The labelling of dissent - politics and psychiatry behind the GreatWall

The labelling of dissent - politics and psychiatry behind the GreatWall就是異議份子的標籤化，政治上的異議份子，在長城背後的政治與精神醫學，就是要講統治者在沒有民主自由的社會裏面去定義政治異議份子有病。所以在這樣的情況下精神醫學不再是客觀中立的醫學，他變成統治者的統治意識形態或統治工具的一個打手，這是一個實例，事實上在中國社會裏面，對待異議份子用精神醫學的方式去說明並不是中國才有，前蘇聯對待很多異議份子也是送到集中營與療養院，理由是他們的政治主張與主政者不同，就被定義成精神疾病，並給予精神治療，從監禁、吃藥，到電擊都發生在中國的法輪功事件。
在中國法輪功的統治人數超過中國共產黨黨員，對官方造成莫大威脅，雖然他們平合，採真、善、忍的思想去傳遞理念，但是當它力量龐大程度超過共產黨時，就形成了政治危機。在1999年的靜坐，就被認為是反動份子，挑動國家權威的反叛人士，從此以後法輪功就變成邪教，因此被逮捕的人就被認為怎麼會說這些話，被指涉成有精神疾病。
The practice of forced incarceration of political dissenters in psychiatric institutions in the former Soviet Union and Eastern Europe undermined the credibility of psychiatric practice in these states and drew forceful condemnation from the international community.
這邊講，透過精神治療的方式把異議份子關起來，進行治療強迫監禁，這種做法在以前的蘇聯跟東歐都有做，而這種做法破壞了精神醫療的可信度，這也引來過際社群的譴責。
Anti-psychiatrists would argue, however, that such forced hospitalisations are consonant with Western psychiatric practice, which conceptualises deviant behaviour in terms of mental illness.Whether or not one accepts that political power is intrinsic to the social role of a psychiatrist (Szasz, 1994), there is little doubt that the potential for exploiting psychiatry to reinforce social norms and even political interests, is enormous.
反精神醫學的陣營說到，這種強迫住院的方式其實跟西方的精神治療要處理的不同，西方醫療會定義會概念化偏差行為，解釋他是精神疾病，其實整個精神醫學不是控制異議份子的工具，而是精神醫學與政治有所共謀。不管你相不相信，精神醫學是有政治力量的介入，無論如何他的腳色就是執行一種政治力量，區分正常與不正常，這是Szasz在1994年所說的。接下來我們看，無疑的使用精神醫學來強化社會規範這件事情，是相當無庸置疑的。
The practice in China of labelling nonconformists as mentally ill has as long a history as the People’s Republic itself, but this abuse of psychiatric practice has hitherto received little comment in the West.
他說其實中國社會對於異議份子貼標籤的做法，跟中華人民共和國成立的時間一樣長久，但這樣濫用精神醫學的作法，西方社會卻很少批評。
The July 1999 crackdown by Chinese authorities against members of the Falun Gong movement has raised fears that political motivations are behind a new wave of involuntary committals of its followers to psychiatric institutions.
在1999年6月中國官方鎮壓法輪功成員，而產生巨大的恐懼，他們認為法輪功成員一定有政治企圖而強制的把他們拘捕，並送進醫療機構。
What is Falun Gong and why the crackdown?
Falun Gong (also known as Falun Dafa) is a popular movement that advocates channelling energy through mental concentration and exercises. It is a meditative discipline that draws from Buddhism, Taoism and the traditional Chinese doctrine of Qigong, and it has been valued for its mental and physical health benefits.
法輪功是一種強調法輪大法的宗派，法輪大法是一種非常普及的運動，他強調讓我們的能量透過心靈專注去引導這種能量，他是一種修行，一種打坐的冥思實踐。他是一種佛教主義，道教主義，氣功，結合三者形成一套身心功法。
to adhere to the core principles of truthfulness, compassion and forbearance.
他的三大原則就是真、善、忍
Initial Chinese government reaction to the increasing popularisation of this spiritual community in the early 1990s was positive.
最早的時候中國對法輪功是正面的。
By July of 1999, the government had announced that Falun Gong was a proscribed organisation and that it should be ‘outlawed and extirpated throughout China’ (Ministry of Public Security, 1999).
到了1999年6月，中國宣稱法輪功是一個違法組織，因該要嚴禁取締，這是公安部門所做的公告。
Amnesty International’s report in December 2000 stated that 77 members had died in custody since July 1999 as a result of ill-treatment, and it condemned the Chinese authorities for failing to investigate such gross violations of human rights (Amnesty International, 2001).
國際特赦組織再2000年12月做了一份報告，認為有77個法輪大法成員死亡，在1999年6月死亡。他們遭到虐待，國際特赦組織譴責這種侵犯人權的行為。
The scale of this abuse is in the context of an estimated 3000 people being sent to mental hospitals for expressing political views in the past two decades (Munro, 2000a). This toll surpasses even the excesses of the Soviet state psychiatric system.
有一種做法，濫用這種統治權威，將近3000人被送進醫院，因為他們表達過政治見解，這個數字遠超過當時的蘇聯對異議份子的監禁。
Approximately 70 million Chinese were practitioners of the exercises, a number which exceeded Communist Party membership at that time.
法輪功的修練者有七千萬人練過，比共產黨員還多
Chinese authorities have frequently asserted that Falun Gong is an ‘evil cult’ and have waged a propaganda campaign to discredit the movement and justify the group’s suppression.
中國將法輪功定義成邪教。Psychiatric abuse濫用精神醫學
