How your emotions change the shape of your heart | Sandeep Jauhar

譯者: Lilian Chiu 審譯者: Melody Tang

No other organ,

沒有任何其他器官，

perhaps no other object in human life,

也許在人類生命中 沒有任何其他物體，

is as imbued with metaphor and meaning as the human heart.

會像人類的心那樣 充滿了隱喻和意義。

Over the course of history,

在歷史上，

the heart has been a symbol of our emotional lives.

心一直象徵著我們的情緒生活。

It was considered by many to be the seat of the soul,

許多人認為它是靈魂的所在，

the repository of the emotions.

情緒儲存在其中。

The very word "emotion" stems in part from the French verb "émouvoir,"

「情緒」這個詞有一部分

源自於法文的動詞「émouvoir」，

meaning "to stir up."

意思是「激起」。

And perhaps it's only logical that emotions would be linked to an organ

或許，將情緒連結到 特色為跳動的器官，

characterized by its agitated movement.

是唯一合邏輯的連結吧。

But what is this link?

但，這個連結是什麼？

Is it real or purely metaphorical?

它是真的嗎？還是只是比喻？

As a heart specialist,

身為心臟科醫生，

I am here today to tell you that this link is very real.

今天我就是來告訴各位，

這個連結是非常真實的。

Emotions, you will learn,

各位將會了解到，情緒

can and do have a direct physical effect on the human heart.

能夠且確實會對人類的心 有直接的實質影響。

But before we get into this,

但在我們進入主題之前， 咱們先談談象徵性的心。

let's talk a bit about the metaphorical heart.

The symbolism of the emotional heart endures even today.

情緒的心至今仍然具有其象徵性。

If we ask people which image they most associate with love,

如果我們去問大家，他們最會 把愛和哪個影像連結起來，

there's no question that the Valentine heart would the top the list.

無疑地，愛心會是榜上的第一名。

The heart shape, called a cardioid,

心形，叫做心臟形曲線，

is common in nature.

在大自然中很常見。

It's found in the leaves, flowers and seeds of many plants,

可以在許多植物的樹葉、 花朵、種子上看到這個形狀，

including silphium,

包括羅盤草，

which was used for birth control in the Middle Ages

在中世紀，它被用來做節育用，

and perhaps is the reason why the heart became associated

也許這就是為什麼心會被連結到

with sex and romantic love.

性和浪漫的愛。

Whatever the reason,

不論原因是什麼，

hearts began to appear in paintings of lovers in the 13th century.

十三世紀時，心開始 出現在愛人的畫作中。

Over time, the pictures came to be colored red,

隨著時間過去，這些圖像 漸漸被著上紅色，

the color of blood,

血的顏色，

a symbol of passion.

象徵熱情。

In the Roman Catholic Church,

在羅馬天主教教堂，

the heart shape became known as the Sacred Heart of Jesus.

心形成為知名的耶穌聖心。

Adorned with thorns and emitting ethereal light,

被莖棘環繞並發散出永恆的光茫，

it became an insignia of monastic love.

它成為宗教裡愛的象徵。

This association between the heart and love has withstood modernity.

心和愛之間的關聯 經得起現代的考驗。

When Barney Clark, a retired dentist with end-stage heart failure,

退休牙醫巴內 克拉克 在心臟衰竭的末期時，

received the first permanent artificial heart in Utah in 1982,

於 1982 年在猶他州得到了 第一顆永久的人工心臟，

his wife of 39 years reportedly asked the doctors,

據說他結婚 39 年的妻子問醫生：

"Will he still be able to love me?"

「他還會愛我嗎？」

Today, we know that the heart is not the source of love

現今，我們知道心並非愛

或任何情緒的來源；

or the other emotions, per se;

the ancients were mistaken.

古人搞錯了。

And yet, more and more, we have come to understand

但，我們越來越了解，

that the connection between the heart and the emotions is a highly intimate one.

心和情緒之間的連結 是非常親密的連結。

The heart may not originate our feelings,

我們的感覺也許不是來自心，

but it is highly responsive to them.

但心對情緒有很強的反應。

In a sense, a record of our emotional life

在某種意義上，我們的情緒生活

被記錄在我們的心上。

is written on our hearts.

Fear and grief, for example, can cause profound cardiac injury.

