Why Broken Hearts Hurt — and What Heals Them | Yoram Yovell | TED

翻译人员: Eric Ma 校对人员: Bruce Wang

I'm Yoram Youvel.

我是约拉姆·尤维尔

I'm a psychiatrist and neuroscientist at the Hebrew University of Jerusalem.

我是耶路撒冷希伯来大学的 精神科医生和神经科学家。

And when I was 14 years old, my father died.

当我14岁的时候， 我的父亲去世了。

I was sitting in class

我正坐在教室里，

when my mother and my grandfather knocked on the door

当时我的母亲和祖父 敲门

and asked me out to the corridor.

让我去走廊。

"Your father's very sick," my mother said.

我妈妈说：“你父亲病得很重。”

"Your father is dead."

“你父亲去世了。”

And then I felt it.

然后我感觉到了。

A crushing pain in my chest.

我的胸口剧痛。

I can still feel a glimpse of it whenever I think of my father.

我仍能感受到一丝它的存在， 每当我想起我的父亲时。

He was a doctor, a scientist, a paratrooper.

他是一名医生、 科学家、伞兵。

He was a young, strong, happy, healthy man.

他是一个年轻、坚强、 快乐、健康的人。

He was my hero.

他是我的英雄。

And his death broke my heart.

他的去世让我心碎。

Do you remember the pain you felt when someone broke your heart?

你是否还记得有人让你伤心 时你所感受到的痛苦吗？

When your best friend or your mother died?

当你你最好的朋友 或你妈妈去世的时候？

Or the man you loved told you that he doesn't love you anymore.

或者你所爱的人 告诉你他不再爱你了的时候。

You probably do.

你可能会有这样的感觉。

But why do we feel mental pain at all?

但为什么我们会感到精神痛苦呢？

And what's the relationship between physical and mental pain?

身体和精神痛苦 之间有什么关系？

And most importantly, how can we make mental pain better?

最重要的是， 怎样才能改善精神痛苦？

Together with many scientists and physicians,

我与许多科学家和医生一起

I spent years searching for answers to these questions.

花了好几年时间寻找这些 问题的答案。

Now, growing up, I never heard the words,

现在，在成长过程中， 我从未听过这样的话

"We want you to be a doctor and a brain scientist like your father."

“我们希望你像你父亲一样 成为医生和脑科学家。”

But somehow that's what happened.

但不知何故就是这样发生的。

Twelve years after my father died,

父亲去世十二年后，

I was a graduate student at Dr. Eric Kandel’s lab

我曾是一名研究生 在埃里克·坎德尔的实验室

at Columbia University.

位于哥伦比亚大学。

Eric, who won the Nobel Prize

埃里克，获得过诺贝尔奖

for his work on the molecular basis of memory,

因其在记忆的分子 基础方面的工作

was the ultimate mentor.

他是我的终极导师，

Passionate, energetic and inspiring.

充满激情、活力和鼓舞人心。

Under his guidance, I studied a receptor.

在他的指导下，我研究一种受体。

It's a protein that's part of a synapse.

它是一种蛋白质， 是突触的一部分。

And synapses are structures through which nerve cells communicate with each other.

突触是神经细胞 相互交流的结构。

Now that receptor was a GPCR.

现在，那个受体是 GPCR。

That's a G protein coupled receptor.

或 G 蛋白偶联受体。

I'll explain what this means in a minute

我将在一分钟内 解释这意味着什么，

and then you'll understand what this stack of markers is doing here.

然后你就会明白 这堆标记物在这里做什么。

And when I did that,

当我这样做时，

I didn't really realize that work on that receptor,

我并没有真正意识到对 这种受体的研究

which seemed completely unrelated to my future work

似乎与我将来的工作完全无关

as a clinical psychiatrist,

作为临床精神科医生

would one day help us in our search for better treatments

那些研究会帮助我们 寻找更好的治疗方法

for physical and mental pain.

来治疗身心的痛苦

Now a big step along that way was the work of Jaak Panksepp,

现在，朝着这个方向迈出的一大步 的工作是在雅克·潘克塞普的指导下

my other great scientific mentor.

我的另一位伟大的科学导师。

In a classical experiment,

在一项经典实验中，

Panksepp separated puppies from their mothers for 15 minutes.

潘克塞普将小狗与妈妈分 开了15分钟。

Never more than that because he loved animals.

