Mental Health Care That Disrupts Cycles of Violence | Celina de Sola | TED

翻译人员: 阳 姜 校对人员: Yan Li Xiao

There's a shocking statistic I want to share with you.

我要告诉你们一个惊人的数据。

Latin America is home to only eight percent of the world’s population

拉美的人口只占世界百分之八，

but one third of its homicides.

但凶杀案却占全世界的三分之一。

This is especially extreme in the Northern Triangle countries

在北三角国家 即洪都拉斯、危地马拉、萨尔瓦，

of Honduras, Guatemala and El Salvador,

凶杀问题极为严重，

where I'm from and where I live.

那里正是我成长的地方。

Just imagine the impact that this kind of unrelenting violence can have

试着想想这样无尽的暴力

on a person's health, productivity and well-being.

对个人健康、 工作和幸福所造成的影响。

Especially because we know that if we're exposed to violence,

况且我们知道 我们所遭受的暴力会导致心理创伤。

this can result in trauma.

And when that happens,

当遭受暴力时，

our brain's stress response actually shuts down core functions

我们大脑的应激反应 会停止其主要功能，

like problem solving, critical thinking and emotional regulation.

例如问题解决功能、批判性思考功能 以及情感调解功能。

And it elevates the ones that we need to protect ourselves and survive.

暴力促使我们要学会保护我们自身 以及在暴力中存活。

So this makes it really hard to learn to make decisions

所以学会做决定甚至是维持关系 都变得相当困难。

and even maintain relationships.

It can also increase our risks of lung and heart disease, diabetes,

遭受暴力也会增加我们的患病风险 包括：心肺疾病、糖尿病，

anxiety and depression.

焦虑和抑郁。

So imagine what this can mean for entire communities

所以想象以下场景 对整个社区意味着什么，

when almost everybody can be walking around

（场景）几乎所有人都被 无法消解的压力和创伤困扰。

with unaddressed stress and trauma.

Then picture what can happen as individual

当个人与集体的创伤冲突时， 事情又会怎样。

and collective trauma collide.

To make matters worse,

更糟糕的是，

we know that exposure to violence can lead to more violence.

遭受暴力会导致更多暴力的产生。

Research has shown that survivors of violence

研究表明遭受过暴力的人

can be up to six times more likely

较之常人有六倍的可能性

to either be involved in violence or be revictimized.

会参与暴力行为或继续遭受暴力。

It's literally the definition of a vicious cycle.

这恰恰就是一个恶性循环。

The good news is we know that we can interrupt this cycle

好消息是我们能够打破这一循环，

by addressing the underlying trauma with better access to mental health care.

只要我们提供更普及的精神健康干预 去解决潜在的创伤。

The only problem is

唯一的问题在于

access to mental health care in these communities

想要在这些社区中获取精神卫生干预

is virtually non-existent.

是几乎不可能的。

So just to give you an idea,

所以我要告诉你的是

in the United States,

在美国，

there are about 270 mental health care workers

每 10 万人享有约 270 名精神卫生 工作人员所提供的服务。

for every 100,000 people.

In Honduras, this drops to two.

在洪都拉斯十万人只有两人提供服务。

So we're left with this classic conundrum.

所以我们被迫面临这个经典的难题。

We know how to help solve the problem,

我们知道如何解决这个问题，

but we don't have the resources to do it.

但我们缺乏相应资源。

But what if we re-envision what or who these resources could be?

但如果我们重新设想 什么或谁能够被称为资源呢？

I think we should,

我认为我们本身就是资源，

because there are ways to flood communities

因为有许多向社区提供 精神卫生服务的渠道。

with access to mental health care.

It’s already being done, and it’s working.

这些渠道已经被打通 并且正在运转。

And I want to tell you a little bit about how we're doing it at Glasswing.

我想告诉你关于我们在 Glasswing 是如何运作的事情。

We're training thousands of existing government employees like teachers,

我们培训了 成千上万在职的公职人员，

nurses, doctors and police officers

例如教师、护士、医生和警察。

on trauma education and self-care.