A distinctive aspect of the Chinese government’s campaign against Falun Gong has been the forced incarceration of large numbers of its followers in psychiatric hospitals, despite evidence from families refuting the presence of mental illness in most cases.
強迫法輪功成員進入精神醫院，雖然有非常多的證據說明，這些家屬是拒絕接受精神疾病的診斷。
Since the crackdown began, it is estimated that at least 600 practitioners (Munro, 2000b) have been forcibly assigned psychiatric treatment, in an effort to compel them to renounce their beliefs.
自從鎮壓之後，超過600個信徒要接受精神治療，要你相信法輪功是邪教。
As government reports have acknowledged that increasing numbers of practitioners account for a growing proportion of admissions to institutions like the Beijing University of Medical Science.
官方報告指出有越來越多的法輪功信徒被送入北京醫科大學。
Accounts of treatment meted out in these hospitals make frequent reference to forced administration of antipsychotic drugs and electroconvulsive therapy (ECT), deep insertion of acupuncture needles, and physical and psychological deprivations such as the use of seclusion and physical restraints.
他們就是通過開藥，或者使用電療，或用針灸的方式，或是心理身理的虐待，把你監禁起來。
The socalled ‘concentrated reformation process’ involves forcing detained practitioners to write confessional statements renouncing their belief in Falun Gong, with this often being a precondition of their release.
所謂的治療就是不斷的改造，強迫監禁，並要放棄法輪功信仰。
The interweaving of the practice of forensic psychiatry and the workings of the judicial system in China has created a ripe climate for the simultaneous criminalisation and medicalisation of dissenting activity.
一個牽涉到法律，一個牽涉到醫學，在中國社會法律跟醫學共謀在一起定義一個異議份子，法律上讓你成為罪犯定義你成為罪犯，同時成為一個病人，精神醫學跟司法系統，一起結合成為統治者的工具，將意見不同的人定義成精神疾病。在現代法律當中如果你被判精神疾病，你就回沒有罪，主要接受治療，但中國則是予以控告有罪且有病。
Being heavily influenced by Soviet interpretation of mental pathology (Munro, 2000a), Chinese forensic psychiatrists have been all too ready to embrace a similarly wide concept of mental illness in general and schizophrenia in particular.
中國官方受到蘇聯的精神病理學的影響，他們使用精神醫學來廣泛定義精神疾病，甚至用精神分裂來對待異議份子。
This is redolent of the ‘reformist delusions’ said to have emanated from ideological dissenters whom Soviet psychiatrists branded as suffering from ‘paranoid psychosis’ (Wing, 1974).
這些異議份子被認為有一種改革的錯覺與幻想，蘇聯的精神醫學會天上標籤說你有偏執的精神官能症，這是1974的說法。
A forensic-psychiatric appraisal of those whose public behaviour attracted the attention of the authorities was made mandatory, under recent changes to Chinese criminal law.
中國的刑法，去注意到某些人的行為不符合官方期待，之後就用精神醫學來定義，來強制執行這種精神醫學判定。
Such detentions in psychiatric hospitals of people who have never been mentally ill by international standards are a clear abuse of the psychiatric process.
這樣的強制拘禁，在精神病院的治療，根本就沒有精神疾病，如果用國際公定標準根本就沒有，那中國精神醫學的倫理在哪。
Principles underpinning an ethical framework for the practice of psychiatry have been articulated in documents such as ‘Principles for the protection of persons with mental illness and for the improvement of mental health care’, which was adopted by the UN General Assembly in December 1991 (United Nations, 1991).
聯合國在1991年決議，精神醫學的實踐因該有一倫理上的原則，就是要保障精神患者的利益，改善他們的精神衛生的照顧，除此之外都是不正當的使用。
Principle 4 states that ‘A determination of mental illness shall never be made on the basis of political, economic or social status, or membership in a cultural, racial or religious group, or for any other reason not directly relevant to mental health status’.
聯合國大會的第四原則，判定是否為精神疾病不因該從你的政治、經濟，或是社會地位去判定，精神疾病不能用這些理由去判定，或是任何跟精神健康不相干的理由都不因該使用。所以中國的使用是不正當的。
That ‘non-conformity with moral, social, cultural or political values or religious beliefs prevailing in a person’s community, shall never be a determining factor in the diagnosis of mental illness’.
當有些人跟某些人的社會、文化、宗教信仰跟主流不一樣的時候，你不能當作決定性因素說你有精神病。
What can and should be done?
我們該怎麼做。
The term‘psychiatric abuse’, such as we usually associated with the practice of forced hospitalisation of dissenters in the former Soviet Union, was rightly regarded as a horrifying distortion of this medical speciality.
所以濫用精神醫學這個在蘇聯時期，強制異議份子住院的作法是一種醫療專業的恐怖扭曲。
As individuals, we must condemn the use of psychiatry as part of any apparatus of political repression and call on theWPA to investigate claims of abuse.
每一個人都因該譴責濫用精神醫學成為政治壓迫的工具，而這樣的做法是我們因該告訴世界精神協會來調查。
這是一個對待異議份子的例子。統治者也常常使用精神醫學，並聯合法律來處理異議份子，所以精神醫學是不是來規定正常與不正常的工具。

