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三门峡医院看男性肾科那家比较好

2018年01月23日 12:04:33    日报  参与评论()人

三门峡市不孕不育医院在哪三门峡早泄多少钱三门峡陕州区妇幼中人民医院治疗前列腺疾病多少钱 Bessel van der Kolk sat cross—legged on an oversize pillow in the center of a smallish room overlooking the Pacific Ocean in Big Sur. He wore khaki pants, a blue fleece zip-up and square wire-rimmed glasses. His feet were bare. It was the third day of his workshop, ;Trauma Memory and Recovery of the Self,; and 30 or so workshop participants — all of them trauma victims or trauma therapists — lined the room#39;s perimeter. They, too, sat barefoot on cushy pillows, eyeing van der Kolk, notebooks in hand. For two days, they had listened to his lectures on the social history, neurobiology and clinical realities of post-traumatic stress disorder and its lesser-known sibling, complex trauma. Now, finally, he was about to demonstrate an actual therapeutic technique, and his gaze was fixed on the subject of his experiment: a 36-year-old Iraq war veteran named Eugene, who sat directly across from van der Kolk, looking mournful and expectant.从不大的房间望出去,大瑟尔地区太平洋的风光尽收眼底。贝塞尔·范德科尔克(Bessel van der Kolk)盘腿坐在房间中央的超大号靠枕上。他戴着方形金丝眼镜,身穿蓝色拉链式绒头织物衫和卡其布裤子,赤着脚。这天是他主办的“创伤记忆与自我恢复”(Trauma Memory and Recovery of the Self)研讨会的第三天,约30名研讨会参与者(均为创伤受害者或创伤治疗师)沿着房间的四壁围成一圈。他们也都赤脚坐在舒适的靠枕上,手里拿着笔记本,眼睛盯着范德科尔克。两天来,他们聆听他讲解了创伤后应激障碍(post-traumatic stress disorder, PTSD)及其鲜为人知的同类——复杂创伤(complex trauma)的社会历史、神经生物学和临床现状。现在,他终于将向他们演示实际的治疗技术。范德科尔克将目光落在自己的实验对象尤金(Eugene)的身上。这是一名36岁的伊拉克战争退伍军人,此刻他正坐在范德科尔克的对面,面带悲伤,又充满期待。Van der Kolk began as he often does, with a personal anecdote. ;My mother was very unnurturing and unloving,; he said. ;But I have a full memory and a complete sense of what it is like to be loved and nurtured by her.; That#39;s because, he explained, he had done the very exercise that we were about to try on Eugene. Here#39;s how it would work: Eugene would recreate the trauma that haunted him most by calling on people in the room to play certain roles. He would confront those people — with his anger, sorrow, remorse and confusion — and they would respond in character, apologizing, forgiving or validating his feelings as needed. By projecting his ;inner world; into three-dimensional space, Eugene would be able to rewrite his troubled history more thoroughly than other forms of role-play therapy might allow. If the experiment succeeded, the bad memories would be supplemented with an alternative narrative — one that provided feelings of acceptance or forgiveness or love.像过去一样,范德科尔克的治疗从讲述自己的亲身经历开始。“我的母亲对我毫无教养和疼爱之心,”他说。“但我却能让自己体会到在她关爱和抚育下成长的全部感受,并让它们成为我的‘记忆#39;。”因为他做过一项非常特别的练习,他解释道,而这也正是现在尤金将要尝试的。具体的做法是这样的:在场的人们将应尤金的要求扮演各种特定的角色,从而帮助他重现那段深深困扰他的创伤。他将对着这些人表露他的愤怒、悲伤、悔恨和迷茫,而他们则将依据所扮演的角色对他作出相应的回应,或道歉、或宽恕,也可以认同他的感受。通过将自己的“内心世界”投射到三维空间,尤金将得以重塑自己最不堪回首的经历,而且效果会比其他形式的角色扮演治疗更加彻底。如果实验能够成功,那些悲惨的回忆将可以通过另一种方式——一种可以获得认可、宽恕或爱的方式来重新描述。The exercise, which van der Kolk calls a ;structure; but which is also known as psychomotor therapy, was developed by Albert Pesso, a dancer who studied with Martha Graham. He taught it to van der Kolk about two decades ago. Though it has never been tested in a controlled study, van der Kolk says he has had some success with it in workshops like this one. He likes to try it whenever he has a small group and a willing volunteer.这种做法被范德科尔克称为“构造”(structure),它还有个名字叫做精神运动疗法(psychomotor therapy)。舞蹈演员艾伯特·佩索(Albert Pesso)创立了该疗法,并在大约20年前教给了范德科尔克。尽管这种疗法未在对照研究中接受过检验,但范德科尔克称,在几次类似的研讨会中,他们已经有过若干成功的先例。无论何时何地,只要他身边聚集了一小群人,而且有人愿意站出来,他都喜欢尝试一下这种疗法。With some gentle prodding from van der Kolk, Eugene told us how he came to be a specialist in the ed States Army, how he spent a full year stationed in Mosul, the largest city in northern Iraq, and how his job involved disposing of exploded bombs. It was a year of dead bodies, he said. He saw, touched, smelled and stepped in more bodies than he could possibly count. Some of them were children. He was only 26.在范德科尔克温和的鼓励下,尤金向我们讲述了他的故事:他怎样成为美国陆军的技术兵;他在伊拉克北部最大的城市苏尔驻扎的那一整年时间,是如何度过的;以及他的工作怎么会涉及处置已爆炸的炸弹。那一年都在和尸体打交道,他说。他目睹、触摸、嗅闻乃至踏过的尸体简直不可胜数,其中有些还是儿童。而尤金当时只有26岁。People turn to grease when they explode, he told us, because their fat cells burst open. He witnessed multiple suicide bombings. Once, he accidentally stepped in an exploded corpse; only the legs were still recognizable as human. Another time, he saw a kitchen full of women sliced to bits. They#39;d been making couscous when a bomb went off and the windows shattered. He was shot in the back of the head once. He was also injured by an improvised explosive device.尤金告诉我们,当人被炸碎时,脂肪细胞都会爆裂开,于是人就变成了一大团动物油脂。他曾目击过多起自杀式炸弹袭击事件。有一次,他不小心踩在一具爆炸后的尸体上——只有腿部还勉强有点人型。还有一次,他看到一个厨房里,到处散落着女人身体四分五裂的残片——她们正在做古斯米时,一枚爆炸的炸弹震碎了窗户。