個人復元
「復元」著重復元人士在康復的過程中學習如何在社區克服生活上精神病帶所帶來的障礙,並活出一個有尊嚴並有意義的人生。「個人復元」翻譯自「personal recovery」。這個詞語既解作「恢復原狀」,更加是指「恢復元氣,從頭開始」。「個人復元」不只衡量復元人士是否回復原來的狀況(復原),更著重的是個人經歷、自我接納與成長,強調過程中萌生與生命力的再現,帶來正面的結果。
復元的來源
最初,個人復元的概念是由戒毒者的自助組織所提出,後來緊接著七十年代的復元人士運動,精神病復元人士的互助組織亦沿用了復元的理念。近年,復元概念經過不斷的修改與闡釋,不單盛行於自助組織,更獲應用在正式精神康復服務以及成癮服務系統上。本港現時正處於起步階段,一些服務機構以及醫院正在試行應用復元理念於精神康復服務上。
希望
這不代表對自己講一些看似很正面的說話,或是因為「我得你都得」,而是對將來存有希望和信心,相信痛苦會過去,只是暫時的。
整體性
精神病不是生命的全部,而「復元人士」只是自己其中一個身份,其中一部份。因此,明白自己在生命中會有不同的角色,建立不同方面的生活,著重身、心、靈以及社會參與,並照顧生活每一個部份,不單單是留意自己的病。
自主
讓復元人士有自主權去選擇自己所接受的服務,以及復元的路向。
個人化
由於每個人都是獨特的,復元人士亦會有不同的意願、能力,需要以及經歷,同時可能選擇用用不同的方式去努力。因此,就算患上同一個精神病,每個人都經歷都會有所不同,因此每個人都是不一樣的。
朋輩支援
透過有明顯改善的復元人士分享自己的經驗,互相鼓勵和學習彼此成功的經驗,同時著重同理心,不是抱著「我得你都得」的態度,而以用過來人的身份,明白大家的感受。
人際關係及社交網絡
家人、朋友、社區、或是信仰的團體能給予更多的支援,增強復元人士的歸屬感,放下不健康、不美滿的生活。
起伏中成長
復元的過程不是一條直線,中間會有起跌和挫折。重點是抱著開放的態度,從經驗中學習,並且相信這些經驗會令自己成長。正如身體的健康一樣會時好時壞,精神健康亦會好轉或復發。重點是跟自己的病共存,就算有病,都可能有一個富足的人生。
處理精神創傷
提供服務去支援有某些痛苦經歷的復元人士,例如經歷過暴力、性虐待、家庭暴力、戰爭、災難等,因為這些經歷常與酗酒、濫藥及精神健康問題等有直接的關係。透過提供服務及支持,能夠增加復元人士的生理及心理上的安全感,建立他們的信任。
重視個人優勢
重視個人的優勢,而不是病徵。復元人士在個人、家庭以及社區之中都有其優勢去幫助自己的復元過程。復元人士需要了解、重視及欣賞自己的優點,並發揮自己的長處照顧自己以及參加於自己的復元過程之中。
尊重
重視個人的價值及獨特性,並著重去尊重每一個人。社會及大眾對復元人士的尊重以及接納,能消除社會對復元人士的標籤和歧視,給予復元人士信心,幫助復元人士重新投入生活之中。而復元人士之間亦互相尊重彼此不一樣的地方。
希望
這不代表對自己講一些看似很正面的說話,或是因為「我得你都得」,而是對將來存有希望和信心,相信痛苦會過去,只是暫時的。
整體性
精神病不是生命的全部,而「復元人士」只是自己其中一個身份,其中一部份。因此,明白自己在生命中會有不同的角色,建立不同方面的生活,著重身、心、靈以及社會參與,並照顧生活每一個部份,不單單是留意自己的病。
自主
讓復元人士有自主權去選擇自己所接受的服務,以及復元的路向。
個人化
由於每個人都是獨特的,復元人士亦會有不同的意願、能力,需要以及經歷,同時可能選擇用用不同的方式去努力。因此,就算患上同一個精神病,每個人都經歷都會有所不同,因此每個人都是不一樣的。
朋輩支援
透過有明顯改善的復元人士分享自己的經驗,互相鼓勵和學習彼此成功的經驗,同時著重同理心,不是抱著「我得你都得」的態度,而以用過來人的身份,明白大家的感受。
人際關係及社交網絡
家人、朋友、社區、或是信仰的團體能給予更多的支援,增強復元人士的歸屬感,放下不健康、不美滿的生活。
起伏中成長
復元的過程不是一條直線,中間會有起跌和挫折。重點是抱著開放的態度,從經驗中學習,並且相信這些經驗會令自己成長。正如身體的健康一樣會時好時壞,精神健康亦會好轉或復發。重點是跟自己的病共存,就算有病,都可能有一個富足的人生。
處理精神創傷
提供服務去支援有某些痛苦經歷的復元人士,例如經歷過暴力、性虐待、家庭暴力、戰爭、災難等,因為這些經歷常與酗酒、濫藥及精神健康問題等有直接的關係。透過提供服務及支持,能夠增加復元人士的生理及心理上的安全感,建立他們的信任。
重視個人優勢
重視個人的優勢,而不是病徵。復元人士在個人、家庭以及社區之中都有其優勢去幫助自己的復元過程。復元人士需要了解、重視及欣賞自己的優點,並發揮自己的長處照顧自己以及參加於自己的復元過程之中。
尊重
重視個人的價值及獨特性,並著重去尊重每一個人。社會及大眾對復元人士的尊重以及接納,能消除社會對復元人士的標籤和歧視,給予復元人士信心,幫助復元人士重新投入生活之中。而復元人士之間亦互相尊重彼此不一樣的地方。
Source: Substance Abuse and Mental Health Services Association (SAMHSA, 2012).
