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这里是《隐藏的大脑》。
This is Hidden Brain.
我是尚卡尔·韦丹塔。
I'm Shankar Vedanta.
在热门电视剧《黑钱胜地》中，一位聪明的金融顾问突然发现自己站在了法律的对立面。
In the hit television show Ozark, a bright financial adviser finds himself suddenly working on the wrong side of the law.
我们该怎么跟孩子们解释？
What's our story for the kids?
嗯，我们可以告诉他们真相，温迪。
Well, we could tell them the truth, Wendy.
你觉得那样怎么样？
How would that be?
由于商业伙伴马蒂·伯德（杰森·贝特曼饰）的一系列错误决策，他开始为毒品集团工作。
Following a series of bad decisions by his business partner, Marty Byrd, played by Jason Bateman, begins working for a drug cartel.
我希望你在一周内准备好开店。
I want you to be ready to set up shop within a week.
好的。
Yeah.
还有马蒂，我开车经过你家时，最好看到有出售的牌子。
And Marty, when I drive by your house, there better be a for sale sign on their own.
几乎从一开始，尸体就开始不断出现。
Almost from the start, the bodies start to fall.
有人被从阳台上推下去。
People get thrown off balconies.
有人被枪杀。
People get shot.
有人被电击致死。
People are electrocuted.
当政府官员介入后，更多暴力事件接连发生。
When government officials get involved, more violence unfolds.
人们互相背叛。
People betray one another.
他们互相欺骗。
They cheat each other.
他们行事自私且目光短浅。
They act in selfish and shortsighted ways.
让我帮你回忆一下。
Let me just jog your memory for a minute.
曾有个无辜的人被谋杀了。
There was an innocent man who was murdered.
加里。
Gary.
他是个好人。
He was a good man.
你可能会说这是毒品题材电影或电视剧的类型。
You might say this is the genre of the drug movie or television show.
你可以在《火线》《绝命毒师》等广受好评的电视剧，以及《毒品网络》《疤面煞星》等电影中看到这种题材。
You see it in critically acclaimed TV shows like The Wire and Breaking Bad and in movies such as Traffic and Scarface.
跟我的小朋友打个招呼吧。
Say hello to my little friend.
你想玩玩看吗？
You want to play with?
好的。
Okay.
好的。
Okay.
贯穿这些剧集，我们能感受到毒瘾那不可抗拒的力量。
Running through these dramas, we sense the irresistible power of drug addiction.
海洛因、可卡因或冰毒那无法平息的诱惑，以及毒品交易蔓延之处随之而来的混乱与犯罪。
The implacable draw of heroin or cocaine or methamphetamine, the chaos and crime that follow everywhere the drug trade is plied.
我曾将许多这类电视剧和电影当作娱乐消遣。
I have watched many of these TV shows and movies as entertainment.
多年来，我还报道过研究毒瘾科学的研究人员的工作。
For many years, I also reported on the work of researchers who study the science of drug addiction.
不久前，我接触到一个颠覆性的观点，彻底改变了我对成瘾的理解。
Some time ago I came by a mind bending idea that transformed my understanding of addiction.
它挑战了我对毒品和成瘾本质的认知。
It challenged how I think about drugs and what it means to be addicted.
这让我意识到，尽管关于毒品交易的影视剧扣人心弦，却远未能捕捉到成瘾在我们所有人生活中深刻的故事。
And it told me that as gripping as TV shows and movies about the drug trade might be, they don't begin to capture the profound story of addiction in all of our lives.
今天我们从将分两集讲述的故事开始。
Today we begin with a story we are telling across two episodes.
它将改变你对大脑的认知，并为如何获得幸福满足的人生提供深刻见解。
It will change the way you think about your brain and offer some profound insights into what it means to live a life of happiness and contentment.
本周《隐藏大脑》将探讨快乐、痛苦与平衡。
Pleasure, pain and balance this week on Hidden Brain.
我们都自以为知道成瘾是什么样子。
All of us think we know what addictions look like.
我们看过关于帮派暴力和毒窝的影视作品。
We've seen the movies and TV shows about gang violence and drug dens.
在斯坦福大学，安娜·莱姆克研究成瘾科学。
At Stanford University, Anna Lemke studies the science of addiction.
她认为我们对成瘾的概念理解过于狭隘。
She argues our conception of addiction is far too narrow.
安娜·莱姆克，欢迎来到《隐藏的大脑》。
Anna Lemke, welcome to Hidden Brain.
谢谢邀请。
Thank you for having me.
我很高兴来到这里。
I'm excited to be here.
安娜，你是在硅谷中心执业的心理医生。
Anna, you're a practicing psychiatrist in the heart of Silicon Valley.
我认为加州的湾区可能是人类历史上最富裕国家里最富庶的地区。
And I think of California's Bay Area as perhaps the, you know, the richest part of the richest country in the history of humankind.
所以十七世纪的时间旅行者可能会假设，即使街道不是用黄金铺就的，至少人们也会对如此巨大的物质成就感到非常幸福。
So a time traveler from the seventeenth century might assume that, you know, even if the streets were not paved with gold, at a minimum, people would be very happy with so much material success.
你的精神科诊所门可罗雀吗？
Is your psychiatric practice empty?
我至今仍惊讶于人们外在表现与内心真实体验之间的巨大差距。
I still marvel at the gap between how people present outwardly and the truth of their inner experience.
我们每天都会见到那些看似拥有一切的人：财富、美貌、有意义的工作。
We see people every day who seem to have everything you could ever want: wealth, beauty, meaningful work.
但当你深入了解时，却发现他们过得痛苦不堪。
And yet when you look under the hood, they're miserably unhappy.
安娜，随着时间的推移，你接诊的抑郁症、焦虑症和慢性疼痛患者越来越多，他们有时很难找到病因或根源。
So over time, Anna, you've seen more and more patients suffering from depression, anxiety, and chronic pain, ailments for which they are hard pressed sometimes to find a source or a or a cause.
正如你常说的，这些人健康、富裕、受过良好教育，看似拥有生活中想要的一切。
And as you say often, these are healthy, affluent, educated people with seemingly everything they could want in life.
你的一位患者是位前途无量的年轻医生。
One patient of yours was a young physician with a very promising career.
能描述一下你初次见他时的情形吗？
Can you describe what he was like when you first met him?
讨人喜欢的年轻人。
Delightful young man.
英俊、善良、体贴、周到。
Handsome, kind, thoughtful, considerate.
他来找我其实是因为酒驾。
He came to me in fact because he got a DUI.
他当时是酒后驾驶。
He was driving under the influence.
但事实证明，酒精并非他的主要问题。
But as it turned out, alcohol was not his primary problem.
当他在我诊室时，他向我坦白自己确实有上瘾问题，但不是酒精上瘾，而是网络赌博和体育博彩成瘾。
Once he was in my office, he revealed to me that he did in fact have an addiction problem, but it wasn't addiction to alcohol, it was an addiction to online gambling, sports betting.
他的故事是这样的。
And his story went like this.
他曾是高中和大学非常成功的运动员，一级联赛选手，获得过各种荣誉，确实是位出色的运动员。
He was a very successful high school and collegiate athlete, division one, all kinds of accolades, really a remarkable athlete.
那种高水平竞技体育的参与循环，伴随激烈比赛的肾上腺素，胜利与失败，那完全就是他的精神寄托，对吧？
And that cycle of engagement in high level athletics, the adrenaline that goes along with high level competition, the wins, the losses, that absolutely was his jam, right?
这让他保持忙碌投入，感到非常非常快乐。
It kept him busy and engaged and really, really happy.
但当职业生涯自然结束时，像许多高水平运动员一样，他陷入了一种自由落体般的失落感，一种存在主义的深刻失望，某种身份认同危机。
But when that career came to its natural end, like so many high level athletes, there was a sort of a free falling disappointment to kind of an existential, profound disappointment, a bit of an identity crisis.
尽管他即将进入医学院——这给了他新的身份认同——但他确实非常怀念通过体育参与获得的那种高强度循环。
And although he was headed to medical school, which, you know, gave him kind of a new identity to latch onto, he really missed that cycle of intensity that he got through participation in sports.
后来他被大学同学邀请参加梦幻橄榄球联盟。
And then he was invited by his collegiate buddies to participate in fantasy football, in a fantasy football league.
你知道的，他们聚在一起挑选自己的球队。
And, you know, they all get together and they choose their teams.
当时还涉及一些小额赌注。
And then there was, you know, minor money involved in that.
但他变得非常非常沉迷，比他的大学同学们都要严重。
But he got really, really into it, more so than his buddies from college.
这几乎成为了他通过体育博彩重新投入体育竞技的导火索。
And that was really almost the spark for him then to begin to want to engage athletically through sports betting and sports gambling.
