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| Title: | 哀傷的時間性：癌末病患照顧者與過世病人之關係流變與倫理連結
Grieving temporality: the “becoming” relationship and ethical bond between caregivers and deceased patients |
| Authors: | 李宛霖
Lee, Wan-Lin |
| Contributors: | 林耀盛
姜忠信
李宛霖
Lee, Wan-Lin |
| Keywords: | 喪親悲傷
照顧者
持續性連結
縱貫式研究
Bereavement
Caregiver
Continuing bonds
Longitudinal study |
| Date: | 2019 |
| Issue Date: | 2019-08-07 16:33:59 (UTC+8) |
| Abstract: | 陪伴至親的臨終過程會帶來巨大的痛苦，在癌末臨終處境，不僅末期病患深受折磨，照顧者亦陷落受苦深淵。在受苦時刻，喪親經驗也帶出重新認識「關係」（relationship）的可能性。過去的悲傷研究多將重點放在悲傷適應的結果，而忽略探究喪親者與逝者間的關係本質與悲傷的歷程性。本研究擬融合不同的知識論典範，以質化與量化研究並進的方式釐清研究問題。研究目的在嘗試與西方持續性連結理論進行對話，懸置悲傷適應論的框架，進而從關係取向理解悲傷現象，故在知識論上，將以量化實徵論與詮釋現象學兩種取向進行問題探究。在研究一中，研究者擬修訂西方的悲傷量表與持續性連結量表，以增加工具本身的文化適切度。研究二以研究一所發展之量表工具，對臺灣癌末病患家屬從病人過世前，至病人過世後半年至一年的期間進行縱貫式追蹤研究。研究三將同時以量表與質性訪談持續追蹤數位家屬，整合量化資料與質性訪談的研究結果，分析末期病患家屬如何在悲傷歷程當中安置逝者，藉此對持續性連結理論做出修正，並提出一套適合解釋臺灣喪親悲傷現象的理論模式。透過三個子研究的整合，研究發現臨終照顧到喪親悲傷的過程，是空間、時間、關係和倫理的軌跡：（1）量化的悲傷軌跡給出的是均值的線性悲傷時間，但喪親者的悲傷敘事帶出深度安靜的存有時間，量表分數回答的是「什麼」（what），但無法捕捉敘事時間綿延皺褶的「如何」（how）。（2）關係默化是地下莖（塊莖）式的流變，斷而未斷的關係存有連結，內化與外化不再是二分的關係類型，而是可以並置、超越、或是交錯的意義。（3）家庭倫理連結的流動是臺灣本土喪親現象的重要意涵，這也使得喪親研究需轉向「關係」，西方的心理韌性、照顧負荷論與持續性連結理論，都可嘗試以關係先於主體的認識論重新探究之。最後，本研究提出哀傷的時間性是朝向生命缺口的倫理學，並討論應用於悲傷陪伴的可能性與未來研究方向。
Caring for terminally ill people causes great suffering for caregivers. At the same time, for the bereaved caregiver, the experience from caring to grieving also brings out the possibility to review the relationship with the patient. The aim of the study was to understand the bereavement process with a vision of relationship. Using mixed-method design, the present study suspended the grief adaptation framework in mainstream psychology, exploring the grieving process and the nature of relationship with patient in Taiwanese bereaved caregivers. In study 1, the authors developed Chinese version of HGRC and R-CBS. In study 2, using the instruments developed in study 1, we investigated grief and CB reactions in caregivers of cancer patients at the time points of pre-loss and post-loss within 1 year. In study 3, we conducted a convergent mixed method design, using both quantitative instruments data and qualitative narrative texts to understand the way that the caregivers make sense of relationship with the deceased patients. By integrating results of three studies, we’ve found that the process from caring to grieving is crisscross of time, space, relation and ethics. First, the quantitative grief trajectories are the average scores derived from the population norm. The quantitative scores represented chronological time and certainly answered the question of ’what’ outcome. But grief narratives were deep folds of duration, which