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关于经前综合征的好消息 – 译学馆
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关于经前综合征的好消息

Robyn Stein DeLuca: The good news about PMS

有多少人听过经前综合征
How many people here have heard of PMS?
所有人都听说过 对吗
Everybody, right?
大家都知道女人在月经来潮前
Everyone knows that women go a little crazy
会变得有点狂躁
right before they get their period,
这种生理周期将她们拋上一架 无法避免的荷尔蒙过山车
that the menstrual cycle throws them onto an inevitable hormonal roller coaster
满载着不理性和易怒
of irrationality and irritability.
这里有个普遍的假设
There’s a general assumption
就是生殖激素的波动会导致极端情绪
that fluctuations in reproductive hormones cause extreme emotions
大多数女性都会受此影响
and that the great majority of women are affected by this.
而在这里要告诉你们 有科学证据表明
Well, I am here to tell you that scientific evidence says
以上假设并不成立
neither of those assumptions is true.
我来这儿是要你们带来些 关于经前综合症的好消息
I’m here to give you the good news about PMS.
但是首先 让我们来看一下 经前综合征的概念
But first, let’s take a look at how firmly the idea of PMS
在美国文化中是多么的根深蒂固
is entrenched in American culture.
如果你去查阅报刊杂志中的文章
If you examine newspaper or magazine articles,
就会发现”每个女人都有经前综合征“ 这个假设有多么普遍
you’ll see how widely assumed it is that everyone gets PMS.
REDBOOK杂志有一篇文章 标题为《你:从经前综合征解放》
In an article in the magazine Redbook titled “You: PMS Free,”
读者被告知80%到90%的女性 都为经前综合征所扰
readers were informed that between 80 to 90 percent of women suffer from PMS.
L.A. Muscle杂志警告它的读者
L.A. Muscle magazine warned its readers
40%到50%的女性有经前综合征
that 40 to 50 percent of women suffer from PMS,
并且它主导着女性的身心健康
and that it plays a major role in women’s mental and physical health,
几年前 甚至《华尔街日报》 也刊登过一篇文章
and a couple of years ago, even the Wall Street Journal
介绍经前综合征的钙疗法
ran an article on calcium as a treatment for PMS,
并且向其女性读者设问:
asking its female readers,
“你每个月都会成为“巫婆”么”
“Do you turn into a witch every month?”
通过所有的这些文章 你可能会认为 应该已经有小山一般的大量研究
From all these articles, you would think there must be a mountain of research
证实了经前综合征普遍存在的本质
verifying the widespread nature of PMS.
然而 经过50年的研究
However, after five decades of research,
还是没有得出一致的结论 不管是从定义上 原因上
there’s no strong consensus on the definition, the cause,
还是治疗 甚至经前综合征它本身的存在上
the treatment, or even the existence of PMS.
按照心理学家最常用的定义
As most commonly defined by psychologists,
经前综合征包含了负面的行为 认知和身体上的一系列症状
PMS involves negative behavioral, cognitive and physical symptoms
从排卵期延续到月经期
from the time of ovulation to menstruation.
但它的棘手之处在于
But here’s where it gets tricky.
用于诊断经前综合征的有超过150种的症候
Over 150 different symptoms have been used to diagnose PMS,
这里列举了其中一些
and here are just a few of those.
我想澄清一点
Now, I want to be clear here.
我不是说女性不会出现这些症状
I’m not saying women don’t get some of these symptoms.
而是说即使出现了其中一些症状
What I’m saying is that getting some of these symptoms
也不意味着就有精神障碍
doesn’t amount to a mental disorder,
而当心理学家提到精神障碍时
and when psychologists come up with a disorder
这是一个很模糊的定义
that’s so vaguely defined,
所以这个标签也就变得毫无意义了
the label eventually becomes meaningless.
按照这么一份冗长的 涵盖甚广的症状清单
With a list of symptoms this long and wide,
经前综合征我可能有 你可能有
I could have PMS, you could have PMS,
坐第三排那位男士可能有
the guy in the third row here could have PMS,
我的狗也可能有 (笑声)
my dog could have PMS. (Laughter)
有些研究员说 你必须同时满足五条症状
Some researchers said you had to have five symptoms.
而另一些人说只要三条
Some said three.
有些研究员说 只有当那些症状严重到会
Other researchers said that symptoms were only meaningful
干扰你的正常生活时才有意义
if they were highly disturbing to you,
但另一些人又说 即使症状轻微也一样
