Depression, the secret we share | Andrew Solomon

Translator: Jeffrey Teh Reviewer: Bighead Ge

"I felt a Funeral, in my Brain,

「我腦裏面感覺到有一場葬禮，

and Mourners to and fro

而殮葬嘅人不停行嚟行去，

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

當我嘅感覺返返嚟，佢哋就坐返埋位，

that Sense was breaking through --

And when they all were seated,

a Service, like a Drum --

葬禮儀式好似鼓一樣敲打著。

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

直至我嘅腦完全麻木，

my Mind was going numb --

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

跟住我聽到佢哋移靈安葬我嘅遺體，

而我嘅靈魂就好似木一樣敲碎緊，

with those same Boots of Lead, again,

仲有佢哋好似之前一樣 鉛一樣沉重嘅腳步，

then Space -- began to toll,

而成個大嘅空間好似有一個鐘喺度響。

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

天堂好似一個鐘咁，

而人就好似耳朵，

聽到定時響起嘅鐘聲，

and I, and Silence, some strange Race,

但我同寂靜屬於同一個異端，

wrecked, solitary, here --

都係擱淺喺荒島上，孤零零喺度。

[And] then a Plank in Reason, broke,

隨著支持我嘅木板斷開，

and I fell down and down --

我不斷墜落， 墜落，

and hit a World, at every plunge,

撞到好多嘢然後跌落一個世界，

and Finished knowing -- then --"

我唔再認識事物。」

We know depression through metaphors.

我哋喺好多喑喻裏邊見到抑鬱症

Emily Dickinson was able to convey it in language,

艾米莉 ‧ 狄金森將抑鬱症轉化為文字

Goya in an image.

戈雅將抑鬱症轉化成油畫

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

一半嘅藝術創作

係想表達抑鬱症嘅典形狀態

As for me, I had always thought myself tough,

至於我， 我一直認為自己係堅強

one of the people who could survive

如果一班人被咗去集中營嘅話

if I'd been sent to a concentration camp.

我會係其中一個可以存活落嚟嘅人

In 1991, I had a series of losses.

1991 年，我經歷一連串嘅打擊

My mother died,

我母親過世、一段感情結束咗

a relationship I'd been in ended,

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

同埋我結束咗幾年外國生活

返返去美國

and I got through all of those experiences intact.

而我經歷以上打擊都仍然係好硬淨

But in 1994, three years later,

但係喺 1994，三年之後

I found myself losing interest in almost everything.

我發覺自己幾乎對所有嘢都冇興趣

我唔想做任何之前想做嘅嘢

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

and I didn't know why.

我都唔知點解會噉樣

The opposite of depression is not happiness, but vitality.

抑鬱嘅反面唔係快樂， 係活力

And it was vitality

活力就係嗰時我覺得我失去咗嘅嘢

that seemed to seep away from me in that moment.

Everything there was to do seemed like too much work.

每日要做嘅嘢實在太多啦

I would come home

我想返屋企

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

見到電話答錄機上面閃著紅色燈 我冇咁驚

and instead of being thrilled to hear from my friends,

因為唔使聽到朋友留言

I would think,

我就諗︰點解我要覆返咁多人嘅電話？

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

Or I would decide I should have lunch,

或係我應該要食午餐啦

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

但我會諗， 我要將食物攞出嚟

and put it on a plate

擺喺個碟度

and cut it up and chew it and swallow it,

又要切、又要擺入個口度，又要吞咗去

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

感覺好似耶穌行十架嘅路一樣

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

而有一樣成日喺討論抑鬱症嘅時候

會忽略嘅嘢係

is that you know it's ridiculous.

你知道抑鬱症係非常荒謬嘅一件事

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

你知道當你經歷抑鬱症嘅時候

佢係有幾咁荒謬

You know that most people manage

你知道大部分人 會聽答錄機嘅留言同食晏

to listen to their messages and eat lunch

and organize themselves to take a shower

安排好沖涼、出去屋企

and go out the front door

and that it's not a big deal,

呢啲都係好簡單

and yet you are nonetheless in its grip

但當你仍然係喺抑鬱症嘅控制當中

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

你搵唔到方法解決佢

And so I began to feel myself doing less

之後我覺得自己做嘢做得愈嚟愈少

and thinking less

又諗得少、感受又愈嚟愈少

and feeling less.

It was a kind of nullity.

可以話係無能

And then the anxiety set in.

跟著焦慮嚟勒

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

如果你話俾我聽之後嗰幾個月

我都要處於抑鬱狀態

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

我會話︰只要佢十一月完，我就冇問題

But if you said to me,

但係如果你同我講

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

我呢幾個月都要極度焦慮

我寧願割腕自殺，好過極度焦慮幾個月

I would rather slit my wrist than go through it.

It was the feeling all the time

我嗰陣成日都會有一種感覺

like that feeling you have if you're walking

好似你行路突然跣襯或者拤倒

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

而地下快速衝埋你度咁嘅感覺

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

但係嗰種恐懼感並唔係 剩係跌落地嘅半秒鐘

it lasted for six months.