尤金曾经头部后侧中弹,也曾经因土制的爆炸装置受伤。But none of those experiences haunted him quite as much as this one: Several months into his tour, while on a security detail, Eugene killed an innocent man and then watched as the man#39;s mother discovered the body a short while later.但这些经历对他的困扰,与下面这件事相比,只是小巫见大巫:在任职几个月后,尤金在一次安保任务中杀死了一名无辜的男子,然后他还眼看着那名男子的母亲在不久之后发现了儿子的遗体。;Tell us more about that,; van der Kolk said. ;What happened?; Eugene#39;s fragile composure broke at the question. He closed his eyes, covered his face and sobbed.“请讲得再详细一些,”范德科尔克说,“发生了什么事?”简单的问题打破了尤金强忍着的镇定。他闭上眼睛,用手遮住脸,开始抽泣。;The witness can see how distressed you are and how badly you feel,; van der Kolk said. Acknowledging and reflecting the protagonist#39;s emotions like this — what van der Kolk calls ;witnessing; them — is a central part of the exercise, meant to instill a sense of validation and security in the patient.“见人看得出你有多么痛心和难过,”范德科尔克说。范德科尔克像这样承认事件主人公的情绪,并对其情绪做出反应,他把这个过程称为“见”,这是练习的核心部分,旨在向患者灌输受到认可的感觉以及安全感。Eugene had aly called on some group members to play certain roles in his story. Kresta, a yoga instructor based in San Francisco, was serving as his ;contact person,; a guide who helps the protagonist bear the pain the trauma evokes, usually by sitting nearby and offering a hand to hold or a shoulder to lean on. Dave, a child-abuse survivor and small-business owner in Southern California, was playing Eugene#39;s ;ideal father,; a character whose role is to say all the things that Eugene wished his real father had said but never did. They sat on either side of Eugene, touching his shoulders. Next, van der Kolk asked who should play the man he killed. Eugene picked Sagar, a stand-up comedian and part-time financial consultant from Brooklyn. Finally, van der Kolk asked, Who should play the man#39;s mother?在此之前,尤金已经拜托了一些小组成员来扮演他故事中的角色。居住在旧金山的瑜伽教练克雷斯塔(Kresta)担任他的“联络人”,就像是一个向导,帮助主人公承受回忆唤起的创伤。联络人通常就坐在主人公的身旁,在需要时提供一只持的手臂或一个可以依靠的肩膀。戴夫(Dave)是虐待儿童案件的幸存者,现在是南加州的一个小企业主。在这里,他扮演的角色是尤金的“理想父亲”,他的任务是对尤金说一些尤金一直期盼能从自己真正的父亲口中听到,但真正的父亲从来没有说过的话。这两个人分别坐在尤金的两侧,手搭在他的肩膀上。接下来,范德科尔克询问尤金希望由谁来扮演那名被自己杀害的人。尤金选择了塞格尔(Sagar),来自纽约布鲁克林区的脱口秀笑星及兼职财务顾问。最后,范德科尔克问道,谁来扮演那男子的母亲?Eugene pointed to me. ;Can you do it?; he asked.尤金指着我。“可以拜托你吗?”他问。I swore myself in as the others had, by saying, ;I enroll as the mother of the man you killed.; Then I moved my pillow to the center of the room, across from Eugene, next to van der Kolk.“我愿意扮演被害人的母亲,”我学着其他人的样子宣布承担这个任务,然后把自己的靠枕搬到了房间的中央,面对着尤金,挨着范德科尔克。;O.K.,; van der Kolk said. ;Tell us more about that day. Tell us what happened.;“好了,”范德科尔克说。“请告诉我们更多关于那一天的事吧,都发生了些什么?”Psychomotor therapy is neither widely practiced nor supported by clinical studies. In fact, most licensed psychiatrists probably wouldn#39;t give it a second glance. It#39;s hokey-sounding. It was developed by a dancer. But van der Kolk believes strongly that dancers — and musicians and actors — may have something to teach psychiatrists about healing from trauma and that even the hokey-sounding is worthy of our attention. He has spent four decades studying and trying to treat the effects of the worst atrocities we inflict on one another: war, rape, incest, torture and physical and mental abuse. He has written more than 100 peer-reviewed papers on psychological trauma. Trained as a psychiatrist, he treats more than a dozen patients a week in private practice — some have been going to him for many years now — and he oversees a nonprofit clinic in Boston, the Trauma Center, that treats hundreds more. If there#39;s one thing he#39;s certain about, it#39;s that standard treatments are not working. Patients are still suffering, and so are their families. We need to do better.精神运动疗法目前既没有在临床实践中广泛实施,也没有得到临床研究的持。事实上,大多数执业精神科医生恐怕都不会看它第二眼。它听起来就像做戏,而且还是由舞蹈演员创立的。但范德科尔克相信,舞者——以及乐手和演员——在促进精神创伤的愈合方面可能的确有过人之处,值得精神科医生借鉴,这个方法虽然有些矫揉造作,但仍然值得关注。他花了40年的时间,来研究人们施加在彼此身上最惨痛的暴行,比如战争、强奸、乱伦、拷打,以及生理和心理的虐待所造成的影响,并尝试进行治疗。他撰写了100多篇关于心理创伤的经过同行评议的文章。而且,作为一名训练有素的精神科医生,他的私人诊所每周都接诊数十名患者——其中有些人找他看病已有多年。此外,他还负责着位于波士顿的一家名为“创伤中心”(Trauma Center)非营利性诊所,那里还为另外数百名患者提供诊治。如果有一件事是他可以断言的,那就是:常规的治疗方法不管用。患者们仍然痛苦不堪,他们的家人也不能幸免。我们还需要做得更好才行。Van der Kolk takes particular issue with two of the most widely employed techniques in treating trauma: cognitive behavioral therapy and exposure therapy. Exposure therapy involves confronting patients over and over with what most haunts them, until they become desensitized to it. Van der Kolk places the technique ;among the worst possible treatments; for trauma. It works less than half the time, he says, and even then does not provide true relief; desensitization is not the same as healing. He holds a similar view of cognitive behavioral therapy, or C.B.T., which seeks to alter behavior through a kind of Socratic dialogue that helps patients recognize the maladaptive connections between their thoughts and their emotions. ;Trauma has nothing whatsoever to do with cognition,; he says. ;It has to do with your body being reset to interpret the world as a dangerous place.; That reset begins in the deep recesses of the brain with its most primitive structures, regions that, he says, no cognitive therapy canaccess. ;It#39;s not something you can talk yourself out of.; That view places him on the fringes of the psychiatric mainstream.