创伤的定义与影响

In the preamble to the definition of PTSD, we write, these people have been exposed to an extraordinary event that's outside of normal human experience. 在创伤后应激障碍（PTSD）的定义前言中，我们写道，这些人经历了一场非同寻常的、超乎正常人类经验的事件。

So it turned out that this is not an unusual experience at all. 结果发现，这根本不是一个不寻常的经历。

The trauma is not the event that happens. 创伤并非发生的事件本身。

The trauma is how you respond to it. 创伤是你对此的反应。

The degree to which when you're traumatized, your body keeps mobilizing itself to fight. 在你受到创伤时，你的身体会持续动员自己进行战斗。

You have all kind of immunological abnormalities, you have endocrine abnormalities, and that really devastates your health, your physical health. 你会出现各种免疫系统异常、内分泌异常，这严重损害你的健康，你的身体健康。

Has a long range, oftentimes the physical problems are longer lasting than the mental problems. 从长远来看，身体问题往往比心理问题持续的时间更长。

创伤的保护因素

One of the largest mitigating factors against getting traumatized is who is there for you at that particular time. 对抗创伤的最大缓解因素之一是，在那个特定时刻谁在你身边支持你。

药物治疗的局限性

I did the first study on Prozac for PTSD, the first study for Zoloft for PTSD and a number of other conventional drugs. 我做了第一项关于百优解治疗 PTSD 的研究，第一项关于左洛复治疗 PTSD 的研究，以及其他一些常规药物的研究。

What we found is it didn't work very well. 我们发现它们效果不太好。

Bessel van der Kolk 教授介绍

Hi, my name is Bessel van der Kolk. 大家好，我叫 Bessel van der Kolk。

I'm a psychiatrist, neuroscientist. 我是一名精神病学家，神经科学家。

Your author of the book, "The Body Keeps The Score". 我是《身体记述一切》这本书的作者。

Chapter 1: 创伤的初步认知与越战士兵的案例

I got interested in trauma on my first day working at the Veterans Administration. 我对创伤的兴趣始于我在退伍军人管理局工作的第一天。

By the very first day that I met Vietnam veterans, I was just blown away. 在我遇到的第一批越南退伍军人身上，我深受震撼。

These were guys who were my age who were clearly smart and competent and had done very good things; flying helicopters and running boats, and doing good stuff in the military. 这些人与我同龄，明显聪明能干，在军队里做过很多好事；开过直升机、驾驶过快艇，做过很棒的事情。

And they clearly were just a shadow of their former self. 而他们明显已经只是过去的影子了。

And what particularly intrigued me is that they had nightmares apart what had happened and also that they kept referring back to that dead comrades. 尤其让我着迷的是，他们会做关于所发生事情的噩梦，并且不断提起牺牲的战友。

Their heart seemed to be with the people who were no longer around. 他们的心似乎留在了那些已经不在的人那里。

And what struck me immediately is they had a very hard time connecting with new people after the war. 我立即注意到的是，战后他们很难与新认识的人建立联系。

What also struck me is how their bodies were clearly affected by trauma. 同样让我印象深刻的是，他们的身体明显受到了创伤的影响。

These were guys who used to be athletic, in other words, who were slumped over and they were uptight and their voices were uptight, and they were sort of passive much of the time. 这些曾经是运动员的人，现在却弓着身子，神情紧张，声音也紧绷着，大部分时间显得很被动。

And then people told 'em something that was disappointing and they went from zero to 10, and blew up and became extremely angry. 当有人告诉他们一些令人失望的事情时，他们会瞬间爆发，变得极其愤怒。

And it was just at the time that we were having two small children who were a little bit like that. 这正是我有两个小孩的时候，他们那时也有些像这样。

You know, there were little babies go from zero to 10, but I know when a baby becomes very upset, within 10 minutes you could sort of hold them and calm them down. 你知道，小宝宝也会有情绪失控的时候，但当宝宝非常难过时，你可以在10分钟内抱着他们，让他们平静下来。

And these soldiers were very much like little babies except the stuff that's supposed to happen to allow you to not overreact to the minor things seemed to have been destroyed or something seemed to have happened to them that made it very hard for them to modulate their responses to the their environment. 而这些士兵就像小婴儿一样，但不同的是，那些本应帮助他们不过度反应于小事的机制似乎已被摧毁，或者发生了什么事，让他们很难调节对环境的反应。

And what is also really striking is that they had a hard time being anyway meaningfully involved in the present. 同样令人震惊的是，他们很难真正投入当下。

They had a hard time loving their wives and girlfriends. 他们很难去爱他们的妻子和女朋友。

They had a hard time really connecting with their kids. 他们很难真正与自己的孩子建立联系。

So if something seems to have been destroyed by their capacity to engage and possibly even to learn new experiences. 这似乎摧毁了他们参与互动，甚至学习新体验的能力。

创伤认知的演变：从“异常”到“普遍”

1978 was the year that I first saw veterans. 1978年是我第一次见到退伍军人。

And that was also the time that my colleagues and, I soon, joined them, started to think about how is what these guys suffer from different from what other people who are in secular textbooks, because clearly they were different and I couldn't find the textbook to describe them. 那时，我的同事们，以及很快加入他们的我，开始思考这些家伙所遭受的痛苦与教科书上描述的其他人的痛苦有何不同，因为他们显然不同，而我找不到一本教科书来描述他们。

Around that time that I first started to work for the VA, a group of us started to define what trauma is and started to define what happens to people. 大约在那时，我开始在退伍军人管理局工作，我们一群人开始定义什么是创伤，以及人们会发生什么。

In the preamble to the definition of PTSD, we write, these people have been exposed to an extraordinary event that's outside of normal human experience. 在PTSD定义的前言中，我们写道，这些人经历了一场非同寻常的、超乎正常人类经验的事件。

And in retrospect, that shows us how ignorant and narrow minded we were because it turned out that this is not an unusual experience at all. 回过头来看，这显示了我们多么无知和狭隘，因为事实证明，这根本不是一个不寻常的经历。

That one out of five women in America has a history of sexual molestation. 在美国，五分之一的女性有性侵犯的经历。

Even a lot of men have history of sexual molestation. 甚至有很多男性也有性侵犯的经历。

One out of four kids get beaten very hard by their parents. 四分之一的孩子会受到父母的严厉殴打。

One out of eight kids see physical fights between their parents. 八分之一的孩子目睹过父母之间的肢体冲突。

When we started to work with inner city kids, the amount of trauma that these kids experienced was just on unspeakable. 当我们开始与城市贫困地区的孩子们一起工作时，这些孩子们所经历的创伤是难以言喻的。

So somehow we had managed to turn a completely blind eye how what happens in people's environment creates the mind and creates who people become and creates certain forms of pathology. 不知何故，我们竟然对人们所处的环境如何塑造心智、塑造他们成为什么样的人以及产生某些病态视而不见。

It was a real wake up call and there was a lot of debate of what a trauma is to this day. 这是一个真正的警钟，直到今天，关于什么是创伤仍有许多争论。

创伤的核心：无法应对的压倒性体验

And even sometimes when I define it in the way we officially do, people still don't like what I say. 即使有时我按照官方的定义来解释，人们仍然不喜欢我所说的。

But basically what the trauma is is something that happens to you that makes you so upset that it overwhelms you, it freaks you out and you cannot, you just stand there or sit there, lie there or whatever, and you are at a loss, what to do. 但基本上，创伤是指发生在你身上的某件事，让你如此沮丧，以至于压倒了你，让你惊慌失措，你只能站着、坐着、躺着，不知所措。

You feel terrible, helpless, hopeless, and you collapse. 你感到可怕、无助、绝望，然后崩溃。

Basically, there's an internal state of, "oh my God". 基本上，这是一种内心的状态：“我的天哪”。

So it's not somebody being mean to you or nasty to you or it is really bad stuff, but the trauma is not the event that happens. 所以，这不是有人对你不好或恶意对待你，或者事情真的很糟糕，但创伤并非发生的事件本身。

The trauma is how you respond to it. 创伤是你对此的反应。

Let me give you an example. 让我给你举个例子。

As a medical student, I was trained to deal with all kind of very difficult situations. 作为一名医学生，我曾接受过处理各种极其困难情况的训练。

And I remember vividly during my internship that a kid was brought in a-little child- with third degree burn wounds all over his body. 我清楚地记得在我实习期间，一个孩子被送来，全身都有三度烧伤的伤口。

But I was trained as a medical student about what to do. 但作为医学生，我接受过如何处理的训练。

So rather than freaking out, I thought, okay, I need to get my IV going, I need my fluids going. 所以我没有惊慌失措，而是想，好了，我需要开始打静脉输液，需要输液。

I focused on what to do. 我专注于我该做什么。

So that exposure to these horribly burn kids was not the trauma for me because I was not paralyzed in my actions because I'd been trained to deal with it. 因此，接触这些烧伤严重的儿童对我来说不是创伤，因为我没有因行动麻痹而不知所措，因为我接受过处理这种情况的训练。

And of course that happens to policemen, that happens to people in the service, it happens to physicians, nurses, etcetera, is you get trained on what to do and not to get overwhelmed by your feelings, but to actually be able to continue to act and do something. 当然，警察、军人、医生、护士等等也会遇到这种情况，他们接受训练知道该怎么做，不会被自己的情绪压倒，而是能够继续采取行动并做些事情。

And when you're traumatized, you just are unable to do anything. 而当你受到创伤时，你就什么也做不了。

It's a subjective experience. 这是一种主观体验。

And what may be traumatic for you may not be traumatic for me, and vice versa, depending on our personality and our training. 对我来说是创伤的，对你来说可能不是，反之亦然，这取决于我们的个性和训练。

An event becomes traumatic if your response is, "oh my God". 当你的反应是“我的天哪”时，一件事件就变成了创伤。

And when there is nothing you can think of, you can do to stave off the inevitable where you basically collapse in state of confusion, maybe rage, maybe collapse because you are unable to function in the face of this particular threat. 当你无计可施，无法阻止不可避免的事情发生，你基本上就陷入混乱、愤怒，或者因为无法应对眼前的威胁而崩溃。

