脑改造的未来对我们所有人来说到底是什么样子的人来说尤其重要。
Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。
It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.
然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。
In keeping with that theme, I'd like to thank the sponsors of today's podcast.
为了与这个主题保持一致，我要感谢今天播客的赞助商。
And now for my discussion with Dr. Casey Halpern.
现在我与 Casey Halpern 博士进行讨论。
Casey, I should say Dr. Halpern for those listening, welcome.
凯西，我应该对那些聆听的哈尔彭博士说，欢迎。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Thank you.
谢谢你。
Great to be here.
很高兴来到这里。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
It's been a long time coming.
已经很久了。
We were colleagues at Stanford, and then recently you moved, of course, to University of Pennsylvania, also an incredible institution.
我们是斯坦福大学的同事，当然，最近你搬到了宾夕法尼亚大学，这也是一所令人难以置信的机构。
We're sorry to lose you.
我们很遗憾失去你。
Dr. Casey Halpern:
凯西·哈尔彭博士：
It was bittersweet for me, too.
这对我来说也是苦乐参半。
Andrew Huberman:
安德鲁·休伯曼：
Stanford's loss is UPenn's gain.
斯坦福大学的损失是宾夕法尼亚大学的收益。
But let's talk about your work, past and present.
但让我们谈谈你过去和现在的工作。
As I've told the listeners already, you're a neurosurgeon, which I consider the astronauts of neuroscience, because you're in somewhat uncharted territory, or very uncharted territory, and yet precision is everything, right?
正如我已经告诉听众的那样，你是一名神经外科医生，我认为你是神经科学的宇航员，因为你处于某种未知的领域，或者非常未知的领域，但精确性就是一切，对吧？
The margins of error are very, very small.
误差幅度非常非常小。
So for those that aren't familiar with the differences between neurosurgery, neurology, psychiatry, maybe you could just educate us a bit.
因此，对于那些不熟悉神经外科、神经病学、精神病学之间差异的人，也许您可以教育我们一些。
What does a neurosurgeon do, and what does the fact that you're a neurosurgeon do for your view of the brain?
神经外科医生是做什么的？你是一名神经外科医生这一事实对你对大脑的看法有何影响？
How do you think about and conceptualize the brain?
您如何思考和概念化大脑？
Dr. Casey Halpern:
凯西·哈尔彭博士：
The scope of neurosurgery is quite broad.
神经外科的范围相当广泛。
When I was in medical school, I was drawn to neurosurgery because of a procedure known as deep brain stimulation.
当我在医学院时，我被神经外科所吸引，因为一种被称为深部脑刺激的手术。
When I was at Penn as a college student, I actually watched my first deep brain stimulation surgery performed by Gordon Baltuch, who to date is one of my career mentors.
当我还是宾夕法尼亚大学的一名学生时，我实际上观看了戈登·巴尔图奇（Gordon Baltuch）进行的我的第一次深部脑刺激手术，他迄今为止是我的职业导师之一。
Deep brain stimulation is one surgery that neurosurgeons offer, but it's actually sort of a very small minority of what neurosurgery does.
深部脑刺激是神经外科医生提供的一种手术，但它实际上只占神经外科手术的一小部分。
We take out brain tumors.
我们切除脑肿瘤。
We clip aneurysms in the brain.
我们夹住大脑中的动脉瘤。
We take care of patients that have had traumatic brain injury, concussion, spine surgeries, 90% of what neurosurgeons do around the country.
我们照顾患有脑外伤、脑震荡、脊柱手术的患者，这些是全国神经外科医生所做的 90% 的工作。
Taking care of herniated discs and lumbar fusions.
治疗椎间盘突出和腰椎融合。
So, the scope is the entire central nervous system, including the peripheral nervous system.
所以，范围是整个中枢神经系统，包括周围神经系统。
We take care of patients with carpal tunnel syndrome and nerve disorders.
我们照顾患有腕管综合症和神经疾病的患者。
Now, over the course of the past two decades or so, there's been a mission in the field to sub-specialize.
现在，在过去二十年左右的时间里，该领域一直存在着细分专业化的使命。
And so historically, neurosurgeons did everything in that domain, but now we sub-specialize, and I'm lucky to be at Penn Medicine, where we can focus on one of these areas.
从历史上看，神经外科医生在该领域做了所有事情，但现在我们进行了细分，我很幸运能够在宾夕法尼亚大学医学院工作，在那里我们可以专注于其中一个领域。
So I'm chief of stereotactic functional neurosurgery All I do is deep brain stimulation surgery, and a complement to that is focused ultrasound or transcranial focused ultrasound, which is a non-invasive way to do an ablation in the brain, recently FDA approved, and it's FDA approved for tremor at the moment.
所以我是立体定向功能神经外科的负责人，我所做的就是深部脑刺激手术，以及聚焦超声或经颅聚焦超声的补充，这是一种在大脑中进行消融的非侵入性方法，最近获得了 FDA 的批准，目前 FDA 批准了它用于震颤。
These two procedures are, for me, my every day, but still the minority of what neurosurgeons have to offer.
对我来说，这两个手术是我的日常工作，但仍然是神经外科医生必须提供的少数服务。
The majority of neurosurgery, in my mind, is a bit more structural than it is physiology or deeply rooted in how the brain functions.
在我看来，大多数神经外科手术都比生理学更具结构性，或者更深入地探讨大脑的功能。
When we take out a brain tumor, we have to find a safe trajectory to get to the brain tumor, and then we remove it, and we help the patient recover in the ICU.
当我们取出脑肿瘤时，我们必须找到一条安全的轨迹到达脑肿瘤，然后将其切除，并帮助患者在ICU中康复。
Similar to a brain aneurysm, often we don't have to go into the brain to clip a brain aneurysm, but we go around the brain or under the brain to get there.
与脑动脉瘤类似，通常我们不必进入大脑来夹住脑动脉瘤，而是绕过大脑或大脑下方即可到达那里。
And in my mind, those surgeries are a bit more structural.
在我看来，这些手术更具结构性。
Deep brain stimulation, the surgery that I do routinely, is a procedure where, yes, there is structure involved, of course.
深部脑刺激是我经常进行的手术，当然，这是一个涉及结构的手术。
We have to place a very thin wire that's insulated deep into a part of the brain that's involved in Parkinson's disease, for example.
例如，我们必须将一根非常细的电线深入到与帕金森病有关的大脑部分。
But that's actually not the therapy.
但这实际上不是治疗方法。
The therapy is delivering electrical stimulation through the tip of that wire, or one of the tips, as there actually are multiple contacts at the bottom of the wire.
该疗法是通过该导线的尖端或其中一个尖端提供电刺激，因为导线的底部实际上有多个触点。
They're very small.
它们很小。
But that's all done out of the operating room.
但这一切都是在手术室外完成的。
This stimulation wire is connected to a battery pack or a pulse generator that's kind of like a pacemaker.
该刺激线连接到电池组或类似于起搏器的脉冲发生器。
And so we deliver this therapy, and I always tell patients, it's a bit more like I have to implant a tool to deliver you a medication.
因此，我们提供这种疗法，我总是告诉患者，这更像是我必须植入一个工具来为您提供药物。
But that medication is going to be in the form of electricity, and it's going to be delivered into a very small region of the brain.
但这种药物将以电的形式传递到大脑的一个非常小的区域。
And it's that procedure that's inspired me to not just become a neurosurgeon, but has really defined the focus of my research laboratory as well.
正是这个过程不仅激励我成为一名神经外科医生，而且也真正确定了我研究实验室的重点。
Andrew Huberman:
安德鲁·休伯曼：
Maybe by way of anecdote, you could tell us one of the more outrageous or surprising, or who knows, delightful and thrilling things about the brain that you've observed as a consequence of stimulating different brain areas.
也许通过轶事，你可以告诉我们一件更令人震惊或令人惊讶的事情，或者谁知道，你观察到刺激不同大脑区域的结果是大脑中令人愉快和激动的事情。
In textbooks, we always hear about the kind of dark stuff.
在教科书中，我们总是听到那种黑暗的东西。
Stimulate one brain area, somebody goes into a rage.
刺激某一大脑区域，某人就会勃然大怒。
Stimulate another brain area, person starts laughing uncontrollably.
刺激另一个大脑区域，人就会开始无法控制地大笑。
First of all, given that some of the information, let's hope not much, but some of the information in textbooks is incorrect, are those sorts of statements true?
首先，鉴于有些信息，我们希望不要太大，但教科书上的一些信息是不正确的，这些说法是真的吗？
Can one observe those in the clinic?
可以在诊所观察吗？
And what are some of the more interesting, and I don't necessarily mean entertaining, but surprising things that you've seen when you've poked around in the brain, deliberately, of course.
还有哪些更有趣的东西，我的意思不一定是娱乐性的，而是当你故意在大脑中探索时所看到的令人惊讶的事情，当然。
And what have you seen?
你看到了什么？
What have you heard?
你听到了什么？
Dr. Casey Halpern:
凯西·哈尔彭博士：
I have to say, I am amazed by these effects every day.
我不得不说，我每天都对这些效果感到惊讶。
I'm very privileged to be able to interact with the human brain in this way.
我非常荣幸能够以这种方式与人脑互动。
It's always with the goal of trying to provide somebody with a meaningful therapy.
它始终致力于为某人提供有意义的治疗。
But when we deliver electrical stimulation, these electrodes, while they might be sitting in a very small region of the brain, there are regions within a few millimeters of where these electrodes are that, if stimulated, could cause a temporary, very brief side effect, a moment of laughter, like you said, or a moment of panic.
但是，当我们提供电刺激时，这些电极虽然可能位于大脑的一个非常小的区域，但在这些电极所在的几毫米范围内有一些区域，如果受到刺激，可能会导致暂时的、非常短暂的副作用，就像你说的那样，一瞬间的笑声，或者一瞬间的恐慌。
And of course, we can just shut that electrode off.
当然，我们可以关闭该电极。
But often, these side effects could be therapeutic.
但通常，这些副作用可能是有治疗作用的。
And actually, that's how we have discovered ways to use deep brain stimulation, not just for movement disorders like Parkinson's disease, but for example, patients with Parkinson's disease that have a psychiatric comorbidity like depression or obsessive-compulsive disorder.
事实上，这就是我们如何发现使用深层脑刺激的方法，不仅适用于帕金森病等运动障碍，还适用于患有抑郁症或强迫症等精神共病的帕金森病患者。
A lot of these patients are highly compulsive and impulsive.
很多这样的患者都有很强的强迫性和冲动性。
Sometimes these problems actually melt away.
有时这些问题实际上会消失。
And we're trying to help their tremor, but the patients also tell us that their gambling issue has gotten better, or their mood has improved.
我们正在努力帮助他们的震颤，但患者也告诉我们，他们的赌博问题已经好转，或者他们的情绪有所改善。
And why is that?
这是为什么呢？
Well, there's probably more than one reason.
嗯，原因可能不止一个。
You can help somebody's mood by making their tremor go away, of course.
当然，你可以通过让某人的颤抖消失来改善他们的情绪。
But we see laughter in the clinic sometimes.
但有时我们会在诊所里看到笑声。
And why is that?
这是为什么呢？
And that's because we're stimulating parts of the brain that are not just involved in these motor circuits, but they're also involved in what we call a limbic circuit, or part of the brain involved in emotion.
这是因为我们刺激的大脑部分不仅与这些运动回路有关，而且还与我们所说的边缘回路有关，或者与情绪有关的大脑部分有关。
And if we learn how to modulate those areas therapeutically, step by step, we can actually develop these therapies for other indications, like depression.
如果我们学会如何一步一步地在治疗上调节这些区域，我们实际上可以开发针对其他适应症（例如抑郁症）的疗法。
I would say the most impressive and consistent effect we have when we have a patient with tremor who has been tremoring for the past 20 years, if we can deliver stimulation through that electrode in the clinic, we have immediate relief of tremor.
我想说，最令人印象深刻和一致的效果是，当我们有一个在过去 20 年里一直在颤抖的颤抖患者时，如果我们可以在诊所通过该电极提供刺激，我们就能立即缓解颤抖。
And that is the effect that inspired me to be a neurosurgeon when I was in college.
这就是我在大学时成为一名神经外科医生的灵感。
I've never really wanted to do anything else, except help develop that type of therapeutic for another kind of symptom.
除了帮助开发针对另一种症状的治疗方法之外，我从来没有真正想做任何其他事情。
I'm very interested in obesity and related eating disorders, compulsive behavior, the urge to have something that might be delicious, but dangerous or unhealthy or a drug or a compulsion like we see in OCD or obsessive compulsive disorder.
我对肥胖和相关的饮食失调、强迫行为、想要吃一些可能美味但危险或不健康的东西的冲动、或者像我们在强迫症或强迫症中看到的药物或强迫行为非常感兴趣。
Interestingly, like we see tremor melt away when we deliver electricity to a certain part of the brain, we can see these more psychiatric problems.
有趣的是，就像当我们向大脑的某个部位输送电流时，我们会看到震颤消失一样，我们可以看到更多的精神问题。
They're not all psychiatric disorders, but let's say disorders of the brain.
它们并不都是精神疾病，但可以说是大脑疾病。
We can see symptoms of those disorders also improve, and often immediately, just like we do with tremor.
我们可以看到这些疾病的症状也得到改善，而且通常是立即改善，就像我们对震颤所做的那样。
So, I see it all the time.
所以，我一直看到它。
To pick out one would be a challenge because, for me, this is my every day.
选择一个将是一项挑战，因为对我来说，这就是我的每一天。
Andrew Huberman:
安德鲁·休伯曼：
The speed of the relief that you describe for tremor is really incredible.
你所描述的震颤缓解速度确实令人难以置信。
Just thinking about drug therapies, and there too, there are side effects, but There are still a lot of mysteries as to, for instance, why SSRIs even work when they work.
想想药物疗法，也有副作用，但仍然有很多谜团，例如，为什么 SSRIs 有效时甚至有效。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And-
还有——
Dr. Casey Halpern:
凯西·哈尔彭博士：
The timing is always a challenge.
时机始终是一个挑战。
Andrew Huberman:
安德鲁·休伯曼：
Timing, dosage, yes, absolutely.
时间、剂量，是的，绝对的。
I'd love to learn more from you about OCD.
我很想向您了解更多有关强迫症的信息。
I have several reasons for asking this.
我问这个问题有几个原因。
First of all, I'm a somewhat obsessive person.
首先，我是一个有点强迫症的人。
I tend to be very narrowly focused, although I confess it's not a step function.
我倾向于非常狭窄地关注，尽管我承认这不是一个阶梯函数。
It takes me some time to turn off the chatter, but once I'm into a thought train or a mode of being and thinking and work, it's very hard for me to exit that mode.
我需要一些时间才能停止喋喋不休，但一旦我进入一种思维模式或一种存在、思考和工作模式，我就很难退出这种模式。
It's like a deep trench.
就像一条深沟。
Adaptive in some circumstances, less adaptive in others, as you know.
如您所知，在某些情况下适应性强，在其他情况下适应性较差。
The other is that when I was a kid, I had a little bit of a grunting tick.
另一个是，当我还是个孩子的时候，我有一点点咕噜声。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh.
哦。
Andrew Huberman:
安德鲁·休伯曼：
I had this intense desire to clear my throat, to the point where my dad said, "Look, you need to stop that." And he used to squeeze my hand every time I'd do it, and I used to hide in the backseat of the car or in the closet to do it because it provided so much relief.
我非常想清清嗓子，以至于我爸爸说：“听着，你需要阻止它。”每次我做这件事的时候，他都会捏我的手，而我常常躲在汽车后座或壁橱里做这件事，因为这样可以减轻很多压力。
And then it eventually passed.
然后它最终还是过去了。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I wasn't medicated.
我没有吃药。
They never did anything about it.
他们从未对此采取任何行动。
Every once in a while now, if I'm very fatigued, if I've been working a lot, I notice it starts to come back.
现在，每隔一段时间，如果我非常疲劳，如果我工作了很多，我就会注意到它开始回来。
I'll do this grunting.
我会做这个咕噜声。
And so it's been a pet neurological symptom for me that reminds me that these circuits exist in all of us, and that sometimes they go haywire, and sometimes they just have subtle overexcitation or something of that sort.
所以这对我来说是一种宠物神经系统症状，它提醒我这些回路存在于我们所有人身上，有时它们会失控，有时它们只是有微妙的过度兴奋或类似的东西。
And then the third reason is that I get thousands of questions about OCD.
第三个原因是我收到了数千个关于强迫症的问题。
Could you perhaps just tell us what is OCD?
您能告诉我们什么是强迫症吗？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
What are some brain areas involved?
涉及哪些大脑区域？
What are the current range of treatments?
目前的治疗范围有哪些？
And what's the difference between someone who is obsessive and somebody who has true OCD?
强迫症患者和真正的强迫症患者有什么区别？
Dr. Casey Halpern:
凯西·哈尔彭博士：
So a brief disclosure, as a neurosurgeon, I do take care of patients with severe obsessive compulsive disorder.
所以简单说一下，作为一名神经外科医生，我确实照顾患有严重强迫症的患者。
But my perspective on OCD may be a little bit different than a psychiatrist who lives and breathes OCD and sees patients every single day with OCD.
但我对强迫症的看法可能与精神科医生有些不同，因为精神科医生生活在强迫症中，呼吸着强迫症，每天都会见到强迫症患者。
I probably take care of three to five patients a year with deep brain stimulation for obsessive compulsive disorder, so I don't see these patients as routinely.
我每年可能会用深部脑刺激治疗强迫症患者来照顾三到五个患者，所以我不会像常规那样去看这些患者。
But my laboratory is geared as a researcher.
但我的实验室是为研究人员设计的。
I'm very focused on trying to improve outcomes of deep brain stimulation for OCD.
我非常专注于尝试改善强迫症的深部脑刺激的结果。
So I do feel I have expertise and a perspective to share, but just a brief disclosure.
所以我确实觉得我有专业知识和观点可以分享，但只是简单的披露。
I do feel that as a neurosurgeon, I am obligated to better understand where the obsessions in the brain come from, and how we can interrupt them to stop the compulsion that's associated with the obsession, sort of the intrinsic most feature of OCD, better than we're actually doing it.
我确实觉得，作为一名神经外科医生，我有义务比我们实际做的更好地了解大脑中的强迫观念从何而来，以及我们如何打断它们以停止与强迫观念相关的强迫行为，这是强迫症最本质的特征。
For example, if we were to offer a patient with tremor deep brain stimulation surgery, of course, there's some risk to the procedure, but the outcome is so consistent and positive that many patients are willing to take on that risk.
例如，如果我们要为患者提供震颤深部脑刺激手术，当然，该手术存在一定的风险，但结果是如此一致和积极，以至于许多患者愿意承担这种风险。
For obsessive-compulsive disorder, the surgery risk is about the same.
对于强迫症来说，手术风险也差不多。
However, the benefit is not quite as robust.
然而，好处并不那么强劲。
And so a lot of patients, and their referring psychiatrists, are reluctant to refer these patients to us, and it's completely understandable.
因此，很多患者和他们的转诊精神科医生不愿意将这些患者转诊给我们，这是完全可以理解的。
I've been leading an endeavor with a number of collaborators around the country to try to better understand these circuits in the brain, study them in humans, both invasively and non-invasively.
我一直在与全国各地的许多合作者一起努力，试图更好地了解大脑中的这些回路，并在人类身上进行侵入性和非侵入性研究。
That would be with an electrode-based surgery, sort of like we do in epilepsy to understand where seizures come from.
这将通过基于电极的手术来实现，就像我们在癫痫病中所做的那样，以了解癫痫发作的来源。
We want to understand better where obsessions come from, but we're also working with imaging experts and geneticists to understand OCD at a broader level as well.
我们希望更好地了解强迫症从何而来，但我们也正在与影像专家和遗传学家合作，以在更广泛的层面上了解强迫症。
I consider OCD to be a spectrum disorder in a way, and I apologize to those who might feel that I'm using that term incorrectly.
我认为强迫症在某种程度上是一种谱系障碍，我向那些可能认为我错误地使用了这个术语的人道歉。
I'm using it in a way to describe patients that have obsessions, and even some related compulsions, might not meet criteria for OCD.
我用它来描述有强迫观念的患者，甚至一些相关的强迫行为，可能不符合强迫症的标准。
It may be something, Andrew, that you have.
安德鲁，这可能是你拥有的东西。
And as a neurosurgeon, I'm really obsessive about safety and compulsive about my surgical procedures.
作为一名神经外科医生，我非常注重安全性，并且对手术程序有强迫性。
So, I think that some aspect of OCD, which we often joke about, but we should consider seriously because people do suffer from this, some aspect of it helps us.
所以，我认为强迫症的某些方面，我们经常开玩笑，但我们应该认真考虑，因为人们确实患有这种疾病，它的某些方面对我们有帮助。
There are famous CEOs that probably have some level of OCD, surgeons and scientists alike.
有些著名的首席执行官可能有一定程度的强迫症，外科医生和科学家也一样。
So, perhaps if it can be controlled, it's an asset, but if it goes awry and is uncontrollable, then it becomes obsessive compulsive disorder.
所以，也许如果它能被控制，它就是一种资产，但如果它出了问题并且无法控制，那么它就会变成强迫症。
And I tend to see the patients that are the most severe, so they have failed medication.
我往往会看到病情最严重的患者，所以他们的药物治疗失败了。
And there are multiple medications that are worth trying for OCD.
对于强迫症，有多种药物值得尝试。
Some can actually be very helpful.
有些实际上非常有帮助。
Andrew Huberman:
安德鲁·休伯曼：
Which neurotransmitter systems do they tend to poke at?
他们倾向于攻击哪些神经递质系统？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Well, SSRIs are sort of the first line for OCD, but also tricyclics can be helpful, so this is still the serotonin system.
嗯，SSRIs 是治疗强迫症的一线药物，但三环类药物也有帮助，所以这仍然是血清素系统。
But as we know, the serotonin system interacts with the neurogenergic system and the dopamine system, so it's hard to be specific to one of these things.
但正如我们所知，血清素系统与神经系统和多巴胺系统相互作用，因此很难具体说明其中之一。
And I think that's also why it's hard for us to predict how these medications are going to work for these kinds of patients.
我认为这也是为什么我们很难预测这些药物将如何对这类患者起作用。
But tricyclics and SSRIs can be very helpful and are definitely first line.
但三环类药物和 SSRI 类药物非常有帮助，而且绝对是一线药物。
And there's others.
还有其他的。
Exposure response prevention is probably the most effective option, which is kind of like cognitive behavioral therapy.
暴露反应预防可能是最有效的选择，有点像认知行为疗法。
But these are different and offered by psychologists, and this is a whole field, and there's a A field, or I should say a whole clinic at my institution, focused-- It was started by Edna Foa at Penn, who this is what they do for these patients, is offer these types of cognitive therapies exposure to the stressor and to try to get patients to habituate to whatever it is that stresses them and causes these compulsions to help these patients live every day and function.
但这些是不同的，是由心理学家提供的，这是一个完整的领域，有一个A领域，或者我应该说在我的机构中有一个完整的诊所，专注于——它是由宾夕法尼亚大学的埃德娜·福阿（Edna Foa）发起的，他们为这些患者所做的就是提供这些类型的认知疗法，暴露在压力源下，并试图让患者习惯于任何给他们带来压力并导致这些强迫的东西，以帮助这些患者每天生活和发挥作用。
These are all fabulously helpful therapies for a variety of patients, but there's still about 30% of patients that still suffer from OCD, and some of them have severe OCD.
这些对于各种患者来说都是非常有用的疗法，但仍有大约 30% 的患者仍然患有强迫症，其中一些患有严重的强迫症。
Sometimes it's moderate to severe.
有时是中度到重度。
And those are the patients that I'm really motivated to try to help.
这些是我真正有动力去帮助的患者。
Our therapies for those patients right now, I would say, are worth pursuing, but not optimal.
我想说，我们现在对这些患者的治疗值得追求，但不是最佳的。
And so it's one of those things that we have to balance as a researcher, because when you see patients like this, you want to do everything you can to help them.
因此，这是我们作为研究人员必须平衡的事情之一，因为当你看到这样的患者时，你会想尽一切努力来帮助他们。
And I think it's important to educate patients on the risk and benefits of them.
我认为教育患者了解其风险和益处非常重要。
This is deep brain stimulation surgery, but also capsulotomy, which is more of an ablation approach, a little bit like deep brain stimulation, but rather than delivering stimulation through an electrode, you can actually heat the tissue and even destroy it.
这是深部脑刺激手术，也是囊切开术，这更像是一种消融方法，有点像深部脑刺激，但不是通过电极提供刺激，而是实际上可以加热组织，甚至破坏它。
Some would say this part of the brain is very safe to destroy.
有人会说，破坏大脑的这一部分是非常安全的。
It's kind of like an appendix.