比如，恐懼、悲慟 會造成嚴重的心臟損傷。

The nerves that control unconscious processes such as the heartbeat

控制無意識過程的神經例如心跳

can sense distress

能夠感受到憂苦，

and trigger a maladaptive fight-or-flight response

並觸發一種適應不良的 「戰或逃」反應，

that triggers blood vessels to constrict,

這就會觸發血管緊縮，

the heart to gallop

心臟得要更拼命，

and blood pressure to rise,

血壓會上升，

resulting in damage.

造成傷害。

In other words,

換言之，

it is increasingly clear

我們越來越清楚知道，

that our hearts are extraordinarily sensitive to our emotional system,

我們的心臟對於 我們的情緒系統超級敏感，

to the metaphorical heart, if you will.

也可以說，是對 象徵性的心超級敏感。

There is a heart disorder first recognized about two decades ago

有一種心臟疾病， 大約在二十年前才被初次發現，

called "takotsubo cardiomyopathy," or "the broken heart syndrome,"

叫做「章魚壺心肌症」 或「心碎症候群」。

in which the heart acutely weakens in response to intense stress or grief,

這種疾病是心臟在應對

強烈的壓力或悲慟時會急遽減弱，

such as after a romantic breakup or the death of a loved one.

比如和另一半分手 或愛人過世之後。

As these pictures show, the grieving heart in the middle

中間的這張照片是悲傷的心臟，

looks very different than the normal heart on the left.

看起來和左側的正常心臟很不同。

It appears stunned

它看起來受到震驚， 經常會鼓起來，

and frequently balloons into the distinctive shape of a takotsubo,

成為章魚壺的獨特形狀， 就是右側的圖，

shown on the right,

a Japanese pot with a wide base and a narrow neck.

章魚壺是一種日本壺， 底很寬但頸很窄。

We don't know exactly why this happens,

我們不知道為什麼 會發生這種狀況，

and the syndrome usually resolves within a few weeks.

這種症候群通常 會在幾週之內消失。

However, in the acute period,

然而，在急性期，

it can cause heart failure,

它可能會造成心臟衰竭、

life-threatening arrhythmias,

有生命危險的 心律失常，甚至死亡。

even death.

For example, the husband of an elderly patient of mine

比如，我有一位年長病人，

她的先生最近過世了。

had died recently.

She was sad, of course, but accepting.

當然，她很傷心，但她接受了。

Maybe even a bit relieved.

可能甚至鬆了一口氣。

It had been a very long illness; he'd had dementia.

他生了很久的病，失智症。

But a week after the funeral, she looked at his picture

但在葬禮的一週後， 她看著他的照片，

and became tearful.

開始落淚。

And then she developed chest pain, and with it, came shortness of breath,

接著，她開始出現胸痛，

隨之而來的是呼吸短促、

distended neck veins, a sweaty brow,

頸部血管擴張、額頭出汗、

a noticeable panting as she was sitting up in a chair --

坐在椅子上時會有明顯的氣喘—–

all signs of heart failure.

全都是心臟衰竭的徵兆。

She was admitted to the hospital,

她住院了，

where an ultrasound confirmed what we already suspected:

在醫院，超音波 確認了我們的懷疑：

her heart had weakened to less than half its normal capacity

她的心臟變弱了，

只剩不到一半的正常能力，

and had ballooned into the distinctive shape of a takotsubo.

且鼓起來成為章魚壺的形狀。

But no other tests were amiss,

但其他的檢測沒發現問題，

no sign of clogged arteries anywhere.

全身都沒有血管阻塞的徵兆。

Two weeks later, her emotional state had returned to normal

兩週後，她的情緒狀態恢復正常，

and so, an ultrasound confirmed,

超音波確認了

had her heart.

她的心臟也恢復正常。

Takotsubo cardiomyopathy has been linked to many stressful situations,

章魚壺心肌症和許多壓力情境有關，

including public speaking --

包括公開演說——

(Laughter)

（笑聲）

(Applause)

（掌聲）

domestic disputes, gambling losses,

家庭糾紛、賭博輸錢，

even a surprise birthday party.

甚至生日派對的驚喜。

(Laughter)

（笑聲）

It's even been associated with widespread social upheaval,

它也和普遍的社會動亂有關，

such as after a natural disaster.

