读书碎片 | 如何用一头奶牛治愈抑郁症
书籍：Lost Connections
作者：Johann Hari
章节：第14章：The Cow读书碎片 #008
以下内容来自阅读中的随手记录，思想在这里被暂时放下。
提到“抗抑郁药”，许多人的脑海里立刻浮现出一颗颗小药丸，装在药瓶里，按时吞下，等待大脑里的化学物质发生变化。
长久以来，现代医学向我们灌输了一个根深蒂固的观念：抑郁症仅仅是大脑中化学物质的失衡，而每天按时吞服这些由制药工厂生产出来的药片，是修复大脑、治愈痛苦的标准解药。
然而，Johann Hari在《Lost Connections》里讲了一个故事，让“抗抑郁药”这个词从药瓶里走了出来——它变成了一头奶牛。
21世纪初，一位名叫德里克·萨默菲尔德（Derek Summerfield）的南非精神科医生，来到了柬埔寨的农村。那里的人们大多是种水稻的农民，生活中潜伏着巨大的危险——20世纪六七十年代美国战争遗留下来的地雷依然遍布四周，时不时就会有人被炸伤。
德里克去那里的目的是研究这种危险如何影响当地人的心理健康。当时，西方制药公司正试图首次在柬埔寨推销抗抑郁药物，但他们遇到了一个尴尬的语言障碍：高棉语中根本没有“抗抑郁药”这个词的准确翻译，当地人对这个概念感到非常困惑。
为了让当地人理解，德里克解释说，抑郁症就是一种“无法摆脱的深深的悲伤”。
柬埔寨的医生们听完后恍然大悟，说：“哦，我们这里确实有这样的人。”
有一位农民在水稻田里被地雷炸断了左腿。虽然他装上了假肢，但他陷入了深深的绝望和持续的焦虑之中。因为带着假肢在水田中艰难跋涉不仅肉体上极其痛苦，还会不断唤起他被炸伤的恐怖记忆。他觉得自己的人生完蛋了，根本不想活下去。
当地医生和邻居们并没有给他开精神类药物。相反，他们坐下来，和他一起讨论他的生活和困境。他们意识到，虽然他不能种水稻了，但他完全有能力做一名奶农。
于是，社区里的人凑钱给他买了一头奶牛。在接下来的几个月和几年里，这位农民的生活发生了改变，他那曾经深重的抑郁症完全消失了。
柬埔寨的医生对德里克说：“你看，医生，这头奶牛就是镇痛剂，就是抗抑郁药。”
这个故事给德里克，以及作者Hari带来了巨大的认知冲击。
在西方主流医学（也就是我们一直以来被灌输的观念）看来，“抗抑郁药”必须是能够改变大脑化学物质的药片。因此，“一头奶牛是抗抑郁药”听起来简直像个笑话。
但Hari指出，这头奶牛不仅治好了那个农民的抑郁症，而且揭示了西方医学模式的致命盲区。
柬埔寨人并没有告诉那个农民“问题全在你脑子里”、“你要振作起来”或者“吃下这颗药片”。这个解决方案是集体性的——农民自己无法买得起奶牛，他在绝望中也想不到这个出路；是社区的人和他站在一起，赋权（empowering）他去改变了自己的生活。
德里克医生反思了自己在伦敦顶尖医院的执业经历，他意识到：“当我真正（对病人）产生积极影响时，往往是因为我解决了他们的社会处境，而不是解决了他们大脑里的东西。”
听完这个故事后，Hari提出了一个核心命题：如果我们一直以来对“抗抑郁药”的定义都是错的呢？
我们一直以为抗抑郁药就是每天吞下的药片。
但是，如果有针对性地、基于证据地改变我们的生活方式，本身就是一种“抗抑郁药”呢？
抑郁症的解药不在药瓶里，而在我们的社会关系和生活环境的重建中。面对生活的困境，有时候我们需要的不一定是百忧解（Prozac），而是一头能让我们重新找回生活掌控感和价值感的“奶牛”。
Early in the twenty-first century, a South African psychiatrist named Dr. Derek Summerfield landed in Cambodia, in a stretch of countryside that looked like all the clichés of South Asia you’ve ever seen—peaceful rice paddies rippling to the far horizon. Most people there were subsistence rice farmers, living as people had for centuries—but they had a problem. Every now and then, one of them would stand on a covered mound of earth, and an explosion would echo out across the paddies. Old land mines left behind by the U.S. war in the 1960s and 1970s were still lying there, all around them.
21世纪初，一位名叫德里克·萨默菲尔德博士的南非精神科医生来到了柬埔寨的一片乡村，那里看起来就像你见过的所有南亚陈词滥调——宁静的稻田一直荡漾到遥远的地平线。 那里的大多数人都是维持生计的稻农，像几个世纪以来的人们一样生活着——但他们面临一个问题。 时不时地，他们中的一个人会踩到一个被掩盖的土堆，随后爆炸声便会在稻田上空回荡。 20世纪六七十年代美国战争遗留下来的旧地雷仍然躺在那里，散布在他们周围。
Derek was there to learn about how this danger affects the mental health of the local Cambodians. By coincidence, not long before he arrived, antidepressants had begun to be marketed in Cambodia for the very first time—but there was a problem for the companies trying to sell them. It turned out there was no obvious translation for the word antidepressant into the Khmer language. It was an idea that seemed to puzzle them.
