I always wanted to become a walking laboratory of social engagement:

我總是想成為

to resonate other people's feelings, thoughts, intentions, motivations,

人際交流的行動實驗室

in the act of being with them.

藉由和別人在一起

As a scientist, I always wanted to measure that resonance,

來體會他們的感受、想法、意圖與動機

that sense of the other that happens so quickly,

身為科學家，我總希望能度量這種人與人之間

in the blink of an eye.

身為科學家，我總希望能度量這種人與人之間

We intuit other people's feelings;

瞬間即生的共鳴感

we know the meaning of their actions even before they happen.

我們能自然領會別人的感受

We're always in this stance

甚至在他們行動以前

of being the object of somebody else's subjectivity.

就知道行動所代表的意義

We do that all the time. We just can't shake it off.

無論何時

It's so important that the very tools we use to understand ourselves,

我們總是某人主觀意識中的客體

to understand the world around us,

這是我們無法擺脫的一點

are shaped by that stance.

這很重要

We are social to the core.

我們正是仰賴這一點

So my journey in autism really started

來學會了解我們自己及周遭的世界

when I lived in a residential unit for adults with autism.

我們完完全全是社會動物

Most of those individuals had spent most of their lives

我對自閉症的了解是從我住進一個

in long-stay hospitals.

為自閉症患者而設的成人之家中開始的

This is a long time ago.

他們多數都在醫院裡度過大部分的人生

And for them, autism was devastating.

這是很久以前的事了

They had profound intellectual disabilities.

對他們來說，自閉症是場災難

They didn't talk.

他們有嚴重的智力障礙、不說話

But most of all,

更糟的是

they were extraordinarily isolated from the world around them,

他們極度封閉在自己的世界裡

from their environment

與周遭的環境隔絕

and from the people.

與他人隔絕

In fact, at the time, if you walked into a school

如果你走進一所當時的自閉症特教學校

for individuals with autism,

事實上你會聽到很多聲音

you'd hear a lot of noise,

喧鬧聲、人們做各種事情的聲音

plenty of commotion, actions, people doing things.

但他們總是各自做自己的事

But they're always doing things by themselves.

可能在看天花板上的燈

So they may be looking at a light in the ceiling,

可能獨自待在角落

or they may be isolated in the corner,

或反覆做一些無意義的動作

or they might be engaged in these repetitive movements,

來達到自我刺激的目的

in self-stimulatory movements that led them nowhere.

極度地封閉在自己的世界裡

Extremely, extremely isolated.

如今我們知道

Well, now we know that autism is this disruption,

是自閉症使他們無法

the disruption of this resonance that I am telling you about.

與他人產生共鳴感

These are survival skills.

但這是生存本能

These are survival skills that we inherited

是經由數十萬年的演化

over many, many hundreds of thousands of years of evolution.

所傳承下來的生存本能

You see, babies are born in a state of utter fragility.

所傳承下來的生存本能

Without the caregiver, they wouldn't survive,

你們都知道，新生兒是全然無助的

so it stands to reason that nature would endow them

沒有人照顧便不能生存

with these mechanisms of survival.

所以大自然賦予他們

They orient to the caregiver.

這些生存的機制

From the first days and weeks of life,

他們會追尋照顧他們的人

babies prefer to hear human sounds,

從出生後的幾天到幾周內

rather than just sounds in the environment.

嬰兒就偏好人聲

They prefer to look at people rather than at things,

而不是周遭的其他聲音

and even as they're looking at people, they look at people's eyes,

他們偏好看著人而不是其他東西

because the eye is the window to the other person's experiences,

當他們對著人看時

so much so that they even prefer to look at people

他們甚至會盯著人的眼睛看

who are looking at them rather than people who are looking away.

因為眼睛是通往他人經驗的途徑

Well, they orient to the caregiver.

所以他們甚至會偏好盯著正在看他們的人

The caregiver seeks the baby.

而不是看著旁邊的人

And it's out of this mutually reinforcing choreography

他們追尋照顧他們的人

that a lot that is of importance to the emergence of mind --

照顧者則追尋著嬰兒

the social mind, the social brain -- depends on.

