英国新闻听力 抑郁症（在线收听）

即使在那些经济政治稳定，生活状况越来越好的国家，患抑郁症的人群也呈上涨趋势。

注释：

Withdrawn adj. 孤僻的，性格内向的 

problematic adj. 问题的，有疑问的 

bipolar disorder 躁郁症 

imbalance n. 不均衡，不平衡 

dilemma n. 进退两难的境地，困难的选择 

fallacious adj. 荒谬的

Depression

CLAUDIA HAMMOND: Last week on the program we talked about the increasing burden of mental health problems in the world, and just one of those illnesses on the up, is depression. Even in countries where things seem to be getting better with better with more economic and political stability, depression is on the increase. Here’s one woman’s experience.

WOMAN: I remember being suicidal from the time I was around 11 or 12, but I didn’t know why. Everyone thought I was a happy child, but inside I had a lot of aggression. I was moody, I didn’t like my life, I thought I was unloved, I felt hopeless, but in Kenya those things are taken as mood swings, so my parents just assumed I was withdrawn and moody.

CLAUDIA HAMMOND: This woman’s depression was so serious that she suicidal, yet her family saw her behavior as perfectly normal. But while some people like her are struggling to get their depression taken seriously, a recent article in the British Medical Journal, has suggested that in some places depression is over diagnosed, with everyday sadness being labeled as depression, when that’s all it is sadness. This was the topic of a conference de-medicalizing misery, held in London a few days ago. To discuss whether too many people are being given a diagnosis of depression, I spoke to Dr. Frank Jenga, President of the African Association of Psychiatrists on the line from the Kenyan capital, Nairobi. And to Joanna Moncrieff, a psychiatrist and senior lecturer at University College London. She believe some people are being treated for depression unnecessarily

JOANNA MONCRIEFF: I think it’s been massively over diagnosed in the last few years, although I have to say as well that I have a problem with the whole concept of depression. So I don’t only believe that it’s being over diagnosed, I think the process of diagnosing depression is itself problematic. And I think that rather than trying to diagnose a disease in a medical sort of way, we should actually trying to be address individual’s problems, and see people as individuals with a unique set of circumstances that have led them to seek help.

CLAUDIA HAMMOND: Is there a case for that you think Frank, I mean you are diagnosing people with depression, do you think it is a actual disease and actual illness?

FRANK JENGA: Yes I mean, I’ve been in practice for many many many years, and I am confident that there are a large number of human beings over the world who suffer from a very distinct clinical entity, that is recognizable in all cultures as a depressive illness. And let me tell you this, and this is the most boring thing about my practice, all depression looks identical, and you might say you are depressed in Chinese, You might say it in Japanese, in English, in Swahili. At the end of the day, a trained psychiatrist or doctor will be able to diagnose that is a clinical depression.

CLAUDIA HAMMOND: So Joanna, would you say that it just depend on the psychiatrist or should we not be diagnosing anybody with depression?

JOANNA MONCRIEFF: I just wanted to come back on Frank’s assertion that there is this very clear cut universal syndrome of depression. And look at this historically that what we call depression now, is not even spoken about, not recognized, not thought about prior to the 1950’s. It’s actually been invented alongside the anti-depressants. And what has happened recently, in fact in western countries is the market for anti-depressants is now saturated, and now people who would have been diagnosed as depressed 10 years ago, are having a diagnosis of bipolar disorder, that’s the latest fashionable diagnosis. So, you know diagnosis are constructed, and they were response to social circumstances, and I don’t think it’s the case that there is simply this clear cut easily recognizable entity called depression out there.

FRANK JENGA: Completely false! 50 years ago we didn’t have mobile phones, we didn’t have computers, we didn’t regularly go into outer space. There are so many things that have developed and changed technologically in the world in the last 50 years for which we have had to define and redefine boundaries, and give them new names. I think the fact that things have changed or didn’t exist 50 years ago, is not an argument, for the fact that it did not exist then. We just didn’t have a good or proper definition of those conditions. That is my argument.

CLAUDIA HAMMOND: I mean definitely it does seem to be something that, you know a lot of people, or some people are pleased to get that diagnosis, and that they are, you know, relieved to find that there something is wrong with them, if you like, or this is what’s happening, so it seems to make sense to people, doesn’t it?

