No other organ, perhaps no other object in human life, is as imbued with metaphor and meaning as the human heart.
没有其他器官，可能在整个人生中也没有其他的东西，像人类的心脏一样充满隐喻和意义。
Over the course of history, the heart has been a symbol of our emotional lives.
在历史的长河中，心是我们情感生活的象征。
It was considered by many to be the seat of the soul, the repository of the emotions.
它曾被很多人视为灵魂的座驾，情感的仓库。
The very word "emotion" stems in part from the French verb "émouvoir," meaning "to stir up."
“emotion（情感）”这个词部分源自法语动词“emouvoir”，意思是“搅动”。
And perhaps it's only logical that emotions would be linked to an organ characterized by its agitated movement.
也许将情感和以跳动为特征的器官联系在一起是唯一的正确逻辑。
But what is this link? Is it real or purely metaphorical?
但这个联系是什么？它是真实的还是纯粹隐喻？
As a heart specialist, I am here today to tell you that this link is very real.
作为心脏专家，我今天在这里要告诉你们，这个联系是真实的。
Emotions, you will learn, can and do have a direct physical effect on the human heart.
你将了解到，情感能够，也实会对人类心脏产生直接的物理影响。
But before we get into this, let's talk a bit about the metaphorical heart.
但在我们深入之前，让我们来谈谈隐喻意义上的心。
The symbolism of the emotional heart endures even today.
即便在今天，情感之心的象征意义仍然存在。
If we ask people which image they most associate with love,
如果问人们哪一个图片可以让人联想到爱，
there's no question that the Valentine heart would the top the list.
毫无疑义，恋人之心会高居榜首。
The heart shape, called a cardioid, is common in nature.
心脏的形状，称为心形，在自然中很常见。
It's found in the leaves, flowers and seeds of many plants, including silphium,
它存在于树叶、鲜花和很多植物的种子中，包括串叶松香草，
which was used for birth control in the Middle Ages
曾经在中世纪被用于生育控制，
and perhaps is the reason why the heart became associated with sex and romantic love.
这也许就是为什么心会与性爱与浪漫联系在一起。
Whatever the reason, hearts began to appear in paintings of lovers in the 13th century.
出于某种原因，13世纪，情人的画像中开始出现心形图案。
Over time, the pictures came to be colored red, the color of blood, a symbol of passion.
随着时间的推移，这些画被涂成红色，鲜血的颜色，激情的象征。
In the Roman Catholic Church, the heart shape became known as the Sacred Heart of Jesus.
在罗马天主教会，心的形状被称为耶稣的圣心。
Adorned with thorns and emitting ethereal light, it became an insignia of monastic love.
装饰着荆棘，散发着缥缈的光芒，它成了修道院之爱的象征。
This association between the heart and love has withstood modernity.
这种心与爱之间的联系经受住了现代的考验。
When Barney Clark, a retired dentist with end-stage heart failure, received the first permanent artificial heart in Utah in 1982,
1982年，患有末期心力衰竭的退休牙医巴尼·克拉克在犹他州接受了首例永久性人工心脏移植手术，
his wife of 39 years reportedly asked the doctors, "Will he still be able to love me?"
他39岁的妻子曾向医生咨询，“他还会爱我吗？”
Today, we know that the heart is not the source of love or the other emotions, per se; the ancients were mistaken.
今天，我们知道心脏不是爱或其他情感的源头，古人弄错了。
And yet, more and more, we have come to understand that the connection between the heart and the emotions is a highly intimate one.
然而，我们开始越来越多地了解到心脏和情感的联系是极为亲密的整体。
The heart may not originate our feelings, but it is highly responsive to them.
心脏可能不是我们感觉的起源，但它对感觉非常敏感。
In a sense, a record of our emotional life is written on our hearts.
在某种意义上，我们情感生活的记录就写在我们的心脏上。
Fear and grief, for example, can cause profound cardiac injury.