而係持續咗半年

It's a sensation of being afraid all the time

嗰種感覺令你一直覺得好驚

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

但你又唔會知道你驚嘅係乜嘢

And it was at that point that I began to think

就喺嗰個時候我開始諗

that it was just too painful to be alive,

活著真係太痛苦

and that the only reason not to kill oneself

而唯一唔自殺嘅理由

was so as not to hurt other people.

就係因為唔想 因為我自殺會傷害到其他人

And finally one day, I woke up

然後有一日，當我瞓醒

and I thought perhaps I'd had a stroke,

突然間覺得我中風

because I lay in bed completely frozen,

因為我喺床上完全郁唔到

looking at the telephone, thinking,

我望住個電話，諗

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

「有啲唔對路， 我要打去搵人幫手」

and I couldn't reach out my arm

但我連手都遞唔到

and pick up the phone and dial.

噉點拎起電話打呢？

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

經過四個鐘頭我依煞瞓喺張床

郁都郁唔到

the phone rang,

電話響，我用盡力咁攞起個電話

and somehow I managed to pick it up,

and it was my father, and I said,

嗰個係我老豆打嚟

我話「 我遇到好大嘅麻煩，

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

我哋必須諗辦法解決佢。」

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

第二日我就開始治療同食藥

And I also started reckoning with this terrible question:

而我同時諗到一個好弊嘅問題

If I'm not the tough person

如果我唔係一個堅強嘅人

who could have made it through a concentration camp,

可以喺集中營裏面生存嘅人

then who am I?

噉我係乜？

And if I have to take medication,

如果我要靠藥物

is that medication making me more fully myself,

噉藥物係咪令我做返真正嘅自己？

or is it making me someone else?

定係將我變成第二個人？

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

如果藥物令我變成第二個人

噉我應該有咩感受？

我對抗抑鬱會有兩個好處

I had two advantages as I went into the fight.

The first is that I knew that, objectively speaking,

第一就係客觀嚟講，我會有好嘅生活

I had a nice life,

and that if I could only get well,

如果當我好返

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

噉之後就會有更美好嘅嘢等住我

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

第二樣就係我會得到好好嘅治療

But I nonetheless emerged and relapsed,

但我好轉又復發，好轉又復發

and emerged and relapsed,

and emerged and relapsed,

and finally understood

最後我終於明白

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

我以後都要靠食藥同治潦生活

And I thought,

我就諗 ，抑鬱症到底 係化學問題定精神問題呢？

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

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

需要化學治療定係心理治療？

And I couldn't figure out which it was.

我搞唔清楚

And then I understood that actually,

跟住我明白到

我哋無論呢兩個領域嘅知識 都未夠深入去解釋事物

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

The chemical cure and the psychological cure

化學治療同心理治療都有佢哋嘅作用

both have a role to play,

and I also figured out that depression was something

我同時發覺抑鬱症係一種

同我哋內心深深糾纏著嘅嘢嚟

that was braided so deep into us

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

即係話我哋冇辦法將 佢由我哋人格同個性當中分離

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

我想講我哋對抑鬱症嘅治療方法 其實係唔係好好

They're not very effective.

嗰啲治療都唔係好有效

They're extremely costly.

而且仲非常昂貴

They come with innumerable side effects.

有好多數唔曬嘅副作用

They're a disaster.

呢啲治療嘅禍害好大

但慶幸嘅係我生活喺呢個年代

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

而唔係五十年前

when there would have been almost nothing to be done.

五十年前面對抑鬱症係束手無策

I hope that 50 years hence,

我希望五十年之後

people will hear about my treatments

當人聽到我呢一刻接受過嘅治療

會覺訝異點解會有人接受咁原始嘅科學

and be appalled that anyone endured such primitive science.

Depression is the flaw in love.

抑鬱症喺感情上係一個裂口

If you were married to someone and thought,

如果你今日同某人結婚，然後諗

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

「如果我老婆過生， 我會搵另一個」

it wouldn't be love as we know it.

噉樣就唔係我哋所認知嘅愛情

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

如果冇預料過會失去，噉就唔叫做愛情

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

預見過絕望係人變得親密嘅原動力

There are three things people tend to confuse:

人成日會撈亂三樣嘢︰

depression, grief and sadness.

抑鬱、哀痛同悲傷

Grief is explicitly reactive.

哀痛係好有反應

If you have a loss and you feel incredibly unhappy,

如果你因為失去某樣嘢而非常唔開心

and then, six months later,

半年之後你仲係覺得好難過

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

但比起半年前好咗啲

嗰種應該哀痛

it's probably grief,

and it will probably ultimately resolve itself in some measure.

佢自己最後會慢慢消失

If you experience a catastrophic loss,

如果你經歷過一場浩劫，感覺好慘

and you feel terrible,

and six months later you can barely function at all,

六個月後你只能夠僅僅噉捱落去

then it's probably a depression that was triggered

好可能就係浩劫發生嗰陣

同時引起你嘅抑鬱

by the catastrophic circumstances.

The trajectory tells us a great deal.

