We train soldiers for war. Let's train them to come home, too | Hector Garcia

譯者: 易帆 余 審譯者: Ellen Tung

Carlos,

卡洛斯，

the Vietnam vet Marine

越戰海軍陸戰隊老兵，

who volunteered for three tours and got shot up in every one.

他自願參與了三次戰役， 每次戰役他都受了槍傷。

In 1971, he was medically retired

在 1971年， 他因身體上的問題退役了。

because he had so much shrapnel in his body

因為他體內有太多的子彈碎片

會觸發金屬探測儀。

that he was setting off metal detectors.

在接下來的 42 年當中， 他惡夢連連，

For the next 42 years, he suffered from nightmares,

extreme anxiety in public,

在公共場所會極度不安，

isolation, depression.

感到孤立、沮喪。

He self-medicated with alcohol.

他用酒精麻醉自己。

He was married and divorced three times.

結婚三次又離婚三次。

Carlos had post-traumatic stress disorder.

卡洛斯患有 創傷後壓力症候群（PTSD）。

現在，我成為一名幫助人們 減輕痛苦的心理學家，

Now, I became a psychologist to help mitigate human suffering,

and for the past 10 years, my target has been the suffering caused by PTSD,

在過去的 10 年，我專注在

像卡洛斯這樣受 PTSD 所苦的退伍軍人，

as experienced by veterans like Carlos.

他們是我的研究目標。

Until recently, the science of PTSD just wasn't there.

直到最近，有關 PTSD 的 科學研究才慢慢出來，

因此，我們以前 並不知道應該怎樣做。

And so, we didn't know what to do.

We put some veterans on heavy drugs.

我們讓一部分退伍軍人大量服藥。

Others we hospitalized and gave generic group therapy,

另一部分則讓他們住院觀察， 進行一般性的團體治療，

and others still we simply said to them,

其他的我們只是對他們說：

"Just go home and try to forget about your experiences."

「回家吧，試著忘掉你的過去。」

最近，我們還嘗試用 治療犬、野外療養——

More recently, we've tried therapy dogs, wilderness retreats --

many things which may temporarily relieve stress,

很多能夠短期減緩壓力的方式，

but which don't actually eliminate PTSD symptoms over the long term.

但並不能長期根除 PTSD 的症狀。

但是事情已經有所改變了。

But things have changed.

我今天來是想告訴各位， 我們已經可以徹底根除 PTSD 了，

And I am here to tell you that we can now eliminate PTSD,

not just manage the symptoms,

不僅僅是控制那些症狀，

and in huge numbers of veterans.

而且可以運用在 大量的退伍軍人身上。

因為最新的科學研究已經

Because new scientific research has been able to show,

客觀的、重覆的顯示

objectively, repeatedly,

which treatments actually get rid of symptoms and which do not.

哪些治療可以消除症狀， 而哪些不行。

Now as it turns out,

現在，結果表明，

the best treatments for PTSD use many of the very same training principles

PTSD 的最佳治療方式，

與軍隊訓練士兵備戰的準則 有幾分相似。

that the military uses in preparing its trainees for war.

而製造戰爭——

Now, making war --

this is something that we are good at.

是我們擅長的事情。

We humans have been making war since before we were even fully human.

我們人類一直都在製造戰爭，

甚至在我們還沒 成為人類之前就開始了。

從那之後，我們從使用石頭、肌腱，

And since then, we have gone from using stone and sinew

to developing the most sophisticated and devastating weapon systems imaginable.

到發展你能想像到最複雜、 最具毀滅性的武器系統。

且為了使我們的戰士 能夠使用這些武器，

And to enable our warriors to use these weapons,

we employ the most cutting-edge training methods.

我們會用最先進的 訓練方式訓練他們。

We are good at making war.

我們善於製造戰爭。

And we are good at training our warriors to fight.

我們善於鍛鍊我們的士兵去作戰。

Yet, when we consider the experience of the modern-day combat veteran,

但是，當我們思考 現代戰爭老兵的經歷時，

we begin to see that we have not been as good

我們就會意識到，

我們在協助老兵回家 這件事上並不擅長。

at preparing them to come home.

