伦理与疗愈：先天性唇腭裂患者的疾痛叙事

长久以来,生物医学在疾病疗愈上占据绝对优势,认为疾病是生物分子结构激变或生理激素紊乱造成的结果。美国人类学家凯博文通过对中国精神疾病的田野研究试图证明,身体是社会的身体,疾病是文化的建构。从疾病的社会建构论与疾痛叙事角度出发,以中国医学科学院整形医院整形一科的田野实践为依据,对先天性唇腭裂患者的生活世界绘以深描,从病患的主体经验和体验出发,展现文化如何形塑身体观与疾病观,社会文化逻辑如何影响医学话语实践,以期对如何看待先天性唇腭裂患者,如何减轻先天性唇腭裂患者的疾痛进行反思。     

叙事病历临床应用的可能路径

在对叙事医学教育工具“平行病历”相关的文献进行梳理的基础上,概括出国内外研究的主要特征;指出临床实践中推行平行病历困境的症结,并明确提出应使用叙事病历概念,应讨论的主体是叙事书写,应强调中国本土叙事医学临床实践经验等主张。以安宁疗护领域的“对话体”叙事病历运用为例,提出拓展病历书写的多重可能性和人文容纳力的理解。致力于对病历开展反思性研究,旨在推动医学界将病历作为叙事医学教育临床转化的重要起点;通过提供个案和可供遵循的路径,助力形成相对完善的教育体系,并提出构建具有中国主体性叙事医学框架的可能。

     

隐喻与规训—关于安多藏区疾病叙事的医学人类学阐释

四川安多藏区佛教文献和民间仪式中保存的疾病叙事借助象征与隐喻的作用在藏族社群内部衍生出诸多行为、道德规范,起到了塑造、巩固社群内部秩序的作用。这种关于疾病的叙事是藏族佛教知识精英进行构建的历史结果,它作为藏族传统文化的特定组成部分与藏区社会医疗卫生现代化之间存在一定张力。因此,想要正确理解、妥善处理当今安多地区藏族社会医疗卫生文化中存在的传统与现代之间的冲突,就必须借助医学人类学方法转变藏区民众对疾病的传统式文化解读,以基于病患主体的疾病叙事取代宗教性的疾病叙事。

     

发展“中医人类学”的必要性与意义

中医人类学不同于惯常的人类学将目光投向“异域”医疗体系与疾病文化的理解,而是借用人类学的基本理念与研究方法,同时接纳中医文化中看待、感受、体悟事物的习惯及方式,以此为基点再去看待其他医学体系的理论与方法,甚至包括所谓“主流”的西医。同时,中医人类学为现代生物医学的话语霸权、中医现代化的取向提供反思性引导;以中医视角批判生物医学的研究,为“中西之争”提供建设性话题,为中医药走出去开辟蹊径;并尝试以中医视角对其他医学体系进行研究,为传统医疗体系的发展开拓多元化道路。     

王充的“疾虚妄”与怀疑精神

王充的《论衡》不仅在思想史上具有重要意义 ,而且它所反映的王充的治学特色同样具有很高的学术价值和现实意义。本文初步讨论了王充“疾虚妄”的态度、怀疑精神、实证精神 ,并做了简要的评价。     

整合循证医学与叙事医学的可能与不可能

基于整合循证医学与叙事医学的假定目标提出三点思考,其一是重视研究循证医学与叙事医学的不可通约性,将前者定义为视觉(证据)优势的医学,后者定义为听觉(共情)优势的医学,并予以价值分野的阐释;其二是从思想史的角度考察循证医学与叙事医学的精神发育,从中捕捉两种医学认知路径的类型意义;其三建议将肿瘤这一涉及身心灵不同境遇的临床领域作为整合循证医学与叙事医学思维路径的试验田。     

临床医学人文:困境与出路——兼谈叙事医学对于临床医学人文的意义

当下,医学人文正滑向空壳化,如果它无法融入临床路径和制度,就难以根植于临床大夫的观念与行为,推动临床医学人文从自发走向自觉,对医学人文关怀的临床价值,推动医学人文关怀进入临床的观念和路径等方面存在认知误区.剖析了造成医学人文悬空的诸多职业惯性与制度设计缺陷,极力推介丽塔·卡蓉的"叙事医学"范式,重点介绍了"平行病历",希望以此为契机推动医学人文关怀真正贴近临床,融入现代诊疗制度.     

