We see with the eyes, but we see with the brain as well. And seeing with the brain is often called imagination. And we are familiar with the landscapes of our own imagination, our inscapes. We've lived with them all our lives. But there are also hallucinations as well. And hallucinations are completely different. They don't seem to be of our creation. They don't seem to be under control. They seem to come from the outside and to mimic perception.
我们用眼睛看世界 但我们也用大脑看 用大脑来看,也就是我们常说的想象 我们很熟悉自己想象的模式 也就是内心世界,它伴随我们一生 然而想象之外还有幻觉 幻觉跟想象截然不同 它似乎不是我们所创造的 好像也不受我们的控制 它似乎源自外界
So I am going to be talking about hallucinations
又伪装成我们自己的感知
and a particular sort of visual hallucination, which I see among my patients. A few months ago, I got a phone call from a nursing home where I work. They told me that one of their residents, an old lady in her 90s, was seeing things, and they wondered if she'd gone bonkers or, because she was an old lady, whether she'd had a stroke, or whether she had Alzheimer's.
所以我将就幻觉做一些解释 也会提到我在病人身上观察到的 一种特殊的视觉幻觉 几个月前我接到从我工作的养老院 打来的一个电话 他们告诉我住客中有一位90多的老太太 “看到了一些东西” 他们怀疑她是不是疯了 或者因为年纪大 得了中风,或是老年痴呆症
And so they asked me if I would come and see Rosalie, the old lady. I went in to see her. It was evident straightaway that she was perfectly sane and lucid and of good intelligence, but she'd been very startled and very bewildered, because she'd been seeing things. And she told me -- the nurses hadn't mentioned this -- that she was blind, that she had been completely blind from macular degeneration for five years. But now, for the last few days, she'd been seeing things.
所以他们请我去看看罗萨莉 也就是那个老太太 我去了后 马上就发现 她不仅完全神志正常 还非常清醒、明智 就是有点吓坏了,还有点奇怪 为什么她会出现幻视 她还说 护士忘了告诉我 她眼睛是看不见的 她五年前就因为视网膜黄斑退化而完全失明了 近几天却看到了幻象
So I said, "What sort of things?" And she said, "People in Eastern dress, in drapes, walking up and down stairs. A man who turns towards me and smiles, but he has huge teeth on one side of his mouth. Animals too. I see a white building. It's snowing, a soft snow. I see this horse with a harness, dragging the snow away. Then, one night, the scene changes. I see cats and dogs walking towards me. They come to a certain point and then stop. Then it changes again. I see a lot of children. They're walking up and down stairs. They wear bright colors, rose and blue, like Eastern dress."
我问:“什么样的幻象?” 她说:“许多人穿着东方服饰 那种长袍式的,在楼梯上上下下 一个男的转过来对我笑 但他的嘴巴只有一边长着牙,很大的牙 还有很多动物 有一栋白色的楼,天在下雪,小雪 我还看到一匹戴着挽具的马不断把雪拖走 然后有一天晚上,幻象变了 变成好多猫和狗朝我这边走 走着走着就停了 然后又变了 这回我看到很多小朋友在楼梯上爬上爬下 他们穿着颜色鲜艳的衣服,有玫瑰色,有蓝色 就像东方服饰。”
Sometimes, she said, before the people come on, she may hallucinate pink and blue squares on the floor, which seem to go up to the ceiling. I said, "Is this like a dream?" And she said, "No, it's not like a dream. It's like a movie." She said, "It's got color. It's got motion. But it's completely silent, like a silent movie." And she said it's a rather boring movie.
她说,有时候在她看到人之前 她还能看到地板上粉色和蓝色的方块 跑到天花板上 我问:“像不像做梦?” 她说:“不,不像梦。像个电影。” “它是有颜色的,还有动作 不过一点声音都没有,像默片。” 她还说那电影相当无聊
(Laughter)
她说:“所有人都穿着东方衣服
She said, "All these people with Eastern dress, walking up and down, very repetitive, very limited."
爬上爬下,不停地,一点别的花样都没有。”
(Laughter)
(笑声)
And she had a sense of humor. She knew it was a hallucination, but she was frightened. She had lived 95 years, and she'd never had a hallucination before. She said that the hallucinations were unrelated to anything she was thinking or feeling or doing, that they seemed to come on by themselves, or disappear. She had no control over them. She said she didn't recognize any of the people or places in the hallucinations, and none of the people or the animals -- well, they all seemed oblivious of her. And she didn't know what was going on. She wondered if she was going mad or losing her mind.
