与Amen博士一起解锁可能改变你生活的大脑奥秘

你并非受限于现有的头脑。

You are not stuck with the brain you have.

你可以让它变得更好。

You could make it better.

我可以证明这一点。

I can prove it.

当NFL在足球创伤性脑损伤问题上没有说实话时，我进行了大规模的NFL研究。

I did the big NFL study when the NFL was not telling the truth about traumatic brain injury in football.

我们80%的脑损伤球员都得到了改善。

Eighty percent of our brain damage players got better.

我们想向听众们致以诚挚的谢意。

We want to extend a heartfelt thank you to our listeners.

由于你们不可思议的支持，我们的《时间到了》节目已登上苹果心理健康播客榜首、健康健身榜第二名，以及总榜第26名。

Because of your incredible support, we're out of time has reached number one on Apple's mental health podcast chart, number two on the health and fitness chart, and number 26 overall.

没有你们我们不可能做到这一切。

We couldn't have done this without you.

感谢您与我们共同走过这段旅程。

Thank you for being part of this journey with us.

如果有人存在物质使用障碍问题，请拨打1。

If someone has a problem with substance use disorder, please call 1.

号码是(888) 831-1581。

That's (888) 831-1581.

如果我们无法帮助您，我们会将您转介给能提供帮助的人。

And if we can't help you, we'll make a referral to someone who can.

请讲，我们时间到了。

Please, we're out of time.

今天在《时间到了》节目中，我们邀请到了世界著名精神病学家和脑健康先驱丹尼尔·阿门博士，这位帮助数百万人改变大脑、改变生活的专家。

Today on We're Out of Time, I'm joined by world renowned psychiatrist and brain health pioneer, doctor Daniel Amen, the man helping millions change their brains and change their lives.

你帮助数百万人重新思考心理健康的含义，不仅是情感上的，还包括身体和神经层面的健康。

You've helped millions rethink what it means to be mentally healthy, not just emotionally, but physically and neurologically.

是什么最初让你将大脑视为治愈之门？

What first led you to see the brain as the gateway to healing?

18岁时，我是一名步兵医护兵。由于比你年长，我18岁那年正值越南战争征兵，于是我成为了一名步兵医护兵，正是在那里我爱上了医学。

So when I was 18, I was an infantry medic, so being older than you, when I turned 18, was a draft in Vietnam was going on and I became an infantry medic and that's where I fell in love with medicine.

但大约一年后，我意识到自己不喜欢被枪指着的感觉，于是主动接受再培训成为X光技师，这个转变非常重要。

But about a year into it, I realized I didn't like being shot at so I got myself retrained as an x-ray technician and that was very important.

我们教授常说：'不看怎么知道？'

Our professors used to say, how do you know unless you look?

这句话深深影响了我。1975年退伍后，我读完大学进入医学院。大二那年，我深爱的人试图自杀，我带她去看了一位出色的精神科医生。那时我意识到，如果他成功帮助她（他确实做到了），受益的将不止她一人。

And that really stuck with me and then 1975, I got out of the army, finished college, went to medical school and when I'm a second year medical student, someone I love tries to kill herself And I took her to see a wonderful psychiatrist and I came to realize if he helped her, which he did, it wouldn't just help her.

还会惠及她的子女。

That it would help her children.

更将影响她的孙辈——因为他们将在一个更快乐、更稳定的长辈影响下成长。

It would help her grandchildren as they would be shaped by someone who was happier and more stable.

因此在1979年，我爱上了精神病学，因为我发现它能改变几代人的命运。

So in 1979, I fell in love with psychiatry because I realized it can change generations of people.

你在成瘾治疗领域的工作，正在改变一代又一代人。

Your work in addiction changes generations of people.

但我爱上了唯一一个从不观察其所治疗器官的医学专科。

But I fell in love with the only medical specialty that never looks at the organ it treats.

想想看。

Think about that.

没错。

That's right.

对吧？

Right?

其他所有专科医生都会观察器官，而精神科医生只能猜测。

Every other medical specialist look at the organ, psychiatrists guess.

我知道这是不对的，也相信这会改变。

And I knew it was wrong and I knew it would change.

我在医学院时就对此感到不满，后来在精神科住院医师期间也是如此。

I started agitated at medical school and then in my psychiatric residency.

我就想，我们为什么不观察大脑呢？

I'm like, well, why aren't we looking at the brain?

当然，我们应该研究大脑。

Of course, we should look at the brain.

所以当1991年我有机会进行一项名为脑部SPECT成像的研究时——这正是我们在Amen诊所所做的影像研究——它彻底改变了我生活中的一切，从入睡时间到饮食习惯，再到与他人的互动方式。

So when I had the opportunity in 1991 to do a study called Brain SPECT Imaging, which is the imaging study we do at Ameren Clinics, it literally changed absolutely everything in my life from the time I go to bed to what I eat to how I interact with other people.

而我意识到，大多数精神问题并非心理健康问题，而是大脑健康问题。

And what I realized, most psychiatric issues are not mental health issues, they're brain health issues.

