How isolation fuels opioid addiction | Rachel Wurzman

翻译人员: psjmz mz 校对人员: Yinchun Rui

What does it mean to be normal?

正常的意思是什么？

And what does it mean to be sick?

有病又意味着着什么？

I've asked myself this question from the time I was about seven,

我从 7 岁起就问自己这个问题，

when I was diagnosed with Tourette syndrome.

当时我被诊断患有妥瑞氏症。

Tourette's is a neurological disorder

妥瑞氏症是一种神经障碍，

characterized by stereotyped movements I perform against my will, called tics.

以违反本意的刻板动作为特征，也叫抽搐。

Now, tics are technically involuntary,

抽搐基本上是无意识的，

in the sense that they occur without any conscious attention

抽搐是在我没有任何有意识注意或意图

or intention on my part.

的情况下发生的。

But there's a funny thing about how I experience tics.

但我所经历的抽搐有一件有趣的事。

They feel more unvoluntary than involuntary,

它们感到的是不自愿多于强制。

because I still feel like it's me moving my shoulder,

因为我仍能感觉到是我在移动我的肩膀，

not some external force.

而不是外力使然。

Also, I get this uncomfortable sensation, called premonitory urge,

我也有这种不舒服的感觉，叫前兆的冲动，

right before tics happen,

就在抽搐发生前，

and particularly when I'm trying to resist them.

尤其当我试图抗拒它时。

Now, I imagine most of you out there understand what I'm saying,

现在，我想你们大多数人理解我所说的，

but unless you have Tourette's, you probably think you can't relate.

但除非你有妥瑞氏症， 你可能认为你无法感同身受。

But I bet you can.

但我打赌你能。

So, let's try a little experiment here and see if I can give you

所以，让我们来做个小实验看我能不能

a taste of what my experience feels like.

让你体验一番我的感觉怎么样。

Alright, ready?

好了，准备好了吗？

Don't blink.

不要眨眼。

No, really, don't blink.

不，真的，别眨眼。

And besides dry eyes, what do you feel?

除了眼睛干涩，你还有什么感觉？

Phantom pressure?

幻影压力？

Eyelids tingling?

眼睛刺痛？

A need?

需要？

Are you holding your breath?

你在屏住呼吸吗？

(Laughter)

（笑声）

Aha.

阿哈。

(Laughter)

（笑声）

That's approximately what my tics feels like.

这大概就是我抽搐的感觉。

Now, tics and blinking, neurologically speaking, are not the same,

从神经学的角度来说， 抽搐和眨眼是不一样的，

but my point is that you don't have to have Tourette's

但我的点在于你不需要有抽搐症

to be able to relate to my experience of my premonitory urges,

就能够跟我的先兆冲动体验联系起来，

because your brain can give you similar experiences and feelings.

因为你的大脑会给你相似的体验和感受。

So, let's shift the conversation from what it means to be normal versus sick

所以，让我们把对话 从什么是正常、什么是有病

to what it means that a majority of us are both normal and sick.

转到我们大多数人的 正常和有病意味着什么。

Because in the final analysis, we're all humans

因为归根结底，我们全都是

whose brains provide for a spectrum of experiences.

由大脑提供一系列体验的人类。

And everything on that spectrum of human experiences

并且人类体验的所有东西

is ultimately produced by brain systems

最终都是由认为处于不同状态的

that assume a spectrum of different states.

大脑系统产生的。

So again, what does it mean to be normal,

那么再问一句，正常的意思是什么，

and what does it mean to be sick,

有病又意味着什么，

when sickness exists on the extreme end of a spectrum of normal?

当疾病处于正常范围的极端边缘时呢？

As both a researcher who studies differences in how individuals' brains

作为一个研究个体大脑

wire and rewire themselves,

任何连接和重组的研究者，

and as a Touretter with other related diagnoses,

以及作为妥瑞氏症和相关疾病患者，

I have long been fascinated by failures of self-regulation

长期以来，我一直被冲动和强迫行为谱系

on the impulsive and compulsive behavioral spectrums.

的自我调节失败所困扰。

Because so much of my own experience of my own body

因为我自己身体的体验

and my own behavior

和我自己的行为

has existed all over that map.

在那张图谱上到处都是。

So with the spotlight on the opioid crisis,

随着阿片类药物危机进入聚光灯下，

I've really found myself wondering lately:

我最近发现自己在想：

Where on the spectrum of unvoluntary behavior

我们会把滥用阿片类止痛药或海洛因

do we put something like abusing opioid painkillers or heroin?

放在非自愿行为范围的哪里呢？

By now, we all know that the opioid crisis and epidemic is out of control.