她很幽默 而且知道那是个幻觉 但她有点害怕,因为她活了95年 从来没有出现过幻觉 她说那些幻觉跟她的意识和行为 一点都不相干 总是这么无缘无故地出现,又无缘无故地消失 完全不受她控制 而幻觉中出现的 人和地点 她一个都不认识 里面的人和动物 也好像看不见她 她不知道这是这么了 她想,她是疯了 还是在失去理智
Well, I examined her carefully. She was a bright old lady, perfectly sane. She had no medical problems. She wasn't on any medications which could produce hallucinations. But she was blind. And I then said to her, "I think I know what you have." I said, "There is a special form of visual hallucination which may go with deteriorating vision or blindness. This was originally described," I said, "right back in the 18th century, by a man called Charles Bonnet. And you have Charles Bonnet syndrome. There's nothing wrong with your brain. There's nothing wrong with your mind. You have Charles Bonnet syndrome."
于是我为这个活泼的老太太 做了详尽的检查 结果发现她的神智完全正常,没有精神问题 她所吃的药也都没有致幻的副作用 不过,她是盲的 所以我说: “我想我知道你的问题是什么了。 有一种特殊的视觉幻觉 会发生在视力受损或完全失明的人身上 这种现象 最早在18世纪 被一个叫查尔斯·邦纳的人描述过 你得的就是邦纳症候群(Charles Bonnet syndrome) 问题既不在你的大脑,也不在你的意识 你只是得了这种邦纳症候群。”
And she was very relieved at this, that there was nothing seriously the matter, and also rather curious. She said, "Who is this Charles Bonnet?" She said, "Did he have them himself?" And she said, "Tell all the nurses that I have Charles Bonnet syndrome."
她大松一口气 还好不是什么重病 完了还相当好奇 她问:“这个查尔斯 他也有这种幻觉吗? 还有,告诉那些护工,
(Laughter)
我只不过是得了邦纳症候群。“
"I'm not crazy. I'm not demented. I have Charles Bonnet syndrome." Well, so, I did tell the nurses.
(笑声) “我没疯,也没傻,我只是得了邦纳症候群。” 于是我照她的意思告诉了护工们
Now this, for me, is a common situation. I work in old-age homes, largely. I see a lot of elderly people who are hearing-impaired or visually impaired. About 10 percent of the hearing-impaired people get musical hallucinations. And about 10 percent of the visually impaired people get visual hallucinations. You don't have to be completely blind, only sufficiently impaired.
其实这种现象对我来说并不稀奇 我在养老院工作 认识很多老人 是听力或视力受损的 10%的听力受损者 有听觉幻觉 10%的视力受损者 有视觉幻觉 不一定要完全失明 或完全听不到,才会有这种幻觉
Now, with the original description in the 18th century, Charles Bonnet did not have them. His grandfather had these hallucinations. His grandfather was a magistrate, an elderly man. He'd had cataract surgery. His vision was pretty poor. And in 1759, he described to his grandson various things he was seeing.
18世纪的查尔斯·邦纳 其实并没有这种症状 产生幻觉的是他的祖父 一位年长的长官 这个长官曾接受过白内障手术 视力不大好 1759年,他向孙子描述了 他看到的各种各样的幻象
The first thing he said was he saw a handkerchief in midair. It was a large blue handkerchief with four orange circles. And he knew it was a hallucination. You don't have handkerchiefs in midair. And then he saw a big wheel in midair. But sometimes he wasn't sure whether he was hallucinating or not, because the hallucinations would fit in the context of the visions. So on one occasion, when his granddaughters were visiting them, he said, "And who are these handsome young men with you?"
第一个幻象 是一块悬浮在空中的手帕 大大的,蓝色的 还有四个橙色的圆圈 他知道这是个幻觉 因为手帕不会浮在半空 他还看到过一个大轮子浮在空中 不过有时候他也搞不清楚看到的到底是不是幻觉 因为这些幻觉 会融合在现实的背景里 有一次,当他的孙女们来探望他时,他又看到了幻觉 他问:“这几个跟你们在一起的帅小伙子是谁啊?”
