Essentials: Compulsive Behaviors & Deep Brain Stimulation | Dr. Casey Halpern
Dr. Casey Halpern:
凯西·哈尔彭博士：
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.
欢迎来到 Huberman Lab Essentials，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
And now for my discussion with Dr. Casey Halpern.
现在我与 Casey Halpern 博士进行讨论。
Casey, I should say Dr. Halpern, welcome.
凯西，我应该说哈尔彭博士，欢迎。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Great to be here.
很高兴来到这里。
Dr. Casey Halpern:
凯西·哈尔彭博士：
You're a neurosurgeon, which I consider the astronauts of neuroscience.
你是一名神经外科医生，我认为你是神经科学的宇航员。
For those that aren't familiar with the differences between neurosurgery, neurology, psychiatry, maybe you could just educate us a bit.
对于那些不熟悉神经外科、神经病学、精神病学之间差异的人，也许你可以教育我们一些。
What does a neurosurgeon do, and how do you think about and conceptualize the brain?
神经外科医生是做什么的？您如何思考和概念化大脑？
Andrew Huberman:
安德鲁·休伯曼：
The scope of neurosurgery is quite broad.
神经外科的范围相当广泛。
We take out brain tumors.
我们切除脑肿瘤。
We clip aneurysms in the brain.
我们夹住大脑中的动脉瘤。
We take care of patients that have had traumatic brain injury, concussion, spine surgeries.
我们照顾患有脑外伤、脑震荡、脊柱手术的患者。
90% of what neurosurgeons do around the country, taking care of herniated discs and lumbar fusions.
全国 90% 的神经外科医生所做的工作都是治疗椎间盘突出和腰椎融合。
So, the scope is the entire central nervous system, including the peripheral nervous system.
所以，范围是整个中枢神经系统，包括周围神经系统。
We take care of patients with carpal tunnel syndrome and nerve disorders.
我们照顾患有腕管综合症和神经疾病的患者。
Historically, neurosurgeons did everything in that domain.
从历史上看，神经外科医生在这个领域做了所有的事情。
But now, we sub-specialize, and I'm lucky to be at Penn Medicine, where we can focus on one of these areas.
但现在，我们进行了细分，我很幸运能够在宾夕法尼亚大学医学院工作，在那里我们可以专注于这些领域之一。
So I'm chief of stereotactic functional neurosurgery.
所以我是立体定向功能神经外科的主任。
All I do is deep brain stimulation surgery, and a complement to that is focused ultrasound or transcranial focused ultrasound, which is a non-invasive way to do an ablation in the brain, recently FDA approved, and it's FDA approved for tremor at the moment.
我所做的就是深部脑刺激手术，对此的补充是聚焦超声或经颅聚焦超声，这是一种在大脑中进行消融的非侵入性方法，最近获得了 FDA 的批准，目前 FDA 批准了它用于震颤。
Deep brain stimulation is a procedure where we have to place a very thin wire that's insulated deep into a part of the brain that's involved in Parkinson's disease, for example.
例如，在深度脑刺激过程中，我们必须将一根非常细的电线深入到与帕金森病有关的大脑部分中。
But that's actually not the therapy.
但这实际上不是治疗方法。
The therapy is delivering electrical stimulation through the tip of that wire, or one of the tips, as there actually are multiple contacts at the bottom of the wire.
该疗法是通过该导线的尖端或其中一个尖端提供电刺激，因为导线的底部实际上有多个触点。
They're very small.
它们很小。
It's a bit more like I have to implant a tool to deliver you a medication, but that medication is going to be in the form of electricity, and it's going to be delivered into a very small region of the brain.
这有点像我必须植入一个工具来给你输送药物，但这种药物将以电的形式输送到大脑的一个非常小的区域。
I'm very privileged to be able to interact with the human brain in this way.
我非常荣幸能够以这种方式与人脑互动。
It's always with the goal of trying to provide somebody with a meaningful therapy.
它始终致力于为某人提供有意义的治疗。
But when we deliver electrical stimulation, these electrodes, while they might be sitting in a very small region of the brain, there are regions within a few millimeters of where these electrodes are that, if stimulated, could cause a temporary, very brief side effect, a moment of laughter, like you said, or a moment of panic.
但是，当我们提供电刺激时，这些电极虽然可能位于大脑的一个非常小的区域，但在这些电极所在的几毫米范围内有一些区域，如果受到刺激，可能会导致暂时的、非常短暂的副作用，就像你说的那样，一瞬间的笑声，或者一瞬间的恐慌。
And of course, we can just shut that electrode off.
当然，我们可以关闭该电极。
But often, these side effects could be therapeutic.
但通常，这些副作用可能是有治疗作用的。
And actually, that's how we have discovered ways to use deep brain stimulation, not just for movement disorders like Parkinson's disease, but for example, patients with Parkinson's disease that have a psychiatric comorbidity like depression or obsessive compulsive disorder.
事实上，这就是我们如何发现使用深层脑刺激的方法，不仅适用于帕金森病等运动障碍，还适用于患有抑郁症或强迫症等精神共病的帕金森病患者。
A lot of these patients are highly compulsive and impulsive.
很多这样的患者都有很强的强迫性和冲动性。
Sometimes these problems actually melt away, and we're trying to help their tremor, but the patients also tell us that their gambling issue has gotten better or their mood has improved.
有时这些问题实际上消失了，我们试图帮助他们的震颤，但患者也告诉我们，他们的赌博问题已经好转，或者他们的情绪有所改善。
And why is that?
这是为什么呢？
Well, there's probably more than one reason.
嗯，原因可能不止一个。
You can help somebody's mood by making their tremor go away, of course.
当然，你可以通过让某人的颤抖消失来改善他们的情绪。
But we see laughter in the clinic sometimes.
但有时我们会在诊所里看到笑声。
And why is that?
这是为什么呢？
And that's because we're stimulating parts of the brain that are not just involved in these motor circuits, but they're also involved in what we call a limbic circuit, or part of the brain involved in emotion.
这是因为我们刺激的大脑部分不仅与这些运动回路有关，而且还与我们所说的边缘回路有关，或者与情绪有关的大脑部分有关。
And if we learn how to modulate those areas therapeutically, step by step, we can actually develop these therapies for other indications, like depression.
如果我们学会如何一步一步地在治疗上调节这些区域，我们实际上可以开发针对其他适应症（例如抑郁症）的疗法。
I would say the most impressive and consistent effect we have when we have a patient with tremor who has been trembling for the past 20 years, if we can deliver stimulation through that electrode in the clinic, we have immediate relief of tremor.
我想说，最令人印象深刻和一致的效果是，当我们有一个在过去 20 年里一直颤抖的颤抖患者时，如果我们可以在诊所通过该电极提供刺激，我们就能立即缓解颤抖。
And that is the effect that inspired me to be a neurosurgeon when I was in college.
这就是我在大学时成为一名神经外科医生的灵感。
I've never really wanted to do anything else, except help develop that type of therapeutic for another kind of symptom.
除了帮助开发针对另一种症状的治疗方法之外，我从来没有真正想做任何其他事情。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I'd love to learn more from you about OCD.
我很想向您了解更多有关强迫症的信息。
Could you perhaps just tell us what is OCD?
您能告诉我们什么是强迫症吗？
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
Dr. Casey Halpern:
凯西·哈尔彭博士：
What are some brain areas involved?
涉及哪些大脑区域？
What are the current range of treatments?
目前的治疗范围有哪些？
And what's the difference between someone who is obsessive and somebody who has true OCD?
强迫症患者和真正的强迫症患者有什么区别？
Andrew Huberman:
安德鲁·休伯曼：
My perspective on OCD may be a little bit different than a psychiatrist who lives and breathes OCD and sees patients every single day with OCD.
我对强迫症的看法可能与一个生活在强迫症中、呼吸着强迫症、每天都会见到强迫症患者的精神科医生有些不同。
I probably take care of three to five patients a year with deep brain stimulation for obsessive-compulsive disorder.
