TED2003
Sherwin Nuland: How electroshock therapy changed me
Sherwin Nuland om elektrochok terapi
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Kirurg og forfatter Sherwin Nuland beskriver udviklingen af elektrochok terapi som en kur for alvorlig, livstruende depression -- Inklusivt hans egen. Det er en bevægende og hudløs ærlig tale om befrielse, tilgivelse og en ny chance i livet.
Sherwin Nuland - Doctor
A practicing surgeon for three decades, Sherwin Nuland witnessed life and death in every variety. Then he turned to writing, exploring what there is to people beyond just anatomy. Full bio
A practicing surgeon for three decades, Sherwin Nuland witnessed life and death in every variety. Then he turned to writing, exploring what there is to people beyond just anatomy. Full bio
Double-click the English transcript below to play the video.
00:26
I'd like to do pretty much what I did the first time,
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Jeg vil gerne gøre stort set det samme som første gang,
00:28
which is to choose a light-hearted theme.
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og tale om et opløftende emne.
00:31
Last time, I talked about death and dying.
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Sidste gang talte jeg om døden og at dø.
00:34
This time, I'm going to talk about mental illness.
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Denne gang vil jeg tale om mental sygdom.
00:39
But it has to be technological,
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Men det skal jo være noget teknologisk,
00:40
so I'll talk about electroshock therapy. (Laughter)
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så jeg vil tale om elektrochok. (Latter)
00:45
You know, ever since man had any notion
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Siden mennesket har været opmærksom
00:48
that some of his other people, his colleagues,
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på at nogle af hans artsfæller, hans kollegaer,
00:52
could be different, could be strange, could be severely depressed
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kunne være anderledes - sære - svært deprimeret
00:56
or what we now recognize as schizophrenia,
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eller det, vi i dag kender som skizofrene,
01:00
he was certain that this kind of illness
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var man sikker på, at den slags sygdom
01:03
had to come from evil spirits getting into the body.
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måtte komme fra onde ånder, som fandt adgang til ens krop.
01:06
So, the way of treating these diseases
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Så måden man behandlede disse sygdomme
01:08
in early times was to, in some way or other,
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i gamle dage var, på en eller anden måde,
01:11
exorcise those evil spirits, and this is still going on, as you know.
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at uddrive disse onde ånder. Og det forgår stadigt i dag, som bekendt.
01:16
But it wasn't enough to use the priests.
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Men det var ikke nok at bruge præster.
01:18
When medicine became somewhat scientific, in about 450 BC,
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Da medicinen blev delvist videnskabeligt ca. 450 f.kr.,
01:23
with Hippocrates and those boys,
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med Hippocrates og de drenge.
01:25
they tried to look for herbs, plants
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De prøvede at finde urter, planter,
01:29
that would literally shake the bad spirits out.
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som bogstaveligt talt ville ryste de onde ånder ud.
01:32
So, they found certain plants that could cause convulsions.
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Så de fandt særlige planter, der ville forårsage ryste-kramper.
01:35
And the herbals, the botanical books of up to the late Middle Ages,
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Og "Urter," de botaniske bøger langt op i middelalderen
01:41
the Renaissance are filled with prescriptions
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og Renæssancen, er fyldt med opskrifter
01:45
for causing convulsions to shake the evil spirits out.
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på frembringelse af ryste-kramper, som skulle ryste de onde ånder ud.
01:50
Finally, in about the sixteenth century,
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Endeligt, omkring det 16 århundrede,
01:54
a physician whose name was Theophrastus Bombastus Aureolus von Hohenheim,
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fik en læge hvis navn var Theophrastus Bombastus Auricularis von Hohenheim,
02:00
called Paracelsus, a name probably familiar to some people here --
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kaldet Paracelsus, et navn der sikkert er bekendt for nogle af jer,
02:04
(Laughter) -- good, old Paracelsus
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-- (latter) -- gode gamle Paracelsus,
02:09
found that he could predict the degree of convulsion
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fandt, at han kunne forudsige mængden af kramper
02:13
by using a measured amount of camphor to produce the convulsion.
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ved at bruge en afmålt mængde af kampfer til at frembringe kramper.
02:17
Can you imagine going to your closet, pulling out a mothball, and
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Kunne du forstille dig at gå hen til dit skab, tage en mølkugle ud og
02:20
chewing on it if you're feeling depressed?
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tygge på den, hvis du følte dig deprimeret?
02:23
It's better than Prozac, but I wouldn't recommend it.
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Det er sikkert bedre end Prozac, men jeg vil nu ikke anbefale det.
02:26
So what we see in the seventeenth, eighteenth century
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Så hvad vi så i det 17 og 18 århundrede
02:29
is the continued search for medications other than camphor that'll do the trick.
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var den forsatte søgen efter andre medikamenter end kampfer.
02:34
Well, along comes Benjamin Franklin,
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Så kom Benjamin Franklin,
02:36
and he comes close to convulsing himself
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og han var nær ved at få ryste-kramper selv
02:38
with a bolt of electricity off the end of his kite.
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af et elektriske stød fra hans drage.
02:42
And so people begin thinking in terms of electricity to produce convulsions.
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Så folk begyndte at tænke på elektricitet, når de ville skabe kramper.
