TED Talks Live
Hector Garcia: We train soldiers for war. Let's train them to come home, too
豪特・加西亞: 我們訓練士兵做戰，也要訓練他們回家。
Filmed:
Readability: 4.3
1,099,517 views
在士兵被送到戰場之前，他們會被訓練如何應對極度危險的環境。但，心理學家豪特・加西亞（Hector Garcia）說，他們也需要訓練如何從戰場中回歸到平民生活，藉由應用訓練士兵作戰的相同原則，加西亞正在幫助那些遭受創傷後壓力症候群（PTSD）的退伍軍人找回他們的人生。中文翻譯者：余易帆
Hector Garcia - Psychologist
Hector A. Garcia has spent his career as a frontline psychologist delivering evidence-based psychotherapies to veterans with posttraumatic stress disorder (PTSD). Full bio
Hector A. Garcia has spent his career as a frontline psychologist delivering evidence-based psychotherapies to veterans with posttraumatic stress disorder (PTSD). Full bio
Double-click the English transcript below to play the video.
00:12
Carlos,
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卡洛斯，
00:14
the Vietnam vet Marine
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越戰海軍陸戰隊老兵，
00:16
who volunteered for three tours
and got shot up in every one.
and got shot up in every one.
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他自願參與了三次戰役，
每次戰役他都受了槍傷。
每次戰役他都受了槍傷。
在1971年，他因身體上的問題退役了。
00:20
In 1971, he was medically retired
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00:22
because he had so much
shrapnel in his body
shrapnel in his body
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因為他體內有太多的子彈碎片
00:25
that he was setting off metal detectors.
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會觸發金屬探測儀。
在接下來的42年當中，他惡夢連連，
00:28
For the next 42 years,
he suffered from nightmares,
he suffered from nightmares,
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00:31
extreme anxiety in public,
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在公共場所會極度不安，
00:33
isolation, depression.
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感到孤立、沮喪。
00:35
He self-medicated with alcohol.
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他用酒精麻醉自己。
00:37
He was married and divorced three times.
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結婚三次又離婚三次。
00:40
Carlos had post-traumatic stress disorder.
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卡洛斯患有創傷後壓力症候群（PTSD）。
現在，我成為一名幫助人們
減輕痛苦的心理學家，
減輕痛苦的心理學家，
00:44
Now, I became a psychologist
to help mitigate human suffering,
to help mitigate human suffering,
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00:47
and for the past 10 years, my target
has been the suffering caused by PTSD,
has been the suffering caused by PTSD,
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在過去的10年，我專注在
像卡洛斯這樣受PTSD所苦的退伍軍人
像卡洛斯這樣受PTSD所苦的退伍軍人
00:52
as experienced by veterans like Carlos.
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作為我的研究目標。
00:55
Until recently, the science of PTSD
just wasn't there.
just wasn't there.
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直到最近，有關PTSD的科學研究還不是很多，
因此，我們並不知道應該怎樣做。
01:01
And so, we didn't know what to do.
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01:03
We put some veterans on heavy drugs.
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我們讓一部分退伍軍人大量服藥。
01:05
Others we hospitalized
and gave generic group therapy,
and gave generic group therapy,
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另一部分則讓他們住院觀察，
進行一般性的團體治療，
進行一般性的團體治療，
01:08
and others still we simply said to them,
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其他的我們只是對他們說：
01:10
"Just go home and try to forget
about your experiences."
about your experiences."
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「回家吧，嘗試著去忘掉你的過去。」
最近，我們還嘗試用治療犬、野外療養——
01:15
More recently, we've tried therapy dogs,
wilderness retreats --
wilderness retreats --
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01:18
many things which may
temporarily relieve stress,
temporarily relieve stress,
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很多能夠短期減緩壓力的方式，
01:21
but which don't actually eliminate
PTSD symptoms over the long term.
PTSD symptoms over the long term.
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但並不能長期根除PTSD的症狀。
但是事情已經有所改變了。
01:26
But things have changed.