Why is that?

為什麼會這樣呢？

我們的祖先生活在衝突當中，

Well, our ancestors lived immersed in conflict,

他們會在他們生活的地方進行戰鬥。

and they fought right where they lived.

所以直到人類的進代進化史，

So until only very recently in our evolutionary history,

人類不需要學習如何回家，

there was hardly a need to learn how to come home from war,

因為我們從來不這麼做。

because we never really did.

但如今值得慶幸的是，

But thankfully, today,

most of humanity lives in far more peaceful societies,

大多數人都居住在相當 和平的社會中，

and when there is conflict, we, especially in the United States,

當衝突發生時，特別是我們美國人，

now have the technology to put our warriors through advanced training,

我們有先進的科技可以訓練士兵，

drop them in to fight anywhere on the globe

把他們送到世界各地打仗，

當戰爭結束時，

and when they're done,

jet them back to peacetime suburbia.

再把他們載回和平地區。

But just imagine for a moment what this must feel like.

但是讓我們想像一下這種感受。

我和那些退伍戰士聊過， 他們告訴我，

I've spoken with veterans who've told me

當你有一天身處阿富汗 殘暴的戰火之中，

that one day they're in a brutal firefight in Afghanistan

where they saw carnage and death,

目睹到殺戮和死亡，

and just three days later, they found themselves

只要三天的時間，他們就會發現

toting an ice chest to their kid's soccer game.

他們竟在孩子的足球比賽中 找冰桶當掩護。

「腦袋作怪」是他們 最常使用的詞匯。

"Mindfuck" is the most common term.

(Laughter)

（笑聲）

It's the most common term I've heard to describe that experience.

這是我最常聽到 用於描述那種經歷的術語。

And that's exactly what that is.

而那就是他們所經歷的。

Because while our warriors spend countless hours training for war,

因為我們花大量的時間讓士兵備戰，

we've only recently come to understand

卻直到最近才意識到

that many require training on how to return to civilian life.

他們也需要被訓練學習 如何回歸平民生活。

如同任何訓練一樣，

Now, like any training, the best PTSD treatments require repetition.

最佳的 PTSD 治療方式 也需要重複進行。

In the military,

在軍隊中，

we don't simply hand trainees Mark-19 automatic grenade launchers

我們不會丟一把 Mark-19 自動榴彈槍給新兵，

and say, "Here's the trigger, here's some ammo and good luck."

然後跟他說：「這裡是扳機， 還有一些彈藥，祝你好運。」

No. We train them, on the range and in specific contexts,

不，我們會在不同的領域 及特定背景中訓練他們，

一遍又一遍的訓練，

over and over and over

until lifting their weapon and engaging their target

直到他們拿起武器， 瞄準目標的行為，

is so engrained into muscle memory

深深地刻在肌肉的記憶當中，

that it can be performed without even thinking,

即使在任何你能想像到的緊張時刻，

even under the most stressful conditions you can imagine.

這一系列行為也能夠 不經思索的被執行出來。

這些也同樣適用於 以訓練為基礎的治療上。

Now, the same holds for training-based treatments.

The first of these treatments is cognitive therapy,

治療的第一步是認知治療，

and this is a kind of mental recalibration.

這是一種「精神重新修正」的療程。

當退伍軍人從戰場中回到家裡時，

When veterans come home from war,

their way of mentally framing the world is calibrated

因為長時間在危險環境中生活

to an immensely more dangerous environment.

造成他們對世界的認知方式有誤。

So when you try to overlay that mind frame onto a peacetime environment,

所以當你試圖將和平環境 覆蓋掉他的認知時，

麻煩就會出現。

you get problems.

You begin drowning in worries about dangers that aren't present.

你會煩惱沈浸在一種 不存在的危險當中。

You begin not trusting family or friends.