人的心智，尤其是社會性的心智

We always think about autism

就是在這如舞步般的過程中

as something that happens later on in life.

一來一往、逐漸成形

It doesn't; it begins with the beginning of life.

我們總以為自閉症

As babies engage with caregivers, they soon realize that, well,

是出生成長後逐漸形成的

there is something between the ears that is very important --

不是這樣的。它在出生時就發生了

it's invisible, you can't see it, but it's really critical.

當嬰兒接觸到照顧他們的人

And that thing is called attention.

他們很快就理解到，在兩耳間

And they learn soon enough,

有些非常重要的東西

even before they can utter one word,

那是看不到、但非常重要的東西─

that they can take that attention and move somewhere

就是別人對他們的關注

in order to get things they want.

在能夠開口說話前

They also learn to follow other people's gazes,

他們就先學會藉由吸引別人的注意

because whatever people are looking at is what they are thinking about.

來得到自己想要的

And soon enough, they start to learn about the meaning of things,

他們也學會跟隨別人的目光

because when somebody is looking at something

因為別人目光所及

or somebody is pointing at something,

就是他們心中所想

they're not just getting a directional cue.

很快地，他們就開始學習事物的意義

They are getting the other person's meaning of that thing,

因為當某人看著一樣東西

the attitude.

或是指著一樣東西

And soon enough, they start building this body of meanings,

那並不只代表了一個方向

but meanings that were acquired within the realm of social interaction.

也代表了這樣東西對這個人的意義

Those are meanings that are acquired

這個人對這樣東西的看法

as part of their shared experiences with others.

他們開始架構事物的意義

Well, this is a 15-month-old little girl,

那些他們在跟別人互動的過程中

and she has autism.

所學習到的意義

And I am coming so close to her that I am maybe two inches from her face,

這些都是從與他人共享的經驗中

and she's quite oblivious to me.

所學習到的

Imagine if I did that to you, came two inches from your face.

這是一個十五個月大

You'd do probably two things, wouldn't you?

患有自閉症的小女孩

You would recoil. You would call the police.

我已經靠近到離她的臉只有五公分

(Laughter)

她卻完全無視於我

You would do something,

想像一下我對你做同樣的事

because it's literally impossible to penetrate somebody's physical space

我向你靠近到離你的臉只有五公分

and not get that reaction.

你可能會有兩個反應

We do so, remember, intuitively, effortlessly.

你會向後退、或是叫警察（笑聲）

This is our body wisdom;

你一定會做點什麼

it's not something mediated by our language.

因為侵犯到某人的空間而不引起任何反應

Our body just knows that.

實在是不太可能的事

And we've known that for a long time.

記住，這是我們不加思索的直覺反應

And this is not something that happens to humans only.

是我們身體自然的判斷

It happens to some of our phyletic cousins,

不需要言語作為媒介

because if you're a monkey, and you look at another monkey,

我們的身體本來就知道該這樣做

and that monkey has a higher hierarchy position than you,

而這並不是人類獨有的

and that is considered to be a signal or threat,

我們在演化上的遠親也是如此

well, you are not going to be alive for long.

因為如果你是隻猴子

So something that in other species are survival mechanisms,

你這樣看著另一隻地位比你高的猴子

without which they wouldn't basically live,

你這樣看著另一隻地位比你高的猴子

we bring into the context of human beings,

而你的舉動被認為是一種暗示或威脅

and this is what we need to simply act, socially.

你就活不久了

Now, she is oblivious to me and I'm so close to her,

這對其他物種來說

and you think, maybe she can see you,

是不可或缺的生存本能

maybe she can hear you.

對人類而言

Well, a few minutes later,

則是產生人際互動的基本條件

she goes to the corner of the room,

好，我離她這麼近她還是無視於我

and she finds a tiny little piece of candy, an M&M.

你們可能會想

So I could not attract her attention,

她也許看得見或聽得見我

but something -- a thing -- did.

幾分鐘後她到房間的角落去了

Now, most of us make a big dichotomy

找到一小顆M&M's巧克力

between the world of things and the world of people.

