جدال با بی‌قدرتی در تجربه بیماری: روایت‌پژوهی مصرف‌کنندگان طب مکمل و جایگزین

اقبال مصرف‌کنندگان خدمات سلامت به انواع طب‌های مکمل و ‌جایگزین موجب تغییراتی شگرف در تجربۀ بیماری و پیوست‌های اجتماعی اقتصادی آن شده‌است. رفتارهای بازاندیشانه‌ای که با بهنجارترشدن طب بدیل، مشاهده می‌شود؛ در ایران کمتر موضوع پژوهش‌های اجتماعی قرار گرفته‌است. پژوهش حاضر با به­کارگیری روش روایت‌پژوهی، روند این رفتارها را در بازگویی تجربۀ بیماران، مطالعه می‌کند. بدین‌منظور، بیست‌ونه مصاحبۀ روایی با بیمارانی که تجربۀ مفصلی در این زمینه داشته‌اند انجام و پس از بازنویسی به‌صورت روایت‌های خطی منسجم، با روش‌ تحلیل‌تماتیک کدگذاری شدند. بنا به یافته­ها، «احساس بی‌قدرتی» یکی از مضامین پرطنین در تجربۀ بیماری است که در سه مقولۀ «بی‌قدرتی نهادی»، «بی‌قدرتی در روایت بیماری» و «بی‌قدرتی در فرآیند تجویز» بازنمایی می‌شود. بخشی از این احساس، بازنمودی ناگزیر از بی‌قدرتی پزشکان به واسطۀ تزلزل جایگاه علم است. نتایج نشان می‌دهد که اعمال اقتدار ناهمگن نهادهای بالادستی حوزۀ سلامت، بدون ‌در نظرگرفتن فهم بیماران از فرآیند درمان، زمینه‌ساز ناکامی سیاستگذاری‌های سلامت در قبال طب‌های غیررایج شده‌­است. مدیریت این میدان به نفع سلامت حداکثری، تنها از مسیر به‌رسمیت‌شناختن نیاز بیماران به‌داشتن رابطه‌ای متوازن با کادر درمان و اهتمام به توجیه‌ بیمار نسبت به عوارض داروهای تجویز‌شده میسر است.

Coping with Powerlessness in the Experience of Illness: A Narrative Study of Complementary and Alternative Medicine Users

Introduction: The growing tendency of health service consumers to use a variety of complementary and alternative medicine has led to dramatic changes in the experience of the illness and its socioeconomic attachments. Reflexive behaviors that are observed with the normalization of alternative medicine have not been thoroughly studied in social research in Iran.Method: The present study uses narrative analysis to study the trend of such behaviors in retelling the experience of patients. For this purpose, twentynine narrative interviews with patients with extensive experience in this field were selected based on five criteria, that are, (1) “the health status” of those who have sought for or tried any types of alternative medicine, which also implies the reason for their referral in most cases, (2) “type of alternative medicine” to which they have referred, which may be either one or more courses of treatment with possibly different medicines, (3) “the organizational type” of the provider of medical services, whether academic, popular, based on religious beliefs, etc., (4) “age” categorized as young or middleaged, and (5) “gender”. The interviews were rewritten and compiled as coherent linear narratives, from the beginning of the patient’s story to its end. After that, the narratives were coded by thematic analysis.Findings: The results showed that “feeling of powerlessness” was one of the most frequent themes in the narratives of the experience of illness. Major dimensions of the feeling of powerlessness can be seen as (A) institutional powerlessness, which is summarized as (A1) powerlessness in prosecuting medical malpractice, (A2) dissatisfaction with hospital services, (A3) inequality in access to health care, and (A4) insulting the private sphere and personal information, (B) weakness in the narrative of the illness, which is described by two subcategories (B1) denial of the patient’s symptoms, and (B2) the specialized language of physicians, and (C) powerlessness in the prescribing process, categorized as (C1) being unaware of what the drugs might do, i.e., their side effects or in a number of cases what the patients call drug addiction, and (C2) having an unbalanced relationship with the physicians.Conclusion: Reviewing these findings, the present article addresses how the “feeling of powerlessness” affects the experience of illness and uses Ulrich Beck’s idea of the late modernity to show how patients’ powerlessness is in part the inevitable representation of physicians’ powerlessness due to the faltering position of science. The findings also show that without considering patients’ understanding of the treatment process, heterogeneous power practices underlie the failure of health policies towards complementary and alternative medicine. Furthermore, managing this field in the interests of maximum health is possible only by recognizing the patients’ need to have a balanced relationship with the medical staff and briefing the patient on the side effects of the prescribed drugs.