We train soldiers for war. Let's train them to come home, too | Hector Garcia

翻译人员: Junyi Sha 校对人员: Conway Ye

Carlos,

卡洛斯，

the Vietnam vet Marine

一个越战海军陆战队员，

who volunteered for three tours and got shot up in every one.

自愿参与了三次行动， 每次行动中他都受了枪伤。

In 1971, he was medically retired

在1971年，他因健康原因退役了，

because he had so much shrapnel in his body

因为他体内有太多的子弹碎片，

that he was setting off metal detectors.

导致可能触发金属探测仪。

在接下来的42年当中， 他被噩梦缠身，

For the next 42 years, he suffered from nightmares,

extreme anxiety in public,

在公共场所会极度不安，

isolation, depression.

封闭、抑郁。

He self-medicated with alcohol.

他利用酒精自我麻醉。

He was married and divorced three times.

他结过又离过三次婚。

Carlos had post-traumatic stress disorder.

卡洛斯患有创伤后应激障碍（PTSD）。

Now, I became a psychologist to help mitigate human suffering,

我是一名帮助人类 减轻痛苦的心理学家，

and for the past 10 years, my target has been the suffering caused by PTSD,

在过去的10年当中，我一直把 像卡洛斯这样的退伍军人经历的

as experienced by veterans like Carlos.

PTSD作为我的研究目标。

Until recently, the science of PTSD just wasn't there.

不久前，关于PTSD的研究 都还不够完善。

And so, we didn't know what to do.

因此，我们一直都不知道要怎样应对。

We put some veterans on heavy drugs.

我们让一部分退伍军人大量服药。

Others we hospitalized and gave generic group therapy,

另一部分则让他们住院观察， 进行一般性的团体治疗，

and others still we simply said to them,

还有一些我们就简单的对他们说：

"Just go home and try to forget about your experiences."

“回家吧，尝试去忘记你的经历。”

More recently, we've tried therapy dogs, wilderness retreats --

最近，我们还尝试训练医疗犬， 荒野静修等等——

many things which may temporarily relieve stress,

很多能够短期减缓压力的方式，

but which don't actually eliminate PTSD symptoms over the long term.

但并不能长期彻底根除 PTSD造成的症状。

But things have changed.

但是事情已经有所改善了。

And I am here to tell you that we can now eliminate PTSD,

我今天来是想告诉你们， 我们已经可以彻底根除PTSD了，

not just manage the symptoms,

不仅仅是缓解症状，

and in huge numbers of veterans.

而且对大量的退伍军人都有效。

Because new scientific research has been able to show,

因为最新的科学研究已经能够

objectively, repeatedly,

客观地，重复地表明

which treatments actually get rid of symptoms and which do not.

哪些治疗能真正消除病症， 而哪些不能。

Now as it turns out,

结果表明，

the best treatments for PTSD use many of the very same training principles

对于PTSD的最佳治疗方式， 是使用许多与军队训练战士

that the military uses in preparing its trainees for war.

备战时相同的原则。

Now, making war --

制造战争——

this is something that we are good at.

这是我们擅长的事情。

We humans have been making war since before we were even fully human.

我们人类一直都在制造战争，甚至 当我们还没有完全进化就开始了。

自从那时起， 我们已经从使用石头和肌腱，

And since then, we have gone from using stone and sinew

to developing the most sophisticated and devastating weapon systems imaginable.

发展到了使用能够想象到的 最复杂的，最具毁灭性的武器。

And to enable our warriors to use these weapons,

为了使我们的战士 能够使用这些武器，

we employ the most cutting-edge training methods.

我们会使用最先进的 训练方式训练他们。

We are good at making war.

我们善于制造战争。

And we are good at training our warriors to fight.

我们还善于锻炼我们的战士去作战。

Yet, when we consider the experience of the modern-day combat veteran,

但是，当我们考虑当今老兵的经历，

we begin to see that we have not been as good

我们就会意识到，我们并不善于

at preparing them to come home.

