Summary · 摘要
This is Gabor Maté’s third appearance on Rangan Chatterjee’s Feel Better, Live More, recorded in London around the publication of The Myth of Normal, and it runs nearly two hours across the full range of Maté’s work. It opens on addiction, defined broadly: any behaviour a person finds temporary pleasure or relief in, therefore craves and continues despite negative consequences. By that definition the subject is not only drugs but sex, pornography, gambling, eating, shopping, the internet, gaming, self-cutting and work — and Maté’s contention is that addictions are not primary problems, inherited diseases or moral failures but attempts at emotional pain relief. Hence the reframe that organises everything after it: the first question is not why the addiction but why the pain. Chatterjee brings a case of his own — a young man too ashamed to make eye contact about his pornography use, whose real deficit turned out to be a missing tribe, and who was released from it by joining a boxing club. Maté’s reading is that the man was after a dopamine spike, not sex, and that what he wanted was simply to feel like a normal human being.
The middle of the conversation widens into the culture. Maté argues this society fundamentally demands that people be other than who they are, producing a near-universal self-suppression with mental and physical consequences; that its core values — materialistic, individualistic, aggressive, competitive — are projected onto human nature as if they were human nature; and that studying humans in this environment is like studying a zebra in the London Zoo rather than the savannah. He and Chatterjee take competition apart from several angles: Chatterjee’s immigrant parents asking what happened to the missing one percent, capitalism as a dog-eat-dog system with eight people holding as much wealth as the bottom half of humanity, and the rugby player Jonny Wilkinson, who kicked the World Cup-winning drop goal at twenty-four and could not get out of bed the next morning. Maté’s formulation is that there are two common ways to wake up — failing, and, more dramatically, succeeding, because then you find that what you wanted is empty. Both men then test this on themselves in unusually candid detail: Maté on ten years, twenty-five thousand articles and three years of daily writing that left him despondent enough to see a therapist and watch his blood pressure rise, and the therapist’s line that his problem was not the book but his relationship to the book; Chatterjee on becoming a number-one bestseller and noticing that he felt only quietly content, with his daughter’s sports kit still to wash.
From there the conversation turns clinical. Maté and Chatterjee, both physicians, indict a training that recruits people at seventeen, frays medical students’ telomeres faster than their peers’, and measures their compassion highest on the day they arrive. Maté offers multiple sclerosis as the salient case: first described by Charcot in the nineteenth century as caused by long-term vexation and grief, supported since by dozens of studies linking childhood trauma and stress to onset and course, and still almost never asked about by neurologists. He would delete the phrase evidence-based from the medical dictionary, calling what actually happens practice-placed evidence; he reclaims psychosomatic in its literal sense; and he points at essential hypertension, ninety-five percent of it officially unexplained, and asks the profession to read the word. Then comes his definition of trauma — not what happened to you but what happened inside you as a result — with its two faces, the open wound that is unbearable to touch and the scar that is thick, inflexible and without nerve endings, so that trauma both sensitises and numbs. Alongside big-T events he insists on the small-t trauma of things that should have happened and did not: the child’s need to be seen, heard and accepted unconditionally, and to feel all their emotions. Depression, he suggests, is exactly what the word says — emotions pushed down because feeling them put a child at odds with their environment.
The parenting section is prefaced by a refusal to blame parents, and grounded in his mother’s diary entry from a maternity hospital in 1944, breaking her heart while following a doctor’s four-hour feeding schedule. Sleep training and time-out are treated as the same message delivered by loving parents on expert advice: your feelings do not matter, and our acceptance is conditional on your behaviour. He tells the story of slapping his three-year-old son Daniel for refusing to sing happy birthday — the same Daniel who, at forty-seven, co-wrote this book with him — as an illustration of how trauma is passed on unwittingly, and offers the repair as evidence that repair is possible while advising younger parents not to make it necessary. The final movement returns to the body: the four personality patterns Maté kept seeing in chronic illness and palliative care (automatic concern for others’ emotional needs while suppressing your own; rigid identification with duty, role and responsibility; the suppression of healthy anger; and the two fatal beliefs that you are responsible for how others feel and must never disappoint anyone); disease as a possible teacher rather than a discrete entity; Jeff Rediger’s and Kelly Turner’s work on so-called spontaneous healing, which turns out never to be spontaneous; and the reason women carry eighty percent of autoimmune disease — not genetics, not diet, but the role a culture assigns them of absorbing everyone else’s stress, with women of colour carrying more still. The two men close by noticing that their books independently arrived at the same healing principles, Chatterjee’s alignment, contentment and control matching Maté’s authenticity, acceptance and agency, to which Maté adds healthy anger: the capacity to say no, you will not do this to me.
