What does it mean to be normal? And what does it mean to be sick? I've asked myself this question from the time I was about seven, when I was diagnosed with Tourette syndrome. Tourette's is a neurological disorder characterized by stereotyped movements I perform against my will, called tics. Now, tics are technically involuntary, in the sense that they occur without any conscious attention or intention on my part.
正常是什麼意思? 生病又是什麼意思? 我從七歲開始, 就在問我自己這個問題, 那時我被診斷出妥瑞氏症。 妥瑞氏症是一種神經性失調, 特徵就是我非刻意 也會做出刻板的動作, 稱為抽搐。 技術上來說,抽搐並不是自願的, 也就是,抽搐發生時 我並不會意識到, 我也沒有意圖要這麼做。
But there's a funny thing about how I experience tics. They feel more unvoluntary than involuntary, because I still feel like it's me moving my shoulder, not some external force. Also, I get this uncomfortable sensation, called premonitory urge, right before tics happen, and particularly when I'm trying to resist them. Now, I imagine most of you out there understand what I'm saying, but unless you have Tourette's, you probably think you can't relate. But I bet you can. So, let's try a little experiment here and see if I can give you a taste of what my experience feels like. Alright, ready?
但我對於抽搐的體驗 有一點十分有趣。 覺得比較像是不由自主 而不是無意識的, 因為我仍然感覺得到我在動肩膀, 並不是外力造成的。 此外,就在抽搐發生之前, 我會有一種不舒服的感覺, 叫做前驅性衝動, 特別是當我試圖抗拒時。 我相信在座大部分的人 都懂我所說的, 但除非你也有妥瑞氏症, 不然你可能會認為你無法體會。 但我敢說你可以。 咱們來做個小實驗,看看我能否 讓各位嚐到我的體驗是什麼滋味。 準備好了嗎?
Don't blink. No, really, don't blink. And besides dry eyes, what do you feel? Phantom pressure? Eyelids tingling? A need? Are you holding your breath?
別眨眼。說真的,不要眨眼。 除了眼睛很乾之外, 你還感覺到什麼? 不知哪來的壓力? 眼瞼刺痛? 有需求? 你有在憋氣嗎?
(Laughter)
(笑聲)
Aha.
啊哈。
(Laughter)
(笑聲)
That's approximately what my tics feels like. Now, tics and blinking, neurologically speaking, are not the same, but my point is that you don't have to have Tourette's to be able to relate to my experience of my premonitory urges, because your brain can give you similar experiences and feelings.
我的抽搐大約就是這種感覺。 就神經學上來說, 抽搐和眨眼是不一樣的, 但我的重點是, 你不用得妥瑞氏症, 也能夠感受我的前驅性衝動體驗, 因為你的大腦會給你 類似的體驗和感覺。
So, let's shift the conversation from what it means to be normal versus sick to what it means that a majority of us are both normal and sick. Because in the final analysis, we're all humans whose brains provide for a spectrum of experiences. And everything on that spectrum of human experiences is ultimately produced by brain systems that assume a spectrum of different states. So again, what does it mean to be normal, and what does it mean to be sick, when sickness exists on the extreme end of a spectrum of normal?
咱們把話題從 「正常和生病是什麼意思」 轉到「我們大部分人 既正常又生病是什麼意思」。 因為到頭來,我們都是 大腦提供經驗光譜的人類。 在人類經驗光譜上的一切 最終都是由大腦系統所產生, 這些系統假設存在不同狀態的光譜。 倘若生病位於正常光譜的最尾端, 那麼正常是什麼意思, 生病又是什麼意思呢?
As both a researcher who studies differences in how individuals' brains wire and rewire themselves, and as a Touretter with other related diagnoses, I have long been fascinated by failures of self-regulation on the impulsive and compulsive behavioral spectrums. Because so much of my own experience of my own body and my own behavior has existed all over that map.
