智慧人生篇章 第36期:何以解忧?

Each year the serious depression affects 6% of UKadults and 121 million people worldwide. At sometime in our lives, one in six of us will experience anepisode and the World Health Organisation predictsby 2020 depression will be the largest single healthissue in developed countries. As well as being apersonal hell for its sufferers, tackling depression isbig business. This week GlaxoSmithKline accepted a$3 billion penalty from US authorities after pleadingguilty to wrongly marketing two leading anti-depression drugs and a range of othermisdemeanours. But even this huge penalty may be offset by the $17 billion sales of the samedrugs in the years covered by the settlement alone. The case raises ethical and regulatoryissues, but the wider context is commercialisation of mental healthcare. Drug companies havea natural interest in finding pharmacological solutions to medical problems and use theirconsiderable resources to promote them to both doctors and patients. Medication cancertainly help, and sometimes there's no alternative.

英国每年有6%的成年人抱受严重抑郁症的困扰，全世界则有1亿2千1百万人。每六个人中就有一人在某段时期有抑郁的经历。世界卫生组织预计，到2020年，抑郁症将成为发达国家中最大的健康问题。抑郁症让患者痛苦万分，应对工作也同样十分棘手。这周，由于违规营销两大主要抗抑郁药物以及一系列其它罪行，葛兰素史克公司向美国当局支付了30亿美元的罚金。尽管受到严惩，但该公司仅在违规营销这几年就凭同种药物达成了170亿美元的销售额，足以抵消掉罚款金额。这一案子揭露了道德和管理方面的问题，但从更广的层面来看，体现的是精神治疗商业化的问题。药品公司的天性就是通过在医疗问题中寻找药理学的解决方法来谋求利益，并且运用它们相当丰富的资源向医生和患者推销药物。药物治疗当然有用，而且这有时是唯一的解决办法。

But I think many of us reach first for a prescription when problems arise. And perhaps we findthat congenial. We often seem to treat our minds and bodies like a car that goes wrong. Wewant to get them fixed, so we can get on with our lives But another body of thought holds thataddressing the underlying causes of depression, not just tackling its symptoms, meanschanging how we live and even how we think. A substantial movement along these lines isunderway in mainstream healthcare and clinical psychology, and rather surprisingly, it drawson Buddhist meditation and mindfulness practice.

但我认为有许多人遇到问题一开始就想着去开药方。也许我们觉得生病吃药是天经地义的。人们总像对待出故障的汽车那样对待自己的身心。我们想修好它们，继续自己的生活。但另外一种看法是我们不仅仅要解决症状，还要解决导致抑郁症的根本原因，这意味着改变我们的生活和思考方式。主流的医疗保健和临床心理学正在沿着此方针开展实际的进展。令人吃惊的是，它运用了佛教中的冥想和正念的做法。

Mindfulness Based Cognitive Therapy aims at avoiding depression relapse. Using meditation,it asks people to accept the troubling thoughts and feelings that can grow into depression,seeing them as part of their experience, at least for now. That mirrors the Buddhistunderstanding that we suffer because what we want is at odds with the way life is. Youralternative is turning towards reality with awareness and finding a more creative response.I see in my own work as a mindfulness trainer that when people stop fighting what they findchallenging and stop judging themselves harshly they are able to access a kinder responseand a sense of peace. This assumes that people have the resources within themselves to copemore effectively. That doesn't mean there's no place for drugs in alleviating the effects ofdepression, but you can also help yourself. And that's an important insight whether you'redepressed or not.

正念认知疗法旨在避免抑郁症复发。它要求人们运用冥想来接受可能会演变成抑郁的一些不安的想法和感受，把它们看作是自身体验的一部分，至少在当前如此。这反映出佛教的思想：人之所以受苦是因为其欲望与生活相悖。你要做出取舍，有意识地转向现实，做出更有创造力的回应。作为一位正念教练，我在工作中注意到，当人们不再与他们所认为的挑战作斗争，不再严厉地自我评定时，他们会更加善待生活，获得心灵上的平静。由此可以假设出人们体内有能使自己更有效运作的源泉。这并不是说药品在缓解抑郁方面没有一席之地，而是说人可以自救。能否自救是洞悉自己是否抑郁的十分重要的一点。