escape from the measure of chronological time. Second, relationship with the deceased was the process of ‘becoming’. The silent transformation of relationship went beyond the binary classification of internalized and externalized CB. Third, the re-cathexis of ethical bond had significant meaning in Taiwanese bereaved caregivers. We suggest to reinvestigate the western concept of resilience, caring burden and continuing bonds theory using the relational approach. Finally, our study proposed a theory of grieving temporality, emphasizing the infinite ethic toward the Other. Findings have both theoretical and clinical implications. |
| Reference: | Derrida, J（2016）：《馬克思的幽靈：債務國家、哀悼活動和新國際》（何一譯）。北京：中國人民大學出版社。（原著出版年：1994）
Zaner（2001）：《醫院裡的哲學家》（譚家瑜譯）。台北：心靈工坊。（原著出版年：1993）
何雪綾（2015）：〈社區醫療照護模式中末期患者家屬參與患者之 [預立醫療計劃討論] 的心理歷程特徵〉。臺灣大學心理學研究所學位論文，1-172。
余德慧（2000）：〈從心理學的面向探討後現代生命倫理的實踐〉。本土心理學研究，14，157-196。
余德慧（2001）：《詮釋現象心理學》。台北：心靈工坊。
余德慧（2006）：《臺灣巫宗教的心靈療遇》。台北：心靈工坊。
余德慧、石世明、夏淑怡、王英偉（2006）：〈病床陪伴的心理機制：一個二元複合模式的提出〉。應用心理研究，29，71-100。
余德慧、李維倫、林耀盛、余安邦、陳淑惠、許敏桃、石世明（2004）：〈倫理療癒作為建構臨床心理學本土化的起點〉。本土心理學研究，22，253-325。
李維倫（2017）：〈華人本土心理學的文化主體策略〉。本土心理學研究，47，3-79。
李維倫、賴憶嫺（2009）：〈現象學方法論：存在行動的投入〉。中華輔導與諮商學報，25，275-321。
林耀盛（2001）：〈時間與意義：疾病, 創傷及敘說之交疊構面〉。本土心理學研究，15，221-270。
林耀盛（2003）：〈書寫創傷：探究“九二一震災”受創者的心理社會療癒經驗〉。本土心理學研究，19，3-64。
林耀盛（2005）：〈說是一物即不中：從倫理性轉向療癒觀點反思震災存活者的悲悼歷程〉。本土心理學研究，23，259-317。
林耀盛（2006）：〈慢性病心理社會模式之探討：以癌症為例〉。臨床心理學刊，3(2)，56-67。
林耀盛（2008）。〈社會心理學本土化：反殖民主義與後現代論述之間〉。見楊中芳（主編）：《本土心理研究取徑論叢》。台北：遠流出版社。
林耀盛（2016a）：〈行深：「臨床」、「臨終」、「治癒」和「療遇」交錯的人文徵候及其超越〉。本土心理學研究，46，195-237。
林耀盛（2016b）。〈實證論陰影及其超越：迂迴或直面〉。臺灣心理諮商季刊，8(2)，36-43。
林耀盛（2018）。〈倫理的不及處？創傷與哀傷的透工/體驗〉。論文發表於「言語、意義與行動：華人倫理實踐論壇」。台北：政治大學華人主體研究中心主辦。
林耀盛、邱子芸（2015）：〈臨終處境的陪伴轉化：癌末病患及其照顧者心理經驗與存在現象探究〉。中華心理衛生學刊，28(2)，189-219。
林耀盛、侯懿真、許敏桃（2011）：〈悲悼的歧義：癌症新近喪偶者的心理反應經驗探究〉。生死學研究，11，1-40。
林耀盛、羅愔愔（2010）。〈患者與照顧者間照顧覺知落差對雙方心理與生活適應之影響：以婦癌病患為例〉。中華輔導與諮商學報，27，161-197。
侯懿真（2006）：〈悲悼的歧義：癌症新近喪偶者的心理反應經驗探究〉。高雄醫學大學心理系研究所學位論文。
柏格森（2009）：《時間與自由意志》（吳士棟譯）。北京：商務印書館。
單士宏（2018）：《列維納斯：與神聖性的對話》（姜丹丹、趙鳴、張引宏譯）。上海：華東師範大學出版社。
德勒茲（2010）：《資本主義與精神分裂．卷2．千高原》（姜宇輝譯）。上海市：上海書店出版社。
高舒、林耀盛（2018）：〈哀悼時刻：照顧者從臨床陪伴到「後臨終」情感現象的心理轉化經驗〉。中華心理衛生學刊，31(3)，275-301。
許敏桃、余德慧、李維倫（2005）。〈哀悼傷逝的文化模式：由連結到療癒〉。本土心理學研究，24，49-84。
黑爾德（2009）：《時間現象學的基本概念》。上海：上海譯文出版社。
彭榮邦、翁士恆（2018）：〈直面受苦：人文臨床心理學的心理病理學芻議〉。中華心理衛生學刊，31(3)，227-251。
楊婉儀（2012）：〈責任與意志──萊維納斯與尼采思想中的倫理與時間意涵比較研究〉。論文發表於責任與意志哲學與生命教育系第十三屆比較哲學學術研討會──經典與生命的對話。臺灣：南華大學。
楊婉儀（2017）：《死．生存．倫理：從列維納斯觀點談超越與人性的超越》。台北：聯經出版社。
雷庚玲、陳立容（2010）：〈學齡前兒童之母親遊戲行為初探：依戀比較與文化比較〉。中華心理學刊，52(4)，397-424。
Albuquerque, S., Narciso, I., & Pereira, M. (2018). Posttraumatic growth in bereaved parents: A multidimensional model of associated factors. Psychological Trauma, 10(2), 199-207.
