A Nation of Hypochondriacs

一个疑病症患者的国度

Norman Cousins

诺曼·克森斯

The main impression growing out of twelve years on the faculty of a medical school is that the No.1 health problem in the U.S. today, even more than AIDS or cancer, is that Americans don't know how to think about health and illness. Our reactions are formed on the terror level. We fear the worst, expect the worst, thus invite the worst. The result is that we are becoming a nation of weaklings and hypochondriacs, a self-medicating society incapabel of distinguishing between casual, everyday symptoms and those that require professional attention.

在一所医学院校任教十二年来,我获得的主要印象是:当今美国头号的健康问题,甚至比爱滋病或癌症都更为严重的问题,就是美国人不知道如何去认识健康与疾病。我们的反应是建立在恐惧这个尺度之上的。我们怕最坏的事,期待着最坏的事,而恰恰就招来了最坏的事。结果,我们变成了一个一个虚弱的、自疑有病的国度,一个分不清哪些 是日常偶发症状、哪些又是需要医生医治的症状,而自己擅自用药的社会。

Somewhere in our early educatioin we become addicted to the notion that pain means sickness. We fail to learn that pain is the body's way of informing the mind that we are doing something wrong, not necessarily that something is wrong. We don't understand that pain may be telling us that we are eating too much or the wrong things; or that we are smoking too much or drinking too much; or that there is too much emotional congestion in our lives; or that we are being worn down by having to cope daily with overcrowded streets and highways, the prounding noise of garbage grinders, or the cosmic distance between the entrance to the airport and the departure gate. We get the message of pain all wrong. Instead of addressing ourselves to the cause, we become pushovers for pills, driving the pain underground and inviting it to return with increased authority.

在我们早期教育的某个阶段,我们变 得对疼痛即疾病这一概念深信不疑。我们不知道,人体只是用疼痛这种方式通知大脑,我们的行为出了差错,而并—定是健康有间题。我们不明白,疼痛可能是在告威我们,或吃得太饱,或吃得不当,或吸烟太多,或饮酒过度,或生 活中感愔煎熬太苦,或因每天都得面对拥挤的大街和公路、忍受垃圾粉碎机的撞击声和奔波于从机场入口到登机 □之间的长距离而被搞得过分疲劳。我们把疼痛传达的信息全搞错了。我们不去探査其缘由,却大服其药,把疼痛 压下去,从而招致它以更大的威力再次发作。

Early in life, too, we become seized with the bizarre idea that we are constantly assaulted by invisible monsters called germs, and that we have to be on constant alert to protect ourselves against their fury. Equal emphasis, however, is not given to the presiding fact that our bodies are forestalling an attack is to maintain a sensible life-style.

我们在少年时代就种下了一种奇怪的观念:一种肉眼看不见的叫做 细菌的小妖怪在不断向我们进玟,我们必须常备不懈地保护自己不受其伤害。然而，我们对另一个重要事实却未能给予同样的重视，那就是，我们的身体装备精良，足以对付这些小妖怪，而且防止妖怪进攻的最佳途径就是保持合理的生活方式。

The most signficant single statement about health to appear in the medical journals during the past decade is by Dr. Franz Ingelfinger, the late and former editor of the New England Journal of Medicine. Ingelfinger noted that almost all illnesses are self-limiting. That is, the human body is capable of handling them without outside intervention. The thrust of the article was that we need not feel we are helpless if disease tries to tear away at our bodies, and that we can have greater confidence in the reality of a healing system that is beautifully designed to meet of its problems. And even when ourside help is required, our own resources have something of value to offer in a combined strategy of treatment.

《新英格兰医学杂志》前主编（已故）弗朗兹·英杰芬格博士的文章,是过去十年中医学刊物上发表的有关健康的最重要论述,他指出，几乎所有的疾病本身都有一定的极限。也就是说，人体可在没有外来干预的情况下对付这些疾患。这篇文章雄辩地指出，受到疾病攻击时，我们无需感到无助，而且对下述事实应抱有更充分的信心：人体的康复机制十分精妙，足以应付大部分疾病。即使在需要外援的情况下,我们的肌体本身也能对治疗进行有力的合作。

No one gets out of this world alive, and few people come through life without at least one serious illness. If we are give a serious diagnosis, it is useful to try to remain free of panic and depression. Panic can constrict the blood vessels and impose an additional burden on the heart. Depression, as medical researchers all the way back to Galen have observed, can set the stage for other illnesses or intensify existing ones. Is is no surprise that so many patients who learn that they have cancer or heart disease---or any other catastrophic disease---become worse at the time of diagnosis. the moment they have a label to attach to their symptoms, the illness deepens. All the terrible things they have heard about disease produce the kind of despair that in turn complicates the underlying condition. It is not unnatural to severely apprehensive about a serious diagnosis, but a reasonable confidence is justified. Cancer today, for example, is largely a treatable disease. A heavily damaged heart can be reconditioned. Even a positive HIV diagnosis does not necessarily mean that the illness will move into the active stage.