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我今天來是想告訴各位，
我們已經可以徹底根除PTSD了，
我們已經可以徹底根除PTSD了，
01:28
And I am here to tell you
that we can now eliminate PTSD,
that we can now eliminate PTSD,
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01:33
not just manage the symptoms,
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不僅僅是控制那些症狀，
01:35
and in huge numbers of veterans.
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而且可以運用在大量的退伍軍人身上。
01:37
Because new scientific research
has been able to show,
has been able to show,
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因為最新的科學研究已經
01:40
objectively, repeatedly,
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客觀的、重覆的顯示
01:42
which treatments actually
get rid of symptoms and which do not.
get rid of symptoms and which do not.
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哪些治療可以消除症狀，而哪些不行。
01:45
Now as it turns out,
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現在，結果表明，
01:47
the best treatments for PTSD use
many of the very same training principles
many of the very same training principles
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PTSD的最佳治療方式，
與軍隊訓練士兵備戰的準則
有幾分相似。
有幾分相似。
01:52
that the military uses
in preparing its trainees for war.
in preparing its trainees for war.
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而製造戰爭——
01:58
Now, making war --
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02:00
this is something that we are good at.
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是我們擅長的事情。
我們人類一直都在製造戰爭，
甚至在我們還沒成為人類之前就開始了。
甚至在我們還沒成為人類之前就開始了。
02:02
We humans have been making war
since before we were even fully human.
since before we were even fully human.
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最那之後，我們從使用石頭、肌腱、
02:08
And since then, we have gone
from using stone and sinew
from using stone and sinew
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02:11
to developing the most sophisticated
and devastating weapon systems imaginable.
and devastating weapon systems imaginable.
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到發展你能想像到的最覆雜、
最具毀滅性的武器系統。
最具毀滅性的武器系統。
02:16
And to enable our warriors
to use these weapons,
to use these weapons,
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且為了使我們的戰士
能夠使用這些武器
能夠使用這些武器
02:18
we employ the most cutting-edge
training methods.
training methods.
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我們會用最先進的訓練方式訓練他們。
02:20
We are good at making war.
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我們善於制造戰爭。
我們善於鍛鍊我們的士兵去作戰。
02:22
And we are good at training
our warriors to fight.
our warriors to fight.
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但是，當我們思考現代戰爭老兵的經歷時，
02:26
Yet, when we consider the experience
of the modern-day combat veteran,
of the modern-day combat veteran,
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02:30
we begin to see that we
have not been as good
have not been as good
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我們就會意識到，
我們在協助老兵回家這件事上並不擅長。
02:33
at preparing them to come home.
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為什麽會這樣呢？
02:35
Why is that?
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我們的祖先生活在沖突當中，
02:37
Well, our ancestors lived
immersed in conflict,
immersed in conflict,
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他們會在他們生活的地方進行戰鬥。
02:41
and they fought right where they lived.
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所以直到人類的進代進化史，
02:44
So until only very recently
in our evolutionary history,
in our evolutionary history,
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02:47
there was hardly a need to learn
how to come home from war,
how to come home from war,
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人類是沒有學習如何回家的需求的，
02:50
because we never really did.
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因為我們從來不這麼做。
但如今值得慶幸的是，
02:53
But thankfully, today,
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02:54
most of humanity lives
in far more peaceful societies,
in far more peaceful societies,
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大多數人都居住在相當和平的社會中，
02:57
and when there is conflict,
we, especially in the United States,
we, especially in the United States,
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當衝突發生時，特別是我們美國人，
03:01
now have the technology to put
our warriors through advanced training,
our warriors through advanced training,
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我們有先進的科技可以訓練士兵，
03:05
drop them in to fight
anywhere on the globe
anywhere on the globe
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把他們送到世界各地打仗，
03:08
and when they're done,
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當戰爭結束時，
03:09
jet them back to peacetime suburbia.
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再把他們載回和平地區。
但是讓我們想象一下這種感受。
03:12
But just imagine for a moment
what this must feel like.
what this must feel like.
