孤独是一种病 比肥胖更可怕

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.

英格兰布莱克浦——一位女士在电话里快活地聊着春暖花开，还有她上周刚度过的81岁生日。“是谁和你一起庆生的，贝柔？”艾利森问道；她的工作就是当个耐心的听众。

“No one, I …” And with that, Beryl’s cheer turned to despair.

“没有人。我......”因为艾利森这句话，贝柔的情绪从快活转为低落。

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.

当贝柔承认自己不只生日那天独自在家，还有好一段时间都是如此，说话的声音开始颤抖。这通电话是她一个多星期以来首度与人交谈。

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.

在英格兰西北区的这个海滨小镇，每周都有大约1万通类似的电话打进此地一栋不起眼的办公大楼。它是Silver Line求助热线的所在地。这是一个为老人服务的24小时热线中心。这些老人家打电话来，是为了满足生活的某种基本需求：与他人保持联系。

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.

诗人艾米莉•狄金森(Emily Dickinson)把孤独感描述为“不可丈量的恐怖”，那是一种悄无声息的伤害。不过在英国，人们逐渐认为，它的危害甚至更严重：它是应该被严肃对待的公共卫生课题，值得公共资金的投入和举国关注。

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.

与地方政府和国家医疗服务体系(National Health Service)合作、致力于减缓孤独现象的计划正在数十个城镇兴起。就连消防队也受了相关训练，除了查看民宅的防火安全，他们也要注意屋主是否有与世隔绝的迹象。

“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.”

“从地方当局、卫生署到媒体，各界对这件事的关注在迅速提高，”保罗‧坎恩(Paul Cann)表示。他是老龄英国(Age UK)牛津郡分部的行政主管，也是有五年历史的伦敦“终结孤独”倡议行动(The Campaign ot End Loneliness)的发起人。“每个人都该关心孤独这件事。”

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.”

学者已经发现，越来越多的证据显示，孤独与生理疾病还有行为与认知能力下降都有关联。孤独也比肥胖更可能预示人的早逝。“孤独对个人健康与自主生活能力的深刻影响，是很重要的公共卫生问题，”加州大学旧金山分校的老龄医学专家卡拉‧M‧佩里西诺托(Dr. Carla M. Perissinotto)说。“不论从医学或道德的眼光来看，我们都不能再忽略那些觉得自己孤单或不受重视的长者了。”

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.

在英国与美国，65岁以上的民众大约每三人里就有一人独居，而美国年龄在85岁以上的人，有一半是独居。两国的研究都显示，60岁以上者老境孤独的比例在10%到46%之间。

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.

就在英国的公共部门、私人机构、义工团体都动员起来对付孤独的时候，研究人员也在更深入了解它的生物学基础。在今年稍早发表于《细胞》(Cell)期刊的一篇报告里，麻省理工学院(Massachusetts Institute of Techonology)的神经科学家认为他们找到了人脑产生孤独感的区域。这个叫做中缝背核(dorsal raphe nucleus, DRN)的部位最为人所知的是它和忧郁症的关联。

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)与她的同事发现，实验用小鼠住在一起的时候，鼠脑中缝背核里的多巴胺神经元比较不活跃。不过老鼠被隔离一小段时间再放回鼠群里的时候，这些神经元的活动会大幅增加。

“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.”

“这是我们第一次发现孤独感的细胞学根源，”戴博士说。她是麻省理工学院皮考尔学习和记忆研究所(Picower Institute for Learning and Memory)助理教授，也是该篇报告的主要作者。“在小鼠隔离了24小时之后，我们开始看到这种变化。”

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.

约翰•T•卡奇奥波(John T. Cacioppo)是芝加哥大学(University of Chicago)心理学教授，也是该校认知与社会神经科学中心(Center for Cognitive and Social Neuroscience)主任。他自20世纪90年代以来就一直在研究孤独感。他说，孤独感与口渴、饥饿、疼痛很相似，是一种反向讯号。

“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.

卡奇奥波表示：“拒绝承认自己的孤独感，就像拒绝承认自己饿了一样，没有意义。”不过他也说，“孤独”这个字本身有负面涵义，意味着一个人不善社交或无法自立更生。

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.

这种没有被言说的污名，从打给Silver Line的电话里很能看得出来。大部分去电寻求建议的人，问的都是，比方说，“怎么烤火鸡”这种问题；有些人一天会打上好几通。有位女性每小时都会打这条专线问时间。只有极少数人会坦诚地讨论自己的孤单感受。

Yet the impulse to call in to services like The Silver Line is a healthy one, Cacioppo said.

不过卡奇奥波说，想给这类服务热线打电话的冲动是健康的。

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的执行主管苏菲‧安德鲁斯(Sophie Andrews)表示，这条专线在近三年前开通后，很快就涌入大量电话，她很惊讶。如今他们在布莱克浦的中心每天接听大约1500通电话。

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.

安德鲁斯还说，她最担心的不是那些打电话来的人，而是那些因为孤独而过度抑郁，以至于连电话也不想打的人。“对于最难接触到的人群，我们需要引起更多的重视，”她说。

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.

卡奇奥波对Silver Line这类努力表示赞许，但他也警告，孤独的问题还有很多细分，解决之道也不如表面看来那么显而易见。也就是说，电话专线能帮人暂时缓解孤独的感觉，却不太可能降低长期的孤独感。

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.

卡奇奥波的研究显示，孤独感会影响许多身体重要功能，至少部分是因为人体应激反应被过度激发造成的。他的研究工作显示，长期感觉孤独与皮质醇浓度上升有关（这是一种主要的应激荷尔蒙），也与较高的血管阻力有关；血管阻力能使血压上升、减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.

卡奇奥波的研究还显示，脑部受孤独感刺激所释放出的警示讯号会影响白细胞的生成，而这有可能损及免疫系统对抗感染的能力。

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.

人们透过医学而非心理学或社会学的角度研究孤独感，不过是近几年的事。前面提到的老龄医学医师佩里西诺托决定要投入孤独感的研究，是因为她开始觉得有些因素在影响她的病人的健康状况，但她却不知是什么。

Although plenty of research into loneliness takes place in the United States, Britain remains well ahead in addressing the problem.

虽然有很多孤独感的研究是在美国做的，不过在应对这个问题方面，英国还是领先许多。

“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.

“美国的公共卫生行动还不怎么认可这个问题，一般人也不太了解孤独感会影响健康，”杨百翰大学(Brigham Young University)的心理学教授茱莉安‧浩特─朗斯泰德(Julianne Holt- Lunstad)说。她的研究也显示出孤独感与健康损害有关。

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.

老龄英国是一个与美国退休人员协会(AARP)相似的组织，他们监督一系列旨在减轻老人孤独处境的项目。该组织也与消防队合作，让消防人员在上门检查时，也注意屋主是否有孤独或与世隔绝的迹象。

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.

另一个慈善组织Open Age每周在伦敦市中心组织400多种活动：缝纫团体、时事讨论会、阅读俱乐部、体能锻炼、电脑班。活动举办地点则在教堂大厅、运动中心或社会住宅。该组织员工也会上门探视，想办法让老人出门走走。

“We try to work out what it is that’s preventing them from leaving the house,” said Helen Leech, the organization’s director.

“我们会去了解是什么原因使他们不愿出门，”Open Age的主任海伦‧利奇(Helen Leech)说。

Men and women differ greatly in how they grapple with loneliness. Seventy percent of the calls to The Silver Line are from women.

男女应付孤独感的方式大不相同。打给Silver Line的有70%是女性。