Dr. Paul Conti: Therapy, Treating Trauma & Other Life Challenges
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。
Andrew Huberman:
安德鲁·休伯曼：
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. Paul Conti.
今天我的嘉宾是保罗·孔蒂博士。
Dr. Conti is a psychiatrist who did his training at Stanford School of Medicine and then went on to be Chief Resident at Harvard Medical School.
康蒂博士是一位精神病学家，曾在斯坦福大学医学院接受培训，后来成为哈佛医学院的首席住院医师。
He now runs the Pacific Premier Group, which is a collection of psychiatrists and therapists focusing on solving complex human problems, including trauma, addiction, personality, and psychiatric disorders.
他现在经营着 Pacific Premier Group，该集团由精神病学家和治疗师组成，专注于解决复杂的人类问题，包括创伤、成瘾、人格和精神疾病。
Andrew Huberman:
安德鲁·休伯曼：
Today we discuss trauma in detail and the therapeutic process in detail.
今天我们详细讨论创伤和治疗过程。
For instance, we discuss what is trauma?
比如我们讨论什么是创伤？
How do you know if you have trauma?
你怎么知道你是否有外伤？
Dr. Conti shares with us, for instance, that not every experience that we think is traumatic is necessarily traumatic, and yet many people might have trauma without even realizing it.
例如，孔蒂博士与我们分享，并非所有我们认为是创伤性的经历都一定是创伤性的，但许多人可能在没有意识到的情况下遭受创伤。
We also talk about the therapeutic process generally.
我们还一般性地谈论治疗过程。
For instance, how to pick a therapist, how to best approach and go through therapy, and how to evaluate whether or not therapy and your relationship to the therapist is working or not.
例如，如何选择治疗师，如何最好地接受和完成治疗，以及如何评估治疗以及您与治疗师的关系是否有效。
Andrew Huberman:
安德鲁·休伯曼：
We also talk about self-therapies because we acknowledge that not everyone has access to or can afford therapy, and we talk about drug therapies, for instance, antidepressants, antipsychotics.
我们还谈论自我治疗，因为我们承认并不是每个人都能获得或负担得起治疗，我们还谈论药物治疗，例如抗抑郁药、抗精神病药。
We talk about alcohol, cannabis, ketamine, and the psychedelics, including psilocybin, LSD, and we talk about the clinical use of MDMA and what the future of that looks like.
我们谈论酒精、大麻、氯胺酮和致幻剂，包括裸盖菇素、LSD，我们谈论 MDMA 的临床用途及其未来。
Andrew Huberman:
安德鲁·休伯曼：
The reason for bringing Dr. Conti onto this podcast is because I see him as the person who has the greatest and most holistic view of therapy, trauma, drug therapies, talk therapies, and how self-therapy and work with others can be integrated for both healing and growing from difficult circumstances.
将康迪博士引入这个播客的原因是因为我认为他对治疗、创伤、药物治疗、谈话治疗以及如何将自我治疗和与他人合作结合起来以从困难的环境中治愈和成长有着最伟大和最全面的观点。
Dr. Conti is also the author of an exceptional book entitled "Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal from It." That book describes trauma and its many features, and many tools, some of which we discuss on the podcast today.
康蒂博士还是一本杰出著作的作者，题为《创伤：看不见的流行病：创伤如何发生以及我们如何从中治愈》。那本书描述了创伤及其许多特征和许多工具，其中一些我们今天在播客上讨论。
Andrew Huberman:
安德鲁·休伯曼：
Whether or not you have trauma or not, by the end of today's episode, you will have a much deeper understanding about what trauma is.
无论您是否有创伤，在今天的节目结束时，您都会对什么是创伤有更深入的了解。
In fact, I'm confident that you will gain insight into whether or not you have trauma or not, whether or not people close to you have trauma or not, and the various paths to recovering and indeed growing from trauma that we can all take.
事实上，我相信你会深入了解自己是否有创伤，你身边的人是否有创伤，以及我们都可以采取的从创伤中恢复和成长的各种途径。
As you'll soon learn, Dr. Conti is an exceptional communicator and has a unique window into the trauma and therapeutic process that I know that all of us can benefit from.
您很快就会了解到，孔蒂医生是一位出色的沟通者，并且拥有了解创伤和治疗过程的独特窗口，我知道我们所有人都可以从中受益。
Andrew Huberman:
安德鲁·休伯曼：
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将有关科学和科学相关工具的零成本消费者信息带给公众。
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. Paul Conti.
现在我与保罗·康迪博士进行讨论。
Paul, thank you so much for being here today.
保罗，非常感谢你今天来到这里。
Paul Conti:
保罗·孔蒂：
Oh, thank you so much for having me.
哦，非常感谢你邀请我。
Andrew Huberman:
安德鲁·休伯曼：
I've been looking forward to this.
我一直期待着这一点。
I've received a ton of questions about trauma, about therapy, about how to assess where one is in their own arc of problems and addressing familial issues and relationship issues and so forth.
我收到了大量关于创伤、治疗、如何评估一个人在自己的问题弧线中的位置以及解决家庭问题和人际关系问题等等的问题。
If we could just start off very basic and just get everyone oriented.
如果我们能从非常基础的开始，让每个人都以导向为导向就好了。
Paul Conti:
保罗·孔蒂：
Sure.
当然。
Andrew Huberman:
安德鲁·休伯曼：
How should we define trauma?
我们应该如何定义创伤？
We all have hard experiences.
我们都有艰难的经历。
Some of them we might ruminate on more than others, but what is trauma?
其中一些我们可能会比其他人更多地思考，但什么是创伤？
Paul Conti:
保罗·孔蒂：
To make the definition relevant, I think we have to look at trauma as not anything negative that happens to us, but something that overwhelms our coping skills, and then leaves us different as we move forward.
为了使这个定义具有相关性，我认为我们必须将创伤视为发生在我们身上的任何负面事件，而是压倒我们应对技能的事物，然后使我们在前进时变得不同。
It changes the way that our brains function, and then that change is evident in us as we move forward through life.
它改变了我们大脑的运作方式，当我们在生活中前进时，这种变化就会在我们身上变得显而易见。
Andrew Huberman:
安德鲁·休伯曼：
How do we know if we have trauma or not?
我们如何知道自己是否有创伤？
I've heard before everyone has trauma.
我以前就听说过每个人都有创伤。
For instance, I've heard that if we are a child, or when we are a child, and we request love from a parent or attention from a parent, if they dismiss us, that that's a microtrauma.
例如，我听说，如果我们还是个孩子，或者当我们还是个孩子的时候，我们请求父母的爱或父母的关注，如果他们拒绝我们，那就是微创伤。
Is that overstating or unfair to the real issue of trauma?
这对于创伤的真正问题是夸大还是不公平？
Do we all have trauma?
我们都有创伤吗？
What are microtraumas?
什么是微创伤？
Paul Conti:
保罗·孔蒂：
I think traumas that we might categorize as disappointments or things that are negative but not deeply impactful, I think is not a helpful definition.
我认为我们可能将创伤归类为失望或消极但影响不大的事情，我认为这不是一个有用的定义。
I think the helpful definition is something that rises to the magnitude of really changing us and something that we can see both in how we behave, we can see it in mood, anxiety, behavior, sleep, physical health, so we can identify it, and we can also see it in brain changes.
我认为有用的定义是真正改变我们的程度，我们可以在我们的行为方式中看到它，我们可以在情绪、焦虑、行为、睡眠、身体健康中看到它，所以我们可以识别它，我们也可以在大脑变化中看到它。
The fact that we become, say, more hypervigilant, more vigilant, and then we can see that different parts of the brain are more active.
事实上，我们变得更加高度警惕，更加警惕，然后我们可以看到大脑的不同部分更加活跃。
That definition captures how trauma, if it rises to a certain level ...
这个定义描述了创伤如何上升到一定程度......
what we would say, trauma that makes a post-trauma syndrome, leaves us different, I think is the helpful definition of trauma because it's a clinical definition.
我们想说的是，创伤导致创伤后综合症，让我们与众不同，我认为这是创伤的有用定义，因为它是一个临床定义。
It's changes in us as people, and we can map those changes to identifiable shifts in our brain function.
这是我们作为人的变化，我们可以将这些变化映射到我们大脑功能的可识别的变化。
Andrew Huberman:
安德鲁·休伯曼：
How do we know if we've been changed by something?
我们怎么知道我们是否被某些事情改变了？
I can think back to childhood events where some kid on the playground or in the classroom said something I didn't like, something negative about me.
我可以回想起童年时发生的事情，一些孩子在操场上或教室里说了一些我不喜欢的话，一些关于我的负面的话。
I think most people can do that.
我想大多数人都能做到。
We have a great memory for the kid that said something awful, or the parent or teacher that said something awful that really felt like it hurt us or at least stuck with us.
对于那些说了一些可怕的话的孩子，或者那些说了一些可怕的话的父母或老师，我们有一个美好的记忆，这些事情确实伤害了我们，或者至少让我们难以忘怀。
Clearly one's brain, my brain in this example, has been changed by that event such that I remember it, but how do we know if something has actually changed the way that we are?
显然，一个人的大脑，在这个例子中是我的大脑，已经被那个事件改变了，所以我记得它，但我们怎么知道某些事情是否真的改变了我们的方式呢？
Because, of course, we don't know how we would be otherwise.
因为，当然，我们不知道否则我们会怎样。
Paul Conti:
保罗·孔蒂：
Right.
对。
That's difficult.
那很难。
It's doable, but it's difficult because the response ...
这是可行的，但很难，因为响应......
if the trauma rises to the level of changing our brains, and I don't just mean we have a new memory.
如果创伤上升到改变我们大脑的程度，我不仅仅意味着我们有了新的记忆。
We can have memories of something that was negative, and in that sense it changes the brain because now there's something we can call to mind, but it doesn't change the functioning of the brain.
我们可以对一些消极的事情有记忆，从这个意义上说，它改变了大脑，因为现在我们可以想起一些东西，但它不会改变大脑的功能。
If trauma rises to the level of changing the functioning of our brains, then there's almost always a reflex of guilt and shame around the trauma that can lead us, it often leads us to bury it, to avoid it, to feel that now there's something negative inside of me and it feels shameful, or it feels like no one else would accept it.
如果创伤上升到改变我们大脑功能的程度，那么围绕创伤几乎总是会产生一种内疚和羞耻的反射，这会导致我们，它常常导致我们埋葬它，避免它，感觉现在我内心有一些消极的东西，感觉可耻，或者感觉没有人会接受它。
What happens is people tend to avoid looking at the change in them, which is exactly the opposite of what needs to be done.
所发生的情况是，人们倾向于避免看到自己的变化，这与需要做的事情恰恰相反。
The idea of in a viral pandemic, we want to stay away from one another and isolate, but with the trauma epidemic, we need to communicate with other people.
在病毒大流行中，我们希望彼此远离并隔离，但在创伤流行中，我们需要与其他人沟通。
We need to communicate and put words to what's gone on inside of us.
我们需要沟通并表达我们内心的想法。
Paul Conti:
保罗·孔蒂：
Very often a person knows.
很多时候一个人知道。
I've done so much clinical work over about 20 years that has focused on trauma, and a lot of the times the person knows, but they're not admitting it to themselves because they're afraid of it.
大约 20 年来，我做了很多临床工作，重点关注创伤，很多时候人们都知道这一点，但他们不会向自己承认，因为他们害怕。
They don't know what to do.
他们不知道该怎么办。
But if they start talking, then they'll talk about the event or the situation.
但如果他们开始说话，他们就会谈论事件或情况。
It could be something acute or it could be something chronic that really has been harmful to them, and then they feel different afterwards.
它可能是急性的，也可能是慢性的，对他们确实有害，然后他们就会感觉不一样。
Like, "Oh, after that, I started thinking differently, feeling differently," but that doesn't always happen.
就像，“哦，在那之后，我开始以不同的方式思考，感觉不同，”但这并不总是发生。
Sometimes it's a process of exploration through dialogue, whether it's written or whether it's spoken, of the person exploring the changes inside of themselves, maybe changes to their self-talk inside, changes to their thoughts about the world and whether they can navigate safely and readily in it.
有时，这是一个通过对话进行探索的过程，无论是书面的还是口头的，人们探索自己内心的变化，也许是他们内心自言自语的变化，他们对世界的看法的变化，以及他们是否能够安全、轻松地在其中航行。
Paul Conti:
保罗·孔蒂：
An anchor as I talk about this, the example I'll use at times is the example of my own life where when I was much younger, in my early 20s, my younger brother took his life by suicide.
作为主播，当我谈论这个问题时，我有时会用我自己生活中的例子，当我年轻得多时，20岁出头，我的弟弟自杀了。
The response of guilt and shame and hiding all of it inside of me was very dramatic, but I wasn't acknowledging it because I didn't know what to do about it, and I felt guilty, and I felt responsible, and I felt ashamed.
内疚和羞耻以及将所有这些隐藏在我内心的反应非常戏剧性，但我没有承认它，因为我不知道该怎么办，我感到内疚，我感到有责任，我感到羞耻。
There was an avoidance inside of me, and then I wasn't saying to myself, "Hey, before this you thought that you could be effective and you could make your way in the world, and if you were a good person and you worked hard, you could make a difference." Then afterwards, I thought, "I can't get anywhere.
我内心有一种逃避，然后我不会对自己说：“嘿，在此之前你认为你可以高效，你可以在这个世界上取得成功，如果你是一个好人并且努力工作，你可以有所作为。”后来我想：“我哪儿也去不了。
The world's against me," and I felt like my options were all gone.
世界都在反对我”，我感觉我的选择都消失了。
I was 24 years old.
那年我24岁。
Paul Conti:
保罗·孔蒂：
I didn't see that the change was in me, but I was taking care of myself poorly.
我没有看到自己身上发生了变化，但我自己照顾得不好。
There was enough going on that was unhealthy that I couldn't avoid the realization that, "Hey, I'm different now, and in these ways that are automatic." My reflex to "Can I make my way in the world, can I have a good life, can I be happy?" Well, my reflexes to that were all different.
有足够多的不健康的事情发生，我无法避免意识到，“嘿，我现在不一样了，在这些方面，这是自动的。”我的本能反应是“我能在这个世界上找到自己的出路，我能拥有美好的生活，我能幸福吗？”嗯，我对此的反应完全不同。
They were coming through the lens of heightened anxiety, heightened vigilance, a sense of guilt, a sense of shame and a sense of nonbelonging in the world.
他们的内心充满了高度的焦虑、高度的警惕、罪恶感、羞耻感和对世界的不归属感。
It was ultimately good and helpful people around me and my own realization that "Hey, things are not going well," that led me to then get some help and to be able to talk about it and realize, "Oh my gosh, I need to face these things that are going on inside of me."
最终，我周围的好人和乐于助人的人以及我自己的认识“嘿，事情进展不顺利”，这让我获得了一些帮助，并且能够谈论它并意识到，“哦，天哪，我需要面对我内心发生的这些事情。”
Andrew Huberman:
安德鲁·休伯曼：
From a psychoanalytic, psychological, and maybe even a neuroscience perspective, two questions.
从精神分析、心理学，甚至神经科学的角度来看，有两个问题。
Why do you think that when we experience trauma these things that we call guilt and shame surface?
你认为为什么当我们经历创伤时，我们称之为内疚和羞耻的东西就会浮现出来？
Everything you're telling me is that in the end that's not adaptive.
你告诉我的一切最终都是不适应性的。
Why would we be built that way?
为什么我们要这样建造？
That's the first question.
这是第一个问题。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Then the second question is, how should we conceptualize guilt and shame?
那么第二个问题是，我们应该如何概念化内疚和羞耻？
I think we hear "guilt," we hear "shame." How should we think about it?
我想我们听到“内疚”，我们听到“羞耻”。我们应该如何思考呢？
Those emotions must exist in us for some reason, but in this case, it seems like they don't serve us well.
由于某种原因，这些情绪一定存在于我们身上，但在这种情况下，它们似乎并不能很好地为我们服务。
Maybe in that order or in reverse order, what is guilt really?
也许按照这个顺序或者相反的顺序，内疚到底是什么？
What is shame really?
真正的耻辱是什么？
Why is it that we seem to be reflexively wired to feel guilty and feel ashamed when that's the exact opposite of what we need to do in the case of trauma?
为什么我们似乎会本能地感到内疚和羞耻，而这与我们在遭受创伤时需要做的恰恰相反？
Paul Conti:
保罗·孔蒂：
Right.
对。
No, I think these are great questions; I don't think anyone knows the answers for sure, but my read of all of that is that there's something adaptive that has happened in us through evolution that now becomes maladaptive in the way we live in the modern world.
不，我认为这些都是很好的问题；我认为没有人确切知道答案，但我对所有这些的解读是，通过进化，我们身上发生了一些适应性的事情，现在这些适应性的事情变得不适应我们在现代世界的生活方式。
If you think of through most of human development, people weren't living that long, and the idea was to survive and reproduce, so traumatic things that happened to us, it would make sense for them to stay with us.
如果你想想在人类发展的大部分时间里，人们的寿命并没有那么长，而我们的想法是为了生存和繁衍，所以发生在我们身上的创伤性的事情，对他们来说留在我们身边是有意义的。
If you ate a new food and got really, really sick, it's like you better remember that.
如果你吃了一种新食物，然后病得很重，你最好记住这一点。
If you see someone from the group of people a couple miles away and one of those people attacks you, it's like you better remember that.
如果你看到几英里外一群人中的某个人，其中一个人攻击你，你最好记住这一点。
The traumatic things that are emblazoned in our brain are built to last.
铭刻在我们大脑中的创伤性事物注定会长久存在。
Things that are positive will generate some emotion inside of us, but things that are profoundly negative are much more likely to stay with us.
积极的事情会在我们内心产生一些情绪，但极度消极的事情更有可能留在我们身边。
Paul Conti:
保罗·孔蒂：
I think that that was adaptive when all of that was about survival.
我认为当这一切都与生存有关时，这是适应性的。
I think the same thing is true with, say, shame.
我认为同样的情况也适用于羞耻感。
I think here it makes sense to talk a little bit, and actually, I'm interested in your thoughts about this, that the limbic system — the system often is called the emotion system in our brains — has actually, of course, varying function.
我认为在这里谈论一点是有道理的，实际上，我对你对此的想法很感兴趣，边缘系统——该系统通常被称为我们大脑中的情感系统——当然，实际上具有不同的功能。
One aspect is affect.
一方面是影响。
Affect is aroused in us, which I think the meaning then is it's created in us without our choice.
情感是在我们身上被唤起的，我认为这意味着它是在我们身上被创造出来的，而不是我们的选择。
If we're walking down the road and someone jumps in front of us or pushes us, then there's a response of fear, anger, heart starts beating faster, more blood to the muscles, we're getting ready to fight or run, and then we become aware of it.
如果我们走在路上，有人跳到我们前面或推我们，那么我们就会产生恐惧、愤怒的反应，心跳加快，肌肉流血更多，我们准备好战斗或逃跑，然后我们就会意识到这一点。
The aroused affect in us is also about survival, and it has a very deep impact upon us.
我们内心所唤起的情感也是关乎生存的，它对我们的影响是非常深远的。
Paul Conti:
保罗·孔蒂：
Shame is an aroused affect.
羞耻是一种被唤起的情感。
It can be raised in us without our choice, and it's very powerful, which if you think about that, is an extremely strong deterrent.
它可以在我们不经选择的情况下在我们体内产生，而且非常强大，如果你想一想，这是一种极其强大的威慑力。
If you had ...
如果你有...
imagine a tribe or group of people that are sheltered together, and someone eats half the food at night or something — there's a very negative response.
想象一下，一个部落或一群人被庇护在一起，有人在晚上吃了一半的食物或其他什么——这会是一个非常消极的反应。
That person feels shame because shame is so powerful to control behavior.
那个人会感到羞耻，因为羞耻对于控制行为有如此强大的力量。
The way that trauma can change our brains and stay with us in a way that says, "Be more vigilant, look at the world in a different way, act more defensively," and how that links to shame and to guilt, and then guilt becomes what gets called "feeling," technically, where we relate the aroused affect to ourselves.
创伤可以改变我们的大脑，并以一种“更加警惕，以不同的方式看待世界，更加防御性的行为”的方式陪伴着我们，以及它如何与羞耻和内疚联系起来，然后内疚就变成了所谓的“感觉”，从技术上讲，我们将激发的情感与我们自己联系起来。
Paul Conti:
保罗·孔蒂：
Shame, the aroused affect, and guilt, the next step, when the shame gets related to self, are such profound behavioral interventions and deterrence that you can see, I think, how evolutionarily it kind of all makes sense.
羞耻，被激发的情感，以及下一步，当羞耻与自我相关时，内疚，是如此深刻的行为干预和威慑，我认为，你可以看到，从进化的角度来看，这一切是多么有意义。
If we're fighting for survival and we're an elder statesman if we make it to 20, this makes sense, but it doesn't make sense in a world where we live much longer, we navigate in all sorts of different ways, and there's so much coming at us that can be traumatizing.
如果我们为生存而战，如果我们能活到20岁，我们就是一位年长的政治家，这是有道理的，但在一个我们寿命更长、我们以各种不同方式航行、有太多事情向我们袭来、可能造成创伤的世界里，这是没有意义的。
Paul Conti:
保罗·孔蒂：
If you think about the news, how many times have I written a prescription for someone that says, "No more news"?
如果你想想新闻，我有多少次为某人开出“没有更多新闻”的处方？
Andrew Huberman:
安德鲁·休伯曼：
You've actually written those prescriptions.
你实际上已经写了这些处方。
Paul Conti:
保罗·孔蒂：
Oh yes.
哦，是的。
Yes.
是的。
Glance at the news.
扫一眼新闻。
Look at the news for news.
看看新闻就知道新闻了。
"Anything going on I need to know?" But what people are doing is they're looking at it and they're clicking and they're clicking, and there's a sense of being enthralled in a very frightening way with the horrors that are in front of us.
“有什么事情需要我知道吗？”但人们所做的就是他们看着它，他们点击，他们点击，有一种以一种非常可怕的方式被我们面前的恐怖所吸引的感觉。
Paul Conti:
保罗·孔蒂：
It shows how, yes, trauma can come through acute things that happen to us.
是的，它表明创伤是如何通过发生在我们身上的严重事件而产生的。
Trauma can come through chronic things, chronic denigration, whether it's based upon socioeconomic status, immigration status, race, religion, sexuality, gender identity.
创伤可能来自长期的事情、长期的诽谤，无论是基于社会经济地位、移民身份、种族、宗教、性取向、性别认同。
These chronic traumas of being denigrated by the society around us or treated as less than can change the brain, but vicarious experiences can too.
这些因被周围社会诽谤或被忽视而遭受的慢性创伤可以改变大脑，但替代经历也可以。
We know this is not theoretical.
我们知道这不是理论上的。
We know that the changes in the brain can come from vicarious experiences too, which is why people who are glued to the news and then feeling like, "Oh my goodness, what is happening?
我们知道大脑的变化也可能来自替代经历，这就是为什么人们沉迷于新闻然后感觉，“天哪，发生了什么事？
The mothers in the Ukraine who've lost babies in the war," and there are things that are so terrifying that if we spend so much time with that, it has a similar effect.
乌克兰的母亲们在战争中失去了婴儿”，有些事情是如此可怕，如果我们花这么多时间在这上面，它也会产生类似的效果。
Paul Conti:
保罗·孔蒂：
Our brains are built to change from trauma, but not in the way we experience trauma and not in the way that we live life, in terms of the nature of living life and the duration of life in the modern world, where these traumas that happen to us are often so bad for us because they change how our brain is functioning and then our entire orientation to the world is different.
我们的大脑是为了从创伤中改变而生的，但不是以我们经历创伤的方式，也不是以我们生活方式的方式，在现代世界中，就生活的本质和生命的持续时间而言，发生在我们身上的这些创伤往往对我们来说非常糟糕，因为它们改变了我们大脑的运作方式，然后我们对世界的整个方向都不同了。
That could be for years and years and decades and decades.
这可能会持续数年、数十年、数十年。
It brings so much misery and suffering, and at times it brings death.
它带来如此多的痛苦和痛苦，有时甚至带来死亡。
Paul Conti:
保罗·孔蒂：
If you think about it, 100,000 overdose deaths in this country in a year, 100,00.
如果你想一想，这个国家一年内就有 10 万人因吸毒过量死亡，10 万人。
Where is so much of that arising from?
这么多的东西是从哪里产生的？
As a person who's treated addiction very intensively over many years.
作为一个多年来一直在大力治疗毒瘾的人。
I think that, well, I feel sure that the majority of addiction that I see and treat arises, ultimately the roots of it are in trauma, and are in trying to soothe something that's stuck inside that the person isn't letting outside because of the guilt and shame, but it's running around in their head and they're tormented by it.
我认为，嗯，我确信我所看到和治疗的大多数成瘾都是由创伤引起的，最终根源在于创伤，并且是在试图抚慰那些深藏在内心的东西，而这些东西是人们因为内疚和羞耻而不让出来的，但它在他们的脑海里跑来跑去，他们被它折磨着。
Now there's a pool for these drugs, or sometimes medicines, to sooth.
现在有一个池子可以存放这些药物，有时甚至是药物来舒缓情绪。
Paul Conti:
保罗·孔蒂：
The opiates that were given after a minor surgery, okay, yeah, they help the pain from the minor surgery, but what they're really helping is the pain inside.
小手术后给予的阿片类药物，好吧，是的，它们可以缓解小手术带来的疼痛，但它们真正缓解的是内心的疼痛。
But that very quickly turns into addiction, danger, risk, and we see that over and over again, and not in a theoretical way.
但这很快就会变成成瘾、危险、风险，我们一遍又一遍地看到这种情况，而且不是以理论上的方式。
I see that in people who have been in my practice with addiction arising from trauma who have subsequently died.
我在接受我的治疗的那些因创伤而上瘾但随后死亡的人身上看到了这一点。
It's writ large in our existence in the modern world.
这在我们现代世界的存在中体现得淋漓尽致。
Andrew Huberman:
安德鲁·休伯曼：
Incredible to me that this is the way it works.
令我难以置信的是，这就是它的工作方式。
What I mean by that is this idea that I've heard about before, I think it was a Freudian concept of a repetition compulsion.
我的意思是我以前听说过这个想法，我认为这是弗洛伊德的强迫性重复概念。
This is what boggles my mind as I'm hearing this, something happens to us or we observe something traumatic, and instead of acknowledging that and trying to distance from it, there seems to be a reflex of shame and guilt in many cases and stuffing it away, and then a repetition of behaviors to continue to try and just stuff it away.
当我听到这个消息时，这让我感到困惑，我们发生了一些事情，或者我们观察到一些创伤性的事情，而不是承认这一点并试图远离它，在许多情况下，似乎有一种羞耻和内疚的反射，并将其隐藏起来，然后重复行为，继续尝试将其隐藏起来。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Like you're trying to pack, I don't know ...
就像你想打包一样，我不知道......
recently I was packing a home and trying to get a sleeping bag back into the bag.
最近，我正在收拾行李，并试图将睡袋放回袋子里。
It seems like it's always trying to mushroom out the top, this kind of thing.
看起来它总是试图从顶部冒出来，这种事情。
It takes a lot of ongoing effort.
这需要大量持续的努力。
At the same time, if this thing really exists, this repetition compulsion, people will return over and over again to the kinds of scenarios, or at least the kinds of emotional states that look just like the trauma, or resemble it in some way.
