【TED】一段精神疾病的传奇——从内心看起

中英文稿

我是一个患有慢性精神分裂症的女人 我曾经有几百天都 待在精神病医院里面 也许我有可能一生 大部分时间都待在医院的病房里 但是我的人生并没有这样 事实上， 我成功的离开了医院 将近三十年了 这可能是我最自豪的成就了 但是这并不代表我没有 精神上的挣扎 当我从耶鲁大学毕业以后 我得到了第一份法律工作， 我在纽黑文的医生， 外特 告诉我他将在三个月之后 停止他的治疗工作。这发生在 我准备离开纽黑文的几年前。 外特对我有很大的帮助， 想到他的离开几乎 让我崩溃

我最好的朋友史蒂夫 感觉到了有东西很不对 飞到了纽黑文来和我待在一起 现在我要读一段我自己的笔记了： 我打开我一室一厅的房子 史蒂夫后来告诉我 即使他多次见过我病发的时候，也还是 为他当天见到的我吃惊。 我有一个星期没怎么吃东西了 我很憔悴， 我走路的时候 感觉自己的脚是木头做的 我感觉自己的脸是一张面具 我把所有的窗帘都关起来了 正午的时候 我的房间几乎是完全黑暗的 空气难闻， 屋子凌乱 史蒂夫， 作为一个律师和心理学家，治疗过 很多有严重精神病的患者， 直到今天 他会觉得这是他见过的最坏的情况了 “你好”， 我说， 然后回到我沉静了 一时的沙发上 谢谢你的到来 摇摇欲坠的世界，词， 声音 告诉钟停下来 时间， 时间来了 “外特要离开了”， 史蒂夫说 “我被推倒坟墓里了， 处境就是坟墓” 我呻吟到 地心引力在把我往下拉 我很害怕， 告诉他门离开“

作为一个年轻女人， 我在精神病院里 待过三段很长的时间。 我的医生给我诊断了慢性精神分裂 给了我一个”不乐观“的预测 就是说， 我只能在看护下活着 做很低下的工作 但是很幸运的是， 我其实没有 执行这个预测 相反， 我是一个南加州大学Gould 法学院的首席法律教授， 心理学教授，精神病学教授。 我有很多亲近的朋友 和亲爱的丈夫， 他今天也来了

谢谢！ 他当然是我人生钟的明星。

我想和你分享这是怎样发生的， 而且向你描述我作为一个精神病患者 我想说的是，这只是我的经历 因为每个人的精神病多有不同的症状

让我们从精神分裂的定义开始把， 精神分裂是一种大脑疾病 它的主要症状是幻想， 或者是与 现实脱离 妄想和幻觉 是这个病的标志 妄想是顽固，错误和不会因为现实而改变的信仰 幻觉是不存在的感觉 比如， 当我病发的时候， 我总是有我用我的想法 杀了几百个人的错觉 我有时候会觉得 自己脑子里正要发生核爆炸 也有时候， 我有幻觉 有个人在我后面 高举这一把刀 想象以下在清醒的情况下做噩梦

言语和思想经常变得没有头绪 简直没有任何逻辑 当人有散漫的联想的时候， 就会把一些很相似的词 放在一起， 没有任何意义 感觉像一个文字混在一起的“沙拉” 和大部分人以为的恰好相反，精神分裂不是 多重人格或 人格分裂 精神分裂的大脑不是分开的， 是破碎的

每个人都看到过街上有人 不修边幅， 营养不良 站在外面乱对自己说话 或者大声嚷嚷 这种人多半是有精神分裂 但是精神分裂出现在很多不同的 社会层次中。 其中有很多患者 是有全职工作的， 承担着很大责任的。 几年前， 我决定 把我的个人经历写下来 而且我像和你分享更多我的个人经历 以此给大家一个轻身经历的人的角度看待这个事情

接下载这件事发生在我上耶鲁大学法学院 的第一学期的第七周 从我的笔记中： ”我的两个同学， Rebel和Val 和我约了一个时间 星期五一起在图书馆 学习我们的备忘录的作业 但是我们没有完成， 因为我开始 胡言乱语

