Depression, the secret we share | Andrew Solomon

譯者: Shiwen He 審譯者: Marssi Draw

"I felt a Funeral, in my Brain,

「在我的腦海中，有一場葬禮，

and Mourners to and fro

哀悼者來來去去，

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

不停踩踏，踩踏，直到我感覺

感官衝破了覺知。

that Sense was breaking through --

And when they all were seated,

當眾人全都就座，

a Service, like a Drum --

儀式開始，像擊鼓般，

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

不斷敲擊、敲擊，直到感覺

我的意識就此麻木。

my Mind was going numb --

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

此刻我聽見他們抬起棺木，

嘰嘎聲穿透我的魂。

with those same Boots of Lead, again,

鉛靴的踏步聲再度揚起，

then Space -- began to toll,

伴隨喪鐘迴盪，

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

彷彿天空是具大鐘，

只剩下一只耳朵存在，

and I, and Silence, some strange Race,

而我與寂靜間，一場微妙的追逐，

wrecked, solitary, here --

獨自在此破碎。

[And] then a Plank in Reason, broke,

就在此時，理性忽然斷了弦，

and I fell down and down --

我不斷墜落，

and hit a World, at every plunge,

每次墜落都撞上一個世界，

and Finished knowing -- then --"

最終豁然開朗。 」

We know depression through metaphors.

我們透過文學隱喻認識了憂鬱。

Emily Dickinson was able to convey it in language,

艾蜜莉．狄更生（十九世紀美國詩人） 用詩歌描寫它，

Goya in an image.

哥雅（西班牙畫家）用繪畫詮釋，

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

半數藝術品的目的

是為了描述這象徵性的狀態。

As for me, I had always thought myself tough,

對我而言，我總把自己看做一名鬥士，

one of the people who could survive

是那種即使被送往集中營

if I'd been sent to a concentration camp.

也可以存活下來的人。

In 1991, I had a series of losses.

1991 年，我經歷了一連串的不幸。

My mother died,

我的母親去世，

a relationship I'd been in ended,

戀情終結，

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

多年居住外國之後，

我返回了美國。

and I got through all of those experiences intact.

我安然無恙地經歷這一切。

But in 1994, three years later,

但是到了 1994 年，即三年之後，

I found myself losing interest in almost everything.

我發現自己對所有的事情都失去了興趣。

任何我曾經喜歡做的事情，

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

我都不願意做。

and I didn't know why.

對此我毫無頭緒。

The opposite of depression is not happiness, but vitality.

憂鬱的反面

不是快樂，而是活力。

正是這種活力，

And it was vitality

that seemed to seep away from me in that moment.

在那時似乎從我體內一點一點地消失。

Everything there was to do seemed like too much work.

任何需要做的事情

都變得困難無比。

I would come home

我回到家裡，

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

看到答錄機上閃爍跳躍的紅燈，

and instead of being thrilled to hear from my friends,

我非但不會因為有朋友的音訊而感到興奮。

I would think,

我會想著：

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

「怎麼有這麼多人需要我回覆電話！」

Or I would decide I should have lunch,

又比如，我知道自己該吃午餐了。

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

我就會想，我需要把食物取出來，

and put it on a plate

放在盤子上，

and cut it up and chew it and swallow it,

切開它們，嚼碎它們再嚥下去。

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

這對我就像耶穌受難一樣難熬。

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

有關憂鬱的討論中，

有一點經常讓人困惑，

is that you know it's ridiculous.

那就是你明白這一切都很荒謬。

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

當你經歷這一切的時候， 你知道這很荒謬。

You know that most people manage

你知道大多數人能夠

to listen to their messages and eat lunch

聽他們的電話留言、吃午飯、

and organize themselves to take a shower

打點好自己、沖個澡，

and go out the front door

然後走出大門。

and that it's not a big deal,

這些事無關緊要，

and yet you are nonetheless in its grip

但你卻依然深陷其中，

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

你無法找到逃離的方式。

And so I began to feel myself doing less

於是我發現自己做的事越來越少，

and thinking less

思考愈來愈少，

and feeling less.

感覺越來越少，

It was a kind of nullity.

處在一種虛無狀態中。

And then the anxiety set in.

這時焦慮出現了。

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

如果你告訴我，

我會在下個月一直憂鬱，

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

我會說：「只要我知道， 憂鬱會在 11 月消失，我就能挺過去。」

But if you said to me,

然而如果你這樣說：

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

「你會在下個月嚴重焦慮。」

我寧願割腕也不願意承受。

I would rather slit my wrist than go through it.

It was the feeling all the time

這是一種持續的感受，

like that feeling you have if you're walking

就好像你走在路上，

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

你跌倒了或者絆倒了，

地面猛然衝向你。

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

但是這感覺不是只有半秒，

it lasted for six months.

