【书籍连载】登天之梯：一个儿童心理咨询师的诊疗笔记 中英逐句对照 第五章 part 2

Like Laura and Virginia, Leon had been deprived of the critical stimuli necessary to develop the brain areas that modulate stress and link pleasure and comfort with human company. His cries had gone unanswered, his early need for warmth and touch unmet. At least Virginia had known consistent care in her foster homes, even though she was moved from one to another repeatedly, and at least Laura had known the constant presence of her mother, even if she hadn’t received enough physical affection from her. But Leon’s early life was maddeningly inconstant. Sometimes Maria would pay attention to him, others times she would leave him home alone for the whole day. Occasionally Alan was home and would play with him, but more often he was out working or too exhausted from his long days to cope with a baby. An environment of such intermittent care punctuated by total abandonment may be the worst of all worlds for a child. The brain needs patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby’s stress system on high alert. Receiving no consistent, loving response to his fears and needs, Leon never developed the normal association between human contact and relief from stress. What he learned instead was that the only person he could rely on was himself.

像劳拉和弗吉尼亚一样，莱昂被剥夺了开发大脑区域所必需的关键刺激，这些大脑区域调节压力并将快乐和舒适与人类公司联系起来。他的哭声没有得到回应，他早年对温暖和触摸的需求没有得到满足。至少弗吉尼亚在她的寄养家庭中得到了始终如一的照顾，尽管她一再从一个寄养家庭搬到另一个寄养家庭，至少劳拉知道她母亲一直在身边，即使她没有从她那里得到足够的肉体关爱。但莱昂的早年生活变化无常，令人发狂。有时玛丽亚会注意他，有时她会整天把他一个人留在家里。艾伦偶尔在家陪他玩，但更多时候他在外面工作，或者因为长时间的工作而筋疲力尽，无力应付婴儿。这种断断续续的照顾环境，间或被完全遗弃，对孩子来说可能是世界上最糟糕的环境。大脑需要有规律的、重复的刺激才能正常发育。从恐惧、孤独、不适和饥饿中解脱出来的痉挛性、不可预知的解脱使婴儿的压力系统处于高度戒备状态。由于没有收到对他的恐惧和需求的始终如一的、充满爱意的回应，莱昂从未发展出人际交往与缓解压力之间的正常联系。相反，他学到的是，他唯一可以依靠的人就是他自己。莱昂从未发展出人际交往与缓解压力之间的正常联系。相反，他学到的是，他唯一可以依靠的人就是他自己。莱昂从未发展出人际交往与缓解压力之间的正常联系。相反，他学到的是，他唯一可以依靠的人就是他自己。

When he did interact with others, his neediness made him seem alternately demanding, aggressive, and cold. In vain attempts to get the love and attention he desperately required, Leon would lash out, hit people, take things, and destroy them. Receiving only punishment, his rage grew. And the “worse” he behaved, the more he confirmed to those around him that he was “bad” and didn’t deserve their affection. It was a vicious cycle, and as Leon got older his misbehavior escalated from bullying into crime.

当他确实与他人互动时，他的需要让他看起来时而要求苛刻、咄咄逼人、时而冷漠。为了获得他迫切需要的爱和关注，但徒劳无功，莱昂会猛烈抨击，打人，拿东西，毁掉他们。只受到惩罚，他的愤怒越来越大。他表现得越“坏”，他就越向周围的人证实他是“坏”的，不值得他们的爱。这是一个恶性循环，随着里昂年龄的增长，他的不当行为从欺凌升级为犯罪。

Leon could see that other people liked to be hugged and touched, but since his own needs for that had been neglected, he began to find it repellent. He could see that other people enjoyed interacting with each other, but because he’d been denied early attention, it now mostly left him cold. He just didn’t understand relationships.

里昂看得出别人喜欢被拥抱和抚摸，但由于他自己的需求被忽视了，他开始觉得很反感。他看得出来其他人喜欢相互交流，但由于他早年得不到关注，现在大多让他感到冷漠。他只是不明白人际关系。

Leon could enjoy food, could enjoy material pleasures like toys and television, and could relish physical sensations, including those associated with his developing sexuality. But because he’d been neglected when key social circuitry of the brain was developing he couldn’t really appreciate the pleasure of pleasing someone else or receiving their praise, nor did he suffer particularly from the rejection that followed if his behavior displeased teachers or peers. Having failed to develop an association between people and pleasure, he saw no need to do as they wished, felt no joy in making them happy, and didn’t care whether or not they got hurt.

莱昂可以享受美食，可以享受玩具和电视等物质享受，还可以享受身体的感觉，包括那些与他发展中的性欲相关的感觉。但是因为在大脑的关键社交回路发育时他被忽视了，他无法真正体会到取悦别人或得到他们称赞的乐趣，如果他的行为让老师或同龄人不高兴，他也不会因为随之而来的拒绝而感到特别痛苦. 由于未能在人与快乐之间建立联系，他认为没有必要为所欲为，让他们快乐并不快乐，也不在乎他们是否受到伤害。

When he was two-and-a-half, Leon’s behavioral problems qualified him for an early intervention preschool program, which could have been a great opportunity, but in fact only worsened his problems. Now his mother no longer left him alone during the day, and he was exposed to enough cognitive stimulation to learn to talk and to intellectually understand what was expected of him. But this didn’t make up for what he’d missed. While well intentioned, the program had only one caregiver to handle five or six severely troubled toddlers, a child to adult ratio that may not be enough to give appropriate attention to normal children that age, let alone those with emotional disorders.