“备忘录是探访”， 我告诉他们 “他们有写观点， 观点就在你脑子里， Pat 曾经就这么说， 你杀了人吗？‘ Rebel 和Val看着我， 好像我在 他们脸上泼了冷水一样 “你在说什么？， Elyn？“ ”哦， 你知道的， 谁是什么， 什么是谁？， 天堂和地狱，让我们去屋顶。 那是平的， 那里安全。“ Rebel和Val跟着我 问我怎么了 ”这就是真正的我“ 我说 高高的挥着我的手 然后， 在星期五很晚的时候， 在法学院的楼顶上 我开始唱歌，很大声 ”来到佛罗里达 阳光和灌木 你想跳舞吗？“ ”你嗑药了吗” 有人问， “你high了吗？” “咳？不可能， 没有嗑药。 来到佛罗里达， 阳光灌木， 那里有柠檬， 那里有恶魔 “你吓倒我了”， 他们一个人说， Rebel和Val 回到了图书馆。 我耸耸肩， 跟着他们。

回来之后， 我告诉我的同学他们 有没有同样的胡言乱语的经历 像我一样 “我觉得有人进入了我的案件” 我说 “我们要把关节装起来， 我不相信关节， 但是 它们能把身体连起来。－－ 这就是一个散漫联想的例子 最终我回到了宿舍 到了后， 我没有办法安心。 我脑子里都是噪音 到处都是桔子树和我写不出来的法律备忘录 以及那些我需要为之负责任的大规模谋杀。 坐在床上， 我摇来摇去 在孤独和恐惧中呻吟。” 这次发病让我第一次在美国住院了， 我前两次在英国

继续我的笔记： “第二天， 我来到我教授办公室， 问 我能不能晚点交作业， 然后喔喔喔欧开始胡言乱语， 就像前一天晚上一样 他最后把我送到急诊室 到了之后，有一个人， 我就叫他“医生”吧， 和他的野蛮助手们，飞扑下来 把我举的高高的 然后狠狠的摔在了一张金属床上 重的我都看到星星了 然后它们把我的手脚都帮起来了 用很厚的皮带 一个我丛没有听到过的声音丛我嘴里说出来： 一半呻吟， 一半尖叫 惨无人性，纯粹恐惧 然后这个声音又出现了 从我的肚子了逼出来的 刮着我的喉咙 这个事情导致了我被强制住院 其中一个理由我医生给的强制住院的理由是 我严重 生活不自理 为了支持这个说法， 它们在我的档案里写说我 不能完成我耶鲁法学院的作业。 我不知道这对其他的纽黑文的人意味着什么 （笑声）

在第二年， 我又 在医院里待了五个月 有时候， 我会再机械限制中度过20小时， 手被捆这， 手和脚被紧紧的捆着 手和脚被捆着， 而且胸前 还有一个网子绑着 我没有打任何人 我没有害任何人， 我没有直接威胁任何人 如果你没有被限制过， 你可能 对这个经历有个不差的印象 但是其实糟透了

再美国， 每周 都有一到三个人死于这种限制 他们被缧， 吸着自己的呕吐物 他们被窒息， 他们心脏病发作 不知道这种机械限制是在 救人还是害人 当我在耶鲁法学院刊物上给学生准备关于机械限制的 讲义时， 我咨询了一位知名的法学教授 和精神病学家 并向他肯定了这种 限制时伤人自尊， 痛苦和可怕的 他理解的看着我， 说 “Elyn， 你还是不明白： 这些人又精神病。 他们和你和我都不一样 他们不会像你我一样经历限制。 我当时没有勇气告诉他 不， 我们和你并没有什么不同 我们不喜欢被捆绑在床上 跟他一样不喜欢在那里受苦 事实上， 最近 我肯定现在还是有人觉得 这些限制能帮助病人感到安全 我从来没有遇到过一个精神病 同意这种说法 今天， 我非常赞成心理治疗 但是非常反对强制型治疗 我觉得强迫没有效果， 而且对一个有严重精神病的人 实施强制手段 是很可怕的