同时，如果这个东西真的存在，这种强迫性重复，人们会一遍又一遍地回到那种场景，或者至少是那种看起来就像创伤或在某种程度上相似的情绪状态。
Andrew Huberman:
安德鲁·休伯曼：
The question I have for you is, is the repetition compulsion a real thing, and why would we be wired that way?
我想问你的问题是，重复强迫症是真实存在的吗？为什么我们会这样？
My understanding of this concept of the repetition compulsion is that we all want to solve our traumas, and it allows us to put ourselves into micro, or again, macro versions of that over and over again.
我对重复强迫这个概念的理解是，我们都想解决我们的创伤，它使我们能够一次又一次地将自己置于微观或宏观版本中。
We get to run the experiment again and again in attempt to solve it.
我们一次又一次地进行实验，试图解决这个问题。
Andrew Huberman:
安德鲁·休伯曼：
In the case of taking a drug that ...
如果服用某种药物...
it's clear, certain drugs like opioids, it's clear how that would not allow us to deal with it.
很明显，某些药物如阿片类药物，很明显我们无法应对它。
It's just masking the emotional state.
它只是掩盖情绪状态。
But why is it, for instance, that somebody who experiences sexual trauma then places themselves into circumstances of more sexual trauma?
但是，为什么经历过性创伤的人随后会将自己置于更多性创伤的环境中呢？
Why is it that somebody who is in an abusive relationship goes on to have a second and third or fourth verbally or physically abusive relationship?
为什么处于虐待关系中的人会继续发生第二次、第三次或第四次口头或身体虐待关系？
On the face of it, you just go, that makes no sense.
从表面上看，你就走吧，这没有任何意义。
Yet, we see this over and over and over again.
然而，我们一次又一次地看到这种情况。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
The first thing I would say, the validity of the repetition compulsion concept is a strong yes.
我要说的第一件事是，强制重复概念的有效性是肯定的。
Yes, we see that over and over.
是的，我们一遍又一遍地看到这一点。
It's not necessarily in everyone, but boy, it is in a lot of people who have suffered trauma, and I think there's a very good reason.
不一定每个人都有这种情况，但是很多遭受过创伤的人都有这种情况，我认为这是有充分理由的。
On the surface of it, it makes no sense.
从表面上看，这没有任何意义。
But then if we think, well, how do our brains actually function?
但如果我们想一想，我们的大脑实际上是如何运作的呢？
We're trained, at least in Western society, I think, to think of ourselves as logical creatures that, oh, we're logical, and ultimately everything in us can just boil down to logic.
我认为，至少在西方社会，我们被训练把自己视为逻辑生物，哦，我们是有逻辑的，最终我们身上的一切都可以归结为逻辑。
If we think about it enough, we're going to understand how to make the right decisions, which is completely not true.
如果我们思考得足够多，我们就会明白如何做出正确的决定，但这完全是不正确的。
Paul Conti:
保罗·孔蒂：
The limbic system, the emotion system, so to speak, inside of us, always trumps logic.
可以说，我们内心的边缘系统、情感系统总是胜过逻辑。
If you think about it, does it ever make sense to run into a burning building?
如果你想一想，冲进一座着火的大楼还有意义吗？
Logic says no, but if someone you love is in the burning building, people run right in because the limbic system says yes.
逻辑上说不，但如果你爱的人在燃烧的大楼里，人们就会跑进去，因为边缘系统说是。
When logic and emotion come head to head, emotion wins all the time.
当逻辑和情感正面交锋时，情感总是获胜。
If emotion is powerful enough, it will always win.
如果情感足够强大，它总是会获胜。
The limbic system is so important, and the limbic system does not care about the clock or the calendar, and that's the answer.
边缘系统是如此重要，而边缘系统并不关心时钟或日历，这就是答案。
Paul Conti:
保罗·孔蒂：
And I'll also say why to the repetition compulsion.
我也会解释为什么会有重复强迫症。
The limbic system doesn't know, oh, it's now, it's today, it's May, it's 2022.
边缘系统不知道，哦，是现在，是今天，是五月，是2022年。
It just doesn't care at all.
它根本不在乎。
How I would relate that to the repetition compulsion is when people are repeating what they're trying to do, is to make things right, with the idea that if we can repeat the situation and make it right, it will fix everything, which makes perfect sense.
我将其与重复强迫联系起来是，当人们重复他们试图做的事情时，就是把事情做对，如果我们能够重复这种情况并做对，它就会解决一切，这是完全有道理的。
If we think, well, where is that concept coming from?
如果我们思考，这个概念从何而来？
It's coming from the emotional part of the brain that wants relief from suffering of the trauma and does not understand the clock or the calendar.
它来自大脑的情感部分，它想要摆脱创伤的痛苦，但不了解时钟或日历。
If I can solve something now, I will also solve something in the past.
如果我现在能解决一些问题，我也会解决过去的一些问题。
Paul Conti:
保罗·孔蒂：
Which is why I can't tell you how many times I've sat with someone.
这就是为什么我无法告诉你我和某人坐在一起的次数。
Let's say we're starting to do therapy.
假设我们开始进行治疗。
A person will say, "Oh gosh, I know.
一个人会说：“天哪，我知道。
Look, you just can't help me.
听着，你就是帮不了我。
My last seven relationships have been abusive." I'll say back something sometimes, like, "Well, look, if you tell me that you've had seven relationships that have been abusive in different ways, I'll agree with you." I only say that because that's never what someone says.
我过去的七段感情都是虐待行为。”有时我会回嘴，比如，“好吧，听着，如果你告诉我你有过七段以不同方式虐待的关系，我会同意你的观点。”我这么说只是因为从来没有人这么说过。
"But I think what you're going to tell me is you've had the same relationship seven times.
“但我想你要告诉我的是，你已经有过七次同样的关系了。
It's not seven things, it's one." That's always ...
这不是七件事，而是一件事。”那总是...
I don't think one time yet that has failed to be the case.
我认为这种情况还没有发生过。
Paul Conti:
保罗·孔蒂：
If you think about it, that's how we start to elucidate what's going on.
如果你想一想，这就是我们开始阐明正在发生的事情的方式。
They made the light bulb that goes off.
他们制造了会熄灭的灯泡。
I have not had seven different abusive relationships.
我还没有经历过七种不同的虐待关系。
I have had one that I have repeated seven times.
我已经重复了七次了。
And now we start getting to what's really going on and what needs to happen.
现在我们开始了解到底发生了什么以及需要发生什么。
That person needs to face what happened in that original abusive relationship, and it always comes down to the same sort of concepts of the person feeling terrified while the abuse was going on, feeling guilty, feeling ashamed, feeling like, oh, they brought it on themselves, they deserve it, they don't deserve anything better, because the brain is trying to make sense of it.
这个人需要面对在最初的虐待关系中发生的事情，这总是归结为同样的概念，即当虐待发生时，这个人感到害怕，感到内疚，感到羞耻，感觉就像，哦，这是他们自己造成的，他们应得的，他们不应该得到更好的东西，因为大脑正在试图理解它。
Or "I thought I could make that okay, but I couldn't." Then there's more guilt and more shame.
或者“我以为我可以做到这一点，但我做不到。”然后更多的内疚和羞耻。
Paul Conti:
保罗·孔蒂：
If that's stuck inside of someone, that's bundled up inside of someone, like a medical abscess inside a person, a walled-off infection inside the body, this is the same concept in the brain, then of course the limbic system is going to want to fix that.
如果它卡在某人体内，被捆绑在某人体内，就像人体内的医疗脓肿，体内的封闭感染，这在大脑中是相同的概念，那么边缘系统当然会想要修复它。
It fixes it by trying to, "Let's recreate that situation and make it right this time." That's I think one of the best examples of how the right approach of how, let's look at that, let's talk about that.
它通过尝试“让我们重现那种情况并这次改正”来解决这个问题。我认为这是正确方法的最佳例子之一，让我们来看看，让我们来谈谈。
What's really going on there?
那里究竟发生了什么？
Wait, who should feel guilty and ashamed?
等等，谁应该感到内疚和羞耻？
Is it the person who was abused or the person who was abusing?
是被虐待的人还是被虐待的人？
We can get at what's going on inside the person, and that's what changes that, and then the eighth relationship can be entirely different than the first seven.
我们可以了解一个人的内心正在发生什么，这就是改变它的原因，然后第八种关系可能与前七种完全不同。
Paul Conti:
保罗·孔蒂：
I see that all the time.
我一直都看到这一点。
This isn't esoteric or soft.
这并不深奥或软弱。
I see that play out clinically over and over again.
我在临床上一次又一次地看到这种情况的发生。
Why do things get better?
为什么事情会变得更好？
Because we go to the trauma and we unlock it.
因为我们触及创伤并解锁它。
It's not hidden inside where it can control things.
它并不隐藏在它可以控制事物的地方。
We bring it to the surface and then we can take away its power.
我们把它带到地面，然后我们就可以夺走它的力量。
Andrew Huberman:
安德鲁·休伯曼：
I keep hearing in this narrative that so much of our reflexive response to trauma, both emotional and the repetition compulsion in terms of behaviors, is about some very deep attempt to change the past.
我在这个叙述中不断听到，我们对创伤的反射性反应，无论是情感上的还是行为上的强迫性重复，都是关于改变过去的一些非常深刻的尝试。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
In fact, in an offline conversation, I recall you saying something about this, that the number of behaviors and thoughts and avoidance of behaviors and avoidance of thoughts that human beings put in to try and change the past is remarkable, and eerie, and maladaptive, it sounds like.
事实上，在一次线下谈话中，我记得你曾说过这样的话，即人类为试图改变过去而投入的行为和想法以及避免行为和避免想法的数量是惊人的，听起来很怪异和适应不良。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
That really stuck with me because I think we all want to feel like we're in control of our future and how we feel in the moment, and to some extent, it works for a brief while.
这真的让我难以忘怀，因为我认为我们都希望感觉自己掌控着自己的未来以及当下的感受，而且在某种程度上，它在短时间内有效。
There's this thing that happened and it evokes some internal arousal, and then you have to know what to do with that arousal.
发生了这件事，它引起了一些内在的兴奋，然后你必须知道如何处理这种兴奋。
I think for many people, including myself, there's this fundamental question; the thought about the thing, the event or events, evokes this arousal, this internal state.
我认为对很多人来说，包括我自己，都存在这个基本问题：对事物、事件或事件的思考会唤起这种唤醒，这种内部状态。
It makes some people feel sleepy and exhausted.
它使一些人感到困倦和疲惫。
Other people feel really anxious.
其他人感到非常焦虑。
Other people feel angry.
其他人感到愤怒。
Arousal has all these different dimensions, as you know.
如您所知，唤醒具有所有这些不同的维度。
Then there's this question of what to do with it.
然后就是如何处理它的问题。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I'd love to hear a, maybe even just a top-contour prescriptive of what does one do?
我很想听到一个，甚至可能只是一个关于一个人做什么的顶部轮廓说明？
I'll even just put myself in it.
我什至会把自己也放进去。
What do I do?
我该怎么办？
I'm feeling upset about something.
我对某事感到不安。
Should I feel like my options are healthy catharsis?
我应该觉得我的选择是健康的宣泄吗？
I could tell the story, feel it?
我可以讲这个故事，感觉到吗？
I can pack it down.
我可以把它打包下来。
I always hear that it's bad to pack it down, but of course one has to be functional in life and deal with things and we have responsibilities, work and relational responsibilities, et cetera.
我总是听说把它打包起来是不好的，但当然，一个人必须在生活中发挥作用并处理事情，我们有责任，工作和关系责任等等。
We need to sleep at night.
我们晚上需要睡觉。
Catharsis, healthy catharsis, packing it down at the other extreme, telling the story, and yet I think a lot of people are afraid to tell the story because it's in that telling there's a, perhaps a reemergence of the arousal.
宣泄，健康的宣泄，把它压缩到另一个极端，讲述这个故事，但我认为很多人都害怕讲述这个故事，因为在讲述的过程中，可能会出现一种兴奋的重新出现。
The arousal can become greater.
觉醒可以变得更大。
Is that what people mean when they say things are going to get worse before they get better?
当人们说事情在好转之前会变得更糟时，这就是这个意思吗？
Andrew Huberman:
安德鲁·休伯曼：
I guess the simple version of this long-winded question is, it's clear we need to confront these things.
我想这个冗长问题的简单版本是，很明显我们需要面对这些事情。
We can't change the past by ...
我们无法改变过去...
a reflexive response isn't going to do that efficiently.
条件反射的反应并不能有效地做到这一点。
How do we deal with arousal?
我们如何应对性唤起？
How does one take what they feel inside about something shameful?
一个人如何看待可耻的事情的内心感受？
What do you do with it in a moment, and does that have to be done in the presence of a skilled, trained therapist?
一会儿你会用它做什么？这是否必须在熟练且训练有素的治疗师在场的情况下完成？
Or as I'm driving to work in the morning and something comes up, "I can't deal with this right now" comes to mind, what do I do?
或者，当我早上开车去上班时，突然出现了一些事情，“我现在无法处理这个问题”，我该怎么办？
Do I deal with it right then?
那我现在就去处理它吗？
I know this is a big multidimensional question, but I think it's the one that a lot of people grapple with.
我知道这是一个很大的多维问题，但我认为这是很多人都在努力解决的问题。
We want to deal with things.
我们想要处理事情。
How do we deal with that internal arousal?
我们如何应对这种内在的唤醒？
Paul Conti:
保罗·孔蒂：
We so often try and change the trauma of the past in order to control the future.
我们常常试图改变过去的创伤，以控制未来。
What that really adds up to is the trauma of the past dominates our present.
真正加起来的是过去的创伤主宰着我们的现在。
It doesn't have to be that way.
事情并不一定是这样的。
Remember, we're talking about traumas that rise to the level of changing the brain.
请记住，我们谈论的是上升到改变大脑水平的创伤。
As you're saying, that involves re-experience, it involves hypervigilance, increased arousal, changes in mood states, changes in anxiety, changes in sleep, changes in behavior.
正如你所说，这涉及重新体验，涉及过度警觉、觉醒增加、情绪状态的变化、焦虑的变化、睡眠的变化、行为的变化。
These are all changes that in a sense push towards dominating our present.
从某种意义上说，这些变化都在推动我们现在的统治。
Then we're not really living in the present as we're trying to control the future.
那么我们并没有真正活在当下，因为我们试图控制未来。
We're not going to do a great job of controlling our future if we're not really living in the present.
如果我们没有真正活在当下，我们就无法很好地掌控自己的未来。
The way to come at that ...
到达那里的方式...
again in the moment, if we're saying ...
此刻，如果我们说……
okay, in the moment if I need to fall asleep, I might say, "Okay, let me try and put that out of my mind.
好吧，在我需要入睡的那一刻，我可能会说：“好吧，让我试着把这件事抛到脑后。
Let me try and thought redirect." There's short-term strategies that can let us be functional in the context of these changes, but the answer is to go look directly at that thing.
让我试着重新思考一下。”有一些短期策略可以让我们在这些变化的背景下发挥作用，但答案是直接关注这个问题。
Look at that trauma, explore that trauma.
看看那个创伤，探索那个创伤。
Paul Conti:
保罗·孔蒂：
Sure, that can be done with a professional, and sometimes that's what makes sense, but not always.
当然，这可以由专业人士来完成，有时这是有意义的，但并非总是如此。
Sometimes it can be done by talking to another person, writing it down.
有时可以通过与另一个人交谈并将其写下来来完成。
Look at what's going on inside of me that my mind is so stuck to this.
看看我的内心到底发生了什么，我的思想如此执着于此。
Let's explore that, because it's almost as if we're so afraid so often of looking at the trauma that has changed us that we'll look anywhere but at that.
让我们来探讨一下这个问题，因为我们似乎经常害怕看到那些改变了我们的创伤，以至于我们会到处寻找而不是看到它。
Paul Conti:
保罗·孔蒂：
...
...
that we'll look anywhere but at that, right?
我们会到处看看，除了那个，对吧？
It's like it's hidden in a closet, and we'll shine the light everywhere else, but we're not going to open that door.
就像它藏在壁橱里一样，我们会把灯照射到其他地方，但我们不会打开那扇门。
And that's where people will say the same as I've heard over and over, and I myself have thought this at times, like, "Oh, if I talk about that I'm going to start crying and never stop." Or, "I'm going to just fall apart," which is never what happens.
这就是人们会说我一遍又一遍听到的同样的话，我自己有时也这么想，就像，“哦，如果我谈论这个，我就会开始哭泣，永远不会停止。”或者，“我会崩溃”，这从来都不会发生。
No one ever starts crying and never stops.
没有人会开始哭泣并且永远不会停止。
What ends up happening is when the person puts words to it — it could be in writing, it could be talking to a trusted other or with a therapist — things start to change.
最终发生的事情是，当这个人说出自己的想法时——可以是书面形式，也可以是与值得信赖的其他人或治疗师交谈——事情开始发生变化。
I mean, just the fact that you can talk about it, you can put words to it, and other people don't recoil, right?
我的意思是，事实上你可以谈论它，你可以用语言表达它，而其他人不会退缩，对吗？
Paul Conti:
保罗·孔蒂：
I mean, how many times has someone said something for the first time, and when they're telling me about the trauma, there's such an anxious ...
我的意思是，有多少次有人第一次说出某件事，当他们告诉我有关创伤的事情时，我感到如此焦虑......
like looking as if I'm going to recoil from it, right?
看起来好像我要回避它，对吧？
Meaning I'm going to recoil from them.
这意味着我会回避他们。
And then there's a sense of surprise if the person says, "Well, I was abused by this coach when I was a kid," and there's not a response of recoiling.
然后，如果这个人说：“嗯，我小时候被这个教练虐待过”，并且没有任何退缩的反应，就会有一种惊讶的感觉。
You can see the change, and people will say a lot, like, "Wow, I can't believe you can hear me say that and be okay with it." So you think about what's going on inside of them, what a sense of shame, a sense of this is something awful about me for people to recoil from, and it's just not true.
你可以看到这种变化，人们会说很多，比如，“哇，我不敢相信你能听到我这么说，而且还能接受。”所以你想想他们内心正在发生什么，这是一种多么羞耻的感觉，这种感觉对我来说是可怕的，让人们退缩，但这不是真的。
Paul Conti:
保罗·孔蒂：
But here's where trauma is.
但这就是创伤所在。
It's insidious and it's pervasive, right?
它很阴险而且很普遍，对吗？
Because if that convinces us to continually hide it away, then how do we explore it?
因为如果这说服我们不断地将其隐藏起来，那么我们如何探索它呢？
That example of the person who says, "Okay, I was abused by a coach when I was a child." I mean, I'm thinking of a couple of very real cases, people that I've taken care of, and once they start talking about it, then they start talking about how they were just innocent kids and they didn't know, and they really wanted to be on the team where this coach was treating them as special.
那个人说：“好吧，我小时候被教练虐待过。”我的意思是，我想到了几个非常真实的案例，我照顾过的人，一旦他们开始谈论这件事，他们就会开始谈论他们只是无辜的孩子，他们不知道，他们真的很想加入教练视他们为特殊的球队。
And now, they can look at themselves from the outside.
而现在，他们可以从外部审视自己。
They can look at themselves like they would look at someone else.
他们可以像看待别人一样看待自己。
Paul Conti:
保罗·孔蒂：
You think it's so easy for us to see what's real and true if it's someone else.
你认为如果是别人的话，我们很容易看出什么是真实的。
If you ask someone, "What do you think of someone who's 10, 11 years old who's manipulated and abused by an adult?
如果你问某人：“你对 10、11 岁的人被成年人操纵和虐待有何看法？
We'd say, 'Oh my goodness, I feel compassion for that person.'" Right?
我们会说，‘天哪，我对那个人感到同情。’”对吧？
But if it's us, then, oh no, it's guilt and shame and we have to hide it away.
但如果是我们，那么，哦不，这是内疚和羞耻，我们必须把它藏起来。
And when the person starts looking at it, they can sort of see it from the outside, and it starts to take the energy out of it, right?
当人们开始观察它时，他们可以从外面看到它，并且它开始从中吸取能量，对吗？
Then, well, who should feel guilty about that?
那么，谁应该为此感到内疚呢？
Who's done something wrong?
谁做错了什么？
Paul Conti:
保罗·孔蒂：
And so now the conceptions come together, which is often a reflexive, "That was my fault.
所以现在这些概念聚集在一起，这通常是一种条件反射，“那是我的错。
Oh, I did it.
哦，我做到了。
I went back to it.
我又回到了原来的话题。
I still stayed on the team.
我仍然留在队里。
I went back next season.
我下个赛季就回去了。
I let it happen again." All the guilt and shame inside the person gets juxtaposed to like, what really happened there?
我让它再次发生。”人内心所有的内疚和羞耻感都与喜欢并列在一起，那里到底发生了什么？
And then they say, "Right.
然后他们说：“好吧。
I was a terrified child.
我是一个害怕的孩子。
I didn't understand at all." And they can come to a place of compassion, and now we are working against the guilt and shame.
我根本不明白。”他们可以达到同情的地步，现在我们正在努力消除内疚和羞耻。
Paul Conti:
保罗·孔蒂：
And if the person cries about it, that's great.
如果这个人为此哭泣，那就太好了。
I mean, crying is one of the best coping mechanisms we have.
我的意思是，哭泣是我们最好的应对机制之一。
It doesn't hurt us, and it lets us grieve things.
它不会伤害我们，而且会让我们感到悲伤。
We can't grieve if there's guilt and shame inside of us.
如果我们内心有愧疚和羞耻，我们就不会悲伤。
It just blocks grief, right?
它只是阻止悲伤，对吗？
It has to be a clean slate, in a sense, in order to feel sadness.
从某种意义上说，它必须是一个干净的石板，才能感受到悲伤。
And then you see that it shifts from anxiety, anger, and frustration, usually directed towards the self, guilt and shame, towards being able to process it and being able to bring to bear some compassion, and being able to direct the negative emotions, so to speak, where they're warranted.
然后你会发现，它从通常针对自我、内疚和羞耻的焦虑、愤怒和沮丧转变为能够处理它并能够承担一些同情心，并能够将负面情绪引导到需要的地方。
And my goodness, the changes that happen.
天哪，发生的变化。
I mean, it's not like people are miraculously cured, but it's remarkable how just getting it out there and having one hour of talking like that, like what we're talking about now, can leave a person feeling immensely better.
我的意思是，这并不是说人们奇迹般地被治愈了，但值得注意的是，只要把它拿出来，进行一小时的谈话，就像我们现在谈论的那样，就能让一个人感觉好多了。
Andrew Huberman:
安德鲁·休伯曼：
It seems to me in hearing this that there's this weird wiring that we have, because what I'm hearing is when traumas happen to us or we observe them, what we need to do most is to confront those and the emotions around that directly.
在我看来，听到这些，我们有一种奇怪的感觉，因为我听到的是，当创伤发生在我们身上或我们观察到它们时，我们最需要做的就是直接面对这些以及周围的情绪。
But instead, our system defaults to guilt, shame, and trying to hide it, and this repetition compulsion of placing us back into things similar to those traumas, or even maybe even worse traumas, in an attempt to resolve it.
但相反，我们的系统默认了内疚、羞耻，并试图隐藏它，并且这种重复强迫性地让我们回到与那些创伤类似的事情，甚至可能是更严重的创伤，试图解决它。
Andrew Huberman:
安德鲁·休伯曼：
It's like the most maladaptive wiring diagram I could possibly think of, emotional and presumably physiological wiring diagram.
这就像我能想到的最不适应的接线图，情感接线图和大概的生理接线图。
And this notion of trying to change the past by doing things now, when the exact opposite is what's going to be beneficial, also seems like ...
这种试图通过现在做事来改变过去的想法，而恰恰相反却是有益的，似乎也......
The whole system seems completely backwards.
整个系统看起来完全落后了。
And I'm chuckling as I say this, not because I'm amused, it's because I'm just baffled once again at how our wiring can often not serve us well.
当我说这句话时，我咯咯地笑，不是因为我被逗乐了，而是因为我再次对我们的布线常常不能很好地为我们服务感到困惑。
Andrew Huberman:
安德鲁·休伯曼：
But it raises what I think is an important and interesting question, which is earlier you were talking about how people will seek out media that's really disturbing.
但它提出了一个我认为重要且有趣的问题，即之前您谈到的人们将如何寻找真正令人不安的媒体。
They'll traumatize and retraumatize themselves on a daily basis.
他们每天都会给自己带来创伤和再次创伤。
So that could be viewed as the repetition compulsion, or the person will have the same abusive relationship with seven different partners in sequence.
因此，这可以被视为重复强迫，或者该人将依次与七个不同的伴侣发生相同的虐待关系。
Seems terrible, and yet, as I say this, it also is becoming clear to me how this almost seems like a poor but desperate attempt to resolve it in some way.
看起来很糟糕，然而，正如我所说，我也越来越清楚，这似乎是一个以某种方式解决这个问题的可怜但绝望的尝试。
And so the fork in the road, if I understand correctly, is to really get to the seed incident, really get to the thing that started it all, as opposed to repeating it all?
所以，如果我理解正确的话，岔路口就是真正了解种子事件，真正了解引发这一切的事情，而不是重复这一切？
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Does that have to be done in the presence of a therapist?
这是否必须在治疗师在场的情况下进行？
Is there a benefit to taking a walk and thinking about these things, breaking down and crying if that's what's necessary, or feeling angrier if that's what comes up?
散步并思考这些事情，如果有必要的话会崩溃并哭泣，或者如果发生了会感到更愤怒，有什么好处吗？
The reason I ask it this way is because I worry, I'll just speak to my own experience, I worry that in reactivating or touching into the emotions around something, that that is itself a form of the repetition compulsion because you're feeling it all over again.
我这样问的原因是因为我担心，我只想谈谈我自己的经历，我担心在重新激活或触及某些事物周围的情绪时，这本身就是一种重复强迫的形式，因为你会再次感受到它。
It's just that you're not seeking out something to evoke that feeling.
只是你没有在寻找东西来唤起这种感觉。
Andrew Huberman:
安德鲁·休伯曼：
So I realize this is a little bit of a circular argument or question, but I think it's one that I really struggle with in trying to parse all the outcome-based therapies that I hear about and the recommendations that people make.
所以我意识到这有点循环论证或问题，但我认为这是我在试图解析我听到的所有基于结果的疗法和人们提出的建议时真正遇到的问题。
I mean, how should we conceptualize this?
我的意思是，我们应该如何概念化这个？
Something happens.
有事发生了。
It sounds like we need to deal with that thing directly.
看来我们需要直接处理那件事了。
Do we need to do that with somebody else?
我们需要和其他人一起做吗？
Can we do that on our own?
我们可以自己做吗？
If we don't have resources and we have to do it on our own, can't hire someone, can't pay someone to work with us, how do we do that in a way that isn't retraumatizing ourself in a major way or in a minor way?
如果我们没有资源，必须自己做，无法雇用某人，无法付钱给与我们一起工作的人，我们如何才能以一种不会对自己造成重大或轻微伤害的方式做到这一点呢？
How do we know where we are in that landscape?
我们如何知道我们在那个风景中的位置？
Paul Conti:
保罗·孔蒂：
Right.
对。
Again, those are, I think, great questions, and I think it starts with real introspection.
我再次强调，这些都是很好的问题，而且我认为这要从真正的内省开始。
When things are bouncing around in our minds, often it's very nonproductive, right?
