THE PERFECT CASE

完美的案例

After my TEDx talk, calls and emails poured in, too many to manage. As I tried to keep up with the influx, my stress levels went through the roof. How ironic, I thought, that my research into how stress could kill you was most likely about to kill me!

在我的 TEDx 演講之後，電話和電子郵件紛至遝來，太多了，難以管理。當我試圖跟上湧入的人群時，我的壓力水平飆升。我想，多麼諷刺的是，我對壓力如何殺死你的研究很可能要殺死我！

Voices spoke up from all over the country, all over the world, clamoring to tell their stories of sudden and “impossible” recoveries. I wanted to investigate every single one and dig out the knowledge that was locked inside, but there were just too many. It was overwhelming. I would have needed an entire team of researchers and interviewers to screen every case pouring in. And while I now had a small platform of legitimacy to work from, I didn’t have the bandwidth for that kind of large-scale project. The medical world had opened its door to the idea that spontaneous healing had something to teach us all—but just a crack. I knew I wouldn’t be able to convince anyone to fund a longitudinal study on spontaneous healing yet. I was going to have to keep going on my own and do everything I could with what I had. And what I had was this: one man, one desk, and about one thousand emails.

來自全國各地、世界各地的聲音響起，吵著要講述他們突然和“不可能”恢復的故事。我想調查每一個人，並挖掘出隱藏在裡面的知識，但實在是太多了。這讓人不知所措。我需要一個完整的研究者和採訪團隊來篩選湧入的每一個案例。雖然我現在有一個合法的小平臺可以工作，但我沒有頻寬來做這種大型專案。醫學界已經向這樣一種想法敞開了大門，即自發治癒可以教會我們所有人——但只是一個裂縫。我知道我還無法說服任何人資助一項關於自發癒合的縱向研究。我將不得不繼續自己，用我所擁有的一切來做我能做的一切。而我所擁有的是：一個人、一張桌子和大約一千封電子郵件。

I came up with a triage process for rapidly identifying the most promising, legitimate cases. At the most basic level, to pass into “investigation” territory, a case had to be a genuinely incurable illness and have documented evidence of both accurate diagnosis and clear remission with no complicating factors that could explain their recovery. Once it passed that first hurdle, I evaluated it on a couple of other fronts, one being the specific disease. For whatever reason, there are some diseases that simply lend themselves toward spontaneous remissions much more than others. There are other illnesses that we just don’t know very much about; they’re rare and not well documented. We don’t know how they behave and when they can be considered “incurable.” But when Mirae Bunnell’s case came along, I felt a hard yank on my line. This one was a big fish.

我想出了一個分類流程，用於快速識別最有希望、最合法的案例。在最基本的層面上，要進入“調查”領域，病例必須是一種真正無法治癒的疾病，並且有準確診斷和明確緩解的書面證據，沒有可以解釋其康復的複雜因素。一旦它通過了第一個障礙，我就從其他幾個方面對其進行了評估，其中一個是特定的疾病。無論出於何種原因，有些疾病比其他疾病更有利於自發緩解。還有其他一些疾病我們只是不太瞭解;它們很少見，而且沒有很好的記錄。我們不知道他們的行為如何，以及他們何時可以被認為是“不治之症”。但是當Mirae Bunnell的案子出現時，我感到我的線路受到了重重的拉扯。這條魚是一條大魚。

It was just one of dozens of cases in my in-box one morning when I rushed in to work late, turned on my computer, and scrolled through my email, skimming for anything urgent before I started doing rounds. The subject line was “SR patient Mirae Bunnell,” and I clicked on it absentmindedly, intending to file it into the folder of potential cases to follow up on later. But ten minutes later, I was sitting there with my coat still on, reading Mirae’s message again. It ticked all the boxes for a watertight case of SR: An incurable disease. A very careful and thoroughly documented diagnosis. Prestigious doctors at a world-class medical facility. Clearly documented evidence of diagnosis and remission, including scans, diagnostic pathology reports, operative notations from her doctors—everything. And finally, as a self-described “left-brained, analytical person,” a “hard-core data geek,” she was able to speak with clarity and precision about what she had experienced. But a particular passage in Mirae’s email had snagged my attention. She wrote that she believed her healing had coalesced around her process of, as she phrased it, “changing my relationship with myself, and with the world.”

這隻是我收件匣裡的幾十個案例中的一個，一天早上我匆匆忙忙地上班，打開電腦，滾動流覽我的電子郵件，在開始查房之前流覽任何緊急內容。主題是“SR 患者 Mirae Bunnell”，我心不在焉地點擊了一下，打算把它歸檔到潛在病例的資料夾中，以便以後跟進。但十分鐘后，我坐在那裡，外套還穿著，再次閱讀Mirae的資訊。它滿足了 SR 的所有條件：一種不治之症。一個非常仔細和完整記錄的診斷。世界級醫療機構的著名醫生。清晰記錄的診斷和緩解證據，包括掃描、診斷病理報告、醫生的手術記錄——一切。最後，作為一個自稱「左腦、善於分析的人」和「鐵杆數據極客」，她能夠清晰準確地講述她的經歷。但Mirae電子郵件中的一段特別內容引起了我的注意。她寫道，她相信她的康復是圍繞著她的過程凝聚在一起的，正如她所說，“改變了我與自己和世界的關係”。

The idea of changing your relationship with yourself is big, deep, and nebulous. What exactly did it mean in practice, and could it truly catalyze healing? This was what I wanted to explore with Mirae, if she were willing.

改變你與自己的關係的想法是巨集大的、深奧的和模糊的。這在實踐中究竟意味著什麼，它真的能促進癒合嗎？這就是我想和Mirae一起探索的東西，如果她願意的話。

A stroke of luck: Mirae, a software exec living in Saint Louis, Missouri, replied to my request for more information right away. As she and I corresponded by email, the details of her story emerged. By the time I met her in person and she shook my hand with a firm grip and a wide, exuberant smile, I fully understood how miraculous it was that she was standing before me, living, breathing, and thriving.

幸運的是：住在密蘇里州聖路易斯的軟體主管Mirae立即回復了我提供更多資訊的請求。當她和我通過電子郵件通信時，她的故事細節浮出水面。當我親自見到她時，她緊緊握住我的手，露出燦爛而燦爛的笑容，我完全明白她站在我面前，活著、呼吸著、欣欣向榮，這是多麼神奇的事情。

TOO BUSY TO BE SICK

太忙了，沒有時間生病

Mirae noticed the bump in her neck while in the middle of an important negotiation at work. At the time, her work was her life. She was in software sales at a large U.S.-based company and in charge of leading contract negotiations for a client’s new multiyear agreement. The deal was important, worth hundreds of millions of dollars, and came with an enormous amount of responsibility. Negotiating the deal would take months. Mirae threw herself into it, working around the clock to get it done.

Mirae 在工作中進行一次重要的談判時注意到了她脖子上的隆起。當時，她的工作就是她的生命。她曾在一家美國大型公司從事軟體銷售工作，負責領導客戶新多年協定的合同談判。這筆交易很重要，價值數億美元，並且伴隨著巨大的責任。談判這筆交易需要幾個月的時間。Mirae 全身心投入其中，夜以繼日地工作以完成它。

In her early forties, she was an active, ambitious, independent woman. She loved her little town, a woodsy suburb on the outskirts of Saint Louis. Her longtime boyfriend lived next door, and they got together in the evenings to cook dinner and catch up. They’d been dating for ten years but hadn’t married or moved in together—they liked having their own space. Mirae walked every day with her dogs in the dog park that she’d helped create in town. Active with both Pilates and yoga, she was seemingly athletic and strong. But there was more going on, unseen, beneath the surface.

四十出頭時，她是一個積極、雄心勃勃、獨立的女性。她喜歡她的小鎮，聖路易斯郊區一個樹木繁茂的郊區。她交往多年的男朋友住在隔壁，他們晚上聚在一起做晚飯和敘舊。他們已經約會了十年，但還沒有結婚或搬到一起——他們喜歡擁有自己的空間。Mirae 每天都帶著她的狗在她説明在鎮上創建的狗公園裡散步。她積极參加普拉提和瑜伽，看起來運動健壯。但在表面之下還有更多看不見的事情。

When she was a kid, Mirae got sick from a tick bite. The lymph nodes behind her ears swelled, and she ran a fever. But her doctor didn’t recommend any kind of treatment, saying that it was just a “normal reaction” to the bite. This was in a suburb of Saint Louis, where Mirae grew up in a conservative Mormon family. Her mother, a gifted dancer and pianist, set professional career ambitions aside to stay at home and focus on raising the children. Her father traveled and worked long hours, climbing the corporate ladder. He also served as a bishop in the Mormon church. Her parents were very religious and strict, teaching their children to attend all church meetings and services and abide by a very high set of standards. Mirae grew up believing that any deviation from the straight and narrow was a catastrophic transgression. The message was that if you abided by the Commandments, you would be able to stay together forever, even in the afterlife. And if you didn’t, you’d be cast out and separated from your family. Forever.

當她還是個孩子的時候，Mirae 因蜱蟲叮咬而生病。她耳後的淋巴結腫大，她發燒了。但她的醫生沒有推薦任何形式的治療，說這隻是對咬傷的“正常反應”。那是在聖路易斯的郊區，Mirae 在一個保守的摩門教家庭長大。她的母親是一位才華橫溢的舞蹈家和鋼琴家，她將職業抱負放在一邊，留在家裡專注於撫養孩子。她的父親出差和長時間工作，爬上公司的階梯。他還擔任摩門教的主教。她的父母非常虔誠和嚴格，教導他們的孩子參加所有的教堂聚會和禮拜，並遵守一套非常高的標準。Mirae 從小就相信，任何偏離正道和狹隘的行為都是災難性的越界。它傳達的資訊是，如果你遵守誡命，你將能夠永遠在一起，即使在來世也是如此。如果你不這樣做，你就會被趕出去，與家人分離。永遠。

Her older sisters didn’t seem to have a problem walking the path. They were obedient and good; they’d grown up talented and were musically gifted but had set aside their career ambitions to stay home and raise children like their mother. To Mirae, it seemed that was what women in the Mormon church were supposed to do. But she had a more rebellious spirit.

她的姐姐們走這條路似乎沒有問題。他們聽話，善良;他們從小就有才華，在音樂方面也很有天賦，但放棄了自己的職業抱負，像母親一樣留在家裡撫養孩子。對Mirae來說，這似乎是摩門教教會的女性應該做的。但她的精神更加叛逆。

“I didn’t want things to be mapped out for me,” she says now. “I told my parents that when I grew up, I was never going to get married. I was going to have a career. I was going to make a thousand dollars for every year I was old.” She laughs. “They just rolled their eyes. But I was determined that I was never going to be dependent on someone else.”

“我不想讓事情為我規劃好，”她現在說。“我告訴我的父母，我長大後永遠不會結婚。我打算有一份事業。我每老一輩就賺一千美元。她笑著說。他們只是翻了個白眼。但我下定決心，我永遠不會依賴別人。

She ran away for the first time at fourteen, made friends that were older, owned cars, and lived in apartments. She was resourceful and hardworking, doing odd jobs to start making her own money. And then, she got pregnant.

她在 14 歲時第一次離家出走，結交了年紀較大的朋友，擁有汽車，住在公寓裡。她足智多謀，勤奮工作，打零工開始自己賺錢。然後，她懷孕了。

Everyone told her to give the baby up for adoption. She refused.

每個人都告訴她把孩子交給別人收養。她拒絕了。

“They kept telling me, ‘You cannot keep this baby, it’s not fair to the child,’” she says. “But just like always, if somebody put a rule in front of me, I was going to break it.”

“他們一直告訴我，'你不能留住這個孩子，這對孩子不公平，'”她說。“但就像往常一樣，如果有人把規則擺在我面前，我就會打破它。”

She took her driver’s test with all the other sixteen-year-olds, except she was eight months pregnant. But she was determined not to let it slow her down. She got her GED and started taking college classes while working full-time. She worked hard; she landed a better job, and then an even better one. By the time she was in her early twenties, she was traveling extensively for work, putting in long hours. She had a young son. She’d accepted help from her family in caring for him, but she felt conflicted about it. They were raising him the same way she’d been raised, and she worried that he would start to cast judgment on her choices and circumstances. But she didn’t feel like she had a choice; she couldn’t do it alone. Plus, she just wasn’t feeling well. She was young, driven, and by all outward appearances, healthy. So why did she feel so depleted, so dragged down? Life was harder than it needed to be.

