演講MP3+雙語(yǔ)文稿:注意！你的情緒會(huì)改變你心臟的形狀

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[演講者及介紹]Sandeep Jauhar

桑迪普·喬哈爾，醫(yī)生，作家，心臟病學(xué)家，熱衷于傳播醫(yī)學(xué)。

[演講主題]你的情緒會(huì)改變你心臟的形狀

[中英文字幕]

翻譯者psjmz mz 校對(duì)者 Yolanda Zhang

00:13

No other organ, perhaps no other object inhuman life, is as imbued with metaphor and meaning as the human heart. Over thecourse of history, the heart has been a symbol of our emotional lives. It wasconsidered by many to be the seat of the soul, the repository of the emotions.The very word "emotion" stems in part from the French verb"émouvoir," meaning "to stir up." And perhaps it's onlylogical that emotions would be linked to an organ characterized by its agitatedmovement.

沒(méi)有其他器官，可能在整個(gè)人生中也沒(méi)有其他的東西，像人類的心臟一樣充滿隱喻和意義。在歷史的長(zhǎng)河中，心是我們情感生活的象征。它曾被很多人視為靈魂的座駕，情感的倉(cāng)庫(kù)。“emotion（情感）”這個(gè)詞部分源自法語(yǔ)動(dòng)詞“emouvoir”，意思是“攪動(dòng)”。也許將情感和以跳動(dòng)為特征的器官聯(lián)系在一起是唯一的正確邏輯。

00:52

But what is this link? Is it real or purelymetaphorical? As a heart specialist, I am here today to tell you that this linkis very real. Emotions, you will learn, can and do have a direct physicaleffect on the human heart.

但這個(gè)聯(lián)系是什么？它是真實(shí)的還是純粹隱喻？作為心臟專家，我今天在這里要告訴你們，這個(gè)聯(lián)系是真實(shí)的。你將了解到，情感能夠，也實(shí)會(huì)對(duì)人類心臟產(chǎn)生直接的物理影響。

01:15

But before we get into this, let's talk abit about the metaphorical heart. The symbolism of the emotional heart endureseven today. If we ask people which image they most associate with love, there'sno question that the Valentine heart would the top the list. The heart shape,called a cardioid, is common in nature. It's found in the leaves, flowers andseeds of many plants, including silphium, which was used for birth control inthe Middle Ages and perhaps is the reason why the heart became associated withsex and romantic love.

但在我們深入之前，讓我們來(lái)談?wù)勲[喻意義上的心。即便在今天，情感之心的象征意義仍然存在。如果問(wèn)人們哪一個(gè)圖片可以讓人聯(lián)想到愛(ài)，毫無(wú)疑義，戀人之心會(huì)高居榜首。心臟的形狀，稱為心形，在自然中很常見(jiàn)。它存在于樹(shù)葉，鮮花和很多植物的種子中，包括串葉松香草，曾經(jīng)在中世紀(jì)被用于生育控制，這也許就是為什么心會(huì)與性愛(ài)與浪漫聯(lián)系在一起。

01:56

Whatever the reason, hearts began to appearin paintings of lovers in the 13th century. Over time, the pictures came to becolored red, the color of blood, a symbol of passion. In the Roman CatholicChurch, the heart shape became known as the Sacred Heart of Jesus. Adorned withthorns and emitting ethereal light, it became an insignia of monastic love.This association between the heart and love has withstood modernity. WhenBarney Clark, a retired dentist with end-stage heart failure, received thefirst permanent artificial heart in Utah in 1982, his wife of 39 yearsreportedly asked the doctors, "Will he still be able to love me?"

