男同志精神醫療就醫經驗主體敘說

美國精神醫學會已將男同志去病化四十餘年，但近年來仍有部份男同志陳述在精神醫療具有負面就醫經驗，可惜國內精神醫療相關文獻從未深刻探討與反省，所以本研究目的旨在深入理解男同志精神醫療就醫緣起、就醫困境、及就醫需求與實務建議。研究對象為六位具有精神醫療就醫經驗之成年男同志。研究方法採取敘說研究之「整體─內容」與「類別─內容」分析，將男同志就醫故事做為資料進行探討與整理。研究結果為六位男同志敘說之精神醫療就醫故事，其主要發現如下：一、就醫緣起：男同志經常面臨龐大壓力引發精神疾患或被迫就醫才走入精神醫療，同性性癖好與同性情慾受到社會文化譴責、及陰柔男同志因為女性特質而遭受貶低等性別少數壓力也扮演過程中的重要致因。二、就醫困境：男同志認為心理健康工作者過份重視藥物治療，漠視性傾向議題，對男同志生活型態欠缺理解，擁抱異性戀假設與同性戀恐懼、及未能設身處地展現同理態度。男同志的個人盲點、及未能獲得意識覺醒，也會限制他們從精神醫療的介入中獲益。三、就醫需求與實務建議：男同志要求心理健康工作者實踐去病化的完整治療，提高對男同志族群的認識，及具體展現同理態度。協助男同志處理盲點，催化醫療體制改革，及採取社會正義觀點的介入，也是十分重要的層面。最後僅依據上述研究結論對心理健康工作者與研究者提出未來建議，以期作為建構多元性別與公平正義價值觀之精神醫療體系的設計參考。

關鍵字

男同志；精神醫療；就醫經驗

並列摘要

The American Psychiatric Association has de-pathologized gays more than forty years ago. But, there have still been some gays stating their negative medical experience in psychiatric service in recent years. It is a pity that it has not been profoundly explored or reflected in documents regarding psychiatric service in Taiwan. This study thus aimed to have an in-depth understanding of the reasons gays have sought psychiatric service, their dilemma in the service, and their medical needs as well as practical recommendations. The participants of study were six adult gays with psychiatric service experience. For research method, the “holistic - content” and “categorical - content” analysis of the narrative research were used to explore and sort the data of the gays’ medical service stories. Our findings were the stories of psychiatric service narrated by the six gays, mainly as follows. 1.Why seeking medical service: it is often that gays suffer psychiatric disorders as a result of the huge pressure on them, or receive psychiatric service only when they are forced to. Sexual minority stressors, such as homosexual preference and homosexual desire subject to social and cultural criticism, and feminine gays belittled for girlishness, also are important resulting factors in the process. 2.Dilemma in medical service: gays think that psychiatry service providers over-emphasize drug treatment, disregard issues of sexuality, lack understanding of gays’ lifestyle, embrace heterosexual assumptions and homophobia, and fail to show empathy by being in other’s shoe. Individual blind spot and lack of consciousness rising in gays also retard them to benefit from the involvement of psychiatric service. 3.Medical needs and practical recommendations: gays require mental health professionals to practice de-pathologized and complete treatment, to increase the understanding of the gay population, and to specifically exhibit empathy. Other important aspects include assisting gays in handling their blind spot, promoting health care reform, and allowing intervention of the view of social justice. Last, based on the above conclusions, we propose recommendations for mental health professionals and researchers. The recommendations are hoped to be reference in design and building psychiatry service system with gender diversity and values of fairness and justice.