TED童年创伤怎样影响一生的健康

童年创伤不是一件长大就能解决的事。儿科医生Nadine解释虐待、忽视、和父母精神健康不良或有药物或饮酒问题，都会影响儿童的大脑发展。童年经历影响终身，在高压环境下长大的儿童比他人得到心肺疾病的比例高三倍。

演说者：NadineBurkeHarris

演说题目：童年创伤怎样影响一生的健康！

Inthemid-90s,theCDCandKaiserPermanentediscoveredanexposurethatdramaticallyincreasedtheriskforsevenoutof10oftheleadingcausesofdeathintheUnitedStates.Inhighdoses,itaffectsbraindevelopment,theimmunesystem,hormonalsystems,andeventhewayourDNAisreadandtranscribed.Folkswhoareexposedinveryhighdoseshavetriplethelifetimeriskofheartdiseaseandlungcanceranda20-yeardifferenceinlifeexpectancy.Andyet,doctorstodayarenottrainedinroutinescreeningortreatment.Now,theexposureImtalkingaboutisnotapesticideorapackagingchemical.It’schildhoodtrauma.

90年代中期,CDC和KaiserPermanente发现:暴露于某种事物中会极大增加死亡风险,七成美国民众的首要死因皆由此引起。暴露剂量较高时,会影响大脑发育,免疫系统,内分泌系统,甚至影响到基因的读取及转录方式。暴露在极高剂量下的人群,有3倍的风险患上心脏病和肺癌,预期寿命缩短20年。然而,目前医生们还未被培训以常规筛查和治疗的手段来应对这种风险。我所说的暴露危害并不针对某种农药或包装上的化学物质。而是儿童期创伤。

Okay.WhatkindoftraumaamItalkingabouthere?Imnottalkingaboutfailingatestorlosingabasketballgame.Iamtalkingaboutthreatsthataresosevereorpervasivethattheyliterallygetunderourskinandchangeourphysiology:thingslikeabuseorneglect,orgrowingupwithaparentwhostruggleswithmentalillnessorsubstancedependence.

那么,我要说的是哪种创伤呢？我要说的可不是考试不及格或输掉篮球比赛。我要说的是那种如此严重而又无处不在的威胁,以致于它让我们毛骨悚然,并从生理上改变了我们：比如,受虐待或被忽视,又或者,抚养我们的父母,本身就深受精神疾病之苦,或是深陷于"物质依赖"疾病。

Now,foralongtime,IviewedthesethingsinthewayIwastrainedtoviewthem,eitherasasocialproblem--refertosocialservices--orasamentalhealthproblem--refertomentalhealthservices.Andthensomethinghappenedtomakemerethinkmyentireapproach.WhenIfinishedmyresidency,IwantedtogosomeplacewhereIfeltreallyneeded,someplacewhereIcouldmakeadifference.So,IcametoworkforCaliforniaPacificMedicalCenter,oneofthebestprivatehospitalsinNorthernCalifornia,andtogether,weopenedaclinicinBayview-HuntersPoint,oneofthepoorest,mostunderservedneighborhoodsinSanFrancisco.Now,priortothatpoint,therehadbeenonlyonepediatricianinallofBayviewtoservemorethan10,children,sowehungashingle,andwewereabletoprovidetop-qualitycareregardlessofabilitytopay.Itwassocool.Wetargetedthetypicalhealthdisparities:accesstocare,immunizationrates,asthmahospitalizationrates,andwehitallofournumbers.Wefeltveryproudofourselves.

一直以来,我都按照所教导的方式来看待这些事情。要么把它当成一个社会问题--交给社会服务去处理,要么把它当成一个心理健康问题--交给心理健康咨询来解决。后来发生了一些事情,使我反思我的整个思维方式。在医院实习结束后,我想去个我觉得真正需要我的地方,去个我可以有所作为的地方。因此，我选择为加利利福尼亚太平洋医疗中心(CPMC)工作,这是加利福尼亚医院之一,医院合作,在旧金山最穷、社区服务最差的居民区--湾景区猎人角（Bayview-HuntersPoint）开了一家诊所。在此之前,整个湾景区（Bayview）社区仅有一名儿科医生,为一万多名儿童服务,因此,我们开始挂牌营业,提供最优质的医疗服务,不论是否有能力支付医疗费用。这种感觉很棒。我们找出了在医疗服务上现状与标准的差距：普及医疗保健,免疫接种率、哮喘住院率等,我们都完成了达标。我们为自己感到骄傲。

ButthenIstartednoticingadisturbingtrend.AlotofkidswerebeingreferredtomeforADHD,orAttentionDeficitHyperactivityDisorder,butwhenIactuallydidathoroughhistoryandphysical,whatIfoundwasthatformostofmypatients,IcouldntmakeadiagnosisofADHD.MostofthekidsIwasseeinghadexperiencedsuchseveretraumathatitfeltlikesomethingelsewasgoingon.Somehow,Iwasmissingsomethingimportant.

但就在那时,我开始注意到一种令人忧心的趋势。很多孩子因为多动症（简称ADHD),被送到我这里进行医治,可是,当我对孩子们的病史和身体状况进行彻查时,却发现大多数患儿的情况,我无法下"多动症"(ADHD)的诊断。多数来就诊的孩子都经历过如此严重的创伤,让人觉得似乎事情并不简单。不知怎的,我漏查了某个重要的因素。

Now,beforeIdidmyresidency,Ididamastersdegreeinpublichealth,andoneofthethingsthattheyteachyouinpublichealthschoolisthatifyoureadoctorandyouseekidsthatalldrinkfromthesamewell,and98ofthemdevelopdiarrhea,youcangoaheadandwritethatprescriptionfordoseafterdoseafterdoseofantibiotics,oryoucanwalkoverandsay,"Whatthehellisinthiswell?"So,IbeganreadingeverythingthatIcouldgetmyhandsonabouthowexposuretoadversityaffectsthedevelopingbrainsandbodiesofchildren.

在实习之前,我曾攻读公共健康硕士学位,在公共健康学校里,我们曾学过这样的一课,如果你是一名医生,当你知道有个孩子从同一口井中饮水,其中98人患了腹泻,你可以着手治疗,给每个病人都开抗生素,一剂,一剂,又一剂的开。可是你也可以走去井边，问声,"井里到底有什么鬼东西?"所以,我开始查阅手头所有的相关资料,了解暴露在不幸中,是如何影响儿童的大脑和身体发育的。

Andthenoneday,mycolleaguewalkedintomyoffice,andhesaid,"Dr.Burke,haveyouseenthis?"InhishandwasacopyofaresearchstudycalledtheAdverseChildhoodExperiencesStudy.Thatdaychangedmyclinicalpracticeandultimatelymycareer.

然后有一天,一个同事走进我的办公室,他问我,"伯克医生,你看过这个吗?"在他手里的是一份调查研究的复印件,题目是"童年不良经历(ACE)研究"。那一天,改变了我的临床实践,也最终改变了我的职业生涯。

TheAdverseChildhoodExperiencesStudyissomethingthateverybodyneedstoknowabout.ItwasdonebyDr.VinceFelitaatKaiserandDr.BobAndattheCDC,andtogether,theyasked17,adultsabouttheirhistoryofexposuretowhattheycalled"adversechildhoodexperiences,"orACEs.Thoseincludephysical,emotional,orsexualabuse;physicaloremotionalneglect;parentalmentalillness,substancedependence,incarceration;parentalseparationordivorce;ordomesticviolence.Foreveryyes,youwouldgetapointonyourACEscore.AndthenwhattheydidwastheycorrelatedtheseACEscoresagainsthealthout