出于某種原因，13世紀(jì)，情人的畫(huà)像中開(kāi)始出現(xiàn)心形圖案。隨著時(shí)間的推移，這些畫(huà)被涂成紅色，鮮血的顏色，激情的象征。在羅馬天主教會(huì)，心的形狀被稱為耶穌的圣心。裝飾著荊棘，散發(fā)著縹緲的光芒，它成了修道院之愛(ài)的象征。這種心與愛(ài)之間的聯(lián)系經(jīng)受住了現(xiàn)代的考驗(yàn)。1982年，患有末期心力衰竭的退休牙醫(yī)巴尼·克拉克在猶他州接受了首例永久性人工心臟移植手術(shù)，他39歲的妻子曾向醫(yī)生咨詢，“他還會(huì)愛(ài)我嗎？”

02:49

Today, we know that the heart is not thesource of love or the other emotions, per se; the ancients were mistaken. Andyet, more and more, we have come to understand that the connection between theheart and the emotions is a highly intimate one. The heart may not originateour feelings, but it is highly responsive to them. In a sense, a record of ouremotional life is written on our hearts. Fear and grief, for example, can causeprofound cardiac injury. The nerves that control unconscious processes such as theheartbeat can sense distress and trigger a maladaptive fight-or-flight responsethat triggers blood vessels to constrict, the heart to gallop and bloodpressure to rise, resulting in damage. In other words, it is increasingly clearthat our hearts are extraordinarily sensitive to our emotional system, to themetaphorical heart, if you will.

今天，我們知道心臟不是愛(ài)或其他情感的源頭，古人弄錯(cuò)了。然而，我們開(kāi)始越來(lái)越多地了解到心臟和情感的聯(lián)系是極為親密的整體。心臟可能不是我們感覺(jué)的起源，但它對(duì)感覺(jué)非常敏感。在某種意義上，我們情感生活的記錄就寫(xiě)在我們的心臟上。例如，恐懼和悲傷會(huì)導(dǎo)致嚴(yán)重的心臟損傷?？刂茻o(wú)意識(shí)過(guò)程，如心跳的神經(jīng)可以感覺(jué)到痛苦，并引發(fā)適應(yīng)不良的“戰(zhàn)斗或逃跑”反應(yīng)，導(dǎo)致血管收縮，心跳加速和血壓上升，導(dǎo)致?lián)p傷。換句話說(shuō)，越來(lái)越清晰的是，我們的心臟對(duì)我們的情感系統(tǒng)，對(duì)隱喻的心，極度敏感。

03:53

There is a heart disorder first recognizedabout two decades ago called "takotsubo cardiomyopathy," or "thebroken heart syndrome," in which the heart acutely weakens in response tointense stress or grief, such as after a romantic breakup or the death of aloved one. As these pictures show, the grieving heart in the middle looks verydifferent than the normal heart on the left. It appears stunned and frequentlyballoons into the distinctive shape of a takotsubo, shown on the right, aJapanese pot with a wide base and a narrow neck. We don't know exactly why thishappens, and the syndrome usually resolves within a few weeks. However, in theacute period, it can cause heart failure, life-threatening arrhythmias, evendeath.

大約20年前，人們首次發(fā)現(xiàn)了一種名為“應(yīng)激性心肌病”的心臟病，即“心碎綜合癥”，在這種情況下，心臟在面對(duì)巨大的壓力或悲傷時(shí)急劇衰弱，比如跟愛(ài)人分手或愛(ài)人去世后。就像這些照片顯示的，中間悲傷的心跟左邊正常的心看來(lái)很不同。它看起來(lái)像是被打暈了，往往會(huì)膨脹成章魚(yú)壺的獨(dú)特形狀，如右圖所示，一種有寬的底座和窄的日本鍋。我們還不知道這個(gè)發(fā)生的確實(shí)原因，這種癥狀通常會(huì)在幾周內(nèi)消失。然而，在急性期，它可能會(huì)導(dǎo)致心臟衰竭，危及生命的心律失常，甚至死亡。

04:44

For example, the husband of an elderlypatient of mine had died recently. She was sad, of course, but accepting. Maybeeven a bit relieved. It had been a very long illness; he'd had dementia. But aweek after the funeral, she looked at his picture and became tearful. And thenshe developed chest pain, and with it, came shortness of breath, distended neckveins, a sweaty brow, a noticeable panting as she was sitting up in a chair --all signs of heart failure. She was admitted to the hospital, where anultrasound confirmed what we already suspected: her heart had weakened to lessthan half its normal capacity and had ballooned into the distinctive shape of atakotsubo. But no other tests were amiss, no sign of clogged arteries anywhere.Two weeks later, her emotional state had returned to normal and so, anultrasound confirmed, had her heart.

