目的：聾人以手語、口語、口手語三種方式作為溝通管道並以視覺體察世界，本研究回顧特教、心理、輔具三方面近幾年研究上對聾人的描述，試圖從中整理出各專業領域對聾人的觀點，以及尚未回應到的面向。三個領域由不同方向描述聾人樣貌，卻也帶出一般社會對健康的預設，且過去所使用的研究方法大部分透過問卷調查或與聽人比較之下得來的結果。聾人自我內涵受限於語言的隔閡，自我的默存現象在問卷架構的框架中並未獲得開展，故本研究嘗試以現象學心理學質性訪談的方式，嘗試揭露其寓居於世的自我樣貌。本研究目的有二：一是藉由研究者與聾人進行手語質性晤談，探索聾人自我認同形成過程期間會經歷過什麼樣的生命經驗，而聾人又是如何看待這些經驗並從中反思此我在世的意義；二是聾人對現今自我的現象描述，探索其目前寓居於世的樣貌，並跳脫既有特教與輔具看待聾人的觀點，重新論述沉默對聾人存有的意涵。 方法：本研究於為聾人服務的協會，徵求慣用自然手語的聾人共六位。資料蒐集後，以李維倫與賴憶嫺（2009）的現象學分析方法進行分析，呈現六位聾人的置身結構。 結果與討論：一、聾人經由配戴輔具以及與聽人相處的域外經驗，意識到內在憂懼情緒與不安全感，但也讓聾人開始思考此我的本真，並在屬己與陷溺間做出決斷。而聾人經由各種以退為進的「離席」形式，漸漸退居聽人社會的邊緣，讓此有在沉默中仍能保留位格，這是「去中心」的策略，離開喧囂而在沉默中開展本真自我。二、眼睛的凝視象徵聾人對世界的「參與」以及「我在」，手語為穿越象徵符號的「真實界」，是聾人寓居於世立命的根基，而手語具有一種情感性理解的視覺圖像的對比，而不僅是語言聽覺層次的撫慰或宣稱，能與他人建立起緊密深刻的連結。三、聾人自我「聽不見」的匱乏造就了寂靜之聲的決斷，逐步抵達聾人自我的存有本體性，聾人有其置身所在的自我，其與聽人自我為質性上的不同，而非聽損程度量上的差異。 結語：本研究避開過往將聾人視為缺損者的語境所塑造的小寫文化（deaf culture）的論述，語意學轉向大寫文化（Deaf Culture）重構理解聾人的置身所在，指出將聽力喪失（hearing loss）轉化為能力獲得（ability gaining），進而提出臨床實務的反思。 / Purpose: Deaf people have different ways to contact with people, that is, sign language, learn speaking, or use both ways to communicate. In order to criticize the current views about the deaf from the ableism in past decades, critical reviews of the related domains are articulated, including “deaf children’s special education,” “psychological health” and “hearing aid/ cochlear implant.” The accomplished goal among the three domains is all to try to improve the deficiency from the adaptive view and expect deaf people to adjust their life in the hearing-like way. A few of studies under the ableism used the questionnaires to collect data to understand the deaf. However, it is the outsider view and the state of mind of the deaf is restricted by the questionnaire design. Methods: The phenomenological psychology approach is adopted to explore the experiences of the “Deaf-Self” to avoid the ableism trap; it is the Epoch attitude to understand who they are and their modes of existences. Six deaf participants were interviewed through sign language. The data analysis procedures of carrying out phenomenological psychology were based on six steps: data collection, empathic immersion, meaning units, constituent themes, situated structure, and general structure. Results and discussion: First, deaf people feel alien to life word in the ontological insecurity meaning when they use the hearing-aid devices. To preserve their authentic life world, deaf people community is built in silence beyond the hearing world that is designed under the normative adaptive views. The Deaf did not think they are disabling so it is not necessary to adjust to live into the “normal” world. Second, the way they express the sign language through focusing their eyes is meant “presence” and “engaging,” they always gaze at everything carefully and attentively. Sign language is the root of the deaf-identity. When deaf people use sign language, it means they can give their voices to the world from the authentic self. Sign language is not only a skill which makes deaf people to communicate with each other smoothly, but also is the affection and vitality in itself; it is beyond the symbolic meaning to reach the close relationships to each other. Third, ‘hearing-loss’ is not equivalent to ‘disability’, it means different modes of existences. Conclusion: We turn the deficiency conceptualization to the “ability gaining” perspective to construct the ‘Deaf Culture’ to propose the Deaf and hearing people are different from their cultures and habitus; it is not the severity of hearing impairments to distinguish them. They present the ability diversity and unique way of being-in-the-world. The clinical practice is discussed from the outcome implications.

