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Do you remember where you were on June 12th, 2016?
你们还记得2016年6月12日自己身处何处吗？
A few of you might, but I'm betting the vast majority probably don't.
可能少数人会记得，但我敢说大部份人是不记得的。
On June 12th, 2016, a lone gunman walked into Pulse Nightclub,
2016年6月12日，一个持枪男子只身走进脉冲夜店，
killing 46 people in the deadliest mass shooting by a single gunman in U.S. history.
枪杀46人，造成了美国历史上最为严重的大规模枪杀事件。
Now let's go back about a decade. How about August 29th, 2005? Do you remember where you were?
现在让我们回溯十年。看看2005年8月29日。你们还记得当天你们身处何处吗？
We've got a few heads nodding out there. That was Hurricane Katrina.
好的，有些人在点头了。那就是卡特理娜飓风。
Over 1,800 dead in the costliest natural disaster ever to hit the North American continent.
超过1800人丧命于这场造成北美大陆史上最严重经济破坏的自然灾害中。
Now let's go back another few years and go for 100 percent recognition.
现在再让我们向前追溯几年，试试百分百的识别度。
Do you remember where you were on September 11th, 2001? Everybody's head nodding now.
你们是否记得自己2001年9月11日身处何处？现在所有人都在点头了。
The September 11th attacks left over 3,000 dead in the worst terrorist attack in U.S. history.
911这场美国史上最可怕的恐怖袭击，造成了逾3000人死亡。
Do you remember how you felt? Were you confused? Afraid? Did you feel sick? Were you vulnerable?
你还记得你当时的感受吗？你是不是很困惑？很害怕？你感到恶心吗？你是不是觉得自己很脆弱？
Every time this happens, we're becoming more and more desensitized.
每当发生这样的事件，我们都变得越来越麻木。
We frequently see news coverage of mass shootings, natural disasters that result in enormous loss of life,
我们频繁地看到新闻报导大规模枪击案件、自然灾害，这些事件造成了无数人丧失生命，
terrorist attacks, and then we change the channel to watch something more friendly.
还有恐怖袭击，然后我们就切换频道，想看点令人心安的东西。
This is the society that we live in today,
这就是我们现今生存的社会，
but the impact of these traumatic events are no less serious on those who are directly affected,
但是这些创伤性事件的影响对直接受到影响的人而言绝非平淡，
and now the impact of emotional pain on our society is more problematic than ever.
现在情感的痛苦对我们这个社会来说，更加严重。
Do you remember where you were on April 20th, 1999?
你们是否还记得自己1999年4月20日身处何处？
Two students walked into Columbine High School armed with shotguns, semi-automatic rifles, and a bevy of homemade explosives,
两个学生走进科伦拜高中，手持猎枪、半自动来复枪和一堆自制炸药，
killing 12 students and a teacher, in what was, at the time, the worst high school shooting in U.S. history.
杀死了十二名学生和一位老师，那是当时美国历史上最严重的校园枪击案。
I remember where I was. I had just walked into the library with my best friend in order to meet others preparing to go to lunch.
我还记得我当时在哪里。我刚和我最好的朋友一起走进图书馆，为了跟其他伙伴一起去吃午饭。
Moments later, a teacher ran through the same doors we'd just entered
没过几分钟，一个老师从我们刚进来的门冲进来，
yelling for everyone to get under the tables; that somebody had a gun.
大声叫着有个人拿着枪，并要所有人躲到桌子底下去。
I remember how I felt. I was confused. I was afraid. I felt sick. And I was vulnerable.
我记得我当时的感受。我很困惑。我很害怕。我还直犯恶心。当时我神经非常脆弱。
And just minutes later, I was playing dead underneath a table next to a pool of blood.
几分钟后，我在桌子底下装死，边上就是一滩血迹，
I had just been shot, and I had witnessed my best friend murdered right in front of me
我刚刚中了一枪，我也看着我最好的朋友，就在我面前被枪杀了，
as we were huddled together waiting for help to come.
就在我们挤在一起等待救援的时候。
I was broken. I was in shock, and I was in pain.
我那时非常崩溃，惊恐到极点，也无比疼痛。
But my understanding of pain that day was nothing like my understanding of pain today.
但是我那时对于疼痛的理解，和我今日对疼痛的理解截然不同。
What's the first thing you think of when you think of pain?