例如，恐惧和悲伤会导致严重的心脏损伤。
The nerves that control unconscious processes such as the heartbeat can sense distress
控制无意识过程，如心跳的神经可以感觉到痛苦，
and trigger a maladaptive fight-or-flight response that triggers blood vessels to constrict,
并引发适应不良的“战斗或逃跑”反应，导致血管收缩，
the heart to gallop and blood pressure to rise, resulting in damage.
心跳加速和血压上升，导致损伤。
In other words, it is increasingly clear that our hearts are extraordinarily sensitive to our emotional system,
换句话说，越来越清晰的是，我们的心脏对我们的情感系统，
to the metaphorical heart, if you will.
对隐喻的心，极度敏感。
There is a heart disorder first recognized about two decades ago called "takotsubo cardiomyopathy," or "the broken heart syndrome,"
大约20年前，人们首次发现了一种名为“应激性心肌病”的心脏病，即“心碎综合症”，
in which the heart acutely weakens in response to intense stress or grief,
在这种情况下，心脏在面对巨大的压力或悲伤时急剧衰弱，
such as after a romantic breakup or the death of a loved one.
比如跟爱人分手或爱人去世后。
As these pictures show, the grieving heart in the middle looks very different than the normal heart on the left.
就像这些照片显示的，中间悲伤的心跟左边正常的心看来很不同。
It appears stunned and frequently balloons into the distinctive shape of a takotsubo,
它看起来像是被打晕了，往往会膨胀成章鱼壶的独特形状，
shown on the right, a Japanese pot with a wide base and a narrow neck.
如右图所示，一种有宽的底座和窄的日本锅。
We don't know exactly why this happens, and the syndrome usually resolves within a few weeks.
我们还不知道这个发生的确实原因，这种症状通常会在几周内消失。
However, in the acute period, it can cause heart failure, life-threatening arrhythmias, even death.
然而，在急性期，它可能会导致心脏衰竭，危及生命的心律失常，甚至死亡。
For example, the husband of an elderly patient of mine had died recently.
比如，我的一个老年病人的丈夫最近去世了。
She was sad, of course, but accepting. Maybe even a bit relieved.
她很悲伤，当然，但接受这个现实了。也许松一口气。
It had been a very long illness; he'd had dementia.
这是一场持续了多年的疾病，他患有老年痴呆。
But a week after the funeral, she looked at his picture and became tearful.
但在葬礼结束的一周后，她看着他的照片，变得泪眼模糊。
And then she developed chest pain, and with it, came shortness of breath, distended neck veins,
然后她出现了胸痛，随之而来的是呼吸急促，脖子上青筋膨胀，
a sweaty brow, a noticeable panting as she was sitting up in a chair -- all signs of heart failure.
额头出汗，当她坐在椅子上时，明显地感到气喘吁吁--这些都是心脏衰竭的迹象。
She was admitted to the hospital, where an ultrasound confirmed what we already suspected:
她被送进了医院，医院超声波验证了我们的怀疑：
her heart had weakened to less than half its normal capacity and had ballooned into the distinctive shape of a takotsubo.
她的心脏已经衰弱到只有不到一半的正常功能，并且膨胀成明显的章鱼壶形状。
But no other tests were amiss, no sign of clogged arteries anywhere.
但检查不出其他问题，没有动脉阻塞的现象。
Two weeks later, her emotional state had returned to normal and so, an ultrasound confirmed, had her heart.
2周后，她的情感状态恢复正常，并且，超声波检测确认，心脏也恢复了健康。
Takotsubo cardiomyopathy has been linked to many stressful situations,
应激性心肌病跟很多压力环境有关，
including public speaking -- domestic disputes, gambling losses, even a surprise birthday party.
包括公共演讲--家庭纷争，赌博损失，甚至一个惊喜的生日派对都包括在内。
It's even been associated with widespread social upheaval, such as after a natural disaster.
它甚至与广泛的社会动乱有关，比如一场自然灾害后。
For example, in 2004, a massive earthquake devastated a district on the largest island in Japan.