but others said minor symptoms were just as important.
多年来 因为没有一个
For many years, because there was no standardization
对经前综合征的标准定义
in the definition of PMS,
所以当心理学家尝试去报告患病率时
when psychologists tried to report prevalence rates,
他们的估算从5%
their estimates ranged from five percent of women
到97%的女性不等
to 97 percent of women,
也就是说在同时 要么几乎没人有经前综合征 要么几乎人人都有
so at the same time almost no one and almost everyone had PMS.
总的来说 这些经前综合征的 研究方法有相当大的弊端
Overall, the weaknesses in the methods of research on PMS have been considerable.
首先 很多研究要求女性 回溯报告她们的症状
First, many studies asked women to report their symptoms retrospectively,
靠记忆回顾
looking to the past and relying on memory,
我们已知这种方法会夸大事实
which is known to inflate reporting of PMS
与之相较的另一种方法叫做前瞻性报告
compared to what’s called prospective reporting,
被测者要每天记录发生的症状
which involves keeping a daily log of symptoms
至少持续两个月的时间
for at least two months in a row.
还有很多研究仅关注中产阶级白人女性
Many studies also exclusively focused on white, middle-class women,
而把研究成果应用到所有的女性时 就会产生问题
which makes it problematic to apply study findings to all women.
我们知道关于经前综合征的观点存在有很强的文化要素
We know there’s a strong cultural component to the belief in PMS
因为它在西方国家之外几乎闻所未闻
because it’s nearly unheard of outside of Western nations.
第三 很多研究并没有使用对照组
Third, many studies failed to use control groups.
如果我们想了解有经前综合征的
If we want to understand the specific characteristics
女性有何特别
of women who have PMS,
我们就需要能够将她们 与没有经前综合征的女性作对比
we need to be able to compare them to women who don’t have PMS.
最后一点 很多不同类型的 用于诊断经前综合征的调查问卷
And finally, many different types of questionnaires were used
都着重于研究
to diagnose PMS, focusing on different symptoms,
症状持续的时间和严重性
symptom duration and severity.
无论在任何条件下 可靠的研究
To do reliable research on any condition,
都要求科学家必须就构成这种条件的
scientists must agree on the specific characteristics
特征达成一致
that make up that condition
所以他们总是讨论着一样的事情
so they’re all talking about the same thing,
但对于经前综合征来说 情况并非如此
and with PMS, this has not been the case.
然而 在1994年
However, in 1994,
《精神障碍诊断与统计手册》
the Diagnostic and Statistical Manual of Mental Disorders,
又被称作DSM——
known as the DSM, thankfully —
它也是一本供心理健康专业人员使用的手册——
it’s also the manual for mental health professionals —
将经前综合征(PMS)重新定义为PMDD:
they redefined PMS as PMDD,
即经前焦虑障碍
Premenstrual Dysphoric Disorder.
而其中的焦虑指的是一种烦躁或不安的情绪
And dysphoria refers to a feeling of agitation or unease.
根据这些新的DSM指南
And according to these new DSM guidelines,
(患有经前焦虑障碍的人) 上一年大多数月经周期中
in most menstrual cycles in the last year,
在11种可能的症状中至少有5种
at least five of 11 possible symptoms
应当出现在月经开始前的一个星期
must appear in the week before menstruation starts;
这些症状在月经开始后应当好转
the symptoms must improve once menstruation has begun;
然后在月经结束后一个星期内消失
and the symptoms must be absent the week after menstruation has ended.
其中一些症状必须是来自以下列举的四个:
One of these symptoms must come from this list of four:
明显的情绪波动 易怒 焦虑 或抑郁
marked mood swings, irritability, anxiety, or depression.
其它症状可能包含于第一张
The other symptoms could come from the first slide
或者第二张幻灯片中的所列项
or from those on the second slide,
包括感到情绪失控
including symptoms like feeling out of control
以及睡眠或胃口的改变
and changes in sleep or appetite.
DSM现在还要求这些症状
The DSM also required now that the symptoms
应该与临床上显著的痛苦相联系——
should be associated with clinically significant distress —
应当对工作
there should be some kind of disturbance in work
学习或者人际关系形成干扰——
or school or social relationships —
这些症状及其严重程度应当反映在
