which is to choose a light-hearted theme.

挑個輕鬆的話題

Last time, I talked about death and dying.

上次我談論生與死

This time, I'm going to talk about mental illness.

這次要談談精神疾病

But it has to be technological,

為著重技術面

so I'll talk about electroshock therapy. (Laughter)

我選擇談電擊療法 (笑聲)

You know, ever since man had any notion

各位知道，自從人類最早發現

that some of his other people, his colleagues,

身邊有些人，同僚等等

could be different, could be strange, could be severely depressed

可能和自己不同、行徑怪異，或嚴重憂鬱

or what we now recognize as schizophrenia,

或是現在所謂的精神分裂症

he was certain that this kind of illness

就斷定這種疾病

had to come from evil spirits getting into the body.

一定是惡魔邪靈附身

So, the way of treating these diseases

若要加以醫治

in early times was to, in some way or other,

在早期，是使用各種方法

exorcise those evil spirits, and this is still going on, as you know.

驅邪除魔，至今仍是如此，誠如各位所知

But it wasn't enough to use the priests.

但是祭司的療癒力量有限

When medicine became somewhat scientific, in about 450 BC,

西元450年左右，醫學發展成為科學

with Hippocrates and those boys,

醫學之父希波克拉底和他的學生

they tried to look for herbs, plants

開始研究各種藥草、植物

that would literally shake the bad spirits out.

找出能有效將邪魔驅除於人體之外的藥方

So, they found certain plants that could cause convulsions.

他們發現某些植物會導致人體抽搐

And the herbals, the botanical books of up to the late Middle Ages,

各種《草藥集》，涵蓋截至中世紀晚期

the Renaissance are filled with prescriptions

即文藝復興時期的植物書籍

for causing convulsions to shake the evil spirits out.

記載許多誘發抽搐，來驅除邪靈的處方

Finally, in about the sixteenth century,

最後，到了大約16世紀

a physician whose name was Theophrastus Bombastus Aureolus von Hohenheim,

一位名為霍因罕(Theophrastus Bombast von Hohenheim) 的醫生

called Paracelsus, a name probably familiar to some people here --

又名帕拉切爾蘇斯(Paracelsus) ，在座可能有人知道

(Laughter) -- good, old Paracelsus

(笑聲) 老頑固帕拉切爾蘇斯

found that he could predict the degree of convulsion

發現他能預測抽搐程度

by using a measured amount of camphor to produce the convulsion.

他利用定量的樟腦，誘發人體抽搐

Can you imagine going to your closet, pulling out a mothball, and

你能想像，打開衣櫃，取出一顆樟腦丸

chewing on it if you're feeling depressed?

嚼食它，來緩解你的憂鬱嗎？

It's better than Prozac, but I wouldn't recommend it.

效果比百憂解好，不過我可不建議這麼做

So what we see in the seventeenth, eighteenth century

發展到17、18世紀

is the continued search for medications other than camphor that'll do the trick.

人類繼續尋找樟腦以外的療方

Well, along comes Benjamin Franklin,

這時出現了班傑明‧富蘭克林

and he comes close to convulsing himself

他幾乎導致自己的身體抽搐

with a bolt of electricity off the end of his kite.

當時是透過風箏傳導下來的雷電電流

And so people begin thinking in terms of electricity to produce convulsions.

所以人們開始思考如何用電流引發抽搐

And then, we fast-forward to about 1932,

到了1932年左右

when three Italian psychiatrists, who were largely treating depression,

有三位主治憂鬱症的義大利醫生

began to notice among their patients, who were also epileptics,

觀察同時患有憂鬱症和癲癇症的病人

that if they had an epileptic -- a series of epileptic fits,

發現這些病人癲癇症發作之後

a lot of them in a row -- the depression would very frequently lift.

連續發作多次後，憂鬱症會相對減輕

Not only would it lift, but it might never return.

不但減輕，有時甚至完全根治

So they got very interested in producing convulsions,

所以他們很熱中研究如何誘發抽搐

measured types of convulsions.

控制抽搐的程度

And they thought, "Well, we've got electricity, we'll plug somebody into the wall.

他們想：「我們有電源，何不把身體通電試試看？」

That always makes hair stand up and people shake a lot."

「身體觸電會毛髮直豎、渾身顫抖」

So, they tried it on a few pigs, and none of the pigs were killed.

他們用豬做電擊實驗，所有的豬都活了下來

So, they went to the police and they said,

他們就跑去跟警察說

"We know that at the Rome railroad station,

「我們知道在羅馬火車站，」

there are all these lost souls wandering around,

「有許多徘徊的流浪漢，」

muttering gibberish. Can you bring one of them to us?"

