Summary · 摘要
This is a compilation episode: Rangan Chatterjee splices together his long Feel Better, Live More conversation with Gabor Maté and his conversation with former monk Jay Shetty, so the two run as one two-hour arc. The Maté half opens on the mantra that organises all of his work — the first question is not why the addiction but why the pain — and on the broad definition of addiction he uses when he asks a room how many people are addicted: any behaviour a person finds temporary pleasure or relief in and therefore craves, suffers negative long-term consequences from, and cannot give up. Under that definition almost every hand goes up, which is his point: addiction is a continuum dispersed through the whole society, and the identified drug addicts are only its narrow visible edge. He grounds the claim in twelve years on Vancouver’s Downtown Eastside, where every one of his severely addicted patients had been heavily traumatised in childhood — all the women sexually abused, all the men neglected, beaten or emotionally abused.
Maté then makes the argument that widens addiction into a theory of health. Children can be hurt in two ways: by bad things that should not have happened, and by good things that should have happened and did not — his own case, a Jewish infant in wartime Hungary whose mother loved him but was too terrorised and depressed to translate that love into responsive behaviour. Those early adaptations get programmed in, which is how a survival strategy becomes a diagnosis decades later: his infant tuning-out becomes ADHD in his fifties. He extends this to physical illness (When the Body Says No), to the mind-body unity that medical schools do not teach but that is scientifically uncontroversial, and to language itself — hypertension pulled apart into “hyper tension,” “lifestyle change” corrected to “life change,” “addict” traced to the Latin for a debtor assigned as a slave. Throughout he draws a hard line between blame and responsibility: nobody is at fault, everybody did their best, but unconscious patterns can only be changed once they are made conscious.
The social case follows. Modern society is a zoo: in an evolutionary blink we went from hunter-gatherer attachment bands to alienated urban isolation, and children are raised under increasingly artificial conditions — a maternity leave system Maté calls barbaric, sleep training that teaches an infant its emotions do not matter, a Danish/British/German/Canadian crying study whose result was simply that Danish parents were around more and picked their babies up. Facebook substitutes the language of friendship for friendship. Addiction, disconnection, shame and isolation form a self-feeding loop, so that the society generates addiction in many of its members. He questions why alcohol and cigarettes — far more lethal over thirty years — are legal while heroin is criminalised, tells the story of Shannon, a 35-year-old patient who lost her tolerance during six months clean and died of an overdose three days after returning, and describes his own shopping addiction through Internal Family Systems: a part that wants him to feel good for a moment, to be understood rather than indulged. He ends on innate healing capacity, on Stephen Hawking outliving his prognosis by five decades, and on the observation that “health” comes from “wholeness,” which makes “physical health” a contradiction in terms.
Shetty’s half runs on identity and practice. He opens with Charles Horton Cooley — I am not what I think I am, I am not what you think I am, I am what I think you think I am — a perception of a perception, and the root of the goals we pursue because we imagine others value them. His remedy is a values audit built on two honest ledgers, how you spend your money and how you spend your time, followed by three questions about each thing you are currently pursuing: is this desire mine, where is it really coming from, and do I still want it. He treats the audit as gardening — pull the weeds, plant the seeds, do it regularly rather than once — and insists the practices be made fun, with jars counting comparison, complaint and criticism against collaboration, support and gratitude. He adds Yale’s “job crafting” research on hospital workers who did identical work and told themselves opposite stories about it, argues that gratitude only does its work when it is expressed and specific (a person, a place, a project, daily), quotes Daisaku Ikeda that happiness cannot be built on the unhappiness of others, and closes on why the metrics — followers, bestseller lists — are the wrong target: do the work that serves, and the numbers are a byproduct.
