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TED, Daniel Levitin: How to stay calm when you know you'll be stressed (1)

Daniel Levitin: How to stay calm when you know you'll be stressed (1)

00:12A few years ago, I broke into my own house. I had just driven home, it was around midnight in the dead of Montreal winter, I had been visiting my friend, Jeff, across town, and the thermometer on the front porch read minus 40 degrees -- and don't bother asking if that's Celsius or Fahrenheit, minus 40 is where the two scales meet -- it was very cold. And as I stood on the front porch fumbling in my pockets, I found I didn't have my keys. In fact, I could see them through the window, lying on the dining room table where I had left them. So I quickly ran around and tried all the other doors and windows, and they were locked tight. I thought about calling a locksmith -- at least I had my cellphone, but at midnight, it could take a while for a locksmith to show up, and it was cold. I couldn't go back to my friend Jeff's house for the night because I had an early flight to Europe the next morning, and I needed to get my passport and my suitcase.

01:07So, desperate and freezing cold, I found a large rock and I broke through the basement window, cleared out the shards of glass, I crawled through, I found a piece of cardboard and taped it up over the opening, figuring that in the morning, on the way to the airport, I could call my contractor and ask him to fix it. This was going to be expensive, but probably no more expensive than a middle-of-the-night locksmith, so I figured, under the circumstances, I was coming out even.

01:35Now, I'm a neuroscientist by training and I know a little bit about how the brain performs under stress It releases cortisol that raises your heart rate, it modulates adrenaline levels and it clouds your thinking. So the next morning, when I woke up on too little sleep, worrying about the hole in the window, and a mental note that I had to call my contractor, and the freezing temperatures, and the meetings I had upcoming in Europe, and, you know, with all the cortisol in my brain, my thinking was cloudy, but I didn't know it was cloudy because my thinking was cloudy.

02:12(Laughter)

02:14And it wasn't until I got to the airport check-in counter, that I realized I didn't have my passport.

02:19(Laughter)

02:21So I raced home in the snow and ice, 40 minutes, got my passport, raced back to the airport, I made it just in time, but they had given away my seat to someone else, so I got stuck in the back of the plane, next to the bathrooms, in a seat that wouldn't recline, on an eight-hour flight. Well, I had a lot of time to think during those eight hours and no sleep.

02:42(Laughter)

02:43And I started wondering, are there things that I can do, systems that I can put into place, that will prevent bad things from happening? Or at least if bad things happen, will minimize the likelihood of it being a total catastrophe. So I started thinking about that, but my thoughts didn't crystallize until about a month later. I was having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and I somewhat embarrassedly told him about having broken my window, and, you know, forgotten my passport, and Danny shared with me that he'd been practicing something called prospective hindsight.

03:18(Laughter)

03:19It's something that he had gotten from the psychologist Gary Klein, who had written about it a few years before, also called the pre-mortem. Now, you all know what the postmortem is Whenever there's a disaster, a team of experts come in and they try to figure out what went wrong, right? Well, in the pre-mortem, Danny explained, you look ahead and you try to figure out all the things that could go wrong, and then you try to figure out what you can do to prevent those things from happening, or to minimize the damage.

03:47So what I want to talk to you about today are some of the things we can do in the form of a pre-mortem.Some of them are obvious, some of them are not so obvious. I'll start with the obvious ones.

03:58Around the home, designate a place for things that are easily lost. Now, this sounds like common sense, and it is, but there's a lot of science to back this up, based on the way our spatial memory works. There's a structure in the brain called the hippocampus, that evolved over tens of thousands of years, to keep track of the locations of important things -- where the well is, where fish can be found, that stand of fruit trees, where the friendly and enemy tribes live. The hippocampus is the part of the brain that in London taxicab drivers becomes enlarged. It's the part of the brain that allows squirrels to find their nuts. And if you're wondering, somebody actually did the experiment where they cut off the olfactory sense of the squirrels, and they could still find their nuts They weren't using smell, they were using the hippocampus, this exquisitely evolved mechanism in the brain for finding things. But it's really good for things that don't move around much, not so good for things that move around. So this is why we lose car keys and reading glasses and passports. So in the home, designate a spot for your keys -- a hook by the door, maybe a decorative bowl. For your passport, a particular drawer. For your reading glasses, a particular table. If you designate a spot and you're scrupulous about it, your things will always be there when you look for them.

05:23What about travel? Take a cell phone picture of your credit cards, your driver's license, your passport, mail it to yourself so it's in the cloud. If these things are lost or stolen, you can facilitate replacement.

05:36Now these are some rather obvious things Remember, when you're under stress, the brain releases cortisol. Cortisol is toxic, and it causes cloudy thinking. So part of the practice of the pre-mortem is to recognize that under stress you're not going to be at your best, and you should put systems in place.

05:54And there's perhaps no more stressful a situation than when you're confronted with a medical decision to make. And at some point, all of us are going to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision.

06:11And so I want to talk about that. And I'm going to talk about a very particular medical condition. But this stands as a proxy for all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making -- any kind of decision you have to make that would benefit from a rational assessment of the facts.

06:30So suppose you go to your doctor and the doctor says, "I just got your lab work back, your cholesterol's a little high." Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke And so you're thinking having high cholesterol isn't the best thing, and so the doctor says, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin." And you've probably heard of statins, you know that they're among the most widely prescribed drugs in the world today, you probably even know people who take them. And so you're thinking, "Yeah! Give me the statin."