培训内容是创伤教育和自我照料。

We're essentially trying to create a whole core of lay mental health workers

我们致力于建立一个体系，

该体系以长期从事一线工作的 精神健康工作者为核心。

who are already serving on the front lines

and can therefore step in and buffer the impacts of violence and trauma

这样这个体系就能够

on themselves and on the communities they serve.

降低暴力和创伤带给他们自身及 所服务社区的负面影响。

We've trained health care workers

我们的培训使得 精神卫生从业人员

to be able to recognize the signs of trauma,

能够识别精神创伤的特征，

to be able to help patients understand what they're experiencing

帮助病人来理解 他们正在经历的病情，

and equip them with tools to cope or refer them if they need it.

并教会他们应对的方法 或在他们需要时给予帮助。

We've actually seen that trauma-informed violence prevention work in hospitals

我们发现在医院中 进行创伤知情方面的暴力行为预防，

can reduce the likelihood of revictimization by up to 30 percent.

人们遭受暴力的可能性 会降低百分之三十。

(Applause)

（掌声）

In schools, we know that if children and adolescents

在校园中， 我们了解到如果儿童和青少年

have access to a caring adult that can help them cope with stress,

能够得到有爱心的成人的关爱 将会帮助他们应对压力，

their grades improve,

提升成绩，

their conduct improves and their resilience.

提高表现及增强适应力。

And in our work with police,

当我们与警察一同工作时，

90 percent of the police we trained

我们所培训的警察中的 90%

actually felt better able to regulate their emotions

感到他们确实能够更好地管理情绪，

and to deal with anxiety and fear.

能够应对焦虑和恐惧。

Eighty percent even told us

百分之八十的警察告诉我们

that they felt better equipped to help their peers.

他们有了更好的方式 去帮助他们的同伴。

I want to share a story with you.

我将讲述一个故事。

Back in 2018, our Guatemala team was working in a community

在 2018 年，我们的一支队伍 在危地马拉的一个社区中工作，

with really high rates of crime, violence and stigma.

那里充斥着犯罪、暴力和不光彩的事。

One of the schools we were working in

我们服务的众多学校中的一所

is actually a school where kids ended up

是一些被开除的孩子及犯事孩子 的最终去处，

if they got expelled or if they got in trouble.

So that's why Walter, a 17-year-old student,

所以这使得 17 岁的学生 Walter 感到诧异并有些不解，

was really surprised and a little confused, when Eluvia,

one of our trauma-informed school coordinators,

当作为创伤知情校园协调者的 Eluvia

showed up to recruit him and his friends to work at the local primary school.

出现并招募他和他的朋友 在本地的小学工作。

But Eluvia's from that community,

Eluvia 来自于那个社区，

and she knew that if she could empower a young man like Walter

她深知如果她能够给 Walter 这样的年轻人赋权

to become involved and become a school coordinator,

使其参与并成为一名学校协调者的话，

she could not only transform his life

她将不仅改变 Walter 的生活，

but also the life of the kids he'd work with.

也会改变那些 Walter 服务的孩子的生活。

So sure enough, a couple of weeks later,

果然，几周后，

Walter was trained and leading a group of 20 little kids in a glee club.

Walter 接受了训练 并指导一个有 20 位小朋友的合唱团。

He loved it.

他很热爱这项工作。

(Applause)

（掌声）

He loved it so much that he continued to show up every week

他的热爱使他在未来两年多时间里 持续性地每周开展工作。

for over two years.

But one afternoon,

但一天下午，

one of Walter's neighbors ran into the school screaming

Walter 的一位邻居冲进学校，

that Walter had to get home

喊 Walter 得赶紧回家

because his sister had been shot and killed.

因为她妹妹被枪杀了。

Walter sprinted out.

Walter 冲出学校。

And as he described it to me,

他向我描述，

he felt his mind and body go numb.

他先是精神呆滞肢体麻木。

Then he felt his heart start to race and his chest fill with rage.

