TEDSummit 2019
Sandeep Jauhar: How your emotions change the shape of your heart
桑德普 · 喬: 情緒如何改變心臟的形狀
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心臟病學家及作家桑德普 · 喬說：「我們的情緒生活被記錄在我們的心臟裡。」在這場讓人吃驚的演說中，他帶大家探究情緒影響我們心臟健康的神秘方式——造成心臟改變形狀以因應悲慟和恐懼，真對情緒上的心碎做出破碎的反應。他並呼籲大家轉變照護我們最重要的器官的方式。
Sandeep Jauhar - Physician, writer
Sandeep Jauhar is a practicing cardiologist passionate about communicating medicine in all its glorious, quirky, inescapable humanity. Full bio
Sandeep Jauhar is a practicing cardiologist passionate about communicating medicine in all its glorious, quirky, inescapable humanity. Full bio
Double-click the English transcript below to play the video.
00:13
No other organ,
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沒有任何其他器官，
00:14
perhaps no other object in human life,
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也許在人類生命中
沒有任何其他物體，
沒有任何其他物體，
00:18
is as imbued with metaphor
and meaning as the human heart.
and meaning as the human heart.
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會像人類的心那樣
充滿了隱喻和意義。
充滿了隱喻和意義。
00:23
Over the course of history,
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在歷史上，
00:24
the heart has been a symbol
of our emotional lives.
of our emotional lives.
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心一直象徵著我們的情緒生活。
00:28
It was considered by many
to be the seat of the soul,
to be the seat of the soul,
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許多人認為它是靈魂的所在，
00:32
the repository of the emotions.
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情緒儲存在其中。
00:35
The very word "emotion" stems in part
from the French verb "émouvoir,"
from the French verb "émouvoir,"
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「情緒」這個詞有一部分
源自於法文的動詞「émouvoir」，
00:42
meaning "to stir up."
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意思是「激起」。
00:44
And perhaps it's only logical
that emotions would be linked to an organ
that emotions would be linked to an organ
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或許，將情緒連結到
特色為跳動的器官，
特色為跳動的器官，
00:48
characterized by its agitated movement.
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是唯一合邏輯的連結吧。
00:51
But what is this link?
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但，這個連結是什麼？
00:53
Is it real or purely metaphorical?
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它是真的嗎？還是只是比喻？
00:57
As a heart specialist,
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身為心臟科醫生，
00:59
I am here today to tell you
that this link is very real.
that this link is very real.
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今天我就是來告訴各位，
這個連結是非常真實的。
01:05
Emotions, you will learn,
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各位將會了解到，情緒
能夠且確實會對人類的心
有直接的實質影響。
有直接的實質影響。
01:07
can and do have a direct
physical effect on the human heart.
physical effect on the human heart.
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01:14
But before we get into this,
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但在我們進入主題之前，
咱們先談談象徵性的心。
咱們先談談象徵性的心。
01:15
let's talk a bit about
the metaphorical heart.
the metaphorical heart.
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01:18
The symbolism of the emotional heart
endures even today.
endures even today.
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情緒的心至今仍然具有其象徵性。
01:23
If we ask people which image
they most associate with love,
they most associate with love,
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如果我們去問大家，他們最會
把愛和哪個影像連結起來，
把愛和哪個影像連結起來，
01:28
there's no question that the Valentine
heart would the top the list.
heart would the top the list.
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無疑地，愛心會是榜上的第一名。
01:33
The heart shape, called a cardioid,
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心形，叫做心臟形曲線，
01:36
is common in nature.
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在大自然中很常見。
01:38
It's found in the leaves,
flowers and seeds of many plants,
flowers and seeds of many plants,
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可以在許多植物的樹葉、
花朵、種子上看到這個形狀，
花朵、種子上看到這個形狀，
01:43
including silphium,
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包括羅盤草，
01:45
which was used for birth control
in the Middle Ages
in the Middle Ages
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在中世紀，它被用來做節育用，
01:48
and perhaps is the reason why
the heart became associated
the heart became associated
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也許這就是為什麼心會被連結到
01:52
with sex and romantic love.
