Medicalization and women : O, the Oprah Magazine diagnosed through critical discourse analysis

This thesis uses critical discourse analysis (COAl to explore and examine direct-toconsumer (OTC) pharmaceutical drug advertisements appearing in four issues of 0, The Oprah Magazine in 2006. The theoretical underpinnings of this thesis emerge from social scientists and feminists analyses regarding the medicalization of everyday life. The findings of this study highlight three types of discourses used by pharmaceutical companies. First, I explore the use of historical and contemporary gender norms to seJi pharmacological products; second, J examine discourses which normalize the use of chemical solutions as the first line of defense to address a wide range of everyday problems; and finally, I assess how phannaceutical advertisements provide an illusion of autonomy by responsibilizing individuals as patients, at the same time as they suggest that real independence can only be achieved with medication. My discussion of these themes also includes an analysis of why 0 Magazine, which explicitly promotes women's empowerment through holistic approaches to health and personal growthmight support such advertising. Thus I explore: how does OTC advertising benefit both pharmaceutical companies and 0 Magazine itself? I conclude through a brief discussion of the larger implications of OTC advertising for women's health.

ADHD and medicalization: consideration of the senses and meanings of symptoms presented by children diagnosed

The present paper is a reflection on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and its relations to the process of medicalization as well as the meanings and perspectives apprehended through three case studies of children diagnosed with such disorder in a doctoral research in which the main purpose was to understand the meanings and peculiarities of ADHD symptomatology .We’ve utilized the model of qualitative research, grounded in psychoanalytic perspective, and conducted the psychodiagnosis for three children who were referred for psychological treatment. The survey found that those children had few experiences of both continence and frustration tolerance. It was evidenced how the school uses the logic of medicalization to try solving the problems with their children when it came to the school dimension. The variety of symptomatic manifestations and psychic dynamics presented by the cases that were studied revealed the weaknesses and inconsistencies of the referred diagnosis.

Accounting for Fetal Death: Vital Statistics and the Medicalization of Pregnancy in the United States

Recent reports by the Centers for Disease Control and Prevention have decried the high rate of fetal mortality in the contemporary United States. Much of the data about fetal and infant deaths, as well as other poor pregnancy outcomes, are tabulated and tracked through vital statistics. In this article, I demonstrate how notions of fetal death became increasingly tied to the surveillance of maternal bodies through the tabulating and tracking of vital statistics in the middle part of the twentieth century. Using a historical analysis of the revisions to the United States Standard Certificate of Live Birth, and the United States Standard Report of Fetal Death, I examine how the categories of analysis utilized in these documents becomes integrally linked to contemporary ideas about fetal and perinatal death, gestational age, and prematurity. While it is evident that there are relationships between maternal behavior and birth outcomes, in this article I interrogate the ways in which the surveillance of maternal bodies through vital statistics has naturalized these relationships. Copyright 2013 Elsevier Ltd. All rights reserved.

The social construction of infant mortality: From grassroots to medicalization

Infant mortality as a problematic situation has been recognized for some 130 years in one form or another. It has undergone various changes in its empirical dimensions relative to whom we study within the population, what we study--low birth-weight vs. pre-term births--and how we study it--whether demographically or medically. An analysis of the process by which the condition was raised by claims makers as an intolerable situation among America's urban residents reveals that demographic and medical data were sparse. Nonetheless, a judgement about the meaning and significance of the condition was made, and that interpretation led to the promulgation of systems to both document and address the condition as it has come to be defined.^ This investigation depicts the historical context and natural history of infant mortality as one of a number of social problems that came to be defined through the interplay among groups and individuals making claims and how their claims came to the public policy agenda as worthy of collective resources--who won, who lost and why. The process of social definition focuses attention on the claims makers and the ways they contrast the meaning, origins and remedies for this troubling condition. The historical context becomes the frame of reference for understanding the actions of the claims makers and the meaning and significance they attached to the problem.^ We purport that "context" provides a closer reality than disjoined "value free" accounts. Context provides the evidence for the definition, who participated in the process, why and by what means.^ The role of women in the definitional process reveals the differences in approaches utilized by the women of the settlement house reform movement and African-American women working at the grass-roots. Much of the work done by these two groups provided options to the problem's remedy; however, their differences paved the way to our current (principally medically-oriented) definition and its inherent limitations. ^