你知道，一开始只是50美元、100美元的小赌。
And, you know, it started with $50, a $100.
而这时他已经开始上医学院了。
And at this time he's now started medical school.
他正在修读医学预科课程。
He's doing his pre med courses.
他正在为临床学年做准备。
You know, he's getting ready for his clinical years.
他有这部手机。
He had this phone.
他可以在大查房时掏出手机——本应专心听讲的场合——浏览各种体育赛事结果并下注。
He could pull it out during grand rounds, you know, when he was supposed to be listening to the speaker and scroll through results of all the different sports and then he could place a bet.
这种便捷性彻底俘虏了他，他发现自己完全沉迷其中，从每月几百美元发展到每周数千美元，最终变成每日豪赌。
And that accessibility just absolutely ensnared him, and he found himself completely caught up in it to the point where he was now spending not hundreds of dollars, but thousands of dollars, not monthly, but weekly, and eventually daily.
大约六个月后，他完全花光了从父母那里继承来用于支付医学院学费的信托基金。
And in about six months, he completely spent the trust fund that he had inherited from his parents in order to pay for medical school.
他感到非常羞愧，没有告诉任何人。
And he was so ashamed that he didn't tell anybody.
他心想，只要我能赢一次，就能把钱都赢回来，然后就没事了。
And he thought to himself, well, if I can just win, then I can get all the money back and then I'll be fine.
于是他瞒着所有人申请了一笔巨额贷款来支付医学院学费。
So he took out an enormous loan, without telling anybody, to pay for medical school.
他想着，好吧，我要把钱存进银行，以后慢慢还。
And he thought, okay, I'm going to put it in the bank, you know, I'm going to pay it back.
结果他把这笔钱也输光了。
And instead he gambled that away too.
安娜还有一位病人，开始做一件看起来比体育博彩更无害的事。
Anna had another patient who started doing something that might seem even more harmless than sports betting.
这个人发现自己从网购的循环中获得了强烈的快感。
So this was somebody who just found himself really getting intense pleasure out of the cycle of shopping online.
他会花相当多的时间搜索各种他感兴趣想买的商品。
He would spend quite a bit of time searching for different items that he was interested in buying.
这种类似寻宝的过程让他非常着迷且充满成就感。
And the process of kind of like the treasure hunting was very entrancing and rewarding for him.
整个过程缓慢累积，直到他选定要购买的商品并完成下单。
All kind of building up slowly to the point where he would choose the item that he would buy and then buy it.
然后他会满怀期待地等待商品配送到家，这一切都让他感到无比愉悦。
And then he would be waiting in anticipation for it to be delivered to his home and all of that was very pleasurable.
当包裹送达后，他拆开包装取出商品，拿到心仪之物时的快感简直妙不可言。
And then it would be delivered and he would open it and take it out and it was the thing that he wanted and it felt so good and it was just, you know, wonderfulness for him.
由于这个循环过程如此令人着迷，他开始越来越频繁地进行购物，逐渐将其作为调节情绪的生理依赖。
So because that cycle was so entrancing for him, he started to do it more and more and he kind of came to rely on it as a physiologic crutch for managing his mood.
但随着时间的推移，他发现这个循环周期变得越来越短，从中获得的期待感和愉悦感也越来越少。
But over time what he found was that, the cycle got shorter and shorter and the anticipation and pleasure that he got from it got less and less.
到最后，几乎就在拆开包裹拿到商品的瞬间，整个过程就结束了。
To the point where as soon as he opened the box and got what he had ordered, it was over.
然后他又会回到网上，试图购买下一件东西。
And then he'd be online again, trying to buy the next thing.
最终他的房子里堆满了不需要也不想要的物品，还欠下了数万美元的信用卡债务。
And eventually he ended up with rooms in his house full of stuff that he didn't need or want and tens of thousands of dollars of credit card debt.
但即便如此他还是停不下来。
And yet even then he couldn't stop.
于是作为最后手段，他开始购买些廉价商品——钥匙扣、马克杯、棒球帽、廉价太阳镜，这些他根本不需要的东西。
So what he started to do as kind of a last resort is he bought like these cheap items, key chains, mugs, caps, cheap sunglasses, things he didn't need or want.
东西一到手就立即退货。
Then as soon as he got them, he would return them.
——哇哦。
-Wow.
——因为他已经身无分文了。
-Because he didn't have any money.
但他就是无法打破这个购物循环。
But he couldn't break the shopping cycle.
我想谈谈最后一位病人，你称之为雅各布的男子。
I want to talk about one last patient, a man you called Jacob.
给听众们一个提示，接下来的故事会涉及性和自杀的内容。
And a note for listeners that this next story includes references to both sex and suicide.
雅各布在你初次见他时已届中年，甚至可能更年长一些。
Jacob was middle aged or maybe even a little older when you first met him.
安娜，他的故事是怎样的？
What was his story, Anna?
雅各布是斯坦福大学的科学家。
Jacob was a Stanford scientist.
顺便说明，我要强调我已获得患者许可讲述他们的故事，并使用化名并隐藏其他识别特征。
And by the way, let me just emphasize that I got permission from my patients to relay their stories and I use pseudonyms and hide other identifying features.
雅各布是斯坦福大学的科学家，他来找我是为了寻求对严重性成瘾的帮助。
So Jacob was a Stanford scientist who came to me seeking help specifically for a severe sex addiction.
包括性行为、色情内容和强迫性自慰。
So sex pornography, compulsive masturbation.
他描述的是在九十年代，他会使用色情内容并自慰，频率可能高达每天一次，但当时这种行为还是可控的。
And what he described was in the nineties, he used pornography and he masturbated, you know, as much as daily, but it was never unmanageable.
他仍能履行父亲和丈夫的职责，在职业领域也很成功。
He was still able to function as a father, as husband, he was successful in his profession.
但随着互联网的出现，特别是2000年代初智能手机的普及，他发现这种追求变得失控了。
But with the advent of the internet, and especially in the early 2000s, in the smartphone, he found that this pursuit of his became unmanageable.
也就是说，他每天花越来越多时间观看色情内容直到深夜，甚至因此缺席本该参加的学术会议——由于前一整晚都在看色情内容和反复自慰，他根本没准备演讲。
Which is to say that he was using more and more pornography for more hours every day, late into the night, not showing up at a conference that he was supposed to speak at, prepared to give that speech because he had been up the entire night before watching pornography, repeatedly masturbating.
随着时间的推移，他需要越来越强烈的刺激才能获得相同效果，于是从普通的色情内容升级到更变态的色情形式。
And over time he needed more and more potent forms to get the same effect, so he escalated from sort of vanilla toast pornography to more deviant forms of pornography.
后来连色情内容本身也无法满足他了。
And then pornography itself wasn't adequate.
于是他开始去现场表演场所并招妓。
So then he was going to live shows and meeting up with prostitutes.
最终他的成瘾发展到进入聊天室，在聊天室里与其他人进行危险行为，把所有可用时间都投入这种活动，导致他的生活彻底崩溃。
Eventually his addiction progressed to the point where he was going into chat rooms, doing dangerous things with other people in chat rooms, spending all of his available time engaged in this activity to the point that essentially his life completely fell apart.
他的妻子离开了他。
His wife left him.
天啊。
Oh my God.
他甚至考虑结束自己的生命，还在办公室附近找了个地方想上吊自杀。
And he was thinking about ending his life and even found a spot near his office where he thought about hanging himself.
当然，每个案例都各不相同。
Each of these cases, of course, is different.
网购不同于赌博。
Online shopping is not the same as gambling.
赌博也不同于色情内容。
And gambling is not the same thing as pornography.
但渐渐地，安娜不仅看到了这些患者之间的联系，还发现与许多未寻求精神科医生帮助的人也有相似之处。
But in time, Anna came to see connections not just between these patients, but to many people who are not seeking help from a psychiatrist.
比如像她这样的人。
People like herself.
您正在收听《隐藏的大脑》。
You're listening to Hidden Brain.
我是香卡·韦丹塔。
I'm Shankar Vedanta.
这里是《隐藏的大脑》。
This is Hidden Brain.
我是香卡·韦丹塔。
I'm Shankar Vedanta.
在斯坦福大学多年的执业生涯中，精神病学家安娜·莱姆克发现，生活在湾区——美国最富裕地区之一的大量居民，正遭受着一种奇怪的病症困扰。
Over many years of practice at Stanford University, psychiatrist Anna Lemke has found that lots of people living in the Bay Area, one of the wealthiest parts of The United States, were suffering from a strange malady.
尽管在教育程度和物质财富方面取得了巨大成功，她的许多病人却并不快乐。
Despite being blessed with great success in terms of education and material wealth, many of her patients were unhappy.
某天，安娜在自己身上看到了与她治疗的患者相似的特质。
At one point, Anna saw something in herself that reminded her of the patients she was treating.
