重新思考抑郁症

这是隐藏的思维。

This is Hidden Brain.

我是尚卡尔·维丹塔。

I am Shankar Vedanta.

几个世纪以来，人们一直将发烧视为一种危险的疾病，一个必须被消灭的敌人。

For centuries, regarded fever as a dangerous disease, an enemy to be crushed.

在古代和中世纪医学中，发烧被认为是由血液中过热或体液失衡引起的，表明身体内部的平衡已严重失调。

In ancient and medieval medicine, fever was thought to represent an excess of heat or humor in the blood, a sign that the body's internal balance had gone dangerously askew.

治疗方法旨在驱除体内的热。

Treatments aimed to drive out the heat.

病人被放血、泻下，或被浇上冷水。

Patients were bled, purged, or doused with cold water.

有些人被裹在冰块里，或被给予旨在降温的饮食。

Some were packed in ice or fed diets designed to cool the blood.

直到十九世纪，发烧仍被广泛视为一种能够从内部吞噬人体的破坏性力量。

Well into the nineteenth century, fever was still widely feared as a destructive force that could consume a person from within.

医生们会开具含汞化合物、奎宁或大量酒精的处方。

Doctors prescribed mercury based compounds, quinine, or alcohol in large quantities.

患者会被要求接受退热治疗，比如长时间浸泡在冷水中，或被裹在醋浸透的床单里，所有这些都旨在迫使体温下降。

Patients were subjected to fever cures in which they were submerged in prolonged cold baths or were wrapped in vinegar soaked sheets all in the hope of forcing the body's temperature back down.

直到十九世纪末和二十世纪初，科学家们才开始认识到，发热并非一种疾病，而是人体免疫系统的自然反应。

It wasn't until the late nineteenth and early twentieth centuries that scientists began to recognize fever not as a disease but as a natural response of the body's immune system.

研究显示，真正的问题是感染，而不是发热。

Research showed that infections, not fever, were the real enemy.

研究表明，适度的发热实际上有助于身体对抗感染，通过减缓细菌生长和增强免疫功能。

Studies showed that moderate fever actually helped the body fight infection by slowing the growth of bacteria and enhancing immune function.

这一转变标志着医学观念的深刻变革。

This shift marked a profound change in medical thinking.

医生们不再盲目地抑制发热，而是开始将其视为身体活力和自我防御能力的体现。

Instead of reflexively suppressing fever, physicians began to see it as evidence of the body's vitality and capacity for self defense.

如今，虽然极高的发烧仍被视为危险并接受治疗，但轻度至中度发烧通常被允许自然发展——这默默承认了曾经被视为致命疾病的发热，实际上是身体强大的表现。

Today, while very high fevers are still considered dangerous and treated, mild to moderate fevers are often allowed to run their course a quiet acknowledgment that what was once seen as a deadly illness is in fact a sign of the body's strength.

今天在节目中，我们将探讨一个可能性：适用于我们身体健康的道理，或许也同样适用于我们的心理健康。

Today on the show, we investigate the possibility that what is true of our physical health may also be true of our mental health.

即使是像抑郁这样的顽疾，也可能源于我们强烈的求生与繁荣的本能。

That even a scourge like depression may have its roots in our powerful drive to survive and flourish.

抑郁的起源——本期《隐藏的思维》。

The Origins of Depression This week on Hidden Brain.

请注意，本故事涉及自杀话题。

A note that this story includes a discussion of suicide.

如果你或你所爱的人正遭受自杀念头的困扰，有人可以提供帮助。

If you or someone you love is struggling with thoughts of suicide, there are people who can help.

请拨打或发送短信至自杀与危机热线：988。

Call or text the Suicide and Crisis Lifeline at 988.

如果你身处美国以外的地区，我们已在节目笔记中提供了链接，帮助你查找本国的心理健康支持资源。

If you're outside The US, we've included a link in our episode notes where you can find mental health support in your country.

我们生活在一个崇尚力量与自信、赞美幸福与积极情绪的文化中。

We live in a culture that prizes strength and confidence and that celebrates happiness and high mood.

所以当这些事物悄然离去，当我们的精力消失，当快乐无影无踪时，我们自然会认为一定出了严重的问题。

So when those things slip away, when our energy disappears, when joy goes missing, we naturally assume that something must have gone very wrong.

我们会寻找需要解决的问题，需要治愈的疾病。

We look for a problem to fix, a disease to cure.

在康奈尔大学，心理学家乔纳森·罗滕伯格长期以来一直在思考，这种看待抑郁的方式是否正确。

At Cornell University, psychologist Jonathan Rottenberg has long asked if this is the right way to think about depression.

约翰·罗滕伯格，欢迎来到《隐藏的思维》。

John Rottenberg, welcome to Hidden Brain.

谢谢。

Thank you.

能和你们在一起真是太好了。

It's wonderful to be here with you.

三十年前，约翰，你是一个自信、从容的大学毕业生，正准备结婚并开启职业生涯。

Thirty years ago, John, you were a confident, self assured college graduate preparing to get married and to start a career.

那时你的生活是什么样子？你对未来有什么计划？

What was your life like at the time, and what were your plans for the future?

我当时在学习。

I was studying.

我在巴尔的摩的一个历史学博士项目中读书。

I was in a PhD program in history living in Baltimore.

在约翰斯·霍普金斯大学。

At Johns Hopkins University.

我研究美国历史，觉得自己是房间里最聪明的人。

I studied American history, and I thought I was the smartest guy in the room.

然后，我经历了一系列非常奇怪的事情，而我完全无法理解这些经历。

And I was then struck by a series of very bizarre experiences that I had no framework for understanding.

告诉我发生了什么。

Tell me what happened.

在很多方面，你的人生才刚刚开始。

In many ways, you had all of your life before you.

你已经从常春藤盟校毕业了。

You had graduated from an Ivy League school.

你快要结婚了。

You were about to get married.

