Inge Missmahl brings peace to the minds of Afghanistan

23,732 views ・ 2010-09-29

TED


請雙擊下方英文字幕播放視頻。

譯者: Lin Su-Wei(林書暐) 審譯者: Zhu Jie
00:16
So I want to tell you a story -- an encouraging story --
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我要告訴各位一個故事,一個鼓舞人心的故事,
00:19
about addressing
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將讓各位了解
00:21
desperation, depression and despair in Afghanistan,
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充斥著絕望和失望的阿富汗,
00:24
and what we have learned from it,
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我們能從中學到什麼,
00:26
and how to help people
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以及如何幫助人們
00:28
to overcome traumatic experiences
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克服過去受過的創傷,
00:32
and how to help them to regain some confidence
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還有如何在往後的日子,也就是未來,
00:35
in the time ahead -- in the future --
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讓這裡的人們重獲信心,
00:37
and how to participate again in everyday life.
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並再度回到正常的生活裡。
00:41
So, I am a Jungian psychoanalyst,
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我是屬於聯合公會的心理治療師,
00:43
and I went to Afghanistan in January 2004, by chance,
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在偶然的機會下,我在2004年1月來到阿富汗,
00:47
on an assignment for Medica Mondiale.
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為蒙帝亞勒醫療團隊(Medica Mondiale)服務。
00:50
Jung in Afghanistan --
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榮格(Jung)在阿富汗..(註:圖中左下的男士,知名心理學家)
00:52
you get the picture.
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你們都知道那裡的情形。
00:55
Afghanistan is one of the poorest countries in the world,
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阿富汗是世界上最窮的國家之一,
00:58
and 70 percent of the people are illiterate.
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有70%的人是文盲。
01:01
War and malnutrition kills people
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戰爭和營養不良不但奪走了生命,
01:03
together with hope.
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也扼殺了希望。
01:05
You may know this from the media,
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你也許從其他媒體得知這些資訊。
01:07
but what you may not know
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但你所不知道的是
01:09
is that the average age of the Afghan people is 17 years old,
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阿富汗人民的平均年齡才17歲,
01:12
which means they grow up in such an environment
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那是因為他們生長在這個環境
01:15
and -- I repeat myself --
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我再重覆一次
01:17
in 30 years of war.
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他們生長在這已經打仗30年的環境裡。
01:19
So this translates
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這環境讓暴力事件
01:21
into ongoing violence,
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不斷發生,
01:23
foreign interests, bribery,
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外國團體對利益的覬觎,賄賂事件,
01:25
drugs, ethnic conflicts,
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毒品,種族衝突,
01:28
bad health, shame, fear
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糟糕的健康條件,羞恥,恐懼,
01:31
and cumulative traumatic experiences.
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這些累積更多心理的創傷。
01:34
Local and foreign military
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當地和外國的軍隊
01:36
are supposed to build peace together with the donors
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應該要與那些捐贈機構、政府和非政府組織
01:39
and the governmental and non-governmental organizations.
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一起建構和平的環境。
01:42
And people had hope, yes,
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這樣人們才有希望,沒錯,
01:44
but until they realized
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但是,當地人們目前只覺得
01:46
their situation worsens every day --
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他們每天生活一天比一天糟,
01:48
either because they are being killed
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因為,除了要擔心丟掉性命之外,
01:50
or because, somehow,
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更因為,不知怎麼,
01:53
they are poorer than eight years ago.
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他們比8年前還要窮困。
01:56
One figure for that:
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有一個數字是這樣顯示的:
01:58
54 percent of the children under the age of five years
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5歲以下孩童有54%
02:01
suffer from malnutrition.
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營養不良。
02:03
Yet, there is hope.
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不過,還是有希望的。
02:06
One day a man told me,
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有天某個人告訴我,
02:08
"My future does not look brilliant,
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"我的未來是看不到光明的,
02:10
but I want to have a brilliant future for my son."
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但我希望我兒子能有個燦爛的未來。"
02:14
This is a picture I took in 2005,
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這張照片是我在2005拍攝的,
02:16
walking on Fridays over the hills in Kabul,
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某個星期五,喀布爾上的小山丘一景。
02:19
and for me it's a symbolic picture
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對我來說,這是一張
02:21
of an open future for a young generation.
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為年輕一代開創未來的象徵性照片。
02:27
So, doctors prescribe medication.
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就像醫生要針對病因開處方配藥一樣。
02:31
And donors
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捐贈者
02:33
are supposed to bring peace
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透過蓋學校和鋪設道路
02:35
by building schools and roads.
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帶來和平。
02:40
Military collect weapons,
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軍隊沒收了武器,
02:42
and depression stays intact.
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但,絕望仍然在當地揮之不去。
02:45
Why?
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為什麼?
