論"心病"的危害程度與心理暗示

Soon after Suzanne O’Sullivan had left medical school in Dublin, she met a patient named Yvonne, whose mysterious illness appeared to bear little relation to any of her previous studies.

在奧沙利文•蘇珊娜（Suzanne O’Sullivan）離開都柏林一所醫學院後不久，她遇到了一位名叫伊馮（Yvonne）的病人，伊馮所患的神祕疾病似乎與她以前的任何研究都扯不上關係。

Yvonne, she was told, had been stacking the fridges in a supermarket when a colleague had accidentally sprayed a fine mist of window cleaner in her face. She tried to wash her eyes, left work and went to bed early, hoping they would feel less sore the next day. But when she woke up, her vision was worse – everything was so blurry she struggled to read the time on the clock. Twenty-four hours later, she could not tell night from day.

據伊馮所說，她當時在一家超市向冰箱裏堆放物品，一個同事無意間不小心將玻璃清潔劑的噴霧噴到了她的臉上。她試着去洗眼睛，並提早下班離開工作回家休息，希望眼睛疼痛能夠有所好轉。但第二天當她醒來的時候，她的視力變得更糟了，看什麼都很模糊，以至於她要竭盡全力才能看清鬧鐘上的時間。24小時之後情況已經惡化到她無法辨認白天黑夜了。

O’Sullivan’s colleagues assumed Yvonne was faking it, perhaps for some kind of lawsuit. “There’ll be no Oscar for that performance,” one muttered

奧沙利文的同事們認爲伊馮是裝病，以便於進行訴訟。“這種表演不會得奧斯卡獎，”一個員工嘟囔着。

Except after six months of examinations, doctors could find nothing wrong with Yvonne’s eyes. She was eventually admitted to the neurology unit where O’Sullivan was working. During the observations, Yvonne’s eyes would flicker between her husband and the doctors; as the consultant moved an ophthalmoscope close to her eyes, she blinked. It certainly seemed like her eyes were responding to her surroundings, yet she continued to claim that she was enveloped in an impenetrable darkness.

經過長達六個月的檢查，醫生始終也沒有發現伊馮的眼睛有問題。她最終來到了奧沙利文所工作的神經科進行檢查。觀測期間，醫生髮現伊馮的眼睛在看到她丈夫和醫生的時候會顫動；當醫療顧問將檢目鏡（ophthalmoscope）接近她的眼睛，她的眼睛會眨動。很明顯伊馮的眼睛對於周遭的環境能夠做出反應，但據她本人的說法，她的眼睛始終被一團漆黑籠罩。

O’Sullivan’s colleagues assumed she was faking it, perhaps for some kind of lawsuit. “There’ll be no Oscar for that performance,” one muttered after they had left the ward. O’Sullivan herself was unconvinced. “I liked Yvonne. I felt sorry for her. But I did not believe she was blind,” she writes in her new book It’s All in Your Head, recently shortlisted for the Wellcome Book Prize.

奧沙利文的同事們認爲伊馮是裝病，以便於進行訴訟。“這種表演不會得奧斯卡獎，”一個員工嘟囔着。奧沙利文自己不服氣。“我喜歡伊馮。我爲她感到難過。但我不相信她的眼睛瞎了，”她在她的新書《一切都源於你的想象》中寫到，該書最近入圍了英國惠康圖書獎（Wellcome Book Prize）。

Now she knows better. At the Royal London Hospital she has become an expert in “psychosomatic” illnesses. She has treated people who are paralysed from the waist down, or who have such severe cramp in their fingers that their hand has become little more than a claw; one woman could not even empty her bladder without a medical catheter. Yet when doctors look, they can find no physiological cause – suggesting the problem originates in the mind, not the body.

現在她對這種情況有了更深的瞭解。在倫敦皇家醫院（Royal London Hospital），她已經成爲了一個“心身疾病”的專家。她治療那些下半身癱瘓，或有嚴重抽筋症狀的手指，他們的手已成爲一個爪子形狀；一個女人甚至沒有醫用導管就無法排尿。對於這些症狀，醫生卻無法找到任何生理病因，這表明問題源於頭腦，而不是身體。

In this light, it’s perfectly possible that Yvonne really wasn’t conscious of what she was seeing – somehow, her unconscious mind was discarding the information before she became aware of it.

