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人们对精神分裂症的误解 – 译学馆
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人们对精神分裂症的误解

What People Get Wrong About Schizophrenia

30多年前 埃琳·萨克斯被确诊为精神分裂症
Over 30 years ago, Elyn Saks was diagnosed with schizophrenia.
她被告知余生可能会在疗养院看电视
She was told she’d probably live her life at a care facility watching TV,
或如果幸运 可能会找到收银员的工作
or maybe find work as a cashier, if she was lucky.
如今她是南加利福尼亚州大学法律学院院长
Today she’s a dean at the University of Southern California law school,
精神分析学家 麦克阿瑟的同事
a psychoanalyst, and a MacArthur Fellow.
她的故事揭示出我们在过去数十年间
Her story reveals just how much we’ve learned
我们了解精神分裂症本身以及
about schizophrenia in the past few decades
如何治疗它的历程
and about how to treat it.
而如今仍存在未与科学
But there are some myths about schizophrenia
契合的关于精神分裂症的谬见
that haven’ t caught up to the science,
因此 这里就是隐藏在其后的真相
so here’s the truth behind some of them.
首先 患精神分裂症并非意味着你犹豫不决
First, having schizophrenia doesn’t mean you’re indecisive,
或时常改变自己的心意
or you change your mind a lot,
或拥有多重人格
or you have multiple personalities,
很显然三分之二的美国人如是说
which apparently nearly two-thirds of Americans think is a thing.
也许会有这种想法的原因是
Maybe they’re thinking that
由于该词源自希腊文
because “schizophrenia” comes from
意为“分裂的精神”
Greek words for “split mind”.
但这指的是患者与现实分裂
but that’s because the patients split
而非患者本身分裂
from reality, not themselves,
患精神分裂症的人便经常会产生幻觉:
people with schizophrenia often experience hallucinations:
即虚幻的情感或见解
false sensations or perceptions.
例如 65%的病人反映会听到一些声音
65% of patients report hearing voices, for example,
因此这是最为常见的症状之一
making it one of the most common symptoms.
但幻觉也可以被视化
But the hallucinations can also be visual,
如看到眼睛余光处有移动物体
like seeing movement in the periphery of their vision,
或可触化 如感到身上有东西在爬
or tactile, like feeling things crawling on them.
也许并不奇怪的是
And perhaps not surprisingly,
病人们也经常会产生妄想:
patients often present with delusions as well:
即虚妄之想 如萌生有人跟踪的想法
false beliefs, like the idea that people are spying on them.
心理学家认为妄想很可能源自病人
Psychologists think those delusions probably stem from
自身试图探究非凡幻觉产生的缘由
patients trying to make sense of their unusual hallucinations.
例如 如果你听到声音
Like, if you’re hearing voices
但房间里却无旁人
and no one else is in the room,
那么有间谍秘密跟踪你的
the idea that there are spies secretly spying
想法似乎便不那么牵强了
on you doesn’t seem that far-fetched.
患者甚至可能会相信自己是另一个人
A patient might even come to believe they’re someone else,
但这与拥有多重人格或转换身份
but that’s not the same as having multiple personalities
如表现出分离式身份混乱的症状不一样
or switching between them, like with dissociative identity disorder.
而易与这些症状一并而至的还有
There are also other emotional and behavioral changes
其它情绪及行为的变化
that tend to accompany these symptoms,
如混乱的思绪与言语 以及淡漠的情感
like disorganized thoughts and speech, and flat affect,
但凡正常人都不会将此类情感外露
where someone basically never shows emotions outwardly.
在一些极端案例中 精神分裂症会导致
In extreme cases, schizophrenia can result in catatonia,
紧张症 即无法移动或应答
which is the inability to move or respond,
虽然这极其罕见
although that’s super rare.
几十年来 人们认为一切
For decades, people thought that all this was
都因糟糕的父母 尤其是坏母亲而起
the result of bad parenting: especially bad mothers.
