Depression, the secret we share | Andrew Solomon

翻译人员: Wei Wu 校对人员: Tingting Zhao

"I felt a Funeral, in my Brain,

“我的脑海中，进行着一场葬礼，

and Mourners to and fro

悼念者络绎不绝

kept treading -- treading -- till [it seemed]

不停的走着, 踩踏着

直到仪式的氛围渐浓

that Sense was breaking through --

And when they all were seated,

当所有人入座

a Service, like a Drum --

仪式开始， 敲鼓的声音

kept beating -- beating -- till I [thought]

沉重有力，敲打着, 敲打着

直到我的意识变得麻木

my Mind was going numb --

And then I heard them lift a Box and creak across my Soul

我听见他们抬起棺材

沉重的脚步， 摇摇晃晃

with those same Boots of Lead, again,

我的灵魂， 吱呀作响

then Space -- began to toll,

四周， 丧钟响起

As [all] the Heavens were a Bell, and Being, [but] an Ear,

天堂， 就像一个铃铛

存在， 那么就是一只耳朵

and I, and Silence, some strange Race,

安静的我， 如同异类

wrecked, solitary, here --

在此孤独， 在此腐朽

[And] then a Plank in Reason, broke,

失去依靠， 理性开始崩塌

and I fell down and down --

我从高处坠落

and hit a World, at every plunge,

跌入一个又一个世界

and Finished knowing -- then --"

终于， 看清

We know depression through metaphors.

我们能够在一些文学作品中看到抑郁的影子

Emily Dickinson was able to convey it in language,

艾米莉·迪金森（美国十九世纪著名女诗人）通过诗歌诠释它

Goya in an image.

戈雅（西班牙画家）通过绘画表达

Half the purpose of art is to describe such iconic states.

许多艺术作品产生的初衷

就是为了表达这充满象征意义的状态

As for me, I had always thought myself tough,

就我自己来说，我一度认为自己非常坚强

one of the people who could survive

认为自己是那一类即使被送去集中营

if I'd been sent to a concentration camp.

也可以存活下来的人

In 1991, I had a series of losses.

1991年，我经历了一连串的不幸

My mother died,

母亲去世

a relationship I'd been in ended,

爱情终结

I moved back to the United States from some years abroad,

我也在几年的海外生活之后

回到了美国

and I got through all of those experiences intact.

我在经历了这一切之后依旧安然无恙

But in 1994, three years later,

然而在1994年，也就是三年之后

I found myself losing interest in almost everything.

我突然发现自己对几乎所有的事情都失去了兴趣

甚至不愿意去做那些

I didn't want to do any of the things I had previously wanted to do,

我曾经很想去做的事情

and I didn't know why.

我不知道这是为什么

The opposite of depression is not happiness, but vitality.

抑郁的反面

并非快乐，而是活力

而正是这样的活力

And it was vitality

that seemed to seep away from me in that moment.

似乎就在那段时间从我的身体中慢慢消失了

Everything there was to do seemed like too much work.

所有需要完成的事情

都感觉那么麻烦

I would come home

回到家的时候

and I would see the red light flashing on my answering machine,

看着电话留言机上闪烁的红灯

and instead of being thrilled to hear from my friends,

我不但不会因为听到朋友们的声音感到兴奋

I would think,

反而会想

"What a lot of people that is to have to call back."

怎么有这么多人等我回电话

Or I would decide I should have lunch,

有时该吃午饭了

and then I would think, but I'd have to get the food out

我却开始想，我还得把食物拿出来

and put it on a plate

放到盘子里

and cut it up and chew it and swallow it,

得切，得嚼，得咽

and it felt to me like the Stations of the Cross.

让我感觉就像耶稣受难一样

And one of the things that often gets lost in discussions of depression

人们在谈论抑郁时

时常忽略了一点

is that you know it's ridiculous.

那就是你知道这一切都很荒谬

You know it's ridiculous while you're experiencing it.

即使你正处在抑郁之中， 你也知道这一切都很荒谬

You know that most people manage

你知道多数人都可以让自己

to listen to their messages and eat lunch

去听语音留言，去吃午餐

and organize themselves to take a shower

紧接着让自己冲个澡

and go out the front door

然后出门

and that it's not a big deal,

你知道这根本不是什么大不了的事情

and yet you are nonetheless in its grip

然而你已经被它掌控

and you are unable to figure out any way around it.

并且无法找到任何解决的方式

And so I began to feel myself doing less

于是我开始感到自己事情做得越来越少

and thinking less

思考得越来越少

and feeling less.

感知得越来越少

It was a kind of nullity.

就好像整个人已经没什么价值了

And then the anxiety set in.

紧接着焦虑就来了

If you told me that I'd have to be depressed for the next month,

如果你告诉我

我会在接下来的一个月里一直抑郁

I would say, "As long I know it'll be over in November, I can do it."

我会说，“只要一个月之后不抑郁了我就可以接受。”

But if you said to me,

但如果你告诉我

"You have to have acute anxiety for the next month,"

“你会在接下来的一个月里严重焦虑。”

那么我宁可割腕也不愿意忍受

I would rather slit my wrist than go through it.

It was the feeling all the time

这是一种持续的感觉

like that feeling you have if you're walking

就好像你走在路上

and you slip or trip and the ground is rushing up at you,

滑倒了或者绊倒了

地面猛冲向你的感觉

but instead of lasting half a second, the way that does,

但这种感觉不是半秒钟

it lasted for six months.

而是持续6个月

It's a sensation of being afraid all the time

这是一种时时刻刻感到惧怕

but not even knowing what it is that you're afraid of.

却不知道自己在惧怕什么的感觉

And it was at that point that I began to think

就在那时我开始想

that it was just too painful to be alive,

活着太痛苦了

and that the only reason not to kill oneself

人不自杀的唯一原因

was so as not to hurt other people.

