次の英文を読み、18~25の問題に文脈上最も適した答えを選べ。

When I use the word (18)illness here, I shall mean something fundamentally different from what I mean when I write disease. By *invoking the term illness, I mean to *conjure up the *innately human experience of symptoms and suffering. Illness refers to how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability. Illness is the lived experience of monitoring bodily processes such as *respiratory wheezes, *abdominal cramps, *stuffed sinuses, or painful joints. Illness involves the evaluation of those processes as expectable, serious, or requiring treatment. The illness experience includes categorizing and explaining, in common-sense ways accessible to all lay persons in the social group, the forms of distress caused by those *pathophysiological processes. And when we speak of illness, we must include the patient's judgments about how best to cope with the distress and with the practical problems in daily living it creates. Illness behavior consists of initiating treatment (for example, changing diet and activities, eating special foods, resting, engaging in exercise, taking over the counter medication or on-hand prescription drugs) and deciding when to seek care from professionals or alternative. practitioners.

(19)Illness problems are the principal difficulties that symptoms and disability create in our lives. For example, we may be unable to walk up our stairs to our bedroom. Or we may experience distracting low back pain while we sit at work. Headaches may make it impossible to focus on homework assignments or housework, leading to failure and frustration. We may feel great anger because no one can see our pain and therefore objectively determine that our disability is real. As a result, we sense that our complaints are not believed, and we experience frustrating pressure to prove we are in constant pain. We may become demoralized and lose our hope of getting better, or we may be depressed by our fear of death or of becoming an*invalid. We grieve over lost health, altered body image, and dangerously declining self-esteem. Or we feel shame because of disfigurement. A11these are illness problems.

(20)Disease is the problem from the practitioner's perspective. In the narrow biological terms of the biomedical model, this means that disease is *reconfigured only as an alteration in biological structure or functioning. When chest pain can be reduced to a treatable *acute lobar pneumonia, this biological reductionism is an enormous success. When chest pain is reduced to *coronary artery disease for which calcium blockers and nitroglycerine are prescribed, while the patient's fear, the family's frustration, the job conflict, and the financial crisis go undiagnosed and unaddressed, it is a failure. In the practitioner's act of recasting illness as disease, something essential to the experience of chronic illness is lost; it continues for a long time and cannot be cured, so it is not *legitimated as subject for clinical concern, nor does it receive an intervention. Treatment assessed solely through the rhetoric of improvement in disease process may confuse the patient's (and family's) assessments of care in the rhetoric of illness problems. Therefore, at the heart of clinical care for the chronically ( 21 )-those who cannot be cured but must continue to live with ( 22 )-there is a potential(and, in many cases, actual)source of conflict.

To complete the (23)picture, I shall introduce a third term,(24)sickness, and define it as the understanding of a disorder in its general sense across a population in relation to macrosocial (economic, political, institutional) forces. Thus, when we talk of the relationship of *tuberculosis to poverty and malnutrition that places certain populations at higher risk for the disorder, we are invoking tuberculosis as sickness; similarly, when we discuss the contribution of the tobacco industry and their political supporters to the *epidemiological burden of lung cancer in North America, we are describing the sickness cancer. Not just researchers but patients, families, and healers, too, may*extrapolate from illness to sickness, adding another wrinkle to the experience of disorder, seeing it as a reflection of political oppression, economic deprivation, and other social sources of human misery.

【Adapted from“The Illness Narratives:Suffering, Healing, And The Human Condition, ”by Arthur Kleinman, Basic Books, 1988. pp. 1-6】
Glossary:

• invoke 引き合いに出す
• conjure up ~を思い起こさせる
• innately 本質的に
• respiratory wheeze ゼーゼーいう息
• abdominal cramps 腹部の痛みを伴ったけいれん
• stuffed sinuses 詰まった鼻
• pathophysiological 病態生理学の
• invalid 肢体不自由者
• reconfigure 再構成する
• acute lobar pneumonia 急性大葉性肺炎
• coronary artery 冠状動脈
• legitimate 正当化する
• tuberculosis 結核
• epidemiological 疫学の
• extrapolate 推定する

• 18. (B)illnessは何を意味するか。
  • A. human experience of suffering received by the patient
  • B. human experience of symptoms received by the family
  • C. human experience of suffering received by the patient and file doctors
  • D. human experience of symptoms received by the patient and the relatives
• 19. (19)Illness problemsとは何か。
  • A. inability to walk up stairs to a bedroom
  • B. distracting low back pain while sitting at work
  • C. the great anger we feel because no one can see our pain
  • D. the major difficulties that symptoms and disability bring in our lives
• 20. (20)Diseaseとは何か。
  • A. the problem from the medical doctor's way of researching facts
  • B. the problem from the medical doctor's act
  • C. the problem from the practitioner's feeling and impression
  • D. the problem from the practitioner's judgment from his viewpoint
• 21. ( 21 )に入るのに最も適当な語を選べ。
  • A. problem
  • B. ill
  • C. illness
  • D. pneumonia
• 22. ( 22 )に入るのに最も適当な語を選べ。
  • A. problem
  • B. ill
  • C. illness
  • D. pneumonia
• 23. (23)pictureの意味に最も近いものを選べ。
  • A. a visual representation of a person, object, or scene, as a painting drawing, photograph
  • B. any visible image, however produced
  • C. the image or perfect likeness of someone else
  • D. a particular image or reality as portrayed in an account or description
• 24. (24)sicknessの定義に最も近い意味のものを選べ。
  • A. the understanding of illness in its general sense across a population in relation to macrosocial forces
  • B. the understanding of a biological model in its general sense across a population in relation to macrosocial forces
  • C. the understanding of cancer in its general sense across a population in relation to macrosocial forces
  • D. the understanding of physical or mental functions in its general sense across a population in relation to macrosocial forces
• 25. (25)sickness cancerに関係として最も近いものを選べ。
  • A. flowers and allergies
  • B. global warming and heat wave
  • C. air pollution and lung disorder
  • D. a nuclear power plant disaster and environmental pollution