点击上方“精彩英语演讲”，选择“设为星标”
英语演讲视频，第一时间观看
每一个孩子都是上帝的天使，在这个欢快的日子里，首先英语演讲君祝愿所有儿童能在这一天，愉快地度过属于他们的节日，但愿你们的眼睛永远清澈无邪，充满笑容。
祝福完了，今天英语演讲君就为广大的父母和小朋友们准备了3个非常有价值的，和童年健康成长的TED演讲，一起陪你成长！
别给孩子一个清单式的人生
天下父母都希望自己的孩子可以一帆风顺少走弯路，从学生时期到参加工作，一路都可以保持人生赢家的势头。 你的孩子是否在过一种清单式的童年？ 清单式的童年，过度的溺爱和控制，狭隘的“成功”定义给孩子过高的期望，事无巨细的管理孩子的生活， 这样的养育方式适得其反。
其实，正确的教育方式：避免过度呵护。 今天，我们来看一个精彩的视频。 演讲者， Julie Lythcott-Haims， 曾就读于哈佛大学法学院、加州艺术学院、 斯坦福大学，毕业后曾是一名律师， 之后又在斯坦福大学任校长助理、 教务长等职十几年之久， 而她同时也是两个孩子的妈妈。 她用激情和诙谐的语言告诉你一种新的教育方式。
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双语演讲稿
Most of us go through life trying to do our best at whatever we do,whether it’s our job, family, schoolor anything else.I feel that way. I try my best.But some time ago, I came to a realizationthat I wasn’t getting much better at the things I cared most about,whether it was being a husband or a friendor a professional or teammate,and I wasn’t improving much at those thingseven though I was spending a lot of timeworking hard at them.I’ve since realized from conversations I’ve had and from researchthat this stagnation, despite hard work,turns out to be pretty common.
大多数人在生活中都会尝试把每件事做到最好，无论是在职场上、家庭、学校或其它领域。我也有同感，也会努力尝试。但前一段时间，我开始意识到，我总是无法在自己最在意的事情上做得更好。比如做一个好丈夫或好朋友，一名专业人士或好队友，我一直无法在这些事情上有很大的提升，哪怕我花了很多时间努力完成。我之后在与他人的谈话和研究中意识到，无论你多努力，这种瓶颈总是一直出现。
So I’d like to share with you some insights into why that isand what we can all do about it.What I’ve learnedis that the most effective peopleand teams in any domaindo something we can all emulate.They go through life deliberately alternating between two zones:the learning zone and the performance zone.
所以我想跟各位分享一些见解，并提出一些解决的办法。我所了解的是，无论哪个领域，各行业的佼佼者都有可以让我们仿效的地方。我发现，他们在日常生活中会有意识地在这两种状态中切换，学习状态和执行状态，
The learning zone is when our goal is to improve.Then we do activities designed for improvement,concentrating on what we haven’t mastered yet,which means we have to expect to make mistakes,knowing that we will learn from them.That is very different from what we do when we’re in our performance zone,which is when our goal is to do something as best as we can, to execute.Then we concentrate on what we have already masteredand we try to minimize mistakes.
在学习状态，我们的技能可以进步。我们会透过设计过的活动来提升技能。专注于尚未掌握的事情，这意味着我们一定会有失误，但我们也一定能从中学到东西。这跟我们执行状态时所做的事情很不一样，执行状态的目的是把我们最好的一面表现出来。我们会专注在已经掌握好的技能，并把失误减到最小。
Both of these zones should be part of our lives,but being clear about when we want to be in each of them,with what goal, focus and expectations,helps us better perform and better improve.The performance zone maximizes our immediate performance,while the learning zone maximizes our growthand our future performance.The reason many of us don’t improve muchdespite our hard workis that we tend to spend almost all of our time in the performance zone.This hinders our growth,and ironically, over the long term,also our performance.
这两种状态都是我们生活的一部分，但当你想要自在的处在这两种状态，你得清楚知道你的目标、关注点、预期效果是什么，这样才能帮助你在执行和改进方面都做得更好。执行状态注重当下的表现，学习状态会加速人的成长，并且提升未来的表现。很多人，无论如何努力都没办法有所提高。原因在于：我们总是花费太多时间在执行状态。这样会阻碍成长。讽刺的是，长时间下来，也会引响我们的表现。
So what does the learning zone look like?Take Demosthenes, a political leaderand the greatest orator and lawyer in ancient Greece.To become great,he didn’t spend all his timejust being an orator or a lawyer,which would be his performance zone.But instead, he did activities designed for improvement.Of course, he studied a lot.He studied law and philosophy with guidance from mentors,but he also realized that being a lawyer involved persuading other people,so he also studied great speechesand acting.To get rid of an odd habit he had of involuntarily lifting his shoulder,he practiced his speeches in front of a mirror,and he suspended a sword from the ceilingso that if he raised his shoulder,it would hurt.