是因为不想伤害身边的人

And finally one day, I woke up

终于有一天，我醒来的时候

and I thought perhaps I'd had a stroke,

我觉得我可能中风了

because I lay in bed completely frozen,

因为我躺在床上整个人是完全僵硬的

looking at the telephone, thinking,

我看着电话，心想

"Something is wrong and I should call for help,"

“不好了，我该打电话求助。”

and I couldn't reach out my arm

但我没办法伸出手去

and pick up the phone and dial.

没有办法拿到电话来拨号

And finally, after four full hours of my lying and staring at it,

终于，在我躺在那盯着电话整整四小时之后

the phone rang,

电话铃响了

and somehow I managed to pick it up,

我不记得自己怎么拿到的电话

and it was my father, and I said,

是我父亲打来的

我说，“我现在遇到大麻烦了，

"I'm in serious trouble. We need to do something."

我们必须做点什么。”

The next day I started with the medications and the therapy.

第二天我开始吃药

开始接受治疗

And I also started reckoning with this terrible question:

与此同时我开始思考

一个可怕的问题

If I'm not the tough person

如果我不是那种坚强到

who could have made it through a concentration camp,

即使被送去集中营也可以存活下来的人

then who am I?

那么我是谁呢？

And if I have to take medication,

如果我需要吃药的话

is that medication making me more fully myself,

那么药物是让我变得更像自己

or is it making me someone else?

还是让我更不像自己？

And how do I feel about it if it's making me someone else?

如果会让我变得像别人

那么我又如何感觉到这点呢？

在这个抗争的过程中我有两个优势

I had two advantages as I went into the fight.

The first is that I knew that, objectively speaking,

首先是我很清楚，客观地说

I had a nice life,

我有一个不错的生活条件

and that if I could only get well,

如果我能好起来

there was something at the other end that was worth living for.

那么最终是会有一些东西

值得我去为之而活的

And the other was that I had access to good treatment.

另外一点就是我能接受好的治疗

But I nonetheless emerged and relapsed,

但我却不知为何,好转了又复发

and emerged and relapsed,

又好转，又复发

and emerged and relapsed,

再好转，再复发

and finally understood

最后我才意识到

I would have to be on medication and in therapy forever.

我必须一辈子

依赖药物以及治疗

And I thought,

于是我想，“但这到底是一个化学问题

"But is it a chemical problem or a psychological problem?

还是一个心理问题？

And does it need a chemical cure or a philosophical cure?"

这到底需要化学疗法还是心理疗法（原话为“哲学”）呢？”

And I couldn't figure out which it was.

我无法找到问题的答案

And then I understood that actually,

然后我明白了

we aren't advanced enough in either area for it to explain things fully.

事实上我们对这两个领域的了解都还不够

都还不足以完全弄清真相

The chemical cure and the psychological cure

化学治疗和心理治疗

both have a role to play,

都发挥着重要的作用

and I also figured out that depression was something

我也发现抑郁是这样一个东西

深深的嵌入在我们的体内

that was braided so deep into us

that there was no separating it from our character and personality.

我们无法将它彻底剥离

它已经嵌入到我们的性格和个性中了

I want to say that the treatments we have for depression are appalling.

我想说现在我们所用的

治疗抑郁症的方法太可怕了

这些方法没有什么效果

They're not very effective.

They're extremely costly.

还非常昂贵

They come with innumerable side effects.

并且伴随着无数的副作用

They're a disaster.

它们简直就是灾难

但我很感激我活在当下

But I am so grateful that I live now and not 50 years ago,

而不是50年前

when there would have been almost nothing to be done.

那个时候还不存在

有效的方法

I hope that 50 years hence,

我希望50年后

people will hear about my treatments

人们听到我接受的治疗方法

会震惊于竟然有人愿意忍受

and be appalled that anyone endured such primitive science.

如此原始简单的科学

Depression is the flaw in love.

抑郁是爱的附属品

If you were married to someone and thought,

如果你跟一个人结婚了，然后想

"Well, if my wife dies, I'll find another one,"

“好吧，如果我的妻子去世了，我会找一个新的，”

it wouldn't be love as we know it.

那么据我们所知这不叫爱

There's no such thing as love without the anticipation of loss,

没有这样一种爱情

可以只感受幸福而不体验失去

and that specter of despair can be the engine of intimacy.

这种绝望的幽灵

会成为亲密关系的动力

There are three things people tend to confuse:

有三种东西是人们容易混淆的

depression, grief and sadness.

抑郁，悲伤，难过

Grief is explicitly reactive.

悲伤是一种明确的反应

If you have a loss and you feel incredibly unhappy,

如果你遭遇了不幸并感到极度不快乐

and then, six months later,

紧接着六个月以后

you are still deeply sad, but you're functioning a little better,

你还是非常难过，但是生活大致正常了

这很有可能是悲伤

it's probably grief,

and it will probably ultimately resolve itself in some measure.

而且它很有可能在最终

一定程度地自我恢复

If you experience a catastrophic loss,

如果你经历了一次灾难性的打击

and you feel terrible,

然后感觉非常糟糕

and six months later you can barely function at all,

并且六个月之后你依然无法正常生活

then it's probably a depression that was triggered

那么很有可能就是你的抑郁

被这种灾难性的情形触发了

by the catastrophic circumstances.

The trajectory tells us a great deal.

这中变化的过程告诉我们很多信息

People think of depression as being just sadness.

人们往往认为抑郁只是难过而已

It's much, much too much sadness,

只是太多太多的难过

much too much grief

太多的悲伤

at far too slight a cause.

起因却微不足道

As I set out to understand depression,

当我开始着手了解抑郁

and to interview people who had experienced it,

并且采访那些有过这样经历的人时

I found that there were people who seemed, on the surface,

我发现有些人

从表面上看来

to have what sounded like relatively mild depression

好像是比较轻微的抑郁

却已经因此彻底丧失行为能力了

who were nonetheless utterly disabled by it.