她和其他所有16歲的孩子一起參加了駕駛考試，除了她懷孕八個月。但她決心不讓它放慢她的腳步。她獲得了 GED，並在全職工作的同時開始參加大學課程。她努力工作;她找到了一份更好的工作，然後又找到了一份更好的工作。到她 20 歲出頭時，她經常出差，工作時間很長。她有一個年幼的兒子。她接受了家人的幫助來照顧他，但她對此感到矛盾。他們以與她一樣的方式撫養他，她擔心他會開始對她的選擇和環境進行評判。但她覺得自己別無選擇;她不能獨自完成。另外，她就是感覺不舒服。她年輕，有動力，從外表上看，她很健康。那麼，為什麼她會感到如此疲憊，如此沮喪呢？生活比它需要的要艱難。

Looking back, she feels now that she was always sick, never healthy. She calls her twenties “the decade of exhaustion.” She calls her thirties “the decade of pain.” Joint pain, muscle pain, nerve pain, seemingly migrating throughout her body without an apparent cause. Signs of a body in distress, a system out of whack. Finally, in her early forties, after seeing doctor after doctor, she got a diagnosis: chronic Lyme, from the tick bite that was never treated. By this time in her career, she was in a major role at a software company. Her work involved managing contract negotiations worth hundreds of millions of dollars, and she was getting ready to start negotiations for a new deal that would demand long hours for the next eight to ten months. It felt like an impossible time to be sick.

回想起來，她現在覺得自己總是生病，從來沒有健康過。她稱自己的 20 多歲是「疲憊不堪的十年」。她稱自己的 30 多歲是“痛苦的十年”。關節痛、肌肉痛、神經痛，似乎無緣無故地在她的全身遷移。身體陷入困境的跡象，系統失靈。最後，在她四十出頭的時候，在看了一次又一次的醫生之後，她得到了一個診斷：慢性萊姆病，來自從未得到治療的蜱蟲叮咬。在她的職業生涯中，她在一家軟體公司擔任重要職務。她的工作涉及管理價值數億美元的合同談判，她正準備開始一項新協定的談判，該協定將需要在接下來的 8 到 10 個月內長時間工作。感覺像是一個不可能生病的時間。

Her doctor ordered a PICC line installed in her chest for dispensing the powerful antibiotics that he hoped would flush the Lyme infection out of her system for good. The central catheter entered her body on the inside of her left arm, a few inches above the elbow, and extended through increasingly larger veins to reach an area near the upper chamber of the heart. She would wrap the external portion of the PICC line to the inside of her arm with a flesh-colored bandage to keep hidden under the sleeve of her shirt. She didn’t want anybody to see it or know she was sick. Sickness was weakness; it was failure. As deal negotiations intensified, her workdays swelled to fourteen hours, then sixteen. She’d slip out of the office, sit in her car in the parking lot, hang the IV bag over the rearview mirror, and hook in.

她的醫生要求在她的胸部安裝一根 PICC 管線，用於分配強效抗生素，他希望這些抗生素可以永久地將萊姆病感染從她的系統中排出。中心導管從她的左臂內側進入她的身體，在肘部上方幾英寸處，並通過越來越大的靜脈延伸到心臟上腔附近的區域。她會用肉色繃帶將 PICC 線的外部包裹到手臂內側，以隱藏在襯衫袖子下。她不想讓任何人看到或知道她生病了。疾病就是虛弱;這是失敗。隨著交易談判的加劇，她的工作時間增加到14小時，然後是16小時。她會溜出辦公室，坐在停車場的車裡，把靜脈輸液袋掛在後視鏡上，然後插上鉤子。

She wasn’t initially alarmed by the lump on her neck. It was most likely a result of the Lyme, said the doctors, and would go away as she continued with the antibiotic treatment protocol. Lymph nodes, she knew, wrapped around the neck just under the skin, in a chain like a strand of pearls. Her doctor rolled the lump between his fingers and said, “It doesn’t feel like cancer.” When the lump started getting larger instead of smaller, she was frustrated. She didn’t have time for this right now. After years of health struggles, she was starting to wonder, Why me? On paper, she should have been a shoo-in for a disease-free life. She had seemingly healthy habits. She ate pretty well, even though she often bolted her food standing up or ate distractedly at her desk. She exercised, working out in her home gym or squeezing in a Pilates class before work. She tried to get enough sleep, but it was hard. Sometimes she needed to pull an all-nighter, fueled by caffeine, to get the job done. But this was life, right? She wasn’t doing anything differently from anyone else. In fact, she felt like she was more health-conscious than most, despite pushing herself pretty hard. Why had illness chosen her?

她最初並沒有被脖子上的腫塊嚇到。醫生說，這很可能是萊姆病的結果，並且會隨著她繼續接受抗生素治療方案而消失。她知道，淋巴結纏繞在皮膚下的脖子上，像一串珍珠一樣鎖成一條鏈子。她的醫生在他的手指之間滾動腫塊說：“感覺不像癌症。當腫塊開始變大而不是變小時，她感到很沮喪。她現在沒有時間做這些。經過多年的健康鬥爭，她開始想，為什麼是我？從紙面上看，她本應過上無病生活的必經之路。她似乎有健康的習慣。她吃得還不錯，儘管她經常站著吃東西或在辦公桌上分心地吃東西。她鍛煉身體，在家裡的健身房鍛煉，或者在上班前參加普拉提課。她試圖獲得足夠的睡眠，但這很困難。有時，她需要通宵達旦地喝咖啡因才能完成工作。但這就是生活，對吧？她所做的事與其他人沒有什麼不同。事實上，她覺得自己比大多數人都更注重健康，儘管她很努力地逼迫自己。為什麼疾病選擇了她？

Rebellious as always, she refused to bow to the demands of her body—she would finish this deal, and then she would turn her attention back to her health. She triaged based on priority, and the deal was more important. There was always something or other wrong with her body; she couldn’t stop and drop everything each time there was a glitch.

一如既往的叛逆，她拒絕屈服於自己身體的要求——她會完成這筆交易，然後她會把注意力轉回她的健康上。她根據優先順序進行分類，這筆交易更重要。她的身體總是有事情或其他問題;每次出現故障時，她都無法停下來並放下所有東西。

She started pulling her hair over one shoulder to hide the lump, but it had gotten to the point where it was impossible to hide. She was partnered with a dealmaker, a guy who sat next to her with his laptop open, running spreadsheets to figure out various scenarios as she worked the deal. They weren’t especially close, just colleagues. But one day, he pulled up a chair next to her, looked her straight in the eyes, and said, “What the hell is on your neck?”

她開始把頭髮拉到一邊的肩膀上，以掩蓋那個腫塊，但它已經到了無法隱藏的地步。她與一位交易撮合者合作，這個人坐在她旁邊，打開筆記型電腦，在她進行交易時運行電子表格來弄清楚各種情況。他們不是特別親密，只是同事。但有一天，他拉了她旁邊的一把椅子，直視著她的眼睛，說：“你脖子上到底是什麼鬼？

She tried to brush off his concerns with an “Oh, it’s nothing,” but he cut her off.

她試圖用「哦，沒什麼」來消除他的擔憂，但他打斷了她。

“I just have to tell you, it’s bigger every week. Every time I come back, it’s bigger,” he said. “You have to do something.”

“我只需要告訴你，每周都在大。每次我回來，它都會更大，“他說。“你必須做點什麼。”

On March 31, she finished the deal, and on April 1, she went in for the biopsy. Two days later, late in the evening, her phone rang.

3 月 31 日，她完成了交易，4 月 1 日，她去做了活檢。兩天后，深夜，她的電話響了。

“You’re going to get a phone call tomorrow, and I want you to be ready for it,” said her doctor’s voice on the other end of the line. “You’re going to get some results, and it’s gonna be really scary. I want you to get an appointment right away; do not wait until Monday.”

“你明天要接到一個電話，我希望你做好準備，”電話另一端醫生的聲音說。“你會得到一些結果，這真的很可怕。我希望你馬上預約;不要等到星期一。

She calmly agreed to everything. When she hung up the phone, she sat in silence, stunned. Then she called her boyfriend next door and burst into tears, repeating everything the doctor had just said. Thirty seconds later, he rushed into her kitchen, dropped to one knee, and asked her to marry him.

她平靜地同意了一切。當她掛斷電話時，她沉默地坐著，目瞪口呆。然後她打電話給隔壁的男朋友，淚流滿面，重複了醫生剛才說的一切。30秒后，他衝進她的廚房，單膝跪地，請求她嫁給他。

“Are you kidding me?” she cried. “You’re doing this now?”

“你在開玩笑嗎？”“你現在在做這個？”

She pulled him to his feet, shaking her head. No, no, no, she was thinking. She hadn’t absorbed the impact of the news, but she’d seen it in his eyes—it was bad. She wanted to turn back the clock, unwind it all, go back to before.

她把他拉起來，搖了搖頭。不，不，不，她在想。她還沒有吸收這個消息的影響，但她從他的眼睛里看到了——這很糟糕。她想讓時鐘倒流，放鬆一切，回到以前。

“This did not happen!” she cried. “You did not just do that!”

“這沒有發生！”“你不是剛才做的！”

Her mind was racing; she wanted to believe that she was about to wake up from some terrible dream. But the doctor’s words were echoing in her ears: metastatic melanoma.

她的頭腦在飛速運轉;她想相信她即將從某個可怕的夢中醒來。但醫生的話在她耳邊回蕩：轉移性黑色素瘤。

A TUMOR NAMED “MEL”

一個名為“MEL”的腫瘤

In bodies everywhere, every day, a cell mutates and cancer begins. It could be happening to any of us at any time. You go about your day, making coffee, driving to work, completely unaware. But your immune system is aware. It flags the site and sends a team of cells (including the natural killer cells that we learned about earlier) to gobble up the mutated cell and flush it out of the body. Good-bye, cancer! You cook dinner, you go to bed, none the wiser. Your immune system has wiped it out before it can gain a toehold and spread like a weed in a sidewalk crack. But a weak immune system is that crack in the sidewalk, letting the seed grow; the roots shoot down into the soil and spread. Ineffective natural killer cells and lymphocytes can miss a mutation, and the cancer continues its rapid cell division.

在任何地方的體內，每天都有一個細胞發生突變，癌症開始出現。它隨時可能發生在我們任何人身上。你過著自己的一天，煮咖啡，開車去上班，完全沒有意識到。但您的免疫系統是知道的。它標記該位點併發送一組細胞（包括我們之前瞭解的自然殺傷細胞）吞噬突變的細胞並將其排出體外。再見了，癌症！你做晚飯，你上床睡覺，一點也不聰明。您的免疫系統在它站穩腳跟並像人行道裂縫中的雜草一樣蔓延之前就將其消滅了。但較弱的免疫系統是人行道上的裂縫，讓種子生長;根向下伸入土壤並蔓延開來。無效的自然殺傷細胞和淋巴細胞可能會漏診突變，癌症會繼續快速細胞分裂。

With melanoma, there’s usually a primary site where that mutation starts, somewhere cutaneous, on the skin. You might notice an unusual skin lesion or a mole that changes in appearance or bleeds. If there can be anything “good” about melanoma, this is it: its tendency to announce itself. Certain cancers are more lethal simply because they don’t send up these kinds of red flags. Pancreatic cancer and colon cancer are two examples of these. By the time symptoms appear, the cancer is already very advanced, less treatable, and deadlier. Melanoma is typically a more “survivable” cancer simply because it’s more frequently found early. But when a primary site can’t be found, or when it goes metastatic—breaking free of the primary site and spreading through the body—then it’s a whole other ball game. Metastatic melanoma is Stage IV cancer, which means it’s already advanced.

