亨利·马什 (Henry Marsh) 的新作“And Finally”检测了（医学）知识的局限性和舒适性。

A Neuroscientist Faces Death, and Learns

Henry Marsh’s “And Finally” tests the limits — and comforts — of knowledge.

By Kieran Setiya

Jan. 17, 2023

译者注：虽然书评标题用了Neuroscientist，但是马什（Marsh)本人在书中强调过：neurosurgeon不是neuroscientist，就像plumber不是材料学家（大意）。

罗马哲学家西塞罗（Roman philosopher Cicero）说过，哲学思考就是学习如何死亡。16 世纪的散文作家米歇尔·德·蒙田 (Michel de Montaigne) 时而认真、时而开玩笑地回应他。 “如果你不知道怎么死，别担心，”蒙田开玩笑地总结道。 “大自然会告诉你到时候该做什么，完完全全不必担心。”

我们不需要为了死亡而去学习有关死亡的生物力学（biological mechanics of dying）。但了解这些可能在你面对死亡时会有所帮助。如果哲学家们还没有想出如何做到这一点——至少他们的建议不能让每个人都满意——医生会不会做得好一些？亨利·马什(Henry Marsh) 是一位作家和退休医生，《经济学人》杂志说，“神经科学在他身上找到了博斯韦尔（Boswell；a person who records in detail the life of a usually famous contemporary）。” 在他最近出版的书中，他从医生变成了病人，面对可能会终止他生命的诊断。

It was said by the Roman philosopher Cicero that to philosophize is to learn how to die. He was echoed by the 16th-century essayist Michel de Montaigne, sometimes in earnest, at other times in jest. “If you don’t know how to die, don’t worry,” Montaigne playfully concluded. “Nature will tell you what to do on the spot, fully and adequately.”

We don’t need to learn the biological mechanics of dying in order to die. But it may help to know them in facing death. If the philosophers haven’t figured out how to do that — at least not to everyone’s satisfaction — might a physician have more luck? Henry Marsh is an author and retired doctor, in whom, said The Economist, “neuroscience has found its Boswell.” In his most recent book, the physician becomes a patient, confronting a diagnosis that will probably end his life.

许多年前，马什（Marsh)在牛津大学攻读哲学，但一年后他放弃了，改读更实用的医学院。他发现自己在这本书中，回到了关于意识和对死亡的恐惧的哲学问题，尽管他是通过叙述而不是通过争论；他的这些技能是作为一名临床医生以病历讲故事多年磨练出来的。马什（Marsh)知道如何布置场景、如何制造悬念、以及如何让读者大吃一惊。

Many years ago, Marsh read philosophy at Oxford University, but he left for the more practical world of medicine after a year. He finds himself returning in this book to philosophical questions about consciousness and fear of death, though he does so through narrative, not argument, his skills honed by years of storytelling as a clinician recounting case histories. Marsh knows how to set a scene, how to create suspense and how to surprise the reader.

举个例子：他以“诱饵和转变话题”作为书的开头。 “当时看来，这似乎是个笑话，”他写道，“我应该对自己的大脑进行扫描。”我们猜想他病得很重，我们假设扫描会发现肿瘤；诗意般的不公正。事实上，扫描显示的是衰老造成的普通脑损耗，即随着岁月而萎缩的大脑。真正的诊断后来才出现：他得了晚期前列腺癌，之所以延误了检测，是由于作为医生的他，以为只有患者才会生病。 （在观察到一位朋友对无法治愈的肿瘤的消息，只有平静反应，马什说：“很难知道这是由于他很坚忍还是由于他有额叶脑损伤。”）

Case in point: He opens with a bait-and-switch. “It seemed a bit of a joke at the time,” he writes, “that I should have my own brain scanned.” We know he’s about to be seriously ill and we assume that the scan will reveal a tumor; poetic injustice. In fact, what the scan reveals is the ordinary attrition of aging, a brain diminished by the years. The real diagnosis comes later: advanced prostate cancer, its detection delayed by the misguided fortitude of a doctor who assumes that only patients get sick. (About a friend’s calm response to news of an untreatable tumor, Marsh observes: “It was difficult to know whether this came from stoicism or frontal brain damage.”)