你正在攻读博士学位，而且觉得自己是房间里最聪明的人。

You were doing this PhD, and you thought you were the smartest person in the room.

感觉一切都很顺利。

It felt like everything was going your way.

是的。

Yes.

所以当我开始感到不适时，我根本没有足够的框架去理解这些情况。

And so when I started to feel unwell, I didn't have really much of a framework to to go on.

我首先注意到一些毫无道理的身体症状。

I first noticed physical symptoms that didn't make a whole lot of sense.

我左边身体感到疼痛。

I had pain on the left side of my body.

我以为可能是心脏出了问题。

I thought there might be something wrong with my heart.

我感到身体虚弱。

I felt physically weak.

我觉得自己可能发烧了，或者得了类似流感的病。

Like, I thought I might have a fever or some kind of flu like illness.

我感觉极度疲惫。

I felt incredibly run down.

我以为它会自己好起来。

And I thought that it would just go away on its own.

然后其他问题开始了。

And then other problems started.

所以它没有好转，反而变得更糟了。

So rather than it getting better, it got worse.

开始发生变化的是，我的专注力、阅读能力和思考能力迅速衰退。

So what started to change was that my ability to focus, read, think, that degenerated pretty rapidly.

我用来理解世界的工具，这个真正定义了我是谁的工具——我的大脑、我的思维，不再正常运转了。

So this tool that I used to understand the world, this tool that really defined who I was, my brain, my mind, was not working right.

所以我现在在一个历史学项目里，正在写论文，却连一本书都读不下去了。

So here I am in a history program, and I'm working on a dissertation, and I can't read a book.

我的意思是，我能看见页面上的字，但注意力已经几乎为零了。

I mean, I can look at a page and I see the words, and my ability to concentrate is getting to be close to zero.

于是我开始感到害怕。

So I started to get scared.

这到底该怎么解释呢？

What could explain this?

我更加困惑了，感觉有什么可怕的事情正在我身上发生，却不知道到底是什么。

So I was even more baffled, and I felt like something terrible was happening to me, but I didn't know what it was.

这种情况是在什么时候才变得清晰起来的？

At what point did this clarify itself?

医生是什么时候给你做出诊断的，约翰？

At what point did doctors come up with a diagnosis, John?

花了好几个月。

It took months.

我记得回到家。

I remember going home.

我当时住在巴尔的摩，从那里回康涅狄格州，见到了一位我父亲同事的精神科医生。

I was living in Baltimore, home, and that was very difficult to Connecticut, and meeting with a psychiatrist who was a colleague of my father's.

我相信这位同事是第一个提出这可能是抑郁症的人。

And I believe that colleague was the first person to suggest that this might be depression.

这彻底颠覆了我的认知。

And that rocked my world.

我所经历的感觉，并不是我所理解的抑郁症症状，比如感到悲伤或对事物失去兴趣。

The sensations I was experiencing were not what I understood to be the symptoms of depression, which were feeling sad or just losing interest in things.

我更多感受到的是极度的疲惫和无法集中注意力。

I was really more experiencing this terrible fatigue, this inability to concentrate.

于是，我得到了转诊，去巴尔的摩见了一位精神科医生，并开始服药。

And so I did get a referral to see a psychiatrist in Baltimore, and I was started on medication.

但不幸的是，药物对我没有帮助。

And unfortunately, it didn't help me.

我继续挣扎，对这种情况越来越沮丧，功能也越来越退化。

And I continued to struggle and become more and more distraught over the situation and less and less functional.

所以我每天大部分时间都躺在地上。

So I was spending large parts of the day lying on the ground.

对于一个如此以自己的思维能力和智力为傲的人来说，我想知道你在经历这一切时是否感到羞耻。

Well, for someone who was so proud of his own mind and how his mind worked, I'm wondering if there was an element of shame that you felt as you were experiencing this.

是的，我感到羞辱，觉得自己完全迷失了，如果无法思考，我就不再认识自己，我失去了存在的理由。

Yes, I felt humiliated, and I felt completely, like I didn't know who I was if I couldn't think, that I had no I had no reason I had no reason for being.

我生命中没有任何目标。

I had no purpose in life.

这非常可怕，而治疗最初没有效果，让情况变得更糟。

And it was very scary, and the fact that the treatment did not initially help me made it worse.

我当时女友一直支持我，她陪在我身边。

And I had support of my then girlfriend, and she she stayed with me.

但我变得越来越难相处。

But I became more and more difficult to be around.

我变得情绪更加不稳定。

I became more emotionally volatile.

我花了好几个小时不停地哭泣。

I spent hours and hours crying.

我开始产生自杀的幻想，不想活下去，甚至觉得我根本没有未来，越来越难以想象自己会有未来。

I started to experience suicidal fantasies of not wanting to be alive or even believing that I simply wouldn't have a future, it became more and more difficult for me to imagine that I would have a future.

我不认为自己能从这种状态中走出来，因为抑郁感比我自身还要强大。

I didn't see myself as ever being able to emerge from this because the depression felt like it was bigger than me.

它比我更强。

It was stronger than me.

它比我更有力量。

It was more powerful than me.

这是一种令人绝望的无力感。

And that was a horrible feeling of powerlessness.

约翰，我想知道当时你是如何看待自己的未来的。

I'm wondering how you viewed your future at this time, John.

几个月前还那么光明的道路，这时对你来说是否已经关闭了呢？

Did the the path that seemed so bright some months earlier, did it seem that it had closed off for you?

完全关闭了。

Completely.

到这个时候，我已经从我的历史学项目中请了假。

By this point, I had gone on leave from my history program.

我告诉我的导师我可能不会回到这个项目了，这非常非常艰难。

I had told my adviser that I was probably not coming back to the program, which was very, very difficult.

未来的方向变得非常模糊。

And the path forward was very unclear.

