用心理療法能治糖尿病和癌癥?

 

What if Age Is Nothing but a Mind-Set?

用心理療法能治糖尿病和癌癥?

One day in the fall of 1981, eight men in their 70s stepped out of a van in front of a converted monastery in New Hampshire. They shuffled forward, a few of them arthritically stooped, a couple with canes. Then they passed through the door and entered a time warp. Perry Como crooned on a vintage radio. Ed Sullivan welcomed guests on a black-and-white TV. Everything inside — including the books on the shelves and the magazines lying around — were designed to conjure 1959. This was to be the men’s home for five days as they participated in a radical experiment, cooked up by a young psychologist named Ellen Langer.

1981年秋季的一天，新罕布什爾州一座經(jīng)改建的修道院前，八名70多歲的老年男子走下了面包車。他們步履蹣跚，其中一些人像關(guān)節(jié)炎患者一樣彎腰駝背，還有兩位拄著拐杖。他們進(jìn)門后，就像進(jìn)入了一條時(shí)間隧道。老式收音機(jī)里傳來佩里·科莫(Perry Como，人稱“C先生”，美國歌手、電視明星)的低聲吟唱。黑白電視機(jī)上，埃德·沙利文(Ed Sullivan，美國娛樂作家和電視節(jié)目主持人)正向嘉賓們表示歡迎。這里的一切——包括書架上的書和四下里散落的雜志——都是為營造出1959年的氛圍而設(shè)計(jì)和布置的。在五天的時(shí)間里，這里將成為這些老人暫時(shí)的家園。他們所參與的，是年輕的心理學(xué)家埃倫·蘭格(Ellen Langer)精心策劃的一項(xiàng)“激進(jìn)實(shí)驗(yàn)”。

The subjects were in good health, but aging had left its mark. “This was before 75 was the new 55,” says Langer, who is 67 and the longest-serving professor of psychology at Harvard. Before arriving, the men were assessed on such measures as dexterity, grip strength, flexibility, hearing and vision, memory and cognition — probably the closest things the gerontologists of the time could come to the testable biomarkers of age. Langer predicted the numbers would be quite different after five days, when the subjects emerged from what was to be a fairly intense psychological intervention.

雖然受試者們的健康狀況都相當(dāng)不錯(cuò)，但衰老已經(jīng)在他們身上留下了痕跡。“那時(shí)還沒有‘75歲是新的55歲’這樣的概念，”蘭格說，如今67歲的她是哈佛大學(xué)任職時(shí)間最長的心理學(xué)教授。這些老人在抵達(dá)實(shí)驗(yàn)地點(diǎn)之前接受了一系列檢查，如靈巧性、握力、柔韌性、聽覺和視覺、記憶力和認(rèn)知功能——當(dāng)年，這些很可能是老年學(xué)家掌握的最接近年齡測(cè)試生物標(biāo)志物的指標(biāo)。蘭格預(yù)測(cè)，五天之后，當(dāng)受試者們結(jié)束大強(qiáng)度心理干預(yù)的時(shí)候，這些指標(biāo)都將大為改觀。

Langer had already undertaken a couple of studies involving elderly patients. In one, she found that nursing-home residents who had exhibited early stages of memory loss were able to do better on memory tests when they were given incentives to remember — showing that in many cases, indifference was being mistaken for brain deterioration. In another, now considered a classic of social psychology, Langer gave houseplants to two groups of nursing-home residents. She told one group that they were responsible for keeping the plant alive and that they could also make choices about their schedules during the day. She told the other group that the staff would care for the plants, and they were not given any choice in their schedules. Eighteen months later, twice as many subjects in the plant-caring, decision-making group were still alive than in the control group.

在此之前，蘭格已經(jīng)進(jìn)行了兩項(xiàng)涉及老年患者的研究。其中一項(xiàng)發(fā)現(xiàn)，在獎(jiǎng)勵(lì)的激勵(lì)下，處于記憶力減退早期階段的養(yǎng)老院老人能夠在記憶力測(cè)試中獲得更好的成績。這說明，在許多情況下，對(duì)外界漠然被錯(cuò)誤地當(dāng)作大腦退化。在另一項(xiàng)如今被公認(rèn)為社會(huì)心理學(xué)經(jīng)典的研究中，蘭格將室內(nèi)植物分發(fā)給兩組養(yǎng)老院老人。她告訴其中一組老人他們要負(fù)責(zé)養(yǎng)活這些植物，并允許他們對(duì)自己的作息安排做出選擇。而另一組老人則被告知，植物有工作人員照顧，且他們沒有得到作息安排上的任何選擇。18個(gè)月后，關(guān)懷植物、并能對(duì)自己的作息時(shí)間表做出決策的那一組仍然健在的老人是對(duì)照組的兩倍。

To Langer, this was evidence that the biomedical model of the day — that the mind and the body are on separate tracks — was wrongheaded. The belief was that “the only way to get sick is through the introduction of a pathogen, and the only way to get well is to get rid of it,” she said, when we met at her office in Cambridge in December. She came to think that what people needed to heal themselves was a psychological “prime” — something that triggered the body to take curative measures all by itself. Gathering the older men together in New Hampshire, for what she would later refer to as a counterclockwise study, would be a way to test this premise.

在蘭格看來，這些證據(jù)顯示了當(dāng)時(shí)的生物醫(yī)學(xué)模式——即心靈和身體分道而馳——陷入了認(rèn)識(shí)誤區(qū)。12月，當(dāng)我在她位于馬薩諸塞州劍橋的辦公室里見到她時(shí)，她說，當(dāng)時(shí)醫(yī)學(xué)界相信“病原體侵入是導(dǎo)致人體患病的唯一途徑，而要恢復(fù)健康，也惟有擺脫病原體”。她逐漸產(chǎn)生的一個(gè)設(shè)想是，人需要某種心理上的“觸發(fā)刺激”來自行痊愈，也就是觸發(fā)身體自行動(dòng)用所有的康復(fù)手段。讓上文提到的老年男性匯聚新罕布什爾州，進(jìn)行她后來所稱的“逆時(shí)針”研究，就是測(cè)試這個(gè)假設(shè)的一種方式。

The men in the experimental group were told not merely to reminisce about this earlier era, but to inhabit it — to “make a psychological attempt to be the person they were 22 years ago,” she told me. “We have good reason to believe that if you are successful at this,” Langer told the men, “you will feel as you did in 1959.” From the time they walked through the doors, they were treated as if they were younger. The men were told that they would have to take their belongings upstairs themselves, even if they had to do it one shirt at a time.

她要求實(shí)驗(yàn)組的老人不要止步于對(duì)舊時(shí)光的緬懷，而是要讓自己穿越回去，棲息于其中——“從心理層面嘗試做回22年前的自己，”蘭格向我描述道。她還對(duì)他們說：“我們有很好的理由相信，如果你們能成功地做到這一點(diǎn)，你們會(huì)覺得自己還是1959年的那個(gè)人。”從他們進(jìn)門的那一刻起，他們就被當(dāng)做年輕人對(duì)待。他們被告知，他們必須自己把行李搬上樓去，哪怕他們一次只拿得動(dòng)一件襯衫。

Each day, as they discussed sports (Johnny Unitas and Wilt Chamberlain) or “current” events (the first U.S. satellite launch) or dissected the movie they just watched (“Anatomy of a Murder,” with Jimmy Stewart), they spoke about these late-'50s artifacts and events in the present tense — one of Langer’s chief priming strategies. Nothing — no mirrors, no modern-day clothing, no photos except portraits of their much younger selves — spoiled the illusion that they had shaken off 22 years.

每天，他們討論著體育(約翰尼·尤尼塔斯[Johnny Unitas，曾獲國家橄欖球聯(lián)盟最有價(jià)值球員]或威爾特·張伯倫[Wilt Chamberlain，前美國NBA聯(lián)盟職業(yè)籃球運(yùn)動(dòng)員])和“時(shí)事”(美國發(fā)射第一枚衛(wèi)星)，或是評(píng)析剛剛看過的電影(詹姆斯·斯圖爾特[Jimmy Stewart]主演的《桃色血案》[“Anatomy of a Murder”])——他們使用現(xiàn)在時(shí)態(tài)談?wù)撨@些50年代末的物品和事件，這也是蘭格主要的“觸發(fā)刺激”策略之一。不會(huì)有任何東西，包括鏡子和現(xiàn)代服裝，來擾亂這種“時(shí)光倒流22年”的幻覺，即使有照片，那也是他們自己年輕時(shí)的肖像。

At the end of their stay, the men were tested again. On several measures, they outperformed a control group that came earlier to the monastery but didn’t imagine themselves back into the skin of their younger selves, though they were encouraged to reminisce. They were suppler, showed greater manual dexterity and sat taller — just as Langer had guessed. Perhaps most improbable, their sight improved. Independent judges said they looked younger. The experimental subjects, Langer told me, had “put their mind in an earlier time,” and their bodies went along for the ride.