對於黑色素瘤，通常有一個原發部位，突變開始於皮膚上的某個地方。您可能會注意到不尋常的皮損或外觀發生變化或出血的痣。如果黑色素瘤有什麼“好”的地方，那就是它：它傾向於宣佈自己。某些癌症更致命，僅僅是因為它們不會發出這些類型的危險信號。胰腺癌和結腸癌就是其中的兩個例子。當癥狀出現時，癌症已經非常晚期，更難治療，而且更致命。黑色素瘤通常是一種更“存活”的癌症，僅僅是因為它更常見於早期發現。但是，當找不到原發部位，或者當它發生轉移時——脫離原發部位並擴散到全身——那就完全是另一回事了。轉移性黑色素瘤是IV期癌症，這意味著它已經是晚期。

Doctors searched for Mirae’s primary site but found nothing. She scrolled through her memory—maybe there’d been something last year, a scabby spot on her scalp that took a while to heal, but at the time, she’d just assumed she’d nicked it on something. Could that have been the primary site? There was no way to know.

醫生搜索了Mirae的主要部位，但一無所獲。她翻閱著自己的記憶——也許去年發生了什麼事情，頭皮上的一個結痂點花了一段時間才癒合，但當時，她只是認為她在什麼東西上劃傷了它。那會是主要地點嗎？我們無從得知。

Metastatic melanoma with an unknown primary site (MUP) is rare, and there’s not a lot of research on it—outcomes are poorly defined. But in general it’s considered to be not a good sign. Patients with it have a very low life expectancy, with a median survival rate of about ten months.¹ Things improve a bit if surgery is an option. With surgery, the five-year survival rate rockets to over 30 percent, which is a testimony to how far we’ve come in treating and managing cancer. But. It’s important to note here that when we talk about survival rates, we’re not talking about remissions. We’re simply talking about people who are still alive a certain amount of time later. Melanoma is a cancer that a person could live with for months or even years. But once it’s metastasized, melanoma is considered incurable. Depending on treatment, five-year survival rates can range from 18 percent to only 8 percent. And if surgery is impossible, that percentage drops even more.²,³

原發部位不明 （MUP） 的轉移性黑色素瘤很少見，而且沒有很多研究——結果定義不明確。但總的來說，這被認為不是一個好兆頭。患有它的患者預期壽命非常低，中位生存率約為10個月。¹如果可以選擇手術，情況會有所改善。通過手術，五年生存率飆升至 30% 以上，這證明瞭我們在治療和管理癌症方面取得了多大的進步。但。這裡需要注意的是，當我們談論存活率時，我們並不是在談論緩解。我們只是在談論在一定時間后還活著的人。黑色素瘤是一種癌症，一個人可能會患有數月甚至數年。但是一旦轉移，黑色素瘤就被認為是無法治癒的。根據治療方式，五年生存率從 18% 到僅 8% 不等。如果無法進行手術，這個百分比會下降得更多。²，³

Melanoma, Mirae’s doctors said, is “the cancer that kills you by millimeters.” Worse, the tumor was not resectable. It was tangled up in her lymph nodes, so large that it was deviating her right carotid artery, causing (according to the notes the doctor scribbled on her file), significant compression and thinning of the right internal jugular vein. These two vessels—the carotid arteries and the internal jugular veins—are the main vessels carrying blood to and from the brain. The neck is full of vital structures; crammed in a small space are the structures that get food to your stomach, blood to and from your brain and head, air to and from your body, muscles to support and turn the head, and nerves that send messages to your body to do everything from scratch an itch, to run, to breathe. Mirae’s tumor was simply too interwoven with these structures to remove. The oncologist, panning over it on the CAT scan, called it “beautifully complex” with Mirae sitting right there. She was shocked, almost offended.

Mirae 的醫生說，黑色素瘤是“讓你以毫米為單位殺死的癌症”。更糟糕的是，腫瘤無法切除。它纏在她的淋巴結中，如此之大，以至於它偏離了她的右頸動脈，導致（根據醫生在她的檔案上潦草的筆記）右頸內靜脈的嚴重壓迫和變薄。這兩條血管——頸動脈和頸內靜脈——是將血液輸送到大腦和從大腦輸送血液的主要血管。脖子上充滿了重要的結構;在一個狹小的空間裡，塞滿了將食物輸送到你的胃裡，血液進出你的大腦和頭部，空氣進出你的身體，支撐和轉動頭部的肌肉，以及向你的身體發送信息的神經，從抓癢、跑步、呼吸。Mirae 的腫瘤與這些結構交織在一起，無法切除。這位腫瘤學家在 CAT 掃描中平移它時稱它「非常複雜」，Mirae 就坐在那兒。她感到震驚，幾乎被冒犯了。

“There was nothing beautiful about it,” she says now. “That thing was going to kill me!”

“這沒有什麼美妙的，”她現在說。“那東西要了我的命！”

But then, gazing at this image that seemed suddenly very separate from her—not her own body at all, just a picture illuminated on the wall—she could see how it could be beautiful. It was so impossibly big, so unusual. It was amazing, really, that a body could still be working, with that giant mass filling up the neck. It really was its own entity. They decided to give it a nickname: “Mel,” short for melanoma.

但隨後，凝視著這幅突然間似乎與她格格不入的圖像——根本不是她自己的身體，只是牆上照亮的一幅照片——她可以看到它是多麼美麗。它是如此之大，如此不尋常。真的，一個身體還能工作，那個巨大的腫塊填滿了脖子，這真是太神奇了。它真的是自己的實體。他們決定給它起個綽號：“Mel”，黑色素瘤的縮寫。

The immediate concern was the amount of pressure Mel was putting on Mirae’s life-sustaining blood vessels and esophagus. Even though the tumor couldn’t be removed completely, one doctor wanted to try surgery right away, to take some of the pressure off the vital structures of her neck, which would buy her a little time. Another thought they should try chemo, to shrink it first, and maybe get more. Everyone was looking at her scans—doctors, nurses, technicians—amazed and horrified. One nurse went over to her.

最直接的擔憂是梅爾對Mirae維持生命的血管和食道施加的壓力。儘管腫瘤無法完全切除，但一位醫生想立即嘗試手術，以減輕她頸部重要結構的一些壓力，這將為她贏得一點時間。另一個人認為他們應該嘗試化療，先縮小它，也許會得到更多。每個人都在看著她的掃描結果——醫生、護士、技術人員——都感到驚訝和恐懼。一名護士走到她身邊。

“We were all out in the hallway trying to figure out how you breathe,” she said to Mirae. “Can you breathe?”

“我們都在走廊里試圖弄清楚你是怎麼呼吸的，”她對 Mirae 說。“你能呼吸嗎？”

And in that moment, she found suddenly that she could not take a breath.

而在那一刻，她突然發現自己無法呼吸。

For months, she’d been telling herself that the swelling in her neck wasn’t anything too terrible, that she’d take care of it as soon as she was done with her deal at work, just like she took care of everything. But now, her mind replayed the images of the “beautifully complex” tumor pressing into her esophagus, and the nurse’s question—Can you breathe?—echoed in her ears, collapsing her mental ability to stave off the effects of the tumor. As she struggled to breathe and the nurses crowded around to help, dropping her hospital bed flat, tipping her back, and pressing an oxygen mask over her mouth, she tried to process what she was being told—that she would not recover from this cancer.

幾個月來，她一直在告訴自己，她脖子上的腫脹並不是什麼太可怕的事情，她會在工作完成後立即處理它，就像她處理所有事情一樣。但現在，她的腦海中重播著“美麗複雜”的腫瘤壓入食道的畫面，護士的問題——你能呼吸嗎——在她耳邊回蕩，使她抵禦腫瘤影響的心理能力崩潰。當她呼吸困難時，護士們圍著她幫忙，把她的病床放平，向後傾斜，用氧氣面罩捂住嘴巴，她試圖理解她被告知的事情——她不會從這種癌症中恢復過來。

I looked at Mirae’s scans—she emailed her medical file to me, and when I clicked on the attachments and the CAT scan image filled my computer screen, I could see why they’d given Mel its own nickname. I could also see that there were metastases far from the original tumor site, which essentially indicates that the cancer is incurable. At that stage, the median survival rate is about six to twelve months, and treatment is palliative.

我查看了Mirae的掃描結果——她通過電子郵件將她的醫療檔案發送給我，當我點擊附件時，CAT 掃描圖像填滿了我的電腦螢幕，我明白了為什麼他們給Mel起了自己的昵稱。我還可以看到遠離原始腫瘤部位的轉移，這基本上表明癌症無法治癒。在該階段，中位生存率約為 6 至 12 個月，治療為姑息治療。

The treatment plan they laid out was a gauntlet of thorny odds: there was a fifty-fifty chance that she’d have the right genetic makeup for the drug they wanted to try. Then, if she made it over that hurdle, she had a fifty-fifty chance that she’d tolerate the drug, a powerful and toxic one that many weren’t able to continue taking. And then, even if she cleared those two previous hurdles, there was only a fifty-fifty chance that the chemo would be able to shrink the tumor by 30 percent, the bare minimum required to make it resectable. The oncologist was honest with her. He put the chances of the drug having any effect at all at around 5 percent.

他們制定的治療計劃是一個棘手的考驗：她有 50% 的機會擁有適合他們想要嘗試的藥物的基因組成。然後，如果她克服了那個障礙，她就有550的機會耐受這種藥物，一種許多人無法繼續服用的強大而有毒的藥物。然後，即使她清除了前兩個障礙，化療能夠將腫瘤縮小 30% 的機會也只有 50% 的機會，這是使其可切除所需的最低限度。腫瘤科醫生對她很誠實。他認為這種藥物有任何效果的幾率在5%左右。

She won the first coin toss, at least: she had the right genetic makeup for the drug.

至少，她贏得了第一次拋硬幣：她擁有適合這種藥物的基因組成。

It’s difficult to hear what sounds like hopeful plans for treatment when the long game of that treatment is not actually expected or intended to make you better. It’s only expected to extend your life, and maybe improve the quality of the time remaining. Swept up in the language of action and treatment, Mirae used the word cure when talking to one of her doctors, who immediately stopped her.

當治療的長期遊戲實際上並不預期或打算讓您變得更好時，很難聽到聽起來充滿希望的治療計劃。它只會延長您的壽命，並可能提高剩餘時間的品質。Mirae 被行動和治療的語言所吸引，在與她的一位醫生交談時使用了治愈這個詞，但醫生立即阻止了她。

“We don’t talk about a cure with this disease,” she said gently. “We talk about managing the progression of the illness.”

“我們不談論治癒這種疾病的方法，”她溫和地說。“我們談論管理疾病的進展。”

The reality of her diagnosis had been sinking in incrementally; now it felt like a bottomless abyss. It wasn’t a question of if this cancer would kill her; it was a question of when.

她被診斷出的現實正在逐漸沉入;現在感覺就像一個無底的深淵。這不是這種癌症是否會殺死她的問題;這是一個時間問題。

It was surreal, Mirae thought, that one minute you could be sitting at your desk, finishing up a deal at work that you’d thought was so important, and the next, lying on a hospital bed trying to come to terms with your own imminent death. I’m a smart person, she thought. How did I get to the point where I had this thing sticking out of my neck, and I did nothing for so long? She was overwhelmed with regret. And a part of her wondered if this illness was a message.

Mirae 想，這太超現實了，前一分鐘你可能還坐在辦公桌前，完成你認為非常重要的工作交易，下一分鐘，你躺在醫院的病床上，試圖接受自己即將到來的死亡。我是個聰明人，她想。我是怎麼走到脖子上露出這個東西的地步，而且這麼長時間什麼都沒做？她被遺憾所淹沒。她的一部分想知道這種疾病是否是一種資訊。

“It was as if my body said, You’ve been treating me like crap for years. Caffeine, no sleep, eating like a racehorse. Maybe this cancer was my body saying, ‘Screw you. I’m done.’”

“就好像我的身體在說，多年來你一直把我當垃圾。咖啡因，不睡覺，像賽馬一樣吃東西。也許這個癌症是我的身體在說，『去。我受夠了。

They began the drug therapy in May, just as the white-and-pink dogwood trees began to bloom all over Saint Louis. As her body was flooded with heavy daily doses of cytotoxic drugs, she felt exhausted, nauseous, thirsty.

他們於 5 月開始藥物治療，當時白色和粉紅色的山茱萸樹開始在聖路易士各地開花。當她的身體每天被大量劑量的細胞毒性藥物淹沒時，她感到筋疲力盡、噁心、口渴。

“Why me?” Mirae said. “Sure, I wanted to do things my own way most of my life. But I’m the nicest person I know. I’m considerate. I’m kind. I put everyone else first. If there was a dead animal on the side of the road, I’d stop and bury it if I could. The world is a better place with me in it. I’m a good person. Why was God doing this to me?”