身為研究者,我研究個人的大腦 在自我串接和重新串接上的差異。 同時我也是個妥瑞氏症患者, 具有其他相關的診斷結果。 我一直都很著迷於 衝動性和強迫性行為光譜的 自我調節失靈。 因為我對於我自己身體 及自己行為的經驗當中, 有好大一部分都在 那地圖上處處可見。
So with the spotlight on the opioid crisis, I've really found myself wondering lately: Where on the spectrum of unvoluntary behavior do we put something like abusing opioid painkillers or heroin? By now, we all know that the opioid crisis and epidemic is out of control. Ninety-one people die every day in this country from overdose. And between 2002 and 2015, the number of deaths from heroin increased by a factor of six. And something about the way that we treat addiction isn't working, at least not for everyone. It is a fact that people suffering from addiction have lost free will when it comes to their behavior around drugs, alcohol, food or other reward-system stimulating behaviors. That addiction is a brain-based disease state is a medical, neurobiological reality. But how we relate to that disease -- indeed, how we relate to the concept of disease when it comes to addiction -- makes an enormous difference for how we treat people with addictions.
所以,當大家聚焦於 鴉片類藥物的危機上時, 我發現自己在納悶: 要把濫用類鴉片止痛藥物或海洛英 放在不由自主行為光譜上的哪裡? 目前,我們都知道類鴉片藥物的 危機和流行已經失控了。 在這個國家裡,每天就有 91 人 因為用藥過量而死。 在 2002 年到 2015 年之間, 因為海洛英而死的 人數增加了六倍。 我們治療成癮的方式似乎無效, 至少不是人人都有效。 事實就是,飽受成癮之苦的人 已失去自由意志, 無法控制他們與藥物、 酒精、食物相關的行為, 或其他由報償系統所刺激的行為。 成癮是以大腦為基礎的 一種疾病狀態, 在醫學和神經生物學上, 這都是現實。 但我們如何看待那疾病—— 的確,涉及成癮與疾病相關的概念 會使我們治療成癮者的方式大大不同。
So, we tend to think of pretty much everything we do as entirely voluntary. But it turns out that the brain's default state is really more like a car idling in drive than a car in park. Some of what we think we choose to do is actually things that we have become programmed to do when the brakes are released. Have you ever joked that your brain was running on autopilot? Guess what? It probably was. OK? And the brain's autopilot is in a structure called the striatum. So the striatum detects emotional and sensory motor conditions and it knows to trigger whatever behavior you have done most often in the past under those same conditions.
我們傾向於認為我們 所做的一切都是自願的。 但結果發現大腦的預設狀態 其實比較像是空轉的汽車, 而不是關掉引擎的汽車。 有些我們認為是自己選擇去做的行為, 其實是鬆開煞車後 我們的內建機制讓我們去做的。 你是否曾開玩笑說 你的大腦在「自動駕駛」? 你猜怎樣?很可能是真的。 好嗎? 大腦的自動駕駛是在 所謂的紋狀體結構中。 紋狀體會偵測 情緒和感覺運動的狀態, 它知道要觸發你過去 在同樣的條件下最常做的行為。
Do you know why I became a neuroscientist? Because I wanted to learn what made me tick.
你們知道我為什麼 會成為神經科學家嗎? 因為我想了解是什麼讓我 做出行為(音同「抽搐」)。
(Laughter)
(笑聲)
Thank you, thank you.
謝謝,謝謝。(笑聲)
(Laughter)
I've been wanting to use that one in front of an audience for years.
多年來我一直想找機會 在觀眾面前用這個梗。
(Applause)
(掌聲)
So in graduate school, I studied genetic factors that orchestrate wiring to the striatum during development. And yes, that is my former license plate.
在研究所時,我學的是基因因子 在發展過程中負責安排 紋狀體串接的因子。 是的,那是我之前的 車牌(紋狀體)。
(Laughter)
(笑聲)
And for the record, I don't recommend any PhD student get a license plate with their thesis topic printed on it, unless they're prepared for their experiments not to work for the next two years.
