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脑创伤后个性可能从坏变好吗?

更新时间:2018/1/18 20:57:30 来源:本站原创 作者:佚名

When personality changes from bad to good
脑创伤后个性可能从坏变好吗?

In the classic 80s rom-com Overboard, Goldie Hawn’s spoilt, selfish character suffers a brain injury in a yachting accident. As well as causing memory loss, the accident transforms her personality in positive ways – she becomes caring and considerate and less materialistic.

在经典的80年代浪漫喜剧《落水姻缘》(Overboard,又名《小迷糊表错情》)中,在一次游艇事故中因为大脑受到损伤,戈尔迪·霍恩(Goldie Hawn)被宠坏的自私个性受到打击。除了造成记忆丧失,这次事故还以积极的方式改变了她的个性——她变得有爱心、体贴,不再那么信奉物质主义了。

That a brain injury could lead to this kind of personality change may sound far-fetched, but consider the real-life “Patient 3534”, a woman who had a brain tumour removed at the age of 70, leaving damage to the front of both sides of her brain. According to her husband, who’d known her for 58 years, before her surgery she had a “stern” personality, was highly irritable and grumpy. After the brain surgery, he said that she was “happier, more outgoing, and more talkative than ever before”.

脑损伤导致的这种个性改变听起来有些牵强,但想想现实生活中的"3534号患者",她是一个在70岁时摘除了脑肿瘤的女人,她的大脑两侧都留下了损伤。据认识她长达58年的丈夫说,在手术前,她"苛刻、脾气暴躁、易怒"。他表示,在接受脑部手术后,她"比以前更快乐、更外向、更健谈"。

Patient 3534 is not the only one with such a change. There is now evidence that, at least for a minority of patients, beneficial personality changes are a reality, a revelation that is bound to prompt a new perspective on the impact brain damage has on personality.

"3534号患者"并不是唯一发生这种变化的人。目前有证据表明,至少对少数患者而言,有益的人格改变是实际存在的,这一发现必然会引发对脑损伤对人格影响的新认识。

Although it has long been known that brain damage can change personality, the literature has almost exclusively focused on personality impairments. Take the famous case of Phineas Gage, the 19th-Century railway worker who was described by friends as “no longer Gage” after an iron rod blasted through the front of his brain in a terrible accident. The once shrewd, intelligent man was said to have become aggressive and impulsive (although according to modern accounts, he later overcame these problems and started a new life as a horse carriage driver).

尽管人们早就知道脑损伤会改变人的个性,但现有文献几乎只关注人的个性缺陷。以著名的菲尼亚斯·盖奇(Phineas Gage)为例,这位19世纪的铁路工人被朋友描述为"不再是盖奇",因为在一场可怕的事故中,一根铁棒穿过他的大脑。据说,此后,这个曾经聪明机灵的人变得好斗和冲动(尽管根据现代的记录,他后来克服了这些问题,开始了作为马车司机的新生活)。

Similar to Gage’s story, there are also many modern published accounts of patients with damage to the front of their brains subsequently exhibiting disinhibited (socially inappropriate) behaviour, or even behavior that appears psychopathic.

与盖奇的经历相似,还有许多关于现代病人的报告,在大脑受损后,他们的大脑中出现了被抑制的行为(不当社会行为),甚至还表现出精神病态的行为。

But this negative picture “may only capture part of the story” according to a recent study in the journal Neuropsychologia. A team, led by psychologist Marcie King at the University of Iowa, found that out of 97 previously healthy patients who had suffered permanent damage to a specific area of their brains, 22 of them showed positive personality changes afterwards. Of the remainder, 54 had negative personality changes and the rest showed no change at all. These observations were based on asking a relative or close friend to rate 26 aspects of their personality before and after the injury.

