ABOUT THE SPEAKER
Thomas Insel - Neuroscientist and psychiatrist
The Director of the National Institute of Mental Health, Thomas Insel supports research that will help us understand, treat and even prevent mental disorders.

Why you should listen

Thomas Insel has seen many advances in the understanding of mental disorders since becoming the Director of the National Institute of Mental Health (NIMH) in 2002. During his tenure, major breakthroughs have been made in the areas of practical clinical trials, autism research and the role of genetics in mental illnesses.

Prior to his appointment at the NIMH, Insel was a professor of psychiatry at Emory University, studying the neurobiology of complex social behaviors. While there, he was the founding director of the NSF Center for Behavioral Neuroscience and director of the NIH-funded Center for Autism Research. He has published over 250 scientific articles and four books and has served on numerous academic, scientific, and professional committees and boards. He is a member of the Institute of Medicine, a fellow of the American College of Neuropsychopharmacology, and a recipient of the Outstanding Service Award from the U.S. Public Health Service and the 2010 La Fondation IPSEN Neuronal Plasticity Prize. 

More profile about the speaker
Thomas Insel | Speaker | TED.com
TEDxCaltech

Thomas Insel: Toward a new understanding of mental illness

Filmed:
1,412,184 views

今時今日,多得提早發現,心臟病嘅死亡率比幾十年前少咗63%。多馬.印索,國立精神健康單位主任想知道:我哋係唔係可以係抑鬱症同埋精神分裂症度做一模一樣嘅嘢? 他話係呢條新嘅研究路程上,重新建構係好重要嘅第一步:我哋必須停止將佢哋諗成係「精神病」,并且開始將佢哋當成係「腦疾病」唻理解。(係TEDxCaltech錄影)
- Neuroscientist and psychiatrist
The Director of the National Institute of Mental Health, Thomas Insel supports research that will help us understand, treat and even prevent mental disorders. Full bio

Double-click the English transcript below to play the video.

