Becker G, Janson-Bjerklie S, Benner P, Slobin K, Ferketich S
Medical Anthropology Program, School of Nursing, University of California, San Francisco 94143-0612.
Soc Sci Med. 1993 Aug;37(3):305-13. doi: 10.1016/0277-9536(93)90262-3.
Asthma is an invisible and unpredictable chronic illness characterized by recurrent episodes of airflow obstruction and airway inflammation. Until recently, psychological factors were thought to play a major role in this condition. The notion of an emotionally-based illness serves to discredit asthma as a 'real' illness among health professionals and patients alike, contributes to the sense of stigma that persons who have asthma experience, and impedes effective management. Findings from research with a sample of 95 adults with physician diagnosed and documented asthma indicate that persons who have asthma walk a tightrope between delaying formal medical intervention and seeking treatment too soon. Uncertainty about the quality and speed of care available in an emergency department shapes, in part, the nature of the lived experience of asthma and affects feelings of control over the illness. These concerns create a push-pull dynamic, as individuals struggle to make decisions about emergency department use that will provide relief, ensure autonomy, deter the experience of stigma, and diminish the threat of death.
哮喘是一种隐匿且不可预测的慢性疾病，其特征为气流阻塞和气道炎症反复发作。直到最近，心理因素仍被认为在这种疾病中起主要作用。基于情绪的疾病观念致使哮喘在医疗专业人员和患者中都被视为并非“真正”的疾病，加重了哮喘患者所感受到的耻辱感，并阻碍了有效治疗。对95名经医生诊断并记录患有哮喘的成年人进行的研究结果表明，哮喘患者在延迟正规医疗干预和过早寻求治疗之间艰难权衡。急诊科可用护理的质量和速度的不确定性，在一定程度上塑造了哮喘患者的实际体验的性质，并影响对疾病的控制感。这些担忧造成了一种推拉动态，因为个人在决定是否前往急诊科时挣扎不已，既要寻求缓解，确保自主性，避免耻辱感，又要降低死亡威胁。
