一千个自杀的理由

又是一个沉重的话题，关于自杀。

无注释原文：

To Know Suicide

The New York Times

When the American artist Ralph Barton killed himself in 1931 he left behind a suicide note explaining why, in the midst of a seemingly good and full life, he had chosen to die.

“Everyone who has known me and who hears of this,” he wrote, “will have a different hypothesis to offer to explain why I did it.”

Most of the explanations, about problems in his life, would be completely wrong, he predicted. “I have had few real difficulties,” he said, and “more than my share of affection and appreciation.” Yet his work had become torture, and he had become, he felt, a cause of unhappiness to others. “I have run from wife to wife, from house to house, and from country to country, in a ridiculous effort to escape from myself,” he wrote. The reason he gave for his suicide was a lifelong “melancholia” worsening into “definite symptoms of manic-depressive insanity.”

Barton was correct about the reactions of others. It is often easier to account for a suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law than it is to attribute it to mental illness.

Certainly, stress is important and often interacts dangerously with depression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder (also known as manic-depressive illness). When depression is accompanied by alcohol or drug abuse, which it commonly is, the risk of suicide increases perilously.

Suicidal depression involves a kind of pain and hopelessness that is impossible to describe — and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to it. How can you say what it feels like to go from being someone who loves life to wishing only to die?

Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. Everything is an effort, all day and throughout the night. There is no hope, no point, no nothing.

The burden you know yourself to be to others is intolerable. So, too, is the agitation from the mania that may simmer within a depression. There is no way out and an endless road ahead. When someone is in this state, suicide can seem a bad choice but the only one.

It has been a long time since I have known suicidal depression. I am one of millions who have been treated for depression and gotten well; I was lucky enough to have a psychiatrist well versed in using lithium and knowledgeable about my illness, and who was also an excellent psychotherapist.

This is not, unfortunately, everyone’s experience. Many different professionals treat depression, including family practitioners, internists and gynecologists, as well as psychiatrists, psychologists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis.

Distinguishing between bipolar depression and major depressive disorder, for example, can be difficult, and mistakes are common. Misdiagnosis can be lethal. Medications that work well for some forms of depression induce agitation in others. We expect well-informed treatment for cancer or heart disease; it matters no less for depression.

We know, for instance, that lithium greatly decreases the risk of suicide in patients with mood disorders like bipolar illness, yet it is too often a drug of last resort. We know, too, that medication combined with psychotherapy is generally more effective for moderate to severe depression than either treatment alone. Yet many clinicians continue to pitch their tents exclusively in either the psychopharmacology or the psychotherapy camp. And we know that many people who have suicidal depression will respond well to electroconvulsive therapy (ECT), yet prejudice against the treatment, rather than science, holds sway in many hospitals and clinical practices.

Severely depressed patients, and their family members when possible, should be involved in discussions about suicide. Depression usually dulls the ability to think and remember, so patients should be given written information about their illness and treatment, and about symptoms of particular concern for suicide risk — like agitation, sleeplessness and impulsiveness. Once a suicidally depressed patient has recovered, it is valuable for the doctor, patient and family members to discuss what was helpful in the treatment and what should be done if the person becomes suicidal again.

People who are depressed are not always easy to be with, or to communicate with — depression, irritability and hopelessness can be contagious — so making plans when a patient is well is best. An advance directive that specifies wishes for future treatment and legal arrangements can be helpful. I have one, which specifies, for instance, that I consent to ECT if my doctor and my husband, who is also a physician, think that is the best course of treatment.

Because I teach and write about depression and bipolar illness, I am often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential.

I was fortunate that my psychiatrist had both. It was a long trip back to life after nearly dying from a suicide attempt, but he was with me, indeed ahead of me, every slow step of the way.

- ◆ -

注：中文文本为机器翻译仅供参考，并非一一对应

含注释全文：

To Know Suicide

一千个自杀的理由

The New York Times

When the American artist Ralph Barton killed himself in 1931 he left behind a suicide note explaining why, in the midst of a seemingly good and full life, he had chosen to die.

1931年，美国艺术家拉尔夫·巴顿（Ralph Barton）在自杀时留下了一份遗书，解释生活看似美好充实的自己，为何选择了死亡。

表示“正当…的时候；在…之中”，英文解释为“in the middle of an event, situation, or activity”举个🌰：

I'm sorry but I'm too busy - I'm in the midst of writing a report.

恐怕我太忙了——我正在写一份报告。

“Everyone who has known me and who hears of this,” he wrote, “will have a different hypothesis to offer to explain why I did it.”

“所有认识我、听说这件事的人，”他写道，“都会有不同的假说来解释我为什么这么做。”

表示“假设，假说”，英文解释为“an idea or explanation for something that is based on known facts but has not yet been proved”举个🌰：

Several hypotheses for global warming have been suggested.