最终， 我来到了洛杉矶 在南加州法学院教书 这些年来， 我一直反对用药 为此会付出一切。 我感觉到我不服用药物也可以保持 我想要证明毕竟 我精神上没问题,只不过是诊断上犯得错误而已 我的理念是服药越少,瑕疵就越少 我的分析师 Kaplan博士,当时劝我 坚持服药并且就这样生活下午 但是我决定我想要最最后一次尝试 从文中引用: "我开始减少我的用药量,而在短时间之内 我就感觉到了一些变化 在从牛津旅行回来后,我冲进了Kaplan 的办公室,冲向角落,蹲了下来 捂住我的脸,开始颤抖 在我周围我感觉到了拿了匕首的恶魔 他们把我切成了碎片 或者让我吞下滚烫的煤球 Kaplan后来把我当时情景描述为"在撕心裂肺的痛苦中蠕动" 即使在这个状态下,他准确地描述为 急性神经病 我拒绝服用更多的药物 因为任务还没有完成

在与Kaplan的面会结束后, 我去看了Marder医生,一位精神分裂症专家 他是负责观察我用药的副作用的 他觉得我可能有一定程度上的精神分裂 一次在他的办公室,我坐在沙发上,蜷缩起来, 然后开始喃喃自语 "头破血流,人们试图杀戮, 我能不能把你的办公室彻底当垃圾处理?" "如果你那么想的话,你需要现在离开." Marder说 "好吧.小一点.在冰上的火.告诉他们不要杀我. 告诉他们不要杀我.我做错什么了? 成百上千个想法被封锁 "Elyn,你是不是觉得 你对自己或他人很危险? 我认为你应该待在医院里 我可以现在就让你被容纳进来,整个事情会变得 十分分散." "哈哈哈, 你想把我放在医院里? 医院是不好的,它们都疯了,它们都十分难过 任何一个人都得远离医院.我就是上帝,或者我以前是." 在那个情况下, 当我说"我是上帝,或者我以前是"的时候,我的丈夫 在边上记了一笔 他问:"那你是退出了还是被开除了?" (笑声) "我创造生命然后我拿走他们, 原谅我吧,因为我不知道该做什么."

最后,我在朋友面前倒塌了, 然后每个人都想说服我去继续服用药物 我在也不能否定事实了, 而且我无法改变这样一个事实 那堵隔离我,Elyn还有Saks教授的墙 与那个疯女人住院的年头所隔离 在废墟中倒塌."

任何关于此疾病都暗示我不应该在这里 但是我还是在这里.我觉得吧..有三个原因: 第一,我已经有了极好的治疗了 一周四到五次的心理分析和心理治疗 持续了几十年,以及非常先进的心理配药 第一,我有我的家庭成员都朋友都知道 我和我的疾病 这些关系给我的人生 一个意味和一个深度,他们还帮助我 在这些症状面前找到生活的方向 第三,我在一个极具支持力的工作环境里工作 就在USC法律学校 这是一个不仅仅满足我需求的地方 而且实际上它拥抱我的需求 它也同样是一个刺激思考的地方 能够使我的脑子充满各种复杂的问题 这些都是最强有力最有依赖性的抵御 我精神疾病的武器

即使这些全都有---良好的治疗,融合的家庭和 朋友,和谐的工作环境-- 直到很晚我才公开了 我这个疾病 因为与精神疾病作斗争的烙印 太强大了以至于我想让别人知道 如果你今天啥都没听到, 你一定得记住这一点:这些都不是"精神分裂症" 而是患有精神分裂症的人们,而这些人可能 是你的配偶,也可能是你的孩子 可能是你的邻居,也可能是你的朋友 还有可能是你的同事

好吧.我就说说我最后的想法 我们需要为精神疾病的研究和治疗 进行更多的资源投资 我们理解这些疾病越到位, 我们能提供的治疗就越先进,这样一来, 我们就能给人们带来更多的关怀 而且不需要使用外力 而且,我们应该停止将精神疾病最恶化 说洛杉矶监狱是美国最大的心理医疗机构 是国家的悲剧和谣言 美国的监狱是那些被精神疾病所折磨的人 占领的,而且很多人在那 是因为他们从未接受过足够的治疗 我当初可以轻松地沦落到大家上 一条对娱乐行业和新闻业的建议: 整体来说,你们在与烙印和各种偏见斗争中 干得很不错 拜托了,继续让我们在你们的电影中,你的戏剧中, 你们的专栏中, 看到那些受严重精神疾病折磨的人 同情地描述他们, 并且有深度地挖掘他们, 通过他们亲身的经验而不是简单的一个诊断

最近,我朋友提出一个问题: 如果我手里有一片瞬间可以 治好我的药片,我吃不吃它? 诗人Rainer Maria Rilke 被提供了心理分析 他拒绝了,说到:"不要把我的邪恶拿走, 因为我的天使也有可能逃跑." 而我的精神病 是一个现实的噩梦,里面的恶魔十分可怕 以至于所有的天使都逃走了 那么我会不会吃掉那个药片了? 我不希望被看作是对于如果我没有精神疾病我会 拥有的生活所后悔 而我也不是在向任何人寻求怜悯 我实际想说的是我们所共享的人性 比精神疾病要重要的多 那些经历过精神疾病的人想要的 要是其他所有人想要的 Sigmund Freud说到:"去工作,去爱."