在這段小住結(jié)束時(shí)，這些老人再度接受了檢查。實(shí)驗(yàn)組在多項(xiàng)指標(biāo)上遠(yuǎn)遠(yuǎn)優(yōu)于對(duì)照組。后者之前就來到了這所修道院，但研究人員只鼓勵(lì)他們回憶過去，而沒有要求他們想象自己重返年輕時(shí)代。實(shí)驗(yàn)組老人的身體柔韌性更強(qiáng)，手部更加靈巧，坐姿時(shí)腰背也挺得更直——正如蘭格所猜測(cè)的那樣。也許最不可思議的是，他們的視力也有所改善。獨(dú)立的評(píng)委表示他們看上去更年輕了。蘭格告訴我，實(shí)驗(yàn)組受試者“讓自己的心境回到了年輕時(shí)代”，他們的身體也隨之調(diào)整。

The results were almost too good. They beggared belief. “It sounded like Lourdes,” Langer said. Though she and her students would write up the experiment for a chapter in a book for Oxford University Press called “Higher Stages of Human Development,” they left out a lot of the tantalizing color — like the spontaneous touch-football game that erupted between heretofore creaky seniors as they waited for the bus back to Cambridge. And Langer never sent it out to the journals. She suspected it would be rejected.

實(shí)驗(yàn)結(jié)果太棒了，簡直讓人難以置信。“聽起來就像盧爾德(法國南部小鎮(zhèn)，著名朝圣地，相傳人們可以在那里治愈一切疾病——譯注)一樣，”蘭格說。雖然她和她的學(xué)生們?cè)谂＝虼髮W(xué)出版社(Oxford University Press)出版的《人類發(fā)展的較高階段》(Higher Stages of Human Development)中用一個(gè)章節(jié)的篇幅介紹這項(xiàng)實(shí)驗(yàn)，但他們省略了很多動(dòng)人的情節(jié)，例如，在等巴士返回劍橋時(shí)，這些之前很僵硬，仿佛一動(dòng)就會(huì)咯吱作響的老骨頭自發(fā)組織了一場觸身式橄欖球賽。出于對(duì)退稿的擔(dān)心，蘭格沒敢將這些內(nèi)容寫在投稿給刊物的文章中。

After all, it was a small-sample study, conducted over a mere five days, with plenty of potentially confounding variables in the design. (Perhaps the stimulating novelty of the whole setup or wanting to try extra hard to please the testers explained some of the great improvement.) But more fundamental, the unconventionality of the study made Langer self-conscious about showing it around. “It was just too different from anything that was being done in the field as I understood it,” she said. “You have to appreciate, people weren’t talking about mind-body medicine,” she said.

畢竟，這只是為期五天的一個(gè)小樣本研究，設(shè)計(jì)中存在大量潛在混淆的變量。(或許是整個(gè)實(shí)驗(yàn)令人振奮的新穎性，或者是受試者為了取悅測(cè)試者而格外努力，這些都可能在一定程度上解釋某些指標(biāo)的顯著改觀。)但更為根本的是，這項(xiàng)研究的標(biāo)新立異使蘭格不太好意思到處展示。“在我看來，這跟該領(lǐng)域當(dāng)時(shí)在進(jìn)行的研究工作相去太遠(yuǎn)，”她說。“要知道，那時(shí)沒有人談?wù)撋硇尼t(yī)學(xué)(mind-body medicine)。”

Langer did not try to replicate the study — mostly because it was so complicated and expensive; every time she thought about trying it again, she talked herself out of it. Then in 2010, the BBC broadcast a recreation, which Langer consulted on, called “The Young Ones,” with six aging former celebrities as guinea pigs.

蘭格沒有嘗試重復(fù)這項(xiàng)實(shí)驗(yàn)，主要是因?yàn)樗珡?fù)雜，成本也太高，每次她產(chǎn)生再試一次的念頭，她都勸阻了自己。直到2010年，英國廣播公司(BBC) 聘請(qǐng)?zhí)m格擔(dān)任顧問，重復(fù)了這項(xiàng)實(shí)驗(yàn)，并將其做成一檔節(jié)目，名為“年輕一代”(The Young Ones)，把六位年邁的前名星當(dāng)作實(shí)驗(yàn)對(duì)象。

The stars were squired via period cars to a country house meticulously retrofitted to 1975, right down to the kitschy wall art. They emerged after a week as apparently rejuvenated as Langer’s septuagenarians in New Hampshire, showing marked improvement on the test measures. One, who had rolled up in a wheelchair, walked out with a cane. Another, who couldn’t even put his socks on unassisted at the start, hosted the final evening’s dinner party, gliding around with purpose and vim. The others walked taller and indeed seemed to look younger. They had been pulled out of mothballs and made to feel important again, and perhaps, Langer later mused, that rekindling of their egos was central to the reclamation of their bodies.

這些明星們被老式轎車送到了一幢精心改建成1975年風(fēng)格(甚至包括那個(gè)時(shí)期俗氣的墻面藝術(shù))的鄉(xiāng)間別墅。一周后，他們重新露面，一個(gè)個(gè)都顯得青春煥發(fā)，就像當(dāng)年蘭格實(shí)驗(yàn)中那些年逾七旬的老人一樣。他們的檢測(cè)指標(biāo)也出現(xiàn)明顯改善。有個(gè)人進(jìn)去時(shí)還坐著輪椅，出來時(shí)卻可以自己拄著拐杖行走了。還有一位，一開始就連穿襪子也要?jiǎng)e人幫忙，到實(shí)驗(yàn)結(jié)束前夕卻操辦了告別晚宴，意志堅(jiān)定精神抖擻地忙進(jìn)忙出。其他人步行時(shí)腰桿也挺得更直，確實(shí)看起來年輕多了。他們不再被束之高閣，而是再次覺得自己重要，有價(jià)值。后來蘭格想到，喚醒自我意識(shí)也許在他們身體重現(xiàn)活力的神奇變化中起到了核心作用。

The program, which was shown in four parts and nominated for a Bafta Award (a British Emmy), brought new attention to Langer’s work. Jeffrey Rediger, a psychiatrist and the medical and clinical director of Harvard’s McLean Hospital, was invited by a friend of Langer’s to watch it with some colleagues last year. Rediger was aware of Langer’s original New Hampshire study, but the made-for-TV version brought its tantalizing implications to life.

這檔分四集播出的節(jié)目獲得了英國電影學(xué)院獎(jiǎng)(Bafta Award，相當(dāng)于英國的艾美獎(jiǎng)[Emmy])提名，并引發(fā)人們對(duì)蘭格的研究產(chǎn)生新的關(guān)注。去年，蘭格的一個(gè)朋友邀請(qǐng)哈佛大學(xué)醫(yī)學(xué)院教學(xué)附屬麥克萊恩醫(yī)院 (Harvard’s McLean Hospital)的精神病學(xué)家、醫(yī)務(wù)和臨床主任杰弗里·雷迪格(Jeffrey Rediger)與同事們一起觀看了這檔節(jié)目。雷迪格早就對(duì)蘭格當(dāng)年在新罕布什爾州進(jìn)行的研究略知一二，但這個(gè)為電視制作的版本生動(dòng)展現(xiàn)了該項(xiàng)研究的誘人影響。

“She’s one of the people at Harvard who really gets it,” Rediger told me. “That health and illness are much more rooted in our minds and in our hearts and how we experience ourselves in the world than our models even begin to understand.”

“蘭格是哈佛大學(xué)里真正懂行的幾個(gè)人之一，”雷迪格告訴我。“也就是說，健康和疾病在更大程度上植根于我們的思想和心情，以及我們?cè)谑郎先绾误w驗(yàn)自己，而這是現(xiàn)有醫(yī)學(xué)模式根本不理解的。”

Langer’s house in Cambridge was as chilly as a meat locker when we arrived together, having walked from campus, last winter. The back door had been left open all day so that her aging, coddled Westie, Gus, could relieve himself in the yard. (Langer’s partner, Nancy Hemenway, who normally would be at home, was away.) Gus has a brain tumor. “He was supposed to be dead over a year ago,” Langer said. “But I think he might outlive us all.”

去年冬天，我和蘭格從校園里一起步行到她家去，房子里冷得好像冷藏室一樣。后門整天敞開著，好讓她寵愛的那條老西高地白梗犬格斯(Gus)可以自由地跑到院子里去玩。(蘭格的伴侶，南希·海明威[Nancy Hemenway]通常在家，但那天正好出去了。)格斯患有腦腫瘤。“照說它在一年前就會(huì)死，”蘭格說。“但我覺得它說不定比我們所有人都活得久。”

In the kitchen, Langer began laying out wide noodles for a lasagna she was making for an end-of-term party. It was the last time she would meet with her students for a while; they were about to scatter for the winter break, and she was leaving for a sabbatical in Puerto Vallarta, Mexico, where she and Nancy have another home. (Langer planned to Skype into weekly lab meetings.)

