TEDGlobal>London
Daniel Levitin: How to stay calm when you know you'll be stressed
丹尼尔·列维京: 有压力时你如何保持镇静
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当你有压力时，你没有在最佳状态。实际上，人的大脑已经进化了几千年，在有压力的情况下会释放皮质醇，理性的有逻辑的思维被抑制，但却能帮助你逃生，比方说在被狮子攻击时。神经学家丹尼尔·列维京认为，在紧张的情况下，当你的思维变得混乱时，有一种方法能避免重大的错误，那就是做事前剖析。“我们有时会失败“，他说，”这个方法就是要超前思考可能的失败会是什么。“
Daniel Levitin - Neuroscientist
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Double-click the English transcript below to play the video.
00:13
A few years ago,
I broke into my own house.
I broke into my own house.
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几年前，我闯入了自己的家。
我开车回到家，
00:16
I had just driven home,
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在蒙特利尔的寒冬，
大约午夜时分，
大约午夜时分，
00:18
it was around midnight
in the dead of Montreal winter,
in the dead of Montreal winter,
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我开车从城镇一边到另一边，
去看望我的朋友Jeff,
去看望我的朋友Jeff,
00:20
I had been visiting my friend,
Jeff, across town,
Jeff, across town,
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门廊上的温度计显示零下40度——
00:23
and the thermometer on the front porch
read minus 40 degrees --
read minus 40 degrees --
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不需要知道是摄氏度还是华氏度,
00:27
and don't bother asking
if that's Celsius or Fahrenheit,
if that's Celsius or Fahrenheit,
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00:30
minus 40 is where the two scales meet --
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到了零下40度，
两个温度显示都一样——
两个温度显示都一样——
00:33
it was very cold.
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天气非常冷。
00:34
And as I stood on the front porch
fumbling in my pockets,
fumbling in my pockets,
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当我站在门廊，摸索着我的口袋，
00:37
I found I didn't have my keys.
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发现找不到钥匙。
00:40
In fact, I could see them
through the window,
through the window,
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实际上，我透过窗户能看到我的钥匙，
00:42
lying on the dining room table
where I had left them.
where I had left them.
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我把它们留在了餐桌上。
00:45
So I quickly ran around
and tried all the other doors and windows,
and tried all the other doors and windows,
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我赶紧围着房子转，
找能进去的门和窗户，
找能进去的门和窗户，
00:48
and they were locked tight.
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而它们都被锁紧了。
00:50
I thought about calling a locksmith --
at least I had my cellphone,
at least I had my cellphone,
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我想到打电话给锁匠，
至少我还有手机，
至少我还有手机，
00:53
but at midnight, it could take a while
for a locksmith to show up,
for a locksmith to show up,
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但在午夜，
锁匠要过来可能需要一段时间，
锁匠要过来可能需要一段时间，
00:56
and it was cold.
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并且天气真的很冷。
01:00
I couldn't go back to my friend
Jeff's house for the night
Jeff's house for the night
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当晚我又不能回朋友Jeff的家，
01:03
because I had an early flight
to Europe the next morning,
to Europe the next morning,
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因为第二天我要坐早班机到欧洲，
必须要进屋里拿护照和行李。
01:05
and I needed to get
my passport and my suitcase.
my passport and my suitcase.
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01:08
So, desperate and freezing cold,
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因此，在绝望和寒冷中，
01:10
I found a large rock and I broke
through the basement window,
through the basement window,
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我找到一块大石头，
打破了地下室的窗户，
打破了地下室的窗户，
清理了玻璃碎片后，
01:14
cleared out the shards of glass,
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我爬进屋里，
01:16
I crawled through,
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01:17
I found a piece of cardboard
and taped it up over the opening,
and taped it up over the opening,
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找到了一块硬纸板，用胶带
把它封贴在打破的窗户上，
把它封贴在打破的窗户上，
01:21
figuring that in the morning,
on the way to the airport,
on the way to the airport,
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我想着早晨去机场的路上，
01:24
I could call my contractor
and ask him to fix it.
and ask him to fix it.
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可以打电话给承包商，
请他来修理窗户。
请他来修理窗户。
01:26
This was going to be expensive,
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修理费会很昂贵，
01:28
but probably no more expensive
than a middle-of-the-night locksmith,
than a middle-of-the-night locksmith,
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但不会比在午夜时
找锁匠来开锁更贵，
找锁匠来开锁更贵，
01:31
so I figured, under the circumstances,
I was coming out even.
I was coming out even.
