ABOUT THE SPEAKER
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).

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.


More profile about the speaker
Hector Garcia | Speaker | TED.com
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

Filmed:
1,099,517 views

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。
- 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

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

00:12
Carlos卡洛斯,
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卡洛斯,
00:14
the Vietnam越南 vet兽医 Marine海洋
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一个越战海军陆战队员,
00:16
who volunteered自告奋勇 for three tours
and got shot射击 up in every一切 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。
在1971年,他因健康原因退役了,
00:20
In 1971, he was medically医疗 retired退休
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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弹片 in his body身体
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导致可能触发金属探测仪。
00:25
that he was setting设置 off metal金属 detectors探测器.
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在接下来的42年当中,
他被噩梦缠身,
00:28
For the next下一个 42 years年份,
he suffered遭遇 from nightmares噩梦,
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00:31
extreme极端 anxiety焦虑 in public上市,
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在公共场所会极度不安,
00:33
isolation隔离, depression萧条.
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封闭、抑郁。
00:35
He self-medicated自药 with alcohol.
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他利用酒精自我麻醉。
00:37
He was married已婚 and divorced离婚 three times.
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他结过又离过三次婚。
00:40
Carlos卡洛斯 had post-traumatic创伤后 stress强调 disorder紊乱.
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卡洛斯患有创伤后应激障碍(PTSD)。
00:44
Now, I became成为 a psychologist心理学家
to help mitigate减轻 human人的 suffering痛苦,
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我是一名帮助人类
减轻痛苦的心理学家,
00:47
and for the past过去 10 years年份, my target目标
has been the suffering痛苦 caused造成 by PTSDPTSD,
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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
00:52
as experienced有经验的 by veterans老兵 like Carlos卡洛斯.
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PTSD作为我的研究目标。
00:55
Until直到 recently最近, the science科学 of PTSDPTSD
just wasn't there.
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不久前,关于PTSD的研究
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老兵 on heavy drugs毒品.
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我们让一部分退伍军人大量服药。
01:05
Others其他 we hospitalized住院
and gave generic通用 group therapy治疗,
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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,
01:08
and others其他 still we simply只是 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忘记
about your experiences经验."
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最近,我们还尝试训练医疗犬,
荒野静修等等——
01:15
More recently最近, we've我们已经 tried试着 therapy治疗 dogs小狗,
wilderness荒野 retreats务虚会 --
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01:18
many许多 things which哪一个 may可能
temporarily暂时 relieve缓解 stress强调,
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很多能够短期减缓压力的方式,
01:21
but which哪一个 don't actually其实 eliminate消除
PTSDPTSD symptoms症状 over the long term术语.
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但并不能长期彻底根除
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,
01:28
And I am here to tell you
that we can now eliminate消除 PTSDPTSD,
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01:33
not just manage管理 the symptoms症状,
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不仅仅是缓解症状,
01:35
and in huge巨大 numbers数字 of veterans老兵.
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而且对大量的退伍军人都有效。
01:37
Because new scientific科学 research研究
has been able能够 to show显示,
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因为最新的科学研究已经能够
01:40
objectively客观地, repeatedly反复,
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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。
01:42
which哪一个 treatments治疗 actually其实
get rid摆脱 of symptoms症状 and which哪一个 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最好 treatments治疗 for PTSDPTSD use
many许多 of the very same相同 training训练 principles原则
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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
备战时相同的原则。
01:52
that the military军事 uses使用
in preparing准备 its trainees学员 for war战争.
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01:58
Now, making制造 war战争 --
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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。
02:02
We humans人类 have been making制造 war战争
since以来 before we were even fully充分 human人的.
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自从那时起,
我们已经从使用石头和肌腱,
02:08
And since以来 then, we have gone走了
from using运用 stone and sinew腱子
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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。
02:11
to developing发展 the most sophisticated复杂的
and devastating破坏性的 weapon武器 systems系统 imaginable想象.
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为了使我们的战士
能够使用这些武器,
02:16
And to enable启用 our warriors勇士
to use these weapons武器,
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我们会使用最先进的
训练方式训练他们。
02:18
we employ采用 the most cutting-edge前沿
training训练 methods方法.
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我们善于制造战争。
02:20
We are good at making制造 war战争.
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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训练
our warriors勇士 to fight斗争.
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但是,当我们考虑当今老兵的经历,
02:26
Yet然而, when we consider考虑 the experience经验
of the modern-day现代 combat战斗 veteran老将,
