臨床文化能力的渴望：再思台灣產後憂鬱

Achieving Cultural Competence in Healthcare: Rethinking Postpartum Depression in Taiwan

「產後憂鬱」的現形，來自於精神醫學的建制化（institutionalization）、醫學知識的推廣，並被國家納入健康治理的一環；個人的文化信念與道德世界，也因為社會急遽變遷而有所變化，逐漸認納「疾病」作為尋求改變的角色認同。本文藉由分析「產後憂鬱」在台灣逐步浮現的過程及其現代性意義，闡釋當代精神醫學尋求「文化能力」的思辨路徑。透過作者的臨床經驗觀察，並且爬梳跨文化精神醫學的論述與臨床研究文獻，以跨學科的視角，對產後憂鬱的認識論與診斷的政治進行檢驗與對話。本文認為，產後憂鬱的疾病經驗是隨著社會變遷而浮現的。診斷如同「雙面刃」，一來有助人改善處境的意義，卻也有縮限問題解釋空間的可能。因此本文強調，產婦的病痛與就醫的主體經驗需要更進一步的探究。臨床工作者的文化能力，在於對受苦經驗進行脈絡化的理解，避免污名的產生，並致力於協助產婦於當代更新變動的社會條件下，持續賦權以面對當代的困境。 The appearance of post-partum depression in Taiwan is due to the institutionalization of psychiatry, the promotion of medical knowledge over indigenous understandings, and the state's health policy. Individuals' cultural and moral beliefs have also been reshaped under rapid societal changes. Hence the disease identity then has been reinforced. In this article, I analyze the gradual emergence and modern significance of post-partum depression in Taiwan, and explain contemporary processes in the search for cultural competence in the field of psychiatry. I apply observations from my own clinical experience to explore cross-cultural aspects of psychiatric treatment. I also review the clinical research literature to examine and discuss the epidemiology of postpartum depression and the politics of diagnosis from an interdisciplinary perspective. I propose that post-partum depression has emerged along with social change. Making a diagnosis is a double-edged sword. Medical intervention can be helpful, but it can also narrow the interpretation of the experience. Therefore, there is a need for further exploration of maternal subjectivity, both in the illness itself and in receiving medical treatment. Clinicians' cultural competence lies in contextualized understanding for patients in need, empowering patients to handle their everyday struggles, and avoiding possible stigma.