鄭重聲明,我並不建議 任何博士生選取和他們 論文題目一樣的車牌, 除非他們已準備好接受自己的 實驗在接下來的兩年都不會成功。 (笑聲)我最終還是找出方法了。
(Laughter)
I eventually did figure it out. So, my experiments were exploring how miswiring in the striatum relates to compulsive behaviors. Meaning, behaviors that are coerced by uncomfortable urges you can't consciously resist. So I was really excited when my mice developed this compulsive behavior, where they were rubbing their faces and they couldn't seem to stop, even when they were wounding themselves. OK, excited is the wrong word, I actually felt terrible for them. I thought that they had tics, evidence of striatal miswiring. And they were compulsive, but it turned out, on further testing, that these mice showed an aversion to interacting and getting to know other unfamiliar mice. Which was unusual, it was unexpected. The results implied that the striatum, which, for sure, is involved in compulsive-spectrum disorders, is also involved in human social connection and our ability to -- not human social connection, but our ability to connect.
我的實驗是要探討 紋狀體的錯誤串接 和強迫行為的關係。 意思就是,被你無法 有意識地抗拒的 不舒服衝動所強制造成的行為。 所以,我真的很興奮 看見我的小鼠發展出 這種強迫行為, 牠們一直在磨擦自己的臉, 甚至弄傷自己似乎仍停止不了。 好吧,不該用興奮這個詞, 我其實為牠們感到很難過。 我以為牠們抽搐,也就是 有紋狀體發生串接錯誤的證據。 牠們是強迫性的, 但結果,進一步的測試發現, 這些小鼠對於和其他 不熟悉的小鼠進行互動 或是去認識牠們產生出反感現象。 這很不尋常,這是我們未預期的。 這些結果意味著 肯定和強迫性光譜失調 有所關聯的紋狀體 也會影響人類的社會連結 以及我們的能力—— 不是人類的社會連結, 而是我們去連結的能力。
So I delved deeper, into a field called social neuroscience. And that is a newer, interdisciplinary field, and there I found reports that linked the striatum not just to social anomalies in mice, but also in people. As it turns out, the social neurochemistry in the striatum is linked to things you've probably already heard of. Like oxytocin, which is that hormone that makes cuddling feel all warm and fuzzy. But it also implicates signaling at opioid receptors. There are naturally occurring opioids in your brain that are deeply linked to social processes.
所以我再深入鑽研, 進入到所謂社會神經科學的領域。 那是一個更新的跨學科領域, 在那裡,我找到了 和紋狀體有關的報告, 不只是和小鼠的社交異常有關, 也和人有關。 結果發現, 在紋狀體中的社交神經化學 和一些你可能已經 聽過的東西有關。 比如催產素,它是一種荷爾蒙, 會讓擁抱感覺起來很溫暖和柔軟。 但這也意味著對鴉片類 藥物的接受器發出訊號。 在你的大腦中有天然 產生的鴉片類藥物, 它們和社交過程有很深的關聯性。
Experiments with naloxone, which blocks opioid receptors, show us just how essential this opioid-receptor signaling is to social interaction. When people are given naloxone -- it's an ingredient in Narcan, that reverses opioid overdoses to save lives. But when it's given to healthy people, it actually interfered with their ability to feel connected to people they already knew and cared about. So, something about not having opioid-receptor binding makes it difficult for us to feel the rewards of social interaction.
鈉洛酮會阻斷鴉片類藥物的 接受器,而鈉洛酮的實驗顯示 鴉片類藥物的接受器的訊號發送 對於社交互動而言有多重要。 當對人施用鈉洛酮——它是 鹽酸烯丙羥嗎啡酮的一種成分, 能逆轉鴉片類藥物過量, 以拯救性命。 但給健康的人施用時, 它會干預他們感受自己和已相識 且在乎的人有所連結的能力。 所以,若無法和鴉片類 藥物的接受器連結, 就會出於某種原因, 讓我們很難感覺到 社交互動帶來的報償。
Now, for the interest of time, I've necessarily gotten rid of some of the scientific details, but briefly, here's where we're at. The effects of social disconnection through opioid receptors, the effects of addictive drugs and the effects of abnormal neurotransmission on involuntary movements and compulsive behaviors all converge in the striatum. And the striatum and opioid signaling in it has been deeply linked with loneliness.
