1、TED英语演讲童年创伤怎样影响一生的健康docTED英语演讲：童年创伤怎样影响一生的健康童年创伤不是一件长大就能解决的事。儿科医生Nadine解释虐待、忽视、和父母精神健康不良或有药物或饮酒问题，都会影响儿童的大脑发展。童年经历影响终身，在高压环境下长大的儿童比他人得到心肺疾病的比例高三倍。下面是我为大家收集关于TED英语演讲：童年创伤怎样影响一生的健康，欢迎借鉴参考。演说题目：童年创伤怎样影响一生的健康!演说者：Nadine Burke HarrisIn the mid-90s, the CDC and Kaiser Permanente discovered an exposure tha
2、t 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 life
3、time 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 Im talking about is not a pesticide or a packaging chemical. Its childhood trauma.90年代中期, CDC和Kaiser Permanente发现: 暴露于某种
4、事物中 会极大增加死亡风险, 七成美国民众的首要死因皆由此引起。 暴露剂量较高时,会影响大脑发育, 免疫系统,内分泌系统, 甚至影响到基因的读取及转录方式。 暴露在极高剂量下的人群, 有3倍的风险患上心脏病和肺癌, 预期寿命缩短20xx年。 然而,目前医生们还未被培训 以常规筛查和治疗的手段来应对这种风险。 我所说的暴露危害并不针对 某种农药或包装上的化学物质。 而是儿童期创伤。Okay. What kind of trauma am I talking about here? Im not talking about failing a test or losing a basketball
5、 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,我要说的是哪种创伤呢? 我要说的可不是 考试不及格或输掉篮球比赛。 我要说的是那种 如此严重而又无
6、处不在的威胁, 以致于它让我们毛骨悚然, 并从生理上改变了我们： 比如,受虐待或被忽视, 又或者,抚养我们的父母, 本身就深受精神疾病之苦, 或是深陷于”物质依赖”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 so
7、mething 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, an
8、d 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-qua
9、lity 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.一直以来, 我都按照所教导的方式 来看待这些事情。 要么把它当成一个社会问题- 交给社会服务去处理, 要么把它当成一个心理健康问题- 交给心理
10、健康咨询来解决。 后来发生了一些事情, 使我反思我的整个思维方式。 在医院实习结束后, 我想去个我觉得真正需要我的地方, 去个我可以有所作为的地方。 因此，我选择为加利利福尼亚 太平洋医疗中心(CPMC)工作, 这是加利福尼亚北部 最优秀的私立医院之一, 我与该医院合作,在旧金山最穷、 社区服务最差的居民区- 湾景区猎人角(Bayview-Hunters Point) 开了一家诊所。 在此之前, 整个湾景区(Bayview)社区 仅有一名儿科医生, 为一万多名儿童服务, 因此,我们开始挂牌营业, 提供最优质的医疗服务, 不论是否有能力支付医疗费用。 这种感觉很棒。 我们找出了在医疗服务上现状与
11、标准的差距： 普及医疗保健, 免疫接种率、哮喘住院率等, 我们都完成了达标。 我们为自己感到骄傲。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 co
12、uldnt 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.但就在那时,我开始注意到 一种令人忧心的趋势。 很多孩子因为多动症(简称ADHD), 被送到我这里进行医治, 可是,当我对孩子们的病史和 身体状况进行彻查时, 却发现大多数患儿的情况, 我无法下”多动症”(ADHD)的诊断。
13、多数来就诊的孩子都经历过 如此严重的创伤, 让人觉得似乎事情并不简单。 不知怎的,我漏查了某个重要的因素。Now, before I did my residency, I did a masters degree in public health, and one of the things that they teach you in public health school is that if youre a doctor and you see 100 kids that all drink from the same well, and 98 of them develop dia
14、rrhea, 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 ch
15、ildren.在实习之前,我曾攻读公共健康硕士学位, 在公共健康学校里, 我们曾学过这样的一课, 如果你是一名医生, 当你知道有100个孩子从 同一口井中饮水, 其中98人患了腹泻, 你可以着手治疗, 给每个病人都开抗生素, 一剂,一剂,又一剂的开。 可是你也可以走去井边， 问声,”井里到底有什么鬼东西?” 所以,我开始查阅手头所有的相关资料, 了解暴露在不幸中, 是如何影响儿童的大脑和身体发育的。And then one day, my colleague walked into my office, and he said, “Dr. Burke, have you seen this?”