07:06But there's a question you should ask at this point, a statistic you should ask for that most doctors don't like talking about, and pharmaceutical companies like talking about even less. It's for the number needed to treat. Now, what is this, the NNT? It's the number of people that need to take a drug or undergo a surgery or any medical procedure before one person is helped. And you're thinking, what kind of crazy statistic is that? The number should be one. My doctor wouldn't prescribe something to me if it's not going to help. But actually, medical practice doesn't work that way. And it's not the doctor's fault, if it's anybody's fault, it's the fault of scientists like me We haven't figured out the underlying mechanisms well enough. But GlaxoSmithKline estimates that 90 percent of the drugs work in only 30 to 50 percent of the people. So the number needed to treat for the most widely prescribed statin, what do you suppose it is?How many people have to take it before one person is helped? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by Bloomberg.com. I ran through the numbers myself. 300 people have to take the drug for a year before one heart attack, stroke or other adverse event is prevented.

08:23Now you're probably thinking, "Well, OK, one in 300 chance of lowering my cholesterol. Why not, doc? Give me the prescription anyway." But you should ask at this point for another statistic, and that is, "Tell me about the side effects" Right? So for this particular drug, the side effects occur in five percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress --but now you're thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug. "But wait a minute. Remember under stress you're not thinking clearly. So think about how you're going to work through this ahead of time, so you don't have to manufacture the chain of reasoning on the spot.300 people take the drug, right? One person's helped, five percent of those 300 have side effects, that's 15 people. You're 15 times more likely to be harmed by the drug than you are to be helped by the drug.

09:15Now, I'm not saying whether you should take the statin or not. I'm just saying you should have this conversation with your doctor. Medical ethics requires it, it's part of the principle of informed consent You have the right to have access to this kind of information to begin the conversation about whether you want to take the risks or not.

09:32Now you might be thinking I've pulled this number out of the air for shock value, but in fact, it's rather typical, this number needed to treat. For the most widely performed surgery on men over the age of 50, removal of the prostate for cancer, the number needed to treat is 49. That's right, 49 surgeries are done for every one person who's helped. And the side effects, in that case, occur in 50 percent of the patients.They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you're lucky, and you're one of the 50 percent who has these, they'll only last for a year or two.

10:11So the idea of the pre-mortem is to think ahead of time to the questions that you might be able to ask that will push the conversation forward. You don't want to have to manufacture all of this on the spot.And you also want to think about things like quality of life Because you have a choice oftentimes, do you I want a shorter life that's pain-free, or a longer life that might have a great deal of pain towards the end?These are things to talk about and think about now, with your family and your loved ones. You might change your mind in the heat of the moment, but at least you're practiced with this kind of thinking.

10:44Remember, our brain under stress releases cortisol, and one of the things that happens at that moment is a whole bunch on systems shut down. There's an evolutionary reason for this. Face-to-face with a predator, you don't need your digestive system, or your libido, or your immune system, because if you're body is expending metabolism on those things and you don't react quickly, you might become the lion's lunch, and then none of those things matter. Unfortunately, one of the things that goes out the window during those times of stress is rational, logical thinking, as Danny Kahneman and his colleagues have shown. So we need to train ourselves to think ahead to these kinds of situations.

11:26I think the important point here is recognizing that all of us are flawed. We all are going to fail now and then. The idea is to think ahead to what those failures might be, to put systems in place that will help minimize the damage, or to prevent the bad things from happening in the first place

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Daniel Levitin: How to stay calm when you know you'll be stressed (1) Daniel Levitin: Wie man ruhig bleibt, wenn man weiß, dass man gestresst sein wird (1) Daniel Levitin: Cómo mantener la calma cuando sabes que vas a estar estresado (1) Daniel Levitin: Come mantenere la calma quando si sa di essere stressati (1) ダニエル・レヴィチン:ストレスがかかるとわかっているときに冷静でいる方法 (1) Daniel Levitin: Jak zachować spokój, gdy wiesz, że będziesz zestresowany (1) Daniel Levitin: Como manter a calma quando se sabe que se vai estar stressado (1) Данило Левітін: Як зберігати спокій, коли знаєш, що буде стрес (1) 丹尼尔·莱维汀:当你知道自己会有压力时如何保持冷静 (1)

00:12A few years ago, I broke into my own house. |||||włamałem się|||| 00: 12 Hace unos años, irrumpí en mi propia casa. 00:12Il y a quelques années, je suis entré par effraction dans ma propre maison. 00:12Несколько лет назад я вломился в собственный дом. I had just driven home, it was around midnight in the dead of Montreal winter, I had been visiting my friend, Jeff, across town, and the thermometer on the front porch read minus 40 degrees -- and don't bother asking if that's Celsius or Fahrenheit, minus 40 is where the two scales meet -- it was very cold. ||||||||||||||||||||||||||temperature gauge||||||||||||||||||||||||||| ||||||||||||||||||||||||||termometr|||przedniej|||||||||||||||||||||||| Acababa de conducir a casa, era alrededor de la medianoche en el invierno de Montreal, había estado visitando a mi amigo Jeff, al otro lado de la ciudad, y el termómetro en el porche delantero leía menos 40 grados, y no me molesto en preguntar si eso es todo. Celsius o Fahrenheit, menos 40 es donde se encuentran las dos escalas: hacía mucho frío. Je venais de rentrer chez moi, vers minuit, en plein hiver montréalais, j'avais rendu visite à mon ami Jeff, de l'autre côté de la ville, et le thermomètre sur le porche indiquait moins 40 degrés - et ne vous donnez pas la peine de demander si c'est en Celsius ou en Fahrenheit, moins 40 est l'endroit où les deux échelles se rejoignent - il faisait très froid. Я только что поехал домой, было около полуночи в самый разгар монреальской зимы, я гостил у своего друга Джеффа на другом конце города, и термометр на переднем крыльце показывал минус 40 градусов — и не трудитесь спрашивать, правда ли это. Цельсий или Фаренгейт, минус 40 — это место, где сходятся две шкалы — было очень холодно. And as I stood on the front porch fumbling in my pockets, I found I didn't have my keys. ||||||||grzebiąc|||kieszeniach||||||| |||||||porche delantero|buscando torpemente||||||||||llaves Y cuando me paré en el porche delantero rebuscando en mis bolsillos, descubrí que no tenía mis llaves. Et alors que je me tenais sur le porche à tâtonner dans mes poches, j'ai découvert que je n'avais pas mes clés. 當我站在前廊上摸索口袋時,我發現我沒有帶鑰匙。 In fact, I could see them through the window, lying on the dining room table where I had left them. De hecho, pude verlos a través de la ventana, acostado en la mesa del comedor donde los había dejado. So I quickly ran around and tried all the other doors and windows, and they were locked tight. Так что я быстро обежал и попробовал все остальные двери и окна, и они были плотно заперты. I thought about calling a locksmith -- at least I had my cellphone, but at midnight, it could take a while for a locksmith to show up, and it was cold. |||||key service professional|||||||||||||||||||||||| |||||ślusarz|||||||||||||||||||||||| |||||cerrajero|||||||||||||||||||||||| Pensé en llamar a un cerrajero... al menos tenía el móvil, pero a medianoche podía tardar un rato en aparecer un cerrajero, y hacía frío. J'ai pensé à appeler un serrurier - au moins j'avais mon téléphone portable, mais à minuit, cela pouvait prendre un certain temps avant qu'un serrurier ne se présente, et il faisait froid. I couldn't go back to my friend Jeff's house for the night because I had an early flight to Europe the next morning, and I needed to get my passport and my suitcase.

