身体表現性障害と語り : NBMにおける語りの治療的意義の検討  [in Japanese] Somatoform Disorder and Narratives : Therapeutic Significance of Narrative in NBM  [in Japanese]

近年,evidence based medicine (EBM)を補完するものとしてnarrative based medicine(NBM)が提唱されているが,医療における物語の機能はそれにとどまらず,語ること自体に治療的意義があると思われる.語りの治療的機能を検討するため,われわれは治療経過において,複数の物語を展開させた身体表現性障害女性症例を提示し,考察を加えた.患者は長期間顔面の感覚異常を訴え,多くの身体的治療が無効に終わった後,精神科病棟に入院した.2度目の入院で,患者はそれまで触れなかった家族との葛藤を語り,その後身体へのこだわりが和らいで症状が改善した.治療経過を検討すると,(1)身体疾患としての物語り,(2)うつ病としての物語り,(3)人生の問題という3つの物語りをみてとることができ,治療過程において当初優勢だった(1)が後景に退き,(3)が表面に出ることによって患者の生活や対人関係に変化が起きたと考えられた.

In recent years, narrative based medicine (NBM) has become widely recognized as a necessary complement to evidence based medicine (EBM). However, narratives in medical practice not only complement EBM, but are also of therapeutic significance. In consideration of the therapeutic function of narratives, the present report describes a 54-year-old married woman with a somatoform disorder who developed three narratives during the course of her treatment. She complained of long-term dysesthesia in her face and was hospitalized in our psychiatric ward after many unsuccessful somatic treatments. During her second psychiatric hospitalization, she began to talk about familial conflicts that she had not discussed previously. Subsequently, her facial preoccupation improved and she began to feel better. For this patient, the following three narratives were identified: (1) narrative of a somatic patient, (2) narrative of a depressive patient, and (3) narrative about problems in her life that were uncovered during the development of her treatment. The present report discussed the relationship between the change in the dominant narrative and the improvement of her condition.