Partimos de la idea, que la noción de salud se constituye en una relación dialógica entre el individuo y la sociedad, en la cual, esta última reconoce la condición de salud del individuo, donde el primero es un ser consciente, entre otras cosas, del papel que puede cumplir en sociedad, según sus condiciones de salud o enfermedad.
Tal construcción como hecho sociológico y antropológico presenta mayores discusiones, ya que los aportes hechos por disciplinas como la medicina son muy claros al momento de generar una definición. Sin embargo, a la hora de establecer una relación con la cultura, se encuentran las siguientes dificultades: primero, aterrizar el concepto a categorías relacionadas con el universo simbólico que representa la cultura; de hecho Arthur Kleinman nos plantea que no existe una medicina esencial. No existe una medicina que sea independiente de su contexto histórico, no existe ninguna entidad ubicua e intemporal llamada medicina; puesto que, si tenemos en cuenta, existen enfermedades y enfermos como mundos culturales posibles; por tanto, la concepción de salud también se suscribe al contexto histórico.
Los primeros análisis del padecimiento se introdujeron desde corrientes como la sociología funcionalista. Estos dieron los primeros aportes y, aunque no reflejaban la diversidad de la experiencia de los individuos, establecieron dentro de la literatura antropológica conceptos tales como el rol del enfermo, la conducta ante la enfermedad, la carrera del enfermo; además de otras orientaciones teóricas.
Estos aspectos precedieron el desarrollo de la corriente que desde la década de los ochenta se conoce como la Experiencia de Padecimiento, cuyos estudios antropológicos abordan las enfermedades crónicas, la experiencia de la enfermedad o del padecimiento y el dolor. En el marco de la Experiencia de Padecimiento se encuadran tres corrientes teóricas y metodológicas utilizadas ampliamente en el análisis del tema de la experiencia. Ellas son: la Teoría Fundamentada, en su gran mayoría representada por los planteamientos de Anselm Strauss; la Fenomenología, cuyos principales representantes en la antropología médica son Byron Good, Kathy Charmaz y Arthur Kleinman; estos últimos, cuyas obras no son consideradas en términos estrictamente fenomenológicos, sino que su propuesta se ubica más dentro de la corriente interpretativa; y, por último, la economía política de la salud, que engloba la posición teórica de varios autores adscritos a varias disciplinas, ligados así mismo a la tradición marxista.
La concepción de la enfermedad como proceso biológico e individual se ha hecho presente desde una etapa histórica en el campo de la salud que despersonaliza al sujeto hasta presentarlo como un ente pasivo; en tanto que presenta al sistema de salud como ente curador, dejando de lado lo particular, lo existencial, el contenido subjetivo de la enfermedad, del sufrimiento y de la curación, como eventos de la vida y de la experiencia.
La noción de salud-enfermedad como hecho social La noción de salud-enfermedad es entendida como proceso de construcción simbólica, social y discursiva. Vista la salud-enfermedad como una noción binaria dialéctica, de pares opuestos, que se definen de forma separada según su interacción; es decir, se define lo que es la salud en una sociedad en tanto lo que se concibe como enfermedad y viceversa. Este efecto dialéctico genera una visión tanto de la salud como de la enfermedad y el respectivo procedimiento a llevar dadas estas consideraciones.
Se comprende a partir de esto a la enfermedad como categoría social que tiene una construcción de tipo simbólico; la cual entreteje una maraña de relaciones sociales a través del lenguaje, donde no en pocas ocasiones subyacen significados que no se alcanzan a entrever. Así entonces, entendemos a la salud en los mismos términos que a la enfermedad, pero incluyendo en esta idea la noción de lo que una sociedad considera qué debería ser, en el plano de lo ideal, su vida.
La comprensión de la noción de salud-enfermedad tiene dimensiones históricas en tanto depende de procesos en el tiempo, de circunstancias específicas y de momentos que generan sus diferentes formas de interpretación, semantización y transformación. Reconociendo la relación íntima existente entre lenguaje y realidad, se realizará el intento de acercar la interpretación antropológica en contraste con lo que la gente semantiza por la noción de salud-enfermedad.
La concepción de salud-enfermedad es una noción socialmente construida, en donde la medicina alopática ha elaborado unas sustentaciones teóricas que hablan de las causas de la enfermedad desde lo biológico, a partir de paradigmas universalistas, que no reconocen en los procesos de salud-enfermedad que están íntimamente relacionados con las estructuras sociales y que es importante empezar a identificar esos significados de la enfermedad y de lo que se manifiesta como padecer. “Estamos demasiado inclinados a percibir la enfermedad como un fenómeno exclusivamente biológico e individual, pero la antropología concibe esta, así como a la salud, a la aflicción y la muerte como fenómenos dependientes de la cultura y de la vida social” (Hernáez, 2008:43).
Surge entonces una pregunta personal y profesional que indaga acerca de la dimensión cultural de la enfermedad como una metáfora o forma simbólica que además de biológica es social, psicológica y cultural, y que evidencia la existencia de tantas enfermedades como mundos culturales posibles. No sólo la inquietud se enmarca en la perspectiva de lo social; también es importante indagar ese entramado simbólico que viven las personas que padecen la enfermedad, por tanto, más que hablar desde una perspectiva psicológica, es preciso establecer qué redes sociales e individuales soportan este padecer.
Estas redes se entretejen en narrativas correspondientes a las vivencias subjetivas de las enfermedades; vivencias que se manifiestan a la par de los procesos biológicos en el organismo. Así, éstas se presentan en forma de síntomas, a los cuales se les concede una interpretación; entendiendo que los síntomas son realidades simbólicas y representaciones que evocan no sólo disfunciones fisiopatológicas, sino también mundos locales de aflicción.
Escritor: Erika Castrillon
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