安娜，我想聚焦你40岁前后的那段人生经历。
Anna, I want to zoom into your life around the time you turned 40.
那时你生活中发生了什么？
What was going on in your life at this time?
那时我的生活很好。
My life was good then.
你知道，我的婚姻很幸福。
You know, my marriage was fine.
我的孩子们都很健康。
My kids were healthy.
我的工作既有回报又有意义。
My work was rewarding and meaningful.
作为一个40岁的女性，我的健康状况相对不错。
I was in relatively good health for a 40 year old woman.
所以一切都很好。
So things were good.
你一直都很喜欢阅读。
Now you've always loved reading.
大约就在那个时候，你迷上了一套非常受欢迎的系列书籍。
And around this time, you fell in love with a very popular book series.
是什么书呢？
What was it?
是《暮光之城》系列。
It was the Twilight Saga.
你能简单告诉我《暮光之城》讲的是什么吗？
And can you tell me a little bit about what the Twilight Saga is?
坦白说我没读过这些书。
I confess I have not read the books.
它们的大致情节是怎样的？风格如何？
What is their broad plot and what it was a bit like?
嗯，你知道，我是在送孩子上小学时接触到《暮光之城》的，当时有一群妈妈围在一起讨论。
Well, you know, I was turned on to the Twilight Saga when I dropped my kids off at elementary school and there was a group of moms clustered around.
梅根就是其中一位妈妈，她是我的朋友。
Megan was one of the moms, my friend.
她们全都笑得前仰后合。
And they were all laughing hysterically.
我走过去问，嘿，什么这么好笑？
And I went over and I said, hey, what's so funny?
梅根说，哦，我一直在读这本超爱的言情小说。
And Megan said, oh, I've been reading this romance novel that I absolutely love.
我去书店想买续集却找不到。
And I went into the bookstore to try to get the sequel and I couldn't find it.
我就问书店老板，嘿，那个续集在哪？
So I went up to the book store owner and I said, hey, you know, where's the the the sequel?
他说，在青少年读物区。
And he said, it's in the teenager section.
对吧？
Right?
所以妈妈们都笑疯了。
So all the moms started cracking up.
她们觉得那是最搞笑的事了。
They thought that was the funniest thing.
但她接着说，你们必须得读读这本书。
But she said, but you guys have to read it.
它真的很好看。
It's so good.
所以我说，好吧，梅根。
So I said, okay, Megan.
这本书叫什么名字？
What is it called?
因为我一直在找本好书看。
Because I I'm always looking for a good read.
对吧？
Right?
她说，哦，叫《暮光之城》系列。
She said, oh, it's called the Twilight Saga.
于是我想，好吧，我就试试看吧。
So I thought, okay, I'll give it a try.
它完全让我着迷了。
And it was absolutely mesmerizing for me.
仿佛我这辈子从未读过小说一样。
It was as if I had never read a novel in my life.
突然间，这本关于一群青少年吸血鬼互相咬脖子的故事彻底让我沉浸其中。
And all of a sudden, this novel about a bunch of teenage vampires running around biting each other on the neck just absolutely transported me.
这感觉真的很奇怪。
It was really weird.
后来《暮光之城》系列书籍被改编成了非常受欢迎的电影系列。
So the Twilight books eventually spawned a very popular series of films.
我想给你们播放其中一部电影的片段。
I want to play you a clip from one of those movies.
一个名叫贝拉的女孩正在质问她认识的男孩爱德华的真实身份。
A teenage girl named Bella is confronting a boy she knows, Edward, about his true nature.
我知道你是什么。
I know what you are.
说出来
And say it
大声说出来。
out loud.
说出来。
Say it.
吸血鬼。
Vampire.
你害怕吗？
Are you afraid?
不。
No.
好的。
Okay.
这里有很多，你知道的，令人屏息的停顿，但我听到的是幻想、超自然之类的内容。
So there are a lot of, you know, breathless pauses here, but I'm hearing, you know, fantasy, paranormal stuff.
不过这听起来像是个足够无害的消遣，安娜。
But it sounds like an innocent enough pastime, Anna.
哦，足够无害的消遣？
Oh, an innocent enough pastime?
当然。
Sure.
一开始总是无害的。
It always starts out innocent.
而且，你知道，它确实曾经是。
And, of course, you know, it was.
但后来发生的是，它改变了我当下的感受，那种共鸣如此深刻，以至于我想不断重现那种感觉。
But what happened was it changed the way I felt in the moment in a way that resonated so deeply that I wanted to keep recreating that feeling.
那是一种什么样的感觉？
And what was that feeling?
那本质上是一种虚无感。
It was essentially a feeling of non being.
当我阅读《暮光之城》系列时，它仿佛将我带到了另一个时空，让我彻底忘记了自我。
While I was reading the Twilight Saga, it just transported me to another time and place such that I completely forgot myself.
而这种自我遗忘显然是我当时所需要且渴望的。
And that self forgetting was clearly something that I needed and wanted.
你知道的，我读完了整个系列。
You know, I read the whole saga.
我记得好像是四本书。
I think it's like four books.
之后我又想再次体验那种感觉。
And then I wanted to recreate that feeling again.
于是我把整个系列又重读了一遍。
So I read the whole saga again.
-哇。
-Wow.
-愉悦，但不如第一次那么愉悦。
-Pleasurable, but not as pleasurable as the first time around.
但那时，我已完全沉迷于吸血鬼言情小说这一类型。
But by then, I was completely tapped into this whole genre of vampire romance novels.
于是我开始投入越来越多的时间、精力和创造力来获取和阅读吸血鬼言情小说。
And so I started to invest larger and larger amounts of time, energy, and creativity into obtaining and reading vampire romance novels.
你知道，起初看似无害，但后来变得有点痴迷。
You know, seemingly innocent to start with, but it became a bit of an obsession.
当吸血鬼言情小说看完后，我又转向狼人言情小说，接着还有通灵师、占卜师等各种题材
And and when I ran out of vampire romance novels, I moved on to werewolf romance novels, and then there was necromancers and soothsayers and
哦，天啊。
Oh, wow.
各种超自然言情小说。
All kinds of paranormal romance novels.
我们是从哪里搞到这些书的？
Where are we procuring this books?
我住在一个藏书有限的小图书馆旁边。
So I live right next to a little library which has a limited collection.
所以当我读完本地图书馆的有限藏书后，要么骑车去总馆，要么通过馆际互借系统预订。
So when I went through the limited collection at my local library, I either biked over to the main library or you can order through the interlibrary loan.
要知道，其中一些言情小说的封面相当暴露。
And, you know, some of these romance novels have very revealing covers.
比如那种封面是肌肉男站在船头之类的撕衣激情小说。
Like, it was some bodice ripper with some hunk on the cover, you know, at the prow of a ship or something.
我实在不想被人看到在任何地方读这种书。
Like, I wouldn't wanna be seen reading that anywhere.
于是安娜想出了个办法，不让家人朋友知道她在读什么。
So Anna came up with a way to hide what she was reading from her family and friends.
我从未向任何人透露过这件事。
I haven't revealed this to anybody.
这太糟糕了。
This is terrible.
但我其实会把书藏在另一本书里，这样如果我的孩子或丈夫经过时，看起来我像是在读另一本书。
But I would actually put the book inside another book so that if one of my kids came by or my husband came by, I could look like I was reading the other book.
哇，比如医学期刊之类的。
Wow, like a medical journal or something.
不过那可能骗不了他们，因为你知道，他们会知道我不可能花那么多时间读医学期刊。
Except that might not really trick them because like, you know, they would know that I wouldn't spend that much time reading a medical journal.
我是说，我八年级时就干过这种事，安娜。
I mean, I used to do this in eighth grade, Anna.
我觉得这种书套书的把戏，我在八年级时就玩得炉火纯青了。
I felt like, you know, the trick of the book inside the book was something I had perfected in eighth grade.
我知道。
I know.
我知道。
I know.
而我四十多岁才发现这个办法。
And I discovered it in my forties.
我能说什么呢？
What can I tell you?
属于大器晚成吧。
Was a late bloomer.
安娜，你对你文学的热爱从纸质书转向电子领域后，曾一度得到了极大的提升。
So at at one point, Anna, your your love of this literature received a turbocharge when you moved from the the printed page to the electronic domain.
跟我说说这是怎么发生的。
Tell me how that happened.
嗯，我朋友苏珊说，'你应该买个Kindle，这样就不用随身带着这些书了'。
Well, my friend Susan said, oh, you should get a Kindle because then you don't have to, you know, be carrying these books around.
那时候Kindle刚推出不久。
Kindles had just come out then.
当然，我很喜欢这个主意，因为这样获取书籍会很方便。
And of course, that was very I liked that idea because it would be easy access.
