2011年7月12日星期二

[摘要] 健康社會學導讀

總評：本書是很好的英國健康社會學的教科書。在編排方式上也很親切，另外概念解釋也寫的很清楚。每一章最後附有進一步閱讀文獻。就格式上來說，是非常適合初學者閱讀與依其指示進一步閱讀相關文獻。推薦給健康社會學的初學者們。

書 名:健康社會學導讀
作 者：ANNE-MARIE BARRY；CHRIS YUILL
譯 者：郭寶運、黃俊榮
裝訂/頁數： 平裝 / 339頁
出版社：韋伯文化
出版日：2009/09/01

謝詞
緒論
第一部分 理論、觀點與概念
第一章 社會學理論：解釋與理論化

  1. 社會學：一種調查與解釋的方法
  2. 社會學理論簡介

第二章 健康與醫學的概念
  1. 現代醫學的發展：科學、理性與啟蒙時代的遺產
    • 愛丁堡醫學院的掘墓人。→啟蒙時代鞏固了與醫學有關之具體研究方法（亦即科學方法）的發展。科學思維之所以佔有優勢地位，據稱是因為證據與理論並非衍生於信仰，而是衍生於觀察，並且在實驗過程中獲得確認。透過這種方法取得的證據被認為是公正的、理性的(rational)，且純粹地描述這個自然世界。←參見替代療法相關討論。(26)
  2. 身體、健康與疾病的醫療觀點
    • 本節作者引用了Sarah Nettleton, Lupton 還有Bryan Turner，可以很明顯地看出英國式的醫療社會學的討論。讀起來也相對較為理論一些。(27-8)
  3. 「醫療典範」：醫療知識的社會建構
  4. 傅柯與臨床凝視
推薦書籍：Foucault (1973) "The Birth of the Clinic" ; Lupton, D. (2003) "Medicine as Culture"

第三章 醫療權力與知識
  1. 「醫療自主」：醫師懂得最多
    • Ivan Illich(1993)提出「醫源病」(iatrogenesis)的概念，字面上是指由醫師所造成的傷害。以最基本的意義來看，這個詞是指醫療介入所引發的有害後果。此外，伊利奇利用這個概念讓我們注意我們的文化對於醫學與醫療從業者的依賴，因此我們並不為疾病尋找其他的解釋或療法。(38)
  2. 公共衛生：日常生活的道德觀
    • 「公共衛生」是指那些由一般大眾所共有的健康與疾病領域，被視為能夠接受預防醫療的介入。...公共衛生政策衍生四個重點：第一，高風險類別涵蓋了大多數人。...第二，公共衛生已顯露出其與個人身體的制約與控制有關。...第三，在個人的控制與制約之上，存在著社會身體的制約。...最後一個重點，公共衛生政策的分析衍生了一種何謂病態(生病)以及何謂正常健康與正常行為的意識。後者通常是以數據上的平均做為理解的依據。(42)
    • (關於常態與病態的討論，可參考Seale, C. (1998) 'Normal/Pathological' in C. Jenks (eds)，他認為談常態，必然得由涂爾幹入手，接著談社會整合的問題，以及最後談權力問題。相關的概念有normal, pathological, menbership, social construction, stigma, deviance, surveillance. http://www.google.com/books?hl=zh-TW&lr=&id=DEExO1mBv1EC&oi=fnd&pg=PR7&ots=fzu75Z2zoW&sig=yBZ5mwLos8oxNLZIwy9wLc7LLqs#v=onepage&q=normal%2Fpathological&f=false )
  3. 現代「掘墓人」：醫療專業的不衰權力
    • 對生與死議題進行相關討論，討論了生殖技術，誰來診斷死亡（界定死亡）以及植物人之生死與利益關係人及其利益的討論。可以供教學參考。(47-52)
建議閱讀：
Petersen, A. and Lupton, D. (2000) The new Public Health: Discourses, Knowledges, strategies.


