從治療室反思失業潮
作者: 張凱理 / 7577次阅读 时间: 2010年6月19日
www.psychspace.com心理学空间网2008-12-27 13:45:00
從治療室反思失業潮心理学空间c'gFM:C`"B
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A Psychotherapist’s Reflections upon the Implications of Unemployment
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張凱理醫師 Nov 4, 2001 心理学空间+g)Jn}*I%n`\"uo
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(1) some newsclips
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主計處廿三日發布九月份失業率為5.26%, 廣義失業率7.22%, 廣義失業人口72.8萬人, 波及人口近120萬人. 其中影響僅及個人約14.2萬人, 影響波及全戶達103.9萬人. (工商中時, 10/24)
gV:si,M0九月份台灣地區廿三縣市, 總計有十六縣市失業率在五%以上, 新竹市居第二位. (工商, 10/24)心理学空间h0f9^{]I"G
勞保局失業給付業務, 過去每月受理約為七、八千件, 目前每月五萬件. (中晚, 10/23)心理学空间v{+Q};dm#K1C N,Mw u
88年度中斷健保人數23萬677人, 89年度168萬4699人. (ETtoday, 5/1)心理学空间 s Ci:U/vp;O|O
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(2) business cycle (Juglar’s eight-year cycle)心理学空间\&~e A)?,Q6O

CB]/MY bu R0A typical cycle (composed of three phases, properity, crisis, and liquidation) recur every 9 or 10 years. (Clement Juglar, 1860) Subsequent analysis has tended to designate 1825, 1836, 1847, 1857, 1866, 1873, 1882, 1890, 1900, 1907, 1913, 1920, and 1929 as initial years of crisis. In the years since 1929, the regularity of business fluctuations has been somewhat offset by government anticyclical policies. (Encyclopaedia Britannica, 2001)心理学空间G!B7N,]M

0VmO~+R*q I0(3) When work disappears: the world of the new urban poor (William Julius Wilson, 1996)心理学空间g)mPIktz
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The author persuasively argues that the problems endemic to America’s inner cities--- from fatherless households to drugs and violent crimes --- stems directly from the disappearance of blue-collar jobs in the wake of a globalized economy.心理学空间[^!f9ET5WsQ1lU

(YL"D8Y^S R0(4) Hardest Times: The Trauma of Long Term Unemployment (Thomas J. Cottle, 2001)心理学空间3L;J!~EDaO

]u2}9hV `&}e9F0Holmes & Rahe’s Social Readjustment Rating Scale (SRRS):
k ^3P-]:n0ZF,Vwe-Z0Measure the adjustment time needed for 43 life events. Life crisis: any cluster of life events whose values summed to 150 life change units or more in one year. Major crisi: 300 or more. The greater the summed scores, the greater the individual’s vulnerability or lowering of resistance to disease, and the more serious the disease will be.
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Beware the man who tells you he lives day to day. That is a man who’s either recovering from alcohol, unemployed, or a man planning to die.
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%x;I9R @t1tm0The trouble is that the rotten nine-to-five boredom routine we’ve invented called work, that affects who you are, what you are, and how much you can love.心理学空间 W']^ T Si U
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George barely ventured outside his home during his last months. He simply could not let himself be seen.心理学空间~bT+X9n~8lGYI

