從治療室反思失業潮
作者: 張凱理 / 5300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

A Psychotherapist’s Reflections upon the Implications of Unemployment

張凱理醫師 Nov 4, 2001 

(1) some newsclips

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)
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)
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)
88年度中斷健保人數23萬677人, 89年度168萬4699人. (ETtoday, 5/1)

(2) business cycle (Juglar’s eight-year cycle)

A 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)

(3) When work disappears: the world of the new urban poor (William Julius Wilson, 1996)

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.

(4) Hardest Times: The Trauma of Long Term Unemployment (Thomas J. Cottle, 2001)

Holmes & Rahe’s Social Readjustment Rating Scale (SRRS):
Measure 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.


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.

The 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.

George barely ventured outside his home during his last months. He simply could not let himself be seen.

“You know what they call people like me?” George asked one after-noon returning from a meeting with several unemployed men.
“Long-term unemployed? Discouraged worker?”
“You’re not even close.”
“Depressed?”
“Well, that too?”
“Suicidal?”
“Who isn’t?”
“Am I getting closer?”
“You’re thinking too much like a psychologist. Think like a man.”
“They call men like you bums.”
”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.”

... 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.

After 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. 

The 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.

“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.

… 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. 

… 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. 

Brenner 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.

An unemployed man can become a quietly desperate and lonely man. … long-term unemployment is not something people readily speak out.

… 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.”

Might 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.

Almost 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.

In 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 …

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 … 

… 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?”

Men 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.

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 …


(5) adult development

early adulthood (20-40) / middle adulthood (40-60) / late adulthood (60>)

developmental lines (main concerns)
intimacy / love / sex
the body
time & death
relationship with children
relationship with parents
mentor relationship
relationship with society
work
play
finances

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 …
Clearly, work lies at the center of these so-called projects.

(6) family: the “no-longer secure” base

“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.)

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)

How 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 … 

… the reversal of gender role. … too many of the boundaries that properly differentiate family members have all but disappeared … 

Domestic violence
wife abusers share the following characteristics:
1. presence of alcohol
2. hostility toward dependency
3. excessive brooding
4. social approval
5. socioeconomic factors 
6. flashes of anger
7. military service
8. having been battered children (Larry Siegel, 2000)

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)


(7) relationship between unemployment and crime

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.
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)

(8) relationship between unemployment and suicide

Individual-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.

As 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.

To 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)

(9) years later … 

“lacking a father is like lacking a backbone”
The 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)


(10) Dealing effectively with job loss: A unique approach to rebuilding your life (Eileen Berman, 1999)

house of seven “C’s”: courage / confidence / confrontation / communication / choice / change / control

Bob 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.”
Bob 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.”
“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!”
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! 
Bob could hardly wait to get home to Annie and start work on their plans for the future. (ibid, p74)

(11) What can psychotherapists do?

“Don’t come at these guys too strong,” Alfred had advised.
“Tell them where you are and let them come to you. They’re
frightened. Treat them like cats. Stay still, and they’ll come to 
you. They want to, ‘cept they don’t know how to do it.”

set up anonymous hot line for consultation
set up low-fee (or free) walk-in clinic, and be there and wait …
and/or reach out
intent listening 
backed up with social and psychiatric services

facing such harsh external reality, what will be the most suitable
treatment model be like?

Appendix:: studies done in Taiwan
1. 失業成因之探討, 台大經研所, 劉亮吟, 1985.
2. 台灣地區失業率衡量之再研究, 暨南經研所, 陳招蓉, 1998.
3. 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.
4. 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.
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.
6. 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.
7. 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. 
8. 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.
9. 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.
10. 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.
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. 
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.

References:
1. Hardest Times: The Trauma of Long Term Unemployment, by Thomas J. Cottle, Praeger, 2001.
2. Absent Fathers, Lost Sons: The Search for Masculine Identity, by Guy Corneau, Shambhala, 1991.
3. Dealing Effectively with Job Loss: A unique approach to rebuilding your life, by Eileen Berman,
Engineering & Management Press, 1999.
4. Criminology, 7th ed. by Larry Siegel, Wadsworth, 2000.
5. Comprehensive Textbook of Suicidology, by Ronald W. Maris, Alan L. Berman, & Morton M., `
Silverman, Guilford Press, 2000.
6. The Interpreted World: An Introduction to Phenomenological Psychology, by Ernesto Spinelli,
Sage, 1989.
7. A Phenomenological Exploration of the Meaning of Work in the Context of Unemployment,
by Patricia Goodspeed, doctoral dissertation, University of Rochester, 2000.
8. Adult Development: A New Dimension in Psychodynamic Theory and Practice, by Calvin A.
Colarusso, Plenum, 1981
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«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

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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

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