为他们回家做准备。

Why is that?

为什么会这样呢？

Well, our ancestors lived immersed in conflict,

我们的祖先生活在冲突当中，

他们就在他们生活的地方进行斗争。

and they fought right where they lived.

所以直到进化史的近代阶段，

So until only very recently in our evolutionary history,

there was hardly a need to learn how to come home from war,

人类都几乎没有学习 如何从战场回家的需求，

因为我们从来没有真正这样做过。

because we never really did.

But thankfully, today,

但值得庆幸的是，当今，

most of humanity lives in far more peaceful societies,

大多数人类都居住在和平社会当中，

and when there is conflict, we, especially in the United States,

当冲突发生时，我们， 特别是美国，

now have the technology to put our warriors through advanced training,

有这些科技，可以让 我们的士兵进行先进的训练，

drop them in to fight anywhere on the globe

把他们扔在世界的任何角落去打仗，

and when they're done,

当战争结束时，

jet them back to peacetime suburbia.

再把他们载回和平地区。

But just imagine for a moment what this must feel like.

但是让我们想象一下这种感受。

我和那些退伍战士聊过， 他们告诉我，

I've spoken with veterans who've told me

曾经他们身处阿富汗残暴的交火当中，

that one day they're in a brutal firefight in Afghanistan

where they saw carnage and death,

目睹杀戮和死亡，

and just three days later, they found themselves

而三天后他们就要

toting an ice chest to their kid's soccer game.

带着冰袋去参加孩子的足球比赛。

“思想混乱”是他们最常使用的词汇。

"Mindfuck" is the most common term.

(Laughter)

（笑声）

It's the most common term I've heard to describe that experience.

这是我听到过的最常用于 描述那种经历的术语。

And that's exactly what that is.

但那就是他们所经历的。

Because while our warriors spend countless hours training for war,

因为当我们的战士 正花费大量的时间准备战争，

we've only recently come to understand

我们却最近才意识到，

他们中的许多也需要 被训练如何回归平民生活。

that many require training on how to return to civilian life.

Now, like any training, the best PTSD treatments require repetition.

就像任何训练一样， 最佳的PTSD治疗方案也需要被反复进行。

In the military,

在军队中，

we don't simply hand trainees Mark-19 automatic grenade launchers

我们不会简单地递给新兵 Mark-19自动榴弹枪，

然后说：“这里是扳机， 还有一些弹药，祝你好运。”

and say, "Here's the trigger, here's some ammo and good luck."

No. We train them, on the range and in specific contexts,

不。我们训练他们， 在场地中，在不同的环境下，

over and over and over

一遍又一遍的，

until lifting their weapon and engaging their target

直到举起武器瞄准目标的行为，

is so engrained into muscle memory

根深蒂固的刻在肌肉记忆当中；

that it can be performed without even thinking,

直到即使在你们能想象的 最紧张的时刻，

even under the most stressful conditions you can imagine.

这一系列行为也能够 不经思考的被正确执行。

Now, the same holds for training-based treatments.

以训练为基础的治疗也是一样的道理。

The first of these treatments is cognitive therapy,

治疗的第一步是认知疗法，

and this is a kind of mental recalibration.

这是一种心理的重新校准。

When veterans come home from war,

当退伍军人从战争回家时，

their way of mentally framing the world is calibrated

他们对世界的认知是被校对过的，

to an immensely more dangerous environment.

以适应那种极度危险的战争环境。

So when you try to overlay that mind frame onto a peacetime environment,

所以当你试图将这种认知 嫁接于和平环境之上时，

you get problems.

就会出现问题。

You begin drowning in worries about dangers that aren't present.

你就会沉浸在对那些 本不存在的危险的忧虑当中。

You begin not trusting family or friends.

你开始不信任家人和朋友。

Which is not to say there are no dangers in civilian life; there are.