“為什麼是我？”Mirae 說。“當然，我一生中的大部分時間都想以自己的方式做事。但我是我認識的最好的人。我很體貼。我很善良。我把其他人放在第一位。如果路邊有死去的動物，如果可以的話，我會停下來把它埋起來。有我在其中，世界會變得更美好。我是個好人。神為什麼這樣對我呢？

She plunged into a dark period, convinced that her illness was punishment for the choices she’d made earlier in life, the ways that she’d gone against the grain. She’d essentially left the Mormon church; she’d gone against her family’s wishes time and again. She didn’t want to believe everything they believed. She didn’t want to wear the dresses her sisters wore or acquiesce to the life she believed she was supposed to want as a woman in the Mormon faith. She’d had a baby out of wedlock, as a teenager. She’d always been the bad one, the wrong one, the mistake. She still had that cold fear that when she died, she’d be alone—excommunicated from everyone she loved.

她陷入了一段黑暗的時期，堅信她的疾病是對她早年所做的選擇的懲罰，她違背了常規的方式。她基本上已經離開了摩門教;她一次又一次地違背了家人的意願。她不想相信他們所相信的一切。她不想穿她姐妹們穿的衣服，也不想默許她認為自己作為摩門教女性應該想要的生活。她十幾歲時就生了一個未婚生子。她一直都是壞的那個，錯誤的那個，錯誤的那個。她仍然有那種冰冷的恐懼，擔心當她死去時，她會孤身一人——與她所愛的每個人被逐出教會。

Before her diagnosis, time had seemed infinite—like an ocean. You could scoop up a bucketful and there was always more. She’d been counting on it—that wide-open sea, the future stretching before her. There was so much still to do. Her son, now married, was graduating from dental school and moving across the country for his residency. She’d spent so many years pouring her time and energy into work—to prove everyone wrong and give him the kind of life that didn’t seem possible with a single, teenage mom. Suddenly, now that the future wasn’t infinite, work didn’t seem to matter much at all, even though it was where she’d focussed so much of her attention. How ironic that the things she’d prioritized the most seemed now to matter the least.

在她被診斷出之前，時間似乎是無限的——就像一片海洋。你可以舀一桶，而且總是有更多。她一直指望著它-那片廣闊的大海，在她面前延伸的未來。還有很多事情要做。她的兒子現在已經結婚了，即將從牙科學校畢業，並搬到全國各地去住院。她花了這麼多年的時間和精力投入到工作中——證明每個人都錯了，給他一種單身十幾歲的媽媽似乎不可能的生活。突然之間，既然未來不是無限的，工作似乎根本不重要，儘管這是她集中了大量注意力的地方。多麼諷刺的是，她最優先考慮的事情現在似乎變得最不重要了。

“What hit me the hardest,” Mirae says, “was that I was out of time to rewrite things.”

“對我打擊最大的是，”Mirae 說，“我沒有時間重寫。

To rewrite things?

重寫東西？

“The story of my life,” she replies. “The story I was telling myself about who I was. It was all wrong. And I was out of time to fix it.”

“我的人生故事，”她回答。“我告訴自己關於我是誰的故事。一切都錯了。我沒有時間修復它。

THE IMPORTANCE OF YOUR STORY

您的故事的重要性

I’ve called spontaneous remission a black box that hasn’t been unpacked by medical science. With literal black box technology like the kind we use on commercial airplanes, data flows in during the flight and is encoded and stored. If something goes wrong and the plane crashes, investigators can pull essential information out of the black box to figure out what might have happened.

我把自發緩解稱為醫學尚未解開的黑匣子。使用我們在商用飛機上使用的那種文字黑盒技術，數據在飛行過程中流入並被編碼和存儲。如果出現問題，飛機墜毀，調查人員可以從黑匣子中提取重要資訊，以弄清楚可能發生了什麼。

We each have a black box inside of us as well, collecting data on everything that’s happened to us over the course of our lives. I’m talking about memories and old emotions, past traumas and losses that have imprinted themselves on our psyches and cells, deep-seated stress and anxiety that can’t be accessed by a few minutes of meditation or a change in life circumstances. Griefs and grudges that we hang on to like a security blanket; ideas about ourselves—who we are, what we are capable of, what we deserve or don’t deserve—that were recorded during our formative years. Just as the medical community shies away from unpacking the black box of spontaneous healing, most of us do the same with our own black boxes, leaving these subconscious beliefs about ourselves, others, and the world wholly unexamined.

我們每個人的內心也都有一個黑匣子，收集我們一生中發生的一切數據。我說的是記憶和舊的情緒，過去的創傷和損失已經烙印在我們的心理和細胞上，根深蒂固的壓力和焦慮，這些都無法通過幾分鐘的冥想或生活環境的變化來獲得。我們像安全毯一樣緊緊抓住的悲傷和怨恨;關於我們自己的想法——我們是誰，我們能做什麼，我們應該做什麼或不值得——這些都是在我們成長過程中記錄下來的。正如醫學界迴避解開自發治癒的黑匣子一樣，我們大多數人對自己的黑匣子也做了同樣的事情，讓這些關於自己、他人和世界的潛意識信念完全沒有得到檢驗。

This black box I’m talking about isn’t just a metaphor. It’s real.

我所說的這個黑匣子不僅僅是一個隱喻。這是真的。

A more scientific term for it is your default mode network (DMN). The DMN is basically a collection of loosely connected regions of the brain, both older structures deep in the brain and newer ones in the cerebral cortex, which are activated, or light up, when you engage in certain categories of thinking. I say “light up” because that’s what it looks like on an fMRI—areas of the brain glow bright out of the silvery gray like when you blow on embers in a fire.

更科學的術語是預設模式網路 （DMN）。DMN 基本上是大腦中鬆散連接的區域的集合，既有大腦深處的舊結構，也有大腦皮層中的新結構，當你進行某些類別的思考時，這些結構會被啟動或亮起。我說“點亮”是因為這就是 fMRI 上的樣子——大腦區域從銀灰色中發出明亮的光芒，就像你在火中吹灰燼一樣。

What lights up your DMN? Daydreaming. Thinking about yourself and others. Getting “likes” on social media. Remembering things that have happened in the past; imagining what might happen in the future. When you become self-reflective or aware of your own emotions. Basically, the DMN is most active when you’re not focusing on elements of the outside world but instead are turning inward to a more introspective mode. It yearns for narrative, helping us compose the story of who we are by linking our past with the present and what we consider possible or likely for our futures.⁴

是什麼點亮了你的 DMN？白日夢。考慮自己和他人。在社交媒體上獲得“讚”。記住過去發生的事情;想像未來可能發生的事情。當你開始自我反省或意識到自己的情緒時。基本上，當你不關注外部世界的元素，而是轉向更內省的模式時，DMN 是最活躍的。它渴望敘事，通過將我們的過去與現在以及我們認為可能或可能的未來聯繫起來，幫助我們構建我們是誰的故事。⁴

We interpret the things that happen to us in our unique way and “record” events the way we perceived them. When we go back over these events in our minds, as we all tend to do with significant things (especially if they’re negative or we experienced them intensely), we activate the DMN repeatedly in the same patterns, creating neural pathways with deepening “grooves” over time. As a kid in school, did you ever write on your desk? I remember the smooth beige wood the desks were made of and how when I started writing, my pencil just skated over the slick surface. But as I pressed into the same lines over and over, the grooves got deeper and more permanent. Pretty soon, all I could do was draw the same shape, retrace the same deepening, darkening lines. This is what happens in your brain, in the DMN, when you go over traumas and stresses and memories and griefs, and all kinds of other beliefs about who you are, over and over.

我們以獨特的方式解釋發生在我們身上的事情，並以我們感知事件的方式“記錄”事件。當我們在腦海中回顧這些事件時，就像我們都傾向於處理重要的事情一樣（特別是如果它們是消極的或我們強烈經歷過它們），我們會以相同的模式反覆啟動 DMN，隨著時間的推移，創造出具有加深“凹槽”的神經通路。作為一個在學校的孩子，你有沒有在書桌上寫過東西？我記得書桌是用光滑的米色木頭製成的，當我開始寫字時，我的鉛筆只是在光滑的表面上滑行。但當我一遍又一遍地壓入相同的線條時，凹槽變得更深、更持久。很快，我所能做的就是畫出相同的形狀，回溯同樣加深、變暗的線條。這就是在你的大腦中，在 DMN 中，當你一遍又一遍地回顧創傷、壓力、記憶和悲傷，以及關於你是誰的各種其他信念時發生的事情。

The idea of the DMN is relatively new in neuroscience, so there isn’t a consensus on all the areas of the brain that officially comprise this nebulous yet very important brain system. We do tend to agree that any definition of the DMN should include the prefrontal cortex (the locus of planning, decision-making, and behavior regulation), the cingulate cortex (part of the limbic system, tasked with emotion and memory formation), and the inferior parietal lobe (in charge of interpreting those formed emotions and processing language and sensory information). This all comes together to form what an outside observer might call your personality and what you might call “me.” Neuroscientists have nicknamed it the me network. It’s the neurobiological basis of the self; it’s who you are.

DMN 的概念在神經科學中相對較新，因此對於正式構成這個模糊但非常重要的大腦系統的所有大腦區域還沒有達成共識。我們確實傾向於同意 DMN 的任何定義都應該包括前額葉皮層（計劃、決策和行為調節的場所）、扣帶皮層（邊緣系統的一部分，負責情緒和記憶形成）和下頂葉（負責解釋這些形成的情緒並處理語言和感覺資訊）。這一切結合在一起，形成了外部觀察者可能稱之為你的人格和你可能稱之為“我”的東西。神經科學家將其昵稱為 me 網路。它是自我的神經生物學基礎;這就是你是誰。

Now, it’s important to pause and point out that this isn’t all of who you are. There is more to identity than just the DMN; the sum total of a person can’t be wrapped up in one neurological network. When it comes to radical healing in particular, we’ll see that identity runs much deeper than this, but the DMN is an essential place to start. It’s the blueprint of the building that you’ve been conditioned to think of as you. Your life, your identity, your sense of self, your story, your method of operating in the world—it’s all built based on this blueprint.

現在，重要的是要停下來指出，這並不是你的全部。身份不僅僅是 DMN;一個人的總和不能被包裹在一個神經網路中。特別是當涉及到激進的治療時，我們會看到身份認同比這更深，但 DMN 是一個重要的起點。它是你習慣於將自己視為的建築藍圖。你的生活、你的身份、你的自我意識、你的故事、你在世界上的運作方式——所有這些都建立在這個藍圖之上。

So what happens when your sense of self—when your blueprint identity—is built upon ideas that are negative, damaging, or limiting? What do your self-imposed negative beliefs or limitations do to your brain chemistry? To the cycles of stress and fight or flight in your body? To your biological systems, to your cells? To your likelihood of developing disease and to your capacity for healing from it? What’s in your black box that could be keeping you from healing or even making you sick?

那麼，當你的自我意識——當你的藍圖身份——建立在消極、有害或限制性的想法之上時，會發生什麼呢？你自我強加的消極信念或限制對你的大腦化學有什麼影響？對你體內的壓力和戰鬥或逃跑的迴圈？對你的生物系統，對你的細胞？您患病的可能性以及您從疾病中康復的能力？你的黑匣子裡有什麼可能會阻止你痊癒甚至讓你生病？

WHAT’S IN YOUR BLACK BOX?

你的黑匣子裡有什麼？

Back in 1985, a researcher’s slip of the tongue launched a study that would reshape the landscape of modern medicine. Vincent Felitti, head of the Department of Preventive Medicine at Kaiser Permanente in San Diego, California, was trying to understand why patients kept dropping out of his weight-loss clinic. The clinic was one of the most successful initiatives at the Department of Preventive Medicine, and yet strangely, it had a 50 percent attrition rate. Participants would begin to lose weight very successfully and would be well on their way toward their stated weight-loss goals, and then suddenly they would drop out and disappear. Why on earth would people be dropping out just as they were about to realize their goals?

