What does it mean to be normal? And what does it mean to be sick?
正常状态是什么样子？生病状态又是什么含义？
I've asked myself this question from the time I was about seven, when I was diagnosed with Tourette syndrome.
我大概7岁起就开始自问这个问题，那时候，我被确诊为妥瑞症。
Tourette's is a neurological disorder characterized by stereotyped movements I perform against my will, called tics.
妥瑞症是神经障碍，特点是典型的手脚不听使唤，也就是抽动障碍。
Now, tics are technically involuntary, in the sense that they occur without any conscious attention or intention on my part.
抽动障碍是无意识发生的，也就是说，我自己并非自愿且无意识的情况下发生的。
But there's a funny thing about how I experience tics.
但我对抽动障碍的体验有一个有趣之处。
They feel more unvoluntary than involuntary, because I still feel like it's me moving my shoulder, not some external force.
与其说是无意识的，不如说是我自愿的，因为我感觉到就像是自己在移动肩膀，而不是什么外力。
Also, I get this uncomfortable sensation, called premonitory urge, right before tics happen,
而且我还会有一种不太舒服的感觉，是抽动障碍的前兆，
and particularly when I'm trying to resist them.
我越想控制就越控制不住。
Now, I imagine most of you out there understand what I'm saying,
现在，我猜大多数人已经理解我所描述的内容了，
but unless you have Tourette's, you probably think you can't relate.
但如果你们没有得过妥瑞症，可能还是无法真正地感同身受。
But I bet you can.
不过我相信你们可以感同身受的。
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?
那么，让我们来做一个小小的实验，看看你们是否能体验到我的感受。好，准备好了吗？
Don't blink. No, really, don't blink. And besides dry eyes, what do you feel?
别眨眼哦。我说真的呢，千万别眨眼。除了会感到眼睛干涩之外，还有什么感觉呢？
Phantom pressure? Eyelids tingling? A need? Are you holding your breath? Aha.
有没有觉得有奇异的压力感？有没有觉得眼睑刺痛？是否需要帮助呢？你是不是已经不自觉地屏住了呼吸呢？就是这种感觉了！
That's approximately what my tics feels like.
我的抽动障碍大概就是这样的感觉。
Now, tics and blinking, neurologically speaking, are not the same,
抽动障碍和抑制自己眨眼，从神经学的角度讲，并不是一回事。
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,
不过，我想告诉大家的是：即便没得妥瑞症，也能感受到我的体验--抽动障碍的前兆。
because your brain can give you similar experiences and feelings.
因为你们的的大脑会让你们有与我类似的体验和感受。
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.
那么现在我要抛开正常状态与生病状态的对比，来聊一聊正常状态与生病状态兼具是怎样的体验。
Because in the final analysis, we're all humans whose brains provide for a spectrum of experiences.
因为归根结底，我们是人类，而人类的大脑都会储存一系列经历。
And everything on that spectrum of human experiences is ultimately produced by brain systems that assume a spectrum of different states.
而这一系列经历最终都是由大脑系统产生的，因为大脑系统会出于不同的状态下。
So again, what does it mean to be normal, and what does it mean to be sick,
那么，让我们再来问一个问题：正常状态是什么意思，生病状态又是什么意思，
when sickness exists on the extreme end of a spectrum of normal?
这个问题的情境是生病状态出于正常状态的最末端上。
As both a researcher who studies differences in how individuals' brains wire and rewire themselves,
我是一名研究人员，我会研究每个人大脑发送信息和再发送信息的方式有何不同，
and as a Touretter with other related diagnoses,
而作为一名妥瑞症患者，我还会研究其他相关的症状。
I have long been fascinated by failures of self-regulation on the impulsive and compulsive behavioral spectrums.
我一直对无法自我管理强迫性的行为冲动感兴趣。
Because so much of my own experience of my own body and my own behavior has existed all over that map.
因为我本人有太多身体和行为上的经历与这方面有关。
So with the spotlight on the opioid crisis, I've really found myself wondering lately:
在阿片类药物危机备受关注的今天，我最近就开始思考一个问题：
Where on the spectrum of unvoluntary behavior do we put something like abusing opioid painkillers or heroin?
在自愿行为的图谱上，滥用阿片类止疼药和海洛因的行为应该置于何处呢？
By now, we all know that the opioid crisis and epidemic is out of control.
但现在，我们都知道阿片类药物危机和流行病已经无法控制了。
Ninety-one people die every day in this country from overdose.
美国每天有91人因为服药过量而死亡。
And between 2002 and 2015, the number of deaths from heroin increased by a factor of six.