噉樣嘅軌跡畀我哋了解到

抑鬱症係一件好嚴重嘅事

People think of depression as being just sadness.

人哋覺得抑鬱症就同等於悲傷

It's much, much too much sadness,

但係抑鬱症卻係帶著太多太多嘅悲傷

much too much grief

同埋太多太多嘅哀痛

at far too slight a cause.

而一切都係由小事引起

As I set out to understand depression,

當我開始去了解抑鬱症

and to interview people who had experienced it,

開始同一啲曾經患過嘅人傾嘅時候

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

我發現嗰啲人表現上睇起嚟 有輕微嘅抑鬱

to have what sounded like relatively mild depression

但實際上抑鬱症令佢哋失去咗生活能力

who were nonetheless utterly disabled by it.

And there were other people who had what sounded

另一邊有批人聽起上嚟 有好嚴重嘅抑鬱

as they described it like terribly severe depression

who nonetheless had good lives

但佢哋卻係兩次病發之間生活得好好

in the interstices between their depressive episodes.

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

跟著我開始搵出

係乜原因畀令某啲人比另一啲更堅強

to be more resilient than other people.

What are the mechanisms that allow people to survive?

係乜嘢機制

令人就算有抑鬱都可以生存落嚟？

And I went out and I interviewed person after person

跟著我一個又一個咁同曾經抑鬱嘅人傾

who was suffering with depression.

One of the first people I interviewed

其中一個人形容抑鬱症

described depression as a slower way of being dead,

係一個慢慢死亡嘅過程

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

一開頭聽到呢種講法係好事嚟

because it reminded me that that slow way of being dead

因為佢提醒咗我

慢慢步入死亡真係可以死亡

can lead to actual deadness,

that this is a serious business.

呢樣嘢係好嚴肅

It's the leading disability worldwide,

抑鬱症係全世界第一大 引致失去活動能力嘅疾病

and people die of it every day.

每日都有人因為抑鬱症而離開世界

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

其中一個喺我了解抑鬱症嘅時候傾嘅人

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

係我一個認識多年嘅好友

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

佢喺大學第一年有精神問題

and then plummeted into a horrific depression.

之後惡化成幾多人驚嘅抑鬱症

She had bipolar illness,

佢精神好兩極化

or manic depression, as it was then known.

即係之後嘅躁狂抑鬱症

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

經過多年鋰鹽治療

佢復完得相當唔錯

and then eventually, she was taken off her lithium

到最後醫生停咗開鋰鹽俾佢

to see how she would do without it,

睇下佢可唔可以唔使藥物都得

and she had another psychosis,

跟著佢又再度精神失常

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

仲惡化成我見過最嚴重嘅抑鬱症

in which she sat in her parents' apartment,

佢坐喺佢父母間屋裏面

more or less catatonic, essentially without moving,

手腳好硬，坐喺度唔郁

day after day after day.

日日都係咁

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

幾年之後我問佢呢段經歷時

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

佢已經係詩人同心理治療師 Maggie Robins

when I interviewed her, she said,

佢話︰「我一直重複唱著

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

Where Have All The Flowers Gone，

over and over, to occupy my mind.

令我個腦剩係得呢首歌。

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

我唱著呢首歌去掩蓋心入邊把聲，

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

嗰把聲就係

『你係冇用嘅， 你對世界嚟講可有可無。

你根本唔配活喺呢個世界上。』

You don't even deserve to live.'

And that was when I really started thinking

呢個時候我開始諗住自殺。」

about killing myself."

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

你有抑鬱嘅時候唔會諗

你戴咗一塊灰色面紗

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

唔會覺得自己係透過負面情緒去睇嘢

You think that the veil has been taken away,

你只會認為一塊 代表快樂嘅面紗被人攞走咗

the veil of happiness,

and that now you're seeing truly.

你覺得宜家先係睇到真實嘅世界

It's easier to help schizophrenics who perceive

同樣係人格分裂嘅病人

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

內心覺得有嘢需要驅趕嘅一類病人

比較容易治療

but it's difficult with depressives,

但抑鬱類型嘅病人就難啲

because we believe we are seeing the truth.

因為病人相信佢哋睇到真實世界

But the truth lies.

但真實世界卻係講緊大話

I became obsessed with that sentence:

我成日聽到呢句說話

"But the truth lies."

「但真實世界卻係講緊大話」

And I discovered, as I talked to depressive people,

當我同抑鬱嘅人傾計嘅時候

that they have many delusional perceptions.

我發現佢哋有好多幻覺

People will say, "No one loves me."

佢哋會話「冇人愛我」

And you say, "I love you,

然後你同佢講

your wife loves you, your mother loves you."

「我愛你，你老婆愛你， 你媽咪愛你。」

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

你可以好快咁應返佢哋大部分人

但係抑鬱症嘅人會話

But people who are depressed will also say,

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

「無論我哋點樣努力， 我哋最後都會死。」

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

或者佢哋會話

「兩個人之間唔會有真正嘅溝通。

between two human beings.

Each of us is trapped in his own body."