差异中的医学人类学与社会学意义——对《中国人群死亡及其危险因素流行水平、趋势和分布》数据的透视

从医学人类学的视角对《中国人群死亡及其危险因素流行、趋势和分布》一书进行了评述,认为本书以大量的数据重新论证了医学人类学和社会医学的基本命题,也给读者带来了一些关于"人类发展与疾病流行"关系的思考.     

差异中的医学人类学与社会学意义——对《中国人群死亡及其危险因素流行水平、趋势和分布》数据的透视

从医学人类学的视角对《中国人群死亡及其危险因素流行、趋势和分布》一书进行了评述,认为本书以大量的数据重新论证了医学人类学和社会医学的基本命题,也给读者带来了一些关于"人类发展与疾病流行"关系的思考。     

外科医生视角下叙事医学的困境与出路

以外科医生视角探讨叙事医学在泌尿外科临床实践过程中存在的困境和挑战,并结合叙事医学的相关理论和方法（平行病历、精细阅读等）,寻求解决叙事医学本土化和推广困难的路径。目前,国内外科叙事医学存在的主要问题有：对叙事医学理念关注和重视不足、叙事医学师资力量薄弱、缺少高水平叙事医学教育平台和教育目标等。通过培养叙事医学理念、丰富叙事医学教学资源和建立叙事医学训练体系等多种方法和手段,培养外科医生的叙事能力（共情能力、反思能力等）,加快叙事医学理念在外科学领域的普及推广,改善医疗服务质量。     

病患的意义：从体验到概念的蜕变过程

美国哲学家S.K.图姆斯基于本人罹患的播散性或多发性硬化症的直接经验,阐述了关于病患意义构成及其变化四个层次的观点,这是他对梅洛-庞蒂身体现象学思想的具体化和当下化的应用。通过对这四个层次观点的梳理(感觉经验层次、患病的体验层次、疾病的认识层次、疾病状态的认识层次),认为研究病患意义具有极大的临床价值:即了解和读懂患者赋予病患的各种意义,将有助于改变目前临床医学问诊将患者的体验转变为医学概念术语的蜕变过程,有助于改善医患关系,并且对医学诊断和治疗目标带来深刻的影响。     

Sustaining our Spirits: Spiritual Study/Discussion Groups For Coping with Medical Illness

Illness is a universal experience that evokes a range of difficult emotions and tough spiritual questions, often without satisfying answers. Illness can be alienating and isolating. Sustaining ones spirits and preserving identity in the face of illness is a challenge for patients, family members, and caregivers. This paper introduces Spiritual study/discussion groups to strengthen patients perceived coping with illness. The groups introduce a spiritual perspective, provide emotional support, and offer a variety of spiritual coping tools, utilizing traditional and contemporary resources. Preliminary evaluations suggest that a healing time and space is created through the provision of comfort, connection, support, and inspiration.     

医患关系何解？——医者患病经历文献述评

综述医者患病经历相关文献发现,医、患分野和矛盾植根于医学和医学模式本身,是在现代医学发展过程中被建构出来的,解决医患关系问题应着眼于审视和改变医学文化和医学模式内部造成医患矛盾、分歧的根本原因,创造机会打破严格的医、患角色区隔,实现病人得治、医者得安、医患共同。在医者患病经历文献中,能追溯医患同源的起点,能洞悉医患分化和冲突所在,也能看到形成医患共同体的可能性,为实现和谐医患关系指明方向。

     

Spontaneous Reports of Religious Coping by Patients with Chronic Physical Illness