這感覺要持續六個月。

It's a sensation of being afraid all the time

這是一種無時無刻感到害怕，

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

卻不知道你在害怕什麼的感覺。

And it was at that point that I began to think

那一刻我開始想，

that it was just too painful to be alive,

活著太痛苦了。

and that the only reason not to kill oneself

人不會自殺的唯一理由，

was so as not to hurt other people.

就是不想傷害旁人。

And finally one day, I woke up

終於有一天，我醒來，

and I thought perhaps I'd had a stroke,

我想我可能中風了。

because I lay in bed completely frozen,

因為我躺在床上，渾身僵硬。

looking at the telephone, thinking,

我看著電話，心想：

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

「出事了，我應該打電話求救。」

and I couldn't reach out my arm

我卻無法伸出胳膊，

and pick up the phone and dial.

無法拿起電話撥號，

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

終於，在我躺著盯著電話 整整四個小時之後，

the phone rang,

電話響了。

and somehow I managed to pick it up,

不知怎麼我拿起了聽筒，

and it was my father, and I said,

那是我父親來電。

我說：「我麻煩大了，

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

我們必須做點什麼。 」

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

第二天我開始接受藥物治療

和心理治療。

And I also started reckoning with this terrible question:

並且我開始思索

這個可怕的問題：

If I'm not the tough person

如果我不是個堅強的人，

who could have made it through a concentration camp,

不是那種可以在集中營裡存活的人，

then who am I?

那麼我是誰？

And if I have to take medication,

如果我必須服用藥物，

is that medication making me more fully myself,

那麼藥物是讓我變得更像我自己，

or is it making me someone else?

還是讓我變成了別人？

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

我要如何知道

藥物是否讓我變成了別人呢？

在這場戰鬥中我有兩個優勢：

I had two advantages as I went into the fight.

The first is that I knew that, objectively speaking,

第一，我很清楚，客觀地說，

I had a nice life,

我有很好的生活。

and that if I could only get well,

一旦我好起來，

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

還會有一些東西

值得我去追求。

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

另外一點是我能接受很好的治療。

But I nonetheless emerged and relapsed,

然而我卻反覆發作，

and emerged and relapsed,

好轉又發作，

and emerged and relapsed,

又一次好轉，再發作。

and finally understood

終於我明白，

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

自己必須一輩子

服藥和治療。

And I thought,

於是我想：「但是這到底是化學問題

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

還是心理問題？

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

是需要化學療法還是哲學療法？」

And I couldn't figure out which it was.

我想不出是哪一種。

And then I understood that actually,

接著我懂了，

事實上，我們對這兩個領域的了解

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

都不足以完全解釋真相。

The chemical cure and the psychological cure

化學療法和心理療法都有

both have a role to play,

各自的作用。

and I also figured out that depression was something

同時我明白了憂鬱是一種

深深根植於我們體內的東西。

that was braided so deep into us

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

我們無法從性格和個性中

將憂鬱剝離開來。

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

我想說我們對憂鬱的治療

方法太過恐怖。

這些方法不太有效，

They're not very effective.

They're extremely costly.

而且代價高昂，

They come with innumerable side effects.

還帶來無數副作用，

They're a disaster.

簡直就是場災難。

不過我很慶幸自己活在現代，

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

而不是 50 年前，

when there would have been almost nothing to be done.

那時候幾乎沒有任何

治療的辦法。

I hope that 50 years hence,

我想 50 年以後，

people will hear about my treatments

人們聽說我的治療方法，

會驚訝於居然有人能忍受

and be appalled that anyone endured such primitive science.

如此原始粗糙的科學。

Depression is the flaw in love.

憂鬱是愛的缺陷。

If you were married to someone and thought,

如果你將要和另一半結婚，然後想：

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

「好吧，如果我妻子死了，我會再找一個。」

it wouldn't be love as we know it.

這不是我們熟知的愛情。

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

沒有這樣一種愛情，

只有獲取幸福卻不用體驗失去。

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

這種絕望的幽靈，

會是親密關係的動力。

There are three things people tend to confuse:

人們容易混淆三件事：

depression, grief and sadness.

憂鬱，悲傷和難過。

Grief is explicitly reactive.

悲傷是明確的反應。

If you have a loss and you feel incredibly unhappy,

如果你因為損失而感到非常不開心，

and then, six months later,

那麼六個月之後，

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

你仍然很難過，但日常作息好轉了一些。

這大概就是悲傷。

it's probably grief,

and it will probably ultimately resolve itself in some measure.

它可能最終在一定程度上

能自行修復。

If you experience a catastrophic loss,

如果你經歷了一次災難性的打擊，

and you feel terrible,

你感覺非常糟糕，

and six months later you can barely function at all,

六個月之後依然無法正常生活，

then it's probably a depression that was triggered

那麼可能就是一種憂鬱

被災難性的情形所觸發了。

by the catastrophic circumstances.

The trajectory tells us a great deal.

這個分析軌跡告訴我們很多訊息。

People think of depression as being just sadness.

人們認為憂鬱只是難過。

It's much, much too much sadness,

只是太多太多的難過，

much too much grief

太多太多的悲傷，

at far too slight a cause.