比如，我的一個(gè)老年病人的丈夫最近去世了。她很悲傷，當(dāng)然，但接受這個(gè)現(xiàn)實(shí)了。也許松一口氣。這是一場(chǎng)持續(xù)了多年的疾病，他患有老年癡呆。但在葬禮結(jié)束的一周后，她看著他的照片，變得淚眼模糊。然后她出現(xiàn)了胸痛，隨之而來(lái)的是呼吸急促，脖子上青筋膨脹，額頭出汗，當(dāng)她坐在椅子上時(shí)，明顯地感到氣喘吁吁——這些都是心臟衰竭的跡象。她被送進(jìn)了醫(yī)院，醫(yī)院超聲波驗(yàn)證了我們的懷疑：她的心臟已經(jīng)衰弱到只有不到一半的正常功能，并且膨脹成明顯的章魚(yú)壺形狀。但檢查不出其他問(wèn)題，沒(méi)有動(dòng)脈阻塞的現(xiàn)象。2周后，她的情感狀態(tài)恢復(fù)正常，并且，超聲波檢測(cè)確認(rèn)，心臟也恢復(fù)了健康。

05:57

Takotsubo cardiomyopathy has been linked tomany stressful situations, including public speaking --

應(yīng)激性心肌病跟很多壓力環(huán)境有關(guān)，包括公共演講——

06:05

(Laughter)

（笑聲）

06:11

(Applause)

（掌聲）

06:17

domestic disputes, gambling losses, even asurprise birthday party.

家庭爭(zhēng)分，賭博損失，甚至一個(gè)驚喜的生日派對(duì)都包括在內(nèi)。

06:22

(Laughter)

（笑聲）

06:24

It's even been associated with widespreadsocial upheaval, such as after a natural disaster. For example, in 2004, amassive earthquake devastated a district on the largest island in Japan. Morethan 60 people were killed, and thousands were injured. On the heels of thiscatastrophe, researchers found that the incidents of takotsubo cardiomyopathyincreased twenty-four-fold in the district one month after the earthquake,compared to a similar period the year before. The residences of these casesclosely correlated with the intensity of the tremor. In almost every case,patients lived near the epicenter.

它甚至與廣泛的社會(huì)動(dòng)亂有關(guān)，比如一場(chǎng)自然災(zāi)害后。例如，2004年，一場(chǎng)大地震摧毀了日本最大島嶼上的一個(gè)地區(qū)，超過(guò)60個(gè)人死亡，幾千人受傷。在這場(chǎng)災(zāi)難之后，研究者發(fā)現(xiàn)跟一年前同期相比，該地區(qū)在大地震后一個(gè)月的應(yīng)激性心肌病發(fā)病率增加了24倍，這些病例發(fā)生的位置與地震的強(qiáng)度密切相關(guān)。在幾乎每個(gè)病例中，病人都是住在震中附近。

07:11

Interestingly, takotsubo cardiomyopathy hasbeen seen after a happy event, too, but the heart appears to react differently,ballooning in the midportion, for example, and not at the apex. Why differentemotional precipitants would result in different cardiac changes remains amystery. But today, perhaps as an ode to our ancient philosophers, we can saythat even if emotions are not contained inside our hearts, the emotional heartoverlaps its biological counterpart, in surprising and mysterious ways.

有趣的是，應(yīng)激性心肌病也曾在一些愉快的事件后被發(fā)現(xiàn)，但心臟反應(yīng)似乎不一樣，在中部膨脹，而不是在頂部。為什么不同的情緒會(huì)導(dǎo)致心臟的不同變化仍然是個(gè)迷。但今天，也許是作為對(duì)我們古代哲學(xué)家的贊歌，我們可以說(shuō)即便情感不存在于我們的心臟中，情感的心跟它的生物體依然是以一種驚人和神秘的方式相對(duì)應(yīng)的。

07:55

Heart syndromes, including sudden death,have long been reported in individuals experiencing intense emotionaldisturbance or turmoil in their metaphorical hearts. In 1942, the Harvardphysiologist Walter Cannon published a paper called "'Voodoo' Death,"in which he described cases of death from fright in people who believed theyhad been cursed, such as by a witch doctor or as a consequence of eating taboofruit. In many cases, the victim, all hope lost, dropped dead on the spot. Whatthese cases had in common was the victim's absolute belief that there was anexternal force that could cause their demise, and against which they werepowerless to fight. This perceived lack of control, Cannon postulated, resultedin an unmitigated physiological response, in which blood vessels constricted tosuch a degree that blood volume acutely dropped, blood pressure plummeted, theheart acutely weakened, and massive organ damage resulted from a lack oftransported oxygen.

