TED英語演講：童年創(chuàng)傷怎樣影響一生的健康
童年創(chuàng)傷不是一件長大就能解決的事。兒科醫(yī)生Nadine解釋虐待、忽視、和父母精神健康不良或有藥物或飲酒問題，都會影響兒童的大腦發(fā)展。童年經(jīng)歷影響終身，在高壓環(huán)境下長大的兒童比他人得到心肺疾病的比例高三倍。下面是小編為大家收集關(guān)于TED英語演講：童年創(chuàng)傷怎樣影響一生的健康，歡迎借鑒參考。
演說題目：童年創(chuàng)傷怎樣影響一生的健康!
演說者：Nadine Burke Harris
In the mid-'90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of 10 of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy. And yet, doctors today are not trained in routine screening or treatment. Now, the exposure I'm talking about is not a pesticide or a packaging chemical. It’s childhood trauma.
90年代中期, CDC和Kaiser Permanente發(fā)現(xiàn): 暴露于某種事物中 會極大增加死亡風(fēng)險, 七成美國民眾的首要死因皆由此引起。 暴露劑量較高時,會影響大腦發(fā)育, 免疫系統(tǒng),內(nèi)分泌系統(tǒng), 甚至影響到基因的讀取及轉(zhuǎn)錄方式。 暴露在極高劑量下的人群, 有3倍的風(fēng)險患上心臟病和肺癌, 預(yù)期壽命縮短20年。 然而,目前醫(yī)生們還未被培訓(xùn) 以常規(guī)篩查和治療的手段來應(yīng)對這種風(fēng)險。 我所說的暴露危害并不針對 某種農(nóng)藥或包裝上的化學(xué)物質(zhì)。 而是兒童期創(chuàng)傷。
Okay. What kind of trauma am I talking about here? I'm not talking about failing a test or losing a basketball game. I am talking about threats that are so severe or pervasive that they literally get under our skin and change our physiology: things like abuse or neglect, or growing up with a parent who struggles with mental illness or substance dependence.
那么,我要說的是哪種創(chuàng)傷呢? 我要說的可不是 考試不及格或輸?shù)艋@球比賽。 我要說的是那種 如此嚴重而又無處不在的威脅, 以致于它讓我們毛骨悚然, 并從生理上改變了我們： 比如,受虐待或被忽視, 又或者,撫養(yǎng)我們的父母, 本身就深受精神疾病之苦, 或是深陷于"物質(zhì)依賴"疾病。
Now, for a long time, I viewed these things in the way I was trained to view them, either as a social problem -- refer to social services -- or as a mental health problem -- refer to mental health services. And then something happened to make me rethink my entire approach. When I finished my residency, I wanted to go someplace where I felt really needed, someplace where I could make a difference. So, I came to work for California Pacific Medical Center, one of the best private hospitals in Northern California, and together, we opened a clinic in Bayview-Hunters Point, one of the poorest, most underserved neighborhoods in San Francisco. Now, prior to that point, there had been only one pediatrician in all of Bayview to serve more than 10,000 children, so we hung a shingle, and we were able to provide top-quality care regardless of ability to pay. It was so cool. We targeted the typical health disparities: access to care, immunization rates, asthma hospitalization rates, and we hit all of our numbers. We felt very proud of ourselves.
