點擊上方「精彩英語演講」，選擇「設為星標」
英語演講視頻，第一時間觀看
每一個孩子都是上帝的天使，在這個歡快的日子裡，首先英語演講君祝願所有兒童能在這一天，愉快地度過屬於他們的節日，但願你們的眼睛永遠清澈無邪，充滿笑容。
祝福完了，今天英語演講君就為廣大的父母和小朋友們準備了3個非常有價值的，和童年健康成長的TED演講，一起陪你成長！
別給孩子一個清單式的人生
天下父母都希望自己的孩子可以一帆風順少走彎路，從學生時期到參加工作，一路都可以保持人生贏家的勢頭。 你的孩子是否在過一種清單式的童年？ 清單式的童年，過度的溺愛和控制，狹隘的「成功」定義給孩子過高的期望，事無巨細的管理孩子的生活， 這樣的養育方式適得其反。
其實，正確的教育方式：避免過度呵護。 今天，我們來看一個精彩的視頻。 演講者， Julie Lythcott-Haims， 曾就讀於哈佛大學法學院、加州藝術學院、 史丹福大學，畢業後曾是一名律師， 之後又在史丹福大學任校長助理、 教務長等職十幾年之久， 而她同時也是兩個孩子的媽媽。 她用激情和詼諧的語言告訴你一種新的教育方式。
#startvideo#a2c98842cd68af2ef5aefcd2b3e12709#endvideo#
雙語演講稿
Most of us go through life trying to do our best at whatever we do,whether it’s our job, family, schoolor anything else.I feel that way. I try my best.But some time ago, I came to a realizationthat I wasn’t getting much better at the things I cared most about,whether it was being a husband or a friendor a professional or teammate,and I wasn’t improving much at those thingseven though I was spending a lot of timeworking hard at them.I』ve since realized from conversations I』ve had and from researchthat this stagnation, despite hard work,turns out to be pretty common.
大多數人在生活中都會嘗試把每件事做到最好，無論是在職場上、家庭、學校或其它領域。我也有同感，也會努力嘗試。但前一段時間，我開始意識到，我總是無法在自己最在意的事情上做得更好。比如做一個好丈夫或好朋友，一名專業人士或好隊友，我一直無法在這些事情上有很大的提升，哪怕我花了很多時間努力完成。我之後在與他人的談話和研究中意識到，無論你多努力，這種瓶頸總是一直出現。
So I』d like to share with you some insights into why that isand what we can all do about it.What I』ve learnedis that the most effective peopleand teams in any domaindo something we can all emulate.They go through life deliberately alternating between two zones:the learning zone and the performance zone.
所以我想跟各位分享一些見解，並提出一些解決的辦法。我所了解的是，無論哪個領域，各行業的佼佼者都有可以讓我們仿效的地方。我發現，他們在日常生活中會有意識地在這兩種狀態中切換，學習狀態和執行狀態，
The learning zone is when our goal is to improve.Then we do activities designed for improvement,concentrating on what we haven’t mastered yet,which means we have to expect to make mistakes,knowing that we will learn from them.That is very different from what we do when we’re in our performance zone,which is when our goal is to do something as best as we can, to execute.Then we concentrate on what we have already masteredand we try to minimize mistakes.
在學習狀態，我們的技能可以進步。我們會透過設計過的活動來提升技能。專注於尚未掌握的事情，這意味著我們一定會有失誤，但我們也一定能從中學到東西。這跟我們執行狀態時所做的事情很不一樣，執行狀態的目的是把我們最好的一面表現出來。我們會專注在已經掌握好的技能，並把失誤減到最小。
Both of these zones should be part of our lives,but being clear about when we want to be in each of them,with what goal, focus and expectations,helps us better perform and better improve.The performance zone maximizes our immediate performance,while the learning zone maximizes our growthand our future performance.The reason many of us don’t improve muchdespite our hard workis that we tend to spend almost all of our time in the performance zone.This hinders our growth,and ironically, over the long term,also our performance.
這兩種狀態都是我們生活的一部分，但當你想要自在的處在這兩種狀態，你得清楚知道你的目標、關注點、預期效果是什麼，這樣才能幫助你在執行和改進方面都做得更好。執行狀態注重當下的表現，學習狀態會加速人的成長，並且提升未來的表現。很多人，無論如何努力都沒辦法有所提高。原因在於：我們總是花費太多時間在執行狀態。這樣會阻礙成長。諷刺的是，長時間下來，也會引響我們的表現。
So what does the learning zone look like?Take Demosthenes, a political leaderand the greatest orator and lawyer in ancient Greece.To become great,he didn’t spend all his timejust being an orator or a lawyer,which would be his performance zone.But instead, he did activities designed for improvement.Of course, he studied a lot.He studied law and philosophy with guidance from mentors,but he also realized that being a lawyer involved persuading other people,so he also studied great speechesand acting.To get rid of an odd habit he had of involuntarily lifting his shoulder,he practiced his speeches in front of a mirror,and he suspended a sword from the ceilingso that if he raised his shoulder,it would hurt.
那麼，學習狀態是怎樣的情況？來看看狄摩西尼，這位政治領袖，古希臘最偉大的演說家和律師。他會偉大的原因，不是因為他把時間都花在演說和執行律師業務上面，也就是說他不會一直處在執行狀態。相反的，他做了很多改善的活動。毋庸置疑，他花很多時間在學習。比如他在精神導師的指導下學習法律及哲學，但他也同時意識到，作為律師他需要說服別人，所以他也研究名人的演講及學習演戲。為了改變不由自主聳肩的壞習慣，他會在鏡子前練習演說，並且在天花板上吊一把劍。一旦聳肩，他就會被刺到。
(Laughter)
（觀眾笑）
To speak more clearly despite a lisp,he went through his speeches with stones in his mouth.He built an underground roomwhere he could practice without interruptionsand not disturb other people.And since courts at the time were very noisy,he also practiced by the ocean,projecting his voice above the roar of the waves.
