Somatic symptoms of no identifiable organic cause remain medically unexplained and have been delved into to only a limited degree from a biologicist conception of health. Different critical theories study contextual, gender-related and subjective factors for Somatic Symptoms of No Identifiable Organic Cause and their care models. This study has been aimed at reviewing published Spanish studies (1995-2002) exploring explanatory SSNIOC's by relating them to the underlying health theories. A search was run in Medline, Sociologycal Abstracts, Psycinfo, Doyma, Google and Scirus, using the key words: Gender and health, Primary care, Somatic complaints and women or gender, Fibromialgy, Chronic fatigue, Functional syndromes, Feminist studies and primary care, malaise women, a total of 31 articles having been selected and classified by health theories: biomedical, psychosocial, socialist, biopsychosocial, ecosocial, psychoanalytical and feminist.. Explanatory/care models were then identified by theory-related blocks, according to: terms use for SNIOC's; related/causal factors, care models, physician-patient relationship factors. Within the biomedical framework, physiopathological, directive care explanations were found focusing on the medical viewpoint, tending toward adapting the patient to his/her degree of chronicity with symptomatic and antidepressant treatments. In critical theory models: symptoms are related to the social context, subjective gender experiences, focusing on the patient viewpoint; avoiding medicalization, aimed at constructing the subjective significance of the symptoms, on empowering the woman and on her taking responsibility for herself. It is advisable to recognize the existence of theories alternative to biomedical theory which broaden the comprehension of SSNIOC's, by including contextual, gender-related subjective factors related to the wellness-illness process which give rise to care models of greater integral care potential.
Resumen: En el presente trabajo se describe el proceso elaborativo suscitado a partir de una intervención narrativo-conversacional breve, dirigida a reforzar el tratamiento y la reintegración social de personas con uso problemático de drogas. La intervención comprendió tres sesiones centradas en la reconstrucción de la experiencia en tratamiento y de las expectativas respecto de la próxima reintegración social, a partir de un ejercicio narrativo basado en una metáfora del tratamiento como viaje. Participaron 10 personas captadas en dos unidades de tratamiento en Ciudad de México. El ejercicio de una escucha activa propició la integración cognitivo-afectiva de la experiencia en el tratamiento, así como el esclarecimiento de expectativas, temores o deseos suscitados por el próximo término del mismo. Se observó una abundante producción metafórica, vinculada con nuevas formas de significar la experiencia, una amplia expresión de afectos y una mayor claridad ante el futuro.Abstract: This paper describes the elaborative process drawn from the implementation of a brief narrative-conversational intervention, aimed at reinforcing treatment and social reintegration of people with drug abuse problems. The intervention comprised three sessions focused on a dialogical reconstruction of the experience in treatment and expectations about social reintegration, by means of a narrative exercise based on the metaphor of treatment as a journey. A sample of 10 participants was recruited from two treatment units in Mexico City. Active listening led to a greater cognitive-affective integration of treatment experience, as well as to clearing up expectations, fears and desires caused by the upcoming end of treatment. An ample metaphorical production was observed, which was linked to new ways of signifying experience, a wide expression of affections, and a clearer picture of the future.Palabras clave: terapia narrativa, terapia conversacional, abuso de drogas, metáfora, proceso elaborativo.
Introducción: el consumo de drogas impacta a la familia: afecta el estado de salud de sus miembros, la calidad de sus relaciones, su situación económica e integración social. Diversas formas de afrontamiento del uso de drogas han sido identificadas; dependen del estilo de paternidad y de la incidencia de un discurso dominante que impregna las prácticas y los relatos familiares con una narrativa que reproduce la lógica de la exclusión y el estigma. Objetivo: analizar el contenido de la experiencia reportada por jóvenes usuarios de drogas, a propósito de la intervención de su familia al inicio del tratamiento. Método: estudio cualitativo con base en el análisis temático y casuístico de entrevistas biográfico-narrativas con una muestra de once jóvenes usuarios de drogas en tratamiento. Resultados: se identificaron dos narrativas de la intervención familiar: relatos referentes a medidas disciplinarias y represivas que pueden llegar a alcanzar altos grados de violencia y, con una frecuencia menor, relatos sobre expresiones de apoyo familiar agrupadas en dos categorías, apoyo afectivo y práctico-informativo. Discusión y conclusiones: la intervención de la familia frente al uso de drogas y el tratamiento puede ser interpretada en términos de un ejercicio del control de tipo “posicional” y de una cultura colectivista, con predominio del principio de autoridad y falta de apoyo afectivo.
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