目前为止，我们都知道阿片类药物 的危机和流行已经无法控制。

Ninety-one people die every day in this country from overdose.

这个国家每天有 91 个人因为过度使用而死亡。

And between 2002 and 2015,

在 2002 年到 2015 年间，

the number of deaths from heroin increased by a factor of six.

死于海洛因的人数增加了六倍。

And something about the way that we treat addiction isn't working,

还有我们治疗上瘾的方法不起作用，

at least not for everyone.

至少不对任何人都有效。

It is a fact that people suffering from addiction

事实上沉迷于上瘾的人

have lost free will

已经失去自由意志，

when it comes to their behavior around drugs, alcohol, food

当涉及到他们所染上的药物、酒精、食物

or other reward-system stimulating behaviors.

或其他奖励系统刺激行为的行为时。

That addiction is a brain-based disease state

上瘾作为一种以大脑为基础的疾病，

is a medical, neurobiological reality.

是医学和神经生物学的现实。

But how we relate to that disease --

但我们如何与这种疾病联系起来——

indeed, how we relate to the concept of disease when it comes to addiction --

确实，当我们谈到上瘾时 如何与疾病的概念联系起来——

makes an enormous difference for how we treat people with addictions.

这会让我们对待上瘾的人的方式大为不同。

So, we tend to think of pretty much everything we do as entirely voluntary.

我们倾向于认为我们所做 的一切都是完全自主的。

But it turns out that the brain's default state

但其实大脑的默认状态

is really more like a car idling in drive than a car in park.

其实更像一辆怠速中的汽车而非停止的汽车。

Some of what we think we choose to do

一些我们认为我们选择去做的事情

is actually things that we have become programmed to do

其实是当刹车松开时，我们

when the brakes are released.

被编程去做的事情。

Have you ever joked that your brain was running on autopilot?

你曾经开玩笑说过你的大脑在自动驾驶吗？

Guess what?

猜猜怎么的？

It probably was.

它可能真是。

OK?

明白？

And the brain's autopilot is in a structure called the striatum.

大脑的自动驾驶仪位于 一个叫做纹状体的结构中。

So the striatum detects emotional and sensory motor conditions

纹状体检测情绪和感官运动状况，

and it knows to trigger whatever behavior you have done most often

它知道在同样的条件下去触发

in the past under those same conditions.

你过去常做的任一行为。

Do you know why I became a neuroscientist?

你知道我为什么成为一名神经科学家吗？

Because I wanted to learn what made me tick.

因为我想知道是什么让我抽搐。

(Laughter)

（笑声）

Thank you, thank you.

谢谢，谢谢。

(Laughter)

（笑声）

I've been wanting to use that one in front of an audience for years.

多年来，我一直想在观众面前使用这个词。

(Applause)

（鼓掌）

So in graduate school, I studied genetic factors

所以在研究生时，我研究了

that orchestrate wiring to the striatum during development.

形成纹状体发展过程中的基因因素。

And yes, that is my former license plate.

是的，那是我以前的车牌。

(Laughter)

（笑声）

And for the record, I don't recommend

注意一下，我不推荐

any PhD student get a license plate with their thesis topic printed on it,

哪个博士研究生拿到印有 他们论文题目的车牌，

unless they're prepared for their experiments not to work

除非他们准备接下来两年

for the next two years.

的实验不出成果。

(Laughter)

（笑声）

I eventually did figure it out.

我最终确实解决了。

So, my experiments were exploring how miswiring in the striatum

我的实验是探索纹状体中的错误连接

relates to compulsive behaviors.

是如何与强迫行为有关的。

Meaning, behaviors that are coerced

意思是，由不舒服的冲动

by uncomfortable urges you can't consciously resist.

所强迫的行为，你无法有意识地抗拒。

So I was really excited when my mice developed

所以当我的老鼠出现这种强迫行为时，

this compulsive behavior,

我真的很兴奋，

where they were rubbing their faces and they couldn't seem to stop,

它们擦着脸，似乎停不下来，

even when they were wounding themselves.

即便它们在伤害自己。

OK, excited is the wrong word,

好吧，兴奋是个错误的词汇，

I actually felt terrible for them.

我其实为它们感到糟糕。

I thought that they had tics, evidence of striatal miswiring.

我认为它们有抽搐，这是纹状线错误的证据。

And they were compulsive,

它们有强迫症，

but it turned out, on further testing,

但原来是，在进一步的测试中，

that these mice showed an aversion to interacting

这些老鼠表现出了对了解和

and getting to know other unfamiliar mice.