并不是说扫描不可怕；马什对他慢慢萎缩的大脑的影象感到恐惧和惊奇，将他的这种经历比作夜空的景象——暗指哲学家伊曼纽尔·康德（Immanuel Kant）。在马什的一篇题词中，引用康德：“有两件事使我的头脑充满新的和日益增长的钦佩和敬畏，我头顶的星空和我内心的道德法则。”

我想大脑是良心之声的合适的神经科学替代品。马什发现“很难理解‘我’就是我大脑中的 860 亿个神经细胞”，它们连起来“比从地球到月球的距离还要长”。在书中，他暗示说，“现实世界只是电化学脉冲的一种模式。”看到这里，我希望他当年能再坚持多读一段时间哲学。我们不是大脑，而是具身存在（embodied beings）——正如哲学家们至少一个世纪以来一直在争论的那样——将我们困在脑海中的笛卡尔式“思想面纱”用神经元面纱所取代，是无益的。

Not that the scan isn’t frightening; Marsh feels fear as well as wonder at the image of his slowly withering brain, comparing his experience to a vision of the night sky — an allusion to the philosopher Immanuel Kant. “Two things fill the mind with ever new and increasing admiration and awe,” Kant declaims in one of Marsh’s epigraphs, “the starry heavens above me and the moral law within me.”

I suppose the cerebrum is a suitably neuroscientific substitute for the voice of conscience. Marsh finds it “very hard to comprehend that ‘I’ am the 86 billion nerve cells of my brain,” its wiring longer “than the distance from the earth to the moon.” At one point he suggests, in passing, that “the real world is just a pattern of electrochemical impulses.” At moments like these, I wish he’d stuck with philosophy a little longer. We are not brains, but embodied beings — as philosophers have been arguing for at least a century — and the Cartesian “veil of ideas” that traps us in our minds is not helpfully replaced with a veil of neurons.

但这些都是书里的次要元素。在大多数情况下，马什并没有假装能够回答关于心灵的形而上学问题，甚至没有假设我们这样的人可以回答这些问题：“你不能用黄油做的刀，去切黄油，”一位神经科学家朋友打趣道。相反，我们寻求隐喻。在头脑比喻成为计算机之前，它是电话（机），再之前是蒸汽机，尽管弗洛伊德的精神分析理论“使本我和自我（id and ego）听起来像是抽水马桶的组成部件”。

马什的文笔经常很有趣，有时他拿自己开玩笑。他对弗洛伊德对梦的解释不屑一顾，并抱怨其他人的梦“非常无聊”；却发现自己正在讲述关于妻子的一场漫长的噩梦。他给他的孙女们讲的童话故事具有寓言元素，比如“孤儿独角兽患上了可怕的下垂角病”。像许多其他人一样，马什接受了“化学阉割”治疗前列腺癌；这剥夺了癌细胞的雄激素，但也伴随着乳房发育、阳痿、和肌肉损失这些副作用。

But these are minor elements of the book. For the most part, Marsh does not pretend to answer metaphysical questions about the mind, or even assume that they can be answered by the likes of us: “You can’t cut butter with a knife made of butter,” quips a neuroscientist friend. Instead, we reach for metaphors. Before the mind was a computer, it was a telephone exchange, and before that a steam engine, though Freud’s psychoanalytic theory “made the id and ego sound like the components of a flushing toilet.”

Marsh is often funny, sometimes at his own expense. Dismissing Freud on dream interpretation and complaining that other people’s are “quite remarkably boring,” he finds himself narrating a long nightmare about his wife. The fairy stories he tells his granddaughters have allegorical elements, like an “orphaned unicorn who develops the dreaded Droopy Horn Disease.” Like many others, Marsh was treated for prostate cancer by “chemical castration,” depriving cancerous cells of androgen, with side effects of breast development, impotence and muscle loss.