这是加博尔·马泰第三次做客兰甘·查特吉（Rangan Chatterjee）的《Feel Better, Live More》，录于伦敦、时值《常态的迷思》出版前后，近两小时的对话覆盖了马泰全部工作的疆域。开场谈成瘾，且是宽口径的定义：任何能让人获得短暂快感或解脱、因而渴求并在明知负面后果下仍持续的行为。按此定义，谈的就不只是毒品，还包括性、色情、赌博、进食、购物、互联网、游戏、自伤与工作——而马泰的主张是：成瘾不是原发问题、不是遗传疾病、不是道德缺陷，而是缓解情绪痛苦的尝试。由此得出统摄全场的那个转向：首要的问题不是”为什么成瘾”，而是”为什么痛”。查特吉带来了自己的案例——一个羞愧到不敢与他对视的年轻男子，色情成瘾背后真正缺失的是”部落”，最终把他解放出来的是加入了一家拳击俱乐部。马泰的解读是：这个人要的不是性，而是多巴胺的一次飙升；他想要的，不过是感觉自己像个正常人。
对话的中段扩展到文化层面。马泰认为，这个社会从根本上要求人们成为”非他所是”，由此产生一种近乎普遍的自我压抑，并带来心理与生理后果；社会的核心价值——物质主义、个人主义、攻击性、竞争性——被投射到人性上，仿佛那就是人性；而在这样的环境里研究人类，就像在伦敦动物园而非草原上研究斑马。他与查特吉从多个角度拆解”竞争”：查特吉的移民父母追问那消失的百分之一，资本主义作为一个弱肉强食的系统（八个人所持财富相当于人类底层一半的总和），以及橄榄球运动员乔尼·威尔金森——二十四岁踢进世界杯决赛制胜一球，第二天早上却起不来床。马泰的表述是：唤醒通常有两条路——失败，以及更戏剧性的成功，因为那时你会发现自己想要的东西是空的。两人随后以罕见的坦率把这一点用在自己身上：马泰讲他十年间收集两万五千篇文章、三年每日写作，写到消沉去见治疗师、血压升高，而那位治疗师的一句话是——你的问题不是这本书，是你与这本书的关系；查特吉则讲他登上销量榜首那一刻，只感到安静的满足，心里还惦记着女儿明天上学要穿的运动服还没洗。
自此对话转向临床。两位医生共同指控这样一种训练：十七岁就把人招进医学院，让医学生的端粒比同龄人磨损更快，而他们的同理心在入学第一天达到峰值、此后一路下降。马泰以多发性硬化症为最鲜明的例证：十九世纪由夏科（Charcot）首次描述为”长期的烦扰与悲伤”所致，此后数十项研究支持童年创伤、压力与其发病及病程的关联，而神经科医生几乎从不询问。他说若能从医学词典里删掉一个短语，那就是”循证”——因为实际发生的是”以实践安置证据”；他为”心身”一词恢复其字面含义；他指着”原发性高血压”——其中百分之九十五官方称原因不明——请同行读一读这个词本身。接着是他对创伤的定义：创伤不是发生在你身上的事，而是那件事在你内部造成的结果。它有两副面孔：一是碰不得的开放伤口，二是厚硬、僵化、没有神经末梢的疤痕——所以创伤既让人过度敏感，又让人麻木。除了”大写 T”的事件，他坚持还有”小写 t”的创伤：本该发生却没有发生的事——孩子被看见、被听见、被无条件接纳的需要，以及感受全部情绪的需要。他提出，抑郁（depression）正是这个词字面的意思：情绪被压下去，因为一个孩子若感受它们，就会与其环境格格不入。
育儿部分以”绝不责怪父母”作为前提，并以他母亲 1944 年在产科医院日记里的那一段作为根基——她心都碎了，却仍遵从医生每四小时喂一次的医嘱。睡眠训练与”计时隔离”（time-out）被视为同一条讯息，由充满爱意的父母依据专家建议传递出来：你的感受不重要；我们的接纳取决于你的表现。他讲了自己因三岁儿子丹尼尔拒唱生日歌而扇他耳光的往事——正是这位如今四十七岁的丹尼尔与他合写了这本书——用以说明创伤如何在不自知中被传递；他把后来的修复作为”修复是可能的”的证据，同时劝年轻父母：别让修复成为必要。最后一段回到身体：马泰在慢性病与临终关怀中反复看到的四种人格模式（自动关心他人情绪需要而压抑自己的；对责任、角色与义务的僵硬认同；健康愤怒的被压制；以及两条”致命信念”——你要为别人的感受负责、你绝不能让任何人失望）；疾病可以是老师，而不只是一个离散实体；杰夫·雷迪格与凯莉·特纳关于”自发疗愈”的研究，结论恰恰是它从不自发；以及女性为何承担了百分之八十的自身免疫疾病——不是基因，不是饮食，而是文化派给她们的角色：吸收所有人的压力；有色人种女性承担得更多。两人最后注意到，各自的书竟独立抵达同样的疗愈原则：查特吉的”对齐、满足、掌控”对应马泰的”真实、接纳、能动”；而马泰再加一条——健康的愤怒，即说”不”的能力：你不可以这样对我。
Key points · 要点
- [00:00:30] Maté defines addiction as any behaviour a person finds temporary pleasure or relief in and therefore craves and continues despite negative consequences — pleasure or relief short term, harm long term, inability to give it up.马泰把成瘾定义为：任何让人获得短暂快感或解脱、因而渴求、并在明知负面后果下仍持续的行为——短期是快感或解脱，长期是伤害，且明知有害仍无法戒除。
- [00:01:00] By that definition addiction covers sex, pornography, gambling, eating, shopping, the internet, gaming, self-cutting and work, not only drugs; addictions are not primary problems, inherited diseases or moral failures but attempts at emotional pain relief, so the first question is not why the addiction but why the pain.按此定义，成瘾涵盖性、色情、赌博、进食、购物、互联网、游戏、自伤与工作，而不只是毒品；成瘾不是原发问题、遗传疾病或道德缺陷，而是缓解情绪痛苦的尝试——所以首要的问题不是”为什么成瘾”，而是”为什么痛”。
