TED演讲 | 幻觉背后的心智

We see with the eyes, but we see with the brain as well. And seeing with the brain is often called imagination.

我们用眼睛看世界，但我们也用大脑看。用大脑来看，也就是我们常说的想象。

And we are familiar with the landscapes of our own imagination, our inscapes. We've lived with them all our lives.

我们很熟悉自己想象的模式，也就是内心世界，它伴随我们一生。

But there are also hallucinations as well, and hallucinations are completely different.

然而想象之外还有幻觉，幻觉跟想象截然不同。

They don't seem to be of our creation. They don't seem to be under our control. They seem to come from the outside, and to mimic perception.

它似乎不是我们所创造的，好像也不受我们的控制，它似乎源自外界，又伪装成我们自己的感知。

So I am going to be talking about hallucinations, and a particular sort of visual hallucination which I see among my patients.

所以我将就幻觉做一些解释，也会提到我在病人身上观察到的一种特殊的视觉幻觉。

A few months ago, I got a phone call from a nursing home where I work.

几个月前我接到从我工作的养老院打来的一个电话。

They told me that one of their residents, an old lady in her 90s, was seeing things,

他们告诉我住客中有一位90多的老太太“看到了一些东西”。

and they wondered if she'd gone bonkers or, because she was an old lady, whether she'd had a stroke, or whether she had Alzheimer's.

他们怀疑她是不是疯了，或者因为年纪大得了中风，或是老年痴呆症。

And so they asked me if I would come and see Rosalie, the old lady. I went in to see her.

所以他们请我去看看罗萨莉，也就是那个老太太。

It was evident straight away that she was perfectly sane and lucid and of good intelligence,

我去了后，马上就发现她不仅完全神志正常，还非常清醒、明智。

but she'd been very startled and very bewildered, because she'd been seeing things.

就是有点吓坏了，还有点奇怪，为什么她会出现幻视。

And she told me -- the nurses hadn't mentioned this -- that she was blind, that she had been completely blind from macular degeneration for five years.

她还说，护士忘了告诉我，她眼睛是看不见的，她五年前就因为视网膜黄斑退化而完全失明了。

But now, for the last few days, she'd been seeing things.

近几天却看到了幻象。

So I said, "What sort of things?" And she said, "People in Eastern dress, in drapes, walking up and down stairs.

我问：“什么样的幻象？”她说：“许多人穿着东方服饰，那种长袍式的，在楼梯上上下下。

A man who turns towards me and smiles. But he has huge teeth on one side of his mouth. Animals too.

一个男的转过来对我笑，但他的嘴巴只有一边长着牙，很大的牙，还有很多动物。

I see a white building. It's snowing, a soft snow. I see this horse with a harness, dragging the snow away.

有一栋白色的楼，天在下雪，小雪，我还看到一匹戴着挽具的马不断把雪拖走。

Then, one night, the scene changes. I see cats and dogs walking towards me. They come to a certain point and then stop.

然后有一天晚上，幻象变了，变成好多猫和狗朝我这边走，走着走着就停了。

Then it changes again. I see a lot of children. They are walking up and down stairs. They wear bright colors, rose and blue, like Eastern dress."

然后又变了，这回我看到很多小朋友在楼梯上爬上爬下，他们穿着颜色鲜艳的衣服，有玫瑰色，有蓝色，就像东方服饰。”

Sometimes, she said, before the people come on, she may hallucinate pink and blue squares on the floor, which seem to go up to the ceiling.

她说，有时候在她看到人之前，她还能看到地板上粉色和蓝色的方块跑到天花板上。

I said, "Is this like a dream?" And she said, "No, it's not like a dream. It's like a movie." She said, "It's got color. It's got motion.

我问：“像不像做梦？”她说：“不，不像梦。像个电影。”“它是有颜色的，还有动作。

But it's completely silent, like a silent movie." And she said that it's a rather boring movie.

不过一点声音都没有，像默片。”她还说那电影相当无聊。

She said, "All these people with Eastern dress, walking up and down, very repetitive, very limited."

她说：“所有人都穿着东方衣服，爬上爬下，不停地，一点别的花样都没有。”

And she has a sense of humor. She knew it was a hallucination. But she was frightened. She'd lived 95 years and she'd never had a hallucination before.

