is that you have to be slightly crazy.

才能符合TED演講的主要評選標準

I distinctly remember that I wanted to say something important about it,

我很清楚地記得，我當時想說一些很重要的事情

but I'm getting a little bit confused because ...

但接下來我的思緒變得有點混亂，因為…

You, sir. I saw you touching your glasses just now,

就是你，先生。我看見你正在碰觸你的眼鏡

whilst at the same time,

同時

the lady over there was distinctly scratching her nose.

那邊的那位小姐很明顯地正在抓她的鼻子

I saw you!

我看見妳囉！

(Laughter)

（觀眾的笑聲）

And there is something going on between the two of you, some sort of ...

你們之間好像正在上演著甚麼事情，像是在…

(Laughter)

（觀眾的笑聲）

communication.

溝通

And I distinctly get the impression that you want to ruin my TED talk.

接著，我很明顯地感受到你們試圖破壞我的TED演講

(Laughter)

（觀眾的笑聲）

Is that true?

這是真的嗎？

So, maybe some of you start to worry a little bit about my mental health.

也許在你們之中，有些人開始有些擔憂我的身心健康狀況

Maybe after my TED talk,

也許當我結束這場TED演講

you want to take me to the local hospital for a psychiatric assessment.

你想帶我去當地的醫院，進行精神科的評估

Let's imagine, I tell the psychiatrist

我們假設，我告訴精神科醫生

that apart from these delusional thoughts, I'm also hearing voices,

我除了有這些妄想的念頭，我還會聽見聲音

and that I haven't been functioning very well for the last six months.

而且過去六個月以來，我的身心狀況一直不是很好

By telling this, I will meet likely criteria

經由我這麼一說，我可能得到的診斷結果

for one of these so-called "schizo" diagnoses.

其中一項即是所謂的「精神分裂症患者」

Let's say I meet criteria for schizophrenia

我們假設我的診斷結果就是「精神分裂症」

which is the prototypical diagnostic formulation for "madness."

而它即是「瘋狂」的典型病症

Now, my family, by this time, will be notified of this diagnosis.

此時，我的家人們被告知我的診斷結果

Since they don’t know what it is,

由於他們不知道這是甚麼疾病

they will start looking on the Internet, what this condition actually is.

他們會開始在網路上搜尋此疾病究竟是甚麼

They'll look in the most prestigious scientific journals,

他們會閱讀最具權威性的科學期刊

and they find that I have a devastating genetic brain disease,

然後發現我得了一種非常嚴重的腦部遺傳疾病

or a debilitating neurological disorder.

或者是一種神經系統疾病

So now they start to be really worried,

現在他們開始非常憂心

and they start looking for information about my likely prognosis.

開始尋找關於我病情可能的預後推估

And they find that my prognosis is bad.

然後他們發現我的預後並不樂觀

I am totally disabled for the remainder of my lifetime.

完全喪失我人生剩餘時日的自主能力

Wow! That’s scary, isn’t it?

天啊！聽起來很嚇人，可不是嗎？

But you will note, that there is nothing in this terminology

但是你會發現，僅以這一個醫學術語

that actually allows them to understand what is the matter with me.

無法使我的家人們真正地瞭解我究竟怎麼了

The information is disconnected from anything that we can understand

我們完全無法理解此醫學術語所提供的資訊

as a mental function.

與心理功能絲毫沒有連結

What is offered is a stereotype consisting of three things:

這個醫學術語只呈現由以下三點所構成的既定印象：

a mystifying Greek name,

一個令人困惑的希臘名詞

an unproven hypothesis of a genetic brain disease,

一個沒有經過證實的假設：腦部遺傳疾病

and a hopeless view of outcome.

以及沒有任何希望的後果

Meet my cousin, Elizabeth.

我與我的表妹伊莉莎白見了面

Elizabeth completed two university studies and is a witty and compassionate person;

我的表妹伊莉莎白完成了兩個學士學位，是一位非常風趣與富有同情心的人

quite unlike me.

非常不像我

We were always close, and we both ended up in psychiatry.

我們以前很親近，而且最終都走向精神病學之路

However, me, as a psychiatrist, and she, as a patient.

差別只在於我是精神科醫生，而她是病患

And over the last 15 years, she has worked very hard at her recovery,

過去15年以來，她很努力地進行復健療程

taking her medications, accepting numeral hospital admissions,

服用藥物、在許多醫院進行評估

and receiving a range of psychiatric diagnoses,

收到不同類型的精神疾病診斷報告

including several of the schizo diagnoses.

其中包含一些精神分裂症的診斷報告

And then, five years ago, there was this great moment,

接著，五年前，發生了一件振奮人心的事情

because she applied for a job and was accepted.

因為她應徵了一個職缺，而且得到了這份工作

But, when her employer found out about her diagnosis,

但是，當她的雇主知道關於她的診斷報告

he immediately tried to dismiss her.