01:07So, desperate and freezing cold, I found a large rock and I broke through the basement window, cleared out the shards of glass, I crawled through, I found a piece of cardboard and taped it up over the opening, figuring that in the morning, on the way to the airport, I could call my contractor and ask him to fix it. ||||||||||||||||||||pieces of glass|||||||||||||||||||||||||||||||||||||||| ||||||||||||||||||||fragmentos de vidrio||||gateé|||||||||||||||||||||||||||||||||||| |||||||||kamień||||||piwnica|||||szkło||||przeszłam|||||||||||||||||||||||||||||||||||| 01: 07 Así que, desesperada y helada, encontré una gran roca y rompí la ventana del sótano, limpié los fragmentos de vidrio, me arrastré, encontré un pedazo de cartón y lo pegué en la abertura, pensando que en La mañana, camino al aeropuerto, pude llamar a mi contratista y pedirle que lo arregle. 01:07Désespéré et transi de froid, j'ai trouvé une grosse pierre et j'ai brisé la fenêtre du sous-sol, j'ai enlevé les éclats de verre, j'ai rampé, j'ai trouvé un morceau de carton et je l'ai collé sur l'ouverture, pensant que dans la matinée, sur le chemin de l'aéroport, je pourrais appeler mon entrepreneur et lui demander de la réparer. 01:07所以,絕望和寒冷,我發現了一塊大石頭,我打破了地下室的窗戶,清除了玻璃碎片,我爬了進去,我找到了一塊紙板,把它貼在了開口上,認為在早上,在去機場的路上,我可以打電話給我的承包商並要求他修理它。 This was going to be expensive, but probably no more expensive than a middle-of-the-night locksmith, so I figured, under the circumstances, I was coming out even. Esto iba a ser costoso, pero probablemente no más caro que un cerrajero de media noche, así que, dadas las circunstancias, salía bien. Cela allait coûter cher, mais probablement pas plus cher qu'un serrurier en pleine nuit, alors je me suis dit que, vu les circonstances, j'étais quitte. Это должно было быть дорого, но, вероятно, не дороже, чем работа слесаря посреди ночи, так что я решил, что в данных обстоятельствах я даже выйду. 這會很貴,但可能不會比半夜的鎖匠貴,所以我想,在這種情況下,我還是出來吧。

01:35Now, I'm a neuroscientist by training and I know a little bit about how the brain performs under stress It releases cortisol that raises your heart rate, it modulates adrenaline levels and it clouds your thinking. |||brain scientist||||||||||the way|||||||||||||||adjusts||||||| ||||||||||||||||||||||||||||moduluje||||||| 01: 35 Ahora, soy neurocientífico con entrenamiento y sé un poco sobre cómo funciona el cerebro bajo el estrés. Libera cortisol que eleva su ritmo cardíaco, modula los niveles de adrenalina y nubla su pensamiento. 01:35Je suis neuroscientifique de formation et j'en sais un peu plus sur la façon dont le cerveau réagit au stress. Il libère du cortisol qui accélère le rythme cardiaque, module les niveaux d'adrénaline et trouble la pensée. 01:35現在,我是一名經過訓練的神經科學家,我對大腦在壓力下的表現有一點了解。它會釋放皮質醇,提高你的心率,調節腎上腺素水平,並影響你的思維。 So the next morning, when I woke up on too little sleep, worrying about the hole in the window, and a mental note that I had to call my contractor, and the freezing temperatures, and the meetings I had upcoming in Europe, and, you know, with all the cortisol in my brain, my thinking was cloudy, but I didn't know it was cloudy because my thinking was cloudy. ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||moje||| Así que a la mañana siguiente, cuando desperté con muy poco sueño, me preocupé por el agujero en la ventana y una nota mental de que tenía que llamar a mi contratista, y las bajas temperaturas, y las reuniones que tenía por venir en Europa, y, Sabes, con todo el cortisol en mi cerebro, mi pensamiento estaba nublado, pero no sabía que estaba nublado porque mi pensamiento estaba nublado. Alors le lendemain matin, quand je me suis réveillé après avoir trop peu dormi, je me suis inquiété du trou dans la fenêtre, j'ai noté mentalement que je devais appeler mon entrepreneur, et les températures glaciales, et les réunions que j'avais prévues en Europe, et, vous savez, avec tout le cortisol dans mon cerveau, ma pensée était trouble, mais je ne savais pas qu'elle était trouble parce que ma pensée était trouble. 所以第二天早上,當我睡得太少醒來時,我擔心窗戶上的洞,心裡記著我必須打電話給我的承包商,還有寒冷的氣溫,以及我即將在歐洲舉行的會議,而且,你知道,我的大腦充滿了皮質醇,我的思維變得渾濁,但我不知道它是渾濁的,因為我的思維是渾濁的。