这是一期合辑节目：兰甘·查特吉把他与加博尔·马泰的长篇 Feel Better, Live More 对话，与他和前僧人杰伊·谢蒂的对话剪辑在一起，构成一条两小时的完整弧线。马泰这一半以贯穿他全部工作的箴言开场——首要问题不是”为何成瘾”，而是”为何有此痛苦”——以及他向满场听众提问时使用的宽泛成瘾定义：任何让人获得短暂快感或缓解、因而渴求、长期带来负面后果、却又戒不掉的行为。在这个定义下几乎所有人都会举手，而这正是他的论点：成瘾是一个连续谱，弥散在整个社会中，被指认出来的”瘾君子”只是它狭窄的可见边缘。他以在温哥华东区十二年的工作为依据：他那些重度成瘾的病人无一例外在童年遭受过严重创伤——所有女性都曾被性侵，所有男性都曾被忽视、殴打或情感虐待。
接着马泰把成瘾扩展为一套健康理论。孩子会以两种方式受伤：本不该发生的坏事发生了；以及本该发生的好事没有发生——他自己就是后者，战时匈牙利的一个犹太婴儿，母亲深爱他，却因过度惊恐与抑郁而无法把爱转译成有回应的行为。这些早期适应被写入程序，于是一种生存策略在数十年后变成一个诊断：婴儿期的”走神”在他五十多岁时成了注意力缺陷障碍。他把这条线索延伸到躯体疾病（《当身体说不》）、延伸到医学院不教却在科学上毫无争议的身心一体，也延伸到语言本身——把 hypertension（高血压）拆成 hyper tension（过度紧张），把”生活方式的改变”更正为”生活的改变”，把 addict（成瘾者）追溯到拉丁文中因债务而被判为奴的人。他自始至终在”责怪”与”责任”之间划出清晰界线：无人有过错，人人已尽力，但无意识的模式唯有被意识到才可能改变。
社会层面的论证随之展开。现代社会是一座动物园：在演化意义上的一瞬间，我们从狩猎采集的依附小群体走到了疏离的都市孤岛，孩子在越来越人造的条件下被养大——马泰称之为野蛮的产假制度、教婴儿”你的情绪不重要”的睡眠训练，以及一项比较丹麦、英国、德国、加拿大婴儿哭泣的研究，其结论不过是：丹麦父母陪伴更多，也更愿意在孩子哭时把他抱起来。Facebook 用”朋友”这个词替代了朋友。成瘾、断联、羞耻与孤立形成自我喂养的循环，于是这个社会在它众多成员身上制造出成瘾。他质问：为什么三十年后致死率高得多的酒精与香烟是合法的，而海洛因要被刑事化？他讲述了 35 岁的病人香农的故事——她戒断六个月后耐受性归零，回来三天就死于过量——也用”内在家庭系统”描述自己的购物成瘾：那是一个只想让他快活片刻的部分，需要被理解而不是被纵容。他以人类与生俱来的疗愈能力作结，谈到斯蒂芬·霍金比预后多活了五十年，并指出 health（健康）源自 wholeness（整全），因此”身体健康”这个说法本身就是自相矛盾。
谢蒂那一半围绕身份与练习展开。他以查尔斯·霍顿·库利的话开场——我不是我以为的我，我不是你以为的我，我是”我以为你以为的我”——一种对感知的感知，也是我们去追逐那些自以为别人看重之物的根源。他的解药是一份”价值观审计”，建立在两本诚实的账簿上：你怎么花钱，你怎么花时间；然后对当下正在追求的每件事问三个问题：这个渴望是我自己的吗？它究竟从哪里来？我是否仍想追求它。他把审计比作园艺——拔草、播种，要定期做而不是做一次——并坚持要让练习变得有趣：用两个罐子分别记录比较、抱怨、批评，与协作、支持、感恩。他补充了耶鲁关于”工作塑造”的研究：做完全相同工作的医院员工，对自己的工作讲述着截然相反的故事；他主张感恩唯有被表达且具体时才起作用（每天一个人、一个地方、一个项目）；他引用池田大作的话——幸福无法建立在他人的不幸之上；最后谈到为何各种指标（粉丝数、畅销榜）是错误的目标：把服务人的事做好，数字只是副产品。
Key points · 要点
[00:00:30] The mantra that organises the whole conversation: all drugs and all addictive behaviours either soothe pain directly or distract from it, so the first question is not why the addiction but why the pain. 贯穿整场对话的箴言：所有成瘾物质与成瘾行为，要么直接抚慰痛苦，要么让人从痛苦中分心；所以首要问题不是”为何成瘾”，而是”为何有此痛苦”。
[00:03:02] The working definition: any behaviour a person finds temporary pleasure or relief in and therefore craves, suffers negative consequences from in the long term, and is unable to give up — drugs, but also sex, gambling, shopping, work, the internet, political power, wealth, hoarding. 操作性定义：任何让人获得短暂快感或缓解、因而渴求、长期带来负面后果、且戒不掉的行为——毒品，也包括性、赌博、购物、工作、网络、政治权力、财富、囤积。
[00:04:05] Under that definition nearly every hand in a room goes up: addiction is a continuum dispersed through society, and identified drug addicts are only a narrow segment of an addicted population. 在这个定义下，一屋子人几乎都会举手：成瘾是弥散于社会的连续谱，被指认出来的”瘾君子”只占成瘾人群中很窄的一段。
[00:05:06] Twelve years on Vancouver’s Downtown Eastside: every severely addicted patient had been heavily traumatised in childhood — all the women sexually abused, all the men neglected, beaten or emotionally abused — matching large-scale findings that greater childhood adversity means greater adult addiction risk. 在温哥华东区的十二年：每一位重度成瘾病人都在童年遭受过严重创伤——所有女性曾被性侵，所有男性曾被忽视、殴打或情感虐待——这与大规模研究的发现一致：童年逆境越多，成年成瘾风险越高。
[00:06:39] Two ways a child is hurt: bad things happening that should not, and needs going unmet. Maté was not beaten or neglected, but his mother was too terrorised and depressed to be the attuned, responsive presence he needed — and that alone was enough. 孩子受伤的两种方式：本不该发生的坏事发生了；以及需求未被满足。马泰没有挨打、没有被忽视，但他的母亲过于惊恐与抑郁，无法成为他所需要的那种调谐、有回应的存在——仅此就足以造成伤害。