比如在天然災害之後。

For example, in 2004,

比如，2004 年，

a massive earthquake devastated a district on the largest island in Japan.

一次大地震破壞了

日本最大島上的一個區域。

More than 60 people were killed, and thousands were injured.

超過 60 人死亡，數千人受傷。

On the heels of this catastrophe,

緊接在這場大災難之後，

researchers found that the incidents of takotsubo cardiomyopathy

研究者發現，

在地震後一個月，

increased twenty-four-fold in the district one month after the earthquake,

該區域中得章魚壺心肌症的案例數

compared to a similar period the year before.

比去年差不多時期要高了 24 倍。

The residences of these cases

這些病人的住所

closely correlated with the intensity of the tremor.

和震動強度有密切的關係。

In almost every case, patients lived near the epicenter.

幾乎每位病人都住在震央附近。

Interestingly, takotsubo cardiomyopathy has been seen after a happy event, too,

有趣的是，章魚壺心肌症

也會在快樂的事件之後出現，

but the heart appears to react differently,

但心臟的反應顯然不同，

ballooning in the midportion, for example, and not at the apex.

比如，中間部分會 鼓起，頂端則不會。

Why different emotional precipitants would result in different cardiac changes

為什麼不同的情緒狀態 會造成不同的心臟改變？

remains a mystery.

這仍然是個謎。

But today, perhaps as an ode to our ancient philosophers,

但，現今，也許是對於 古代哲學家的讚頌，

we can say that even if emotions are not contained inside our hearts,

我們可以說，即使

情緒不是裝在我們的心臟裡，

the emotional heart overlaps

情緒的心仍然

和象徵性的心有所重疊（口誤），

its biological counterpart,

和生物學的心有所重疊，

in surprising and mysterious ways.

這當中的關係既驚人又神秘。

Heart syndromes, including sudden death,

心臟的症候群包括猝死，

have long been reported in individuals experiencing intense emotional disturbance

常常發生在經歷強烈情緒障礙的人，

or turmoil in their metaphorical hearts.

或是象徵性的心非常混亂的人身上。

In 1942,

1942 年，

the Harvard physiologist Walter Cannon published a paper called "'Voodoo' Death,"

哈佛生理學家沃爾特 坎農

出版了一篇論文《巫毒之死》，

in which he described cases of death from fright

他在文中提到， 有些人會因為驚嚇而死

in people who believed they had been cursed,

他們相信自己被詛咒，

such as by a witch doctor or as a consequence of eating taboo fruit.

比如巫醫施加的詛咒 或吃了禁忌食物造成的詛咒。

In many cases, the victim, all hope lost, dropped dead on the spot.

許多案例的受害者 失去所有希望，當場死亡。

What these cases had in common was the victim's absolute belief

這些案例的共通點是， 受害者完全相信

that there was an external force that could cause their demise,

外部的力量能造成他們的死亡，

and against which they were powerless to fight.

且他們完全沒有能力 對抗這種力量。

This perceived lack of control, Cannon postulated,

坎農假設，這種覺得 自己無法控制的感受

resulted in an unmitigated physiological response,

會造成無法減輕的生理反應，

in which blood vessels constricted to such a degree

血管會收縮到了會導致

that blood volume acutely dropped,

血流量下降的程度，

blood pressure plummeted,

血壓會爆跌，

the heart acutely weakened,

心臟會劇烈衰弱，

and massive organ damage resulted from a lack of transported oxygen.

因為缺乏氧氣輸送， 導致大量的器官受損。

Cannon believed that voodoo deaths

坎農相信，巫毒造成的死亡

were limited to indigenous or "primitive" people.

僅限於原住民或「原始」人。

But over the years, these types of deaths have been shown to occur

但，多年來，已經發現這類死亡

也會發生在各種現代人身上。

in all manner of modern people, too.

Today, death by grief has been seen in spouses and in siblings.

現今，已知有配偶和手足 因為悲慟而死。

Broken hearts are literally and figuratively deadly.

破碎的心是會致命的， 不論在實際上或比喻上都是。

These associations hold true even for animals.

