理解人性、痛苦与实践——与Sabrina Coninx博士和Peter Stilwell博士探讨现象学、能动论及可供性

欢迎收听《言语的力量》播客，通过更有效的沟通提升患者护理质量。

Welcome to the Words Matter podcast, enhancing patient care through better communication.

欢迎来到《言语的力量》播客新一期节目。我是奥利弗·汤普森。秉承着探索临床实践理论层面与哲学基础的承诺，本期我将全力以赴。因为今天，我将与萨布丽娜·康尼克斯博士和彼得·斯蒂尔韦尔博士展开对话。萨布丽娜是哲学家，目前就职于德国鲁尔大学哲学研究所。

Welcome to another episode of Words Matter podcast. I'm Oliver Thompson. So following my commitment to explore the theoretical aspects and philosophical underpinnings of clinical practice, I'm diving in with both feet in this episode. Because today, I'm speaking with doctor Sabrina Connix and doctor Peter Stillwell. Sabrina is a philosopher currently located at the Institute for Philosophy at the Ruhr University in Germany.

萨布丽娜是心智哲学家，她的研究横跨哲学、心理学与神经科学交叉领域，尤其关注疼痛及其他躯体感觉的本质。其研究涵盖这些心理现象的现象性、神经实现机制、因果嵌入性及生物功能。彼得目前是加拿大麦吉尔大学博士后研究员，研究方向包括运用质性研究方法及理论概念性途径来探索疼痛、苦难及医患沟通。彼得去年曾做客本播客，许多听众会熟悉他2019年与凯瑟琳·哈曼合著的杰出论文——该文提出以能动主义作为理论框架，引领我们超越生物社会模式。此后他一直笔耕不辍。

Sabrina is a philosopher of mind, and her research involves working at the interface of philosophy, psychology, and neuroscience. And she has a particular interest in the nature of pain and other bodily sensations, and her research encompasses the phenomenality, neural implementation, causal embeddedness, and biological function of these mental phenomena. And Peter is currently a postdoctoral researcher at McGill University in Canada, and his research interests include utilizing qualitative methodologies as well as theoretical and conceptual approaches to explore pain and suffering and patient clinician communication. And Peter spoke to me on the podcast last year, and many of you will be familiar with this excellent paper from 2019 with Katherine Harman introducing an activism as a theoretical framework to move us beyond the biohazard social model. And he's been very busy since then.

他发表了多篇相关论文，包括最新与萨布丽娜合作的论文——这也将成为本期讨论重点。本期我们将现象学作为哲学框架进行探讨，论述能动主义及其理论视角对理解疼痛与实践的价值。我们还将讨论惰性主义与倾向主义的关系，试图厘清这两种理论的异同。我们会探讨惰性主义方法如何帮助我们解决整合难题（这是他们新论文的核心），以及能动主义如何实现神经肽与肘部、膝盖、认知、脊柱及社会关系等不同现象的因果整合。

He's published a number of related papers, including his most recent paper with Sabrina, which we get to speak about in this episode. So in this episode, we speak about phenomenology as a philosophical framework. We talk about an activism and the value of this theoretical perspective for understanding pain and practice. We also speak about inactivism in relation to dispositionism and try to tease out some of the differences and similarities between these two theories. We speak about how inactive approaches can help us address the integration problem, which is the focus of their new paper, and how an activism can causely integrate different phenomena, such as neuropeptides with elbows, with knees, with cognition, with spines, with social relationships.

我们将'可供性'视为改善疼痛患者护理与管理的潜在机遇，讨论这个概念如何帮助我们理解急性与慢性疼痛超越时间维度的本质差异。这场对话令人振奋不已——萨布丽娜的哲学家视角与彼得凭借临床背景衔接转化这些思想的能力相得益彰。他们围绕论文主题展现的热情、好奇心及对各种衍生话题的探索意愿令人愉悦。我已将这篇开放获取论文链接放入节目注释，请务必一读。

We speak about affordances as potential opportunities to better care and manage people living with pain and how the concept of affordances can help us understand differences between acute and chronic pain, which moves beyond mere temporal differences. So this was just a thrilling conversation. The combination of Sabrina's perspective as a philosopher and Peter's ability to bridge and translate these ideas with his clinical background was a complete joy. Their passion, curiosity, and willingness to explore all sorts of different topics related to their paper was immense fun. And I put the link to the paper in the show notes, and it's open access, so please make sure you give it a read.

现在有请萨布丽娜·科宁克斯博士与彼得·斯蒂尔韦尔博士。

So I bring you doctor Sabrina Koninx and doctor Peter Stilwell.

彼得、萨布丽娜，欢迎来到播客节目。

Peter and Sabrina, welcome to the podcast.

非常感谢邀请我们来到这里。这是莫大的荣幸。

Thanks a lot for having us here. It's a great pleasure.

是啊，很高兴能来。回来真好。

Yeah, happy to be here. Good to be back.

没错。彼得，我们上次交谈是在去年七月。我们聊过一些今天可能会涉及的话题，谈到隐喻和生物心理社会模型，但没机会深入探讨行动主义。我收到了一些不是仇恨邮件，而是失望的邮件，人们说'很喜欢这期节目'，但觉得我们时间不够，没能深入探讨你们最近的工作和这些理念。

That's right. So, Peter, you and I spoke, it was in July, actually, last year. We spoke about some of the stuff that we might touch on today. We spoke about metaphors and the biopsychosocial model, but didn't really get a chance to dig down a bit more into an activism. So I got some not hate mail, but disappointment mail from people saying, 'Love the episode,' But I think we kind of ran out of time before we were able to explore some of these ideas and the work that you've both done recently, actually.

所以很期待这次对话。

So looking forward to having this chat.

是啊，太棒了。记得我们当时提到行动主义时都很兴奋，但只是浅尝辄止。

Yeah. Awesome. Yeah. I know we kind of were like, woah, we'll talk about an activism. And then we like briefly just glossed over it.

后来我收到听众留言说很喜欢那期节目，这总是让人欣慰。你永远不知道观众反应会怎样，但他们说想听更多内容。我挺意外的，没想到大家会这么感兴趣。上次我故意讲得比较浅显，现在很高兴知道大家想深入了解。

And then I got messages to people like, I loved it, like enjoyed it, which was always nice to hear. You never know how this stuff's gonna land, but they're like, we want to hear more. And I'm like, really? Like, I didn't think people were going to be that even interested in it. So I tried to keep it superficial last time, and I'm glad to hear people want to hear a bit more.

那么或许你们可以先介绍一下自己目前的学术背景和正在从事的工作？

So perhaps you could both introduce yourselves, your current academic and intellectual background and what you're currently up to.

好的，很高兴分享。我目前在德国波鸿鲁尔大学担任博士后研究员，在一个名为‘情境认知’的研究培训小组工作。这个小组广泛探讨认知现象的情境层面相关问题，疼痛肯定是其中一部分。我在博士期间主要研究心灵哲学和围绕疼痛的传统哲学问题。

Yeah, happy to. So I'm currently working as a postdoctoral researcher at the Ruhr University in Bockholm, Germany, and I'm working there in a research training group called situated cognition. So it's all about different questions concerning the situational aspects of cognitive phenomena understood very broadly. Pain definitely is a part of that. And I've worked in my PhD a lot on the philosophy of mind and more traditional philosophical questions that were surrounding pain.

那么，疼痛的生物学功能是什么？我们能否借此赋予疼痛某种特定内容？疼痛的现象体验与神经处理之间有什么关系？在研究小组的一次活动中，我有幸遇到彼得，发现临床领域也有人对哲学感兴趣。这就是我们合作的开始——了解哲学家的关注点如何与临床实践产生共鸣，寻找彼此学习的交汇点。

So, but what is the biological function of pain? Can we use this to ascribe a certain content to pain, for example? What's the relation between the phenomenal experience of pain and neural processing and these kinds of things? And then on one event of my research training group, was lucky to meet Peter and to find out that there's people working in clinical contexts who are interested in philosophy. And that was the beginning of our journey and just like, I think getting to know what is the interest of philosophers, is the interest of clinical practice and like seeing where commonalities are and where we can learn from each other.

太棒了，谢谢。彼得？

Brilliant, thank you. Peter?

太好了。我也是博士后研究员，目前在加拿大麦吉尔大学工作，位于魁北克的物理与职业治疗学院。之前上过播客详细介绍过我的跨领域背景，这里就不重复了。现在的研究兴趣主要集中在疼痛及疼痛相关痛苦的理论与质性研究。在德国参加暑期学校时认识了萨布丽娜，他们做的4E认知研究太酷了，让我不禁反思自己在加拿大的研究方向。

Awesome. Yeah, so I'm also a postdoc researcher. So currently I'm at McGill University in Canada. So that's in Quebec and I'm in the school of physical and occupational therapy. So yeah, that's, I know I was on the podcast before and I kind of went through my kind of detailed eclectic history, so I'm not going to repeat all that again, but in terms of my research interests now, so mostly theoretical and qualitative research focused around pain and pain related suffering, and yeah, connected with Sabrina when I went to a summer school in Germany, and they do such cool stuff out there, like inactive work, do the kind of 4E work, so I was like, wow, what am I doing?

他们在做这么多前沿工作，最终促成了我和萨布丽娜的合作，最近还有篇联合论文发表，非常兴奋。

What am I doing here in Canada? Like they're doing a lot of cool stuff. So ended up collaborating with Sabrina and then recently had a paper come out. So excited about that.

我们待会会讨论那篇论文。这次可不会重蹈覆辙拖到第49分钟才提学术倡议，保证早点深入这个话题。萨布丽娜，你提到的哲学论述与临床实践之间的互动很有意思。

And we'll talk about that paper. We're not going make the same mistake as last time and get to minute forty nine and then mention an activism. So we'll make sure we dive into that early on. Yeah. But Sabrina, it's interesting what you said about this interaction between philosophical discourse and knowledge and clinical practice.

你们显然正在共同探索这个领域。虽然不确定是否算得上运动，但哲学进入临床实践确实获得了更多接纳空间。不确定这种趋势是一直存在，还是因为临床工作者开始追问实践本质、疼痛本质、患者体验等深层次问题——这些既是实证问题也是哲学命题。两个学科的融合非常精彩。

You guys are obviously embarking on this journey together. But there's just a sense I don't know if it's a movement, but there's certainly much more appetite for or much more space for philosophy to enter clinical practice. And I'm not quite sure if it's always been there or it's just people are becoming the questions that clinicians are asking about the nature of practice, the nature of pain, the nature of patients' experience, all that kind of stuff, that these are kind of deeply philosophical questions as well as evidential questions. But this coming together, the two disciplines, if you like, is brilliant.

是的，非常感谢。所以我确实无法从临床角度过多评价，也不清楚他们为何一直对此感兴趣。我感觉至少在疼痛哲学领域，已有大量出色的研究，特别是关于急性疼痛的——试图理解其本质，以及我们日常生活中所认为的典型急性疼痛案例。我认为近年来疼痛问题确实越来越受到关注。

Yeah, thanks a lot. So I cannot really say so much how this has been from the clinical perspective or how they have always been interested. I have the feeling that at least in the philosophy of pain, there has been a lot of really great research been done, especially on acute pain. So trying to understand what that is, what paradigmatic cases of acute pain are that we think about like in everyday life. And I think that especially like in the last years, pain has more common to focus.

但我认为显然还有许多工作要做。这也很正常。有些哲学家会说'这不是我的研究方向，所以我不关心我的工作可能对临床实践产生什么影响'，但我对这个问题很感兴趣。我不想只是坐在这里研究理论，更希望与可能受我思考影响的人们交流，了解他们的观点。因为我始终致力于实践导向的哲学研究，力求发展的哲学体系不违背我们对特定主题的最佳认知。

But I think that there's definitely still a lot of work to be done. And that I think that's also fine. Some philosophers say like, okay, this is not what my research is about, so I'm not interested in seeing what kind of consequences my work can maybe have for clinical practice, but I'm definitely interested in this question and seeing like, okay, I just don't want to sit here, so to say, and work on that, but I also want to talk to people where this might have an impact of what I'm thinking about. And to also get to know their perspectives, because I think that I've always been like working on an empirically orientated philosophy. So I've always tried to develop a philosophy that does not contradict our best knowledge about a certain subject matter.

这通常需要研读学术论文，了解各类研究结果。但我觉得这种交流最宝贵的是能获知对方的视角——他们最初关注什么？因为哲学家提出的问题往往与临床工作者不同。对我而言，能接触患者或与患者直接交谈的机会非常珍贵，这能彻底改变认知。比如某些哲学术语的使用方式，我从未意识到可能存在问题，直到听到患者说'当人们这样描述我时，我的感受是...'

