The Touch of Madness

Feature stories, read aloud: Download the Audm app for your iPhone.

精选故事，大声朗读：下载适用于您 iPhone 的 Audm 应用程序。

By the time Nev Jones entered DePaul University’s esteemed doctoral program in philosophy, she had aced virtually every course she ever took, studied five languages and become proficient in three, and seemed to have read and memorized pretty much everything.

当内夫·琼斯进入德保罗大学受人尊敬的哲学博士课程时，她几乎已经完成了她所学过的所有课程，学习了五种语言并精通三种语言，并且似乎已经阅读并记住了几乎所有内容。

Small and slightly built, with a commanding presence that emerged when she talked, she was the sort of student that sharp teachers quickly notice and long remember: intellectually voracious , relentlessly curious, endlessly capable, and, as one of her high school teachers put it, “magnificently intense.” Her mind drew on a well-stocked, seemingly flawless memory with a probing, synthesizing intelligence.

她身材娇小，身材瘦小，说话时散发出一种威严的气息，她是那种让敏锐的老师很快就会注意到并长期记住的学生：求知欲强、好奇心旺盛、能力无穷，而且正如她的一位高中老师所说，“非常热情”。她的大脑利用了丰富的、看似完美的记忆力和探索性、综合性的智慧。

With astounding frequency she produced what one doctoral classmate called “genius-level reflections.”

她以惊人的频率产生了一位博士同学所说的“天才级的反思”。

So Jones grew alarmed when, soon after starting at DePaul in the fall of 2007, at age 27, she began having trouble retaining things she had just read.

因此，2007 年秋天，27 岁的琼斯在德保罗开始学习后不久，她开始难以记住刚刚读过的东西，这让她感到震惊。

She also struggled to memorize the new characters she was learning in her advanced Chinese class.

她还很难记住在高级汉语课上学到的新汉字。

She had experienced milder versions of these cognitive and memory blips a couple times before, most recently as she’d finished her undergraduate studies earlier that year.

她之前曾经历过几次较温和的认知和记忆障碍，最近一次是在她当年早​​些时候完成本科学业时。

These new mental glitches were worse.

这些新的心理问题更加严重。

She would study and draw the new logograms one night, then come up short when she tried to draw them again the next morning.

她会在晚上学习并绘制新的语标，然后在第二天早上再次尝试绘制它们时却出现了问题。

These failures felt vaguely neurological.

这些失败感觉有点神经病。

As if her synapses had clogged.

好像她的突触被堵塞了。

She initially blamed them on the sleepless, near-manic excitement of finally being where she wanted to be .

她最初将他们归咎于终于到达她想去的地方时的失眠、近乎狂躁的兴奋。

She had wished for exactly this, serious philosophy and nothing but, for half her life.

她半辈子都渴望得到这种严肃的哲学，除此之外什么也没有。

Now her mind seemed to be failing.

现在她的脑子似乎有些不灵了。

Words started to look strange.

言语开始显得奇怪。

She began experiencing “inarticulable atmospheric changes,” as she put it—not hallucinations, really, but alterations of temporality, spatiality, depth perception, kinesthetics.

正如她所说，她开始经历“无法形容的大气变化”——实际上不是幻觉，而是时间性、空间性、深度知觉和动觉的改变。

Shimmerings in reality’s fabric.

在现实的织物中闪闪发光。

Sidewalks would feel soft and porous.

人行道会感觉柔软且多孔。

Audio and visual input would fall out of sync, creating a lag between the movement of a speaker’s lips and the words’ arrival at Jones’ ears.

音频和视觉输入会不同步，从而在说话者嘴唇的运动和单词到达琼斯耳朵之间产生滞后。

Something was off .

Something was off .

“You look at your hand,” as she described it to me later, holding hers up and examining it front and back, “and it looks the same as always.

“你看看你的手，”她后来向我描述道，举起自己的手，前后检查，“它看起来和平常一样。

But it’s not.

但事实并非如此。

It’s yours—but it’s not.

它是你的——但它不是。

Nothing has changed”—she let her hand drop to her knee—”yet it’s different.

一切都没有改变”——她把手放到膝盖上——“但情况有所不同。

And that’s what gets you.

这就是你的目标。

There’s nothing to notice; but you can’t help but notice.”

没有什么需要注意的；但你会情不自禁地注意到。”

Another time she found herself staring at the stone wall of a building on campus and realizing that the wall’s thick stone possessed two contradictory states.

还有一次，她发现自己盯着校园一栋建筑的石墙，发现这堵厚厚的石头有着两种矛盾的状态。

She recognized that the wall was immovable and that, if she punched it, she’d break her hand.

She recognized that the wall was immovable and that, if she punched it, she’d break her hand.

Yet she also perceived that the stone was merely a constellation of atomic particles so tenuously bound that, if she blew on it, it would come apart.

然而她也意识到，这块石头只是一个由原子粒子组成的星座，它们的结合非常脆弱，如果她对它吹气，它就会四分五裂。

She experienced this viscerally.

她内心深处经历过这一点。

She felt the emptiness within the stone.

她感觉到石头内部一片空虚。

Initially she found these anomalies less threatening than weird.

Initially she found these anomalies less threatening than weird.

But as they intensified, the gap between what she was perceiving and what she could understand rationally generated an unbearable cognitive dissonance.

但随着它们的加剧，她的感知与理性理解之间的差距产生了难以忍受的认知失调。

How could something feel so wrong but she couldn’t say what?

How could something feel so wrong but she couldn’t say what?

She had read up the wazoo about perception, phenomenology, subjectivity, consciousness.

She had read up the wazoo about perception, phenomenology, subjectivity, consciousness.

She of all people should be able to articulate what she was experiencing.

She of all people should be able to articulate what she was experiencing.

Yet she could not.

Yet she could not.

“Language had betrayed me,” she says.

“语言背叛了我，”她说。

“There was nothing you could point to and say, ‘This looks different about the world .’ There were no terms.

“There was nothing you could point to and say, ‘This looks different about the world .’ There were no terms.

I had no fucking idea .”

我他妈的根本不知道。”

Too much space was opening within and around and below her.

Too much space was opening within and around and below her.

She worried she was going mad.

她担心自己要疯了。

She had seen what madness looked like from the outside.

She had seen what madness looked like from the outside.

When Jones was in her teens, one of her close relatives, an adult she’d always seen frequently, and whom we’ll call Alex for privacy reasons, had in early middle age fallen into a state of almost relentless schizophrenia.

当琼斯十几岁的时候，她的一位近亲，一位她经常见到的成年人，出于隐私原因我们称他为亚历克斯，在中年初期陷入了一种几乎无情的精神分裂症状态。

It transformed Alex from a warm, caring, and open person who was fully engaged with the world into somebody who was isolated from it—somebody who seemed remote, behaved in confusing and alarming ways, and periodically required hospitalization.

它使亚历克斯从一个热情、有爱心、开放、完全融入世界的人变成了一个与世界隔绝的人——一个看起来很冷漠、行为方式令人困惑和令人震惊、并且定期需要住院治疗的人。

Jones now started to worry this might be happening to her.

Jones now started to worry this might be happening to her.

Jones already knew more about madness than most people do.

Jones already knew more about madness than most people do.

In the house where she grew up, in Boise, Idaho, in the early 1990s, she liked to sit in the book-lined living room and read.

In the house where she grew up, in Boise, Idaho, in the early 1990s, she liked to sit in the book-lined living room and read.

And even early on, when she was just 12 or 13, she took a special interest in the extensive library of books on philosophy and madness—deckle-edged volumes bought decades before and then left there by her mother’s first husband, a brilliant philosophy scholar who had become deeply psychotic and was institutionalized with a diagnosis of schizophrenia.

甚至在很早的时候，当她只有 12 或 13 岁的时候，她就对图书馆里大量关于哲学和疯狂的书籍特别感兴趣——这些书是她母亲的第一任丈夫几十年前买的，然后留在了那里。

That had all happened before Jones was born.

这一切都发生在琼斯出生之前。

Now, as an adolescent, she would sit for hours reading this man’s books: Camus and Sartre at first, some Hesse on the side, then, as a high schooler, Plato, Kant, Hegel, Nietzsche.

现在，作为一个青少年，她会花几个小时阅读这个人的书：一开始是加缪和萨特，旁边是一些黑塞，然后，作为一个高中生，柏拉图、康德、黑格尔、尼采。

Reading philosophy helped Jones think.

阅读哲学有助于琼斯思考。

It helped order the disorderly.

它有助于秩序混乱。

Yet later, in college, she lit up when she discovered the writers who laid the philosophical foundation for late 20-century critical psychiatry and madness studies: Michel Foucault, for instance, who wrote about how Western culture, by medicalizing madness , brands the mad as strangers to human nature.

然而后来，在大学里，当她发现那些为 20 世纪末批判精神病学和疯狂研究奠定了哲学基础的作家时，她眼前一亮：例如，米歇尔·福柯 (Michel Foucault) 写到，西方文化如何通过医学化疯狂，将疯狂的人视为人性的陌生人。

Foucault described both the process and the alienating effect of this exclusion-by-definition, or “othering,” as it soon came to be known, and how the mad were cut out and cast away, flung into pits of despair and confusion, leaving ghosts of their presence behind.

福柯描述了这种定义上的排斥或很快为人所知的“他者”的过程和疏远效果，以及疯子如何被排除和抛弃，被扔进绝望和混乱的深渊，留下他们存在的幽灵。

To Jones, philosophy, not medicine, best explained the reverberations from the madness that had touched her family: the disappearance of the ex-husband; the alienation of Alex, who at times seemed “there but not there,” unreachable.

对琼斯来说，哲学，而不是医学，最能解释她家人的疯狂所带来的影响：前夫的失踪； the alienation of Alex, who at times seemed “there but not there,” unreachable.

Jones today describes the madness in and around her family as a koan, a puzzle that teaches by its resistance to solution, and which forces upon her the question of how to speak for those who may not be able to speak for themselves.

琼斯今天将她家庭内部和周围的疯狂描述为一个公案，一个通过抵制解决来教导的谜题，这迫使她思考如何为那些可能无法为自己说话的人说话的问题。

Jones has since made a larger version of this question—of how we think of and treat the mad, and why in the West we usually shunt them aside —her life’s work.

此后，琼斯对这个问题提出了一个更大的版本——我们如何看待和对待疯子，以及为什么在西方我们通常将他们放在一边——这是她一生的工作。

Most of this work radiates from a single idea: Culture shapes the experience, expression, and outcome of madness.

Most of this work radiates from a single idea: Culture shapes the experience, expression, and outcome of madness.

The idea is not that culture makes one mad.

这个想法并不是文化让人发疯。

It’s that culture profoundly influences every aspect about how madness develops and expresses itself, from its onset to its full-blown state, from how the afflicted experience it to how others respond to it, whether it destroys you or leaves you whole.

文化深刻地影响着疯狂如何发展和表达的各个方面，从它的开始到它的全面发展，从受苦的人如何经历它到其他人如何回应它，无论它摧毁你还是让你完整。

This idea is not original to Jones.

这个想法并非琼斯原创。

It rose from the observation, first made at least a century ago and well-documented now, that Western cultures tend to send the afflicted into a downward spiral rarely seen in less modernized cultures .

它源于至少一个世纪前首次提出、现在已被充分记录的观察，即西方文化倾向于将受苦者送入在不太现代化的文化中罕见的螺旋式下降。

Schizophrenia actually has a poorer prognosis for people in the West than for those in less urbanized, non-Eurocentric societies .

Schizophrenia actually has a poorer prognosis for people in the West than for those in less urbanized, non-Eurocentric societies .

When the director of the World Health Organization’s mental-health unit, Shekhar Saxena, was asked last year where he’d prefer to be if he were diagnosed with schizophrenia, he said for big cities he’d prefer a city in Ethiopia or Sri Lanka, like Colombo or Addis Ababa, rather than New York or London, because in the former he could expect to be seen as a productive if eccentric citizen rather than a reject and an outcast.

去年，当世界卫生组织心理健康部门主任谢卡尔·萨克塞纳（Shekhar Saxena）被问到，如果被诊断出患有精神分裂症时，他更愿意去哪里时，他说，对于大城市，他更喜欢埃塞俄比亚或斯里兰卡的城市，比如科伦坡或亚的斯亚贝巴，而不是纽约或伦敦，因为在前者，他可能会被视为一个富有成效但古怪的公民，而不是一个拒绝和被遗弃的人。

Over the past 25 years or so, the study of culture’s effect on schizophrenia has received increasing attention from philosophers, historians, psychiatrists, anthropologists, and epidemiologists, and it is now edging into the mainstream.

过去25年左右，文化对精神分裂症影响的研究越来越受到哲学家、历史学家、精神病学家、人类学家和流行病学家的关注，现已逐渐成为主流。

In the past five years, Nev Jones has made herself one of this view’s most forceful proponents and one of the most effective advocates for changing how Western culture and psychiatry respond to people with psychosis .

在过去的五年里，内夫·琼斯使自己成为这一观点最有力的支持者之一，也是改变西方文化和精神病学对精神病患者的反应的最有效的倡导者之一。

While still a graduate student at DePaul she founded three different groups to help students with psychosis continue their studies.

当她还是德保罗大学的研究生时，她成立了三个不同的团体来帮助患有精神病的学生继续学业。

After graduating in 2014, she expanded her reach first into the highest halls of academe, as a scholar at Stanford University, and then into policy, working with state and private agencies in California and elsewhere on programs for people with psychosis, and with federal agencies to produce toolkits for universities, students, and families about dealing with psychosis emerging during college or graduate study.

2014 年毕业后，她首先以斯坦福大学学者的身份进入学术界的最高层，然后进入政策领域，与加利福尼亚州和其他地方的州和私人机构合作开展针对精神病患者的项目，并与联邦机构合作为大学、学生和家庭制作应对大学或研究生学习期间出现的精神病的工具包。

Now in a new position as an assistant professor at the University of South Florida, she continues to examine—and ask the rest of us to see—how culture shapes madness.

现在，她担任南佛罗里达大学助理教授的新职位，继续研究并要求我们其他人看看文化如何塑造疯狂。

In the United States, the culture’s initial reaction to a person’s first psychotic episode, embedded most officially in a medical system that sees psychosis and schizophrenia as essentially biological, tends to cut the person off instantly from friends, social networks, work, and their sense of identity.