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我们就会意识到,我们并不善于
02:30
we begin开始 to see that we
have not been as good
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02:33
at preparing准备 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祖先 lived生活
immersed沉浸 in conflict冲突,
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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战斗 right where they lived生活.
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所以直到进化史的近代阶段,
02:44
So until直到 only very recently最近
in our evolutionary发展的 history历史,
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02:47
there was hardly几乎不 a need to learn学习
how to come home from war战争,
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人类都几乎没有学习
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感激地, today今天,
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大多数人类都居住在和平社会当中,
02:54
most of humanity人性 lives生活
in far more peaceful平静的 societies社会,
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当冲突发生时,我们,
特别是美国,
02:57
and when there is conflict冲突,
we, especially特别 in the United联合的 States状态,
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03:01
now have the technology技术 to put
our warriors勇士 through通过 advanced高级 training训练,
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有这些科技,可以让
我们的士兵进行先进的训练,
03:05
drop下降 them in to fight斗争
anywhere随地 on the globe地球
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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 doneDONE,
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当战争结束时,
03:09
jet喷射 them back to peacetime和平时期 suburbia郊区.
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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想像 for a moment时刻
what this must必须 feel like.
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我和那些退伍战士聊过,
他们告诉我,
03:17
I've spoken with veterans老兵 who've谁一直 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野蛮
firefight交火 in Afghanistan阿富汗
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目睹杀戮和死亡,
03:22
where they saw carnage大屠杀 and death死亡,
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而三天后他们就要
03:25
and just three days later后来,
they found发现 themselves他们自己
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03:28
toting身背 an ice chest胸部
to their kid's孩子的 soccer足球 game游戏.
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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
"MindfuckMindfuck" is the most common共同 term术语.
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03:35
(Laughter笑声)
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(笑声)
03:36
It's the most common共同 term术语
I've heard听说 to describe描述 that experience经验.
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这是我听到过的最常用于
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究竟 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,
03:41
Because while our warriors勇士
spend countless无数 hours小时 training训练 for war战争,
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我们却最近才意识到,
03:45
we've我们已经 only recently最近 come to understand理解
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他们中的许多也需要
被训练如何回归平民生活。
03:47
that many许多 require要求 training训练
on how to return返回 to civilian平民 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。
03:51
Now, like any training训练, the best最好
PTSDPTSD treatments治疗 require要求 repetition重复.
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在军队中,
03:55
In the military军事,
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我们不会简单地递给新兵
Mark-19自动榴弹枪,
03:56
we don't simply只是 hand trainees学员
Mark-标记-19 automatic自动 grenade手榴弹 launchers发射
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然后说:“这里是扳机,
还有一些弹药,祝你好运。”
04:00
and say, "Here's这里的 the trigger触发,
here's这里的 some ammo弹药 and good luck运气."
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不。我们训练他们,
在场地中,在不同的环境下,
04:03
No. We train培养 them, on the range范围
and in specific具体 contexts上下文,
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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直到 lifting吊装 their weapon武器
and engaging their target目标
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根深蒂固的刻在肌肉记忆当中;
04:12
is so engrained根深蒂固 into muscle肌肉 memory记忆
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04:14
that it can be performed执行
without even thinking思维,
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直到即使在你们能想象的
最紧张的时刻,
04:16
even under the most stressful压力
conditions条件 you can imagine想像.
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这一系列行为也能够
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相同 holds持有
for training训练 base基础 treatments治疗.
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治疗的第一步是认知疗法,
04:23
The first of these treatments治疗
is cognitive认知 therapy治疗,
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04:27
and this is a kind
of mental心理 recalibration重新校准.
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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老兵 come home from war战争,
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他们对世界的认知是被校对过的,
04:32
their way of mentally精神上 framing取景
the world世界 is calibrated校准
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以适应那种极度危险的战争环境。
04:35
to an immensely非常
more dangerous危险 environment环境.
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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,
04:38
So when you try to overlay覆盖 that mind心神 frame
onto a peacetime和平时期 environment环境,
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04:44
you get problems问题.
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就会出现问题。
04:45
You begin开始 drowning溺死 in worries
about dangers危险 that aren't present当下.
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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。
04:49
