TED英语演讲：童年创伤怎样影响一生的健康

Word文档TED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进展。童年经受影响终身，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：NadineBurkeHarris

Inthemid-90s,theCDCandKaiserPermanentediscoveredanexposurethatdramaticallyincreasedtheriskforsevenoutof10oftheleadingcausesofdeathintheUnitedStates.Inhighdoses,itaffectsbraindevelopment,theimmunesystem,hormonalsystems,andeventhewayourDNAisreadandtranscribed.Folkswhoareexposedinveryhighdoseshavetriplethelifetimeriskofheartdiseaseandlungcanceranda20-yeardifferenceinlifeexpectancy.Andyet,doctorstodayarenottrainedinroutinescreeningortreatment.Now,theexposureImtalkingaboutisnotapesticideorapackagingchemical.Itschildhoodtrauma.

90年月中期,CDC和KaiserPermanente发觉:暴露于某种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.WhatkindoftraumaamItalkingabouthere?Imnottalkingaboutfailingatestorlosingabasketballgame.Iamtalkingaboutthreatsthataresosevereorpervasivethattheyliterallygetunderourskinandchangeourphysiology:thingslikeabuseorneglect,orgrowingupwithaparentwhostruggleswithmentalillnessorsubstancedependence.

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竞赛。我要说的是那种如此严峻而又无处不在的威逼,以致于它让我们毛骨悚然,并从生理上转变了我们：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,或是深陷于物质依靠疾病。

Now,foralongtime,IviewedthesethingsinthewayIwastrainedtoviewthem,eitherasasocialproblem--refertosocialservices--orasamentalhealthproblem--refertomentalhealthservices.Andthensomethinghappenedtomakemerethinkmyentireapproach.WhenIfinishedmyresidency,IwantedtogosomeplacewhereIfeltreallyneeded,someplacewhereIcouldmakeadifference.So,IcametoworkforCaliforniaPacificMedicalCenter,oneofthebestprivatehospitalsinNorthernCalifornia,andtogether,weopenedaclinicinBayview-HuntersPoint,oneofthepoorest,mostunderservedneighborhoodsinSanFrancisco.Now,priortothatpoint,therehadbeenonlyonepediatricianinallofBayviewtoservemorethan10,000children,sowehungashingle,andwewereabletoprovidetop-qualitycareregardlessofabilitytopay.Itwassocool.Wetargetedthetypicalhealthdisparities:accesstocare,immunizationrates,asthmahospitalizationrates,andwehitallofournumbers.Wefeltveryproudofourselves.

始终以来,我都根据所教育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--交给心理健康询问来解决。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-HuntersPoint)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,我们开头挂牌营业,供应最优质的医疗服务,不论是否有力量支付医疗费用。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。我们为自己感到傲慢。

ButthenIstartednoticingadisturbingtrend.AlotofkidswerebeingreferredtomeforADHD,orAttentionDeficitHyperactivityDisorder,butwhenIactuallydidathoroughhistoryandphysical,whatIfoundwasthatformostofmypatients,IcouldntmakeadiagnosisofADHD.MostofthekidsIwasseeinghadexperiencedsuchseveretraumathatitfeltlikesomethingelsewasgoingon.Somehow,Iwasmissingsomethingimportant.

但就在那时,我开头留意到一种令人忧心的趋势。许多孩子由于多动症(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,却发觉大多数患儿的状况,我无法下多动症(ADHD)的诊断。多数来就诊的孩子都经受过如此严峻的创伤,让人觉得好像事情并不简洁。不知怎的,我漏查了某个重要的因素。

Now,beforeIdidmyresidency,Ididamastersdegreeinpublichealth,andoneofthethingsthattheyteachyouinpublichealthschoolisthatifyoureadoctorandyousee100kidsthatalldrinkfromthesamewell,and98ofthemdevelopdiarrhea,youcangoaheadandwritethatprescriptionfordoseafterdoseafterdoseofantibiotics,oryoucanwalkoverandsay,Whatthehellisinthiswell?So,IbeganreadingeverythingthatIcouldgetmyhandsonabouthowexposuretoadversityaffectsthedevelopingbrainsandbodiesofchildren.