创伤的缓冲因素：他人的支持

An event like that may not become a trauma in the long range. 这样的事件可能不会在长远来看成为创伤。

If at the moment that you collapse, other people around you come over and say, oh, I see that you're really in bad shape, let me help you. 如果在你崩溃的那一刻，你身边的人过来对你说，“哦，我看你状况很糟，让我来帮你。”

Let me take over for you and do things that you cannot do yourself. “让我来接替你，做你无法自己做的事情。”

And so the greatest protector against the trauma is the people around you whether they're able to protect you and to do what needs to be done or whether the people around you actually make it worse by continuing to do terrible things to you or blaming you for your responses. 因此，对抗创伤的最大保护者是你身边的人，无论他们是否能够保护你并做该做的事情，或者他们是否通过继续对你做可怕的事情或因你的反应而责怪你，反而让情况变得更糟。

创伤的普遍性：远超想象

Trauma is actually unlike what we first thought, extremely common. 创伤实际上与我们最初的看法不同，极其普遍。

At least one out of eight kids in America witness physical violence between their parents. 在美国，至少有八分之一的孩子目睹过父母之间的肢体暴力。

A larger number of kids get hit in very nasty ways by their own caregivers. 更多的孩子受到自己照顾者的恶劣对待。

A very large number of people in general, but women in particular, have sexual experiences that were clearly unwanted and that left them helpless and befuddled, confused and enraged because they had no choice about what they were doing. 总的来说，有很多人，尤其是女性，有过明显非自愿的性经历，使她们感到无助、困惑、迷茫和愤怒，因为她们对此无能为力。

These experiences extremely common. 这些经历非常普遍。

So people usually think about the military when they talk about trauma, but I like to say somewhat outside scientifically, that's for every soldier who gets PTSD in the war zone, there's these 30 children who gets traumatized at home. 所以人们通常在谈论创伤时会想到军队，但我喜欢说一些不那么科学但更现实的比喻：每有一个士兵在战区患上PTSD，就有30个孩子在家中遭受创伤。

创伤在大脑中的运作方式：生存本能

The nature of trauma is that an experience enters into your ears, into your skin, into your eyes, into sensations, and it goes down into a very primitive part of your brain that automatically interprets what is going on. 创伤的本质是，一种体验通过你的耳朵、皮肤、眼睛、感觉进入，然后进入你大脑中一个非常原始的部分，它会自动解读正在发生的事情。

That's not your frontal lobe. 那不是你的额叶。

What your frontal lobe, your conscious cognitive self; that is a later issue. 你的额叶，你的有意识的认知自我；那是后续的问题。

The first thing is a somatic response. 首先是身体反应。

So something happens to you, your survival brain makes the first interpretation and says, is this dangerous or is this safe? 所以当你遇到某些事情时，你的生存大脑会做出第一步解读，并说：这是危险的还是安全的？

That decision is made for you by that primitive survival brain. 这个决定是由那个原始的生存大脑为你做出的。

And that's what we learned a lot about when we study trauma is the power of that primitive brain, which occupies a very large part of our brain that really automatically makes decisions for us. 而我们从研究创伤中学到很多的就是这个原始大脑的力量，它占据了我们大脑的很大一部分，真的会自动为我们做决定。

And on the basis of the messages we get from our body, our cognition interprets in a particular way depending on our prior experiences. 而基于我们从身体接收到的信息，我们的认知会根据我们过去的经历以特定的方式进行解读。

But the message come from our hormones and our physiological impulses that have to do with survival. 但信息来自我们的荷尔蒙和与生存相关的生理冲动。

We are talking about staying alive. 我们谈论的是如何活下来。

And so when you're being raped or you're being beaten or you see your parents getting killed, your body starts automatically going to a state trying to make yourself survive. 所以当你被强奸、被殴打，或者看到父母被杀害时，你的身体会自动进入一种试图让自己活下来的状态。

One of the states is going to fight-flight, to get up and to punch people and to become very angry. 一种状态是战斗-逃跑，站起来揍人，变得非常愤怒。

And that's oftentimes when people are traumatized, they'll fight-flight responses continue to get activated in response to situations where people, their environment says, hey, hey, cool it, this is not so bad. 而这通常发生在人们受到创伤时，他们的战斗-逃跑反应会持续激活，以应对那些环境告诉他们“嘿，冷静点，这没那么糟”的情况。

But people have these automatic responses or on a more primitive level even, is that people's brain shuts down and they lose track of themselves and they basically make themselves disappear. 但人们会有这些自动反应，甚至在更原始的层面上，是人们的大脑会关闭，他们会失去自我意识，基本上会让自己消失。

Very much like animals can do that also in the wild because they can sort of collapse and play possum as it were. 就像野生动物会那样做一样，它们会蜷缩起来，装死。

And playing possum is exactly what happens to people also. 而装死的情况也同样会发生在人身上。

And when you beat a kid enough, that kid starts collapsing and no longer respond to this environment. 当你足够严厉地对待一个孩子时，那个孩子就会开始崩溃，不再对这个环境做出反应。

And so it is either fight-flight or collapse, none of which have anything to do with cognition. 所以要么是战斗-逃跑，要么是崩溃，这两者都与认知无关。

And doing cognitive therapy with that is really a misunderstanding of what happens with traumatized people. 而对创伤人群进行认知疗法，实际上是对创伤人群发生情况的误解。

They have automatic responses and they don't have these responses because they're stupid or because they don't understand what's going on. 他们有自动反应，但这并非因为他们愚蠢或不理解发生的事情。

Most people actually do understand that their reactions are completely out of whack. 大多数人实际上明白自己的反应完全不正常。

They don't need to be told that, and but because they react in such an extreme way, they feel deeply ashamed about themselves because they say to themselves, I'm a nut cake. 他们不需要别人告诉他们这一点，但因为他们的反应如此极端，他们对自己感到深深的羞愧，因为他们对自己说：“我疯了”。

I screamed at people. 我对人们大喊大叫。

I collapsed when I had to stand up for myself. 当我必须为自己站出来时，我却崩溃了。

And so you have these automatic responses that are not a product of your cognitive assessment. 所以你有这些自动反应，它们不是你认知评估的结果。

They're product of your animal brain trying to stay alive in the face of something that that part of your brain interprets as a life threat, even though people around you by now go, this is not a life threat at all. 它们是你动物大脑为了在它认为的生命威胁面前生存下来而产生的产物，即使你身边的人现在会说：“这根本不是什么生命威胁”。

婴儿的心智发展与创伤烙印

We come into the world being able to do what little babies can do and what can little babies do? 我们来到这个世界时，能够像小婴儿一样，而小婴儿能做什么？

They can breathe, they can sleep, they can suck, they can feel hungry, they can poop, they can pee, they can cry, and that's about it. 他们会呼吸、睡觉、吸吮、感到饥饿、排便、排尿、哭泣，仅此而已。

And so we call that the housekeeping of the body. 所以我们称之为身体的“家政管理”。

Little babies already can do that. 小婴儿已经能够做到这一点。

And little babies, the system would get very activated. 而小婴儿的系统会变得非常活跃。

So babies will scream and they'll cry, and they'll look catastrophic, and then the people around them pick them up and soothe them and calm that part of their brain down. 所以婴儿会尖叫、哭泣，看起来很糟糕，然后周围的人会抱起他们，安抚他们，让他们大脑的那个部分平静下来。

Much of the imprint of trauma is in a very primitive survival part of your brain that's already in place in little babies. 创伤的很大一部分印记在大脑中一个非常原始的生存部分，这个部分在小婴儿时期就已经存在了。

In fact, what the research recently has been showing this little area way, just way this base of your skull, periaqueductal gray, that I like to call the cockroach brain as a part of you that just picks up what's dangerous and what's safe. 事实上，最近的研究表明，头骨基部有一个小区域，我称之为“蟑螂脑”，它是你用来识别危险和安全的那个部分。

And now it turns out that when you're traumatized, that little part of your brain, which is usually very quiet for most of us, continues to just send messages to you when you're traumatized. 现在看来，当你受到创伤时，大脑的那个小部分，对我们大多数人来说通常都很安静，在受到创伤时会持续向你发送信息。

And so there's always this sort of message you get from deep down inside of your body of I'm in danger, I'm not safe. 所以你总会从身体深处收到这样的信息：“我很危险，我不安全。”

So you're always uptight, always on alert, and you spend much of your energy trying to suppress those feelings of fear in order not to embarrass yourself in order to be able to work with what you do. 所以你总是紧张，总是警惕，并且你会花费大量精力试图压抑那些恐惧感，以免让自己难堪，以便能够继续工作。

And so it's very primitive. 所以这是非常原始的。

大脑地图的形成：早期经历的关键作用

And then on top of that middle of the primitive part of your brain, you develop a limbic system. 然后，在你大脑原始部分的上方，你会发展出边缘系统。

And your limbic system basically creates an internal map of the world that tells you what out there is safe, what is dangerous. 你的边缘系统基本上会创造一个内部世界地图，告诉你外面什么地方是安全的，什么地方是危险的。

So if you say to me, boy, after this interview is over, let's go to the store and plow down the street, and have a nice lager beer. 所以如果你对我说：“嘿，这次采访结束后，我们去商店逛逛街，喝杯不错的拉格啤酒。”

I go like, wow, that's so cool because I love that bar and I don't love that bar. 我会说：“哇，那太棒了，因为我喜欢那个酒吧，但不喜欢另一个酒吧。”

So already in my internal mind I have a map of what is safety and what's dangerous, and that map is created by the experiences that we have. 所以在我内心的脑海中，我已经有了一个关于安全与危险的地图，这张地图是由我们的经历创造的。

And so the brain is a use dependent organ and the brain gets formed on the basis of the experiences that we have, particularly in the first few years of your life. 因此，大脑是一个依赖于使用的器官，大脑的形成基于我们的经历，尤其是在你生命的前几年。

And so if you're a little kid and you grow up in very safe surroundings and people are delighted to see you, and people say, isn't she cute? 所以，如果你是个小孩子，在非常安全的环境中长大，人们看到你很高兴，并说：“她多可爱啊！”

Isn't she wonderful? “她多棒啊！”

You grow up with a sense of, I'm so cute and people love me because that becomes the map of your world. 你会在一种“我真可爱，人们爱我”的感觉中长大，因为这成为了你世界的地图。

