論"心病"的危害程度與心理暗示

Soon after Suzanne O’Sullivan had left medicalschool in Dublin, she met a patient named Yvonne,whose mysterious illness appeared to bear littlerelation to any of her previous studies.

在奧沙利文•蘇珊娜(Suzanne O’Sullivan)離開都柏林一所醫(yī)學(xué)院后不久，她遇到了一位名叫伊馮(Yvonne)的病人，伊馮所患的神秘疾病似乎與她以前的任何研究都扯不上關(guān)系。

Yvonne, she was told, had been stacking the fridgesin a supermarket when a colleague had accidentallysprayed a fine mist of window cleaner in her face. She tried to wash her eyes, left work andwent to bed early, hoping they would feel less sore the next day. But when she woke up, hervision was worse – everything was so blurry she struggled to read the time on the clock.Twenty-four hours later, she could not tell night from day.

據(jù)伊馮所說，她當(dāng)時在一家超市向冰箱里堆放物品，一個同事無意間不小心將玻璃清潔劑的噴霧噴到了她的臉上。她試著去洗眼睛，并提早下班離開工作回家休息，希望眼睛疼痛能夠有所好轉(zhuǎn)。但第二天當(dāng)她醒來的時候，她的視力變得更糟了，看什么都很模糊，以至于她要竭盡全力才能看清鬧鐘上的時間。24小時之后情況已經(jīng)惡化到她無法辨認(rèn)白天黑夜了。

O’Sullivan’s colleagues assumed Yvonne was faking it, perhaps for some kind of lawsuit. “There’ll be no Oscar for that performance,” one muttered

奧沙利文的同事們認(rèn)為伊馮是裝病，以便于進行訴訟。“這種表演不會得奧斯卡獎，”一個員工嘟囔著。

Except after six months of examinations, doctors could find nothing wrong with Yvonne’s eyes.She was eventually admitted to the neurology unit where O’Sullivan was working. During theobservations, Yvonne’s eyes would flicker between her husband and the doctors; as theconsultant moved an ophthalmoscope close to her eyes, she blinked. It certainly seemed like hereyes were responding to her surroundings, yet she continued to claim that she was envelopedin an impenetrable darkness.

經(jīng)過長達六個月的檢查，醫(yī)生始終也沒有發(fā)現(xiàn)伊馮的眼睛有問題。她最終來到了奧沙利文所工作的神經(jīng)科進行檢查。觀測期間，醫(yī)生發(fā)現(xiàn)伊馮的眼睛在看到她丈夫和醫(yī)生的時候會顫動;當(dāng)醫(yī)療顧問將檢目鏡(ophthalmoscope)接近她的眼睛，她的眼睛會眨動。很明顯伊馮的眼睛對于周遭的環(huán)境能夠做出反應(yīng)，但據(jù)她本人的說法，她的眼睛始終被一團漆黑籠罩。

O’Sullivan’s colleagues assumed she was faking it, perhaps for some kind of lawsuit. “There’llbe no Oscar for that performance,” one muttered after they had left the ward. O’Sullivanherself was unconvinced. “I liked Yvonne. I felt sorry for her. But I did not believe she wasblind,” she writes in her new book It’s All in Your Head, recently shortlisted for the WellcomeBook Prize.

奧沙利文的同事們認(rèn)為伊馮是裝病，以便于進行訴訟。“這種表演不會得奧斯卡獎，”一個員工嘟囔著。奧沙利文自己不服氣。“我喜歡伊馮。我為她感到難過。但我不相信她的眼睛瞎了，”她在她的新書《一切都源于你的想象》中寫到，該書最近入圍了英國惠康圖書獎(Wellcome Book Prize)。

Now she knows better. At the Royal London Hospital she has become an expert in“psychosomatic” illnesses. She has treated people who are paralysed from the waist down, orwho have such severe cramp in their fingers that their hand has become little more than aclaw; one woman could not even empty her bladder without a medical catheter. Yet whendoctors look, they can find no physiological cause – suggesting the problem originates in themind, not the body.

現(xiàn)在她對這種情況有了更深的了解。在倫敦皇家醫(yī)院(Royal London Hospital)，她已經(jīng)成為了一個“心身疾病”的專家。她治療那些下半身癱瘓，或有嚴(yán)重抽筋癥狀的手指，他們的手已成為一個爪子形狀;一個女人甚至沒有醫(yī)用導(dǎo)管就無法排尿。對于這些癥狀，醫(yī)生卻無法找到任何生理病因，這表明問題源于頭腦，而不是身體。

In this light, it’s perfectly possible that Yvonne really wasn’t conscious of what she was seeing– somehow, her unconscious mind was discarding the information before she became aware ofit.