她很幽默，而且知道那是个幻觉，但她有点害怕，因为她活了95年，从来没有出现过幻觉。

She said that the hallucinations were unrelated to anything she was thinking or feeling or doing, that they seemed to come on by themselves, or disappear.

她说那些幻觉跟她的意识和行为一点都不相干，总是这么无缘无故地出现，又无缘无故地消失。

She had no control over them. She said she didn't recognize any of the people or places in the hallucinations.

完全不受她控制，而幻觉中出现的人和地点，她一个都不认识。

And none of the people or the animals, well, they all seemed oblivious of her.

里面的人和动物也好像看不见她。

And she didn't know what was going on. She wondered if she was going mad or losing her mind.

她不知道这是这么了，她想，她是疯了，还是在失去理智。

Well, I examined her carefully. She was a bright old lady, perfectly sane. She had no medical problems.

于是我为这个活泼的老太太做了详尽的检查，结果发现她的神智完全正常，没有精神问题。

She wasn't on any medications which could produce hallucinations. But she was blind.

她所吃的药也都没有致幻的副作用，不过，她是盲的。

And I then said to her, "I think I know what you have." I said, "There is a special form of visual hallucination which may go with deteriorating vision or blindness.

所以我说：“我想我知道你的问题是什么了。有一种特殊的视觉幻觉会发生在视力受损或完全失明的人身上。

This was originally described," I said, "right back in the 18th century, by a man called Charles Bonnet.

这种现象最早在18世纪被一个叫查尔斯·邦纳的人描述过。

And you have Charles Bonnet syndrome. There is nothing wrong with your brain. There is nothing wrong with your mind. You have Charles Bonnet syndrome."

你得的就是邦纳症候群(Charles Bonnet syndrome)群。问题既不在你的大脑，也不在你的意识，你只是得了这种邦纳症候。”

And she was very relieved at this, that there was nothing seriously the matter, and also rather curious.

她大松一口气，还好不是什么重病，完了还相当好奇。

She said, "Who is this Charles Bonnet?" She said, "Did he have them himself?"

她问：“这个查尔斯，他也有这种幻觉吗？”

And she said, "Tell all the nurses that I have Charles Bonnet syndrome."

还有，“告诉那些护工，我只不过是得了邦纳症候群。”

"I'm not crazy. I'm not demented. I have Charles Bonnet syndrome." Well, so I did tell the nurses.

“我没疯，也没傻，我只是得了邦纳症候群。”于是我照她的意思告诉了护工们。

Now this, for me, is a common situation. I work in old-age homes, largely.

其实这种现象对我来说并不稀奇，我在养老院工作。

I see a lot of elderly people who are hearing impaired or visually impaired.

认识很多老人是听力或视力受损的。

About 10 percent of the hearing impaired people get musical hallucinations.

10%的听力受损者有听觉幻觉。

And about 10 percent of the visually impaired people get visual hallucinations.

10%的视力受损者有视觉幻觉。

You don't have to be completely blind, only sufficiently impaired.

不一定要完全失明或完全听不到，才会有这种幻觉。

Now with the original description in the 18th century, Charles Bonnet did not have them.

18世纪的查尔斯·邦纳，其实并没有这种症状。

His grandfather had these hallucinations. His grandfather was a magistrate, an elderly man.

产生幻觉的是他的祖父，一位年长的长官。

He'd had cataract surgery. His vision was pretty poor. And in 1759, he described to his grandson various things he was seeing.

这个长官曾接受过白内障手术，视力不大好，1759年，他向孙子描述了他看到的各种各样的幻象。

The first thing he said was he saw a handkerchief in midair. It was a large blue handkerchief with four orange circles.

第一个幻象是一块悬浮在空中的手帕，大大的，蓝色的，还有四个橙色的圆圈。

And he knew it was a hallucination. You don't have handkerchiefs in midair. And then he saw a big wheel in midair.

他知道这是个幻觉，因为手帕不会浮在半空，他还看到过一个大轮子浮在空中。

But sometimes he wasn't sure whether he was hallucinating or not, because the hallucinations would fit in the context of the visions.

不过有时候他也搞不清楚看到的到底是不是幻觉，因为这些幻觉会融合在现实的背景里。

So on one occasion, when his granddaughters were visiting them, he said, "And who are these handsome young men with you?"