仅此而已， 因为他喜欢动物。

When puppies lose their mothers,

当小狗失去母亲时，

they make a sound which is called the separation distress cry.

它们会发出一种 叫做分离求救哭声的声音。

And it goes like this.

事情是这样的。

(Imitates puppy wailing)

（模仿小狗哭泣）

Puppies do it,

小狗是这样

kittens do it, babies do it.

小猫和小宝宝也是这样。

All young mammals do it

所有年轻的哺乳动物

when they're in pain or when they miss their mothers.

在痛苦 或想念母亲时都会这样做

And we all know how this cry makes us feel inside.

而且我们都知道这种哭声 使我们内心有怎样的感觉。

Panksepp and his colleagues then traced the brain circuits

潘克塞普和他的同事们 追踪了大脑回路

that produce these cries in guinea pigs,

在豚鼠身上产生这些哭声时

and they made a startling discovery.

他们有一个惊人的发现。

That these are the very same circuits that are active when humans feel sad

这些回路与人类的回路 完全相同

and when they experience depression.

当他们感到悲伤和经历抑郁时 处于活动状态。

And these circuits are also part of the brain's pain matrix

这些回路也是大脑疼痛矩阵 的一部分

that mediates our sensations of physical and mental pain.

它介导我们 对身心痛苦的感觉。

But why are we born with this terrible gift

但是，为什么我们天生就 有这种可怕的天赋

hardwired into our brains?

嵌入我们的大脑呢？

Well, probably because like any pain, mental pain is an alarm system.

好吧，可能因为像任何痛苦一样， 精神痛苦是一种警报系统。

Its task is to prevent damage.

它的任务是防止损坏。

When babies lose their mothers, they hurt and they cry.

当宝宝失去母亲时， 他们会受伤然后哭泣。

Which brings their mothers back,

这使他们的母亲回来了，

and it also makes them seek their mothers.

也促使他们寻找母亲。

In the wild, this is life-saving.

在野外，这可以挽救生命。

Puppies and babies cannot survive without their mothers.

没有母亲，小狗和婴儿 就无法生存。

So now we know why we have mental pain.

所以现在我们知道 为什么会有精神痛苦了。

It is the glue that keeps us together in couples, in families and communities.

正是粘合剂使我们在夫妻、 家庭和社区中团结在一起。

And when someone we love goes away or is taken away from us,

当我们所爱的人离开 或被带走时，

it's this pain which draws us back together.

正是这种痛苦使 我们重新团结起来。

And once we realize this,

一旦我们意识到这一点，

then we can answer an age-old question

就可以回答一个古老的问题

that poets and philosophers have been asking for thousands of years.

这是诗人和哲学家几千年来 一直在问的。

Does love always hurt?

爱总是很痛苦吗？

What do you think?

你觉得怎么样？

Does love always hurt?

爱总是很痛苦吗？

Yes, love always hurts, of course.

是的，当然，爱情总是很痛苦的。

Because that's what it's supposed to do.

因为那是它应该做的。

Mental pain is simply the high price,

精神痛苦只是我们 付出的高昂代价，

the very high price, that we pay for our ability to love.

非常高的代价，为爱情能付出的

And personally,

就我个人而言，

and, you know, I've been around the block a couple of times,

而且，你知道，我已经 在街区里待过几次了，

personally, I think it's worth it.

我个人认为这是值得的。

But we're not entirely defenseless against pain

但是我们并非完全 无法抵御疼痛，

because our brains produce endorphins

因为我们的大脑会产生内啡肽

or endogenous opioids,

或内源性阿片类药物，

our very own feel-good molecules,

它是我们自己感觉良好的分子，

the natural remedy for both physical and mental pain.

是缓解身体和精神痛苦 的自然疗法。

Endorphins are released in the brain during aerobic exercise

内啡肽会在有氧运动时释放

or when we're close to someone we love,

或当我们与所爱的人 保持亲密关系时，

and immediately after severe injuries.

以及在严重受伤后。

And we now know what endorphins do,

现在我们知道内啡肽的作用了，

they attach to special receptors in the brain,

它们附着在大脑中的特殊 受体上

and the most important among them are mu opioid receptors.

其中最重要的是 阿片类药物受体。

And just like the receptor I worked on in Kandel's lab,

就像我在坎德尔实验室 研究的受体一样，

mu opioid receptors are GPCR.

mu阿片类药物受体是 GPCR。

Here's how they work.