Aron, A., Aron, E. N., & Smollan, D. (1992). Inclusion of Other in the Self Scale and the structure of interpersonal closeness. Journal of personality and social psychology, 63(4), 596-612.
Bauman, Z. (2013). Liquid modernity. Malden, USA: John Wiley & Sons.
Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: the hopelessness scale. Journal of consulting and clinical psychology, 42(6), 861.
Binswanger, L. (1993). Dream and existence. Review of Existential Psychology & Psychiatry, 19(1), 81-105.
Boelen, P. A., Stroebe, M. S., Schut, H. A. W., & Zijerveld, A. M. (2006). Continuing Bonds and Grief: A Prospective Analysis. Death Studies, 30(8), 767-776.
Bonanno, G. A., Boerner, K., & Wortman, C. B. (2008). Trajectories of grieving. In Handbook of bereavement research and practice: Advances in theory and intervention (pp. 287-307). Washington, DC, US: American Psychological Association.
Bonanno, G. A., & Malgaroli, M. (2019). Trajectories of grief: Comparing symptoms from the DSM‐5 and ICD‐11 diagnoses. Depression and anxiety, 1-9.
Bonanno, G. A., Neria, Y., Mancini, A., Coifman, K. G., Litz, B., & Insel, B. (2007). Is there more to complicated grief than depression and posttraumatic stress disorder? A test of incremental validity. Journal of abnormal psychology, 116(2), 342.
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York: Basic Boooks.
Canguilhem, G. (1989). The normal and the pathological (C. R. Fawcett, Trans.). Cambridge, MA, USA: The MIT Press.
Chan, C. L., Chow, A. Y., Ho, S. M., Tsui, Y. K., Tin, A. F., Koo, B. W., & Koo, E. W. (2005). The experience of Chinese bereaved persons: A preliminary study of meaning making and continuing bonds. Death Studies, 29(10), 923-947.
Chen, S. C., Lai, Y. H., Liao, C. T., & Lin, C. C. (2005). Psychometric testing of the Impact of Event Scale-Chinese Version (IES-C) in oral cancer patients in Taiwan. Supportive care in cancer, 13(7), 485-492.
Cohen, M. Z., Kahn, D. L., & Steeves, R. H. (2000). Hermeneutic phenomenological research: A practical guide for nurse researchers. London, UK: SAGE Publications.
Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. London, UK: SAGE Publications.
Creswell, J. W., & Cresswell, J. D. (2018). Research desigh: qualitative, quantitative and mixed methods approach. London, UK: SAGE Publication.
Currier, J. M., Irish, J. E., Neimeyer, R. A., & Foster, J. D. (2015). Attachment, continuing bonds, and complicated grief following violent loss: testing a moderated model. Death Studies, 39(4), 201-210.
Deleuze, G., & Parnet, C. (2007). dialogues II. USA: Columbia University Press.
Derrida, J. (1999). Adieu to Emmanuel Levinas (P.-A. Brault & M. Naas, Trans.). Stanford, California: Stanford University Press.
Derrida, J. (2003). The work of mourning. Chicago, USA: University of Chicago Press.
Field, N. P. (2006). Continuing Bonds in Adaptation to Bereavement: Introduction. Death Studies, 30(8), 709-714.
Field, N. P., & Filanosky, C. (2009). Continuing bonds, risk factors for complicated grief, and adjustment to bereavement. Death Studies, 34(1), 1-29.
Field, N. P., & Friedrichs, M. (2004). Continuing bonds in coping with the death of a husband. Death Studies, 28(7), 597-620.
Field, N. P., Gal-Oz, E., & Bonanno, G. A. (2003). Continuing bonds and adjustment at 5 years after the death of a spouse. Journal of consulting and clinical psychology, 71(1), 110-117.
Field, N. P., Nichols, C., Holen, A., & Horowitz, M. J. (1999). The relation of continuing attachment to adjustment in conjugal bereavement. Journal of consulting and clinical psychology, 67(2), 212.
Fink, B. (2014). Against Understanding. London, UK: Routledge.
