TED Talks Live
Hector Garcia: We train soldiers for war. Let's train them to come home, too
赫克托・加西亚: 我们训练士兵在战场上冲锋陷阵；让我们也训练他们如何回家
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在士兵被送去战场之前，他们会被训练如何应对极度危险的环境。但是，心理学家赫克托・加西亚说，他们也需要训练如何从战场回归平民生活。通过遵循与训练士兵备战时相同的原则，加西亚正帮助那些遭受PTSD（创伤后应激障碍症）的退伍军人找回他们的人生。
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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一个越战海军陆战队员，
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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自愿参与了三次行动，
每次行动中他都受了枪伤。
每次行动中他都受了枪伤。
在1971年，他因健康原因退役了，
00:20
In 1971, he was medically retired
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因为他体内有太多的子弹碎片，
00:22
because he had so much
shrapnel in his body
shrapnel in his body
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导致可能触发金属探测仪。
00:25
that he was setting off metal detectors.
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在接下来的42年当中，
他被噩梦缠身，
他被噩梦缠身，
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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在公共场所会极度不安，
00:33
isolation, depression.
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封闭、抑郁。
00:35
He self-medicated with alcohol.
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他利用酒精自我麻醉。
00:37
He was married and divorced three times.
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他结过又离过三次婚。
00:40
Carlos had post-traumatic stress disorder.
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卡洛斯患有创伤后应激障碍（PTSD）。
00:44
Now, I became a psychologist
to help mitigate human suffering,
to help mitigate human suffering,
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我是一名帮助人类
减轻痛苦的心理学家，
减轻痛苦的心理学家，
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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在过去的10年当中，我一直把
像卡洛斯这样的退伍军人经历的
像卡洛斯这样的退伍军人经历的
00:52
as experienced by veterans like Carlos.
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PTSD作为我的研究目标。
00:55
Until recently, the science of PTSD
just wasn't there.
just wasn't there.
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不久前，关于PTSD的研究
都还不够完善。
都还不够完善。
因此，我们一直都不知道要怎样应对。
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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我们让一部分退伍军人大量服药。
01:05
Others we hospitalized
and gave generic group therapy,
and gave generic group therapy,
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另一部分则让他们住院观察，
进行一般性的团体治疗，
进行一般性的团体治疗，
01:08
and others still we simply said to them,
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还有一些我们就简单的对他们说：
“回家吧，尝试去忘记你的经历。”
01:10
"Just go home and try to forget
about your experiences."
about your experiences."
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最近，我们还尝试训练医疗犬，
荒野静修等等——
荒野静修等等——
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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很多能够短期减缓压力的方式，
01:21
but which don't actually eliminate
PTSD symptoms over the long term.
PTSD symptoms over the long term.
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但并不能长期彻底根除
PTSD造成的症状。
PTSD造成的症状。
但是事情已经有所改善了。
01:26
But things have changed.
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我今天来是想告诉你们，
我们已经可以彻底根除PTSD了，
我们已经可以彻底根除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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不仅仅是缓解症状，
01:35
and in huge numbers of veterans.
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而且对大量的退伍军人都有效。
01:37
Because new scientific research
has been able to show,
has been able to show,
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因为最新的科学研究已经能够
01:40
objectively, repeatedly,
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客观地，重复地表明
哪些治疗能真正消除病症，
而哪些不能。
而哪些不能。
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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01:45
Now as it turns out,
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结果表明，
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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对于PTSD的最佳治疗方式，
是使用许多与军队训练战士
是使用许多与军队训练战士
备战时相同的原则。
01:52
that the military uses
in preparing its trainees for war.
in preparing its trainees for war.
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01:58
Now, making war --
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制造战争——
02:00
this is something that we are good at.