早在 1985 年，一位研究人員的口誤就啟動了一項將重塑現代醫學格局的研究。加利福尼亞州聖地牙哥 Kaiser Permanente 預防醫學系主任文森特·費利蒂 （Vincent Felitti） 試圖理解為什麼患者不斷從他的減肥診所退出。該診所是預防醫學系最成功的舉措之一，但奇怪的是，它的流失率高達 50%。參與者會開始非常成功地減肥，並且正在朝著他們既定的減肥目標前進，然後突然間他們會退出並消失。人們到底為什麼會在即將實現目標時輟學呢？

Interviewing one particular patient who’d been a star of the clinic, dropping almost three hundred pounds over the course of a year before she abruptly quit the program, Dr. Felitti misspoke while reading through a list of interview questions. “How old were you when you became sexually active?” he said—or thought he said. The patient replied, “Forty pounds.” Confused, he asked the question again, and she gave the same answer—and then burst into tears.

Felitti 博士採訪了一位特定的病人，她曾是診所的明星，在她突然退出該計劃之前的一年內減掉了近 300 磅，Felitti 醫生在閱讀一系列採訪問題時說錯了話。“你開始性活躍的時候幾歲？”“病人回答說：”四十磅。他感到困惑，又問了一遍這個問題，她也給出了同樣的答案——然後淚流滿面。

Felitti suddenly realized that he’d tangled up two questions and transposed phrases. Instead of asking the patient how old she’d been when she became sexually active, he’d asked, “How much did you weigh when you became sexually active?” The answer she’d blurted out revealed a truth that she might never have been able to admit otherwise: that she’d been abused as a child. Her first sexual experience was with a family member at the age of four.

Felitti 突然意識到他把兩個問題搞砸了，並換了個短語。他沒有問病人她性活躍時多大了，而是問道：“你開始性活躍時體重是多少？她脫口而出的答案揭示了一個她可能永遠無法承認的事實：她小時候曾被虐待過。她的第一次性經歷是在四歲時與一位家庭成員發生性關係。

It was a revelatory moment. Felitti recalibrated his questions, expanded the scope of his interviews, and quickly determined that people were dropping out of the weight-loss clinic not in spite of the fact that they were losing weight but because of it. One woman, who regained close to forty pounds in only three weeks after a colleague at work commented on how great she looked and asked her out, said, “Overweight is overlooked, and that is what I need to be.” She also had a history of suffering from abuse.

這是一個啟示性的時刻。Felitti 重新調整了他的問題，擴大了他的採訪範圍，並很快確定人們退出減肥診所不是因為因為他們正在減肥，而是因為它。一位女士在同事評論她看起來有多棒並約她出去后，在短短三周內就恢復了近 40 磅，她說：“超重被忽視了，這就是我需要成為的。她也有遭受虐待的歷史。

With that slip of the tongue, Felitti had accidentally uncovered the secret to treating his patients. The link between childhood sexual abuse and obesity was profound and, it turned out, widespread. People were gaining weight almost intentionally as a survival strategy in response to the trauma they’d experienced as young children. Therefore, he couldn’t just focus on devising strategies for people to lose weight in the present day; they’d have to time travel into their childhoods and heal from that trauma before they could lose weight, keep it off, and get healthy. And when Felitti expanded the scope of his inquiry into childhood trauma and present-day health, partnering with Richard Anda, a leading epidemiologist, to design a massive longitudinal study, they discovered that the issue went beyond sexual abuse and beyond obesity. Far beyond.

通過這個口誤，Felitti 無意間發現了治療他的病人的秘密。童年性虐待和肥胖之間的聯繫是深遠的，而且事實證明，這種聯繫很普遍。人們幾乎是有意為之地增加體重，作為一種生存策略，以應對他們小時候經歷的創傷。因此，他不能只專注於為當今的人們制定減肥策略;他們必須穿越時空回到童年並從創傷中治癒，然後才能減肥、保持體重和恢復健康。當 Felitti 擴大對童年創傷和當今健康的調查範圍，與領先的流行病學家 Richard Anda 合作設計一項大規模縱向研究時，他們發現這個問題超出了性虐待和肥胖。遠不止於此。

Felitti and Anda identified ten types of childhood stress and trauma that they called adverse childhood experiences, or ACEs. They screened seventeen thousand study participants over two years, using a combination of physical exams and interviews about their pasts and childhoods. What they found was that strong links between childhood trauma and present-day illness existed across multiple types of experiences and multiple categories of disease. Abuse and neglect, losing a parent, witnessing domestic violence, living with someone who suffered from mental illness or drug dependency, or even just the constant, low-level chronic stress of emotional neglect—all these experiences and more emerged as major predictors for everything from obesity and diabetes to cancer and heart disease. Or, as telomere researchers Blackburn and Epel would put it, for stepping prematurely into the disease span.

Felitti 和 Anda 確定了十種類型的童年壓力和創傷，他們稱之為不良童年經歷 （ACE）。他們在兩年內篩選了 17000 名研究參與者，結合使用體檢和關於他們過去和童年的訪談。他們發現，童年創傷和當今疾病之間存在著多種類型的經歷和多種疾病類別的強烈聯繫。虐待和忽視、失去父母、目睹家庭暴力、與患有精神疾病或藥物依賴的人一起生活，甚至只是情緒忽視的持續、低水準的慢性壓力——所有這些經歷以及更多經歷都成為從肥胖和糖尿病到癌症和心臟病等一切事物的主要預測因素。或者，正如端粒研究人員 Blackburn 和 Epel 所說，過早地進入了疾病跨度。

So how exactly do these past experiences turn into illness in adulthood?

那麼，這些過去的經歷究竟是如何在成年後變成疾病的呢？

At first glance, what the ACE study shows us is that trauma and stress from early childhood leads to disease-causing behaviors. For example, here’s how the CDC explains the pathway to illness established by ACEs: trauma or chronic stress early in life can disrupt your neurodevelopment. In adulthood, the result of that disruption is that we sometimes don’t make great choices on everything from what we eat or with whom we live to whether or not we smoke, and thus we put ourselves at risk of developing all kinds of disease, from diabetes to heart disease to cancer. We tend to call these lifestyle illnesses because they have their roots in the way we live. Discovering that the root cause of many of our choices and habits can be traced back to experiences from childhood was a huge revelation, one that is finally beginning to reshape the way we screen for and treat these illnesses. I say “finally” because this change was a very long time coming.

乍一看，ACE 研究向我們展示的是，童年早期的創傷和壓力會導致致病行為。例如，以下是 CDC 對 ACE 建立的疾病途徑的解釋：生命早期的創傷或慢性壓力會破壞您的神經發育。在成年後，這種干擾的結果是，我們有時不會在所有事情上做出很好的選擇，從我們吃什麼或與誰住在一起，到我們是否吸煙，因此我們使自己面臨患上各種疾病的風險，從糖尿病到心臟病再到癌症。我們傾向於稱這些為生活方式疾病，因為它們植根於我們的生活方式。發現我們許多選擇和習慣的根本原因可以追溯到童年的經歷，這是一個巨大的啟示，它終於開始重塑我們篩查和治療這些疾病的方式。我說“終於”是因為這種變化已經來了很久。

Felitti and Anda first published the results of their study in 1998. It should have made every doctor in the country sit up and reevaluate how they were practicing medicine. Instead, most people either ignored or dismissed it. Correlation does not equal causation, was the cry from most—a rejection based on the idea that having both trauma in childhood and illness in adulthood was just a coincidence. But the ACE study was so well designed, so well run, and has since been backed up by so many supporting studies that I suspect the real reason it was initially rejected is because the idea behind it was just too big. If we believed the results of the ACE study, we would have been compelled to change the way we practiced medicine from the ground up. It’s a huge and overwhelming task to think about how to overhaul these systems that we’ve built an entire industry around.

Felitti 和 Anda 於 1998 年首次發表了他們的研究結果。它應該讓這個國家的每一位醫生都坐下來重新評估他們是如何行醫的。相反，大多數人要麼忽視它，要麼不屑一顧。相關性不等於因果關係，這是大多數人的呼聲——這種拒絕是基於這樣一種觀點，即童年時期的創傷和成年後的疾病只是一個巧合。但是 ACE 研究設計得如此之好，運行得如此之好，並且此後得到了如此多的支援研究的支援，以至於我懷疑它最初被拒絕的真正原因是它背後的想法太大了。如果我們相信 ACE 研究的結果，我們將被迫從頭開始改變我們的行醫方式。思考如何徹底改革我們構建了整個行業的這些系統，這是一項艱巨而艱巨的任務。

“Nobody wanted to know this,” Vince Felitti says now in describing the negative response to his groundbreaking study. “But it was real.”⁵

“沒有人想知道這個，”文斯·費利蒂 （Vince Felitti） 在描述對他的開創性研究的負面反應時說。“但這是真的。”⁵

It’s easy to look at the path of progression as laid out by the CDC—the line that leads from childhood experiences to disrupted neurodevelopment to health-risk behaviors—and think, Oh, ACEs don’t apply to me, because you’re not engaging in those behaviors. Maybe you took the ACE screening test and found that you had one or two, but you have healthy habits today. That’s great, and what it might mean is that you were able to develop resilience or coping tactics, either on your own or with the help of others in your life. But it unfortunately doesn’t mean that ACEs don’t impact you. Only half of the ACE-related illnesses that people are suffering from can be chalked up to their current behaviors. The other half? It has to do with the fact that stress and trauma can literally rewrite your DNA, recoding your body to be more susceptible to disease and even allowing that illness-prone code to be passed on to your children. As we already know, toxic stress can alter the chemistry and biology of your body, down to your very cells. It’s not just that ACEs lead to disease-causing behaviors—they lead directly to disease.

我們很容易看到 CDC 制定的進展路徑——從童年經歷到神經發育中斷再到健康風險行為的界限——然後想，哦，ACE 不適用於我，因為你沒有參與這些行為。也許您參加了 ACE 篩查測試，發現自己有一兩次，但您今天有健康的習慣。這很好，這可能意味著您能夠自己或在生活中其他人的幫助下培養韌性或應對策略。但不幸的是，這並不意味著 ACE 不會影響您。人們所患的與 ACE 相關的疾病中，只有一半可以歸結為他們目前的行為。另一半呢？這與壓力和創傷可以真正改寫你的DNA，重新編碼你的身體使其更容易感染疾病，甚至讓這種容易生病的密碼傳遞給你的孩子有關。正如我們已經知道的那樣，有毒的壓力會改變您身體的化學和生物學，甚至您的細胞。ACE 不僅會導致致病行為，還會直接導致疾病。

And what if you took the ACE screening test and didn’t have any ACEs? Also wonderful news. But it doesn’t mean that stress, trauma, grief, or other experiences from your past aren’t written into your DMN and affecting your health or ability to heal today. The ACE study confirmed that ten types of trauma impact health and cause disease. It doesn’t mean other types of stress don’t; it just means we haven’t measured those yet.

如果您參加了 ACE 篩查測試但沒有任何 ACE 怎麼辦？這也是個好消息。但這並不意味著您過去的壓力、創傷、悲傷或其他經歷沒有寫入您的 DMN 並影響您今天的健康或治癒能力。ACE 研究證實，十種類型的創傷會影響健康並導致疾病。這並不意味著其他類型的壓力不會;這隻是意味著我們還沒有測量這些。

At this point in my study of spontaneous healing, I knew I had to look beyond what science had absolutely confirmed to what it was pointing toward. The ACE study focused on childhood experiences and proved that those experiences shape your health. But in some ways, the ACE study was a blunt tool; it was a place to start, but it didn’t encapsulate the whole story of how our past experiences shape our current identities and also our health. I had to wonder, what about all the experiences we haven’t yet studied? Experiences the ACE study didn’t look at—like the ideas we receive about ourselves early on about who we are, what we deserve (or don’t), what might be bad or wrong about us? What about grief and heartbreak, or the grudges we hold against those who have hurt us? How do these experiences affect us? How do our perceptions and interpretations of these experiences affect us, working their way through the body over the course of months, years, decades? How might they shape the map of our default mode network, determining how we think about ourselves and how we define who we are?