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,假如你是一名医生,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,井里究竟有什么鬼东西?所以,我开头查阅手头全部的相关资料,了解暴露在不幸中,是如何影响儿童的大脑和身体发育的。

Andthenoneday,mycolleaguewalkedintomyoffice,andhesaid,Dr.Burke,haveyouseenthis?InhishandwasacopyofaresearchstudycalledtheAdverseChildhoodExperiencesStudy.Thatdaychangedmyclinicalpracticeandultimatelymycareer.

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讨论的复印件,题目是童年不良经受(ACE)讨论。那一天,转变了我的临床实践,也最终转变了我的职业生涯。

TheAdverseChildhoodExperiencesStudyissomethingthateverybodyneedstoknowabout.ItwasdonebyDr.VinceFelitaatKaiserandDr.BobAndattheCDC,andtogether,theyasked17,500adultsabouttheirhistoryofexposuretowhattheycalledadversechildhoodexperiences,orACEs.Thoseincludephysical,emotional,orsexualabuse;physicaloremotionalneglect;parentalmentalillness,substancedependence,incarceration;parentalseparationordivorce;ordomesticviolence.Foreveryyes,youwouldgetapointonyourACEscore.AndthenwhattheydidwastheycorrelatedtheseACEscoresagainsthealthoutcomes.Whattheyfoundwasstriking.Twothings:Numberone,ACEsareincrediblycommon.Sixty-sevenpercentofthepopulationhadatleastoneACE,and12.6percent,oneineight,hadfourormoreACEs.Thesecondthingthattheyfoundwasthattherewasadose-responserelationshipbetweenACEsandhealthoutcomes:thehigheryourACEscore,theworseyourhealthoutcomes.ForapersonwithanACEscoreoffourormore,theirrelativeriskofchronicobstructivepulmonarydiseasewastwoandahalftimesthatofsomeonewithanACEscoreofzero.Forhepatitis,itwasalsotwoandahalftimes.Fordepression,itwasfourandahalftimes.Forsuicidality,itwas12times.ApersonwithanACEscoreofsevenormorehadtriplethelifetimeriskoflungcancerandthreeandahalftimestheriskofischemicheartdisease,thenumberonekillerintheUnitedStatesofAmerica.

童年不良经受(ACE)的讨论是每一个人都应当要了解的。VinceFelitti博士和BobAnda博士分别在Kaiser和CDC进行了这项讨论,他们两人一起询问了17,500成年人,了解他们的童年不良经受,又称ACE。这包括生理上、情感上患病的不幸或是性侵害;生理或情感上患病的忽视;父母患有精神疾病、物质依靠、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动的。结论有两点：第一点,ACE非常普遍,简直令人不行思议。67%的人曾至少有一个ACE得分,有12.6%(八分之一)的人有四或四以上的ACE得分。讨论发觉的其次点,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。假如一个人的ACE分数大于等于4分,他患慢性堵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,ofcoursethismakessense.Somepeoplelookedatthisdataandtheysaid,Comeon.Youhavearoughchildhood,youremorelikelytodrinkandsmokeanddoallthesethingsthataregoingtoruinyourhealth.Thisisntscience.Thisisjustbadbehavior.

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,你更简单酗酒和抽烟,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.

Itturnsoutthisisexactlywherethesciencecomesin.Wenowunderstandbetterthanweeverhavebeforehowexposuretoearlyadversityaffectsthedevelopingbrainsandbodiesofchildren.Itaffectsareaslikethenucleusaccumbent,thepleasureandrewardcenterofthebrainthatisimplicatedinsubstancedependence.Itinhibitstheprefrontalcortex,whichisnecessaryforimpulsecontrolandexecutivefunction,acriticalareaforlearning.AndonMRIscans,weseemeasurabledifferencesintheamygdala,thebrainsfearresponsecenter.So,therearerealneurologicreasonswhyfolksexposedtohighdosesofadversityaremorelikelytoengageinhigh-riskbehavior,andthatsimportanttoknow.

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患病的不幸会怎样影响儿童大脑和身体的发育。早年患病的不幸会影响大脑的伏隔核(nucleusaccumbens)--人脑中与欢乐和奖赏相关的处理中心,它与物质依靠疾病相关。早年患病的不幸还会抑制大脑的前额叶皮质(Prefrontalcortex),而前额皮质对神经冲动掌握与执行功能是必不行少的,这个区域对于学习力量特别关键。在核磁共振成像扫描(MRI)上,我们观看到大脑的恐惊反应中枢-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：为什么人们一旦患病大量不幸,则更简单消失高风险行为。了解了这点非常重要。

Butitturnsoutthatevenifyoudontengageinanyhigh-riskbehavior,yourestillmorelikelytodevelopheartdiseaseorcancer.Thereasonforthishastodowiththehypothalamicpituitaryadrenalaxis,thebrainsandbodysstressresponsesystemthatgovernsourfight-or-flightresponse.Howdoesitwork?Well,imagineyourewalkingintheforestandyouseeabear.Immediately,yourhypothalamussendsasignaltoyourpituitary,whichsendsasignaltoyouradrenalglandthatsays,Releasestresshormones!Adrenaline!Cortisol!Andso,yourheartstartstopound,yourpupilsdilate,yourairwaysopenup,andyouarereadytoeitherfightthatbearorrunfromthebear.Andthatiswonderfulifyoureinaforestandtheresabear.(Laughter)Buttheproblemiswhathappenswhenthebearcomeshomeeverynight,andthissystemisactivatedoverandoverandoveragain,anditgoesfrombeingadaptive,orlife-saving,tomaladaptive,orhealth-damaging.Childrenareespeciallysensitivetothisrepeatedstressactivation,becausetheirbrainsandbodiesarejustdeveloping.Highdosesofadversitynotonlyaffectbrainstructureandfunction,theyaffectthedevelopingimmunesystem,developinghormonalsystems,andeventhewayourDNAisreadandtranscribed.

但事实证明,即使你不从事任何高风险的行为,你仍旧更简单患上心脏疾病或癌症。由于这与下丘脑-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-flightresponse)。这一系统是如何运行的呢?想象你闲逛在森林里,突然看到一头熊。你的下丘脑会马上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!你的心脏因而开头快速跳动,瞳孔扩张,呼吸道打开,这时你已预备好：要么就和熊战斗,要么就逃跑。这个反应很棒--假如你在森林里,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,由于他们的大脑和身体正处在发育阶段。高剂量的不良经受不仅会影响大脑结构和功能,还会影响正在发育的免疫系统,以及正在发育的内分泌系统,甚至还会影响我们的DNA读取和转录方式。

Soforme,thisinformationthrewmyoldtrainingoutthewindow,becausewhenweunderstandthemechanismofadisease,whenweknownotonlywhichpathwaysaredisrupted,buthow,thenasdoctors,itisourjobtousethisscienceforpreventionandtreatment.Thatswhatwedo.

这些学问让我彻底抛弃了以前所受训的那一套,由于,当我们了解疾病机制时,当我们不仅知道哪些路径被干扰,而且知道它们是怎样被干扰时,作为医生,我们的职责,就是使用这门科学去做疾病的防治工作。那就是我们要做的。

SoinSanFrancisco,wecreatedtheCenterforYouthWellnesstoprevent,screenandhealtheimpactsofACEsandtoxicstress.Westartedsimplywithroutinescreeningofeveryoneofourkidsattheirregularphysical,becauseIknowthatifmypatienthasanACEscoreof4,shestwoandahalftimesaslikelytodevelophepatitisorCOPD,shesfourandhalftimesaslikelytobecomedepressed,andshes12timesaslikelytoattempttotakeherownlifeasmypatientwithzeroACEs.Iknowthatwhenshesinmyexamroom.Forourpatientswhodoscreenpositive,wehaveamultidisciplinarytreatmentteamthatworkstoreducethedoseofadversityandtreatsymptomsusingbestpractices,includinghomevisits,carecoordination,mentalhealthcare,nutrition,holisticinterventions,andyes,medicationwhennecessary.ButwealsoeducateparentsabouttheimpactsofACEsandtoxicstressthesamewayyouwouldforcoveringelectricaloutlets,orleadpoisoning,andwetailorthecareofourasthmaticsandourdiabeticsinawaythatrecognizesthattheymayneedmoreaggressivetreatment,giventhechangestotheirhormonalandimmunesystems.