当他两岁半时，Leon 的行为问题使他有资格参加早期干预学前班计划，这本可以是一个很好的机会，但实际上只会使他的问题变得更糟。现在，他的母亲白天不再让他一个人呆着，他也受到了足够的认知刺激，可以学习说话，也可以从理智上理解对他的期望。但这并不能弥补他错过的一切。虽然用心良苦，但该计划只有一名看护人来照顾五六个有严重问题的蹒跚学步的幼儿，儿童与成人的比例可能不足以适当关注该年龄段的正常儿童，更不用说那些有情绪障碍的儿童了。

The cognitive development of his cortex did, however, allow Leon to take note of how other people behaved. Over time he became able to mimic appropriate behavior when he wanted to. This allowed him to manipulate others into getting what he wanted, though his underdeveloped limbic and relational neural systems limited him to shallow, superficial relationships. For him people were just objects that either stood in his way or acceded to his needs. He was a classic sociopath (the psychiatric diagnosis is antisocial personality disorder, or ASPD), and one I think who was almost entirely a product of his environment, not his genes. I believe that if he had been raised the way his brother Frank had been, he probably would have grown up to have a normal life, and would almost certainly have never become a murderer and rapist.

然而，大脑皮层的认知发展确实让莱昂能够注意到其他人的行为。随着时间的推移，他变得能够在他想要的时候模仿适当的行为。这使他能够操纵他人以获得他想要的东西，尽管他不发达的边缘和关系神经系统将他限制在肤浅、肤浅的关系中。对他来说，人只是阻碍他前进或满足他需要的东西。他是一个典型的反社会者（精神病学诊断是反社会人格障碍，或 ASPD），我认为他几乎完全是他的环境的产物，而不是他的基因。我相信，如果他像他哥哥弗兰克那样被抚养长大，他可能会长大后过上正常人的生活，而且几乎可以肯定永远不会成为杀人犯和强奸犯。

Even the steps taken to help him—for example the preschool intervention program that placed him in a group of other disturbed children—only worsened his condition. Research has repeatedly found that surrounding a child with other troubled peers only tends to escalate bad behavior. This pattern of backfiring interventions would continue through his childhood and adolescence as he was shunted into “special ed” and other programs. There, he also found other antisocial peers who reinforced each other’s impulsivity. They became partners in crime, egging each other on and modeling for each other the idea that violence is the best way to solve problems. Furthermore, through what he saw in his neighborhood, at the movies, and on the TV that was always on in most of the places where he spent his time, he also got the message that violence solves problems and that there was pleasure to be had in wielding physical power over others. Leon learned to copy the worst of human behavior, but remained unable to understand why he should imitate the best.

即使是为帮助他而采取的措施——例如将他置于一群其他心烦意乱的儿童中的学前干预计划——也只会使他的状况恶化。研究一再发现，将孩子与其他有问题的同龄人在一起只会加剧不良行为。这种适得其反的干预模式将持续到他的童年和青春期，因为他被分流到“特殊教育”和其他项目。在那里，他还发现了其他反社会的同龄人，他们互相强化了对方的冲动。他们成为犯罪伙伴，互相怂恿并互相示范暴力是解决问题的最佳方式。此外，通过他在附近、电影院和在他度过的大部分时间里总是开着的电视上看到的东西，他还得到这样的信息，即暴力可以解决问题，并且在对他人施加体力时会感到快乐。莱昂学会了模仿人类最坏的行为，但仍然不明白为什么他应该模仿最好的行为。

There are other brain disorders that affect the ability to empathize that provide insight on sociopathy like Leon’s. Most notable are autism spectrum disorders (ASDs), including what was previously known as Asperger’s syndrome, the less severe form of autism. ASDs appear to be strongly genetically influenced and range widely in their link to disability. About one-third of autistic children never learn to speak and all of them tend to isolate themselves from others, frequently focusing more on objects than on people. Autistic boys don’t usually engage in imaginative play—and although many people on the spectrum desperately want to connect with others, they have great difficulty in forming and understanding relationships.

还有其他影响移情能力的脑部疾病，这些疾病提供了对像莱昂这样的社会病态的洞察力。最值得注意的是自闭症谱系障碍 (ASD)，包括以前称为阿斯伯格综合症的症状，这是一种不太严重的自闭症。ASD 似乎受到强烈的遗传影响，并且与残疾的联系范围很广。大约三分之一的自闭症儿童从未学会说话，而且他们都倾向于将自己与他人隔离开来，通常更关注物体而不是人。自闭症男孩通常不参与富有想象力的游戏——尽管许多自闭症患者迫切希望与他人建立联系，但他们在建立和理解人际关系方面存在很大困难。

ASDs are almost always accompanied by sensory integration problems and differences in sensitivity, such as being unable to tolerate “itchy” fabrics and being overwhelmed by loud noises or bright lights. Autistic children also have repetitive behaviors like rocking and odd obsessions, typically with moving objects—for example, trains or the wheels on toy cars. Some autistic people are highly talented at understanding complex systems like math, music, and computer science, and most develop focused interests in particular objects or ideas.