我每年可能会通过深部脑刺激治疗强迫症患者照顾三到五个患者。
So I don't see these patients as routinely, but my laboratory is geared as a researcher.
所以我不经常见到这些病人，但我的实验室是为研究人员服务的。
I'm very focused on trying to improve outcomes of deep brain stimulation for OCD.
我非常专注于尝试改善强迫症的深部脑刺激的结果。
So I do feel I have expertise and a perspective to share.
所以我确实觉得我有专业知识和观点可以分享。
I do feel that, as a neurosurgeon, I am obligated to better understand where the obsessions in the brain come from and how we can interrupt them to stop the compulsion that's associated with the obsession better than we're actually doing it.
我确实觉得，作为一名神经外科医生，我有义务更好地了解大脑中的强迫观念从何而来，以及我们如何打断它们，以比我们实际做的更好地阻止与强迫观念相关的强迫行为。
I've been leading an endeavor with a number of collaborators around the country to try to better understand these circuits in the brain, study them in humans, both invasively and noninvasively.
我一直在与全国各地的许多合作者一起努力，试图更好地了解大脑中的这些回路，并在人类身上进行侵入性和非侵入性研究。
That would be with an electrode-based surgery, sort of like we do in epilepsy to understand where seizures come from.
这将通过基于电极的手术来实现，就像我们在癫痫病中所做的那样，以了解癫痫发作的来源。
We want to understand better where obsessions come from.
我们想更好地了解痴迷从何而来。
But we're also working with imaging experts and geneticists to understand OCD at a broader level as well.
但我们还与影像专家和遗传学家合作，在更广泛的层面上了解强迫症。
I consider OCD to be a spectrum disorder in a way.
我认为强迫症在某种程度上是一种谱系障碍。
And I apologize to those who might feel that I'm using that term incorrectly.
我向那些可能认为我错误使用该术语的人表示歉意。
I'm using it in a way to describe Patients that have obsessions and even some related compulsions might not meet criteria for OCD.
我用它来描述有强迫症的患者，甚至一些相关的强迫症可能不符合强迫症的标准。
As a neurosurgeon, I'm really obsessive about safety and compulsive about my surgical procedures.
作为一名神经外科医生，我非常注重手术的安全性和强迫性。
So I think that some aspect of OCD, which we often joke about, but we should consider seriously because people do suffer from this, some aspect of it helps us.
所以我认为强迫症的某些方面，我们经常开玩笑，但我们应该认真考虑，因为人们确实患有这种疾病，它的某些方面对我们有帮助。
There are famous CEOs that probably have some level of OCD, surgeons and scientists alike.
有些著名的首席执行官可能有一定程度的强迫症，外科医生和科学家也一样。
So perhaps if it can be controlled, it's an asset.
因此，如果它可以被控制，也许它就是一种资产。
But if it goes awry and is uncontrollable, then it becomes obsessive-compulsive disorder.
但如果出了差错，无法控制，那就成了强迫症。
And I tend to see the patients that are the most severe, so they have failed medication, and there are multiple medications that are worth trying for OCD.
我倾向于看到最严重的患者，因此他们的药物治疗失败了，并且有多种药物值得尝试治疗强迫症。
Some can actually be very helpful.
有些实际上非常有帮助。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Which neurotransmitter systems do they tend to poke at?
他们倾向于攻击哪些神经递质系统？
Andrew Huberman:
安德鲁·休伯曼：
Well, SSRIs are sort of the first line for OCD, but also tricyclics can be helpful, so this is still the serotonin system.
嗯，SSRIs 是治疗强迫症的一线药物，但三环类药物也有帮助，所以这仍然是血清素系统。
But as we know, the serotonin system interacts with the neurogenergic system and the dopamine system, so it's hard to be specific to one of these things.
但正如我们所知，血清素系统与神经系统和多巴胺系统相互作用，因此很难具体说明其中之一。
And I think that's also why it's hard for us to predict how these medications are going to work for these kinds of patients.
我认为这也是为什么我们很难预测这些药物将如何对这类患者起作用。
But tricyclics and SSRIs can be very helpful and are definitely first line.
但三环类药物和 SSRI 类药物非常有帮助，而且绝对是一线药物。
And there's others.
还有其他的。
Exposure response prevention is probably the most effective option, which is kind of like cognitive behavioral therapy, but these are different and offered by psychologists, and this is a whole field.
暴露反应预防可能是最有效的选择，有点像认知行为疗法，但这些是不同的，并且是由心理学家提供的，这是一个完整的领域。
And there's a whole clinic at my institution, Focused.
我的机构有一个完整的诊所，专注。
It was started by Edna Foa at Penn.
它是由宾夕法尼亚大学的埃德娜·福阿发起的。
This is what they do for these patients, is offer these types of cognitive therapies exposure to the stressor and to try to get patients to habituate to whatever it is that stresses them and causes these compulsions to help these patients live every day and function.
这就是他们为这些患者所做的，就是提供这些类型的认知疗法，让他们暴露在压力源下，并试图让患者习惯任何给他们带来压力并导致这些强迫的东西，以帮助这些患者每天生活和发挥作用。
These are all fabulously helpful therapies for a variety of patients, but there's still about 30% of patients that still suffer from OCD, and some of them have severe OCD.
这些对于各种患者来说都是非常有用的疗法，但仍有大约 30% 的患者仍然患有强迫症，其中一些患有严重的强迫症。
Sometimes it's moderate to severe, and those are the patients that I'm really motivated to try to help.
有时是中度到重度，这些是我真正有动力去帮助的患者。
Our therapies for those patients right now, I would say are worth pursuing, but not optimal.
我想说，我们现在对这些患者的治疗值得追求，但不是最佳的。
And so it's one of those things that we have to balance as a researcher, because when you see patients like this, you want to do everything you can to help them.
因此，这是我们作为研究人员必须平衡的事情之一，因为当你看到这样的患者时，你会想尽一切努力来帮助他们。
And I think it's important to educate patients on the risk and benefits of them.
我认为教育患者了解其风险和益处非常重要。
This is deep brain stimulation surgery, but also capsulotomy, which is more of an ablation approach, a little bit like deep brain stimulation, but rather than delivering stimulation through an electrode, you can actually heat the tissue and even destroy it.
这是深部脑刺激手术，也是囊切开术，这更像是一种消融方法，有点像深部脑刺激，但不是通过电极提供刺激，而是实际上可以加热组织，甚至破坏它。
Some would say this part of the brain is very safe to destroy.
有人会说，破坏大脑的这一部分是非常安全的。
It's kind of like an appendix.
它有点像附录。
Others would say it's safer to modulate.
其他人会说调节更安全。
I have seen patients do very well with these ablations.
我见过患者在这些消融术中效果很好。
And so you asked me earlier what I find so amazing about the brain, these effects that we can have.
所以你早些时候问我，我发现大脑有什么神奇之处，我们可以产生这些影响。
Sometimes the lack of effect is what's so amazing.
有时候，缺乏效果才是如此令人惊奇。
You can actually traverse parts of the brain without having any adverse effects on patients' function, at least that you can test.
实际上，您可以遍历大脑的某些部分，而不会对患者的功能产生任何不利影响，至少可以测试。
But you can also destroy small parts of the brain.
但你也可以破坏大脑的一小部分。
We're talking three or four millimeters in size.
我们所说的尺寸是三到四毫米。
These little ablations can be really helpful for patients but have no obvious side effects that we can tell, perhaps after a short recovery from surgery.
这些小消融对患者确实有帮助，但我们可以看出，也许在手术后短暂恢复后，没有明显的副作用。
But nonetheless, despite how safe they might be, these surgical procedures still are surgical procedures, and patients are hesitant to proceed, especially when they know that their chance of a transformative effect is quite low.
