演講MP3+雙語(yǔ)文稿:為什么要訓(xùn)練祖母治療抑郁癥

聽(tīng)力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語(yǔ)文稿，供各位英語(yǔ)愛(ài)好者學(xué)習(xí)使用。本文主要內(nèi)容為演講MP3+雙語(yǔ)文稿:為什么要訓(xùn)練祖母治療抑郁癥，希望你會(huì)喜歡！

【演講者及介紹】Dixon Chibanda

精神病學(xué)家，對(duì)人類大腦充滿熱情，他研究大腦如何影響我們的行為，以及我們?nèi)绾巫霾拍茏屆總€(gè)人都開(kāi)心。

【演講主題】為什么要訓(xùn)練祖母治療抑郁癥

【中英文字幕】

Translated by Qikai Guo. Reviewed by Chan Yuxin

00:00

On a warm August morning in Harare, Farai, a 24-year-old mother of two, walks towards a park bench. She looks miserable and dejected. Now, on the park bench sits an 82-year-old woman, better known to the community as Grandmother Jack. Farai hands Grandmother Jack an envelope from the clinic nurse. Grandmother Jack invites Farai to sit down as she opens the envelope and reads. There's silence for three minutes or so as she reads. And after a long pause, Grandmother Jack takes a deep breath, looks at Farai and says, "I'm here for you. Would you like to share your story with me?"

在哈拉雷（津巴布韋首都） 8 月的一個(gè)溫暖的早晨，范蕾，一位有兩個(gè)孩子的 24 歲母親 走向了公園的長(zhǎng)凳。她看起來(lái)痛苦又沮喪。那條長(zhǎng)凳上還坐著 一位 82 歲的老婦人，社區(qū)的人都親切的叫她 杰克奶奶。范蕾遞給杰克奶奶一個(gè) 從診所護(hù)士那拿到的信封。杰克奶奶請(qǐng)范蕾坐下，在她打開(kāi)信封并閱讀時(shí)，有大概三分鐘，兩人都默不作聲。過(guò)了一會(huì)兒，杰克奶奶深吸了一口氣，看著范蕾說(shuō)，“有我在呢。想和我說(shuō)說(shuō)你的故事嗎？”

01:01

Farai begins, her eyes swelling with tears. She says, "Grandmother Jack, I'm HIV-positive. I've been living with HIV for the past four years. My husband left me a year ago. I have two kids under the age of five. I'm unemployed. I can hardly take care of my children."

范蕾開(kāi)始了講述，她的眼睛滿含淚水。她說(shuō)，“杰克奶奶，我的艾滋病檢測(cè)結(jié)果呈陽(yáng)性。過(guò)去四年來(lái)，我一直是艾滋病毒攜帶者。我的丈夫一年前離開(kāi)我了。我有兩個(gè)孩子，他們都還不到五歲。我還失業(yè)了，我?guī)缀鯚o(wú)力撫養(yǎng)我的孩子。

01:28

Tears are now flowing down her face. And in response, Grandmother Jack moves closer, puts her hand on Farai, and says, "Farai, it's OK to cry. You've been through a lot. Would you like to share more with me?"

這時(shí)眼淚不停地從她臉頰流下。作為回應(yīng)，杰克奶奶坐近了一些，并且輕輕撫摸范雷，她說(shuō)，“范雷，哭吧，沒(méi)關(guān)系的。你經(jīng)歷了很多。你想和我再說(shuō)說(shuō)嗎？”

01:47

And Farai continues. "In the last three weeks, I have had recurrent thoughts of killing myself, taking my two children with me. I can't take it anymore. The clinic nurse sent me to see you." There's an exchange between the two, which lasts about 30 minutes. And finally, Grandmother Jack says, "Farai, it seems to me that you have all the symptoms of kufungisisa."

接下來(lái)，范雷繼續(xù)了講述?！霸谶^(guò)去的三周里，我經(jīng)常想到自殺，帶著我的兩個(gè)孩子一起。我真的無(wú)法承受了。是診所護(hù)士讓我來(lái)見(jiàn)你的?！?在接下來(lái)的三十分鐘里，她們互訴衷腸。最后，杰克奶奶說(shuō)，“范雷。在我看來(lái)，你有 kufungisisa 的所有癥狀。”