鑑於以上這種情況，伊馮或許有可能無法意識到自己能夠看到的東西，不知怎的，在她能夠意識到之前，她的潛意識在不知不覺中就將信息過濾掉了。

Keen to know more, I spoke to O’Sullivan about her career and her recent book detailing these remarkable case studies.

爲了瞭解更多的信息，我採訪到了奧沙利文，談她的職業生涯，以及她在新書中詳細介紹的這些典型案例。

Although O’Sullivan had seen Patients like Yvonne from the very beginning of her career, the interest intensified once she started specialising in epilepsy. Patients would often come to her suffering from debilitating seizures that left them writhing around on the floor, limbs flailing, helpless, yet when they came in to the hospital for neurological tests, they showed none of the signature brain activity of epilepsy; they were “psychogenic” seizures. “It became obvious no one is talking about these problems that are consistently common, but which are getting no attention in medical journals or medical conferences,” she says. “This is a very neglected area.”

他們真的遭受某種程度的殘疾。他們比大多數身體疾病的人都更殘疾。

That silence brings stigma, meaning that most patients end up feeling insulted by the diagnosis. “Their first reaction is ‘you think I’m doing it on purpose’ or ‘you think it’s not real’ or ‘I could stop it if wanted’,” O’Sullivan says. “There’s this perception that there is a degree of wilfulness”.

雖然奧沙利文已經在早期治療類似伊馮這樣的患者，當她開始專攻癲癇研究的時候她的職業興趣進一步提升了。患者早期的症狀通常有滿地打滾抽筋，肢體痙攣而無助，但當他們來到醫院進行神經學檢查時，他們發現癲癇患者腦部活動並沒有出現那些典型的癲癇症狀；他們是“心因性”的癲癇發作。她說：“很明顯沒有人討論這些普遍存在的問題，在醫學雜誌或醫學會議上沒有受到重視”。她說，“這個領域的研究常常被人忽視。”

If you find their symptoms hard to believe, consider the many profound ways that your emotions already move your body. O’Sullivan points out that every time we cry, or laugh, or shake with anger, if we feel so sad that it is hard to lift ourselves from our bed, or queasy with nausea after we hear of a friend’s food poisoning, then we are experiencing psychosomatic phenomena first-hand. In fact, up to 30% of people visiting their family doctor or GP (and 50% of women seeing their gynaecologist) are enduring symptoms that cannot be explained with a physical cause – suggesting they may be psychosomatic in origin. The difference is that for most of us those feelings pass and we can return to our normal lives, but for O’Sullivan’s patients they are exaggerated and chronic, lasting months, years, even a lifetime.

這種沉默帶來了恥辱，這意味着大多數患者最終因爲診斷結果而感到被羞辱。奧沙利文說：“他們的第一反應是，你認爲我是故意的，或者你認爲這不是真的”或者“我可以阻止它”。“這種看法認爲病人有一定程度的任性”。

They really are disabled. They are more disabled than most people with a physical disease

如果你很難相信他們的症狀，那麼想一想你的情緒如何在很多方面深刻的影響着你身體狀況的。奧沙利文指出，每一次我們哭，或笑，或氣得發抖，如果我們很悲傷，很難起牀，或聽到一個朋友的食物中毒後感到的反胃噁心，這都是心身現象所帶來的反應。事實上，30% 去看家庭醫生或全科醫生的人表示（和50%看婦科醫生的女性病患）經歷了難以用身體疾病解釋的症狀——暗示它們可能起源於心理致病的因素。不同的是，對我們大多數人來說，這些感覺過去之後我們可以恢復到正常生活，但對奧沙利文的患者，這些症狀被放大，拖長，持續數月，數年，甚至一輩子。

She emphasises that the psychological origin does not make the blindness, fatigue, seizures or paralysis any less debilitating. “They really are disabled. They are more disabled than most people with a physical disease.”