但尽管如此，尽管它们可能非常安全，但这些外科手术仍然是外科手术，患者对是否继续进行犹豫不决，尤其是当他们知道获得变革性效果的机会相当低时。
We can generally achieve a responder rate of about 50%, and responders still have symptomatic OCD.
我们一般可以达到50%左右的缓解率，并且缓解者仍然有症状的强迫症。
So I'm really sort of inspired to really find a way to deliver these therapies in a more disease-specific or symptom-specific way.
因此，我真的很受启发，真正找到一种方法，以更针对疾病或症状的方式提供这些疗法。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I'd like to take a quick break and acknowledge our sponsor, Function.
我想稍微休息一下并感谢我们的赞助商 Function。
Function provides over 160 advanced lab tests to give you a clear snapshot of your bodily health.
功能提供超过 160 项高级实验室测试，让您清晰了解自己的身体健康状况。
This snapshot gives you insights into your heart health, your hormone health, autoimmune function, nutrient levels, and much more.
通过此快照，您可以深入了解心脏健康状况、激素健康状况、自身免疫功能、营养水平等。
They've also recently added access to advanced MRI and CT scans.
他们最近还增加了先进的 MRI 和 CT 扫描的访问权限。
Function not only provides testing of over 160 biomarkers key to your physical and mental health, it also analyzes these results and provides recommendations for improving your health from top doctors.
Function 不仅提供对您身心健康至关重要的 160 多种生物标记物的测试，还分析这些结果并提供顶级医生改善您健康的建议。
For example, in a recent test with Function, I learned that some of my blood lipids were slightly out of range.
例如，在最近的一次 Function 测试中，我发现我的一些血脂稍微超出了范围。
As a result, I decided to start supplementing with nattokinase, which can naturally help reduce LDL cholesterol.
因此，我决定开始补充纳豆激酶，它自然可以帮助降低低密度脂蛋白胆固醇。
And it did.
确实如此。
In a follow-up test, I could confirm that this strategy worked.
在后续测试中，我可以确认这个策略是有效的。
My blood lipids are now back exactly where I want them.
我的血脂现在完全回到了我想要的水平。
Comprehensive lab testing of the sort that Function offers is just so important for health.
Function 提供的全面实验室测试对于健康非常重要。
How else are you going to know what's going on under the hood?
否则你怎么知道幕后发生了什么？
And while I've been doing blood work for years, it used to be time-consuming, complicated, and expensive.
虽然我从事血液检查已有多年，但它过去非常耗时、复杂且昂贵。
In fact, I used to spend thousands of dollars per year trying to get this kind of data, and the data, frankly, were not all that good.
事实上，我曾经每年花费数千美元试图获得此类数据，但坦率地说，这些数据并不那么好。
But now with Function, it's extremely easy and affordable.
但现在有了 Function，它变得非常简单且经济实惠。
A Function membership is only a dollar a day, $365 a year.
Function 会员每天仅需 1 美元，每年 365 美元。
And if you think about the information it provides and the health challenges it helps you avoid and the proactive things that it can do for you to enhance your health, I truly look at it as a savings.
如果您考虑一下它提供的信息、它可以帮助您避免的健康挑战以及它可以为您增强健康所做的积极主动的事情，我确实将其视为一种节省。
To learn more, visit functionhealth.com/huberman and use the code Huberman for a $50 credit towards your membership.
要了解更多信息，请访问 functionhealth.com/huberman 并使用代码 Huberman 获得 50 美元的会员积分。
Again, that's functionhealth.com/huberman.
同样，这是 functionhealth.com/huberman。
Were one to come into your clinic for this sort of work of ablations or stimulation, where would you first start to probe in the brain?
如果有人来到您的诊所进行此类消融或刺激工作，您会首先开始探测大脑的哪里？
Andrew Huberman:
安德鲁·休伯曼：
This is a disorder of both cortex and the subcortex.
这是皮质和皮质下的疾病。
We find that areas in the cortex, like the prefrontal and orbitofrontal cortex, are not functioning the way they would in a non-OCD patient.
我们发现皮质区域，如前额皮质和眶额皮质，不能像非强迫症患者那样发挥作用。
They are often hyper ...
他们常常非常...
functioning, and we need to find a way to try to normalize their function.
功能，我们需要找到一种方法来尝试使其功能正常化。
And then there are projections to the subcortex.
然后还有到皮层下的投射。
This is the basal ganglia, like caudate, putamen, or the dorsal striatum, and these are interconnected with the ventral striatum.
这是基底神经节，如尾状核、壳核或背侧纹状体，它们与腹侧纹状体相互连接。
This is an area of the brain that I focus a lot of my energy in.
这是我集中精力的大脑区域。
This is the ventral striatum, which is not limited to, but includes the nucleus accumbens.
这是腹侧纹状体，它不仅限于伏隔核，还包括伏隔核。
This is an area of the brain that we know to be involved in gating reward-seeking behavior.
我们知道，这是大脑中参与控制寻求奖励行为的区域。
When it's perturbed, it seems to gate compulsive behavior, meaning a rat will pursue a reward despite punishment, despite a foot shock, for example.
当它受到干扰时，它似乎会抑制强迫行为，这意味着老鼠会不顾惩罚（例如足部电击）而追求奖励。
And that can be similar to an OCD patient.
这与强迫症患者类似。
They will check their home for safety until 3:00 a.m.
他们将检查家中的安全直至凌晨 3:00。
in the morning and not sleep that night, doing something because of the urge, but despite the risk.
早上和晚上都没有睡觉，因为冲动而做某事，但尽管有风险。
When our judgment consistently sort of puts us at risk, that's where we have something like OCD.
当我们的判断始终让我们处于危险之中时，我们就会患上强迫症。
Contamination behavior, where if they feel contaminated, they will wash their hands for hours repeatedly, or if they drop their toothbrush on the floor, this will lead to a compulsive behavior of cleaning a toothbrush and brushing your teeth consistently.
污染行为，如果他们感到被污染，他们会反复洗手几个小时，或者如果他们把牙刷掉在地板上，这将导致持续清洁牙刷和刷牙的强迫行为。
Very, very common symptoms that we see or signs that patients report to us or that we observe.
我们看到的非常非常常见的症状或患者向我们报告或我们观察到的迹象。
But patients with eating disorders, if they have binge eating disorder, they'll overeat.
但饮食失调的患者，如果患有暴食症，就会吃得过多。
If they have bulimia, they might purge despite the risk of these things.
如果他们患有贪食症，他们可能会不顾这些事情的风险而进行净化。
And so addiction is similar.
所以成瘾是相似的。
We tend to drug seek if we're addicted.
如果我们上瘾了，我们就会倾向于寻求毒品。
We'll pay off a dealer in order to get our fix despite the risk, and that type of urge despite the risk is something that I've always been really interested in, and it's a common denominator to all of these problems.
尽管有风险，我们还是会付钱给经销商，以便得到修复，而这种尽管有风险的冲动是我一直非常感兴趣的，也是所有这些问题的共同点。
And if you think about these problems, these are some of the most common conditions in our society today.
如果你考虑一下这些问题，就会发现这些是当今社会最常见的一些情况。
And I think the nucleus accumbens and the cortical areas that we've been discussing that sort of send projections to these areas are probably at least one of the main circuits involved in these kinds of things.
我认为我们一直在讨论的伏隔核和皮质区域向这些区域发送投射可能至少是涉及此类事物的主要回路之一。
Dr. Casey Halpern:
凯西·哈尔彭博士：
What is nucleus accumbens?
什么是伏隔核？
What roles does it play in healthy brain behavior and in pathology?
它在健康的大脑行为和病理学中发挥什么作用？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
The nucleus accumbens is a part of the brain, part of our reward circuits.
伏隔核是大脑的一部分，是我们奖励回路的一部分。
It has a lot of functions.
它有很多功能。
It interconnects with many parts of the brain.
