Ezra Klein

I want to end by talking a bit about the brain itself and what all this implies for it. And I guess one thing to ask is why there is this difference between hurt and harm, why it is so possible for the nervous system to send such wrong signals, why we think the system didn’t evolve to keep a tighter linkage between the two of them. How do you understand the cause of wrong signals or incorrect Interpretation?

埃兹拉·克莱恩

最后，我想谈谈大脑本身以及这一切对它意味着什么。我有一件事要问，为什么受伤害和会伤害（hurt and harm）之间存在这种差异，为什么神经系统会如此发出这样的错误信号，为什么我们认为系统没有进化以在两者之间保持更紧密的联系他们中的。你如何理解错误信号或错误解释的原因？

Rachel Zoffness

Two things that come to mind for me is we’re seeing this anxiety epidemic in America, but around the world also. And the way we talk to patients about anxiety is very similar. The body is getting stuck in emergency danger mode even though there’s not actually a lion coming to eat you, which is biologically the purpose that your fight or flight system, your stress and anxiety system exists for.

But again, when I think about this with people and including myself, I look around and I now I’m hyper attuned to this now that I understand this pain process. And I’m constantly thinking, what are the drivers of anxiety? What are the drivers of stress? What are the drivers of this chronic pain recipe?

So there’s a lot of things in our environment, I think, that are contributing to what we’re seeing with this explosion of anxiety and this explosion of chronic pain, which again, is not coincidental, this relationship. And the other thing I think about when you say that is, you mentioned earlier, the body keeps the score.

And I talk about that book all the time because what happens in that book is, it’s very clearly shown, the science all illustrates that trauma, like everything else, doesn’t just live in the brain. It also lives in the body. It’s like the brain is connected to the body of the time, which I think is what we’re trying to illustrate here today, and then the body keeps the score.

雷切尔·佐夫内斯

我想到的两件事是我们在美国看到这种焦虑流行，但在世界各地也是如此。我们与患者谈论焦虑的方式非常相似。身体陷入紧急危险模式，即使实际上并没有狮子来吃你，这在生物学上是你的投入战斗或逃跑系统（fight or flight system）、你的压力和焦虑系统存在的目的。

但是，当我与包括我自己在内的人一起思考这个问题时，我环顾四周，现在我已经理解了这个疼痛的过程，因此我对此非常适应。我一直在想，焦虑的驱动因素是什么？压力的驱动因素是什么？这种慢性疼痛治疗方法的驱动因素是什么？

因此，我认为，在我们的环境中有很多因素导致了我们所看到的这种焦虑的爆发和慢性疼痛的爆发，这种关系再次并非巧合。当你这么说时，我想到的另一件事是，你之前提到过，身体会记分（keeps the score）。

我一直在谈论那本书，因为那本书中发生的事情非常清楚地表明，科学都说明了创伤，就像其他一切一样，不仅仅存在于大脑中。它也存在于体内。这就像大脑与时间的身体相连，我认为这就是我们今天在这里试图说明的，然后身体会记分。

You see how trauma changes your physiology. It changes your nervous system. It changes even your immune functioning and your endocrine functioning. It changes muscle tension. And what we also know is that trauma changes the brain also to amplify pain. It makes your brain more sensitive and more of a finely tuned instrument.

And if you think about why, if you’ve experienced a trauma, what it means is your brain wasn’t quite properly prepared for this terrible thing that happened. So after a trauma, people experience a lot of different symptoms, and one of them is called hypervigilance.

Hypervigilance is when, quite literally, you’re extra vigilant. You’re extra aware. And in your environment around you and outside of you, small bits of sensory information from the environment can trigger an exaggerated response.

So if you’ve lived through a trauma, and a trauma can be many different things, and someone taps you on the shoulder and you’re experiencing these symptoms of P.T.S.D. or post trauma, you’ll be hypervigilant. You’ll jump out of your chair from something as not dangerous as someone tapping you on your shoulder.

And similarly, the reason that’s happening, of course, is because your brain has become extra sensitive as a result of that trauma. And the same thing happens with internal sensory messages also. After a trauma, your brain is not just scanning your external environment for possible danger. It’s also scanning your internal environment. Is anything wrong? What about now? Is that dangerous? What about that?

So having lived through all the things that we’ve collectively lived through over the last couple of decades, it’s not actually a surprise to me that chronic pain is on the rise when combined with the lack of pain education across disciplines, when combined with the major stressors that we’ve had, when combined with the fact that we’re treating pain incorrectly as a purely biomedical problem rather than a biopsychosocial problem.

