Each year the serious depression affects 6% of UK adults and 121 million people worldwide. At some time in our lives, one in six of us will experience an episode and the World Health Organisation predicts by 2020 depression will be the largest single health issue in developed countries. As well as being a personal hell for its sufferers, tackling depression is big business. This week GlaxoSmithKline accepted a $3 billion penalty from US authorities after pleading guilty to wrongly marketing two leading anti-depression drugs and a range of other misdemeanours. But even this huge penalty may be offset by the $17 billion sales of the same drugs in the years covered by the settlement alone. The case raises ethical and regulatory issues, but the wider context is commercialisation of mental healthcare. Drug companies have a natural interest in finding pharmacological solutions to medical problems and use their considerable resources to promote them to both doctors and patients. Medication can certainly help, and sometimes there's no alternative.
英國每年有6%的成年人抱受嚴重抑郁癥的困擾,全世界則有1億2千1百萬人。每六個人中就有一人在某段時期有抑郁的經歷。世界衛生組織預計,到2020年,抑郁癥將成為發達國家中最大的健康問題。抑郁癥讓患者痛苦萬分,應對工作也同樣十分棘手。這周,由于違規營銷兩大主要抗抑郁藥物以及一系列其它罪行,葛蘭素史克公司向美國當局支付了30億美元的罰金。盡管受到嚴懲,但該公司僅在違規營銷這幾年就憑同種藥物達成了170億美元的銷售額,足以抵消掉罰款金額。這一案子揭露了道德和管理方面的問題,但從更廣的層面來看,體現的是精神治療商業化的問題。藥品公司的天性就是通過在醫療問題中尋找藥理學的解決方法來謀求利益,并且運用它們相當豐富的資源向醫生和患者推銷藥物。藥物治療當然有用,而且這有時是唯一的解決辦法。
But I think many of us reach first for a prescription when problems arise. And perhaps we find that congenial. We often seem to treat our minds and bodies like a car that goes wrong. We want to get them fixed, so we can get on with our lives But another body of thought holds that addressing the underlying causes of depression, not just tackling its symptoms, means changing how we live and even how we think. A substantial movement along these lines is underway in mainstream healthcare and clinical psychology, and rather surprisingly, it draws on Buddhist meditation and mindfulness practice.
但我認為有許多人遇到問題一開始就想著去開藥方。也許我們覺得生病吃藥是天經地義的。人們總像對待出故障的汽車那樣對待自己的身心。我們想修好它們,繼續自己的生活。但另外一種看法是我們不僅僅要解決癥狀,還要解決導致抑郁癥的根本原因,這意味著改變我們的生活和思考方式。主流的醫療保健和臨床心理學正在沿著此方針開展實際的進展。令人吃驚的是,它運用了佛教中的冥想和正念的做法。
Mindfulness Based Cognitive Therapy aims at avoiding depression relapse. Using meditation, it asks people to accept the troubling thoughts and feelings that can grow into depression, seeing them as part of their experience, at least for now. That mirrors the Buddhist understanding that we suffer because what we want is at odds with the way life is. Your alternative is turning towards reality with awareness and finding a more creative response. I see in my own work as a mindfulness trainer that when people stop fighting what they find challenging and stop judging themselves harshly they are able to access a kinder response and a sense of peace. This assumes that people have the resources within themselves to cope more effectively. That doesn't mean there's no place for drugs in alleviating the effects of depression, but you can also help yourself. And that's an important insight whether you're depressed or not.
正念認知療法旨在避免抑郁癥復發。它要求人們運用冥想來接受可能會演變成抑郁的一些不安的想法和感受,把它們看作是自身體驗的一部分,至少在當前如此。這反映出佛教的思想:人之所以受苦是因為其欲望與生活相悖。你要做出取舍,有意識地轉向現實,做出更有創造力的回應。作為一位正念教練,我在工作中注意到,當人們不再與他們所認為的挑戰作斗爭,不再嚴厲地自我評定時,他們會更加善待生活,獲得心靈上的平靜。由此可以假設出人們體內有能使自己更有效運作的源泉。這并不是說藥品在緩解抑郁方面沒有一席之地,而是說人可以自救。能否自救是洞悉自己是否抑郁的十分重要的一點。