Would Long-ill Parent Hardly Yield Filial Children? Interpersonal Suffering and Its Transformation of Child Caregivers

背景與目的：「久病無孝子」揭示長期照顧的壓力作為一種孝道的困境。過去有許多研究發現長期照顧的壓力經常對照顧者的身心適應有負向的影響，但多以症狀作為研究的結果變項，並大部分僅討論照顧者與被照顧者兩者間的關係、或者照顧者與其他家人間的關係，缺乏對照顧者所處整體人際脈絡的考量，亦未考量症狀以外的苦痛展現方式。另外，過去研究大多採量化方式，僅討論「照顧」與「影響結果」間的關聯，缺乏對於照顧者每天所面對人際互動的具體樣貌──在照顧者與被照顧者雙方都面臨許多壓力、卻又時刻共處的情況下，可能增加了許多人際衝突與苦痛的發生機會。而面對衝突與照顧的壓力、同時顧及孝道的要求，就成了子女輩照顧者的挑戰。然而，過去關於孝道研究所提出對親子間的相互性之強調，並未能回應若關係中缺乏相互性、違反人際規則時的負向處境。因此，本研究的目的即希望由可能違反相互性之人際衝突著手，具體瞭解子女輩照顧者在照顧生病長輩過程中之人際苦痛經驗，並瞭解個體在這些經驗中嘗試了什麼樣的方式轉化自身的苦痛。方法：以半結構式訪談法，訪談18位子女輩照顧者在照顧生病長輩過程中之人際衝突經驗內涵。結果：以主題分析法進行資料分析後，歸納呈現：1）子女輩照顧者之人際苦痛經驗內涵，包含不同衝突╱苦痛來源與其比較、怨的敘說特性、以及常見因應方式；2）子女輩照顧者在這些經驗中，如何透過不同的認知歷程、以及與生活世界的療遇因子之碰撞，而轉化了苦痛；3）甚至可能進一步超越了自己此時所受的苦，將關懷延續到下一代、社會、自我生命的成長、或未來處境的規劃。討論與結論：照顧經驗鑲嵌於人際脈絡之下，常與人與人之間互惠性倫理的違反有關，在照顧過程中的苦痛經驗往往不能脫離與長輩之間原本的關係品質，並且照顧關係外的他人也在其中扮演相當重要的角色。另外，本研究以余德慧等人所提的「倫理的缺口」作為怨的定義，重新理解怨的敘說與轉化，嘗試整合其歷程，同時，本研究也會針對媳婦在照顧處境中的特殊性進行論述。最後，並提出上述各討論在臨床應用上的意義。Background & Objective: The saying “long-ill parent could hardly yield filial children” implies the dilemma, i.e., whether or not to fulfill filial piety, which child caregivers would face if they have cared their ill parent for a long time. Past studies have showed that caregiving would be a chronic stress, which would bring caregivers many negative physical and psychological outcomes. Yet, most of these studies took “symptoms” as dependent variables, and most of them only focused on the relationships of caregiver-recipient or caregiver-family, hence failed to explore the whole interpersonal context of caregiving. On the other hand, most of these studies adopted quantitative research paradigms, and only investigated the relationships between caregiving and outcome variables. Therefore, we could hardly imagine what their everyday interpersonal interactions might be. When both elders and caregivers have lots of stress, it is very easy for them to encounter conflicts. As a result, child caregivers would be very likely to face the challenge of filial piety. However, past studies about filial piety which emphasized the reciprocity between parents and children might not be able to account for the situations lacking reciprocity. Accordingly, this study aimed to explore the interpersonal suffering and its potential transformation of child caregivers. Method: Semi-structured interview was adopted to explore the interpersonal suffering experiences in 18 child caregivers of ill elders. Result: With thematic analysis, the data showed: 1) The interpersonal suffering experiences included the source of interpersonal conflicts, features of the narratives, and frequently-used coping strategies. 2) The transformation of child caregivers included some cognitive processes and healing factors encountered in their liveworlds. 3) Some child caregivers even transcended their suffering into the well-being of their children, welfare of the whole society, or their own growth and plan for the future. Discussion & Conclusion: First, it is hard to understand caregiving experiences without considering their interpersonal context. The interpersonal suffering often arises from the ethical experience other than interpersonal reciprocity, hence to do with the prior relationships between elders and their child caregivers before the elders became ill. Moreover, people other than the caregiver-recipient dyads also play a role in their suffering. Second, the discussion takes “the ethical experience other than interpersonal reciprocity”, defined by Yee et al. (2004) to reconstruct the narratives and transformation processes of interpersonal suffering. Meanwhile, the situations of daughters-in-law as caregivers will be specially discussed. Last, clinical implications are suggested