精神科婚姻治療門診病人的婚姻狀況

Marital Conditions of Patients in a Couple Therapy Clinic of a Psychiatric Center

本研究的目的在探討不同嚴重程度精神病人的婚姻狀況，以及精神病與婚姻狀況間是如何關聯的。研究者以五年間在婚姻治療門診的30位個案為研究對象，依病人的精神科診斷，將個案分成重型精神病（重型組，14名）、輕型精神病（輕型組，6名）及V-code狀況（V-code組，10名）等三組，比較其人口學特質、因應疾病行為，以及婚姻狀況等變項。本研究用整體功能量表得分來證明此三診斷群組確能代表精神病的嚴重程度。三組個案的婚姻狀況特徵如下：重型組：發病早、病程久、病人功能最差、配偶和原生家庭協同照顧病人、婚姻最穩定；輕型組：婚姻關係功能差、婚姻衝突大且不穩定；V-code組：雖能力佳，但所遭遇的問題無法用舊辦法解決，故其婚姻反比重型組不穩定。在探討上述特徵的歷程中發現三個影響婚姻狀況建構的因素：（1）疾病會經由對病人整體功能的影響，來影響他在權階關係中的位置；（2）經由家庭成員對病信念，影響日常互動及婚姻生活的建構；（3）疾病本身的素質會影響家族的照顧結構。此外也發現衝突發生於參與者間信念衝突及權階關係規則變動時，而個案的問題正標示著關係發展的阻滯，如本研究中三組個案所分別企求的自主、親密／平權／分化、合作，也正標示著關係成熟的方向。文末對本研究在實務上的應用亦有所討論。

Purposes of this study were to explore characteristics of marital conditions in cases of different severity of mental illness and to find how mental illness and marital conditions are connected. Thirty couples admitted to a marital therapy clinic in a psychiatric center were studied and were allocated to major psychiatric disorder group(n=14), minor psychiatric disorder group(n=6), and V-code conditions group(n=10). The major psychiatric disorder group had the youngest age of onset, the longest illness history, the lowest functioning level, the mechanism of care/protection, and the most stable marriage. The minor psychiatric disorder group had the worst relational functioning, the most severe marital conflicts and the least stable marriage. The V-code condition group had the best personal and relational functioning, and living conditions, but their marital conditions were less stable than the major psychiatric disorder group. Three factors that would affect constructing marital conditions were noted: (1)Patients’ integrated functioning would affect their hierarchical relationship. (2)Belief system toward illness would affect reciprocal interaction. (3)Elements of illness per se would affect family structure. Authors also noted that problems of these groups, i.e. autonomy, intimacy/equality/differentiation, and collaboration indicated obstacles of relational development and directions of intervention as well.