他对随后的放射治疗的描述，是对这项技术的颂扬（不是针对用这项技术的人员），几乎是用抒情的方式描述的。 “只有当我自己被诊断出患有癌症时，”他写道，“我才能看到患者与医生之间的距离有多大，而医生对他们的患者正在经历的事情了解得有多么少。”这并不是说他在评判谁。马什承认自己作为一名外科医生缺乏同情心，也承认作为一名医生日常工作所需的超然态度。他对临床医生的建议是务实的：“与患者交谈时，你应该始终坐着，永远不要显得匆忙。”

His account of the subsequent radiotherapy celebrates the technology, which is almost lyrically described; not so much the medical practitioners. It “was only when I was diagnosed with cancer myself,” he writes, “that I could see just how great is the distance that separates patients from doctors, and how little doctors understand about what their patients are going through.” Not that he’s judgmental. Marsh acknowledges his own failures of compassion as a surgeon and the detachment needed to function as a doctor from day to day. His advice to clinicians is pragmatic: “You should always be seated when talking to patients, and never appear to be in a hurry.”

当我们想了解如何死去时，马什对我们有什么指教？在某种程度上，书中有对“协助自杀”（安乐死）的审慎论证；到目前为止，安乐死并没有导致批评者所推测的滥用职权。在某种程度上，他反对过分希望长生不老的论点。活70岁应该足够了——死亡对于年轻人来说是不同的——我们必须在这个星球上为其他人腾出空间。 “我在阳光下度过了一段时光，”马什写道，“现在轮到下一代了。”【译者注：马什当时是70岁左右。】

What lessons does he have for the rest of us, as we learn how to die? In part, a measured argument for assisted suicide, which has not so far led to the abuses conjectured by its critics. In part, an argument against the immoderate wish to live forever. Seventy years should be enough — death is different when it comes to someone young — and we have to make room on the planet for other people. “I have had my time in the sun,” Marsh writes, “now it is the turn of the next generation.”

在面对死亡时，我不敢说他比哲学做得更好，但我认为马什并不比哲学做得更差。这里没有虚假的安慰。他的文字在温柔的波浪中起伏，含义很深，就像洋面非常广阔，足以让我们从道德的角度来看待人生。他在书中穿插了 DIY （自己动手）和建造玩具屋、给医院增添装饰、和徒步旅行喜马拉雅。马什是坐着讲故事，他并不急着赶路。

I’m not sure he does better than philosophy when it comes to facing death, but I don’t think Marsh does worse. There’s no false comfort here. Instead, there’s prose that breaks in gentle waves, its undercurrents deep, the surface of an ocean vast enough to put our lives in moral perspective. The narrative takes detours through DIY and dollhouses, hospital décor and Himalayan hikes. Marsh is seated, storytelling, and he is in no hurry.

Kieran Setiya在麻省理工学院教哲学，是《生活是艰难的：哲学如何帮助我们找到自己的出路》的作者。

Kieran Setiya teaches philosophy at M.I.T. and is the author of “Life Is Hard: How Philosophy Can Help Us Find Our Way.”

·       亨利·马什 (2014)。 不要伤害：生、死和脑部手术的故事。魏登菲尔德和尼科尔森。 书号 9781780225920 。

·       亨利·马什 (2017)。 录取：脑外科生活。魏登菲尔德和尼科尔森。 书号 9781474603867 。

·       亨利·马什 (2022)。 最后：生死攸关。乔纳森·凯普。 书号 9781787331136 。

Publications

·       Marsh, Henry (2014). Do No Harm: Stories of Life, Death and Brain Surgery. Weidenfeld & Nicolson. ISBN 9781780225920.

·       Marsh, Henry (2017). Admissions: A life in Brain Surgery. Weidenfeld & Nicolson. ISBN 9781474603867.

·       Marsh, Henry (2022). And Finally: Matters of Life and Death. Jonathan Cape. ISBN 9781787331136.