02:47
Because people don't have tools
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因為當地的居民沒有掌握
02:49
to cope with it, to get over it.
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應付絕望的工具。
02:54
So, soon after my arrival,
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所以,在這趟旅程之後,
02:56
I had confirmed something which I had already known;
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我就更加確認了那些我已經知道的事情,
02:59
that my instruments come from the heart of modern Europe, yes.
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我的治療手法是來自最先進的歐洲地區,
03:02
However, what can wound us
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然而,那些會對我們產生創傷的行為,
03:04
and our reaction to those wounds --
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還有我們對這些創傷的反應,
03:06
they are universal.
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是放諸四海皆準的。
03:08
And the big challenge
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所以,最大的挑戰就是
03:10
was how to understand the meaning of the symptom
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了解這些症狀,在這特殊的文化內涵中
03:13
in this specific cultural context.
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所代表的意義。
03:16
After a counseling session, a woman said to me,
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在一次的心理諮詢後,一位女人對我說:
03:19
"Because you have felt me, I can feel myself again,
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"因為妳能體會我的感受,讓我又重新感受自己,
03:22
and I want to participate again
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我希望能再重新回到
03:24
in my family life."
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過去的家庭生活。"
03:27
This was very important,
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這非常重要,
03:29
because the family is central
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因為在阿富汗,家庭
03:31
in Afghans' social system.
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是社會系統的重心。
03:34
No one can survive alone.
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在這裡沒有人能獨自生活。
03:37
And if people feel used, worthless and ashamed,
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而這裡的人經常會感到自己被利用、毫無價值和羞愧,
03:40
because something horrible has happened to them,
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是因為有些可怕的事情發生在他們身上,
03:43
then they retreat, and they fall into social isolation,
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於是他們開始退縮,陷入一種社會孤立的情況,
03:46
and they do not dare to tell this evil
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因為他們不敢把這種罪惡感
03:49
to other people or to their loved ones,
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告訴其他人或是他們所愛的人,
03:52
because they do not want to burden them.
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因為他們不想成為別人的包袱。
03:54
And very often violence is a way to cope with it.
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這種壓抑,通常就會訴諸暴力來紓解。
03:58
Traumatized people also easily lose control --
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心理受創的人很容易失去控制,
04:01
symptoms are hyper-arousal and memory flashbacks --
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這種人的症狀,是過度警覺和不斷回想過去,
04:03
so people are in a constant fear
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人會處於一種常態性的驚嚇狀態,
04:05
that those horrible feelings of that traumatic event
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過去的受創事件所帶來的恐懼感
04:08
might come back unexpectedly,
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會在無預警的情況下出現,
04:10
suddenly,
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是突然的出現,
04:12
and they cannot control it.
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沒有辦法控制。
04:15
To compensate this loss of inner control,
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為了去補償這種內在控制的損失,
04:18
they try to control the outside,
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他們會試著去控制外在環境,
04:21
very understandably -- mostly the family --
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這外在環境大多都是家庭,非常合理,
04:23
and unfortunately,
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非常不幸的,
04:25
this fits very well
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這也將整個文化內涵
04:27
into the traditional side,
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轉入一個更為傳統、
04:30
regressive side, repressive side,
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更落後、更壓抑、
04:32
restrictive side of the cultural context.
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更受限的環境下。
04:36
So, husbands start beating wives,
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所以,丈夫會開始毆打妻子,
04:39
mothers and fathers beat their children,
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父母會開始歐打小孩,
04:41
and afterward, they feel awful.
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打過之後,他們又會感覺很糟。
04:43
They did not want to do this, it just happened --
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他們根本不想這麼做,但事情就是這樣發生了。
04:45
they lost control.
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他們就這樣失去了控制。
04:48
The desperate try
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這種絕望感
04:50
to restore order and normality,
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會一直不斷出現,甚至逐漸變成常態,
04:53
and if we are not able to cut this circle of violence,
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如果我們不能阻絕這種暴力的迴圈,
04:57
it will be transferred to the next generation without a doubt.
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它就會變成下一代中理所當然的事情。
05:00
And partly this is already happening.
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這種現象已經有出現一些了。
05:03
So everybody needs a sense for the future,
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每個人都需要一個對未來的憧憬。
05:06
and the Afghan sense of the future
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而阿富汗人民對未來的憧憬
05:08
is shattered.
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已經被打碎了。
05:12
But let me repeat the words of the woman.
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讓我重述剛剛那位女人的話:
05:15
"Because you have felt me,
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"因為妳能體會我的感受,
05:17
I can feel myself again."
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讓我又重新感受自己。"
05:20
So the key here is empathy.
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關鍵點就在同理心。
05:22
Somebody has to be a witness
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要有人見證
05:24
to what has happened to you.