而后他感觉他的心脏剧烈跳动， 他极其愤怒。

He knew who had killed his sister.

他知道是谁杀害了妹妹。

And he ran up to his room to get a gun.

接着他跑进屋里拿了把枪。

Let me pause there for a sec.

让我稍稍停顿一下。

Do you remember what I told you a minute ago,

你是否还记得我一分钟之前所说的

about how violence can lead to more violence?

关于暴力是如何导致更多暴力？

That could have been Walter.

这本可能发生在 Walter 身上。

But it wasn't.

还好这没发生。

Because he told me that when he pictured his mentor, Eluvia,

他对我说他想起了 他的引路人——Eluvia，

and the little glee club kids finding out that their role model had killed someone,

以及小合唱团里的孩子们，

他意识到因为有他们作为榜样 这才抚慰了他的暴戾，

he put the gun down.

他放下枪。

And that, that right there --

这就是……

(Applause)

（掌声）

is where the cycle of violence stopped.

打破暴力行为恶性循环之关键所在。

(Applause)

（掌声）

That's everything.

这就是整个故事。

I have other stories like Walter and Eluvia's.

我还有像 Walter 和 Eluvia 的许多其他故事。

But to interrupt and to stop this epidemic of violence,

但要阻断暴力行为的发生，

we need thousands more.

我们还需要更多这样的故事。

And there are great ways to do this that are replicable.

有很多可以通用的好方法 能产生这种效果。

We know that we can provide more health care in communities

我们清楚我们能比常人 在社区中提供更多健康照料服务。

provided by regular people.

I’m talking about community, and I’m talking about systems change

我这是在讲社区 及同时期的系统变化。

at the same time.

First, we train everybody in public schools,

首先，我们对公立学校，

public hospitals, clinics and police precincts

公立医院、诊所和派出所的 每个人进行培训，

on trauma, education and self care

培训精神创伤、 教育以及自我照料，

so they can better take care of themselves

这样他们就能够更好地照料自己，

and also those that they serve understand trauma and manage it.

和那些能够理解精神创伤 且能够很好处理应对的人。

Then we train a subset as interventionists

我们会接着把他们培训成为干预者，

so they can deal with emergencies,

这样他们就能应对紧急事件，

providing crisis intervention and ongoing support.

进行危机干预并持续提供支持了。

And then we train a subset of those interventionists as trainers

接着我们又会从干预者中 选出一部分成为培训讲师，

so they can continue to train their peers

因而他们能够持续培训他们的同辈，

and they can train other organizations

并且他们也能培训其他机构，

so we can have a growing network of trauma-informed services

这样每个社区的创伤 知情服务网不断扩展。

in each community.

The great thing is this model is scalable and it’s cost-effective,

这种模式的好处是 规模调整灵活且低耗高效，

because we're working within public systems

因为我们培训针对的是 公职系统的人员。

with people that are already there.

So really, we know that violence happens between people,

我们知道暴力行为 在人群互动中产生，

but so does healing.

但暴力行为也在 人群互动中得到抑制。

That's where it starts.

这就是我们的出发点。

So we know the power lies in people, in relationships,

所以我们知道治愈的力量存在于 个人、社区的交往互动中。

in a community healing itself.

One of my favorite quotes by Viktor Frankl in “Man’s Search for Meaning” is:

我最爱引用维克多·弗兰克尔的是 来自《活出意义来》的文字：

"Between stimulus and response, there is a space.

“在刺激和反应之间,有一个空间。

In that space is our power to choose our response.

在那个空间中, 我们有力量选择自己的反应。

And in our response lies our growth and our freedom."

而我们的反应展现了 我们的成长和自由。”

Our goal is to literally infiltrate the space

我们的目的就是通过 对暴力刺激与反应之间的空间，

in between violent stimulus and response,

with mental health knowledge and skills

采用精神卫生知识和方法 而逐步进行影响，

so that communities can pave their own way to healing and resilience.

以达到社区能够 自愈及适应调节的效果。

Thank you so much.

非常感谢。

(Applause and cheers)

（掌声和喝彩）