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必要なのは人との繋がり―「依存症」 間違いだらけの常識(TED)

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ジョハン・ハリ: 「依存症」― 間違いだらけの常識

「依存症」― 間違いだらけの常識

薬物からスマートフォンまで、「依存症」を引き起こすものとは一体何でしょう?どうしたら依存症を克服できるのでしょう?現在行われている対策が失敗し、愛する人々が薬物中毒に苦しむ様子を自分の目で見てきたジョハン・ハリは、なぜ依存症にこういう対応をするのか、もっと良い方法はないのかと疑問を持ちました。この人類長年の問題ともいえる命題の探求のため、世界を旅して彼が得た意外な捉え方や明るい見通しを、非常に個人的なトークの中で紹介します。(約15分)。

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辿り着いたこたえは、これまでの常識と真逆の事だった

ジョハン・ハリは、まわりにいる大切な人たちが薬物依存に苦しんでいたのを見て、なにか救う方法がないかと答えを探し始めました。すると、調べて行くうちに答えのわからない疑問点が次々と出てきました。

たとえば、『 依存症の真の原因とは何か?』ということです。

いろいろと調べましたが、結局答えは見つかりませんでした。そのため、ジョハン・ハリは世界中の識者に会いに行きます。そのなかで、ジョハン・ハリはいくつかの興味深い事実を知ります。そして、これまでの薬物対策や依存治療に対する常識が、まったく見当違いだったことがわかるのです。

私達の常識と思っていることとはなんでしょう?依存状態とはどのようなことをいうのでしょうか。薬やアルコール、人や物に依存するとはどういうことなのか。ジョハン・ハリはそのことについて観客に尋ねます。ジョハン・ハリは薬物を例に出し、薬物依存とはこれまでの認識では

  1. 薬物には依存性物質が含まれている
  2. これをしばらく摂り続けると、体がこの物質に依存して生理的に必要とするようになる
  3. 20日後には薬物中毒になる

であると、説明します。

実際、ジョハン・ハリも依存症状について調べる前は、同じような認識を持っていました。しかし、あるカナダにいる心理学のアレキサンダー教授と話しているうちに、この説のおかしさにジョハン・ハリは気が付きます。

アレキサンダー教授から、「骨折患者やその他の病人に対して、痛みの緩和剤としてモルヒネなどの薬物が長期間投与されたとしても、その患者は薬物中毒にはならない」という話を聞いたのです。

この話から、ジョハン・ハリは『このような状態が続けば依存状態になる』と思われていたこと事態が、間違っていたのではないかという疑問を抱くようになりました。

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きっかけは、実験のやりなおし

そもそも、なにをもって『依存状態』をさすのかは、昔20世紀中に行われた、ある一連の実験の結果として生まれたものでした。

ネズミをオリに入れて、2本の水ボトルを設置します。一つは水だけ、もう一つは水に薬物を混ぜたものを入れて、どちらを選ぶかというものです。結果はご想像の通り、ネズミは薬物を混ぜた水を飲んで自ら命を縮めました。しかし、アレキサンダー教授はこの実験のおかしさに気が付きます。

檻には、ネズミと水しか準備されていなかったのです。

そこで、アレキサンダー教授は新たな実験をします。それは、オリのなかにネズミが喜ぶようなチーズや遊具、同性や異性のネズミをたくさんいれて同じ日数を過ごさせてみたのです。このオリを、アレキサンダー教授は「ネズミの楽園」と名付けました。そうして実験が行われたところ、驚く結果が出ました。

薬物が入った水は、ほとんど飲まれなかったのです。

独房状態のカゴではほぼ100%過剰摂取したのに対し、ネズミが幸せに社会生活を営むオリの中では0%だったのです。この結果に、アレクサンダー教授はネズミの世界だからこうなったのだと、いったん結論付けます。しかし、それは覆されます。なんと、人間でも同様の結果がもたらされたのです。

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依存は寂しさや孤独を埋める代償行為

それは、兵士の薬物依存でした。

ベトナム戦争が行われていた時、兵士のほとんどは薬物を過剰摂取していました。当時のニュースでは、終戦後は街に薬物患者が溢れると危惧したものまで流れていました。しかし、終戦後に追跡調査を行ったところ、95%の兵士が薬物をパッと止めていたのです。

薬物の依存性についての一般論が正しいとすれば、この結果はおかしいとアレキサンダー教授は考えます。そもそも依存症には、別の側面があるのではと考え始めるのです。

この件について、オランダのピーター・コーエン教授曰く、そもそも「依存症」と呼ぶこと自体が間違っているのではないかと述べています。

「繋がり」と呼ぶべきではなかろうか。

人は他人と心を通い合わせ繋がることを自然と求める動物なので、健康で幸福な人間は触れ合いを通じて関係を築きます。しかしそれができない人は、人生の中で経験したトラウマ、孤立、虐待などが原因となり、安心感を求めて人間以外に繋がる対象を探し始めます。

Maybe we should call it bonding.

