「瘋狂」(⑵□□□□□□)是契訶夫(⑴.□.□□□□□)作品中時常出現的主題之ㄧ。但在過去的研究中，都僅就單篇或數篇作品討論，無法窺見此主題的全貌。因此本論文特地蒐集「六號病室」(□□□□□□ □ 6)、「套中人」(□□□□□□□ □ □□□□□□□)等十七篇相關作品，將其中的「瘋狂」主題做有系統的整理與分析，由此歸納出作者的道德觀、價值觀與世界觀。 為了透徹瞭解契訶夫的作品，首先先從他對「正常」與「不正常」的定義出發，再結合契訶夫的價值系統與哲學觀，得出契訶夫對「瘋狂」獨特的解讀。另外，在契訶夫的「瘋狂」主題中，所討論的不僅是瘋狂的人，還包括了瘋狂的世界，以及兩者間的交互影響。最後得出一幅廣大的、悲哀的瘋狂圖像。

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.

目前國內針對精神障礙者就業相關文獻，主要著重於就業影響因素。因此，本研究以復元統合模式為架構，探究精神障礙者在職業抉擇歷程裡有哪些影響因子以及其與復元之關係。本研究為理解精神障礙者如何解讀自己曾經歷的職業抉擇歷程，採半結構訪談之方式訪談七位具有多年就業經驗的精神障礙者，研究結果如下： 1.精神障礙者職業抉擇影響因素包含： (1)個人因素：清楚身體現況、過去就業經驗、職業倦怠。 (2)家庭因素：家人促進職涯發展情況與家人阻礙職涯發展情況。 (3)非正式支持因素：朋友與宗教組織提供就業資訊與建議。 (4)工作環境因素：交通、工作穩定性、職場友善度、工作機會。 (5)正式支持因素：就業服務單位協助轉介、就業服務員之協助。 (6)社會大眾汙名化：雇主對於精神障礙者的不友善、民眾對於精神障礙者的偏見與歧視、疾病自我汙名化。 2.職業抉擇歷程與復元：從受訪者的生命故事裡得知精神障礙者的求職之路蜿蜒迂迴，呼應復元是一個來來回回的過程。而本研究發現雖然工作動機並不一定影響精神障礙者的職業選擇，但在復元過程裡是重要激發強健心理能量的來源。本研究亦看到生涯成熟度對於精神障礙者職業選擇的影響。 3.精神障礙者就業與復元：精神障礙者在參與工作的過程裡，會發展個人策略及尋求相關資源協助，從而增強工作效能。而穩定就業讓精神障礙者得以提高生涯自主性、開始關注生活品質，及具有回饋社會的能力，這都是一種復元的展現。 最後，研究者結合上述研究結果與復元統合模式，嘗試繪製出精神障礙者職業抉擇與復元統合模式之關係，並提出本研究限制與建議，提供精神障礙者、精神障礙者之家屬、服務提供者和政策制定者。 / This research has based on the unity model of recovery to explore the factors affecting career choice of people with mental disorder, as well as to illustrate the relations between these factors and one’s recovery. Departing from domestic correlational literature that mostly underlines the factors impacting employment of people with mental illness, this study aims to shed new light on this research area by employing the framework above. Thereupon, semi-structured interviews are conducted with 7 interlocutors of multi-year working experiences to establish elaborated understandings of their self-narratives on the career choice process. The findings are: 1.Factors influencing the career choice of people with mental illness are as follows: (1)Personal factor: including clear understanding of personal health condition, past employment experiences, and occupational burnout. (2)Family factor: varied conditions where family members may be encouraging or discouraging in one’s career development. (3)Informal supporting factor: such as employment information and advices from friends or religious organizations. (4)Work environment factor: including transportation convenience, job stability, workplace friendliness, and job opportunities. (5)Formal supporting factor: referral from employment service providers, assistance from employment service officers. (6)Public stigma: such as antagonistic attitudes received from employers, prejudice and discrimination from the public, and even more, self-stigma one experiencing. 2.Career choice process and recovery: From the life stories disclosed by the interlocutors, their twist-and-turn paths toward employment could clearly be seen, echoing that of the recovery “is not a perfectly linear process”. Although work motivation might not be the determining cause of their career choice, it is crucial for inciting mental strength during recovery process. Furthermore, this research has also demonstrated the influence of career maturity towards career choice of people with mental disorder. 3.Employment and recovery: During their participation in employment, people with mental illness would develop personal strategies and seek for assistance from related resources in order to thrive at work environment. Moreover, stable employment aids one’s recovery in many ways, such as promoting one’s career autonomy, instilling life qualities, and also strengthening one’s potential to give back to the society. In accordance with the findings mentioned above, this study has made an attempt to depict the relations between career choices of people with mental illness and the unity model of recovery. Lastly, research limitations along with suggestions for further research are subsequently raised, in the hope of serving as a reference for them with mental illness, their families, mental health services providers, and policy makers.