為了克服口齒不清，他會含著石頭練習演講。他還建了一個地下室，以避免練習時被打擾或打擾到別人。因為上法院時會很吵，所以他就對著大海練習，讓自己的聲音比咆哮的海浪還大聲。
His activities in the learning zonewere very different from his activities in court,his performance zone.In the learning zone,he did what Dr. Anders Ericsson calls deliberate practice.This involves breaking down abilities into component skills,being clear about what subskill we’re working to improve,like keeping our shoulders down,giving full concentration to a high level of challengeoutside our comfort zone,just beyond what we can currently do,using frequent feedback with repetition and adjustments,and ideally engaging the guidance of a skilled coach,because activities designed for improvementare domain-specific,and great teachers and coaches know what those activities areand can also give us expert feedback.It is this type of practice in the learning zonewhich leads to substantial improvement,not just time on task performing.For example, research shows that after the first couple of yearsworking in a profession,performance usually plateaus.This has been shown to be true in teaching, general medicine,nursing and other fields,and it happens because once we think we have become good enough,adequate,then we stop spending time in the learning zone.We focus all our time on just doing our job,performing,which turns out not to be a great way to improve.But the people who continue to spend time in the learning zonedo continue to always improve.The best salespeople at least once a weekdo activities with the goal of improvement.They read to extend their knowledge,consult with colleagues or domain experts,try out new strategies,solicit feedback and reflect.The best chess playersspend a lot of time not playing games of chess,which would be their performance zone,but trying to predict the moves grand masters made and analyzing them.Each of us has probably spent many, many, many hourstyping on a computerwithout getting faster,but if we spent 10 to 20 minutes each dayfully concentrating on typing 10 to 20 percent fasterthan our current reliable speed,we would get faster,especially if we also identified what mistakes we’re makingand practiced typing those words.That’s deliberate practice.
他在學習狀態所做的活動與他在法院上執行的活動，兩者是很不一樣的。他在學習狀態時，會做安德森·愛立信博士所說的「循序漸進的練習」。就是把要學習的技能拆分成一小段一小段的技能，並且清楚地知道哪一項技巧目前需要提高。像是放鬆肩膀，全新專注在舒適圈以外更高層次的挑戰，專注超越那些早已掌握的事物。利用快速反饋做重複練習和調整，全力配合熟手教練的指導。因為，為改善而設計的活動是有特定範圍的，好的老師或教練知道什麼活動能帶來進步，並會給予專業的反饋。就是在這種學習狀態下的練習，才能大量的進步，而不是只是花時間在執行業務上。舉個例子，研究表明，在某一領域工作數年後，表現會達到停滯期。這在教學、一般內科、護理及其他領域都得到了印證。這是因為一旦人們覺得自己足夠好了，綽綽有餘了，就不會再花時間學習。我們只會關注在如何完成工作和執行業務上，這種方式變得不利於提高技能。但是那些一直在學習的人們，就會持續地成長。最好的銷售人員，至少每周一次，進行改善訓練。他們閱讀以增長知識，諮詢同行和專家、嘗試新的策略、徵詢意見及反思。最好的棋手，大部分的時間，並不是在跟別人下棋，也就是他們不會一直處在執行的狀態，而是試圖預測並分析大師們的棋路。每個人可能都花了很多時間在電腦前打字，但卻沒有越打越快。但是，如果我們每天抽出 10-20 分鐘，全神貫注地提升打字速度，比平常快上 10%-20% 就好，我們的速度就會越來越快。特別是當我們能找到失誤，並且專注加以練習。這就是一種循序漸進（刻意）的練習。
In what other parts of our lives,perhaps that we care more about,are we working hard but not improving muchbecause we’re always in the performance zone?Now, this is not to say that the performance zone has no value.It very much does.When I needed a knee surgery,I didn’t tell the surgeon,Poke around in there and focus on what you don’t know.
在生活的其他方面，還有哪些是我們比較在意，我們很努力但進步緩慢的地方？是不是因為我們老是停留在執行狀態裡？但以上都不是在說執行狀態沒有用，它是很有價值的。但我需要做膝蓋手術的時候，我可不想告訴醫師：「隨便戳戳吧，探索一下你不知道的事。」
(Laughter)
（觀眾笑）
We』ll learn from your mistakes!I looked for a surgeon who I felt would do a good job,and I wanted her to do a good job.Being in the performance zoneallows us to get things done as best as we can.It can also be motivating,and it provides us with information to identify what to focus on nextwhen we go back to the learning zone.So the way to high performanceis to alternate between the learning zone and the performance zone,purposefully building our skills in the learning zone,then applying those skills in the performance zone.
「我們可以從失誤中學到東西啊！」我會找一位我認為夠好的醫師，我想讓她好好地幫我醫治。在執行狀態時，我們會力求表現到最好，這樣可以激勵我們，並告訴我們，在回到學習狀態的時候，該關注些什麼。所以說，想要表現得好需要在學習狀態和執行狀態之間轉換。在學習狀態下有目的性地積累技巧，然後再將之應用在執行狀態裡。
When Beyoncé is on tour,during the concert,she’s in her performance zone,but every night when she gets back to the hotel room,she goes right back into her learning zone.She watches a video of the show that just ended.She identifies opportunities for improvement,for herself, her dancers and her camera staff.And the next morning,everyone receives pages of notes with what to adjust,which they then work on during the day before the next performance.It’s a spiralto ever-increasing capabilities,but we need to know when we seek to learn,and when we seek to perform,and while we want to spend time doing both,the more time we spend in the learning zone,the more we』ll improve.