Human beings have a natural and innate need to bond, and when we’re happy and healthy, we’ll bond and connect with each other, but if you can’t do that, because you’re traumatized or isolated or beaten down by life, you will bond with something that will give you some sense of relief.

それが、薬物だったり、ギャンブルだったり、物だったり、お金だったり、はたまた人だったりするのではないかとピーター・コーエン教授は指摘します。

ジョハン・ハリは当初、この意見が腑に落ちていませんでした。しかし、我が身を振り返り、次第にこの言葉に納得します。

そして、聴衆に向かって問いかけます。わざわざお金を払って自分の話を聞きにきたあなた達には、大事にしたい仲間や人間関係がいるでしょう。そういう人たちの存在があるから、あなた達は目も当てられない依存状態に陥っていないのではないか、と。

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まとめ:必要なのは、罰を与えるより繋がりを持つこと

現在、世界各国には多くの依存状態から脱け出すためのプログラムが存在しています。しかし、それらが目まぐるしい成果を上げているかと言われてみると、必ずしもそうとはいえない状態だとジョハン・ハリは苦言を呈します。

そんななか、とある政策のおかげで、人口の1%を占めていた薬物患者が半減した国がありました。ポルトガルです。

ポルトガルでは、薬物患者を更生施設に入れたり罰を与えるのではなく、依存症の人に雇用機会を与える超大規模なプログラムを行い、起業したい依存症患者への小額融資を行う政策を行いました。

例えば元々整備士だった人が、働ける位まで回復したら、修理工場に紹介する。修理工場はこの人を一年雇えば、賃金の半分を負担すると働きかけたのです。目標は、国中の依存症患者がもれなく全員、朝起きてベッドから出る理由を持つことでした。

ジョハン・ハリは言います。

人生の中で大変な時期を 経験した方にはわかるでしょう。

傍にいてくれるのは Twitterのフォロワーではないし、立ち直らせてくれるのは Facebook友達ではない。

顔を合わせた付き合いで、お互いを知り尽くし、深い人間関係を持つ生身の友達であるはずです。

If you have a crisis in your life, you’ll notice something.

It won’t be your Twitter followers who come to sit with you. It won’t be your Facebook friends/ who help you turn it round.

It’ll be your flesh and blood friends who you have deep and nuanced and textured, face-to-face relationships with, and there’s a study.

ジョハン・ハリは豊かな暮らしが、逆に孤独を産んで依存症状を引き起こしているのではないかと指摘します。しかし、誤解しないでいただきたいのは、ジョハン・ハリはそもそもこんな社会問題を提議したかったわけではありません。

ただ、大切な人を助けたかっただけです。

しかし、友人を助けるために調べた調査は結果的に大規模なものになり、ジョン・ハリは多くのことを学ぶこととなりました。そして、どうしたらポルトガルのようなやりかたが出来るだろうと考えるようになりました。

ジョハン・ハリはいま、依存状態に悩む大切な友人たちにこう言っているそうです。

あなたともっと深く関わり合いたい。何かをやってても、そうでなくても、大切に思っている。しらふでも、そうじゃなくても、大切な人には変わりはないし、そして必要なときは 駆けつけて一緒にいてあげる。だって、愛する人を一人ぼっちにしたくないし、孤独に感じて欲しくないから

この「君は1人じゃないよ、愛されているんだよ」は、社会的にも、政治的にも、個人的にも、こういう意識で対応すべきだと、ジョハン・ハリは言います。

依存状態と戦うのではなく、愛を持って対処するべきだと。

依存の反対にあるのは、繋がりである。

心の隙間を埋めることが、人を依存症状から抜け出すきっかけになる。ジョハン・ハリのトークは、これを裏付ける貴重な話といえるでしょう。

英語全文

One of my earliest memories is of trying to wake up one of my relatives and not being able to. And I was just a little kid, so I didn’t really understand why, but as I got older, I realized we had drug addiction in my family, including later cocaine addiction.

