[[alternative]]Professionalism and mourning--A study of social and psychological impacts on psychiatrist, whose patients completed suicide

[[abstract]] 本研究旨在探討精神科醫師遭遇病患自殺身亡時的影響與因應、對精神科醫師專業的影響與對自殺的看法、以及專業人員情感需要及支持。主要採質性研究方式進行，以深度訪談方式蒐集資料，共訪談八位受訪者，皆是曾經遭遇病患自殺身亡經驗的精神科醫師，針對訪談結果以持續性比較分析法分析資料。 研究結果發現如下： 一、 精神科醫師面對病患自殺死亡時會有Shock、愧疚感與自責、罪惡感、難過、驚訝、惋惜，甚至有睡眠困擾、自律神經失調的反應。 二、 面對逝者，「責任考量」凌駕「個人需求」。受訪者認為面對病患自殺時最為重要的是責任考量，首要任務以「逝者家屬情緒安撫」為優先考量，其次是事件的「善後處理」。 三、 影響精神科醫師面對病患自殺事件的脈絡有：病患自殺的影響，「關係」扮演舉足輕重的角色；「責任承擔」伴隨的是另一種情緒壓力。 四、 病患自殺發生時與病患所處的治療階段、對於治療介入的深淺、情感的涉入深度、接觸的頻率、對自殺的看法、精神科醫師的資歷以及對個人專業角色認同程度、個人過去接觸死亡的經驗、個人特質等皆會對受訪者造成影響。 研究者根據上述結論加以討論並提出建議，以供實務與後續相關研究的參考。[[abstract]] This study aims to investigate impacts on and the coping strategies of psychiatrists, when they have to face patients’ completed suicide events, the influences on their profession in the field of psychiatry, their attitudes towards suicide, as well as the professional emotion needs and the supports. Qualitative research methodology has been used. In-depth interviews have been conducted to eight interviewees, who are all psychiatrists and have previously experienced patients’ completed suicide. The texts of interviews are analyzed with constant comparative method. The results of this study are as follows: 1. Psychiatrists, when facing patients’ completed suicide, may experience shock, guilt, self-reproach, sadness, astonishment, lamentation, and even sleep disturbance or dysregulation of autonomous nervous system. 2. When facing the deceased, psychiatrists often consider more “responsibility issues” than their “personal needs”. Interviewees usually think that the most important issue is the consideration of responsibility when facing patients’ completed suicide. The premier task is “to placate and conciliate the emotion of the family members”; secondly comes the “damage control processing” directed to the event. 3. The factors influencing psychiatrists when they have to face patients’ completed suicide include (1) the “doctor-patient relationship” which plays a pivotal role in determining the impact of the suicide events to the psychiatrist; (2) the “bearing of the responsibility” that often accompanies another kind of emotional stress. 4. The treatment stage when patient completed suicide, the deepness of therapeutic intervention, the deepness of emotional involvement, the frequency of contact, personal attitude to suicide, the seniority of the psychiatrist, the self-identification of one’s professional role, personal past experiences in contacting the issue of death, and personal character, all of these may contribute to the constructation of impact on the interviewees. Based on the findings of this study, the researcher will discuss and propose probable advices and suggestions for related practices and follow-up studies in the future