And there were other people who had what sounded

另一些人

as they described it like terribly severe depression

从他们的描述中得知他们

经历了非常严重的抑郁

who nonetheless had good lives

他们却能够在抑郁发作的间隙

in the interstices between their depressive episodes.

过着不错的生活

And I set out to find out what it is that causes some people

于是我开始研究

到底是什么

to be more resilient than other people.

使一些人比另一些人能更好地适应

What are the mechanisms that allow people to survive?

是什么样的机制

让这些人能够幸免？

And I went out and I interviewed person after person

于是我去探访了一个又一个

who was suffering with depression.

经历过抑郁的人

One of the first people I interviewed

我第一批采访的人中有一个人

把抑郁描述为

described depression as a slower way of being dead,

一种缓慢的死亡方式

and that was a good thing for me to hear early on

这种说法最初在我听来是好的

because it reminded me that that slow way of being dead

因为这告诉我

缓慢的死亡方式

can lead to actual deadness,

是会以真正的死亡结束的

that this is a serious business.

这不是说着玩的

It's the leading disability worldwide,

这是世界上导致机能障碍的主要原因之一

and people die of it every day.

每天都有人因此死去

One of the people I talked to when I was trying to understand this

在我试图了解这些的时候

其中一个我采访的人

was a beloved friend who I had known for many years,

是我的挚友

我们已经相识很多年了

and who had had a psychotic episode in her freshman year of college,

她曾经在她大学入学的那一年

有过精神病发作

and then plummeted into a horrific depression.

之后陷入了可怕的抑郁

She had bipolar illness,

她患有双相情感障碍

or manic depression, as it was then known.

当时叫做躁郁症

And then she did very well for many years on lithium,

她经过多年的化学治疗

病情控制得很好

于是后来，

and then eventually, she was taken off her lithium

她尝试停止化学治疗

to see how she would do without it,

想看看能够独立的支撑下来

and she had another psychosis,

她却精神病复发

and then plunged into the worst depression that I had ever seen

并且陷入了我所见过的

最严重的抑郁

in which she sat in her parents' apartment,

她在父母的公寓里坐着

more or less catatonic, essentially without moving,

多少有些紧张症的样子，几乎一动不动

day after day after day.

日复一日都是如此

And when I interviewed her about that experience some years later --

当我几年之后采访她那段经历时

she's a poet and psychotherapist named Maggie Robbins --

她叫玛吉·罗宾斯，诗人，精神治疗医师

when I interviewed her, she said,

当我采访她的时候她说

"I was singing 'Where Have All The Flowers Gone,'

“我一遍一遍地唱着‘花儿去向何处’

over and over, to occupy my mind.

来占据我的头脑

I was singing to blot out the things my mind was saying,

来清除我头脑中不停重复的话语

which were, 'You are nothing. You are nobody.

‘你一文不值，你这个无名小辈，

你根本不配活在这世上。’

You don't even deserve to live.'

And that was when I really started thinking

那时候我真正开始

有了自杀的想法。”

about killing myself."

You don't think in depression that you've put on a gray veil

你没有意识到自己抑郁， 但是

你已经戴上了一层灰色的面纱

and are seeing the world through the haze of a bad mood.

并且是透过这层坏情绪的薄纱

来看待这个世界的

You think that the veil has been taken away,

你认为是快乐的面纱

被摘掉了

the veil of happiness,

and that now you're seeing truly.

这样你可以看得更加真实

It's easier to help schizophrenics who perceive

相对而言帮助精神分裂症患者更容易

that there's something foreign inside of them that needs to be exorcised,

他们认为自己身体里面有某些异质

需要被驱除

but it's difficult with depressives,

但对于抑郁症患者来说这很难

because we believe we are seeing the truth.

因为我们坚信自己看到的是事实

But the truth lies.

但事实是会说谎的

I became obsessed with that sentence:

我非常喜欢这句话

"But the truth lies."

“事实是会说谎的。”

And I discovered, as I talked to depressive people,

当我与抑郁症患者交谈时我发现

that they have many delusional perceptions.

他们有很多妄想出来的念头

People will say, "No one loves me."

人们会说，“没人爱我。”

And you say, "I love you,

然后你说，“我爱你，

your wife loves you, your mother loves you."

你的妻子爱你，你的母亲爱你。”

You can answer that one pretty readily, at least for most people.

你可以很快给出这个答案

至少对大多数人是如此

但是抑郁的人还会说

But people who are depressed will also say,

"No matter what we do, we're all just going to die in the end."

“不论我们做什么，

最终都是要死的。”

Or they'll say, "There can be no true communion

或者他们说，“两个人之间

between two human beings.

是不可能有真正的亲密交往的，

Each of us is trapped in his own body."

我们每个人都被自己的身体所束缚了。“

To which you have to say,

对于这个你只有回应说

"That's true,

”这点没错，

but I think we should focus right now on what to have for breakfast."

但我觉得我们眼下要考虑的

是早上该吃什么。“

(Laughter)

（笑声）

A lot of the time,

许多时候

what they are expressing is not illness, but insight,

困扰他们的不是疾病本身， 而是对一些事实的偏执

and one comes to think what's really extraordinary

他们会对一些事实超乎常人的在意

is that most of us know about those existential questions

但是对于我们绝大多数人而言

并不在意这些有关存在的问题

and they don't distract us very much.

There was a study I particularly liked

我有一个特别喜欢的研究

in which a group of depressed and a group of non-depressed people

是要一组抑郁症患者

和一组非抑郁症患者

分别打一小时的电子游戏

were asked to play a video game for an hour,

and at the end of the hour,

一小时结束的时候问他们

they were asked how many little monsters they thought they had killed.

他们认为自己

杀了多少只小怪兽

抑郁组的答案往往准确

The depressive group was usually accurate to within about 10 percent,

误差不超过百分之十

and the non-depressed people

而非抑郁组的人

guessed between 15 and 20 times as many little monsters --

估计的小怪兽数量

却是实际杀掉的

(Laughter)

15到20倍

as they had actually killed.