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I’d been thinking about it a lot lately, partly because it’s now exactly 100 years since drugs were first banned in the United States and Britain, and we then imposed that on the rest of the world. It’s a century since we made this really fateful decision to take addicts and punish them and make them suffer, because we believed that would deter them; it would give them an incentive to stop.

And a few years ago, I was looking at some of the addicts in my life who I love, and trying to figure out if there was some way to help them. And I realized there were loads of incredibly basic questions I just didn’t know the answer to, like, what really causes addiction? Why do we carry on with this approach that doesn’t seem to be working, and is there a better way out there that we could try instead?

So I read loads of stuff about it, and I couldn’t really find the answers I was looking for, so I thought, okay, I’ll go and sit with different people around the world who lived this and studied this and talk to them and see if I could learn from them. And I didn’t realize I would end up going over 30,000 miles at the start, but I ended up going and meeting loads of different people, from a transgender crack dealer in Brownsville, Brooklyn, to a scientist who spends a lot of time feeding hallucinogens to mongooses to see if they like them — it turns out they do, but only in very specific circumstances — to the only country that’s ever decriminalized all drugs, from cannabis to crack, Portugal. And the thing I realized that really blew my mind is, almost everything we think we know about addiction is wrong, and if we start to absorb the new evidence about addiction, I think we’re going to have to change a lot more than our drug policies.

But let’s start with what we think we know, what I thought I knew. Let’s think about this middle row here. Imagine all of you, for 20 days now, went off and used heroin three times a day. Some of you look a little more enthusiastic than others at this prospect. (Laughter) Don’t worry, it’s just a thought experiment. Imagine you did that, right? What would happen? Now, we have a story about what would happen that we’ve been told for a century. We think, because there are chemical hooks in heroin, as you took it for a while, your body would become dependent on those hooks, you’d start to physically need them, and at the end of those 20 days, you’d all be heroin addicts. Right? That’s what I thought.

First thing that alerted me to the fact that something’s not right with this story is when it was explained to me. If I step out of this TED Talk today and I get hit by a car and I break my hip, I’ll be taken to hospital and I’ll be given loads of diamorphine. Diamorphine is heroin. It’s actually much better heroin than you’re going to buy on the streets, because the stuff you buy from a drug dealer is contaminated. Actually, very little of it is heroin, whereas the stuff you get from the doctor is medically pure. And you’ll be given it for quite a long period of time. There are loads of people in this room, you may not realize it, you’ve taken quite a lot of heroin. And anyone who is watching this anywhere in the world, this is happening. And if what we believe about addiction is right — those people are exposed to all those chemical hooks — What should happen? They should become addicts. This has been studied really carefully. It doesn’t happen; you will have noticed if your grandmother had a hip replacement, she didn’t come out as a junkie. (Laughter)

And when I learned this, it seemed so weird to me, so contrary to everything I’d been told, everything I thought I knew, I just thought it couldn’t be right, until I met a man called Bruce Alexander. He’s a professor of psychology in Vancouver who carried out an incredible experiment I think really helps us to understand this issue. Professor Alexander explained to me, the idea of addiction we’ve all got in our heads, that story, comes partly from a series of experiments that were done earlier in the 20th century. They’re really simple. You can do them tonight at home if you feel a little sadistic. You get a rat and you put it in a cage, and you give it two water bottles: One is just water, and the other is water laced with either heroin or cocaine. If you do that, the rat will almost always prefer the drug water and almost always kill itself quite quickly. So there you go, right? That’s how we think it works. In the ’70s, Professor Alexander comes along and he looks at this experiment and he noticed something. He said ah, we’re putting the rat in an empty cage. It’s got nothing to do except use these drugs. Let’s try something different. So Professor Alexander built a cage that he called “Rat Park,” which is basically heaven for rats. They’ve got loads of cheese, they’ve got loads of colored balls, they’ve got loads of tunnels. Crucially, they’ve got loads of friends. They can have loads of sex. And they’ve got both the water bottles, the normal water and the drugged water. But here’s the fascinating thing: In Rat Park, they don’t like the drug water. They almost never use it. None of them ever use it compulsively. None of them ever overdose. You go from almost 100 percent overdose when they’re isolated to zero percent overdose when they have happy and connected lives.