Traditions and contradictions of sexual function definitions for portuguese heterosexual men and women: medicalization and socially constructed gender effects

© 2015 College of Sexual and Relationship Therapists

Um relato de vida, um caminho institucional: juventude, medicalização e sofrimentos sociais

Apresenta-se uma história de vida com o intuito de traçar uma análise das manifestações particulares de uma trajetória individual em diálogo com os elementos presentes na vida de jovens de grupos populares. Foca-se na discussão dos equipamentos sociais na produção de sentidos, lugares e sofrimentos em algumas vidas, ocasionando processos em que "doenças" e medicalização são geradas a partir de problemas sociais. Com base nos pressupostos da pesquisa etnográfica, acompanhou-se a trajetória de uma jovem, por quatro anos, em sua passagem por serviços sociais de atenção à infância e à juventude, assim como de saúde mental. Considera-se que as políticas sociais devem intervir com jovens sob uma compreensão ampliada dos problemas sociais, sendo que o campo da atenção em saúde mental, em conexão com a esfera social, deve cuidar das situações de sofrimento sem que haja a homogeneização das necessidades, traduzindo-se numa iatrogenia e na medicalização do social.

Treatment of depression in older adults beyond fluoxetine

This review aimed to discuss the importance of the comprehensive treatment of depression among older adults in Brazil. The abuse of selective serotonin reuptake inhibitors, including fluoxetine hydrochloride, as antidepressants has been considered a serious public health problem, particularly among older adults. Despite the consensus on the need for a comprehensive treatment of depression in this population, Brazil is still unprepared. The interface between pharmacotherapy and psychotherapy is limited due to the lack of healthcare services, specialized professionals, and effective healthcare planning. Fluoxetine has been used among older adults as an all-purpose drug for the treatment of depressive disorders because of psychosocial adversities, lack of social support, and limited access to adequate healthcare services for the treatment of this disorder. Preparing health professionals is a sine qua non for the reversal of the age pyramid, but this is not happening yet.

