The Lived Experience in Enlisted Soldiers with Suicide Attempts Post the Service Suspension in Taiwan

自殺雖是個人結束生命的行為，卻和社會文化有密切的關係，現今社會的多元化，導致自殺現象變的更為複雜。當兵是我國18歲男子之義務，軍中世界有其特殊文化，役男無法適應部隊生活出現自殺行為，經診斷罹患精神疾患，辦理停役終止軍旅生涯。停役後雖少去軍中壓力，但停役者回歸社會面臨環境的改變，需要更多的努力方能適應新的世界，因此本研究目的在瞭解軍中自殺企圖者停役後的生活經驗。 本研究於北部一所國軍精神專科醫院，針對五位於軍中發生自殺行為，辦理停役的病患，以民族誌研究方法，於民國94年2月到96年2月間，運用半結構式深度訪談及參與式觀察等方式，收集停役者生活之主觀經驗，期間五位停役者共訪談十二次，每次訪談一小時三十分到兩小時之間。研究結果以故事性方式描繪停役者生活，並經由分析與歸納，探討停役對其影響與意義。 研究發現軍中自殺企圖者，停役後深受憂鬱症、自殺與未當完兵等多重烙印之苦。停役者自許為「正常」的精神病患，但是由於擔心他人對精神病的偏見，故以身體疾患掩飾憂鬱症；然而家屬與他人指責停役者是「沒有用的」、「丟臉」、「裝病」、「無法完成男人的使命」，並採取嘲弄與排斥的態度。這些處境讓停役者覺得自己「與眾不同」、「不是個男人」、「不被寄予希望」，工作機會受到限制，於是對外界武裝自己，造成與家人關係變的僵化，與外界關係處於矛盾的狀態。但是因著醫療人員、朋友接納的態度與正向互動的經驗，讓停役者在面對困境之虞，仍然有了改變的契機，因著他人的接納，停役者進而接納自我，並開始在信念與態度上有了轉變。「停役」對於停役者來說成為生命的轉捩點，社會支持力量的介入，促使停役者轉化苦痛的經驗，獲取正向與健全的轉變，習得疾病照護知識、轉而正向看待事物、對於自我角色能更加的掌控，並能與他人建立穩固有意義的關係。 研究結果有助於停役者的家屬與社會大眾，了解軍中自殺企圖者停役後生活之現象，面對停役者採取接納的態度，並提供停役者適切的照護，以期在轉變過程中，停役者能於社會中獲取更多促進與支持的力量。Although suicide is an action for an individual to end his life, it is closely connected to social culture, and the multi-faceted culture of today causes the phenomenon of suicide to be even more complicated. Military service is mandatory for Taiwanese males at 18 years of age. The military has its own unique culture, and suicides often take place when conscripts cannot adapt to it. When these conscripts are diagnosed with psychiatric diseases, they are separated from the service. However, when they return to society and are free from the pressures of the military, they again have to adapt to a new environment, an adaptation which frequently requires considerable effort. The objective of this study was to understand the life experiences of conscripts who attempted suicide following separation from the military. Five subjects who attempted suicide and were then separated from their uniformed services were selected from a national army psychiatric hospital located in northern Taiwan. An ethnographic method of study was applied. The subjective life experiences of these separated conscripts were collected using semi-structured deep interviews and participatory observations between February 2005 and February 2007. There were a total of 12 interviews and each interview lasted from 90 to 120 minutes. The life experiences of these separated conscripts were narrated as a story and the results were analyzed and compiled in order to study the effect and meaning of separation from conscription on their lives. The study found that life following separation from military service was full of difficulties for conscripts who attempted suicide. In the early stages, the conscripts experienced mockery, rejection, and questioned the existence of their underlying psychiatric diseases. This caused the conscripts to feel isolated, to erect a facade, to feel hopeless about the future, and to be unable to build steady relationships with others. However, after a certain period of experiencing acceptance from mentors, friends, the army, and healthcare workers, the separated conscript began to experience positive interactions and learned to accept themselves. Changes began to occur, the conscript developed new social interactions, and changes in their beliefs and actions were evident. Life after separation from the service was fraught by the social stigma surrounding the separation, depression, and suicide. In addition, one's relationship with their family became strained and distant. Nevertheless, service separation also served as a turning point in their lives. Support from society helped to transform their bitter experiences into a positive and healthy transition, and in the process, obtain knowledge on the medical care they needed, become more optimistic with a positive outlook on life, have better control of their role in life, and to build steady and meaningful relationships. This study will help families of separated conscripts and society to understand the phenomenon of life following separation from the service of those who attempted suicide, and to show acceptance and provide them with proper care. Hopefully, more positive support will be available for the separated conscript in transition.口試委員會審查書i 中文摘要iii 英文摘要iv 第一章 緒論1 第一節研究動機與背景1 第二節研究重要性2 第三節研究目的3 第二章 文獻查證4 第一節疾病解釋模式4 第二節自殺6 第三節軍中自殺15 第三章 研究方法19 第一節研究設計19 第二節研究場所19 第三節研究對象21 第四節資料收集過程22 第五節資料分析方法27 第六節研究資料的嚴謹度28 第四章 典範案例31 第一節阿勝轉變的故事31 第二節小龍蛻變的故事34 第三節憂鬱王子小偉的故事38 第五章 研究結果44 第一節停役者與家的關係44 第二節停役者與他人的關係52 第三節停役者與自己的關係62 第六章 討論75 第一節多重烙印75 第二節尋找關係79 第三節生命的轉變81 第七章 結論與建議84 第一節結論84 第二節限制85 第三節建議與應用85 參考資料87 中文文獻87 英文文獻89 附錄 附錄一人體試驗委員會證明文件97 附錄二初步篩檢表99 附錄三研究邀請函100 附錄四研究說明與參與同意書101 附錄五訪談指引104 表目錄 表一 停役者資料表22 表二 訪談過程25 表三 停役者生命轉變摘要表44 圖目錄 圖一 分析歸納的過程2