A lot of people said, when I chose to write about my depression,

当我决定写下自己的抑郁经历时，许多人说

that it must be very difficult to be out of that closet,

要揭开这个秘密让别人知道

一定非常不容易

to have people know.

他们说，”人们会用不一样的口吻跟你说话吗？“

They said, "Do people talk to you differently?"

I said, "Yes, people talk to me differently.

我说，”是的，人们用不一样的口吻跟我说话。

They talk to me differently insofar

这种不一样体现在

as they start telling me about their experience,

人们会告诉我他们自己的经历

or their sister's experience,

或是他们的兄弟姐妹的经历

or their friend's experience.

或是他们朋友的经历

Things are different because now I know

我现在明白， 每个家庭

that depression is the family secret that everyone has.

都埋藏着一个抑郁的故事

着改变了我的看法

I went a few years ago to a conference,

几年前我去参加一个学术会议

and on Friday of the three-day conference,

连开三天， 第一天是周五

one of the participants took me aside, and she said,

一个与会者把我叫到一边， 她说

"I suffer from depression and I'm a little embarrassed about it,

“我有抑郁症

我为此有点难为情

而且我一直在吃某种药物

but I've been taking this medication,

and I just wanted to ask you what you think?"

我只是想问问看你的意见？”

我但是尽我所能给了一些建议

And so I did my best to give her such advice as I could.

And then she said, "You know, my husband would never understand this.

之后她说， “其实，

我的丈夫并不知道这件事情

He's really the kind of guy to whom this wouldn't make any sense,

他是那种无法理解这种事情的人

所以， 嗯， 我们的谈话能否保密。”

so, you know, it's just between us."

And I said, "Yes, that's fine."

我说， “好， 没有问题。”

On Sunday of the same conference,

周日开会的时候

her husband took me aside,

她的丈夫把我叫到了一边

(Laughter)

and he said, "My wife wouldn't think

对我说， “我的妻子并不知道

that I was really much of a guy if she knew this,

我跟她了解的那个我之间的不同

but I've been dealing with this depression and I'm taking some medication,

我有抑郁症， 有一段时间了

我现在需要吃一些药物维持

and I wondered what you think?"

我想听听你的看法？”

They were hiding the same medication

他们两个人

服用同一种药物， 并且将药物藏在

in two different places in the same bedroom.

同一个卧室的不同的地方

(Laughter)

于是我对他说

And I said that I thought communication within the marriage

我觉得婚姻内部的沟通问题

might be triggering some of their problems.

可能是他抑郁的原因之一

(Laughter)

（笑声）

But I was also struck

让我感到震惊的

是人们想要保守这样的秘密

by the burdensome nature of such mutual secrecy.

并因此成熟的沉重负担

Depression is so exhausting.

抑郁让人精疲力尽

It takes up so much of your time and energy,

它会消耗掉你几乎全部的时间和精力

and silence about it,

而对此保持沉默

it really does make the depression worse.

只会让抑郁的症状变得更加严重

And then I began thinking

我开始考虑所有可能的途径

about all the ways people make themselves better.

帮助抑郁的人们变得好一些

I'd started off as a medical conservative.

我在治疗方法上，一开始是很保守的

I thought there were a few kinds of therapy that worked,

我觉得只有少数几种疗法是有效的

it was clear what they were --

就那么几种——

there was medication,

药物治疗

there were certain psychotherapies,

几类特定的精神疗法

there was possibly electroconvulsive treatment,

电休克疗法有时候有效果

其它所有的方法都是扯淡

and that everything else was nonsense.

But then I discovered something.

但是后来我的看法变了

If you have brain cancer,

如果你的脑子里长了肿瘤

and you say that standing on your head for 20 minutes every morning

然后你觉得自己每天早晨

倒立20分钟会让自己感觉好一些

makes you feel better,

it may make you feel better, but you still have brain cancer,

或许让你自己感觉好一些

但是你的脑瘤还在那里

and you'll still probably die from it.

你还是可能因此死去

But if you say that you have depression,

但是如果你患上了抑郁

and standing on your head for 20 minutes every day

然后你觉因为每天倒立20分钟

感觉好一些，那是有一定效果的

makes you feel better, then it's worked,

because depression is an illness of how you feel,

因为抑郁是你的感觉和情绪出了问题

and if you feel better,

如果你感觉好一些了

then you are effectively not depressed anymore.

那么你的抑郁就会少一些

所以我现在变得非常的宽容

So I became much more tolerant

各种奇怪的偏门疗法我都能接受了

of the vast world of alternative treatments.

And I get letters, I get hundreds of letters

我收到了成百上千的邮件

from people writing to tell me about what's worked for them.

人们写信跟我分享他们使用的治疗方法

就在刚才还有人在幕后问我

Someone was asking me backstage today about meditation.

关于药物治疗的事情

My favorite of the letters that I got was the one that came from a woman

有一封邮件提供的方法我很喜欢

是一位女士写给我的

who wrote and said that she had tried therapy, medication,

她尝试过心理疗法，不管用

药物疗法，也不行，各种方法都尝试了，还是不行

she had tried pretty much everything,

最后她自己发现了一个方法，她希望我告诉全世界

and she had found a solution and hoped I would tell the world,

她认为最好的疗法是用纱线做一些小制品

and that was making little things from yarn.

(Laughter)

（笑声）

She sent me some of them.

她还给我邮寄了一些（笑声）

(Laughter)

And I'm not wearing them right now.

我现在没穿在身上

(Laughter)

I suggested to her that she also should look up

我建议她再去医院查查

obsessive compulsive disorder in the DSM.

看看有没有强迫症（译注：演讲者在开玩笑）

And yet, when I went to look at alternative treatments,

当我去了解其它偏门疗法时

I also gained perspective on other treatments.