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我和那些退伍戰士聊過，
他們告訴我，
他們告訴我，
03:17
I've spoken with veterans who've told me
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03:19
that one day they're in a brutal
firefight in Afghanistan
firefight in Afghanistan
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當你有一天身處阿富汗殘暴的戰火之中，
03:22
where they saw carnage and death,
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目睹到殺戮和死亡，
只要三天的時間，他們就會發現
03:25
and just three days later,
they found themselves
they found themselves
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03:28
toting an ice chest
to their kid's soccer game.
to their kid's soccer game.
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他們竟在孩子的足球比賽中
找冰櫃當掩護。
找冰櫃當掩護。
「腦袋作怪」是他們最常使用的詞匯。
03:32
"Mindfuck" is the most common term.
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03:35
(Laughter)
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（笑聲）
03:36
It's the most common term
I've heard to describe that experience.
I've heard to describe that experience.
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這是我最常聽到
用於描述那種經歷的術語。
用於描述那種經歷的術語。
而那就是他們所經歷的。
03:39
And that's exactly what that is.
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03:41
Because while our warriors
spend countless hours training for war,
spend countless hours training for war,
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因為我們花大量的時間讓士兵備戰，
03:45
we've only recently come to understand
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卻直到最近才意識到
03:47
that many require training
on how to return to civilian life.
on how to return to civilian life.
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他們也需要被訓練學習
如何回歸平民生活。
如何回歸平民生活。
如同任何訓練一樣，最佳的
PTSD治療方式也需要重複進行。
PTSD治療方式也需要重複進行。
03:51
Now, like any training, the best
PTSD treatments require repetition.
PTSD treatments require repetition.
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03:55
In the military,
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在軍隊中，
03:56
we don't simply hand trainees
Mark-19 automatic grenade launchers
Mark-19 automatic grenade launchers
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我們不會丟一把
Mark-19自動榴彈槍給新兵，
Mark-19自動榴彈槍給新兵，
04:00
and say, "Here's the trigger,
here's some ammo and good luck."
here's some ammo and good luck."
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然後跟他說，「這裏是扳機，
還有一些彈藥，祝你好運。」
還有一些彈藥，祝你好運。」
04:03
No. We train them, on the range
and in specific contexts,
and in specific contexts,
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不，我們會在不同的領域
及特定背景中訓練他們，
及特定背景中訓練他們，
04:08
over and over and over
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一遍又一遍的訓練，
04:09
until lifting their weapon
and engaging their target
and engaging their target
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直到他們拿起武器，瞄準目標的行為，
04:12
is so engrained into muscle memory
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深深地刻在肌肉的記憶體當中，
04:14
that it can be performed
without even thinking,
without even thinking,
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即使在任何你想像的到的緊張時刻，
04:16
even under the most stressful
conditions you can imagine.
conditions you can imagine.
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這一系列行為也能夠
不經思索的被執行出來。
不經思索的被執行出來。
這些也同樣適用於以訓練為基礎的治療上。
04:20
Now, the same holds
for training base treatments.
for training base treatments.
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治療的第一步是認知治療，
04:23
The first of these treatments
is cognitive therapy,
is cognitive therapy,
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04:27
and this is a kind
of mental recalibration.
of mental recalibration.
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這是一種「精神重新修正」的療程。
當老兵從戰場中回到家裏時，
04:31
When veterans come home from war,
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04:32
their way of mentally framing
the world is calibrated
the world is calibrated
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因為長時間在危險環境中生活
04:35
to an immensely
more dangerous environment.
more dangerous environment.
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造成他們對世界的認知方式有誤。
04:38
So when you try to overlay that mind frame
onto a peacetime environment,
onto a peacetime environment,
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所以當你試圖將和平環境
覆蓋掉他的認知時，
覆蓋掉他的認知時，
04:44
you get problems.
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麻煩就會出現。
04:45
You begin drowning in worries
about dangers that aren't present.
about dangers that aren't present.
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你會煩惱沈浸在一種不存在的危險當中。
04:49
You begin not trusting family or friends.
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你開始不信任家人和朋友。
我並不是說平民生活中就沒有危險；還是有。
04:53
Which is not to say there are no
dangers in civilian life; there are.
dangers in civilian life; there are.
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只是說遇到危險的幾率，
04:58
It's just that the probability
of encountering them
of encountering them
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05:01
compared to combat
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相比戰爭中而言，
05:02
is astronomically lower.