02:12(Laughter)

02:14And it wasn't until I got to the airport check-in counter, that I realized I didn't have my passport. 02:14Ce n'est que lorsque je suis arrivé au comptoir d'enregistrement de l'aéroport que j'ai réalisé que je n'avais pas mon passeport. 02:14直到我到達機場報到櫃檯時,我才意識到我沒有護照。

02:19(Laughter)

02:21So I raced home in the snow and ice, 40 minutes, got my passport, raced back to the airport, I made it just in time, but they had given away my seat to someone else, so I got stuck in the back of the plane, next to the bathrooms, in a seat that wouldn't recline, on an eight-hour flight. ||pośpieszyłem się|||||||||||||||||||||||||||||||||||||||||||||||||||się nie odchyla||||| 02: 21Así que corrí a casa en la nieve y el hielo, 40 minutos, obtuve mi pasaporte, volví corriendo al aeropuerto, lo hice justo a tiempo, pero habían cedido mi asiento a otra persona, así que me quedé atascado en la parte de atrás. del avión, al lado de los baños, en un asiento que no se reclinaría, en un vuelo de ocho horas. 02:21 J'ai donc couru jusqu'à la maison dans la neige et la glace, 40 minutes, j'ai récupéré mon passeport, j'ai couru jusqu'à l'aéroport, je suis arrivé juste à temps, mais ils avaient donné mon siège à quelqu'un d'autre, alors je me suis retrouvé coincé à l'arrière de l'avion, à côté des toilettes, dans un siège qui ne s'inclinait pas, pour un vol de huit heures. 02:21於是我在冰天雪地裡跑回家,40分鐘,拿了護照,跑回機場,我及時趕到了,但他們把我的座位讓給了別人,所以我被困在後面在八小時的飛行中,在飛機上,在浴室旁邊,坐在一個不能傾斜的座位上。 Well, I had a lot of time to think during those eight hours and no sleep.

02:42(Laughter)

02:43And I started wondering, are there things that I can do, systems that I can put into place, that will prevent bad things from happening? 02:43J'ai commencé à me demander s'il y avait des choses que je pouvais faire, des systèmes que je pouvais mettre en place, qui empêcheraient les mauvaises choses de se produire. Or at least if bad things happen, will minimize the likelihood of it being a total catastrophe. O al menos si suceden cosas malas, minimizará la probabilidad de que sea una catástrofe total. So I started thinking about that, but my thoughts didn't crystallize until about a month later. Así que empecé a pensar en eso, pero mis pensamientos no se cristalizaron sino hasta un mes después. J'ai donc commencé à y réfléchir, mais mes idées ne se sont cristallisées qu'un mois plus tard. I was having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and I somewhat embarrassedly told him about having broken my window, and, you know, forgotten my passport, and Danny shared with me that he'd been practicing something called prospective hindsight. ||||||||||||||||z zakłopotaniem||||||||||||||||||||||||||przewidywanie przyszłości Estaba cenando con mi colega, Danny Kahneman, el ganador del Premio Nobel, y algo avergonzado le conté que había roto mi ventana y, ya sabes, olvidé mi pasaporte, y Danny me contó que había estado practicando algo llamado retrospectiva prospectiva. Je dînais avec mon collègue, Danny Kahneman, le lauréat du prix Nobel, et je lui ai dit avec embarras que j'avais cassé ma vitre, et, vous savez, j'ai oublié mon passeport, et Danny m'a dit qu'il avait pratiqué quelque chose appelé rétrospective prospective. 我正在和我的同事、諾貝爾獎得主丹尼·卡尼曼共進晚餐,我有些尷尬地告訴他我的窗戶被打破了,而且,你知道,我忘記了我的護照,丹尼告訴我,他一直在練習一種叫做「前瞻性的事後諸葛亮。

03:18(Laughter)

03:19It's something that he had gotten from the psychologist Gary Klein, who had written about it a few years before, also called the pre-mortem. ||||||||||||||||||||||||pre-mortem 03:19 C'est quelque chose qu'il a appris du psychologue Gary Klein, qui avait écrit à ce sujet quelques années auparavant, et qui s'appelle aussi le pre-mortem. 03:19這是他從心理學家加里‧克萊恩那裡得到的東西,幾年前他寫過相關文章,也稱為事前剖析。 Now, you all know what the postmortem is Whenever there's a disaster, a team of experts come in and they try to figure out what went wrong, right? ||||||analiza pośmiertna||||||||||||||||||||| Ahora, todos saben qué es el postmortem Siempre que hay un desastre, un equipo de expertos entra y trata de averiguar qué fue lo que salió mal, ¿no? Maintenant, vous savez tous ce qu'est l'autopsie. Chaque fois qu'il y a un désastre, une équipe d'experts arrive et essaie de comprendre ce qui ne va pas, n'est-ce pas? Well, in the pre-mortem, Danny explained, you look ahead and you try to figure out all the things that could go wrong, and then you try to figure out what you can do to prevent those things from happening, or to minimize the damage. Danny a expliqué qu'au cours de l'autopsie, on se projette dans l'avenir et on essaie de déterminer toutes les choses qui pourraient mal tourner, puis on essaie de déterminer ce que l'on peut faire pour empêcher ces choses de se produire, ou pour minimiser les dégâts.