就像碧昂斯的巡演，演唱會上，她處在執行表演的狀態，但每晚回到酒店，她就直接投入到學習狀態裡。她會觀看剛剛結束的表演，為自己、舞群和攝像師，尋找改進的機會。第二天早上，所有人都會收到一份通知，上面寫著那些地方需要改進，如此團隊成員就可以在下一次表演之前做出調整。如此團隊的能力就可以一直向上提升。但我們需要清楚的是，何時「學」、何時「做」，何時兩樣一起。投入越多時間在學習狀態，就能取得越多的進步。
So how can we spend more time in the learning zone?First, we must believe and understandthat we can improve,what we call a growth mindset.Second, we must want to improve at that particular skill.There has to be a purpose we care about,because it takes time and effort.Third, we must have an idea about how to improve,what we can do to improve,not how I used to practice the guitar as a teenager,performing songs over and over again,but doing deliberate practice.And fourth, we must be in a low-stakes situation,because if mistakes are to be expected,then the consequence of making them must not be catastrophic,or even very significant.A tightrope walker doesn’t practice new tricks without a net underneath,and an athlete wouldn’t set out to first try a new moveduring a championship match.
那麼我們要怎樣才能多花點時間在學習狀態呢？首先，要相信並理解一件事，那就是我們可以改進，也就是所謂的「成長心態」。其次，要在具體的技巧上做改進。並且要有一個我們在乎的目標，因為它需要時間和努力。第三，我們必須要知道該如何提升，要做些什麼來提升，而不是像我年輕時彈吉它那樣，同首曲子一遍又一遍的重複，而是要做「循序漸進的練習」。第四，我們必須保持在低風險狀態，因為如果如預期的發生了失誤，那麼造成的後果就不會影響太大，或是關係重大。走鋼絲的演員，不會在沒有護網的情況下練習新的技巧；運動員並不會在冠軍比賽中，嘗試新的動作。
One reason that in our liveswe spend so much time in the performance zoneis that our environments often are, unnecessarily, high stakes.We create social risks for one another,even in schools which are supposed to be all about learning,and I’m not talking about standardized tests.I mean that every minute of every day,many students in elementary schools through collegesfeel that if they make a mistake,others will think less of them.No wonder they’re always stressed outand not taking the risks necessary for learning.But they learn that mistakes are undesirableinadvertentlywhen teachers or parents are eager to hear just correct answersand reject mistakes rather than welcome and examine themto learn from them,or when we look for narrow responsesrather than encourage more exploratory thinkingthat we can all learn from.When all homework or student work has a number or a letter on it,and counts towards a final grade,rather than being used for practice,mistakes, feedback and revision,we send the message that school is a performance zone.
我們在生活中，花很多時間在執行狀態裡，這箇中原因是：我們常常處在不必要的高風險環境中。我們彼此製造了社會風險。哪怕是在學校，一個被認定為純粹學習的地方，我不是在說標準測驗，我說的是學生每時每刻、從小學到大學，都會覺得別人會因為他們犯錯而輕視他們。難怪他們總是緊張兮兮，不願為學習冒必要的風險。老師、家長對正確答案趨之若鶩的態度，無意中，讓學生害怕犯錯。而不是勇於試錯、檢視過錯、並從中吸取教訓。又或者，我們只想聽「標準答案」，而不是鼓勵學生進行可以學到更多的開拓性思考。一旦學生的作業、作品都被評定等級、標上分數，最後記錄到期末成績後，它們就起不到練習、試錯、反饋和修正的作用了，我們讓孩子誤以為：學校只是個讓你表現的地方。
The same is true in our workplaces.In the companies I consult with,I often see flawless execution cultureswhich leaders foster to encourage great work.But that leads employees to stay within what they knowand not try new things,so companies struggle to innovate and improve,and they fall behind.
職場中也同樣如此。那些諮詢我的公司，我常見到領導者鼓勵推動「完美執行 」的文化。但這樣就會導致員工僅僅停留在他們已知的範疇，而不去嘗試新的事物，公司因此很難創新、進步，從而落居下風。
We can create more spaces for growthby starting conversations with one anotherabout when we want to be in each zone.What do we want to get better at and how?And when do we want to execute and minimize mistakes?That way, we gain clarity about what success is,when, and how to best support one another.
我們可以透過交流，為彼此開創進步的空間，聊聊我們何時應該投身於何種狀態。在哪些方面可以做得更好？何時決策、怎樣控損？如此，我們可以明確什麼是成功、何時以及如何去支持對方。
But what if we find ourselves in a chronic high-stakes settingand we feel we can’t start those conversations yet?Then here are three things that we can still do as individuals.First, we can create low-stakes islands in an otherwise high-stakes sea.These are spaces where mistakes have little consequence.For example, we might find a mentor or a trusted colleaguewith whom we can exchange ideas or have vulnerable conversationsor even role-play.Or we can ask for feedback-oriented meetings as projects progress.Or we can set aside time to read or watch videos or take online courses.Those are just some examples.Second, we can execute and perform as we’re expected,but then reflect on what we could do better next time,like Beyoncé does,and we can observe and emulate experts.The observation, reflection and adjustment is a learning zone.And finally, we can leadand lower the stakes for others by sharing what we want to get better at,by asking questions about what we don’t know,by soliciting feedback and by sharing our mistakesand what we』ve learned from them,so that others can feel safe to do the same.
