Kagawa-Singer M
School of Nursing, University of California Los Angeles 90024.
Soc Sci Med. 1993 Aug;37(3):295-304. doi: 10.1016/0277-9536(93)90261-2.
The patients presented in this paper were being treated for cancer. None denied the diagnosis, and all were adhering to the medical regimen. Yet these patients also said that they were healthy in the face of the implications of their disease and the physical toll imposed by the treatments. The definition of health currently used by the American health care system is too restrictive to encompass the perception voiced by these individuals. This paper proposes to broaden the concept of health to help provide a legitimate place in society for individuals with chronic, life-threatening illnesses. A theoretical framework is proposed which might explain how these patients could still see themselves as healthy despite their disease. The core concept of health in this model is a sense of self-integrity, and the construct of health has two dimensions, Physical Status and Social Function. Individuals with chronic, life-threatening diseases like cancer use both of these dimensions simultaneously in order to negotiate and reestablish a sense of self-integrity based on their continued social functioning even in light of their acknowledged physical condition. Implications for restructuring our thinking about health, disease, and the mechanisms used to cope with cancer are outlined in order to develop a more realistic definition of health which is contextually based in the lives of the individuals with the disease. The criteria for assessment would not be biologic integrity alone, but a complex compromise between personal needs, social obligations, and physical abilities.
本文所呈现的患者均正在接受癌症治疗。无人否认诊断结果，且所有人都坚持医疗方案。然而，这些患者也表示，尽管身患疾病并承受着治疗带来的身体损害，但他们仍觉得自己是健康的。美国医疗系统目前所使用的健康定义过于狭隘，无法涵盖这些患者所表达的观念。本文提议拓宽健康概念，以便为患有慢性、危及生命疾病的个体在社会中提供一个合理的位置。文中提出了一个理论框架，该框架或许能够解释为何这些患者尽管身患疾病却仍能视自己为健康的。此模型中健康的核心概念是自我完整性意识，健康结构有两个维度，即身体状况和社会功能。患有诸如癌症等慢性、危及生命疾病的个体同时运用这两个维度，以便即使鉴于其公认的身体状况，仍能基于其持续的社会功能来协商并重新建立自我完整性意识。文中概述了对我们关于健康、疾病以及用于应对癌症的机制的思维进行重构的意义，以便形成一个更现实的、基于患病个体生活背景的健康定义。评估标准将不仅仅是生物完整性，而是个人需求、社会义务和身体能力之间的复杂折衷。
