Ware N C, Kleinman A
Department of Social Medicine, Harvard Medical School, Boston, Massachusetts 02115.
Psychosom Med. 1992 Sep-Oct;54(5):546-60. doi: 10.1097/00006842-199209000-00003.
An anthropological view of culture and somatic experience is presented through elaboration of the notion that illness has a social course. Contemporary anthropology locates culture in local worlds of interpersonal experience. The flow of events and processes in these local worlds influences the waxing and waning of symptoms in a dialetic involving body and society over time. Conversely, symptoms serve as a medium for the negotiation of interpersonal experience, forming a series of illness-related changes in sufferers' local worlds. Thus, somatic experience is both created by and creates culture throughout the social course of illness. Findings from empirical research on neurasthenia in China, and chronic fatigue syndrome (CFS) in the United States, corroborate this formulation. Attributions of illness onset to social sources, the symbolic linking of symptoms to life context, and the alleviation of distress with improvement in circumstances point to the sociosomatic mediation of sickness. Transformations occasioned by illness in the lives of neurasthenic and CFS patients confirm the significance of bodily distress as a vehicle for the negotiation of change in interpersonal worlds. An indication of some of the challenges anthropological thinking poses for psychosomatic medicine concludes the discussion.
通过阐述疾病具有社会进程这一概念，展现了对文化与躯体体验的人类学观点。当代人类学将文化置于人际体验的局部世界中。这些局部世界中的事件和过程的流动，随着时间的推移，在涉及身体与社会的辩证关系中影响着症状的消长。反之，症状作为人际体验协商的媒介，在患者的局部世界中形成了一系列与疾病相关的变化。因此，在疾病的整个社会进程中，躯体体验既由文化塑造，又塑造着文化。对中国神经衰弱和美国慢性疲劳综合征（CFS）的实证研究结果证实了这一表述。将疾病发作归因于社会因素、将症状与生活情境进行象征性联系，以及随着情况改善痛苦减轻，都指向了疾病的社会躯体调节作用。神经衰弱和CFS患者生活中因疾病引发的转变，证实了身体痛苦作为人际世界中协商变化的媒介的重要性。讨论最后指出了人类学思维给身心医学带来的一些挑战。