以下是它们的工作原理。

Like all GPCRs, mu opioid receptors are made of seven spirals

像所有GPCR一样，mu阿片类药物受体 由七个螺旋

or loops that are stacked together,

或环组成，它们堆叠在一起，

sticking through both sides of the cell membrane.

穿过细胞膜的两侧。

Like this, OK.

像这样，好吧。

And when endorphins attach to mu opioid receptors from the outside,

而且，当内啡肽从外部附着 在阿片类药物受体上时，

they cause them to change their shape.

它们会使它们改变形状。

Like this, OK?

像这样，好吗？

And this triggers a series of events inside the neurons

这会触发神经元 内部的一系列事件

which eventually ease the pain.

最终缓解疼痛。

Now, forget the molecules for a second.

现在，暂时忘记这些分子。

When you hug someone you love

当你拥抱一个你所爱的人时，

who is suffering from severe physical or mental pain,

他正遭受严重 身体或精神痛苦

you actually cause her brain to release endorphins.

你实际上会让她的大脑 释放内啡肽。

They attach to mu opioid receptors in her synapses and turn them on,

它们附着在她突触中 的阿片受体上，然后开启，

and they soothe her pain.

缓解她的疼痛。

And yet, sometimes mental pain gets so intense

但是，有时精神痛苦会 变得如此强烈

that no amount of love can soothe it.

以至于任何爱都无法抚慰它。

But medicine has powerful drugs that can ease any physical pain.

但是医学上有强大的药物， 可以缓解任何身体上的痛苦。

These are the narcotics or opioids like morphine.

这些是麻醉品 或阿片类药物，例如吗啡。

Narcotics work mainly by activating mu opioid receptors.

麻醉品主要通过激活 mu 阿片受体起作用。

But if so, can narcotics also treat the pain of separation?

但是，如果这样，麻醉药是否能 治疗分离的痛苦吗？

It was Jaak Panksepp who found the answer.

这正是潘克塞普找到的答案。

Panksepp gave his puppies in a separation experiment

潘克塞普在一次分离实验中 给了他的小狗

tiny, tiny doses of morphine,

微小剂量的吗啡，

lower than the lowest doses that are used to treat physical pain,

低于用于治疗 身体疼痛的最低剂量，

and his puppies immediately stopped crying

他的小狗立刻 停止了哭泣，

and started playing with each other as if they no longer miss their mothers.

开始互相玩耍， 好像它们不再想念妈妈一样。

Let's go to humans now.

现在让我们研究人类。

When mental pain in humans becomes too intense to bear

当人类的精神痛苦 变得难以承受时，

people, some people, will do anything to stop it,

有些人 会不惜一切代价阻止这种痛苦，

even try to kill themselves.

甚至试图自杀。

Indeed, and I'm saying this as a clinical psychiatrist,

事实上，我是这样说的， 作为一名临床精神科医生，

unbearable mental pain is a huge risk factor for suicide.

难以忍受的精神痛苦 是自杀的巨大危险因素。

But if narcotics treat physical pain,

但是，如果麻醉药可以 治疗身体上的痛苦，

and if they can soothe the mental pain of separation,

如果它们能缓解 分离带来的精神痛苦，

can they also help suicidal people become less suicidal?

它们还能帮助自杀者 减少自杀倾向吗？

A few years ago,

几年前，

together with Panksepp and other colleagues,

与潘克塞普 和其他同事

my research team conducted a clinical trial.

我的研究团队一起 进行了一项临床试验。

We gave people who were severely suicidal very low doses of a narcotic drug,

我们给严重自杀倾向的人服用了 非常低剂量的麻醉药物，

called buprenorphine, for four weeks.

即丁丙诺啡，为期四周。

We discovered that tiny, tiny doses of buprenorphine,

我们发现， 微小剂量的丁丙诺啡

which are too low to treat physical pain,

低到无法治疗身体疼痛的剂量

helped many of them become less suicidal.

帮助了他们中的许多人 减少自杀倾向。

But narcotics are extremely dangerous drugs.

但是麻醉品是极其 危险的药物。

They may cause addiction, and they're lethal in overdose.

它们可能会导致成瘾， 过量服用会致命。

In contrast, endorphins are not lethal in overdose,

相比之下，内啡肽 在服用过量时不会致命，

and they're much less likely to cause addiction.

