冲动：10. 反思

当我刚开始研究多巴胺激动剂时，有一个巨大的谜团。

When I first started investigating dopamine agonists, there was one great mystery.

在本系列节目中，我们听到了许多人在服用处方药后出现冲动行为的故事。

We've heard throughout this series from people who developed impulsive behaviors after taking prescription drugs.

但既然他们说这些副作用毁掉了他们的生活，为什么他们没有更大声地呐喊呢？

But if, as they say, these side effects tore their lives apart, why weren't they shouting more loudly?

我爸爸会去复诊，你知道，医生会问你有没有发现自己有什么不同吗？

My dad would have gone to his appointments, you know, have you noticed anything differently about yourself?

没有。

No.

一切都很好。

Everything's fine.

一切都很好。

Everything's fine.

而这部分原因在于，你知道，我愿意告诉医生我突然对色情内容着迷吗？所以这些事根本不会被提起。

And that's partly because, you know, do I wanna tell my doctor that I'm suddenly obsessed with porn so these things don't get talked about?

弗雷迪先是看到他那本分退休的数学老师父亲变得 reckless 驾驶，随后损失了超过30万英镑的毕生积蓄给骗子。

Freddie first watched his straight laced retired maths teacher dad become a reckless driver before he lost more than £300,000 of his life savings to scammers.

他所描述的这种羞耻感或尴尬感，恰恰成了阻碍人们敞开心扉的原因。

What he's describing, this sense of shame or embarrassment, becomes the very thing preventing people from opening up.

神经精神科医生瓦莱丽·冯已经为医生提供冲动控制治疗建议长达二十年。

Neuropsychiatrist Valerie Voon has been advising doctors on how to treat impulse control for two decades.

她说，患者习惯于从身体而非心理角度看待药物的副作用。

She says patients are used to thinking about side effects in physical rather than psychological terms.

因此，人们可以接受血压变化或头痛这类药物副作用，因为它们是身体症状，但像赌博、性行为改变或购物行为变化这样的复杂行为，却很难被当作副作用看待。

So people can accept that they have, changes in blood pressure or a headache as a side effect from a medication, which is like a physical symptom, but actually a complex behavior, you know, like gambling, you know, changes in your sexual behaviors or shopping behaviors.

我觉得这非常令人困惑。

I think it's incredibly confusing.

瓦莱丽表示，医生处理冲动控制问题的最佳方式是消除任何羞耻感或污名化。

Valerie says the best way for doctors to handle impulse control problems is to remove any sense of shame or stigma.

而应将其视为与其他副作用同等对待。

Instead, just to treat them like any other side effect.

我们努力让这些行为正常化，以便人们能够自由地谈论它们。

We try to normalize them so that people can talk about them freely.

所以当我这样做时，比如说，这些潜在的副作用有一系列可能的表现。

So when I do this, you know, I let's say there's a range of these, you know, potential side effects that could occur.

它们与身体症状或生理副作用并无不同，我们只是希望你能坦诚相告，因为如果我们意识到这种情况正在发生，就能加以应对。

They're not dissimilar to physical symptoms or physical side effects, And we just need you to be kind of open and upfront about it because it's something that we can manage if we understand that it's happening.

药物剂量可以下调或停用，副作用也就随之消失。

The medication can just be titrated down or stopped, and the side effect stops.

但她表示，人们常常意识不到自己正在发生变化。

But she says often people don't have insights into the fact they're changing.

当你真正询问患者他们认为这是为什么时，他们经常会描述出各种可能的诱因，以及为什么会发生这种情况。

When you actually ask the patient why do they think this is happening, they not uncommonly will describe, you know, lots of different scenarios that might be triggers and why this might be the case.

实际上，我只是在享受乐趣。

And actually, I might just be enjoying myself.

我终于体验到了这种自由。

I'm finally experiencing this freedom.

你知道，这只是我在探索自己兴趣的一部分。

You know, this is just part of me kind of exploring what I'm interested in.

我认为，在这种情况下，人们面临的困难是，你无法分辨哪些是药物的影响，哪些是本人的本性。

I think the difficulty that one faces in circumstances like this is that you don't know how much is the medicine and how much is the person.

而且，人本来就是永远无法被完全了解的。

And one never knows people completely anyway.

这是弗朗西斯，她的律师丈夫安德鲁曾因诈骗客户60万英镑而入狱，后来却选择了自杀。

Here's Francis, whose solicitor husband Andrew went to prison for defrauding his clients out of £600,000 before he later took his own life.

我们所有人随着时间都会改变。

We all change over time.

你知道的。

You know?

所以当他四十几岁的时候，已经和我二十多岁嫁给他时的那个男人完全不同了。

So by the time he was in his mid to late forties, he was a different person to the man I married in his late twenties.