但很快，我就开始经常上亚马逊，寻找类似《暮光之城》系列的作品。
But pretty soon, I also started regularly going on Amazon and looking for, you know, things that were similar to the Twilight saga.
你猜怎么着？
And guess what?
亚马逊会主动推荐这些书，现在我们都知道了。
Amazon will suggest those to you as we all know now.
所以亚马逊替我完成了筛选工作。
And so Amazon did the work for me.
我只需要看看推荐列表，心想‘哦，他们建议我读这本’。
All I had to do was look in my feed and say, oh, they're telling me I should read this one.
‘他们又推荐我读那本’。
They're telling me that I should read that one.
后来我还发现可以在亚马逊上找到免费书籍。
And like later on in the process, I also discovered that you can get free books on Amazon.
只要是浪漫题材的免费书，我都会下载阅读。
So anything that was free that was in the romance category, I would download and read.
这确实是我沉迷的开始，因为有了电子阅读器后，我彻底变成了一个连环读者。
And that was really the beginning of the end for me because once I had that electronic reader, I essentially became a chain reader.
就像我刚读完一本书，就会立刻从当地图书馆借阅或在亚马逊上购买另一本。
Like as soon as I finished one book, I would either borrow from the local library or buy on Amazon another book.
这些全都是爱情小说。
These were all romance novels.
我甚至发展到这样一种程度：只要不是必须处理工作或家庭事务，我就在读爱情小说。
And I got to a point where whenever I wasn't doing something that I absolutely had to do, like for my work or my family, I was reading romance novels.
哇。
Wow.
后来发展到我只想做这件事。
And then it got to where, like, that's all I wanted to do.
我对其他任何事情都提不起兴趣。
And I didn't enjoy anything else.
我甚至不太愿意陪伴孩子和丈夫。
I didn't even really want to be with my kids or my husband.
对吧？
Right?
我只希望那些时光快点过去，这样我就能继续读言情小说了。
I just wanted those times to rush through them so that I could go back to reading romance novels.
另一件我事后才意识到的事是，那些相对温和的言情小说——就是那些性爱场景描写不太露骨的——已经无法满足我了。
The other thing that I only realized in retrospect was that these sort of tamer versions of romance where, you know, the sex scenes aren't super graphic, well, those stopped working for me.
我需要越来越露骨的言情小说类型，才能获得我所追求的那种刺激感。
And now I needed ever more graphic types of romance novels in order to get that zing that I was looking for.
所以到了这个阶段，这已经不再是关于阅读的乐趣或你对文字的热爱了。
So this was no longer about the pleasure of reading at this point or your love of language.
它已经变成了另一种东西。
It it it had become something else.
哦，它绝对变成了另一种东西。
Oh, it had absolutely become something else.
当然，这根源在于阅读的乐趣，以及我一直从小说中获得的愉悦感。
And of course, was rooted in the pleasure of reading and the pleasure that I've always gotten from fiction.
但问题是后来我到了一个阶段，真的不在乎它是否写得糟糕、情节拙劣或角色乏味了。
But what happened was I got to a point where I really didn't care if it was badly written or badly plotted or the characters were uninteresting.
我会直接翻到高潮部分，双关语请见谅。
I would just flip through to the climax, pun intended.
于是我开始阅读非常露骨的色情文学。
So then I got to where I was, like, reading really graphic erotica.
越露骨越好。
And the more graphic, the better.
性爱场景越多越好。
The more sex scenes, the better.
但这一切都是为了达到那个瞬间，获得某种非常特定的感觉。
But it was all about getting to that moment and getting a certain very specific feeling.
是啊。
Yeah.
我掌握了这个诀窍：随便拿起一本言情小说，翻到三分之二或四分之三处，你就能直接找到关键情节。
And I became the possessor of the knowledge that if you take any romance novel and you open it up to two thirds over three quarters of the way through, you know, you'll get right to the point.
也就是说这些言情小说都是精心设计的。
Which is to say these are these romance novels are engineered.
它们都是按照固定套路写成的。
They're written according to a recipe.
所以到了这个时候，你知道，你是斯坦福大学备受尊敬的研究员和精神科医生。
So at this point, you know, you're a respected researcher and psychiatrist at Stanford University.
你有一个美满的家庭。
You have a great family.
但已经不复存在了。
But no longer.
很快就不复存在了。
Soon to be no longer.
好吧。
Okay.
但但这就是我想问你的。
But but that's what I wanna ask you about.
你知道，你你你在某些方面所做的事，肯定与你公众形象不符，那种你自认为是个母亲、拥有美满家庭的感觉。
You know, you you you have you know, what you are doing in some ways must have felt at odds with your public persona, the the the sense that you had that you were a mom, that you had a great family.
你对这种新发现的激情文学感到难为情吗？
Were you embarrassed by your newfound love of steamy literature?
首先，我并没有真正意识到当时发生了什么。
First of all, I didn't really see what was happening as it was happening.
我偶尔会和朋友开玩笑说，哎呀，我对吸血鬼爱情小说或者爱情小说上瘾了。
I would occasionally joke to friends, oh, I'm so addicted to vampire romance novels or romance novels in general.
但正因为能拿这事开玩笑，我觉得这肯定意味着我并没有真的沉迷其中，或者这根本不是一个问题。
But just by being able to joke about it, I felt that that must mean I'm really not addicted to it or it's not really a problem.
很大程度上由于科技的原因，我能够秘密进行这些行为。
The other thing was that because of the technology in large part, I could do the behavior secretly.
自从有了Kindle，我可以在上面阅读任何内容，而没人知道我读的是什么。
Once I got the Kindle, you know, I could be reading something on that Kindle that nobody else knew what I was reading.
而在此之前，我绝不想在任何地方被人看到读那些东西。
Whereas before, I wouldn't wanna be seen reading that anywhere.
那会非常尴尬。
That would just be really embarrassing.
但在Kindle上阅读，感觉是匿名的。
But on a Kindle, like it was anonymous.
这对你的病人护理有什么影响？
How did this affect your patient care?
因为在这整个过程中，你大概还在治疗其他病人，帮助人们戒除各种瘾症。
Because presumably through all of this, you were still treating other patients and helping people with their addictions.
没错。
Right.
当这一切发生时，我并没有真正意识到它的发生，也没有将其与我的患者们正在经历的事情联系起来。
As it was happening, I didn't really see it happening and I didn't relate it as being similar to what my patients were going through.
这一点我直到事后回顾时才真正看清。
That that I really only saw in retrospect.
但我开始对自己的工作失去兴趣。
But I started to be less interested in my work.
就像之前一样，那份曾赋予我意义、目标和快乐的工作开始变得单调、灰暗且乏味。
Like again, the work that had given me meaning and purpose and joy started to be dull and gray and boring.
我发现自己对工作越来越不上心，只想赶紧做完回家看言情小说。
And I I found myself less engaged and more just wanting to rush through the work so that I could go home and read romance novels.
所以你工作时并不看这些书。
So you weren't reading these at work.
你把阅读时间都留在了家里。
You reserved the reading at home.
嗯，有那么一天——差不多是这种行为发展到顶峰的时候。
Well, there was one day, and this was sort of near the sort of culmination of this behavior.
那段时间我对时间的感知很模糊，但我觉得这种状态持续了大概一两年。
Time is weird for me then, but I think it developed over the course of about a year or two.
但我确实带了本言情小说去上班，在两位病人问诊间隙的十分钟里阅读。
But I did bring a romance novel to work and was reading in the ten minutes between patients.
我不想扮演业余心理医生的角色，不过... 没关系。
So I don't wanna play armchair psychiatrist, but but it seems that you were That's okay.
你知道，你是在用这些书里的情感作为一种逃避。
You know, you you you were using your emotion in these books as a kind of escape.
你觉得你在逃避什么？
What do you think you were escaping from?
嗯，这正是最耐人寻味的地方。
Well, that's what's so fascinating.
我其实并没有什么需要逃避的。
I really didn't have anything to escape from.
我有个很棒的丈夫。
I have a great husband.
我有这些可爱的孩子。
I have got these great kids.
我有自己热爱的工作。
I have work that I adore.
我的病人们都非常好。
My patients are just so fantastic.
一切都很好。
There was nothing wrong.
我其实只是逃避到
I was really just escaping to.
而我逃避的目的地就是不必待在自己的身体里，不必思考，能够体验这种强烈的欣快感，你知道的，那个对我来说非常非常愉悦的异度空间。
And the thing that I was escaping to was just not having to be in my body, not having to think, being able to experience this kind of intense euphoria, you know, this other place which was very, very pleasant for me.
就是感觉很棒。
Just felt good.
我还想指出的另一点是，我们反复看到的模式是：某件事最初是令人愉悦的。
The other thing I just want to flag here is that the pattern we've seen over and over again which is that something starts out being pleasurable.