- [00:04:03] Chatterjee describes a young patient too ashamed to make eye contact about online pornography, who had told no one; what he actually lacked was a tribe, and joining a boxing club resolved it.查特吉讲述一位年轻患者，因网络色情成瘾羞愧到不敢与他对视、从未告诉过任何人；他真正缺的是”部落”，加入拳击俱乐部后问题得以化解。
- [00:06:05] Maté’s reading: it was never about sex but about a dopamine spike — the brain chemical that makes us feel alive, vital, present and curious; the man just wanted to feel like a normal human being.马泰的解读：这从来无关性，而关乎多巴胺的飙升——那种让我们感到鲜活、有生气、在场、好奇的脑内化学物质；这个人只是想感觉自己像个正常人。
- [00:07:08] Both note a hierarchy of acceptable addictions: pornography and heroin are unacceptable, while being addicted to Instagram, consumption, shopping or power is fine.两人都指出存在一种”可接受成瘾”的等级：色情与海洛因不可接受，而对 Instagram、消费、购物或权力上瘾却无妨。
- [00:08:11] Maté argues this society fundamentally demands that people be other than who they are, creating an almost universal demand for self-suppression with mental and physical health consequences.马泰主张，这个社会从根本上要求人们成为”非他所是”，制造出一种近乎普遍的自我压抑要求，并带来心理与生理健康后果。
- [00:09:12] The zebra analogy: you would study a zebra in the savannah, not the London Zoo; we evolved for ninety percent of our existence in small band hunter-gatherer groups, connected and belonging — we are like zoo creatures right now.斑马之喻：要理解斑马的天性，你会去草原而不是伦敦动物园；我们物种存在的约九成时间里生活于小型狩猎采集群落，彼此连结、有归属——而我们现在就像动物园里的动物。
- [00:14:17] The idea that we are individually competitive creatures comes with the rise of capitalism; eight people now control as much wealth as the bottom fifty percent of humanity, and selfish acts get called human nature while generous ones never do.“人天生个体化地竞争”这一观念随资本主义兴起而来；如今八个人所持财富相当于人类底层百分之五十的总和；自私之举被称作”人性如此”，慷慨之举却从来不被这样称呼。
- [00:16:18] Jonny Wilkinson wrote down as a boy that he wanted to play for England and win the World Cup; he kicked the winning goal at twenty-four and could not get out of bed the next morning, saying rugby had changed from play into something that said who he was.乔尼·威尔金森小时候写下愿望：为英格兰出战、赢得世界杯；他二十四岁踢进制胜一球，第二天却起不来床——他说橄榄球何时从”玩”变成了关于”我是谁”的事。
- [00:17:49] Maté’s formulation: there are two common ways to wake up — one is to fail, the more dramatic is to succeed, because then you discover that what you wanted is empty.马泰的表述：唤醒通常有两条路——一是失败，更具戏剧性的是成功，因为那时你会发现自己想要的东西是空的。
- [00:41:58] Medical training itself is traumatising: residents’ and students’ telomeres fray faster than those of others their age, and studies show compassion is highest as they begin their studies and diminishes after.医学训练本身即具创伤性：住院医与医学生的端粒比同龄人磨损更快；研究显示他们的同理心在入学之初最高，此后一路衰减。
- [00:45:02] Multiple sclerosis was first described by Charcot in the nineteenth century as caused by long-term vexation and grief; dozens of studies since link childhood trauma and stress to it, yet the average neurologist never asks — as if the disease had a life of its own.多发性硬化症最早由夏科在十九世纪描述为”长期的烦扰与悲伤”所致；此后数十项研究将其与童年创伤和压力相联，但普通神经科医生从不询问——仿佛这疾病有它自己的生命。