那麽，学习状态是怎样的情况？来看看狄摩西尼，这位政治领袖，古希腊最伟大的演说家和律师。他会伟大的原因，不是因为他把时间都花在演说和执行律师业务上面，也就是说他不会一直处在执行状态。相反的，他做了很多改善的活动。毋庸置疑，他花很多时间在学习。比如他在精神导师的指导下学习法律及哲学，但他也同时意识到，作为律师他需要说服别人，所以他也研究名人的演讲及学习演戏。为了改变不由自主耸肩的坏习惯，他会在镜子前练习演说，并且在天花板上吊一把剑。一旦耸肩，他就会被刺到。
(Laughter)
（观众笑）
To speak more clearly despite a lisp,he went through his speeches with stones in his mouth.He built an underground roomwhere he could practice without interruptionsand not disturb other people.And since courts at the time were very noisy,he also practiced by the ocean,projecting his voice above the roar of the waves.
为了克服口齿不清，他会含着石头练习演讲。他还建了一个地下室，以避免练习时被打扰或打扰到别人。因为上法院时会很吵，所以他就对着大海练习，让自己的声音比咆哮的海浪还大声。
His activities in the learning zonewere very different from his activities in court,his performance zone.In the learning zone,he did what Dr. Anders Ericsson calls deliberate practice.This involves breaking down abilities into component skills,being clear about what subskill we’re working to improve,like keeping our shoulders down,giving full concentration to a high level of challengeoutside our comfort zone,just beyond what we can currently do,using frequent feedback with repetition and adjustments,and ideally engaging the guidance of a skilled coach,because activities designed for improvementare domain-specific,and great teachers and coaches know what those activities areand can also give us expert feedback.It is this type of practice in the learning zonewhich leads to substantial improvement,not just time on task performing.For example, research shows that after the first couple of yearsworking in a profession,performance usually plateaus.This has been shown to be true in teaching, general medicine,nursing and other fields,and it happens because once we think we have become good enough,adequate,then we stop spending time in the learning zone.We focus all our time on just doing our job,performing,which turns out not to be a great way to improve.But the people who continue to spend time in the learning zonedo continue to always improve.The best salespeople at least once a weekdo activities with the goal of improvement.They read to extend their knowledge,consult with colleagues or domain experts,try out new strategies,solicit feedback and reflect.The best chess playersspend a lot of time not playing games of chess,which would be their performance zone,but trying to predict the moves grand masters made and analyzing them.Each of us has probably spent many, many, many hourstyping on a computerwithout getting faster,but if we spent 10 to 20 minutes each dayfully concentrating on typing 10 to 20 percent fasterthan our current reliable speed,we would get faster,especially if we also identified what mistakes we’re makingand practiced typing those words.That’s deliberate practice.
他在学习状态所做的活动与他在法院上执行的活动，两者是很不一样的。他在学习状态时，会做安德森·爱立信博士所说的「循序渐进的练习」。就是把要学习的技能拆分成一小段一小段的技能，并且清楚地知道哪一项技巧目前需要提高。像是放松肩膀，全新专注在舒适圈以外更高层次的挑战，专注超越那些早已掌握的事物。利用快速反馈做重复练习和调整，全力配合熟手教练的指导。因为，为改善而设计的活动是有特定范围的，好的老师或教练知道什么活动能带来进步，并会给予专业的反馈。就是在这种学习状态下的练习，才能大量的进步，而不是只是花时间在执行业务上。举个例子，研究表明，在某一领域工作数年后，表现会达到停滞期。这在教学、一般内科、护理及其他领域都得到了印证。这是因为一旦人们觉得自己足够好了，绰绰有余了，就不会再花时间学习。我们只会关注在如何完成工作和执行业务上，这种方式变得不利于提高技能。但是那些一直在学习的人们，就会持续地成长。最好的销售人员，至少每周一次，进行改善训练。他们阅读以增长知识，咨询同行和专家、尝试新的策略、征询意见及反思。最好的棋手，大部分的时间，并不是在跟别人下棋，也就是他们不会一直处在执行的状态，而是试图预测并分析大师们的棋路。每个人可能都花了很多时间在电脑前打字，但却没有越打越快。但是，如果我们每天抽出 10-20 分钟，全神贯注地提升打字速度，比平常快上 10%-20% 就好，我们的速度就会越来越快。特别是当我们能找到失误，并且专注加以练习。这就是一种循序渐进（刻意）的练习。
In what other parts of our lives,perhaps that we care more about,are we working hard but not improving muchbecause we’re always in the performance zone?Now, this is not to say that the performance zone has no value.It very much does.When I needed a knee surgery,I didn’t tell the surgeon,Poke around in there and focus on what you don’t know.
在生活的其他方面，还有哪些是我们比较在意，我们很努力但进步缓慢的地方？是不是因为我们老是停留在执行状态里？但以上都不是在说执行状态没有用，它是很有价值的。但我需要做膝盖手术的时候，我可不想告诉医师：「随便戳戳吧，探索一下你不知道的事。」
(Laughter)
（观众笑）
We’ll learn from your mistakes!I looked for a surgeon who I felt would do a good job,and I wanted her to do a good job.Being in the performance zoneallows us to get things done as best as we can.It can also be motivating,and it provides us with information to identify what to focus on nextwhen we go back to the learning zone.So the way to high performanceis to alternate between the learning zone and the performance zone,purposefully building our skills in the learning zone,then applying those skills in the performance zone.
