精神疾病患者道德生涯現象：個案研究

Phenomenology of Moral Career in the Schizophrenia Patient: Case Study

林耀盛(Yaw-Sheng Lin)；劉又華(Yu-Hua Liu)

位子 ； 道德 ； 精神病 ； Moral ； place ； psychotic

身心障礙研究季刊

12卷2期（2014 / 06 / 01）

94 - 105

繁體中文

背景與目的：本文以「個案研究」探討精神分裂症（思覺失調症）「住院病人」的道德處境，以深入理解精神疾病患者的存在意義。方法：深度訪談一位罹病4年餘的46歲男性（簡稱B）精神分裂症（思覺失調症）病患，深受妄想症狀影響，而後以詮釋現象心理學分析訪談資料。結果：B的罹病經驗呈現（1）『「食物界線的社會分類秩序」診斷為「自我異常」的疑惑感』、（2）『經由「遠距關係」感通以化解「在世災難」』、（3）『對過世母親性「認同」以寬解受苦』、（4）『「人我關係匱乏」和「照顧倫理」行動之間』等處境現象。結論：精神病患的道德生涯，是一種尋找「位子」的過程。從「失位」、「錯位」、「位移」到「在位」的置身結構，顯示症狀的創真行動，是一種再建構的歷程，而非僅是心理病理的意涵。

Background and objectives: This study was to explore the existential situation of moral career through the case study, and to promote understanding of the schizophrenic's psychological experience. Methods: In-depth interview with a 46-year old male, who had affected more than 4 years (Called B) psychiatric experiences, deeply suffered with paranoid symptoms, was conducted. After data collection, we interpreted data using qualitative method which was grounded in phenomenological psychology. Results: B was infected experience rendering 'food boundaries of social classification order' mistaken with the psychopathology diagnosis. B faced the institutional hospital life still instill a sense of hope in the real order. What the reality is understood beyond the positivism paradigm. It is shown the mode of being in the unique way. Conclusion: The moral career of mental disorder patient was found to search for the 'place'. From 'displace' and 'out of place' to 'em-place' in the situated structure, it is revealed the repetitive symptom is meant the creative action and construction process rather psychopathological meaning.

1. 宋文里(2012)。創真行動：閱讀史瑞伯的一種他者論意義。應用心理研究，53，215-250。
   連結：
2. 李維倫、賴憶嫺(2009)。現象學方法論：存在行動的投入。中華輔導與諮商學報，25，275-321。
   連結：
3. 龔卓軍(2005)。生病詮釋現象學從生病經驗的詮釋到醫病關係的倫理基礎。生死學研究，1，97-129。
   連結：
4. 林耀盛 (2008)。正常與偏差。中國時報，取自：http://www.wretch.cc/blog/liuty/20591942 (2014/1/12)。
5. Corrigan, P.,Watson, A.(2002).Understanding the impact of stigma on people with mental illness.World Psychiatry: Official Journal of the World Psychiatric Association (WPA),1(1),16-20.
6. Goffman, E.(1961).Asylums: Essay on the social situation of mental patients and other inmates.Garden City, NY:Doubleday.
7. Goffman, E.(1963).Stigma: Notes on the management of spoiled identity.Englewood Cliffs, NJ:Prentice-Hall.
8. Heidegger, M.,Macquarrie, J.(trans.),Robinson, E.(trans.)(1990).Being and time.Oxford:Blackwell.
9. Korsbek, L.(2013).Illness insight and recovery: How important is illness insight in peoples' recovery process?.Psychiatric Rehabilitation Journal,36(3),222-225.
10. Radley, A.,Chamberlain, K.(2001).Health psychology and the study of the case: from method to analytic concern.Social Science and Medicine,53,321-332.
11. Royse, D.,Thyer, B. A.,Padgett, D. K.,Logan, TK.(2006).Program evaluation: An introduction.United States:Thomson Brooks.
12. Rulf, S.(2003).Phenomenological Contributions on Schizophrenia:A Critical Review and Commentary on the Literature between 1980-2000.Journal of Phenomenological Psychology,34(1),1-46.
13. Rüsch, N.,Angermeyer, M. C.,Corrigan, P. W.(2005).Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma.European Psychiatry,20(8),529-539.
14. Sontag, S.(1990).Illness as metaphor and AIDS and its metaphor.N.Y.:Anchor Book/Doubleday.
15. Whitley, R.,Campbell, R. D.(2014).Stigma, agency and recovery amongst people with severe mental illness.Social Science and Medicine,107,1-8.
16. Willig, C.(2001).Introducing qualitative research in psychology: Adventures in theory and method.Buckingham:Open University Press.
17. Yang, L. H.,Kleinman, A.,Link, B. G.,Phelan, J. C.,Lee, S.,Good, B.(2007).Culture and stigma: Adding moral experience to stigma theory.Social Science and Medicine,64(7),1524-1535.
18. 王聲昌譯、Freud(2006)。史瑞伯：妄想症案例的精神分析。台北市:心靈工坊。
19. 林美伶、熊秉荃、林淑蓉、胡海國(2002)。精神分裂症患者之烙印處境。慈濟醫學雜誌，14(6)，381-388。
20. 林淑蓉(2008)。身體、意象與變異的自我感：精神分裂症患者的主體經驗。台灣人類學刊，6(2)，3-46。

1. 梁瓊宜、呂又慧(2016)。從病人到人─專業關係再建構？精障會所工作者之主體生成歷程。臺大社會工作學刊，33，129-170。
2. 林耀盛,李弘毅(2021)。精神病院裡雙重患病經驗詮釋：思覺失調症患者罹癌生活世界。中華心理衛生學刊，34(3)，261-290。
3. 林耀盛、林孟瑤(2018)。症狀作為存在：探索青年女性思覺失調症患者心理現象。身心障礙研究，16(2)，94-106。