TAKING CONTROL OF YOUR HEALTH

掌控您的健康

One of the problems that has plagued the research into spontaneous healing is a failure to quantify the degree to which people truly participate in various treatment methods. Millions of studies look at whether someone participated in a particular treatment program, but not how or to what extent. People apply themselves to tasks in radically different ways—some as if their life depends on it, and some because they’ll get fifty dollars at the end.

困擾自發癒合研究的問題之一是未能量化人們真正參與各種治療方法的程度。數以百萬計的研究著眼於某人是否參與了特定的治療計劃，而不是如何或參與到什麼程度。人們以截然不同的方式投入到任務中——有些人好像他們的生活依賴於它，而另一些人則因為他們最終會得到 50 美元。

The scientific method allows us a standardized approach to experimentation that makes sure there are consistencies across studies so that we can draw important comparisons. It creates an essential template for science and research that we use to measure the efficacy of medications, treatment methods, lifestyle changes, and so on. But not everything is measurable in this way.

科學方法為我們提供了一種標準化的實驗方法，確保研究之間存在一致性，以便我們可以進行重要的比較。它為科學和研究創造了一個重要的範本，我們用它來衡量藥物的療效、治療方法、生活方式的改變等。但並非所有事情都可以以這種方式衡量。

The traditional scientific method as it is typically practiced is only designed to study things that we can see and touch. When we do a study that measures the impact of a medication, we know exactly how many grams are in the pill that a participant swallows. But when we do a study that measures the impact of something like meditation, we approach it similarly. We track how many times a week participants meditate and for how long. We can record that Jane Doe meditated three times a week for twenty minutes each time; we can compare her data to a control group that didn’t meditate at all. However, there’s so much we don’t know about Jane. How intensive were her sessions? To what degree was she personally invested in it? How effective were her meditation techniques at calming fight or flight and initiating the relaxation response? How deep did she go? What did her meditation practice mean to her? Was she simply waiting for the time to be over, or did she engage with the process with intensity and an open heart?

通常採用的傳統科學方法僅用於研究我們可以看到和觸摸的事物。當我們進行一項衡量藥物影響的研究時，我們確切地知道參與者吞下的藥丸中有多少克。但是，當我們進行一項衡量冥想之類事物影響的研究時，我們會以類似的方式處理它。我們跟蹤參與者每周冥想的次數和時間。我們可以記錄 Jane Doe 每周冥想 3 次，每次 20 分鐘;我們可以將她的數據與根本沒有冥想的對照組進行比較。然而，我們對 Jane 的瞭解太多了。她的訓練強度如何？她個人對它的投入程度如何？她的冥想技巧在平息戰鬥或逃跑以及啟動放鬆反應方面效果如何？她走得有多深？她的冥想練習對她意味著什麼？她只是在等待時間結束，還是以熱情和開放的心態參與這個過程？

There are so many nuances, so many internal factors that are invisible to our carefully controlled, quantitative studies. We are leaving too much unexamined because it doesn’t fit inside the narrowly defined sphere of the scientific method as we have currently formulated it. Our study design can tell us that Juniper Stein practiced yoga for two hours every day, but it wouldn’t reveal how much more intensively she engaged than the woman doing the lotus pose right next to her. It can tell us that Patricia Kaine prayed for a certain number of hours, but not what those prayers meant to her.

有太多的細微差別，太多的內部因素，是我們精心控制的定量研究所看不到的。我們沒有研究太多內容，因為它不適合我們目前制定的科學方法的狹義定義範圍。我們的研究設計可以告訴我們，Juniper Stein 每天練習瑜伽兩個小時，但這並不能揭示她比旁邊做蓮花姿勢的女人更投入。它可以告訴我們派翠夏·凱恩（Patricia Kaine）祈禱了一定的時間，但不知道這些祈禱對她意味著什麼。

Looking at spontaneous healing, it becomes apparent that degree of involvement in a treatment tactic may be of the ultimate importance, and yet most studies ignore this or simply aren’t able to account for it. We see all the time that people receiving an intervention—anything from chemo to diet to meditation—vary enormously in terms of their response. It occurred to me that the relevant independent variable might not be the presence or absence of a particular intervention but the use that these individuals make of it. Before I went off to college as a young man, I remember people saying to me, “College is what you make of it.” What they meant was, I couldn’t simply sit in a classroom and expect to get the depth and breadth of learning and knowledge that might really change my life. I had to do that part myself.

看看自發癒合，很明顯，參與治療策略的程度可能是最終重要的，但大多數研究都忽略了這一點，或者根本無法解釋它。我們一直看到，接受干預的人——從化療到飲食再到冥想——在他們的反應方面差異很大。我突然想到，相關的自變數可能不是特定干預的存在與否，而是這些人對它的利用。在我年輕時上大學之前，我記得人們對我說，「大學就是你對它的評價」。他們的意思是，我不能簡單地坐在教室里，期望獲得可能真正改變我生活的學習和知識的深度和廣度。那部分我必須自己做。

So the question becomes, how deeply do people immerse themselves in these various pathways to healing? And how much of a difference does that really make?

所以問題就變成了，人們在這些不同的治癒途徑中沉浸在多深的程度？這到底有多大的不同呢？

Medicine is in the early stages of accepting—albeit grudgingly—the role of the mind in healing the body. Some doctors are finally beginning to recommend stress-reduction techniques, as they’ve come to realize how large a role fight or flight actually plays in creating a disease pathway. But something holds us back. Most of us, both doctors and patients, are still trained to look for silver bullets; we look for an easier treatment than changing our lives. But what spontaneous healing has taught us is that waking up to a deeper awareness of our value and strength is capable of changing our physiology. If we assume that the mind is powerful and capable of altering disease progression, it follows that a significant mental change may be capable of precipitating a significant physiological change—in some cases even a remission.

醫學正處於接受——儘管很不情願——心靈在治癒身體中的作用的早期階段。一些醫生終於開始推薦減壓技術，因為他們已經意識到戰鬥或逃跑在創造疾病途徑中實際上起著多麼大的作用。但有些事情阻礙了我們。我們大多數人，包括醫生和患者，仍然接受過尋找靈丹妙藥的培訓;我們尋找的治療方法比改變我們的生活更容易。但自發的療癒教會我們的是，醒來后對我們的價值和力量有更深的認識，能夠改變我們的生理機能。如果我們假設心智是強大的並且能夠改變疾病進展，那麼一個重大的心理變化可能能夠促使一個顯著的生理變化——在某些情況下甚至是緩解。

In the late 1980s, a study² done at Stanford University by David Spiegel showed that women with breast cancer survived eighteen months longer, on average, if they attended group therapy twice a week. The study got a lot of press and attention and is still repeatedly cited and viewed as a landmark study today. But when others tried to replicate the study, they couldn’t.

在 1980 年代後期，大衛·斯皮格爾 （David Spiegel） 在斯坦福大學進行的一項研究² 表明，如果女性乳腺癌患者每周參加兩次團體治療，平均可以多存活 18 個月。這項研究得到了很多媒體和關注，今天仍然被反覆引用並被視為一項具有里程碑意義的研究。但是當其他人試圖複製這項研究時，他們無法複製。

And then Alastair Cunningham gave it a try. Cunningham, a professor and psychologist whose main passion was the intersection between behavioral medicine and health psychology, designed a study to investigate that very same link between therapy and survival. In the 1990s, he was running a cancer clinic at the University of Toronto. At the age of forty-seven, he himself had been diagnosed with stage III colon cancer and given a 30 percent chance of survival. Dr. Cunningham is unusual for a few reasons, and it’s these unique characteristics that made me sit up and take notice. Unlike the tradition where psychologists, trained as they are in the study of the mind, have little to do with medicine, and vice versa, he was a psychologist working in a medical clinic for cancer patients and also a professional at treating cancer who himself had been diagnosed with cancer. This wasn’t just an abstraction or a professional interest for him; it was personal.