02:47
And then, we fast-forward to about 1932,
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Og nu spoler vi tiden frem til omkring 1932,
02:51
when three Italian psychiatrists, who were largely treating depression,
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hvor tre Italienske læger, som for det meste behandlede depression,
02:57
began to notice among their patients, who were also epileptics,
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begyndte at ligge mærke til, at blandt dem der også var epileptikere
03:00
that if they had an epileptic -- a series of epileptic fits,
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at hvis de havde et epileptisk -- en hel serie af epileptiske anfald,
03:03
a lot of them in a row -- the depression would very frequently lift.
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i række efter hinanden -- depressionen ville da ofte formindskes.
03:07
Not only would it lift, but it might never return.
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Ikke bare formindskes, men nogen fik det aldrig igen.
03:11
So they got very interested in producing convulsions,
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Så de blev meget interesseret i at frembringe kramper,
03:16
measured types of convulsions.
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kontrollerede slags kramper.
03:18
And they thought, "Well, we've got electricity, we'll plug somebody into the wall.
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Og de tænkte, "Nå ja, vi har jo det der elektricitet, vi prøver at sætte strøm til nogen.
03:21
That always makes hair stand up and people shake a lot."
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Det får jo altid deres hår til at rejse sig og folk ryster en masse."
03:24
So, they tried it on a few pigs, and none of the pigs were killed.
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Så, de testede det på et par svin, og ingen af svinene døde.
03:28
So, they went to the police and they said,
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Så de gik til politiet og sagde,
03:30
"We know that at the Rome railroad station,
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"Vi ved at på Rom´s banegård
03:33
there are all these lost souls wandering around,
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vandrer alle de der fortabte sjæle rundt,
03:35
muttering gibberish. Can you bring one of them to us?"
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og mumler volapyk. Kunne i bringe én af dem til os?"
03:39
Someone who is, as the Italians say, "cagoots."
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Én, der er det Italienerne kalder "cagutis."
03:42
So they found this "cagoots" guy,
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Så de fandt en "cagutis" gut,
03:44
a 39-year-old man who was really hopelessly schizophrenic,
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en 39-år-gammel mand, der var håbløst skizofren,
03:47
who was known, had been known for months,
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som var kendt for i måneder,
03:50
to be literally defecating on himself,
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at have smurt sig i lort - bogstaveligt talt,
03:54
talking nothing that made any sense,
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som ikke sagde noget, der gav mening,
03:56
and they brought him into the hospital.
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og ham bragte de så hen på hospitalet.
03:58
So these three psychiatrists, after about two or three weeks of observation,
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Så disse tre psykiatere - efter cirka to til tre ugers observation -
04:02
laid him down on a table,
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lagde ham på et bord,
04:04
connected his temples to a very small source of current.
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og forbandt hans tindinger til en meget svag strøm.
04:09
They thought, "Well, we'll try 55 volts, two-tenths of a second.
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De tænkte, "Vi prøver 55 volt, to tiende dele af et sekund.
04:13
That's not going to do anything terrible to him."
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Det kan da umuligt gøre ham noget slemt."
04:16
So they did that.
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Så det gjorde de.
04:17
Well, I have the following from a firsthand observer,
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Jeg har det følgende fra et øjenvidne,
04:21
who told me this about 35 years ago,
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der fortalte mig det for ca 35 år siden,
04:24
when I was thinking about these things
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da jeg overvejede dette emne
04:26
for some research project of mine.
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til et forsknings projekt.
04:29
He said, "This fellow" -- remember, he wasn't even put to sleep --
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Han sagde, "Denne fyr -- husk på, han var ikke engang bedøvet --
04:33
"after this major grand mal convulsion,
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efter denne drabelige omgang kramper,
04:35
sat right up, looked at these three fellas and said,
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satte sig op, kiggede på de tre gutter og sagde,
04:38
'What the fuck are you assholes trying to do?' "
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"Hvad helvede har i røvhuller gang i?"
04:42
(Laughter)
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(Latter)
04:50
If I could only say that in Italian.
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Kunne jeg dog bare sige det på Italiensk.
04:53
Well, they were happy as could be, because he
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Nå ja, de blev så glade, for han
04:56
hadn't said a rational word in the weeks of observation.
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havde ikke ydret én fornuftig sætning i de uger, han blev observeret.
05:00
So they plugged him in again,
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Så de satte ham i stikket igen,
05:05
and this time they used 110 volts for half a second.
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og denne gang brugte de 110 volt i ca et halvt sekund.
05:09
And to their amazement, after it was over,
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Og til deres forbløffelse, efter det var slut,
05:12
he began speaking like he was perfectly well.
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begyndte han at tale, som var han sig selv igen.
05:15
He relapsed a little bit, they gave him a series of treatments,
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Han fik lidt tilbage fald, men de gav ham en serie behandlinger,
05:18
and he was essentially cured.
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og han blev praktisk taget kureret.
05:19
But of course, having schizophrenia,
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Men naturligvis, med skizofreni
05:22
within a few months, it returned.
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kom det jo tilbage i løbet af et par måneder.
05:24
But they wrote a paper about this,
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Men de skrev en afhandling om dette,
05:26
and everybody in the Western world began using electricity
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og alle i den vestlige verden begyndte at bruge elektricitet
05:31
to convulse people who were either schizophrenic or severely depressed.
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til at frembringe kramper på folk, der var enten skizofrene eller deprimerede
05:35
It didn't work very well on the schizophrenics,
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Det fungerede ikke særligt godt på de skizofrene,
05:37
but it was pretty clear in the '30s and by the middle of the '40s
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men det stod rimeligt klart i 30rne og i midten af 40rne,
05:40
that electroconvulsive therapy was very, very effective
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at elektrisk krampe-terapi var meget, meget effektivt
05:46
in the treatment of depression.