Now, when he first saw this, Professor Alexander thought, maybe this is just a thing about rats, they’re quite different to us. Maybe not as different as we’d like, but, you know — But fortunately, there was a human experiment into the exact same principle happening at the exact same time. It was called the Vietnam War. In Vietnam,20 percent of all American troops were using loads of heroin, and if you look at the news reports from the time, they were really worried, because they thought, my God, we’re going to have hundreds of thousands of junkies on the streets of the United States when the war ends; it made total sense. Now, those soldiers who were using loads of heroin were followed home. The Archives of General Psychiatry did a really detailed study, and what happened to them? It turns out they didn’t go to rehab. They didn’t go into withdrawal. Ninety-five percent of them just stopped. Now, if you believe the story about chemical hooks, that makes absolutely no sense, but Professor Alexander began to think there might be a different story about addiction. He said, what if addiction isn’t about your chemical hooks? What if addiction is about your cage? What if addiction is an adaptation to your environment?

Looking at this, there was another professor called Peter Cohen in the Netherlands who said, maybe we shouldn’t even call it addiction. Maybe we should call it bonding. Human beings have a natural and innate need to bond, and when we’re happy and healthy, we’ll bond and connect with each other, but if you can’t do that, because you’re traumatized or isolated or beaten down by life, you will bond with something that will give you some sense of relief. Now, that might be gambling, that might be pornography, that might be cocaine, that might be cannabis, but you will bond and connect with something because that’s our nature. That’s what we want as human beings.

And at first, I found this quite a difficult thing to get my head around, but one way that helped me to think about it is, I can see, I’ve got over by my seat a bottle of water, right? I’m looking at lots of you, and lots of you have bottles of water with you. Forget the drugs. Forget the drug war. Totally legally, all of those bottles of water could be bottles of vodka, right? We could all be getting drunk — I might after this — (Laughter) — but we’re not. Now, because you’ve been able to afford the approximately gazillion pounds that it costs to get into a TED Talk, I’m guessing you guys could afford to be drinking vodka for the next six months. You wouldn’t end up homeless. You’re not going to do that, and the reason you’re not going to do that is not because anyone’s stopping you. It’s because you’ve got bonds and connections that you want to be present for. You’ve got work you love. You’ve got people you love. You’ve got healthy relationships. And a core part of addiction, I came to think, and I believe the evidence suggests, is about not being able to bear to be present in your life.

Now, this has really significant implications. The most obvious implications are for the War on Drugs. In Arizona, I went out with a group of women who were made to wear t-shirts saying, “I was a drug addict,” and go out on chain gangs and dig graves while members of the public jeer at them, and when those women get out of prison, they’re going to have criminal records that mean they’ll never work in the legal economy again. Now, that’s a very extreme example, obviously, in the case of the chain gang, but actually almost everywhere in the world we treat addicts to some degree like that. We punish them. We shame them. We give them criminal records. We put barriers between them reconnecting. There was a doctor in Canada, Dr. Gabor Mate, an amazing man, who said to me, if you wanted to design a system that would make addiction worse, you would design that system.

Now, there’s a place that decided to do the exact opposite, and I went there to see how it worked. In the year 2000, Portugal had one of the worst drug problems in Europe. One percent of the population was addicted to heroin, which is kind of mind-blowing, and every year, they tried the American way more and more. They punished people and stigmatized them and shamed them more, and every year, the problem got worse. And one day, the Prime Minister and the leader of the opposition got together, and basically said, look, we can’t go on with a country where we’re having ever more people becoming heroin addicts. Let’s set up a panel of scientists and doctors to figure out what would genuinely solve the problem. And they set up a panel led by an amazing man called Dr. Joao Goulao, to look at all this new evidence, and they came back and they said, “Decriminalize all drugs from cannabis to crack, but” — and this is the crucial next step — “take all the money we used to spend on cutting addicts off, on disconnecting them, and spend it instead on reconnecting them with society.” And that’s not really what we think of as drug treatment in the United States and Britain. So they do do residential rehab, they do psychological therapy, that does have some value. But the biggest thing they did was the complete opposite of what we do: a massive program of job creation for addicts, and microloans for addicts to set up small businesses. So say you used to be a mechanic. When you’re ready, they’ll go to a garage, and they’ll say, if you employ this guy for a year, we’ll pay half his wages. The goal was to make sure that every addict in Portugal had something to get out of bed for in the morning. And when I went and met the addicts in Portugal, what they said is, as they rediscovered purpose, they rediscovered bonds and relationships with the wider society.