02:25

The word "kufungisisa" opens up a floodgate of tears. So, kufungisisa is the local equivalent of depression in my country. It literally means "thinking too much." The World Health Organization estimates that more than 300 million people globally, today, suffer from depression, or what in my country we call kufungisisa. And the World Health Organization also tells us that every 40 seconds, someone somewhere in the world commits suicide because they are unhappy, largely due to depression or kufungisisa. And most of these deaths are occurring in low- and middle-income countries.

kufungisisa 這個(gè)詞 讓范蕾再也止不住淚水。事實(shí)上，在我的國(guó)家，kufungisisa 就相當(dāng)于抑郁癥。它的字面意思是 “想的太多”。根據(jù)世界衛(wèi)生組織的估計(jì)，目前全球有 3 億多人患有抑郁癥，或者用我國(guó)的叫法，患上了 Kufungisisa。世界衛(wèi)生組織也告訴我們，每 40 秒鐘。世界的某個(gè)角落就會(huì)有人自殺，因?yàn)樗麄兓畹貌豢鞓?lè)，主要是由于患有 抑郁癥或 kufungisisa。大部分的自殺行為 都發(fā)生于中低收入的國(guó)家。

03:17

In fact, the World Health Organization goes as far as to say that when you look at the age group between 15 to 29, a leading cause of death now is actually suicide. But there are wider events that lead to depression and in some cases, suicide, such as abuse, conflict, violence, isolation, loneliness -- the list is endless. But one thing that we do know is that depression can be treated and suicides averted.

事實(shí)上，世界衛(wèi)生組織甚至表明，年齡在 15 歲到 29 歲之間的群體中，目前主要的死因就是自殺。但導(dǎo)致抑郁癥甚至自殺的原因 其實(shí)有很多，比如虐待，沖突，暴力，孤立，寂寞，等等。但我們知道的是，抑郁癥是可治療的，自殺也是可避免的。

03:54

But the problem is we just don't have enough psychiatrists or psychologists in the world to do the job. In most low- and middle-income countries, for instance, the ratio of psychiatrists to the population is something like one for every one and a half million people, which literally means that 90 percent of the people needing mental health services will not get it. In my country, there are 12 psychiatrists, and I'm one of them, for a population of approximately 14 million.

但問(wèn)題是，世界上沒(méi)有足夠的 精神病學(xué)家或心理學(xué)家 來(lái)完成這項(xiàng)工作。比如在大多數(shù)中低收入的國(guó)家，精神科醫(yī)生與總?cè)丝诘谋壤?是 1 比 150 萬(wàn)。這個(gè)數(shù)字意味著 90％ 需要 心理健康服務(wù)的人群 無(wú)法得到應(yīng)有的服務(wù)。在我的祖國(guó)，共有 12 位精神科醫(yī)生，我就是其中之一，要為約 1400 萬(wàn)人口服務(wù)。

04:28

Now, let me just put that into context. One evening while I was at home, I get a call from the ER, or the emergency room, from a city which is some 200 kilometers away from where I live. And the ER doctor says, "One of your patients, someone you treated four months ago, has just taken an overdose, and they are in the ER department. Hemodynamically, they seem to be OK, but they will need neuropsychiatric evaluation." Now, I obviously can't get into my car in the middle of the night and drive 200 kilometers. So as best as we could, over the phone with the ER doctor, we come up with an assessment. We ensure that suicidal observations are in place. We ensure that we start reviewing the antidepressants that this patient has been taking, and we finally conclude that as soon as Erica -- that was her name, 26-year-old -- as soon as Erica is ready to be released from the ER, she should come directly to me with her mother, and I will evaluate and establish what can be done.

現(xiàn)在，我給大家講個(gè)實(shí)際的例子。一天晚上，我在家休息，接到了一個(gè) ER，也就是急診室的 電話，那個(gè)城市和我住的地方 相距 200 公里。急診室醫(yī)生說(shuō)，“你的一個(gè)病人，就是四個(gè)月前接受治療的那個(gè)，現(xiàn)在服藥過(guò)量，正在一個(gè)急診科里。從血流動(dòng)力上看沒(méi)什么問(wèn)題，但需要進(jìn)行神經(jīng)精神病方面的評(píng)估。” 但我當(dāng)時(shí)顯然不會(huì)在半夜驅(qū)車 200 公里到達(dá)現(xiàn)場(chǎng)。所以我當(dāng)時(shí)能做的 就是和電話那頭急診室醫(yī)生 進(jìn)行了一個(gè)評(píng)估。我們確認(rèn)自殺監(jiān)管到位。我們確認(rèn)我們檢查了那個(gè)病人 一直服用的抗抑郁藥物，最后我們得出結(jié)論，26 歲的愛(ài)瑞卡——那是她的名字—— 一旦愛(ài)瑞卡可以從急診室出院，她應(yīng)該和她母親直接來(lái)我這里，然后我會(huì)評(píng)估她的精神狀況，也會(huì)盡我所能來(lái)幫助她。