当事情在我们的脑海中跳来跳去时，通常是非常没有生产力的，对吧？
It's the same thing over and over again, and that's not helpful for us.
一遍又一遍地重复同样的事情，这对我们没有帮助。
So there's an idea which sometimes gets called an observing ego, the ability to stop and look at what's going on inside of ourselves.
因此，有一种想法有时被称为“观察自我”，即停下来观察自己内心发生的事情的能力。
And so if we're just thinking about it, and we're thinking in the same way we sort of, in a sense, always think about it, then all we're doing is reinforcing the trauma.
因此，如果我们只是在思考它，并且我们的思考方式与我们在某种意义上总是思考它的方式相同，那么我们所做的就是强化创伤。
But if we can distance enough to be like, "Huh, I'm interested in what's going on inside of me," right?
但如果我们能够保持足够的距离，“嗯，我对我内心发生的事情感兴趣，”对吗？
Paul Conti:
保罗·孔蒂：
And think of a certain person who really loves music, and at some point in our therapy work, I learned she was taking long drives but the radio wasn't on.
想想一个真正热爱音乐的人，在我们的治疗工作中的某个时刻，我得知她要长途驾驶，但收音机没有打开。
And I was like, well, what's going on?
我当时想，好吧，发生了什么事？
And I asked, and what was going on is she was running over and over again in her head, "I'm a loser, I'm a loser," and she didn't want the music on because the music would drown out what she felt she had to say to herself, right?
我问，发生了什么事，她脑子里一遍又一遍地跑着，“我是一个失败者，我是一个失败者，”她不想放音乐，因为音乐会淹没她觉得她必须对自己说的话，对吗？
And it was that, wow, that's interesting.
哇，这很有趣。
And then her ability to observe that and to think, "Why am I doing that?" when it comes into her mind.
然后她有能力观察并思考“我为什么要这么做？”当它进入她的脑海时。
"What does that trace to?
“这说明了什么？
When did I start doing that?"
我什么时候开始这么做的？”
Paul Conti:
保罗·孔蒂：
Like I say, I'm saying it for a point of exaggeration, but nobody comes out of the womb programmed to think, "I'm a loser," right?
就像我说的，我这么说有点夸张，但没有人从子宫里出来就注定会想：“我是一个失败者，”对吗？
So we don't think that when we're born, so where does that come from?
所以当我们出生时我们不这么想，那它从哪里来呢？
Then we can think in ways that allow us to have new thoughts that we weren't having.
然后我们可以用一些方式思考，让我们产生我们没有的新想法。
It's not just bouncing around in our minds.
它不只是在我们的脑海中跳来跳去。
And if we speak or write, there are even more mechanisms that come online in our brains that are then sort of monitoring mechanisms.
如果我们说话或写字，我们的大脑中就会出现更多的机制，这些机制就是某种监控机制。
We think in a different way if we're using words, and we are better able often to bring in that observing ego, like "What's going on inside of me?"
如果我们使用语言，我们会以不同的方式思考，并且我们经常能够更好地引入观察性的自我，例如“我内心发生了什么？”
Paul Conti:
保罗·孔蒂：
So it can be very helpful to think, it can be helpful to talk to someone, to a trusted other, friend, family, clergy; to write.
因此，思考是非常有帮助的，与某人、与值得信赖的人、朋友、家人、神职人员交谈也很有帮助；写。
I mean, these are things that can be done without expending any resources, and sometimes it can make really a big difference.
我的意思是，这些事情不需要花费任何资源就可以完成，有时甚至可以带来很大的改变。
"Wait, when did I start thinking that?" And interestingly, in this case, we did it in therapy, but it became very clear what that was rooted to, right?
“等等，我什么时候开始这么想的？”有趣的是，在这种情况下，我们在治疗中做到了这一点，但它的根源是什么变得非常清楚，对吗？
And then in the therapy, which was still relatively young, but we'd done several sessions and we weren't talking at all about what we needed to talk about.
然后是治疗，虽然还比较年轻，但我们已经做了几次治疗，但我们根本没有谈论我们需要谈论的事情。
But that's what got us to what we needed to talk about.
但这就是我们需要讨论的事情。
When did that start?
那是从什么时候开始的？
And now we're in that same place of exploring that, and what was the reflex to it, and the sense of guilt and sense of shame.
现在我们正处于探索这一点的同一个地方，以及对此的反应是什么，以及内疚感和羞耻感。
And it's where all of that came from, that just got boiled down to "I'm a loser," right?
这就是所有这些的来源，归结为“我是一个失败者”，对吧？
Which this person didn't even have in their mind, like "I didn't think about myself that way."
这个人根本没有想到这一点，比如“我没有那样考虑自己”。
Paul Conti:
保罗·孔蒂：
And it's so interesting that our memories don't in and of themselves have meaning.
有趣的是，我们的记忆本身并没有意义。
It's like they're flat or colorless, and they're colored in by the emotions that we attach to them, so the idea that certain memories now before the trauma were changed by the trauma.
就好像它们是扁平的或无色的，它们被我们依附于它们的情感所染色，所以创伤之前的某些记忆被创伤改变了。
So I tell the story sometimes of a person who won an award when they were in high school that they thought was, "Oh my gosh, it shows I can do it.
所以我有时会讲一个在高中时获奖的人的故事，他们认为，“哦，天哪，这表明我能做到。
I can get out there," that after trauma, they saw the award with a negative emotion attached to it that was like, "Oh, it was given to me and I didn't deserve it," and almost it was mocking.
我可以出去，”在遭受创伤后，他们看到这个奖项时带着一种负面情绪，就像是，“哦，它是给我的，我不配得到它，”这几乎是一种嘲笑。
Like, "That's going to be the greatest achievement in my life, and I was 17," or something.
比如，“这将是我一生中最伟大的成就，当时我 17 岁”，或者其他什么。
Paul Conti:
保罗·孔蒂：
And to have someone think ...
并让某人认为...
like that's not how they felt about that at the time, it's the trauma that changed the self-talk, the internal state going forward, and, talking about miraculous in a negative way, also changed that going backward, right?
就像他们当时的感受不是这样，是创伤改变了自言自语，改变了前进的内部状态，并且以消极的方式谈论奇迹，也改变了向后的情况，对吗？
And when we can really look at that, where did that come from, and we can start unraveling it, it changes.
当我们真正能够看到它，它从哪里来，并且我们可以开始解开它时，它就会改变。
Paul Conti:
保罗·孔蒂：
So in those cases, often it's helpful to have a good therapist.
因此，在这些情况下，拥有一位优秀的治疗师通常会有所帮助。
It's not always necessary, and certainly it's not always possible, so we need other strategies.
这并不总是必要的，当然也不总是可能的，所以我们需要其他策略。
And some of those, I write about some of those in the book, of how can we get at trauma without those formalized mechanisms?
其中一些，我在书中写了一些，如果没有这些正式的机制，我们如何才能获得创伤？
And sometimes, if the symptoms are significant enough, we really do need to talk to somebody professional who can help us get to the root of the trauma.
有时，如果症状足够严重，我们确实需要与专业人士交谈，他们可以帮助我们找到创伤的根源。
And there's so many times that's the answer to what's going on with people.
很多时候，这就是人们所发生的事情的答案。
Paul Conti:
保罗·孔蒂：
People I've seen who've had five residential stays, I'm not exaggerating this, for mental health reasons, for substance reasons, and no one's ever taken a trauma history.
我见过的人有过五次住院经历，我并没有夸大这一点，出于心理健康原因，出于物质原因，而且没有人有过外伤史。
And then when you take a trauma history, you see, well, that's obviously where this is all coming from, right?
然后当你记录创伤史时，你会发现，这显然就是这一切的来源，对吗？
That's when the drug use started shortly thereafter, the negative self-talk and the negative feelings that led to the drug use.
不久之后就开始吸毒，消极的自言自语和消极情绪导致了吸毒。
Then you go after the trauma and you can change things, whereas trying to change things without looking, introspecting, talking about the trauma, I think, of course was futile.
然后你追随创伤，你就可以改变事情，而试图改变事情而不审视、内省、谈论创伤，我认为当然是徒劳的。
Andrew Huberman:
安德鲁·休伯曼：
Do you think that people can start to have negative fantasies?
你认为人们会开始产生负面幻想吗？
I mean, you mentioned this woman who would take these long drives to berate herself.
我的意思是，你提到过这个女人，她会开长途车来责备自己。
I'm not familiar with that, but I'll give a little bit of personal disclosure here.
我对此并不熟悉，但我会在这里透露一些个人信息。
I've felt several times in my life that I will start to create a narrative about something that truly hasn't happened, about something terrible that somebody is going to do that's going to upset me.
在我的一生中，我曾多次感觉到我将开始创作一个故事，讲述一些真正没有发生的事情，讲述某人将要做的一些可怕的事情，这会让我心烦意乱。
And for the longest time, I would wonder, why am I doing this?
在很长一段时间里，我都在想，我为什么要这样做？
Andrew Huberman:
安德鲁·休伯曼：
And I have a couple ideas about why.
对于原因我有几个想法。
One is that I was attempting to just avoid thinking about other things.
一是我试图避免思考其他事情。
It's just anger is such an attractive emotional force in ...
只是愤怒是一种如此有吸引力的情感力量......
It's an attractant.
这是一种引诱剂。
It's not attractive; we don't like it, and yet oftentimes, anger is a great way to replace feeling something else, feeling sad or having to do work or to do something useful.
它没有吸引力；我们不喜欢它，但很多时候，愤怒是取代其他感觉、悲伤或必须做工作或做一些有用的事情的好方法。
So it has this kind of gravitational force to it.
所以它有这种引力。
That was one idea.
这是一个想法。
The other idea was in imagining kind of worst outcomes, then actually that relationship could actually seem a lot better in reality.
另一个想法是想象最糟糕的结果，然后实际上这种关系在现实中看起来会好得多。
It's almost like creating this negative contrast.
这几乎就像创造这种负面对比。
It's like, oh, well, then it's not that bad.
就好像，哦，好吧，那就没那么糟糕了。
Andrew Huberman:
安德鲁·休伯曼：
And then the third possibility is, I have no idea why, but it seemed like a reflex, and I spent some time thinking about it.
然后第三种可能性是，我不知道为什么，但这似乎是一种条件反射，我花了一些时间思考它。
I can't say I've resolved it completely.
我不能说我已经完全解决了这个问题。
But why would somebody have a narrative, or a default narrative when driving or when walking, of I'm just going to spend some time and think about how terrible this thing is going to turn out, or how someone's going to upset me or harm me, or how terrible I am?
但是，为什么有人会在开车或走路时有一个叙述，或者一个默认的叙述，即我只是要花一些时间思考这件事会变得多么可怕，或者有人会如何让我心烦意乱或伤害我，或者我有多糟糕？
It seems, again, like maladaptive thinking, maladaptive wiring, and yet I have to assume that it serves some purpose.
这似乎又像是适应不良的思维、适应不良的线路，但我不得不假设它有某种目的。
Paul Conti:
保罗·孔蒂：
Yeah, yeah.
是啊，是啊。
I mean, I think there are three factors there, and they're all bad.
我的意思是，我认为存在三个因素，而且它们都很糟糕。
And I think you spoke to at least two of them, right?
我想你至少和他们中的两个人谈过，对吧？
They, I think, speak so powerfully to how insidious trauma is, and how these are real brain changes inside of us.
我认为，它们有力地说明了创伤是多么阴险，以及这些是我们体内真正的大脑变化。
So I would say there are three factors: punishment, avoidance, and control.
所以我想说有三个因素：惩罚、回避和控制。
So the trauma inside of us that makes the guilt and shame so often, so often leads to a desire to punish oneself.
因此，我们内心的创伤常常使人感到内疚和羞耻，常常导致惩罚自己的欲望。
And the idea that, "Oh, that was my fault," or, "I deserve that." Well, what do we do if something is someone's fault?
还有“哦，那是我的错”或者“我活该”的想法。那么，如果某些事情是某人的错，我们该怎么办？
Then someone now deserves punishment, right?
那么现在有人应该受到惩罚，对吗？
I mean, we punish them.
我的意思是，我们惩罚他们。
We send them to jail, we give them a fine, we punish them, and so what we do is punish ourselves.
我们把他们送进监狱，我们给他们罚款，我们惩罚他们，所以我们所做的就是惩罚我们自己。
And if we tell ourselves we're a loser or this awful thing is going to happen, then part of what we're doing is saying to ourselves, "See?
如果我们告诉自己我们是失败者或者这种可怕的事情即将发生，那么我们所做的一部分就是对自己说：“看到了吗？
You deserved that.
这是你应得的。
You're not going to have anything better."
你不会有更好的事情了。”
Paul Conti:
保罗·孔蒂：
It's a negative, it's a very negative way that the brain tries to make us, in a sense, do better by hurting us more for the things that we couldn't and shouldn't have been able to, weren't expected to control in the first place.
从某种意义上说，这是一种消极的、非常消极的方式，大脑试图通过对我们不能、不应该能够、一开始不希望控制的事情造成更多伤害来让我们做得更好。
The second is distraction, as you said.
第二个是分心，正如你所说。
Anger, that kind of fantasy, can distract us from feeling an emotion that can be much more negative.
愤怒，这种幻想，可以分散我们的注意力，让我们无法感受到更加消极的情绪。
Anger, it can be more gratifying, certainly, than guilt or shame, although guilt and shame can serve a punishment purpose.
愤怒当然比内疚或羞耻更令人满足，尽管内疚和羞耻可以达到惩罚的目的。
But if anger is directed also towards ourselves, then it can serve punishment too.
但如果愤怒也针对我们自己，那么它也可以起到惩罚作用。
So punishment, avoidance, and the sense of control, that if you think ahead to something awful that you're imagining is going to happen, well, maybe that will let you avoid it.
所以惩罚、回避和控制感，如果你提前想到你想象的可怕的事情将会发生，那么，也许这会让你避免它。
Paul Conti:
保罗·孔蒂：
I mean, you can see the brain here, in a sense, really confused.
我的意思是，从某种意义上说，你可以在这里看到大脑，真的很困惑。
I mean, part of the brain wants to punish, part of the brain doesn't want to think about it at all, and part of the brain wants to make it better.
我的意思是，大脑的一部分想要惩罚，大脑的一部分根本不想考虑它，而大脑的一部分想要让它变得更好。
And then how all of that resolves if we're not aware that, hey, this is in the context of our brains being deeply impacted by trauma, so what's going on here is all maladaptive, right?
如果我们没有意识到，嘿，这是在我们的大脑受到创伤深深影响的背景下，那么所有这一切如何解决，所以这里发生的都是适应不良，对吗？
Because these negative fantasies of the future, they may help us feel better about something in the present, but they don't help us make anything better.
因为这些对未来的消极幻想可能会帮助我们对当下的事情感觉更好，但它们并不能帮助我们让事情变得更好。
They don't help us make anything better, so this is kind of the sequela.
它们不能帮助我们做得更好，所以这就是后遗症。
This is where trauma and all this reflexive stuff that happens after trauma ultimately lead us, and you can see how we get lost, how I've seen over and over again in my own life, in the lives of other people, how, man, we get stuck in those situations.
这就是创伤和创伤后发生的所有这些反射性的东西最终引导我们的地方，你可以看到我们如何迷失方向，我如何在自己的生活中，在其他人的生活中一遍又一遍地看到，我们如何陷入这些情况。
Paul Conti:
保罗·孔蒂：
And that's why I see people sometimes, this has been going on for 30 years, 40 years, and it's just been going on over and over and over again, because there's no natural end to any of this unless we look at it in a different way, that we have knowledge and information like, "Whoa, this isn't the way it has to be.
这就是为什么我有时会看到人们，这种情况已经持续了 30 年、40 年，而且一直在一遍又一遍地发生，因为这一切都没有自然的结束，除非我们以不同的方式看待它，我们拥有这样的知识和信息，“哇，这不是它必须的方式。
Let me bring a novel perspective to this." It doesn't change on its own.
让我对此提出一个新颖的视角。”它本身不会改变。
Andrew Huberman:
安德鲁·休伯曼：
I'm struck by your statement that these thoughts or behaviors can make us feel better, but they don't actually make anything better.
我对你的说法感到震惊，你说这些想法或行为可以让我们感觉更好，但实际上并没有让任何事情变得更好。
In that way, this mode of imagining terrible outcomes starts to immediately seem like taking opioids.
这样一来，这种想象可怕结果的模式立即开始看起来像是服用阿片类药物。
You know, you feel better in the moment, but it doesn't actually make anything better, and it probably makes things worse.
你知道，你此刻感觉好多了，但这实际上并没有让任何事情变得更好，而且可能会让事情变得更糟。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And just a question of how much worse, and in what direction.
只是问题是，情况会变得更糟，以及朝哪个方向恶化。
And so I want to just pause on that concept, because I think that concept of makes us feel better but doesn't make anything better, I think it answers an earlier question about this, what seems to be a totally maladaptive wiring diagram.
所以我想暂停一下这个概念，因为我认为这个概念让我们感觉更好，但并没有让任何事情变得更好，我认为它回答了之前关于这个的问题，这似乎是一个完全不适应的接线图。
We need to confront the thing, but we don't want to go into the repetition compulsion.
我们需要面对这件事，但我们不想陷入强迫性的重复。
So it's a knife edge there to navigate through trauma.
所以这是一个度过创伤的刀刃。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Working with a very skilled clinician like yourself, I think, is the ideal circumstance for people.
我认为，与像您这样技术精湛的临床医生一起工作对于人们来说是理想的环境。
And of course, there are people who can't access support from somebody for whatever reason.
当然，有些人由于某种原因无法获得某人的支持。
You've talked about journaling as a useful tool.
您谈到日记是一种有用的工具。
Could you maybe highlight some of the other things that people can do on their own?
您能否强调一下人们可以自己做的其他一些事情？
And then I'd also like to talk about what makes for a good therapist.
然后我还想谈谈如何成为一名优秀的治疗师。
What should people look for, for those that are seeking therapy, especially nowadays, when a lot of therapy is being done remotely?
对于那些正在寻求治疗的人来说，尤其是在很多治疗都是远程进行的今天，人们应该寻找什么？
Andrew Huberman:
安德鲁·休伯曼：
But let's just start with the, let's just call them self-generated or zero-cost sorts of things, journaling being the first, and then what are some of the others, and what kind of structure would you recommend someone put around journaling?
但是，让我们从这些东西开始，让我们称它们为自生成或零成本之类的东西，日记是第一个，然后是其他一些，您会建议人们在日记周围采用什么样的结构？
Carry a journal around all day and jot things down as they come up, or sit down and spend an hour writing in complete sentences, for instance?
例如，整天随身携带一本日记，并在出现问题时记下来，或者坐下来花一个小时写下完整的句子？
Paul Conti:
保罗·孔蒂：
Yeah.
是的。
If I could add something to what you had just said before the question, that we have these short-term coping mechanisms in us, and in a way, it makes sense, right?
如果我可以在你刚才在问题之前所说的基础上补充一些内容，我们体内有这些短期应对机制，在某种程度上，这是有道理的，对吗？
If we find ourselves in just terrible situations, then a short-term coping mechanism can get us through them.
如果我们发现自己处于可怕的境地，那么短期应对机制可以帮助我们度过难关。
So our brains are built that way, and that's part of survival too.
所以我们的大脑就是这样构建的，这也是生存的一部分。
And whether now, in the modern world, whether it's food, it's drugs, it's sex, it's alcohol, or it's negative thoughts, this is short-term soothing.
无论是现在，在现代世界，无论是食物、毒品、性、酒精还是消极的想法，这都是短期的安慰。
Even the negative thoughts, the anger is short-term soothing at the expense of long-term change.
即使是消极的想法、愤怒也只是短期的舒缓，而代价是长期的改变。
Paul Conti:
保罗·孔蒂：
And that's where addictive pathways come into play, and that's where, again, how we're built evolutionarily for survival doesn't help us in the way humans have evolved.
这就是成瘾途径发挥作用的地方，这也是我们为生存而进化的方式对我们人类进化方式没有帮助的地方。
We haven't lived this way throughout 99.9 something percent of human history, right?
在人类历史的 99.9% 的时间里，我们并没有这样生活过，对吗？
So we're not adapted to this.
所以我们不适应这个。
So I want to just make a point of saying that about the short-term soothing at the expense of long-term change.
所以我想强调的是，以牺牲长期变化为代价来获得短期安慰。
Paul Conti:
保罗·孔蒂：
And then the question you had asked about journaling or what can we do that's outside of a professional, I think the hallmark of it has to be bringing new eyes to it, thinking about self with a curiosity instead of just a simple automaticity or repetition.
然后你问的关于日记的问题或者我们可以在专业之外做什么，我认为它的标志必须是带来新的视角，带着好奇心思考自我，而不仅仅是简单的自动或重复。
"Why am I thinking about this?
“我为什么要考虑这个？
When did this start?
这是从什么时候开始的？
Why is this in me?" It's that, whether it's words or whether we're writing, that's so important.
为什么这个会在我身上？”就是这样，无论是文字还是我们在写作，这都很重要。
So I think for journaling, it depends on the person.
所以我认为对于写日记，这取决于人。
I mean, we don't want somebody carrying around a journal all day if then there's a compulsion to, "I need to write about everything that's going on in my mind." That might be good to, okay, write a little bit at night, right?
我的意思是，我们不希望有人整天随身携带日记，如果有一种强迫感，“我需要写下我脑海中发生的一切。”晚上写一点可能会很好，对吗？
Or someone who might think, "Sometimes this really comes into my mind in a strong way and it could be unpredictable.
或者有人可能会想：“有时这真的会以一种强烈的方式出现在我的脑海中，而且它可能是不可预测的。
I want to have the journal with me, so ...
我想随身携带日记，所以...
ah, that thing is back in my mind now.
啊，那件事现在又浮现在我的脑海里了。
Let me write about it," because then putting words to it and then being able to read those words, right?
让我写一下，”因为然后把文字写进去，然后就能读到这些文字，对吗？
Paul Conti:
保罗·孔蒂：
And when people read, even do a little bit of journaling and they read, "Oh, I thought again about how I'm a terrible person who can't have a good life because I was in such a bad car accident," or, "because that person attacked me," or, "because when I was in school, I was bullied because I looked different than everyone else," or, "I acted different from everyone else." Wow.
当人们阅读时，甚至写一点日记，他们会读到，“哦，我再次想到我是一个多么糟糕的人，因为一场严重的车祸而无法过上美好的生活”，或者，“因为那个人袭击了我”，或者，“因为当我在学校的时候，我被欺负了，因为我看起来与其他人不同，”或者，“我的行为与其他人不同。”哇。
To actually see that written out, it's a little bit of that like when you're saying it to someone as if it were someone else, because now there's enough distance from it, like I'm looking at the words I wrote, that we get some distance and we can start to integrate some of the, not just the compassion, but integrating compassion and logic, right?
要真正看到写出来的内容，有点像当你对某人说这句话时，就好像这是另一个人一样，因为现在离它足够远了，就像我看着我写的文字一样，我们有了一定的距离，我们可以开始整合一些内容，不仅仅是同情心，而是整合同情心和逻辑，对吗？
Of like, "Okay, I feel a sense of compassion now.
就像，“好吧，我现在感到一种同情心。
Now, wait, what does this mean?
现在，等等，这是什么意思？
What really happened here?
这里到底发生了什么？
And gosh, I did start thinking differently after that.
天哪，从那以后我确实开始有不同的想法了。
I started ...
我开始...
That's where this came from.
这就是它的来源。
That's why I'm saying this."
这就是我这么说的原因。”
Paul Conti:
保罗·孔蒂：
It's those kind of revelations that we can have through, again, the written or spoken word.
我们可以通过书面或口头语言获得这些启示。
And I think, again, that involves a trusted other or writing.
我再次认为，这涉及到值得信赖的他人或写作。
And I think those are ways we can do this, where we bring some de novo perspective to something that often has been bouncing around inside of us.
我认为这些是我们可以做到这一点的方法，我们将一些从头开始的视角带到我们内心经常跳动的事物上。
And it's amazing to me that you can see such intelligent, empathically attuned people who've had the same thing running over and over again in their mind for years.
令我惊讶的是，你能看到如此聪明、富有同理心的人多年来一直在脑海中一遍又一遍地思考同样的事情。
And it just points out that our brains don't automatically say, "Hey, wait a second, I've been spinning wheels here for a long, long time.
它只是指出我们的大脑不会自动说：“嘿，等一下，我已经在这里旋转了很长一段时间了。
Was there another way to look at this?"
还有其他的方式来看待这个问题吗？”
Paul Conti:
保罗·孔蒂：
We need something from the outside, which can just be knowledge, right?
我们需要来自外部的东西，可以是知识，对吗？
Which is why I think what we're doing here, or the reason I wrote the book that I wrote was apprehending this amazing surprise to me, which is, wow, some huge percentage of everything I'm treating is rooted in trauma and the opacity of trauma, which is why we don't see that, oh, the depression, the panic attacks, the life change, the addiction, the maladaptive choices, oh, this is all coming from trauma, because it hides itself in that opacity.
这就是为什么我认为我们在这里所做的事情，或者我写这本书的原因是理解这个对我来说令人惊讶的惊喜，那就是，哇，我正在治疗的所有事情中有很大一部分都根源于创伤和创伤的不透明性，这就是为什么我们看不到，哦，抑郁，惊恐发作，生活改变，成瘾，适应不良的选择，哦，这一切都来自创伤，因为它隐藏在这种不透明性中。
So we need a de novo perspective if we're doing it on our own, and we need that if we're doing it in therapy, which might link to finding the right therapist, which is also part of your question.
因此，如果我们自己做这件事，我们需要一个从头开始的视角，如果我们在治疗中做这件事，我们需要这个视角，这可能与寻找合适的治疗师有关，这也是你问题的一部分。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I definitely want to know about how to assess and find the right therapist.
是的，我确实想知道如何评估和找到合适的治疗师。
Before we cover that, however, something came up in the course of your answer.
然而，在我们讨论这个问题之前，您的回答过程中出现了一些问题。
I can immediately relate to this idea that certain behaviors are really maladaptive, and stuffing things down or avoiding the topic is problematic, and bringing a curiosity and an introspection and almost a third personing of the experience that we've had in order to try and address it from, truly, from a new perspective.
我可以立即想到这样的想法：某些行为确实是不适应的，把事情压下去或回避这个话题是有问题的，并带来好奇心和内省，以及我们所经历的几乎第三人称的经历，以便尝试从一个新的角度真正地解决这个问题。
Andrew Huberman:
安德鲁·休伯曼：
It occurred to me as we were discussing this, however, that some people, and yes, maybe I'm talking a little bit about my own experience, we have a sense of our own identity and how people view us in our ability to be functional in the world in ways that we like.
然而，当我们讨论这个问题时，我突然想到，有些人，是的，也许我正在谈论一些我自己的经历，我们对自己的身份有一种感觉，以及人们如何看待我们以我们喜欢的方式在世界上发挥作用的能力。
Effective at work, or a good brother or a good mother or father or human being in the world.
在工作中表现出色，或者是世界上的好兄弟、好母亲、好父亲或人类。
We have relationships, and I think that one thing that I have heard, and maybe I've experienced, is that sometimes those maladaptive thoughts or behaviors, the things that generate a repetition of anger or of arousal or activation or sadness, that we have some internal process where we funnel that into a functionality in the world, so we ...