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性和浪漫的愛。
01:55
Whatever the reason,
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不論原因是什麼，
01:57
hearts began to appear in paintings
of lovers in the 13th century.
of lovers in the 13th century.
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十三世紀時，心開始
出現在愛人的畫作中。
出現在愛人的畫作中。
02:02
Over time, the pictures
came to be colored red,
came to be colored red,
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隨著時間過去，這些圖像
漸漸被著上紅色，
漸漸被著上紅色，
02:06
the color of blood,
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血的顏色，
02:08
a symbol of passion.
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象徵熱情。
02:09
In the Roman Catholic Church,
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在羅馬天主教教堂，
02:11
the heart shape became known
as the Sacred Heart of Jesus.
as the Sacred Heart of Jesus.
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心形成為知名的耶穌聖心。
02:16
Adorned with thorns
and emitting ethereal light,
and emitting ethereal light,
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被莖棘環繞並發散出永恆的光茫，
02:20
it became an insignia of monastic love.
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它成為宗教裡愛的象徵。
02:24
This association between the heart
and love has withstood modernity.
and love has withstood modernity.
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心和愛之間的關聯
經得起現代的考驗。
經得起現代的考驗。
02:28
When Barney Clark, a retired dentist
with end-stage heart failure,
with end-stage heart failure,
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退休牙醫巴內 克拉克
在心臟衰竭的末期時，
在心臟衰竭的末期時，
02:34
received the first permanent
artificial heart in Utah in 1982,
artificial heart in Utah in 1982,
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於 1982 年在猶他州得到了
第一顆永久的人工心臟，
第一顆永久的人工心臟，
02:39
his wife of 39 years
reportedly asked the doctors,
reportedly asked the doctors,
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據說他結婚 39 年的妻子問醫生：
02:45
"Will he still be able to love me?"
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「他還會愛我嗎？」
02:48
Today, we know that the heart
is not the source of love
is not the source of love
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現今，我們知道心並非愛
或任何情緒的來源；
02:52
or the other emotions, per se;
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02:54
the ancients were mistaken.
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古人搞錯了。
02:55
And yet, more and more,
we have come to understand
we have come to understand
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但，我們越來越了解，
02:58
that the connection between the heart
and the emotions is a highly intimate one.
and the emotions is a highly intimate one.
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心和情緒之間的連結
是非常親密的連結。
是非常親密的連結。
03:03
The heart may not originate our feelings,
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我們的感覺也許不是來自心，
03:06
but it is highly responsive to them.
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但心對情緒有很強的反應。
03:08
In a sense, a record of our emotional life
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在某種意義上，我們的情緒生活
被記錄在我們的心上。
03:11
is written on our hearts.
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03:13
Fear and grief, for example,
can cause profound cardiac injury.
can cause profound cardiac injury.
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比如，恐懼、悲慟
會造成嚴重的心臟損傷。
會造成嚴重的心臟損傷。
03:18
The nerves that control unconscious
processes such as the heartbeat
processes such as the heartbeat
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控制無意識過程的神經例如心跳
03:23
can sense distress
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能夠感受到憂苦，
03:25
and trigger a maladaptive
fight-or-flight response
fight-or-flight response
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並觸發一種適應不良的
「戰或逃」反應，
「戰或逃」反應，
03:30
that triggers blood vessels to constrict,
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這就會觸發血管緊縮，
03:33
the heart to gallop
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心臟得要更拼命，
03:35
and blood pressure to rise,
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血壓會上升，
03:37
resulting in damage.
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造成傷害。
03:39
In other words,
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換言之，
03:41
it is increasingly clear
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我們越來越清楚知道，
03:44
that our hearts are extraordinarily
sensitive to our emotional system,
sensitive to our emotional system,
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我們的心臟對於
我們的情緒系統超級敏感，
我們的情緒系統超級敏感，
03:49
to the metaphorical heart, if you will.
