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我们用眼睛看世界

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但我们也用大脑看

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用大脑来看，也就是我们常说的想象

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我们很熟悉自己想象的模式

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也就是内心世界，它伴随我们一生

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然而想象之外还有幻觉

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幻觉跟想象截然不同

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它似乎不是我们所创造的

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好像也不受我们的控制

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它似乎源自外界

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又伪装成我们自己的感知

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所以我将就幻觉做一些解释

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也会提到我在病人身上观察到的

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一种特殊的视觉幻觉

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几个月前我接到从我工作的养老院

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打来的一个电话

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他们告诉我住客中有一位90多的老太太

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“看到了一些东西”

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他们怀疑她是不是疯了

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或者因为年纪大

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得了中风，或是老年痴呆症

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所以他们请我去看看罗萨莉

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也就是那个老太太

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我去了后

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马上就发现

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她不仅完全神志正常

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还非常清醒、明智

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就是有点吓坏了，还有点奇怪

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为什么她会出现幻视

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她还说

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护士忘了告诉我

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她眼睛是看不见的

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她五年前就因为视网膜黄斑退化而完全失明了

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近几天却看到了幻象

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我问：“什么样的幻象？”

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她说：“许多人穿着东方服饰

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那种长袍式的，在楼梯上上下下

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一个男的转过来对我笑

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但他的嘴巴只有一边长着牙，很大的牙

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还有很多动物

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有一栋白色的楼，天在下雪，小雪

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我还看到一匹戴着挽具的马不断把雪拖走

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然后有一天晚上，幻象变了

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变成好多猫和狗朝我这边走

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走着走着就停了

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然后又变了

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这回我看到很多小朋友在楼梯上爬上爬下

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他们穿着颜色鲜艳的衣服，有玫瑰色，有蓝色

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就像东方服饰。”

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她说，有时候在她看到人之前

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她还能看到地板上粉色和蓝色的方块

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跑到天花板上

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我问：“像不像做梦？”

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她说：“不，不像梦。像个电影。”

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“它是有颜色的，还有动作

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不过一点声音都没有，像默片。”

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她还说那电影相当无聊

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她说：“所有人都穿着东方衣服

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爬上爬下，不停地，一点别的花样都没有。”

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(笑声)

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她很幽默

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而且知道那是个幻觉

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但她有点害怕，因为她活了95年

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从来没有出现过幻觉

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她说那些幻觉跟她的意识和行为

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一点都不相干

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总是这么无缘无故地出现，又无缘无故地消失

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完全不受她控制

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而幻觉中出现的

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人和地点

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她一个都不认识

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里面的人和动物

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也好像看不见她

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她不知道这是这么了

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她想，她是疯了

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还是在失去理智

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于是我为这个活泼的老太太

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做了详尽的检查

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结果发现她的神智完全正常，没有精神问题

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她所吃的药也都没有致幻的副作用

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不过，她是盲的

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所以我说：

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“我想我知道你的问题是什么了。

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有一种特殊的视觉幻觉

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会发生在视力受损或完全失明的人身上

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这种现象

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最早在18世纪

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被一个叫查尔斯·邦纳的人描述过

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你得的就是邦纳症候群(Charles Bonnet syndrome)

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问题既不在你的大脑，也不在你的意识

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你只是得了这种邦纳症候群。”

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她大松一口气

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还好不是什么重病

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完了还相当好奇

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她问：“这个查尔斯

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他也有这种幻觉吗？

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还有，告诉那些护工，

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我只不过是得了邦纳症候群。“

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(笑声)

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“我没疯，也没傻，我只是得了邦纳症候群。”