每個人只會畀自己嘅身體困住。」

To which you have to say,

你只可以回答

"That's true,

「冇錯，但我覺得我哋宜家應該諗，

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

我哋早餐食啲乜。」

(Laughter)

（笑聲）

A lot of the time,

好多時佢哋表逹嘅並唔係一種病，

what they are expressing is not illness, but insight,

而係佢哋睇嘢嘅角度

and one comes to think what's really extraordinary

而佢哋會覺得好特別嘅嘢會係

is that most of us know about those existential questions

我哋大部分人都一早知道嘅問題

呢啲問題唔會好令我哋分心

and they don't distract us very much.

There was a study I particularly liked

我幾鐘意一個調查

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

一班抑鬱症病人同一班冇抑鬱嘅人

需要分別玩電子遊戲一粒鐘

were asked to play a video game for an hour,

and at the end of the hour,

當佢哋玩完

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

佢哋要回答佢哋覺得喺遊戲裏面

殺咗幾多隻怪獸

抑鬱症嗰班人通常講到 10% 之內誤差嘅數字

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

and the non-depressed people

至於冇抑鬱症嘅人

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

佢哋估嘅數字

係佢哋真正殺咗數目嘅 15-20 倍

(Laughter)

as they had actually killed.

（笑聲）

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

好多人會話，當我決定寫我嘅抑鬱症

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

係一個非常困難嘅決定

to have people know.

佢哋問︰

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

「人哋同你傾計嘅時候會唔會唔同？」

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

我話︰「係， 人哋同我傾計會有唔同。」

They talk to me differently insofar

佢哋會同我講佢哋抑鬱症嘅經驗

as they start telling me about their experience,

or their sister's experience,

可能係佢哋家姐、細妹

or their friend's experience.

可能係佢哋嘅朋友

Things are different because now I know

宜家唔同啦因為我知道

that depression is the family secret that everyone has.

抑鬱症每個家庭都曾經有過

I went a few years ago to a conference,

前幾年我去咗個研討會

and on Friday of the three-day conference,

喺嗰個為期三日嘅研討會入面

其中一日，係星期五嚟

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

其中一個參加者將我拉到一旁 然後佢同我講︰

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

「我有抑鬱症，呢個病令我覺得尷尬，

但係我一路有食藥。

but I've been taking this medication,

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

我剩係想問下你你點樣睇？」

所以我就盡我所能答佢

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.

佢跟住話︰ 「你知嗎？

我老公永遠唔會明白架。

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

呢樣嘢對佢完全冇意義。

所以， 呢個係我哋嘅秘密。」

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

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

我答 ︰「冇問題。」

On Sunday of the same conference,

跟著喺研討會嘅最後一日

her husband took me aside,

佢丈夫又拉埋我一邊

(Laughter)

（笑聲）

and he said, "My wife wouldn't think

佢話 ︰「我老婆 如果知道我有抑鬱症嘅話，

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

絕對唔會覺得我係一個男人。

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

我有療程，有食藥。 我想知道你點諗？」

and I wondered what you think?"

They were hiding the same medication

佢哋兩夫妻將佢哋同一款藥

in two different places in the same bedroom.

收埋喺同一間睡房嘅唔同地方

(Laughter)

（笑聲）

And I said that I thought communication within the marriage

我諗佢哋溝通唔係好好

might be triggering some of their problems.

導致一啲問題出現

(Laughter)

（笑聲）

But I was also struck

同時我都因為佢哋互相提防而覺得辛苦

by the burdensome nature of such mutual secrecy.

Depression is so exhausting.

抑鬱症令人好攰

It takes up so much of your time and energy,

佢用咗你好多時間同精力

and silence about it,

唔理抑鬱症只會令抑鬱症惡化

it really does make the depression worse.

And then I began thinking

然後我開始諗抑鬱症患者康復嘅方法

about all the ways people make themselves better.

I'd started off as a medical conservative.

我會由傳統治療開始

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

我知道只有少數治療 至可以對患者有幫助

it was clear what they were --

好明顯係某幾種方法

there was medication,

有藥物治療

there were certain psychotherapies,

有一啲心理治療

there was possibly electroconvulsive treatment,

仲可能有電痙攣療法

但其他方法都係冇用

and that everything else was nonsense.

But then I discovered something.

我發現咗一樣嘢

If you have brain cancer,

如果你有腦癌

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

而每朝倒立廿分鐘會令你感覺好啲

makes you feel better,

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

可能真係會畀你感覺好啲啦

但係你嘅腦癌從來都冇消失過

and you'll still probably die from it.

你最終都有可能死於腦癌

But if you say that you have depression,

但如果你有抑鬱症

and standing on your head for 20 minutes every day

每日倒立廿分鐘

會畀你感覺好一啲， 噉就真係有效啦

makes you feel better, then it's worked,

because depression is an illness of how you feel,

因為抑鬱症係你認知上出現咗問題

and if you feel better,

你感覺好啲就代表咗你唔再係抑鬱

then you are effectively not depressed anymore.

所以我開始接受其他唔同嘅治療

So I became much more tolerant

of the vast world of alternative treatments.