But this is often about, of course, reading research papers, like getting to know what are the results of all these different kinds of studies they've done. But I think that in this communication the awesome thing is to get to know the perspective of the other person. So to get to know what are they interested in the first place, because I think philosophers ask often different questions than people who are working more in clinical practice, for example. And also just for me getting the chance to talk to people who have been in contact with patients or to talk to patients themselves, because I think that this again changes perspective a lot and understanding how terminology is, for example, problematic that I've never thought about, because this is how philosophers talk about these things. But to hear then, okay, this is how this makes me feel when people talk about me this way, for example.

我认为这种视角转换正是跨学科研究给我们哲学家带来的巨大价值。希望我们也能通过质疑术语、追问'你具体指什么？''考虑过后果吗？'这些哲学家常提的'刁钻问题'来做出贡献。

And I think this perspective taking is really the great thing that this interdisciplinary work can bring also for us as philosophers. And I hope also that we can contribute in this way, so to say, to question terms, to ask, like, do you exactly mean with this? Have you thought about your consequence, like typical questions that the nasty philosophers are asking, that this can contribute as well?

完全同意。如你所知，这源于我们'健康课程'系列的讨论，当时我与多位哲学家和临床医师交流。临床医师们实际上正在实践中践行这种因果哲学。彼得，或许你能谈谈你经验中哲学与实践的联系？它们并非割裂的——当面对患者时，你关于其本质的思考、诊疗立场的选择，虽然临床医师未必有意识地提出哲学问题，但你必然会对所重视的知识类型和采用的方法做出判断，这些无论你是否意识到，都与哲学紧密相连。

Yeah, completely. I think, as you probably know, we both know that this is off the back of the Course Health series where I spoke to several philosophers and clinicians, and the clinicians are subscribing to the philosophy, right? So they're pretty much enacting or embodying this philosophy of causation in their practice. And so, Peter, maybe you could say something about the connection in your experience between philosophy and practice, because they're not these two separate things, that when you're with a patient thinking about the nature of them and what you're going to do and where you're going to stand epistemologically, they may not have a conscious question like that as a clinician, but you'll be having you'll be placing judgments about the sorts of knowledge that you're going to value and the sorts of methods that you're going to use, which whether you know it or not, these are tied to philosophy or at least questioning some of those assumptions.

确实。我最初对哲学产生兴趣是源于质性研究的工作。这要求我们不断反思基本假设、价值取向和研究工具——即塑造我们研究的世界观或范式。正是这点引导我接触梅洛-庞蒂的现象学，继而发现其中蕴含的丰富理论资源。

Yeah, I guess the path that I went, like what got me initially interested in philosophy was my work as a qualitative researcher. So naturally that's something that we're encouraged to do. So to consider our underlying assumptions, what we value, the tools we use, all of that, like our, what would be referred to as our paradigm or our worldview that shapes our research and our research questions. That's something that's a core part of qualitative research. So that's kind of what got me into going into Merleau Ponty, into phenomenology and then realizing there's all these kind of rich, rich kind of theory, rich concepts that we can draw from, from a research perspective.

但正如你所说，这些现象学概念（具身性、自我性、时间性等）同样影响着临床实践——我们理解患者体验的方式，验证其感受的准确性，甚至可能启发治疗干预手段。无论是研究还是临床都有巨大获益。我仍在学习这些复杂文献，因此特别感谢与萨布丽娜这样的学者合作，毕竟我并未接受过正规哲学训练。

But there's also that connection, as you mentioned, to clinical practice, those same phenomenological concepts, things like embodiment, selfhood, temporality, how we experience time, how we experience ourselves in the world. Like all of these concepts can also shape kind of the way we approach clinical practice, the way that we understand or navigate patients' experiences. So I think it can help us better validate patients' experiences, better kind of understand that kind of sense making that happens, and it also could point to potential therapeutic interventions. I think there's lots of benefits both in terms of research and clinical practice, and I'm still learning as I go and navigating all this complex literature. That's why working with with people like Sabrina, and I'm like, so thankful because can make sense of it because I don't have a a actual a formal training in any philosophy, really.

那么你什么时候才能成为哲学家呢？必须接受正规训练吗？在我看来，这不像是个受保护的称号。虽然你的背景是临床医生，但你从事的哲学思考在我看来不亚于大多数哲学家——可以说你现在大部分工作就是哲学。

But so when do you become a philosopher? Have you is it you've got to have formal training? To me, it would seem it's not like some protected title. You're engaging in obviously, your background is a clinician, but you're engaging in philosophy as much as I'd imagine most philosophers, if you like. That's most of your work now.

所以你是要等到某天醒来突然说'嗯，我现在感觉像个哲学家了，我符合这个类别'吗？或者你可能永远会对哲学家的身份抱有些冒名顶替综合征。

So, you waiting for a moment when you just wake up and say, Yeah, I feel like a philosopher now. I meet that category. Or you'll probably always have some imposter syndrome in regards to philosophy.

是啊，我甚至不知道该怎么定义自己。我做过太多不同类型的工作...当人们问'你的背景是什么？是临床医生还是研究员？'

Yeah. I don't even know what to label myself because I like, I've done so many kind of different things that are, yeah. And people are like, what's your background? Are you a clinician? Are you a researcher?

是知识传播者还是哲学家？我自己都搞不清楚。但我不会自称为哲学家。萨布丽娜可能更清楚这个问题——什么时候才算哲学家或从事哲学？这是个受保护的称号吗？还是只要参与这些思想探讨就算？

Are you a knowledge translator, a philosopher? I'm like, I don't even know, but I wouldn't label myself as a philosopher. I don't know, Sabrina would have better insight into this, like, when are you a philosopher or doing philosophy? Is it a protected title? Is it just engaging in these ideas?

我不知道。

I don't know.

不得不说这是个非常棘手的问题。什么是哲学？他在做哲学。我觉得单这个问题就够做一整期播客了。而且即使在哲学内部也存在不同流派，如果你做的工作非常实证化，人们会质疑这还是正经哲学吗？

I have to say, like this is a really tricky question. So what philosophy? He's doing philosophy. You can make an entire podcast just about this question, I think. And I also think that there's like different strands even within philosophy that sometimes if you work so empirically related, like is this still proper philosophy?

首先这个问题本身就很难界定。特别是在认知科学这个领域——我通常把自己归在这个交叉学科，这里汇聚了神经科学家、心理学家、临床从业者、语言学研究者和哲学家——学科间早已没有严格界限。某种程度上这正是其美妙之处：虽然你可以通过哲学专业训练成为哲学家，但后来可能完全转向其他领域。比如物理学哲学领域就有许多出色的哲学家根本没学过哲学专业。所以我认为专业训练并非唯一标准，这些标签本身可能就没多大意义。

And this question what this is in the first place. So I would say, especially in this field of cognitive science maybe, which I would normally localize myself in, so where really new scientists, psychologists, people from clinical practice, from linguistic studies and philosophy come together, there's no like strict borderline between this anymore. And to a certain degree, this is the nice part of it that, of course, you can be a philosopher by training if you study that, but later on do something completely different. And there's like awesome philosophers in philosophy of physics, for example, who have not studied philosophy, but really like started to do that. So I wouldn't say that the training there is the only relevant thing to do and that these labels are maybe not useful in the first place.

所以对我来说，彼得，你是个哲学家，我对此没有意见。

So to me, Peter, you're a philosopher, I'm fine with that.

我可能只是不像你说的那样做正统哲学，但好处在于和萨布丽娜合作就像亲眼看到理论付诸实践并理解它，因为如果我没说错的话，你更像是分析哲学家，至少从学术背景来看是这样吧？萨布丽娜？

I maybe just don't do proper philosophy as you put it, but that's been the benefit is like working with Sabrina is like seeing it actually in action and understanding, because if correct me if I'm wrong, but you're more of like what would be considered like an analytical philosopher, at least by training, right? Sabrina?

是的，从学术背景来说，我会自称分析哲学家，但后来明显转向了更多自然主义哲学方向，更注重实证数据之类的。可以说这是我职业生涯中的一次转变。不过话说回来，分析哲学与大陆哲学之间的界限本身就很难界定，某种程度上这其实是地理划分，而非方法论差异。

Yeah, so by training, would say I'm an analytical philosopher, but definitely going more into naturalistic philosophy a lot where it's like really about taking into account empirical data and so on. So this was more like the shift that I made, I would say, along the career. But also, again, there's often this distinction between analytic and continental philosophy, and even this one is super tricky. One of them is about geography, actually. It's not really about the methods.

就像我说的，这些问题确实很复杂。但没错，我就读的大学非常注重分析哲学训练。总体而言这很有用，因为它能锻炼思维的精确性——让你学会审视前提与结论，发现自身论证的漏洞。

Like I said, I think that's really complex questions also there. But yeah, as I say, from the university where I studied, it was a lot about analytic philosophy. And I think that's in general quite useful because it's very it makes you sharpen your mind to a certain degree to be precise about things or to look for the premises and the conclusions and to see where maybe your own arguments might be flawed.

这类技能不仅在临床实践中很有价值，在日常生活中也是如此，对吧？就是能对自己提出的主张或思维方式保持觉察。那我们就深入探讨下吧。或许我们一直在回避'行动主义'和'现象学'这两个棘手概念的定义问题。不如先试着给现象学勾勒个轮廓，向从未接触过的人解释下这个概念？

And those kind of skills are just valuable in clinical practice, but just in life, right? Just being able to have that awareness about the sorts claims that you're making or the way in which you're thinking. So let's dive into that. And this is maybe we've just been avoiding the sticky muddiness of who's going to define an activism and phenomenology and how we approach these two. But let's start with trying to get some kind of shape or some kind of definition to phenomenology and how you would describe that to someone who's not heard of it before.

这个问题我可以谈谈，因为关键点在于行动主义的理论基础正是现象学。这是一种融合不同传统的折衷方法，现象学就是其中之一。广义上说，现象学是对体验或意识的研究——就像我之前提到的梅洛-庞蒂、胡塞尔等思想家的工作，这些一个多世纪前的学者探索的常被忽视的领域。作为质性研究者，我感兴趣的是应用现象学，把这些关于体验研究的概念运用到我的研究中，当然也包括临床实践。我们可以借鉴这个丰富的理论体系，来理解人们体验身体与世界的不同方式。

Yeah, I can touch on that because I guess an important thing to note is like, inactivism has a foundation in phenomenology. So it's kind of this eclectic approach that brings together different traditions and phenomenology is one of those. So really kind of broadly understood phenomenology is the study of experience or the study of consciousness, and so I previously mentioned work of like Merleau Ponty, Husserl, lots of thinkers like Husserl going back over a century ago, like these thinkers exploring stuff that's often overlooked or not commonly discussed, and so what I've been interested as a qualitative researcher is to use what would be called like applied phenomenology. So taking these kind of concepts related to the study of experience and applying that in my research, also as I mentioned clinical implications as well. So this rich kind of body of literature to draw from to try to understand those different ways that people experience their bodies and different ways they experience their world.

我认为从研究和临床角度，现象学最吸引人的是：过去几十年的研究（奥利弗你也参与了这些质性研究）反复显示，患者常感到被敷衍对待，觉得医生不理解他们的处境。现象学提供的正是让临床工作者真正理解患者身心体验的途径，这既能更好地验证患者的感受，也可能指向被忽视的治疗方法——甚至能帮助我们重新理解现有疗法。这完全是审视问题的新视角。萨布丽娜，如果你想接着这个话题谈谈现象学，或者过渡到行动主义的定义——我知道上期播客只是浅尝辄止。

So I think that what's attractive to me about it, guess from a research and a clinical standpoint is we know from the past several decades, and I know Oliver, you've been a part of this doing qualitative research, we hear time and time again that patients say they feel dismissed. They feel like they're not listened to. They feel like the clinician doesn't understand what they're going through, and I think what phenomenology has to offer is ways for clinician to actually better understand how people experience their bodies, how they experience their worlds, and that can help us potentially better validate their experiences, but also point to different types of therapeutic approaches that may be overlooked, but also it may help us better understand some of the therapies that we already do. It's just a new way of actually looking at things. So maybe Sabrina, if you want to jump off that, if you want to add anything about phenomenology or maybe even bridge into what an activism is, because that's the challenging thing, and I know on the last podcast, just a really superficial glaze.

不久前我听一位精神病学家谈论行动主义。他说，要在简短的对话、甚至一本书或一篇论文中全面概述行动主义的内涵实在太难了。这就像新瓶装旧酒，如果你只是简单提几句，人们会觉得——哇，这些我都知道了。

I heard a psychiatrist talking about an activism not too long ago. And he said, it's so hard to just like in a really brief conversation or even in a book or even in a single paper to actually give a robust overview of what an activism is. And he's like, it ends up just looking like old wine in a new bottle. If you just do a, you do like a little, a little brief snippet of it. And people are like, woah, I already know that stuff.