00:12
So let's start初時 with some good news新聞,
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我哋先唻d好消息,
00:15
and the good news新聞 has to do with what do we know
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而呢個好消息同我哋究竟知道有幾多個
00:17
based基於 on biomedical生物醫學 research研究
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因為生物醫學嘅研究,
00:20
that actually講真 has changed the outcomes結果
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而真正改變咗其結果既
00:23
for many好多 very serious嚴重 diseases疾病?
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嚴重疾病?
00:26
Let's start初時 with leukemia白血病,
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我哋就由白血病開始講,
00:28
acute急性 lymphoblastic痳巴細胞 leukemia白血病, ALL,
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急性淋巴細胞性白血病,ALL,
00:31
the most common常見 cancer癌症 of children孩子.
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係細路仔最常見嘅癌症。
00:33
When I was a student學生,
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當我仲係學生嘅時候,
00:35
the mortality死亡率 rate was about 95 percent百分比.
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死亡率係大概95%。
00:39
Today今日, some 25, 30 years later之後, we're talking講嘢 about
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而家,25、30年之後,我哋講梗嘅係
00:42
a mortality死亡率 rate that's reduced減少 by 85 percent百分比.
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降咗85%嘅死亡率。
00:46
Six thousand children孩子 each每個 year
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係之前,每年因為呢個病而死既6000名兒童
00:49
who would have previously以前 died of this disease疾病 are cured治癒.
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都得救。
00:53
If you want the really big numbers數字,
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如果你想要大d嘅數字,
00:55
look at these numbers數字 for heart disease疾病.
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我哋不妨來睇吓心臟病嘅數字。
00:57
Heart disease疾病 used to be the biggest最大 killer殺手,
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係以前,心臟病係最犀利既殺手,
00:59
particularly特別 for men男人 in their佢哋 40s.
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尤其是係對四十幾歲的男性唻講。
01:01
Today今日, we've我哋都 seen看到 a 63-percent百分比 reduction減少 in mortality死亡率
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依家,我哋睇到降咗63%既
01:04
from heart disease疾病 --
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心臟病死亡率,
01:06
remarkably顯著, 1.1 million deaths死亡 averted避免 every year.
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值得一提嘅係,每年都有110萬條性命獲救。
01:11
AIDS爱滋病, incredibly令人難以置信, has just been named,
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愛滋病,令人難以置信地,係上個月先
01:14
in the past過去 month, a chronic慢性 disease疾病,
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被定為係慢性病,
01:16
meaning意義 that a 20-year-old who becomes成為 infected感染 with HIVHiv
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意思即係話,一個人係20歲時感染到HIV嘅話,
01:19
is expected預期 not to live weeks禮拜, months, or a couple夫婦 of years,
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佢預期嘅壽命唔係幾個禮拜、幾個月,或者係幾年,
01:23
as we said only a decade同你十年 ago,
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好似我哋之前講嘅十年左右,
01:25
but is thought to live decades幾十年,
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而依家所認為嘅幾十年,
01:28
probably可能 to die in his '60s or '70s from other causes原因 altogether完全.
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有可能要到佢六、七十歲,同埋其他起因一起病逝。
01:32
These are just remarkable顯著, remarkable顯著 changes變化
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係尋找一d頭等殺手過程中,
01:35
in the outlook前景 for some of the biggest最大 killers殺手.
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呢d改變係非常非常卓越嘅。
01:38
And one in particular特定
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特別係其中一個,
01:40
that you probably可能 wouldn't唔會 know about, stroke中風,
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你有可能唔知到嘅,就係中風,
01:42
which has been, along沿 with heart disease疾病,
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呢個病,連同心臟病,
01:44
one of the biggest最大 killers殺手 in this country國家,
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係呢個國家頭等殺手之一。
01:46
is a disease疾病 in which now we know
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我哋而家知道呢個病
01:48
that if you can get people into the emergency緊急 room間房
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只要你係病發之內三粒鐘
01:50
within three hours小時 of the onset發病,
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將病患送入急診嘅話,
01:53
some 30 percent百分比 of them will be able to leave離開 the hospital醫院
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大概有30%嘅人係可以
01:55
without any disability殘疾 whatsoever任何.
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係完全冇任何殘疾嘅情況下出院。
01:58
Remarkable顯著 stories故事,
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呢d係非常唔簡單嘅事,
02:01
good-news好消息 stories故事,
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係d帶住好消息嘅事,
02:03
all of which boil down to understanding理解
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而呢d事全部都要歸結於
02:06
something about the diseases疾病 that has allowed允許 us