我知道自己仍在继续与劳拉的关系，她愿意陪在我身边简直不可思议，但我并不确定自己能否挺过这一关。

I knew that I was somehow continuing with my relationship with Laura, which was incredible that she was staying with me, but I wasn't sure that I was gonna make it to the other side.

我真的非常怀疑自己能否挺过这一关。

I really had a lot of doubt that I was gonna make it to the other side.

我已经到了极限。

And I was at my limit.

每一天，我都觉得自己已经达到了所能承受的极限。

Every day, I felt I was at my absolute limit of what I could possibly bear.

我想，没有人能承受这样的痛苦。

I thought that no person no person can bear this.

我的意思是，我感觉自己完全被摧毁了。

I mean, I felt completely obliterated.

约翰，你的抑郁持续了多久？最后又是怎么结束的？

How long did your depression last, John, and and how did it finally come to an end?

我想，它持续了四年，期间我全身心投入心理学和情绪障碍的研究。

It lasted, I guess you could say, four years, and it involved my really dedicating myself and sinking myself into the study of psychology and into the study of mood disorders.

我申请了研究生院。

I applied to graduate school.

我想，也许我能重新救赎自己，也许我能修复自己的心智。

I thought maybe I can rehabilitate myself, maybe I can rehabilitate my mind.

奇迹般地，我被斯坦福大学的一个博士项目录取了——那正是我妻子的家乡，所以她欣喜若狂。

And miraculously, I was admitted to a PhD program, actually a really tremendous PhD program at Stanford University, and that was where my wife's family was from, and so she was overjoyed.

到那时，我们已经结婚并且即将迎来一个孩子。

By that point, we were married and expecting a child.

所以，我能够想象到，生活中还是有值得活下去的理由的，即使每天我都觉得自己在装样子。

So there were things, I could imagine that there were things to live for, even if I felt like I was faking it every day.

我仍然难以集中注意力。

I was still struggling to concentrate.

我对自己的能力能否胜任这个博士项目没有信心，但我决定试一试。

I did not feel confident in my ability to do this PhD program, but I was going to try.

能够有机会理解抑郁症，这个想法在我心中，是我唯一的希望。

And the idea that I would have the opportunity to understand depression, it felt like, in my heart, my only chance.

我认为这足以慢慢把我推向我需要去的方向，我逐渐回到了人间。

I think it was enough to gradually move me in the direction that I needed to be, and I sort of returned to the land of the living.

但这是一个渐进的过程。

But it was a gradual process.

当约翰·罗滕伯格最初陷入严重抑郁时，他是通过一种特定的视角来看待它的。

When John Rottenberg first fell into a severe depression, he saw it through a particular lens.

和我们许多人一样，他一直认为抑郁是一种性格缺陷或大脑化学物质的异常。

Like many of us, he had absorbed the notion that depression was a flaw in character or in brain chemistry.

他花了多年时间才以不同的视角看待自己的经历。

It took years for him to see his experience in a different light.

那就是我们回来的时候。

That's when we come back.

您正在收听《隐藏的思维》。

You're listening to Hidden Brain.

我是 Shankar Vedanta。

I'm Shankar Vedanta.

这是《隐藏的思维》。

This is Hidden Brain.

我是 Shankar Vedanta。

I'm Shankar Vedanta.

几十年来，我们一直被告诉抑郁是一种功能失调，是大脑化学物质的故障，或是认知回路的缺陷。

For several decades now, we've been told that depression is a malfunction, a glitch in our brain chemistry, a flaw in our cognitive wiring.

但在康奈尔大学，心理学家约翰·罗滕伯格表示，这种观点可能是错误的，或者至少是不完整的。

But at Cornell University, psychologist John Rottenberg says this account may be wrong or at least incomplete.

约翰，你会如何描述我们目前对抑郁症的主流看法？

John, how would you describe the prevailing model that we have of depression?

我们目前对抑郁症的主流看法是，抑郁症反映的是抑郁者内心的一种根本性缺陷。

The prevailing model that we have of depression is that depression reflects some fundamental defect that is inside the depressed person.

这种缺陷可能存在于人的思维中，比如一个人的思考方式；也可能存在于人的大脑中，比如神经元之间循环的化学物质。

That defect might be in the person's mind, like the way that the person thinks, Or that defect might be in the person's brain, like in the chemicals that are circulating between the neurons.

或者这种缺陷可能存在于人与他人的互动方式中。

Or that defect might be in how the person is interacting with other people.

但归根结底，人们之所以抑郁，是因为他们自身存在某种根本性的缺陷或多种缺陷，这些缺陷解释了他们为何会经历或反复经历抑郁发作。

But in the final analysis, the reason that people are depressed is that they have some fundamental defect or defects inside themselves that explain why they are subject to episode or repeated episodes of depression.

你说缺陷模型常常将抑郁症归咎于异常的大脑化学物质，并声称抗抑郁药是解决方案，但证据并不完全支持这一观点。

You say that the defect model often blames depression on faulty brain chemistry and claims that antidepressants are the solution, but that the evidence doesn't fully support this idea.

为什么会这样呢，约翰？

How so, John?

人们研究抑郁症的生物学因素已经五十年、六十年、七十年了。

People have been studying the biological contributions to depression for fifty, sixty, seventy years.

我相信抑郁症确实涉及一些生物学因素。

And I do believe that part of depression involves biological factors.

但这和说抑郁症是由大脑中的单一生物学原因引起的，是完全不同的。

But that's very different from saying that there is a biological cause, a single cause in the brain.

寻找抗抑郁药催生了大量的治疗方法。

And the search for antidepressants has led to a large number of therapies.

目前有二十多种不同的抗抑郁药，但没有一种可以被称为治愈手段。

There's over 20 different antidepressants, but none of them could be called a cure.

我认为，经常用来描述化学失衡的这个比喻有点误导性，因为这种失衡从未被真正分离出来。

And I do think it's a bit misleading, this metaphor that's often used to talk about a chemical imbalance, because that imbalance has never been isolated.