在美国，文化对一个人第一次精神病发作的最初反应，最正式地嵌入到将精神病和精神分裂症视为本质上的生物学的医疗系统中，往往会立即切断该人与朋友、社交网络、工作和身份感的联系。

This harm can be greatly reduced , however, when a person’s first care comes from the kind of comprehensive, early intervention programs, or EIPs, that Jones works on.

然而，当一个人的首要护理来自琼斯所从事的那种全面的早期干预计划（EIP）时，这种伤害可以大大减少。

These programs emphasize truly early intervention, rather than the usual months-long lag between first symptoms and any help; high, sustained levels of social, educational, and vocational support; and building on the person’s experience, ambitions, and strengths to keep them as functional and engaged as possible.

These programs emphasize truly early intervention, rather than the usual months-long lag between first symptoms and any help; high, sustained levels of social, educational, and vocational support;并以个人的经验、抱负和优势为基础，让他们尽可能发挥作用并参与其中。

Compared to treatment as usual, EIPs lead to markedly better outcomes across the board, create more independence, and seem to create far less trauma for patients and their family and social circles.

与通常的治疗相比，EIP 可以带来明显更好的全面治疗结果，创造更多的独立性，并且似乎给患者及其家人和社交圈造成的创伤要少得多。

Recommendations From Nev Jones : A good resource for finding psychosis treatment programs in your area .

Nev Jones 的建议：这是寻找您所在地区精神病治疗方案的良好资源。

Work on such programs is especially important right now, as officials of the U.S. mental health-care system , responding to protocols and incentives established by the federal government under the Obama administration, have rushed to change their standard response to first episodes of psychosis.

目前，此类项目的工作尤其重要，因为美国精神卫生保健系统的官员为了响应奥巴马政府领导下的联邦政府制定的协议和激励措施，已急于改变他们对首次精神病发作的标准反应。

Jones stands to wield a transformative influence on these efforts, both directly through her work at USF and indirectly through her growing renown.

琼斯将直接通过她在南佛罗里达大学的工作和间接通过她日益增长的声誉对这些努力产生变革性的影响。

Jones talks to anyone she can about why and how we should change our response to the mad.

琼斯与任何人谈论我们为什么以及如何改变我们对疯子的反应。

In the past five years she has talked to thousands of individuals touched by madness, scores of public, academic, and policy audiences, and policymakers and mental-health program designers both abroad and all over the U.S., from tiny Vermont non-profits to the City of Los Angeles.

在过去的五年里，她与国外和美国各地的数千名被疯狂感动的人、数十名公众、学术和政策受众、政策制定者和心理健康项目设计者进行了交谈，从佛蒙特州的小型非营利组织到洛杉矶市。

Her push to change the wider culture is working.

她推动改变更广泛文化的努力正在发挥作用。

As clinical psychologist Vaughan Bell, of University College, London, and London’s famed Maudsley Hospital, puts it, “She is shaking things up.”

正如伦敦大学学院和伦敦著名的莫兹利医院的临床心理学家沃恩·贝尔所说，“她正在改变一切。”

Bell, who met Jones when she gave a series of talks in the United Kingdom in 2012, is one of many who feel Jones brings something unique to the forces of reform.

贝尔于 2012 年在英国进行一系列演讲时认识了琼斯，贝尔是众多认为琼斯为改革力量带来了独特东西的人之一。

To hear Jones talk, whether to a crowd or one-on-one, is to understand why.

聆听琼斯的演讲，无论是对人群还是一对一的演讲，都可以理解其中的原因。

When she speaks you get all of her.

当她说话的时候，你就得到了她的全部。

She leans forward, she locks her eyes on yours in seemingly unbreakable contact, she bores into your thoughts.

她向前倾身，用看似牢不可破的接触将目光锁定在你的身上，她深入你的思绪。

She gestures almost constantly.

她几乎不停地打手势。

Sometimes she holds both palms up, as in an open plea.

有时她会举起双手，就像公开恳求一样。

More often she holds her left hand out, as if offering the audience something, while her right, closed as if holding a pen or a conductor’s baton, drives the point gently but persistently home.

更多时候，她伸出左手，仿佛在向观众提供什么，而她的右手则紧握，仿佛握着一支钢笔或指挥棒，轻轻而持久地表达要点。

Sometimes she enters a preacherly rhythm.

有时她会进入一种传教的节奏。

“What would it look like ,” she asks, “if we focused on the social obstacles people face, instead of just their symptoms?

她问道：“如果我们关注人们面临的社交障碍，而不仅仅是他们的症状，那会是什么样子？

How would it change things if we put people through school instead of telling them to settle for jobs shelving books?

如果我们让人们完成学业而不是让他们满足于书架上的工作，这会如何改变事情？

What if we listened to what it feels like to be mad , instead of telling people their experiences are just sound and fury meaning nothing?”

如果我们倾听生气的感觉，而不是告诉人们他们的经历只是喧哗和愤怒，毫无意义，会怎么样？”

In the first years of her speaking and advocacy, Jones sometimes came on too strong.

在她演讲和倡导的最初几年，琼斯有时显得过于强势。

She could press so hard that people pulled back.

她可以用很大的力气让人们退缩。

She’s learned to speak directly in ways flattering to those she seeks to reach.

她学会了以讨好她想要接触的人的方式直接说话。

“It’s difficult to be critical but not alienating,” she’ll tell an audience.

“批评但不疏远是很困难的，”她告诉观众。

“It’s difficult to be ambitious but realistic.” Then she’ll tell them, in so many words, that they must change their thinking.

“雄心勃勃但现实困难。”然后她会用很多话告诉他们必须改变想法。

“Nev has a way of saying things,” says Cherise Rosen, a leader in first-episode psychosis response who collaborates with Jones and often sees her speak, “that gets people to see psychosis and schizophrenia in a new way.

“内夫有一种说话的方式，”首发精神病反应的领导者切丽丝·罗森（Cherise Rosen）说，她与琼斯合作，经常看到她说话，“这让人们以一种新的方式看待精神病和精神分裂症。

I’ve seen her pose questions that just stop a room for a moment—and then everyone is working around a new idea.”

我见过她提出的问题让整个房间暂时停了下来，然后每个人都在讨论一个新想法。”

Jones stands out because she so effectively represents two things.

琼斯之所以脱颖而出，是因为她有效地代表了两件事。

First, she conveys, as few do, the fullness and urgency of the intellectual and evidence-based arguments for change.

首先，她像很少有人那样表达了基于知识和证据的变革论点的完整性和紧迫性。

And second, she makes uniquely vivid the human stakes involved, both in the destruction of people’s lives—to say nothing of their suffering—and in what the rest of us lose when culture casts them aside .

其次，她以独特的方式生动地描绘了所涉及的人类利害关系，既包括人们生命的毁灭（更不用说他们的痛苦），也包括当文化将他们抛在一边时我们其他人所失去的东西。

For it happens that Jones herself was once deemed unreachable and flung into her own pit of despair.

因为琼斯本人曾经被认为是遥不可及的，并被扔进了自己的绝望深渊。

She re-emerged only because she found a therapist who listened, and a few strands of culture she wove into a lifeline.

她重新出现只是因为她找到了一位愿意倾听的治疗师，并且她将一些文化编织成了生命线。

Jones set out for DePaul in August of 2007, looking forward to a fresh new chapter.

2007 年 8 月，琼斯出发前往德保罗，期待开启新的篇章。

She hoped to free herself of snags and burdens that had long tugged at her.

她希望摆脱长期以来困扰她的障碍和负担。

Her life to that point had been one of singular scholastic accomplishment, but in retrospect she sees that the traces and echoes of madness in her family gnawed at her: the pregnant absence implied by all those books; the debilities and isolation suffered by her relative Alex.

迄今为止，她的一生在学术上取得了非凡的成就，但回想起来，她发现家庭中疯狂的痕迹和回声不断折磨着她：所有这些书所暗示的怀孕的缺席；她的亲戚亚历克斯所遭受的虚弱和孤立。

When Jones was 17, her mother, wanting to leave parts of her own life behind, decided to move to Virginia.

琼斯 17 岁时，她的母亲想把自己生活的一部分抛在脑后，决定搬到弗吉尼亚州。

Jones decided she’d pass and moved instead to Buffalo to finish high school.

琼斯决定通过考试，并搬到布法罗完成高中学业。

Her housing fell through though, so she spent her senior year moving from one tenuous living situation to another.

然而，她的住房破裂了，所以她在大四的时候从一种脆弱的生活环境搬到了另一种生活环境。

She won a full scholarship to Cornell University anyway.

无论如何，她获得了康奈尔大学的全额奖学金。

But the rough year threw her off.

但艰难的一年让她失望了。

Realizing she wanted something more real than school, she got a year’s deferral and joined an obscure non-profit she’d read about.

意识到自己想要比学校更真实的东西，她得到了一年的延期，并加入了她读到的一个不起眼的非营利组织。

The work, helping low-caste “untouchables” living through civil war in Nepal, proved dangerous and all too real; she saw a young man shot dead on the street, witnessed forced child marriages, and regularly walked past a prisoner’s camp from which she could hear screams of the tortured.

这项工作旨在帮助低种姓“贱民”度过尼泊尔内战，但事实证明它既危险又真实。她看到一名年轻人在街上被枪杀，目睹了强迫童婚，并经常路过一个战俘营，在那里她可以听到受酷刑者的尖叫声。

Eventually she scraped together enough cash to flee to Japan, where, penniless and sick with parasites, she headed for a Zen monastery she’d read about.

最终，她凑够了钱逃到了日本，身无分文，又患有寄生虫病，她前往她读到的一座禅寺。

Once there, she found she liked sitting in meditation.

到达那里后，她发现自己喜欢静坐冥想。

It cleared the mind.

It cleared the mind.

Time disappeared.

Time disappeared.

Winter passed.

Winter passed.

Spring arrived.

Spring arrived.

Blossoms bloomed.

Blossoms bloomed.

July came.

July came.

She was due at Cornell a few weeks later.

几周后她就到了康奈尔大学。

She sat and wrote Cornell a letter informing the school that she had decided to become a zenni —a Zen nun, essentially—and because not even Cornell could offer so high a calling, it needn’t hold her space any longer.

她坐下来给康奈尔大学写了一封信，通知学校她已经决定成为一名禅尼（zenni）——本质上是一名禅宗尼姑——而且因为即使是康奈尔大学也无法提供如此崇高的使命，它不再需要为她保留空间。

(“I wish I had a copy of that letter,” she says now, “because, God, the youthful arrogance.”) A dim, badly focused print shows her eventual ordination more than a year later.

（“我希望我有那封信的副本，”她现在说道，“因为，天啊，年轻人的傲慢。”）一张昏暗、焦距不佳的印刷品显示了一年多后她最终的任命。

Shorn bald, she bows in a white robe to accept her new name, Ekun zenni —”profusion of wisdom.” Almost another year after that, she changed course yet again.

剃光头后，她穿着白色长袍鞠躬接受她的新名字，Ekun zenni——“丰富的智慧”。差不多又过了一年，她再次改变了方向。

Disenchanted with the monastery (a racket, she realized, that she wanted out of), she returned to the U.S. She was 19.

她对修道院不再抱有兴趣（她意识到，这是一个她想要摆脱的喧嚣），于是她回到了美国。那时她 19 岁。

In Portland, Oregon, she spent a year painting houses and tutoring illiterate adults until, realizing she was ready, she began to study philosophy.

在俄勒冈州波特兰，她花了一年的时间粉刷房屋并辅导文盲成年人，直到意识到自己已经准备好了，她开始学习哲学。

She studied seriously, ferociously, without quarter.

她学习认真、刻苦、毫不留情。

At the University of Oregon she joined with other smart, persistent young women to take over the philosophy club (no small feat in a discipline known for mansplaining) and make it the center of undergraduate philosophy.

在俄勒冈大学，她与其他聪明、执着的年轻女性一起接管了哲学俱乐部（这对于以男性说教闻名的学科来说是一个不小的壮举），并使其成为本科生哲学的中心。

More important, her studies confirmed that philosophy offered her enough richness and challenge to bring to it all her intensity.

更重要的是，她的研究证实哲学为她提供了足够的丰富性和挑战，使她能够全身心投入哲学。

She headed for DePaul with a 4.09 grade point average and summa cum laude honors.

她以 4.09 的平均成绩和优异的成绩前往德保罗。

She would arrive, it would turn out, all too perfectly positioned to learn how culture shapes madness.

事实证明，她到达这里时，处于完美的位置，可以了解文化如何塑造疯狂。

One of the first scholars to note culture’s profound effect on madness was Emil Kraepelin, the German neuropsychiatrist whose 1883 Compendium der Psychiatrie (later the Lehrbuch der Psychiatrie ) became a widely used guide for psychiatric diagnosis.

德国神经精神病学家埃米尔·克雷佩林 (Emil Kraepelin) 是最早注意到文化对疯狂产生深远影响的学者之一，他 1883 年出版的《精神病学纲要》（后来的《精神病学手册》）成为广泛使用的精神病学诊断指南。

In the Lehrbuch’ s early editions, Kraepelin described madness and most other mental illness as products of faulty brains and biology.

在《Lehrbuch》的早期版本中，克雷佩林将疯狂和大多数其他精神疾病描述为有缺陷的大脑和生物学的产物。

He defined what he originally called dementia praecox, or “precocious madness,” as a condition distinguished by hallucinations, paranoia, detachment from reality, sometimes profoundly disordered thinking, and what Kraepelin then saw as an inescapable neural decline.

他最初将他所谓的早熟痴呆或“早熟疯狂”定义为一种以幻觉、偏执、脱离现实、有时思维严重混乱以及克雷佩林随后认为不可避免的神经衰弱为特征的病症。

In 1908, another psychiatrist, Paul Eugen Bleuler, recast dementia praecox as schizophrenia, or “split mind,” to connote a mind divided between reality and delusion.

1908 年，另一位精神病学家保罗·尤金·布鲁勒 (Paul Eugen Bleuler) 将早发性痴呆重新定义为精神分裂症，或“分裂的心灵”，意指分裂为现实与幻觉的心灵。

By that time, 25 years after Kraepelin first called it dementia praecox , both Bleuler and Kraepelin saw schizophrenia as less hard-wired and more variable than Kraepelin originally had.

当时，距克雷佩林首次将其称为早发性痴呆 25 年后，布洛伊勒和克雷佩林都认为精神分裂症比克雷佩林最初认为的精神分裂症不那么顽固，而且更加多变。

Despite that, Western culture today continues to view schizophrenia as something essentially biologically fixed, invariably progressive, and, with rare exception, permanent.

