本研究之目的：一為探究年輕思覺失調症患者，於荒野臨界中如何形塑其此際體態；二為探討患者主要照顧者面對精神分裂體驗，從何接應患者，如何賦予其心理照顧意義。而後，以對元結構方式，探討患者及其照顧者雙方的心理經驗。研究者將患者「生命經驗」及其主要照顧者「照顧經驗」並置於現象場脈絡中，透過深度訪談，進行現象還原，以接近患者的內在經驗，反思照顧者照顧行動意義。方法上，本研究採取立意抽樣，以年輕思覺失調症患者與其主要照顧者作為研究對象，以配對方式進行資料蒐集，共三對受訪者（6位）接受訪談，患者部分為三位男性，而雙親照顧者部分為一位男性、兩位女性。資料蒐集後，以Henri Ellenberger之現象學分析方法（林耀盛，2002）分析。研究結果發現，年輕思覺失調症患者與其雙親主要照顧者共構之置身結構經驗的定向軌跡為：（1）超常隱匿於日常偽裝之下；（2）超常現身，即特異性經驗被看見，包含病者與雙親照顧者；（3）芻思心緒，反覆思索當前之事件；（4）經驗賦義，理解所發生的事，並給出位置，將其涵容於自我之中；（5）存有的流變：希望與憂懼心思。研究貢獻為在臨床心理實務上可能的幫助：可協助狀態逐漸穩定之個案進行經驗之整理，使其看見自己的狀態，而非僅僅使其擁有病識感、願意配合醫療處遇。而對雙親做為主要照顧者，可協助其釐清對於疾病狀態的未知，及自我照顧技藝的發展。礙於現實收案狀況，難以擴大取樣具異質性的思覺失調症患者，資料豐富度較為不足，為未來研究可改善之處。 / Purpose: This study is exploring (1) how the young schizophrenic patient perceived who he/she is in “the wilderness”; (2) how their caregivers faced with the schizophrenic experiences and constructed the meaning of caring; and (3) disclosing the patients and their caregiver’s mutual situated experiences by the meta-dyadic structure. Methods: Taking a qualitative approach grounded in phenomenological psychology, this study conducted in-depth interviews by which researchers strived to observe, analyze and understand, from their first-person perspective, how they live under such situation. The participants were recruited through purposive sampling. Three patient-caregiver dyads (three male schizophrenic patients with one male and two female caregivers) were interviewed. The analysis step is adopted by Henri Ellenberger’s existential-phenomenological method (Yaw-Sheng Lin, 2002). Results: Five over-arching themes emerged in the analysis on the transformation of experiences of suffering and caring. (1) Camouflaging the “extra-normal” in daily life. (2) “Extra-normal” is understood through the singularity in the daily life, including the patient and caregiver can “encounter” the unique experience. (3) Ruminative reflection about what happening? (4) Make sense of schizophrenic experiences through blurry the boundary between the normal and abnormal to integrate self into life orientation. (5) Existential experience as becoming process through the state of mind of “hope” and “Angst”. Conclusions: The outcome is implicated in clinical practice: (1) Return to young schizophrenic patients’ lifeworld beyond psychopathology comprehension to articulate the intersubjective understanding relationships. (2) Help caregiver to understand their uncanny situation and cultivate the caring ethics for self and the other. Limitation, future research agenda and suggestion are discussed and proposed.

本研究以復元觀點探討思覺失調症青少年的生活適應，將適應區分初發病、生病後及現況三階段，分析其(1)身、心、社會功能的轉變，以及與環境系統之互動情形；(2)影響生活適應之因素；(3)促進復元之因素；(4)復元結果。本研究採半結構訪談之方式，訪談十位思覺失調症青少年，研究結果如下： 一、思覺失調症青少年之生活適應 疾病初發階段，就罹病青少年而言，疾病因應策略分為五種：「轉移注意力」、「問題解決」、「情緒導向」、「調適」與「無法處理」，並因疾病而從學校撤退，此外，青少年對發病原因傾向自我歸因與內省。家庭系統，在缺少疾病衛教的情形下，家屬與罹病青少年一同經歷混亂與無助，但仍展現出多重求助行為。醫院系統，醫生著重病理症狀控制，缺少疾病衛教與情緒支持，然而，住院經驗並非完全負向，亦具正向影響。 生病後，就罹病青少年而言，疾病對其身、心、社會功能的影響相當廣泛，但也帶給其覺醒與成長的契機。家庭系統，家屬對青少年的互動關係與教養方式會產生正向變化，但家屬之疾病態度與因應策略卻包含正、負向。學校系統，青少年與同儕交往的深淺，易受疾病汙名影響；老師對疾病的態度與因應方式亦可區分為正、負向。復健系統，參與復健可提供罹病青少年場域的轉換，協助其疾病穩定與調適。 青少年與疾病共生的過程，會嘗試運用資源與優勢，與環境達到良好的適配；在疾病因應上發展出更多正向力量，學會使用「問題解決」策略，也從單一因應策略，發展到多重策略。此時青少年仍對未來充滿希望，並展現出他們渴望獨立自主，不讓家人擔心的成熟。 二、影響生活適應之因素 1.個人層面：人格特質與疾病因應策略。 2.家庭及非正式網絡：家人言論、支持、態度與疾病因應策略，以及同 儕互動方式。 3.正式網絡：老師關懷、給予彈性與連結輔導資源、醫護人員互動方式 與疾病衛教、精神復健機構之處遇模式、住院過程。 4.社會汙名：經驗到來自雇主或同學的歧視，影響青少年的自我評價與 疾病接納度。 三、促進復元之因素 1.正式支持：經濟因素、處境改變、參與復健、專業人員協助、穩定就 業。 2.非正式支持：網友支持、休閒娛樂。 3.復元三大基石：症狀減緩、信念與態度、家庭支持。 四、生活適應歷程中的復元 依據復元統合模式之復元指標達成的數量，本研究有五位思覺失調症青少年目前為完全復元型、四位半復元型和一位初學型，分別展現不同的內在力量，呈現出「優遊自在」、「學習與調適」與「挫折與探索」的人生，而激發其改變與成長的轉捩點為「自我覺醒」與「參與復健」。思覺失調症青少年具復元的可能性，不僅是為了克服障礙而發展因應策略，更是超越障礙與追求自主性的展現。 最後，研究者結合上述研究結果，嘗試繪製出思覺失調症青少年之復元統合模式，並提出本研究限制與建議，提供學校、心理衛生醫護人員、服務提供者、青少年病患之家屬與未來研究者參考。 / This study aimed to use perspective of recovery to explore the life adjustment of adolescents with schizophrenia and distinguish the process of life adjustment into the initial, stable and current three stages, discussed (a) the respondents’ bio-psycho-social function changes and the interaction with the environment system；(b) the related factors of life adjustment；(c) the facilitating factors of recovery, and(d)the respondents’ result of recovery. This research adopted a semi-structured interview to interview ten adolescents with schizophrenia. The study results are as follows： 一、The life adjustment of adolescents with schizophrenia In the initial stage, for the respondents, their illness coping strategies can be divided into five types：distraction, problem-focused, emotion-focused, accommodation and unable to handle, and they drop-out of school because of illness. Besides, respondents tend to self-attribution and introspection of the cause of the illness. In the family system, because of the lack of patient education situation, the family experience chaos and helplessness with the respondents either, but also show multiple help-seeking behavior. In the hospital system, doctors focus on the control of symptoms, lack of patient education and emotional support；however, the experience of hospitalization is not completely negative and it also has positive influence. In the stable stage, for the respondents, the illness has a wide range of effects on their bio-psycho-social function, but it also provided them an opportunity to awaken and grow. In the family system, the parenting style and relationship between respondents and their family have a positive change, but the attitudes toward illness and coping strategies of the family included positive and negative types.In the school system, the depth of relationship between respondents and peers are easily influenced by illness stigma, and teachers’ attitudes toward illness and coping strategies also include positive and negative types. Participate in rehabilitation can provide the respondents the conversion of the field to help them stabilize and accommodate illness. For respondents, it is a symbiotic process with illness, respondents will try to use resources and advantages to achieve a good fit with the environment and develop more strength to cope illness. They also learned to use " problem-focused " strategy and from using single strategy changed to use multi-strategies. At this moment, respondents are still hopeful for the future and long for independence, they are mature enough to not let their families worry. 二、There are four types of factors that influenced the life adjustment： 1.Personal factors：characteristics and illness coping strategies. 2.Family and informal network：speech, support, attitude and illness coping strategies from family and peer interaction. 3.Formal network：Teachers provide care, flexibility and connect counseling resources. Interaction with mental health practitioners and patient education. Treatment modes from psychiatric rehabilitation agencies. Hospitalization process/experience. 4.Social stigma：Discrimination from employers or classmates influenced respondents’ self-evaluation and acceptance for illness. 三、There are three types of factors that facilitate recovery： 1.Formal support：financial issue, change for status, participate in rehabilitation, assistance from professionals, employment. 2.Informal support：net-pals support and entertainment. 3.Three cornerstones of recovery：symptom remission, faith /attitude and family support. 四、The recovery from life adjustment of adolescents with schizophrenia According to the recovery target of the unity model of recovery which adolescents with schizophrenia achieved, they were divided into three recovery stages：five are full-recovery, four are semi-recovery, one is novitiate recovery, and they also show different mental strengths respectively which presented " comfort and leisure", "learning and accommodation" and "frustration and exploration" of life. Besides, the turning points which inspired respondents to change and grow are "self-awareness" and "participation in rehabilitation". Adolescents with schizophrenia have the potential for recovery, they not only developed coping strategies to overcome obstacles, but also presented how they transcended obstacles and pursued autonomy. Finally, according to the results, the investigator came up a recovery unity model suited for the adolescents with schizophrenia, and discussed the limitations of this study and the advices for school system, mental health practitioners, service providers, the family and future researchers.