它有点像附录。
Others would say it's safer to modulate.
其他人会说调节更安全。
I have seen patients do very well with these ablations.
我见过患者在这些消融术中效果很好。
And so you asked me earlier what I find so amazing about the brain, these effects that we can have.
所以你早些时候问我，我发现大脑有什么神奇之处，我们可以产生这些影响。
Sometimes the lack of effect is what's so amazing.
有时候，缺乏效果才是如此令人惊奇。
You can actually traverse parts of the brain without having any adverse effects on patients' function, at least that you can test.
实际上，您可以遍历大脑的某些部分，而不会对患者的功能产生任何不利影响，至少可以测试。
But you can also destroy small parts of the brain.
但你也可以破坏大脑的一小部分。
We're talking three or four millimeters in size.
我们所说的尺寸是三到四毫米。
These little ablations can be really helpful for patients but have no obvious side effects that we can tell, perhaps after a short recovery from surgery.
这些小消融对患者确实有帮助，但我们可以看出，也许在手术后短暂恢复后，没有明显的副作用。
But nonetheless, despite how safe they might be, these surgical procedures still are surgical procedures, and patients are hesitant to proceed, especially when they know that their chance of a transformative effect is quite low.
但尽管如此，尽管它们可能非常安全，但这些外科手术仍然是外科手术，患者对是否继续进行犹豫不决，尤其是当他们知道获得变革性效果的机会相当低时。
We can generally achieve a responder rate of about 50%, and responders still have symptomatic OCD.
我们一般可以达到50%左右的缓解率，并且缓解者仍然有症状的强迫症。
So I'm really sort of inspired to really find a way to deliver these therapies in a more disease-specific or symptom-specific way.
因此，我真的很受启发，真正找到一种方法，以更针对疾病或症状的方式提供这些疗法。
But we're years away probably from that therapy, since it's all part of a research study at the moment.
但我们距离这种疗法可能还有好几年的时间，因为目前这只是研究的一部分。
Andrew Huberman:
安德鲁·休伯曼：
What brain areas should I think about when I think about OCD?
当我想到强迫症时，我应该想到哪些大脑区域？
Years ago, I remember opening a textbook, I think I was an undergraduate still, and work from Judith Rapoport at the National Institutes of Mental Health, this would be late '80s, early '90s, had done some neuroimaging, or maybe it was PET or some other imaging technique, and had identified portions of the basal ganglia-
几年前，我记得打开一本教科书，我想我还是一名本科生，朱迪思·拉波波特（Judith Rapoport）在国家心理健康研究所的工作，那是在 80 年代末，90 年代初，做了一些神经影像学，或者可能是 PET 或其他成像技术，并识别了基底神经节的部分 -
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure
当然可以
Andrew Huberman:
安德鲁·休伯曼：
...
...
caudate putamen type structures in OCD and maybe some differences in boys versus girls.
强迫症中的尾壳核类型结构以及男孩与女孩之间可能存在的一些差异。
So what brain areas?
那么大脑有哪些区域呢？
Are there sex differences in terms of OCD?
强迫症方面是否存在性别差异？
And were one to come into your clinic for this sort of work of ablations or stimulation, where would you first start to probe in the brain?
如果有人来到你的诊所进行这种消融或刺激工作，你会首先开始探测大脑的哪里？
Dr. Casey Halpern:
凯西·哈尔彭博士：
This is a disorder of both cortex and the subcortex.
这是皮质和皮质下的疾病。
The cortical control areas, areas that are involved in inhibitory control, we have found to not function properly in patients with OCD.
我们发现强迫症患者的皮质控制区（参与抑制控制的区域）无法正常运作。
So areas like the orbital frontal cortex and the prefrontal cortex.
所以像眶额皮质和前额皮质这样的区域。
If you image these areas or study them even in a rodent model of OCD, which, quite honestly, these models, they model aspects of OCD, but OCD is a human condition.
如果你想象这些区域或研究它们，甚至在强迫症的啮齿动物模型中，老实说，这些模型，它们模拟了强迫症的各个方面，但强迫症是人类的一种状况。
You can't really model this whole condition in a mouse or a rat.
你无法真正在小鼠或大鼠身上模拟整个情况。
But perhaps you can model compulsive behavior in a rat, sure.
但也许你可以模拟老鼠的强迫行为，当然。
And that-
还有那个——
Andrew Huberman:
安德鲁·休伯曼：
Pulling out their hair.
拔掉他们的头发。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, exactly.
是的，完全正确。
That's not necessarily obsessive compulsive disorder, but that is compulsive behavior.
这不一定是强迫症，但那是强迫行为。
And perhaps if you can ameliorate that in a rat, that might be helpful for a patient with OCD.
也许如果你能改善老鼠的这种情况，这可能会对强迫症患者有所帮助。
But we have to approach animal modeling of OCD thoughtfully, and most scientists do, I think.
但我们必须深思熟虑地建立强迫症的动物模型，我认为大多数科学家都是这样做的。
And when we study OCD in models or in humans with imaging, and we're trying to do it invasively with electrodes like we do in epilepsy patients, we find that areas in the cortex, like the prefrontal and orbital frontal cortex, are not functioning the way they would in a non-OCD patient.
当我们在模型或人体中通过成像研究强迫症时，我们尝试像在癫痫患者中那样用电极进行侵入性研究，我们发现皮层中的区域，如前额叶和眶额皮层，不能像非强迫症患者那样发挥作用。
They are often hyperfunctioning, such that while you might say, well, they're hyperfunctioning, so aren't these patients functioning better than a-
他们通常功能亢进，因此，虽然你可能会说，好吧，他们功能亢进，那么这些患者的功能不是比-
Andrew Huberman:
安德鲁·休伯曼：
Hyperfocused.
高度专注。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, hyperfocused.
是啊，注意力高度集中。
Exactly.
确切地。
No, I would say it's not so much an up or a down, it's more that they're just dysfunctional.
不，我想说，这与其说是上升或下降，不如说是它们功能失调。
And we need to find a way to try to restore normal function to these areas.
我们需要找到一种方法来尝试恢复这些区域的正常功能。
It's not so much directional, really.
实际上，这并不是那么有方向性。
We tend to oversimplify brain function by thinking about it with directionality too much.
我们倾向于过度简单化大脑功能，因为我们对大脑功能的思考过于具有方向性。
Unfortunately, imaging studies sometimes demonstrate activation or hypoactivation, and that's where I think these kinds of things can be misconstrued.
不幸的是，影像学研究有时会证明激活或低激活，这就是我认为这类事情可能被误解的地方。
But what I would call the cortical areas of OCD is that they're dysregulated, and we need to find a way to try to normalize their function.
但我所说的强迫症的皮质区域是失调的，我们需要找到一种方法来尝试使其功能正常化。
So the frontal lobe is huge, but areas of the frontal lobe that are a bit more basal, like the OFC or orbital frontal cortex and the prefrontal cortex, definitely consistently seem to be implicated in patients with OCD.
因此，额叶很大，但额叶的基础区域（例如 OFC 或眶额皮质和前额皮质）似乎始终与强迫症患者有关。
And then there are projections to the subcortex.
然后还有到皮层下的投射。
This is the basal ganglia, like you were saying, caudate putamen or the dorsal stratum, and these are interconnected with the ventral stratum.
这是基底神经节，就像你说的，尾壳核或背层，它们与腹层相互连接。
This is an area of the brain that I focus a lot of my energy in.
这是我集中精力的大脑区域。
This is the ventral stratum, which is not limited to, but includes the nucleus accumbens.
这是腹侧层，不限于但包括伏隔核。
This is an area of the brain that we know to be involved in gating reward-seeking behavior.
我们知道，这是大脑中参与控制寻求奖励行为的区域。
When it's perturbed, it seems to gate compulsive behavior, meaning a rat will pursue a reward despite punishment, despite a foot shock, for example, and that can be similar to an OCD patient.
当它受到干扰时，它似乎会抑制强迫行为，这意味着老鼠尽管受到惩罚，但仍会追求奖励，例如，尽管脚受到电击，这可能与强迫症患者相似。
They will check their home for safety until 3:00 AM in the morning and not sleep that night.
他们会检查家中的安全情况直到凌晨 3:00，并且当晚不睡觉。
In a way, that is similar to a rat seeking out a food reward despite a foot shock.
在某种程度上，这类似于一只老鼠在足部受到电击的情况下仍寻求食物奖励。
Doing something because of the urge, but despite the risk.
出于冲动而去做某事，但尽管有风险。
And perhaps there is some normal judgment there.
也许那里有一些正常的判断。
We all have to take risks to function in everyday society.
我们所有人都必须承担风险才能在日常社会中发挥作用。
To be successful, we have to take a risk.
为了成功，我们必须承担风险。
To take care of patients with surgery, there's some risk there.
照顾手术病人是有一定风险的。
We make a judgment call, and that's not a condition.
我们做出判断，但这不是条件。
That's just normal.
这很正常。
But when our judgment consistently puts us at risk, that's where we have something like OCD.
但是，当我们的判断持续将我们置于危险之中时，我们就会患上强迫症。
But OCD is also one of many conditions that suffer from these kinds of problems.
但强迫症也是导致此类问题的众多病症之一。
We tend to label them because they tend to present in a consistent way.
我们倾向于给它们贴上标签，因为它们往往以一致的方式呈现。
So we have patients with OCD that have hyper-checking behavior or contamination behavior where if they feel contaminated, they will wash their hands for hours repeatedly, or if they drop their toothbrush on the floor, this will lead to a compulsive behavior of cleaning a toothbrush or brushing your teeth consistently.
因此，我们有强迫症患者，他们有过度检查行为或污染行为，如果他们感到被污染，他们会反复洗手几个小时，或者如果他们把牙刷掉在地板上，这将导致持续清洁牙刷或刷牙的强迫行为。
Very common symptoms that we see or signs that patients report to us or that we observe.
我们看到的非常常见的症状或患者向我们报告或我们观察到的迹象。
But patients with eating disorders, if they have binging disorder, they'll overeat.
但患有饮食失调的患者，如果他们有暴食症，他们就会吃得过多。
If they have bulimia, they might purge despite the risk of these things.
如果他们患有贪食症，他们可能会不顾这些事情的风险而进行净化。
And so addiction is similar.
所以成瘾是相似的。
We tend to drug seek if we're addicted.
如果我们上瘾了，我们就会倾向于寻求毒品。
We'll pay off a dealer in order to get our fix despite the risk.
尽管有风险，我们还是会付钱给经销商，以便修复问题。
And that type of urge despite the risk is something that I've always been really interested in, and it's a common denominator to all of these problems.
尽管存在风险，但这种冲动是我一直非常感兴趣的事情，也是所有这些问题的共同点。
And if you think about these problems, these are some of the most common conditions in our society today.
如果你考虑一下这些问题，就会发现这些是当今社会最常见的一些情况。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I really appreciate that you're building this bridge from OCD to nucleus accumbens, which is, of course, associated with reward in various forms, and we'll get to that.
是的，我真的很感激你正在建立从强迫症到伏隔核的桥梁，这当然与各种形式的奖励相关，我们会做到这一点。
I'll share a personal anecdote as a form of question.
我将以提问的形式分享一个个人轶事。
When I was in college and studying a lot, I relied on caffeine as a stimulant.
当我在大学学习时，我依赖咖啡因作为兴奋剂。
I've never really been into drugs or alcohol.
我从来没有真正吸毒或酗酒。
I've been lucky in that sense.
从这个意义上说我很幸运。
I don't drink, and I could care less if alcohol disappeared.
我不喝酒，而且我也不在乎酒精是否消失。
Never really liked recreational drugs, so I was never drawn to them.
我从来没有真正喜欢过消遣性药物，所以我从来没有被它们吸引过。
However, when I was in college, at the time, there were these little epinephrine pills that were common in a lot of sports supplements.
然而，当我上大学的时候，当时有很多运动补充剂中常见的肾上腺素小药丸。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh.
哦。
Andrew Huberman:
安德鲁·休伯曼：
These are pre-workout type things.
这些是锻炼前类型的事情。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Not unlike energy drinks now, which I completely avoid.
与现在的能量饮料没什么不同，我完全避免喝能量饮料。
And I had this experience of taking one of these and drinking some coffee, and of course, it gave me a lift in energy.
我有过服用其中一种并喝一些咖啡的经历，当然，它让我精力充沛。
These are very similar to amphetamine.
这些与安非他明非常相似。
They were legal over-the-counter at the time.
当时它们是合法的非处方药。
They're now either banned or illegal.
现在它们要么被禁止，要么非法。
I do not recommend them.
我不推荐他们。
And I had a lot of energy, but what I noticed is that my grunting tic came back, and I made one mistake.
我精力充沛，但我注意到我的咕噜声又回来了，我犯了一个错误。
I still think of this as one mistake, which was I engaged in a superstitious behavior.
我至今仍认为这是一个错误，是我的一种迷信行为。
I knocked on wood, and then somehow it felt very rewarding.
我敲了敲木头，然后不知何故感觉非常有成就感。
It gave me some totally irrational, but internally rational sense of security around-- I forget what I was knocking on wood about.
它给了我一种完全非理性但内在理性的安全感——我忘记了我在敲木头的目的。
And I found that I couldn't break that knock on wood compulsion.
我发现我无法打破敲木头的冲动。
I felt I needed to knock on wood.
我觉得我需要敲木头。
And so then I started sneaking knock on woods in mid-exam and studying, and pretty soon, I was knocking on wood often.
于是我开始在考试和学习中偷偷敲木头，很快，我就经常敲木头了。
I developed a superstition.
我产生了迷信。
And so I'm curious about the role of superstition and compulsion and the crossover there.
所以我很好奇迷信和强迫的作用以及它们之间的交叉。
It makes sense logically to me, but I was equally shocked to learn that when I stopped taking this stimulant, which I was quite happy to stop because it did make me feel too alert, couldn't sleep well, et cetera, that the superstition went away as well.
这对我来说在逻辑上是有道理的，但我同样震惊地发现，当我停止服用这种兴奋剂时，我很高兴停止服用这种兴奋剂，因为它确实让我感觉太警觉，睡不好等等，迷信也消失了。
And I'm guessing this has something to do with some of the reward circuitry, as it's called, related to stimulants.
我猜这与某些奖励回路有关，正如所谓的，与兴奋剂有关。
Again, I am not encouraging anyone to take stimulants, although healthy use of caffeine or safe use of caffeine might be the one universally accepted stimulant.
再次强调，我并不鼓励任何人服用兴奋剂，尽管健康使用咖啡因或安全使用咖啡因可能是一种普遍接受的兴奋剂。
It was really surprising to me how quickly this came on, how quickly it engaged my thinking and my behavior, the obsessions and the compulsions, and how quickly it turned off when I stopped taking this sports stimulant or whatever it was.
令我惊讶的是，这种情况发生得如此之快，它如此之快地吸引了我的思维和行为，困扰和强迫，以及当我停止服用这种运动兴奋剂或其他什么东西时，它又如此迅速地消失了。
I don't even remember.
我什至不记得了。
I think it was some form of epinephrine.
我认为这是某种形式的肾上腺素。
Ephedrine.
麻黄碱。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
It's not epinephrine.
这不是肾上腺素。
Excuse me.
打扰一下。
I misspoke.
我说错了。
Ephedrine.
麻黄碱。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
Does what I described sound totally outside the bounds of logic?
我所描述的听起来完全超出逻辑范围吗？
Or am I imagining it all?
还是这一切都是我的想象？
Dr. Casey Halpern:
凯西·哈尔彭博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
It did happen.
它确实发生了。
I'm certain it happened.
我确信它发生了。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
No, I don't think you're imagining it at all.
不，我认为你根本没有想象到这一点。
The grunting that you mentioned to me, first of all, I didn't comment, but not to put a label on it, but it sounds like a tic.
你跟我提到的咕噜声，首先我没有评论，但也不是想给它贴上标签，但听起来像是抽搐。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And tics in young males, extremely common.
而抽动症在年轻男性中极为常见。
And they do tend to go away as-
他们确实倾向于消失——
Andrew Huberman:
安德鲁·休伯曼：
Blinking tics like this?
像这样眨眼抽搐？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
I have a good friend who, actually a famous neuroscientist, I won't mention who it is, who's worked very hard to suppress his blinking tic.
我有一个好朋友，实际上是一位著名的神经科学家，我就不提他是谁了，他非常努力地抑制眨眼的抽动。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And when he gets fatigued, it comes back.
当他感到疲劳时，它就会回来。
And he's very high functioning-
而且他的机能非常高-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
in his personal life and his professional life.
在他的个人生活和职业生活中。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But when you're talking to him and he starts doing this, you start wondering-
但是当你和他说话并且他开始这样做时，你开始想知道-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
what's going on?
发生什么事了？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
No.
不。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And it's unfortunate.
这很不幸。
People with these problems, especially as they get more severe, then you get Tourette syndrome.
患有这些问题的人，尤其是当他们变得更严重时，就会患上图雷特综合症。
It's hard to function in our society.
在我们的社会中发挥作用是很困难的。
I have some friends that have Tourette, and I'll tell you, I'm just so inspired because they're so confident and people obviously notice these problems, but they just live their life, and they're very successful, and that's not typical.
我有一些患有抽动秽语症的朋友，我会告诉你，我很受启发，因为他们非常自信，人们显然注意到了这些问题，但他们只是过着自己的生活，而且非常成功，这并不典型。
I have friends that I went to Penn with undergrad that had these kinds of problems, and I was always just so happy and inspired by them.
我有一些朋友，我和本科生一起去宾夕法尼亚大学，遇到了这些问题，我总是很高兴，并受到他们的启发。
But what's more typical is these problems cause people to lose their confidence and not pursue their profession as they may have done, or things of that nature.
但更典型的是，这些问题导致人们失去信心，不再像以前那样从事自己的职业，或者类似的事情。
So I I think it's all related to the fact that our brains are very vulnerable.
所以我认为这都与我们的大脑非常脆弱这一事实有关。
And to get back to your question about the stimulant, I think your brain was very vulnerable to it.
回到你关于兴奋剂的问题，我认为你的大脑很容易受到它的影响。
You sort of may have had a predisposition to it.
你可能有这样的倾向。
You mentioned that you're a little obsessive, and with the tic there, maybe you have this kind of, on the mild side of the spectrum, OCD.
你提到你有点强迫症，而且有抽动症，也许你有这种轻微的强迫症。
And I probably do as well, by the way.
顺便说一句，我可能也是这么做的。
So I also have avoided drugs for that reason in my life.
因此，我在生活中也因此避免吸毒。
I'll drink a little bit of wine here and there, but that's about it.
我会时不时地喝一点酒，但仅此而已。
But I think most people don't avoid these things, and we see these problems in relation to not just taking a stimulant, but any kind of environmental exposure.
但我认为大多数人不会避免这些事情，我们看到这些问题不仅与服用兴奋剂有关，还与任何类型的环境暴露有关。
Our own society causes so much stress, and that's why I think we have these human conditions.
我们自己的社会造成了如此大的压力，这就是为什么我认为我们有这些人类状况。
These are human conditions.
这些都是人类的状况。
We try to model them in animals, but most animals don't have these kinds of problems.
我们尝试在动物身上建立模型，但大多数动物没有这些问题。
I've heard that an animal, like a monkey in the wild, can have depression, a monkey's version of depression.
我听说动物，比如野外的猴子，可能会患有抑郁症，这是猴子版本的抑郁症。
But I don't think it's really typical or human depression.
但我不认为这真的是典型的或人类的抑郁症。
And certainly, it's not as prevalent as depression is in our human society.
当然，它在我们人类社会中并不像抑郁症那么普遍。
I think we haven't evolved to manage the stresses that are in this society that we currently have, and stimulants is probably one of them.
我认为我们还没有进化到能够应对当前社会所面临的压力，兴奋剂可能就是其中之一。
And I suspect you are probably a little bit vulnerable.
我怀疑你可能有点脆弱。
It's possible the stimulant led to an overdrive of your prefrontal and orbitofrontal cortex and even brought out a little OCD behavior related to this superstition that you had.
兴奋剂可能会导致你的前额叶和眶额皮层过度兴奋，甚至引发一些与你的迷信相关的强迫症行为。
So, no, I believe that entirely, and I also think that's why things like OCD and other kinds of psychiatric disorders tend to present themselves in college when people leave their home, and they're in school, and they're stressed, and they're getting exposed to things that they haven't been exposed to before outside of the home.
所以，不，我完全相信这一点，而且我也认为这就是为什么当人们离开家时，像强迫症和其他精神疾病这样的事情往往会在大学里出现，他们在学校，他们有压力，他们接触到他们以前在家庭之外没有接触过的东西。
And their brains aren't evolved and sophisticated enough yet to help them cope with these kinds of stresses, and how it manifests is in these kinds of conditions.
他们的大脑还没有进化和成熟到足以帮助他们应对这些类型的压力，以及在这些情况下压力的表现方式。
And I don't want to put a label on those conditions, but certainly it could be a psychiatric disorder, but it could also just be lots of anxiety.
我不想给这些情况贴上标签，但它肯定可能是一种精神疾病，但也可能只是很多焦虑。
It could also be the kind of problems that you had as well.
这也可能是您也遇到的问题。
And I think the nucleus accumbens and the cortical areas that we've been discussing that sort of send projections to these areas are probably at least one of the main circuits involved in these kinds of things.
我认为我们一直在讨论的伏隔核和皮质区域向这些区域发送投射可能至少是涉及此类事物的主要回路之一。
Andrew Huberman:
安德鲁·休伯曼：
I'm relieved it's no longer present, but I confess, I always feel it close by.
我很庆幸它不再存在，但我承认，我总是感觉它就在附近。
A long run helps.
长跑有帮助。
So being slightly fatigued, not overly fatigued, but slightly fatigued-
所以有点累，不是过度疲劳，而是轻微疲劳——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh, yeah
哦，是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
seems to move out the kind of physical compulsion.
似乎搬出了那种肉体上的强迫。
But tried to channel it.
但试图引导它。
Never taken any medication for it, and here I am.
从未服用过任何药物，而我就在这里。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Still going.
还在继续。
I may call you for a referral at some point, but-
我可能会在某个时候打电话给你寻求推荐，但是-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure
当然可以
Andrew Huberman:
安德鲁·休伯曼：
...
...
at this point, I'm feeling okay.
此时，我感觉还好。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Let's talk about nucleus accumbens and reward circuitry and the relationship between OCD, reward, addiction.
我们来谈谈伏隔核和奖赏回路，以及强迫症、奖赏、成瘾之间的关系。
And to just give you a sense of where I'm headed with this is into the realm of food-related and eating-related behaviors and disorders.
为了让你们了解我的研究方向，我将进入与食物相关和与饮食相关的行为和疾病领域。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Because I know you're doing some very important work there.
因为我知道你正在那里做一些非常重要的工作。
What is nucleus accumbens?
什么是伏隔核？
I know we all have one.
我知道我们都有一个。
We have or two.
我们有一两个。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
One on each side of the brain.
大脑两侧各一个。
What is it?
它是什么？
What roles does it play in healthy brain behavior and in pathology?
它在健康的大脑行为和病理学中发挥什么作用？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
The nucleus accumbens is a part of the brain, part of our reward circuits, the hub of the reward circuits that I've always been most fascinated in.
伏隔核是大脑的一部分，是我们奖励回路的一部分，是我一直最着迷的奖励回路的枢纽。
There are scientists around the world, arguably some of the leading scientists in the world, the father of addiction neuroscience, I call him, although he tells me I'm nuts, Rob Malenka, who has studied the nucleus accumbens since the beginning of his career and who I worked with when I was at Stanford.
世界各地都有科学家，可以说是世界上一些领先的科学家，我称他为成瘾神经科学之父，尽管他告诉我我疯了，罗布·马伦卡（Rob Malenka），他从职业生涯开始就研究伏隔核，我在斯坦福大学时与他一起工作。
Fabulous scientist and mentor.
杰出的科学家和导师。
Taught me so much.
教会了我很多。
Taught the world so much.
教会了世界很多东西。
Andrew Huberman:
安德鲁·休伯曼：
Incredible-
难以置信——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
person, scientist, and physician as well.
个人、科学家和医生。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
MD, PhD, and brilliant in both ways.
医学博士、博士，在这两个方面都很出色。
And very fatherly in a lot of way in terms of teaching people how to do science and be good citizens as well.
在教导人们如何做科学和如何成为好公民方面，他在很多方面都非常慈父般。
But the nucleus accumbens is an area that is also very complicated because it has a lot of functions.
但伏隔核也是一个非常复杂的区域，因为它有很多功能。
It interconnects with many parts of the brain.
它与大脑的许多部分相互连接。
But there are some things about the nucleus accumbens that are very consistent.
但伏隔核有一些事情是非常一致的。
So when I started getting interested in reward and what I could do as a surgeon to try to improve how we manage rewards, and what I mean by that specifically is if you have an urge for a reward, that's a normal phenomenon.