它从未被完全阐明。

It's never been fully characterized.

它无法被测量。

It can't be measured.

因此，你所拥有的是一些对许多人有用但依赖于隐喻的治疗方法。

And so what you have are treatments which are useful for many people, but it relies on a metaphor.

患者前来寻求帮助。

The patient comes in and wants help.

医生或精神科医生可能会告诉他们，他们有化学物质失衡，但问题是，你无法向他们展示具体的数值，也无法证明治疗正在改变这个数值。

The physician or psychiatrist might tell them that they have a chemical imbalance, but the problem is you can't present to them their number, and you can't show that the treatment is changing that number.

所以你实际上是在做空洞的敷衍。

So you're really engaging in hand waving.

我认为这并没有充分反映我们现有的知识水平，也没有对真正挣扎的人保持完全坦诚。

And I don't think that's doing a full service to our level of knowledge and being fully candid with with people who are really struggling.

这与例如医生担心你胆固醇过高时的情况形成对比，你可以通过血液检测实际显示你的胆固醇水平。

So this would be in contrast to something like, you know, if a physician worries that you have high cholesterol, you can take a blood test and actually show what your cholesterol levels are.

通过合适的药物，你可以展示你的胆固醇水平正在发生变化。

And with the right medications, you can then show that your cholesterol levels are changing.

你是在说，当涉及到像抑郁症这样的情况时，不存在类似的系统。

You're saying that no similar system exists when it comes to something like depression.

对。

Correct.

因此，这种疾病模型或缺陷模型中涉及的主要神经递质之一是血清素。

So one of the main neurotransmitters that's implicated in this disease model or defect model is serotonin.

目前没有办法检测你大脑中的血清素水平，就像你能检测胆固醇或胰岛素那样。

There's no way to assay serotonin and give your reading where you are with respect to serotonin right now in your brain like you can with cholesterol or you can with insulin.

抑郁症确实涉及生物学因素，但它并不像糖尿病或亨廷顿病那样是一种明确的疾病。

So depression involves biology, but it's not a disease in the same way that diabetes is a disease or Huntington's disease is a disease.

在那种情况下，我们知道哪些基因负责，也理解这些基因如何运作以及它们与这种神经疾病症状的关系。

I mean, in that case, we know what genes are responsible, and we understand what those genes are doing and how it relates to the symptoms of this neurological disorder.

而关于抑郁症，我们的理解要模糊得多。

Depression, the understanding is much more diffuse.

也许它和血清素有关。

Like, maybe it has something to do with serotonin.

也许它和多巴胺有关。

Maybe it has something to do with dopamine.

这是完全不同的理解层次。

That's a very different level of understanding.

另一种看待缺陷模型的方式是，它将抑郁症归咎于认知缺陷，并认为正确的心理治疗就是解决方案。

Another way to think about the defect model blames depression on faulty cognition and claims that the solution is the right kind of psychotherapy.

但你说，证据也并不完全支持这种解释吗？

But you say that the evidence doesn't fully support this explanation either?

嗯，我认为所有这些疗法都是有效的。

Well, I think that all of these are valid therapies.

所以，如果你正在经历抑郁症，药物治疗是一种选择，认知行为疗法也是一种选择。

So if you're struggling with depression, medications are an option, and cognitive behavioral therapy is an option.

拥有多种选择是件好事。

And that's a good thing to have multiple options.

但同样，这与声称人们之所以会抑郁，是因为他们的思维方式中存在根本性的认知缺陷，是完全不同的说法。

But again, that's very different from saying that the reason that people become depressed in the first place is because there is something fundamentally deficient in their cognition in the way that they're thinking.

相反，这些认知变化可能是维持抑郁状态的一部分，因此心理治疗才可能有效。

It could be instead that these changes in cognition are part of what's maintaining the depression, which is why the therapy can be useful.

所以我确实相信认知行为疗法非常有帮助，它能协助人们度过抑郁发作，而认知行为疗法中学到的技能有助于维持人们的良好状态。

So I do believe that cognitive behavioral therapies can be really helpful, only in helping people resolve a depression episode, but the skills that are learned in cognitive behavioral therapy can be useful in keeping people well.

所以我确实认为认知是导致抑郁的一个因素。

So I do believe that cognition is a contributing factor to depression.

但这与说所有抑郁患者在看待世界的方式上都有某种缺陷或不足是完全不同的。

But that, again, is different than saying that people who were depressed all are somehow defective or deficient in how they think about the world.

约翰的观点并不是说药物和心理治疗无效，应该被抛弃。

John's point is not that medications and psychotherapy are ineffective and should be discarded.

他认为它们已经帮助了数百万人，并且还能帮助更多人。

He thinks they have helped millions and could help millions more.

他的观点仅仅是，抑郁并不一定意味着大脑出了问题。

His point is only that depression is not necessarily evidence that there is something wrong with the brain.

事实上，他认为抑郁的能力是大脑中固有的。

In fact, he believes the capacity for depression is wired into the brain.

毫无疑问，自然赋予了我们产生低落情绪的能力。

There's no question that nature built us with the capacity for low mood.

一旦你具备了低落情绪的能力，你就具备了更严重、更持久的低落情绪的能力。

And once you have that capacity for low mood, you have the capacity for more serious, more severe, more long lasting low mood.

因此，这是一种非常重要的适应机制。

And so that is a very important adaptation.

情绪整合了所有内部和外部环境的输入信息。

Mood is what is integrating all of the inputs, both inside of your body and outside in your environment.

而情绪正是在问：我接下来该做什么？

And mood is the thing that's asking the question, what should I do next?

我所处的这个环境是适合行动的，还是不适合行动的？

Is this environment that I'm in good for action or is it bad for action?