而且它们导致成瘾的可能性 要小得多。

So narcotics and endorphins probably activate mu opioid receptors

因此，麻醉剂和内啡肽可能 激活阿片类药物受体

in different ways.

以不同的方式。

Now, if we could find drugs that activate mu opioid receptors

现在，如果我们能找到 能激活阿片受体的药物，

in a way that resembles how endorphins activate them,

其方式类似于内啡肽 激活它们的方式，

we might be able to treat physical and mental pain

我们也许能够治疗 身心痛苦，

without some of the dangerous side effects of narcotics.

而不会产生麻醉品的危险副作用。

And when my research team came to this conclusion,

当我的研究小组 得出这个结论时，

I suddenly remembered what I had learned in Kandel's lab many, many years ago.

我突然想起了很多年前 我在坎德尔实验室学到的东西。

Some GPCRs can be activated by two different drugs at the same time.

一些GPCR可以同时 被两种不同的药物激活。

And when this happens,

而且，当这种情况发生时，

the result may be different from what happens

结果可能与发生的结果不同

when they're activated by just one drug.

当仅由一种药物激活时。

So our research team then used molecular computing technologies

因此，我们的研究小组随后使用 分子计算技术

to create a detailed virtual model of the human mu opioid receptor.

创建了人类 mu 阿片受体的详细虚拟模型。

And then, with the help of programs known as molecular docking algorithms,

然后，在被称为分子对接算法 的程序的帮助下，

we screened thousands of existing drugs on a virtual model of the receptor.

我们在受体的虚拟模型 上筛选了数千种现有药物。

Eventually, we found a way to teach an old dog,

最终，我们找到了一种方法 来教一只老狗，

that's the human mu opioid receptor,

那就是人类 mu 阿片受体，

some new tricks.

一些新技巧。

We found two drugs that are not narcotics,

我们发现了两种非麻醉药物，

and they work together in very, very small doses

它们在非常非常小的 剂量下协同作用

to activate the human mu opioid receptor.

以激活人类 mu 阿片受体。

I'm not telling you their names,

我不会告诉你他们的名字，

because we still have to run many tests and clinical trials

因为我们仍然需要进行 许多测试和临床试验

before we can be certain

在我们能确定前，

that their combination does exactly what we think it does.

它们的组合完全 符合我们的想象。

But both of these drugs have been around for many, many years,

但是这两种药物已经 存在了很多年，

and they've been used by millions of people.

并且已经 被数百万人使用。

So we know that they're safe for humans.

因此，我们知道它们 对人类是安全的。

Here's our bottom line.

这是我们的底线。

Let's summarize what we've seen.

让我们总结一下我们所看到的。

First and foremost, mental pain is real.

首先，精神痛苦是真实存在的。

It's hardwired into our brains.

它与我们的大脑息息相关。

And mental pain is an essential part of mourning and depression and sadness.

精神痛苦是哀悼、抑郁 和悲伤的重要组成部分。

And when it gets severe enough, it can actually make people suicidal.

而且，当它变得足够严重时， 它实际上会使人们产生自杀倾向。

Endorphins are brain's natural remedy for physical and mental pain,

内啡肽是大脑缓解身体 和精神痛苦的自然疗法

and they work mainly, not exclusively,

它们主要起作用，不是唯一的

but mainly by activating mu opioid receptors.

而是主要通过激活阿片 受体来起作用。

Now, narcotics also activate mu opioid receptors,

现在，麻醉品还 能激活阿片类药物受体，

but in a way that causes addiction and can lead to death.

但会导致成瘾 并可能导致死亡。

And this is why narcotics are so dangerous.

这就是为什么毒品 如此危险。

New computational technologies have helped us identify two existing drugs

新的计算技术帮助 我们确定了两种现有的药物

that together may treat physical and mental pain

它们可以共同治疗 身心疼痛，

without some of the severe side effects of narcotics.

而不会产生麻醉品的严重 副作用。

However, this is still a work in progress.

但是，这项工作仍在进行中。

It would be a few years before it may become an approved treatment.

它可能要过几年才能 成为批准的治疗方法。

But, and this is the last thing I'm going to say,

但是，这是 我要说的最后一句话，

regardless of drugs,

无论使用什么药物，

you have the ability to help family and friends

你都有能力 帮助家人和朋友

who are in severe physical or mental pain.

当他们身心遭受严重痛苦时。

Thank you very much.

非常感谢。

(Applause)

（掌声）