让大脑的生理功能保持健康，你的心智就会更健全——因为大脑的生理功能塑造了你的心智。如果大脑处于炎症状态，你的心智就会更加焦虑。

Get the physical functioning of your brain healthy and your mind is better because the brain, the physical functioning of your brain creates your mind and if your brain is inflamed, your mind's much more anxious.

也会更加消极。

It's much more negative.

我在奥罗尔罗伯茨大学医学院就读时，他们总强调四个维度：

Now, where I went to medical school at Oral Roberts University, they always talked about four circles.

生物、心理、社会与精神。

Biological, psychological, social, and spiritual.

而我始终相信这四个维度缺一不可。

And I believe in all four circles all the time.

但当人们来到你们的治疗中心时，却没人检查他们的大脑，这简直荒谬至极。

But when people come to one of your treatment centers, no one's looking at their brain which is basically insane.

没错。

Right.

去年有3400万份抗抑郁药处方是在没有任何生物学数据支持下开出的。

And last year there were three forty million prescriptions written for antidepressants without any biological data.

我认为抑郁症本就不该作为一种诊断结果。

And I don't think depression should be a diagnosis.

我把抑郁看作胸痛症状。

I think of depression like chest pain.

没人会被诊断为胸痛。

Nobody gets a diagnosis of chest pain.

为什么？

Why?

因为它既不能说明病因，也无法指导治疗方案。

It doesn't tell you what's causing it, and it doesn't tell you what to do for it.

对吧？

Right?

胸痛的原因多种多样。

There are so many different causes of chest pain.

心脏病发作、心律失常、心脏感染、肺癌、肺炎、胀气、溃疡、幽门螺旋杆菌感染、悲伤、焦虑都可能引发胸痛。

Heart attack, heart arrhythmia, heart infection, lung cancer, pneumonia, gas, an ulcer, H pylori, grief, anxiety can cause chest pain.

你不会得到一个笼统的诊断。

You don't get a diagnosis.

如果心脏病专家对所有人的胸痛都采用同一种治疗方式，他会被吊销执照并以医疗事故被起诉，因为这太荒谬了。

And if a cardiologist gave everybody the same treatment for chest pain, he'd lose his license and be sued for malpractice because it's ridiculous.

但现实中，你去医院说'我很疲惫、很悲伤、半夜会惊醒'，

But yeah, you go to the doctor and you go, I'm tired, I'm sad, I wake up in the middle of the night.

结果就被开了选择性血清素再吸收抑制剂，而你根本不知道这药是好是坏。

You end up on an SSRI and you have no idea if that's a good thing or a bad thing.

如果他们做8到20小时的心理测试呢？

What if they do eight to twenty hours of psych testing?

心理测试有帮助，但它无法告诉你大脑内部发生了什么。

So psych testing helps but it doesn't tell you one thing about what's going on in your brain.

它不会告诉你大脑是否健康、是否活动不足或过度活跃。

It doesn't tell you if your brain is healthy, if it's underactive, if overactive.

它不会告诉你大脑是否因脑震荡而受到创伤。

It doesn't tell you if the brain has been traumatized from a concussion.

它不会告诉你大脑是否因生活在霉菌环境中而中毒。

It doesn't tell you if the brain is toxic because you're living in a mold filled environment.

认为你抑郁就该服用Lexapro的想法荒谬至极，然而这种情况每天都在发生，我是说真的每天数以百万次。

The idea that you're depressed take Lexapro is ludicrous but yet it's happening millions of times, I mean literally every day.

你们所做的与定量脑电图（Q EEG）有什么区别？

What's the difference between what you're doing and a Q EEG?

实际上我们在Ammon诊所两者都做。

So we actually do both here at Ammon clinics.

定量脑电图是观察大脑中的电活动。

Quantitative EEG looks at the electrical activity in the brain.

SPECT扫描关注的是血流量及线粒体功能或能量代谢情况。

SPECT looks at blood flow and mitochondrial function or energy metabolism.

我很欣赏你说你们两者都做。

I love the fact that you said you do both of them.

明白吗？

Okay?

因为作为创新者，你我有时会承受很多非议。

Because you and I have taken a lot of heat sometimes because we're innovators.

对吧？

Okay?

我们所做之事不仅高效持久，更能惠及众多人群。

And we've done something that is effective and built to last and helps a lot of people.

你掀起了一场真正的脑健康革命。

You've launched a true revolution in brain health.

它是如何改变当今我们对精神疾病的认知和治疗方式的？

How is it changing the way we think about and treat mental illness today?

那么，我们来做个比较吧。

Well, let's just compare.

如果我们将其视为心理健康，基于症状群集而无生物学数据的诊断。

If we think of it as mental health, diagnosis based on symptom clusters with no biological data.

精神病学的治疗效果并不比我出生的1954年更好。

The outcomes in psychiatry are not better than the year I was born, 1954.

想想看，对吧？

Think about that, right?