鑒于以上這種情況，伊馮或許有可能無法意識到自己能夠看到的東西，不知怎的，在她能夠意識到之前，她的潛意識在不知不覺中就將信息過濾掉了。

Keen to know more, I spoke to O’Sullivan about her career and her recent book detailing theseremarkable case studies.

為了了解更多的信息，我采訪到了奧沙利文，談她的職業(yè)生涯，以及她在新書中詳細介紹的這些典型案例。

Although O’Sullivan had seen patients like Yvonne from the very beginning of her career, theinterest intensified once she started specialising in epilepsy. Patients would often come to hersuffering from debilitating seizures that left them writhing around on the floor, limbs flailing,helpless, yet when they came in to the hospital for neurological tests, they showed none of thesignature brain activity of epilepsy; they were “psychogenic” seizures. “It became obvious noone is talking about these problems that are consistently common, but which are getting noattention in medical journals or medical conferences,” she says. “This is a very neglected area.”

他們真的遭受某種程度的殘疾。他們比大多數(shù)身體疾病的人都更殘疾。

That silence brings stigma, meaning that most patients end up feeling insulted by thediagnosis. “Their first reaction is ‘you think I’m doing it on purpose’ or ‘you think it’s not real’or ‘I could stop it if wanted’,” O’Sullivan says. “There’s this perception that there is a degree ofwilfulness”.

雖然奧沙利文已經(jīng)在早期治療類似伊馮這樣的患者，當(dāng)她開始專攻癲癇研究的時候她的職業(yè)興趣進一步提升了?；颊咴缙诘陌Y狀通常有滿地打滾抽筋，肢體痙攣而無助，但當(dāng)他們來到醫(yī)院進行神經(jīng)學(xué)檢查時，他們發(fā)現(xiàn)癲癇患者腦部活動并沒有出現(xiàn)那些典型的癲癇癥狀;他們是“心因性”的癲癇發(fā)作。她說：“很明顯沒有人討論這些普遍存在的問題，在醫(yī)學(xué)雜志或醫(yī)學(xué)會議上沒有受到重視”。她說，“這個領(lǐng)域的研究常常被人忽視。”

If you find their symptoms hard to believe, consider the many profound ways that youremotions already move your body. O’Sullivan points out that every time we cry, or laugh, orshake with anger, if we feel so sad that it is hard to lift ourselves from our bed, or queasy withnausea after we hear of a friend’s food poisoning, then we are experiencing psychosomaticphenomena first-hand. In fact, up to 30% of people visiting their family doctor or GP (and 50%of women seeing their gynaecologist) are enduring symptoms that cannot be explained with aphysical cause – suggesting they may be psychosomatic in origin. The difference is that formost of us those feelings pass and we can return to our normal lives, but for O’Sullivan’spatients they are exaggerated and chronic, lasting months, years, even a lifetime.

這種沉默帶來了恥辱，這意味著大多數(shù)患者最終因為診斷結(jié)果而感到被羞辱。奧沙利文說：“他們的第一反應(yīng)是，你認(rèn)為我是故意的，或者你認(rèn)為這不是真的”或者“我可以阻止它”。“這種看法認(rèn)為病人有一定程度的任性”。

They really are disabled. They are more disabled than most people with a physical disease

如果你很難相信他們的癥狀，那么想一想你的情緒如何在很多方面深刻的影響著你身體狀況的。奧沙利文指出，每一次我們哭，或笑，或氣得發(fā)抖，如果我們很悲傷，很難起床，或聽到一個朋友的食物中毒后感到的反胃惡心，這都是心身現(xiàn)象所帶來的反應(yīng)。事實上，30% 去看家庭醫(yī)生或全科醫(yī)生的人表示(和50%看婦科醫(yī)生的女性病患)經(jīng)歷了難以用身體疾病解釋的癥狀——暗示它們可能起源于心理致病的因素。不同的是，對我們大多數(shù)人來說，這些感覺過去之后我們可以恢復(fù)到正常生活，但對奧沙利文的患者，這些癥狀被放大，拖長，持續(xù)數(shù)月，數(shù)年，甚至一輩子。

She emphasises that the psychological origin does not make the blindness, fatigue, seizuresor paralysis any less debilitating. “They really are disabled. They are more disabled than mostpeople with a physical disease.”