想到疼痛，你的第一反应是什么？
Is it a broken arm? Headache? Sprained ankle? Maybe a gunshot wound?
手臂骨折吗？头疼？还是踝关节扭伤？或者是枪伤？
Those are the things that I used to associate with pain, and they're pretty in line with the medical definition of pain:
这些是我过去对于疼痛的联想，它们也非常符合疼痛的医学定义：
A variably unpleasant sensation associated with actual or potential tissue damage
与实际或潜在组织损伤相关的一系列不愉快感受，
and mediated by specific nerve fibers to the brain where its conscious appreciation may be modified by various factors.
并受特定神经纤维传递向大脑，而大脑对自我及外界的意识评估可能受到诸多因素的调节。
Do you notice anything missing from that definition?
你们有没有注意到有什么是这个定义所遗漏的吗？
Do you see any mention of the emotional components of pain? Me neither.
你们是否注意到疼痛的情感部份并未被提及？我也没有。
In 1996, the American Pain Society introduced the phrase, "Pain is the fifth vital sign,"
1996年，美国疼痛学会引入了这种说法，“疼痛是第五种生命征象。”
meaning that when you walked into an emergency room, the initial assessment of your condition was based on five data points:
这意味着当你走进急诊室，医生对你病情的初步评估将会基于这五个数据：
pulse rate, temperature, respiration rate, blood pressure, and pain.
脉搏率、体温、呼吸率、血压以及疼痛。
This was brought about by a cultural movement that was adamant that we were under-treating pain.
这是由一场文化运动发起的，他们坚称我们对疼痛治疗不足。
And patient satisfaction surveys were put in place in order to track the outcome and effectiveness of this new implementation.
有关部门进行了病人满意度调查，以追踪这项新政策的实施效果。
And what better way to promote these new policies than to tie physician and hospital compensation to patient satisfaction?
还有什么比将医生与薪资和病人满意度紧密联系起来更有效的方法来推进新政策呢？
A recent survey by the industry group Physicians Practice reports that
最近一项由产业群组“诊所医生”进行的调查显示，
three out of ten doctors are paid bonuses based upon patient satisfaction surveys,
十分之三的医生因病人满意度调查获得奖金，
and hospitals with better scores receive bigger payments from insurers.
得分较高的医院也能从保险公司处获得更多酬金。
Naturally, administrators and physicians began to support this new movement with the goal being to get everyone's pain to zero on the scale.
自然而然地，政府和医生都开始支持这项新运动，以使每个人的痛苦降到最低。
That was the mark. The ethical dilemma immediately became,
那就是标靶。伦理难题马上变成，
"Do I issue this person narcotics in order to keep them happy, or deny them,
“我开麻醉剂给这个病人是为了让他们快乐吗？还是拒绝他们？
and potentially hurt my compensation, the revenue of the hospital,
这样可能降低我的薪酬和医院的收入，
or at worst, open myself up to a grievance for under-treating pain that could potentially result in the loss of my job?"
或者最坏情况就是，会使我面临一场疼痛治疗不足的申诉，而可能让我失去工作？”
I have experience with pain. Less than an hour after scrambling out the back door of the Columbine High School library,
我体验过这种疼痛。不到我爬出科伦拜高中图书馆后门的一小时内，
I was medicated on a variety of substances that were intended to sedate and to relieve pain.
我服用了很多种镇定剂和止痛药。
I was 17 years old and I'd never drank a beer or smoked weed, much less anything harder.
那时我17岁，从来没有喝过啤酒，也没有抽过大麻，更别说更强的东西了。
I had no idea of what these medications were even supposed to do.
我根本不知道这些药物本应该治疗什么。
All I knew at age 17 was that a lot of highly educated people had prescribed me medications
十七岁的我所能知道的就是有很多受过高等教育的人给我开了很多药，
that were intended to make me feel better and they were working,
让我更舒服些，这些药的确在起作用，
only not in the fashion that they were intended.
只是并不是按照它们本来的方式起作用。
Now if you only remember one thing from my talk today, let it be this:
如果你只能记住我今天演讲内容的一样东西，那就请记住这个：
Opioids are profoundly more effective at relieving the symptoms of emotional pain than they are at relieving the symptoms of physical pain.
