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研究生:李舒中
論文名稱:「妄想性敘事」的文化分析:一個民族誌的研究
指導教授:林淑蓉林淑蓉引用關係
學位類別:博士
校院名稱:國立清華大學
系所名稱:人類學研究所
學門:人文學門
學類:人類學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:292
中文關鍵詞:妄想症狀主體性醫療人類學
相關次數:
  • 被引用被引用:4
  • 點閱點閱:1012
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:5
論文摘要


妄想是普遍存在於人類歷史與社會裡的特殊現象,同時它長久以來就是與「瘋狂」有著高度相關的概念。在臨床領域中,妄想也是普遍存在的一種精神狀況,但其相關的理論認定複雜分歧,同時也缺乏明確穩定的定義。
現行精神醫學對於妄想概念的認定與特徵化,主要是延續了十九世紀所發展出來的妄想理念,它也反映了特定精神病理學、哲學與心理學方面理論歷史的發展及轉變結果。然而存留在現行主要精神診斷系統(例如DSM)的這些妄想概念特徵,卻逐漸在臨床與生活的各種場域裡遭受到質疑,像是妄想內容的不可能性或怪異(implausibility / bizarreness)、妄想信念態度的堅持(conviction)、妄想無法在面對反證或矛盾訊息時作出具有彈性的調整(incorrigibility)、以及妄想的不可理解性(un- understand- ability)等等。透過對於這些妄想概念特徵的相關討論,尤其是其中由Karl Jaspers對於妄想所揭櫫的「不可理解」特質之探討,本研究將妄想現象的理解作為民族誌觀察與思辯的對象,並著重於探索妄想現象在社會文化及歷史等面向上的可能意義與理解。
妄想作為一種異常信念的現象,其概念化與實踐的問題特性,也還在於精神症狀本身的概念化方式上。透過對於妄想內容在敘事、歷史、社會與政治經濟以及跨文化研究等方面的不同見解、晚近有關症狀理念的重新探討,以及醫療符號學與醫療人類學的相關論述發展,本研究試圖超越將妄想視為只是一種疾病症狀的臨床診斷性、負面化認定,而朝向將妄想視為一種正面、多元的主體性意義來進行觀察、想像與理解。
藉由晚近精神醫療人類學有關經驗、主體性、差異與敘事等方面的探討,妄想作為一種社會文化、歷史與存在性的理解及意義,以及妄想作為一種主體經驗的展演,其可能性透過本研究開展的民族誌場域,予以進行了試探性的呈現。
本研究透過三個急性精神病房住院者的第一人稱妄想敘事之分析,試圖從這些妄想相關的敘事與現象分析裡,還原被生物精神醫療處置所簡化、扭曲或忽略的妄想意義內涵,並將其與個別妄想者的深度經驗歷史、生命歷程、社會文化情境聯繫起來。
在詳盡的敘事以及觀察資料的呈現與分析中,本研究呈現出妄想現象在臨床領域裡可能呈現出來的豐盛意義,將妄想現象從純然的「不可理解」等主流特徵化的方式裡,脫解出其最微量與最起碼的「可能理解性」;而透過這種多重意義的還原與歸返,本研究對於生物醫學將妄想現象界定為具有「不可理解」等特徵的作法,視為「理解」本身的「症狀」,並將其與晚近有關症狀及主體性的探討,一併來進行反思與討論。
第一章 導論:問題意識、理論回顧與研究方法 001
一•問題意識與研究目的 001
二•理論文獻回顧 003
A. 對於妄想症狀特徵的再議 004
B. 妄想症狀與其理解 012
C. 醫療人類學晚近研究的相關性 020
三•研究方法 – 疾病與症狀的敘事研究 025
四•小結 029

第二章 田野地點介紹 031
田野場地與田野歷程介紹 031
註釋 039

第三章 夜行中的雅若
一•介紹 040
二•田野觀察與互動歷程概要 040
三•臨床呈現 042
四•會談敘事與初步分析 042
五•分析與討論 101
六•民族誌作者的我 109
七•結論 110
八•註釋 112

第四章 毀容女小倩的妄想故事
一•介紹 114
二•田野歷程梗概 114
三•醫療的呈現與資訊 118
四•會談敘事與初步分析 119
五•分析討論 198
六•民族誌作者的我 208
七•結論 209
八•註釋 211

第五章 鵰面女彩妹,她的被害妄想敘事與展演
一•引 213
二•臨床呈現 215
三•妄想敘事 215
四•分析與討論 245
五•民族誌歷程的我 252
六•結論 256
七•註釋 258

第六章 結論:「症狀」及其不滿 260
註釋 267

附錄一 病房平面圖 268

附錄二 受訪者同意書 269

參考書目 271
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