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til behandling af depression.
05:48
And of course, in those days, there were no antidepressant drugs,
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Og naturligvis, var der dengang, ikke noget der hed antidepressiva,
05:51
and it became very, very popular.
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og det blev meget, meget populært.
05:54
They would anesthetize people,
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De bedøvede folk,
05:56
convulse them, but the real difficulty was
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gav dem kramper, men det store problem var,
05:59
that there was no way to paralyze muscles.
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at der ikke var nogen metode til at lamme muskler.
06:01
So people would have a real grand mal seizure.
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Så folk ville få nogen virkeligt drabelige krampeanfald.
06:04
Bones were broken. Especially in old, fragile people,
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Ben brækkede -- specielt på gamle, skrøbelige mennesker,
06:07
you couldn't use it.
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kunne man ikke bruge det.
06:09
And then in the 1950s, late 1950s, the so-called muscle relaxants
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Men så i 1950, de sene 1950ere, blev muskel-afslapningmidler
06:14
were developed by pharmacologists,
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udviklet af farmaceuter,
06:16
and it got so that you could induce a complete convulsion,
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og det gjorde muligt at frembringe en komplet krampe,
06:20
an electroencephalographic convulsion -- you could see it on the brain waves --
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en elektroencefalografisk krampetrækning -- man kunne se det på hjernebølgerne --
06:23
without causing any convulsion in the body except a little bit of twitching of the toes.
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uden at frembringe nogen kramper i kroppen, på nær lidt rysten i tæerne.
06:28
So again, it was very, very popular and very, very useful.
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Så det var igen meget, meget populært og meget, meget nyttigt.
06:34
Well, you know, in the middle '60s,
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Nåh, men så i midten af 60erne,
06:36
the first antidepressants came out. Tofranil was the first.
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kom de første antidepressiva frem. Tofranil var det første.
06:40
In the late '70s, early '80s, there were others,
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Og i de sene 70ere og tidlige 80ere kom der flere,
06:44
and they were very effective.
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som var meget effektive.
06:45
And patients' rights groups seemed to get very upset
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Og patientrettigheds-grupperne blev åbenbart meget oprørt
06:48
about the kinds of things that they would witness.
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over de ting, de kom til at være vidne til.
06:51
And so the whole idea of electroconvulsive, electroshock therapy disappeared,
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Så hele ideen med eletro-krampe, elektrochok-terapi forsvandt
06:57
but has had a renaissance in the last 10 years.
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-- men det har haft en renæssance i de seneste 10 år.
07:01
And the reason that it has had a renaissance
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Og årsagen til at det har fået en renæssance
07:04
is that probably about 10 percent of the people, severe depressives,
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er sikkert, at ca. 10 procent af de stærkt depressive patienter,
07:10
do not respond, regardless of what is done for them.
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ikke får nogen bedring, uanset hvad der gøres.
07:15
Now, why am I telling you this story at this meeting?
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Hvorfor fortæller jeg denne historie ved dette møde?
07:19
I'm telling you this story, because actually ever since
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Jeg fortæller denne historie, fordi faktisk lige siden
07:22
Richard called me and asked me to talk about
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Richard ringede til mig og og bad mig tale om
07:24
-- as he asked all of his speakers --
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-- som han beder af alle sine talere --
07:26
to talk about something that would be new to this audience,
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at tale om noget, som ville være nyt for jer,
07:29
that we had never talked about, never written about,
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som vi aldrig har holdt tale om og aldrig skrevet om.
07:32
I've been planning this moment.
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Jeg har længe planlagt dette øjeblik.
07:35
This reason really is that I am a man who, almost 30 years ago,
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Årsagen er i virkeligheden, at jeg er en mand, som for næsten 30 år siden
07:40
had his life saved by two long courses of electroshock therapy.
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fik sit liv reddet ved to lange forløb med elektrochok terapi.
07:48
And let me tell you this story.
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Og lad mig fortælle denne historie.
07:52
I was, in the 1960s, in a marriage. To use the word bad
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Jeg var, i 1960erne, i et ægteskab ... at bruge ordet "dårligt"
07:58
would be perhaps the understatement of the year.
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ville måske være dette års underdrivelse.
08:01
It was dreadful.
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Det var rædselsfuldt.
08:03
There are, I'm sure, enough divorced people in this room
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Der er sikkert mange fraskilte i denne sal
08:06
to know about the hostility, the anger, who knows what.
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der kender til den fjendtlighed, den vrede, og hvad ved jeg.
08:12
Being someone who had had a very difficult childhood,
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Som én, der har haft en meget besværlig barndom,
08:17
a very difficult adolescence --
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og en meget besværlig ungdom,
08:18
it had to do with not quite poverty but close.
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-- det havde noget at gøre med -- ikke just fattigdom, men tæt på.
08:22
It had to do with being brought up in a family where no one spoke English,
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Det havde noget at gøre med at vokse op i en familie, hvor ingen talte Engelsk
08:25
no one could read or write English.
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Ingen kunne læse eller skrive Engelsk.
08:27
It had to do with death and disease and lots of other things.
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Det havde noget at gøre med død og sygdom om mange andre ting.
08:31
I was a little prone to depression.
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-- Jeg havde også en tendens til depression.