台灣報紙對精神病患烙印化之初探

台灣報紙對精神病患烙印化之初探 
The Stigma of Mental Illness in Taiwan Newspapers

王美珍(Wang Mei-chang)

政治大學新聞研究所碩士班一年級

摘要
社區復建體系難以建立。
危險而暴力的傾向。
最常出現的版面是「地方新聞」(44.7%)，
報導性質以「純新聞」(83.4%)為主，
報導主題以「暴力犯罪」(32.3%)，
以「警方」為主要消息來源(37.1%)，
報導語氣以中性或混合的比例為最高(49.8%)，負面居次(34.8%)，正面為最少(15.3%)。
超過一半以上的報導只描述精神病患的負面特質，共佔了65.2%，
強調的負面特質是「危險而具攻擊性的」(59.9%)，
報導中最常出現的缺失為「不必要的提及精神病的身份」(35.4%)，
十三年間的烙印情形，發現整體來說有逐漸改進的趨勢，但是當中仍有三年烙印的程度升高，而最近的92年尤其亦有再增高的趨勢，後續報導的態勢如何，仍需要關懷此議題的研究者持續觀察之。

壹、緒論
現今全球每四個人中即有一人在一生中遭受精神障礙的問題。
五個是因心理疾病的問題引起：包括憂鬱症、酒精依賴、精神分裂症、躁鬱症及恐慌症。
造成的「失能生命人年（DALYs）」，已佔各種疾病或傷害的11.5%，估計到了2020年還會上昇到15%。
媒體報導侵權，長期在犯罪新聞中斷然將犯罪行為「歸因」於精神病，對精神病患的人權造成極大的傷害。
包括媒體觀察基金會在內的數個民間團體，也發起了「不要叫我瘋子」的活動，說明精神病就是一種病，如同心臟病、糖尿病、牙周病一樣，不應被特殊化與污名化，亦強調精神病患的暴力發生率並沒有比一般人高，不應一有事故發生，就冠上「瘋子」的烙印，如此將精神病患犯罪化只會深對精神病患的誤解和歧視而已。