范德科尔克尤其对创伤治疗中最常用的两种方法持有异议:认知行为疗法(cognitive behavioral therapy,简称CBT)和暴露疗法(exposure therapy)。暴露疗法是让患者一遍又一遍地面对最困扰他们的问题,直到他们对此变得麻木。范德科尔克把它贬斥为“最不可能治疗”创伤的方法。它的成功率还不到一半,他说,就算“成功”了也无法提供真正的解脱:脱敏与痊愈是两个不同的概念。他对认知行为疗法,也有类似的看法。认知行为疗法试图通过一种苏格拉底式的对话,帮助患者认识到自己的思想与情绪之间的联系调试不良,从而改变患者的行为。“但创伤与认知可没有一丁点儿关系,”范德科尔克说。“真正的问题在于,创伤改造了你的身体,让你觉得这世界很危险。”这种改造源于我们大脑中最原始结构的深处,认知疗法所无法触及的地带。“这不是你劝解自己说几句就可以解决的。”这些观点令他游离出了精神学主流。It#39;s not the first time van der Kolk has been there. In the early 1990s, he was a lead defender of repressed-memory therapy, which the Harvard psychologist Richard McNally later called ;the worst catastrophe to befall the mental-health field since the lobotomy era.; Van der Kolk served as an expert witness in a string of high-profile sexual-abuse cases that centered on the recovery of repressed memories, testifying that it was possible — common, even — for victims of extreme or repeated sexual trauma to suppress all memory of that trauma and then recall it years later in therapy. He#39;d seen plenty of such examples in his own patients, he said, and could cite additional cases from the medical literature going back at least 100 years.范德科尔克并不是第一次陷入这种境地。20世纪90年代初,他是记忆抑制治疗(repressed-memory therapy)的一名主要的拥护者。该疗法后来被哈佛大学的心理学家理查德·麦克纳利(Richard McNally)称为“自脑叶切除术时代以来降临到心理健康领域的最大灾难。”在当时的一系列引人注目的性虐待案件中(均与恢复受抑制的记忆密切相关),范德科尔克担任了专家人,作称遭受极端或反复性创伤的受害者有可能——甚至普遍——会压抑自己关于那些创伤的所有记忆,直至多年后在治疗中才回想起来。他表示,在自己的患者中见过很多这样的例子,此外,他还能从医学文献中找出此类案例,至少可以回溯100年。In the 1980s and ‘90s, people from all over the country filed scores of legal cases accusing parents, priests and day care workers of horrific sex crimes, which they claimed to have only just remembered with the help of a therapist. For a time, judges and juries were persuaded by the testimony of van der Kolk and others. It made intuitive sense to them that the mind would find a way to shield itself from such deeply traumatic experiences. But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned. Most research psychologists argued that it was much more likely for so-called repressed memories to have been implanted by suggestive questioning from overzealous doctors and therapists than to have been spontaneously recalled. In time, it became clear that innocent people had been wrongfully persecuted. Families, careers and, in some cases, entire lives were destroyed.20世纪80年代和90年代,全美各地涌起了一股性虐诉讼的风潮,人们纷纷指控父母、牧师和日托务人员犯下了恐怖的性犯罪,并声称,他们是在治疗师的帮助下才刚刚想起来的。一时间,法官和陪审团都被范德科尔克等人的言说了。他们直觉感到,人的心灵确实会找一种途径来屏蔽过度痛苦的经历。但随着指控变得越来越稀奇古怪——譬如被外星人绑架或神秘的撒旦邪教之类——持这一理论的声音日渐衰弱。大多数心理学研究专家认为,与其说是受害者自发地回忆起了这些所谓的“被压抑的记忆”,可能性要大得多的是,过分狂热的医生和治疗师的暗示性提问在他们的头脑中植入了这样的故事。随着时间的推移,事实逐渐浮出水面:的确有无辜的人被错误地起诉了。他们的家庭、事业、甚至在某些情况下整个生活,都被毁于一旦。After the dust settled in what was dubbed ;the memory wars,; van der Kolk found himself among the casualties. By the end of the decade, his lab at Massachusetts General Hospital was shuttered, and he lost his affiliation with Harvard Medical School. The official reason was a lack of funding, but van der Kolk and his allies believed that the true motives were political.待这场日后被称为“记忆之战”的争论尘埃落定之后,范德科尔克自己也付出了代价。90年代末,他在马萨诸塞州总医院(Massachusetts General Hospital)的实验室被关停,还失去了在哈佛医学院(Harvard Medical School)的职位。官方给出的理由是资金不足,但范德科尔克及其持者认为,真正的动机是政治因素。Van der Kolk folded his clinic into a larger nonprofit organization. He began soliciting philanthropic donations and honed his views on traumatic memory and trauma therapy. He still believed that repressed memories were a common feature of traumatic stress. Traumatic experiences were not being processed into memories, he reasoned, but were somehow getting ;stuck in the machine; and then expressed through the body. Many of his colleagues in the psychiatric mainstream spurned these ideas, but he found another, more receptive audience: body-oriented therapists who not only embraced his message but also introduced him to an array of alternative practices. He began using some of those practices with his own patients and then testing them in small-scale studies. Before long, he had built a new network of like-minded researchers, body therapists and loyal friends from his Harvard days.范德科尔克将自己的诊所并入了一家规模更大的非营利组织中。他开始募集慈善捐款,并将关注的目标集中在创伤记忆及创伤治疗之上。