然後 Alastair Cunningham 試了試。坎寧安 （Cunningham） 是一位教授和心理學家，他的主要熱情是行為醫學和健康心理學之間的交叉點，他設計了一項研究來調查治療與生存之間的相同聯繫。1990 年代，他在多倫多大學經營一家癌症診所。47 歲時，他自己被診斷出患有 III 期結腸癌，存活率為 30%。Cunningham 博士不尋常有幾個原因，正是這些獨特的特徵讓我坐起來注意到了。與傳統上，受過心靈研究訓練的心理學家與醫學無關不同，反之亦然，他是一名心理學家，在癌症患者的醫療診所工作，也是一名治療癌症的專業人士，他自己也被診斷出患有癌症。這對他來說不僅僅是一個抽象或專業興趣;這是個人的。

Cunningham ran a study³ in 1998 that contradicted the Spiegel study, failing to find the same link between therapy and recovery or longevity. Group therapy, Cunningham concluded, did not have a significant impact on disease course or survival rate.

坎寧安在 1998 年進行了一項研究³，該研究與 Spiegel 的研究相矛盾，未能在治療與康復或長壽之間找到相同的聯繫。Cunningham 得出結論，團體治療對病程或生存率沒有顯著影響。

But Cunningham noticed something interesting. A very small slice of the study group actually did show significant improvement after therapy. Seven women in the intervention group lived significantly longer than the others; and two of the seven were still alive eight years after the start of the study and appeared to be in remission. It was too small a sample to be statistically significant; Cunningham’s overall conclusion still had to be “no significant effect found.” But after reviewing those patients’ accounts of their experiences of participating in the study, Cunningham began to suspect that a person’s level of involvement in therapy had something major to do with the outcome.

但 Cunningham 注意到了一些有趣的事情。研究組中的一小部分人實際上在治療后確實顯示出顯著改善。干預組的 7 名女性的壽命明顯長於其他女性;7 人中有 2 人在研究開始 8 年後仍然活著，並且似乎處於緩解期。樣本太小，不具有統計學意義;Cunningham 的總體結論仍然必須是「未發現顯著影響」。但在審查了這些患者對他們參與研究的經歷的描述后，坎寧安開始懷疑一個人對治療的參與程度與結果有重大關係。

Here’s what he discovered about those seven survivors: they actively sought out other approaches to healing in addition to the therapy that everyone else participated in. Those who lived longer were doing a number of things on their own, not dictated by the study. They were personally invested, and it showed. They reported intensive meditation, dedicated yoga practice, journaling, intentional gratitude, and more. Basically, they exhibited not only a pattern of taking responsibility for their own treatment but also a willingness to radically change habits, routines, and even the larger scaffolding of their lives. Admitting that other interpretations were possible, Cunningham theorized that a “get up and go” attitude might be related to survival or remission.

以下是他對這七名倖存者的發現：除了其他人都參與的治療之外，他們還積極尋找其他治療方法。那些活得更久的人自己做了很多事情，而不是由研究決定的。他們是個人投資的，這表明瞭這一點。他們報告了密集的冥想、專注的瑜伽練習、寫日記、有意識的感恩等等。基本上，他們不僅表現出對自己的治療負責的模式，而且還願意從根本上改變習慣、常規，甚至他們生活中更大的腳手架。坎寧安承認其他解釋是可能的，他理論上「起床走」的態度可能與生存或緩解有關。

He didn’t expect to find this in the study and certainly wasn’t looking for it. But Cunningham couldn’t ignore what he’d seen—that the people who lived longer or achieved remission were the ones who took it a step further, who dedicated themselves to their own care.

他沒想到會在研究中找到這個，當然也不是在尋找它。但 Cunningham 不能忽視他所看到的——那些活得更久或獲得緩解的人是那些更進一步、全身心投入到自己護理中的人。

Cunningham then designed a more focused prospective longitudinal study⁴ to investigate the link between what he called “psychological work” and longevity in patients with metastatic cancer. Psychological work is a term that casts a fairly wide net, and into that net we can place a lot of the pathways used by the survivors in this book. Cunningham certainly would have included therapy and other forms of self-help; I think immediately of the deep work on the self done by Mirae, Patricia, and others—the profound reassessing of identity, goals, and desires. This time, Cunningham zeroed in on highly motivated patients who had shown a prior interest in self-help techniques. He found a significant relationship between “involvement in self-help” and survival duration. His next study attempted to zoom in even closer. What did “involvement in self-help” mean to participants?

然後，Cunningham 設計了一項更有針對性的前瞻性縱向研究⁴，以調查他所謂的“心理工作”與轉移性癌症患者壽命之間的聯繫。心理學工作是一個撒了相當大網的術語，我們可以將倖存者在本書中使用的許多途徑放入該網中。坎寧安肯定會包括治療和其他形式的自助;我立即想到了Mirae、Patricia和其他人對自我所做的深入工作——對身份、目標和慾望的深刻重新評估。這一次，Cunningham 將注意力集中在積極性高的患者身上，這些患者之前對自助技術表現出興趣。他發現 「參與自助」 與存留時間之間存在顯著關係。他的下一個研究試圖放大得更近。“參與自助”對參與者意味著什麼？

Cunningham’s 2002 study, Fighting for life: a qualitative analysis of the process of psychotherapy-assisted self-help in patients with metastatic cancer,⁵ was an unusually intensive effort to go deep and figure out what was really going on, both quantitatively and qualitatively, in patients’ lives when they participated in these types of studies. Though small, it was very carefully done, with over one hundred hours devoted to the study of each participant. Few studies have ever invested anything close to this degree of effort. Cunningham found that nine patients, whom he classified as “highly involved,” were the ones who devoted regular daily time—often several hours—to meditation, mental imaging, cognitive monitoring, journaling, or relaxation activities. Of those nine, eight enjoyed a high quality of life and lived at least two years beyond their original prognoses. And out of those eight, two had complete, unexpected remissions, which remained years after the time of publication.

Cunningham 在 2002 年的研究《為生命而戰：對轉移性癌症患者心理治療輔助自助過程的定性分析》⁵ 是一項異常密集的研究，旨在深入並弄清楚患者在參與這些類型的研究時生活中的真實情況，包括定量和定性。雖然規模很小，但做得非常仔細，每個參與者都投入了 100 多個小時來研究。很少有研究投入過接近這種程度的努力。Cunningham 發現，9 名患者被他歸類為“高度參與”，他們每天定期（通常是幾個小時）進行冥想、心理成像、認知監測、寫日記或放鬆活動。在這 9 人中，有 8 人享受著高品質的生活，並且至少比他們最初的預測活了兩年。在這8個專案中，有2個完全、意外地緩解，這些緩解在發佈後仍持續數年。

At the other end of the spectrum, Cunningham singled out eight subjects who were significantly less involved than the average participant. By their own reporting, they were either unconvinced that self-help would really do anything to change their disease trajectory or were hampered by issues such as diminished self-esteem. In other words, feeling unworthy of the efforts. In this group, none had a good quality of life. Only one lived more than two years after diagnosis and was therefore on the low end of the curve, though her medical prognosis was no more unfavorable at the onset of therapy than for the “high involvement” group.

另一方面，Cunningham 挑選了 8 名受試者，他們的參與度明顯低於普通參與者。根據他們自己的報告，他們要麼不相信自助真的會改變他們的疾病軌跡，要麼受到自尊心下降等問題的阻礙。換句話說，感覺不值得付出努力。在這一組中，沒有人有良好的生活品質。只有一人在診斷後存活了兩年多，因此處於曲線的低端，儘管她在治療開始時的醫療預後並不比「高參與度」組更不利。

Overall, Cunningham found that people who were highly involved with what he took to calling “self-help therapies” lived nearly three times longer than those with low involvement. And it’s interesting to note that the self-help therapies that Cunningham identified track very closely with the kinds of spiritual, psychological, and life-changing work done by those who experienced spontaneous remissions.