因为性格并不是一种固定不变的东西。

Because personality isn't this concrete thing.

这不是一成不变的。

It's not static.

它不会永远保持不变。

It doesn't stay the same forever.

多巴胺激动剂的作用在哪里结束，而他真正的自我又从哪里开始？我之前真正了解他多少？又不了解多少？

Where did the dopamine agonist stop, and where did he begin, and how much had I known him beforehand, and how much had I not known?

也许这里需要考虑的，远不止是再多印几条警告。

Perhaps there's more to be considered here than a few more printed warnings.

如果我们一生都在建立基于人格固定不变的这种观念之上的人际关系，那么当人格发生变化时，我们该怎么办？

If we spend our whole lives forging relationships based on the idea that personalities are fixed, what do we do when they change?

我是诺埃尔·蒂瑟拉奇，BBC的调查记者。

I'm Noel Titheradge, an investigations correspondent from the BBC.

在过去一年里，我一直在揭露治疗运动障碍药物所导致的毁灭性副作用。

I've spent the past year uncovering the devastating side effects caused by medication for movement disorders.

这是来自《阴影世界》播客的BBC第四电台节目《冲动》。

For Radio four from the Shadow World podcast, this is Impulsive.

第十集：反思。

Episode 10, reflections.

当我于2026年初录制这一集时，我仍然不断接到电话和消息，讲述人们服用这些药物的经历。

As I sit recording this episode in early twenty twenty six, I'm still getting new phone calls and messages about people's experiences on these drugs.

新闻业的许多方面都缺乏科学性，但这些源源不断的新报道让我开始思考这个问题的真实规模。

There are a lot of things about journalism which are unscientific, but this constant flow of news stories makes me wonder about the true scale of this issue.

每一封新邮件都令人痛苦，因为我知道这些副作用的影响可能在停药后仍持续很久。

Each new email can feel agonising, knowing that the impact of these side effects may be felt long after the prescriptions have stopped.

这些药物对你来说付出了怎样的代价？

What's the cost been to you of these medications?

我的生活真的被夺走了。

I had my life taken away from me, really.

我的家、我居住的社区，但最重要的是我的儿子。

My home, where I lived, the community I lived in, but above all, my son.

我真的找不到合适的词来形容这有多么毁灭性。

I just don't have the words to say, really, of how devastating that is.

弗朗西斯的女儿爱丽丝现在已经结婚并有了自己的孩子。

Frances' daughter Alice is now married and has children of her own.

她妈妈就住在附近。

Her mom lives just down the road.

我现在差不多把我的生活看作是备选方案B。

I sort of think of my life now as option b.

它们夺走了我的备选方案A。

They cost me option a.

最好的情况本应该是哈里和爸爸还在身边。

The best option would be Harry and dad being here.

我的孩子们能有一个祖父和一个叔叔。

My kids having a grandfather and an uncle.

哈里能拥有完整的人生。

Harry having a full life.

我努力过得充实快乐，尽量珍惜当下，但这终究不是备选方案A。

I try and live fully and happily and make the most of, but it's not option a.

对于一些使用这些药物的用户来说，他们花了多年时间才重新掌控自己的财务状况。

For some of the users of these drugs, it's taken years to get back on top of their finances.

以露西为例，她在被开具部分多巴胺激动剂治疗心理健康问题后，发展出了赌博成瘾。

Take Lucy who developed a gambling addiction after being prescribed a partial dopamine agonist for her mental health.

自从我停用阿立哌唑后，我的生活变得好多了。

Since I've been off Aripiprazole, my life is so much better.

我有了男朋友。

I've got a boyfriend.

他几乎就住在我妈家。

He's practically living at my mom's.

所以过去一年里，一切都进行得非常顺利。

So that's going really well for the last year.

我很快就要去度假了。

I'm going on holiday soon.

我自己付的钱。

I paid for myself.

但很难不想象，如果没吃这些药，她现在可能会在哪里。

But it's hard not to wonder where she might have been now without the medication.

我现在本可以有能力全款买一套房子。

I would be in a position now where I could maybe buy a house outright.

我不至于还住在童年的卧室里。

I wouldn't be in my childhood bedroom still.

就是那个我住了四十年的同一间卧室。

The same bedroom I've been in for forty years.

露西也因她的性亢进留下了心理创伤。

Lucy also bears psychological scars from her hypersexuality.

在那十年里，我并没有很多次，大概只有七八次。

I didn't have loads of in that ten year period, maybe like seven or eight.

但到最后，我根本无法发生性行为，因为我的身体不允许了。

But at the end of it, I couldn't actually have sex because my body wouldn't let me.