Sintomas somatoformes em Medicina Geral e Familiar

RESUMO: Os doentes que vão à consulta com sintomas físicos para os quais o médico não encontra uma causa orgânica, são frequentes na Medicina Geral e Familiar, embora não sejam específicos, e são o objecto de estudo do presente trabalho. Não deixar uma doença por diagnosticar (erro de tipo II) sem contudo rotular pessoas saudáveis como doentes (erro de tipo I) é um dos mais difíceis problemas da prática clínica diária e para o qual não existe uma orientação infalível e não é previsível que alguma vez venha a existir. Mas se o diagnóstico de doença ou não-doença é difícil, o tratamento dos que não tem doença, embora com sofrimento, também não é mais fácil, sobretudo, se estivermos conscientes do sofrimento que determina a medicalização e a iatrogenia. O presente trabalho está estruturado em 3 partes. Na primeira parte descrevemos a nossa visão integrada do que apreendemos da leitura da literatura publicada e à qual tivemos acesso. À semelhança do que se verifica na maioria das áreas da Medicina esta é também uma em que o conhecimento cresce a ritmo exponencial. No entanto, à falta de conceitos precisos e de definições consensuais sucede um conhecimento, por vezes, pouco consistente, tanto mais que estamos na fronteira entre a cultura leiga e a cultura erudita médica em que os significados devem, a todo o momento, ser validados. Fizemos uma revisão sobre as definições do que está em questão, sobre o que se sabe sobre a frequência dos sintomas físicos na população, quantos recorrem aos serviços de saúde e o que lhes é feito. Passámos por uma revisão da fisiologia destes sintomas e algumas explicações fisiopatológicas para terminarmos sobre o que os doentes pensam sobre os seus sintomas e os cuidados que recebem e o que os profissionais pensam sobre estes doentes. Esta parte termina com uma revisão das propostas de abordagem para este tipo de doentes. Na segunda parte, descrevemos os estudos empíricos focados no problema dos pacientes com sintomas físicos mas sem evidência de doença orgânica. Começa por uma apresentação dos aspectos processuais e metodológicos dos estudos realizados, mais especificamente, de dois estudos quantitativos e um qualitativo. No primeiro estudo pretendeu-se avaliar quais são os sintomas físicos e a sua frequência na população em geral e a frequência de pacientes que procuram (ou não) os serviços de saúde tendo como motivo este tipo de sintomas. O objectivo deste estudo é contribuir para a demonstração que este tipo de sintomas faz parte da vida do dia-a-dia e que, na maioria das vezes, só por si não significa doença, sem contudo negar que representa sofrimento, por vezes até maior do que quando há patologia orgânica. Se no primeiro estudo era demonstrar que os sintomas físicos são frequentes na população, no segundo estudo o objectivo é demonstrar que pacientes com este tipo de sintomas são igualmente frequentes e que o tipo de sintomas apresentados na consulta não difere dos referidos pela população em geral. Pretendia-se ainda saber o que é feito ou proposto pelo médico a estes doentes e se estes doentes traziam ou não, junto com os sintomas, ideias explicativas para os mesmos. Finalmente e não menos importante, é avaliar o grau de fidedignidade do diagnóstico de sintoma somatoforme, chamando assim ao sintoma físico que foi “levado” à consulta e que o médico diagnosticou como não tendo causa orgânica. O terceiro estudo parte do conhecimento adquirido que a Medicina tem muitas respostas para este problema, mas poucas que se possam considerar satisfatórias se usadas isoladamente. Que a maioria das soluções é procurada entre a cultura médica e num paradigma reducionista de separação mente-corpo. Contudo, se o sintoma é “construído” pelo doente, se o principal problema não está no sintoma mas na forma como o paciente o vê, então pareceu-nos lógico que a solução também tem que passar por integrarmos no plano de abordagem o que o doente entende ser melhor para si. Nesta sequência, entrevistaram-se alguns doentes cujo diagnóstico de sintomas somatoformes estava demonstrado pelo teste do tempo. Por isso, entrevistaram-se doentes que já tinham ido à consulta de MGF há mais de 6 meses por sintomas somatoformes e, na data da entrevista, o diagnóstico se mantinha inalterado, independentemente da sua evolução. As entrevistas visaram conhecer as ideias dos doentes sobre o que as motivou a procurarem a consulta, o que pensavam da forma como foram cuidados e que ideias tinham sobre o que os profissionais de saúde devem fazer para os ajudar a restabelecer o equilíbrio com o seu ambiente evitando a medicalização, a iatrogenia e a evolução para a cronicidade. Na terceira parte, discutem-se e integram-se os resultados encontrados no conhecimento previamente existente. Tenta-se teorizar, fazer doutrina sobre o tema e contribuir para abordagens terapêuticas mais personalizadas, abrangentes, variadas e multimodais, baseadas sempre no método clínico centrado no paciente, ou de modo menos correcto mas enfático, baseadas no método centrado na relação. Apresentam-se algumas hipóteses de trabalhos futuros sobre o tema e, sobretudo, esperamos ter contribuído para o reconhecimento da necessidade de a comunicação médico-doente ser uma aprendizagem transversal a todos os profissionais de saúde e ao longo da vida, com a ideia que é sempre possível fazer melhor, caso contrário tenderemos, inexoravelmente, a fazer cada vez pior.