05:39

And we assumed that that would take about a week. A week passes. Three weeks pass. No Erica. And one day I get a call from Erica's mother, and she says, "Erica committed suicide three days ago. She hanged herself from the mango tree in the family garden." Now, almost like a knee-jerk reaction, I couldn't help but ask, "But why didn't you come to Harare, where I live? We had agreed that as soon as you're released from the ER, you will come to me." Her response was brief. "We didn't have the 15 dollars bus fare to come to Harare."

我們估計(jì)那要花大概一周。一周過(guò)去了，三周過(guò)去了，愛(ài)瑞卡沒(méi)有來(lái)。一天我接到了愛(ài)瑞卡母親的電話，她說(shuō)，“愛(ài)瑞卡三天前自殺了。她在自家院子里的 芒果樹(shù)上上吊了?！?那時(shí)候，就像膝跳反射一樣，我忍不住問(wèn)道，“但是你們?yōu)槭裁礇](méi)來(lái) 我在哈拉雷的住處？ 我們都說(shuō)好了，一旦愛(ài)瑞卡出院，你們就會(huì)過(guò)來(lái)。” 她的答案很簡(jiǎn)短，“我們付不起十五美元的巴士錢，去不了哈拉雷?！?/p>

06:28

Now, suicide is not an unusual event in the world of mental health. But there was something about Erica's death that struck me at the core of my very being. That statement from Erica's mother: "We didn't have 15 dollars bus fare to come to you," made me realize that it just wasn't going to work, me expecting people to come to me. And I got into this state of soul-searching, trying to really discover my role as a psychiatrist in Africa.

在精神健康領(lǐng)域，自殺很常見(jiàn)。但是愛(ài)瑞卡的死 卻深深地震撼了我。愛(ài)瑞卡母親的話： “我們付不起十五美元的 巴士錢去找你，” 讓我明白了，讓病人來(lái)找我，根本就行不通。我開(kāi)始進(jìn)行深刻的反思，想要探尋我作為非洲的 一名精神病學(xué)家的角色。

07:09

And after considerable consultation and soul-searching, talking to colleagues, friends and family, it suddenly dawned on me that actually, one the most reliable resources we have in Africa are grandmothers. Yes, grandmothers. And I thought, grandmothers are in every community. There are hundreds of them. And --

在經(jīng)過(guò)一系列咨詢和自我反思，以及和同事、朋友和家人的交流后，我突然之間明白了，實(shí)際上，在非洲，我們最可靠的資源 就是我們的奶奶們。沒(méi)錯(cuò)，奶奶們。我認(rèn)為，奶奶們無(wú)處不在。數(shù)量眾多，而且——

07:37

(Laughter)

（笑聲）

07:38

And they don't leave their communities in search of greener pastures.

而且也不會(huì)拋下我們 去追求更好的生活。

07:43

(Laughter)

（笑聲）

07:45

See, the only time they leave is when they go to a greener pasture called heaven.

她們唯一離開(kāi)的時(shí)候，是要去一個(gè)更好的地方，天堂。

07:49

(Laughter)

（笑聲）

07:50

So I thought, how about training grandmothers in evidence-based talk therapy, which they can deliver on a bench? Empower them with the skills to listen, to show empathy, all of that rooted in cognitive behavioral therapy; empower them with the skills to provide behavior activation, activity scheduling; and support them using digital technology. You know, mobile phone technology. Pretty much everyone in Africa has a mobile phone today.

所以我想，何不訓(xùn)練一下奶奶們，讓她們進(jìn)行循證型的談話治療，在長(zhǎng)凳上就能進(jìn)行？ 讓她們可以通過(guò)傾聽(tīng)他人 來(lái)表達(dá)同情心。這些都源于認(rèn)知行為療法； 可以讓奶奶們提供行為激活，安排活動(dòng)日程，并且讓她們運(yùn)用數(shù)碼科技，就是移動(dòng)電話技術(shù)。畢竟在非洲，現(xiàn)在幾乎每個(gè)人都有手機(jī)。

08:26

So in 2006, I started my first group of grandmothers.