心臟綜合癥，包括猝死，長(zhǎng)期以來(lái)，在個(gè)人隱喻之心經(jīng)受了強(qiáng)烈的情感干擾或混亂后的猝死廣泛見(jiàn)諸報(bào)端。1942年，哈佛生理學(xué)家沃爾特·坎農(nóng)發(fā)表了一篇名為《巫毒教的死亡》的論文，在文中，他描述了一些相信自己被詛咒的人因?yàn)榭謶侄劳龅陌咐?，比如被巫醫(yī)或食用禁果后。在很多案例中，犧牲者絕望至極，當(dāng)場(chǎng)猝死。這些案例的共同之處在于犧牲者們絕對(duì)相信有一種外部的力量會(huì)導(dǎo)致他們的死亡，并且他們無(wú)力反抗。坎農(nóng)假定，這些明顯的失控引發(fā)了全面的生理反應(yīng)，血管收縮到使血容量急劇下降的程度，血壓下降，心臟急劇衰弱，并且因?yàn)槿鄙傺鯕獾妮斔投鴮?dǎo)致大規(guī)模的器官損壞。

09:06

Cannon believed that voodoo deaths werelimited to indigenous or "primitive" people. But over the years,these types of deaths have been shown to occur in all manner of modern people,too. Today, death by grief has been seen in spouses and in siblings. Brokenhearts are literally and figuratively deadly.

坎農(nóng)認(rèn)為巫毒教的死亡僅限于土著或“原始”人。但許多年來(lái)，這些類型的死亡也出現(xiàn)在各種各樣的現(xiàn)代人身上。今天，因悲傷而導(dǎo)致的死亡出現(xiàn)在配偶和兄弟姐妹上。破碎的心在生理上和隱喻上都是致命的。

09:33

These associations hold true even foranimals. In a fascinating study in 1980 published in the journal"Science," researchers fed caged rabbits a high-cholesterol diet tostudy its effect on cardiovascular disease. Surprisingly, they found that somerabbits developed a lot more disease than others, but they couldn't explainwhy. The rabbits had very similar diet, environment and genetic makeup. Theythought it might have something to do with how frequently the technicianinteracted with the rabbits. So they repeated the study, dividing the rabbitsinto two groups. Both groups were fed a high-cholesterol diet. But in onegroup, the rabbits were removed from their cages, held, petted, talked to,played with, and in the other group, the rabbits remained in their cages andwere left alone. At one year, on autopsy, the researchers found that therabbits in the first group, that received human interaction, had 60 percentless aortic disease than rabbits in the other group, despite having similarcholesterol levels, blood pressure and heart rate.

這種聯(lián)系甚至在動(dòng)物身上也成立。在1980年發(fā)表在《科學(xué)》期刊上的一個(gè)有趣研究中，研究人員給籠養(yǎng)的兔子喂食高膽固醇食物，以研究其對(duì)心血管疾病的影響。出乎意料的是，他們發(fā)現(xiàn)一些兔子患的病就是比其他兔子多，但他們無(wú)法解釋為什么。這些兔子的飲食結(jié)構(gòu)，環(huán)境和基因構(gòu)成都是類似的。他們認(rèn)為可能和技術(shù)員跟兔子互動(dòng)頻率有關(guān)。所以他們重復(fù)了這個(gè)研究，把這些兔子分成兩組。兩組都吃高膽固醇的食物。但其中一組，兔子被帶出籠子，被人們抱著，愛(ài)撫著，和它說(shuō)話，和它玩耍，另一組的兔子則被留在籠子里不聞不管。一年之后，在對(duì)兔子進(jìn)行解剖時(shí)，研究者發(fā)現(xiàn)第一組的兔子，那組有人類互動(dòng)的兔子，主動(dòng)脈疾病比另一組少60%，盡管有相似的膽固醇水平，血壓和心率。

