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科塔尔症候群:当人们相信自己已经死了

Cotard's Syndrome: When People Believe They're Dead

[开场音乐]
[INTRO ♪]
想象一下 明早睁开眼
Imagine opening your eyes tomorrow morning
然后意识到自己在睡梦中死了
and realizing that you died in your sleep.
这不像在恐怖电影里
It ’ s not like in a horror movie,
你既不是幽灵也不是僵尸
you ’ re not a ghost or a zombie.
你只是非常非常肯定 虽然自己还能走 说话
You’re just very, very sure that you’re not alive anymore,
但的确是已经死了
even though you’re still walking and talking.
这就是科塔尔综合症
That’s Cotard’s Syndrome.
首例在案的科塔尔综合症发生于1880年
First described in 1880,
患者相信他们已经死了 从未存在过
people with Cotard’s Syndrome believe they’re dead,
或者身体的某一部分自发消失
never existed, or that parts of their own body have spontaneously
或被损坏
vanished or been destroyed.
这很罕见 相关的研究也不是很多
It’s rare, and there hasn’t been a whole lot of research into it.
但研究科塔尔综合症已经帮心理学家更好地
But studying Cotard’s Syndrome has helped psychologists
理解大脑如何创造我们对现实的认知
gain a better understanding of how our brains create what we consider reality.
据实录 死亡是一种非常有压力的体验
According to case reports, being dead is a very stressful experience.
它决定了生活中的一切——
It dominates everything in your life— socializing, self-care,
当你不再是这片土地上的一个生命体
and even eating become far less important
社交 自顾 甚至吃饭都不那么重要了
when you’re no longer part of the land of the living.
你的家人和朋友看起来注意不到的事实
The fact that your friend and family don’t seem to
只会使焦虑的状况加重
notice only adds to the anxiety.
2009年一项研究中有这样一个例子
In one case published in a 2009 study,
一位88岁的老人
an 88-year-old man was admitted to the hospital
因严重的抑郁发作而入院
for a severe depressive episode.
他解释说 因为最近他离世了
He explained that he was depressed
但是他认识的人中没人愿意埋葬他
because he had passed away recently,
他感觉很失落
but none of the people he knew had bothered to bury him.
同一研究中的另一案例
In another case from the same study,
一个46岁的女人说 她的身体只是空壳
a 46-year-old woman explained that she was ‘ a body without content ’ —
大脑 内脏都消失了 她是半透明的
that her brain and intestines had vanished, and that she was translucent.
她拒绝洗澡 因为她认为自己可溶
She refused to bathe because she believedthat she was soluble,
如果她洗澡 身体可能会被冲走
and her body might wash away if she did.
科塔尔综合症非常特别
Cotard ’ s is very distinctive,
但是在DSM-5中(精神障碍诊断与统计手册)
but it ’ s not listed as a standalone disorder in the DSM 5,
它没有被列为单独的精神失调
the guide mental health professionals use for diagnosis.
反之 它被归类为躯体妄想
Instead, it falls under the category of somatic delusions—
(对身体的不正确认识)中的一种
untrue beliefs about the body—
并常被认为是抑郁症和精神病的一种罕见症状
and is usually seen as a rare symptom of depression and psychosis.
这让科塔尔综合症普遍很难被准确定位
That makes it hard to estimate the exact prevalence of Cotard’s,
但我们知道它很罕见
but we know it ’ s uncommon,
而且似乎随着年龄增长 它的发生率略高一些
and seems to become slightly less rare as people get older.
观察墨西哥医院两年来的
One study looked at two years of general psychiatric admissions
一般精神病就诊记录的一项研究发现
to hospitals in Mexico and found that only
仅有0.62%患者表现出科塔尔综合症
around 0.62% of patients exhibited Cotard’s.
另一研究观察了香港老年人
And another, which looked at the elderly population in Hong Kong,
发现约3.2%严重抑郁患者
found that around 3.2% of those with severe depression
表现出科塔尔综合症
showed symptoms of Cotard’s.
心理学家仍不能确认这种错觉如何发展
Psychologists still don’t know exactly how the delusion develops,
但弄明白科塔尔综合症的根源
but understanding the root of Cotard’s Syndrome
能帮他们将我们身体和存活感觉联系背后的
can help them piece together the psychological and neurological components
心理学 神经学成分组合在一起
behind our connection to our body and our sense of being alive.
调查表明这些症状最可能来源于
Research suggests that the symptoms most likely come from
大脑中负责面部识别和情绪反应