我们有关系，我认为我听到的一件事，也许我经历过的一件事是，有时那些不适应的想法或行为，那些产生愤怒、兴奋、激活或悲伤的重复的事情，我们有一些内部过程，我们将其转化为世界的一种功能，所以我们……
I'll give a more concrete example.
我将举一个更具体的例子。
Andrew Huberman:
安德鲁·休伯曼：
In thinking about things that have upset me in the past, and in imagining bad outcomes in the future, there's a certain internal state of arousal that comes about, and for many years I was able to use that.
在思考过去让我心烦意乱的事情以及想象未来的糟糕结果时，会产生某种内在的唤醒状态，多年来我一直能够利用它。
Not to feel angry, but rather to work an extra three hours a day, or to pack my schedule with work and social engagement so I could show up in a way that I hopefully was a very good brother to my sister, for instance.
不要感到生气，而是每天多工作三个小时，或者用工作和社交活动来安排我的日程，这样我就可以以一种我希望成为我姐姐的好兄弟的方式出现。
So in a way, it was a transformation of something negative inside of me into a functionality in the world that was actually very rewarding and beneficial.
所以在某种程度上，这是我内心的一些消极的东西转变为世界上实际上非常有益和有益的功能。
And yet, in describing it, I can immediately see how it would be wonderful if I could source from something else.
然而，在描述它时，我立刻就能明白，如果我能从其他东西中获取信息，那该多好啊。
And yet, you can imagine and I can imagine how one would be reluctant, maybe even terrified of giving up that source.
然而，你可以想象，我也可以想象，人们会多么不情愿，甚至可能害怕放弃这一来源。
It's a fuel.
它是一种燃料。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And I think in knowing some of the traumas of other people and their reluctance to work through those — obviously I'm not a therapist, I sense this over and over again, that one's positive identity can often be linked to something difficult in their past, and so people are reluctant to give up this fuel because in that sense, it's functional.
我认为，在了解其他人的一些创伤以及他们不愿解决这些创伤的过程中——显然我不是治疗师，我一次又一次地感觉到这一点，一个人的积极身份往往可以与他们过去的困难联系在一起，所以人们不愿意放弃这种燃料，因为从这个意义上说，它是功能性的。
The only thing that allowed me to start to address this, and why I'm still so curious about this, because I don't think I've worked through this process completely, again — a little more self-disclosure there — is that I was told these words: "Just imagine how much better it would be if you could source from a different fuel.
唯一让我开始解决这个问题的原因，以及为什么我仍然对此感到好奇，因为我认为我还没有完全完成这个过程——还有更多的自我披露——是有人告诉我这些话：“想象一下，如果你可以从不同的燃料中获取，那会好得多。
A fuel that felt better."
一种感觉更好的燃料。”
Paul Conti:
保罗·孔蒂：
Mm-hmm.
嗯嗯。
Right.
正确的。
Andrew Huberman:
安德鲁·休伯曼：
Maybe it was this sentence, it was, "Maybe you could actually be much more effective.
也许就是这句话，“也许你实际上可以更有效。
Maybe you could be 10 times the better brother.
也许你可以比兄弟好十倍。
Maybe you could have 10 times more insight or work capacity, et cetera." So it's on that hint of a promise that at least I was inspired to start looking into these things and reading about trauma in your book and elsewhere and started to think about this.
也许你的洞察力或工作能力可以提高十倍，等等。”因此，正是基于这种承诺的暗示，至少我受到启发，开始研究这些事情，并在您的书和其他地方阅读有关创伤的内容，并开始思考这一点。
So again, I realize this is a long-winded question and a somewhat complex idea, but I think, or I hope that people will be able to resonate with this idea that sometimes we want to stay attached to this short-term soothing — the punishment, distraction, or control — because it evokes this arousal and then we can apply that arousal.
所以，我再次意识到这是一个冗长的问题，也是一个有点复杂的想法，但我认为，或者我希望人们能够与这个想法产生共鸣，即有时我们想要保持对这种短期舒缓的依恋——惩罚、分心或控制——因为它会唤起这种唤醒，然后我们可以应用这种唤醒。
Paul Conti:
保罗·孔蒂：
Yes, yes.
是的，是的。
I think what you're describing maps, I think, clinically to what gets called sublimation.
我认为你所描述的在临床上映射到所谓的升华。
So there's something negative inside of us, but we sort of transfer that energy.
所以我们内心有一些消极的东西，但我们会转移这种能量。
We transfer that into something that is adaptive or that is positive.
我们将其转化为适应性或积极的东西。
So the idea of the anger, when I think of that thing and it makes anger in me, I channel that into harder work, or I channel that into "I'm going to go be nicer to my brother," right?
因此，当我想到那件事时，愤怒的想法就会让我感到愤怒，我会将其转化为更加努力的工作，或者将其转化为“我要对我的兄弟更好一点”，对吗？
Something like that.
类似的事情。
Paul Conti:
保罗·孔蒂：
And there's validity to that, but it can become self-justifying if a person thinks, "Well, look at what this is doing for me.
这是有道理的，但如果一个人认为：“好吧，看看这对我做了什么，它就会变得自我辩护。
I wouldn't work as hard without it." Now, we start to become attached to the trauma, whereas I think what you had said is absolutely true, that just because we can sublimate some of the negative effect, feeling, emotion that comes from trauma into something productive doesn't mean that that's best.
没有它我就不会那么努力地工作。”现在，我们开始依恋创伤，而我认为你所说的是绝对正确的，仅仅因为我们可以将创伤带来的一些负面影响、感觉、情绪升华成富有成效的东西，并不意味着那是最好的。
Paul Conti:
保罗·孔蒂：
I mean, we can get to our destination by taking a very circuitous route.
我的意思是，我们可以走一条非常迂回的路线到达目的地。
We might waste an hour getting there, but we get there.
我们可能会浪费一个小时到达那里，但我们到达那里了。
That doesn't mean that that's best.
这并不意味着那是最好的。
And it also doesn't look at all the negative, right?
而且它也没有看到所有的负面因素，对吧？
In this example, the wasted fuel, the wasted time.
在这个例子中，浪费了燃料，浪费了时间。
We get somewhere, but we are not optimizing, and I have yet to see one person who has addressed the trauma and become less functional.
我们取得了一些进展，但我们并没有优化，而且我还没有看到一个人已经解决了创伤并变得功能减弱。
It's always either they're just as functional, but they're happier, or more functional, because as you said, just because we may be able to sublimate, well, maybe what's going on will be 10 times better if we weren't sublimating, because the sublimation limits us.
总是要么他们同样有功能，但他们更快乐，或者更有功能，因为正如你所说，只是因为我们可能能够升华，好吧，如果我们不升华，也许发生的事情会好10倍，因为升华限制了我们。
It limits our-
它限制了我们——
Paul Conti:
保罗·孔蒂：
If we weren't sublimating, because the sublimation limits us, it limits our perspective to only what we can see and do through the lens of the trauma.
如果我们没有升华，因为升华限制了我们，它把我们的视角限制在我们通过创伤的镜头所能看到和做的事情上。
And that is never better than the alternative.
这永远比其他选择更好。
Andrew Huberman:
安德鲁·休伯曼：
Thank you for that.
谢谢你。
Paul Conti:
保罗·孔蒂：
You're welcome.
不客气。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Let's discuss how one could or should go about finding a really good therapist.
让我们讨论一下一个人可以或应该如何寻找一位真正优秀的治疗师。
Typically, in my experience, this is done by word of mouth.
根据我的经验，通常这是通过口耳相传来完成的。
There's this person, you might want to work with them, they're really great.
有这样一个人，你可能想和他们一起工作，他们真的很棒。
But what are some of the characteristics that one should look for, and should we take into account whether or not we are a person who, for instance, I've heard this from listeners, although I'm definitely not talking about myself here, cloaking something.
但是，我们应该寻找哪些特征，我们是否应该考虑我们是否是一个人，例如，我从听众那里听到过这样的人，尽管我绝对不是在这里谈论我自己，掩盖什么。
Some people will say, "I want to work with a somatic therapist," because I've actually heard someone say, "I think in feels.
有些人会说，“我想和躯体治疗师一起工作”，因为我实际上听到有人说，“我根据感觉思考。
I feel stuff in my body.
我感觉身体里有东西。
So I want to work with someone who can really acknowledge that." Or someone else will say, "I want to work with somebody who has this orientation or that orientation, or is open to my particular lifestyle, or isn't going to tell me that I have to leave my relationship."
所以我想和一个能够真正承认这一点的人一起工作。”或者其他人会说：“我想与有这种或那种倾向的人一起工作，或者对我的特定生活方式持开放态度，或者不会告诉我必须离开我的关系。”
Andrew Huberman:
安德鲁·休伯曼：
I feel like people already show up to the question of who to work with, with all these things internally, some of which are voiced, and some of which aren't.
我觉得人们已经开始考虑与谁合作的问题，所有这些事情都在内部进行，其中有些是表达出来的，有些则没有。
So I'd love for you to talk about maybe some of the core features of a really good therapist and then how to look for a therapist and also how to think about oneself in looking for a therapist because of these kind of predispositions.
因此，我希望您能谈谈真正优秀的治疗师的一些核心特征，然后如何寻找治疗师，以及由于这些倾向而在寻找治疗师时如何考虑自己。
Paul Conti:
保罗·孔蒂：
Right.
对。
Well, there's a lot of data about this over the years that if you look at what are the top 10 important factors to find in a therapist, just repeat "rapport" 10 times.
嗯，多年来有很多关于这方面的数据，如果你看看治疗师最重要的 10 个因素是什么，只需重复“融洽”10 次即可。
I mean, that's the key.
我的意思是，这就是关键。
And if you think about that, that's pretty amazing right, because therapeutic modalities can be so different?
如果你想一想，这真是太神奇了，因为治疗方式可以如此不同？
And I think what that's telling us is, in a way, something very obvious.
我认为这在某种程度上告诉我们一些非常明显的事情。
What does rapport mean?
融洽关系是什么意思？
It's paying attention, it's trust, it's a back and forth, it's like, "Yeah, even though I'm doing something difficult, I'm doing it with someone who's really helping me.
它是关注，是信任，是来来回回，就像是，“是的，尽管我正在做一些困难的事情，但我是和一个真正帮助我的人一起做的。
Someone who's in it with me, someone who's really paying attention, wants me to be better." That's indispensable, I mean, it's just indispensable.
一个和我在一起的人，一个真正关注我的人，希望我变得更好。”这是不可或缺的，我的意思是，它只是不可或缺的。
And I write in the book, if a therapist's not making eye contact, or this is the way they do it and you got to fit into the box of the way they do it, that is not going to be helpful.
我在书中写道，如果治疗师没有进行眼神交流，或者这就是他们做事的方式，而你必须适应他们做事方式的框框，那不会有帮助。
Paul Conti:
保罗·孔蒂：
And then what I think about that is the different modalities, it doesn't actually tell us that, "Oh, the modality's irrelevant." I think that's not true.
然后我想到的是不同的模式，它实际上并没有告诉我们，“哦，模式无关紧要。”我认为这不是真的。
And I think that good therapists are not pigeonholed by a certain modality.
我认为优秀的治疗师不会被某种模式所束缚。
They may come at the world largely through a psychodynamic or a CBT or a DBT lens.
他们可能主要通过心理动力学、CBT 或 DBT 视角来看待这个世界。
There's lots of different ways to do therapy.
有很多不同的治疗方法。
But when you really talk to those people, really good experienced therapists, it's all coming through the vehicle of the rapport, but they're practically shifting to what the person needs.
但是，当你真正与这些人，真正经验丰富的治疗师交谈时，一切都是通过融洽的媒介来实现的，但他们实际上正在转向人们的需求。
I don't understand the idea that like, "Oh, I just do this.
我不明白这样的想法，“哦，我只是这样做。
I don't do that." When people are pigeonholed that way, I don't think they help their patients very well.
我不这样做。”当人们被这样分类时，我认为他们不能很好地帮助他们的病人。
We have to be diverse enough to say, "Hey, I want all the arrows in the quiver.
我们必须足够多样化才能说：“嘿，我想要箭袋里的所有箭头。
And even though there might be one that I favor and that's the lens I see things through, no, I can be versatile.
尽管可能有一个我喜欢的视角，那就是我看待事物的视角，但不，我可以多才多艺。
I can shift, I can adapt to what this person needs." And I think if you have that, you've got a winning combination.
我可以改变，我可以适应这个人的需要。”我认为如果你具备了这一点，那么你就拥有了一个成功的组合。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
So people should perhaps try a few therapists and maybe have a session or two or three to see if the rapport feels like it's taking root.
因此，人们也许应该尝试几位治疗师，也许进行一两次或三次治疗，看看这种融洽的关系是否正在扎根。
Do I have that right?
我有这个权利吗？
Paul Conti:
保罗·孔蒂：
Yeah.
是的。
And I think that's why word of mouth is important.
我认为这就是为什么口碑如此重要。
If someone you trust tells you, "Hey, this is a good person," that says a lot, it already makes the pretest probability is quite high.
如果你信任的人告诉你，“嘿，这是一个好人”，这说了很多，这已经使得预测试概率相当高。
But yes, it's interesting to see when people have a therapist or they call their insurance and they're assigned a therapist, this thought that, "Oh, that's the person I have to have now." And it's like, "No, you should look at that like anyone you'd be interviewing for a job." But you got to bring, again, the right set of thoughts to that to be helped, which is, "Look, I want someone who's has rapport with me.
但是，是的，有趣的是，当人们有治疗师或者他们打电话给他们的保险并被指派一名治疗师时，他们会想，“哦，这就是我现在必须拥有的人。”就像，“不，你应该像你面试工作的任何人一样看待这个问题。”但你必须再次带着正确的想法来获得帮助，那就是，“看，我想要一个与我关系融洽的人。
I don't want someone who's going to make it easy," who's like, "Well it's, gosh, it's kind of pleasant," because then that means they're not talking about the difficult things.
我不想要一个能让事情变得简单的人，”他会说，“好吧，天哪，这有点令人愉快，”因为那样就意味着他们不会谈论困难的事情。
So if one brings, "I know this isn't going to be easy, I got to talk about difficult things."
因此，如果有人说：“我知道这并不容易，我必须谈论困难的事情。”
Paul Conti:
保罗·孔蒂：
Even if one doesn't recognize, "Oh, I got to talk about the trauma in me," but to go to therapy thinking, "No, I mean sometimes it's enjoyable, but a lot of times it's not.
即使一个人没有意识到，“哦，我必须谈论我内心的创伤”，但在接受治疗时会想，“不，我的意思是有时它是令人愉快的，但很多时候却不是。
Right.
对。
It's hard work.
这很辛苦。
It can be excruciating.
这可能会让人难以忍受。
We can cry doing it." But to say, "That's how I'm going to be helped and I want someone who's going to do that with me, who's really looking at what's going on inside of me, how do we help me?" And I can feel the robustness of that if one brings that approach and then looks at the therapist through that lens, you're very likely to then move on from someone who's not a good choice and really stick with someone who is, even though that doesn't mean it's always pleasant and enjoyable.
我们可能会哭着做这件事。”但是要说，“这就是我得到帮助的方式，我希望有人能和我一起做这件事，真正关注我内心发生的事情，我们如何帮助我？”我可以感受到这种方法的稳健性，如果一个人采用这种方法，然后通过这个镜头来看待治疗师，那么你很可能会离开一个不是好的选择的人，并真正坚持与一个不是好的选择的人在一起，尽管这并不意味着它总是令人愉快和愉快的。
I mean it has to not be that sometimes.
我的意思是有时不一定是这样。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Well, maybe we could drill a little deeper into the mechanics of therapy.
好吧，也许我们可以更深入地研究治疗机制。
I put out a few questions to audience asking what they want to know about therapy.
我向观众提出了几个问题，询问他们想了解有关治疗的哪些信息。
And it was amazing.
这太棒了。
I got hundreds if not thousands of responses saying, "How should I show up to therapy?" So for instance, should people take a five-minute meditative drop-in before or should they just show up cold and let it emerge during therapy?
我收到了成百上千的回复，询问“我应该如何接受治疗？”例如，人们应该在治疗前进行五分钟的冥想，还是应该表现得冷漠并在治疗过程中让它出现？
Is it a good idea to take notes or to not take notes?
记笔记好还是不记笔记好？
And then post-therapy?
然后治疗后呢？
How should clients, patients as they're sometimes called — one or the other, I never know which — how should they process that information?
客户、病人（有时被称为病人）——一个或另一个，我不知道是哪个——他们应该如何处理这些信息？
Should they take some designated time afterwards and in an ideal world, take a 30-minute walk afterwards and think about the material, or should they set it aside and come back to it?
他们应该在事后花一些指定的时间，在理想的情况下，事后散步 30 分钟并思考这些材料，还是应该把它放在一边然后再回来思考？
Andrew Huberman:
安德鲁·休伯曼：
Of course there are constraints, work and family, et cetera, but there's a lot of knowledge out there about how to best show up to a workout – warm up for five, 10 minutes, then do this, et cetera.
当然，还有工作和家庭等方面的限制，但关于如何最好地参加锻炼，有很多知识——热身五分钟、十分钟，然后这样做，等等。
And then the cool down, I mean here we're talking about hard psychological work aimed at bettering oneself.
然后冷静下来，我的意思是我们在这里谈论的是旨在提高自己的艰苦的心理工作。
So to my knowledge, I've not ever seen this information anywhere.
据我所知，我从未在任何地方看到过此信息。
It'd be very useful to hear your thoughts on this.
听到您对此的想法非常有用。
Paul Conti:
保罗·孔蒂：
Yeah.
是的。
Well I'm not trying to duck the question, but I think it varies so much by person.
好吧，我并不是想回避这个问题，但我认为这个问题因人而异。
So if you think about ...
所以如果你想...
the first part of your question I think was, "How to show up to therapy." And I think the answer would be whatever lets you be fully present when you're in therapy.
我认为你问题的第一部分是“如何接受治疗”。我认为答案就是让你在接受治疗时能够全身心投入的一切。
Now for some people that's going to be, "I show up early, I sit, I calm myself, and I meditate a little bit." I mean, that's how then they're present.
现在对于一些人来说，“我很早就出现，我坐下来，让自己平静下来，然后冥想一下。”我的意思是，他们就是这样出现的。
For other people, they show up, walk into the room, they can stop and now they're present.
对于其他人来说，他们出现，走进房间，他们可以停下来，现在他们就在场。
So whatever works for that person so that they're really there, their thoughts, their energy is really in what's going on.
因此，无论什么对那个人有效，让他们真正在那里，他们的想法，他们的能量都真正存在于正在发生的事情中。
And the same thing applies on the other end.
同样的事情也适用于另一端。
There are people who are really well served by going for a walk if they can, or sitting quietly after therapy, kind of putting that in order, otherwise they lose some of it, right?
有些人如果可以的话去散步，或者在治疗后安静地坐着，这样会得到很好的服务，有点整理一下，否则他们会失去一些，对吗？
Paul Conti:
保罗·孔蒂：
Or some of the ah-ha's, right?
或者一些啊哈的，对吧？
Or the, "Oh, that's an interesting thought," that they really need to put it in order.
或者，“哦，这是一个有趣的想法”，他们真的需要把它整理好。
Maybe that involves taking some notes during therapy.
也许这需要在治疗期间做一些笔记。
For other people, they need to do the exact opposite.
对于其他人来说，他们需要做完全相反的事情。
They need to leave, not think about that at all.
他们需要离开，根本不去想这个。
And then they can reflect on it later and learn from it.
然后他们可以稍后反思并从中学习。
So we're so different.
所以我们是如此不同。
Human beings, there's such a diversity in us that there's no hard answer to that.
人类，我们有着如此多的多样性，对此没有硬性的答案。
It's being present when it's happening, then being able to consolidate and retain what's been gained is most important.
当它发生时它就在场，然后能够巩固和保留所获得的东西是最重要的。
And I think we have to figure that out person by person.
我认为我们必须逐一解决这个问题。
I mean, I try and do that in the work of, what's serving this person best?
我的意思是，我尝试在工作中做到这一点，什么最能为这个人服务？
And sometimes it evolves and sometimes we talk about it, but it varies so much.
有时它会演变，有时我们会谈论它，但它变化很大。
Andrew Huberman:
安德鲁·休伯曼：
If someone were thinking about embarking on therapy or more therapy to address trauma or just general issues of life, what is the frequency that you recommend?
如果有人正在考虑开始治疗或更多治疗来解决创伤或只是生活中的一般问题，您建议的频率是多少？
I could imagine two extreme models.
我可以想象两个极端的模型。
One is, "Okay, I'm going to finally tackle this trauma.
其中之一是，“好吧，我终于要解决这个创伤了。
I'm going to do therapy three times a week," but for a shorter period of time, six months over and out versus this open-ended model of once a week, typically, for as long as it takes.
我将每周进行三次治疗，”但治疗时间较短，持续六个月，而这种开放式模式通常每周一次，只要需要就可以。
Paul Conti:
保罗·孔蒂：
Right.
对。
I think that also varies.
我认为这也各不相同。
And I work with people in varied ways, from someone who's doing well and we meet for a half hour every six months, to doing weeklong hourly sessions, to spending three intense days with someone in a row.
我以各种方式与人们一起工作，从表现良好的人（我们每六个月见面一次半小时），到每周一次的每小时会议，再到与某人连续度过三天紧张的时光。
So I think as far as kind of guiding principles, what I have found in my own life, because I value my own therapy tremendously.
所以我认为就指导原则而言，我在自己的生活中发现了什么，因为我非常重视自己的治疗。
So I found in my own life and in my own clinical work that if it's less than once a week, then it's hard for us to retain really.
所以我在自己的生活和临床工作中发现，如果每周少于一次，那么我们就很难真正保留。
We spend a lot of time kind of catching up, "Okay, what's happened?
我们花了很多时间来追赶，“好吧，发生了什么事？
Let's get back to the place we were at before." Which is why I think if we're really going to get somewhere, we're not just trying to maintain something right?
让我们回到之前的地方。”这就是为什么我认为如果我们真的要取得某个目标，我们不仅仅是试图维持某些正确的东西？
Then I think once a week for an hour is really kind of the minimum.
然后我认为每周一次，每次一小时确实是最少的。
Paul Conti:
保罗·孔蒂：
But more intensive work, it's like the more intensive it is, it's not linear, it's an exponential gain.
但是越密集的工作，就像越密集，它不是线性的，而是指数级的增益。
We do a lot of intensive work where someone will come and do 30 clinical hours with us over the course of a week.
我们做了很多密集的工作，每周都会有人来和我们一起做 30 小时的临床工作。
So five or six different clinicians, 30 clinical hours.
五六位不同的临床医生，三十个临床小时。
And we've found that the benefits of doing that are immense.
我们发现这样做的好处是巨大的。
It's like it's a year's worth of therapy consolidated.
就好像一年的治疗得到了巩固。
You think, well 30 hours — let's say we go almost every week, maybe that's 45 or 50 hours — but 30 hours with that kind of intensity is worth probably 60 hours done in a different way because then it's in us in an active way.
你想，好吧，30 个小时——假设我们几乎每周都去，也许是 45 或 50 个小时——但是 30 个小时的这种强度可能值得 60 个小时以不同的方式完成，因为这样它就以一种积极的方式存在于我们之中。
It's in the therapist in an active way — becomes very, very dynamic.
它以一种积极的方式存在于治疗师之中——变得非常非常有活力。
So I think turning up the intensity, if there's something that we really need to process, absolutely makes sense, and I do that in my own life.
所以我认为，如果我们确实需要处理某些事情，那么提高强度绝对是有意义的，我在自己的生活中就是这样做的。
If there's something now it's like, "Whoa, something is really distressing me and it's linking into prior trauma and I can see what's going on in me."
如果现在有什么事情，那就是，“哇，有些事情真的让我很痛苦，它与之前的创伤有关，我可以看到我身上发生了什么。”
Paul Conti:
保罗·孔蒂：
I start to have ruminative thoughts with negativity.
我开始产生消极的沉思。
I'm like, "I got to go more, right?" Because I got to do that processing so I can get to the place that I am, which is not that.
我想，“我还得走更多，对吧？”因为我必须进行这种处理，这样我才能到达我所在的地方，但事实并非如此。
It's not that the trauma has no impact on me, it's that the impact is much less than it was before the therapy.
并不是说创伤对我没有影响，而是影响比治疗前小得多。
And that I most often, more often than not, have an ability to see when it's now intruding into my thoughts and it's taking me away from what I really think and believe, or being able to draw logic and emotion together and make good decisions.
而且我常常有能力看到它何时侵入我的思想，它使我远离我真正的想法和信念，或者能够将逻辑和情感结合在一起并做出正确的决定。
Turning up the intensity then absolutely makes sense.
调高强度绝对是有意义的。
Andrew Huberman:
安德鲁·休伯曼：
This very deep, intensive work of 30 hours in a week.
这是每周 30 个小时的非常深入、密集的工作。
What brings somebody to the type of work of that sort?
是什么促使人们从事此类工作？
Is it a suicide risk or a severe addiction situation?
这是自杀风险还是严重的成瘾情况？
I mean, how does one gauge how much therapy they ought to be doing?
我的意思是，如何衡量他们应该接受多少治疗？
And should it always be on the therapist to decide that frequency?
频率是否应该始终由治疗师来决定？
What would bring someone to a situation of five therapists and 30 hours a week in one week?
是什么让一个人每周有 5 名治疗师，每周工作 30 小时？
Paul Conti:
保罗·孔蒂：
It's usually a person who is really distressed by something, whether that's so negatively impacting their life, or sometimes a person comes to a realization, "I just can't take this anymore.
通常是一个人对某件事感到非常苦恼，无论这件事对他们的生活产生了如此负面的影响，或者有时一个人意识到，“我再也无法忍受这件事了。
I'm sick of the cyclical depression.
我厌倦了周期性的抑郁症。
I got to stop having panic attacks.
我必须停止惊恐发作。
I need help." But it's usually some crisis point, with the idea of crisis in the meaning of something comes to a head and after it things are going to be different, not a crisis and things are going to be negative afterwards, but a point where then that cognitive flexibility comes to the fore of like, "Well, I need to do something different." So, that's often what brings us.
我需要帮助。”但这通常是某个危机点，危机的意思是某事达到顶峰，之后事情就会有所不同，不是危机，之后事情会变得消极，而是认知灵活性出现在这样的时刻，“好吧，我需要做一些不同的事情。”所以，这通常就是给我们带来的。
Sometimes it's other people pointing it out, or if somebody's had an intervention somewhere or yes, that person's been hospitalized after a suicide attempt or they've gone back to rehab again for the third or fourth time and their life is really in danger.
有时是其他人指出的，或者如果有人在某个地方进行了干预，或者是的，那个人在自杀未遂后被送往医院，或者他们第三次或第四次再次回到康复中心，他们的生命确实处于危险之中。
Paul Conti:
保罗·孔蒂：
Sometimes it's that and sometimes it's a person realizing, "I just want to look at myself, want to understand myself better.
有时是这样，有时是一个人意识到，“我只是想看看自己，想更好地了解自己。
I know that what's going on in me isn't as good as it can be." So I think people can come to it for all sorts of different ways.
我知道我内心的情况并没有达到应有的程度。”所以我认为人们可以通过各种不同的方式来实现这一点。
And I think yes, I think a lot of times it would be the therapist to say it, "More intensive work can make a difference." But I think the person also needs to take ownership of their own therapy.