-----------ABSTRACT: Patients who go to consultation with physical symptoms, for which the doctor does not find an organic cause, are the subject of the present study. They are common in family medicine, although not specific. Do not let an undiagnosed disease (type II error), but without labeling healthy people as patients with disease (type I error) is one of the most difficult problems in clinical practice and for which doesn’t exist an infallible guide and it is unlikely that any since coming into existence. But, if the diagnosis of disease or non-disease is difficult, the treatment of those who do not have the disease, though suffering, it is not easy, especially if we are aware of the suffering that medicalization and iatrogenic determines. This work is structured in three parts. In the first part we describe our integrated view of what we grasp from reading the published literature and to which we had access. Similar to that found in most areas of medicine, this is also one in which knowledge grows exponentially. However, the absence of precise concepts and consensual definitions determines an inconsistent knowledge, especially because we're on the border between secular culture and medical culture where, at all times, the meaning must be validated. We did a review on the definitions of what is at issue, what is known about the frequency of physical symptoms in the population, how many use the services of health and what they receive as care. We went through a review of the physiology of these symptoms and some pathophysiological explanations, to finish on what patients think about their symptoms and how they perceived the care they received and, finally, what professionals think about these patients. This part ends with a review of the approaches proposed for such patients. In the second part, we describe the empirical studies focused on the problem of patients with physical symptoms but no evidence of organic disease. Begins with a presentation of the procedural and methodological aspects of studies, more specifically, two quantitative and one qualitative. The first study sought to assess which are the physical symptoms, their incidence in the general population and the frequency they seek (or not) health services on behalf of those symptoms. The aim behind this study was to contribute to the demonstration that this type of symptoms is part of life's day-to-day and that, in most cases, does not represent disease by itself, without denying that they represent suffering, sometimes even greater than when there are organic disease. The first study endeavor to demonstrate that the physical symptoms are common in the population. The second study aspires to demonstrate that patients with such symptoms are also common and that the type of symptoms presented in the consultation does not differ from those in the general population. The aim was also to know what is done or proposed by the physician for these patients and if these patients brought or not, along with the symptoms, explanatory ideas for them. Finally and not least, it would try to assess the degree of reliability of diagnosis of somatoform symptoms, thus drawing the physical symptom that patient presents in the consultation and that the doctor diagnosed as having no organic cause. The third study starts from the acquired knowledge that medicine has many answers to this problem, but few can be considered satisfactory if used in isolation. The most solutions are sought in the medical culture and based on a reductionist paradigm of mind-body. However, if the symptom is "built" by the patient, if the main problem is not the symptom but the way the patient sees it, then it seemed logical to us that the solution must integrate the approaches that patients believes are best for them. Subsequently, a few patients, whose diagnosis of somatoform symptoms was demonstrated by the test of time, were interviewed. Therefore, patients who were interviewed had gone to the consultation of family medicine more than 6 months before for somatoform symptoms and. at the moment of the interview, the diagnosis remained unchanged, regardless of their evolution. The interviews aimed to ascertain the patients' ideas about what motivated them to seek consultation, what they thought about the care they got and which ideas they have about what health professionals should do to help these patients to re-establish equilibrium with its environment avoiding medicalization, iatrogenic effects and the evolution to chronicity. In the third section, we discuss and integrate the results found in previously existing knowledge. Attempts to theorize on the subject and contribute to more personalized treatment, comprehensive, varied and multi-modal approaches, always based on patient-centered clinical method, with emphasis on the relationship. We presents some hypotheses for future work on the subject and,above all, defend the recognition of the importance of lifelong learning communication skills for all health professionals, with the idea that we can always do better, otherwise we tend inexorably to do worse.