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我哋對d疾病嘅認知,而呢d認知
02:09
to detect檢測 early早期 and intervene干預 early早期.
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令到我哋可以提早發現、介入。
02:12
Early早期 detection檢測, early早期 intervention干預,
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提早發現、介入,
02:15
that's the story故事 for these successes成功.
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就個就係之所以可以成功嘅重點。
02:18
Unfortunately不幸, the news新聞 is not all good.
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伯係好不幸,唔係全部都係好消息。
02:20
Let's talk about one other story故事
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我哋來講講另一個
02:23
which has to do with suicide自殺.
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同自殺有關嘅古仔。
02:24
Now this is, of course課程, not a disease疾病, per se.
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咁當然啦,自殺本身唔係一種病。
02:27
It's a condition條件, or it's a situation情況
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佢係一種會導致死亡嘅
02:30
that leads導致 to mortality死亡率.
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條件或情況。
02:32
What you may可能 not realize實現 is just how prevalent普遍 it is.
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你有可能冇發覺到其實佢究竟有幾咁流行。
02:35
There are 38,000 suicides自殺 each每個 year in the United聯合 States國家.
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係美國,每一年都有38000宗自殺案件。
02:39
That means意味着 one about every 15 minutes分鐘.
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亦即係話每15分鐘就死一個。
02:42
Third第三 most common常見 cause原因 of death死亡 amongst之間 people
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呢個係15歲到25歲年齡層嘅
02:45
between之間 the ages年齡 of 15 and 25.
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第三大死因。
02:48
It's kind一種 of an extraordinary非凡 story故事 when you realize實現
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如果你知道係呢個國家自殺所死嘅人係
02:50
that this is twice兩次 as common常見 as homicide殺人
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謀殺既兩倍,
02:52
and actually講真 more common常見 as a source of death死亡
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同時仲要比交通事故身亡嘅人數仲要多嘅時候,
02:55
than traffic交通 fatalities死亡 in this country國家.
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你就會知道呢件事係幾咁唔尋常。
02:58
Now, when we talk about suicide自殺,
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而家講到自殺,
03:01
there is also a medical醫療 contribution貢獻 here,
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我哋就唻提吓醫學上嘅供獻,
03:04
because 90 percent百分比 of suicides自殺
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因為90%嘅自殺案件
03:06
are related相關 to a mental心理 illness疾病:
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係同精神病有關:
03:08
depression抑鬱症, bipolar disorder障礙, schizophrenia精神分裂癥,
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抑鬱症、躁鬱症、精神分裂症、
03:11
anorexia厭食症, borderline邊緣 personality人格. There's a long list列表
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厭食、邊緣型人格。有好多好多唔同嘅
03:14
of disorders障礙 that contribute貢獻,
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精神病都同自殺有關,
03:16
and as I mentioned提到 before, often經常 early早期 in life.
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而且,正與我所講嘅,通常係早期就有。
03:20
But it's not just the mortality死亡率 from these disorders障礙.
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但係,呢d病唔單止淨係同死亡人數有關,
03:24
It's also morbidity發病率.
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佢嘅發病率都好有關連。
03:25
If you look at disability殘疾,
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如果你睇吓有關殘疾,
03:28
as measured測量 by the World世界 Health健康 Organization組織
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世界衛生組織計算,
03:30
with something they call the Disability殘疾 Adjusted調整 Life Years,
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佢哋利用佢哋所謂嘅傷殘調整生命年,
03:33
it's kind一種 of a metric度量 that nobody would think of
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呢個其實只不過係一種除咗
03:35
except除咗 an economist經濟學家,
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經濟學家之外,係冇人諗到嘅公式,
03:37
except除咗 it's one way of trying試圖 to capture捕獲 what is lost失去
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佢係我哋嚐試去評估因為殘疾
03:40
in terms條款 of disability殘疾 from medical醫療 causes原因,
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而損失嘅嘢,
03:43
and as you can see, virtually爭 D 30 percent百分比
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正與你所見到,係醫學上
03:46
of all disability殘疾 from all medical醫療 causes原因
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實質上係有30%嘅殘疾
03:48
can be attributed由于 to mental心理 disorders障礙,
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係可以歸因於精神病、
03:51
neuropsychiatric神經 syndromes綜合徵.
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中樞神經精神症候群。
03:53
You're probably可能 thinking思維 that doesn't make any sense.
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你有可能覺得唔係好合理。
03:56
I mean, cancer癌症 seems好似 far more serious嚴重.
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我嘅意思係話,癌症點睇都係嚴重好多。
03:58
Heart disease疾病 seems好似 far more serious嚴重.
