《台灣社會研究季刊》 第81期：
一般論文
台灣公共衛生體系市場化與醫療化的歷史發展分析／陳美霞(81 民 100.03 頁 03-78)
2003 年SARS 流行對台灣經濟及社會的沈重打擊，暴露公衛體系的種種問題，本文分析其中市場化及醫療化這兩類問題。目前台灣公共衛生或醫療相關學術研究文獻，尚未對此兩大問題做過系統分析；此外，這兩類問題，幾乎都是分開被不同的人，不同的文章提出的，亦即，一般認為這是兩個互不相關的問題。以歷史的考察為主要研究取徑，本文作者指出，台灣公共衛生體系的醫療部門從光復後至今—尤其在1980 年代之後，是不斷商品化、市場化的過程；而公衛體系則是不斷醫療化的過程，這個過程也是在1980 年代後加速進行。作者進一步提出，公衛體系的這兩大問題不但相關，甚至有共生的關係︰即，要是公衛體系的醫療部門不過度市場化，它過度醫療化的問題不會存在；反之，要是公衛體系不將健康問題醫療化，醫療部門過度市場化的問題不易產生。兩者共生互促共息，缺一無以為繼。
關鍵字：醫療化、市場化、共生關係、公共衛生體系、台灣、醫療體系
The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 had an enormous economic and social impact on Taiwan. It revealed that Taiwan’s public health system had many problems. Of these problems, this paper analyzes two major ones: its marketization and medicalization, for which the health and medical literature in Taiwan lacks a systematic analysis. Moreover, these two issues were mostly raised separately by different researchers or commentators, and treated as un-related problems. Using a historical inquiry approach, the author argues that the medical sector of Taiwan’s public health system has been continuously commodified and marketized since Taiwan was returned to China from the colonial Japanese government. The pace of this marketization process has been particularly fast starting from the 1980s. In the same period, Taiwan’s public health system has also been continuously medicalized and this process has also been much faster. The author further argues that the marketization and medicalization processes are not only related but also have symbiotic relationships. On the one hand, the over-medicalization of the public health system would not have occurred if the medical sector was not over-marketized; on the other, the over-marketization of the medical sector would not have occurred if Taiwanese people’s health problems were not medicalized. These two problems have a mutually beneficial relationship; without one, the other would not have continued.
Keywords:medicalization, marketization, symbiotic relationships, national public health system, Taiwan, medical care system
是減害還是加害？愛滋新聞論述中的毒癮者框架／徐美苓、熊培伶、賴若函、吳姿嫺、施馨堯(81 民 100.03 頁 79-128)
台灣過去多年的愛滋病絕大部份是經由性行為傳染，但自2004 年起，毒品病患感染人數激增，實施以提供清潔針具以及以口服方式（例如美沙冬或丁基原啡因）取代注射（海洛因）方式的替代療法，也成了衛生當局極力推動的愛滋防治政策。本研究從社會建構論的角度切入，以框架（framing）分析的取徑，探討媒體論述中有關「愛滋」與「毒品」交集的的毒癮者框架。我們以2004-2007 年四年間的新聞文本作為觀察對象，以愛滋、毒癮、吸毒、減害療法、美沙冬、針具交換等重要關鍵詞，至《中國時報》、《聯合報》、《蘋果日報》新聞資料庫進行相關文本搜尋。根據針對742 則文本的觀察，新聞所出現的毒癮者描述大致可分為「可被醫治的病人」、「受害者」、「無藥可救的失敗者」、「加害者／失序者」等四個類別，以及以上任一類別的混合。雖然減害計畫的實施，使得毒癮者被新聞框架為可被醫治病人的數量躍升，成為所有類別的第二高，但整體而言，毒癮者仍舊是以負面框架再現為大宗，其中又以加害者／失序者的框架類別為最多。本研究希冀從具在地性的思維與關懷的角度，藉此新聞論述框架剖析進一步帶入健康議題相關者權利面向的省思。
關鍵字：毒癮、框架分析、減害計畫、愛滋病、新聞論述
The increasing number of HIV patients due to injecting drug use (IDU) enabled the Taiwanese government to implement harm reduction program, including distribution of clean needles and drug substitution treatment, in 2004. By taking a social constructionist perspective and using van Gorp’s framing package approach, this study analyzed how frames of injecting drug users are represented in the news discourse when addressing the reconstructed social problem of IDU and HIV/AIDS in Taiwan. Seven hundred and forty two relevant news stories from China Times, United Daily News, and Apple Daily, dated from January 2004 to December 2007, were collected via the newspaper web databases. The results showed that injecting drug users were framed as one of the following: curable patients, victims, incurable losers, victimizers/deviants, and the mixed type of any of the four frames. Although increased number of news stories while injecting drug users were framed as curable patients was found, frames with negative nature were still the majority in the news discourse, whereas injecting drug users as victimizers/deviants were the predominant. Based on the findings, the study went further to discuss issues related to health and rights from indigenous and humanitarian perspectives.
