研究生: 周心瑜
論文名稱: 汙名化的管理策略與社會互動:以下泌尿道症候群患者為例
指導教授: 張清富
關鍵字: 污名、醫療照護、尿失禁、尿路症狀
在當前的醫療社會學之中，病患的處境與常被社會觀點所左右，往往被化約為特定思考角度。本文以泌尿科最常見疾病——下泌尿道症狀患者為研究對象，了解最容易造成患者心理烙印的尿路症狀高危險群患者在不同性別樣本經歷心理烙印之差異情形。尿路症狀在社會是種容易隱忍的疾病，但卻又常發生在你我周遭，社會對此疾病的詮釋通常較為負面，對此詮釋，患者備有壓力且容易產生心理烙印，不論內外都背負著一份煎熬。
本文以下泌尿道症候群的污名化為主軸，藉此了解患者對此污名影響，並分別試著由內外在角度分析，從內在的公眾污名與自我污名對於不同研究樣本會呈現怎樣的成因和表像，作用於患者身上之後又會折射出什麼樣的心理衝擊；從外在的來自患者的各種社會互動以及醫患間的種種社會現象，患者們又將如何運用他們的求生技巧，又將如何來應對來自生理與心理上的雙重衝擊。
本文採質性訪談、參與觀察、歷史研究及文獻資料方式，共計訪談2位醫生與8位病患具有泌尿道症狀的個案。研究結果發現不論症狀的明顯與能見度，尿路症狀患者的心理烙印包括：社交的中斷、喪失身體的控制和推測為與生俱來的問題等。從兩性上來看，男性可能覺得害怕頻繁上洗手間會被象徵為性無能，女性則可能會害怕缺乏社會認同等的問題，也有可能希望將此症狀視為其個人之秘密。
因此可見，不管是哪一種尿路症狀，均會造成患者心理的烙印，甚至影響個人的自我看法與衝擊其社會互動。他們的疾病並不只是社會化的建構，同時也反映出個人在社會脈絡中的心理痛苦。望本文結果可讓護理人員、社會民眾以及其他社會各階層人士參考在遇見有尿路症狀個案時，除尿失禁個案外須考慮頻尿與急尿個案之心理層面之影響。
Abstract
People with mental illness put up with a lot more than their illness. Some illnesses are traditionally to be negative by the public. These prepositions usually contribute major stress toward people with mental health problems. Stigma is considered to be negative opinion or judgments held by individuals or society. Stigma and prejudice are quite often as distressing as the symptoms themselves.
This paper examines the stigma associated with LUTS. Like Urinary Frequency and Urgency, distinguished with the stigma of incontinence, analyze the impact upon the study subject. This study intends to find out whether the subjects’ lower social rank will strengthen the level of stigma. The personal image may influence themselves.
Qualitative data for this study came from in-depth interviews with two doctors and eight patients with urinary symptoms. We find that stigma is associated with frequency and urgency – not just incontinence. The stigma of frequency/urgency is rooted in the interruption of social interaction, the feel of loss of controlling themselves and blaming themselves. The stigma of urinary symptoms depends on whether or not the symptoms are perceptible. Men felt stigmatized for making frequent trips to the bathroom and feared being seen as sex-impotent. Women have a fear of carrying an unclean body and a lack of social identity. Men also intuitively feel more pressure than women.
No matter what kind of urinary symptoms, they all affect people on the personal, inter-personal and/or social — not just physical — levels. The community and healthcare professionals should take stigma consequences (e.g. low self-esteem, anxiety or depression) into consideration while facing with individuals with urinary symptoms.