因為微不足道的事情而起。

As I set out to understand depression,

當我開始了解憂鬱，

and to interview people who had experienced it,

採訪了經歷過憂鬱的人們，

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

我發現有些人

表面上看起來

to have what sounded like relatively mild depression

似乎有輕微的憂鬱，

他們卻因此完全喪失了行為能力。

who were nonetheless utterly disabled by it.

And there were other people who had what sounded

另外一些人，

as they described it like terribly severe depression

根據他們的描述，

有非常嚴重的憂鬱，

who nonetheless had good lives

卻能在憂鬱的間隙

in the interstices between their depressive episodes.

過著不錯的生活。

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

我開始著手研究，

為什麼有些人

to be more resilient than other people.

比另一些人有更好的復元能力。

What are the mechanisms that allow people to survive?

是什麼機制

讓人得以倖存？

And I went out and I interviewed person after person

我出去採訪了一個又一個

who was suffering with depression.

因憂鬱而受苦的人。

One of the first people I interviewed

我最早採訪的某個人

將憂鬱描述為

described depression as a slower way of being dead,

一種緩慢的死亡方式。

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

最初就聽到這說法對我來說是好事，

because it reminded me that that slow way of being dead

因為它提醒了我

緩慢的死亡

can lead to actual deadness,

可以通往真正的死亡。

that this is a serious business.

這可是正經話。

It's the leading disability worldwide,

憂鬱是世界上名列前茅的身心障礙，

and people die of it every day.

每天都有人因此喪生。

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

當我試著了解這些的時候，

我的一位採訪對象，

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

也是我的摯友，

我與她相識多年。

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

在她大一的時候，

有過一次精神病發作，

and then plummeted into a horrific depression.

之後她陷入了可怕的憂鬱。

She had bipolar illness,

她患有雙相障礙，

or manic depression, as it was then known.

當時也稱為躁鬱症。

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

經過多年的鋰治療，

她恢復得不錯。

於是到最後，

and then eventually, she was taken off her lithium

她停止了化學治療，

to see how she would do without it,

看看自己不治療能撐多久。

and she had another psychosis,

然而她的精神病復發，

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

接著陷入了我所見過

最嚴重的憂鬱。

in which she sat in her parents' apartment,

她坐在父母的公寓裡，

more or less catatonic, essentially without moving,

多少有點緊張型精神分裂症， 幾乎一動也不動，

day after day after day.

就這樣過了一天又一天。

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

多年後我採訪她，談起了這段經歷──

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

她叫瑪姬．羅賓 (Maggie Robbins) ， 是一位詩人和精神治療師──

when I interviewed her, she said,

當我採訪她時，她說：

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

「 當時我一遍一遍地唱著 《花兒都去哪兒了》，

over and over, to occupy my mind.

滿腦子都是這首歌。

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

我唱著歌來清除腦子裡的那個聲音，

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

那個聲音說：『你什麼都不是，你一文不名。

你不配活著。』

You don't even deserve to live.'

And that was when I really started thinking

從那一刻起，我真的開始想要

殺死我自己。 」

about killing myself."

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

你憂鬱的時候，並不像是

你戴上了一個灰色面紗，

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

透過沮喪情緒的霧霾

來看待這個世界。

You think that the veil has been taken away,

而是你認為那層快樂的面紗

已經被拿走，

the veil of happiness,

and that now you're seeing truly.

所以現在你面對的是赤裸裸的現實。

It's easier to help schizophrenics who perceive

幫助精神分裂症患者相對容易一些，

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

他們知道身體裡有異物，

需要把它們弄出去。

but it's difficult with depressives,

而對於憂鬱症患者就困難多了，

because we believe we are seeing the truth.

因為我們相信自己看到的是現實。

But the truth lies.

但是事實會說謊。

I became obsessed with that sentence:

我為這句話著迷：

"But the truth lies."

「事實會說謊。」

And I discovered, as I talked to depressive people,

據我觀察，當我和憂鬱症患者交談時，

that they have many delusional perceptions.

他們有許多妄想的念頭。

People will say, "No one loves me."

他們會說：「沒人愛我。」

And you say, "I love you,

你會說：「我愛你，

your wife loves you, your mother loves you."

你的妻子愛你，你的媽媽愛你。」

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

你可以馬上說出這個答案，

至少大多數人是這樣。

但是憂鬱症患者還會說：

But people who are depressed will also say,

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

「不管我們做什麼，

最終，我們都會死去。」

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

或者他們會說：「人與人之間

between two human beings.

不可能有真正的交流。

Each of us is trapped in his own body."

我們每個人都被困在自己的身體裡。」

To which you have to say,

關於這點你會反駁說：

"That's true,

「這沒錯，

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

但是我認為，我們當下應該考慮的是

早飯吃什麼。」

(Laughter)

（笑聲）

A lot of the time,

大多數時候，

what they are expressing is not illness, but insight,

他們所表現出來的不是病症，而是思想偏執。

and one comes to think what's really extraordinary

他們對這些問題特別在意，

is that most of us know about those existential questions

而大多數人都知道這些存在主義問題，

但是我們不會太困擾。

and they don't distract us very much.