貳、文獻探討
一、烙印與精神病
烙印(stigma)一詞最早源於古希臘，當時的人為了區分一般人和其他道德上或行為上有缺陷或不正常的人，就在他們的身上「加標記或火印」，一生都無法抹去，以標示他們的不一樣，如罪犯、奴隸之類。
烙印更指向的是象徵性的意義，表示一種「社會建構的識別」，其含意偏向於羞恥而非實質的肉體標記。
Goffman認為，烙印代表了下等、被貶抑、脫離常軌、可恥、罪惡、邪惡等「腐敗的證章」，是一種當個人無法符合社會「正常」的情境或是偏離「社會期許」時，加諸於個人一種負面的評價。被烙印的人會被賦予一些屬性(attribute)，例如惡劣(bad)、危險(dangerous)或脆弱(weak)，其結果會使該人在我們的腦海中從一種一般、正常的認識便成以帶有污點和貶抑的眼光看待。
以最近台北縣康復之友精神病復健中心成立的居民抗議案件為例，居民抗議的反對的理由是：「精神病患在中庭、電梯等公共空間自由來去將對老人、小孩造成安全威脅，萬一病患跳樓、縱火、打人怎麼辦？」住戶在陳情書中也陳言：「精神病患皆為不定時炸彈，隨時可能爆發，『全體居民莫不為老幼婦孺與個人生命財產而驚恐』
「烙印」是由何而生？
媒體對精神病患的呈現影響了民眾對於精神病患的接收資訊，其是否強化了精神病患與常人的區隔。


二、 媒體、精神病與烙印
在電視部分，Wahl和Roth(1982)研究美國黃金時段的電視節目中精神病患的形象，結果發現精神病最常出現的形象是是「躁進的」(aggressive)、「思緒混亂的」(confused)、「危險的」(dangerous)、「不可預測的」(unpredictable)。而「穩重的」、「忠誠的」、「友善的」和「誠實」的正面特質則是少之又少。
Signorielli(1989)則發現72%主要時段節目對精神病的描述都是具有暴力傾向的，而其中有超過五分之一(21.6%)是殺人的描述。
戲劇中對精神病患角色的描寫最常見的包括貧窮、低水準以及比一般人智商低，而也被描述的精神疾病好像都被描寫的一模一樣，沒有什麼差異性。
報紙部分，多半被描述為「危險」的和「不可預測的」，且在頭版出現、被描述為危險人物的比率又比其他版面來得高。
從醫學的觀點來說，此種病患現實感喪失的狀況下造成病患自傷及傷人的危險性，值得注意的是，此種危險性涉及自殺或自傷的比例甚高，為一般人口自傷、自殺的100倍以上，然而涉及傷人或殺人的比例則極低，為一般人口的1/30以下。
即使是最危險的精神患者暴力發生率只有萬分之五，遠低於一般人一生中發生言語暴力或肢體衝突的機率。除此之外，即使精神病患有暴力行為發生，該行為也不一定單純是由精神病所引起，往往是還合併了其他的風險因素，如：酗酒、藥物濫用(substance misuse)等(Walsh,2002)。除此之外，也可能是受到嘲弄或是受害之後的反擊(Julio,2003)。
「疑似精神病患」、或「疑似精神異常」，以「不定時炸彈」、「瘋漢砍人」、「人魔發狂」等誇大、聳動字眼的形容精神病患，如此雖能吸引閱聽人注意，但卻也加深了民眾對精神病患的烙印與懼怕。
媒體簡化、粗糙和偏誤的報導就成了一枚烙印的圖章，不止刻記在所有精神病患的身上，也透過每日新聞的輸送，刻印在所有閱聽人的心中。

三、 研究重要性
這樣的誤解，不僅是對精神病患人權的傷害而已，其實也是對於全民健康安全體系的一種危害。因此反而簡化了社會精神病患漸增所面臨的精神病安養、復健及國人心理衛生與精神病患自殺率高的問題。
精神疾病的醫療及復健，是不可分開的一體兩面；目前世界上精神醫療、復健模式，均逐漸從以醫院為基礎（Hospital－based）轉向以也重視社區為基礎（community－based）的模式。
「社區復健」，是指「社區精神醫療」，也就是機構（醫院）外的治療，包括社區復健中心，庇護性工場、康復之家及居家照顧。
長期的社區照護系統，這已經是現代精神病醫護不得不可的趨勢8。如果媒體的報導烙印了精神病患，便會使社區居民排拒精神復健中心在社區成立，形成NIMBY(Not In My Back Yard)效應(Wahl,1993)，使得民眾抗拒在自家附近成立復健安養中心，最終會使得精神病患無路可去。

