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  • 學位論文

窮困的媽媽與新時代少女:子宮頸癌防治的媒體論述,1950~2008

Poor Mothers and Modern Girls:The Media Discourses of Cervical Cancer Prevention, 1950~2008

指導教授 : 王秀雲

摘要


本論文探討子宮頸癌(潛在)患者樣貌的變遷及其與子宮頸癌的醫學知識的關係。子宮頸癌的醫學知識,從戰後至今經過數次轉變,而在此歷程中,無論是醫學論述或是大眾論述中,到底誰容易得到子宮頸癌亦隨之有所不同。而此醫學知識與不同技術的發展,亦影響人們對子宮頸癌的認知。相關行動者(如醫師與媒體)亦藉由這些條件,建構出罹患子宮頸癌女性的樣貌,並提出相對應的預防措施建議,如子宮頸抹片和子宮頸癌疫苗,而此種種亦成為形塑子宮頸癌預防技術主要的「使用者」–女人的關鍵背景。 為觀察子宮頸癌及其預防方法的各種討論,本論文使用1950年代以來新聞媒體和醫普期刊關於子宮頸癌的報導文章及醫學報告作為材料。我運用場域分析(arena analysis)的方法,分析過去五十幾年來,在子宮頸癌預防網絡中,各個行動者如何談論子宮頸癌防治,並以當時的子宮頸癌醫學知識作為背景。 子宮頸癌的預防論述所建構出來的女人意象可分為三個時期: 1950年代,大多是窮苦而罹患絕症的中高齡婦女/母親的形象;至1970年代隨著病毒理論的出現,轉變成性頻繁的女人;到1990年代後期,由於「過早」性行為的提出及疫苗的出現,進一步將年輕女孩納入成為子宮頸癌高危險群。在致病原因方面,從個人無力控制的環境因素(含遺傳、男性的包皮、籠統的衛生條件),到明確地指出個人性行為(如多重性伴侶、「過早」發生性行為)的患癌風險,女人亦逐漸地從早期的不確定或是多重因素的受害者成為主要的責任歸屬者。再者,子宮頸癌的疾病逐漸由一般的癌症轉變成幾乎是一種性病,與性行為的緊密連結,使得性的管理成為子宮頸癌的預防主要內容之一,醫學知識扮演了鞏固「性階層」的角色;而男性與子宮頸癌關係的忽隱忽現,也顯示了子宮頸癌論述中的性別政治;新預防技術如HPV疫苗的出現和使用,女性疾病預防看似更嚴密,但是其與其他技術的關係的不確定性及忽略男性的傳染角色,卻可能造成預防的問題。

並列摘要


The thesis examines the medical and social construction of the images of the cervical cancer patient and risk group as knowledge concerning the disease changed in Taiwan since the 1950s. Medical knowledge played an important role in defining who might be at high risk and the nature of the disease, was also critical in the making of public health policy against the disease. In the thesis, by analyzing newspapers articles and medical writings about cervical cancer since the 1950s, I observe the changing discussions and preventive suggestions against the background of what medical knowledge was available at the time. By using arena analysis, I show how different actors (physicians, popular writers, journalists) in the prevention network employed the discourses of precautions against cervical cancer. The images of the cervical cancer patient and who was at high risk underwent profound changes that can be divided into three periods. In the period between 1950s and 1970s, poor middle-age mothers with children figured prominently in the newspaper. The stories were written with much sympathy, and women who suffered from the disease were often victims who were in need of social support. In the period between late 1970s and late 1980s, the patient became someone whose sexual life was in question and promiscuity was more than implied. Since the 1990s, young girls who are sexually active were included in the so-called high risk group. From the worthy victim to someone who was solely responsible for the diseases, the etiology of cervical cancer intertwined with social and cultural beliefs. While cervical cancer has come to be considered highly related to sexual practice and treated as a kind of sexual transmitted disease, discourses on prevention of the disease also became a form of regulation of sexuality in the society. As a result, medical knowledge is critical in endorsing and consolidating the existing "sexual hierarchy." The gender politics in cervical cancer discourses is also revealing; when it was clear that HPV was critical in initiating the disease, the focus of prevention was on women only (as opposed to earlier period when the etiology was not clear it was recommended that men should keep their foreskin clean as a prevention measure), as if men did not have anything to do with the transmission. At the present, although women seem to have more choices for prevention as a result of new prevention technology being available, they also the main target for increased medicalization and stigmatization.

參考文獻


◎中文書目:
王佩芬(2001),〈重新說故事—子宮頸抹片檢查〉。新竹:清華大學社會學研究所碩士論文。
王秀雲(2007),〈神奇的一針所掩蓋的技術網絡–談子宮頸癌預防〉。《科學發展》375:81-82。
王秀雲(2008),〈「太太醫學」:臺灣婦女醫學寶鑑(1950s-1990s)初探〉。《科技、醫療與社會》未刊稿。
仇思源(2004),〈誰需要子宮頸癌抹片檢查〉。《媽媽寶寶》206:168-170。

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