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慢性疼痛的现象学-存在主义理解:超越现有的医疗模式。

The phenomenological-existential comprehension of chronic pain: going beyond the standing healthcare models.

作者信息

Lima Daniela Dantas, Alves Vera Lucia Pereira, Turato Egberto Ribeiro

机构信息

Rua Presidente Bernardes 1293 ap,43 Jd, Flamboyant, Campinas CEP 13091-160, SP, Brasil.

出版信息

Philos Ethics Humanit Med. 2014 Jan 10;9:2. doi: 10.1186/1747-5341-9-2.

Abstract

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to patient's subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being's integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain.

摘要

生物医学模式的一个显著特征是其对人的 compartmentalized 观点。这种看待人类的方式起源于希腊思想;它由笛卡尔提出,直到今天它仍然将人类视为由不同实体组合成某种形式的存在。基于这种观察,人们开始认为健康治疗的重点可以仅仅放在身体的受影响部位,而无需关注患者的主观性。通过将疼痛仅仅视为一种感觉反应,这种模式无法涵盖慢性疼痛,因为后者是一个复杂的过程,可能独立于组织损伤而发生。到了20世纪下半叶,当无法否认心理与身体之间的关系时,对慢性疼痛的当前理解出现了:即慢性疼痛是一种个体体验,是身体、心理和社会因素综合作用的结果,因此不能脱离表达疼痛的个体来单独看待。这种理解使得观点有了显著改善,强调了疼痛作为个体体验的特征。然而,将慢性疼痛理解为多种因素的综合,与当前看待生病过程的方式相对应,因为其概念持有笛卡尔二元论和单一现实的实证主义前提。另一方面,对于现象学来说,个体在其整体性中不仅仅是部分的简单总和。现象学将人视为一个意向性实体,其中身体、心灵和世界相互交织并相互构成,从而确立了人的整体功能。因此,只有从现象学的角度,从表达和传达疼痛的个体所经历的体验出发,才有可能真正理解慢性疼痛过程。

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