他立即嘗試解雇她

And when he found out he couldn’t,

當他發現他無法這麼做

she was forced to disclose her diagnosis to the entire office.

她被強迫將自己的診斷報告公開至整個辦公室

Nobody initially wanted to work with her.

起初沒有人願意與她共事

But now, five years later, she has an exemplary work record.

但是現在，五年過後，她的工作表現優異

But because of the extremely negative expectations associated with psychosis,

因為人們將極端負面的預想與精神疾病聯想在一起

diagnosed people face an uphill struggle.

被診斷出患有精神疾病的人們處境非常艱難

A very few end up in paid employment.

僅有非常少數的精神疾病患者爭取到有薪工作

So, why do I tell you this?

那麼，為何我要告訴你們這件事情呢？

Well, psychosis, schizophrenia,

精神疾病、精神分裂症

these are conditions that typically start in adolescence.

這些病症通常始於青春期

There is widespread consensus that in order to recover from psychosis,

如果想治癒精神疾病，我們需要有一個廣泛共識

you need a perspective of hope, a possibility to change.

你必須以一個抱有希望的觀點看待此事、相信改變的可能性

And I think it is clear that the concept or the stereotype of psychosis

我相信，如同我剛剛所描述的，大眾對於精神疾病的概念與既定印象

as represented,

已經非常的清楚

is devoid of exactly that – of hope and change.

正是缺少希望與改變

So, can we do better?

那麼，我們可以做些甚麼來改善這件事呢？

Well, a bunch of people got together,

那就是將一群人聚集起來

and this was really a mixed group of patients, professionals, relatives,

由患者、專業人士與親戚們所組成的一群人

and we asked ourselves the question: what do we really know about psychosis?

接著，我們捫心自問：我們對於精神疾病真正了解了多少？

Is schizophrenia really best represented as this stereotype

對於精神分裂症最貼切的解釋

of a devastating genetic brain disease?

真的是既定印象中的無可救藥的腦部遺傳疾病？

Or is schizophrenia perhaps something

又或者，精神分裂症

that is connected to a human mental function,

與人類的心理功能有關

just like disorders of anxiety and depression

就像是焦慮症或是憂鬱症

are connected to human emotion?

跟人類的情緒有所關聯？

And if it is connected, can we reach young people

如果有所關聯，我們可否接觸這些年輕人

to give them a message of hope and change?

給予他們希望與改變的可能性？

So, to cut a long story short, let’s have a look at what we came up with.

那麼我長話短說，來看看我們提出的想法

(Video) Psychosis experiences, everybody has them, and so do you.

（觀看影片）精神疾病的經驗，每個人都有，你也是

Throughout the day, we are exposed to stimuli

一整天下來，我們接觸到的刺激

that we hear, see, taste, feel and smell.

來自聽覺、視覺、味覺、觸覺與嗅覺的刺激

Our brain helps us to transform this information

我們的大腦幫助我們處理這些訊息

into an image of the surrounding world.

將它們轉變為周遭環境的意象

In other words, we translate external sensory information from our environment

換句話說，我們將來自周遭的外部感官感覺訊息

into an internal mental experience.

轉化至內部心理經驗

Sensory translations are highly personal.

感官感覺的轉化非常主觀

For example, two people are walking through the woods at night.

舉例來說，兩個人在黑夜中穿越樹林

One watched a violent horror film earlier that evening, whereas the other did not.

其中一人在傍晚時曾看過暴力恐怖片，另一人則沒有看那部影片

As a result, one hears and sees rather different things compared to the other.

如此一來，兩個人聽見與看見的事物則有所差異

This is because powerful negative emotions, occasioned by the film,

這是因為那部影片所產生的強烈負面情緒

distort a person's interpretation of sensory perception.

扭曲了一個人對於感官感覺的解讀方式

One can say, therefore, that this person is experiencing a mild psychotic event.

也可以說這個人正經歷一件輕微的精神疾病事件

Childhood adversities, cannabis use, and genetic factors

童年遭遇的不幸、吸食大麻與基因遺傳因素

can trigger negative interpretations.

皆可能引發一個人以負面的方式解讀感官感覺

This can cause you to feel that the world is full of threats.

這可能使你感覺世界充滿了威脅

For example, you may start thinking that you are being stalked,

舉例來說，你可能開始認為有人正在跟蹤你

or that people on TV are talking about you.

或者電視上的人們正在討論你

Such ways of thinking are called delusions.

諸如此類的想法，被稱為妄想

You may also misinterpret your inner mental processes.

你可能還會誤解你內部的心理歷程

For example, your thoughts can be so overpowering

舉例來說，你的想法可能會過於強烈

that you interpret them as external voices, or visions.