医学中没有其他专科领域没有取得重大进展。

There's no other specialty in medicine that has not made significant progress.

25%的成年人口正在服用精神类药物。

Twenty five percent of the adult population is on psychiatric drugs.

这对制药行业来说是巨大的胜利。

Huge win for the pharmaceutical industry.

对我们的社会却是巨大的损失。

Huge loss for our society.

当你将其视为心理健康问题时，57%的少女表示长期感到悲伤，而年轻人的自杀率上升了46%

When you think of it as mental health, fifty seven percent of teenage girls report being persistently sad and suicide in the young has gone up seven and forty six percent.

我想听听这个

I wanna hear about that.

详细说说这个，因为太有意思了

Tell me about that in detail because that was so interesting What

自2000年以来，年轻人自杀率上升了746%

you Suicide has gone up seven hundred and forty six percent since the year 2000 in young people.

这太可悲了——我们却认为这是心理健康问题，而实际上是因为口袋里的手机或社交媒体耗尽了你的多巴胺储备，你不断将自己的生活与那些根本不真实的生活进行比较

It's so sad and we we're thinking of it as you have a mental health problem when your dopamine stores have been depleted because of the cell phone in your pocket or because of social media and you constantly comparing your life to people's lives that are in fact not real.

你正被大公司——Facebook、谷歌——为了金钱而劫持，因为他们的算法让你悲伤、愤怒和焦虑

You are being hijacked by big corporations, Facebook, Google for money because their algorithms make you sad, mad and anxious.

你越悲伤愤怒，就越可能停留在这些平台上

And the sadder and madder you are, the more likely you are to stay on the platforms.

这些平台不在乎你的健康，它们只关心营销和赚钱

And the platforms are not about your health, they're about marketing and making money.

2000年到2025年间发生的是手机革命和社交媒体兴起，孩子们不再只花30分钟在手机上。

So what happened from 2000 to 2025 is we had the cell phone revolution and social media where children aren't spending thirty minutes on their phone.

他们每天花7小时甚至10小时在手机上。

They're spending seven hours or ten hours on their phone.

多巴胺——这种‘更多’的神经递质，是动力、专注、热情的源泉，本应激励孩子们完成事情，现在却把他们推向极端甚至死亡。因为每次收到通知、每次滑动屏幕，都在刺激伏隔核释放微量多巴胺，这种大脑快感最终会耗尽你的愉悦系统。

And dopamine, which is the neurotransmitter of more, it's a neurotransmitter of motivation, of focus, of zest, of let's get stuff done, that were thrilling these kids to death and literally to death because every time you get a notification, every time you scroll, you're getting a little bit of dopamine which presses on the nucleus accumbens, that pleasure in your brain and it wears it out.

所以如果你想象一下

So if you think of

于是你对任何实际行动都感受不到乐趣。

So you find no pleasure in anything of action.

最终你会对一切失去兴趣，转而寻求药物刺激，因为药物最初能让你产生快感，但长期只会让你更加麻木。

You end up no pleasure in anything and then you go to substances because the substances make you feel initially but then it flattens you out further over time.

确实如此。

That's right.

但我想完整阐述这个关于心理健康或大脑健康的观点——传统心理健康治疗只是根据症状匹配疗法。

So but I I wanna finish this idea of mental health or brain health because mental health it's oh you have this problem based on these symptoms, so we'll do these treatments.

如果找医生介入，通常就是开药治疗。

Which usually are medication if you get a doctor involved.

若是大脑健康问题，我们必须饮食得当，按时就寝，还要坚持锻炼。

If it's brain health, we have to eat right, and you have to go to bed, And you have to exercise.

或许你还应该补充欧米伽3脂肪酸。

And probably you should be taking omega three fatty acids.

嗯。

Mhmm.

可能还应该戒酒。

And you probably shouldn't be drinking.

大麻也并非无害。

And marijuana is not innocuous.

你必须恢复健康——当我们75%的人超重或肥胖，50%处于糖尿病或前期糖尿病状态时，心理健康根本无从谈起，因为超重时体内脂肪会产生损害大脑的炎症因子。

It's you have to get healthy and with seventy five percent of us overweight or obese and fifty percent of us diabetic or pre diabetic, there's no way you're gonna be mentally healthy because if you're overweight, the fat on your body is producing inflammatory cytokines that are damaging your brain.

这倒让我想问问您对GLP-1类药物（比如Zepbound）的看法。

That just brought me to how you feel about GLP ones, like Zepbound.

嗯，我觉得这就像腹腔镜手术一样，绝不会是我首推的建议，因为它们不会教你养成好习惯。

Well, I think of it like lapbound surgery, would never be the first thing I'd recommend because they don't teach you habits.

但如果你没有其他方法控制体重，那么它们可以作为一种工具。

But if there's no other way for you to manage your weight, then they can be a tool.

但如果你不把它作为通往健康的入门工具，长远来看最终会伤害你。

But if you don't use it as a gateway tool to get healthy, it's gonna end up hurting you in the long run.