但如果我們處在長期高風險狀態下，並且無法展開這樣的交流怎麼辦？依然有三件事是可以自己著手去做的。首先，是在高風險的海洋中，開闢一塊低風險的島嶼。讓錯誤發生時不會造成嚴重的後果。比如說，我們可以找一位導師或可以信任的同事，和他們分享想法，或是接受批評。甚至角色扮演。或者是隨著項目的進展，舉辦反饋會議。又或者我們可以抽出時間去閱讀或看視頻或是參加線上課程。這只是幾個例子。第二，我們可以實踐並達成期望的表現，但事後反思如何改進，就像碧昂斯那樣。我們還可以觀察和模仿專家，這些觀察、反思、調整都能讓我們學習到很多。最後，我們可以引導並降低彼此的風險，問他們，我們在哪方面可以再取得進步，透過詢問未知的問題、徵求意見、 分享失誤，並從中汲取教訓，如此其他人也就能安心地做同樣的事。
Real confidence is about modeling ongoing learning.What if, instead of spending our lives doing, doing, doing,performing, performing, performing,we spent more time exploring,asking,listening,experimenting, reflecting,striving and becoming?What if we each always had somethingwe were working to improve?What if we created more low-stakes islandsand waters?And what if we got clear,within ourselves and with our teammates,about when we seek to learn and when we seek to perform,so that our efforts can become more consequential,our improvement never-endingand our best even better?
真正的自信是對不斷學習的展示。如果，我們沒有把人生耗費在做、做、做、表現、表現、表現上，而是更多地去探索、詢問、傾聽、實踐、反思、拼命去成為想成為的人，會怎麼樣？如果我們每個人，都有某些事情讓我們可為之努力，從而提升呢？如果我們創造更多的低風險區域和環境呢？如果我們自己或整個團隊都清楚知道，何時學習、何時表現，如此我們的努力就會有更多回報，就可以精益求精，團隊就會越來越好。
Thank you.
謝謝。
童年創傷是如何影響你的健康的？
每個人在童年時期多多少少都會有過一些不愉快的經歷，長大以後，慢慢地就忘記了……但是，童年的創傷並不是隨著你長大就能全部恢復的。
前美國兒科學會會長Robert Block博士所言, 「童年不良經歷（ACE）是今天我們國家所面臨的唯一最大的未能解決的公共健康威脅。」
今天分享這個演講，兒科醫生Nadine Burke Harris向我們講述，童年創傷是如何影響一生的健康的？
1. 「童年不良經歷」，又稱為ACE。這包括生理上、情感上遭受的不幸或是性侵害；生理或情感上遭受的忽視；父母患有精神疾病、物質依賴、遭到監禁；父母分居或離婚；或家庭暴力。
2. 關於ACE的研究發現，在調查人群中ACE十分普遍，並且ACE得分越高，健康狀況越糟糕。經歷過嚴重創傷的人患心臟病和肺癌的風險會增加三倍。
3. 即使你不從事任何高風險的行為，你仍然更容易患上心臟疾病或癌症。因為高劑量的童年不良經歷不僅會影響兒童的大腦結構和功能，還會影響正在發育的免疫系統，以及正在發育的內分泌系統，甚至還會影響我們的DNA讀取和轉錄方式。
4. 童年不良經歷對人的一生的健康影響巨大。這種病症是可以治療的，也是可以戰勝的。我們今天最需要的是直面這個問題的勇氣，並且承認，這個問題確實存在，與我們息息相關。
雙語演講稿
↓上下滑動查看↓
In the mid-'90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of 10 of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy. And yet, doctors today are not trained in routine screening or treatment. Now, the exposure I'm talking about is not a pesticide or a packaging chemical. It’s childhood trauma.
90年代中期, CDC和Kaiser Permanente發現: 暴露於某種事物中 會極大增加死亡風險, 七成美國民眾的首要死因皆由此引起。 暴露劑量較高時,會影響大腦發育, 免疫系統,內分泌系統, 甚至影響到基因的讀取及轉錄方式。 暴露在極高劑量下的人群, 有3倍的風險患上心臟病和肺癌, 預期壽命縮短20年。 然而,目前醫生們還未被培訓 以常規篩查和治療的手段來應對這種風險。 我所說的暴露危害並不針對 某種農藥或包裝上的化學物質。 而是兒童期創傷。
Okay. What kind of trauma am I talking about here? I'm not talking about failing a test or losing a basketball game. I am talking about threats that are so severe or pervasive that they literally get under our skin and change our physiology: things like abuse or neglect, or growing up with a parent who struggles with mental illness or substance dependence.
那麼,我要說的是哪種創傷呢? 我要說的可不是 考試不及格或輸掉籃球比賽。 我要說的是那種 如此嚴重而又無處不在的威脅, 以致於它讓我們毛骨悚然, 並從生理上改變了我們： 比如,受虐待或被忽視, 又或者,撫養我們的父母, 本身就深受精神疾病之苦, 或是深陷於"物質依賴"疾病。
Now, for a long time, I viewed these things in the way I was trained to view them, either as a social problem -- refer to social services -- or as a mental health problem -- refer to mental health services. And then something happened to make me rethink my entire approach. When I finished my residency, I wanted to go someplace where I felt really needed, someplace where I could make a difference. So, I came to work for California Pacific Medical Center, one of the best private hospitals in Northern California, and together, we opened a clinic in Bayview-Hunters Point, one of the poorest, most underserved neighborhoods in San Francisco. Now, prior to that point, there had been only one pediatrician in all of Bayview to serve more than 10,000 children, so we hung a shingle, and we were able to provide top-quality care regardless of ability to pay. It was so cool. We targeted the typical health disparities: access to care, immunization rates, asthma hospitalization rates, and we hit all of our numbers. We felt very proud of ourselves.