- [00:58:50] His definition of trauma: not what happened to you but what happened inside you as a result. A wound has two forms — an open sore that reacts violently to any touch, and a scar that is thick, inflexible and lacking nerve endings — so trauma both sensitises and numbs.他对创伤的定义：不是发生在你身上的事，而是那件事在你内部造成的结果。创口有两种形态——碰之剧痛的开放伤口，以及厚硬、僵化、没有神经末梢的疤痕——所以创伤既让人过度敏感，又让人麻木。
- [01:00:20] Alongside big-T trauma there is the small-t trauma of what should have happened but did not: children need to be seen, heard and accepted unconditionally and to feel all their emotions — and depression is literally emotions pushed down because feeling them put the child at odds with their environment.除了”大写 T”的创伤，还有”小写 t”的创伤——本该发生却没有发生：孩子需要被无条件地看见、听见、接纳，也需要能感受全部情绪；而抑郁正是字面意义上的”把情绪压下去”，因为感受它们会让孩子与其环境格格不入。
- [01:06:27] Sleep training works because the infant gives up, flooded with cortisol, receiving the message that their feelings do not matter; time-out delivers the message that acceptance is purely conditional on pleasing the parent — both done by loving parents on expert advice.睡眠训练之所以”有效”，是因为婴儿放弃了——体内充斥皮质醇，接收到的讯息是”你的感受不重要”；而”计时隔离”传递的讯息是接纳完全取决于是否让父母满意——两者都由充满爱意的父母依专家建议施行。
- [01:12:36] Maté tells the story of slapping his three-year-old son Daniel for refusing to sing happy birthday — the same Daniel, now forty-seven, who co-wrote this book — as how trauma is passed on unwittingly; they have since done a lot of repair, but he advises younger parents not to make repair necessary.马泰讲述自己因三岁的儿子丹尼尔拒唱生日歌而扇他耳光——正是这位如今四十七岁、与他合写此书的丹尼尔——以说明创伤如何在不自知中被传递；父子后来做了大量修复，但他劝年轻父母：别让修复成为必要。
- [01:22:44] When Chatterjee says he felt he let his son down, Maté corrects him: those are not feelings, those are beliefs; the feelings are shame and guilt, and they predate the child by decades.当查特吉说他觉得自己辜负了儿子，马泰纠正道：那些不是感受，是信念；感受是羞耻与内疚，而它们比这个孩子早了几十年就已存在。
- [01:27:50] The four patterns Maté kept seeing in chronic illness and palliative care: automatic concern for others’ emotional needs while suppressing your own; rigid identification with duty, role and responsibility; the suppression of healthy anger; and two fatal beliefs — that you are responsible for how others feel and must never disappoint anybody. Nobody is born with them; they are adaptations, and it is not your fault.马泰在慢性病与临终关怀中反复看到的四种模式：自动关切他人情绪需要而压抑自己的；对责任、角色与义务的僵硬认同；健康愤怒被压制；以及两条”致命信念”——你要为别人的感受负责、你绝不能让任何人失望。没有人生来如此，它们都是适应；这不是你的错。
- [01:49:43] Women hold eighty percent of autoimmune disease because they are acculturated into exactly those traits, above all absorbing the stresses of their families and spouses; the MS gender ratio went from about one to one in the 1930s to three and a half women per man, too fast for genetics.女性承担了百分之八十的自身免疫疾病，因为文化正是把那几种特质塑造给她们，尤其是吸收家庭与配偶的压力；多发性硬化症的性别比从 1930 年代的约一比一变为三点五名女性对一名男性——对基因来说变化太快。