很难深入探讨其中的细微差别。所以也许我该把话题交给萨布丽娜，因为我确实不擅长这个。我觉得需要剖析其中这些棘手的部分。

Like it's hard to get into some of the nuances. So maybe I'll pass it over to you Sabrina and because because I'm definitely not good at it. I think exploring some of these, these tricky pieces of it.

因为你根本不是哲学家彼得，这就是原因。你要是哲学家就不一样了。

It's because you're not a philosopher Peter. That's why. See if you're a philosopher.

我想确实是这样。

I think that's it, yeah.

我认为这确实与话题本身的复杂性有关。讨论行动主义的棘手之处在于，正如皮帕提到的，它拥有极其丰富的理论基础，融合了多种相互交织的思想传统。研究者们彼此启发，而这些学者往往更符合某一传统而非其他。比如行动主义既涉及现象学，又包含生态心理学——就像吉布森的理论，不同传统思想之间存在着大量互动交流。

So I would definitely say that it also has to do with the complexity of the topic itself. So I would definitely go for that. So I think a bit of tricky thing when talking about an activism is on the one hand, as Pipa already indicated, that it has such a rich theoretical foundation in really bringing ideas from multiple traditions that are themselves intertwined and that researchers have been inspired by other researchers who would rather fit into one of these traditions than the other. And this is like an activism on the one hand, phenomenology, but also ecological psychology. So it was Gibson, where there is like a lot of has been also interaction and like exchange of ideas about between these different kind of traditions.

当我们谈论行动主义本身时，这个标签通常用于指代一系列关联程度不一的学说。很难说存在一套所有行动主义者都认同的核心假设。不同学者往往强调这个更广泛行动主义项目中不同侧面。因此讨论时，我更倾向于说明我们研究方法中的行动主义特征，而非要求所有自称行动主义者的人都必须认同这些。彼得提到的重视个体生活体验及其变革潜力，这肯定是关键要素之一。

And when we talk about an activism itself, this is often a label that's rather used, I would say, for a family of more or less closely related approaches. So I wouldn't say like, oh, there's this one set of assumptions that all an activists would agree to or consider most central. So I think often they highlight different aspects of something that's like a broader, an active project maybe. Therefore, we talk about an activism, I can maybe more say what we consider an active about our approach, because I think that's like a fair thing to do without saying, oh, everyone else who calls themselves an activist have to buy into this as well. So I think one aspect definitely is what Peter mentioned, so to take the lived experience of the person and their transformative potential seriously.

我们需要思考：疼痛时如何感知自我？如何体验疼痛中的身体？如何感知环境及与环境互动的可能性？现象学这类方法或许能帮助我们结构化这类体验。虽然主观体验常是整体性的，但现象学可以帮我们识别特别相关的不同面向，或揭示急性疼痛与慢性疼痛患者体验方式的差异。

So to consider how do we experience ourselves when we are in pain? How do we experience our body being in pain? And how do we experience our environment and our opportunities to interact with the environment when we are in pain? And what phenomenology or these kind of approaches can maybe do is to help us to structure a little bit this kind of experience. I mean, for us the experience is often like one thing, so we have like a it feels like a one integrated whole, but maybe phenomenology can help us a little bit like to see different aspects that seem particularly relevant or to allow us to indicate differences in how people experience themselves or live in pain when talking about acute or chronic pain, for example.

我认为我们还需要重点强调的是，要考虑患者与世界的积极互动。这种互动元素相当重要，因此要观察患者如何在疼痛中与其物理和社会环境建立联系。第三点可能是，采取积极方法时常常需要考虑人们与环境的动态互动关系。我们必须思考生理过程、体验现象层面以及社会文化过程是如何动态相互影响的？

And I think what we also definitely highlight a lot is that to consider the person's active engagement with the world. So this interactive element is quite important. So to see how the person relates in pain to their physical and social environment. And yeah, maybe as the third point, would say that what's often relevant for an active approach is to consider people in this dynamic interaction with their environment. So to really see that we have to consider how do physiological processes, experiential and so phenomenal aspects, well as like social cultural processes, how do they dynamically interact?

当我们讨论慢性化过程时，这些因素如何相互塑造？我认为这些内容大致构成了我们谈论'能动主义'时的核心理念。我们也完全清楚，这可以说是我们在临床背景下思考疼痛最有用的概念方法论工具箱。当然在非临床背景下可能存在其他思考疼痛的方式，其他现象也可能需要不同的思考框架。

How do they shape each other when we talk, for example, about this process of chronification? And I would say together this mixes up more or less to what do we have in mind when talking about an activism. We are also perfectly aware that this is, so to say, what we consider the most useful conceptual methodological toolbox for thinking about pain in clinical context. So there might be other ways to think about pain when we are not interested in the clinical context, and there are other phenomena that we need to think about maybe in different ways.

这些观点非常有帮助。我想重点探讨的是：当我们拥有这种关于疼痛的理论框架——至少是关于疼痛体验的理论，以及你提到的这些不同领域（虽然你没用'生物心理社会'这个词）如何相互作用和整合的问题时，其假设是如果我们能更好地理解这种整合机制，建立更连贯的解释框架，就可能催生不同的治疗方法，或让我们对现有疗法有更深理解。我正在努力消化这些内容。

That's really helpful. And I think there's lots of things I want to pick up on. One was just trying to step back a bit and say, having this conception, this theory about pain, or at least the lived experience of pain, and how these different aspects, this kind of integration problem which you alluded to, that you've got these different kind of domains you didn't say biopsychosocial, but how these things interact and integrate. The assumption is if we can understand that better, if there's a better framework which explains that in a coherent way, that might lead us to different approaches and methods, either new approaches to patients or a better understanding of the current approaches. I'm just trying to get that material.

这不仅仅是理论探讨对吧？实际上我们说的是这与持续性疼痛患者的护理实践存在关联。你们并不是把这当作兴趣爱好来研究——虽然我们确实带点研究癖好。但你们主张这种理论实际上可能改变或支持现有临床实践。

This can just be thinking for thinking's sake, right? But actually, we're saying that there is a linkage to care, to the care of people which are experiencing persistent pain. You guys just aren't thinking about this as a hobby. We probably are a bit of a hobby. But you're arguing that actually this can potentially change practice or support current practice, perhaps.

那么对于临床医生而言，能否请你尽可能阐明这些潜在影响？我理解这个理论体系仍在发展中。

So for clinicians, what, if you can, any way that you can tease out what those implications are potentially? And I recognise it's still pretty evolving.

我可以简要谈谈，然后萨布丽娜可以接着我的话说。虽然我现在不做临床只做研究，但这个理论吸引我之处在于它提供了一个宏观全面的框架，能够容纳各种要素——至少许多能动主义者是这么主张的。历史上我们有过各种疼痛治疗方法和理解模型。

Yeah, I can briefly touch on it and then Sabrina, you can kind of pick up where I leave off. So what's attractive, I don't see patients anymore, I just do research, but what's attractive to me is it is a very kind of big picture or kind of a comprehensive framework that starts to kind of fit everything within it. At least that's what a lot of activists are arguing. So historically we have all these different types of treatments. We have these different types of models to understand factors related to pain.

有些模型专注于恐惧因素（这是众所周知的），有些则侧重认知干预。而能动主义的魅力在于它提供了这种可伸缩的宏观框架：你可以像萨布丽娜提到的聚焦生理过程，也可以拉远视角观察整个人与环境互动。具体取决于你的临床或科研兴趣点，但我认为在临床实践中往往需要这种宏观视角。

So some models focus on fear as most people are well aware of. Other models focus on working with cognitions. And what's attractive with inactivism is it's this big picture framework where you're able to kind of zoom in and zoom out at different levels. So you can zoom in as Sabrina already mentioned on physiological processes, but you can also zoom out and look at that whole person interacting in their environment. So it depends on what your particular clinical interest is or your scientific interest, but I would argue a lot of times we need to zoom out if we're approaching clinical practice.

我们需要综合考虑所有这些以复杂方式相互作用的因素，研究如何与患者合作，如何针对其中某些因素及其相互作用进行干预，帮助个体更好地适应环境或处境，从而有望过上更好的生活并实现有意义的目标。这是一种宏观层面的方法，但对我而言其吸引力在于能够整合历史上相互割裂的治疗方法和模型，将所有内容统一到一个框架下——如果这样解释能说得通的话。

We need to consider all these different factors that are working together in complex, complex ways, and looking at working with patients and how we can actually target some of those factors and how they're interacting together to help a person better attune maybe to their environment or their situation to live hopefully a better life and work towards meaningful goals. So it is like a really kind of broad strokes kind of approach, but to me that's attractive because you can start to make sense of treatments and models that have historically been very separated. So you can actually start to bring it all together under one roof, if that makes any sense.

是的，我完全同意。我认为互动方式的一个额外优势在于它始终将疼痛体验者——即患者本人——置于核心位置（这是毋庸置疑的），同时将慢性化理解为发生在主体（包括其大脑、身体）与环境之间的动态关系，其中还涉及主体的关注点、需求、自我叙事和期望。我们作为有机体总是试图以某种方式适应环境，而当慢性疼痛发生时，这不仅关乎主体对情境的调适，也涉及环境对主体的反向影响。

Yeah, so yeah, I will fully agree. I think maybe like an additional benefit of the inactive way is that it's always considering, of course, it's the person who's like experiencing pain. That's out of question. But like the chronification is really understood as something that happens in relation between the subject, including of course their brain, their body, but also their concerns, their needs, their self narratives and their expectations in relation to the environment. And I think that often there is this kind of idea that we try as organisms to adapt or attune somehow to our environment, and that when chronic pain happens, this is not just about the attunement of the subject to the situation, but also the other way around.

因此我们不仅要治疗患者，更需要思考如何创造让人能够蓬勃发展的环境。这不是简单地说慢性疼痛是脑部疾病或社会问题，而是所有这些因素以某种程度共同作用的结果。大脑固然重要，但其他因素同样需要被纳入考量。互动模型的关键价值就在于这种关系视角——始终关注我们如何在这些情境中相互作用。

So it's not just that we have to fix patients, but we quite often also have to ask like how do we have to create contexts in which a person can actually flourish and thrive, for example. And that this is not about saying chronic pain is a brain disorder, pain is about the social issue, you know, it's like it's all these things coming together to a certain degree. And of course the brain plays an important role, but also all these other kinds of things equally have to be taken into account. And I think that this is really an important aspect for us about this inactive model, that it has this kind of relation aspect that's always about how do we interact in these kinds of situations.

我认为有必要重新阐明现有最知名模型（即生物-心理-社会模型）的问题：在您看来，该模型目前未能有效整合现象/生活体验与神经肽、踝关节、背部问题、社会关系等要素——虽然这些确实存在于BPS模型中，但其相互关系未被清晰表述。正如我们在研究和上次与Karimi Muscuto的播客中所见，临床医生难以表述这些关系（即便声称采用BPS模型的研究最终仍主要概念化生物因素，因为这更简单且符合临床思维惯性）。请您重新阐述生物-精神病学模型的问题，这为何需要互动理论来支撑或取代？

And I think what would be helpful would be to just re articulate the problem with existing and let's say the most well known model, the bio suck social model, how that doesn't currently, in your view, kind of meet the task to integrate these different aspects of both phenomena or lived experience plus kind of neuropeptides and ankles and backs and social relationships and all that stuff that, whilst that's in the biopsychosocial model, those relationships aren't clearly articulated, and clinicians find it hard to articulate, as we see in both research and the last podcast I did with Karimi Muscuto, where she looked at biopsychosocial or research which was claimed to be within the BPS model, but ultimately they conceptualized mainly the biological factors because it's easy and it's it's fluent and it's on the edge of most of our tongues as clinicians. So I suppose just rearticulate, in your view, the issues with the bio psychiatric model, which warrants a theory like an activism to either underpin it or overtake it or?

好的，我先开始回答，然后Sabrina可以补充。你提到Creamy的播客，我很喜欢那期节目，那篇论文也很棒。

Yeah, I start on that. And then Sabrina, you can jump in. Yeah, you mentioned Creamy's podcast. I love that one. I like the paper too.

我们有篇论文（仍在审稿中但已提交）与她的研究高度相似——虽然不知道能否发表。不过确实很享受你们合作的播客和论文。Jenny Satchel博士——她的工作总是如此出色。

We, I had one paper and it's still in review, but submitted and it's like very, very similar to that one. Whether it'll see that ever see the light of day, who knows, you know, how that goes. But, yeah, I really enjoyed both the paper and the podcast that you did with her. Her Jenny Satchel, like she, Doctor. Satchel does such, such good work.