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心臟點睇都係嚴重好多。
04:01
But you can see actually講真 they are further進一步 down this list列表,
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但係,你可以睇到心臟病同埋癌症係名單度仲要再落去d,
04:04
and that's because we're talking講嘢 here about disability殘疾.
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呢個係因為我哋依家講梗係殘疾。
04:07
What drives驅動器 the disability殘疾 for these disorders障礙
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究竟係嘜嘢令到d精神病,譬如話精神分裂、躁鬱症,同埋抑鬱症,
04:09
like schizophrenia精神分裂癥 and bipolar and depression抑鬱症?
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係嘜嘢令到佢哋變成咗殘疾呢?
04:13
Why are they number數量 one here?
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點解佢哋係個名單度係第一名?
04:16
Well, there are probably可能 three reasons原因.
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咁,其實大概係有三個原因嘅。
04:18
One is that they're highly高度 prevalent普遍.
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第一,就係佢哋係非常之流行。
04:20
About one in five people will suffer遭受 from one of these disorders障礙
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係5個人之間就有1個人係佢一生之中
04:23
in the course課程 of their佢哋 lifetime一生.
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會罹患其中一種精神病。
04:26
A second第二, of course課程, is that, for some people,
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第二,當然就係因為當中真係有d人
04:28
these become成為 truly真正 disabling禁用,
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因為個病而變咗真係殘疾,
04:29
and it's about four to five percent百分比, perhaps或者 one in 20.
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個數據大概係4到5%,20個人當中就有一個。
04:33
But what really drives驅動器 these numbers數字, this high morbidity發病率,
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但係真正令到d數據咁高,令到個發病率咁高,
04:37
and to some extent程度 the high mortality死亡率,
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令到個死亡率有所偏高
04:39
is the fact事實 that these start初時 very early早期 in life.
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嘅原因其實係因為呢d病係生命嘅好早期就開始。
04:43
Fifty五十 percent百分比 will have onset發病 by age年齡 14,
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50%嘅人嘅係14歲嘅時候發病,
04:46
75 percent百分比 by age年齡 24,
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75%係24歲,
04:49
a picture圖片 that is very different不同 than what one would see
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呢個同我哋所認為主要導致
04:53
if you're talking講嘢 about cancer癌症 or heart disease疾病,
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發病率同死亡率嘅原因,
04:55
diabetes糖尿病, hypertension高血壓 -- most of the major主要 illnesses疾病
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例如癌症或者心臟病、糖尿病、高血壓--呢d
04:59
that we think about as being sources來源 of morbidity發病率 and mortality死亡率.
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重大疾病,係好唔同。
05:03
These are, indeed講真, the chronic慢性 disorders障礙 of young年輕 people.
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呢d精神病確實係年輕人嘅慢性病。
05:09
Now, I started初時 by telling話畀 you that there were some good-news好消息 stories故事.
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咁,我開頭同你哋講咗一d好消息。
05:12
This is obviously顯然 not one of them.
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好明顯,呢個唔係其中之一。
05:13
This is the part部分 of it that is perhaps或者 most difficult困難,
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呢個可以講係最艱難的一部份,
05:16
and in a sense this is a kind一種 of confession懺悔 for me.
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係某個定義上,係我嘅懺悔。
05:19
My job工作 is to actually講真 make sure that we make progress進展
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我嘅工作其實就係要確保我哋
05:24
on all of these disorders障礙.
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係呢d疾病上高有所進展。
05:26
I work for the federal聯邦 government政府.
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我為聯邦政府做嘢。
05:28
Actually講真, I work for you. You pay支付 my salary人工.
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其實,我係為你哋做嘢。係你哋俾我人工。
05:30
And maybe at this pointD, when you know what I do,
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有可能係呢個時候,當你知道我係做咩嘅,
05:33
or maybe what I've failed to do,
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又或者係我冇做咩嘅,
05:35
you'll你咪會 think that I probably可能 ought應該 to be fired炒魷,
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你會認為我係應該被人炒魷,
05:37
and I could certainly梗係 understand理解 that.
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而我係非常之明白呢點嘅。
05:39
But what I want to suggest建議, and the reason原因 I'm here
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但係,我所提出嘅,我之所以會係呢度
05:41
is to tell you that I think we're about to be
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就係想同你講我認為我哋對呢d疾病嘅認知
05:45
in a very different不同 world世界 as we think about these illnesses疾病.
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將會好唔同。
05:49
What I've been talking講嘢 to you about so far is mental心理 disorders障礙,
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到而家,我所同你講嘅都係精神病,
05:52
diseases疾病 of the mind介意.
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係精神方面嘅疾病。
05:54