08:33
So, as things got worse, as we really began to hate each other,
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Så, da tingene blev værre, da vi virkeligt begyndte at hade hinanden,
08:37
I became progressively depressed over a period of a couple of years,
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begyndte jeg gradvis, at blive deprimeret løbet af nogen år,
08:41
trying to save this marriage,
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mens jeg kæmpede for dette ægteskab,
08:43
which was inevitably not to be saved.
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som tydeligvis ikke stod til at redde.
08:47
Finally, I would schedule -- all my major surgical cases,
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Til sidst, ville jeg planlægge -- alle mine store operationer,
08:53
I was scheduling them for 12, one o'clock in the afternoon,
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Jeg placerede dem til klokken tolv - et stykker om eftermiddagen,
08:57
because I couldn't get out of bed before about 11 o'clock.
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fordi jeg ikke kunne komme ud af sengen før kl. 11.
09:01
And anybody who's been depressed here knows what that's like.
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Og alle som har prøvet at være deprimeret her, ved hvordan det er.
09:04
I couldn't even pull the covers off myself.
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Jeg kunne ikke engang løfte min dyne.
09:08
Well, you're in a university medical center,
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Man er i universitetets operationscenter,
09:10
where everybody knows everybody, and it's perfectly clear to my colleagues,
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hvor alle kender alle, og mine kollegaer så det tydeligt,
09:13
so my referrals began to decrease.
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så henvisningerne til mig, begyndte at dale.
09:15
As my referrals began to decrease,
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Som henvisningerne begynde at dale,
09:18
I clearly became increasingly depressed
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blev jeg tydeligt mere og mere deprimeret,
09:22
until I thought, my God, I can't work anymore.
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du godeste, jeg kan ikke arbejde længere.
09:24
And, in fact, it didn't make any difference
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Og det gjorde egentlig ingen forskel,
09:26
because I didn't have any patients anymore.
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for jeg havde ingen patienter længere.
09:28
So, with the advice of my physician,
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Så, efter råd fra min læge,
09:32
I had myself admitted to the acute care psychiatric unit of our university hospital.
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fik jeg mig selv indlagt hos Akut Psykiatrisk afdeling på vores universitets hospital.
09:37
And my colleagues, who had known me since medical school
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Og mine kollegaer, som kendte mig siden lægestudiet
09:40
in that place, said, "Don't worry, chap. Six weeks,
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på stedet, sagde, "Ikke noget problem, makker. Seks uger,
09:42
you're back in the operating room. Everything's going to be great."
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og du er tilbage i operationsrummet igen. Alt bliver godt."
09:46
Well, you know what bovine stercus is?
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Ja, i ved vel hvad bovine stercus står for ikke?
09:50
That proved to be a lot of bovine stercus.
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Det viste sig at være det rene bovine stercus.
09:56
I know some people who got tenure in that place with lies like that.
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Jeg kender flere, der er blevet fastansatte ved at fyre den slags løgne af.
10:01
(Laughter)
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(Latter)
10:07
So I was one of their failures.
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Så jeg var en af deres nederlag.
10:10
But it wasn't that simple. Because by the time
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Men det var ikke bare så simpelt. For på den tid
10:12
I got out of that unit, I was not functional at all.
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forlod jeg afdelingen, Jeg fungerede overhovedet ikke længere.
10:17
I could hardly see five feet in front of myself.
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Jeg kunne knapt nok se fem fod frem for mig.
10:19
I shuffled when I walked. I was bowed over.
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Jeg slæbte fødderne når jeg gik. Jeg var sammenbøjet.
10:22
I rarely bathed. I sometimes didn't shave. It was dreadful.
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Jeg gik sjældent i bad. Jeg barberede mig til tider ikke. Det var forfærdeligt.
10:27
And it was clear -- not to me,
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Og det stod helt klart -- bare ikke for mig,
10:30
because nothing was clear to me at that time anymore --
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for ingenting stod længere klart for mig --
10:33
that I would need long-term hospitalization
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at jeg have brug for en lang-tids indlæggelse
10:37
in that awful place called a mental hospital.
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på det frygtelige sted, man kalder et psykiatrisk hospital.
10:41
So I was admitted, in 1973, in the spring of 1973,
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Så jeg blev indlagt, i 1973, foråret 1973,
10:47
to the Institute of Living, which used to be called the Hartford Retreat.
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på "De Levendes Institut", hvilket før blev kaldt Hartford Rekreat.
10:50
It was founded in the eighteenth century,
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Det blev grundlagt i det 18 århundrede,
10:52
the largest psychiatric hospital in the state of
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det største psykiatriske hospital i staten
10:56
Connecticut, other than the huge public hospitals
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Connecticut, udover de store offentlige hospitaler
10:58
that existed at that time.
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der fandtes dengang.
11:01
And they tried everything they had.
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De forsøgte med alt hvad de havde.
11:02
They tried the usual psychotherapy.
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De prøvede med almindelig psykoterapi.
11:04
They tried every medication available in those days.
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De forsøgte med alt tilgængelig medicin fra dengang.
11:07
And they did have Tofranil and other things -- Mellaril, who knows what.
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De havde Trofranil og andre ting -- Mellaril, hvem ved hvad.
11:11
Nothing happened except that I got jaundiced from one of these things.
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Intet skete, udover at jeg blev endnu mere dyster.
11:15
And finally, because I was well known in Connecticut,
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Og endeligt, fordi jeg var velkendt i Connecticut,
11:21
they decided they better have a meeting of the senior staff.
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besluttede de, at de nok hellere måtte have et møde med de overordnede.
11:25
All the senior staff got together, and I later found out what happened.