總體而言，坎寧安發現，高度參與他所說的「自助療法」的人比參與度低的人長近三倍。有趣的是，Cunningham 確定的自助療法與那些經歷自發緩解的人所做的精神、心理和改變生活的工作非常密切。

Cunningham distilled his research into a basic framework that distinguished conditions or characteristics associated with poor survival outcomes versus longer survival, and here’s what he came up with:

Cunningham 將他的研究提煉成一個基本框架，該框架區分與不良生存結果和較長生存率相關的條件或特徵，以下是他得出的結論：

Conditions associated with poor survival outcomes:

與不良生存結果相關的情況：

• Inflexibility associated with low self-esteem or fixed worldview
  與低自尊或固定世界觀相關的不靈活
• Skepticism about self-help techniques, or a limited ability to apply them
  對自助技巧持懷疑態度，或應用這些技巧的能力有限
• Other activities seemed more immediately appealing
  其他活動似乎更吸引人
• Meaning was habitually sought outside the individual, from some external source
  意義習慣性地在個人之外，從某種外部來源尋求
• Strong, contrary views about the validity of spiritual ideas
  關於精神觀念有效性的強烈、相反的觀點

Conditions associated with longer survival:

與較長存留期相關的條件：

• Strong will to live
  強烈的生存意志
• Actual changes in habits of thought and activity
  思維和活動習慣的實際變化
• Relaxation practices, meditation, mental imaging, cognitive monitoring
  放鬆練習、冥想、心理成像、認知監測
• Becoming involved in a search for meaning in one’s life
  參與尋找人生的意義

Were survivors psychologically different from their peers who did not survive? What made the difference?

倖存者的心理是否與未能倖存的同齡人不同？是什麼造成了差異？

In a study⁶ that attempted to clarify this question, Cunningham found that survivors tended to display a much higher degree of early involvement in their psychological self-help than others. Another series of studies into the effects of yoga on cancer recovery found that the small number of people who actually experienced recoveries had a very different, and much deeper and more significant, relationship to the practice than those who did not. The results of these studies, plus the others leading up to it, convinced Cunningham that engaging in this sort of “identity healing” work was potentially a major factor in recovery. But because such a small slice of subjects truly engaged in it, it was difficult—if not impossible—to get this across in the published studies. Studies, by design, look at averages, and the average results washed out the exceptional, making the effect of the interventions tested by Cunningham seem “minimal.”

在一項試圖澄清這個問題的研究⁶中，Cunningham 發現倖存者往往比其他人表現出更高的早期心理自助參與度。另一系列關於瑜伽對癌症康復影響的研究發現，與沒有經歷過康復的人相比，少數真正經歷過康復的人與瑜伽練習的關係非常不同，而且關係更深刻、更重要。這些研究的結果，加上導致它的其他研究，使 Cunningham 相信，從事這種 “身份修復 ”工作可能是康復的一個主要因素。但是，由於只有一小部分受試者真正參與其中，因此很難——如果不是不可能的話——在已發表的研究中闡明這一點。根據設計，研究著眼於平均值，平均結果抵消了異常結果，這使得 Cunningham 測試的干預措施的效果似乎“微乎其微”。

As hard as Cunningham tried, he still couldn’t overcome the core problem with traditional approaches to scientific studies—that their very design preemptively negates the exact question he was trying to answer. How you relate to the activity makes a huge difference and, as Cunningham found, designing a study that truly incorporates the degree of involvement of participants is almost impossibly difficult. It would rely entirely on self-reporting and transparency and would be subject to the vagaries of language and perception.

儘管 Cunningham 努力嘗試，但他仍然無法克服傳統科學研究方法的核心問題——它們的設計本身就先發制人地否定了他試圖回答的確切問題。你與活動的關係會產生巨大的差異，正如 Cunningham 發現的那樣，設計一項真正納入參與者參與程度的研究幾乎是不可能的困難。它將完全依賴於自我報告和透明度，並將受到語言和觀念變幻莫測的影響。

Alastair Cunningham was a uniquely suited person to tackle this problem. He’s now retired but still runs groups for those seeking to take treatment into their own hands. Crucially, he’s been on both sides of the desk—as a psychologist and as a patient.

阿拉斯泰爾·坎寧安 （Alastair Cunningham） 是解決這個問題的獨特人選。他現在已經退休，但仍然為那些尋求自己動手治療的人經營小組。至關重要的是，他既是心理學家，也是病人。

What Cunningham saw, through the research that has spanned the bulk of his career, is that how fully we immerse ourselves in these healing pathways can have an enormous impact on the course of an illness. It’s common sense, really. We certainly expect that the amount and quality of effort has a payoff in sports, but we have lost this perspective when it comes to our health.

通過貫穿他職業生涯大部分時間的研究，Cunningham 看到的是，我們是否完全沉浸在這些治癒途徑中會對疾病的進程產生巨大影響。這是常識，真的。我們當然期望努力的數量和質量在運動中得到回報，但在我們的健康方面，我們已經失去了這種觀點。

It’s important to point out that taking responsibility for your healing process is not the same thing as taking the blame for your illness. Certainly it’s true that when we know better, we do better. But it’s also true that you have little say about the family, cultural programming, and genetic structure into which you were born. Part of the resistance to “mind-body medicine,” on the part of the medical mainstream, is the belief that this approach to healing “blames” the patients for their illnesses. The overriding theory is that the downsides (that people will feel that they brought illness upon themselves through something they did or didn’t do) overwhelm any potential benefit. And while I disagree, I also have to admit that there’s some truth to it. Some people do feel blamed and overwhelmed by the idea of taking ownership of health and healing. And the mind-body medicine movement isn’t always great at untangling “blame” from “ownership.”

重要的是要指出，對自己的康復過程負責與為疾病負責不是一回事。當然，當我們瞭解得更多時，我們確實會做得更好。但同樣事實是，你對你出生的家庭、文化節目和遺傳結構幾乎沒有發言權。醫學主流對 「身心醫學」 的部分抵制是，他們認為這種治療方法將患者的疾病 「歸咎 」在內。最重要的理論是，缺點（人們會覺得他們通過做或沒做的事情給自己帶來了疾病）壓倒了任何潛在的好處。雖然我不同意，但我也不得不承認這有一定的道理。有些人確實對擁有健康和康復的想法感到責備和不知所措。身心醫學運動並不總是擅長將「責備」與「擁有權」分開。

BEING SICK IS NOT YOUR FAULT

生病不是你的錯

One of the good things about our current medical model is that you can often just go in, get your illness treated, and not feel judged or pressured. Sometimes, you just want to let your cold be a cold, or your heart disease just be heart disease. Or have your alcohol problem or bipolar disorder be understood simply as a disease. And there’s an important place for that. Marcia Angell, in an article for The New England Journal of Medicine,⁷ presented the argument succinctly. While she admits that there is some value to exploring the link between disease and the mind and that there may be something real there, she believes that it’s not worth exploring because the potential damage when people blame themselves for their illnesses is too great.

我們目前的醫療模式的一個好處是，您通常可以進去治療您的疾病，而不會感到被評判或壓力。有時，你只是想讓你的感冒成為感冒，或者你的心臟病只是心臟病。或者將您的酒精問題或雙相情感障礙簡單地理解為一種疾病。這有一個重要的地方。Marcia Angell 在《新英格蘭醫學雜誌》的一篇文章中⁷ 簡潔地提出了這一論點。雖然她承認探索疾病與心靈之間的聯繫有一些價值，並且那裡可能存在真實的東西，但她認為不值得探索，因為當人們將疾病歸咎於自己時，潛在的損害太大了。

Dr. Angell comes down hard on illness as a reflection of the psyche. She gives a great example from history about how tuberculosis was assumed to have a psychological cause until it was discovered to be associated with mycobacterium tuberculosis and susceptible to treatment with rifampin. The same could be said about the treatment of syphilis or gonorrhea, historically viewed as moral illnesses, but actually bacterial in nature and now easily treated with antibiotics. But a biological basis does not always indicate a biological cause. In other words, just because the biological level is involved does not mean that the biological level is always the primary cause.

Angell 博士嚴厲批評疾病是心理的反映。她從歷史上舉了一個很好的例子，說明結核病是如何被認為具有心理原因的，直到發現它與結核分枝桿菌有關並且對利福平治療敏感。梅毒或淋病的治療也是如此，梅毒或淋病在歷史上被視為道德疾病，但實際上是細菌性的，現在很容易用抗生素治療。但生物學基礎並不總是表明生物學原因。換句話說，僅僅因為涉及生物水準並不意味著生物水平總是主要原因。

Angell’s dismissal seems to have less to do with whether there’s anything valid to explore and more to do with a concern that people will blame themselves for their illnesses. Her stance that people not blame themselves if they don’t get better is valid and essential, but it exists outside of the question about the role that our deep beliefs about ourselves and the world play in our health and illnesses. We can’t confuse the two. We can, and should, take the stance that we are not to blame for the illnesses that come our way and that we have more power than we know when it comes to healing from them. As Oprah says, “When we know better, we do better.”