Le suicide comme langage de l'oppression. Ethnographie d'un service d'urgences psychiatriques

Ce travail s'intéresse à la problématique du suicide à partir de l'émergence en Suisse, vers la fin des années '90, de la prévention du suicide comme préoccupation sociale et politique. Au début, ce sont les milieux associatifs qui ont soulevé à cette question en percevant le suicide comme le reflet d'une souffrance d'origine sociale. Par la suite, la prévention du suicide est progressivement devenue une problématique de santé publique appréhendée essentiellement sous le registre médical comme étant le symptôme d'une pathologie psychiatrique. Après une première partie consacrée aux processus sociopolitiques et aux transformations morales touchant le suicide et sa prévention, ce travail approfondit, au travers d'un terrain ethnographique, la prise en charge des personnes présentant des problématiques suicidaires au sein d'un service d'urgences psychiatriques.Malgré une approche se voulant biopsychosociale, l'analyse des discours et des pratiques soignantes montre que la dimension sociale est largement négligée, conduisant à une médicalisation de situations de détresse qui sont principalement de nature sociale. En effet, parmi la population qui fréquente le service, on observe une surreprésentation de personnes issues des classes sociales défavorisées présentant souvent des trajectoires biographiques particulièrement difficiles. Au fil des entretiens avec les patients émerge une analyse voyant la souffrance psychique et la prise en charge psychiatrique comme étant aujourd'hui une manière d'obtenir une reconnaissance sociale et symbolique. Les problématiques suicidaires peuvent ainsi être interprétées comme une forme d'expression, un langage au travers duquel s'exprime la position sociale défavorisée.En adoptant une posture militante construite à partir de la réalité ethnographique, les problématiques suicidaires sont analysées comme l'expression d'une condition d'oppression liée à un cadre social et économique de plus en plus contraignant, à des rapports de pouvoir inégaux ainsi qu'à une lecture individualisante, médicalisante et pathologisante des problèmes sociaux.The present thesis discusses suicide prevention in Switzerland, which emerged as a social and political issue at the end of the '90s. At first, this question was taken up by associations considering suicide as a reflection of social suffering. Thereafter, suicide prevention gradually became a public health matter conceived with a medical approach as a symptom of a psychiatric disease. The first part of this work analyzes the sociopolitical process and moral transformations concerning suicide and its prevention. The second part is based on an ethnographic fieldwork conducted in a psychiatric emergency unit that attends people who have tried to attempt their life or consider doing it. Through the analysis of discourses and practices of the medical staff, this research shows that the social aspect of suicide is widely neglected, leading to a medicalization of social problems. In fact, amongst patients attending the emergency unit, there is an over-­-representation of people from disadvantaged classes having very difficult life stories. Interviews with patients also revealed that psychic suffering and psychiatric treatment is nowadays a way to get social and symbolical recognition. Suicidal problems can be understood as a language expressing a disadvantaged social position. By adopting a militant position constructed from the ethnographic reality, suicide is analyzed as the expression of an oppressed condition related to a more and more restricted social and economic situation, to unequal power relations as well as to an individualistic, medical and pathological interpretation of social problems.

Le devenir féminin transgenre : une étude qualitative et réflexive sur le genre, la corporéité et la subjectivité sexuelle

RésuméCette thèse en psychologie qualitative et critique de la santé propose un éclairage, sur la subjectivité transgenre, différent des modèles dominants en clinique. Les nosologies de type DSM et de la psychiatrie dominante focalisent sur la seule question de la transition transsexuelle, elles utilisent la sexualité comme outil dans les diagnostics différentiels permettant d'effectuer le gatekeeping de la transition médicalisée du genre. Elles sont décrites comme un dispositif de médicalisation du genre, induisant des pratiques maltraitantes. Une méthodologie qualitative inspirée de la théorie ancrée ainsi que de l'analyse réflexive est utilisée. Un échantillon de 15 personnes représentant la diversité des personnes transgenres FtM a été recruté. Les données provenant d'entrevues non directives sont analysées dans une perspective verticale et horizontale. Les résultats soulignent l'inadéquation des typologies cliniques, de la place qui est donnée à la sexualité dans les procédures diagnostiques et de l'opposition qu'elles construisent entre identité (de genre) et sexualité. Ils plaident pour une vision deleuzienne de type nomade, incarnée et sexuée de la subjectivité transgenre.AbstractThe broad of this study in critical health psychology is to build an understanding of transgender subjectivity which contrast with dominant clinical models. DSM nosology types and dominant psychiatry have traditionally focused only on transsexual transitioning. They use sexuality as a diagnostic tool to address the gatekeeping of the medical transition. These practices have been described as medicalization of gender, inducing mistreatment. A qualitative methodology mixing grounded theory and reflexivity has been used. A sample of 15 persons has been recruited to represent transgender FtM diversity. Data were collected through in-depth interview and analysed case by case and by themes. Results show that dominant clinical typologies of TG are inappropriate, as well as the way sexuality is used in this practices and the opposition between (gender) identity and sexuality. We propose a deleuzian concept of becoming and multiplicity to understand transgender subjectivity.

