身體與自我：台灣乳癌婦女的醫療人類學研究

Body and Self: A Medical Anthropological Study of Women with Breast Cancer in Taiwan

王世麗(Shih-Li Wang)

指導教授 ： 林淑蓉

國立清華大學/人文社會學院/人類學研究所/博士(2012年)

摘要

本研究旨在探討乳癌婦女在生病過程中之身體經驗與自我建構的關係，筆者將身體視為是一個具有行動力的經驗主體，能感知、詮釋自身的生活世界並建構自我概念與認同。乳房是婦女最重要的自我認同來源，乳癌婦女有90％以上皆需接受改良性乳房根除術或乳房保留手術，而手術後失去乳房的身體經驗與自我感更是受到社會文化所影響。為此，本文主要是以20名接受前述手術之後、癌症分期為零至三期的婦女報導人口述資料作為分析的文本，探討她們在為期一年的治療過程中，透過與家人、醫療體系、病友團體及有關係的他人之間的持續互動，進而重新建構對於自我理解與認同的經驗。在本文中，筆者以「身體」作為資料分析的思考路徑，關注於其日常生活所經驗到的獨特意義並詮釋這些身體經驗，尤其是個人與社會的互動關係對於影響其想法與行動上的文化意義，試圖將此種特殊的生命轉折看待為重新建構自我的一個基礎與媒介，藉此探究台灣乳癌婦女如何透過重大疾病經驗與身體的改變來審視內在的生命經驗，進而展現出主體性與能動性的契機。
人類學者在討論「自我」（self）這個概念時，乃是將之放在「關係」的脈絡中，強調自我是一種變動的社會關係，理解自我的最好途徑便是透過身體，身體因而成為社會與自我認同的媒介。有別於生物醫學模式強調飲食、環境與遺傳等的生物致癌因素，人類學者主張生病的身體經驗即是病人的整體受苦經驗，身體症狀是日常生活中，壓抑與衝突的一種象徵性表達，其反映出社會關係的不協調，是一種社會苦難的經驗與受壓抑的社會關係。因此筆者欲透過20名報導人來釐清研究之問題意識，亦即：在台灣社會文化的脈絡下，手術後的乳癌婦女重新建構自我的文化特質為何？研究結果發現，從社會文化脈絡而言，報導人透過身體改變所重新建構的自我包括四個重要的文化因素，即是：一、含括生物醫學與超自然的病因多重解釋；二、婦女與夫家及娘家的「壓力與依靠」共存關係；三、醫療權力關係中的不對等與婦女的身體自主性；四、疾病開啟婦女主體性與能動性的契機。筆者認為此四種文化因素不僅是個人、家庭與社會的長期互動結果，同時更反映出台灣傳統漢人社會中強調「和諧」的人觀與宇宙觀。

關鍵字

身體 ； 自我 ； 乳癌婦女 ； 疾病經驗 ； 人觀 ； 宇宙觀

並列摘要

The purpose of this study was to explore the relationship between the body experience and self-construction of the women with breast cancer during their illness period. The author considered the body as an actively subject filled with experiences which can perceive and interpret its own life world, and constructing of self-concept and identity.
Although the breast is the most important origin of the self-identity for woman, above 90% of breast cancer women need to suffer from the modified radical mastectomy or the breast conserving surgery. Moreover, the body experiences and the perceptions of lost their breast after the surgeries are influenced by the social cultural factors. Accordingly, this study focused on analyzing the narrative data of twenty women informants being suffered from the above mentioned surgeries, and their cancer stage were categorized from 0 to 3, in order to explore and interpret their experience of self understanding and identity, which gained through the sustained interactions with families, multi-medical systems, supporting group of cancer patients, and significant others during the year-long treatment process.
In this text, the body theories were taken as the thought path of data analysis. The author focused on the special meaning of its experience in the daily life (these body experiences were interpreted), especially the cultural meanings, which affected its thought and action, of the interaction relationship between individuals and society. Trying to consider such particular life transition as the foundation and the medium of self-reconstruction, the author explored how the female breast cancer patients inspect their inner life experience through the major disease experience and the body changes, consequently unfolded the opportunity of subjectivity and initiative. Discussing the concept of self the anthropologists put it in the context of relationship which focus that the self is a changing social relation hence the body is the best way to understand it. As a result, the body becomes the medium between society and self-identity. Differing from the biological medical model focusing on the diet, environment, heredity, and other biological carcinogenic, the anthropologists argue that the body experiences of illness are the overall social suffering experiences of the patients. The physical symptoms, which are the symbolic expression of the repression and conflicts in the daily life, reflecting the disharmony of social relationship: some kinds of social suffering and repression. Therefore, the author tended to clarify the problem consciousness of the research by these informants: in the context of social culture in Taiwan, what are the cultural characters of the self- reconstruction of the women with breast cancer after their surgery.
Consequently, in social and culture contexts, this research found that the self, which were reconstructed by the informants through the body changes, contained four important cultural factors: first, the multiple explanations of etiology; second, the stress and dependence co-relationship in Han’s patrilineal and matriarchal families; third, the obedience and flee in the medical power relationship; the last, Breast cancer created the opportunities of the women self-subjectivity and agencies. The author argued that these four cultural factors are not only the consequences of long term interactions between individuals, families, and society, but also the reflection of personhood and cosmology of traditional Han society in Taiwan.

並列關鍵字

Body ； Self ； Women with Breast Cancer ； Illness experiences ； Personhood ； Cosmology

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