Keywords:framing analysis, harm reduction, HIV/AIDS, injecting drug use, news discourse
台灣透析醫療社會力的轉變／林文源(81 民 100.03 頁 129-186)
本文以透析病患團體介入醫療場域的行動，分析近三十年來台灣透析醫療社會力的轉變。本文借助Michel Foucault與行動者網絡理論，發展「意向性佈署」概念，指出在不同歷史時空的政策、與腎臟醫療專業關係、社會處境等條件下，病患團體的佈署介入使透析醫療場域呈現「集體性浮現：整體動員與社會賦體」、「場域雙元化：去正當性的權利與矛盾的集體性」、「垂直整合：新／去集體性與例行化」等三種透析醫療體制，構成透析病患團體的集體意向性。在這些模式下，不但浮現不同面貌的醫療品質議題，病患族群的集體性與社會、自我認同樣貌也不斷變形。其中各階段的透析醫療社會力也有不同可能性與限制。
最後，除了在理論上試圖發展「實作體制」、「意向性佈署」分析社會力構成與轉變的概念工具外，這個個案分析也顯示，儘管當前透析病患團體數量增多，透析醫療社會力並未累積，反而以依附垂直整合體制為主，這是當前透析醫療社會力發展的隱憂與限制。
關鍵字：社會力、病患團體、意向性佈署、社會運動、透析
This study explores the transformation of societal agency in the field of dialysis medicine by examining the case of patients’ organizations actions in Taiwan in the last three decades. A new concept of ‘deployment of intentionality’ is devised from Michel Foucault and Actor-Network theory’s insights to portray the changing regimen of dialysis practice and social intentionality toward patients.
The analysis examines the changing dialysis regimen and patients’ agency deployed by patients’ organizations and other policy, professional, and social actors in different eras: ‘emergence of collectivity: mobilization of the collective identity, and societal embodiment,’ ‘dualization of the field: de-legitimatization of rights and the contradictive collectivity,’ and ‘vertical integration: emergence and erosion of collective identity and routinitization.’
Theoretically, this study elaborates the conceptual frameworks of regime of practice and deployment of intentionality to trace the transformation of societal agency. Empirically, the analysis shows a worrying future. The increasing amount of patients’ organizations does not increase the possibility of changing the regime of vertical integration and the dialysis patients’ agency is diminished.
Keywords:societal agency, patients’ organization, deployment of intentionality, social movement, dialysis
對蚊子宣戰：二次戰後台灣根除瘧疾的科技與社會研究／林宜平(81 民 100.03 頁 187-235)
二次戰後WHO以噴灑DDT消滅瘧蚊，在世界各國展開根除瘧疾計畫，台灣是戰後全球除瘧行動中，極少數完全根絕瘧疾，並且長期維持無本土病例的國家。本研究從科技與社會的觀點，回顧從日治到美援台灣瘧疾防制「對人法」與「對蚊法」的爭議；戰後以DDT家戶噴射對瘧蚊宣戰的準備、攻擊、肅清與保全；批判檢視台灣戰前／戰後瘧疾死因與盛行率的變化；最後從社會世界的理論觀點，討論台灣成功除瘧的歷史與社會脈絡。
本研究發現，台灣戰後的除瘧行動，有延續自日治時期的瘧蚊研究，瘧原蟲檢驗技術，藥物治療，以及防瘧體系的支持。戰後世界衛生組織、美國與國民黨政府耗費眾多人力與物力，全力支持DDT家戶噴射，有冷戰與戒嚴的特殊歷史脈絡。台灣根除瘧疾得以長期維持，除了對人法舊技術與對蚊法新技術同時並行，以及戒嚴時期限制人民海外旅行之外，矮小瘧蚊也不敵台灣生態環境的變遷，節節敗退。此外，台灣在1952 年代全面噴射DDT之前，瘧疾盛行率已經大幅下降。
DDT是戰後全球瘧疾根除計畫的邊界物，標準化的家戶噴射作業流程雖然無法在全球各地同步執行，但是和台灣的人與非人行動者，組成穩固的防瘧技術網絡，成為非常少數的成功案例。本研究具體回應「超越國家單位的國際書寫架構」，從社會世界的理論觀點，討論DDT在台灣除瘧所扮演的角色，不但可以協助理解技術物的多重社會性格，對當前全球公共衛生政策，也有重要貢獻。
關鍵字：瘧疾、戰後、DDT、根除計畫、科技與社會
After World War II, the World Health Organization promoted the use of residual DDT spraying to eradicate malaria. Taiwan was one of the very few countries to successfully eradicate malaria and to stay malaria-free for many years. In this study, I took the Science, Technology and Society (STS) perspective to review the Taiwanese history of malaria eradication, starting from the Japanese colonial period up to the USAID after WWII, as well as the scientific controversies surrounding malaria control. I explored the “war against mosquitoes” from the phases of preparation, attack, consolidation, and maintenance, and re-analyzed the malaria mortality and morbidity data to elucidate the social and historical context of malaria eradication in Taiwan.
I suggest that the malaria eradication efforts in Taiwan had indeed continued from the Japanese Colonial period. There were entomological studies, parasite-examining techniques, medication, and anti-malaria public health systems. During the post-war period, the WHO, US and Taiwanese governments spent a lot of money and manpower to support DDT residual spraying. Other than treating the patients and the mosquitos, Taiwanese people were not allowed to travel under marshal law, and An. Minimus retreated because of the ecological changes in Taiwan. Furthermore, the prevalence of malaria in Taiwan had dramatically dropped before DDT spraying began in 1952.
DDT was a boundary object in the post-war global malaria eradication program. While the standardized house-spraying methods could not apply to many countries during this time, there were human and non-human actors forming to consolidate malaria eradication networks in Taiwan. This study aims to retell the Taiwan story on the international level. Social world theory helps clarify the multiple social characters of objects, and may contribute to global public health policies.
Keywords:Malaria, post-war, DDT, Eradication Program, Science, Technology and Society
保守與激進之上：中國政治自由主義的希望與困境／陳宜中(81 民 100.03 頁 237-279)
本文從「漸進實現（中國）自由民主」的視野申論指出：正因為自由民主並非一蹴可幾，而有其重要的實現條件；我們既不該無條件支持拒絕和平漸進的威權或後極權體制，也不該輕易接受那種以為「只要推翻一黨專政，自由民主便將水到渠成」的迷思。我們應有必要對政治保守主義（主張維持、保留政治現狀）與政治激進主義（主張以劇烈手段推翻政治現狀）進行雙重反思，以避免採取僵固的保守或激進立場。本文並分析指出：從漸進實現自由民主的角度，民主過渡的動力或主體並非最主要的問題。更關鍵的問題在於：自由民主的實現與穩定條件，如何能在漸進的發展過程中漸漸形成、茁壯、邁向成熟？這在實踐面上意味著：要逼著威權政府逐漸落實基本人權、社會公正與憲政法治，展開漸進的政治改革，逐步釋放有限度但不斷擴大的民主權力以及言論、出版、集會、結社自由；以使多元的、良性的社會整合機制得以漸漸形成，以為自由民主的漸進實現提供更多、更有利的社會及政治條件。
關鍵字：保守主義、激進主義、中國、自由民主、市場列寧主義
This paper argues, from the perspective of ‘gradual realization of Chinese liberal democracy’, that political liberals should not fix upon either political conservatism or political radicalism. Rather, a ‘double reflection’ on both is called for. Since the current authoritarian or post-totalitarian regime has not adopted a path of development that is favorable to peaceful political transformation, any uncritical or unconditional support of the political status quo would have few affinities with political liberalism. However, to the very extent that conditions for realizing and stabilizing a successful liberal democracy remain deficient, full-blooded democratic transition or revolution is not sensible either. In the last analysis the most pertinent ‘practical question’ today is: how could gradual, progressive reforms—with respect to basic civil rights, rule of law, constitutionalism, social justice, and democratic control from below—come about through the public bringing unceasing pressure to bear on the present regime, so as to effect increasingly better conditions for a potentially well-ordered liberal democracy? Thus conceived, the problematic of ‘gradual realization of Chinese liberal democracy’ suggests that we move beyond the reified stance on either political conservatism or political radicalism.
Keywords:conservatism, radicalism, China, liberal democracy, market Leninism
邏輯實證論在台灣：透過殷海光對思想與文化產生的影響／陳瑞麟(81 民 100.03 頁 281-319)
本文討論邏輯實證論如何透過殷海光而對台灣的思想和文化產生深遠的影響。這樣的影響如何發生呢？
思想史其實是一部思想影響史。本文將提出一個「結構－動態分析」方法，即分別分析影響源和被影響者的思想結構，以看出其中的動態演變。所謂思想結構由一組論旨（即傳統上的思想內容）、論域（思想所涉及的主題和範圍）和方法論三者構成的。被影響者在這三個項目上對影響源的不同程度之吸收，導致不同程度的回應型態：完全接受、局部接受、轉化、背離。本文將應用上述模式來探討邏輯實證論對台灣的影響。
首先，我們要討論邏輯實證論對殷海光的影響廣度與深度，根據「結構－動態分析」，我們將分析邏輯實證論的思想結構與殷海光的實證論版本；接著，我們討論殷海光如何把他的版本應用到文化的領域上— 《中國文化的展望》其實是殷海光建構「文化科學」的一個嘗試。再來，我們將探討殷海光的思想在「中西文化論戰」中的角色。最後討論「歷史學」和「哲學」這兩個學科中受到殷海光影響的成分，雖然它們繼承了殷版實證論的方法論精神，但內容已有所轉變。
關鍵字：邏輯實證論、殷海光、台灣思想史、中國文化
Logical positivism had ever left a distinguished mark on the intellectual history in Taiwan, since Yin Hai-Kuang introduced Taiwanese scholars to logical positivism in the 1950s. What was this history?
The intellectual history amounts to a history of ideas through the influences of a thinker or a school of thought on another one. To analyze such a history, I propose a structural-dynamic approach, which considers a thinker’s or a school’s system of thought as a unit. The approach requires that one should compare the system of thought of the thinker who has influences over the others with that of the affected scholars. By such a comparison, one can find a series of micro-dynamic changes from the sources to the affected.
According to the structural-dynamic approach, I first compare Yin’s thought with logical positivism, showing the slight change from the latter to the former. Next I point out that Yin attempted to construct a cultural science by using the scientific method presented by logical positivists in his great work Prospects of Chinese Culture, in which Yin enlarged the range of logical positivism. Yin also played an important role in the great debate on Chinese versus Western culture, which burst out in 1962. All of these events show that the influence of logical positivism on the intellectuals in Taiwan through Yin Hai-Kuang’s works.
Keywords:logical positivism, Yin Hai-Kuang, intellectual history, Taiwan, Chinese culture
問題與討論
記2010年東亞批判刊物金門會議：編按／陳光興(81 民 100.03 頁 321-327)
沖繩在東亞中的角色／新崎盛暉（富永悠介、阮欣婷譯）(81 民 100.03 頁 329-339)
金門冷戰的歷史與其影響／李福井(81 民 100.03 頁 341-351)
戰後日本左派中的亞洲聯合／池上善彥（顏麗蕊譯）(81 民 100.03 頁 353-363)
中國國內問題的冷戰背景／錢理群(81 民 100.03 頁 365-380)
從暗處看到了希望／白永瑞(81 民 100.03 頁 381-384)
東亞共同體構想與韓半島分斷體制／白樂晴（黃文俊 譯）(81 民 100.03 頁 385-389)
大陸批判知識份子的困惑：在金門東亞批判刊物會議上的發言／錢理群(81 民 100.03 頁 391-394)
民眾視角與民眾的連帶／孫歌(81 民 100.03 頁 395-410)
書介與評論
做為「方法」的溝口雄三教授／張永堂(81 民 100.03 頁 411-434)
回想戰爭苦痛，再思生命的價值：評Japan’s Contested War Memories: The ‘Memory Rift’ in Historical Consciousness of World War II／呂詠彥(81 民 100.03 頁 435-442)
怎樣「反叛」，如何「抗議」？試論「搖滾樂改變世界」的政治想像／張世倫(81 民 100.03 頁 443-461)
左異聲響
「社會住宅」導言／徐進鈺(81 民 100.03 頁 463-467)
市民城市權論述的建構：找回城市的使用價值／徐進鈺(81 民 100.03 頁 469-476)
社會權論述的路障／趙剛(81 民 100.03 頁 477-489)
以住宅「社會化」對抗貧窮「污名化」／王增勇(81 民 100.03 頁 491-499)