精神障礙者的服務深受現代精神醫學的影響，「診斷」會先於「人」作為看待精神障礙者的框架。隨著對精神疾病的詮釋更加多元，開始出現一些以重視精神障礙者主體性、社會結構取向、優勢正向思考為特點的另類工作方法。本研究所探討的繪畫團體和展覽行動也是基於以上理念的工作方法。 本研究透過與五位精神障礙者的深度訪談，以及對他們繪畫作品的視覺評估，來瞭解他們參與繪畫團體和展覽行動中的轉化歷程。本研究以精神障礙者的生命故事和作品作為開啟，去走進每一個人的生命經驗，去瞭解每一個人的個性、想法，藉此放下視他們為精神障礙者的視框，逐漸展現每一個獨特的個體。基於對每一個個體的深入理解，從而瞭解到他們如何在繪畫團體中感受當下的平靜專注、運用創作練習自我表達、透過自我覺察促成改變的契機、彼此被看見、被傾聽，並獲得人對人之影響力的過程。繪畫也成為了一種非結構化的工作方式，去幫助工作者更貼近每個精神障礙者的內心世界。隨著繪畫團體的「自我探索」面向不斷加深，個人生命背後共有的社會處境被看見，該團體開始有意識地以展覽行動來朝向「社會參與」的面向發展。該團體運用展覽為精神障礙者建立一個真實社會互動的空間、獲得新的身份以及人際磨合和情緒控制的學習，並透過情感共鳴的方式達到去污名的效果。 / The service for people with psychosocial disability is deeply influenced by the modern psychiatry, which tends to see the person as a diagnosis rather than a man / women. As the interpretation of mental illness is becoming more diverse, there comes some alternative treatment methods, which emphasize the individuality of people with psychosocial disability, using social structure orientation and strength-based thinking. The art group and art exhibition studied in this paper are also based on above philosophy. Through in-depth interviews with five people with psychosocial disability and visual assessment on their artworks, this study aims to understand their changing experience in the art group and art exhibition. This study starts with the life stories and artworks of the five interviewees, stressing them as unique individuals with own personality then thoughts rather than those imposed stereotypes of people with psychosocial disability. Based on the depth understanding of every interviewees, the study described their experience in the art group allowing them to feel peaceful and focused, and through art making they were able to express and develop awareness of self, hence promoting changes in self and relationships. The art group described in this study used nonstructural working method, which allowed the group leader and social workers to become closer to the inner world of people with psychosocial disability. With time, shared self-experiences emerged among the art group members, and the group started to evolve towards more social participation in ways of art exhibition. The art exhibition provided them a platform for real interaction with the society, for formulation of new identity, for opportunities to learn interpersonal skills and emotion control, and for diminishing stigmatization through emotional empathy. Keywords: people with psychosocial disability, personal stories, art group, art exhibition

京都大学 / 0048 / 新制・論文博士 / 博士(教育学) / 乙第13257号 / 論教博第162号 / 新制||教||184(附属図書館) / 京都大学大学院教育学研究科臨床教育学専攻 / (主査)准教授 田中 康裕, 教授 河合 俊雄, 教授 岡野 憲一郎 / 学位規則第4条第2項該当 / Doctor of Philosophy (Education) / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(人間・環境学) / 甲第22165号 / 人博第915号 / 新制||人||219(附属図書館) / 2019||人博||915(吉田南総合図書館) / 京都大学大学院人間・環境学研究科共生人間学専攻 / (主査)教授 岡田 温司, 准教授 武田 宙也, 教授 田邊 玲子, 教授 香川 檀 / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(文学) / 甲第22186号 / 文博第833号 / 新制||文||690(附属図書館) / 京都大学大学院文学研究科文献文化学専攻 / (主査)教授 松村 朋彦, 准教授 川島 隆, 教授 中村 唯史 / 学位規則第4条第1項該当 / Doctor of Letters / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(教育学) / 甲第20844号 / 教博第217号 / 新制||教||174(附属図書館) / 京都大学大学院教育学研究科臨床教育学専攻 / (主査)教授 皆藤 章, 教授 岡野 憲一郎, 准教授 髙橋 靖恵 / 学位規則第4条第1項該当 / Doctor of Philosophy (Education) / Kyoto University / DGAM

京都大学 / 新制・課程博士 / 博士(農学) / 甲第23250号 / 農博第2457号 / 新制||農||1084(附属図書館) / 学位論文||R3||N5340(農学部図書室) / 京都大学大学院農学研究科応用生命科学専攻 / (主査)教授 木岡 紀幸, 教授 植田 充美, 教授 矢﨑 一史 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

University of Macau / Faculty of Education