(Laughter)
孙女们却说:“诶,爷爷,没有你说的帅小伙啊。”
And they said, "Alas, Grandpapa, there are no handsome young men." And then the handsome young men disappeared. It's typical of these hallucinations that they may come in a flash and disappear in a flash. They don't usually fade in and out. They are rather sudden, and they change suddenly.
突然间帅小伙们就消失了 这是一种典型的幻觉 刷一下来,刷一下去 没有渐变 相当突然,变得也快
Charles Lullin, the grandfather, saw hundreds of different figures, different landscapes of all sorts. On one occasion, he saw a man in a bathrobe smoking a pipe, and realized it was himself. That was the only figure he recognized. On one occasion, when he was walking in the streets of Paris, he saw -- this was real -- a scaffolding. But when he got back home, he saw a miniature of the scaffolding, six inches high, on his study table. This repetition of perception is sometimes called "palinopsia."
查尔斯·鲁林,也就是那个祖父 看到过几百个不同的人像 还有各种各样的景色 有一次,他看到一个穿浴袍的男人在抽烟斗 然后意识到,那就是他自己 那是唯一一个他辨认出来的人像 还有一次,他在巴黎的街道上 当真看到了一个脚手架 回到家后,却看到了那个脚手架的迷你版 六英尺高,就立在他的书桌上 这种感知的重复 有时会被称作视像保留
With him and with Rosalie, what seems to be going on -- and Rosalie said, "What's going on?" -- and I said that as you lose vision, as the visual parts of the brain are no longer getting any input, they become hyperactive and excitable, and they start to fire spontaneously. And you start to see things. The things you see can be very complicated indeed.
这种在查尔斯·鲁林和罗斯莉 身上发生的 让罗斯莉问道“我这是这么了?”的现象 我这么解释吧:随着视力的减退 大脑与视力相关的部分渐渐失去了信息输入 从而进入一种过度活跃的、待激活的状态 于是它开始自发地活动 让人产生幻象 产生的幻象可以相当复杂
With another patient of mine who also had some vision, the visions she had could be disturbing. On one occasion, she said she saw a man in a striped shirt in a restaurant. And he turned round, and then he divided into six figures in striped shirts, who started walking towards her. And then the six figures came together, like a concertina. Once, when she was driving, or rather, her husband was driving, the road divided into four and she felt herself going simultaneously up four roads.
我有一个病人 (像查尔斯·鲁林一样)视力没有完全减退 她看到的幻象比较恼人 她说有一次她看到 餐馆里有一个穿条纹恤衫的男人 他转过身 然后就突然分裂成6个同样穿条纹恤衫的人像 开始朝她走来 然后六个人就合了起来,就像手风琴一样 有一次她正在开车 应该说,是他丈夫在开 路突然就分裂成了4条 她感觉就像同时在4条路上行驶
She had very mobile hallucinations as well. A lot of them had to do with a car. Sometimes she would see a teenage boy sitting on the hood of the car. He was very tenacious, and he moved rather gracefully when the car turned. And then when they came to a stop, the boy would do a sudden vertical takeoff, 100 foot in the air, and then disappear.
她的幻觉充满动感 往往会牵涉到车 有时她会看到一个青年男孩 坐在引擎盖上 紧抓不放,车转弯时 他便随着车的动作缓缓倾斜 车停下后 男孩便会突然垂直飞到100尺的高空 然后消失
Another patient of mine had a different sort of hallucination. This was a woman who didn't have trouble with her eyes but the visual parts of her brain, a little tumor in the occipital cortex. And, above all, she would see cartoons. And these cartoons would be transparent, and would cover half the visual field, like a screen. And especially, she saw cartoons of Kermit the Frog.
还有一个病人,有另外一种幻觉 这位女病人视力并无问题 问题出在她脑部的视觉部分 她的枕叶皮层有一个小肿瘤 尤其引人注意的是,她看到的幻象是卡通的 而且是半透明的 像屏幕一样盖住半个视野 特别的是,她看到的是青蛙柯密特(芝麻街人物)
(Laughter)
(笑声)
Now, I don't watch Sesame Street, but she made a point of saying, "Why Kermit?" she said, "Kermit the Frog means nothing to me." You know, I was wondering about Freudian determinants: Why Kermit? "Kermit the Frog means nothing to me."