參、研究問題
媒體文本主要是透過偏頗的主題呈現、負面特質的強調和報導上的缺失造成對精神病患病患的烙印。
在監督聯盟或其他相關人權團體的努力下，也可能造成精神病患烙印化減少的情形。

肆、研究方法
研究方法：內容分析法。
研究範圍：「精神衛生法」頒布後(民國79年12月)至民國92年的新聞報導。
研究對象：中國時報、聯合報，以「精神病患」為關鍵字搜尋。
類目建構
1.報導出現的版面：
(1).政治/要聞/焦點
(2).地方/綜合
(3).社會/社會焦點
(4).醫藥保健/生活
(5).體育/綜藝
(6).國際/寰宇/兩岸
(7).民意論壇
2.報導呈現性質：
(1).純新聞
(2).特寫/特稿/專訪/社論
(3).專欄/短評
(4).讀者投書
(5)文藝作品
(三).報導的主題：
(1).暴力犯罪
(2).非暴力犯罪
(3).自殺
(4).(非犯罪的)特殊案件
(5).民眾態度
(6).精神病受害事件
(7).精神病患的相關活動宣傳
(8).個案探討
(9).權益探討
(10).政策法規
(11).醫療服務資訊
(12).疾病知識
(13).其他
(三).消息來源
(1).警方
(2).法官/檢察官
(3).民眾
(4).醫護人員
(5).社工
(6).政府官員
(7)學者專家
(8).精神病患者
(9).精神病患家屬
(10).外電
(11).記者
(12).未交待或不明確
(13).其他
(四).報導語氣：
(1).正面
(2).中性/混合
(3).負面：包括歧視、恐懼、道德判斷、醜化、嫌惡、貼標籤、排斥、使用特殊負面用語等。
(五).精神病患的特質呈現
1.一般描述：
特質包含對精神病之外觀、思想、行為的形容描述，區分為以下三類：
(1).正面：Ex.可愛的、乖巧的、工作努力的。
(2).負面：如暴力的、骯髒的、愚笨無能的、怪異的……等。
(3).無特別描述。
2.負面特質類型：
(1).危險、具暴力傾向的。
(2).無法控制的：強調行為的不確定性及不可預測、其他人的無計可施，但不一定涉及暴力。
(3).怪異的：例如：喝尿、在馬路上大吼等。
(4).沒有治癒希望的。
(5).難以照顧的。
(6).愚笨、無能力的：形容為笨拙、傻傻的、能力不足的。
(7).自我傷害的。
(8).流落街頭的。
(9).反社會的：
(10).製造麻煩、擾民的。
(11).羞恥的。
(12).悲觀的。
(13).骯髒的。
(14).歇斯底里的。
(15). 其他。
(六).報導中出現的缺失
(1).先入為主的精神病定義：
指並未經過醫師或家屬、本人等多方消息來源查證或未提及相關病史即以「精神病患」、「疑似精神病患」、「疑似精神異常」、「被疑有精神病傾向」、「可能是精神病患」稱之。
(2).使用聳動、誤導的標題或標題與內文資訊不一致：
標題使用煽動性、情緒性的字眼，或標題稱為精神病患但內文對象並不確定為病患而可能誤導視聽者。
(3).不必要的提及精神病患身份：
(4).語言使用帶歧視意味或貼標籤、誇大字眼：如「瘋漢」、「煞星」、「不定時炸彈」、「抓狂」。
(5).其他：不適於歸類於前述類目者。
(6).無以上缺點
肆、研究結果
一、精神病患報等呈現的方式：
(一).精神病患報導出現的版面 ：：「地方/綜合」(44.7%)、「社會/社會焦點」(29.1%)。
(二).精神病患報導的型態
在報導的型態上，以「純新聞」佔了絕大部分的比例(83.4%)，其他依次為「讀者投書」(6.4%)、「特寫/特稿/專訪」(5.1%)、「專欄/短評」(4.2%)、「文藝作品/書評/影評」（1.0%）。
二.報導主題
暴力犯罪，約佔了整個精神病患新聞報導的將近三分之一。
暴力犯罪與其他報導主題的比例極為懸殊，而暴力犯罪的高比例呈現，可能造成或加強一般民眾認為精神病患是具暴力傷人傾向的刻板印象。
，精神病患自殺的報導僅佔了3.8%，遠遠低於精神病暴力犯罪的報導比例，與實際精神病患自殺率高於一般人、而暴力犯罪不比一般人高的情況不符合。
三.消息來源
警方也意味著在媒體的呈現上精神病患往往被視為一種治安的問題。
警方並非醫護專業人員，在精神病患的認定與處理的角度上可能有偏頗或失當之處，而記者如果自身對精神病沒有足夠的先備知識，又在報導社會案件時過份仰賴警察作為唯一的消息來源而未從其他的角度進行平衡報導。
四.報導語氣
在正面語氣的部分，分佈的狀況與負面語氣相較則較為平均。
精神病患自殺的報導僅佔了3.8%，遠遠低於精神病暴力犯罪的報導比例，與實際精神病患自殺率高於一般人、而暴力犯罪率不比一般人高的情況不符合。
五.報導中呈現的精神病患特質
(一).一般分佈
(二).負面特質
『精神疾病患者被形容成「不定時炸彈」，但每星期義務指導十幾名精神疾病患者寫書法的朱硯清，卻不這麼認為。他說，不少患者對朱硯清說，大多數的精神疾病患者都很好相處，部分人的智商和學識甚至超越常人，課餘就有患者與他談鬼谷子、佛學、易經等。他們不但在上課時懂得尊師重道，偶爾在街上遇見也老師長、老師短地親切問候。⋯⋯』【2001-07-06/聯合報/18版/宜蘭縣新聞】