一直以來, 我都按照所教導的方式 來看待這些事情。 要麼把它當成一個社會問題-- 交給社會服務去處理, 要麼把它當成一個心理健康問題-- 交給心理健康諮詢來解決。 後來發生了一些事情, 使我反思我的整個思維方式。 在醫院實習結束後, 我想去個我覺得真正需要我的地方, 去個我可以有所作為的地方。 因此，我選擇為加利利福尼亞 太平洋醫療中心(CPMC)工作, 這是加利福尼亞北部 最優秀的私立醫院之一, 我與該醫院合作,在舊金山最窮、 社區服務最差的居民區-- 灣景區獵人角(Bayview-Hunters Point) 開了一家診所。 在此之前, 整個灣景區(Bayview)社區 僅有一名兒科醫生, 為一萬多名兒童服務, 因此,我們開始掛牌營業, 提供最優質的醫療服務, 不論是否有能力支付醫療費用。 這種感覺很棒。 我們找出了在醫療服務上現狀與標準的差距： 普及醫療保健, 免疫接種率、哮喘住院率等, 我們都完成了達標。 我們為自己感到驕傲。
But then I started noticing a disturbing trend. A lot of kids were being referred to me for ADHD, or Attention Deficit Hyperactivity Disorder, but when I actually did a thorough history and physical, what I found was that for most of my patients, I couldn't make a diagnosis of ADHD. Most of the kids I was seeing had experienced such severe trauma that it felt like something else was going on. Somehow, I was missing something important.
但就在那時,我開始注意到 一種令人憂心的趨勢。 很多孩子因為多動症(簡稱ADHD), 被送到我這裡進行醫治, 可是,當我對孩子們的病史和 身體狀況進行徹查時, 卻發現大多數患兒的情況, 我無法下"多動症"(ADHD)的診斷。 多數來就診的孩子都經歷過 如此嚴重的創傷, 讓人覺得似乎事情並不簡單。 不知怎的,我漏查了某個重要的因素。
Now, before I did my residency, I did a master's degree in public health, and one of the things that they teach you in public health school is that if you're a doctor and you see 100 kids that all drink from the same well, and 98 of them develop diarrhea, you can go ahead and write that prescription for dose after dose after dose of antibiotics, or you can walk over and say, "What the hell is in this well?" So, I began reading everything that I could get my hands on about how exposure to adversity affects the developing brains and bodies of children.
在實習之前,我曾攻讀公共健康碩士學位, 在公共健康學校裡, 我們曾學過這樣的一課, 如果你是一名醫生, 當你知道有100個孩子從 同一口井中飲水, 其中98人患了腹瀉, 你可以著手治療, 給每個病人都開抗生素, 一劑,一劑,又一劑的開。 可是你也可以走去井邊， 問聲,"井裡到底有什麼鬼東西?" 所以,我開始查閱手頭所有的相關資料, 了解暴露在不幸中, 是如何影響兒童的大腦和身體發育的。
And then one day, my colleague walked into my office, and he said, "Dr. Burke, have you seen this?" In his hand was a copy of a research study called the Adverse Childhood Experiences Study. That day changed my clinical practice and ultimately my career.
然後有一天, 一個同事走進我的辦公室, 他問我,"伯克醫生,你看過這個嗎?" 在他手裡的是 一份調查研究的複印件, 題目是"童年不良經歷(ACE)研究"。 那一天,改變了我的臨床實踐, 也最終改變了我的職業生涯。
The Adverse Childhood Experiences Study is something that everybody needs to know about. It was done by Dr. Vince Felita at Kaiser and Dr. Bob And at the CDC, and together, they asked 17,500 adults about their history of exposure to what they called "adverse childhood experiences," or ACEs. Those include physical, emotional, or sexual abuse; physical or emotional neglect; parental mental illness, substance dependence, incarceration; parental separation or divorce; or domestic violence. For every yes, you would get a point on your ACE score. And then what they did was they correlated these ACE scores against health outcomes. What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population had at least one ACE, and 12.6 percent, one in eight, had four or more ACEs. The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes: the higher your ACE score, the worse your health outcomes. For a person with an ACE score of four or more, their relative risk of chronic obstructive pulmonary disease was two and a half times that of someone with an ACE score of zero. For hepatitis, it was also two and a half times. For depression, it was four and a half times. For suicidality, it was 12 times. A person with an ACE score of seven or more had triple the lifetime risk of lung cancer and three and a half times the risk of ischemic heart disease, the number one killer in the United States of America.
童年不良經歷(ACE)的研究 是每一個人都應該要了解的。 Vince Felitti博士和Bob Anda博士 分別在 Kaiser 和 CDC 進行了這項研究, 他們兩人一起詢問了17,500成年人, 了解他們的"童年不良經歷",又稱ACE。 這包括生理上、情感上 遭受的不幸或是性侵害; 生理或情感上遭受的忽視; 父母患有精神疾病、物質依賴、遭到監禁; 父母分居或離婚; 或家庭暴力。 每個問題只要回答"是", ACE分數就增加一分。 接下來, 他們將ACE分數與健康狀況關聯起來, 得出的結果是令人震驚的。 結論有兩點： 第一點,ACE十分普遍, 簡直令人不可思議。 67%的人曾至少有一個ACE得分, 有12.6%(八分之一)的人 有四或四以上的ACE得分。 研究發現的第二點, 是ACE與健康狀況之間 存在著一種劑量反應關係： ACE得分越高,健康狀況越糟糕。 如果一個人的ACE分數大於等於4分, 他患慢性阻塞性肺病的相對風險 是ACE分數為0時的2.5倍。 患上肝炎的風險是2.5倍。 而患上抑鬱症的風險是4.5倍。 自殺風險是12倍。 ACE分數大於等於7的人 終身都有3倍的風險患上肺癌, 和3.5倍的風險患上冠心病-- 這種目前在美國 當屬頭號殺手的疾病。
Well, of course this makes sense. Some people looked at this data and they said, "Come on. You have a rough childhood, you're more likely to drink and smoke and do all these things that are going to ruin your health. This isn't science. This is just bad behavior."
當然,這其實挺有道理。 有些人看了這些數據之後會說, "好啦,你有個糟糕的童年, 你更容易酗酒和抽菸, 還去做一切 會毀掉你健康的事情。 這又不是科學,這只是壞的行為而已."