There was a study I particularly liked

我特別喜歡這個研究：

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

一群憂鬱症患者

和一群非憂鬱症患者

被要求玩一個小時的電玩。

were asked to play a video game for an hour,

and at the end of the hour,

一小時後問他們，

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

他們認為自己

殺死了多少只小怪獸。

憂鬱症組的回答通常是準確的，

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

誤差在 10％ 以內。

and the non-depressed people

而非憂鬱症組的人，

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

回答打死小怪獸的數量

比實際數目

(Laughter)

多了 15 到 20 倍 。 ──（笑聲）──

as they had actually killed.

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

當我選擇寫下我自己的憂鬱經歷，很多人說

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

要揭開這個秘密，讓別人知道，

一定非常困難。

to have people know.

他們說：「人們會用不同的口吻和你說話嗎？」

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

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

我回答：「是的，人們用不一樣的語氣和我說話。

They talk to me differently insofar

這種不一樣表現在

as they start telling me about their experience,

他們會開始和我談自己的經歷，

or their sister's experience,

或者他們姐妹的經歷，

or their friend's experience.

或者他們朋友的經歷。

Things are different because now I know

事情和以前有所不同，因為現在我知道

that depression is the family secret that everyone has.

憂鬱是每個家庭裡的秘密。

I went a few years ago to a conference,

幾年前我參加一個會議，

and on Friday of the three-day conference,

會議有三天，這天是週五。

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

一名與會者把我拉到一旁，對我說：

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

「我有憂鬱症，

我覺得有點不好意思，

但是我一直在服這種藥，

but I've been taking this medication,

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

我只想問問你的意見？」

於是我盡我所能給了她一些建議。

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.

然後她說：「你知道，

我丈夫永遠不會理解這些。

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

他就是那種認為這些都是胡說八道的人，

所以我想，嗯，希望我們的談話能保密。」

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

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

我回答：「當然沒問題。」

On Sunday of the same conference,

週日在同一個會議上，

her husband took me aside,

她的丈夫把我拉到一邊，

(Laughter)

and he said, "My wife wouldn't think

他說：「我妻子如果知道這事，

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

她就不會覺得我是個男子漢，

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

但是我一直在對抗憂鬱，

而且在服用藥物，

and I wondered what you think?"

我想能否聽聽你的建議？」

They were hiding the same medication

他們兩個

把同樣的藥物藏在

in two different places in the same bedroom.

臥室不同的地方。

(Laughter)

於是我對他說，

And I said that I thought communication within the marriage

我認為婚姻中的溝通

might be triggering some of their problems.

可能引起他們的某些問題。

(Laughter)

（笑聲）

But I was also struck

不過我也震驚於

這種相互隱瞞的

by the burdensome nature of such mutual secrecy.

惱人天性。

Depression is so exhausting.

憂鬱令人精疲力盡，

It takes up so much of your time and energy,

它消耗了你那麼多的時間和精力。

and silence about it,

對此緘口不提，

it really does make the depression worse.

只會讓憂鬱更糟糕。

And then I began thinking

我開始考慮各種方法

about all the ways people make themselves better.

可以讓人們感覺更好。

I'd started off as a medical conservative.

一開始我對醫學治療較保守。

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

我認為一些療法是有效的，

it was clear what they were --

它們確實有效──

there was medication,

包括藥物治療，

there were certain psychotherapies,

還有一些特定的心理治療，

there was possibly electroconvulsive treatment,

電痙攣療法也可能有效。

除此以外的都沒用。

and that everything else was nonsense.

But then I discovered something.

但是後來我發現，

If you have brain cancer,

如果你得了腦癌，

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

而且你認為每天早上

倒立 20 分鐘能讓你感覺好些，

makes you feel better,

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

這可能讓你感覺好一些，

但是你仍然會有腦癌。

and you'll still probably die from it.

你還是有可能因此死去。

But if you say that you have depression,

不過如果你說你得了憂鬱症，

and standing on your head for 20 minutes every day

然後每天倒立 20 分鐘

讓你感覺好些，那麼這是有效的。

makes you feel better, then it's worked,

because depression is an illness of how you feel,

因為憂鬱是一種關於感受的疾病。

and if you feel better,

如果你感覺好一點了，

then you are effectively not depressed anymore.

那麼你就不會那麼憂鬱了。

所以我開始對無數的替代療法

So I became much more tolerant

抱有更加寬容的看法。

of the vast world of alternative treatments.

And I get letters, I get hundreds of letters

我收到來信，多達幾百封的來信。

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

人們來信告訴我，什麼樣的療法對他們有效。

今天有人在後臺問我關於

Someone was asking me backstage today about meditation.

