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当多年沉睡后的清醒只是暂时性的 – 译学馆
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当多年沉睡后的清醒只是暂时性的

When Waking up After Decades Turned out to Be Temporary

想象你明天醒来发现
Imagine you woke up tomorrow to discover
40年已经过去
that forty years had passed,
“瑞普·凡·温克”的套路
Rip Van Winkle style.
历经短暂的见识未来的兴奋之后
After the brief moment of excitement to see the future,
你意识到自己的一半寿命已流逝
you realize half your life is gone and
你不得不作出妥协
you have to make peace with that.
而对于许多罹患不寻常之症
For many of those with an unusual disease called
如急性脑病 简称EL的人来说
encephalitis lethargica, or EL,
这确会发生在他们身上
that was basically what happened.
在19世纪60年代以及70年代早期
In the late 1960s and early 70s,
在历经数年的沉沉昏厥之后
after years of almost a complete stupor,
他们突然醒来
they suddenly woke up.
当一些人很难理解
While some had trouble understanding
时间已然流逝之时
that time had passed,
另一些人却很清楚
others revealed they were
自己失去的每一天
mostly aware of every passing day,
只是无法动弹而已
they just hadn’t been able to move.
尽管在早前
Pretty soon, though,
同样驱使人们
the same medication that had
醒来的冥想
allowed them to wake up
会造成使其衰弱的副作用
caused such debilitating side effects
即几乎所有的
that almost every patient had
病人都得被打回原形
to return to the way they were before.
“瑞普·凡·温克”的故事固然悲壮
The story of E.L.is a tragic one,
但其也针对将意志
but it also says a lot about
转换为行动的脑化学物解释颇多——
the brain chemistry that translates will into action,
当灾难进行干预时会发生什么
what happens when disease interferes,
以及甚至服用最靠谱的
and how even the most promising
药都会适得其反
drugs can unexpectedly backfire.
一切大约始于1917年
It all began around 1917,
人们深受严重睡眠问题 精神错乱
when people began to suffer severe sleepiness,
双目移动困难以及瘫痪的困扰
delirium, problems moving their eyes and paralysis.
在接下来的几年间
Over the next several years
世界范围内出现了约一百万此类案例
there were about a million cases worldwide,
一种观点阐释此种疾病
I’ll talk of a view that the disease
即被称之为“睡眠症”的病症
which people started calling”Sleeping Sickness”,
会造成大脑区域发炎
caused inflamation in your part of the brain
亦是我们所知的诱发
we now know it’s involved
神志清醒的“元凶”
in keeping you conscious.
但医生并没有找到有效疗法
But doctors couldn’t find an effective treatment
以及我们如今称之为病毒的病症
and the disease, which we now think it was a virus,
会杀死约1/3的被感染人群
killed about a third of the people it infected.
1918年 因传染性流感
When the flu epidemic started killing
而毙命的人数为1000万
tens of millions of people in 1918,
对于急性脑病 人们众说纷纭
people cannot stop talking about EL as much.
但不幸的是 甚至于那些存活下来的人
But unfortunately, even among those who survived EL,
故事亦并未画上句号
the story didn’t stop there.
在历经几年 甚至数十载的先期治疗后
After their initial recovery, sometimes years or even decades later,
许多病人的症候发展
many developed symptoms
到了与帕金森症类似的境地
similar to Parkinson’s disease.
即某些神经组织开始瓦解
In Parkinson’s some nerve tissues start to break down,
使患者出现颤抖
causing things like tremors,
僵硬和动作迟缓等症状
stiffness, and slow movement.
但通常会加重年长者的病情
But it generally develops in older people
而患急性脑病的病人没那么年长
and the patients who had EL weren’t necessarily old.
而不少案例中的病人
In some ways, these patients’
所患的病症也更加极端
symptoms were also more extreme.
例如 他们有时会步速放缓
For example, they’d sometimes slow down
然后彻底停止移动
and completely stop moving,
呈现出任意一种诸如此类的尴尬姿态
holding whatever awkward positions they found themselves in,
即便别人挪动其身体也无济于事
even if someone else moved their body.
许多人最终患上紧张性神经症或无法动弹
Eventually, a lot of them became catatonic or immobile.
随后很多人会将这一段经历描述为
Later on, some would describe the experience as a resistance
“断绝其按照既定想法移动的阻力”
that would stop them from moving the way they wanted to.