我也接触到了其它疗法的不同的视角

I went through a tribal exorcism in Senegal

我研究过塞内加尔一个部落的净化仪式

that involved a great deal of ram's blood

他们在仪式中使用了大量的公羊血

and that I'm not going to detail right now,

这里我就不详细讲了

but a few years afterwards I was in Rwanda,

但是几年之后，当我去卢旺达

working on a different project,

参与另一个项目时

and I happened to describe my experience to someone,

我向一个当地人介绍了那个仪式

and he said,

他说，“嗯，你知道

"Well, that's West Africa, and we're in East Africa,

那是西非，我们这里是东非

and our rituals are in some ways very different,

我们的宗教仪式有一些不同的地方

but we do have some rituals

但是我们也有一些地方是共通的

that have something in common with what you're describing."

（我们的方法）跟你描述的那种有些相似

然后我说，“哦”。 他说，“是的”，然后他继续说道

And he said,

"But we've had a lot of trouble with Western mental health workers,

但是西方世界跑过来的心理治疗师给我们添了不少麻烦

尤其是那些大屠杀之后跑来的心理医生们 （译注：指1990年代卢旺达大屠杀）

especially the ones who came right after the genocide."

于是我问他，“什么麻烦？”

I said, "What kind of trouble did you have?"

他说，“是这样的

And he said, "Well, they would do this bizarre thing.

他们做的事情很古怪

They didn't take people out in the sunshine

他们并不会让人去阳光下活动

虽然这会让人感觉舒服

where you begin to feel better.

They didn't include drumming or music to get people's blood going.

他们不使用音乐或打鼓的方式激发人们的情绪

They didn't involve the whole community.

他们不会让整个社区参与其中

They didn't externalize the depression as an invasive spirit.

他们也没有将抑郁外显化为一种恶灵

进行驱逐

Instead what they did was they took people one at a time into dingy little rooms

相反的，他们将那些（抑郁的）人单独地

带到一个昏暗的小房间

and had them talk for an hour

花一个小时

about bad things that had happened to them."

让他们回忆发生在他们身上的悲惨的事情。”

(Laughter)

（笑声）（掌声）

(Applause)

He said, "We had to ask them to leave the country."

他说，“我们只能请他们离开这个国家了。”

(Laughter)

（笑声）

Now at the other end of alternative treatments,

现在，我想分享另外一种替代的疗法

弗兰克·若萨克夫接受了这种替代疗法

let me tell you about Frank Russakoff.

弗兰克的抑郁症可能是我见过的

Frank Russakoff had the worst depression perhaps that I've ever seen in a man.

最严重的抑郁症之一

He was constantly depressed.

他一直处于抑郁状态

He was, when I met him,

当我刚见到他的时候

at a point at which every month, he would have electroshock treatment.

他每个月都要接受电休克治疗

Then he would feel sort of disoriented for a week.

所以他每个月第一周会被电的迷迷糊糊

Then he would feel okay for a week.

第二周变得正常起来

Then he would have a week of going downhill.

第三周开始情绪又开始走下坡路

And then he would have another electroshock treatment.

然后他就会寻求下一次电休克治疗

当我开始见到他的时候，他说

And he said to me when I met him,

"It's unbearable to go through my weeks this way.

“这种（电休克的）周期对于我而言是无法避免的

我不能这么下去了

I can't go on this way,

and I've figured out how I'm going to end it

我知道如果我不能够变好起来

if I don't get better."

意味着什么

"But," he said to me, "I heard about a protocol at Mass General

“但是”， 他对我说，

“我听说麻省总院最近在进行医疗实验，

for a procedure called a cingulotomy, which is a brain surgery,

实验一种脑手术，叫扣带回切开术

and I think I'm going to give that a try."

我想我会去尝试一下。”

And I remember being amazed at that point to think that someone

我至今都记得当时我听到后的惊喜的心情

想想这样一个人

who clearly had so many bad experiences

经历了如此多的悲惨经历

with so many different treatments

忍受了那么多的治疗方法

still had buried in him, somewhere, enough optimism

骨子里依然有一种与生俱来的乐观

to reach out for one more.

要去尝试新的东西

And he had the cingulotomy, and it was incredibly successful.

后来他做了扣带回切开术

出乎意料地成功

He's now a friend of mine.

他跟我现在成为了朋友

He has a lovely wife and two beautiful children.

他有一个可爱的妻子和两个漂亮的小孩

He wrote me a letter the Christmas after the surgery,

那次手术的圣诞节后，他写了一封信给我

and he said,

他说

"My father sent me two presents this year,

“我的父亲今年寄给我两件礼物

First, a motorized CD rack from The Sharper Image

一个是某个品牌的车载CD架

that I didn't really need,

我不是很需要

but I knew he was giving it to me to celebrate

但是我知道他是给我这个的目的

the fact that I'm living on my own and have a job I seem to love.

是想要庆祝一下，我可以重新开始

并且有了一份喜欢的工作

And the other present was a photo of my grandmother,

另外一件礼物

是我外婆的一张照片

who committed suicide.

她自杀了

As I unwrapped it, I began to cry,

当我拆开包装的时候，我开始哭泣

and my mother came over and said,

我的妈妈过来问道

'Are you crying because of the relatives you never knew?'

‘你哭是因为你从来没有见过外婆么？’

我说，‘不，是因为她的痛苦，我同样经历过。’

And I said, 'She had the same disease I have.'

I'm crying now as I write to you.

写这封信的现在，我又忍不住哭泣

It's not that I'm so sad, but I get overwhelmed,

不是因为悲伤，而是因为我再也无法承受

I think, because I could have killed myself,

我想我曾经也可能会自杀

but my parents kept me going, and so did the doctors,

但是我的父母给了我勇气

还有治疗我的医生们

and I had the surgery.

还有这个手术

I'm alive and grateful.

我活着，心怀感恩

We live in the right time, even if it doesn't always feel like it."