所以在 2006 年，我開(kāi)創(chuàng)了我的第一個(gè) 奶奶團(tuán)。

08:33

(Applause)

（掌聲）

08:37

Thank you.

謝謝。

08:38

(Applause)

（掌聲）

08:41

Today, there are hundreds of grandmothers who are working in more than 70 communities. And in the last year alone, more than 30,000 people received treatment on the Friendship Bench from a grandmother in a community in Zimbabwe.

現(xiàn)在，已經(jīng)有數(shù)百位奶奶們 在超過(guò) 70 個(gè)社區(qū)中工作。僅在去年，就有超過(guò)三萬(wàn)人 在友情長(zhǎng)凳上 接受了津巴布韋 某個(gè)社區(qū)的奶奶的治療。

09:01

(Applause)

（掌聲）

09:09

And recently, we published this work that is done by these grandmothers in the Journal of the American Medical Association. And --

最近，我們將 這些奶奶們完成的工作 發(fā)布在了美國(guó)醫(yī)學(xué)會(huì)的期刊上。不僅如此——

09:18

(Applause)

（掌聲）

09:20

And our results show that six months after receiving treatment from a grandmother, people were still symptom-free: no depression, suicidal ideation completely reduced. In fact, this clinical trial showed that grandmothers were more effective at treating depression than doctors and --

我們的數(shù)據(jù)表明，在經(jīng)過(guò)一位奶奶 六個(gè)月的治療后，人們的病癥紛紛消失了： 也不再抑郁，自殺想法大大降低。這個(gè)臨床試驗(yàn)表明，我們的奶奶們相比醫(yī)生 要有效得多。

09:45

(Laughter)

（笑聲）

09:46

(Applause)

（掌聲）

09:54

And so, we're now working towards expanding this program. There are more than 600 million people currently aged above 65 in the world. And by the year 2050, there will be 1.5 billion people aged 65 and above. Imagine if we could create a global network of grandmothers in every major city in the world, who are trained in evidence-based talk therapy, supported through digital platforms, networked. And they will make a difference in communities. They will reduce the treatment gap for mental, neurological and substance-use disorders.

所以，我們現(xiàn)在正在致力于 擴(kuò)大這個(gè)項(xiàng)目。全世界目前有 6 億 65 歲以上的人。到了 2050 年，這個(gè)人數(shù)會(huì)增加到 15 億。想像一下，如果我們 在全世界的所有主要城市 創(chuàng)造一個(gè)奶奶們的關(guān)系網(wǎng)絡(luò)，她們都受過(guò)循證談話治療的訓(xùn)練，并由電子平臺(tái)支持，通過(guò)網(wǎng)絡(luò)工作。她們會(huì)在社區(qū)中起到顯著的作用，減少精神，神經(jīng) 和藥物使用障礙方面的治療缺口。

10:48

So, Farai had six sessions on the bench with Grandmother Jack. Today, Farai is employed. She has her two children at school. And as for Grandmother Jack, one morning in February, we expected her to see her 257th client on the bench. She didn't show up. She had gone to a greener pasture called heaven. But I believe that Grandmother Jack, from up there, she's cheering on all the other grandmothers -- the increasing number of grandmothers who are making a difference in the lives of thousands of people. And I'm sure she's in awe when she realizes that something that she helped to pioneer is now spreading to other countries, like Malawi, the island of Zanzibar and coming closer to home here in the Unites States in the city of New York. May her soul rest in peace.

范蕾在這張長(zhǎng)凳上和杰克奶奶 進(jìn)行了六個(gè)療程的治療。現(xiàn)在，范蕾有了工作，兩個(gè)孩子也在上學(xué)。至于杰克奶奶，二月的一天早晨，我們以為 她會(huì)在長(zhǎng)凳上治療第 257 名病人，但她并沒(méi)有出現(xiàn)。因?yàn)樗チ艘粋€(gè)更好的地方，天堂。但我相信杰克奶奶 一直以來(lái)都在天堂 鼓舞著其他的奶奶們—— 幫助著許多人的，隊(duì)伍不斷壯大的奶奶們。我也相信，當(dāng)她知道她所倡導(dǎo)的精神 正在其他國(guó)家不斷傳播，比如馬拉維，桑給巴爾島，同時(shí)也將馬上 影響到美國(guó)，就在紐約，我相信她一定會(huì)感到敬畏。愿她的靈魂安息。

12:00

Thank you.

謝謝。

12:01

(Applause)

（掌聲）

12:04

(Cheering)

（歡呼）

12:06

(Applause)

（掌聲）