它与大脑的许多部分相互连接。
So when I started getting interested in reward and what I could do as a surgeon to try to improve how we manage rewards.
因此，当我开始对奖励以及作为一名外科医生我可以做些什么来尝试改善我们管理奖励的方式感兴趣时。
And what I mean by that specifically is if you have an urge for a reward, that's a normal phenomenon.
我的具体意思是，如果你有获得奖励的冲动，这是正常现象。
That's not something we're trying to stop.
这不是我们想要阻止的事情。
The issue is if you have an urge for a reward that either puts you or somebody else at risk, it's probably a reward we shouldn't have.
问题是，如果你急于获得某种奖励，而这会让你或其他人面临风险，那么这可能是我们不应该获得的奖励。
If you're a drug addict and you use heroin or an opiate, that opiate might make you feel better because life is stressful, but the risk of doing those things is really high.
如果您是一名吸毒者，并且使用海洛因或阿片类药物，那么阿片类药物可能会让您感觉好一些，因为生活压力很大，但做这些事情的风险确实很高。
In fact, potentially lethal.
事实上，可能致命。
If you have OCD and you can't sleep at night because you're so nervous that you didn't lock the door, and you've checked 30 times, that's an urge we got to treat.
如果你有强迫症，你晚上睡不着觉，因为你太紧张了，没有锁门，而且你已经检查了 30 次，这就是我们必须治疗的冲动。
Eating disorder is the same.
饮食失调也是一样的。
This problem can be ameliorated or improved upon by a better understanding and a tailored treatment to the nucleus accumbens specifically.
通过更好地了解伏隔核并进行针对性的治疗，可以改善或改善这个问题。
It seems that repeated exposure to something like a drug of abuse or any type of reward that is a really strong reward, in a way, it can hijack normal functioning of the nucleus accumbens.
似乎反复接触滥用药物或任何类型的奖励，这是一种真正强烈的奖励，在某种程度上，它可以劫持伏隔核的正常功能。
So the goal is to just disrupt perhaps what is kind of habitual, or at least this kind of recurring problem that is happening.
因此，我们的目标可能只是打破某种习惯，或者至少打破这种正在发生的反复出现的问题。
People that have binge eating disorder, at least at a severe level, they tend to binge about once a day.
患有暴食症的人，至少在严重程度下，他们往往每天暴食一次。
So what we decided to do in the operating room was to actually try to leverage a tool that we use all the time when we take care of patients with Parkinson's.
因此，我们决定在手术室里做的是实际尝试利用我们在照顾帕金森病患者时一直使用的工具。
So with Parkinson's, a lot of these patients, not all, have tremor.
因此，对于帕金森氏症，很多（不是全部）患者都会出现震颤。
And so when we place an electrode into this motor structure to try to improve their movement disorder, we often can hear tremor cells, and we convert their electrical signal to an audible signal, so we can actually hear it.
因此，当我们将电极放入这个运动结构中以尝试改善他们的运动障碍时，我们经常可以听到震颤细胞的声音，并且我们将它们的电信号转换为可听信号，因此我们实际上可以听到它。
And it sounds kind of like the tremor looks.
听起来有点像颤抖的样子。
The frequency of the signal is the same as the hand shaking.
信号的频率与握手的频率相同。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So it might be .
可能是这样。
Andrew Huberman:
安德鲁·休伯曼：
Exactly.
正是如此。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And you're poking around in a dedicated, careful way, of course.
当然，你会以一种专注、小心的方式四处探索。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
One poke at a time.
一次戳一戳。
Dr. Casey Halpern:
凯西·哈尔彭博士：
One poke at a time with a very fine wire or set of wires, listening to the electrical activity until you encounter some cells that are sending out electrical activity-
用一根或一组非常细的电线一次戳一下，听电活动，直到遇到一些正在发出电活动的细胞——
Andrew Huberman:
安德鲁·休伯曼：
That's right
没错
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
at a similar frequency.
以相似的频率。
Andrew Huberman:
安德鲁·休伯曼：
Exactly.
正是如此。
Dr. Casey Halpern:
凯西·哈尔彭博士：
And then you can stimulate them or quiet them and see if the tremor goes away.
然后你可以刺激它们或让它们安静下来，看看震颤是否消失。
Andrew Huberman:
安德鲁·休伯曼：
So we are very confident that when we stimulate that area of, in this case, the subthalamic nucleus, we will disrupt that tremor circuit and that tremor will dissolve, and it does.
因此，我们非常有信心，当我们刺激该区域（在本例中为丘脑底核）时，我们将破坏该震颤回路，震颤就会消失，而且确实如此。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So what is the analog to tremor in terms of appetite and desire to binge?
那么，就食欲和暴饮暴食的欲望而言，颤抖的类比是什么？
Andrew Huberman:
安德鲁·休伯曼：
Craving.
渴望。
So craving is a term that-- There's probably other terms we could use, by the way, but that's the term we've chosen to use for a number of reasons.
所以，渴望这个术语——顺便说一句，我们可能还可以使用其他术语，但我们出于多种原因选择使用这个术语。
One, because people relate with that term.
一，因为人们与这个词相关。
People that have binge eating disorder or obesity, if you ask them if they crave, the answer will often be yes.
患有暴食症或肥胖症的人，如果你问他们是否渴望，答案通常是肯定的。
If you ask them if they lose control or binge, they might not know what you mean, or they might not actually feel out of control, even when they are.
如果你问他们是否失去控制或暴饮暴食，他们可能不知道你的意思，或者即使他们确实感到失控，他们也可能不会真正感到失控。
But the word craving is relatable, and so we set out to see if we could identify craving cells.
但“渴望”这个词是有相关性的，所以我们开始研究是否可以识别“渴望”细胞。
In a patient with OCD, which is related, in fact, we target a very similar part of the brain, we tried to identify cells related to obsessions, and we believe we did do that.
事实上，在强迫症患者中，我们以大脑中非常相似的部分为目标，试图识别与强迫症相关的细胞，我们相信我们确实做到了。
It was a single case study where we tried to optimize where our electrode was placed.
这是一个单一案例研究，我们试图优化电极的放置位置。
So we had some proof of concept that we would be able to elicit a sort of disease-specific symptom in the operating room, assuming the patient could tolerate being awake.
因此，我们有一些概念证明，假设患者能够忍受清醒，我们将能够在手术室中引发某种特定于疾病的症状。
Not everybody needs to be awake for this procedure, but at least for these first in-human trials where We're trying to establish where in the brain we need to be.
并不是每个人都需要在这个过程中保持清醒，但至少对于这些首次人体试验来说，我们试图确定我们需要在大脑中的哪个位置。
I think this type of approach is really critical.
我认为这种方法非常关键。
Dr. Casey Halpern:
凯西·哈尔彭博士：
As many of you know, I've been taking AG1 for nearly 15 years now.
你们很多人都知道，我服用 AG1 已有近 15 年了。
I discovered it way back in 2012, long before I had a podcast, and I've been taking it every day since.
我早在 2012 年就发现了它，那时我还没有播客，从那时起我就每天都在听它。
AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.
据我所知，AG1 是市场上质量最高、最全面的基础营养补充剂。
It combines vitamins, minerals, prebiotics, probiotics, and adaptogens into a single scoop that's easy to drink and tastes great.
它将维生素、矿物质、益生元、益生菌和适应原结合到一勺中，易于饮用且味道极佳。
It's designed to support things like gut health, immune health, and overall energy, and it does so by helping to fill any gaps that you might have in your daily nutrition.
它旨在支持肠道健康、免疫健康和整体能量等，并通过帮助填补您日常营养中可能存在的任何缺口来实现这一目标。
And of course, we should all eat high-quality whole foods, but most of us are probably not getting enough prebiotics, vitamins, and minerals, and AG1 ensures that those gaps are filled.