尽管如此，今天的西方文化仍然认为精神分裂症本质上是一种生物学上固定的、总是进步的、而且除了极少数例外是永久性的。

Today’s psychiatry remains largely the biocentric psychiatry of Kraepelin’s Lehrbuch—and schizophrenia its most confounding problem.

今天的精神病学在很大程度上仍然是克雷佩林的《Lehrbuch》中以生物为中心的精神病学，而精神分裂症是其最令人困惑的问题。

Most historians rightly cast Kraepelin as the founder of biological psychiatry—the psychiatry of brains, genes, and drugs, which still dominates today .

大多数历史学家正确地将克雷佩林视为生物精神病学的创始人——大脑、基因和药物的精神病学，至今仍占主导地位。

Yet Kraepelin can also be seen as the founder of cultural psychiatry.

然而克雷佩林也可以被视为文化精神病学的创始人。

Kraepelin eventually found that culture plays a primary role in shaping psychosis and schizophrenia.

克雷佩林最终发现文化在精神病和精神分裂症的形成中起着主要作用。

In Java, for instance, he saw schizophrenia patients whose symptoms, while similar to those he had observed in Europeans, differed in their combinations, intensities, frequency, and duration.

例如，在爪哇，他看到精神分裂症患者的症状虽然与他在欧洲人中观察到的症状相似，但其组合、强度、频率和持续时间有所不同。

Fewer of the Javanese patients heard voices or felt other people influencing their thoughts.

很少有爪哇患者听到声音或感受到其他人影响他们的想法。

They felt less initial depression but more agitation.

他们最初的抑郁感有所减轻，但更加烦躁。

Most strikingly, Kraepelin observed, the most severe cases, of the sort that in Europe filled asylums with permanent residents, were seldom found and did far better than those in Europe.

克雷佩林观察到，最引人注目的是，欧洲收容所里挤满了永久居民的最严重病例很少被发现，而且情况比欧洲的情况要好得多。

Once his eye was caught, Kraepelin started seeing culture’s effects everywhere.

一旦引起注意，克雷佩林就开始看到文化的影响无处不在。

In his native Germany, for instance, schizophrenic Saxons were more likely to kill themselves than were Bavarians, who were, in turn, more apt to do violence to others.

例如，在他的祖国德国，患有精神分裂症的撒克逊人比巴伐利亚人更有可能自杀，而巴伐利亚人则更容易对他人实施暴力。

In a 1925 trip to North America, Kraepelin found that Native Americans with schizophrenia, like Indonesians, didn’t build in their heads the elaborate delusional worlds that schizophrenic Europeans did, and hallucinated less.

在 1925 年的北美之行中，克雷佩林发现，患有精神分裂症的美洲原住民和印度尼西亚人一样，并没有像欧洲精神分裂症患者那样在头脑中构建出复杂的妄想世界，而且产生的幻觉也更少。

Kraepelin died in 1926, before he could publish a scholarly version of those findings.

克雷佩林于 1926 年去世，当时他还没来得及发表这些发现的学术版本。

Late in his life, he embraced some widely held but horrific ideas about scientific racism and eugenics.

在他生命的晚年，他接受了一些关于科学种族主义和优生学的广泛持有但可怕的想法。

Yet he had clearly seen that culture exerted a powerful, even fundamental, effect on the intensity, nature, and duration of symptoms in schizophrenia, and in bipolar disorder and depression.

然而他清楚地看到，文化对精神分裂症、双相情感障碍和抑郁症症状的强度、性质和持续时间产生了强大的、甚至是根本性的影响。

He urged psychiatrists to explore just how culture created such changes.

他敦促精神病学家探索文化如何造成这种变化。

Even today, few in medicine have heeded this call .

即使在今天，医学界也很少有人注意到这一呼吁。

Anthropologists, on the other hand, have answered it vigorously over the last couple of decades.

另一方面，人类学家在过去几十年里对此做出了积极的回答。

To a cultural anthropologist, culture includes the things most of us would expect—movies, music, literature, law, tools, technologies, institutions, and traditions.

对于文化人类学家来说，文化包括我们大多数人所期望的东西——电影、音乐、文学、法律、工具、技术、制度和传统。

It also includes a society’s predominant ideas, values, stories, interpretations, beliefs, symbols, and framings—everything from how we should dress, greet one another, and prepare and eat food, to what it means to be insane.

它还包括一个社会的主导思想、价值观、故事、解释、信仰、符号和框架——从我们应该如何着装、互相问候、准备和吃食物，到疯狂意味着什么。

Madness, in other words, is just one more thing about which a culture constructs and applies ideas that guide thought and behavior.

换句话说，疯狂只是文化构建和应用指导思想和行为的思想的另一件事。

But what connects these layers of culture to something so seemingly internal as a person’s state of mind?

但是，是什么将这些文化层次与一个人的精神状态这样看似内在的东西联系起来呢？

The biocultural anthropologist Daniel Lende says that it helps here to think of culture as a series of concentric circles surrounding each of us.

生物文化人类学家丹尼尔·伦德 (Daniel Lende) 表示，将文化视为围绕我们每个人的一系列同心圆，对此很有帮助。

For simplicity’s sake, let’s keep it to two circles around a core, with each circle embedding and expressing many of the larger culture’s dominant ideas and values—in this case, about what it means to be mad.

为了简单起见，让我们将其保留为围绕一个核心的两个圆圈，每个圆圈都嵌入并表达了许多更大文化的主导思想和价值观——在这种情况下，是关于生气意味着什么。

The outermost circle consists of a culture’s most tangible, recognizable institutions, practices, concepts, and social structures.

最外层的圆圈由文化中最有形、最容易识别的制度、实践、概念和社会结构组成。

This is the realm of government, universities, clinics; of laws about sanity and responsibility; of medical practices, standards, and diagnostic categories; of depictions of the mad in art or literature (Ophelia, Norman Bates) or history (Lizzie Borden, Rasputin, Jared Loughner); of the batshit-crazy assortment of slang we use to refer to madness—cracked, cuckoo, psycho, schizo, nutso, unmoored, unhinged, demented, mad as a hatter, off one’s box, loopy.

这是政府、大学、诊所的领域；有关理智和责任的法律；医疗实践、标准和诊断类别；艺术或文学（奥菲莉亚、诺曼·贝茨）或历史（莉齐·波登、拉斯普京、贾里德·拉夫纳）中对疯子的描述；我们用来指称疯狂的各种疯狂俚语——cracked、cuckoo、psycho、schizo、nutso、unmoored、unhinged、demented、mad as a hatter、out one of the box、loopy。

Virtually everyone interacts with this outer layer of culture.

几乎每个人都与文化的外层互动。

It so thoroughly encapsulates our experience that we can easily forget it’s there.

它如此彻底地概括了我们的经历，以至于我们很容易忘记它的存在。

The next, closer circle of culture is our social world—the friends, family, classmates, fellow workers, and neighbors whose lives rub against ours day-to-day.

下一个更紧密的文化圈是我们的社交世界——朋友、家人、同学、同事和邻居，他们的生活与我们的日常生活息息相关。

In Lende’s circular schema of cultural influence, it’s this closer social layer that most intimately and powerfully transmits to us the ideas, values, and opinions of the wider culture around us, while establishing a sort of customized subculture as well.

在伦德的文化影响循环图式中，正是这个更紧密的社会层最密切、最有力地向我们传递了我们周围更广泛文化的思想、价值观和观点，同时也建立了一种定制的亚文化。

Through this layer especially we observe, assess, and, in turn, influence the culture around us.

我们尤其通过这一层来观察、评估并反过来影响我们周围的文化。

Finally, and most intimately and crucially, a central premise of psychiatric anthropology is that we connect to both these layers of culture primarily through individual interactions.

最后，也是最密切和最重要的，精神病人类学的一个中心前提是，我们主要通过个体互动与这两个文化层建立联系。

The anthropologist Edward Sapir was one of the first to note this.

人类学家爱德华·萨皮尔是最早注意到这一点的人之一。

“The true locus of culture,” he wrote in 1932, “is in the interactions of specific individuals”—specifically via “the world of meanings which each …

他在 1932 年写道，“文化的真正核心在于特定个体的互动”——特别是通过“每个人……的意义世界”。

of these individuals may unconsciously abstract for himself from his participation in these interactions.”

这些人中的一些人可能会无意识地将自己从参与这些互动中抽象出来。”

In a more expansive view, such interactions, defined broadly, are the base currency of cultural exchange: a long conversation between friends; a joke told and laughed at (or not); an eight-year-old watching Psycho ; a teenager reading Virginia Woolf; a colleague who belittles someone you admire; a friend who won’t meet your eye.

从更广泛的角度来看，这种互动从广义上讲是文化交流的基础货币：朋友之间的长时间交谈；讲了一个笑话并被嘲笑（或不被嘲笑）；一个八岁的孩子正在看《惊魂记》；一个正在阅读弗吉尼亚·伍尔夫作品的青少年；贬低你敬佩的人的同事；一个不会与你正视的朋友。

Such interactions don’t merely express and transmit culture.

这种互动不仅仅是表达和传播文化。

By constantly filtering, evaluating, and tweaking culture, they create it.

通过不断地过滤、评估和调整文化，他们创造了文化。

Likewise, we sense and evaluate culture, and our places in it, in every social exchange that we take part in, witness, or hear of.

同样，在我们参与、见证或听到的每一次社会交流中，我们都会感知和评估文化以及我们在文化中的地位。

By this view, when people in mental distress are shunned and relegated to a class of others needing care away from the rest of us, they are pushed outside of culture precisely when they need it most.

按照这种观点，当精神痛苦的人被回避并被归入需要照顾的阶层，远离我们其他人时，他们恰恰在最需要的时候被排除在文化之外。

They may seem utterly detached from reality.

他们可能看起来完全脱离现实。

But they will keenly comprehend their exile.

但他们会敏锐地理解他们的流放。

This is portrayed vividly in a memoir written by a man of Kraepelin’s time, Daniel Paul Schreber.

克雷佩林时代的丹尼尔·保罗·施雷伯 (Daniel Paul Schreber) 所写的回忆录生动地描述了这一点。

Schreber’s career as a prominent German judge ended when, in 1884, he went mad at the age of 42.

1884 年，施雷伯在 42 岁时发疯，结束了他作为德国著名法官的职业生涯。

His renowned Memoirs of My Nervous Illness, written during a remission and published in 1903, describes with astounding lucidity damned near every torment that schizophrenia can bring.

他著名的《我的神经病回忆录》于 1903 年在缓解期间写成，以惊人的清晰描述了精神分裂症可能带来的几乎每一种折磨。

Of these, Schreber’s worst agony was clearly the isolation his treatment forced on him.

其中，施雷伯最痛苦的显然是他的治疗强加给他的孤立。

At the asylum he was placed in (the same sort Kraepelin visited to refine his view of dementia praecox ), Schreber was miserable and spoke little.

在他被安置的精神病院（克雷佩林为了完善他对早发性痴呆的看法而参观过的精神病院），施雷伯很痛苦并且很少说话。

He writes that, while hospitalized there, he was “completely cut off from the outside world, without any contact with my family,” “forsaken,” “left to rot.”

他写道，在那里住院期间，他“与外界完全隔绝，与家人没有任何联系”，“被抛弃”，“任其腐烂”。

The completeness of this alienation helps explain the anthropologist’s fascination with schizophrenia.

这种疏离的完整性有助于解释人类学家对精神分裂症的迷恋。

Schizophrenia is where culture—Western culture, anyway—disintegrates.

精神分裂症是文化——无论如何，西方文化——瓦解的地方。

Jones had chosen DePaul partly because the philosophy department had recently hired several young professors strong in feminist and Asian areas of study—an expansion, presumably, of the department’s more traditional continental horizons.

琼斯选择德保罗的部分原因是哲学系最近聘请了几位在女权主义和亚洲研究领域很有实力的年轻教授——这可能是该系更传统的大陆视野的扩展。

She was especially excited about studying with Tina Chanter, a feminist scholar from the U.K. becoming known for her work on “abjection”—the marginalization of people by labeling.

她对与蒂娜·钱特（Tina Chanter）一起学习感到特别兴奋，蒂娜·钱特是一位来自英国的女权主义学者，因其关于“落魄”（通过标签将人们边缘化）的研究而闻名。

To Jones’ dismay, she arrived that fall of 2007 to find the department not happily in transition, but miserably riven by a microcosmal culture war—part of a larger academic culture war going on in the U.S. then (and now)—that would eventually make the national news.

令琼斯沮丧的是，她于 2007 年秋天来到该系，发现该系的转型并不顺利，而是被一场微观文化战争（当时（和现在）美国正在发生的一场更大的学术文化战争的一部分）悲惨地撕裂，这场战争最终成为全国新闻。

The department was having trouble assimilating (or squashing, depending on whom you asked) the new diversity it had hired.

该部门在吸收（或压制，取决于你问的是谁）它所雇用的新的多样性方面遇到了困难。

Namita Goswami, for instance, an assistant professor specifically recruited for her expertise in Asian studies, would suffer tenure denial that she characterized as discriminatory, retaliatory, and contrary to department policy; DePaul said she was just a poor scholar.

例如，纳米塔·戈斯瓦米 (Namita Goswami) 是一位因其在亚洲研究方面的专业知识而专门招聘的助理教授，她将遭受终身教职被拒绝，她将其描述为歧视性、报复性的，并且违反了部门政策；德保罗说她只是一个穷学者。

She was one of four women in the department who would eventually sue DePaul after being let go.

她是该部门四名在被解雇后最终起诉德保罗的女性之一。

(Three settled with the university in 2012, on terms kept confidential; the fourth case, Goswami’s, was settled out of court, on terms kept confidential, in 2015.)

（其中三起案件于 2012 年与大学达成和解，条款保密；第四起案件是 Goswami 的案件，于 2015 年在庭外和解，条款保密。）

The graduate students, meanwhile, found they were often judged by any position they took in these culture wars, and by their alliances and interests.

与此同时，研究生们发现，人们常常根据他们在这些文化战争中所采取的立场、联盟和利益来评判他们。

Their annual reviews before faculty committees were “like trials,” says one of Jones’ classmates, designed to expose whose side you were on.

琼斯的一位同学说，他们在教师委员会面前进行的年度审查“就像审判”，旨在揭露你站在哪一边。

Jones, the lone woman among her entering cohort of a half-dozen new Ph.D. candidates, was irked by this infighting, which reflected divisions along lines of not just gender but philosophy and politics.