鉴于此 治疗的第一步通常
Because of that, the first treatment was usually
是迅速使患者从家庭中剥离出来
to immediately remove the patient from their family,
但如果全家都赞成如此 那么此举欠妥
which isn’t a good idea if the family is supportive.
根据我们此后的调查
From the research we’ve done since then,
基因产生的最大化作用显而易见
it’s clear that genes play the biggest role.
50%的精神分裂症实属遗传
Schizophrenia is about 50% heritable,
这意味着遗传学具有相当的前瞻性
which means that genetics are fairly predictive,
事实上 针对双胞胎的同一研究表明
in fact, in identical twin studies,
如果双胞胎一方患有精神分裂症
it was shown that if one identical twin has schizophrenia,
另一方的患病几率为50%
there’s a 50/50 chance that the other one will.
如果父母一方患病
And if one of your parents has it,
那么你罹患此病的几率亦有10%
there’s about a 10 % chance that you’ll be diagnosed, too.
因此其是遗传性心理混乱的高发病症之一
That makes it one of the most highly heritable psychological disorders.
所处环境亦会发挥作用
Your environment can play a role,
但并不像心理学家曾经认为的那般重要
but it ’ s not nearly as important as psychologists used to think.
例如 一份2004年的研究表明
For example, a 2004-study found that
被矛盾重重以及关系混沌的家庭收养的孩子
children adopted to a home with lots of conflict and chaotic relationships
极易可能被诊断为精神分裂症
were more likely to be diagnosed,
而病症产生的前提在于存在基因风险因素
but that was only if they also had genetic risk factors,
例如 血亲家庭的其他人也身患此症
like someone else in their family had it.
在无基因风险因素的前提下
A rocky home life had no effect
坎坷的家庭生活对群体诊断几率并无影响
on the rate of diagnosis in the group without genetic risk factors,
这说得通
which makes sense,
毕竟我们了解诸多关于
now that we know more about
精神分裂症人群脑中的真思实想
what’s actually happening in the brains of people with schizophrenia.
精神分裂症在很长一段时间被认为
For a long time, schizophrenia was thought to be caused
因脑中神经递质多巴胺过多而引起
by too much of the neurotransmitter dopamine in the brain,
因此阻塞多巴胺的药物对缓解某些严重症状有益
because drugs that block dopamine helped with some of the worst symptoms.
这一观点似乎有些道理
and the idea seemed to make sense,
因为大量多巴胺会使人产生幻觉
because floods of dopamine can cause hallucinations.
这也正是某些精神类药物的作用机理
That’s exactly how some psychoactive drugs work.
麻烦的是 这些药物有时会加重其它症状
The trouble is, these drugs sometimes made other symptoms worse,
而其中缘由并不十分明朗
for reasons that aren’t entirely clear.
因此最新调查已深入至明晰紊乱根源的脑解剖学
So more recent research has looked to brain anatomy to understand the root of the disorder.
值得一提的是 研究者观察到了附着在
Specifically, researchers looked at changes to gray matter,
脑部表层上多数的灰质以及暗色组织
the darker-colored tissue that’s mostly on the surface of the brain.
灰质会在童年与成年期期间消失
Everyone loses gray matter between childhood and adulthood
这是名曰“突触削减”的正常过程
as part of a normal process called synaptic pruning,
即某些关联会消失
where some connections are lost,
而留下的部分会愈发健壮
but the ones you keep get stronger.
但精神分裂症患者失去的灰质更多
But patients with schizophrenia lose a lot more gray matter,
会从顶叶区开始出现损耗
and those losses start in the parietal lobe,
顶叶为处理混杂在其它物质中的
an area of the brain that handles sensory information
传感信息和声音加工的脑部区域
and some sound processing, among other things,
其可能助于解释这些幻觉
which might help explain the hallucinations.