谢谢.

谢谢.谢谢.你们真善良.

So I'm a woman with chronic schizophrenia. I've spent hundreds of days in psychiatric hospitals. I might have ended up spending most of my life on the back ward of a hospital, but that isn't how my life turned out. In fact, I've managed to stay clear of hospitals for almost three decades, perhaps my proudest accomplishment. That's not to say that I've remained clear of all psychiatric struggles. After I graduated from the Yale Law School and got my first law job, my New Haven analyst, Dr. White, announced to me that he was going to close his practice in three months, several years before I had planned to leave New Haven. White had been enormously helpful to me, and the thought of his leaving shattered me.

My best friend Steve, sensing that something was terribly wrong, flew out to New Haven to be with me. Now I'm going to quote from some of my writings: "I opened the door to my studio apartment. Steve would later tell me that, for all the times he had seen me psychotic, nothing could have prepared him for what he saw that day. For a week or more, I had barely eaten. I was gaunt. I walked as though my legs were wooden. My face looked and felt like a mask. I had closed all the curtains in the apartment, so in the middle of the day the apartment was in near total darkness. The air was fetid, the room a shambles. Steve, both a lawyer and a psychologist, has treated many patients with severe mental illness, and to this day he'll say I was as bad as any he had ever seen. 'Hi,' I said, and then I returned to the couch, where I sat in silence for several moments. 'Thank you for coming, Steve. Crumbling world, word, voice. Tell the clocks to stop. Time is. Time has come.' 'White is leaving,' Steve said somberly. 'I'm being pushed into a grave. The situation is grave,' I moan. 'Gravity is pulling me down. I'm scared. Tell them to get away.'"

As a young woman, I was in a psychiatric hospital on three different occasions for lengthy periods. My doctors diagnosed me with chronic schizophrenia, and gave me a prognosis of "grave." That is, at best, I was expected to live in a board and care, and work at menial jobs. Fortunately, I did not actually enact that grave prognosis. Instead, I'm a chaired Professor of Law, Psychology and Psychiatry at the USC Gould School of Law, I have many close friends and I have a beloved husband, Will, who's here with us today.

(Applause) Thank you. He's definitely the star of my show.

I'd like to share with you how that happened, and also describe my experience of being psychotic. I hasten to add that it's my experience, because everyone becomes psychotic in his or her own way.

Let's start with the definition of schizophrenia. Schizophrenia is a brain disease. Its defining feature is psychosis, or being out of touch with reality. Delusions and hallucinations are hallmarks of the illness. Delusions are fixed and false beliefs that aren't responsive to evidence, and hallucinations are false sensory experiences. For example, when I'm psychotic I often have the delusion that I've killed hundreds of thousands of people with my thoughts. I sometimes have the idea that nuclear explosions are about to be set off in my brain. Occasionally, I have hallucinations, like one time I turned around and saw a man with a raised knife. Imagine having a nightmare while you're awake.

Often, speech and thinking become disorganized to the point of incoherence. Loose associations involves putting together words that may sound a lot alike but don't make sense, and if the words get jumbled up enough, it's called "word salad." Contrary to what many people think, schizophrenia is not the same as multiple personality disorder or split personality. The schizophrenic mind is not split, but shattered.

Everyone has seen a street person, unkempt, probably ill-fed, standing outside of an office building muttering to himself or shouting. This person is likely to have some form of schizophrenia. But schizophrenia presents itself across a wide array of socioeconomic status, and there are people with the illness who are full-time professionals with major responsibilities. Several years ago, I decided to write down my experiences and my personal journey, and I want to share some more of that story with you today to convey the inside view.