蘭格在廚房里忙活著，拿出寬面條準(zhǔn)備做意大利千層面，好在期末聚會(huì)上招待大家。這是今后一段時(shí)間內(nèi)她最后一次跟自己的學(xué)生碰面了——寒假開始后，大家將各奔東西，而她準(zhǔn)備動(dòng)身前往墨西哥的巴亞爾塔港休長假，她和南希在那里還有一個(gè)居所。(蘭格計(jì)劃通過Skype參與每周一次的實(shí)驗(yàn)室會(huì)議。)

“Family recipe?” I asked of the dinner.

“這是家傳的菜譜嗎?”我問起了晚餐。

“I don’t follow recipes — you should know that,” she said. She piled on an immoderate amount of cheese. “Besides, if I blow it, what’s going to be the cost?” Langer said. “Is it anyone’s last meal?” She added, “My students aren’t going to love me if my lasagna’s no good?”

“我從不拘泥于菜譜的——這你知道，”她一邊說，一邊往面上大量地堆奶酪。“再說，就算我搞砸了又怎么樣?這又不是誰最后的晚餐;就算我做的千層面不好吃，難道我的學(xué)生們就會(huì)因此不愛戴我?”

Langer was born in the Bronx and went to N.Y.U., becoming a chemistry major with her eye on med school. That all changed after she took Psych 101. Her professor was Philip Zimbardo, who would later go to Stanford and investigate the effects of authority and obedience in his well-known prison experiment. Human behavior, as Zimbardo presented it, was more interesting than what she’d been studying, and Langer soon switched tracks.

蘭格出生于布朗克斯，在紐約大學(xué)攻讀化學(xué)專業(yè)，想著以后進(jìn)醫(yī)學(xué)院。然而，在她聽了《心理學(xué)101》(Psych 101)課之后，一切都改變了。她師從的菲利普·津巴多(Philip Zimbardo)教授后來去斯坦福大學(xué)任教，并在著名的監(jiān)獄實(shí)驗(yàn)中研究了權(quán)威和服從的影響。蘭格從津巴多教授的講課中發(fā)現(xiàn)，人類行為比她之前學(xué)的東西更有意思，于是她很快換了專業(yè)。

She went on to graduate work at Yale, where a poker game led to her doctoral dissertation on the magical thinking of otherwise logical people. Even smart people fall prey to an “illusion of control” over chance events, Langer concluded. We aren’t really very rational creatures. Our cognitive biases routinely steer us wrong. Langer’s notion that people are trained not to think and are thus extremely vulnerable to right-sounding but actually wrong notions prefigured many of the tenets of “behavioral economics” and the work of people like Daniel Kahneman, who won a Nobel Prize in economic sciences. But unlike many researchers who systematically work out one concept until they own it, Langer’s peripatetic mind quickly moved on to other areas of inquiry. “I was never — and maybe this is a character flaw — the type of person who is going to take one idea and beat it to death,” she said. “Part of that is that I have so many ideas. If whatever it is I’m excited about now doesn’t happen, it doesn’t matter, because there’s always the next possibility.”

她的研究生階段在耶魯大學(xué)(Yale)度過，在那里，一場撲克游戲給了她啟迪，使她寫出一篇有關(guān)通常講究邏輯的人們迸發(fā)突發(fā)奇想的博士論文。蘭格的結(jié)論是：即使聰明人也容易陷入對(duì)于偶然事件的“控制錯(cuò)覺”。我們真的算不上一種高度理性的生物。認(rèn)知偏見經(jīng)常將我們導(dǎo)向錯(cuò)誤的方向。蘭格認(rèn)為，人們養(yǎng)成了不假思索的習(xí)慣，這使他們很容易被似是而非的理念誤導(dǎo)。這一觀念的形成早于許多流派的“行為經(jīng)濟(jì)學(xué)”，也早于諾貝爾經(jīng)濟(jì)學(xué)獎(jiǎng)得主丹尼爾·卡尼曼 (Daniel Kahneman)等人的研究。但與許多鍥而不舍地鉆研某個(gè)概念、直到它為自己所有的研究者不同，蘭格的思維經(jīng)常信馬由韁地轉(zhuǎn)向其他研究領(lǐng)域。“我從來不是能追著一個(gè)問題打破砂鍋問到底的人，或許這是一種性格缺陷，”她說。“部分原因是我總是有太多的想法。如果現(xiàn)在讓我激動(dòng)不已的東西沒能搞出名堂，那沒關(guān)系，因?yàn)槭冀K存在下一個(gè)可能性。”

By the 1970s, Langer had become convinced that not only are most people led astray by their biases, but they are also spectacularly inattentive to what’s going on around them. “They’re just not there,” as she puts it. When you’re not there, Langer reasoned, you’re very likely to end up where you’re led. She set up a number of studies to show how people’s thinking and behavior can easily be manipulated with subtle primes.

到了20世紀(jì)70年代，蘭格逐漸確信，多數(shù)人不僅被自己的偏見帶上歧途，還對(duì)身邊發(fā)生的事情極其漫不經(jīng)心。就像她所說的，“他們就是心不在焉。”蘭格的推理是，當(dāng)你心不在焉的時(shí)候，你很容易被牽著走。她設(shè)立了多項(xiàng)研究，旨在揭示人們思路和行為很容易被細(xì)微的“觸發(fā)刺激”所操縱。

In one, she and her colleagues found that office workers were far more likely to comply with a ridiculous interdepartmental memo if it looked like other official memos. In another, created with her Yale mentor, Robert Abelson, they asked behavioral and traditional therapists to watch a video of a person being interviewed, who was labeled either “patient” or “job applicant,” and then evaluate the person. The behavioral therapists regarded the interviewee as well adjusted regardless of whether they were told the person was a patient or an applicant. But the traditional therapists found the interviewee labeled “patient” significantly more disturbed. Even trained observers “were mindlessly led by the label,” Langer says.

在一項(xiàng)研究中，她和同事們發(fā)現(xiàn)，只要看起來跟其他官方的內(nèi)部通知差不多，哪怕是一份內(nèi)容荒謬的跨部門通知，也會(huì)讓上班族們照辦。在另一項(xiàng)與她在耶魯大學(xué)的導(dǎo)師羅伯特·艾貝爾森(Robert Abelson)合作創(chuàng)建的研究中，他們要求行為治療師和傳統(tǒng)治療師觀看某個(gè)身份被標(biāo)注為“患者”或“求職者”的人接受采訪的視頻，然后對(duì)此人做出評(píng)估。無論是對(duì)所謂的“患者”還是“求職者”，行為治療師認(rèn)為這位受訪者相當(dāng)自如得體。但是在傳統(tǒng)治療師眼里，“患者”身份的受訪者明顯更加不安。蘭格指出，這說明，即使訓(xùn)練有素的觀察者“也很容易被標(biāo)簽搞得沒頭沒腦”。

If people could learn to be mindful and always perceive the choices available to them, Langer says, they would fulfill their potential and improve their health. Langer’s technique of achieving a state of mindfulness is different from the one often utilized in Eastern “mindfulness meditation” — nonjudgmental awareness of the thoughts and feelings drifting through your mind — that is everywhere today. Her emphasis is on noticing moment-to-moment changes around you, from the differences in the face of your spouse across the breakfast table to the variability of your asthma symptoms. When we are “actively making new distinctions, rather than relying on habitual” categorizations, we’re alive; and when we’re alive, we can improve. Indeed, “well-being and enhanced performance” were Langer’s goals from the beginning of her career.

蘭格表示，如果人們能夠?qū)W會(huì)多留點(diǎn)心，始終察覺到身邊可以把握的選擇，那么，他們將能充分發(fā)揮自己的潛能，并改善自己的健康。蘭格所說的達(dá)到專注狀態(tài)的技巧與在當(dāng)今大行其道的東方式“正念禪修”不同，后者是對(duì)你的腦海中飄過的思想和感受達(dá)到不加評(píng)判的認(rèn)知。而蘭格強(qiáng)調(diào)的是留心你身邊每時(shí)每刻的細(xì)微變化，從早餐桌對(duì)面配偶臉色的差異，到你的哮喘癥狀的改變。當(dāng)我們?cè)?ldquo;積極主動(dòng)發(fā)現(xiàn)新的差別，而不是依賴于習(xí)慣性的”分類時(shí)，我們會(huì)真正覺得自己活著;而當(dāng)我們覺得自己活著，我們就能改善。的確，在職業(yè)生涯伊始，蘭格就以“福祉和增強(qiáng)的表現(xiàn)”為目標(biāo)。

Martin Seligman in the past two decades has come to be recognized as the father of positive psychology. Tal Ben-Shahar, who taught a popular undergraduate course at Harvard on the subject until 2008, calls Langer “the mother of positive psychology,” by virtue of her early work that anticipated the field.