個人復元與醫學模式的分別
個人復元與醫學模式的分別,可以簡單由基本概念、實踐以及目標去看:
基本概念
醫學模式
圍繞著科學性、病歷、診斷的結果、治療,以及醫護人員和病人的參與
個人復元
圍繞著人道主義,個人的經歷、意義、成長,並包括受培訓及有經驗的專家的參與(包括復元人士及照顧者)
實踐的方式
醫學模式
主要集中在疾病和病徵,以減輕病徵為基礎,鼓勵復元人士被動及順從地適應康復計劃
個人復元
著重了解個人情況,尊重復元人士的意願,以個人希望、目標及能力為基礎,讓復元人士學會自我管理,促進自主權
服務目標
醫學模式
目標為主醫護人員主導,控制病情,預防復發,並回到病前的水平
個人復元
目標由復元人士主導,提升全人健康,對自己我的控制,不單恢復,更有成長和轉變
*資料來源: Slade, M. (2009). Differences between traditional and recovery-oriented services.
雖然「個人復元」和「醫學模式」有著不同的地方,其實兩者是可以並存的。當我們推行「個人復元」時,不代表不去減輕病徵,亦不代表不重視治療的科學性、病人的病歷、診斷的結果、治療,以及醫護人員的參與等。
「個人復元」的突破
為什麼要推行「復元」?因為…
1.
復元指的是無論你的身體狀況如何,都可以有滿足而豐盛的人生: 復元不是單單減少/減輕病徵,更是能自己管理自己的生活,有滿意的學業/工作表現,以及社區參與。
2.
復元過程是一個癒合和轉化的旅程,復元人士可以自主地選擇,過一個對自己有意義的人生,實現自己的潛能。
3.
復元亦包括包容、尊重及減少患病對復元人士的負面影響的過程,讓復元人士發掘及建立自己的價值、興趣,建立一個不單是「精神病患者」的身份及生活。
在復元的過程之中,除了復元人士有所改變,照顧他們的人亦會一起經歷這些變化。因為在這個過程之中,不止是復元人士有情緒起伏,他們的家人、朋友或其他照顧者都會有感到不安、失落的時侯,亦有成長,感到有希望的時侯。 因此,「復元」包括了復元人士,亦包括了他們的家人/照顧者。

*資料來源: Davidson et al., 2009, SAMHSA/div>
社區支援
社會的支持對復元人士非常重要。有研究指出有足夠的社會支持能提升復元人士的心理健康、自尊心、自主權及倡導權、生活質素,從而有助個人的復元。接受過社區義工服務的復元人士亦表示感到更多的社會支持,而其全人健康亦有提升的趨勢。
復元與家屬的關係

1.
在復元的過程中,不只復元人士經歷個人的改變及轉化,家屬也一起經歷轉化。
2.
家屬會經歷不安、失落,但同時也會經歷成長,充滿希望的時候。
3.
復元的對象是一個整體,包括了復元人士和他們的家屬。
在明白復元的過程中,家屬可以
1.
參與培訓,學習如何協助復元人士 經過復元的過程;
2.
參與討論、策劃;
3.
參與及協助建立以復元為基礎的服務。
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