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所以我觉得，在这种情况下
即使打破了窗户，也还划得来。
即使打破了窗户，也还划得来。
01:36
Now, I'm a neuroscientist by training
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我是一个职业的神经科学家，
01:39
and I know a little bit
about how the brain performs under stress.
about how the brain performs under stress.
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我大概知道在压力下
大脑是如何工作的。
大脑是如何工作的。
01:43
It releases cortisol
that raises your heart rate,
that raises your heart rate,
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大脑会释放皮质醇引起你的心率加速，
01:46
it modulates adrenaline levels
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它调节你的肾上腺素水平
01:49
and it clouds your thinking.
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并阻碍你的思维能力。
01:51
So the next morning,
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第二天早晨，
01:53
when I woke up on too little sleep,
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我醒来的时候严重睡眠不足，
01:55
worrying about the hole in the window,
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还在担心窗户上打破的洞，
01:58
and a mental note
that I had to call my contractor,
that I had to call my contractor,
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心里想着必须打电话给承包商，
02:01
and the freezing temperatures,
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还有，天气非常寒冷，
02:02
and the meetings I had upcoming in Europe,
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在欧洲有个会要开，
02:05
and, you know, with all
the cortisol in my brain,
the cortisol in my brain,
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还有，因为我大脑释放的皮质醇，
02:08
my thinking was cloudy,
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我的思维变得混沌，
但我没觉察到它很混沌，
因为我的思维很混沌。
因为我的思维很混沌。
02:10
but I didn't know it was cloudy
because my thinking was cloudy.
because my thinking was cloudy.
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02:13
(Laughter)
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（笑声）
02:15
And it wasn't until I got
to the airport check-in counter,
to the airport check-in counter,
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直到我在登机手续办理柜台时，
02:18
that I realized I didn't have my passport.
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才意识到我忘了带护照。
02:20
(Laughter)
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（笑声）
02:22
So I raced home in the snow
and ice, 40 minutes,
and ice, 40 minutes,
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于是，我在冰天雪地中
用了40分钟赶回家，
用了40分钟赶回家，
02:26
got my passport,
raced back to the airport,
raced back to the airport,
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拿了护照后，又赶回机场，
02:28
I made it just in time,
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刚好赶上了飞机，
02:30
but they had given away
my seat to someone else,
my seat to someone else,
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但他们已把我的座位给了别人，
02:32
so I got stuck in the back of the plane,
next to the bathrooms,
next to the bathrooms,
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我不得不坐在飞机最后一排，
紧挨着洗手间，
紧挨着洗手间，
02:35
in a seat that wouldn't recline,
on an eight-hour flight.
on an eight-hour flight.
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在八个小时的飞行中，
我的座椅都不能往后倾。
我的座椅都不能往后倾。
02:39
Well, I had a lot of time to think
during those eight hours and no sleep.
during those eight hours and no sleep.
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于是我就有了很多时间去思考，
因为我在八小时中无法睡觉。
因为我在八小时中无法睡觉。
02:43
(Laughter)
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（笑声）
我开始想，我能做些什么，
02:44
And I started wondering,
are there things that I can do,
are there things that I can do,
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有什么切实可行的方法，
02:47
systems that I can put into place,
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02:49
that will prevent bad things
from happening?
from happening?
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可以防止不好的事发生呢？
02:51
Or at least if bad things happen,
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或者至少，
就算不好的事情真的会发生，
就算不好的事情真的会发生，
02:53
will minimize the likelihood
of it being a total catastrophe.
of it being a total catastrophe.
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也能把损失降到最小。
02:59
So I started thinking about that,
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所以，我开始思考这个问题，
但我没有想出来，
直到一个月后，
直到一个月后，
03:00
but my thoughts didn't crystallize
until about a month later.
until about a month later.
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我和同事，也是诺贝尔奖获得者
Danny Kahneman去吃晚餐，
Danny Kahneman去吃晚餐，
03:03
I was having dinner with my colleague,
Danny Kahneman, the Nobel Prize winner,
Danny Kahneman, the Nobel Prize winner,
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我有点尴尬地告诉他，
我打破窗户爬进屋里，
我打破窗户爬进屋里，
03:07
and I somewhat embarrassedly told him
about having broken my window,
about having broken my window,
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03:10
and, you know, forgotten my passport,
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还有忘记拿护照的事，
而Danny和我分享了
03:13
and Danny shared with me
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03:14
that he'd been practicing
something called prospective hindsight.
something called prospective hindsight.