没有一个人能活着离开这个世界，极少有人一生—世没生过一次重病。如果医生诊断说你得了重病，力戒恐慌和沮丧是大有益处的。恐慌会使血管收缩，增加心脏负担。而沮丧，正如自占希腊名医盖伦以来的医学专家们所指出的.可诱发其他疾病或家中目前的疾病，难怪许多患者一听说自己得了癌症或心脏病—或其他什么灾难性疾病，病症立即就会恶化。一旦给自己的各种症状贴上某种标签，病情便随他们想起听到过的有关疾病的种种可怕的事情，感到绝望，而这反过来又使病情愈发严重。诊断得了重病，忧心忡忡，本属合情合理，但也应保持一定的信心。例如，癌症现在已基本上是一种可治之 症。严重受损的心脏也可以重新修复。即使诊断出HIV呈阳性。也不一定就意味着疾病会进入活跃期。

One of the interesting things researchers at the UCLA medical center have discovered is that the enviroment of medical treatment can actually be enhanced if seriously ill patients can be kept free of depression. In a project involving 75 malignantmelanoma patients, it was learned that a direct the connection exists between the mental state of the patient and the ability of the immuse system to do its job. In a condition of emotional devastation, immune function is impaired. Conversely, liberation from depression and panic is frequently accompanied by a an increase in the body's interleukins, vital substances in the immune system that help activate cancer-killing immune cells. The wise physician, therefore, is conscious of both the physical and emotional needs of the patient.

加利福尼亚大学洛杉矶分校医学中心的研究人员有一个有趣的发 那就：让重病患者摆脱沮丧心情，实际上就能使医疗环境得以改善。一项包括75名恶性黑瘤患者的研究显示，病人的心理状态和免疫功能之间存在直接联系。在心情十分恶劣的情况下，免疫系统也会受损。相反，摆脱了沮丧和恐慌，常常会使得体内白细胞间素增多，而这种物质在免疫系统中至关重要，它有助于激活克癌免疫细胞。因此明智的医生对病人的身体和心理需求都会加以重视。

People who have heart attacks are especially prone to despair. After they come through the emergency phase of the episode, they begin to reflect on all the things they think they will be unable to do. They wonder whether they will be able to continue at their jobs, whether they will be able to perform satisfactorily at sex, whether they can play tennis or golf again. In short, they contemplate an existence drained of usefulness and joy. The spark goes out of their souls. It may help for these people to know that in addition to miracles that modern medicine can perform, the heart can make its own bypass around the occluded arterirs and that collateral circulation can provide a rich supply of oxygen. A heart attack need not be reggarded as consignment to a mincing life-style. Under circumstances of good nutrition, a reasonable amount of exercise and a decrease in the wear and tear of stressful events, life expectancy need not be curtailed.

心脏病患者尤其容易心情沮丧。闯过急救阶段以后，他们便开始思考所有那些他们认为自己再也不能做的事情。他们担心是否还能继续工怍，是否还能正常发挥性功能，是否还能打网球或高尔夫球。总之，他们臆想出一种没有一点奉献和换了的生活。他们灵魂中的火花熄灭了。 让这些人了解下事实将是有益的：一方面现代医学能创造奇迹，另一方面，心脏本身也可以使血液绕过阻塞的动脉，而这种旁侧循环同样可提供足够的氧气。无须认为患上心脏病就意味着要战战兢兢地生活，只要营养良好，适当运动，减少重大事件对自己的压力，寿命就未必会缩短。

Plainly, the American people need to be re-educated about their health. They need to know that they are the possessors of a remarkably robust mechanism. They need to be de-intimidated about disease. They need to understand the concept of a patient-physician partnership in which the best that medical science has to offer is combined with the magnificent resources of mind and body.

显然，美过人需要接受一次健康问题的再教育。他们应该知道，自己拥有十分强健的肌体，不必为疾病所吓倒。他们需要理解这样一个概念：患者和医生要建立一种伙伴关系。这样，医学可提供的最佳治疗就能与患者身体和心理的奇妙功能结合起来。

We need not wait, of course, for a catastrophic illness before we develop confidence in our ability to rise to a serious challenge. Confidence is useful on the everyday level. We are stronger than we think. Much stronger.

当然，我们不必等到了灾难性疾病才对自己奋起对抗严重挑战的能力树立其信心。信心每时每刻都是重要的。我们比自己想象中的要更强健。强健得多。

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