他仍坚信,记忆抑制是创伤应激的一个普遍特征。范德科尔克解释道,创伤经历并没有被加工成记忆,而是莫名其妙地“卡壳”了,日后才在躯体上表现出来。精神病学的主流研究者大多都对这些理论嗤之以鼻,但范德科尔克在另一个群体中找到了更愿意接受它们的人:身体导向治疗师们不仅欣然接纳了他的观点,还向他介绍了一系列替代疗法。他开始使用其中一些疗法来尝试治疗自己的患者,并在小规模的研究中对他们加以测试。不久,他就与志同道合的研究人员、身体治疗师以及他在哈佛时结交的忠实伙伴建立起了一个新的关系网络。The group converged around an idea that was powerful in its simplicity. The way to treat psychological trauma was not through the mind but through the body. In so many cases, it was patients#39; bodies that had been grossly violated, and it was their bodies that had failed them — legs had not run quickly enough, arms had not pushed powerfully enough, voices had not screamed loudly enough to evade disaster. And it was their bodies that now crumpled under the slightest of stresses — that dove for cover with every car alarm or saw every stranger as an assailant in waiting. How could their minds possibly be healed if they found the bodies that encased those minds so intolerable? ;The single most important issue for traumatized people is to find a sense of safety in their own bodies,; van der Kolk says. ;Unfortunately, most psychiatrists pay no attention whatsoever to sensate experiences. They simply do not agree that it matters.;这群人秉持着一个简洁有力的观念:精神创伤的治疗应该通过身体而不是通过心理进行。很多病例中,受到严重侵犯的是患者的身体,是他们的身体辜负了他们的期望——腿跑得不够快,手臂抗拒得不够有力,呼救的声音还不够大,以至于他们未能逃脱魔爪。如今,同样是他们的身体屈于哪怕最轻微的压力之下——一听到汽车防盗器的鸣叫声就会慌忙躲闪,每见到一个陌生人就觉得那是一个蓄势待发的攻击者。如果容纳思想的躯体如此不堪重负,那他们的心灵又怎么可能会痊愈?“对于创伤受害者而言,唯一最重要的问题就是要让自己的身体找到安全感,”范德科尔克说。“不幸的是,大多数精神科专家对感官体验都不屑一顾。他们根本就不觉得这有什么重要。”That van der Kolk does think it matters has won him an impressive and diverse fan base. ;He#39;s really a hero,; says Stephen Porges, a professor of psychiatry at the University of North Carolina, Chapel Hill. ;He#39;s been extraordinarily courageous in confronting his own profession and in insisting that we not discount the bodily symptoms of traumatized people as something that#39;s ‘just in their heads.#39; ;范德科尔克对身体感受的重视为他赢得了背景各异的众多粉丝。“他是一个真正的英雄,”北卡罗来纳大学教堂山分校(University of North Carolina, Chapel Hill)的精神病学教授史蒂芬·波格斯(Stephen Porges)表示。“他一直表现出大无畏的态度,挑战自己的学术圈子,并始终坚持不应简单地认定创伤受害者存在身体症状‘仅仅是脑筋出了问题#39;。”These days, van der Kolk#39;s calendar is filled with speaking engagements, from Boston to Amsterdam to Abu Dhabi. This spring, I trailed him down the East Coast and across the country. At each stop, his audience comprised the full spectrum of the therapeutic community: psychiatrists, psychologists, social workers, art therapists, yoga therapists, even life coaches. They formed long lines up to the podium to introduce themselves during coffee breaks and hovered around his table at lunchtime, hoping to speak with him. Some pulled out their cellphones and asked to take selfies with him. Most expressed similar sentiments:连日来,范德科尔克的日程表被约得满满的,演讲地点从波士顿到阿姆斯特丹,再到阿布扎比。今年春天,我跟随他的脚步,走遍了东海岸和全美各地。每到一站,捧场的观众均遍及治疗领域的方方面面:精神科医生、心理学家、社会工作者、艺术治疗师、瑜伽治疗师,乃至生活教练。在讲座的中间休息时间,他们排成长队逐一到讲台上去做自我介绍,午餐时还会在他的桌子附近徘徊,希望能和他搭话。一些人掏出手机,想要与他合影留念。很多人表达了诸如此类的观点:Thank you so much for what you said about this treatment, that therapy, those studies.非常感谢您宣讲了关于这种治疗、疗法或研究的信息。Your research on cutting, child sexual abuse, family violence confirms what I have seen in my own patients, or experienced myself, for decades now.您关于自我割伤、儿童期性虐待和家庭暴力的研究实了过去几十年来我从自己的患者或者亲身经历中所见的事实。Can you help me?您可以帮助我吗?Van der Kolk#39;s entire life has been a study in human trauma. He was born in The Hague in the summer of 1943, three years into the German occupation of the Netherlands and one year before the great Dutch famine, when a military blockade cut off food and fuel shipments to the country#39;s western provinces and more than 20,000 people starved to death. His father was imprisoned in a Nazi work camp. According to van der Kolk family lore, his mother had to ride her bike to the hospital when she went into labor with him, and his first birthday cake was made of tulip bulbs because there was hardly any flour.范德科尔克自己的整个人生就好像一项关于人类创伤的研究。1943年的夏天,他在海牙出生。这是德国占领荷兰的第三年,次年,军事封锁切断了通往荷兰西部省份的粮食和燃料补给,导致逾2万人饿死,史称“冬季饥荒”。他的父亲被囚禁在纳粹集中营里。按照范德科尔克家族中的传说,他的母亲快要分娩的时候不得不自己骑自行车到医院,而他的第一个生日蛋糕是用郁金香球茎做的,因为当时基本上没有面粉。He was a weak and scrawny boy, but daring nonetheless. Ask him about his childhood, and he will tell you about playing amid the bombed-out ruins of his native city. Nearly everyone around him was deeply traumatized. His neighbors on either side were Holocaust survivors. His mother did not enjoy motherhood; she was pulled out of school at 14 to care for her father and then pulled away from a satisfying career to assume her wifely duties. By the time Bessel, her middle child, was old enough to know her, she had grown bitter and cold. His father was an executive at Royal Dutch Shell, and despite being a devout Protestant and dedicated pacifist, he suffered violent rages and inflicted them on his children. In his new book, ;The Body Keeps the Score,; which comes out this fall, van der Kolk mentions being locked in the basement as a little boy for what he describes as ;normal 3-year-old offenses; and hating himself for being too puny to fight back.