10:54

Today, the care of the heart has becomeless the province of philosophers, who dwell upon the heart's metaphoricalmeanings, and more the domain of doctors like me, wielding technologies thateven a century ago, because of the heart's exalted status in human culture,were considered taboo. In the process, the heart has been transformed from analmost supernatural object imbued with metaphor and meaning into a machine thatcan be manipulated and controlled. But this is the key point: thesemanipulations, we now understand, must be complemented by attention to theemotional life that the heart, for thousands of years, was believed to contain.

今天，對(duì)心靈的關(guān)懷已不再是哲學(xué)家們的專利，他們專注于心靈的隱喻意義，并且越來(lái)越多的進(jìn)入像我這樣的醫(yī)生領(lǐng)域，運(yùn)用著甚至1個(gè)世紀(jì)前的技術(shù)，因?yàn)樾呐K在人類文化中的崇高地位，被認(rèn)為是禁忌。在這個(gè)過(guò)程中，心臟從充滿隱喻和意義的超自然的物體轉(zhuǎn)變成了可以操縱和控制的機(jī)器。但這里有個(gè)關(guān)鍵點(diǎn)：我們現(xiàn)在明白，這些操縱必須輔以對(duì)情感生活的關(guān)注，畢竟數(shù)千年來(lái)，人們認(rèn)為情感生活包含在心臟之中。

11:46

Consider, for example, the Lifestyle HeartTrial, published in the British journal "The Lancet" in 1990.Forty-eight patients with moderate or severe coronary disease were randomlyassigned to usual care or an intensive lifestyle that included a low-fat vegetariandiet, moderate aerobic exercise, group psychosocial support and stressmanagement advice. The researchers found that the lifestyle patients had anearly five percent reduction in coronary plaque. Control patients, on theother hand, had five percent more coronary plaque at one year and 28 percentmore at five years. They also had nearly double the rate of cardiac events,like heart attacks, coronary bypass surgery and cardiac-related deaths.

比如，《生活方式心臟試驗(yàn)》，1990年發(fā)表于英國(guó)《柳葉刀》雜志。48名患有中度或重度冠狀動(dòng)脈疾病的患者被隨機(jī)分配到常規(guī)護(hù)理或一組包括低脂素食，適度有氧運(yùn)動(dòng)，群體社會(huì)心理支持以及壓力管理建議的密集生活方式小組。研究者發(fā)現(xiàn)密集生活組病人冠狀動(dòng)脈斑塊減少了近5%。控制組，反之，一年后冠狀動(dòng)脈斑塊增加了5%，并且5年后增加了28%。他們患心臟病的幾率翻倍，比如心臟病發(fā)作，冠狀動(dòng)脈搭橋手術(shù)和心臟病相關(guān)的死亡。

12:41

Now, here's an interesting fact: somepatients in the control group adopted diet and exercise plans that were nearlyas intense as those in the intensive lifestyle group. Their heart disease stillprogressed. Diet and exercise alone were not enough to facilitate coronarydisease regression. At both one- and five-year follow-ups, stress managementwas more strongly correlated with reversal of coronary disease than exercisewas.

有一個(gè)有趣的事實(shí)：對(duì)照組的一些患者采用的飲食和鍛煉計(jì)劃幾乎與生活方式密集組的患者一樣多。他們的心臟疾病仍然在持續(xù)。單靠飲食和運(yùn)動(dòng)不足以促進(jìn)冠狀動(dòng)脈疾病的消退。在1年和5年的隨訪中，人們發(fā)現(xiàn)相比鍛煉，壓力管理與冠狀動(dòng)脈疾病的逆轉(zhuǎn)更加緊密相關(guān)。

13:14

No doubt, this and similar studies aresmall, and, of course, correlation does not prove causation. It's certainlypossible that stress leads to unhealthy habits, and that's the real reason forthe increased cardiovascular risk. But as with the association of smoking andlung cancer, when so many studies show the same thing, and when there aremechanisms to explain a causal relationship, it seems capricious to deny thatone probably exists. What many doctors have concluded is what I, too, havelearned in my nearly two decades as a heart specialist: the emotional heartintersects with its biological counterpart in surprising and mysterious ways.