我不看芝麻街的 不过她坚持要问我: ”为什么是柯密特?“她说,”青蛙柯密特对我来说一点意义都没有啊。“ 当时我正在研究弗洛伊德决定因素 为什么是柯密特? ”青蛙柯密特对我来说一点意义都没有啊。“
She didn't mind the cartoons too much. But what did disturb her was she got very persistent images or hallucinations of faces, and as with Rosalie, the faces were often deformed, with very large teeth or very large eyes. And these frightened her. Well, what is going on with these people? As a physician, I have to try and define what's going on and to reassure people, especially to reassure them that they're not going insane.
她并不大关注那部卡通 让她非常苦恼的是 这些幻觉持续地出现 而且跟罗斯莉的情况一样,幻觉中的脸往往是扭曲的 要么长着大牙,要么长着大眼 这让她感到非常不安 那么,这些病人是怎么了? 作为一个医生,我必须尝试阐释这些现象 来安抚他们 尤其得告诉他们,他们没疯
Something like 10 percent, as I said, of visually impaired people get these. But no more than one percent of the people acknowledge them, because they are afraid they will be seen as insane or something. And if they do mention them to their own doctors, they may be misdiagnosed.
我前面提到过,视力受损的人 有10%会产生幻觉 但不超过1%会承认 因为他们担心会被当成疯子之类 而如果他们向医生提起这种症状 医生可能会做出错误的诊断
In particular, the notion is that if you see things or hear things, you're going mad. But the psychotic hallucinations are quite different. Psychotic hallucinations, whether they are visual or vocal, they address you. They accuse you, they seduce you, they humiliate you, they jeer at you. You interact with them. There is none of this quality of being addressed with these Charles Bonnet hallucinations. There is a film. You're seeing a film which has nothing to do with you -- or that's how people think about it.
而且,大家往往认为 如果你看到或听到幻觉,你就是疯了 其实我们提到的这种幻觉跟精神病幻觉是不一样的 精神病的幻觉,不管是视觉的还是听觉的 都对付你,指控你 诱惑你,羞辱你 嘲弄你 跟你互动 而这些 都没有出现在邦纳式的幻觉中 邦纳式幻觉就像一部电影,尽管你在看,电影却没有牵涉到你 反正患者们是这么认为的
There is also a rare thing called temporal lobe epilepsy, and sometimes, if one has this, one may feel oneself transported back to a time and place in the past. You're at a particular road junction. You smell chestnuts roasting. You hear the traffic. All the senses are involved. And you're waiting for your girl. And it's that Tuesday evening back in 1982. The temporal lobe hallucinations are all sense hallucinations, full of feeling, full of familiarity, located in space and time, coherent, dramatic. The Charles Bonnet ones are quite different.
还有一种少有的症状叫颞叶癫痫 有时,如果一个人产生这种症状 他可能会感到自己被带回 到过去的一个时空 在某一个路口 闻到烤栗子的香味 听到车来车往,所有的感官都参与着 等待着心上人 那可能是1982年的某个周二夜晚 这种颞叶异常导致的幻觉 是多感官的 充满着情绪和熟悉感 发生在特定时空中 情节合乎逻辑而戏剧感十足 邦纳式的不一样
In the Charles Bonnet hallucinations, you have all sorts of levels, from the geometrical hallucinations -- the pink and blue squares the woman had -- up to quite elaborate hallucinations with figures and especially faces. Faces, and sometimes deformed faces, are the single commonest thing in these hallucinations. And one of the second commonest is cartoons.
在邦纳式幻觉中 有好几种等级 从几何幻觉 比如老太太看到的粉色和蓝色的方块 到非常复杂的幻觉 比如各种人像,尤其是面容 这些面容,有时是扭曲的面容 是唯一一种在这些幻觉中 最常见的幻象 一种第二常见的幻象是卡通
So, what is going on? Fascinatingly, in the last few years, it's been possible to do functional brain imagery, to do fMRI on people as they are hallucinating, and, in fact, to find that different parts of the visual brain are activated as they are hallucinating. When people have these simple, geometrical hallucinations, the primary visual cortex is activated. This is the part of the brain which perceives edges and patterns. You don't form images with your primary visual cortex.
