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題名:疾病書寫:疾病、失能與關懷倫理
作者:張錫恩
作者(外文):Hsi-En Chang
校院名稱:淡江大學
系所名稱:英文學系博士班
指導教授:杜德倫
學位類別:博士
出版日期:2022
主題關鍵詞:疾病書寫毒物跨物質性創傷乳房切除術後女性怪物性身體形象醫療凝視身分認同關懷倫理pathographytoxicitytrans-corporalitytraumapost-mastectomy womenmonstrositybody-imagemedical gazeidentityethics of care
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醫師在收集「病史」時,會透過聽取患者的「故事」,包括他們的經歷、感受、症狀等來收集材料。通過將患者的「故事」吸納至治療與科學的框架中,患者的經歷成為醫學知識的背景。此舉除了能體現患者的主體性,患者第一人稱的主觀性亦可被科學客觀性的非人格化話語所取代。第一章介紹斯維拉娜·亞歷塞維奇(Svetlana Alexievich)的《車諾比的悲鳴》(2005),探討有毒的場域、身體及生活型態如何以複雜的方式與疾病交織在一起。接著說明,這些車諾比核事故之目擊者的故事,美化及政治化蘇聯所造成的緩慢暴力。車諾比核事故除了導致人們與環境有關的身體健康問題外,還造成人們各種壓力源,包括出生缺陷、歧視、精神疾病。這些擔憂影響人們的心理健康,即所謂懼射線症。第二章探討奧德雷·洛德(Audre Lorde)的《
癌日記》(The Cancer Journals ,1980),主要側重於討論乳癌的致殘特徵,其導致的不僅僅是女性身體的衰退;它也破壞了女性身體的文化形象及社會功能。然後,女性因身體形象的改變而變成具怪物性的雌雄混合體。長期以來,在西方的想像中,怪異的身體很可能與不正常的身體相互干預,並從而與失能議題聯繫。第三章研究保羅·卡拉尼西(Paul Kalanithi)的《當呼吸化為空氣》(2016),討論生命政治與「醫療凝視」如何引導醫師修改患者的故事,以使他們的敘事切合生物醫學範式並過濾掉非生物醫學材料。最後,卡拉尼西透過自身疾病的演變使人們更加了解疾病的身份是如何形成的,以及它如何塑造一個患有絕症的人。作為一名醫師,卡拉尼西了解患者在診斷中的位置,感受到患者對於「生命無常」的擔憂,並且以患者的角度看待「醫病關係」
。通過對這三部作品的分析,可以大致了解以下概念:(1)環境與人類福祉之間的密切關係;(2)有或沒有乳房的女性的社會及文化含義;(3)醫患之間的積極互動。這些同時實現並激發人類、非人類與環境之間聯結的可見與不可見的界面。
When physicians assemble a ‘medical history’, they collect materials by listening to the ‘stories’ of their patients—their experiences, feelings, symptoms, etc. Through the process of transforming the ‘story’ of the patients to the frame of therapy and science, the patient’s experience becomes the background of medical knowledge and embodies the patient’s subjectivity. The first-person subjectivity is replaced by the impersonal discourse of scientific objectivity. Chapter One looks at Svetlana Alexievich’s Voices from Chernobyl: The Oral History of a Nuclear Disaster (2005), which explores how the toxicity of places, bodies and life-styles are entwined in complex ways related with illnesses. Next, the stories of these witnesses of the nuclear plant disaster in Chernobyl embellish and politicize the slow violence caused by the Soviet Union. Besides the physical health issues related to the environment, the Chernobyl disaster enc
ompassed a variety of stressors—birth defects, discrimination, mental illness—the mental health concerns of the people were exhibited as fears about the health effects manifested as radiophobia. Chapter Two examines Audre Lorde’s The Cancer Journals (1980) which mainly focus on discussing the disabling character of breast cancer which results in more than simply the physical degradation of the bodies of women; it as well relates to the cerebral ravaging of body-image and function of women. Then, through the altered images of their bodies, women turn out to be ‘monstrous’ female-male hybrids. And for a long time, within the Western imagination, the monstrous body is most likely connected to the way in which the monstrous intercedes with the abnormal body linking it to the concern of disability. Chapter Three scrutinizes Paul Kalanithi’s When Breath Becomes Air (2016), developing a discourse of how biopolitics and the ‘medical gaze’ lead doctors to modify the patients
stories in order to fit them into a biomedical paradigm and filter out non-biomedical material. Lastly, the evolution of Kalanithi’s illness improves the apprehension of how illness identity is formed and how it shapes a person living with terminal illness. As a doctor, Kalanithi understands the position of a patient in diagnosis feeling his patients’ concerns about ‘the impermanence of life’ and also sees ‘the patient-physician relationship’ from the patients’ own perspectives. The analysis of these three works unfolds a general conceptualization about (1) the relationship between the environment and human welfare, (2) the social and cultural meanings of women with or without breasts, and (3) the proactive interaction between physicians and patients. And simultaneously this analysis materializes and stimulates visible and invisible interfacings of human, nonhuman and environmental linkages.
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