在我研究自發癒合的這一點上，我知道我必須超越科學絕對證實的事物，看看它所指向的。ACE 研究側重於童年經歷，並證明這些經歷會影響您的健康。但在某些方面，ACE 研究是一個生硬的工具;這是一個起點，但它並沒有概括我們過去的經歷如何塑造我們現在的身份和我們的健康的全部故事。我不得不想，我們還沒有研究過的所有經歷呢？ACE 研究沒有關注的經歷——比如我們早期對自己的想法，關於我們是誰，我們應該（或不應該）什麼，我們可能有什麼壞處或錯誤？悲傷和心碎，或者我們對那些傷害過我們的人的怨恨呢？這些經歷對我們有什麼影響？我們對這些經歷的感知和解釋如何影響我們，在幾個月、幾年、幾十年的時間里，它們在身體中發揮作用？它們將如何塑造我們的預設模式網路地圖，決定我們如何看待自己以及我們如何定義我們是誰？

When I first read the ACE study, I felt pretty bleak. When you learn that the best treatment to prevent these experiences from ever taking root and altering your neurodevelopment and physiology is early intervention, it’s easy to feel hopeless, especially if you have some serious stuff in your black box. I know I did. I scrolled back mentally through my childhood and teenage years, thinking of all the experiences that had very likely made me more susceptible to all kinds of illnesses borne out of years and years of toxic stress. When I took the ACE quiz, I discovered that I had seven ACEs.

當我第一次讀到 ACE 研究時，我感到非常沮喪。當您瞭解到防止這些經歷生根發芽並改變您的神經發育和生理機能的最佳方法是早期干預時，很容易感到絕望，尤其是如果您的黑匣子里有一些嚴重的事情。我知道我做到了。我在腦海中回顧了我的童年和青少年時期，想著所有很可能使我更容易患上各種疾病的經歷，這些疾病是由多年的有毒壓力所產生的。當我參加 ACE 測驗時，我發現我有 7 個 ACE。

Seven.

七。

It’s hard to look at that and not feel doomed to disease. I realize now that my parents were both physically and emotionally abusive. Life was, every day, a war zone. My brother and I were hit. We were forced to endure deprivation in the name of religion. My mother required that I drink and eat spoiled milk and food and created all kinds of other extreme situations to demonstrate that she owned every aspect of my mind, body, and soul. I now believe that she was suffering from her own unaddressed history of loss and, perhaps because of that, had a particularly difficult relationship with me, her oldest child and son. She used to say that the problems between us started when I was two years old, that she went away for the weekend and when she returned, I wouldn’t come to her when she called me. She never got over it, and our relationship never recovered. As I grew older, she tried to convince me that there was something inherently bad about me, deep down. And it nearly worked. I didn’t realize until much later—after I broke away—that if anyone had known what was going on, my siblings and I would have been removed from the home.

很難看著這一點而不覺得註定要生病。我現在意識到我的父母在身體和情感上都受到了虐待。生活每天都是戰區。我和我哥哥被擊中了。我們被迫以宗教的名義忍受匱乏。我媽媽要求我喝和吃變質的牛奶和食物，並製造各種其他極端情況，以證明她擁有我思想、身體和靈魂的方方面面。我現在相信，她自己沒有被提及的失去歷史所困擾，也許正因為如此，她與我、她最大的孩子和兒子的關係特別困難。她曾經說，我們之間的問題從我兩歲的時候開始，她週末出去了，當她回來時，她打電話給我時我不會來找她。她從未克服它，我們的關係也從未恢復過。隨著我年齡的增長，她試圖說服我，在我的內心深處，我本來就有壞的地方。它幾乎奏效了。直到很久以後，在我離開之後，我才意識到，如果有人知道發生了什麼，我和我的兄弟姐妹就會被趕出家門。

Looking back, I see that I had it the worst out of all my siblings. But now, all my siblings suffer from a variety of chronic illnesses. Studying remarkable survivors, such as the ones reflected in this book, has been one of the most important factors changing my own trajectory; it has been a very personal quest to figure out what genuinely heals a soul. And for me, moving beyond childhood trauma and making sure my body wasn’t locked into a cycle of chronic fight or flight also meant getting out of my default mode network.

回想起來，我發現我在所有兄弟姐妹中經歷了最糟糕的事情。但現在，我所有的兄弟姐妹都患有各種慢性疾病。研究非凡的倖存者，例如本書中反映的倖存者，一直是改變我自己軌跡的最重要因素之一;弄清楚什麼才能真正治癒一個靈魂，是一項非常個人化的追求。對我來說，超越童年創傷並確保我的身體不會陷入慢性戰鬥或逃跑的迴圈中，也意味著擺脫我的預設模式網路。

New experiences are one way to do this; any time you get out of your daily routine and experience something new, your brain exits the DMN, and you get bumped out of your default mode of operating. It’s an enormous opportunity both for changing your thought patterns and changing your health. When you get out of the DMN, you have the chance to create and reinforce new neural pathways that can override existing ones.

新體驗是實現這一目標的一種方式;每當你走出日常生活並體驗新事物時，你的大腦就會退出 DMN，你就會脫離預設的運作模式。這是改變您的思維模式和改變您的健康的巨大機會。當您擺脫 DMN 時，您有機會創建和加強可以覆蓋現有神經通路的新神經通路。

The term default mode network, as mechanical as that sounds, is a much more accurate and precise way of describing what we used to call the ego. The ego has been poorly defined in popular culture, but essentially what it refers to is an individual’s identity or sense of self—how we integrate our unconscious and conscious selves, our higher and lower impulses, and decide what is true about our lives. But when we talk about the ego, it’s often in terms that suggest it’s fixed or permanent, when in fact identity is much more fluid than that. And the great thing about the term default mode network is that it accurately captures the way that identity is, in part, a function of neural synapses and pathways that can be edited or redrawn, the way a map can be edited or redrawn as a landscape changes over time.

默認模式網路這個詞，雖然聽起來很機械，但用來描述我們過去所說的自我是一種更準確和精確的方式。自我在流行文化中的定義很糟糕，但本質上它指的是個人的身份或自我意識——我們如何整合我們的無意識和有意識的自我，我們的高低衝動，並決定我們生活的真實情況。但是，當我們談論自我時，它往往是暗示它是固定的或永久的，而事實上，身份比這要流動得多。術語預設模式網路的偉大之處在於，它準確地捕捉了身份在一定程度上是可以編輯或重新繪製的神經突觸和通路的功能，就像隨著景觀隨時間變化而編輯或重新繪製地圖的方式一樣。

GETTING OUT OF YOUR DEFAULT MODE NETWORK

退出預設模式網路

We rely on thought patterns to live our lives. Imagine if, every time you slid into the driver’s seat of your car, you had to think and puzzle through every individual step involved in piloting it to the grocery store: the gas pedal, the steering wheel, signaling, all the micro-tasks that you do unconsciously. You need to be able to perform routine tasks without actively thinking them through. This code that was written into our DMN long ago when we learned how to walk, talk, ride a bike, drive a car, and so on is absolutely necessary if we want to survive and function. When it comes to driving across town, we want to fall back on the programming of our DMN. When it comes to automatically seeing ourselves as damaged, wrong, broken, disempowered, or unworthy, we definitely don’t.

我們依靠思維模式來生活。想像一下，每次你滑上汽車的駕駛座時，你都必須思考和解開駕駛它到雜貨店所涉及的每一個步驟：油門踏板、方向盤、信號，以及你無意識地完成的所有微任務。您需要能夠執行日常任務，而無需主動考慮它們。很久以前，當我們學習如何走路、說話、騎自行車、開車等等時，這段代碼就被寫進了我們的 DMN 中，如果我們想生存和運作，它是絕對必要的。當涉及到開車穿越城鎮時，我們希望依靠 DMN 的程式設計。當談到自動將自己視為受損、錯誤、破碎、無權或不值得時，我們絕對不會。

Depending on the DMN for day-to-day living and routine tasks makes sense. But letting these patterns and ruts define who we are, doesn’t. Radical change—and perhaps, radical healing—can only come when we’re able to see and understand ourselves in a completely new light. Perhaps this is why humans have been coming up with ritual, cultural ways of interrupting our default mode networks for millennia—everything from prayer to meditation, from dance to travel to art, can do it. And perhaps this is also why disrupting the DMN may very well play a large role in spontaneous healing.

依靠 DMN 進行日常生活和日常任務是有意義的。但讓這些模式和陳規定義我們是誰，並不能。只有當我們能夠以全新的眼光看待和理解自己時，才會發生徹底的改變——也許是徹底的治癒。也許這就是為什麼人類幾千年來一直在想出儀式性的、文化的方式來打斷我們的預設模式網路——從祈禱到冥想，從舞蹈到旅行再到藝術，一切都可以做到。也許這也是為什麼破壞 DMN 很可能在自發癒合中發揮重要作用的原因。

When she started the chemo for her melanoma, Mirae was more exhausted than she’d ever been in her life. She would lie in bed for twenty hours a day and still felt too weak to even take the dogs out for a short walk. She was constantly feverish, nauseous, and so thirsty that she could drink gallons of water and still want more. Her body ached, her joints burned. Sometimes she couldn’t tell if she was shaking from fever or having convulsions. She lost control of her bladder, making her wonder if she’d lost consciousness. And strange, vivid scenes played out in front of her. She started having the same dream over and over: a set of hands appeared in front of her, big and gentle. She knew them, although she didn’t know exactly how; they just radiated a sense of home. In one dream, the hands showed her a book, slowly turning the pages. It seemed like she was meant to read it, but she couldn’t quite make sense of the words, and where there were supposed to be pictures, it was just blank.

當她開始對黑色素瘤進行化療時，Mirae 比她一生中任何時候都更加疲憊。她每天躺在床上二十個小時，仍然覺得太虛弱了，甚至無法帶狗出去散步。她經常發燒、噁心、口渴，以至於她可以喝幾加侖的水，但仍然想要更多。她的身體疼痛，關節灼熱。有時她分不清自己是發燒發抖還是抽搐。她失去了對膀胱的控制，讓她懷疑自己是不是失去了知覺。奇怪而生動的場景在她面前上演。她開始一遍又一遍地做同樣的夢：一雙手出現在她面前，又大又溫柔。她了解他們，儘管她不知道具體是怎麼知道的;他們只是散發著一種家的感覺。在一個夢中，雙手向她展示了一本書，慢慢地翻頁。看起來她是要讀的，但她不太明白這些字，本該有圖片的地方，卻是空白的。

She chalked it up to the chemo—all those chemicals were probably messing with her sleep rhythms. But she couldn’t shake the feeling that there was something to be learned from the dreams she was having. They were always the same. They were so vivid and real, unlike any dreams she’d ever had before in her life. She dreamed of the big hands again, this time flipping through pages of sheet music she couldn’t read. But this time, a voice spoke. “Your life is like sheets of music,” it said. “The frequency of your life sings a beautiful song that your ears cannot yet hear.”

她將其歸咎於化療——所有這些化學物質可能都擾亂了她的睡眠節奏。但她無法擺脫一種感覺，即從她的夢中可以學到一些東西。他們總是一樣的。它們是如此生動和真實，與她一生中從未做過的任何夢都不同。她又夢見了那雙大手，這一次她翻閱了一頁頁她看不懂的樂譜。但這一次，一個聲音說話了。“你的生活就像樂譜，”它說。“你生命的頻率唱著一首你耳朵還聽不見的美麗歌曲。”

She woke up, grabbed a pad of paper, and wrote that down. After that, she wrote down everything she was thinking and feeling when she woke up. She wrote:

她醒來后，拿起一張紙，寫下來。之後，她寫下了她醒來時所想和感受到的一切。她寫道：

• I was not made with smooth edges or to fit in a box. 我不是用光滑的邊緣製成的，也不是為了裝進盒子里。
• This is all part of my plan. 這都是我計劃的一部分。
• The plan cannot be revealed right now; have faith. 該計劃現在不能透露;要有信心。
• The plan cannot be revealed in fear. 這個計劃不能在恐懼中被揭示出來。
• My plan has no pictures because I choose what it will look like and how it will show up. 我的計劃沒有圖片，因為我選擇它的外觀和顯示方式。

As she journaled her dreams and what they meant to her, she started to look at herself, she says now, “in the third person.” She was able to zoom out, seeing the big picture of her life and identity from above. She’d always felt “wrong,” “bad,” or “not good enough” in the context of her family. But for the first time, she could see herself clearly. In a sense, her whole life had been like a play; she’d been playing a part on a stage, a role that she and her family had decided on a long time ago. She’d been cast from the beginning as “the rebel.” Now she saw that she wasn’t any of the bad things she’d always felt; she was simply playing the role that had been given to her. In a sense, it was exactly what her family needed. She was imperfect, but perfect for the context of her family. She was, as she put it, “perfectly imperfect.”