過去20年里，馬丁·賽里格曼(Martin Seligman)被公認(rèn)為積極心理學(xué)之父。而憑借其在該領(lǐng)域的早期研究工作，蘭格被2008年之前在哈佛大學(xué)講授一門深受歡迎的本科課程的塔爾·班夏哈(Tal Ben-Shahar)譽(yù)為“積極心理學(xué)之母”。

Langer came to believe that one way to enhance well-being was to use all sorts of placebos. Placebos aren’t just sugar pills disguised as medicine, though that’s the literal definition; they are any intervention, benign but believed by the recipient to be potent, that produces measurable physiological changes. Placebo effects are a striking phenomenon and still not all that well understood. Entire fields like psychoneuroimmunology and psychoendocrinology have emerged to investigate the relationship between psychological and physiological processes. Neuroscientists are charting what’s going on in the brain when expectations alone reduce pain or relieve Parkinson’s symptoms. More traditionally minded health researchers acknowledge the role of placebo effects and account for them in their experiments. But Langer goes well beyond that. She thinks they’re huge — so huge that in many cases they may actually be the main factor producing the results.

蘭格認(rèn)為，增強(qiáng)福祉的途徑之一是利用各種各樣的安慰劑。安慰劑并不只是偽裝成藥物的糖丸(盡管那確實(shí)是字面上的定義);沒有危害、接受者相信有效，能夠產(chǎn)生可測(cè)量的生理變化的任何干預(yù)措施都可稱為安慰劑。安慰劑效應(yīng)是一種引人注目的現(xiàn)象，至今仍未獲得很好的理解。目前已經(jīng)涌現(xiàn)出了心理神經(jīng)免疫學(xué)和精神內(nèi)分泌學(xué)等完整的研究領(lǐng)域，專門探討心理與生理過程之間的關(guān)系。神經(jīng)科學(xué)家試圖跟蹤記錄當(dāng)僅憑期望就減輕疼痛或緩解帕金森氏病癥狀時(shí)，大腦中究竟發(fā)生了哪些變化。意識(shí)較為傳統(tǒng)的醫(yī)學(xué)研究人員承認(rèn)安慰劑效應(yīng)的作用，并在自己的實(shí)驗(yàn)中計(jì)入這些效應(yīng)。但蘭格走得更遠(yuǎn)。她認(rèn)為，安慰劑效應(yīng)是巨大的——在許多情況下，它們實(shí)際上可能是產(chǎn)生結(jié)果的主要因素。

As an example, she points to a study she conducted in a hair salon in 2009. She got the idea from a study undertaken nearly a decade earlier by three scientists who looked at more than 4,000 subjects over two decades and found that men who were bald when they joined the study were more likely to develop prostate cancer than men who kept their hair. The researchers couldn’t be sure what explained the link, though they suspected that androgens (male hormones including testosterone) could be affecting both scalp and prostate. Langer had another theory: “Baldness is a cue for old age,” she says. “Therefore, men who go bald early in life may perceive themselves as older and may consequently be expected to age more quickly.” And those expectations may actually lead them to experience the effects of aging. To explore this relationship between expectations of aging and physiological signs of health, Langer and her colleagues designed the hair-salon study. They had research assistants approach 47 women, ranging in age from 27 to 83, who were about to have their hair cut, colored or both. They took blood-pressure readings. After the subjects’ hair was done, they filled out a questionnaire about how they felt they looked, and their blood pressure was taken again. In a paper published in 2010 in the journal Perspectives on Psychological Science, they reported that the subjects who perceived themselves as looking younger after the makeover experienced a drop in blood pressure.

她援引自己2009年在一家美發(fā)沙龍進(jìn)行的研究作為例證。該研究的靈感來源于近10年前三位科學(xué)家進(jìn)行的另一項(xiàng)研究，他們?cè)?0年期間追蹤調(diào)查了 4000多名受試者，發(fā)現(xiàn)在加入研究時(shí)禿頂?shù)哪行员阮^發(fā)豐茂的男性更容易患前列腺癌。研究人員不能肯定這種關(guān)聯(lián)從何而來，但他們懷疑這也許是因?yàn)樾奂に?包括睪酮)對(duì)頭皮和前列腺都有影響。蘭格則提出了另一種理論：“脫發(fā)是衰老的暗示之一。因此，早早禿頂?shù)哪行钥赡芨杏X自己更老，結(jié)果預(yù)期自己會(huì)更快衰老。”而這種預(yù)期實(shí)際上可能導(dǎo)致他們?cè)庥鏊ダ闲?yīng)。為了探討對(duì)衰老的預(yù)期與健康的生理體征之間的這種關(guān)系，蘭格和她的同事們?cè)O(shè)計(jì)了一項(xiàng)在美發(fā)沙龍進(jìn)行的研究。他們讓研究助理們?nèi)ソ佑|來美發(fā)沙龍剪發(fā)、染發(fā)或者先剪后染的47名女性(其年齡從27歲到83歲不等)，并記錄下她們的血壓讀數(shù)。受試者們做好發(fā)型之后，就各自對(duì)自己外貌的觀感填寫了一份調(diào)查問卷，并再次測(cè)量血壓。在這篇2010年發(fā)表于《心理科學(xué)透視》(Perspectives on Psychological Science)期刊的論文中，他們報(bào)告稱，那些認(rèn)為自己在做好發(fā)型后顯得更加年輕的受試者血壓有所下降。

A few years earlier, Langer and one of her students, Alia Crum, conducted a study, published in the journal Psychological Science, involving 84 hotel chambermaids. The maids had mostly reported that they didn’t get much exercise in a typical week. The researchers primed the experimental group to think differently about their work by informing them that cleaning rooms was fairly serious exercise — as much if not more than the surgeon general recommends. Once their expectations were shifted, those maids lost weight, relative to a control group (and also improved on other measures like body mass index and hip-to-waist ratio). All other factors were held constant. The only difference was the change in mind-set.

幾年前，蘭格和她的學(xué)生阿莉婭·克拉姆(Alia Crum)進(jìn)行了一項(xiàng)研究，并發(fā)表在《心理科學(xué)》(Psychological Science)雜志上。該研究涉及84名酒店客房女服務(wù)員。她們大多報(bào)告稱，自己在典型的一周工作期間沒有什么鍛煉機(jī)會(huì)。研究人員引導(dǎo)實(shí)驗(yàn)組的女服務(wù)員換一種心態(tài)看待自己的工作，告訴她們：打掃房間其實(shí)是一種強(qiáng)度不小的鍛煉，運(yùn)動(dòng)量不比衛(wèi)生局局長所建議的要少。在她們的預(yù)期改變后，這些女服務(wù)員的體重相對(duì)于對(duì)照組有所減輕(其他指標(biāo)，如身體質(zhì)量指數(shù)[BMI]和腰臀比也有所改善)。其他所有因素都保持恒定。唯一變化的只有受試者的心態(tài)。

Critics hunted for other explanations — statistical errors or subtle behavior changes in the weight-loss group that Langer hadn’t accounted for. Otherwise the outcome seemed to defy physics. “To which I would say, ‘There’s no discipline that is complete,’ ” Langer responds. “If current-day physics can’t explain these things, maybe there are changes that need to be made in physics.”

批評(píng)者尋找其他解釋，如統(tǒng)計(jì)錯(cuò)誤，或者蘭格未能計(jì)入的體重下降組的細(xì)微行為變化。否則，那樣的結(jié)果似乎有悖于物理學(xué)。“對(duì)此我想說，‘沒有一個(gè)學(xué)科是絕對(duì)完美的’，”蘭格回應(yīng)道。“如果當(dāng)代的物理學(xué)無法解釋這些現(xiàn)象，也許是物理學(xué)本身需要一些改變了。”

In the course of her career, Langer says, she has written or co-written more than 200 studies, and she continues to churn out research at a striking pace. Just before winter break, in her final meeting with two dozen or so students and postdocs, Langer went around the table checking the progress of nearly 30 experiments, all of which manipulated subjects’ perceptions. Some used a special clock that could be set to run at half-speed or double-speed. In one study, sleeping subjects were fooled, upon awakening, into thinking they had more or less sleep than they actually did. She posits that the scores on measures of short-term memory and reaction time will vary accordingly, regardless of how long the subjects actually slept. In a yet-to-be-published diabetes study, Langer wondered whether the biochemistry of Type 2 diabetics could be manipulated by the same psychological intervention — the subjects’ perception of how much time had passed. Her theory was that the diabetics’ blood-glucose levels would follow perceived time rather than actual time; in other words, they would spike and dip when the subjects expected them to. And that’s what her data revealed. When a student emailed her with the results this fall, she could barely contain her excitement. “This is the beginning of a psychological cure for diabetes!” she told me.