我想是的，我想很多时候治疗师会说，“更密集的工作可以带来不同。”但我认为这个人也需要掌控自己的治疗。
And so if I don't feel helped enough, well, I have to think about that and talk to the therapist about that because maybe that therapist isn't a match, or maybe you talk to the therapist and the therapist can change his or her approach, or maybe you talk to the therapist and increase the frequency.
因此，如果我感觉帮助不够，那么我必须考虑这一点并与治疗师讨论这一点，因为也许该治疗师不匹配，或者也许你与治疗师交谈并且治疗师可以改变他或她的方法，或者也许你与治疗师交谈并增加频率。
But the idea is to be aware of it and if one's needs aren't being met, to acknowledge that, right?
但我们的想法是要意识到这一点，如果一个人的需求没有得到满足，就承认这一点，对吧？
Paul Conti:
保罗·孔蒂：
Because people can get into a rhythm of therapy where it's really not helping them but they either feel sort of nihilistic about it like, "Oh, I'm no better and I'm going to therapy." Or sometimes there's a sense that "Well, I'm in therapy," so I'm kind of checking that box of doing something for myself, but it's not really getting me anywhere.
因为人们可能会进入一种治疗节奏，这种治疗实际上对他们没有帮助，但他们要么对此感到有点虚无主义，比如，“哦，我也没有好转，我要去接受治疗。”或者有时会有一种感觉，“嗯，我正在接受治疗”，所以我有点勾选为自己做点什么，但这并没有真正让我有任何进展。
And then the part of the brain that's controlled by the guilt and shame and avoidance thinks that's a great idea.
然后大脑中由内疚、羞耻和回避控制的部分会认为这是一个好主意。
So again, this ability to observe ourselves and like, "What's going on?
再说一次，这种观察自己并喜欢“发生了什么事？
Am I being helped in the way I ...
我是否以我的方式得到帮助...
Do I feel helped?
我感觉得到帮助了吗？
Am I in some ways even happy that I'm not feeling helped?
在某些方面，我是否因为自己没有受到帮助而感到高兴？
Because I don't have to face this thing I don't want to face," right?
因为我不必面对这个我不想面对的事情，”对吧？
Or "Am I too afraid to say I need more help?"
或者“我是否太害怕而不敢说我需要更多帮助？”
Paul Conti:
保罗·孔蒂：
We really need to look at ourselves, and this is where the insurance systems often are very difficult because it's hard sometimes for a person to say, "I need more therapy," because that may not be possible.
我们确实需要审视自己，这就是保险系统通常非常困难的地方，因为有时一个人很难说“我需要更多治疗”，因为这可能是不可能的。
So there are negative factors in the world around us.
所以我们周围的世界存在着负面因素。
But ultimately I think the answer to the question comes down to observing ourselves and taking ownership of what's going on in us and how we're feeling.
但最终我认为这个问题的答案归结为观察我们自己并掌握我们内心发生的事情和我们的感受。
And then feeling that commitment to self or to self-care to say, "I need to go change this."
然后感受到对自我或自我照顾的承诺，说：“我需要改变这一点。”
Andrew Huberman:
安德鲁·休伯曼：
And for those that maybe don't have the means or insurance or access to do even one-day-a-week therapy, in the journaling model, could one perhaps take an entire day, as awful as it might seem, to do a lot of journaling and thinking and walking?
对于那些可能没有办法、没有保险或没有机会进行每周一天的治疗的人来说，在日记模式中，人们是否可能需要一整天的时间，尽管看起来很糟糕，做大量的日记、思考和散步？
Do a self-generated intensive.
进行自生强化训练。
Do you think there's utility to that?
你认为这有什么用处吗？
Paul Conti:
保罗·孔蒂：
I mean there could be, but again it depends by person because there could also be something negative about that.
我的意思是可能有，但这又取决于个人，因为这也可能有负面影响。
If it's someone who's not at the point, not ready for that.
如果某人不在关键时刻，说明他还没有准备好。
I mean we don't come at directly, at the trauma immediately, at least most of the time we don't do that, and we often don't explore it in depth.
我的意思是，我们不会立即直接面对创伤，至少在大多数时候我们不会这样做，而且我们常常不会深入探索它。
This idea that, "Oh, that person now has to go through every second of the trauma," is actually not true.
这种“哦，那个人现在必须经历每一秒的创伤”的想法实际上是不正确的。
I mean sometimes it is, but that's not the common situation.
我的意思是有时是这样，但这不是常见情况。
More often that person has to acknowledge, like the example of, "I was sexually abused." And if they acknowledge that and say, "Okay, gosh, what has that done to me?" That doesn't mean, "Well let's parse out every moment of how that was and the terror of that." So that can lead people to a worse place.
更多时候，该人必须承认，例如“我受到性虐待”。如果他们承认这一点并说：“好吧，天哪，这对我造成了什么影响？”这并不意味着，“好吧，让我们分析一下那是怎样的每一刻以及其中的恐怖。”所以这可能会导致人们走向更糟糕的地方。
Paul Conti:
保罗·孔蒂：
So I think the idea of biting off small pieces, so to speak, where a person is writing or is talking.
所以我想到了咬掉小碎片的想法，可以这么说，在一个人正在写作或正在说话的地方。
But I think if one is writing, it is good to communicate with another, another trusted person.
但我认为，如果一个人在写作，那么与另一个人、另一个值得信赖的人交流是件好事。
And if there's not someone in one's personal life, there are clergy members.
如果一个人的个人生活中没有某人，那么也有神职人员。
Even if one isn't affiliated with an organized religion, you could probably go places and get a clergy to want to help you.
即使一个人不属于任何有组织的宗教，您也可能会去一些地方并找到一位神职人员来帮助您。
I mean there are people out there who want to help other people.
我的意思是有人想帮助别人。
So, you say, "What if someone has no one?" I mean, almost never do we have no one.
所以，你说：“如果有人没有人怎么办？”我的意思是，我们几乎从来没有没有人。
Because we could probably go find someone, but we need to take that in pieces.
因为我们或许可以去找某人，但我们需要将其分解。
So there's some risk to trying to do the intensive thing on one's own.
因此，尝试自己做高强度的事情是有一定风险的。
Paul Conti:
保罗·孔蒂：
And that's where I would put in, if a person's having suicidal thoughts or even thoughts of death, of not wanting to be alive, "I don't deserve to be alive," I mean these are warning signs for really getting help.
这就是我要插入的地方，如果一个人有自杀念头，甚至死亡念头，不想活下去，“我不值得活着”，我的意思是，这些是真正寻求帮助的警告信号。
So there are some signs that say, "Hey, don't try and do that on your own.
所以有一些迹象表明，“嘿，不要尝试自己做这件事。
Go try and find a resource." And it's things that get to that level of severity, and often a person knows that.
去尝试寻找资源。”事情会达到这种严重程度，人们通常都知道这一点。
I mean, "Am I in a place where I know I'm not healthy and I'm having scary thoughts?" then we need that.
我的意思是，“我是否处于一个明知自己不健康并且产生可怕想法的地方？”那么我们需要那个。
That's a person who really shouldn't be doing that on their own.
这种人确实不应该自己做这种事。
Andrew Huberman:
安德鲁·休伯曼：
Great, thank you for that.
太好了，谢谢你。
Paul Conti:
保罗·孔蒂：
Yeah, you're welcome.
是的，不客气。
Andrew Huberman:
安德鲁·休伯曼：
So we've been talking a lot about talking, and now I'd like to talk a little bit about chemistry.
我们已经聊了很多，现在我想谈谈化学。
Drugs.
毒品。
So maybe first we could talk prescription drugs.
所以也许我们首先可以谈谈处方药。
I mean you're a psychiatrist, so you're approved to, and presumably do, prescribe medication where appropriate.
我的意思是，您是一名精神科医生，因此您被批准并且可能会在适当的情况下开药。
I mean this is a vast landscape, of course.
当然，我的意思是这是一片广阔的风景。
We've got ADHD, and I should just tell you, I get more questions about ADHD and the drugs related to ADHD and dopamine than any other topic, any other topic.
我们有注意力缺陷多动症，我应该告诉你，我收到的关于注意力缺陷多动症以及与注意力缺陷多动症和多巴胺相关的药物的问题比任何其他主题、任何其他主题都多。
So there's ADHD, there's OCD, there's depression, there's antidepressants and so forth.
所以有注意力缺陷多动症、强迫症、抑郁症、抗抑郁药等等。
Is there some way that we can wrap our arms around all of that as a way of wading into this drug question and just address how does one decide when medication is useful?
有没有什么方法可以让我们解决所有这些问题，从而解决这个药物问题，并解决人们如何决定药物何时有用？
Because in the end, the dissection tool that the psychiatrist or therapist has is language.
因为归根结底，精神科医生或治疗师拥有的解剖工具就是语言。
And at some point, one has to make an assessment about dopamine or serotonin or whether or not a given drug would help.
在某些时候，人们必须对多巴胺或血清素或某种药物是否有帮助进行评估。
Andrew Huberman:
安德鲁·休伯曼：
And most therapies, I believe, don't involve putting someone in a brain scanner.
我相信，大多数疗法并不涉及对某人进行脑部扫描。
And to my knowledge, there still is not a very good blood test to assess, "Oh, is this person's dopamine low or high?" Correct me if I'm wrong.
据我所知，目前还没有一个很好的血液测试来评估，“哦，这个人的多巴胺是低还是高？”如果我错了请纠正我。
And ultimately that — and I know there are companies out there, so I'm not trying to undermine those companies.
最终，我知道有一些公司，所以我并不想破坏这些公司。
But if I happen to do that in this statement: if you take a blood test and find that your serotonin metabolites are low, my understanding is, it's possible that you are too low in serotonin in the brain.
但如果我碰巧在这个声明中这样做：如果你进行血液检查，发现你的血清素代谢物很低，我的理解是，有可能你大脑中的血清素含量太低。
But that's a very indirect window into what's really going on.
但这是了解真实情况的一个非常间接的窗口。
So how do you think about prescription drugs in the context of treating trauma and other conditions?
那么您如何看待处方药在治疗创伤和其他疾病方面的作用呢？
And then maybe we'll drill into some of the more specific conditions.
然后也许我们会深入研究一些更具体的条件。
Paul Conti:
保罗·孔蒂：
I mean, I would first comment that there aren't tests for these things.
我的意思是，我首先要评论的是，这些东西没有测试。
And I think the tests for metabolites ...
我认为代谢物测试......
I mean things are so different — by the time what we're talking about has been metabolized, often to some very significant extent, left the brain, now it's in the peripheral blood, that we really don't learn from that.
我的意思是事情是如此不同——当我们谈论的东西已经被代谢时，通常在某种程度上，离开了大脑，现在它进入了外周血液，我们真的没有从中学到东西。
I think that we tend to utilize medicines in this country because we have a healthcare system that's so based on throughput that we want to polish the hood when there's a problem in the engine.
我认为我们在这个国家倾向于使用药物，因为我们有一个基于吞吐量的医疗保健系统，当发动机出现问题时，我们希望抛光引擎盖。
So we overutilize medicines, often, as an endpoint, right?
所以我们经常过度使用药物作为终点，对吧？
"Oh, we're going to make that person's depression better with an antidepressant." Well, I mean maybe, right?
“哦，我们将用抗抑郁药来改善那个人的抑郁症。”嗯，我的意思是也许，对吧？
But most of the time for the person's depression to really get better and stay better, they need to unravel what's driving the depression, right?
但大多数时候，为了让一个人的抑郁症真正好转并保持更好的状态，他们需要弄清楚是什么导致了抑郁症，对吗？
So the first step is ...
所以第一步是......
I think there are two steps to it.
我认为有两个步骤。
Paul Conti:
保罗·孔蒂：
The first assessment step is, is there a diagnosis that the vast majority of the time, if not sometimes all the time, really warrants a medicine?
第一个评估步骤是，是否有一种诊断在绝大多数情况下（如果不是有时总是）确实需要药物治疗？
So the bipolar disorder, OCD, ADD, right?
那么双相情感障碍、强迫症、ADD，对吗？
These are diagnoses that we understand more about them and what's going on in the brain and how medicines can treat or stabilize them.
我们对这些诊断、大脑中发生的情况以及药物如何治疗或稳定它们有更多的了解。
Which doesn't mean the medicine is necessarily, it's not a substitute for therapy, but sometimes the medicine and therapy can go hand in hand.
这并不意味着药物是必然的，它不能替代治疗，但有时药物和治疗可以齐头并进。
So for OCD, for example, warrants therapy, but it almost, not always, but it almost always warrants medicine too.
例如，对于强迫症来说，需要治疗，但几乎、并非总是如此，但它几乎总是需要药物治疗。
So that you can ease the systems that are making the rigidity and the repetition in the brain.
这样你就可以缓解大脑中僵化和重复的系统。
So the first kind of branch point can be, what is the diagnosis?
那么第一种分支点可以是，诊断是什么？
What is the level of severity?
严重程度是多少？
And I think that's very, very important.
我认为这非常非常重要。
Where I think it's a little more maybe even interesting is using medicines to help the person engage in the therapy as productively as possible.
我认为更有趣的是使用药物来帮助患者尽可能有效地进行治疗。
Paul Conti:
保罗·孔蒂：
And here's where I think we're so limited by how we categorize medicines and this sort of pharmaceutical insurance-driven medical system we have that I think throws us off in tremendous ways.
我认为这就是我们对药物的分类方式以及我们拥有的这种药物保险驱动的医疗系统的局限性，我认为这在很大程度上让我们陷入困境。
So you think about how medicines are categorized, so antidepressants, and the vast majority of people who are helped by antidepressants, they don't have clinically severe depression.
所以你想想药物是如何分类的，抗抑郁药，以及绝大多数接受抗抑郁药帮助的人，他们没有临床上严重的抑郁症。
Those medicines create more distress tolerance in us.
这些药物可以增强我们对痛苦的耐受力。
And if you think about how helpful that can be.
如果你想想这会有多大帮助。
Now you're going to do something difficult where you're going to bring that trauma or the stressors to the surface, and you're going to process and you're going to try and make life change.
现在你要做一些困难的事情，你要把创伤或压力源带到表面，你要处理，你要尝试改变生活。
If we can make more distress tolerance in us, that can be so much better.
如果我们能够增强对痛苦的耐受力，那就更好了。
And think about the category of medicines that are called antipsychotics, which really puts people off.
想想那些被称为抗精神病药的药物，这确实让人望而却步。
But most of the prescriptions for antipsychotics are not for psychosis.
但大多数抗精神病药物的处方并不是针对精神病。
Paul Conti:
保罗·孔蒂：
And there are ways in which low dosing of some of those medicines can help intervene in negative pathways, in pathways that are about distress and sending out those tendrils of neurons that are about hypervigilance and avoidance in our brain.
有些药物的低剂量可以通过多种方式帮助干预消极通路，即与痛苦有关的通路，并发出与我们大脑中的过度警惕和回避有关的神经元卷须。
And we can often get at that.
我们经常可以做到这一点。
And if you can improve someone's distress tolerance and you can use medicines that take away what clinically is rumination, not the standard meaning of that word, but the clinical meaning of it where there're distress centers in our brain that are overactive, and then we get stuck in these maladaptive negative pathways where we think about something over and over and over again with no real chance of solving it because that's not what's going on inside of us.
如果你可以提高某人的痛苦耐受力，你可以使用药物来消除临床上的沉思，不是这个词的标准含义，而是它的临床含义，即我们大脑中的痛苦中心过度活跃，然后我们就会陷入这些适应不良的消极路径中，我们一遍又一遍地思考某件事，没有真正的机会解决它，因为这不是我们内心正在发生的事情。
So medicines can help that, but we have to have some flexibility around their conception and the modern medical system of 15-minute visits to a psychiatrist that are weeks apart, I mean, I don't understand how that goes well.
因此，药物可以对此有所帮助，但我们必须对其概念和现代医疗系统有一定的灵活性，即每隔几周去看一次精神科医生，每次 15 分钟，我的意思是，我不明白这如何顺利进行。
Paul Conti:
保罗·孔蒂：
In the vast majority of times I think it doesn't go well because it's not enough time to do the therapy, to even generate the understanding.
在绝大多数情况下，我认为进展并不顺利，因为没有足够的时间进行治疗，甚至没有足够的时间来产生理解。
So then medicines get thrown at the person.
然后药物就会被扔到这个人身上。
This is how we use, I think, approximately five times as much medicine across the board as, say, the Dutch population.
我认为，这就是我们使用药物的方式，大约是荷兰人口的五倍。
And I think, well why is ...
我想，为什么......
five times more is a lot more medicine.
五倍就需要更多的药物。
And they have a healthcare system and a cultural system that, to the best of my understanding, is more rooted in taking responsibility for oneself.
据我所知，他们拥有医疗保健系统和文化系统，这些系统和文化系统更加植根于对自己负责。
So if a person comes in and cholesterol is high, the first order of business is, "Hey, you could take better care of yourself." This person really needs to lose some weight, exercise more.
因此，如果一个人进来时胆固醇很高，首要任务就是“嘿，你可以更好地照顾自己。”这个人确实需要减肥，多运动。
They're not just jumping to, "Let me give you a medicine," and shift you through the healthcare system and out the other side of the door.
他们不仅仅是跳到“让我给你开药”，然后让你通过医疗保健系统，然后走出门的另一边。
Paul Conti:
保罗·孔蒂：
And the same thing is true in mental health.
心理健康也是如此。
And I'm not trying to be critical to the psychiatrists or the nurse practitioners or people who are practicing in that way, because oftentimes there is no choice.
我并不是想批评精神科医生或执业护士或以这种方式执业的人，因为通常别无选择。
If they're working in a healthcare system that the standard is highly spaced apart 15-minute visits, what alternative is there?
如果他们工作的医疗保健系统的标准是间隔 15 分钟就诊，那么还有什么选择呢？
But to look at, "Okay, I'm going use medicines because I don't have another tool to bring to bear." So I think the healthcare system and its focus on throughput and its short-term — we talk about short-term response.
但要看看，“好吧，我要使用药物，因为我没有其他工具可以使用。”所以我认为医疗保健系统及其对吞吐量和短期的关注——我们谈论的是短期反应。
They're short-term soothing at the expense of long-term health.
它们只是短期的舒缓作用，但却以长期的健康为代价。
And I think that is the metaphor that applies to our healthcare system, where if we are going to try and treat a symptom in a short term, we're going to do it in a 15-minute visit, then we're going to do it in a way that maybe it soothes a symptom, maybe it doesn't, but it does not get at the problem.
我认为这就是适用于我们的医疗保健系统的比喻，如果我们要尝试在短期内治疗某种症状，我们将在 15 分钟的访问中完成，然后我们将以某种方式进行，也许可以缓解症状，也许不能，但它并不能解决问题。
Paul Conti:
保罗·孔蒂：
We need to invest more resources to get at the problem.
我们需要投入更多的资源来解决这个问题。
And I think that's where a sort of protest, if people as a society, we say "Look, we don't like the way our healthcare is going.
我认为这就是一种抗议，如果人们作为一个社会，我们说“看，我们不喜欢我们的医疗保健的方式。
We need more focus on what the actual problems are." That yes, we would spend more money treating people and taking care of people because it's more human time, but ultimately about less suffering, less death, and ultimately more productivity.
我们需要更多地关注实际问题。”是的，我们会花更多的钱来治疗和照顾人们，因为这是更多的人性时间，但最终是为了减少痛苦、减少死亡，并最终提高生产力。
I think as an economy, we would save so much money if we spent money on the human aspects of mental healthcare because people would be more functional.
我认为，作为一个经济体，如果我们把钱花在心理保健的人性化方面，我们会节省很多钱，因为人们会变得更加机能。
They're spending less time in the hospital.
他们在医院呆的时间越来越少。
They're more productive when they're working.
他们工作时效率更高。
There's less entry into the criminal justice system.
进入刑事司法系统的人数较少。
So I think medicines get overused, in part for systemic reasons, in large part for systemic reasons, and also for some of these categorization reasons.
所以我认为药物被过度使用，部分是出于系统性原因，很大程度上是出于系统性原因，还有一些分类原因。
Paul Conti:
保罗·孔蒂：
"That person meets some technical criteria for depression.
“这个人符合抑郁症的一些技术标准。
We've got to give them this medicine." Instead of really thinking, "Wait, what's going on in this person?" And I see this over and over again.
我们必须给他们这种药。”而不是真正思考：“等等，这个人到底怎么了？”我一遍又一遍地看到这一点。
I see someone is on seven medicines, and they're on seven medicines to treat seven different symptoms, and now they have side effects from all those seven medicines.
我看到有人服用七种药物，他们服用七种药物来治疗七种不同的症状，现在他们都有这七种药物的副作用。
Maybe two of them are to treat the side effects from the other five and that's bad.
也许其中两个是为了治疗其他五个的副作用，这很糟糕。
And if you really get at what's going on in them, now they're doing much better and maybe they're on two medicines.
如果你真正了解他们的情况，现在他们的情况好多了，也许他们正在服用两种药物。
So, I don't know if that's a helpful answer to that.
所以，我不知道这是否是一个有用的答案。
Andrew Huberman:
安德鲁·休伯曼：
It is.
是的。
It's a very helpful answer.
这是一个非常有帮助的答案。
I mean, I think at least in the spheres that I run these days, I hear a lot of negative statements about antidepressants.
我的意思是，我认为至少在我这些天所管理的领域中，我听到了很多关于抗抑郁药的负面言论。
I think I'm old enough to remember the book "Listening to Prozac." And I remember when Prozac and things like it first started showing up and the excitement.
我想我已经足够大了，可以记得《聆听百忧解》这本书了。我还记得当百忧解和类似的东西第一次出现时的兴奋。
And then nowadays I hear more about the problems with all these drugs.
现在我听到更多关于所有这些药物的问题。
And maybe that's just because I have arms in both the scientific but also in the kind of wellness community, where people think a lot about behavioral change.
也许这只是因为我不仅涉足科学领域，而且涉足健康社区，人们对行为改变进行了很多思考。
Fortunately, I think, that they do that.
我认为幸运的是，他们做到了。
But of course these drugs, as you mentioned, can have enormous utility as well.
当然，正如您提到的，这些药物也可以发挥巨大的作用。
I'd like to just pick up on one theme that I haven't heard a lot about anywhere else, which is the short-term versus the long-term use of these drugs.
我想谈谈我在其他地方没有听说过的一个主题，即这些药物的短期使用与长期使用。
Andrew Huberman:
安德鲁·休伯曼：
Because I could imagine someone feeling like they're finally going to tackle something that's been inside them for a long time.
因为我可以想象有人感觉自己终于要解决内心深处的一些问题了。
Either because they're really struggling or because they're just done with not working it through and they decide to start a medication that would give them higher levels of distress tolerance for a short while.
要么是因为他们真的很挣扎，要么是因为他们已经受够了无法解决的问题，他们决定开始服用一种药物，让他们在短时间内获得更高水平的痛苦耐受力。
I mean, is there anything to say that someone couldn't take a properly prescribed medication for a week or for the first three months of the work and then know that they can come off it?
我的意思是，有什么可以说有人不能在一周或工作的前三个月服用正确处方的药物，然后知道他们可以戒掉它吗？
Because I think that the black-and-white model of, "Okay, you're either going to start this drug and stay on it forever or be taking some drugs forever, or you're not going to take anything." I mean that just seems to ...
因为我认为黑白模型是：“好吧，你要么开始使用这种药物并永远坚持下去，要么永远服用某些药物，或者你什么也不服用。”我的意思是，这似乎...
Does life have to work that way?
生活就一定要这样吗？
Is there short-term use that can be effective?
有没有短期使用可以有效的？
Paul Conti:
保罗·孔蒂：
Absolutely yes.
绝对是的。
In American medicine, we are so much better at starting medicines than we are at taking them away.
在美国医学中，我们更擅长开始用药，而不是停止用药。
And part of that I think is driven by such a strong presence of the pharmaceutical industry, and the pharmaceutical industry does a lot of very good things.
我认为部分原因是制药行业的强大影响力，制药行业做了很多非常好的事情。
But there's such a thing as too much of a good thing.
但有这样的事情，那就是好事太多了。
And then as a society, when something seems positive, this I think also is human nature.
然后作为一个社会，当某些事情看起来积极时，我认为这也是人性。
We can overinvest in it.
我们可以对其进行过度投资。
So if you think about when Prozac and those kinds of medicines came out, they were safer medicines.
因此，如果您想一下百忧解和此类药物何时问世，它们是更安全的药物。
They're billed as antidepressants, and the thought was, "Well, they're going to fix depression," and it's not how that works.
它们被宣传为抗抑郁药，人们的想法是，“好吧，它们会治疗抑郁症”，但事实并非如此。
So if we look at them as tools, then we can deploy them sometimes for the longer term, because sometimes that's necessary, but absolutely for the shorter term, I mean absolutely.
因此，如果我们将它们视为工具，那么我们有时可以长期部署它们，因为有时这是必要的，但绝对是短期的，我的意思是绝对的。
Paul Conti:
保罗·孔蒂：
If we thought of Prozac and those kind of medicines, not as, "Oh, they're antidepressants." Look, what they do is they seem to make there be more serotonin in certain circuits that are important for mood regulation, anxiety regulation, distress tolerance.
如果我们想到百忧解和这类药物，就不会说“哦，它们是抗抑郁药。”看，它们的作用似乎是使某些回路中产生更多的血清素，这对于情绪调节、焦虑调节、痛苦耐受力很重要。
So those medicines can really help somebody if they're very severely depressed and we want to get them feeling better.
因此，如果某人患有非常严重的抑郁症，那么这些药物确实可以帮助他们，而我们想让他们感觉好一些。
They can also help someone if they could use more distress tolerance in a discrete period of time.
如果某人能够在一段时间内表现出更强的抗压能力，他们也可以帮助别人。
When we think about them that way, we think about them as tools that we could apply for short term or long term.
当我们以这种方式思考它们时，我们会将它们视为可以短期或长期应用的工具。
We don't see them as fixes, and we don't see them as then substitutes for the human-to-human work that needs to be done.
我们不认为它们是解决办法，也不认为它们可以替代需要完成的人与人之间的工作。
Paul Conti:
保罗·孔蒂：
...
...
institutes for the human to human work that needs to be done.
需要完成人与人之间工作的机构。
I mean, I've been in my training at times in healthcare systems, and I've seen in many other circumstances that look at medicines as answers, and this idea that, "Oh, that person is a ...
我的意思是，我有时在医疗保健系统中接受过培训，并且我在许多其他情况下看到过将药物视为答案，并且这种想法是，“哦，那个人是......
" And a lot of times there'll be a number, right?
“很多时候都会有一个数字，对吧？
And the number is the diagnosis and that number gets this medicine.
这个数字就是诊断结果，这个数字就得到了这种药。
And I'm not sure we could be more misguided than that.
我不确定我们是否会被误导得更严重。
And that's what leads to adding medicines.
这就是导致添加药物的原因。
Adding medicines, it's not working, of course it's not working because no one's really paying attention to what's going on.
加药，没用，当然没用，因为没有人真正关注正在发生的事情。
So add more medicines and then medicines for the medicines.
所以先加药再加药。
Paul Conti:
保罗·孔蒂：
And I mean, we know this is true, we know this is true, but we haven't had the wherewithal as a society to say, like with a lot of things in society, to say, look, this isn't okay.
我的意思是，我们知道这是真的，我们知道这是真的，但作为一个社会，我们没有足够的资金来说，就像社会上的很多事情一样，说，看，这不好。
I mean we need more — give these people who are trying to help us, they need more latitude to help us.