2002-2015年间，因服用海洛因过量而死亡的人数增长了1/6。
And something about the way that we treat addiction isn't working, at least not for everyone.
我们治疗毒瘾的方法可能有些地方出了错，导致方法无奏效，至少不是对每个人都奏效。
It is a fact that people suffering from addiction have lost free will
事实是：受毒瘾困扰的人已经丧失了自由的意志，
when it comes to their behavior around drugs, alcohol, food or other reward-system stimulating behaviors.
无法控制自己不吸毒、不喝酒或者不做其他由奖励系统刺激的行为。
That addiction is a brain-based disease state is a medical, neurobiological reality.
这种毒瘾是与大脑有关的疾病状态，是医学上现实存在的一种神经学状态。
But how we relate to that disease, indeed, how we relate to the concept of disease when it comes to addiction,
但我们看待这类疾病的方式、我们看待这类毒瘾这种疾病概念的方式，
makes an enormous difference for how we treat people with addictions.
对于我们治疗瘾君子的方式会产生巨大影响。
So, we tend to think of pretty much everything we do as entirely voluntary.
所以我们有了一种倾向——将我们做的所有事情看成完全自愿的。
But it turns out that the brain's default state is really more like a car idling in drive than a car in park.
但这样做的结果是：大脑这种默认状态更像是车在漫无目的地游走，而非停留在在驻车档。
Some of what we think we choose to do is actually things that we have become programmed to do when the brakes are released.
有一些我们认为是自己选择去做的事情，实际上是像被设定了去做一样，因为制动器已经完全松开了。
Have you ever joked that your brain was running on autopilot?
你们是否曾开过类似的玩笑，说自己的大脑就像有自动驾驶仪一样呢？
Guess what? It probably was. OK?
但你们知道吗？其实很有可能是这样的，大家明白吗？
And the brain's autopilot is in a structure called the striatum.
但大脑的自动驾驶仪其实是位于纹状体。
So the striatum detects emotional and sensory motor conditions
所以，是纹状体感受到情感和知觉的情况，
and it knows to trigger whatever behavior you have done most often in the past under those same conditions.
知道在同样的情境下你过去最经常做的行为是怎样的，并帮你激发出来。
Do you know why I became a neuroscientist?
你们知道我为什么成了一名神经系统科学家吗？
Because I wanted to learn what made me tick. Thank you, thank you.
因为我想知道我为什么会有这样的行为。谢谢大家，谢谢。
I've been wanting to use that one in front of an audience for years.
多年来，我一直想在观众面前用这个。
So in graduate school, I studied genetic factors that orchestrate wiring to the striatum during development.
我读研期间学的是遗传因素。遗传因素会协调给纹状体发送的信号。
And yes, that is my former license plate.
我之前拿过这方面的执照。
And for the record, I don't recommend any PhD student get a license plate with their thesis topic printed on it,
这里想说的是，我不推荐我的博士后学生去攻读去考他们论文题目有关的执照，
unless they're prepared for their experiments not to work for the next two years.
除非他们希望自己未来两年里的实验都无法成功。
I eventually did figure it out.
我最后还是搞定了。
So, my experiments were exploring how miswiring in the striatum relates to compulsive behaviors.
我的实验目的是探索纹状体中信号发送错误与强迫性行为有什么关系。
Meaning, behaviors that are coerced by uncomfortable urges you can't consciously resist.
所谓强迫性行为就是受到胁迫才做的行为，会让人感到不舒服和压迫感，但人的意识却无法对其抵抗。
So I was really excited when my mice developed this compulsive behavior,
所以，我看到我的小鼠有了强迫性行为后，我感到很兴奋。
where they were rubbing their faces and they couldn't seem to stop, even when they were wounding themselves.
小鼠的反应是会不断的摩挲脸颊，根本停不下来，即便给自己疗伤的时候也是如此。
OK, excited is the wrong word, I actually felt terrible for them.
好吧，我承认用兴奋这个词是不对的，我也为小鼠们感到抱歉。
I thought that they had tics, evidence of striatal miswiring.
我以为小鼠们也有了抽动障碍，因为他们的纹状体有发送错误的信号。
And they were compulsive, but it turned out, on further testing,
而且这种行为是强迫性的，但最终通过进一步检测发现，
that these mice showed an aversion to interacting and getting to know other unfamiliar mice.
这些小鼠很厌恶跟自己不熟悉的其他小鼠互动或者相互了解。
Which was unusual, it was unexpected.
这一点很不寻常，出乎了我的意料。
The results implied that the striatum, which, for sure, is involved in compulsive-spectrum disorders,
结果表明，纹状体一定与强迫性障碍有关，
is also involved in human social connection and our ability to, not human social connection, but our ability to connect.