蘭格說，在她的職業(yè)生涯中，她已經(jīng)獨(dú)立撰寫或與他人合作撰寫了200多篇研究論文，如今她繼續(xù)以驚人的速度發(fā)表大量研究。就在寒假前，她與二十多個(gè)學(xué)生和博士后最后一次開會(huì)時(shí)，蘭格圍著桌子檢查著近30項(xiàng)實(shí)驗(yàn)的進(jìn)展，這些實(shí)驗(yàn)都涉及操縱受試者的感知。一些實(shí)驗(yàn)使用了特制的時(shí)鐘，這些鐘能夠以正常時(shí)鐘的一半速度或者兩倍速度運(yùn)轉(zhuǎn)。在某一項(xiàng)研究中，受試者一覺醒來后受到蒙騙，讓他們以為自己睡得比實(shí)際時(shí)間更久或者更短。蘭格設(shè)想，這些受試者的短期記憶和反應(yīng)時(shí)間等指標(biāo)的得分將發(fā)生相應(yīng)變化，而無論他們的實(shí)際睡眠時(shí)間有多長。在一項(xiàng)尚未發(fā)表的糖尿病研究中，蘭格想知道2型糖尿病患者的生化檢查結(jié)果是否也能通過同樣的心理干預(yù)——即受試者對(duì)于已經(jīng)過去了多長時(shí)間的感知——來操縱。她的理論是，糖尿病人血糖水平會(huì)跟隨受試者感知到的時(shí)間(而不是實(shí)際時(shí)間)波動(dòng);換句話說，它會(huì)按照受試者的預(yù)期上升或者下降。而實(shí)驗(yàn)數(shù)據(jù)揭示的情況正是這樣。今年秋天，當(dāng)學(xué)生通過電子郵件向她報(bào)告實(shí)驗(yàn)結(jié)果時(shí)，她幾乎無法抑制自己內(nèi)心的激動(dòng)。她告訴我說：“這是用心理療法治療糖尿病的開端!”

Some of the new experiments rely on variables that change self-perception. In a study using avatars, scheduled to take place at the popular gaming facility Second Life, subjects will watch a digital version of themselves playing tennis and gradually getting thinner from the exertion. Langer is exploring whether watching an avatar will have a physiological effect on the real person. “You see yourself, you’re playing tennis,” Langer said. “The question is: Will people lose weight? We’ll see.”

有些新實(shí)驗(yàn)依賴于改變自我感知的變量。在一項(xiàng)擬在流行的虛擬游戲世界“第二人生”(Second Life)中進(jìn)行的研究中，受試者將觀看自己的數(shù)字化身打網(wǎng)球，并因?yàn)轶w力消耗而逐漸變得苗條起來。蘭格希望研究觀察化身會(huì)否對(duì)真人造成生理影響。“你看到自己在打網(wǎng)球，”蘭格說。“問題是：人們會(huì)因此減肥么?我們拭目以待。”

Some of Langer’s colleagues in the academy see her as a valuable force in psychology, praising her eccentric intelligence and ingenious study designs. Steven Pinker, the writer and Harvard professor, told me that she filled an important niche within the school’s department, which has often harbored “mavericks with nontraditional projects,” including “B. F. Skinner’s utopian novels and manifestoes and Herb Kelman’s encounter groups between Arab and Israeli activists — not to mention Timothy Leary and Richard Alpert,” who would become Ram Dass.

蘭格在學(xué)術(shù)圈內(nèi)的一些同事肯定了她在心理學(xué)領(lǐng)域的價(jià)值和影響力，贊賞她的獨(dú)到智慧和巧妙研究設(shè)計(jì)。哈佛大學(xué)教授和作家史蒂文·平克(Steven Pinker)告訴我，她在學(xué)院內(nèi)部占有重要的一席之地，該學(xué)院經(jīng)常孕育出“搞出非傳統(tǒng)項(xiàng)目的特立獨(dú)行者”，包括“伯爾赫斯·弗雷德里克·斯金納(B. F. Skinner)的烏托邦小說和宣言、赫布·克爾曼(Herb Kelman)組織的讓阿拉伯與以色列活動(dòng)人士匯聚一堂的會(huì)心小組——更不用說蒂莫西·利里(Timothy Leary)和理查德·阿爾珀特(Richard Alpert，已更名為拉姆·達(dá)斯[Ram Dass])了。”

But Langer’s sensibility can feel at odds with the rigors of contemporary academia. Sometimes she will give equal weight to casually hatched ideas and peer-reviewed studies. She spoke loosely to me of her New Hampshire counterclockwise study as having been “replicated” three times — in Britain, the Netherlands and South Korea. But none of these were lab experiments. They were events made for television. The study that arguably made Langer’s name — the plant study with nursing-home patients — wouldn’t have “much credibility today, nor would it meet the tightened standards of rigor,” says James Coyne, professor emeritus of psychology at the University of Pennsylvania medical school and a widely published bird dog of pseudoscience. (Though, as Coyne also acknowledges, “that is true of much of the work of the ’70s, including my own concerning depressed persons depressing others.”) Langer’s long-term contributions, Coyne says, “will be seen in terms of the thinking and experimenting they encouraged.”

然而，蘭格的這種感性有時(shí)會(huì)與當(dāng)代學(xué)術(shù)界的嚴(yán)謹(jǐn)格格不入。有時(shí)候，她會(huì)對(duì)信手拈來的靈感和經(jīng)過同行評(píng)議的研究給予同等份量。她含糊地告訴我，她在新罕布什爾州做過的“逆時(shí)針”研究，已經(jīng)在英國、荷蘭和韓國“重復(fù)”了三次。但這些都不是在嚴(yán)格的實(shí)驗(yàn)室條件下開展的實(shí)驗(yàn)，而是為制作電視節(jié)目而搞的活動(dòng)。賓夕法尼亞大學(xué)(University of Pennsylvania)醫(yī)學(xué)院心理學(xué)榮譽(yù)退休教授、經(jīng)常發(fā)表文章揭露偽科學(xué)的詹姆斯·科因(James Coyne)稱，當(dāng)年那項(xiàng)可以說令蘭格成名的研究(養(yǎng)老院老人與植物)，“在今天看來并沒有多少可信度，也不會(huì)滿足如今收緊之后的嚴(yán)謹(jǐn)標(biāo)準(zhǔn)。”(但科因也承認(rèn)，“20世紀(jì)70年代的大多數(shù)工作，包括我自己的那項(xiàng)‘抑郁癥患者可導(dǎo)致其他人抑郁’的研究，也是這種情況。”)科因表示，蘭格的長期貢獻(xiàn)“將體現(xiàn)于它們所鼓舞的思維和實(shí)驗(yàn)”。

Four years ago, Langer and her colleagues published in Psychological Science a study that came closest in spirit to the original counterclockwise study in New Hampshire. Here, too, the placebo was a health prime, a situational nudge. They had two groups of subjects go into a flight simulator. One group was told to think of themselves as Air Force pilots and given flight suits to wear while guiding a simulated flight. The other group was told that the simulator was broken and that they should just pretend to fly a plane. Afterward, they gave each group an eyesight test. The group that piloted the flight performed 40 percent better than the other group. Clearly “mind-set manipulation can counteract presumed physiological limits,” Langer said. If a certain kind of prompt could change vision, Langer thought, there was no reason, that you couldn’t try almost anything. The endgame, she has said many times since, is to “return the control of our health back to ourselves.”

四年前，蘭格及其同事在《心理科學(xué)》上發(fā)表了一項(xiàng)研究，這是與新罕布什爾州“逆時(shí)針”研究在精神上最接近的一項(xiàng)研究。這項(xiàng)研究的安慰劑仍是某種健康觸發(fā)刺激，某種情景暗示。研究者把兩組受試者分別送入飛行模擬器，要求其中一組受試者設(shè)想自己是空軍飛行員，并讓他們?cè)诓倏v模擬飛行時(shí)穿著飛行服。而另一組受試者則被告知，模擬器壞了，他們只需要假裝在操縱飛機(jī)。隨后，兩組人接受了視力測(cè)試。結(jié)果“飛行員組”的檢測(cè)結(jié)果比另一組高出40%。蘭格總結(jié)道，顯然“操縱心態(tài)可以抵消假定的生理局限”。如果某種提示可以改變視力的話，蘭格認(rèn)為，那就沒理由不敢嘗試幾乎任何東西。在那之后，她多次表示，終極目的是將 “健康的控制權(quán)交還給我們自己”。

Last spring, Langer and a postdoctoral researcher, Deborah Phillips, were chatting when the subject of the counterclockwise study came up. Over the more than 30 intervening years, Langer had explored many dimensions of health psychology and tested the power of the mind to ease various afflictions. Perhaps it was finally time to run the counterclockwise study again. But if they did, she wanted to raise the stakes: Could they shrink the tumors of cancer patients? Langer often says she has no clue where her ideas come from — but in this case it was crystal clear: Metastatic breast cancer killed her mother at 56, when Langer was 29.