我的意思是，我们需要更多——给那些试图帮助我们的人，他们需要更多的自由来帮助我们。
We need more human-to-human contact to get at what's really going on.
我们需要更多的人与人之间的接触来了解到底发生了什么。
And yes, that's an investment of time and energy and money in the short term.
是的，这是短期内对时间、精力和金钱的投资。
And sometimes that's money from the systems.
有时这是来自系统的钱。
But if we do that, my goodness, look at the payoff of that.
但如果我们这样做，天哪，看看这样做的回报。
Andrew Huberman:
安德鲁·休伯曼：
What is your thought about anxiety and ADHD as a separate phenomena in terms of medication?
您如何看待焦虑和多动症作为药物治疗中的独立现象？
Again, ADHD is the thing that seems to come up most in questions.
再次强调，多动症似乎是最受关注的问题。
I can't tell you the number of especially students, but also young working professionals and even people who are outside those categories who are interested in or taking Ritalin, Adderall, modafinil, armodafinil or Vyvanse, because they seem to struggle focusing without it.
我无法告诉你有多少人，特别是学生，还有年轻的职业人士，甚至那些不属于这些类别的人，对利他林、阿得拉、莫达非尼、阿莫达非尼或 Vyvanse 感兴趣或服用这些药物，因为如果没有这些药物，他们似乎很难集中注意力。
Or, and I don't know because I'm not one of those individuals, or because they seem to just like how well they can focus when they do take those compounds.
或者，我不知道，因为我不是那些人中的一员，或者因为他们似乎只是喜欢服用这些化合物时能够集中注意力。
Andrew Huberman:
安德鲁·休伯曼：
And so my understanding is these compounds mainly increase dopaminergic transmission in the brain, also adrenaline, epinephrine in the brain.
所以我的理解是这些化合物主要增加大脑中的多巴胺能传输，还有大脑中的肾上腺素、肾上腺素。
So they're more or less stimulants.
所以它们或多或少是兴奋剂。
At least chemically they look a lot like cocaine and amphetamine, although they're not quite cocaine and amphetamine.
至少在化学上它们看起来很像可卡因和安非他明，尽管它们不完全是可卡因和安非他明。
So should we be concerned about this?
那么我们应该关心这个吗？
Is this a different sort of epidemic?
这是一种不同类型的流行病吗？
Can these drugs be used to train the brain to focus, and then people can withdraw from these drugs?
这些药物可以用来训练大脑集中注意力，然后人们就可以戒掉这些药物吗？
I mean I think this is a huge topic and one that maybe warrants its own episode entirely.
我的意思是，我认为这是一个很大的话题，也许完全值得单独讨论一下。
But as long as we're on the topic, what are your thoughts about medication for ADHD?
但就我们的主题而言，您对治疗多动症的药物有何看法？
Paul Conti:
保罗·孔蒂：
Sure.
当然。
I think medication for ADHD can be extremely effective.
我认为治疗多动症的药物非常有效。
And the studies show us that.
研究向我们表明了这一点。
They show us that if there is ADD, then medication for ADD is very, very helpful.
他们告诉我们，如果存在注意力缺失症，那么治疗注意力缺失症的药物是非常非常有帮助的。
And that's true in youths.
对于年轻人来说也是如此。
It seems to be true if adults have adult ADHD or ADD, we kind of know that's true.
如果成年人患有成人多动症或ADD，这似乎是真的，我们知道这是真的。
But all attention deficit is not attention deficit disorder.
但所有注意力缺陷并不都是注意力缺陷障碍。
And then we go to the reflexive 15-minute visits, throw medicines at things, right?
然后我们进行 15 分钟的反思性访问，向东西扔药物，对吗？
Attention deficit can come from many, many places.
注意力缺陷可能来自很多很多地方。
And one of them is anxiety.
其中之一就是焦虑。
There's so many other reasons.
还有很多其他原因。
Depression affects attention, poor sleep affects attention.
抑郁影响注意力，睡眠不好影响注意力。
Poor diet can affect attention.
不良饮食会影响注意力。
Stress in life can affect attention, and certainly trauma and the problems that trauma spins off can affect attention.
生活中的压力会影响注意力，当然创伤和创伤引发的问题也会影响注意力。
So this is really the truth that ...
所以这确实是事实......
While teaching once about medicines and pharmacology, I was frustrated about how the answer to everything was, "What medicine do we use?
在教授一次有关药物和药理学的课程时，我对所有问题的答案感到沮丧：“我们使用什么药物？
What medicine do we use?"
我们用什么药？”
Paul Conti:
保罗·孔蒂：
As opposed to, this is just one piece of the puzzle.
相反，这只是拼图的一小部分。
And I told an anecdote, which I think it was a clinical anecdote, what do you think is going on?
我讲了一个轶事，我认为这是一个临床轶事，你认为这是怎么回事？
And I think that if I told that to, I don't know, middle school students or something, they would probably say, "You just told a story of a person with a rock in their shoe," which is the story that I was actually telling, but several people I was talking to are physicians, right?
我认为，如果我告诉中学生或其他人，我不知道他们可能会说，“你刚刚讲了一个鞋里有石头的人的故事”，这就是我实际上讲的故事，但与我交谈的几个人都是医生，对吗？
So ADD.
所以添加。
It's like no, every time the person steps down, the rock hurts and they're not able to maintain attention, that's what's going on.
就像不，每次人走下来时，岩石都会受伤，他们无法保持注意力，这就是正在发生的事情。
But we're so programmed to think about medicines and inappropriate use of ADD medicines.
但我们天生就会思考药物和ADD药物的不当使用。
As you said, there's dopaminergic impact, there's epinephrine, norepinephrine impact.
正如你所说，有多巴胺能影响，有肾上腺素、去甲肾上腺素影响。
We're affecting what are called prefrontal alpha two receptors that really need to be helped if there's real ADD.
我们正在影响所谓的前额阿尔法二受体，如果确实存在注意力缺失症，这些受体确实需要得到帮助。
Paul Conti:
保罗·孔蒂：
But if there isn't, that is not a good thing to do.
但如果没有的话，那就不是一件好事了。
Which is why it is quite fascinating that when people have ADD, they tolerate generally stimulants very well without the other problems that can come of stimulants.
这就是为什么令人着迷的是，当人们患有ADD时，他们通常能够很好地耐受兴奋剂，而不会出现兴奋剂可能带来的其他问题。
And again, I don't claim to know why that is, but we see that phenomenon.
再说一次，我并不声称知道这是为什么，但我们看到了这种现象。
But when people are being treated for ADD and they don't have ADD, which sometimes they know they don't have ADD, but the stimulants make them function better.
但是，当人们接受注意力缺陷障碍治疗时，他们并没有注意力缺陷多动症，有时他们知道自己没有注意力缺陷多动症，但兴奋剂使他们的功能更好。
So they go to somebody and get the stimulants, that's not a good thing to do, right?
所以他们去找某人并获得兴奋剂，这不是一件好事，对吧？
Paul Conti:
保罗·孔蒂：
Because stimulants when they're not needed over time, they do affect our physical function, they affect our judgment.
因为随着时间的推移不再需要兴奋剂，它们确实会影响我们的身体机能，影响我们的判断力。
There are a lot of negative things that come from that.
由此产生了很多负面的事情。
They can affect the vigilance inside of us.
它们会影响我们内心的警惕性。
So yes, it's a valid diagnosis, but it gets made when it's not present very often, which we see with a lot of diagnoses that you can throw medicine at.
所以，是的，这是一个有效的诊断，但它是在它不经常出现的情况下做出的，我们在很多诊断中都看到了这种情况，你可以对其进行药物治疗。
Paul Conti:
保罗·孔蒂：
We see the same thing with bipolar disorder.
我们在双相情感障碍中也看到同样的情况。
True bipolar disorder is extremely important to utilize medicines effectively.
真正的双相情感障碍对于有效使用药物极其重要。
But how many people are diagnosed with bipolar disorder who ...
但有多少人被诊断患有双相情感障碍......
they absolutely don't have bipolar disorder, but it can be a catch-all diagnosis because there's in a sense something to do for it, in quotes, and you can throw medicine at it.
他们绝对没有双相情感障碍，但它可以是一个包罗万象的诊断，因为从某种意义上说，可以采取一些措施来治疗它，用引号引起来，并且你可以对其进行药物治疗。
Paul Conti:
保罗·孔蒂：
So I mean, what do we expect, if we have a healthcare system where you get 15-minute visits with your psychiatrist, of course we're going to throw medicines at everything, and then the training paradigms are going to look at it through that lens.
所以我的意思是，如果我们有一个医疗保健系统，您可以与精神科医生进行 15 分钟的就诊，那么我们期望什么，当然我们会对所有事情都进行药物治疗，然后培训范式将通过这个镜头来看待它。
And then very often — again, I give the example of seeing somebody on seven medicines.
然后，我经常举一个例子，看到有人服用七种药物。
I mean the first thought I have is, "How many of those medicines are actually counterproductive?" And a lot of the time, it's not like, oh, every now and then one is counterproductive.
我的意思是，我的第一个想法是，“这些药物中有多少实际上会起到反作用？”很多时候，并不是说，哦，时不时的就会适得其反。
No, that's the case a lot of the time.
不，很多时候都是这样。
And again, I come back to, if we're not putting thought into it, what other result would we expect?
我再说一遍，如果我们不深思熟虑，我们还会期待什么其他结果？
Andrew Huberman:
安德鲁·休伯曼：
Thank you for that answer.
谢谢你的回答。
I'm very curious what constitutes negative effects of stimulants?
我很好奇兴奋剂的负面影响是什么？
So if somebody's taking Adderall or Ritalin in order to work longer hours or focus because they have attention deficit but not necessarily ADHD.
因此，如果有人服用阿得拉或利他林是为了延长工作时间或集中注意力，因为他们有注意力缺陷，但不一定是多动症。
And again, I'm not recommending anyone do this, I've just heard the numbers that have come back, at least from surveys and discussions with colleagues at Stanford and elsewhere, other college campuses, that upwards of 75% of college students use semiregularly these drugs, not by prescription, just to study and to learn.
再说一遍，我并不是建议任何人这样做，我只是听到了一些数据，至少从斯坦福大学和其他地方以及其他大学校园的同事的调查和讨论中得知，超过 75% 的大学生不定期使用这些药物，而不是通过处方，只是为了学习和学习。
I can imagine sleep issues because these are stimulants.
我可以想象睡眠问题，因为这些都是兴奋剂。
What sorts of other issues can they create for people, problems that they can create?
他们还可以给人们带来什么样的其他问题？
Paul Conti:
保罗·孔蒂：
I think a touchstone maybe that's running through our conversation is prioritizing the short-term benefit over solving the long-term problem, which we might say is a human tendency.
我认为贯穿我们谈话的一个试金石可能是优先考虑短期利益而不是解决长期问题，我们可以说这是人类的倾向。
And we see it across the topics that we're discussing.
我们在我们正在讨论的主题中都看到了这一点。
So short-term use of stimulants, sure, people are more alert, they can stay awake more, they can study more intensely and longer.
所以短期使用兴奋剂，当然，人们会更加警觉，他们可以保持更清醒，他们可以更集中、更长时间地学习。
Okay, there's some short-term benefit of that, even there there can be problems.
好吧，这有一些短期的好处，即使可能存在问题。
But let's just say for sake of argument that in the short term there's something to be gained by doing that.
但为了论证起见，我们只能说，短期内这样做是有好处的。
But oh my goodness, there's so much risk to that.
但天哪，这样做的风险太大了。
And how many times have I seen someone who they're doing that, and they're just doing that to study, and now they're addicted to the amphetamines, and their behavior changes and they don't know it.
我见过多少次有人这样做，他们只是为了学习而这样做，现在他们对安非他明上瘾了，他们的行为发生了变化，但他们却不知道。
Paul Conti:
保罗·孔蒂：
Talk about shifting our brain towards a more defensive sort of suspicious outward view of the world, that we see a lot of that.
谈论将我们的大脑转向一种更具防御性的、可疑的外在世界观，我们看到了很多这种情况。
So we see judgment impairment, we see heightened levels of anxiety, we see more impulsivity in decision making.
因此，我们看到判断力受损，焦虑程度加剧，决策时更加冲动。
And sometimes it can get to the point of seeing frank psychosis.
有时甚至会达到明显的精神病的地步。
Now that's not common, but have I seen young people who've done exactly what you're describing, they're using Adderall or they're using Ritalin to study, and then I see them when they're coming in to the hospital, they're screaming about how someone's trying to hurt them.
现在这种情况并不常见，但我是否见过年轻人完全按照你所描述的方式做，他们正在使用阿德拉或利他林来学习，然后当他们进入医院时我看到他们尖叫着有人试图伤害他们。
Boy, then it's the worst-case scenario.
伙计，这就是最坏的情况了。
But it shows that's where that can go.
但它表明这就是可以去的地方。
And how much is there between the "Oh, I'm just using it to study," and that severe outcome that is actually quite negative for a person.
“哦，我只是用它来学习”和实际上对一个人来说非常负面的严重结果之间有多少差距。
It might change how they think about that friendship or that relationship.
这可能会改变他们对友谊或关系的看法。
Paul Conti:
保罗·孔蒂：
A lot negative happens when we change our brains without an ability to see what is it actually doing to us?
当我们改变大脑却无法看到它实际上对我们做了什么时，就会发生很多负面的事情？
Which is part of my whole theme about trauma.
这是我关于创伤的整个主题的一部分。
It changes our brains and we don't know it.
它改变了我们的大脑，而我们却浑然不知。
Well, the same is often true of amphetamines used inappropriately.
嗯，不当使用安非他明通常也是如此。
It shifts our brain, and we don't realize that we're a little bit more impulsive in our decision making, a little bit less trusting.
它改变了我们的大脑，我们没有意识到我们在做决定时变得更加冲动，更加不信任。
These are significant negative things that if we don't know it, the person will just say, "Oh, I'm just using it to study, I'm using it to work more." That's not without its high level of risk.
这些都是重大的负面影响，如果我们不知道的话，人们只会说：“哦，我只是用它来学习，我用它来做更多的工作。”这并非没有高风险。
Andrew Huberman:
安德鲁·休伯曼：
What are your thoughts on cannabis?
您对大麻有什么看法？
I've said it many times on this podcast before, I'll say again.
我之前在这个播客上说过很多次了，我再说一遍。
I feel fortunate that I've never really been attracted to alcohol or drugs of any kind, so much so that if all the alcohol and all the marijuana and all the cocaine and amphetamine disappeared, I wouldn't notice any change in my life.
我感到幸运的是，我从来没有真正被酒精或任何形式的毒品所吸引，以至于如果所有的酒精、所有的大麻、所有的可卡因和安非他明都消失了，我不会注意到我的生活有任何变化。
And I feel lucky in that way because I know a lot of people feel an attraction to these things, almost a gravitational force from their first drink.
我在这方面感到很幸运，因为我知道很多人都感受到这些东西的吸引力，几乎是他们第一次喝酒时的引力。
They just feel ...
他们只是觉得...
I once heard it described in this, I think it was in Augusten Burroughs book "Dry," he was an alcoholic, he said that the first drink he had, it felt like this magic elixir that meshed with the physiology of his blood in the most seamless way.
我曾经听过这样的描述，我想是在奥古斯汀·巴勒斯的书《干》中，他是一个酒鬼，他说他喝的第一杯酒，感觉就像是这种神奇的灵丹妙药，以最无缝的方式与他的血液生理机能相结合。
Andrew Huberman:
安德鲁·休伯曼：
And as I was reading this, I thought, "Oh my goodness." First of all, that's the most foreign experience for me in terms of alcohol.
当我读到这篇文章时，我想：“天哪。”首先，就酒精而言，这对我来说是最陌生的经历。
And second, gosh, that must be terrible, but at the same time you could really understand why someone would be drawn to that.
其次，天哪，这一定很糟糕，但同时你可以真正理解为什么有人会被它吸引。
So cannabis nowadays is legal or decriminalized in many areas of the U.S. A lot of people seem to use the argument it's better than drinking, or they only do it for sleep or anxiety management.
因此，如今大麻在美国许多地区都是合法的或非刑事化的。很多人似乎都认为大麻比喝酒更好，或者他们只是为了睡眠或焦虑管理而吸大麻。
I'm not looking to demonize or support cannabis.
我无意妖魔化或支持大麻。
So what are your thoughts about cannabis for anxiety management, depression, and maybe even for ADHD, for that matter?
那么，您对大麻治疗焦虑、抑郁，甚至多动症的看法如何？
Paul Conti:
保罗·孔蒂：
Sure.
当然。
If I could make an alcohol comment, the number of times I've seen alcohol having been a good idea for coping with something approaches zero.
如果我可以对酒精发表评论，那么我看到酒精是应对某些事情的好主意的次数接近于零。
The alcohol for coping is just never good.
用酒精来应对从来都不是好事。
And there's an additional risk factor that there's certain genetic profiles where people respond strongly to alcohol, as you're saying.
正如你所说，还有一个额外的风险因素，即某些基因特征使人们对酒精反应强烈。
It's not just, oh, there's a little bit of short-term relief of distress, but there's a sort of euphoric response.
这不仅仅是，哦，有一点短期的痛苦缓解，而且有一种欣快的反应。
And those genetics, we don't understand them completely.
而那些遗传学，我们并不完全了解。
They seem to be in Northern European populations, more prevalent as you head west in Northern Europe.
它们似乎存在于北欧人群中，当你在北欧向西行进时，这种现象更为普遍。
So we understand where risk factors are demographically, but we can't pinpoint that for any one person.
因此，我们了解人口统计学上的风险因素，但我们无法针对任何人确定这一点。
And there's a tremendous risk of that, when a person responds so strongly to alcohol or habituates coping to alcohol.
当一个人对酒精反应如此强烈或习惯于应对酒精时，就会存在巨大的风险。
Paul Conti:
保罗·孔蒂：
Cannabis is a little bit of a different story.
大麻的情况有点不同。
I mean, how I have seen that play out, and again, this isn't coming from any expertise around the neuropharmacology of it, like how is this really working in the brain.
我的意思是，我是如何看待这种情况的，再说一次，这并不是来自于它的神经药理学的任何专业知识，比如它是如何在大脑中真正发挥作用的。
It comes from an observation that what it seems to do is to narrow our attentional perspective.
它来自于一种观察，即它的作用似乎是缩小我们的注意力视角。
So it's why people will say, well, they want to use cannabis before watching a movie with friends or something.
所以这就是为什么人们会说，好吧，他们想在和朋友一起看电影或做其他事情之前使用大麻。
And I think, okay, I think why people are doing that is because our cognitive spectrum narrows, and then instead of worrying about that thing at work or that relationship issue, one can just be present, it gates out other attentional intrusions.
我想，好吧，我认为人们这样做是因为我们的认知范围缩小了，然后我们不用担心工作中的事情或关系问题，而是可以直接存在，它可以排除其他注意力的干扰。
So in some ways, I mean I've absolutely seen it be helpful to people.
所以在某些方面，我的意思是我绝对看到它对人们有帮助。
I mean, it's been legalized in Oregon, which is where I spend a lot of my time.
我的意思是，它在俄勒冈州已经合法化，我在那里度过了很多时间。
And it's not where all of my practice is.
这并不是我所有练习的地方。
But what I have seen is it is at times helpful, say around sleep, because a person can gate out other intrusive thoughts and they can just relax and go to sleep.
但我所看到的是，它有时是有帮助的，比如在睡眠方面，因为一个人可以排除其他侵入性的想法，他们可以放松并入睡。
Paul Conti:
保罗·孔蒂：
But there can be another side of that too, that at higher levels of distress, at higher levels of tension, what it can do is narrow the focus of cognition to the thing that is negative.
但也可能有另一面，即在较高程度的痛苦、较高程度的紧张下，它所能做的就是将认知焦点缩小到消极的事物上。
So the idea that, oh, this is a treatment for depression, anxiety, trauma is not true.
所以，哦，这是治疗抑郁、焦虑和创伤的想法是不正确的。
Can it be helpful under certain circumstances?
在某些情况下有帮助吗？
I think the answer to that is, yeah, I mean, I know the answer to that is yes, because I've seen it play out clinically that way.
我认为答案是，是的，我的意思是，我知道答案是肯定的，因为我已经看到它在临床上是这样发挥作用的。
Paul Conti:
保罗·孔蒂：
But I think it can also be harmful too.
但我认为它也可能是有害的。
So there again, anything that has any power to influence our brains, we want to be thoughtful and careful about it.
因此，任何有能力影响我们大脑的事物，我们都希望深思熟虑并小心谨慎。
I mean, do I think that it's safer than alcohol?
我的意思是，我认为它比酒精更安全吗？
Yes.
是的。
I mean, we so clearly see that.
我的意思是，我们清楚地看到这一点。
Does that mean it's just uniformly safe?
这是否意味着它完全安全？
No. So we want to be respectful of anything that can change how our brain is working.
不。所以我们要尊重任何可以改变我们大脑工作方式的事物。
And I think that certainly includes alcohol, and I think it certainly includes cannabis too.
我认为这肯定包括酒精，我认为它肯定也包括大麻。
Andrew Huberman:
安德鲁·休伯曼：
I'd love to talk about psychedelics for two reasons.
我很想谈谈迷幻药，原因有两个。
One, there seems to be a tremendous amount of interest in psychedelics as a therapeutic clinical tool.
第一，人们似乎对迷幻药作为一种临床治疗工具抱有极大的兴趣。
I know there's also recreational use.
我知道还有娱乐用途。
And I'll just preface all this by saying that my stance is, we absolutely know for sure that these are controlled substances, they're illegal to possess, sell or use in most of the country.
我首先要说的是，我的立场是，我们绝对确定这些是受管制物质，在该国大部分地区拥有、销售或使用它们是非法的。
There are few areas where they are decriminalized.
很少有地区将其非刑事化。
And psychedelics is a broad category of course, and we can touch on some of the different ones.
当然，迷幻药是一个广泛的类别，我们可以触及一些不同的类别。
But whereas five years ago or so, I was truly afraid to say the word psychedelics in any kind of public venue, there are laboratories at Stanford working on ketamine, psilocybin, MDMA, mostly in animal models.
但大约五年前，我真的不敢在任何公共场所说出迷幻药这个词，而斯坦福大学有一些实验室正在研究氯胺酮、裸盖菇素、摇头丸，主要是在动物模型中。
There's terrific work going on at Johns Hopkins School of Medicine, and Matthew Johnson's Lab and others looking at the clinical applications mainly of high-dose psilocybin and LSD.
约翰·霍普金斯大学医学院、马修·约翰逊实验室和其他实验室正在进行出色的工作，主要研究大剂量裸盖菇素和 LSD 的临床应用。
Andrew Huberman:
安德鲁·休伯曼：
There's the MAPS trials with MDMA.
有 MDMA 的 MAPS 试验。
So nowadays it's safe for an academic like me to say the word "psychedelics." And I'd love to approach this question of psychedelics from a place of true exploration and curiosity, but with the preface that we're talking about this in a legal clinical setting, and the legality is something that's now in process.
所以现在像我这样的学者说“迷幻药”这个词是很安全的。我很乐意从真正的探索和好奇心来探讨迷幻药的问题，但序言是我们在法律临床环境中讨论这个问题，而合法性现在正在进行中。
I don't think it's completed, but that's my understanding.
我不认为它已经完成，但这是我的理解。
But there are trials.
但也有考验。
You can go to clinicaltrials.gov and put in MDMA, and you'll see a bunch of clinical trials that are happening and they're recruiting subjects.
你可以访问 ClinicalTrials.gov 并输入 MDMA，你会看到大量正在进行的临床试验，并且他们正在招募受试者。
So I think it's safe to have the conversation now.
所以我认为现在进行对话是安全的。
Andrew Huberman:
安德鲁·休伯曼：
And I'd love your thoughts about psychedelics.
我很想听听你对迷幻药的看法。
Maybe we could start with psilocybin and LSD as a broad category of drugs, that, at least my understanding is, they touch on mainly the serotonin system, some specific receptor activation and modulation, tend to change notions of space and time, adjust internal state.
也许我们可以从裸盖菇素和LSD作为一个广泛的药物类别开始，至少我的理解是，它们主要涉及血清素系统，一些特定的受体激活和调节，往往会改变空间和时间的概念，调整内部状态。
Maybe we could start there and then maybe venture into some of the other ones.
也许我们可以从这里开始，然后再尝试其他一些。
So what are your thoughts on these drugs for a therapeutic potential, also potential hazards, et cetera?
那么您对这些药物的治疗潜力、潜在危险等有何看法？
Paul Conti:
保罗·孔蒂：
Yeah, I think if we look at the true psychedelics, so psilocybin and LSD, because ketamine and MDMA, they're different categories of medicine, they are these sort of novel tools to bring to bear.
是的，我想如果我们看看真正的迷幻药，比如裸盖菇素和LSD，因为氯胺酮和MDMA，它们是不同类别的药物，它们是可以发挥作用的新颖工具。
But if we start with psilocybin, LSD, true psychedelics, I think why they have gained so much momentum over the last several years is because the data coming from the labs and the academic centers is so powerfully positive.
But if we start with psilocybin, LSD, true psychedelics, I think why they have gained so much momentum over the last several years is because the data coming from the labs and the academic centers is so powerfully positive.
And as someone who's ...
作为一个...
I'm interested in anything that's potentially helpful, and I want to learn and understand that because a lot of things that are potentially helpful, you go and look at the data and you see that that's not helpful, or that that's harmful.
我对任何可能有用的东西都感兴趣，我想学习和理解，因为很多东西可能有帮助，你去查看数据，你会发现那些没有帮助，或者有害。
Paul Conti:
保罗·孔蒂：
I think what we have seen with psychedelics is that they're so helpful, and the trials are bearing that out.
我认为我们所看到的迷幻药非常有帮助，试验也证明了这一点。
And of course these are used in professional hands, and with the right kind of guidance are extremely powerful tools, but used in the right way by someone who knows how to utilize them in the right setting can have an immense positive impact.
当然，这些是由专业人士使用的，并且在正确的指导下是非常强大的工具，但由知道如何在正确的环境中使用它们的人以正确的方式使用可以产生巨大的积极影响。
Paul Conti:
保罗·孔蒂：
And that's why I think that the thought is there across people and more and more people feel comfortable saying it and talking about it, I mean we're in the state of Oregon now where the thought is we're moving towards legalization of psilocybin early in 2023.
这就是为什么我认为人们都有这种想法，越来越多的人愿意说出并谈论它，我的意思是我们现在在俄勒冈州，我们的想法是我们将在 2023 年初实现裸盖菇素的合法化。
And it's part the new data and how it meshes with the older data, how it meshes with data from the '60s and '70s that showed such a strong, powerful impact of these medicines.
它是新数据的一部分，以及它如何与旧数据相结合，如何与 60 年代和 70 年代的数据相结合，显示了这些药物如此强大的影响。
And I have a whole set of thoughts about what's happening there, and they're conjectures.
And I have a whole set of thoughts about what's happening there, and they're conjectures.
Paul Conti:
保罗·孔蒂：
But my read of, as best I can try and understand the neuroscience and the clinical applicability and the changes, is what happens is we see less communication, less chatter in the outer parts of the brain, in the outer parts of the cortex.
但据我所知，尽我所能尝试理解神经科学、临床适用性和变化，我们看到大脑外部、皮质外部的交流、喋喋不休减少。
And I think that as human beings we sort of glorify the parts of the brain that only we have.