That's actually講真 becoming成為 a rather unpopular受歡迎 term術語 these days,
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其實,呢個詞依家已經好唔流行,
05:58
and people feel that, for whatever無論 reason原因,
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而且d人認為無論係咩理由,
06:00
it's politically政治 better to use the term術語 behavioral行為 disorders障礙
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係政策上唻講,用行為障礙唻稱乎,並且
06:03
and to talk about these as disorders障礙 of behavior行為.
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當成係行為疾病唻講會比較好。
06:07
Fair公平 enough. They are disorders障礙 of behavior行為,
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都啱嘅。佢哋係行為失常病,
06:09
and they are disorders障礙 of the mind介意.
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亦都係精神上嘅疾病。
06:11
But what I want to suggest建議 to you
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但係我想提醒你哋嘅就係
06:14
is that both of those terms條款,
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呢兩個已經沿用咗一個世紀有多
06:15
which have been in play for a century世紀 or more,
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嘅詞
06:18
are actually講真 now impediments障礙 to progress進展,
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其實對我哋嘅進展係有所障礙嘅。
06:21
that what we need conceptually概念 to make progress進展 here
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其實,我哋而家需要嘅就係係概念上有所進展,
06:26
is to rethink反思 these disorders障礙 as brain大腦 disorders障礙.
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我哋應該將呢d疾病諗成係腦部嘅疾病。
06:31
Now, for some of you, you're going to say,
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嗱,而家你哋有d人會諗住:
06:33
"Oh my goodness善良, here we go again.
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「哦,我的天啊,又唻了。
06:35
We're going to hear聽到 about a biochemical生化 imbalance失衡
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我哋又要聽d咩生化失調,
06:38
or we're going to hear聽到 about drugs藥物
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或者又要聽d有關藥物嘅嘢,
06:39
or we're going to hear聽到 about some very simplistic簡單 notion概念
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又或者又要聽d簡化咗嘅概念
06:44
that will take our subjective主觀 experience經驗
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將我哋自己主觀既經驗
06:47
and turn it into molecules分子, or maybe into some sort排序 of
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變成分子,又或者將d抑鬱症
06:53
very flat, unidimensional understanding理解
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或精神分裂症變成
06:56
of what it is to have depression抑鬱症 or schizophrenia精神分裂癥.
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非常平板、單維度嘅概念。」
07:00
When we talk about the brain大腦, it is anything but
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當我哋講到大腦嘅時候,佢絕對
07:05
unidimensional or simplistic簡單 or reductionistic還原論.
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唔係單維度或簡單或還原論。
07:08
It depends要睇, of course課程, on what scale規模
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當然,呢個都係要睇吓你用咩規模、
07:11
or what scope範圍 you want to think about,
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用咩範圍諗,
07:13
but this is an organ器官 of surreal超現實主義 complexity複雜性,
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但係呢個器官係超現實嘅複雜,
07:20
and we are just beginning初時 to understand理解
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而且我哋依家先至啱啱開始了解
07:23
how to even study研究 it, whether係唔係 you're thinking思維 about
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要點樣去研究佢,冇論你係諗住
07:25
the 100 billion neurons神經元 that are in the cortex皮質
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個100億係大腦皮質嘅神經元,
07:28
or the 100 trillion万億 synapses突觸
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又或者係連接所有嘢嘅
07:30
that make up all the connections連接.
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100萬億突觸。
07:32
We have just begun初時 to try to figure out
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對於呢個咁複雜、負責信息處理嘅機器,
07:36
how do we take this very complex複雜 machine
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我哋依家啱啱先開始嚐試搞清楚
07:40
that does extraordinary非凡 kinds of information信息 processing處理
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我哋究竟應該點樣樣去思考、
07:42
and use our own自己 minds頭腦 to understand理解
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去理解
07:45
this very complex複雜 brain大腦 that supports支持 our own自己 minds頭腦.
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呢個支撐我哋思考嘅複雜大腦。
07:49
It's actually講真 a kind一種 of cruel殘酷 trick把戲 of evolution演化
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其實進化真係同我哋開咗個大玩嘅玩笑,
07:51
that we simply淨係 don't have a brain大腦
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俾咗我哋一個冇辦法自己
07:55
that seems好似 to be wired有線 well enough to understand理解 itself本身.
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分析自己嘅大腦。
07:58
In a sense, it actually講真 makes使 you feel that
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係某種意義上,
08:00
when you're in the safe安全 zone of studying研究 behavior行為 or cognition認知,
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相較於嚐試去研究呢個咁複雜、神祕嘅器官,
08:03