去年春天，蘭格和博士后研究員德博拉·菲利普斯(Deborah Phillips)在聊天時(shí)談起了“逆時(shí)針”研究。自那以來的30多年里，蘭格探索了健康心理學(xué)的多個(gè)層面，做了很多利用思維的威力來緩解各種病痛的試驗(yàn)。也許現(xiàn)在終于到了再次進(jìn)行“逆時(shí)針”的時(shí)候了。但是，如果真的要做，這次她想要加大賭注：他們能夠縮小癌癥患者的腫瘤么?蘭格常說，她不知道自己那些稀奇古怪的想法從何而來，但這一次，她的靈感源泉顯而易見：在她29歲時(shí)，她的母親因轉(zhuǎn)移性乳腺癌去世，享年僅56歲。

Phillips suggested that perhaps they should start with early-stage cancers, ones perceived as more curable, but Langer was firm: It had to be a big, common killer that traditional Western medicine had no answer for. She settled on Stage 4 metastatic breast cancer. Treatment of such cases is usually framed in terms of so-called comfort care. “The medical world has given up on these people,” Langer says.

菲利普斯提出，或許她們應(yīng)當(dāng)從被認(rèn)為治愈希望較大的早期癌癥著手，但蘭格的態(tài)度很堅(jiān)決：必須是一種死亡率較高、常見、傳統(tǒng)的西方醫(yī)學(xué)束手無策的癌癥。最后，她選擇了4期轉(zhuǎn)移性乳腺癌。此類病例的治療通常被框定于所謂“舒適護(hù)理”的范疇。蘭格說：“醫(yī)學(xué)界已經(jīng)放棄了這些患者。”

The study, which is planned for the spring, is designed to include three groups of 24 women with Stage 4 breast cancer who are in stable condition and undergoing hormonal therapy. Two groups will gather at resorts in San Miguel de Allende, Mexico, under the supervision of Langer and her staff. The experimental group will live for a week in surroundings that evoke 2003, a date when all the women were healthy and hopeful, living without a mortal threat hanging over them. They will be told to try to inhabit their former selves. Few clues of the present day will be visible inside the resorts or, for that matter, outside them. In the living areas, turn-of-the-millennium magazines will be lying around, as will DVDs of films like “Titanic” and “The Big Lebowski.” San Miguel de Allende, which has historically been a place known for its nearby healing mineral springs, is a Unesco World Heritage Site, and many of its buildings look as they did a few hundred years ago. “The whole town is a time capsule,” Langer says. (The other group at San Miguel will have the support of fellow cancer patients but will not live in the past; a third group will not experience any research intervention.)

該研究計(jì)劃將在春季開展，設(shè)計(jì)招募三組患有4期乳腺癌、病情穩(wěn)定且正在接受激素治療的婦女，每組24人。其中兩個(gè)組將在墨西哥圣米格爾德阿連德的度假勝地集合，接受蘭格和她手下研究人員的監(jiān)管。實(shí)驗(yàn)組將“穿越”回2003年——也就是她們?nèi)匀簧眢w健康，人生尚未被死亡陰影籠罩，對(duì)未來充滿憧憬的年代 ——在這樣的環(huán)境中生活一周。她們將被告知盡量做回當(dāng)年的自己。度假區(qū)內(nèi)部不會(huì)出現(xiàn)任何與當(dāng)下有關(guān)的東西(就此而言，度假區(qū)外也將是這樣)。生活區(qū)里擺放的將是世紀(jì)之交之時(shí)的雜志，還有《泰坦尼克號(hào)》(Titanic)和《謀殺綠腳趾》(The Big Lebowski)等電影DVD。圣米格爾德阿連德素以其附近具有神秘治愈能力的礦物溫泉而著稱，被聯(lián)合國教科文組織列為世界遺產(chǎn)(Unesco World Heritage Site)，這里的許多建筑看起來與幾百年前一樣。蘭格說：“該鎮(zhèn)宛如一個(gè)時(shí)間膠囊。”(圣米格爾的另一組受試者將得到癌癥病友的支持，但不會(huì)穿越回過去;第三組則不會(huì)受到任何研究干預(yù)。)

As with the original counterclockwise experiment, subjects will be tested before and after on relevant measures — in this case the size of their tumors and the levels of circulating proteins in their blood known to be made by cancer cells — in addition to variables like mood and energy and pain levels. The experimental group will bring with them the same kinds of primes that the New Hampshire men did, like photographs of their younger selves. “We won’t make them haul their bags up the stairs,” Langer says. But otherwise they will be nudged to do all they can for themselves.

與最初的“逆時(shí)針”實(shí)驗(yàn)一樣，受試者在實(shí)驗(yàn)前后會(huì)接受相關(guān)指標(biāo)的檢測(cè)，這一次主要檢測(cè)的是腫瘤的大小和血液中已知由癌細(xì)胞產(chǎn)生的循環(huán)蛋白的水平，此外還有情緒、精力以及疼痛程度等變量。實(shí)驗(yàn)組還會(huì)像當(dāng)年新罕布什爾州實(shí)驗(yàn)的參與者那樣，攜帶一些幫助營造當(dāng)年氛圍的觸發(fā)刺激，如自己年輕時(shí)的照片。“我們不會(huì)要求她們自己把行李搬上樓，”蘭格說，但在其他方面會(huì)鼓勵(lì)她們盡可能自立。

The staff will encourage the women to think anew about their circumstances in an attempt to purge any negative messages they have absorbed during their passage through in the medical system. This is crucial, Langer says, because just as the mind can make things better, it can also make things worse. The nocebo effect is the flip side of the more positive placebo effect, and she says that one of the most pernicious nocebo effects can occur when a patient is informed by her doctor that she is ill. The diagnosis itself, Langer says, primes the symptoms the patient expects to feel. “You change a word here or there, and you get vastly different results,” Langer says. She told me about a yet-to-be-published study she did in 2010 that found that breast-cancer survivors who described themselves as “in remission” were less functional and showed poorer general health and more pain than subjects who considered themselves “cured.”

研究人員將鼓勵(lì)這些婦女換一種方式思考自己的處境，力求摒棄她們之前在醫(yī)療系統(tǒng)接受治療期間吸收的負(fù)面信息。蘭格表示，這一點(diǎn)至關(guān)重要，因?yàn)檎缧膽B(tài)可以讓事情向更好的方向發(fā)展，它也可能使事情變得更糟。反安慰劑效應(yīng)是更為積極的安慰劑效應(yīng)的另一面。蘭格稱，最糟糕的反安慰劑效應(yīng)之一可能發(fā)生在患者從醫(yī)生那里得知自己患病的消息時(shí)。蘭格說，診斷本身就是患者預(yù)期自己將會(huì)感受到的種種癥狀的觸發(fā)刺激。“如果你在這里或那里換一個(gè)詞，結(jié)果可能截然不同，”她表示。她向我介紹了一項(xiàng)她在2010年進(jìn)行、但尚未發(fā)表的研究。該研究發(fā)現(xiàn)，與自認(rèn)為已經(jīng)“治愈”的乳腺癌幸存者相比，那些認(rèn)為自己“處于緩解期”的患者身體功能和整體健康狀況都較差，還往往感到更加疼痛。

So there will be no talk of cancer “victims,” nor anyone “fighting” a “chronic” disease. “When you’re saying ‘fighting,’ you’re already acknowledging the adversary is very powerful,” Langer says. " ‘Chronic’ is understood as ‘uncontrollable’ — and that’s not something anyone can know.”

因此，實(shí)驗(yàn)中將不會(huì)提到癌癥“受害者”，或者與“慢性”疾病“戰(zhàn)斗”。“當(dāng)你使用‘戰(zhàn)斗’這個(gè)詞時(shí)，你已經(jīng)承認(rèn)了對(duì)手非常強(qiáng)大，”蘭格表示。“而‘慢性’往往被理解為‘無法控制’——這不是可以讓受試者知道的事情。”

Of course, the subjects hope to get better, and everything about the setup is nudging them in that direction. So the study becomes a kind of open placebo experiment. Langer has long believed it’s possible to get people to gin up positive effects in their own body — in effect, to decide to get well. Last fall, she tested that proposition, but in reverse: She recruited a number of healthy test subjects and gave them the mission to make themselves unwell. The subjects watched videos of people coughing and sneezing. There were tissues around and those in the experimental group were encouraged to act as if they had a cold. No deception was involved: The subjects weren’t misled, for example, into thinking they were being put into a germ chamber or anything like that. This was explicitly a test to see if they could voluntarily change their immune systems in measurable ways.

