固守或鬆手：年輕乳癌患者處境經驗與心理成長的現象探究

Holding-on or Letting-go: Exploring the Phenomena of the Situated Experience and Psychological Growth among Young Breast Cancer Patients

目的：本研究探討年輕乳癌患者罹病後，從受苦到經驗正向改變的心理轉化。研究探討問題包括「年輕乳癌患者／存活者的時間感籌劃」、「年輕乳癌患者／存活者的處境經驗」和「從乳癌經驗的處境與時間感面向，嘗試理解心理成長的發展軌跡」三層次。
方法：研究以立意取樣王韋婷（2014）研究的受試者，共有四位參與者，平均罹癌年齡35.75歲，接受訪談。資料分析以現象學心理學方法進行，而後詮釋討論。
結果與討論：參與者的主題置身結構，呈現「時間感：乳癌經驗的牽掛結構」、「處境經驗：創傷後成長是多重現象」和「後創傷成長：異質性軌跡」三重性，帶出照顧倫理行動的開展。研究發現兩位年輕乳癌參與者以釋放控制，是「在己生命」開展了生活世界；另外兩位參與者以固守控制，是考量他人的「為己生命」。「在己」不是「自我」的孤立化，而是將變化融入原本就是自我，回到存有自身。「為己」並非「在己」把變化接納為自我，而是一種對「他人」照顧的責任與對自己生命的承擔。然而，「在己」或「為己」不僅止於獨善其身的「自己」，而是如何看到更完整自己的關係處境，意即自己是「家己」，帶著以家庭為核心的「咱們」倫理關係。
結論：研究顯示心理成長敘事，焦慮的意義不是心理病理學上的單調性，是具存有論與倫理性的意涵。量表指標的分組是科學架構，但取消了情感動力。由此顯示罹病處境的匱乏作為存有的開展，以及在世情懷的牽掛，都是自我與他者的遭逢，也就是關係我（relational self）的「家己」關係到「咱們」關係的成長軌跡，顯示關係我的文化特性。

The study aims to explore how young breast cancer survivors perceive psychological growth since operation treatment, focusing on their transformative experiences of interpersonal situatedness and sense of future temporality. There has been much discussion about perceived positive changes from negative stress events, such as“posttraumatic growth”(PTG), a concept describing positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances. These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual’s understanding of the world and their place in it. PTG involves“life-changing”psychological shifts in thinking and relating to the world and the self that contribute to a personal process of change which is deeply meaningful. It is also known as“benefit-finding”or“adversarial growth”. Although the experience of positive changes and PTG in breast cancer has been shown in some studies, it has not been adequately studied in young breast cancer patients. How do young breast cancer patients experience positive change from the sufferings and pains of disease? How do those survivors who experience positive changes view and reflect on these illness processes? These issues are further explored in this article.
The participants in this study were recruited from a sampling of subjects from Wang’s dissertation (2014). Four participants with a mean age 35.75 were interviewed and their data were transcribed and then analyzed via a phenomenological psychology approach. The data analysis procedures of carrying out phenomenological psychology were based on six steps: data collection, empathic immersion, meaning units, constituent themes, situated structure, and general structure.
Three themes of breast cancer survivors’experiences emerged from the data analysis: (1) temporality: solicitude modes of being-in-the-world, (2) situatedness: post-traumatic growth as a multiple phenomenon, and (3) trajectory: heterogeneity. This research shows how cancer treatment can be conceptualized as an overflow of normal suffering experience and carrying out the ethical action of care. Two participants faced their limited lifetime by taking on an authentic mode of being-toward-death by letting-go of control, which illustrates their“being-in-itself”and living with existential uncertainty. The other two participants held onto control in their limited lifetime and engaged with a future temporality of hope to cope with their predicament, which illustrates“being-for-itself”and projects the possibilities of avoiding the constraints of others in the future. Regardless of patients’“being-in-itself”or“being-for-itself”, the results show how the suffering of illness constitutes a form of Dasein and being-in-the-world of the relation self (family self；ka-kī), as well as a movement from the self to significant familiar others through ethical action. Dasein, then, is what constitutes being-towards-death at this moment. The suffering crispation experienced by patients reflected the existential depth of meaning. In Heidegger’s words,“The totality of being of Dasein as care means: ahead-of-itself-already-being-in (a world) as being-together-with beings encountered in the world.”
This study shows that the meaning of anxiety is not the monotony of psychopathology, but rather the ontological meaning of ethical caring. The classification of scale indicators is a scientific structure that weakens affective experiences. The disease is a positive and innovative experience for participants’living reality rather than just a fact of disease cells growing or decreasing. This observation shows that the suffering of illness can spur growth dynamics growth toward the disclosive affectivity of Sorge (care) in one’s being-in-the-world, which consists of encountering the self and others, or cultivating a relational self between me and family that is related to the cultural characteristics of a“we-ness”trajectory through life and death. Ethical caring is the cornerstone of a relational understanding of human subjectivity and is radically different from medical positivism. The implications of this study’s outcomes and future research agendas are discussed in the final section.