而你將這些想法解讀為外部的聲音或幻象

As a result, you may hear voices or see things that are not really there.

如此一來，你還可能會聽見不存在的聲音或看見不存在的事物

These experiences are called hallucinations.

這種經驗被稱為幻覺與幻聽

If perception of external environments or inner thoughts become psychotic,

如果無法分辨外部環境的感官感覺與內部的想法

it is possible, with help, to learn how to modify this.

可藉由其他人事物的幫助下，學習如何改正它

It's a learning process that many people with psychotic symptoms find profitable.

許多具有精神疾病症狀的患者發現，這是一種有益的學習方法

PsychoseNet tries to facilitate this process.

PsychoseNet試著促進此種學習方法

(Video ends)

（影片結束）

(On-stage) Jim van Os: Do you notice the difference

（演講者）Jim van Os：你注意到影片當中

with the presentation of the schizophrenia stereotype?

與大眾對於精神分裂病症的既定印象的差異了嗎？

Yet, this is what science suggests psychosis is about.

這就是科學對於精神疾病所提出的論點

There are four important points of difference here:

有四個不同的論點：

What is psychosis? What is the role of the brain?

什麼是精神疾病？大腦扮演著甚麼角色？

What is the role of genes? And what is the prognosis of psychosis?

基因扮演著甚麼角色？以及精神疾病的預後是甚麼？

Psychosis is about, what you could say, hyper meaning.

精神疾病是關於甚麼呢？可以說是過度解讀

It is about that we sometimes attach too much meaning

我們有時對於外部環境

to the external environment.

附加了過多的解讀與含義

And seeing signals in random noise is actually quite human.

在雜亂無章的噪音當中取得一些訊息，其實是相當自然的

So, experiences of hyper meaning are quite common.

因此，過度解讀的經驗也相當常見

Think about being madly in love

想想瘋狂地墜入愛河

or being madly worried that your love is unfaithful,

或者過度憂慮你的另一伴不忠誠

or seeing a face in the dark.

又或者看見一張臉孔出現在黑暗之中

Actually, 30% of the general population,

事實上，當人們被詢問是否有精神疾病的經驗

when asked, will admit to having had one or more psychotic experiences.

有30%的人們會承認至少有過1次或者多次這種經驗

Things like hearing voices or seeing things, mind reading,

像是聽見聲音、看見某些事物、讀心

thought broadcasting, having special powers.

認為被惡意散播或者擁有特異功能等等

Low level, mild, but still all the things that are the hallmark of psychosis.

即使是中低程度的精神疾病經驗，這些經驗依然都具有精神疾病的特點

Thirty percent!

30%的人們都有過這些經驗！

So, I want you to look at the person on your left,

現在，我要你看看你左邊的人

and then look at the person on your right.

再看看你右邊的人

And if it's not them ...

如果他們不是那30%

it is you!

就是你！

(Laughter)

（觀眾的笑聲）

This is not to say that the brain is not important;

這並不意味著大腦不重要

the brain is very important.

大腦非常的重要

But it is like learning a language.

但是就像是學習一個語言

The brain provides us with the biological capacity to acquire speech.

大腦發展出說話的能力，使我們得以說話

But it is the early environment that programs this capacity

但這是因應早期環境所發展出的能力

so that we speak Chinese, English, French, or Dutch.

這也是為何我們能夠說中文、英文、法文或者荷蘭語

And it's the same with psychosis.

跟精神疾病之所以會發生的情況相同

The brain provides us with the biological capacity

大腦提供我們獲得心理經驗的能力

to have mental experiences in the first place.

使我們從一開始就擁有心理經驗

But it is the environment that can program this capacity

問題在於，環境的因素造成此能力在發展的過程之中

towards psychotic modes of thinking.

朝向以具有精神疾病症狀的方式思考

People growing up in circumstances of childhood trauma,

如果人們的成長中曾經歷童年創傷

unsafety, or extreme exclusion,

感到不安或者曾被嚴重地排擠的經驗

have a higher risk of developing psychotic symptoms.

發展出精神疾病症狀的風險較高

This is because these environments can program our thinking

這是因為此類環境會使我們的思考邏輯

towards the formation of psychotic symptoms.

朝向具有精神疾病症狀的方式發展

Genes do play a role, genetic factors are important,

基因也是其中因素之一，基因的因素至關重要

but their role is not nearly as dominant or as specific as is often portrayed.

但是基因並非主導因素，或像是它經常被描述般的如此特定

And, importantly, genes may act in ways that are complementary to the environment,

最重要的是，基因很有可能為了配合周遭環境，做出相應的反應

by making people more or less sensitive to the environments that cause psychosis.

調整人們對於周遭可能會引起精神疾病症狀的事物的敏感度

And, with regard to the outcome, some people with psychotic symptoms

確實，有些精神疾病患者的案例

have a very severe illness and very poor prognosis.

