放逐於自身之外：亂倫創傷主體的心靈地景

亂倫性侵創傷在主流精神醫學和臨床心理學的實證論述框架中，經常被簡化為創傷後壓力症候群(PTSD)。然而，已有許多醫學人類學和臨床實務研究指出，忽視主體歷史脈絡和殊異性的標準化診斷，往往造成令心理創傷被精神疾病遮蔽的弔詭。然而，不可見的心理創傷如何被看見？精神分析對於心靈真實(psychic reality)的重視有助於超越精神病理學的限制，透過揭露主體無意識欲望的夢和自由聯想，以象徵隱喻的方式貼近創傷真實。只不過，自幼長期受創的後果之一即為夢的缺乏和聯想的不自由。基於長年針對亂倫創傷主體進行的「臨床田野」研究，本文嘗試提出「心靈地景」(psychic landscape)概念，作為窺見亂倫心理創傷樣貌的媒介。對亂倫創傷主體而言，作為自我認同基礎的「家」，經常由迫害－情感依附等衝突對立面構成。後果是倖存者裂解的自我被驅逐至一個無外在可逃離、無時無刻被監控的「內在放逐」(inner exile)狀態。此種無法言說的恐怖，外顯為令人不解、而易被精神病理化的症狀。本文將以一個與亂倫創傷主體遭逢的田野日誌為例，說明精神分析式的聆聽如何協助創傷主體揭露自身創傷與欲望混織的心靈地景，而此地景又如何可能在研究者與研究對象間的傳移(transference)關係中轉化。

關鍵字

亂倫創傷；心靈地景；內在放逐；臨床田野；心靈真實

並列摘要

Contemporary psychiatry and clinical psycholog y generally frame the incest trauma within the positivist discourse of post-traumatic stress disorder (PTSD). This categorization goes hand in hand with a tendency to pathologize and medicate psychotrauma. However, the standardized diagnostic reasoning may render the trauma invisible to the professional eye. In practice, due to the ineffability of incest trauma, victims are often subjected to different diagnoses of mental illness (schizophrenia, borderline personality disorder, antisocial personality disorders, etc.). For how can psychological trauma be seen or conceived? From a psychoanalytical perspective, and based on ＂clinical fieldwork＂ (Peng 2014a) on incest trauma over a decade, the author advances the notion of the ＂psychic landscape＂ to illustrate the power of imagery metaphors as a means to access to the subject's inner experience. For many incest survivors, ＂home＂, the presupposed fundamental space for constructing self-identity, is constituted of ambivalent representations that often combine one element with its very opposite: for instance, persecution-attachment, betrayal-demand for loyalty. The consequence is that the survivor's self is forced into a state of ＂inner exile＂, in which the split self is permanently monitored and there is no ＂outside＂ to flee to; i.e., the subject is deprived of authority over her/his own psychic territory. The extreme terror of inner exile can manifest itself in puzzling symptoms, such as inexplicable fear, global anxiety, somatization, dissociation, lying, repeated victimization, etc. Taking a Taiwanese incest survivor's case as an example, this paper describes the transferential process through which the traumatic psychic landscape emerges. By doing so, the author reiterates the need to go beyond the pathologizing tendency in contemporary psychiatry and bring the psychic reality, or subjective truth, back into focus when approaching psychotrauma.