當她記錄自己的夢境以及夢境對她的意義時，她開始審視自己，她現在說，“以第三人稱”。她能夠縮小，從上面看到她的生活和身份的大局面。在她的家庭環境中，她總是覺得“錯”、“壞”或“不夠好”。但這是她第一次能清楚地看到自己。從某種意義上說，她的一生就像一齣戲;她一直在舞臺上扮演一個角色，這個角色是她和她的家人很久以前就決定的。她從一開始就被塑造成叛逆者。現在她明白了，她並不是她一直覺得的那種壞事;她只是在扮演被賦予她的角色。從某種意義上說，這正是她家人所需要的。她不完美，但非常適合她的家庭環境。正如她所說，她是“完全不完美的”。

She began to understand that she’d been performing for everyone in her life instead of being her authentic self. As independent and ambitious as she’d always been, she’d also spent her whole life trying to please other people—her parents, her bosses, her son—but never herself.

她開始明白，她一直在為她生命中的每個人表演，而不是做真實的自己。儘管她一直都是獨立且雄心勃勃的，但她也一生都在努力取悅其他人——她的父母、她的老闆、她的兒子——但從來沒有取悅過她自己。

“Whatever those dreams or visions were, they were so healing for me,” she says. “Instead of feeling I had done wrong, I realized I was perfect. Perfectly flawed, perfectly suited to my own human experience.”

“無論那些夢或幻覺是什麼，它們對我來說都是如此治癒，”她說。“我沒有覺得自己做錯了，而是意識到自己很完美。完全有缺陷，完全適合我自己的人類經歷。

At the same time, she was also making the same big, hard changes that others who experienced spontaneous remissions tended to make in the face of a devastating diagnosis. She changed the way she ate and thought about nutrition. The chemo made it hard to get food in and keep it down, so she narrowed her diet to the most nutritionally dense foods and ate as much of those as possible. She also realized she needed to think about how she was eating. To slow down, appreciate the process, and visualize the nutrients flowing into her body. She also radically changed the structure of her life to bring down stress and allow herself to turn off chronic fight or flight by taking a leave of absence from work.

與此同時，她也在做出與其他經歷自發緩解的人在面對毀滅性診斷時往往會做出的同樣重大而艱難的改變。她改變了自己的飲食方式，並思考了營養。化療使她難以攝入和減少食物，因此她將飲食範圍縮小到營養最豐富的食物，並盡可能多地吃這些食物。她還意識到她需要考慮自己的飲食方式。要放慢腳步，欣賞這個過程，並想像流入她身體的營養物質。她還從根本上改變了自己的生活結構，以減輕壓力，並通過請假來讓自己擺脫長期的戰鬥或逃跑。

I want to pause to point out something important here. Mirae was lucky to have the support structure in place to take a long chunk of time off work—she had savings, and her workplace, so appreciative of her years of hard work and overtime, gave her a lot of latitude. She had just completed a huge business deal for them, and they told her to take as much time as she needed. Not everybody has this option available to them, and that’s important to be cognizant of; for many of us, having to get by and make ends meet means being locked into a routine that might make it harder to heal.

我想暫停一下，指出這裡的一些重要事情。Mirae 很幸運，她有充足的支持結構，可以抽出很長時間來休假——她有積蓄，而且她的工作場所非常感謝她多年的辛勤工作和加班，給了她很大的自由度。她剛剛為他們完成了一項巨大的商業交易，他們告訴她需要多少時間就花多少時間。並非每個人都有這個選項，重要的是要認識到這一點;對於我們中的許多人來說，必須勉強維持生計意味著被束縛在一種可能使人更難治癒的日常生活中。

But healing is less about what happens on the outside and much more about what happens on the inside. You don’t have to quit your job to improve your health or even experience radical healing. You don’t need to have a lot of disposable income. The wealthiest people can suffer from the worst illnesses, and those with much less can experience dramatic recoveries. There are cost barriers to some of the strategies that people have used, such as yoga, Rolfing, or eating organically, but you can’t buy a spontaneous healing. There are no silver bullets; there is no external thing that will end up being the one thing that turns your health around. When you zoom out on the big picture of spontaneous healing, you see that each person finds her own path to the clearing.

但治癒不是關於外在發生的事情，而是關於內部發生的事情。您不必辭職來改善您的健康情況，甚至不必經歷徹底的康復。你不需要有很多可支配收入。最富有的人可能會患上最嚴重的疾病，而那些身患疾病的人可能會經歷戲劇性的康復。人們使用的一些策略存在成本障礙，例如瑜伽、Rolfing 或有機飲食，但你不能買到自發的治癒。沒有靈丹妙藥;沒有外部因素最終會成為改變您健康的一件事。當你把鏡頭拉遠到自發療癒的大局時，你會看到每個人都找到了自己的通往空地的道路。

Mirae now believes that it wasn’t the costlier tactics she tried that made the difference. Taking the time off work certainly helped; it meant time to sleep, rest, and reflect. But at its core, what taking the time off really represented was setting boundaries. She started saying no to stuff that felt overwhelming and unnecessary, that stretched her too far. She stopped apologizing for missing meetings, for not being there every minute. She stopped feeling guilty about it.

Mirae 現在相信，並不是她嘗試的代價更高的策略造成了影響。請假當然有説明;這意味著有時間睡覺、休息和反思。但從本質上講，休假真正代表的是設定界限。她開始對那些讓人感到不知所措和不必要的事情說不，這些事情讓她走得太遠了。她不再為錯過會議而道歉，不再為沒有每一分鐘都在場而道歉。她不再為此感到內疚。

“The big thing was realizing that I didn’t owe anybody else anything,” she says. “I owed my body the time.”

“最重要的是意識到我不欠別人任何東西，”她說。“我欠我的身體時間。”

Mirae knew what the doctors were hoping for—a shrinkage of 30 percent, just enough to operate—was unlikely. She also knew that any increase in size could damage the vital structures of her neck. So she started tracking Mel’s size herself with a cloth tape measure, to check for any change in between scans. She was afraid Mel might start to grow. But then suddenly, Mel started to shrink. Fast. When she called her doctor to report that Mel was disappearing at a rate of a half inch per week, hitting the 30 percent mark and then blowing past it, he didn’t believe her until she went in so he could see for himself. He was at a complete loss.

Mirae 知道醫生們所希望的是什麼 — 收縮 30%，剛好夠手術 — 是不可能的。她還知道，任何尺寸的增加都會損害她脖子的重要結構。因此，她開始用捲尺自己跟蹤 Mel 的尺碼，以檢查掃描之間的任何變化。她擔心梅爾可能會開始長大。但突然間，梅爾開始萎縮。快。當她打電話給醫生報告說梅爾以每周半英寸的速度消失，達到 30% 大關，然後飛過它時，他不相信她，直到她進去，他才能親眼看到。他完全不知所措。

“There must be a lot of people praying for you,” he finally said, with no other way to explain what she was experiencing.

“肯定有很多人為你祈禱，”他終於說了，沒有其他方法可以解釋她正在經歷的事情。

BECOMING AN “N OF 1”

成為 “N OF 1”

The obvious question: Was Mirae simply a “high responder” to the chemotherapy drug?

顯而易見的問題是：Mirae 只是對化療藥物的「高反應者」嗎？

While responses to chemo certainly do vary from person to person, Mirae’s results leaped far over what was known to be possible with this drug, even at the outside limits. Her doctors could not attribute what was unfolding to her course of treatment. As Mirae’s tumor melted like ice on a hot stove, they were in uncharted territory.

雖然對化療的反應肯定因人而異，但Mirae的結果遠遠超過了這種藥物的已知可能性，即使在外部限制下也是如此。她的醫生無法將發生的事情歸因於她的治療過程。當Mirae的腫瘤像熱爐上的冰一樣融化時，他們處於未知領域。

As the weeks turned to months, Mel had shrunk to the point where it wasn’t visible from the outside anymore. Her medical team was astonished and wondering what on earth was going on in there. There was only one way to find out.

隨著幾周變成幾個月，梅爾已經縮小到從外面再也看不到的地步。她的醫療團隊感到驚訝，想知道那裡到底發生了什麼。只有一種方法可以找出答案。

The surgeon performed the neck dissection as planned, successfully removing thirty-three lymph nodes from the right side of Mirae’s neck. Since cancer often spreads through the lymphatic system, we often remove lymph nodes to assess the extent of spread. The surgeon attempted to remove what was left of the tumor but wasn’t able to—because it wasn’t there. The pathology report revealed no trace of disease—an impossible result. And the tissue removed from the site of the tumor showed only a faint swirl of black pigment, an inky echo of what had once been there. Mel, that beautifully complex, malignant tumor that had rapidly swelled into Mirae’s life-sustaining central arteries, had simply vanished.

外科醫生按計劃進行了頸部清掃術，成功地從Mirae的頸部右側切除了33個淋巴結。由於癌症通常通過淋巴系統擴散，因此我們通常會切除淋巴結以評估擴散程度。外科醫生試圖切除腫瘤的剩餘部分，但沒能成功——因為它不存在。病理報告顯示沒有疾病痕跡——這是一個不可能的結果。從腫瘤部位切除的組織只顯示出一個微弱的黑色色素漩渦，與曾經存在過的東西形成墨色的回聲。梅爾，那個美麗複雜的惡性腫瘤，迅速膨脹到未來維持生命的中央動脈，就這樣消失了。

Mirae will tell anyone who asks that her doctors at Washington University gave her incredible care. They were highly skilled, compassionate, and dedicated. She emphasizes how grateful she is for everything they did. But she was surprised that they weren’t more interested in finding out what she might have done during those intervening seven months, between diagnosis of incurable metastatic cancer and diagnosis of complete remission, that could have played a part in her unexpected recovery. They did marvel at her recovery. They wrote a study on her and published it. At conferences, they give presentations on her remarkable case. When they see her now, they give her a high five and call her by her nickname: “the Miracle.” But they seem content to leave her recovery unpacked. Mirae is simply what they call “an N of 1,” which in statistics-speak, means in a class of her own, a data point with no equal.

Mirae 會告訴任何詢問的人，她在華盛頓大學的醫生給了她難以置信的照顧。他們技術嫻熟、富有同情心且敬業。她強調她對他們所做的一切感到非常感激。但她感到驚訝的是，他們並不更有興趣瞭解她在這七個月內，從診斷出無法治癒的轉移性癌症到被診斷為完全緩解之間可能做了什麼，這可能對她的意外康復起到了作用。他們確實對她的康復感到驚訝。他們寫了一份關於她的研究並發表了。在會議上，他們介紹她非凡的案例。當他們現在看到她時，他們與她擊掌，並稱她為“奇跡”。但他們似乎滿足於讓她的康復情況解開。Mirae 就是他們所說的“N of 1”，用統計學的話來說，這意味著在她自己的一個類別中，一個無與倫比的數據點。

We can’t be sure exactly what happened inside Mirae’s body while she experienced her remarkable recovery. We haven’t yet figured out how to predict when a spontaneous healing might occur so that we can observe what happens as it is unfolding. All we can do now is put the puzzle pieces together as best we can. And while there are still pieces missing, the picture is beginning to come together.

我們無法確定Mirae在經歷顯著康復時體內到底發生了什麼。我們還沒有弄清楚如何預測何時會發生自發癒合，以便我們可以觀察它正在發生的情況。我們現在能做的就是盡可能地把拼圖拼湊起來。雖然仍然缺少一些碎片，但情況已經開始拼湊起來。

We know that traumatic experiences like ACEs, and very probably other types of stressful or negative experiences, can become part of our default mode network, a brain map that becomes a landscape of limitations. Finding ways to get out of your default mode network can lead to shifts not only in the way you think but also in the way your body functions on a chemical or even molecular level. So while we can’t literally rewrite the past, what we can do is change how we experience it and change what becomes part of our default mode going forward.

我們知道，像 ACE 這樣的創傷經歷，很可能是其他類型的壓力或消極經歷，可以成為我們預設模式網路的一部分，一張大腦地圖，成為一片限制景觀。尋找擺脫預設模式網路的方法不僅會導致您的思維方式發生變化，而且會導致您的身體在化學甚至分子水準上的運作方式發生變化。因此，雖然我們不能從字面上改寫過去，但我們能做的是改變我們體驗它的方式，並改變我們未來預設模式的一部分。

How? That starts with perception.