所以我不能吸引她的注意

Now, for this girl, that division line is not so clear,

但是某樣東西卻可以

and the world of people is not attracting her

好，我們多數人會用二分法來看這世界─

as much as we would like.

物品的世界、人的世界

Now, remember that we learn a great deal by sharing experiences.

但對這女孩來說，人與物的分別

What she is doing right now is that her path of learning is diverging,

不是那麼清楚，而人的世界

moment by moment,

並不像我們所想的那樣吸引她

as she is isolating herself further and further.

要記住

So we feel sometimes that the brain is deterministic,

我們很多的學習都是從經驗分享而來

the brain determines who we're going to be.

現在在她身上發生的事是

But, in fact, the brain also becomes who we are,

她的學習隨著她越來越封閉自己

and at the same time that her behaviors are taking away

而逐漸走上不同的道路

from the realm of social interaction,

所以有時候我們會覺得

this is what's happening with her mind,

大腦決定了我們會成為怎樣的人

and this is what's happening with her brain.

但事實上我們也會影響大腦的發展

Well, autism is the most strongly genetic condition

所以當她跟別人的互動越來越少

of all developmental disorders.

在此同時

And it's a brain disorder.

這對她的心智及大腦都造成影響

It's a disorder that begins much prior to the time

自閉症是所有發展障礙中

that the child is born.

與基因關聯最強的一種

We now know that there is a very broad spectrum of autism.

它是一種腦部疾病

There are those individuals who are profoundly intellectually disabled

是一種早在出生前就發生的疾病

but there are those that are gifted.

是一種早在出生前就發生的疾病

There are those individuals who don't talk at all;

我們現在知道了

there are those individuals who talk too much.

自閉症會以很多不同樣貌顯現

There are those individuals that if you observe them in their school,

有些人有嚴重的智力障礙

you see them running the periphery fence all the school day if you let them,

有些人則是有特殊的天份

to those individuals who cannot stop coming to you

有些人完全不說話，有些人卻說個不停

and trying to engage you repeatedly, relentlessly,

如果你到他們的學校去

but often in an awkward fashion,

你可能會看到有些人若未經制止

without that immediate resonance.

會繞著學校的圍籬跑個不停

Well, this is much more prevalent than we thought at the time.

有些人則會不斷試圖引起你的注意

When I started in this field,

有些人則會不斷試圖引起你的注意

we thought there were four individuals with autism per 10,000 --

但他們使用的方式通常讓人感到不舒服

a very rare condition.

也無法引起別人共鳴

Well, now we know it's more like one in 100.

這種狀況遠比我們當初想的要普遍

There are millions of individuals with autism all around us.

當我剛踏入這個領域時

The societal cost of this condition is huge,

我們認為每一萬人中約有四人患有自閉症

in the US alone, maybe 35 to 80 billion dollars.

算是一種很罕見的疾病

And you know what?

現在我們知道大約每百人中就有一個

Most of those funds are associated with adolescents and particularly adults

我們周遭有幾百萬的人患有自閉症

who are severely disabled,

這種疾病的社會成本很大

individuals who need wraparound services --

只在美國，也許就要花上350億到800億美金

services that are very, very intensive.

而你們知道嗎？

And those services can cost in excess of 60,000 to 80,000 dollars a year.

絕大多數的經費都被用在

Those are individuals who did not benefit from early treatment,

青少年及有嚴重障礙的成人身上

because now we know that autism creates itself

他們需要非常密集的全方位服務

as individuals diverge in that pathway of learning that I mentioned to you.

他們需要非常密集的全方位服務

Were we to be able to identify this condition

每年就需要六到八萬美金以上的費用

at an earlier point, and intervene and treat --

這些都是未從早期療育獲益的人

I can tell you, this has been probably something that has changed my life

因為我們現在知道，當他們的學習

in the past 10 years,

像我之前說的那樣走上另一條路時

this notion that we can absolutely attenuate this condition.

自閉症的狀況就會越加惡化

Also, we have a window of opportunity,

如果我們能做到早期發現

because the brain is malleable for just so long,

並且在早期就介入治療

and that window of opportunity happens in the first three years of life.