基於時間考量,我必須 省略一些科學細節, 但簡短來說,這是我們目前的進度。 鴉片類藥物接受器的 社會連結斷絕造成的效應、 成癮性藥物的效應, 以及異常神經傳遞的效應, 它們對於非自願性動作 和強迫行為的影響 都會合在紋狀體當中。 而紋狀體以及紋狀體中的 鴉片類藥物訊號 和寂寞有很深的關聯性。
When we don't have enough signaling at opioid receptors, we can feel alone in a room full of people we care about and love, who love us. Social neuroscientists, like Dr. Cacioppo at the University of Chicago, have discovered that loneliness is very dangerous. And it predisposes people to entire spectrums of physical and mental illnesses.
若沒有足夠的訊號傳送到 鴉片類藥物的接受器, 即使在一間房間中滿滿都是 我們在乎的人、愛的人, 同時也愛我們的人, 我們仍會感到孤獨。 社會神經科學家,比如 芝加哥大學的卡奇奧波, 發現寂寞是非常危險的。 它會讓人傾向 全部的光譜都是身體和心理疾病。
Think of it like this: when you're at your hungriest, pretty much any food tastes amazing, right? So similarly, loneliness creates a hunger in the brain which neurochemically hypersensitizes our reward system. And social isolation acts through receptors for these naturally occurring opioids and other social neurotransmitters to leave the striatum in a state where its response to things that signal reward and pleasure is completely, completely over the top. And in this state of hypersensitivity, our brains signal deep dissatisfaction. We become restless, irritable and impulsive. And that's pretty much when I want you to keep the bowl of Halloween chocolate entirely across the room for me, because I will eat it all. I will.
可以這樣想: 當你在最飢餓的時候, 幾乎任何食物吃起來 都是美味,對吧? 同樣的,寂寞會 在大腦中創造出飢餓, 它會以神經化學的方式 將我們的報償系統做超增感。 而社會孤立會 透過接受器而產生影響, 讓這些自然產生的鴉片類藥物 和其他社交神經傳遞質 造成紋狀體進入一種狀態, 它對於發送報償和愉悅訊號的事物 會做出完全過火的反應。 在這種超增感的狀態中, 我們的大腦會發出深深不滿的訊號。 我們會變得焦躁不安、 易怒,且容易衝動。 那時我大概就會請你們把房間中 整碗萬聖節巧克力都留給我, 因為我會把它們全部吃光。我會的。 這就帶出了另一樣東西,
And that brings up another thing that makes social disconnection so dangerous. If we don't have the ability to connect socially, we are so ravenous for our social neurochemistry to be rebalanced, we're likely to seek relief from anywhere. And if that anywhere is opioid painkillers or heroin, it is going to be a heat-seeking missile for our social reward system. Is it any wonder people in today's world are becoming addicted so easily? Social isolation -- excuse me -- contributes to relapse.
會讓社會連結斷絕變得很危險。 如果我們沒有建立社會連結的能力, 我們會非常渴望我們的社交 神經化學能夠被重新平衡, 以致於我們很可能會 從其他地方尋求出口。 如果那「其他地方」是 鴉片類止痛藥物或海洛英, 它會是我們社交報償系統的 導熱飛彈。 有沒有人納悶 為什麼現今世界上的人 這麼容易上癮? 社會孤立—— 抱歉—— 會造成復發。
Studies have shown that people who tend to avoid relapse tend to be people who have broad, reciprocal social relationships where they can be of service to each other, where they can be helpful. Being of service lets people connect. So -- if we don't have the ability to authentically connect, our society increasingly lacks this ability to authentically connect and experience things that are transcendent and beyond ourselves. We used to get this transcendence from a feeling of belonging to our families and our communities. But everywhere, communities are changing. And social and economic disintegration is making this harder and harder.