有一次，当他的孙女们来探望他时，他又看到了幻觉，他问：“这几个跟你们在一起的帅小伙子是谁啊？”

And they said, "Alas, Grandpapa, there are no handsome young men." And then the handsome young men disappeared.

孙女们却说：“诶，爷爷，没有你说的帅小伙啊。”突然间帅小伙们就消失了。

It's typical of these hallucinations that they may come in a flash and disappear in a flash.

这是一种典型的幻觉，刷一下来，刷一下去。

They don't usually fade in and out. They are rather sudden, and they change suddenly.

没有渐变，相当突然，变得也快。

Charles Lullin, the grandfather, saw hundreds of different figures, different landscapes of all sorts.

查尔斯·鲁林，也就是那个祖父，看到过几百个不同的人像，还有各种各样的景色。

On one occasion, he saw a man in a bathrobe smoking a pipe, and realized it was himself.

有一次，他看到一个穿浴袍的男人在抽烟斗，然后意识到，那就是他自己。

That was the only figure he recognized. On one occasion when he was walking in the streets of Paris, he saw -- this was real -- a scaffolding.

那是唯一一个他辨认出来的人像，还有一次，他在巴黎的街道上当真看到了一个脚手架。

But when he got back home, he saw a miniature of the scaffolding six inches high, on his study table.

回到家后，却看到了那个脚手架的迷你版，六英尺高，就立在他的书桌上。

This repetition of perception is sometimes called palinopsia.

这种感知的重复 有时会被称作视像保留。

With him and with Rosalie, what seems to be going on -- and Rosalie said, "What's going on?" --

这种在查尔斯·鲁林和罗斯莉身上发生的让罗斯莉问道“我这是这么了？”的现象

and I said that as you lose vision, as the visual parts of the brain are no longer getting any input, they become hyperactive and excitable, and they start to fire spontaneously.

我这么解释吧：随着视力的减退，大脑与视力相关的部分渐渐失去了信息输入，从而进入一种过度活跃的、待激活的状态，于是它开始自发地活动。

And you start to see things. The things you see can be very complicated indeed.

让人产生幻象，产生的幻象可以相当复杂。

With another patient of mine, who, also had some vision, the vision she had could be disturbing.

我有一个病人（像查尔斯·鲁林一样）视力没有完全减退，她看到的幻象比较恼人。

On one occasion, she said she saw a man in a striped shirt in a restaurant. And he turned around.

她说有一次她看到，餐馆里有一个穿条纹恤衫的男人，他转过身，

And then he divided into six figures in striped shirts, who started walking towards her.

然后就突然分裂成6个同样穿条纹恤衫的人像，开始朝她走来，

And then the six figures came together again, like a concertina.

然后六个人就合了起来，就像手风琴一样。

Once, when she was driving, or rather, her husband was driving, the road divided into four and she felt herself going simultaneously up four roads.

有一次她正在开车，应该说，是他丈夫在开，路突然就分裂成了4条，她感觉就像同时在4条路上行驶。

She had very mobile hallucinations as well. A lot of them had to do with a car. Sometimes she would see a teenage boy sitting on the hood of the car.

她的幻觉充满动感，往往会牵涉到车，有时她会看到一个青年男孩坐在引擎盖上。

He was very tenacious and he moved rather gracefully when the car turned.

他紧抓着不放，车转弯时，他便随着车的动作缓缓倾斜。

And then when they came to a stop, the boy would do a sudden vertical takeoff, 100 foot in the air, and then disappear.

车停下后，男孩便会突然垂直飞到100尺的高空，然后消失。

Another patient of mine had a different sort of hallucination. This was a woman who didn't have trouble with her eyes,

还有一个病人，有另外一种幻觉，这位女病人视力并无问题。

but the visual parts of her brain, a little tumor in the occipital cortex.

问题出在她脑部的视觉部分，她的枕叶皮层有一个小肿瘤。

And, above all, she would see cartoons. These cartoons would be transparent and would cover half the visual field, like a screen.

尤其引人注意的是，她看到的幻象是卡通的，而且是半透明的，像屏幕一样盖住半个视野。

And especially she saw cartoons of Kermit the Frog. Now, I don't watch Sesame Street, but she made a point of saying, "Why Kermit?"