德里克去那里是为了了解这种危险如何影响当地柬埔寨人的心理健康。 巧合的是，就在他到达前不久，抗抑郁药开始首次在柬埔寨推销——但试图销售这些药物的公司遇到了一个问题。 原来，高棉语中没有抗抑郁药这个词的明显翻译。 这个概念似乎让他们感到困惑。
Derek tried to explain it. Depression is, he said, a profound sense of sadness that you can’t shake off. The Cambodians thought about this carefully and said, yes, we do have some people like that.
德里克试图解释它。 他说，抑郁症是一种你无法摆脱的深深的悲伤。 柬埔寨人仔细想了想，然后说，是的，我们这里确实有这样的人。
They gave an example: a farmer whose left leg was blown off by a land mine, who came to the doctors for medical help and got fitted with a new limb but didn’t recover. He felt constantly anxious about the future and was filled with despair. ...even with his new artificial limb, his old job—working in the rice paddies—was just too difficult, and he was constantly stressed and in physical pain, and that was making him want to just stop living, and give up.
他们举了一个例子：一位农民的左腿被地雷炸断了，他来找医生寻求医疗帮助，并装上了新的假肢，但没有康复。 他一直对未来感到焦虑，并充满了绝望。 ……即使有了新的假肢，他的旧工作——在稻田里劳作——也实在太困难了，他不断承受着压力和肉体的痛苦，这让他只想停止生存，选择放弃。
They then explained that they didn’t need these new-fangled antidepressants, because they already had antidepressants for people like this in Cambodia. When they realized this man was despondent, the doctors and his neighbors sat with him, and talked through his life and his troubles. They believed that he would be perfectly capable of being a dairy farmer, and that would involve less painful walking on his false leg and fewer disturbing memories.
他们接着解释说，他们不需要这些新奇的抗抑郁药，因为在柬埔寨，他们已经有了针对这类人的抗抑郁药。 当他们意识到这个男人很沮丧时，医生和他的邻居们和他坐在一起，详细讨论了他的生活和他的麻烦。 他们认为他完全有能力做一名奶农，这样他就不用带着假肢痛苦地行走，也会减少那些令人不安的回忆。
So they bought him a cow. In the months and years that followed, his life changed. His depression—which had been profound—went away.
于是他们给他买了一头牛。 在接下来的几个月和几年里，他的生活改变了。 他那曾经深重的抑郁症消失了。
You see, doctor, the cow was an analgesic, and antidepressant, they told Derek.
你看，医生，这头奶牛就是镇痛剂，就是抗抑郁药，他们告诉德里克。
To them, an antidepressant wasn’t about changing your brain chemistry, an idea that seemed bizarre to their culture. It was about the community, together, empowering the depressed person to change his life. This wasn’t an individualistic solution—they weren’t telling him the problem was all in his head and to pull his socks up or swallow a pill. It was a collective solution. He could never have gotten that cow on his own; the solution couldn’t have come from him alone, because he was too distressed, and anyway he didn’t have the cash.
对他们来说，抗抑郁药并不是用来改变你的大脑化学物质的，这个想法在他们的文化看来很荒谬。 它是关于社区团结起来，赋权给抑郁的人去改变他的生活。 这不是一个个人主义的解决方案——他们没有告诉他问题全在他的脑子里，让他自己振作起来或者吞下一颗药丸。 这是一个集体的解决方案。 他自己一个人是绝对弄不到那头牛的；这个解决方案不可能单靠他自己得出，因为他太痛苦了，而且无论如何他也没有钱。
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When he reflected on it, Derek realized this was true in his own psychiatric practice, back in a leading London hospital. He thought about the people he worked with there, and it hit him: When I make a difference, it’s when I’m addressing their social situation, not what’s between their ears, he told me later over a beer.
当德里克反思这件事时，他意识到这在他在伦敦一家顶尖医院的精神科执业经历中也是对的。 他想到了他在那里共事的人们，然后他顿悟了：当我产生积极影响时，往往是因为我解决的是他们的社会处境，而不是他们两耳之间的东西，他后来喝着啤酒告诉我。
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What if we have just been defining antidepressants in the wrong way? We have thought of antidepressants solely as the pills we swallow once (or more) a day. But what if we started to think of antidepressants as something very different? What if changing the way we live—in specific, targeted, evidence-based ways—could be seen as an antidepressant, too? What if what we need to do now is expand our idea of what an antidepressant is?
如果我们一直以来对抗抑郁药的定义都是错的呢？ 我们一直认为抗抑郁药仅仅是我们每天吞下一次（或更多次）的药片。 但是如果我们开始把抗抑郁药看作是一种完全不同的东西呢？ 如果有针对性地、基于证据地改变我们的生活方式，也能被视为一种抗抑郁药呢？ 如果我们现在需要做的，是扩展我们对抗抑郁药的认知呢？