Frankl, V. E. (1986). The doctor and the soul: From psychotherapy to logotherapy: Vintage.
Freud, S. (1917). Mourning and melancholia. Standard edition of the works of Sigmund Freud, 14. In: London.
Gadamer, H.-G. (1996). The enigma of health: The art of healing in a scientific age (J. Gaiger & N. Walker, Trans.). Malden, USA: Polity Press.
Gamino, L. A., Sewell, K. W., & Easterling, L. W. (2000). Scott & White Grief Study-Phase II: Toward an adaptive model of grief. Death Studies, 24, 633–660.
Gendlin, E. T. (1978). Heidegger and the Philosophy of Psychology. Review of Existential Psychology and Psychiatry, 16(1-3), 43-71.
Gergen, K. J. (2009). Relational being: Beyond self and community. New York, USA: Oxford University Press.
Guetterman, T. C., Fetters, M. D., & Creswell, J. W. (2015). Integrating Quantitative and Qualitative Results in Health Science Mixed Methods Research Through Joint Displays. Ann Fam Med, 13(6), 554-561.
Hebert, R. S., Schulz, R., Copeland, V. C., & Arnold, R. M. (2009). Preparing family caregivers for death and bereavement. Insights from caregivers of terminally ill patients. Journal of pain and symptom management, 37(1), 3-12.
Heidegger, M. (1996). Being and time: A translation of Sein und Zeit (J. Stambaugh, Trans.). New York: State University of New York Press. (Original work published in 1954).
Ho, S. M., Chan, I. S., Ma, E. P., & Field, N. P. (2013). Continuing bonds, attachment style, and adjustment in the conjugal bereavement among Hong Kong Chinese. Death studies, 37(3), 248-268.
Hogan, N. S., Greenfield, D. B., & Schmidt, L. A. (2001). Development and validation of the Hogan grief reaction checklist. Death Studies, 25(1), 1-32.
Hogan, N. S., & Schmidt, L. A. (2016). Hogan Grief Reactions Checklist (HGRC). Techniques of grief therapy: Assessment and intervention, 39-45. London, UK: Routledge.
Holmes, T. H., & Rahe, R. H. The social readjustment rating scale. Journal of Psychosomatic Research, 11(2), 213-218.
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: a measure of subjective stress. Psychosomatic medicine, 41(3), 209-218.
Hsu, M.-T., Kahn, D. L., Yee, D.-H., & Lee, W.-L. (2004). Recovery through reconnection: A cultural design for family bereavement in Taiwan. Death Studies, 28(8), 761-786.
Jasper, K. (1954). Psychologie der Weltanschauung Berlin, Göttingen, Heidelberg: Springer.
Kissane, D., & Bloch, S. (2002). Family Focused Grief Therapy: A Model of Family-Centred Care during Palliative Care and Bereavement. New York, USA: McGraw-Hill Education.
Klass, D. (2006). Continuing Conversation about Continuing Bonds. Death Studies, 30(9), 843-858.
Klass, D., Silverman, P. R., & Nickman, S. (1996). Continuing bonds: New understandings of grief. London, UK: Routledge.
Klass, D., & Steffen, E. M. (2017). Continuing Bonds in Bereavement: New Directions for Research and Practice. London, UK: Routledge.
Kleinman, Arthur (1988/1994). The illness narratives : suffering, healing, and the human condition. New York: Basic Books.
Kleinman, A. (2012). Culture, bereavement, and psychiatry. The Lancet, 379(9816), 608-609.
Lee, W.-L., Hou, Y.-C., & Lin, Y.-S. (2017). Revisiting the Continuing Bonds Theory: The Cultural Uniqueness of the Bei Dao Phenomenon in Taiwanese Widows/Widowers. Qualitative health research, 27(12), 1892-1904.
Levinas, E. (1969). Totality and Infinity: an Essay on Exteriority (A. Lingis, Trans.). Pittsburgh, USA: Duquesne University Press.
Mancini, A. D., & Bonanno, G. A. (2011). Loss and grief: the role of individual differences. In B. T. Litz, D. Charney, M. J. Friedman, & S. M. Southwick (Eds.), Resilience and Mental Health: Challenges Across the Lifespan (pp. 189-199). Cambridge, USA: Cambridge University Press.
McCarthy, J. R., & Prokhovnik, R. (2014). Embodied relationality and caring after death. Body & Society, 20(2), 18-43.
Mol, A. (2008). The logic of care: Health and the problem of patient choice. London, UK: Routledge.
Moustakas, C. (1994). Phenomenological research methods: Sage Publications.
Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24(6), 541-558.