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也可以說，是對
象徵性的心超級敏感。
象徵性的心超級敏感。
03:52
There is a heart disorder
first recognized about two decades ago
first recognized about two decades ago
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有一種心臟疾病，
大約在二十年前才被初次發現，
大約在二十年前才被初次發現，
03:56
called "takotsubo cardiomyopathy,"
or "the broken heart syndrome,"
or "the broken heart syndrome,"
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叫做「章魚壺心肌症」
或「心碎症候群」。
或「心碎症候群」。
04:01
in which the heart acutely weakens
in response to intense stress or grief,
in response to intense stress or grief,
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這種疾病是心臟在應對
強烈的壓力或悲慟時會急遽減弱，
04:08
such as after a romantic breakup
or the death of a loved one.
or the death of a loved one.
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比如和另一半分手
或愛人過世之後。
或愛人過世之後。
04:11
As these pictures show,
the grieving heart in the middle
the grieving heart in the middle
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中間的這張照片是悲傷的心臟，
04:15
looks very different
than the normal heart on the left.
than the normal heart on the left.
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看起來和左側的正常心臟很不同。
04:18
It appears stunned
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它看起來受到震驚，
經常會鼓起來，
經常會鼓起來，
04:20
and frequently balloons into
the distinctive shape of a takotsubo,
the distinctive shape of a takotsubo,
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成為章魚壺的獨特形狀，
就是右側的圖，
就是右側的圖，
04:24
shown on the right,
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04:25
a Japanese pot with a wide base
and a narrow neck.
and a narrow neck.
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章魚壺是一種日本壺，
底很寬但頸很窄。
底很寬但頸很窄。
04:29
We don't know exactly why this happens,
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我們不知道為什麼
會發生這種狀況，
會發生這種狀況，
04:32
and the syndrome usually resolves
within a few weeks.
within a few weeks.
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這種症候群通常
會在幾週之內消失。
會在幾週之內消失。
04:35
However, in the acute period,
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然而，在急性期，
04:37
it can cause heart failure,
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它可能會造成心臟衰竭、
04:40
life-threatening arrhythmias,
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有生命危險的
心律失常，甚至死亡。
心律失常，甚至死亡。
04:42
even death.
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04:43
For example, the husband
of an elderly patient of mine
of an elderly patient of mine
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比如，我有一位年長病人，
她的先生最近過世了。
04:49
had died recently.
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04:51
She was sad, of course, but accepting.
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當然，她很傷心，但她接受了。
04:55
Maybe even a bit relieved.
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可能甚至鬆了一口氣。
04:57
It had been a very long illness;
he'd had dementia.
he'd had dementia.
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他生了很久的病，失智症。
05:00
But a week after the funeral,
she looked at his picture
she looked at his picture
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但在葬禮的一週後，
她看著他的照片，
她看著他的照片，
05:04
and became tearful.
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開始落淚。
05:06
And then she developed chest pain,
and with it, came shortness of breath,
and with it, came shortness of breath,
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接著，她開始出現胸痛，
隨之而來的是呼吸短促、
05:11
distended neck veins, a sweaty brow,
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頸部血管擴張、額頭出汗、
05:14
a noticeable panting
as she was sitting up in a chair --
as she was sitting up in a chair --
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坐在椅子上時會有明顯的氣喘—–
05:18
all signs of heart failure.
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全都是心臟衰竭的徵兆。
05:23
She was admitted to the hospital,
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她住院了，
05:25
where an ultrasound confirmed
what we already suspected:
what we already suspected:
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在醫院，超音波
確認了我們的懷疑：
確認了我們的懷疑：
05:29
her heart had weakened
to less than half its normal capacity
to less than half its normal capacity
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她的心臟變弱了，
只剩不到一半的正常能力，
05:36
and had ballooned into
the distinctive shape of a takotsubo.
the distinctive shape of a takotsubo.
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且鼓起來成為章魚壺的形狀。
05:40
But no other tests were amiss,
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但其他的檢測沒發現問題，
05:43
no sign of clogged arteries anywhere.
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全身都沒有血管阻塞的徵兆。
05:46
Two weeks later, her emotional state
had returned to normal
had returned to normal
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兩週後，她的情緒狀態恢復正常，
05:50
and so, an ultrasound confirmed,
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超音波確認了
05:55
had her heart.