- [01:53:17] The two books converged independently: Chatterjee’s alignment, contentment and control map onto Maté’s authenticity, acceptance and agency, to which Maté adds healthy anger — the capacity to say no, you will not do this to me.两本书独立地趋同：查特吉的”对齐、满足、掌控”对应马泰的”真实、接纳、能动”，而马泰再加一条——健康的愤怒，即说”不，你不可以这样对我”的能力。
Selected quotes · 摘引
“so the first question in addiction for me is not why the addiction but why the pain” — 00:01:30
“所以在成瘾这件事上，对我而言首要的问题不是’为什么成瘾’，而是’为什么痛’。“（译文，非引文本身）
“this is a society that fundamentally demands of people that they be other than who they are” — 00:08:11
“这是一个从根本上要求人们成为’非他所是’的社会。“（译文，非引文本身）
“come on people read the word hyper tension hyper tension too much tension that’s what causes hypertension” — 00:56:15
“拜托，各位读一读这个词——hyper tension，过多的紧张；那才是高血压的成因。“（译文，非引文本身）
“trauma is not what happened to you trauma is what happened inside you as a result of what happened to you” — 00:58:50
“创伤不是发生在你身上的事；创伤是那件事在你内部造成的结果。“（译文，非引文本身）
“these really so-called really nice people who never get angry they’re the ones to develop malignancy and autoimmune disease” — 01:29:53
“那些所谓真正’好’、从不生气的人，正是最容易罹患恶性肿瘤与自身免疫疾病的人。“（译文，非引文本身）
People & works · 人物与著作
- Gabor Maté — physician and author; the guest, appearing for the third time on the show around the publication of The Myth of Normal.加博尔·马泰 —— 医生、作家；本期嘉宾，第三次做客该节目，时值《常态的迷思》出版。
- Rangan Chatterjee — physician and host of Feel Better, Live More; brings his own patient cases, his childhood conditioning around achievement, and his son’s infant illness into the conversation.兰甘·查特吉 —— 医生、《Feel Better, Live More》主持人；他把自己的患者案例、童年围绕成就的塑造、以及儿子婴儿期的疾病带入对话。
- Daniel Maté — Maté’s eldest son, a lyricist and musical theatre writer, co-writer of The Myth of Normal; the three-year-old in the birthday story, forty-seven when the book came out.丹尼尔·马泰 —— 马泰的长子，作词人与音乐剧编剧，《常态的迷思》的合著者；生日故事中那个三岁的孩子，书出版时四十七岁。
- “The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture” — the book under discussion; ten years of research, three years of daily writing, cut down from double its finished length.《常态的迷思：有毒文化中的创伤、疾病与疗愈》 —— 本次讨论的著作；十年研究、三年每日写作，成稿时从原本两倍的篇幅删减而来。
- Jonny Wilkinson — England rugby player who kicked the World Cup-winning goal at twenty-four; described as unable to get out of bed the next morning, and as saying rugby changed from play into a statement about who he was.乔尼·威尔金森 —— 英格兰橄榄球运动员，二十四岁踢进世界杯制胜一球；据述第二天早上起不来床，并说橄榄球从”玩”变成了关于”我是谁”的宣示。
- Russell Brand — told Maté that he was not writing the book for himself but for the world, which helped him past his ego.罗素·布兰德 —— 他对马泰说，你写这本书不是为自己，而是为世界；这句话帮他越过了自我。
- Dick Schwartz and Internal Family Systems (IFS) — Chatterjee credits IFS with making peace with parts of himself; Maté describes a joint programme comparing IFS with Compassionate Inquiry and notes considerable overlap.迪克·施瓦茨与内在家庭系统（IFS） —— 查特吉说 IFS 帮他与自身各个部分和解；马泰提到两人曾合办课程比较 IFS 与”同情探询”，并指出二者有大量交叠。