低落情绪是令人不快的，就像疼痛令人不快、焦虑令人不快一样，但我认为人们更容易理解疼痛是一种进化出来的机制，帮助我们保护身体免受物理伤害，而焦虑则是一种帮助我们避开威胁的机制。

And so low moods are unpleasant, just as pain is unpleasant, anxiety is unpleasant, but I think it's easier for people to see that pain is an evolved mechanism that allows us to protect our body from physical damage, and anxiety is a mechanism that allows us to avoid threats.

但情绪的目的是什么？

But what is the purpose of mood?

人们更难看出情绪本身可能具有某种目的，但它实际上与焦虑、疼痛以及其他如发烧等保护机制有着极大的相似性。

It's harder for people to see that mood itself could have a purpose, but it actually is sharing a great amount of similarity with anxiety, with pain, and with other mechanisms like fever that are protecting us.

从进化角度来看，约翰，你认为情绪实际上在为我们做什么？

From an evolutionary perspective, John, what do you think mood is actually doing for us?

它在告诉我们：是继续前进，还是应该停止？

It's telling us, should we proceed or should we stop?

所以，如果你从最基础的层面来想，比如一只小型觅食动物，它来到了一片草地上，但这里没有可以吃的草叶。

So if you think at the most basic level of a little foraging animal where it's reached a patch of grass where there no leaves of grass to eat.

而它环顾四周，到处都没有可以吃的草叶。

And everywhere it looks, there's no leaves of grass to eat.

这个生物是该继续移动，还是应该停下来？

Should the organism keep moving or should the organism stop?

放大来看，想象一场大饥荒，没有任何食物可用。

Writ large, imagine there's a famine and there's no food available.

情绪是一种停止机制。

Mood is a stop mechanism.

当我们谈到人类时，引发低落情绪的情境变得远比对身体安全的威胁更加复杂。

And when we come to humans, the situations that can prompt low mood become much more complicated than threats to your physical well-being.

它们还涉及你未来生存和繁衍的前景。

They involve also your future prospects for survival and reproduction.

当你面临两难抉择，不确定是该继续还是该停止时，就会体验到低落的情绪。

You experience low mood when there is a dilemma, and it is uncertain whether or not you should proceed or whether you should stop.

低落的情绪迫使你比你愿意的更久地思考这种状况。

And low mood forces you to think about the situation maybe longer than you would like.

但如果没有它，我们会让自己陷入危险，并且会贸然前进。

But without it, subject ourselves to harm, and we would be moving forward rashly.

我的意思是，想想一个人去世后会发生什么。

I mean, think about what happens after someone dies.

会有葬礼。

There's a funeral.

所有人都会聚在一起。

Everyone comes together.

他们并不感到愉快，但他们会将这一刻视为重要的节点：我必须弄清楚我是谁，以及没有这个人，我该如何继续生活。

They do not feel good, but they mark this as an important moment where I have to figure out who am I and how will I continue without this person in my life.

我认为每个人都会认为悲伤是一种自然的、不可避免的过程。

And I think everyone would would see that grief is a natural process, an inevitable process.

这是一种跨文化的历程。

It's a cross cultural process.

甚至在其他物种中也能观察到。

It's even observed in other species.

而且，和抑郁一样，它非常令人不快。

And it, again, like depression, is very unpleasant.

这是一种非常艰难的状态。

It's a very difficult state.

因此，自然并不以我们的幸福为优化目标。

So nature is not optimized for our happiness.

自然更关心的是我们能否生存和繁衍，而不是我们是否体验到快乐。

Nature really cares more that we survive and reproduce than that we experience joy.

你知道，我的抑郁实际上符合其中一些特征，因为我曾投入了大量精力在成为历史学家的人生规划上。

You know, my depression actually fits some of these parameters in that I had invested so much in this life plan to become a historian.

而且我觉得我当时就感觉到，作为一名历史学家找到工作会很困难，我的身体似乎在告诉我：你别再追求这条路了。

And that I think I sensed that I was gonna have difficulty getting a job as a historian, and my body was kind of saying, you're not going to pursue this.

于是我被迫停下脚步，违心地重新思考，制定一个新的生活计划——这绝非易事，但最终却把我引向了一个更可行的未来。

And so I was forced to stop and reconsider, kind of against my will, and come up with a new life plan, which was not an easy process at all, but did ultimately put me on a path towards a more viable future for myself.

你知道，我们之前曾与东北大学的丽莎·费德曼·巴瑞特讨论过大脑的问题。

You know, we talked with Lisa Feldman Barrett at Northeastern University some time ago Brain.

她在情绪领域提出的一个有趣且富有争议的观点是：情绪并非对世界的反应，而是对世界的预测。

And one of her interesting and provocative ideas when it comes to the world of emotions is she argues that emotions are predictions about the world rather than reactions to the world.

情绪本质上是一种指引，告诉我们：向前走，去追求这个，这会很有趣，保持兴奋，充满活力；或者反过来，退后，小心，害怕，这里很危险。

They are basically guides that tell us, go forward, seek this out, this is gonna be fun, be excited, have high energy, or on the other hand, withdraw, be careful, be afraid, something is dangerous here.

因此，当我们把情绪视为预测而非反应时，这与你的观点非常契合——即情绪在某种程度上是一种指引，告诉我们接下来该做什么。

So when we think about emotions as predictors as opposed to reactions, that fits very well with your thesis that moods in some ways are a guide telling us what to do next.

我完全同意这一点。

I completely agree with that.

已经发生的事，就像泼出去的水，无法挽回了。

What's already happened is spilled milk.

从进化的角度来看，这并不重要。

From the perspective of evolution, it doesn't matter.

举个例子，我记得9·11事件时，看着飞机撞上双子塔，我立刻感到恐惧、悲伤和愤怒。

To give an example, I remember nineeleven and watching the planes hit the towers, and I felt immediate terror, and I felt immediate sadness, and I felt immediate rage.

但这都是关于未来的。

But it was about the future.