因此，当我开始对奖励以及作为一名外科医生我可以做些什么来尝试改善我们管理奖励的方式感兴趣时，我的具体意思是，如果你有对奖励的渴望，那是一种正常现象。
That's not something we're trying to stop.
这不是我们想要阻止的事情。
The issue is if you have an urge for a reward that either puts you or somebody else at risk, it's probably a reward we shouldn't have.
问题是，如果你急于获得某种奖励，而这会让你或其他人面临风险，那么这可能是我们不应该获得的奖励。
I suppose you could say, well, it depends on the size of the reward and the size of the risk and how that fits into your societal norms.
我想你可能会说，这取决于回报的大小和风险的大小，以及它们如何符合你的社会规范。
But for example, if you're obese and you have a doctor who is advising that you lose weight and try to control your eating habits, perhaps better food choices is an important way for you to be healthier.
但举例来说，如果您肥胖，并且医生建议您减肥并尝试控制饮食习惯，那么也许更好的食物选择是让您变得更健康的重要途径。
And not pursuing those better food choices, that's an urge that we probably need to treat.
而不是追求更好的食物选择，这是我们可能需要应对的一种冲动。
If you're a drug addict and you use heroin or opiate, considering the opiate crisis right now, or cocaine, which is untreatable at the moment, that cocaine might make you feel like you have some more energy that day to deal with your work, or that opiate might make you feel better because life is stressful.
如果你是一名吸毒者，考虑到目前的阿片危机，你使用海洛因或阿片制剂，或者使用目前无法治疗的可卡因，那么可卡因可能会让你感觉当天有更多的精力来处理工作，或者阿片制剂可能会让你感觉更好，因为生活压力很大。
But the risk of doing those things is really high.
但做这些事情的风险确实很高。
In fact, potentially lethal.
事实上，可能致命。
So that's an urge that's treatable.
所以这是一种可以治疗的冲动。
If you have OCD and you Can't sleep at night because you're so nervous that you didn't lock the door and you checked 30 times.
如果你有强迫症，你晚上睡不着觉，因为你太紧张了，你没有锁门，你检查了30次。
That's a reality for some people with severe OCD.
对于一些患有严重强迫症的人来说，这是现实。
That's an urge we got to treat.
这是我们必须应对的冲动。
Eating disorders, the same.
饮食失调，同样如此。
Eating disorders and obesity are obviously linked because of the relationship of a patient with food, but they're also quite distinct.
由于患者与食物的关系，饮食失调和肥胖显然有联系，但它们也截然不同。
Not everybody with obesity has an eating disorder, and obviously not everybody with an eating disorder has obesity.
并非每个肥胖症患者都患有饮食失调症，显然也不是每个患有饮食失调症的人都患有肥胖症。
I'm particularly interested in patients that have binge eating disorder as well as obesity because they're so heavily linked.
我对患有暴食症和肥胖症的患者特别感兴趣，因为它们之间的联系非常紧密。
Not everybody with binge eating disorder has obesity, but on average, most are overweight.
并非所有暴食症患者都患有肥胖症，但平均而言，大多数人都超重。
We are doing a deep brain stimulation trial at Penn where we're trying to modulate the nucleus accumbens and understand it better in patients that have failed gastric bypass surgery, the most aggressive form of treatment for obesity.
我们正在宾夕法尼亚大学进行一项深部脑刺激试验，试图调节伏隔核，并更好地了解胃绕道手术失败的患者的情况，胃绕道手术是治疗肥胖症最积极的治疗方式。
And we believe they failed gastric bypass surgery because of binge eating disorder, meaning they just can't control how much they eat.
我们相信他们的胃绕道手术失败是因为暴食症，这意味着他们无法控制自己的饮食量。
So their obesity is either related or even due to overeating, not some predisposition to that body habitus.
因此，他们的肥胖要么与暴饮暴食有关，甚至是由于暴饮暴食，而不是某种身体习惯的倾向。
Obesity is a phenotype, something that we can see.
肥胖是一种表型，是我们可以看到的。
Not everybody is obese because of the same thing.
并不是每个人都因为同样的原因而肥胖。
So it's very important.
所以这非常重要。
I was taught this by a close mentor and friend, Tom Wadden, when he was the director of the Obesity Center at Penn, or the Center for Weight and Eating Disorders.
我的一位亲密导师兼朋友汤姆·瓦登（Tom Wadden）教导了我这一点，当时他是宾夕法尼亚大学肥胖中心（即体重和饮食失调中心）的主任。
And he said to me, "You know, Casey, be careful with obesity.
他对我说：“你知道，凯西，要小心肥胖。
You're interested in addiction, and I understand you're interested in the addictive tendencies of certain patients with obesity and their relationship with food, but not everybody with obesity has that problem." And in fact, it's probably present in about 20% of patients with obesity.
你对成瘾感兴趣，我知道你对某些肥胖患者的成瘾倾向及其与食物的关系感兴趣，但并不是每个肥胖患者都有这个问题。”事实上，大约 20% 的肥胖患者可能存在这种情况。
But now taking a step back, 20% of patients with obesity is still a massive problem of epidemic proportions.
但现在退一步来说，20%的肥胖患者仍然是一个大范围的流行病。
And perhaps some of these patients have either some form of binge eating disorder, or I should say some degree of binge eating disorder, or at least loss of control eating, which is common to both.
也许其中一些患者患有某种形式的暴食症，或者我应该说是某种程度的暴食症，或者至少是饮食失控，这对两者来说都是常见的。
So that's a feature that I think eating disorder experts, obesity experts, neurosurgeons, obesity medicine experts would agree is common to eating disorders and obesity.
因此，我认为饮食失调专家、肥胖专家、神经外科医生、肥胖医学专家都认为这是饮食失调和肥胖症的共同特征。
And I also believe is common to addicts, and perhaps patients with OCD, is sort of a loss of control disorder.
我还认为，对于成瘾者（也许还有强迫症患者）来说，这是一种失控障碍。
It's actually not a disorder known by the DSM-5, some diagnostic manual, but a feature, I should say, of these conditions that's common.
它实际上不是 DSM-5（某些诊断手册）中已知的疾病，而是这些常见病症的一个特征。
And that common denominator, I believe, can be restored, or at least this problem can be ameliorated or improved upon by a better understanding and a tailored treatment to the nucleus accumbens specifically.
我相信，这个共同点是可以恢复的，或者至少可以通过更好地理解和针对伏核进行量身定制的治疗来改善或改善这个问题。
We have learned in mice that if you expose a mouse, now this is just a model, if you expose a mouse to high-fat food, not food that they would normally eat, food that is 60% fat, high fat, it's like butter.
我们在老鼠身上了解到，如果你让一只老鼠接触，现在这只是一个模型，如果你让一只老鼠接触高脂肪食物，而不是它们通常吃的食物，60%脂肪的食物，高脂肪，就像黄油一样。
We've learned that if you expose them to food like that, within two weeks, their nucleus accumbens is not functioning like a mouse that was never exposed to that high-fat food.
我们了解到，如果让它们接触这样的食物，两周之内，它们的伏核就无法像从未接触过这种高脂肪食物的老鼠一样发挥作用。
There's aspects of it that are hyperactive, I could say, and there's aspects of it that are hypoactive or decreased activity.
我可以说，它的某些方面是过度活跃的，而它的某些方面是不活跃或活动减少的。
But either way, it's not functioning properly.
但无论哪种方式，它都无法正常运行。
And most likely that function is predisposing continued behavior and then probably eventually leads to things like a habit that gets developed.
最有可能的是，这种功能会引发持续的行为，然后可能最终导致诸如养成习惯之类的事情。
And that's a whole other area of these kinds of problems that is very complicated and poorly understood.
这是此类问题的另一个领域，非常复杂且知之甚少。
But in any case, if we just focus on the behavior at hand, it seems that repeated exposure to something like high-fat food, a drug of abuse, or any type of reward that is a really strong reward, in a way, it can hijack normal functioning of the nucleus accumbens.
但无论如何，如果我们只关注手头的行为，似乎反复接触高脂肪食物、滥用药物或任何类型的真正强烈奖励的奖励，在某种程度上，它可以劫持伏隔核的正常功能。
So the goal of our invasive trial is to try to restore normal functioning to that nucleus accumbens.
因此，我们侵入性试验的目标是尝试恢复伏隔核的正常功能。
In mice, there seems to be a signal that predicts when they're going to lose control, and we can use that signal to deliver a sort of a real-time therapy in the form of deep brain stimulation, just a brief amount of stimulation.
在老鼠身上，似乎有一个信号可以预测它们何时会失去控制，我们可以利用该信号以深部脑刺激的形式提供一种实时治疗，只是短暂的刺激。
And that actually blocks the behavior.
这实际上阻止了这种行为。
And what's interesting is over time, that signal actually decreases in frequency, which suggests some level of restoring normal function to that circuit in a mouse, and we're trying to do that now in a human trial.
有趣的是，随着时间的推移，该信号的频率实际上会降低，这表明小鼠的该电路在一定程度上恢复了正常功能，我们现在正试图在人体试验中做到这一点。
Andrew Huberman:
安德鲁·休伯曼：
Fascinating.
令人着迷。
Where is the stimulation provided?
刺激在哪里提供？
Because I would imagine that if one were to stimulate nucleus accumbens, you would see a reinforcement of whatever behavior coincided or preceded the stimulation.
因为我想象，如果一个人要刺激伏隔核，你会看到刺激同时或之前的任何行为都会得到强化。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So the stimulation, it's a brief delivery of stimulation, anywhere between five and 10 seconds, that is intended to just disrupt the perturbed signaling that's happening in the nucleus accumbens.
因此，刺激是一种短暂的刺激，时间在 5 到 10 秒之间，旨在破坏伏隔核中发生的扰动信号。
There are disorders like depression, let's say, that I would describe as a bit more of a state disorder.
有些疾病，比如抑郁症，我将其描述为一种状态障碍。
And this is obviously oversimplified because we know that there's fluctuations in mood and depression as well, so don't let me oversimplify it too much.
这显然过于简单化了，因为我们知道情绪和抑郁也有波动，所以不要让我把它过于简单化。
But for now, let's forgive the oversimplification.
但现在，让我们原谅这种过于简单化的说法。
If we accept that depression is a state disorder, or maybe Parkinson's disease is a state disorder, recognizing that they do fluctuate.
如果我们接受抑郁症是一种状态障碍，或者帕金森病是一种状态障碍，并认识到它们确实存在波动。
These types of problems most likely, but not definitely, most likely need a continuous therapy of some form, a therapy that's consistent.
这些类型的问题很可能（但并非绝对）最有可能需要某种形式的连续治疗，即一致的治疗。
Perhaps a therapy that fluctuates with the condition, but nevertheless still consistent.
也许治疗会随着病情而波动，但仍然一致。
Binge eating disorder or OCD or addiction, and binging disorder in the context of obesity.
暴食症或强迫症或成瘾，以及肥胖背景下的暴食症。
A lot of these patients are functioning quite normally every single day.
其中许多患者每天的功能都非常正常。
It's just that intermittently throughout the day, there's brief interruptions in their normal function such that they have thoughts about food or the drug of abuse that they're really longing to have.
只是在一天中间歇性地，他们的正常功能会出现短暂的中断，这样他们就会想到他们真正渴望的食物或滥用药物。
And so we want to deliver an episodic therapy delivered at the right time, and only at the right time, to try to interrupt the circuit aberration or the problem at hand that is going to lead to that dangerous behavior, and to kind of get the patient back on track to what they're doing.
因此，我们希望在正确的时间，并且仅在正确的时间，提供间歇性治疗，以尝试中断电路失常或手头将导致危险行为的问题，并让患者回到他们正在做的事情的正轨。
I don't necessarily think that it leads to a reinforcement.
我并不一定认为这会导致强化。
It's possible.
这是有可能的。
We have to study that more.
我们必须更多地研究这一点。
But rather, the goal is to just disrupt perhaps what is kind of habitual, or at least this kind of recurring problem that is happening.
相反，我们的目标可能只是打破某种习惯，或者至少打破这种正在发生的反复出现的问题。
People that have binge eating disorder, at least at a severe level, they tend to binge about once a day.
患有暴食症的人，至少在严重程度下，他们往往每天暴食一次。
But they don't binge all day long, of course.
但当然，他们不会整天暴饮暴食。
They have a moment, perhaps when they get home from work and they're stressed, where they might have a bout of binge.
他们有一段时间，也许是当他们下班回家，感到压力很大时，他们可能会暴饮暴食。
Andrew Huberman:
安德鲁·休伯曼：
What constitutes a binge?
什么构成暴饮暴食？
And I also want to know, does binge eating disorder come on suddenly, meaning as an entire disorder?
我还想知道，暴食症是否突然出现，即作为一种整体疾病？
One day people wake up, suddenly they have binge eating disorder, or is this a few too many buffets?
有一天，人们一觉醒来，突然暴食症，还是自助餐吃太多了？
And I'm being entirely serious here, kind of unlimited food-
我是认真的，无限量的食物-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and a circuit gets flipped or kind of starts moving into the high RPMs, so to speak.
可以这么说，电路发生翻转或者开始进入高转速。
So how does it come on?
那么它是怎么发生的呢？
And I'm actually surprised to hear that it's once a day.
听说每天一次，我真的很惊讶。
I would think, just hearing binge eating disorder, I assumed it's like OCD, which it probably fluctuates across the day as well.
我想，只要听到暴食症，我就认为它就像强迫症一样，它也可能在一天中波动。
But I would've thought any time people are around food, they just simply can't control their intake of food.
但我认为任何时候人们在食物周围，他们就是无法控制食物的摄入量。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So what does this look like in terms of the onset of the disorder, and then what do you think underlies this once-a-day type of phenomena?
那么，从疾病的发作来看，这是什么样的？那么您认为这种每天一次的现象背后的原因是什么？
That's pretty interesting.
这很有趣。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
So severe binge eating disorder, these patients will binge about once a day.
如此严重的暴食症，这些患者每天大约会暴食一次。
It could be a couple times a day, but in general, it's not more than that.
一天可能有几次，但一般不会超过这个次数。
Moderate is about three to four times a week, for example.
例如，适度是每周大约三到四次。
The reason I think that that seems surprising to you, and if you think about it, it is surprising, and I agree with you, but the reason for that is actually just in the definitions of the word.
我认为这对你来说似乎很令人惊讶，如果你仔细想想，这很令人惊讶，我同意你的观点，但其原因实际上只是在这个词的定义中。
And as a neurosurgeon, in full disclosure, as I mentioned, I don't see these patients clinically.
作为一名神经外科医生，正如我所提到的，我完全公开地说，我在临床上没有看到这些患者。
I see them for research trial purposes, and I try to understand the literature around eating disorders, and I obviously collaborate with fabulous eating disorders in these problems that are highly innovative people.
我看到它们是出于研究试验的目的，我尝试了解有关饮食失调的文献，而且我显然与高度创新的人在这些问题上与神话般的饮食失调进行了合作。
But the word binge, there's a definition to that word.
但是“狂欢”这个词，是有一个定义的。
And you can't necessarily binge all day because our stomachs are not big enough.
而且你不一定能整天暴饮暴食，因为我们的胃不够大。
And so there's a limit to how much one can eat.
所以一个人吃多少是有限制的。
And to meet criteria for a binge, you have to have a sense of loss of control.
为了满足暴饮暴食的标准，你必须有一种失控的感觉。
You have to eat an enormous amount of food in a brief period of time.
你必须在短时间内吃掉大量的食物。
And yes, generally, that doesn't happen more than about once a day in a patient with severe binge eating disorder.
是的，一般来说，对于患有严重暴食症的患者来说，这种情况每天发生的次数不会超过一次。
However, they can lose control quite often, and in fact, perhaps even at every meal, they might meet criteria for a bout of loss of control where they, yes, they may have lost control, but they might not have eaten enough to constitute what we would define as a binge.
然而，他们经常会失去控制，事实上，也许甚至在每顿饭上，他们都可能符合一次失去控制的标准，是的，他们可能失去了控制，但他们可能吃得不够多，不足以构成我们定义的暴饮暴食。
There's no specific number to that, by the way.
顺便说一句，没有具体数字。
It's really just compared to their normal meal, perhaps it's 50% of their daily calories in that one brief moment.
这实际上只是与他们的正常膳食相比，也许在那一瞬间消耗了他们每日卡路里的 50%。
So that's why I think it seems surprising that binges aren't happening more often than that.
这就是为什么我认为暴饮暴食并没有比这更频繁地发生似乎令人惊讶。
What I would say is if we replace the term binge with loss of control eating, loss of control eating could happen dozens of times a week.
我想说的是，如果我们用“失控饮食”代替“暴饮暴食”这个词，那么“失控饮食”可能每周会发生几十次。
And in fact, in the patients that we're studying, we've seen patients that lose control 20, 30 times a week.
事实上，在我们正在研究的患者中，我们发现患者每周会失控 20 到 30 次。
And that's probably the term you have in mind when you say you're surprised that it's just one time a day.
当你说你对一天只有一次感到惊讶时，你脑海中可能会想到这个词。
And it's specifically related to the fact that these patients have to eat such a large amount of food in such a brief period of time.
这与这些患者必须在如此短的时间内吃下如此大量的食物有关。
So it's hard to do that more than once a day.
所以每天很难做到超过一次。
Andrew Huberman:
安德鲁·休伯曼：
I see.
我明白了。
You mentioned that some preexisting anxiety might bias somebody to have a binge.
你提到一些预先存在的焦虑可能会导致某人暴饮暴食。
I'm also fascinated by something I've observed before, which was when I was in college, my girlfriend had a roommate who we were aware was bulimic-
我也对我以前观察到的一些事情很着迷，那是在我上大学的时候，我女朋友有一个室友，我们知道他患有贪食症——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
and would binge and then purge.
并且会暴饮暴食然后清除。
And often, when she ingested alcohol, that would lead to a binge.
通常，当她饮酒时，会导致暴饮暴食。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
Which is kind of the opposite of anxiety when I think about alcohol as something that slightly reduces prefrontal activity, somewhat of a sedative, or certainly a sedative at higher dosages.
当我认为酒精会稍微降低前额叶活动，某种程度上是镇静剂，或者肯定是高剂量的镇静剂时，这与焦虑正好相反。
So this brings me to something that you said, I won't say it as eloquently as you did, that it seems like it's neither the case that anxiety leads to binging, nor that hypo reduced activation of the forebrain and lower anxiety leads to binging.
因此，这让我想到了你所说的，我不会像你那样雄辩地说，似乎既不是焦虑导致暴饮暴食，也不是前脑激活不足和较低的焦虑导致暴饮暴食。
It's this dysregulation of circuitry-
这是电路的失调-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
that the seesaw could go either way and it can throw things off, but it's off balance in both cases.
跷跷板可以朝任何一个方向移动，也可以把东西扔掉，但在这两种情况下它都会失去平衡。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And that seems to pose a problem.
这似乎带来了一个问题。
It seems like it's a particularly tricky problem, and kind of explains to me in my non-clinical awareness why medication might be really hard to use as a way to treat this, but that being able to poke around in the brain and assay in real time, "How do you feel?
这似乎是一个特别棘手的问题，在我的非临床意识中向我解释了为什么药物可能真的很难用来治疗这个问题，但能够在大脑中进行实时分析，“你感觉怎么样？
Do you feel like binging now, or do you feel further from the binge impulse?" Is that what you do with these patients?
你现在想暴饮暴食吗，还是感觉远离暴饮暴食的冲动？”你们就是这么对待这些病人的吗？
Are they awake while you're stimulating the brain?
当你刺激大脑时他们醒着吗？
Because it's one thing to say, "I stimulate a brain area and that binging goes away," or partial relief or complete relief, but how do you know?
因为说“我刺激大脑某个区域，暴饮暴食就消失了”、部分缓解或完全缓解是一回事，但你怎么知道呢？
Are they in there with a donut?
他们里面有甜甜圈吗？
And you're tempting them?
而你却在诱惑他们？
So how do you actually know if ablating a brain area is going to lead to relief or exacerbation or no impact on this disorder?
那么，你如何真正知道消融大脑区域是否会导致这种疾病的缓解、恶化或没有影响呢？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
So there's a lot to unpack there.
所以那里有很多东西需要解压。
I'll try to go one step at a time.
我会尝试一步一步地走下去。
And if I miss something, please remind me.
如果我错过了什么，请提醒我。
Andrew Huberman:
安德鲁·休伯曼：
No, and I tend to ask these three-part questions-
不，我倾向于问这些由三部分组成的问题-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
specifically of neurosurgeons because I like to challenge you guys.
特别是神经外科医生，因为我喜欢挑战你们。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Because again, you are the astronauts of neuroscience.
因为，你们是神经科学的宇航员。
Also, I'm just going to take a moment to poke at neurosurgeons-
另外，我只是想花点时间谈谈神经外科医生——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh, here we go
哦，我们开始吧
Andrew Huberman:
安德鲁·休伯曼：
...
...
because I have a couple close friends who are neurosurgeons, and I consider Casey a friend.
因为我有几个亲密的朋友，他们是神经外科医生，我认为凯西是朋友。
I don't know if he considers me a friend, but-
我不知道他是否把我当朋友，但是——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Of course
当然
Andrew Huberman:
安德鲁·休伯曼：
...
...
I consider him a friend.
我把他当作朋友。
I'm teasing there, too.
我也在那边吐槽
Which is, first of all, they all have incredible hands, right?
首先，他们都有一双令人难以置信的双手，对吧？
They all guard their hands with the kind of protection that you would guard the most important tools of your trade.
他们都像保护自己行业中最重要的工具一样保护自己的双手。
So they're very careful with their hands.
所以他们对自己的手非常小心。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Because-
因为——
Andrew Huberman:
安德鲁·休伯曼：
You're not going to see them doing heavy deadlifts.
你不会看到他们做大重量硬拉。
You're not, because of the way that impacts the-
你不是，因为它影响-
Dr. Casey Halpern:
凯西·哈尔彭博士：
That's exactly correct
这是完全正确的
Andrew Huberman:
安德鲁·休伯曼：
...
...
motor neurons.
运动神经元。
It's all about fine control.
这一切都与精细控制有关。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So if your neurosurgeon does heavy deadlifts, you might want to consider getting a different neurosurgeon.
因此，如果您的神经外科医生进行大重量硬拉，您可能需要考虑换一位神经外科医生。
I hope I didn't put anyone out of work there.
我希望我没有让任何人失业。
And then the other thing is that you all tend to be very calm people, at least on the exterior.
另一件事是，你们都往往是非常冷静的人，至少在外表上是这样。
We'll return to this later.
我们稍后再讨论这一点。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Okay.
好的。
Andrew Huberman:
安德鲁·休伯曼：
But I do throw three or four questions out at once.
但我确实会同时抛出三四个问题。
So elevated autonomic arousal and alertness-
因此自主神经的唤醒和警觉性提高了-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
as well as decreased autonomic arousal and alertness both seem to be able to lead to binging.
以及自主神经兴奋度和警觉性的降低似乎都会导致暴饮暴食。
And then there's this question of how do you know whether or not to stimulate or to ablate or whether or not to leave a structure alone?
接下来的问题是，你如何知道是否要刺激或消融，或者是否要留下一个结构？
In other words, what does one of these experiments look like in the laboratory?
换句话说，这些实验在实验室中是什么样子的？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Sort of a-
有点像-
Andrew Huberman:
安德鲁·休伯曼：
Clinic, excuse me.
诊所，对不起。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, of course.
是的，当然。
These are questions I think about all the time.
这些是我一直在思考的问题。
I do want to come back to the deadlifting comment.
我确实想回到硬举评论上来。
And you referred to this earlier as well, and I don't know if I addressed it sufficiently either, is what comes first here?
您之前也提到过这一点，我也不知道我是否充分解决了这个问题，这里首先考虑的是什么呢？
Or how does this develop?
或者说这是如何发展的？
I think, first of all, I like to understand these kinds of problems in the construct of what I consider to be a bit of a two-hit hypothesis.
我认为，首先，我喜欢在我认为有点二次打击假设的构造中理解这类问题。
So you need, like in the concussion literature, the second hit can be devastating.
所以你需要像脑震荡文献中那样，第二次打击可能是毁灭性的。
So if you have a concussion, you want to only return to play when your symptoms are gone and cleared by a physician.
因此，如果您患有脑震荡，只有在您的症状消失并被医生治愈后才可以重返赛场。
So in the context of eating disorders, or let's say binge eating disorder, now first of all, I didn't mention it earlier, but this is the most common eating disorder.
因此，在饮食失调的背景下，或者说暴食症，现在首先，我之前没有提到它，但这是最常见的饮食失调。
Affects anywhere between 3% and 5% of the population.