范德科尔克是一个骨瘦如柴的孱弱男孩,但这丝毫没有减损他的勇敢。如果问起他的童年往事,他会告诉你在故乡城市遭受轰炸后的废墟上玩耍的故事。他周围几乎每个人都遭受了深深的创伤。左右的邻居都是犹太人大屠杀的幸存者。他的母亲一点也不乐意当妈妈;14岁的时候她就辍学照顾自己的父亲,之后又被迫离开了自己喜爱的职业以承担身为人妻的责任。在家里的第二个孩子贝塞尔懂事之前,她的性格已经变得刻薄而冷漠。范德科尔克的父亲是荷兰皇家壳牌集团(Royal Dutch Shell)的高管。尽管他是一名虔诚的新教徒,也是忠实的和平主义者,但盛怒之下他也会在孩子们身上泄愤。在秋天将要面世的新书《身体记得》(The Body Keeps the Score)中,范德科尔克提到,当他还是个小男孩时,曾经因为“正常的3岁孩子都会惹的祸”而被关在地下室里,只能怨恨自己太弱小,无力反抗。As a teenager, he began traveling on his own. He liked to hitchhike into France. On one such trip, as he passed a monastery, he heard the chanting of monks and was so taken with the sound that he asked the driver to let him off there. He spent the rest of that summer, and the following Easter break, and the summer after that, at the monastery contemplating monkhood. The abbot took a liking to him and promised that if he joined the order, they would send him to Geneva for medical school. ;I seriously considered it,; he told me. But in the end, a youthful thirst for adventure beat out any yearning he might have felt for quiet meditation, and he chose the University of Hawaii instead. ;I still have some spiritual feelings,; he says. ;I believe that all things are connected. But organized religion gives me the creeps.;十几岁的时候,他开始独自旅行。他喜欢搭便车到法国去。在一次这样的旅行中,他在途经一所修道院时听到修道士们诵经的声音,并为之深深打动,于是请求司机让他在那里下车。他在那所修道院度过了当年夏天剩下的所有时间,然后是次年的复活节假期,以及之后的又一个夏天,甚至考虑要不要成为一名修道士。修道院院长对他很有好感,并承诺如果他加入修会,他们就送他到日内瓦读医学院。“我认真考虑过这个提议,”他告诉我。但最终,年轻的心对冒险的渴望战胜了他对安静冥想的向往,于是他选择了夏威夷大学(University of Hawaii)。“我仍然有一些精神感应,”他说。“我相信万事万物都彼此关联。但组织有序的宗教让我浑身发毛。”And so in 1962, he came to the ed States and made his way from the University of Hawaii to the University of Chicago to Harvard Medical School, where he posed to science and medicine all of his many questions about the horrors of human nature and the miracles of human resilience. ;The human species is messed up,; he says. ;We make the same mistakes over and over, and I#39;m deeply curious about why that is. Why do we keep doing things that we know are horrible and will have terrible consequences?;就这样,1962年,范德科尔克来到了美国,并先后就读于夏威夷大学、芝加哥大学(University of Chicago)和哈佛医学院。在这里,他将自己关于人性中恐怖的一面,以及人类神奇的适应和恢复能力的许多问题,摆在了科学和医学面前。“人类这个物种可真是一团糟,”他说。“我们总是一遍又一遍地犯同样的错误。我真好奇这究竟是为什么。为什么我们明知道会酿成大祸,惹来不可收拾的后果,却还是会一意孤行?”One of van der Kolk#39;s first jobs out of school was as a staff psychiatrist at the Veterans Affairs clinic in Boston; he arrived there in 1978, in time for the influx of Vietnam veterans. ;The waiting list to see a doctor was a mile long,; he says. ;And the clinic#39;s walls were pocked full of fist imprints.;离开学校后,范德科尔克的头几份工作里包括在退伍军人事务部下属的一家波士顿诊所担任精神科医师。他入职时正值1978年,越战老兵洪水一般地涌来。“等候看诊的队伍足有一英里长,”他说。“诊所的墙上到处是被拳头打出来的印记。”The first thing van der Kolk noticed about his new patients was how utterly stuck in the past they were. Even the older veterans from World War II seemed to vacillate between one of two states: immersion in their wartime experiences or lifeless disengagement. In Rorschach tests, every inkblot was a dead baby, a fallen comrade or nothing at all. It was as if war had broken the projector of their imaginations, he says, and their only options were to play one reel over and over or turn the machine off altogether.在这些新患者身上,范德科尔克首先注意到的一件事是,他们都将自己完全困在过去里。即使是那些从二战战场上归来的老一批的退伍军人也常常在两种状态之间摇摆:或是沉溺于战争经历中无法自拔,或是看破红尘四大皆空。在罗夏测试(Rorschach test)中,他们不是把墨迹看成死去的婴儿或倒下的战友,就是觉得什么都不像。仿佛是他们脑海中的投影仪被战争弄坏了,范德科尔克说,于是他们只能选择把一卷影像翻来覆去地看,或者干脆把机器彻底关掉。The second thing that struck van der Kolk was how the men managed their own conditions. Almost all of them claimed that highly risky behaviors were capable of yanking them into the present in a way that no form of therapy could (one patient, for example, rode his Harley at breakneck speeds whenever he felt himself swirling into a rage or disconnecting from his surroundings). Van der Kolk#39;s treatment — the only thing he had been taught in medical school — involved getting the men to talk. In both group and one-on-one sessions, he would ask them about their horrible memories, nightmares and troubles at home. But talking didn#39;t seem to help; in some cases, he thought, it made things worse.令范德科尔克感到震惊的第二件事是这些人控制自己状况的方式。几乎所有人都声称,与任何形式的治疗相比,高风险的行为更可能将他们拉回现实(例如,一名患者称,每当觉得自己快要暴跳如雷或者游离于现实之外时,他就骑着哈雷托车玩儿命地飙车)。范德科尔克的治疗手段——也就是医学院唯一教他做的——是让这些人敞开心扉,多多交谈。在小组和一对一的治疗会话中,他都会询问他们很多问题,关于那些可怕的回忆、关于梦魇以及在家里遇到的麻烦等等。但谈话似乎并没什么帮助;甚至在某些病例中,他觉得适得其反。