倫理療癒作為建構臨床心理學本土化的起點

Ethical Healing as the Starting Point for Indigenization of Clinical Psychology

本文主張，一種由互惠性的人情倫理背反而出的「非」關係倫理經驗構成了受苦的療癒因子。所謂的「互惠性的人情倫理」指的是如父慈子孝、兄友弟恭等「應該如此」的人際生活秩序，而「非」關係的倫理經驗則是一種源起性的人際遭逢時刻。能夠達到這樣的瞭解並非僅來自淺顯直接的實徵資料調查，而是經過了「華人本土心理學研究追求卓越計畫第五分項計畫：文化、心理病理與治療（2000-2004）」（以下簡稱「卓越第五分項計畫」）之研究團隊四年來在不同的研究場域中，不斷地調整探問的焦點，不斷地反思研究的發現之後，所獲得的成果。本團隊初始的目標在於探索適性的本土心理治療的可能形貌，例如，華人對憂鬱症的身體化與其對身體表達的關照之間是否有異於西方的憂鬱症現象、華人心理治療的過程是否有關鍵的改變因素、華人臨終心理療癒的機制為何，以及中醫、收驚影響華人的身心契合性如何等問題。然而，經過了兩年的研究後，我們發現這樣的提問方式並不能為本土臨床心理學的開展踏出一個堅強的立足點，反而突顯了本土臨床心理學的困境，亦即：相較於西方強大的心理醫療知識，前述研究的提問，除了給出一些與西方心理醫療不同氛圍的異國情調之外，實在難以與之爭輝。從第二年開始，我們逐漸領悟出一個道理：西方心理醫療對心理疾病的契合，就如同華人心理療法對生活苦惱的契合。也就是說，本土臨床心理學的發展，必須轉回生活世界，讓華人生活世界的行事理路說話，讓華人自行建構的人間系統說話；必須在華人生活世界的秩序與失序之間發現苦痛的因子，並進一步瞭解華人的療癒之道。轉向生活世界後，我們發現華人生活苦痛的關鍵在於其所處的生活秩序，我們稱之為倫理。同時我們發現，此種倫理的重點不在於其秩序性，而在於其情感性，亦即，倫理是情緒的主體，是心理康健或困苦的維繫。人們透過倫理的勾連，使得各種療癒因子慢慢顯露。無論是親人對憂鬱病人的態度，或是人們透過宗教性的聚合而連繫，抑或失親者透過人際網絡而疏通，皆一再顯示生活世界的療癒因素遠比我們想像的還要龐大。於是，我們為本土臨床心理學的開展尋得一個定位，也獲得一個起點。然而，儘管本團隊返回生活世界的探究，但在人情倫理的範圍中亦未止步，我們進一步發現，倫理受苦的療癒並非在於重返人情倫理的調冶，而是相反地，必須去除有系統的人情倫理，揭露「臨在倫理」 （ethical acts in presence）的深度，使得倫理性的情感本身不被宿緣結構（即原本的人情倫理形式）所擄，另以「邊界反應」來帶領受苦者與其相伴者，使得倫理的現身能俱足「外轉內翻」（inside out），從「事不關己」裡獲得「關己性」，成就所謂的「非關係」倫理。這種「非關係」的倫理以身體經驗為感覺的登錄對象，寫入渾體感官，因而俱足療癒因子的基本條件。為了完整說明本文的主張，並一併討論相關的議題，本文將以下面四個步驟進行。首先，申論以「生活世界」做為開展本土臨床心理學所立足的視野層次。其次，回顧討論本研究團隊過去四年來以生活中的受苦取代醫療模式中的精神疾病論述後，所獲得的研究成果。這一部分的討論也將呈現過去四年來研究的限制，成為下一階段研究轉折的基礎。再來，進入獲致「非」關係倫理之療癒過程的描述與討論。最後，重新思考建構整個本土臨床心理學之「非」關係倫理的療癒去路。

In this paper, we propose that an ethical experience other than interpersonal reciprocity constitutes a healing factor for people who are suffering. Ethics based on reciprocity in interpersonal interaction entail obligations that regulate interpersonal ordering such as those in the parent-child relationship. This understanding does not arise from direct empirical observations, but from a 4-year team research project in which team members explored different fields and topics of psychological healing in order to reflect on approaches appropriate to an indigenous clinical psychology. The research group first focused on some possible formations of indigenous psychotherapy for Chinese patients, such as somatization of depression, key factors of change in psychotherapy, the mechanism of healing in the dying process, and the matching of Chinese medicine to the mind-body conditions of Chinese people. After 2 years we found that this direction could not provide a solid standpoint for the development of an indigenous clinical psychology, and instead just manifested the difficulties of doing so. That is, compared with the huge body of Western psychological knowledge, the above ways of inquiry could only provide a kind of exoticism to Western knowledge. After the second year, we began to see that the match between Western psychotherapy and mental illness is similar to the match between Chinese healing operations and life suffering. In other words, development of an indigenous psychology requires returning to the real life conditions of ordinary people (their lifeworlds) and letting the logic of Chinese ways of behaving speak to these conditions, and letting the human relatedness built into the way of living in Chinese societies manifest itself in order to identify the factors related to suffering and healing in Chinese people's lives. After returning to people's lifeworlds, we found the key factor of Chinese people's suffering was in the interpersonal ordering in which they situated themselves, which is called 'the ethical'. We also found that 'the ethicals' were not about regulative principles, but about emotion. That is, people's feelings are subject to 'the ethicals', which in turn is the key element relating to people's psychological health or suffering. People establish their own ways of healing in terms of building up ethical relatedness. In all examined conditions--the caregivers' attitude toward depressed or suffering patients, gathering for religious reasons, and the channeling of grief through interpersonal networking of people who lost loved ones-lifeworld healing was greater than expected. 'The Ethicals' in the lifeworld thus became the anchor of our indigenous psychology and also a starting point for our inquiry. Our research group did not stop at the territory of interpersonal ordering, we advanced further into the lifeworld and found that healing of ethical suffering did entail going back to fix the disordered, but rather withdrawing from systematic interpersonal ordering and disclosing the depth of 'the ethical acts in presence,' in order to relieve the emotionality of continuous interpersonal obligations. We also found that the reaction on the edge, the edge of our take-for-granted, could bring the suffered together with the caregivers into a journey of being 'inside out,' transform the indifferent to the concerned, and formulate the 'otherwise' ethical experience. This 'otherwise' ethical experience first registered itself in bodily level and became the basic condition for healing. To illustrate our understanding and to discuss related issues, this paper consists of 4 parts. First, we discuss the lifeworld as the standpoint for the development of an indigenous clinical psychology. Second, we review the results of our studies in the past four years, which focused on suffering in life rather than on mental illness in the medical system. This part of the discussion also describes the limitations of past studies as the starting point for our inquiry. Third, we then make clear the way we obtained the direction toward the 'otherwise' ethical experience as the key for healing. And forth, we reflect on the construction of the 'otherwise' ethical experience as the healing approach for indigenous clinical psychology.