Unchained Minds: Self-Accounts of Madness

This thesis explores the connection between the historical and social construction of madness in relation to how society currently views madness and schizophrenia. The anti-psychiatry movement has been outlined using the work of anti-psychiatrists David Cooper, R. D. Laing and Franco Basaglia. Foucault’s work regarding madness and the asylum is also reviewed to give an overarching analysis of madness, including analysis of its creation. With the help of Basaglia, madness as class warfare and social disease are explored. By connecting this analysis to the medicalization of schizophrenia and the use of counter-narratives, this thesis uses the work of Deleuze and Guattari to illustrate how mental illness can be redefined through deterritorialization, reterritorialization and lines of flight. Specifically, this thesis uses a Foucauldian textual analysis to examine self-narratives of schizophrenia including, the films A Beautiful Mind and The Best of Youth, and the books Two Accounts of a Journey Through Madness, The Center Cannot Hold and Living With Voices. These self-narratives illustrate the importance of considering an individual’s voice when determining treatment options for mental illness. Overall, a shift in thinking is needed. The findings suggest self-help groups are not enough on their own and should be combined with medical intervention. Self-narratives are an important step in the recovery process as it allows one to come to terms with their voice hearing experiences. As well, self-narratives are useful in the treatment process as a tool that can help to redefine dominant conceptualizations of schizophrenia and mental illness today.

La racialisation comme constitution de la différence : une ethnographie documentaire de la santé publique aux États-Unis

On note de nos jours une intensification, aux États-Unis, de l’usage de la race en santé publique, une idée qui est parfois rejetée dans la mesure où elle est associée à des pratiques controversées. Les races sont vues, dans ce contexte, comme le produit du racisme, une technologie du pouvoir de l’État moderne qui a consisté à fragmenter l’humanité pour permettre les colonisations. C'est ainsi que la race a été prise en charge par le discours pour marquer la différence, discours qui est constitué d'un ensemble hétérogène de dispositifs, des institutions, des énoncés scientifiques, des normes et des règles. Le racisme s’est développé en parallèle avec l'affirmation d'un pouvoir sur la vie visant à assurer la gestion des corps et des populations, notamment par le biais des pratiques de santé publique. Cette thèse s'appuie sur une étude ethnographique réalisée sur un corpus de documents de la santé publique parus aux États-Unis et issus de bureaux fédéraux et d’une importante revue spécialisée dans le domaine sanitaire, et qui ont été publiés entre 2001 et 2009. Cette étude a analysé la manière dont la race est représentée, produite comme objet de connaissance, et régulée par les pratiques discursives dans ces documents. Les résultats confirment que le discours sur la race varie au cours du temps. Toutefois, les résultats indiquent la relative permanence en santé publique d'un régime racialisé de représentation qui consiste à identifier, à situer et à opposer les sujets et les groupes à partir de labels standardisés. Ce régime est composé d'un ensemble de pratiques représentationnelles qui, couplées aux techniques disciplinaires et à l’idée de culture, aboutissent à la caractérisation et à la formation d’objets racialisés et à des stéréotypes. De plus, cet ensemble d’opérations qui fabrique la racialisation, a tendance, avec la sanitarisation et la culturalisation, à naturaliser la différence, à reproduire l’ordre symbolique et à constituer les identités raciales. Par ailleurs, la racialisation apparaît tiraillée entre un pouvoir sur la vie et un pouvoir sur la mort. Enfin, cette étude propose une alternative postraciale qui envisage la constitution des groupes humains de manière fluide et déterritorialisée.

L’utérus artificiel ou l’effacement du corps maternel : de l’obstétrique à la machinique