藥物治療的事情。

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

我最喜歡的一封來信

是來自一位女士。

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

她說她嘗試過心理治療，

也嘗試過藥物治療， 嘗試了幾乎所有的治療方式。

she had tried pretty much everything,

她找到一個治療方法希望我能告訴全世界，

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

那就是用紗線做些小東西。

and that was making little things from yarn.

(Laughter)

（笑聲）

She sent me some of them.

她還寄給我一些她的作品。（笑聲）

(Laughter)

And I'm not wearing them right now.

我今天並沒有把它們戴在身上，

(Laughter)

I suggested to her that she also should look up

我建議她還應該去醫院，

obsessive compulsive disorder in the DSM.

檢查一下是否得了強迫症。

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

然而，當我去了解各種療法的時候，

I also gained perspective on other treatments.

我也對其它療法有了新看法。

I went through a tribal exorcism in Senegal

我在塞內加爾參加了一次部落驅魔，

that involved a great deal of ram's blood

裡面還有很多公羊的血，

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

這裡我就不描述細節了。

but a few years afterwards I was in Rwanda,

但是多年之後，我在盧旺達

working on a different project,

做另一個計畫。

and I happened to describe my experience to someone,

我湊巧把自己的經歷告訴某個人，

and he said,

他說：「嗯，你知道，

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

那裡是西非，我們這兒是東非，

and our rituals are in some ways very different,

我們的儀式在一些方面很不同，

but we do have some rituals

不過我們確實有一些儀式

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

內容和你描述的相同。」

我回答說「哦。」然後他說：「是的。」

And he said,

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

他又說：「不過西方的心理工作者 讓我們很苦惱，

尤其是大屠殺之後來的那些心理醫生。」

especially the ones who came right after the genocide."

我問：「你對他們有什麼意見嗎？」

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

他回答：「嗯，

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

他們做一些古怪的事。

They didn't take people out in the sunshine

他們不帶人們去陽光下，

那裡才讓人感覺舒服。

where you begin to feel better.

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

他們不用鼓聲或者音樂使人血脈沸騰，

They didn't involve the whole community.

他們不動員整個社區的人，

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

他們不把憂鬱看做侵略性的幽靈

進行驅逐。

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

相反的是，他們把人們一個個

帶到昏暗的小屋子裡，

and had them talk for an hour

跟他們談上一個小時，

about bad things that had happened to them."

談論發生在他們身上的悲慘故事。」

(Laughter)

（笑聲）（鼓掌）

(Applause)

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

他說：「我們不得不要求他們離境。」

(Laughter)

（笑聲）

Now at the other end of alternative treatments,

談到另一種替代療法，

我和大家說說 法蘭克 (Frank Russakoff) 的故事。

let me tell you about Frank Russakoff.

法蘭克得了非常糟糕的憂鬱症，

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

也許是我所見過最嚴重的病患。

He was constantly depressed.

他一直處於憂鬱狀態。

He was, when I met him,

我遇到他時，

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

他每個月都要接受電擊治療，

Then he would feel sort of disoriented for a week.

之後一週他會感覺茫然迷惘，

Then he would feel okay for a week.

下一週他會覺得舒服一些，

Then he would have a week of going downhill.

再下週他就會墜入谷底，

And then he would have another electroshock treatment.

那時他就會再做一次電擊治療。

我遇到他時，他告訴我：

And he said to me when I met him,

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

「我無法忍受這樣一週一週的循環。

我不能繼續這樣下去，

I can't go on this way,

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

我已經想好了怎麼結束這一切，

if I don't get better."

如果我不能好起來的話。

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

但是，我聽說在麻省總醫院

有一項醫療實驗

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

叫做扣帶回切開術，是一種腦部手術，

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

我想去試試看。」

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

我記得當時自己很吃驚，

想到他這個人

who clearly had so many bad experiences

有過那麼多悲慘的經歷，

with so many different treatments

用了那麼多不同的療法，

still had buried in him, somewhere, enough optimism

在他內心某處依然懷有一種樂觀天性，

to reach out for one more.

支撐著他再試一次。

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

他做了扣帶回切開手術，

出乎意料地成功。

He's now a friend of mine.

他現在是我的朋友，

He has a lovely wife and two beautiful children.

有一個可愛的妻子和兩個漂亮的孩子。

He wrote me a letter the Christmas after the surgery,

術後的聖誕節他寫了一封信給我，

and he said,

他說：

"My father sent me two presents this year,

「今年我父親寄了兩個聖誕禮物給我，

First, a motorized CD rack from The Sharper Image

第一個禮物是夏珀影像的 唱片電動收藏架。

that I didn't really need,

我並不很需要這個，

but I knew he was giving it to me to celebrate

但是我明白，他送我這個是為了

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

慶祝我獨立生活，

並且有了一份自己還算喜歡的工作。

And the other present was a photo of my grandmother,

另一份禮物

是一張我祖母的照片。

who committed suicide.

我祖母是自殺去世的。

As I unwrapped it, I began to cry,

當我拆開包裝的時候，我哭了。

and my mother came over and said,

我母親走過來問我：

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

「你是因為沒有見過她才哭的嗎？」

我回答：「我哭是因為 她得了跟我一樣的病。」

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

I'm crying now as I write to you.

寫給你這封信的時候，我正在流淚。

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

不是因為悲傷，而是我無法承受。

I think, because I could have killed myself,

我想我差點就會自殺，

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

但是我的父母讓我挺過來了，

還有醫生們也幫助我，

and I had the surgery.

讓我做了手術。

I'm alive and grateful.

我活了下來，充滿感激。

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

我生在一個美好的時代，

雖然不是每時每刻感覺都美好。」

I was struck by the fact that depression

讓我震驚的是，憂鬱症廣泛地

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

被看做是一種

現代西方世界中產階級的產物。

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

於是我開始觀察憂鬱症

在不同情境下的表現方式。

and one of the things I was most interested in

其中我最感興趣的是

was depression among the indigent.

生活貧苦的憂鬱症患者。

所以我開始嘗試研究，

And so I went out to try to look

at what was being done for poor people with depression.

了解窮人如何治療憂鬱症。

And what I discovered is that poor people

我發現窮人

are mostly not being treated for depression.

幾乎都沒有得到憂鬱症的治療。

憂鬱症是一種基因缺陷，

Depression is the result of a genetic vulnerability,

which is presumably evenly distributed in the population,

它大致上平均分佈於人群中。

and triggering circumstances,

在窮人身上，

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

憂鬱症的情況

可能會更為嚴重。

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

然而如果你有美好的人生，

但卻總是不開心，

but feel miserable all the time,

you think, "Why do I feel like this?

你會想：「我為什麼感到不開心？

I must have depression."

我肯定是憂鬱了。」

And you set out to find treatment for it.

於是你到處尋找治療方法。

但是如果你的生活一團糟，

But if you have a perfectly awful life,

and you feel miserable all the time,

你總是感到不開心，

the way you feel is commensurate with your life,

那麼你的感受和生活狀態是相符的。

and it doesn't occur to you to think,

你就不會想：

"Maybe this is treatable."

「也許這病醫得好。」

And so we have an epidemic in this country

所以我們國家的低收入人群中，

of depression among impoverished people

憂鬱症像傳染病一樣到處蔓延，

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

卻沒有被關注和治療。

and that's not being addressed,

這個問題一直沒有解決，

and it's a tragedy of a grand order.

變成了一個巨大的悲劇。

And so I found an academic

我找到一位學者，

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

她在華盛頓特區外圍的貧民窟裡

進行一項研究。

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

她挑出一些因為患其它疾病而就醫的女性，

and diagnosed them with depression,

診斷出她們有憂鬱症後，

為她們提供了六個月的實驗計劃。

and then provided six months of the experimental protocol.

One of them, Lolly, came in,

其中的一位叫羅莉，

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

這是她第一天來看病時的陳述。

她是一位女性，順帶一提。

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

她有七個孩子，她說：

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

「我以前有份工作，但是我不得不辭職。

because I couldn't go out of the house.

因為我無法走出家門。

我和我的孩子無話可說，

I have nothing to say to my children.

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

早上，我巴不得他們都快點離開上學去。

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

然後我就爬到床上，用被子蒙住腦袋。

下午三點他們就回家了，

and three o'clock when they come home,

時間過得超快。」

it just comes so fast."

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

她說：「我已經吃了很多泰諾，

anything I can take so that I can sleep more.

吃各種藥，好讓自己多睡一會。

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

我丈夫一直說我又蠢又醜。

I wish I could stop the pain."

我希望能停止痛苦。」

Well, she was brought into this experimental protocol,

她後來被加入到實驗治療計劃。

and when I interviewed her six months later,

六個月之後我採訪了她，

she had taken a job working in childcare

她已經在美國海軍幼兒園工作，

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

她離開了虐待她的丈夫。

她對我說：

and she said to me,

「我的孩子們現在開心多了。」

"My kids are so much happier now."

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

還說：「我的新家裡

有一間房間給男孩子，一間房間給女孩子，

and one room for the girls,

但是到了晚上，他們都會來到我的床頭。

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

and we're doing homework all together and everything.

我們一起做功課，一起做每件事。

One of them wants to be a preacher,

我有個兒子想當牧師，

one of them wants to be a firefighter,

還有一個兒子想做個消防員，

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

其中一個女兒說她以後會當個律師。

They don't cry like they used to,

他們不再像過去一樣哭泣，

and they don't fight like they did.

也不像過去一樣打架。

如今我只需要我的孩子們就夠了。

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

Things keep on changing,

一切都不斷變化，

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

我的穿著、我的情緒、我的行為都變了。

I can go outside not being afraid anymore,

我不再畏懼出門，

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

我想那些壞情緒再也不會回來了。

這多虧了米蘭達醫生。

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

不然我還待在家裡蒙頭大睡。

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

if I were still alive at all.

