I had two mysteries that were hanging over me.

有很長的一段時間，

I didn't understand them

有兩個謎團一直困擾著我。

and, to be honest, I was quite afraid to look into them.

我不了解它們，

The first mystery was, I'm 40 years old,

老實說，我也很害怕去探究它們。

and all throughout my lifetime, year after year,

第一個謎是：我四十歲，

serious depression and anxiety have risen,

我的一生中，年復一年，

in the United States, in Britain,

嚴重的憂鬱和焦慮越來越多，

and across the Western world.

在美國、在英國，

And I wanted to understand why.

在整個西方世界都是。

Why is this happening to us?

我想要了解原因。

Why is it that with each year that passes,

為什麼我們會發生這種狀況？

more and more of us are finding it harder to get through the day?

為什麼隨著每一年過去，

And I wanted to understand this because of a more personal mystery.

越來越多的人覺得難以度過每一天？

When I was a teenager,

我之所以想了解這一點， 是出於一個私人的謎團。

I remember going to my doctor

我記得青少年時去看醫生，

and explaining that I had this feeling, like pain was leaking out of me.

向醫生解釋說，我感覺痛苦 好像不斷地從我身上滲漏出來。

I couldn't control it,

我無法控制它，

I didn't understand why it was happening,

我不了解為什麼會發生這種狀況，

I felt quite ashamed of it.

我也感到很羞恥。

And my doctor told me a story

醫生跟我說了個故事，

that I now realize was well-intentioned,

現在我了解他的意圖很好，

but quite oversimplified.

但故事太簡化了，並非完全錯誤。

Not totally wrong.

我的醫生說：「我們知道 人為什麼會這樣。

My doctor said, "We know why people get like this.

有些人天生腦內的 化學物質就失衡 ——

Some people just naturally get a chemical imbalance in their heads --

顯然你是其中之一。

you're clearly one of them.

我們只要開一些藥給你，

All we need to do is give you some drugs,

你腦內的化學物質就能均衡正常。」

it will get your chemical balance back to normal."

所以我開始吃一種叫做克憂果的藥，

So I started taking a drug called Paxil or Seroxat,

它在不同的國家有不同的名稱。

it's the same thing with different names in different countries.

我感覺好很多，真的振作起來。

And I felt much better, I got a real boost.

但過沒多久，這種 痛苦的感覺又回來了。

But not very long afterwards,

所以我服用的劑量越來越高，

this feeling of pain started to come back.

後來的十三年，我所服用的 劑量一直都是法定的最高量。

So I was given higher and higher doses

在那十三年間大部分的時間， 和幾乎是後段的全部時間，

until, for 13 years, I was taking the maximum possible dose

我仍然感到痛苦。

that you're legally allowed to take.

我開始問我自己： 「這是怎麼回事？

And for a lot of those 13 years, and pretty much all the time by the end,

因為你已經做了主流文化 告訴你要做的所有事項——

I was still in a lot of pain.

為什麼你仍然感覺這麼糟？」

And I started asking myself, "What's going on here?

所以，為了探索這兩個謎，

Because you're doing everything

為了完成我寫的書， 我踏上了一趟環球大旅程。

you're told to do by the story that's dominating the culture --

旅行超過四萬英里。

why do you still feel like this?"

我想要和世界上 最頂尖的專家坐下來談，

So to get to the bottom of these two mysteries,

了解憂鬱症和焦慮症的成因，

for a book that I've written

還有很重要的，要如何解決，

I ended up going on a big journey all over the world,

還想和那些經歷過憂鬱症 和焦慮症的人談談，

I traveled over 40,000 miles.

瞭解他們是用何種方法走出來的。

I wanted to sit with the leading experts in the world

一路上我認識了很多了不起的人， 並向他們學到非常多。

about what causes depression and anxiety

但我學到的重點是，

and crucially, what solves them,

目前，我們有科學證據證明

and people who have come through depression and anxiety

憂鬱症和焦慮症的九種不同成因。

and out the other side in all sorts of ways.

其中兩種的確是受到生理的影響。

And I learned a huge amount

你的基因可能會讓你 對這些問題比較敏感，

from the amazing people I got to know along the way.

不過它們無法決定你的命運。

But I think at the heart of what I learned is,

還有當你憂鬱時 大腦的確會產生變化，

so far, we have scientific evidence

讓你更難擺脫憂鬱。

for nine different causes of depression and anxiety.

但已經證明，大部分 造成憂鬱和焦慮的原因

Two of them are indeed in our biology.

都跟生物學無關。

Your genes can make you more sensitive to these problems,

而是與我們的生活方式有關。

though they don't write your destiny.