第四章 挑戰醫療霸權
  1. 「生命的奇蹟」：生殖的醫療殖民化
    • 這節的討論主要針對女性的生殖進行討論，不只談到醫療化的問題，也談到女性身體作為商品的相關議題。
  2. 挑戰生物醫學模式的霸權：替代療法

第五章 證據與研究：社會學研究法的導覽
  1. 社會學作為科學
  2. 研究的進行
  3. 量化方法與質化方法
  4. 倫理

第二部分 關鍵主題
第六章 階級與健康
  1. 何謂階級
  2. 健康不平等
    • [安：本節用圖示法說明了健康不平等在階級上的表現。階級越死，死亡率越高。作者討論這也許跟生存環境有關。我在想，這也許也跟社會整合程度有關，社會整合程度佳者，自我感覺良好，社經條件較佳，也能夠活命較久。]
  3. 社會不平等
    • 在貧窮的體驗一小節，提到一個有趣的討論，如下：「杜布森(Barbara Dobson)等人研究了四十八個家庭(其中有一半是只剩母親的單親家庭），此項研究調查了這些家庭的食品購買模式以及對飲食的態度(Dobson et al. 1994)。杜布森等人發現了一種生活模式，此生活模式中的食品與飲食皆己喪失其愉悅的社會面與文化面(比如說食物有其樂趣，或可與親朋好友分享)，取而代之的是一種嚴格的紀律與常態的經濟限制。購物時，任何嘗試新產品或有趣產品的想法都被擺到一邊，剩下的選擇僅限於便宜的品牌、僅限於那些由母親判斷孩子們可能會吃的食品。這最後一點相當重要，可說明為何某些人會吃那些可能在其他情況下被視為「垃圾」的食物。這類母親會購買炸馬鈴薯片或巧克力，就是因為不想浪費錢來買小孩可能不想吃的食物。我們在這裡看到了一個例子，一個非理性情境之中的理性選擇。我們也必須注意，許多家庭都擁有健康飲食的意識，但他們對接受的資訊感到懷疑，或者對實行健康飲食計劃所需的金錢感到卻步。」(113) 原書資訊：Dobson, B., Beardsworth, A., Keil, T. and Walker, R. (1994)Diet, Choice and Poverty: Social, Cultural and Nutritional Aspects of Food Consumption Among Low-income Families. London: Family Policy Studies Centre.
  4. 解釋階級與健康的不平等
    • （心理社會觀點：強調不平等社會之中的生活壓力）
    • 威金森(Wilkinson, 1996)表示，收入差距的縮小、貧窮現象的減少以及社會團結觀念的產生，比較可能是是平均壽命獲得延長的原因。我們在這裡看到一個例子，生活在較平等社會之中的人（並且在身分認同與意志上擁有共識），會比較健康。　社會凝聚力暗示了一種身處在社會或社會團體之中的歸屬感；這通常會表現在對於他人的協助上，並且將重點放在團體上，而非個人。就是這種歸屬感幫助人們變得更加健康。(118)
    • 奧克莉與拉揚(Oakley and Rajan, 1991)研究了社會階級、社會支持與年輕孕婦之間的關係。他們的發現因為兩個原因變得有趣。第一，他們表示，傳統認為社群與社會凝聚力乃勞工級專屬現象的觀象其實有誤。擁有支持性之社會接觸網絡的，主要是中產階級女性。而這導致他們的第二項發現：女性若能與他人建立出一段支援關係，便能夠生出較重、較健康的嬰兒。我們再次看到，特定形式的社會接觸確實可用來取得較佳的健康狀態。(119)
    • （新唯物論觀點：強調資源的分配不均）→回應心理社會觀點，提出四項異議
      • 不平等現象的結構因素在心理－社會闡釋中的角色不夠充分。不平等現象之所以存在的真正起因，並未獲得處理或解釋，似乎暗示這些起因較不重要。
      • 將結構緊密的社群視為好事的同時，我們也必須格外小心：社會連結有時候也可能成為壓力的來源，或因此對他者或少數團體產生排斥感。
      • 若只是將焦點放在社群層次的社會凝聚力，並無法說明較大型的社會機構與結構(例如政府或經濟)如果影響各種可促成或阻礙社會凝聚力的條件。
      • 再一次，若只是將焦點放在社會凝聚力，整體的政治脈絡就會遭到忽略。雖然並非心理－社會觀點支持者的本意，但這可能導致人們開始怪罪受害者，使得政府將健康不良的原因歸咎為社群的社會凝聚力不足。(121)
      • 延伸閱讀：Social science and Medicine 51(7)(2000)主題為階級與健康的不平等，可參考。