所以你的朋友向你推荐了这本爱情小说，你读了《暮光之城》系列，觉得很有趣、很享受，于是你又继续读更多。
So your friend tells you about this romance novel, you read the Twilight saga, you find it fun, you find it enjoyable, and so you go back for more.
但在这个过程中，某种平衡被打破了，你不再是因为获得快乐而读这些书。
But somewhere along this process, sort of the balance shifts and now you're no longer actually reading these things because they're giving you pleasure.
而是你意识到自己几乎是为了逃避痛苦而读它们。
It's that you know you're reading them almost to avoid pain.
听起来对吗？
Does that sound right?
这确实是关键——我们最初出于理性原因开始某种行为，它也确实成功实现了我们的目标，无论是带来快乐还是完成其他目标。
That's really the key that we we start out doing whatever the behavior is for, you know, rational reasons, and it succeeds in achieving what we're trying to achieve either to give us pleasure or to, accomplish some other goal.
但如果这种行为劫持了我们大脑的奖励回路，它就会获得自主生命。
But if it then hijacks our brain's reward pathway, it gets a life of its own.
然后即使当它不再实现我们想要的效果时，我们也无法停止。
And then even when it stops doing what we want it to do, we can't stop.
而这正是成瘾的标志性特征。
And that's really the hallmark of addiction.
稍后回来时，我们将探讨这种日益全球化的顽疾背后的脑科学原理。
When we come back, the brain science behind an increasingly global malady.
您正在收听的是《隐藏的大脑》。
You're listening to Hidden Brain.
我是尚卡尔·维丹塔。
I'm Shankar Vedanta.
这里是《隐藏的大脑》。
This is Hidden Brain.
展开剩余字幕（还有 199 条）
我是尚卡尔·韦丹塔。
I'm Shankar Vedanta.
安娜·莱姆克是斯坦福大学行为科学领域的精神科医生兼研究员。
Anna Lemke is a psychiatrist and researcher in the behavioral sciences at Stanford University.
她是《放纵时代的平衡之道》一书的作者。
She's the author of Finding Balance in the Age of Indulgence.
安娜，你的许多患者都深受强迫性过度消费问题的困扰，你自己也曾亲历过类似情况。
Anna, many of your patients suffered from problems related to compulsive overconsumption, and you experienced some of this yourself.
但你比患者们拥有一个巨大优势。
But you had a big advantage over your patients.
你作为研究大脑的科研人员，深知神经科学中一项关于脑内痛觉与愉悦感关系的重要发现。
You were a researcher and a scientist who studies the brain, and you knew about a very important discovery in neuroscience that has to do with the relationship between pain and pleasure inside the brain.
这项发现是什么？
What was this discovery?
这项发现揭示了痛觉与愉悦感在大脑中共享同一区域的事实。
This discovery was the fact that pain and pleasure are co located in the brain.
大脑中处理愉悦感的区域同样也处理疼痛感，它们就像天平的两端一样运作。
So the same parts of the brain that process pleasure also process pain and they work like opposite sides of a balance.
所以几乎就像跷跷板一样？
So almost like a seesaw?
没错。
Exactly.
就像儿童游乐场里的跷跷板。
Like a seesaw or a teeter totter in a kid's playground.
当跷跷板或平衡木在中央支点上与地面保持水平时，它就处于静止状态，也就是神经科学家所说的内稳态。
And when that teeter totter or that beam on a central fulcrum is level with the ground, it's at rest, or what neuroscientists call homeostasis.
当我们体验愉悦时，它会向一侧倾斜；当我们感受痛苦时，它会向相反方向倾斜。
And when we experience pleasure, it tips one way and when we experience pain, it tips in the opposite direction.
这个平衡系统遵循某些规则，其中第一条也是最重要的规则是：平衡系统总是试图保持水平状态。
And there are certain rules governing this balance and the first and most important rule is that the balance wants to remain level.
也就是保持内稳态。
That is at homeostasis.
我们的大脑会非常努力地在任何偏离中立状态后恢复平衡。
And our brains will work very hard to restore a level balance after any deviation from neutrality.
所以当我们追求愉悦的事物时，比如我咬一口美味的甜点时，想象我本质上是在按压跷跷板的愉悦那一侧。
So when we reach for things that are pleasurable, when I bite into a delicious dessert for example, I'm imagining that I'm essentially pressing down on the pleasure side of that seesaw.
没错。
That's right.
所以当我们做愉悦的事情并在奖励路径中释放多巴胺，平衡向愉悦一侧倾斜时，大脑会立即非常努力地恢复平衡，首先会向痛苦一侧倾斜同等且相反的幅度，然后再回到水平位置。
So when we do something that's pleasurable and we release dopamine in the reward pathway and the balance tilts to the side of pleasure, No sooner has that happened than our brains will work very hard to restore a level balance and they do that first by tilting an equal and opposite amount to the side of pain before going back to the level position.
我喜欢想象成这些小神经适应小精灵跳上天平痛苦的那一侧，这就是所谓的低谷、宿醉和后续效应。
And I like to imagine that as these little neuro adaptation gremlins hopping on the pain side of the balance and that's the come down, the hangover, the after effect.
这种情况经常发生在我们仍在体验多巴胺冲击时，而且往往是在无意识状态下发生的。
And it often happens even while we're still experiencing the dopamine hit and it often happens outside of conscious awareness.
所以如果我脑海中浮现这样的画面：压下滑跷板的一边，而这些小精灵跳到另一边，为什么它们要压向痛苦的那侧呢？
So if I have this image here about pressing down on one side of the seesaw and these and these gremlins are jumping on the other side, why is it they want to press down on the side of pain?
为什么不直接尝试达到平衡状态呢？
Why not just try and get to, you know, equilibrium?
为什么要如此用力按压以至于跷跷板会向反方向倾斜？
Why why press down so much that it tips over in the other direction?
这是个很好的问题。
That's a great question.
我并不完全清楚为什么这个机制是这样构建的，为什么我们要为每个快乐付出代价。
And I don't exactly know why the mechanism is built like that, why we pay a price for every pleasure.
但我猜测这与这种机制让我们成为终极追求者有关——永不满足于现状，总是渴望更多。
But I suspect it has to do with the fact that that kind of mechanism makes us the ultimate seekers, never satisfied with what we have, always looking for more.
细想一下，我们经过数百万年进化，形成了趋乐避苦的本能。
When if you think about it, we are evolved over millions of years of evolution to approach pleasure and avoid pain.
在此基础上，这种快乐痛苦的平衡机制意味着：一旦获得想要的奖励，在体验快乐的同时，我们会立即记住获取途径并想要重现这个过程。
And then on top of that, you have this pleasure pain balance whereby as soon as we get whatever reward we're looking for, we experience pleasure, we immediately remember where and how that happened and we want to recreate it.
这种重现行为会因多巴胺冲击后的急速消退而加速——就像经历多巴胺自由落体。
And that recreation is accelerated by the fact that as soon as we get that hit of dopamine, we essentially go into dopamine free fall.
这就是那些在痛苦端作祟的小精灵。
That's those gremlins on the pain side of the balance.
现在我们处于多巴胺不足的状态，会感到一种强烈的动力去做那些能带来下一次奖励的工作——要知道在人类历史的大部分时期，这意味着每天步行数十公里。
And now we're in a dopamine deficit state and we feel this overwhelming motivation to do the work it takes to get the next reward, which, you know, for most of human existence has meant walking tens of kilometres every day.
你知道，需要付出巨大努力才能获得一点点回报。
You know, involved doing enormous work in order to get just a little bit of reward.
所以多巴胺本身无所谓好坏。
So it's not that dopamine is good or bad.
关键在于多巴胺对生存至关重要，它让我们保持行动，永远追寻下一个目标。
It's that dopamine is essential for survival and it keeps us moving and always looking for the next thing.
所以多巴胺不仅参与感受快乐的过程。
So dopamine is not involved only in feeling pleasure.
或许更重要的是，它还涉及动机形成——这正是你刚才讨论的内容。
Perhaps more importantly, it's also involved in motivation, which is of course what you're talking about just now.
你能解释一下多巴胺作为快乐信使，同时又是动机构建者之间的这种关联吗？
Can you explain that connection between dopamine as a messenger of pleasure, but also dopamine as the architect for motivation?
是的。
Yeah.
有一个非常著名的实验，科学家们培育出大脑奖励通路中缺乏多巴胺受体的大鼠。
So there's a very famous experiment in in which rats were bioengineered to not have dopamine receptors in the reward pathway of the brain.
科学家们发现，如果把食物直接放进大鼠嘴里，大鼠会吃掉食物并似乎从中获得快感。
And what the scientists discovered was that if they put food into the rat's mouth, the rat would eat the food and seem to get pleasure from the food.
