聽我說,病痛敘事的主觀語言在劇情片中的再現 —以《潛水鐘與蝴蝶》為例 Listen to me , the subjective expression of illness from the patient in The diving bell and the butterfly 李若韻 作 By Jo-yun Lee 聯絡資訊: 李若韻 服務單位:國立政治大學廣播電視學系碩士班一年級學生 聯絡地址:11605 台北市文山區指南路二段64號 國立政治大學廣播電視學系碩士班 TEL: 0928-857699 EMAIL: [email protected]
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聽我說,病痛敘事的主觀語言在劇情片中的再現
—以《潛水鐘與蝴蝶》為例
Listen to me , the subjective expression of illness from the patient in The diving bell and the butterfly
Listen to me , the subjective expression of illness from the patient in The diving bell and the butterfly Abstract
Illness, a watershed separating health from disease, designates a “normal person” as a “patient.” And the patient is immediately deprived of identity and self-articultation. Patients become simply medical proper nouns. Medical community has divided health communication into two kinds of discourse, objective language and subjective language. The former is the science language which possess proper nouns, signs and communication purpose. The latter is the language of patients, describing personal experience and mental perception of suffering from illness.Subjective language represents the fact that illness were constructed by social context and also complement objective language the proximate reality. Pathography, which narrates and interprets patient’s experience, is an example of subjective language. Moreover, the patient will finally redeem the identity of his/her physical body.
As a form of health communication, medical fiction film represents the scene by rich symbols to achieve audience’s secondary identification and makes audience a transcendental subject sightseeing the patient’s world. However, film is merely a representation form of screenwriters and directors. When the film tries to narrate the reality, how much proportion of subjective language still exists? There seems to be a gray area between reality and discourse in the film that need to be discussed. “The Diving Bell and the Butterfly” is a medical feature film adopted by pathography. The patient is the actor, also the main narrator in the film. This research focuses on how fiction films represent subjective language and did they bring the new power of interpretation for patients.
Take illness narratives and film narratives as reference background, this research discuss the possibility of film representing subjective language in a critical point. It takes “The Diving Bell and the Butterfly “as a research text.
Research objectives/questions 1. How medical fiction films represent subjective language? Analyze the
difference of patients’ interpretation of illness between pathography and feature films.
2. Did medial fiction film adopted by pathography bring patients the new power of interpretation?
Conclusion 1. Simulate persistent vegetative state experience