03:47So what I want to talk to you about today are some of the things we can do in the form of a pre-mortem.Some of them are obvious, some of them are not so obvious. 03: 47 Entonces, de lo que quiero hablarles hoy son algunas de las cosas que podemos hacer en forma de pre-mortem. Algunas de ellas son obvias, algunas de ellas no son tan obvias. I'll start with the obvious ones. Empezaré por lo obvio.

03:58Around the home, designate a place for things that are easily lost. |||wyznacz miejsce|||||||| 03:58Dans la maison, désignez un endroit pour les objets qui se perdent facilement. 03:58В доме выделите место для вещей, которые легко потерять. Now, this sounds like common sense, and it is, but there's a lot of science to back this up, based on the way our spatial memory works. ||||||||||||||||||||||||przestrzenna|| Ahora, esto suena como el sentido común, y lo es, pero hay mucha ciencia para respaldar esto, basada en la forma en que funciona nuestra memoria espacial. Cela semble relever du bon sens, et c'est le cas, mais il existe de nombreuses données scientifiques pour étayer cette affirmation, basées sur le fonctionnement de notre mémoire spatiale. There's a structure in the brain called the hippocampus, that evolved over tens of thousands of years, to keep track of the locations of important things -- where the well is, where fish can be found, that stand of fruit trees, where the friendly and enemy tribes live. ||||||||hipokamp|||||||||||||||||||||||||||||||||||||| Hay una estructura en el cerebro llamada hipocampo, que evolucionó a lo largo de decenas de miles de años, para hacer un seguimiento de la ubicación de las cosas importantes, donde se encuentra el pozo, donde se pueden encontrar peces, que se alzan los árboles frutales, donde los amigos Y las tribus enemigas viven. Il existe dans le cerveau une structure appelée hippocampe, qui a évolué pendant des dizaines de milliers d'années, pour garder en mémoire l'emplacement des choses importantes : où se trouve le puits, où l'on peut trouver du poisson, ce peuplement d'arbres fruitiers, où vivent les tribus amies et ennemies. The hippocampus is the part of the brain that in London taxicab drivers becomes enlarged. El hipocampo es la parte del cerebro que en Londres aumenta el tamaño de los taxistas. L'hippocampe est la partie du cerveau qui, chez les chauffeurs de taxi londoniens, est hypertrophiée. 海馬體是倫敦計程車司機大腦中變大的部分。 It's the part of the brain that allows squirrels to find their nuts. ||||||||wiewiórki|||| Es la parte del cerebro que permite a las ardillas encontrar sus nueces. And if you're wondering, somebody actually did the experiment where they cut off the olfactory sense of the squirrels, and they could still find their nuts They weren't using smell, they were using the hippocampus, this exquisitely evolved mechanism in the brain for finding things. ||||||||||||||||||||||||||||||||||||highly refined|||||||| ||||||||||||||węchowy||||||||||||||||||||||wyjątkowo||||||do znajdowania rzeczy|| Et si vous vous posez la question, sachez que quelqu'un a fait l'expérience de couper le sens olfactif des écureuils, et qu'ils ont quand même pu trouver leurs noisettes. Ils n'utilisaient pas l'odorat, ils utilisaient l'hippocampe, ce mécanisme très évolué du cerveau qui permet de trouver des choses. 如果你想知道,有人確實做了這個實驗,他們切斷了松鼠的嗅覺,他們仍然可以找到堅果他們沒有使用嗅覺,他們使用的是海馬體,這是大腦中精心進化的機制為了尋找東西。 But it's really good for things that don't move around much, not so good for things that move around. Pero es realmente bueno para cosas que no se mueven mucho, no tan buenas para cosas que se mueven. Mais c'est très bon pour les choses qui ne bougent pas beaucoup, moins bon pour les choses qui bougent. So this is why we lose car keys and reading glasses and passports. So in the home, designate a spot for your keys -- a hook by the door, maybe a decorative bowl. Entonces, en el hogar, designe un lugar para las llaves: un gancho en la puerta, tal vez un tazón decorativo. À la maison, réservez un endroit pour vos clés : un crochet près de la porte, un bol décoratif, etc. 因此,在家裡,為鑰匙指定一個位置——門邊的掛鉤,也許是一個裝飾性的碗。 For your passport, a particular drawer. |||||szuflada For your reading glasses, a particular table. If you designate a spot and you're scrupulous about it, your things will always be there when you look for them. |||||||dokładny||||||||||||| Si vous désignez un endroit et que vous le respectez scrupuleusement, vos affaires seront toujours là quand vous les chercherez. 如果你指定一個地點並且小心謹慎,那麼當你尋找時,你的東西就會一直在那裡。

05:23What about travel? Take a cell phone picture of your credit cards, your driver's license, your passport, mail it to yourself so it's in the cloud. If these things are lost or stolen, you can facilitate replacement. 如果這些東西遺失或被盜,可以方便更換。

05:36Now these are some rather obvious things Remember, when you're under stress, the brain releases cortisol. 05:36Il s'agit là de choses plutôt évidentes Rappelez-vous que lorsque vous êtes stressé, le cerveau libère du cortisol. Cortisol is toxic, and it causes cloudy thinking. So part of the practice of the pre-mortem is to recognize that under stress you're not going to be at your best, and you should put systems in place. Une partie de la pratique de l'autopsie consiste donc à reconnaître que, sous l'effet du stress, on ne sera pas au mieux de sa forme et qu'il convient de mettre en place des systèmes.