毫無(wú)疑問(wèn)，這項(xiàng)研究和類似的研究規(guī)模都很小，當(dāng)然，相關(guān)性并不能證明因果關(guān)系。當(dāng)然可能壓力導(dǎo)致不健康習(xí)慣，是心血管風(fēng)險(xiǎn)增加的真正原因。但就像吸煙和肺癌的關(guān)系一樣，當(dāng)如此多的研究都顯示了同樣的事情，當(dāng)存在解釋因果關(guān)系的機(jī)制時(shí)，否定一個(gè)可能存在的說(shuō)法是不負(fù)責(zé)任的。許多醫(yī)生得出的結(jié)論，也是我近20年作為心臟專家了解到的：情感之心與它的生理對(duì)應(yīng)物以一種驚奇和神秘的方式相交叉。

13:58

And yet, medicine today continues toconceptualize the heart as a machine. This conceptualization has had greatbenefits. Cardiology, my field, is undoubtedly one of the greatest scientificsuccess stories of the past 100 years. Stents, pacemakers, defibrillators,coronary bypass surgery, heart transplants -- all these things were developedor invented after World War II.

然而，今天的醫(yī)學(xué)繼續(xù)將心臟概念化為一臺(tái)機(jī)器。這種概念化有很大的好處。心臟病學(xué)，我的領(lǐng)域，毫無(wú)疑問(wèn)是過(guò)去100年最具成就的科學(xué)領(lǐng)域之一。支架，起搏器，除顫器，冠狀動(dòng)脈搭橋手術(shù)，心臟移植——所有這些都是在二戰(zhàn)后發(fā)展或發(fā)明的。

14:28

However, it's possible that we areapproaching the limits of what scientific medicine can do to combat heartdisease. Indeed, the rate of decline of cardiovascular mortality has slowedsignificantly in the past decade. We will need to shift to a new paradigm tocontinue to make the kind of progress to which we have become accustomed. Inthis paradigm, psychosocial factors will need to be front and center in how wethink about heart problems.

然而，我們可能已經(jīng)接近了科學(xué)藥物在對(duì)抗心臟疾病上的極限。事實(shí)上，在過(guò)去的十年中，心血管疾病死亡率的下降速度已經(jīng)明顯放緩。我們需要轉(zhuǎn)向新的模式去繼續(xù)取得我們已經(jīng)習(xí)慣的進(jìn)步。在這種模式下，心理社會(huì)因素將需要成為我們思考心臟問(wèn)題的前提和中心。

15:01

This is going to be an uphill battle, andit remains a domain that is largely unexplored. The American Heart Associationstill does not list emotional stress as a key modifiable risk factor for heartdisease, perhaps in part because blood cholesterol is so much easier to lowerthan emotional and social disruption.

這將是一場(chǎng)艱苦的戰(zhàn)斗，在很大程度上它仍然是一個(gè)尚未被探索的領(lǐng)域。美國(guó)心臟學(xué)會(huì)仍然沒(méi)有把情感壓力作為心理疾病的一個(gè)可改變危險(xiǎn)因素，部分原因可能是因?yàn)檠獕褐械哪懝檀枷啾惹楦泻蜕鐣?huì)混亂更容易降低。

15:26

There is a better way, perhaps, if werecognize that when we say "a broken heart," we are indeed sometimestalking about a real broken heart. We must, must pay more attention to thepower and importance of the emotions in taking care of our hearts.

也許，有更好的方式。如果我們知道當(dāng)人們說(shuō)“破碎的心”時(shí)，他們說(shuō)的確實(shí)是一顆真的破碎的心臟。在照看我們的心臟時(shí)，我們就必須更加關(guān)注情感的力量和重要性。

15:47

Emotional stress, I have learned, is oftena matter of life and death.

我認(rèn)識(shí)到，情感壓力往往是生死攸關(guān)的問(wèn)題。

15:53

Thank you.

謝謝。

15:54

(Applause)

（掌聲）