You begin开始 not trusting信任的 family家庭 or friends朋友.
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你开始不信任家人和朋友。
04:53
Which哪一个 is not to say there are no
dangers危险 in civilian平民 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。
只是说遇到危险的几率,
04:58
It's just that the probability可能性
of encountering遇到 them
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05:01
compared相比 to combat战斗
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相比战争中而言,
是极低的。
05:02
is astronomically天文数字 lower降低.
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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。
05:05
So we never advise劝告 veterans老兵
to turn off caution警告 completely全然.
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而是训练他们,去根据所处环境,
05:08
We do train培养 them, however然而,
to adjust调整 caution警告
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调整他们的警惕程度。
05:11
according根据 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你自己
in a bad neighborhood邻里,
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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晚餐 with family家庭?
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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,
05:21
We train培养 veterans老兵 to be fiercely激烈 rational合理的,
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让他们能够系统化的衡量他们在
05:25
to systematically系统 gauge测量
the actual实际 statistical统计 probability可能性
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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。
05:28
of encountering遇到, say, an IEDIED
here in peacetime和平时期 America美国.
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通过足够的练习,那些
被校正的认知就会留存。
05:33
With enough足够 practice实践,
those recalibrations重新校准 stick.
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治疗的下一步是暴露疗法,
05:39
The next下一个 of these treatments治疗
is exposure曝光 therapy治疗,
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就好像实地演习,
05:41
and this is a kind of field领域 training训练,
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也是所有被证明
有效的疗法中见效最快的。
05:44
and the fastest最快的 of the proven证明
effective有效 treatments治疗 out there.
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你们还记得卡洛斯吗?
05:47
You remember记得 Carlos卡洛斯?
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这就是他选择的治疗方案。
05:49
This was the treatment治疗 that he chose选择.
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05:51
And so we started开始 off
by giving him exercises演习,
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我们从给他一些练习开始,
05:54
for him, challenging具有挑战性的 ones那些:
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对他来说,最具挑战性的是:
05:55
going to a grocery杂货 store商店,
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去杂货店,
05:57
going to a shopping购物 mall购物中心,
going to a restaurant餐厅,
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去商场,餐厅,
06:00
sitting坐在 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危重 --
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要停留在这些环境当中。
06:05
staying in these environments环境.
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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扫描 the room房间,
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他希望能够坐在一个
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计划 escape逃逸 routes路线,
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06:13
where he could get his hands
on a makeshift凑合的 weapon武器.
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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离开, 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记得 his training训练
in the Marine海洋 Corps兵团,
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06:23
and he pushed through通过 his discomfort不舒服.
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他战胜了自己的不安情绪。
06:25
And every一切 time he did this,
his anxiety焦虑 ratcheted棘轮 down a little bit,
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每当他这样做时,
焦虑感就会逐渐减少,
06:28
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,
直到最后,
06:31
until直到 in the end结束,
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06:32
he had effectively有效 relearned重新学习
how to sit in a public上市 space空间
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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请享用 himself他自己.
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他也会听他战时经历的录音,
06:41
He also listened听了 to recordings录音
of his combat战斗 experiences经验,
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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。
06:47
He listened听了 until直到 those memories回忆
no longer generated产生 any anxiety焦虑.
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他不断消化那些记忆,
06:52
He processed处理 his memories回忆 so much
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06:55
that his brain no longer needed需要
to return返回 to those experiences经验
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以至于不需要再在梦里
06:58
in his sleep睡觉.
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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,
07:00
And when I spoke with him
a year after treatment治疗 had finished,
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他告诉我:
07:03
he told me,
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07:05
"Doc文件, this is the first time in 43 years年份
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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没有 had nightmares噩梦."
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07:13
Now, this is different不同
than erasing擦除 a memory记忆.
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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,
07:18
Veterans退伍军人 will always remember记得
their traumatic创伤 experiences经验,
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但是通过足够量的训练,