研究指出,比較能夠避免復發的人, 通常擁有廣闊且對等的社交關係, 在這些關係中,他們能互相幫忙, 能有所貢獻就會讓人連結。 所以—— 如果我們沒有進行真實連結的能力, 我們的社會越來越缺乏 這種建立真實連結的能力, 越來越缺乏體驗超越己身 卓越事物的能力。 我們以前會從所屬家庭和社區的 歸屬感來得到這種超越。 但,不論在哪裡,社區都在改變。 而社會和經濟的崩解 讓它越來越困難。
I'm not the only person to point out that the areas in the country most economically hard hit, where people feel most desolate about their life's meaning, are also the places where there have been communities most ravaged by opioids. Social isolation acts through the brain's reward system to make this state of affairs literally painful. So perhaps it's this pain, this loneliness, this despondence that's driving so many of us to connect with whatever we can. Like food. Like handheld electronics. And for too many people, to drugs like heroin and fentanyl.
除了我以外還有其他人也指出, 在這個國家中最受到 經濟影響的區域, 這裡的人對於自己 生命的意義最感到淒涼, 這些區域正好也是 受到鴉片類藥物蹂躪 最嚴重的社區所在的區域。 社會孤立會透過大腦的 報償系統產生影響, 會讓這種事情的狀態真的很痛苦。 所以,也許正是 這種痛苦、這種寂寞、 這種失望, 驅使許多人盡可能 去建立各種連結。 比如食物。 比如手持式電子裝置。 也有太多人因此轉向 海洛因和芬太奴這類藥物。
I know someone who overdosed, who was revived by Narcan, and she was mostly angry that she wasn't simply allowed to die. Imagine for a second how that feels, that state of hopelessness, OK? But the striatum is also a source of hope. Because the striatum gives us a clue of how to bring people back. So, remember that the striatum is our autopilot, running our behaviors on habit, and it's possible to rewire, to reprogram that autopilot, but it involves neuroplasticity. So, neuroplasticity is the ability of brains to reprogram themselves, and rewire themselves, so we can learn new things. And maybe you've heard the classic adage of plasticity: neurons that fire together, wire together. Right?
我認識一個人,她用藥過量, 鹽酸烯丙羥嗎啡酮讓她活過來, 她最憤怒的一點就是 她連想死都不被允許。 想像一下,那種沒有希望的狀態 是什麼樣的感覺,好嗎? 但紋狀體也是希望的來源。 因為紋狀體給了我們一條線索, 讓我們知道要如何把人救回來。 所以,記住紋狀體 是我們的自動駕駛, 根據習慣來主導我們的行為, 而且能夠把那自動駕駛 重新串接、重新編程。 但這會涉及到神經可塑性。 神經可塑性是 讓大腦可以將自己 重新編程的一種能力, 以及重新串接, 讓我們能學習新事物。 也許你們聽說過關於 可塑性的經典格言: 神經元會一起發動、一起串接。 對吧?
So we need to practice social connective behaviors instead of compulsive behaviors, when we're lonely, when we are cued to remember our drug. We need neuronally firing repeated experiences in order for the striatum to undergo that necessary neuroplasticity that allows it to take that "go find heroin" autopilot offline. And what the convergence of social neuroscience, addiction and compulsive-spectrum disorders in the striatum suggests is that it's not simply enough to teach the striatum healthier responses to compulsive urges. We need social impulses to replace drug-cued compulsive behaviors, because we need to rebalance, neurochemically, our social reward system. And unless that happens, we're going to be left in a state of craving. No matter what besides our drug we repeatedly practice doing.
