對於精神分裂症中的自我障礙的現象學精神病理學研究

A Phenomenological Psychopathological Investigation of Self-disorder in Schizophrenia

朱健樂(Kin-Lok Chu)

指導教授 ： 鄭喜恒

國立清華大學/人文社會學院/哲學研究所/碩士(2020年)

摘要

「自我（self）」這個議題在哲學中具有高度的爭議性，包括：自我是什麼？我們是如何意識到自己的？自我是如何存在的？現象學對於以上的問題提出了系統性的解釋和理論，也有當代的精神病理學家採用這套自我意識理論來解釋精神分裂症中的症狀。根據現象學的立場，意識蘊含某種最小化的自我，但是這種自我並不是獨立存在的意識主體，而是隱含在經驗中的、無處不在的第一人稱呈現模式。另一方面，精神分裂症是一個長期受爭議的精神病，因為這種疾病中的諸多症狀之間既沒有清晰的界線，這個疾病本身也沒有明確的定義。根據當代的現象學精神病理學的研究，精神分裂症的根本病理是源於最小化的、核心的自我遭受到干擾，這導致患者體驗到各種異常的經驗，因此精神病理學家把這種精神分裂症的前驅期稱為「自我障礙」，其他諸如幻覺、妄想之類的具體症狀則被視為後期的症狀。本文的研究目的是雙向的：一方面是通過精神分裂症的現象學解釋來審視現象學的自我意識理論本身，另一方面是通過現象學的自我意識理論來闡明精神分裂症中的三種核心症狀：基本自我感減弱、過度反思或者增加反思、失去常識或者自然的明證性。在本文的結尾部份，筆者會論述「基本自我感減弱」這種症狀是源於患者缺乏時間層面的自我意識，這導致他們持續地感覺到無處不在的匿名經驗，從而產生出疏離感。

關鍵字

現象學 ； 精神病理學 ； 最小化的自我 ； 自我障礙 ； 精神分裂症

並列摘要

The topic of self is highly controversial in philosophy: What is a self? How are we aware of ourselves? How does the self exist? Phenomenology provides a systematic explanation and theory for these problems and some contemporary psychopathologists have adopted the phenomenological account of self-consciousness to explain the schizophrenia symptoms. According to phenomenology, consciousness implies a minimal form of self which is not a subject independent of conscious experiences, but the ubiquitous first-personal character of the experiential phenomena. On the other hand, “schizophrenia” has long been a controversial category, its boundaries uncertain, its essence ill-defined. According to contemporary phenomenological psychopathology, schizophrenia is associated with disorders that disturb the functioning of the minimal or core self and cause the patients to suffer from various abnormal experiences. Psychopathologists named this prepsychotic stages of schizophrenia as "self-disorder", and other explicit symptoms such as hallucinations and delusions are considered as late symptoms. The purpose of this thesis is two-way: on the one hand, it examines the phenomenological account of self-consciousness through the phenomenological account of schizophrenia, and on the other hand, it clarifies the phenomenological account of three fundamental schizophrenia symptoms (including diminished sense of basic self, hyperreflectivity and lack of natural evidence) through the phenomenological account of self-consciousness. At the end of this thesis, I argue that the symptom of diminished sense of basic self is associated with the lack of temporal self-awareness, which causes the patients continuously to feel anonymized or even alienated.

並列關鍵字

phenomenology ； psychopathology ； the minimal self ； self-disorder ； schizophrenia

參考文獻

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