但如果把食物放在哪怕只有一个身长的距离外，大鼠就会活活饿死。
But if they put the food even, you know, a single body length, the way the rat would starve to death.
换句话说，我们不仅需要多巴胺来体验快感，还需要它提供动力去努力获取奖励。
In other words, we need dopamine, not just for the experience of pleasure, but also for the motivation to do the work, to go get the reward.
多巴胺可能是通过制造这种多巴胺缺失状态，或者说在天平痛苦端制造那些小恶魔，来激发我们的动力。
And probably the way that dopamine makes us motivated is to create this dopamine deficit state or those gremlins on the pain side of the balance.
那么当我们把这个经过数百万年进化的大脑，移植到只需按个按钮就能获得一切的现代环境中时，会发生什么？
So what happens when we transport this brain that evolved, you know, over millions of years into the modern environment where everything is now available at the touch of a button?
这套让我们在快感后立即体验痛苦的古老神经回路，与现代生态系统严重不匹配。
This ancient wiring that has us experiencing pain in the immediate aftermath of pleasure is woefully mismatched for our modern ecosystem.
为什么？
Why?
因为我们被快感包围着。
Because we are surrounded by pleasure.
我们比人类历史上任何时候都更容易接触到成瘾性药物和行为。
We have more access to more reinforcing drugs and behaviors than at any point in human history.
甚至连那些你原本认为健康的活动，比如阅读、锻炼或玩游戏，也在某种程度上被药物化了。
Even things that previously you could have thought of as healthy, like reading or exercise or playing games has become drugified, has been turned into a drug in some way.
这使得我们都更容易上瘾，也更容易陷入多巴胺缺失状态——我们的大脑会通过下调自身多巴胺的分泌和传递来补偿过度的快感，不仅降到基线水平以下，还会产生持续的生理渴求，随之而来的还有焦虑、易怒和抑郁等症状。
Making us all more vulnerable to the problem of addiction and also making us more vulnerable to the problem of this dopamine deficit state whereby our brains try to compensate for this excess of pleasure by down regulating our own dopamine production and transmission, not just to baseline, but below baseline, creating this constant physiologic craving for more pleasure, but also the things that go along with craving, which are anxiety, irritability, and depression.
所以说，我们大脑中驱使我们去追求快乐、逃避痛苦的机制，正如你所说，是在数百万年的稀缺环境中进化形成的。
So the mechanisms in our brain that compel us to you know, approach pleasure and avoid pain, you say were evolved over millions of years for a world of scarcity.
而如今，由于我们被如此丰富的物质包围，就像你说的，我们仿佛在从多巴胺的消防水龙带中狂饮。
Whereas today, because we're surrounded by so much stuff, we're sort of drinking from a fire hose of dopamine, as you put it.
是的。
Yeah.
这就是所谓的'富足悖论'。
This is it's it's the Plenty Paradox.
对吧？
Right?
这就是物质过剩带来的生理性压力。
It's the literal physiologic stress of overabundance.
那么请用我们之前讨论的跷跷板比喻来解释一下。
So walk me through the same seesaw analogy that we talked about earlier.
想象一下，十万年前，我发现了一棵枣树，树上有美味的枣子。
You know, again, a 100,000 years ago, you know, I found a a date tree, and the date tree had delicious dates.
吃这些枣子让我的大脑感到非常快乐，但那棵树上并没有多少枣子。
And it made my my brain very happy to eat some of those dates, but there were not very many dates on that one tree.
我必须找到下一棵树，而下一棵树可能像你说的那样在三英里之外，需要付出巨大努力才能到达。
I had to find the next tree, and the next tree might have been, as you say, three miles away, and so it required a huge amount of effort to get to that next date tree.
在我们所处的这个触手可及的世界里，这个跷跷板发生了什么变化？
What's happening with that seesaw now in the world in which we live where things are in fact available at the touch of a button?
是的。
Yeah.
让我们先回顾一下，当你寻找枣树时，跷跷板理论是如何运作的。
Well, let's go back for a second and talk about what's happening with the seesaw when you're looking for the date tree.
因为当你在环境中搜寻时，试图找到一棵结着几颗枣子的枣树，你的快乐痛苦平衡会向痛苦一侧倾斜。
Because what happens as you're scouring your environment to try to find, you know, one date tree with a couple of dates on it, is that your pleasure pain balance goes onto the pain side.
对吧？
Right?
因为你又饿又累，还要长途跋涉。
Because you're hungry and you're walking and you're tired.
最终当你找到这棵枣树时，你会欣喜若狂，吃下枣子后，你的快乐痛苦平衡就会恢复到水平状态。
And then finally, you find this date tree and you know, you 're ecstatic and you eat this date and your balance, your pleasure pain balance goes back to the level position.
这种感觉就像狂喜，因为其中的关键在于快乐痛苦平衡的趋向性。
Which feels like euphoria because part of the key here is the directionality of the pleasure pain balance.
如果我因为饥饿而感到痛苦，然后找到食物让我趋向快乐，这种快感就像我一开始处于平衡状态，然后使用兴奋剂达到高潮一样强烈。
So if I'm in pain because I'm hungry and then I find something to eat and it moves me in the direction of pleasure, that's as pleasurable as if I start out with a level balance and I use an intoxicant and I get high.
有意思。
Interesting.
那么现在同样的痛苦与快乐平衡，会发生什么？
And so now the same pain, pleasure balance now, what happens now?
是的，所以在现代世界，比如说硅谷就是个典型例子，不过现在全世界都是这样。
Yeah, so now in the modern world, let's say, yeah, take Silicon Valley because it's a prime example, but it's also true all over the world now.
你去觅食时感到饥饿，对吧？
You go and you're hungry, right?
你正在寻找一棵枣树，突然发现亚马逊直接给你运了一整箱枣子到厨房餐桌上。
You're looking for a date tree and all of a sudden, you've got like a whole crate of dates shipped to you from Amazon right on your kitchen table.
顺便说一句，这些枣子个头巨大。
And by the way, they're giant.
它们大得反常。
They're like abnormally giant dates.
所以你吃了颗亚马逊的巨型枣子，它会刺激奖励通路释放多巴胺——因为商家还添加了糖、盐、脂肪和调味剂。
So you eat a giant date from Amazon and it releases dopamine in your reward pathway because they've also added sugar and salt and fat and flavorings.
可能是咖啡风味枣之类的，谁知道呢？
It's like coffee dates or something, who knows?
然后你获得了多巴胺的释放，哇，感觉棒极了。
And you get the release of dopamine and wow, that feels great.
因为想想看，哇，人类历史上谁曾有过这样的枣子体验？
Because like, wow, who's ever had a date like that in the history of humans?
而一旦结束，你的快乐痛苦天平就会向痛苦一侧倾斜，因为那些小恶魔正试图补偿所有的多巴胺。
And then as soon as it's over, your pleasure pain balance tips to the side of pain because those gremlins are trying to compensate for all that dopamine.
当你处于多巴胺不足状态，天平痛苦端的小恶魔作祟时，你就会想要恢复平衡。
And as soon as you're in that dopamine deficit state with the gremlins on the pain side of the balance, you want to restore a level balance.
那最简单的方法是什么？
And what is the easiest way to do that?
嗯，你可以等到小恶魔自己跳下去。
Well, you could wait until the gremlins hop off.
因为只要你等得够久，它们就会离开，体内平衡就会恢复。
Because if you wait long enough, they will hop off and homeostasis will be restored.
或者你可以再吃一颗枣子。
Or you could eat another date.
如果你再吃一颗枣子，因为面前就有一整箱枣子，这样见效会更快。
And if you eat another date, because there's a whole crate of dates right in front of you, that would work faster.
对吧？
Right?
也许这次你会吃两颗，因为这样既能平衡你的状态，又能让你偏向快乐的一侧。
And maybe you'll eat two this time because then that'll level your balance, but also get you over to the pleasure side.
很快你就会吃掉整箱枣子。
And pretty soon you've eaten the whole crate of dates.
现在你基本上是在和那些神经适应的小怪物作战了。
And now you're essentially at war with those neuro adaptation gremlins.
我们越是试图压下跷跷板的快乐端，小怪物就越是要压下另一端以求平衡，你认为久而久之，小怪物会开始压向跷跷板的另一端，最终导致我们抑郁和焦虑。
And the more we then try and press down on the pleasure side of the seesaw, and the more the gremlins try and press down on the other side to achieve homeostasis, you make the case that over time, the gremlins start to push down on the opposite side of the seesaw and then we end up depressed and anxious.
安娜，解释一下这是怎么发生的。
Explain how this happens, Anna.
当我们持续用高度强化的物质和行为轰炸奖励通路时，就会在平衡的痛苦端积累越来越多的小怪物。
Well what happens as we continually bombard our reward pathway with highly reinforcing substances and behaviors is that we accumulate more and more gremlins on the pain side of the balance.