当然，我们都应该吃高质量的天然食品，但我们大多数人可能没有摄入足够的益生元、维生素和矿物质，而 AG1 可确保填补这些空白。
If you'd like to try AG1, you can go to drinkag1.com/huberman to get a special offer.
如果您想尝试 AG1，可以访问 Drinkag1.com/huberman 以获得特别优惠。
For a limited time, AG1 is giving away a week's supply of AGZ, which is their sleep supplement, and a free bottle of vitamin D3+K2 with your subscription.
在有限的时间内，AG1 将赠送一周的 AGZ（这是他们的睡眠补充剂），以及一瓶免费的维生素 D3+K2。
AGZ is something that I helped design.
AGZ是我帮忙设计的。
It tastes great, and it's the only sleep supplement I take.
味道很好，也是我唯一服用的睡眠补充剂。
It has a collection of different things in it that has dramatically improved my sleep, both my slow-wave deep sleep and my rapid eye movement sleep, and I absolutely love it.
它里面有一系列不同的东西，极大地改善了我的睡眠，包括我的慢波深度睡眠和快速眼动睡眠，我非常喜欢它。
Again, that's drinkag1.com/huberman to get a week's supply of AGZ and a bottle of D3+K2 with your subscription.
再次强调，通过 Drinkag1.com/huberman 订阅即可获得一周的 AGZ 和一瓶 D3+K2。
What is the status of non-invasive brain stimulation, ablation, and blocking activity in the brain?
非侵入性脑刺激、消融和大脑活动阻断的现状如何？
My understanding is that transcranial magnetic stimulation is being used to treat depression and a number of other brain syndromes non-invasively, so no drilling through the skull.
我的理解是，经颅磁刺激被用于非侵入性地治疗抑郁症和许多其他脑部综合症，因此不需要钻穿颅骨。
My understanding is that the spatial precision isn't that great.
我的理解是空间精度不是那么好。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Ultrasound is something I hear a lot about these days, and my understanding is that ultrasound can allow researchers and clinicians to stimulate specific brain areas.
这些天我经常听到超声波，我的理解是超声波可以让研究人员和临床医生刺激特定的大脑区域。
What are your thoughts on these forms of non-invasive, meaning no flipping open of a piece of the skull, type brain stimulation and blockade of brain activity?
您对这些非侵入性形式（即无需翻开头骨、大脑刺激和大脑活动封锁）有何看法？
Andrew Huberman:
安德鲁·休伯曼：
We need to embrace non-invasive approaches.
我们需要采用非侵入性方法。
Some of them are a little fluffy in that we don't understand how they work.
其中一些有点模糊，因为我们不明白它们是如何工作的。
We don't necessarily understand how deep brain stimulation works, by the way.
顺便说一句，我们不一定了解大脑深层刺激的工作原理。
But because we don't know exactly how they work, they're not as precise as we would like them to be, so we have work to do there.
但因为我们不知道它们到底是如何工作的，所以它们并不像我们希望的那样精确，所以我们还有很多工作要做。
And I actually think that work is doable and actually underway.
我实际上认为这项工作是可行的并且实际上正在进行中。
TMS, transcranial magnetic stimulation, it is FDA approved for depression, by the way.
顺便说一句，TMS，即经颅磁刺激，它已被 FDA 批准用于治疗抑郁症。
It's also FDA approved for OCD and for nicotine addiction.
它还获得 FDA 批准用于治疗强迫症和尼古丁成瘾。
We believe we can use TMS to define a circuit that, if modulated, improves OCD, albeit temporarily.
我们相信我们可以使用 TMS 来定义一个电路，如果对其进行调制，可以改善强迫症，尽管是暂时的。
And in those patients, if it's temporary, they would be appropriate for an invasive study.
对于这些患者，如果这是暂时的，他们将适合进行侵入性研究。
So, something we're actively working on.
所以，我们正在积极努力。
I've always believed that neurosurgeons need to be part of the discussion with these non-invasive approaches.
我一直相信神经外科医生需要参与这些非侵入性方法的讨论。
We don't need to do them.
我们不需要做这些。
But I think we can help make them more precise and to probe non-invasively with purpose.
但我认为我们可以帮助它们变得更加精确，并有目的地进行非侵入性探测。
Perhaps one day there will be a TMS target for anorexia and obesity.
也许有一天，经颅磁刺激（TMS）会成为治疗厌食症和肥胖症的目标。
If we are scratching the surface with invasive approaches to these problems, we're even doing less with the brain stimulation.
如果我们只是用侵入性方法来解决这些问题，那么我们在大脑刺激方面就做得更少了。
So we have so much work to do there.
所以我们在那里还有很多工作要做。
Eating disorders and TMS have been so scarcely studied, or there has been such little research done in that space.
饮食失调和 TMS 的研究很少，或者说在该领域的研究很少。
And so it is an area that we need to work on.
所以这是我们需要努力的一个领域。
So ultrasound right now, transcranial magnetic resonance-guided focused ultrasound.
所以现在的超声波是经颅磁共振引导的聚焦超声波。
So this is an FDA-approved method to deliver an ablation to the brain non-invasively.
因此，这是 FDA 批准的一种非侵入性大脑消融方法。
There are researchers, myself included, that are trying to use transcranial magnetic resonance-guided focused ultrasound or MRI-guided focused ultrasound, to use it in a modulatory way, not just as an ablation, but to drive neuronal activity or inhibit it, perhaps.
包括我在内的一些研究人员正在尝试使用经颅磁共振引导的聚焦超声或 MRI 引导的聚焦超声，以调节的方式使用它，不仅仅是作为消融，而且可能是驱动或抑制神经元活动。
We're still learning how to do that.
我们仍在学习如何做到这一点。
There are trials that are trying to understand if you can use ultrasound to open the blood-brain barrier so you can deliver a medication to that specific area, perhaps for a brain tumor or something like that.
有一些试验试图了解是否可以使用超声波打开血脑屏障，以便将药物输送到特定区域，也许可以治疗脑肿瘤或类似疾病。
So, it's a very exciting field.
所以，这是一个非常令人兴奋的领域。
And it is FDA approved for tremor right now.
目前 FDA 已批准它用于治疗震颤。
And so I actually do it routinely for patients with tremor with Parkinson's or essential tremor.
所以我实际上经常为患有帕金森氏症或特发性震颤的患者做这件事。
And so I love doing it.
所以我喜欢这样做。
It's often just kind of a miracle because there's no incision.
这通常是一个奇迹，因为没有切口。
I don't have to place an electrode into the brain to achieve a similar result.
我不必将电极放入大脑即可获得类似的结果。
It's fabulously effective for these patients.
对于这些患者来说，它非常有效。
It treats patients on one side, usually their dominant hand or their worst hand.
它治疗患者的一侧，通常是他们的优势手或最差的手。
And it really speaks to the fact that, wow, you can deliver, non-invasively, an ablation to the brain in a hypothesized zone that we think is related to the problem at hand.
这确实说明了这样一个事实：哇，您可以在我们认为与当前问题相关的假设区域中对大脑进行非侵入性消融。
And at least with tremor, it works really well.
至少对于颤抖来说，它的效果非常好。
Could this be effective for psychiatric disease, obesity, eating disorders?
这对精神疾病、肥胖、饮食失调有效吗？
Well, perhaps.
嗯，也许吧。
Actually, that would be the ideal.
事实上，这将是理想的情况。
The problem is we don't know where to do the ablation.
问题是我们不知道在哪里进行消融。
There is a trial that we would like to do for OCD, where we would deliver an ablation to the same area of the brain that we've been delivering ablations to for years for patients with OCD, and it helps a bit.
我们想针对强迫症进行一项试验，我们将对强迫症患者的大脑同一区域进行消融，多年来我们一直在对强迫症患者进行消融，这会有所帮助。
That's called a capsulotomy.
这就是所谓的囊切开术。
But really, the outcome is probably going to be about the same.