Aq{sH7a.^V4b0“You know what they call people like me?” George asked one after-noon returning from a meeting with several unemployed men.
&y3JbknQ0“Long-term unemployed? Discouraged worker?”
iX9@1T#G*lA0“You’re not even close.”心理学空间%j"L&\ap6W N;Pc)O
“Depressed?”心理学空间]+w`4|)M5Y$LZ
“Well, that too?”心理学空间&d:j,^H/~+d6ZR
“Suicidal?”
a}[ T wc ri'C2_0“Who isn’t?”心理学空间+} ||l2J
“Am I getting closer?”
i-wsb+mI0“You’re thinking too much like a psychologist. Think like a man.”
5cZ/k!WO0“They call men like you bums.”
j.H!Ba{"Kq:e(|0”Now you’re hot. They call us undesirables. You hear that? They don’t want us around. They don’t want us seen. They don’t even want us seeing one another, or ourselves. They don’t want us. We clog up their systems. We’re no good to anyone, especially our families. We’re undesirables.”
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1gcgW$S:k!A.R5W0... unemployment appears to have a quality of life-and-death import to it. Unless one confronts it directly, it is difficult to observe how powerfully it hits a man or woman, and how it can take a person to the brink, and then shove him or her over. For many people, long-term unemployment truly constitutes the hardest times.
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Ld s)K4_2f2]%L7VP0After six months of being out of work, with benefits terminated, the person no longer believe that he or she is even a statistic, and in fact, he or she isn’t. … These are so-called hidden unemployed, … the “non-class of non-workers” … most of these people disappear from all government lists. In fact, many of them seem to disappear off the face of the earth. They are the ones properly described as enduring the hardest times. 
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H5q H;C2OmpI0The focus in this inquiry is the single human being. The term used in describing this research is life study. Simply put, the life study is a personal portrait of a person in his or her own words, it is the person’s (version of the) story one seeks to learn. … the life study finds its origin in the act of bearing witness or testimony.
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9QQ9~.b7xD+NSV|0“And what do you do?” … this natural, seemingly inbred assumption of having a job makes the reality of unemployment so drastic and traumatic for men.心理学空间!r iQ*E'p y [

e1M zS3D2m^+Op0… three months and six months, respectively, represent the cutoff dates used by federal and state governments as well as insurance companies to categorize people as long-term and very long-term unemployed. … Surprisinly, no one seems to know precisely what all of the long-term unemployed people are doing. 
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w!QBo,u7a2T@3Od,b0… the spouse and children feel the repercussions within days. Research indicates that within two weeks of a man being laid off, medical and psychological problems begin to emerge among family members. 心理学空间U:Pi6Esiu'[v

cHVs7Z9EL)_0Brenner was able to document how a sustained 1% yearly rise in unemployment significantly increased what he called “social stress indicators” such as suicide, homicide, mental hospital and prison admissions, cirrhosis of the liver, cardiovascular and kidney disease, and general mortality.
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Q(V%`[H&hp0An unemployed man can become a quietly desperate and lonely man. … long-term unemployment is not something people readily speak out.
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^ffcV0… relatively few long-term unemployed persons ever consult psychiatrist, psychologists, or social workers for long stretches of time, if at all. … they simply cannot afford it. The worlds of psychiatry and psychology, do not stand in the best position to evaluate relationships between unemployment and psychological symptomatology. … “many psychiatrists spend a good part of their lives buried in offices away from real-life situations.”
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6MEx m\^0Might it be that research itself brings forth pain from men who previously had been able to control it? Would some of the men have been better off not speaking to anyone about their situations, lest they withdraw into despair? … Many days driving home I thought about these questions.心理学空间~Qi*j:]-_.^

o#U OOs+A0Almost surreal in nature, inquiries into their personal and work histories, remembrances of parents, deions of early career aspirations, and evaluations of their lives, became an opportunity for them to compose their obituaries.
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)b2|} pw1v0In time, their anger receded, as though their bodies could no longer sustain it. … With the anger receding, one recognized the sounds of shame and guilt. … and the shame is learned by family members …心理学空间.d7}_ ?2e"g(_l
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In the early days of being out of work, when benefits still come in and hope continues to run fairly high, a brotherhood is often forged among unemployed men. … Over time, however … 
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… they ask their wives to evaluate them, ask questions of their wives that once may have wishes to ask their parents, especially their fathers. “Am I worthwhile? Am I lovable?”心理学空间6XA-b1u Y#P&]

