2型糖尿病成人男性患者の病気の体験 : ライフヒストリー法を用いたナラティブアプローチ

我々は、生活習慣病としての糖尿病患者の病気の体験を明らかにするためには、その人の生活に焦点をあてること、つまりその人の糖尿病に関連した過去から現在までのフィールドを、その人の意味づけの中で、その人自身の語り(ナラティブ)から見ていくことが重要であると考えた。そこで、本研究は、個人に焦点をあて、生活、つまり身の回りの具体的な関係を対象とし、個人が自らの言葉で語ること(ナラティブ)を大事にするライフヒストリー法を用いて、2型糖尿病成人男性患者がどのように病気を体験しているのかを明らかにすることを目的とした。研究方法は、ライフヒストリー法を用いた。データ分析は、インタビューによって得られた対象者の語り(ナラティブ)を聞き手である研究者がライフヒストリーヘと構成し、語り手によって自覚化された病気の体験を明らかにしていった。対象者は、研究参加への同意が得られた4人の糖尿病成人男性患者であった。 2型糖尿病成人男性患者は、ライフヒストリー法を用いたナラティブアプローチによって、病気の体験を自覚化していった。ナラティブアプローチによって自覚化された病気の体験は、「解放された身体」「免罪された身体」「大事にしたい身体」「治る(症状が消えた)身体」であった。「解放された身体」を自覚化していったAさんは、自分の能力を糖尿病(親の持っている病気)を含めた身体の能力として解釈していた。そのAさんはライフヒストリーの語りの中で、<鉛がはがれたように軽くなったからだ>の体験を語り、自分の身体へ関心を向け、身体へ気遣いを向けられるようになっていった。「免罪された身体」を自覚化していったBさんは、病気になったら会社も人生も終わりになり、何もすることがなくなると解釈していた。そのBさんはライフヒストリーの語りの中で、生活を自覚してこなかった<悪かった私>の体験を語り、自分を許し、地元の名士の言葉で自分が許されたことで自分の身体を気遣う気持ちを表していった。一方、「大事にしたい身作土を自覚化していったCさんは、<自分がつくってきたからだ>が、糖尿病によって<骨が減って魅力がなくなったからだ>となり自分が恥ずかしいと解釈していた。ライフヒストリーの語りの中で、<魅力がなくなったからだ(骨)>の体験を語り、今からは大事にしたいという自分を芽生えさせていった。さらに、「活る(症状が消える)身体」を自覚化していったDさんは、<待つことが普通の生活パターン>という生活への対処を身につけており、糖尿病の療養法を簡単に活してくれるものと解釈していた。Dさんはライフヒストリーの語りの中で、<病院に来たら活る(症状が消える)>体験を語り、自分の病気、身体へ関心を向け始めていった。これらのことから、人が生活習慣病としての糖尿病の療養に取り組んでいくためには、「習慣としての身体」を意識にあげていく必要があることが示唆された。

We considered it important to direct particular attention to the life history of patients with diabetes mellitus, which is a lifestyle-related disease, and to clarify the disease experience of patients by analyzing the course of a patient's life from the past to the present as it is narrated by the patient according to his/her interpretation. In this study, therefore, we focused on individual patients and evaluated their concrete relationships with people around them by the life history method, based on narratives of the patients them-selves to clarify their disease experiences. The subjects were 4 adult males with type II diabetes mellitus who consented to the study. Their narratives, recorded during interviews, were reconstituted into life histories by the researcher who interviewed them, and the disease experiences perceived by the narrators were presented. The subjects became conscious of their disease experiences through the narrative approach using the life history method. The disease experiences made conscious by the narrative approach were "the body being set free", "the body being acquitted", "the body that the patient wants to take good care of", and "the body being cured (relieved from symptoms)". Mr. A, who became conscious of his "body being set free", interpreted his abilities as those of his body including diabetes mellitus (disease inherited from his parents). He described an experience in his narration of his life history of having felt his body becoming light as if a lead plate had been detached from it. He then directed his attention to his body, and he became able to take good care of it. Mr. B, who became aware of his "body being acquitted", considered that both his company and his personal life had ended as he became ill, and that he would have nothing to do. He talked about "bad me" not having paid due attention to his life, forgave himself, and began to express his will to pay more attention to his body, after he felt forgiven by the words of a local prominent person. Mr. C, who became conscious of "the body that he wanted to take good care of", had thought that diabetes made "his body that he had created" "a less attractive body that had lost bone", and he was ashamed of himself. He talked about his experience of "losing the attractiveness (bone) of his body" in his narration of his life history and began to feel that he should take better care of his body. Mr. D, who became conscious of "the body being cured (relieved from symptoms)", had acquired a lifestyle of "taking things for granted" and expected that his disease would be cured easily. He described his experience of "cure of his disease (disappearance of symptoms)" in his narration of his life history, and began to have more interest in his disease and his body. These observations suggest that patients must become conscious of "the body as a result of a lifestyle" before they can seriously face treatment for diabetes mellitus as a lifestyle-related disease.

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KJ00004175397

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