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于是我照她的意思告诉了护工们

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其实这种现象对我来说并不稀奇

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我在养老院工作

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认识很多老人

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是听力或视力受损的

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10%的听力受损者

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有听觉幻觉

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10%的视力受损者

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有视觉幻觉

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不一定要完全失明

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或完全听不到，才会有这种幻觉

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18世纪的查尔斯·邦纳

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其实并没有这种症状

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产生幻觉的是他的祖父

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一位年长的长官

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这个长官曾接受过白内障手术

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视力不大好

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1759年，他向孙子描述了

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他看到的各种各样的幻象

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第一个幻象

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是一块悬浮在空中的手帕

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大大的，蓝色的

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还有四个橙色的圆圈

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他知道这是个幻觉

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因为手帕不会浮在半空

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他还看到过一个大轮子浮在空中

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不过有时候他也搞不清楚看到的到底是不是幻觉

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因为这些幻觉

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会融合在现实的背景里

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有一次，当他的孙女们来探望他时，他又看到了幻觉

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他问：“这几个跟你们在一起的帅小伙子是谁啊？”

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孙女们却说：“诶，爷爷，没有你说的帅小伙啊。”

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突然间帅小伙们就消失了

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这是一种典型的幻觉

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刷一下来，刷一下去

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没有渐变

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相当突然，变得也快

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查尔斯·鲁林，也就是那个祖父

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看到过几百个不同的人像

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还有各种各样的景色

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有一次，他看到一个穿浴袍的男人在抽烟斗

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然后意识到，那就是他自己

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那是唯一一个他辨认出来的人像

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还有一次，他在巴黎的街道上

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当真看到了一个脚手架

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回到家后，却看到了那个脚手架的迷你版

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六英尺高，就立在他的书桌上

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这种感知的重复

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有时会被称作视像保留

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这种在查尔斯·鲁林和罗斯莉

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身上发生的

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让罗斯莉问道“我这是这么了？”的现象

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我这么解释吧：随着视力的减退

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大脑与视力相关的部分渐渐失去了信息输入

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从而进入一种过度活跃的、待激活的状态

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于是它开始自发地活动

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让人产生幻象

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产生的幻象可以相当复杂

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我有一个病人

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（像查尔斯·鲁林一样）视力没有完全减退

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她看到的幻象比较恼人

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她说有一次她看到

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餐馆里有一个穿条纹恤衫的男人

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他转过身

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然后就突然分裂成6个同样穿条纹恤衫的人像

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开始朝她走来

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然后六个人就合了起来，就像手风琴一样

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有一次她正在开车

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应该说，是他丈夫在开

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路突然就分裂成了4条

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她感觉就像同时在4条路上行驶

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她的幻觉充满动感

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往往会牵涉到车

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有时她会看到一个青年男孩

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坐在引擎盖上

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紧抓不放，车转弯时

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他便随着车的动作缓缓倾斜

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车停下后

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男孩便会突然垂直飞到100尺的高空

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然后消失

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还有一个病人，有另外一种幻觉

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这位女病人视力并无问题

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问题出在她脑部的视觉部分

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她的枕叶皮层有一个小肿瘤

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尤其引人注意的是，她看到的幻象是卡通的

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而且是半透明的

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像屏幕一样盖住半个视野

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特别的是，她看到的是青蛙柯密特（芝麻街人物）

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（笑声）

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我不看芝麻街的

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不过她坚持要问我：

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”为什么是柯密特？“她说，”青蛙柯密特对我来说一点意义都没有啊。“