我告訴你們

It's not that that window closes; it doesn't.

我們絕對可以減輕自閉症的症狀

But it diminishes considerably.

這個想法在過去十年裡

And yet, the median age of diagnosis in this country

改變了我的人生

is still about five years,

但我們只有一小段時間可以採取行動

and in disadvantaged populations,

因為大腦只在那一段時間裡有可塑性

the populations that don't have access to clinical services,

這段寶貴的時間是在三歲以前

rural populations, minorities,

這段寶貴的時間是在三歲以前

the age of diagnosis is later still,

並不是說在那之後就完全沒有機會了

which is almost as if I were to tell you

但是機會確實大大降低

that we are condemning those communities to have individuals with autism

目前在美國自閉症得到確診的平均年齡

whose condition is going to be more severe.

一般還是在五歲

So I feel that we have a bioethical imperative.

對於那些得不到臨床服務

The science is there.

住在偏遠地區或

But no science is of relevance

身為少數族裔的弱勢族群來說

if it doesn't have an impact on the community.

確診的年齡還要更晚

And we just can't afford that missed opportunity,

這幾乎像是我們對這些族群宣告

because children with autism become adults with autism.

他們的自閉症患者

And we feel that those things we can do

注定要陷入越來越嚴重的狀況

for these children, for those families, early on,

就醫學倫理而言，我們有不可推卸的責任

will have lifetime consequences --

我們已經有這些科學知識

for the child, for the family, and for the community at large.

但如果它們不能為社會所用

So this is our view of autism.

它們就沒有多大用處

There are over a hundred genes that are associated with autism.

而我們不能失去這樣的機會

In fact, we believe there are going to be

因為患有自閉症的兒童會長大成人

something between 300 and 600 genes associated with autism,

我們如果能夠及早盡我們所能

and genetic anomalies, much more than just genes.

為他們及他們的家庭做點事

And we actually have a bit of a question here,

對這些家庭或整個社會來說

because if there are so many different causes of autism,

都會有長遠的影響

how do you go from those liabilities to the actual syndrome?

這就是我們對自閉症的看法

Because people like myself,

跟自閉症有關的基因有上百個

when we walk into a playroom,

事實上我們相信

we recognize a child as having autism.

可能有300到600個基因或基因異常

So how do you go from multiple causes

與自閉症有關

to a syndrome that has some homogeneity?

問題來了

And the answer is what lies in between,

這麼多不同的不利因素

which is development.

到底是怎樣發展成自閉症的呢？

And in fact, we are very interested in those first two years of life,

因為當人們─　好比我自己

because those liabilities don't necessarily convert into autism.

走入一間遊戲室時

Autism creates itself.

我們可以分辨出一個孩子是不是有自閉症

Were we to be able to intervene during those years of life,

到底為什麼這麼多不同成因

we might attenuate for some, and God knows, maybe even prevent for others.

最後會導致這麼相似的症狀呢？

So how do we do that?

原來答案在成因與呈現的症狀之間:

How do we enter that feeling of resonance,

也就是孩子的發育

how do we enter another person's being?

事實上，我們對兩歲之前這段時間非常有興趣

I remember when I interacted with that 15-month-old,

因為這些不利因素並不必然發展成自閉症

the thing that came to my mind was,

因為這些不利因素並不必然發展成自閉症

"How do you come into her world?

自閉症是自行形成

Is she thinking about me? Is she thinking about others?"

如果我們能在兩歲之前就介入

Well, it's hard to do that,

我們也許可以減輕一些孩子的症狀

so we had to create the technologies.

誰知道，我們說不定甚至可以預防它的發生

We had to basically step inside a body.

但我們要怎麼做呢？

We had to see the world through her eyes.

我們要怎麼創造共鳴感？

And so in the past many years,

又要怎麼進入另一個人的世界呢？

we've been building these new technologies

我記得在我跟那十五個月大的女孩互動時

that are based on eye tracking.

我心裡在想

We can see, moment by moment, what children are engaging with.

「要怎麼進入她的世界呢？」