05:54And there's perhaps no more stressful a situation than when you're confronted with a medical decision to make. |||||||||||faced with|||||| 05:54Il n'y a peut-être pas de situation plus stressante que celle où l'on est confronté à une décision médicale. 05:54也許沒有什麼比當你面臨醫療決定時更有壓力的了。 And at some point, all of us are going to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision. Y en algún momento, todos nosotros estaremos en esa posición, donde debemos tomar una decisión muy importante sobre el futuro de nuestra atención médica o la de un ser querido, para ayudarlos a tomar una decisión. Et à un moment donné, nous serons tous dans cette situation, où nous devrons prendre une décision très importante sur l'avenir de nos soins médicaux ou de ceux d'un être cher, pour l'aider à prendre une décision.

06:11And so I want to talk about that. And I'm going to talk about a very particular medical condition. But this stands as a proxy for all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making -- any kind of decision you have to make that would benefit from a rational assessment of the facts. Pero esto representa un poder para todo tipo de decisiones médicas, y de hecho para decisiones financieras y decisiones sociales, cualquier tipo de decisión que tenga que tomar que se beneficiaría de una evaluación racional de los hechos. Mais cela sert de proxy pour toutes sortes de prises de décisions médicales, et en fait pour les décisions financières et sociales - tout type de décision que vous devez prendre qui bénéficierait d'une évaluation rationnelle des faits. 但這代表了各種醫療決策,實際上也代表了財務決策和社會決策——你必須做出的任何類型的決策都會受益於對事實的理性評估。

06:30So suppose you go to your doctor and the doctor says, "I just got your lab work back, your cholesterol's a little high." 06: 30Supongo que acude a su médico y el médico dice: "Acabo de hacer que su laboratorio vuelva a funcionar, su colesterol está un poco alto". 06:30 Supposons que vous alliez chez votre médecin et qu'il vous dise : "Je viens de recevoir vos résultats d'analyse, votre taux de cholestérol est un peu élevé." 06:30假設你去看醫生,醫生說:“我剛剛拿回你的化驗結果,你的膽固醇有點高。” Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke And so you're thinking having high cholesterol isn't the best thing, and so the doctor says, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin." ||||||||||||||||||||||||||||||||||||||||||||||||||||statyna Ahora, todos saben que el colesterol alto está asociado con un mayor riesgo de enfermedad cardiovascular, ataque cardíaco, accidente cerebrovascular y, por lo tanto, piensa que tener colesterol alto no es lo mejor, y por eso el médico dice: Me gustaría administrarle un medicamento que lo ayude a reducir su colesterol, una estatina ". 現在,你們都知道高膽固醇與心血管疾病、心臟病、中風的風險增加有關,所以你們認為高膽固醇並不是最好的事情,所以醫生說,「你知道,我」我想給你一種可以幫助你降低膽固醇的藥物,他汀類藥物。” And you've probably heard of statins, you know that they're among the most widely prescribed drugs in the world today, you probably even know people who take them. ||||||||||||||przepisywanych||||||||||||| Y es probable que haya oído hablar de las estatinas, sabe que están entre los medicamentos más recetados en el mundo hoy en día, probablemente incluso conozca a las personas que los toman. And so you're thinking, "Yeah! Give me the statin."

07:06But there's a question you should ask at this point, a statistic you should ask for that most doctors don't like talking about, and pharmaceutical companies like talking about even less. ||||||||||||||||||||||||firmy farmaceutyczne|||||| 07: 06 Pero hay una pregunta que debe hacer en este punto, una estadística que debe preguntar para que a la mayoría de los médicos no les guste hablar y a las compañías farmacéuticas les guste hablar aún menos. 07:06Mais il y a une question que vous devriez poser à ce stade, une statistique que vous devriez demander et dont la plupart des médecins n'aiment pas parler, et les sociétés pharmaceutiques encore moins. It's for the number needed to treat. Es por el número necesario para tratar. Il s'agit du nombre nécessaire pour traiter. Это для количества, необходимого для лечения. 這是為了需要治療的人數。 Now, what is this, the NNT? It's the number of people that need to take a drug or undergo a surgery or any medical procedure before one person is helped. Es la cantidad de personas que necesitan tomar un medicamento o someterse a una cirugía o cualquier procedimiento médico antes de que se ayude a una persona. Il s'agit du nombre de personnes qui doivent prendre un médicament ou subir une opération chirurgicale ou toute autre procédure médicale avant qu'une personne ne soit aidée. Это количество людей, которым необходимо принять лекарство, пройти операцию или любую другую медицинскую процедуру, прежде чем одному человеку будет оказана помощь. 這是指在一個人得到幫助之前需要服用藥物或接受手術或任何醫療程序的人數。 And you're thinking, what kind of crazy statistic is that? The number should be one. |||być| El número debe ser uno. Le chiffre doit être un. My doctor wouldn't prescribe something to me if it's not going to help. Mi doctor no me recetaría algo si no me va a ayudar. Мой врач не назначит мне что-то, если это не поможет. But actually, medical practice doesn't work that way. Mais en réalité, la pratique médicale ne fonctionne pas de cette manière. 但實際上,醫療實踐並非如此。 And it's not the doctor's fault, if it's anybody's fault, it's the fault of scientists like me We haven't figured out the underlying mechanisms well enough. Y no es culpa del médico, si es culpa de alguien, es culpa de científicos como yo. No hemos descubierto los mecanismos subyacentes lo suficientemente bien. But GlaxoSmithKline estimates that 90 percent of the drugs work in only 30 to 50 percent of the people. So the number needed to treat for the most widely prescribed statin, what do you suppose it is?How many people have to take it before one person is helped? Entonces, ¿cuál es el número necesario para tratar la estatina más recetada? ¿Cuántas personas deben tomarla antes de que se ayude a una persona? Quel est donc le nombre de personnes à traiter pour la statine la plus prescrite ? Combien de personnes doivent prendre cette statine avant qu'une seule ne soit aidée ? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by Bloomberg.com. Esto es según la investigación realizada por los investigadores Jerome Groopman y Pamela Hartzband, confirmados de forma independiente por Bloomberg.com. C'est ce qui ressort d'une étude menée par Jerome Groopman et Pamela Hartzband, spécialistes de la recherche, et confirmée de manière indépendante par Bloomberg.com. 這是根據研究從業者 Jerome Groopman 和 Pamela Hartzband 的研究得出的,並得到 Bloomberg.com 的獨立證實。 I ran through the numbers myself. Repasé los números yo mismo. 我自己查了一下這些數字。 300 people have to take the drug for a year before one heart attack, stroke or other adverse event is prevented. ||||||||||||||||niepożądane||| 300 personas deben tomar el medicamento durante un año antes de prevenir un ataque cardíaco, un derrame cerebral u otro evento adverso. 300 personnes doivent prendre le médicament pendant un an avant qu'une crise cardiaque, un accident vasculaire cérébral ou un autre événement indésirable ne soit évité. 300 человек должны принимать препарат в течение года, прежде чем будет предотвращен один сердечный приступ, инсульт или другое нежелательное явление.