琼斯是六名新博士生队伍中唯一的女性。候选人对这种内讧感到恼火，这不仅反映出性别上的分歧，还反映出哲学和政治上的分歧。

Yet she also found the battle energizing, and, engaging it with her usual intensity, took pleasure in the camaraderie she quickly found with some of the other women in the department, both graduate students and professors, including Goswami and Chanter.

然而，她也发现这场战斗充满活力，并且以她一贯的强度参与其中，并为她很快与系里其他一些女性（包括研究生和教授，包括戈斯瓦米和尚特）建立的友情感到高兴。

Unsurprisingly, this put some distance between her and some students and faculty.

毫不奇怪，这使她与一些学生和教师之间产生了一定的距离。

To an extent, of course, this only strengthened her allegiance with those challenging the departmental patriarchy.

当然，在某种程度上，这只会加强她对那些挑战部门父权制的人的忠诚。

Academically, meanwhile, she was impressing everyone with how fast and deeply she read, how forcefully she wrote, and how quickly her mind worked.

与此同时，在学术上，她的阅读速度和深度、写作的力度和思维速度给每个人留下了深刻的印象。

She was killing it.

她正在杀死它。

And Jones found Chanter to be everything she had hoped for—an inspiration, a protector, and a surprisingly warm mentor, despite her reputation as distant and cool.

琼斯发现尚特满足了她所希望的一切——一个灵感、一个保护者和一个令人惊讶的温暖导师，尽管她以冷漠和冷漠而闻名。

Jones fell for Chanter as only an ardent student can fall for a seemingly perfect master.

琼斯爱上了尚特，就像只有热心的学生才能爱上看似完美的大师一样。

The affection seemed to her mutual.

在她看来，这种感情是相互的。

Chanter was the “epitome,” Jones wrote later, “of everything I wanted to be.”

琼斯后来写道，尚特是“我想成为的一切的缩影”。

Yet even as Jones was impressing everyone and bonding with her fellow feminists, she was beginning to feel a resurgence of the memory and cognitive issues that troubled her, and, as the year went on, deeper and more vivid distortions in reality’s fabric.

然而，尽管琼斯给所有人留下了深刻的印象，并与其他女权主义者建立了联系，但她开始感到困扰她的记忆和认知问题再次出现，而且随着时间的推移，现实结构中出现了更深、更生动的扭曲。

These began to go well beyond squishy sidewalks and vaporous walls.

这些开始远远超出了柔软的人行道和雾气弥漫的墙壁。

Her imagination seemed to grow powerful enough to make imagined things real, and both those imagined things and real things themselves began to seem more powerful and autonomous.

她的想象力似乎变得强大到足以使想象的事物成为现实，而那些想象的事物和真实的事物本身都开始显得更加强大和自主。

Her ideas and thoughts started to seem like actual objects apart from her, existing in space, so that anyone could come into contact with them.

她的想法和想法开始看起来像是除了她之外的真实物体，存在于太空中，以便任何人都可以接触到它们。

Her thought-objects and other objects often took on auditory qualities, and she couldn’t tell whether she was imagining the sounds or perceiving them.

她的思想对象和其他对象经常呈现出听觉特性，她无法判断这些声音是她想象的还是感知的。

She felt a terrifying sense of exposure, and, to protect herself, increasingly went mute.

她有一种可怕的暴露感，为了保护自己，她越来越沉默。

Early in this period she grew worried enough to see a psychologist.

在此期间的早期，她变得非常担心，去看了心理学家。

After a few visits, the psychologist told Jones she couldn’t figure out what was amiss and could do nothing for her.

经过几次拜访后，心理学家告诉琼斯，她无法弄清楚出了什么问题，也无法为她做任何事情。

Jones stopped going.

琼斯不再继续前行。

As winter set in and her perceptions grew stranger, Jones struck her classmates as increasingly odd.

随着冬天的到来，琼斯的看法变得越来越陌生，她的同学们觉得她越来越奇怪。

Now and then she stared into space and seemed oblivious to her surroundings.

她时不时地凝视着太空，似乎忘记了周围的环境。

Jones now recalls that, at some point that winter, during one of her weekly visits with Chanter, she confessed to Chanter some of the perceptual anomalies she was experiencing.

琼斯现在回忆起，那年冬天的某个时候，在她每周拜访尚特一次期间，她向尚特坦白了她所经历的一些感知异常。

Chanter was concerned enough to walk her straight to the student counseling center.

尚特很担心，直接带她去了学生咨询中心。

Recommendations From Nev Jones : Two model care provider, NAVIGATE and ONTRACKNY .

Nev Jones 的推荐：两个模范护理提供商：NAVIGATE 和 ONTRACKNY。

“Are you hearing voices?” the director asked.

“你听到声音了吗？”导演问道。

Jones was not.

琼斯不是。

She disliked this query and what seemed to her its accusatory tone.

她不喜欢这种询问，也不喜欢这种询问的语气，在她看来，这是一种指责的语气。

It felt like both a checklist item and a trick question.

这感觉既像一个清单项目，又像一个棘手的问题。

One that could bring trouble.

一个可能带来麻烦的人。

She did not return to the counseling center.

她没有返回咨询中心。

Through the long winter, walking through darkness and dirty snow to reach the halls of philosophy, Jones battled to control her thoughts but continued to do well in class.

漫长的冬天，琼斯穿过黑暗和肮脏的雪地到达哲学殿堂，她努力控制自己的思想，但在课堂上仍然表现出色。

At first, says Azadeh Erfani, a fellow philosophy doctoral candidate whom Jones became close to that first year, Jones just seemed anxious and depressed.

琼斯在第一年就与他关系密切的哲学博士生阿扎德·埃尔法尼 (Azadeh Erfani) 说，起初，琼斯看上去只是焦虑和沮丧。

Yet even as Jones managed to hide her deeper confusion, her perceptions became more peculiar and her social relations more taxing.

然而，尽管琼斯设法隐藏了她更深层次的困惑，她的看法却变得更加奇特，她的社会关系也变得更加繁重。

She seemed to be wandering into unnavigable murk.

她似乎正在陷入无法航行的黑暗之中。

At some point that winter she confessed her growing confusion to Erfani.

那年冬天的某个时候，她向埃尔法尼承认自己越来越困惑。

In March, when many of the department’s women gathered at a restaurant brunch to catch up after a break between semesters, Erfani found Jones sitting alone on the carpeted steps leading to one of the side rooms.

三月份，当该系的许多女性在学期休息后聚集在一家餐厅吃早午餐时，埃尔法尼发现琼斯独自坐在通往一间侧室的铺着地毯的台阶上。

Morose and confused, Jones was barely able to speak.

琼斯心情郁闷、困惑，几乎说不出话来。

Erfani took her home.

埃尔法尼带她回家。

Back in September, when the two women had begun their friendship, Jones had told Erfani about Alex’s schizophrenia, and confided that she sometimes worried about going mad herself someday.

早在九月份，当这两个女人开始建立友谊时，琼斯就告诉埃尔法尼亚历克斯患有精神分裂症，并透露她有时担心有一天自己会发疯。

Now it became clear to both women that this might be happening.

现在，两位女士都清楚这可能会发生。

In the weeks after Erfani rescued Jones from the restaurant steps, Jones, aided by Erfani, resumed her search for help.

在埃尔法尼从餐厅台阶上救出琼斯后的几周内，琼斯在埃尔法尼的帮助下继续寻求帮助。

This was a fraught venture, because, in much of the Western world, an initial medical visit often accelerates a first episode.

这是一次令人担忧的冒险，因为在西方世界的大部分地区，初次就诊往往会加速首次发作。

A 2013 review, for instance, found that a first hospitalization often caused psychotic patients distress rivaling that caused by the symptoms that drove them to the hospital.

例如，2013 年的一项审查发现，精神病患者首次住院常常会感到痛苦，其痛苦程度可与驱使他们去医院的症状所造成的痛苦相媲美。

The care could wreak as much havoc as the ailment.

护理可能会像疾病一样造成严重破坏。

Irene Hurford, a psychiatrist and psychosis-response expert at the University of Pennsylvania, says it’s easy to see why.

宾夕法尼亚大学精神病学家和精神病反应专家艾琳·赫福德表示，原因很容易理解。

The initial admission to an emergency room or hospital, she says, is far too often traumatic .

她说，最初进入急诊室或医院往往会造成创伤。

Many ERs, overwhelmed to start with and facing patients long distressed and long neglected, routinely resort to physical and chemical restraints.

许多急诊室一开始就不堪重负，面对长期痛苦和长期忽视的患者，通常会诉诸物理和化学束缚。

Many staff, reflecting the culture around them, see first-episode psychosis as a gate to doom—and convey that to the patients.

许多工作人员反映了他们周围的文化，将首发精神病视为厄运之门，并将其传达给患者。

“They are told all sorts of nonsense,” Hurford says.

“他们被告知各种各样的废话，”赫福德说。

“‘You’ll be on medicine the rest of your life.

“‘你的余生都将靠药物治疗。

You have to accept you have a brain illness.'” In reality, early symptoms of schizophrenia may indicate anything from a one-time event to the beginning of either an occasional episodic struggle or something deep and chronic.

你必须承认自己患有脑部疾病。”事实上，精神分裂症的早期症状可能表明任何事情，从一次性事件到偶尔的间歇性挣扎或深层和慢性的事情的开始。

It runs the gamut.

它涵盖了所有领域。

This is why best practice, as one 2001 study puts it, involves not a rush to judgment but “an embracing of diagnostic uncertainty.”

这就是为什么正如 2001 年的一项研究所指出的那样，最佳实践不是急于做出判断，而是“拥抱诊断的不确定性”。

Yet many patients encounter not uncertainty but a view of schizophrenia as biologically hard-wired and inevitably progressive—”the terminal cancer of mental health,” as Richard Noll described the conventional wisdom from Kraepelin’s time, in his book American Madness: The Rise and Fall of Dementia Praecox .

然而，许多患者遇到的并不是不确定性，而是认为精神分裂症在生物学上是与生俱来的，并且不可避免地会进展——正如理查德·诺尔（Richard Noll）在他的著作《美国疯狂：早发性痴呆的兴衰》中描述的那样，是“精神健康的晚期癌症”。

In patients, this view encourages hopelessness and despair; in friends, acquaintances, and family, a rush to the exits.

对于患者来说，这种观点会助长绝望和绝望。在朋友、熟人和家人面前，人们急忙冲向出口。

In the West, the mere word schizophrenia can be enough to make people feel crazy and alone.

在西方，仅仅精神分裂症这个词就足以让人感到疯狂和孤独。

By contrast, multiple lines of research find schizophrenia is less crippling in developing countries.

相比之下，多项研究发现，精神分裂症在发展中国家的危害程度较小。

This is partly because, in many of these countries, people are likely to attribute madness not to a broken brain but to more normalized disturbances, such as temporary infestations of bad spirits.

部分原因是，在许多这样的国家，人们可能不会将疯狂归因于大脑损坏，而是归因于更正常的干扰，例如恶灵的暂时侵扰。

In his book Crazy Like Us: The Globalization of the American Psyche , Ethan Watters describes how, in Zanzibar, schizophrenia is seen as an unusually intense inhabitation of spirits, and psychotic episodes as passing phenomena.

伊森·沃特斯（Ethan Watters）在他的《像我们一样疯狂：美国心理的全球化》一书中描述了在桑给巴尔，精神分裂症如何被视为一种异常强烈的精神寄居，而精神病发作则被视为一种短暂的现象。

In one household Watters came to know well, a woman with schizophrenia, Kimwana, was allowed to drift back and forth from illness to relative health without much monitoring or comment by the rest of the family.

在沃特斯熟悉的一个家庭中，一位患有精神分裂症的妇女金瓦娜（Kimwana）被允许在疾病和相对健康之间来回摇摆，而没有受到家庭其他成员的太多监督或评论。

Because her swings from psychosis to wellness and back were not treated as the disappearance and return of her “self,” as is common in the West, Kimwana, Watters writes, “felt little pressure to self-identify as someone with a permanent mental illness.”

沃特斯写道，因为她从精神病到健康再回来的转变并没有像西方常见的那样被视为“自我”的消失和回归，所以她“没有感受到自我认同为患有永久性精神疾病的人的压力。”

Kimwana’s case resembles some of those that Kraepelin saw in Indonesia in the 1920s.

Kimwana 的案例与 Kraepelin 20 年代在印度尼西亚看到的一些案例类似。

In 1967, the transcultural psychiatrist Wolfgang Pfeiffer followed Kraepelin’s tracks there and found the same thing.

1967年，跨文化精神病学家沃尔夫冈·菲佛（Wolfgang Pfeiffer）追踪克雷佩林的踪迹，也发现了同样的情况。

In Indonesia, as the comparative psychiatry scholar Wolfgang Jilek later described, Pfeiffer found that “hallucinations …

在印度尼西亚，正如比较精神病学学者 Wolfgang Jilek 后来描述的那样，Pfeiffer 发现“幻觉……

were accepted by the tradition-directed patient with equanimity and not reflected upon with delusional elaboration.

被传统导向的病人平静地接受，而不是用妄想的阐述来反思。

Chronic residual states were well integrated into traditional society.” Madness was still madness.

长期残留的状态很好地融入了传统社会。”疯狂仍然是疯狂。

But when accepted as something that would pass, it often did.

但当被认为是会过去的事情时，它常常会过去。

Jones, hunting for help in 2008, desperately needed a place that would view madness that way.

2008 年，琼斯寻求帮助，他迫切需要一个能够以这种方式看待疯狂的地方。

Like most patients in America, she found it hard to find.

像美国的大多数病人一样，她发现很难找到。

The first place she visited with Erfani was a large hospital emergency room.

她和埃尔法尼一起参观的第一个地方是一家大型医院急诊室。

Jones recalls the visit with a darker tone than Erfani does, but both agree the visit did not go well.

琼斯回忆起这次访问时的语气比埃尔法尼的语气要阴沉，但两人都同意这次访问进行得并不顺利。

As Jones remembers it, a nurse took the two of them into an exam room, spent most of her time querying Erfani, as if Jones’ own account would be useless—”as if I wasn’t there ,” Jones says—and when she finished and grabbed the doorknob to fetch a doctor, turned to Erfani and said: “I’m not the one who makes the diagnoses.