你会看到创伤如何改变你的生理机能。它会改变你的神经系统。它甚至会改变你的免疫功能和内分泌功能。它改变肌肉张力。我们还知道，创伤会改变大脑，从而加剧疼痛。它使你的大脑更加敏感，更像是一台经过精细调谐的乐器。

如果你想想为什么，如果你经历过创伤，这意味着你的大脑没有为发生的这件可怕的事情做好充分的准备。所以在创伤之后，人们会经历很多不同的症状，其中之一就是过度警觉。

从字面上看，过度警惕是指你格外警惕。你特别清楚。在你周围和外部的环境中，来自环境的少量感官信息会引发夸大的反应。

所以，如果你经历过创伤，而创伤可能有很多不同的东西，有人拍了拍你的肩膀，而你正在经历这些创伤后应激障碍或创伤后的症状，你就会高度警惕。有人轻拍你的肩膀，你会从椅子上跳起来，虽然轻拍你的肩膀并没有什么危险。

同样，发生这种情况的原因当然是因为你的大脑由于创伤而变得格外敏感。同样的事情也发生在内部感官信息上。遭受创伤后，你的大脑不仅会扫描你的外部环境以寻找可能的危险。它还在扫描你的内部环境。有什么问题吗？现在呢？那很危险吗？那个怎么样？

因此，在经历了我们在过去几十年中共同经历的所有事情后，慢性疼痛的上升与缺乏跨学科的疼痛教育相结合，再加上我们遇到的主要压力源，再加上我们错误地将疼痛视为纯粹的生物医学问题而不是生物心理社会问题。

Ezra Klein

This gets to this weird metaphysics of the self sometimes. When we’re even talking in that conversation about you, right, if you say, well, who are you? What are you? I’d be like, well, my mind, my consciousness is up here in this lump of tissue somewhere.

But then we’re having all this difficulty, me, right, convincing my brain, my mind, it does not listen to me when I tell it, all kinds of things, frankly, in my life. And it gets a little Buddhist, right, who is thinking these thoughts. But there is something interesting to me across a bunch of these disciplines from the trauma response work, to chronic pain, to how difficult it is and how uncertain of a task it is, or how sort of circuitous of a task it is to convince your brain of something.

Even though in theory, you can think a thought and it happens in the same vicinity of the brain, it’s not like the rest of the system listens. How do you think about that? What is the brain’s learning system?

埃兹拉·克莱因

有时这会涉及到这种奇怪的自我形而上学。当我们甚至在那次谈话中谈论你时，对，如果你说，好吧，你是谁？你是做什么的？我会想，好吧，我的思想，我的意识就在这团软组织（脑）中的某个地方。

但是然后我们遇到了所有这些困难，我，对，说服我的大脑，我的思想，当我告诉它时它不听我说，坦率地说，在我的生活中有各种各样的事情。它有点像佛教徒，对吧，谁在想这些想法。但是，这些学科中有一些对我来说很有趣的事，从创伤反应到慢性疼痛，再到任务的难度和不确定性，或者说服你的大脑这个任务是多么迂回。

即使，在理论上，你可以有一个想法，并且它发生在大脑里，但身体系统的其他部分并不像在听。你怎么看？大脑的学习系统是什么？

Rachel Zoffness

I think as the brain’s danger detector, it’s really adaptive to listen and pay extreme attention to a danger message, and to say, this means I have to stop doing all the things. This means I can’t go to work and I have to stop exercising.

Because for acute pain, again, that’s life saving. You don’t go for a run when you’ve broken your leg. I know I keep using the same example, but it’s just such an obvious one, and a lot of people have had injuries like that, where your body is telling you to stop. You cannot use that body part.

So pain is really hardwired. There’s a lot of stuff about pain that’s like, this is instinctive and it’s lifesaving. So it is, of course, very hard to tell your brain, yes, this is an instinct you’ve had for evolutionary eons, and it has saved your life. But now ignore all the instincts and don’t do all the things that you’ve instinctively done to save your life. You’re going against nature in a way.

So it turns out, and I don’t think this will surprise you, that better understanding pain actually changes pain. And we can explain why, now that we know about the biopsychosocial pain recipe. Once you understand pain better, you’re going to be hopefully less scared of getting out of bed and going for a walk, even if it’s just for 60 seconds, or five minutes, or whatever.

You’re going to be less scared of attempting to resume hobbies. Maybe you will seek out appropriate multidisciplinary care and you will go to a trauma therapist to treat untreated trauma because trauma and pain are best friends. There’s an 80 percent co-morbidity of trauma and chronic pain.

Maybe you will get a PT and an OT. So learning about pain actually changes your pain experience, in part because have this new understanding and appreciation for what the pain experience is, and maybe you’re going to go about treating it differently, but you’re surely going to understand it differently.