我一直关注他们的研究进展。其实我们在上期节目已讨论过很多：BPS模型相当模糊。回顾1977年那篇开创性论文，该模型实际上是建立在系统理论之上的。

Love following the stuff that they're up to. But yeah, so I guess I touched on a lot of this stuff on the last episode that we did. So the biopsychosocial model is quite vague. So you look at like the original paper from '77, kind of that landmark paper introducing the biopsychosocial model. He hinges the kind of model on systems theory.

你看，好吧，他在理论基础方面提供了什么？大约就一段话。说的是信息在系统间流动。差不多就是这样。不过，乔治·英格尔确实贡献了许多精彩内容，推动我们——我认为是让医疗更人性化，摆脱单纯的神经肽和生化过程，正如你提到的，临床实践和健康疾病远不止这些。

You look at, okay, well what does he offer in terms of a theoretical foundation? It's about a paragraph. And it says information flows across systems. And that's about it. That said, there's so much wonderful stuff that George Ingle had to offer and really moved us towards, I think humanizing healthcare and moving away just from, as you mentioned, neuropeptides and biochemical processes, there's so much more to clinical practice and health and illness than that.

因此我认为他的贡献巨大且影响深远，但确实缺乏理论基础，导致这个模型最终被以各种可能并非乔治·英格尔本意的方式应用。上期节目我提到过，这个模型最终变得非常线性化，甚至某种程度上被生物医学化，极易碎片化。人们像分桶一样看待这些事物。临床SOAP记录就是如此：主观部分列几条，客观部分列几条，然后利用患者叙述只是为了得出诊断或所谓的根本原因。而借鉴行动主义等理论，能帮助我们避免割裂事物，还能让我们汲取这个发展了一个多世纪的丰富理论体系——这正是当时缺失的，也是乔治·英格尔所处时代的局限。不过现象学当时已经存在，他却未加借鉴，或许这就是时代特征吧。

So I think he has had a ton to offer and it's very influential, but there is that kind of lack of a theoretical foundation and the model in turn ends up getting applied in very different ways, maybe ways that George Engel didn't intend. So I believe on the last episode I talked about the model ending up being quite linear, like applied in a very linear way or even biomedicalized in a sense and very easily fragmented. People look at these things like in terms of buckets. You see that even with clinical SOAP notes, it's like subjective, here's a couple things, objective, here's a couple things, and then using the person's narrative as a means to just get to a diagnosis or some sort of so called root cause, and I think by looking at theory like in activism, it can start to help us avoid splitting things up, help us avoid fragmenting things, and also it allows us to draw from this rich theory that's been developing for over a century, that so was something that wasn't, it was missing, and it was part of like the time that George Ingle was doing this work. That said, phenomenology existed then, and he didn't really draw from that, and maybe it was just a sign of the times.

我不确定，没深入思考过甚至没表达过这个观点——也许他知晓，但在当时医学期刊上白纸黑字写这些可能不被接受。现象学直到最近才变得更具吸引力。

I don't know, I haven't thought about this much, or even expressed it, but maybe he knew, but it just wasn't acceptable in a sense to start to put that on paper in these medical journals. Only recently has I think phenomenology been more attractive to people.

同样没深入思考过，但70年代那篇论文问世时，所谓优质的社会学研究基本就是定量研究。要为行动主义或现象学辩护，就得逆心理学和社会学研究部门的潮流而行，因为必须采用个案研究、生活体验或第一人称质性研究方法——这些在70年代都非主流。

Again, haven't thought too much about it, but in the 70s when that paper arose, quality or rather sociological research was mainly quantitative research. I mean, draw upon, to make a case for an activism or phenomenology at that stage, you'd be very much going against, you know, the stuff which has been done in research departments in psychology or sociology, because you would have to start to talk about the single case or lived experience or first person qualitatively type approaches, which weren't kind of mainstream in the 70s, I don't think.

我认为，没错，一针见血，被视为不可信的数据就是劣质数据。我们需要客观数据才能真正理解现状。这种认知正在转变，而奥利弗你正是推动者之一——通过制作这类播客，邀请哲学家和以多元视角探讨问题的嘉宾。所以当我在推特上看到你想做定性研究系列时，简直欣喜若狂，感觉这就是关键所在。

I think that's, yeah, spot on and viewed as like untrustworthy, you're not good data. And it's like, we need objective data to really understand what's going on. And that's been shifting and you've been a part of that, Oliver, like doing podcasts like this, bringing on philosophers, bringing on people that are talking about things in very different ways. And so I was super excited on Twitter when I saw that you were wanting to do a qualitative series. And I was like, yes, like that's it.

至少在我看来，定性研究需要更多曝光机会。确实如此。

There needs to be more exposure for qualitative research, at least in my opinion. Yeah.

那我们就深入探讨你2021年刚发表的论文吧，标题是《可能性场域中的疼痛：针对急慢性疼痛的主动研究法》，发表在《综合》期刊上。这篇鸿篇巨制——你知道的，我当时正在履行陪审员义务，正是这篇论文陪伴我度过了那两三天。它显然极大程度上延续了你的研究脉络，彼得。你写的那篇论文是2018还是2019年来着？

So let's dive into your recent paper, which is really recent 2021, which was titled Pain in the Field of Affordances An Active Approach to Acute and Chronic Pain, and that's in the journal Synthes. So that was a behemoth of a paper. I was as you know, I've been on I was on jury duty, and that paper kept me comfort, at least the two, three days that I was there. So this builds on- certainly builds on your work, Peter, quite significantly. You know, that paper that you wrote, was it twenty eighteen, nineteen?

对，2019年，没错。

Yeah. 2019, yeah.

那本期刊是《认知科学》吗？不，《现象学》。提醒我一下那本期刊叫什么。

And the journal was Cognitive Science? No, Phenomenology. Remind me what the journal was.

是的，《现象学与认知科学》。编辑是肖恩·加拉格尔和丹·扎哈维，他们都是著名的现象学家，加拉格尔的研究主要涉及活跃传统领域。这是个很适合发表的地方。

Yeah, Phenomenology and Cognitive Sciences. So editors, Sean Gallagher and Dan Zahavi, so they're well known kind of phenomenologists and Gallagher work, does a lot of work in an active tradition. It was a good spot for that.

所以这显然是在你研究基础上的延伸。我猜，萨布丽娜，这也是你一直感兴趣并从事的研究领域吧。

So this really obviously builds on your work. And I'm guessing, Sabrina, this is an area that you've obviously been interested in and working in previously too.

是的。对我来说最重要的是——这也正是本文的重点——疼痛的面向行动性。我长期以来对这个议题很感兴趣，很大程度上是受到科林·克莱因著作《身体命令什么》的影响，他在书中提出了疼痛的指令性理论，认为疼痛的主要功能是告诉我们该做什么。当然不是指需要概念参与的那种指令，而是强调疼痛的动机特性。

Yes. So I think that for me mostly, and that's why also this is more in the focus of this paper, is really the action orientatedness of pain. So I've been quite interested in the question for a while. A lot coming from the work of Colin Klein, has written about a book called What the Body Commands, where he's like developing an imperative approach to pain and saying like, what the main function of pain is somehow to tell us what to do. Of course, not in the sense of like having concepts and these things that are needed for that, but that it's really about the motivation and character of pain.

我对疼痛与行动之间的实际关系这个问题很感兴趣。我的研究起点是发现很难找到某种所有疼痛都会引发的特定行为。人们常说疼痛与回避行为相关，这有一定道理。但仅就急性疼痛而言，它就能驱使我们做出各种不同行为。

And I was quite interested in the question of like what is actually the relation between pain and action, to take a look at that. And I think where I was coming from is that I found it really tricky to find a certain kind of behaviour that all pains relate to. So there's often this idea of like, oh, it's somehow about avoidance, right? And I mean, somehow this seems to be right. But pain motivates us to do so many different things when we just talk about acute pain.

比如当我烫伤手时，会想用冷水冲洗，或者避免触碰伤口组织，甚至可能因此取消晚上与朋友的聚会。可见疼痛以非常复杂的方式塑造着我们与行动和动机的关系。这正是我的研究切入点。后来读到彼得的研究时，发现行动主义理论也强调这种面向行动性，并探讨其与可供性（affordance）概念的联系——这尤其体现在从事精神病哲学研究的学者著作中。

When I burn my hand, I want to put it onto cold water, for example, or I don't want to touch the tissue. And I might not be motivated anymore to meet with my friends in the evening. So it has like these really complex ways of how it shapes our relation to action and motivation, of course. And this was a little bit where I was coming from. And then reading also Peter's work and seeing that an activism really puts this focus on action orientatedness and how this might go together with affordances, which is particularly found in the work of authors who work in the philosophy of psychiatry.

例如，Sanne Kidehan、Giovanna Golombati和Joe Kruger研究抑郁症、强迫症等病症，观察在这些情况下我们与世界的互动关系——即我们如何感知哪些行为可能性与自己相关或具有吸引力——这似乎是一个适用于疼痛研究的有趣方法，可以探究急性和慢性疼痛（特别是在对比时）如何改变我们与世界的复杂互动关系。我认为这正是我最初关注的核心问题。

So, for example, Sanne Kidehan or Giovanna Golombati and Joe Kruger who work on conditions such as depression, OCD, and seeing how in these kind of conditions our interactive relation to the world, so how, what kind of action possibilities we perceive as relevant for us or as attractive, that this seems to be an interesting approach to apply to pain and see how acute and chronic pain, especially like when comparing this, how this changed our quite complex interactive relation to the world. I think that this was the main focus of interest where I was coming from.

你在论文开篇提出了两个问题：一是除了时间性外，急性和慢性疼痛还有哪些区别？（时间性是常见定义标准，比如一个超过12周，另一个未超过）二是急性疼痛如何转变为慢性疼痛？

And there were two, or at least you articulate two questions early on in the paper, or you asked two questions. One was how do acute and chronic pains differ from one another beside temporality? And temporality is the common definition. One's more than 12 and one isn't, or something like that. And also, how does acute pain transform into chronic pain?

但你预设了从急性到慢性的某种转变过程。或许你可以直接回答这些问题，或者用比我更准确的方式重新表述这些问题。

But you're presuming there's some kind of journey there from acute to chronic. So just maybe answer those questions or just reframe those questions better than I've done.

我认为这是个很好的框架。对我来说始终存在这两个问题，它们确实很难完全割裂。但查阅慢性疼痛文献时，我注意到常见做法是直接对比急性与慢性疼痛患者的大脑，却鲜有研究关注中间过程——因为这需要长期追踪可能发展为慢性疼痛的急性患者，进行定期检查。

I think this is like a great framing. So for me, were like, so to say, always two questions. And it's really hard to fully tear them apart. But I have the feeling when looking at the literature on chronic pain, there's quite often like, I don't know, for example, we look at the brain of an acute pain patient and we look at the brain of a chronic pain patient. But there's hardly studies where you really have like a lot of images of what happens in between, because then you already need to have an acute pain patient and assume that this is going to be a chronic pain patient at some point and do like regular investigations, for example.

我们经常做这种静态对比，这固然是很好的起点。正如你所说，时间标准显得很武断，甚至不是最有价值的部分——有些患者带着持续数年的疼痛仍能很好生活，他们不会寻求临床治疗。这些慢性疼痛患者并非我们治疗研究的目标人群。所以关键不在时间。Valerie Hardcastle说得好：慢性疼痛绝非'未能停止的急性疼痛'。

So often we have this static comparison and it can be a great starting point because as you said, like the temporal criterion is really just it seems so arbitrary and it's not really the even like interesting thing about it in the sense of there are patients who have persistent pains for years and they can live with quite well. So they are not the ones that come into the clinical context or that ask for treatment, but they are quite good at managing their situations. These might be chronic pain patients that are not of relevance in the sense for understanding what we actually want to understand in treatment. So it's not about the time. I think Valerie Hardcastle framed that in saying chronic pain is not simply acute pain that has failed to stop.

这个描述非常精辟。我的思路是：先理解目标慢性疼痛病例的机制，再探究导致慢性化的各种因素。因为慢性化绝非某个时间点的突变，而是多种因素共同作用的渐进过程。

And I think that's a great characterisation of that. And I think that was a little bit about like, okay, let's first understand like what is happening in those chronic pain cases that we're interested in, and then have a look of like what are the different factors that contribute to this process of chronification, because I would definitely say like there's not one point in time where we say like oh and now you're a chronic pain patient. That's not the way to think about it. So I think it's really it's a gradual process in which a lot of different factors are involved.

Peter，作为后续问题：我们知道某些因素能预测疼痛持续，比如一系列心理社会因素。若在这些因素上达到特定分值，就更可能发展为慢性疼痛。虽然这个问题已有答案，但恐怕并不令人满意。

And so Peter, perhaps you can just to follow-up, I guess the answer to that question would be like, well, we know some of the factors that predict more persistent pain situations, and someone would list a series of psychosocial factors. And if you meet a certain score on some of those factors, you'd be likely or less likely to achieve a chronic pain state or situation. So that question's been addressed, but it's just not satisfactory, I'm guessing.