纹状体还与人类的社会联系，哦不，是我们的社交能力有关。
So I delved deeper, into a field called social neuroscience.
于是，我又进一步研究了社会神经科学领域。
And that is a newer, interdisciplinary field,
这是一个更新的跨学科领域，
and there I found reports that linked the striatum not just to social anomalies in mice, but also in people.
在这个领域中，我发现了一些与纹状体有关的报告，报告内容不只与小鼠的社会反常现象有关，也与人有关的。
As it turns out, the social neurochemistry in the striatum is linked to things you've probably already heard of.
报告显示，与纹状体有关的社会神经化学也与我们可能已经听过的概念有关。
Like oxytocin, which is that hormone that makes cuddling feel all warm and fuzzy.
比如催产素。催产素是一种荷尔蒙，让人在拥抱时感觉到温暖的沉浸感。
But it also implicates signaling at opioid receptors.
但催产素也会让阿片受体感受到信号。
There are naturally occurring opioids in your brain that are deeply linked to social processes.
人类的大脑中有自然发生的阿片类物质，这类物质与社会历程密切相关。
Experiments with naloxone, which blocks opioid receptors,
一种名为纳洛酮的物质可以阻止阿片受体，
show us just how essential this opioid-receptor signaling is to social interaction.
与纳洛酮有关的实验表明，阿片受体的信号对于社会联系来说至关重要。
When people are given naloxone, it's an ingredient in Narcan, that reverses opioid overdoses to save lives.
一旦人体摄入纳洛酮，它就会成为盐酸烯丙羟吗啡酮的部分原料，而盐酸烯丙羟吗啡酮会扭转阿片类药物过量的情况，从而拯救生命。
But when it's given to healthy people,
但健康的人如果摄入了纳洛酮，
it actually interfered with their ability to feel connected to people they already knew and cared about.
他们与人社交的能力就会受到干扰，不管社交的对象是已经认识的人还是他们在意的人。
So, something about not having opioid-receptor binding makes it difficult for us to feel the rewards of social interaction.
所以，由于不能约束阿片受体，所以我们就很难感受到社交中获得奖励的感觉。
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.
由于时间的原因，我们略过了一些科学方面的细节，但下面我们要简略带过一些。
The effects of social disconnection through opioid receptors,
阿片受体造成的不想社交的感觉、
the effects of addictive drugs and the effects of abnormal neurotransmission on involuntary movements and compulsive behaviors all converge in the striatum.
上瘾药物的影响、由异常神经传递造成的不自主运动和强迫性行为的影响，这些都与纹状体有关。
And the striatum and opioid signaling in it has been deeply linked with loneliness.
纹状体及其中的阿片信号与孤独感有很大的关系。
When we don't have enough signaling at opioid receptors,
当阿片受体中信号不足的时候，
we can feel alone in a room full of people we care about and love, who love us.
即便置身于满是人的房间，哪怕这些人是我们在意的人、爱我们而且我们也爱的人，我们还是会感觉孤独。
Social neuroscientists, like Dr. Cacioppo at the University of Chicago, have discovered that loneliness is very dangerous.
包括芝加哥大学卡乔波博士在内的社会神经系统科学家都已经发现，孤独感是很危险的。
And it predisposes people to entire spectrums of physical and mental illnesses.
因为孤独感会让人有身体和心理生病的预先设定中。

Think of it like this: when you're at your hungriest, pretty much any food tastes amazing, right?
大家可以设想一下：如果你已经饿极了，那么眼下能吃到任何食物都是极好的，对吗？
So similarly, loneliness creates a hunger in the brain which neurochemically hypersensitizes our reward system.
那么与此类似，孤独感也会让大脑处于饥饿状态，会从神经化学的角度让我们的奖励系统变得更加敏感。
And social isolation acts through receptors for these naturally occurring opioids and other social neurotransmitters
而这些自然发生的阿片物质等社会神经传导物质会作用于阿片受体，从而产生社交孤立的感觉，
to leave the striatum in a state where its response to things that signal reward and pleasure is completely, completely over the top.
让纹状体处于一种对任何发送奖励和欢愉信号物体的反应都会被过分夸大的状态。
And in this state of hypersensitivity, our brains signal deep dissatisfaction.
在这样一种高度敏感的状态下，我们的大脑就会产生深深的失望感。
We become restless, irritable and impulsive.
我们会很躁动、易怒又冲动。
And that's pretty much when I want you to keep the bowl of Halloween chocolate entirely across the room for me,
就好像饿极了的我希望有人能把万圣节的巧克力碗端到我房间里来，
because I will eat it all. I will.