- Compassionate Inquiry — the method Maté teaches; here demonstrated on Chatterjee’s guilt about his son, and contrasted with self-judgment as the shift from “why did I do this” to “I wonder why I did that”.同情探询 —— 马泰教授的方法；此处用于处理查特吉对儿子的内疚，并与自我评判对照：从”我为什么要这么做”转向”我好奇我为什么会那样做”。
- Jean-Martin Charcot — the French physician who first described multiple sclerosis in the nineteenth century and attributed it to long-term vexation and grief (the auto-captions render the name phonetically).让-马丹·夏科 —— 十九世纪首次描述多发性硬化症的法国医生，将其归因于”长期的烦扰与悲伤”（自动字幕把这个名字拼成了音近形式）。
- William Osler — cited for his observations of the type of person who develops angina, contrasted with the type C personality associated with chronic conditions.威廉·奥斯勒 —— 因其对心绞痛患者人格类型的观察而被引用，并与和多种慢性病相关的”C 型人格”作对照。
- Jeff Rediger — Harvard psychiatrist and physician at McLean Hospital, doctor of divinity, author of “Cured” on so-called spontaneous healing.杰夫·雷迪格 —— 哈佛精神科医生、麦克莱恩医院单元主任、神学博士，著有《Cured》，研究所谓”自发疗愈”。
- Kelly Turner — oncological psychologist and author of the book on radical remission, reaching similar conclusions.凯莉·特纳 —— 肿瘤心理学家，著有关于”根本性缓解”的著作，得出相似结论。
- Benjamin Spock — the North American paediatrician who for decades was the arbiter of child-rearing advice and who wrote of the tyranny of the infant who wants to be picked up at night.本杰明·斯波克 —— 数十年间北美育儿建议的权威，他曾写到”夜里想被抱起的婴儿的暴政”。
- Stephen Hawking — cited as a British example of outliving a terminal prognosis, diagnosed with ALS at twenty and given two years.斯蒂芬·霍金 —— 被举为超越绝症预后的英国例子：二十岁确诊渐冻症，被判定只剩两年。
- Jim Carrey — quoted by Chatterjee as wishing everyone could become rich and famous so they would realise it does not make you happy.金·凯瑞 —— 查特吉引述其名言：希望人人都能又富又红，好让他们明白这并不带来幸福。
- Jaak Panksepp’s brain systems (unnamed here) — Maté again invokes the mammalian circuits for play, love, lust, fear, grief and anger when explaining healthy aggression at the close.（此处未点名的）雅克·潘克塞普脑系统 —— 结尾谈”健康攻击性”时，马泰再次援引哺乳动物用于玩耍、爱、性欲、恐惧、悲伤与愤怒的脑回路。
- “Doctor in the House” — Chatterjee’s BBC One series in which he lived alongside struggling families for four to six weeks, with every family improving or reversing their conditions.《Doctor in the House》 —— 查特吉的 BBC One 系列节目，他与健康受困的家庭同住四到六周，每个家庭的病情都逆转或显著好转。
- “Happy Mind, Happy Life” — Chatterjee’s book, whose healing principles of alignment, contentment and control the two men find converge with Maté’s.《Happy Mind, Happy Life》 —— 查特吉的著作，其疗愈原则”对齐、满足、掌控”被二人发现与马泰的原则趋同。
Source · 来源
- Original: https://www.youtube.com/watch?v=kPfQCQX30vw
- Channel/Show · 频道/节目: Dr Rangan Chatterjee · published 2022-09-14
- Registered from the Notion「GaborMate 阅览室」播客视频 / 文字讲稿 collection.