她強調，心理根源或許使失明、疲勞、癲癇或癱瘓等症狀更令人感到殘疾。他們真的遭受某種程度的殘疾。他們比大多數身體疾病的人都更殘疾。

Consider Camilla, a lawyer in London, who had been diagnosed with epilepsy before O’Sullivan managed to show that it was psychogenic. She described how humiliating she found the seizures; how people try to help by sitting on her to stop her limbs from flailing about, and stick their fingers down her throat to stop her choking; one man knelt beside her, asking if she was OK, before stealing her mobile phone. “But do you know what happens all the time? People video me on their mobile phones and walk away laughing,” she told O’Sullivan. The more you know about these patients, the harder it is to believe that anyone would deliberately expose themselves to this humiliation.

例如倫敦的一個律師卡米拉（Camilla），在被奧沙利文證明爲心因性疾病之前，她曾經被診斷出患有癲癇。她描述了癲癇發作所帶來的羞辱；有人試圖坐在她身上以阻止她四肢亂動，並堅持用他們的手指伸進着她的喉嚨阻止她窒息；一個人跪在她旁邊，問她是否還好，然後偷走了她的手機。“但是你知道大部分情況下發生了什麼嗎？人們用手機拍攝我的視頻然後笑着走開，“她告訴奧沙利文。你對這些病人瞭解的越多，就越難相信任何人都會故意使自己忍受這樣的恥辱。

O’Sullivan has nevertheless met a few fakers, such as Judith, who claimed to be suffering seizures as the side-effect of chemotherapy for leukaemia years before. Hoping to get to the bottom of the story, O’Sullivan called her into a hospital ward, where a video camera could film a seizure when or if it occurred. Sure enough, at 9:15 in the evening, a nurse found Judith lying on the floor unconscious, falling so hard that she had apparently fractured her hand. When O’Sullivan played back the video, however, she saw there had been no seizure at all. Judith had simply raised her hand and hit it hard against the wall four times, before lying down gently on the floor, pulling down a plate with her to attract the nurse. Indeed, looking at the medical records, it became clear that Judith had never suffered from leukaemia, either.

什麼樣的精神折磨會使人覺得發生了疾病？

What kind of mental torment would make someone invent an illness?

奧沙利文也曾經遇到過一些騙子，如朱迪思（Judith），她自稱患有白血病化療的副作用之一癲癇。爲了能夠進行深入調查，奧沙利文把她叫進了一家醫院的病房，使用視頻攝像機監控她是否和發生痙攣時的情況。果然，在晚上9:15，護士發現朱迪思躺在地上不省人事，並因爲從高處跌落而造成手骨折斷。當奧沙利文重新查看錄像時卻發現病人並沒有發生痙攣。朱迪思只是舉起了手，朝着牆壁猛擊了四次，然後躺在地板上，過程中打碎了一個盤子吸引護士的注意。事實上，從這些醫療記錄看來，很顯然朱迪思也從來沒有患過白血病。

Although such patients with “factitious” illnesses may add to the stigma of people like Camilla or Yvonne, O’Sullivan still feels compassion for these people. After all, what kind of mental torment would make someone behave in this way? Even if Judith hadn’t suffered from leukaemia, perhaps she had witnessed it in someone else – an experience she found difficult to process in any other way? “Factitious illness is one of most serious disorders I know,” O’Sullivan says.

雖然“人造”疾病可能會加深人們對於像卡米拉或伊馮這樣的患者不好的印象，奧沙利文仍然對這些人感到同情。畢竟，什麼樣的精神折磨會使人這樣做？即使朱迪思沒有患上白血病，也許她在從別人身上見過這樣的症狀——一種她在其他方式中難以處理的經歷？“人造的疾病是我所知道的最嚴重的疾病，”奧沙利文說。

There is currently precious little research on the best way to treat psychosomatic illness, but she tends to refer her patients to psychiatrists or to a cognitive behavioural therapist (CBT) who might be able to unknot the distress or trauma that is leading to the illness.