安吉爾的解僱似乎與是否有任何值得探索的東西無關，而與擔心人們會為自己的疾病自責有關。她的立場是，如果人們沒有好轉，他們就不會責怪自己，這是有效和必要的，但它存在於我們對自己和世界的深刻信念在我們的健康和疾病中所扮演的角色之外。我們不能混淆這兩者。我們可以，也應該採取這樣的立場，即我們不應該為我們遇到的疾病負責，並且在治癒疾病方面，我們擁有比我們所知道的更大的力量。正如奧普拉所說，「當我們瞭解得更多時，我們就會做得更好。

The case of Dr. John Sarno is a perfect example. Sarno, who died just a few years ago at the age of ninety-three, was a doctor at New York University whose approach to treating chronic pain was, to say the least, controversial. He believed that most chronic pain was psychological at its root. He understood this not as blame but as opportunity. He was able to take on the patients whose pain had not responded to traditional modalities; he often said that some 80 percent of them would go on to get better.⁸

John Sarno 博士的案例就是一個很好的例子。幾年前去世的 Sarno 享年 93 歲，他是紐約大學的一名醫生，至少可以說，他治療慢性疼痛的方法存在爭議。他認為大多數慢性疼痛的根源是心理上的。他認為這不是責備，而是機會。他能夠接受對傳統方式沒有疼痛反應的患者;他經常說，他們中大約80%的人會繼續變得更好。⁸

His obituary in The New York Times detailed how colleagues at NYU would “belittle him behind his back in lunchtime conversations … even as some would visit him privately for their ailments.” I’ve experienced this dynamic; it’s tragic—and contrary to the true spirit of scientific inquiry—that the politics of health cause people to take such a public position. But it’s also important to understand that there are a lot of smart closet professionals who want more freedom to talk about these issues.

他在《紐約時報》上的訃告詳細描述了紐約大學的同事如何「在午餐時間的談話中背地貶低他......即使有些人會私下來看他治療他們的疾病。我經歷過這種動態;這是悲劇性的——與科學探索的真正精神相反——健康政治導致人們採取如此公開的立場。但同樣重要的是要明白，有很多聰明的壁櫥專業人士希望有更多的自由來談論這些問題。

And now, after his death, Dr. Sarno is being proven right. Studies are emerging,⁹ after all those years of doubt and skepticism, showing that there often is an emotional basis for chronic pain. Ahead of the research, without any “gold standard,” double-blind studies to pass the test of the establishment, Sarno forged ahead, knowing that his patients experienced radical recoveries when chronic pain was approached through the lens of emotion and anxiety. And he was right.

現在，在他去世后，Sarno 博士被證明是正確的。經過這麼多年的懷疑和懷疑，⁹ 的研究不斷湧現，表明慢性疼痛往往有情感基礎。在研究之前，沒有任何「黃金標準」、雙盲研究來通過建制派的考驗，Sarno 勇往直前，因為他知道，當通過情緒和焦慮的鏡頭來處理慢性疼痛時，他的病人會經歷徹底的康復。他是對的。

I believe that as doctors, we need to listen more to our patients—and I don’t just mean in the exam room. I mean listen to the larger messages, the many voices whispering all across the country and around the world, trying to tell us what they know intuitively about their bodies, and illness, and healing. So many people wrote testimonials to John Sarno, expressing how his methodology had saved their lives. And the response from the medical community was, “The studies don’t back it up.” Well, now, finally, they do.

我相信，作為醫生，我們需要更多地傾聽患者的聲音——我指的不僅僅是在檢查室里。我的意思是傾聽更大的資訊，在全國和世界各地低語的許多聲音，試圖告訴我們他們對自己的身體、疾病和治癒的直覺瞭解。很多人給 John Sarno 寫了推薦信，表達了他的方法如何挽救了他們的生命。“醫學界的回應是，”研究沒有支援它。好吧，現在，終於，他們做到了。

I remember a patient of mine saying to me, in the context of a larger conversation, “I know that I hang on to injuries longer than other people.” It stuck in my mind, and now I realize why—it perfectly encapsulates the way so many people can know something intuitively, instinctually, about how their bodies heal or hang on to injury and illness, and medicine just isn’t equipped to hear them.

我記得我的一位病人在一次更大的對話中對我說：“我知道我比其他人承受傷害的時間更長。它一直留在我的腦海中，現在我明白了為什麼——它完美地概括了這麼多人憑直覺、本能地了解他們的身體如何癒合或承受傷害和疾病的方式，而醫學只是沒有能力聽到他們。

If we want to make radical progress in the field of health care, we have to start looking for the whole truth, instead of half-truths that fortify our own biases and skepticisms. From mainstream medicine to mind-body medicine, we’ve gotten too polarized to be productive. Each side demonizes the other, unable to acknowledge what’s right about each approach to healing. When we are too nervous to explore the truth about high achievers in healing because we worry that people might feel blame, we do everyone a disservice.

如果我們想在醫療保健領域取得根本性的進步，我們必須開始尋找全部的真相，而不是強化我們自己的偏見和懷疑的半真半假。從主流醫學到身心醫學，我們已經變得過於兩極分化，以至於無法提高工作效率。每一方都妖魔化對方，無法承認每種治療方法的正確之處。當我們因為擔心人們可能會感到責備而無法探索高成就者的真相時，我們就會對每個人都造成傷害。

So who has the power to change this dynamic?

那麼，誰有能力改變這種動態呢？

You do.

是嗎。

Over the years, I’ve seen that change comes slowly, even as technology advances by leaps and bounds. We have incredible new resources at our fingertips, from wearables that utilize big data to give us a window into the inner workings of our bodies, to the vanguard of immunotherapy, where researchers reprogram cells from our own bodies and then rerelease them as new, improved cancer fighters. All of this is exciting and holds incredible potential for revolutionary new approaches to health and healing. But will we take this opportunity? The kind of change we need means reevaluating the very structure that medicine is built on. It means questioning some of our basic assumptions about how we practice medicine and how we approach disease. The drivers of change here will not be doctors and other practitioners—they will be people like you and me. People who decide they aren’t going to wait for the experts to come up with the solutions they need. Those who feel the pull of something higher are the drivers of progress—your choices have the power to shape not only your own health and vitality but also the field of medicine.

多年來，我看到變化來得很慢，即使技術突飛猛進。我們擁有觸手可及的令人難以置信的新資源，從利用大數據為我們提供瞭解身體內部運作的視窗的可穿戴設備，到免疫療法的先鋒，研究人員從我們自己體內重新程式設計細胞，然後將它們重新釋放為新的、改進的癌症鬥士。所有這些都令人興奮，並且具有革命性的新健康和治療方法的巨大潛力。但我們會抓住這個機會嗎？我們需要的那種改變意味著重新評估醫學賴以生存的結構。這意味著質疑我們關於如何行醫和如何應對疾病的一些基本假設。這裡變革的驅動力不是醫生和其他從業者，而是像你我這樣的人。那些決定不等待專家提出他們需要的解決方案的人。那些感受到更高事物的吸引力的人是進步的驅動力——您的選擇不僅能夠塑造您自己的健康和活力，還能夠塑造醫學領域。

If anything you hear makes you feel blamed or responsible for your illness, rather than empowered, you should ignore it. Set it aside—it’s not for you, and that’s okay. Not every message is for every listener. Not everything will resonate or inspire. And not everything has to happen immediately. Sometimes we do need illness as a respite—a time to recalibrate, to rest, to reassess. Sometimes we aren’t ready to say goodbye yet to a part of ourselves that is holding us back. Sometimes, like Mirae, like so many people who experience spontaneous healing, we need time. Give yourself that time. There is no set schedule for any of this. This should feel like an opportunity, not a burden. If it feels like a burden, it might not be the right time to burn your boat—and that’s okay. This is your path. No one else’s.