例如，2004年，一场大地震摧毁了日本最大岛屿上的一个地区。
More than 60 people were killed, and thousands were injured.
超过60个人死亡，几千人受伤。
On the heels of this catastrophe, researchers found that
在这场灾难之后，研究者发现，
the incidents of takotsubo cardiomyopathy increased twenty-four-fold in the district one month after the earthquake,
该地区在大地震后一个月的应激性心肌病发病率增加了24倍，
compared to a similar period the year before.
这是跟一年前同期相比得出的数据。
The residences of these cases closely correlated with the intensity of the tremor.
这些病例发生的位置与地震的强度密切相关。
In almost every case, patients lived near the epicenter.
在几乎每个病例中，病人都是住在震中附近。
Interestingly, takotsubo cardiomyopathy has been seen after a happy event, too,
有趣的是，应激性心肌病也曾在一些愉快的事件后被发现，
but the heart appears to react differently, ballooning in the midportion, for example, and not at the apex.
但心脏反应似乎不一样，在中部膨胀，而不是在顶部。
Why different emotional precipitants would result in different cardiac changes remains a mystery.
为什么不同的情绪会导致心脏的不同变化仍然是个迷。
But today, perhaps as an ode to our ancient philosophers,
但今天，也许是作为对我们古代哲学家的赞歌，
we can say that even if emotions are not contained inside our hearts,
我们可以说即便情感不存在于我们的心脏中，
the emotional heart overlaps its biological counterpart, in surprising and mysterious ways.
情感的心跟它的生物体依然是以一种惊人和神秘的方式相对应的。
Heart syndromes, including sudden death,
心脏综合症，包括猝死，
have long been reported in individuals experiencing intense emotional disturbance or turmoil in their metaphorical hearts.
长期以来，在个人隐喻之心经受了强烈的情感干扰或混乱后的猝死广泛见诸报端。
In 1942, the Harvard physiologist Walter Cannon published a paper called "'Voodoo' Death,"
1942年，哈佛生理学家沃尔特·坎农发表了一篇名为《巫毒教的死亡》的论文，
in which he described cases of death from fright in people who believed they had been cursed,
在文中，他描述了一些相信自己被诅咒的人因为恐惧而死亡的案例，
such as by a witch doctor or as a consequence of eating taboo fruit.
比如被巫医或食用禁果后。
In many cases, the victim, all hope lost, dropped dead on the spot.
在很多案例中，牺牲者绝望至极，当场猝死。
What these cases had in common was the victim's absolute belief that there was an external force
这些案例的共同之处在于牺牲者们绝对相信有一种外部的力量
that could cause their demise, and against which they were powerless to fight.
会导致他们的死亡，并且他们无力反抗。

This perceived lack of control, Cannon postulated, resulted in an unmitigated physiological response,
坎农假定，这些明显的失控引发了全面的生理反应，
in which blood vessels constricted to such a degree that blood volume acutely dropped, blood pressure plummeted,
血管收缩到使血容量急剧下降的程度，血压下降，心脏急剧衰弱，
the heart acutely weakened, and massive organ damage resulted from a lack of transported oxygen.
并且因为缺少氧气的输送而导致大规模的器官损坏。
Cannon believed that voodoo deaths were limited to indigenous or "primitive" people.
坎农认为巫毒教的死亡仅限于土著或“原始”人。
But over the years, these types of deaths have been shown to occur in all manner of modern people, too.
但许多年来，这些类型的死亡也出现在各种各样的现代人身上。
Today, death by grief has been seen in spouses and in siblings.
今天，因悲伤而导致的死亡出现在配偶和兄弟姐妹上。
Broken hearts are literally and figuratively deadly.
破碎的心在生理上和隐喻上都是致命的。
These associations hold true even for animals.
这种联系甚至在动物身上也成立。
In a fascinating study in 1980 published in the journal "Science,"
在1980年发表在《科学》期刊上的一个有趣研究中，
researchers fed caged rabbits a high-cholesterol diet to study its effect on cardiovascular disease.