『 攻擊性精神病患就好比不定時炸彈。民國七十三年間，精神異常男子蔡心讓闖入台北市螢橋國小，以油漆桶裝滿硫酸液潑向正在上課的學童，蔡心讓雖然當場持刀割腕切腹自殺死亡，但有卅九名天真可愛的學童卻無辜受害，當時教育部長朱匯森趕到醫院看見病童在病床上痛苦呻吟．搖頭慨嘆歹徒沒有人性，也以「吃人的老虎」形容精神病患隱藏在社會人群中所造成的威脅和危害⋯⋯』【1997-06-26/聯合報/14版/綜合新聞】
六.報導中出現的缺失
『疑似精神異常的南投市老榮民陳達華，昨天下午涉嫌持斧頭追殺與他有嫌隙的鄰居陳文輝未果，一路瘋狂殺害攣生女童郭文琪、郭文瑜及另一老榮民楊茂發，並砍傷七人⋯⋯警方調查，陳X華(六十八歲)，住南投市民族路五百十六巷民權新村，疑患精神分裂症，曾與鄰居陳X輝(七十一歲)發生口角，昨天下午四時卅分，他忽然持斧頭涉嫌追殺在巷口閒坐的陳文輝，陳文輝及時逃避，僅左臂受傷⋯⋯』。【1992-04-19/聯合報/07版/社會新聞】

『（標題）「垃圾屋」惡臭 芳鄰欲抓狂疑似精神病患 屋內養鴿、狗 還堆廢棄物
（內文）中和市圓通路二五二巷的一棟公寓三樓，住著一位疑似患有精神病的陳姓男子，不但在屋內堆放大量廢棄物，還豢養鴿子和流浪狗，引起的惡臭讓附近住戶受不了，但各單位對於這種狀況，都表示束手無策⋯⋯同一樓層的趙先生表示，陳姓男子疑似有精神病，不斷的從外面撿垃圾回來放⋯⋯附近的錦中里里長廖清羅表示，陳姓男子平時還好，只是常常喝酒，喝了酒就很不正常⋯⋯【2003-10-30/聯合報/B2版/台北縣新聞】

