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1、In the mid-90s,90 年代中期,the CDC and Kaiser PermanenteCDC 和 Kaiser Permanente 发现:discovered an exposurethat dramatically increased the risk暴露于某种事物中会极大增加死亡风险,for seven out of 10 of the leadingcauses of death in the United States.七成美国民众的首要死因皆由此引起。In high doses, it affectsbrain development,暴露剂量较高时,会影响大脑发
2、育,the immune system, hormonal systems,免疫系统,内分泌系统,and even the way our DNAis read and transcribed.甚至影响到基因的读取及转录方式。Folks who are exposed in very high doses暴露在极高剂量下的人群,have triple the lifetime riskof heart disease and lung cancer有 3 倍的风险患上心脏病和肺癌,and a 20-year differencein life expectancy.预期寿命缩短 20 年。An
3、d yet, doctors today are not trainedin routine screening or treatment.然而,目前医生们还未被培训以常规筛查和治疗的手段来应对这种风险。Now, the exposure Im talking about isnot a pesticide or a packaging chemical.我所说的暴露危害并不针对某种农药或包装上的化学物质。Its childhood trauma.而是儿童期创伤。Okay. What kind of traumaam I talking about here?那么,我要说的是哪种创伤呢？Im
4、not talking about failing a testor losing a basketball game.我要说的可不是考试不及格或输掉篮球比赛。I am talking about threatsthat are so severe or pervasive我要说的是那种如此严重而又无处不在的威胁,that they literally get under our skinand change our physiology:以致于它让我们毛骨悚然,并从生理上改变了我们：things like abuse or neglect,比如,受虐待或被忽视,or growing up w
5、ith a parent who struggles with mental illness又或者,抚养我们的父母, 本身就深受精神疾病之苦,or substance dependence.或是深陷于 物质依赖 疾病。Now, for a long time,一直以来,I viewed these things in the way I was trained to view them,我都按照所教导的方式来看待这些事情。either as a social problem -refer to social services -要么把它当成一个社会问题-交给社会服务去处理,or as a me
6、ntal health problem -refer to mental health services.要么把它当成一个心理健康问题-交给心理健康咨询来解决。And then something happenedto make me rethink my entire approach.后来发生了一些事情,使我反思我的整个思维方式。When I finished my residency,在医院实习结束后,I wanted to go someplacewhere I felt really needed,我想去个我觉得真正需要我的地方,someplace where I could mak
7、e a difference.去个我可以有所作为的地方。So I came to work forCalifornia Pacific Medical Center,因此，我选择为加利利福尼亚太平洋医疗中心(CPMC)工作,one of the best private hospitalsin Northern California,这是加利福尼亚北部最优秀的私立医院之一,and together, we opened a clinicin Bayview-Hunters Point,我与该医院合作,在旧金山最穷、社区服务最差的居民区-one of the poorest, most unde
8、rservedneighborhoods in San Francisco.湾景区猎人角（Bayview-Hunters Point）开了一家诊所。Now, prior to that point,在此之前,there had been onlyone pediatrician in all of Bayview整个湾景区（Bayview）社区仅有一名儿科医生 ,to serve more than 10,000 children,为一万多名儿童服务,so we hung a shingle, and we were ableto provide top-quality care因此,我们开始
9、挂牌营业, 提供最优质的医疗服务,regardless of ability to pay.不论是否有能力支付医疗费用。It was so cool. We targetedthe typical health disparities:这种感觉很棒。 我们找出了在医疗服务上现状与标准的差距：access to care, immunization rates,asthma hospitalization rates,普及医疗保健,免疫接种率、哮喘住院率等,and we hit all of our numbers.我们都完成了达标。We felt very proud of ourselves
10、.我们为自己感到骄傲。But then I started noticinga disturbing trend.但就在那时,我开始注意到一种令人忧心的趋势。A lot of kids were beingreferred to me for ADHD,很多孩子因为多动症（简称 ADHD),or Attention DeficitHyperactivity Disorder,被送到我这里进行医治,but when I actually dida thorough history and physical,可是,当我对孩子们的病史和身体状况进行彻查时,what I found was thatf
11、or most of my patients,却发现大多数患儿的情况,I couldnt make a diagnosis of ADHD.我无法下 多动症 (ADHD)的诊断。Most of the kids I was seeinghad experienced such severe trauma多数来就诊的孩子都经历过如此严重的创伤,that it felt like something elsewas going on.让人觉得似乎事情并不简单。Somehow I was missing something important.不知怎的,我漏查了某个重要的因素。Now, before
12、 I did my residency,I did a masters degree in public health,在实习之前,我曾攻读公共健康硕士学位,and one of the things that they teach youin public health school在公共健康学校里,我们曾学过这样的一课,is that if youre a doctor如果你是一名医生,and you see 100 kidsthat all drink from the same well,当你知道有 100 个孩子从同一口井中饮水,and 98 of them develop diar
13、rhea,其中 98 人患了腹泻,you can go aheadand write that prescription你可以着手治疗,for dose after doseafter dose of antibiotics,给每个病人都开抗生素,一剂, 一剂,又一剂的开。or you can walk over and say, What the hell is in this well?可是你也可以走去井边，问声, 井里到底有什么鬼东西?So I began reading everything thatI could get my hands on所以,我开始查阅手头所有的相关资料,ab
14、out how exposure to adversity了解暴露在不幸中,affects the developing brainsand bodies of children.是如何影响儿童的大脑和身体发育的。And then one day,my colleague walked into my office,然后有一天,一个同事走进我的办公室,and he said, Dr. Burke,have you seen this?他问我, 伯克医生,你看过这个吗?In his hand was a copyof a research study在他手里的是一份调查研究的复印件,called
15、 the Adverse ChildhoodExperiences Study.题目是 童年不良经历(ACE)研究 。That day changed my clinical practiceand ultimately my career.那一天,改变了我的临床实践, 也最终改变了我的职业生涯。The Adverse Childhood Experiences Study童年不良经历(ACE)的研究is something that everybodyneeds to know about.是每一个人都应该要了解的。It was done by Dr. Vince Felitti at Ka
16、iserand Dr. Bob Anda at the CDC,Vince Felitti 博士和 Bob Anda 博士分别在 Kaiser 和 CDC 进行了这项研究,and together, they asked 17,500 adultsabout their history of exposure他们两人一起询问了 17,500 成年人,to what they called adverse childhood experiences, or ACEs.了解他们的 童年不良经历 ,又称 ACE。Those include physical, emotional,or sexual abuse;这包括生理上、情感上遭受的不幸或是性侵害；physical or emotional neglect;生理或情感上遭受的忽视；parental mental illness,substance dependence, incarceration;父母患有精神疾病、物质依赖、遭到监禁；parental separ