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她的心臟也恢復正常。
05:56
Takotsubo cardiomyopathy has been linked
to many stressful situations,
to many stressful situations,
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章魚壺心肌症和許多壓力情境有關，
06:02
including public speaking --
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包括公開演說——
06:05
(Laughter)
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（笑聲）
06:10
(Applause)
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（掌聲）
06:16
domestic disputes, gambling losses,
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家庭糾紛、賭博輸錢，
06:20
even a surprise birthday party.
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甚至生日派對的驚喜。
06:22
(Laughter)
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（笑聲）
06:23
It's even been associated
with widespread social upheaval,
with widespread social upheaval,
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它也和普遍的社會動亂有關，
06:28
such as after a natural disaster.
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比如在天然災害之後。
06:30
For example, in 2004,
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比如，2004 年，
06:32
a massive earthquake devastated a district
on the largest island in Japan.
on the largest island in Japan.
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一次大地震破壞了
日本最大島上的一個區域。
06:39
More than 60 people were killed,
and thousands were injured.
and thousands were injured.
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超過 60 人死亡，數千人受傷。
06:43
On the heels of this catastrophe,
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緊接在這場大災難之後，
06:45
researchers found that the incidents
of takotsubo cardiomyopathy
of takotsubo cardiomyopathy
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研究者發現，
在地震後一個月，
06:50
increased twenty-four-fold in the district
one month after the earthquake,
one month after the earthquake,
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該區域中得章魚壺心肌症的案例數
06:56
compared to a similar
period the year before.
period the year before.
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比去年差不多時期要高了 24 倍。
07:00
The residences of these cases
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這些病人的住所
07:02
closely correlated with
the intensity of the tremor.
the intensity of the tremor.
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和震動強度有密切的關係。
07:05
In almost every case,
patients lived near the epicenter.
patients lived near the epicenter.
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幾乎每位病人都住在震央附近。
07:10
Interestingly, takotsubo cardiomyopathy
has been seen after a happy event, too,
has been seen after a happy event, too,
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有趣的是，章魚壺心肌症
也會在快樂的事件之後出現，
07:17
but the heart appears
to react differently,
to react differently,
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但心臟的反應顯然不同，
07:19
ballooning in the midportion,
for example, and not at the apex.
for example, and not at the apex.
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比如，中間部分會
鼓起，頂端則不會。
鼓起，頂端則不會。
07:24
Why different emotional precipitants
would result in different cardiac changes
would result in different cardiac changes
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為什麼不同的情緒狀態
會造成不同的心臟改變？
會造成不同的心臟改變？
07:29
remains a mystery.
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這仍然是個謎。
07:31
But today, perhaps as an ode
to our ancient philosophers,
to our ancient philosophers,
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但，現今，也許是對於
古代哲學家的讚頌，
古代哲學家的讚頌，
07:36
we can say that even if emotions
are not contained inside our hearts,
are not contained inside our hearts,
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我們可以說，即使
情緒不是裝在我們的心臟裡，
07:42
the emotional heart overlaps
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情緒的心仍然
和象徵性的心有所重疊（口誤），
和生物學的心有所重疊，
07:48
its biological counterpart,
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07:50
in surprising and mysterious ways.
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這當中的關係既驚人又神秘。
07:54
Heart syndromes, including sudden death,
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心臟的症候群包括猝死，
07:58
have long been reported in individuals
experiencing intense emotional disturbance
experiencing intense emotional disturbance
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常常發生在經歷強烈情緒障礙的人，
08:03
or turmoil in their metaphorical hearts.
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或是象徵性的心非常混亂的人身上。
08:07
In 1942,
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1942 年，
08:09
the Harvard physiologist Walter Cannon
published a paper called "'Voodoo' Death,"
published a paper called "'Voodoo' Death,"
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哈佛生理學家沃爾特 坎農
出版了一篇論文《巫毒之死》，
08:14
in which he described
cases of death from fright
cases of death from fright
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他在文中提到，
有些人會因為驚嚇而死
有些人會因為驚嚇而死
08:18
in people who believed
they had been cursed,
they had been cursed,
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他們相信自己被詛咒，
08:20
such as by a witch doctor
or as a consequence of eating taboo fruit.
or as a consequence of eating taboo fruit.