something you can observe觀察,
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你會覺得研究行為或認知能力
08:04
that in a way feels感覺 more simplistic簡單 and reductionistic還原論
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係好保險嘅,因為
08:07
than trying試圖 to engage從事 this very complex複雜, mysterious神秘 organ器官
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你有d實質嘅嘢可以觀察,
08:12
that we're beginning初時 to try to understand理解.
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你會覺得比較簡單、比較簡化。
08:15
Now, already in the case情況下 of the brain大腦 disorders障礙
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咁而家繼續我之前同你哋
08:18
that I've been talking講嘢 to you about,
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講過嘅大腦疾病:
08:20
depression抑鬱症, obsessive compulsive disorder障礙,
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抑鬱症、強迫症、
08:22
post-traumatic創傷後 stress應力 disorder障礙,
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創傷後壓力症候群,
08:25
while we don't have an in-depth深入 understanding理解
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雖然我哋未有辦法可以深入了解呢d病
08:27
of how they are abnormally異常 processed處理
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異常過程,
08:31
or what the brain大腦 is doing in these illnesses疾病,
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或者個腦係呢d病度究竟係度做梗嘜,
08:33
we have been able to already identify識別
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但係我哋已經可以分辨出一d
08:36
some of the connectionalconnectional differences差異, or some of the ways方式
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連接上嘅差別,或者係患有呢d病嘅病人
08:39
in which the circuitry電路 is different不同
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個腦嘅電路
08:41
for people who have these disorders障礙.
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有咩差別。
08:43
We call this the human人類 connectomeconnectome,
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我哋叫呢d叫做「人體聯結體」,
08:45
and you can think about the connectomeconnectome
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你可以將個聯結體當成係
08:47
sort排序 of as the wiring佈綫 diagram of the brain大腦.
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大腦嘅接線圖。
08:49
You'll你咪會 hear聽到 more about this in a few幾個 minutes分鐘.
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我之後會再講多d有關呢個。
08:51
The important重要 piece一塊 here is that as you begin初時 to look
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最重要嘅一點就係當你開始研究
08:54
at people who have these disorders障礙, the one in five of us
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嗰五個人其中一個
08:58
who struggle鬥爭 in some way,
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俾呢d疾病纏身嘅人,
09:00
you find that there's a lot of variation變化
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你會發覺嗰大腦嘅線路
09:02
in the way that the brain大腦 is wired有線,
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連接嘅方式可以好唔同,
09:06
but there are some predictable預測 patterns模式, and those patterns模式
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但係,係有d可以預測到嘅模式可尋嘅。
09:08
are risk風險 factors因素 for developing發展 one of these disorders障礙.
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而呢d模式就係形成呢d病嘅風險因素。
09:12
It's a little different不同 than the way we think about brain大腦 disorders障礙
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呢個同我哋平時所講大腦疾病有d唔同,
09:15
like Huntington's亨廷顿嘅 or Parkinson's帕金森的 or Alzheimer's阿尔茨海默病嘅 disease疾病
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就好似亨丁頓舞蹈症、柏金遜症,或者係阿茲海默症,
09:18
where you have a bombed-out炸毀 part部分 of your cortex皮質.
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呢d病會炸咗你部份嘅大腦皮質。
09:20
Here we're talking講嘢 about traffic交通 jams堵塞, or sometimes有時 detours走彎路,
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我哋而家講梗嘅問題係塞車,有時候係繞道,
09:23
or sometimes有時 problems個問題 with just the way that things are connected連接
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又或者係d線路本身就係咁樣聯接,
09:26
and the way that the brain大腦 functions功能.
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同埋個大腦本身嘅運作問題。
09:27
You could, if you want, compare比較 this to,
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如果你想嘅話,你可以攞
09:31
on the one hand, a myocardial心肌 infarction梗死, a heart attack攻擊,
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心肌梗塞,即係心臟病,同心律不整唻比較:
09:34
where you have dead tissue組織 in the heart,
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心臟病會令到你個心死咗d組織,
09:35
versus an arrhythmia心律失常, where the organ器官 simply淨係 isn't functioning功能
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而心律不整就係因為你個器官自己內部溝通不良,
09:39
because of the communication通信 problems個問題 within it.
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令到成個器官冇辦法運作正常。
09:41
Either一係 one would kill you; in only one of them
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任何一種都可以致命;但係,淨係得一個
09:43
will you find a major主要 lesion病變.
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係有重大嘅病變。
09:46
As we think about this, probably可能 it's better to actually講真 go
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當我哋諗到呢個嘅時候,我哋不妨深層d
09:49
