孤獨是一種病 比肥胖更可怕大綱
BLACKPOOL, England — The woman on the other end of the phone spoke lightheartedly of spring and her 81st birthday the previous week. “Who did you celebrate with, Beryl?” asked Alison, whose job was to offer a kind ear.
英格蘭布萊克浦——一位女士在電話裏快活地聊着春暖花開，還有她上週剛度過的81歲生日。“是誰和你一起慶生的，貝柔？”艾利森問道；她的工作就是當個耐心的聽衆。
“No one, I …” And with that, Beryl’s cheer turned to despair.
“沒有人。我......”因爲艾利森這句話，貝柔的情緒從快活轉爲低落。
Her voice began to quaver as she acknowledged that she had been alone at home not just on her birthday, but for days and days. The telephone conversation was the first time she had spoken in more than a week.
當貝柔承認自己不只生日那天獨自在家，還有好一段時間都是如此，說話的聲音開始顫抖。這通電話是她一個多星期以來首度與人交談。
About 10,000 similar calls come in weekly to an unassuming office building in this seaside town at the northwest reaches of England, which houses The Silver Line Helpline, a 24-hour call center for older adults seeking to fill a basic need: contact with other people.
在英格蘭西北區的這個海濱小鎮，每週都有大約1萬通類似的電話打進此地一棟不起眼的辦公大樓。它是Silver Line求助熱線的所在地。這是一個爲老人服務的24小時熱線中心。這些老人家打電話來，是爲了滿足生活的某種基本需求：與他人保持聯繫。
Loneliness, which Emily Dickinson described as “the Horror not to be surveyed,” is a quiet devastation. But in Britain, it is increasingly being viewed as something more: a serious public health issue deserving of public funds and national attention.
詩人艾米莉•狄金森(Emily Dickinson)把孤獨感描述爲“不可丈量的恐怖”，那是一種悄無聲息的傷害。不過在英國，人們逐漸認爲，它的危害甚至更嚴重：它是應該被嚴肅對待的公共衛生課題，值得公共資金的投入和舉國關注。
Working with local governments and the National Health Service, programs aimed at mitigating loneliness have sprung up in dozens of cities and towns. Even fire brigades have been trained to inspect homes not just for fire safety but for signs of social isolation.
與地方政府和國家醫療服務體系(National Health Service)合作、致力於減緩孤獨現象的計劃正在數十個城鎮興起。就連消防隊也受了相關訓練，除了查看民宅的防火安全，他們也要注意屋主是否有與世隔絕的跡象。
“There’s been an explosion of public awareness here, from local authorities to the Department of Health to the media,” said Paul Cann, chief executive of Age UK Oxfordshire and a founder of The Campaign to End Loneliness, a five-year-old group based in London. “Loneliness has to be everybody’s business.”
“從地方當局、衛生署到媒體，各界對這件事的關注在迅速提高，”保羅‧坎恩(Paul Cann)表示。他是老齡英國(Age UK)牛津郡分部的行政主管，也是有五年曆史的倫敦“終結孤獨”倡議行動(The Campaign ot End Loneliness)的發起人。“每個人都該關心孤獨這件事。”
Researchers have found mounting evidence linking loneliness to physical illness and to functional and cognitive decline. As a predictor of early death, loneliness eclipses obesity. “The profound effects of loneliness on health and independence are a critical public health problem,” said Dr. Carla M. Perissinotto, a geriatrician at the University of California, San Francisco. “It is no longer medically or ethically acceptable to ignore older adults who feel lonely and marginalized.”
學者已經發現，越來越多的證據顯示，孤獨與生理疾病還有行爲與認知能力下降都有關聯。孤獨也比肥胖更可能預示人的早逝。“孤獨對個人健康與自主生活能力的深刻影響，是很重要的公共衛生問題，”加州大學舊金山分校的老齡醫學專家卡拉‧M‧佩裏西諾託(Dr. Carla M. Perissinotto)說。“不論從醫學或道德的眼光來看，我們都不能再忽略那些覺得自己孤單或不受重視的長者了。”
In Britain and the United States, roughly one in three people older than 65 live alone, and in the United States, half of those older than 85 live alone. Studies in both countries show the prevalence of loneliness among people older than 60 ranging from 10 percent to 46 percent.