And I get letters, I get hundreds of letters

然後我收到好多患者寄嚟嘅信

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

講有咩方法對佢哋奏效

就好似今日噉就有人喺後台 問我藥物方面嘅嘢

Someone was asking me backstage today about meditation.

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

一個女士曾經寫過一封我係最鐘意嘅

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

佢話佢曾經嘗試過治療、藥物

she had tried pretty much everything,

所有嘅嘢都試過曬

最後佢搵到一種方法，想我同大家分享

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

就係用毛冷整唔同嘅小飾物

and that was making little things from yarn.

(Laughter)

（笑聲）

She sent me some of them.

佢仲送咗啲佢整嘅作品

(Laughter)

（笑聲）

And I'm not wearing them right now.

不過我宜家冇帶著佢哋

(Laughter)

I suggested to her that she also should look up

我叫佢睇一睇

obsessive compulsive disorder in the DSM.

心理醫學診斷同統計手冊裡面

有關強迫症嘅部分

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

當我搵其他治療嘅時候

I also gained perspective on other treatments.

我對佢哋了解深咗

I went through a tribal exorcism in Senegal

我曾經去過塞內加爾 一個部落嘅驅邪儀式

that involved a great deal of ram's blood

儀式入面有好多公羊嘅血

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

我唔喺度描述啦

but a few years afterwards I was in Rwanda,

但幾年後我喺盧旺達參與另一項計畫

working on a different project,

and I happened to describe my experience to someone,

我要同人講我喺塞內加爾嘅經歷

and he said,

佢話︰「嗰度係西非，你知嗎？

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

我哋係喺東非，

and our rituals are in some ways very different,

我哋嘅儀式同佢哋嘅 喺幾方面都有好大分別，

but we do have some rituals

但同時都有一啲相同嘅地方。

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

我話係呀

And he said,

佢話佢哋同西方心理健康人員 有唔少麻煩

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

尤其係嗰啲喺種族屠殺之後嚟嘅人

especially the ones who came right after the genocide."

我問︰「佢哋帶俾你咩麻煩？」

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

佢話︰「佢哋做啲嘢真係好好，

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

They didn't take people out in the sunshine

佢哋不但止冇帶病人曬太陽，

令病人感覺好啲，

where you begin to feel better.

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

佢哋仲冇打鼓或者播音樂，

令病人嘅血活起上嚟。

They didn't involve the whole community.

佢哋冇帶動成個社群，

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

佢哋冇將抑鬱症

講成係一種入侵性嘅惡靈。

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

佢哋反而將病人逐個帶入黑房，

and had them talk for an hour

由佢哋自己講返

about bad things that had happened to them."

佢哋經歷過痛苦嘅嘢。」

(Laughter)

（笑聲） （掌聲）

(Applause)

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

佢話 ︰「 我哋只好請佢哋離開國家。」

(Laughter)

（笑聲）

Now at the other end of alternative treatments,

宜家講下其他另類療法

介紹一下 Frank Russakoff

let me tell you about Frank Russakoff.

Frank Russakoff 有好嚴重嘅抑鬱症

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

應該話我係從來未喺 任何一個男人身上見過嘅

He was constantly depressed.

佢成日抑鬱

He was, when I met him,

當我見佢嘅時候

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

佢每個月都要接受電擊治療

Then he would feel sort of disoriented for a week.

治療完之後嘅一個禮拜佢會覺得迷茫

Then he would feel okay for a week.

之後第二個禮拜又會好返

Then he would have a week of going downhill.

跟著又會抑鬱

And then he would have another electroshock treatment.

噉樣嘅話佢又要去接受電擊治療

當我見到佢，佢同我講

And he said to me when I met him,

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

「我已經忍受唔到噉樣過日子，

我唔可以再繼續噉樣落去。

I can't go on this way,

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

假如情況冇好轉，我知道點樣解決佢。」

if I don't get better."

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

佢又同我講︰「但係，

我聽過麻省總醫院有個療法叫做

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

扣帶回切開術， 係一種腦科手術，

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

我諗我可以試試。」

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

我記得當時我好開心

因為一個人已經經歷過咁多

who clearly had so many bad experiences

慘痛經歷、咁多唔同嘅治療

with so many different treatments

still had buried in him, somewhere, enough optimism

但佢內心仲抱著一絲嘅樂觀

to reach out for one more.

佢願意再試多次

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

佢做咗個好成功嘅手術

He's now a friend of mine.

宜家仲係我朋友

He has a lovely wife and two beautiful children.

佢有一個好老婆同兩個可愛嘅細路

He wrote me a letter the Christmas after the surgery,

佢手術之後嘅聖誕節寫咗封信俾我

and he said,

佢話︰

"My father sent me two presents this year,

「我老豆今年寄咗我兩份禮物，

First, a motorized CD rack from The Sharper Image

第一份係 The Sharper Image 牌嘅 可捲動式 CD 架，

that I didn't really need,

但我唔需要佢。

but I knew he was giving it to me to celebrate

不過我知道佢送嚟係想

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

慶祝我可以獨立生活、

有自己鐘意嘅工。

And the other present was a photo of my grandmother,

另一份禮物係我婆婆嘅相，

who committed suicide.