因此，我们在旧金山创办了青少年健康中心,目的是预防、筛查和治愈ACE和毒性应激的影响。我们开头在孩子们的定期体检中,对每个孩子进行例行检查,由于我知道,假如我的病人ACE得分为4分,她患上肝炎或慢性堵塞性肺病(COPD)的概率是1.5倍,患上抑郁症的概率是4.5倍,她自杀的几率是ACE得分为0的病人的12倍。她在我的检查室里,我就已经知道这一切了。对于检查结果为阳性的病人,我们有一支多学科综合治疗团队,致力于削减不良经受造成的影响,并使用最佳疗法治疗病症,包括家庭访视、护理协调、心理保健、养分、综合干预措施,以及必要时结合药物治疗。但我们也教家长们了解ACE和毒性应激造成的影响,这种影响与电源插座或铅中毒的危急性可以相提并论,我们调整了哮喘及糖尿病患儿的护理服务,意识到他们可能需要更乐观主动的治疗,以作用于他们的内分泌和免疫系统。

Sotheotherthingthathappenswhenyouunderstandthisscienceisthatyouwanttoshoutitfromtherooftops,becausethisisntjustanissueforkidsinBayview.Ifiguredtheminutethateverybodyelseheardaboutthis,itwouldberoutinescreening,multi-disciplinarytreatmentteams,anditwouldbearacetothemosteffectiveclinicaltreatmentprotocols.Yeah.Thatdidnothappen.Andthatwasahugelearningforme.WhatIhadthoughtofassimplybestclinicalpracticeInowunderstandtobeamovement.InthewordsofDr.RobertBlock,theformerPresidentoftheAmericanAcademyofPediatrics,Adversechildhoodexperiencesarethesinglegreatestunaddressedpublichealththreatfacingournationtoday.Andforalotofpeople,thatsaterrifyingprospect.Thescopeandscaleoftheproblemseemssolargethatitfeelsoverwhelmingtothinkabouthowwemightapproachit.Butforme,thatsactuallywherethehopeslie,becausewhenwehavetherightframework,whenwerecognizethistobeapublichealthcrisis,thenwecanbegintousetherighttoolkittocomeupwithsolutions.FromtobaccotoleadpoisoningtoHIV/AIDS,theUnitedStatesactuallyhasquiteastrongtrackrecordwithaddressingpublichealthproblems,butreplicatingthosesuccesseswithACEsandtoxicstressisgoingtotakedeterminationandcommitment,andwhenIlookatwhatournationsresponsehasbeensofar,Iwonder,whyhaventwetakenthismoreseriously?

当你理解了这门科学时,你会想要把它广而告之,由于这不仅仅是湾景区(Bayview)孩子的问题。我原来以为其他人一旦了解到这一点,就会着手例行检查、组建多学科治疗团队,甚至大家争先恐后想找到最有效的治疗方案。可这些都没有发生。这可是给了我一个很大的教训。我原以为简洁的找到最好的临床手段来治疗就行了,现在我明白了,这是一场运动。正如RobertBlock博士,这位前美国儿科学会会长所言,童年不良经受(ACE)是今日我们国家所面临的,唯一,最大的,未能解决的公共健康威逼.对于许多人来说,这个前景可不容乐观。这个问题的范围之广,规模之大使我们不得不考虑应对之策。但在我看来,危机即是转机，当我们确立正确框架时,当我们意识到这是公共健康危机时,我们才能开头使用正确的方法来求得解决方案。从烟草到铅中毒,再到艾滋病,在解决公共健康问题方面,美国实际上保持着良好记录,但要,在ACE和毒性应激方面取得同样胜利,则需要下定决心、履行承诺,当我看到,我们国家对这一问题至今的反应时,我想知道,为什么我们没有更仔细的对待这个问题?

Youknow,atfirstIthoughtthatwemarginalizedtheissuebecauseitdoesntapplytous.Thatsanissueforthosekidsinthoseneighborhoods.Whichisweird,becausethedatadoesntbearthatout.TheoriginalACEsstudywasdoneinapopulationthatwas70percentCaucasian,70percentcollege-educated.Butthen,themoreItalkedtofolks,ImbeginningtothinkthatmaybeIhaditcompletelybackwards.IfIweretoaskhowmanypeopleinthisroomgrewupwithafamilymemberwhosufferedfrommentalillness,Ibetafewhandswouldgoup.AndthenifIweretoaskhowmanyfolkshadaparentwhomaybedranktoomuch,orwhoreallybelievedthatifyousparetherod,youspoilthechild,Ibetafewmorehandswouldgoup.Eveninthisroom,thisisanissuethattouchesmanyofus,andIambeginningtobelievethatwemarginalizetheissuebecauseitdoesapplytous.Maybeitseasiertoseeinotherzipcodesbecausewedontwa