and that symptoms and symptom severity should now be documented
至少连续两个周期的日志记录中
by keeping a daily log for at least two cycles in a row.
最后 DSM要求情绪障碍
And finally, the DSM required that the emotional disturbance
应当不仅仅是简单的某种已经存在的障碍的恶化
should be more than simply an exacerbation of an already existing disorder.
所以从科学上讲 这是一个进步
So scientifically speaking, this is an improvement.
现在我们有了数量有限的症状
We now have a limited number of symptoms,
并且要求对正常生活产生显著影响
and a high impact on functioning that’s required,
对症状的描述和发生时间也做了详细规定
and the reporting and timing of symptoms have both become very specific.
运用这个准则
Well, using this criteria
并且参照最近的研究
and looking at most recent studies,
我们看到平均来说
we see that on average,
3%到8%的女性患有经前焦虑障碍
three to eight percent of women suffer from PMDD.
不是所有的女性 也不是大部分的女性
Not all women, not most women,
不是大多数女性 甚至也不是很多女性
not the majority of women, not even a lot of women:
只有3%到8%
three to eight percent.
对其他人来说 像导致压力的事件 令人愉悦的场合
For everyone else, variables like stressful events or happy occasions
甚至是一周当中任何一天这样的变量
or even day of the week
都是比生理期更强大的情绪预测因子
are more powerful predictors of mood than time of the month,
而这也是科学界
and this is the information the scientific community has had
自90年代以来的数据显示
since the 1990s.
2002年 我和同事们发表了一篇文章
In 2002, my colleagues and I published an article
描述对经前综合征和经前焦虑障碍的研究
describing the PMS and PMDD research,
还有其它几篇类似的文章出现在心理学期刊上
and several similar articles have appeared in psychology journals.
问题是 为什么这些信息没有惠及大众
The questions is, why hasn’t this information trickled down to the public?
为什么这些迷思仍然持续
Why do these myths persist?
当然 女性从书本 电视 电影和网络上
Well, certainly the onslaught of messages that women receive
接受到的大量的宣称每个人都会得经前综合征的信息
from books, TV, movies, the Internet, that everyone gets PMS
对于使她们确信那就是真相起了很大的作用
go a long way in convincing them it must be true.
研究表明 一个女性越是相信每个人都会有经前综合征
Research tells us that the more a woman believes that everyone gets PMS,
那她就越会相信而错误地说:她确实有经前综合征
the more likely she is to erroneously report that she has it.
让我来告诉你我所说的“错误地”是什么意思
Let me tell you what I mean by “erroneously.”
你可能会问她“你有经前综合征吗?”
You might ask her, “Do you have PMS?”
她会回答:“是的”
and she says yes,
但是 当你检查她写的
but then, when you have her keep a daily log
近两个月的心理症状时
of psychological symptoms for two months,
却无法找到这些症状
no correlation is found between her symptoms
跟生理期之间的关联
and time of the month.
另一个经前综合征迷思仍然持续的原因
Another reason for the persistence of the PMS myth
是跟女性角色的狭窄边界有关
has to do with the narrow boundaries of the feminine role.
像琼·克莱斯勒这样的女权主义心理学家
Feminist psychologists like Joan Chrisler
曾经提出:贴上了经前综合征的标签后
have suggested that taking on the label of PMS
可以让女性有借口表现出一些情绪 而这些情绪往往被认为是不够淑女的
allows women to express emotions that would otherwise be considered unladylike.
有一个对于“好女人”的近乎放之四海皆准的定义
The near universal definition of a good woman
她要快乐 充满爱心 关心他人
is one who is happy, loving, caring for others,
并且对这种角色设定感到非常满意
and taking great satisfaction from that role.
这样一来 经前综合征就成为了一个允许她们正当地发怒 抱怨 烦躁
Well, PMS has become a permission slip to be angry, complain, be irritated,
却不会失去“好女人”的称号
without losing the title of good woman.
我们知道一个女性所处环境的变量
We know that the variables in a woman’s environment
要比她的荷尔蒙更容易导致她愤怒
are much more likely to cause her to be angry than her hormones,
但是当她把这种愤怒情绪归咎于荷尔蒙时
but when she attributes anger to hormones,
就无须为此负责 还能避免批评
she’s absolved of responsibility or criticism.
“哦 那不是真正的她 她控制不了”
“Oh, that’s not who she is. It’s out of her control.”
尽管这可以当做一种实用工具 实际上却否定了女性的情绪