我婆婆死於自殺。

As I unwrapped it, I began to cry,

當我拆禮物，我就喊咗出嚟，

and my mother came over and said,

然後我媽咪過嚟同我講︰

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

『你係咪未見過婆婆而喊？』

我答︰『婆婆同我都有同樣嘅病。』

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

I'm crying now as I write to you.

我喊係因為我寫俾你。

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

我唔係傷心， 而係我個腦太多嘢啦。

I think, because I could have killed myself,

我覺得自己會自殺，

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

但父母同醫生支持我。

and I had the surgery.

我做咗手術，我仲生存，我好感激。

I'm alive and grateful.

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

雖然有時感覺唔係活喺一個啱嘅年代，

我哋確實活喺一個啱嘅年代。」

I was struck by the fact that depression

我驚訝抑鬱症竟然

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

被認為係一種現代、西方、中產嘅嘢

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

於是我就睇下抑鬱症

喺其他唔同地方係點發生

and one of the things I was most interested in

我最感到興趣嘅係低下階層嘅抑鬱情況

was depression among the indigent.

所以我搵出針對窮人嘅抑鬱有乜係做咗

And so I went out to try to look

at what was being done for poor people with depression.

And what I discovered is that poor people

我發現大多數有抑鬱症嘅窮人 都冇接受過治療

are mostly not being treated for depression.

抑鬱症係基因易受損嘅結果

Depression is the result of a genetic vulnerability,

which is presumably evenly distributed in the population,

呢種基因按理會喺 成個人口裡面平均分布

and triggering circumstances,

而發病情況，尤其窮人會相對嚴重

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

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

但實情係如果你有一個美好嘅生活

但一直覺得自己好淒慘

but feel miserable all the time,

you think, "Why do I feel like this?

同埋問︰「點解我會有咁嘅感覺？

I must have depression."

我應該有抑鬱啦。」

然後你去搵治療

And you set out to find treatment for it.

但係如果你有一個好慘嘅人生

But if you have a perfectly awful life,

and you feel miserable all the time,

而你一直都覺得好慘

the way you feel is commensurate with your life,

你慘嘅感覺同你慘嘅生活呼應

and it doesn't occur to you to think,

你唔會諗呢個病可以醫得好

"Maybe this is treatable."

And so we have an epidemic in this country

換句話講，我哋抑鬱國家 入面嘅貧窮人口

of depression among impoverished people

爆發咗一種流行病叫做抑鬱症

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

但冇人提過佢、冇人會醫過佢

and that's not being addressed,

冇人重視過佢

and it's a tragedy of a grand order.

可以話係社會悲劇

And so I found an academic

所以我搵咗一個學者

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

佢進行梗一個 關於華盛頓外圍貧民區嘅研究

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

佢揀咗求診嘅女性做對象

and diagnosed them with depression,

呢啲女性係因為其他病至求診

但後來都發現到有抑鬱

and then provided six months of the experimental protocol.

於是班人得到六星期嘅試驗性治療

One of them, Lolly, came in,

Lolly 係其中一個參加嘅人

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

佢第一日入嚟就話佢係七個細路嘅母親

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

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

佢以前有做嘢，但佢宜家要放棄份工

because I couldn't go out of the house.

「因為我出唔到間屋。

我同細路冇嘢講。

I have nothing to say to my children.

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

朝早， 我唔可以等住佢哋走，

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

我只好返上床用被遮住個頭。

三點鐘當小朋友返到屋企，

and three o'clock when they come home,

我覺得時間過得好快。

it just comes so fast."

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

佢仲話︰ 「我一直有食開 Tylenol，

anything I can take so that I can sleep more.

任何可以畀我瞓耐啲嘅藥物。

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

我丈夫一直話我又蠢又醜，

I wish I could stop the pain."

我希望痛楚可以停止。」

Well, she was brought into this experimental protocol,

佢就係噉帶咗入嚟呢個試驗性嘅治療

and when I interviewed her six months later,

六個月後我再同佢傾

she had taken a job working in childcare

佢已經喺一間美國海軍嘅托兒所度做

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

佢離開有暴力傾向嘅丈夫

佢話畀我知

and she said to me,

佢啲細路比以前仲開心咗添

"My kids are so much happier now."

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

佢間新屋入面整咗一間房專門俾男仔

and one room for the girls,

仲有一間房專門俾女仔

「但係夜晚細路都去晒我張床，

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

and we're doing homework all together and everything.

我哋一齊做功課同埋其他嘢。

One of them wants to be a preacher,

其中一個小朋友話想做牧師，

one of them wants to be a firefighter,

另一個想做消防員。

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

有個女話想做律師。

They don't cry like they used to,

佢哋唔似以前噉喊，同埋冇再打交。

and they don't fight like they did.