如果你聽到的任何事情讓你覺得自己受到了責備或對自己的疾病負責，而不是被賦予了權力，你應該忽略它。把它放在一邊 — 它不適合你，沒關係。並非每條消息都適合每個偵聽者。並非一切都會引起共鳴或啟發。而且，並非所有事情都必須立即發生。有時我們確實需要疾病作為喘息的機會——一個重新校準、休息、重新評估的時候。有時我們還沒有準備好與阻礙我們前進的自己說再見。有時，就像Mirae一樣，就像許多經歷自發治癒的人一樣，我們需要時間。給自己那段時間。這些都沒有固定的時程表。這應該感覺像是一個機會，而不是負擔。如果感覺像是一種負擔，那麼現在可能不是燒毀你的船的合適時機——這沒關係。這就是你的道路。沒有其他人的。

To move forward without feeling judged, blamed, or responsible, it’s important to remember that ultimately, it’s not about the illness. It’s not about right or wrong or about specific things that you do or don’t do that will heal you or not. It’s about getting a life that’s meaningful, where you understand and experience your own worth, and where you know what your purpose is and what you want from this life—however short or long it may be.

要在不感到被評判、責備或負責任的情況下向前邁進，重要的是要記住，歸根結底，這與疾病無關。這與對或錯無關，也不是關於你做或不做會治癒你的具體事情。這是關於獲得有意義的生活，在這裡你理解和體驗自己的價值，你知道你的目標是什麼，你想從這一生中得到什麼——無論它有多短或長。

Sarah, thirty-eight years old, was manic when she was admitted to McLean. She’d been struggling with bipolar disorder most of her life and more recently, relapses of alcoholism. She was living at her mom’s house, had lost her job, was ripping through money. Her family had bailed her out financially over and over and checked her in at the hospital when her symptoms got out of control. She was on multiple medications, but they didn’t seem to be working as they once had.

38 歲的莎拉 （Sarah） 在被麥克萊恩收治時很躁狂。她一生中的大部分時間都在與躁鬱症作鬥爭，最近又酗酒復發。她住在她媽媽家，失去了工作，正在花錢。她的家人一次又一次地在經濟上救助她，並在她的癥狀失控時去醫院為她檢查。她服用了多種藥物，但它們似乎不像以前那樣起作用。

Sarah’s identical twin, Theresa, asked me for a family meeting. She, too, had been diagnosed with bipolar disorder as a teenager; she, too, had struggled with it for years. She understood exactly what Sarah was going through and wanted to help. When the day came for the meeting and Theresa walked into my office, I was stunned. I could barely see the resemblance between the twins. Sarah struggled with physical ailments that are often the by-product of mental illness and depression. Bipolar disorder can affect body health in many ways, from obesity to heart and thyroid disease, perhaps triggered by the cocktail of stress hormones bombarding the body’s cells and tissues during flares. Sarah appeared many years older, and the many mixed episodes of hard living, depression, and mania had taken their toll on her body.

Sarah 的同卵雙胞胎 Theresa 邀請我召開家庭會議。她在十幾歲時也被診斷出患有躁鬱症;她也多年來一直在為此掙扎。她完全理解Sarah正在經歷的事情，並希望提供説明。當會議的那天到來時，Theresa 走進我的辦公室，我驚呆了。我幾乎看不出這對雙胞胎之間的相似之處。莎拉與身體疾病作鬥爭，這些疾病通常是精神疾病和抑鬱症的副產品。雙相情感障礙會以多種方式影響身體健康，從肥胖到心臟和甲狀腺疾病，這可能是由發作期間壓力荷爾蒙轟炸身體細胞和組織的雞尾酒引發的。莎拉看起來老了很多歲，艱苦的生活、抑鬱和躁狂症的許多混合發作對她的身體造成了傷害。

Theresa told me her own story. She and her sister had spent their twenties with an apparently similar trajectory, seeing the same psychiatrist, who would put them on one medication, then pull them off and try another. They never seemed to be able to get their symptoms under control. She began to notice that other approaches tended to keep her more stable: staying away from alcohol, for one, and watching what she ate and if she went out at night or stayed in and slept. When she turned twenty-eight, she decided: Enough.

特蕾莎告訴我她自己的故事。她和姐姐在二十多歲的時候，有著明顯相似的軌跡，去看同一位精神科醫生，醫生會讓他們服用一種藥物，然後讓他們停葯並嘗試另一種。他們似乎永遠無法控制自己的癥狀。她開始注意到其他方法往往使她更穩定：例如，遠離酒精，注意她吃什麼，以及她是晚上出去還是呆在家裡睡覺。當她 28 歲時，她決定：夠了。

“I just decided I was done—done with the cycle of never-ending medication trials, of talk therapy, of relapse,” she said. “I took control of my life.”

“我只是覺得我已經結束了——結束了永無止境的藥物試驗、談話療法和復發的迴圈，”她說。“我掌控了自己的生活。”

She cut out processed foods, immersed herself in a Buddhist meditation practice. Meditation, of course, isn’t a magic pill that can fix a serious mental illness. But for Theresa, it was the linchpin that grounded her, around which all the other changes spun. And with the level of dedication and commitment to learning that she brought to it, I don’t doubt it had profound effects on her brain and, following from that, her body.

她戒掉了加工食品，沉浸在佛教冥想練習中。當然，冥想並不是可以解決嚴重精神疾病的靈丹妙藥。但對 Theresa 來說，這是讓她腳踏實地的關鍵，所有其他變化都圍繞著它展開。憑藉她對學習的奉獻精神和承諾，我毫不懷疑這對她的大腦產生了深遠的影響，進而對她的身體產生了深遠的影響。

It was hard to make real change, sometimes agonizingly so. The first two years were difficult. But Theresa’s meditation practice opened the door to other big changes and led to a fulfilling career and a loving marriage. Now, she feels that self-care has built up her reserves so that setbacks don’t knock her for a loop anymore. She’s been healthy, happy, and off any form of medication for the past eight years. “You can do this,” she said to her sister. “You just have to decide to.” The sisters sat side by side, looking like they had come from two different worlds. They were sixty seconds apart in age but years apart in health.

做出真正的改變是很困難的，有時甚至是痛苦的。最初的兩年很艱難。但 Theresa 的冥想練習為其他重大變化打開了大門，並帶來了充實的事業和充滿愛的婚姻。現在，她覺得自我照顧已經建立了她的儲備，這樣挫折就不會再讓她陷入困境。在過去的八年裡，她一直很健康、快樂，並且沒有服用任何形式的藥物。“你可以做到的，”她對姐姐說。“你只需要決定。”姐妹倆並排坐著，看起來就像來自兩個不同的世界。他們的年齡相差 60 秒，但健康情況相差數歲。

These twins illustrate how biology is not destiny. The DNA of identical twins is 99 percent the same. And yet, their physical health does not run as parallel as their genes do. Sarah’s and Theresa’s health profiles are now so different that looking at them on paper, a physician would probably never guess they were sisters. Theresa had a “burn your boat” moment, while Sarah never did. Their lives diverged sharply from that moment on.

這對雙胞胎說明瞭生物學不是命運。同卵雙胞胎的DNA與99%相同。然而，他們的身體健康情況並不像他們的基因那樣平行。Sarah 和 Theresa 的健康情況現在大不相同，以至於在紙上看她們時，醫生可能永遠不會猜到她們是姐妹。Theresa 有過「燒毀你的船」的時刻，而 Sarah 從來沒有。從那一刻起，他們的生活發生了巨大的變化。

Relying on old habits, routines, or ways of thinking or being in the world isn’t a character flaw. It’s part of being human. As we’ve already examined, our DMN makes life efficient and more manageable, but it can also sabotage us despite our best intentions. Even people who are making lifesaving changes, who are on the pathway to health and recovery, will leave themselves an out. It’s often an unconscious choice—a safety valve that you leave in place, a pathway back to unhealthy behaviors that, for whatever reason, help you get through difficult or stressful times. If you have a boat floating out there when stress is low and conditions are optimal—when you’re winning the fight—it’s probably okay. The problem occurs when things get tough. When it seems like you might lose. When you question your choice to fight. That’s when you fall back—if there’s a place to fall back to. The body is comfortable with the old homeostasis.