一直以來, 我都按照所教導(dǎo)的方式 來看待這些事情。 要么把它當(dāng)成一個社會問題-- 交給社會服務(wù)去處理, 要么把它當(dāng)成一個心理健康問題-- 交給心理健康咨詢來解決。 后來發(fā)生了一些事情, 使我反思我的整個思維方式。 在醫(yī)院實習(xí)結(jié)束后, 我想去個我覺得真正需要我的地方, 去個我可以有所作為的地方。 因此，我選擇為加利利福尼亞 太平洋醫(yī)療中心(CPMC)工作, 這是加利福尼亞北部 最優(yōu)秀的私立醫(yī)院之一, 我與該醫(yī)院合作,在舊金山最窮、 社區(qū)服務(wù)最差的居民區(qū)-- 灣景區(qū)獵人角(Bayview-Hunters Point) 開了一家診所。 在此之前, 整個灣景區(qū)(Bayview)社區(qū) 僅有一名兒科醫(yī)生, 為一萬多名兒童服務(wù), 因此,我們開始掛牌營業(yè), 提供最優(yōu)質(zhì)的醫(yī)療服務(wù), 不論是否有能力支付醫(yī)療費用。 這種感覺很棒。 我們找出了在醫(yī)療服務(wù)上現(xiàn)狀與標準的差距： 普及醫(yī)療保健, 免疫接種率、哮喘住院率等, 我們都完成了達標。 我們?yōu)樽约焊械津湴痢?/p>
But then I started noticing a disturbing trend. A lot of kids were being referred to me for ADHD, or Attention Deficit Hyperactivity Disorder, but when I actually did a thorough history and physical, what I found was that for most of my patients, I couldn't make a diagnosis of ADHD. Most of the kids I was seeing had experienced such severe trauma that it felt like something else was going on. Somehow, I was missing something important.
但就在那時,我開始注意到 一種令人憂心的趨勢。 很多孩子因為多動癥(簡稱ADHD), 被送到我這里進行醫(yī)治, 可是,當(dāng)我對孩子們的病史和 身體狀況進行徹查時, 卻發(fā)現(xiàn)大多數(shù)患兒的情況, 我無法下"多動癥"(ADHD)的診斷。 多數(shù)來就診的孩子都經(jīng)歷過 如此嚴重的創(chuàng)傷, 讓人覺得似乎事情并不簡單。 不知怎的,我漏查了某個重要的因素。
Now, before I did my residency, I did a master's degree in public health, and one of the things that they teach you in public health school is that if you're a doctor and you see 100 kids that all drink from the same well, and 98 of them develop diarrhea, you can go ahead and write that prescription for dose after dose after dose of antibiotics, or you can walk over and say, "What the hell is in this well?" So, I began reading everything that I could get my hands on about how exposure to adversity affects the developing brains and bodies of children.
在實習(xí)之前,我曾攻讀公共健康碩士學(xué)位, 在公共健康學(xué)校里, 我們曾學(xué)過這樣的一課, 如果你是一名醫(yī)生, 當(dāng)你知道有100個孩子從 同一口井中飲水, 其中98人患了腹瀉, 你可以著手治療, 給每個病人都開抗生素, 一劑,一劑,又一劑的開。 可是你也可以走去井邊， 問聲,"井里到底有什么鬼東西?" 所以,我開始查閱手頭所有的相關(guān)資料, 了解暴露在不幸中, 是如何影響兒童的大腦和身體發(fā)育的。
And then one day, my colleague walked into my office, and he said, "Dr. Burke, have you seen this?" In his hand was a copy of a research study called the Adverse Childhood Experiences Study. That day changed my clinical practice and ultimately my career.
然后有一天, 一個同事走進我的辦公室, 他問我,"伯克醫(yī)生,你看過這個嗎?" 在他手里的是 一份調(diào)查研究的復(fù)印件, 題目是"童年不良經(jīng)歷(ACE)研究"。 那一天,改變了我的臨床實踐, 也最終改變了我的職業(yè)生涯。
The Adverse Childhood Experiences Study is something that everybody needs to know about. It was done by Dr. Vince Felita at Kaiser and Dr. Bob And at the CDC, and together, they asked 17,500 adults about their history of exposure to what they called "adverse childhood experiences," or ACEs. Those include physical, emotional, or sexual abuse; physical or emotional neglect; parental mental illness, substance dependence, incarceration; parental separation or divorce; or domestic violence. For every yes, you would get a point on your ACE score. And then what they did was they correlated these ACE scores against health outcomes. What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population had at least one ACE, and 12.6 percent, one in eight, had four or more ACEs. The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes: the higher your ACE score, the worse your health outcomes. For a person with an ACE score of four or more, their relative risk of chronic obstructive pulmonary disease was two and a half times that of someone with an ACE score of zero. For hepatitis, it was also two and a half times. For depression, it was four and a half times. For suicidality, it was 12 times. A person with an ACE score of seven or more had triple the lifetime risk of lung cancer and three and a half times the risk of ischemic heart disease, the number one killer in the United States of America.