影响 3% 到 5% 的人口。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And it's probably under-diagnosed in obesity, by the way.
顺便说一句，肥胖症的诊断可能不足。
And if obesity affects 35% of our population, most likely binge eating disorder affects more than 3% to 5%.
如果肥胖影响了 35% 的人口，那么暴食症很可能影响超过 3% 至 5%。
But that's the current literature estimate on the prevalence.
但这是目前文献对患病率的估计。
So, how do we develop binge eating disorder, and is it related to this anxiety question?
那么，我们是如何患上暴食症的，它与这个焦虑问题有关吗？
I think that there is a predisposition.
我认为有一种倾向。
That's the first hit.
这是第一击。
I actually think all humans have this predisposition, just some have it more than others.
我实际上认为所有人类都有这种倾向，只是有些人比其他人更具有这种倾向。
I don't think that we've evolved to live in a society where foods are so readily available and enormously delicious and have so much sugar and fat in them.
我不认为我们已经进化到生活在这样一个社会：食物如此容易获得、非常美味，而且含有如此多的糖和脂肪。
Not that there's any particular problem with either of these macronutrients.
这并不是说这些常量营养素有什么特别的问题。
It's just the excess of it and how they're refined that I think is the problem.
我认为问题在于它的过量以及它们的提炼方式。
There's high fructose corn syrup in almost everything we eat.
我们吃的几乎所有食物中都含有高果糖玉米糖浆。
It's in bread.
是在面包里的
I don't even know why it's in bread sometimes.
有时我什至不知道为什么它会出现在面包里。
It's just kind of crazy.
这有点疯狂。
So, I don't think we're evolved to live in a society that has food that's so readily available like that.
所以，我不认为我们进化到可以生活在一个如此容易获得食物的社会中。
And cheap, by the way.
顺便说一句，而且便宜。
In fact, the cheaper the foods are sort of the more refined and palatable and, I would argue, dangerous to eat.
事实上，越便宜的食物就越精致、越美味，但我认为，吃起来也很危险。
I think they change our reward circuits for the worse and put us at risk for wanting more.
我认为它们使我们的奖励循环变得更糟，并使我们面临想要更多的风险。
I tend to get a headache when I eat food like that, and perhaps that's evolutionary advantage because I don't want to eat those foods because they actually do make me sick.
当我吃这样的食物时，我往往会头疼，也许这就是进化优势，因为我不想吃这些食物，因为它们确实让我生病。
So, in a lot of ways, I kind of wish that headache on everybody because perhaps we wouldn't have all these problems.
所以，在很多方面，我希望每个人都感到头疼，因为也许我们不会遇到所有这些问题。
Or at least some of them would go away.
或者至少其中一些会消失。
So I think that's the first issue is a predisposition to or a vulnerability to these types of foods, which we undoubtedly all have to a certain extent, but some more than others.
所以我认为第一个问题是对这些类型食物的倾向或脆弱性，毫无疑问，我们都在一定程度上拥有这些食物，但有些人比其他人更严重。
So that's the first hit is this predisposition in the context of this sort of food-focused society.
因此，在这种以食物为中心的社会背景下，第一个打击就是这种倾向。
And then the second hit is probably a stressful event or a stressful life.
然后第二次打击可能是一个有压力的事件或有压力的生活。
And probably a recurring stressful event.
并且可能是反复出现的压力事件。
I'm not sure this is published.
我不确定这是否已发布。
I've never sat down with an eating disorder expert and had this question about how this develops, and I'm not sure it's actually well-known.
我从来没有与饮食失调专家坐下来询问过这种情况是如何发展的，而且我不确定它是否真的众所周知。
But in a lot of ways, I think that that answer anybody would agree with, that we need sort of a predisposition and the exposure, the environmental exposure, and the genetic predisposition.
但在很多方面，我认为任何人都会同意这个答案，即我们需要某种倾向和暴露，环境暴露和遗传倾向。
But also a stressor.
但也是一个压力源。
And that stressor is probably one that's recurring.
而这种压力源可能会反复出现。
And it's obvious in our society, these stressors are everywhere and how we can manage them is often poor.
很明显，在我们的社会中，这些压力源无处不在，而我们管理它们的方法往往很差。
And I think we can all relate with that.
我想我们都可以理解这一点。
And then there's something else in the background that I think is really important to mention is that patients with these kinds of problems are embarrassed because our society doesn't think fondly of these kinds of patients.
我认为还有一些背景值得一提，那就是患有此类问题的患者感到尴尬，因为我们的社会并不喜欢这类患者。
Binge eating disorder patients, they do tend to be overweight.
暴食症患者确实容易超重。
That's obviously a stigma.
这显然是一种耻辱。
Obesity is another stigma.
肥胖是另一个耻辱。
Then there's the opposite.
然后是相反的情况。
In a way, it's an opposite, by the way, from a phenotype standpoint, is that's anorexia.
在某种程度上，这是相反的，顺便说一句，从表型的角度来看，这就是厌食症。
That's another stigma.
这是另一个耻辱。
And gosh, not to make this about one sex over another, but when girls are told they're pretty because they're thin, it just reinforces this problem.
天哪，不是为了让一种性别优于另一种性别，但是当女孩被告知她们因为瘦而漂亮时，这只会让这个问题更加严重。
And of course, you want to compliment people and make them feel good about themselves, but the problem is that in this vulnerable society, that that can lead to problems because people start thinking, "Oh, I should be thin or thinner." So I I think that it's a little bit of a societal understanding that our brains are very vulnerable, and I think that will really help.
当然，你想赞美人们并让他们自我感觉良好，但问题是在这个脆弱的社会中，这可能会导致问题，因为人们开始思考，“哦，我应该瘦一点或更瘦。”所以我认为，社会对我们的大脑非常脆弱这一点有一定的了解，我认为这确实会有帮助。
Changing society is hard, and most of society is not ill-meaning.
改变社会是困难的，社会大多数人也没有恶意。
It's all done by accident, but that is the society that we live in.
这一切都是偶然造成的，但这就是我们生活的社会。
So if we can try to improve that stigma, and be kinder to people in that way, I think a lot of these problems would get better.
因此，如果我们能够尝试改善这种耻辱，并以这种方式对人们更加友善，我认为很多问题都会得到改善。
People that are obese, that feel embarrassed by their obesity, it doesn't help.
肥胖的人，因肥胖而感到尴尬的人，这没有帮助。
It only makes it worse because they give up.
这只会让事情变得更糟，因为他们放弃了。
Same thing might be true for anorexics.
对于厌食症患者来说，情况可能也是如此。
So, I really think it's important to consider all of these things, and that's why it's so complicated.
所以，我真的认为考虑所有这些事情很重要，这就是它如此复杂的原因。
And it would be so hard to do a well-controlled study to understand it better because there's so many of these variables to control for that you really can't control for.
进行良好对照的研究来更好地理解它是非常困难的，因为有太多的变量需要控制，而你确实无法控制。
You might be able to control for them in a mouse's home cage, but not in the society that we live in.
你也许能够在老鼠的笼子里控制它们，但在我们生活的社会中却无法控制它们。
So, that's my brief summary of how I would answer your first question.
这就是我如何回答你的第一个问题的简短总结。
Then I think your second question, I take that as, well, how do you study such a complicated problem in the operating room and in the clinic?
那么我想你的第二个问题，我认为，你如何在手术室和诊所研究如此复杂的问题？
Because I mention the operating room because that's the first step here.
因为我提到手术室是因为这是第一步。
First, just to clarify, we have an NIH-funded trial approved by the FDA for research to do this first in human study.
首先，需要澄清的是，我们有一项由 NIH 资助并获得 FDA 批准的试验，旨在首先在人体研究中进行这项研究。
We've treated two patients.
我们已经治疗了两名患者。
We have four more to come at Penn, and in this study, it's something I've been working towards my entire career.
我们还有四个人要在宾夕法尼亚大学进行，在这项研究中，这是我整个职业生涯一直在努力的事情。
What we don't know is where in the nucleus accumbens will we identify cells or regions that seem to be involved in this reward-seeking behavior?
我们不知道的是，我们将在伏核中的哪个位置识别出似乎参与这种寻求奖励行为的细胞或区域？
I would call it appetitive.
我会称之为食欲。
It's like appetite, but the word appetitive is, I think, a good word to use.
这就像食欲，但我认为“食欲”这个词用得很好。
What part of the nucleus accumbens is appetitive?
伏隔核的哪一部分有食欲？
Is the whole thing appetitive?
整个事情都让人胃口大开吗？
Probably not.
可能不会。
It's huge.
它是巨大的。
In my world, it's huge.
在我的世界里，它是巨大的。
As a neurosurgeon, I target parts of the brain that are three or four millimeters in size.
作为一名神经外科医生，我的目标是大脑三到四毫米大小的部分。
The nucleus accumbens is almost a centimeter in size.
伏隔核的大小几乎为一厘米。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
I didn't realize it was that large.
我没有意识到它有这么大。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
This reminds me of discussions around the amygdala.
这让我想起了有关杏仁核的讨论。
Everyone thinks amygdala, fear.
每个人都认为杏仁核，恐惧。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But amygdala's got a lot of different sub-regions.
但杏仁核有很多不同的子区域。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And stimulation of certain areas of the amygdala makes people feel great.
刺激杏仁核的某些区域会让人感觉很棒。
Dr. Casey Halpern:
凯西·哈尔彭博士：
That's right.
没错。
Andrew Huberman:
安德鲁·休伯曼：
And stimulation of other areas makes them feel terribly afraid.
而其他部位的刺激则让他们感到非常害怕。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
And that shouldn't surprise us because when we treat patients with Parkinson's disease for tremor, if we're in one part of the subthalamic nucleus, we'll help their tremor.
这不应该让我们感到惊讶，因为当我们治疗帕金森病患者的震颤时，如果我们位于丘脑底核的一部分，我们就会帮助他们震颤。
If we're in another part of the subthalamic nucleus, the neurologist is looking at me like, "Why isn't this working?" And that shouldn't surprise us.
如果我们在丘脑底核的另一部分，神经科医生会看着我，“为什么这不起作用？”这不应该让我们感到惊讶。
We already know that two or three millimeters deviation, or two or three millimeters away from where we want to be, and you might not have the result you want.
我们已经知道，偏差两到三毫米，或者偏离我们想要的位置两到三毫米，您可能不会得到您想要的结果。
And that's probably also true for these more limbic structures like the amygdala and the nucleus accumbens.
对于杏仁核和伏核等边缘结构来说，情况可能也是如此。
So, regarding the nucleus accumbens, we traverse some of the nucleus accumbens, not all of it, in order to place the electrode that we want to use to detect when cravings are happening, for example, and to try to block the cravings from leading to the behavior related to the reward-seeking, which is the overeating in this case.
因此，对于伏核，我们会穿过一些伏核，而不是全部，以便放置我们想要用来检测渴望何时发生的电极，并试图阻止渴望导致与寻求奖励相关的行为，在这种情况下就是暴饮暴食。
So what we decided to do in the operating room was to actually try to leverage a tool that we use all the time when we take care of patients with Parkinson's.
因此，我们决定在手术室里做的是实际尝试利用我们在照顾帕金森病患者时一直使用的工具。
So with Parkinson's, a lot of these patients, not all, have tremor.
因此，对于帕金森氏症，很多（不是全部）患者都会出现震颤。
And so when we place an electrode into this motor structure to try to improve their movement disorder, we often can hear tremor cells, and we convert their electrical signal to an audible signal so we can actually hear it.
因此，当我们将电极放入这个运动结构中以尝试改善他们的运动障碍时，我们经常可以听到震颤细胞的声音，并且我们将它们的电信号转换为可听信号，这样我们就可以真正听到它。
And it sounds kind of like the tremor looks like.
而且听起来有点像震颤的样子。
The frequency of the signal is the same as the hand shaking.
信号的频率与握手的频率相同。
Andrew Huberman:
安德鲁·休伯曼：
So .
所以。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
And so the patient with Parkinson's is-
所以帕金森病患者是——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Awake
醒着
Andrew Huberman:
安德鲁·休伯曼：
...
...
trembling.
颤抖。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
They're awake, and you're poking around-
他们醒了，而你却在四处探寻——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yep
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
in a dedicated, careful way, of course.
当然，是以一种专注、谨慎的方式。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
One poke at a time.
一次戳一戳。
Andrew Huberman:
安德鲁·休伯曼：
One poke at a time-
一次戳一戳——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
with a very fine wire or set of wires-
用一根非常细的电线或一组电线-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yep
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
listening to the electrical activity until you encounter some cells that are sending out electrical activity-
聆听电活动，直到遇到一些正在发出电活动的细胞-
Dr. Casey Halpern:
凯西·哈尔彭博士：
That's right
没错
Andrew Huberman:
安德鲁·休伯曼：
...
...
at a similar frequency.
以相似的频率。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
And then you can stimulate them or quiet them and see if the-
然后你可以刺激他们或让他们安静下来，看看是否——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
tremor goes away.
震颤消失。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So we are very confident that when we stimulate that area of, in this case, the subthalamic nucleus, we will make that tremor.
因此，我们非常有信心，当我们刺激该区域（在本例中为丘脑底核）时，我们就会产生震颤。
We will disrupt that tremor circuit, and that tremor will dissolve, and it does.
我们会扰乱那个颤抖回路，那个颤抖就会消失，而且它确实会消失。
That's why Parkinson's is so beautiful and inspiring from a surgical-
这就是为什么帕金森病如此美丽，并且通过外科手术令人鼓舞——
Andrew Huberman:
安德鲁·休伯曼：
And tractable.
并且易于处理。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
But what is the-
但那是什么——
Dr. Casey Halpern:
凯西·哈尔彭博士：
It makes us feel we understand the brain-
它让我们感觉我们了解大脑——
Andrew Huberman:
安德鲁·休伯曼：
Right
右
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
at least in that limited way.
至少以这种有限的方式。
Andrew Huberman:
安德鲁·休伯曼：
So what is the analog to tremor in terms of appetite and desire to binge?
那么，就食欲和暴饮暴食的欲望而言，颤抖的类比是什么？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Craving.
渴望。
So craving is a term that-- There's probably other terms we could use, by the way, but that's the term we've chosen to use for a number of reasons.
所以，渴望这个术语——顺便说一句，我们可能还可以使用其他术语，但我们出于多种原因选择使用这个术语。
One, because people relate with that term.
一，因为人们与这个词相关。
People that have binge eating disorder or obesity, if you ask them if they crave, the answer will often be yes.
患有暴食症或肥胖症的人，如果你问他们是否渴望，答案通常是肯定的。
If you ask them if they lose control or binge, they might not know what you mean, or they might not actually feel out of control even when they are.
如果你问他们是否失去控制或暴饮暴食，他们可能不知道你的意思，或者即使他们知道，他们也可能不会真正感到失控。
But the word craving is relatable, and so we set out to see if we could identify craving cells.
但“渴望”这个词是有相关性的，所以我们开始研究是否可以识别“渴望”细胞。
In a patient with OCD, which is related, in fact, we target a very similar part of the brain, we tried to identify cells related to obsessions, and we believe we did do that.
事实上，在强迫症患者中，我们以大脑中非常相似的部分为目标，试图识别与强迫症相关的细胞，我们相信我们确实做到了。
It was a single case study, where we tried to optimize where our electrode was placed.
这是一个单一案例研究，我们试图优化电极的放置位置。
So we had some proof of concept that we would be able to elicit a sort of disease-specific symptom in the operating room, assuming the patient could tolerate being awake.
因此，我们有一些概念证明，假设患者能够忍受清醒，我们将能够在手术室中引发某种特定于疾病的症状。
Not everybody needs to be awake for this procedure, but at least for these first in-human trials where
并不是每个人都需要在这个过程中保持清醒，但至少在这些首次人体试验中
Andrew Huberman:
安德鲁·休伯曼：
We're trying to establish where in the brain we need to be.
我们正在尝试确定我们需要在大脑中的哪个位置。
I think this type of approach is really critical.
我认为这种方法非常关键。
And by the way, none of this has been published, but I think it's so important for people to know this, so I am willing to share some aspects of what we're trying to do.
顺便说一句，这些都还没有发表，但我认为人们了解这一点非常重要，所以我愿意分享我们正在努力做的一些方面。
But that's really the first goal of this trial, is to identify where in the nucleus accumbens we can detect these craving cells.
但这确实是这项试验的第一个目标，是确定我们可以在伏核中的哪个位置检测到这些渴望细胞。
So we have to provoke food craving in the operating room.
所以我们必须在手术室里激发人们对食物的渴望。
That's the first thing.
这是第一件事。
Dr. Casey Halpern:
凯西·哈尔彭博士：
How do you do that?
你是怎么做到的？
Andrew Huberman:
安德鲁·休伯曼：
Well, there are somewhat validated ways to do that.
嗯，有一些经过验证的方法可以做到这一点。
So for example, we ask patients to provide pictures of food that they rate very highly as something that they would typically crave.
例如，我们要求患者提供他们认为非常渴望的食物的图片。
And depending on the patient, it might be something that's very salty.
根据病人的不同，它可能是非常咸的东西。
It could be very sweet, like a donut.
它可能非常甜，就像甜甜圈一样。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Donuts are good.
甜甜圈很好吃。
Andrew Huberman:
安德鲁·休伯曼：
I love donuts.
我喜欢甜甜圈。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Right.
对。
Donuts are great.
甜甜圈很棒。
Andrew Huberman:
安德鲁·休伯曼：
You should try the cronut when you're here in New York City.
当你来到纽约时，你应该尝试一下可甜甜甜圈。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I just might.
我只是可能会。
I try not to eat that sort of thing for all the reasons they change your brain.
我尽量不吃那种东西，因为它们会改变你的大脑。
Andrew Huberman:
安德鲁·休伯曼：
It's worth one bite.
值得一咬。
Dr. Casey Halpern:
凯西·哈尔彭博士：
It's worth one bite.
值得一咬。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Just try to stop yourself after that one bite.
咬一口后试着阻止自己。
Andrew Huberman:
安德鲁·休伯曼：
So if I were one of these patients, given the fact that the binges come on pretty seldom, once a day, I imagine you have them come to the operating room fasted or semi-fasted?
因此，如果我是这些患者中的一员，考虑到暴食很少发生，每天一次，我想你会让他们禁食或半禁食地来到手术室？
Dr. Casey Halpern:
凯西·哈尔彭博士：
They're fasted, yeah.
他们禁食了，是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
They're fasted, which there are probably surgical-
他们禁食，这可能是手术-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
reasons for wanting that, too.
也有这样的愿望的理由。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
They kind of have to be.
他们必须如此。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
And then you've done the craniotomy, you've removed a patch of skull-
然后你完成了开颅手术，移除了一块头骨-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
lowered the wire-
放下电线——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
into the nucleus accumbens, and then they are viewing pictures of food that they crave and thinking about it.
进入伏隔核，然后他们就会看到他们渴望的食物的图片并思考它。
Do they have olfactory cues, smells of cronuts and donuts?
它们有嗅觉线索吗？有甜甜圈和甜甜圈的气味吗？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, we'd love to do the olfactory cues.
是的，我们很乐意做嗅觉提示。
We haven't implemented that, but that is a great-- Thank you, and I'll give you full credit when we do.
我们还没有实现这一点，但这真是太棒了——谢谢，当我们实现时，我将给予您充分的信任。
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
I didn't review the grant, but it sounds-- I'm so glad this work is funded because this is, this time it's not a joke when I refer to you neurosurgeons as the astronauts of the brain.
我没有审查这笔拨款，但听起来——我很高兴这项工作得到了资助，因为这一次，当我将你们神经外科医生称为大脑宇航员时，这不是一个笑话。
This is out on the extreme edge of what we don't know-
这是我们不知道的极端边缘——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
about how the brain functions.
关于大脑如何运作。
And this is so far and away different than giving a mouse access to a high-fat food.
这与让老鼠吃高脂肪食物有很大不同。
I'm not being disparaging of the mouse work.
我并不是在贬低鼠标的工作。
But so the person says, well, I'm the patient in this case, so I might say, "I'm hungry, a donut sounds really good right now."
但是这个人会说，好吧，我是这个案例中的病人，所以我可能会说，“我饿了，现在吃一个甜甜圈听起来真的很好。”
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But craving to me is like I'll cross the street, cross town, be late for my meeting, eat three of these.
但对我来说，渴望就像我要过马路，穿过城镇，开会迟到，吃其中的三个。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Maybe even hide that from somebody that cares about me that doesn't want me doing this.
甚至可能对那些关心我但不想让我这样做的人隐瞒这一点。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
This kind of thing.
这种事。
Hide it from myself.
对我自己隐瞒它。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
These kinds of behaviors I'm projecting.
我正在预测这些行为。
I'm fortunate that I have cravings for things in life, but donuts are not among the more extreme of them.
我很幸运，我对生活中的事物有渴望，但甜甜圈并不是其中最极端的。
So this is all happening in real-time-
所以这一切都是实时发生的——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
and you're listening to the cells the same way you would listen to and search for tremor cells.
你正在倾听这些细胞，就像你倾听和寻找震颤细胞一样。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
Same exact tools.
完全相同的工具。
Andrew Huberman:
安德鲁·休伯曼：
And you're doing that by recording from a small population of cells in the area?
你是通过记录该区域的一小部分细胞来做到这一点的吗？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
In fact, we do get multi-unit activity, which is multiple cells.
事实上，我们确实获得了多单元活动，即多个细胞。
But we really try to find one, a single unit to listen to.
但我们确实试图找到一个、一个单一的单元来听。
Andrew Huberman:
安德鲁·休伯曼：
One neuron?
一个神经元？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Because it's just much easier to understand what that one neuron is doing versus trying to listen to multiple.
因为与尝试聆听多个神经元相比，理解一个神经元在做什么要容易得多。
And we also measure local field potential recordings, but those are analyzed, which is more of a population response, thousands of cells.
我们还测量了局部场电位记录，但这些记录是经过分析的，这更多的是群体反应，即数千个细胞。
Andrew Huberman:
安德鲁·休伯曼：
Kind of a chorus of cells.
有点像细胞合唱团。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
That we measure offline.
我们离线测量。
The device that we use to sort of treat these patients or intervene that we're studying, it can't do single unit recordings.
我们正在研究的用于治疗这些患者或进行干预的设备无法进行单个单元的记录。
It's only doing these more population responses.
它只是做这些更多的人口反应。
So we correlate what we see in the operating room at the single unit level to the population response, but we do that all offline.
因此，我们将在手术室中看到的单个单元级别的情况与人群反应相关联，但我们都是在线下进行的。
And I can explain that in a moment.
我稍后可以解释这一点。
But yeah, so we try to identify these craving cells.
但是，是的，所以我们尝试识别这些渴望细胞。
And because this is a feasibility study, and we can't be in the operating room searching for hours and hours and hours, we have guidelines that we've set for ourselves, that we've developed with the NIH or the FDA to make sure that what we're doing is feasible and safe as well.
因为这是一项可行性研究，我们不能在手术室里花上好几个小时，所以我们为自己制定了指导方针，我们与 NIH 或 FDA 共同制定了这些指导方针，以确保我们正在做的事情是可行和安全的。
So we will spend a limited time trying to identify these craving cells.
因此，我们将花费有限的时间来尝试识别这些渴望细胞。
But another sort of strategy that we think is really important is the effect of the stimulation.
但我们认为真正重要的另一种策略是刺激的效果。
So a lot of patients, and this gets to sort of your question earlier about what comes first.
所以有很多病人，这很早就回答了你的问题，即什么是最重要的。
A lot of people, when they binge, or they lose control over food, or seek drugs, that moment of vulnerability is preceded by what we call a moment of sort of pre-meal negative affect.
很多人，当他们暴饮暴食、失去对食物的控制或寻求毒品时，脆弱的时刻之前就会出现我们所说的餐前负面情绪。
Which basically means right before they binge, they're feeling down, or they feel stressed, or anxious, and they compensate for that momentary symptom by binging or losing control over food.
这基本上意味着在他们暴饮暴食之前，他们感到沮丧，或者感到压力或焦虑，并且他们通过暴饮暴食或失去对食物的控制来补偿这种短暂的症状。
Not everybody meets criteria for a binge, so I try to specify that we are looking at loss of control eating specifically just because the criterion of a binge is not as critical for us.
并不是每个人都符合暴饮暴食的标准，所以我试图明确指出，我们正在特别关注饮食失控，因为暴食的标准对我们来说并不那么重要。
So what we want to be able to do is trigger stimulation when this craving is detected by the device.
因此，我们希望能够在设备检测到这种渴望时触发刺激。
But we trigger it only when the craving is there, and we believe that if we can sort of temporarily elevate their mood ever so briefly, again, this is about five to 10 seconds of stimulation only, that perhaps that elevation in mood could actually sort of disrupt the craving to binge cycle.