更为古怪的是 病患有时候
Even weirder, they’d occasionally move
只为应合刺激而移动
in response to some stimulus
例如 接住扔给他们的球
like by catching a ball if you threw it to them.
研究者知晓帕金森症源自“黑质”的恶化
Researchers knew that Parkinson came from the deterioration in the”substantia nigra”,
而黑质便是与动机和
a part of the brainstem involved
运动有关的脑干区域
in motivation and movement.
因此医生发现
So doctors figured that
急性脑病患者的症状也与此区域有关联
EL patients’ symptoms were connected to that part of the brain too.
但尚无有效的疗法
But without any useful treatments,
此区域的病人大都被送到
patients in this state were mostly just left
医院和医疗机构呆上数十年
to live in hospitals and mental institutions for decades.
差不多直到20世纪60年代晚期
At least until the late 1960s,
著名神经学家奥利弗·萨克斯曾在布朗克斯医院
in the Bronx’s hospital where the now famous neurologist Oliver Sacks
开启自己的事业之旅
who was just starting his career,
并决心尝试名为“左旋多巴”的新药
decided to try a newly invented drug called”L-DOPA”.
在有些病人突然苏醒了的时候
That’s when some of the patients suddenly woke up.
而存在于脑中的
See those deteriorating neurons
恶性神经细胞则负责传输多巴胺
in the brain were responsible for transmitting Dopamine,
一种与奖励有关的神经递质
a neurotransmitter involved in reward and motivation.
在大脑的其它区域
In other areas of the brain,
多巴胺与奖励和愉悦紧密相关
dopamine is associated with feelings of reward and pleasure,
但在黑质中其似乎与
but in the substantia nigra it seems to be associated
负责激励机制有关
with the motivation to move at all.
不能仅靠专注于
You can’t just fix the problem
多巴胺而解决问题
by taking straight up dopamine
因为其不能穿透脑血管壁垒
because it can’t cross the blood-brain barrier.
但“左旋多巴”却是可以进入大脑
But L-DOPA was a form of dopamine that could get into
以及刺激多巴胺受体的物质
the brain and stimulate the dopamine receptors there.
人们于1967年发现此药
In 1967 this drug was found
有助于治疗帕金森病
to help people with Parkinson’s disease,
因此萨克斯认为其亦可帮助急性脑病患者
so Sacks thought it might help EL patients too.
真的奏效了!
And it worked!
几乎所有病人都经历过
Almost every patient experienced
某些不可思议的清醒状态
some kind of miraculous awakening
然后便康复了
and returned to health
至少起初是如此
at least at first.
一名被称之为洛斯·R的病人
One patient, identified only as Rose R.,
可以十分详尽地讲出
began telling stories of celebrities
如乔治·格什温等名人的故事
like George Gershwin, all in perfect detail,
即使这些事发生在40多年前
even though they’d happened more than 40 years earlier.
她也知道在自己罹患紧张性精神症
She also knew the dates of big events
期间那些重大事件的发生日期
that happened while she was catatonic
如珍珠港事件 或肯尼迪被刺案
like Pearl Harbor or The Kennedy Assassination
但却宣称“一切都不真实”
but said”None of it felt real”.
而另外一位名为伦纳德·L的病人
Others like a patient named Leonard L.,
则迫切想要离开医院
were eager just to leave the hospital,
这一被自己称之为“人类动物园”的地方
which he called a”human zoo”,
从而去探寻花花世界
to experience the outside world.
几周之内
Within weeks,
或在某些案例中 只消几天
or in some cases just days,
大多数人都难以幸免于
almost everyone began to suffer
药物所致的严重后果
severe problems with the drug.
一些人出现幻觉
Some had hallucinations,
行为呈现爆发性与攻击性
explosive and aggressive behavior
或产生性副作用
or sexual side effects.
除此之外
On top of that,
药物似乎会随时间的推移而失效
the drug seemed to lose its effectiveness over time.
萨克斯尝试发现不会产生如此
Sacks tried to find doses that would work
极端副作用的药物剂量
without such extreme side effects,
但对大多数病人而言
but for almost every patient,
不过非此即彼罢了
there was just no middle ground.
