身體、心靈、醫療化：台灣女性主義運動的性侵傷害論述變遷

自1990年代開始，性侵害受害者的心理健康受到越來越多的關注，新聞報導常以心理創傷（psychological trauma），描述性暴力造成的身心靈變化。2013年，衛生福利部公布為期三年的「國民心理健康促進計劃」，計畫改善性侵害受害者的心理健康狀態。本研究受益於醫療社會學的洞見，試圖探問性暴力如何轉化為醫療問題，並構成醫療化的整體現象。以台灣的女性主義運動作為分析背景，本研究採取文獻分析法，資料來源為報章雜誌及女性主義倡議者所撰寫的相關論著，探討性侵害後果的概念與演變。本研究發現，在1970年代，少數倡議者提出「雙重受害」並呼籲關注性侵害的社會心理面向的影響。而在1980年代的女性主義運動者，則將論述重點放在司法流程的「二度傷害」，強調二度傷害不是技術問題，而是父權結構的產物。自1990年代開始，社會普遍認為有必要透過心理諮商輔導及精神醫療介入治療性侵害導致之「心理創傷」。本研究也追索促成性侵害醫療化的原因，文獻分析的結果顯示，相較於醫療專業的主動擴權，1990年代的女性主義運動引介醫療論述以強化性侵害的嚴重性並尋求改革，乃是促成性侵害醫療化的可能因素。在這個醫療框架下，政府透過立法動員醫療專業，提供性侵害被害者心理治療服務。最後，性侵害的醫療化也體現在，日益增加的創傷後壓力症（Post-traumatic Stress Disorder）司法精神鑑定。如何詮釋PTSD鑑定結果，則在台灣的醫療與法律專業之間形成持續性的論辯。

關鍵字

性侵害；心理創傷；創傷後壓力症；醫療化

並列摘要

Since the 1990s, the mental health issue resulting from sexual assault has been attracting more and more concern in Taiwan. While “psychological trauma” has become a common term in news coverages to describe the effects of sexual violence on the body and mind. In 2013, the Ministry of Health of Taiwan announced a three-year plan to improve the sexual assault victims’ mental health in the National Mental Health Promotion Project. Benefiting from the insight of medical sociology, this study examines the ways in which sexual violence is medicalized and turns into a medical problem. Based on the context of feminist movement in Taiwan, this study discusses the conceptualization of the consequences of sexual assault by reviewing newspapers and relevant publications written by the feminist advocates. In the 1970s, the double victimization was discussed and the social-psychological effects on the victims aroused concern among few advocates. In the 1980s, the feminist advocates focused on the discriminations against victims during legal proceedings. They saw the secondary victimization less as a technical issue than a product of the patriarchal society. After the 1990s, the psychological counseling and psychiatric intervention are considered necessary to treat psychological trauma caused by the sexual assault experience. This study also traces the causes of the medicalization of sexual violence. By reviewing relevant publications, it shows that instead of an active expansion of the medical jurisdiction, the medicalization of sexual violence is possibly a result of the feminist political agenda in the 1990s. In order to call for change, the feminist movement depicted sexual violence as resulting in serious mental issues. Under this medical framework of sexual violence, the government further mobilized the medical professionals through legislative power to offer psychological treatments for the victims. Finally, the medicalization is embodied by the increasing forensic psychiatric assessment of PTSD. The legal cases opened up a continual debate on the interpretations of PTSD between medical and legal professionals in Taiwan.