它们只是在履行职责，试图恢复体内平衡。
They're just doing their job, you know, trying to restore homeostasis.
久而久之，这些小恶魔就在痛苦那端安营扎寨，搭起帐篷支起烧烤架。
And over time, you know, those gremlins essentially are camped out on the pain side of the balance, tents and barbecues in tow.
此时我们已陷入成瘾大脑状态。
And now we're in addicted brain.
我们改变了享乐阈值，现在需要更大剂量、更强效的毒品不是为了获得快感，而是仅仅为了恢复平衡感受常态。
We've changed our hedonic or joy set point such that now we need more of our drug quantity wise and more potent forms of our drug not to get high, but just to level the balance and feel normal.
最关键的是，我们不再吸毒时，带着倾向痛苦一侧的快乐痛苦天平行走，这意味着我们正经历戒断任何成瘾物质时都会出现的通用症状：焦虑、易怒、失眠、抑郁和渴求。
And most importantly, we're not using, we're walking around with a pleasure pain balance tilted to the side of pain, which means we are experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression and craving.
作为成瘾精神病学家，你治疗过许多药物依赖患者。
I mean, you're an addiction psychiatrist and you treat many patients who are dependent on drugs.
这里说的药物是传统意义上的化学物质，通过吞服、吸食、鼻吸或摄入。
So drugs in the conventional sense of a chemical that is swallowed or smoked or snorted or ingested.
显然这是非常严重的问题，但你现在提出的主张要激进得多。
And obviously that is a very big problem, but you know you're making a much more radical claim here.
你是说我们的成瘾问题不仅限于尼古丁、可卡因和海洛因。
You're saying that our problem with addiction is not just limited to nicotine and cocaine and heroin.
你说得完全正确。
You're absolutely right.
我想说的是，科学、技术和创新已经让我们几乎能把所有人类行为都变成‘毒品’。
What I'm saying is that science, technology and innovation has allowed us to drugify almost every human behavior.
如果你还没上瘾，那么它很快就会出现在你附近的网站上。
If you're not addicted yet, it's coming soon to a website near you.
而我更激进的观点是，抑郁、焦虑和自杀率的上升——顺便说这些在世界上最富裕的国家上升最快——部分原因在于我们用过多的多巴胺过度刺激了大脑的奖赏通路。
And my bigger claim is that the rising rates of depression, anxiety and suicide, which by the way are rising fastest in the richest nations in the world, are due in part to the fact that we are overloading our brains reward pathway with too much dopamine.
并且我们的大脑为了补偿过多的快感，本质上正在个体和集体层面下调自身多巴胺的生成与传递，不仅降到基线水平，实际上还低于基线水平。
And that in our brains effort to compensate for too much pleasure, we are essentially individually and collectively down regulating our own dopamine production and transmission, not just to baseline levels, but actually below baseline levels.
所以我们正处于多巴胺缺乏状态。
So we are in a dopamine deficit state.
这意味着我们都变得更不快乐、更焦虑、更抑郁、更易怒，更难从过去能带给我们快乐的事物中获得愉悦——那些曾让几代人感到快乐的事物——同时也对痛苦更敏感，对吧？
Which means that we're all unhappier, more anxious, more depressed, more irritable, less able to take joy in the things that used to give us joy or that have given people joy for generations and also more susceptible to pain, right?
现在哪怕是最轻微的冒犯也会让我们感到痛苦，这并不是因为我们被宠坏了或价值观改变了。
Even the merest slight now can make us pain and that we're not this isn't happening because somehow we're spoiled or our values have changed.
这是因为我们通过不断用这些高回报物质和行为轰炸大脑，实际上已经生理性地改变了大脑结构。
It's because we've literally physiologically changed our brains as a result of constantly bombarding them with these high reward substances and behaviors.
安娜，某种程度上这让我觉得非常颠覆认知，因为我能理解尼古丁、酒精、大麻、海洛因或可卡因为什么会上瘾。
So in some ways this feels really mind bending to me, Ana, because you know I can see how nicotine and alcohol and marijuana or heroin or cocaine, I can see how these could be addictive.
但你提到的许多事物——食物、社交关系、性亲密——这些本身并不是问题。
But many of the things you're talking about, you know, food or social connection or sexual intimacy, these are not things that are inherently problems.
事实上，其中很多正是人之为人的组成部分。
In fact, many of them are part of what it means to be human.
请谈谈现代社会是如何把这些原本正常健康的事物，用你的话说，给'毒品化'的。
Talk about how our modern societies have taken these normal healthy things and in effect, as you would put it, drugify them.
现代社会将性行为、进食、游戏这些原本正常健康的事物毒品化，主要是通过增加四个要素：数量、可获得性、效力和新颖性。
So the way that our modern society has drugified these things that used to be normal and healthy like having sex or eating food or playing games is essentially by increasing four factors, quantity, access, potency, and novelty.
因为我们惊人的制造系统能大量生产这些成瘾物质，卓越的供应链又能将它们运往全球各地。
Because our incredible manufacturing system has allowed us to make these reinforcing substances in enormous quantities and our amazing supply chain allows us to ship them all over the world.
我最喜欢的一个例子是，1880年代卷烟机发明后，香烟制造商的生产速度从每分钟4支提升到了每分钟2万支。
One of my favorite sort of anecdotes is that in the 1880s, the cigarette rolling machine was invented, allowing manufacturers of cigarettes to go from manufacturing four cigarettes a minute to 20,000 cigarettes a minute.
哇。
Wow.
这只是我们全面改造的一个缩影。
And that's just one example of what we've done all around.
就我自己来说，当我沉迷于言情小说并开始寻找其他同类作品时，发现市面上存在着一个完整的言情小说宇宙。
And my, you know, my own romance novel reading addiction that developed, and one of the things that I discovered when I went looking for other romance novels is that there's a whole universe of romance novels out there.
根本没有尽头，数量多到无穷无尽。
There was no, it was really a never ending quantity.
数量确实至关重要，因为我们越是频繁接触这些成瘾性物质或行为，大脑就越容易形成成瘾性神经回路。
And quantity really matters because the more we use our drug of choice, our substance or behavior that's reinforcing, the more that we expose our brains to and the more often the more likely we are to change our brains to this addicted kind of circuitry.
所以数量是第一个驱动因素。
So quantity is the first driver.
其他因素是什么？
What are the others?
是的。
Yeah.
所以数量是第一要素。
So quantity is the first one.
可获得性或便捷性至关重要。
Availability or access is huge.
如果你在街角就能买到毒品的社区长大，大量流行病学数据显示你尝试毒品并上瘾的几率会更高。
So if you you grow up in a neighborhood where drugs are sold on the street corner, we have lots of epidemiologic data showing that you're more likely to try drugs and more likely to get addicted to them.
如今我们生活在一个能更便捷获取成瘾物质或行为的世界，无论是吸血鬼言情小说、薯片、游戏、色情内容，还是传统毒品如酒精、大麻和尼古丁。
And now we live in a world where we all have more access to our substance or behavior of choice, whether it's vampire romance novels or potato chips or games or pornography or old fashioned drugs like alcohol, cannabis and nicotine.
当然，智能手机本质上相当于为网络世代24/7输送数字多巴胺的皮下注射器。
And of course, the smartphone is essentially the equivalent of the hypodermic syringe delivering digital dopamine 20 fourseven for our wired generation.
事实确实如此。
And that's really what it is.
智能手机彻底改变了一切。
Smartphone totally changed things.
当人们可以随身携带这个能获取数字媒体和数字内容的设备时，我们本质上都对这些数字毒品更加上瘾了。
When people could carry in their pocket this device that gave them access to digital media and digital content 20, we all essentially became more addicted to these kinds of digital drugs.
好的。
All right.
我们已经讨论了数量和可获取性。
So we've talked about quantity and we've talked about accessibility.
接下来是什么？
What's next?
是的。
Yeah.
可获得性，可访问性。
Availability, accessibility.
另一个因素是效力。
And the other one is, potency.
要克服天平痛苦侧这些障碍（通常被称为耐受性），方法之一就是要么使用更多毒品，要么使用更强效的形式，要么采用更强效的毒品输送机制。
So one of the ways to overcome these gremlins on the pain side of the balance or what's often referred to as tolerance is to either use more of the drug or use more potent forms or have a more potent drug delivery mechanism.
以阿片类药物为例，使用者最初可能吸食鸦片，但最终会转向效力强约10倍的海洛因。
So for example, with opioids, someone might start out using opium, but eventually go to heroin, which is about 10 times more potent.
随后可能进一步升级为效力强50至100倍的芬太尼。
And then eventually progressed to fentanyl, which is 50 to a 100 times more potent.
