Anthropology, History and Social Medicine, University of California, San Francisco, San Francisco, CA, USA.
Cult Med Psychiatry. 2011 Jun;35(2):113-33. doi: 10.1007/s11013-011-9210-6.
In this article, I describe a new form of clinical subjectivity in Thailand, emerging out of public debate over medical care at the end of life. Following the controversial high-tech death of the famous Buddhist monk Buddhadasa, many began to denounce modern death as falling prey to social ills in Thai society, such as consumerism, technology-worship, and the desire to escape the realities of existence. As a result, governmental and non-governmental organizations have begun to focus on the end-of-life as a locus for transforming Thai society. Moving beyond the classic outward focus of the medical gaze, they have begun teaching clinicians and patients to gaze inward instead, to use the suffering inherent in medicine and illness to face the nature of existence and attain inner wisdom. In this article, I describe the emergence of this new gaze and its major conceptual components, including a novel idea of what it means to be 'human,' as well as a series of technologies used to craft this humanity: confession, "facing suffering," and untying "knots" in the heart. I also describe how this new subjectivity has begun to change the long-stable Buddhist concept of death as taking place at a moment in time, giving way for a new concept of "end-of-life," an elongated interval to be experienced, studied, and used for inner wisdom.
在本文中，我描述了泰国一种新形式的临床主观性，这种主观性源自生命末期医疗保健的公共辩论。在著名佛教僧侣 Buddhadasa 有争议的高科技死亡之后，许多人开始谴责现代死亡成为泰国社会中社会弊病的牺牲品，例如消费主义、对技术的崇拜以及逃避存在现实的欲望。因此，政府和非政府组织开始将生命末期视为改变泰国社会的一个切入点。他们超越了医学凝视的经典外向焦点，开始教导临床医生和患者向内凝视，利用医学和疾病固有的痛苦来面对存在的本质并获得内在智慧。在本文中，我描述了这种新凝视的出现及其主要概念组成部分，包括对“人性”意味着什么的新观念，以及一系列用于塑造这种人性的技术：忏悔、“面对苦难”和解开心中的“结”。我还描述了这种新的主观性如何开始改变佛教中死亡发生在特定时刻的长期稳定概念，为“生命末期”的新概念让路，即一个延长的间隔，需要经历、研究和用于内在智慧。