我宜家需要嘅就只係我小朋友。

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

Things keep on changing,

事情一直喺度改變梗，

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

我著衫、我對事物嘅感覺，

仲有我平時嘅態度都有唔同。

I can go outside not being afraid anymore,

我可以行出門口而唔覺得驚。

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

我唔覺得以前唔好嘅感覺會返返嚟。

如果唔係 Miranda 醫生，

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

我可能仲要匿喺屋企用被襟著個頭。

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

if I were still alive at all.

如果我仲活著嘅話，

我會問上帝派一隻天使嚟，

I asked the Lord to send me an angel,

and He heard my prayers."

令佢可以聽到我嘅禱告。」

I was really moved by these experiences,

佢嘅經驗令我非常感動

and I decided that I wanted to write about them

我決定將佢嘅經歷寫落嚟

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

唔只寫入我喺寫梗嘅一本書

仲會寫喺專欄裡面

and I got a commission from The New York Times Magazine

同埋紐約時代雜誌邀請我 寫關於窮人嘅抑鬱症

to write about depression among the indigent.

我就寫咗我遇過真實嘅故事

And I turned in my story,

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

但編輯打嚟話︰

「我哋登唔到噉樣嘅文章。」

And I said, "Why not?"

我話點解唔得？

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

佢話個故事太牽強啦

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

「呢啲人係社會嘅最底層，

and then they get a few months of treatment

佢哋接受咗幾個月治療之後，

and they're virtually ready to run Morgan Stanley?

就可以去摩根史坦利返工？

簡直難以置信。」

It's just too implausible."

佢話︰「我從來未聽過噉樣嘅嘢。」

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

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

我話你冇聽過就代表咗

呢單係一單「新」聞

is an indication that it is news."

(Laughter)

（笑聲） （掌聲）

(Applause)

"And you are a news magazine."

我仲話呢個係一間新聞雜誌社嚟架

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

噉傾咗一輪之後

佢哋同意刊登我嘅文章

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

但我諗好多佢哋講嘅嘢都係好怪

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

同埋有偏見

佢哋覺得如果我哋去醫班窮人

the notion that somehow if we went out

and treated a lot of people in indigent communities,

就係剝削梗佢哋

that would be exploitative,

because we would be changing them.

原因係我哋會改變佢哋

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

呢啲虛偽嘅道德情操似乎無處不在

that treatment of depression,

佢哋覺得抑鬱症嘅治療 藥物以至其他嘢

the medications and so on, are an artifice,

都係人工合成嘅、唔係自然嘅

and that it's not natural.

And I think that's very misguided.

而我覺得佢哋係非常之誤導

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

人隻牙脫落係正常不過嘅事

but there is nobody militating against toothpaste,

但唔會因為噉有人反對用牙膏

at least not in my circles.

至少我圈子裏面嘅人冇

People then say,

然後有人會話

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

抑鬱症唔係每個人都一定會經歷嘅嘢？

我哋唔係進化到有抑鬱症架咩？

Didn't we evolve to have depression?

抑鬱症唔通唔係我哋性格嘅一部分？

Isn't it part of your personality?"

To which I would say, mood is adaptive.

噉我就會話，情緒係可以改嘅

Being able to have sadness and fear

能夠有傷痛、恐懼、快樂、舒適

and joy and pleasure

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

以及其他唔同嘅情緒

其實係非常珍貴嘅

And major depression

抑鬱症係由於情緒系統崩潰

is something that happens when that system gets broken.

It's maladaptive.

係壞嘅轉變

People will come to me and say,

有啲人走嚟同我講︰

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

「如果我再撐多年， 我應該會走出抑鬱症。」

I think I can just get through this."

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

我一直同佢哋講︰ 「你可以走得返出嚟，

但你永遠唔會再係年輕。

but you'll never be 37 again.

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

人生短暫， 但你成年都喺度講想放棄。

Think it through."

諗下啦。」

It's a strange poverty of the English language,

英文入面關於抑鬱嘅字真係好少

and indeed of many other languages,

其他語言都係噉

that we use this same word, depression,

我哋用同一個字︰depression

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

去形容一個細路

喺佢生日嗰日遇到落雨時嘅感覺

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

同一個字會形容一個人自殺前嘅心情

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

有啲人同我講︰

「抑鬱係唔係平時傷心嘅延續？」

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

我話︰「可以係延續嘅， 抑鬱係有傷心嘅延續。」

There is a certain amount of continuity,

but it's the same way there's continuity

打個比喻

between having an iron fence outside your house

你間屋出面道圍欄有一個好細嘅鏽跡

that gets a little rust spot

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

你可以磨佢然後再上漆

and what happens if you leave the house for 100 years

但如果你唔理間屋一百年

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

成個欄就會生鏽到剩返一堆橙色嘅鏽屑

就係開頭小小嘅生鏽我哋要去解決

And it's that orange dust spot,

that orange dust problem,

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

所以宜家啲人話

So now people say,

「你食咗開心丸， 你會開心嗎？」

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

And I don't.

對於我嚟講冇

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

我唔會因為食晏而覺得傷心

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

我唔會因為我嗰電話答錄機而傷心

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

我唔會因為沖涼而傷心

I feel more, in fact, I think,

我諗我感受到更多

because I can feel sadness without nullity.