(二).使用煽情、聳動的標題
『慘!慘!!精神病婦 殺害兩稚子 割腕獲救 酗酒 嗑藥 忘了我是誰 手持藍波刀 開腸 破腹』【1991-10-20/聯合報/07版/社會新聞】
『不定時炸彈連環爆 精神患者夜刺病友 一死一傷』
【1999-04-01/聯合報/09版/社會】
『精神病患遊走泰山街頭猶如不定時炸彈 鄉民膽戰』
【1991-01-06/中國時報/台北縣新聞】
『抓狂的煞星當街揮刀見人就砍殺死兩路人 中壢市傳命案,精神病患劉育華涉嫌行兇後企圖自殺,被捕送醫未脫險』
【1997-06-03/聯合報/07版/社會】

(三).不必要提及精神病患身份
『因患暴力型精神分裂症被送進省立玉里醫院祥和復健園區接受治療的丁正宏，前天深夜涉嫌持剪刀刺殺曾與他發生爭吵的病友⋯⋯』【1999-04-01/聯合報/09版/社會】

(四).語帶歧視、貼標籤

七.烙印化曲線分佈
民國86年全國性的精神障礙者組織中華民國康復之友聯盟成立，其目的都是要加強精神疾病的衛教宣導，保障精神疾患的權益。

伍、結論
民眾對精神病患懷有害怕與排斥的態度，導致復健體系難以建立。
造成自殺率的高昇。

Definitions and Meanings of Social Exclusion

Definitions and Meanings of Social Exclusion


Smyth and Jones (1999, p. 13) note the extent to which the term has been used to describe a broad range of social issues, including the marginalised position of women, disabled children, homeless people, ethnic minorities, young people and nomadic workers.

Smyth and Jones (1999, p. 13) note the extent to which the term has been used to describe a broad range of social issues, including the marginalised position of women, disabled children, homeless people, ethnic minorities, young people and nomadic workers.Within a socio-economic context where independence (or dependence on the labour market) is normative, those individuals who rely on welfare services for income support, housing etc. are easily labelled as deficient and seen to be responsible for their circumstances.

'… what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown' (Cabinet Office, 2000).

Policy from a social constructionist perspective can be seen as a process of argumentation wherein policy constitutes a representation of a political issue. In this context, social exclusion has been conceptualised as:
Disadvantage related to social economic and political norms;
The process through which disadvantage comes about; and
The outcome of processes of marginalisation.


Percy Smith (2000) notes that commonalties include definitions that identify: (i) multiple factors; (ii) the dynamic nature of social exclusion; (iii) policy frameworks; and (iv) views about the need for participation in mainstream society.
Benn (2000), pp. 314-317) notes that the social exclusion paradigm does little to challenge labour market trends towards casualisation and lower wages and, in encouraging people into the resultant low-paid employment, fails to adequately deal with poverty.

The capitulation and failure to address the fundamental inequities of late capitalism is seen by some authors to be a major flaw in the social exclusion discourse.

Ruth Levitas (1998), in an insightful and telling critique, notes the concept of social exclusion is the reduction of complex inequities and divisions into a simple dichotomy that ignores the inequities within the so-called excluded (e.g. the working poor) and minimises considerations of race, class and gender. Her work is critical in providing an analysis of the multiple meanings and political malleability of the term. Such flexibility has a political purpose in that different, often contradictory meanings of the term are used to inform policy that legitimates the current restructuring of social relations and ignores structural inequities, despite a rhetoric that acknowledges them.

Homelessness and Social Exclusion
For the most part, homelessness has been predominately explained at the causal level, however as a function of individual deficit, whether as individual moral failings (e.g. alcoholism, dysfunctional personalities, gamblers etc.) or victims of systemic inequities (e.g. labour market restructuring, housing market changes). In these explanations, the emphasis is on individual change or adaptation to societal norms and priorities.

Foucauldian concepts of discourse, power/knowledge and surveillance to pose a challenge to the construction of homelessness as a social exclusion.
need for researchers, policy and service provision to be more inclusive of the voices of homeless people in the development of both policy and services.

the concept of social exclusion has underpinned the establishment of policy units aimed at addressing the needs of identified groups of socially excluded.
using concepts from a social constructionist, and in particular Foucauldian, perspective on social policy.
the adoption of Chamberlain and Johnson's (2001) 'objective' cultural definition of homelessness


Chamberlain and Johnson (2001, pp. 39-40) argue a case for establishing an objective definition of homelessness based on an understanding of shared community standards of minimum housing requirements.

