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婆婆吞藥昏迷，手足無措的我。

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事情要從多年前的某一天開始說起，我的婆婆不知什麼原因吞了二十幾顆安眠藥而昏迷，所幸在醫院待了一晚後清醒回家，婆婆突發的吞藥舉動嚇壞了家人。那幾年，婆婆也因帶狀性皰疹(皮蛇)的神經性疼痛反復發作，苦不堪言。當時曾與精神科醫師討論婆婆的狀況，醫師聽了我詳盡描述之後，表示婆婆是重度憂鬱症，這樣的狀況會妨礙工作、學習、睡眠、飲食等日常運作，無法享受過去喜歡的活動，而且有自殺的風險，需要住院。

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面對親人，即使透過自己的心理專業能夠理解和協助婆婆的狀態，但仍不免會陷入焦急，懷疑自己能做什麼？也更能體會當家人病情嚴重時，醫生的診斷能給家屬方向，不用像隻無頭蒼蠅般到處亂撞。再者，我也不忍心將婆婆送進醫院，想到婆婆怕生，處在不熟悉環境會不自在，若住進急性病房，家人只有特定的時段能去探望時，她會更恐慌害怕，反而加重症狀，屆時，醫生會視狀況加重藥量或打針讓她平靜下來，想到這裡我就怯步了。

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老年憂鬱症主要症狀

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在與銀髮個案諮商或與長者進行活動時，發現老年憂鬱症與其他年齡層的憂鬱症最大差別在於，這些長者們大多會抱怨身體疼痛、疲倦、全身無力、失眠、沒有食慾等「生理」症狀，不習慣甚至不知道如何表達自己心理的感受。臨床上，老年憂鬱性疾患的評估需要詳細的病史詢問和檢查，而他們常以身體不適的症狀取代情緒低落狀態，容易造成醫師判斷上的困難，也常被家人誤以為是一般老化的現象，而輕忽了他們的心理需求。再加上長者們容易出現記憶力變差的情形，例如忘記家裡地址和電話、忘記物品擺在哪裡，所以有時會跟老年失智症混淆。

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他們會覺得自己沒用，越來越悲觀和焦慮，對生活失去熱情，甚至不想活了。有時會突然出現失禁、疼痛感增強等情況，卻檢查不出哪裡有問題，長期無法改善症狀也讓他們倍感挫折；也擔心他人異樣的眼光，和怕造成他人困擾而不願出門。

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「房子都被堆滿了，整間屋子都是這樣，沒用了」婆婆握著我的手，看著我說。「衣服也沒得換了，沒地方晒，都被堆滿了…」婆婆持續擔憂甚至害怕地叨念著。坐在一旁的公公顯得面容憔悴和蒼白，本來明顯的眼袋變得更大了。

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老公蹲下身問婆婆昨晚有沒有睡好，婆婆說：「都沒睡。房子都被堆滿了，整龍都是這樣，工廠那邊，你二哥住的地方也沒有地方可以走，衣服棉被也沒地方晒…你看了就知道。」婆婆重複這些內容，老公安撫著：「好，我們看完醫生以後陪妳回去看看，看要怎麼整理…」婆婆嘆了一口氣。「沒辦法整理…真的…我沒有騙你。」婆婆邊說，雙手不斷顫抖，兩頰腮幫子也不自主地一直抽動。

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回到家後，只見家裡一如往常的乾淨整齊，婆婆卻指著屋子說：「你看，房子都被堆滿了，整龍都是這樣，沒用了。」老公說沒關係我們慢慢清，要婆婆帶我們去看什麼東西清不掉，婆婆說：「沒用啦！不可能！」在我們一再要求下，她帶我們上樓看，她指著床下的一大包雜物，說：「你看，怎麼清？」。

