多愁善感不是病

Medicating Women’s Feelings

多愁善感不是病

WOMEN are moody. By evolutionary design, we are hard-wired to be sensitive to our environments, empathic to our children’s needs and intuitive of our partners’ intentions. This is basic to our survival and that of our offspring. Some research suggests that women are often better at articulating their feelings than men because as the female brain develops, more capacity is reserved for language, memory, hearing and observing emotions in others.

女性往往情緒化。通過進化的設計，我們天生對環(huán)境敏感、能感同身受地理解孩子的需求、能直觀地感知伙伴的意圖。這是我們自身和后代生存的基本要素。有些研究顯示，與男性相比，女性往往更擅長表達自己的感情。因為女性大腦發(fā)育的過程中，有更多容量留給了語言、記憶、聽覺和觀察他人的情緒。

These are observations rooted in biology, not intended to mesh with any kind of pro- or anti-feminist ideology. But they do have social implications. Women’s emotionality is a sign of health, not disease; it is a source of power. But we are under constant pressure to restrain our emotional lives. We have been taught to apologize for our tears, to suppress our anger and to fear being called hysterical.

這些是植根于生物學的觀察結果，并不是為了迎合任何女權主義或反女權主義的思想。但是，它們的確產(chǎn)生了一些社會影響。女性的情緒是健康而非疾病的標志，是力量的來源。但是，我們經(jīng)常面臨需要控制情感的壓力。人們叮囑我們要為自己的眼淚道歉、要克制憤怒，而且要擔心被人形容歇斯底里。

The pharmaceutical industry plays on that fear, targeting women in a barrage of advertising on daytime talk shows and in magazines. More Americans are on psychiatric medications than ever before, and in my experience they are staying on them far longer than was ever intended. Sales of antidepressants and antianxiety meds have been booming in the past two decades, and they’ve recently been outpaced by an antipsychotic, Abilify, that is the No. 1 seller among all drugs in the United States, not just psychiatric ones.

制藥行業(yè)利用了這種恐懼，在日間脫口秀節(jié)目和雜志上投放了大量針對女性的廣告。目前，服用精神藥物的美國人比以往任何時候都多，而且根據(jù)我的經(jīng)驗，他們的服藥期限也遠遠超過了預期的時長。過去20年，抗抑郁和抗焦慮藥物的銷量一直在激增;最近，抗精神分裂藥安律凡(Abilify)的銷量超過了這兩者。它是美國所有藥物，而不僅僅是精神藥物中銷量最高的。

As a psychiatrist practicing for 20 years, I must tell you, this is insane.

作為一個行醫(yī)20年的精神科醫(yī)生，我必須告訴你，這簡直是瘋了。

At least one in four women in America now takes a psychiatric medication, compared with one in seven men. Women are nearly twice as likely to receive a diagnosis of depression or anxiety disorder than men are. For many women, these drugs greatly improve their lives. But for others they aren’t necessary. The increase in prescriptions for psychiatric medications, often by doctors in other specialties, is creating a new normal, encouraging more women to seek chemical assistance. Whether a woman needs these drugs should be a medical decision, not a response to peer pressure and consumerism.

如今，美國至少有四分之一的女性都在服用精神藥物，而男性僅有七分之一。女性被診斷患有抑郁癥或焦慮癥的可能性幾乎是男性的兩倍。對于很多女性來說，這些藥物極大地提高了她們的生活品質，但對另一些人而言卻并無必要。醫(yī)生開的精神藥物越來越多，開藥的往往是其他領域的醫(yī)生，這創(chuàng)造了一種新常態(tài)，鼓勵更多女性去尋求化學支持。一名女性是否需要這些藥物，應該是一個醫(yī)療決定，而不是對同輩壓力和消費主義的回應。

The new, medicated normal is at odds with women’s dynamic biology; brain and body chemicals are meant to be in flux. To simplify things, think of serotonin as the “it’s all good” brain chemical. Too high and you don’t care much about anything; too low and everything seems like a problem to be fixed.

這種用藥的新常態(tài)不符合女性動態(tài)的生物學屬性;大腦和身體的化學物質原本就應該波動不定。為了簡化問題，請想象血清素是產(chǎn)生“一切都很好”這種感覺的大腦化學物質。如果它的水平太高，人們就會什么都不在意;如果太低，那么一切似乎都是需要解決的問題。

In the days leading up to menstruation, when emotional sensitivity is heightened, women may feel less insulated, more irritable or dissatisfied. I tell my patients that the thoughts and feelings that come up during this phase are genuine, and perhaps it’s best to re-evaluate what they put up with the rest of the month, when their hormone and neurotransmitter levels are more likely programmed to prompt them to be accommodating to others’ demands and needs.

在月經(jīng)即將到來的日子里，女性的情緒敏感度會提高，女性可能更容易受到外部影響，更焦躁或更容易感到不滿。我告訴我的患者，這個階段產(chǎn)生的想法和感覺是真實的，或許應該重新評估她們在一個月的其他時間里忍受的事情——那個時候，她們的荷爾蒙和神經(jīng)遞質所處的水平，更傾向于促使她們遷就他人的訴求和需要。

The most common antidepressants, which are also used to treat anxiety, are selective serotonin reuptake inhibitors (S.S.R.I.s) that enhance serotonin transmission. S.S.R.I.s keep things “all good.” But too good is no good. More serotonin might lengthen your short fuse and quell your fears, but it also helps to numb you, physically and emotionally. These medicines frequently leave women less interested in sex. S.S.R.I.s tend to blunt negative feelings more than they boost positive ones. On S.S.R.I.s, you probably won’t be skipping around with a grin; it’s just that you stay more rational and less emotional. Some people on S.S.R.I.s have also reported less of many other human traits: empathy, irritation, sadness, erotic dreaming, creativity, anger, expression of their feelings, mourning and worry.

