暗影地帶下的龍發堂：體制外精神病院作為生活社區的法社會學考察

Abstract

摘要 本文建構一組由上位規範向下、三個層次的投影模型，第一層次是人的界分，界分為有精神病與無精神病的二元對分；第二層是精神病院的空間，被界分為合法/合宜與非法/不合宜的二元對分；第三個層次是社區與機構的二元對分。 透過三道投影的討論，我們將逐步堆疊出當代精神照護的體系，如何看待、界定以及處遇「精神病」、「精神病患」，和「精神病院」；其次集中在精神衛生法中「機構/社區」二元對立的觀念的批判。 我們接著要將龍發堂在內的體制外精神病院，與這個體系進行對照，發掘出它們是作為怎樣的畸零的存在。 關於龍發堂的實際情況，我們一部份採用二手資料，收集新聞報導、政府文件及相關歷史文件；另部份採用實地觀察，以及訪談法，訪問專家與相關人士，取得一手資料。而資料分析，則採用紮根理論中開放式譯碼與主軸式譯碼的工具，分析訪談內容，形成理論。 在原本理想的模型投射之下，想像中的龍發堂，為一置放精神病患、屬於非法/不合宜精神病院的機構。然而在我們的討論之下，發現到其實對於三個層次的投影都有溢出。 而原本三個層次本身體系的界分線，在對龍發堂的實際狀況投影中，也都產生了暗影地帶，而使得原本的界分變得模糊。 本文也對龍發堂現況，及精神衛生法及整體精神醫療相關法令，提出建議： 1. 對精神病照護的健保補助提升資源挹注，特別是精神復健階段的補助； 2. 對精神護理機構與精神復健機構設置標準酌與放寬，同時簡化整併評鑑體系，對補助措施合理寬鬆化； 3. 對「機構/社區」頑固劃分對立的條文加以檢討，在精神照護機構分類納入「治療性社區」概念，給予相關類型院所更完備法律授權。

In this article we built a 3-layer-projection model. The first layer was the dichotomy of people with/without mental disorder. The second layer was the dichotomy of psychiatric asylums which are legal and proper/illegal and improper. The third layer was the dichotomy of community/institution. Via the 3-layer-projection model, by step and step, we found out that how contemporary mental health care system defines and treats “mental disorders”, “mental patients” and “mental asylums”. Then we criticized the dichotomy of community/institution in the mental health law. Then we compared the out-of-system mental care facilities including Long Fa Tang Temple with this model and figured out how weird these facilities are in this system. Parts of our empirical data of the Long Fa Tang Temple were from second-hand data, including news reports, government documents and relating historical documents; the other parts were from on-the-spot investigations and interviews to experts and relating people. We analyzed all these discovery with theoretical tools of grounded theory such as open coding and axial coding. The Long Fa Tang Temple under the ideal projection model, as we thought, should be an illegal and improper institution, in which we locate mental patients. In our further discussion, however, we found that the true situation went beyond the 3-layer-projection model. The borderlines within the layers, furthermore, became blurred in the projection, and there came the twilight zones. We also offered some suggestions to the situation of the Long Fa Tang Temple and the mental health law as below: