TEDxMidAtlantic
Rachel Wurzman: How isolation fuels opioid addiction
瑞秋•沃茲曼: 孤立如何促成鴉片類藥物上癮
Filmed:
Readability: 5.6
1,794,730 views
妥瑞氏症、海洛英成癮，和社交媒體迷戀有什麼共通性？神經科學家瑞秋•沃茲曼說，它們都會合在大腦中的一個區域，叫做紋狀體。而這項重要的發現，能夠重塑我們對於鴉片類藥物危機的了解。沃茲曼分享了她研究中的洞見，並說明社會孤立會如何影響復發以及用藥過量的比率；她還點出，有意義的人類連結其實就可能是恢復的一種強大來源。
Rachel Wurzman - Neuroscientist
Through her nonprofit SeekHealing, Rachel Wurzman aims to reduce opioid overdose rates by building communities that are inherently resilient to addiction. Full bio
Through her nonprofit SeekHealing, Rachel Wurzman aims to reduce opioid overdose rates by building communities that are inherently resilient to addiction. Full bio
Double-click the English transcript below to play the video.
00:13
What does it mean to be normal?
0
1634
2067
正常是什麼意思？
00:16
And what does it mean to be sick?
1
4857
1876
生病又是什麼意思？
00:21
I've asked myself this question
from the time I was about seven,
from the time I was about seven,
2
9087
3457
我從七歲開始，
就在問我自己這個問題，
就在問我自己這個問題，
00:24
when I was diagnosed
with Tourette syndrome.
with Tourette syndrome.
3
12568
2523
那時我被診斷出妥瑞氏症。
00:27
Tourette's is a neurological disorder
4
15115
2104
妥瑞氏症是一種神經性失調，
00:29
characterized by stereotyped movements
I perform against my will, called tics.
I perform against my will, called tics.
5
17243
5436
特徵就是我非刻意
也會做出刻板的動作，
也會做出刻板的動作，
稱為抽搐。
00:35
Now, tics are technically involuntary,
6
23524
3015
技術上來說，抽搐並不是自願的，
00:38
in the sense that they occur
without any conscious attention
without any conscious attention
7
26563
3215
也就是，抽搐發生時
我並不會意識到，
我也沒有意圖要這麼做。
我也沒有意圖要這麼做。
00:41
or intention on my part.
8
29802
1600
00:44
But there's a funny thing
about how I experience tics.
about how I experience tics.
9
32228
4769
但我對於抽搐的體驗
有一點十分有趣。
有一點十分有趣。
00:49
They feel more unvoluntary
than involuntary,
than involuntary,
10
37021
4620
覺得比較像是不由自主
而不是無意識的，
而不是無意識的，
00:53
because I still feel like it's me
moving my shoulder,
moving my shoulder,
11
41665
2960
因為我仍然感覺得到我在動肩膀，
00:56
not some external force.
12
44649
1600
並不是外力造成的。
00:58
Also, I get this uncomfortable sensation,
called premonitory urge,
called premonitory urge,
13
46696
4825
此外，就在抽搐發生之前，
我會有一種不舒服的感覺，
叫做前驅性衝動，
叫做前驅性衝動，
01:03
right before tics happen,
14
51545
1370
01:04
and particularly
when I'm trying to resist them.
when I'm trying to resist them.
15
52939
2384
特別是當我試圖抗拒時。
01:07
Now, I imagine most of you out there
understand what I'm saying,
understand what I'm saying,
16
55633
3048
我相信在座大部分的人
都懂我所說的，
都懂我所說的，
01:10
but unless you have Tourette's,
you probably think you can't relate.
you probably think you can't relate.
17
58705
3472
但除非你也有妥瑞氏症，
不然你可能會認為你無法體會。
不然你可能會認為你無法體會。
01:15
But I bet you can.
18
63776
1266
但我敢說你可以。
01:17
So, let's try a little experiment here
and see if I can give you
and see if I can give you
19
65664
3017
咱們來做個小實驗，看看我能否
讓各位嚐到我的體驗是什麼滋味。
01:20
a taste of what my experience feels like.
20
68705
3102
01:23
Alright, ready?
21
71831
1150
準備好了嗎？
01:25
Don't blink.
22
73776
1277
別眨眼。說真的，不要眨眼。
01:27
No, really, don't blink.
23
75077
1611
01:28
And besides dry eyes, what do you feel?
24
76712
3206
除了眼睛很乾之外，
你還感覺到什麼？
你還感覺到什麼？
01:33
Phantom pressure?
25
81509
1348
不知哪來的壓力？
01:35
Eyelids tingling?
26
83794
1309
眼瞼刺痛？
01:37
A need?
27
85945
1150
有需求？
01:39
Are you holding your breath?
28
87810
1595
你有在憋氣嗎？
01:41
(Laughter)
29
89429
1151
（笑聲）
01:42
Aha.
30
90604
1151
啊哈。
01:43
(Laughter)
31
91779
1150
（笑聲）
01:47
That's approximately
what my tics feels like.
what my tics feels like.
32
95942
3516
我的抽搐大約就是這種感覺。
01:52
Now, tics and blinking,
neurologically speaking, are not the same,
neurologically speaking, are not the same,
33
100315
3691
就神經學上來說，
抽搐和眨眼是不一樣的，
抽搐和眨眼是不一樣的，
01:56
but my point is that you
don't have to have Tourette's
don't have to have Tourette's
34
104030
4548
但我的重點是，
你不用得妥瑞氏症，
你不用得妥瑞氏症，
02:00
to be able to relate to my experience
of my premonitory urges,
of my premonitory urges,
35
108602
4999
也能夠感受我的前驅性衝動體驗，
02:05
because your brain can give you
similar experiences and feelings.
similar experiences and feelings.
36
113625
5647
因為你的大腦會給你
類似的體驗和感覺。
類似的體驗和感覺。
02:12
So, let's shift the conversation from
what it means to be normal versus sick
what it means to be normal versus sick
37
120078
5801
咱們把話題從
「正常和生病是什麼意思」
「正常和生病是什麼意思」
02:17
to what it means that a majority of us
are both normal and sick.
are both normal and sick.
38
125903
5278
轉到「我們大部分人
既正常又生病是什麼意思」。
既正常又生病是什麼意思」。
02:24
Because in the final analysis,
we're all humans
we're all humans
39
132697
3357
因為到頭來，我們都是
02:28
whose brains provide
for a spectrum of experiences.
for a spectrum of experiences.
40
136078
4850
大腦提供經驗光譜的人類。
02:34
And everything on that spectrum
of human experiences
of human experiences
41
142563
2746
在人類經驗光譜上的一切
02:37
is ultimately produced by brain systems
42
145333
4363
最終都是由大腦系統所產生，
02:41
that assume a spectrum
of different states.
of different states.
43
149720
2933
這些系統假設存在不同狀態的光譜。
02:45
So again, what does it mean to be normal,
44
153744
2675
倘若生病位於正常光譜的最尾端，
02:48
and what does it mean to be sick,
45
156443
1960
那麼正常是什麼意思，
02:50
when sickness exists on the extreme end
of a spectrum of normal?
of a spectrum of normal?
46
158427
5015
生病又是什麼意思呢？
02:57
As both a researcher who studies
differences in how individuals' brains
differences in how individuals' brains
47
165880
3698
身為研究者，我研究個人的大腦
在自我串接和重新串接上的差異。
03:01
wire and rewire themselves,
48
169602
1770
03:03
and as a Touretter
with other related diagnoses,
with other related diagnoses,
49
171396
2999
同時我也是個妥瑞氏症患者，
具有其他相關的診斷結果。
具有其他相關的診斷結果。
03:06
I have long been fascinated
by failures of self-regulation
by failures of self-regulation
50
174419
4606
我一直都很著迷於
衝動性和強迫性行為光譜的
自我調節失靈。
自我調節失靈。
03:11
on the impulsive and compulsive
behavioral spectrums.
behavioral spectrums.
51
179049
4269
03:15
Because so much of my own
experience of my own body
experience of my own body
52
183342
4124
因為我對於我自己身體
及自己行為的經驗當中，
及自己行為的經驗當中，
03:19
and my own behavior
53
187490
1238
有好大一部分都在
那地圖上處處可見。
那地圖上處處可見。
03:20
has existed all over that map.
54
188752
2325
03:25
So with the spotlight
on the opioid crisis,
on the opioid crisis,
55
193561
4774
所以，當大家聚焦於
鴉片類藥物的危機上時，
鴉片類藥物的危機上時，
03:31
I've really found myself
wondering lately:
wondering lately:
56
199636
3420
我發現自己在納悶：
03:35
Where on the spectrum
of unvoluntary behavior
of unvoluntary behavior
57
203080
3616
要把濫用類鴉片止痛藥物或海洛英
03:38
do we put something like abusing
opioid painkillers or heroin?
opioid painkillers or heroin?
58
206720
5147
放在不由自主行為光譜上的哪裡？
目前，我們都知道類鴉片藥物的
危機和流行已經失控了。
危機和流行已經失控了。
03:45
By now, we all know that the opioid crisis
and epidemic is out of control.
and epidemic is out of control.
59
213569
5810
03:52
Ninety-one people die every day
in this country from overdose.
in this country from overdose.
60
220084
3024
在這個國家裡，每天就有 91 人
因為用藥過量而死。
因為用藥過量而死。
03:55
And between 2002 and 2015,
61
223464
2649
在 2002 年到 2015 年之間，
03:58
the number of deaths from heroin
increased by a factor of six.
increased by a factor of six.
62
226137
3596
因為海洛英而死的
人數增加了六倍。
人數增加了六倍。
04:04
And something about the way
that we treat addiction isn't working,
that we treat addiction isn't working,
63
232125
4539
我們治療成癮的方式似乎無效，
04:08
at least not for everyone.
64
236688
1734
至少不是人人都有效。
04:11
It is a fact that people
suffering from addiction
suffering from addiction
65
239569
3436
事實就是，飽受成癮之苦的人
04:15
have lost free will
66
243029
1918
已失去自由意志，
04:16
when it comes to their behavior
around drugs, alcohol, food
around drugs, alcohol, food
67
244971
6098
無法控制他們與藥物、
酒精、食物相關的行為，
04:23
or other reward-system
stimulating behaviors.
stimulating behaviors.
68
251093
3067
或其他由報償系統所刺激的行為。
04:26
That addiction is a brain-based
disease state
disease state
69
254792
4143
成癮是以大腦為基礎的
一種疾病狀態，
一種疾病狀態，
04:30
is a medical, neurobiological reality.
70
258959
3063
在醫學和神經生物學上，
這都是現實。
這都是現實。
04:35
But how we relate to that disease --
71
263625
2524
但我們如何看待那疾病——
04:38
indeed, how we relate to the concept
of disease when it comes to addiction --
of disease when it comes to addiction --
72
266173
5356
的確，涉及成癮與疾病相關的概念
04:43
makes an enormous difference
for how we treat people with addictions.
for how we treat people with addictions.
73
271553
4112
會使我們治療成癮者的方式大大不同。
04:49
So, we tend to think of pretty much
everything we do as entirely voluntary.
everything we do as entirely voluntary.
74
277420
5059
我們傾向於認為我們
所做的一切都是自願的。
所做的一切都是自願的。
04:55
But it turns out
that the brain's default state
that the brain's default state
75
283000
2887
但結果發現大腦的預設狀態
04:57
is really more like a car
idling in drive than a car in park.
idling in drive than a car in park.
76
285911
5981
其實比較像是空轉的汽車，
而不是關掉引擎的汽車。
05:04
Some of what we think we choose to do
77
292672
2508
有些我們認為是自己選擇去做的行為，
05:07
is actually things that we
have become programmed to do
have become programmed to do
78
295204
4015
其實是鬆開煞車後
我們的內建機制讓我們去做的。
05:11
when the brakes are released.
79
299243
1786
05:14
Have you ever joked that your brain
was running on autopilot?
was running on autopilot?
80
302950
4134
你是否曾開玩笑說
你的大腦在「自動駕駛」？
你的大腦在「自動駕駛」？
05:20
Guess what?
81
308196
1150
你猜怎樣？很可能是真的。
05:21
It probably was.
82
309744
1309
05:23
OK?
83
311871
1158
好嗎？
05:25
And the brain's autopilot
is in a structure called the striatum.
is in a structure called the striatum.
84
313053
5164
大腦的自動駕駛是在
所謂的紋狀體結構中。
所謂的紋狀體結構中。
05:31
So the striatum detects
emotional and sensory motor conditions
emotional and sensory motor conditions
85
319903
5712
紋狀體會偵測
情緒和感覺運動的狀態，
05:40
and it knows to trigger
whatever behavior you have done most often
whatever behavior you have done most often
86
328006
6429
它知道要觸發你過去
在同樣的條件下最常做的行為。
05:46
in the past under those same conditions.
87
334459
2734
05:51
Do you know why I became a neuroscientist?
88
339546
2444
你們知道我為什麼
會成為神經科學家嗎？
會成為神經科學家嗎？
05:55
Because I wanted to learn
what made me tick.
what made me tick.
89
343540
2371
因為我想了解是什麼讓我
做出行為（音同「抽搐」）。
做出行為（音同「抽搐」）。
05:57
(Laughter)
90
345935
2454
（笑聲）
06:00
Thank you, thank you.
91
348413
1546
謝謝，謝謝。（笑聲）
06:01
(Laughter)
92
349983
1263
多年來我一直想找機會
在觀眾面前用這個梗。
在觀眾面前用這個梗。
06:03
I've been wanting to use that one
in front of an audience for years.
in front of an audience for years.
93
351270
3228
06:06
(Applause)
94
354522
1642
（掌聲）
06:08
So in graduate school,
I studied genetic factors
I studied genetic factors
95
356188
3255
在研究所時，我學的是基因因子
06:11
that orchestrate wiring
to the striatum during development.
to the striatum during development.
96
359467
3734
在發展過程中負責安排
紋狀體串接的因子。
紋狀體串接的因子。
06:16
And yes, that is my former license plate.
97
364458
3545
是的，那是我之前的
車牌（紋狀體）。
車牌（紋狀體）。
06:20
(Laughter)
98
368027
1412
（笑聲）
06:21
And for the record, I don't recommend
99
369463
1810
鄭重聲明，我並不建議
06:23
any PhD student get a license plate
with their thesis topic printed on it,
with their thesis topic printed on it,
100
371297
4110
任何博士生選取和他們
論文題目一樣的車牌，
論文題目一樣的車牌，
06:27
unless they're prepared
for their experiments not to work
for their experiments not to work
101
375431
2673
除非他們已準備好接受自己的
實驗在接下來的兩年都不會成功。
實驗在接下來的兩年都不會成功。
06:30
for the next two years.
102
378128
1171
（笑聲）我最終還是找出方法了。
06:31
(Laughter)
103
379323
1154
06:32
I eventually did figure it out.
104
380501
1607
06:34
So, my experiments were exploring
how miswiring in the striatum
how miswiring in the striatum
105
382132
5413
我的實驗是要探討
紋狀體的錯誤串接
和強迫行為的關係。
和強迫行為的關係。
06:39
relates to compulsive behaviors.
106
387569
2064
06:41
Meaning, behaviors that are coerced
107
389657
2777
意思就是，被你無法
有意識地抗拒的
有意識地抗拒的
06:44
by uncomfortable urges
you can't consciously resist.
you can't consciously resist.
108
392458
3377
不舒服衝動所強制造成的行為。
06:48
So I was really excited
when my mice developed
when my mice developed
109
396165
3952
所以，我真的很興奮
看見我的小鼠發展出
看見我的小鼠發展出
06:52
this compulsive behavior,
110
400141
2238
這種強迫行為，
牠們一直在磨擦自己的臉，
牠們一直在磨擦自己的臉，
06:54
where they were rubbing their faces
and they couldn't seem to stop,
and they couldn't seem to stop,
111
402403
3246
甚至弄傷自己似乎仍停止不了。
06:57
even when they were wounding themselves.
112
405673
1928
好吧，不該用興奮這個詞，
06:59
OK, excited is the wrong word,
113
407625
2865
07:02
I actually felt terrible for them.
114
410514
2920
我其實為牠們感到很難過。
07:06
I thought that they had tics,
evidence of striatal miswiring.
evidence of striatal miswiring.
115
414514
4302
我以為牠們抽搐，也就是
有紋狀體發生串接錯誤的證據。
有紋狀體發生串接錯誤的證據。
07:11
And they were compulsive,
116
419973
1809
牠們是強迫性的，
07:13
but it turned out, on further testing,
117
421806
3873
但結果，進一步的測試發現，
07:17
that these mice showed
an aversion to interacting
an aversion to interacting
118
425703
4763
這些小鼠對於和其他
不熟悉的小鼠進行互動
不熟悉的小鼠進行互動
或是去認識牠們產生出反感現象。
07:22
and getting to know other unfamiliar mice.
119
430490
2067
這很不尋常，這是我們未預期的。
07:24
Which was unusual, it was unexpected.
120
432581
2044
07:26
The results implied that the striatum,
121
434649
3270
這些結果意味著
肯定和強迫性光譜失調
有所關聯的紋狀體
有所關聯的紋狀體
07:29
which, for sure, is involved
in compulsive-spectrum disorders,
in compulsive-spectrum disorders,
122
437943
2999
也會影響人類的社會連結
以及我們的能力——
以及我們的能力——
07:32
is also involved in human
social connection and our ability to --
social connection and our ability to --
123
440966
5162
07:38
not human social connection,
but our ability to connect.
but our ability to connect.
124
446152
2961
不是人類的社會連結，
而是我們去連結的能力。
而是我們去連結的能力。
07:44
So I delved deeper,
125
452387
2087
所以我再深入鑽研，
07:46
into a field called social neuroscience.
126
454498
2825
進入到所謂社會神經科學的領域。
07:49
And that is a newer,
interdisciplinary field,
interdisciplinary field,
127
457347
2294
那是一個更新的跨學科領域，
07:51
and there I found reports
that linked the striatum
that linked the striatum
128
459665
2692
在那裡，我找到了
和紋狀體有關的報告，
和紋狀體有關的報告，
07:54
not just to social anomalies in mice,
129
462381
2815
不只是和小鼠的社交異常有關，
07:57
but also in people.
130
465220
1452
也和人有關。
07:59
As it turns out, the social
neurochemistry in the striatum
neurochemistry in the striatum
131
467458
5677
結果發現，
在紋狀體中的社交神經化學
08:06
is linked to things
you've probably already heard of.
you've probably already heard of.
132
474243
4707
和一些你可能已經
聽過的東西有關。
聽過的東西有關。
08:10
Like oxytocin,
133
478974
1429
比如催產素，它是一種荷爾蒙，
08:12
which is that hormone that makes
cuddling feel all warm and fuzzy.
cuddling feel all warm and fuzzy.
134
480427
4175
會讓擁抱感覺起來很溫暖和柔軟。
08:17
But it also implicates
signaling at opioid receptors.
signaling at opioid receptors.
135
485475
3608
但這也意味著對鴉片類
藥物的接受器發出訊號。
藥物的接受器發出訊號。
08:21
There are naturally occurring
opioids in your brain
opioids in your brain
136
489943
2436
在你的大腦中有天然
產生的鴉片類藥物，
產生的鴉片類藥物，
08:24
that are deeply linked
to social processes.
to social processes.
137
492403
3389
它們和社交過程有很深的關聯性。
08:30
Experiments with naloxone,
which blocks opioid receptors,
which blocks opioid receptors,
138
498754
4739
鈉洛酮會阻斷鴉片類藥物的
接受器，而鈉洛酮的實驗顯示
接受器，而鈉洛酮的實驗顯示
08:35
show us just how essential
this opioid-receptor signaling is
this opioid-receptor signaling is
139
503517
5334
鴉片類藥物的接受器的訊號發送
對於社交互動而言有多重要。
08:40
to social interaction.
140
508875
1572
08:45
When people are given naloxone --
it's an ingredient in Narcan,
it's an ingredient in Narcan,
141
513736
4318
當對人施用鈉洛酮——它是
鹽酸烯丙羥嗎啡酮的一種成分，
鹽酸烯丙羥嗎啡酮的一種成分，
08:50
that reverses opioid overdoses
to save lives.
to save lives.
142
518078
3284
能逆轉鴉片類藥物過量，
以拯救性命。
以拯救性命。
08:53
But when it's given to healthy people,
143
521386
2461
但給健康的人施用時，
08:55
it actually interfered
with their ability to feel connected
with their ability to feel connected
144
523871
3666
它會干預他們感受自己和已相識
且在乎的人有所連結的能力。
08:59
to people they already knew
and cared about.
and cared about.
145
527561
2812
09:03
So, something about not having
opioid-receptor binding
opioid-receptor binding
146
531275
5881
所以，若無法和鴉片類
藥物的接受器連結，
藥物的接受器連結，
就會出於某種原因，
09:09
makes it difficult for us to feel
the rewards of social interaction.
the rewards of social interaction.
147
537180
3965
讓我們很難感覺到
社交互動帶來的報償。
社交互動帶來的報償。
09:14
Now, for the interest of time,
148
542270
1492
基於時間考量，我必須
省略一些科學細節，
省略一些科學細節，
09:15
I've necessarily gotten rid
of some of the scientific details,
of some of the scientific details,
149
543786
3008
09:18
but briefly, here's where we're at.
150
546818
2166
但簡短來說，這是我們目前的進度。
09:22
The effects of social disconnection
through opioid receptors,
through opioid receptors,
151
550228
3976
鴉片類藥物接受器的
社會連結斷絕造成的效應、
社會連結斷絕造成的效應、
09:26
the effects of addictive drugs
152
554228
2286
成癮性藥物的效應，
09:28
and the effects of abnormal
neurotransmission
neurotransmission
153
556538
2491
以及異常神經傳遞的效應，
09:31
on involuntary movements
and compulsive behaviors
and compulsive behaviors
154
559053
2857
它們對於非自願性動作
和強迫行為的影響
和強迫行為的影響
09:33
all converge in the striatum.
155
561934
2889
都會合在紋狀體當中。
09:38
And the striatum
and opioid signaling in it
and opioid signaling in it
156
566839
3532
而紋狀體以及紋狀體中的
鴉片類藥物訊號
鴉片類藥物訊號
09:42
has been deeply linked with loneliness.
157
570395
2888
和寂寞有很深的關聯性。
09:48
When we don't have enough signaling
at opioid receptors,
at opioid receptors,
158
576877
3517
若沒有足夠的訊號傳送到
鴉片類藥物的接受器，
鴉片類藥物的接受器，
09:52
we can feel alone in a room full of people
we care about and love, who love us.
we care about and love, who love us.
159
580418
5713
即使在一間房間中滿滿都是
我們在乎的人、愛的人，
我們在乎的人、愛的人，
同時也愛我們的人，
我們仍會感到孤獨。
我們仍會感到孤獨。
09:58
Social neuroscientists, like Dr. Cacioppo
at the University of Chicago,
at the University of Chicago,
160
586774
4509
社會神經科學家，比如
芝加哥大學的卡奇奧波，
芝加哥大學的卡奇奧波，
10:03
have discovered that loneliness
is very dangerous.
is very dangerous.
161
591307
2840
發現寂寞是非常危險的。
10:06
And it predisposes people
162
594873
1260
它會讓人傾向
10:08
to entire spectrums
of physical and mental illnesses.
of physical and mental illnesses.
163
596157
4173
全部的光譜都是身體和心理疾病。
10:16
Think of it like this:
when you're at your hungriest,
when you're at your hungriest,
164
604515
3358
可以這樣想：
當你在最飢餓的時候，
當你在最飢餓的時候，
10:19
pretty much any food
tastes amazing, right?
tastes amazing, right?
165
607897
3206
幾乎任何食物吃起來
都是美味，對吧？
都是美味，對吧？
10:23
So similarly, loneliness
creates a hunger in the brain
creates a hunger in the brain
166
611127
4720
同樣的，寂寞會
在大腦中創造出飢餓，
在大腦中創造出飢餓，
10:27
which neurochemically hypersensitizes
our reward system.
our reward system.
167
615871
5192
它會以神經化學的方式
將我們的報償系統做超增感。
將我們的報償系統做超增感。
10:34
And social isolation
acts through receptors
acts through receptors
168
622355
2953
而社會孤立會
透過接受器而產生影響，
透過接受器而產生影響，
10:37
for these naturally occurring opioids
and other social neurotransmitters
and other social neurotransmitters
169
625332
3951
讓這些自然產生的鴉片類藥物
和其他社交神經傳遞質
和其他社交神經傳遞質
10:41
to leave the striatum in a state
170
629307
2429
造成紋狀體進入一種狀態，
10:43
where its response to things
that signal reward and pleasure
that signal reward and pleasure
171
631760
4150
它對於發送報償和愉悅訊號的事物
10:47
is completely, completely over the top.
172
635934
2947
會做出完全過火的反應。
在這種超增感的狀態中，
10:51
And in this state of hypersensitivity,
173
639307
3032
10:54
our brains signal deep dissatisfaction.
174
642363
4214
我們的大腦會發出深深不滿的訊號。
10:59
We become restless,
irritable and impulsive.
irritable and impulsive.
175
647976
4775
我們會變得焦躁不安、
易怒，且容易衝動。
易怒，且容易衝動。
11:05
And that's pretty much when I want you
to keep the bowl of Halloween chocolate
to keep the bowl of Halloween chocolate
176
653769
3707
那時我大概就會請你們把房間中
整碗萬聖節巧克力都留給我，
整碗萬聖節巧克力都留給我，
11:09
entirely across the room for me,
because I will eat it all.
because I will eat it all.
177
657500
2854
因為我會把它們全部吃光。我會的。
11:12
I will.
178
660378
1151
這就帶出了另一樣東西，
11:13
And that brings up another thing
that makes social disconnection
that makes social disconnection
179
661553
3666
會讓社會連結斷絕變得很危險。
11:17
so dangerous.
180
665243
1444
11:19
If we don't have the ability
to connect socially,
to connect socially,
181
667346
2334
如果我們沒有建立社會連結的能力，
11:21
we are so ravenous for our social
neurochemistry to be rebalanced,
neurochemistry to be rebalanced,
182
669704
4841
我們會非常渴望我們的社交
神經化學能夠被重新平衡，
神經化學能夠被重新平衡，
11:26
we're likely to seek relief from anywhere.
183
674569
2294
以致於我們很可能會
從其他地方尋求出口。
從其他地方尋求出口。
11:28
And if that anywhere
is opioid painkillers or heroin,
is opioid painkillers or heroin,
184
676887
5841
如果那「其他地方」是
鴉片類止痛藥物或海洛英，
11:34
it is going to be a heat-seeking missile
for our social reward system.
for our social reward system.
185
682752
6061
它會是我們社交報償系統的
導熱飛彈。
有沒有人納悶
11:42
Is it any wonder people in today's world
are becoming addicted so easily?
are becoming addicted so easily?
186
690601
5704
為什麼現今世界上的人
這麼容易上癮？
這麼容易上癮？
11:51
Social isolation --
187
699022
1817
社會孤立——
11:56
excuse me --
188
704926
1150
抱歉——
11:59
contributes to relapse.
189
707736
1467
會造成復發。
12:01
Studies have shown that people
who tend to avoid relapse
who tend to avoid relapse
190
709953
4127
研究指出，比較能夠避免復發的人，
12:06
tend to be people who have broad,
reciprocal social relationships
reciprocal social relationships
191
714104
4799
通常擁有廣闊且對等的社交關係，
12:10
where they can be
of service to each other,
of service to each other,
192
718927
2029
在這些關係中，他們能互相幫忙，
12:12
where they can be helpful.
193
720980
1264
能有所貢獻就會讓人連結。
12:14
Being of service lets people connect.
194
722268
1808
12:18
So --
195
726101
1150
所以——
12:21
if we don't have the ability
to authentically connect,
to authentically connect,
196
729863
5402
如果我們沒有進行真實連結的能力，
12:27
our society increasingly lacks
this ability to authentically connect
this ability to authentically connect
197
735289
4252
我們的社會越來越缺乏
這種建立真實連結的能力，
這種建立真實連結的能力，
12:33
and experience things that
are transcendent and beyond ourselves.
are transcendent and beyond ourselves.
198
741101
4254
越來越缺乏體驗超越己身
卓越事物的能力。
卓越事物的能力。
我們以前會從所屬家庭和社區的
歸屬感來得到這種超越。
歸屬感來得到這種超越。
12:37
We used to get this transcendence
199
745379
1598
12:39
from a feeling of belonging
to our families and our communities.
to our families and our communities.
200
747001
3213
12:42
But everywhere, communities are changing.
201
750238
3074
但，不論在哪裡，社區都在改變。
12:45
And social and economic disintegration
is making this harder and harder.
is making this harder and harder.
202
753800
6561
而社會和經濟的崩解
讓它越來越困難。
12:54
I'm not the only person to point out
203
762414
2556
除了我以外還有其他人也指出，
12:56
that the areas in the country
most economically hard hit,
most economically hard hit,
204
764994
3444
在這個國家中最受到
經濟影響的區域，
經濟影響的區域，
13:00
where people feel most desolate
about their life's meaning,
about their life's meaning,
205
768462
3470
這裡的人對於自己
生命的意義最感到淒涼，
生命的意義最感到淒涼，
13:03
are also the places
206
771956
2144
這些區域正好也是
13:06
where there have been communities
most ravaged by opioids.
most ravaged by opioids.
207
774124
6554
受到鴉片類藥物蹂躪
最嚴重的社區所在的區域。
最嚴重的社區所在的區域。
13:14
Social isolation acts
through the brain's reward system
through the brain's reward system
208
782284
3468
社會孤立會透過大腦的
報償系統產生影響，
報償系統產生影響，
13:17
to make this state of affairs
literally painful.
literally painful.
209
785776
3000
會讓這種事情的狀態真的很痛苦。
13:21
So perhaps it's this pain,
this loneliness,
this loneliness,
210
789720
4310
所以，也許正是
這種痛苦、這種寂寞、
這種痛苦、這種寂寞、
13:26
this despondence
211
794054
2984
這種失望，
13:29
that's driving so many of us
to connect with whatever we can.
to connect with whatever we can.
212
797062
3378
驅使許多人盡可能
去建立各種連結。
去建立各種連結。
13:33
Like food.
213
801434
1150
比如食物。
13:35
Like handheld electronics.
214
803757
1800
比如手持式電子裝置。
13:38
And for too many people,
to drugs like heroin and fentanyl.
to drugs like heroin and fentanyl.
215
806360
3508
也有太多人因此轉向
海洛因和芬太奴這類藥物。
海洛因和芬太奴這類藥物。
13:41
I know someone who overdosed,
who was revived by Narcan,
who was revived by Narcan,
216
809892
3733
我認識一個人，她用藥過量，
鹽酸烯丙羥嗎啡酮讓她活過來，
鹽酸烯丙羥嗎啡酮讓她活過來，
13:46
and she was mostly angry
that she wasn't simply allowed to die.
that she wasn't simply allowed to die.
217
814753
3682
她最憤怒的一點就是
她連想死都不被允許。
她連想死都不被允許。
13:50
Imagine for a second how that feels,
that state of hopelessness, OK?
that state of hopelessness, OK?
218
818459
4198
想像一下，那種沒有希望的狀態
是什麼樣的感覺，好嗎？
是什麼樣的感覺，好嗎？
13:55
But the striatum is also a source of hope.
219
823959
4029
但紋狀體也是希望的來源。
14:00
Because the striatum gives us a clue
of how to bring people back.
of how to bring people back.
220
828012
3683
因為紋狀體給了我們一條線索，
讓我們知道要如何把人救回來。
讓我們知道要如何把人救回來。
14:05
So, remember that the striatum
is our autopilot,
is our autopilot,
221
833560
3096
所以，記住紋狀體
是我們的自動駕駛，
是我們的自動駕駛，
14:08
running our behaviors on habit,
222
836680
1562
根據習慣來主導我們的行為，
14:10
and it's possible to rewire,
to reprogram that autopilot,
to reprogram that autopilot,
223
838266
4367
而且能夠把那自動駕駛
重新串接、重新編程。
重新串接、重新編程。
14:14
but it involves neuroplasticity.
224
842657
1681
但這會涉及到神經可塑性。
14:16
So, neuroplasticity
is the ability of brains
is the ability of brains
225
844362
2723
神經可塑性是
讓大腦可以將自己
重新編程的一種能力，
重新編程的一種能力，
14:19
to reprogram themselves,
226
847109
2762
14:21
and rewire themselves,
so we can learn new things.
so we can learn new things.
227
849895
2484
以及重新串接，
讓我們能學習新事物。
讓我們能學習新事物。
14:24
And maybe you've heard the classic
adage of plasticity:
adage of plasticity:
228
852403
2587
也許你們聽說過關於
可塑性的經典格言：
可塑性的經典格言：
14:27
neurons that fire together, wire together.
229
855014
2800
神經元會一起發動、一起串接。
14:30
Right?
230
858323
1184
對吧？
14:31
So we need to practice social
connective behaviors
connective behaviors
231
859531
4308
因此，當我們寂寞時，
當我們不由自主地
14:35
instead of compulsive behaviors,
when we're lonely,
when we're lonely,
232
863863
3103
被迫轉向藥物時，
14:38
when we are cued to remember our drug.
233
866990
3738
反而是要練習社會連結的行為。
14:45
We need neuronally firing
repeated experiences
repeated experiences
234
873371
4087
我們需要不斷重覆檢視
神經元發動的經驗，
神經元發動的經驗，
14:49
in order for the striatum to undergo
that necessary neuroplasticity
that necessary neuroplasticity
235
877482
3674
紋狀體才能產生必要的神經可塑性，
14:53
that allows it to take
that "go find heroin" autopilot offline.
that "go find heroin" autopilot offline.
236
881180
6000
這種可塑性會關掉
「去找海洛英」的自動駕駛功能。
14:59
And what the convergence
of social neuroscience, addiction
of social neuroscience, addiction
237
887204
4849
而社會神經科學、成癮，
以及衝動性光譜失調
以及衝動性光譜失調
通通在紋狀體中會合的現象，
15:04
and compulsive-spectrum disorders
in the striatum suggests
in the striatum suggests
238
892077
2794
意味著僅僅是教紋狀體
對強迫性的慾望
對強迫性的慾望
15:06
is that it's not simply enough
239
894895
1706
15:08
to teach the striatum healthier
responses to compulsive urges.
responses to compulsive urges.
240
896625
3015
做出比較健康的反應是不夠的。
15:12
We need social impulses
to replace drug-cued compulsive behaviors,
to replace drug-cued compulsive behaviors,
241
900038
5769
我們需要用社交衝動
來取代會暗示我們
轉向藥物的強迫行為，
轉向藥物的強迫行為，
15:17
because we need to rebalance,
neurochemically, our social reward system.
neurochemically, our social reward system.
242
905831
6214
因為在神經化學上，
我們需要重新平衡
我們需要重新平衡
我們的社交報償系統。
如果沒有重新平衡，
我們就會處於渴望的狀態，
我們就會處於渴望的狀態，
15:24
And unless that happens,
243
912069
1165
15:25
we're going to be left
in a state of craving.
in a state of craving.
244
913258
2663
15:28
No matter what besides our drug
we repeatedly practice doing.
we repeatedly practice doing.
245
916331
3476
不論除了藥物之外，
我們不斷重覆練習做什麼。
我們不斷重覆練習做什麼。
15:37
I believe that the solution
to the opioid crisis
to the opioid crisis
246
925539
4857
我相信鴉片類藥物危機的解決方案
15:42
is to explore how social
and psychospiritual interventions
and psychospiritual interventions
247
930420
3625
就是要去探究社會和心理的干預方式
15:46
can act as neurotechnologies in circuits
248
934069
3921
如何能在負責處理社交
和藥物引發之報償的電路中
和藥物引發之報償的電路中
15:50
that process social
and drug-induced rewards.
and drug-induced rewards.
249
938014
3392
扮演神經技術的角色。
15:54
One possibility is to create
and study scalable tools
and study scalable tools
250
942783
5111
一種可能性就是要創造並研究
可擴充的工具，
15:59
for people to connect with one another
251
947918
2485
讓大家能夠以相互利益
為基礎和彼此連結，
為基礎和彼此連結，
16:02
over a mutual interest
252
950427
1602
透過心理靈性的做法來恢復。
16:04
in recovery through
psychospiritual practices.
psychospiritual practices.
253
952053
2167
因此，心理靈性的做法
什麼都有可能涉及，
什麼都有可能涉及，
16:06
And as such, psychospiritual practice
could involve anything
could involve anything
254
954244
3262
16:09
from people getting together
as megafans of touring jam bands,
as megafans of touring jam bands,
255
957530
3484
從巡迴演出的搖滾樂團
超級粉絲聚集在一起，
超級粉絲聚集在一起，
16:14
or parkour jams, featuring
shared experiences of vulnerability
shared experiences of vulnerability
256
962959
4016
或是跑酷大交流，
特色是關於脆弱
及個人成長的共同經驗，
及個人成長的共同經驗，
16:18
and personal growth,
257
966999
1190
16:20
or more conventional things,
like recovery yoga meetups,
like recovery yoga meetups,
258
968213
3105
或是比較常見的，
如復元式瑜伽聚會，
如復元式瑜伽聚會，
或是以比較傳統的靈性體驗
之概念為中心的聚會。
之概念為中心的聚會。
16:23
or meetings centered
around more traditional conceptions
around more traditional conceptions
259
971342
2866
16:26
of spiritual experiences.
260
974232
1848
16:28
But whatever it is,
261
976104
2206
但，不論是什麼，
16:30
it needs to activate
262
978334
2600
都需要啟動紋狀體中
16:32
all of the neurotransmitter
systems in the striatum
systems in the striatum
263
980958
2921
所有和處理社會連結有關的
神經傳遞質系統。
神經傳遞質系統。
16:35
that are involved
in processing social connection.
in processing social connection.
264
983903
2777
16:41
Social media can't go
deep enough for this.
deep enough for this.
265
989411
2364
這方面，社交媒體
無法做到足夠的深度。
無法做到足夠的深度。
16:43
Social media doesn't so much
encourage us to share,
encourage us to share,
266
991799
3278
社交媒體鼓勵我們做的，
主要是比較，而不是分享。
16:47
as it does to compare.
267
995101
1587
16:48
It's the difference between having
superficial small talk with someone
superficial small talk with someone
268
996712
4500
和某人進行非常表面的小聊
16:53
and authentic, deeply connected
conversation with eye contact.
conversation with eye contact.
269
1001236
4535
不同於有著眼神接觸
和深刻連結的真實談話。
和深刻連結的真實談話。
16:58
And stigma also keeps us separate.
270
1006442
3291
汙名也讓我們保持著分離的狀態。
17:01
There's a lot of evidence
that it keeps us sick.
that it keeps us sick.
271
1009757
3427
有很多證據顯示，
它一直讓我們生病。
它一直讓我們生病。
17:05
And stigma often makes it safer
for addicts to connect with other addicts.
for addicts to connect with other addicts.
272
1013806
4240
汙名通常會讓成癮者覺得
和其他成癮者連結是比較安全的。
和其他成癮者連結是比較安全的。
17:10
But recovery groups centered around
reestablishing social connections
reestablishing social connections
273
1018656
4793
但以重新建立社會連結
為重點的康復小組
為重點的康復小組
17:15
could certainly be inclusive
of people who are seeking recovery
of people who are seeking recovery
274
1023473
4885
肯定能接納
想從各種心理健康問題中康復的人。
17:20
for a range of mental health problems.
275
1028382
2960
17:24
My point is, when we connect
around what's broken,
around what's broken,
276
1032093
3822
我的重點是，當我們在破碎中連結，
17:29
we connect as human beings.
277
1037902
2928
我們是以人類的身分在連結。
17:33
We heal ourselves
from the compulsive self-destruction
from the compulsive self-destruction
278
1041998
5926
我們對於社會連結斷絕造成的痛苦，
反應會是強迫性自我毀滅，
而我們能將我們自己從中治癒。
而我們能將我們自己從中治癒。
17:39
that was our response
to the pain of disconnection.
to the pain of disconnection.
279
1047948
3399
17:44
When we think of neuropsychiatric
illnesses as a spectrum of phenomenon
illnesses as a spectrum of phenomenon
280
1052180
6191
我們之所以會是人，
有部分是因為某些現象，
有部分是因為某些現象，
當我們把神經精神疾病想成
是這些現象的光譜，
是這些現象的光譜，
17:50
that are part of what make us human,
281
1058395
2865
17:53
then we remove the otherness of people
who struggle with self-destruction.
who struggle with self-destruction.
282
1061284
3563
那麼我們就會把在自我摧毀中
掙扎的人的相異性給除去了。
掙扎的人的相異性給除去了。
17:57
We remove the stigma
283
1065307
3405
我們把醫生和病人以及照護者
18:01
between doctors and patients
and caregivers.
and caregivers.
284
1069924
3462
之間的汙名除去了。
18:05
We put the question of what it means
to be normal versus sick
to be normal versus sick
285
1073966
5333
我們把「正常和生病
是什麼意思」這個問題
是什麼意思」這個問題
18:11
back on the spectrum
of the human condition.
of the human condition.
286
1079323
3000
放回了人類境況的光譜上。
18:14
And it is on that spectrum
where we can all connect
where we can all connect
287
1082831
5010
在這個光譜上，
我們都能彼此聯繫，
18:19
and seek healing together,
for all of our struggles with humanness.
for all of our struggles with humanness.
288
1087865
4142
一起爲人類的所有痛苦尋求療癒。
18:24
Thank you for letting me share.
289
1092873
1563
謝謝各位我讓分享。
18:26
(Applause)
290
1094460
4055
（掌聲）
ABOUT THE SPEAKER
Rachel Wurzman - NeuroscientistThrough her nonprofit SeekHealing, Rachel Wurzman aims to reduce opioid overdose rates by building communities that are inherently resilient to addiction.
Why you should listen
A neuroscientist and neuroethicist by training, Rachel Wurzman is passionate about two-way communication between the neuroscientific community and lay public that inspires transformative change in how human beings connect with each other, with technology and with institutions like medicine and government. She has authored more than 20 peer-reviewed articles and book chapters in the fields of neuroscience, neuroethics and policy, including Wiley's number one most frequently downloaded article out of over 20 neurology journals in 2016.
Wurzman serves as director of science for the nonprofit, SeekHealing, which implements creative ways to connect people intentionally and authentically in order to build communities that are inherently resilient to addiction. SeekHealing serves people at risk for overdose and provides free, connection-oriented support services to anyone at any stage in the addiction healing process.
Wurzman believes that an appreciation for how brain systems filter the various spectrums of human experience can be used to transform how society responds to current crises, ranging from the opioid epidemic to political hyperpolarization. In addition to studying the effects of SeekHealing's programs in opioid-ravaged lives and communities, Wurzman's ongoing research in neuroethics also addresses the implications of a biopsychosocial and "systems-oriented" perspective on neuropsychiatric spectrum phenomena (such as addiction) for research, treatment and social policy. Her advice and insights into neurocognition have been utilized to inform policy in past positions as a neuroscience and neuroethics advisor to the Pentagon, an intern in the White House Office of Science and Technology Policy under the Obama administration, and through her involvement with the International Neuroethics Society. Wurzman completed her doctoral and postdoctoral training at Georgetown University and the University of Pennsylvania, respectively.
Rachel Wurzman | Speaker | TED.com