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比如巫醫施加的詛咒
或吃了禁忌食物造成的詛咒。
或吃了禁忌食物造成的詛咒。
08:25
In many cases, the victim, all hope lost,
dropped dead on the spot.
dropped dead on the spot.
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許多案例的受害者
失去所有希望，當場死亡。
失去所有希望，當場死亡。
08:31
What these cases had in common
was the victim's absolute belief
was the victim's absolute belief
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這些案例的共通點是，
受害者完全相信
受害者完全相信
08:36
that there was an external force
that could cause their demise,
that could cause their demise,
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外部的力量能造成他們的死亡，
08:39
and against which
they were powerless to fight.
they were powerless to fight.
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且他們完全沒有能力
對抗這種力量。
對抗這種力量。
08:41
This perceived lack of control,
Cannon postulated,
Cannon postulated,
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坎農假設，這種覺得
自己無法控制的感受
自己無法控制的感受
08:45
resulted in an unmitigated
physiological response,
physiological response,
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會造成無法減輕的生理反應，
08:48
in which blood vessels
constricted to such a degree
constricted to such a degree
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血管會收縮到了會導致
08:53
that blood volume acutely dropped,
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血流量下降的程度，
08:56
blood pressure plummeted,
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血壓會爆跌，
08:58
the heart acutely weakened,
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心臟會劇烈衰弱，
09:00
and massive organ damage resulted
from a lack of transported oxygen.
from a lack of transported oxygen.
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因為缺乏氧氣輸送，
導致大量的器官受損。
導致大量的器官受損。
09:05
Cannon believed that voodoo deaths
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坎農相信，巫毒造成的死亡
09:09
were limited to indigenous
or "primitive" people.
or "primitive" people.
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僅限於原住民或「原始」人。
09:13
But over the years, these types of deaths
have been shown to occur
have been shown to occur
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但，多年來，已經發現這類死亡
也會發生在各種現代人身上。
09:18
in all manner of modern people, too.
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09:21
Today, death by grief has been seen
in spouses and in siblings.
in spouses and in siblings.
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現今，已知有配偶和手足
因為悲慟而死。
因為悲慟而死。
09:28
Broken hearts are literally
and figuratively deadly.
and figuratively deadly.
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破碎的心是會致命的，
不論在實際上或比喻上都是。
不論在實際上或比喻上都是。
09:32
These associations hold true
even for animals.
even for animals.
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這些關聯性也會出現在動物身上。
09:36
In a fascinating study in 1980
published in the journal "Science,"
published in the journal "Science,"
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1980 年有一篇有趣的研究
刊載在《科學》期刊上，
09:42
researchers fed caged rabbits
a high-cholesterol diet
a high-cholesterol diet
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研究者用高膽固醇食物
餵食被關在籠中的兔子，
餵食被關在籠中的兔子，
09:46
to study its effect
on cardiovascular disease.
on cardiovascular disease.
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來研究它對心血管疾病的影響。
09:50
Surprisingly, they found that some rabbits
developed a lot more disease than others,
developed a lot more disease than others,
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意外的是，他們發現，有些兔子
發展出來的疾病比其他兔子還多，
發展出來的疾病比其他兔子還多，
09:56
but they couldn't explain why.
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但他們無法解釋原因。
09:57
The rabbits had very similar diet,
environment and genetic makeup.
environment and genetic makeup.
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這些兔子吃的東西、
環境、基因組成都很類似。
10:03
They thought it might have
something to do with
something to do with
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他們認為這個現象可能
10:06
how frequently the technician
interacted with the rabbits.
interacted with the rabbits.
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和技術人員有多常
和兔子互動有關。
和兔子互動有關。
10:10
So they repeated the study,
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所以他們重做了該研究，
這次將兔子分為兩組。
這次將兔子分為兩組。
10:12
dividing the rabbits into two groups.
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10:14
Both groups were fed
a high-cholesterol diet.
a high-cholesterol diet.
