內在與外緣間異質身體：詮釋乳癌第一、二期存活者之心理經驗現象

Body multiplicity of the Breast Cancer Survivor: Exploring the Psychological Experiences of the Illness Adaptation Process

研究目的：本文嘗試以術後乳癌存活者的疾病調適為問題領域，以「回到存活者敘說」的立場，描繪詮釋其術後面對身體意象轉變的心理生活經驗歷程。研究方法：共訪談六位受訪者，其中四位受訪者，曾選擇接受乳房重建手術；兩位未施行乳房重建者，採用義乳的方式作為修補。經由訪談資料的反覆閱讀分析與交叉比較，以符號現象學心理學作為資料解析方法。研究結果：資料呈現四種脈絡主題結構，即「乳房重建的兩難考量」、「執守和釋放的控制度」、「乳癌是一種關係事件」和「生活世界的受苦拋物線」。本研究不只是探索個案的疾苦病痛現象，更從生活世界出發，揭露乳癌患者存活認同歷程中主觀福祉和心理福祉的成長軌跡。研究結論：當患者可以從接納自己和接受疾病，進而以彈性化認同面對新生活，而非一味以「回到從前」作為失落哀悼目標時，即使面臨乳癌復發的可能風險，仍然可以在心理上，建構具意義度的生活世界。

Purpose: We explored the lives of breast cancer survivors using a phenomenological perspective to understand their variable processes of biographical experiences for few of such studies from the insiders’ views. Methods: We conducted interviews with 6 breast cancer patients (mean age 44.83) to find out how their lives changed with the illness from their own perspective. Each person was interviewed once or twice; all interviews lasted at least one hour each. Four of them had chosen to have reconstructive surgery after the mastectomy; two had not. We used an interpretative phenomenology method consisting of rereading and analyzing the narratives case by case, and repeatedly comparing the interview transcripts. Results: Four contextual psychological reactions to the illness were identified: the dilemma of breast reconstruction surgery, the issue of control and holding on versus letting go, breast cancer as an interpersonal or relational event rather than an individual or personal encounter, and the impact on daily life. Conclusions: If patients observe and learn about their illness while under the threat of loss, and if they withstand the stigma and work through this loss to normalize their lives, they can take on a greater social purpose and improve their psychological well-being even after being ill.