所以你认为这可能是个不错的选择——我不是在替你说——只要你能随后坚持正确的饮食习惯，用它来开个头是可以的。

So you think it's a good maybe, I'm not putting words in your mouth, but it would be okay to give you a head start so long as you followed it up with the right eating behaviors.

如果它能教会你计算摄入的卡路里，把卡路里当作钱来对待，就像我讨厌浪费钱一样。

If it teach if you can use it to teach you to know how many calories you eat, to think of calories like money and you know, it's like I hate wasting money.

我就是讨厌浪费。

It's just I hate it.

我是个注重价值的人。

I'm a value driven person.

但我觉得卡路里也是同样的道理。

But I think of the same thing as calories.

是这样的，我有一个理念会教给我的病人。

Is this, I have a thing I teach my patients.

我喜欢提问。

I like questions.

我爱它吗？它也会爱我吗？

Do I love it and does it love me back?

因为你与食物之间存在一种关系。

Because you're in a relationship with food.

我不知道你是否曾有过一段糟糕的关系，我确实...

I don't know if you've ever been in a bad relationship, I certainly

我与食物的关系糟糕透了。

I'm in a horrible relationship with food.

这是我仅剩的东西了。

It's the only thing I got left.

我曾经历过糟糕的关系，但现在你见到了我妻子，我正处在人生中最美好的关系中。

So I've been in bad relationships, but now you met my wife, I'm in the best relationship of my life.

嗯哼。

Uh-huh.

我绝对不要和食物建立糟糕的关系，因为这方面我能掌控。

I'm damn sure not gonna be in a bad relationship with food because I can control that.

我只是问自己这个问题：我爱它吗？

And I just ask myself this question, do I love it?

就像我爱甜甜圈，但它们讨厌我。

Like I love donuts, but they hate me.

它们让我头脑昏沉，让我发胖，让我的膝盖疼痛。

They make me foggy, they make me fat, they make my knees hurt.

就像在说'不，我不会吃甜甜圈，因为它不爱我'。

It's like no, I'm not gonna eat the donut because it doesn't love me.

而我如此爱自己，只想把有益的东西放进身体。

And I love me so much, I only wanna put something in me.

我最近去了白宫，别嫉妒我。

I was at the White House recently, don't hate me.

我认识你，我称他为总统。

I know you, I call him the president.

我并不讨厌你。

I do not hate you.

我当时坐在丽莎·特劳特旁边，她和丈夫肯尼共同拥有'正义'这匹马。

I was sitting next to Lisa Trout and Lisa and her husband Kenny own Justify.

'正义'是赢得三冠王的纯种赛马。

Justify is the Triple Crown winning thoroughbred.

我坐在她旁边时问她：你会给'正义'喂垃圾食品吗？

And as I was sitting next to her I'm like, would you ever feed Justify junk food?

她说：不会。

And she goes, no.

我又问：你会灌醉它吗？

I said, would you ever get them drunk?

她说：不会。

She goes, no.

我问，你会给他们吸毒吗？

I said, you ever get them stoned?

不会。

No.

我在想，为什么？

I thought, why?

他永远无法发挥出全部潜力。

He would never perform to his potential.

但我们不是更值得珍惜吗？

But aren't we worth so much more?

是的。

Yes.

但我们甚至不考虑摄入体内的东西——你的大脑消耗了你摄入热量的20%到30%。我认为治疗中心真的应该把重点放在人们的饮食上。绝对如此。

But we don't even think about what we put in our bodies and your brain uses 20 to 30% of the calories you consume and I think treatment centers should really be focused on feeding people Absolutely.

我知道你也有同样的想法。

And I know you have the same thought.

蓝色饮食是我们通常为大众提供的基本膳食方案。

The blue diets are what we typically serve our people in a general way.

意思是，我们会

Mean, we'll

在蓝色区域饮食中请务必戒酒。

Just hold the alcohol with the blue zone diet.

嗯，我们确实这么做。

Well, we do.

我们这么做是因为这被称为康复治疗。

We do because it's called rehab.

好的。

Alright.

在你的新书《重塑大脑，改变疼痛》中，你写道疼痛不是两个独立问题，而是一个整体系统。

In your new book, Change Your Brain, Change Your Pain, you write that pain isn't two problems, it's one system.

情绪疼痛与身体疼痛如何相互交织？为何这一点常被误解？

How does emotional pain and physical pain intertwine and why is that so often misunderstood?

所以慢性疼痛。

So chronic pain.

如果你持续疼痛超过三周，这不仅仅是背部、膝盖或颈部的问题，而是已经激活了你大脑中的疼痛回路。

If you've had pain for more than three weeks, it's not just in your back or in your knee or in your neck, it's activated the pain circuits in your brain.

谢谢。

Thank you.

这些回路与引发悲伤、抑郁和焦虑的回路是相同的。

And they're the same circuits that cause grief and depression and anxiety.