「成天瘋言瘋語， 可不可以帶一個來參加我們的實驗？」

Someone who is, as the Italians say, "cagoots."

就是義大利人所謂的腦袋秀逗

So they found this "cagoots" guy,

於是他們找到一個腦袋秀逗的男子

a 39-year-old man who was really hopelessly schizophrenic,

一個嚴重精神分裂的39歲男子

who was known, had been known for months,

大家都知道他已經好幾個月

to be literally defecating on himself,

經常在自己身上大小便

talking nothing that made any sense,

整天胡言亂語

and they brought him into the hospital.

於是他被帶到醫院

So these three psychiatrists, after about two or three weeks of observation,

交給這三名醫生，經過兩三週的觀察

laid him down on a table,

醫師讓他平躺在病床上

connected his temples to a very small source of current.

將兩邊太陽穴連接微量電流

They thought, "Well, we'll try 55 volts, two-tenths of a second.

他們想：「先試55伏特、1/5秒，」

That's not going to do anything terrible to him."

「應該不會造成傷害。」

So they did that.

於是他們就這麼做

Well, I have the following from a firsthand observer,

以下是第一線觀察員告訴我的

who told me this about 35 years ago,

他告訴我的時候大約是35年前

when I was thinking about these things

當時我正在思索這些電擊實驗

for some research project of mine.

做為我研究計畫的參考

He said, "This fellow" -- remember, he wasn't even put to sleep --

觀察員說：「這個流浪漢，」(記得嗎？他當時是清醒的)

"after this major grand mal convulsion,

「這次大發作抽筋完後，」

sat right up, looked at these three fellas and said,

「站起身來，瞪著三位醫生，大罵：

'What the fuck are you assholes trying to do?' "

『你們這些混帳，在我身上亂搞什麼？』

(Laughter)

(笑聲)

If I could only say that in Italian.

可惜我不會用義大利文講給各位聽

Well, they were happy as could be, because he

醫生們非常開心，因為這個流浪漢

hadn't said a rational word in the weeks of observation.

在觀察期一句合邏輯的話也沒說過

So they plugged him in again,

於是他們再度把他的身體通電

and this time they used 110 volts for half a second.

這次通110伏特，持續半秒鐘

And to their amazement, after it was over,

他們高興地發現，電擊以後

he began speaking like he was perfectly well.

流浪漢居然開始正常說話

He relapsed a little bit, they gave him a series of treatments,

偶爾復發，醫生就給他一連串的治療

and he was essentially cured.

結果他被治好了

But of course, having schizophrenia,

當然，因為他患的是精神分裂症

within a few months, it returned.

幾個月後，他又再度患病了

But they wrote a paper about this,

但是醫生們做出一篇研究報告

and everybody in the Western world began using electricity

西方醫學界便開始利用電擊

to convulse people who were either schizophrenic or severely depressed.

誘發精神分裂症或重度憂鬱症患者的身體抽搐

It didn't work very well on the schizophrenics,

療效對精神分裂症患者並不理想

but it was pretty clear in the '30s and by the middle of the '40s

但30年代至40年代中，很明顯地

that electroconvulsive therapy was very, very effective

電擊療法對憂鬱症的療效

in the treatment of depression.

非常顯著

And of course, in those days, there were no antidepressant drugs,

而且當時還沒有發明抗憂鬱藥

and it became very, very popular.

所以當時很流行

They would anesthetize people,

將病人麻醉

convulse them, but the real difficulty was

施予電擊，但是真正的困難是

that there was no way to paralyze muscles.

因為當時無法抑制肌肉的抽搐

So people would have a real grand mal seizure.

因此電擊會導致病人真的癲癇大發作

Bones were broken. Especially in old, fragile people,

骨頭斷裂，尤其是老弱的病人

you couldn't use it.

並不適用電擊療法

And then in the 1950s, late 1950s, the so-called muscle relaxants

1950年代末期，出現所謂的肌肉鬆弛劑

were developed by pharmacologists,

由藥理學家發明的

and it got so that you could induce a complete convulsion,

便可施予完整的電擊治療

an electroencephalographic convulsion -- you could see it on the brain waves --

即腦電圖(electroencephalographic)癲癇，會顯現在腦波中

without causing any convulsion in the body except a little bit of twitching of the toes.

但是身體不會痙攣，只有腳趾會稍微抽動

So again, it was very, very popular and very, very useful.

所以電擊療法變得非常普遍、有效

Well, you know, in the middle '60s,

各位知道，到了60年代中期

the first antidepressants came out. Tofranil was the first.

