日常生活的偏離與歸返：反芻思考在憂鬱失能經驗中的角色

Dropping Out and Returning To Daily Life: The Role of Depressive Rumination in the Experience of Depression and Disability

研究目的：本研究以現象學方法重返憂鬱者主觀經驗，了解憂鬱反芻的經驗意涵。研究方法：本研究共計5名受訪者（4女1男），皆符合重鬱症診斷，並有憂鬱後反覆思考的經驗。受訪者填寫貝克憂鬱量表第二版（Beck Depression Inventory-II, BDI-II）並接受約1.5小時的訪談。訪談全程錄音謄為逐字稿，並依照李維倫、賴憶嫺（2009）建議的步驟進行現象學分析。研究結果：本研究以「日常生活—病人生活—受苦生活」的普遍結構說明憂鬱失能的經驗，是在：（1）失能、失控感，（2）與他人、自我的比較中「偏離」日常生活，並掉落受苦生活的處境。此時受訪者意欲歸返日常生活，也就是和「他人」、「病前自我」表現地一樣好。然而，「變好」的過程艱難且充滿挫折，受訪者常對自己留在受苦生活而「無法變好」的處境進行自我批判。對於接受精神醫療協助的擔心，則使受訪者感到衝突而拒絕成為「病人」，也就是進入病人生活。當其無法回歸日常，又不願進入病人生活─則留在無以命名的受苦，並以反芻意義化其所在。當意義化將受訪者帶往不利處境，則使其經驗次發性受苦，並再次以意義化命名其處境，形成憂鬱反芻的迴圈。研究結論：本研究以「處境意義化」解釋受苦、反芻的迴圈，及其難以中止的可能原因。助人工作者應協助憂鬱者探索受苦經驗的多元可能，共同找出有利的意義化。

Purpose: This study examines the subjective experience of depressive rumination, to descript an experiential structure of this phenomenon. Methods: A total of 5 patients (1 male, 4 female) diagnosed with a major depressive disorder and referred by a psychiatrist participated in this study. They all had the experience of thinking repetitively when feeling depressed. All completed the Beck Depression Inventory-II (BDI-II) and were interviewed by the researcher 1-2 times, for about 1.5 hours each time. Interviews were transcribed verbatim. Phenomenological analysis was used to analyze the text. Results: Our results indicated a general structure of perceived experience: Daily life-Patient’s life-Suffering life. People with depression and disability experience themselves as existentially apart from their daily life. They experience a “suffering life” through: (1) a sense of disability and lack of control, and (2) comparing their suffering to daily life/other people’s lives. When people are suffering, they want to go back to daily life, to have life be as good as before. However, the process of “being good” is hard and full of frustration. Participants criticized themselves for living a suffering life. When they asked for medical service, they rejected the label of “patient”, which to them means they would live a “patient’s life.” When people can’t return to a normal daily life, they feel conflict. They remain in a suffering state that is nameless. The experience of depressive rumination is the effort to make sense of this nameless suffering. However, this effort to make sense of things may cause them to live with much more distress and experience secondary suffering. After that, people make sense of their secondary suffering again. This creates the circle of depressive rumination and suffering. Conclusions: This article indicates that the effort to “make sense of my suffering” may explain the reason depressive rumination and suffering are sustained. Psychotherapists should help depressive patients explore their suffering and find a more adaptive way of making sense of their situation.