合理化“會操才會好”治療模式的情境脈絡之探討

Exploring the Contexts that Legimitize a Tough-love Approach in a Rehabilitation Ward

鄧雅凌(Ya-Ling Teng) ； 王劼(Jye Wang) ； 張玲慧(Ling-Hui Chang)

《職能治療學會雜誌》 26卷1期 (2008/11) Pp. 64-79

https://doi.org/10.6594/JTOTA.2008.26(1).05

摘要

本文以批判角度，探討促進台灣某一復健病房的「會操才會好」治療態度之社會文化情境脈絡。疾病或不適經驗裡隱含社會文化或醫療實踐等情境脈絡，這脈絡關係背後蘊藏複雜的權力互動因素，卻被誤解為一種自然發生的現象。在本文章中的批判理論將著重抽絲剝繭地解析此一錯綜複雜的關係。
本文通訊作者於2002年在台灣某復健病房進行四個月的民族誌研究，了解個案與照顧者的復健經驗。以有目的的取樣方式針對住院復健的神經系統損傷個案做參與觀察。共有21對個案與照顧者參與研究。資料來源包括參與觀察的田野筆記，與個案、照顧者、復健醫療人員正式錄音訪談的逐字稿與病歷等。本研究資料分析遵循質性研究原則。
結果顯示在復健病房有三個社會實踐促進「會操才會好」的治療模式的產生與延續：個案和照顧者之問的同儕情誼、治療師和個案之間的醫病關係轉換成老師學生的教育關係、與利用隱喻(metaphor)「操」來定義復健。儒家傳統教育強調努力工作與昇華的思想與復健「會操才會好」的概念相符合，因此幫助個案與照顧者適應此特殊復健文化，而這被誤解為社會實象的「會操才會好」之實踐，將以皮耶托社會化理論中文化再生產(cultural reproduction)、慣習(habitus)、信念(doxa)與其隱含的權力互動觀念進一步解釋，並探討其所延伸出之倫理困境。

關鍵字

復健 ； 疾病經驗 ； 民族誌

並列摘要

This paper problematizes a tough-love(superscript vi) pedagogy observed in an inpatient rehabilitation unit in Taiwan. It explores the sociocultural contexts that facilitate such a practice. A critical approach to illness and medical institutions claims that illness is often mystified under the name of nature. It investigates how the social origin of illness and/or the practice of a local medical institution in a particular place interact with local contextual factors.
The findings drew upon a four-month ethnographic fieldwork study in a rehabilitation unit in Taiwan in 2002. The purpose was to understand the lived experiences of the patients and caregivers with rehabilitation. Purposive sampling was used to recruit patient participants who had acquired a physical disability within the past year in the study. Total of 21 patient-caregiver pairs participated in the study. Data were collected via participant observation, chart reviews, and taped in-depth interviews with patients, caregivers, and rehabilitation professionals. Detailed daily field notes were taken. Interview tapes were transcribed verbatim. Data was analyzed in accordance with qualitative research guidelines.
The findings suggest that three local practices on the rehabilitation unit provided a cultural legitimacy for the perpetuation of a tough-love approach in therapy: (1) the camaraderie between patients and caregivers established the ground the collective behaviors of fellow patients and caregivers to structure individual experience, (2) the therapeutic relationship between therapist and student was cast as a pedagogical one, (3) use of metaphors to define rehabilitation.
Certain Chinese pedagogy that stresses the relationship between grueling work and redemption was emphasized in therapy. It facilitated the acculturation of new patients and caregivers to the tough-love pedagogy. The discussion also draws upon Bourdieu's social theories of cultural reproduction, habitus, disposition, doxa, and power to explore how this so-called nature, including structures and values, can be produced and perpetuated. Questions with regards with associated ethical dilemmas were raised.

並列關鍵字

rehabilitation ； illness experience ； ethnography