「語り」による糖尿病療養支援の実践(心身医療におけるエビデンス・ベイスト・アプローチとナラティブ・アプローチ:理論・実践・研究,シンポジウム,第47回日本心身医学会総会)  [in Japanese] The Practice of Narrative-based Diabetes Care(Symposium/Evidence-based Approach and Narrative Approach in Psychosomatic Medicine: Theory, Practice and Research)  [in Japanese]

糖尿病学の急速な進歩にもかかわらず,糖尿病治療の現実はなお満足すべき成果を上げていない.それは「糖尿病という疾病が患者の日常生活と密接に結びつき,その治療には患者自身による日常の生活管理が求められるからではないか」と思われる.糖尿病という疾病は,その治療が個人の裁量によって成立するうえ,患者の価値観が深く関わってくる.こうした疾病に対しては,生物医学的モデルだけでは限界があるといわざるをえない.このような現状に対して,糖尿病に対する心理行動学的な研究が興り,患者の行動変化への介入・支援に大きな成果を上げてきた.しかし,これだけでは解決困難な症例にも多く遭遇する.こうした症例に対して,われわれはナラティヴ・アプローチを実践している.近代科学を特徴づける客観性,二元論(因果論)に基礎を置く従来のアプローチと比べ,ナラティヴ・アプローチは医療人類学的視点を取り入れ,患者の主観や事象の解釈を重視した,非線形アプローチである点が特徴で,生物医学的モデルの及ばない領域を補うことによって,糖尿病診療の可能性を広げることが期待される.

Despite rapid advances in recent years in the field of diabetology, current diabetic therapies still remain unsatisfactory and lead to poor outcomes. What is problematic presumably is that diabetic disorders are closely related to daily life style of the patient, and that the effective therapy requires good self-management of patient's daily life. In diabetes, the treatment significantly depends on the discretion of individual patients and profoundly involves the concept of values by which they live. Here biomedical models are quite limited in offering solutions to diabetic disorders. To cope with the difficulty of this nature in diabetic treatment, psychobehavioral study of diabetes has arisen as an alternative approach and made considerable achievements in intervention and support to change patient's behavior. However, there are encountered many cases that challenge the psychobehavioral approach. In these cases, we employ a narrative approach. Unlike the conventional approach based on objectivity and dualism (cause and effect) that characterize modern science, the narrative approach incorporates viewpoints from medical anthropology into diabetic treatment and heavily weighs patient's subjective attitude and interpretation of events. It is a nonlinear approach and complementary to those areas that are still beyond what biomedical models may address to. The narrative approach is expected to expand the possibility of diabetes practice.