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这是我们擅长的事情。
我们人类一直都在制造战争，甚至
当我们还没有完全进化就开始了。
当我们还没有完全进化就开始了。
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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自从那时起，
我们已经从使用石头和肌腱，
我们已经从使用石头和肌腱，
02:08
And since then, we have gone
from using stone and sinew
from using stone and sinew
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发展到了使用能够想象到的
最复杂的，最具毁灭性的武器。
最复杂的，最具毁灭性的武器。
02:11
to developing the most sophisticated
and devastating weapon systems imaginable.
and devastating weapon systems imaginable.
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为了使我们的战士
能够使用这些武器，
能够使用这些武器，
02:16
And to enable our warriors
to use these weapons,
to use these weapons,
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我们会使用最先进的
训练方式训练他们。
训练方式训练他们。
02:18
we employ the most cutting-edge
training methods.
training methods.
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我们善于制造战争。
02:20
We are good at making war.
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我们还善于锻炼我们的战士去作战。
02:22
And we are good at training
our warriors to fight.
our warriors to fight.
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但是，当我们考虑当今老兵的经历，
02:26
Yet, when we consider the experience
of the modern-day combat veteran,
of the modern-day combat veteran,
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我们就会意识到，我们并不善于
02:30
we begin to see that we
have not been as good
have not been as good
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02:33
at preparing them to come home.
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为他们回家做准备。
为什么会这样呢？
02:35
Why is that?
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02:37
Well, our ancestors lived
immersed in conflict,
immersed in conflict,
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我们的祖先生活在冲突当中，
他们就在他们生活的地方进行斗争。
02:41
and they fought right where they lived.
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所以直到进化史的近代阶段，
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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人类都几乎没有学习
如何从战场回家的需求，
如何从战场回家的需求，
因为我们从来没有真正这样做过。
02:50
because we never really did.
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但值得庆幸的是，当今，
02:53
But thankfully, today,
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大多数人类都居住在和平社会当中，
02:54
most of humanity lives
in far more peaceful societies,
in far more peaceful societies,
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当冲突发生时，我们，
特别是美国，
特别是美国，
02:57
and when there is conflict,
we, especially in the United States,
we, especially in the United States,
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03:01
now have the technology to put
our warriors through advanced training,
our warriors through advanced training,
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有这些科技，可以让
我们的士兵进行先进的训练，
我们的士兵进行先进的训练，
03:05
drop them in to fight
anywhere on the globe
anywhere on the globe
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把他们扔在世界的任何角落去打仗，
03:08
and when they're done,
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当战争结束时，
03:09
jet them back to peacetime suburbia.
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再把他们载回和平地区。
但是让我们想象一下这种感受。
03:12
But just imagine for a moment
what this must feel like.
what this must feel like.
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我和那些退伍战士聊过，
他们告诉我，
他们告诉我，
03:17
I've spoken with veterans who've told me
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曾经他们身处阿富汗残暴的交火当中，
03:19
that one day they're in a brutal
firefight in Afghanistan
firefight in Afghanistan
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目睹杀戮和死亡，
03:22
where they saw carnage and death,
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而三天后他们就要
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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带着冰袋去参加孩子的足球比赛。
“思想混乱”是他们最常使用的词汇。
03:32
"Mindfuck" is the most common term.
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03:35
(Laughter)
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（笑声）
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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这是我听到过的最常用于
描述那种经历的术语。
描述那种经历的术语。
但那就是他们所经历的。
03:39
And that's exactly what that is.
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因为当我们的战士
正花费大量的时间准备战争，
正花费大量的时间准备战争，
03:41
Because while our warriors
spend countless hours training for war,
spend countless hours training for war,
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我们却最近才意识到，
03:45
we've only recently come to understand
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他们中的许多也需要
被训练如何回归平民生活。
被训练如何回归平民生活。
03:47
that many require training
on how to return to civilian life.
on how to return to civilian life.
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就像任何训练一样，
最佳的PTSD治疗方案也需要被反复进行。
最佳的PTSD治疗方案也需要被反复进行。
03:51
Now, like any training, the best
PTSD treatments require repetition.