还有另一个刻板信条需要进行澄清:
There’s one more persistent myth that needs to be cleared up:
即精神分裂症患者疯狂且危险
the idea that schizophrenics are wild and dangerous,
为了自身以及其他人的安全需要被关起来
and need to be locked up for their own and everyone else’s safety.
这并不正确
That’s just not true.
虽然精神错乱的人有时会行为异常
Although sometimes people with the disorder behave in unusual ways,
但实际上 他们并不好斗或暴力
they’re typically not aggressive or violent,
且终身接受住院治疗的情况也不常见
and lifelong hospitalization isn’t as common these days.
有些经历此种症状的人会完全恢复
Some people who experience these symptoms recover completely,
而多数人会通过药物和治疗控制病症
and most others can control their symptoms with medicine and therapy.
谈及药物治疗 那些针对多重
When it comes to medication, newer drugs that target
神经传导物质的新型药物似乎比
multiple neurotransmitters seem to be more effective
十多年前的药物更为有效
than the medications used a few decades ago.
这可能由于除了出现多巴胺的阻塞功能
That’s probably because in addition to blocking dopamine,
引发了多巴胺诱发型幻觉的情况外
and therefore dopamine-induced hallucinations,
它们也刺激着血清素的产生
they also stimulate serotonin production.
由于血清素是使人感觉良好的神经传导物质
Since serotonin is one of those feel-good neurotransmitters,
因此血清素越多 越易改善诸如
having more of it likely improves some of the other symptoms
胆怯和情感匮乏的其它症状
like withdrawal and flat affect.
最近的调查也表明
Recent research has also shown
老式谈话疗法也十分有效
that good old talk therapy can help, too.
一份于2016年发表的针对400名患者的研究表明
A 2016-study of 400 patients found
那些采取综合途径 即实现了
that those who received a comprehensive approach,
精神疗法与小剂量药物治疗相结合的人
with low doses of medications alongside therapy,
被证实比那些仅
reported a better quality of life
通过药物控制病情的人过得更好
than those who managed their illness only with medication.
还记得那位出现在本集开头的学者埃琳·萨克斯吗?
And remember Elyn Saks, the researcher from the beginning of this episode?
她的工作聚焦于如何使患者变得如她般成绩斐然
Her work centers around how some patients become high-functioning like herself:
以及益于其获得学位和发展事业的因素
the factors that helped them earn degrees and have professional careers.
很多人采用认知策略
Many used cognitive strategies
即除采取通过工作分散精力的策略之外
like asking themselves if their hallucinations were reasonable,
患者可以扪心自问——这些幻觉是否合理
in addition to strategies like distracting themselves with their work.
现在 别误会我
Now, don’t get me wrong,
精神分裂症是不易医治的心理失调症
schizophrenia is a difficult disorder to treat,
有着较比普通紊乱病症
and has different standards of recovery
如焦虑或绝望更为多样的康复标准
than more common disorders like anxiety or depression.
但这一诊断并非意味着
But a diagnosis doesn’t mean
你注定在精神病院居住
you’re doomed to live in a mental health facility,
或本人对社会造成了威胁
or that you’re a danger to society,
正如这并非意为你犹豫不决
just like it doesn’t mean you’re indecisive
或拥有一位糟糕的母亲一样
or had a terrible mother.
事实上 研究表明
In fact, studies estimate that
四分之三的病患会完全康复
as many as three-quarters of patients recover fully
或如果拥有可以依赖的稳固后盾
or at least enough that they can lead fairly normal lives
以及得到所需的帮助
if they have a strong support network
他们至少可以过上相对正常的生活
to rely on and get the help they need.
感谢观看本集“心理科学秀”!
Thanks for watching this episode of SciShow Psych!
虽然精神分裂症可能并非“多重人格”
While schizophrenia might not be “multiple personalities”,
但你可以通过观看“分离式身份混乱”
you can learn what that actually is
这一期节目了解其具备的确切性质
by watching our episode on Dissociative Identity Disorder.

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