「我们可以从失误中学到东西啊！」我会找一位我认为够好的医师，我想让她好好地帮我医治。在执行状态时，我们会力求表现到最好，这样可以激励我们，并告诉我们，在回到学习状态的时候，该关注些什么。所以说，想要表现得好需要在学习状态和执行状态之间转换。在学习状态下有目的性地积累技巧，然后再将之应用在执行状态里。
When Beyoncé is on tour,during the concert,she’s in her performance zone,but every night when she gets back to the hotel room,she goes right back into her learning zone.She watches a video of the show that just ended.She identifies opportunities for improvement,for herself, her dancers and her camera staff.And the next morning,everyone receives pages of notes with what to adjust,which they then work on during the day before the next performance.It’s a spiralto ever-increasing capabilities,but we need to know when we seek to learn,and when we seek to perform,and while we want to spend time doing both,the more time we spend in the learning zone,the more we’ll improve.
就像碧昂斯的巡演，演唱会上，她处在执行表演的状态，但每晚回到酒店，她就直接投入到学习状态里。她会观看刚刚结束的表演，为自己、舞群和摄像师，寻找改进的机会。第二天早上，所有人都会收到一份通知，上面写着那些地方需要改进，如此团队成员就可以在下一次表演之前做出调整。如此团队的能力就可以一直向上提升。但我们需要清楚的是，何时「学」、何时「做」，何时两样一起。投入越多时间在学习状态，就能取得越多的进步。
So how can we spend more time in the learning zone?First, we must believe and understandthat we can improve,what we call a growth mindset.Second, we must want to improve at that particular skill.There has to be a purpose we care about,because it takes time and effort.Third, we must have an idea about how to improve,what we can do to improve,not how I used to practice the guitar as a teenager,performing songs over and over again,but doing deliberate practice.And fourth, we must be in a low-stakes situation,because if mistakes are to be expected,then the consequence of making them must not be catastrophic,or even very significant.A tightrope walker doesn’t practice new tricks without a net underneath,and an athlete wouldn’t set out to first try a new moveduring a championship match.
那麽我们要怎样才能多花点时间在学习状态呢？首先，要相信并理解一件事，那就是我们可以改进，也就是所谓的「成长心态」。其次，要在具体的技巧上做改进。并且要有一个我们在乎的目标，因为它需要时间和努力。第三，我们必须要知道该如何提升，要做些什么来提升，而不是像我年轻时弹吉它那样，同首曲子一遍又一遍的重复，而是要做「循序渐进的练习」。第四，我们必须保持在低风险状态，因为如果如预期的发生了失误，那麽造成的后果就不会影响太大，或是关系重大。走钢丝的演员，不会在没有护网的情况下练习新的技巧；运动员并不会在冠军比赛中，尝试新的动作。
One reason that in our liveswe spend so much time in the performance zoneis that our environments often are, unnecessarily, high stakes.We create social risks for one another,even in schools which are supposed to be all about learning,and I’m not talking about standardized tests.I mean that every minute of every day,many students in elementary schools through collegesfeel that if they make a mistake,others will think less of them.No wonder they’re always stressed outand not taking the risks necessary for learning.But they learn that mistakes are undesirableinadvertentlywhen teachers or parents are eager to hear just correct answersand reject mistakes rather than welcome and examine themto learn from them,or when we look for narrow responsesrather than encourage more exploratory thinkingthat we can all learn from.When all homework or student work has a number or a letter on it,and counts towards a final grade,rather than being used for practice,mistakes, feedback and revision,we send the message that school is a performance zone.
我们在生活中，花很多时间在执行状态里，这个中原因是：我们常常处在不必要的高风险环境中。我们彼此制造了社会风险。哪怕是在学校，一个被认定为纯粹学习的地方，我不是在说标准测验，我说的是学生每时每刻、从小学到大学，都会觉得别人会因为他们犯错而轻视他们。难怪他们总是紧张兮兮，不愿为学习冒必要的风险。老师、家长对正确答案趋之若鹜的态度，无意中，让学生害怕犯错。而不是勇于试错、检视过错、并从中吸取教训。又或者，我们只想听「标准答案」，而不是鼓励学生进行可以学到更多的开拓性思考。一旦学生的作业、作品都被评定等级、标上分数，最后记录到期末成绩后，它们就起不到练习、试错、反馈和修正的作用了，我们让孩子误以为：学校只是个让你表现的地方。
The same is true in our workplaces.In the companies I consult with,I often see flawless execution cultureswhich leaders foster to encourage great work.But that leads employees to stay within what they knowand not try new things,so companies struggle to innovate and improve,and they fall behind.
职场中也同样如此。那些咨询我的公司，我常见到领导者鼓励推动「完美执行 」的文化。但这样就会导致员工仅仅停留在他们已知的范畴，而不去尝试新的事物，公司因此很难创新、进步，从而落居下风。
We can create more spaces for growthby starting conversations with one anotherabout when we want to be in each zone.What do we want to get better at and how?And when do we want to execute and minimize mistakes?That way, we gain clarity about what success is,when, and how to best support one another.
我们可以透过交流，为彼此开创进步的空间，聊聊我们何时应该投身于何种状态。在哪些方面可以做得更好？何时决策、怎样控损？如此，我们可以明确什么是成功、何时以及如何去支持对方。
But what if we find ourselves in a chronic high-stakes settingand we feel we can’t start those conversations yet?Then here are three things that we can still do as individuals.First, we can create low-stakes islands in an otherwise high-stakes sea.These are spaces where mistakes have little consequence.For example, we might find a mentor or a trusted colleaguewith whom we can exchange ideas or have vulnerable conversationsor even role-play.Or we can ask for feedback-oriented meetings as projects progress.Or we can set aside time to read or watch videos or take online courses.Those are just some examples.Second, we can execute and perform as we’re expected,but then reflect on what we could do better next time,like Beyoncé does,and we can observe and emulate experts.The observation, reflection and adjustment is a learning zone.And finally, we can leadand lower the stakes for others by sharing what we want to get better at,by asking questions about what we don’t know,by soliciting feedback and by sharing our mistakesand what we’ve learned from them,so that others can feel safe to do the same.