So the following episode happened the seventh week of my first semester of my first year at Yale Law School. Quoting from my writings: "My two classmates, Rebel and Val, and I had made the date to meet in the law school library on Friday night to work on our memo assignment together. But we didn't get far before I was talking in ways that made no sense.

'Memos are visitations,' I informed them. 'They make certain points. The point is on your head. Pat used to say that. Have you killed you anyone?' Rebel and Val looked at me as if they or I had been splashed in the face with cold water. 'What are you talking about, Elyn?' 'Oh, you know, the usual. Who's what, what's who, heaven and hell. Let's go out on the roof. It's a flat surface. It's safe.' Rebel and Val followed and they asked what had gotten into me. 'This is the real me,' I announced, waving my arms above my head. And then, late on a Friday night, on the roof of the Yale Law School, I began to sing, and not quietly either. 'Come to the Florida sunshine bush. Do you want to dance?' 'Are you on drugs?' one asked. 'Are you high?' 'High? Me? No way, no drugs. Come to the Florida sunshine bush, where there are lemons, where they make demons.' 'You're frightening me,' one of them said, and Rebel and Val headed back into the library. I shrugged and followed them.

Back inside, I asked my classmates if they were having the same experience of words jumping around our cases as I was. 'I think someone's infiltrated my copies of the cases,' I said. 'We've got to case the joint. I don't believe in joints, but they do hold your body together.'" -- It's an example of loose associations. -- "Eventually I made my way back to my dorm room, and once there, I couldn't settle down. My head was too full of noise, too full of orange trees and law memos I could not write and mass murders I knew I would be responsible for. Sitting on my bed, I rocked back and forth, moaning in fear and isolation." This episode led to my first hospitalization in America. I had two earlier in England.

Continuing with the writings: "The next morning I went to my professor's office to ask for an extension on the memo assignment, and I began gibbering unintelligably as I had the night before, and he eventually brought me to the emergency room. Once there, someone I'll just call 'The Doctor' and his whole team of goons swooped down, lifted me high into the air, and slammed me down on a metal bed with such force that I saw stars. Then they strapped my legs and arms to the metal bed with thick leather straps. A sound came out of my mouth that I'd never heard before: half groan, half scream, barely human and pure terror. Then the sound came again, forced from somewhere deep inside my belly and scraping my throat raw." This incident resulted in my involuntary hospitalization. One of the reasons the doctors gave for hospitalizing me against my will was that I was "gravely disabled." To support this view, they wrote in my chart that I was unable to do my Yale Law School homework. I wondered what that meant about much of the rest of New Haven. (Laughter)

During the next year, I would spend five months in a psychiatric hospital. At times, I spent up to 20 hours in mechanical restraints, arms tied, arms and legs tied down, arms and legs tied down with a net tied tightly across my chest. I never struck anyone. I never harmed anyone. I never made any direct threats. If you've never been restrained yourself, you may have a benign image of the experience. There's nothing benign about it.

Every week in the United States, it's been estimated that one to three people die in restraints. They strangle, they aspirate their vomit, they suffocate, they have a heart attack. It's unclear whether using mechanical restraints is actually saving lives or costing lives. While I was preparing to write my student note for the Yale Law Journal on mechanical restraints, I consulted an eminent law professor who was also a psychiatrist, and said surely he would agree that restraints must be degrading, painful and frightening. He looked at me in a knowing way, and said, "Elyn, you don't really understand: These people are psychotic. They're different from me and you. They wouldn't experience restraints as we would." I didn't have the courage to tell him in that moment that, no, we're not that different from him. We don't like to be strapped down to a bed and left to suffer for hours any more than he would. In fact, until very recently, and I'm sure some people still hold it as a view, that restraints help psychiatric patients feel safe. I've never met a psychiatric patient who agreed with that view. Today, I'd like to say I'm very pro-psychiatry but very anti-force. I don't think force is effective as treatment, and I think using force is a terrible thing to do to another person with a terrible illness.