Van der Kolk scoured the clinic#39;s medical library for books on shell shock and combat fatigue — anything that might help him better understand what he was seeing or give him some clue about how to treat it. Post-traumatic stress disorder was not yet a recognized condition. Then he came across a book at Harvard#39;s Francis A. Countway medical library, ;The Traumatic Neurosis of War.; It was published in 1941, just before shellshocked American veterans would return from World War II. In its pages, van der Kolk found the first seeds of an idea that would ultimately shape his career: The nucleus of neurosis is physioneurosis. In other words, he thought, the root of what would eventually be called PTSD lay in our bodies.范德科尔克翻遍了诊所的医学图书馆中关于炮弹休克症(shell shock)和战斗疲劳症(combat fatigue)的书籍,寻找可能帮助他更好地了解患者症状的任何信息,或者有助于他进行治疗的任何提示。在那个时代,创伤后应激障碍还未被公认为一种疾病。后来,他在哈佛的弗朗西斯·A·康特韦医学图书馆(Francis A. Countway Library of Medicine)里发现了一本书:《战争的创伤性神经官能症》(The Traumatic Neurosis of War)。该书出版于1941年,正好是在饱受炮弹休克症困扰的美国老兵从第二次世界大战中归来之前。在这本书中,范德科尔克找到了一些最初的灵感。这些灵感最终指明了他职业生涯的方向:神经官能症的核心在于躯体性神经官能症。换句话说,他认为,日后所称的PTSD的根源深埋在人类的身体之中。This meshed perfectly with what van der Kolk was seeing in his patients. In addition to their nightmares and hallucinations, many of them had a host of physical ailments, including headaches, fatigue, digestive troubles and insomnia. When he tried accessing their traumas in therapy, they often became jittery, broke into cold sweats or shut down. The book, van der Kolk said, did not offer any suggestions for treatment, but it did give him a starting point. In the two decades that followed, he made a careful study of all his patients#39; physiological symptoms. And in 1994, not long before his Harvard lab was shuttered, he wrote a paper in The Harvard Review of Psychiatry summarizing all he had learned. Traumatic stress, it seemed, triggered a cascade of physiological catastrophes that affected almost every major system in the body.这与范德科尔克在患者身上的所见所闻完全吻合。除了噩梦和幻觉,许多患者还遭受着众多生理症状的折磨,包括头痛、疲劳、消化系统疾患和失眠等。当他在治疗中试图触及他们的创伤时,他们往往一下子就变得如同惊弓之鸟一般,浑身冷汗涔涔或者将自己完全封闭起来。范德科尔克表示,虽然这本书并没有提供任何治疗建议,但给了他一个起点。在接下来的20年里,他仔细研究了他所有患者的生理症状。1994年,就在他在哈佛的实验室被关闭前不久,他撰写了一篇论文总结了自己的所有发现,并发表在《哈佛精神病学》(The Harvard Review of Psychiatry)上。创伤应激似乎可以触发一连串的生理性灾难,几乎影响到身体的所有主要系统。Eugene was on military leave in San Francisco, about halfway through his tour of duty, when he first realized something was wrong. The bay was cool and breezy; people were walking around in parkas and hoodies. But he was sweating profusely. He thought his months in the desert had maybe activated some weird sweat gene that needed time to turn itself off. He figured it would pass eventually. It didn#39;t. By the time he came home for good, sweat was the least of his problems. He was seeing dead bodies on the side of the road. And he could not stop going to the bathroom. At his first post-military job in the corporate offices of a large bank, he went to the bathroom so often that he was sure his co-workers wondered what was wrong with him.尤金第一次意识到自己出了问题时,他的役期差不多已经过半,当时正在旧金山军事休假。海湾天气凉爽,微风拂面;四周漫步的人们都身着风雪大衣和连帽衫。但他自己却满头大汗。他一度以为这是因为数月来自己在沙漠中的生活,激活了某些与出汗有关的奇特基因,需要过一段时间它们才会自行关闭。他估计慢慢就会好起来的。但事实并非如此。等他彻底退役回家时,他才发现,出汗只是个最最微不足道的问题。他出现了幻视,看到路边堆积着尸体。他需要不停地去卫生间。他退伍后的第一份工作是在一家大的总部办公室任职,由于他去洗手间太过频繁,他敢肯定同事们都怀疑他有毛病。 /201409/327982河南省三门峡郑大中医医院治疗男性不育多少钱

三门峡市包皮手术价钱Fitness trackers–the Bluetooth-enabled bracelets and wearable devices that monitor things like a person’s heart rate, steps taken and calories burned–had a moment last year. Then everyone realized that knowing how many steps they’d taken each day wasn’t all that helpful. What do you do with that information? Reports surfaced that half of fitness tracking devices had become inactive; industry experts suggest that number is closer to 85%.健康追踪器(也就是基于蓝牙技术的腕带和可穿戴设备,能监测人们的心率、行走步数和消耗的卡路里)去年着实热闹了一阵。然后所有人都意识到,光知道自己每天走了多少步其实没什么用。您会拿这些信息做什么用呢?一些研究报告发现,这类设备有半数最终都闲置了起来;业内专家则认为这个数字要接近85%。The fitness tracker moment has passed. The next wave of connected devices is taking a different approach: Instead of incentivizing users to exercise or sleep or eat healthy, and rewarding them for it with virtual badges and digital high-fives, this new class of devices use shame, guilt, and in one case, a physical shock, to keep their owners in line.健康追踪设备可谓大势己去。下一波互联设备则采取了全新的互动方式:它们不再鼓励用户去锻炼,也不是鼓励他们保持饮食和睡眠健康,同时用什么虚拟奖牌和数字化击掌致意来奖励他们;相反,这些全新设备用羞耻感、负罪感,以及某种情况下的物理震动来让用户守规矩。Where first-generation fitness trackers offered the carrot, the latest class is offering the stick. Soon everything you own, from your chair, to your lighter, to your fork or belt, will be able to scold you.如果说第一代健康追踪设备奉上的是胡萝卜,那最新一代设备挥舞的就是大棒了。很快,你所拥有的一切东西,从板凳到打火机,从叉子到皮带,都能把你骂上一顿。