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是極低的。
所以我們從不建議退伍軍人
徹底關閉他們的警惕性。
徹底關閉他們的警惕性。
05:05
So we never advise veterans
to turn off caution completely.
to turn off caution completely.
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05:08
We do train them, however,
to adjust caution
to adjust caution
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而是訓練他們，根據所處的環境，
05:11
according to where they are.
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調整他們的警惕程度。
如果你發現身處在惡劣的環境中，
05:13
If you find yourself
in a bad neighborhood,
in a bad neighborhood,
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05:16
you turn it up.
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你就要開啟警惕。
和家人一起在外吃飯呢？
05:17
Out to dinner with family?
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05:19
You turn it way down.
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你就應該把它調節到很低。
我們訓練退伍軍人，
讓他們變得相當理智，
讓他們變得相當理智，
05:21
We train veterans to be fiercely rational,
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讓他們能夠系統化的衡量
目前所處的環境，
目前所處的環境，
05:25
to systematically gauge
the actual statistical probability
the actual statistical probability
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05:28
of encountering, say, an IED
here in peacetime America.
here in peacetime America.
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比如說，身處在和平時期的美國
被安裝簡易爆炸裝置的可能性。
被安裝簡易爆炸裝置的可能性。
有了足夠的練習，
那些重新校正的認知就會留存。
那些重新校正的認知就會留存。
05:33
With enough practice,
those recalibrations stick.
those recalibrations stick.
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治療的下一步是暴露療法，
05:39
The next of these treatments
is exposure therapy,
is exposure therapy,
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05:41
and this is a kind of field training,
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就好像實地演習，
也是所有被證明有效的療法中最快見效的。
05:44
and the fastest of the proven
effective treatments out there.
effective treatments out there.
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你們還記得卡洛斯嗎？
05:47
You remember Carlos?
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05:49
This was the treatment that he chose.
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這就是他選擇的治療方案。
05:51
And so we started off
by giving him exercises,
by giving him exercises,
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所以我們從給他一些練習開始，
05:54
for him, challenging ones:
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像是對他來說，最具挑戰性的：
05:55
going to a grocery store,
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去雜貨店、
05:57
going to a shopping mall,
going to a restaurant,
going to a restaurant,
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去商場、餐廳、
06:00
sitting with his back to the door.
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背對著門坐著。
而且，最重要的——
06:03
And, critically --
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要停留在這些環境當中。
06:05
staying in these environments.
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剛開始的時候，他表現的非常不安。
06:07
Now, at first he was very anxious.
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06:09
He wanted to sit
where he could scan the room,
where he could scan the room,
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他希望能夠坐在一個
可以掃視整個餐廳的位置，
可以掃視整個餐廳的位置，
06:12
where he could plan escape routes,
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讓他可以計劃逃脫路線，
06:13
where he could get his hands
on a makeshift weapon.
on a makeshift weapon.
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讓他可以隨手拿到臨時武器的地方。
06:17
And he wanted to leave, but he didn't.
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他很想離開那兒，但是他沒有。
他想起了他在海軍陸戰隊的訓練，
06:20
He remembered his training
in the Marine Corps,
in the Marine Corps,
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06:23
and he pushed through his discomfort.
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他戰勝了他的不安情緒。
06:25
And every time he did this,
his anxiety ratcheted down a little bit,
his anxiety ratcheted down a little bit,
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每當他這樣做時，
他的焦慮感就會逐漸減少，
他的焦慮感就會逐漸減少，
06:28
and then a little bit more
and then a little bit more,
and then a little bit more,
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然後再減少一點點，
再減少一點兒，
再減少一點兒，
06:31
until in the end,
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直到最後，
06:32
he had effectively relearned
how to sit in a public space
how to sit in a public space
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他就能夠重新學會
如何坐在公共場所當中
如何坐在公共場所當中
好好地享受他自己的時光。
06:38
and just enjoy himself.
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他也會聽他戰時經歷的錄音，
06:41
He also listened to recordings
of his combat experiences,
of his combat experiences,
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06:45
over and over and over.