它对我之前做过的事感到极度厌恶。

It was so appalled by what I'd done previously.

和现在的伴侣一起，我花了大量努力才重新享受性生活。

And it's taken a lot of effort with my current partner to actually enjoy sex again.

我不希望因为自己做过的事而感到羞耻，因为那不是真正的我。

I don't want to be ashamed about what I did because it wasn't me.

我不能活在过去。

I can't live in the past.

我为此失去了十年光阴。

Like, I lost ten years to it.

我现在必须好好生活。

I've got to live my life now.

对于史蒂夫——这位在开处方药后沉迷于网络摄像头网站的退休地毯安装工来说，这些死亡只是其中一部分。

For Steve, the retired carpet fitter who became addicted to webcam sites after his prescription, the deaths are just part of it.

从经济上讲，它毁了我。

Financially, it killed me.

我现在还在还债。

I'm still paying money off now.

但失去她的生命，我认为这是最严重的事。

But the loss of her life, I think it was the biggest thing.

她从不相信那是药物造成的。

She never believed it was the drug.

这种药物毁掉了你的婚姻吗？

Did this medication cost you your marriage?

当然。

Definitely.

当然。

Definitely.

如果没有利维平诺，我绝对不可能做出这样的事，不可能达到我所做事情的程度。

A 100% would not have done what I did, the scale of what I did, without livipinol.

史蒂夫现在独自面对晚期帕金森病。

Steve is now facing advanced Parkinson's alone.

并不孤单，但有些日子，你知道，两三天没人说话，这彻底改变了你的生活。

It's not lonely, but some days, you know, two or three days without speaking to anybody until it's just changed your life completely.

在本系列中，我们听到了约200位联系过我的人中部分人关于这些药物的经历。

In this series, we've heard from a handful of the 200 people who've contacted me about their experiences on these medications.

我们知道，还有成千上万的人受到了影响。

We know that thousands more have been affected.

一些医生在开这些药时，并未充分告知潜在的副作用，尽管早在上世纪八十年代的学术报告中就已经描述了这种关联。

Some prescribed these drugs without sufficient warnings about the potential side effects despite academic reports describing the link going back to the nineteen eighties.

那么，这种影响的规模有多大呢？

And what about the scale?

卫生部门将发生率超过十分之一的副作用定义为非常常见。

Health authorities call a side effect very common if it affects more than one in ten people.

但多项研究估计，这些药物至少会导致六分之一的帕金森病患者出现冲动控制障碍。

But multiple studies have estimated these drugs cause impulse control disorders in at least one in six Parkinson's patients.

并非所有副作用都会很严重，但一些论文甚至指出比例可能高达三分之一。

Not all side effects will be severe, but some papers put it even higher at more like one in three.

当弗雷迪的父亲比尔最初患病时，医生只给了他两年寿命，但他后来又活了十四年。

When Freddie's dad, Bill, first got sick, he was only given two years to live, but he went on to live for another fourteen.

当比尔的葬礼到来时，过去几年的起伏经历极大地改变了弗雷迪对父亲的看法。

By the time Bill's funeral arrives, the roller coaster events of the previous years have dramatically affected how Freddie sees his father.

那是夏天。

It was summer.

那是2022年8月。

It was August 2022.

那是父亲去世、火化以及之后在酒吧举行的追思会后大约六周。

It was about six weeks after dad's passing, crematorium, and pub reception afterwards.

追思会在村里的酒吧举行，正是弗雷迪和比尔前一年共进最后一顿圣诞晚餐的地方。

The wake is in the village pub, the same one where Freddie and Bill had eaten their final Christmas dinner together the year before.

我们吃了一些三明治和小吃，到场的有家人、一些老朋友，还有些曾经的学生和同事，这很温馨。

We had some sandwiches and nibbles or whatever, and there's a mix of family and and some old friends and some old pupils and colleagues that had come down, which is nice.

弗雷迪被众多比尔昔日学生主动联系的数量所震撼。

Freddie's overwhelmed by the number of Bill's old pupils who get in touch.

有很多特别温暖的故事，讲述你父亲在九十年代为什么是他们最喜爱的老师。

Lots of really nice stories of why your dad was my favorite teacher in the nineties.

有一个学生其实是靠奖学金入学的，他出身于相当贫困的家庭，而父亲给了他很多辅导，这个人后来取得了非凡的成就。当他得知父亲去世的消息后，决定设立一项以父亲命名的奖学金，帮助来自贫困家庭的孩子进入牛津或剑桥大学。

One pupil actually he'd actually come to the school on a scholarship and he was actually from a fairly poor background and dad had given him a lot of coaching and this guy had gone on to to do great things and when he heard of dad's passing, he decided to set up a scholarship for kids from poor backgrounds to go to Oxford or Cambridge and the scholarship was in dad's name.