但我们只有在渴望存在时才会触发它，而且我们相信，如果我们能够如此短暂地暂时提升他们的情绪，那么这只是大约五到十秒的刺激，也许情绪的提升实际上可以扰乱渴望暴饮暴食的循环。
Maybe that's a habit, maybe it's not.
也许这是一种习惯，也许不是。
But if you crave and then you binge, if we can interrupt that with this moment of feeling good- That might be a really good therapy for a patient.
但如果你渴望然后暴饮暴食，如果我们能在这感觉良好的时刻打断它——这对病人来说可能是一个非常好的治疗方法。
And in fact, when we do deep brain stimulation for obsessive-compulsive disorder, we can fairly reliably induce a positive affect.
事实上，当我们对强迫症进行深层脑刺激时，我们可以相当可靠地诱发积极的影响。
The problem is that it's not sustained, and the reason it's likely not sustained is because with obsessive-compulsive disorder, we treat that condition with continuous stimulation.
问题是它不能持续，而它可能不能持续的原因是因为对于强迫症，我们通过持续刺激来治疗这种情况。
And it's not surprising that over time, the effect kind of goes away.
毫不奇怪，随着时间的推移，这种影响会消失。
So when they're in the clinic and we turn the device on, our patients feel great, and we feel like we've solved the problem.
因此，当我们在诊所打开设备时，我们的患者感觉很棒，我们感觉我们已经解决了问题。
But they call us the next day and they're like, "My depression came back," or, "My OCD hasn't gotten better and my mood's back to where it was.
但第二天他们打电话给我们，说“我的抑郁症又回来了”，或者“我的强迫症没有好转，我的情绪又回到了原来的状态。
Can you get it back to where it was yesterday?
你能把它恢复到昨天的位置吗？
Because that felt great."
因为那感觉很棒。”
Andrew Huberman:
安德鲁·休伯曼：
The brain loves homeostatic regulation.
大脑喜欢稳态调节。
Dr. Casey Halpern:
凯西·哈尔彭博士：
It does.
确实如此。
Andrew Huberman:
安德鲁·休伯曼：
It does not like to shift patterns.
它不喜欢改变模式。
Dr. Casey Halpern:
凯西·哈尔彭博士：
It's regression to the norm.
这是回归常态。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And I think there's sort of a tolerance effect there that is limiting the effect of continuous stimulation.
我认为那里存在某种耐受效应，限制了持续刺激的效果。
And actually, in a mouse, if you do continuous stimulation, the sort of blockade of binge eating goes away.
事实上，如果对小鼠进行连续刺激，对暴饮暴食的抑制就会消失。
So actually, in a mouse, we've actually demonstrated, we published this not too long ago in PNAS, that if you deliver stimulation intermittently and only when sort of a craving signal is detected, so to speak, that effect will be the most robust and durable.
所以实际上，我们已经在小鼠身上证明了，我们不久前在《美国国家科学院院刊》上发表了这一点，如果你间歇性地提供刺激，并且只有在检测到某种渴望信号时，可以这么说，这种效果将是最强大和持久的。
But if you deliver it continuously, actually the benefit goes away over time.
但如果你不断地提供它，实际上好处会随着时间的推移而消失。
So I've always encouraged my colleagues to consider more of an episodic stimulation approach rather than continuous deep brain stimulation.
因此，我一直鼓励我的同事更多地考虑采用间歇性刺激方法，而不是持续的深层脑刺激。
But of course, that's for these more episodic conditions, whereas these more, quote-unquote, "state disorders," as I oversimplified earlier, they might need more of a continuous therapy.
但当然，这是针对这些更偶发的情况，而这些更多的是，引用不引用，“状态障碍”，正如我之前过于简单化的那样，他们可能需要更多的连续治疗。
So that's definitely subject for a lot of research in the future.
所以这绝对是未来大量研究的主题。
So in any case, the goal in the operating room was to identify a craving cell, deliver stimulation safely, but also to capture a moment of elevated mood.
因此，无论如何，手术室的目标是识别渴望细胞，安全地提供刺激，同时捕捉情绪高涨的时刻。
We were able to do that as we are in our OCD patients as well, and also to get an intraoperative CAT scan.
我们能够做到这一点，就像我们在强迫症患者中一样，并且还进行了术中 CAT 扫描。
We have devices now in the operating room that allow us to get imaging in real time.
我们现在手术室里有设备可以让我们实时获得成像。
They're fabulous tools that we didn't have 10 years ago.
它们是我们 10 年前所没有的极好的工具。
So we can confirm accuracy.
这样我们就可以确认准确性。
Andrew Huberman:
安德鲁·休伯曼：
You can see where the electrode is-
你可以看到电极在哪里-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly
正是如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
precisely.
准确地说。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly.
正是如此。
With 0.5 millimeters of error.
误差0.5毫米。
So super precise or as precise as we think we need to be.
非常精确或达到我们认为需要的精确程度。
And we use connectomics.
我们使用连接组学。
So there's a tool in brain imaging called tractography, where we can actually measure circuit connections.
因此，大脑成像中有一种称为纤维束成像的工具，我们可以实际测量电路连接。
It's an indirect assay, but we believe it's powerful.
这是一种间接测定，但我们相信它很强大。
It has its assumptions, but like anything in science, but we can actually map out where the nucleus accumbens connects to the prefrontal cortex, sort of the cortical control, inhibitory control pathway, and where that pathway intersects with the nucleus accumbens, and we can target that area structurally.
它有它的假设，但就像科学中的任何东西一样，但我们实际上可以绘制出伏隔核与前额叶皮层的连接位置，即皮质控制、抑制控制通路，以及该通路与伏隔核相交的位置，并且我们可以在结构上瞄准该区域。
So those three goals of the surgery we aim to set out to accomplish.
因此，我们旨在实现手术的这三个目标。
And we believed if we achieved two of those three, that we would have a successful result in our early trial.
我们相信，如果我们实现了这三项中的两项，我们就会在早期试验中取得成功。
Andrew Huberman:
安德鲁·休伯曼：
Amazing.
太棒了。
Given that, at least to me, the non-clinician, that anorexia is the mirror image of binge eating disorder, and at least from what I learned, one of the more deadly psychiatric conditions.
鉴于，至少对我这个非临床医生来说，厌食症是暴食症的镜像，至少从我了解到的情况来看，厌食症是更致命的精神疾病之一。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But also quite common.
但也很常见。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Is it possible that nucleus accumbens, this so-called reward circuit, is also involved in anorexia, but somehow it is the resistance to eating, the craving of the fasted state or something like that, that's being reinforced?
有没有可能伏隔核，即所谓的奖赏回路，也与厌食症有关，但不知何故，它是对进食的抵抗，对禁食状态的渴望或类似的东西，被强化了？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And I ask this for two reasons.
我这么问有两个原因。
One, because I'm genuinely curious about anorexia.
一，因为我真的对厌食症很好奇。
I've observed anorexia in a number of people I know, and it's a striking thing to see somebody just resist food despite all better knowledge of the fact that they're getting quite ill, maybe even at risk of death.
我观察到很多我认识的人都患有厌食症，令人震惊的是，尽管人们更清楚地知道他们病得很重，甚至可能面临死亡的危险，但他们还是拒绝食物。
But the other reason is that if, in fact, nucleus accumbens is the site which can harbor cells to promote craving and craving of fasted states, so to speak- ...
但另一个原因是，如果事实上伏隔核是可以容纳促进渴望和禁食状态渴望的细胞的地方，可以这么说——......
then that, I think, might tell us something fundamental about how the brain works, which is that structures don't control functions per se.
那么，我认为，这可能会告诉我们一些关于大脑如何工作的基本信息，即结构本身并不控制功能。
Structures control dynamics-
结构控制动力学-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
of interactions.
的互动。
Sort of like an orchestra conductor has a certain number of operations that they perform, but really, their main function is to coordinate the actions of a lot of things, not to make sure that the violins always play in-
有点像管弦乐队指挥有一定数量的操作，但实际上，他们的主要功能是协调很多事情的动作，而不是确保小提琴始终演奏——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
a certain way alongside the oboes.
以某种方式与双簧管并驾齐驱。
You can tell I'm not a musician here.
你可以看出我不是这里的音乐家。
Dr. Casey Halpern:
凯西·哈尔彭博士：
At least you have an appreciation for the oboes.
至少你对双簧管有鉴赏力。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Those usually get left out.
这些通常被排除在外。
Andrew Huberman:
安德鲁·休伯曼：
What's that?
那是什么？
The oboes?
双簧管？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, they usually get ignored.
是的，他们通常会被忽视。
Andrew Huberman:
安德鲁·休伯曼：
Oh my God.
天哪。
My partner plays the oboe, so-
我的搭档演奏双簧管，所以-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh, wow
哦，哇
Andrew Huberman:
安德鲁·休伯曼：
...
...
yeah.
是的。
So, yeah, so-
所以，是的，所以——
Dr. Casey Halpern:
凯西·哈尔彭博士：
I think it's a great analogy, by the way.
顺便说一句，我认为这是一个很好的类比。
I make this statement, it's a little controversial, but I actually think people would understand where I'm coming from across all of these sort of subspecialties of medicine.
我做出这样的声明，这有点争议，但我实际上认为人们会理解我来自所有这些医学亚专业的背景。
But I actually think, especially with obesity, remember, it's a phenotype that's reflective often, but not always of a behavior.
但我实际上认为，尤其是肥胖，请记住，这是一种经常反映的表型，但并不总是反映一种行为。
But if you consider patients that have obesity and they exhibit some sort of compulsion towards food, so they overeat despite the risk of it.
但如果你考虑一下肥胖患者，他们对食物表现出某种强迫性，所以他们会吃得过多，尽管有风险。
I think those kinds of patients are more similar to anorexics than they are different.
我认为这类患者与厌食症患者的相似之处多于不同之处。
Anorexia and obesity are both phenotypes that are, at least in this specific case of obesity and in anorexia, a result of a compulsion to either over or undereat despite the risk.
厌食症和肥胖症都是表型，至少在肥胖和厌食症的具体情况下，都是尽管有风险但仍强迫性地吃得过多或过少的结果。
These types of compulsions are driven by societal pressures ...
这些类型的强迫行为是由社会压力驱动的......
brain vulnerabilities that are probably more similar than they are different.
大脑的弱点可能相似之处多于不同之处。
They just happen to manifest differently.
它们只是碰巧以不同的方式表现出来。
Why they manifest differently is probably related to each patient's predisposition or perhaps preference.
为什么它们表现不同可能与每个患者的倾向或偏好有关。
That's hard to know.
这很难知道。
Like you, I have a personal connection to these eating disorders, anorexia included, and yeah, I think it's very scary.
和你一样，我与这些饮食失调（包括厌食症）有个人联系，是的，我认为这非常可怕。
And it's a condition that often instills fear in psychiatrists because I think, not everybody by the way.
这种情况经常让精神科医生感到恐惧，因为我认为，顺便说一句，并不是每个人都如此。
I have some phenomenal psychiatrists that I work with, both at Stanford and at Penn.
在斯坦福大学和宾夕法尼亚大学，我有一些出色的精神病学家一起工作。
They're also involved in my obesity study that take care of these patients.
他们也参与了我的肥胖研究并照顾这些患者。
These are heroes, but there's a lot of psychiatrists that are not in this domain that find anorexia scary for the reason you said.
这些都是英雄，但是有很多不属于这个领域的精神科医生因为你所说的原因而觉得厌食症很可怕。
It has the highest mortality of all psychiatric conditions.
它是所有精神疾病中死亡率最高的。
That includes depression.
这包括抑郁症。
Because not only can these patients die of suicide, but they die of metabolic complications of being underweight.
因为这些患者不仅会死于自杀，还会死于体重不足的代谢并发症。
So it is a scary condition.
所以这是一个可怕的情况。
I relate with that.
我同意这一点。
I am trying, over time, to bridge what I'm doing in obesity and binging disorder to anorexia for two reasons.
随着时间的推移，我正在努力将我在肥胖和暴食症方面所做的事情与厌食症联系起来，原因有两个。
One, because I think these problems are more similar than they are different, and two, because of the need.
一是因为我认为这些问题的相似之处多于不同之处，二是因为需要。
And I think we're well-positioned to sort of tackle anorexia using similar approaches.
我认为我们有能力使用类似的方法来解决厌食症。
Not identical, but similar approaches.
不完全相同，但相似的方法。
The nucleus accumbens has been studied in patients with anorexia in China.
在中国，伏隔核已在厌食症患者中进行了研究。
Actually, my first postdoc, who I had the honor to train when I was at Stanford, is a neurosurgeon in China, and before he came to me, actually was involved in a trial of anorexia that had some benefits.
事实上，我在斯坦福大学时有幸培养过的第一个博士后是中国的一名神经外科医生，在他来找我之前，他实际上参与了一项对厌食症有一些好处的试验。
And there's studies in Europe and elsewhere that have examined preliminarily the effects of deep brain stimulation targeting the nucleus accumbens for anorexia.
欧洲和其他地方的研究初步检验了针对伏核的深部脑刺激对厌食症的影响。
Colleagues of mine in Canada, Andres Lozano, who's a wonderful neurosurgeon scientist, has been studying the effects of going after area 25, which is directly connected to the nucleus accumbens by-- It's a monosynaptic connection, so in a lot of ways perhaps delivering stimulation there could be very similar to delivering stimulation to the nucleus accumbens.
我在加拿大的同事安德烈斯·洛扎诺 (Andres Lozano) 是一位出色的神经外科医生科学家，他一直在研究 25 区的影响，该区与伏隔核直接相连，这是一种单突触连接，因此在很多方面，向那里传递刺激可能与向伏隔核传递刺激非常相似。
It's all part of one critical inhibitory control circuit.
它都是一个关键抑制控制电路的一部分。
He's seen benefits as well.
他也看到了好处。
So I definitely think there's some evidence that this is an area that we need to be studying.
所以我绝对认为有一些证据表明这是我们需要研究的领域。
I think our more episodic approach with responsive stimulation going after sort of a signal in the nucleus accumbens that seems to be related to the compulsion to withhold from eating, I think is what we will be trying to accomplish in our study.
我认为，我们采用反应性刺激的更间歇性方法，追踪伏隔核中的某种信号，这似乎与克制饮食的强迫有关，我认为这就是我们在研究中将努力完成的目标。
It's right now just being conceived, though.
不过，现在才刚刚构思。
These studies, they move so slowly because you have to get a grant.
这些研究进展缓慢，因为你必须获得资助。
That grant gets reviewed by the NIH six months after you submit it.
该资助将在您提交六个月后由 NIH 进行审核。
Often gets rejected because it's too innovative and too high-risk, so then you have to edit it and decrease the risk.
通常会因为太创新、太高风险而被拒绝，所以你必须对其进行编辑并降低风险。
So my obesity study took two years to get funded.
所以我的肥胖研究花了两年时间才获得资助。
And I worry about that timeframe, because that's a lot of time for patients with anorexia to suffer that I might be able to help, at least in a small sample of patients.
我担心这个时间范围，因为对于厌食症患者来说，这需要很长的时间，而我可能能够提供帮助，至少对一小部分患者来说是这样。
But that is the nature of how these things go.
但这就是事情发展的本质。
You also have to get FDA approval to do these kinds of things.
您还必须获得 FDA 的批准才能做这些事情。
We try to do all of this in parallel.
我们尝试并行完成所有这些工作。
It's an enormous undertaking, and in a lot of ways, we're starting from scratch, but in some ways, we have some preliminary data to go after this.
这是一项艰巨的任务，在很多方面，我们都是从头开始，但在某些方面，我们有一些初步数据可以进行。
So my hope is in about a year we'll have a similar trial for anorexia at Penn, so more to come on that.
所以我希望大约一年后，我们将在宾夕法尼亚大学进行类似的厌食症试验，因此还会有更多的试验。
And we're not the only lab that's trying to go after it because of the clear need.
由于明确的需求，我们并不是唯一一个试图追求这一目标的实验室。
So...
所以...
Andrew Huberman:
安德鲁·休伯曼：
What is the status of non-invasive brain stimulation, ablation, and blocking activity in the brain?
非侵入性脑刺激、消融和大脑活动阻断的现状如何？
I get a lot of questions about transcranial magnetic stimulation.
我收到很多关于经颅磁刺激的问题。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I've actually had that done-
我实际上已经做到了-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh
噢
Andrew Huberman:
安德鲁·休伯曼：
...
...
as a research subject.
作为研究课题。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
When I was at Berkeley, Rich Ivory's lab put a coil on my head.
当我在伯克利时，里奇·艾沃里的实验室在我的头上放了一个线圈。
I was tapping my finger in concert to a drum beat, and then all of a sudden because of the stimulation, it was impossible for me to keep time-
我随着鼓点敲击着手指，突然因为刺激，我无法保持时间了——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
with the drum beat.
随着鼓点的敲击。
Dr. Casey Halpern:
凯西·哈尔彭博士：
That's cool.
太酷了。
Andrew Huberman:
安德鲁·休伯曼：
It's a pretty wild experience to not have motor control and then to have motor control returned-
没有电机控制然后又恢复电机控制是一种非常疯狂的经历——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
at the flip of a switch.
按下开关。
When someone else is controlling the switch-
当其他人控制开关时-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
makes it especially eerie.
使它特别令人毛骨悚然。
So my understanding is that transcranial magnetic stimulation is being used to treat depression and a number of other brain syndromes non-invasively, so no drilling through the skull.
所以我的理解是，经颅磁刺激被用来非侵入性地治疗抑郁症和许多其他大脑综合症，所以不需要钻穿颅骨。
Surgeons don't like that.
外科医生不喜欢这样。
Surgeons love to cut and drill.
外科医生喜欢切割和钻孔。
With purpose, but they do.
有目的，但他们确实这样做了。
Dr. Casey Halpern:
凯西·哈尔彭博士：
With purpose, yes.
有目的的，是的。
Andrew Huberman:
安德鲁·休伯曼：
But my understanding is that the spatial precision isn't that great.
但我的理解是空间精度不是那么好。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Ultrasound is something I hear a lot about these days, and my understanding is that ultrasound can allow researchers and clinicians to stimulate specific brain areas, perhaps with more precision.
这些天我经常听到超声波，我的理解是超声波可以让研究人员和临床医生刺激特定的大脑区域，也许更精确。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Maybe you could just give us a-
也许你可以给我们一个-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure
当然可以
Andrew Huberman:
安德鲁·休伯曼：
...
...
brief coverage of what those are being used for.
简要介绍它们的用途。
What are your thoughts on these forms of non-invasive, meaning no flipping open of a piece of the skull, type brain stimulation and blockade of brain activity?
您对这些非侵入性形式（即无需翻开头骨、大脑刺激和大脑活动封锁）有何看法？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Yeah, and I wanted to clarify also, these surgeries generally don't, by the way, require a full craniotomy.
是的，我还想澄清一下，顺便说一句，这些手术通常不需要完整的开颅手术。
It's usually just a small opening about the size of a dime in the bone, so just to clarify.
它通常只是骨头上一个大约一毛钱大小的小开口，所以只是澄清一下。
But that is-
但那就是——
Andrew Huberman:
安德鲁·休伯曼：
Painless, too, right?
也无痛吧？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Well, usually without pain.
嗯，通常没有疼痛。
They-
他们——
Andrew Huberman:
安德鲁·休伯曼：
Yeah, a little bit of scalp numbing, but-
是啊，有点头皮发麻，但是——
Dr. Casey Halpern:
凯西·哈尔彭博士：
We give a scalp block, and the patients are getting IV sedation, so they in general don't feel anything.
我们进行头皮阻滞，患者接受静脉注射镇静剂，所以他们一般不会有任何感觉。
And if they do, they tell me, and we give them more local anesthetic.
如果他们这样做了，他们会告诉我，我们会给他们更多的局部麻醉。
But they're usually asleep during that part.
但他们通常在这段时间睡着了。
So it's minimally invasive.
所以它是微创的。
But in a lot of ways, there's no such thing as a minimally invasive procedure in the brain.
但从很多方面来说，大脑中并不存在微创手术。
It's kind of a misnomer.
这有点用词不当。
Andrew Huberman:
安德鲁·休伯曼：
I'm so glad to hear you say that.
我很高兴听到你这么说。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh, no. I am not one of those neurosurgeons that you've probably encountered, and we have mutual friends that-- And these mutual friends are some of my ...
哦，不。我不是你可能遇到过的神经外科医生之一，我们有共同的朋友——这些共同的朋友是我的一些......
favorite people in neurosurgery, and they probably actually think more like me than not.
最喜欢神经外科领域的人，他们的想法可能实际上更像我。
But there are neurosurgeons that you're absolutely right.
但有些神经外科医生认为你是绝对正确的。
And this is true for all surgeries.
对于所有手术都是如此。
In a lot of ways, they think what they do is sort of the ground truth or is closer to the ground truth, and I get that.
在很多方面，他们认为自己所做的事情是基本事实，或者更接近基本事实，我明白这一点。
Probing with purpose.
有目的地探索。
I actually really like that.
我真的很喜欢这样。
I'm going to use that, if you don't mind.
如果你不介意的话，我会用它。
Andrew Huberman:
安德鲁·休伯曼：
It's just describing what you do.
它只是描述你所做的事情。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yep.
是的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
But I actually have always said this.
但其实我一直都这么说。
I've said it publicly, I've said it to my boss, I've said this to my team.
我已经公开说过了，我已经对我的老板说过了，我已经对我的团队说过了。
We need to embrace non-invasive approaches.
我们需要采用非侵入性方法。
Some of them are a little fluffy.
其中一些有点蓬松。
Fluffy in that we don't understand how they work.
蓬松之处在于我们不明白它们是如何工作的。
We don't necessarily understand how deep brain stimulation works, by the way.
顺便说一句，我们不一定了解大脑深层刺激的工作原理。
But because we don't know exactly how they work, they're not as precise as we would like them to be, so we have work to do there, and I actually think that work is doable and actually underway.
但因为我们不知道它们到底是如何工作的，所以它们并不像我们希望的那样精确，所以我们有工作要做，而且我实际上认为这项工作是可行的并且实际上正在进行中。
At Stanford, we have great collaborators that I think are doing this, people like Nolan Williams and Conor Liston at Cornell, and others.
在斯坦福大学，我们有一些很棒的合作者，我认为他们正在做这件事，比如康奈尔大学的诺兰·威廉姆斯和康纳·利斯顿等人。
I think that TMS, transcranial magnetic stimulation, it is FDA approved for depression, by the way.
顺便说一句，我认为 TMS（经颅磁刺激）已被 FDA 批准用于治疗抑郁症。
It's also FDA approved for OCD and for nicotine addiction.
它还获得 FDA 批准用于治疗强迫症和尼古丁成瘾。
Andrew Huberman:
安德鲁·休伯曼：
Where do they put the coil for those three?
他们把这三个线圈放在哪里？
Or more or less.
或多或少。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Well, it's always on the scalp and over the frontal lobe, and there's different parts of the frontal lobe that have been demonstrated to be a little better or a little bit worse.
嗯，它总是在头皮和额叶上方，额叶的不同部分已被证明稍微好一点或稍微差一点。
But what the FDA has approved for depression, I believe is similar to what's been approved for OCD.
但我相信 FDA 批准用于治疗抑郁症的药物与批准用于治疗强迫症的药物类似。
But for addiction, I believe it is a different target, but we'd have to ask our TMS experts on that.
但对于成瘾，我相信这是一个不同的目标，但我们必须就此询问我们的 TMS 专家。
Andrew Huberman:
安德鲁·休伯曼：
Can they direct the transcranial magnetic stimulation deep below the cortex?
他们能否将经颅磁刺激引导到皮层深处？
Dr. Casey Halpern:
凯西·哈尔彭博士：
They try, and we're actually studying this in OCD patients now.
他们尝试过，我们现在正在强迫症患者中研究这一点。
As a part of our invasive trial, we are trying to pool patients from a TMS trial that's in parallel to what we're doing, all funded by the Foundation for OCD Research, where we believe we can use TMS to define a circuit that, if modulated, improves OCD, albeit temporarily.
作为我们侵入性试验的一部分，我们正在尝试汇集来自 TMS 试验的患者，该试验与我们正在做的事情并行，所有试验均由强迫症研究基金会资助，我们相信我们可以使用 TMS 来定义一个回路，如果进行调节，可以改善强迫症，尽管是暂时的。
And in those patients, if it's temporary, they would be appropriate for an invasive study.
对于这些患者，如果这是暂时的，他们将适合进行侵入性研究。
So something we're actively working on.
这是我们正在积极开展的工作。
I've always believed that neurosurgeons need to be part of the discussion with these non-invasive approaches.
我一直相信神经外科医生需要参与这些非侵入性方法的讨论。
We don't need to do them, but I think we can help make them more precise and to probe noninvasively with purpose rather than this more kind of a non-invasive blast effect.