JOANNA MONCRIEFF: I think there is some people who find the idea that they have a chemical imbalance in their brain helpful. However I have concerns about that, because I don’t think we’ve really got any evidence that there is a chemical imbalance in people’s brains, and I think that if people view their problems in that way, they may not take the steps that they need to take to address the circumstances that have led to them feeling depressed.

CLAUDIA HAMMOND: Is there a danger Frank that we might ignore the circumstances and just medicate people for depression, when in fact there could be things that change in their life instead that might make that difference?

FRANK JENGA: You see, this is the dilemma in the minds of some of us which is that if one tries to argue that all sad people have clinical depression, then that to me is clearly nonsense, but to argue that there are not people with a clearly defined syndrome, recognizable by trained individuals as depression, is equally fallacious in my view. I can say I have seen many people with a clear cut well defined depressive illness that has responded to appropriate intervention, but I also admit that there are many sad people, who have been wrongly diagnosed as suffering from depression.

CLAUDIA HAMMOND: So finally, Joanna, we’ve heard that it may make a massive difference to people to be able to be treated and that maybe treatments should be being increased, I mean should be being made more available across the world to give people these opportunities?

JOANNA MONCRIEFF: Well, I don’t think that we’ve got any really good evidence that using drug treatment actually helps people with any sort of depression. And I think its being over diagnosed in western countries, and the market for anti-depressants is probably now saturated in the west, and therefore the drug companies are looking to promote an increased diagnosis of depression in other areas of the world .

FRANK JENGA: Let me say this. Recent evidence in the Lancet actually, by a chap called Vikram Bathel, has demonstrated without absolutely any doubt in the world, that if you do not treat depression, say in mothers of small babies the growth of those children is retarded. In fact the argument now is that there is an absolute great imperative to systematically, properly, and adequately treat depression, particularly in the poorer countries. And the place, played in depression, in the causation of poverty in the developing world, is now without question, without doubt, and therefore the treatment of depression in the developing world is in fact itself a strategy for poverty reduction. 

抑郁症

克劳迪娅?哈蒙德：在上周的节目中我们谈到了全人类精神负担增加的健康问题，其中一个呈上涨趋势的病症即是抑郁症。即使在那些经济政治稳定，生活状况越来越好的国家，患抑郁症的人群也呈上涨趋势。下面是一位女士的经历。

女士：我记得从大约11到12岁时起我就有了自杀倾向，但是我不知道原因。每个人都觉得我是一个快乐的小孩子，但在内心深处，我有很强的侵略性。我喜怒无常，讨厌自己的生活，觉得没有人爱我，感到非常无助，但在肯尼亚，这些都被视为是心情的阴晴不定。因此父母认为我仅仅是性格比较孤僻忧郁。

克劳迪娅?哈蒙德：刚刚这位女士的抑郁症比较严重，她蓄意自杀。然而她的父母却认为她的行为举止非常正常。当一些人和这位女士一样，努力使自己的抑郁症被认真对待时，最近发表在英国医学期刊上的一篇文章暗示了这样一种情况—随着普通的悲伤被贴上抑郁症的标签，在一些地方，本来仅仅是悲伤的心情却被夸张的诊断成了抑郁症。这种情况就是不久前在伦敦举行的de-medicalizing misery会议上讨论的主题。为了探讨是否有过多的人被诊断成患有抑郁症，我采访了在肯尼亚首都内罗毕的非洲精神病学协会会长弗兰克?詹戈医生，及精神病学家和伦敦大学学院的高级讲师乔安娜?蒙克里夫。她相信一些人没有必要被当作抑郁症患者对待。

乔安娜?蒙克里夫：尽管我不得不承认对抑郁症的整个概念仍存疑惑，但我认为最近几年很多人被过度诊断为抑郁症。我相信这不只是过度诊断的问题，诊断抑郁症的这个过程本身就存在问题。我们不应该设法用医学方式来诊断病症，而应该努力找出人们的问题所在，并视人们为因其所处的特殊环境所致而寻求帮助的个体。