ASD 几乎总是伴随着感觉统合问题和敏感性差异，例如无法忍受“发痒”的织物，以及被嘈杂的噪音或强光淹没。自闭症儿童也有重复行为，如摇晃和奇怪的痴迷，通常是移动物体——例如，火车或玩具车的轮子。一些自闭症患者在理解数学、音乐和计算机科学等复杂系统方面非常有天赋，并且大多数人对特定的对象或想法产生了浓厚的兴趣。

People with Asperger’s are better at connecting with others and functioning in society than those with more severe forms of autism, but their obsessions and inability to read social cues often keep them isolated. Their poor social skills can also make it hard for them to get or keep a job, although in some cases their mathematical and engineering abilities more than compensate for their awkwardness. Many children tagged as “geeks” or “nerds” because of their inability to relate to their peers may have an ASD or come close to meeting the criteria for one.

患有阿斯伯格综合症的人比患有更严重自闭症的人更善于与他人建立联系并在社会中发挥作用，但他们的痴迷和无法阅读社交线索往往使他们孤立无援。他们糟糕的社交技能也会让他们很难找到或保住工作，尽管在某些情况下，他们的数学和工程能力足以弥补他们的尴尬。许多由于无法与同龄人相处而被标记为“极客”或“书呆子”的孩子可能患有自闭症或接近于自闭症的标准。

In order to function socially, people need to develop what is known as a “theory of mind.” They need to know, in other words, that other people are distinct from them, have different knowledge about the world and have different desires and interests. In autism this distinction is blurred. One reason some autistic children may not talk is that they don’t recognize the need to communicate; they aren’t aware that other people don’t know what they know. In one famous experiment, researchers put a pencil in a tube that ordinarily held candy and asked autistic children what someone outside the room would expect to find in it. Normal and even Down syndrome preschoolers said candy. But the autistic children insisted that others would expect the pencil, not realizing that people who hadn’t seen the candy removed would think it was still there. The children knew the candy was gone, so their logical assumption was that everyone else must know, too. (The brain regions involved in coding “theory of mind” are believed to be in the left medial frontal cortex, just over the eyes.)

为了在社会上发挥作用，人们需要发展所谓的“心智理论”。换句话说，他们需要知道其他人与他们不同，对世界有不同的了解，有不同的愿望和兴趣。在自闭症中，这种区别是模糊的。一些自闭症儿童不会说话的原因之一是他们没有意识到交流的必要性；他们不知道其他人不知道他们所知道的。在一个著名的实验中，研究人员将一支铅笔放入通常装有糖果的管子中，并询问自闭症儿童在房间外的人会期望从中找到什么。正常甚至唐氏综合症学龄前儿童都说糖果。但是自闭症儿童坚持认为其他人会期待铅笔，没有意识到没有看到糖果被拿走的人会认为它还在那里。孩子们知道糖果不见了，所以他们的逻辑假设是其他人也必须知道。（据信，参与编码“心理理论”的大脑区域位于左侧内侧额叶皮层，就在眼睛上方。）

Unlike sociopaths like Leon, however, autistic people, although odd, do not tend toward violence or crime despite their problems with perspective taking and with recognizing, for example, that ignoring someone might be hurtful to him. Their problem with empathy is conceptual. Autistic people can be insensitive to the feelings and needs of others, but this usually occurs when they cannot fully perceive these feelings, not because they wish to cause harm or to be unkind. They have every capacity to love and feel emotional pain, but not the wiring that allows them to easily understand how to interact and have relationships. They may have difficulty imagining what it’s like to be in someone else’s shoes—sometimes called “mind-blindness”—but they do not lack sympathy for those people’s experiences when they become aware of them.

然而，与莱昂这样的反社会者不同，自闭症患者虽然很奇怪，但并不倾向于暴力或犯罪，尽管他们在换位思考方面存在问题，并且在认识到忽视某人可能对他造成伤害等方面存在问题。他们的同理心问题是概念性的。自闭症患者可能对他人的感受和需求不敏感，但这通常发生在他们无法完全感知这些感受时，而不是因为他们希望造成伤害或不友善。他们有能力去爱和感受情感上的痛苦，但没有让他们轻松理解如何互动和建立关系的线路。他们可能难以想象设身处地为别人着想是什么感觉——有时称为“心智盲”——但当他们意识到这些人的经历时，他们并不缺乏同情。

Sociopaths like Leon are different. Their inability to empathize is a difficulty with mirroring the feelings of others coupled with a lack of compassion for them. In other words, they not only don’t completely recognize what other people feel, but they don’t care if they hurt them or they even actively desire to do so. They can imagine walking in someone else’s shoes, and they can predict how other people will behave based upon this ability to put themselves in someone else’s place, but they don’t care what it’s like there. Their only concern is how others will affect them.