那么,究竟为什么会产生幻觉呢? 很棒的是,近几年 我们能够做出脑功能成像 当我们给正产生幻觉的人做功能性磁共振成像(fMRI)时 我们的确发现大脑视觉部位 有不同区域被激活 这时被检测者正在经历幻觉 如果被检测者有的是简单的几何幻觉 被激活的区域则是初级视觉皮质 这是大脑感知边缘和图案的部分 而我们光靠这里是无法形成完整影像的
When images are formed, a higher part of the visual cortex is involved, in the temporal lobe. And in particular, one area of the temporal lobe is called the fusiform gyrus. And it's known that if people have damage in the fusiform gyrus, they may lose the ability to recognize faces. But if there's an abnormal activity in the fusiform gyrus, they may hallucinate faces, and this is exactly what you find in some of these people. There is an area in the anterior part of this gyrus where teeth and eyes are represented, and that part of the gyrus is activated when people get the deformed hallucinations.
影像形成时 一个位于颞叶的较高级视觉皮质 会有一定活动 尤其是颞叶中 叫做梭状回的一个区域,显著地活跃 调查显示,如果梭状回损伤 患者可能因此无法辨认面容 而当梭状回异常时 患者则可能看到面容的幻象 这正是我们前面提到的几位病人所出现的症状 梭状回的前部有一个区域 负责处理有关牙齿和眼睛的影像 而当病人出现扭曲的幻觉时 正是这一部位出现了活动
There is another part of the brain which is especially activated when one sees cartoons. It's activated when one recognizes cartoons, when one draws cartoons and when one hallucinates them. It's very interesting that that should be specific. There are other parts of the brain which are specifically involved with the recognition and hallucination of buildings and landscapes.
还有一个区域 会在病人看到卡通幻象时 出现活动 人们观看卡通 画卡通,或看到卡通幻象时,都是这一部位被激活 这是一个特别有趣的现象 大脑还有几个别的部位 相应地跟其他视觉元素的辨别与幻觉有关
Around 1970, it was found that there were not only parts of the brain,
比如楼房和风景
but particular cells. "Face cells" were discovered around 1970. And now we know that there are hundreds of other sorts of cells, which can be very, very specific. So you may not only have "car" cells, you may have "Aston Martin" cells.
1970年左右,人们发现特化的不是一块区域 而是相应的脑细胞 “脸细胞”是1970年左右发现的 至今,我们已经发现了 数百种与各类视觉元素对应的脑细胞 这种对应关系可以非常琐细、明确 比如说 “车”细胞 可能还有“阿斯顿·马丁(一种车)”细胞
(Laughter)
(笑声)
I saw an Aston Martin this morning. I had to bring it in.
今早我看到一部阿斯顿·马丁
(Laughter)
我一直想提提它
And now it's in there, somewhere. So --
现在我的脑子里就有这种“阿斯顿·马丁”细胞 (笑声)
(Laughter)
那么,这一程度的幻觉,只会由这一整块可以称作下颞叶皮质的区域
now, at this level, in what's called the inferotemporal cortex, there are only visual images, or figments or fragments. It's only at higher levels that the other senses join in and there are connections with memory and emotion. And in the Charles Bonnet syndrome, you don't go to those higher levels. You're in these levels of inferior visual cortex, where you have thousands and tens of thousands and millions of images, or figments or fragmentary figments, all neurally encoded in particular cells or small clusters of cells.
形成视觉影像、 幻象,或片段 只有更高程度的幻觉 才会有视觉以外的感官参与 同时牵涉到记忆与情感 在邦纳症候群中 更高程度的幻觉并不会出现 牵涉到初级视觉皮质的幻觉 有上百上千 甚至更多的图像、 幻象,或残缺幻象 这些都被编译 在特定的脑细胞或脑细胞簇中
Normally, these are all part of the integrated stream of perception, or imagination, and one is not conscious of them. It is only if one is visually impaired or blind that the process is interrupted. And instead of getting normal perception, you're getting an anarchic, convulsive stimulation, or release, of all of these visual cells in the inferotemporal cortex. So, suddenly, you see a face. Suddenly, you see a car. Suddenly this and suddenly that. The mind does its best to organize and to give some sort of coherence to this, but not terribly successfully.