我们活在美好的时代

虽然有时候看起来很糟。”

I was struck by the fact that depression

我很不能理解为什么

is broadly perceived to be a modern, Western, middle-class thing,

人们普遍的把抑郁症看成是

现代西方中产阶级特有的一种病

and I went to look at how it operated in a variety of other contexts,

于是我开始寻找抑郁症

与其它社会因素的关联

and one of the things I was most interested in

在可能相关的社会因素中

was depression among the indigent.

我对贫困和抑郁的关系特别感兴趣

于是我做了一些研究

And so I went out to try to look

at what was being done for poor people with depression.

尝试去了解穷人是如何治疗抑郁的

And what I discovered is that poor people

我发现大多数情况下

are mostly not being treated for depression.

穷人的抑郁症不会得到治疗

抑郁属于基因的缺陷

Depression is the result of a genetic vulnerability,

which is presumably evenly distributed in the population,

这意味着在不同的人群中容易抑郁的人的比例应该是一样的

and triggering circumstances,

生活环境的不同导致了发病率的不同

which are likely to be more severe for people who are impoverished.

而当人们处于贫困的生活环境中时

抑郁症的发病率更高, 也更严重

And yet it turns out that if you have a really lovely life

但是, 如果你的生活一帆风顺

然后你觉得自己一直都不开心

but feel miserable all the time,

you think, "Why do I feel like this?

你会反思, "我为什么不开心?"

I must have depression."

"我一定是抑郁了."

And you set out to find treatment for it.

然后你会去找医生给你治疗

但是如果你的生活本来就很糟糕

But if you have a perfectly awful life,

and you feel miserable all the time,

然后你一直都不开心

the way you feel is commensurate with your life,

你的感觉和你的生活状态是相称的

and it doesn't occur to you to think,

于是你就不会想到这个是病

"Maybe this is treatable."

"或许这个可以治疗一下"

And so we have an epidemic in this country

所以实际上我们这个国家的低收入人群中

of depression among impoverished people

抑郁症像是传染病一样流行

that's not being picked up and that's not being treated

但是却一直没有被人注意过, 没有人评估过患病的规模

and that's not being addressed,

也没有人为这些低收入者提供治疗

and it's a tragedy of a grand order.

这是非常大的一个悲剧

And so I found an academic

后来我发现了一位研究人员

who was doing a research project in slums outside of D.C.,

她当时正在华盛顿特区周边的贫民窟中

做与之相关的一项研究

where she picked up women who had come in for other health problems

当有妇女前来看其它的疾病时, 她会邀请这些妇女

and diagnosed them with depression,

做一个抑郁症的诊断

同时提供一份六个月的实验协议

and then provided six months of the experimental protocol.

One of them, Lolly, came in,

其中有一位女士, 名叫洛莉

and this is what she said the day she came in.

以下是她第一天到诊所来的自述

她说她是一位母亲

She said, and she was a woman, by the way, who had seven children.

7个孩子的母亲, 她说,

She said, "I used to have a job but I had to give it up

"我曾经有一份工作, 但是不得不辞掉了"

because I couldn't go out of the house.

"因为我无法离开我的屋子"

我一句话都不想跟我的孩子们说

I have nothing to say to my children.

In the morning, I can't wait for them to leave,

早晨, 我迫不及待的让孩子们出门上学

and then I climb in bed and pull the covers over my head,

然后立刻爬上床蒙头大睡

然后下午三点他们就陆续回家了

and three o'clock when they come home,

时间过得太快了

it just comes so fast."

She said, "I've been taking a lot of Tylenol,

她说, "我已经吃了很多的泰诺(一种止痛药)"

anything I can take so that I can sleep more.

以及其它所有能够让我多睡一会儿的东西

My husband has been telling me I'm stupid, I'm ugly.

我的丈夫一直说我蠢, 说我令人讨厌

I wish I could stop the pain."

我真希望能够结束这痛苦

Well, she was brought into this experimental protocol,

然后她接受了实验协议开始进行治疗

and when I interviewed her six months later,

六个月之后当我去采访她的时候

she had taken a job working in childcare

她有了一份新工作, 在美国海军(的幼儿园)

for the U.S. Navy, she had left the abusive husband,

照看孩子, 她离开了以前那个虐待她的丈夫

她对我说

and she said to me,

我的孩子们现在比以前开心多了

"My kids are so much happier now."

She said, "There's one room in my new place for the boys

她说, 现在我的新家有两个孩子的卧室

男孩子们一间, 女孩子们一间

and one room for the girls,

到了晚上的时候, 他们都会来到我的房间

but at night, they're just all up on my bed,

and we're doing homework all together and everything.

我们一直做家庭作业, 做其它的事情

One of them wants to be a preacher,

一个儿子立志做一名牧师

one of them wants to be a firefighter,

另一个想要做消防队员

and one of the girls says she's going to be a lawyer.

我的一个女儿想要做一名律师

They don't cry like they used to,

他们不像以前那样哭得那么频繁

and they don't fight like they did.

也不再像以前那样相互打来打去了

看着这些孩子, 我现在觉得很满足

That's all I need now, is my kids.

Things keep on changing,

一切都在不断的变好

the way I dress, the way I feel, the way I act.

我的穿着, 我的情绪, 我的言行

I can go outside not being afraid anymore,

我不会再像以前那样害怕出门

and I don't think those bad feelings are coming back,

也不会再担心糟糕的心情会卷土重来

如果没有米兰达医生(那位研究人员)的帮助

and if it weren't for Dr. Miranda and that,

我现在可能还我在家里, 用被子蒙住头呼呼大睡

I would still be at home with the covers pulled over my head,

if I were still alive at all.

或许我已经死了

我曾祈祷上帝为我下凡一位天使

I asked the Lord to send me an angel,

and He heard my prayers."