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Alle de overordnede holdt møde, og jeg har siden fundet ud af hvad der skete.
11:31
They put all their heads together and they decided
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De stak deres hoveder sammen, og de besluttede,
11:35
that there was nothing that could be done
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at der ikke var mere, der kunne gøres
11:37
for this surgeon who had essentially separated himself from the world,
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for denne kirurg, der mere eller mindre havde separeret sig selv fra omverden,
11:41
who by that time had become so overwhelmed,
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der på det tidspunkt var blevet så overmandet
11:45
not just with depression and feelings
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-- ikke bare med depression og følelser
11:48
of worthlessness and inadequacy,
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af uværdighed og utilstrækkelighed,
11:50
but with obsessional thinking,
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men med tvangstanker,
11:53
obsessional thinking about coincidences.
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tvangstanker omkring tilfældige sammenfald.
11:55
And there were particular numbers that every time I saw them,
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Og det var i særdeleshed tal, som gjorde mig frygtelig oprørt,
11:58
just got me dreadfully upset -- all kinds of ritualistic observances,
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hver gang jeg så dem. Alle mulige ritualer --
12:04
just awful, awful stuff.
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bare frygteligt, frygteligt.
12:06
Remember when you were a kid, and you had to step on every line?
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Husker du fra din barndom, hvor du gik på linjerne på fortovet?
12:09
Well, I was a grown man who had all of these rituals,
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Jeg var en voksen mand, der havde den slags ritualer,
12:13
and it got so there was a throbbing, there was a ferocious fear in my head.
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og det blev så slemt, at hvis jeg hørte noget banke -- så skete der frygtelige ting oppe i mit hovede.
12:17
You've seen this painting by Edvard Munch,
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I har alle set Edvard Munch´s maleri,
12:19
The Scream. Every moment was a scream.
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"Skriget." "Skriget." Min hverdag var et stort skrig.
12:24
It was impossible. So they decided there was no therapy,
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Det var helt umuligt. Så de besluttede, at der ikke fandtes nogen behandling,
12:27
there was no treatment. But there was one treatment,
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der fandtes ingen behandling. Men der var dog én behandling,
12:30
which actually had been pioneered at the Hartford hospital in the early 1940s,
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som faktisk blev udforsket på Hartford hospital i de tidlige 1940erne,
12:35
and you can imagine what it was. It was pre-frontal lobotomy.
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og i kan nok nok forstille jer hvad det var. Det var det hvide snit.
12:43
So they decided -- I didn't know this, again,
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Så de besluttede -- Jeg vidste intet om dette, som sagt,
12:45
I found this out later --
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Det var noget jeg fandt ud af senere --
12:46
that the only thing that could be done was
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at det eneste der kunne gøres
12:48
for this 43-year-old man to have a pre-frontal
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for denne 43-år-gamle mand var at give ham det ...
12:52
lobotomy.
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hvide snit
12:55
Well, as in all hospitals, there was a resident
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Nå ja, som ved alle hospitaler, var der en reservelæge
12:58
assigned to my case. He was 27 years old,
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tilknyttet min sag. Han var 27 år gammel,
13:01
and he would meet with me two or three times a week.
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og han havde møder med mig to tre gange om ugen.
13:03
And of course, I had been there, what, three or four months at the time.
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Og naturligvis, jeg havde været der -- tre eller fire måneder på det tidspunkt.
13:07
And he asked to meet with the senior staff, and they agreed to meet with him
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Og han bad om et møde med den øverste ledelse, og det gik de med til,
13:10
because he was very well thought of in that place.
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for de havde høje tanker om ham på stedet.
13:12
They thought he had a really extraordinary future.
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De mente han havde en meget lysende fremtid for sig.
13:16
And he dug in his heels and said,
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Og han satte hælene i og sagde,
13:17
"No. I know this man better than any of you. I have met with him over and over again.
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"Nej. Jeg kender denne mand bedre end nogen af jer. Jeg har mødt ham gang på gang.
13:21
You've just seen him from time to time. You've read reports and so forth.
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I har bare set ham ind i mellem. I har læst hans journaler og så videre.
13:25
I really honestly believe that the basic problem here is pure depression,
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Jeg tror, helt ærligt at hovedproblemet her er rendyrket depression,
13:30
and all of the obsessional thinking comes out of it.
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og at alle tvangstankerne kommer heraf.
13:33
And you know, of course, what'll happen if you do a pre-frontal lobotomy.
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Og i ved naturligvis, hvad der sker hvis man får det hvide snit.
13:36
Any of the results along the spectrum,
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Resultatet bliver alt fra slemt,
13:40
from pretty bad to terrible, terrible, terrible
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til forfærdeligt, frygteligt, slemt.
13:42
is going to happen. If he does the best he can,
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Hvis han gøre det bedste han kan,
13:46
he will have no further obsessions,
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vil han ikke længere have tvangstanker,
13:48
probably no depression, but his affect will be dulled,
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sandsynligvis ingen depression, men hans væsen vil være sløvet,
13:51
he will never go back to surgery,
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han vil aldrig vende tilbage til kirurgi,
13:53
he will never be the loving father that he was to his two children,
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han vil aldrig blive den kærlige far som han var for sine to børn,
13:57
his life will be changed. If he has the usual result,
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han liv vil være forandret. Hvis han får det sædvanlige resultat,
14:00
he will end up like 'One Flew Over the Cuckoo's Nest.'
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vil han ende som Jack Nicholson i "Gøgereden"
14:03
And you know about that, just essentially in a stupor the rest of his life."