这些细胞通常 参与形成感知和想象 人们通常是无法意识到这一过程的 只有当你的视力受损或丧失 这一过程才会被干扰 在这种情况下,你的感知不再正常 一种不受控的、 痉挛的释放活动 发生在位于初级视觉皮质的 这些视觉脑细胞中 这种活动的结果就是,你突然看到一张脸,转瞬看到一辆车 突然这,突然那 大脑会尝试控制场面 尝试使这一切符合逻辑 但不会很成功
When these were first described, it was thought that they could be interpreted like dreams. But, in fact, people say, "I don't recognize the people. I can't form any associations. Kermit means nothing to me." You don't get anywhere, thinking of them as dreams.
这些现象最初被描述时 人们相信,跟梦一样,这种幻觉也能被强行中止 不过实际上患者表示 “我认不出来谁是谁。完全没办法想到任何信息。” ”青蛙柯密特对我来说一点意义都没有啊。“ 把这种现象视作梦的一种是行不通的
Well, I've more or less said what I wanted. I think I just want to recapitulate and say this is common. Think of the number of blind people. There must be hundreds of thousands of blind people who have these hallucinations but are too scared to mention them. So this sort of thing needs to be brought into notice, for patients, for doctors, for the public. Finally, I think they are infinitely interesting and valuable, for giving one some insight as to how the brain works.
唔,我应该说得差不多了 我再概括一下 其实帮纳症候群是个常见现象 你们想,在盲人人群中 肯定有上百上千 有这样的幻觉 然而却不敢提起 所以不管是病人,医生还是公众 都有必要认识到这一现象的常见性 最后 我发现帮助别人认识大脑作用的原理 是一件无比有趣而有意义的事情
Charles Bonnet said, 250 years ago -- he wondered how, thinking of these hallucinations, how, as he put it, the theater of the mind could be generated by the machinery of the brain. Now, 250 years later, I think we're beginning to glimpse how this is done. Thanks very much.
查尔斯·邦纳在250年前 在对这些幻觉现象的观察的促使下,思考了这个问题 心智的戏剧性 是如何产生于大脑运作的呢? 250年后的今天 我想我们已经能够开始领悟这个精妙的过程 非常感谢
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Chris Anderson: That was superb. Thank you so much. You speak about these things with so much insight and empathy for your patients. Have you yourself experienced any of the syndromes you write about?
克里斯·安德森:非常精彩,非常感谢你 你说得非常精到 也很能理解你的病人 你自己有没有过这些症状呢?
Oliver Sacks: I was afraid you would ask that.
奥利弗·萨克斯:我挺怕你问这个的
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Well, yeah, a lot of them. And, actually, I'm a little visually impaired myself. I'm blind in one eye and not terribly good in the other. And I see the geometrical hallucinations. But they stop there.
嗯,有,很大一部分 事实上我自己也有一定的视力受损 我的一只眼睛是看不到的,另一只视力也不大好 我看到过几何幻觉 不过最多也就这个程度了
CA: And they don't disturb you? Because you understand what's doing it, it doesn't make you worried?
安德森:它们会不会让你感到很不安? 或者说是不是因为你了解这一现象而没这么担心?
OS: Well, they don't disturb me any more than my tinnitus, which I ignore. They occasionally interest me, and I have many pictures of them in my notebooks. I've gone and had an fMRI myself, to see how my visual cortex is ticking over. And when I see all these hexagons and complex things, which I also have, in visual migraine, I wonder whether everyone sees things like this and whether things like cave art or ornamental art may have been derived from them a bit.
萨克斯:耳鸣让我烦心得多 耳鸣我也是听而不闻 不过偶尔我会对自己的幻觉很感兴趣 我还把它们画在了笔记本里 我自己就曾做过功能性磁共振成像 看看我的视觉皮层在造什么反 我看到六边形的幻觉 或更复杂的幻觉, 往往伴随着偏头痛 那是我就会想是不是别人也会有这样的幻觉 洞穴壁画和装饰艺术 是不是也取材于这种幻觉
CA: That was an utterly, utterly fascinating talk. Thank you so much for sharing.
安德森:你今天的演讲非常非常精彩 感谢你的分享
OS: Thank you. Thank you.
萨克斯:谢谢,谢谢
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