童年不良經(jīng)歷(ACE)的研究 是每一個人都應(yīng)該要了解的。 Vince Felitti博士和Bob Anda博士 分別在 Kaiser 和 CDC 進行了這項研究, 他們兩人一起詢問了17,500成年人, 了解他們的"童年不良經(jīng)歷",又稱ACE。 這包括生理上、情感上 遭受的不幸或是性侵害; 生理或情感上遭受的忽視; 父母患有精神疾病、物質(zhì)依賴、遭到監(jiān)禁; 父母分居或離婚; 或家庭暴力。 每個問題只要回答"是", ACE分數(shù)就增加一分。 接下來, 他們將ACE分數(shù)與健康狀況關(guān)聯(lián)起來, 得出的結(jié)果是令人震驚的。 結(jié)論有兩點： 第一點,ACE十分普遍, 簡直令人不可思議。 67%的人曾至少有一個ACE得分, 有12.6%(八分之一)的人 有四或四以上的ACE得分。 研究發(fā)現(xiàn)的第二點, 是ACE與健康狀況之間 存在著一種劑量反應(yīng)關(guān)系： ACE得分越高,健康狀況越糟糕。 如果一個人的ACE分數(shù)大于等于4分, 他患慢性阻塞性肺病的相對風(fēng)險 是ACE分數(shù)為0時的2.5倍。 患上肝炎的風(fēng)險是2.5倍。 而患上抑郁癥的風(fēng)險是4.5倍。 自殺風(fēng)險是12倍。 ACE分數(shù)大于等于7的人 終身都有3倍的風(fēng)險患上肺癌, 和3.5倍的風(fēng)險患上冠心病-- 這種目前在美國 當(dāng)屬頭號殺手的疾病。
Well, of course this makes sense. Some people looked at this data and they said, "Come on. You have a rough childhood, you're more likely to drink and smoke and do all these things that are going to ruin your health. This isn't science. This is just bad behavior."
當(dāng)然,這其實挺有道理。 有些人看了這些數(shù)據(jù)之后會說, "好啦,你有個糟糕的童年, 你更容易酗酒和抽煙, 還去做一切 會毀掉你健康的事情。 這又不是科學(xué),這只是壞的行為而已."
It turns out this is exactly where the science comes in. We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children. It affects areas like the nucleus accumbent, the pleasure and reward center of the brain that is implicated in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning. And on MRI scans, we see measurable differences in the amygdala, the brain's fear response center. So, there are real neurologic reasons why folks exposed to high doses of adversity are more likely to engage in high-risk behavior, and that's important to know.