And I think that as human beings we sort of glorify the parts of the brain that only we have.
Paul Conti:
保罗·孔蒂：
I mean certainly in my growing up, what did I learn?
I mean certainly in my growing up, what did I learn?
Even if you think about learning about the brain in high school, and learn that, wow, we're great as humans because we have language and other animals don't, and we can use tools, and aren't we so great because we have this part of the brain that other animals don't, and it lets us function.
即使你考虑在高中学习大脑，并了解到，哇，我们作为人类很伟大，因为我们有语言，而其他动物没有，而且我们可以使用工具，我们不是很伟大，因为我们拥有其他动物没有的大脑部分，它让我们发挥作用。
Right?
正确的？
Okay, there's some truth to that, that we can do things others can't do.
Okay, there's some truth to that, that we can do things others can't do.
But we get lost often in the outer parts of the cortex, which I think are about survival.
But we get lost often in the outer parts of the cortex, which I think are about survival.
So we come back to the things you and I talked about early on of, why are these trauma mechanisms in us?
那么我们回到你和我之前讨论过的事情，为什么我们身上会有这些创伤机制？
So much of what's going on in our brains is about survival.
So much of what's going on in our brains is about survival.
And I think living, so to speak, in the cortex, in the outer part of the brain, is consistent with a focus on survival.
And I think living, so to speak, in the cortex, in the outer part of the brain, is consistent with a focus on survival.
Paul Conti:
保罗·孔蒂：
So if you think, that's where language is, that's where vision is, that's where executive function is, so planning and task execution.
So if you think, that's where language is, that's where vision is, that's where executive function is, so planning and task execution.
So much of that is about making our way in the world around us.
其中很大一部分是为了在我们周围的世界中开辟道路。
So we tend to glorify that and think, well, that's in a sense where our existence is.
So we tend to glorify that and think, well, that's in a sense where our existence is.
And I believe that is not true.
我相信这不是真的。
And again, can I say that for sure?
再说一次，我可以肯定地说吗？
Of course not, right?
当然不是，对吧？
But my read of 20 years of doing clinical work and thinking about all sorts of medicines, and thinking about the psychedelics in a lot of depth, I think that what they do is they take us out of the cortex because that's where we run into these problems.
但我读了 20 年的临床工作、对各种药物的思考，以及对致幻剂的深入思考，我认为它们所做的是把我们带出大脑皮层，因为这就是我们遇到这些问题的地方。
That's where we bounce things over and over again that the distress centers deep in our brain, in the brain stem, kind of align with the outer parts of the cortex.
这就是我们一遍又一遍地反弹事物的地方，痛苦集中在我们的大脑深处，在脑干，有点与皮质的外部部分对齐。
Paul Conti:
保罗·孔蒂：
And they say, "Wait, we're in distress, we want to stay alive." Often a lot of us have had trauma that makes these changes in the brain.
And they say, "Wait, we're in distress, we want to stay alive." Often a lot of us have had trauma that makes these changes in the brain.
And then we're thinking all the time, like "What would I do if there were war?
然后我们一直在思考，比如“如果发生战争我该怎么办？
What would I do if there's civil war?
如果发生内战我该怎么办？
If someone bombs us?
如果有人轰炸我们？
What will I do if the economy collapses?
如果经济崩溃我该怎么办？
What will I do if somebody gets sick?" We're thinking all this future projection that is all coming from a place of fear.
如果有人生病了我该怎么办？”我们认为所有这些未来的预测都来自于恐惧。
It's all coming from a desire to think about things and control the future with this part of the brain that is so uniquely human.
这一切都来自于用人类独特的大脑部分来思考事物和控制未来的愿望。
And I think when we take the neurotransmission out of those places and we set it in a part of the brain, and, say, the insular cortex, the parts of the brain that are sort of in the middle, which I believe is where our humanness really is.
我认为，当我们将神经传递从这些地方取出，并将其设置在大脑的一部分中时，比如说岛状皮层，大脑中位于中间的部分，我相信这就是我们人性真正所在的地方。
Paul Conti:
保罗·孔蒂：
So the psychedelics make there be less chatter or communication in these other parts of the brain.
So the psychedelics make there be less chatter or communication in these other parts of the brain.
And then we become seated in the part of the brain that I believe is most about our experience of true humanness.
And then we become seated in the part of the brain that I believe is most about our experience of true humanness.
Which is why when you read about people who have experiences, and I've heard about them and people talk to me about this, they've utilized it, they talk with me.
这就是为什么当你读到有经验的人时，我听说过他们，人们和我谈论这个，他们利用了它，他们和我交谈。
So whether it's someone telling me their story or it's coming from research data, it's why people can see with clarity that, "Oh, that trauma, that thing is not my fault." We feel a sense of compassion for ourselves.
因此，无论是有人告诉我他们的故事还是来自研究数据，这就是为什么人们可以清楚地看到，“哦，那个创伤，那件事不是我的错。”我们对自己有一种同情心。
We relieve ourselves, release ourselves from guilt.
我们释放自己，从罪恶感中解脱出来。
And it's like, why is this so helpful to people?
就像，为什么这对人们如此有帮助？
Paul Conti:
保罗·孔蒂：
And I think it's because it can do what we are trying to get at in good therapy, but it can really catalyze that by just putting a person in that part of the brain that can see it for what it is without all that chatter in the cortex about how you got to think it's your fault or you won't avoid it again.
我认为这是因为它可以做到我们在良好的治疗中试图达到的目标，但它确实可以催化这一点，只需将一个人放在大脑的那个部分，可以看到它的本来面目，而无需在皮质中喋喋不休地告诉你如何认为这是你的错，否则你将不会再避免它。
And that makes the repetition compulsion.
这使得重复成为一种强迫。
How do I think ahead to the next thing that might happen, and what else bad might happen?
我如何提前考虑下一件可能发生的事情，以及可能发生什么不好的事情？
Paul Conti:
保罗·孔蒂：
I mean, we don't get anywhere doing that.
我的意思是，我们没有任何进展。
And I think where we get somewhere is when we seat ourselves deeper in the brain, which I think we do if we're doing really good therapy and we're in the deep parts of the brain.
我认为当我们将自己置于大脑的更深处时，我们就能到达某个地方，我认为如果我们进行了非常好的治疗并且我们处于大脑的深处，我们就会做到这一点。
But these psychedelics, the medicinal value, I believe, is putting us in that part of the brain where a person can really find truth.
但我相信，这些迷幻药的药用价值正在让我们进入大脑中真正可以找到真理的部分。
And that's why I think that it's come so far in these few years, because I think that is very clinically evident and I think we're going to see more and more the value of that and what the psychedelics do, can become, I believe, a heuristic for understanding like, wait, how are our brains really functioning and what are the parts that really matter to our experience of being human?
这就是为什么我认为它在这几年里取得了如此大的进步，因为我认为这在临床上是非常明显的，我认为我们会越来越多地看到它的价值，我相信迷幻药的作用可以成为一种启发式的理解，比如，等等，我们的大脑到底是如何运作的，以及哪些部分对我们作为人类的经历真正重要？
Paul Conti:
保罗·孔蒂：
It's those parts of the brain, the deep parts of the brain, the insular cortex and the areas around it that, say, light up when a person has an experience of spiritual ecstasy or an experience of connection with another person.
比如说，当一个人体验到精神上的狂喜或体验到与另一个人的联系时，大脑的那些部分、大脑的深层、岛状皮层及其周围的区域就会被点亮。
So we kind of have these telltale markers that something is going on there that's very important and very special.
所以我们有一些明显的标记，表明那里正在发生一些非常重要和非常特别的事情。
And I think we're more attracted to the outer parts of the brain, and probably because they're easier to study.
我认为我们对大脑的外部部分更感兴趣，可能是因为它们更容易研究。
Paul Conti:
保罗·孔蒂：
I mean, as you know better than I do, we started studying the brain through lesion studies, right?
我的意思是，正如你比我更了解的那样，我们开始通过病变研究来研究大脑，对吧？
Because it was easier to see, if a person got hurt in this part of the brain or had a stroke in that part of the brain, what changes?
因为更容易看出，如果一个人大脑的这个部分受伤或者大脑的那个部分中风，会发生什么变化？
So we look at the cortex because, one, it's easier to study and we tend to glorify it.
所以我们关注大脑皮层，因为，第一，它更容易研究，而且我们倾向于赞美它。
And I think that has been misguided.
我认为这被误导了。
And I think that we're learning about how that's been misguided through the study of these novel modalities from Western perspectives, but of course they've been used for a long, long time in other cultures, but novel from our perspective.
我认为，通过从西方的角度研究这些新颖的模式，我们正在了解这是如何被误导的，当然它们在其他文化中已经使用了很长很长时间，但从我们的角度来看是新颖的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I'm fascinated by this idea that in these middle brain structures is where our humanity lies.
是的，我对这个想法很着迷，即我们的人性就在这些中脑结构中。
And as you said, I also wonder whether or not other animals experience life more from that orientation with less chatter.
正如你所说，我也想知道其他动物是否可以通过更少的喋喋不休从这个方向体验更多的生活。
We can only guess, but a dog lover and being in the presence of animals that seem to just be present in what's happening in their immediate environment, not too much anticipation.
我们只能猜测，但是一个爱狗者和在动物面前的人似乎只是出现在他们周围环境中发生的事情，没有太多的期待。
They're sentient.
他们是有知觉的。
Paul Conti:
保罗·孔蒂：
I mean, what you're talking about is sentience is important, and sentience is extremely important.
我的意思是，你所说的是感知力很重要，而且感知力极其重要。
And if we're going to overvalue, say, language, then I think we undervalue sentience.
如果我们要高估语言，那么我认为我们低估了感知力。
Which is why I think we tend to undervalue animals and their suffering, because, well, they're not saying anything about it and they're not writing about it.
这就是为什么我认为我们倾向于低估动物和它们的痛苦，因为，好吧，他们没有对此说任何话，也没有写下来。
So okay, it's easy to ignore.
所以好吧，这很容易被忽视。
And we think about, again, the hubris of that, oh, because we can think and talk and write, we must be feeling more than species that don't do that.
我们再次想到这种傲慢，哦，因为我们可以思考、说话和写作，我们一定比不这样做的物种有更多的感受。
I mean I think that is so true and that we're going to understand more about sentience in other species and how that's at the core of existence.
我的意思是，我认为这是千真万确的，我们将更多地了解其他物种的感知能力，以及它如何成为存在的核心。
And my hope would be that we value more humans and animals through the evolution of that understanding.
我希望通过这种理解的发展，我们能够更加重视人类和动物。
Andrew Huberman:
安德鲁·休伯曼：
The hallucinations that accompany psychedelics like LSD and psilocybin have such an attractive force to them as a concept and as an experience.
像LSD和裸盖菇素这样的迷幻药所伴随的幻觉对于他们来说作为一种概念和一种体验具有如此大的吸引力。
And so I think most often when people hear hallucinogens and psychedelics, they think about hallucinating, it makes sense why they would.
所以我认为，当人们听到致幻剂和致幻剂时，他们通常会想到产生幻觉，这是有道理的。
But what's so interesting to me is, nothing in your answer about psychedelics, psilocybin and LSD focused on hallucinations per se.
但令我感兴趣的是，你关于迷幻药、裸盖菇素和LSD的回答中没有任何内容集中于幻觉本身。
It was more about feeling states, accessing a feeling state or a relation to an event or to a person or to oneself, maybe even, I caught hints of maybe even empathy for oneself for the first time.
更多的是关于感觉状态，进入一种感觉状态或与事件、人或自己的关系，甚至，我什至第一次发现了对自己的同理心的暗示。
None of that had to do with seeing sounds or hearing colors, and these kind of cliche statements about hallucination.
这些都与看到声音或听到颜色以及这些关于幻觉的陈词滥调无关。
Andrew Huberman:
安德鲁·休伯曼：
So I am aware of laboratories, one at University of California, Davis in particular, but a few others that are trying to generate chemical variants of psychedelics that lack the hallucinogenic properties, but maintain these other properties as therapeutic tools.
因此，我知道一些实验室，特别是加州大学戴维斯分校的一个实验室，以及其他一些实验室正在尝试产生迷幻药的化学变体，这些变体缺乏致幻特性，但保留了这些其他特性作为治疗工具。
And as I say that, I realize that people in the psychedelic community are probably thinking, "Oh, that's horrible, that's the dismantling of the core thing." But the simple question is, do you think the hallucinations are valuable for anything?
当我这么说时，我意识到迷幻界的人们可能会想，“哦，这太可怕了，这就是核心事物的拆除。”但简单的问题是，你认为幻觉有什么价值吗？
Paul Conti:
保罗·孔蒂：
And I think we're really getting into the philosophical, the ontological.
我认为我们真正进入了哲学、本体论。
There's this sort of "I'm trying to understand being." And I don't claim to know the answer to that.
有一种“我正在尝试理解存在”。我并不声称知道这个问题的答案。
I think that at times it seems like the hallucinations have a metaphorical or a symbolic way of being helpful, because people will come to understand things that they hold dear and true after the experience, that often, not always, come through the lens of the hallucination.
我认为有时幻觉似乎有一种隐喻或象征性的帮助方式，因为人们在经历过之后会开始理解他们所珍视和真实的事物，这些事物通常（并非总是）来自幻觉的镜头。
So are the hallucinations necessary?
那么幻觉有必要吗？
Are those hallucinations sometimes important, sometimes not?
这些幻觉有时重要，有时不重要吗？
I mean, I think we don't understand that, and I think we want to be respectful of the mystery of that.
我的意思是，我认为我们不明白这一点，而且我认为我们希望尊重这一奥秘。
But what I think is fascinating is when you think about substance abuse and what that means is, well, one aspect of that is that a person has experiences, thoughts, conceptions of self in the world, with the substance that without the substance they know are wrong.
但我认为有趣的是，当你想到药物滥用时，这意味着，嗯，其中的一个方面是，一个人在世界上有经验、思想、自我概念，有物质，如果没有物质，他们知道是错误的。
Paul Conti:
保罗·孔蒂：
People talk about liquid courage, and "I feel better about myself and I feel courageous because I've had a couple of drinks." Now after that, "I feel like normal about myself," and that was false.
人们谈论液体勇气，“我对自己感觉好多了，而且因为喝了几杯酒而感到勇敢。”在那之后，“我感觉自己很正常”，但那是错误的。
And we see that, that's part of what substance intoxication means.
我们看到，这就是物质中毒的一部分含义。
But what we see with the psychedelic medicines is something that's incredibly different, that people are having experiences that are so delinked from our normal experience of reality.
但我们在迷幻药物中看到的是非常不同的东西，人们所经历的经历与我们正常的现实经历是如此脱节。
And then when they come, in a sense, back online in a normal cognitive way, they realize, "Wow, now I'm applying all those mechanisms of trying to understand truth to that, and what I see is that it's true, and wow, it's true." I mean we hear that all the time, which tells me, hey, something different is going on there.
然后，当他们在某种意义上以正常的认知方式回到网上时，他们意识到，“哇，现在我正在应用所有这些试图理解真相的机制，我看到的是这是真的，哇，这是真的。”我的意思是我们一直听到这样的消息，这告诉我，嘿，那里正在发生一些不同的事情。
And of course these are powerful tools, so misused, very bad things can happen.
当然，这些都是强大的工具，因此滥用，可能会发生非常糟糕的事情。
Paul Conti:
保罗·孔蒂：
But you think about the clinical utility and what does it mean that so many people change for the healthier or even change their lives after an experience because it so resonates as like, "Oh, now I understand something that's true and it's not something bizarre.
但你想想临床效用，以及这么多人在一次经历后变得更健康，甚至改变他们的生活意味着什么，因为它如此共鸣，“哦，现在我明白了一些真实的事情，这并不奇怪。
It's like, I wasn't responsible for being raped that time," or, "I'm not less than, even though my sexuality or my gender identity's different from some silly binary concept." People can often get it, and they feel differently about themselves, and guilt and shame are impacted.
就像，我对那次被强奸不负有责任，”或者，“我不小于，即使我的性取向或我的性别认同与一些愚蠢的二元概念不同。”人们经常会得到它，他们对自己的感觉不同，内疚和羞耻感受到影响。
So I think we're likely to see that they are powerful antitrauma mechanisms, again, used clinically in the right hands.
所以我认为我们很可能会看到它们是强大的抗创伤机制，再次在临床上被正确使用。
And I think that we're also going to see that they're heuristic for understanding our brain, that goes against what I see as some of the reflexive hubris of "Well, the outer parts must be the best because that's what makes us human and other animals don't have it.
我认为我们也会看到它们对于理解我们的大脑是启发式的，这与我所认为的一些本能的傲慢背道而驰，“好吧，外部部分必须是最好的，因为这就是我们人类和其他动物所不具备的。
And we're better because we're human." I mean, it makes no sense.
我们变得更好，因为我们是人类。”我的意思是，这没有意义。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to talk about MDMA, and I'll preface this by saying I was a participant, actually technically I'm still a participant in a clinical trial, so I have experience of doing it twice at the ...
我想谈谈 MDMA，我会先说我是参与者，实际上从技术上讲我仍然是临床试验的参与者，所以我有两次在......
Andrew Huberman:
安德鲁·休伯曼：
So I have experience of doing it twice.
所以我有做过两次的经验。
The trial involves three separate dosings of this.
该试验涉及三种不同的剂量。
I was reluctant to do it outside of a clinical trial, mostly because I was aware there can be some cardiac effects.
我不愿意在临床试验之外这样做，主要是因为我知道可能会对心脏产生一些影响。
And I like the idea there'd be a clinician on hand.
我喜欢有一名临床医生在场的想法。
And I'll just say that I found the experiences to be profound, beneficial, and very different from one session to the next.
我只想说，我发现这些经历是深刻的、有益的，并且每一堂课的体验都非常不同。
The first one, felt a whole collection of ideas and relational things came up that felt very powerful and transformative.
第一个感觉是一系列想法和相关事物的出现，感觉非常强大和具有变革性。
And I do think that I learned there, I exported a number of things.
我确实认为我在那里学到了很多东西，我输出了很多东西。
My particular experience isn't relevant here, but the second time I expected it to be the same way.
我的具体经历在这里并不相关，但第二次我预计也会是同样的情况。
And it was very mellow and relaxing and was deeply tied to kind of notions of acceptance.
它非常柔和和放松，并且与接受的概念紧密相连。
So there weren't all these revelations and "Wow," new insights.
所以并没有所有这些启示和“哇”的新见解。
It was very much about of grounding into a calmer state.
这很大程度上是为了让自己进入一种更平静的状态。
Andrew Huberman:
安德鲁·休伯曼：
So I have the personal experience of benefiting from these in ways that I think still benefit me and was very struck by the power of MDMA, and my very crude understanding of the pharmacology and the state that is being under MDMA is that it encourages or increases dopaminergic transmission but also serotonergic transmission, which is to my knowledge a kind of a rare state for the brain to be in, that typically it's more of a seesaw dopaminergic drive towards external goals or more serotonergic drive towards more plasticity or comfort with what one already has.
因此，我有个人从这些中受益的经历，我认为这些方式仍然对我有益，并且对 MDMA 的力量感到非常震惊，我对药理学和 MDMA 下的状态的非常粗略的理解是，它鼓励或增加多巴胺能传输，但也促进血清素能传输，据我所知，这是大脑处于的一种罕见状态，通常它更像是一种朝向外部目标或更多目标的跷跷板多巴胺能驱动力。血清素驱动力使人对已有的东西更具可塑性或舒适感。
Andrew Huberman:
安德鲁·休伯曼：
And so with both those systems amplified, the only way I can describe it subjectively is that it ...
因此，随着这两个系统的放大，我可以主观地描述它的唯一方式是它......
Everything sort of funneled back in and it was almost like a pursuit of inner landscape.
一切都重新回归，这几乎就像是对内心风景的追求。
And I can only imagine what it would be like in the context of doing this with somebody else also taking MDMA.
我只能想象如果其他人也服用 MDMA 的话会是什么样子。
I have no idea what that's like.
我不知道那是什么样的。
That's my report of the experience.
这就是我的经验报告。
I know that the experience can vary.
我知道体验可能会有所不同。
What are your thoughts about the chemistry and what sorts of states do you think MDMA is creating that can explain why it's a useful therapeutic tool in some cases and what sorts of cases those might be?
您对这种化学反应有何看法？您认为 MDMA 会产生什么样的状态来解释为什么它在某些情况下是一种有用的治疗工具，以及这些情况可能是什么类型？
Paul Conti:
保罗·孔蒂：
Sure.
当然。
To clarify, I think part of what we're starting with is this is very different than the psychedelics, which are seating our consciousness in these deep centers of the brain.
需要澄清的是，我认为我们首先要考虑的是，这与迷幻药非常不同，迷幻药将我们的意识置于大脑的深层中心。
Whereas what MDMA is doing is sort of flooding with positive neurotransmitters in certain parts of the brain.
而 MDMA 的作用是在大脑的某些部位充满积极的神经递质。
And I think what that creates is a greater permissiveness inside to entertain or approach different things.
我认为这会创造出一种更大的包容性来娱乐或处理不同的事情。
So I think where we see it's ...
所以我认为我们看到的地方是......
My read of the data is around potentially, and we're seeing in some of the trials, tremendous benefit for trauma.
我读到的数据是有潜力的，而且我们在一些试验中看到，这对创伤有巨大的好处。
And you think about what we were talking about earlier, how this reflexive guilt, shame, hypervigilance, avoidance.
你想想我们之前讨论过的，这种反射性的内疚、羞耻、过度警惕、回避是如何产生的。
And when these systems are flooded with these neurotransmitters, it's more permissive to think about that and to think about that without, again, all the chatter of "That's your fault," or, "You're never going to get anywhere because of that," or, "You know what that means." They kind of go away.
And when these systems are flooded with these neurotransmitters, it's more permissive to think about that and to think about that without, again, all the chatter of "That's your fault," or, "You're never going to get anywhere because of that," or, "You know what that means."他们有点消失了。
And then we can think about it in a way that isn't through the lens of fear.
然后我们就可以不通过恐惧的视角来思考它。
And I think that's the power there is that there it is permissive of approaching something, contemplating something.
我认为这就是允许接近某事、思考某事的力量。
Paul Conti:
保罗·孔蒂：
A novelty, as we talk about, de novo approach.
正如我们所说，这是一种新颖的从头方法。
And I think that's also why the experience can vary because you could also see how if you're not thinking about something, so there's not a clinical guidance to it, you could be in a state where, "I just feel good.
我认为这也是为什么体验会有所不同，因为你也可以看到，如果你没有考虑某件事，所以没有临床指导，你可能会处于一种状态，“我只是感觉很好。
And I'm thinking about good things and that can feel good." But that's not necessarily problem solving.
我正在思考美好的事情，这会让我感觉很好。”但这并不一定能解决问题。
So the clinical guidance says, "Hey, let's take that state and do something with it." Now that you're in this state, "Hey, let's make hay while the sun is shining." You're in a state where we can look at things that are traumatic.
因此，临床指南说：“嘿，让我们采取这种状态并利用它做点什么。”既然你处于这种状态，“嘿，趁着阳光明媚，我们去晒干草吧。”你处于一种我们可以看到创伤性事物的状态。
We can approach them from a de novo perspective.
我们可以从头开始的角度来看待它们。
And I think that explains why you had these different experiences from one to the other, because your brain is just in a state that's conducive to something.
And I think that explains why you had these different experiences from one to the other, because your brain is just in a state that's conducive to something.
But if there's not the mechanism to have that thing happen conducive to something therapeutic, then you might go there on your own or you might just be in a state where you have a sense of well-being and you sit with that.
But if there's not the mechanism to have that thing happen conducive to something therapeutic, then you might go there on your own or you might just be in a state where you have a sense of well-being and you sit with that.
Andrew Huberman:
安德鲁·休伯曼：
Which sort of seems like a waste to me.
这对我来说似乎是一种浪费。
I mean this is what I tell people when they ask about MDMA.
我的意思是，当人们询问 MDMA 时，我就是这么告诉他们的。
I said, at least from my experience, that the potential hazard there is that in that very high dopaminergic, serotonergic state, there were moments where I felt like I could get excited about any one specific concept — that I might even just think about, for instance, water and how nourishing it is, and really just go down the path of water, and the world and all the water, and you're in a state that is very prone to suggestion.
I said, at least from my experience, that the potential hazard there is that in that very high dopaminergic, serotonergic state, there were moments where I felt like I could get excited about any one specific concept — that I might even just think about, for instance, water and how nourishing it is, and really just go down the path of water, and the world and all the water, and you're in a state that is very prone to suggestion.
Internal suggestion.
内部建议。
And so the guidance turned out ...
结果指导结果是......
The guidance from the clinician turned out to be immensely valuable in allowing me to go into my own head for bits of time, but then also to resurface and share an exchange in a way that ...
The guidance from the clinician turned out to be immensely valuable in allowing me to go into my own head for bits of time, but then also to resurface and share an exchange in a way that ...
to try and really get something out of it that was useful and that I could export.
尝试真正从中得到一些有用的东西并且我可以出口。
Andrew Huberman:
安德鲁·休伯曼：
Because of course, water is wonderful, but I'm not really interested in growing my relationship to water.
当然，水是美妙的，但我对发展与水的关系并不真正感兴趣。
And I really felt like in ...
我真的感觉就像在...
I could understand for the ...
我可以理解为...
I never went to raves or anything growing up.
我从小到大从来没有参加过狂欢派对或任何其他活动。
I never did MDMA recreationally, but I understood for the first time how people could get really attached to an environment and feel connected to things because I think with all that serotonin, you just feel connected to everything around you.
我从来没有消遣性地吸过摇头丸，但我第一次理解了人们如何能够真正依恋一个环境并感受到与事物的联系，因为我认为有了所有的血清素，你就会感觉与周围的一切都有联系。
So I think it's a slippery slope there.
所以我认为这是一个滑坡。
And I don't know what the future of the clinical use of MDMA looks like, but I would hope that whoever's thinking about guiding these sessions is really thinking carefully also about evolving the practice to help people really move through in a sequential way so they can leave with something valuable.
And I don't know what the future of the clinical use of MDMA looks like, but I would hope that whoever's thinking about guiding these sessions is really thinking carefully also about evolving the practice to help people really move through in a sequential way so they can leave with something valuable.
Paul Conti:
保罗·孔蒂：
Yes, 100%.
是的，100%。
These are such powerful tools and yes, they're powerful tools, and we're using them without respect for them.
这些都是非常强大的工具，是的，它们是强大的工具，但我们在使用它们时并不尊重它们。
Without clinical guidance, we incur risk.
如果没有临床指导，我们就会面临风险。
I mean, getting obsessed with water, well, it probably isn't going to hurt you, but if someone is out using it, they're around other people, what one can feel positively about or become obsessed in the short term about can be very counterproductive.
I mean, getting obsessed with water, well, it probably isn't going to hurt you, but if someone is out using it, they're around other people, what one can feel positively about or become obsessed in the short term about can be very counterproductive.
There can be a lot of risk to that.
这可能存在很大的风险。
So I think it anchors back to, these are very powerful tools, we're coming to understand them much, much more.
所以我认为这可以追溯到，这些都是非常强大的工具，我们对它们的了解越来越多。
And we're coming to understand that they have immense potential to be helpful to us.
