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治疗活动构建了治疗对象:医学寻求真理的方式、组织现实的形式、调节患者的身体、疾病和文化?

Healing activities construct the objects of therapy: Medicine's way of seeking truth, organizing forms of reality, regulating patients' bodies, illness and culture?

作者信息

Cypress Brigitte S

机构信息

Department of Nursing, East Stroudsburg University of Pennsylvania, Pocono Summit, Pennsylvania.

出版信息

Nurs Philos. 2019 Apr;20(2):e12236. doi: 10.1111/nup.12236. Epub 2019 Mar 20.

Abstract

In this paper, I will explore the concept that healing activities shape the objects of therapy and seek to construct those objects through therapeutic activities. Objects of therapy are the persons, patients, human bodies, diseases, physiological processes and personal suffering-that which clinical medicine constructs through its distinctive formative processes, practices and knowledge. The rationale for choice of philosophical sources namely, Cassirer, Foucault, the anthropological perspective of Good and the sociological account of Frank will be discussed. The claim articulated by Good will be examined and its relationship to culture, illness, medical knowledge, practice, truth, and science. I then focus on Frank's concepts of the patient and the body and how medical knowledge and practices affects it. The concept that the medicalization of the illness narrative silences the patient's voice requiring an ethic of listening will be emphasized, described and further supported by Charon's (2006, Narrative medicine: Honoring the stories of illness. New York, NY: Oxford University Press) and Cassell's (2015, The nature of suffering and the goals of medicine. New York, NY: Oxford University Press) thoughts on narrative of illness in clinical medicine. My position concludes that healing activities construct the objects of therapy: as the medical culture's way of seeking truth; as medicine's way of mediating and organizing forms of reality through culture and symbolic forms; and, as medicine's way of entering the body and constructing the disease. Lastly, I suggest that in spite of the remarkable progress in the control of disease, the failure to address the interpretation of illness meanings is a fundamental flaw in the work of "doctoring." The experience and meanings of illness are at the centre of clinical practice and is a moral, political, ethical and professional obligation. The person is a cultural construct, a complex and culturally shaped way of experiencing self and other, and cultural "work" is required to constitute the person who is the object of medical attention and it also necessitates the ethic of listening.

摘要

在本文中,我将探讨治愈活动塑造治疗对象这一概念,并试图通过治疗活动构建这些对象。治疗对象包括人、患者、人体、疾病、生理过程以及个人痛苦,即临床医学通过其独特的形成过程、实践和知识所构建的内容。将讨论选择哲学来源(即卡西尔、福柯、古德的人类学视角以及弗兰克的社会学阐述)的理由。将审视古德所提出的观点及其与文化、疾病、医学知识、实践、真理和科学的关系。接着,我将聚焦于弗兰克关于患者和身体的概念,以及医学知识和实践如何对其产生影响。疾病叙事的医学化使患者声音沉默这一概念需要倾听伦理,这将通过夏伦(2006年,《叙事医学:尊重疾病故事》。纽约,纽约州:牛津大学出版社)和卡塞尔(2015年,《痛苦的本质与医学的目标》。纽约,纽约州:牛津大学出版社)关于临床医学中疾病叙事的观点来强调、描述并进一步予以支持。我的立场总结认为,治愈活动构建治疗对象:作为医学文化寻求真理的方式;作为医学通过文化和象征形式调解和组织现实形式的方式;以及作为医学进入身体并构建疾病的方式。最后,我认为尽管在疾病控制方面取得了显著进展,但未能解决疾病意义的阐释问题是“行医”工作中的一个根本缺陷。疾病的体验和意义是临床实践的核心,是一项道德、政治、伦理和专业义务。人是一种文化建构,是体验自我和他人的复杂且受文化塑造的方式,构成医学关注对象的人需要文化“工作”,这也需要倾听伦理。

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