然而,事實證明我們恰恰要用科學(xué)來分析它。 目前,我們前所未有的更加理解 早年遭受的不幸 會怎樣影響兒童大腦和身體的發(fā)育。 早年遭受的不幸會影響大腦的伏隔核 (nucleus accumbens)-- 人腦中與快樂和獎賞相關(guān) 的處理中心, 它與"物質(zhì)依賴"疾病相關(guān)。 早年遭受的不幸 還會抑制大腦的前額葉皮質(zhì)(Prefrontal cortex), 而前額皮質(zhì)對神經(jīng)沖動控制 與執(zhí)行功能是必不可少的, 這個區(qū)域?qū)τ趯W(xué)習(xí)能力非常關(guān)鍵。 在核磁共振成像掃描(MRI)上, 我們觀察到大腦的恐懼反應(yīng)中樞 - 杏仁核(amygdala)中, 存在可以測量的差異。 因此,這便可以從神經(jīng)學(xué)角度詮釋： 為什么人們一旦遭受大量不幸, 則更容易出現(xiàn)高風(fēng)險行為。 了解了這點十分重要。
But it turns out that even if you don't engage in any high-risk behavior, you're still more likely to develop heart disease or cancer. The reason for this has to do with the hypothalamic–pituitary–adrenal axis, the brain's and body's stress response system that governs our fight-or-flight response. How does it work? Well, imagine you're walking in the forest and you see a bear. Immediately, your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal gland that says, "Release stress hormones! Adrenaline! Cortisol!" And so, your heart starts to pound, your pupils dilate, your airways open up, and you are ready to either fight that bear or run from the bear. And that is wonderful if you're in a forest and there's a bear. (Laughter) But the problem is what happens when the bear comes home every night, and this system is activated over and over and over again, and it goes from being adaptive, or life-saving, to maladaptive, or health-damaging. Children are especially sensitive to this repeated stress activation, because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.
但事實證明, 即使你不從事任何高風(fēng)險的行為, 你仍然更容易患上 心臟疾病或癌癥。 因為這與"下丘腦-垂體-腎上腺軸"有關(guān)-- 它是大腦和身體的應(yīng)激反應(yīng)系統(tǒng), 支配我們做出"或戰(zhàn)或逃反應(yīng)"。 (fight-or-flight response)。 這一系統(tǒng)是如何運行的呢? 想象你漫步在森林里, 突然看到一頭熊。 你的下丘腦會立即 向你的垂體發(fā)送信號, 垂體再向你的腎上腺發(fā)送信號： "釋放應(yīng)激激素! 腎上腺素! 皮質(zhì)醇!" 你的心臟因而開始快速跳動, 瞳孔擴張,呼吸道打開, 這時你已準備好： 要么就和熊戰(zhàn)斗,要么就逃跑。 這個反應(yīng)很棒-- 如果你在森林里, 那還有一只熊。 (笑聲) 可問題是,假如每個晚上 熊都回家來該怎么辦, 這套系統(tǒng)將一遍又一遍地被激活, 它就會從適應(yīng)到不適應(yīng), 從救你的命到損害你的健康。 兒童對這種反復(fù)的應(yīng)激激活尤其敏感, 因為他們的大腦和身體 正處在發(fā)育階段。 高劑量的不良經(jīng)歷不僅 會影響大腦結(jié)構(gòu)和功能, 還會影響正在發(fā)育的免疫系統(tǒng), 以及正在發(fā)育的內(nèi)分泌系統(tǒng), 甚至還會影響 我們的DNA讀取和轉(zhuǎn)錄方式。
So for me, this information threw my old training out the window, because when we understand the mechanism of a disease, when we know not only which pathways are disrupted, but how, then as doctors, it is our job to use this science for prevention and treatment. That's what we do.
這些知識讓我徹底拋棄了 以前所受訓(xùn)的那一套, 因為,當(dāng)我們了解疾病機制時, 當(dāng)我們 不僅知道哪些路徑被干擾, 而且知道它們是怎樣被干擾時, 作為醫(yī)生,我們的職責(zé), 就是使用這門科學(xué) 去做疾病的防治工作。 那就是我們要做的。
So in San Francisco, we created the Center for Youth Wellness to prevent, screen and heal the impacts of ACEs and toxic stress. We started simply with routine screening of every one of our kids at their regular physical, because I know that if my patient has an ACE score of 4, she's two and a half times as likely to develop hepatitis or COPD, she's four and half times as likely to become depressed, and she's 12 times as likely to attempt to take her own life as my patient with zero ACEs. I know that when she's in my exam room. For our patients who do screen positive, we have a multidisciplinary treatment team that works to reduce the dose of adversity and treat symptoms using best practices, including home visits, care coordination, mental health care, nutrition, holistic interventions, and yes, medication when necessary. But we also educate parents about the impacts of ACEs and toxic stress the same way you would for covering electrical outlets, or lead poisoning, and we tailor the care of our asthmatics and our diabetics in a way that recognizes that they may need more aggressive treatment, given the changes to their hormonal and immune systems.