That's how people respond to you. 这就是人们对你的反应。

And that basically that stays with you for much of the rest of your life. 而且这基本上会伴随你一生的大部分时间。

If you're a little kid and people say to you, as I hear all the time, I wish you hadn't been born. 如果你是个小孩子，人们对你说（我经常听到）：“我真希望你没出生。”

I try to abort you but I fail, you're just really ruined my life. “我试图让你流产但失败了，你真的毁了我的生活。”

You're just have always been pain in the ass. “你一直是个麻烦精。”

That becomes your map of the world. 这成为了你世界的地图。

And a little kid doesn't say when you're three years-old or five years old, mom, you're crazy saying that about me because a little kid doesn't have other ways of looking at the world. 而一个三岁或五岁的孩子不会说：“妈妈，你说这话真是疯了。”因为小孩子没有其他看待世界的方式。

So the world that you live in is the only world that is. 所以你所 lived 的世界就是唯一的世界。

And if you're being treated as an difficult, unpleasant person, that becomes your perception of yourself. 如果你被当作一个困难、令人不快的人对待，这就会成为你对自己的看法。

I'm fundamentally a bad defective person. 我本质上是一个糟糕的、有缺陷的人。

And that, people's cognition does not make that go away. 而这一点，人们的认知并不能消除。

People can tell you till you're blue in the face, oh, you're wonderful, you're terrific. 你可以告诉他们，直到你脸色发青，说：“哦，你很棒，你很出色。”

I've known a whole bunch of people like that who were very abused and neglected as kids who have become amazing musicians. 我认识很多这样的人，他们小时候遭受了严重的虐待和忽视，长大后却成为了杰出的音乐家。

Artists, athletes, the world adores them and deep inside they still feel like crap, that they're defective people, because that imprint stays with them. 艺术家、运动员，全世界都崇拜他们，但他们内心深处仍然觉得自己很糟糕，觉得自己是有缺陷的人，因为那种印记仍然伴随着他们。

创伤历史回顾：从战争到家庭

My colleagues and I started to look at these dramatized soldiers primarily. 我的同事们和我起初主要研究这些遭受创伤的士兵。

We actually went back over what had been written before. 我们查阅了之前已有的文献。

The library at the VA I was working, didn't have a single book about war trauma, war neurosis, any of these things. 我工作的退伍军人管理局的图书馆里，没有一本关于战争创伤、战争神经症或任何这类主题的书。

But so I went down to the old Harvard Medical Library and I dug up a book that was written in 1941 by a guy by the name of Abram Kardiner who had been working with first World War soldiers. 于是我去了哈佛医学院旧图书馆，找到了一本由 Abram Kardiner 于 1941 年撰写的书，他曾与第一次世界大战的士兵们一起工作。

And he writes about his first World War soldiers back a long time ago. 他很久以前就写过关于第一次世界大战士兵的情况。

He writes, "these guys suffer from a physioneurosis. 他写道：“这些人患有身体神经官能症。”

"Their bodies continue to re-experience the trauma." “他们的身体不断重温创伤。”

And he says, "and the trauma keeps coming back, keeps revisiting them in the form of nightmares and flashbacks." 他说：“创伤会不断回来，以噩梦和闪回的形式反复出现。”

They keep reliving what happened back there. 他们不断重温当时发生的事情。

They cannot leave it behind, and the trauma keeps coming back either as images or as behaviors as the people behave again, as if they're getting raped or getting assaulted even though they're not getting raped or getting assaulted. 他们无法将其抛诸脑后，创伤会以图像或行为的形式反复出现，人们会再次表现得好像他们正在被强奸或攻击，即使他们并没有被强奸或攻击。

So what we defined, but people had seen that before us all the way back to well over a hundred years at the core of trauma is that you get stuck and that event keeps coming back in terms of images, behaviors, and physical sensations. 所以，我们所定义的，但在此之前人们就已观察到的，远溯至一百多年前，创伤的核心是你被困住，并且那次事件以图像、行为和身体感觉的形式不断重现。

So that became at the core of our definition of PTSD. 这成为了我们 PTSD 定义的核心。

The second piece is that having been constantly bombarded with this horrifying stuff makes you preoccupied with how do I go on with my life? 第二点是，不断被这些可怕的事情轰炸，让你专注于“我该如何继续我的生活？”

And so you work very hard on avoiding things that make you lose your senses. 所以你非常努力地避免让你失去理智的事情。

And so people avoid and people suppress it and people actually learn to not feel things in their bodies and they stifle internal sensations, eternal feelings. 所以人们会回避，人们会压抑，人们实际上学会不去感受身体内的东西，他们压抑内心的感觉，永恒的情感。

So that's the second piece is on the one side is this fight-flight keeps going on. 所以这是第二点，一方面是战斗-逃跑反应在持续进行。

The other thing is you calm yourself down. 另一方面是你让自己平静下来。

You try to suppress yourself, you try not to feel, and so at the end you don't feel very alive. 你试图压抑自己，你试图不去感受，最终你觉得自己不太像活着。

And the third thing is that you continue to be hyper alert. 第三点是你继续保持高度警惕。

You know, you just keep being bombarded, you keep overreacting to all kinds of things in general. 你知道，你就是不断地被轰炸，你对各种事情都过度反应。

That's the original definition of PTSD, and that is still the definition as you find in the textbook still. 这就是 PTSD 的原始定义，而且至今仍在教科书中使用。

But what we discovered is that the whole impact of trauma is much larger and it also affects the way you feel about yourself, the way you feel about other people, the way you are able to notice yourself, the way you experience yourself. 但我们发现，创伤的整体影响更大，它还影响你对自己的感受，你对别人的感受，你对自己察觉的能力，你对自己的体验。

And it has a lot of self distortions and distortions of your body also. 它还会导致许多自我扭曲和身体上的扭曲。

And then over time we again, rediscovered something because these things always have been noted before, the degree to which when you're traumatized, your body keeps mobilizing itself to fight and that you have all kind of immunological abnormalities, you have endocrine abnormalities and that really devastates your health, your physical health, and the long range, oftentimes the physical problems are longer lasting than the mental problems. 随着时间的推移，我们再次发现了某些东西，因为这些现象一直被人们注意到：在你受到创伤时，你的身体会持续动员起来进行战斗，你会出现各种免疫系统异常、内分泌异常，这严重损害你的健康、你的身体健康，从长远来看，身体问题往往比心理问题持续时间更长。

创伤对不同年龄大脑的影响差异

The other thing that we discovered, which is still an area of some controversy in the field, not for me but for my colleagues who are in power, is that trauma affects the mind to the brain very differently depending on the age at which you are. 我们发现的另一件事，在一个仍存在争议的领域，对我而言并非如此，但对有权势的同事们而言是如此，那就是创伤对大脑和心智的影响，在不同年龄段差异很大。

And so if something terrible happens to me right now, I have a whole well-developed brain and my brain isn't really growing all that much anymore. 所以，如果现在发生在我身上一件可怕的事情，我拥有一个发育成熟的大脑，我的大脑不再有太多增长。

So I'll get an imprint of the trauma that is pretty much superimposed on a relatively well-functioning brain. 因此，创伤的印记将很大程度上叠加在一个相对功能良好的大脑上。

If you're two, three or four years-old, your mind and your brain is growing. 如果你只有两三四岁，你的心智和大脑正在发育。

What various of my research friends have shown is that trauma at different ages affects different ways of wiring the brain and it gets very complex. 我的多位研究朋友表明，不同年龄段的创伤会影响大脑的不同连接方式，这变得非常复杂。

As like my friend Marty Teicher has really shown that trauma at age three changes the brain very differently than trauma at age five and trauma age 14, and that the brain keeps growing and evolving. 例如，我的朋友 Marty Teicher 已经证明，三岁时的创伤与五岁时的创伤以及十四岁时的创伤会以非常不同的方式改变大脑，而大脑会持续生长和发展。

And so different events have a different imprint of the brain. 因此，不同的事件会对大脑留下不同的印记。

That's one aspect. 这是其中一个方面。

And the other thing that is terribly important is not only what's happening to you but what's happening to your environment. 另一个极其重要的事情是，不仅要看你身上发生了什么，还要看你的环境发生了什么。

And by and large, as I said before, if you are really freaked out as a kid and your parents are there for you and they smile at you and say, I'll take care of it, don't worry about it, honey, I know what to do. 总的来说，正如我之前所说，如果你小时候非常惊恐，而你的父母在你身边，他们对你微笑并说：“我会处理的，别担心，亲爱的，我知道该怎么做。”

Or you have a doctor who really knows what they're doing, who you can trust, you're going like, okay, I can relax now 'cause even if I can't take care of it, other people can take care of it for me. 或者你有一位真正了解自己工作、值得你信任的医生，你会觉得：“好吧，我现在可以放松了，因为即使我无法处理，其他人也能为我处理。”

创伤中的信任危机与心理健康的挑战

One of the largest mitigating factors against getting traumatized is who is there for you at that particular time? 对抗创伤的最大缓解因素之一是，在那个特定时刻谁在你身边支持你？

When you feel constantly threatened, of course, you don't trust anybody, but there is a reason to not trust people. 当你感到持续受到威胁时，当然，你不会信任任何人，但确实有理由不信任他人。

The tradition in mental health is to dismiss people; the reality of people's lives. 心理健康领域的传统是忽视人们；忽视人们生活的现实。

For example, it's only in the past few years that people are beginning to talk about the impact of poverty or the impact of racism or the impact of unemployment. 例如，直到最近几年，人们才开始谈论贫困、种族主义或失业的影响。

And people have been sort of been labeling people, oh, do something wrong with you, let me fix you. 人们一直都在给别人贴标签：“哦，你有什么问题，让我来帮你解决。”

But mental health professionals have been very defective in helping people to really come to terms with what actually has happened to them and what's happening to them right now. 但心理健康专业人士在帮助人们真正面对已经发生的事情以及他们现在正在经历的事情方面，一直做得非常不足。