Take Quitbit. It’s a “smart lighter,” which measures how much its owner smokes, in hopes that that information will motivate them to cut back on the habit. Its designers created the device after they tried to track their own smoking with Google Docs and iPhone notes. They realized they weren’t always proud of how much they smoked, and therefore weren’t motivated to continue recording the behavior. So they built a lighter that records the data for them. In addition to tracking the data, which founders Takuji Nakano and Ata Ghofrani say is proven to help smokers decrease their smoking, Quitbit can be programmed to only work a certain number of times each day. They’re careful not to push the guilt factor, since it takes time for smokers to come around to the idea of quitting. “We have to be really gentle with it and will continually ease them into it by making them more cognitive about how much they’re smoking,” Nakano says. “We want to empower them to just try to quit.” The Quitbit crossed its funding goal on Kickstarter and will be available for purchase later this year.比如Quitbit,这是个“智能打火机”,它能测出用户抽了多少烟。它的设计意图是希望这类信息能让用户少抽点烟。它的设计师是在用“谷歌医生”(Google Docs)和iPhone notes追踪自己的抽烟情况后才有了设计它的念头。他们知道自己并不总会因为自己抽了多少烟而感到自豪,因此也不会很有动力地记录这种行为。所以他们才会打造这么一款打火机来记录抽烟数据。中野卓二和阿塔o高夫拉尼这两位创始人表示,这款设备确实能帮吸烟者少抽烟。除此之外,Quitbit还能设定每天有效工作的次数。他们很注意不要激发吸烟者的负罪感,因为吸烟者需要一定的时间来认识到戒烟的必要性。中野说:“我们不得不小心行事,通过让吸烟者逐步意识到自己的吸烟量,持续地推动他们慢慢戒烟。我们希望能让他们确实有动力试着戒烟。”Quitbit已在众筹网站Kickstarter上公布了募资目标,今年晚些时候就能上市销售。For drinkers, there are a myriad of iPhone breathalyzer tools that not only tell users how intoxicated they are and how long until they’ll be sober, but map out alcohol intake over time in a handy chart. The quantified drinker can choose from breathalyzer devices from BACTrack (which I reviewed last year),Breathometer, or Alcohoot.喝酒的人们则可以选用各种iPhone上的酒精测试工具。它们不仅能告诉用户他们到底醉到了什么程度,还需要多久才能清醒,还能通过一个简明的表格显示出一段时间以来的酒精摄入量。喜欢定量的饮酒者可以选择的工具有BACTrack(去年我评测过),Breathometer或Alcohoot。For speed-eaters, there’s Hapifork, an electronic fork that vibrates when its user eats too fast. The idea is that eating more slowly helps users consume less food, chewing more frequently to aid digestion and decrease gastric reflux. Naturally, there’s an app to go with it, tracking one’s eating speeds over time.吃得太快的人可以使用Hapifork。这是一款电子叉子,用户如果吃得太快,它就会开始震动。它的设计理念是,吃得慢一些可以让用户吃得少些,咀嚼更充分以帮助消化,同时减少肠胃返流。它自然也自带了一款应用,可以监测用户一段时间内的饮食速度。For fixing bad posture, there’s the LumoBack, a connected belt that vibrates any time its wearer slouches. A sensor can be set to pulse until the wearer has adjusted into a “good posture.” A related smartphone app allows users to “watch” their posture, assigning a score for how straight one is sitting or standing. In addition, the LumoBack tracks time spent standing, sitting, and sleeping.如果要纠正不良体态,可以用LumoBack,每当用户弓腰塌背时,这条联网的带子就会震动。带子上的一个传感器会不断跳动,直到用户调整到“正确姿势”为止。一个相关的智能手机应用可以让用户“看到”自己的体态,并给自己坐得或站得有多直打分。此外,它还能监测我们站立、端坐及睡觉各花了多少时间。For those uncomfortable wearing a vibrating belt, there’s Darma, the “smart cushion.” This device offers vibrating reminders to stand up (sitting kills, remember?) and to alert users to correct their bad posture. The company touts the cushion’s non-intrusiveness, since it is not stuck on your body.有些人不喜欢戴着震动带,他们可以用Darma,所谓的“智能靠垫”。这个设备能发出震动提示,让用户站起来(记得吗?坐着很难受),同时警告用户纠正自己的糟糕体态。生产这款设备的公司大谈这个“靠垫”是如何不烦人,因为它不需要挂在身体上。But the most punishing device, not yet available in the market, is the Pavlok, its name a nod to the father of classical conditioning research. Pavlok was created by Maneesh Sethi, a blogger who became Internet-famous when he hired a woman to slap him every time he mindlessly opened Facebook. The Pavlok bracelet, which has been beta testing several hundred users, grew out of that experiment. (The company will launch a crowdfunding campaign later this year, Sethi says.)而最具惩罚性、目前还没有上市的一款设备叫Pavlok,这个名字是为了纪念经典条件反射理论研究之父的。它的发明者是梅尼西o塞西,这是一位在网上暴得大名的主。之所以出名,是因为他曾经雇了一位女性,只要看到他不当心打开了Facebook就扇他一巴掌。Pavlok腕带就是从这种试验中打造出来的,而且正在几百位用户中进行测试(塞西称,公司今年晚些时候会为此发布一个众筹计划)。Users can program the bracelet to change a variety of habits, from opening fewer tabs in their web browser, to meditating every day. Pavlok users assign themselves a goal and choose a “referee,” who gets a text message to check in every day at 7 p.m. If the user hasn’t completed their goal, they get a shock through the bracelet and charged money through the app. If they complete their goal, they get rewards like lottery tickets or money. Sethi says the bracelet starts with punishment for bad behavior, and moves to positive feedback for good behavior over time. “The negative gets you started and the positive keeps the habit going,” he says. “As you start to succeed, you can take away the negative reinforcement and give positive reinforcement. And then the habit comes more automatic and you don’t need it at all.”