因此，要真正摆脱并远离疼痛，你必须拥有一个健康的大脑。

And so learning to really get out and stay out of pain, you have to have a healthy brain.

你知道吗，最近因各种负面新闻登上头条的泰诺，实际上对缓解悲伤也有帮助。

And did you know Tylenol, which has made the news for all the wrong reasons recently, actually helps with grief.

它确实能缓解分手带来的情感痛苦。

It actually helps with the emotional pain from a breakup.

为什么会这样呢？

Why would that be?

因为它能抑制相同的神经回路。

Because it calms down the same circuits.

再比如欣百达，一种非常有效的抗抑郁药，它获得了FDA批准用于治疗慢性疼痛。

Or Cymbalta, one of the really good antidepressants, it's FDA approved for chronic pain.

这是为什么呢？

Why is that?

还有SAM e这种补充剂，已被发现对情绪有益，同时也能缓解关节炎症状。

Or SAM e, the supplement that's been found to be helpful for mood also helps arthritis.

为什么会这样？

Why is that?

因为它们作用于大脑中的痛苦传导通路。

Because they work on the suffering pathway in the brain.

所以当你思考疼痛时，要想到三条传导通路。

So when you think of pain, think of three pathways.

首先是感觉通路——比如我踢到脚趾时，它会激活大脑中称为丘脑的部分，然后传递到感觉皮层，让你喊出‘哎哟，我的脚趾好痛’。

There's the feeling pathway, oh, I stubbed my toe, so it activates a part of the brain called the thalamus and then goes to the sensory cortex, go, ouch, oh, my toe hurts.

然后如果你的大脑中部处于忙碌状态，就会激活痛苦通路，这种通路会将疼痛与恐惧和忧虑混合在一起。

And then if your brain is busy in the middle, it'll activate the suffering pathway and that sort of smears that pain with fear and dread.

哦，我可能再也不能跳舞了。

Oh, I won't be able to dance again.

然后如果你的额叶——也就是平静通路——工作不正常，你就无法关闭疼痛。

And then if the calming pathway which is your frontal lobes isn't working right, you won't be able to turn off the pain.

所以在《改变大脑，改变疼痛》一书中，我最终讨论了这三种回路以及如何平衡它们，这样你就不会生活在慢性疼痛中。

And so ultimately in change your brain, change your pain, I talk about those three circuits and how to balance them so you're not living a life of chronic pain.

我很喜欢这个观点。

I love that.

我很喜欢这个观点。

I love that.

这是你的创新吗？

Did you innovate that?

现在，人们已经讨论过这三种回路，但我真正感兴趣的是为什么Simlta和Sammy对生理和情感疼痛都有效。

What now, people have talked about these three circuits but I really got interested in why does Simlta and Sammy work for both physical and emotional pain.

在书中，书中的主角被称为'厄运循环'。

And in the book, the star of the book is called the doom loop.

这就是你身体或情感上受伤的方式。

It's how you hurt physically or emotionally.

我的意思是，我可能因为被拒绝、丢了工作或妻子离开我而受伤。

I mean I could hurt because I got rejected or I lost my job or my wife left me.

它会激活同样的神经回路，所以当疼痛发生时，恐惧中枢会将其扩散，进而导致消极思维。

It activates those same circuits and so it's pain happens, the fear center smears it which then leads to negative thinking.

我称它们为ANCE，即自动负面思维。

I call them ANCE, automatic negative thoughts.

嗯。

Mhmm.

这进而导致肌肉紧张，加剧疼痛，继而形成不良习惯。

Which then goes to muscle tension, which increases pain, which then goes to bad habits.

无论是阿片类药物、苯二氮卓类药物、酒精、大麻还是其他什么，都会让你陷入这种恶性循环。

Whether it's opiates or benzos, alcohol, marijuana, whatever, which then just keeps you into this doom loop.

要摆脱这种困境，我们需要一个治愈

And to get out of it, we need a healing

循环。

loop.

所以你的意思是所有这些因素相互叠加，然后就开始了一个恶性循环，不断重复。

So what you're saying is all these things compress on each other and then it just starts a vicious cycle of repeat.

没错。

Right.

周而复始。

Rinse and repeat.

而慢性疼痛患者有很高的自杀率，这是肯定的。

And people in chronic pain have a high incidence of suicide because For sure.

他们只是预判一切都不会奏效，看到的是一生都将与慢性疼痛为伴。

They're just predicting nothing will work and they see a life of chronic pain.

我在书的开篇讲述了一位警官的故事，他遭遇了两次高速车祸，最终患上慢性背痛，经历了多次手术、服用阿片类药物、酗酒，并试图自杀。

I opened the book with the story of a police officer who was involved in two high speed car crashes, ended up with chronic back pain, sick surgeries, opiates, alcohol and he tried to kill himself.

我遇见了他，并像往常一样对他进行了扫描。

And I met him and as I do, I scanned him.

大脑的换挡器，也就是前扣带回，工作负荷过重。

The brain's gear shifter, it's called the anterior cingulate gyrus, is working way too hard.