a little deeper更深 into one particular特定 disorder障礙, and that would be schizophrenia精神分裂癥,
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睇吓其中一個特別d嘅病,就係精神分裂症,
09:52
because I think that's a good case情況下
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因為我認為呢個係好好嘅案例
09:54
for helping幫手 to understand理解 why thinking思維 of this as a brain大腦 disorder障礙 matters個問題.
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能夠有助於理解於點解要將呢個病歸納成大腦疾病。
09:58
These are scans掃描 from Judy朱迪 Rapoport拉波波特 and her colleagues同事
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呢d係由國立精神健康單位,朱迪.拉波波特同埋佢d同事,
10:02
at the National國家 Institute研究所 of Mental心理 Health健康
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係研究患有非常早發性精神分裂症
10:04
in which they studied研究 children孩子 with very early早期 onset發病 schizophrenia精神分裂癥,
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嘅細路仔度所掃描出唻嘅,
10:07
and you can see already in the top返回頁首
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你可以睇到上高
10:09
there's areas一區 that are red or orange, yellow黃色,
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有紅、橙、黃嘅地方
10:11
are places地方 where there's less gray灰色 matter個問題,
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係有比較少嘅灰色神經組織。
10:14
and as they followed黎緊 them over five years,
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為咗要管制住年齡配對,
10:15
comparing比較 them to age年齡 match匹配 controls控制,
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佢哋研究追蹤呢d細路仔五年,
10:17
you can see that, particularly特別 in areas一區 like
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你可以發現,特別係係好似
10:19
the dorsolateral prefrontal前額葉 cortex皮質
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背外側前額葉皮層或者係顳上回度,
10:21
or the superior優越 temporal時間 gyrus, there's a profound深刻 loss損失 of gray灰色 matter個問題.
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都可以搵到大量嘅灰色神經組織損失。
10:26
And it's important重要, if you try to model模型 this,
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如果你想將佢諗得實質d,
10:27
you can think about normal正常 development發展
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你可以將正常發育
10:29
as a loss損失 of cortical皮質 mass質素, loss損失 of cortical皮質 gray灰色 matter個問題,
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就係一部份嘅皮質,即係皮質嘅灰色神經組織,流失,
10:33
and what's happening發生 in schizophrenia精神分裂癥 is that you overshoot過火 that mark馬克,
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而精神分裂就係呢d灰色神經組織損失得太多。
10:36
and at some pointD, when you overshoot過火,
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當你損失到一定嘅量嘅時候,
10:38
you cross a threshold閾值, and it's that threshold閾值
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過咗一個點嘅時候,就係係呢一個點度,
10:41
where we say, this is a person who has this disease疾病,
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我哋界定咗呢個人係有呢個病,
10:44
because they have the behavioral行為 symptoms症狀
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因為佢哋有幻覺同埋妄想呢
10:47
of hallucinations幻覺 and delusions妄想.
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方面嘅行為症狀。
10:49
That's something we can observe觀察.
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呢個係我哋可以觀察到嘅。
10:50
But look at this closely密切 and you can see that actually講真 they've佢地已經 crossed越過 a different不同 threshold閾值.
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但係,睇真d,你會發覺佢哋已經 過咗另一個唔通嘅臨界點。
10:56
They've佢地已經 crossed越過 a brain大腦 threshold閾值 much earlier較早時,
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他哋係好早期嘅時候就過咗個大腦嘅臨界點,
10:59
that perhaps或者 not at age年齡 22 or 20,
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應該唔係係22或20歲,
11:02
but even by age年齡 15 or 16 you can begin初時 to see
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而係15或16歲嘅時候,你就可以開始睇到
11:05
the trajectory軌跡 for development發展 is quite都幾 different不同
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個大腦嘅發育軌道已經係好唔同,
11:07
at the level水平 of the brain大腦, not at the level水平 of behavior行為.
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已唔係係行為方面。
11:11
Why does this matter個問題? Well first because,
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點解呢個好重要呢? 第一,因為
11:13
for brain大腦 disorders障礙, behavior行為 is the last thing to change.
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腦疾病,行為上嘅改變會係最尾嗰個。
11:16
We know that for Alzheimer's阿尔茨海默病嘅, for Parkinson's帕金森的, for Huntington's亨廷顿嘅.
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我哋係阿茲海默症、柏金遜症、亨丁頓舞蹈症上就可以知道。
11:19
There are changes變化 in the brain大腦 a decade同你十年 or more
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當你第一次睇到行為上嘅變化之前,
11:21
before you see the first signs迹象 of a behavioral行為 change.
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個大腦已經起碼有十年或以上嘅改變。
11:26
The tools工具 that we have now allow允許 us to detect檢測
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我哋而家所用器工具可以洗我哋提早好多
11:29
these brain大腦 changes變化 much earlier較早時, long before the symptoms症狀 emerge出現.
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測試到呢d腦部嘅變化,早到係d症狀出現之前。
11:34
But most important重要, go back to where we started初時.