但如果我们处在长期高风险状态下，并且无法展开这样的交流怎么办？依然有三件事是可以自己着手去做的。首先，是在高风险的海洋中，开辟一块低风险的岛屿。让错误发生时不会造成严重的后果。比如说，我们可以找一位导师或可以信任的同事，和他们分享想法，或是接受批评。甚至角色扮演。或者是随着项目的进展，举办反馈会议。又或者我们可以抽出时间去阅读或看视频或是参加线上课程。这只是几个例子。第二，我们可以实践并达成期望的表现，但事后反思如何改进，就像碧昂斯那样。我们还可以观察和模仿专家，这些观察、反思、调整都能让我们学习到很多。最后，我们可以引导并降低彼此的风险，问他们，我们在哪方面可以再取得进步，透过询问未知的问题、征求意见、 分享失误，并从中汲取教训，如此其他人也就能安心地做同样的事。
Real confidence is about modeling ongoing learning.What if, instead of spending our lives doing, doing, doing,performing, performing, performing,we spent more time exploring,asking,listening,experimenting, reflecting,striving and becoming?What if we each always had somethingwe were working to improve?What if we created more low-stakes islandsand waters?And what if we got clear,within ourselves and with our teammates,about when we seek to learn and when we seek to perform,so that our efforts can become more consequential,our improvement never-endingand our best even better?
真正的自信是对不断学习的展示。如果，我们没有把人生耗费在做、做、做、表现、表现、表现上，而是更多地去探索、询问、倾听、实践、反思、拼命去成为想成为的人，会怎么样？如果我们每个人，都有某些事情让我们可为之努力，从而提升呢？如果我们创造更多的低风险区域和环境呢？如果我们自己或整个团队都清楚知道，何时学习、何时表现，如此我们的努力就会有更多回报，就可以精益求精，团队就会越来越好。
Thank you.
谢谢。
童年创伤是如何影响你的健康的？
每个人在童年时期多多少少都会有过一些不愉快的经历，长大以后，慢慢地就忘记了……但是，童年的创伤并不是随着你长大就能全部恢复的。
前美国儿科学会会长Robert Block博士所言, “童年不良经历（ACE）是今天我们国家所面临的唯一最大的未能解决的公共健康威胁。”
今天分享这个演讲，儿科医生Nadine Burke Harris向我们讲述，童年创伤是如何影响一生的健康的？
1. “童年不良经历”，又称为ACE。这包括生理上、情感上遭受的不幸或是性侵害；生理或情感上遭受的忽视；父母患有精神疾病、物质依赖、遭到监禁；父母分居或离婚；或家庭暴力。
2. 关于ACE的研究发现，在调查人群中ACE十分普遍，并且ACE得分越高，健康状况越糟糕。经历过严重创伤的人患心脏病和肺癌的风险会增加三倍。
3. 即使你不从事任何高风险的行为，你仍然更容易患上心脏疾病或癌症。因为高剂量的童年不良经历不仅会影响儿童的大脑结构和功能，还会影响正在发育的免疫系统，以及正在发育的内分泌系统，甚至还会影响我们的DNA读取和转录方式。
4. 童年不良经历对人的一生的健康影响巨大。这种病症是可以治疗的，也是可以战胜的。我们今天最需要的是直面这个问题的勇气，并且承认，这个问题确实存在，与我们息息相关。
双语演讲稿
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In the mid-'90s, the CDC and Kaiser Permanente discovered an exposure that dramatically increased the risk for seven out of 10 of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy. And yet, doctors today are not trained in routine screening or treatment. Now, the exposure I'm talking about is not a pesticide or a packaging chemical. It’s childhood trauma.
90年代中期, CDC和Kaiser Permanente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. What kind of trauma am I talking about here? I'm not talking about failing a test or losing a basketball game. I am talking about threats that are so severe or pervasive that they literally get under our skin and change our physiology: things like abuse or neglect, or growing up with a parent who struggles with mental illness or substance dependence.
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, for a long time, I viewed these things in the way I was trained to view them, either as a social problem -- refer to social services -- or as a mental health problem -- refer to mental health services. And then something happened to make me rethink my entire approach. When I finished my residency, I wanted to go someplace where I felt really needed, someplace where I could make a difference. So, I came to work for California Pacific Medical Center, one of the best private hospitals in Northern California, and together, we opened a clinic in Bayview-Hunters Point, one of the poorest, most underserved neighborhoods in San Francisco. Now, prior to that point, there had been only one pediatrician in all of Bayview to serve more than 10,000 children, so we hung a shingle, and we were able to provide top-quality care regardless of ability to pay. It was so cool. We targeted the typical health disparities: access to care, immunization rates, asthma hospitalization rates, and we hit all of our numbers. We felt very proud of ourselves.