Within the numerous subjective camera shots, the patient’s monologue, and imagination in the film, these elements represent the patient’s subjective language and provide audiences a point of view to enter the patient’s “the diving bell” world, therefore these subjective arrangements show the viewpoint of the patient’s world and lead audiences to see how the patient go through as well more than the blinking of his eyes. The film offers a chance to “gaze” the patient’s dis-ease, and help audience understand the patient’s social state.
2. No health communication?! The patient uses beautiful metaphors and symbolizations to depict his illness experience in the book, no matter when his conditions are good or not. In the film, it’s presented as the same style but the screenwriter adds some more magnificent scenes within it to replace the pain and the fear of the patient. The patient is thus constructed to be an anti-illness hero under the military metaphor, but at the same time he is still consumed as a body of other’s who couldn’t really speak for himself. In this essay, I consider a film adopted by pathography cannot bring new interpretation; Furthermore, I question if health communication can construct an image of so-called normal/healthy physical body. Keyword:the other, illness narrative, pathography, mediated representation of medical movies
一、每個人心中的病情世界
一個既定、不讓人多加揣測的疾病名稱,彷彿一道分水嶺,畫分了健康與病
痛,讓一個「普通人」旋即成為「病患」,而其消失了原有的身分、也消失了原
有生活的進行,僅剩下客觀的醫學用語,成為疾病中的他者。
病患的身分確定起自「病情告知」,即為病人經由自身感知或其他原因求診,
醫師評估後確定有一個客觀無誤的「病情」,正以實體可描述的的狀態存在著,
便將該發展統整後告訴病人與家屬,讓病人與家屬獲得知識並進行理解,進而共
同謀求處理對策使病情改善或是消失。而在其中所使用的語言與論域空間,均是
由「解決」該疾病為出發點。醫療是醫學知識與臨床實踐的累積,醫師成為詮釋
醫療的唯一媒介,當兩方的關係與權力不對等時,使得求醫成為一種釋惑的行
為。現代醫學語言會將症狀(symptoms)轉化成徵侯(signs),讓一切症狀都能
夠看見與描述,疾病成為這些現象的聚合體,其存在的本質與醫生所觀察、描述
的方式,有著對應的關係(許禮安,2005:44-45.57;張苙雲,1998:213)。
但這樣以醫生作為核心的醫療方式,焦點注重在病患外顯生病行為的面向
上, 並且當醫生向病患解釋疾病時,容易將自身的社經地位、人格特質,投射
到病人而不自覺(張笠雲,1998:219),對於病人內心所感知的疾病氛圍,是許
多醫學語言無法表達清楚的,例如曾有臨床實驗為了判別疼痛控制的成效,請病
人對自己的疼痛感覺打分數,從完全不痛的0分到極度疼痛的10分不等,但其實
病患對自身的疼痛感知很難明確的表達,例如答案可能為「不知道痛幾分,也說
不出是屬於哪種痛法,反正全身都很奇怪就對了」,而這些無法量化的非醫學語
言,屬於病患的自我詮釋,可能才是該疾病的真實樣貌,能夠脫離將症狀「標準
化」的方式。
圖一、疾病世界的示意圖。(許禮安,2008)
圖姆斯(S. Kay Toombs,2000)以現象學的方式分析醫生和患者各自的世界,
區分四個部份分析:自己的世界、共有的世界、醫生和患者的不同觀點、對醫療
實踐的影響;許禮安更繪製了一張「醫生的醫療世界」與「病人的生活世界」區
分開來的釋意圖(許禮安,2005:45-46);米許樂(Elliot G. Mishler,1995)直接
分類醫病溝通時,存在的兩種語言:「醫學的聲音」(voice of medicine)和「生活
世界的聲音」(voice of lifeworld)(張苙雲,1998:216-220)。上述的論點均建立
在醫生和病人對疾病的認知是彼此獨立,並且不相往來的。由於醫師對於疾病的
知識來自學校訓練、臨床經驗、專家見解,而病患對於疾病的知識則從親友或自
身的經驗、通俗性的醫學雜誌或電視媒體,兩方無論在接收與處理疾病的方式均
南轅北轍,但在「治癒」的前提上,醫師所建立的病情世界遠大於病人所感知的,
也於是醫學語言成為醫病溝通中的官方語言了。
疾病狀態所構成的「病情世界」是非常廣泛的,堆疊著眾人的生命歷史與生
活事件,所謂的眾人包括病患、家屬、醫護人員、密醫、親戚朋友、鄰居路人、
閒雜人等以及非人的鬼神,所謂事件包括所有可確定與不可確定、可預期與不可
預期,只要讓正常或健康的生活世界因而產生質變,都可稱之「病情世界」(許
禮安,2005:61)。
醫療者如果堅守保護「自我」的醫療堡壘,是無助於解決醫療「無用」的現實困境,更
無助於解決病人的生死困惑,因此導致醫生與病人之間處於能量停滯的狀態。唯有醫療
人員可以走出堡壘與保護線,才能看到病人的生活世界,那是一個多元實在的異質世
界,醫生與病人之間的能量才有機會開始流動。(許禮安,2005:159)
病情世界的建構是如此的複雜,甚至是以一種病患生活脈絡所推展的病情故
事,其用語能夠渲染病患與家屬的心情,更能完整記錄一個病患的生命歷程,成
為一部珍貴的個案研究。
過去較多的研究會在「醫病溝通」上多加改進,期望在兩者之間的理解程度
可以多達平衡,例如建立良好溝通品質的必要三條件: 一、醫師和病人掌握醫
療專業訊息興趣和能力是否對等;二、醫療人員是否有意願與能力能將知識傳授
給對方;三、病人是否有能力將自己身上的病痛讓醫療人員明瞭(張笠雲,1998:
212)。前兩項屬於醫學闡釋,第三項則為病患對於疾病經驗的詮釋。
在第一、第二項所強調的醫病溝通,目的仍在於兩方能夠順暢的應答,但構
成溝通的障礙因素很多,最主要的是環境因素(environmental or external factors,
noise)、溝通的心理背景因素(cognitive or central factors)、外在感官因素(sensational
or peripheral factors)、時間因素(time limits, the dimensional factor)(劉樹泉,2004: