Why Broken Hearts Hurt — and What Heals Them | Yoram Yovell | TED

譯者: 麗玲 辛

I'm Yoram Youvel.

我是尤拉姆·尤維爾 （Yoram Youvel）。

I'm a psychiatrist and neuroscientist at the Hebrew University of Jerusalem.

我是耶路撒冷希伯來大學的 精神科醫師和神經科學家。

And when I was 14 years old, my father died.

在我 14 歲的時候， 我父親過世了。

I was sitting in class

我那時正在上課，

when my mother and my grandfather knocked on the door

突然我媽媽和爺爺敲門，

and asked me out to the corridor.

把我叫到走廊上。

"Your father's very sick," my mother said.

「你爸爸病得很重」，媽媽說。

"Your father is dead."

「你爸爸過世了。」

And then I felt it.

然後我感受到了一陣劇痛，

A crushing pain in my chest.

一種胸口被壓迫的痛。

I can still feel a glimpse of it whenever I think of my father.

我至今仍能在回憶起父親時 感受到一絲那時的痛楚。

He was a doctor, a scientist, a paratrooper.

他是一位醫生、 一位科學家、一名傘兵。

He was a young, strong, happy, healthy man.

他年輕、強壯、快樂、健康。

He was my hero.

他是我的英雄，

And his death broke my heart.

而他的去世讓我心碎。

Do you remember the pain you felt when someone broke your heart?

你是否記得當某人 讓你心碎時的痛楚？

When your best friend or your mother died?

當你最好的朋友或母親去世時？

Or the man you loved told you that he doesn't love you anymore.

或者當你愛的人告訴你 他不再愛你時？

You probably do.

你大概還記得吧。

But why do we feel mental pain at all?

但是為什麼我們會感受到 精神上的痛苦呢？

And what's the relationship between physical and mental pain?

而身體痛苦和精神痛苦 之間的關係是什麼呢？

And most importantly, how can we make mental pain better?

最重要的是，我們如何減輕精神痛苦？

Together with many scientists and physicians,

我和許多科學家和醫生

I spent years searching for answers to these questions.

一起花了多年時間 尋找這些問題的答案。

Now, growing up, I never heard the words,

成長過程中，我從未聽到過

"We want you to be a doctor and a brain scientist like your father."

「我們希望你成為像你父親一樣的 醫生和腦科學家」這樣的話。

But somehow that's what happened.

但不知怎麼的，這確實發生了。

Twelve years after my father died,

在我父親去世十二年後，

I was a graduate student at Dr. Eric Kandel’s lab

我成為了哥倫比亞大學埃里克·坎德爾 (Eric Kandel) 博士實驗室的研究生。

at Columbia University.

Eric, who won the Nobel Prize

埃里克因為在記憶的 分子基礎研究方面的工作

for his work on the molecular basis of memory,

而獲得了諾貝爾獎，

was the ultimate mentor.

他是最好的導師，

Passionate, energetic and inspiring.

充滿熱情、精力和啟發。

Under his guidance, I studied a receptor.

在他的指導下，我研究了一種受體，

It's a protein that's part of a synapse.

這種蛋白質是突觸的一部分。

And synapses are structures through which nerve cells communicate with each other.

突觸是神經細胞之間相互交流的結構。

Now that receptor was a GPCR.

那個受體是一種 GPCR，

That's a G protein coupled receptor.

即 G 蛋白耦合受體。

I'll explain what this means in a minute

我會稍後解釋這是什麼意思，

and then you'll understand what this stack of markers is doing here.

然後你會明白為什麼 會有這堆筆放在這裡。

And when I did that,

當我在研究那個受體時，

I didn't really realize that work on that receptor,

我並沒有意識到，

這項研究似乎與我未來 作為臨床精神科醫師的工作毫不相關，

which seemed completely unrelated to my future work

as a clinical psychiatrist,

would one day help us in our search for better treatments

但後來它卻幫助我們尋找

治療身體和精神痛苦更好的方法。

for physical and mental pain.

Now a big step along that way was the work of Jaak Panksepp,

在這條路上，一個重要的進展是 我另一位偉大的科學導師

賈克·潘克賽普 (Jaak Panksepp) 的研究。

my other great scientific mentor.

In a classical experiment,

在一個經典實驗中，

Panksepp separated puppies from their mothers for 15 minutes.

潘克賽普將小狗與它們的母親 分開 15 分鐘。

Never more than that because he loved animals.

他從不超過這個時間，因為他愛動物。

When puppies lose their mothers,

當小狗失去母親時，

they make a sound which is called the separation distress cry.

它們會發出一種叫做分離痛苦的叫聲。

And it goes like this.

這叫聲是這樣的

(Imitates puppy wailing)

（模仿小狗的叫聲）。

Puppies do it,

小狗會這樣，

kittens do it, babies do it.

貓咪會這樣，嬰兒也會這樣。

All young mammals do it

所有的年幼哺乳動物在痛苦 或思念母親時都會這樣叫。

when they're in pain or when they miss their mothers.

And we all know how this cry makes us feel inside.

我們都知道這種叫聲 會讓我們內心有什麼感受。

Panksepp and his colleagues then traced the brain circuits

潘克賽普和他的同事們隨後追蹤了

豚鼠發出這些叫聲時， 大腦中的神經迴路，

that produce these cries in guinea pigs,

and they made a startling discovery.

他們有了一個驚人的發現：

That these are the very same circuits that are active when humans feel sad

在人類感到悲傷和抑鬱時，

同樣的這些迴路也會活躍，

and when they experience depression.

And these circuits are also part of the brain's pain matrix

並且這些迴路也是 大腦疼痛基質的一部分，

that mediates our sensations of physical and mental pain.

這些基質調節我們的身體 和精神痛苦的感受。

But why are we born with this terrible gift

但為什麼我們的大腦會內建

hardwired into our brains?

這個可怕的天賦呢？

Well, probably because like any pain, mental pain is an alarm system.

這可能是因為像任何疼痛一樣， 精神痛苦也是一種警報系統，

Its task is to prevent damage.

它的任務是防止損害。

When babies lose their mothers, they hurt and they cry.

當嬰兒失去母親時， 他們會感到痛苦並哭泣，

Which brings their mothers back,

這會召喚他們的母親回來，

and it also makes them seek their mothers.

也使他們尋找母親。

In the wild, this is life-saving.

在野外，這會救命的。

Puppies and babies cannot survive without their mothers.

小狗和嬰兒沒有母親是無法生存的。

So now we know why we have mental pain.

現在我們知道為什麼 我們會有精神痛苦了。

It is the glue that keeps us together in couples, in families and communities.

它是將我們維繫在一起的膠水， 維繫夫妻、家庭和社會群體。

And when someone we love goes away or is taken away from us,

當我們愛的人離開我們或被奪走時，

it's this pain which draws us back together.

正是這種痛苦讓我們重新聚在一起。

And once we realize this,

一旦我們明白了這一點，

我們就能回答詩人和哲學家

then we can answer an age-old question

that poets and philosophers have been asking for thousands of years.

數千年來一直在問的一個古老問題：

Does love always hurt?

愛是否總是令人痛苦？

What do you think?

你覺得呢？

Does love always hurt?

愛是否總是令人痛苦？

Yes, love always hurts, of course.

是的，愛總是令人痛苦，當然，

Because that's what it's supposed to do.

因為理應如此。

Mental pain is simply the high price,

精神痛苦純粹是

我們為了能夠愛而付出的高昂代價。

the very high price, that we pay for our ability to love.

And personally,

而就我個人而言，

and, you know, I've been around the block a couple of times,

我走過了好幾回，

personally, I think it's worth it.

我個人認為這是值得的。

But we're not entirely defenseless against pain

但我們並非完全無法對抗痛苦，

because our brains produce endorphins

因為我們的大腦會產生內啡肽

or endogenous opioids,

或內源性鴉片類物質，

our very own feel-good molecules,

這些是我們自我感覺良好的分子， 是身體和精神痛苦的天然療法。

the natural remedy for both physical and mental pain.

Endorphins are released in the brain during aerobic exercise

內啡肽會在有氧運動時，

or when we're close to someone we love,

當我們接近所愛的人，

and immediately after severe injuries.

或者在嚴重受傷後釋放。

And we now know what endorphins do,

我們現在了解內啡肽的運作，

they attach to special receptors in the brain,

它們會附著在大腦中的特殊受體上，

and the most important among them are mu opioid receptors.

其中最重要的是 μ 鴉片受體。

And just like the receptor I worked on in Kandel's lab,

就像我在坎德爾實驗室 研究的受體一樣，

mu opioid receptors are GPCR.

μ 鴉片受體也是 GPCR。

Here's how they work.

它們運作的方式是如何呢？

Like all GPCRs, mu opioid receptors are made of seven spirals

像所有 GPCR 一樣， μ 鴉片受體由七個螺旋或環組成，

or loops that are stacked together,

它們堆疊在一起，

sticking through both sides of the cell membrane.

穿過細胞膜的兩側。

Like this, OK.

就像這樣，

And when endorphins attach to mu opioid receptors from the outside,

內啡肽從外部附著在 μ 鴉片受體上時，

they cause them to change their shape.

它們會使受體改變形狀，

Like this, OK?

像這樣，

And this triggers a series of events inside the neurons

這會觸發神經元內的一連串反應，

which eventually ease the pain.

最終減輕痛苦。

Now, forget the molecules for a second.

現在，先忘掉分子吧。

When you hug someone you love

當你擁抱一個你愛的人，

who is suffering from severe physical or mental pain,

當她正在經歷嚴重的 身體或精神痛苦時，

you actually cause her brain to release endorphins.

你實際上會讓她的大腦釋放內啡肽。

They attach to mu opioid receptors in her synapses and turn them on,

內啡肽會附著在她突觸中的 μ 鴉片受體上，並啟動它們，

and they soothe her pain.

舒緩她的痛苦。

And yet, sometimes mental pain gets so intense

然而，有時精神痛苦會變得劇烈到

that no amount of love can soothe it.

再多的愛也無法舒緩。

But medicine has powerful drugs that can ease any physical pain.

但是，醫學有強大的藥物 可以減輕任何身體痛苦。

These are the narcotics or opioids like morphine.

這些是麻醉藥或 鴉片類藥物，比如嗎啡。

Narcotics work mainly by activating mu opioid receptors.

麻醉藥主要通過激活 μ 鴉片受體來產生作用。

But if so, can narcotics also treat the pain of separation?

如果是這樣，麻醉藥是否 也能治療分離的痛苦呢？

It was Jaak Panksepp who found the answer.

賈克·潘克賽普找到了答案。

Panksepp gave his puppies in a separation experiment

潘克賽普在分離實驗中給小狗狗

tiny, tiny doses of morphine,

服用極少量的嗎啡，

lower than the lowest doses that are used to treat physical pain,

劑量低於治療身體痛苦的最低劑量，

and his puppies immediately stopped crying

小狗立即停止哭泣，

and started playing with each other as if they no longer miss their mothers.

開始玩耍，好像它們不再思念母親。

Let's go to humans now.

再回到人類。

When mental pain in humans becomes too intense to bear

當人類的精神痛苦變得無法忍受時，

people, some people, will do anything to stop it,

有些人會做任何事情來停止它，

even try to kill themselves.

甚至試圖自殺。

Indeed, and I'm saying this as a clinical psychiatrist,

作為臨床精神科醫師， 的確，我可以證實，

unbearable mental pain is a huge risk factor for suicide.

無法忍受的精神痛苦是 巨大的自殺風險因素。

But if narcotics treat physical pain,

但是，如果麻醉藥能治療身體痛苦，

and if they can soothe the mental pain of separation,

如果它們能舒緩分離的精神痛苦，

can they also help suicidal people become less suicidal?

能不能也幫助那些自殺傾向的人， 讓他們不那麼想自殺呢？

A few years ago,

幾年前，

together with Panksepp and other colleagues,

我與潘克賽普和其他同事

my research team conducted a clinical trial.

一起進行了一項臨床試驗。

We gave people who were severely suicidal very low doses of a narcotic drug,

我們給嚴重自殺傾向的患者 服用非常低劑量的麻醉藥，

called buprenorphine, for four weeks.

一種名為丁丙諾啡的 麻醉藥，為期四週。

We discovered that tiny, tiny doses of buprenorphine,

我們發現極少量的丁丙諾啡，

which are too low to treat physical pain,

劑量低於治療身體痛苦的最低劑量，

helped many of them become less suicidal.

幫助了許多患者，不再那麼想自殺。

But narcotics are extremely dangerous drugs.

但是，麻醉藥是極其危險的藥物。

They may cause addiction, and they're lethal in overdose.

它們可能成癮，而且過量時是致命的。

In contrast, endorphins are not lethal in overdose,

相比之下，內啡肽在過量時不會致命，

and they're much less likely to cause addiction.