琼斯记得，一名护士带着他们两个进入检查室，大部分时间都在询问埃尔法尼，仿佛琼斯自己的账户毫无用处——“就好像我不在那里一样，”琼斯说——当她完成后，抓住门把手去叫医生，转向埃尔法尼说：“我不是做出诊断的人。

But I can tell you right now, having seen a lot of these people, I think she’s a schizo.” She concluded by saying, “You should have taken her right to Cook County”—presumably because Cook County’s hospital treated the indigent and had a locked ward.

但我现在可以告诉你，在见过很多这样的人之后，我认为她是一个精神分裂症患者。”她最后说，“你应该带她去库克县”——大概是因为库克县的医院收治穷人，而且病房上锁。

To Jones the whole thing felt like a dramatization of Foucault’s warning about medicine branding and outcasting the mad.

对琼斯来说，整件事就像福柯关于医学品牌和排斥疯子的警告的戏剧化。

The two friends waited until the nurse was down the hall, then slipped out of the building.

两个朋友一直等到护士走到走廊尽头，然后溜出了大楼。

Erfani was becoming worried that Jones might harm herself.

埃尔法尼开始担心琼斯可能会伤害自己。

She was particularly alarmed at a recurring hallucination that Jones described: A man would point a gun at her head and talk to her.

她对琼斯描述的反复出现的幻觉感到特别震惊：一个男人会用枪指着她的头并与她说话。

Jones claimed that this didn’t bother her.

琼斯声称这并没有困扰她。

She said the man held the gun to her head in a “non-threatening” way.

她说，这名男子以“非威胁”的方式用枪指着她的头。

Erfani found this hard to credit.

埃尔法尼发现这很难相信。

Jones told Erfani that she sometimes doubted whether Erfani or she herself or anyone else really even existed.

琼斯告诉埃尔法尼，她有时怀疑埃尔法尼、她自己或其他人是否真的存在。

Perhaps she was imagining everything, not just this man with the gun.

也许一切都是她的想象，而不仅仅是这个拿着枪的男人。

Erfani began to worry that Jones was listening as much to the guy holding the gun as to the people actually around her.

埃尔法尼开始担心琼斯不仅在听拿枪的人说话，也在听她周围的人说话。

After much calling around, Jones found the number of a local “first-episode” clinic—one specifically for people having first psychotic breaks—and phoned just before closing time.

经过多次打电话后，琼斯找到了当地一家“首发”诊所的电话号码——专门为患有首次精神病发作的人服务——并在关门前打了电话。

A therapist answered.

一位治疗师回答道。

“Of course I can see you,” she told Jones.

“我当然可以看到你，”她告诉琼斯。

“Can you come in at eight tomorrow morning?” Jones went in the next day and had a warm, supportive visit with the therapist, whom we’ll call Dr. Holland.

“明天早上八点可以进来吗？”第二天，琼斯进去对治疗师（我们称他为霍兰德医生）进行了热情、支持性的拜访。

Holland became Jones’ weekly talk therapist.

霍兰德成为琼斯的每周谈话治疗师。

Jones also saw a prescribing psychiatrist every few weeks.

琼斯还每隔几周去看一位精神科医生。

Over the next six years, Holland proved smart, persistent, and unfailingly empathetic, and the clinic quite literally a lifesaver.

在接下来的六年里，霍兰德证明了他的聪明、坚持和始终如一的同理心，而诊所确实是一个救星。

Yet Jones, like so many, would find her diagnosis disorienting.

然而，琼斯和许多人一样，会发现她的诊断令人困惑。

Her psychiatrist told her, during her first visit that spring of 2008, that he had little doubt she was in the early stage of a psychotic episode.

2008 年春天，她第一次来访时，她的精神科医生告诉她，他毫不怀疑她正处于精神病发作的早期阶段。

The episode might prove either brief and shallow or long and intense.

这一集可能会简短而浅薄，也可能会漫长而激烈。

Jones asked whether she had schizophrenia.

琼斯问她是否患有精神分裂症。

He said she might.

他说她可能会。

Jones was devastated.

琼斯彻底崩溃了。

She alternated, she says, between “They’re wrong!” and “My life is over.”

她说，她时而说“他们错了！”和“我的生命结束了。”

In the weeks following, her delusions and hallucinations intensified.

在接下来的几周里，她的妄想和幻觉更加严重。

The sidewalks grew so soft that she sometimes overcompensated and stumbled.

人行道变得如此柔软，以至于她有时会过度补偿而绊倒。

The meds the doctor prescribed made her feel jumpy and disconnected.

医生开出的药物让她感到紧张和疏离。

Jones knew she was acting odd.

琼斯知道她的行为很奇怪。

She worried first that her classmates could tell something was off, and then, as her self-consciousness slid into paranoia, that they could read her thoughts.

她首先担心她的同学们会看出有些事情不对劲，然后，当她的自我意识陷入偏执时，他们会读懂她的想法。

She began to have vague and then troublingly specific visions of harming herself.

她开始出现模糊的、然后是令人不安的具体的伤害自己的景象。

Later she would recognize these, as well as other fantasies still to come, as examples of a psychotic phenomenon that Eugen Bleuler called “double registration” or “double bookkeeping.” In double bookkeeping, the psychotic person keeps two ledgers.

后来她会认识到这些以及即将出现的其他幻想，都是尤金·布洛伊勒（Eugen Bleuler）称之为“双重登记”或“双重簿记”的精神病现象的例子。在双重簿记中，精神病人保留两个分类账。

She can perceive a hallucination or fantasy as utterly real to her but also not real to the rest of the world, and thus not something that she should really act upon.

她可以认为幻觉或幻想对她来说是完全真实的，但对世界其他人来说却不是真实的，因此她不应该真正采取行动。

Jones later explained this idea to me as we were walking across the Stanford campus.

后来当我们穿过斯坦福大学校园时，琼斯向我解释了这个想法。

She might well see a red rabbit grazing on the lawn before us, she said, and that rabbit might seem as thoroughly real as my presence next to her.

她说，她很可能会看到一只红兔子在我们面前的草坪上吃草，而那只兔子看起来就像我在她身边一样真实。

But she would also recognize that the rabbit was not real to the rest of us, and that I was, and that she should not expect me or anyone else to perceive it.

但她也会认识到，对于我们其他人来说，这只兔子并不真实，而我却是真实的，而且她不应该指望我或其他任何人能够感知到它。

Likewise with the stone walls whose double nature Jones had so vividly perceived, stiff enough to break her toe but vaporous enough to blow into particles with her breath.

同样，琼斯清楚地感受到了石墙的双重性质，坚硬到足以折断她的脚趾，但又像蒸汽一样，足以被她的呼吸吹成颗粒。

In this double-bookkeeping version of reality, you could indulge the reality shown on the private ledger even as you lived according by the ledger that everyone else read from.

在这个双重记账版本的现实中，你可以沉迷于私人账本上显示的现实，即使你按照其他人阅读的账本生活。

It was usually fantasy, not intention.

这通常是幻想，而不是意图。

So it is with even many of the violent fantasies that some psychotic people have.

一些精神病患者的许多暴力幻想也是如此。

While such fantasies are not uncommon (in non-psychotic people too), psychosis raises the likelihood of violent behavior only modestly, to roughly that of people who struggle with substance abuse.

虽然这种幻想并不罕见（在非精神病人中也是如此），但精神病只是适度地增加了暴力行为的可能性，与与药物滥用作斗争的人大致相同。

Jones was still attending classes.

琼斯仍在上课。

Some of her professors had no clue anything was amiss.

她的一些教授并不知道有什么问题。

Most of her fellow students knew better.

她的大多数同学都知道得更清楚。

“She wouldn’t sleep,” Erfani says.

“她不睡觉，”埃尔法尼说。

“She’d do all these readings to prepare.

“她会做所有这些阅读来准备。

She felt she needed to stay in the program no matter what.

她觉得无论如何她都需要留在这个项目中。

From our perspective, at the time, that didn’t seem like the best idea.”

从我们当时的角度来看，这似乎不是最好的主意。”

Monday, April 21st, 2008, was a particularly fine spring morning in Chicago, with a warming sun and magnolia blossoms scenting the air.

2008 年 4 月 21 日星期一，芝加哥春天的早晨格外晴朗，阳光温暖，空气中弥漫着玉兰花的香气。

The kind of day that, after a tough winter, can seem a miracle, lifting one’s spirits and hopes.

在经历了一个艰难的冬天之后，这样的一天似乎是一个奇迹，让人振奋并充满希望。

Jones, ready to start the week’s classes and only a few weeks away from summer, was enjoying the walk to campus when she noticed she had a voicemail from Dr. Holland.

琼斯准备开始本周的课程，距离夏天只剩下几周了，她正在享受步行去校园的时光，这时她注意到自己收到了霍兰德博士的语音邮件。

Holland seldom had reason to call.

荷兰很少有理由打电话。

Jones became anxious as soon as she saw the message.

琼斯一看到这条信息就着急了。

She would later see the call, and the news it relayed, as the moment in which she went from clinging to a safe place within a small subculture to being flung away from it.

后来她看到了这个电话，以及它所传达的消息，那一刻，她从依附于一个小亚文化中的安全之地，变成了被抛弃的时刻。

The effect would prove catastrophic and lasting.

事实证明，其影响将是灾难性的且持久的。

Holland’s message said to please call immediately.

霍兰德的消息说请立即打电话。

When Jones reached her, Holland told her she had just spoken with Tina Chanter, and that Chanter had asked her to tell Jones that she should not come to campus until further notice, and that, if she did, she risked being intercepted by security officers.

当琼斯找到她时，霍兰德告诉她，她刚刚与蒂娜·钱特谈过话，钱特让她告诉琼斯，在接到进一步通知之前，她不应该来校园，如果她这样做，她就有被保安拦截的风险。

When Jones asked why, Holland explained that Chanter said that someone on campus—possibly a student, possibly faculty—had apparently expressed concerns about Jones’ behavior.

当琼斯问为什么时，霍兰德解释说，尚特说校园里有人——可能是学生，也可能是教师——显然对琼斯的行为表示了担忧。

(Chanter, when offered multiple chances to confirm or correct a detailed chronology of her role in this story, replied simply that her memory of the events does not match the version reconstructed here.

（当颂特有多次机会确认或更正她在这个故事中的角色的详细年表时，她简单地回答说，她对事件的记忆与此处重建的版本不符。

She declined to be more specific.)

她拒绝透露更多具体信息。）

Jones was stunned.

琼斯惊呆了。

Her behavior ?

她的行为？

She thought she knew damn well what that was supposed to mean.

她以为她非常清楚这意味着什么。

Just two months before, about the time Jones’ confusion was starting to be noticeable, a student at Northern Illinois University, an hour west, had shot 22 other students, killing five, before killing himself.

就在两个月前，大约在琼斯的困惑开始变得明显的时候，向西一小时车程的北伊利诺伊大学的一名学生枪杀了另外 22 名学生，造成 5 人死亡，然后自杀。

Ten months before that, a mentally ill student at Virginia Polytechnic Institute and State University had shot dead 27 fellow students and five professors.

十个月前，弗吉尼亚理工学院暨州立大学一名患有精神疾病的学生枪杀了 27 名同学和 5 名教授。

Both stories received massive media attention.

这两个故事都受到了媒体的广泛关注。

A fear of such disasters spread across campuses all over the U.S. It was a bad time to act unhinged.

对此类灾难的恐惧蔓延到美国各地的校园。现在不是胡思乱想的好时机。

To some around her, it seemed, Jones was a bomb waiting to blow .

对于她周围的一些人来说，琼斯似乎是一颗等待爆炸的炸弹。

Jones, furious, hung up on her therapist, sat beneath a magnolia tree and, between tears, furiously called people.

愤怒的琼斯挂断了治疗师的电话，坐在一棵木兰树下，泪流满面，愤怒地打电话给人们。

She phoned and emailed Chanter but got no response.

她给尚特打电话并发电子邮件，但没有得到回复。

She got a message to Namita Goswami, the Asian studies professor who would later sue the university for being fired, who replied saying she’d speak to Chanter and get back; Jones doesn’t recall hearing from her again.

她收到了一条消息给亚洲研究教授纳米塔·戈斯瓦米(Namita Goswami)，后者后来起诉该大学被解雇，后者回复说她会与尚特交谈并返回；琼斯不记得再收到过她的消息。

Jones next tried Frank Perkins, one of the few male faculty members she liked.

琼斯接下来尝试了弗兰克·帕金斯，他是她喜欢的少数男性教员之一。

Perkins and Jones were due to travel together to a conference that coming weekend.

帕金斯和琼斯原定于下周末一起前往参加一个会议。

Perkins responded that Chanter had asked him not to take Jones to the conference, lest there be “catastrophic consequences.” She called other faculty and friends, too, but no one answered.

帕金斯回应说，钱特要求他不要带琼斯参加会议，以免造成“灾难性后果”。她也给其他教员和朋友打电话，但没有人接听。

No one called back.

没有人回电话。

She had become the unwanted mad.

她已经变成了一个不受欢迎的疯子。

Every effort at contact seemed to isolate her further.

每一次的接触似乎都让她更加孤立。

For hours she walked around “in a kind of blank, devastating reverie,” as she recalled later, “not wanting to go home, not knowing what to do.” She boarded the elevated train that ran north along the Lake Michigan shoreline.

她后来回忆说，她“在一种茫然、毁灭性的遐想中”走了几个小时，“不想回家，不知道该怎么办。”她登上了沿着密歇根湖岸线向北行驶的高架列车。

She would ride that train a lot that month, gazing at the landscape.

那个月她经常乘坐火车，欣赏风景。

The speed of everything passing by, she later wrote, “served as a kind of escape from what otherwise seemed a life that had just come to a full stop.”

她后来写道，一切事物流逝的速度“是对刚刚结束的生活的一种逃避”。

Sometime the next day, Jones believes it was, she walked to Chanter’s office to ask what had happened.

琼斯相信是在第二天的某个时候，她走到尚特的办公室询问发生了什么事。

Chanter was out.

尚特出去了。

Someone in the next office said Chanter was in class.

隔壁办公室有人说尚特正在上课。

She’d return soon.

她很快就会回来。

Jones sat in a chair down the hall.

琼斯坐在走廊尽头的一把椅子上。

“The minute she saw me,” Jones says, “she races by me into her office, closes the door.” Jones, choking back tears, knocked.

“她一看到我，”琼斯说，“她就从我身边冲进她的办公室，关上门。”琼斯强忍着泪水敲了敲门。

As she remembers it, Chanter opened the door a crack and said: “I refuse to talk to you.