前提是我還活著。

我向上帝禱告，賜我一個天使吧，

I asked the Lord to send me an angel,

and He heard my prayers."

衪真的聽到了我的祈禱。」

我真的被這些經歷深深打動。

I was really moved by these experiences,

and I decided that I wanted to write about them

我決定寫下這些，

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

不僅僅寫在我的書中，

還要寫一篇文章。

and I got a commission from The New York Times Magazine

我從紐約時代雜誌得到一份約稿，

寫寫低收入者的憂鬱情況。

to write about depression among the indigent.

我交出了稿件，

And I turned in my story,

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

我的編輯打電話告訴我：

「我們可不能發表這個。」

我問：「為什麼不行？」

And I said, "Why not?"

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

她回答說：「這故事太勉強了。

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

這些人處於社會最底層，

and then they get a few months of treatment

然後他們接受了幾個月的治療，

and they're virtually ready to run Morgan Stanley?

接著就能去管理摩根斯坦利了？ （Morgan Stanley：知名投資公司）

這太沒說服力了。」

It's just too implausible."

她說：「我從來沒聽過這種事情。」

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

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

我回答：「你沒有聽過這樣的事情，

正說明了這是條新聞。」

is an indication that it is news."

(Laughter)

（笑聲）（掌聲）

(Applause)

"And you are a news magazine."

「而你們可是一家新聞雜誌社。」

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

經過一些交涉協商，

他們同意發表。

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

之後我想了很多，雜誌社的想法

在某個詭異的層面上 跟另一個觀點雷同，

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

即人們依然對治療憂鬱症

覺得反感。

the notion that somehow if we went out

如果我們去貧窮地區

and treated a lot of people in indigent communities,

大規模治療人們的憂鬱症，

that would be exploitative,

這會是一件具有剝削意義的事情，

because we would be changing them.

因為我們將會改造他們。

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

似乎所有的人

都有一種錯誤的道德約束，

that treatment of depression,

認為憂鬱症的治療，

the medications and so on, are an artifice,

包括藥物和其他治療，都是人工的、

and that it's not natural.

而不是自然的過程。

And I think that's very misguided.

我想這想法是非常誤導人的。

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

按照自然規律， 人的牙齒應該逐漸掉落，

but there is nobody militating against toothpaste,

但是沒人會反對使用牙膏，

at least not in my circles.

至少我身邊沒人反對。

People then say,

接著人們會說：「那麼，

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

憂鬱症難道不是人們應該經歷的過程嗎？

憂鬱難道不是我們演化的結果嗎？

Didn't we evolve to have depression?

它不是個性的一部分嗎？」

Isn't it part of your personality?"

To which I would say, mood is adaptive.

對此我想說的是， 情緒是可以適應調整的。

Being able to have sadness and fear

我們能夠感受悲傷、害怕、

and joy and pleasure

快樂、愉悅，

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

和其它所有的情緒，

這彌足珍貴。

And major depression

當這個感覺系統失靈的時候，

is something that happens when that system gets broken.

嚴重的憂鬱症就出現了，

It's maladaptive.

這是情緒上無法適應。

People will come to me and say,

人們來找我，跟我說：

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

「即使如此，我想如果能再堅持一年，

I think I can just get through this."

我就能好起來。」

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

我總是這樣回答他們： 「你可能會好起來，

但是你的 37 歲無法再來一次。

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，你打算放棄

這整整一年，

Think it through."

你再想想吧。」

It's a strange poverty of the English language,

英語其實貧瘠得有點怪，

and indeed of many other languages,

實際上很多其它語言也是如此，

that we use this same word, depression,

我們用同一個詞（depression：沮喪）

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

來形容小孩在

過生日那天碰到下雨的心情。

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

同時也用這個詞來形容人們

自殺前一分鐘的心情。

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

人們問我：「那麼，憂鬱是不是連續的悲傷？」

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

我回答在某種意義上， 憂鬱就是長時間的悲傷。

There is a certain amount of continuity,

悲傷和憂鬱之間有一定的連續性。

but it's the same way there's continuity

但是兩者的連續性，就像是

between having an iron fence outside your house

悲傷就像是你家院子裡的鐵柵欄

that gets a little rust spot

有點鏽斑，

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

於是你必須打砂紙和重新上點漆。

and what happens if you leave the house for 100 years

憂鬱則像是如果你離家 100 年之後，

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

鐵柵欄從裡到外鏽到只剩下

一堆橘色粉末。

而就是那堆橘色粉末，

And it's that orange dust spot,

that orange dust problem,

那堆橘色的麻煩

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

就是我們要解決的問題。

所以現在人們問：

So now people say,

「你吃了那些讓你快樂的藥，感覺開心嗎？」

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

And I don't.

不，我不會開心。

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

但是我不再為了得吃午飯而沮喪，

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

不再因為電話答錄機而難過，

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

也不會因為要洗澡而煩惱。

I feel more, in fact, I think,

實際上，我想我能感受到更多。

because I can feel sadness without nullity.