研究人员给笼养的兔子喂食高胆固醇食物，以研究其对心血管疾病的影响。
Surprisingly, they found that some rabbits developed a lot more disease than others, but they couldn't explain why.
出乎意料的是，他们发现一些兔子患的病就是比其他兔子多，但他们无法解释为什么。
The rabbits had very similar diet, environment and genetic makeup.
这些兔子的饮食结构，环境和基因构成都是类似的。
They thought it might have something to do with how frequently the technician interacted with the rabbits.
他们认为可能和技术员跟兔子互动频率有关。
So they repeated the study, dividing the rabbits into two groups.
所以他们重复了这个研究，把这些兔子分成两组。
Both groups were fed a high-cholesterol diet.
两组都吃高胆固醇的食物。
But in one group, the rabbits were removed from their cages, held, petted, talked to, played with,
但其中一组，兔子被带出笼子，被人们抱着，爱抚着，和它说话，和它玩耍，
and in the other group, the rabbits remained in their cages and were left alone.
另一组的兔子则被留在笼子里不闻不管。一
At one year, on autopsy, the researchers found that the rabbits in the first group,
年之后，在对兔子进行解剖时，研究者发现第一组的兔子，
that received human interaction, had 60 percent less aortic disease than rabbits in the other group,
那组有人类互动的兔子，主动脉疾病比另一组少60%，
despite having similar cholesterol levels, blood pressure and heart rate.
尽管有相似的胆固醇水平，血压和心率。
Today, the care of the heart has become less the province of philosophers,
今天，对心灵的关怀已不再是哲学家们的专利，
who dwell upon the heart's metaphorical meanings,
他们专注于心灵的隐喻意义，
and more the domain of doctors like me, wielding technologies that even a century ago,
并且越来越多的进入像我这样的医生领域，运用着甚至1个世纪前的技术，
because of the heart's exalted status in human culture, were considered taboo.
因为心脏在人类文化中的崇高地位，被认为是禁忌。
In the process, the heart has been transformed from an almost supernatural object imbued with metaphor and meaning
在这个过程中，心脏从充满隐喻和意义的超自然的物体
into a machine that can be manipulated and controlled.
转变成了可以操纵和控制的机器。
But this is the key point: these manipulations, we now understand,
但这里有个关键点：我们现在明白，
must be complemented by attention to the emotional life that the heart, for thousands of years, was believed to contain.
这些操纵必须辅以对情感生活的关注，毕竟数千年来，人们认为情感生活包含在心脏之中。
Consider, for example, the Lifestyle Heart Trial, published in the British journal "The Lancet" in 1990.
比如，《生活方式心脏试验》，1990年发表于英国《柳叶刀》杂志。
Forty-eight patients with moderate or severe coronary disease
48名患有中度或重度冠状动脉疾病的患者
were randomly assigned to usual care or an intensive lifestyle that included a low-fat vegetarian diet,
被随机分配到常规护理或一组包括低脂素食，
moderate aerobic exercise, group psychosocial support and stress management advice.
适度有氧运动，群体社会心理支持以及压力管理建议的密集生活方式小组。
The researchers found that the lifestyle patients had a nearly five percent reduction in coronary plaque.
研究者发现密集生活组病人冠状动脉斑块减少了近5%。
Control patients, on the other hand, had five percent more coronary plaque at one year and 28 percent more at five years.
控制组，反之，一年后冠状动脉斑块增加了5%，并且5年后增加了28%。
They also had nearly double the rate of cardiac events, like heart attacks, coronary bypass surgery and cardiac-related deaths.
他们患心脏病的几率翻倍，比如心脏病发作，冠状动脉搭桥手术和心脏病相关的死亡。
Now, here's an interesting fact: some patients in the control group adopted diet and exercise plans
有一个有趣的事实：对照组的一些患者采用的饮食和锻炼计划
that were nearly as intense as those in the intensive lifestyle group.