So a good amount of distrust is very well justified and very likely today, if you're a traumatized person, you don't go to a doctor and say, "I was raped when I was four years-old and that's why I come to be treated." 因此，相当程度的不信任是有充分理由的，而且很可能今天，如果你是一个遭受创伤的人，你不会去看医生说：“我四岁时被强奸了，所以才来治疗。”

No, people go, come to be treated because today you blow up at your husband and today you cannot have a safe, satisfactory sexual relationship with your new partner. 不，人们会来寻求治疗，因为你今天对你的丈夫大发雷霆，或者你无法与你的新伴侣建立安全、令人满意的性关系。

And that's why coming into treatment because the body ultimately reacts to certain stimuli, and most people actually are barely aware or not aware at all, that their reactions that they're having right now are actually are rooted in experience that they've had before. 这就是为什么人们会寻求治疗，因为身体最终会对某些刺激做出反应，而大多数人几乎没有意识到，或者根本没有意识到，他们现在的反应实际上根植于他们过去的经历。

So if you go to a physician or a mental health practitioner who doesn't understand that they're going to try to fix you with drugs or cognitive behavioral treatment to not do these crazy things anymore, it usually doesn't work very well because you need to really develop a deep sense of this what happened to me. 所以，如果你去看一个不理解这一点的医生或心理健康从业者，他们会尝试用药物或认知行为疗法来“修复”你，让你不再做这些疯狂的事情，这通常效果不佳，因为你需要真正深刻地认识到“发生了什么事在我身上”。

This is what I'm dealing with. 这是我正在处理的问题。

I need to really acknowledge like, oh my God, that was terrible what happened to me, and I need to take care of the wounds that I'm carrying inside of myself. 我需要真正地承认：“我的天哪，我所经历的是多么可怕”，我需要照顾我内心深处的伤痛。

This issue of self-compassion and really knowing that your reactions are understandable and are rooted in you getting stuck in the past is a terribly important part of beginning to recover from trauma. 这种自我关怀的问题，以及真正认识到你的反应是可以理解的，并且根植于你被过去困住的事实，是开始从创伤中恢复过来极其重要的一部分。

And as long as you ignore that, you're just a crazy person who has crazy reactions. 只要你忽视这一点，你就只是一个有疯狂反应的疯子。

创伤的持续影响：改变大脑与自我认知

The problem with trauma is that it starts off with something that happens to us or that's done to us, but that's not where it stops because it changes your brain. 创伤的问题在于，它始于发生在我们身上的事，或者别人对我们做的事，但它并没有在那里停止，因为它改变了你的大脑。

And from now that event itself is over, but you continue to react to things as if you're in danger and your brain actually gets changed in a variety of different ways. 从现在起，事件本身已经结束，但你继续对事物做出反应，就好像你仍处于危险之中，而你的大脑实际上在以各种不同的方式发生改变。

And the problem then becomes that you are not able to engage or to learn or to see other people's point of view or to coordinate your feelings with your thinking. 然后问题就变成了，你无法参与、学习、理解他人的观点，或者协调你的情感与思考。

And so yet it becomes an internal issue, how the trauma continues to fester inside of you in a variety of different sensations and perceptions. 因此，它变成了一个内在的问题，创伤如何在各种不同的感觉和感知中在你体内持续发酵。

Yes, there is something wrong with you, but people don't come to see, oh, see me because of what happened to them. 是的，你身上有问题，但人们不来看我，哦，不是因为他们身上发生了什么。

People go, come to see me because if feel is something really wrong with me, I cannot connect with my kids. 人们来找我，是因为他们觉得“我身上有问题，我无法和我的孩子建立联系”。

I become angry with all my coworkers. 我对所有的同事都变得愤怒。

Nobody can stand being around me because I am so reactive. 没有人能忍受在我身边，因为我太容易激动了。

Yes, trauma causes that there is something wrong with you, and my job as a psychiatrist and all the colleagues and students I have is to help you to feel safe in your body and to feel like the trauma is over. 是的，创伤导致你身上有问题，而我作为一名精神病医生，以及我所有的同事和学生的工作，就是帮助你感到身体安全，并让你觉得创伤已经结束。

And if you don't continue to react to all kind of things now as if somebody is trying to hit you or rape you. 并且让你不再像现在这样，对各种事情都做出仿佛有人要打你或强奸你的反应。

创伤与压力的区别

I think the most important thing to know is that there's a difference between trauma and stress. 我认为最重要的一点是，创伤和压力是有区别的。

As I like to say to people, life sucks a good amount of the time. 正如我喜欢告诉人们的那样，生活在大部分时间里都很糟糕。

Now we all have jobs and situations that are really unpleasant, but the moment that the situation is over, it's over. 我们都有工作和一些真正令人不快的情况，但当情况结束后，它就结束了。

You go on with your life. 你继续生活。

A trauma is happens and when it's over, your body continues to relive it. 创伤发生了，当它结束后，你的身体会继续重温它。

And the core issue is that your body does it. 而核心问题是你的身体在这样做。

Your endocrine system, your neurohormonal system, the immunological system continues to react as if you're back there. 你的内分泌系统、神经荷尔蒙系统、免疫系统会继续反应，就好像你回到了当时一样。

So there is something about the development of the mind that gets stopped at that point because the trauma cannot be integrated as, oh yeah, that really sucked, but it's over now. 所以心智发展到某个点就会停止，因为创伤无法被整合为“哦，是的，那真的糟透了，但它已经结束了”。

Trauma makes you think that it's still happening right now. 创伤让你觉得它现在仍在发生。

So the big challenge of treating trauma is how do we help people to live in bodies that feel fundamentally safe? 所以治疗创伤的巨大挑战是如何帮助人们生活在感觉根本上安全（safe）的身体里？

Where something unpleasant happens to you, you don't react as if your life is in danger. 当你不愉快的事情发生时，你不会反应得好像你的生命处于危险之中。

But you go like, oh, how do I solve this? 而是你会想，“哦，我该如何解决这个问题？”

But when you're traumatized, what's very striking and a whole variety of different brain studies, what you show is that when you show a nontraumatized person something ambiguous and difficult, their cognitive brain tries to figure out what's going on. 但是当你受到创伤时，在各种不同的脑部研究中，一个非常引人注目的是，当你向未受创伤的人展示一些模糊而困难的事物时，他们的认知大脑会试图弄清楚发生了什么。

Where you saw this same stimulus to people who are traumatized, the emotional brain reacts like, is this dangerous or is this safe? 而当你向受创伤的人展示同样的刺激时，他们的情绪大脑会反应：“这是危险的还是安全的？”

Your brain goes into, is my life in danger? 你的大脑会进入“我的生命是否处于危险之中？”的状态。

And that's an emotional reaction, what lights up in the brain is a very different part of the brain, but then when you have to solve a problem, so you're continuously trying to manage your emotional reactions. 这是一种情绪反应，大脑中被点亮的是一个非常不同的区域，但随后当你必须解决问题时，你就会持续试图管理你的情绪反应。

Chapter 2: 童年创伤的塑造与深远影响

People have always noticed that people relive their trauma. 人们一直注意到，人们会重温他们的创伤。

But as I said before, usually people are not aware of it. 但正如我之前所说，通常人们并没有意识到这一点。

Kids are not aware of that they're reliving their having been beaten or witnessing domestic violence. 孩子们没有意识到他们正在重温被殴打或目睹家庭暴力。

And when they go to school, they react in a very angry and defiant way with their teachers say, oh, "this reminds me about my mom and dad fighting, making me scared." 当他们去学校时，他们会对老师做出非常愤怒和挑衅的反应，老师说：“哦，这让我想起我父母吵架，吓到我了。”

No, had they have an automatic reaction to adults who started in any way not okay to blow up and become very frightened so they don't make the connection. 不，他们对成年人的自动反应是，一旦有任何不妥当的苗头，他们就会爆发并变得非常害怕，所以他们没有把这两者联系起来。

And so what happened when we created this diagnosis of PTSD, you know, we weren't very perceptive, you know, we're just beginning to see something for the first time. 所以，当我们创建 PTSD 诊断时，你知道，我们并不够敏锐，你知道，我们才刚刚开始第一次看到某些东西。

And the most obvious thing in which people relive the trauma is in nightmares. 人们重温创伤最明显的方式就是做噩梦。

In nightmares, people see it again or they experience the event in their dreams. 在噩梦中，人们会再次看到它，或者在梦中体验那次事件。

That is the most obvious, and we could see it. 这是最明显的，我们能看到。

It took us a long time to realize that people also are continue to reenact the trauma in their relationships. 我们花了很长时间才意识到，人们还在人际关系中不断重演创伤。

That they may relate to their kid the same way they related to people who hurt them as little children, and so they don't make that connection. 他们可能以对待伤害过他们的小时候的人的方式来对待自己的孩子，所以他们没有将这两者联系起来。

But what what allows you to make the connection is when you actually have images of what happened back there, but most people don't have visual images. 但让你能够建立联系的是当你真正拥有当时发生的事情的图像时，但大多数人没有视觉图像。

Most people have sensory reactions, how they feel suddenly feel uptight, they feel nervous, panicky, anxious, enraged. 大多数人有感官反应，比如突然感到紧张，感到不安、恐慌、焦虑、愤怒。

They don't know where it's come from after they read books like mine they know at least where it comes from. 他们不知道这些情绪从何而来，但在读了我的书之后，他们至少知道它的来源。

Comes from some part of your brain that you actually cannot really know because it's beyond cognition. 它来自你大脑的某个部分，你实际上无法真正了解，因为它超越了认知。

So, oh, that's why I'm doing that stuff. 所以，哦，这就是我为什么会这样做。

That's sort of helpful to know but most people who are reenacting or replaying the trauma are not aware that they're recreating or replaying the trauma. 知道这一点有点帮助，但大多数正在重演或回放创伤的人并没有意识到他们正在重现或回放创伤。

童年创伤的塑造：亲子关系的关键作用

So trauma affects the developing brain different from a well-developed brain. 所以创伤对发育中的大脑的影响与对已成熟的大脑不同。

The research is really very, its intriguing about this and that's the degree to which parents hold and modulate kids' traumatic responses. 这项研究确实非常有趣，它涉及到父母在多大程度上能够安抚和调节孩子创伤性的反应。