与不熟悉的老鼠互动的厌恶。

Which was unusual, it was unexpected.

这很不寻常，很出乎意料。

The results implied that the striatum,

结果提示纹状体，

which, for sure, is involved in compulsive-spectrum disorders,

肯定，与强迫症有关，

is also involved in human social connection and our ability to --

也涉及人们的社会联系和我们的能力——

not human social connection, but our ability to connect.

不是人们的社会联系， 而是我们社会连接的能力。

So I delved deeper,

所以我更深入地研究，

into a field called social neuroscience.

进入一个叫社会神经科学的领域。

And that is a newer, interdisciplinary field,

这是一个新兴的跨学科领域，

and there I found reports that linked the striatum

在那里我发现了一些报告表明纹状体

not just to social anomalies in mice,

不仅仅与老鼠的社交异常有关，

but also in people.

也对人类有关。

As it turns out, the social neurochemistry in the striatum

事实证明，纹状体中的社交神经化学与

is linked to things you've probably already heard of.

你可能已经听说过的东西有关。

Like oxytocin,

比如催产素，

which is that hormone that makes cuddling feel all warm and fuzzy.

正是这种荷尔蒙让拥抱的感觉温暖而迷离。

But it also implicates signaling at opioid receptors.

但它也暗示了阿片受体的信号传递。

There are naturally occurring opioids in your brain

大脑中自然产生的阿片类物质

that are deeply linked to social processes.

与社交过程密切相关。

Experiments with naloxone, which blocks opioid receptors,

用能阻断阿片类受体的纳洛酮做的实验，

show us just how essential this opioid-receptor signaling is

向我们展示了这种阿片受体信号

to social interaction.

对社交互动多么重要。

When people are given naloxone -- it's an ingredient in Narcan,

当人们服用纳洛酮时—— 纳洛酮是纳尔康的一种成分，

that reverses opioid overdoses to save lives.

可以逆转阿片类药物过量来拯救生命。

But when it's given to healthy people,

但这个药物给到健康的人时，

it actually interfered with their ability to feel connected

这实际上干扰了他们

to people they already knew and cared about.

与已经认识和关心的人建立联系的能力。

So, something about not having opioid-receptor binding

所以，没有阿片类受体的结合，

makes it difficult for us to feel the rewards of social interaction.

我们就很难感受到社会互动的回报。

Now, for the interest of time,

现在，为了时间的考虑，

I've necessarily gotten rid of some of the scientific details,

我必须去掉一些科学细节，

but briefly, here's where we're at.

但简短地说，这就是我们的进展。

The effects of social disconnection through opioid receptors,

通过阿片受体的社会脱节的影响，

the effects of addictive drugs

成瘾药物的影响，

and the effects of abnormal neurotransmission

以及神经传导异常对

on involuntary movements and compulsive behaviors

无意识运动和强迫行为的影响，

all converge in the striatum.

所有都集中在纹状体上。

And the striatum and opioid signaling in it

纹状体和其中的阿片类信号

has been deeply linked with loneliness.

与孤独密切相关。

When we don't have enough signaling at opioid receptors,

当我们没有足够的阿片受体信号时，

we can feel alone in a room full of people we care about and love, who love us.

在一个满是我们关心和爱着，同时也爱 我们的人的房间，我们也会感到孤独。

Social neuroscientists, like Dr. Cacioppo at the University of Chicago,

社会神经科学家，比如芝加哥大学 的卡西奥普博士（Dr. Cacioppo），

have discovered that loneliness is very dangerous.

发现孤独非常危险。

And it predisposes people

它使人容易患上

to entire spectrums of physical and mental illnesses.

各种生理和心理疾病。

Think of it like this: when you're at your hungriest,

这样想：当你最饿的时候，

pretty much any food tastes amazing, right?

几乎所有的食物尝起来都很美味，对吧？

So similarly, loneliness creates a hunger in the brain

所以类似，孤独也会在大脑中造成饥饿，

which neurochemically hypersensitizes our reward system.

在神经化学上会导致我们的 奖赏系统处于敏感状态。

And social isolation acts through receptors

社会隔离通过这些

for these naturally occurring opioids and other social neurotransmitters

自然产生的阿片类物质和其他 社会神经传递素的受体作用

to leave the striatum in a state

使纹状体处于一种状态，

where its response to things that signal reward and pleasure

会对表示奖励和快乐的事物的

is completely, completely over the top.

反应完全过度。

And in this state of hypersensitivity,

在这种过敏状态下，

our brains signal deep dissatisfaction.

我们的大脑发出强烈不满的信号。

We become restless, irritable and impulsive.

