Nations M K, Rebhun L A
Project HOPE, Fortaleza, Ceará, Brazil.
Cult Med Psychiatry. 1988 Jun;12(2):141-200. doi: 10.1007/BF00116857.
Current theories of fatalism and neglect and current descriptions of childhood illness in impoverished Northeastern Brazil are evaluated. Findings of an ongoing multidisciplinary project indicate that neglect and fatalism theories are incomplete as applied to the Brazilian Northeast. Intensive interviews and observations with bereaved mothers and traditional healers show that mothers' failure to obtain medical care for severely ill children is due more to real-life bureaucratic and geographic barriers to access than to fatalistic or neglectful attitudes on the part of the poor, that mothers' flat affect in response to infant deaths is due more to folk Catholic beliefs than to lack of emotional attachment to infants, that fatalistic statements are often post hoc and do not indicate fatalistic behavior, and that decisions about whether to treat severely ill infants are made by mothers and families in consultation with traditional healers in accord with a folk system of classification of high risk infants. What have been described as "death accepting," "pathogenic," and "ethnoeugenic" attitudes are part of a folk ethical system developed to guide reactions to terminal childhood illness. We argue that human behavior, especially in the realm of health, cannot be understood without reference to both biomedical and psychosocial realities.
对宿命论与忽视的当前理论以及巴西东北部贫困地区儿童疾病的当前描述进行了评估。一个正在进行的多学科项目的研究结果表明，宿命论与忽视理论在应用于巴西东北部时并不完整。对失去孩子的母亲和传统治疗师进行的深入访谈及观察显示，母亲未能为重病儿童寻求医疗护理，更多是由于现实生活中获取医疗服务存在官僚和地理障碍，而非穷人的宿命论或忽视态度；母亲对婴儿死亡表现出的平淡情绪反应，更多是由于民间天主教信仰，而非对婴儿缺乏情感依恋；宿命论言论往往是事后的，并不表明宿命论行为；关于是否治疗重病婴儿的决定是由母亲和家庭与传统治疗师协商后，根据一套民间高危婴儿分类系统做出的。被描述为“接受死亡”“致病”和“种族优生”的态度，是一种民间道德体系的一部分，该体系旨在指导对儿童绝症的反应。我们认为，不参考生物医学和社会心理现实，就无法理解人类行为，尤其是在健康领域的行为。
