Alves Paulo Cesar
Departamento de Sociologia, Universidade Federal da Bahia. R. Augusto Viana s/n/Palácio da Reitoria, Canela. 40110-909 Salvador BA Brasil.
Cien Saude Colet. 2018 Feb;23(2):381-388. doi: 10.1590/1413-81232018232.15162017.
The short story "The Death of Ivan Ilyich" (1886), Leo Tolstoy (1828-1910) provides key elements for a reflection on the meaning of long-term illness. Based on Tolstoy's short story the present paper analyzes the multiple dimensions of the process of illness. It starts with the argument that illness is not an a priori totality, but a trajectory of associations between the sick person, the doctor, family members, friends and caregivers. Acting, being affected, thinking and feeling all come together in the development of these associations. The analysis of the Ivan Ilyich's illness will consider the following points: (a) illness as otherness and incomprehensibility (growing unfamiliarity with one's body and the stages by which the body is gradually objectified); (b) illness as trajectories in an field of practices that involves the development of skills and the "education of attention"; (c) modes of health care as a set of techniques, objects and discourses that are put together or associated throughout trajectories concerned with the establishment of health. Long-term illness is therefore a mode of immersion of the sick person in networks of relations that come to be a part of her everyday life.
短篇小说《伊万·伊里奇之死》（1886年），列夫·托尔斯泰（1828 - 1910）提供了思考长期疾病意义的关键要素。基于托尔斯泰的短篇小说，本文分析了疾病过程的多个维度。文章开篇提出论点，即疾病并非一个先验的整体，而是病人、医生、家庭成员、朋友和护理人员之间关联的轨迹。在这些关联的发展过程中，行动、受影响、思考和感受都交织在一起。对伊万·伊里奇疾病的分析将考虑以下几点：（a）疾病作为他者性和不可理解性（对自身身体以及身体逐渐被客体化的阶段越来越陌生）；（b）疾病作为一个实践领域中的轨迹，这涉及技能的发展和“注意力的培养”；（c）医疗保健模式作为一组技术、对象和话语，它们在与健康确立相关的整个轨迹中被组合或关联在一起。因此，长期疾病是病人融入成为其日常生活一部分的关系网络的一种方式。