首度發明抗憂鬱劑，當時最早是妥富腦 (Tofranil)

In the late '70s, early '80s, there were others,

70、80年代出現其他抗憂鬱藥物

and they were very effective.

效果都很好

And patients' rights groups seemed to get very upset

加上當時病患權益團體非常不滿

about the kinds of things that they would witness.

抗議他們所目睹的一些電擊治療情形

And so the whole idea of electroconvulsive, electroshock therapy disappeared,

因此醫界停用電擊療法

but has had a renaissance in the last 10 years.

直到近10年才又恢復使用

And the reason that it has had a renaissance

原因是

is that probably about 10 percent of the people, severe depressives,

大約有1/10的病患，重度憂鬱患者

do not respond, regardless of what is done for them.

對什麼治療都沒有反應

Now, why am I telling you this story at this meeting?

我為什麼要在此分享這個故事呢？

I'm telling you this story, because actually ever since

我告訴大家這個故事，其實是因為

Richard called me and asked me to talk about

理查打電話給我，邀我來演講

-- as he asked all of his speakers --

他對所有講者的一貫要求

to talk about something that would be new to this audience,

是希望我能帶給聽眾新思維

that we had never talked about, never written about,

談論史無前例的議題

I've been planning this moment.

我一直期待準備這一刻

This reason really is that I am a man who, almost 30 years ago,

因為30年前左右

had his life saved by two long courses of electroshock therapy.

我的命是兩段電擊療程救回來的

And let me tell you this story.

所以我想分享這個故事

I was, in the 1960s, in a marriage. To use the word bad

在1960年代，我身陷糟糕的婚姻

would be perhaps the understatement of the year.

「糟糕」根本不足以形容

It was dreadful.

簡直是一場磨難

There are, I'm sure, enough divorced people in this room

我相信在座也有些離婚人士

to know about the hostility, the anger, who knows what.

知道那種敵意、憤怒，無盡的折磨

Being someone who had had a very difficult childhood,

我有個不堪的童年

a very difficult adolescence --

青少年時期也不好過

it had to do with not quite poverty but close.

雖不貧賤，亦不遠矣

It had to do with being brought up in a family where no one spoke English,

我們全家沒有人會說英語

no one could read or write English.

也不會讀寫英文

It had to do with death and disease and lots of other things.

又遭逢親人病、死，和其他的苦難

I was a little prone to depression.

我經常憂鬱

So, as things got worse, as we really began to hate each other,

所以當情況越來越糟，我們開始彼此憎恨

I became progressively depressed over a period of a couple of years,

有幾年我的憂鬱症變得日益嚴重

trying to save this marriage,

試圖挽救破裂的婚姻

which was inevitably not to be saved.

但終究是回天乏術

Finally, I would schedule -- all my major surgical cases,

後來，我所有的病患手術，都得安排在

I was scheduling them for 12, one o'clock in the afternoon,

中午12點或下午1點才開始

because I couldn't get out of bed before about 11 o'clock.

因為我根本沒辦法在11點以前下床

And anybody who's been depressed here knows what that's like.

在座有得過憂鬱症的人才會了解那種情形

I couldn't even pull the covers off myself.

我連掀開棉被的力氣都沒有

Well, you're in a university medical center,

當時我是在大學附設醫院

where everybody knows everybody, and it's perfectly clear to my colleagues,

大家都很熟，同事們很清楚我的情況

so my referrals began to decrease.

所以我的轉介病患越來越少

As my referrals began to decrease,

當我的手術病患數量銳減

I clearly became increasingly depressed

更加劇了我的憂鬱症

until I thought, my God, I can't work anymore.

直到我發覺，天哪，我沒辦法工作了

And, in fact, it didn't make any difference

事實上也沒什麼差別

because I didn't have any patients anymore.

因為當時我已經沒有任何病患了

So, with the advice of my physician,

所以，我接受我的醫師建議

I had myself admitted to the acute care psychiatric unit of our university hospital.

住進了我們大學醫院的精神科急性監護病房

And my colleagues, who had known me since medical school

當時，從醫學院唸書就認識我的同事們

in that place, said, "Don't worry, chap. Six weeks,

給我打氣說：「放心，只要短短六週，」

you're back in the operating room. Everything's going to be great."

「你就可以回手術室操刀了，一切都會很順利」

Well, you know what bovine stercus is?

你知道英文的「bovine stercus (牛糞)」是什麼意思嗎？

That proved to be a lot of bovine stercus.

那些安慰話根本是牛糞，一派胡言

I know some people who got tenure in that place with lies like that.