是的，我认为这正是行动导向性和现象学要素发挥作用的地方。你可以给某人一个启动工具，或者发一份预后筛查问卷甚至无需见面——让他们在候诊室填写问卷，算出分数后就能判断其风险等级（高风险、低风险或中等风险）。

Yeah, I think this is where that action orientedness and the phenomenological pieces come into play. So you can give somebody a start back tool or you can give somebody some prognostic screening questionnaire and not even see them. You can do it. You can have them fill this questionnaire out in the waiting room. You can get your scores and you can say, oh, you're high risk, low risk, medium risk, whatever it might be.

我认为多数行动主义者会认同这种做法，但我们需要增加一个层面来真正定性理解患者的体验，并引出‘可供性’概念——他们的行动可能性是什么？急性疼痛如何改变了他们对行动可能性的认知？慢性疼痛又如何改变了这些可能性？这为生物心理社会模型等现有模型的局限提供了补充，那些模型缺乏对这种行动导向方法的明确关注，也忽略了我们对身体和世界的感知方式——而这正是行动主义的核心（尽管命名各异，比如‘行动’与‘互动’就嵌在术语中）。这能引领我们开发新型疗法，或至少理解那些本就包含行动要素的现有疗法。

I think most inactivists would say, yeah, that's perfectly fine to do that, but we also need to add another layer in there to actually truly understand in a more kind of qualitative sense, what that person's experience is and leading into that idea of affordances, what are their action possibilities? How has acute pain changed how they view their action possibilities? How has chronic pain changed their action possibilities? So I think it adds another layer in there, and that I guess if we're talking kind of to circle back to bring it together, so you talked about what are some of the limitations of other models, things like the biopsychosocial model, it doesn't have an explicit focus on this kind of action oriented approach, and it doesn't have a specific focus on how we perceive our body and how we perceive our world, and I think this is a core piece of inactivism, or people call it different things inaction, for example, even in the word there, action is in there, action and interaction. And I think this can lead us to different types of therapeutic approaches, or at least maybe understand therapeutic approaches that already exist that involve action.

多数人应该听过体验式学习——通过具身化或主动学习进行的实践教育，大量研究表明其价值远高于被动灌输式教学。当我研究行动主义文献时不禁反思临床实践：我们采用的是主动还是被动教育？近年研究给了我们重要启示：单纯采用‘解释疼痛’方法（让患者坐着听神经生理学原理、区分伤害与危害、识别黄色预警等）效果有限可能是有原因的。

So I think most of people will have heard of experiential learning. So how we're actually doing embodied or kind of active learning and a rich literature base suggesting that that's a lot more valuable than this more kind of didactic approach where we're just providing passive education. So I started while exploring the inactive literature, realizing like, well what are we doing in clinical practice? Are we doing active education or passive education? And I think we learned some, some, some really good lessons over the last couple of years with the research coming out, showing that, okay, maybe this just explain pain approach, just sitting a person down, describing the neurophysiology of pain, describing hurt versus harm, yellow flags, all these things may maybe there's a reason why we're not seeing these big, big effect sizes.

或许我们该结合主动学习策略与体验式教育。上次播客讨论的‘主动隐喻’概念就很有趣——它将诊所里通常被被动使用的隐喻转化为主动体验，让患者通过动作积极表达对疼痛的理解。比如把‘膝盖生锈了’‘这是自然磨损’的说法改为‘活动即良药’，并配合诊室内外的运动，帮助患者具身化新的认知，以积极方式重塑体验。这与现有许多研究不谋而合。

Maybe we should be actually combining this with more active learning strategies, experiential learning. So I know we talked about the idea of an active metaphor last time I was on the podcast and that's super interesting to me because it takes something traditionally kind of maybe more passive in the context of how it's used in clinics and makes it more active. So you're getting people to actually act out their understandings of pain in a positive way. So I think we talked about saying things like, oh, your knee's rusty, or that's just wear and tear, and then changing that to something like motion is lotion and combining that actually with movements inside and outside the clinic to actually help the person embody maybe a new understanding or shape their experience or perception in positive ways. And I think that aligns with a lot of the work that's already out there.

比如Johann Vleian本周在加拿大疼痛大会提出的：刻意制造预期违背，利用预测误差帮患者打破固有模式，以新视角感知世界，重新投入有意义的活动（复工/运动/抱孩子等）。这些都需要行动——难怪康复治疗师、整脊师等身体工作者会对行动主义产生共鸣（这最初让我很惊讶）。原本以为没人会在意这种结合功能行动与现象学的理论，但它恰好整合了零散的文献。

So works of Johann Vleian, I was listening to him at the Canadian Pain Conference this week, it's going on I guess again today, so I'll jump in after this, but so he's talking about these things, intentionally creating this expectation violation with patients, creating those prediction errors to help them get out of those kinds of stuck patterns that they get in to shape their perception in new and kind of positive ways and help them engage in their environment, engage in activities that are meaningful to them, whether that's getting back to work or getting back to sports, picking up your child, all of these things involve action, and I think that's why a lot of people in the rehab professions are jumping onto an activism, which was really a shocker to me initially doing this work. Was like, nobody's going to care. Like it's, I'm like, I see interest in it. Like, I see it as value and I see this function in action and phenomenology is very important, but I'm like, nobody else is going to care about this type of stuff. But then people like physiotherapists, occupational therapists, chiropractors, people that do a lot of body movement type work, osteopaths, they're going, wait a minute, this kind of makes sense.

Sabrina，关于我们在急慢性疼痛中采取的立场（如论文提到的‘渗透性立场’），或许你能补充？我记得你之前阐释得很精彩。

And it fits with the body of literature that's been kind of fragmented. So it starts to bring it all all together. And maybe Sabrina, I know I didn't talk about this kind of idea of the stances that we take in acute versus kind of chronic pain, like this permeating stance, we talk about that in the paper, maybe you can add on onto that, because I think you've nicely explained it before.

是的，我简单说几句。看到这种哲学理念与文献中的发现——甚至是迥异领域的研究——如何相互印证非常有趣。最近我们开始研究运动员教练领域，发现其中关于行动导向的理念存在诸多相似之处。因为在慢性疼痛研究中，我们注意到患者往往将注意力从环境转向身体本身，将环境视为充满敌意、充满‘回避信号’而非‘参与邀请’的场所，这些互动可能性不再被视作有意义的存在。

Yeah, maybe I can just say a few words. So, was also like, I was really, it was so interesting to get to see how this philosophy philosophical idea is like falling together with things that you find in the literature and like very different literature. I think just lately we have been started to look a little bit more into like coaching with athletes and that there are really a lot of ideas when it comes to this action orientatedness where there are similarities. Because for us, so to say, when looking at the literature that we were considering that what happens in chronic pain is often that there's like this focus on the body instead of like on the environment, that the environment is more experienced like a hostile place, so there are not much attractive possibilities to interact. It's a lot of things that scream like avoid me rather than something that are inviting to engage with, and that these things are no longer considered as meaningful.

因此某些行为可能会被采取，但它们已不再符合我们对自己的认知或我们认为重要的事物。这些情境实际上被投射到未来，以至于看不到改变的可能性，许多事物伴随着我们，像是失去了能动性或控制感。可以说，我们的会计方法对治疗也有一点影响，那就是真正尝试为人们重新打开世界，我们可以说这是可以被引导的。就像彼得在他的工作中展示的那样，使用特定术语、传递信息，同时也让人们去探索。这样，才能真正摆脱这些固定的行为模式，重新灵活地与世界互动。

So certain actions might be taken, but they no longer, so to say, fit into who we think we are or what's important to us. And that these are situations that are really projected into the future, so that there's no opportunity seen for change and that a lot of things come with us like a lost feeling of agency or control. And that what so to say our accountant also has a little bit of consequence for treatment is really try to open up the world again for the people, and that we can so to say that this can be guided. And with like how Peter has shown in his work, like using certain kind of terms, sending messages, but also let people explore. So, to really get out of these stock behaviour patterns and get back into like a flexible engagement with the world.

即使无法采取与过去相同的行为，也要看到存在哪些行动可能性，并将它们视为有意义的。当然，我认为这些更像是描绘一幅广阔的图景。但至少在论文中，我们尝试通过一些具体例子来展示如何实现这一点。例如，使用某些词语将注意力从身体部位转移到外部世界的事物上，让人专注于'我能做什么'而非'不能做什么'。我认为这源于这种行动导向的方法，与其他研究非常契合——这对我们来说是令人兴奋的部分，我们看到这与某些研究相吻合，与其他成果也能呼应，某种程度上将它们整合在一起。

And also if like the same behaviour as before might not be possible, but to see what is which action possibilities are out there and to consider them as meaningful. And that these are things that of course I think again it's more like painting a broad picture. But at least in the paper we have tried to show here and there with a few concrete examples of how this might be implemented. And for example, in just like using certain words that take away the focus from the body part to things out there in the world to like make the person focus like this is what I can do instead of things like seeing what they can't do. And I think that this comes from this approach, from this action orientated approach, and that this really nicely fits with other research that was like the awesome part for us, think, where we could see like, oh, this fits with this has been doing hair, and this fits with other things that have been doing hair, and kind of bringing this together.

我想这就是为什么这篇论文也相当紧凑。

And I think that's why the paper is also quite dense.

关于《健康本源》系列节目，你们刚做完那些内容，那个团队也在提出主张——可以说是划定了立场，提出了一套因果理论或因果本体论，但这对我们重视并用于患者决策的证据有影响，也影响我们与患者互动、实践和工作的方式。所以尽管这是围绕倾向主义的因果争论，它对实践和循证实践都有影响。当我与临床医生交谈时，他们特别强调主观叙述的重要性，与患者共同构建包含因果信息的故事，这样你就能理解为何个体处于当前状况，并可能找到治疗或康复的方法。我好奇的是，如果我把他们的书扔上火星，人们必须基于'健康本源'重建医疗体系，那会是什么样子？

So the Course Health episodes, you know, just did those, and that group are making also claims, if you like, putting a stake in the ground, saying we've got a theory of causation or an ontology of causation, but have got implications for the evidence that we value and we utilise to make decisions with patients, and also the way in which we interact and practise and work with patients. So there are some- so even though it's an argument around causation centred on dispositionism, it's got some implications for practise and evidence based practise. So one thing that comes- that came out when I spoke to the clinicians in that series was the focus on the subjective accounts and constructing a story with the person which has causal information within that, which you can understand, you can get some kind of leverage as to why that individual is where they are and potentially how you can work with them to to help to treat them or to recover. I'm interested if I got their book, threw it up into Mars and people had to kind of reboot health care based on on cause health, what would it look like?

同样地，如果我把你们的论文——它几乎有书那么厚——扔上另一个星球，让你们基于此重建医疗体系，会是什么样？我的感觉是，你们都会对第一人称的主观叙述和经验深感兴趣，与个体合作识别倾向性或核心特质。

Likewise, if I got your paper, it's big enough. It's about it's almost the size of a book. And I threw that up also onto another planet and said, and you rebooted health care based on that. What would it look like? My sense is that you'd both be deeply interested in the first person subjective account and experience and working with that individual to either identify dispositions, if you like, or properties on this for the part of the core sales guys.

但在你们这边，重点是识别可供性。我是否过于简化了？或者说这些会是吸引你们注意的潜在因素？请帮我理解这个表述不清的问题。

But on your side, it would be identifying affordances. Am I simplifying it too much? Or these would be potential things that would draw your attention. Help me make sense of my inartificate question.

我很喜欢这个问题。也许我先简单说几句，然后交给萨布丽娜。我听了部分节目，下载了那本书开始阅读，但学术生活太忙碌了，我需要静下心来读完。萨布丽娜对那本书更了解，但据我所听所读，确实存在许多相似之处，如你提到的现象学关注、高度以人为本的护理、不回避复杂性和不确定性。在非活性文献中，他们经常谈到很难找到单一原始原因来解释一个人为何处于现状，实际上有许多因素在相互作用。

I love it. Maybe I'll briefly mention something, then I'll pass it over to Sabrina. I'm not like, I listened to some of the episodes and I downloaded the book and I started to go through it and life is hectic as an academic and I'm like, oh, I just need to like sit down and go through the whole book, so I think Sabrina has got a better knowledge of what that book's all about, but from what I've heard and what I've read, there's a ton of similarities, as you mentioned, focus on phenomenology, focus on very kind of person centered care, not shying away from complexity and uncertainty. So in the inactive literature, they talk a lot about how it's very difficult to, rarely is there just kind of this one single original cause, and you can kind of follow that through and explain why a person kind of ended up where they are. Instead there's many, many factors interacting together.