已经提出了好几种全球变暖的假说。

Most of the explanations, about problems in his life, would be completely wrong, he predicted. “I have had few real difficulties,” he said, and “more than my share of affection and appreciation.” Yet his work had become torture, and he had become, he felt, a cause of unhappiness to others. “I have run from wife to wife, from house to house, and from country to country, in a ridiculous effort to escape from myself,” he wrote. The reason he gave for his suicide was a lifelong “melancholia” worsening into “definite symptoms of manic-depressive insanity.”

他预言，大部分解释都和他生活中的问题有关，并且完全是错的。“我几乎没有真正的困难，”他说，而且“我得到的喜爱和欣赏比应得的要多”。然而，他的工作变成了折磨，而且他觉得自己成了别人不幸福的原因。“我换了一任又一任妻子，搬了一处又一处住所，去了一个又一个国家，全都是为了荒唐地逃避自我，”他写道。他给出的自杀理由，是伴随他一生的“沉郁”，而且这种情绪日益恶化，成了“躁狂抑郁性精神病的明确症状”。

表示“折磨，煎熬”，英文解释为“a very unpleasant experience”举个🌰：

The rush-hour traffic was sheer torture as usual.

交通高峰期像往常一样简直就是一种煎熬。

表示“愚蠢的；荒唐的；可笑的”，英文解释为“stupid or unreasonable and deserving to be laughed at”举个🌰：

Do I look ridiculous in this hat?

我戴这顶帽子看着很可笑吗？

melancholia /ˌmelənˈkoʊliə/ 表示“抑郁症”，英文解释为“the condition of feeling unhappy or sad for no obvious reason”。

表示“燥狂抑郁病的”，英文解释为“If someone is manic-depressive, they have a medical condition in which they sometimes feel excited and confident and at other times very depressed. People now use the term to refer to someone with this condition.”。

表示“精神失常；精神错乱；精神病”，英文解释为“the state of being insane”举个🌰：

He was found not guilty, by reason of insanity.

他以精神失常为理由获判无罪。

Barton was correct about the reactions of others. It is often easier to account for a suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law than it is to attribute it to mental illness.

巴顿对其他人反应的猜测是正确的。通常，人们更容易将自杀归咎于外部原因，比如婚姻或工作上的问题、身体疾病、经济压力或法律问题，而非精神疾病。

Certainly, stress is important and often interacts dangerously with depression. But the most important risk factor for suicide is mental illness, especially depression or bipolar disorder (also known as manic-depressive illness). When depression is accompanied by alcohol or drug abuse, which it commonly is, the risk of suicide increases perilously.

当然，压力是重要因素，而且常常会与抑郁症相互影响，颇为危险。但对自杀而言，最重要的风险因素是精神疾病，尤其是抑郁症或双相障碍（又称躁狂抑郁症）。通常，抑郁会与酒精和药物滥用相伴相随，这时，自杀的风险会增加到危险的水平。

表示“交流，交往；互相作用，互相影响”，英文解释为“to communicate with or react to”举个🌰：

We are studying how these two chemicals interact.

我们在研究这两种化学物质是如何相互作用的。

表示“双相型障碍；躁郁症；躁狂抑郁性精神病”，英文解释为“Bipolar disorder is a mental illness in which a person's state of mind changes between extreme happiness and extreme depression.”

📍bipolar /baɪˈpəʊlə/ 作形容词本身表示“完全对立的；有两极的”，英文解释为“Bipolar systems or situations are dominated by two strong and opposing opinions or elements.”如：the bipolar world 两极世界。

perilous /ˈperələs/ 形容词性，表示“非常危险的”，英文解释为“extremely dangerous”举个🌰：

The country roads are quite perilous.

这些乡间道路很危险。

Suicidal depression involves a kind of pain and hopelessness that is impossible to describe — and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to it. How can you say what it feels like to go from being someone who loves life to wishing only to die?

有自杀倾向的抑郁症，涉及一种无法描述的痛苦和绝望。我是体验过才这么说的。我从事的是精神病学的教学工作，也写过自己患上双相障碍症的文章，但文字难以准确描述这种疾病。从一个热爱生活的人，变成一个只求一死的人，这种感觉你该怎么表达？

psychiatry /saɪˈkaɪətrɪ/ 表示“精神病学”，英文解释为“Psychiatry is the branch of medicine concerned with the treatment of mental illness.”

表示“公平地对待；合理地处理”，英文解释为“to treat someone or something in a way that is fair and shows their or its true qualities”举个🌰：

This postcard doesn't do justice to the wonderful scenery.

这张明信片没能充分展现那美丽的景色。

Suicidal depression is a state of cold, agitated horror and relentless despair. The things that you most love in life leach away. Everything is an effort, all day and throughout the night. There is no hope, no point, no nothing.

