兩位已婚女性精神障礙者家庭生活調適歷程之敘事研究

Abstract

在復元理念與社區復健服務的倡導之下，精神障礙者在家庭及社區的生活漸受重視，個人如何於疾病和家庭生活間自我調適、轉化角色並運用資源，實為復健諮商重要議題。 本研究採用敘事研究的方法，藉深度訪談探討兩位在婚後罹患精神疾病的女性，重新參與家庭生活之調適歷程。經資料蒐集、分析與詮釋後，分別呈現兩位參與者的家庭生活經驗，再進一步歸納統整研究結果。主要發現如下： 研究參與者在其家庭經驗中，個人感知的壓力超出身心負荷範圍，引發精神疾病，角色功能失調，影響整個家庭系統的運作。在謀求新的平衡狀態之重組階段，家庭成員也扮演著重要角色。家庭生活與疾病之間，彼此牽引，兩位參與者賦予家庭的意義，存在矛盾性。而患病經驗造就轉機，喚起個人自覺，也帶給家庭生活新的風貌。 調適歷程中參與者採行角色轉化與生活目標轉變等策略。家庭角色任務的執行上，涵蓋「下修期待」、「解放自我」以及「轉移職責，量力而為」三種。另以「放緩步伐，坦然接受現實」、「自我照護，兼顧內外需求」、以及「攝取知識、自我精進」、「擔任志工，扶助弱勢」方式，進行心態與生活目標的調整。整體生命走向，朝「與自己和解」之路邁進。 研究亦針對參與者在調適歷程中所面臨的各種助力、阻力進行討論。得知個人內在、家庭內部與外在環境的支持均相當重要，而阻力則可能促使病症復發。最後，基於研究結果，就復健諮商服務體系、精障者個人和其家庭，以及對未來研究等面向，提出若干建議。

With the advocacy of recovery concept and community rehabilitation services, lives of people with mental disorder in families and community gradually attract more attention. How do individuals make self-adjustment, and role transforming between illness and family life as well as using resources is in fact an important issue for rehabilitation counseling. In this study, narrative research method is adopted to explore the re-adaptation process of two female suffering from mental illness after marriage to participate in family life in-depth interviews. After data collection, analysis and interpretation, family life experience of two participants are respectively presented so as to further summarize the findings. The main findings are as follows： In the studies on participants in their family experience, personal perception beyond the physical and mental stress load range causes mental illness and role dysfunction, thus affecting the operation of the entire family system. In the restructuring phase of seeking a new equilibrium state, family members also play an important role. Family life and disease draw each other; contradictory exists in the significance given by two participants. The illness experience made the turn, evoked personal consciousness, also brought a new style to family life. During adjustment process, participants implemented changes in the role of transformation and life goals and other strategies. The performance of family roles covers "Reducing expectations", "Self-liberation" as well as "transfer of responsibilities, estimate one's strength before acting". In addition, "Slow down the pace, frankly accept the reality", "Self-care for both internal and external demands", "Intake knowledge for self-sophisticated", "served as a volunteer to help disadvantaged" and other approaches for attitude and life goals adjustment. The whole life moves toward the road of "self-reconciliation". The study also discusses about various aid skills and resistance facing during adjustment process and found that both intrapersonal and family as well as external environment support are quite important, while resistance may induce disease recurrence. On the basis of research findings, several recommendations were put forward for rehabilitation counseling service system, individuals with mental disorder and their families, as well as future-oriented researches.