最初引发问题的因素可能并非实际维持疼痛、残疾或你所关注现象的原因。因此我认为这种多因素复杂交织的理解方式与我们在论文中的描述非常相似。我想我们还没有深入讨论'可供性'究竟是什么，甚至这个词的真正含义。简单来说，它就是行动可能性，但至少我的理解是——这是个关系性术语。行动可能性不仅关乎环境要素，也不仅涉及个人技能、倾向或特定视角。

The initial thing that started things off may not be what's actually maintaining pain or maintaining disability or whatever your phenomenon that you're interested in. So I think that understanding of like so many factors working together in complex ways is very similar to what we described in the paper. And I guess that we haven't really talked too much about like really what affordances are or what that, what that word even really means. So it is like, in really simple terms, it's action possibilities, but the, the, the term, as, as at least I understand it is a relational term. So action possibilities aren't just about what's in the environment, and it's not just about a person and their skills or dispositions or their certain perspective.

这是两者的结合。通过'可供性'这个单词，你同时考量了环境和个体对环境的感知方式，这取决于他们的经历、身体类型和生理特征。这正是吸引我的地方——吉布森为之困扰的（据我理解）正是如何用单个词汇承载如此丰富的内涵。这个词能立即引导你关注个体、他们与环境的互动，以及环境为特定个体提供的可能性。它启示我们：塑造个体可供性的途径是多元的——可以通过身体层面干预，通过改变信念系统，通过调整人与环境的互动方式，甚至可以通过改造物理环境或社会文化环境来为个体创造特定行动可能。

It's a combination of the two. So both with one word, affordances, you're considering both the environment and you're also considering that individual and how they perceive their environment, and that depends on their history, depends on the type of bodies they have, depends on their physiology, so that's what's attractive to me is in a single word, which is awesome that that's what Gibson struggled with, at least to my understanding, in a single word you can have this kind of rich foundation. You're immediately drawn to both the person, their interaction in their environment, and what the environment affords that particular person. So it points us to the idea that there's many, many ways that we can actually shape a person's affordances. You can intervene at the level of the body, you can intervene with a person's beliefs, you can intervene with how that person interacts with the environment, but you could also just shape the physical environment or even sociocultural environment in a certain way that affords certain actions for that individual.

因此我认为'可供性'这个单词蕴含着巨大的探索空间。这并非否定生物心理社会模型的价值，而是说这个概念能有效避免割裂式思维——因为你根本无法割裂。也许该让萨布丽娜接着谈了，我的长篇大论到此为止。

So I think with one single word, affordances, there's so much you can tap into. And that's why I'm like, it's not saying the biopsychosocial model is no good, but it's like with that concept of affordances, you're less likely, I think, to start to just split things up, because you can't. Maybe Sabrina jump on that. I'm done with my rambles.

不，这真是对可供性方法非常精彩的阐释，我完全赞同。就像库尔斯豪斯方法，我也看到许多相似之处——特别是在我们得出的结论方面。你提出的'基于此构建的医疗体系会是什么样'这个问题，我认为很多方面都会非常相似。对我们而言同样重要的是如何表述可供性方法，因为关于可供性本身也存在不同的概念化理解和应用方式。

No, this was like a very nice advocating for the affordance approach, really enjoyed that. I would also, I would fully agree, like with the Coors House approach, see a lot of similarities, especially when it comes to like what are the consequences that we draw. So you asked the question about how would healthcare look like if we build on that. And I think a lot of things will be very similar. I think what's also for us important, and how we phrase the affordance approach, because there are also, when it comes to affordances, different conceptualizations of it and how it has been used.

我们特别关注'可供性场域'这个概念，即个体如何感知其行动可能性与环境。这种第一人称视角绝对是其中的关键要素。虽然我们也考虑社会文化因素和生理因素（这些在库尔斯健康框架中同样存在），但我们视它们为平等要素——不确定对方是否持相同观点。

So we really focus on this field of affordances, which is about how does an individual perceive their action possibilities and their environment. So, I think that this first person perspective is definitely also one important aspect in there. I think for us we also consider like all these other aspects, like sociocultural aspects and physiological aspects, I think that in the Course Health Framework they also play a role. So I would consider them as equal. I'm not sure if they would consider them equal.

他们有时强调'自我叙事'是核心，我不确定这是否意味着比其他要素更重要。我们谨慎主张没有哪个要素更重要，这可能因具体案例而异。通常我们考虑的是无明确起源病因的案例（虽然确实存在少数可确定病因的情况）。即便发现生理病因，我们也不能断言'只有这个生理因素相关'——比如当肿瘤是疼痛主因时，其他因素依然扮演重要角色。

Sometimes they say like the self narrative is at the heart of it, so I don't know if it's considered like more important than other things. And we really try to be careful about saying that none of this is more important and this might also really depend on different cases. So I think of course we often think about cases in which there is for example no originary cause and there's going to be a few cases however in which we find them. And of course in these cases this might not be like we cannot say like, okay, the only thing that's relevant here is this or that physiological thing. But maybe it's still like the most useful thing to start with this, for example, when a person has a tumour that's causing primarily, so to say, the pain condition, then of course, still many other things play an important role.

因此患者体验到的疼痛绝非单一因素所致，而是各类因素共同作用的结果，否则就过度简化了。当然确实存在需要优先手术干预的案例，术后再观察效果。但对我们大多数人而言，那些无明确病因的案例才是重点研究对象——这类案例数量庞大且必须认真对待。

So the reason why the person experiences the pain they do is not just because of that, it's also because of all the other kind of factors. Otherwise this would be an oversimplification. But there are still those cases where we generally say, okay, the first thing we would do is to make a surgical intervention and see how this has been then working out. But of course, I think that for most of us, those cases are of interest in which we don't have this. And there are many of them and they have to be taken seriously.

但除此之外，是的，我确实认为他们的方法有很多相似之处。读这本书真的很有收获，我做了很多笔记，特别是他们关于还原论的论述，非常有趣。

But besides from that, yeah, I would really say I see a lot of similarities to their approach. It has been really great reading the book. I made so many notes on like, this is so exciting, especially how they how they argue about reductionism has been like really interesting.

你对‘一切皆可行’这种论点怎么看？当你完全沉迷于个体、第一人称体验时，它就变成了这种模糊、不确定、复杂多变的互动，而那些严格的证据和指南在这种情境下未必适用。特别是考虑到可供性环境或可供性场域，这种互动的复杂性和独特性。作为临床医生，你可能会陷入一种‘我可以随意编造任何东西’的境地——我可以创造任何可供性场域，或关注任何我认为作为临床医生有趣或重要的东西。那么你如何建立质量把控机制呢？

What do you say about kind of the argument that, well, anything goes? Or the minute you're just totally obsessed with the individual, the first person experience, and it becomes this murky, uncertain, ambiguous, complex interaction, and those kind of rigidity of evidence and guidelines kind of don't fit necessarily in that in that landscape, Particularly if you think of the landscape of affordances or the field of affordances, it's like it's the complexity and the uniqueness of those interactions. I suppose you arrive at a position as a clinician where you say, well, this is I can pretty much just make up anything. Like, I can just create any field of affordances or draw my attention to any particular thing which I think, you know, I think is interesting or important as a clinician. So how do you how do you build in quality checks?

我不知道自己问题的答案，但你们是怎么做到的？什么时候算是做好了积极干预，什么时候没做好？谁来评判？

I couldn't know the answer to my question, but how do you do that? When are you doing an activism well and when are you not doing it well? How can anyone judge?

这个问题非常有趣，因为桑妮卡·达罕在她的《主动精神病学》一书中，用的措辞和你一模一样。她问道：这是否意味着在干预措施上可以随心所欲？因为她讨论了如何塑造可供性，如何在人-环境系统中找到多个干预点。然后她反问：所以这是否意味着可以不顾一切地任意妄为？她的答案很明确：绝对不是。我的观点也完全相同——你仍然需要参考最佳可用证据，审视随机对照试验，考虑指南要求，识别危险信号。

Super interesting question because that, Sanica Dahan, her book, An Active Psychiatry, she words it exactly how you worded it. She she's like, does this mean like anything goes in terms of interventions? Cause she talks about how you can shape affordances, how there's many points of intervention across that person environment system. And she's like, so does that mean, you can just do whatever and throw caution to the wind? And she's like, definitely not, and so my perspective would be just the same, like you still have to look at the best available evidence, you still have to look at RCTs, you have to consider guidelines, You have to know red flags.

你必须能够识别严重病理。这是‘聚焦细节’的理念，但如果是讨论疼痛或体验，我们还需要‘拉远视角’，重视现象学成分和个体的生活体验。通常临床实践指南里会有一句话提到‘医生应采取以人为本的方法或认可患者的感受’。其实我们讨论的所有关于塑造可供性的现象学内容，都可以有意义地归入指南中这一句话的范畴。

You have to be able to identify serious pathology. That's that idea of zooming in, but we also need to zoom out if we're talking about pain, if we're talking about experience, we need to also appreciate that phenomenological component, the lived experience of the individual. And typically that's found within clinical practice guidelines. The one sentence they put in there that says clinicians should take a person centered approach or validate patients. Really So all that phenomenology, all that stuff that we've been talking about shaping affordances would, in kind of meaningful ways would fit with under that one sentence in those, in those guidelines.

因此我们对此进行了延伸。在论文中我们还大量引用了临床实践指南的内容——我们主要关注肌肉骨骼健康领域，而近年来指南确实发生了很大变化（奥利弗你知道，大多数人也清楚），更强调如瑞娜所说的‘辅导而非修复’，做引导者而非解释者。所以对于大多数肌肉骨骼病症，这种基于可供性或主动干预的方法非常契合，更注重主动性的内容。

So we've just extrapolated upon that. So one thing that we did with the paper too, is we drew a lot from what the clinical practice guidelines say. So we focus mostly on MSK Health and it just so happens that guidelines have really changed. You know this Oliver, most people know this, changed a lot over the last couple years, and there's more of a focus on this kind of, as Rina put it, coaching rather than fixing, being a guider rather than an explainer. So for most kind of MSK conditions, I think it fits nicely with this kind of affordance based or an active approach, and a focus on more active things.

我们在指南中看到对支持性自我管理和运动锻炼的强调。不过我们在论文中选取案例时非常谨慎，仍然指出药物在某些情况下很重要，手法治疗也可能通过改变个人可供性发挥作用。所以这并不是说可以随心所欲，你仍需考虑证据、患者认为合理的方案、可行性，并采取这种以患者为中心的方法。

We see that in guidelines, emphasizing supported self management, emphasizing exercise. That said, I think we were quite careful about what we put in there as some examples. We still highlight, yeah, pharmaceuticals can be important. Manual therapies can be important in certain contexts that can potentially shape a person's affordances. So I wouldn't say it means you can do whatever, you still need to consider the evidence, need to consider what the patient thinks is reasonable, what is viable, and, and take this kind of patient centered approach.

话虽如此，如果患者说，你知道吗，我真的认为这种干预对我最有利。这将最好地塑造我的治疗效果。但历史上这种做法曾造成伤害，没有任何试验推荐使用，指南明确表示不应提供这种治疗。那么仅仅因为患者声称需要或想要，就实际提供这种治疗是没有道理的。

That said, if a patient says, you know what, I really think this intervention is, is going to be the best for me. That's going to shape my outcome the best. And it's something that, you know, historically has caused harm. It's something that's not advocated in any trials. Guidelines specifically say do not offer this, it doesn't make sense to actually then offer that, just because the patient says that that's something that they need or they want.

因此我认为，这正是我们需要进行这些艰难对话、重塑人们对高质量或高价值治疗的认知的时候。但正如你所知，奥利弗，关于高价值与低价值护理的讨论确实非常具有挑战性。这真的是极其困难、充满挑战的话题。

So I think that's where having these difficult conversations and shaping a person's maybe view of what is high quality or high value treatment is something that maybe we should be doing, But these are difficult, you know this Oliver, like difficult challenging conversations to have about high value versus low value care. So really, really challenging, challenging stuff.

我能问一下吗？因为我想继续讨论功能可供性（affordances），我们总是点到即止又跳开话题，部分是我的错导致分心。但具体来说，这些功能可供性在哪里？它们存在于何处？我该如何发现和认识它们？

Can I just ask, because I want to stay on affordances, because we dart on them, then we jump off them, it's partly my fault for getting distracted? But in terms of affordances, where are they? Where where are they? How do I find them? How do I know them?

因为你们谈到过塑造它们。所以我只是好奇，这些东西到底是什么？我能在商业街上看到它们吗？它们究竟是什么？实际操作中该如何了解它们？

Because you guys have talked about shaping them. And so I just, what are these things? Can I see them walking down the high street? Like, what are they? And how practically can you get to know them?