依賴舊習慣、慣例或思維方式或為人處世並不是性格缺陷。這是人類的一部分。正如我們已經研究過的，我們的 DMN 使生活更高效、更易於管理，但它也可能破壞我們，儘管我們的意圖是好的。即使是那些正在做出挽救生命的改變，那些正在走向健康和康復的人，也會把自己排除在外。這通常是一種無意識的選擇——一個你留在原地的安全閥，一條回到不健康行為的途徑，無論出於何種原因，它都能説明你度過困難或壓力大的時期。如果你有一艘船在壓力較低且條件最佳時漂浮在那裡——當你贏得戰鬥時——這可能沒問題。當事情變得艱難時，問題就會出現。當你看起來可能會輸的時候。當你質疑你選擇戰鬥時。那時你就會退後——如果有地方可以退後的話。身體對舊的體內平衡感到滿意。

To attain the life you want, especially while ill, you have to identify any boats you have waiting in the harbor and burn them down for good. Earlier, we talked a little about what a “boat” can look like—how it could be a habit, food, or substance. An addiction, such as to alcohol or tobacco, would be an obvious example, but anything you’re attached to that causes a stimulus-reward response in your brain falls into this category. Foods, activities, routines, even people can activate your dopamine loop and keep you stuck in ruts you know don’t ultimately work for you. But boats can be even harder to see. Often, they look like “reasons why not.”

為了獲得你想要的生活，尤其是在生病的時候，你必須找出你在港口等待的任何船隻並永遠燒毀它們。早些時候，我們談到了“船”是什麼樣子——它如何成為一種習慣、食物或物質。成癮，例如酒精或煙草，就是一個明顯的例子，但你所依戀的任何事情都會在你的大腦中引起刺激-獎勵反應，就屬於這一類。食物、活動、例行公事，甚至人都可以啟動您的多巴胺迴圈，讓您陷入您知道最終對您不起作用的陳規中。但船隻可能更難看到。通常，它們看起來像 「為什麼不」。。

When faced with a sweeping or difficult change, we can look for reasons why the change won’t work, or why it’s not worth the effort. Talking yourself out of making the changes you know you need to make is a type of boat. Relationships can be boats, in unexpected ways—sometimes, even a rewarding relationship with a friend or lover or family member can become a way out of necessary change, when we worry so much about the impact that change will have on the relationship that it keeps us from moving forward. And it’s true that sometimes, people in our lives can struggle when we make radical change. Other people’s emotions and expectations then become a boat—a seemingly valid reason not to move forward with radical change, because you are too afraid of what you might lose.

當面臨全面或困難的更改時，我們可以尋找更改不起作用的原因，或者為什麼不值得付出努力。說服自己不要做出你知道需要做出的改變是一種船。關係可以是一艘船，以意想不到的方式——有時，當我們非常擔心變化會對關係產生影響，以至於阻止我們前進時，即使是與朋友、愛人或家人的有益關係也可能成為擺脫必要變化的一種方式。確實，有時，當我們做出徹底的改變時，我們生活中的人可能會感到掙扎。然後，其他人的情緒和期望就變成了一艘船——一個看似合理的理由，不推進激進的變革，因為你太害怕你可能會失去什麼。

It’s easy—effortless, almost—to come up with reasons why not. One way to identify your boats is to try to become aware of those reasons why not that fly into your mind, without really trying, when you picture your life once you make the change you know you need to make. Do you worry about someone’s anger or disappointment? Are you afraid of the unknown? Do you picture your life without a routine you rely on and feel resentful and resistant?

想出不這樣做的理由很容易——幾乎毫不費力。識別你的船的一種方法是嘗試意識到那些沒有飛入你腦海的原因，當你想像出你知道你需要做出的改變後的生活時，不要真正嘗試。你擔心別人的憤怒或失望嗎？你害怕未知嗎？你是否想像過沒有你所依賴的日常生活並感到怨恨和抗拒的生活？

Sometimes, when we make radical change, we do experience loss. When I left home to pursue the life I knew was right for me, I lost a lot. I lost my home, my community, and much of my family. I lost a version of myself that I left behind in that small town in the cornfields. But I gained so much more. In the story, Cortés’s army loses a fleet of ships but gains an empire. What we often need to do to find the courage to light the match is to focus not on what we stand to lose but what we stand to gain.

有時，當我們做出徹底的改變時，我們確實會經歷損失。當我離開家去追求我知道適合我的生活時，我失去了很多。我失去了我的家、我的社區和我的大部分家人。我失去了一個版本的自己，我把它留在了那個玉米地里的小鎮上。但我收穫的遠不止於此。在故事中，科爾特斯的軍隊失去了一支艦隊，但獲得了一個帝國。為了鼓起勇氣點燃火柴，我們經常需要做的是，不要關注我們將失去什麼，而是關注我們將得到什麼。

LIGHTING THE MATCH

點燃火柴

People find motivation to make radical change, and stick to it, in all kinds of ways. Claire Haser told me that at first, she was motivated primarily by fear. In the early days of her diagnosis, when she was nauseous with terror at the thought of dying so soon, she came across some studies online that said that salt was found to have a causative effect with pancreatic cancer. “I love salt,” she said. “But I was amazed at how fast I got it out of my diet.” But fear, as motivation, can only take you so far.

人們找到動力去做出徹底的改變，並以各種方式堅持下去。克雷爾·哈瑟 （Claire Haser） 告訴我，起初，她的動機主要是恐懼。在她確診的早期，當她對這麼快就死去的想法感到恐懼和噁心時，她在網上看到了一些研究，這些研究稱鹽被發現對胰腺癌有致病作用。“我喜歡鹽，”她說。“但我對我從飲食中攝取它的速度感到驚訝。”但恐懼作為動力，只能帶你走這麼遠。

Fear got Claire started, but fear is a fuel that burns hot and fast. It can’t sustain us through the long journey of fighting a chronic or incurable illness. For Claire, the work she did to confront death, to decide what kind of life she wanted to have with the time she had left, made that fear evaporate and gave her a more renewable source of motivation and power. She started to ask questions like, “What is this cancer trying to teach me?” “What’s the message of this illness?” “What is the opportunity?” For Claire, she found the motivation to be uncompromising in her pursuit of the life she wanted by listening to her body, becoming more in tune with it, and by moving toward ways of being and thinking that made her feel better in her body, mind, and soul.

恐懼讓 Claire 開始了，但恐懼是一種燃燒又熱又快的燃料。它無法支撐我們度過與慢性或不治之症作鬥爭的漫長旅程。對 Claire 來說，她為面對死亡所做的工作，決定她想用自己剩下的時間過什麼樣的生活，讓這種恐懼消失了，給了她一個更可更新的動力和力量來源。她開始問這樣的問題，「這種癌症想教我什麼？“這種疾病的信息是什麼？”“機會是什麼？”對 Claire 來說，她找到了在追求自己想要的生活時毫不妥協的動力，通過傾聽自己的身體，變得更加與身體協調，並朝著讓她的身體、思想和靈魂感覺更好的存在和思考方式前進。

Juniper Stein was the one who said, “I accepted the diagnosis, but not the prognosis.” She accepted that she would have to live with this disease—what she did not accept was the expectation about how she would live with it. She did not want to be a young newlywed in a wheelchair. She didn’t want to be physically held back. She didn’t want to be a burden on her family. She had a vision of what she did want: a family, a body that worked, that could carry her through the world and accomplish everything she wanted to do, and to be able to live without the constant distraction of debilitating pain. As she pushed through the hardest, most painful days of her yoga practice, she kept that vision in her mind: what she wanted.

Juniper Stein 是那個說：“我接受了診斷，但不接受預後的人。她接受了她將不得不與這種疾病共存——她不接受的是關於她將如何與這種疾病共存的期望。她不想成為一個坐在輪椅上的年輕新婚夫婦。她不想在身體上受到阻礙。她不想成為家人的負擔。她對自己真正想要的有一個願景：一個家庭，一個能運轉的身體，可以帶著她穿越世界，完成她想做的一切，並且能夠在沒有不斷被使人衰弱的痛苦分心的情況下生活。當她度過瑜伽練習中最艱難、最痛苦的日子時，她將那個願景牢記在心：她想要什麼。

Mirae Bunnell said it was easy to understand the changes she needed to make but hard to get her mind on board. It resisted, stuck in its own feedback loop of stimulation and reward, the chemical pleasure pathways that reinforce old patterns with hits of dopamine and serotonin. “It’s like a negotiation,” she says now. “My physical body was telling my mind what it needed to heal and stay healthy, but my mind balked at the discipline required to fulfill that.”