情況非常嚴重，預後推估極為悲觀

But, this is a minority.

但這只佔少數

There are also people with schizophrenia, who show complete recovery.

還是有精神分裂症患者完全痊癒的案例

And, between those two extremes is a wide spectrum of variation.

而介於此兩種極端案例之間的中間範圍，則涵蓋廣泛的可能性

In fact, extreme variation is the rule.

事實上，任何情況都是有可能的

The notion of extremely uniform poor outcome is a myth.

對於預後抱持極端負面態度是完全沒有根據的

Psychosis is something that varies from day to day,

因為精神疾病是一種每天持續變化的疾病

even from moment to moment within a day.

甚至一天之中的任何時刻都會改變

It is capturing this dynamic variation

就像是為了應對動態變化的環境與情緒

in response to the environment and the emotions

而做出的相應變化

that is key to treatment and diagnosis.

這就是治療方法與診斷報告中的關鍵參考依據

So, if psychosis is all about hyper meaning varying during the day

如果精神疾病就是一天當中，為了應對環境與情緒

in response to environment and emotions,

所做出的過度解讀

a remarkable opportunity presents itself.

那麼一個令人驚奇的機會也出現了

And this is because we can now diagnose psychosis

因為現在我們可以依照精神疾病本身的程度

at the level of the experience itself,

來診斷它

in such a way, that it becomes the first step towards treatment,

如此一來，這即是進行療程的第一步

without a need to invoke the scary schizo labels.

而不需要被貼上令人害怕的精神分裂症患者的標籤

And since young people are well versed in technology,

再者，年輕人現今已經非常熟悉如何應用科技

why not use technology to empower them

為何不利用科技的力量來幫助他們

to monitor their experiences themselves,

監控他們自身的經歷

so that they can gain an insight and get a grip?

如此一來，他們能夠深入了解自己，而且適時控制自己？

To this end, our group developed this simple mobile app.

為了實踐這個想法，我們團隊研發了這個簡單的手機軟體

Its purpose is to allow people

它的目的

to monitor their mental states and experiences in daily life,

是讓人們能夠在日常生活當中，監測自己的心理狀態與經歷的心理經驗

feeding that information back to them, so that they can learn and cope.

手機軟體會將訊息反饋給使用者，如此一來就能夠學習如何應對

So, this app actually works as follows.

這個手機軟體的運作方式就是

At multiple random moments during the day, the app gives off a signal,

在一天當中，此手機軟體會在多次隨機的時間點發出通知

and each time there is a signal, people are asked to input information,

每一次發出通知，使用者都會被要求輸入訊息

less than two minutes.

完成訊息輸入的時間不超過兩分鐘

Information about emotions, thoughts, context, and activities.

訊息包含使用者的情緒、想法、所處的環境與參與的活動

With this information,

有了這些訊息

patterns of vulnerability and resilience can actually be made visible.

受影響的程度與適應度即可被量化為可觀察的資料

People then have access to the experiences of hyper meaning

使用者能夠了解他們所經歷的過度解讀經驗

as they evolve in the flow of daily life, in response to emotions and environments,

發生於日常生活當中，為了對應環境與情緒下所做出的過度解讀

allowing them to actually understand what is going on,

使他們明白到底發生了甚麼事

and allowing them to develop better ways of coping.

也使他們學習以更好的方式解讀這些訊息

In clinical practice, we find this works very well,

在臨床實驗中，我們發現這個方法非常可行

particularly with people in the early stages of psychosis.

尤其是正經歷初期精神疾病階段的患者

So, where does all this leave us then?

那麼，這些訊息留給了我們甚麼呢？

Well, today is about reaching the impossible.

就是將不可能變為可能

I think it is, in fact, much simpler.

事實上，我認為這做起來並不困難

I think that nothing stands in our way

我認為沒有任何事物阻礙著我們

to make today the first day we can all feel connected to psychosis,

讓今天成為我們對精神疾病盡一份心力的第一天

because it is all a question of perception.

因為這只是一個攸關感官感覺的問題

When we see a person with psychotic symptoms

當我們看見一個人顯現出精神疾病的症狀

we can with a little effort, information, and particularly education,

我們只需付出少許的努力、接受特定的教育宣導

not see the stereotype of a devastating brain disease,

以及忽視那些認為精神疾病是嚴重的腦部遺傳疾病的既定印象

but instead see a person who's struggling with the way we attach meaning

以另一種觀點看待精神疾病這件事，是一個人正苦惱該如何解讀

to the internal and external environment.

來自內部與外部環境的訊息

And this is sometimes a difficult and painful process,

有時這是一段艱難與痛苦的過程

but we are all experts.

但是現在的我們都已經非常瞭解它了

Thank you.

感謝您蒞臨此場演講

(Applause)

（掌聲）