It turns out this is exactly where the science comes in. We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children. It affects areas like the nucleus accumbent, the pleasure and reward center of the brain that is implicated in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning. And on MRI scans, we see measurable differences in the amygdala, the brain's fear response center. So, there are real neurologic reasons why folks exposed to high doses of adversity are more likely to engage in high-risk behavior, and that's important to know.
然而,事實證明我們恰恰要用科學來分析它。 目前,我們前所未有的更加理解 早年遭受的不幸 會怎樣影響兒童大腦和身體的發育。 早年遭受的不幸會影響大腦的伏隔核 (nucleus accumbens)-- 人腦中與快樂和獎賞相關 的處理中心, 它與"物質依賴"疾病相關。 早年遭受的不幸 還會抑制大腦的前額葉皮質(Prefrontal cortex), 而前額皮質對神經衝動控制 與執行功能是必不可少的, 這個區域對於學習能力非常關鍵。 在核磁共振成像掃描(MRI)上, 我們觀察到大腦的恐懼反應中樞 - 杏仁核(amygdala)中, 存在可以測量的差異。 因此,這便可以從神經學角度詮釋： 為什麼人們一旦遭受大量不幸, 則更容易出現高風險行為。 了解了這點十分重要。
But it turns out that even if you don't engage in any high-risk behavior, you're still more likely to develop heart disease or cancer. The reason for this has to do with the hypothalamic–pituitary–adrenal axis, the brain's and body's stress response system that governs our fight-or-flight response. How does it work? Well, imagine you're walking in the forest and you see a bear. Immediately, your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal gland that says, "Release stress hormones! Adrenaline! Cortisol!" And so, your heart starts to pound, your pupils dilate, your airways open up, and you are ready to either fight that bear or run from the bear. And that is wonderful if you're in a forest and there's a bear. (Laughter) But the problem is what happens when the bear comes home every night, and this system is activated over and over and over again, and it goes from being adaptive, or life-saving, to maladaptive, or health-damaging. Children are especially sensitive to this repeated stress activation, because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.
但事實證明, 即使你不從事任何高風險的行為, 你仍然更容易患上 心臟疾病或癌症。 因為這與"下丘腦-垂體-腎上腺軸"有關-- 它是大腦和身體的應激反應系統, 支配我們做出"或戰或逃反應"。 (fight-or-flight response)。 這一系統是如何運行的呢? 想像你漫步在森林裡, 突然看到一頭熊。 你的下丘腦會立即 向你的垂體發送信號, 垂體再向你的腎上腺發送信號： "釋放應激激素! 腎上腺素! 皮質醇!" 你的心臟因而開始快速跳動, 瞳孔擴張,呼吸道打開, 這時你已準備好： 要麼就和熊戰鬥,要麼就逃跑。 這個反應很棒-- 如果你在森林裡, 那還有一隻熊。 (笑聲) 可問題是,假如每個晚上 熊都回家來該怎麼辦, 這套系統將一遍又一遍地被激活, 它就會從適應到不適應, 從救你的命到損害你的健康。 兒童對這種反覆的應激激活尤其敏感, 因為他們的大腦和身體 正處在發育階段。 高劑量的不良經歷不僅 會影響大腦結構和功能, 還會影響正在發育的免疫系統, 以及正在發育的內分泌系統, 甚至還會影響 我們的DNA讀取和轉錄方式。
So for me, this information threw my old training out the window, because when we understand the mechanism of a disease, when we know not only which pathways are disrupted, but how, then as doctors, it is our job to use this science for prevention and treatment. That's what we do.
這些知識讓我徹底拋棄了 以前所受訓的那一套, 因為,當我們了解疾病機制時, 當我們 不僅知道哪些路徑被幹擾, 而且知道它們是怎樣被幹擾時, 作為醫生,我們的職責, 就是使用這門科學 去做疾病的防治工作。 那就是我們要做的。
So in San Francisco, we created the Center for Youth Wellness to prevent, screen and heal the impacts of ACEs and toxic stress. We started simply with routine screening of every one of our kids at their regular physical, because I know that if my patient has an ACE score of 4, she's two and a half times as likely to develop hepatitis or COPD, she's four and half times as likely to become depressed, and she's 12 times as likely to attempt to take her own life as my patient with zero ACEs. I know that when she's in my exam room. For our patients who do screen positive, we have a multidisciplinary treatment team that works to reduce the dose of adversity and treat symptoms using best practices, including home visits, care coordination, mental health care, nutrition, holistic interventions, and yes, medication when necessary. But we also educate parents about the impacts of ACEs and toxic stress the same way you would for covering electrical outlets, or lead poisoning, and we tailor the care of our asthmatics and our diabetics in a way that recognizes that they may need more aggressive treatment, given the changes to their hormonal and immune systems.