我当时就想，哦，你无法摆脱疼痛，因为它一直在循环。

And I'm like, oh, you can't get away from the pain because it just cycles.

这就是那条痛苦通路，当我们让它平静下来后，他重获了新生。

So that was that suffering pathway and as we calmed it down, he got his life back.

你感觉如何？

How'd you feel?

他说我还是疼，只是不再总想着它了。

And he said I still hurt, I just don't think about it all the time.

所以我用藏红花给他治疗，这是我最喜欢的补充剂之一，能提升血清素，让扣带回平静下来。

And so I fixed him with saffron, one of my favorite supplements, raises serotonin, calms down the singulate.

我们用藏红花、欧米伽3脂肪酸和姜黄素来抑制痛苦传导通路。

We use saffron, omega three fatty acids, curcumins to calm the suffering pathway.

我教会他不要轻信自己脑中那些愚蠢的想法。

I taught him not to believe every stupid thing he thought.

我对所有患者都传授这个理念。

I teach this for all my patients.

每当你感到悲伤、愤怒、紧张或失控时，就把你正在想的事情写下来。

Whenever you feel sad, mad, nervous, out of control, write down what you're thinking.

只需问问自己这些想法是否真实。

Just ask yourself whether or not it's true.

我们通过催眠缓解紧张情绪，我教会他如何通过饮食来爱护大脑，并让他与妻子重归于好。

We used hypnosis to calm down the tension and I taught him how to love and care for his brain by what he ate and reconnected with his wife.

我太喜欢这个了。

I love that.

我太喜欢这个了。

I love that.

你每个细节都讲得恰到好处，每一个都是。

You hit every note on that, every single one.

你在沃尔特·里德陆军医疗中心和特里普勒陆军医疗中心开始了你的精神病学职业生涯。

You began your psychiatric career at Walter Reed and Tripler Army Medical Center.

早期与士兵相处的经历让你对创伤和隐形伤口有何认识？

What did those early experiences with soldiers teach you about trauma and invisible wounds?

我年轻时曾是步兵卫生员，后来退伍上了医学院，之后又重返军队。

So I was an infantry medic when I was young and then I got out the army, went to medical school and then I went back in.

我非常珍惜在沃尔特·里德的时光，其中一个重要教训是——我的第一篇专业论文题为《越战后应激障碍：过去与当下生活事件的隐喻》。

And I loved my time at Walter Reed and one of the big lessons, my first professional paper was called Post Vietnam Stress Disorder, a metaphor for current and past life events.

我逐渐确信，并且现在更加坚信：你带入战争的头脑往往决定了你从战争中带出的头脑。

And what I came to believe and actually believe more strongly now, it's the brain you bring into war that often determines the brain that comes out of war.

噢，请详细说说

Oh explain

这基于我提出的一个概念——脑储备。

It's based on a concept I developed called brain reserve.

假设两名士兵在伊拉克同乘一辆坦克，经历同样的爆炸冲击、同样的作用力、同样的角度，所有条件都相同。

So take two soldiers, put them in the same tank in Iraq, expose them to the same blast, same forces, same angles, everything's the same.

其中一人毫发无损地离开，另一人却终身残疾。

One of them walks away unharmed, the other one's permanently disabled.

为什么？

Why?

关键在于他们遭遇事故时的大脑状态。

It's the brain they brought into that accident.

他们的母亲在怀孕期间是否承受巨大压力？这会降低大脑储备。

So did they have a mom who was really stressed when she was pregnant with that child that decreases brain reserve?

他们是否以健康的方式喂养孩子？

Did they feed the child in a healthy way?

这会增加大脑储备。

That increases brain reserve.

他们是否参加过激烈的橄榄球比赛？

Did they play tackle football?

这会降低大脑储备。

That decreases brain reserve.

他们有过脑震荡吗？

Did they have concussions?

影响脑储备的因素实在太多，既有增加也有减少的。

Did they there's so many things of both increase and decrease reserve.

我认为观察他们的大脑非常重要。

And I think it's so important to look at their brain.

我曾发表过一项关于创伤后应激障碍和创伤性脑损伤的大型研究。

I published a huge study on PTSD and traumatic brain injury.

影像学检查可以区分。

And imaging can separate.

这是创伤后应激障碍还是创伤性脑损伤？或者两者兼有？

Is this post traumatic stress disorder or is this traumatic brain injury or is it both?

为什么这很重要？

And why is that important?

因为情绪创伤往往会激活你大脑中的神经回路。

Well, emotional trauma tends to activate activate the the circuits circuits in in your your brain, brain.

身体创伤往往会抑制这些脑区活动。

Physical Physical trauma trauma tends tends to to deactivate them.

所以如果你不清楚状况，可能会对他们采取完全错误的治疗方式。

So if you don't know, you may do the exact wrong thing for them.