Mirae Bunnell 說，很容易理解她需要做出的改變，但很難讓她接受。它抵抗著，卡在自己的刺激和獎勵的反饋迴圈中，那些通過多巴胺和血清素的打擊強化舊模式的化學快樂通路。“這就像一場談判，”她現在說。“我的身體告訴我的大腦需要什麼來治癒和保持健康，但我的大腦對實現這一點所需的紀律猶豫不決。”

When stress is high, we fall back on old, engrained ways of coping. The science of how the brain works is clear on this; under pressure or in the moment, the brain will play a trick on us and convince us that the right thing to do is to use the old behavior, the familiar path. “Just this one time,” we tell ourselves, and we believe it. The mind is powerful in this way. We see it most easily with addiction—the neural pathways that arc toward immediate pleasure and comfort—but it plays out in all kinds of scenarios that affect health and our capacity for radical healing. We talked earlier about addictions—to alcohol or drugs and also to foods, habits, routines. Even certain ways of thinking can be addictive. A negative or limiting thought pattern, for example, can become addictive and prevent you from developing mental circuitry that’s more healing. And it’s just as difficult to break and rewrite those old thought patterns, habits, and beliefs as it is to overcome an addiction. Your biology and neurology will do anything and everything to keep you from making change.

當壓力很大時，我們會回到舊的、根深蒂固的應對方式。關於大腦如何工作的科學對此很清楚;在壓力下或當下，大腦會捉弄我們，並說服我們正確的做法是使用舊的行為，熟悉的路徑。“就這一次，”我們告訴自己，我們相信它。以這種方式，頭腦是強大的。我們最容易在成癮中看到它——通往即時快樂和舒適的神經通路——但它在各種影響健康和我們徹底治癒能力的場景中發揮作用。我們之前談到了成癮——對酒精或藥物，以及食物、習慣、日常生活。即使是某些思維方式也會讓人上癮。例如，消極或限制性的思維模式可能會讓人上癮，並阻止您發展更能治癒的心理迴路。打破和改寫那些舊的思維模式、習慣和信念與克服成癮一樣困難。你的生物學和神經學會做任何事情來阻止你做出改變。

So how do you make radical change and stick to it when you’re up against this kind of nefarious opponent—your own mind and body?

那麼，當你面對這種邪惡的對手——你自己的思想和身體——時，你如何做出徹底的改變並堅持下去呢？

Some people mark change with a ceremony. Some make big changes all at once—Jan, relocating to Brazil. Pablo, rapidly switching his diet and never going back. Others, like Claire, do better with a process of learning how to gradually meet their deeper needs so that the old, unhealthy, or out-of-date behaviors begin to fall away on their own. They “fill the hole in the soul” that this belief or habit was trying to assuage until they simply don’t need them anymore.

有些人用儀式來紀念變化。有些人一下子做出了重大改變 - Jan 搬到了巴西。巴勃羅，迅速改變他的飲食習慣，再也沒有回頭。其他人，比如 Claire，在學習如何逐漸滿足他們更深層次的需求方面做得更好，這樣舊的、不健康或過時的行為就會開始自行消失。他們「填補靈魂中的空洞」，這種信念或習慣試圖緩解這種想法或習慣，直到他們根本不需要它們。

When your back is up against the wall and you’re in danger of falling back into old habits, beliefs, or choices, it can be hard to make the right decision in that moment. It’s important to make a plan ahead of time for what you’re going to do in that situation, because your mind (DMN) will trick you when you’re in the moment, feeling the pressure. Here are some things to ask yourself now:

當你背靠牆，你有回到舊習慣、信仰或選擇的危險時，在那一刻可能很難做出正確的決定。提前為在這種情況下要做什麼制定計劃很重要，因為當你處於當下，感受到壓力時，你的大腦 （DMN） 會欺騙你。現在要問自己一些事情：

• What are my triggers? In what situations or circumstances do I struggle the most to stick to my guns? Can I avoid these or prepare better for them?
  我的觸發器是什麼？在什麼情況或情況下，我最難以堅持自己的立場？我可以避免這些或更好地為它們做好準備嗎？
• What is the vision I have for my life—something so inspiring, I would sacrifice immediate pleasure to attain it? What will help me to achieve that? What might prevent it?
  我對人生的願景是什麼——如此鼓舞人心，以至於我願意犧牲立即的快樂來實現它？什麼能幫助我實現這一目標？什麼可能會阻止它？
• Who can I trust to counsel me in this situation? Who can I call who’ll support instead of undermining me?
  在這種情況下，我可以信任誰來為我提供諮詢？我可以打電話給誰來支援而不是削弱我？
• What “reward” can I give myself for following through? Make it meaningful and immediate. Contact with someone you care about? Play a favorite song? Something that makes you feel great.
  我能給自己什麼「獎勵」來堅持下去呢？使其有意義和即時。與您關心的人聯繫？播放喜歡的歌曲？讓你感覺很棒的東西。
• What will help me understand my value and worth and see the importance and goodness that I bring into the world?
  什麼會説明我理解我的價值和價值，並看到我帶給世界的重要性和善良？
• Why did I decide to make this change in my life? Remember your reasons. Recall your vision of the life, the healthy body, you really want. Let yourself feel it.
  為什麼我決定在我的生活中做出這樣的改變？記住你的理由。回想一下你對生命的願景，你真正想要的健康身體。讓自己感受一下。

Our minds are wired in certain ways that keep us from truly burning our boats and going all in. Those long-standing synapses pull us toward habits, routines, and beliefs that can be damaging and that can stunt healing and hold us back. Why would you hack a new path through the forest if there’s already a well-trodden path? Imagine water running through riverbeds, the deep grooves carved into the earth. Thoughts—which manifest as electricity in the brain—take the path of least resistance, just as water will do as it finds its way across a grooved landscape. Over time, those riverbeds get deeper and deeper, the stream more and more difficult to divert. We already know that your DMN can lock you into patterns of thought and habit that can come to define your life and health, writing a map for your future that you don’t even realize you’re following. But we also know that the DMN can be rewritten.

我們的思想以某種方式連接起來，這使我們無法真正地燃燒我們的船隻並全力以赴。那些長期存在的突觸將我們拉向習慣、例行公事和信念，這些習慣、例行公事和信念可能會造成破壞，並可能阻礙愈合併阻礙我們。如果已經有一條人跡罕至的小路，你為什麼要在森林中開闢一條新的小路呢？想像一下，水流過河床，在泥土上刻出深深的凹槽。思想——在大腦中表現為電流——走的是阻力最小的路徑，就像水在凹槽景觀中穿行一樣。隨著時間的推移，這些河床越來越深，溪流越來越難以改道。我們已經知道，您的 DMN 可以將您鎖定在可以定義您的生活和健康的思維模式和習慣中，為您的未來繪製一張您甚至沒有意識到自己正在遵循的地圖。但我們也知道 DMN 可以重寫。

Forging a new neural pathway is a leap of faith. The good news is that our brains are not hardwired; we can create new neuro associations that link pleasure and reward with healthier habits. But it’s not easy. It means burning the boats of those old neuro associations so we can create new ones. Picture Indiana Jones, making his way through the temple of deadly obstacles at the end of Indiana Jones and the Last Crusade. He comes face-to-face with a wide, un-crossable chasm. The only way to proceed is to step into the abyss, with no idea what will happen. He does—and a solid bridge meets his foot. It was there all along, camouflaged but present. When your brain creates new synapses, the transmitters in your neurons do a similar leap, reaching into an abyss to connect, build a new bridge. When Indy gets across the gap, he tosses a handful of sand to outline the path and make it easier to see next time, faster to cross. Neuro associations in your brain work the same way, making the path easier and more familiar the next time you need it.