第七章 族群、「種族」與健康
  1. 人口統計資料
  2. 「種族」、種族歧視與族群：定義、辯論與議題
  3. 族群、健康與社會
    • [我認為結論很好地摘要了本文的重點，這章我讀起來比較沒有什麼感覺。但必須要注意打破刻板印象的誤解，譬如「中國」，什麼是「中國人」？什麼是「台灣人」？這些都是需要在瞭解以後，然後根據目的，以精確而不歧視的方式來加以定義與討論的。]
第八章 性別與健康
  1. 在當代社學中思考性別
    • [應該注意到陽剛特質與陰性特質的相互形塑與定義的特質。](160)
  2. 瞭解性別與健康－處於重大轉折？
    • 一些參考書目：
    • Annandale, H. and Hunt. K (eds) (2000) Gender Inequalities in Health.
    • Courtenay, W. H. (2000) 'Constructions of masculinity and their influence on men's well-being: a theory of gender and health.'
    • Green, S. E. (2006) 'We're tired, not sad': benefits and burdens of mothering a child with a disability.
    • O'Brien, R. Hunt, K. and Hart, G. (2005) It's caveman stuff, but that is to a certain extent how guys still operate.
    • Watson, J. (2000) Male Bodies: Health, Culture and Identity.
    • Williams, C. (2000) Doing health, doing gender: teenagers, diabetes and asthma.
    • White, R. (2002) Social and political aspects of men's health.
    • Williams, S. J. (2003) Medicine and the Body. Chap 2.

第九章 精神的健康
  1. 心理疾病的原因為何？
    • (對於心理健康和疾病的批判實在論)Pilgirm and Rogers(1994)考慮到若要充分瞭解世界苦難與悲劇的成果，就必須意識到人類生命的一個複雜性：即人類同時是有機生物性及社會性的個體。此觀點讓我們看見身為人類的重要性，以及人類完全不能被化約的事實。(177) Pilgrim, D. and Rogers, A. (1994) 'something old, something new ... sociology and the organization of psychiatry', sociology, 28(2):521-38
  2. 心理健康與疾病的態度和建構
    • 本節討論了污名化相關的理論，也回顧了Goffman的討論。(178-183)
  3. 心理健康與疾病的模式
  4. 種族與心理健康
  5. 性別與心理健康
  6. 關注憂鬱症
  7. 自殺
    • 自殺的三種觀點：Durkheim 《自殺論》。詮釋社會學家J. D. Douglas, 1967。Taylor, 1989,1990的自殺理論。
    • J. D. Douglas, 1967, The social meaning of Suicide.
    • Taylor, S. (1989) Suicide. ;(1990) Beyond Durkheim: sociology and suicide, Social Studuies review, 6(2):70-4.
  8. 延伸閱讀
    1. Busfield, J. (ed.) 2001, Rethinking the sociology of mental health.
    2. Goffman, E. 污名
    3. Philo, G. (ed.) (1996) Media and Mental Distress.
    4. Philgrim, D.(2005) Key concepts in Mental health.
    5. Philgrim, D. and Rogers, A. (2005) A sociology of Mental health and Illness.
    6. Prior, L. (1993) The social organization of mental illness.
    7. 期刊文章：Prigrim, D. and Bentall, R. (1999) 'The medicalisation of misery: a critical realist analysis of the concept of depression.'
    8. 網站：http:/www.mind.org.tw
    9. Muntaner, C., Eaton, w. W. and Diala, C. C. (2000) Social inequalities in mental health: a review of concepts and underlying assumptions.
第十章 身體社會學：慢性病與殘障

