精神疾病與求助行為：問題與對策

MENTAL DISORDERS AND HELP-SEEKING BEHAVIOR: PROBLEMS AND STRATEGIES

本文作者將綜合分析其過去所做四項研究：精神疾病患者求助行為的研究；社區民眾對身體疾病與精神疾病的求助行為；「要神也要人」：精神疾病與民俗醫療；仙人掌的故事——慢性精神病人復建的一種新途徑；加上最近完成的一項研究——龍發堂的故事；一共五項有關精神疾病與求助行為的資料，研討有關的問題及其對策。研究者所收集的研究樣本：住院精神疾病112例；門診精神疾病131例；龍發堂精神疾病145例；綜合醫院身體疾病72例；社區樣本117例；以及仙人掌計劃精神疾病22例；共計有599例。在求助行為的型態中，發現民俗醫療的使用率很高（高達84%）。有關求助行為的問題分析可以就三個層面來加以歸納和討論：生物學層面——意指疾病的病理本質；心理學層面——指對疾病的心理反應，認知（特别是解釋模式）及其障礙；社會文化層面——指疾病的家庭反應、障礙、迷信，以及社會文化背景體系的反應及其後果。在對策方面，精神疾病的慢性化後果是問題的主要核心；而現代精神醫療體系和心理衛生政策如何適應協調與輔導民俗醫療體系是研擬對策時的重要課題。

The fact that the chronic mental patients do not receive proper and adequate mental health care in Taiwan is addressed, and the reasons behind are elucidated in terms of the help-seeking behavior of the patients and their families. Review of literatures and, in particular, five articles written by the author and his associates are made, which include: (1) a study of the help-seeking behavior of psychiatric patients; (2) the help-seeking behavior with respect to physical or mental illness in the community; (3) ''god and man'': mental disorders and folk healing (case report); (4) the story of Cafe' Cactus: a new way to the rehabilitation of chronic psychotic patients; (5) the story of Long-Hwa-Tang: a preliminary study of the help-seeking behavior of patients with chronic mental illness and their rehabilitation models. In total, 599 cases are included in the above-mentioned 5 studies (112 inpatients, 131 outpatients, 117 community respondents, 22 coffeeshop cases, 72 non-psychiatric patients, and 145 Long-Hwa-Tang patients). Three-dimension approach in accordance to the bio-psycho-social model is adopted to analyze and formulate the associated problems as well as the pertinent strategies with reference to the findings from the literature review. The chronicity of mental disorders, the popularity of folk healing, the unique role played by family, and other characteristics in the help-seeking process in Chinese culture are depicted. Cultural accommodation and indigenization of modern psychiatry to the Community are emphasized and discussed.