不是说平民生活中就没有危险； 危险是存在的。

只是说遇到危险的几率，

It's just that the probability of encountering them

compared to combat

相比战争中而言，

is astronomically lower.

是极低的。

So we never advise veterans to turn off caution completely.

所以我们从不建议退伍军人 彻底关闭他们的警惕性。

We do train them, however, to adjust caution

而是训练他们，去根据所处环境，

according to where they are.

调整他们的警惕程度。

If you find yourself in a bad neighborhood,

如果你在一个治安很差的社区，

you turn it up.

你就要开启警惕性。

Out to dinner with family?

和家人一起在外吃饭呢？

You turn it way down.

你就应该把它调节到很低。

We train veterans to be fiercely rational,

我们训练退伍军人， 让他们变得绝对理性化，

to systematically gauge the actual statistical probability

让他们能够系统化的衡量他们在

of encountering, say, an IED here in peacetime America.

和平时期的美国遭遇到 比如，简易爆炸装置的可能性。

通过足够的练习，那些 被校正的认知就会留存。

With enough practice, those recalibrations stick.

The next of these treatments is exposure therapy,

治疗的下一步是暴露疗法，

and this is a kind of field training,

就好像实地演习，

and the fastest of the proven effective treatments out there.

也是所有被证明 有效的疗法中见效最快的。

You remember Carlos?

你们还记得卡洛斯吗？

This was the treatment that he chose.

这就是他选择的治疗方案。

And so we started off by giving him exercises,

我们从给他一些练习开始，

for him, challenging ones:

对他来说，最具挑战性的是：

going to a grocery store,

去杂货店，

going to a shopping mall, going to a restaurant,

去商场，餐厅，

sitting with his back to the door.

背对着门坐着。

而且，最重要的是——

And, critically --

要停留在这些环境当中。

staying in these environments.

Now, at first he was very anxious.

刚开始的时候，他表现得非常不安。

He wanted to sit where he could scan the room,

他希望能够坐在一个 可以扫视整个餐厅的位置，

这样他就可以计划逃脱路线，

where he could plan escape routes,

where he could get his hands on a makeshift weapon.

这样他就可以随手拿取临时武器。

And he wanted to leave, but he didn't.

他很想离开那儿，但是他没有。

他想起了在海军陆战队的训练，

He remembered his training in the Marine Corps,

and he pushed through his discomfort.

他战胜了自己的不安情绪。

And every time he did this, his anxiety ratcheted down a little bit,

每当他这样做时， 焦虑感就会逐渐减少，

and then a little bit more and then a little bit more,

然后再减少一点点， 再减少一点儿，

until in the end,

直到最后，

he had effectively relearned how to sit in a public space

他重新学会了如何坐在公共场所当中，

and just enjoy himself.

仅仅是享受他自己的时光。

He also listened to recordings of his combat experiences,

他也会听他战时经历的录音，

over and over and over.

一遍又一遍的。

He listened until those memories no longer generated any anxiety.

他听这些录音，直到 不再对其产生焦虑。

He processed his memories so much

他不断消化那些记忆，

that his brain no longer needed to return to those experiences

以至于不需要再在梦里

in his sleep.

回到那些记忆当中。

And when I spoke with him a year after treatment had finished,

当我在他治疗结束一年之后 再与他交流时，

he told me,

他告诉我：

"Doc, this is the first time in 43 years

“医生，这是我在43年当中

that I haven't had nightmares."

第一次没有做噩梦。”

Now, this is different than erasing a memory.

然而，这并不是清除记忆的过程。

Veterans will always remember their traumatic experiences,

退伍军人们会永远记得 他们的创痛经历，

but with enough practice,

但是通过足够量的训练，

those memories are no longer as raw or as painful as they once were.

那些记忆将不再像以往 那样鲜活，那样让人痛苦。

They don't feel emotionally like they just happened yesterday,

他们情感上不再觉得 那些经历依然历历在目，

and that is an immensely better place to be.