她強調(diào)，心理根源或許使失明、疲勞、癲癇或癱瘓等癥狀更令人感到殘疾。他們真的遭受某種程度的殘疾。他們比大多數(shù)身體疾病的人都更殘疾。

Consider Camilla, a lawyer in London, who had been diagnosed with epilepsy before O’Sullivanmanaged to show that it was psychogenic. She described how humiliating she found theseizures; how people try to help by sitting on her to stop her limbs from flailing about, andstick their fingers down her throat to stop her choking; one man knelt beside her, asking if shewas OK, before stealing her mobile phone. “But do you know what happens all the time? Peoplevideo me on their mobile phones and walk away laughing,” she told O’Sullivan. The more youknow about these patients, the harder it is to believe that anyone would deliberately exposethemselves to this humiliation.

例如倫敦的一個律師卡米拉(Camilla)，在被奧沙利文證明為心因性疾病之前，她曾經(jīng)被診斷出患有癲癇。她描述了癲癇發(fā)作所帶來的羞辱;有人試圖坐在她身上以阻止她四肢亂動，并堅持用他們的手指伸進著她的喉嚨阻止她窒息;一個人跪在她旁邊，問她是否還好，然后偷走了她的手機。“但是你知道大部分情況下發(fā)生了什么嗎?人們用手機拍攝我的視頻然后笑著走開，“她告訴奧沙利文。你對這些病人了解的越多，就越難相信任何人都會故意使自己忍受這樣的恥辱。

O’Sullivan has nevertheless met a few fakers, such as Judith, who claimed to be sufferingseizures as the side-effect of chemotherapy for leukaemia years before. Hoping to get to thebottom of the story, O’Sullivan called her into a hospital ward, where a video camera could filma seizure when or if it occurred. Sure enough, at 9:15 in the evening, a nurse found Judith lyingon the floor unconscious, falling so hard that she had apparently fractured her hand. WhenO’Sullivan played back the video, however, she saw there had been no seizure at all. Judith hadsimply raised her hand and hit it hard against the wall four times, before lying down gently onthe floor, pulling down a plate with her to attract the nurse. Indeed, looking at the medicalrecords, it became clear that Judith had never suffered from leukaemia, either.

什么樣的精神折磨會使人覺得發(fā)生了疾病?

What kind of mental torment would make someone invent an illness?

奧沙利文也曾經(jīng)遇到過一些騙子，如朱迪思(Judith)，她自稱患有白血病化療的副作用之一癲癇。為了能夠進行深入調(diào)查，奧沙利文把她叫進了一家醫(yī)院的病房，使用視頻攝像機監(jiān)控她是否和發(fā)生痙攣時的情況。果然，在晚上9:15，護士發(fā)現(xiàn)朱迪思躺在地上不省人事，并因為從高處跌落而造成手骨折斷。當(dāng)奧沙利文重新查看錄像時卻發(fā)現(xiàn)病人并沒有發(fā)生痙攣。朱迪思只是舉起了手，朝著墻壁猛擊了四次，然后躺在地板上，過程中打碎了一個盤子吸引護士的注意。事實上，從這些醫(yī)療記錄看來，很顯然朱迪思也從來沒有患過白血病。

Although such patients with “factitious” illnesses may add to the stigma of people like Camillaor Yvonne, O’Sullivan still feels compassion for these people. After all, what kind of mentaltorment would make someone behave in this way? Even if Judith hadn’t suffered fromleukaemia, perhaps she had witnessed it in someone else – an experience she found difficult toprocess in any other way? “Factitious illness is one of most serious disorders I know,” O’Sullivansays.

雖然“人造”疾病可能會加深人們對于像卡米拉或伊馮這樣的患者不好的印象，奧沙利文仍然對這些人感到同情。畢竟，什么樣的精神折磨會使人這樣做?即使朱迪思沒有患上白血病，也許她在從別人身上見過這樣的癥狀——一種她在其他方式中難以處理的經(jīng)歷?“人造的疾病是我所知道的最嚴(yán)重的疾病，”奧沙利文說。

There is currently precious little research on the best way to treat psychosomatic illness, butshe tends to refer her patients to psychiatrists or to a cognitive behavioural therapist (CBT)who might be able to unknot the distress or trauma that is leading to the illness.