但实际上，结果可能会大致相同。
It's a nice method because it's non-invasive, but we need to find a new target for these conditions.
这是一个很好的方法，因为它是非侵入性的，但我们需要为这些情况找到一个新的目标。
And because of the common denominator of the urge despite the risk, sort of that compulsion, perhaps it could be the same target.
由于尽管存在风险，但冲动的共同点，某种强迫性，也许它可能是同一个目标。
I don't know.
我不知道。
But I would argue we need to do these modulatory experiments either with a device or with invasive recordings to better understand where these problems are coming from to define where we should do an ultrasound treatment.
但我认为我们需要使用设备或侵入性录音进行这些调节实验，以更好地了解这些问题的根源，从而确定我们应该在哪里进行超声治疗。
There has been a revolution in America, it was in Europe before it was in America, where we would do stereo encephalography, which is basically like doing an EEG Of patients with epilepsy, but with invasive electrodes.
美国发生了一场革命，先是在欧洲，然后在美国，我们会进行立体脑描记术，这基本上就像对癫痫患者进行脑电图检查一样，但是使用侵入性电极。
And we would place tiny little wires, less than a millimeter in diameter, all throughout the brain into parts of the brain that we believe are involved in seizures.
我们会将直径小于一毫米的细小电线遍布整个大脑，插入我们认为与癫痫发作有关的大脑部分。
And we would admit the patients to the hospital and figure out where the seizures were starting and propagating and then we could stimulate these electrodes to see if there was a symptom that was important and try to identify a region that we thought we could either remove surgically, ablate with a laser, or put a stimulator in it, perhaps.
我们会让病人入院，找出癫痫发作在哪里开始和蔓延，然后我们可以刺激这些电极，看看是否有重要的症状，并尝试找出我们认为可以通过手术切除、用激光消融或在其中放置刺激器的区域。
That's commonplace now for epilepsy.
对于癫痫来说，这现在很常见。
And it works extremely well, and it's very safe.
而且它的效果非常好，而且非常安全。
Of course, it's still a brain procedure, but the complication rate is surprisingly low, quite honestly, for the amount of electrodes that we place.
当然，这仍然是一个大脑手术，但老实说，对于我们放置的电极数量来说，并发症发生率出奇地低。
And it's extremely well-tolerated.
而且它的耐受性非常好。
Most of these patients leave the hospital, and they don't even feel like they've had surgery.
大多数患者出院后，他们甚至感觉不到自己做过手术。
So, there's actually a lot of interest in using that procedure to study mental health disorders.
因此，实际上人们对使用该程序来研究心理健康障碍很感兴趣。
We are trying to do it for patients with obsessive-compulsive disorder.
我们正在努力为强迫症患者做到这一点。
We're awaiting an FDA decision on that.
我们正在等待 FDA 对此的决定。
But actually, I credit our colleagues at Baylor and at UCSF for studying this already, bringing together the epilepsy technique and the psychiatry expertise to study how we could better target electrodes in depression.
但实际上，我相信贝勒大学和加州大学旧金山分校的同事已经对此进行了研究，将癫痫技术和精神病学专业知识结合起来，研究如何更好地针对抑郁症使用电极。
And I'll tell you, if they have a consistent target, perhaps there it becomes an ultrasound target.
我会告诉你，如果他们有一个一致的目标，也许它会成为超声波目标。
But right now, the approach is a bit more reversible because you can always shut that electrode off or even remove the electrode if perhaps it's not in the optimal location to treat the depression.
但现在，这种方法更具可逆性，因为如果电极不在治疗抑郁症的最佳位置，您可以随时关闭电极，甚至移除电极。
But actually, after a large volume of cases, perhaps they could pool that data to develop a new ultrasound target for depression.
但实际上，经过大量病例研究后，也许他们可以汇集这些数据来开发治疗抑郁症的新超声目标。
I think that would be fabulous and probably is their long-term goal.
我认为这将是非常棒的，并且可能是他们的长期目标。
Not to speak for them, but that would be something that I'm sure is on their radar.
不是为他们说话，但我确信这会是他们关注的事情。
You might ask, well, why aren't you doing this for obesity right now in our study?
您可能会问，那么，为什么在我们的研究中现在不这样做来治疗肥胖呢？
And the reason is that we've developed a target for obesity and binge eating disorder, developed out of mice, that we believe is relevant for the human state because you can model this problem in a mouse a bit better than you can model depression or OCD.
原因是我们已经在老鼠身上开发出了肥胖和暴食症的目标，我们相信这与人类状态相关，因为你可以在老鼠身上模拟这个问题，比模拟抑郁症或强迫症要好一些。
So we feel like we can rely on the pre-clinical studies more, whereas with these perhaps more, I don't want to say more complicated, but more human mental health conditions that are hard to model in a mouse, you really have to study it in the human, and you can perhaps start in an epileptic patient, a patient that has electrodes, and try to provoke a depressed state or study epileptics that have comorbid depression, for example.
所以我们觉得我们可以更多地依赖临床前研究，而有了这些也许更多，我不想说更复杂，但更人类的心理健康状况，很难在小鼠中建模，你真的必须在人类身上进行研究，你也许可以从癫痫患者开始，有电极的患者，并尝试激发抑郁状态或研究患有抑郁症的癫痫患者。
And that can really validate this approach as well.
这也确实可以验证这种方法。
But in the end, it's getting into the human brain that we need to do in the disease specifically, that will eventually lead to a non-invasive approach, either a lesion or modulatory approach.
但最终，我们需要进入人类大脑来专门治疗这种疾病，这最终将导致一种非侵入性方法，无论是损伤方法还是调节方法。
Modulatory would be like TMS or lesion approach would be with ultrasound.
调节就像 TMS 一样，或者病变方法就像超声波一样。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Perhaps one of the most underestimated but powerful tools to improve your mental health, your physical performance, and your cognitive performance is ensuring you get enough hydration every day.
确保您每天摄入足够的水分，也许是改善您的心理健康、身体表现和认知表现的最被低估但最强大的工具之一。
The unfortunate reality, however, is that tap water often contains contaminants that negatively impact our health.
然而不幸的现实是，自来水通常含有对我们的健康产生负面影响的污染物。
So while we're trying to get great hydration, that can cause serious problems.
因此，当我们努力补充水分时，这可能会导致严重的问题。
In fact, a 2020 study by the Environmental Working Group estimated that more than 200 million Americans are exposed to PFAS chemicals, also known as forever chemicals, through drinking tap water.
事实上，环境工作组 2020 年的一项研究估计，超过 2 亿美国人通过饮用自来水接触到 PFAS 化学物质（也称为永久化学物质）。
These forever chemicals are linked to serious health issues, such as hormone disruption, gut microbiome disruption, fertility issues, and many other health problems, some of which are just now coming to light.
这些永久性化学物质与严重的健康问题有关，例如激素紊乱、肠道微生物组紊乱、生育问题和许多其他健康问题，其中一些问题刚刚被发现。
For all these reasons, I was thrilled when I came across Rorra Water Filters, and now they're a sponsor of this podcast.
出于所有这些原因，当我遇到 Rorra 滤水器时，我感到很兴奋，现在他们是这个播客的赞助商。
Rorra makes what I believe are the best water filters on the market.
我认为 Rorra 制造的是市场上最好的滤水器。
Rorra's filtration technology removes harmful substances, including endocrine disruptors and disinfection byproducts, while preserving beneficial minerals like magnesium and calcium.
Rorra 的过滤技术可去除有害物质，包括内分泌干扰物和消毒副产物，同时保留镁和钙等有益矿物质。
It requires no installation or plumbing, so it's extremely convenient.
它不需要安装或管道，因此非常方便。
It's built from medical-grade stainless steel, and it fits beautifully on your countertop.
它由医用级不锈钢制成，非常适合放在您的台面上。
It's something that you would want to have in your kitchen.
这是您希望在厨房里拥有的东西。
If you'd like to try Rorra, you can go to rorra.com/huberman and get an exclusive discount.
如果您想尝试 Rorra，可以访问 rorra.com/huberman 并获得独家折扣。
Again, that's Rorra, R-O-R-R-A.com/huberman.
再说一次，那是 Rorra，R-O-R-R-A.com/huberman。
If people can be made to feel or make themselves feel just a little bit better, a little less anxious just prior to a craving episode or a binge episode, maybe even if people can become better at detecting their own internal states and when they're veering toward a binge or veering toward using a drug or maybe even veering towards suicidal thinking.
如果可以让人们在渴望发作或暴饮暴食之前感觉或让自己感觉好一点，少一点焦虑，也许即使人们可以更好地检测自己的内部状态，以及何时转向暴饮暴食或转向使用药物，甚至可能转向自杀念头。
Seems like that awareness seems like maybe among the best tools that people could develop.
似乎这种意识可能是人们可以开发的最好工具之一。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
I've always thought that if we could improve awareness, we can improve outcomes.
我一直认为，如果我们能够提高意识，我们就能改善结果。
I think that's probably true for many of these patients.
我认为对于这些患者中的许多人来说可能都是如此。
The problem, I think, comes down to the fact that some of these patients are so resistant to treatment, and the patients that we see as a surgeon, for example, are the patients that they've tried cognitive behavioral therapy, certainly have tried medications, they've tried behavioral management.
我认为，问题归结于这样一个事实：其中一些患者对治疗非常抵触，例如，我们作为外科医生看到的患者是他们尝试过认知行为疗法的患者，当然也尝试过药物治疗，他们尝试过行为管理。
They're as aware as they could possibly be, and they still lose control.
他们尽其所能地意识到，但他们仍然失去控制。
We've had this studied in the lab.
我们已经在实验室对此进行了研究。
So we will bring patients to the laboratory with this implanted device to try to provoke this electrographic electrical signal that can be detected by the actual device that will stimulate them when they're at home.
因此，我们将带着这种植入设备将患者带到实验室，尝试激发这种电描记电信号，该信号可以被实际设备检测到，当他们在家时会刺激他们。
But before we actually initiate stimulation, we want to see, can this device detect this craving cell signal?
但在我们真正开始刺激之前，我们想看看这个设备能否检测到这种渴望细胞信号？
Which is going to be different than what we saw in the operating room because that's a single cell.
这与我们在手术室看到的不同，因为那是一个单细胞。
But these devices, these electrodes are about a millimeter in diameter instead of a tenth of a millimeter, which is what we use in the operating room.
但这些设备、这些电极的直径约为一毫米，而不是我们在手术室使用的十分之一毫米。
So they're only hearing or detecting, I should say, thousands of cells' responses.
所以我应该说，他们只是听到或检测到数千个细胞的反应。
And we actually have a way to provoke binges.
我们实际上有办法引发暴饮暴食。
It's called a mood provocation.
这就是所谓的情绪挑衅。
It's very well validated.
它已经得到很好的验证。
It's a little bit like provoking seizures in the epilepsy monitoring unit.
这有点像在癫痫监测装置中引发癫痫发作。
But here, in these sort of a psychiatric monitoring unit or the food monitoring unit, we actually have a psychiatrist and eating disorder specialist come and induce a mood that is related to each patient's self-described binge episode.
但在这里，在这种精神监测单位或食物监测单位中，我们实际上有一位精神科医生和饮食失调专家来诱导一种与每个患者自我描述的暴饮暴食事件相关的情绪。
Dr. Casey Halpern:
凯西·哈尔彭博士：
So the psychiatrist comes in and provokes-
于是精神科医生进来并挑衅——
Andrew Huberman:
安德鲁·休伯曼：
Yes
是的
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
a feeling that can evoke the negative behavior.
一种可能引发消极行为的感觉。
Andrew Huberman:
安德鲁·休伯曼：
That's exactly right.
完全正确。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Wow.
哇。
Andrew Huberman:
安德鲁·休伯曼：
So that we can video and synchronize the video to the brain signal recordings.
这样我们就可以录像并将视频同步到大脑信号记录中。
The patients all wear an eye tracker so we can see what they're eating at all times and what they're looking at specifically.
患者都戴着眼动仪，这样我们就可以随时看到他们在吃什么以及他们具体在看什么。
And that allows us to have the best temporal resolution possible to understand what is happening right before the bite.
这使我们能够拥有尽可能最佳的时间分辨率，以了解被咬之前发生的情况。
And even under video surveillance through a one-way mirror in a laboratory setting, when patients are very well aware that they're there to be studied if they're going to binge, they still do.
即使在实验室环境中通过单向镜进行视频监控，当患者非常清楚自己是否要暴饮暴食时，他们仍然会暴饮暴食。
And we believe they do because they just can't control it, as aware as they are of it.
我们相信他们这样做是因为他们无法控制它，尽管他们意识到这一点。
And it's probably because they're the most severe.
这可能是因为它们是最严重的。
So I think if we can improve awareness, not just the societal awareness that I was talking about earlier, but the patient awareness around their problem, I think that could be a powerful way to help so many of these patients, and that's sort of the role of cognitive behavioral therapy.
所以我认为，如果我们能够提高意识，不仅仅是我之前谈到的社会意识，而是患者对其问题的意识，我认为这可能是帮助这么多患者的有效方法，这就是认知行为疗法的作用。
The problem with cognitive behavioral therapy, or I should say the limitation of it, I actually don't have any problem with it, I think it's a wonderful treatment, is that if you stop it, many of these patients go back to their old behaviors.
认知行为疗法的问题，或者我应该说它的局限性，实际上我对它没有任何问题，我认为这是一种很棒的治疗方法，就是如果你停止它，许多患者会回到原来的行为。
I don't want to say old habits, but it might be a habit, but the old behaviors.
我不想说旧习惯，但这可能是一种习惯，而是旧行为。
And so that's the problem is it's not necessarily lasting in the absence of continued cognitive behavioral therapy.
所以问题是，如果没有持续的认知行为治疗，它不一定会持久。
Some people can benefit from it long-term, but some can't.
有些人可以长期受益，但有些人则不能。
But I think in the less severe patients, improving awareness is key.
但我认为对于病情不太严重的患者，提高意识是关键。
But in these really refractory patients, this is the disease.
但在这些真正难治的患者中，这就是疾病。
Despite the awareness, they can't control themselves.
尽管他们有意识，但他们无法控制自己。
And that's what we're trying to restore, is that improved ability to control their behavior.
这就是我们试图恢复的，就是提高控制他们行为的能力。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Do you think there's a role for machines and artificial intelligence here?
您认为机器和人工智能在这里能发挥作用吗？
There are a couple laboratories up at the University of Washington that are using particular signature patterns within voice to try and help people who are suicidally depressed know when they're headed towards an episode before they even can consciously know.
华盛顿大学有几个实验室正在使用声音中的特定特征模式来尝试帮助那些有自杀倾向的抑郁症患者在他们有意识地知道之前就知道他们何时会陷入困境。
So this gets right down to issues of free will and whether or not machines can be-
所以这直接归结为自由意志的问题以及机器是否可以-
Andrew Huberman:
安德鲁·休伯曼：
Yes
是的
Dr. Casey Halpern:
凯西·哈尔彭博士：
...
...
smarter than we are.
比我们聪明。
But one could argue that some of the search algorithms on Google and other search engines are actually more aware of our preferences than we are.
但有人可能会说，谷歌和其他搜索引擎上的一些搜索算法实际上比我们更了解我们的偏好。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Basically, what these are, these are devices that are listening to people talk all day.
基本上，这些是什么，这些是整天听人们说话的设备。
They're also paying attention to patterns of breathing and how well people slept, et cetera.
他们还关注呼吸模式和人们的睡眠质量等等。
Integrating a huge number of cues and then signaling somebody with a yellow light.