这是一个巨大的进步。

But it's often difficult.

但这常常也很困难。

And, like any training, it may not work for everybody.

而且，就像是任何训练一样， 它不一定适用于所有人。

此外还存在着信任问题。

And there are trust issues.

Sometimes I'm asked,

有时，我会被问道：

"If you haven't been there, Doc, how can you help me?"

“如果你从没上过战场，医生， 你要怎么帮我呢？“

Which is understandable.

我很理解这种想法。

但是考虑到回归平民生活，

But at the point of returning to civilian life,

you do not require somebody who's been there.

你们并不需要一个经历过战场的人。

You don't require training for operations on the battlefield;

你们不需要训练战场上的行为；

you require training on how to come home.

你们需要被训练如何回到家中。

For the past 10 years of my work,

在我过去十年的工作经历当中，

I have been exposed to detailed accounts

我已经接触过了你们能够想象到的

of the worst experiences that you can imagine,

最糟糕的，能具体到琐碎细节的

daily.

日常情况。

And it hasn't always been easy.

事情并不总是那么顺利。

There have been times where I have just felt my heart break

很多时候，我会感到疲惫，

or that I've absorbed too much.

或者太过专注。

But these training-based treatments work so well,

但是这些基于训练的 治疗方法效果出奇的好，

that whatever this work takes out of me, it puts back even more,

无论我花费多少功夫， 它都能给我带来更多回报，

because I see people get better.

因为我看到了人们正在康复。

I see people's lives transform.

我看到了人们的生活正在发生转变。

Carlos can now enjoy outings with his grandchildren,

卡洛斯已经能和他的 孙子孙女们出去玩了，

曾经他甚至无法和他自己的 孩子们一起这样做。

which is something he couldn't even do with his own children.

And what's amazing to me is that after 43 years of suffering,

最令我惊讶的， 是在43年的折磨之后，

it only took him 10 weeks of intense training to get his life back.

仅仅花费了10周时间进行 高强度训练，他就重获了自己的人生。

当我和他交流的时候，他告诉我：

And when I spoke with him, he told me,

"I know that I can't get those years back.

“我知道我无法重获那些错过的岁月。

但至少现在，无论在这世上 我还剩下多少时间，

But at least now, whatever days that I have left on this Earth,

我都可以在平静中度过。”

I can live them in peace."

He also said, "I hope that these younger veterans don't wait

他还说：“我希望那些年轻的退伍军人

to get the help they need."

不再需要苦苦等候迟来的帮助。”

And that's my hope, too.

那也是我所希望的。

因为，

Because ...

人生是短暂的，

this life is short,

and if you are fortunate enough to have survived war

如果你们有幸在战争当中

or any kind of traumatic experience,

或是各种创伤性经历中幸存下来，

you owe it to yourself to live your life well.

你们亏欠自己一个美好的人生。

And you shouldn't wait to get the training you need

不该浪费时间去等待那些帮助你们

to make that happen.

实现美好人生的训练。

Now, the best way of ending human suffering caused by war

事实上，能够避免战后创伤的最佳方式，

is to never go to war.

就是避免战争。

But we are just not there yet as a species.

但是我们这个物种 还没有达到那样的境界。

但在那之前，

Until we are,

the mental suffering that we create in our sons and in our daughters

当我们把子女送去战场，

when we send them off to fight

给他们造成的精神折磨

can be alleviated.

是可以被缓解的。

But we must ensure that the science, the energy level, the value

但是我们必须要确保 那些科学成果，能源供给，

that we place on sending them off to war

我们将他们送去战场时的价值观，

is at the very least mirrored

至少是要能够体现

in how well we prepare them to come back home to us.

我们准备让他们回到家中的。

This much, we owe them.

我们欠他们的，就是这么多。

Thank you.

谢谢。

(Applause)

（掌声）