我们变得焦躁不安、易怒和冲动。

And that's pretty much when I want you to keep the bowl of Halloween chocolate

这非常像当我让你们把整个房间里面的

entirely across the room for me, because I will eat it all.

万圣节巧克力给我留下，因为我会全部吃光。

I will.

我会的。

And that brings up another thing that makes social disconnection

这就引发了另一件让社会脱节如此

so dangerous.

危险的事情。

If we don't have the ability to connect socially,

如果我们没有社交能力，

we are so ravenous for our social neurochemistry to be rebalanced,

我们如此渴望我们的社会神经化学重新平衡，

we're likely to seek relief from anywhere.

我们可能会在任何地方寻求解脱。

And if that anywhere is opioid painkillers or heroin,

如果那是阿片类止痛药或海洛因，

it is going to be a heat-seeking missile for our social reward system.

它将成为我们社交奖励系统的热追踪导弹。

Is it any wonder people in today's world are becoming addicted so easily?

当今世界的人们如此容易上瘾， 这有什么好奇怪的吗？

Social isolation --

社交孤立——

excuse me --

抱歉——

contributes to relapse.

导致复发。

Studies have shown that people who tend to avoid relapse

研究表明，那些倾向于避免复发的人

tend to be people who have broad, reciprocal social relationships

往往是那些有着广泛、互惠的社会关系的人，

where they can be of service to each other,

他们可以相互帮助，

where they can be helpful.

他们可以提供帮助。

Being of service lets people connect.

能够帮助让人们产生联系。

So --

所以——

if we don't have the ability to authentically connect,

如果我们没有能力建立真正的联系，

our society increasingly lacks this ability to authentically connect

我们的社会日渐缺乏这种真正联系

and experience things that are transcendent and beyond ourselves.

和体验超越自己的能力。

We used to get this transcendence

我们曾经从对家庭和

from a feeling of belonging to our families and our communities.

社区的归属感中获得这种超越。

But everywhere, communities are changing.

但到处，社区在发生变化。

And social and economic disintegration is making this harder and harder.

并且社会和经济的解体使 这一目标越来越难以实现。

I'm not the only person to point out

我不是唯一一个指出

that the areas in the country most economically hard hit,

受经济打击最大的国家地区，

where people feel most desolate about their life's meaning,

那些人们对生活的意义感到最孤独的地方，

are also the places

那里也是

where there have been communities most ravaged by opioids.

阿片类药物肆虐最严重的地区。

Social isolation acts through the brain's reward system

社交孤立通过大脑的奖励系统起作用

to make this state of affairs literally painful.

让这种状态很痛苦。

So perhaps it's this pain, this loneliness,

也许就是这种痛苦，这种孤独，

this despondence

这种沮丧，

that's driving so many of us to connect with whatever we can.

让我们如此多的人抓住一切的稻草。

Like food.

比如食物，

Like handheld electronics.

比如手持电子产品。

And for too many people, to drugs like heroin and fentanyl.

还有对太多的人来说，则是像海洛因 和芬太尼这样的毒品。

I know someone who overdosed, who was revived by Narcan,

我认识一个使用过量的人， 被纳洛酮救活后，

and she was mostly angry that she wasn't simply allowed to die.

她非常生气的是自己不被允许去死。

Imagine for a second how that feels, that state of hopelessness, OK?

试想一下那种感觉，那种绝望的感觉，好吧？

But the striatum is also a source of hope.

但是纹状体也是希望的源泉。

Because the striatum gives us a clue of how to bring people back.

因为纹状体给了我们如何把人们带回来的线索。

So, remember that the striatum is our autopilot,

所以，记住纹状体是我们的自动驾驶仪，

running our behaviors on habit,

按习惯行事，

and it's possible to rewire, to reprogram that autopilot,

并且是有可能重连，重新编程这个自动驾驶仪，

but it involves neuroplasticity.

但这涉及到神经可塑性。

So, neuroplasticity is the ability of brains

神经的可塑性是大脑

to reprogram themselves,

重新编程自己的能力，

and rewire themselves, so we can learn new things.

并且重连它们，这样我们就能够学新东西。

And maybe you've heard the classic adage of plasticity:

也许你听过关于可塑性的经典格言：

neurons that fire together, wire together.

一起激发的神经元连在一起。

Right?

是吧？

So we need to practice social connective behaviors

所以我们需要实践社交联结行为

instead of compulsive behaviors, when we're lonely,

而非强迫性的行为，当我们孤独时，

when we are cued to remember our drug.