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, 这是加利福尼亚北部 最优秀的私立医院之一, 我与该医院合作,在旧金山最穷、 社区服务最差的居民区-- 湾景区猎人角(Bayview-Hunters Point) 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。
But then I started noticing a disturbing trend. A lot of kids were being referred to me for ADHD, or Attention Deficit Hyperactivity Disorder, but when I actually did a thorough history and physical, what I found was that for most of my patients, I couldn't make a diagnosis of ADHD. Most of the kids I was seeing had experienced such severe trauma that it felt like something else was going on. Somehow, I was missing something important.
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, before I did my residency, I did a master's degree in public health, and one of the things that they teach you in public health school is that if you're a doctor and you see 100 kids that all drink from the same well, and 98 of them develop diarrhea, you can go ahead and write that prescription for dose after dose after dose of antibiotics, or you can walk over and say, "What the hell is in this well?" So, I began reading everything that I could get my hands on about how exposure to adversity affects the developing brains and bodies of children.
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100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。
And then one day, my colleague walked into my office, and he said, "Dr. Burke, have you seen this?" In his hand was a copy of a research study called the Adverse Childhood Experiences Study. That day changed my clinical practice and ultimately my career.
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。
The Adverse Childhood Experiences Study is something that everybody needs to know about. It was done by Dr. Vince Felita at Kaiser and Dr. Bob And at the CDC, and together, they asked 17,500 adults about their history of exposure to what they called "adverse childhood experiences," or ACEs. Those include physical, emotional, or sexual abuse; physical or emotional neglect; parental mental illness, substance dependence, incarceration; parental separation or divorce; or domestic violence. For every yes, you would get a point on your ACE score. And then what they did was they correlated these ACE scores against health outcomes. What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population had at least one ACE, and 12.6 percent, one in eight, had four or more ACEs. The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes: the higher your ACE score, the worse your health outcomes. For a person with an ACE score of four or more, their relative risk of chronic obstructive pulmonary disease was two and a half times that of someone with an ACE score of zero. For hepatitis, it was also two and a half times. For depression, it was four and a half times. For suicidality, it was 12 times. A person with an ACE score of seven or more had triple the lifetime risk of lung cancer and three and a half times the risk of ischemic heart disease, the number one killer in the United States of America.
童年不良经历(ACE)的研究 是每一个人都应该要了解的。 Vince Felitti博士和Bob Anda博士 分别在 Kaiser 和 CDC 进行了这项研究, 他们两人一起询问了17,500成年人, 了解他们的"童年不良经历",又称ACE。 这包括生理上、情感上 遭受的不幸或是性侵害; 生理或情感上遭受的忽视; 父母患有精神疾病、物质依赖、遭到监禁; 父母分居或离婚; 或家庭暴力。 每个问题只要回答"是", ACE分数就增加一分。 接下来, 他们将ACE分数与健康状况关联起来, 得出的结果是令人震惊的。 结论有两点： 第一点,ACE十分普遍, 简直令人不可思议。 67%的人曾至少有一个ACE得分, 有12.6%(八分之一)的人 有四或四以上的ACE得分。 研究发现的第二点, 是ACE与健康状况之间 存在着一种剂量反应关系： ACE得分越高,健康状况越糟糕。 如果一个人的ACE分数大于等于4分, 他患慢性阻塞性肺病的相对风险 是ACE分数为0时的2.5倍。 患上肝炎的风险是2.5倍。 而患上抑郁症的风险是4.5倍。 自杀风险是12倍。 ACE分数大于等于7的人 终身都有3倍的风险患上肺癌, 和3.5倍的风险患上冠心病-- 这种目前在美国 当属头号杀手的疾病。
Well, of course this makes sense. Some people looked at this data and they said, "Come on. You have a rough childhood, you're more likely to drink and smoke and do all these things that are going to ruin your health. This isn't science. This is just bad behavior."
当然,这其实挺有道理。 有些人看了这些数据之后会说, "好啦,你有个糟糕的童年, 你更容易酗酒和抽烟, 还去做一切 会毁掉你健康的事情。 这又不是科学,这只是坏的行为而已."
It turns out this is exactly where the science comes in. We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children. It affects areas like the nucleus accumbent, the pleasure and reward center of the brain that is implicated in substance dependence. It inhibits the prefrontal cortex, which is necessary for impulse control and executive function, a critical area for learning. And on MRI scans, we see measurable differences in the amygdala, the brain's fear response center. So, there are real neurologic reasons why folks exposed to high doses of adversity are more likely to engage in high-risk behavior, and that's important to know.