那些感受确实关乎未来，因为当时我们都在问：谁干的？接下来会发生什么？我们现在所处的地方安全吗？

It really was those feelings were about the future because there were the questions about who had done this and what would happen next and were we safe where we were right now?

那些肇事者必须付出代价。

And whoever did this had to pay.

我认为人们以为自己是在对已经发生的事做出反应，但真正让这些情绪如此强烈的是它们对未来的潜在影响。

I think that people thought that they were reacting against what had happened, but it was really the implications for the future that made those feelings so strong.

所以我同意，我们的情绪是为了帮助我们在当下做出必要的行动，而这是一个面向未来的过程。

So I agree that our feelings are there to help us do what we need to do in the moment, and that's a future oriented system.

再深入一点，你曾告诉我，你的抑郁有多严重，感觉看不到任何尽头。

To bear down on this just a moment longer, you told me how debilitating your depression was, how you felt like there was no end in sight.

你甚至有过结束自己生命的念头。

You even had thoughts of ending your own life.

一种如此 debilitating 的状况，一种让你考虑自杀的状况，怎么会被理解为一种有益的适应呢？

How could a condition that is so disabling, a condition that, you know, prompted you to consider suicide, how could this be understood as a beneficial adaptation?

我认为，在我们当代生活中，抑郁症的许多方面并没有对我们起到积极作用。

Well, I think that there's many things about depression in our contemporary life that are not serving us well.

我的观点只是，原始的适应机制是有用的，并不是说每一次抑郁情绪都有用。

My point only is that the original adaptation is useful, not that every instance of depressed mood is useful.

事实上，适应机制形成时的环境与我们当前的环境之间可能存在不匹配。

And in fact, there can be mismatches between the environment in which the adaptation emerged in our current environment.

我还想特别提出一点，这是人类抑郁症独有的：语言的力量以及它对抑郁发作的影响。

Another thing that I really want to bring up that is unique to humans in human depression is the power of language and what that does to depressive episodes.

因为从进化角度来看，重要的是要记住，这种适应机制在多个物种中都存在。

Because I think in an evolutionary perspective, it's important to keep in mind that this adaptation is seen across species.

因此，我们可以谈论小鼠的抑郁或狗的抑郁。

And so we can talk about mouse depression or dog depression.

但我的狗，我有一只叫赛勒斯的狗，我认为在他的生命中，肯定有过环境不理想、也许感到抑郁的时候。

But my dog, I had a dog Cyrus, and I think that there probably were times in his life when his environment was unpropitious and maybe he was depressed.

但赛勒斯并没有责备自己。

But Cyrus did not get down on himself.

他没有说自己作为一只狗很失败。

He did not say that he was failing as a dog.

他也没有说，自己根本不该来到这个世界。

He didn't say that he should never have been born.

对吧？

Right?

这听起来有点好笑，但我完全是认真的：正因为人类拥有独特的自我认知和自我叙事能力，人类的抑郁才会变得如此深刻和可怕。

It's funny, but I mean this in all seriousness that these are some of the things because of our unique ability use and to have a self view and a self story that human depression can be much, much more deep and terrifying.

我们利用了一些让我们区别于其他物种、并某种程度上掌控整个地球的工具，但这些工具也反过来被用来对付我们自己。

We're using some of the tools that enabled us to differentiate ourselves from other species and have, in a sense, mastery of the entire earth, but these are some of the tools that are also used against ourselves.

所以，这依然是一个完全合理的适应机制，但在一个高度聪明、善于运用语言的人手中，我们反而成了自己最大的敌人。

So again, a perfectly good adaptation, but in the hands of a highly intelligent person using language, we become our own worst enemies.

所以某种程度上，约翰，我听到你说的是，正如你所讨论的，焦虑的能力其实是好事，因为它让我们警惕捕食者或威胁。

So in some ways, what I hear you saying, John, is that, you know, as you discussed, the capacity for anxiety is a good thing, which is that it's important to be on the lookout for predators or threats.

在我们的进化历史中，这是一种非常有用的适应机制。

And in our evolutionary history, this was a very useful adaptation.

但在我们当今生活的现代世界里，我们被大量关于潜在威胁的信息所淹没。

But in the modern world in which we live, we are inundated with stories about things that could be threatening.

我们在阅读博客文章。

We're reading blog posts.

我们在阅读报纸文章。

We're reading newspaper articles.

我们在观看有线电视。

We're watching cable television.

我们在社交媒体上，不断被告知环境中存在的各种威胁。

We're on social media, and we're constantly being told about all the threats that are in our environments.

这种自然且健康的恐惧反应和对威胁的警觉，如今却被推到了极致，因为我们所处的环境不断反复地按下这个按钮。

This natural, healthy adaptation to experience fear, to be wary of threats, now gets put into hyperdrive because we are in an environment that is constantly pressing that button over and over again.

你想要表达的就是这一点吗？

Is that the point that you're making?

这正是我想表达的观点。

It is the point that I'm making.

但我在谈论抑郁时会稍作不同，因为一些环境因素涉及我们的文化。

And I make it a little bit different for depression because some of the environmental factors involve our culture.

所以，例如，我们不仅仅体验自己的情绪。

So for example, we don't simply experience our mood.

我们还会将自己的情绪与我们认为自己应该体验的，或认为他人正在体验的情绪进行比较。

We also experience our mood relative to what we believe we should be experiencing, or what we believe other people are experiencing.

因此，社交媒体这一现象彻底改变了人们体验情绪的方式，因为人们在社交媒体上常常展示的是充满极致喜悦和一系列精彩经历的生活。

So this phenomenon of social media has really changed how people experience their mood, because what people often project on social media are lives where I am leading an ecstatic existence of a series of amazing experiences.

如果你看到他人的社交媒体动态，你可能会认为他人正经历着异常积极的情绪，从而让你质疑：为什么我没有这样的体验？

And if you witness other people's social media feeds, you may come to believe that other people are experiencing off the charts positive affect, leads you to ask the question, why am I not experiencing this?