克劳迪娅?哈蒙德：弗兰克，你认为情形是那样吗？你在替那些抑郁症患者诊断，你认为抑郁症真的是一种疾病吗？

弗兰克?詹戈：是的。我已经实践了很多很多年，我可以自信的说世界上有很多人在遭受这种在任何文化中都被公认为是抑郁症病症的独特临床实体。我要告诉你这是我实践中最令人厌烦的事，所有的抑郁症看上去是一样的，你可能用中文说你很抑郁，可能用日语说，也可能用英语或者斯瓦希里语说。在一天的末尾，一个受过训练的精神病学家或者医生能够诊断出那就是临床抑郁症。

克劳迪娅?哈蒙德：那么乔安娜，你是否觉得那仅仅取决于精神病学家或者我们不应该诊断那些抑郁症患者？

乔安娜?蒙克里夫：我只是想回到弗兰克刚才的断言。他认为有明确的普遍抑郁症综合病症。从历史上看，在二十世纪五十年代以前，我们现在所称之为的抑郁症根本没有被提出，被认识到或者被考虑到。它事实上是与抗抑郁药一起出现的。最近发生的是，现在在西方国家事实上抗抑郁药市场已经饱和。10年前被诊断为抑郁症的那些人现在被诊断患有躁郁症，这是最近流行的诊断。诊断是人为创立的，根据社会环境的变化而变化，所以我认为事情不是将这个明确易辨认的实体称为抑郁症这么简单。

弗兰克?詹戈：你完全错了！50年前我们没有手机、电脑，也不会有规律的去太空。过去的50年中世界上的很多东西都有了技术上的发展和变化，我们必须给它们定义和再定义分界，并给他们命名。我认为事物变化或者50年前不存在的这些事实不是一个论据，因为那时它确实不存在。我们对那些情形并没有一个好的或者合适的定义。这就是我的论点。

克劳迪娅?哈蒙德：确切的说，一些人似乎很乐意得到这样的诊断结果。当发现自己确实有些问题时，他们会感到安心。这对人们而言似乎是有意义的，不是吗？

乔安娜?蒙克里夫：有些人认为脑部出现化学成分不均衡是有益的。我关注过这个问题，因为我不认为有任何证明显示人们的脑部有化学成分不均衡。如果人们用那种方式来看待他们的问题，那么他们肯定不会采取必要的措施来找出导致他们感觉抑郁的环境。

克劳迪娅?哈蒙德：弗兰克，我们可能忽视了环境，仅仅用药物去治疗那些抑郁症患者，而如果事实是他们生活中的一些改变造就了这些差别，这样做是否会有危险呢？

弗兰克?詹戈：这就是我们中的一些人需要面对的两难境地。如果有人争论说所有的有悲伤情绪的人都患有临床抑郁症，他的争论对我而言完全是胡说。但如果有人争论说任何患有明确的综合病症患者都不能被受训过的个体确认为抑郁症患者，那这个争论对我而言也是谬论。我确实见过很多人明确患有抑郁症病症，对适当的干涉有反应，当然我也承认有很多心情悲伤的人被误诊为患有抑郁症。

克劳迪娅?哈蒙德：乔安娜，我们听说那些能够接受治疗的人的情况与没有接受治疗的会大有不同，可能治疗机会会越来越多。我是指应该给全世界的人们提供越来越多的治疗机会？

乔安娜?蒙克里夫：我们现在还没有足够的证据显示使用药物治疗对患有任何一种抑郁症的患者有帮助。我认为西方国家存在着抑郁症的过度诊断，并且西方国家的抗抑郁药市场已经饱和。因此那些制药公司期望在世界其他地区推动抑郁症确诊的增加。

弗兰克?詹戈：让我来说。一个叫维克拉姆?巴塞尔的人在Lancet杂志上发表的一个最新证据证明，毫无疑问在这个世界上，如果不治疗抑郁症，例如那些小婴儿的妈妈的抑郁症，那么那些孩子会成长迟缓。事实上现在的论点是：系统的、适当的并且充分的治疗抑郁症的需要是非常强烈的，尤其是在那些比较贫苦的国家。毫无疑问，抑郁症遍布横行的地区就是那些贫穷的发展中国家。因此事实上发展中国家的抑郁症治疗本身就是减少贫困的一个战略。