因此，我們在舊金山創辦了 青少年健康中心, 目的是預防、篩查和治癒 ACE和毒性應激的影響。 我們開始在孩子們的定期體檢中, 對每個孩子進行例行檢查, 因為我知道,如果我的病人ACE得分為4分, 她患上肝炎或慢性阻塞性肺病(COPD) 的概率是1.5倍, 患上抑鬱症的概率是4.5倍, 她自殺的機率 是ACE得分為0的病人的12倍。 她在我的檢查室裡, 我就已經知道這一切了。 對於檢查結果為陽性的病人, 我們有一支多學科綜合治療團隊, 致力於減少不良經歷造成的影響, 並使用最佳療法治療病症, 包括家庭訪視、護理協調、 心理保健、營養、 綜合幹預措施, 以及必要時結合藥物治療。 但我們也教家長們了解 ACE和毒性應激造成的影響, 這種影響與電源插座或鉛中毒 的危險性可以相提並論, 我們調整了哮喘及糖尿病患兒的護理服務, 意識到他們可能需要更積極主動的治療, 以作用於他們的內分泌和免疫系統。
So the other thing that happens when you understand this science is that you want to shout it from the rooftops, because this isn't just an issue for kids in Bayview. I figured the minute that everybody else heard about this, it would be routine screening, multi-disciplinary treatment teams, and it would be a race to the most effective clinical treatment protocols. Yeah. That did not happen. And that was a huge learning for me. What I had thought of as simply best clinical practice I now understand to be a movement. In the words of Dr. Robert Block, the former President of the American Academy of Pediatrics, "Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today." And for a lot of people, that's a terrifying prospect. The scope and scale of the problem seems so large that it feels overwhelming to think about how we might approach it. But for me, that's actually where the hopes lie, because when we have the right framework, when we recognize this to be a public health crisis, then we can begin to use the right tool kit to come up with solutions. From tobacco to lead poisoning to HIV/AIDS, the United States actually has quite a strong track record with addressing public health problems, but replicating those successes with ACEs and toxic stress is going to take determination and commitment, and when I look at what our nation's response has been so far, I wonder, why haven't we taken this more seriously?
當你理解了這門科學時, 你會想要把它廣而告之, 因為這不僅僅是 灣景區(Bayview)孩子的問題。 我本來以為 其他人一旦了解到這一點, 就會著手例行檢查、 組建多學科治療團隊, 甚至大家爭先恐後 想找到最有效的治療方案。 可這些都沒有發生。 這可是給了我一個很大的教訓。 我原以為簡單的找到 最好的臨床手段來治療就行了, 現在我明白了,這是一場運動。 正如Robert Block博士, 這位前美國兒科學會會長所言, "童年不良經歷(ACE)是 今天我們國家所面臨的,唯一,最大的, 未能解決的公共健康威脅." 對於很多人來說, 這個前景可不容樂觀。 這個問題的範圍之廣,規模之大 使我們不得不考慮應對之策。 但在我看來,危機即是轉機， 當我們確立正確框架時, 當我們意識到 這是公共健康危機時, 我們才能開始使用 正確的方法來求得解決方案。 從菸草到鉛中毒,再到愛滋病, 在解決公共健康問題方面, 美國實際上保持著良好記錄, 但要,在ACE和毒性應激方面 取得同樣成功, 則需要下定決心、履行承諾, 當我看到,我們國家 對這一問題至今的反應時, 我想知道, 為什麼我們沒有更認真的對待這個問題?
You know, at first I thought that we marginalized the issue because it doesn't apply to us. That's an issue for those kids in those neighborhoods. Which is weird, because the data doesn't bear that out. The original ACEs study was done in a population that was 70 percent Caucasian, 70 percent college-educated. But then, the more I talked to folks, I'm beginning to think that maybe I had it completely backwards. If I were to ask how many people in this room grew up with a family member who suffered from mental illness, I bet a few hands would go up. And then if I were to ask how many folks had a parent who maybe drank too much, or who really believed that if you spare the rod, you spoil the child, I bet a few more hands would go up. Even in this room, this is an issue that touches many of us, and I am beginning to believe that we marginalize the issue because it does apply to us. Maybe it's easier to see in other zip codes because we don't want to look at it. We'd rather be sick.
要知道,一開始我還想, 這是因為我們漠視了這個問題, 以為它跟我們無關。 以為只有別的小孩, 鄰居家的小孩才有這問題。 但很奇怪,數據可不是這麼說的。 初始ACE的研究樣本群體為： 白人佔70%, 大學畢業佔70%。 後來,我和大家談得多了, 我便開始想,也許 我把這個問題完全本末倒置了。 如果我問現場這個房間內有多少人 在成長過程中 有家庭成員患有精神疾病, 我相信,會有幾個人舉手。 如果我再問,有多少人 父親或母親酗酒, 或者是堅信： 孩子要打,慣不得。 我敢打賭會有更多的人舉手。 即使只是在我們的會場, 這也是一個影響到了很多人的問題。 我開始相信 我們漠視這個問題 是因為,它與我們息息相關。 也許把它說成別的地區的事, 我們才能更容易的看清楚, 因為我們自己情願生病, 也不願意正視這個問題。
Fortunately, scientific advances and, frankly, economic realities make that option less viable every day. The science is clear: Early adversity dramatically affects health across a lifetime. Today, we are beginning to understand how to interrupt the progression from early adversity to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms go unrecognized, whose asthma management is not connected, and who goes on to develop high blood pressure and early heart disease or cancer will be just as anomalous as a six-month mortality from HIV/AIDS. People will look at that situation and say, "What the heck happened there?" This is treatable. This is beatable. The single most important thing that we need today is the courage to look this problem in the face and say, this is real and this is all of us. I believe that we are the movement. Thank you.