打造新的神經通路是信念的飛躍。好消息是我們的大腦並不是固定的;我們可以創建新的神經關聯，將快樂和獎勵與更健康的習慣聯繫起來。但這並不容易。這意味著燒掉那些舊的神經協會的船，這樣我們就可以創建新的神經協會。想像一下印第安那鐘斯，在《印第安納瓊斯和最後的十字軍東征》結尾穿過致命障礙的殿堂。他面對著一條寬闊的、無法逾越的鴻溝。唯一的辦法就是踏入深淵，不知道會發生什麼。他做到了——一座堅固的橋樑與他的腳相接。它一直都在那裡，偽裝但存在。當你的大腦產生新的突觸時，你神經元中的遞質也會做類似的跳躍，伸入深淵連接，建立新的橋樑。當 Indy 越過缺口時，他扔了一把沙子來勾勒出路徑，以便下次更容易看到，更快地穿過。您大腦中的神經關聯以相同的方式工作，讓您下次需要時更容易、更熟悉這條路。

It takes forty-five days to create a new neural pathway. Forty-five days: a month and a half. When you think about it that way, in the span of a whole life, it’s not so long! But when you’re in it, doing the day-to-day, trying to change a habit, a thought pattern, a belief you’ve held on to all your life, it can feel endless.

創建新的神經通路需要 45 天。四十五天：一個半月。當你這樣想時，在一生的時間跨度中，它並不長！但是，當你身處其中，做每一天，試圖改變你一生堅持的習慣、思維模式、信念時，它會感覺無窮無盡。

To get through those forty-five days, treat yourself like Pavlov’s dog. Your job now is to neuro-condition yourself like you’re your own lab rat. What you want to do is give yourself massive instant pleasure when you do anything that’s keeping you on that road to healing. Anything from recognizing a negative or limiting thought pattern to choosing a healing food over an inflammatory one is worth rewarding. Make your own list—what is rewarding for you?

要度過這 45 天，請像對待巴甫洛夫的狗一樣對待自己。你現在的工作是讓自己像自己的實驗室老鼠一樣進行神經調節。你想做的是，當你做任何讓你走上治癒之路的事情時，給自己巨大的即時快樂。從識別消極或限制性的思維模式到選擇治癒食物而不是炎症食物，任何事情都是值得獎勵的。列出你自己的清單——什麼對你來說有什麼獎勵？

And remember through it all that what you are doing is creating an entirely new map. It’s hard going when you’re laying a new path. It’s frustrating. But you’re moving forward. You’ve left the beach; the harbor is far behind you. There’s no boat waiting there anyway. Turning back is not an option. We take the city or we die.

請記住，您正在做的是創建一張全新的地圖。當你鋪設一條新的道路時，這很困難。這很令人沮喪。但你正在向前邁進。你已經離開了海灘;港口就在你身後很遠。反正那裡沒有船等著。回頭不是一種選擇。我們佔領這座城市，否則我們就會死亡。

You can do anything for forty-five days. Because after those forty-five days, there will be the rest of your life.

你可以在四十五天內做任何事情。因為在這 45 天之後，你的餘生將如此。

Over the past fifteen years, I’ve seen a lot of stunning recoveries. And as we’ve covered over the course of this book, they are each unique. There is only one story exactly like Claire’s; only one like Mirae’s. But it’s in the personal that we find the universal—and, I believe, the way forward. For medicine to take that next important leap, we need to act on some of the most urgent lessons of spontaneous remission, which tell us that to reach new depths of recovery, we have to heal the following: our diets, our immune systems, our stress responses, and our identities. It’s these four threads that run so brilliantly through the fabric of nearly every story of recovery I’ve examined and which could lay the groundwork for a revolution in medicine. But first, we can accomplish this revolution on a smaller scale, for ourselves, as the survivors profiled in this book have done—if we burn our boats.

在過去的 15 年裡，我看到了很多驚人的恢復。正如我們在本書中介紹的那樣，它們都是獨一無二的。只有一個故事與 Claire 的故事一模一樣;只有一個像Mirae的。但正是在個人中，我們找到了普遍性——我相信，這也是前進的道路。為了讓醫學實現下一個重要飛躍，我們需要根據一些最緊迫的自發緩解教訓採取行動，這些教訓告訴我們，要達到新的恢復深度，我們必須治癒以下問題：我們的飲食、我們的免疫系統、我們的壓力反應和我們的身份。正是這四條線索如此出色地貫穿了我研究過的幾乎所有康復故事的結構，併為醫學革命奠定了基礎。但首先，我們可以像本書中描述的倖存者所做的那樣，為自己在較小的規模上完成這場革命——如果我們燒毀我們的船。

When I left for college, I left home for good. For years, I’d been living a kind of half-life, trying to compromise between what my family wanted and expected from me and what I wanted out of life—what I needed to be a healthy, thriving person. They were locked into a model, based on punitive rules and narrow beliefs, that I couldn’t bear to exist in anymore. At the same time, it was painful to leave, because the stakes were high; if I left, I couldn’t go back. I would be excommunicated. I would be dead to them.

當我離開去上大學時，我永遠離開了家。多年來，我一直過著一種半衰期的生活，試圖在我的家人對我的期望和我對生活的期望之間做出妥協——我需要一個健康、繁榮的人。他們被鎖定在一個基於懲罰性規則和狹隘信念的模式中，我無法忍受再存在於這個模式中。與此同時，離開也是痛苦的，因為風險很高;如果我離開了，我就回不去了。我會被逐出教會。我對他們來說就死了。

It was one of the hardest things I’ve ever done. And it turned out to be one of my most important gifts, because after I made my choice, they didn’t leave me any avenue back. I was the one who left the boat to go to shore; they were the ones who burned the boat. A difficult time in your life—like an illness—is often a time when people choose to burn their boats. But look at the Cortés story: he gave the order; the soldiers didn’t make that choice. Sometimes, illness burns your boat for you. The question is: Do you lie down on the beach, or do you move forward?

這是我做過的最困難的事情之一。事實證明，這是我最重要的禮物之一，因為在我做出選擇后，他們沒有給我留下任何回頭的路。我是離開船上岸的人;他們是燒了船的人。您生命中的困難時期（例如疾病）通常是人們選擇燒毀船隻的時候。但看看科爾特斯的故事：他下達了命令;士兵們沒有做出這個選擇。有時，疾病會為你燒毀你的船。問題是：你是躺在海灘上，還是向前走？

None of us know how much time we have here. There is no key to immortality—not even spontaneous healing lasts forever. What the survivors of incurable illness in this book found was a way to move forward that accepted this: that there would be an end, but that in the meantime, they were going to live the best, most authentic and fulfilling lives that they could. They were going to find those big, deep changes that made them feel better and more alive and lean into them as hard as they could. If it meant restructuring their lives, they did it. If it meant letting go of limiting relationships, they let them go. They looked at themselves in the mirror and asked, What is the story I’ve been telling about myself, and how is it wrong? None of them embarked on this journey halfway or with the idea that they would cheat death; they set forth with the mission to claim the life that was theirs for the time they had. In doing so, they healed. They healed the way they treated their bodies. They healed how they responded to the stresses and challenges of life. They healed their toxic or damaging beliefs about the world and what was possible. And finally, they healed the story of who they are, so they could find the freedom and the capacity to make lifesaving changes.

我們誰也不知道我們在這裡有多少時間。不朽沒有鑰匙——即使是自發的治癒也無法永遠持續。這本書中不治之症的倖存者找到了一種前進的道路，他們接受了這一點：終有一天會結束，但與此同時，他們將過上他們所能過的最好、最真實和最充實的生活。他們將找到那些讓他們感覺更好、更有活力的重大、深刻的變化，並盡可能努力地投入其中。如果這意味著重組他們的生活，他們就這樣做了。如果這意味著放棄限制性的關係，他們就會放手。他們看著鏡子里的自己，問道，我一直在講述的關於自己的故事是什麼，怎麼會錯？他們都沒有半途而廢地踏上這段旅程，也沒有想到他們會欺騙死亡;他們的使命是奪取他們所擁有的生命。在此過程中，他們痊癒了。他們治癒了他們對待自己身體的方式。他們治癒了他們如何應對生活中的壓力和挑戰。他們治癒了他們對世界和可能性的有毒或破壞性信念。最後，他們治癒了自己的故事，這樣他們就可以找到自由和能力來做出拯救生命的改變。

“It was foremost a struggle of the mind and spirit,” Mirae said of her recovery. “The body followed.”

“這首先是思想和精神的鬥爭，”Mirae 談到她的康復時說。“屍體跟著。”