然而,事实证明我们恰恰要用科学来分析它。 目前,我们前所未有的更加理解 早年遭受的不幸 会怎样影响儿童大脑和身体的发育。 早年遭受的不幸会影响大脑的伏隔核 (nucleus accumbens)-- 人脑中与快乐和奖赏相关 的处理中心, 它与"物质依赖"疾病相关。 早年遭受的不幸 还会抑制大脑的前额叶皮质(Prefrontal cortex), 而前额皮质对神经冲动控制 与执行功能是必不可少的, 这个区域对于学习能力非常关键。 在核磁共振成像扫描(MRI)上, 我们观察到大脑的恐惧反应中枢 - 杏仁核(amygdala)中, 存在可以测量的差异。 因此,这便可以从神经学角度诠释： 为什么人们一旦遭受大量不幸, 则更容易出现高风险行为。 了解了这点十分重要。
But it turns out that even if you don't engage in any high-risk behavior, you're still more likely to develop heart disease or cancer. The reason for this has to do with the hypothalamic–pituitary–adrenal axis, the brain's and body's stress response system that governs our fight-or-flight response. How does it work? Well, imagine you're walking in the forest and you see a bear. Immediately, your hypothalamus sends a signal to your pituitary, which sends a signal to your adrenal gland that says, "Release stress hormones! Adrenaline! Cortisol!" And so, your heart starts to pound, your pupils dilate, your airways open up, and you are ready to either fight that bear or run from the bear. And that is wonderful if you're in a forest and there's a bear. (Laughter) But the problem is what happens when the bear comes home every night, and this system is activated over and over and over again, and it goes from being adaptive, or life-saving, to maladaptive, or health-damaging. Children are especially sensitive to this repeated stress activation, because their brains and bodies are just developing. High doses of adversity not only affect brain structure and function, they affect the developing immune system, developing hormonal systems, and even the way our DNA is read and transcribed.
但事实证明, 即使你不从事任何高风险的行为, 你仍然更容易患上 心脏疾病或癌症。 因为这与"下丘脑-垂体-肾上腺轴"有关-- 它是大脑和身体的应激反应系统, 支配我们做出"或战或逃反应"。 (fight-or-flight response)。 这一系统是如何运行的呢? 想象你漫步在森林里, 突然看到一头熊。 你的下丘脑会立即 向你的垂体发送信号, 垂体再向你的肾上腺发送信号： "释放应激激素! 肾上腺素! 皮质醇!" 你的心脏因而开始快速跳动, 瞳孔扩张,呼吸道打开, 这时你已准备好： 要么就和熊战斗,要么就逃跑。 这个反应很棒-- 如果你在森林里, 那还有一只熊。 (笑声) 可问题是,假如每个晚上 熊都回家来该怎么办, 这套系统将一遍又一遍地被激活, 它就会从适应到不适应, 从救你的命到损害你的健康。 儿童对这种反复的应激激活尤其敏感, 因为他们的大脑和身体 正处在发育阶段。 高剂量的不良经历不仅 会影响大脑结构和功能, 还会影响正在发育的免疫系统, 以及正在发育的内分泌系统, 甚至还会影响 我们的DNA读取和转录方式。
So for me, this information threw my old training out the window, because when we understand the mechanism of a disease, when we know not only which pathways are disrupted, but how, then as doctors, it is our job to use this science for prevention and treatment. That's what we do.
这些知识让我彻底抛弃了 以前所受训的那一套, 因为,当我们了解疾病机制时, 当我们 不仅知道哪些路径被干扰, 而且知道它们是怎样被干扰时, 作为医生,我们的职责, 就是使用这门科学 去做疾病的防治工作。 那就是我们要做的。
So in San Francisco, we created the Center for Youth Wellness to prevent, screen and heal the impacts of ACEs and toxic stress. We started simply with routine screening of every one of our kids at their regular physical, because I know that if my patient has an ACE score of 4, she's two and a half times as likely to develop hepatitis or COPD, she's four and half times as likely to become depressed, and she's 12 times as likely to attempt to take her own life as my patient with zero ACEs. I know that when she's in my exam room. For our patients who do screen positive, we have a multidisciplinary treatment team that works to reduce the dose of adversity and treat symptoms using best practices, including home visits, care coordination, mental health care, nutrition, holistic interventions, and yes, medication when necessary. But we also educate parents about the impacts of ACEs and toxic stress the same way you would for covering electrical outlets, or lead poisoning, and we tailor the care of our asthmatics and our diabetics in a way that recognizes that they may need more aggressive treatment, given the changes to their hormonal and immune systems.
因此，我们在旧金山创办了 青少年健康中心, 目的是预防、筛查和治愈 ACE和毒性应激的影响。 我们开始在孩子们的定期体检中, 对每个孩子进行例行检查, 因为我知道,如果我的病人ACE得分为4分, 她患上肝炎或慢性阻塞性肺病(COPD) 的概率是1.5倍, 患上抑郁症的概率是4.5倍, 她自杀的几率 是ACE得分为0的病人的12倍。 她在我的检查室里, 我就已经知道这一切了。 对于检查结果为阳性的病人, 我们有一支多学科综合治疗团队, 致力于减少不良经历造成的影响, 并使用最佳疗法治疗病症, 包括家庭访视、护理协调、 心理保健、营养、 综合干预措施, 以及必要时结合药物治疗。 但我们也教家长们了解 ACE和毒性应激造成的影响, 这种影响与电源插座或铅中毒 的危险性可以相提并论, 我们调整了哮喘及糖尿病患儿的护理服务, 意识到他们可能需要更积极主动的治疗, 以作用于他们的内分泌和免疫系统。
So the other thing that happens when you understand this science is that you want to shout it from the rooftops, because this isn't just an issue for kids in Bayview. I figured the minute that everybody else heard about this, it would be routine screening, multi-disciplinary treatment teams, and it would be a race to the most effective clinical treatment protocols. Yeah. That did not happen. And that was a huge learning for me. What I had thought of as simply best clinical practice I now understand to be a movement. In the words of Dr. Robert Block, the former President of the American Academy of Pediatrics, "Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today." And for a lot of people, that's a terrifying prospect. The scope and scale of the problem seems so large that it feels overwhelming to think about how we might approach it. But for me, that's actually where the hopes lie, because when we have the right framework, when we recognize this to be a public health crisis, then we can begin to use the right tool kit to come up with solutions. From tobacco to lead poisoning to HIV/AIDS, the United States actually has quite a strong track record with addressing public health problems, but replicating those successes with ACEs and toxic stress is going to take determination and commitment, and when I look at what our nation's response has been so far, I wonder, why haven't we taken this more seriously?