As I said before, when as a kid you get bitten by a dog, it's really very scary and very nasty. 正如我之前所说，当你还是个孩子时被狗咬，那真的很可怕也很糟糕。

But if your parents pick you up and say, oh, "I'm so sorry, let's go and take care of it and let's give you a bath and we'll give you some extra special food," 但如果你的父母抱起你，说：“哦，我很抱歉，我们去处理一下，给你洗个澡，还会给你吃些特别的食物。”

that dog bite doesn't become a big issue because the foundation of your safety has not been destroyed. 那么这次狗咬就不会成为一个大问题，因为你安全的基础没有被摧毁。

A study I like to quote actually and teach people about is a study that was done in London right after the second World War because London was being bombed by the Nazis. 我喜欢引用并教授给大家的一项研究是二战后不久在伦敦进行的一项研究，因为当时伦敦正遭受纳粹的轰炸。

The Brits decided let's send the kids in London who were being bombed out to the bucolic English countryside to live with very nice people. 英国人决定把伦敦那些遭受轰炸的孩子送到宁静的英国乡村，让他们和善良的人们一起生活。

And when the war is over, they'll come back and they won't have seen all these dead people and they had corpses and all the bombing, they'd be much better off. 战争结束后，他们会回来，他们就不会看到所有这些死人、尸体和轰炸，他们会过得好得多。

And so after the war, Anna Freud of all people, Sigmund Freud's daughter and her friend Dorothy Burlingham, did a study of what happened to these kids. 所以战争结束后，安娜·弗洛伊德，西格蒙德·弗洛伊德的女儿，以及她的朋友 Dorothy Burlingham，对这些孩子的情况进行了一项研究。

It turned out that the kids who stayed in London with their parents did just fine because the safety of kids is determined by how safe they feel with their parents. 结果发现，留在伦敦和父母在一起的孩子们都很好，因为孩子的安全感取决于他们与父母在一起时的安全感。

While the kids who went to the countryside like Oliver Sacks who some of your listeners may also be a great fan of like I am, he was shipped to the countryside and in his autobiography Oliver Sacks writes, like one of the two most traumatic events in my life was being shipped off to the countryside, and I was a really scared and upset kid who was primarily preoccupied with but my parents are still alive, but I didn't see them anymore. 然而，那些被送到乡村的孩子们，比如奥利弗·萨克斯（也许你的一些听众也像我一样是他的粉丝），他被送往乡村，在他的自传中，奥利弗·萨克斯写道，他生命中最具创伤性的两件事之一就是被送到乡村，那时我还是个非常害怕和不安的孩子，我主要担心的是我的父母是否还活着，但我再也见不到他们了。

创伤中的人际连接与社群支持

But trauma also really taught us is the degree to which we are profoundly interconnected and interdependent people and we are relational creatures. 但创伤也真正教会我们的是，我们在很大程度上是相互联系、相互依存的，我们是关系型生物。

And as long as our relationships are intact, by and large we're pretty good with trauma. 只要我们的关系完好无损，总的来说，我们就能很好地应对创伤。

Who knows that the US Marine Corps and the armed services, they take a bunch of people who are obviously, who sometimes escape their own horrible child environments, had to and join the military and what does the military do for them? 谁知道美国海军陆战队和军队，他们招募了一群人，这些人显然有时逃离了自己糟糕的童年环境，不得不加入军队，而军队为他们做了什么？

They create a sense of cohesion, a sense of predictability, a sense of safety. 他们创造了凝聚力、可预测性和安全感。

And so through all these exercises they can do in the army, you feel very connected with your group. 所以通过军队里的所有这些训练，你会感到与你的团队非常亲近。

And when you go to war with your group, you feel very safe that your buddies are there to protect you and that really protects you against getting traumatized. 当你与你的团队一起去战斗时，你会感到非常安全，因为你的战友在那里保护你，这真的能保护你免受创伤。

And the very first study I did, before we knew anything about trauma was the discovery that the PTSD started for many soldiers when they saw their best friend being blown up because they really had the sense of safety and cohesion because they had a friend but then that friend got killed the whole world collapsed and they no longer had the safety that came with the group. 而我的第一个研究，在我们了解创伤之前，就发现了许多士兵的 PTSD 是在他们看到最好的朋友被炸死时开始的，因为他们曾经拥有安全感和凝聚力，因为他们有个朋友，但当那个朋友去世后，整个世界都崩塌了，他们也不再拥有团队带来的安全感。

And so what you see with many traumatized people is that they continue to really pull towards reconnecting with people who have had similar experiences. 所以，你会发现许多受创伤的人会继续倾向于与有相似经历的人重新建立联系。

Because when you say I was raped and I was raped too, you're going like, you know what I'm talking about, you're special. 因为当你（我说）“我被强奸了”时，而对方说：“我也被强奸了”，你就会觉得，“你知道我在说什么，你很特别。”

I can be safe with you. 我可以和你在一起感到安全。

As opposed to all these people who have no idea what I'm talking about. 而不是那些完全不明白我在说什么的人。

童年创伤的长期影响：过度反应与亲密关系障碍

The lingering effect of childhood trauma is that you continue to react to mild stressors as if your life is in danger. 童年创伤的持续影响是，你继续对轻微的压力源做出反应，就好像你的生命处于危险之中。

You tend to become hyper reactive. 你往往会变得过度反应。

People see your reactions as exaggerated. 人们认为你的反应是夸张的。

Somebody may irritate you in the supermarket, they may yell at this person. 在超市里有人可能会惹恼你，他们可能会对这个人喊叫。

You may develop road rage. 你可能会产生路怒症。

You may have a difficult time putting up with misbehavior from your spouse or your kids, and you have exaggerated emotional responses. 你可能很难忍受配偶或孩子的行为不端，并且会有夸张的情绪反应。

The other thing is, it oftentimes is very hard to negotiate intimate relationships. 另一件事是，协商亲密关系通常非常困难。

Negotiating both of our needs. 协商我们双方的需求。

Your needs and my needs actually is a very complex phenomenon. 你的需求和我以及我的需求实际上是一个非常复杂的现象。

How do we make compromises? 我们如何做出妥协？

How do we make both of us happy at the same time? 我们如何同时让双方都开心？

And when you have a childhood trauma that oftentimes becomes very difficult. 而当你经历童年创伤时，这往往变得非常困难。

Very difficult to say, okay honey, if that's what you need, I wouldn't want to do that, but I'm fine with you if you do that. 非常难说：“好吧，亲爱的，如果你需要那样，我虽然不想这样做，但我没问题如果你那样做。”

And these issues of boundaries and who's responsible for what becomes very hard thing to negotiate, oftentimes. 而关于界限和谁该负责什么的问题，也常常变得难以协商。

改变社会的公共卫生议题：从个人到系统

The big question for me continues to be how do you help kids, in particular, who have been exposed to enormous amount of violence, life threats, people who don't pay attention to them, how do you help these kids get a sense of self, a sense of agency so they can actually make a life for themselves where they can learn, acquire skills, acquire competencies, so they become full-fledged human beings? 对我来说，一直以来的大问题是，如何帮助那些遭受了巨大暴力、生命威胁、无人关注的孩子们，如何帮助这些孩子建立自我意识和自主感，让他们能够真正为自己创造生活，在那里他们可以学习、获得技能、掌握能力，从而成为完整的人？

What the data show is that the long-term effect of child abuse and neglect, which is rampant in our country, is the biggest public health issue in America. 数据显示，儿童虐待和忽视的长期影响，在我们国家非常普遍，这是美国最大的公共卫生问题。

Let me give you an example. 让我给你举个例子。

There is other societies that are much more trauma savvy than we are where it is not the enormous amount of incoming inequality where parents actually are helped to take care of their kids. 还有一些社会比我们更能应对创伤，那里没有巨大的收入不平等，父母实际上得到了帮助来照顾他们的孩子。

Where healthcare is universal, where childcare is universal. 医疗保健是全民的，儿童保育也是全民的。

One of these places is Holland, which happens to be my native country, which I left when I was 18 years-old and which has become a very nice place. 其中一个地方是荷兰，碰巧是我的祖国，我18岁时离开了那里，如今它已成为一个非常美好的地方。

So in a culture like that, that really looks at what are the antecedents for getting people to be dysfunctional? 所以在这样的文化中，它真正关注的是导致人们失功能的先决条件是什么？

They do all these things to help people to take care of their kids. 他们做所有这些事情来帮助人们照顾他们的孩子。

And so in the Netherlands right now the incarceration rate is 58 per 100,000 people. 因此，目前在荷兰，监禁率是每10万人中有58人。

In the US it's 950 per 100,000 people. 而在美国，每10万人中有950人。

So the big issue is a political issue. 所以大问题是政治问题。

How do we rearrange our society to really know about trauma and to really do all the things that are necessary so that people who grow up under extreme adverse conditions can develop a brain and a mind that can help them to become full-fledged members of society instead of so on the edge as drug addicts and disabled people or people who need to go to jail? 我们如何重新安排我们的社会，真正了解创伤，并真正做好所有必要的事情，以便在极端不利条件下长大的人们能够发展出大脑和心智，帮助他们成为社会上完整的一员，而不是边缘化的瘾君子、残疾人或需要进监狱的人？

That's our big issue, and that's the big challenge that we have. 这是我们的大问题，也是我们面临的巨大挑战。

Chapter 3: 创伤的治疗方法：超越传统认知

I was raised in the mainstream culture as a professor, prestigious institutions and what's mainstream culture, the culture we live in is that when you are feel bad, you take a swig of alcohol or you take a swig of something to make that feeling go away. 我是在主流文化中长大的，作为一名教授，在享有盛誉的机构里，而主流文化是：当你感觉不好时，你就喝一杯酒，或者喝点什么来让这种感觉消失。

I call our medical culture right now a post alcoholic culture where if you feel bad, you take something to make that feeling go away. 我现在称我们的医学文化为“后酒精文化”，即当你感觉不好时，你就吃点什么来让这种感觉消失。

And it turned out that that taking something didn't make the feelings go away, but wiggling your fingers in front of people's eyes as you think about the trauma made the trauma go away. 结果发现，吃点什么并不能让感觉消失，但当你想到创伤时，在人们眼前晃动手指却能让创伤消失。