因为我会一颗都不剩。我一定会吃光的。
And that brings up another thing that makes social disconnection so dangerous.
这里又引出了另一样东西，这样东西也会让社交孤立变得十分可怕。
If we don't have the ability to connect socially,
如果我们没有能力进行社交，
we are so ravenous for our social neurochemistry to be rebalanced, we're likely to seek relief from anywhere.
我们就会渴望社会神经化学能做再次平衡，我们就很有可能从其他地方寻求安慰。
And if that anywhere is opioid painkillers or heroin, it is going to be a heat-seeking missile for our social reward system.
而如果我们寻求安慰的对象是阿片类止痛药或者海洛因的话，这对于我们的社会奖励体系来说就会是点火就着的场面。
Is it any wonder people in today's world are becoming addicted so easily?
说到这里，大家就很容易理解为什么会有这么多人吸毒了。
Social isolation, excuse me, contributes to relapse.
但很遗憾地说，社交孤立只会恶性循环。
Studies have shown that people who tend to avoid relapse tend to be people
研究表明，想要避免恶性循环的人通常是这样一种人：
who have broad, reciprocal social relationships where they can be of service to each other, where they can be helpful.
他们的社交关系很广，平时礼尚往来很多，彼此互相服务，互为所用。
Being of service lets people connect.
为他人某便利就会产生社交联系。
So if we don't have the ability to authentically connect,
所以，如果我们不能真正地与他人联系，
our society increasingly lacks this ability to authentically connect and experience things that are transcendent and beyond ourselves.
我们的社交就会越来越缺乏真正与他人联系的能力，就无法体验超乎自我的东西。
We used to get this transcendence from a feeling of belonging to our families and our communities.
以前，我们获得这种超乎自我的体验通常是从家庭和社群中。
But everywhere, communities are changing. And social and economic disintegration is making this harder and harder.
但无论在哪个地方，社群都是在不断变化的。社会解体和经济崩让这一点越来越难实现。
I'm not the only person to point out that the areas in the country most economically hard hit,
在我之前就有人指出，经济受到重创的地区，
where people feel most desolate about their life's meaning,
其民众会感到了无生趣，
are also the places where there have been communities most ravaged by opioids.
这样的地方，其各社群往往都会受阿片类药物的侵蚀。
Social isolation acts through the brain's reward system to make this state of affairs literally painful.
社交孤立会通过大脑的奖励系统发挥作用，让这种状态变得很痛苦。
So perhaps it's this pain, this loneliness, this despondence that's driving so many of us to connect with whatever we can.
所以，或许是这种痛苦感、这种孤独感和绝望感，迫使我们中的很多人去尽可能地社交。
Like food. Like handheld electronics. And for too many people, to drugs like heroin and fentanyl.
就像饥饿的人寻找食物，就像我们寻找手持型电子设备去进行社交。还有很多人则是选择了海洛因和芬太尼。
I know someone who overdosed, who was revived by Narcan, and she was mostly angry that she wasn't simply allowed to die.
我知道有些人服药过量后，盐酸烯丙羟吗啡酮仿佛让他/她恢复了生机。不能简简单单地寻思，会让他/她感到很生气。
Imagine for a second how that feels, that state of hopelessness, OK?
大家能感受到这种心情吗？能感受到这种绝望吗？
But the striatum is also a source of hope.
但纹状体也能为人带来希望。
Because the striatum gives us a clue of how to bring people back.
因为纹状体会给我们线索，让我们知道如果将他人拽离深渊。
So, remember that the striatum is our autopilot, running our behaviors on habit,
所以，请记住，纹状体是自动驾驶仪，会让我们的行为成为习惯，
and it's possible to rewire, to reprogram that autopilot, but it involves neuroplasticity.
而且这个自动驾驶仪是可以重新发送信号并进行程序改编的，但与此同时也具有神经可塑性。
So, neuroplasticity is the ability of brains to reprogram themselves, and rewire themselves, so we can learn new things.
所以，神经可塑性是大脑进行程序改编和再次发送信号的能力，这样，我们才能学会新知识。
And maybe you've heard the classic adage of plasticity:
或许有些观众有听过关于可塑性的经典名言：
neurons that fire together, wire together. Right?
突触前神经元向突触后神经元的持续重复的刺激可以导致突触传递效能的增加，对吗？
So we need to practice social connective behaviors instead of compulsive behaviors,
所以，我们应该多多锤炼连接性的行为，而非强迫性的行为，
when we're lonely, when we are cued to remember our drug.