而上帝听到了我的声音." (译注: 指米兰达博士)

我被这些真实的故事深深打动了

I was really moved by these experiences,

and I decided that I wanted to write about them

我之前计划只是写一本书来记录

not only in a book I was working on, but also in an article,

但是现在我觉得远远不够

我还要写一篇文章(让更多的人知道)

and I got a commission from The New York Times Magazine

所以我跟纽约时报杂志说好

写一篇有关低收入群里中抑郁症的报告

to write about depression among the indigent.

当我写好之后

And I turned in my story,

and my editor called me and said, "We really can't publish this."

我的编辑打电话给我说

我们真的没办法发表这个

然后我问, "为什么?"

And I said, "Why not?"

And she said, "It just is too far-fetched.

她说, "故事太牵强了"

These people who are sort of at the very bottom rung of society

这些人生活在接近社会底层的地方

and then they get a few months of treatment

然后他们经过了六个月的治疗

and they're virtually ready to run Morgan Stanley?

然后他们就可以去管理摩根史坦利了? (译注: 一家知名投资机构)

太没有说服力了

It's just too implausible."

她说, "我从来没有听过这样的事情"

She said, "I've never even heard of anything like it."

And I said, "The fact that you've never heard of it

然后我说, "你从没有听说过"

恰恰说明这个是一个'新闻'

is an indication that it is news."

(Laughter)

(笑声)(掌声)

(Applause)

"And you are a news magazine."

而且你们是一家新闻媒体啊

So after a certain amount of negotiation, they agreed to it.

来回协商了几次之后

他们同意发表了

But I think a lot of what they said was connected in some strange way

但是他们说的话让我想了很多

他们这种态度跟另外一个观点多少有点关系

to this distaste that people still have for the idea of treatment,

即很多人还是反感

抑郁症需要治疗这个观点

the notion that somehow if we went out

好像这就意味着我们会开始

and treated a lot of people in indigent communities,

大规模的开始治疗低收入者

that would be exploitative,

这将是一件带有剥削性质的事情

because we would be changing them.

因为我们是在改造他们

There is this false moral imperative that seems to be all around us,

看起来我们所有的人

都受到一种教条的影响

that treatment of depression,

即治疗抑郁的疗法也好,

the medications and so on, are an artifice,

药物也好, 都是人造的产物

and that it's not natural.

并不是自然的结果

And I think that's very misguided.

我觉得这完全是使入歧途了

It would be natural for people's teeth to fall out,

虽然人老了掉牙是很自然的时候

but there is nobody militating against toothpaste,

但是这并不影响任何人使用牙膏

at least not in my circles.

至少我的周围没有

People then say,

人们可能会接着问, "那么, 抑郁本身

"But isn't depression part of what people are supposed to experience?

不应该是我们注定需要经历的一个过程么

难道抑郁不是我们的演化的结果么

Didn't we evolve to have depression?

难道这不是你个性的一部分么

Isn't it part of your personality?"

To which I would say, mood is adaptive.

对此我的看法是, 情绪是有适应性的

Being able to have sadness and fear

对于我们而言

and joy and pleasure

能够感受喜怒哀乐

and all of the other moods that we have, that's incredibly valuable.

以及其它丰富的情感

意义重大

And major depression

而当一个人总是抑郁的时候, 那一定是

is something that happens when that system gets broken.

他的情绪系统出问题了

It's maladaptive.

不再能够适应环境了

People will come to me and say,

有些人会跟我这样说,

"I think, though, if I just stick it out for another year,

"即便如此, 我想如果我自己再多熬一年"

I think I can just get through this."

我就可以走出抑郁了

And I always say to them, "You may get through it,

对此我总是这样回答, "或许你能够自己走出来,

但是失去的青春你再也找不回了

but you'll never be 37 again.

Life is short, and that's a whole year you're talking about giving up.

人生苦短, 你现在却在跟我说

要浪费一年的时间(自己挺过抑郁)

Think it through."

你再想想

It's a strange poverty of the English language,

关于抑郁这种情感, 英语中用来形容的词出奇地少

and indeed of many other languages,

当然别的语言也多不到哪里去

that we use this same word, depression,

我们用'depression'这一个单词 (译注: 中文可以翻译成'沮丧'或'抑郁')

to describe how a kid feels when it rains on his birthday,

即用来描述一个小孩子

生日那天下大雨的心情

and to describe how somebody feels the minute before they commit suicide.

也用来描述一个自杀者

自杀前一分钟的感觉

People say to me, "Well, is it continuous with normal sadness?"

人们会问, "这是不是就是长时间的悲伤?"

And I say, in a way it's continuous with normal sadness.

某种意义上可以这么理解

There is a certain amount of continuity,

悲伤和抑郁之间有一定的连续性

but it's the same way there's continuity

但是他们之间的连续性就像是

between having an iron fence outside your house

悲伤可以看成是你房子周围的铁栅栏

有一点生锈了

that gets a little rust spot

that you have to sand off and do a little repainting,

你需要用沙纸打磨一下重新喷漆

and what happens if you leave the house for 100 years

但是如果你的房子100年没有人住了

and it rusts through until it's only a pile of orange dust.

那么铁栅栏会锈蚀到只剩下

一堆黄锈

悲伤和抑郁的差别

And it's that orange dust spot,

that orange dust problem,

就好比生了一点锈和锈蚀到什么都没有了

that's the one we're setting out to address.

后者是我们要解决的问题

现在人们会问

So now people say,

你吃了这些快乐丸(指抗抑郁药), 你快乐么

"You take these happy pills, and do you feel happy?"

And I don't.

不

But I don't feel sad about having to eat lunch,

但是我不会因为要吃饭而不开心

and I don't feel sad about my answering machine,

不会因为要回电话而不开心

and I don't feel sad about taking a shower.

不会因为要洗澡而感到不开心

I feel more, in fact, I think,

事实上我觉得自己的感受比以前更多

because I can feel sadness without nullity.