PTSD treatments require repetition.
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在军队中，
03:55
In the military,
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我们不会简单地递给新兵
Mark-19自动榴弹枪，
Mark-19自动榴弹枪，
03:56
we don't simply hand trainees
Mark-19 automatic grenade launchers
Mark-19 automatic grenade launchers
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然后说：“这里是扳机，
还有一些弹药，祝你好运。”
还有一些弹药，祝你好运。”
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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不。我们训练他们，
在场地中，在不同的环境下，
在场地中，在不同的环境下，
04:03
No. We train them, on the range
and in specific contexts,
and in specific contexts,
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04:08
over and over and over
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一遍又一遍的，
直到举起武器瞄准目标的行为，
04:09
until lifting their weapon
and engaging their target
and engaging their target
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根深蒂固的刻在肌肉记忆当中；
04:12
is so engrained into muscle memory
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04:14
that it can be performed
without even thinking,
without even thinking,
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直到即使在你们能想象的
最紧张的时刻，
最紧张的时刻，
04:16
even under the most stressful
conditions you can imagine.
conditions you can imagine.
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这一系列行为也能够
不经思考的被正确执行。
不经思考的被正确执行。
以训练为基础的治疗也是一样的道理。
04:20
Now, the same holds
for training base treatments.
for training base treatments.
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治疗的第一步是认知疗法，
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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这是一种心理的重新校准。
当退伍军人从战争回家时，
04:31
When veterans come home from war,
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他们对世界的认知是被校对过的，
04:32
their way of mentally framing
the world is calibrated
the world is calibrated
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以适应那种极度危险的战争环境。
04:35
to an immensely
more dangerous environment.
more dangerous environment.
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所以当你试图将这种认知
嫁接于和平环境之上时，
嫁接于和平环境之上时，
04:38
So when you try to overlay that mind frame
onto a peacetime environment,
onto a peacetime environment,
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04:44
you get problems.
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就会出现问题。
04:45
You begin drowning in worries
about dangers that aren't present.
about dangers that aren't present.
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你就会沉浸在对那些
本不存在的危险的忧虑当中。
本不存在的危险的忧虑当中。
04:49
You begin not trusting family or friends.
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你开始不信任家人和朋友。
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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不是说平民生活中就没有危险；
危险是存在的。
危险是存在的。
只是说遇到危险的几率，
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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相比战争中而言，
是极低的。
05:02
is astronomically lower.
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所以我们从不建议退伍军人
彻底关闭他们的警惕性。
彻底关闭他们的警惕性。
05:05
So we never advise veterans
to turn off caution completely.
to turn off caution completely.
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而是训练他们，去根据所处环境，
05:08
We do train them, however,
to adjust caution
to adjust caution
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调整他们的警惕程度。
05:11
according to where they are.
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如果你在一个治安很差的社区，
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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你就要开启警惕性。
和家人一起在外吃饭呢？
05:17
Out to dinner with family?
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你就应该把它调节到很低。
05:19
You turn it way down.
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我们训练退伍军人，
让他们变得绝对理性化，
让他们变得绝对理性化，
05:21
We train veterans to be fiercely rational,
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让他们能够系统化的衡量他们在
05:25
to systematically gauge
the actual statistical probability
the actual statistical probability
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和平时期的美国遭遇到
比如，简易爆炸装置的可能性。
比如，简易爆炸装置的可能性。
05:28
of encountering, say, an IED
here in peacetime America.
here in peacetime America.
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通过足够的练习，那些
被校正的认知就会留存。
被校正的认知就会留存。
05:33
With enough practice,
those recalibrations stick.
those recalibrations stick.
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治疗的下一步是暴露疗法，
05:39
The next of these treatments
is exposure therapy,
is exposure therapy,
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就好像实地演习，
05:41
and this is a kind of field training,
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也是所有被证明
有效的疗法中见效最快的。
有效的疗法中见效最快的。
05:44
and the fastest of the proven
effective treatments out there.
effective treatments out there.