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当时我正在研究弗洛伊德决定因素

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为什么是柯密特？

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”青蛙柯密特对我来说一点意义都没有啊。“

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她并不大关注那部卡通

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让她非常苦恼的是

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这些幻觉持续地出现

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而且跟罗斯莉的情况一样，幻觉中的脸往往是扭曲的

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要么长着大牙，要么长着大眼

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这让她感到非常不安

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那么，这些病人是怎么了？

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作为一个医生，我必须尝试阐释这些现象

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来安抚他们

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尤其得告诉他们，他们没疯

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我前面提到过，视力受损的人

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有10%会产生幻觉

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但不超过1%会承认

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因为他们担心会被当成疯子之类

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而如果他们向医生提起这种症状

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医生可能会做出错误的诊断

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而且，大家往往认为

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如果你看到或听到幻觉，你就是疯了

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其实我们提到的这种幻觉跟精神病幻觉是不一样的

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精神病的幻觉，不管是视觉的还是听觉的

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都对付你，指控你

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诱惑你，羞辱你

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嘲弄你

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跟你互动

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而这些

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都没有出现在邦纳式的幻觉中

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邦纳式幻觉就像一部电影，尽管你在看，电影却没有牵涉到你

223
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反正患者们是这么认为的

224
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还有一种少有的症状叫颞叶癫痫

225
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有时，如果一个人产生这种症状

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他可能会感到自己被带回

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到过去的一个时空

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在某一个路口

229
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闻到烤栗子的香味

230
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听到车来车往，所有的感官都参与着

231
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等待着心上人

232
00:11:24,000 --> 00:11:28,000
那可能是1982年的某个周二夜晚

233
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这种颞叶异常导致的幻觉

234
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是多感官的

235
00:11:32,000 --> 00:11:35,000
充满着情绪和熟悉感

236
00:11:35,000 --> 00:11:37,000
发生在特定时空中

237
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情节合乎逻辑而戏剧感十足

238
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邦纳式的不一样

239
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在邦纳式幻觉中

240
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有好几种等级

241
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从几何幻觉

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比如老太太看到的粉色和蓝色的方块

243
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到非常复杂的幻觉

244
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比如各种人像，尤其是面容

245
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这些面容，有时是扭曲的面容

246
00:12:03,000 --> 00:12:06,000
是唯一一种在这些幻觉中

247
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最常见的幻象

248
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一种第二常见的幻象是卡通

249
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那么，究竟为什么会产生幻觉呢？

250
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很棒的是，近几年

251
00:12:16,000 --> 00:12:20,000
我们能够做出脑功能成像

252
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当我们给正产生幻觉的人做功能性磁共振成像(fMRI)时

253
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我们的确发现大脑视觉部位

254
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有不同区域被激活

255
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这时被检测者正在经历幻觉

256
00:12:33,000 --> 00:12:36,000
如果被检测者有的是简单的几何幻觉

257
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被激活的区域则是初级视觉皮质

258
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这是大脑感知边缘和图案的部分

259
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而我们光靠这里是无法形成完整影像的

260
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影像形成时

261
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一个位于颞叶的较高级视觉皮质

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会有一定活动

263
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尤其是颞叶中

264
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叫做梭状回的一个区域，显著地活跃

265
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调查显示，如果梭状回损伤

266
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患者可能因此无法辨认面容

267
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而当梭状回异常时

268
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患者则可能看到面容的幻象

269
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这正是我们前面提到的几位病人所出现的症状

270
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梭状回的前部有一个区域

271
00:13:22,000 --> 00:13:27,000
负责处理有关牙齿和眼睛的影像

272
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而当病人出现扭曲的幻觉时

273
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正是这一部位出现了活动

274
00:13:34,000 --> 00:13:36,000
还有一个区域

275
00:13:36,000 --> 00:13:38,000
会在病人看到卡通幻象时

276
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出现活动

277
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人们观看卡通

278
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画卡通，或看到卡通幻象时，都是这一部位被激活

279
00:13:47,000 --> 00:13:50,000
这是一个特别有趣的现象

280
00:13:50,000 --> 00:13:53,000
大脑还有几个别的部位

281
00:13:53,000 --> 00:13:55,000
相应地跟其他视觉元素的辨别与幻觉有关

282
00:13:55,000 --> 00:13:58,000
比如楼房和风景

283
00:13:58,000 --> 00:14:01,000
1970年左右，人们发现特化的不是一块区域

284
00:14:01,000 --> 00:14:03,000
而是相应的脑细胞

285
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“脸细胞”是1970年左右发现的

286
00:14:08,000 --> 00:14:10,000
至今，我们已经发现了

287
00:14:10,000 --> 00:14:12,000
数百种与各类视觉元素对应的脑细胞

288
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这种对应关系可以非常琐细、明确

289
00:14:14,000 --> 00:14:16,000
比如说

290
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“车”细胞

291
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可能还有“阿斯顿·马丁(一种车)”细胞

292
00:14:21,000 --> 00:14:23,000
(笑声)