一旦你了解了它們，

And there are real brain changes that can happen when you become depressed

就會開啟一套截然不同的解決方案，

that can make it harder to get out.

可以和化學抗憂鬱劑一起 提供給患者作為治療選項。

But most of the factors that have been proven

比如，

to cause depression and anxiety

如果你很孤單， 你比較有可能會憂鬱。

are not in our biology.

如果你在工作職位上沒有任何 掌控權，只能照別人的意思做，

They are factors in the way we live.

你就比較有可能會憂鬱。

And once you understand them,

如果你很少走入大自然，

it opens up a very different set of solutions

你就比較有可能會憂鬱。

that should be offered to people

我還發現，有一件事結合了 許多憂鬱和焦慮的成因。

alongside the option of chemical antidepressants.

不是所有的成因，但很多。

For example,

大家都知道，

if you're lonely, you're more likely to become depressed.

你們都有自然的生理需求，對吧？

If, when you go to work, you don't have any control over your job,

當然。

you've just got to do what you're told,

你們需要食物，你們需要水，

you're more likely to become depressed.

你們需要庇護，你們需要乾淨的空氣。

If you very rarely get out into the natural world,

如果我把這些都奪走， 你們很快就會出問題。

you're more likely to become depressed.

但，同時，

And one thing unites a lot of the causes of depression and anxiety

每個人也都有自然的精神需求。

that I learned about.

你們需要有歸屬感。

Not all of them, but a lot of them.

你們需要感受到 自己生活的意義和目的。

Everyone here knows

你們需要人們關注你、重視你。

you've all got natural physical needs, right?

你們需要覺得會有個具意義的未來。

Obviously.

我們所建立的文化擅長很多事。

You need food, you need water,

很多方面都比以前更好—— 很高興我活在現代。

you need shelter, you need clean air.

但，我們越來越不擅長

If I took those things away from you,

滿足這些深處、根本的心理需求。

you'd all be in real trouble, real fast.

這不是唯一的問題，

But at the same time,

但我認為這是這種危機 越來越高的主要原因。

every human being has natural psychological needs.

我很難去接受這個事實。

You need to feel you belong.

我真的很努力去轉換這個概念：

You need to feel your life has meaning and purpose.

從原本認為我的憂鬱症 只是我大腦的問題，

You need to feel that people see you and value you.

轉變到是有許多原因造成的，

You need to feel you've got a future that makes sense.

包括我們許多的生活方式。

And this culture we built is good at lots of things.

我真正逐漸開始了解它，

And many things are better than in the past --

是有一天，我和一位 南非的精神科醫師面談，

I'm glad to be alive today.

德瑞克 ‧ 沙梅菲爾德博士。 他是個很棒的人。

But we've been getting less and less good

柬埔寨於 2001 年 首次提供化學抗憂鬱劑

at meeting these deep, underlying psychological needs.

給人民使用，

And it's not the only thing that's going on,

正好那時沙梅菲爾德博士也在那裡。

but I think it's the key reason why this crisis keeps rising and rising.

當地的醫生，柬埔寨人， 從來沒有聽過這些藥物，

And I found this really hard to absorb.

他們問這些是什麼？他做了解釋。

I really wrestled with the idea

他們對他說：

of shifting from thinking of my depression as just a problem in my brain,

「我們不需要，我們已經 有抗憂鬱劑了。」

to one with many causes,

他說：「什麼意思？」

including many in the way we're living.

他以為他們會說某種藥草療法，

And it only really began to fall into place for me

如聖約翰草、銀杏之類的。

when one day, I went to interview a South African psychiatrist

但，他們卻告訴他一個故事。

named Dr. Derek Summerfield.

在他們的社區 有個農夫，在稻田工作。

He's a great guy.

有一天，他踩到了地雷，

And Dr. Summerfield happened to be in Cambodia in 2001,

那是和美國打戰時留下來的，

when they first introduced chemical antidepressants

他的腿被炸斷了。

for people in that country.

他們幫他裝了義肢，

And the local doctors, the Cambodians, had never heard of these drugs,

一陣子之後，他又回到田裡工作。

so they were like, what are they?

但，很顯然，戴著義肢

And he explained.

在水中工作非常痛苦，

And they said to him,

我猜想，要他回到當初 被炸傷的稻田裡工作

"We don't need them, we've already got antidepressants."

也是件很難過的事。

And he was like, "What do you mean?"

這個人開始整天哭泣，

He thought they were going to talk about some kind of herbal remedy,

他拒絕下床，

like St. John's Wort, ginkgo biloba, something like that.

他出現了典型憂鬱症的所有病徵。

Instead, they told him a story.

