精神に病をもつ人の自尊心が低下した時の心身と行動の構造

Psychiatric Illness Persons' Structure of Mind, Body and Behavior When They Felt Low Self-Esteem

要旨

　本研究の目的は，精神に病をもつ人の自尊心回復に向けた看護支援プログラムの開発をめざして，自尊心が低下した時に，浮かぶ考えやとる行動，気分の経験世界がどのように繋がっているかを記述することである．方法は，34名の地域で住む当事者を対象に，修正版Grounded theory approachを用いて分析した．結果，自尊心が低下する状況が生じた時，《否定的な自己像》が活性化し，それにより，否定的な《バランスを失った思考》が次々に引き出され，それらの思考が頭の中をグルグル回り，《追い詰められた不快な気分》，《不快な身体現象》，自己内外に対し《攻撃または守りとしての行動》が生じ，彼らはその悪循環に巻き込まれていた．悪循環は自己に対する強いこだわりの思いから生じると解釈できた．悪循環から脱出する看護支援として，《否定的な自己像》を認識する，スキーマの修正，リラクゼーション活動，肯定的自己評価を意識化できる，などの必要性が示唆された．

Abstract

　A qualitative, inductive study was conducted to describe the experiences（structure of mind, body and behavior） of persons with psychiatric illness when they felt low self-esteem to develop a nursing care program to facilitate self-esteem recovery. Data was collected from 34 persons with psychiatric illness living in the community, and then analyzed using a modified grounded theory approach. As a result, five components were found. When the conditions which lowered their self-esteem were present, their “negative self-image” was activated, and “unbalanced thoughts” whirled around in their minds, they continued “to feel as if they were chased down,” “uncomfortable physical phenomenon” developed, and they could not help exhibiting “self-defensive or aggressive behavior.” They were involved in this vicious circle, which could be interpreted to arise from their obsession with themselves. It is suggested that in order to assist persons with psychiatric illness to break out of the vicious circle the nurses should help them perceive their “negative self-image,” make modifications to it, enhance mental and physical relaxation, and become more conscious of affirmative self-evaluation.