08:23Now you're probably thinking, "Well, OK, one in 300 chance of lowering my cholesterol. ||||||||||obniżeniu|| 08: 23Ahora probablemente estés pensando: "Bueno, está bien, una de cada 300 posibilidades de bajar mi colesterol. 08:23 Теперь вы, наверное, думаете: «Ну, хорошо, один из 300 шансов снизить уровень холестерина. Why not, doc? Give me the prescription anyway." But you should ask at this point for another statistic, and that is, "Tell me about the side effects" Right? So for this particular drug, the side effects occur in five percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress --but now you're thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug. ||||||||||układ pokarmowy||||||||||||||||||||| Incluyen cosas terribles, como dolor muscular y articular debilitante, dolor gastrointestinal, pero ahora están pensando: "El cinco por ciento, no es muy probable que me pase a mí, todavía tomaré el medicamento". Et ils comprennent des choses terribles - douleurs musculaires et articulaires débilitantes, troubles gastro-intestinaux - mais vous vous dites maintenant : "Cinq pour cent, il est peu probable que cela m'arrive, je prendrai quand même le médicament. 其中包括可怕的事情——使人衰弱的肌肉和關節疼痛、胃腸道不適——但現在你在想,「百分之五,這種情況不太可能發生在我身上,我仍然會服用藥物。 "But wait a minute. Remember under stress you're not thinking clearly. N'oubliez pas qu'en cas de stress, vous n'avez pas les idées claires. So think about how you're going to work through this ahead of time, so you don't have to manufacture the chain of reasoning on the spot.300 people take the drug, right? Entonces, piense en cómo va a trabajar en esto antes de tiempo, para no tener que fabricar la cadena de razonamiento en el momento. 300 personas toman el medicamento, ¿verdad? Réfléchissez donc à l'avance à la manière dont vous allez résoudre ce problème, afin de ne pas avoir à fabriquer la chaîne de raisonnement sur place.300 personnes prennent le médicament, n'est-ce pas ? 所以提前考慮一下你將如何解決這個問題,這樣你就不必當場製造推理鏈。300 人服用這種藥物,對吧? One person's helped, five percent of those 300 have side effects, that's 15 people. Une personne est aidée, cinq pour cent de ces 300 personnes ont des effets secondaires, soit 15 personnes. You're 15 times more likely to be harmed by the drug than you are to be helped by the drug. Vous avez 15 fois plus de chances d'être lésé par le médicament que d'être aidé par lui.

09:15Now, I'm not saying whether you should take the statin or not. I'm just saying you should have this conversation with your doctor. Medical ethics requires it, it's part of the principle of informed consent You have the right to have access to this kind of information to begin the conversation about whether you want to take the risks or not. 醫學道德要求它,它是知情同意原則的一部分。您有權獲得此類信息,以開始討論您是否願意承擔風險。

09:32Now you might be thinking I've pulled this number out of the air for shock value, but in fact, it's rather typical, this number needed to treat. 09: 32 Ahora podría estar pensando que he sacado este número del aire por valor de choque, pero en realidad es bastante típico, este número debe tratarse. 09:32 Vous pensez peut-être que j'ai tiré ce chiffre de l'air pour choquer, mais en fait, il est plutôt typique, ce nombre nécessaire pour traiter. 09:32現在你可能會認為我憑空捏造這個數字是為了達到震撼的效果,但事實上,這是相當典型的,這個數字需要處理。 For the most widely performed surgery on men over the age of 50, removal of the prostate for cancer, the number needed to treat is 49. ||||||||||||usunięcie prostaty||||||||||| Para la cirugía más ampliamente realizada en hombres mayores de 50 años, la extirpación de la próstata por cáncer, el número necesario para tratar es 49. Pour l'intervention chirurgicale la plus pratiquée chez les hommes de plus de 50 ans, à savoir l'ablation de la prostate en cas de cancer, le nombre de cas à traiter est de 49. 對於 50 歲以上男性進行最廣泛的手術——前列腺癌切除術,需要治療的人數為 49 人。 That's right, 49 surgeries are done for every one person who's helped. Así es, se realizan 49 cirugías por cada persona que ha ayudado. And the side effects, in that case, occur in 50 percent of the patients.They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. |||||||||||||||||||nietrzymanie moczu|||kałowa nietrzymanie| Y los efectos secundarios en ese caso ocurren en el 50 por ciento de los pacientes. Incluyen impotencia, disfunción eréctil, incontinencia urinaria, lagrimeo rectal, incontinencia fecal. Les effets secondaires, dans ce cas, se produisent chez 50 % des patients, notamment l'impuissance, la dysfonction érectile, l'incontinence urinaire, la déchirure rectale et l'incontinence fécale. 在這種情況下,50% 的患者都會出現副作用,包括陽痿、勃起功能障礙、尿失禁、直腸撕裂、大便失禁。 And if you're lucky, and you're one of the 50 percent who has these, they'll only last for a year or two. Et si vous avez de la chance et que vous faites partie des 50 % qui en ont, ils ne dureront qu'un an ou deux.