  1. 身體研究的關鍵議題
  2. 文明身體：被控制的身體與「乾淨的」身體
  3. 雕塑過的身體：創造完美
    • [身體作為文化形象的象徵，肥胖與不道德或個人失敗連結] (210-1)
  4. 「失敗的」身體：健康不佳或生病
    • 「個人傳記的斷裂」(Biographical disruption)：一開始面臨慢性病時，自我認同所產生的不穩定、質疑與重組的現象。(214)
    • 對於biographical disruption的回顧，見Williams (2000) Chronic illness as biographical disruption or biographical disruption as chronic illness? Reflections on a core comcept.提出了平衡的意見，認為慢性病不該只被視為一種斷裂，其應該視為一種連續。(217)
    • 治療的過程：醫病關係。病人的情感性面向 Robison, 1998 醫療旋轉木馬；Wiles et al., 2004，復健師與病人之間的照護關係與情感。
    • 工具面向。醫用關係。Pound et al., 2005 ; Lutfey, 2005:421.
  5. 傷殘人士與殘障
    • 失能的醫學模型V.S.失能的社會模型
參考資料：
Barnes, C. and Mercer, G. (2003) Disability
Bordo, S. (1990) Reading the slender body, in M. Jacobs, E. F. Keller and S. Shuttleworth (eds) Body/Politics: Women and the discourse of Science.
Bury, M. (1997) Health and Illness in a changing society.
Hawkes, G. (1996) A sociology of sex and sexuality.
Hockey, J. and James, A. (2007) Embodying Health Identities.
Shilling, C. (2003) The body and Social Theory; (2007) Embodying SOciology: Retrospect, Progress and Prospects.
Williams, S. J., Bendelow, G. and Birke, L. (2003) Debating Biology: Sociological Reflections on Health, Medicine, and Society.
期刊文章
Bury, M. (2001) Illness narratives: fact or fiction?
Pound, P. Gompertz, P. and Ebrahim, S. (1998) Illness in the context of older age: the case of strroke.
Frank. A. W. (1997) Illness as moral occasion: restoring agnecy to ill people.
Williams, S. J. (2003) Medicine and the Body

第十一章 健康、年齡與生活過程
  1. 社會中的老化：一般觀點
    • 年齡歧視。
  2. 身體與老化
    • 衣著的年齡等級：老人穿得太光鮮亮麗會讓人覺得奇怪。(233)
    • 老化不等於疾病。(234)
  3. 老化的社會學理論
    • 撤離理論：老年人放棄其在社會上的角色，以使其走到人生盡頭時，對社會造成的斷裂影響能降到最低。(逐漸步入死亡的觀點)
    • 依賴理論：年長者之生活會因為貧窮、無法取得社會和文化資源而受到限制。
    • 第三時期理論：老年也可以是「黃金時期」，因為年老後就不須再投入家庭與工作，而有了自由的時間，加上消費主義社會，使其得以經歷到更充實豐富的生活。(234) [第一時期：依賴父母；第二時期，自給自足，但有社會責任；第三時期，黃金時期；第四時期，又老又病。]
  4. 健康與生命歷程
    • （從生命週期到生命歷程）生命週期：從自然科學所借用而來的概念，指涉的是人類生命中一系列的明確階段。（但此想法認為人無差異，但當代社會中，生命的樣態越來越複雜、易變且片斷化。因此轉向「生命歷程」(life course)：現代社會中愈來愈流動與零碎化的現象，此現象也反映出在生命某階段應該做某事的舊式確定性變得愈來愈不穩定。(237)將生命視為歷程(course)，個人在歷程中有選擇權，這種觀點比將生命視為個人幾無掌控權的週期(cycle)更易於理解。(238)
    • （個人時間與歷史時間）個人時間是指在個人生命中的事件，例如談戀愛、旅行或大學時所做的事。歷史時間指的是在歷史中造成特定階段的事件或社會態度，例如第二次世界大戰，或者一九六０年代對性的態度轉變。[使用這兩個概念來分析老人，有三個好處：]1.重視差異性2.瞭解群體效果(cohort effect)如何形塑健康信念和對疾病的態度；3.個人時間和歷史時間的經驗會「紀錄」在身體上，在年長時以健康良好或健康不佳的方式呈現出來。(238-9)
    • 失智症與社會死亡(social death)
  5. 進一步參考文獻：書籍 Gilleard, C. and Higgs, P. (2005) Contexts of Ageing: Class, Cohort and Community; Hepworth, M. (2000) Stories of Ageing (Rethinking Ageing); Hockey, J. and James, A. (2003) Social Identities across the Lifecourse.　期刊：Tulle, E. and Mooney, E. (2002) 'Moving to "age-appropriate" housing:government and self in later life' ; Bond, J., Peace, S.M., Dittmaann-kohli, F. and Westerhoff, G. (2007) Ageing in Society: European Perspectives on Gerontology.