幸運的是,科學進步, 坦率地說,還有經濟現實 逐漸使我們無法再繼續漠視下去了。 科學研究清楚顯示： 早期不良經歷對人的一生 的健康影響巨大。 今天,我們開始了解如何中斷 從早期不良經歷發展至 疾病和過早死亡這一進程, 從現在算起,30年後, 高ACE分數的兒童, 如果其行為症狀未被識別, 哮喘診療未與ACE相關聯, 持續發展為高血壓, 並患上早期心臟病或癌症, 那麼這就象6個月的嬰兒患愛滋病一樣, 都是異常的。 人們看到這種情況都會說： "這究竟發生的是什麼鬼事?" 這種病症是可以治療的, 也是可以戰勝的。 我們今天最需要的是 直面這個問題的勇氣, 並且承認,這個問題確實存在, 與我們息息相關。 我相信我們將實現這一變革運動。謝謝大家。
兒童性教育刻不容緩
很長一段時間，性侵都是焦點話題，尤其是兒童性侵。對中國來說，兒童性教育普遍落後，父母們恥於和孩子談及這個話題。
根據兒童安全公益組織Kidsafe基金會的統計，當前我國有2500萬存在不同程度性侵的兒童，18歲以下的孩子中，每四個女孩就有一個曾受到性侵犯，而每六個男孩就有一個遭受性侵。
由於幼童年齡較小，往往會恐懼施暴者的淫威，從而不敢告知父母。而青少年對於性侵感到羞恥和畏懼，選擇獨自舔舐傷口。那麼，作為家長，我們有該如何留意自己孩子究竟是否遭受性侵呢？
今天再分享一個TED演講視頻，讓我們一起聽聽荷蘭健康教育專家Sanderijn vander Doef教授對兒童性教育的思考。
#startvideo#8c1c7e6700ff88f9e8c9c08e076e126e#endvideo#
給家長的TED演講
幼兒能懂的性教育，從保護自己開始
演講摘要稿
↓上下滑動查看↓
演講最開始，Doef教授分享了一個發生在她身邊的小故事：
幾年前的一天，她與同事需要去同事的家裡拿一些東西，同事年幼的兒子開的門。三歲的小男孩，打開門非常好奇地看著她。
當時她穿著長褲，留著短髮，但也戴著耳環，化了妝，小男孩很疑惑，突然問了她一個問題：我能看看你的小雞雞嗎？
其實，對於三歲的孩子來講，這是個好問題。
為什麼呢，因為在這個年齡段的孩子，正在嘗試理解世界的複雜性，他們發現這個世界上有兩種人：男人和女人。
而據他們這麼大年齡所知：男人，穿褲子，留短髮；女人，穿裙子，留長髮。
但是當他們再長大一些，會發現，有一個特徵，可以準確無疑地分辨男女，那就是性器官。
所以小男孩問我了那個問題，他非常疑惑，只是想確認一下。
再一次強調，這對於三歲孩子來說，是個非常非常好的提問，但是，更加重要的，是成年人應對這類問題的方式。
這一次，小男孩的提問讓他媽媽很生氣，她說提這種問題很不合適，這是個錯誤的問題並命令他回到自己的房間去。
我們能從這個小故事中學到什麼？
首先，兒童、幼兒會有很多問題，很多關於性的問題。
其次，談及這些問題讓很多成人感到難堪和尷尬。
不僅僅如此，當我們看到兒童與性有關的行為也會如此。
兒童與性，是個非常敏感的組合。作為性學家的20年致力於研究這個課題，也遭遇了不少誤解、抵制。
到底為什麼讓成年人對於這類問題感到難堪和尷尬呢？在於我們看待性的方式，以及對性的理解、定義。
有人會把與性有關的話題僅僅看作成年人的話題，少兒不宜。對於這類人，性大概是指性行為。
這也是我們想保護兒童的出發點，保護他們不被成人性行為的潛在危險所侵害。
但是，如果我們不去回答孩子們的這類問題，可能會引起什麼後果呢？
讓我們來看看三個可能的後果吧。
①：第一種可能，沒有得到問題答案的孩子們，他們能馬上明白，好吧這是一個錯誤的問題，問了一個錯誤的人。
然後他們會到別的地方尋求答案，問問同齡人，朋友，或許去網上找找答案。
這是我們希望孩子得到關於性的答案嗎？
②：第二種結果，每當兒童有性慾望時（這在孩子身上常發生），他們會感到羞愧，內疚，因為這正是他們從成年人那兒得到的信息：這是不合適的，是錯誤的，小孩子不可以有（性慾）。
③：還有一種結果是，孩子無法在他們感到不適，甚至面臨性侵的時候拒絕別人，因為他們沒有學會拒絕，甚至不知道他們是可以拒絕的。
所以，如果我們換個角度來看待性，會怎麼樣？用更寬闊的視角。
在這種視角下，性，很明顯屬於所有人，也很明顯是從人一出生就有的，人的一生不斷在發展，直到我們身為成人對的性體驗，並且，性慾望不分年齡。
所以，我們需要明白，性，是可以和孩子討論的東西，在討論的方式上，不同年齡的人不同家庭的不同價值觀，在表達方式上也會不一樣，但是，讓孩子知道，他/她的感覺是真實存在的，每一個年齡段都是正常的。
比如，小孩子會通過與小朋友們玩遊戲來疏解感覺，成年人會通過性行為來疏解，當然，向孩子解釋這種區別非常重要。
而解釋的過程正是我們對孩子進行性教育的過程。
性教育所教授的內容遠不單指生殖，還關乎情緒和感受，關於認識自己的身體，關於為自己而自豪，與社會關係有關，性教育與多元化、價值觀也有聯繫。
確切地說，上述的話題都可以與孩子討論。
怎麼做呢？用一些淺顯易懂的語言就可以了，並且簡明扼要，這就是孩子所需要的。
還是有一些人，害怕對幼小的孩子進行性教育，他們擔心這會促成過早的性行為，這個想法也是錯誤的！大錯特錯！
有很多研究表明情況並非如此，性教育，甚至是幼年期的性教育，不會促成早期性行為，與之相反的是，這更好地保護了孩子，不僅僅是保護，還給了他們所需要的一切信息。
所以，我們保護孩子天真地對於性一無所知，是在向他們傳遞信息：性是危險的，性是錯誤的。
正確的做法是坦率地、清楚地回答他們的所有問題。
大家還記得上文裡的小故事嗎，小男孩問她能否看下她的小雞雞，她是如何回答的呢？
她說，不可以，你不可以看我的小雞雞，因為我是個女人，女人沒有小雞雞，只有男人才有，還有什麼問題嗎？
就像Doef教授在演講中提到的：我們從認識性開始認識我們的身體，並為我們自己感到驕傲。
希望有一天，我們不需要掌握這些知識。學校可以是學校，孩子可以是孩子。
防止未來失聯