当我们被提示记起我们的药物时。

We need neuronally firing repeated experiences

我们需要重复的神经放电体验

in order for the striatum to undergo that necessary neuroplasticity

来让纹状体经历必要的神经可塑性，

that allows it to take that "go find heroin" autopilot offline.

从而让“去找海洛因”的自动驾驶仪下线。

And what the convergence of social neuroscience, addiction

而社会神经科学、成瘾

and compulsive-spectrum disorders in the striatum suggests

和强迫性神经障碍在纹状体中的融合表明

is that it's not simply enough

仅仅教会纹状体

to teach the striatum healthier responses to compulsive urges.

对强迫性冲动做出更健康的反应是不够的。

We need social impulses to replace drug-cued compulsive behaviors,

我们需要社交脉冲 来取代毒品带来的强迫性行为，

because we need to rebalance, neurochemically, our social reward system.

因为我们需要在神经化学上 重新平衡我们的社交奖励系统。

And unless that happens,

除非这个发生，

we're going to be left in a state of craving.

我们会陷入渴望的状态。

No matter what besides our drug we repeatedly practice doing.

无论我们除了药物之外，我们重复实践做什么。

I believe that the solution to the opioid crisis

我相信阿片类药物危机的解决方案

is to explore how social and psychospiritual interventions

在于探索社交和精神干预

can act as neurotechnologies in circuits

如何作为神经技术在处理

that process social and drug-induced rewards.

社交和药物诱导奖励的回路中发挥作用。

One possibility is to create and study scalable tools

一种可能是创造和研究可扩展的工具，

for people to connect with one another

让人们通过心理和精神实践

over a mutual interest

在恢复方面的

in recovery through psychospiritual practices.

共同利益上相互联系。

And as such, psychospiritual practice could involve anything

正因为如此，精神实践可以涉及任何东西，

from people getting together as megafans of touring jam bands,

从人们聚集在一起，组成巡回乐队，

or parkour jams, featuring shared experiences of vulnerability

或者跑酷的交通堵塞，分享共同的脆弱体验

and personal growth,

和个人成长，

or more conventional things, like recovery yoga meetups,

或者更传统的东西，比如恢复瑜伽，

or meetings centered around more traditional conceptions

或者围绕更传统的精神体验观念

of spiritual experiences.

展开的会议。

But whatever it is,

但不管是什么，

it needs to activate

它需要激活

all of the neurotransmitter systems in the striatum

纹状体中所有参与处理

that are involved in processing social connection.

社会联系的神经递质系统。

Social media can't go deep enough for this.

社交媒体在这方面的深度还不够。

Social media doesn't so much encourage us to share,

社交媒体在鼓励我们分享上面

as it does to compare.

远不如鼓励相互攀比。

It's the difference between having superficial small talk with someone

这是与某人进行肤浅的闲聊

and authentic, deeply connected conversation with eye contact.

和用眼神进行真诚、深入的交谈的区别。

And stigma also keeps us separate.

羞耻也让我们分离。

There's a lot of evidence that it keeps us sick.

有很多的证据表明它会让我们生病。

And stigma often makes it safer for addicts to connect with other addicts.

羞耻常常让瘾君子跟瘾君子 联系变得更加安全。

But recovery groups centered around reestablishing social connections

但以重建社会关系为中心的康复小组

could certainly be inclusive of people who are seeking recovery

肯定会包括那些

因一系列心理健康问题寻求康复的人。

for a range of mental health problems.

My point is, when we connect around what's broken,

我的观点是，当我们围绕破坏的东西联系起来，

we connect as human beings.

我们作为人类联系在一起。

We heal ourselves from the compulsive self-destruction

我们从强迫性的对隔离的痛苦反应中

that was our response to the pain of disconnection.

的自我毁灭里治愈自己。

When we think of neuropsychiatric illnesses as a spectrum of phenomenon

当我们认为神经精神疾病是构成

that are part of what make us human,

我们人类自身的一系列现象的一部分时，

then we remove the otherness of people who struggle with self-destruction.

那么我们就消除了把那些挣扎在 自我毁灭中的人视为异类的看法。

We remove the stigma

我们消除了医生、

between doctors and patients and caregivers.

病人和护理人员之间的耻辱。

We put the question of what it means to be normal versus sick

我们把正常和疾病的区别是什么的问题

back on the spectrum of the human condition.

放回到人类状态的范围上。

And it is on that spectrum where we can all connect

正是在这个范围上， 我们所有人都能联系起来，

and seek healing together, for all of our struggles with humanness.

一起寻求治愈，为所有与人性的斗争。

Thank you for letting me share.

谢谢让我分享。

(Applause)

（鼓掌）