因此，你在自己认为应该感受的情绪、实际感受的情绪，以及你认为他人正在感受的情绪之间，体验到了巨大的落差。

So you're experiencing a big discrepancy between what you believe you ought to be feeling and what you are feeling and what you believe other people are feeling.

因此，在这种环境中，你的情绪变成了一个大问题。

So your mood becomes a big problem in this environment.

然后你开始问自己：我怎么了，为什么会这样感觉？

And then you start to ask the question, What is wrong with me that I feel this way?

我相信，现在有更多人提出这个问题，比人类历史上任何时候都要多。

And I believe that more people are asking that question right now than have ever asked that question in human history.

当然，如果我想起我十九世纪的俄罗斯和东欧农民祖先，他们生活在村庄里，我不认为他们时时刻刻都在想：我为什么会有这样的感受？

Certainly, if I think about my Russian and Eastern European peasant ancestors in the nineteenth century who were living in villages, I do not think that they were all the time thinking, What is wrong with the way that I am feeling?

我认为，当时人们对负面情绪有更大的接受度，认为这些情绪是正常且可预期的。

I think there was a greater acceptance that negative emotions perhaps were par for the course to be expected.

因此，我们当代环境中有一些因素可能正在加剧低落情绪。

So there's a number of things that are going on in our contemporary environment that are probably exacerbating low mood.

所以，这里的问题可能并不是社会比较本身，因为正如你所指出的，在我们的祖先环境中，某种程度的社会比较可能是有益的。

So here again, the problem might not be social comparison per se, because again, as you point out, in our ancestral environments, perhaps some social comparison was useful.

如果有人建了一座比你更好的小屋，那你就会学会如何建造更好的小屋。

If somebody figured out how to build a better hut than your hut, then you learn to build a better hut yourself.

但现在我们面对的是与数百万人的社交比较，那些运动能力更强的人、晚餐更精致的人、关系更幸福的人。

But now we're confronted with social comparison with millions of other people, people who are better athletes, people who are eating nicer dinners, people who are in happier relationships.

我们不断问自己：为什么我总是达不到标准？

And we're constantly asking ourselves the question, why is it that I have fallen short?

完全正确。

Completely.

但与小屋的例子不同，你至少能看到小屋是什么样子。

And, as opposed to the example of the hut, well, see what the hut looks like.

但事实上，我们并不了解任何人真正经历着什么。

But the truth is, we don't know what anyone is experiencing.

因此，当我们做出这些比较时，本质上是在黑暗中摸索。

So we're really in the dark fundamentally when we make these comparisons.

我们所拥有的，只是别人所说或所展现的样子。

All we have are what other people say or what other people look like.

不幸的是，在我们的文化中，关于低落情绪的透明度非常低。

And unfortunately, in our culture, there isn't a lot of transparency about low mood.

人们不想在自己的Facebook主页上发帖说：‘我今天心情低落。’

People don't want to post on their Facebook profile, I'm having a low mood day.

当人们真的发布这样的内容时，往往也不知道该如何回应。

And people often don't know how to react when they do post such a thing.

约翰，你还观察到，我们现代文化促使人们以可能让自己陷入不快乐的方式追求幸福。

You also observed, John, that our modern culture leads people to pursue happiness in ways that may set themselves up for unhappiness.

你这是什么意思？

What do you mean by this?

嗯，

Well,

我认为在当今的环境中，许多人为自己设定了非常不切实际的目标。

I believe in our contemporary environment, a lot of people have developed very unrealistic goals for themselves.

例如，年轻人会说：‘我要成为亿万富翁’，或者‘我要在社交媒体上积累一千万粉丝’，或者‘我要美到极致，成为时尚模特，让全世界的人都关注我’——不幸的是，很少有人能实现这些极不现实的目标。

For example, in young people saying, I'm going to be a billionaire, or I'm going to amass 10,000,000 followers on social media, or I'm going to be the most beautiful so that I will be a fashion model and people will follow me all around the world, that unfortunately, very few people will succeed at these very unrealistic goals.

因此，如果你的幸福取决于实现这些目标，就很容易感到抑郁。

And consequently, if your happiness is contingent on reaching these goals, will tend to feel depressed.

约翰，你能谈一谈在美国，我们实际上把追求幸福写入了我们的基本文献之一吗？

Can you talk a moment, John, about how in The United States we've actually written the pursuit of happiness into one of our foundational documents?

你认为这对我们的心态有什么影响？

What do you think that does to our mental states?

追求幸福这个理念显然由来已久。

Well, the idea of pursuing happiness obviously is very old.

你说得对，托马斯·杰斐逊在《独立宣言》中将其列为人类基本的渴望。

And you're right, Thomas Jefferson included that in the Declaration of Independence as a fundamental human aspiration.

我认为关键在于如何追求幸福，对吧？

I think the question is how to pursue happiness, right?

那么，幸福是当你追求生活中其他有意义的事情时，一路体验到的感受吗？

So is it that happiness is something that you experience along the way as you pursue other things that are meaningful in your life?

比如组建家庭、从事有意义的工作，或者帮助他人？

So for example, starting a family or meaningful work or helping others?

还是说幸福本身就是最终目标？

Or is happiness an end in itself?

也就是说，我现在就想获得幸福，我需要弄清楚今天做什么才能立刻感到快乐。

Meaning, I want happiness now, and I need to figure out what I will do today to feel happy right now.

这两者截然不同。

Those are very different.

我认为许多人已经开始训练自己，把幸福视为一种短期现象。

And I think many people have started to train themselves on thinking about happiness as a short term phenomenon.

我不确定托马斯·杰斐逊当年认为，追求幸福意味着18世纪的农民必须找到方法在今天体验到欣快感。

And I'm not sure that Thomas Jefferson was thinking that the pursuit of happiness meant that the eighteenth century farmers needed to find a way to experience euphoria today.