每次感到孤独、每次看到什么东西就想到服药的时候就要锤炼自己。
We need neuronally firing repeated experiences in order for the striatum to undergo that necessary neuroplasticity
我们需要对神经元做持续重复的刺激，才能让纹状体达到必要的可塑性，
that allows it to take that "go find heroin" autopilot offline.
才能抑制住“服用海洛因”的自动驾驶仪下线。
And what the convergence of social neuroscience, addiction and compulsive-spectrum disorders in the striatum suggests is that
社会神经学、吸毒上瘾、强迫性障碍都与纹状体有关，这个事实表明，
it's not simply enough to teach the striatum healthier responses to compulsive urges.
只让纹状体学会对强迫性的念头做出更为健康的响应是不够的。
We need social impulses to replace drug-cued compulsive behaviors,
我们需要社会性冲动才能替代需要药物来控制的强制性行为，
because we need to rebalance, neurochemically, our social reward system.
因为我们需要从神经化学的角度重新平衡社会奖励系统。
And unless that happens, we're going to be left in a state of craving.
如果这一天不到来，我们会处于一种渴望的状态。
No matter what besides our drug we repeatedly practice doing.
不管怎样，除了我们的药，我们会反复做其他事情。
I believe that the solution to the opioid crisis is to explore how social and psychospiritual interventions can act
我认为，解决阿片类药物危机的方案就是探索社会干预与心理干预会怎样
as neurotechnologies in circuits that process social and drug-induced rewards.
在处理社会和药物驱动奖励的闭环中起到神经技术的作用。
One possibility is to create and study scalable tools for people
一个可能性是为人们研制可量化的工具，
to connect with one another over a mutual interest in recovery through psychospiritual practices.
让大家出于互惠的角度，通过不断锤炼内心，来彼此联系并得到痊愈。
And as such, psychospiritual practice could involve anything from people getting together as megafans of touring jam bands,
这里所说的锤炼内心包括但不限于与人共同参加拥挤的乐队演出，
or parkour jams, featuring shared experiences of vulnerability and personal growth,
跑酷堵塞，这些都是在共同经历脆弱与个人成长，
or more conventional things, like recovery yoga meetups,
也有更为传统的选择，比如恢复瑜伽聚会、
or meetings centered around more traditional conceptions of spiritual experiences.
与精神体验有关的更为传统的会面。
But whatever it is, it needs to activate all of the neurotransmitter systems in the striatum
但无论选择了哪种方式，都需要激活纹状体中所有的神经递质系统，
that are involved in processing social connection.
因为神经递质系统与处理社交联系有关。
Social media can't go deep enough for this.
社交媒体在这方面做得远远不够。
Social media doesn't so much encourage us to share, as it does to compare.
它并不能鼓励我们分享，只会鼓励我们攀比。
It's the difference between having superficial small talk with someone and authentic, deeply connected conversation with eye contact.
这就是与某人肤浅的闲聊与带着目光交流地与做真正深入联系的交流之间的区别。
And stigma also keeps us separate. There's a lot of evidence that it keeps us sick.
羞耻的烙印也会让我们与他人保持距离，有很多证据表明这会让我们生病。
And stigma often makes it safer for addicts to connect with other addicts.
而羞耻的烙印让瘾君子之间更能安心地交流。
But recovery groups centered around reestablishing social connections
但以重建社交联系的康复团体，
could certainly be inclusive of people who are seeking recovery for a range of mental health problems.
肯定包括寻求一系列心理健康问题治疗的人。
My point is, when we connect around what's broken, we connect as human beings.
我的观点是：当我们带着破碎的心与周围的世界相联系时，我们是以人的身份在相互联系。
We heal ourselves from the compulsive self-destruction that was our response to the pain of disconnection.
我们为自己疗伤，让自己避免强制性的自我伤害，这是我们对与他人疏离所造成痛苦的响应。
When we think of neuropsychiatric illnesses as a spectrum of phenomenon that are part of what make us human,
如果我们将神经精神病学的疾病视为人与生俱来的现象，
then we remove the otherness of people who struggle with self-destruction.
我们就不会将挣扎于自我伤害的人视作异类了。
We remove the stigma between doctors and patients and caregivers.
医患和看护人员之间也就不存在羞耻烙印的问题。
We put the question of what it means to be normal versus sick back on the spectrum of the human condition.
那么正常状态与生病状态的问题也就成了人类与生俱来的两种状态。
And it is on that spectrum where we can all connect and seek healing together, for all of our struggles with humanness.
只有从这样的角度看，我们才能彼此联系并相互治愈，这是我们生而为人就要进行的抗争。
Thank you for letting me share.
感谢倾听。