但是,根据《神经心理学杂志》(Neuropsychologia)的最近一项研究,这种消极的画面"可能仅仅捕捉到故事的一个部分"。由爱荷华大学心理学家玛西·金(Marcie King)领导的一个研究小组发现,在97名之前健康的患者中,在其大脑某个特定区域遭受永久性损伤后,其中22人表现出了积极的个性变化。剩下的人当中,有54人的个性发生负面变化,而其余的人则没有任何变化。这些观察结论是基于在患者受伤前后分别请患者的一位亲戚或密友在26个方面给患者所做出的打分。

Past research has hinted at ways that damage to specific brain regions can sometimes have positive effects. For instance, a 2007 study of Vietnam War veterans found that those who had suffered damage to the areas thought to play a role in the development of post-traumatic stress disorder (regions involved in emotion and decision making) were less likely to have developed PTSD. Similar research found that patients with damage to an area important for emotions, were less prone to depression.

以往的研究显示,对大脑特定区域的损害有时会产生积极的影响。例如,2007年一项针对越战老兵的研究发现,被认为对"创伤后应激障碍"有影响的部分(涉及情感和决策的区域)受损的人患上创伤后应激障碍的可能性更小。类似的研究发现,那些对情绪有重要影响的区域受损的患者,患抑郁症的几率较低。

However, the new study is the first to document more wide-ranging beneficial personality changes in a large group of patients.

然而,这项新的研究是首度在大量患者记录上进行的广泛的有益人格变化的研究。

As another example, take “Patient 2410”, a 30-year-old man who needed surgery after suffering a brain aneurysm. Both he and his spouse described how, pre-injury, he was short-tempered and prone to anger, and generally “mopey”. Post injury, by contrast, he laughs and jokes and is “more passive and easy going”.

另一个例子是"2410号患者",这是一个30岁的男人,他患上了脑动脉瘤,需要做手术。他和配偶都描述到,在手术前,他脾气暴躁,容易发怒,而且通常是"闷闷不乐"。相比之下,手术后,他会大笑和开玩笑,而且"更顺从更随和"。
 
So what is going on, how can brain damage have such unexpected effects? The likelihood of a patient showing personality improvements seemed to be unrelated to gender, age, educational background or intelligence. Instead, what seemed relevant was a history of a difficult personality, such as a short temper and other negative traits, combined with a particular pattern of brain damage.

那么这到底是怎么回事?大脑损伤怎么会有这样意想不到的效果呢?患者表现出个性改善的可能性似乎与性别、年龄、教育背景或智力无关。相反,相关的似乎是过去有难相处的个性,如脾气暴躁和其他负面特征,外加一种特定的脑损伤模式。

To understand this further, King and her colleagues scanned the brains of all of the patients. They found that those who showed personality improvements were more likely than the others to have experienced damage to the most frontal regions of the brain, the bilateral frontal polar region, which is important for taking other people’s perspective and decision making.

为了对此获得深入认识,玛西·金和她的同事们扫描了所有患者的大脑。他们发现,那些表现出个性改善的人比其他人更可能受到大脑额叶区域的损伤,而这个区域对接受他人的观点和制定决策非常重要。

The methods, though, are highly exploratory and so the authors urge some caution. Their approach only allowed them to uncover broad patterns between brain damage and personality outcomes, and future research could help accurately identify which areas are associated with specific personality changes.

不过,这些方法还是高度探索性的,因此研究人员敦促人们保持谨慎。他们的研究方法让他们仅仅揭示大脑损伤与个性结果之间的广泛联系模式,而未来的研究将有助于准确识别哪些区域与特定的个性变化有关。

Also, while the personality changes for some patients were seen as positive, this shouldn’t be taken to downplay the seriousness of brain injury. Complete recovery from severe brain injury is extremely rare, and even when a patient appears fine on the surface, they may experience lasting hidden challenges, such as difficulty learning new information. Brain injury can also leave a person more vulnerable to further conditions like dementia.