假设你以为这是情绪创伤，但实际上他们脑活动低下，这时给他们服用SSRI类药物可能会解除抑制反而加重病情——因为SSRI会降低脑活动，若原本就活动不足再进一步抑制，可能导致他们产生杀人或自杀倾向。

So say you think it's emotional trauma but really they have low activity, give them an SSRI and you can disinhibit them and make them worse because SSRIs decrease brain activity but if you start with decreased activity and you decrease it further, now they can become homicidal or suicidal.

你对经颅磁刺激疗法（TMS）怎么看？

How do you feel about TMS?

我是TMS疗法的忠实支持者，当然前提是采用扫描引导的TMS治疗方案。

I'm a huge fan of TMS if it's scan guided TMS, right?

认为所有抑郁症患者都该刺激左额叶，这种疗法默认每位抑郁患者左前额叶皮层活动低下。

To stimulate everybody's left frontal lobe who's depressed assumes everybody who's depressed has low left prefrontal cortex activity.

这是个错误的假设。

That's a wrong assumption.

你怎么

How do you

先用QEEG（定量脑电图）来诊断吗？

figure out first with the QEEG?

你需要对他们进行成像检查。

You image them.

你可以使用定量脑电图（QEEG）、SPOT、PET，或者我在UCLA的朋友会使用功能性磁共振成像（FMRI）。

So you could use quantitative EEG or you can use SPOT or you can use PET or I have a friend at UCLA who uses FMRI.

但我们需要一些生物学数据来指导治疗，这种盲目治疗的方式应该被淘汰。

But we need some biological data to target treatment, this flying blind stuff should go away.

没错，必须客观而非主观。

No, needs to be objective and not subjective.

这正是你

That's what you're

对于创伤后应激障碍（PTSD），我还是EMDR疗法的忠实支持者。

Now I'm also for PTSD, I'm a huge fan of EMDR.

我掌握这项技术并经常实践，发现它对右脑治疗效果非常显著。

And I know how to do it, I practice it, and I find it incredibly helpful for the right brain.

没错。

That's right.

你治疗成瘾已有数十年。

You've treated addiction for decades.

从你的角度来看，当一个人摆脱成瘾，当渴望不再控制他们时，大脑里实际发生了什么？

From your perspective, what's actually happening in the brain when someone breaks free, when that craving no longer controls them?

嗯，他们的大脑正在恢复健康。

Well, their brain is getting healthy.

这就是当渴望消失时发生的事——我最近在播客上采访了朱利叶斯·兰德尔，他曾经深陷大麻成瘾的困扰。

That's what happens when the craving you know, I just had on the podcast was Julius Randle who really struggled with marijuana addiction.

他现在已经完全不受困扰了。

And he doesn't struggle at all.

他甚至不再去想它了。

He doesn't even think about it anymore.

我认为很大程度上是因为他的大脑更健康了，而且他不再相信自己冒出的每一个愚蠢念头。

I think in large part because his brain is much healthier and he doesn't believe every stupid thing he thinks.

他还是个目标明确的人。

He's also very goal directed.

我让所有病人都做一个练习，叫'一页奇迹'，只用一张纸。

I have all of my patients do an exercise called the one page miracle on one piece of paper.

你想要什么？

What do you want?

人际关系、工作、金钱、身体、情感、精神健康。

Relationships, work, money, physical, emotional, spiritual health.

作为一名高水平运动员，他以目标为导向，所以清楚自己想要什么，而大麻与这些目标毫不相干。

And as a high level athlete, he's goal driven, so he knows what he wants and marijuana just doesn't fit any of them.

没错。

Right.

此外，他希望拥有更健康的大脑，因为这才是让他成为优秀篮球运动员的关键。

Plus, he wants to have a better brain because that's what makes him a great basketball player.

关键就在于他的大脑。

It's his brain.

他想成为一名好父亲，这是什么意思？

He wants to be a good dad, what is that?

这是我的大脑。

It's my brain.

所以我认为关键在于让你的大脑保持健康。

And so I think it's getting your brain healthy.

而在成瘾治疗领域，关于健康大脑的讨论实际上非常少。

And the addiction treatment field, there's actually very little discussion about healthy brain.

关于让我们关注并让你的大脑恢复健康，这样你就不必被控制。

About let's look at it and get your brain healthy so you don't have to be controlled.

没错。

That's right.

大多数治疗中心根本不谈论大脑。

Most most treatment centers don't talk about the brain at all.

好的。

Alright.

在我的新书《体验超越》中，我探讨了康复之后会发生什么，即当一个人真正超越成瘾或创伤身份的那一刻。

In my new book, Experiencing Transcendence, I talk about what happens after recovery, that moment when someone truly moves beyond the identity of addiction or trauma.

从你的角度来看，当一个人达到那种更高层次的平静或目标时，大脑中发生了什么？

From your view, what's happening in the brain when someone reaches that higher level of peace or purpose?

大脑中有一个有趣的区域，叫做默认模式网络。

So there's an interesting area of the brain, it's called the default mode network.

主要位于大脑后部顶叶中部的后扣带回区域。

Mostly in the posterior cingulate in the back top middle part of the brain.

