评论
打印
Over 30 years ago, Elyn Saks was diagnosed with schizophrenia.
30多年前，伊琳·萨克斯被诊断患有精神分裂症。
She was told she'd probably live her life at a care facility watching TV, or maybe find work as a cashier, if she was lucky.
有人告诉她，她很可能一辈子在一家护理机构里看电视，或是幸运的话，能在银行当收银员。
Today she's a dean at the University of Southern California law school, a psychoanalyst, and a MacArthur Fellow.
如今，她是南加州大学法学院院长、精神分析师，也是麦克阿瑟研究员。
Her story reveals just how much we've learned about schizophrenia in the past few decades and about how to treat it.
她的故事揭示了我们过去几十年中对精神分裂症的了解，以及如何对其进行治疗。
But, there are some myths about schizophrenia that haven't caught up to the science, so here's the truth behind some of them.
但是，有一些关于精神分裂症的荒谬观点还没有赶上科学发展的步伐，所以我们要来说说一些观点背后的真相。
First, having schizophrenia doesn't mean you're indecisive, or you change your mind a lot,
首先，患有精神分裂症并不意味着你会犹豫不决，或者你经常改变自己的想法，
or you have multiple personalities—which apparently nearly two-thirds of Americans think is a thing.
又或者你有多重性格，这显然是近三分之二的美国人所认为的事实。
Maybe they're thinking that because "schizophrenia" comes from Greek words for "split mind."
也许他们认为，因为“精神分裂症”一词来自希腊语中的“分裂思维”。
But that's because the patients split from reality, not themselves.
但那是因为病人脱离了现实，而不是与他们自己相脱离。
People with schizophrenia often experience hallucinations: false sensations or perceptions.
精神分裂症患者经常会产生幻觉：错误的感觉或知觉。
65% of patients report hearing voices, for example, making it one of the most common symptoms.
例如，65%的患者报告听到声音，这是最常见的症状之一。
But the hallucinations can also be visual, like seeing movement in the periphery of their vision, or tactile, like feeling things crawling on them.
不过，幻觉也可以是视觉上的，比如在视野外围看到运动，或者是触觉上的，比如感觉到有东西爬到他们身上。
And perhaps not surprisingly, patients often present with delusions as well—false beliefs, like the idea that people are spying on them.
也许这些都并不奇怪，病人经常出现错觉和错误的念头，比如人们在监视他们。
Psychologists think those delusions probably stem from patients trying to make sense of their unusual hallucinations.
心理学家认为，这些错觉可能源于患者试图搞明白他们不正常的幻觉。
Like, if you're hearing voices and no one else is in the room, the idea that there are spies secretly spying on you doesn't seem that far-fetched.
比如，如果你听到声音，而房间里却没有其他人，那么有秘密监视你的间谍的这种想法似乎并不那么牵强附会。
A patient might even come to believe they're someone else.
病人甚至会相信自己是别人。
But that's not the same as having multiple personalities or switching between them, like with dissociative identity disorder.
但这与拥有多重人格或在不同人格之间转换不同，这种是分离性身份障碍。
There are also other emotional and behavioral changes that tend to accompany these symptoms,
伴随这些症状的还有其他情绪和行为上的变化，
like disorganized thoughts and speech, and flat affect, where someone basically never shows emotions outwardly.
比如杂乱无章的思想和言语，以及平缓的情绪，在这些情绪中，当事人基本上从不表现出外露的情感。
In extreme cases, schizophrenia can result in catatonia, which is the inability to move or respond, although that's super rare.
在极端的情况下，精神分裂症会导致紧张症，即不能运动或反应，尽管这种情况非常罕见。
For decades, people thought that all this was the result of bad parenting—especially bad mothers.
几十年来，人们一直认为这一切都是父母养育不佳的结果，尤其是孩子拥有糟糕的母亲。
Because of that, the first treatment was usually to immediately remove the patient from their family—which isn't a good idea if the family is supportive.
正因为如此，治疗的第一步通常是立即将患者从家中接走，如果家庭能够给予支持的话，这样做就不是一个好主意。
From the research we've done since then, it's clear that genes play the biggest role.
从那以后所做的研究来看，很明显基因发挥着最大的作用。
Schizophrenia is about 50% heritable, which means that genetics are fairly predictive
精神分裂症大约有50%是可遗传的，这意味着遗传学相当具有预测性。
—in fact, in identical twin studies, it was shown that if one identical twin has schizophrenia, there's a 50/50 chance that the other one will.
事实上，在同卵双胞胎的研究中，有研究表明，如果同卵双胞胎中有一人患有精神分裂症，那么另一人的患病可能性就是50/50。
And if one of your parents has it, there's about a 10% chance that you'll be diagnosed, too.
如果你的父母中有一人患有此病，你也有10%的可能被诊断出患有此病。
That makes it one of the most highly heritable psychological disorders.
这使它成为最可能遗传的心理障碍之一。
Your environment can play a role, but it's not nearly as important as psychologists used to think.
环境可能发挥作用，但它并不像心理学家过去认为的那样重要。
For example, a 2004 study found that children adopted to a home with lots of conflict and chaotic relationships were more likely to be diagnosed,
例如，2004年的一项研究发现，被收养到一个有很多冲突和混乱关系的家庭中的孩子，更有可能被诊断出患病。
but that was only if they also had genetic risk factors, like someone else in their family had it.
但前提是这些孩子也有遗传风险因素，就像他们家里的其他人一样。
A rocky home life had no effect on the rate of diagnosis in the group without genetic risk factors.
在没有遗传危险因素的人群中，不稳定的家庭生活对诊断率没有影响。
Which makes sense, now that we know more about what's actually happening in the brains of people with schizophrenia.