因此，我們在舊金山創(chuàng)辦了 青少年健康中心, 目的是預(yù)防、篩查和治愈 ACE和毒性應(yīng)激的影響。 我們開始在孩子們的定期體檢中, 對每個孩子進行例行檢查, 因為我知道,如果我的病人ACE得分為4分, 她患上肝炎或慢性阻塞性肺病(COPD) 的概率是1.5倍, 患上抑郁癥的概率是4.5倍, 她自殺的幾率 是ACE得分為0的病人的12倍。 她在我的檢查室里, 我就已經(jīng)知道這一切了。 對于檢查結(jié)果為陽性的病人, 我們有一支多學(xué)科綜合治療團隊, 致力于減少不良經(jīng)歷造成的影響, 并使用最佳療法治療病癥, 包括家庭訪視、護理協(xié)調(diào)、 心理保健、營養(yǎng)、 綜合干預(yù)措施, 以及必要時結(jié)合藥物治療。 但我們也教家長們了解 ACE和毒性應(yīng)激造成的影響, 這種影響與電源插座或鉛中毒 的危險性可以相提并論, 我們調(diào)整了哮喘及糖尿病患兒的護理服務(wù), 意識到他們可能需要更積極主動的治療, 以作用于他們的內(nèi)分泌和免疫系統(tǒng)。
So the other thing that happens when you understand this science is that you want to shout it from the rooftops, because this isn't just an issue for kids in Bayview. I figured the minute that everybody else heard about this, it would be routine screening, multi-disciplinary treatment teams, and it would be a race to the most effective clinical treatment protocols. Yeah. That did not happen. And that was a huge learning for me. What I had thought of as simply best clinical practice I now understand to be a movement. In the words of Dr. Robert Block, the former President of the American Academy of Pediatrics, "Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today." And for a lot of people, that's a terrifying prospect. The scope and scale of the problem seems so large that it feels overwhelming to think about how we might approach it. But for me, that's actually where the hopes lie, because when we have the right framework, when we recognize this to be a public health crisis, then we can begin to use the right tool kit to come up with solutions. From tobacco to lead poisoning to HIV/AIDS, the United States actually has quite a strong track record with addressing public health problems, but replicating those successes with ACEs and toxic stress is going to take determination and commitment, and when I look at what our nation's response has been so far, I wonder, why haven't we taken this more seriously?
當(dāng)你理解了這門科學(xué)時, 你會想要把它廣而告之, 因為這不僅僅是 灣景區(qū)(Bayview)孩子的問題。 我本來以為 其他人一旦了解到這一點, 就會著手例行檢查、 組建多學(xué)科治療團隊, 甚至大家爭先恐后 想找到最有效的治療方案。 可這些都沒有發(fā)生。 這可是給了我一個很大的教訓(xùn)。 我原以為簡單的找到 最好的臨床手段來治療就行了, 現(xiàn)在我明白了,這是一場運動。 正如Robert Block博士, 這位前美國兒科學(xué)會會長所言, "童年不良經(jīng)歷(ACE)是 今天我們國家所面臨的,唯一,最大的, 未能解決的公共健康威脅." 對于很多人來說, 這個前景可不容樂觀。 這個問題的范圍之廣,規(guī)模之大 使我們不得不考慮應(yīng)對之策。 但在我看來,危機即是轉(zhuǎn)機， 當(dāng)我們確立正確框架時, 當(dāng)我們意識到 這是公共健康危機時, 我們才能開始使用 正確的方法來求得解決方案。 從煙草到鉛中毒,再到艾滋病, 在解決公共健康問題方面, 美國實際上保持著良好記錄, 但要,在ACE和毒性應(yīng)激方面 取得同樣成功, 則需要下定決心、履行承諾, 當(dāng)我看到,我們國家 對這一問題至今的反應(yīng)時, 我想知道, 為什么我們沒有更認真的對待這個問題?
