Martínez Rebecca G
University of Missouri, Columbia, 113 McAlester Hall, Rural Sociology, Columbia, Missouri 65211, USA.
Soc Sci Med. 2005 Aug;61(4):797-808. doi: 10.1016/j.socscimed.2004.08.050. Epub 2004 Dec 10.
Social scientists concerned with studying the social and cultural meaning of illness problematize the relationship between disease and illness, noting that illness can exist without disease-abnormal physical changes in the body. What has received less attention is the existence of disease-made visible through technological advances-in the absence of illness. Cervical cancer (or the more ambiguous cervical abnormalities) is an example of a disease that is largely symptomless in its early stages and can occur in the absence of illness. In this paper I explore how women seek to understand and negotiate cervical cancer in the context of their everyday lives, as they are confronted with seemingly disparate and contradictory physical and psychological states of well-being, sickness, and disease. This experience is what I call living on the borderlands of health, disease, and illness, where all of these states are experienced concurrently and boundaries between them blur. Through observations of patient-doctor interactions, ethnographic interviews with doctors and women seeking treatment for cervical cancer and pre-cancerous abnormalities, I analyze how women try to understand their medical experience. And they do so with the added challenge of little information being shared with them by the doctors who treat them. While patients do not ask many questions of their doctors, this does not mean that women are disinterested in their health. In fact, they develop strategies for eliciting clinical information about their medical conditions and actively seek to make sense of their experiences. By problematizing the concepts of health, disease, and illness, and avoiding the tendency to see these as distinct and contradictory phenomenon, we can gain a better understanding of their interrelatedness, and how people negotiate this borderland.
关注研究疾病的社会和文化意义的社会科学家对疾病与病患之间的关系提出了质疑,指出即使身体没有出现异常的生理变化(即没有疾病),病患状态也可能存在。较少受到关注的是在没有病患的情况下,通过技术进步而显现出来的疾病的存在。宫颈癌(或者更具模糊性的宫颈异常)就是一种在早期基本没有症状且可能在没有病患状态时出现的疾病的例子。在本文中,我探讨女性在日常生活背景下如何试图理解和应对宫颈癌,因为她们面临着幸福、患病和疾病等看似截然不同且相互矛盾的生理和心理状态。这种经历就是我所说的生活在健康、疾病和病患的边缘地带,在那里所有这些状态同时被体验到,它们之间的界限也变得模糊。通过观察医患互动、对医生以及寻求宫颈癌和癌前异常治疗的女性进行人种志访谈,我分析女性是如何试图理解她们的就医经历的。而且她们这样做还面临着治疗她们的医生很少与她们分享信息这一额外挑战。虽然患者不会向医生问很多问题,但这并不意味着女性对自己的健康不感兴趣。事实上,她们会制定策略来获取有关自身病情的临床信息,并积极试图理解自己的经历。通过对健康、疾病和病患概念提出质疑,并避免将这些概念视为截然不同且相互矛盾的现象的倾向,我们能够更好地理解它们的相互关联性,以及人们如何在这个边缘地带进行协商。