像莱昂这样的反社会人士是不同的。他们无法同理心是因为难以反映他人的感受，加上对他人缺乏同情心。换句话说，他们不仅不完全理解别人的感受，而且他们不在乎他们是否伤害了他们，甚至主动想要这样做。他们可以想象穿上别人的鞋子走路，他们可以根据这种设身处地的能力来预测其他人的行为，但他们不关心那里的情况。他们唯一关心的是别人会如何影响他们。

In essence, they have a “theory of mind,” but it is twisted. Not being able to fully experience love, they see it as something you promise in order to get sex, for example, not as a genuine feeling. Because they use other people’s feelings as a way to manipulate them, sociopaths assume that’s what everyone else does, too. Not feeling pleasure from relationships, they don’t believe others genuinely feel it, either. Since they are selfish, they believe others act only in their own self-interest as well. As a result, they dismiss appeals for attention or mercy as manipulative attempts to take power, not as genuine emotional pleas. They are emotionally frozen, in an ice that distorts not only their own feelings, but also how they see the feelings of others and then respond to them.

本质上，他们有一个“心智理论”，但它被扭曲了。由于无法充分体验爱，他们将其视为您为了获得性爱而做出的承诺，例如，而不是一种真实的感觉。因为他们利用他人的感受来操纵他们，所以反社会人士认为其他人也是这样做的。他们不会从人际关系中感受到快乐，他们也不相信其他人会真正感受到这种快乐。因为他们是自私的，所以他们相信其他人也只为自己的利益行事。因此，他们将寻求关注或怜悯的呼吁视为夺取权力的操纵企图，而不是真正的情感请求。他们在情感上被冻结了，冰层不仅扭曲了他们自己的感受，也扭曲了他们如何看待他人的感受，然后如何回应他人的感受。

UNSURPRISINGLY RESEARCH HAS now identified that some of the chemical correlates of sociopathy can be found in some of the same neurotransmitter systems that compose our stress response systems: alterations in serotonin, norepinephrine, and dopamine systems have been implicated in aggressive, violent, or antisocial behavior. Young people exhibiting antisocial traits and callous behavior tend to have abnormal levels of the stress hormone cortisol (which can be measured in a saliva test). Sociopaths are notorious for being able to fool lie detector tests, which actually measure physical responses related to anxiety and stress, not deception. It appears that their stress systems—either because they were placed on overdrive due to early trauma or because of genetic vulnerability or, most likely, some combination of both—are dysregulated, no longer responsive to anything except extreme stimulation. This makes them appear “cold” and unemotional and allows them to lie with impunity, as they do not show the signs of fear of detection that tend to give others away. It may also mean that far higher levels of painful or pleasurable stimulation are necessary in order for them to feel anything at all. Unlike people whose response to trauma is to get stuck in a highly sensitized state in which any stress at all triggers a massive response, sociopaths’ systems appear to have gotten stuck at the other end of the spectrum, in deadening—and sometimes deadly—numbness.

不出所料，研究现在已经确定，在构成我们的应激反应系统的一些相同神经递质系统中可以发现一些与社会病态相关的化学物质：血清素、去甲肾上腺素和多巴胺系统的改变与攻击性、暴力或反社会行为有关. 表现出反社会特征和冷酷行为的年轻人往往有异常水平的应激激素皮质醇（可以在唾液测试中测量）。反社会人士因能够骗过测谎仪测试而臭名昭著，测谎仪测试实际上测量的是与焦虑和压力相关的身体反应，而不是欺骗。看来他们的压力系统——要么是因为他们由于早期创伤而过度运转，要么是因为遗传脆弱性，或者很可能是两者的某种结合——失调了，除了极度刺激外不再对任何事物有反应。这使他们显得“冷漠”且没有感情，并允许他们撒谎而不受惩罚，因为他们没有表现出害怕被发现的迹象，而这种迹象往往会暴露他人。这也可能意味着需要更高水平的痛苦或愉悦刺激才能让他们有任何感觉。与那些对创伤的反应是陷入高度敏感状态的人不同，在这种状态下，任何压力都会引发巨大的反应，反社会者的系统似乎陷入了光谱的另一端，变得麻木——有时甚至是致命的——麻木. 这也可能意味着需要更高水平的痛苦或愉悦刺激才能让他们有任何感觉。与那些对创伤的反应是陷入高度敏感状态的人不同，在这种状态下，任何压力都会引发巨大的反应，反社会者的系统似乎陷入了光谱的另一端，变得麻木——有时甚至是致命的——麻木. 这也可能意味着需要更高水平的痛苦或愉悦刺激才能让他们有任何感觉。与那些对创伤的反应是陷入高度敏感状态的人不同，在这种状态下，任何压力都会引发巨大的反应，反社会者的系统似乎陷入了光谱的另一端，变得麻木——有时甚至是致命的——麻木.

While preparing my testimony, I thought hard about what I would say about Leon and what I believed about his own responsibility for his actions. Why did he kill? Why does anyone kill? Are these even the right questions? Maybe, I thought, I should try to understand what keeps the rest of us from killing, what didn’t put the brakes on Leon’s behavior. How exactly had things gone so wrong for this boy? How had he forged his misfortune, neglect, and trauma into hate—or did those things forge him entirely?

在准备我的证词时，我仔细考虑了我要对莱昂说些什么，以及我认为他对自己的行为负有什么责任。他为什么杀人？为什么有人杀人？这些甚至是正确的问题吗？也许，我想，我应该试着去了解是什么阻止了我们其他人的杀戮，又是什么没有阻止莱昂的行为。这个男孩究竟怎么会变得如此不对劲？他是如何将自己的不幸、疏忽和创伤变成仇恨的——或者这些东西完全塑造了他？

He was unquestionably guilty and did not meet the legal definition of insanity, which requires that a person be unable to tell right from wrong. Leon knew that murder was against the law and that it was reprehensible; he’d admitted it and he did not have any diagnosable mental illness that would impair his moral reasoning.