有自杀倾向的抑郁症，是一种充斥着冰冷、焦灼的恐惧，以及无尽的绝望的状态。你在生命中最热爱的东西，都会被滤去。整日整夜里，一切都很艰难。没有希望，没有意义，什么都没有。

表示“紧张不安的，焦虑的”，英文解释为“so nervous or upset that you are unable to keep still or think calmly”举个🌰：

LR was getting visibly agitated.

看得出来，LR焦虑不安。

📍下一段出现名词形式：agitation.

表示“持续严厉的；持续强烈的”，英文解释为“continuing in a severe or extreme way”如：relentless criticism/pressure 不断的严厉批评/施压，relentless heat 持续高温。

The burden you know yourself to be to others is intolerable. So, too, is the agitation from the mania that may simmer within a depression. There is no way out and an endless road ahead. When someone is in this state, suicide can seem a bad choice but the only one.

知道自己是别人的负担也让人无法忍受。躁狂引发的焦虑不安也同样令人难以忍受，在抑郁期间，躁狂或许一触即发。没有出口，而前方的路却看不到尽头。这种状态下，自杀可能像是一个糟糕的选择，但也是唯一的选择。

表示“躁狂症”，英文解释为“a state of extreme physical and mental activity, often involving a loss of judgment and periods of euphoria”。

1）表示“（分歧或消极情绪）酝酿，积聚”，英文解释为“If a disagreement or negative emotion simmers, it grows slowly stronger over a period of time and could become more serious at any moment.”举个🌰：

She's been simmering with resentment ever since the meeting.

会议之后她便心生怨恨，一直耿耿于怀。

2）表示“用文火炖；煨”，英文解释为“When you simmer food or when it simmers, you cook it by keeping it at boiling point or just below boiling point.”举个🌰：

Simmer the sauce gently for 10 minutes.

把调味汁用文火炖10分钟。

🎬电影《朱莉与茱莉亚》（Julie and Julia）中的台词提到：It's simmering. 水开了。

It has been a long time since I have known suicidal depression. I am one of millions who have been treated for depression and gotten well; I was lucky enough to have a psychiatrist well versed in using lithium and knowledgeable about my illness, and who was also an excellent psychotherapist.

我知道有自杀倾向的抑郁症已经很长时间了。我是接受抑郁症治疗并康复的的数百万人之一。我够幸运，遇到了一名非常精通锂（lithium）疗法的精神病医生，他非常了解我的病，同时也是一名出色的心理治疗师。

psychiatrist /saɪˈkaɪətrɪst/表示“精神病医生”，英文解释为“A psychiatrist is a doctor who treats people suffering from mental illness.”

表示“熟知的；通晓的”，英文解释为“If someone is well-versed in a particular subject, they know a lot about it.”举个🌰：

He is well-versed in many styles of jazz.

他通晓多种风格的爵士乐。

📺英剧《性爱自修室》（Sex Education）第一季第4集中的台词提到：I'm not particularly well-versed 我不是很精通。 

This is not, unfortunately, everyone's experience. Many different professionals treat depression, including family practitioners, internists and gynecologists, as well as psychiatrists, psychologists, nurses and social workers. This results in wildly different levels of competence. Many who treat depression are not well trained in the distinction among types of depression. There is no common standard for education about diagnosis.

遗憾的是，并非人人都有这样的经历。治疗抑郁症的，会有许多不同的专业人士，包括家庭医生、内科医生和妇科医生，以及精神病医生、心理学家、护士和社会工作者。他们的能力水平相去甚远。许多治疗抑郁的人并未得到过良好的训练，不懂区分不同类型的抑郁。而与诊断相关的教育也没有一致的标准。

表示“妇科学家，妇科医生”，英文解释为“a doctor skilled in the treatment of women's diseases, especially those of the reproductive organs”。

Distinguishing between bipolar depression and major depressive disorder, for example, can be difficult, and mistakes are common. Misdiagnosis can be lethal. Medications that work well for some forms of depression induce agitation in others. We expect well-informed treatment for cancer or heart disease; it matters no less for depression.

比如，双相障碍中的抑郁，与重性抑郁障碍可能就很难区分，而诊断错误也很常见。误诊可能是致命的。对某些类型的抑郁能够奏效的药物，在治疗其他类型的抑郁时，可能会引发焦躁。我们期望治疗癌症或心脏病的人能见多识广。对抑郁症而言，这样的要求也同样重要。

表示“致命的；极其危险的”，英文解释为“able to cause or causing death; extremely dangerous”举个🌰：

Three minutes after the fire started, the house was full of lethal fumes.