And while this can be a useful tool, it serves to invalidate women’s emotions.
当人们对一个女性的愤怒作出回应时
When people respond to a woman’s anger
他会想“噢 这只是生理期的原因”
with the thought, “Oh, it’s just that time of the month,”
她通常就不会被认真对待 也不太可能会发生有益的改变
her ability to be taken seriously or effect change is severely limited.
那么还有谁能从经前综合征的迷思中获益呢
So who else benefits from the myth of PMS?
我可以告诉你们 经前综合征的治疗
Well, I can tell you that treating PMS
已经发展成一个有利可图 蓬勃发展的行业
has become a profitable, thriving industry.
目前 亚马逊网站上有超过1900种关于治疗经前综合征的书籍在售
Amazon.com currently offers over 1,900 books on PMS treatment.
通过谷歌 可以很快搜索出一箩筐的信息
A quick Google search will bring up a cornucopia
全是关于诊所 讲习所和研讨会的
of clinics, workshops and seminars.
那些著名的医学信息资源网站
Reputable Internet sources of medical information
如“网络医生”“梅约诊所”都将经前综合征列为一种已知的精神障碍
like WebMD or the Mayo Clinic list PMS as a known disorder.
它不是一种已知的精神障碍 却被列为一种
It’s not a known disorder, but they list it.
他们还列出了内科医生治疗经前综合征的处方药
And they also list the medications that physicians have prescribed to treat it,
比如抗抑郁剂或者激素
like anti-depressants or hormones.
有趣的是 这两家网站都表示药物治疗经前综合征的
Interestingly, though, both websites say that the success of medication
成功率因人而异
in treating PMS symptoms vary from woman to woman.
而这完全不合常理
Well, that doesn’t make sense.
如果你得了一种由确切原因导致的明显的精神疾病
If you’ve got a distinct disorder with a distinct cause,
假设那就是“经前综合征”
which PMS is supposed to be,
那么针对它的治疗方法应该为大量的女性带来病情改善
then the treatment should bring improvement for a great number of women.
但是对于经前综合征的这些治疗方法却并不是这么回事
This has not been the case with these treatments,
而且 美国食品和药品管理局的法规规定 如果要认定一种药物有效
and FDA regulations say that for a drug to be deemed effective,
那么它的目标人群中的很大一部分
a large portion of the target population
应当有临床上的显著改善
should see clinically significant improvement.
而我们从经前综合征的所谓“治疗”上并未看到上述效果
So we have not had that at all with these so-called treatments.
然而 坚持宣扬经前综合征是一种
However, the financial gain of perpetuating the myth
可治疗的普遍的精神疾病这一谬见
that PMS is a common mental disorder
所获得的经济收益是巨大的
and is treatable is quite substantial.
当女性服用抗抑郁剂或激素等处方药时
When women are prescribed drugs like anti-depressants or hormones,
医疗协议要求她们每三个月复诊
medical protocol requires that they have physician follow-up every three months.
那是一个很大的就医量
That’s a lot of doctor visits.
医药企业能获取数不清的利润
Pharmaceutical companies reap untold profits
只要女人们相信她们应该在
when women are convinced they should take a prescribed medication
整个怀孕期间服用处方药
for all of their child-bearing lives.
非处方药像痛经药Midol
Over-the-counter drugs like Midol
甚至声称能够治疗像紧张和易怒 这样的经前综合征症状
even claim to treat PMS symptoms like tension and irritability,
尽管它们只含有利尿剂 止痛剂
even though they only contain a diuretic, a pain reliever
和咖啡因
and caffeine.
我没有立场去争论咖啡因的神奇力量
Now, far be it from me to argue with the magical powers of caffeine,
但我并不认为它有缓解紧张的作用
but I don’t think reducing tension is one of them.
自2002年以来 Midol为青少年市场开发了适用的产品
Since 2002, Midol has marketed a Teen Midol to adolescents.
他们早早的就瞄准了年轻女孩
They are aiming at young girls early,
说服她们相信每个人都会得经前综合征 那会使你变成一个怪物
to convince them that everyone gets PMS and that it will make you a monster,
但是等一等 你还是有救的
but wait, there’s something you can do about it:
服用Midol 就会变回正常人
Take Midol and you will be a human being again.
2013年 Midol获得了4800万美元的销售收入
In 2013, Midol took in 48 million dollars in sales revenue.
维持关于经前综合征的迷思对某些机构来说是有利可图的
So while perpetuating the myth of PMS has been lucrative for some,
但是对女性自己则会产生严重的不良后果