那裡有些終身職教授都會扯這種謊言

(Laughter)

(笑聲)

So I was one of their failures.

我是他們謊言的活證

But it wasn't that simple. Because by the time

狀況根本沒那麼單純，因為後來

I got out of that unit, I was not functional at all.

我出院時，完全沒有行為能力

I could hardly see five feet in front of myself.

連眼前一公尺半以外都看不到

I shuffled when I walked. I was bowed over.

走路步履蹣跚，彎腰駝背

I rarely bathed. I sometimes didn't shave. It was dreadful.

很少洗澡，不刮鬍子，邋遢不堪

And it was clear -- not to me,

我的狀況很明顯－－只是我自己不知道

because nothing was clear to me at that time anymore --

當時我什麼也不知道－－

that I would need long-term hospitalization

我很顯然需要長期住院

in that awful place called a mental hospital.

住進精神療養院這個糟糕的地方

So I was admitted, in 1973, in the spring of 1973,

所以1973年春，我住進了精神療養院

to the Institute of Living, which used to be called the Hartford Retreat.

住進安生機構(Institute of Living)，本來是哈特福特安養院

It was founded in the eighteenth century,

該院成立於18世紀

the largest psychiatric hospital in the state of

是康乃狄克州最大的精神病院

Connecticut, other than the huge public hospitals

僅次於大型公立醫院

that existed at that time.

在當時來說

And they tried everything they had.

住進療養院以後，醫師們試過所有的療法

They tried the usual psychotherapy.

他們試過一般的心理治療

They tried every medication available in those days.

開過當時所有的憂鬱症藥物

And they did have Tofranil and other things -- Mellaril, who knows what.

包括妥富腦、美力廉(Mellaril) ，還有其他各式各樣的藥

Nothing happened except that I got jaundiced from one of these things.

除了害我得黃疸病，病情一點也沒好轉

And finally, because I was well known in Connecticut,

最後，因為我在康州的名氣

they decided they better have a meeting of the senior staff.

他們為我召開資深醫師會診

All the senior staff got together, and I later found out what happened.

召集所有資深醫護人員，我後來才知道內情

They put all their heads together and they decided

他們集思廣益的結論是

that there was nothing that could be done

我已經無藥可醫

for this surgeon who had essentially separated himself from the world,

他們認為我已經完全自我封閉

who by that time had become so overwhelmed,

被完全擊垮

not just with depression and feelings

不只是憂鬱及感覺

of worthlessness and inadequacy,

毫無自我價值和無能

but with obsessional thinking,

還有強迫性思考

obsessional thinking about coincidences.

滿腦子不停地想著各種巧合

And there were particular numbers that every time I saw them,

每次看到某些特定數字

just got me dreadfully upset -- all kinds of ritualistic observances,

我都會非常苦惱。還有各種怪癖

just awful, awful stuff.

簡直糟糕透了

Remember when you were a kid, and you had to step on every line?

記得小時候走路，地上每條線你都想踩嗎？

Well, I was a grown man who had all of these rituals,

我當時已經是成人了，還是有很多怪癖

and it got so there was a throbbing, there was a ferocious fear in my head.

整個腦子被強烈的恐懼感攫獲

You've seen this painting by Edvard Munch,

大家看過孟克的畫作《吶喊》吧？

The Scream. Every moment was a scream.

這「吶喊」的意象無時不刻在我腦子裡轟轟作響

It was impossible. So they decided there was no therapy,

我病入膏肓，醫師們束手無策

there was no treatment. But there was one treatment,

百藥難醫，只剩一個辦法

which actually had been pioneered at the Hartford hospital in the early 1940s,

1940年代早期這家醫院率先採用這種療法

and you can imagine what it was. It was pre-frontal lobotomy.

大家猜得到，就是腦前額葉切除術

So they decided -- I didn't know this, again,

所以他們決定

I found this out later --

後來我才知道

that the only thing that could be done was

唯一的希望

for this 43-year-old man to have a pre-frontal

就是給這個43歲的老男人

lobotomy.

做腦前額葉切除術

Well, as in all hospitals, there was a resident

就像所有醫院的做法

assigned to my case. He was 27 years old,

他們指派一位住院醫師給我，年方27

and he would meet with me two or three times a week.

我每週給他看診2、3次

And of course, I had been there, what, three or four months at the time.

當時我已經在那裡住院3、4個月了

And he asked to meet with the senior staff, and they agreed to meet with him

他也跟資深醫護人員會診

because he was very well thought of in that place.

大家都公認他是個好醫生

They thought he had a really extraordinary future.

認為他前途無量