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兩組都餵食高膽固醇的食物。
10:17
But in one group, the rabbits
were removed from their cages,
were removed from their cages,
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但，其中一組兔子被放出籠子，
10:22
held, petted, talked to, played with,
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工作人員會抱牠們、
拍牠們，和牠們玩，
拍牠們，和牠們玩，
10:26
and in the other group,
the rabbits remained in their cages
the rabbits remained in their cages
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另一組的兔子則被
丟在籠子裡不管。
丟在籠子裡不管。
10:29
and were left alone.
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10:31
At one year, on autopsy,
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一年後，根據解剖，
10:34
the researchers found
that the rabbits in the first group,
that the rabbits in the first group,
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研究者發現，
第一組的兔子，
10:40
that received human interaction,
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有和人互動的兔子，
10:42
had 60 percent less aortic disease
than rabbits in the other group,
than rabbits in the other group,
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得到主動脈疾病的
比另一組低了六成，
比另一組低了六成，
10:48
despite having similar cholesterol levels,
blood pressure and heart rate.
blood pressure and heart rate.
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雖然兩組的膽固醇含量、
血壓、心跳都差不多。
血壓、心跳都差不多。
10:53
Today, the care of the heart has become
less the province of philosophers,
less the province of philosophers,
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現今，對心的照顧比較
不屬於哲學家的領域，
不屬於哲學家的領域，
10:59
who dwell upon the heart's
metaphorical meanings,
metaphorical meanings,
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哲學家專注的是心的象徵性意義，
11:04
and more the domain of doctors like me,
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而比較屬於我這種醫生的領域。
11:08
wielding technologies
that even a century ago,
that even a century ago,
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我們使用的技術，在一世紀前，
11:11
because of the heart's exalted
status in human culture,
status in human culture,
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因為心在人類文化中的崇高地位，
11:14
were considered taboo.
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甚至可能被視為禁忌。
11:16
In the process, the heart
has been transformed
has been transformed
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在這個過程中，心已經有了轉變，
11:20
from an almost supernatural object
imbued with metaphor and meaning
imbued with metaphor and meaning
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從幾乎是超自然的物體，
充滿象徵和意義，
充滿象徵和意義，
11:25
into a machine that can be
manipulated and controlled.
manipulated and controlled.
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變成可以操弄和控制的機器。
11:31
But this is the key point:
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但，重點是：
11:33
these manipulations, we now understand,
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我們現在了解，這些操弄
11:36
must be complemented
by attention to the emotional life
by attention to the emotional life
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一定要搭配對於情緒生活的
注意，才能完善，
注意，才能完善，
11:41
that the heart, for thousands of years,
was believed to contain.
was believed to contain.
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數千年來，人們都相信心
包含著這些情緒生活。
包含著這些情緒生活。
11:45
Consider, for example,
the Lifestyle Heart Trial,
the Lifestyle Heart Trial,
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比如，想想看生活方式心臟試驗，
11:49
published in the British journal
"The Lancet" in 1990.
"The Lancet" in 1990.
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1990 年刊載在英國
期刊《刺胳針》上。
期刊《刺胳針》上。
11:53
Forty-eight patients with moderate
or severe coronary disease
or severe coronary disease
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48 名有中度或嚴重
冠狀動脈疾病的病人
冠狀動脈疾病的病人
11:57
were randomly assigned to usual care
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被隨機指派使用一般照護
12:00
or an intensive lifestyle
that included a low-fat vegetarian diet,
that included a low-fat vegetarian diet,
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或者特別護理的生活方式，包括
低脂素食餐、適度的有氧運動、
12:06
moderate aerobic exercise,
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12:08
group psychosocial support
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團體心理社會支持，
以及壓力管理建議。
以及壓力管理建議。
12:09
and stress management advice.
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12:11
The researchers found
that the lifestyle patients
that the lifestyle patients
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研究者發現，生活方式組的病人
12:16
had a nearly five percent reduction
in coronary plaque.
in coronary plaque.