最常見的抗抑郁藥——這些藥也用于治療焦慮癥——是選擇性血清素再攝取抑制劑(selective serotonin reuptake inhibitors，簡稱SSRI)，它能強化血清素的輸送。SSRI讓你感覺“一切都好”。但太好也不是好事，較多的血清素可能會讓你更加冷靜、抑制恐懼感，但也可能會讓你變得麻木，身體和情感上皆是如此。這些藥物經(jīng)常會壓抑女性對性生活的興趣。SSRI傾向于鈍化消極情緒，而非激發(fā)積極情緒。在服用 SSRI時，你可能不會面帶笑容地四處蹦跳，而只是會變得更加理性，不那么情緒化。一些服用SSRI的人也曾透露，其他許多人之常情也減少了，諸如同理心、惱火、悲傷、性夢、創(chuàng)造力、憤怒、哀痛、擔憂，以及自身情緒的表達。

Obviously, there are situations where psychiatric medications are called for. The problem is too many genuinely ill people remain untreated, mostly because of socioeconomic factors. People who don’t really need these drugs are trying to medicate a normal reaction to an unnatural set of stressors: lives without nearly enough sleep, sunshine, nutrients, movement and eye contact, which is crucial to us as social primates.

很明顯，有些情況是需要精神藥物的。問題是，有太多真正患病的人仍未得到治療，這多半是因為社會經(jīng)濟因素。那些并非真正需要這些藥物的人，則試圖通過服藥，讓自己對一系列反常的壓力來源做出正常的反應，諸如嚴重缺乏睡眠、陽光、營養(yǎng)、運動和眼神接觸——這對人類這種社會性靈長目動物至關重要。

If the serotonin levels of women are constantly, artificially high, they are at risk of losing their emotional sensitivity with its natural fluctuations, and modeling a more masculine, static hormonal balance. This emotional blunting encourages women to take on behaviors that are typically approved by men: appearing to be invulnerable, for instance, a stance that might help women move up in male-dominated businesses. Primate studies show that giving an S.S.R.I. can augment social dominance behaviors, elevating an animal’s status in the hierarchy.

如果女性的血清素水平一直處在人為提高的狀態(tài)，她們可能就會喪失情緒的敏感度及其自然波動，進而形成一種更男性化的、平穩(wěn)的激素平衡。這種情緒上的鈍化，會促使女性做出通常被男性認可的行為舉止，例如表現(xiàn)得無堅不摧，這種姿態(tài)可能有助于女性在男性主導的商業(yè)領域向上走。靈長目動物的研究表明，SSRI能增強社會支配行為，提高動物在社會階層中的地位。

But at what cost? I had a patient who called me from her office in tears, saying she needed to increase her antidepressant dosage because she couldn’t be seen crying at work. After dissecting why she was upset — her boss had betrayed and humiliated her in front of her staff — we decided that what was needed was calm confrontation, not more medication.

不過，這么做要付出什么代價?有一個患者曾經(jīng)流著淚從辦公室打電話給我，說她需要加大抗抑郁藥的劑量，因為她不能在工作場所讓人看到自己哭。我們分析了她傷心的原因——她的老板在她的下屬面前揭她的丑并羞辱了她——隨后得出結論，她需要做的是冷靜地對抗，而不是服用更多藥物。

Medical chart reviews consistently show that doctors are more likely to give women psychiatric medications than men, especially women between the ages of 35 and 64. For some women in that age group the symptoms of perimenopause can sound a lot like depression, and tears are common. Crying isn’t just about sadness. When we are scared, or frustrated, when we see injustice, when we are deeply touched by the poignancy of humanity, we cry. And some women cry more easily than others. It doesn’t mean we’re weak or out of control. At higher doses, S.S.R.I.s make it difficult to cry. They can also promote apathy and indifference. Change comes from the discomfort and awareness that something is wrong; we know what’s right only when we feel it. If medicated means complacent, it helps no one.

通過病例審閱可以明顯看出，相比之下，醫(yī)生給女性患者開精神治療藥物的可能性更大，尤其是35歲到64歲的女性。對于這個年齡段的一些女性來說，她們的更年期癥狀聽起來可能很像抑郁癥，而且愛哭是普遍現(xiàn)象。哭泣不全是因為悲傷。當我們感到恐懼或受挫、目睹不公，或是被人類的苦難深深觸動時，我們都會流淚。此外，有些女性格外愛哭。這并不意味著我們感情脆弱或處于失控狀態(tài)。高劑量的SSRI讓哭泣變得困難，它們還會讓人更加冷漠和無動于衷。只有我們感到不舒服，或意識到什么地方不對勁，才會做出改變;我們通過感知來判斷對錯。如果藥物讓人變得漠然，對任何人都沒好處。