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一遍又一遍地聽。
他不斷聽這些錄音，直到
不再對它們產生不安情緒
不再對它們產生不安情緒
06:47
He listened until those memories
no longer generated any anxiety.
no longer generated any anxiety.
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他不斷地經歷那些回憶，
06:52
He processed his memories so much
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06:55
that his brain no longer needed
to return to those experiences
to return to those experiences
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讓他在睡夢中，腦子不再需要
06:58
in his sleep.
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回到那些經歷中。
在他治療結束一年之後與他交流時，
07:00
And when I spoke with him
a year after treatment had finished,
a year after treatment had finished,
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07:03
he told me,
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他告訴我：
07:05
"Doc, this is the first time in 43 years
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「醫生，這是我在43年當中
第一次沒有做惡夢。」
07:10
that I haven't had nightmares."
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這不同於清除你的回憶。
07:13
Now, this is different
than erasing a memory.
than erasing a memory.
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退伍軍人會永遠記得
他們的創痛經歷，
他們的創痛經歷，
07:18
Veterans will always remember
their traumatic experiences,
their traumatic experiences,
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07:21
but with enough practice,
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但透過足夠的訓練，
07:22
those memories are no longer as raw
or as painful as they once were.
or as painful as they once were.
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那些回憶將不再像以往
那樣鮮活、那樣痛苦。
那樣鮮活、那樣痛苦。
他們不再感到那些經歷恍如昨日，
07:28
They don't feel emotionally
like they just happened yesterday,
like they just happened yesterday,
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07:31
and that is an immensely
better place to be.
better place to be.
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這是一個巨大的進步。
但這並不簡單。
07:37
But it's often difficult.
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而且，就像是任何訓練一樣，
它不一定適用於所有人。
它不一定適用於所有人。
07:39
And, like any training,
it may not work for everybody.
it may not work for everybody.
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而且，還存在信任問題。
07:44
And there are trust issues.
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有時，我會被問道：
07:45
Sometimes I'm asked,
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07:47
"If you haven't been there, Doc,
how can you help me?"
how can you help me?"
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「醫生，如果你從未經歷戰場，
你要如何幫我？」
你要如何幫我？」
07:49
Which is understandable.
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這是可以被理解的。
但是要回歸平民生活，
07:52
But at the point of returning
to civilian life,
to civilian life,
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07:56
you do not require
somebody who's been there.
somebody who's been there.
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你並不需要一個經歷過戰場的人。
你不需要訓練戰場上的行為；
07:59
You don't require training
for operations on the battlefield;
for operations on the battlefield;
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08:03
you require training on how to come home.
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你需要訓練如何回到家中。
在我過去十年的工作經歷當中，
08:10
For the past 10 years of my work,
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我已經接觸過任何你們能想像到
08:13
I have been exposed to detailed accounts
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08:16
of the worst experiences
that you can imagine,
that you can imagine,
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最糟糕的經歷細節，
08:18
daily.
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幾乎每天都會接觸到。
08:19
And it hasn't always been easy.
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那的確不容易，
08:22
There have been times
where I have just felt my heart break
where I have just felt my heart break
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很多時候，我會感到心痛，
08:25
or that I've absorbed too much.
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或者太過投入。
但是這些以訓練為基礎的
治療方法太有效了，
治療方法太有效了，
08:28
But these training-based
treatments work so well,
treatments work so well,
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08:31
that whatever this work takes out of me,
it puts back even more,
it puts back even more,
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因此，無論這個工作都辛苦，
我都覺得很有價值，
我都覺得很有價值，
08:34
because I see people get better.
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因為我看到了人們正在變好。
我看到了人們的生活正在發生轉變。
08:38
I see people's lives transform.
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卡洛斯已經可以和他的
孫子們一起出去玩了，
孫子們一起出去玩了，
08:42
Carlos can now enjoy outings
with his grandchildren,
with his grandchildren,
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08:46
which is something he couldn't even do
with his own children.
with his own children.
