捕捉不确定性:疼痛的主观性转向及其社会后果  

Capturing Uncertainty:The Turn to Subjective Pain and Its Social Consequences

作　　者：梅笑 Mei Xiao

机构地区：[1]复旦大学社会发展与公共政策学院,上海200433

出　　处：《浙江学刊》2024年第4期76-86,239,共12页Zhejiang Academic Journal

摘　　要：20世纪中叶以来,医学领域出现了对疼痛认知的主观性转向,即认识到疼痛不一定与实际存在的身体损伤相关,而是一种受到心理、文化、社会等复杂因素影响的主观感受。认可并强调疼痛的主观性产生了一系列社会影响,比如拓宽了对疼痛的研究范围,提高了针对癌症疼痛、慢性疼痛的治疗水平,但也为医疗实践带来了独特的挑战。特别是在疼痛评估的过程中,普遍存在着尊重患者疼痛主诉和需要将其转化为客观数值的矛盾。为了更好地解释这个用客观数值捕捉主观体验的过程,以及这个过程中的现实困境,本文在现有研究的基础上提炼了两个基于主观性与客观性概念而搭建的解释框架,分别将疼痛评估看作以通约为核心的标准化手段和来自医护人员的专业判断。在利用经验材料对这两个解释框架的适用性进行辨析后,本文进一步提出了第三个解释框架,指出将疼痛评估作为“以物为中介的沟通过程”更加符合田野调查中观察到的经验现象,也有助于超越主观性与客观性的二元框架。疼痛评估实际上是一种捕捉不确定性的努力,对其社会后果的考察需要关注物在其中所扮演的重要角色。Since the mid-2oth century,both the medical community and the public increasingly acknowledge pain as a predominantly subjective experience.That is,pain is not necessarily associated with an actual injury,but affected by complex psychological,cultural and social factors.To recognize and emphasize pain as a subjective experience has had important social consequences,e g.expanding the scope of pain research,improving treatment for cancer pain and chronic pain etc.But it also brings specific challenges.In particular,there is a tension between the principle of respecting the patient's self-report of pain and the need for objective data in treatment.In order to better understand and explain this tension and its consequences,this paper synthesizes and critically evaluates two existing explanatory frameworks built upon the dual concepts of objectivity and subjectivity of pain.It then proposes a third explanatory framework that examines pain assessment as an"object-mediated"communicative process.This third framework not only better explains empirical data,but also helps to understand pain assessment as an effort to capture uncertainty.This paper argues that the theoretical explication of pain assessment needs to transcend the dichotomy of objectivity and subjectivity,and takes seriously the role played by material objects.

关 键 词：疼痛 主观性转向 物的社会学 医患沟通 

分 类 号：R402[医药卫生—临床医学]