目的：本研究探討乳癌患者從受苦到經驗正向改變的轉化，以王韋婷（2014）研究為基礎進行探討。該研究於術後一日、三個月、六個月與一年，追蹤測量乳癌患者的創傷後成長（PTG），並依量表分數變化將參與者分為四種軌跡發展組別，分別為高穩定組、中間組、上升組與下降組。本研究以訪談方式進行後續追蹤。 方法：研究採取雙盲設計，抽取王韋婷（2014）研究參與者樣本，共有五位參與者，平均罹癌年齡35.6歲，接受單次訪談。資料分析以現象學心理學方法進行，並對應其受創傷成長發展軌跡組別（分別為高穩定組三位、中間組兩位），進行討論。 結果與討論：研究結果發現，參與者的主題置身結構包括：「癌症療程是溢出常態的受苦經驗」、「受苦經驗中的照顧倫理行動」、「反求諸己的受苦意涵」、「在世牽掛的流變」，並由此帶出「生活是日常與非日常的背景-前景辯證歷程」。本研究顯示PTG高穩定組的參與者，從焦慮過渡到操煩，朝向生活世界的歷程，是打開此在與生活世界、社會的交往。PTG中間組的兩位參與者，試圖領會身體限制的存在意義，仍在尋求身體的安居。只有身體的返家意識，在安居中獲得熟悉感，才能夠出發朝向世界，因此在未來的時間流變中，仍有持續邁向成長的可能性。 結論：PTG高維持組受訪者以釋放控制，帶出了「朝死而生」的本真活動，是「在己生命」開展了生活世界。PTG中間組以固守控制，將現今未能解除的困境寄望未來，是他人束縛下求全的「為己生命」。最後，提出研究限制與未來研究建議。 / Objectives: The study aims to explore how the young breast cancer survivors perceived psychological growth since operation treatment, focusing on their transformative experiences of interpersonal situatedness and sense of future temporality. Methods: Based on the dissertation by Wang (2014), the participants are recruited from Wang’s research the subjects were divided into four groups (stable high, middle stable, low increasing, and sharp decreasing) by the patterns of their posttraumatic growth(PTG) scores assessed at 1day, 3, 6, 12 months after surgery. There are five participants whose mean age 35.6 at diagnosis were interviewed and data transcribed, and analyzed by phenomenological psychology approach. Results: Four themes emerged from the data analysis, including: (1) Enduring suffering out of daily order under cancer treatment. (2) Ethical act to care for suffering experiencing. (3) Meaning transformation of the suffering. (4) Different solicitude modes of being-in-the-world. Participants belonging to stable high group turn their state of mind from anxiety (Angst) into care (Sorge), facing the life situation and engage in life world. Participants belonging to middle stable group try to realize existential meaning and the sense of uncanny body, seeking for the dwelling of the habitual body. The ill life is an unhomelike being-in-the-world in which the lived body, the central vehicle of this being-in of Da-sein, takes on alien and uncanny qualities. Health, in contrast to this frustrating unhomelikeness, is a homelike being-in-the-world in which the lived body in most cases has a transparent quality as the point of access to the world in understanding activities. Conclusion: Participants belonging to stable high group carry on limited lifetime and take authentic mode of being toward death, illustrating ‘being-in-itself’, and the experience of illness underlines our homeless predicament, but it can also serve as a springboard to addressing and living with existential uncertainty in a more authentic way. Participants belonging to middle stable group hold on limited lifetime and take future temporality as a hope to leave the predicament, illustrating ‘being-for-itself’, and it projects the possibilities of the future, on the basis of the care pattern of meaning constituting its past, as a means of constructing its present. In Heidegger’s words, ‘‘The totality of being of Dasein as care means: ahead-of-itself-already-being-in (a world) as being-together-with beings encountered in the world”. The outcome implication and further research agenda are discussed.

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.