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甚至玩一些以前他無法跟
自己孩子一起玩的東西。
自己孩子一起玩的東西。
對我來說最驚喜的是
在43年的折磨之後，
在43年的折磨之後，
08:49
And what's amazing to me
is that after 43 years of suffering,
is that after 43 years of suffering,
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08:53
it only took him 10 weeks
of intense training to get his life back.
of intense training to get his life back.
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他只花了10周的時間進行高強度的訓練，
他就重獲了他的人生。
他就重獲了他的人生。
當我和他交流的時候，他告訴我：
08:58
And when I spoke with him, he told me,
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09:00
"I know that I can't get those years back.
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「我知道我無法挽回那些錯過的歲月。
但至少現在，無論在這世上
我還剩下多少時間，
我還剩下多少時間，
09:05
But at least now, whatever days
that I have left on this Earth,
that I have left on this Earth,
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09:10
I can live them in peace."
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我可以在平靜中度過。」
他還說：「我希望那些年輕的退伍軍人
09:13
He also said, "I hope that these
younger veterans don't wait
younger veterans don't wait
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09:16
to get the help they need."
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不要為他們需要的幫助猶豫。」
09:18
And that's my hope, too.
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那也是我所希望的。
因為，
09:21
Because ...
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人生是短暫的，
09:23
this life is short,
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如果你們有幸在戰爭當中
09:25
and if you are fortunate enough
to have survived war
to have survived war
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09:28
or any kind of traumatic experience,
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或是各種創傷性經歷中幸存下來，
09:30
you owe it to yourself
to live your life well.
to live your life well.
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你虧欠自己一個美好的人生。
所以，你們不該等待接受那些
09:34
And you shouldn't wait
to get the training you need
to get the training you need
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09:37
to make that happen.
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幫助你獲得美好人生的訓練。
現在，能夠避免戰後創傷的最佳方式，
09:40
Now, the best way of ending
human suffering caused by war
human suffering caused by war
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就是避免戰爭。
09:46
is to never go to war.
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但是我們人類還沒有達到那樣的境界。
09:49
But we are just not there
yet as a species.
yet as a species.
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在那之前，
09:52
Until we are,
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09:53
the mental suffering that we create
in our sons and in our daughters
in our sons and in our daughters
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當我們把子女送去戰場，
09:58
when we send them off to fight
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所造成的精神折磨
10:00
can be alleviated.
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是可以被緩解的。
但是我們必須要確保
我們將他們送去戰場時
我們將他們送去戰場時
10:03
But we must ensure that the science,
the energy level, the value
the energy level, the value
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那些科學、資源水準、價值觀，
10:09
that we place on sending them off to war
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至少是要能夠反應
10:13
is at the very least mirrored
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10:15
in how well we prepare them
to come back home to us.
to come back home to us.
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我們會好好地準備
讓他們回到家中的水準。
讓他們回到家中的水準。
因為我們欠他們的，
遠比我們給的多。
遠比我們給的多。
10:19
This much, we owe them.
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10:22
Thank you.
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謝謝。
10:23
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Hector Garcia - PsychologistHector A. Garcia has spent his career as a frontline psychologist delivering evidence-based psychotherapies to veterans with posttraumatic stress disorder (PTSD).
Why you should listen
Hector A. Garcia is a psychologist with the Valley Coastal Bend Veterans Health Care System and a clinical assistant professor in the Department of Psychiatry at UT Health Science Center at San Antonio.
In his work as a researcher, Garcia examines barriers to PTSD care, masculine identity and its impact on PTSD treatment-seeking, and how occupational burnout impacts PTSD care providers, who daily hear detailed accounts of trauma. As a teacher and scientist, he explores how evolutionary psychology and biology have influenced human tendencies toward violence in religion.
Garcia's groundbreaking book, Alpha God: The Psychology of Religious Violence and Oppression, reveals how human evolutionary history has left us prone to religiously inspired bloodshed. In particular, he explains how men's competition over evolutionary resources -- especially sexual primacy and territorial control -- has too often been projected onto notions of God, resulting in religious warfare, the oppression of women and ecological devastation. His regular blog on Psychology Today examines the evolutionary psychology of violence, politics, religion and our everyday lives.
Hector Garcia | Speaker | TED.com