特别的是，她看到的是青蛙柯密特（芝麻街人物）我不看芝麻街的，不过她坚持要问我：“为什么是柯密特？”

she said, "Kermit the Frog means nothing to me. You know, I was wondering about Freudian determinants. Why Kermit? Kermit the Frog means nothing to me."

她说，“青蛙柯密特对我来说一点意义都没有啊。”当时我正在研究弗洛伊德决定因素，为什么是柯密特？“青蛙柯密特对我来说一点意义都没有啊。”

She didn't mind the cartoons too much. But what did disturb her was she got very persistent images or hallucinations of faces and as with Rosalie,

她并不大关注那部卡通，让她非常苦恼的是，这些幻觉持续地出现，而且跟罗斯莉的情况一样，

the faces were often deformed, with very large teeth or very large eyes. And these frightened her.

幻觉中的脸往往是扭曲的，要么长着大牙，要么长着大眼，这让她感到非常不安。

Well, what is going on with these people? As a physician, I have to try and define what's going on, and to reassure people, especially to reassure them that they're not going insane.

那么，这些病人是怎么了？作为一个医生，我必须尝试阐释这些现象来安抚他们，尤其得告诉他们，他们没疯。

Something like 10 percent, as I said, of visually impaired people get these.

我前面提到过，视力受损的人有10%会产生幻觉。

But no more than one percent of the people acknowledge them, because they are afraid they will be seen as insane or something.

但不超过1%会承认，因为他们担心会被当成疯子之类。

And if they do mention them to their own doctors they may be misdiagnosed.

而如果他们向医生提起这种症状，医生可能会做出错误的诊断。

In particular, the notion is that if you see things or hear things, you're going mad, but the psychotic hallucinations are quite different.

而且，大家往往认为，如果你看到或听到幻觉，你就是疯了，其实我们提到的这种幻觉跟精神病幻觉是不一样的。

Psychotic hallucinations, whether they are visual or vocal, they address you.

精神病的幻觉，不管是视觉的还是听觉的都对付你，

They accuse you. They seduce you. They humiliate you. They jeer at you. You interact with them.

指控你，诱惑你，羞辱你，嘲弄你，跟你互动。

There is none of this quality of being addressed with these Charles Bonnet hallucinations.

而这些都没有出现在邦纳式的幻觉中。

There is a film. You're seeing a film which has nothing to do with you, or that's how people think about it.

邦纳式幻觉就像一部电影，尽管你在看，电影却没有牵涉到你，反正患者们是这么认为的。

There is also a rare thing called temporal lobe epilepsy, and sometimes, if one has this, one may feel oneself transported back to a time and place in the past.

还有一种少有的症状叫颞叶癫痫，有时，如果一个人产生这种症状，他可能会感到自己被带回到过去的一个时空。

You're at a particular road junction. You smell chestnuts roasting. You hear the traffic. All the senses are involved.

在某一个路口，闻到烤栗子的香味，听到车来车往，所有的感官都参与着。

And you're waiting for your girl. And it's that Tuesday evening back in 1982.

等待着心上人，那可能是1982年的某个周二夜晚。

And the temporal lobe hallucinations are all-sense hallucinations, full of feeling, full of familiarity, located in space and time, coherent, dramatic.

这种颞叶异常导致的幻觉是多感官的，充满着情绪和熟悉感，发生在特定时空中，情节合乎逻辑而戏剧感十足。

The Charles Bonnet ones are quite different.

邦纳式的则很不一样。

So in the Charles Bonnet hallucinations, you have all sorts of levels, from the geometrical hallucinations --

在邦纳式幻觉中，有好几种等级，从几何幻觉，

the pink and blue squares the woman had -- up to quite elaborate hallucinations with figures and especially faces.

比如老太太看到的粉色和蓝色的方块，到非常复杂的幻觉，比如各种人像，尤其是面容，

Faces, and sometimes deformed faces, are the single commonest thing in these hallucinations. And one of the second commonest is cartoons.

这些面容，有时是扭曲的面容，是唯一一种在这些幻觉中最常见的幻象，一种第二常见的幻象是卡通。

So, what is going on? Fascinatingly, in the last few years, it's been possible to do functional brain imagery, to do fMRI on people as they are hallucinating.

那么，究竟为什么会产生幻觉呢？很棒的是，近几年我们能够做出脑功能成像。

And in fact, to find that different parts of the visual brain are activated as they are hallucinating.