在英國與美國，65歲以上的民衆大約每三人裏就有一人獨居，而美國年齡在85歲以上的人，有一半是獨居。兩國的研究都顯示，60歲以上者老境孤獨的比例在10%到46%之間。
While the public, private and volunteer sectors in Britain are mobilizing to address loneliness, researchers are deepening their understanding of its biological underpinnings. In a paper published earlier this year in the journal Cell, neuroscientists at the Massachusetts Institute of Technology identified a region of the brain they believe generates feelings of loneliness. The region, known as the dorsal raphe nucleus, or DRN, is best known for its link to depression.
就在英國的公共部門、私人機構、義工團體都動員起來對付孤獨的時候，研究人員也在更深入瞭解它的生物學基礎。在今年稍早發表於《細胞》(Cell)期刊的一篇報告裏，麻省理工學院(Massachusetts Institute of Techonology)的神經科學家認爲他們找到了人腦產生孤獨感的區域。這個叫做中縫背核(dorsal raphe nucleus, DRN)的部位最爲人所知的是它和憂鬱症的關聯。
Kay M. Tye and her colleagues found that when mice were housed together, dopamine neurons in the DRN were relatively inactive. But after the mice were isolated for a short period, the activity in those neurons surged when those mice were reunited with other mice.
戴琦(Kay M. Tye)與她的同事發現，實驗用小鼠住在一起的時候，鼠腦中縫背核裏的多巴胺神經元比較不活躍。不過老鼠被隔離一小段時間再放回鼠羣裏的時候，這些神經元的活動會大幅增加。
“This is the first time we’ve found a cellular substrate for this experience,” said Tye, an assistant professor at the Picower Institute for Learning and Memory at MIT and a senior author of the paper. “And we saw the change after 24 hours of isolation.”
“這是我們第一次發現孤獨感的細胞學根源，”戴博士說。她是麻省理工學院皮考爾學習和記憶研究所(Picower Institute for Learning and Memory)助理教授，也是該篇報告的主要作者。“在小鼠隔離了24小時之後，我們開始看到這種變化。”
John T. Cacioppo, a professor of psychology at the University of Chicago and director of the university’s Center for Cognitive and Social Neuroscience, has been studying loneliness since the 1990s. He said loneliness is an aversive signal much like thirst, hunger or pain.
約翰•T•卡奇奧波(John T. Cacioppo)是芝加哥大學(University of Chicago)心理學教授，也是該校認知與社會神經科學中心(Center for Cognitive and Social Neuroscience)主任。他自20世紀90年代以來就一直在研究孤獨感。他說，孤獨感與口渴、飢餓、疼痛很相似，是一種反向訊號。
“Denying you feel lonely makes no more sense than denying you feel hunger,” he said. Yet the very word “lonely” carries a negative connotation, Cacioppo said, signaling social weakness, or an inability to stand on one’s own.
卡奇奧波表示：“拒絕承認自己的孤獨感，就像拒絕承認自己餓了一樣，沒有意義。”不過他也說，“孤獨”這個字本身有負面涵義，意味着一個人不善社交或無法自立更生。
The unspoken stigma of loneliness is amply evident during calls to The Silver Line. Most people call asking for advice on, say, roasting a turkey. Many call more than once a day. One woman rings every hour to ask the time. Only rarely will someone speak frankly about loneliness.
這種沒有被言說的污名，從打給Silver Line的電話裏很能看得出來。大部分去電尋求建議的人，問的都是，比方說，“怎麼烤火雞”這種問題；有些人一天會打上好幾通。有位女性每小時都會打這條專線問時間。只有極少數人會坦誠地討論自己的孤單感受。
Yet the impulse to call in to services like The Silver Line is a healthy one, Cacioppo said.
不過卡奇奧波說，想給這類服務熱線打電話的衝動是健康的。
Sophie Andrews, chief executive of The Silver Line, said she was surprised by the explosion of calls shortly after the service began operating nearly three years ago. The Blackpool call center now receives some 1,500 calls a day.
Silver Line的執行主管蘇菲‧安德魯斯(Sophie Andrews)表示，這條專線在近三年前開通後，很快就涌入大量電話，她很驚訝。如今他們在布萊克浦的中心每天接聽大約1500通電話。
Andrews said she was most concerned not about those who called The Silver Line, but those who were too depressed by their isolation to pick up the phone. “We need to raise awareness with the people who are the hardest to reach,” she said.