当你理解了这门科学时, 你会想要把它广而告之, 因为这不仅仅是 湾景区(Bayview)孩子的问题。 我本来以为 其他人一旦了解到这一点, 就会着手例行检查、 组建多学科治疗团队, 甚至大家争先恐后 想找到最有效的治疗方案。 可这些都没有发生。 这可是给了我一个很大的教训。 我原以为简单的找到 最好的临床手段来治疗就行了, 现在我明白了,这是一场运动。 正如Robert Block博士, 这位前美国儿科学会会长所言, "童年不良经历(ACE)是 今天我们国家所面临的,唯一,最大的, 未能解决的公共健康威胁." 对于很多人来说, 这个前景可不容乐观。 这个问题的范围之广,规模之大 使我们不得不考虑应对之策。 但在我看来,危机即是转机， 当我们确立正确框架时, 当我们意识到 这是公共健康危机时, 我们才能开始使用 正确的方法来求得解决方案。 从烟草到铅中毒,再到艾滋病, 在解决公共健康问题方面, 美国实际上保持着良好记录, 但要,在ACE和毒性应激方面 取得同样成功, 则需要下定决心、履行承诺, 当我看到,我们国家 对这一问题至今的反应时, 我想知道, 为什么我们没有更认真的对待这个问题?
You know, at first I thought that we marginalized the issue because it doesn't apply to us. That's an issue for those kids in those neighborhoods. Which is weird, because the data doesn't bear that out. The original ACEs study was done in a population that was 70 percent Caucasian, 70 percent college-educated. But then, the more I talked to folks, I'm beginning to think that maybe I had it completely backwards. If I were to ask how many people in this room grew up with a family member who suffered from mental illness, I bet a few hands would go up. And then if I were to ask how many folks had a parent who maybe drank too much, or who really believed that if you spare the rod, you spoil the child, I bet a few more hands would go up. Even in this room, this is an issue that touches many of us, and I am beginning to believe that we marginalize the issue because it does apply to us. Maybe it's easier to see in other zip codes because we don't want to look at it. We'd rather be sick.
要知道,一开始我还想, 这是因为我们漠视了这个问题, 以为它跟我们无关。 以为只有别的小孩, 邻居家的小孩才有这问题。 但很奇怪,数据可不是这么说的。 初始ACE的研究样本群体为： 白人占70%, 大学毕业占70%。 后来,我和大家谈得多了, 我便开始想,也许 我把这个问题完全本末倒置了。 如果我问现场这个房间内有多少人 在成长过程中 有家庭成员患有精神疾病, 我相信,会有几个人举手。 如果我再问,有多少人 父亲或母亲酗酒, 或者是坚信： 孩子要打,惯不得。 我敢打赌会有更多的人举手。 即使只是在我们的会场, 这也是一个影响到了很多人的问题。 我开始相信 我们漠视这个问题 是因为,它与我们息息相关。 也许把它说成别的地区的事, 我们才能更容易的看清楚, 因为我们自己情愿生病, 也不愿意正视这个问题。
Fortunately, scientific advances and, frankly, economic realities make that option less viable every day. The science is clear: Early adversity dramatically affects health across a lifetime. Today, we are beginning to understand how to interrupt the progression from early adversity to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms go unrecognized, whose asthma management is not connected, and who goes on to develop high blood pressure and early heart disease or cancer will be just as anomalous as a six-month mortality from HIV/AIDS. People will look at that situation and say, "What the heck happened there?" This is treatable. This is beatable. The single most important thing that we need today is the courage to look this problem in the face and say, this is real and this is all of us. I believe that we are the movement. Thank you.
