為什麼睡不著？失眠疾病敘事裡的病痛意義

根據統計，台灣有超過四分之一，至少六百萬人有睡眠障礙，每年台灣人以超過台幣十億的醫療費用來解決失眠困擾，且問題仍有繼續惡化的趨勢。跟隨醫療人類學家Arthur Kleinman的論點，本文實際操作其學術建議，以人類學所擅長的民族誌工作，為失眠病人書寫疾病敘事，並探討失眠病痛的意義。本文詮釋：第一，失眠病人在中醫、西醫和另類醫療脈絡中，分別產生身心二分、身即是心心即是身，以及身心靈一體，三種不同的身體理解；病人越是積極參與疾病敘事，越能賦權自己微弱的主體性。第二，失眠敘事顯示出老人和中年婦女在生活世界均面臨家庭與社會關係疏離、斷裂的危機。第三，失眠敘事協助我們獲得透視病痛意義的眼光，看見失眠不是簡單的生理疾病，而是個複雜的心理、社會病痛，失眠不僅是個人的病痛，更是社會的苦難。第四，台灣高失眠率的時代意義是，為追求世界級的競爭力，台灣家庭和社會的時間與關係被集體綁架了，我們需要搶救時間，搶救斷裂的家庭與社會關係，起而行的陪伴身邊的人，一起從失眠敘事中搏回病痛中虛弱或失格的主體性。

關鍵字

失眠；疾病敘事；病痛意義

並列摘要

According to statistic data, there are over 1/4 population, at least six billions Taiwanese have sleep disorder. Taiwanese spend more than 1,000billions NT dollars to solve the problem each year. And the situation still tends to be worse. Following medical anthropologist Arthur Kleinman’s research suggestion, it is to conduct ethnography work, writing illness narratives of insomnia patience, and discuss the meanings of insomnia illness. This article interprets: First, patience have different body understanding in different medical context, body-self dichotomy of western medicine, body as self and self as body in Chinese medicine, body soul spirit trinity in alternative medicine. And the more a patient does illness narratives, the more subjectivity he or she empowers. Second, elders and middle-aged women both show they face the crisis of family and social alienation. Third, insomnia narratives assists us to obtain the perspective, to see that insomnia is not only a simple physiological disease, but is a complex psychological, and social illness, not only individual illness, but also social suffering. Fourth, Taiwan with high insomnia rate, the significance of the time is for striving global competitive power, the time and the relations of family and society has been collectively kidnapped. We must rescue the time. We must rescue the broken relations of family and society. We should get up and accompany people close by, through insomnia narratives to regain subjectivity from weak or disqualified illness.