我们不需要这样做，但我认为我们可以帮助它们变得更加精确，并有目的地进行非侵入性探测，而不是这种更多的非侵入性爆炸效应。
I just can't imagine how that is going to be as effective as probing with purpose, but you can do that noninvasively as well, and I think we need to do better in that way.
我只是无法想象这将如何像有目的的探测一样有效，但你也可以非侵入性地做到这一点，我认为我们需要在这方面做得更好。
I do believe that's possible, and I think people are actively trying to do it.
我确实相信这是可能的，而且我认为人们正在积极尝试这样做。
Getting deep in the brain with TMS, I think will always be hard, but you can get there indirectly by using connectivity assays and targeting superficial structures that have high connectivity to deep structures.
我认为通过 TMS 深入大脑始终很困难，但您可以通过使用连接性分析并针对与深层结构具有高连接性的浅表结构来间接到达那里。
So for example, perhaps one day there will be a TMS target for anorexia and obesity.
例如，也许有一天，TMS 会针对厌食症和肥胖症制定一个目标。
If we are scratching the surface with invasive approaches to these problems, we're even doing less with the brain stimulation.
如果我们只是用侵入性方法来解决这些问题，那么我们在大脑刺激方面就做得更少了。
So we have so much work to do there.
所以我们在那里还有很多工作要做。
Eating disorders and TMS have been so scarcely studied or there have been such little research done in that space.
饮食失调和 TMS 的研究很少，或者说在该领域的研究很少。
And so it is an area that we need to work on.
所以这是我们需要努力的一个领域。
For the obvious reason, for example, in a patient with anorexia, just thinking practically, placing a device in a patient who is significantly underweight might not be the best approach.
出于显而易见的原因，例如，对于患有厌食症的患者，只要实际思考，将设备放置在体重明显不足的患者体内可能不是最好的方法。
Wound erosion and issues like that could come up.
伤口糜烂和类似的问题可能会出现。
So developing a non-invasive approach, I think, is critical.
因此，我认为开发一种非侵入性方法至关重要。
The problem is: Where do we target?
问题是：我们的目标在哪里？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And so the only way to answer that, I think reliably, is to accept that we have to get into the brain before we're out of the brain.
因此，我认为可靠地回答这个问题的唯一方法就是接受这样一个事实：我们必须先进入大脑，然后才能离开大脑。
And with these kinds of conditions, we're only just starting to get into the brain.
在这些条件下，我们才刚刚开始进入大脑。
So I worry that we're a long way away from a non-invasive approach that really works consistently.
所以我担心我们离真正有效的非侵入性方法还有很长的路要走。
Andrew Huberman:
安德鲁·休伯曼：
Sorry to interrupt.
抱歉打扰。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I want to make sure we touch on ultrasound because-
我想确保我们接触超声波，因为-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Sure.
当然。
No, I'd love that
不，我很乐意
Andrew Huberman:
安德鲁·休伯曼：
...
...
historically, it seemed that there was a bit more permission for people to probe around in the human brain.
从历史上看，人们似乎有更多的权限来探索人脑。
I've sometimes refer on the podcast to some of these papers that were done allowing patients to self-stimulate in the brain.
我有时会在播客中提到其中一些论文，这些论文允许患者在大脑中进行自我刺激。
These are work done in the '60s, and now his name escapes me, Robert.
这些都是 60 年代完成的工作，现在我记不起他的名字了，罗伯特。
Anyway, there's a couple of papers published in Science allowing patients to stimulate a couple of different brain areas, asking which ones they preferred, and I was always shocked and slightly intrigued by the fact that the brain area that all three of these patients, who I don't think had any syndromes, I think they volunteered for these experiments.
不管怎样，《科学》杂志上发表了几篇论文，允许患者刺激几个不同的大脑区域，询问他们更喜欢哪一个，我总是感到震惊，并且有点好奇，我认为这三个患者的大脑区域没有任何综合症，我认为他们自愿参加这些实验。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Incredible.
难以置信。
Andrew Huberman:
安德鲁·休伯曼：
I don't think you could do this anymore.
我认为你不能再这样做了。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Regulatory-
监管-
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Things have changed
事情已经改变了
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
was not the same as it is now
以前和现在不一样
Andrew Huberman:
安德鲁·休伯曼：
Things have changed, fortunately.
幸运的是，事情已经发生了变化。
But all three of them seemed to like some midline thalamic structure, which for those listening, is just an area kind of in the dead center of the brain, more or less, that evoked a sense of frustration and anger, which surprised me because I would've thought...
但他们三个人似乎都喜欢某种中线丘脑结构，对于那些倾听的人来说，这只是大脑正中心的一个区域，或多或少地引起了一种挫败感和愤怒感，这让我感到惊讶，因为我本以为……
Oh, it's Robert Heath-
哦，这是罗伯特·希思——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
his experiments.
他的实验。
Rather than patients preferring to stimulate areas that evoke laughter or joy or a feeling of drunkenness or delight.
而不是患者更喜欢刺激引起笑声或欢乐或醉酒或愉悦感的区域。
It also explains a lot of what I observe in social media, this sort of people repeatedly engaging in battles that are kind of trivial.
这也解释了我在社交媒体上观察到的很多现象，即这类人反复参与一些微不足道的争斗。
It seems like frustration and anger might have its own reward circuitry.
沮丧和愤怒似乎有其自己的奖励回路。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Anyway, I don't want to go too far down that rabbit hole, but it-
无论如何，我不想在那个兔子洞里走得太远，但是它——
Dr. Casey Halpern:
凯西·哈尔彭博士：
It's a deep one
这是一个深奥的
Andrew Huberman:
安德鲁·休伯曼：
It's a deep one.
这是一个深奥的。
And kind of gets to our nature-
这有点接近我们的本性——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
as humans and what we find interesting or rewarding.
作为人类以及我们认为有趣或有价值的事情。
But The inability to probe around the brain in a safe way without the need for somebody to be very sick-
但是，如果某人病得很重，就无法以安全的方式探测大脑周围——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
I think would be enormously powerful and, at least to my mind, if I were in charge, which I'm not, would offer the opportunity to really come to an understanding about how the human brain works without all these issues of how to translate from mouse studies.
我认为这将是非常强大的，至少在我看来，如果我负责（但我不是），将提供机会真正了解人脑如何工作，而无需所有这些如何从小鼠研究中转化的问题。
And again, there's huge value to animal studies, as we both agree, but so many of the things that we want to know about the human brain involve asking the person, "Hey, what do you feel when that set of neurons is stimulated, and what don't you feel?"
再说一次，正如我们都同意的那样，动物研究具有巨大的价值，但是我们想了解人类大脑的很多事情都涉及到询问人：“嘿，当这组神经元受到刺激时，你有什么感觉，你没有感觉什么？”
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And a mouse, we can ask and ask, but they're not going to tell us, and if they do tell us, they're not going to tell us in English.
还有一只老鼠，我们可以问啊问，但他们不会告诉我们，即使他们告诉我们，他们也不会用英语告诉我们。
So, how do we overcome this challenge?
那么，我们如何克服这一挑战呢？
But first, ultrasound, or if you prefer-
但首先，超声波，或者如果你愿意的话-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure
当然可以
Andrew Huberman:
安德鲁·休伯曼：
...
...
after ultrasound, is ultrasound going to be really useful towards solving these clinical issues and these basic issues?
超声检查之后，超声检查对于解决这些临床问题和基本问题真的有用吗？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
So I think, let's start with ultrasound, then we'll come back to it.
所以我想，让我们从超声波开始，然后再回到它。
So ultrasound right now, transcranial magnetic resonance-guided focused ultrasound.
所以现在的超声波是经颅磁共振引导的聚焦超声波。
So this is an FDA-approved method to deliver an ablation to the brain non-invasively.
因此，这是 FDA 批准的一种非侵入性大脑消融方法。
There are researchers, myself included, that are trying to use transcranial magnetic resonance-guided focused ultrasound or MRI-guided focused ultrasound, to use it in a modulatory way.
有研究人员，包括我自己，正在尝试使用经颅磁共振引导的聚焦超声或 MRI 引导的聚焦超声，以调制的方式使用它。
Not just as an ablation, but to drive neuronal activity or inhibit it, perhaps.
也许不仅仅是作为一种消融，还可以驱动或抑制神经元活动。
We're still learning how to do that.
我们仍在学习如何做到这一点。
There are trials that are trying to understand if you can use ultrasound to open the blood-brain barrier, so you can deliver a medication to that specific area, perhaps for a brain tumor or something like that.
有一些试验试图了解是否可以使用超声波打开血脑屏障，以便可以将药物输送到特定区域，也许可以治疗脑肿瘤或类似疾病。
So, it's a very exciting field.
所以，这是一个非常令人兴奋的领域。
And it is FDA-approved for tremor right now.
目前它已获得 FDA 批准用于治疗震颤。
And so I actually do it routinely for patients with tremor with Parkinson's or essential tremor.
所以我实际上经常为患有帕金森氏症或特发性震颤的患者做这件事。
And so, I love doing it.
所以，我喜欢这样做。
It's often just kind of a miracle because there's no incision.
这通常是一个奇迹，因为没有切口。
I don't have to place an electrode into the brain to achieve a similar result.
我不必将电极放入大脑即可获得类似的结果。
Andrew Huberman:
安德鲁·休伯曼：
How early into the pathology of Parkinson's can someone think about approaching this?
在帕金森病的病理学研究中，人们多久可以考虑解决这个问题？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So for instance, if somebody has a parent or a sibling and they're developing some resting tremor-
举例来说，如果某人有父母或兄弟姐妹，并且他们正在出现一些静止性震颤-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
obviously, they should talk to a neurologist, but-
显然，他们应该和神经科医生谈谈，但是-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
a neurosurgeon.
神经外科医生。
But-
但是——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
this non-invasive approach could be incredible for them-
这种非侵入性的方法对他们来说可能是不可思议的——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
as opposed to just only taking drugs to increase dopamine levels.
而不仅仅是服用药物来增加多巴胺水平。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, so depending on the reason you have tremor would dictate the kind of medication you would use.
是的，所以根据你震颤的原因决定你要使用的药物种类。
It could be Parkinson's, but if it's not, it might be essential tremor.
这可能是帕金森病，但如果不是，则可能是特发性震颤。
By the way, essential tremor is 10 times as common as Parkinson's.
顺便说一句，特发性震颤的发病率是帕金森病的 10 倍。
Andrew Huberman:
安德鲁·休伯曼：
Really?
真的吗？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Essential tremor is the most common neurologic condition in patients over the age of 70.
特发性震颤是 70 岁以上患者最常见的神经系统疾病。
We often aren't aware of that.
我们常常没有意识到这一点。
People with essential tremor feel they have the forgotten disease because there's no Michael J.
患有特发性震颤的人感觉他们患有这种被遗忘的疾病，因为没有迈克尔·J·
Fox for essential tremor.
狐狸用于特发性震颤。
I sent a letter to Bill-
我给比尔写了一封信——
Andrew Huberman:
安德鲁·休伯曼：
Sorry, is it essential tremor or?
抱歉，是特发性震颤还是？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Essential tremor.
特发性震颤。
Andrew Huberman:
安德鲁·休伯曼：
Essential tremor.
特发性震颤。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yep.
是的。
E-S-S-E-N-T-I-A-L.
基本的。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I actually sent a letter to Bill Clinton.
我实际上给比尔·克林顿写了一封信。
I've observed a tremor in him, and I think he's actually disclosed that he has it, and I hoped he'd become a champion for patients with essential tremor.
我观察到他有震颤，我认为他实际上已经透露了自己患有震颤，我希望他能成为特发性震颤患者的捍卫者。
Sandra Day O'Connor does as well.
桑德拉·戴·奥康纳也是如此。
She's also public about it.
她也公开了这件事。
But I was not able to get them eager to become the champion for this condition.
但我无法让他们渴望成为这种情况下的冠军。
But like Michael J.
但就像迈克尔·J.
Fox, these patients need a champion like that.
福克斯，这些病人需要这样的冠军。
But unfortunately, it's a bit of a forgotten disease.
但不幸的是，这是一种被遗忘的疾病。
Nevertheless, because of the FDA approval of focused ultrasound for tremor, they're just trying to get some attention, for sure.
尽管如此，由于 FDA 批准聚焦超声治疗震颤，他们肯定只是想引起一些关注。
And it's fabulously effective for these patients.
它对这些患者非常有效。
It treats patients on one side, usually their dominant hand or their worst hand, and it really speaks to the fact that, wow, you can deliver non-invasively an ablation to the brain in a hypothesized zone that we think is related to the problem at hand.
它治疗患者的一侧，通常是他们的惯用手或最差的手，这确实说明了这样一个事实：哇，你可以在我们认为与当前问题相关的假设区域对大脑进行非侵入性消融。
And at least with tremor, it works really well.
至少对于颤抖来说，它的效果非常好。
Could this be effective for psychiatric disease, obesity, eating disorders?
这对精神疾病、肥胖、饮食失调有效吗？
Well, perhaps.
嗯，也许吧。
Actually, that would be the ideal.
事实上，这将是理想的情况。
The problem is we don't know where to do the ablation.
问题是我们不知道在哪里进行消融。
There is a trial that we would like to do for OCD, where we would deliver an ablation to the same area of the brain that we've been delivering ablations to for years for patients with OCD, and it helps a bit.
我们想针对强迫症进行一项试验，我们将对强迫症患者的大脑同一区域进行消融，多年来我们一直在对强迫症患者进行消融，这会有所帮助。
That's called a capsulotomy.
这就是所谓的囊切开术。
But really, the outcome is probably going to be about the same.
但实际上，结果可能会大致相同。
It's a nice method because it's non-invasive, but we need to find a new target for these conditions.
这是一个很好的方法，因为它是非侵入性的，但我们需要为这些情况找到一个新的目标。
And because of the common denominator of the urge despite the risk, sort of that compulsion, perhaps it could be the same target.
由于尽管存在风险，但冲动的共同点，某种强迫性，也许它可能是同一个目标。
I don't know.
我不知道。
But I would argue we need to do these modulatory experiments, either with a device or with invasive recordings, to better understand where these problems are coming from to define where we should do an ultrasound treatment.
但我认为我们需要通过设备或侵入性录音进行这些调节实验，以更好地了解这些问题的根源，从而确定我们应该在哪里进行超声治疗。
So, you're right.
所以，你是对的。
Historically, without much regulation, we've probed the brain.
从历史上看，我们在没有太多监管的情况下探测了大脑。
The problem, we can't learn a lot from those experiments now, well, in this way at least.
问题是，我们现在无法从这些实验中学到很多东西，至少以这种方式。
We don't know exactly where those electrodes were.
我们不知道这些电极到底在哪里。
We didn't have MRI scanning or high-quality CAT scanning to know where those electrodes were with certainty.
我们没有 MRI 扫描或高质量 CAT 扫描来确定这些电极的位置。
And we know two or three millimeters matters.
我们知道两到三毫米很重要。
And we also didn't have the tools to place electrodes in a precise way back then.
当时我们也没有精确放置电极的工具。
So unfortunately, we can't learn a lot from those experiments right now, so we're sort of redesigning them.
不幸的是，我们现在无法从这些实验中学到很多东西，所以我们正在重新设计它们。
And there is a way to do it now.
现在有一种方法可以做到这一点。
Patients with epilepsy benefit from this all the time.
癫痫患者一直受益于此。
There has been a revolution in America, it was in Europe before it was in America, where we would do stereo encephalography, which is basically like doing an EEG of patients with epilepsy, but with invasive electrodes, and we would place tiny little wires, less than a millimeter in diameter, all throughout the brain into parts of the brain that we believe are involved in seizures And we would admit the patients to the hospital and figure out where the seizures were starting and propagating.
美国发生了一场革命，先是在欧洲，然后是在美国，我们会进行立体脑描记术，这基本上就像对癫痫患者进行脑电图检查一样，但是使用侵入性电极，我们会将直径小于一毫米的细小电线放置在整个大脑中，进入我们认为与癫痫发作有关的大脑部分。我们会将患者送入医院，并找出癫痫发作开始和传播的位置。
And then we could stimulate these electrodes to see if there was a symptom that was important, and try to identify a region that we thought we could either remove surgically, ablate with a laser, or put a stimulator in it, perhaps.
然后我们可以刺激这些电极，看看是否存在重要的症状，并尝试识别我们认为可以通过手术切除、用激光消融或在其中放置刺激器的区域。
That's commonplace now for epilepsy.
对于癫痫来说，这现在很常见。
And it works extremely well, and it's very safe.
而且它的效果非常好，而且非常安全。
Of course, it's still a brain procedure, but the complication rate is surprisingly low, quite honestly, for the amount of electrodes that we place.
当然，这仍然是一个大脑手术，但老实说，对于我们放置的电极数量来说，并发症发生率出奇地低。
And it's extremely well-tolerated.
而且它的耐受性非常好。
Most of these patients leave the hospital, and they don't even feel like they've had surgery.
大多数患者出院后，他们甚至感觉不到自己做过手术。
So there's actually a lot of interest in using that procedure to study mental health disorders.
因此，实际上人们对使用该程序来研究心理健康障碍很感兴趣。
We are trying to do it for patients with obsessive-compulsive disorder.
我们正在努力为强迫症患者做到这一点。
We're awaiting an FDA decision on that.
我们正在等待 FDA 对此的决定。
But actually, I credit our colleagues at Baylor and at UCSF for studying this already.
但实际上，我相信贝勒大学和加州大学旧金山分校的同事已经对此进行了研究。
We have fabulous colleagues at UCSF that have studied depression using this type of approach.
我们在加州大学旧金山分校有一些出色的同事，他们使用这种方法研究抑郁症。
A mutual friend of ours, Eddie Chang, who's a wonderful friend and colleague, somebody I've emulated for many years as well, and the psychiatry team at UCSF have worked together on this, bringing together the epilepsy technique and the psychiatry expertise to study how we could better target electrodes in depression.
我们共同的朋友艾迪·张（Eddie Chang）是一位很棒的朋友和同事，也是我多年来一直效仿的人，他和加州大学旧金山分校的精神病学团队在这方面进行了合作，将癫痫技术和精神病学专业知识结合起来，研究如何更好地针对抑郁症使用电极。
And I'll tell you, if they have a consistent target, perhaps there it becomes an ultrasound target.
我会告诉你，如果他们有一个一致的目标，也许它会成为超声波目标。
But right now, the approach is a bit more reversible because you can always shut that electrode off or even remove the electrode if perhaps it's not in the optimal location to treat the depression.
但现在，这种方法更具可逆性，因为如果电极不在治疗抑郁症的最佳位置，您可以随时关闭电极，甚至移除电极。
But actually, after a large volume of cases, perhaps they could pool that data to develop a new ultrasound target for depression.
但实际上，在大量病例之后，也许他们可以汇集这些数据来开发治疗抑郁症的新超声目标。
I think that would be fabulous and probably is their long-term goal.
我认为这将是非常棒的，并且可能是他们的长期目标。
Not to speak for them, but that would be something that I'm sure is on their radar.
不是为他们说话，但我确信这会是他们关注的事情。
And Baylor's trying to do the same thing for depression.
贝勒正在尝试为抑郁症做同样的事情。
Their approaches are a little bit different, but a similar tool to try to understand depression, and we're working with all of these types of colleagues, some of these are our friends, to try to bring this to OCD as well, and it makes sense to try to do this for addiction and obesity and anorexia.
他们的方法有点不同，但有一个类似的工具来尝试理解抑郁症，我们正在与所有这些类型的同事（其中一些是我们的朋友）合作，尝试将其也应用于强迫症，尝试针对成瘾、肥胖和厌食症这样做是有意义的。
You might ask, "Well, why aren't you doing this for obesity right now in our study?" And the reason is that we've developed a target for obesity and binge eating disorder, developed out of mice, that we believe is relevant for the human state because you can model this problem in a mouse a bit better than you can model depression or OCD.
你可能会问，“那么，在我们的研究中，为什么现在不针对肥胖采取这种做法呢？”原因是我们已经在老鼠身上开发出了肥胖和暴食症的目标，我们相信这与人类状态相关，因为你可以在老鼠身上模拟这个问题，比模拟抑郁症或强迫症要好一些。
So we feel like we can rely on the preclinical studies more, whereas with these perhaps more, I don't want to say more complicated, but more human mental health conditions that are hard to model in a mouse, you really have to study it in the human, and you can perhaps start in an epileptic patient, a patient that has electrodes, and try to provoke a depressed state or study epileptics like Dr. Chang has done that have comorbid depression, for example.
所以我们觉得我们可以更多地依赖临床前研究，而有了这些也许更多，我不想说更复杂，但更多的人类心理健康状况，很难在小鼠中建模，你真的必须在人类身上进行研究，你也许可以从癫痫患者开始，一个有电极的患者，并尝试引发抑郁状态或研究像张博士那样患有共病抑郁症的癫痫患者。
And that can really validate this approach as well.
这也确实可以验证这种方法。
But in the end, it's getting into the human brain that we need to do in the disease specifically, that will eventually lead to a non-invasive approach, either a lesion or modulatory approach.
但最终，我们需要进入人类大脑来专门治疗这种疾病，这最终将导致一种非侵入性方法，无论是损伤方法还是调节方法。
Modulatory would be like TMS or lesion approach would be with ultrasound.
调节就像 TMS 一样，或者病变方法就像超声波一样。
Andrew Huberman:
安德鲁·休伯曼：
I couldn't agree more.
我完全同意。
Meanwhile, because there are many, many millions of people suffering from depression, eating disorders, Parkinson's, and essential tremor, et cetera.
同时，因为有数以百万计的人患有抑郁症、饮食失调、帕金森氏症和特发性震颤等。
Well, first of all, I should say, based on everything you've told me thus far, it's amazing to me that any pharmacologic treatments work because of how systemic they are-
好吧，首先，我应该说，根据你迄今为止告诉我的一切，令我惊讶的是，任何药物治疗都有效，因为它们是系统性的——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and impacting serotonergic neurons over here and dopaminergic neurons over there and not targeting any specific batch of cells.
影响这里的血清素能神经元和那里的多巴胺能神经元，而不是针对任何特定批次的细胞。
It makes perfect sense as to why all the side effects exist.
对于为什么存在所有副作用，这是完全有道理的。
But earlier you said something that really grabbed my attention I want to come back to, which is that if people can be made to feel or make themselves feel just a little bit better, a little less anxious just prior to a craving episode or a binge episode, maybe even if people can become better at detecting their own internal states and when they're veering toward a binge or veering toward using a drug or maybe even veering towards suicidal thinking.
但之前你说了一些真正引起我注意的事情，我想回到这里，那就是，如果人们能够在渴望发作或暴饮暴食之前感觉或让自己感觉好一点，少一点焦虑，也许即使人们可以更好地检测自己的内部状态，以及当他们转向暴饮暴食或转向使用药物，甚至可能转向自杀想法时。
Based on what you said earlier, that those pre-behavioral states on the drift on the steering , those sound like powerful levels of awareness, at least for now, until we have specific sites in the brain that we can target non-invasive methods that could be deployed to millions and millions of people.
根据您之前所说，转向漂移时的那些前行为状态，听起来像是强大的意识水平，至少目前如此，直到我们在大脑中找到可以针对数百万人部署的非侵入性方法的特定位点。
Seems like that awareness seems like maybe among the best tools that people could develop.
似乎这种意识可能是人们可以开发的最好工具之一。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes, 100% agree with you.
是的，100%同意你的观点。
Andrew Huberman:
安德鲁·休伯曼：
So for the person with OCD or who suffers from anorexia or binge eating disorder and to their clinicians, I just want to highlight that you said that.
因此，对于患有强迫症或患有厌食症或暴食症的人以及他们的临床医生，我只想强调你说过这一点。
Again, I'm not a clinician.
再说一遍，我不是临床医生。
I always say this.
我总是这么说。
I don't prescribe anything.
我不开任何处方。
I profess things.
我承认事情。
But awareness of one's thinking seems immensely powerful in this context.
但在这种情况下，对自己思维的认识似乎非常强大。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And after all, it is the clinical probe that you use because let's say the patient were to lie to you about their experience of what happens in their mind when you stimulate, basically the whole thing, the whole surgery, the whole procedure could go badly wrong.
毕竟，这是你使用的临床探针，因为假设病人要向你撒谎，告诉你当你刺激时他们的脑海中会发生什么，基本上整个事情，整个手术，整个过程都可能会出现严重错误。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
So it's up to the patient to be, of course, honest with you, and they're-
因此，当然，病人是否要对你诚实，他们是——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
incentivized to do that, but to be honest with themselves about, "Ah, I've gone all day without a binge." But the smell of a donut or the thought of a donut is starting to have a particular allure.
这样做的动机，但要诚实地告诉自己，“啊，我一整天都没有暴饮暴食。”但甜甜圈的气味或甜甜圈的想法开始具有特殊的吸引力。
That awareness seems like an incredibly powerful thing to own and to build and cultivate.