柬埔寨醫生說：

There was a farmer in their community who worked in the rice fields.

「此時，我們給了他抗憂鬱劑。」

And one day, he stood on a land mine

沙梅菲爾德博士問：「那是什麼？」

left over from the war with the United States,

他們解釋，那就是他們去陪他坐坐。

and he got his leg blown off.

他們傾聽他說話。

So they him an artificial leg,

他們了解他的痛苦是合情合理的——

and after a while, he went back to work in the rice fields.

他在憂鬱的煎熬中很難看到這一點，

But apparently, it's super painful to work under water

但其實，他生活中造成憂鬱的成因 是完全可以理解的。

when you've got an artificial limb,

其中一位醫生在跟 社區民眾談話時，想到：

and I'm guessing it was pretty traumatic

「如果我們買一頭牛給這個人， 他就能變成酪農，

to go back and work in the field where he got blown up.

他就不用待在讓他感覺 這麼糟的田裡工作了。」

The guy started to cry all day,

所以他們買了一頭牛給他。

he refused to get out of bed,

幾週之內，他就不再哭泣了，

he developed all the symptoms of classic depression.

一個月之內，憂鬱症也沒了。

The Cambodian doctor said,

他們對沙梅菲爾德博士說： 「博士，那頭牛就是抗憂鬱劑，

"This is when we gave him an antidepressant."

那就是你的意思，對吧？」

And Dr. Summerfield said, "What was it?"

（笑聲）（掌聲）

They explained that they went and sat with him.

如果在座大部分的人在成長過成中 被灌輸的憂鬱症知識和我相同，

They listened to him.

這聽起來會像是個爛笑話吧？

They realized that his pain made sense --

「我去找醫生拿抗憂鬱劑， 她給了我一頭牛。」

it was hard for him to see it in the throes of his depression,

但，那些柬埔寨醫生靠著直覺，

but actually, it had perfectly understandable causes in his life.

根據這個個案， 沒有科學根據的軼事，

One of the doctors, talking to the people in the community, figured,

就知道了世界上最重要的醫療組織，

"You know, if we bought this guy a cow,

世界衛生組織，

he could become a dairy farmer,

根據最佳科學證據所得之結果，

he wouldn't be in this position that was screwing him up so much,

數年來持續在告訴我們的事。

he wouldn't have to go and work in the rice fields."

如果你感到憂鬱，

So they bought him a cow.

如果你感到焦慮，

Within a couple of weeks, his crying stopped,

你並不是軟弱，你並沒有發瘋，

within a month, his depression was gone.

基本上，你並不是零件故障的機器。

They said to doctor Summerfield,

你是人類，只是有些需求未被滿足。

"So you see, doctor, that cow, that was an antidepressant,

這裡還有一點也同等重要， 要想想那些柬埔寨醫生

that's what you mean, right?"

及世界衛生組織並沒有說什麼。

(Laughter)

他們沒有對這位農夫說：

(Applause)

「嘿，老兄，你得要振作起來。

If you'd been raised to think about depression the way I was,

想辦法解決這個問題 是你自己的責任。」

and most of the people here were,

正好相反，他們說的是：

that sounds like a bad joke, right?

「我們大家在此一起陪你振作起來，

"I went to my doctor for an antidepressant,

我們同心協力就能 想辦法解決這個問題。」

she gave me a cow."

這是每個憂鬱的人都需要的，

But what those Cambodian doctors knew intuitively,

也是每個憂鬱的人都應得的。

based on this individual, unscientific anecdote,

這就是為什麼聯合國 最頂尖的醫生之一

is what the leading medical body in the world,

在 2017 世界衛生日的官方聲明中，

the World Health Organization,

說我們需要少談一點化學失衡，

has been trying to tell us for years,

多談一點生活方式的失衡。

based on the best scientific evidence.

藥物的確能讓某些人喘口氣—— 有段時間我確實得到舒緩——

If you're depressed,

但，正因為這個問題 超越生物學的範疇，

if you're anxious,

因此解決方案也得要更深入。

you're not weak, you're not crazy,

但，當我初次聽到這些時，

you're not, in the main, a machine with broken parts.

我記得我心想：

You're a human being with unmet needs.

「好，我看到了科學證據， 也閱讀了很多文獻，

And it's just as important to think here about what those Cambodian doctors

我訪問的很多專家 都解釋了這個狀況，」

and the World Health Organization are not saying.

但我不斷想著： 「我們怎麼可能辦到？」

They did not say to this farmer,

讓我們憂鬱的事物，

"Hey, buddy, you need to pull yourself together.

大部分的情況下都比 柬埔寨農夫的狀況還要複雜。

It's your job to figure out and fix this problem on your own."