因为我现在能够体会到悲伤, 但是不会感到虚无

I feel sad about professional disappointments,

我会因为工作上的不如意而悲伤

about damaged relationships,

会因为破碎的爱情悲伤

about global warming.

会因为全球变暖而悲伤

Those are the things that I feel sad about now.

这些是我当下能够体会到的悲伤

And I said to myself, well, what is the conclusion?

最后我问自己, "结论是什么呢?"

How did those people who have better lives

为什么有些人的生活条件更好

even with bigger depression manage to get through?

却需要去战胜更严重的抑郁?

What is the mechanism of resilience?

又为什么我们能够康复?

And what I came up with over time

我总是一次次地遇见

was that the people who deny their experience,

抑郁之后的康复者不愿意接受这段经历

and say, "I was depressed a long time ago,

他们会说, "我很久之前抑郁过,

I never want to think about it again,

我再也不想回忆那段时光了

I'm not going to look at it

我也不会再去分析它

and I'm just going to get on with my life,"

我只希望继续自己当下的生活

ironically, those are the people who are most enslaved by what they have.

讽刺的是, 恰恰是这些人

最容易被他们过往经历的纠缠不放

Shutting out the depression strengthens it.

回避抑郁, 只会让它更凶猛

While you hide from it, it grows.

你越躲, 它越强

而另外一些人

And the people who do better

are the ones who are able to tolerate the fact that they have this condition.

他们承认并接纳自己有抑郁这个事实

他们表现得更好一些

能够接纳自己抑郁的人

Those who can tolerate their depression are the ones who achieve resilience.

最终会康复起来

So Frank Russakoff said to me,

弗兰克对我说

"If I had a do-over, I suppose I wouldn't do it this way,

如果一切重新来过

那么我可能会换种处理方式

but in a strange way, I'm grateful for what I've experienced.

但是很奇怪地, 我很感激

感激我经历过的一切

I'm glad to have been in the hospital 40 times.

我很高兴住了40次医院

这段经历让我深刻的理解了什么是爱

It taught me so much about love,

and my relationship with my parents and my doctors

我的爱人, 我的父母, 以及我的医生

has been so precious to me, and will be always."

这对我而言都是巨大的恩赐, 过去是, 将来也是.

And Maggie Robbins said,

玛吉·罗宾斯说

"I used to volunteer in an AIDS clinic,

我在艾滋诊所做过志愿者

and I would just talk and talk and talk,

我跟自己负责的病人

and the people I was dealing with weren't very responsive, and I thought,

不断的说话, 但是

他们的反应并不积极, 然后我想

'That's not very friendly or helpful of them.'"

'是不是对他们来说这样不太友好, 或不管用.'

(Laughter)

"And then I realized,

后来我意识到

I realized that they weren't going to do more

我意识到在第一次见面的简短聊天中

than make those first few minutes of small talk.

他们只要能够坐在那里就好

It was simply going to be an occasion

第一次的聊天实际上是一个机会

where I didn't have AIDS and I wasn't dying,

让他们认识到虽然我没有艾滋病, 我没有等待死亡,

but could tolerate the fact that they did

但是我能够接受他们有艾滋病

and they were.

并不断恶化的事实

Our needs are our greatest assets.

我们的需求是我们最宝贵的财富

后来我学会了

It turns out I've learned to give all the things I need."

如何尽我所能(去帮助他人)

Valuing one's depression does not prevent a relapse,

正视抑郁的价值

并不能保证不再复发

but it may make the prospect of relapse

但是却能改变看待抑郁复发的态度

and even relapse itself easier to tolerate.

甚至会减弱抑郁复发的程度

我们要解决的问题

The question is not so much of finding great meaning

并不是要去找到伟大的意义和决策

and deciding your depression has been very meaningful.

让你的抑郁看起来意义非凡

It's of seeking that meaning and thinking, when it comes again,

而是要去寻找这样的意义

能够让你思考, 当抑郁卷土重来

"This will be hellish, but I will learn something from it."

"这会向下地狱般痛苦,

但是我会受益良多

I have learned in my own depression

我从自己的抑郁中看到

how big an emotion can be,

情绪的作用能够如此之大

how it can be more real than facts,

甚至能够盖过客观存在

而且我发现我的这段经历

and I have found that that experience

has allowed me to experience positive emotion

让我能够更加强烈和专注的

in a more intense and more focused way.

去感受和体会积极向上的情绪

The opposite of depression is not happiness,

抑郁的反面不是快乐

but vitality,

而是活力

and these days, my life is vital,

现在这段时间, 我的生活充满活力

即便我有时会悲伤, 也是如此

even on the days when I'm sad.

I felt that funeral in my brain,

我看到自己的脑海中也进行着一场葬礼

and I sat next to the colossus at the edge of the world,

我坐在世界的边缘

挨着一个巨人

and I have discovered something inside of myself

我发现

身体里的一些东西

that I would have to call a soul

称为灵魂的东西

that I had never formulated until that day 20 years ago

在20年前尚未真正的成型

when hell came to pay me a surprise visit.

直到地狱的使者突然出现

I think that while I hated being depressed

我想, 虽然我很厌恶抑郁时候的状态

and would hate to be depressed again,

也很厌恶抑郁旧病复发

I've found a way to love my depression.

我还是会寻到一种方法接受并爱抑郁的自己

I love it because it has forced me to find and cling to joy.

我爱它, 因为他迫使我去寻找快乐

并牢牢抓住

I love it because each day I decide,

我爱它, 因为它让我在生活中

sometimes gamely,

牢牢抓住

and sometimes against the moment's reason,

让我活下去的理由, 虽然有时候也会不那么理性

to cleave to the reasons for living.

虽然偶尔也会游戏人生

And that, I think, is a highly privileged rapture.

而这, 我想, 是非常值得高兴和赞赏的事情.

谢谢大家

Thank you.

(Applause)

（掌声）

Thank you.

(Applause)