[00:11:47] When the Body Says No: colitis, Crohn’s, MS, ALS, malignancy, psoriasis, eczema, chronic fatigue — the symptoms are not imagined, but they have much to do with relational and emotional patterns adopted in childhood. 《当身体说不》：结肠炎、克罗恩病、多发性硬化、渐冻症、恶性肿瘤、银屑病、湿疹、慢性疲劳——症状并非想象出来的，但它们与童年形成的关系与情绪模式密切相关。
[00:13:51] Blame says you could have done otherwise and are therefore at fault; responsibility says you did this unconsciously, because you were programmed by your childhood, which was programmed by your parents’ childhood. There is no responsibility without consciousness. “责怪”说：你本可以不这样做，所以是你的错；“责任”说：你是在无意识中这样做的，因为你被自己的童年所编程，而你的童年又被父母的童年所编程。没有意识，就没有责任可言。
[00:16:53] Chatterjee’s “addictive personality” is reframed: the personality is a defensive structure built to deal with pain, an overlay on who you actually are — you are not your personality, and stripping the cover off makes you more yourself. 查特吉的”成瘾型人格”被重新定义：人格是为应对痛苦而建的防御结构，是覆盖在真实自我之上的一层——你不是你的人格；剥掉这层覆盖，你会更接近你自己。
[00:20:30] Language as diagnosis: “essential hypertension” means we do not know what causes it; slow the word down and it is hyper tension — too much tension in people’s lives. Black American men have far higher rates than their biological relatives in Africa, which James Baldwin explained as living in a condition of suppressed rage. 语言即诊断：“原发性高血压”的意思其实是我们不知道病因；把这个词放慢，它就是 hyper tension——人们生活中的紧张太多了。美国黑人男性的患病率远高于他们在非洲的血亲，詹姆斯·鲍德温对此的解释是：他们活在被压抑的愤怒之中。
[00:29:05] Ape mothers hold their babies for months and human societies did not separate children from parents until recently; the US maternity and childcare system is called barbaric, and a study of British, German, Canadian and Danish infants found Danish babies cried much less — their parents were around more and picked them up. 猿类母亲会抱着幼崽数月，人类社会直到不久之前也不曾把孩子与父母分开；美国的产假与托育制度被称为野蛮，而一项比较英国、德国、加拿大与丹麦婴儿的研究发现丹麦婴儿哭得少得多——他们的父母陪伴更多，也更愿意把孩子抱起来。
[00:34:41] Jay Shetty’s opening frame, from Charles Horton Cooley: I am not what I think I am, I am not what you think I am, I am what I think you think I am — we live in a perception of a perception of ourselves. 杰伊·谢蒂的开场框架，来自查尔斯·霍顿·库利：我不是我以为的我，我不是你以为的我，我是”我以为你以为的我”——我们活在对自我感知的感知之中。
[00:41:23] The values audit: values are not what is in your head or heart but how you spend your money and how you spend your time — go through the bank statement, and audit the hours. 价值观审计：价值观不在你的脑子里或心里，而在你怎么花钱、怎么花时间——去翻银行流水，去审计你的时间。
[00:43:26] Then three questions about each thing you are currently pursuing: is this your own desire, where is it actually coming from, and do you still want to pursue it, pursue it differently, or not at all — so you stop building sandcastles the tide will take. 然后对你当下追求的每件事问三个问题：这是你自己的渴望吗？它究竟从哪里来？你是否仍想追求它、换个方式追求、还是根本不追求——好让你不再堆建终将被潮水冲走的沙堡。
[00:56:41] Modern society as a zoo: in an evolutionary blink we moved from hunter-gatherer attachment bands to alienated, disconnected life, and Johann Hari’s Lost Connections names what followed — with autoimmune disease and addiction spreading into countries that did not have them. 现代社会像一座动物园：在演化意义上的一瞬，我们从狩猎采集的依附小群体走向疏离与断联，约翰·哈里的《失去联结》命名了随之而来的一切——自身免疫疾病与成瘾正扩散到从前没有它们的国家。
[01:01:20] The self-feeding loop: traumatised first, then behaviours that soothe the pain but deepen the shame and hiding, and the disconnection furthers the isolation, the isolation the pain, and the pain the addiction. 自我喂养的循环：先是创伤，然后是抚慰痛苦却加深羞耻与隐藏的行为；断联加剧孤立，孤立加剧痛苦，痛苦又加剧成瘾。