鸦片类药物在缓解情绪痛苦症状方面要比缓解身体疼痛有效得多。
I often think back to my pain that day and if I were to rate it on the pain scale,
我经常会回想我当日的疼痛，如果要给我的疼痛程度打个分，
my physical pain would've been a three or a four, and that was likely the response I offered when I was asked.
那我身体上的疼痛可能是3或4分，要是问到我，我很可能就是这么回答的。
But my emotional pain was an absolute ten. I was in agony beyond comprehension.
但是我情感上的痛苦，绝对是10分。我的痛苦超出你们的理解。
But that was never asked; it was never talked about.
但是从没有人问过我我情感上的痛苦；也从未被提及。
Acute physical pain ends relatively quick; complex emotional pain does not.
身体上急剧的疼痛恢复地很快；但是复杂情感上的痛苦却很慢。
My physical pain had subsided in just a matter of days
我身体上的疼痛在短短几日之内消减了很多，
but my emotional pain was just as debilitating as it was lying in the hospital bed that day,
但我情感上的痛苦却使我像在医院躺着的那天一样虚弱，
so I continued taking the medication that was prescribed for my pain.
所以我持续不断地服用医生开给我缓解痛苦的药物。
I was addicted before I even knew what was happening.
在我甚至不知道发生了什么之前，我就已经对药物成瘾了。
A recent survey by the American Society of Addiction Medicine reports that
最近一项由美国药物成瘾医学会开展的调查表明，
86 percent of heroin users began by taking prescription opioids.
86%的海洛因吸食者最初都只是在服用鸦片类处方药。
And in 2012 alone, over 259 million opioid prescriptions were filled in the U.S.
仅在2012年一年之间，美国就开出了超过二亿五千九百万张鸦片类药物处方。
That is more than enough to give every American adult their own bottle of pills.
差不多能给每个成年美国人配一瓶药。
I very quickly began drug-seeking in order to soothe my emotional pain
很快我就开始吸毒，只为了缓解我情感上的痛苦，
and it was only a matter of months before the prescriptions had turned to alcohol, marijuana, and elicit narcotics.
就是几个月的时间，这张处方就变成了酒精、大麻，还引出了毒品。
And as addiction always does, over the course of the next decade, my tolerance continued to build,
在接下来的十年间，毒瘾都一直在，我的耐药性不断增加，
my life continued to be unmanageable, and my emotional pain stayed unresolved.
我的生活仍然无法掌控，而我情感上的痛苦依然无法解决。
It was like I had pressed a pause button on my emotional growth.
就像是我在我的情感成长上按下了暂停键一样。
I was managing my pain in the only way I knew how, and I wasn't alone.
我用我所知的唯一方法来控制我的痛苦，而我并不孤单。
I believe that emotional pain is what's driving the addiction epidemic.
我认为情感上的痛苦是导致吸毒流行的原因。
Think of someone you know who struggles with addiction.
想想一个你认识、正在跟毒瘾抗争的人。
I'm betting you can point to an element of unaddressed or unresolved emotional pain in that person.
我打赌你能指出那个人情感上未曾解决的痛苦因素。
Now think of a time you were in intense emotional pain and how desperate you were to stop it.
现在想想，你处于一段情感极度痛苦的时间，你也极其想要停止这种痛苦。
What if you had been offered an immediate route to feeling better.
如果有人给你指了一条让你舒服点的快捷方式呢？
Imagine for a moment breaking your leg in an avalanche.
想象一下，你在雪崩里折了一条腿。
Now that injury alone can be a fairly traumatic experience, but it's manageable.
受伤本身是一场痛苦的经历，但它的痛苦是可以被控制的。
With short term pain management, most would make a full recovery.
短期的疼痛治疗可以让大多数人完全康复。
But now imagine sustaining that exact same injury, only this time your close friend was skiing next to you,
但现在想象一下，你仍受着同样程度的伤，只是这次你的亲密伙伴就在你身边滑雪，
and they didn't make it out of the avalanche alive.
但是他们却并未在这场雪崩中幸存。
It seems so crystal clear to me that there would be two very different pain management strategies
我认为十分清楚，该有两种截然不同的疼痛治疗策略
for what would appear to be an identical physiological injury, only there's not.
以治疗生理上完全一样的伤口，只是却没有。
Emotional pain is toxic, it's pervasive, and society has programmed us to avoid it.
