地域生活に移行した統合失調症患者の生活体験―初発者と再発者の比較を通して

Life-experiences of People with Schizophrenia after They Were Discharged from Hospital: Comparisons between First-episode Patients and Relapsed Patients

要旨

　本研究は，精神病院退院後看護面接を実施した統合失調症初発者2名，再発者2名の生活体験の特徴を比較検討し，対象者の視点から生活体験を描き出し，質的にその意味を検討した．両者の生活体験は，変化するものと一貫して変化しないものに分類できた．初発者では，【病気である自分に対する思い】が，再発者では，【病気に対する特有の理解】と【対処策を自ら考える】が時間とともに変化していた．また一貫して変化しない生活体験として，初発者では，【不確かな自己】と【将来への不安】が，再発者では，【深まりにくい自己洞察】【幅広い不安】や【固定化された行動の方向性】【こだわり】【理性と感情の乖離】という特徴が抽出された．両者の特徴の比較から，再発を繰り返す過程で，理性と感情の乖離，行動の方向性，こだわりが固定化される可能性について言及した．また，自我境界の成立に伴う不安や社会参加のレベルが病気の理解とつきあいを変えていくという特徴を，彼らの自己領域から社会領域への出立の視点から考察した．

Abstract

　This study explores characteristics of the life-experiences of people with schizophrenia （2 first episode patients and 2 relapsed patients） who were given nursing counselling after they were discharged from psychiatric hospital. Their life-experiences were described from their point of view, and classified into “variable life-experiences” and “non-variable life-experiences.” It was found out that thoughts about self with an illness had changed over time among first episode patients. On the other hands, two variable life-experiences were altered among relapsed patients, which were［their unique understanding about their illness］and［considering their way to deal with problems］. The non-variable life-experiences found among first episode patients were［the uncertain self］and［the anxiety about their future］. In contrast,［a difficulty in improvement of their insights］,［a wide-range of uncertainty］,［stereotyped way of taking action］,［obsession］and［the gap between reason and emotion］were found among relapsed patients.

　The results indicate that there is a possibility of increasing the gap between reason and emotion, stereotyping the way of taking action, making patients stick to certain tasks and creating meanings in their own way for their perceived body condition in a process of relapsing. Therefore, the characteristics such as uncertainty caused by establishing their ego boundary and converting the level of social involvement and understanding about their illnesses, were considered from the aspect of a journey from self area to social area.