目前很少有人研究治療心身疾病的最好方式，但奧沙利文常常建議她的病人去看精神科醫(yī)生或進行認(rèn)知行為治療(cognitive behavioural therapist)。這種療法或許可以解開致病痛苦或心靈創(chuàng)傷。

And there are some real success stories. Not all cases can be pinned to a specific event, butCamilla realised that her seizures may have been linked to the death of her young son, settingher on the path to recovery. Yvonne, meanwhile, seemed to have been struggling to juggle thestresses of work, children, and an overbearing husband, and as she learned to cope with thoseupsets, her sight slowly returned.

有一些真正成功故事。并非所有的病例都可以歸咎于一個特定的事件，但卡米拉意識到她的癲癇發(fā)作可能與她的小兒子的死亡有關(guān)，意識到這點有助于她慢慢恢復(fù)。同時伊馮似乎一直在努力平衡工作，孩子和專橫的丈夫之間的關(guān)系，當(dāng)她學(xué)會了應(yīng)付那些煩心的事，她的視力慢慢恢復(fù)。

Patients with paralysis or muscle spasms can also respond well to physiotherapy. “They needto learn how to use their legs again,” O’Sullivan says. It’s often an uphill struggle; particularlywith seizures, relapse is common. “We have to give ongoing support and reassurance.”

癱瘓或肌肉痙攣患者也對理療有很好的反應(yīng)。“他們需要學(xué)習(xí)如何使用他們的腿，”奧沙利文說。這通常是一場艱苦的斗爭，特別是癲癇發(fā)作，復(fù)發(fā)是常見的。“我們必須給予持續(xù)的支持和保證。”

One of O’Sullivan’s biggest concerns is the rate of misdiagnosis – doctors overlooking thepsychological origin of these illnesses, instead prescribing the patients drugs, or evenadmitting them for harmful surgery. She says this may come from the doctors’ fear; somehow,it seems more serious missing a physical cause of an illness than a psychological cause – yetthe damage can be just as great.

奧沙利文最大的擔(dān)憂之一是誤診率：醫(yī)生可以忽略這些疾病的心理根源，而不是給病人開藥，甚至是承認(rèn)這些錯誤治療的危害性。她說，這可能來自于醫(yī)生的恐懼，不知何故，人們似乎更容易忽略一個疾病的心理因素而不是身體癥狀，但兩者的損害時同樣大的。

“The people who have been told they have epilepsy – they will be put on a toxic medication forat least a couple of years, before they accept it’s not going to work.” Over that time, thecondition has become a part of the patients’ life – they’ve told their friends, families, andemployer, making it much harder to accept the new diagnosis. “You become wedded to itthrough your own belief and the doctor’s belief,” O’Sullivan says. “You are getting treatmentyou don’t need for a disease you don’t have, and you are deprived of the treatment you do need– you’re not referred for CBT, a physiotherapist or a psychiatrist.”

被診斷為癲癇患者的人通常被告知要進行最少兩年的藥物治療，但仍然難以奏效。“在那個時候，這些條件已經(jīng)成為病人的生活的一部分，他們告訴他們的朋友，家庭和雇主，以至于更難以接受新的診斷結(jié)果。“通過自己相信和醫(yī)生的診斷，你已經(jīng)和診斷結(jié)果密不可分，”奧沙利文說。“你接受不需要的治療，診治不存在的病，你失去了你真正需要的治療——你沒有接受CBT治療，或看物理治療師或精神科醫(yī)生。”

Perhaps inspired by meeting Yvonne at the start of her career, she would like to raiseawareness of psychosomatic illnesses at the earliest stages of a doctor’s training. “My feeling isthat it needs to start at medical school-level,” she says. “I must have encountered thesepatients thousands of times but I have no recollection of being told how I should help them.”

也許受到伊馮案例的啟發(fā)，奧沙利文希望能在在醫(yī)生訓(xùn)練的早期階段提高對心身疾病的認(rèn)識。“我的感覺是，需要從醫(yī)學(xué)院開始，”她說。“我一定無數(shù)次遇到類似的病狀，但我不記得有人告訴我該如何幫助他們。”

For the time being, she hopes that her book will at least spark that conversation; so far, shehas already found that a small number of patients are becoming more accepting of thediagnosis, and are less afraid of the stigma attached to it. “I have my fingers crossed that itwill be a talking point, that people will feel less ashamed.”

暫時，她希望她的書至少能激起相關(guān)討論，到目前為止，她已經(jīng)發(fā)現(xiàn)了少量的病人變得越來越接受診斷結(jié)果，并且對它所帶來的恥辱感也不那么害怕了。“我希望這成為一個討論的要點，人們不會因此感到羞愧。”