你開始不信任家人和朋友。

我並不是說平民生活中 就沒有危險；還是有。

Which is not to say there are no dangers in civilian life; there are.

只是說遇到危險的幾率，

It's just that the probability of encountering them

相比戰爭中而言，

compared to combat

is astronomically lower.

是極低的。

所以我們從不建議退伍軍人 徹底關閉他們的警惕性。

So we never advise veterans to turn off caution completely.

We do train them, however, to adjust caution

而是訓練他們，根據所處的環境，

according to where they are.

調整他們的警惕程度。

If you find yourself in a bad neighborhood,

如果你發現身處在惡劣的環境中，

you turn it up.

你就要開啟警惕。

Out to dinner with family?

和家人一起在外吃飯呢？

You turn it way down.

你就應該把它調節到很低。

We train veterans to be fiercely rational,

我們訓練退伍軍人， 讓他們變得相當理智，

讓他們能夠系統化的衡量 目前所處的環境，

to systematically gauge the actual statistical probability

of encountering, say, an IED here in peacetime America.

比如說，身處在和平時期的美國 被安裝土製炸彈的可能性。

有了足夠的練習， 那些重新校正的認知就會留存。

With enough practice, those recalibrations stick.

The next of these treatments is exposure therapy,

治療的下一步是暴露療法，

and this is a kind of field training,

就好像實地演習，

也是所有被證明 有效的療法中最快見效的。

and the fastest of the proven effective treatments out there.

You remember Carlos?

你們還記得卡洛斯嗎？

This was the treatment that he chose.

這就是他選擇的治療方案。

And so we started off by giving him exercises,

所以我們從給他一些練習開始，

for him, challenging ones:

像是對他來說，最具挑戰性的：

going to a grocery store,

去雜貨店、

going to a shopping mall, going to a restaurant,

去商場、餐廳、

sitting with his back to the door.

背對著門坐著。

而且，最重要的——

And, critically --

要停留在這些環境當中。

staying in these environments.

剛開始的時候，他表現的非常不安。

Now, at first he was very anxious.

He wanted to sit where he could scan the room,

他希望能夠坐在一個 可以掃視整個餐廳的位置，

讓他可以計劃逃脫路線，

where he could plan escape routes,

where he could get his hands on a makeshift weapon.

讓他可以隨手拿到臨時武器的地方。

他很想離開那兒，但是他沒有。

And he wanted to leave, but he didn't.

他想起了他在海軍陸戰隊的訓練，

He remembered his training in the Marine Corps,

and he pushed through his discomfort.

他戰勝了他的不安情緒。

And every time he did this, his anxiety ratcheted down a little bit,

每當他這樣做時， 他的焦慮感就會逐漸減少，

and then a little bit more and then a little bit more,

然後再減少一點點， 再減少一點點，

until in the end,

直到最後，

he had effectively relearned how to sit in a public space

他就能夠重新學會 如何坐在公共場所當中，

好好地享受他自己的時光。

and just enjoy himself.

He also listened to recordings of his combat experiences,

他也會聽他戰時經歷的錄音，

一遍又一遍地聽。

over and over and over.

He listened until those memories no longer generated any anxiety.

他不斷聽這些錄音， 直到不再對它們產生不安情緒。

He processed his memories so much

他不斷地經歷那些回憶，

讓他在睡夢中，腦子不再需要

that his brain no longer needed to return to those experiences

in his sleep.

回到那些經歷中。

在他治療結束一年之後與他交流時，

And when I spoke with him a year after treatment had finished,

he told me,

他告訴我：

"Doc, this is the first time in 43 years

「醫生，這是我在 43 年當中

第一次沒有做惡夢。」

that I haven't had nightmares."

Now, this is different than erasing a memory.

這不同於清除你的回憶。

退伍軍人會永遠記得 他們的創痛經歷，

Veterans will always remember their traumatic experiences,

但透過足夠的訓練，

but with enough practice,

those memories are no longer as raw or as painful as they once were.