雷切尔·佐夫内斯

我认为作为大脑的危险探测器，它真的很适应倾听危险信息并给予极大关注，然后说，这意味着我必须停止做所有的事情。这意味着我不能去上班，我必须停止锻炼。

因为对于急性疼痛，这又可以挽救生命。当你摔断腿时，你不会去跑步。我知道我一直在用同一个例子，但这是一个很明显的例子，很多人都受过这样的伤，你的身体告诉你停下来。你现在不能使用那个身体部位。

所以疼痛真的是天生的。有很多关于疼痛的东西，比如，这是本能的，它可以挽救生命。所以，当然，很难告诉你的大脑，是的，这是你进化亿万年来的本能，它救了你的命。但是现在忽略所有的本能，不要做所有你本能地做的事情来挽救你的生命。你在某种程度上违背了自然。

所以事实证明，我认为这不会让你感到惊讶，更好地理解疼痛实际上会改变疼痛。既然我们知道了生物心理社会疼痛的秘诀，我们就可以解释原因了。一旦你更好地理解疼痛，你就不会那么害怕起床去散步，即使只是 60 秒、5 分钟、或其他任何时间长度。

你将不再害怕尝试恢复爱好。也许你会寻求适当的多学科护理，并且你会去找创伤治疗师来治疗未经治疗的创伤，因为创伤和疼痛是最好的朋友。外伤和慢性疼痛有 80% 的合并症。

也许你会获得 PT 和 OT（康复训练）。所以了解疼痛实际上会改变你的疼痛体验，部分原因是对疼痛体验有了新的理解和理解，也许你会以不同的方式对待它，但你肯定会以不同的方式理解它。

Ezra Klein

I want to go back to something here that we had talked about earlier, which is the ways you take control of the pain dial. And in your five parts here, stress and anxiety, mood, attention, interpretations and understanding of pain, and coping behaviors, and as I read through that part of the workbook, something that seemed very clear was that this was just how to live.

That if you had no pain whatsoever, or maybe no pain yet as a person, that it would still be true, that trying to understand what is a good day for you and a bad day for you, trying to understand the ways in which you sleep, and see friends, and stress, and all the rest of it, there’s something — I mean, beyond just that pain needs to be treated holistically, it was striking to me how much the way to think about pain just seems to be an offshoot of the way to think about or try to approach your life.

And pain sometimes forces a sharpening of that, a more systematic approach. But it was more similar, and that struck me as, in a way, profound. I’m curious, all this work you do on pain, how it changes your thinking about just how to live a day.

埃兹拉·克莱因

我想回到我们之前讨论过的事情，那就是你控制疼痛程度的方式。在你书里的五个部分中，压力和焦虑、情绪、注意力、对疼痛的解释和理解，以及应对行为，当我通读你的书的这一部分时，似乎很清楚的一点是，这就是如何生活。

如果你没有任何痛苦，或者作为一个人可能还没有痛苦，那仍然是真的睡觉、见朋友、压力，以及其他所有这些——我的意思是，除了疼痛需要整体治疗之外，让我吃惊的是，思考疼痛的方式本身似乎是一种思考或尝试接近你的生活的方式的分支（offshoot）。

痛苦有时会迫使它变得更敏锐，一种更系统的方法。但它更相似，这在某种程度上给我留下了深刻的印象。我很好奇，你在疼痛方面所做的所有这些工作，它如何改变你对如何生活一天的想法。

Rachel Zoffness

I think that is a profound interpretation of what we’re saying here about how pain works, and why we have it, and how to get back on track. And I think what you’re getting at is this totally true idea that we’re all really out of balance.

We know that a lot of the times as human beings, we’ve become more isolated. We don’t really exist in communities the way we’re biologically built to do. And we are sedentary for so many hours. And we do have all these insane stressors piling up, and I don’t think we’re managing them very well.

So I think what you’re getting at, which is very true, is if you want to manage a pain problem, you sort of have to get your life in order. You have to learn sleep hygiene. And a lot of people are reliant on medications because again, the biomedical model. We have a lot of pills and procedures as solutions for every problem.

We have to get our social connections. We have to pay attention to those and not ignore them because social medicine is real. We have to pay attention of course, to our bodies. Are we going outside? Are we moving our bodies? Do we have enough support in that realm?

Like for example, if you’re going to try and build up your muscles, do you have a physical therapist to work with? Do you have an occupational therapist? So you’re seeing outside — you’re sort of seeing the matrix, which is yes, everything is interconnected when it comes to human health.

And I think to me, that’s what’s so compelling about this idea of biopsychosocial health. It turns out that the treatment for depression is not just a pill. We know that now also, with all this recent research. And the treatment for anxiety is not just a pill. And shocking to no one, the treatment for pain is also not just a pill.