第三部分 脈絡
第十二章 照顧的場所
  1. 機構
  2. 政策之轉變：從機構轉移到社區
    • 相關的電影＜惡魔島＞(Papillon, 1973)；＜刺激1995＞(The Shawshank Redemption)，＜飛越杜鵑窩＞(One Flew over the Cuckoo's Nest)
  3. 社區
    • 機構造成的醫源性後果(iatrogenic effect)(259)
    • 從機構照護，轉移到社區照護的可能問題與討論。(260-4)
  4. 照護與照護者
    • 討論了照護、家、家庭、身體觸碰之間關係。(266-270)
  5. 建議讀物：Goffman, E. (1975) Asylums: Essays on the social situation of Mental patients and other inmates.; Prior, L. (1993) The Social Organization of Mental Illnes.; Twigg, J. (2006) The Body in Health and Social care 期刊 Angus, J., Kontos, P., Dyck, I., Mckeever, P. and Poland, B. (2005) 'the personal significance o home: habitus and experience of receiving long-term care' ; Little, M., Paul, K., Jordens, C.F.C. and Sayers, E-J. (2000) 'Vulnerability in the narratives of patients and their carers:studies of colorectal caner'
第十三章 健康照顧的脈絡
  1. 社區照護
  2. 健康照護和健康照護政策的概念

名詞解釋
參考書目


第三章進階參考書目：
生與死：

(1)

The Technological Regulation of Death: With Reference to the Technological Regulation of Birth

Abstract

The technological management and regulation of birth is well documented (see, for example, Arms 1975; Oakley 1980; Arney 1982; Arney and Neil 1982; Rothman 1982; DeVries 1985). Following DeVries (1981) in juxtaposing the analysis of birth alongside death, this article draws a parallel between the technological management and regulation of birth and the technological regulation of death in Intensive Care. The analysis builds on the literature concerning the social organisation of death (Sudnow 1967; Glaser and Strauss 1965, 1968). It considers the strategic practice of withdrawing technological support from the dying patient in stages, in order to `mimic' the more gradual decline of `natural' death. This is associated with two ends: it allows time for the emotional adaptation of the patient's relatives and health care professionals to the patient's imminent death; and it also allows death to be presented as a less dramatic disjuncture. If death appeared too abrupt or professionally induced this might become the subject of disputation or litigation. Stress is laid on the role of technology as a means of facilitating a greater surveillance and scheduling of death and allowing greater control over the process of dying. It illustrates the use of high-technology medicine as part of a (technological) rite of passage.

(2)Negotiating natural death in intensive care

Jane Elizabeth SeymourCorresponding Author Contact Information, E-mail The Corresponding Author

Sheffield Palliative Care Studies Group, University of Sheffield, Trent Palliative Care Centre, Little Common Lane, Abbey Lane, Sheffield S11 9NE, UK


Abstract

Recent empirical evidence of barriers to palliative care in acute hospital settings shows that dying patients may receive invasive medical treatments immediately before death, in spite of evidence of their poor prognosis being available to clinicians. The difficulties of ascertaining treatment preferences, predicting the trajectory of dying in critically ill people, and assessing the degree to which further interventions are futile are well documented. Further, enduring ethical complexities attending end of life care mean that the process of withdrawing or withholding medical care is associated with significant problems for clinical staff. Specific difficulties attend the legitimation of treatment withdrawal, the perceived differences between ‘killing’ and ‘letting die’ and the cultural constraints which attend the orchestration of ‘natural’ death in situations where human agency is often required before death can follow dying.