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在你身上所發生的事情。
05:26
Somebody has to feel how you felt.
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要有人能感受你所感受到的。
05:29
And somebody has to see you and listen to you.
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要有人注意你並聆聽著你。
05:34
Everybody must be able
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每個人都必須要能了解
05:36
to know what he or she has experienced is true,
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這些發生在他們身上的事情已經發生了,
05:40
and this only goes with another person.
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而且這也有可能發生在別人身上。
05:43
So everybody must be able to say,
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讓每個人都能說:
05:45
"This happened to me, and it did this with me,
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"雖然這種不幸的事情發生在我身上,
05:48
but I'm able to live with it, to cope with it,
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但我能與它共存,我能應付這種情況,
05:50
and to learn from it.
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並從中學習。
05:52
And I want to engage myself
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我應該要為孩子
05:54
in the bright future for my children
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甚至我的孫子
05:56
and the children of my children,
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創造燦爛的未來,
05:58
and I will not marry-off my 13 year-old daughter," --
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我不需要把我那13歲的女兒早早嫁出去。"
06:01
what happens too often in Afghanistan.
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這種早嫁女兒的情形常常出現在阿富汗。
06:04
So something can be done,
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有些事情是可以現在就完成的,
06:06
even in such extreme environments as Afghanistan.
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即使現在阿富汗的環境相當惡劣。
06:09
And I started thinking about a counseling program.
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於是我開始思考有關心理諮詢的計畫。
06:12
But, of course, I needed help and funds.
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當然,我需要的就是資金協助。
06:14
And one evening,
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在喀布爾的某天晚宴,
06:16
I was sitting next to a very nice gentleman in Kabul,
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我坐在一位非常紳士的男士旁邊,
06:18
and he asked what I thought would be good in Afghanistan.
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他問我,該怎麼做對阿富汗才是好的。
06:21
And I explained to him quickly,
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我快速的跟他講解,
06:23
I would train psycho-social counselors,
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我希望訓練一批心理社會諮商師,
06:26
I would open centers, and I explained to him why.
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我希望能有一個這樣的機構,然後向他解釋原因。
06:30
This man gave me his contact details at the end of the evening
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那天晚宴結束後,那個男人留下了他的聯絡方式,
06:33
and said, "If you want to do this, call me."
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然後說:"若你真的想這麼做,請聯絡我。"
06:36
At that time, it was the head of Caritas Germany.
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這位男士,在當時是德國慈善社(Caritas Germany)的負責人。
06:41
So, I was able to launch a three-year project with Caritas Germany,
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因此,我就與德國慈善社發起了一個為期三年的計畫,
06:44
and we trained 30 Afghan women and men,
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我們訓練了30名阿富汗男女,
06:46
and we opened 15 counseling centers in Kabul.
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我們在喀布爾創建了15個諮詢中心。
06:49
This was our sign -- it's hand-painted,
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這是我們手工繪製的宣傳招牌,
06:52
and we had 45 all over Kabul.
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散佈在喀布爾45個地方。
06:55
Eleven thousand people came -- more than that.
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目前已經有11000人前來機構諮詢,搞不好更多。
06:57
And 70 percent regained their lives.
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前來的人有70%重拾正常生活。
07:00
This was a very exciting time,
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和這些傑出的阿富汗團隊合作,
07:02
developing this with my wonderful Afghan team.
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創造了這樣令人興奮的成果。
07:05
And they are working with me up to today.
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他們直到今日都還是與我緊密合作。
07:07
We developed a culturally-sensitive
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我們發展出一種符合當地文化的
07:09
psycho-social counseling approach.
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社會心理諮詢療程。
07:12
So, from 2008 up until today,
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從2008年到今日,
07:15
a substantial change and step forward
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我們已經獲得
07:17
has been taking place.
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實質上的改變與進步。
07:19
The European Union delegation in Kabul
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歐盟在喀布爾的代表團,
07:22
came into this and hired me to work
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到這裡來請我就任於
07:24
inside the Ministry of Public Health,
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歐盟的公共衛生部門
07:26
to lobby this approach --
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並推廣這種治療方法。
07:28
we succeeded.
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我們獲得了成功。
07:30
We revised the mental health component
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透過這種系統下的社會心理關懷專案,
07:33
of the primary health care services
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和社會心理諮詢師,
07:35
by adding psycho-social care
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我們重新修正了個人健康服務環節上的
07:37
and psycho-social counselors to the system.
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心智健康的部份。
07:40
This means, certainly, to retrain all health staff.
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這也意味著,我們要重新訓練所有的心輔師。
07:43
But for that, we already have the training manuals,
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現在,我們已經有了訓練手冊,
07:46
which are approved by the Ministry
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這能讓我運用在歐盟的健康部門,
07:49
and moreover, this approach is now part
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這套系統目前被納入
07:51
of the mental health strategy in Afghanistan.
