中文精神分裂症病患敘事能力之研究

Abstract

精神分裂症涵蓋思考、知覺、行動、情感等多方面的障礙，常見的病徵包括妄想、幻覺、雜亂或脫離現實的言語，以及情感淡漠和社會功能退縮。本研究旨在探討中文精神分裂症病患的敘事能力，比較二十二位精神分裂症病患及二十位對照組受試者看圖自編故事的敘事表現。研究者使用改編為中文的「敘事評定量表」(Narrative Assessment Profile, NAP) 分析敘事樣本的八個向度，分別為主題維持、順序性、合理性、指涉能力、背景資訊、評價、聯繫詞，及整體敘事類型，並計算兩組受試者所使用的聯繫詞及特定動詞的數量，此外，研究者也分析兩組受試者如何描述故事人物。 研究結果顯示，無論在言談層次或詞彙層次，兩組受試者的敘事樣本都呈現顯著差異。精神分裂症病患在六個敘事向度上表現較差，分別是主題維持、合理性 、背景資訊、評價、聯繫詞，及整體敘事類型，而在順序性及指涉能力兩向度的得分，和對照組並無顯著差異，顯示精神分裂症病患的敘事能力雖然較差，但仍能夠循序描述事件，並指明故事中所包含的人物與事物。詞彙分析顯示精神分裂症病患較少使用對比聯繫詞 (contrastive connectives) 及心智動詞 (mental verbs)。此外，本研究也發現，精神分裂症病患所描述的故事人物，相較於對照組所描述的故事人物更為平面，較少觸及人物的心理反應，此語言現象可能跟精神分裂症病患的心智理論能力退化有關。

The present study investigates the narrative story-telling of Mandarin-speaking patients with schizophrenia. Schizophrenia is a mental disease characterized by abnormalities in perception and expression, with disorganized speech being one of its representative characteristics. This study aims to provide a comprehensive characterization of schizophrenic speech in Mandarin. Narrative story-telling samples were collected from two groups of participants: the normal control group (20 participants) and the schizophrenic group (22 participants). Participants were asked to narrate three picture stories: (1) the Couple Story, (2) the Old Man and the Dog Story, and (3) the Frog Story. Narrative samples were analyzed using a Mandarin version of Narrative Assessment Profile (NAP), a profile analysis that was designed to evaluate discourse coherence in both typical and atypical speakers (McCabe & Bliss, 2003). Eight dimensions of the narrative performance were examined. They are topic maintenance, event sequencing, reasonableness, referential skill, background information, evaluation, conjunctive cohesion, and the narrative pattern. In addition to the discourse level analysis, lexical choices of specific connectives (causal connectives and contrastive connectives) and verbal predicates (perceptual verbs, psych verbs, and mental verbs) were computed. The study also includes an analysis of character representation within narratives. Schizophrenic narrators in this study had a significantly weaker narrative performance in both discourse level and word level. Their performance in six narrative dimensions (i.e. topic maintenance, reasonableness, background information, evaluation, conjunctive cohesion, and the narrative pattern) was significantly weaker. However, they seemed to preserve an intact ability to identify basic elements in narratives, performing comparably well in dimensions of event sequencing and referential skill. Lexical analysis showed that the schizophrenic group used less contrastive connectives and mental verbs when telling their stories, echoing the findings of NAP. Patients also demonstrated a more superficial character representation in narratives, from which the diminishments of language ability were related with the decline of Theory of Mind (ToM) ability.