我们逐渐认识到它们具有为我们提供帮助的巨大潜力。
But I think and hope that that only also increases our respect for those modalities and what negative can happen if we're not respectful.
但我认为并希望这只会增加我们对这些模式的尊重，以及如果我们不尊重就会产生负面影响。
Andrew Huberman:
安德鲁·休伯曼：
This can be very interesting to see where all of this goes in the next few years, not just in Oregon, but elsewhere.
看看未来几年所有这一切的发展方向可能非常有趣，不仅在俄勒冈州，而且在其他地方。
It's ...
这是...
one way or another, it's happening.
无论如何，它正在发生。
It seems to have a momentum that is not going to stop.
似乎有一股势不可挡的势头。
So very exciting area to be sure.
可以肯定的是，这是一个非常令人兴奋的领域。
Paul Conti:
保罗·孔蒂：
I agree.
我同意。
Andrew Huberman:
安德鲁·休伯曼：
I have a question about language.
我有一个关于语言的问题。
In your book, you talk about how we need to be careful about the use of language around trauma.
在您的书中，您谈到了我们需要如何谨慎使用有关创伤的语言。
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Maybe problem solving and problem describing in general.
也许是一般性的问题解决和问题描述。
At one extreme you hear that your brain and your body hear every word you say, and we have to be so careful with language.
在一种极端情况下，你会听到你的大脑和身体听到你所说的每一个字，我们必须非常小心地对待语言。
And that actually frightened me for a number of years because I would hear that and I thought, "Gosh, if I just think that something is bad now, it's going to hurt me worse." Which itself is part of that whole packing down of an issue.
这实际上让我害怕了很多年，因为当我听到这个消息时，我想，“天哪，如果我现在只是认为有些事情很糟糕，那会对我造成更严重的伤害。” Which itself is part of that whole packing down of an issue.
Very hard to avoid thoughts, without distraction.
很难避免杂念，不分心。
So that's one extreme.
所以这是一种极端。
On the other hand, I can say tell somebody I love them with a tone of hatred.
On the other hand, I can say tell somebody I love them with a tone of hatred.
I can tell somebody I hate them with a tone of love.
I can tell somebody I hate them with a tone of love.
So how should we think about language in parsing trauma?
那么在解析创伤时我们应该如何思考语言呢？
And in your book you talk about, you give some cautionary notes about talking about depression, trauma, and PTSD in terms that might diminish their real severity in some cases.
在你谈到的书中，你对谈论抑郁、创伤和创伤后应激障碍（PTSD）给出了一些警告，这些术语在某些情况下可能会削弱它们的真正严重性。
Andrew Huberman:
安德鲁·休伯曼：
And I was really struck by that.
我对此感到非常震惊。
So maybe just touch on how should we talk about these things in a way that doesn't diminish them for ourselves or for other people.
因此，也许我们应该如何以一种不会影响我们自己或他人的方式来谈论这些事情。
And at the same time honors the fact that there's a lot of trauma out there, and there's a lot of depression out there and we need to talk about it.
同时也尊重这样一个事实：外面有很多创伤，有很多抑郁症，我们需要谈论它。
Paul Conti:
保罗·孔蒂：
I think this a very complicated, and in many ways convoluted topic.
我认为这是一个非常复杂、在很多方面都令人费解的话题。
I think it's wonderful that we have language, but boy, language leads us astray often too.
我认为我们有语言真是太好了，但是，语言也经常让我们误入歧途。
When you think about how people define words.
当你思考人们如何定义词语时。
Someone says a word, what is it?
有人说一句话，那是什么？
Does a person know what that word means" What nuance are they taking from it" We just have to be very careful what we're saying and what we're communicating.
一个人是否知道这个词的意思“他们从中得到了什么细微差别”我们只需要非常小心我们所说的话和我们所交流的内容。
And I think this doesn't mean, because there's a sort of phenomenon now where people are trying to control language I think too much.
我认为这并不意味着，因为现在有一种现象，人们试图控制语言，我想得太多了。
You can't say anything that someone else might find hurtful, or you have to refer to people in ways they choose to be referred to, even if those are ways that others don't understand, or ways they themselves have decided, or ways that might be psychologically or clinically unhelpful.
你不能说任何其他人可能觉得伤害的话，或者你必须以他们选择的方式来提及别人，即使这些方式是别人不理解的，或者是他们自己决定的，或者可能在心理或临床上无帮助的。
So I think the overcontrol of language is not good, but I think the specificity of language, of what are we trying to say?
So I think the overcontrol of language is not good, but I think the specificity of language, of what are we trying to say?
How are we defining it?
我们如何定义它？
Or even the word "trauma."
甚至“创伤”这个词。
Paul Conti:
保罗·孔蒂：
We're talking about trauma, so we want to define what that means.
我们谈论的是创伤，所以我们想定义它的含义。
It doesn't just mean, "Oh, anything kind of negative." Because then that dilutes it down to meaning nothing.
它不仅仅意味着“哦，任何消极的事情”。 Because then that dilutes it down to meaning nothing.
It also doesn't just mean injury and combat.
It also doesn't just mean injury and combat.
We have to talk about what that is.
We have to talk about what that is.
So I think anchoring it to something that rises to the magnitude of overwhelming our coping skills and changing us, then at least I define it that way.
因此，我认为将其锚定在某种足以压垮我们的应对技巧并改变我们的事物上，那么至少我是这样定义的。
And I can communicate that to you and we can understand what we're talking about.
And I can communicate that to you and we can understand what we're talking about.
I think that another aspect of language, while again we need this middle ground, and I don't think that it is okay for the overcontrol of language to shut down expression, but we also have to acknowledge how we're so much less distant from each other through social media.
我认为语言的另一个方面，虽然我们再次需要这个中间立场，而且我不认为过度控制语言来关闭表达是可以的，但我们也必须承认我们如何通过社交媒体彼此之间的距离大大缩短。
And I think social media can do very, very good things, as hopefully we're doing now.
And I think social media can do very, very good things, as hopefully we're doing now.
But it can also be used to harm people from a distance.
But it can also be used to harm people from a distance.
Paul Conti:
保罗·孔蒂：
And how much hatefulness is there out there?
And how much hatefulness is there out there?
That I think comes from anger and frustration in people, again, back to trauma.
That I think comes from anger and frustration in people, again, back to trauma.
Where people just want to be angry, and it's not really issues that they're talking about, but then there's a target of that anger and people feel beleaguered by that.
人们只是想生气，他们谈论的并不是真正的问题，但愤怒的目标是存在的，人们会感到被困扰。
And the words that people use sometimes are so awful that someone reading that ...
And the words that people use sometimes are so awful that someone reading that ...
If you're in the demographic that's being targeted and you're reading that, I mean, how does a person not feel beset upon, vulnerable?
如果你属于被攻击的人群并且你正在读这篇文章，我的意思是，一个人如何不感到被困扰、脆弱？
And then I think that also fuels things like we just had this terrible shooting in Buffalo, just hate motivated.
然后我认为这也助长了诸如我们刚刚在布法罗发生的可怕枪击事件之类的事情，只是出于仇恨动机。
And I think that, because that kind of language becomes very real to people who may take it in, it fuels their hate and then they do something to enact it, which of course creates greater fear and vulnerability.
我认为，因为这种语言对于那些可能接受它的人来说变得非常真实，它会加剧他们的仇恨，然后他们会采取行动来实施它，这当然会造成更大的恐惧和脆弱性。
Paul Conti:
保罗·孔蒂：
And I think there was some civility and decorum that was in our world not that long ago.
And I think there was some civility and decorum that was in our world not that long ago.
I mean, I'm in my early 50s.
I mean, I'm in my early 50s.
I'm not that old.
我没那么老。
But I remember a time when in political discourse, say, people were civil to one another.
但我记得有一段时间，比如说，在政治对话中，人们彼此之间是礼貌的。
Now, so much ...
现在，这么多...
I mean, it's not all of it, but there's an acceptance of things that are just bombastic.
I mean, it's not all of it, but there's an acceptance of things that are just bombastic.
It's a circus sideshow sometimes of people being just angry and aggressive, and it's not really linked to anything, although it's allegedly linked to something, but then other people's anger can attach to it.
这是马戏团的余兴表演，有时人们只是生气和好斗，它实际上与任何事情都没有联系，尽管据称它与某些东西有关，但其他人的愤怒可以附加到它上面。
And it's not about what it's about, but it's about aligning with the anger.
And it's not about what it's about, but it's about aligning with the anger.
And I think that there is so much damage that comes from that.
And I think that there is so much damage that comes from that.
And I think, should it be okay that people sometimes are talking, communicating, using language in ways that would get us suspended from middle school?
我想，人们有时说话、交流、使用语言的方式会让我们被中学停学，这应该可以吗？
Ways I don't want my eight-year-old to see.
Ways I don't want my eight-year-old to see.
Paul Conti:
保罗·孔蒂：
I mean, is that really okay?
I mean, is that really okay?
Or do we need to take a stand for rational use of language?
或者我们是否需要采取合理使用语言的立场？
I don't want my use of language to be overcontrolled by someone who thinks they sort of understand better than the rest of us how to communicate with us.
我不希望我对语言的使用受到那些认为自己比我们其他人更了解如何与我们沟通的人的过度控制。
I don't want that, which is stereotypically a sort of idea of the left.
I don't want that, which is stereotypically a sort of idea of the left.
At least in our society.
至少在我们的社会中是这样。
But I also don't want language that can be so angry and so aggressive that it is perpetuating or spreading vulnerability and that it facilitates trauma.
但我也不希望语言变得如此愤怒和具有攻击性，以至于它会延续或传播脆弱性，并加剧创伤。
And I think we could set standards as a society where we say, "Look, I don't want anybody in power who's going to behave that way." I don't care if their whole agenda is make Paul Conti's life better.
我认为我们可以为一个社会制定标准，我们说：“听着，我不希望任何掌权的人做出这种行为。”我不在乎他们的整个议程是否是让保罗·孔蒂的生活变得更好。
I'm still not going to vote for you.
I'm still not going to vote for you.
If you're behaving towards others in a way that's denigrating, you're behaving in a way that I feel essentially ashamed of.
If you're behaving towards others in a way that's denigrating, you're behaving in a way that I feel essentially ashamed of.
Paul Conti:
保罗·孔蒂：
And I feel that a lot.
我对此深有感触。
I see the politics.
我看到了政治。
I see things play out, it's not always political, of course, not always political.
我看到事情的发展，它并不总是政治性的，当然，并不总是政治性的。
But I see things play out and I think, "Oh my gosh, I feel embarrassed." We're somehow okay with this.
但当我看到事情发展时，我想，“天哪，我感到很尴尬。” We're somehow okay with this.
Well, it doesn't matter which side of the political spectrum it's coming to.
Well, it doesn't matter which side of the political spectrum it's coming to.
And I think that's an indicator that what we're doing is really hurtful to us.
我认为这表明我们所做的事情确实对我们有害。
People become more angry.
People become more angry.
They attach to the anger, people feel more beleaguered, there's more divisions between us.
他们执着于愤怒，人们感到更加陷入困境，我们之间存在更多分歧。
And it seems more and more like, "Well, we can only really identify with people who are just like us." And what does that really mean?
似乎越来越像，“好吧，我们只能真正认同那些和我们一样的人。”这到底意味着什么？
I mean, the divisions that it creates between us.
我的意思是，它在我们之间造成了分歧。
And that promotes so many negative things.
And that promotes so many negative things.
I mean, think about ways in which it promotes white supremacy, it's just one example.
我的意思是，想想它促进白人至上的方式，这只是一个例子。
And we've seen that play out that this is really bad for us, and we've got to look at that.
And we've seen that play out that this is really bad for us, and we've got to look at that.
I mean, if we don't look at that, I don't think it's as though something is going to happen.
我的意思是，如果我们不考虑这一点，我认为不会发生什么事情。
Something is happening.
有事正在发生。
It's happening now.
现在正在发生。
Andrew Huberman:
安德鲁·休伯曼：
And really, to my mind, it really seeps down into the soil of everything that we're talking about on all sides.
事实上，在我看来，它确实渗透到了我们所谈论的各个方面的一切的土壤中。
People are activated, people are upset about one thing or the other.
人们被激活，人们对一件事或另一件事感到不安。
No one is immune from upset, regardless of political affiliation.
无论政治派别如何，没有人能幸免于不安。
And everybody seems to be upset nowadays.
And everybody seems to be upset nowadays.
And as I was hearing you talk about this, I feel a lot of resonance with what you said, and I also am hoping you run for office.
我听到你谈到这个问题，我对你说的很有共鸣，我也希望你竞选公职。
Paul Conti:
保罗·孔蒂：
Thank you.
谢谢你。
I don't think I have the gumption for that, but thank you for that.
我不认为我有这样的进取心，但谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
Well, that would be wonderful.
Well, that would be wonderful.
Paul Conti:
保罗·孔蒂：
Thank you.
谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to talk about a concept of taking care of oneself.
我想谈谈一个照顾自己的概念。
This comes up in the book.
This comes up in the book.
Paul Conti:
保罗·孔蒂：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
This is something we talk a lot about on this podcast.
This is something we talk a lot about on this podcast.
I mean, I think people have heard me blab endlessly, and I'll probably go into the grave telling people to get sunlight in their eyes when they can and to try and get proper sleep and to have a few tools for reducing their anxiety in real-time, and on and on and on.
我的意思是，我认为人们已经听到我没完没了地喋喋不休，我可能会在坟墓里告诉人们尽可能让阳光照射到眼睛里，尝试获得适当的睡眠，并拥有一些实时减少焦虑的工具，等等。
We hear about this concept of taking care of oneself.
我们听说过照顾自己的概念。
And I think at a surface level it can sound a little bit light.
我认为从表面上看，它听起来有点轻。
"Oh.
“哦。
Take care, take good care." But to me it's a deep and powerful concept.
Take care, take good care."但对我来说，这是一个深刻而有力的概念。
And I was very happy to see it in your book and also to learn a lot of ideas about what that really looks like.
我很高兴在你的书中看到它，也学到了很多关于它到底是什么样子的想法。
Andrew Huberman:
安德鲁·休伯曼：
Because whether or not somebody is in the early stages of considering whether or not they have trauma or is in the deep stages of working that through or has made it through the tunnel some distance, taking care of oneself is an ongoing process.
因为无论某人是否处于考虑自己是否遭受创伤的早期阶段，或者是否处于通过隧道或已经走出隧道一段距离的深层阶段，照顾自己都是一个持续的过程。
I'd love for you to just describe what taking care of oneself means to you as a clinician.
我希望您能描述一下照顾自己对您作为临床医生意味着什么。
And of course the practices and things that you encourage people to do.
And of course the practices and things that you encourage people to do.
But how we should think about taking care of oneself?
但我们应该如何考虑照顾自己呢？
Because on one extreme, you could imagine massages or treats, vacations and chefs for hire that take care of everything for ourselves.
因为在一种极端情况下，你可以想象按摩或款待、度假和聘请厨师来为我们自己打理一切。
And on the other extreme, you could say, leaning into life in a way that you're paying attention to small things while working very, very hard.
And on the other extreme, you could say, leaning into life in a way that you're paying attention to small things while working very, very hard.
So it's such a big concept, but how do you think about taking care of oneself?
这是一个很大的概念，但是你如何看待照顾自己呢？
How should I take care of myself?
How should I take care of myself?
How should people take care of themselves?
人们应该如何照顾自己？
Paul Conti:
保罗·孔蒂：
Sure.
当然。
I see here what I think is a very fascinating dichotomy that in some ways, think about how complex our brains are, how complex our psyches, unconscious minds are.
我在这里看到了我认为非常有趣的二分法，在某些方面，思考我们的大脑有多么复杂，我们的心理、无意识思维有多么复杂。
There's so much complexity there.
那里有太多的复杂性。
But on the other hand, psychological concepts that are consistent with health are often very simple.
But on the other hand, psychological concepts that are consistent with health are often very simple.
But I wish, I don't mean light, but simple, straightforward, and I think self-care is absolutely one of them.
但我希望，我指的不是轻松，而是简单、直接，而且我认为自我保健绝对是其中之一。
I mean, how much is talked about how to take care of oneself that just skips over the basics that are necessary as a building block for all else.
我的意思是，有多少关于如何照顾自己的讨论只是跳过了作为其他一切构建模块所必需的基础知识。
So it doesn't matter how many chefs or vacations or whatever a person has if the basics of self-care aren't squared away.
因此，如果一个人的基本自我保健能力没有得到满足，那么一个人有多少厨师、有多少假期或拥有什么都没有关系。
And it's not a light concept to say, "Look, are you sleeping enough?
说“看，你睡够了吗？”这并不是一个简单的概念。
Are you eating well?
你吃得好吗？
Are you getting natural light?
Are you getting natural light?
Are you interacting with people who are good to interact with?
Are you interacting with people who are good to interact with?
Are you accepting negative interactions in your life?
Are you accepting negative interactions in your life?
Are you living in circumstances that make you feel okay or not?" They're very, very basic premises.
你生活的环境让你感觉还好还是不舒服？”它们是非常非常基本的前提。
But so often we're not looking at them at all.
但很多时候我们根本不看它们。
Paul Conti:
保罗·孔蒂：
We're not looking at them at all because we tend to skip over them.
我们根本不看它们，因为我们倾向于跳过它们。
And we tend to skip over them either because, again, in some automatic way that sometimes is trauma-driven, we're not going to look at that, and often not taking care of ourselves can have the punishment, distraction.
我们倾向于跳过它们，因为，再次，以某种有时是创伤驱动的自动方式，我们不会看到它们，并且通常不照顾自己会受到惩罚，分心。
There's so much that can come into that.
其中有很多内容。
Or our sense of power is tied to not taking care of ourselves.
Or our sense of power is tied to not taking care of ourselves.
I mean, I'll give you an example is I tend to, for whatever reason, do reasonably well with very poor self-care.
我的意思是，我给你举个例子，无论出于什么原因，我倾向于在自我保健很差的情况下做得相当好。
And that was very adaptive when I was into medical training, and I'm like, "Okay, I can eat a lot today.
And that was very adaptive when I was into medical training, and I'm like, "Okay, I can eat a lot today.
I can not eat.
我不能吃。
I can sleep two hours, I can sleep eight." I mean, overall that's not good.
我可以睡两个小时，我可以睡八个小时。”我的意思是，总体来说这不太好。
And it hasn't been good for me as I've aged.
随着年龄的增长，这对我来说并不好。
But then I realized some, look, I'm doing all these things that make myself healthier, but what, I ignore that?
But then I realized some, look, I'm doing all these things that make myself healthier, but what, I ignore that?
And why am I ignoring it?
为什么我忽略它？
That was a key question.
这是一个关键问题。
Why am I ignoring it?
为什么我忽略它？
Paul Conti:
保罗·孔蒂：
Because somewhere inside of me, as it was, and still to some extent is, this idea that my ability to be really functional, to generate success in the world around me is tied to my ability to do that.
因为在我内心的某个地方，过去是、现在在某种程度上仍然是这样一种想法，即我真正发挥作用、在周围的世界中取得成功的能力与我做到这一点的能力息息相关。
But if I stop doing that, and now I'm eating and sleeping regularly, then I'm going to lose some edge.
但如果我停止这样做，并且现在我正常饮食和睡眠，那么我就会失去一些优势。
Even, I think about this all the time, but I realize, "Hey, I'm also, I'm not doing it inside." And I think it's really grounding to the basics that really help us of what are the basics of what I'm doing and not doing in my life — diet, exercise, sleep, people, circumstances, leisure activities.
Even, I think about this all the time, but I realize, "Hey, I'm also, I'm not doing it inside."我认为它确实扎根于基础知识，真正帮助我们了解我在生活中正在做什么和不做什么的基础知识——饮食、锻炼、睡眠、人、环境、休闲活动。
I mean sunlight — I mean, I think immensely important and dramatically undervalued.
I mean sunlight — I mean, I think immensely important and dramatically undervalued.
Andrew Huberman:
安德鲁·休伯曼：
Well, I want to thank you for that.
嗯，我想为此感谢你。
And I want to thank you for today's discussion.
我要感谢大家今天的讨论。
I found it to be incredibly informative and I know our listeners will also ...
I found it to be incredibly informative and I know our listeners will also ...
I also want to thank you for the work you do.
我还要感谢你所做的工作。
I mean, you obviously run an incredibly robust clinical practice that I'm aware that you're constantly trying to improve, even though it's operating at the highest levels already.
我的意思是，您显然运行着令人难以置信的强大临床实践，我知道您一直在努力改进，尽管它已经在最高水平上运行。
Paul Conti:
保罗·孔蒂：
I appreciate that.
我很欣赏这一点。
Andrew Huberman:
安德鲁·休伯曼：
I really ...
我真的...
The reason why you're here today is because I've done a wide and deep search for people in these areas and there are so few who have the background in medical training and physiology in the psychoanalytic and psychiatric realm and also have a grounding toward the future, what's coming, and who can encapsulate so many different orientations and bring them together into a coherent piece.
你们今天之所以来到这里，是因为我对这些领域的人进行了广泛而深入的搜索，很少有人拥有精神分析和精神病学领域的医学培训和生理学背景，并且对未来、即将发生的事情有基础，能够概括这么多不同的方向并将它们整合成一个连贯的部分。
So I really, thank you.
所以我真的很谢谢你。
Paul Conti:
保罗·孔蒂：
Appreciate that.
很欣赏这一点。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
And for your book, which is incredible.
对于你的书来说，这真是令人难以置信。
I will go on record saying I think this is the definitive book on trauma.
I will go on record saying I think this is the definitive book on trauma.
And I really encourage people to read it and will continue to encourage people to read it.
我真的鼓励人们阅读它，并将继续鼓励人们阅读它。
So many valuable takeaways and insights and tools there.
So many valuable takeaways and insights and tools there.
So on behalf of the listeners and myself, thank you so much for joining us today.
因此，我谨代表听众和我本人，非常感谢您今天加入我们。
Paul Conti:
保罗·孔蒂：
You're very welcome.
非常不客气。
And I take that to heart, and I'm very appreciative of being here.
我牢记这一点，并且非常感激来到这里。
So you're very welcome and thank you as well.
所以非常欢迎你，也谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Thank you for joining me for my discussion with Dr. Paul Conti.
感谢您参加我与 Paul Conti 博士的讨论。
I also highly recommend that you explore his new book, which is "Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal from It." It's an exceptional resource, both for those that have trauma and those that don't have trauma, or those that suspect they might have trauma.
我还强烈建议您阅读他的新书，《创伤：看不见的流行病：创伤如何发生以及我们如何从中治愈》。对于那些有创伤和没有创伤的人，或者那些怀疑自己可能有创伤的人来说，这都是一种特殊的资源。
Again, it's a deep dive into what trauma is and offers many simple tools that anyone can apply with a therapist or not, in order to heal from trauma.
再次，它深入探讨了创伤是什么，并提供了许多简单的工具，任何人都可以与治疗师一起使用或不使用这些工具，以治愈创伤。
And if you'd like to learn more about Dr. Conti and the work he does directly with patients, please check out his website, pacificpremiergroup.com.
如果您想了解有关 Conti 博士以及他直接为患者所做的工作的更多信息，请访问他的网站 pacificpremiergroup.com。
We've also provided a link to both the book and pacificpremiergroup.com in the show note captions.
我们还在节目注释中提供了本书和 pacificpremiergroup.com 的链接。
If you are learning from and or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习或喜欢此播客，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。
Andrew Huberman:
安德鲁·休伯曼：
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 also leave us up to a five-star review.
在 Spotify 和 Apple 上，您还可以给我们留下五星级的评价。
On YouTube, you can leave us comments or suggestions about content that you'd like us to cover, as well as suggestions of future guests that you'd like us to host on the podcast.
在 YouTube 上，您可以向我们留下关于您希望我们报道的内容的评论或建议，以及您希望我们在播客上主持的未来嘉宾的建议。
We do read all those comments.
我们确实阅读了所有这些评论。
Please also check out the sponsors mentioned at the beginning of today's episode — that is the best way to support this podcast.
另请查看今天节目开头提到的赞助商——这是支持这个播客的最佳方式。
Not so much in today's episode, but in many previous episodes of the Huberman Lab podcast, we discuss supplements.
在今天的节目中，我们讨论了补充剂，但在之前的许多休伯曼实验室播客节目中，我们讨论了补充剂。
While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like improving the transition time and the depth of sleep each night, for improving focus, for managing anxiety, and for many other aspects of mental health, physical health, and performance.
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，例如改善每晚的过渡时间和睡眠深度、提高注意力、控制焦虑以及心理健康、身体健康和表现的许多其他方面。
Andrew Huberman:
安德鲁·休伯曼：
For that reason, the Huberman Lab podcast has partnered with Momentous supplements because first off, they are of the very highest quality.
出于这个原因，Huberman Lab 播客与 Momentous 补充剂合作，因为首先，它们具有最高的质量。
They also ship internationally, which many other supplement companies do not.
他们还进行国际运输，而许多其他补充剂公司则不这样做。
And we wanted to have a one-stop location where people could find and access the supplements that are discussed on the Huberman Lab podcast.
我们希望有一个一站式地点，人们可以在这里找到并访问 Huberman Lab 播客上讨论的补充剂。
So if you go to livemomentous.com/huberman, you'll find many of the supplements that are commonly discussed on the Huberman Lab podcast.
因此，如果您访问 livemomentous.com/huberman，您会发现 Huberman 实验室播客上经常讨论的许多补充剂。
I should just mention that the catalog of supplements there will be expanding in the weeks and months to follow, but already a number of them for sleep and focus and other aspects of mental health, physical health and performance are already there at livemomentous.com/huberman.
我只想提一下，那里的补充剂目录将在接下来的几周和几个月内扩大，但其中一些用于睡眠和注意力以及心理健康、身体健康和表现的其他方面的补充剂已经在 livemomentous.com/huberman 上出现。
If you're not already following Huberman Lab on Instagram and Twitter, please do so.
如果您还没有在 Instagram 和 Twitter 上关注 Huberman Lab，请立即关注。
There, I cover science and science-based tools, some of which overlap with the content of the Huberman Lab podcast, but much of which is distinct from the information covered on the Huberman Lab podcast.
在那里，我介绍了科学和基于科学的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客中涵盖的信息不同。
Andrew Huberman:
安德鲁·休伯曼：
We also have a newsletter called the Neural Network Newsletter, where we offer distilled information, so lists of protocols and key takeaways from podcast episodes.
我们还有一份名为《神经网络新闻通讯》的新闻通讯，我们在其中提供精炼信息、协议列表和播客剧集的关键要点。
If you want to sign up for the newsletter, all it requires is your email.
如果您想订阅时事通讯，只需要您的电子邮件即可。
Please know that we do not share your email with anybody.
请注意，我们不会与任何人分享您的电子邮件。
We have a very clear privacy policy.
我们有非常明确的隐私政策。
You can find all that by going to huberman lab.com.
您可以访问 huberman lab.com 找到所有这些信息。
There's a menu there where you can sign up for the Neural Network Newsletter.
那里有一个菜单，您可以在其中注册神经网络通讯。
You can also immediately get access to some example newsletters so you know what the newsletter is all about.
您还可以立即访问一些新闻通讯示例，以便了解新闻通讯的全部内容。
So thank you once again for joining me for my discussion with Dr. Paul Conti.
再次感谢您参加我与 Paul Conti 博士的讨论。
And last but certainly not least, thank you for your interest in science.
最后但并非最不重要的一点是，感谢您对科学的兴趣。