当这个区域过于活跃时，你会产生很多关于自己的负面杂念。

And when that's too busy, you have a lot of negative chatter about yourself.

而学会平静这个区域——我们确实在冥想中观察到——可以引发超越体验。

And learning to calm that down which we actually see in meditation can cause transcendence.

裸盖菇素也有这种效果，虽然我不是它的狂热支持者，但它确实能平静那个区域。

And psilocybin does it, although I'm not a huge fan, but it calms down that.

眼动脱敏与再加工疗法（EMDR）也能做到这一点。

EMDR does that.

祈祷和冥想也能达到这种效果。

Prayer and meditation does that.

我教给所有病人的一个技巧是：给你的思维起个名字。

And one technique I give to all of my patients is give your mind a name.

你不必理会大脑产生的那些杂音。

It's you don't have to listen to the noise that your brain generates.

所以我把我的思维命名为我的宠物浣熊。

And so I named my mind after my pet raccoon.

等等，你养了只浣熊？

So we both You have a raccoon?

我们都成长于恩西诺市，那时大概是1970年，我16岁。

We both grew up in Encino when I was so I guess it's 1970, I'm 16.

当时我养了只德国牧羊犬，去宠物店买狗链时，一只小浣熊顺着我的腿爬上来，攀到我肩膀上玩我的头发——那时我还有头发，我就收养了它。

I have a German Shepherd, I went to the pet store to get him a leash and a little baby raccoon climbed up the back of my leg up to my shoulders, started playing with my hair when I had hair, and I grabbed her.

她实在太可爱了。

She was so cute.

我买下了她，带她回家，惹了不少麻烦。

I bought her, took her home, got into lots of trouble.

但我很爱她。

But I loved her.

她是个捣蛋鬼。

She was a troublemaker.

她在我妈妈的浴室里撒尿，吃光了我姐姐鱼缸里的鱼，还总在我鞋子里拉浣熊屎。

She t p'd my mom's bathroom, ate all the fish out of my sister's aquarium, would leave raccoon poo in my shoes.

这就是我的名字。

That's my name.

所以我用浣熊的名字给我的思维命名为赫尔米，这样我就不必总是听从它。

And so I named my mind Hermie after the raccoon and so I just don't have to listen to it.

你知道，我可以选择是否要听从它，如果她真的烦到我了，我就把她关进笼子里。

You know, I can choose if I wanna listen to it and if I don't or if she's really bothering me, I put her in a cage.

我总有些可怕的念头冒出来，对吧？

I get these little thoughts that are scary, right?

因为没有人能像我这样吓到自己。

Because nobody can scare me the way I can.

你知道，它们就像云一样。

And you know, they're like clouds.

它们来了，我就说，啊，哦，

They come and I go, ah, oh,

啊，哦。

ah, oh.

我已经明白我的想法并非事实，它们就像云一样。

And I've just learned that my thoughts are not facts, and they're just like clouds.

它们会过去的。

They and they pass.

对吧？

Right?

所以我喜欢你这种表达方式，因为人们的学习方式各不相同。

And so I love the way you put it because it's just a people learn in different ways.

他们需要用不同的方式去倾听。

They have to hear it in different ways.

他们需要用不同的方式去观察。

They have to see it in different ways.

每个人都是不同的。

People are different.

我脑海中充斥着各种疯狂念头，但我不执着于它们，因为让你痛苦的并非那些念头本身，而是你对它们的执着。

I have so many crazy thoughts and I just don't attach to them because it's not the thoughts you have that make you suffer, it's the thoughts you attach to.

顺便说，这很有佛教意味。

So if a guy That's very Buddhist by the way.

你说什么？

I'm sorry?

这是非常佛教的理念。

That's a very Buddhist principle.

嗯，这也是非常基督教的理念。

Well, it's also a very Christian principle.

我正在为教会开发一个名为'阿们四全'的项目，基于罗马书12章1-2节：心意更新而变化。

I'm working on a program for churches called the Amen Whole Four and it's based on Romans chapter 12 verse one and two, be transformed by the renewing of your mind.

这样你就能验证何为神的善良、纯全、可喜悦的旨意。

Then you can test if it fits God's good, perfect and pleasing will.

这个想法说出来，你和听众肯定会觉得我疯了。

And that thought, you know, I'll tell you this and your audience will think I'm really crazy.

但我们家养了两只狗。

But we have two dogs at home.

一只亲我，一只亲塔娜。

And one of them loves me and one of them loves Tana.

亲塔娜的那只，每次她回家时都会兴奋得发疯。

And the one that loves Tana, when she comes home, he's just so happy he acts just insane.

有天那只叫特瑞斯的狗在我办公室陪我。

And one day, Terrace, that was his name, was in my office and hanging out with me.

我突然冒出个念头：要是我杀了塔娜，特瑞斯就会在我回家时特别兴奋了。

And I had the thought, if I killed Tana, Terrace would get really excited when I came home.