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他一直在练习的
称为”预测后见之明“的东西。
称为”预测后见之明“的东西。
（笑声）
03:19
(Laughter)
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03:20
It's something that he had gotten
from the psychologist Gary Klein,
from the psychologist Gary Klein,
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这是他从心理学家Gary Klein
那里学到的。
那里学到的。
03:24
who had written about it
a few years before,
a few years before,
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Gary 前几年已经写了这个理论，
03:26
also called the pre-mortem.
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也称为"事前剖析"。
03:28
Now, you all know what the postmortem is.
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你们都知道事后剖析是什么意思。
03:30
Whenever there's a disaster,
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每当有灾难，
03:31
a team of experts come in and they try
to figure out what went wrong, right?
to figure out what went wrong, right?
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一个专家小组就会前去调查，
尝试找出导致灾难的原因，对吧 ？
尝试找出导致灾难的原因，对吧 ？
而Danny解释，在事前剖析中，
03:36
Well, in the pre-mortem, Danny explained,
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你要预测，
尝试想出可能出错的所有事情，
尝试想出可能出错的所有事情，
03:38
you look ahead and you try to figure out
all the things that could go wrong,
all the things that could go wrong,
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03:42
and then you try to figure out
what you can do
what you can do
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然后你要尝试可能的方法来
03:45
to prevent those things from happening,
or to minimize the damage.
or to minimize the damage.
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防止这些错误发生，
或将损失降到最小。
或将损失降到最小。
03:48
So what I want to talk to you about today
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所以，今天我想和你们谈谈关于
03:51
are some of the things we can do
in the form of a pre-mortem.
in the form of a pre-mortem.
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在事前剖析中，
我们能做的一些事情。
我们能做的一些事情。
有些方式是显而易见的，
而有些则不那么明显。
而有些则不那么明显。
03:55
Some of them are obvious,
some of them are not so obvious.
some of them are not so obvious.
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03:58
I'll start with the obvious ones.
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我先谈显而易见的方式。
03:59
Around the home, designate a place
for things that are easily lost.
for things that are easily lost.
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在家里，指定一个地方，
放容易丢失的东西。
放容易丢失的东西。
04:05
Now, this sounds
like common sense, and it is,
like common sense, and it is,
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这听起来就像是常识，也的确是，
04:09
but there's a lot of science
to back this up,
to back this up,
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但这符合我们空间记忆的工作原理，
04:12
based on the way our spatial memory works.
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有很多科学依据支持这一点。
04:15
There's a structure in the brain
called the hippocampus,
called the hippocampus,
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在我们大脑里，
有一个叫海马体的结构，
有一个叫海马体的结构，
04:18
that evolved over tens
of thousands of years,
of thousands of years,
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已经进化超过数万年了，
04:21
to keep track of the locations
of important things --
of important things --
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它可以追踪重要东西的位置——
例如，水井的位置，
能够发现鱼的地方，
能够发现鱼的地方，
04:25
where the well is,
where fish can be found,
where fish can be found,
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果树的位置，
04:27
that stand of fruit trees,
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以及友好物种和敌对物种
分别居住在哪里。
分别居住在哪里。
04:30
where the friendly and enemy tribes live.
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04:32
The hippocampus is the part of the brain
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海马体是大脑的一部分，
伦敦出租车司机的
海马体结构通常比常人要大。
海马体结构通常比常人要大。
04:34
that in London taxicab drivers
becomes enlarged.
becomes enlarged.
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04:38
It's the part of the brain
that allows squirrels to find their nuts.
that allows squirrels to find their nuts.
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松鼠能找到坚果，
也要归功于它们大脑的海马体。
也要归功于它们大脑的海马体。
你们可能对这点感到疑惑，
但有人的确做了一个实验。
但有人的确做了一个实验。
04:41
And if you're wondering,
somebody actually did the experiment
somebody actually did the experiment
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他们切掉了松鼠的嗅觉器官，
04:44
where they cut off
the olfactory sense of the squirrels,
the olfactory sense of the squirrels,
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04:47
and they could still find their nuts.
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松鼠仍然能找到它们的坚果。
它们不是用嗅觉，
而是用大脑的海马体，
而是用大脑的海马体，
04:49
They weren't using smell,
they were using the hippocampus,
they were using the hippocampus,
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这个进化完美的大脑机制
是用来找东西的。
是用来找东西的。
04:52
this exquisitely evolved mechanism
in the brain for finding things.
in the brain for finding things.
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04:57
But it's really good for things
that don't move around much,
that don't move around much,
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但只是对找固定的东西比较有效，
05:01
not so good for things that move around.
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找会移动的东西却不是很管用。
05:03
So this is why we lose car keys
and reading glasses and passports.
and reading glasses and passports.
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这就是为什么我们会常常找不到
车钥匙，老花镜和护照。
车钥匙，老花镜和护照。
05:07
So in the home,
designate a spot for your keys --
designate a spot for your keys --
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所以，在家里指定一个
地点存放你的钥匙——
地点存放你的钥匙——
门上的挂钩，或是一个装饰碗。
05:10
a hook by the door,
maybe a decorative bowl.
maybe a decorative bowl.
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05:13
For your passport, a particular drawer.
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在一个特定的抽屉存放你的护照。
你的老花镜要放在特定的桌子上。
05:15
For your reading glasses,
a particular table.
a particular table.
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如果你指定了特定的地方，
并且一丝不苟地做这些事，
并且一丝不苟地做这些事，
05:18
If you designate a spot
and you're scrupulous about it,
and you're scrupulous about it,
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当你寻找它们时，
这些东西总是会在那里。
这些东西总是会在那里。
05:21
your things will always be there
when you look for them.
when you look for them.
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关于旅行呢？
05:24
What about travel?
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05:25
Take a cell phone picture
of your credit cards,
of your credit cards,
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用手机拍下你信用卡的照片，
还有你的驾照和护照，
05:28
your driver's license, your passport,
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05:30
mail it to yourself so it's in the cloud.
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把这些照片发到你的电子邮箱，
储存在数据云端。
储存在数据云端。
05:32
If these things are lost or stolen,
you can facilitate replacement.
you can facilitate replacement.
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如果一旦丢失或被盗了，
你可以很方便地用电子件代替它们。
你可以很方便地用电子件代替它们。
05:37
Now these are some rather obvious things.
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这些是一些显而易见的
事前剖析方法。
事前剖析方法。
记住，当你有压力时，
大脑会释放皮质醇。
大脑会释放皮质醇。
05:39
Remember, when you're under stress,
the brain releases cortisol.
the brain releases cortisol.
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05:43
Cortisol is toxic,
and it causes cloudy thinking.
and it causes cloudy thinking.
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皮质醇是有毒的，
它会导致思维不清晰。
它会导致思维不清晰。
所以，做事前剖析的练习，
05:46
So part of the practice of the pre-mortem
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05:49
is to recognize that under stress
you're not going to be at your best,
you're not going to be at your best,
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是要认识到在压力下，
你不是在最佳状态，
你不是在最佳状态，
05:53
and you should put systems in place.
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你还应该把事情做到井然有序。
05:55
And there's perhaps
no more stressful a situation
no more stressful a situation
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不过也许没有什么
比你要做医疗决策
比你要做医疗决策
更紧张的情况了。
05:58
than when you're confronted
with a medical decision to make.
with a medical decision to make.
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06:02
And at some point, all of us
are going to be in that position,
are going to be in that position,
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3296
有时，我们都会经历这种事情，
06:05
where we have to make
a very important decision
a very important decision
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我们必须要做出一个很重要的决策，
06:07
about the future of our medical care
or that of a loved one,
or that of a loved one,
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为我们自己或自己爱的人
做医疗决策。
06:11
to help them with a decision.
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所以，我想谈谈这个话题。
06:12
And so I want to talk about that.
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06:14
And I'm going to talk about
a very particular medical condition.
a very particular medical condition.
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我要说一个非常特殊的医疗情况。
06:17
But this stands as a proxy for all kinds
of medical decision-making,
of medical decision-making,
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但它代表了各种决策：医疗决策，
当然还有财政决策和社交决策——
06:21
and indeed for financial decision-making,
and social decision-making --
and social decision-making --
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4016
06:25
any kind of decision you have to make
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任何你必须做的决策，
06:27
that would benefit from a rational
assessment of the facts.
assessment of the facts.
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可以让你从理性的事实评估中受益。
06:31
So suppose you go to your doctor
and the doctor says,
and the doctor says,
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3136
假设你去看医生，而医生说，
06:34
"I just got your lab work back,
your cholesterol's a little high."
your cholesterol's a little high."
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4120
“我刚拿到你验血结果，
你的胆固醇有点高。”
你的胆固醇有点高。”
06:39
Now, you all know that high cholesterol
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3016
你们都知道，胆固醇高
06:42
is associated with an increased risk
of cardiovascular disease,
of cardiovascular disease,
136
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4136
会增加患心血管疾病，
心脏病和中风的风险。
06:46
heart attack, stroke.
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1416
06:47
And so you're thinking
138
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1216
所以，你会想
高胆固醇不是一件好事，
06:49
having high cholesterol
isn't the best thing,
isn't the best thing,
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2096
那么医生会说：“我给你开点药，
06:51
and so the doctor says,
"You know, I'd like to give you a drug
"You know, I'd like to give you a drug
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399240
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帮助你降低胆固醇，
他汀类药就可以。”
他汀类药就可以。”
06:54
that will help you
lower your cholesterol, a statin."
lower your cholesterol, a statin."
141
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2776
06:57
And you've probably heard of statins,
142
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1896
你可能已经听说过他汀类药物，
现如今是医生开的
06:59
you know that they're among
the most widely prescribed drugs
the most widely prescribed drugs
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最多的处方药之一。
07:01
in the world today,
144
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你甚至可能认识服用这药的人。
07:03
you probably even know
people who take them.
people who take them.
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2079
于是你想，“好吧，给我他汀类药。”
07:05
And so you're thinking,
"Yeah! Give me the statin."
"Yeah! Give me the statin."
146
413135
2381
但这个时候，你必须问一个问题，
07:07
But there's a question
you should ask at this point,
you should ask at this point,
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2435
07:10
a statistic you should ask for
148
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1856
07:11
that most doctors
don't like talking about,
don't like talking about,
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一个许多医生不愿谈论，
07:14
and pharmaceutical companies
like talking about even less.
like talking about even less.
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制药公司更不喜欢谈论到的
一个统计数字。
这个统计数字就是，治疗所需人数。
07:18
It's for the number needed to treat.
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这是什么意思呢，
治疗所需人数（NNT）？
治疗所需人数（NNT）？
07:21
Now, what is this, the NNT?
152
429200
1976
07:23
It's the number of people
that need to take a drug
that need to take a drug
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它是指多少人服用了某种药，
或接收了手术或其他任何治疗方式，
07:26
or undergo a surgery
or any medical procedure
or any medical procedure
154
434280
2856
07:29
before one person is helped.
155
437160
2376
才会有1人收益。
你心说，
这是哪门子统计数字？
这是哪门子统计数字？
07:31
And you're thinking,
what kind of crazy statistic is that?
what kind of crazy statistic is that?
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这数字应该是1啊，
07:34
The number should be one.
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1216
如果这药对我没有帮助，
07:35
My doctor wouldn't prescribe
something to me
something to me
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那医生就不会开给我。
07:37
if it's not going to help.
159
445760
1285
但实际上，
医疗实践不是这样运行的。
医疗实践不是这样运行的。
07:39
But actually, medical practice
doesn't work that way.
doesn't work that way.
160
447069
2484
07:41
And it's not the doctor's fault,
161
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1531
这不是医生的错，
如果是某些人的错，
那就是像我一样的科学家的错。
那就是像我一样的科学家的错。
07:43
if it's anybody's fault,
it's the fault of scientists like me.
it's the fault of scientists like me.
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2919
我们还没有想出足够好的运作机制。
07:46
We haven't figured out
the underlying mechanisms well enough.
the underlying mechanisms well enough.
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2865
但据葛兰素史克制药公司
（Glaxo Smith Kline）估计，
（Glaxo Smith Kline）估计，
07:48
But GlaxoSmithKline estimates
164
456966
2410
90%的药品只对30%到50%的人有用。
07:51
that 90 percent of the drugs work
in only 30 to 50 percent of the people.
in only 30 to 50 percent of the people.
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459400
4976
所以，这种最广泛的处方药的
治疗所需人数，
治疗所需人数，
07:56
So the number needed to treat
for the most widely prescribed statin,
for the most widely prescribed statin,
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3816
你们猜是多少？
08:00
what do you suppose it is?
167
468240
2136
多少人要服用它
才会出现一个受益的人？
才会出现一个受益的人？
08:02
How many people have to take it
before one person is helped?
before one person is helped?
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470400
2816
300。
08:05
300.
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473240
1200
这是根据研究工作者
Jerome Groopman
Jerome Groopman
08:07
This is according to research
170
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1381
和 Pamela Hartzband
做的研究得出的数据，
做的研究得出的数据，
08:08
by research practitioners
Jerome Groopman and Pamela Hartzband,
Jerome Groopman and Pamela Hartzband,
171
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3496
这项研究由Bloomberg.com
权威网站独立证实过。
权威网站独立证实过。
08:12
independently confirmed by Bloomberg.com.
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我自己想了一下这个数字。
08:14
I ran through the numbers myself.
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482800
2400
必须有300人服用此药一年，
08:17
300 people have to
take the drug for a year
take the drug for a year
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485920
2376
08:20
before one heart attack, stroke
or other adverse event is prevented.
or other adverse event is prevented.
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3976
才能预防一起心脏病，
中风或其他疾病。
中风或其他疾病。
现在你可能在想，
08:24
Now you're probably thinking,
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492320
1381
“好吧，还有300分之1的机会
可以降低我的胆固醇。
可以降低我的胆固醇。
08:25
"Well, OK, one in 300 chance
of lowering my cholesterol.
of lowering my cholesterol.
177
493725
2811
08:28
Why not, doc? Give me
the prescription anyway."
the prescription anyway."
178
496560
2216
为什么不服用呢？医生，
给我开这个药。”
给我开这个药。”
但是你应该问医生，
有关这药的另一个统计数字，
有关这药的另一个统计数字，
08:30
But you should ask at this point
for another statistic,
for another statistic,
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498800
2856
那就是，”告诉我这药的副作用。”
对吧？
对吧？
08:33
and that is, "Tell me
about the side effects." Right?
about the side effects." Right?
180
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2576
08:36
So for this particular drug,
181
504280
1656
那么针对这种药，
08:37
the side effects occur
in five percent of the patients.
in five percent of the patients.
182
505960
3656
副作用会发生在5%的患者身上。
这些副作用包括一些可怕的情况——
08:41
And they include terrible things --
183
509640
1667
08:43
debilitating muscle and joint pain,
gastrointestinal distress --
gastrointestinal distress --
184
511331
4444
肌无力，关节疼痛和肠胃不适 ——
但你可能觉得：“ 才5%的比例，
08:47
but now you're thinking, "Five percent,
185
515799
1859
不太可能发生在我身上，
08:49
not very likely
it's going to happen to me,
it's going to happen to me,
186
517682
2014
我还是会服用它。”
08:51
I'll still take the drug."
187
519720
1238
但是，请等等。
08:52
But wait a minute.
188
520982
1194
记住在压力下，你可能
思维混乱，不能考虑清楚。
思维混乱，不能考虑清楚。
08:54
Remember under stress
you're not thinking clearly.
you're not thinking clearly.
189
522200
2336
所以，要提前思考一下你该如何做，
08:56
So think about how you're going
to work through this ahead of time,
to work through this ahead of time,
190
524560
3165
这样你就不用事到临头时
再去进行一连串的推理了。
再去进行一连串的推理了。
08:59
so you don't have to manufacture
the chain of reasoning on the spot.
the chain of reasoning on the spot.
191
527750
3198
300人要服用这药，
才会有一个人受益，对吧？
才会有一个人受益，对吧？
09:02
300 people take the drug, right?
One person's helped,
One person's helped,
192
530973
2492
300人中5%的人会
受药物副作用的影响，
受药物副作用的影响，
09:05
five percent of those 300
have side effects,
have side effects,
193
533489
2407
也就是15人。
09:07
that's 15 people.
194
535920
1480
你受药物副作用伤害的可能性
09:09
You're 15 times more likely
to be harmed by the drug
to be harmed by the drug
195
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3896
09:13
than you are to be helped by the drug.
196
541720
2816
是你受益于药物的15倍。
我并不是想表明
你该不该服用他汀类药物。
你该不该服用他汀类药物。
09:16
Now, I'm not saying whether you
should take the statin or not.
should take the statin or not.
197
544560
2905
我只是说，你应该咨询你的医生。
09:19
I'm just saying you should have
this conversation with your doctor.
this conversation with your doctor.
198
547489
3143
医德要求我们这样做，
09:22
Medical ethics requires it,
199
550656
1320
这是知情同意原则的一部分。
09:24
it's part of the principle
of informed consent.
of informed consent.
200
552000
2296
你有权力要求知道这类信息，
09:26
You have the right to have access
to this kind of information
to this kind of information
201
554320
3216
09:29
to begin the conversation about whether
you want to take the risks or not.
you want to take the risks or not.
202
557560
3896
有权和医生谈你是否
愿意承担这样的风险。
愿意承担这样的风险。
现在你可能会想
09:33
Now you might be thinking
203
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1216
09:34
I've pulled this number
out of the air for shock value,
out of the air for shock value,
204
562720
2696
我为了制造震撼的效果
凭空捏造了这个数字，
凭空捏造了这个数字，
09:37
but in fact it's rather typical,
this number needed to treat.
this number needed to treat.
205
565440
3256
但实际上，这个治疗所需人数
是相当具有代表性的。
是相当具有代表性的。
对于50岁以上的男性，
做的最多的手术是为治疗
做的最多的手术是为治疗
09:40
For the most widely performed surgery
on men over the age of 50,
on men over the age of 50,
206
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4616
09:45
removal of the prostate for cancer,
207
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2216
前列腺癌而切除前列腺，
09:47
the number needed to treat is 49.
208
575600
2576
治疗所需人数是49。
是的，49个患者做了手术
才会出现一个受益的人。
才会出现一个受益的人。
09:50
That's right, 49 surgeries are done
for every one person who's helped.
for every one person who's helped.
209
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4176
09:54
And the side effects in that case
occur in 50 percent of the patients.
occur in 50 percent of the patients.
210
582400
4656
而这种情况手术的副作用
会发生在50%的患者身上。
会发生在50%的患者身上。
这些副作用包括阳痿，
勃起功能障碍，
勃起功能障碍，
09:59
They include impotence,
erectile dysfunction,
erectile dysfunction,
211
587080
2856
尿失禁，直肠撕裂，
10:01
urinary incontinence, rectal tearing,
212
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2776
10:04
fecal incontinence.
213
592760
1456
大便失禁。
如果你“有幸”成为了50%
受副作用影响的人中的一个，
受副作用影响的人中的一个，
10:06
And if you're lucky, and you're one
of the 50 percent who has these,
of the 50 percent who has these,
214
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3496
这些副作用通常只会持续1-2年。
10:09
they'll only last for a year or two.
215
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2040
10:12
So the idea of the pre-mortem
is to think ahead of time
is to think ahead of time
216
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3616
所以，事前剖析是要提前想好
10:16
to the questions
that you might be able to ask
that you might be able to ask
217
604520
2536
你想问医生的问题，
这样会深入推进你和医生的对话。
10:19
that will push the conversation forward.
218
607080
2376
毕竟你不想事到临头
再来思考所有事情。
再来思考所有事情。
10:21
You don't want to have to manufacture
all of this on the spot.
all of this on the spot.
219
609480
3096
10:24
And you also want to think
about things like quality of life.
about things like quality of life.
220
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2896
而且你也需要考虑一下生活质量。
因为通常你是有选择的，
10:27
Because you have a choice oftentimes,
221
615520
1776
你想要较短的没有痛苦的人生，
10:29
do you I want a shorter life
that's pain-free,
that's pain-free,
222
617320
2296
或想要较长的最终
要承受巨大痛苦的人生呢？
要承受巨大痛苦的人生呢？
10:31
or a longer life that might have
a great deal of pain towards the end?
a great deal of pain towards the end?
223
619640
3776
这些都是现在需要
谈论和思考的问题，
谈论和思考的问题，
10:35
These are things to talk about
and think about now,
and think about now,
224
623440
2416
和你的家人，爱人一起。
10:37
with your family and your loved ones.
225
625880
1816
你可能会在事发时改变你的想法，
10:39
You might change your mind
in the heat of the moment,
in the heat of the moment,
226
627720
2496
但至少你练习了这种思维方法。
10:42
but at least you're practiced
with this kind of thinking.
with this kind of thinking.
227
630240
3056
请记住，我们的大脑
在压力下会释放皮质醇，
在压力下会释放皮质醇，
10:45
Remember, our brain under stress
releases cortisol,
releases cortisol,
228
633320
4616
在那一刻发生的一件事是
10:49
and one of the things
that happens at that moment
that happens at that moment
229
637960
2336
你整个思维系统似乎停工了。
10:52
is a whole bunch on systems shut down.
230
640320
1936
这里有一个进化方面的原因。
10:54
There's an evolutionary reason for this.
231
642280
1905
和一个捕食者面对面时，
你不需要你的消化系统，
你不需要你的消化系统，
10:56
Face-to-face with a predator,
you don't need your digestive system,
you don't need your digestive system,
232
644209
3407
性欲或者免疫系统的帮助。
10:59
or your libido, or your immune system,
233
647640
2456
因为如果你的身体忙着在
这些事情上进行新陈代谢，
这些事情上进行新陈代谢，
11:02
because if you're body is expending
metabolism on those things
metabolism on those things
234
650120
3656
11:05
and you don't react quickly,
235
653800
1656
你就不能迅速作出反应，
那么你可能会成为狮子的午餐，
然后那些事情也就不重要了，
然后那些事情也就不重要了，
11:07
you might become the lion's lunch,
and then none of those things matter.
and then none of those things matter.