当我们给正产生幻觉的人做功能性磁共振成像(fMRI)时，我们的确发现大脑视觉部位有不同区域被激活，这时被检测者正在经历幻觉。

When people have these simple geometrical hallucinations, the primary visual cortex is activated.

如果被检测者有的是简单的几何幻觉，被激活的区域则是初级视觉皮质。

This is the part of the brain which perceives edges and patterns. You don't form images with your primary visual cortex.

这是大脑感知边缘和图案的部分，而我们光靠这里是无法形成完整影像的。

When images are formed, a higher part of the visual cortex is involved in the temporal lobe.

影像形成时，一个位于颞叶的较高级视觉皮质会有一定活动。

And in particular, one area of the temporal lobe is called the fusiform gyrus.

尤其是颞叶中叫做梭状回的一个区域，显著地活跃。

And it's known that if people have damage in the fusiform gyrus, they maybe lose the ability to recognize faces.

调查显示，如果梭状回损伤，患者可能因此无法辨认面容。

But if there is an abnormal activity in the fusiform gyrus, they may hallucinate faces, and this is exactly what you find in some of these people.

而当梭状回异常时，患者则可能看到面容的幻象，这正是我们前面提到的几位病人所出现的症状。

There is an area in the anterior part of this gyrus where teeth and eyes are represented, and that part of the gyrus is activated when people get the deformed hallucinations.

梭状回的前部有一个区域负责处理有关牙齿和眼睛的影像，而当病人出现扭曲的幻觉时，正是这一部位出现了活动。

There is another part of the brain which is especially activated when one sees cartoons.

还有一个区域会在病人看到卡通幻象时出现活动。

It's activated when one recognizes cartoons, when one draws cartoons, and when one hallucinates them. It's very interesting that that should be specific.

人们观看卡通，画卡通，或看到卡通幻象时，都是这一部位被激活，这是一个特别有趣的现象。

There are other parts of the brain which are specifically involved with the recognition and hallucination of buildings and landscapes.

大脑还有几个别的部位，相应地跟其他视觉元素的辨别与幻觉有关，比如楼房和风景。

Around 1970, it was found that there were not only parts of the brain, but particular cells.

1970年左右，人们发现特化的不是一块区域，而是相应的脑细胞。

"Face cells" were discovered around 1970. And now we know that there are hundreds of other sorts of cells, which can be very, very specific.

“脸细胞”是1970年左右发现的，至今，我们已经发现了数百种与各类视觉元素对应的脑细胞，这种对应关系可以非常琐细、明确。

So you may not only have "car" cells, you may have "Aston Martin" cells.

比如说 “车”细胞可能还有“阿斯顿·马丁(一种车)”细胞。

I saw an Aston Martin this morning. I had to bring it in. And now it's in there somewhere.

今早我看到一辆阿斯顿·马丁，我一直想提提它，现在我的脑子里就有这种“阿斯顿·马丁”细胞 。

Now, at this level, in what's called the inferotemporal cortex, there are only visual images, or figments or fragments.

那么，这一程度的幻觉，只会由这一整块可以称作下颞叶皮质的区域形成视觉影像、幻象，或片段。

It's only at higher levels that the other senses join in and there are connections with memory and emotion.

只有更高程度的幻觉才会有视觉以外的感官参与，同时牵涉到记忆与情感。

And in the Charles Bonnet syndrome, you don't go to those higher levels.

在邦纳症候群中，更高程度的幻觉并不会出现。

You're in these levels of inferior visual cortex where you have thousands and tens of thousands and millions of images,

牵涉到初级视觉皮质的幻觉有上百上千，甚至更多的图像、幻象，

or figments, or fragmentary figments, all neurally encoded in particular cells or small clusters of cells.

或残缺幻象，这些都被编译在特定的脑细胞或脑细胞簇中。

Normally these are all part of the integrated stream of perception, or imagination, and one is not conscious of them.

这些细胞通常参与形成感知和想象，人们通常是无法意识到这一过程的。

It is only if one is visually impaired or blind that the process is interrupted.

只有当你的视力受损或丧失，这一过程才会被干扰。

And instead of getting normal perception, you're getting an anarchic, convulsive stimulation, or release, of all of these visual cells in the inferotemporal cortex.

