台灣過動兒家庭的飲食療法與運籌行動

Abstract

近年來，注意力缺失過動症(Attention Deficit/Hyperactivity Disorder)的問題越來越受到家長的注意，但是台灣醫界主張的醫療方式：藥物治療，卻較少被家長採用，反而是精神科醫師認為不具療效的飲食療法，卻能得到家長的廣泛認同。同時，在台灣的家庭中負責照顧過動兒的主要行動者，多半都是母親，但大部分的過動症研究是以專家的角度評斷治療方法的有效性，或是只描述母親調適壓力的過程，因此，本研究從母親獨特的社會位置與母職經驗出發，探討母親面對醫學專業權威時，如何透過運籌行動找出最適合自己與小孩的醫療方式，以及哪些結構性因素會影響家庭對於過動症療法的選擇。本文訪談12位育有國中以下過動兒的母親，並透過文獻檔案分析與田野觀察蒐集資料以回答研究問題。 主要研究發現如下： 一、 療法爭議尚未結束，替代醫療其實擁有足夠的科學證據證明其有效性，並不像精神醫學所宣稱的一般無效。同時，精神醫學較為僵化的醫用相處模式，令家長難以透過與醫師溝通來改變醫療方式，結果就容易造成家長的出走。 二、 依據各自的需求與社會條件的不同，進行醫療行為的過動症家長可分成三種行動類型：順從，特製調配與出走。家長承受的相關壓力較大，且較不具備經濟資本與文化資本時，對於精神醫學體系傾向採取順從的行動模式；而不想耽誤治療的黃金期與對於藥物有所疑慮的家長，則會根據自己的需要，進行特製調配，盡可能同時使用自己信任的各種療法。從精神醫學體系出走的家長，一般而言具備最高的文化資本，且承受的壓力最小，同時對於精神醫學體系也最不信任。 三、 飲食療法在台灣較符合社會對於密集母職的需求，所以比起藥物治療，母親更傾向使用飲食療法。也因為社會對於母親的壓迫，導致運籌行動在台灣家庭大多由母親負責，然而父親對於運籌行動的參與程度，也是影響家庭選擇醫療方式的關鍵。當父親越積極投入運籌行動，家庭就越有可能使用耗時費工的飲食療法，相對的，當父親不願意分擔運籌工作時，母親若是無力負擔需要耗費大量時間與心力的替代療法，那就越可能採取較為便利的藥物治療。

In Taiwan, it seems that more and more parents are concerned about the problem of Attention Deficit/Hyperactivity Disorder (ADHD). However, the treatment: medication suggested by psychiatry is seldom used by parents in Taiwan. They prefer dietetic treatment which is dissuaded by psychiatrist. Mother is responsible for caring about children with ADHD, but most of the research for ADHD is either about judging the effectiveness of treatment from expert's opinion or just describing sufferings of mothers. For this reason, this study tries to expound how mothers find the most appropriate way for curing children of ADHD, while they face the authority of medical science. And it also tries to find how structural reasons influence the treatment decisions of mothers. This study applies a qualitative research design. Data were collected by means of in-depth interview from 12 mothers of children with ADHD, from 2012 to March 2013. Biographical records written by parents and published on the Internet also support this finding. This study found: First, the controversy between therapies is still continued. In fact, there are enough scientific evidences to prove the effectiveness of Complementary and Alternative Medicine (CAM), not as a general psychiatry claims invalid. Meanwhile, a rigid user-professional relationship makes parents communicate with psychiatrists in a difficult way and the result causes parents to exit. Second, according to their needs and social conditions, parents can be distributed into three types of action: acceptance, ad hoc use of different approaches and exit. Some parent who bear more pressure, have less economic capital and cultural capital would prefer to accept the psychiatry treatment. Parents who do not want to delay the golden period of treatment or have doubts with drugs might take ad hoc use of different approaches. In other word, they would arrange and try as more therapies as they can. The parents who exit from psychiatry treatment, in general, have the highest cultural capital, and the minimum pressure, but also distrust psychiatry the most. Third, because of dietetic treatments fulfill the requirement of Taiwan society about intensive motherhood. Comparing with medicine therapy, mothers are more inclined to use dietetic treatments. But also because of social oppression for the mothers, they should carry out the logistic action for family. But father also plays an important role in the decision of therapy. As long as father is more actively involved in logistic action, families more likely to use time-consuming work: dietetic treatments. On the other hand, if father refuses to share work, the mother cannot afford to spend a lot of time and effort on alternative therapies, and then they may chose the easy way: taking medication.