This paper draws on ethnographic research to examine the way in which these problems are resolved during medical work within intensive care. Building on insights from the literature, an analysis of observational case study data is presented which suggests that the negotiation of natural death in intensive care hinges upon four strategies. These, which form a framework with which to interpret social interaction between physicians during end of life decision-making in intensive care, are as follows: firstly, the establishment of a ‘technical’ definition of dying-informed by results of investigations and monitoring equipment — over and above ‘bodily’ dying informed by clinical experience. Secondly, the alignment of the trajectories of technical and bodily dying to ensure that the events of non-treatment have no perceived causative link to death. Thirdly, the balancing of medical action with non-action, allowing a diffusion of responsibility for death to the patient’s body; and lastly, the incorporation of patient’s companions and nursing staff into the decision-making process.

Author Keywords: Intensive care; End of life decisions; Technology; Natural death

Soc Sci Med. 1999 Sep;49(5):691-704.


(3) Revisiting medicalisation and 'natural' death.

Source

University of Sheffield, Department of Palliative Medicine, Royal Hallamshire Hospital, UK. j.e.seymour@sheffield.ac.uk

Abstract


The contemporary conceptualisation of natural death in social science and health care literature may be seen as elision of potentially paradoxical ideas in which the process of dying, as opposed to the moment of death, is a key determinant of the manner in which death is regarded. In the predominant rhetoric, medical-technological intervention during dying is emblematic of inhumane and unnatural death. Highly technological clinical settings, where medical intervention in the process of dying is so clearly visible, are held up as extreme examples of the metamorphosis of death from 'natural' into 'unnatural' events. This paper examines the reification of 'natural' death within these writings, focusing on the taken for granted polarisation of technology and 'natural' death with which they are underpinned. The paper then turns to an assessment of the validity of this reification by examining some ethnographic case study data concerning the experiences of the close companions of three people who died, or came near to death, within intensive care: arguably an environment in which death is at its most highly medicalised. The data, which are drawn from a wider ethnography of death and dying in two general adult intensive care units, suggest that it is perceptions of the meaning of technology, rather than its simple minimisation or absence, which determine representations of death within highly technological settings. These perceptions in their turn depend crucially on the circumstances with which dying is attended. In this study the 'natural' process of death was preserved for the companions of dying people when medical technology delivered the outcomes they expected, appeared to be amenable to human manipulation and intention, was accessible to their understanding and seemed to 'fit' with the wider context of the dying person's life. The paper concludes by arguing that it is within the phenomenology of suffering associated with the critical illness or death of a close companion that some insights may be gleaned of the relationship between individual experience, the cultural representation of 'natural' death, and the attitudinal ambivalence with which medical technology is surrounded.

第四章相關文獻
替代醫療(針灸與標準化醫療的比較，以訪談作為方法）
Sociology of Health & Illness Vol. 29 No. 3 2007 ISSN 0141–9889, pp. 412–429
doi: 10.1111/j.1467-9566.2007.00494.x
Sue Jackson and Graham Scambler TrOriginal Article 429May 2007 © Blackwell Publishing Ltd/Editorial Board 2007 0141-9889 Sociology of Health & Illness SHIL Oxford, UK Blackwell Publishing Ltd aditional acupuncturists and perceptions of evidence-based medicine
Perceptions of evidence-based medicine: traditional acupuncturists in the UK and resistance to biomedical modes of evaluation
Sue Jackson and Graham Scambler
Centre for Behavioural and Social Sciences in Medicine, UCL, London
http://www.brown.uk.com/teaching/HEST5001/jackson.pdf
Abstract
Acupuncture and other types of ‘complementary and alternative medicine’ (CAM) are proving increasingly popular in the UK. As attempts to incorporate acupuncture into allopathic medicine have grown in number, the issue of assessing its effectiveness in ways consistent with the concept of evidence-based medicine has become more urgent. The nature, relevance and applicability of such assessments remain controversial however. This paper reports a qualitative study of acupuncturists’ own perceptions of evidence and evidence-based medicine in relation to their therapeutic interventions. The material is presented in two main sections: explaining how acupuncture works, and resisting evidence-based
medicine. The interviews reveal a great deal of scepticism and ambivalence and a deep questioning of the salience of conventional (biomedical) modes of evaluation of interventions.
Keywords: acupuncture, evidence, evidence-based practice, co-optation, paradigmatic rivalry

