体验与存在——一个村落长期慢性病人的病痛叙述.pdf

摘 要 随着生活方式和环境的改变,当今世界长期慢性病流行趋势日益严峻,不 仅成为城乡居民的主要死因之一,而且严重影响病人的日常生活。 慢性病痛是一种活生生的病痛经验,它的无法治愈性使其一旦发生,就成 为病人生活的一部分,因而不可避免地在生活世界中制造失序甚至摧毁生活世 界。但是,人无法长期面对混乱和失序。所幸,生活世界的失序并非是不可逆 的,长期慢性病人可以通过为病痛经验赋予意义来重建生活秩序。 病痛叙述是病人讲述的关于病痛经历的故事,也是赋予病痛经历以意义的过 程。这一过程往往是病人与家人、医务人员等主体在互动基础上的同构,它体 现病人的个体经历和地方的社会文化状况以及人类普遍价值观并同时受到其影 响和形塑。借助于结果导向的技术控制和意义导向的阐释这两种主要的寻求意 义赋予的途径,病人在病痛叙述中将意义赋予自己的病痛经验,其中既有积极 应对,也包含迫不得已的妥协,为病痛侵入所中断和扰乱的生活世界的秩序最 终得以重建。 本文坚持人类学的生物-文化整体论和医学人类学的意义中心或阐释主义 方法论,记录了浙江某地一个村落的长期慢性病人的病痛叙述,并结合现象学 关于生活世界的概念,对其病痛经验进行了考察和分析。疼痛是无法分享的, 但是病痛经验可以。本文得出的结论是:结果导向的技术控制和意义导向的阐 释是意义赋予的两种主要途径,共存于长期慢性病人疾病判断和认知、病痛解 释、求医问药和预后的全过程。面对慢性病难以治愈的特质和资源的限制,长 期慢性病人在寻求治疗和技术控制的同时,也寻求意义阐释,借助于地方文化 中的解释模式、家庭本位的支持体系、善终期待等发现病痛经验的意义,最终 实现生活世界的秩序重建。 关键词:慢性病;病痛经验;病痛叙述;秩序重建1Abstract With the change of lifestyle and environment, the chronic disease pandemic is getting increasingly severe; not only become the major cause of death among urban and rural residents, but also seriously affect the daily life of the patients Chronic illness is living illness experience. It can not be cured, which makes it a part of life once it occurs. Therefore, it inevitably turns patients’ life world into disorder and even unmake the life world. However, man can never stand chaos and disorder in a long term. Fortunately, the disorder of life world is not irreversiblePatients who suffer from chronic illness can always remake the life world by giving meaning to their illness experience Illness narrative is a story about illness experience told by the sufferer, and it is also a process of giving meaning to illness experience. Based on the interaction among the patient, his or her family and health care practitioners, illness narrative reveals the individual experiences, social culture and universal human values and meanwhile is shaped and influenced by these factors. Patients give meaning to their illness experience through illness narratives, with result-oriented technical control and meaning-oriented interpretation as the tw