这是有道理的，现在我们更了解精神分裂症患者大脑中实际发生的事情。
For a long time, schizophrenia was thought to be caused by too much of the neurotransmitter dopamine in the brain because drugs that block dopamine helped with some of the worst symptoms.
长期以来，精神分裂症被认为是由大脑中过多的神经递质多巴胺引起的，因为阻断多巴胺的药物有助于缓解一些最严重的症状。
And the idea seemed to make sense, because floods of dopamine can cause hallucinations—that's exactly how some psychoactive drugs work.
这个想法似乎是有道理的，因为多巴胺泛滥会导致幻觉，这正是一些治疗精神病药物的工作原理。
The trouble is, these drugs sometimes made other symptoms worse, for reasons that aren't entirely clear.
问题是，这些药物有时会使其他症状恶化，原因还不完全清楚。
So more recent research has looked to brain anatomy to understand the root of the disorder.
因此，最近的研究是通过大脑解剖来了解这种疾病的根源。
Specifically, researchers looked at changes to gray matter, the darker-colored tissue that's mostly on the surface of the brain.
具体来说，研究人员观察灰质的变化，这是一种主要位于大脑表面的深色组织。
Everyone loses gray matter between childhood and adulthood as part of a normal process called synaptic pruning, where some connections are lost, but the ones you keep get stronger.
每个人在童年和成年之间都会失去灰质，这是一种称为突触修剪的正常过程的一部分，在这个过程中，一些连接会丢失，但保留下来的连接会增强。
But patients with schizophrenia lose a lot more gray matter.
但是精神分裂症患者会失去更多的灰质。
And those losses start in the parietal lobe, an area of the brain that handles sensory information and some sound processing, among other things, which might help explain the hallucinations.
这些损失从顶叶开始，顶叶是大脑中处理感觉信息和加工某些声音的区域，这可能有助于解释幻觉。
There's one more persistent myth that needs to be cleared up: the idea that schizophrenics are wild and dangerous, and need to be locked up for their own—and everyone else's—safety.
还有一个更持久的谬误需要澄清：精神分裂症患者狂野又危险，为了他们自己和其他人的安全，需要被关起来。
That's just not true.
这不是真的。
Although sometimes people with the disorder behave in unusual ways, they're typically not aggressive or violent.
尽管有时，患有精神障碍的人行为异常，但他们通常不具有攻击性或暴力性。
And lifelong hospitalization isn't as common these days.
如今，终生住院治疗的情况并不常见。
Some people who experience these symptoms recover completely, and most others can control their symptoms with medicine and therapy.
一些经历过这些症状的人会完全康复，而大多数人可以通过药物和治疗来控制症状。
When it comes to medication, newer drugs that target multiple neurotransmitters seem to be more effective than the medications used a few decades ago.
说到药物治疗，针对多种神经递质的新药似乎比几十年前使用的药物更有效。
That's probably because in addition to blocking dopamine, and therefore dopamine-induced hallucinations, they also stimulate serotonin production.
这可能是因为除了阻断多巴胺，和多巴胺诱发的幻觉外，它还会刺激5-羟色胺的产生。
Since serotonin is one of those feel-good neurotransmitters, having more of it likely improves some of the other symptoms like withdrawal and flat affect.
由于血清素是一种让人感觉良好的神经递质，多摄入血清素可能改善一些其他症状，如退缩和情感淡漠。
Recent research has also shown that good talk therapy can help, too.
最近的研究也表明，良好的谈话疗法也有所帮助。
A 2016 study of 400 patients found that those who received a comprehensive approach, with low doses of medications alongside therapy,
2016年对400名患者进行的一项研究发现，接受综合治疗的患者，在接受治疗的同时使用低剂量药物，
reported a better quality of life than those who managed their illness only with medication.
其生活质量比仅使用药物治疗的患者要好。
And remember Elyn Saks, the researcher from the beginning of this episode?
还记得本集开头的研究员伊琳·萨克斯吗？
Her work centers around how some patients become high-functioning like herself: the factors that helped them earn degrees and have professional careers.
她的工作重点是让一些患者如何像她自己一样变得高效：帮助这些患者获得学位并步入职场的因素。
Many used cognitive strategies like asking themselves if their hallucinations were reasonable, in addition to strategies like distracting themselves with their work.
许多人使用认知策略，例如询问自己的幻觉是否合理，此外还有一些策略，如把注意力从工作上移开。
Now, don't get me wrong—schizophrenia is a difficult disorder to treat, and has different standards of recovery than more common disorders like anxiety or depression.
别误会我的意思，精神分裂症是一种很难治疗的疾病，它的康复标准与焦虑或抑郁等常见疾病不同。
But a diagnosis doesn't mean you're doomed to live in a mental health facility, or that you're a danger to society—just like it doesn't mean you're indecisive or had a terrible mother.
但确诊并不意味着你注定要在精神卫生机构中生活，或者说你会对社会构成危险，就像是这并不意味着你优柔寡断或是有位糟糕的母亲。
In fact, studies estimate that as many as three-quarters of patients recover fully or at least enough that they can lead fairly normal lives if they have a strong support network to rely on and get the help they need.
事实上，研究估计，多达四分之三的患者完全康复，或是至少足以使他们能过上相当正常的生活，只要他们有强大的支持网络可以依赖并获得所需的帮助。
Thanks for watching this episode of SciShow Psych!
感谢收看这一集的心理科学秀！
While schizophrenia might not be "multiple personalities," you can learn what that actually is by watching our episode on Dissociative Identity Disorder.
虽然精神分裂症可能不是“多重人格”，但你可以通过观看我们关于分离性身份障碍的视频来了解多重人格到底是怎么回事。