每個(gè)受試者當(dāng)然都希望自己好轉(zhuǎn)，整個(gè)實(shí)驗(yàn)的設(shè)計(jì)都是為了鼓勵(lì)她們進(jìn)入好轉(zhuǎn)的軌道。因此，可以說這項(xiàng)研究是某種公開的安慰劑實(shí)驗(yàn)。長期以來，蘭格一直相信，有可能讓人們激發(fā)自己體內(nèi)的積極效應(yīng)，換句話說就是“決定”讓自己好起來。去年秋天，她從反面對(duì)這個(gè)命題進(jìn)行了測(cè)試：她招募了一批健康的受試者，并交給他們一個(gè)任務(wù)：讓自己感覺不舒服。受試者們觀看了人們咳嗽和打噴嚏的視頻，周圍放了很多紙巾，研究人員鼓勵(lì)實(shí)驗(yàn)組像感冒時(shí)那樣行為。這項(xiàng)實(shí)驗(yàn)沒有任何欺騙成分：比如受試者沒有受到誤導(dǎo)，以為自己身處病菌室之類。這是一場明確的試驗(yàn)，目的是看看他們能否以可衡量的方式從主觀上改變自己的免疫系統(tǒng)。

In the study, which is ongoing, 40 percent of the experimental group reported cold symptoms following the experiment, while 10 percent of those in control group did. Buoyed, Langer ordered further analysis, looking for more concrete proof that they actually caught colds by testing their saliva for the IgA antibody, a sign of elevated immune-system response. In February, the results came in. All of the experimental subjects who had reported cold symptoms showed high levels of the IgA antibody.

在這項(xiàng)仍在進(jìn)行的研究中，40%的實(shí)驗(yàn)組受試者報(bào)告在實(shí)驗(yàn)后出現(xiàn)感冒癥狀，而對(duì)照組中僅有10%的人報(bào)告感冒癥狀。這一結(jié)果令蘭格大受鼓舞。她要求進(jìn)行進(jìn)一步的分析，通過檢測(cè)受試者唾液中的IgA抗體水平(免疫系統(tǒng)反應(yīng)升高的表征)，尋找他們確實(shí)患了感冒的更確鑿證據(jù)。今年2月，結(jié)果出來了。報(bào)告出現(xiàn)感冒癥狀的所有受試者的IgA抗體水平都較高。

Placebo effects have already been proven to work on the immune system. But this study could show for the first time that they work in a different way — that is, through an act of will. “As far as we know today, the placebo responses in the immune system are attributable to unconscious classical conditioning,” says the Italian neuroscientist Fabrizio Benedetti, a leading expert in placebo effects. In Benedetti’s experiments, a suggestion planted in the minds of test subjects produced physiological changes directly, the way a dinner bell might goose the salivary glands of a dog. (In one study, healthy volunteers given a placebo — a suggestion that any pain they experienced was actually beneficial to their bodies — were found to produce higher levels of natural painkillers.) “There’s no evidence that expectations play a role as well,” Benedetti says. Langer plans to further analyze the subjects’ saliva to see whether they actually have the rhinovirus and not just elevated IgA.

此前已經(jīng)證實(shí)安慰劑效應(yīng)可作用于免疫系統(tǒng)。但這項(xiàng)研究可能首次展示這種效應(yīng)以一種不同的方式(即一種意志行為)發(fā)揮作用。安慰劑效應(yīng)的權(quán)威專家、意大利神經(jīng)學(xué)家法布里齊奧·貝內(nèi)代蒂(Fabrizio Benedetti)表示：“據(jù)我們目前所知，免疫系統(tǒng)中的安慰劑反應(yīng)可歸因于無意識(shí)的經(jīng)典條件反射。”在貝內(nèi)代蒂的實(shí)驗(yàn)中，植入受試者思維中的心理暗示直接引起了生理反應(yīng)，就像晚餐鈴引發(fā)狗的唾液腺分泌一樣。(在一項(xiàng)研究中，健康的志愿者得到這樣一種安慰劑：一種心理暗示，讓他們以為自己所經(jīng)受的任何疼痛其實(shí)都有益于身體健康。結(jié)果，他們體內(nèi)產(chǎn)生的天然鎮(zhèn)痛劑水平有所提高。)貝內(nèi)代蒂指出：“尚無證據(jù)表明預(yù)期也能發(fā)揮作用。”現(xiàn)在，蘭格計(jì)劃進(jìn)一步分析受試者的唾液，看其中是否確實(shí)存在鼻病毒，而不只是偏高的IgA抗體水平。

The implications of the open placebo — that is, we know the sugar pill is just a sugar pill, but it still works as medicine — are tantalizing. If placebo effects can be harnessed without deception, it would remove many of the ethical issues that surround placebo work. In a study published in the journal Plos One in 2010, Ted Kaptchuk, a professor of medicine at Harvard Medical School, and his colleagues administered a placebo labeled “placebo” to a test group of patients suffering from irritable bowel syndrome. Their symptoms declined significantly as compared with a no-treatment control group. “At some level everybody realizes they themselves are the placebo,” Langer says.

公開安慰劑(即我們知道自己服用的只是糖丸，但它還是會(huì)產(chǎn)生藥物的效果)的潛在影響是十分誘人的。如果無需欺騙就能收到安慰劑的效果，困擾安慰劑研究的很多倫理問題將不復(fù)存在。在2010年發(fā)表于《公共科學(xué)圖書館期刊》(PLOS One)的一項(xiàng)研究中，哈佛醫(yī)學(xué)院教授特德·卡普特查克(Ted Kaptchuk)及其同事們給予患有腸易激綜合征的試驗(yàn)組患者標(biāo)有“安慰劑”字樣的安慰劑。與無治療的對(duì)照組相比，他們的癥狀顯著減輕了。蘭格說：“在某種程度上，每個(gè)人都意識(shí)到自己就是安慰劑。”

Langer’s cancer study has had to clear the hurdles of three human-subjects ethics boards — one from Mexico, one from Harvard’s psychology department and, for a time, one from the University of Southern California’s medical school, where until recently Debu Tripathy, an oncologist who is recruiting subjects for Langer’s study, was a professor of medicine. In June, progress stalled when the board at U.S.C. asked that the language be tweaked. “There’s so much stuff that’s totally outrageous in this world,” Langer told me at the time. “They want me to add a consent form for the people to sign saying there’s no known benefit to them. But that just introduces a nocebo effect!” (The study now has to clear the ethics board at the University of Texas M.D. Anderson Cancer Center in Houston, where Tripathy presently works.)

蘭格的癌癥研究在啟動(dòng)之前必須得到三個(gè)人類受試者倫理委員會(huì)的批準(zhǔn)。這三個(gè)機(jī)構(gòu)一個(gè)位于墨西哥，一個(gè)位于哈佛大學(xué)心理學(xué)系，南加州大學(xué) (University of Southern California, U.S.C.)醫(yī)學(xué)院一度也是其中之一，為蘭格的研究招募受試者的腫瘤學(xué)家德布·崔帕蒂(Debu Tripathy)直到不久前一直是那里的醫(yī)學(xué)教授。今年6月，當(dāng)南加州大學(xué)的委員會(huì)要求他們對(duì)所用的語言“稍加改進(jìn)”后，該項(xiàng)目陷入了停滯。“實(shí)驗(yàn)的很多內(nèi)容對(duì)這個(gè)世界是離譜的，”當(dāng)時(shí)蘭格對(duì)我表示。“他們要我增加一份同意書，讓受試者簽字聲明：他們知道該實(shí)驗(yàn)對(duì)他們沒有任何已知的益處。但是，這恰恰引入了一個(gè)反安慰劑效應(yīng)!”(目前該研究需要得到位于休斯敦的得州大學(xué)安德森癌癥中心[University of Texas M.D. Anderson Cancer Center]的倫理委員會(huì)的批準(zhǔn)，崔帕蒂現(xiàn)在在那里工作。)

Like the men in New Hampshire, Langer’s cancer patients in San Miguel will pass a richly diverting week. In this case, art classes, cooking classes and writing classes will help distract them from the brute dread of their circumstances and re-engage them in life. The terror of late-stage cancer can be as debilitating as the physical reality, Tripathy says. Some sufferers, he says, show symptoms akin to PTSD. There’s strong evidence that the support of other people boosts the quality of life for cancer patients. There’s less evidence that it improves their health prospects.

就像新罕布什爾州研究中的老人那樣，蘭格的圣米格爾研究中的癌癥患者也將度過精彩紛呈的一周。這一次將開設(shè)美術(shù)課、烹飪課和寫作課，幫助她們分散對(duì)自己病情的極度恐懼，重新投入生活。崔帕蒂表示，像身體現(xiàn)實(shí)那樣，對(duì)晚期癌癥的恐懼本身也可能削弱患者的能力。他說，有些患者表現(xiàn)出類似于創(chuàng)傷后應(yīng)激障礙 (PTSD)的癥狀。目前已經(jīng)有強(qiáng)有力的證據(jù)表明，其他人的支持可大大提高癌癥患者的生活質(zhì)量，但這種支持能夠改善患者健康前景的證據(jù)相對(duì)較少。

I asked Tripathy whether there’s any precedent for what Langer is trying to do. “Well, there are many examples in medicine where improvement in the emotional state seems also to bring about some improvement in the disease state,” he said. “We know, for example, that Tibetan monks can meditate and lower their blood pressure. People with hypertension, they embark on behavioral changes, and you can see the improvement in the medical indexes, like fewer heart attacks. But cancer? That’s a harder thing to fathom.”