And I go like, wow, this is really interesting. 我当时觉得，“哇，这真有趣。”

When I first got to see trauma and got intrigued with it, I looked at the treatments that we have. 当我第一次接触到创伤并对其产生兴趣时，我审视了我们现有的治疗方法。

And so I did the first study on Prozac for PTSD, the first study for Zoloft for PTSD and a number of other conventional drugs. 所以我做了第一个关于百优解治疗 PTSD 的研究，第一个关于左洛复治疗 PTSD 的研究，以及其他一些常规药物的研究。

What we found is it didn't work very well and we published those data in prestigious medical journals and people said, boy, van der Kolk is a great psychopharmacology researcher, but our results showed that they don't work very well. 我们发现它们效果不太好，我们将这些数据发表在享有盛誉的医学期刊上，人们说：“哇，van der Kolk 是个杰出的精神药理学研究者，但我们的研究结果表明，它们效果并不好。”

Somehow psychiatry never got the message that said, no drugs are not particularly helpful and the VA still spends billions of dollars on drugs that don't work. 不知何故，精神病学界从未收到信息，即“不，药物并没有特别大的帮助”，而退伍军人管理局仍然在无效药物上花费数十亿美元。

They were unable to go through the trajectory that I and most of my colleagues went through like, okay, if it doesn't work, let's see what else can work. 他们无法像我和我的大多数同事那样经历一个过程：“好吧，如果这不起作用，让我们看看还有什么可以起作用。”

行为的根源：自我保护的尝试

And people over ask me, how can you put up with all this misery that you hear? 人们经常问我：“你怎么能忍受你听到的所有这些痛苦？”

And I agree, it's not easy, but one of the things that helps you is to really understand that people do the best they can. 我同意，这不容易，但能帮助你的其中一件事是真正理解人们尽了他们最大的努力。

There's somebody who's enraged in response to a minor thing is not becoming enraged because they just are unpleasant, difficult people who don't try. 某人对小事感到愤怒，并不是因为他们就是不愉快、难相处、不努力的人。

No, they try. 不，他们有在努力。

People try to survive. 人们试图生存。

Every person tries to have the best possible life they can have, and sometimes it goes really wrong. 每个人都试图过上最好的生活，但有时事情会真的出错。

But for example, when you're a little kid and you don't feel like anybody's there to help you when you become distressed, you may learn that banging your head against the wall or stabbing yourself or burning yourself or starving yourself may make you feel better. 但举个例子，当你还是个小孩子，在痛苦时感觉没有人可以帮助你，你可能会学会撞墙、捅自己、烧伤自己或饿死自己，可能会让你感觉好些。

And so we can discover is that people do all kind of things that seem pretty weird sometimes on the surface to protect themselves. 所以我们可以发现，人们表面上会做各种看起来很奇怪的事情来保护自己。

ACEs 研究与行为的深层原因

There was a moments in sort of the history of our field that was particularly poignant in this regard. 在我们这个领域的历史中，有过一个特别感人的时刻。

Vince Felitti who is the internist who did the ACE study, the Adverse Childhood Experiences study, had a very important experience that he shared with all of us, which makes perfect sense to me. Vince Felitti，那位进行了 ACE 研究（不良童年经历研究）的内科医生，有一次非常重要的经历，他与我们所有人分享，这让我觉得非常合理。

He had a weight loss program and that's all he did. 他有一个减肥项目，仅此而已。

He was very proud of his weight loss program. 他为自己的减肥项目感到非常自豪。

And then one day a woman came to his office who had lost something like 150 pounds or something in the course of weight loss program and she came back three months later and she had regained almost all of her weight. 有一天，一位女士来到他的办公室，她在减肥项目中减掉了大约150磅的体重，三个月后她又回来了，体重几乎全部反弹。

He said, I didn't know people could gain so much weight in such a short period, what happened to you? 他说：“我没想到人们能在这么短的时间内增重这么多，你发生了什么？”

And she says, you know, Dr. Felitti your weight loss program was terrific, and I became svelte and people's reaction to me completely changed. 她说：“你知道，Felitti 医生，你的减肥项目很棒，我变得苗条了，人们对我的反应也完全改变了。”

So after my last visit to you where you complimented me about how well I was doing, I went back to my office and one of my coworkers said, "boy, you look really hot. 所以，在我最后一次拜访你，你称赞我做得很好之后，我回到办公室，我的一个同事说：“哇，你看起来真性感。

Would you like to go on a date tonight?" “今晚你想和我约会吗？”

And the moment he said that I started to eat and I haven't stopped eating because what I realized is overweight is overlooked. 就在他说完这句话的那一刻，我开始吃东西，而且一直没停下来，因为我意识到，超重被忽视了。

And the way I dealt with my childhood sexual abuse is to make myself grossly obese so nobody would have an interest in me in a sexual way. 我应对童年性虐待的方式就是让自己变得非常肥胖，这样就没有人会对我有性方面的兴趣了。

So that was one of these openings you get to see that some of the behaviors that you may condemn or be upset about actually are behaviors that start off try to take care of yourself. 所以这就是一个让你看到，某些你可能谴责或感到不满的行为，实际上是为了自我保护而开始的行为。

That actually is also true for drug abuse. 这同样适用于药物滥用。

People, you know, people say it's a biological illness, but it's not so simple. 人们，你知道，人们说这是一种生理疾病，但事情并非如此简单。

But, you know, if I say to you right now, oh, I have a little needle with some heroin in it, makes you feel good, would you like to try it, you'd say "you're crazy, I'm not gonna take heroin." 但是，你知道，如果我现在对你说：“哦，我这里有一小管海洛因，能让你感觉很好，你想试试吗？”你会说：“你疯了，我才不碰海洛因。”

But if you are in despair, and you don't know if you're going to make it through the night let's say I have a little drug here that can help you make it through the night, you go like, "please, please give to me." 但如果你处于绝望之中，不知道今晚是否能熬过去，我（假设）说：“我这里有一种小药丸可以帮助你熬过今晚。”你会说：“求求你了，快给我。”

That's where drug addiction comes from. 药物成瘾就由此而来。

That's also to a large degree our opioid epidemic comes from. 在很大程度上，这也是我们阿片类药物泛滥的原因。

It's also the stuff being made available to people, but, you know, among my colleagues who are, you know, have privileged lives, they don't become drug addicts because they have good lives. 这也是提供给人们的药物，但是，你知道，在我那些生活优越的同事中，他们不会成为瘾君子，因为他们的生活很好。

They don't need to cure something in terms of how upset they are but since time immemorial, people take drugs in order to deal with unbearable sensations. 他们不需要在情绪问题上寻求治愈，但自古以来，人们就服用药物来应对无法忍受的感觉。

The military had a huge drug problem during the Vietnam War because people take these drugs in order not to feel their pain. 越南战争期间，军队有一个巨大的毒品问题，因为人们服用这些药物是为了不感受痛苦。

If we really want to take care of drug abuse, we really have to look at social situations and circumstances that make people feel desperate and hopeless. 如果我们真的想解决药物滥用问题，我们必须审视那些让人们感到绝望和无助的社会状况和环境。

心理治疗的有效性：倾听与理解

Very good psychotherapy not to fix people, but helping people to know what they're feeling, find ways in which to cope with those feelings was really quite helpful. 非常好的心理治疗不是去“修复”人们，而是帮助人们认识自己的感受，找到应对这些感受的方法，这确实非常有帮助。

What was very clear is that being in a relationship where people can hear you, where you can talk about how badly you feel, but you can talk about your guilt and where you can start opening up where these feelings come from, how old these feelings are, and how you develop these feelings in response to particular things that happen to you, that was actually quite helpful. 非常清楚的是，处于一种关系中，在那里人们能听到你，你可以谈论你的糟糕感受，谈论你的内疚感，并且可以开始敞开心扉，谈论这些感受的来源、它们的年龄有多大，以及你如何因特定事件而产生这些感受，这实际上非常有帮助。

Finding words for your internal experience, which is oftentimes very difficult for traumatized people. 为内心的体验找到言语，这对受创伤的人来说往往非常困难。

They actually have impairment of being able to know themselves. 他们实际上存在识别自身状况的障碍。

Being able to discover who they are and how they got these reactions is very helpful. 能够发现他们是谁以及他们如何产生这些反应，是非常有帮助的。

EMDR 疗法：眼动脱敏再加工

And then for me, the opening to a new world came when some people in my clinic started to do something very strange, something called EMDR. 然后对我来说，通往新世界的大门是当我诊所里的一些人开始做一件非常奇怪的事情，叫做 EMDR（眼动脱敏再加工）。

Eye movement desensitization and reprocessing. 眼动脱敏再加工。

A technique where you ask people to call up the memory of what you saw back then, what you heard back then, what you felt back then, but you don't ask people to talk about it 'cause the moment you start talking about something, you get more preoccupied whether the person you're talking to understands you, likes you, is disgusted with you. 一种技术，你让人们回忆起当时看到、听到、感受到的记忆，但你不让人们谈论它，因为一旦你开始谈论，你就会更担心你说话的对象是否理解你、喜欢你、或者对你感到厌恶。

So it becomes an interpersonal process. 所以它变成了一个人际过程。

You ask people to just feel it and notice it. 你让人们只是去感受它，去注意到它。

And then what you do is that you ask people to follow your fingers as you move your fingers from side-to-side in front of their eyes. 然后你所做的就是让人们跟着你的手指，当你从侧面移动手指在他们眼前晃动时。

And my first reaction with my students and junior colleagues who do it is like, man, stop this crazy nonsense. 我第一次和我的学生及初级同事们一起做的时候，我的反应是：“老兄，别搞这些疯狂的胡闹了。”

This is a crazy method. 这是个疯狂的方法。

And then I got to see some of the results. 然后我看到了一些结果。

I go like, wow, this is interesting. 我当时想，“哇，这真有趣。”

This is different. 这很不一样。

And so I did a study funded by NIH funded because people saw me as a very good psychopharmacologist, not a guy who had gone off the deep end doing crazy methods like EMDR and they, everybody expected that we'd find that the drugs are much better than EMDR. 所以我做了一项由 NIH 资助的研究，因为人们认为我是一位非常优秀的精神药理学研究者，而不是一个去做 EMDR 这种疯狂方法的人，他们，每个人都期望我们会发现药物比 EMDR 好得多。