她记得，尚特把门打开一条缝，说道：“我拒绝和你说话。

Get out.

出去吧。

Leave campus.

离开校园。

Call your therapist.”

打电话给你的治疗师。”

“Tina, please talk to me,” Jones recalls pleading, in tears.

“蒂娜，请跟我说话，”琼斯回忆道，他泪流满面地恳求道。

But as Jones recalls it, Chanter just repeated, “Call your therapist,” and pushed the door shut.

但据琼斯回忆，钱特只是重复了一遍，“打电话给你的治疗师”，然后就关上了门。

For Jones, the thump of that door closing still resounds.

对于琼斯来说，关门的声音至今仍然回响。

To this day, Jones does not know why she was barred from campus.

直到今天，琼斯还不知道为什么她被禁止进入校园。

She struggled to make sense of it.

她努力想弄清楚这一点。

What had she said or done to provoke it?

她说了些什么或做了什么来激怒它？

Who had said something to Chanter—if anyone even had?

谁对尚特说了些什么——如果有人说过的话？

And what on Earth had they said?

他们到底说了什么？

For at least a week she was told almost nothing.

至少一周以来，她几乎什么也没被告知。

The mad, found guilty of losing touch with reality, are the last to be told what’s going on.

那些因脱离现实而被判有罪的疯子是最后一个被告知发生了什么事的人。

Even years later, no one with first-hand knowledge—not Chanter, not Holland (citing patient-confidentiality ethics), nor any others in the faculty or administration—will talk of what happened that day, or of key events that followed.

即使多年后，没有一个拥有第一手知识的人——无论是尚特、霍兰德（援引病人保密道德），还是教职人员或行政部门的任何其他人——都不会谈论那天发生的事情，或随后发生的关键事件。

We (and Jones) must rely heavily on the triangulation of distant memories, a handful of documents, and reasonable speculations.

我们（和琼斯）必须严重依赖对遥远记忆、少量文件和合理推测的三角测量。

If at times this article reads like a single-source account, it does so for two regrettable reasons: first, because much of this is a story of horror experienced in solitude; second, because only a single source, Jones, has been willing to speak regarding certain key events—perhaps the most crucial in her life—in which others played critical roles.

如果有时这篇文章读起来像一个单一来源的帐户，那么它这样做有两个令人遗憾的原因：第一，因为这很大程度上是一个在孤独中经历的恐怖故事；第二，因为这在很大程度上是一个在孤独中经历的恐怖故事；其次，因为只有一个消息来源，琼斯，愿意谈论某些关键事件（也许是她一生中最重要的事件），而其他人在这些事件中发挥了关键作用。

Most of the DePaul faculty mentioned in this story, as well as the administration, were sent detailed chronologies of the events described here and declined repeated offers to correct, confirm, or comment.

本文中提到的大多数德保罗教职员工以及政府都收到了本文所述事件的详细年表，并拒绝一再提出纠正、确认或评论的请求。

The only comment from DePaul was a statement made via email from the administration that the university has “robust policies and procedures in place for working with students with disabilities to provide reasonable accommodations.”

德保罗唯一的评论是政府通过电子邮件发表的一份声明，称该大学“制定了强有力的政策和程序，为残疾学生提供合理的住宿”。

Though Jones has forgotten a lot, there is much she remembers.

虽然琼斯忘记了很多，但她记得很多。

And with a few exceptions, as noted, whenever I have been able to check her memories against either documentation or the memories of those few who would speak about this period, her account almost invariably matches the record.

正如前面提到的，除了少数例外，每当我能够根据文献或少数谈论这一时期的人的记忆来检查她的记忆时，她的叙述几乎总是与记录相符。

Yet if some things remain foggy, or dependent on only one account, a few things are clear about the weeks running up to the phone call she received amid the magnolias in April of 2008.

然而，如果说有些事情仍然扑朔迷离，或者只依赖于一个说法，那么在 2008 年 4 月她在木兰花丛中接到电话之前的几周里，有一些事情是清楚的。

Clearly everyone felt at sea.

显然每个人都感到茫然。

Clearly Jones was in trouble.

显然琼斯遇到了麻烦。

Some of her schoolmates were trying to help her.

她的一些同学试图帮助她。

And although I could find no report that Jones had made any specific threats in the weeks before she was barred from campus, it appears that someone told faculty—or at least Chanter, the faculty member closest to Jones—that they felt uneasy with Jones’ behavior.

尽管我找不到任何报告表明琼斯在被禁止进入校园之前的几周内曾发出过任何具体威胁，但似乎有人告诉教职员工——或者至少是与琼斯最亲近的教职人员尚特——他们对琼斯的行为感到不安。

“People were alarmed,” Erfani says.

“人们感到震惊，”埃尔法尼说。

Clearly this put Chanter in a hard spot.

显然，这让尚特陷入了困境。

Complicating Chanter’s position was her role as one of two people, along with Erfani, whom Jones had given Holland permission to talk to.

让尚特的处境变得复杂的是，她是两个人之一，另外一个是埃尔法尼，琼斯允许霍兰德与埃尔法尼交谈。

We have no evidence Chanter ever learned anything from Holland; but even if she did, she could not ethically have shared information gained confidentially from Holland with other faculty or students, even if that information was reassuring.

我们没有证据表明尚特从荷兰那里学到了任何东西；但即使她这样做了，从道德上讲，她也不能与其他教师或学生分享从荷兰秘密获得的信息，即使这些信息令人放心。

Today Jones recognizes the difficulty of Chanter’s position, and forgives her.

今天，琼斯认识到尚特处境的困难，并原谅了她。

She sees that, in a fraught situation, Chanter almost surely acted from a combination of genuine concern for Jones and pressure from others to do something .

她认为，在令人担忧的情况下，钱特的行为几乎肯定是出于对琼斯的真正关心和其他人要求他做某事的压力。

What this meant, however, was that, as Jones spiraled into crisis, almost no one other than Jones’ therapist and psychiatrist knew what to do—and neither of them had any clout on campus.

然而，这意味着，当琼斯陷入危机时，除了琼斯的治疗师和精神科医生之外，几乎没有人知道该怎么做，而且他们在校园里都没有任何影响力。

Thus culture took its course.

文化就这样顺其自然地发展了。

In retrospect it’s clear that, in the weeks running up to her phone call with Holland, Jones had entered the doomed space described by Erving Goffman in his classic 1963 study, Stigma: Notes on the Management of Spoiled Identity :

回想起来，很明显，在与霍兰德通电话之前的几周里，琼斯已经进入了欧文·戈夫曼 (Erving Goffman) 在他 1963 年的经典研究《污名：管理被破坏身份的笔记》中描述的注定失败的空间：

The more there is about the individual that deviates in an undesirable direction from what might have been expected to be true of him, the more he is obliged to volunteer information about himself, even though the cost to him of candor may have increased proportionally.

一个人越是偏离人们所期望的正确方向，他就越有义务自愿提供有关自己的信息，尽管他因坦白而付出的代价可能会相应增加。

What candor had Jones offered that cost her so dear?

琼斯的哪些坦诚让她付出了如此高昂的代价？

Jones, searching through the dimness of memory, has come to believe that the simplest, most likely explanation for her being barred from campus is that one particular hallucination she confessed to one person, or perhaps two or three people, got badly misunderstood.

琼斯在模糊的记忆中搜寻，逐渐相信，她被禁止进入校园的最简单、最可能的解释是，她向一个人，或者两三个人承认的一种特殊幻觉，被严重误解了。

A week or two after she was told to stay off campus, Jones says (we can’t confirm this, because no one else will talk, so it remains very much second-, third-, and fourth-hand), Art Munin, then the assistant dean of students, having intervened to clear the way for Jones’ return to class, told Jones that Chanter had told him that someone had told her that Jones had told someone something that made them think Jones wanted to blow up the philosophy building.

琼斯说，在她被告知离开校园一两周后（我们无法证实这一点，因为没有其他人会说话，所以它仍然是二手、三手和四手资料），当时的学生副院长阿特·穆宁（Art Munin）介入为琼斯重返课堂扫清道路，告诉琼斯，尚特告诉他，有人告诉她，琼斯告诉了某人一些事情，让他们认为琼斯想要炸毁哲学大楼。

Erfani and others recall hearing that such rumors had triggered Jones’ banishment.

埃尔法尼和其他人记得听说此类谣言导致琼斯被驱逐。

Jones, meanwhile, feels certain she never made such a threat; among several schoolmates and professors I talked to, none had heard of her doing so.

与此同时，琼斯确信她从未发出过这样的威胁；在我交谈过的几位同学和教授中，没有人听说过她这样做。

Jones wonders if the rumor of a threat stemmed from remarks she made about her perception that the stone walls of the philosophy building were actually atomic aggregations so vaporous that if she “blew on it, the wall would come apart.” She distinctly remembers, and Erfani confirms, that she described this perception to Erfani; but Erfani understood it as a perception, not a threat.

琼斯想知道有关威胁的谣言是否源于她的评论，她认为哲学大楼的石墙实际上是原子聚集体，如此蒸气，如果她“对它吹气，墙就会散架”。她清楚地记得，并且埃尔法尼证实，她向埃尔法尼描述了这种看法；但埃尔法尼将其理解为一种感知，而不是威胁。

And although Erfani does not remember sharing Jones’ hallucination with anyone else, both she and Jones now wonder whether, in some transmutational chain of retellings among other students, or perhaps even as the word of this hallucination reached Chanter’s ears, Jones’ vision of puffing away a wall of weak atomic links had morphed into a scarier vision of her blowing a building to pieces with a bomb.

尽管埃尔法妮不记得与其他人分享过琼斯的幻觉，但她和琼斯现在都想知道，在其他学生之间的一系列重述中，或者甚至当这个幻觉的话语传到尚特耳中时，琼斯吹掉一堵薄弱原子连接墙的愿景是否已经演变成她用炸弹将一座建筑物炸成碎片的更可怕的愿景。

In other words, Jones’ career and life may have been derailed because a game of telephone went bad.

换句话说，琼斯的事业和生活可能因为一场电话游戏出了问题而脱轨。

Although Jones’ exile lasted but a week or two, this brief banishment, she would later record, “set in motion a chain of events that were to forever change my life, perhaps as profoundly as the ‘diagnosis’ of schizophrenia itself.” It released a set of forces that no one understood and no one knew how to stop.

尽管琼斯的流放只持续了一两周，但她后来记录道，这次短暂的流放“引发了一系列事件，这些事件将永远改变我的生活，也许与精神分裂症本身的‘诊断’一样深刻。”它释放出一系列无人能理解、无人知道如何阻止的力量。

And it may have done so not because Jones actually threatened violence, but because the culture around her was so ready to equate psychosis with violence that her diagnosis made her a threat.

这样做可能并不是因为琼斯实际上威胁使用暴力，而是因为她周围的文化已经准备好将精神病与暴力等同起来，以至于她的诊断使她成为一种威胁。

One of the questions here that comes quickest to mind—what did Jones do to provoke such a reaction?—may be a red herring.

这里最快浮现在脑海中的问题之一是——琼斯做了什么才引起这样的反应？——可能是转移注意力。

Her mere passage into psychosis may have been enough to provoke expulsion.

她仅仅陷入精神病就足以导致被开除。

When Jones returned to campus after 10 days or so, she says, virtually none of her fellow students and few of the faculty would even look at her.

她说，大约十天后，当琼斯回到校园时，几乎没有一个同学，甚至很少有教员会看她一眼。

As her classmates pulled back, Jones withdrew further.

当她的同学退开时，琼斯退得更远。

“She was just kind of gone,” says Kieran Aarons, a fellow philosophy graduate student who had also known Jones as a fellow undergraduate in Oregon.

“她就这样消失了，”哲学研究生基兰·亚伦斯 (Kieran Aarons) 说，他也认识琼斯，是俄勒冈州的本科生。

“She wasn’t disrupting anything, or having outbursts.

“她没有扰乱任何事情，也没有发脾气。

But she was very clearly not in the room.”

但她显然不在房间里。”

In the weeks after her return, Jones became estranged not just from Chanter but from the rest of the circle of classmates who’d formed around Chanter.

回来后的几周里，琼斯不仅与尚特疏远了，而且与尚特周围的其他同学也疏远了。

She eventually lost even Erfani, with whom she hasn’t talked since.

她最终甚至失去了埃尔法尼，从那以后她就再也没有和她说过话。

Because it pained Jones to see her professors, she studied their schedules so she could time her entrances and exits from the building so as to avoid them.

因为见到教授让琼斯很痛苦，所以她研究了他们的时间表，这样她就可以安排进出大楼的时间，从而避开他们。

When that wasn’t good enough, she would enter a bathroom and lock herself in a stall for long periods of time, unable to face anyone.

如果这还不够好，她就会走进浴室，把自己锁在隔间里很长一段时间，无法面对任何人。

People noticed this too.

人们也注意到了这一点。

At this point she started having disturbingly vivid visions of killing herself.

这时，她开始出现令人不安的自杀景象。

She felt utterly crushed, helpless, and alone.

她感到彻底崩溃、无助和孤独。

“Nev was surrounded by people who knew nothing about mental illness,” Erfani says.

“内夫周围都是对精神疾病一无所知的人，”埃尔法尼说。

“We didn’t know what to do, and we made a lot of mistakes.”

“我们不知道该怎么办，而且犯了很多错误。”

For all this, Jones holds her classmates and Chanter ever less to blame.

对于这一切，琼斯不再责怪她的同学和尚特。

“In my heart,” she says now, “I think Tina was horrified by what happened, both then and later.” She knows Erfani, too, was trying to do her best amid confusion and fear.

“在我心里，”她现在说道，“我认为蒂娜对当时和后来发生的事情感到震惊。”她知道埃尔法尼也在困惑和恐惧中尽力做到最好。

She recognizes that, in a society terrified of madness, banishment is the default mode.

她认识到，在一个害怕疯狂的社会中，放逐是默认模式。

And banishment it proved.

事实证明，被放逐了。

A circle of friends is itself a wall, the bonds of friendship its mortar.

朋友圈本身就是一堵墙，友谊的纽带就是灰浆。

It surrounds and includes us.

它包围并包括我们。

It shields us from outside threats.

它保护我们免受外部威胁。

By bracing us in our distress, it guards us from our doubts and fears.

通过在困境中支撑我们，它可以保护我们免受怀疑和恐惧。

But the bonds of such a wall can prove weaker than they appear.