另外,虽然一些患者的个性变化被认为是积极的,但也不应忽视脑损伤的严重性。从严重脑损伤中完全恢复极为罕见,即使患者表面上看起来不错,他们也可能会经历一些长期的潜在挑战,如难以学习新知。脑损伤还会使人更容易患上痴呆等疾病。

It therefore seems incredible that brain damage can lead to beneficial personality changes. However, it doesn’t seem quite so outlandish when you consider that brain surgery is sometimes used as a last-resort treatment for psychological problems, such as obsessive compulsive disorder. This brings to mind the dark history of “Psychosurgery”, as it’s known, largely because of the overly-zealous use of crude frontal lobotomy by surgeons such as Walter Freeman in the middle of the 20th Century. However, as King and her colleagues note, modern techniques are more careful and refined, and their aim is often to dial-down brain circuits that are thought to be overactive in certain mental health conditions (for instance, there is evidence that depression is associated with excessive connectivity between frontal brain regions and other neural networks involved in cognition and emotions).

因此,大脑损伤会导致有益的个性改变似乎不可思议。然而,考虑到脑外科手术有时会被用作治疗心理问题(如强迫症)的最后手段时,它看起来就不那么奇怪了。这让我们想起了"精神外科学"众所周知的黑暗历史,这在很大程度上是由于20世纪中期,像沃尔特·弗里曼(Walter Freeman)等外科医生过度狂热地粗暴使用额叶切除手术。然而,玛西·金和她的同事也注意到,现代技术更为谨慎和精确,手术的目的往往是调低大脑回路,后者被认为在患有某些精神疾病时活跃(例如,有证据表明,抑郁症与大脑额叶区域间和其他参与认知和情感神经网络的过度连接有关)。

That the brain can be purposely tweaked in this way provides a clue as to how brain damage can sometimes lead to beneficial changes. In fact, some of the neural circuits targeted by modern psychosurgery are in the same part of the brain that was damaged in those patients who showed personality improvements in King’s new research.

大脑可以被通过这种方式有意地调整,这就提供了一个线索:大脑的损伤有时会导致有益的改变。事实上,现代精神外科针对的一些神经回路与那些在玛西·金的最新研究中显示个性改善的患者大脑部分受损部分是一样的。

These new findings also complement research into the neurological basis of personality, including the finding that extraverts are less sensitive to neural stimulation, for instance, or that highly agreeable people show more brain activation in regions involved in controlling negative emotion. It’s logical that by altering these kinds of neural patterns, brain damage might sometimes have paradoxically beneficial outcomes.

这些新发现还补充了对人格神经学基础的研究,例如,研究发现,外向的人对神经刺激的敏感度较低,或者说,很随和的人在控制消极情绪的区域表现出更多的大脑活动。这个发现是合乎逻辑的,通过改变这些神经模式,大脑损伤有时反而可能产生有益的结果。

It’s worth repeating, though, that brain injury (including “mild” concussion) should always be treated extremely seriously. Even in the rare cases of some apparently beneficial side effects, difficulties will nearly always be part of the clinical picture.

值得重申的是,我们应该非常认真的对待大脑损伤(包括"轻度"脑震荡)。即使在罕见的一些有明显有益副作用的案例中,临床表现中几乎都会存在困难。

And while a positive personality change may seem welcome, remember that our personalities reflect the essence of who we are – it’s likely to be unsettling for patients and their friends and families to adjust to a personal transformation, even a positive one. That said, that a positive personality change is possible, shows that the story of what can happen after brain injury is more complex and surprising than many of us realised.

虽然积极的个性变化可能看起来很受欢迎,但请记住,我们的个性反映了我们的本质——这可能会让患者及其亲朋在适应患者个性转变时感到不安,即使是积极的转变也不例外。这就是说,积极的个性改变是有可能的,这表明,在人们在遭受脑损伤之后发生的事情比我们许多人想象的更加复杂,更令人惊讶。

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