抑郁癥究竟是一種怎樣痛苦的體驗(yàn)？中英互譯

Asforme,Ihadalwaysthoughtmyselftough,oneofthepeoplewhocouldsurviveifI'dbeensenttoaconcentrationcamp.就我自己來說，我一度認(rèn)為自己非常堅(jiān)強(qiáng)，認(rèn)為自己是那一類即使被送去集中營(yíng)也可以存活下來的人。In1991,Ihadaseriesoflosses.Mymotherdied,arelationshipI'dbeeninended,ImovedbacktotheUnitedStatesfromsomeyearsabroad,andIgotthroughallofthoseexperiencesintact.1991年，我經(jīng)歷了一連串的不幸，母親去世，愛情終結(jié)，我也在幾年的海外生活之后回到了美國(guó)，我在經(jīng)歷了這一切之后依舊安然無(wú)恙。

Butin1994,threeyearslater,Ifoundmyselflosinginterestinalmosteverything.Ididn'twanttodoanyofthethingsIhadpreviouslywantedtodo,andIdidn'tknowwhy.

然而在1994年，也就是三年之后，我突然發(fā)現(xiàn)自己對(duì)幾乎所有的事情都失去了興趣甚至不愿意去做那些我曾經(jīng)很想去做的事情，我不知道這是為什么。Theoppositeofdepressionisnothappiness,butvitality.Anditwasvitalitythatseemedtoseepawayfrommeinthatmoment.Everythingtherewastodoseemedliketoomuchwork.IwouldcomehomeandIwouldseetheredlightflashingonmyansweringmachine,andinsteadofbeingthrilledtohearfrommyfriends,Iwouldthink,"Whatalotofpeoplethatistohavetocallback."OrIwoulddecideIshouldhavelunch,andthenIwouldthink,butI'dhavetogetthefoodoutandputitonaplateandcutitupandchewitandswallowit,anditfelttomeliketheStationsoftheCross.抑郁的反面，并非快樂，而是活力。而正是這樣的活力，似乎就在那段時(shí)間從我的身體中慢慢消失了，所有需要完成的事情，都感覺那么麻煩。回到家的時(shí)候，看著電話留言機(jī)上閃爍的紅燈，我不但不會(huì)因?yàn)槁牭脚笥褌兊穆曇舾械脚d奮，反而會(huì)想怎么有這么多人等我回電話。有時(shí)該吃午飯了，我卻開始想，我還得把食物拿出來，放到盤子里，得切，得嚼，得咽，讓我感覺就像耶穌受難一樣。Andoneofthethingsthatoftengetslostindiscussionsofdepressionisthatyouknowit'sridiculous.Youknowit'sridiculouswhileyou'reexperiencingit.Youknowthatmostpeoplemanagetolistentotheirmessagesandeatlunchandorganizethemselvestotakeashowerandgooutthefrontdoorandthatit'snotabigdeal,andyetyouarenonethelessinitsgripandyouareunabletofigureoutanywayaroundit.AndsoIbegantofeelmyselfdoinglessandthinkinglessandfeelingless.Itwasakindofnullity.

