生物醫學意識型態於台灣復健病房住院患者的復健經驗之呈現

The Representations of Biomedical Ideology in the Experiences of Patients in a Rehabilitation Ward in Taiwan.

張玲慧(Ling-Hui Chang)

《職能治療學會雜誌》 24卷 (2006/12) Pp. 36-54

https://doi.org/10.6594/JTOTA.2006.24.04

摘要

本文主要在探討生物醫學意識形態如何主導患者所接受的復健治療，試著藉由復健患者的經驗來討論患者如何學習，透過深受生物醫學意識型態影響的復健凝視來將自己的身體物化，進而觀察、操作、察覺自己的身體與身體經驗，並討論傅科所提「規訓權力」在這種治療過程裡所扮演的角色。
本研究採取人類學的民族誌研究方法，以參與觀察為主要蒐集資料的方式。筆者於2002年在中部某家醫院復健病房針對初次密集住院復健的神經系統損傷的患者進行四個月的田野調查。資料來源包括參與觀察的田野筆記，與患者、照顧者、復健醫療人員正式錄音訪談結果的逐字稿與病歷等。在資料收集與分析方面，則借重現象學、敘說理論與批判理論的理論架構來整理。
筆者在患者對復健治療的主觀經驗中發現以下五個值得探討的議題：1.學習復健凝視來觀察與操縱身體，2.身體的不確定與不可預測感，3.尊重治療師對自己身體的權威，4.對在復健過程中所經歷的身體經驗的重新闡釋，5.對復健的無力感。這五個議題反應出復健治療深受生物醫學意識形態的影響，包括著重身體性操練，同時，在這身體性操練過程中呈現的不平等的醫病關係與強調運用理性來操控身體與控制主觀情緒。另外，本研究也發現治療師在教導患者學習復健凝視的過程時符合傅科所提以規訓權力來塑造行為的特徵。

關鍵字

復健 ； 生物醫學 ； 質性研究 ； 傅科

並列摘要

The representations of biomedical ideology in the experiences of patients in a rehabilitation ward in Taiwan.
This article discusses the contribution of a biomedical ideology to the structure of rehabilitation therapy patients received in a rehabilitation ward in central Taiwan. Subjective experiences of these patients with rehabilitation were used to discuss how the participants learned to use a biomedicine-dominated rehabilitation gaze to objectify their bodies, including observing, manipulating, and perceiving their bodies and their body experiences. I also discuss the representations of Foucault's disciplinary power in the process of enforcing the learning of the gaze.
A four-month ethnographic fieldwork was conducted in an inpatient rehabilitation ward in central Taiwan in 2002. The primary method of data collection was participant observation, mostly targeted at the patients who were first timers in an intensive inpatient rehabilitation program. Field notes, verbatim transcripts from recorded interviews with patients, caregivers, and rehabilitation professionals were the data for further analysis. Phenomenology, narrative theories, and critical theories were the main theoretical frameworks for data collection and analysis.
Five themes emerge from the rehabilitative experiences of the patients: (a) learning of a rehabilitation gaze to observe and manipulate body, (b) uncertainty and lack of confidence in body, (c) acceptance of the therapists' authority over one's own body, (d) reframing body experience in therapy, and (e) a sense of powerless. These themes reflect the totaling influence of biomedical ideology with therapy, including the emphasis on physical training in therapy, the power inequality in therapeutic relationship, and the expectation on patients to use volition to control body and rationalize bodily experiences. The mechanism of how therapists helped patients to learn ”normal behaviors” according to a rehabilitation gaze is also consistent with how disciplinary power is used to make desirable behaviors proposed by Foucault.

並列關鍵字

Rehabilitation ； biomedicine ； qualitative research ； Foucault