And what we found is that this crazy eye movement desensitization had amazing effects on people being able to let go of what happened to say yes, that's what happened to me. 而我们发现的是，这种疯狂的眼动脱敏疗法对人们能够放下所发生的事情，并说“是的，那确实发生在我身上”产生了惊人的效果。

And it happened a long time ago, it's not happening right now. 那发生在很久以前，现在并没有发生。

That was the first time that I saw a nonconventional technique have a very profound effect. 那是我第一次看到一种非传统技术产生如此深刻的影响。

And that really had a very deep effect on my thinking about treatment of trauma, and of course my colleague said, Bessel has gone off the deep end, the data on EMDR was still better than any data of the treatment outcome that anybody had studied, but people didn't want to go there because it's such crazy method. 这深刻地影响了我对创伤治疗的思考，当然我的同事们说：“Bessel 疯了”，EMDR 的数据仍然优于任何人研究过的治疗结果数据，但人们不愿意去尝试，因为它是一种如此疯狂的方法。

So I tried to get money to study what those eye movements do to the brain. 所以我试图获得资金来研究这些眼球运动对大脑有什么作用。

It took us about 15 years to collect money from other sources to finally do that study where we were able to show that you move your eyes from side-to-side, that you actually change brain circuits. 我们花了大约15年时间从其他渠道筹集资金，终于完成了那项研究，我们能够证明，当你左右移动眼睛时，你实际上在改变大脑的神经回路。

That changes the executive function of the brain, the default mode network of the brain and the salience network of the brain. 这改变了大脑的执行功能、大脑的默认模式网络和大脑的显着网络。

So what we discovered with all the other things that happened in neuroscience is that this strange eye movement that sounds so bizarre actually changed the circuitry of the brain to interpret your current reality from a different angle. 所以，我们在神经科学领域发生的其他所有事情中发现的是，这种听起来很奇怪的眼球运动实际上改变了大脑的电路，从而从不同的角度来解读你当前的现实。

But the discovery at this point is that our conventional way of thinking about it is not working, but strange stuff works. 但此时的发现是，我们传统的思维方式不起作用，但奇怪的东西却奏效了。

瑜伽与身体连接：疗愈的另一途径

And then a bunch of yoga teachers come to talk to me and say, we do yoga for PTSD. 然后，一群瑜伽老师来找我，说：“我们通过瑜伽治疗 PTSD。”

It seems to help people. “它似乎能帮助人们。”

And that made sense to me on some level, maybe if you do yoga, yoga can open up your relationship to your body, to your physical self. 这在某种程度上让我觉得有道理，也许如果你做瑜伽，瑜伽可以开启你与身体、与身体自我的关系。

You learn how to breathe calmly. 你学会如何平静地呼吸。

You can learn to pay attention to yourself. 你可以学会关注自己。

You get to see how different movements and different postures affect you. 你就能看到不同的动作和姿势如何影响你。

And so you form a deep relationship to your internal sensory system. 因此，你与你的内部感官系统建立了深厚的关系。

Trauma is carried in the sensations in your body and heartbreak and gut wrench and that you have been able to see in the brain is that your connection with your body becomes weaker and weaker so you don't feel your body anymore. 创伤存在于你身体的感觉中，以及心碎和肠胃绞痛。而你在大脑中可以看到的是，你与身体的联系变得越来越弱，所以你不再感受你的身体。

So you don't feel your pain anymore. 所以你不再感受你的痛苦。

Problem is that if you don't feel your pain anymore, you don't feel your pleasure anymore either. 问题是，如果你不再感受痛苦，你也不会再感受快乐。

I was reading an extraordinary case report of somebody who lost all sensations in their skin, in their bodies. 我读到了一篇非凡的病例报告，关于一个人失去了皮肤和身体的所有感觉。

And it's a very, very rare thing to happen to people. 这种情况对人们来说非常非常罕见。

And what people discovered is if you cannot have a sensation in your skin, you cannot have a sensation of pleasure. 而人们发现的是，如果你无法在皮肤上产生感觉，你就无法产生愉悦感。

A sensation of pleasure is carried by the corpuscles in our skin. 愉悦感是由我们皮肤中的神经小体传递的。

So we need to get pleasurable sensations coming from our body to get a sense of pleasure and joy. 所以我们需要从身体获得愉悦的感觉，才能获得愉悦和快乐。

And that was really interesting to me also because traumatized people, and that's left out of the definition, have a tremendous problem experiencing pleasure and joy. 这对我来说也很有趣，因为受创伤的人（而在定义中被忽略了）在体验快乐和喜悦方面存在巨大问题。

And we applied a number of times to study that. 我们曾多次申请研究这一点。

At the end we did get funded to the very first yoga study for PTSD, and what turned out is that the way the data looked to me, yoga at the end was a more effective treatment for PTSD than any of the drugs we had studied. 最终，我们获得了资助，进行了第一项关于瑜伽治疗 PTSD 的研究，结果数据显示，在我看来，瑜伽比我们研究过的任何药物都更有效地治疗 PTSD。

And we did a number of yoga studies, we published them in respected medical journals, but I've yet to see a psychopharmacology clinic being transformed to to yoga studio even though it's pretty clear that needing to feel safe in your body and to own your body and to feel all the sensation in your body is a critical aspect of healing from PTSD. 我们进行了多项瑜伽研究，并将它们发表在备受尊敬的医学期刊上，但我还没有看到一家精神药理学诊所转型为瑜伽工作室，尽管很明显，感到身体安全、拥有自己的身体并感受身体的所有感觉，是治愈 PTSD 的关键方面。

戏剧、运动与脑波反馈

The next thing that we studied was theater and movement. 接下来我们研究的是戏剧和运动。

And it turns out that playing different roles in your body helps you to feel that your body can feel differently depending on how you organize your relationship to yourself. 结果表明，通过身体扮演不同的角色，可以帮助你感受到身体会因你如何组织与自己的关系而产生不同的感觉。

So I live in the Berkshires and we have a great program here called Shakespeare in the Courts where if you're a juvenile delinquent in this country, you have a 50% chance that the judge will condemn you to become a Shakespearean actor. 我住在伯克郡，这里有一个很棒的项目叫做“法庭上的莎士比亚”，如果你是这个国家的青少年罪犯，你有 50% 的几率会被法官判处成为一名莎士比亚演员。

That's civilization, huh? 这就是文明，是吧？

And the Shakespeare program is enormously helpful because it helps people to feel their bodies and to feel what it feels like to be a king, and it feels like to be a warrior and it feels what it feels like to be Ophelia and you get to really have a deep experience of yourself in different possibilities. 而莎士比亚项目非常有帮助，因为它能帮助人们感受自己的身体，感受成为国王是什么感觉，成为战士是什么感觉，成为奥菲利娅是什么感觉，让你真正体验到自己不同的可能性。

We learned that, that you can actually put electrodes on your skull and you can harvest your brainwaves and project 'em on a computer screen and then you can program the computer screen so that when you make brainwaves that help you to be calm and focused so the computer game is working. 我们了解到，你实际上可以在头骨上放置电极，采集你的脑电波并将其投射到电脑屏幕上，然后你可以编程电脑屏幕，这样当你产生有助于平静和专注的脑电波时，电脑游戏就会运行。

And if your brain makes waves that don't do that, there's no computer game. 如果你的大脑产生的脑电波不这样做，电脑游戏就不会运行。

So your brain wants to play the computer game, but the moment you develop brainwaves that are not helpful to you, the screen goes blank so that your brain sort of wants to do the right thing and you can actually train people to make the right brainwaves, and that's another piece of research that they feel very proud of 'cause it's very hard to find funding for it that we really showed that we can change people's brain and brain connections by playing computer games again for your own brain, which is another important project that I'm working on and trying to implement in the various communities. 所以你的大脑想玩电脑游戏，但一旦你产生对你不利的脑电波，屏幕就会变黑，这样你的大脑就会想做正确的事情，你实际上可以训练人们产生正确的脑电波，这是我们另一项引以为豪的研究项目，因为很难为它找到资金，我们确实证明了通过玩电脑游戏来训练我们自己的大脑，可以改变人们的大脑和脑连接，这也是我正在进行并努力在各个社区推广的另一项重要项目。

And also I did a study of foster care children who are extremely outta control kids who have no prognosis to probably ever function very well because they're just too disorganized and too hurt. 我还对寄养儿童进行了一项研究，他们是极度失控的孩子，几乎没有可能正常生活，因为他们太混乱、太受伤了。

And we did very well with neurofeedback to help to calm their brains down and to learn and to be in classrooms and to have friends. 我们通过神经反馈取得了很好的效果，帮助他们平静大脑，学习，能够在教室里学习，交到朋友。

So there's all these things that at this point they're still called alternatives. 所以，所有这些事情，在这一点上，它们仍然被称为“替代疗法”。

That unless we go there, our patients continue get stuck on not getting better. 如果我们不采用这些方法，我们的病人就会一直停滞不前，无法好转。

You have to keep looking. 你必须不断探索。

迷幻药的潜力：MDMA 与创伤治疗

About 15 years ago, two guys came to talk to me, Rick Dolbin and Michael Mithoefer, and they said, Bessel, so you know a lot about trauma. 大约15年前，两个人来找我，Rick Dolbin 和 Michael Mithoefer，他们说：“Bessel，你对创伤很了解。”

What do you think about this idea? We are thinking about psychedelics. “你怎么看这个想法？我们正在考虑迷幻药。”

What do you think about psychedelics for trauma? “你认为迷幻药对创伤有什么看法？”

And I go like, wow, that you're speaking from my heart because of course I'm a child of the '60s and like everybody else who I know who grew up with me, we dabbled in LSD and psychedelic substances. 我当时想，“哇，你说出了我的心声”，因为我当然是60年代的产物，和我认识的那些和我一起长大的人一样，我们也曾尝试过 LSD 和迷幻物质。

I have a number of friends who are very well known scientists actually, and I asked my, have asked all of my friends, did you top acid as a college student also? 我有几个非常著名的科学家朋友，我问过我的所有朋友：“你们上大学时也吸食过 LSD 吗？”