You know, at first I thought that we marginalized the issue because it doesn't apply to us. That's an issue for those kids in those neighborhoods. Which is weird, because the data doesn't bear that out. The original ACEs study was done in a population that was 70 percent Caucasian, 70 percent college-educated. But then, the more I talked to folks, I'm beginning to think that maybe I had it completely backwards. If I were to ask how many people in this room grew up with a family member who suffered from mental illness, I bet a few hands would go up. And then if I were to ask how many folks had a parent who maybe drank too much, or who really believed that if you spare the rod, you spoil the child, I bet a few more hands would go up. Even in this room, this is an issue that touches many of us, and I am beginning to believe that we marginalize the issue because it does apply to us. Maybe it's easier to see in other zip codes because we don't want to look at it. We'd rather be sick.
要知道,一開始我還想, 這是因為我們漠視了這個問題, 以為它跟我們無關(guān)。 以為只有別的小孩, 鄰居家的小孩才有這問題。 但很奇怪,數(shù)據(jù)可不是這么說的。 初始ACE的研究樣本群體為： 白人占70%, 大學(xué)畢業(yè)占70%。 后來,我和大家談得多了, 我便開始想,也許 我把這個問題完全本末倒置了。 如果我問現(xiàn)場這個房間內(nèi)有多少人 在成長過程中 有家庭成員患有精神疾病, 我相信,會有幾個人舉手。 如果我再問,有多少人 父親或母親酗酒, 或者是堅信： 孩子要打,慣不得。 我敢打賭會有更多的人舉手。 即使只是在我們的會場, 這也是一個影響到了很多人的問題。 我開始相信 我們漠視這個問題 是因為,它與我們息息相關(guān)。 也許把它說成別的地區(qū)的事, 我們才能更容易的看清楚, 因為我們自己情愿生病, 也不愿意正視這個問題。
Fortunately, scientific advances and, frankly, economic realities make that option less viable every day. The science is clear: Early adversity dramatically affects health across a lifetime. Today, we are beginning to understand how to interrupt the progression from early adversity to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms go unrecognized, whose asthma management is not connected, and who goes on to develop high blood pressure and early heart disease or cancer will be just as anomalous as a six-month mortality from HIV/AIDS. People will look at that situation and say, "What the heck happened there?" This is treatable. This is beatable. The single most important thing that we need today is the courage to look this problem in the face and say, this is real and this is all of us. I believe that we are the movement. Thank you.
幸運的是,科學(xué)進步, 坦率地說,還有經(jīng)濟現(xiàn)實 逐漸使我們無法再繼續(xù)漠視下去了。 科學(xué)研究清楚顯示： 早期不良經(jīng)歷對人的一生 的健康影響巨大。 今天,我們開始了解如何中斷 從早期不良經(jīng)歷發(fā)展至 疾病和過早死亡這一進程, 從現(xiàn)在算起,30年后, 高ACE分數(shù)的兒童, 如果其行為癥狀未被識別, 哮喘診療未與ACE相關(guān)聯(lián), 持續(xù)發(fā)展為高血壓, 并患上早期心臟病或癌癥, 那么這就象6個月的嬰兒患艾滋病一樣, 都是異常的。 人們看到這種情況都會說： "這究竟發(fā)生的是什么鬼事?" 這種病癥是可以治療的, 也是可以戰(zhàn)勝的。 我們今天最需要的是 直面這個問題的勇氣, 并且承認,這個問題確實存在, 與我們息息相關(guān)。 我相信我們將實現(xiàn)這一變革運動。謝謝大家。
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