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你们还记得卡洛斯吗？
05:47
You remember Carlos?
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这就是他选择的治疗方案。
05:49
This was the treatment that he chose.
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05:51
And so we started off
by giving him exercises,
by giving him exercises,
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我们从给他一些练习开始，
05:54
for him, challenging ones:
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对他来说，最具挑战性的是：
05:55
going to a grocery store,
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去杂货店，
05:57
going to a shopping mall,
going to a restaurant,
going to a restaurant,
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去商场，餐厅，
06:00
sitting with his back to the door.
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背对着门坐着。
而且，最重要的是——
06:03
And, critically --
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要停留在这些环境当中。
06:05
staying in these environments.
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刚开始的时候，他表现得非常不安。
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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他希望能够坐在一个
可以扫视整个餐厅的位置，
可以扫视整个餐厅的位置，
这样他就可以计划逃脱路线，
06:12
where he could plan escape routes,
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06:13
where he could get his hands
on a makeshift weapon.
on a makeshift weapon.
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这样他就可以随手拿取临时武器。
他很想离开那儿，但是他没有。
06:17
And he wanted to leave, but he didn't.
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他想起了在海军陆战队的训练，
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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他战胜了自己的不安情绪。
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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每当他这样做时，
焦虑感就会逐渐减少，
焦虑感就会逐渐减少，
06:28
and then a little bit more
and then a little bit more,
and then a little bit more,
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然后再减少一点点，
再减少一点儿，
再减少一点儿，
直到最后，
06:31
until in the end,
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06:32
he had effectively relearned
how to sit in a public space
how to sit in a public space
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他重新学会了如何坐在公共场所当中，
仅仅是享受他自己的时光。
06:38
and just enjoy himself.
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他也会听他战时经历的录音，
06:41
He also listened to recordings
of his combat experiences,
of his combat experiences,
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一遍又一遍的。
06:45
over and over and over.
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他听这些录音，直到
不再对其产生焦虑。
不再对其产生焦虑。
06:47
He listened until those memories
no longer generated any anxiety.
no longer generated any anxiety.
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他不断消化那些记忆，
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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以至于不需要再在梦里
06:58
in his sleep.
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回到那些记忆当中。
当我在他治疗结束一年之后
再与他交流时，
再与他交流时，
07:00
And when I spoke with him
a year after treatment had finished,
a year after treatment had finished,
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他告诉我：
07:03
he told me,
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07:05
"Doc, this is the first time in 43 years
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“医生，这是我在43年当中
第一次没有做噩梦。”
07:10
that I haven't had nightmares."
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07:13
Now, this is different
than erasing a memory.
than erasing a memory.
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然而，这并不是清除记忆的过程。
退伍军人们会永远记得
他们的创痛经历，
他们的创痛经历，
07:18
Veterans will always remember
their traumatic experiences,
their traumatic experiences,
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但是通过足够量的训练，
07:21
but with enough practice,
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那些记忆将不再像以往
那样鲜活，那样让人痛苦。
那样鲜活，那样让人痛苦。
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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他们情感上不再觉得
那些经历依然历历在目，
那些经历依然历历在目，
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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这是一个巨大的进步。
但这常常也很困难。
07:37
But it's often difficult.
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而且，就像是任何训练一样，
它不一定适用于所有人。
它不一定适用于所有人。
07:39
And, like any training,
it may not work for everybody.
it may not work for everybody.
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此外还存在着信任问题。
07:44
And there are trust issues.
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有时，我会被问道：
07:45
Sometimes I'm asked,
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“如果你从没上过战场，医生，
你要怎么帮我呢？“
你要怎么帮我呢？“
07:47
"If you haven't been there, Doc,
how can you help me?"
how can you help me?"