几乎与生活方式密集组的患者一样多。
Their heart disease still progressed.
他们的心脏疾病仍然在持续。
Diet and exercise alone were not enough to facilitate coronary disease regression.
单靠饮食和运动不足以促进冠状动脉疾病的消退。
At both one- and five-year follow-ups,
在1年和5年的随访中，
stress management was more strongly correlated with reversal of coronary disease than exercise was.
人们发现相比锻炼，压力管理与冠状动脉疾病的逆转更加紧密相关。
No doubt, this and similar studies are small, and, of course, correlation does not prove causation.
毫无疑问，这项研究和类似的研究规模都很小，当然，相关性并不能证明因果关系。
It's certainly possible that stress leads to unhealthy habits,
当然可能压力导致不健康习惯，
and that's the real reason for the increased cardiovascular risk.
是心血管风险增加的真正原因。
But as with the association of smoking and lung cancer, when so many studies show the same thing,
但就像吸烟和肺癌的关系一样，当如此多的研究都显示了同样的事情，
and when there are mechanisms to explain a causal relationship, it seems capricious to deny that one probably exists.
当存在解释因果关系的机制时，否定一个可能存在的说法是不负责任的。
What many doctors have concluded is what I, too, have learned in my nearly two decades as a heart specialist:
许多医生得出的结论，也是我近20年作为心脏专家了解到的：
the emotional heart intersects with its biological counterpart in surprising and mysterious ways.
情感之心与它的生理对应物以一种惊奇和神秘的方式相交叉。
And yet, medicine today continues to conceptualize the heart as a machine.
然而，今天的医学继续将心脏概念化为一台机器。
This conceptualization has had great benefits.
这种概念化有很大的好处。
Cardiology, my field, is undoubtedly one of the greatest scientific success stories of the past 100 years.
心脏病学，我的领域，毫无疑问是过去100年最具成就的科学领域之一。
Stents, pacemakers, defibrillators, coronary bypass surgery, heart transplants
支架，起搏器，除颤器，冠状动脉搭桥手术，心脏移植，
all these things were developed or invented after World War II.
所有这些都是在二战后发展或发明的。
However, it's possible that we are approaching the limits of what scientific medicine can do to combat heart disease.
然而，我们可能已经接近了科学药物在对抗心脏疾病上的极限。
Indeed, the rate of decline of cardiovascular mortality has slowed significantly in the past decade.
事实上，在过去的十年中，心血管疾病死亡率的下降速度已经明显放缓。
We will need to shift to a new paradigm to continue to make the kind of progress to which we have become accustomed.
我们需要转向新的模式去继续取得我们已经习惯的进步。
In this paradigm, psychosocial factors will need to be front and center in how we think about heart problems.
在这种模式下，心理社会因素将需要成为我们思考心脏问题的前提和中心。
This is going to be an uphill battle, and it remains a domain that is largely unexplored.
这将是一场艰苦的战斗，在很大程度上它仍然是一个尚未被探索的领域。
The American Heart Association still does not list emotional stress as a key modifiable risk factor for heart disease,
美国心脏学会仍然没有把情感压力作为心理疾病的一个可改变危险因素，
perhaps in part because blood cholesterol is so much easier to lower than emotional and social disruption.
部分原因可能是因为血压中的胆固醇相比情感和社会混乱更容易降低。
There is a better way, perhaps, if we recognize that when we say "a broken heart,"
也许，有更好的方式。如果我们知道当人们说“破碎的心”时，
we are indeed sometimes talking about a real broken heart.
他们说的确实是一颗真的破碎的心脏。
We must, must pay more attention to the power and importance of the emotions in taking care of our hearts.
在照看我们的心脏时，我们就必须更加关注情感的力量和重要性。
Emotional stress, I have learned, is often a matter of life and death. Thank you.
我认识到，情感压力往往是生死攸关的问题。谢谢。