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冠狀動脈斑塊減少近 5%。
12:21
Control patients, on the other hand,
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另一方面，控制組的病人
12:23
had five percent more
coronary plaque at one year
coronary plaque at one year
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冠狀動脈斑塊一年就增加了 5%，
12:28
and 28 percent more at five years.
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五年再增加了 28%。
12:30
They also had nearly double
the rate of cardiac events,
the rate of cardiac events,
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他們的心臟病
發生率也有近兩倍，
發生率也有近兩倍，
12:34
like heart attacks,
coronary bypass surgery
coronary bypass surgery
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比如心臟病發作、心臟繞道手術，
12:38
and cardiac-related deaths.
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及心臟相關的死亡。
12:40
Now, here's an interesting fact:
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這裡有個有趣的事實：
12:42
some patients in the control group
adopted diet and exercise plans
adopted diet and exercise plans
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控制組的一些病人採用了
飲食和運動計畫，
飲食和運動計畫，
12:48
that were nearly as intense
as those in the intensive lifestyle group.
as those in the intensive lifestyle group.
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計畫的強度和生活方式組差不多。
12:53
Their heart disease still progressed.
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他們的心臟疾病仍然會持續發展。
12:56
Diet and exercise alone were not enough
to facilitate coronary disease regression.
to facilitate coronary disease regression.
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光是飲食和運動，不足以
促使冠狀動脈疾病復原。
促使冠狀動脈疾病復原。
13:02
At both one- and five-year follow-ups,
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在一年後及五年後的後續追蹤中，
13:06
stress management
was more strongly correlated
was more strongly correlated
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都發現，比起運動，壓力管理
和冠狀動脈疾病的
復原更有關聯性。
復原更有關聯性。
13:09
with reversal of coronary disease
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13:11
than exercise was.
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13:14
No doubt, this and similar
studies are small,
studies are small,
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無疑這項及類似研究的規模都小，
13:17
and, of course, correlation
does not prove causation.
does not prove causation.
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且，當然，有關聯性
不表示就有因果關係。
不表示就有因果關係。
13:20
It's certainly possible that stress
leads to unhealthy habits,
leads to unhealthy habits,
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的確有可能，壓力會
造成不健康的習慣，
造成不健康的習慣，
13:25
and that's the real reason
for the increased cardiovascular risk.
for the increased cardiovascular risk.
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那是心血管疾病風險
增加的真正理由。
增加的真正理由。
13:28
But as with the association
of smoking and lung cancer,
of smoking and lung cancer,
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但，就像是抽菸
和肺癌的關聯一樣，
和肺癌的關聯一樣，
13:32
when so many studies show the same thing,
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當有這麼多研究指出同樣的結論，
13:35
and when there are mechanisms
to explain a causal relationship,
to explain a causal relationship,
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且當有些機制可以
解釋因果關係時，
解釋因果關係時，
13:38
it seems capricious to deny
that one probably exists.
that one probably exists.
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還否認可能有因果關係
存在就太任性了。
存在就太任性了。
13:43
What many doctors have concluded
is what I, too, have learned
is what I, too, have learned
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許多醫生的結論
和我在擔任心臟科醫生
和我在擔任心臟科醫生
近二十年期間所發現的事實一樣：
13:47
in my nearly two decades
as a heart specialist:
as a heart specialist:
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13:51
the emotional heart intersects
with its biological counterpart
with its biological counterpart
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情緒的心會和生物學的心有交集，
13:55
in surprising and mysterious ways.
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這當中的關係既驚人又神秘。
13:58
And yet, medicine today continues
to conceptualize the heart as a machine.
to conceptualize the heart as a machine.
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但，現今的醫學持續
將心概念化成為一台機器。
將心概念化成為一台機器。
14:03
This conceptualization
has had great benefits.
has had great benefits.
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這種概念化有很大的益處。
14:07
Cardiology, my field,
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心臟病學，我的領域，
14:09
is undoubtedly one of the greatest
scientific success stories
scientific success stories
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毫無疑問是過去一百年間
最偉大的科學成功故事之一。
14:14
of the past 100 years.