it comes with some serious adverse consequences for women.
首先 它会导致
First, it contributes to the medicalization
女性生殖健康的医疗化
of women’s reproductive health.
医学领域很早就将这种女性生理期现象
The medical field has a long history of conceptualizing
视为一种需要治疗的疾病了
women’s reproductive processes as illnesses that require treatment,
这样就会产生很多的花费 包括过度的剖腹产手术
and this has come at many costs, including excessive Cesarean deliveries,
子宫切除和指定的激素治疗
hysterectomies and prescribed hormone treatments
而这对女性的健康来说 有百害而无一利
that have harmed rather than enhanced women’s health.
第二 经前综合征的迷思对女性
Second, the PMS myth also contributes to the stereotype of women
不理性和过度情绪化的刻板印象的形成有所助益
as irrational and overemotional.
当生理周期被描述成将女性
When the menstrual cycle is described as a hormonal roller coaster
变成愤怒的野兽的荷尔蒙过山车时
that turns women into angry beasts,
就会很容易让人去怀疑所有女性的能力
it becomes easy to question the competence of all women.
女性在职场上取得了巨大的进步
Women have made tremendous strides in the workforce,
但是在政府或者企业的高层职位中
but still there’s a minuscule number of women at the highest echelons
女性的数量仍然微不足道
of fields like government or business,
当我们思考谁能成为一个好的CEO或者议员时
and when we think about who makes for a good CEO or senator,
那些拥有理性 稳重 能力等素质的人
someone who has qualities like rationality, steadiness, competence
会出现在我们脑海中
come to mind,
而在我们的文化中 男性听起来更符合这些条件
and in our culture, that sounds more like a man than a woman,
而经前综合征的迷思正是导致这种认知的原因之一
and the PMS myth contributes to that.
心理学家认为男性和女性情绪上的
Psychologists know that the moods of men and women
相同之处多过差异
are more similar than different.
有一项研究对男性和女性进行了4到6个月的跟踪
One study followed men and women for four to six months
发现他们经历的情绪波动的次数
and found that the number of mood swings they experienced
和情绪波动的剧烈程度是不一样的
and the severity of those mood swings were no different.
最后 经前综合症的迷思被认为是:
And finally, the PMS myth keeps women from dealing
那些造成她们心烦意乱的症结问题
with the actual issues causing them emotional upset.
人际关系和工作环境的质量等个人问题
Individual issues like quality of relationship or work conditions
或者种族主义 性别歧视 贫困折磨等社会问题
or societal issues like racism or sexism or the daily grind of poverty
都跟每天的情绪有密切关联
are all strongly related to daily mood.
用经前综合征来逃避情绪问题
Sweeping emotions under the rug of PMS
限制了女性去了解她们负面情绪的来源
keeps women from understanding the source of their negative emotions,
同时也夺走了她们采取行动去做出改变的机会
but it also takes away the opportunity to take any action to change them.
所以关于经前综合征的好消息是
So the good news about PMS
虽然一些女性会因为生理周期而出现一些症状
is that while some women get some symptoms because of the menstrual cycle,
但大多数的女性并不因此而患精神疾病
the great majority don’t get a mental disorder.
她们照样工作 上学 照顾家庭
They go to work or school, take care of their families,
一切如常
and function at a normal level.
我们知道男性与女性的情绪和心情
We know the emotions and moods of men and women
极为相近
are more similar than different,
那么就让我们从陈腐的视女性为巫婆的经前综合征迷思中走出来
so let’s walk away from the tired old PMS myth of women as witches
而去接受大多数女性每天都过着情绪高涨 专业有序
and embrace the reality of high emotional and professional functioning
运转正常的生活这一事实
the great majority of women live every day.
谢谢
Thank you.
(掌声)
(Applause)

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视频概述

很多人都将经前综合症视为一种需要治疗的疾病,但事实上,科学家们经过海量的研究,还是没有弄明白经前综合征为何导致女性焦虑,情绪激动等……

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red

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赖皮

视频来源

https://www.youtube.com/watch?v=aI8KiPiVLyY

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