在这种情况下，你的感知不再正常，一种不受控的、痉挛的释放活动，发生在位于初级视觉皮质的这些视觉脑细胞中，这种活动的结果就是，

So, suddenly you see a face. Suddenly you see a car. Suddenly this, and suddenly that.

你突然看到一张脸，转瞬看到一辆车，突然这，突然那。

The mind does its best to organize and to give some sort of coherence to this, but not terribly successfully.

大脑会尝试控制场面，尝试使这一切符合逻辑，但不会很成功。

When these were first described, it was thought that they could be interpreted like dreams.

这些现象最初被描述时，人们相信，跟梦一样，这种幻觉也能被强行中止。

But in fact people say, "I don't recognize the people. I can't form any associations."

不过实际上患者表示 “我认不出来谁是谁。完全没办法想到任何信息。”

"Kermit means nothing to me." You don't get anywhere thinking of them as dreams.

“青蛙柯密特对我来说一点意义都没有啊。” 把这种现象视作梦的一种是行不通的。

Well, I've more or less said what I wanted. I think I just want to recapitulate and say this is common.

唔，我应该说得差不多了，我再概括一下，其实帮纳症候群是个常见现象。

Think of the number of blind people. There must be hundreds of thousands of blind people who have these hallucinations, but are too scared to mention them.

你们想，在盲人人群中，肯定有上百上千有这样的幻觉，然而却不敢提起。

So this sort of thing needs to be brought into notice, for patients, for doctors, for the public.

所以不管是病人，医生还是公众，都有必要认识到这一现象的常见性。

Finally, I think they are infinitely interesting and valuable, for giving one some insight as to how the brain works.

最后，我发现帮助别人认识大脑作用的原理是一件无比有趣而有意义的事情。

Charles Bonnet said, 250 years ago -- he wondered how, thinking these hallucinations, how, as he put it, the theater of the mind could be generated by the machinery of the brain.

查尔斯·邦纳在250年前在对这些幻觉现象的观察的促使下，思考了这个问题，心智的戏剧性是如何产生于大脑运作的呢？

Now, 250 years later, I think we're beginning to glimpse how this is done. Thanks very much.

250年后的今天，我想我们已经能够开始领悟这个精妙的过程，非常感谢。

Chris Anderson: That was superb. Thank you so much. You speak about these things with so much insight and empathy for your patients.

克里斯·安德森：非常精彩，非常感谢你，你说得非常精到，也很能理解你的病人。

Have you yourself experienced any of the syndromes you write about?

你自己有没有过这些症状呢？

Oliver Sacks: I was afraid you'd ask that. Well, yeah, a lot of them.

奥利弗·萨克斯：我挺怕你问这个的，嗯，有，很大一部分。

And actually I'm a little visually impaired myself. I'm blind in one eye, and not terribly good in the other.

事实上我自己也有一定的视力受损，我的一只眼睛是看不到的，另一只视力也不大好。

And I see the geometrical hallucinations. But they stop there.

我看到过几何幻觉，不过最多也就这个程度了。

CA: And they don't disturb you? Because you understand what's doing it, it doesn't make you worried?

安德森：它们会不会让你感到很不安？或者说是不是因为你了解这一现象而没这么担心？

OS: Well they don't disturb me any more than my tinnitus, which I ignore.

萨克斯：耳鸣让我烦心得多，耳鸣我也是听而不闻。

They occasionally interest me, and I have many pictures of them in my notebooks.

不过偶尔我会对自己的幻觉很感兴趣，我还把它们画在了笔记本里。

I've gone and had an fMRI myself, to see how my visual cortex is taking over.

我自己就曾做过功能性磁共振成像，看看我的视觉皮层在造什么反。

And when I see all these hexagons and complex things, which I also have, in visual migraine, I wonder whether everyone sees things like this,

我看到六边形的幻觉，或更复杂的幻觉，往往伴随着偏头痛，那是我就会想是不是别人也会有这样的幻觉。

and whether things like cave art or ornamental art may have been derived from them a bit.

洞穴壁画和装饰艺术是不是也取材于这种幻觉。

CA: That was an utterly, utterly fascinating talk. Thank you so much for sharing.

安德森：你今天的演讲非常非常精彩，感谢你的分享。

OS: Thank you. Thank you.

萨克斯：谢谢，谢谢。