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14:17
Stents, pacemakers, defibrillators,
coronary bypass surgery,
coronary bypass surgery,
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支架、心律調整器、電擊器、
冠狀動脈繞道手術、心臟移植——
14:22
heart transplants --
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14:24
all these things were developed
or invented after World War II.
or invented after World War II.
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所有這些都是在第二次世界大戰
之後開發或發明出來的。
之後開發或發明出來的。
14:28
However, it's possible
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然而，有可能
14:30
that we are approaching the limits
of what scientific medicine can do
of what scientific medicine can do
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我們快要碰到科學醫學
在對抗心臟疾病上
在對抗心臟疾病上
能夠做到的極限了。
14:35
to combat heart disease.
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14:37
Indeed, the rate of decline
of cardiovascular mortality
of cardiovascular mortality
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的確，心血管疾病
死亡率的下降速度
死亡率的下降速度
14:40
has slowed significantly
in the past decade.
in the past decade.
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在過去十年間已經顯著慢下來。
14:45
We will need to shift to a new paradigm
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我們需要轉換到新的範式，
14:48
to continue to make the kind of progress
to which we have become accustomed.
to which we have become accustomed.
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以繼續開創我們已經
習以為常的新進展。
習以為常的新進展。
14:52
In this paradigm, psychosocial factors
will need to be front and center
will need to be front and center
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心理社會因素在這個
範式中非常重要，
範式中非常重要，
14:57
in how we think about heart problems.
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攸關我們如何看待心臟問題。
15:00
This is going to be an uphill battle,
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這將會是一場艱難的戰役，
15:02
and it remains a domain
that is largely unexplored.
that is largely unexplored.
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且這個領域有很大一部分
都還沒有被探索過。
都還沒有被探索過。
15:07
The American Heart Association
still does not list emotional stress
still does not list emotional stress
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美國心臟協會仍未把情緒壓力列為
15:13
as a key modifiable risk factor
for heart disease,
for heart disease,
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心臟疾病的可改變風險的關鍵因素。
15:16
perhaps in part because blood cholesterol
is so much easier to lower
is so much easier to lower
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也許有部分是因為要降低血膽固醇
遠比降低情緒和社會混亂容易許多。
15:21
than emotional and social disruption.
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15:25
There is a better way, perhaps,
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也許會有更好的方法，
15:27
if we recognize that when
we say "a broken heart,"
we say "a broken heart,"
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如果我們能夠了解，
當我們說「破碎的心」時，
當我們說「破碎的心」時，
15:32
we are indeed sometimes talking
about a real broken heart.
about a real broken heart.
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有時我們的確是在講真正破碎的心。
15:37
We must, must pay more attention to
the power and importance of the emotions
the power and importance of the emotions
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在照護我們的心臟時，
我們必須要更加注意
情緒的力量和重要性，
情緒的力量和重要性，
15:44
in taking care of our hearts.
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15:46
Emotional stress, I have learned,
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我學到的是，情緒壓力
15:48
is often a matter of life and death.
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通常攸關生死。
15:53
Thank you.
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謝謝。
15:54
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Sandeep Jauhar - Physician, writerSandeep Jauhar is a practicing cardiologist passionate about communicating medicine in all its glorious, quirky, inescapable humanity.
Why you should listen
In addition to his medical practice, Dr. Sandeep Jauhar writes about medicine and its impacts on culture for a wide-ranging audience. He is a contributing opinion writer for the New York Times and has written three best-selling books.
His most recent book, Heart: A History (a finalist for the 2019 Wellcome Book prize), tells the little-known story of the doctors who risked their careers -- and the patients who risked their lives -- to understand our most vital organ. Weaving his own experiences with the defining discoveries of the past, Jauhar braids tales of breakthrough, hubris and sorrow to create a lucid chronicle of our life's most intimate chamber. The book also confronts the limits of medical technology, arguing that future progress will be determined more by how we choose to live rather than by any device we invent. Indeed, as the book explains, our emotional lives are absolutely key to our heart health. Jauhar is the Director of the Heart Failure Program at Northwell Health's Long Island Jewish Medical Center.
Sandeep Jauhar | Speaker | TED.com