不可能吧。

No way.

是的。

Yeah.

哦，那一定是在你之前经历的那十年之后的事了。

Oh, that must have been after the decade you'd had before that.

是的。

Yeah.

实际上，葬礼和那些故事、支持的信息对我来说非常有帮助，因为我对父亲的记忆严重偏向于过去五到十年，而那段时间的父亲完全变成了另一个人。但听到那些二三十年没见父亲的人讲述他们的回忆，这确实让我感到一些疗愈。

Actually the funeral and the stories and messages of support was was really, really useful for me because my memory of dad was so heavily skewed towards the last five, ten years and for that most of that period dad was a wholly different person And then, you know, hearing from people hadn't seen dad in in twenty, thirty years, and that was actually quite healing, I suppose.

我对这件事并没有那么个人化的情感牵连。

I wasn't so personally attached to it.

这也很令人着迷。

It is also fascinating.

弗雷迪说，比尔的经历彻底改变了他对人格的理解。

Freddie says what happened to Bill has changed his whole perspective on what personality is.

很难想象这些事情会发生在我们自己身上，我们会想，嗯，我绝不会那样做。

It's so hard to imagine those things happening to ourselves, and we think, well, you know, I'd never do that.

我知道，我会用我的自由意志来阻止这种事情发生。

You know, I I would just use my free will to prevent that happening.

我们不明白，药物会让你变成一个会做那种事的人。

We don't understand that the drugs make you someone who would do that.

弗雷迪相信，在吸毒前他所认识的父亲，会希望他讲出自己的故事。

Freddie believes the dad he knew before the drugs would want him to tell his story.

我知道，我父亲在这一切发生之前，一生都在为帕金森病提高公众意识，为慈善机构筹款，我认为他会支持讲述他的故事。

I know that my dad who before all of this happened did a lot of awareness raising for Parkinson's during his life and he did raise lots of money for charity and I think he would have been supportive of telling his story.

弗雷迪希望为患者及其家人提供更好的信息。

Freddie wants better information for patients and their families.

人们需要得到信息，让家人也了解情况，然后带着清醒的认知决定是否继续、或不继续，或做自己想做的事。

People need to be informed, have their family informed around them and then go in with their eyes open and potentially carry on or not or do what they want.

但如果你有远见，就能大大减少可能造成的损害。

But if you have the foresight, then a lot less damage can possibly occur.

多巴胺激动剂药物无疑帮助了大量患者缓解帕金森病等症状，而副作用是任何药物不可避免的代价。

Dopamine agonist drugs undoubtedly help a great many people manage the symptoms of conditions like Parkinson's, and side effects are an inevitable price of any medication.

监管机构表示，他们会不断评估和调整风险与收益的计算。

Regulators say they make and constantly reassess their calculations of the risks and benefits.

但如果我们不能消除这些行为副作用所伴随的羞耻和污名，一旦发生，它们就会被低估。

But unless we can remove the shame and stigma associated with these behavioral side effects, when they do occur, they'll be underreported.

如果没有完整的图景，患者又如何能真正明智地决定自己的治疗方案，以及它可能对自己和家人造成的影响呢？

And without the full picture, how can patients make truly informed decisions about their treatments and the impact it might have on themselves and their families?

《冲动》由我，蒂瑟奇主持。

Impulsive is presented by me, Titheradge.

本系列制片人是露西·伯恩斯，音乐由托马斯·罗斯·菲茨西蒙斯创作，音效设计由查理·布兰登·金负责。

The series producer is Lucy Burns with music by Thomas Ross Fitzsimmons and sound design by Charlie Brandon King.

本系列编辑是马特·威利斯。

The series editor is Matt Willis.

法律咨询由简·克莱门森和莎拉·布兰思韦特提供。

Legal advice from Jane Clementson and Sarah Branthwaite.

编辑政策顾问是马修·埃尔特林厄姆。

The editorial policy adviser is Matthew Eltringham.

制作管理由海伦娜·沃里克·克罗斯和索菲·希尔负责。

Production management by Helena Warrick Cross and Sophie Hill.

对于BBC第四电台，策划执行官是特蕾西·威廉姆斯。

For Radio four, the commissioning executive is Tracy Williams.

策划编辑是丹·克拉克。

The commissioning editor is Dan Clark.

《冲动》是一部长篇音频制作。

Impulsive is a long form audio production.

有关提供帮助和支持以应对节目中提及的一些问题的组织信息，请访问 bbc.co.uk/actionline。

Details of organisations offering help and support with some of the issues raised are available at bbc dot co dot uk slash actionline.