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我很理解这种想法。
07:49
Which is understandable.
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但是考虑到回归平民生活，
07:52
But at the point of returning
to civilian life,
to civilian life,
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你们并不需要一个经历过战场的人。
07:56
you do not require
somebody who's been there.
somebody who's been there.
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你们不需要训练战场上的行为；
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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你们需要被训练如何回到家中。
在我过去十年的工作经历当中，
08:10
For the past 10 years of my work,
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我已经接触过了你们能够想象到的
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，能具体到琐碎细节的
08:18
daily.
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日常情况。
08:19
And it hasn't always been easy.
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事情并不总是那么顺利。
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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很多时候，我会感到疲惫，
或者太过专注。
08:25
or that I've absorbed too much.
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但是这些基于训练的
治疗方法效果出奇的好，
治疗方法效果出奇的好，
08:28
But these training-based
treatments work so well,
treatments work so well,
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无论我花费多少功夫，
它都能给我带来更多回报，
它都能给我带来更多回报，
08:31
that whatever this work takes out of me,
it puts back even more,
it puts back even more,
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因为我看到了人们正在康复。
08:34
because I see people get better.
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08:38
I see people's lives transform.
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我看到了人们的生活正在发生转变。
08:42
Carlos can now enjoy outings
with his grandchildren,
with his grandchildren,
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卡洛斯已经能和他的
孙子孙女们出去玩了，
孙子孙女们出去玩了，
曾经他甚至无法和他自己的
孩子们一起这样做。
孩子们一起这样做。
08:46
which is something he couldn't even do
with his own children.
with his own children.
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最令我惊讶的，
是在43年的折磨之后，
是在43年的折磨之后，
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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仅仅花费了10周时间进行
高强度训练，他就重获了自己的人生。
高强度训练，他就重获了自己的人生。
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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当我和他交流的时候，他告诉我：
08:58
And when I spoke with him, he told me,
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“我知道我无法重获那些错过的岁月。
09:00
"I know that I can't get those years back.
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但至少现在，无论在这世上
我还剩下多少时间，
我还剩下多少时间，
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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我都可以在平静中度过。”
09:10
I can live them in peace."
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他还说：“我希望那些年轻的退伍军人
09:13
He also said, "I hope that these
younger veterans don't wait
younger veterans don't wait
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不再需要苦苦等候迟来的帮助。”
09:16
to get the help they need."
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09:18
And that's my hope, too.
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那也是我所希望的。
因为，
09:21
Because ...
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人生是短暂的，
09:23
this life is short,
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如果你们有幸在战争当中
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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或是各种创伤性经历中幸存下来，
09:30
you owe it to yourself
to live your life well.
to live your life well.
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你们亏欠自己一个美好的人生。
不该浪费时间去等待那些帮助你们
09:34
And you shouldn't wait
to get the training you need
to get the training you need
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实现美好人生的训练。
09:37
to make that happen.
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事实上，能够避免战后创伤的最佳方式，
09:40
Now, the best way of ending
human suffering caused by war
human suffering caused by war
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就是避免战争。
09:46
is to never go to war.
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但是我们这个物种
还没有达到那样的境界。
还没有达到那样的境界。
09:49
But we are just not there
yet as a species.
yet as a species.
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但在那之前，
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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当我们把子女送去战场，
09:58
when we send them off to fight
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给他们造成的精神折磨
10:00
can be alleviated.
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是可以被缓解的。
但是我们必须要确保
那些科学成果，能源供给，
那些科学成果，能源供给，
10:03
But we must ensure that the science,
the energy level, the value
the energy level, the value
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10:09
that we place on sending them off to war
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我们将他们送去战场时的价值观，
至少是要能够体现
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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我们准备让他们回到家中的。
我们欠他们的，就是这么多。
10:19
This much, we owe them.
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10:22
Thank you.
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谢谢。
（掌声）
10:23
(Applause)
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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