这种意识似乎是一种非常强大的东西，需要拥有、建立和培养。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
I've always thought that if we can improve awareness, we can improve outcomes.
我一直认为，如果我们能够提高意识，我们就能改善结果。
I think that's probably true for many of these patients.
我认为对于这些患者中的许多人来说可能都是如此。
The problem, I think, comes down to the fact that some of these patients are so resistant to treatment, and the patients that we see as a surgeon, for example, are the patients that they've tried cognitive behavioral therapy, certainly have tried medications, they've tried behavioral management.
我认为，问题归结于这样一个事实：其中一些患者对治疗非常抵触，例如，我们作为外科医生看到的患者是他们尝试过认知行为疗法的患者，当然也尝试过药物治疗，他们尝试过行为管理。
They are aware of their problem, and they've shown that to us.
他们意识到了自己的问题，并且已经向我们展示了这一点。
They can tell us when they're craving.
他们可以告诉我们他们什么时候想吃。
But despite the craving and despite being involved in this invasive brain surgical trial, highly first-in-human novel study, which I think will have a positive effect, but it's still experimental.
尽管渴望并参与这项侵入性脑外科试验，这是一项高度首次的人体新颖研究，我认为这将产生积极的效果，但它仍然处于实验阶段。
They still can't stop themselves.
他们仍然无法阻止自己。
So they're sort of as made aware as could possibly be.
所以他们尽可能地被意识到了。
Did I use grammar there correctly?
我在那里使用的语法正确吗？
I think so.
我想是的。
They're as aware as they could possibly be, and they still lose control.
他们尽其所能地意识到，但他们仍然失去控制。
We've had this studied in the lab.
我们已经在实验室对此进行了研究。
So we will bring patients to the laboratory with this implanted device to try to provoke this electrographic electrical signal that can be detected by the actual device that will stimulate them when they're at home.
因此，我们将带着这种植入设备将患者带到实验室，尝试激发这种电描记电信号，该信号可以被实际设备检测到，当他们在家时会刺激他们。
But before we actually initiate stimulation, we want to see, can this device detect this craving cell signal?
但在我们真正开始刺激之前，我们想看看这个设备能否检测到这种渴望细胞信号？
Which is going to be different than what we saw in the operating room because that's a single cell.
这与我们在手术室看到的不同，因为那是一个单细胞。
But these devices, these electrodes, are about a millimeter in diameter instead of a tenth of a millimeter, which is what we use in the operating room.
但这些设备、这些电极的直径约为一毫米，而不是我们在手术室使用的十分之一毫米。
So they're only hearing, or detecting I should say, thousands of cells' responses.
所以他们只是听到，或者我应该说，检测到数千个细胞的反应。
And we actually have a way to provoke binges.
我们实际上有办法引发暴饮暴食。
It's called a mood provocation.
这就是所谓的情绪挑衅。
It's very well-validated.
这是经过充分验证的。
It's a little bit like provoking seizures in the epilepsy monitoring unit, but here, in the psychiatric monitoring unit or the food monitoring unit, we actually have a psychiatrist, an eating disorder specialist, come and induce a mood that is related to each patient's self-described binge episode.
这有点像在癫痫监测单元中引发癫痫发作，但在这里，在精神监测单元或食物监测单元中，我们实际上有一位精神科医生，一位饮食失调专家，来诱发与每个患者自我描述的暴饮暴食事件相关的情绪。
Andrew Huberman:
安德鲁·休伯曼：
So the psychiatrist comes in and provokes-
于是精神科医生进来并挑衅——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
a feeling that can evoke the negative behavior.
一种可能引发消极行为的感觉。
Dr. Casey Halpern:
凯西·哈尔彭博士：
That's exactly right.
完全正确。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So that we can video and synchronize the video to the brain signal recordings.
这样我们就可以录像并将视频同步到大脑信号记录中。
The patients all wear an eye tracker so we can see what they're eating at all times and what they're looking at specifically.
患者都戴着眼动仪，这样我们就可以随时看到他们在吃什么以及他们具体在看什么。
And that allows us to have the best temporal resolution possible to understand what is happening right before the bite.
这使我们能够拥有尽可能最佳的时间分辨率，以了解被咬之前发生的情况。
And even under video surveillance through a one-way mirror in a laboratory setting, when patients are very well aware that they're there to be studied if they're going to binge, they still do.
即使在实验室环境中通过单向镜进行视频监控，当患者非常清楚自己是否要暴饮暴食时，他们仍然会暴饮暴食。
And we believe they do because they just can't control it, as aware as they are of it.
我们相信他们这样做是因为他们无法控制它，尽管他们意识到这一点。
And it's probably because they're the most severe.
这可能是因为它们是最严重的。
So I think if we can improve awareness, not just the societal awareness that I was talking about earlier, but the patient awareness around their problem, I think that could be a powerful way to help so many of these patients, and that's sort of the role of cognitive behavioral therapy.
所以我认为，如果我们能够提高意识，不仅仅是我之前谈到的社会意识，而是患者对其问题的意识，我认为这可能是帮助这么多患者的有效方法，这就是认知行为疗法的作用。
The problem with cognitive behavioral therapy, or I should say the limitation of it, I actually don't have any problem with it, I think it's a wonderful treatment, is that if you stop it, many of these patients go back to their old behaviors.
认知行为疗法的问题，或者我应该说它的局限性，实际上我对它没有任何问题，我认为这是一种很棒的治疗方法，就是如果你停止它，许多患者会回到原来的行为。
I don't want to say old habits, but it might be a habit, but the old behaviors.
我不想说旧习惯，但这可能是一种习惯，而是旧行为。
And so, that's the problem, is it's not necessarily lasting in the absence of continued cognitive behavioral therapy.
所以，这就是问题所在，如果没有持续的认知行为治疗，它不一定会持久。
Some people can benefit from it long-term, but some can't.
有些人可以长期受益，但有些人则不能。
But I think in the less severe patients, improving awareness is key.
但我认为对于病情不太严重的患者，提高意识是关键。
But in these really refractory patients, this is the disease.
但在这些真正难治的患者中，这就是疾病。
Despite the awareness, they can't control themselves.
尽管他们有意识，但他们无法控制自己。
And that's what we're trying to restore is that improved ability to control their behavior.
这就是我们试图恢复的，就是提高控制他们行为的能力。
Andrew Huberman:
安德鲁·休伯曼：
Do you think there's a role for machines and artificial intelligence here?
您认为机器和人工智能在这里能发挥作用吗？
There are a couple laboratories up at the University of Washington that are using particular signature patterns within voice to try and help people who are suicidally depressed know when they're headed towards an episode before they even can consciously know.
华盛顿大学有几个实验室正在使用声音中的特定特征模式来尝试帮助那些有自杀倾向的抑郁症患者在他们有意识地知道之前就知道他们何时会陷入困境。
So this gets right down to issues of free will and whether or not machines can be smarter than we are.
因此，这直接涉及到自由意志以及机器是否可以比我们更聪明的问题。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But one could argue that some of the search algorithms on Google and other search engines are actually more aware of our preferences than we are.
但有人可能会说，谷歌和其他搜索引擎上的一些搜索算法实际上比我们更了解我们的偏好。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Basically, what these are, these are devices that are listening to people talk all day.
基本上，这些是什么，这些是整天听人们说话的设备。
They're also paying attention to patterns of breathing and how well people slept, et cetera.
他们还关注呼吸模式和人们的睡眠质量等等。
Integrating a huge number of cues and then signaling somebody with a yellow light, like, "You're headed into a depressive episode." And the person might say, "I feel fine," or, "I feel pretty good.
整合大量的线索，然后用黄灯向某人发出信号，比如“你正陷入抑郁期”。这个人可能会说，“我感觉很好”，或者“我感觉很好。
This is baseline state for me." And they say, "Uh-uh.
这对我来说是基线状态。”他们说：“呃呃。
This is where you were proceeding the last episode that took you down a deep, dark trench and it took months to get out of."
这是你进行最后一集的地方，它把你带入了一条又深又黑的沟渠，花了几个月的时间才摆脱出来。”
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yep.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I wonder whether or not some of these devices could help with the sorts of things that we're talking about today.
我想知道其中一些设备是否可以帮助解决我们今天讨论的各种问题。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
I think so.
我想是的。
I've always said we have to get in the brain before we get out of it, and if we get in the brain and understand what these signals look like, we'll know what those non-invasive signals are.
我总是说，我们必须先进入大脑，然后才能离开它，如果我们进入大脑并了解这些信号是什么样子，我们就会知道那些非侵入性信号是什么。
I think it's possible that we are scientifically sophisticated enough to use machine learning, and sort of this kind of bot technique, to anticipate when somebody is going to be highly impulsive.
我认为我们在科学上可能足够复杂，可以使用机器学习和某种机器人技术来预测某人何时会高度冲动。
Suicide's the most dangerous impulse.
自杀是最危险的冲动。
It's something that is Immensely a focus of the lab is impulsivity.
实验室的一大焦点是冲动。
We've talked mostly about compulsion.
我们主要讨论的是强迫症。
Compulsion being going after a reward or the urge despite the risk.
强迫性地追求奖励或不顾风险的冲动。
Impulsivity is similar but different.
冲动相似但又不同。
It's going after something a little bit...
它正在追求一些东西......
If you model impulsivity in a mouse, it's related to going after a food reward without the sort of paired tone that the mouse is supposed to wait for.
如果你模拟老鼠的冲动，它与追求食物奖励有关，而没有老鼠应该等待的配对音调。
The mouse doesn't want to wait anymore.
老鼠不想再等了。
They just go after the food.
他们只是追求食物。
Andrew Huberman:
安德鲁·休伯曼：
I've been that mouse.
我就是那只老鼠。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, we all have been.
是的，我们都经历过。
We can all relate with this to a certain extent.
我们都可以在某种程度上理解这一点。
Again, it's a spectrum.
再说一次，它是一个频谱。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So in any case, a non-sequitur, but I certainly think that there is a way to use our own body's physiology to anticipate when these impulses are coming online.
所以无论如何，这是不合逻辑的，但我当然认为有一种方法可以利用我们自己身体的生理机能来预测这些冲动何时出现。
How best to do that, I think we're just scratching the surface, but these are the kinds of solutions we need.
如何最好地做到这一点，我认为我们只是触及了表面，但这些正是我们需要的解决方案。
Some of these problems are of epidemic proportions, the largest public health problems in this country, in this world, obesity, opiate crisis, depression-
其中一些问题已成为流行病，是这个国家、这个世界上最大的公共卫生问题，肥胖、鸦片危机、抑郁症——
Andrew Huberman:
安德鲁·休伯曼：
Yeah
是啊
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
suicidality.
自杀倾向。
That's like a third of our country, maybe more.
这相当于我们国家的三分之一，甚至更多。
Probably more if you think about it.
如果你仔细想想，可能会更多。
Andrew Huberman:
安德鲁·休伯曼：
And a colleague of ours at Stanford Psychiatry told me something that still just blows my mind, which is that something like 75% of the antidepressant and anti-anxiety medication that exists in the world is consumed in the United States.
我们斯坦福大学精神病学部的一位同事告诉我一些至今仍令我震惊的事情，那就是世界上 75% 的抗抑郁和抗焦虑药物都是在美国消费的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
It's amazing.
太棒了。
Andrew Huberman:
安德鲁·休伯曼：
Which is an outrageous number.
这是一个令人震惊的数字。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
We do have an obsession in this country for pharmacy.
在这个国家，我们确实对药房有着痴迷。
And the pharmaceutical industry is very powerful here, and probably related to some aspect of capitalism.
而且制药业在这里非常强大，可能与资本主义的某些方面有关。
I'm capitalistic, just like everybody else, but I do worry about that a little bit.
我和其他人一样是资本主义的，但我确实有点担心这一点。
But we tend to over-prescribe, and I think we, as patients, tend to over want medication.
但我们往往会过度开药，而且我认为，作为患者，我们往往会过度想要药物治疗。
We like quick solutions, and sometimes medications provide it, sometimes not, or they're often just a Band-Aid.
我们喜欢快速解决问题，有时药物可以提供这种解决方案，有时则不能，或者它们通常只是创可贴。
Depends on the problem, of course.
当然，取决于问题。
But I agree that we need scalable solutions.
但我同意我们需要可扩展的解决方案。
But I'm a neurosurgeon.
但我是一名神经外科医生。
I'm only going to be able to treat the most severe of patients with these problems.
我只能治疗患有这些问题的最严重的患者。
We've only done about 200,000 deep brain stimulation surgeries ever.
我们迄今为止只做过大约 20 万例脑深部刺激手术。
So the problem we're talking about here is 50 million Americans.
所以我们在这里讨论的问题是5000万美国人。
There's no possibility that surgeons can address that problem.
外科医生不可能解决这个问题。
But we could help inspire an initiative to go after that kind of problem, or help make it more rigorous.
但我们可以帮助激发解决此类问题的主动性，或者帮助使其更加严格。
Because the last thing we need is some sort of wearable fancy tool that wastes people's money and time.
因为我们最不需要的就是某种浪费人们金钱和时间的可穿戴奇特工具。
We need real therapies for these things.
我们需要针对这些事情的真正疗法。
Not that these devices that we're discussing are not.
但这并不是说我们正在讨论的这些设备不是。
I think actually there's lots of promise.
我认为实际上有很多希望。
We use machine learning in the lab all the time.
我们一直在实验室中使用机器学习。
I'm not an electrical engineer or the computational neuroscientist doing this type of work.
我不是从事此类工作的电气工程师或计算神经科学家。
I just help develop the hypotheses around it, and help fundraise around it.
我只是帮助围绕它提出假设，并帮助围绕它筹集资金。
But I definitely think there's a future for it.
但我绝对认为它有未来。
I suspect we're scratching the surface on how best to do it.
我怀疑我们只是在探讨如何最好地做到这一点。
Andrew Huberman:
安德鲁·休伯曼：
Let's talk about your hands.
我们来谈谈你的手。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
All the neurosurgeons I know very faithfully protect their hands.
我认识的所有神经外科医生都非常忠实地保护自己的双手。
And let's talk about-
我们来谈谈——
Dr. Casey Halpern:
凯西·哈尔彭博士：
It's because hand insurance is too expensive.
因为手部保险太贵了。
Andrew Huberman:
安德鲁·休伯曼：
That's right.
没错。
But I'm guessing that you all are not the ones to reach into the garbage disposal, even if your eye is on the switch to make sure that that isn't going to get turned on.
但我猜你们都不是那些把手伸进垃圾处理器的人，即使你们的眼睛盯着开关以确保它不会打开。
They're just too precious.
它们太珍贵了。
They are your livelihood.
他们是你的生计。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And earlier, we talked about deadlifts.
早些时候，我们讨论过硬拉。
There are other forms of exercise.
还有其他形式的锻炼。
There are things like tennis.
有一些事情，比如网球。
There's drawing and painting, a full range of things that one can do with their hands.
有绘画，一整套可以用手做的事情。
Use your imagination, folks.
发挥你的想象力，伙计们。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
Is it true that neurosurgeons don't do any really heavy grip activity because it can refine the motor circuits in the brain and elsewhere that can throw off their neurosurgery game?
神经外科医生是否真的不做任何真正的重握力活动，因为它可以改善大脑和其他地方的运动回路，从而摆脱他们的神经外科游戏？
Dr. Casey Halpern:
凯西·哈尔彭博士：
I would say that many neurosurgeons avoid activities that put their hands at risk.
我想说，许多神经外科医生都会避免进行会让他们的手处于危险之中的活动。
Another one, by the way, there's an annual softball tournament that neurosurgeons come to in New York City, in Central Park, and they play.
顺便说一句，还有一年一度的垒球锦标赛，神经外科医生来到纽约中央公园参加比赛。
Andrew Huberman:
安德鲁·休伯曼：
With a very soft ball.
用一个非常柔软的球。
No, I'm just kidding.
不，我只是开玩笑。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Well, it's actually a very typical hard softball.
嗯，这实际上是一个非常典型的硬垒球。
I don't know why they call it softball.
我不知道为什么他们称之为垒球。
And actually, two close colleagues of mine have gotten injured at that tournament.
事实上，我的两位亲密同事在那场比赛中受伤了。
Andrew Huberman:
安德鲁·休伯曼：
It's also, I must say, and here I'm poking fun, but for those of you who are going in the medical profession, it's also one of the more, how should I say this?
我必须说，这也是我在这里开玩笑的，但是对于你们这些从事医学行业的人来说，这也是其中之一，我该怎么说呢？
Well, I'm just going to say it.
好吧，我只是说说而已。
There's a steep hierarchy of training in neurosurgery.
神经外科培训有严格的等级制度。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
There's a certain harshness that's been conveyed to me about the training, much like astronaut training-
训练向我传达了一定的严厉性，就像宇航员训练一样——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
to be totally fair.
完全公平。
And so maybe this is a tactic to weed out either the younger or the older generation.
因此，这也许是一种淘汰年轻一代或老一代的策略。
Dr. Casey Halpern:
凯西·哈尔彭博士：
This is evolution, right?
这就是进化，对吗？
We have to evolve and-
我们必须进化并且——
Andrew Huberman:
安德鲁·休伯曼：
Wean medical training
断奶医学培训
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
weed out the weak, I guess.
我想，淘汰弱者吧。
Well, I could say that one of the individuals that got injured is one of the more senior surgeons that I work with now and is one of the best athletes that I know, and he's definitely not weak.
好吧，我可以说受伤的人之一是我现在共事的一位资深外科医生，也是我认识的最好的运动员之一，而且他绝对不弱。
But you can get injured playing these sports.
但参加这些运动可能会受伤。
And that being said, I can tell you briefly is, it's funny, my mother came to me recently.
话虽如此，我可以简单地告诉你的是，这很有趣，我妈妈最近来找我。
She has osteopenia, and she told me her doctor told her she's not allowed to do deadlifts, and I was like, "Okay.
她患有骨质减少症，她告诉我她的医生告诉她不允许她做硬拉，我当时想，“好吧。
That's fine.
没关系。
I'm not telling you you should do deadlifts.
我并不是告诉你应该做硬拉。
I just don't exactly understand the relationship." But I can say that I do think...
我只是不太明白其中的关系。”但我可以说我确实认为...
I'll give you a little story here.
我在这里给你讲一个小故事。
The reason why I'm being a little hesitant to confirm that I agree with you on the deadlifts is, when I was operating, this was when I was at Stanford University operating, and As I mentioned earlier, we get an intraoperative CAT scan to confirm accuracy of our lectures.
我之所以有点犹豫是否同意你关于硬拉的观点，是因为当我在做手术时，那是我在斯坦福大学做手术的时候，正如我之前提到的，我们进行了术中 CAT 扫描来确认我们讲座的准确性。
I do this for all of my surgeries.
我所有的手术都是这样做的。
When I was reviewing that CAT scan, the X-ray technician looked at me and whispered into my ear.
当我检查 CAT 扫描时，X 射线技术人员看着我，并在我耳边低语。
He's like, "Your posture is really bad.
他说：“你的姿势实在是太糟糕了。”
It's embarrassing."
这很尴尬。”
Andrew Huberman:
安德鲁·休伯曼：
Your physical posture-
你的身体姿势——
Dr. Casey Halpern:
凯西·哈尔彭博士：
My posture
我的姿势
Andrew Huberman:
安德鲁·休伯曼：
...
...
while doing your surgeries?
在做手术时？
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Uh-huh.
嗯嗯。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And I looked at him and I kind of wanted to say I won't curse, but-
我看着他，我想说我不会咒骂，但是——
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I was getting you in my back .
是的，我在背后支持你。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah, exactly.
是的，完全正确。
I've been doing it intermittently during our conversation because he made me realize that I really did have bad posture.
在我们的谈话中我一直断断续续地这样做，因为他让我意识到我的姿势确实不好。
And we kind of had a little brief aside, and I learned he was a personal trainer, and his name was Zach.
我们聊了一会儿，我了解到他是一名私人教练，他的名字叫扎克。
And he said to me, "Your posture is poor because you're weak.
他对我说：“你的姿势很糟糕，因为你很虚弱。
You need to strengthen your body and strengthen your core." I was like, "How?" He's like, "Power lifting." And I'm like, "I'm a little hesitant to do this." And I'll tell you, I started very slowly, and I can't prescribe power lifting to everybody for the exact reason you said.
你需要增强你的身体并增强你的核心。”我当时想，“怎么样？”他就像是“举重”。我想，“我有点犹豫要不要这样做。”我会告诉你，我开始的速度非常慢，而且我不能因为你所说的确切原因给每个人开举重处方。
And I've gotten hurt doing it, by the way.
顺便说一句，我在做这件事时受伤了。
But I do think I wish I started a little younger, and I would argue that with close supervision and if you have a very experienced trainer, which I would argue if you're a neurosurgeon or an astronaut, or have a highly specialized profession where you need your limbs to function, dentists, things like that.
但我确实认为我希望我开始得更年轻一些，我会说，在密切的监督下，如果你有一个非常有经验的教练，我会说如果你是神经外科医生或宇航员，或者有一个高度专业化的职业，你需要你的四肢发挥作用，牙医，类似的人。
If you're going to take something on like this, it really needs to be extremely carefully supervised.
如果你要承担这样的事情，确实需要非常仔细的监督。
And I can tell you that my trainer had a profound impact on my life and my posture and my physical health.
我可以告诉你，我的教练对我的生活、我的姿势和我的身体健康产生了深远的影响。
And so we did deadlift, I'll admit.
我承认，我们做了硬拉。
So when you brought it up, I kind of chuckled to myself.
所以当你提起这件事时，我有点笑了。
But, yes, I have gotten mildly hurt deadlifting, but it was when I was doing it by myself and I was kind of cocky and I wasn't paying attention.
但是，是的，我在硬拉时受到了轻微伤害，但那是当我自己做的时候，我有点自大，没有注意。
But when I was with him and he was all over my technique, it actually was the most efficient way for me to feel stronger, and it improved my posture, significantly.
但当我和他在一起时，他对我的技术很全面，这实际上是让我感觉更强壮的最有效方法，并且它显着改善了我的姿势。
And I miss him since I've left California.
自从我离开加州后我就想念他。
I have a new trainer in Philadelphia who's great, and I still deadlift occasionally with him.
我在费城有一位很棒的新教练，我仍然偶尔和他一起硬拉。
But I can say I am opposed to deadlifting callously, but if you're extremely well-monitored by an experienced personal trainer or weightlifter, I think it actually could be a great exercise .
但我可以说我冷酷地反对硬拉，但如果你受到经验丰富的私人教练或举重运动员的严格监督，我认为这实际上可能是一项很好的锻炼。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
I'd love to be wrong in this case- ...
在这种情况下我很乐意犯错——...
because I'm a huge proponent, and on the podcast I go on and on.
因为我是一个坚定的支持者，并且在播客上我不停地讲。
There's so much data now pointing to the fact that 180 to 200 minutes of Zone 2 cardio, kind of jogging, cycling, swimming-type behavior is very healthy for everybody, and we should all be doing that, at least that.
现在有大量数据表明，180 到 200 分钟的 2 区有氧运动、慢跑、骑自行车、游泳等行为对每个人都非常健康，我们都应该这样做，至少这样做。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
I need to as well.
我也需要。
Andrew Huberman:
安德鲁·休伯曼：
And that resistance training on the order of six hard sets per muscle group per week is really important just to offset deterioration of muscles and-
每周每个肌群进行六组高强度的阻力训练对于抵消肌肉的退化非常重要，而且——
Dr. Casey Halpern:
凯西·哈尔彭博士：
I'm learning as we go here
当我们来到这里时我正在学习
Andrew Huberman:
安德鲁·休伯曼：
...
...
skeletal function and tendon strength, and that's just to maintain.
骨骼功能和肌腱强度，这只是维持。
We're not talking about all-out sets to absolute failure, but as you point out, with proper form.
我们并不是在谈论全力以赴的绝对失败，而是正如您所指出的，以适当的形式。
So even-
所以甚至——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
the neurosurgeons are doing this, which I think is wonderful.
神经外科医生正在做这件事，我认为这很棒。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
As a final question, or maybe second to final question, earlier I commented on the remarkable calm, at least perceived calm of neurosurgeons.
作为最后一个问题，或者也许是倒数第二个问题，早些时候我评论了神经外科医生非凡的冷静，至少是感知到的冷静。
It could be cause or could be effect of the training.
这可能是训练的原因，也可能是训练的结果。
But it's obvious to me why one would want that trait in their neurosurgeon.
但对我来说，很明显为什么人们希望他们的神经外科医生具有这种特质。
I wouldn't want a hyperactive, certainly not an impulsive neurosurgeon, given that the margins of error are so, so tiny-
我不想要一个多动的神经外科医生，当然也不想要一个冲动的神经外科医生，因为误差幅度是如此、如此之小——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
on a spatial scale, and probably on a temporal scale, too.