如何？這從感知開始。

Mirae said to me once, “It’s the perception that creates the thought that creates the feeling.” How we perceive and interpret the world—ourselves, others, events, and so on—determines how we experience and remember the world, how we feel as we navigate it, and ultimately how we respond biologically. The effects trickle down all the way to our cells. We talked about shifting the way we think about stress, changing threat stress to challenge stress, and how it can actually alter the biology of your body. What I’m talking about here is taking that concept to the next level. When you change your lens not just on the stressors in your life but on your life itself—on who you are fundamentally—you have the potential to change your health on a much larger scale.

Mirae 曾經對我說：“是感知創造了思想，創造了感覺。我們如何感知和解釋世界——我們自己、他人、事件等等——決定了我們如何體驗和記住世界，我們在探索世界時的感受，以及最終我們如何做出生物學反應。這種影響會一直滲透到我們的細胞。我們討論了改變我們對壓力的看法，將威脅壓力轉變為挑戰壓力，以及它如何真正改變您身體的生物學特性。我在這裡談論的是將這個概念提升到一個新的水準。當你改變你的視角時，不僅要關注生活中的壓力源，還要關注你的生活本身——從根本上改變你是誰——你就有可能在更大範圍內改變你的健康。

So how can you get out of your old default modes and change your perceptions? It can start, simply, with experiences. Seeing yourself and the world around you in a new light often begins with the basic first step of doing new things. Breaking your usual routine in some way means being able to see yourself in a new context. It’s a natural way to challenge your assumptions about yourself—about who you are and what you’re capable of. Some people use meditation or yoga to get out of their DMN. Some use travel. For me, education and pursuing lots of new experiences and ways of thinking have been critical and continue to be. There are probably a thousand ways to do it. However, the key is not just having the experience but making something of it. You have to actively integrate a new truth into your life in tangible ways. Mirae’s dreams and new beliefs would have remained only fading memories if she hadn’t changed her daily life to match her new beliefs. People who experienced spontaneous healings disrupted the default mode, got out of that rut, saw and experienced themselves in an entirely new way—and then did the work to integrate that knowledge into their lives.

那麼，您如何才能擺脫舊的預設模式並改變您的觀念呢？它可以簡單地從經驗開始。以新的眼光看待自己和周圍的世界，往往從做新事物的基本第一步開始。以某種方式打破你平常的常規意味著能夠在新的環境中看待自己。這是挑戰你對自己的假設的一種自然方式——關於你是誰以及你能做什麼。有些人使用冥想或瑜伽來擺脫他們的 DMN。有些人使用旅行。對我來說，教育和追求許多新的體驗和思維方式一直很關鍵，並將繼續如此。可能有一千種方法可以做到這一點。然而，關鍵不僅僅是擁有經驗，而是要有所作為。你必須以有形的方式積極地將新的真理融入你的生活。如果Mirae沒有改變她的日常生活以適應她的新信仰，她的夢想和新信仰將只停留在褪色的記憶中。經歷過自發療癒的人打破了預設模式，擺脫了這種陳規，以全新的方式看待和體驗自己——然後努力將這些知識融入他們的生活。

For Mirae, the process was catalyzed by her dreams, which are uncontrollable; you can’t make yourself have revelatory dreams. Some of these experiences can’t be forced or engineered, but you can ask yourself questions that prompt self-reassessment, such as: What is my story? What is the story I’ve told myself about who I am? What story do others tell me about who I am? What do these stories get right, and what do they get wrong?

對於Mirae來說，這個過程是由她無法控制的夢想催化的;你不能讓自己有啟示性的夢想。其中一些經歷不能強迫或設計，但您可以問自己一些問題，促使自己重新評估，例如：我的故事是什麼？我告訴自己的關於我是誰的故事是什麼？別人會告訴我關於我是誰的什麼故事？這些故事哪些是正確的，哪些是錯誤的？

You can also be open to such experiences, to recognize opportunities when they come along and make the most of them. Mirae didn’t turn her back on what her subconscious was trying to communicate. Are there ways that your subconscious, your body, or your immune system is trying to get your attention? Mirae paid attention. She learned to listen and then took the messages seriously. She wrote them down, working out her thoughts and feelings through journaling. She was open, at a basic level, to reassessing her fundamental understanding of who she was and what her purpose was in this life.

您也可以對此類經歷持開放態度，在機會出現時識別並充分利用它們。Mirae 並沒有背棄她的潛意識試圖傳達的東西。您的潛意識、身體或免疫系統是否有辦法試圖引起您的注意？Mirae 注意了。她學會了傾聽，然後認真對待這些資訊。她把它們寫下來，通過日記來表達她的想法和感受。她對重新評估自己對自己是誰以及她今生的目標的基本理解持開放態度。

And then, importantly, she incorporated those lessons into how she lived on the day-to-day level. She began to prioritize taking care of herself, connecting with her partner, making time for the goals and dreams she’d lost sight of long ago, when she’d hooked her sense of self to being “successful” at work. Like Juniper, Jan, and so many others, healing her identity and arriving at a new understanding of herself allowed Mirae to rewrite the rules she’d been living by. She calls that time period “absolutely life-changing.”

然後，重要的是，她將這些經驗教訓融入了她的日常生活中。她開始優先考慮照顧自己，與她的伴侶建立聯繫，為她很久以前忘記的目標和夢想騰出時間，當時她將自我意識與工作中的“成功”挂鉤。像 Juniper、Jan 和許多其他人一樣，治癒自己的身份並對自己有了新的理解，這讓 Mirae 能夠改寫她一直遵循的規則。她稱那段時間「絕對改變了生活」。

Perhaps those who experience remarkable recoveries are the individuals who’ve figured out how to go back to those ideas about who they are—ideas that were forged so long ago, seemingly in steel—and melt them back down. They are still made of the same essential materials, but they’ve gone back to the core of who they really are, underneath all the stories they’ve been told, the trauma they’ve internalized, the stressors or burdens they’ve carried. They find a way to get beyond their default mode networks and are able to see themselves and experience themselves and the world in an entirely new way.

也許那些經歷過顯著恢復的人是那些已經弄清楚如何回到那些關於他們是誰的想法的人——那些很久以前形成的想法，似乎是鋼鐵般的——並將它們融化回來。他們仍然由相同的基本材料製成，但他們已經回到了他們真正是誰的核心，在他們被講述的所有故事、他們內化的創傷、他們所承受的壓力源或負擔之下。他們找到了一種方法來超越預設模式網路，能夠以全新的方式看待自己並體驗自己和世界。

How will this new version of you see the world? What priorities will you have, what changes will you make in your life to reduce stress and increase joy? How will the body of this new you work chemically when it comes to stress hormones and their impact on your cells? How much more successfully will this new you be able to live deeply, immersively, in the parasympathetic?

這個新版本的你，會如何看待這個世界？你會有什麼優先事項，你會在生活中做出哪些改變來減輕壓力和增加快樂？當涉及到壓力荷爾蒙及其對細胞的影響時，這個新你的身體將如何化學作用？這個新的你能夠深深地、沉浸在副交感神經中，會有多成功？

When we dig deep into these cases of remission that doctors haven’t been able to explain or understand, we see that there is a powerful link between our very identities and our immune systems. Perhaps what ultimately determines the health of the “soil” of your body is how well you know who you really are at the most authentic level—beneath appearances, “shoulds,” perceived expectations, and all the masks and roles that you assume for yourself and the world. Because the ripple effects that stem from this one deep, central aspect of identity flow through everything. It determines the way you think, the way you feel, the way you see yourself. Whether you make time for yourself or not. Whether you move your body and go outdoors and breathe deeply or not. Whether you prioritize putting excellent food in your body or not. How and when and how often the stress response clicks on in your body, and the precise levels of hormones that tumble out, and the way that your specific cells respond to that wash of hormones.

當我們深入研究這些醫生無法解釋或理解的緩解病例時，我們會看到我們的身份和免疫系統之間存在著強大的聯繫。也許最終決定你身體「土壤」健康的是你在最真實的層面上有多瞭解自己的真實身份——在外表、「應該」、感知的期望以及你為自己和世界承擔的所有面具和角色之下。因為源於身份認同的這一深刻、核心方面的連鎖反應貫穿於一切。它決定了你的思維方式、你的感受方式、你看待自己的方式。無論您是否為自己騰出時間。無論您是否移動身體並出門並深呼吸。無論您是否優先考慮將優質食物放入體內。壓力反應在您體內發生的方式、時間和頻率，以及翻滾的荷爾蒙的精確水準，以及您的特定細胞對荷爾蒙洗滌的反應方式。

Mirae’s doctors admiringly called her an “N of 1,” essentially meaning that she’s in a unique category shared by no one else—one of a kind. Technically, in medical literature, what the term refers to is a clinical trial where one person is the only subject. Any interventions or strategies tested in such a study are tested on one patient only and are highly individualized, specifically tailored to that person. In some ways, it’s as individual and intensively personal as medicine can get. Perhaps what we each need to do, like Mirae, is to make ourselves an N of 1—to run our own clinical trial where we find the individual changes necessary for us and then lean deeply into those changes. And as we move forward, we’ll talk about strategies for doing just that—how to conduct your own personal, urgent experiment in health, the way the survivors profiled in this book have done.

Mirae 的醫生欽佩地稱她為“N of 1”，基本上意味著她屬於其他人所不具備的獨特類別——獨一無二。從技術上講，在醫學文獻中，該術語指的是一個人是唯一受試者的臨床試驗。此類研究中測試的任何干預措施或策略僅在一名患者身上進行了測試，並且是高度個性化的，專門針對該患者量身定製。在某些方面，它與醫學所能達到的一樣個人化和高度個人化。也許我們每個人都需要做的，就像Mirae一樣，讓自己成為N of 1——運行我們自己的臨床試驗，在那裡我們找到我們必要的個體變化，然後深入研究這些變化。隨著我們向前發展，我們將討論實現這一目標的策略——如何進行你自己的個人緊急健康實驗，就像本書中介紹的倖存者所做的那樣。

We can take the steps we learned about in part 1 of the book to help our bodies regain their natural healing abilities—to bolster and focus our immune systems, to eliminate inflammatory foods and increase nutrient-dense ones, to change the way we deal with stress, and to learn techniques for quieting the chatter in our minds and accessing the parasympathetic. We can do all that, and it will be incredibly beneficial and may even lead to the kinds of remissions that Tom, Juniper, and Jan experienced when they made big, hard changes in their lives. But based on many years researching spontaneous remission, my biggest takeaway is that most of us need to go deeper. We need to dive down to who we are at the bottom of it all. Because ultimately, healing your identity may determine whether or not you’re able to use all those tools and tactics we’ve gone through to live in the parasympathetic and support your health and recovery.

我們可以採取我們在本書第 1 部分中學到的步驟來幫助我們的身體恢復其自然癒合能力——增強和集中我們的免疫系統，消除炎症食物並增加營養豐富的食物，改變我們處理壓力的方式，並學習平息我們腦海中喋喋不休和進入副交感神經的技巧。我們可以做到這一切，這將是非常有益的，甚至可能導致 Tom、Juniper 和 Jan 在生活中做出重大而艱難的改變時所經歷的那種緩解。但根據多年對自發緩解的研究，我最大的收穫是，我們大多數人都需要更深入地瞭解。我們需要深入研究這一切的底層我們是誰。因為最終，治癒您的身份可能會決定您是否能夠使用我們經歷過的所有工具和策略來生活在副交感神經中並支援您的健康和康復。

Today, Mirae is cancer-free. Since her outcome was so out of whack with her prognosis, she still goes in for regular screenings, although as time goes by, they get farther and farther apart. At first, they were every month, then every six, then she finally convinced them to push it to once a year. Finally, after years of clear scans, her oncologist shook his head in wonder.

今天，Mirae 沒有癌症。由於她的結果與她的預後如此不符，她仍然定期進行篩查，儘管隨著時間的推移，他們之間的距離越來越遠。起初，他們每個月一次，然後是每六次，然後她終於說服他們把它推到一年一次。最後，經過多年的清晰掃描，她的腫瘤科醫生驚奇地搖了搖頭。

“Well,” he said. “Looks like I might actually get to use the word cured about this disease in my lifetime.”

“嗯，”他說。“看起來我可能在有生之年真的可以用治癒這個詞來形容這種疾病。”