Eventually, I came to Los Angeles to teach at the University of Southern California Law School. For years, I had resisted medication, making many, many efforts to get off. I felt that if I could manage without medication, I could prove that, after all, I wasn't really mentally ill, it was some terrible mistake. My motto was the less medicine, the less defective. My L.A. analyst, Dr. Kaplan, was urging me just to stay on medication and get on with my life, but I decided I wanted to make one last college try to get off. Quoting from the text: "I started the reduction of my meds, and within a short time I began feeling the effects. After returning from a trip to Oxford, I marched into Kaplan's office, headed straight for the corner, crouched down, covered my face, and began shaking. All around me I sensed evil beings poised with daggers. They'd slice me up in thin slices or make me swallow hot coals. Kaplan would later describe me as 'writhing in agony.' Even in this state, what he accurately described as acutely and forwardly psychotic, I refused to take more medication. The mission is not yet complete.

Immediately after the appointment with Kaplan, I went to see Dr. Marder, a schizophrenia expert who was following me for medication side effects. He was under the impression that I had a mild psychotic illness. Once in his office, I sat on his couch, folded over, and began muttering. 'Head explosions and people trying to kill. Is it okay if I totally trash your office?' 'You need to leave if you think you're going to do that,' said Marder. 'Okay. Small. Fire on ice. Tell them not to kill me. Tell them not to kill me. What have I done wrong? Hundreds of thousands with thoughts, interdiction.' 'Elyn, do you feel like you're dangerous to yourself or others? I think you need to be in the hospital. I could get you admitted right away, and the whole thing could be very discrete.' 'Ha, ha, ha. You're offering to put me in hospitals? Hospitals are bad, they're mad, they're sad. One must stay away. I'm God, or I used to be.'" At that point in the text, where I said "I'm God, or I used to be," my husband made a marginal note. He said, "Did you quit or were you fired?" (Laughter) "'I give life and I take it away. Forgive me, for I know not what I do.'

Eventually, I broke down in front of friends, and everybody convinced me to take more medication. I could no longer deny the truth, and I could not change it. The wall that kept me, Elyn, Professor Saks, separate from that insane woman hospitalized years past, lay smashed and in ruins."

Everything about this illness says I shouldn't be here, but I am. And I am, I think, for three reasons: First, I've had excellent treatment. Four- to five-day-a-week psychoanalytic psychotherapy for decades and continuing, and excellent psychopharmacology. Second, I have many close family members and friends who know me and know my illness. These relationships have given my life a meaning and a depth, and they also helped me navigate my life in the face of symptoms. Third, I work at an enormously supportive workplace at USC Law School. This is a place that not only accommodates my needs but actually embraces them. It's also a very intellectually stimulating place, and occupying my mind with complex problems has been my best and most powerful and most reliable defense against my mental illness.

Even with all that — excellent treatment, wonderful family and friends, supportive work environment — I did not make my illness public until relatively late in life, and that's because the stigma against mental illness is so powerful that I didn't feel safe with people knowing. If you hear nothing else today, please hear this: There are not "schizophrenics." There are people with schizophrenia, and these people may be your spouse, they may be your child, they may be your neighbor, they may be your friend, they may be your coworker.

So let me share some final thoughts. We need to invest more resources into research and treatment of mental illness. The better we understand these illnesses, the better the treatments we can provide, and the better the treatments we can provide, the more we can offer people care, and not have to use force. Also, we must stop criminalizing mental illness. It's a national tragedy and scandal that the L.A. County Jail is the biggest psychiatric facility in the United States. American prisons and jails are filled with people who suffer from severe mental illness, and many of them are there because they never received adequate treatment. I could have easily ended up there or on the streets myself. A message to the entertainment industry and to the press: On the whole, you've done a wonderful job fighting stigma and prejudice of many kinds. Please, continue to let us see characters in your movies, your plays, your columns, who suffer with severe mental illness. Portray them sympathetically, and portray them in all the richness and depth of their experience as people and not as diagnoses.

Recently, a friend posed a question: If there were a pill I could take that would instantly cure me, would I take it? The poet Rainer Maria Rilke was offered psychoanalysis. He declined, saying, "Don't take my devils away, because my angels may flee too." My psychosis, on the other hand, is a waking nightmare in which my devils are so terrifying that all my angels have already fled. So would I take the pill? In an instant. That said, I don't wish to be seen as regretting the life I could have had if I'd not been mentally ill, nor am I asking anyone for their pity. What I rather wish to say is that the humanity we all share is more important than the mental illness we may not. What those of us who suffer with mental illness want is what everybody wants: in the words of Sigmund Freud, "to work and to love."

Thank you.

Thank you. Thank you. You're very kind.