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阿富汗心智健康的策略方案之一。
07:55
So we also have implemented it already
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我們已經在境內三個省的部分醫院
07:57
in some selected clinics in three provinces,
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開始執行這種方案,
08:00
and you are the first to see the results.
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各位將是第一批看到執行成果的人。
08:03
We wanted to know if what is being done is effective.
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我們都想知道這方案的執行成果。
08:06
And here you can see
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各位可以看到,
08:08
the patients all had symptoms of depression,
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所有的病人都有憂鬱症的症狀,
08:11
moderate and severe.
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嚴重性有高有低。
08:14
And the red line is the treatment as usual --
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紅線是用一般傳統方式的治療,
08:16
medication with a medical doctor.
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也就是透過醫生開的藥物來治療。
08:18
And all the symptoms
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而所有的症狀
08:20
stayed the same or even got worse.
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都沒獲得減輕,甚至更糟。
08:23
And the green line is treatment with psycho-social counseling only,
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綠線是透過社會心理諮詢的方式來治療,
08:25
without medication.
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不透過任何藥物。
08:27
And you can see the symptoms almost completely go away,
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各位可以看到憂鬱症狀幾乎完全消失,
08:30
and the psycho-social stress has dropped significantly,
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社會心理的壓力也顯著的降低,
08:33
which is explicable,
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這是有機可循的,
08:35
because you cannot take away the psycho-social stresses,
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因為,根本你沒有辦法移除社會心理的壓力
08:37
but you can learn how to cope with them.
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你只能學著如何去面對、減輕這種壓力。
08:40
So this makes us very happy,
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這個結果讓我們非常開心,
08:42
because now we also have some evidence
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因為我們有顯著的證據
08:44
that this is working.
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證明這套方法有效。
08:47
So here you see,
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各位看到的這張照片,
08:49
this is a health facility in Northern Afghanistan,
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這是在北阿富汗的一個醫療機構,
08:51
and every morning it looks like this all over.
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每天早上你都會看到這種大排長龍的景象。
08:54
And doctors usually have three to six minutes for the patients,
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但醫生只有3到6分鐘診斷一位病人。
08:57
but now this will change.
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現在這種情形已經改變了。
08:59
They go to the clinics,
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現在他們到診所,
09:01
because they want to cure their immediate symptoms,
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是因為他們想要減輕那短暫的焦慮感,
09:03
and they will find somebody to talk to
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他們只是想找人談談,
09:05
and discuss these issues
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討論一些問題,
09:07
and talk about what is burdening them
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討論身上的一些重擔
09:09
and find solutions, develop their resources,
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然後找出解決方案,從自身找出可利用的資源,
09:12
learn tools to solve their family conflicts
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並學習利用這些東西,解決家庭衝突,
09:16
and gain some confidence in the future.
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同時,獲得一些對未來前景的信心。
09:19
And I would like to share one short vignette.
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我想跟各位分享一段小故事。
09:23
One Hazara said to his Pashtun counselor,
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一位哈扎拉族人,對他的普什圖族諮詢師說(註:在阿富汗2族為世仇)
09:27
"If we were to have met some years ago,
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"若我們在幾年前見面,
09:30
then we would have killed each other.
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我們大概會想殺了對方。
09:32
And now you are helping me
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而現在,你正在幫助我
09:34
to regain some confidence in the future."
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重獲對未來的信心。"
09:37
And another counselor said to me after the training,
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另一位諮詢師在訓練後對我說:
09:40
"You know, I never knew why I survived the killings in my village,
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"我從不曉得為什麼全村人都被殺死了,只有我活下來。
09:44
but now I know,
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但我現在知道了。
09:46
because I am part of a nucleus
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因為,我是
09:48
of a new peaceful society in Afghanistan."
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阿富汗新和平社會的一份子。"
09:51
So I believe this kept me running.
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這就是帶領我繼續向前邁進的動力。
09:54
And this is a really emancipatory and political contribution
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這對和平與種族和解
09:57
to peace and reconciliation.
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具有解放性和政治上的貢獻。
10:00
And also -- I think --
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同時,我認為
10:02
without psycho-social therapy,
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沒有這套社會心理療程,
10:04
and without considering this
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沒有這種
10:06
in all humanitarian projects,
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人性化的計畫,
10:08
we cannot build-up civil societies.
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我們就沒辦法建立公民社會。
10:11
I thought it was an idea worth spreading,
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我認為這套方法是值得散播的,
10:14
and I think it must be,
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而我也認為這套方法
10:16
can be, could be replicated elsewhere.
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是必須、是可以被複製在任何地方運行的。
10:19
I thank you for your attention.
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謝謝各位。
10:21
(Applause)
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(掌聲)
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