Face au projet de l’utérus artificiel, ce mémoire est consacré à comprendre et expliquer les tenants sociohistoriques bornant son développement. Employant une méthode de « cartographie du présent », nous établissons en premier lieu la solidité empirique de l’ectogenèse, telle qu’exprimée en laboratoire et par les discours experts actuels. Cette analyse préliminaire permet de dégager la question névralgique de l’effacement du corps maternel dans la procréation, ce que nous problématisons suivant une perspective sociohistorique et anthropologique. L’hypothèse principale de ce mémoire est que l’utérus artificiel constitue l’extension radicale de représentations et pratiques existantes qui effacent de maintes façons le corps; ainsi nous cherchons à repérer le cheminement de cette radicalisation. En fouillant l’archéologie de l’assistance à la procréation – des accoucheuses médiévales à la techno-maternité contemporaine en passant par l’obstétrique moderne – notre objectif est de bien identifier la généalogie de la médicalisation, de la pathologisation et de la technicisation croissantes du corps maternel et de l’engendrement afin de caractériser la construction sociale d’une maternité machinique. Autrement dit, il s’agit de jalonner les représentations et pratiques sociales à l’oeuvre dans l’approche contemporaine de la procréation qui participent à l’oblitération du corps et ainsi créent un terreau fertile pour l’implantation de l’UA.

Médicaliser la maternité en Chine du Sud : l'exemple des postes médicaux consulaires français, 1898-1938

L’histoire de la médicalisation de la maternité en Chine reste encore mal connue et ce mémoire constitue une amorce pour tenter de défricher ce riche et vaste terrain. Il examine dans quel cadre et dans quelle mesure la prise en charge de la maternité des femmes chinoises a évolué au sein des postes médicaux consulaires français du sud de la Chine (Guangdong, Guangxi, Yunnan), de l’arrivée des premiers médecins en 1898, jusqu’à la veille de la Seconde Guerre mondiale en 1938. Il démontre comment a pu se traduire l’œuvre médicale française en matière de prise en charge de la grossesse, de l’accouchement et des soins à donner au nouveau-né dans les établissements de santé consulaires, et tente de voir jusqu’à quel point, pourquoi et dans quels domaines précisément l’offre de soins à l’occidentale proposée par les Français dans ces régions a pu atteindre les futures et nouvelles mères chinoises.

Circulation symbolique des désordres fonctionnels gastro-intestinaux : étude réalisée dans les familles québécoises francophones

La présente étude en anthropologie médicale propose d’examiner la dimension socioculturelle des désordres fonctionnels gastro-intestinaux (DFGI) en considérant l’expérience de six familles québécoises francophones où un pré-adolescent souffre de symptômes associés à un DFGI. Le regard anthropologique qui nous a permis d’appréhender ces expériences de douleur s’appuie principalement sur les travaux issus de la psychiatrie transculturelle, de même que sur les influences de l’anthropologie du corps et de la phénoménologie. À travers ce regard, la somatisation est considérée comme une forme de communication de la douleur, modulée de manière importante par le contexte socioculturel et représentative d’une certaine souffrance sociale. Ce langage ponctué d’idiomes de détresse et de métaphores permet aux individus d’exprimer leur souffrance et de mobiliser un soutien social efficace pour la prendre en charge. Dès lors, le corps doit être perçu comme un corps vécu; comme un lieu de marquage du social, mais également comme un instrument de positionnement social et une frontière où des mouvements d’appartenance et de divergence sont exprimés. Par l’exploration, dans chacune de ces familles, des différentes manières de décrire les symptômes, de les interpréter et d’y réagir, nous avons procédé à la reconstruction d’histoires particulières pour voir comment ces symptômes venaient s’inscrire dans la biographie individuelle et familiale. À travers l’analyse de la construction du sens de la douleur et des pratiques adoptées pour la contrôler, la douleur abdominale nous est apparue comme intimement liée à l’expérience sociale et la médicalisation comme une base pour une meilleure appréhension de cette douleur. Par ses maux de ventre, l’enfant exprime ses limites corporelles et sociales. À l’intérieur de la famille, l’expression de cette limite peut être parfois dérangeante, confrontante, et même entraîner des rapports conflictuels. C’est ainsi qu’est « négociée » une approche appropriée à la douleur qui redéfinit les rôles de chacun par rapport à cette dernière. Le ventre devient le médiateur qui permet le compromis nécessaire au « vivre ensemble » ou au « vivre dans le monde ». À l’issue de ii cette négociation qui implique la participation du médecin traitant, les rapports sont parfois reconstruits et la relation au monde et aux autres peut devenir différente.