ABSTRACT
Abstract Introduction: Pain is a manifestation difficult to describe objectively. Understanding and managing pain by the clinical staff is not just based on scientific concepts, but on representations affected by subjectivity. Objectives: To describe the social representations of pain in the discourse and behavior of the healthcare staff in a medical hospital in Bogotá. Materials and methods: A qualitative, descriptive, cross-sectional trial was conducted using 2 data collection techniques: (i) semi-structured interviews (n=45), including the natural semantics networks technique; (ii) a non-participant observation with a field diary. Results: In the natural semantic network, many descriptors mentioned by the participants (n=88) were identified. The terms referring to the emotional experience were mentioned more often, followed by terms referring to medical care. The field observation identifies a broad diversity in the way pain is understood, marked by a trend to underestimate the subjective aspects of pain. Conclusions: The data, which may be representative of similar institutions in the Colombian and Latin American context, illustrate that there has been a growing interest in approaching pain as a priority in the comprehensive management of the patient. However, strategies are yet to be promoted that result in a more assertive communication, and an identification and legitimation of emotions and subjective suffering of the patient in pain.
Resumen Introducción: El dolor es una manifestación difícil de objetivar. Su comprensión y manejo por parte del personal clínico no solo se basa en conceptos científicos, sino en representaciones afectadas por la subjetividad. Objetivos: Describir las representaciones sociales del dolor en el discurso y en el comportamiento del personal de un hospital de I Bogotá. Materiales y métodos: Se realizó un estudio descriptivo transversal cualitativo utilizando dos técnicas de recolección: i. entrevistas semi-estructuradas (n=45), incluyendo la técnica de redes semánticas naturales; ii. una observación no participante con diario de campo. Resultados: En la red semántica natural se encontraron muchos descriptores mencionados por los participantes (n=88). Los términos relativos a la experiencia emocional son los más mencionados, seguidos por los relativos a la atención médica. En la observación de campo se identifica una gran diversidad en la manera de entender el dolor, marcada por una tendencia a desestimar los aspectos subjetivos del dolor. Conclusión: Los datos, que pueden ser representativos de instituciones similares contexto de Colombia y Latinoamérica, muestran que ha aumentado el interés por abordar el dolor como prioridad en el tratamiento integral del paciente. Sin embargo falta promover aun estrategias que permitan al personal establecer una comunicación más asertiva, y una identificación y legitimación de las emociones y del sufrimiento subjetivo del paciente con dolor.
Subject(s)
HumansABSTRACT
This article addresses some important questions in psychiatric semiology. The concept of a sign is crucial in psychiatry. How do signs emerge, and what gives them validity and legitimacy? What are the boundaries of 'normal' and 'pathological' behaviour and mental experiences? To address these issues, we analyse the characteristics and rules that govern semiological signs and clinical elements. We examine 'normality' from the perspective of Georges Canguilehm and compare the differences of 'normal' in physiology and psychiatry. We then examine the history and the philosophical, linguistic and medical-psychiatric origins of semiology during the eighteenth and nineteenth centuries (the Age of Revolution). The field of rhetoric and oratory has emphasized the importance of passions, emotions and language as applied to signs of madness. Another perspective on semiology, provided by Michel Foucault, lays stress on the concept of 'instinct' and the axis of voluntary-involuntary behaviour. Finally, we analyse how statistics and eugenics have played an important role in our current conceptualization of the norm and therefore the scientific discourse behind the established clinical signs.