Individuals undergoing the stress of physical illness often report the use of religious coping activities. This study compared the frequency of spontaneous reports of religious coping in three groups of patients including those with cancer preparing for a bone marrow transplant (n = 22), chronic pain (n = 36), and cardiovascular disease (n = 53). Participants were asked to respond to a written, open-ended question asking how they were coping with the challenges involved in their medical condition. The question asked them to list the resources, strategies, strengths, or behaviors that they found most helpful. No mention of religion or religious coping was included with the question. Of the 111 participants surveyed, 26.1% included religious coping in their responses. The relative percentage of religious coping was calculated by dividing the total number of coping responses by number of religious responses. Mean percentage of religious coping was highest in participants preparing for a bone marrow transplant (22.9%), followed by the cardiac group (5.7%), and the chronic pain group (3.8%).     

The Role of Family Processes and Coping Strategies in the Relationship Between Parental Chronic Illness and Childhood Internalizing Problems

Sixty-nine families (father, mother, and one child) in which the father had hemophilia, approximately half of whom were HIV positive, were assessed in an examination of the relationship between parental chronic illness, family functioning, child coping strategies, and child adjustment. Latent variable path analyses with partial least-squares estimation procedures (PLS) were used to test a model of the relationship between parental chronic illness, family process variables, child coping strategies, and child internalizing behavior problems. The severity of the father's illness predicted family process variables, which predicted the coping style of the child. The use of more avoidant coping strategies was associated with more internalizing problems.     

Group Therapy with Individuals and Families Coping with Illness or Disability in Israel

This paper illustrates a group intervention with individuals and family caregivers coping with illness/disability, and focuses on the relationship between the process of group development and the process of coping with the illness/disability. People experiencing illness/disability cope with a great deal of pressure and stress that stem from the illness's biopsychosocial demands. A group can provide encouragement and support and reduce helplessness, isolation, and despair through cooperation and use of mutual resources. The design of the intervention was based on our clinical experience with numerous groups for ill/disabled individuals or their family. The process is described and analyzed using examples from three documented groups, and is presented in terms of four variables: group process, group atmosphere, group content, and group intervention.     

Illness Beliefs and Coping Strategies of Diabetic Women

The present study examines the relationship between illness beliefs and coping strategies in diabetic women patients. Measures of illness beliefs and coping strategies were administered to 100 diabetic women. Patients, who believed more strongly in psychosocial, supernatural, and environmental causes of illness, adopted avoidance coping strategies, whereas those who believed less strongly in these causes adhered to approach coping strategies. Patients, who held a strong belief in disease control by themselves and doctors, used approach coping strategies, whereas those who believed in supernatural control of illness used avoidance coping strategies. Approach coping was linked to less severe consequences of illness, less pain, and greater hope for positive outcomes of illness.     

Illness Perceptions,Coping, Benefit Finding,and Adjustment in Individuals with Hepatitis C

Objective

To investigate the ability of illness perceptions, adaptive, and maladaptive coping strategies, and benefit finding to predict physical and psychosocial adjustment among individuals diagnosed with the hepatitis C virus (HCV), within an expanded self‐regulatory model of illness (SRM).

Method

A total of 126 participants with HCV completed an online questionnaire assessing illness perceptions, coping, benefit finding, and four adjustment outcomes, depression, physical functioning, life satisfaction and positive affect.

Results

Illness perceptions made significant contributions to the variance in adjustment outcomes across the four psychosocial and physical adjustment areas. At an individual level, personal control, identification with HCV symptoms, perceptions related to illness duration, illness coherence, and emotional responses to HCV made significant contributions to the prediction of adjustment. Similarly, the combined contributions of adaptive and maladaptive coping strategies explained significant variance across the four adjustment areas. Greater adoption of maladaptive coping strategies predicted poorer physical health, higher reported depression, greater life satisfaction, and positive affect outcomes, while increased engagement with adoptive coping strategies predicted higher positive affect. Increased benefit finding predicted greater positive affect, life satisfaction, and higher depression.

Conclusion

Results demonstrate the ability of the SRM features of illness perceptions and coping, and benefit finding to predict physical and psychosocial adjustment outcomes within the context of HCV.