T5f,F,? |3g.F*Kf q0Men are raised to engage life in terms of agentic thinking and acting. In a sense, he is constantly alienated from time. It’s a bit like asking children why they attend first grade. The girl’s answer is that it’s important for her to be learning reading, writing, and arithmetic, whereas the boy responds that he has to if he wants to get to second grade. … How then, does a boy grab on to the future --- a time that by definition can never arrive, for when it does it is properly described as the present --- and still maintain himself on a rational course? The answer is that society provides it for him in the name of work. When, however, after months of hunting for work, he is left without benefits, income, or hope, the entire plan, the entire orientation to time and destiny falls away, and he is left with nothing. He finds little within himself, minimal strength at best, and certainly no philosophical or psychological foundation to carry him beyond the immediate circumstances of unemployment.心理学空间 B$x0xX x%bD
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How appropriate Kubler-Roth’s observations for terminally ill patients are for long-term unemployed people whose affect in the latter months of their lives seems so flat, and whose detachment from people so palpable. … the fight is over, the strength is gone …心理学空间e Ph4l#ym9[_,V d't

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+s'J RTw4N0(5) adult development
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l;MF(q+}A(Aju s&_0early adulthood (20-40) / middle adulthood (40-60) / late adulthood (60>)心理学空间{)y9K"fCp
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developmental lines (main concerns)心理学空间c/ms8G|1L)PK y
intimacy / love / sex
#{P)u$I/WZw%`0the body心理学空间,q;Tod|8kH{d
time & death
0A }#^Im)z W/zm0relationship with children心理学空间Yy,I:e'y.@H7H
relationship with parents心理学空间b/}5I.ql TO
mentor relationship心理学空间JYC?-V
relationship with society心理学空间7t7nI7O0E3~O2p)b
work心理学空间bQv]"S!L$Z!Ql
play
|YD6c.F\0finances心理学空间%VA)f/fIcN+R;[O
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A man, Levinson wrote, is constantly building and transforming the structure of his life, a structure built in part on the successful completion of tasks …心理学空间(b*D [5Yv wQ hdAxzy
Clearly, work lies at the center of these so-called projects.
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$G{dir$m0(6) family: the “no-longer secure” base
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“He should have taken me somewhere, threw me down, slapped me if that was the only thing that would have quieted me, and made love to me. I mean, pull my clothes off and rape me … Anything to show me he was alive. I mean it. I wanted to be roughed up that night, and feel he was really a man. But he was dead.” (Rosemary Mullen said after her husband committed suicide.)心理学空间%L*F3Aak.wh2x
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Nor do we know how many cases of unemployment, or the threat of it, have led to separations or divorces. … “Unemployment does the same thing to a couple that losing a child does: it wrecks the bond once and forever.” (Cottle, 2001)
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2L*k C,Ab&?h0How can a child feel proud of his or her father when all he does is mope around the house, or drink? … He wasn’t really Daddy anymore … 心理学空间3K%|5D9^4YUDG
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… the reversal of gender role. … too many of the boundaries that properly differentiate family members have all but disappeared … 
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Domestic violence
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'n%A9J K,Kn'Bu01. presence of alcohol心理学空间'U/G&`|$tZ*e
2. hostility toward dependency心理学空间!qxhL2J
3. excessive brooding心理学空间-K0~`%\)aL5h+@
4. social approval
i4|"v/k1dhXj05. socioeconomic factors 心理学空间%g|-p*}D4_"SrD on
6. flashes of anger心理学空间a8Cg7h?[
7. military service心理学空间*i6i7sbouh%R:N7nJN
8. having been battered children (Larry Siegel, 2000)
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In assaulting his capacity to deal with stress and stripping away his pride, his self-definitions, his sense of personal power, and his belief in his ability to control outcomes, not the least of which is his personal destiny, long-term unemployment may lead to aggressive, and outright violent behavior such as wife and child battering, armed robbery, and murder. (Cottle, 2001)心理学空间1Yc(a7x;I {g.vV%]
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(7) relationship between unemployment and crime
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The relationship between unemployment and crime is still unsettled: aggregate crime rates and aggregate unemployment rates seem weakly related. Crime rates sometimes rise during periods of economic prosperity and fall during periods of decline. The crime-unemployment association may be place- and time-specific.心理学空间Gk2?/RWz
Research indicates that neighborhoods with few employment opportunities for youth and adults are the most vulnerable to predatory crime such as armed robbery and muggings. Unemployment destabilized households, and unstable families are likely to breed children who use violence and aggression to deal with limited opportunity. (Larry Siegel, 2000)
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(8) relationship between unemployment and suicide心理学空间K M4{ [3{{4s ?;v.y%M