整合大量线索，然后用黄灯向某人发出信号。
Like, you're headed into a depressive episode, and the person might say, "I feel fine," or, "I feel pretty good.
就像，你正陷入抑郁期，这个人可能会说，“我感觉很好”，或者“我感觉很好。
This is kind of baseline state for me." And they say, "Uh-uh.
这对我来说是一种基线状态。”他们说：“呃呃。
This is where you were preceding the last episode that took you down a deep, dark trench, and it took months to get out of."
这就是你在最后一集之前的地方，它把你带入了一条又深又黑的沟渠，花了几个月的时间才摆脱出来。”
Andrew Huberman:
安德鲁·休伯曼：
Yep.
是的。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I wonder whether or not some of these devices could help with the sorts of things that we're talking about today.
我想知道其中一些设备是否可以帮助解决我们今天讨论的各种问题。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I think so.
我想是的。
I've always said we have to get in the brain before we get out of it.
我总是说我们必须先进入大脑，然后才能离开它。
And if we get in the brain and understand what these signals look like, we'll know what those non-invasive signals are.
如果我们进入大脑并了解这些信号是什么样子，我们就会知道那些非侵入性信号是什么。
I think it's possible that we are scientifically sophisticated enough to use machine learning and sort of this kind of bot technique to anticipate when somebody is going to be highly impulsive.
我认为我们在科学上可能足够复杂，可以使用机器学习和某种机器人技术来预测某人何时会高度冲动。
Suicide is the most dangerous impulse.
自杀是最危险的冲动。
It's something that is immensely a focus of the lab is impulsivity.
实验室非常关注的焦点是冲动。
We've talked mostly about compulsion.
我们主要讨论的是强迫症。
Compulsion being going after a reward or the urge despite the risk.
强迫性地追求奖励或不顾风险的冲动。
Impulsivity is similar but different.
冲动相似但又不同。
It's kind of going after something a little bit-- If you model impulsivity in a mouse, it's related to going after a food reward without the sort of paired tone that the mouse is supposed to wait for.
这有点像追求某种东西——如果你模拟老鼠的冲动，它与追求食物奖励有关，而没有老鼠应该等待的那种配对音调。
The mouse doesn't want to wait anymore.
老鼠不想再等了。
They just go after the food.
他们只是追求食物。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I've been that mouse.
我就是那只老鼠。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, we all have been.
是的，我们都经历过。
We can all relate with this to a certain extent.
我们都可以在某种程度上理解这一点。
Again, it's a spectrum.
再说一次，它是一个频谱。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
So in any case, a non sequitur, but I certainly think that there is a way to use our own body's physiology to anticipate when these impulses are coming online.
所以无论如何，这是不合逻辑的，但我当然认为有一种方法可以利用我们自己身体的生理机能来预测这些冲动何时出现。
How best to do that, I think we're just scratching the surface, but these are the kinds of solutions we need.
如何最好地做到这一点，我认为我们只是触及了表面，但这些正是我们需要的解决方案。
Some of these problems are of epidemic proportions, largest public health problems in this country, in this world, obesity, opiate crisis, depression-
其中一些问题是流行病，是这个国家、这个世界上最大的公共卫生问题，肥胖、鸦片危机、抑郁症——
Dr. Casey Halpern:
凯西·哈尔彭博士：
Oh, my goodness
哦，我的天哪
Andrew Huberman:
安德鲁·休伯曼：
...
...
suicidality.
自杀倾向。
That's like a third of our country, maybe more.
这相当于我们国家的三分之一，甚至更多。
We need scalable solutions.
我们需要可扩展的解决方案。
But I'm a neurosurgeon.
但我是一名神经外科医生。
I'm only going to be able to treat the most severe of patients with these problems.
我只能治疗患有这些问题的最严重的患者。
We've only done about 200,000 deep brain stimulation surgeries ever.
我们迄今为止只做过大约 20 万例脑深部刺激手术。
So the problem we're talking about here is 50 million Americans?
那么我们这里讨论的问题是5000万美国人？
There's no possibility that surgeons can address that problem.
外科医生不可能解决这个问题。
But we could help inspire an initiative to go after that kind of problem, or help make it more rigorous.
但我们可以帮助激发解决此类问题的主动性，或者帮助使其更加严格。
Because the last thing we need is some sort of wearable fancy tool that wastes people's money and time.
因为我们最不需要的就是某种浪费人们金钱和时间的可穿戴奇特工具。
We need real therapies for these things.
我们需要针对这些事情的真正疗法。
Not that these devices that we're discussing are not.
但这并不是说我们正在讨论的这些设备不是。
I think actually there's lots of promise.
我认为实际上有很多希望。
We use machine learning in the lab all the time.
我们一直在实验室中使用机器学习。
I'm not an electrical engineer or the computational neuroscientist doing this type of work.
我不是从事此类工作的电气工程师或计算神经科学家。
I just help develop the hypotheses around it, and help fundraise around it.
我只是帮助围绕它提出假设，并帮助围绕它筹集资金。
But I definitely think there's a future for it.
但我绝对认为它有未来。
I suspect we're scratching the surface on how best to do it.
我怀疑我们只是在探讨如何最好地做到这一点。
Dr. Casey Halpern:
凯西·哈尔彭博士：
I really appreciate you sharing those tools.
我真的很感谢您分享这些工具。
A number of people, I'm guessing out there, might want to become neurosurgeons.
我猜想很多人可能想成为神经外科医生。
I really believe that in hearing today's conversation that you will spark an interest in medicine and/or neurosurgery.
我真的相信，在听到今天的谈话时，您会激发对医学和/或神经外科的兴趣。
Andrew Huberman:
安德鲁·休伯曼：
I hope so.
我希望如此。
Dr. Casey Halpern:
凯西·哈尔彭博士：
Well, certainly you need to be a physician before you can become a neurosurgeon.
嗯，当然，在成为神经外科医生之前，你需要先成为一名医生。
So and neurosurgery in some cases, and that would be beautiful, and I predict that will happen as a consequence of what you've shared today.
因此，在某些情况下进行神经外科手术，这将是美好的，我预测这将是您今天分享的结果的结果。
Really want to thank you for taking time out of your not just immensely busy, but very important schedule, because, again, the work that you're doing is really out there on that cutting, I don't want to say bleeding edge, because in this context, it's not going to sound right, but on that extreme cutting edge of what we understand about how the human brain works and how it can be repaired.
真的要感谢你从非常忙碌而且非常重要的日程中抽出时间，因为，再说一次，你所做的工作确实是在那个切割上，我不想说尖端，因为在这种情况下，它听起来不太正确，但在我们对人类大脑如何工作和如何修复的理解的极端前沿。
So on behalf of everybody and myself as well, thank you so very much.
我谨代表大家和我自己，非常感谢你们。
Andrew Huberman:
安德鲁·休伯曼：
I'm honored.
我很荣幸。
Thank you so much for having me.
非常感谢你邀请我。
Speaker 3:
演讲者3：
Saying how you feel out loud is terrifying, but that's what Hinge's new free audiobook, "No Ordinary Love," is all about.
大声说出你的感受是很可怕的，但这就是 Hinge 的新免费有声读物“No Ordinary Love”的全部内容。
It's a collection of real love stories about five couples that met on Hinge.
这是一本关于五对在 Hinge 上相识的情侣的真实爱情故事的合集。
The stories are written and read by Tembi Dinton-Hurst, Nicola Dinan, Curtis Garner, Raven Smith, and Ruthie Thorpe.
这些故事由坦比·丁顿-赫斯特、尼古拉·迪南、柯蒂斯·加纳、雷文·史密斯和露丝·索普撰写和朗读。
I, Hunter Harris, wrote and read the foreword.
我，亨特·哈里斯，撰写并阅读了前言。
The audiobook's out now.
有声读物现在已经出来了。
Give it a listen.
听一下。