情感痛苦是有毒的，它是普遍存在的，而社会却让我们避之若浼。
We medicate with alcohol and drugs, sex and pornography, even television and technology,
我们试着用酒精、毒品、性、情色，甚至电视剧和科技来疗伤，
and oftentimes, we're doing this without even knowing it.
但更多情况下，我们是无意识地在进行疗伤。
Our society is literally being defined by this pain.
我们的社会实际上是被这种痛苦界定的。
And now, more and more people are dying every month because they're looking for solace in the only way they know how.
现在，每个月都有越来越多的人奄奄一息，因为他们在用他们所知的唯一方式寻求慰藉。
It's the way they were programmed. Everyone has pain; it's unavoidable.
他们被教导使用这种方式。每个人都有痛苦，这是无可避免的。
And I have a simple summary for how we got here.
演讲到此，我有一个简单的概括。
We built a society that is filled with emotional pain and trauma.
我们建立了一个充满情感痛苦与创伤的社会。
We combined that with a healthcare system that's intended to primarily treat physiological symptoms,
我们将它与一个主要治疗生理症状的医疗系统相结合，
and then we put Big Pharma in the driver's seat, aimed directly at profits with regulations that are easy to manipulate.
进而我们将大型医药公司放在驾驶员的位置上，为了从便于操控的法规中直接获取利益。
And now we're in the midst of what the former Surgeon General called the worst public health crisis the nation has ever seen -- two years ago.
我们现在正处于前美国公卫军官团团长两年前所说最严重的公共健康危机中。
It has since worsened, and what was then the addiction epidemic is now commonly referred to as the addiction pandemic.
现在情况更加恶化了，当时小范围流行的药品成瘾，如今已经泛滥成灾。
And here's a glimpse of where we're at today.
让我们将目光投向我们今日的所在。
The New York Times reported last month that overdose deaths rose by 19 percent in 2016,
《纽约时报》上月报导称，2016年过量服药至死人数上升了19%，
and preliminary data for 2017 shows that this trend is only worsening.
而2017年的初步数据显示这个趋势只有更糟糕。
We've now far surpassed the worst years ever recorded for deaths caused by guns, AIDS, and automobile accidents.
如今死亡人数更是远远超过了最严重的枪支、爱滋和车祸事件的死亡记录。
This data is appalling to me.
这份数据使我大为震惊。
There are people in our society today who will still write this off under the guise of, "They're just a bunch of junkies."
现今在我们的社会中，仍有人假借这个名义，流利地写下：“他们就是一群瘾君子。”
Well, I'm here to tell you ... they're not.
好吧，我来这里就是为了告诉大家，他们不是。
They're fathers, mothers, brothers, sisters, they're children, sometimes not even in their teens.
他们也是为人父、为人母，为人兄弟、为人姐妹者，他们也是为人子女者，甚而他们有时还没到青春期。
They're people just like you and me, trying to cope in the only way they know how,
他们就是如你我一般无二的人，试图用他们所知的唯一方式来应对这一切，
and they're dying by the thousands every single month at an ever-increasing rate.
却在以更快的速度逝去，成为每个月成千上万个死者之一。
Addiction is the only disease where we commonly wait until it's at the highest levels of acuity before we try to do something about it.
吸毒是唯一一种在我们能做些什么之前，其剧烈程度就已经达到巅峰的疾病。
And by then, it's often too late. We have to start sooner. We have to practice early interventions.
到那时，为时已晚。我们必须早点出手。我们必须实行早期干涉。
We have to educate youth with real world methods.
我们必须用现实的方法教育年轻人。
We have to stop thinking that people can be rehabilitated in thirty days,
我们必须摒弃那种成瘾者三十天内就可以康复的错误想法，
and then we have to improve accessibility to long-term treatment.
我们更必须改善长期治疗的普及率。
We have to eliminate the stigma associated with addiction
我们必须洗雪药品成瘾者莫须有的污名，
and most importantly, we have to reform a broken healthcare system
最重要的是，我们必须改革这个破败的医疗体系，
that is slowly coming to terms with the fact that they are responsible for this pandemic.
这一体系也正在逐步接受它该对这场泛滥的毒瘾负责的事实。
It took me over a decade of active addiction and many more in recovery
我有十几年的时间都在主动吸毒，而在戒毒上，我又花了更多的时间，
before I finally learned the difference between feeling better and actually being better.