(2)The Rise of Alternative Health Care: A Sociological Account
Author: McQuaide, Michael M
Source: Social Theory & Health, Volume 3, Number 4, November 2005 , pp. 286-301(16)
Publisher: Palgrave Macmillan

Abstract:

This qualitative study focuses on the constellation of sociological conditions that are conducive to the rise of alternative medical care. By all accounts, persons in the West are utilizing alternative forms of health care to a greater extent than at any time during the past half century. Factors accounting for this increase are identified, illustrated and explained. The postmodern culture and its emphasis on relativism and pluralism allow for greater plausibility concerning claims made for alternative care. High levels of discretionary income make out-of-pocket purchases possible. Changing relationships between physicians and patients and an emerging skepticism about conventional medicine's curative power contribute to the expansion of alternative care. The increased privatization of purpose and the corresponding decline of civic culture are consistent with the rise of alternative care as well. Abandoning the socially shared political arena allows for the substitution of individual efforts at self-improvement and alternative forms of health care. The perceived features of alternative medical care are critically examined as a factor driving the popularity of these therapies. Finally, concluding remarks focus on the near-term future of alternative health care.Social Theory & Health (2005) 3, 286–301. doi:10.1057/palgrave.sth.8700061

(3) Images of nature in relation to mood modifying medicines: a user perspective

  1. Fiona Stevenson
  1. Royal Free and University College Medical School, London, UKf.stevenson@pcps.ucl.ac.uk
http://hea.sagepub.com/content/8/2/241.abstract
這篇文章討論了情志草藥的作用，與對「自然」的意向一起討論，看起來是篇有趣的文章。

Abstract


Appeals to nature are common, however the term is associated with multiple or even oppositional meanings. This article explores the way nature is evoked and references are made to chemicals in relation to both prescribed and herbal mood modifying medicines. Data are drawn from 23 interviews with people who were taking, had been offered or had taken, either or both prescribed and herbal mood modifying medicines. Fifteen of the 23 respondents used the ideas of natural and chemical when discussing their medicine taking decisions. Rather than a dichotomy between prescribed and herbal remedies in relation to the ideas of natural and chemical, the notion of translations, and ideas concerning risk, are suggested as more appropriate for understanding how different treatments are assessed.


第十章　身體社會學：慢性病與殘障
Chronic illness as biographical disruption or biographical disruption as chronic illness? Reflections on a core comcept.
  1. Simon Williams
  1. http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.00191/pdf

  1. Sociology of Health & Illness

    Volume 22, Issue 1, pages 40–67, January 2000

    Keywords:

    • biographical disruption;
    • chronic illness;
    • narrative;
    • body;
    • emotions;
    • life-course;
    • life-events

    Taking as its point of departure Bury’s (1982) concept of chronic illness as biographical disruption, this paper provides a critical assessment of its fortunes since that time. Having ‘rescued’ the concept from recent postmodern and disability critiques, the paper provides a series of further reflections on its strengths and weaknesses, including the notion of ‘normal illness’; the importance of timing and context; the significance of continuity as well as loss; and the role of biographical disruption itself in the aetiology of illness. This, in turn, provides the basis for a broader set of reflections on the vicissitudes of the biographically embodied self in conditions of late modernity: a situation of chronic reflexivity in which our bodies/selves are continually problematised if not pathologised. The paper concludes, given this ‘balance sheet’, with a discussion of some potentially fruitful lines of future research, including links with the life-events and inequalities literature.

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