因為我唔會冇嘢走去傷心

I feel sad about professional disappointments,

我可以因為工作上嘅失望而傷心

about damaged relationships,

或者因為轉壞嘅關係，又或者全球暖化

about global warming.

Those are the things that I feel sad about now.

呢啲嘢都係我宜家傷心嘅

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

然後我同自己講，噉又點？

How did those people who have better lives

有更好生活嘅人，甚至有更嚴重抑鬱

even with bigger depression manage to get through?

係點樣走出嚟架呢？

What is the mechanism of resilience?

對抗逆境個心理機制又係點架呢？

And what I came up with over time

我慢慢總結出否定過往有抑鬱嘅人

was that the people who deny their experience,

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

話自己好耐以前曾經抑鬱

I never want to think about it again,

但唔想諗返轉頭，唔再面對佢

I'm not going to look at it

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

只係想過好嘅生活

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

非常諷刺地

呢啲人卻係畀佢哋擁有嘅嘢控制咗

Shutting out the depression strengthens it.

唔正視抑鬱症只會令得情況更加嚴重

While you hide from it, it grows.

當你避佢，佢反而惡化

表現比較好嘅人反而會 接受佢哋有抑鬱症

And the people who do better

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

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

肯面對抑鬱嘅人就會更堅強

So Frank Russakoff said to me,

所以 Frank Russakoff 同我講︰

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

「如果我可以再嚟一次，

我唔會揀呢條路，

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

我反而會揀一個唔尋常嘅方式。

我好感激我經歷過嘅嘢。

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

我好開心我留過院四十次。

我留院學識咗乜係愛。

It taught me so much about love,

and my relationship with my parents and my doctors

我同父母、醫生嘅關係 係以後都係最珍惜嘅。」

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

And Maggie Robbins said,

而 Maggie Robbins 話︰

"I used to volunteer in an AIDS clinic,

「我以前喺一個愛滋病嘅診所做義工。

and I would just talk and talk and talk,

我工作嘅時候，我會唔停咁講嘢。

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

我對著嘅人冇乜反應，

所以我就覺得佢哋唔係好友善。」

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

(Laughter)

（笑聲）

"And then I realized,

「但我之後發覺，

I realized that they weren't going to do more

佢哋除咗頭五分鐘嘅傾計之外，

than make those first few minutes of small talk.

It was simply going to be an occasion

就唔想做其他嘢。

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

好似我冇愛滋病、唔使死，

but could tolerate the fact that they did

但又可以接受到嗰啲人一樣，

and they were.

Our needs are our greatest assets.

我哋嘅需求正正係我哋最大嘅本錢。

我學識點樣放開我想要嘅嘢。」

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

Valuing one's depression does not prevent a relapse,

重視抑鬱症唔擔保抑鬱症唔會復發

but it may make the prospect of relapse

但會令復發嘅心理準備 同復發本身都更容易去接受

and even relapse itself easier to tolerate.

個意義唔係在於去搵抑鬱症嘅意義

The question is not so much of finding great meaning

and deciding your depression has been very meaningful.

或者覺得自己嘅抑鬱症好有意義

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

而係當抑鬱症再嚟嘅時候

雖然好似好弊

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

但我會從中學到嘢

I have learned in my own depression

由以前嘅抑鬱學到情緒可以有幾大

how big an emotion can be,

how it can be more real than facts,

而又點樣可以比事實更加真實

經歷過之後，令我情緒正面嘅時候

and I have found that that experience

has allowed me to experience positive emotion

in a more intense and more focused way.

我識得更加集中同投入咁感受正面情緒

The opposite of depression is not happiness,

抑鬱症嘅相反唔係快樂，係活力

but vitality,

and these days, my life is vital,

而這些日子我的生命充滿活力,

even on the days when I'm sad.

就算傷心嘅時候都係

I felt that funeral in my brain,

我腦入面感受到嗰場葬禮

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

我同一個巨人坐喺世界嘅邊緣

and I have discovered something inside of myself

我發現自己內心嘅一啲嘢

that I would have to call a soul

以前我要呼喚內心

that I had never formulated until that day 20 years ago

但直到廿年前嘅一日

地獄好似派咗使者嚟

之後我明白到所有嘢

when hell came to pay me a surprise visit.

我唔使再呼喚自己

I think that while I hated being depressed

當我唔鐘意抑鬱、唔想再抑鬱嘅時候

and would hate to be depressed again,

I've found a way to love my depression.

我搵到一個愛上抑鬱症嘅方法

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

我愛佢係因為佢令我去尋同埋堅持快樂

I love it because each day I decide,

我愛佢因為我決定每日…

sometimes gamely,

有時因為玩

and sometimes against the moment's reason,

有時因為喺嗰刻特登唱反調

to cleave to the reasons for living.

去擁抱生存嘅理由

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

呢樣嘢可喜可賀，亦係一份榮譽

多謝

Thank you.

(Applause)

（掌聲）

Thank you.

(Applause)