他无疑是有罪的，不符合精神错乱的法律定义，即一个人无法分辨是非。莱昂知道杀人是违法的，应该受到谴责。他承认了这一点，而且他没有任何可诊断的精神疾病会损害他的道德推理。

He met criteria for attention deficit disorder and conduct disorder during most of his childhood and youth. As an adult, Leon certainly fit the profile for both ADHD and ASPD, but those diagnoses, which simply describe symptoms like defiance, callous behavior, and an inability to focus attention, do not imply mental clouding that would overwhelm one’s ability to know that killing and raping people is not acceptable. These disorders involve decreased impulse control, but impaired impulse control does not mean complete lack of free will.

在童年和青年时期的大部分时间里，他都符合注意力缺陷障碍和品行障碍的标准。作为一个成年人，莱昂当然符合 ADHD 和 ASPD 的特征，但这些诊断只是描述了反抗、冷酷行为和无法集中注意力等症状，并不意味着精神上的阴霾会压倒一个人知道杀人的能力强奸人是不可接受的。这些障碍涉及冲动控制能力下降，但冲动控制能力受损并不意味着完全缺乏自由意志。

But what about Leon’s inability to give and receive love? Can we blame him for having a childhood that wilted the part of his brain that allows him to feel the greatest joys most of us have in life: the pain and pleasure of human connection? Of course not. He is responsible, I believe, for his reactions to his vulnerabilities. Virginia and Laura struggled with similar problems, but they did not become violent people, let alone murderers.

但是莱昂无法给予和接受爱呢？我们能责怪他的童年让他大脑中让他感受到我们大多数人生活中最大的快乐的部分变得萎靡不振：人际关系的痛苦和快乐吗？当然不是。我相信，他应对自己的弱点做出反应。弗吉尼亚和劳拉在类似的问题上挣扎，但他们并没有成为暴力的人，更没有成为杀人犯。

One might argue that this difference in outcome is due to gender and, indeed, male gender is the biggest predictor of violent behavior. Male murderers outnumber females by at least nine to one, though it appears that very recently, women have begun to close the gap. Nonetheless, throughout history, in every culture and even in most species, male violence predominates. Among our closest evolutionary cousins, the chimps, it is the males who make war on others, the males who are prone to use force. Yet I’d treated other adolescent boys with far worse histories of neglect, abuse and abandonment, and far fewer opportunities for love and affection than Leon had. Some had literally been raised in cages with no loving family at all, unlike Leon who had two parents and a brother, and who was neglected out of ignorance, not malice. Most of these boys who I’d treated grew up awkward and lonely, many were severely mentally ill, but the vast majority was not malign.

有人可能会争辩说，这种结果差异是由于性别造成的，事实上，男性是暴力行为的最大预测因素。男性凶手的数量至少比女性多 9 比 1，尽管最近女性似乎开始缩小这一差距。尽管如此，纵观历史，在每一种文化中，甚至在大多数物种中，男性暴力都占主导地位。在我们最亲近的进化表亲中，黑猩猩是雄性向其他人发动战争的，雄性更倾向于使用武力。然而，我曾治疗过其他青春期男孩，他们的忽视、虐待和遗弃经历要糟糕得多，获得爱和感情的机会也远少于里昂。有些人确实是在没有亲人的笼子里长大的，不像莱昂，他有两个父母和一个兄弟，并且由于无知而不是恶意而被忽视。

What about genetics? Could that explain Leon’s behavior? Disadvantageous genetics combined with a less-than-ideal environment was likely a factor in how he was raised and who he became. If Leon had had an easier temperament, for example, Maria might not have been so overwhelmed by his needs; if Maria had been more intelligent, she might have discovered better ways to cope with her challenging baby.

遗传学呢？这能解释 Leon 的行为吗？不利的遗传学加上不太理想的环境可能是影响他如何成长和成为什么样的人的一个因素。例如，如果里昂的性情比较轻松，玛丽亚就不会被他的需要压得喘不过气来。如果玛丽亚更聪明一些，她可能会找到更好的方法来应对她爱挑衅的孩子。

But what I think happened in Leon’s life was an escalation of small, in-themselves-inconsequential negative decisions made by him and for him that gradually led to a horrendous outcome for his victims, his family and himself. You may have heard of the “butterfly effect”: the idea that complex systems—most famously, that which determines the earth’s weather—are extraordinarily sensitive to minor fluctuations at certain critical points. Such systems are so responsive to tiny perturbations that, as the example goes, if a butterfly flutters its wings at the wrong instant in Brazil, it can trigger a series of events that may ultimately result in a tornado that devastates a small Texas town. The human brain, the ultimate complex system—in fact, the most complicated object in the known universe—is equally vulnerable to a version of the butterfly effect.