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Og det er i udmærket klar over, han vil praktisk talt gå i en døs resten af sit liv.
14:08
Well, he said, "Can't we try a course of electroshock therapy?"
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Ja, han sagde, "kan vi ikke prøve et række elektrochok-behandlinger?"
14:14
And you know why they agreed? They agreed to humor him.
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Og ved i hvad? - De gik med til det. De gik med for at behage ham.
14:17
They just thought, "Well, we'll give a course of 10.
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De tænkte, "Nå ja, vi giver ham 10 behandlinger.
14:21
And so we'll lose a little time. Big deal. It doesn't make any difference."
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Og vi spilder måske lidt tid. Og hvad så.? Det gør alligevel ingen forskel."
14:25
So they gave the course of 10,
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Så de godkendte 10 behandlinger,
14:26
and the first -- the usual course, incidentally, was six to eight
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og i starten -- det sædvanlige var, forresten, seks til otte behandlinger
14:30
and still is six to eight.
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og det er stadig seks til otte --
14:32
Plugged me into the wires, put me to sleep, gave me the muscle relaxant.
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de tilsluttede mig til ledningerne, bedøvede mig, gav mig et muskel afslappende middel.
14:36
Six didn't work. Seven didn't work.
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Seks virkede ikke. Syv virkede ikke.
14:38
Eight didn't work. At nine, I noticed --
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Otte virkede ikke. ved ni, bemærkede jeg --
14:41
and it's wonderful that I could notice anything
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og det var skønt jeg overhovede bemærkede noget som helst
14:44
-- I noticed a change. And at 10, I noticed a real change.
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-- Jeg bemærkede en forandring. Og ved 10, bemærkede jeg en virkelig forandring.
14:48
And he went back to them, and they agreed to do another 10.
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Og han gik tilbage til dem, og de gik med til at prøve 10 mere.
14:51
Again, not a single one of them
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Igen - ikke en eneste en af dem
14:53
-- I think there are about seven or eight of them --
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-- Jeg mener, der var omkring syv eller otte af dem --
14:55
thought this would do any good. They thought this was a temporary change.
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troede det ville være til nogen nytte. De troede det var en midlertidig ændring.
14:57
But, lo and behold, by 16, by 17,
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Men, sørme, ved 16, og ved 17,
15:01
there were demonstrable differences in the way I felt.
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var der en mærkbar forskel i måden jeg havde det på.
15:05
By 18 and 19, I was sleeping through the night.
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Ved 18 og 19, sov jeg igennem om natten.
15:08
And by 20, I had the sense, I really had the sense
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Og ved 20, begynde jeg at fornemme, jeg havde virkeligt den fornemmelse
15:12
that I could overcome this,
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at jeg kunne overvinde dette,
15:15
that I was now strong enough that by an act of will,
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at jeg nu var stærk nok til at jeg, ved ren viljestyrke,
15:18
I could blow the obsessional thinking away.
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kunne feje tvangstankerne af mig.
15:20
I could blow the depression away.
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Jeg kunne feje depressionen bort.
15:23
And I've never forgotten -- I never will forget
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Og jeg har aldrig glemt - Jeg vil aldrig glemme
15:26
-- standing in the kitchen of the unit,
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-- da jeg stod i køkkenet på afdelingen,
15:29
it was a Sunday morning in January of 1974,
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det var en Søndag morgen i Januar 1973 --4--
15:33
standing in the kitchen by myself and thinking, "I've got the strength now to do this."
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mens jeg stod alene i køkkenet og tænkte, "Jeg har styrken til at klare dette nu."
15:39
It was as though those tightly coiled wires in my head had been disconnected
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Det var, som om de stramt sammenkrøllede ledninger inde i mit hovede var blevet løsnet
15:44
and I could think clearly.
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og jeg kunne tænke klart.
15:46
But I need a formula. I need some thing to say to myself
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Men jeg behøver en opskrift. Jeg behøver noget at sige til mig selv
15:51
when I begin thinking obsessionally, obsessively.
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når mine tvangstanker, besætter mig.
15:55
Well, the Gilbert and Sullivan fans in this room
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Gilbert og Sullivan fan´s her til stede
16:00
will remember "Ruddigore," and they will remember Mad Margaret,
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husker "Ruddy Gore," og de husker gale Margaret,
16:03
and they will remember that she was married
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og de husker, at hun var gift
16:05
to a fellow named Sir Despard Murgatroyd.
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med en fyr, der hed Sir Despard Murgatroyd.
16:09
And she used to go nuts, every five minutes or so in the play,
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Og i stykket gik hun indimellem amok, hvert femte minut eller deromkring,
16:13
and he said to her, "We must have a word to bring you back to reality,
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og han sagde til hende, "Vi må lave et ord der bringer dig tilbage til virkeligheden,
16:16
and the word, my dear, will be 'Basingstoke.'"
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og det ord, min kære, vil være 'Basingstoke."
16:20
So every time she got a little nuts,
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Så hver gang hun gik lidt amok,
16:22
he would say, "Basingstoke!" And she would say,
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han ville udbryde "Basingstoke!" Og hun ville svare,
16:24
"Basingstoke, it is." And she would be fine for a little while.
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"Basingstoke, minsandten" Og så ville hun have det fint for en stund.
16:28
Well, you know, I'm from the Bronx. I can't say "Basingstoke."
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Nu jeg jo fra the Bronx. Jeg kan ikke gå og sige "Basingstoke."
16:32
But I had something better. And it was very simple.