因此,當我們寂寞時, 當我們不由自主地 被迫轉向藥物時, 反而是要練習社會連結的行為。 我們需要不斷重覆檢視 神經元發動的經驗, 紋狀體才能產生必要的神經可塑性, 這種可塑性會關掉 「去找海洛英」的自動駕駛功能。 而社會神經科學、成癮, 以及衝動性光譜失調 通通在紋狀體中會合的現象, 意味著僅僅是教紋狀體 對強迫性的慾望 做出比較健康的反應是不夠的。 我們需要用社交衝動 來取代會暗示我們 轉向藥物的強迫行為, 因為在神經化學上, 我們需要重新平衡 我們的社交報償系統。 如果沒有重新平衡, 我們就會處於渴望的狀態, 不論除了藥物之外, 我們不斷重覆練習做什麼。
I believe that the solution to the opioid crisis is to explore how social and psychospiritual interventions can act as neurotechnologies in circuits that process social and drug-induced rewards. One possibility is to create and study scalable tools for people to connect with one another over a mutual interest in recovery through psychospiritual practices. And as such, psychospiritual practice could involve anything from people getting together as megafans of touring jam bands, or parkour jams, featuring shared experiences of vulnerability and personal growth, or more conventional things, like recovery yoga meetups, or meetings centered around more traditional conceptions of spiritual experiences.
我相信鴉片類藥物危機的解決方案 就是要去探究社會和心理的干預方式 如何能在負責處理社交 和藥物引發之報償的電路中 扮演神經技術的角色。 一種可能性就是要創造並研究 可擴充的工具, 讓大家能夠以相互利益 為基礎和彼此連結, 透過心理靈性的做法來恢復。 因此,心理靈性的做法 什麼都有可能涉及, 從巡迴演出的搖滾樂團 超級粉絲聚集在一起, 或是跑酷大交流, 特色是關於脆弱 及個人成長的共同經驗, 或是比較常見的, 如復元式瑜伽聚會, 或是以比較傳統的靈性體驗 之概念為中心的聚會。
But whatever it is, it needs to activate all of the neurotransmitter systems in the striatum that are involved in processing social connection. Social media can't go deep enough for this. Social media doesn't so much encourage us to share, as it does to compare. It's the difference between having superficial small talk with someone and authentic, deeply connected conversation with eye contact. And stigma also keeps us separate. There's a lot of evidence that it keeps us sick. And stigma often makes it safer for addicts to connect with other addicts. But recovery groups centered around reestablishing social connections could certainly be inclusive of people who are seeking recovery for a range of mental health problems.
但,不論是什麼, 都需要啟動紋狀體中 所有和處理社會連結有關的 神經傳遞質系統。 這方面,社交媒體 無法做到足夠的深度。 社交媒體鼓勵我們做的, 主要是比較,而不是分享。 和某人進行非常表面的小聊 不同於有著眼神接觸 和深刻連結的真實談話。 汙名也讓我們保持著分離的狀態。 有很多證據顯示, 它一直讓我們生病。 汙名通常會讓成癮者覺得 和其他成癮者連結是比較安全的。 但以重新建立社會連結 為重點的康復小組 肯定能接納 想從各種心理健康問題中康復的人。
My point is, when we connect around what's broken, we connect as human beings. We heal ourselves from the compulsive self-destruction that was our response to the pain of disconnection. When we think of neuropsychiatric illnesses as a spectrum of phenomenon that are part of what make us human, then we remove the otherness of people who struggle with self-destruction. We remove the stigma between doctors and patients and caregivers. We put the question of what it means to be normal versus sick back on the spectrum of the human condition. And it is on that spectrum where we can all connect and seek healing together, for all of our struggles with humanness. Thank you for letting me share.
我的重點是,當我們在破碎中連結, 我們是以人類的身分在連結。 我們對於社會連結斷絕造成的痛苦, 反應會是強迫性自我毀滅, 而我們能將我們自己從中治癒。 我們之所以會是人, 有部分是因為某些現象, 當我們把神經精神疾病想成 是這些現象的光譜, 那麼我們就會把在自我摧毀中 掙扎的人的相異性給除去了。 我們把醫生和病人以及照護者 之間的汙名除去了。 我們把「正常和生病 是什麼意思」這個問題 放回了人類境況的光譜上。 在這個光譜上, 我們都能彼此聯繫, 一起爲人類的所有痛苦尋求療癒。 謝謝各位我讓分享。
(Applause)
(掌聲)