[01:04:51] Not lifestyle change but life change: style is superficial and refers to behaviours; the wound received in childhood is what needs healing, and the behaviour changes then follow automatically. 不是”生活方式的改变”，而是”生活的改变”：方式是表层的，指的是行为；需要疗愈的是童年受的伤，行为的改变随后自会发生。
[01:13:28] Shannon, 35, with an opiate addiction, osteomyelitis in her knee and repeated expulsions from hospital; she left the Downtown Eastside, got clean for six months, came back, and died of an overdose within three days because she had lost her tolerance. 35 岁的香农，阿片类成瘾，膝骨髓炎，一再被医院驱逐；她离开东区，戒断六个月，回来后三天内死于过量——因为她已失去耐受性。
[01:26:51] The average North American medical student does not hear the word “trauma” once in four years — yet virtually everything a physician sees has a traumatic connection; and since “health” derives from wholeness, “physical health” is already a contradiction. 北美医学生平均在四年里一次都不会听到”创伤”这个词——然而医生所见的几乎一切都与创伤相连；而既然 health（健康）源自 wholeness（整全），“身体健康”这个说法本身就是矛盾。
[01:39:34] Gratitude has to be expressed, daily and specifically — a person, a place, a project — and the specific message lands where the generic “thanks mate” does not. 感恩必须被表达，每天、具体地——一个人、一个地方、一个项目——具体的讯息能抵达，而泛泛的”谢了兄弟”则不能。
[01:50:45] Daisaku Ikeda, quoted: you cannot build your own happiness on the unhappiness of others — gossip and comparison make an unstable ground, because you then need someone to be inferior in order to feel superior. 引用池田大作：你无法把自己的幸福建立在他人的不幸之上——闲话与比较构成不稳的地基，因为你从此需要有人低你一等，才能觉得自己高人一等。
Selected quotes · 摘引
Note: this transcript is unpunctuated auto-captions; the quotes below are copied exactly as they appear, without added punctuation. · 说明：本转写稿为无标点的自动字幕，以下引文按原样照录，未补标点。
“all addictions are an attempt to regulate an unbearable emotional state internally” — 00:01:01
“一切成瘾都是在试图从内部调节一种难以忍受的情绪状态。“（中文为译文，非引文原文。）
“children can also be hurt when their needs are not met” — 00:06:39
“孩子也会因为需求未被满足而受伤。“（中文为译文，非引文原文。）
“blame says that you did something that you could have done otherwise and so you’re therefore you’re at fault that’s what blame says responsibility says yes you do this to yourself but not consciously or deliberately” — 00:13:51
“责怪说的是：你做了某件事，而你本可以不这样做，所以是你的错——这就是责怪；责任说的是：是的，你对自己做了这件事，但并非有意识、也非蓄意。“（中文为译文，非引文原文。）
“just take the word hypertension and slow down a bit hyper tension hyper tension hyper tension maybe there’s too much tension in people’s lives” — 00:20:30
“就把 hypertension 这个词放慢一点——过度／紧张，过度／紧张，过度／紧张——也许人们的生活里紧张太多了。“（中文为译文，非引文原文。）
“and that disconnection then furthers our sense of isolation that isolation further our pain and that pain further drives our addiction” — 01:01:20
“而那种断联进一步加深我们的孤立感，孤立又加深我们的痛苦，痛苦又进一步驱动我们的成瘾。“（中文为译文，非引文原文。）
People & works · 人物与著作
Gabor Maté — guest in the first half; physician and author on addiction, trauma and the mind-body connection, drawing on twelve years on Vancouver’s Downtown Eastside and on his own infancy in wartime Hungary. 加博尔·马泰 —— 前半场嘉宾；研究成瘾、创伤与身心关联的医生与作家，其论述基于在温哥华东区十二年的工作，以及自己在战时匈牙利的婴儿期经历。