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Men jeg fandt noget der var bedre. Og det var meget simpelt.
16:36
It was, "Ah, fuck it!"
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Det var, "Årrrh, op i røven!"
16:39
(Laughter) Much better than "Basingstoke,"
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(Latter) Meget bedre end Basingstoke,
16:44
at least for me. And it worked -- my God, it worked.
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i det mindste for mig. Og det fungerede, min Gud, det fungerede.
16:48
Every time I would begin thinking obsessionally --
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Hver gang jeg begyndte at få tvangstanker --
16:50
again, once more, after 20 shock treatments
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igen, efter 20 chok behandlinger
16:54
-- I would say, "Ah, fuck it."
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-- ville jeg sige, "Årrrh, op i røven."
16:58
And things got better and better,
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Og så fik jeg det bedre,
17:00
and within three or four months,
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og i løbet af tre til fire måneder,
17:03
I was discharged from that hospital, and I joined a group of surgeons
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blev jeg udskrevet fra hospitalet og jeg meldte mig til en gruppe kirurger,
17:06
where I could work with other people in the community,
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hvor jeg kunne arbejde med andre i lokalsamfundet,
17:10
not in New Haven, but fairly close by.
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ikke på New Haven, men rimeligt tæt ved.
17:13
I stayed there for three years.
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Der blev jeg i tre år.
17:15
At the end of three years, I went back to New Haven,
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Efter de tre år, vendte jeg tilbage til New Haven,
17:19
had remarried by that time.
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havde giftet mig igen på det tidspunkt.
17:23
I brought my wife with me, actually, to make sure I could get through this.
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Jeg tog min kone med mig, for at være sikker på at jeg kunne komme igennem det.
17:29
My children came back to live with us.
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Mine børn kom tilbage for at bo hos os.
17:35
We had two more children after that.
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Vi fik to børn mere bagefter.
17:38
Resuscitated the career, even better than it had been before.
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Genoplivede karrieren, den blev faktisk bedre end den var før.
17:43
Went right back into the university
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Fik straks min gamle stilling tilbage på universitet.
17:47
and began to write books.
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og begyndte at skrive bøger.
17:50
Well, you know, it's been a wonderful life.
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Ja, det har været et skønt liv.
17:53
It's been, as I said, close to 30 years.
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Som sagt er der gået tæt på 30 år.
17:57
I stopped doing surgery about six years ago
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Jeg stoppede med kirurgi for ca seks år siden,
18:00
and became a full-time writer, as many people know.
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og blev fuldtids forfatter, som mange er klar over.
18:04
But it's been very exciting. It's been very happy.
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Men det har været meget spændende. Det har været meget lykkeligt.
18:07
Every once in a while, I have to say, "Ah, fuck it."
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Ind i mellem, er jeg stadig nødt til at sige, "Årrrh, op i røven."
18:09
Every once in a while, I get somewhat depressed and a little obsessional.
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Ind i mellem, bliver jeg stadig lettere deprimeret og får lidt tvangstanker.
18:12
So, I'm not free of all of this. But it's worked. It's always worked.
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Så jeg er ikke fri fra alt det der. Men det fungerede. Det har altid fungeret.
18:22
Why have I chosen, after never, ever talking about this, to talk about it now?
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Hvorfor har jeg besluttet, efter aldrig nogensinde at have talt om dette, at tale om det nu?
18:30
Well, those of you who know some of these books
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Jo, de af jer som kender nogle af disse bøger,
18:33
know that one is about death and dying,
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ved at én er om død og at dø.
18:36
one is about the human body and the human spirit,
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Én er om menneskets krop og sjæl,
18:38
one is about the way mystical thoughts are constantly in our minds,
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Én er om den måde underlige tanker er i vores sind hele tiden,
18:43
and they have always to do with my own personal experiences.
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og de har altid noget at gøre med vores egne personlige erfaringer.
18:48
One might think reading these books
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Man kunne tænke, efter at have læst disse bøger,
18:51
-- and I've gotten thousands of letters about them
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-- jeg har fået tusinder af breve om dem
18:54
by people who do think this --
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af folk, der mener dette --
18:56
that based on my life's history as I've portrayed in the books,
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Det er baseret på min livs historie, som jeg har beskrevet i bogen,
18:59
my early life's history, I am someone who has overcome adversity.
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min tidlige livs historie. Jeg er én der har overvundet hårde trængsler.
19:04
That I am someone who has drunk, drank, drunk
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At jeg er en der har drukket --- drak, drukket --
19:09
of the bitter dregs of near-disaster in childhood
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af de bitre frugter af nær-katastrofer i min barndom,
19:16
and emerged not just unscathed but strengthened.
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og komme ud af det uden skræmmer, men styrket.
19:21
I really have it figured out, so that I can advise people about
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Jeg har virkeligt regnet det ud, så nu er jeg i stand til at give folk råd om
19:24
death and dying, so that I can talk about mysticism and the human spirit.
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død og at dø, så jeg kan tale om mysticisme og den menneskelige ånd.
19:29
And I've always felt guilty about that.
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Og det har jeg altid haft skyldfølelse over.
19:31
I've always felt that somehow I was an impostor
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Jeg har altid følt, at jeg har været en hykler,
19:34
because my readers don't know what I have just told you.
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for mine læsere kender ikke til det jeg lige har fortalt jer.
19:39
It's known by some people in New Haven, obviously,
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Det er kendt for nogle på New Haven, naturligvis,
19:42
but it is not generally known.