因為我可以感覺到傷心，但不空虛。

I feel sad about professional disappointments,

我因為工作上的不順心而難過，

about damaged relationships,

因為破碎的愛情而傷心，

about global warming.

因為全球暖化而傷心，

Those are the things that I feel sad about now.

現在這些事情讓我感到悲傷。

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

我問自己，那麼結論是什麼呢？

How did those people who have better lives

那些生活優渥、 病情更加嚴重的憂鬱症患者

even with bigger depression manage to get through?

是怎麼熬過去的？

What is the mechanism of resilience?

挺過去的方法是什麼呢？

And what I came up with over time

時間流逝，我想到的是，

was that the people who deny their experience,

那些否定自己經歷的人，

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

他們會說：「很久以前我憂鬱了。

I never want to think about it again,

我不想再想那些經歷，

I'm not going to look at it

我不想再看它，

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

我只想繼續我的生活。」

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

諷刺的是，那些人

往往被自己的經歷所困。

Shutting out the depression strengthens it.

迴避憂鬱只會讓它更強大。

While you hide from it, it grows.

越逃離，它就越強大。

能夠好起來的人，

And the people who do better

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

他們能夠接受事實，

承認自己的症狀。

那些可以接納自己有憂鬱症的人

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

會康復起來。

So Frank Russakoff said to me,

法蘭克後來告訴我：

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

「如果一切從頭來過，

我想我不會這樣做，

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

但是很奇怪，我對自己的經歷

非常感激。

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

我很高興自己住了 40 次醫院，

這些經歷教會了我什麼是愛，

It taught me so much about love,

and my relationship with my parents and my doctors

我和父母、醫生之間的關係

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

對我而言非常珍貴，一輩子都受用。」

And Maggie Robbins said,

瑪姬曾說：

"I used to volunteer in an AIDS clinic,

「我以前在愛滋診所裡擔任志工。

and I would just talk and talk and talk,

我會滔滔不絕地

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

對著我負責的病患說話。

他們沒太大反應，於是我想：

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

「他們真不友善，也不配合。」

(Laughter)

"And then I realized,

後來我意識到，

I realized that they weren't going to do more

我意識到他們無法做到更多，

than make those first few minutes of small talk.

除了完成剛開始那幾分鐘的閒談。

It was simply going to be an occasion

這只是一個機會，讓他們看到，

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

雖然我沒有愛滋病，也不會死去，

but could tolerate the fact that they did

但是我可以接受他們的疾病，

and they were.

還有他們正在死去的事實。

Our needs are our greatest assets.

我們的需求是我們最寶貴的財富。

我發現自己學會了付出

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

自己擁有的一切。」

Valuing one's depression does not prevent a relapse,

正視憂鬱的價值

不能防止憂鬱的復發，

but it may make the prospect of relapse

但是可能會使復發的結果好一些，

and even relapse itself easier to tolerate.

甚至能讓自己更容易熬過去。

問題並不在於

The question is not so much of finding great meaning

找尋重大的意義，或者判斷

and deciding your depression has been very meaningful.

你的憂鬱是否很有意義。

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

而是當憂鬱捲土重來的時候，

尋找它的意義，並想：

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

「這會很可怕，

但是我會從中獲益。」

I have learned in my own depression

我從自己的憂鬱中學到，

how big an emotion can be,

情緒的力量有多大，

how it can be more real than facts,

它甚至可以比事實更加真實。

我也發現那些經歷

and I have found that that experience

has allowed me to experience positive emotion

用一種更為強烈和聚焦的方式

in a more intense and more focused way.

讓我經歷正向的情緒。

The opposite of depression is not happiness,

憂鬱的反面不是快樂，

but vitality,

而是活力。

and these days, my life is vital,

現在，我的生活充滿活力，

即使在我感到難過的時候也是如此。

even on the days when I'm sad.

I felt that funeral in my brain,

我曾在腦中感受到那場葬禮，

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

我坐在一個巨人身邊，

就在世界的邊緣，

and I have discovered something inside of myself

我發現我的體內

有個東西，

that I would have to call a soul

我稱之為靈魂。

that I had never formulated until that day 20 years ago

20 年前它從未成型，

when hell came to pay me a surprise visit.

直到地獄冷不防地拜訪我。

I think that while I hated being depressed

我想即使我痛恨自己的憂鬱，

and would hate to be depressed again,

痛恨又被憂鬱纏上，

I've found a way to love my depression.

我還是找到了一種方法讓自己愛上它。

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

我愛自己的憂鬱，因為它迫使我

尋找和抓緊快樂。

I love it because each day I decide,

我愛我的憂鬱，因為每天，我都決定

sometimes gamely,

去抓住活下去的理由。

and sometimes against the moment's reason,

雖然有時候不拘小節，

to cleave to the reasons for living.

有時候不合時宜。

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

我想，這真是天賜的無上喜悅。

謝謝大家。

Thank you.

(Applause)

（掌聲）

Thank you.

(Applause)