人們?cè)谡務(wù)撘钟魰r(shí)時(shí)常忽略了一點(diǎn)，那就是你知道這一切都很荒謬，即使你正處在抑郁之中，你也知道這一切都很荒謬。你知道多數(shù)人都可以讓自己去聽語(yǔ)音留言，去吃午餐緊接著讓自己沖個(gè)澡，然后出門你知道這根本不是什么大不了的事情，然而你已經(jīng)被它掌控，并且無(wú)法找到任何解決的方式，于是我開始感到自己事情做得越來越少，思考得越來越少，感知得越來越少，就好像整個(gè)人已經(jīng)沒什么價(jià)值了。Andthentheanxietysetin.IfyoutoldmethatI'dhavetobedepressedforthenextmonth,Iwouldsay,"AslongIknowit'llbeoverinNovember,Icandoit."Butifyousaidtome,"Youhavetohaveacuteanxietyforthenextmonth,"Iwouldratherslitmywristthangothroughit.Itwasthefeelingallthetimelikethatfeelingyouhaveifyou'rewalkingandyousliportripandthegroundisrushingupatyou,butinsteadoflastinghalfasecond,thewaythatdoes,itlastedforsixmonths.It'sasensationofbeingafraidallthetimebutnotevenknowingwhatitisthatyou'reafraidof.AnditwasatthatpointthatIbegantothinkthatitwasjusttoopainfultobealive,andthattheonlyreasonnottokilloneselfwassoasnottohurtotherpeople.緊接著焦慮就來了，如果你告訴我，我會(huì)在接下來的一個(gè)月里一直抑郁，我會(huì)說，“只要一個(gè)月之后不抑郁了我就可以接受?！钡绻愀嬖V我“你會(huì)在接下來的一個(gè)月里嚴(yán)重焦慮?！蹦敲次覍幙筛钔笠膊辉敢馊淌堋＿@是一種持續(xù)的感覺，就好像你走在路上滑倒了或者絆倒了，地面猛沖向你的感覺。但這種感覺不是半秒鐘，而是持續(xù)6個(gè)月。這是一種時(shí)時(shí)刻刻感到懼怕，卻不知道自己在懼怕什么的感覺，就在那時(shí)我開始想，活著太痛苦了。人不自殺的唯一原因是因?yàn)椴幌雮ι磉叺娜?。Therearethreethingspeopletendtoconfuse:depression,griefandsadness.Griefisexplicitlyreactive.Ifyouhavealossandyoufeelincrediblyunhappy,andthen,sixmonthslater,youarestilldeeplysad,butyou'refunctioningalittlebetter,it'sprobablygrief,anditwillprobablyultimatelyresolveitselfinsomemeasure.Ifyouexperienceacatastrophicloss,andyoufeelterrible,andsixmonthslateryoucanbarelyfunctionatall,thenit'sprobablyadepressionthatwastriggeredbythecatastrophiccircumstances.Thetrajectorytellsusagreatdeal.Peoplethinkofdepressionasbeingjustsadness.It's

much,muchtoomuchsadness,muchtoomuchgriefatfartooslightacause.有三種東西是人們?nèi)菀谆煜囊钟?，悲傷，難過。悲傷是一種明確的反應(yīng)，如果你遭遇了不幸并感到極度不快，緊接著六個(gè)月以后，你還是非常難過，但是生活大致正常了，這很有可能是悲傷，而且它很有可能在最終一定程度地自我恢復(fù)。如果你經(jīng)歷了一次災(zāi)難性的打擊，然后感覺非常糟糕，并且六個(gè)月之后你依然無(wú)法正常生活，那么很有可能就是你的抑郁。被這種災(zāi)難性的情形觸發(fā)了，這中變化的過程告訴我們很多信息，人們往往認(rèn)為抑郁只是難過而已，只是太多太多的難過、太多的悲傷、起因卻微不足道。Butthetruthlies.Ibecameobsessedwiththatsentence:"Butthetruthlies."AndIdiscovered,asItalkedtodepressivepeople,thattheyhavemanydelusionalperceptions.Peoplewillsay,"Noonelovesme."Andyousay,"Iloveyou,yourwifelovesyou,yourmotherlovesyou."Youcananswerthatoneprettyreadily,atleastformostpeople.Butpeoplewhoaredepressedwillalsosay,"Nomatterwhatwedo,we'realljustgoingtodieintheend."Orthey'llsay,"Therecanbenotruecommunionbetweentwohumanbeings.Eachofusistrappedinhisownbody."Towhichyouhavetosay,"That'strue,butIthinkweshouldfocusrightnowonwhattohaveforbreakfast."但事實(shí)是會(huì)說謊的，我非常喜歡這句話“事實(shí)是會(huì)說謊的?！碑?dāng)我與抑郁癥患者交談時(shí)我發(fā)現(xiàn)，他們有很多妄想出來的念頭，人們會(huì)說，“沒人愛我?！比缓竽阏f，“我愛你，你的妻子愛你，你的母親愛你。”你可以很快給出這個(gè)答案，至少對(duì)大多數(shù)人是如此。但是抑郁的人還會(huì)說“不論我們做什么，最終都是要死的?！被蛘咚麄冋f，“兩個(gè)人之間是不可能有真正的親密交往的，我們每個(gè)人都被自己的身體所束縛了?！皩?duì)于這個(gè)你只有回應(yīng)說”這點(diǎn)沒錯(cuò)，但我覺得我們眼下要考慮的是早上該吃什么?！?/p>