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men det er ikke almindeligt kendt.
19:44
So one of the reasons that I have come here to talk about this today
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Så en af årsagerne til, at jeg er kommet her i dag for at tale om dette
19:49
is to -- frankly, selfishly --
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er -- helt ærligt, egoistiske grunde --
19:54
unburden myself and let it be known
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slippe min byrde og lade det blive kendt,
19:57
that this is not an untroubled mind that has written all of these books.
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at det ikke har været et ubekymret sind, som har skrevet alle disse bøger.
20:03
But more importantly, I think,
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Men mere vigtigt, syntes jeg,
20:06
is the fact that a very significant proportion
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er det faktum, at en meget stor gruppe
20:08
of people in this audience are under 30,
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i dette publikum er under 30,
20:12
and there are many, of course, who are well over 30.
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og der er mange, naturligvis, som er et godt stykke over 30.
20:18
For people under 30, and it looks to me like almost all of you
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For folk under 30, hvilket vil for mig forekommer at være næsten jer alle sammen,
20:21
-- I would say all of you --
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-- jeg tror næsten jer alle ---
20:22
are either on the cusp of a magnificent and exciting career
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enten er på kanten af en storslået og spændende karriere
20:27
or right into a magnificent and exciting career:
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eller i fuld gang med en storslået og spændende karriere,
20:31
anything can happen to you. Things change.
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Alt kan ske for jer. Ting forandres.
20:35
Accidents happen. Something from childhood comes back to haunt you.
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Ulykker sker. Noget fra jeres barndom kan komme tilbage og forfølge jer.
20:39
You can be thrown off the track.
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I kan blive smidt af i svinget.
20:41
I hope it happens to none of you,
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Jeg håber ikke det sker for nogen af jer,
20:42
but it will probably happen to a small percentage of you.
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men det vil sandsynligvis hænde for en lille procentdel af jer.
20:47
To those to whom it doesn't happen, there will be adversities.
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For de af jer, som det ikke hænder for, vil der være modstand.
20:52
If I, with the bleakness of spirit,
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Hvis jeg, med den sidste rest af ånden,
20:56
with no spirit, that I had in the 1970s
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uden den ånd, som jeg havde i 1970erne,
21:01
and no possibility of recovery,
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og ingen mulighed for helbredelse,
21:03
as far as that group of very experienced psychiatrists thought,
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ifølge den gruppe af meget erfarne psykiatere´s mening,
21:07
if I can find my way back from this,
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hvis jeg kan finde en vej tilbage fra af dette,
21:09
believe me, anybody can find their way back
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tro mig, så kan alle finde en vej tilbage
21:13
from any adversity that exists in their lives.
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fra hvilken som helst modstand i deres liv.
21:18
And for those who are older, who have lived through
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Og for dem som er ældre, som har levet igennem noget,
21:19
perhaps not something as bad as this,
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der muligvis ikke er så slemt som dette,
21:22
but who have lived through difficult times,
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men som har gået gennem besværlige tider,
21:25
perhaps where they lost everything, as I did,
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muligvis mistet alt, lige som mig,
21:27
and started out all over again, some of these things will seem very familiar.
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og har startet helt forfra - vil noget af dette virke meget familiært.
21:34
There is recovery.
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Der er mulighed forbedring.
21:39
There is redemption. And there is resurrection.
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Der er tilgivelse. Og der er fornyelse.
21:47
There are resurrection themes in every society that has ever been studied,
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Der er fornyelses temaer i hvert et samfund, der nogen sinde er blevet studeret,
21:51
and it is because not just only do we fantasize
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og det er på grund af, at vi ikke bare fantaserer
21:54
about the possibility of resurrection and recovery,
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om muligheden for fornyelse og genopstandelse,
21:57
but it actually happens. And it happens a lot.
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men det sker faktisk. Og det sker mange gange.
22:01
Perhaps the most popular resurrection theme,
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Muligvis er det mest populære genopstandelses-tema,
22:05
outside of specifically religious ones,
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udover de specifikt religiøse,
22:08
is the one about the phoenix, the ancient story of the phoenix,
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den om fuglen føniks, den gamle historie om fuglen føniks,
22:12
who, every 500 years, resurrects itself from its own ashes
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der, for hvert 500 år, genopstår fra sin egen aske,
22:19
to go on to live a life that is
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for at forsætte et liv, der er
22:22
even more beautiful than it was before. Richard,
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endnu smukkere end det var før.
22:25
thanks very much.
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Tak
ABOUT THE SPEAKER
Sherwin Nuland - DoctorA practicing surgeon for three decades, Sherwin Nuland witnessed life and death in every variety. Then he turned to writing, exploring what there is to people beyond just anatomy.
Why you should listen
Sherwin Nuland was a practicing surgeon for 30 years and treated more than 10,000 patients -- then became an author and speaker on topics no smaller than life and death, our minds, our morality, aging and the human spirit.
His 1994 book How We Die: Reflections of Life's Final Chapter demythologizes the process of dying. Through stories of real patients and his own family, he examines the seven most common causes of death: old age, cancer, AIDS, Alzheimer's, accidents, heart disease and stroke, and their effects. The book, one of more than a dozen he wrote, won the National Book Award, was a finalist for the Pultizer Prize, and spent 34 weeks on the New York Times best-seller list. Other books include How We Live, The Art of Aging: A Doctor's Prescription for Well-Being; and The Soul of Medicine: Tales from the Bedside.
Sherwin Nuland | Speaker | TED.com