It’ll be 15 years this year since that experiment began, and the results are in: injecting drug use is down in Portugal, according to the British Journal of Criminology, by 50 percent, five-zero percent. Overdose is massively down, HIV is massively down among addicts. Addiction in every study is significantly down. One of the ways you know it’s worked so well is that almost nobody in Portugal wants to go back to the old system.

Now, that’s the political implications. I actually think there’s a layer of implications to all this research below that. We live in a culture where people feel really increasingly vulnerable to all sorts of addictions, whether it’s to their smartphones or to shopping or to eating. Before these talks began — you guys know this — we were told we weren’t allowed to have our smartphones on, and I have to say, a lot of you looked an awful lot like addicts who were told their dealer was going to be unavailable for the next couple of hours. (Laughter) A lot of us feel like that, and it might sound weird to say, I’ve been talking about how disconnection is a major driver of addiction and weird to say it’s growing, because you think we’re the most connected society that’s ever been, surely. But I increasingly began to think that the connections we have or think we have, are like a kind of parody of human connection. If you have a crisis in your life, you’ll notice something. It won’t be your Twitter followers who come to sit with you. It won’t be your Facebook friends who help you turn it round. It’ll be your flesh and blood friends who you have deep and nuanced and textured, face-to-face relationships with, and there’s a study I learned about from Bill McKibben, the environmental writer, that I think tells us a lot about this. He looked at the number of close friends the average American believes they can call on in a crisis. That number has been declining steadily since the 1950s. The amount of floor space an individual has in their home has been steadily increasing, and I think that’s like a metaphor for the choice we’ve made as a culture. We’ve traded floorspace for friends, we’ve traded stuff for connections, and the result is we are one of the loneliest societies there has ever been. And Bruce Alexander, the guy who did the Rat Park experiment, says, we talk all the time in addiction about individual recovery, and it’s right to talk about that, but we need to talk much more about social recovery. Something’s gone wrong with us, not just with individuals but as a group, and we’ve created a society where, for a lot of us, life looks a whole lot more like that isolated cage and a whole lot less like Rat Park.

If I’m honest, this isn’t why I went into it. I didn’t go in to the discover the political stuff, the social stuff. I wanted to know how to help the people I love. And when I came back from this long journey and I’d learned all this, I looked at the addicts in my life, and if you’re really candid, it’s hard loving an addict, and there’s going to be lots of people who know in this room. You are angry a lot of the time, and I think one of the reasons why this debate is so charged is because it runs through the heart of each of us, right? Everyone has a bit of them that looks at an addict and thinks, I wish someone would just stop you. And the kind of scripts we’re told for how to deal with the addicts in our lives is typified by, I think, the reality show “Intervention,” if you guys have ever seen it. I think everything in our lives is defined by reality TV, but that’s another TED Talk. If you’ve ever seen the show “Intervention,” it’s a pretty simple premise. Get an addict, all the people in their life, gather them together, confront them with what they’re doing, and they say, if you don’t shape up, we’re going to cut you off. So what they do is they take the connection to the addict, and they threaten it, they make it contingent on the addict behaving the way they want. And I began to think, I began to see why that approach doesn’t work, and I began to think that’s almost like the importing of the logic of the Drug War into our private lives.

So I was thinking, how could I be Portuguese? And what I’ve tried to do now, and I can’t tell you I do it consistently and I can’t tell you it’s easy, is to say to the addicts in my life that I want to deepen the connection with them, to say to them, I love you whether you’re using or you’re not. I love you, whatever state you’re in, and if you need me, I’ll come and sit with you because I love you and I don’t want you to be alone or to feel alone.

And I think the core of that message — you’re not alone, we love you — has to be at every level of how we respond to addicts, socially, politically and individually. For 100 years now, we’ve been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection.

Thank you.

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TEDまとめ(1):エキスパートたちが贈る極上のメッセージ ライフハックとしてではなく、英語学習にも極めて有用なのが、著名人が10分程度のプレゼンを行うTEDです。 TED Talksと...