我向崔帕蒂請(qǐng)教蘭格試圖進(jìn)行的研究有沒有任何先例。“嗯，醫(yī)學(xué)上情緒狀態(tài)的改善似乎帶來病情改善的例子還挺不少的，”他說。“例如，我們知道，西藏僧侶可以通過打坐冥想降低血壓。高血壓患者在做出行為改變后，醫(yī)學(xué)指標(biāo)會(huì)有所改善，比如，心臟病發(fā)作減少了。至于癌癥，那就更難說清楚了。”

Positive psychology doesn’t have a great track record as a way to fight cancer. Indeed, when James Coyne and colleagues followed 1,093 people with advanced head-and-neck cancer over nine years, they found even the most optimistic subjects lived no longer than the most pessimistic ones.

積極心理學(xué)在對(duì)付癌癥方面的記錄并不太好。的確，詹姆斯·科因和他的同事曾經(jīng)對(duì)1093名晚期頭頸癌患者進(jìn)行長達(dá)九年的隨訪，結(jié)果發(fā)現(xiàn)，即使是最樂觀的受試者也并不比最悲觀者活得長。

Some cancer patients respond to interventions better than others, Tripathy notes. “But even with high-dose chemotherapy, you rarely see ‘complete response,’ which is total disappearance” of advanced breast cancer. “So if we saw anything like that, boy, that would hit the medical journals in a hurry.”

崔帕蒂指出，有些癌癥患者對(duì)干預(yù)的反應(yīng)好于其他人。“不過，即使是使用大劑量化療，你也很少能看到‘完全反應(yīng)’，即(晚期乳腺癌)完全消失……所以，如果我們能看到那樣的結(jié)果，那很快會(huì)在醫(yī)學(xué)期刊上引起轟動(dòng)。”

One day in Puerto Vallarta in February, Langer sat on the patio of her hillside home. An iguana the length of a celery rib scooted across a high railing, and the dogs went bananas. “That’s Ada,” Langer said. “Or is it Ida? There are two — it’s hard to tell them apart.” When the iguanas first appeared and began devouring the hibiscus, Langer was startled. Now she and Nancy feed them petals for lunch. “That’s the way it is,” she said. “You can be scared. You give it a name, and then it’s a pet.”

2月的一天，蘭格坐在她位于巴亞爾塔港的山景房的露臺(tái)上。一條有芹菜莖那么長的鬣鱗蜥飛快地翻越了高高的欄桿，幾只狗狂躁不已。“這是埃達(dá)，”蘭格說。“是艾達(dá)嗎?它們有兩個(gè)，很難分得清。”當(dāng)鬣鱗蜥第一次出現(xiàn)，并開始狼吞虎咽地吃芙蓉花時(shí)，蘭格嚇了一跳?，F(xiàn)在，她和南希自在地把花瓣喂給它們吃。 “事情就是這樣的，”她說。“你可能會(huì)害怕。你也可以給它取個(gè)名字，讓它變成一只寵物。”

Langer peered out over the deep blue sea, in the direction of a lagoon, where early in her career she conducted experiments on whether dolphins were more likely to want to swim with mindful people. In the last few days, she had been exchanging emails with a writer who wanted to come stay with her for a couple of weeks, taking notes for a screenplay for a Hollywood biopic.

蘭格凝視著環(huán)礁湖方向上深藍(lán)色的大海，在她的職業(yè)生涯早期，她曾做實(shí)驗(yàn)研究海豚是否更愿意跟處于正念狀態(tài)的人一起游泳。在過去的幾天里，她在與一位作家互通電子郵件，那人想要和她一起待上一兩個(gè)星期，為一部好萊塢傳記片的劇本采集素材。

Langer told me that she chose San Miguel for her new counterclockwise study primarily because the town had made “an offer I couldn’t refuse.” A group of local businesspeople, convinced of the value of having Langer’s name attached to San Miguel, arranged for lodging to be made available free to Langer. They also encouraged her to build a Langer Mindfulness Institute, which will take part in research and run retreats. (A local developer donated a beautiful casa, next to his Nick Faldo-designed golf course, to serve as staff quarters for the institute.) Starting sometime next year, adults will be able to sign up for a paid, weeklong counterclockwise experience, presumably with a chance at some of the same rejuvenative benefits the New Hampshire test subjects enjoyed.

蘭格告訴我，她選擇在圣米格爾進(jìn)行新的“逆時(shí)針”研究，主要是因?yàn)樵撴?zhèn)提供的優(yōu)厚條件讓她“無法拒絕”。一群當(dāng)?shù)厣倘松钚艑⑻m格的名字與圣米格爾聯(lián)系在一起將很有價(jià)值，于是他們?yōu)樘m格的實(shí)驗(yàn)安排了免費(fèi)住宿。他們還鼓勵(lì)她建設(shè)一座蘭格正念研究所(Langer Mindfulness Institute)，既開展研究，又運(yùn)營靜思休養(yǎng)之地。(當(dāng)?shù)氐囊晃婚_發(fā)商還捐贈(zèng)給她一棟精美的城堡，用作研究所員工的宿舍，這座城堡位于他那由尼克· 佛度[Nick Faldo，英國職業(yè)高爾夫球手]設(shè)計(jì)的高爾夫球場旁邊。)從明年的某個(gè)時(shí)候開始，成年人將可以報(bào)名參加為期一周的“逆時(shí)針”付費(fèi)體驗(yàn)，想必將和新罕布什爾州實(shí)驗(yàn)的受試者們一樣，有機(jī)會(huì)享受某些返老還童的益處。

Langer says she is in conversation with health and business organizations in Australia about establishing another research facility that would also accept paying customers, who will learn to become more mindful through a variety of cognitive-behavioral techniques and exercises. She has already opened a mindfulness institute in Bangalore, India, where researchers are undertaking a study to look at whether mindfulness can stem the spread of prostate cancer.

蘭格說，她也正在與澳大利亞的一些保健和商業(yè)組織商談建立第二家研究機(jī)構(gòu)，該機(jī)構(gòu)也將接受付費(fèi)客戶，他們將通過多種認(rèn)知行為技巧和練習(xí)來學(xué)習(xí)變得更加專注。她已經(jīng)在印度班加羅爾開設(shè)了一家正念研究所，那里的研究人員正在進(jìn)行一項(xiàng)研究，探討正念能否阻止前列腺癌的擴(kuò)散。

Langer makes no apologies for the paid retreats, nor for what will be their steep price. (This, too, is calculated: In the absence of other cues, people tend to place disproportionate value on things that cost more. Dan Ariely, a psychologist at Duke, and his colleagues found that pricier placebos were more effective than cheap ones.) To my question of whether such a nakedly commercial venture will undermine her academic credibility, Langer rolled her eyes a bit. “Look, I’m not 40 years old. I’ve paid my dues, and there’s nothing wrong with making this more widely available to people, since I deeply believe it.”

蘭格不認(rèn)為這種靜養(yǎng)機(jī)構(gòu)將會(huì)收費(fèi)，而且價(jià)格高昂有什么錯(cuò)。(這一點(diǎn)其實(shí)也是經(jīng)過盤算的：在缺乏其他暗示的情況下，人們傾向于超出比例地注重比較昂貴的東西。杜克大學(xué)[Duke]心理學(xué)家丹·艾瑞里[Dan Ariely]及其同事們發(fā)現(xiàn)，價(jià)格較高的安慰劑比便宜安慰劑更有效。)我問她，此類明顯商業(yè)化的項(xiàng)目會(huì)不會(huì)削弱她的學(xué)術(shù)可信度?蘭格微微轉(zhuǎn)了轉(zhuǎn)她的眼睛。“你看，我不是40歲的人了。我已經(jīng)做出了自己該做的貢獻(xiàn)，再說，將它推廣給更多的人并沒有什么不妥，因?yàn)槲疑钚潘欢ㄓ行А?rdquo;

Medical colleagues have asked Langer if she is setting herself up to fail with the cancer study — and perhaps underappreciating the potential setbacks to her work. It’s also possible that subjects who don’t improve could feel more demoralized by the experience. In her memoir, “Bright-sided,” the journalist Barbara Ehrenreich wrote scorchingly about the sunshine brigade that bombarded her with “positive thinking” as she suffered through breast cancer. Under those conditions, patients who don’t get better might feel as if they themselves were somehow to blame.

醫(yī)學(xué)界的同事們問蘭格，她這項(xiàng)癌癥研究會(huì)不會(huì)弄巧成拙，害自己栽個(gè)跟頭?或許她低估了自己一輩子的研究成果因此遭遇挫折的潛在風(fēng)險(xiǎn)?還有一個(gè)可能性是，病情沒能好轉(zhuǎn)的受試者因這一體驗(yàn)而更加意志消沉。記者芭芭拉·埃倫賴希(Barbara Ehrenreich)在她的回憶錄《失控的正向思考》(Bright-sided)中，尖銳地批評(píng)了當(dāng)她身患乳腺癌時(shí)，各路“陽光族”向她狂轟濫炸“積極思維”。在那種情況下，病情未見起色的患者會(huì)覺得仿佛是自己做錯(cuò)了什么。