本論文試圖以胡塞爾現象學解決哲學史以來留下的哲學難題之可能－「心物或心身二元論」（dualism），克服胡塞爾在《危機》一書中分析的二元論之根源「心靈自然化」問題。哲學層次上心物二分（斷裂）延伸出不可認識之「不可知論」；身心二分說明了理論解釋上的問題，重點是如何看待心靈與身體及其關係都是根本要待釐清。當代心靈哲學為解決心身問題出發而傾向將心靈物化，實體唯物主義為基本共識，精神自然化的思考導致精神醫學採以「器質論」立場。並且科學心理學作為物理學邏輯延續也都導向「還原」方法研究可觀察實驗的行為上。 胡塞爾的將心物關係轉換為「純粹意識中意向活動與意向對象的意向關係」，具體經驗事實世界的本來面貌為意向活動所形構的意向對象，反過來說意義賦予活動成就了事實自身。而身心問題溯回至心靈與身體原初意義而自然消解兩者二分的問題。關於二元論的解決同時是心靈自然化的克服，現象學試圖理解一門非自然化的心靈的可能，徹底批判科學化心理學處理，建構一門徹底擺心理物理科學影響之下的獨立心理學即「純粹現象學心理學」。 關鍵字：胡塞爾、心物二元論、身心二元論、心靈自然化、純粹意識、身體、心靈、現象學心理學、超驗現象學 / The thesis tries to solve the philosophical problem－mind-body dualism－in philosophical history by Edmund Husserl’s phenomenology, and the problem of naturalize mind or soul which causes dualism in “The Crisis of European Sciences and Transcendental phenomenology”. Philosophically, mind-body（matter） dualism leads to agnosticism in epistemology. Mind-body dualism problem comes from the problem of interpretation in theory, and it is important to essentially understand mind, body and their relation. The philosophy of mind in modern times makes mind materialize in order to solve the mind-body dualism, and substance materialism is accepted by most of philosophers. This effects psychiatry thinks psychosis as an organic disease. Besides, scientific psychology is in logical continuity with, and relies partly upon, the physical sciences, and makes use of reductive method to research observable and experimental behavior. Edmund Husserl turns mind-body relation into conscious relation of noesis-noema in pure consciousness. Fact world as noema is constituted by noesis, or bestowing sense achieves things themselves. Solving mind-body problem is going back to primary meaning of mind and body, and then the problem is solved naturally. Solving mind-body dualism is the same as naturalized mind. Phenomenology attempts to know anti-naturalized mind, to criticize thoroughly scientific psychology, and to establish a purely phenomenological psychology which is free of everything psychophysical. Key words：Edmund Husserl、dualism、naturalize mind ∕soul、pure consciousness、body、mind、phenomenological psychology、transcendental phenomenology

社區安寧療護的推展以「居家存有」為中心，以身心整體照顧為導向的醫療，與全然「醫療權力」視角不同。本研究嘗試探討家屬照顧者於居家安寧照顧處境下的經驗，嘗試以「倫理關係」思考居家型的照顧內涵。 本研究透過田野參與觀察及深度訪談法，以北部某醫療院所提供之社區安寧療護服務區域為田野，訪談接受社區安寧照護之五位家屬主要照顧者。資料分析依現象學心理學分析方法（李維倫、賴憶嫺，2009）。而後，邀請兩名受訪者，對資料的組織脈絡描述及其所驅動的主題置身結構，予以交叉討論與分享，提昇質性研究可靠度的品質。 研究結果發現，鄉村型態安寧照顧者的置身經驗中，呈現出一種「鄉村型態的寓居」混合狀態，既安居又陌生的處境。一方面，參與者經驗到的棲居地域，並不侷限於家屋建築或特定地域，更是對地方的認同與情感的依附，從而開展自我「寓居於世」的「照顧者棲居」樣態；另一方面，照顧事件的衝擊，為照顧者帶來一種既熟悉又陌生的詭譎「無居家感」（uncanny）狀態。然而，如此看似矛盾處境，反使其於居家照顧處境之倫理凝視中，啟動反身窺探自我生命，以及於居家照顧處境中與他者間關係的梳理，進一步帶出「居家照顧作為一倫理行動」，進而深刻化「照顧自己/關切他人」的倫理意涵。 由此發現，鄉村型態居家照顧經驗之置身結構，可為與其相似處境之居家照顧者提供置身經驗之參考，並據以推動社區安寧方案的規劃。 / The goal of the home-based palliative care model is to facilitate the patients and their family to feel “being at home.” Differ from the perspective of the “power domination in medical regime,” the home-based palliative care model focuses on the ethical relationship besides the bio-psycho-social care aspects. This study aims to understand the caring situatedness of family members as caregivers in home-based palliative care model, and try to disclose the sense of homelikeness through the caring relationship. We applied the participatory observation and depth interview to collect data. Five family caregivers who agreed the informed consent were recruited from home-based palliative care service in northern Taiwan and were interviewed twice. Interviews were recorded, transcribed, and analyzed by a phenomenological psychology method. The results revealed that there is ambivalent caring experience towards “dwelling in the community-home”. The experiences they felt seemed both strange and familiar. On the one hand, the caregivers’ dwelling pattern of being-in-the-world was constructed from the perspective of human-environment comfortable relationship (sense of feeling at home); on the other hand, they are bothered and struck by the caring problem, they faced the new challenges and thrown into the situation of “uncanny.” It is an unhomelike being-in-the-world in which Da-sein takes on alien and uncanny qualities. However, the two caring modes manifested the meaning of existentiality. Immersed in this situation, caring is not only the labor work, it is also the ethical act to respond the worrisome emotion and regain the relationships with others during the caring experiences. Ethical caring is the cornerstone of relational understanding towards the human subjectivity rather than the medical positivism. By elaborating the situatedness of home-based palliative care model, further planning of the community-based palliative care model in similar situation may base on this study outcome implication.