Alotofthetime,whattheyareexpressingisnotillness,butinsight,andonecomestothinkwhat'sreallyextraordinaryisthatmostofusknowaboutthoseexistentialquestionsandtheydon'tdistractusverymuch.TherewasastudyIparticularlylikedinwhichagroupofdepressedandagroupofnon-depressedpeoplewereaskedtoplayavideogameforanhour,andattheendofthehour,theywereaskedhowmanylittlemonsterstheythoughttheyhadkilled.Thedepressivegroupwasusuallyaccuratetowithinabout10percent,andthenon-depressedpeopleguessedbetween15and20timesasmanylittlemonsters--許多時(shí)候困擾他們的不是疾病本身，而是對(duì)一些事實(shí)的偏執(zhí)。他們會(huì)對(duì)一些事實(shí)超乎常人的在意。但是對(duì)于我們絕大多數(shù)人而言并不在意這些有關(guān)存在的問題。我有一個(gè)特別喜歡的研究。是要一組抑郁癥患者，和一組非抑郁癥患者分別打一小時(shí)的電子游戲，一小時(shí)結(jié)束的時(shí)候問他們他們認(rèn)為自己殺了多少只小怪獸。抑郁組的答案往往準(zhǔn)確，誤差不超過百分之十。而非抑郁組的人估計(jì)的小怪獸數(shù)量卻是實(shí)際殺掉的15到20倍。Iwasstruckbythefactthatdepressionisbroadlyperceivedtobeamodern,Western,middle-classthing,andIwenttolookathowitoperatedinavarietyofothercontexts,andoneofthethingsIwasmostinterestedinwasdepressionamongtheindigent.我很不能理解為什么人們普遍的把抑郁癥看成現(xiàn)代西方中產(chǎn)階級(jí)特有的一種病。于是我開始尋找抑郁癥與其它社會(huì)因素的關(guān)聯(lián)，在可能相關(guān)的社會(huì)因素中，我對(duì)貧困和抑郁的關(guān)系特別感興趣，于是我做了一些研究嘗試去了解窮人是如何治療抑郁的。

AndsoIwentouttotrytolookatwhatwasbeingdoneforpoorpeoplewithdepression.AndwhatIdiscoveredisthatpoorpeoplearemostlynotbeingtreatedfordepression.Depressionistheresultofageneticvulnerability,whichispresumablyevenlydistributedinthepopulation,andtriggeringcircumstances,whicharelikelytobemoresevereforpeoplewhoareimpoverished.

我發(fā)現(xiàn)大多數(shù)情況下，窮人的抑郁癥不會(huì)得到治療。抑郁屬于基因的缺陷，這意味著在不同的人群中容易抑郁的人的比例應(yīng)該是一樣的，生活環(huán)境的不同導(dǎo)致了發(fā)病率的不同。而當(dāng)人們處于貧困的生活環(huán)境中時(shí)抑郁癥的發(fā)病率更高,也更嚴(yán)重。

Andyetitturnsoutthatifyouhaveareallylovelylifebutfeelmiserableallthetime,youthink,"WhydoIfeellikethis?Imusthavedepression."Andyousetouttofindtreatmentforit.Butifyouhaveaperfectlyawfullife,andyoufeelmiserableallthetime,thewayyoufeeliscommensuratewithyourlife,anditdoesn'toccurtoyoutothink,"Maybethisistreatable."但是,如果你的生活一帆風(fēng)順然后你覺得自己一直都不開心你會(huì)反思,"我為什么不開心?""我一定是抑郁了."然后你會(huì)去找醫(yī)生給你治療。但是如果你的生活本來就很糟糕，然后你一直都不開心，你的感覺和你的生活狀態(tài)是相稱的，于是你就不會(huì)想到這個(gè)是病"或許這個(gè)可以治療一下"。

Andsowehaveanepidemicinthiscountryofdepressionamongimpoverishedpeoplethat'snotbeingpickedupandthat'snotbeingtreatedandthat'snotbeingaddressed,andit'satragedyofagrandorder.