根據那個觀點的話， 我們要從何處著手進行呢？

On the contrary, what they said is,

但，在為自己寫書而踏上的

"We're here as a group to pull together with you,

漫長世界之旅中，

so together, we can figure out and fix this problem."

我不斷遇到一些確實在這麼做的人，

This is what every depressed person needs,

從雪黎、舊金山

and it's what every depressed person deserves.

到聖保羅。

This is why one of the leading doctors at the United Nations,

我不斷遇到一些人，他們都了解

in their official statement for World Health Day,

憂鬱症和焦慮症的更深層成因，

couple of years back in 2017,

且大家團結起來，解決它們。

said we need to talk less about chemical imbalances

我無法跟各位聊所有這些 我遇到、寫出來的非凡人物，

and more about the imbalances in the way we live.

也無法談到我所了解造成 憂鬱症和焦慮症的九個成因，

Drugs give real relief to some people --

他們不會讓我講十小時的 TED 演說 —— 你可以跟他們客訴。

they gave relief to me for a while --

但我想把焦點放在兩個成因上，

but precisely because this problem goes deeper than their biology,

如果可以的話，再談兩個 從它們發展出來的解決方案。

the solutions need to go much deeper, too.

第一個，

But when I first learned that,

我們是人類史上最孤單的社會。

I remember thinking,

最近有一項研究，詢問美國人：

"OK, I could see all the scientific evidence,

「你是否覺得你不再 和任何人親近了？」

I read a huge number of studies,

39% 的人說他們正是如此。 「不再和任何人親近了。」

I interviewed a huge number of the experts who were explaining this,"

從孤單的國際測量指標來看，

but I kept thinking, "How can we possibly do that?"

英國和歐洲其他地方 緊接在美國之後，

The things that are making us depressed

所以各位也別沾沾自喜。

are in most cases more complex than what was going on

（笑聲）

with this Cambodian farmer.

我花了很多時間和世上 最頂尖的專家討論孤單這個議題，

Where do we even begin with that insight?

有位很了不起的人， 芝加哥的約翰‧卡喬波教授，

But then, in the long journey for my book,

他在研究中提出的 一個問題讓我想了很多。

all over the world,

約翰卡喬波問：

I kept meeting people who were doing exactly that,

「我們為什麼存在？

from Sydney, to San Francisco,

我們為什麼在這裡， 為什麼活著？」

to São Paulo.

一個重要理由

I kept meeting people who were understanding

就是我們在非洲無樹平原上的祖先

the deeper causes of depression and anxiety

非常擅長一件事。

and, as groups, fixing them.

他們獵殺的動物 體型通常都比他們還大，

Obviously, I can't tell you about all the amazing people

他們獵殺的動物 速度通常都比他們還快，

I got to know and wrote about,

但他們非常擅於組成團體

or all of the nine causes of depression and anxiety that I learned about,

同心協力。

because they won't let me give a 10-hour TED Talk --

這是我們這個物種的超能力——

you can complain about that to them.

我們會團結，

But I want to focus on two of the causes

就像蜜蜂演化成居住在蜂巢中，

and two of the solutions that emerge from them, if that's alright.

人類演化成居住在部落中。

Here's the first.

我們是史上最早開始

We are the loneliest society in human history.

拆散部落的人類。

There was a recent study that asked Americans,

這讓我們感覺糟透了。

"Do you feel like you're no longer close to anyone?"

但不一定要如此。

And 39 percent of people said that described them.

事實上，我書中和人生中的一位英雄

"No longer close to anyone."

是一位名為山姆‧艾佛林頓的醫生。

In the international measurements of loneliness,

他是在東倫敦貧窮地區 執業的家庭醫生，

Britain and the rest of Europe are just behind the US,

我在那裡住過很多年。

in case anyone here is feeling smug.

山姆感到很不舒服，

(Laughter)

他有很多病人來找他都是 因為嚴重的憂鬱症和焦慮症。

I spent a lot of time discussing this

他跟我一樣不反對化學抗憂鬱劑，

with the leading expert in the world on loneliness,

他認為藥物能讓部分人舒緩症狀。

an incredible man named professor John Cacioppo,

但他知道兩件事。

who was at Chicago,

第一，

and I thought a lot about one question his work poses to us.

大部分的時候，他的病人

Professor Cacioppo asked,

會憂鬱和焦慮的理由是 完全可以理解的，比如孤單。

"Why do we exist?

第二，雖然藥物可以 舒緩某一部分人的症狀

Why are we here, why are we alive?"

但卻無法解決大多數人的問題，

One key reason

背後的問題。

is that our ancestors on the savannas of Africa