07:21
but with enough足够 practice实践,
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那些记忆将不再像以往
那样鲜活,那样让人痛苦。
07:22
those memories回忆 are no longer as raw生的
or as painful痛苦 as they once一旦 were.
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他们情感上不再觉得
那些经历依然历历在目,
07:28
They don't feel emotionally感情上
like they just happened发生 yesterday昨天,
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07:31
and that is an immensely非常
better place地点 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经常 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。
07:39
And, like any training训练,
it may可能 not work for everybody每个人.
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此外还存在着信任问题。
07:44
And there are trust相信 issues问题.
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有时,我会被问道:
07:45
Sometimes有时 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?“
07:47
"If you haven't没有 been there, Doc文件,
how can you help me?"
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我很理解这种想法。
07:49
Which哪一个 is understandable可理解.
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但是考虑到回归平民生活,
07:52
But at the point of returning回国
to civilian平民 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要求
somebody who's谁是 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要求 training训练
for operations操作 on the battlefield战场;
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08:03
you require要求 training训练 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过去 10 years年份 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裸露 to detailed详细 accounts账户
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08:16
of the worst最差 experiences经验
that you can imagine想像,
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最糟糕的,能具体到琐碎细节的
08:18
daily日常.
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日常情况。
08:19
And it hasn't有没有 always been easy简单.
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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打破
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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吸收 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,
08:28
But these training-based训练为主
treatments治疗 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,
08:31
that whatever随你 this work takes out of me,
it puts看跌期权 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人们 lives生活 transform转变.
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我看到了人们的生活正在发生转变。
08:42
Carlos卡洛斯 can now enjoy请享用 outings郊游
with his grandchildren孙子,
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卡洛斯已经能和他的
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。
08:46
which哪一个 is something he couldn't不能 even do
with his own拥有 children孩子.
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最令我惊讶的,
是在43年的折磨之后,
08:49
And what's amazing惊人 to me
is that after 43 years年份 of suffering痛苦,
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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。
08:53
it only took him 10 weeks
of intense激烈 training训练 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年份 back.
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但至少现在,无论在这世上
我还剩下多少时间,
09:05
But at least最小 now, whatever随你 days
that I have left on this Earth地球,
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我都可以在平静中度过。”
09:10
I can live生活 them in peace和平."
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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希望 that these
younger更年轻 veterans老兵 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希望, 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幸运 enough足够
to have survived幸存 war战争
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09:28
or any kind of traumatic创伤 experience经验,
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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你自己
to live生活 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不能 wait
to get the training训练 you need
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实现美好人生的训练。
09:37
to make that happen发生.
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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最好 way of ending结尾
human人的 suffering痛苦 caused造成 by war战争
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就是避免战争。
09:46
is to never go to war战争.
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但是我们这个物种
还没有达到那样的境界。
09:49
But we are just not there
yet然而 as a species种类.
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但在那之前,
09:52
Until直到 we are,
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09:53
the mental心理 suffering痛苦 that we create创建
in our sons儿子 and in our daughters女儿
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当我们把子女送去战场,
09:58
when we send发送 them off to fight斗争
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给他们造成的精神折磨
10:00
can be alleviated缓解.
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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,
10:03
But we must必须 ensure确保 that the science科学,
the energy能源 level水平, the value
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10:09
that we place地点 on sending发出 them off to war战争
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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最小 mirrored镜像
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10:15
in how well we prepare准备 them
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掌声)
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Translated by Junyi Sha
Reviewed by Conway Ye

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ABOUT THE SPEAKER
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).

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.


More profile about the speaker
Hector Garcia | Speaker | TED.com