起火3分钟后，房子里充满了致命的毒气。

We know, for instance, that lithium greatly decreases the risk of suicide in patients with mood disorders like bipolar illness, yet it is too often a drug of last resort. We know, too, that medication combined with psychotherapy is generally more effective for moderate to severe depression than either treatment alone. Yet many clinicians continue to pitch their tents exclusively in either the psychopharmacology or the psychotherapy camp. And we know that many people who have suicidal depression will respond well to electroconvulsive therapy (ECT), yet prejudice against the treatment, rather than science, holds sway in many hospitals and clinical practices.

比如，我们知道，锂（lithium）能大幅降低双相障碍等情感障碍患者的自杀风险。然而，这种药物往往会被当做最后的手段。我们也知道，对于中度到重度的抑郁症，药物治疗结合心理治疗，通常比只用其中一种更有效。但许多临床医生不是局限在精神病药物学（psychopharmacology）阵营，就是局限在心理治疗（psychotherapy）阵营。此外，我们知道，许多有自杀倾向的抑郁症患者接受电休克疗法（electroconvulsive therapy）时效果良好，但对于这种疗法的偏见，而非科学研究，却影响着许多医院和临床实践。

表示“应急措施；可首先（或最后）采取的手段”，英文解释为“the first or last course of action that you should or can take in a particular situation”。

短语：

📍as a last resort = in the last resort 表示“作为最后一招，在万不得已的时候”（if all other methods fail）举个🌰：

In the last resort (= in the end) everyone must decide for themselves.

最后人人都得自己作决定。

Police are supposed to use guns only as a last resort.

警方只有在万不得已的时候才能开枪。

🎬电影《陵园路口》（Cemetery Junction）中的台词提到：I need a favor. You're my last resort. 我需要你的帮助 你是我最后一丝希望。

表示“掌握权力；有很大影响”，英文解释为“to have power or a very strong influence”举个🌰：

Fundamentalist beliefs hold sway over whole districts.

原教旨主义信仰在整个地区处于支配地位。

Severely depressed patients, and their family members when possible, should be involved in discussions about suicide. Depression usually dulls the ability to think and remember, so patients should be given written information about their illness and treatment, and about symptoms of particular concern for suicide risk — like agitation, sleeplessness and impulsiveness. Once a suicidally depressed patient has recovered, it is valuable for the doctor, patient and family members to discuss what was helpful in the treatment and what should be done if the person becomes suicidal again.

可能的话，重度抑郁的患者及其家人，应该参与涉及自杀的讨论。抑郁症往往会削弱人的思考能力和记忆力，因此应该给患者提供书面资料，介绍他们的病情和治疗情况，以及尤其需要注意的加大自杀风险的症状，如焦躁、失眠和冲动。一旦有自杀倾向的抑郁症患者康复，医生、患者及家人应当讨论治疗过程中的哪些做法起了作用，以及如果患者又想自杀，应该采取什么措施。这样的讨论十分宝贵。

作动词，表示“缓和，缓解；减轻”，英文解释为“to make something less severe”举个🌰：

Homeless children sniff glue to dull their hunger pains.

无家可归的孩子吸胶毒来减轻饥饿带来的痛苦。

People who are depressed are not always easy to be with, or to communicate with — depression, irritability and hopelessness can be contagious — so making plans when a patient is well is best. An advance directive that specifies wishes for future treatment and legal arrangements can be helpful. I have one, which specifies, for instance, that I consent to ECT if my doctor and my husband, who is also a physician, think that is the best course of treatment.

抑郁症患者经常不好相处，也不容易交流——压抑、易怒、无望的感觉会感染他人——所以最好的做法是，在患者状态良好时制定计划。一种有益的做法是，提前制定一个方案，阐明未来的治疗目标和法律安排。我就有一份方案。例如，它指出，如果我的医生和同为医生的丈夫认为电休克是最好的治疗方案，我就同意采用这种疗法。

contagious /kən'teɪdʒəs/ 1) 表示“（疾病）接触传染的”，英文解释为“A disease that is contagious can be caught by touching people or things that are infected with it.”

2) 表示“（感情、态度、行动）富于感染力的，会蔓延的”，英文解释为“If a feeling, attitude, or action is contagious, other people are quickly affected by it and begin to have it or do it”，如：her contagious enthusiasm 她那富有感染力的热情。

Because I teach and write about depression and bipolar illness, I am often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential.

因为我从事与抑郁症和双相障碍相关的教学和写作，经常有人问我，在治疗双相障碍中最重要的因素是什么。我的回答是能力。同情心固然重要，但能力才是必须的。

I was fortunate that my psychiatrist had both. It was a long trip back to life after nearly dying from a suicide attempt, but he was with me, indeed ahead of me, every slow step of the way.

很幸运，我的精神医生两者兼有。我在尝试自杀之后几乎死去，重新回归生活是一条漫长的路程，但他与我并肩前行，确切说是带领我前行，缓缓地走出了每一步。

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