16、 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, 一个同事走进我的办公室, 他问我,”伯克医生,你看过这个吗?” 在他手里的是 一份调查研究的复印件, 题目是”童年不良经历(ACE)研究”。 那一天,改变了我的临床实践, 也最终改变了我的职业生涯。The Adverse Childhood Experiences Study
17、 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 ab
18、use; 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 th
19、ey 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 outco
20、mes: 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 depres
21、sion, 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.童年不良经历(ACE)的研究 是每一个人都应该要了
22、解的。 Vince Felitti博士和Bob Anda博士 分别在 Kaiser 和 CDC 进行了这项研究, 他们两人一起询问了17,500成年人, 了解他们的”童年不良经历”,又称ACE。 这包括生理上、情感上 遭受的不幸或是性侵害; 生理或情感上遭受的忽视; 父母患有精神疾病、物质依赖、遭到监禁; 父母分居或离婚; 或家庭暴力。 每个问题只要回答”是”, ACE分数就增加一分。 接下来, 他们将ACE分数与健康状况关联起来, 得出的结果是令人震惊的。 结论有两点： 第一点,ACE十分普遍, 简直令人不可思议。 67%的人曾至少有一个ACE得分, 有12.6%(八分之一)的人 有四或四以
23、上的ACE得分。 研究发现的第二点, 是ACE与健康状况之间 存在着一种剂量反应关系： ACE得分越高,健康状况越糟糕。 如果一个人的ACE分数大于等于4分, 他患慢性阻塞性肺病的相对风险 是ACE分数为0时的2.5倍。 患上肝炎的风险是2.5倍。 而患上抑郁症的风险是4.5倍。 自杀风险是12倍。 ACE分数大于等于7的人 终身都有3倍的风险患上肺癌, 和3.5倍的风险患上冠心病- 这种目前在美国 当属头号杀手的疾病。Well, of course this makes sense. Some people looked at this data and they said, “Come o
24、n. You have a rough childhood, youre more likely to drink and smoke and do all these things that are going to ruin your health. This isnt science. This is just bad behavior.”当然,这其实挺有道理。 有些人看了这些数据之后会说, “好啦,你有个糟糕的童年, 你更容易酗酒和抽烟, 还去做一切 会毁掉你健康的事情。 这又不是科学,这只是坏的行为而已.”It turns out this is exactly where the
25、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 t
26、he 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 brains fear response center. So, there are real neurologic reasons why folks exposed to high doses of adversity are
27、more likely to engage in high-risk behavior, and thats important to know.然而,事实证明我们恰恰要用科学来分析它。 目前,我们前所未有的更加理解 早年遭受的不幸 会怎样影响儿童大脑和身体的发育。 早年遭受的不幸会影响大脑的伏隔核 (nucleus accumbens)- 人脑中与快乐和奖赏相关 的处理中心, 它与”物质依赖”疾病相关。 早年遭受的不幸 还会抑制大脑的前额叶皮质(Prefrontal cortex), 而前额皮质对神经冲动控制 与执行功能是必不可少的, 这个区域对于学习能力非常关键。 在核磁共振成像扫描(MR
28、I)上, 我们观察到大脑的恐惧反应中枢 - 杏仁核(amygdala)中, 存在可以测量的差异。 因此,这便可以从神经学角度诠释： 为什么人们一旦遭受大量不幸, 则更容易出现高风险行为。 了解了这点十分重要。But it turns out that even if you dont engage in any high-risk behavior, youre still more likely to develop heart disease or cancer. The reason for this has to do with the hypothalamicpituitaryadr
29、enal axis, the brains and bodys stress response system that governs our fight-or-flight response. How does it work? Well, imagine youre 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, “Re
30、lease 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 youre in a forest and theres a bear. (Laughter) But the problem is what happens when
31、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.
32、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.但事实证明, 即使你不从事任何高风险的行为, 你仍然更容易患上 心脏疾病或癌症。 因为这与”下丘脑-垂体-肾上腺轴”有关- 它是大脑和身体的应激反应系统, 支配我们做出”或战或逃反应”。 (fight-or-flight response)。 这一系统是如何运行的呢? 想象你漫步在森林里, 突然看到一头熊。 你的下丘脑会立即 向你的垂体发送信号, 垂体再向你的肾上腺发送信号： “释放应激激素! 肾上腺素! 皮质醇!” 你的心脏因而开始快速跳动, 瞳孔扩张,呼吸道打开, 这时你已准备好： 要么就和熊战斗,要么就逃跑。 这个反应很棒- 如果你在森林里, 那还有一只熊。 (笑声) 可问题是,假如每个晚上 熊都回家来该怎么办, 这套系统将一遍又一遍地被激活, 它就会从适应到不适应, 从救你的命到损害你的健康。 儿童对这种反复的应激激活尤其敏感, 因为他们的大脑和身