所以實(shí)際上我們這個(gè)國(guó)家的低收入人群中，抑郁癥像是傳染病一樣流行，但是卻一直沒有被人注意過。沒有人評(píng)估過患病的規(guī)模，也沒有人為這些低收入者提供治療，這是非常大的一個(gè)悲劇。Peoplethensay,"Butisn'tdepressionpartofwhatpeoplearesupposedtoexperience?Didn'tweevolvetohavedepression?Isn'titpartofyourpersonality?"TowhichIwouldsay,moodisadaptive.Beingabletohavesadnessandfearandjoyandpleasureandalloftheothermoodsthatwehave,that'sincrediblyvaluable.Andmajordepressionissomethingthathappenswhenthatsystemgetsbroken.It'smaladaptive.人們可能會(huì)接著問,"那么，抑郁本身不應(yīng)該是我們注定需要經(jīng)歷的一個(gè)過程么難道抑郁不是我們的演化的結(jié)果么？難道這不是你個(gè)性的一部分么？對(duì)此我的看法是，情緒是有適應(yīng)性的，對(duì)于我們而言能夠感受喜怒哀樂，以及其它豐富的情感，意義重大。而當(dāng)一個(gè)人總是抑郁的時(shí)候，那一定是他的情緒系統(tǒng)出問題了，不再能夠適應(yīng)環(huán)境了。

Peoplewillcometomeandsay,"Ithink,though,ifIjuststickitoutforanotheryear,IthinkIcanjustgetthroughthis."有些人會(huì)跟我這樣說，“即便如此,，我想如果我自己再多熬一年”我就可以走出抑郁了。AndIalwayssaytothem,"Youmaygetthroughit,butyou'llneverbe37again.Lifeisshort,andthat'sawholeyearyou'retalkingaboutgivingup.Thinkitthrough."對(duì)此我總是這樣回答，“或許你能夠自己走出來，但是失去的青春你再也找不回了。人生苦短，你現(xiàn)在卻在跟我說要浪費(fèi)一年的時(shí)間（自己挺過抑郁）你再想想。Valuingone'sdepressiondoesnotpreventarelapse,butitmaymaketheprospectofrelapseandevenrelapseitselfeasiertotolerate.Thequestionisnotsomuchoffindinggreatmeaninganddecidingyourdepressionhasbeenverymeaningful.

正視抑郁的價(jià)值并不能保證不再?gòu)?fù)發(fā)，但是卻能改變看待抑郁復(fù)發(fā)的態(tài)度，甚至?xí)p弱抑郁復(fù)發(fā)的程度。我們要解決的問題，并不是要去找到偉大的意義和決策讓你的抑郁看起來意義非凡，而是要去尋找這樣的意義，能夠讓你思考。It'sofseekingthatmeaningandthinking,whenitcomesagain,"Thiswillbehellish,butIwilllearnsomethingfromit."Ihavelearnedinmyowndepressionhowbiganemotioncanbe,howitcanbemorerealthanfacts,andIhavefoundthatthatexperiencehasallowedmetoexperiencepositiveemotioninamoreintenseandmorefocusedway.當(dāng)抑郁卷土重來"這會(huì)向下地獄般痛苦，但是我會(huì)受益良多，我從自己的抑郁中看到情緒的作用能夠如此之大，甚至能夠蓋過客觀存在。而且我發(fā)現(xiàn)我的這段經(jīng)歷讓我能夠更加強(qiáng)烈和專注的，去感受和體會(huì)積極向上