但我认为在莱昂的生活中发生的事情是他自己做出的一些无关紧要的小消极决定的升级，这些决定对他的受害者、他的家人和他自己来说逐渐导致了可怕的后果。您可能听说过“蝴蝶效应”：复杂系统（最著名的是决定地球天气的系统）对某些关键点的微小波动异常敏感。这样的系统对微小的扰动非常敏感，例如，如果一只蝴蝶在巴西的错误时刻振翅，它可能引发一系列事件，最终可能导致龙卷风摧毁德克萨斯州的一个小镇。人脑这个终极复杂系统——事实上，是已知宇宙中最复杂的物体——同样容易受到蝴蝶效应的影响。

This might also be called a “snowball effect”: when things go right early on, they will tend to continue to go right and even to self-correct if there are minor problems. But when they go wrong at first, they will tend to continue to go wrong.

这也可以称为“滚雪球效应”：当事情在早期进展顺利时，它们往往会继续保持良好状态，甚至会在出现小问题时自行纠正。但是当他们一开始就出错时，他们往往会继续出错。

This effect is literally built into the architecture of our brains and bodies. For example, it is a tiny chemical gradient that determines which of our early cells will become skin, which will become brain, and which will become bone, heart, and bowel. Other extremely tiny differences tell one neuron to become part of the cerebellum, another to become cerebrum, and similar slight differences in position and in concentration of certain chemicals determine which cells live and which will die.

这种影响确实融入了我们大脑和身体的结构中。例如，它是一个微小的化学梯度，决定了我们早期细胞中哪些会变成皮肤，哪些会变成大脑，哪些会变成骨骼、心脏和肠道。其他极其微小的差异告诉一个神经元成为小脑的一部分，另一个成为大脑的一部分，并且某些化学物质的位置和浓度的类似细微差异决定了哪些细胞存活，哪些细胞死亡。

We don’t have nearly enough genes to begin to determine the location or even the type of every cell: there are just 30,000 for the whole body and yet the brain alone has 86 billion nerve cells (and supporting glial cells for each of those). Each one of those billions of neurons makes between 5,000 and 10,000 connections, producing extraordinarily complex networks. Our bodies and especially our brains are built to magnify practically imperceptible initial incongruities into massively differentiated results. And this, in turn, allows us to respond to the complicated social and physical environment that we face.

我们几乎没有足够的基因来开始确定每个细胞的位置甚至类型：整个身体只有 30,000 个，但仅大脑就有 860 亿个神经细胞（以及支持每个细胞的神经胶质细胞） . 这数十亿个神经元中的每一个都建立了 5,000 到 10,000 个连接，从而产生了极其复杂的网络。我们的身体，尤其是我们的大脑天生就是为了将几乎难以察觉的初始不协调放大为差异巨大的结果。而这反过来又使我们能够应对我们所面临的复杂的社会和物理环境。

So, while for most babies, being born colicky does little more than frustrate their parents, for Leon it overwhelmed his mother’s already limited emotional resources. Without the presence of her extended family, there was no one to hand him off to when she was at her wit’s end, as there had been with Frank. Abandoning her infant during the day, she left him without the critical input he needed to soothe and, ultimately, organize his already slightly dysregulated stress response systems, making them even more chaotic and disorganized.

因此，虽然对于大多数婴儿来说，出生时绞痛只会让他们的父母感到沮丧，但对莱昂来说，这却让他母亲本已有限的情感资源不堪重负。没有她的大家庭在场，当她无计可施时，没有人可以把他交给弗兰克。白天遗弃了她的婴儿，她离开了他，没有他需要的关键输入来安抚，并最终组织他已经轻微失调的压力反应系统，使它们更加混乱和混乱。

This, in turn, left Leon alternately clingy and aggressive, hampering his social skills, which could potentially have allowed him to elicit the warmth and care he needed from elsewhere. It also further alienated him from his parents and created a cycle of misbehavior, punishment and increasing rage and distress. Then he was placed with a negative peer group, from preschool onwards, which further magnified the harm.

这反过来又让莱昂时而粘人又时而咄咄逼人，阻碍了他的社交技巧，而这本可以让他从别处获得他需要的温暖和关怀。这也进一步疏远了他的父母，并造成了一个行为不端、惩罚和越来越愤怒和痛苦的循环。然后，从学龄前开始，他就被置于一个消极的同龄人群体中，这进一步放大了伤害。

Surrounded by normal peers, he might have found people who could reach out to him, who might have offered him healthy friendships that could have led him away from antisocial behavior. But in the company of other angry, distressed, and needy children, and additionally stigmatized by the labels applied to them, he instead became more distressed and out of control, leading him to react with escalating impulsivity and aggression.

在普通同龄人的包围下，他可能会找到可以接触到他的人，他们可能会为他提供健康的友谊，让他远离反社会行为。但在其他愤怒、痛苦和有需要的孩子的陪伴下，再加上被贴在他们身上的标签，他反而变得更加痛苦和失控，导致他的反应越来越冲动和好斗。

At no one point did Leon make a conscious decision to become malevolent, but each small choice he or his family made pushed him further toward sociopathy, and each consequence of those choices made further negative choices increasingly likely. There were numerous forks in the road where different circumstances might have led Leon to become a better person, where better choices could have led to the start of a virtuous—not vicious—cycle. But unfortunately, he rejected every opportunity to turn away from his rage and impulsivity, and at none of those crossroads did he receive the appropriate help and support he needed from other people to pull him from the rut in which he’d become stuck.