這些關聯性也會出現在動物身上。

In a fascinating study in 1980 published in the journal "Science,"

1980 年有一篇有趣的研究

刊載在《科學》期刊上，

researchers fed caged rabbits a high-cholesterol diet

研究者用高膽固醇食物 餵食被關在籠中的兔子，

to study its effect on cardiovascular disease.

來研究它對心血管疾病的影響。

Surprisingly, they found that some rabbits developed a lot more disease than others,

意外的是，他們發現，有些兔子 發展出來的疾病比其他兔子還多，

but they couldn't explain why.

但他們無法解釋原因。

The rabbits had very similar diet, environment and genetic makeup.

這些兔子吃的東西、

環境、基因組成都很類似。

They thought it might have something to do with

他們認為這個現象可能

how frequently the technician interacted with the rabbits.

和技術人員有多常 和兔子互動有關。

So they repeated the study,

所以他們重做了該研究， 這次將兔子分為兩組。

dividing the rabbits into two groups.

Both groups were fed a high-cholesterol diet.

兩組都餵食高膽固醇的食物。

But in one group, the rabbits were removed from their cages,

但，其中一組兔子被放出籠子，

held, petted, talked to, played with,

工作人員會抱牠們、 拍牠們，和牠們玩，

and in the other group, the rabbits remained in their cages

另一組的兔子則被 丟在籠子裡不管。

and were left alone.

At one year, on autopsy,

一年後，根據解剖，

the researchers found that the rabbits in the first group,

研究者發現，

第一組的兔子，

that received human interaction,

有和人互動的兔子，

had 60 percent less aortic disease than rabbits in the other group,

得到主動脈疾病的 比另一組低了六成，

despite having similar cholesterol levels, blood pressure and heart rate.

雖然兩組的膽固醇含量、 血壓、心跳都差不多。

Today, the care of the heart has become less the province of philosophers,

現今，對心的照顧比較 不屬於哲學家的領域，

who dwell upon the heart's metaphorical meanings,

哲學家專注的是心的象徵性意義，

and more the domain of doctors like me,

而比較屬於我這種醫生的領域。

wielding technologies that even a century ago,

我們使用的技術，在一世紀前，

because of the heart's exalted status in human culture,

因為心在人類文化中的崇高地位，

were considered taboo.

甚至可能被視為禁忌。

In the process, the heart has been transformed

在這個過程中，心已經有了轉變，

from an almost supernatural object imbued with metaphor and meaning

從幾乎是超自然的物體， 充滿象徵和意義，

into a machine that can be manipulated and controlled.

變成可以操弄和控制的機器。

But this is the key point:

但，重點是：

these manipulations, we now understand,

我們現在了解，這些操弄

must be complemented by attention to the emotional life

一定要搭配對於情緒生活的 注意，才能完善，

that the heart, for thousands of years, was believed to contain.

數千年來，人們都相信心 包含著這些情緒生活。

Consider, for example, the Lifestyle Heart Trial,

比如，想想看生活方式心臟試驗，

published in the British journal "The Lancet" in 1990.

1990 年刊載在英國 期刊《刺胳針》上。

Forty-eight patients with moderate or severe coronary disease

48 名有中度或嚴重 冠狀動脈疾病的病人

were randomly assigned to usual care

被隨機指派使用一般照護

or an intensive lifestyle that included a low-fat vegetarian diet,

或者特別護理的生活方式，包括

低脂素食餐、適度的有氧運動、

moderate aerobic exercise,

group psychosocial support

團體心理社會支持， 以及壓力管理建議。

and stress management advice.

The researchers found that the lifestyle patients

研究者發現，生活方式組的病人

had a nearly five percent reduction in coronary plaque.

冠狀動脈斑塊減少近 5%。

Control patients, on the other hand,

另一方面，控制組的病人

had five percent more coronary plaque at one year

冠狀動脈斑塊一年就增加了 5%，

and 28 percent more at five years.

五年再增加了 28%。

They also had nearly double the rate of cardiac events,

他們的心臟病 發生率也有近兩倍，

like heart attacks, coronary bypass surgery

比如心臟病發作、心臟繞道手術，

and cardiac-related deaths.

及心臟相關的死亡。

Now, here's an interesting fact:

這裡有個有趣的事實：

some patients in the control group adopted diet and exercise plans

控制組的一些病人採用了 飲食和運動計畫，

that were nearly as intense as those in the intensive lifestyle group.