)^z'L%x$Fs0Individual-level, cross-sectional studies on suicide and unemployment showed that unemployed persons have higher suicide rates than their counterparts. It is not clear to what extent this is due to the pressures of unemployment alone or to preexisting psychiatric morbidity. Women’s unemployment is not always related suicidal potential.
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~ MjZLm$W1h0As regards business cycle and suicide, the evidence is consistent with the linear argument of Henry and Short: the greater the prosperity, the lower the suicide rate, or the greater the trend toward recession, the greater the suicidal rate.
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v!AA;dW _0To understand the relationship for stress and negative events to suicide, it is necessary to these variables in the context of a more general model of coping, vulnerability, and problem-solving skills. (Ronald Maris, et al, 2000)
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h6kzo NT5Mj0(9) years later … 
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w L7Os"MSz0“lacking a father is like lacking a backbone”
`-R7kb#wo;[5dr0The father’s absence results in the child’s lack of internal structure; this is the very essence of a negative father complex. An individual with a negative father complex does not feel himself structured from within. … an internal disorder … will attempt to compensate for it by structuring themselves from the outside. (Absent Fathers, Lost Sons: The Search for Masculine Identity, Guy Corneau, 1991)心理学空间2iv'J9B4Da
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B:^r~5C:r(v'v4V"[0(10) Dealing effectively with job loss: A unique approach to rebuilding your life (Eileen Berman, 1999)
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(NK.a:Og rO0house of seven “C’s”: courage / confidence / confrontation / communication / choice / change / control心理学空间 G]w!Fu Y3j3|*J.C[

hJMmy6zrL0[0Bob listened carefully, appreciating what the doctor told him. “I understand that now. In fact, Dr. Loring, I’ve come to see you as a good friend.” The psychologist stood up and held out his hand. “A good friend, yes, but a professional one.” he remarked. “In other words, Bob, I’m on the periphery of your life, not in the central core. Your wife and kids are the ones who are central to you. As long as you can communicate with each other in healthy ways, you’ll stay in control. I’m here in case you need some help in stepping back and looking at the problem --- getting a new view so you can stay in charge of your life.”
'u]4D&W,In-G+^I0Bob shook the psychologist’s hand with enthusiasm. “I understand,” he said. “And if I feel I need to see you again, I’ll call … and believe me, I won’t feel guilty about it.”
+YG_'E(n pQ4K0“That’s great,” Dr. Loring said as he opened the office door for Bob for the last time. “Hold on to that key, Bob. As long as you have it firmly in your grasp, your House is storm-proof. It’ll take more than an ill wind to blow that House down!”心理学空间Y^?]4k2G
Bob slung his jacket over his shoulder as he walked through the parking lot to his car. What a beautiful day it was! As he opened the car door, he found himself thinking. What an opportunity Annie and I have to start a new life! 心理学空间Qbn@%n,D
Bob could hardly wait to get home to Annie and start work on their plans for the future. (ibid, p74)
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N8Bioky0(11) What can psychotherapists do?
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wv;eKF-d [6bn0“Don’t come at these guys too strong,” Alfred had advised.
rsfj u sQ)[0“Tell them where you are and let them come to you. They’re心理学空间}2u{]4E^b J
frightened. Treat them like cats. Stay still, and they’ll come to 心理学空间 o1m6u-g(Q[/d%~4T
you. They want to, ‘cept they don’t know how to do it.”
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OGK[ x `-|*h0set up anonymous hot line for consultation
TsOv/w"J-ZV \"o0set up low-fee (or free) walk-in clinic, and be there and wait …
Od{ r _;o0and/or reach out心理学空间ev2Y aA8mgx8\ {[
intent listening 心理学空间 V{*`0r!o.{7S l
backed up with social and psychiatric services
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facing such harsh external reality, what will be the most suitable
$|:i oD|oe0t#o0treatment model be like?心理学空间 v^ Q/@"}6z8N4p