莱昂从来没有做出有意识地变得恶毒的决定，但他或他的家人做出的每一个小选择都将他进一步推向反社会，而这些选择的每一个后果都使得进一步消极选择的可能性越来越大。道路上有许多岔路口，不同的环境可能会让莱昂成为一个更好的人，更好的选择可能会导致良性而非恶性循环的开始。但不幸的是，他拒绝了每一个摆脱愤怒和冲动的机会，而且在这些十字路口，他都没有从其他人那里得到他需要的适当帮助和支持，把他从陷入困境的陈规中拉出来。

The brain is built—our selves are built—from millions of tiny decisions—some conscious, most not. Seemingly irrelevant choices can result in tremendously different later outcomes. Timing is everything. We don’t know when the smallest choice, or “stimuli,” will push a developing brain onto the path of genius, or onto the highway to hell. I want to stress that this doesn’t mean that parents have to be perfect. But it’s important to know that young children are extraordinarily susceptible to the spiraling consequences of the choices we—and later they—make, for good and for ill.

大脑是从数以百万计的微小决定中构建出来的——我们自己也是构建出来的——有些是有意识的，大多数不是。看似无关紧要的选择可能会导致后来截然不同的结果。时机就是一切。我们不知道什么时候最小的选择或“刺激”会将正在发育的大脑推上天才之路，或者推上通往地狱的高速公路。我想强调的是，这并不意味着父母必须是完美的。但重要的是要知道，年幼的孩子特别容易受到我们——以及后来他们——做出的选择的螺旋式后果的影响，无论是好是坏。

Fortunately, the virtuous cycle is every bit as cascading and self-amplifying as the vicious cycle. A word of praise at just the right time, for example, can lead a child with a moderate interest in art to become more passionate about it. That intensity can escalate, leading him to develop greater skill, receive more praise, and, ultimately, build into his brain artistic genius, where once there may only have been modest potential.

幸运的是，良性循环与恶性循环一样具有级联性和自我放大性。例如，适时的赞美之词可以让一个对艺术兴趣不大的孩子变得更加热爱艺术。这种强度可以升级，导致他发展出更高的技能，获得更多的赞扬，并最终在他的大脑中培养艺术天才，而在过去，这可能只有适度的潜力。

Some recent research emphasizes the power of this effect in sports. Half of England’s elite young soccer players on the teams that feed their professional leagues are born in the first three months of the year. The rest are equally distributed among the other months. Why should this be? Well, all youth teams have age cutoffs; if you are born earlier in the year, you are likely to be more physically mature, more skilled, and receive more rewards for your competence than those who are born later in that group. The pleasure of reward leads to more practice; we gravitate toward our competence. And, in the positive feedback cycle within the virtuous cycle, practice creates skill, skill attracts reward, and reward fuels practice. This small difference, enhanced over time by practice, leads to a huge difference, giving the earlier-born players a far better chance of making the cut by the time they reach the pros. These positive spirals are hard to predict, however. We just don’t know when the butterfly will billow its tiny breeze into a hurricane.

最近的一些研究强调了这种影响在体育运动中的力量。在英格兰职业联赛的球队中，有一半的精英年轻足球运动员是在一年的前三个月出生的。其余的平均分配给其他月份。为什么会这样？好吧，所有青年队都有年龄限制；如果你今年出生较早，那么你可能比该组出生较晚的人身体更成熟，技能更高，并因你的能力而获得更多奖励。奖励的乐趣导致更多的练习；我们被自己的能力所吸引。并且，在良性循环中的正反馈循环中，实践创造技能，技能吸引奖励，奖励推动实践。随着时间的推移，这种微小的差异会随着实践而增强，从而导致巨大的差异，让出生较早的球员在成为职业球员时有更好的机会晋级。然而，这些积极的螺旋式增长很难预测。我们只是不知道蝴蝶什么时候会把微风吹成飓风。

So what could I tell the court about Leon, and what did I believe about his chances for rehabilitation? I would testify that the development of his brain had been skewed by what had happened to him as an infant. And I would confirm the diagnoses of attention deficit disorder and conduct disorder, which are mitigating factors, even if they do not absolve him of responsibility for his actions.

那么我能告诉法庭关于 Leon 的什么信息，我对他康复的机会有何看法？我可以作证，他的大脑发育已经被婴儿时期发生的事情扭曲了。而且我会确认注意力缺陷障碍和品行障碍的诊断，这是减轻因素，即使它们不能免除他对他的行为的责任。

I would tell the court that his emotional, social, and cognitive problems and neuropsychiatric diagnoses were related to his mother’s unintentional neglect. His stress response systems had certainly received aberrant input: being left alone as an infant amped them up, and there was no one around at that critical time to teach him how to calm them down. And at the same time that these lower systems of the brain became overdeveloped, the higher, cortical regions surrounding them, the areas that modulate our responses to the world, our focus, and our self-control, were left underdeveloped.

