Department of Immunology, Auckland City Hospital, Auckland University of Technology, Auckland, New Zealand.
Explore (NY). 2012 Jan-Feb;8(1):16-25. doi: 10.1016/j.explore.2011.10.005.
Physical diseases that appear to be symbolic somatic representations of patients' personal meanings or individual 'stories' continue to be reported in the medical literature. The identification of a symbolic disease requires a clinical focus upon a patient's highly individual and nuanced meanings largely rendered invisible by the usual methodologies of clinical and research medicine, which has no coherent model for understanding symbolic disease. Therefore, a model is proposed of co-emergence of physicality and subjectivity, body and mind, disease and meaning, disease and symbol, which does provide a coherent basis for understanding symbolic disease. The 'mindbody' co-emergence model avoids mind and body dualism, assumes unbroken continuity between internal body processes and external interpersonal meanings and influences, and asserts that disease-related 'internal' bodily changes and collateral external interpersonal and environmental fluxes are mutually contingent and crucial to the development of the disease. The co-emergence model is discussed specifically in relation to psychoneuroimmunology, but it has exciting clinical and research implications for the whole of medicine.
在医学文献中，仍不断有报告称，那些看似是患者个人意义或个体“故事”的象征性躯体表现的身体疾病。识别象征性疾病需要临床关注患者高度个体化和细微的意义，而这些意义在临床和研究医学的常用方法中大多是看不见的，因为后者没有理解象征性疾病的连贯模式。因此，提出了一种身体与主观性、身心、疾病与意义、疾病与象征共同出现的模型，该模型为理解象征性疾病提供了一个连贯的基础。“身心”共同出现模型避免了身心二元论，假设内在身体过程与外在人际意义和影响之间存在不间断的连续性，并断言与疾病相关的“内在”身体变化和伴随的外在人际和环境变化是相互依存的，对疾病的发展至关重要。该共同出现模型在精神神经免疫学方面进行了具体讨论，但它对整个医学领域具有令人兴奋的临床和研究意义。