这是个很好的问题。我认为这方面存在很多哲学争论。最初，或者说Gibson理论常被解读为：这实际上是主体与世界之间的某种关系属性。可以说是一种关系特性，这种特性打破了传统的主客体区分。这种观点认为，功能可供性以某种恒定形式存在，对特定物种的每个成员而言都存在于世界中。

That's a very good question. I think that there's a lot of philosophical debate on that. So originally, or how Gibson is often interpreted is in the sense of like, that this is really something a relational property between the subject and the world. So that there's, so to say, a property of their relation, a relational property, but so to say that that gives up this typical distinction between subject object. That's kind of an idea and that it's invariant in the sense of like an affordance exists, so to say, in the world for every member of a certain species.

人类根据其拥有的能力和技能，就存在相应的功能可供性。后来又有观点认为这些可供性对特定生命形式的成员具有恒定性。这不仅涉及生物物种，还包括他们的社会文化背景等因素。现在的功能可供性领域实际上研究的是主体如何体验这种'可供性景观'。特定物种和社会背景的成员拥有各自的可供性景观，而我们感知它们的方式总是与我自身及所处情境密切相关。比如想象我面前放着一杯水。

So there are affordances for humans given what kind of abilities and skills they have. Then there has been this idea that these are invariant with respect to members of a certain form of life, And this is not only, so to say, about the biological species, but it's also about their sociocultural background, as one example. And the field of affordances now is really supposed to be, so to say, how the subject experiences the landscape of affordances, one could say. So there's a landscape of affordances for members of a certain species and socio background, and this is really how we perceive them, because also in a certain context, this is always something idiosyncratic with respect to me and the entire situation in which I am. So just think about a glass of water standing in front of me.

一般来说，这杯水可能提供多种可能性：我可以拿起它、可以往后扔、可以做各种事情。但假设我现在口渴，那么最突出的可供性就是用它喝水。这大致就是核心理念。我知道关于'什么是功能可供性'存在着重大的本体论争论。

In general, this might like afford a lot of different things. I can like I can pick it up, I can throw it behind me, I can do whatever with this. But given that I'm, for example, thirsty in a certain situation, the most salient thing would be for me to like drink the water out of it. And this is kind of a bit the idea. And I know that there's like a big ontological debate about what affordances are.

有人认为我刚才提出的观点是关联性的，这是安托瓦内特·基梅拉特别辩护的观点。但也有人认为它们是倾向性。这是支持这一观点的另一派声音。我们在某种程度上避开了这类讨论，因为我们更关注个体如何将世界感知为提供行动可能性的方式。

So some say they are relations, what I've just presented. I think that's an idea that particular Antoinette Chimera has defended. But there are also people who say that they are dispositions. So this is also one strand of people arguing for that. We, to a certain degree, sidestep these kind of things, because we are particularly interested in how does the individual perceive the world as the action possibilities they offer.

因此我们采取了非常主观的研究方法，这是基于我们在此处的特定研究目的。但这背后涉及更宏大的学术争论。正如我所说，法庭上关于倾向性的讨论很多，通常也有将可供性以类似方式解读的可能性。但必须说明这不是我们的专业领域，至少就我个人而言，我自认知识储备不足以给出明确答案，也无法详细论证当我们不采用这种主观视角时可供性的确切定义。

So it's a really subjective approach that we've taken for this particular purpose that we have been interested in here. But there's a way bigger debate behind that. As I mean, in the court held a lot about dispositions and in general there are possibilities to interpret affordances in a quite similar way. But I just have to say like this is not the area of our expertise, at least I could say, speak here for me, that I would not feel to have enough knowledge to make a definite answer and have like a way of arguing for this in much detail and saying what affluences are when we don't take, so to say, this subjective perspective on that.

你们其实无法真正取胜，对吧？假设你们团队发表论文时提出了显著性、效价、负向性和时间视野这四个文献中公认的可供性维度。我想问的是：只有这四个维度，还是存在更多？

You can't win, really, can you? You guys, let's say, produce a paper and this is you've got salience, valence, minus and temporal horizon. These are the four affordances which are in the literature. I'm guessing are there more than four or these are the four?

这通常取决于你咨询文献中的哪位学者。我认为显著性维度几乎被所有研究者采纳，即不同类型的行动可能性对我们显现的相关性程度不同。效价维度是我们特别强调的方面，它在不同研究中都有所体现。实际上我们认为吉布森的工作已包含事物兼具吸引与排斥属性的观点。但正是由于我们对疼痛研究的浓厚兴趣——其中排斥性扮演重要角色——才使这个维度凸显出来。

So normally, this depends a little bit on who you ask in the literature. So I would say that salience is one that almost everyone includes, so that different kinds of action possibilities can appear more relevant to us. The aspect of valence has been something that we particularly highlight, so it's here and there somewhere. So really, I think we also think that this is already in the work of Gibson, that things can be attractive as well as aversive. But I think it has been due to the fact that we're so interested in pain, where aversion plays such a big role that this came to the table.

负向性维度目前主要是罗伊·丁斯的研究成果，我们直接借鉴了他的工作。至于时间视野维度——即我们是从当下还是未来投射的角度感知行动可能性——这在文献中也是相当常见的概念。

And the minus, I think, is something that has been just highlighted so far by Roy Dinggs. So we really take this from his work. And then back to temporal horizon. So how do we perceive action possibilities more with regard to our present or whether we project things in the future? This is something that's also quite common in the literature.

我们更倾向于将其视为主观体验、生活经验的丰富概念化。我们的核心思路是通过这些概念化方式使其具有研究价值，从而识别出'这些可能是不同的干预维度或重要差异显现的领域'。

We rather consider this as a richer conceptualisation of subjective experience, of the lived experience. This is how I think we think about this in a primarily like saying, these are ways how we conceptualise it to make it fruitful and to see, oh, this could be different aspects to intervene on or where we can see important differences.

然后有人提出包含这四个维度的检查清单，配上某种李克特量表之类的东西。这就是挑战所在，不是吗？你们需要通过语言描述将这些概念操作化，必须开始分解落实。某种程度上，生物社会模型已经发生了这种情况——如果你注意到的话，它已经出现了某种程度的理论分化。

And then someone comes up with a checklist with four four of them and, you know, some Leica scale, something like that. And then and this is the challenge, isn't it? Is that you you you to operationalize some of this stuff and just through the the linguistics, by just by talking about it, you've got to begin to break it down to make it operational. And this is perhaps what happened with the bio social model to some extent. It was already slightly kind of fractured, if you like, as a separation developed.

但说起来很容易，好吧。这里有四个维度，我现在要在病人身上寻找这些，你有一个四分模型，随便你怎么称呼它。我不知道你怎么...我想这就像是核心自我的东西。

But it's very easy to say, okay. Here are four dimensions here. I'm now gonna look for those in my patients and just and you you have a kind of quadripartite model, whatever you wanna call it. And I don't know how you yeah. I guess it's like the core self stuff.

你开始把倾向性作为具体目标来寻找，如果你愿意的话，在治疗中，你会变得如此痴迷于发现这些东西，这些属性，从而失去了背景和关系。我只是想评论一下你如何防范这种情况，或者你是否无法防范。我想随之而来的会是有人说，好吧，这听起来很有趣。我想知道这是否会带来更好的护理。我想我说过这个，上次和彼得谈过。

You just start looking for dispositions as specific targets, if you like, with therapy, and you just become so obsessed with finding these things, these properties, and you lose that context and lose that relationship. It was just a comment how you guard against just that and whether you can't. I guess what would come with that was someone would say, Okay, this sounds interesting. I wonder if it leads to better care. I think I said this, spoke to Peter last time about this.

我们来做一项随机对照试验，一组慢性背痛患者接受积极的肌肉骨骼护理，第二组接受其他某种干预。一旦你开始问这些问题，你就必须将其简化为某种可测量的结构。

Let's do a randomised controlled trial where you've got a group of patients that receive an activist musculoskeletal care for their chronic back pain and group two get whatever, some other kind of intervention. The minute you start to ask those questions, you're going to have to reduce it down to some measurable construct.

是的，人们已经测量了可供性。在不同背景下进行了基于可供性的治疗的实验研究。所以实际上有机会以这些方式研究它。

Yeah, and people have measured affordance. Have run experimental studies looking at affordance based therapy in different contexts. So there is opportunity to actually study it in those ways.

捕捉它？它能捕捉到吗？我是说，不能完全捕捉到，那会相当粗糙，不是吗？

Capture it? Could it capture it? I mean, couldn't capture, it would be pretty crude, no?

这取决于你测量什么，但我认为当你观察临床实践时，显然这不是一个清单。你不会说，好了，显著性、效价之类的。但我觉得当我们开始看临床应用时，这是相当直观的。比如一个慢性腰痛患者进来，站在诊室里。你让他们坐下，他们说不行，我不能坐。

It depends on what you're measuring, but I think when you're looking at like clinical practice, I think, yeah, obviously it's not a, it's not a checklist. You're not like, okay, salience, valence, like, but I think it is quite intuitive when we start to look at what clinical applications are. So a patient comes in with chronic low back pain. They're standing in the, standing in the clinical room. And yet you ask them to take a seat and they say, no, I don't, I can't sit.

这会引起太多疼痛。如果我们从可供性的角度考虑，那把椅子对他们来说不再显著。他们看不到坐下的机会。它更像是一种威胁。可能被视为会导致伤害或疼痛的东西，而不是让人能够坐下的事物。

It's causing too much, too much pain. So if we think about that in terms of affordances, that chair is no longer salient to them. They don't see that opportunity to actually sit down. It's more of a threatening thing. It may be viewed as something that may cause injury or pain rather than something that causes the bill or allows a person to actually sit.

如果我们讨论重塑或重建可供性，或许可以通过某些方式引导人们，让他们真正将椅子视为就坐的机会，一个更加显著的机会——如果要用这类术语的话。然后我们可以在不同情境中借鉴这些维度。比如当一个人失去自我认同感，或感觉与世界脱节、无法流畅地参与时，或许可以从心智化角度出发，帮助其更好地与环境协调互动。这可能是重建身份认同的疗法。我认为这些都具有临床潜力，不必拘泥于刻板流程——虽然人们总想那么做，对吧？

So if we're talking about reshaping or reconstructing affordances, there could be ways that we can do that to guide a person so that they actually start to see a chair as an opportunity to sit, as an opportunity that's more salient. If we want to use those types of words. And then we can borrow these other kinds of dimensions in different contexts. So if we're talking about maybe a person losing their sense of identity or feeling like they're no longer kind of attuned to the world or engaging in the world in a fluid manner, maybe you're thinking more in terms of that idea of mindness, so helping a person better align with and interact with their environment in meaningful ways, so that could be therapies that help reconstruct a person's identity. So I think a lot of this stuff, there's clinical potential implications and we don't have to just, it's no checkbox, I don't think, but people always wanna do that stuff, right?

这个例子太棒了，彼得。那把椅子的例子真的很精彩。

They they were great. That was a really nice example actually, Peter. That was really good. The chair.

是的，我们设想过不同案例。刚才那个是我临时编的，不知是否恰当。但讨论可供性时人们总爱拿椅子举例——由于人类的身体构造，椅子提供了就坐的可能性。

Yeah. I we've we've thought of different examples. That one, I just kinda made up randomly there. I don't know how good it is, but it just people people that talk about affordances, they talk about chairs all the time. They're like a human because of the type of body they have, a chair affords sitting.

若换成蚂蚁或其他生物，椅子就不具备这种可供性。这就是核心理念，对吧？

If you're talking about an ant or some other creature, a chair doesn't afford them sitting. These are the ideas, right?

说个切身感受：这个例子让我重新思考个体与椅子的关系。原本只想到恐惧回避，但这个简单例子为实践提供了全新视角——这是我从未意识到的，太妙了。

Just to tell you just the impact of that example on me, I'm now thinking about the relationship between the individual and the chair in a way which I hadn't thought about before. You think about fear and avoidance, but how that simple example really makes me gives you a different perspective on that aspect of practice, which I hadn't been aware of. So it's great.

这个例子之所以精彩，是因为它关联到雷德菲尔德的项目：他们试图建造完全没有就坐功能的房间，但提供躺卧、半倚等不同方式与环境互动。这深刻展现了环境结构如何塑造我们的参与方式——简直像个建筑实验。

I think maybe just like this is a really great example because it connects to the chair. There's like this project by Redfield. They've been trying to build an entire room without an ability to sit, but there are different ways to to lie on the environment or to half stand and lean against it. And they have really tried to show how our environment is structured, how this also shapes our way to engage with it. And it's just like almost more an architectural project.

但我觉得这同时也巧妙揭示了：环境形态的改变会直接影响我们的互动方式。

But I think it's also it's a nice way to see how the shaping of the environment also changes how we also interact with that.