用户可以通过设定自己的腕带来改变很多习惯,既可以在浏览器里少开几个标签,也可以学会每天冥想。Pavlok的用户可以给自己设定一个目标,同时选择一位“仲裁者”。这位仲裁会收到一条短信,每天晚上七点对该用户进行检查。如果这名用户没有完成目标,腕带就会传给他们一阵震动,同时还会被从应用里扣钱。如果他们完成了目标,就能获得票或现金之类的奖励。塞西表示,这种腕带从惩戒坏习惯开始,随着时间推移开始逐渐奖励好行为。他说:“负面回馈先让你开始用上它,慢慢地正面奖励帮助你养成好习惯。当你开始养成好习惯时,就可以取消惩戒措施,代之以正面的奖励。随后,当这个习惯逐渐变得自然而然后,你就不再需要它了。”This wave of punishing devices may end up with same high abandonment rates as fitness trackers. But in the case of breaking bad habits, abandonment doesn’t mean failure–it could mean users have successfully broken their bad habits and no longer need a device to judge them.这一波惩罚神器的浪潮可能最终也会像健康追踪器一样以被丢在一边收场。但如果能借此改掉坏习惯,哪怕丢了也不代表失败——这反而说明用户成功改掉了坏习惯,再也不需要这么个玩意儿来看着自己了。 /201406/306062湖滨区男科医生 河南省三门峡郑大中医医院看前列腺炎好吗

三门峡治疗生殖器疱疹哪家医院好 September is an exciting month in every college freshman’s life. For many, it’s the first time they leave home to live in a new environment. But after the hustle and bustle of the first few weeks, excitement gives way to a less enjoyable emotion — homesickness.对所有大一新生来说,每年的九月都是激动人心的日子。许多人都是第一次走出家门,在一个新环境中生活。但在开学数周的喧嚣过后,激动的心情慢慢地被一丝乡愁所取代。Homesickness manifests itself in many ways. You may miss mum’s cooking, your pets, or even your old bed. All this becomes a fond memory of the past. Homesickness can be a bitter feeling, especially when faced with the challenges of settling into an unfamiliar environment.乡愁的表现方式可谓多种多样。你可能想念妈妈的厨艺、你的宠物、甚至是自己的旧床铺。林林总总汇集成对过去时光的美好记忆。乡愁是苦涩的,尤其当你置身陌生环境中,面临诸多挑战时。But remember, you’re not alone. According to a recent B article, 70 percent of British college students experience homesickness. In this increasingly globalized world in which people migrate to far away places for education, work or a relationship, homesickness is a feeling shared by many adults.但记住,你并不孤单。英国广播公司B近日报道称,70%的英国大学生饱受思乡之苦。在这个日益全球化的世界里,人们为了学业、工作或感情而远走他乡,许多成年人心中都弥漫着乡愁。Relocating to a new place is not an easy process, particularly if you don’t speak the local language or are not familiar with local customs.易地而居并非易事,尤其当你对当地语言与风俗一窍不通时。Homesickness can have similar symptoms to depression, explains psychologist Caroline Schuster in an interview with the B. In extreme cases it can develop into a panic attack, she says, while it can also result in social withdrawal, sleep disruption, nightmares, and concentration problems.心理学家卡洛琳#8226;舒斯特在接受B采访时解释道,乡愁与抑郁症状相似。她表示,乡愁严重时可发展成恐慌症,同时也会导致逃避社交、睡眠障碍、噩梦连连以及注意力无法集中等问题。The most famous adult to have suffered from homesickness is probably Odysseus, the hero of Homer’s epic poem, who spent 10 years on a journey trying to get home. It was the memories of his family that helped him get through those difficult times.饱受思乡之苦的、最为著名的人物要数荷马史诗《奥德赛》中的英雄人物——奥德修斯,他历时十年才与家人团聚。正是凭借与家人有关的记忆,他才得以度过重重难关。But the term homesickness, or nostalgia, wasn’t invented until the 17th century. It was considered a disorder by a Swiss physician, who attributed soldiers’ mental and physical discomfort to their longing to return home, “nostos” in Greek, and the accompanying pain, “algos”.然而,乡愁一词(英文homesickness,又被称为“nostalgia”)直到17世纪才得以面世。一名瑞士医生视其为一种疾病,认为士兵们的身心不适源于他们的思乡之情。Nostalgia一词来自希腊语词,nostos(返乡)以及 algos(思乡之痛)。Back then, people saw homesickness as a dangerous and even fatal disease, says Susan Matt, author of Homesickness: An American History. Gradually, it came to be considered childish and immature, she says, ill-fitting to a culture of capitalism and imperialism that required people to travel and explore.《乡愁:一种美国历史》一书的作者苏珊#8226;马特表示,那时人们将乡愁视为一种危险、甚至致命的疾病。她说,后来,乡愁被认为是幼稚、不成熟的表现,是人们不适应资本主义与帝国主义文化的表现。而这种症状需要他们在旅途中不断摸索克。Studies in recent years, however, have shown that nostalgia may have some benefits to our mental health.而近年来的一些研究结果显示,乡愁可能对我们的心理健康大有裨益。After a decade of surveys and research, Constantine Sedikides, a US social psychologist, found thatnostalgia is what makes us human.经过近十载的调查研究,美国社会心理学家康斯坦丁#8226;塞迪基德斯发现,乡愁是人性的一部分。In an interview with The New York Times, Sedikides explains that nostalgia can counteract loneliness, boredom and anxiety. It makes people more generous toward strangers and more tolerant of outsiders. Couples feel closer and happier when they share nostalgic memories.在接受《纽约时报》采访时,塞迪基德斯解释道,乡愁能够抵消孤独、厌烦以及焦虑。这使得人们在面对陌生人时更加慷慨,对外人更加宽容。分享过往的时光使得情侣间更加亲近和快乐。Sedikides admits that nostalgia has its painful side, but the net effect is to make life seem more meaningful. When people speak wistfully of the past, they typically become more optimistic and inspired about the future. The trick is not to become obsessive about the past, but always to live life forward.塞迪基德斯承认乡愁固然有痛苦的一面,但它可以有效地让生命更有意义。怀旧时,人们通常会变得更加乐观、对未来充满希望。而诀窍在于,不过过分迷恋过去,生活要一直向前看。 /201310/262219三门峡郑大医院精子三门峡市人民医院乳腺外科

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