幸运的是,科学进步, 坦率地说,还有经济现实 逐渐使我们无法再继续漠视下去了。 科学研究清楚显示： 早期不良经历对人的一生 的健康影响巨大。 今天,我们开始了解如何中断 从早期不良经历发展至 疾病和过早死亡这一进程, 从现在算起,30年后, 高ACE分数的儿童, 如果其行为症状未被识别, 哮喘诊疗未与ACE相关联, 持续发展为高血压, 并患上早期心脏病或癌症, 那么这就象6个月的婴儿患艾滋病一样, 都是异常的。 人们看到这种情况都会说： "这究竟发生的是什么鬼事?" 这种病症是可以治疗的, 也是可以战胜的。 我们今天最需要的是 直面这个问题的勇气, 并且承认,这个问题确实存在, 与我们息息相关。 我相信我们将实现这一变革运动。谢谢大家。
儿童性教育刻不容缓
很长一段时间，性侵都是焦点话题，尤其是儿童性侵。对中国来说，儿童性教育普遍落后，父母们耻于和孩子谈及这个话题。
根据儿童安全公益组织Kidsafe基金会的统计，当前我国有2500万存在不同程度性侵的儿童，18岁以下的孩子中，每四个女孩就有一个曾受到性侵犯，而每六个男孩就有一个遭受性侵。
由于幼童年龄较小，往往会恐惧施暴者的淫威，从而不敢告知父母。而青少年对于性侵感到羞耻和畏惧，选择独自舔舐伤口。那么，作为家长，我们有该如何留意自己孩子究竟是否遭受性侵呢？
今天再分享一个TED演讲视频，让我们一起听听荷兰健康教育专家Sanderijn vander Doef教授对儿童性教育的思考。
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给家长的TED演讲
幼儿能懂的性教育，从保护自己开始
演讲摘要稿
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演讲最开始，Doef教授分享了一个发生在她身边的小故事：
几年前的一天，她与同事需要去同事的家里拿一些东西，同事年幼的儿子开的门。三岁的小男孩，打开门非常好奇地看着她。
当时她穿着长裤，留着短发，但也戴着耳环，化了妆，小男孩很疑惑，突然问了她一个问题：我能看看你的小鸡鸡吗？
其实，对于三岁的孩子来讲，这是个好问题。
为什么呢，因为在这个年龄段的孩子，正在尝试理解世界的复杂性，他们发现这个世界上有两种人：男人和女人。
而据他们这么大年龄所知：男人，穿裤子，留短发；女人，穿裙子，留长发。
但是当他们再长大一些，会发现，有一个特征，可以准确无疑地分辨男女，那就是性器官。
所以小男孩问我了那个问题，他非常疑惑，只是想确认一下。
再一次强调，这对于三岁孩子来说，是个非常非常好的提问，但是，更加重要的，是成年人应对这类问题的方式。
这一次，小男孩的提问让他妈妈很生气，她说提这种问题很不合适，这是个错误的问题并命令他回到自己的房间去。
我们能从这个小故事中学到什么？
首先，儿童、幼儿会有很多问题，很多关于性的问题。
其次，谈及这些问题让很多成人感到难堪和尴尬。
不仅仅如此，当我们看到儿童与性有关的行为也会如此。
儿童与性，是个非常敏感的组合。作为性学家的20年致力于研究这个课题，也遭遇了不少误解、抵制。
到底为什么让成年人对于这类问题感到难堪和尴尬呢？在于我们看待性的方式，以及对性的理解、定义。
有人会把与性有关的话题仅仅看作成年人的话题，少儿不宜。对于这类人，性大概是指性行为。
这也是我们想保护儿童的出发点，保护他们不被成人性行为的潜在危险所侵害。
但是，如果我们不去回答孩子们的这类问题，可能会引起什么后果呢？
让我们来看看三个可能的后果吧。
①：第一种可能，没有得到问题答案的孩子们，他们能马上明白，好吧这是一个错误的问题，问了一个错误的人。
然后他们会到别的地方寻求答案，问问同龄人，朋友，或许去网上找找答案。
这是我们希望孩子得到关于性的答案吗？
②：第二种结果，每当儿童有性欲望时（这在孩子身上常发生），他们会感到羞愧，内疚，因为这正是他们从成年人那儿得到的信息：这是不合适的，是错误的，小孩子不可以有（性欲）。
③：还有一种结果是，孩子无法在他们感到不适，甚至面临性侵的时候拒绝别人，因为他们没有学会拒绝，甚至不知道他们是可以拒绝的。
所以，如果我们换个角度来看待性，会怎么样？用更宽阔的视角。
在这种视角下，性，很明显属于所有人，也很明显是从人一出生就有的，人的一生不断在发展，直到我们身为成人对的性体验，并且，性欲望不分年龄。
所以，我们需要明白，性，是可以和孩子讨论的东西，在讨论的方式上，不同年龄的人不同家庭的不同价值观，在表达方式上也会不一样，但是，让孩子知道，他/她的感觉是真实存在的，每一个年龄段都是正常的。
比如，小孩子会通过与小朋友们玩游戏来疏解感觉，成年人会通过性行为来疏解，当然，向孩子解释这种区别非常重要。
而解释的过程正是我们对孩子进行性教育的过程。
性教育所教授的内容远不单指生殖，还关乎情绪和感受，关于认识自己的身体，关于为自己而自豪，与社会关系有关，性教育与多元化、价值观也有联系。
确切地说，上述的话题都可以与孩子讨论。
怎么做呢？用一些浅显易懂的语言就可以了，并且简明扼要，这就是孩子所需要的。
还是有一些人，害怕对幼小的孩子进行性教育，他们担心这会促成过早的性行为，这个想法也是错误的！大错特错！
有很多研究表明情况并非如此，性教育，甚至是幼年期的性教育，不会促成早期性行为，与之相反的是，这更好地保护了孩子，不仅仅是保护，还给了他们所需要的一切信息。
所以，我们保护孩子天真地对于性一无所知，是在向他们传递信息：性是危险的，性是错误的。
正确的做法是坦率地、清楚地回答他们的所有问题。
大家还记得上文里的小故事吗，小男孩问她能否看下她的小鸡鸡，她是如何回答的呢？
她说，不可以，你不可以看我的小鸡鸡，因为我是个女人，女人没有小鸡鸡，只有男人才有，还有什么问题吗？
就像Doef教授在演讲中提到的：我们从认识性开始认识我们的身体，并为我们自己感到骄傲。
希望有一天，我们不需要掌握这些知识。学校可以是学校，孩子可以是孩子。
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