And every one of my friends said, "sure did". 我的每个朋友都说：“当然吸过”。

And I said, how do you think it has affected your career? 我说：“你觉得这对你的职业生涯有什么影响？”

And everyone of my friends says, you know, I think I've become the creative scientist that I am because I took these substances because it allowed me to see that the reality that I was raised in that the reality that I see is a very small part of the overall reality that there is. 我的每个朋友都说：“你知道，我认为我之所以成为今天的创意科学家，是因为我服用过这些物质，它们让我看到，我成长的现实，我所看到的现实，只是存在的所有现实中非常小的一部分。”

Those sort of answers make me feel very curious because one thing that all of us who who know about trauma know is that when you get traumatized, you start living in a very narrow reality. 这些回答让我非常好奇，因为我们所有了解创伤的人都知道，当你受到创伤时，你就会开始生活在一个非常狭窄的现实中。

The reality of the war in Iraq. 伊拉克战争的现实。

The reality of your incest that colors everything you do. 你乱伦的现实，这会影响你所做的一切。

And so you become intellectually and emotionally quite a constricted person because you are always afraid to get hurt and you still feel like I'm about to get hurt again so that becomes your world. 所以你在智力和情感上都成为一个相当受束缚的人，因为你总是害怕受伤，你仍然感觉“我又要受伤了”，所以这就是你的世界。

I said to them, wouldn't it be great if you could do psychedelic substances to see if these substances can open up people's minds and to see that the reality that they live in is just a small part of the reality that there is? 我对他们说：“如果你们能使用迷幻药物，看看这些药物能否打开人们的心智，让他们看到他们所 lived 的现实只是存在现实的一小部分，那岂不是很棒？”

And then I said, don't do it. 然后我说：“别这么做。”

You're crazy. 你疯了。

These drugs are illegal. 这些药物是非法的。

I knew a whole bunch of people who did LSD and psilocybin research back when I was young. 我认识很多在我年轻时就进行 LSD 和裸盖菇素研究的人。

It helps to be around a little bit because I saw that revolution back then. 稍微接触一下会有帮助，因为我目睹了当时的革命。

I had Timothy Leary's offices at Harvard for a period of time. 我曾经在哈佛有过 Timothy Leary 的办公室。

I know what happened to all these guys. 我知道这些人都发生了什么。

I said to Rick and Michael, "Don't do it. It will destroy your career. You'll never get permission." 我对 Rick 和 Michael 说：“别这么做。这会毁了你的事业。你永远不会获得许可。”

And they said, "thank you very much for your opinion, we'll try it anyway." 他们说：“非常感谢您的意见，我们还是会尝试一下。”

And they try it anyway, and through great challenges and lawsuits, etcetera, they got permission to do a study of MDMA for trauma and it worked out pretty well. 他们还是尝试了，经过巨大的挑战和诉讼等等，他们获得了进行 MDMA 创伤研究的许可，结果相当不错。

And they got permission to do a second study, again. 他们再次获得了进行第二项研究的许可。

Very hard to do, and they did very well. 这非常难做到，但他们做得很好。

And then Rick Dolbin was able to collect a large amount of money, largely from Silicon Valley people to do a very large and extremely expensive study of MDMA, also known as ecstasy or molly. 然后 Rick Dolbin 能够筹集到大量资金，主要来自硅谷的人们，来进行一项非常大型且极其昂贵的 MDMA 研究，MDMA 也被称为摇头丸或 M 药。

When that happened, they asked me if I wanted to be the principal investigator of one of the sites; the sites in Boston. 当那发生时，他们问我是否想成为其中一个研究点的首席研究员；波士顿的研究点。

And I said, boy, I admire you so much for having been able to get the study off the ground, I would love to see what it does, but the main reason why I want to be involved in the study is to warn people not to get carried away 'cause last time people got carried away and the whole world collapsed. 我说：“天哪，我非常钦佩你们能够启动这项研究，我很想看看它有什么效果，但我之所以想参与这项研究，主要是为了警告人们不要得意忘形，因为上次人们得意忘形了，整个世界都崩溃了。”

And this time we need to be extremely careful so that if we find something, we do it very carefully and we don't get the backlash. 而这一次，我们需要极其小心，这样如果我们发现了什么，我们就要非常谨慎地去做，以免招致强烈反对。

We did the study, lots of different sites around the us, one in Israel, one in Canada. 我们进行了这项研究，在美国各地有许多不同的研究点，一个在以色列，一个在加拿大。

We saw remarkable results. 我们看到了非凡的结果。

The paper was published. 论文发表了。

Nature Medicine, very prestigious medical journal, that shows that the MDMA caused a very, very substantial drop in PTSD. 《自然医学》，一本非常著名的医学期刊，显示 MDMA 导致 PTSD 评分大幅下降。

Probably more than just about anything else we have studied, although I'm not 100% sure of that, but very dramatic. 可能比我们研究过的任何其他方法都效果更好，尽管我对此不是100%确定，但效果非常显著。

And then what comes up for me is, yeah, you know the PTSD score is interesting, but what we see in the people we work with is much more profound than just PTSD. 然后我想到的是，是的，你知道 PTSD 分数很有趣，但我们看到人们身上的变化，比仅仅是 PTSD 要深刻得多。

So let me tell you how the study is set up. 所以让我告诉你这项研究是如何进行的。

People apply to be in a study. 人们申请参加研究。

It's a very tough study to be in. 这是一项非常艰苦的研究。

It takes about nine months to do it. 大约需要九个月才能完成。

You come in, you get tested up the wazoo. 你进来，接受大量的测试。

You go off all your medications. 你停用所有药物。

You do a lot of tests. 你做很多测试。

You have a number of preparatory sessions, and then finally, after all the preparation, you have a whole day of taking ecstasy while you lie on the bed with the eye shade with two therapists in your room for eight hours. 你会有一些准备会，最后，在所有准备工作之后，你会在床上戴着眼罩，有两位治疗师陪同，进行一整天的摇头丸体验，持续八小时。

And stuff happens, which I'll talk about in a second. 然后事情发生了，我稍后会谈论。

You sort of calm down from the experience, you stay overnight, the next day we interview people again. 你从体验中平静下来，在那里过夜，第二天我们再次采访人们。

We interview people several times in between. 我们之间会进行多次采访。

You have your next experience, a month later number essentially in between, and you have your next experience again. 你会在一个月后进行下一次体验，期间会有几次访谈，然后你再次进行下一次体验。

It's not surprising that our control group where people get an inactive substance also do very well because people get very intensive psychotherapy alongside of the drug. 因此，我们的对照组（服用无效物质的人）也表现得很好，这并不奇怪，因为人们在服药的同时接受了非常密集的心理治疗。

So half people get drug, half people don't get the drug. 所以一半人服用药物，一半人不服用。

But what we see in the people who get the drug is amazing. 但我们在服用药物的人身上看到的是惊人的。

What we see is that people are able to go to places they have never felt safe to go to. 我们看到的是，人们能够去到他们从未感到安全的地方。

This is not a picnic. 这不是一件轻松的事。

People go and see their rape, they see their molestation, they see the horrible things that happened to them, but what MDMA does, it allows people to see themselves with compassion and rather them blaming themselves or getting freaked out. 人们会去看他们被强奸的场景，被猥亵的场景，看到那些发生在他们身上的可怕事情，但 MDMA 的作用是，它让人们能够带着同情心看待自己，而不是责怪自己或惊慌失措。

They go like, oh yeah, that's what happened to me back then. 他们会想：“哦，是的，那是当时发生在我身上的事。”

It was horrible. 那太可怕了。

But what we see is a profound transformation of the personality, not just PTSD. 但我们看到的是个性的深刻转变，而不仅仅是 PTSD。

And so I was very lucky that the organization asked me to analyze the- what is called the secondary data, which I'm doing right now. 所以我非常幸运，该组织让我分析——被称为二次数据，我目前正在这样做。

And the secondary data are, wow, they're just manner for my soul. 而二次数据，哇，简直是滋养我的灵魂。

It's like because it brings the mind back into psychiatry. 这就像是让心智回归精神病学。

After people take MDMA, they're able to talk about themselves, they're able to have compassion for themselves. 在人们服用 MDMA 后，他们能够谈论自己，能够对自己产生同情心。

They're much better able to say, this is what's going on with me. 他们更能清楚地说：“这就是我目前的情况。”

And so all these measures we have about self-perception and self-awareness just shoot up and people become owners of their own lives and they're able to say, yes, this what happened to me, but it's over. 所以我们所有的自我认知和自我意识的指标都飙升了，人们成为自己生活的主人，他们能够说：“是的，这是发生在我身上的事，但它已经结束了。”

And then we look at the whole issue of executive functioning, being able to make plans, being able to attune to other people, being able to feel alive. 然后我们研究整个执行功能的问题，能够制定计划，能够与他人协调，能够感受到生命的活力。

Big changes. 巨大的变化。

People could come to life. 人们重新焕发生机。

And when people are in difficult relationships, they say, honey, that's your problem. 当人们处于困难的关系中时，他们会说：“亲爱的，那是你的问题。”

That's not my problem. 那不是我的问题。

And people sometimes leave abusive relationship and they say, I don't need this abusive relationship. 人们有时会离开虐待性关系，并说：“我不需要这种虐待关系。”

I'm okay. I can take care of myself. “我很好。我能照顾好自己。”

And you see very profound existential transformations in people, and I think that's really at the end holds the promise that people can leave the trauma behind and not say, I'm a veteran who still screwed up. 你看到人们身上发生深刻的生存转变，我认为这最终带来了希望，人们可以放下创伤，不再说：“我是一个仍然搞砸了的退伍军人。”

Yes, I was a veteran back then, I was 18 years-old, but today I'm 23 years-old or 48 years-old or 60; and I'm a plumber, an electrician, a movie maker, whatever. “是的，我那时是个退伍军人，我18岁，但今天我23岁，或48岁，或60岁；我是一名水管工、电工、电影制作人，随便什么。”

And that's part of my experience, but it doesn't define who I am anymore. “这是我经历的一部分，但它不再定义我是谁了。”

It's remarkable. 这真是太了不起了。