意象思维与躯体化症状：疾病表达的文化心理学途径

意象思维是中国人的传统思维模式, 它通过观物取象和取象比类的方式认知世界、推演联系。这种思维模式塑造了中国人特有的身心不分而非两分的身体观、疾病观和治疗观。在中国人的观念中, 身体不仅仅是一具生理躯体, 还具有气、阴阳、五行等本土概念所体现的弥合物质与精神、联结生理与心理的模糊性与开放性。人们在表达疾病感觉时通常不分生理与心理, 任何一方面出现不适感觉即可认为自己生病, 在面对心理医生时也倾向于同时报告躯体状况与心理感觉, 从而使得临床报告出现较高的躯体化报告率。这正是文化心理影响疾病表达的体现。这也使得疾病不仅是一种医学现象, 也是一种文化现象; 医学不仅需要生理知识, 也需要人文知识。

Image Thinking: The Cultural-Psychological Underpinning of Chinese Patients'Somatic Propensity

Under a cultural psychological perspective, the high somatization report rate among Chinese clients is a reasonable phenomenon that has long and deep cultural roots. In lack of the cultural knowledge that underpinned the cultural-psychological structure of a particular nation, one would find it hard to understand the diverse dimensions of a medical phenomenon. The disputes concerning somatization provide a typical case that we could recognize the paradox and limitation of modern medicine and find alternate accounts. Image thinking is the prototype of traditional Chinese thoughts. Differing form the western logic thinking, it is an anthropomorphic, analogous thinking paradigm that reveres the notion of Tian Ren He Yi, the self-evident harmonic corresponding relations between the structure, physiological functions, pathological changes of the human body as microcosm and the change of the nature environments and social world as a macrocosm. All existing elements in the world are supposed to be orderly interconnected via the force of Yin, Yang, and Five Elements. The disorder of natural and social forces is considered as the final cause of human disease and the ultimate source of all disasters and unhappiness. Human body is part of the interconnected world and thus is subject to disturbance from all possible natural and social forces. It is not only a biological body, but also reflects one’s thoughts, emotions, and other psychological aspects. Human diseases, therefore, cannot be distinguished as physical diseases or psychological diseases, since they are interchangeable and almost occur simultaneously. Traditional Chinese Medicine also employs image thinking to explain, diagnose and cure diseases. According to the classic TCM theory, internal organs are centers of all psychological and physiological functions and emotions are regarded as important etiological factors of mental and physical illness. However, once physiological functions are disturbed, the logical methods of treatment become physiological or pharmacological interventions, together with certain psychological interventions. Though psychological interventions mainly serve as supplementary treatments, it is clear that body and mind are always treated together in the categorization and treatment of diseases, which is a distinct feature of TCM. A typical TCM practitioner is thus a physiological doctor and a psychotherapist simultaneously. He or she is suppose to listen to a patient’s chief complaint carefully and examine the patient’s symptom with a holistic view by asking the patient’s living habits, diet, stress, sexual life, etc. A doctor is supposed to speculate the real factors underlying the apparent symptoms through looking, listening, asking, and touching, and the patient should be assigned with a customized treatment both pharmaceutically or psychologically. A practitioner that only detect and treat the bodily symptoms are usually referred as inferior doctors, while eminent doctors always know it is the unbalance status of Yin and Yang that cause any disease in any form and employ their medical knowledge to solve the problem and then restore the body to its normal balanced condition. The long prevalence of TCM in Chinese society has demonstrated the strength of image thinking. It encourages patients to freely talk about their illness, either in physical or psychological way. Both the patients and doctors have the consensus that the categorization of physical or psychological diseases itself is not important, and it is the doctor’s liability to detect the real causes of patients’ symptoms, which may be attributed to biological, social, or psychological factors. The patient’s main complaint of disease is thus a culturally specified behavior that may differ significantly among different cultures.