並且引起成癮的可能性也小得多。

So narcotics and endorphins probably activate mu opioid receptors

因此，麻醉藥和內啡肽可能 以不同的方式激活 μ 鴉片受體。

in different ways.

Now, if we could find drugs that activate mu opioid receptors

如果我們能找到一些藥物，

是用類似內啡肽激活 μ 鴉片受體的方式來激活的，

in a way that resembles how endorphins activate them,

we might be able to treat physical and mental pain

或許我們就能治療身體和精神痛苦，

without some of the dangerous side effects of narcotics.

而沒有麻醉藥的某些危險副作用。

And when my research team came to this conclusion,

當我的研究團隊得出這個結論時，

I suddenly remembered what I had learned in Kandel's lab many, many years ago.

我突然想起了多年前 在坎德爾實驗室中學到的知識。

Some GPCRs can be activated by two different drugs at the same time.

某些 GPCR 可以同時 被兩種不同的藥物激活。

And when this happens,

當這種情況發生，

the result may be different from what happens

結果可能與僅僅 被一種藥物激活時不同。

when they're activated by just one drug.

So our research team then used molecular computing technologies

所以我們的研究團隊 使用分子演算技術，

to create a detailed virtual model of the human mu opioid receptor.

創建了一個人類 μ 鴉片受體的詳細虛擬模型。

And then, with the help of programs known as molecular docking algorithms,

然後，借助於 名為分子對接算法的程式，

we screened thousands of existing drugs on a virtual model of the receptor.

我們在虛擬模型上篩選了 數千種現有的藥物。

Eventually, we found a way to teach an old dog,

最終，我們找到了教這隻老狗

that's the human mu opioid receptor,

（即人類 μ 鴉片受體）

some new tricks.

新把戲的方法。

We found two drugs that are not narcotics,

我們找到了兩種非麻醉藥的藥物，

and they work together in very, very small doses

它們在非常小的劑量下共同作用，

to activate the human mu opioid receptor.

激活人類 μ 鴉片受體。

I'm not telling you their names,

我不會告訴你它們的名字，

because we still have to run many tests and clinical trials

因為我們還需要進行 許多測試和臨床試驗，

before we can be certain

才能確定它們的組合確實 能如我們所想的那樣作用。

that their combination does exactly what we think it does.

But both of these drugs have been around for many, many years,

但是，這兩種藥物 都已經存在了很多年，

and they've been used by millions of people.

並且已被數百萬人使用，

So we know that they're safe for humans.

所以我們知道它們對人體是安全的。

Here's our bottom line.

以下是我們的結論。

Let's summarize what we've seen.

容我總結一下我們所知的。

First and foremost, mental pain is real.

首先，精神痛苦是真實的。

It's hardwired into our brains.

它內建在我們的大腦中。

And mental pain is an essential part of mourning and depression and sadness.

精神痛苦是哀悼、 抑鬱和悲傷的重要成份。

And when it gets severe enough, it can actually make people suicidal.

當痛苦變得相當嚴重時， 實際上會使人產生自殺念頭。

Endorphins are brain's natural remedy for physical and mental pain,

內啡肽是大腦對生理 和精神痛苦的天然療法，

and they work mainly, not exclusively,

主要（但不僅是）

but mainly by activating mu opioid receptors.

通過激活 μ 鴉片受體來起作用。

Now, narcotics also activate mu opioid receptors,

麻醉藥也會激活 μ 鴉片受體，

but in a way that causes addiction and can lead to death.

但足以引起成癮，並可能導致死亡。

And this is why narcotics are so dangerous.

因此麻醉藥是非常危險的。

New computational technologies have helped us identify two existing drugs

新的演算技術幫助我們 找到了兩種現有的藥物，

that together may treat physical and mental pain

它們的組合可能治療身體和精神痛苦

without some of the severe side effects of narcotics.

而不會有麻醉藥的一些嚴重副作用。

However, this is still a work in progress.

然而，這項研究仍在進行中。

It would be a few years before it may become an approved treatment.

可能還需要幾年時間， 才能成為一種被批准的治療方法。

But, and this is the last thing I'm going to say,

但是，這是我要說的最後一件事，

regardless of drugs,

無論是否有藥物，

you have the ability to help family and friends

你都可以幫助那些處於身體

who are in severe physical or mental pain.

或精神劇烈痛苦中的家人和朋友。

Thank you very much.

非常感謝大家。

(Applause)

（掌聲）