計畫的強度和生活方式組差不多。

Their heart disease still progressed.

他們的心臟疾病仍然會持續發展。

Diet and exercise alone were not enough to facilitate coronary disease regression.

光是飲食和運動，不足以 促使冠狀動脈疾病復原。

At both one- and five-year follow-ups,

在一年後及五年後的後續追蹤中，

stress management was more strongly correlated

都發現，比起運動，壓力管理

with reversal of coronary disease

和冠狀動脈疾病的 復原更有關聯性。

than exercise was.

No doubt, this and similar studies are small,

無疑這項及類似研究的規模都小，

and, of course, correlation does not prove causation.

且，當然，有關聯性 不表示就有因果關係。

It's certainly possible that stress leads to unhealthy habits,

的確有可能，壓力會 造成不健康的習慣，

and that's the real reason for the increased cardiovascular risk.

那是心血管疾病風險 增加的真正理由。

But as with the association of smoking and lung cancer,

但，就像是抽菸 和肺癌的關聯一樣，

when so many studies show the same thing,

當有這麼多研究指出同樣的結論，

and when there are mechanisms to explain a causal relationship,

且當有些機制可以 解釋因果關係時，

it seems capricious to deny that one probably exists.

還否認可能有因果關係 存在就太任性了。

What many doctors have concluded is what I, too, have learned

許多醫生的結論 和我在擔任心臟科醫生

in my nearly two decades as a heart specialist:

近二十年期間所發現的事實一樣：

the emotional heart intersects with its biological counterpart

情緒的心會和生物學的心有交集，

in surprising and mysterious ways.

這當中的關係既驚人又神秘。

And yet, medicine today continues to conceptualize the heart as a machine.

但，現今的醫學持續 將心概念化成為一台機器。

This conceptualization has had great benefits.

這種概念化有很大的益處。

Cardiology, my field,

心臟病學，我的領域，

is undoubtedly one of the greatest scientific success stories

毫無疑問是過去一百年間

最偉大的科學成功故事之一。

of the past 100 years.

Stents, pacemakers, defibrillators, coronary bypass surgery,

支架、心律調整器、電擊器、

冠狀動脈繞道手術、心臟移植——

heart transplants --

all these things were developed or invented after World War II.

所有這些都是在第二次世界大戰 之後開發或發明出來的。

However, it's possible

然而，有可能

that we are approaching the limits of what scientific medicine can do

我們快要碰到科學醫學 在對抗心臟疾病上

能夠做到的極限了。

to combat heart disease.

Indeed, the rate of decline of cardiovascular mortality

的確，心血管疾病 死亡率的下降速度

has slowed significantly in the past decade.

在過去十年間已經顯著慢下來。

We will need to shift to a new paradigm

我們需要轉換到新的範式，

to continue to make the kind of progress to which we have become accustomed.

以繼續開創我們已經 習以為常的新進展。

In this paradigm, psychosocial factors will need to be front and center

心理社會因素在這個 範式中非常重要，

in how we think about heart problems.

攸關我們如何看待心臟問題。

This is going to be an uphill battle,

這將會是一場艱難的戰役，

and it remains a domain that is largely unexplored.

且這個領域有很大一部分 都還沒有被探索過。

The American Heart Association still does not list emotional stress

美國心臟協會仍未把情緒壓力列為

as a key modifiable risk factor for heart disease,

心臟疾病的可改變風險的關鍵因素。

perhaps in part because blood cholesterol is so much easier to lower

也許有部分是因為要降低血膽固醇

遠比降低情緒和社會混亂容易許多。

than emotional and social disruption.

There is a better way, perhaps,

也許會有更好的方法，

if we recognize that when we say "a broken heart,"

如果我們能夠了解， 當我們說「破碎的心」時，

we are indeed sometimes talking about a real broken heart.

有時我們的確是在講真正破碎的心。

We must, must pay more attention to the power and importance of the emotions

在照護我們的心臟時，

我們必須要更加注意 情緒的力量和重要性，

in taking care of our hearts.

Emotional stress, I have learned,

我學到的是，情緒壓力

is often a matter of life and death.

通常攸關生死。

Thank you.

謝謝。

(Applause)

（掌聲）