精神障礙者之復健與復元－－一個積極正向的觀點

Rehabilitation and Recovery of Persons with Psychiatric Disability-A Progressive and Positive Perspective

在1980年代，美國的一些精神障礙者提出復元觀點，之後引導歐美精神障礙者復健服務至今。在邁入二十一之際，更加強調進入“The Decade of the Person”，重申重視精神障礙者作為一個“人”，而非等同於“疾病”。許多復元者自身經歷的披露以及幾項長期追蹤研究，都顯示精神障礙者復元的可能性，比例也相當高，重要的是及早給予復健和適應社區的機會。儘管復元觀點與實務在西方已燃燒二十餘年，在台灣卻鮮少有人加以討論，在本文筆者試圖整理復元的定義內涵、復元的過程、復元過程的阻力與助力、並提出一復元過程與結果之參考架構；進而討論復健與治療之別和復健之價值與原則，以及以復元為導向之精神復健體系和實務特色；最後，以復元觀點檢視台灣的精神復健政策與資源，提出粗淺的建議。藉此拋磚引玉，期待未來有相關研究結果激起更深沉的討論。

The concept of recovery has guided the rehabilitation policy and practice in the United States and some European countries since 1980s. The concept was brought into the field by some personal recovery experiences. Their experiences and a few long-term follow-up studies demonstrated that recovery is possible and there are high percentages of persons with psychiatric disability recovered or improved. Although the concept has been popular in the West for more than two decades, there is almost no article focused on this topic in Taiwan. In this article, through literature review the author presents the concept of recovery, the recovery process, the barriers and facilitators of recovery, and further proposes a conceptual framework of recovery process and outcome. In addition, the author discusses the differentiation of rehabilitation and therapy, the principles of rehabilitation, and recovery oriented rehabilitation. Finally, the rehabilitation system and practice in Taiwan are examined from the recovery perspective. Tentative suggestions are made and the author hopes to stimulate related research and discussions in the future.