雷切尔·佐夫内斯

我认为这是对我们在这里所说的关于疼痛是如何产生的、我们为什么会有疼痛、以及如何回到正轨的深刻解释。而且我认为你得到的是这个完全正确的想法，即我们都真的失去了平衡。

我们知道，作为人类，很多时候我们变得更加孤立。我们并不真正存在于我们生来就存在的社区中。我们久坐不动了很多个小时。我们确实有所有这些疯狂的压力源堆积，我认为我们没有很好地管理它们。

我认为你的意思是，这是非常正确的，如果你想解决疼痛问题，你就必须让你的生活井井有条。你必须学会睡眠卫生。很多人都依赖药物，因为生物医学模型。我们有很多药和手术来解决每个问题。

我们必须获得我们的社会关系。我们必须注意这些而不是忽视它们，因为社会医学是真实存在的。当然，我们必须注意我们的身体。我们要出去吗？我们在移动我们的身体吗？我们在那个领域有足够的支持吗？

例如，如果你要尝试增强肌肉，你是否有物理治疗师可以合作？你有职业治疗师吗？所以你看到的是外面——你看到的是矩阵，是的，当涉及到人类健康时，一切都是相互关联的。

我认为，这就是生物心理社会健康理念如此引人注目的地方。事实证明，治疗抑郁症不仅仅是吃药。我们现在也知道，所有这些最近的研究。焦虑症的治疗不仅仅是吃药。令任何人震惊的是，治疗疼痛也不仅仅是吃一片药。

Ezra Klein

And then always your final question, what are three books you would recommend to the audience?

埃兹拉·克莱恩

我总会问的最后一个问题，你会向听众推荐哪三本书？

Rachel Zoffness

One is “Why Zebras Don’t Get Ulcers” by Robert Sapolsky, and it explains how emotional health is always implicated in physical health, and it’s always implicated in pain. Emotional health and mental health matters when it comes to treating pain. If you’re not treating emotional health and mental health, you’re missing a significant part of the pain problem.

The other book is “The Body Keeps the Score,” Bessel van der Kolk. It’s been a bestseller for a very long time for a reason. Again, it shows us unequivocally that trauma and emotions, again, don’t just live in the head. They also come out in the body. Emotions are somatic by definition. Trauma is somatic by definition. That’s not a bad word. If we want to help people who are suffering, we want to reconnect trauma and emotions with physical pain. They’re all connected.

And the third book is going to be “Pain: The Science of Suffering,” which is by Patrick Wall. He’s one of the founders of pain science as we know it today. And he was one of the creators of the gate-control theory of pain. And a lot of the stuff that I talked about today is from this fund of science that he sort of established with his partner, Ron Melzack, back in 1965.

And pain neuroscience has evolved a lot since then, and we a lot more about human health, and all these drivers of pain. But “Pain: the Science of Suffering,” even though some of the science is outdated, really, in my mind lays a foundation for how all of this works and why.

[MUSIC]

雷切尔·佐夫内斯

其中之一是罗伯特·萨波尔斯基 (Robert Sapolsky) 的“为什么斑马不会得溃疡”，它解释了情绪健康如何总是与身体健康有关，而且总是与疼痛有关。在治疗疼痛方面，情绪健康和心理健康很重要。如果你不治疗情绪健康和心理健康，那么你就错过了疼痛问题的重要部分。

另一本书是“The Body Keeps the Score”，作者 Bessel van der Kolk。很长一段时间以来，它一直是畅销书，是有原因的。它再次明确地向我们表明，创伤和情绪不仅仅存在于头脑中。它们也出现在体内。根据定义，情绪是躯体的。根据定义，创伤是躯体性的。这不是一个坏词。如果我们想帮助受疼痛折磨的人，我们希望将创伤和情绪与身体疼痛重新联系起来。他们都是相连的。

第三本书将是“痛：关于受痛折磨的科学”，作者是 Patrick Wall。他是我们今天所知的疼痛科学的创始人之一。他是疼痛门控理论的创始人之一。我今天谈到的很多内容都来自他与合作伙伴 Ron Melzack于 1965 年建立的科学基金。

从那时起，疼痛神经科学有了很大的发展，我们更多地关注人类健康，以及所有这些疼痛的驱动因素。但是“痛：关于受痛折磨的科学”，尽管有些科学已经过时，但在我看来，真的为所有这一切的运作方式和原因奠定了基础。

[音乐]

Ezra Klein

Rachel Zoffness, thank you very much.

埃兹拉·克莱恩

雷切尔·佐夫内斯，非常感谢你。

“The Ezra Klein Show” is produced by Emefa Agawu, Annie Galvin, Jeff Geld, Rogé Karma and Kristin Lin. Fact-checking by Michelle Harris and Kate Sinclair. Mixing by Sonia Herrero and Isaac Jones. Original music by Isaac Jones. Audience strategy by Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. And special thanks to Carole Sabouraud and Kristina Samulewski.

（续完）

非常感谢谷狗翻译。我只是浏览一下翻译后的中文，使其比较可读。如果有错，是我的错。

非常感谢你，我的博客读者。如果这些内容能够帮助你和你的家人减轻一点身体疼痛，我会感到安慰。