安德魯斯還說，她最擔心的不是那些打電話來的人，而是那些因爲孤獨而過度抑鬱，以至於連電話也不想打的人。“對於最難接觸到的人羣，我們需要引起更多的重視，”她說。
Cacioppo lauds efforts like The Silver Line, yet he warns that the problem of loneliness is nuanced and the solutions not as obvious as they might seem. That is, a call-in line can help reduce feelings of loneliness temporarily, but is not likely to reduce levels of chronic loneliness.
卡奇奧波對Silver Line這類努力表示讚許，但他也警告，孤獨的問題還有很多細分，解決之道也不如表面看來那麼顯而易見。也就是說，電話專線能幫人暫時緩解孤獨的感覺，卻不太可能降低長期的孤獨感。
In his research, Cacioppo has shown that loneliness affects several key bodily functions, at least in part through overstimulation of the body’s stress response. Chronic loneliness, his work has shown, is associated with increased levels of cortisol, a major stress hormone, as well as higher vascular resistance, which can raise blood pressure and decrease blood flow to vital organs.
卡奇奧波的研究顯示，孤獨感會影響許多身體重要功能，至少部分是因爲人體應激反應被過度激發造成的。他的研究工作顯示，長期感覺孤獨與皮質醇濃度上升有關（這是一種主要的應激荷爾蒙），也與較高的血管阻力有關；血管阻力能使血壓上升、減少流入主要器官的血液量。
Cacioppo’s research has also shown that the danger signals activated in the brain by loneliness affect the production of white blood cells; this can impair the immune system’s ability to fight infections.
卡奇奧波的研究還顯示，腦部受孤獨感刺激所釋放出的警示訊號會影響白細胞的生成，而這有可能損及免疫系統對抗感染的能力。
It is only in the past several years that loneliness been examined through a medical, rather than psychological or sociological, lens. Perissinotto, the University of California, San Francisco geriatrician, decided to study loneliness when she began to sense there were factors affecting her patients’ health that she was missing.
人們透過醫學而非心理學或社會學的角度研究孤獨感，不過是近幾年的事。前面提到的老齡醫學醫師佩裏西諾託決定要投入孤獨感的研究，是因爲她開始覺得有些因素在影響她的病人的健康狀況，但她卻不知是什麼。
Although plenty of research into loneliness takes place in the United States, Britain remains well ahead in addressing the problem.
雖然有很多孤獨感的研究是在美國做的，不過在應對這個問題方面，英國還是領先許多。
“In the U.S., there isn’t much recognition in terms of public health initiatives or the average person recognizing that loneliness has to do with health,” said Julianne Holt-Lunstad, a professor of psychology at Brigham Young University, whose studies also link loneliness to deteriorating health.
“美國的公共衛生行動還不怎麼認可這個問題，一般人也不太瞭解孤獨感會影響健康，”楊百翰大學(Brigham Young University)的心理學教授茱莉安‧浩特─朗斯泰德(Julianne Holt- Lunstad)說。她的研究也顯示出孤獨感與健康損害有關。
Age UK, an organization similar to AARP in the United States, oversees an array of programs aimed at decreasing loneliness and coordinates efforts with fire brigades to look for signs of loneliness and isolation in the homes they enter.
老齡英國是一個與美國退休人員協會(AARP)相似的組織，他們監督一系列旨在減輕老人孤獨處境的項目。該組織也與消防隊合作，讓消防人員在上門檢查時，也注意屋主是否有孤獨或與世隔絕的跡象。
Another charity, Open Age, runs some 400 activities each week in Central London — sewing circles, current events discussions, book clubs and exercise and computer classes, held at church halls, sport centers, housing projects — and its employees also visit people in their homes to try to get them out and about.
另一個慈善組織Open Age每週在倫敦市中心組織400多種活動：縫紉團體、時事討論會、閱讀俱樂部、體能鍛鍊、電腦班。活動舉辦地點則在教堂大廳、運動中心或社會住宅。該組織員工也會上門探視，想辦法讓老人出門走走。
“We try to work out what it is that’s preventing them from leaving the house,” said Helen Leech, the organization’s director.
“我們會去了解是什麼原因使他們不願出門，”Open Age的主任海倫‧利奇(Helen Leech)說。
Men and women differ greatly in how they grapple with loneliness. Seventy percent of the calls to The Silver Line are from women.
男女應付孤獨感的方式大不相同。打給Silver Line的有70%是女性。