我们的文化已经接受了这样一种观念：抑郁是我们内心出了问题的标志。

Our culture has embraced the idea that depression is a sign of something broken within us.

但约翰关于情感信号的研究表明，抑郁可能源自帮助我们适应和生存的同一情绪系统。

But John's research in affective signs suggests that depression might emerge from the same mood system that helps us to adapt and survive.

当我们回来时，将重新讲述关于抑郁的故事，一个能带来更深理解与希望的故事。

When we come back, writing a new story about depression, one that offers greater understanding and hope.

您正在收听《隐藏的思维》。

You are listening to Hidden Brain.

我是尚卡尔·韦达anta。

I am Shankar Vedanta.

这是隐藏的思维。

This is Hidden Brain.

我是尚卡尔·韦达anta。

I am Shankar Vedanta.

心理学家约翰·罗滕伯格研究抑郁症及其成因。

Psychologist John Rottenberg studies depression and where it comes from.

如果你有关于自己情绪斗争的个人故事，或者有想与《隐藏的思维》听众分享的后续问题或评论，请找一个非常安静的房间，用手机录一段语音备忘录。

If you have a personal story about your own battles with your moods or follow-up questions or comments that you would be willing to share with the Hidden Brain audience, please find a very quiet room and record a voice memo on your phone.

将它发送至 feedbackhiddenbrain dot org。

Email it to us at feedbackhiddenbrain dot org.

邮件主题请写：depression。

Use the subject line depression.

这个邮箱地址是 feedbackhiddenbrain dot org。

That email address again is feedbackhiddenbrain dot org.

约翰，你说你努力反驳抑郁症的缺陷模型，其中一个方面是研究你所说的抑郁症及其他心理障碍中的积极面。

John, you say that part of your effort to push back against the defect model of depression is to investigate what you call silver linings in depression and other psychological disorders.

你所说的积极面是什么意思？

What do you mean by silver linings?

历史上，人们一直认为，随着抑郁症的发生，患者会遭受进一步的伤害。

Well, historically, the idea has been that as people experience depression, they experience further damage.

每一次抑郁发作都会损害你的关系、身体和心智，但这种观点忽略了人们在抑郁发作中主动适应和学习的方式，以及这些发作如何真正成为意义、变革和更美好未来的推动力。

Each episode of depression damages your relationships, damages your body, damages your mind, and that leaves out the active ways that people adapt and learn from their depressive episodes, and the ways that these episodes can actually be engines of meaning, engines of change, engines for a better future.

实际上，我认为这么说不太好，因为很多人很难接受这一点，但这些人反而因此变得更好了。

And the person is actually, I hate to say it because I think many people find this difficult to accept, the better for it.

在你自己的抑郁过程中，你也学到了一些重要的东西。

In the course of your own depression, you learn some important things yourself.

其中之一就是，原来身边的人真的一直在你身边。

One of them is that people were really there for you.

这确实非常真实。

That's deeply true.

我一开始，大概24岁的时候，很可贵地作为一个独立的人，但通过抑郁，我学会了依赖他人是完全可以的，而且每个人都会轮到需要帮助的时候。

I started out, I think, as a 24 year old, laudably as an independent person, but I learned through my depression how much it's okay to to lean on other people and that everyone gets a turn.

我想知道，你自己经历了这么多痛苦之后，是否对经历过同样事情的人产生了更深的同理心？

I'm wondering whether you felt greater empathy for others who've been through the same thing as a result of going through so much suffering yourself.

是的。

I did.

而且我认为这并不仅仅是我一个人这样。

And I don't think it's only me.

我认为抑郁的另一个所谓‘积极面’是，你会对别人的痛苦产生更多的同情。

I think another, you could say, silver lining of depression is that you do develop compassion for other people's suffering.

因为你有了这种体验，即使别人承受痛苦的原因不同，或痛苦的形式不同，你也会对那种痛苦更加敏感。

And because you have, it could be that other people are suffering for a different reason, or it may be a different variety of suffering, but you are a little bit more attuned to that pain.

这在某种程度上是好事，因为它让你以更深刻的方式与自己人性中的一部分产生了联结。

And that is in some it's a good thing because it's a way that you're in touch with a part of your fundamental humanity in a deeper way.

但这并不是痛苦带来的唯一一种反讽。

But that's not the only kind of irony of suffering.

我认为，通过深刻的痛苦，你也能以更深刻的方式体会到不痛苦的珍贵，比如今天我醒来时，不再感到疼痛。

I think that also from suffering deeply, you can come to appreciate not suffering in a more profound way, meaning that I wake up today and I'm not in pain.

这种感觉很美好，而我以前在与抑郁抗争时，是无法体会到这种美好的。

And that is beautiful in a way that I don't think I could appreciate before I struggled with depression.

我并不是想说，所有没有经历过抑郁或其他心理健康危机的人，都在浑浑噩噩地过日子。

And not to say that everyone who's going through life who hasn't experienced depression or some other mental health crisis is sleepwalking through life.

我不会这么说。

I wouldn't say that.

但我确实认为，经历抑郁、甚至有过自杀念头，能让你以比从未经历过这些的人更深刻的方式，去珍惜平凡的生活。

But I do think that the experience of being depressed, of being suicidal, is something that can make you appreciate normality, if a phrase, in more robust way than if you hadn't had this experience in the first place.

你在描述自己的抑郁时告诉我，有时你感觉它比你更庞大、比你更强大，你正在对抗一种在某些方面远比你强大的力量。

You told me when you were describing your depression that at times it felt like it was bigger than you, that it was stronger than you, that you were dealing with a force that in some ways was much more powerful than you were.

但与此同时，约翰，你今天还在这里。

But at the same time, John, you are here today.

而你的抑郁却不在了。

Your depression isn't.