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但係最重要嘅,我哋返返去我哋一開始個邊。
11:37
The good-news好消息 stories故事 in medicine醫學
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係醫學界嘅好消息
11:40
are early早期 detection檢測, early早期 intervention干預.
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就係提早發現、介入。
11:43
If we waited until直到 the heart attack攻擊,
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如果我哋等到心臟病發個陣時,
11:47
we would be sacrificing犧牲 1.1 million lives生活
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係呢個國家,我哋就會有110萬條
11:51
every year in this country國家 to heart disease疾病.
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生命死於心臟病之下。
11:53
That is precisely正是 what we do today今日
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呢個就正正係我哋而家所做嘅嘢,
11:56
when we decide決定 that everybody大家 with one of these brain大腦 disorders障礙,
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當我哋認為每一個有呢d腦疾病、
12:00
brain大腦 circuit電路 disorders障礙, has a behavioral行為 disorder障礙.
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腦電路障礙嘅人係有行為障礙嘅時候。
12:03
We wait until直到 the behavior行為 becomes成為 manifest清單.
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我哋等到d行為出現咗。
12:06
That's not early早期 detection檢測. That's not early早期 intervention干預.
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咁樣唔係提早發現。咁樣唔係提早介入。
12:11
Now to be clear清楚, we're not quite都幾 ready準備 to do this.
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而家我想講明就係,我哋仲未完全準備好咁樣做。
12:13
We don't have all the facts事實. We don't actually講真 even know
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我哋冇全面嘅事實。我哋甚至乎唔知道
12:16
what the tools工具 will be,
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個工具會係咩,
12:19
nor what to precisely正是 look for in every case情況下 to be able
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亦都唔知道係每一個案件中,我哋應該準確地搵咩嘢
12:23
to get there before the behavior行為 emerges出現 as different不同.
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先至可以係行為出現唔同之前,就可以知道。
12:27
But this tells話畀 us how we need to think about it,
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但係,呢個話俾有哋聽我哋應該點樣樣去諗,
12:30
and where we need to go.
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同埋應該行去邊度。
12:31
Are we going to be there soon好快?
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我哋會不會好快就會到個度?
12:33
I think that this is something that will happen發生
261
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我認為呢樣嘢係未來幾年係會發生嘅。
12:35
over the course課程 of the next few幾個 years, but I'd like to finish完成
262
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但係,係我結束之前,我想引用一個係
12:38
with a quote報價 about trying試圖 to predict預測 how this will happen發生
263
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觀念變化同埋科技變化方面諗咗好多嘢嘅人,
12:41
by somebody有人 who's邊個係 thought a lot about changes變化
264
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佢所講到有關嘗試去
12:43
in concepts概念 and changes變化 in technology技術.
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預測會發生嘜嘢事嘅一句話:
12:45
"We always overestimate高估 the change that will occur發生
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「我哋永遠都高估咗係未來兩年會發生嘅變化,
12:48
in the next two years and underestimate低估
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并且低估咗未來十年會發生嘅變化。」
12:50
the change that will occur發生 in the next 10." -- Bill條例草案 Gates盖茨.
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--比爾·蓋茨。
12:54
Thanks多謝 very much.
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多謝大家。
12:55
(Applause掌聲)
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(掌聲)
Translated by Ga-Wai Lau
Reviewed by SHI CHEN

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ABOUT THE SPEAKER
Thomas Insel - Neuroscientist and psychiatrist
The Director of the National Institute of Mental Health, Thomas Insel supports research that will help us understand, treat and even prevent mental disorders.

Why you should listen

Thomas Insel has seen many advances in the understanding of mental disorders since becoming the Director of the National Institute of Mental Health (NIMH) in 2002. During his tenure, major breakthroughs have been made in the areas of practical clinical trials, autism research and the role of genetics in mental illnesses.

Prior to his appointment at the NIMH, Insel was a professor of psychiatry at Emory University, studying the neurobiology of complex social behaviors. While there, he was the founding director of the NSF Center for Behavioral Neuroscience and director of the NIH-funded Center for Autism Research. He has published over 250 scientific articles and four books and has served on numerous academic, scientific, and professional committees and boards. He is a member of the Institute of Medicine, a fellow of the American College of Neuropsychopharmacology, and a recipient of the Outstanding Service Award from the U.S. Public Health Service and the 2010 La Fondation IPSEN Neuronal Plasticity Prize. 

More profile about the speaker
Thomas Insel | Speaker | TED.com

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