problems with the parts of the brain associated with
区域的问题
facial recognition and emotional response.
当你看着别人 甚至是自己时
When you look at another person, or even yourself,
大脑中很多区域
a bunch of separate areas of your brain work together
联合处理那个人的特殊身体特征
to process the specific physical features of that person,
你的记忆也一起合作
and your memories associated with them,
将之组合为一个完整的感觉
bringing it all together into one complete perception.
科学家认为 科塔尔综合症患者脑中
With Cotard ’ s, scientists think the part of the brain that
负责身体认知与先前建立的情感相连的部分
connects those bodily perceptions to previously established emotions
没有照常工作
isn’t working the way it’s supposed to.
它更像是 当人们看着镜中的自己
It ’ s likely that when people look
认出自己的脸
in the mirror and recognize their own face
但是感受不到对它的情感联结
but feel no emotional connection to it,
他们的大脑误将不能联系看作更根本的变化
their brain misinterprets that disconnect as a more fundamental change.
抑郁症患者更可能相信
And people with depression might be more likely to believe
这种无形的改变意味着他们已经死了
that this intangible change must mean they’ve passed away.
但是不是所有的患者 甚至不是所有抑郁症患者
But not all patients—not even all depressed ones—
都有科塔尔综合症这种认知与情感失联
with this kind of disconnect between recognition and emotion exhibit Cotard ’ s Syndrome.
这是随着精神病而来的症状
That’s where the association with psychosis comes in.
精神病就是当某人失去现实感
Psychosis is when someone loses touch with reality,
即理性思维受损的时候
which means their rational thinking is impaired
那种认知损伤
and it takes that kind of cognitive impairment
会使人相信那些显然不正确的事情
to believe something that ’ s obviously not true.
因为精神病患者不能理性思考
Since someone with psychosis isn’t thinking rationally,
所以对于感受不到和自身反射的情感联结
they don’t automatically reject that gnawing“I must be dead” feeling
而产生的“我一定死了”的感觉他们就不再自主抗拒了
they get when they don ’ t feel emotionally connected to their own reflection.
因此他们一旦意识到对自身不熟悉
So once they realize something feels unfamiliar about themselves,
就会使他们最终产生长久 痛苦的死亡错觉
they end up with a prolonged, upsetting delusion that they’re dead,
却不认为这种想法是不可能的
instead of shrugging off the idea as impossible.
因为科塔尔综合症相当罕见
Since Cotard’s Syndrome is fairly rare,
还没有哪项临床研究
there haven ’ t been any clinical studies
得出最好的治疗办法
on the best way to treat it.
医生常用处理精神病性抑郁的方法治疗科塔尔
Doctors usually treat Cotard’s similarlyto psychotic depression—
——组合药物疗法
with a combination of medications, and sometimes electroconvulsive therapy,
有时需配合使用电休克疗法(用电刺激大脑)
which uses electricity to stimulate the brain.
有时这种方法有用 有时没有
Sometimes it works; sometimes it doesn’t.
这也是提醒我们大脑有多强大 奇异
This is one of those illnesses that reminds
的众多病症之一
us just how powerful and bizarre the brain is.
很难想象失去仍然活着的感觉
It’s hard to imagine losing the feelingthat you’re still alive.
但是研究科塔尔综合症能让我们更了解大脑
But studying Cotard ’ s Syndrome can teach us a lot about our brains:
保持存活感觉的情感联系
the emotional connection that preserves our sense of being alive,
以及失去这一联系如何让人相信自己已死
and how losing that connection can make someone believe they’ve died.
有希望的是 随着更多的调查
And hopefully, with more research,
我们也将发现更好的治疗方法
we’ll also find better ways to treat it.
感谢观看本期心理科学秀
Thanks for watching this episode of SciShow Psych.
如果你想更多了解大脑的工作方式
If you’re interested in learning more about how our minds work,
可以访问并订阅youtube.com/scishowpsych
you can go to youtube.com/scishowpsych and subscribe.
[结束曲]
[OUTRO ♪]

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视频概述

有的人活着,但他已经“死”了。你能想象当你一觉醒来,自己认为自己已经死了么?

听录译者

收集自网络

翻译译者

岸雩

审核员

审核员 DL

视频来源

https://www.youtube.com/watch?v=gFiPjH7dOpE

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