但事实证明，这样一堵墙的结合力可能比看上去要弱。

Jones’ had blown apart.

琼斯的房子已经炸裂了。

Jones, getting sicker all the while, staggered through that spring semester of 2008, and ended up taking one medical incomplete.

琼斯的病情一直在恶化，他摇摇晃晃地度过了 2008 年的春季学期，最终接受了一次不完整的体检。

That summer she took and aced a course in abnormal psychology.

那年夏天，她修读了一门变态心理学课程，并取得了优异成绩。

Before her lay the fall semester and the problem of how to get through her second year.

摆在她面前的是秋季学期以及如何度过第二年的问题。

After talking it over with Rick Lee, the philosophy chair (who’d just returned from a year of sabbatical), she began her second year by taking three courses, two of which, neurobiology and psychology, were outside the department.

在与哲学系主任里克·李（Rick Lee，刚刚结束一年的休假）讨论后，她开始了第二年的学习，选修了三门课程，其中神经生物学和心理学两门属于系外课程。

As school began, she says, she was in a bad state: She could scarcely make it to the end of a sentence, whether reading, talking, or listening.

她说，开学后，她的状态很糟糕：无论是读、说还是听，她几乎无法说完一句话。

She told a friend that sometimes when she tried to read, the words would fly around and she would have to grab them and put them back in place.

她告诉一位朋友，有时当她尝试阅读时，单词会飞来飞去，她必须抓住它们并将它们放回原位。

She felt “suspended linguistically, suspended in life.” Her turmoil that second year shows in her transcript, which registers light loads her first two semesters—three classes each semester, all A’s—and then, in the third semester, that spring of 2009, three incompletes.

她感觉“在语言上被悬置了，在生活中也被悬置了”。她第二年的混乱表现在她的成绩单上，记录显示她前两个学期的课业很轻——每学期三门课，全是A——然后，在第三学期，即2009年春天，有三门课未完成。

No classes that second summer.

第二个夏天没有课。

Yet despite being in what she describes as a state of deep psychosis, she submitted at the beginning of her third year a remarkably lucid self-evaluation for a crucial annual progress review she would face the following month before the department’s graduate affairs committee.

然而，尽管她处于她所描述的深度精神病状态，但她在第三年年初提交了一份非常清晰的自我评估，以应对下个月在系研究生事务委员会面前进行的重要年度进展审查。

This was the annual review that Erfani and many others found so confrontational.

埃尔法尼和其他许多人认为这份年度评论极具对抗性。

“I would be the first,” she wrote the committee, “to underscore the underwhelming nature of my performance …

“我会是第一个，”她写信给委员会，“强调我的表现平淡无奇......

over the past year.

过去一年。

There would be little point in marshaling excuses of any kind, though obviously there are significant extenuating circumstances that have made my academic life especially challenging.” She asked to be allowed to remain in school over the coming academic year, taking just one class per quarter, so as to finish a master’s degree rather than a Ph.D. This arrangement, she wrote, would allow her to keep her modest job and essential health insurance.

尽管显然有一些重大的情有可原的情况使我的学术生活变得特别具有挑战性，但编造任何形式的借口都是没有意义的。”她要求在下一学年继续留在学校，每季度只上一节课，以便完成硕士学位而不是博士学位。她写道，这种安排将使她能够保住微薄的工作和基本的健康保险。

Of the actual review a few weeks afterwards—a meeting in which she faced a room full of faculty—she remembers only fragments.

几周后的实际回顾——在一次会议上，她面对着满屋子的教员——她只记得一些片段。

She recreated the meeting on her blog:

她在博客上重现了这次会议：

First, the decision: we are dismissing you, in fact you may not, even as an unfunded student, enroll in any further classes.

首先，决定：我们将解雇您，事实上，即使您是一名没有资助的学生，您也可能无法参加任何进一步的课程。

From a professor I had, until that point, trusted completely: “the decision strikes the committee as simple—you clearly do not have your act together and we have no reason to believe you ever will.” Another professor: “you are a burden on the instructors.” And then some additional reasons, faculty talking more to each other than me: “look at all the withdrawals”; “she hasn’t attended a departmental lecture in almost two years”; “unambiguously uninvolved in the life of the department.” Someone (I’m not looking at them) interjects: “perhaps allowing her just one more term…?” Another “…keeping in mind that if we do this she will immediately lose all her health coverage….” Then: “Absolutely not, but we can discuss the reasons after she leaves.” Clearly she will not succeed.

在那之前，我完全信任一位教授：“这个决定让委员会感到很简单——你显然没有采取一致的行动，我们没有理由相信你会这样做。”另一位教授：“你是导师的负担。”还有一些额外的原因，教师们互相交谈的次数比我多：“看看所有的退学”； “她已经快两年没有参加过系里的讲座了”； “明确不参与部门的生活。”有人（我没有看他们）插话道：“也许再允许她再连任一次……？”另一个“……请记住，如果我们这样做，她将立即失去所有的健康保险……”然后：“当然不是，但是等她走后我们再讨论原因。”显然她不会成功。

Now or ever.

现在或永远。

Recommendations From Nev Jones : General information for families, patients, young adults, providers, or policymakers .

内夫·琼斯的建议：针对家庭、患者、年轻人、提供者或政策制定者的一般信息。

This and similar recollections from Jones are almost all we have of this meeting: how a professor friendly to her, for instance, and who had told her beforehand everything would be OK, sat silent, stiff, and pale, and looked away whenever Jones looked at him; how another professor told her point-blank, “You have no future in philosophy.” None of the several faculty who participated in the review have responded to multiple requests for interviews about what happened there.

琼斯的这种回忆和类似的回忆几乎就是我们对这次会面的全部回忆：例如，一位对她友好的教授，事先告诉她一切都会好起来的，一言不发地坐着，僵硬，脸色苍白，每当琼斯看他时，他就移开视线；他的脸色苍白，一言不发。另一位教授直截了当地告诉她：“你在哲学领域没有未来。”参与审查的几位教员都没有回应多次关于那里发生的事情的采访请求。

The sole record available is a letter that Avery Goldman, writing as committee chair, sent Jones on October 12th, 2009.

唯一可用的记录是艾弗里·戈德曼 (Avery Goldman) 以委员会主席身份于 2009 年 10 月 12 日写给琼斯的一封信。

The letter informs her, without any explanation, that the committee had denied her request.

这封信在没有任何解释的情况下告诉她，委员会拒绝了她的请求。

They offered to credit some prior classwork to fill out her master’s requirements without further study.

他们提出将之前的一些课堂作业记入学分，以满足她硕士的要求，而无需进一步学习。

But they told her explicitly she could no longer take classes.

但他们明确告诉她，她不能再上课了。

If her exile two Aprils before had thrown Jones down a well, she now collapsed at its bottom and lay drowning.

如果说两年前她的流放曾把琼斯扔进井里，那么现在她倒在井底溺水身亡。

She could not think.

她无法思考。

Could not read.

无法阅读。

Could not tell who was real and who was not, what was actually happening and what she was imagining.

分不清谁是真实的，谁不是，真实发生的事情和她想象的事情。

Could not tell whether such distinctions even mattered.

无法判断这种区别是否重要。

When she looked people in the eyes, she felt them enter her mind and read all her thoughts.

当她看着别人的眼睛时，她感觉到他们进入了她的脑海并读出了她所有的想法。

She felt both formless and isolated, selfless and alone, borderless, “as if erased.” For one period many days long, possibly weeks, she surrendered completely to her demons and delusions.

她感到无形又孤立，无私又孤独，没有边界，“仿佛被抹去了”。在一段长达数天甚至数周的时间里，她完全屈服于自己的恶魔和妄想。

“I didn’t even get out of bed,” she said later.

“我什至没有起床，”她后来说。

“And when I say I didn’t get out of bed, I mean I did not get out of bed.

“当我说我没有起床时，我的意思是我没有起床。

There were days I could not summon the energy, or perhaps the will, to walk from the bed to the bathroom.”

有几天我无法鼓起能量，或者说是意志，从床上走到浴室。”

In retrospect, she says, she surrendered to a dynamic she had examined in one of the last philosophy papers she managed to finish, written when things were unraveling the spring before.

她说，回想起来，她屈服于一种动态，她在她设法完成的最后一篇哲学论文中研究过这种动态，这篇论文是在去年春天事情瓦解时写的。

Fifty years earlier, the British psychotherapist Donald Winnicott had proposed that the elaborate delusional worlds that typify schizophrenia in Western cultures are not arbitrary structures of a broken, schizophrenic mind, but a complex set of mental fortifications the person builds to protect herself against the real world, which she worries will seize and lock her away because she is insane.

五十年前，英国心理治疗师唐纳德·温尼科特提出，西方文化中精神分裂症典型的精心设计的妄想世界并不是破碎的精神分裂症心灵的任意结构，而是人们为保护自己免受现实世界的侵害而建立的一套复杂的心理防御工事，她担心现实世界会抓住她并将她锁起来，因为她疯了。

It’s madness as an Escherian stairway to hell.

这就像通往地狱的埃舍尔阶梯一样疯狂。

Years later, Jones would find this vision a credible explanation of her own descent into madness.

多年后，琼斯发现这个幻象是她自己陷入疯狂的可靠解释。

For a year or more after her expulsion, she often stayed in her head’s delusional worlds not because she had lost her mind, but because her mind felt safer in delusion than in her ruined reality.

被开除后一年多的时间里，她常常沉浸在自己的幻想世界中，这并不是因为她失去了理智，而是因为她觉得在幻想中比在被毁灭的现实中更安全。

“Everything is on fire, in flames, burning,” she wrote in her diary.

“一切都着火了，熊熊燃烧，”她在日记中写道。

“My thoughts are everywhere …

“我的思绪无处不在……

a cloud, a pack of birds, a pack of wolves.”

一朵云，一群鸟，一群狼。”

Early in the summer of 2010, more than a year after she’d been expelled, Jones opened her inbox and found an email from a DePaul psychology professor she had studied with two summers before.

2010年初夏，也就是她被开除一年多后，琼斯打开收件箱，发现一封来自她两年前曾与她一起学习的德保罗心理学教授的电子邮件。

Back then, in 2008, the professor had joked to Jones she should get her Ph.D. in psychology, because it was so much better than philosophy.

当时，2008 年，这位教授曾对琼斯开玩笑说她应该获得博士学位。心理学，因为它比哲学好得多。

Now she was making an offer: An incoming doctoral student had suddenly withdrawn, and they had no time to find a replacement through the usual channels.

现在她提出了一个要约：一位即将入学的博士生突然退学了，他们没有时间通过​​通常的渠道寻找替代者。

It was a funded spot, a free ride.

这是一个有资助的地方，免费乘车。

Would Jones like to take it?

琼斯愿意接受吗？

“I thought it was a cosmic joke,” Jones says.

“我认为这是一个宇宙笑话，”琼斯说。

The odds of getting a last-minute offer like this, especially for someone recently dumped by the same university, were close to nil.

在最后一刻获得这样的录取通知书的几率几乎为零，尤其是对于最近被同一所大学抛弃的人来说。

Her initial reaction was, “There is no way I can do this.”

她最初的反应是：“我做不到。”

“What do you mean?” Holland asked.

“你是什么意思？”霍兰德问道。

“Of course you can do this.

“你当然可以这样做。

You’re going to do this.”

你要这么做。”

Jones had many rough times in the first two years of her new doctoral campaign.

琼斯在新博士竞选的头两年经历了许多艰难时期。

But she was now heading up rather than down.

但她现在正在向上而不是向下。

She again had work she loved.

她又找到了自己热爱的工作。

She found several new colleagues of like mind in the department, including a new mentor and friend, Mona Shattell, a nurse who worked in community psychology, and who shared Jones’ evolving view of schizophrenia as a failure less of neural connections than of social and community bonds.

她在该部门找到了几位志同道合的新同事，其中包括一位新的导师和朋友莫娜·沙特尔（Mona Shattell），她是一名从事社区心理学工作的护士，她同意琼斯不断发展的观点，即精神分裂症与其说是神经联系的失败，不如说是社会和社区纽带的失败。

Jones had stopped taking antipsychotics after she and her psychiatrist agreed they didn’t work for her, and she felt better for it.

琼斯和她的精神科医生一致认为抗精神病药物对她不起作用后，她就停止服用抗精神病药物，她感觉好多了。

She completed her Ph.D. in four years.

她完成了博士学位。四年内。

The other lifeline was connection.

另一条生命线是联系。

Primarily through the Internet, Jones soon found other students, who, like her, had been diagnosed with schizophrenia or another serious mental illness and were pursuing graduate work.

琼斯主要通过互联网，很快找到了其他学生，他们和她一样，被诊断患有精神分裂症或其他严重的精神疾病，正在攻读研究生。

Like Jones, they wondered whether fellow academics struggled with psychosis and how they got through.

和琼斯一样，他们想知道其他学者是否患有精神病以及他们是如何度过的。

Together they started a Google Group that soon included 40 or 50 other young academics trying to pursue academic careers despite their psychiatric diagnoses.

他们一起创建了一个 Google 群组，很快就有 40 或 50 名其他年轻学者加入，尽管他们被诊断患有精神病，但仍试图追求学术事业。

Some were getting effective treatment.

有些人正在接受有效的治疗。

Some were not.

有些则不然。

For many of them, Jones says, the online group was the first time they’d been offered a connection back to the rest of the world.

琼斯说，对于他们中的许多人来说，在线小组是他们第一次获得与世界其他地方的联系。

Outside the group they were outcasts.

在团体之外，他们是被排斥的人。

Within the group they were professionals.

在团队中，他们都是专业人士。

Jones had been keeping a blog, “Ruminations on Madness.” Although she later took it down, she used it for a time as “both beacon and homing device,” as she once put it, to build a network of like-minded peers.

琼斯一直在写博客“疯狂的思考”。尽管她后来把它取下来，但正如她曾经所说的那样，她曾一度将其用作“信标和导航设备”，以建立一个由志趣相投的同伴组成的网络。

On the blog, written under a pseudonym, she could safely explore and come to terms with the innermost core of culture.

在用笔名写的博客上，她可以安全地探索并了解文化的最内在核心。

This is the circle of culture that each of us carries within, in which we embed many aspects of the circles composed of our friends, our family, our social worlds, and of the outermost circle of institutions and their structures.

这是我们每个人所承载的文化圈，我们在其中嵌入了由我们的朋友、我们的家庭、我们的社交世界以及最外层的机构及其结构组成的圈子的许多方面。

Some of these embedded values and ideas—the ones we carry as self-stigma—can serve as models of behavior that can cripple us or separate us from others.