我会告诉法庭，他的情绪、社交和认知问题以及神经精神病学诊断与他母亲的无意忽视有关。他的压力反应系统肯定收到了异常的输入：当婴儿被单独留下时，它们会变得更加活跃，而在那个关键时刻周围没有人教他如何让它们平静下来。与此同时，大脑的这些较低系统变得过度发达，而围绕它们的较高皮质区域，即调节我们对世界的反应、我们的注意力和我们的自我控制的区域，却没有得到充分开发。

I would also have to take into consideration the fact that Leon had been drinking when he committed his crime. Alcohol is disinhibiting; it reduces self-control and increases impulsiveness. Leon was already prone to acting without thinking; alcohol only exacerbated this tendency, with deadly consequences for his victims. Would he have committed the crime had he not been drinking first? I suspect not. The alcohol released the already-overwhelmed and improperly developed brakes on his behavior, allowing his rage and lust to take over. Had he not been drunk, he might have stopped himself long before he killed or even assaulted the girls.

我还必须考虑莱昂犯罪时一直在喝酒的事实。酒精是抑制的；它会降低自我控制并增加冲动。莱昂已经很容易不假思索地行动了；酒精只会加剧这种倾向，给受害者带来致命的后果。如果他不是先喝酒，他会犯罪吗？我怀疑不是。酒精释放了他已经不堪重负和不当发展的行为刹车，让他的愤怒和欲望接管了一切。如果他没有喝醉，他可能会在杀死甚至殴打女孩之前很久就停下来。

I ultimately testified about Leon’s early childhood and its effects on his ability to maintain relationships, his impulse control, and his attentiveness. I discussed how early neglect can predispose children to reduced empathy and violence. I included all the mitigating factors that I had found. It was all I could do: there was no case to be made that he was not legally responsible for his actions, and I could not deny that he was an ongoing danger to those around him.

我最终证明了莱昂的童年早期及其对他维持人际关系的能力、他的冲动控制和他的注意力的影响。我讨论了早期忽视如何使儿童倾向于减少同理心和暴力。我包括了我发现的所有缓解因素。这是我所能做的：没有任何理由可以证明他对自己的行为不负法律责任，而且我不能否认他对周围的人来说是一个持续的危险。

During a break I happened to be near the defendant as he watched the victims’ families cry and try to soothe each other. They were despondent, tears running down their cheeks, clinging to each other like survivors on a life raft. Leon said to me, “Why are they crying? I’m the one who’s going to jail.” Again, his emptiness was chilling. He was emotionally blind.

在休息期间，我碰巧在被告附近，因为他看着受害者的家人哭泣并试图互相安抚。他们很沮丧，泪水顺着脸颊流下，像救生筏上的幸存者一样紧紧相拥。莱昂对我说：“他们为什么哭？我是那个要坐牢的人。” 再一次，他的空虚令人不寒而栗。他在情感上是盲目的。

Afterwards, when Leon had been removed as the jury retired to deliberate, Cherise’s mother approached me. Her pain was visible in every step, in the slow movement of her hands, in her expression. “Doctor! Doctor!” she called to me, with great urgency, afraid I might leave before she could talk to me. I stopped, turned, and watched her slowly approach. Almost pleading, she asked, “Why did he do it? You talked to him. Why did he kill my baby? Please tell me. Why?”

之后，当陪审团退下来商议莱昂时，切瑞斯的母亲走近我。她的痛苦在每一步，在她双手的缓慢动作中，在她的表情中都清晰可见。“医生！医生！” 她急切地叫我，生怕我还没来得及跟我说话就走了。我停下来，转过身，看着她慢慢靠近。她几乎是恳求地问道：“他为什么要这么做？你和他说话了。他为什么要杀我的孩子？请告诉我。为什么？”

I shook my head, acknowledging that, even with my expertise, I couldn’t give her a satisfactory answer.

我摇摇头，承认即使以我的专业知识，我也无法给她一个满意的答案。

Crying and holding my arm, she asked again. “You know about these things. Why did he kill my baby?”

哭着挽着我的胳膊，她又问了一遍。“你知道这些事情。他为什么要杀我的孩子？”

“Honestly, I just don’t know for sure,” I said, feeling embarrassed at the inadequacy of my words. I sought out something to help this grieving mother. “I think his heart is cold. Something in him is broken. He’s not able to love like you can—like your daughter could. You hurt so much because you loved her so much. He doesn’t feel things like you do—good things or bad.”

“老实说，我只是不确定，”我说，因为我的话不够充分而感到尴尬。我想方设法帮助这位悲伤的母亲。“我认为他的心是冷的。他身上有什么东西坏了。他无法像你那样去爱——就像你的女儿那样。你伤得那么深，因为你太爱她了。他不像你那样感受事物——好事或坏事。”

She was quiet for a moment. I could see her bring her daughter’s image to mind with a fleeting smile, then more tears. She sighed and nodded. “Yes. He must be broken inside to kill such a beautiful child. She never hurt anyone.” I awkwardly hugged her for a moment and then she walked out toward the rest of her family. I thought of Maria and Alan and Frank. Our research is beginning to unlock the secrets of the brain and the causes of tragedies such as this one, but in that moment I was painfully aware of how much we still don’t know.

她沉默了片刻。我可以看到她带着一闪而过的微笑想起了她女儿的形象，然后流下了更多的眼泪。她叹了口气，点了点头。“是的。他必须内心崩溃才能杀死这么漂亮的孩子。她从不伤害任何人。” 我笨拙地拥抱了她一会儿，然后她朝她的家人走去。我想到了玛丽亚、艾伦和弗兰克。我们的研究正开始解开大脑的秘密以及诸如此类悲剧的成因，但在那一刻，我痛苦地意识到我们仍然不知道有多少。