Within the context of the current discussion, previous observations (Watson & Austerbury, 1986; Keys Young, 1999; Watson, 2000) of the gendered and racialised definitions of homelessness are pertinent. Watson (2000) combines insights from Foucauldian and feminist theory to underline how such objective definitions make women's situation invisible while articulating the potential for developing more comprehensive and critical understandings of how homelessness is both constructed and constituted as a social problem.


These insights are significant in the context of the current discussion when one conceptualises explanations of homelessness as being characterised by the binary concepts, such as 'homed and homeless'. Robinson's (2002) discussion of the meaning of home that those officially or objectively defined as homeless attach to their spatial location underlines the significant shortcomings of objective measures in understanding the diverse experiences of those represented as homeless in policy, research and the media. Robinson's work stresses the importance of incorporating subjectivities and a subject's sense of space in any understanding of the experience of circumstances and is said to constitute the social problem of homelessness.

Exclusion is seen to be a particular property of populations that both symbolically and physically have no stake in society and pose threats to hegemonic principles of independence. Within the British context, such dependencies are to be addressed by programmes that '… assume citizens must exercise personal responsibility by taking up opportunities at school and in the labour market' (Crowther, 2002, p. 204),

A Foucauldian perspective sees welfare practice as a discursive practice in which definitions are contested and administrative, juridical and technical discourses can be seen as expert knowledges that separate the client from the professional. These can be challenged by the discourses of service users and clients (Fraser, 1989, p. 117). An analysis of discursive practices from a Foucauldian perspective translates the politics of needs interpretation, which characterises exclusion/inclusion paradigms to ones that can be seen as politics of discipline, control and subjectification.

homeless populations are constructed within social relations of power that totalise subordinated groups at the expense of a more thorough exploration of their heterogeneity.
the relationship between power and knowledge and how such a relationship is embedded in contemporary thinking and practices in service delivery to 'homeless' people.
that people unable to access resources that are considered necessary for full participation in society are labelled and constructed as excluded, dependent, disinterested and, in some cases, a threat to civic order.

customer service models and public management agenda contribute to a range of client constructions that individualise, and in some cases pathologise, client presentations. In many respects, the structural context in which poverty, social dislocation and disadvantage occur is reduced to the identification of disadvantage in individuals.

Policy discussions around social exclusion are primarily concerned with social cohesion and are characterised by the language of community (Everingham, 2001, p. 105) and a commitment to policies that seek to integrate atomised individuals.


Linked to these concepts are those of normality and otherness, which mark the social divisions and sites where borders of inclusion and exclusion can be drawn (e.g. homeless/homed).

Research and policy understandings of homelessness as social exclusion, while acknowledging contested definitions, assume the category 'homeless' as a given, although radically different explanations about causation, characteristics and potential intervention strategies are provided to address the 'problem'.


The accounts are derived from expert understanding (social scientists policy makers, service providers) and reflect a power/knowledge axis embedded in the social construction of homelessness as a social problem. Usually the experiences and knowledge of the persons who are the object of investigation are missed, or at least reconfigured through an expert gaze.

Foucault's understanding of discursive formation and power (Foucault, 1994a, pp. 326-348) assists in challenging the oppositions that underpin social policy formations based on hierarchical privileging of expert knowledges while creating the space for reclaiming subjugated understandings.

Within the context of homelessness as social exclusion, Foucault's metaphor of the panopticon (Focault, 1979, pp. 195-228) provides an alternative perspective through which to understand the construction of homeless clients. This is manifest as a highly ritualised use of power that identifies, classifies, categorises and subjects individuals to increasing levels of surveillance at the level of both policy development and service delivery.


From these identified problems, planning interventions can be developed and evaluated in terms of their effectiveness in returning individuals to 'normality'. These discourses contribute to the formation of the homeless person as object, with most concern being the management and surveillance of homeless populations in the form of data collection, instalment of support/rehabilitation programmes and the promotion of normative behaviours around independence.

The surveillance that the client undergoes informs a web of documentation and a discourse that serves to objectify and, in many cases, increase the gaze of the expert on the lives of individuals at the expense of broader frames of reference. Given the hegemony of these discourses, there are limitations to the extent to which programmes can be evaluated in terms that consider the distressing effects that broad structural changes have on the lives of people.