才终于明白，感觉上的好和实际身体健康的好是两码事。
Because I had to learn to lean into the pain. I had to quit looking for the fast road to relief.
因为我必须学会忍受痛苦。我必须摒弃寻找解脱“快捷方式”的念头。
I had to do the emotional work that needed to be done no matter how much it hurt.
我必须去完成那些我必须完成的情感工作，无论这些工作有多伤人。
And after multiple attempts at short-term treatment, I finally found a willingness to do whatever it took,
经过多次短期治疗的尝试后，我终于有了尽一切努力的决心，
and I stayed in a continuum of care for 14 consecutive months in order to figure it out.
然后我连续14个月接受不间断的护理，就为了能弄明白。
I had to go through the stages of grief that I should've been going through at age 17, at age 29.
我不得不在29岁时熬过我本该在17岁时经历的痛苦阶段。
But I refused to keep running, and it worked.
但是我拒绝继续这样下去，它也奏效了。
Fortunately for us, there is such a thing as post-traumatic growth,
对我们而言，幸运的是，的确有所谓的“创伤后成长”，
and you're witnessing that on the stage before you today.
今日你就在你面前的舞台上目睹这件事。
Post-traumatic growth is defined as the positive psychological change that can occur in a person after they've experienced a traumatic life event.
创伤后的成长，是指一个人在经历了生活中的磨难后，产生的积极心理变化。
It implies that by finding a way to endure through significant suffering,
这意味着通过找到一种使自己承受巨大痛苦的方法，
you can actually have meaningful development of personal character and elevate yourself to a higher level of functioning.
你实际上使自我个性得到一次有意义的发展，也将你自己提升到一个更高层次。
But achieving post-traumatic growth requires that you lean into the pain.
但是要达到创伤后的成长，你就必须忍受这种伤痛。
You can't run from it. You can't medicate it. So now I have a challenge for you.
你不能逃避。你也不能依靠药物治疗。现在我给予你们一次挑战的机会。
Take an audit of your current level of emotional pain.
评估一下你们目前情感痛苦的程度。
Do you have grief or heartache that you aren't dealing with?
你有没有未曾处理的伤悲？
Has something traumatic happened to you that you haven't healed from?
你有没有未曾愈合的心灵创伤？
If so, take a step towards addressing this pain.
如果有，向前迈出一步来解决这伤痛。
Call a friend, talk to a therapist, just speak your truth to a stranger.
打个电话给朋友，和心理咨询师聊聊，或者就向陌生人诉说你的实情。
Take one small step to shed light on this darkness because I've seen what darkness can do.
迈出一小步，就能照亮无穷黑暗，因为我已经见识过黑暗的手段。
I've seen it in hospital rooms when just one more didn't end up the way it was intended.
我在病房里见识过，未达到预期治疗效果的人。
I've seen it in jails with people who were born addicted and never had a chance to learn anything else.
我在监狱里见识过，生来就是瘾君子的人，从未有过学习其他东西的机会。
I've seen it at funerals for children who died before they ever had a chance to truly live.
我在葬礼上见识过，还未曾体会过生活真味的孩子们过早夭亡。
And I've seen it from underneath a table in the library of my high school.
我也在我高中图书馆的桌子底下见识过。
I want to leave you all with something that I wish I had known at age 17.
我想告诉你们一些我多希望在我17岁时就知道的东西。
Whoever you are, whatever you're going through, in whatever way you might be going through it,
无论你是谁，无论你在经历些什么，无论你在用什么方式度过，
just know this: in order to heal it, you have to feel it.
你只需要知道：创伤需要触摸，才能愈合。
We're not going to solve the addiction pandemic overnight
我们无法一夜之间解决泛滥的毒瘾，
but we will make progress when people start to understand the difference between physical and emotional pain,
但当人们开始理解身体疼痛和情感疼痛的区别时，我们就有了进步，
and then choose to do something about it.
才能选择采取下一步措施。
In recovery, we often say, you keep what you have by giving it away.
在康复过程中，我们常说，赠人玫瑰，手留余香。
Find the courage to lean into the pain, and you can be a force in helping others. Thank you.
找出你接受痛苦的勇气，你就能助他人一臂之力。谢谢大家。