太棒了。我注意到时间问题。我们已经超时一小时了，我想问问是否还有我们没谈到或你特别想确保讨论的内容，以免重蹈覆辙。不过我们已经花了很多时间，我认为涵盖了大量内容，而且比上次更深入地探讨了消极行动主义。

Brilliant. I'm conscious of time. We've gone over an hour, and I want to ask you if there's anything we haven't spoken about or you want to make sure we do speak about and not make the same mistake again. But we've spent a lot of time I think we've covered a ton of stuff and really dived into inactivism more than we did last time anyway.

是的，这次探索消极行动主义和功能可供性等概念的过程确实很有收获。回想多年前我对生物心理社会模型充满热情时，我曾试图建立自己的理解体系并为之倡导。但当我构建完成后又将其解构，想看看还有什么其他可能性。没有什么比看着自己珍视的、认为有意义的思想被推翻后不得不重建更让我欣喜的了——我拥抱这种过程。

Yeah, this has been really a rewarding kind of process to explore inactivism, explore affordances, and similar, I think back to like years ago when I was excited about the biopsychosocial model. And so I kind of really trying to built it up in my own, my own kind of view, and it was an advocate for it. And then once I built it up, tore it down and was like, let's, let's see what, what other options we have. And, there's nothing that brings me more joy than to have those, my ideas and things that I value that I think are meaningful to get them torn away and have to reconstruct that. So I embrace that.

就像研究生阶段的学习经历一样，我希望能看到功能可供性和行动主义领域也经历这种演变。学界存在激烈争论，我乐见其成，因为这终将催生新理论、新方法和新融合。比如未来可能会看到预测加工理论与更具身化、基于主动功能可供性的理论相结合，这种可能性令我兴奋。我绝不是断言这就是终极答案，所有理论和模型都需要不断调整适应。

Like it's something learning through grad school and I'd love to see that happen with affordances and in activism as well. And I think there's hot heated debates in the literature and I like, I love to see that because I think it ultimately will lead us new theories, new approaches and new blends. So maybe mixing predictive processing and more embodied and active affordance based accounts like that in the future, I see possibilities there. In no way am I saying like, this is the thing. Think all theories, all models are going to get adapted.

也许这些想法会引起临床工作者或研究者的共鸣并被采用，那当然很棒。但我们不能戴上眼罩固执己见，这类理论需要持续完善和挑战。不知道你是否认同这种观点——听起来可能有点无政府主义倾向，但这就是我的真实想法。

Maybe this will resonate with people in clinical practice or resonate with researchers and they use it. That's awesome, but I think we can't just be, put our blinders on and be like, this is the thing. There always needs to be work built on to build on this type of stuff, and it needs to be challenged as well, I think. I don't know if you share those same views, that's my, I sound like an anarchist type of view, but that's how I feel.

你听起来像个哲学家，彼得。

You sound like a philosopher, Peter.

或许我确实适合这个角色。

Maybe I do fit in.

我不确定拒绝教条主义是否算哲学思考，但绝对赞同这个观点。这是个漫长的学习过程且仍在继续，还有太多待探索的领域。无论是积极框架还是我们开发的功能可供性框架，都更像是我们心中的理想概念。

I don't know if it's so philosophical to not be dogmatic. I'm not sure yet, but I would definitely agree. So this has been like a really long learning process and I think it's still going on. There's so much more to explore. And also, an active framework or also with the affluence framework we develop, it's more like an ideal idea that we have in our mind.

我们知道存在需要填补的空白——关于事物在实践中如何关联的实证数据，哪些受痛苦体验的方面可能对后续找出最佳治疗方案最为重要。当然，正如彼得所说，并非所有方法都可行。但现在看来，仍有待填补和研究的内容。我还要指出，整合性论述存在更广泛的共性问题，比如：我们如何真正让这些研究人员协同合作？

And we know that there are gaps that have to be filled with empirical data on how do things actually relate in practice, which kind of aspects of an afflicted experience are maybe most important to later on figure out how to treat people best. And of course, there's things like Peter said, not everything goes. But I mean, now it might seem because there are still things that have to be filled and investigated. And I would also say that there are further questions that we can that are general problems of integrative accounts. So, for example, how can we actually bring those researchers all together?

如何促使他们将定量数据转化为定性结果？这些问题并非通过行动主义就能解决，而更像是邀请各方沟通交流、采纳多元视角、认真对待跨学科研究成果，并观察它们如何相互作用与整合。当然，临床实践中许多人可能已深有体会，行动主义也无法解决资源匮乏——资金不足、设备短缺或临床人员超负荷等社会经济和政治层面的问题，这些我们显然完全未触及。

How can we make them translate their results from quantitative to qualitative data? I mean, these are not problems where an activism provides an answer. It's more like an invitation to communicate, to take other people's perspective, to take the results of multiple disciplines seriously and see how more having this idea of like, let's see how they how they interact and how they integrate. And of course, I mean, I think that as clinical practices, many people might be well aware of that, and activism of course doesn't solve any problems with respect to that there's not enough money or equipment or understuffed people in clinical practice. So socioeconomic and sociopolitical problems are like a really big part of clinical practice that we of course do not touch on at all.

是的，这非常明显。我只是认为有必要强调：我们对此有充分认知，而我们能做的贡献或许是提供思考疼痛的新视角。这正是项目启动时的核心理念——尝试以新方式理解疼痛，并严肃对待现有认知。

This is, yeah, I mean, that's really obvious. I just think that this is quite often important to mention that we are quite aware of that, that what we can contribute here is maybe to just give like new ways to think about pain. I think that was our main idea when we started the project. Just try new ways to think about pain and take what we know so far seriously.

如开场所述，我认为各学科临床工作者对这种理论探讨的渴求度...虽然身处个人回音室难以断言，但直觉告诉我，传统理论——无论是整脊、骨疗或物理治疗等专业领域的机械结构生物医学理论——虽仍在院校广泛教授，临床工作者已发现这些理论在实践中帮助有限。因此人们迫切需要更坚实的理论基础来指导诊疗，毕竟最糟糕的莫过于实践中充满矛盾，那种存在主义困惑带来的不适感。你们的工作恰恰为人们提供了向前迈进、系统化开展诊疗的理论基础。

And I think, as I said at the beginning, the appetite for this sort of discourse, you know, again, I have no idea. I'm in my Oneco chamber, you know, so I have no idea, but I'm hoping or my intuition is that there is that clinicians from all, you know, all disciplines are already hungry for a stronger theoretical foundation because the traditional theories, either the theories which are local to the profession, so chiropractic, for example, or osteopathy or physiotherapy, those early kind of theories were mechanistic and structural and biomedical, yet they're still taught prolifically in institutions. Clinicians are figuring out that these theories really don't help them too much at all in clinical practice, and so I think there is a hunger for a stronger theoretical foundation to how people work with patients, because there's nothing worse than just being your practice being filled with contradictions that can be quite an uncomfortable- not a nice, uncomfortable kind of learning and comfortable process, but just being unfulfilled, questioning your existence, all that kind of stuff. So I think your work in an activism really begins to provide some theoretical basis for people to begin to move forward and work with patients in a cogent way.

说得太好了。虽然这不会让事情变简单——比起简单地归咎于椎间盘、肌肉或关节然后继续治疗要复杂得多。

Love it. Yeah. It doesn't make things easier. I don't think though. It's so easy to just blame a disc or blame a muscle or a joint and carry on.

采用这种基于能动性的模型时，当你能精确定位某个结构，患者常会感到强烈认同。但正如文献中提到的（比如肖恩·加拉格尔所说），采用这种互动方式时，临床工作者会抱怨：‘要考虑这么多因素？你让我的工作复杂了好多。’

And I think often patients are very validated with you pinpoint a structure with this more kind of an active affordance based model. There's a lot more to consider. Then people have talked about that in the literature. Sean Gallagher is like, when you take this inactive approach, clinicians are like, well, how can I consider all these things? Like you just make my job a lot more complex.

但你会逐渐适应这种不确定性——这本就是临床实践固有的特性。至少行动主义和倾向性理论不回避这点，它们直面困难坦言：‘是的，这很棘手。’

But I think you become comfortable with that uncertainty. I think that's the uncertainty inherent in practice. But at least an activism and disposition doesn't hide behind. They're not they they put at the forefront. They say, yeah, this is difficult.

这很复杂。我们并非知晓所有答案。而且存在不止一种方式，而传统的机械生物医学理论几乎都假定存在单一的线性路径，这与实际情况并不相符。所以我认为，你是对的。这并没有让事情变得更简单，但在某种程度上让人更能意识到那种复杂性和不确定性。

This is complex. And we don't know all the answers. And there are more than there is more than one way, whereas the traditional kind of mechanistic biological biomedical theories, they pretty much presume a linear single way, which doesn't map out to practice. So I think, yeah, you're right. It doesn't make it easier, but in a way makes one more alive to that complexity and that uncertainty.

是的。而且我在想，现在思考起来，确实如此。它可能具有回报性，因为它或许能解释临床医生遇到的那些异常情况——两个患者，相同病症，相同干预措施，却产生截然不同的反应。临床医生正试图理解这种现象。所以我认为，这就是我从倾向主义简要介绍中听到的要点，他们讨论过，我记得马特2017年的一篇论文中提到过干预措施具有情境敏感性。

Yeah. And I think, yeah, now that I'm thinking about it, I guess it does. It can be rewarding in the sense that it, it starts to maybe explain those unusual situations that clinicians are confronted with where you have two people, same condition, same intervention, and they respond in very, very different ways. And clinicians are like trying to make sense of that. So I think this is where it may, from the brief thing I've heard about dispositionalism is like they've talked about, and I know in one of Matt's papers, maybe 2017, talks about interventions being context sensitive.

因此，对一个人有效的方法可能对另一个人无效，而且随着时间的推移，对同一个人也会发生变化。过去对个体有效的干预措施，在未来实施时可能无法获得相同效果。所以我认为，理解这些涉及的多重因素、复杂的反馈循环后，就会开始明白为什么会出现如此不同的反应和效果。确实如此。

So what worked with one person may not work with another person, and it also changes over time with that same person. So what worked in the past with an individual, same intervention applied in the future, may not get those same outcomes. So I think understanding these, the many factors involved, these complex feedback loops, then you start to realize, oh, well really it makes sense why we get these really different responses and different effects. Yeah.

我想补充一点，也许我们现在正处于这样一个阶段：可以接受并拥抱复杂性、动态性和不确定性，现在只需要找到管理它们的方法。虽然我也不完全确定具体该怎么做。但如果我们能共同面对，这本身就已经很棒了，对吧？

I just wanted to add, like maybe we are right now in the place where we like can come to just accept and embrace complexity, dynamics, uncertainty, and now we just have to find ways to manage them. And I don't know, I'm also not yet entirely sure how to do that. I think if we can all be there together, this would already be great, right?

没错。假装问题不存在对任何人都没有帮助，不是吗？就像假装世界非黑即白、简单线性。这就像孩子们相信圣诞老人一样天真。

Yeah. Yeah. I mean, pretending it's not there just doesn't really help anyone, does it? Like pretending it is just black and white and simple and linear. Like, it's just like children thinking about Santa Claus.

各位，非常感谢。和你们两位交谈真是莫大的荣幸。

Guys, thank you so much. It's been an absolute pleasure speaking to you both.

太棒了。非常感谢。每次和你们交流都很愉快。再次强调，不仅仅是因为你们邀请我们参与，你们所做的工作确实非常重要，无论是研究还是播客，都令人耳目一新。

Awesome. Thanks so much. Always good to talk with you. And once again, not just because you're having us on here, it's really important work that you're doing, like both your research stuff and the podcast, and it's refreshing.

是的，再次感谢邀请。说实话，现在能和人们讨论这篇论文真的很有趣，因为我们刚刚开始基于未知领域撰写新论文——哪些问题是我们无法解答的？目前还有很多未解之谜。所以这确实让人耳目一新，比如思考：为什么这个课题会引起人们的兴趣？

Yeah, thanks again for the invitation. Yeah, and to be fair, it's like it really is a lot of fun actually to now have conversations about this paper with people, because we just started to write new paper just based on what do we not know? Which questions can we not answer? And it's still a lot. So yeah, it's super refreshing also to like to like, hey, like, why is this of interest for people?

能了解到这些真是太棒了。

That's that's just so awesome to get to know.

太精彩了。谢谢各位。

Brilliant. Thanks, guys.

太棒了。保重。

Awesome. Take care.

若您喜欢本期播客，请访问wwwwordsmatter-education.com查看所有节目注释、资源和博客，并了解关于背痛相关语言与沟通的在线课程。我们下次见。

If you enjoyed this podcast, visit wwwwordsmatter-education.com for all the show notes, resources, and blogs, and check out the online course in language and communication in relation to back pain. And I'll see you next time.