293
00:14:23,000 --> 00:14:25,000
今早我看到一部阿斯顿·马丁

294
00:14:25,000 --> 00:14:27,000
我一直想提提它

295
00:14:27,000 --> 00:14:30,000
现在我的脑子里就有这种“阿斯顿·马丁”细胞

296
00:14:30,000 --> 00:14:33,000
(笑声)

297
00:14:33,000 --> 00:14:37,000
那么，这一程度的幻觉，只会由这一整块可以称作下颞叶皮质的区域

298
00:14:37,000 --> 00:14:40,000
形成视觉影像、

299
00:14:40,000 --> 00:14:43,000
幻象，或片段

300
00:14:43,000 --> 00:14:46,000
只有更高程度的幻觉

301
00:14:46,000 --> 00:14:48,000
才会有视觉以外的感官参与

302
00:14:48,000 --> 00:14:50,000
同时牵涉到记忆与情感

303
00:14:50,000 --> 00:14:53,000
在邦纳症候群中

304
00:14:53,000 --> 00:14:55,000
更高程度的幻觉并不会出现

305
00:14:55,000 --> 00:14:58,000
牵涉到初级视觉皮质的幻觉

306
00:14:58,000 --> 00:15:00,000
有上百上千

307
00:15:00,000 --> 00:15:03,000
甚至更多的图像、

308
00:15:03,000 --> 00:15:05,000
幻象，或残缺幻象

309
00:15:05,000 --> 00:15:07,000
这些都被编译

310
00:15:07,000 --> 00:15:11,000
在特定的脑细胞或脑细胞簇中

311
00:15:11,000 --> 00:15:14,000
这些细胞通常

312
00:15:14,000 --> 00:15:18,000
参与形成感知和想象

313
00:15:18,000 --> 00:15:21,000
人们通常是无法意识到这一过程的

314
00:15:21,000 --> 00:15:25,000
只有当你的视力受损或丧失

315
00:15:25,000 --> 00:15:27,000
这一过程才会被干扰

316
00:15:27,000 --> 00:15:30,000
在这种情况下，你的感知不再正常

317
00:15:30,000 --> 00:15:32,000
一种不受控的、

318
00:15:32,000 --> 00:15:35,000
痉挛的释放活动

319
00:15:35,000 --> 00:15:37,000
发生在位于初级视觉皮质的

320
00:15:37,000 --> 00:15:39,000
这些视觉脑细胞中

321
00:15:39,000 --> 00:15:42,000
这种活动的结果就是，你突然看到一张脸，转瞬看到一辆车

322
00:15:42,000 --> 00:15:45,000
突然这，突然那

323
00:15:45,000 --> 00:15:47,000
大脑会尝试控制场面

324
00:15:47,000 --> 00:15:50,000
尝试使这一切符合逻辑

325
00:15:50,000 --> 00:15:52,000
但不会很成功

326
00:15:52,000 --> 00:15:54,000
这些现象最初被描述时

327
00:15:54,000 --> 00:15:58,000
人们相信，跟梦一样，这种幻觉也能被强行中止

328
00:15:58,000 --> 00:16:00,000
不过实际上患者表示

329
00:16:00,000 --> 00:16:03,000
“我认不出来谁是谁。完全没办法想到任何信息。”