Rangan Chatterjee — host of Feel Better, Live More; a GP who describes his own shopping addiction, his BBC series Doctor in the House, his therapy, and his conviction that the specialist has been overvalued and the expert generalist undervalued. 兰甘·查特吉 —— Feel Better, Live More 节目主持人；全科医生，自述有购物成瘾，谈及他的 BBC 系列节目《住院医生》、自己的心理治疗，以及他的看法：专科医生被高估，而”专家型全科医生”被低估。
Jay Shetty — guest in the second half; former monk and author of Think Like a Monk, on identity, values audits, gratitude and dharma as passion plus skills plus compassion. 杰伊·谢蒂 —— 后半场嘉宾；前僧人、《像僧侣一样思考》作者，谈身份、价值观审计、感恩，以及”法”＝热情＋技能＋慈悲。
When the Body Says No: The Cost of Hidden Stress — Maté’s book on chronic illness and emotional patterns, then about to be published in Britain. 《当身体说不：隐性压力的代价》 —— 马泰关于慢性疾病与情绪模式的著作，当时即将在英国出版。
The Myth of Normal: Illness and Health in an Insane Culture — the book Maté describes as forthcoming, on a culture that does not meet human needs. 《正常的神话：一个失常文化中的疾病与健康》 —— 马泰当时描述为即将出版的书，关于一个无法满足人类需求的文化。
In the Realm of Hungry Ghosts — Maté’s addiction book, source of the funeral chapter and of Shannon’s story. 《饿鬼之境》 —— 马泰关于成瘾的著作，葬礼那一章与香农的故事即出自此书。
Charles Horton Cooley — sociologist quoted by Shetty for “I am what I think you think I am,” the quote he opens his book with. 查尔斯·霍顿·库利 —— 谢蒂引用的社会学家，“我是我以为你以为的我”即出自他，也是谢蒂书的开篇引语。
James Baldwin — American writer quoted for the observation that to be a Black American male is to live in a condition of suppressed rage. 詹姆斯·鲍德温 —— 被引用的美国作家，他说：身为美国黑人男性，就是终日活在被压抑的愤怒之中。
Johann Hari, Lost Connections — cited for naming the lost connections that characterise the modern world. 约翰·哈里《失去联结》 —— 被引来命名现代世界所特有的”失去的联结”。
Richard Schwartz (“Dick Schwartz”) and Internal Family Systems — the parts-based therapy Maté has learned and Chatterjee is currently in; used to describe Maté’s shopping addiction. 理查德·施瓦茨（“迪克·施瓦茨”）与内在家庭系统 —— 马泰已学习、查特吉正在接受的”部分”取向疗法；用以描述马泰的购物成瘾。
Stephen Hawking — given two years to live at 20 and outliving the prognosis by more than five decades, cited as evidence of an innate healing capacity medicine does not investigate. 斯蒂芬·霍金 —— 20 岁时被断言只剩两年可活，却比预后多活五十多年；被引为医学未曾研究的”与生俱来的疗愈能力”的证据。
Daisaku Ikeda — Buddhist philosopher quoted by Shetty: it is impossible to build one’s own happiness on the unhappiness of others. 池田大作 —— 谢蒂引用的佛教哲学家：不可能把自己的幸福建立在他人的不幸之上。
Jim Carrey — paraphrased by Shetty on everyone achieving everything they ever wanted just to realise it is not the point. 金·凯瑞 —— 被谢蒂转述：每个人都该实现他们想要的一切，好让他们明白那并不是重点。
Gary Vaynerchuk — cited for the exchange about owning a BMW because of what other people will think of you when you drive it. 加里·维纳查克 —— 被引用的那段对话：你买宝马，是因为在意别人看到你开它时会怎么想。
Peter Diamandis — cited for redefining “billionaire” as someone who impacts the lives of a billion people. 彼得·迪亚曼迪斯 —— 被引用其重新定义：“亿万富翁”应指影响十亿人生活的人。
Harvard Center on the Developing Child / Pediatrics, January 2012 — the article Maté cites on early adaptations necessary for survival but costly to long-term health, behaviour and longevity. 哈佛儿童发展中心／《儿科学》2012 年 1 月 —— 马泰引用的文章，论及那些对生存必要、却以长期健康、行为与寿命为代价的早期适应。
Yale “job crafting” research — the hospital-worker study Shetty cites on assigning meaning to identical work. 耶鲁”工作塑造”研究 —— 谢蒂引用的医院员工研究，关于为完全相同的工作赋予意义。
Source · 来源
- Original: https://www.youtube.com/watch?v=oucfu_6iuDc
- Channel/Show · 频道/节目: Dr Rangan Chatterjee (Feel Better, Live More) · published 2021-07-09
- Registered from the Notion「GaborMate 阅览室」播客视频 / 文字讲稿 collection.