在空间尺度上，也可能在时间尺度上。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
You don't want people doing things in time or being spontaneous at all.
你不希望人们及时做事或者完全自发地做事。
Do you think that this branch of medicine that you're in selects for people that at least can know how to control any kind of fluctuations in autonomic arousal, they can calm themselves in real time?
你认为你所在的这个医学分支选择的人至少能够知道如何控制自主神经兴奋的任何波动，他们可以实时平静自己吗？
And here's a specific question.
这是一个具体问题。
One, I've never operated on the human brain, although I've had the privilege of being in the operating room and seeing this with some of our experiments with people in VR.
第一，我从未对人脑进行过手术，尽管我有幸进入手术室并在 VR 中对人进行的一些实验中看到了这一点。
It's a remarkable thing.
这是一件了不起的事情。
I wish for everybody they would get this experience at some point, not hopefully as a patient unless they have a need, but to observe it.
我希望每个人都能在某个时刻获得这种体验，除非他们有需要，否则希望不是作为患者，而是观察它。
But what was just striking to me is the various stereotype behaviors of the surgeon.
但令我震惊的是外科医生的各种刻板行为。
And when I did surgeries as a graduate student, as a postdoc in the brains of other types of animals, I would find, for instance, that if I started to tremble a little bit, if I tapped my left foot, that my hand would stabilize a bit.
当我作为研究生或博士后对其他类型动物的大脑进行手术时，我会发现，例如，如果我开始稍微颤抖，如果我轻敲左脚，我的手就会稳定一点。
That there's this kind of need to move the body, or one feels the impulse.
存在着这种移动身体的需要，或者说人们感受到了这种冲动。
Maybe that's my-
也许这就是我的——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
Tourette's-like compulsions again.
抽动秽语样强迫症再次出现。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Could be.
可能是。
Andrew Huberman:
安德鲁·休伯曼：
But that one can kind of siphon off some of that energy into another limb so that you could remain precise.
但那个人可以将一些能量吸到另一个肢体中，这样你就可以保持精确。
So are these sorts of things that I'm talking about, maybe it's entirely my imagination, but are these the sorts of things that one learns as a neurosurgeon, how to still the body and still the mind?
那么我所说的这些东西是不是，也许这完全是我的想象，但是这些是作为一名神经外科医生要学习的东西吗？如何让身体和心灵平静下来？
Do you have a meditative practice?
你有冥想练习吗？
When you go into the operating room, if you had a particularly challenging morning or a poor night's sleep, do you have tools that you use to calibrate yourself and get yourself into the zone?
当您进入手术室时，如果您度过了一个特别具有挑战性的早晨或睡眠质量不佳，您是否有工具可以用来校准自己并让自己进入状态？
I think this would be very interesting for people to get some insight into, even if they don't want to be a neurosurgeon.
我认为，即使人们不想成为一名神经外科医生，了解这一点也会非常有趣。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Yeah.
是的。
I completely agree, and I appreciate the earlier reference to neurosurgeons as astronauts, because I've also heard us compared to cowboys before, and-
我完全同意，并且我很欣赏之前将神经外科医生称为宇航员的说法，因为我以前也听过我们与牛仔进行比较，并且-
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
it's a little bit less flattering.
有点不太讨人喜欢。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Some of what we do surgically really does require a substantial amount of confidence, and that confidence hopefully comes from years of training and experience.
我们所做的一些手术确实需要很大的信心，而这种信心希望来自多年的培训和经验。
You always worry that the confidence is sort of misplaced, and that is problematic.
你总是担心信心有点错位，这是有问题的。
Luckily, you so rarely see that because our training is so rigorous.
幸运的是，你很少看到这种情况，因为我们的训练非常严格。
We have American Board of Neurological Surgeons that Sort of allows and assesses surgeons to continue practice and holds us to a really high bar.
我们有美国神经外科医生委员会，它可以允许和评估外科医生继续执业，并让我们保持很高的标准。
I do think it tends to attract a certain personality.
我确实认为它往往会吸引某种个性。
In my subspecialty, as a deep brain stimulation surgeon, we call it stereotactic and functional neurosurgery.
在我的专业领域，作为一名深部脑刺激外科医生，我们称之为立体定向和功能神经外科。
Some people have likened us to the neurologists with a scalpel.
有些人把我们比作拿着手术刀的神经科医生。
We tend to be a bit more intellectual, maybe bedside manner is a little bit friendlier.
我们往往更加理智一点，也许床边的态度更加友好一点。
And then there's the vascular neurosurgeon who doesn't sleep, and so they're not as friendly.
还有血管神经外科医生不睡觉，所以他们不那么友好。
There's the spine surgeons who operate the most, and so they're busy.
脊柱外科医生做手术最多，所以他们很忙。
There are some of these kind of reputations going around, but I agree with you, there's a sort of a common feature of a calmness across neurosurgeons.
有一些这样的声誉，但我同意你的观点，神经外科医生有一个共同的特征，那就是冷静。
And they're some of my, obviously, my favorite people, my closest friends.
显然，他们是我最喜欢的人，我最亲密的朋友。
And I can relate with them probably because of that.
也许正因为如此，我才能与他们产生共鸣。
Sort of a big picture.
有点像一幅大图。
They don't get flustered.
他们不会慌乱。
They tend to be really good at figuring out how to have quality time because we work really hard.
他们往往非常擅长弄清楚如何度过美好时光，因为我们工作非常努力。
Our hours are significant, and so the time with our families, our friends, is less than we would like it to be.
我们的时间很长，因此与家人、朋友在一起的时间比我们希望的要少。
Obviously, that's true for people who work hard across any profession, but definitely true for neurosurgeons.
显然，这对于在任何职业中努力工作的人来说都是如此，但对于神经外科医生来说绝对如此。
And I think that we're very good at figuring out how to make that time high quality.
我认为我们非常擅长弄清楚如何让这段时光变得高质量。
Even just texting with some of my friends that are neurosurgeons, a great friend of mine just became chairman at Duke, and just connecting with him by text, which takes seconds, we feel connected.
即使只是和我的一些神经外科医生朋友发短信，我的一个好朋友刚刚成为杜克大学的董事长，仅仅通过短信与他联系，这需要几秒钟，我们就感到联系在一起。
And I think that's a trait amongst neurosurgeons.
我认为这是神经外科医生的一个特点。
We sort of know how to cut to the chase in a way and prioritize our time.
我们知道如何以某种方式切入正题并优先考虑我们的时间。
It's a skill that we probably have innately, but it's also part of the training.
这是我们与生俱来的技能，但也是训练的一部分。
When we are interns now, there's a lot of work hour regulations that is probably quite appropriate, by the way.
顺便说一句，当我们现在是实习生时，有很多工作时间规定可能非常合适。
I think our hours before were bordering on not necessarily...
我想我们之前的几个小时不一定是......
Let's just say they were not ideal for mental health and sleep, which we know are very important components.
我们只能说，它们对于心理健康和睡眠来说并不理想，而我们知道这是非常重要的组成部分。
Certainly, we had no time for meditation.
当然，我们没有时间冥想。
I definitely did not.
我绝对没有。
I wish I did.
我希望我做到了。
Now, knowing what I know about meditation, my wife's a health coach, I get it, I see it, I practice it myself with her.
现在，了解我对冥想的了解，我的妻子是一名健康教练，我明白了，我看到了它，我自己和她一起练习。
I see the value.
我看到了价值。
I wish I had that tool when I was in training because it's stressful.
我希望我在训练时有这个工具，因为压力很大。
Even with the work hour restrictions, we still don't sleep very much.
即使有工作时间限制，我们仍然睡得不多。
We're still at work a lot, about 80 hours a week.
我们仍然工作很多，每周大约 80 小时。
Andrew Huberman:
安德鲁·休伯曼：
Throughout the entire career?
贯穿整个职业生涯？
Dr. Casey Halpern:
凯西·哈尔彭博士：
There are times when it's more, because after training, there's no work hour restrictions.
有时会更多，因为培训后就没有工作时间限制了。
So sometimes I feel like as faculty, we get abused, and the trainees are a little bit more protected now.
所以有时我觉得作为教师，我们受到了虐待，而学员现在受到了更多的保护。
It definitely was the reverse at one point.
在某一时刻，情况肯定是相反的。
That's also a huge problem.
这也是一个很大的问题。
Probably more of a problem.
恐怕问题更大了。
And I'm joking a little bit.
我是开玩笑的。
I don't necessarily think we're abused, but certainly our hours are significant.
我不一定认为我们受到了虐待，但我们的工作时间确实很重要。
But they come a bit more here and there.
但他们到处来的次数更多一些。
On my OR days when I'm operating, those are long days, but on the days that I'm lucky enough to be a researcher, like you, those days tend to be a bit gentler unless I'm grant writing.
在我手术的日子里，那是漫长的日子，但在我有幸成为一名研究人员的日子里，像你一样，那些日子往往会温和一些，除非我正在撰写资助金。
Those days can be long, as you know.
如你所知，那些日子可能会很长。
So to answer your question, I do think we're sort of self-selected for it, but I also think it's part of the training.
因此，回答你的问题，我确实认为我们是自我选择的，但我也认为这是培训的一部分。
Because of the long hours that we're in the hospital, we're taking care of sick patients, and we have sort of a type A mentor approach where our mentors are hard on us.
由于我们在医院的时间很长，我们要照顾病人，我们有一种 A 型导师方法，导师对我们很严厉。
We learn to cope with our stress and be efficient and prioritize things despite the stress of it all.
尽管压力很大，我们还是学会应对压力，保持高效并优先处理事情。
And I think we take from that this sort of calm demeanor.
我认为我们可以从中汲取这种冷静的态度。
And perhaps it just amplifies what we're probably drawn to because before we come to neurosurgery, we might rotate in neurosurgery.
也许它只是放大了我们可能被吸引的东西，因为在我们进入神经外科之前，我们可能会轮换神经外科。
We might spend a month pretending to be a neurosurgeon, learning from residents and faculty that are practicing the specialty.
我们可能会花一个月的时间假装自己是一名神经外科医生，向从事该专业的住院医师和教员学习。
But prior to actually starting your training, you never experience anything like being a resident in neurosurgery.
但在真正开始训练之前，您从未经历过像神经外科住院医师那样的经历。
The stress and the volume of patients that you have to take care of and the long nights.
您必须照顾的压力和患者数量以及漫长的夜晚。
It can be quite lonely, by the way.
顺便说一句，这可能会很孤独。
You develop friends in the hospital, but sometimes you're on your own when you're on call and you have backup, you can call your chief resident or your attending, but you really have to learn how to take care of patients yourself.
你在医院里结识了朋友，但有时当你待命并且有后备人员时，你只能靠自己，你可以打电话给你的首席住院医生或你的主治医生，但你真的必须学会如何自己照顾病人。
You obviously form teams with nurses and staff and things like that, and other residents, but it can be lonely.
显然，你要与护士、工作人员等以及其他居民组成团队，但这可能会很孤独。
It can be really challenging.
这真的很有挑战性。
And I think because of those experiences that all neurosurgeons go through, we tend to have this sort of unflappable personality that perhaps we started with a bit compared to the average person, but the training definitely amplifies it.
我认为，由于所有神经外科医生都经历过这些经历，我们往往具有这种镇定自若的性格，与普通人相比，我们一开始可能会有点这种性格，但培训肯定会放大这种性格。
Andrew Huberman:
安德鲁·休伯曼：
And do you have tools that you implement if you ever feel that you're getting slightly off-center?
如果您感觉自己有点偏离中心，您是否有可以使用的工具？
Dr. Casey Halpern:
凯西·哈尔彭博士：
I do now.
我现在就这么做了。
When I was in training, I actually remember in my second year, so most neurosurgery programs, when you're a junior resident, in some ways, that's your toughest year.
当我接受培训时，我实际上记得在我的第二年，所以大多数神经外科项目，当你是初级住院医师时，从某些方面来说，那是你最艰难的一年。
Not in every way.
不是在所有方面。
It is your toughest year because you're young and you're inexperienced and you don't know what you don't know.
这是你最艰难的一年，因为你还年轻，缺乏经验，而且你不知道自己不知道什么。
And that's why it's such a tough year, because you have to learn a lot very quickly for patient safety reasons, for self-survival.
这就是为什么今年是如此艰难的一年，因为出于患者安全和自我生存的考虑，你必须快速学习很多东西。
You just have to learn a lot.
你只需要学习很多东西。
And you're on call by yourself in the hospital, and it's a real challenge.
而你自己在医院里待命，这真是一个挑战。
And I think that personally, I gained a lot of weight during that year.
我认为就我个人而言，那一年我的体重增加了很多。
The only exercise I did consciously was taking the stairs.
我唯一有意识地做的运动就是爬楼梯。
I refused to take the elevator And I was at Penn at HUP, where I currently practice now.
我拒绝乘坐电梯，当时我在宾夕法尼亚大学的 HUP，目前在那里实习。
And I remember I would see patients anywhere from the ground floor where the trauma bay was or the ER, all the way up to Founders 12, the 12th floor, and I would never take an elevator.
我记得我会在任何地方看到病人，从一楼的创伤室或急诊室，一直到 Founders 12，即 12 楼，我永远不会乘电梯。
That was my rule for the year because I knew I would not have time to exercise, but I would just take the stairs.
这是我今年的规则，因为我知道我没有时间锻炼，但我只会走楼梯。
And in the beginning of the year, I would be a little winded when I got to the 12th floor.
而且年初的时候，我到了12楼就会有点气喘吁吁。
But by the end of the year, actually, it didn't really faze me, and it became a great habit to have.
但到了年底，实际上，这并没有真正让我感到困扰，而且它成了一个很好的习惯。
The problem with that, though, is I paired that, unfortunately, with a lot of sleepless nights or not enough sleep, let's say.
但问题是，不幸的是，我伴随着很多不眠之夜或睡眠不足，比如说。
And I had this terrible habit of drinking coffee late at night, and I would put a lot of sugar in it, and it was sort of the only way for me to get a quick bout of energy that for some reason I prioritized at that time, obviously knowing that I would crash, which I always did, and I always kind of regretted it, but I still did it anyway.
我有一个可怕的习惯，就是在深夜喝咖啡，我会在里面放很多糖，这是我快速补充能量的唯一方法，出于某种原因，我当时优先考虑了这种方法，显然我知道我会崩溃，我总是这样做，而且我总是有点后悔，但无论如何我还是这么做了。
And I attribute that to poor decision-making, inexperience, and perhaps being a little vulnerable, like I think we all are.
我将其归因于糟糕的决策、缺乏经验，或许还有一点脆弱，就像我认为我们所有人一样。
That's why I relate with a lot of the research that I do.
这就是为什么我参与了我所做的许多研究。
And I remember I got married in my third year, the year after my second year, and my wife and I, or my fiancée at the time, we started going to the gym together in the morning, and my hours were a little better, so I would actually be able to exercise before I operated that day, and I operated almost every day as a third-year resident.
我记得我结婚的时候是我第三年，第二年的后年，我和我的妻子，或者说我当时的未婚妻，我们早上开始一起去健身房，我的时间稍微好一点，所以我实际上可以在手术那天之前锻炼身体，而且我作为三年级住院医师几乎每天都在手术。
So I remember I'd get to the gym really early, and in three months, I lost 20 pounds.
所以我记得我很早就去健身房了，三个月内，我减掉了 20 磅。
And I wasn't trying to lose weight.
而且我并没有想减肥。
I just was sleeping better and taking care of myself.
我只是睡得更好并且照顾好自己了。
And I remember when we got married, I fit into a tuxedo that I had in college, or it would have fit me in college.
我记得当我们结婚时，我穿上了大学时穿的燕尾服，或者说它也适合我大学时穿的。
It actually was a new tuxedo, admittedly, but it was the same size as my tuxedo from college.
诚然，它实际上是一件新的燕尾服，但它和我大学时穿的燕尾服尺寸相同。
So I think that I've always related with the problems that our patients have to a certain extent.
所以我认为我一直在某种程度上关注我们患者所遇到的问题。
And when I've been most vulnerable, which is when I was working the hardest with the least amount of sleep, I related with it the most.
当我最脆弱的时候，也就是我工作最努力、睡眠时间最少的时候，我与它的联系最密切。
And yes, exercise for me has always been my tool.
是的，锻炼对我来说一直是我的工具。
More recently, exercise, some strength training I think is important paired with cardio.
最近，我认为锻炼、一些力量训练与有氧运动相结合很重要。
I don't do enough of either, but I definitely do some, and that helps.
我在这两方面做得还不够，但我确实做了一些，这很有帮助。
Meditation helps me a bit.
冥想对我有一点帮助。
I do that every night before I go to sleep.
我每天晚上睡觉前都会这样做。
I use an app for it.
我使用一个应用程序。
It's probably not the best way to do meditation, but-
这可能不是冥想的最佳方式，但是——
Andrew Huberman:
安德鲁·休伯曼：
If it keeps you doing it regularly-
如果它让你经常这样做-
Dr. Casey Halpern:
凯西·哈尔彭博士：
Exactly
正是如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
it's the best way to do it.
这是最好的方法。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Andrew, I couldn't agree with you more.
安德鲁，我非常同意你的观点。
It's one of those things where I look forward to it every night.
这是我每晚都期待的事情之一。
And sometimes my wife falls asleep and I come to bed a little later and I whisper, I'm like, "Are you okay if I turn the app on?" So-
有时我的妻子睡着了，我会晚一点上床睡觉，然后我低声说，“我打开应用程序，你可以吗？”所以——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
she does the same to me because I think we both value it.
她对我也做了同样的事，因为我认为我们都重视它。
And I think that's been very helpful, and I didn't have that tool probably when I needed it most, but I have it now, and it's very helpful.
我认为这非常有帮助，而且我可能在最需要的时候没有这个工具，但我现在有了它，而且非常有帮助。
Andrew Huberman:
安德鲁·休伯曼：
I really appreciate you sharing those tools.
我真的很感谢您分享这些工具。
A number of people, I'm guessing out there, might want to become neurosurgeons.
我猜想很多人可能想成为神经外科医生。
I really believe that in hearing today's conversation that you will spark an interest in medicine and/or neurosurgery.
我真的相信，在听到今天的谈话时，您会激发对医学和/或神经外科的兴趣。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I hope so.
我希望如此。
Andrew Huberman:
安德鲁·休伯曼：
Well, certainly you need to be a physician before you can become a neurosurgeon, so and neurosurgery in some cases, and that would be beautiful, and I predict that will happen as a consequence of what you've shared today.
嗯，当然，在成为神经外科医生之前，你需要先成为一名医生，所以在某些情况下是神经外科，这将是美好的，我预测这将是你今天分享的结果的结果。
I really appreciate your mentioning of the emphasis and appreciation on quality time.
我非常感谢您提到对优质时间的重视和赞赏。
I very much see this as quality time.
我非常认为这是美好的时光。
I know that our listeners will as well.
我知道我们的听众也会如此。
Really want to thank you for taking time out of your not just immensely busy, but very important schedule because, again, the work that you're doing is really out there on that cutting, I don't want to say bleeding edge, because in this context, it's not going to sound right, but on that extreme cutting edge of what we understand about how the human brain works and how it can be repaired.
真的要感谢你从非常忙碌而且非常重要的日程中抽出时间，因为，再说一次，你所做的工作确实是在那个切割上，我不想说前沿，因为在这种情况下，它听起来不太正确，但在我们对人类大脑如何工作和如何修复的理解的极端前沿。
You're doing marvelous work.
你做得非常出色。
We'll point people to various places they can find you online, and should they need the help of your clinic, to your clinic and your laboratory as well.
我们将引导人们到可以在线找到您的各个地方，如果他们需要您诊所的帮助，我们也会引导您的诊所和实验室。
So on behalf of everybody and myself as well, thank you so very much.
我谨代表大家和我自己，非常感谢你们。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I'm honored.
我很荣幸。
Thank you so much for having me.
非常感谢你邀请我。
Andrew Huberman:
安德鲁·休伯曼：
Thank you for joining me today for my discussion with Dr. Casey Halpern about the use of deep brain stimulation and novel technologies for the treatment of eating disorders and movement disorders of various kinds.
感谢您今天与我一起与 Casey Halpern 博士讨论如何使用深部脑刺激和新技术来治疗各种饮食失调和运动障碍。
For those of you that are interested in learning more about Dr. Halpern's research, please see the links in our show note captions that include links to his laboratory website and to his clinic, as well as various research publications that are available in complete form as downloadable PDFs.
对于那些有兴趣了解更多有关 Halpern 博士研究的人，请参阅我们的显示注释标题中的链接，其中包括他的实验室网站和诊所的链接，以及以完整形式提供的可下载 PDF 形式的各种研究出版物。
If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a terrific zero-cost way to support us.
这是支持我们的绝佳零成本方式。
In addition, please subscribe to the podcast on both Spotify and Apple.
此外，请在 Spotify 和 Apple 上订阅该播客。
And on both Spotify and Apple, you can leave us up to a five-star review.
在 Spotify 和 Apple 上，您都可以给我们五星级的评价。
If you have questions for us or comments or feedback of any kind, please put that in the comments section on YouTube.
如果您对我们有任何疑问或任何类型的评论或反馈，请将其放入 YouTube 的评论部分。
We do read all the comments.
我们确实阅读了所有评论。
Please also check out the sponsors mentioned at the beginning of today's episode.
另请查看今天节目开头提到的赞助商。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
Not so much today, but in many previous episodes of the Huberman Lab podcast, we talk about supplements.
今天不多，但在 Huberman Lab 播客的许多之前的剧集中，我们谈论了补充剂。
While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like enhancing sleep and focus and hormone optimization.
虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如增强睡眠、注意力和荷尔蒙优化。
The Huberman Lab podcast has partnered with Momentous Supplements.
Huberman Lab 播客与 Momentous Supplements 合作。
If you'd like to see the supplements that the Huberman Lab podcast has partnered with Momentous on, you can go to livemomentous, spelled O-U-S, so livemomentous.com/huberman, and there you'll see a number of the supplements that we talk about regularly on the podcast.
如果您想查看 Huberman Lab 播客与 Momentous 合作的补充剂，您可以访问 livemomentous，拼写为 O-U-S，即 livemomentous.com/huberman，在那里您会看到我们在播客上经常讨论的一些补充剂。
I should just mention that that catalog of supplements is constantly being updated.
我只想提一下，补充剂目录正在不断更新。
If you haven't already signed up for the Neural Network Newsletter, this is a monthly Huberman Lab podcast newsletter in which you get some brief show note summaries, as well as a lot of actionable tools in summary form.
如果您还没有订阅神经网络时事通讯，这是 Huberman Lab 播客时事通讯月刊，您可以在其中获得一些简短的显示说明摘要，以及摘要形式的许多可操作工具。
Many people find these very useful for distilling out the vast amount of information that we cover on the podcast.
许多人发现这些对于提炼出我们在播客中涵盖的大量信息非常有用。
So for instance, if you go to hubermanlab.com, you can click on the menu, click to Neural Network Newsletter, or simply Newsletter, and you can sign up.
例如，如果您访问 hubermanlab.com，您可以单击菜单，单击神经网络新闻通讯，或者只是新闻通讯，然后就可以注册。
Just give us your email.
只需给我们您的电子邮件即可。
We do not share your email with anybody.
我们不会与任何人分享您的电子邮件。
And again, it's completely zero cost.
再说一遍，它完全是零成本。
We also have examples of previous newsletters that you can download immediately without having to sign up for anything and decide whether or not you want to sign up.
我们还提供了以前的时事通讯示例，您可以立即下载，无需注册任何内容并决定是否要注册。
Again, that's the Neural Network Newsletter at hubermanlab.com.
同样，这是 hubermanlab.com 上的神经网络通讯。
If you're not already following us on social media, we are hubermanlab on Instagram, on Twitter, on Facebook, and on LinkedIn.
如果您还没有在社交媒体上关注我们，我们在 Instagram、Twitter、Facebook 和 LinkedIn 上是 hubermanlab。
And especially on Instagram and on Twitter, I cover many of the tools that are discussed on the Huberman Lab podcast, but also a lot of science and science-based tools not covered on the Huberman Lab podcast.
特别是在 Instagram 和 Twitter 上，我介绍了 Huberman Lab 播客中讨论的许多工具，但也介绍了 Huberman Lab 播客中未涵盖的许多科学和基于科学的工具。
Again, it's hubermanlab on all platforms.
再说一次，它是所有平台上的 hubermanlab。
Once again, thank you for joining me today for my discussion with Dr. Casey Halpern.
再次感谢您今天加入我与 Casey Halpern 博士的讨论。
I hope you learned as much as I did, and as always, thank you for your interest in science.
我希望你能像我一样学到很多东西，并且一如既往地感谢你对科学的兴趣。