极少数病人会在数月后
Very few were able to continue treatment
继续实施治疗
beyond a couple of months,
而在这之后 病人会被打回原形
and afterward, they went right back to they way they were
或变得更糟
or got even worse.
虽然一些可以讲话的病人说
And although some of the patients who could talk said
自己对再次拥有别样的
they were grateful to have
完整的经历体验很是感激
another taste of “full experience” again,
但其他人却说感到自己
others said they felt newly robbed
被剥离了重回正轨的生活
of the life they almost got back.
而药物产生功效的事实作证了
The fact that the drug worked at all supported
医生想到的症状正发生在这些病人的脑中
what doctors thought was happening in those patients’ brains.
“左旋多巴”刺激黑质
L-DOPA stimulated the “substantia nigra”,
修正所分解的神经细胞
compensating for the degraded neurons.
当病人们想要做自己诚然擅长的事时
For the patients, it suddenly felt like the”resistance” was gone
会猛然发现“抵抗”已荡然无存
when they wanted to do something they actually could.
但医生并未预计到药物的逆转力如此强
But doctors didn’t expect the drug to backfire so badly
他们并未见证过
They hadn’t seen that response
患帕金森综合征的病人的所持症候
with people with Parkinson’s desease,
虽然其会于发病后凸显出来
although it did start to happen later on,
且持续时间更长
it just took longer.
急性脑病患者出现严重
There are probably several reasons
副作用的原因可能为以下几种
for the severe side effects in EL patients.
其一 这些人遭受了十多年的痛苦
For one thing, these people had been suffering for decades,
因此其的神经元细胞比
so their neurons had degraded
那些通常在生命晚期被诊断为
more than in Parkinson’s patients,
帕金森综合征的患者的神经元细胞退化更甚
who are usually diagnosed late in life.
另一个问题在于“左旋多巴”不能
Another problem was that L-DOPA couldn’t be targeted
单一靶向定位“黑质”
to just the “substantia nigra”.
最终其亦会过度刺激自我奖励系统
Eventually it overstimulated their reward system too,
并引起诸如进攻 刺激抑制
leading to side effects like aggression,
以及性亢奋的副作用症候
impulse control and hyper-sexuality.
高剂量的多巴胺副产物
It’s also possible that byproducts
可能也会毒害神经
of dopamine are neurotoxic in high doses
并使人产生幻觉
and can cause hallucinations,
这便阐释出此类副作用亦会
which would explain why these side effects
发生在晚期帕金森综合征患者身上的原因
also happened in late-stage Parkinson’s patients.
我们仍对诸多奥秘知之甚少
There is a lot we still don’t know about all of this.
急性脑病的爆发起因成谜
The cause of the original EL outbreak is a mystery:
其感染了无数人
it infected tons of people
接着几乎完全销声匿迹
and then almost completely disappeared.
即便只有少量可进行作证的案例
And even though there have been only a handful of cases
我们也没有理由认为
since there’s no reason to think
此流行病症不会再次发生
the epidemic couldn’t happen again.
诚然 除却其他因素
Still, if nothing else,
“左旋多巴”所引起的症状教会我们颇多
what happened with L-DOPA taught us a lot
关于大脑如何将欲望转化为行动的知识
about how our brains translate desires into actions.
程序一旦运行
When the process works,
我们甚至不用顾虑太多
we don’t even have to think about it,
但当其崩塌之时
but when it starts to break down,
修复它会比仅仅
fixing it takes a lot more
取代缺失部分花上更多的时间
than just replacing what’s missing.
“左旋多巴”最初可能是神药
L-DOPA might have seemed like a miracle drug at first
但其对大脑产生的作用却如双刃剑
but its effects on the brain were a double-edged sword,
而最终所带来的伤害远大于益处
and in the end it hurt more than it helped.
感谢观看本节“心理学科学秀”
Thanks for watching this episode of SciShow Psych,
特别感谢Patreon的赞助商
and thanks especially to our patrons
是您们使本节目成为可能
on Patreon who make this show possible.
如果你对学习更多
If you’re interested in learning about
可助于我们理解大脑的
more of the history and science
历史与科学的知识感兴趣
that helps us understand our brains,
可以登录我们的网站并进行订阅
you can go to youtube.com/scishowpsych and subscribe.

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病人在历经长时间的沉睡后突然清醒是好还是坏呢?想知道答案吗?快来点击视频进行观看吧!

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