目前很少有人研究治療心身疾病的最好方式，但奧沙利文常常建議她的病人去看精神科醫生或進行認知行爲治療（cognitive behavioural therapist）。這種療法或許可以解開致病痛苦或心靈創傷。

And there are some real success stories. Not all cases can be pinned to a specific event, but Camilla realised that her seizures may have been linked to the death of her young son, setting her on the path to recovery. Yvonne, meanwhile, seemed to have been struggling to juggle the stresses of work, children, and an overbearing husband, and as she learned to cope with those upsets, her sight slowly returned.

有一些真正成功故事。並非所有的病例都可以歸咎於一個特定的事件，但卡米拉意識到她的癲癇發作可能與她的小兒子的死亡有關，意識到這點有助於她慢慢恢復。同時伊馮似乎一直在努力平衡工作，孩子和專橫的丈夫之間的關係，當她學會了應付那些煩心的事，她的視力慢慢恢復。

Patients with paralysis or muscle spasms can also respond well to physiotherapy. “They need to learn how to use their legs again,” O’Sullivan says. It’s often an uphill struggle; particularly with seizures, relapse is common. “We have to give ongoing support and reassurance.”

癱瘓或肌肉痙攣患者也對理療有很好的反應。“他們需要學習如何使用他們的腿，”奧沙利文說。這通常是一場艱苦的鬥爭，特別是癲癇發作，復發是常見的。“我們必須給予持續的支持和保證。”

One of O’Sullivan’s biggest concerns is the rate of misdiagnosis – doctors overlooking the psychological origin of these illnesses, instead prescribing the patients drugs, or even admitting them for harmful surgery. She says this may come from the doctors’ fear; somehow, it seems more serious missing a physical cause of an illness than a psychological cause – yet the damage can be just as great.

奧沙利文最大的擔憂之一是誤診率：醫生可以忽略這些疾病的心理根源，而不是給病人開藥，甚至是承認這些錯誤治療的危害性。她說，這可能來自於醫生的恐懼，不知何故，人們似乎更容易忽略一個疾病的心理因素而不是身體症狀，但兩者的損害時同樣大的。

“The people who have been told they have epilepsy – they will be put on a toxic medication for at least a couple of years, before they accept it’s not going to work.” Over that time, the condition has become a part of the patients’ life – they’ve told their friends, families, and employer, making it much harder to accept the new diagnosis. “You become wedded to it through your own belief and the doctor’s belief,” O’Sullivan says. “You are getting treatment you don’t need for a disease you don’t have, and you are deprived of the treatment you do need – you’re not referred for CBT, a physiotherapist or a psychiatrist.”

被診斷爲癲癇患者的人通常被告知要進行最少兩年的藥物治療，但仍然難以奏效。“在那個時候，這些條件已經成爲病人的生活的一部分，他們告訴他們的朋友，家庭和僱主，以至於更難以接受新的診斷結果。“通過自己相信和醫生的診斷，你已經和診斷結果密不可分，”奧沙利文說。“你接受不需要的治療，診治不存在的病，你失去了你真正需要的治療——你沒有接受CBT治療，或看物理治療師或精神科醫生。”

Perhaps inspired by meeting Yvonne at the start of her career, she would like to raise awareness of psychosomatic illnesses at the earliest stages of a doctor’s training. “My feeling is that it needs to start at medical school-level,” she says. “I must have encountered these patients thousands of times but I have no recollection of being told how I should help them.”

也許受到伊馮案例的啓發，奧沙利文希望能在在醫生訓練的早期階段提高對心身疾病的認識。“我的感覺是，需要從醫學院開始，”她說。“我一定無數次遇到類似的病狀，但我不記得有人告訴我該如何幫助他們。”

For the time being, she hopes that her book will at least spark that conversation; so far, she has already found that a small number of patients are becoming more accepting of the diagnosis, and are less afraid of the stigma attached to it. “I have my fingers crossed that it will be a talking point, that people will feel less ashamed.”

暫時，她希望她的書至少能激起相關討論，到目前爲止，她已經發現了少量的病人變得越來越接受診斷結果，並且對它所帶來的恥辱感也不那麼害怕了。“我希望這成爲一個討論的要點，人們不會因此感到羞愧。”