Neimeyer, R. A. (2001). The language of loss: Grief therapy as a process of meaning reconstruction. In R. A. Neimeyer (Ed.), Meaning reconstruction & the experience of loss. Washington, DC, USA: American Psychological Association.
Neimeyer, R. A., & Hogan, N. S. (2001). Quantitative or qualitative? Measurement issues in the study of grief. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care. (pp. 89-118). Washington, DC, US: American Psychological Association.
Nichterlein, M., & Morss, J. M. (2017). Deleuze and Psychology. London, UK: Routledge.
Nielsen, M. K., Neergaard, M. A., Jensen, A. B., Bro, F., & Guldin, M.-B. (2016). Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement. Clinical psychology review, 44, 75-93.
Normand, C. L., Silverman, P. R., & Nickman, S. L. (1996). bereaved children`s changing relationships with the deceased. In D. Klass, P. R. Silverman, & S. Nickman (Eds.), Continuing bonds: New understandings of grief (pp. 87-112). London, UK: Routledge.
Nowatzki, N. R., & Kalischuk, R. G. (2009). Post-Death Encounters: Grieving, Mourning, and Healing. Omega: Journal of Death & Dying, 59(2), 91-111.
Prigerson, H. G., Maciejewski, P. K., Reynolds III, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., . . . Miller, M. (1995). Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry research, 59(1), 65-79.
Ricoeur, P. (1984). Time and narrative.Chicago, USA: University of Chicago Press.
Root, B. L., & Exline, J. J. (2014). The Role of Continuing Bonds in Coping With Grief: Overview and Future Directions. Death Studies, 38(1), 1-8.
Royse, D., Thyer, B., Padgett, D., & Logan, T. (2006). Program evaluation: An introduction (4 th eds.). Belmont, CA: Brooks-Cole.
Rubin, S. S. (1999). The two-track model of bereavement: Overview, retrospect, and prospect. Death Studies, 23(8), 681-714.
Scholtes, D., & Browne, M. (2015). Internalized and externalized continuing bonds in bereaved parents: their relationship with grief intensity and personal growth. Death Studies, 39(1-5), 75-83.
Schulz, R., Boerner, K., & Hebert, R. S. (2008). Caregiving and bereavement. In Handbook of bereavement research and practice: Advances in theory and intervention (pp. 265-285). Washington, DC, US: American Psychological Association.
Silverman, P. R., & Klass, D. (1996). Introduction: What’s the problem. In D. Klass, P. R. Silverman, & S. Nickman (Eds.), Continuing bonds: New understandings of grief (pp. 3-27), London, UK: Routledge.
Stroebe, M., Gergen, M., Gergen, K., & Stroebe, W. (1996). Broken hearts or broken bonds. In D. Klass, P. R. Silverman, & S. Nickman (Eds.), Continuing bonds: New understandings of grief (pp. 31-44), London, UK: Routledge.
Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: rationale and description. Death Studies, 23(3), 197-224.
Stroebe, M., & Schut, H. (2005). To continue or relinquish bonds: a review of consequences for the bereaved. Death Studies, 29(6), 477-494.
Stroebe, M., Schut, H., & Boerner, K. (2010). Continuing bonds in adaptation to bereavement: Toward theoretical integration. Clinical psychology review, 30(2), 259-268.
Stroebe, M. S. (2001). Bereavement research and theory: Retrospective and prospective. The American Behavioral Scientist, 44(5), 854-865.
Stroebe, M. S., Abakoumkin, G., Stroebe, W., & Schut, H. (2012). Continuing bonds in adjustment to bereavement: Impact of abrupt versus gradual separation. Personal Relationships, 19(2), 255-266.
Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of traumatic stress, 9(3), 455-471.
Tedeschi, R. G., & Calhoun, L. G. (2004). Helping bereaved parents: A clinician`s guide.London, UK: Routledge.
Tedeschi, R. G., Orejuela-Davila, A., & Lewis, P. (2018). Posttraumatic Growth and Continuing Bonds. In D. Klass & E. M. Steffen (Eds.), Continuing Bonds in Bereavement New Directions for Research and Practice (pp. 31-42). London, UK: Routledge.
Wheeldon, J., & Ahlberg, M. K. (2012). Visualizing social science research: Maps, methods, & meaning. London, UK: SAGE Publications. |
| Description: | 博士
國立政治大學
心理學系
101752501 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G1017525011 |
| Data Type: | thesis |
| DOI: | 10.6814/NCCU201900642 |
| Appears in Collections: | [心理學系] 學位論文
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Files in This Item:
| File |
Size | Format | |
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| 501101.pdf | 2188Kb | Adobe PDF2 | 1 | View/Open |
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