0ok4h6xe4Y/[0Appendix:: studies done in Taiwan心理学空间5zt6]R}k
1. 失業成因之探討, 台大經研所, 劉亮吟, 1985.
%h%O5ru.X XB]~02. 台灣地區失業率衡量之再研究, 暨南經研所, 陳招蓉, 1998.
I H%v-q X$PJ03. 失業者與就業者搜尋行為之實證研究, 清大經研所, 魏上凌, 1992.
AdCB9R ^8Xit04. 台灣底層階級研究: 以台中市遊民, 拾荒者, 原住民勞工, 外籍勞工為例, 東海社會所, 方孝鼎, 2000.心理学空间4shu&cIx B
5. 關廠歇業中高齡勞工所得保障之探討, 中正勞工所, 王雯潔, 1999.
HX(qA+UL06. 台灣地區失業者狀況之探討: 以製造業關廠歇業失業者為例, 中正社福所, 黃彩惠, 1996.
gbk z0q&x:_07. 台灣地區民眾失業率和高教低就之研究, 台東師範教研所, 王昭蓉, 1999. 
)gbv]3awa,L:t9mt08. 中年生涯轉換者工作價值轉化學習之研究, 師大社教所, 鄭韻玫, 2000.
MoZm Cdf09. 失業青年之生活壓力, 休閒支持, 休閒決心與身心健康之關係研究, 高師輔導所, 鄭惠文, 1999.
ijQ_ i010. 失業勞工失業歷程之研究: 以九二一重建區中太平, 大里地區為例, 中正勞工所, 呂克志, 2000.心理学空间.?;[-M,F)o&t1uz8Q
11. 輕生行為與經濟因素, 社會背景的關係 --- 年齡層間的比較, 清大經研所, 陳國華, 1995. 心理学空间^y,rr(se
12. 維特效應---自殺瀰: 報紙自殺新聞影響之研究, 南華生死所, 徐婉如, 2000.
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T?8nXB,N0References:
b-AH!LP1Hq6[^01. Hardest Times: The Trauma of Long Term Unemployment, by Thomas J. Cottle, Praeger, 2001.心理学空间d5c+Qv%T*ZM
2. Absent Fathers, Lost Sons: The Search for Masculine Identity, by Guy Corneau, Shambhala, 1991.
9{W+wY V v Z5ndr)v03. Dealing Effectively with Job Loss: A unique approach to rebuilding your life, by Eileen Berman,心理学空间V:C1{Kd*U$Os
Engineering & Management Press, 1999.心理学空间fR+Tw^p
4. Criminology, 7th ed. by Larry Siegel, Wadsworth, 2000.心理学空间7g.Ix:i nV.| [1Z
5. Comprehensive Textbook of Suicidology, by Ronald W. Maris, Alan L. Berman, & Morton M., `心理学空间fi8Y SC0?0D
Silverman, Guilford Press, 2000.心理学空间yQ o \5Uo!g(y
6. The Interpreted World: An Introduction to Phenomenological Psychology, by Ernesto Spinelli,
S'O$qgj$| N+vx,\0Sage, 1989.心理学空间!mICo$Dp:}%l9m
7. A Phenomenological Exploration of the Meaning of Work in the Context of Unemployment,心理学空间Q q-s/o6dB,?9lK;JQd
by Patricia Goodspeed, doctoral dissertation, University of Rochester, 2000.心理学空间.Zf7N Z(Ec5}B#r
8. Adult Development: A New Dimension in Psychodynamic Theory and Practice, by Calvin A.心理学空间J@w&Y?AQH
Colarusso, Plenum, 1981
www.psychspace.com心理学空间网
«有關治療室的書寫 張凱理
《張凱理》
治療室裡的苦境»

 張凱理


1981 陽明醫學院畢業
1983-1988 北榮精神科住院醫師
1989- 北榮精神科主治醫師
1991-1992 美國辛辛那堤大學精神科國際精神分析自體心理學研究中心研究員
2001-2003 台灣精神醫學會監事
2004-2010 台灣心理治療學會理事