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

From Patienthood to Personhood: Clubhouse Workers’ Journey of Professional Formation

服務精障者的會所模式之服務哲學，是「從病人到人」，期望工作者能視精障者為「人」，而非「病人」，與精障會員「肩並肩」工作，建立夥伴關係、並尊重會員自願性。但臺灣提供精神障礙服務的作法，向來承襲醫療化論述的助人學科思維，看重以「專業角色」處理問題。另外，在新管理主義思維的政策下，組織追求服務績效與效率，工作者仍要處理許多文書及行政事項。這些理念與大環境，使得會所中的工作者發展專業主體與建立關係的過程遭遇許多挑戰。本研究發現：在精障會所的工作者，面臨著被社會期待，需承擔「萬能精障代理人角色」，他們同時也被夾擠在會所理念發展與體制政策要求的夾縫之中；面對精障會員起伏的病程，他們有無法安放身心的掙扎等等，需要再形塑專業關係的難題。研究發現顯示出：會所中的工作者反思到，要先經歷主體生成及轉化過程，才能重新建構專業關係，發展在地的服務知識。

The clubhouse philosophy for people with mental illness is summed up as “from patienthood to personhood.” It expects workers to treat each people with mental illness as “a person” instead of “a patient”, so that they can become partners working together “side by side”; the voluntariness of members is then respected. Besides, the organization in pursuit of efficiency and performance is influenced by the policy of “New Managerialism”, while the workers have to deal with la significant amount of office administration. The findings of this research show that clubhouse workers are confronted with the social expectation that they will play the role of “almighty agent for the mentally ill.” In the meantime, the tension between clubhouse development and policy requirements puts them under great pressure. All of the above considerations raise the issue of reconstructing the professional relationship between workers and members. Clubhouse workers reflect that: Before reconstructing the professional relationship, they have to go through the process of transforming their professional subjectivity reflectively via knowledge regarding “from patienthood to personhood” in Taiwan.