330
00:16:03,000 --> 00:16:06,000
”青蛙柯密特对我来说一点意义都没有啊。“

331
00:16:06,000 --> 00:16:11,000
把这种现象视作梦的一种是行不通的

332
00:16:11,000 --> 00:16:16,000
唔，我应该说得差不多了

333
00:16:16,000 --> 00:16:19,000
我再概括一下

334
00:16:19,000 --> 00:16:21,000
其实帮纳症候群是个常见现象

335
00:16:21,000 --> 00:16:23,000
你们想，在盲人人群中

336
00:16:23,000 --> 00:16:25,000
肯定有上百上千

337
00:16:25,000 --> 00:16:27,000
有这样的幻觉

338
00:16:27,000 --> 00:16:29,000
然而却不敢提起

339
00:16:29,000 --> 00:16:32,000
所以不管是病人，医生还是公众

340
00:16:32,000 --> 00:16:38,000
都有必要认识到这一现象的常见性

341
00:16:38,000 --> 00:16:40,000
最后

342
00:16:40,000 --> 00:16:43,000
我发现帮助别人认识大脑作用的原理

343
00:16:43,000 --> 00:16:47,000
是一件无比有趣而有意义的事情

344
00:16:47,000 --> 00:16:50,000
查尔斯·邦纳在250年前

345
00:16:50,000 --> 00:16:54,000
在对这些幻觉现象的观察的促使下，思考了这个问题

346
00:16:54,000 --> 00:16:57,000
心智的戏剧性

347
00:16:57,000 --> 00:17:00,000
是如何产生于大脑运作的呢？

348
00:17:00,000 --> 00:17:03,000
250年后的今天

349
00:17:03,000 --> 00:17:06,000
我想我们已经能够开始领悟这个精妙的过程

350
00:17:06,000 --> 00:17:08,000
非常感谢

351
00:17:08,000 --> 00:17:11,000
(掌声)

352
00:17:11,000 --> 00:17:14,000
克里斯·安德森：非常精彩，非常感谢你

353
00:17:14,000 --> 00:17:16,000
你说得非常精到

354
00:17:16,000 --> 00:17:19,000
也很能理解你的病人

355
00:17:19,000 --> 00:17:24,000
你自己有没有过这些症状呢？

356
00:17:24,000 --> 00:17:26,000
奥利弗·萨克斯：我挺怕你问这个的

357
00:17:26,000 --> 00:17:27,000
(笑声)

358
00:17:27,000 --> 00:17:30,000
嗯，有，很大一部分

359
00:17:30,000 --> 00:17:33,000
事实上我自己也有一定的视力受损

360
00:17:33,000 --> 00:17:36,000
我的一只眼睛是看不到的，另一只视力也不大好

361
00:17:36,000 --> 00:17:40,000
我看到过几何幻觉

362
00:17:40,000 --> 00:17:42,000
不过最多也就这个程度了

363
00:17:42,000 --> 00:17:44,000
安德森：它们会不会让你感到很不安？

364
00:17:44,000 --> 00:17:46,000
或者说是不是因为你了解这一现象而没这么担心？

365
00:17:46,000 --> 00:17:50,000
萨克斯：耳鸣让我烦心得多

366
00:17:50,000 --> 00:17:53,000
耳鸣我也是听而不闻

367
00:17:53,000 --> 00:17:55,000
不过偶尔我会对自己的幻觉很感兴趣

368
00:17:55,000 --> 00:17:58,000
我还把它们画在了笔记本里

369
00:17:58,000 --> 00:18:01,000
我自己就曾做过功能性磁共振成像

370
00:18:01,000 --> 00:18:04,000
看看我的视觉皮层在造什么反

371
00:18:04,000 --> 00:18:08,000
我看到六边形的幻觉

372
00:18:08,000 --> 00:18:10,000
或更复杂的幻觉，

373
00:18:10,000 --> 00:18:12,000
往往伴随着偏头痛

374
00:18:12,000 --> 00:18:14,000
那是我就会想是不是别人也会有这样的幻觉

375
00:18:14,000 --> 00:18:17,000
洞穴壁画和装饰艺术

376
00:18:17,000 --> 00:18:20,000
是不是也取材于这种幻觉

377
00:18:20,000 --> 00:18:22,000
安德森：你今天的演讲非常非常精彩

378
00:18:22,000 --> 00:18:24,000
感谢你的分享

379
00:18:24,000 --> 00:18:26,000
萨克斯：谢谢，谢谢

380
00:18:26,000 --> 00:18:28,000
(掌声)