10:11So the idea of the pre-mortem is to think ahead of time to the questions that you might be able to ask that will push the conversation forward. ||||||przedśmiertne|||||||||||||||||||||| You don't want to have to manufacture all of this on the spot.And you also want to think about things like quality of life Because you have a choice oftentimes, do you I want a shorter life that's pain-free, or a longer life that might have a great deal of pain towards the end?These are things to talk about and think about now, with your family and your loved ones. ||||||||||||||||||||||||||||||często|||||||||||||||||||||||||||||||||||||||||| No querrá tener que fabricar todo esto en el momento. Y también desea pensar en cosas como la calidad de vida. Debido a que tiene la opción muchas veces, ¿quiere una vida más corta que sea sin dolor o más larga? ¿Una vida que podría tener mucho dolor hacia el final? Estas son cosas de las que hablar y pensar ahora, con su familia y sus seres queridos. Il faut aussi penser à des choses comme la qualité de vie. Parce que vous avez souvent le choix, voulez-vous une vie plus courte mais sans douleur, ou une vie plus longue mais avec beaucoup de douleur vers la fin ? Ce sont des choses dont il faut parler et auxquelles il faut penser maintenant, avec votre famille et vos proches. 你不想在現場製造所有這些。而且你還想考慮生活品質之類的事情因為你經常有選擇,你想要更短的無痛苦的生活,還是更長的壽命生命的最後可能會有很大的痛苦嗎?這些是現在與你的家人和你所愛的人談論和思考的事情。 You might change your mind in the heat of the moment, but at least you're practiced with this kind of thinking. Puedes cambiar de opinión en el calor del momento, pero al menos tienes práctica con este tipo de pensamiento. Il se peut que vous changiez d'avis dans le feu de l'action, mais au moins vous avez l'habitude de ce genre de réflexion.

10:44Remember, our brain under stress releases cortisol, and one of the things that happens at that moment is a whole bunch on systems shut down. 10: 44 Recuerde, nuestro cerebro bajo estrés libera cortisol, y una de las cosas que sucede en ese momento es un montón de sistemas que se apagan. 10:44Nous nous souvenons qu'en cas de stress, notre cerveau libère du cortisol et que l'une des choses qui se produit à ce moment-là, c'est que tout un tas de systèmes s'arrêtent. There's an evolutionary reason for this. Face-to-face with a predator, you don't need your digestive system, or your libido, or your immune system, because if you're body is expending metabolism on those things and you don't react quickly, you might become the lion's lunch, and then none of those things matter. ||||||||||||||||||||||||wydatkując|||||||||||||||||||||| Cara a cara con un depredador, no necesita su sistema digestivo, su libido o su sistema inmunológico, porque si su cuerpo está gastando metabolismo en esas cosas y no reacciona rápidamente, puede volverse El almuerzo del león, y entonces ninguna de esas cosas importa. Face à un prédateur, vous n'avez pas besoin de votre système digestif, ni de votre libido, ni de votre système immunitaire, parce que si votre corps dépense du métabolisme pour ces choses et que vous ne réagissez pas rapidement, vous risquez de devenir le repas du lion, et alors aucune de ces choses n'aura d'importance. 當你與掠食者面對面時,你不需要你的消化系統、你的性慾或你的免疫系統,因為如果你的身體在這些東西上消耗新陳代謝而你不迅速反應,你可能會變得獅子的午餐,然後這些事情都不再重要了。 Unfortunately, one of the things that goes out the window during those times of stress is rational, logical thinking, as Danny Kahneman and his colleagues have shown. Desafortunadamente, una de las cosas que sale por la ventana durante esos momentos de estrés es el pensamiento racional y lógico, como han demostrado Danny Kahneman y sus colegas. Malheureusement, l'une des choses qui disparaît pendant ces périodes de stress est la pensée rationnelle et logique, comme l'ont montré Danny Kahneman et ses collègues. 不幸的是,正如丹尼·卡尼曼(Danny Kahneman)和他的同事們所表明的那樣,在壓力時期,理性、邏輯思維就被拋之腦後了。 So we need to train ourselves to think ahead to these kinds of situations. Nous devons donc nous entraîner à anticiper ce genre de situation.

11:26I think the important point here is recognizing that all of us are flawed. |||||||||||||imperfect |||||||uznanie||||||wadliwi 11: 26 Creo que el punto importante aquí es reconocer que todos nosotros estamos equivocados. 11: 26Je pense que le point important ici est de reconnaître que nous avons tous des défauts. 11:26我認為這裡重要的一點是認識到我們所有人都有缺陷。 We all are going to fail now and then. Todos vamos a fallar de vez en cuando. Nous allons tous échouer de temps en temps. 我們都會時不時地失敗。 The idea is to think ahead to what those failures might be, to put systems in place that will help minimize the damage, or to prevent the bad things from happening in the first place |||||||||||||||||||||the specific||||||||||||| La idea es pensar de antemano cuáles podrían ser esas fallas, establecer sistemas que ayuden a minimizar el daño o evitar que ocurran cosas malas en primer lugar. L'idée est de réfléchir à l'avance à ce que pourraient être ces défaillances, de mettre en place des systèmes qui contribueront à minimiser les dommages, ou d'empêcher les mauvaises choses de se produire en premier lieu