其中一些内在的价值观和思想——我们作为自我耻辱而带有的价值观和思想——可以作为行为模式，削弱我们或将我们与他人分开。

They’re hard to set aside if we can’t take them out and examine them in a safe place.

如果我们不能将它们取出并在安全的地方进行检查，就很难将它们放在一边。

For Jones, a key event in this healing process came in July of 2012, when a 24-year-old named James Holmes shot 82 people who were watching a Batman movie in a cinema in Aurora, Colorado.

对于琼斯来说，这个治愈过程中的一个关键事件发生在 2012 年 7 月，当时 24 岁的詹姆斯·霍姆斯 (James Holmes) 枪杀了 82 名正在科罗拉多州奥罗拉市一家电影院观看蝙蝠侠电影的人。

Twelve of them died.

其中十二人死亡。

Holmes had withdrawn the month before from a University of Colorado Ph.D. program in neuroscience because he was battling mental illness.

霍姆斯在一个月前从科罗拉多大学博士课程中退学。神经科学项目，因为他正在与精神疾病作斗争。

In the days before the shooting he had sought care but not received it.

在枪击事件发生前几天，他曾寻求治疗但没有得到治疗。

He was later diagnosed by one psychiatrist as having schizotypal personality disorder, and by another as having schizoaffective disorder.

后来，一位精神科医生诊断他患有精神分裂型人格障碍，另一位精神科医生诊断他患有精神分裂情感障碍。

James Holmes had enough in common with the Nev Jones of 2009 to present the Nev Jones of 2012 with an uncomfortable reminder of how toxic madness could become when society rejects and excludes the afflicted.

詹姆斯·霍姆斯 (James Holmes) 与 2009 年的内夫·琼斯 (Nev Jones) 有足够多的共同点，他向 2012 年的内夫·琼斯 (Nev Jones) 展示了一个令人不安的提醒：当社会拒绝和排斥受苦者时，疯狂会变得多么有毒。

“I suspect it would strike most people as ‘mad,'” she wrote on her blog, “particularly perhaps, those who know me, to identify any sort of kinship, any common bond, with James Holmes, the ‘Batman shooter,’ mass killer, and ‘psychotic son of a bitch,’ as Colorado Congressman Ed Perlmutter has put it.

“我怀疑大多数人都会觉得‘疯狂’，”她在博客中写道，“尤其是那些认识我的人，认为我与詹姆斯·霍姆斯（詹姆斯·霍姆斯）有任何形式的亲属关系，任何共同的纽带，詹姆斯·霍姆斯是‘蝙蝠侠射手’、大规模杀手，正如科罗拉多州国会议员埃德·珀尔穆特所说，‘精神病狗娘养的’。

After all, I cry even over the deaths of the small birds my cats carry in from the deck….

毕竟，我什至会为我的猫从甲板上带进来的小鸟的死亡而哭泣……

And yet school shootings, or acts of extreme violence in which the perpetrator is or recently was a college student, have punctuated my life in strange & powerful ways.

然而，校园枪击事件，或者肇事者是或最近是大学生的极端暴力行为，以奇怪而有力的方式打断了我的生活。

I was diagnosed with schizophrenia just a month after Steven Kazmierczak (quickly identified as ‘schizoaffective’) shot six people to death [including himself] on the campus of NIU, just an hour [from] Chicago.”

史蒂文·卡兹米尔恰克（Steven Kazmierczak）（很快被认定为“精神分裂症患者”）在距芝加哥仅一小时车程的 NIU 校园内枪杀了六人（包括他自己），仅一个月后，我就被诊断出患有精神分裂症。

Back then, in the weeks and months of her worst alienation after being shown the door at DePaul, Jones had become fixated on an image of herself dead, sometimes in a pool of blood, sometimes hanging, at the entrance door of the philosophy building.

当时，在被送出德保罗大学大门后的数周乃至数月里，琼斯一直沉迷于自己死在哲学大楼门口的画面，有时倒在血泊中，有时吊在地上。

A suicide, obviously, to end her excruciating misery—but also a statement of despair, and a refusal to be cast away.

显然，她的自杀是为了结束她难以忍受的痛苦，但同时也是一种绝望的表达，以及拒绝被抛弃的态度。

Like Holmes and others who’ve turned their madness outward, Jones had felt what seemed an insupportable anguish at society’s alienating view of her condition; and her ideas about expressing it rose from models of behavior reflecting a violent culture.

就像福尔摩斯和其他将疯狂转向外在的人一样，琼斯对社会对她的处境的疏远看法感到似乎难以忍受的痛苦；她表达这种想法的想法源于反映暴力文化的行为模式。

Yet the crucial difference between Holmes and Jones— between Holmes and the vast majority of people experiencing psychosis —is that, while Holmes had sought to harm others, Jones had turned her madness on herself.

然而，福尔摩斯和琼斯之间——福尔摩斯和绝大多数患有精神病的人之间——的关键区别在于，虽然福尔摩斯试图伤害他人，但琼斯却把她的疯狂转向了自己。

Jones’ post about Holmes proved a critical step in ending her isolation and bending her trajectory back upward.

琼斯关于福尔摩斯的帖子证明是结束她的孤立并使她的轨迹重新向上的关键一步。

It helped her see how culture shaped her inner torments.

这帮助她了解文化如何塑造她内心的折磨。

It allowed her to safely confess some of her worst memories and doubts in a way that disarmed them.

这让她能够安全地坦白一些最糟糕的记忆和疑虑，从而解除他们的戒心。

Jones’ blog posts also connected her and her ideas with wider circles of culture, including in media and academe.

琼斯的博客文章还将她和她的想法与更广泛的文化圈联系起来，包括媒体和学术界。

These connections provided her with new sources of affirmation and support, and brought her new friends.

这些联系为她提供了新的肯定和支持来源，并给她带来了新朋友。

This attention opened up social and scholarly circles in which her ideas on madness found constructively engaged peers and critics.

这种关注打开了社会和学术圈子，她关于疯狂的想法得到了同行和批评家的建设性参与。

Among them was Stanford’s Tanya Luhrmann, a prominent anthropologist who studied how madness expresses culture.

其中包括斯坦福大学的坦尼娅·鲁尔曼（Tanya Luhrmann），她是一位著名的人类学家，研究疯狂如何表达文化。

Luhrmann eventually met Jones and offered her a postdoctoral fellowship with the culture and mind group in Stanford’s Department of Anthropology.

鲁尔曼最终遇到了琼斯，并为她提供了斯坦福大学人类学系文化与思维小组的博士后奖学金。

Thus began, Jones says, a period in which “my world got bigger.” And safer.

琼斯说，“我的世界变得更大”的时期就这样开始了。而且更安全。

In June of 2014, four years after she hit bottom, and with a fresh Ph.D. in community psychology in hand, Jones packed her stuff and moved to Stanford.

2014 年 6 月，也就是她跌入谷底四年后，她获得了新的博士学位。在掌握了社区心理学的知识后，琼斯收拾好行李搬到了斯坦福大学。

She quickly became an international influence, lecturing all over the U.S. and U.K. and consulting with federal and state mental-health agencies that were overhauling programs for responding to schizophrenia and psychosis.

她很快就产生了国际影响力，在美国和英国各地演讲，并为联邦和州心理健康机构提供咨询，这些机构正在改革应对精神分裂症和精神病的项目。

She continued this work after she left Stanford and continues it now at USF.

离开斯坦福大学后，她继续这项工作，现在在南佛罗里达大学继续这项工作。

She has thus tied a line from her innermost, private circle of internalized culture to social and professional circles through which she is directly changing still-larger institutional circles of culture beyond.

因此，她将她最内在的、私人的内化文化圈与社会和专业圈子联系起来，通过这些圈子，她直接改变了更大的制度文化圈。

It’s not exactly a friction-free process.

这并不完全是一个无摩擦的过程。

As a person of “lived experience,” as advocates call those who’ve felt madness’ touch, Jones regularly faces the tendency among fellow mental-health professionals to discount ideas put forth by people who’ve been mad.

作为一个有“生活经验”的人，倡导者称那些感受到疯狂的人，琼斯经常面临心理健康专业人士的倾向，他们对疯狂的人提出的想法不予理睬。

“We call it stigma,” says her mentor and colleague Mona Shattell.

“我们称之为耻辱，”她的导师兼同事莫娜·沙特尔说。

“But let’s just call it discrimination.” The extent to which many in the mental-health field disregard the experience of colleagues who’ve had mental illness, Shattell says, “is just terrible—we haven’t made much progress.”

“但我们姑且称之为歧视吧。”沙特尔说，心理健康领域的许多人忽视患有精神疾病的同事的经历的程度“太可怕了——我们没有取得太大进展。”

Another colleague, Durham University’s Felicity Callard, sees the same thing.

另一位同事、杜伦大学的菲丽西蒂·卡拉德 (Felicity Callard) 也有同样的看法。

She says professionals who meet a colleague of lived experience at conferences or meetings tend to reduce the person in their minds to “an exemplar of a patient.” Even superb presentations “become simply the testimony of someone who has used psychiatric services.”

她说，专业人士在会议或会议上遇到有生活经验的同事时，往往会将他们心目中的人简化为“病人的典范”。即使是出色的演讲“也只是使用过精神病服务的人的证词”。

But the power of Jones’ thought and presence, Callard says, “makes it very hard to turn Nev into an n of one.” And to the extent such prejudice rises from fear that the once-mad colleague will ignore realities they’d rather not face, Jones’ willingness to confront not just her own experience but seemingly any contradiction, whether in herself or others, simply overrides it.

但卡拉德说，琼斯的思想和存在的力量“使得内夫很难变成一个n合一的人”。在某种程度上，这种偏见是由于担心曾经疯狂的同事会忽视他们不愿面对的现实而产生的，琼斯不仅愿意面对自己的经历，而且愿意面对任何看似矛盾的事情，无论是在她自己还是其他人身上，她都把它压倒了。

This galvanizes others who’ve suffered psychosis.

这激励了其他患有精神病的人。

“She shows what might be possible,” Callard says.

“她展示了一切的可能性，”卡拉德说。

“She enables others to feel things can be said that we thought couldn’t be said.”

“她让其他人感受到我们认为不能说的事情可以说。”

The first time I met Nev Jones, in 2015, we sat in a Starbucks in Boston, and she described how hard it was to watch, a few years earlier, her relative Alex emerge from and then fall back into psychosis.

2015 年，我第一次见到内夫·琼斯 (Nev Jones)，我们坐在波士顿的一家星巴克，她描述了几年前，看着她的亲戚亚历克斯 (Alex) 摆脱精神病，然后又陷入精神病是多么困难。

This happened when Alex’s brother became terminally ill.

这发生在亚历克斯的兄弟病入膏肓时。

Alex, not well then, showed zero emotion on hearing this news, and showed none even when discussing the doomed man’s fate right in front of him.

亚历克斯当时身体不太好，听到这个消息时表情为零，甚至在讨论面前这个注定要失败的人的命运时也没有表现出任何情绪。

Yet while Alex’s brother was still alive but close to his end, Alex went back on medication.

然而，当亚历克斯的兄弟还活着但已接近生命尽头时，亚历克斯又开始接受药物治疗。

The medication wrought an immediate change.

药物立即带来了变化。

Jones, visiting Alex’s brother, watched as Alex, with a face full of sadness and sympathy, touched the cheek of this dying brother as tenderly as one person can touch another.

琼斯探望亚历克斯的兄弟，看着亚历克斯一脸悲伤和同情，像一个人可以触摸另一个人一样温柔地抚摸着这个垂死的兄弟的脸颊。

Jones beheld again the loving, open person she had known as a child.

琼斯再次看到了她小时候认识的那个充满爱心、开放的人。

When Alex later relapsed into madness, Jones wept for days.

当亚历克斯后来再次陷入疯狂时，琼斯哭了好几天。

Many months after Jones told me this, as I was finishing the reporting for this story, I thought about that conversation and emailed Jones to ask one last question: Did she ever worry about relapses?

琼斯告诉我这件事几个月后，当我完成这个故事的报道时，我想起了那次谈话，并给琼斯发了电子邮件问最后一个问题：她是否担心旧病复发？

In the U.S., one in 10 people diagnosed with schizophrenia eventually commits suicide.

在美国，十分之一的被诊断患有精神分裂症的人最终自杀。

“They kill themselves,” says Roberta Payne, the author of the extraordinary memoir Speaking to My Madness , “because they can’t stand the pain anymore.” Back in 2009 and 2010, Jones had nearly joined them.

“他们自杀了，”非凡的回忆录《对我的疯狂说话》的作者罗伯塔·佩恩说，“因为他们再也无法忍受痛苦了。”早在2009年和2010年，琼斯就差点加入他们的行列。

Yet when I asked her about relapses, she said she had pretty much stopped worrying about getting sick again.

然而，当我问她复发的情况时，她说她几乎不再担心再次生病了。

She knew it could happen.

她知道这可能会发生。

But she had become too busy to worry about relapses, and it was no use worrying anyway.

但她已经太忙了，无暇担心旧病复发，而且担心也没用。

“If your experience includes ‘psychosis,'” she wrote, “that becomes a part of who you are.

“如果你的经历包括‘精神病’，”她写道，“那就会成为你的一部分。

It’s now a core part of my identity.

现在它是我身份的核心部分。

It has given me such a strong sense of purpose.” She doesn’t mind, for instance, that she still experiences some stretches and wrinkles in reality’s fabric.

它给了我如此强烈的使命感。”例如，她并不介意她仍然会在现实的结构中经历一些拉伸和皱纹。

She accepts an occasional soft sidewalk or vaporous wall.

她偶尔会接受柔软的人行道或蒸汽墙。

She can talk to someone and not fret if their words seem to take a moment to reach her ears.

她可以与某人交谈，如果他们的话似乎需要一段时间才能传到她的耳朵，她也不会担心。

“It’s like a heightened form of what they tell you before your first violin recital,” she told me.

“这就像他们在你第一次小提琴演奏会之前告诉你的内容的一种强化形式，”她告诉我。

“If you mess up, keep going.

“如果你搞砸了，那就继续吧。

People are only going to notice if you stop playing.”

只有当你停止打球时，人们才会注意到。”

A version of this story originally appeared in the October 2017 issue of Pacific Standard.

这个故事的一个版本最初出现在《太平洋标准》2017 年 10 月号上。