那些回憶將不再像以往 那樣鮮活、那樣痛苦。

They don't feel emotionally like they just happened yesterday,

他們不再感到那些經歷恍如昨日，

and that is an immensely better place to be.

這是一個巨大的進步。

But it's often difficult.

但這並不簡單。

And, like any training, it may not work for everybody.

而且，就像是任何訓練一樣， 它不一定適用於所有人。

而且，還存在信任問題。

And there are trust issues.

Sometimes I'm asked,

有時，我會被問道：

"If you haven't been there, Doc, how can you help me?"

「醫生，如果你從未經歷戰場， 你要如何幫我？」

Which is understandable.

這是可以被理解的。

But at the point of returning to civilian life,

但是要回歸平民生活，

you do not require somebody who's been there.

你並不需要一個經歷過戰場的人。

You don't require training for operations on the battlefield;

你不需要訓練戰場上的行為；

你需要訓練如何回到家中。

you require training on how to come home.

For the past 10 years of my work,

在我過去十年的工作經歷當中，

I have been exposed to detailed accounts

我已經接觸過任何你們能想像到

最糟糕的經歷細節，

of the worst experiences that you can imagine,

daily.

幾乎每天都會接觸到。

And it hasn't always been easy.

那的確不容易，

很多時候，我會感到心痛，

There have been times where I have just felt my heart break

or that I've absorbed too much.

或者太過投入。

但是這些以訓練為基礎的 治療方法太有效了，

But these training-based treatments work so well,

that whatever this work takes out of me, it puts back even more,

因此，無論這個工作都辛苦， 我都覺得很有價值，

because I see people get better.

因為我看到了人們正在變好。

I see people's lives transform.

我看到了人們的生活正在發生轉變。

Carlos can now enjoy outings with his grandchildren,

卡洛斯已經可以和他的 孫子們一起出去玩了，

甚至玩一些以前他無法跟 自己孩子一起玩的東西。

which is something he couldn't even do with his own children.

And what's amazing to me is that after 43 years of suffering,

對我來說最驚喜的是 在 43 年的折磨之後，

it only took him 10 weeks of intense training to get his life back.

他只花了十周進行高強度的訓練， 他就重獲了他的人生。

當我和他交流的時候，他告訴我：

And when I spoke with him, he told me,

"I know that I can't get those years back.

「我知道我無法挽回 那些錯過的歲月。

但至少現在，無論在這世上 我還剩下多少時間，

But at least now, whatever days that I have left on this Earth,

我可以在平靜中度過。」

I can live them in peace."

他還說：「我希望那些 年輕的退伍軍人

He also said, "I hope that these younger veterans don't wait

to get the help they need."

不要為他們需要的幫助猶豫。」

And that's my hope, too.

那也是我所希望的。

因為，

Because ...

人生是短暫的，

this life is short,

and if you are fortunate enough to have survived war

如果你們有幸在戰爭當中

or any kind of traumatic experience,

或是各種創傷性經歷中幸存下來，

you owe it to yourself to live your life well.

你虧欠自己一個美好的人生。

And you shouldn't wait to get the training you need

所以，你們不該等待接受那些

to make that happen.

幫助你獲得美好人生的訓練。

Now, the best way of ending human suffering caused by war

現在，能夠避免 戰後創傷的最佳方式，

is to never go to war.

就是避免戰爭。

But we are just not there yet as a species.

但是我們人類 還沒有達到那樣的境界。

在那之前，

Until we are,

the mental suffering that we create in our sons and in our daughters

當我們把子女送去戰場，

when we send them off to fight

所造成的精神折磨

can be alleviated.

是可以被緩解的。

But we must ensure that the science, the energy level, the value

但是我們必須要確保 我們將他們送去戰場時

那些科學、資源水準、價值觀，

that we place on sending them off to war

is at the very least mirrored

至少是要能夠反應

in how well we prepare them to come back home to us.

我們會好好地準備 讓他們回到家中的水準。

This much, we owe them.

因為我們欠他們的， 遠比我們給的多。

Thank you.

謝謝。

(Applause)

（掌聲）