236
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3976
不幸的是，
11:11
Unfortunately,
237
659480
1416
在紧张时，其中一件会出错的事情是
11:12
one of the things that goes out the window
during those times of stress
during those times of stress
238
660920
3616
11:16
is rational, logical thinking,
239
664560
1976
理性地，有逻辑地思考。
Danny Kahneman和他的同事
已经证明了这点。
已经证明了这点。
11:18
as Danny Kahneman
and his colleagues have shown.
and his colleagues have shown.
240
666560
3416
所以，我们需要培养
自己超前思考的习惯，
自己超前思考的习惯，
11:22
So we need to train ourselves
to think ahead
to think ahead
241
670000
3176
去面对这类事情。
11:25
to these kinds of situations.
242
673200
2256
这里很重要的一点是，要认识
到我们所有人都不是完美的。
到我们所有人都不是完美的。
11:27
I think the important point here
is recognizing that all of us are flawed.
is recognizing that all of us are flawed.
243
675480
6176
我们都会不时地经历失败，
11:33
We all are going to fail now and then.
244
681680
2856
事前剖析就要超前思考
可能的失败会是什么，
可能的失败会是什么，
11:36
The idea is to think ahead
to what those failures might be,
to what those failures might be,
245
684560
3616
井然有序地做事有助于
把伤害减到最小，
把伤害减到最小，
11:40
to put systems in place
that will help minimize the damage,
that will help minimize the damage,
246
688200
3896
或者在第一时间
防止糟糕的事情发生。
防止糟糕的事情发生。
11:44
or to prevent the bad things
from happening in the first place.
from happening in the first place.
247
692120
3520
说回到我在蒙特利尔
那个冰天雪地的晚上，
那个冰天雪地的晚上，
11:48
Getting back to that
snowy night in Montreal,
snowy night in Montreal,
248
696280
2656
11:50
when I got back from my trip,
249
698960
1736
当我从欧洲返程回到家时，
11:52
I had my contractor install
a combination lock next to the door,
a combination lock next to the door,
250
700720
3856
我的承包商在门旁边安装了密码锁，
还有一把钥匙以及
一个简单易记的密码。
一个简单易记的密码。
11:56
with a key to the front door in it,
an easy to remember combination.
an easy to remember combination.
251
704600
3536
我不得不承认，
12:00
And I have to admit,
252
708160
1216
12:01
I still have piles of mail
that haven't been sorted,
that haven't been sorted,
253
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我还是有一堆没有分类的信件，
12:04
and piles of emails
that I haven't gone through.
that I haven't gone through.
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以及一堆没有处理的邮件。
12:07
So I'm not completely organized,
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所以，我还没能完全做到井然有序，
12:09
but I see organization
as a gradual process,
as a gradual process,
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但我把井然有序做事
看成是一个渐进的过程，
看成是一个渐进的过程，
也正在慢慢实现这个目标。
12:12
and I'm getting there.
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12:13
Thank you very much.
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谢谢。
（鼓掌）
12:14
(Applause)
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ABOUT THE SPEAKER
Daniel Levitin - NeuroscientistDaniel Levitin incorporates findings from neuroscience into everyday life.
Why you should listen
Dr. Daniel Levitin is a neuroscientist at McGill University in Montreal, dean at Minerva Schools in San Francisco and a musician. His research focuses on pattern processing in the brain.
His three books This Is Your Brain on Music, The World in Six Songs, and the recent The Organized Mind are all bestsellers. A polymath at heart, he has performed with top musicians and holds a few gold and platinum records.
Levitin earned his B.A. in Cognitive Psychology and Cognitive Science at Stanford University, and went on to earn his Ph.D. in Psychology from the University of Oregon, researching complex auditory patterns and pattern processing in expert and non-expert populations. He completed post-doctoral training at Stanford University Medical School (in Neuroimaging) and at UC Berkeley (in Cognitive Psychology). He has consulted on audio sound source separation for the U.S. Navy, and on audio quality for several rock bands and record labels (including the Grateful Dead and Steely Dan), and served as one of the “Golden Ears” expert listeners in the original Dolby AC3 compression tests. He worked for two years at the Silicon Valley think tank Interval Research Corporation.
He taught at Stanford University in the Department of Computer Science, the Program in Human-Computer Interaction, and the Departments of Psychology, Anthropology, Computer Music, and History of Science.
Daniel Levitin | Speaker | TED.com