这至少能让他们暂时战胜那些痛苦平衡中的小恶魔，获得所追寻的感觉。
And this would allow them to at least temporarily win that battle with their gremlins and get the feeling that they're looking for.
但另一种增强效力的方式是将两种药物混合，形成第三种更新奇的复合药物。
But another way to achieve potency is to combine two drugs to make it a third more novel drug.
这种做法一直存在。
And this is done all the time.
例如人们将阿片类药物与苯二氮䓬类药物混合，或如今可悲地使用新型兽用镇静剂'僵尸药'。
For example, people combining opioids with things like benzodiazepines or now this new veterinary sedative tranq, which people are sadly using.
通过混合两种不同药物，我们得到一种能改变大脑受体反应的新型复合药物，从而突破耐药性。
By combining two distinct drugs together, we get a new novel drug which then changes it up for our brain receptors and allows us to overcome tolerance.
在非违禁物质领域，也存在类似法式吐司冰淇淋这样的组合。
And and in the realm of non illegal substances, can also have combinations like French toast ice cream.
确实如此。
Exactly.
或者，你知道，我很容易沉迷于YouTube视频，尤其是《美国偶像》的幕后花絮。
Or, you know, I very easily get hooked on YouTube videos, especially outtakes of American Idol.
当我思考为什么《美国偶像》对我如此有吸引力时，嗯，他们早就研究透了，对吧？
And when I think about why on earth is American Idol so entrancing for me, well, they've figured it out, right?
他们利用了音乐——这对大多数人的大脑本就具有强化作用，能释放多巴胺，让人感觉愉悦。
They've taken music, which is already reinforcing for most people's brains, releases dopamine, feels good.
然后他们将其与游戏机制结合，打造成竞赛形式，从而制造出一种效力极强的‘瘾品’。
And then they've combined that with gaming, and they've turned it into a competition, and thereby, you know, really made a very potent drug.
你能谈谈‘新奇性’这个因素吗？
Can you talk a moment about the factor that's known as novelty?
这在成瘾性药物中很常见，但同样适用于许多我们过去可能不认为有问题的其他事物。
This is true in drugs of abuse, but it's also true for many of the other things that, you know, previously we might not have thought as being problematic.
是的。
Yeah.
多巴胺对新颖性极其敏感，这就是为什么人们会对新闻这类事物上瘾。
So dopamine is extremely sensitive to novelty, which is why, for example, people can get addicted to things like the news.
这就是新闻的定义。
That's the definition of news.
它是不断向你涌来的新内容。
It's new stuff coming your way.
但现代社会变得如此有害的原因是，为了留住客户并让他们不断回头，你必须把他们之前喜欢的东西重新包装成稍微新颖、不同或更好的形式。
But what's become so so toxic about the modern world is that, you know, in order to maintain customers and keep them coming back, you've got to take the thing that they like before and then package it as slightly new or different or better.
而互联网已经完全掌握了这种手法。
And the Internet has absolutely mastered that.
对吧？
Right?
这些人工智能算法研究我们，找出我们之前花时间浏览的内容和喜欢的东西，然后提供或推荐类似但略有不同的事物。
These AI algorithms learn us, figure out where we've spent time before, what we've liked before, and then proffer or suggest to us things that are similar, but a little bit different.
这完全激发了我们的寻宝机制——我们不断追寻，就是希望下一次点击能带来比之前稍好但又相似的内容。
And that absolutely engages this treasure seeking function where we we keep going because we're hoping that the next hit will be something that's just a little bit better, but similar to what we had before.
你知道吗，我记得我上八年级或者七年级的时候，安娜，老师会告诫我和所有同学要避开当地的一个公园，因为传闻那里有人在买卖和使用毒品。
You know, I remember when I was in eighth grade or maybe seventh grade, Anna, teachers would tell me, you know, to avoid a local park, me and all of my classmates, because the rumor was that drugs were being bought and sold and used at this park.
但是，你看，如果一切都能被'毒品化'，如果各种成瘾行为可以通过无线网络直接传输到我们的客厅和卧室，现在真的很难用围栏隔离并说'别去这个公园'，因为问题已经不再局限于某个公园了。
But, you know, if everything can be drugified, if if addictions can be beamed and streamed and, you know, WiFied into our living rooms and bedrooms, it becomes really now very hard to put a fence around it and say, avoid going to this park because the problem is no longer just with one park.
这正是我们作为个人、家长和学校都面临的问题。
That's the problem we're all facing as individuals, as parents, as schools.
我不知道你怎么想，但当我看到人们都粘在手机上的样子，真的让我感到非常悲哀。
I mean, I don't know about you, but but when I walk around and see the way that people are just glued to their phones, it just makes me really sad.
但我完全理解这种现象。
And yet I totally get it.
我是说，这些东西确实令人着迷。
I mean, these things are they're literally mesmerizing.
我们被这些设备带入了一种恍惚状态。
We are put in a trance by these devices.
它们对我们脆弱的小小人类大脑有着极强的强化作用。
They're highly reinforcing for our very fragile little human brains.
当我们把古老的快乐痛苦跷跷板机制与现代世界相结合——一个不断向快乐端施压的世界，问题就出现了。
When we combine the ancient pleasure pain seesaw and the brain with a modern world that is ready to push hard and often on the pleasure side of the balance, we get trouble.
最终导致强迫性过度消费，以及由此引发的健康、幸福和人际关系等一系列问题。
We end up with compulsive overconsumption and all the associated problems it causes for people's health, well-being, and relationships.
我们还面临着抑郁和焦虑的肆虐。
We also end up with a plague of depression and anxiety.
在下期节目中，我们将探讨如何在这个物质过剩的世界里重塑关系，将不幸转化为蓬勃成长。
In the second part of our story coming up in the next episode how to reset our relationship with a world of plenty and turn unhappiness into thriving.
安娜·莱姆克，感谢你今天做客《隐藏的大脑》节目。
Anna Lemke, thank you for joining me today on Hidden Brain.
哦，非常荣幸。
Oh, you're very welcome.
如果您有后续问题想请教安娜，并愿意与《隐藏的大脑》听众分享，请发送语音备忘录至ideashiddenbrain.org。
If you have follow-up questions that you'd like to ask Anna and that you'd be comfortable sharing with the larger Hidden Brain audience, please send a voice memo to ideashiddenbrain dot org.
邮件主题请注明「成瘾」。
Use the subject line addiction.
那个邮箱地址是ideashiddenbrain.org。
That email address again is ideashiddenbrain dot org.
60秒就足够了，请务必留下您的姓名和电话号码。
Sixty seconds is plenty, and please be sure to include your name and phone number.
《隐藏的大脑》由Hidden Brain Media制作。
Hidden Brain is produced by Hidden Brain Media.
我们的音频制作团队包括布里奇特·麦卡锡、安妮·墨菲·保罗、克里斯汀·黄、劳拉·夸雷尔、瑞安·卡茨、奥顿·巴恩斯和安德鲁·查德威克。
Our audio production team includes Bridget McCarthy, Annie Murphy Paul, Kristen Wong, Laura Quarrell, Ryan Katz, Autumn Barnes, and Andrew Chadwick.
塔拉·博伊尔是我们的执行制片人。
Tara Boyle is our executive producer.
我是Hidden Brain的执行编辑。
I'm Hidden Brain's executive editor.
本周的无名英雄是安吉莉卡（或称杰莉·蒙特罗斯）。
Our unsung hero this week is Angelica or Jelly Monteros.
杰莉在苹果公司的播客运营团队工作，她在我们新播客订阅服务Hidden Brain Plus的推出中发挥了关键作用。
Jelly works on the podcast operations team at Apple, and she played an essential role in the launch of our new podcast subscription, Hidden Brain Plus.
Jelly是那种似乎无所不知的人，当别人遇到问题或需要解决难题时总会向她求助。
Jelly is the type of person who seems to know everything, the person that others turn to for help when there's a question or issue to troubleshoot.
她懂得如何把事情办成，我们对她的所有帮助都感激不尽。
She knows how to get things done and we're so grateful for all her help.
如果你想帮助我们创作更多这样的故事，请考虑加入Hidden Brain Plus。
If you would like to help us build more stories like this, please consider joining Hidden Brain Plus.
在这里，你将发现节目中你喜爱的更多观点和见解，还能有机会获得节目特邀研究人员的答疑解惑。
It's where you'll find even more of the ideas and insights that you love from the show plus you'll have the chance to have your questions answered by researchers we feature on the show.
你可以在Apple播客应用或通过apple.co/hiddenbrain找到Hidden Brain Plus。
You can find Hidden Brain Plus in the Apple Podcasts app or at apple.co/hiddenbrain.
我是Shankar Vedanta。
I'm Shankar Vedanta.
下次见。
See you soon.
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