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那袋雜物在我們看來並不困難，當老公把它拉出時，婆婆極力制止：「麥黨（不要動），沒用了，清了也沒有效。真的啦！真的啦！房子都被堆滿了，整龍都是這樣。」婆婆焦慮拉著老公的手，從她驚悚的神情中，我嗅出空洞和死寂的味道。第二天大伯全家也回來了，一屋子有了人氣，婆婆對他們持續說著相同的話，很認真地要大家相信她。我發覺家人都在的時候，婆婆焦慮輕微了一點。

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老年憂鬱的可能原因

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那晚婆婆半夜起來想要將頭浸入盆內將自己淹死，幸虧公公聽到水聲後立刻起床制止，送急診後所幸無大礙。接下來每個週末，我們都回家陪伴兩老，透過與婆婆交談和觀察，發現平常公公喜歡外出參加活動，在家則是埋首於唱歌消遣，婆婆感到被冷落又不想說出來影響公公的興致。除此之外，孫子和孩子少回去，左右熟識鄰居又搬走，同輩親友陸續離世，逐漸感到不被需要和沒有生活重心。

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老年階段夫妻各自面臨老化、適應的方式和步調不同，婆婆面對當中所產生的認知差異和摩擦常隱忍過去，沒有適度澄清與溝通；加上體諒子孫的工作和學業繁忙，一再吞忍思念之心以及家人齊聚的盼望。

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不僅如此，這幾年來，婆婆也因自己會頻尿或是腹瀉的生理狀況而不願出門，沒人可聊天的情況下越來越缺少人際互動，婆婆開始陷入許多猜想，漸漸幻想也變得愈來愈真實，甚至出現妄想的精神症狀。

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她的精神症狀反應出她因長期慢性疾病與生理功能退化所產生的失落和無能感，以及老化令婆婆感到無助、依賴、孤單和死亡的威脅，都被他投射成家中被垃圾塞滿、無法清理的「無用」樣貌。那天去看完皮膚科，雖然醫生表示不是皮蛇而是黴菌感染，但在她的認知裡，她相信是壞運當頭，惡靈附身，病痛以及皮蛇的症狀加深婆婆內心的恐懼；認為得到皮蛇之外，自己還滿身細菌、臭味薰天，害怕被外人看見自己的不堪。對她而言，每遠離家門ㄧ步，就是逼自己曝露在大庭廣眾之下，並且遠離家中供奉的神明，對死亡的恐懼整個翻攪出來，這些恐懼也伴隨身體不自主的痙攣現象和恐慌症狀。

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在老年憂鬱照護的路上，讓我們一起「聆聽、面對、守護與合作」

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聆聽

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從婆婆精神症狀消失至恢復往日作息的過程，明白即使當她心理生病時也與我們一樣渴望被接納和被信任，而我們的言行都在傳遞對婆婆的「認同感」和接納程度。陪伴與照護在於深深的聆聽，那是一份願意好好聽對方說話，願意進入對方生命感受彼此同在的態度。

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面對

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幫婆婆的身體和腳丫子擦藥時，婆婆問：「妳不怕嗎？」我想她其實是要表達：「這病會傳染，我很臭，妳怎麼敢碰我。」我笑著說：「怎麼會怕，每天擦藥就會好了，而且妳是我媽媽，當然不會怕呀！」老公會坐在沙發上讓婆婆靠著他，他手攬著婆婆的肩膀，引導婆婆放鬆，常說失眠的婆婆，總是沒多久就睡著了。

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很多時候我們都活在自己恐懼的想像裡，當婆婆一次次看見自己所害怕的厄運不會降臨，同時也不會牽連家人，慢慢地，她感受到每一個人的關愛和重視，於是有了安全感和自信心。當照顧者／陪伴者願意面對與正視父母長輩的老年變化，一起與他們學著變老，感受彼此共同的想望，就會交織出溫暖的支持力量。

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守護

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看見家人們齊心照顧和陪伴的力量，感動之餘也焦慮事務繁忙下無法多回去陪老人家。透過正念靜心的自我照護，了解到自己若是覺得愧疚沒多陪伴老人家，反而陷入負面情緒中，讓生命的能量愈來愈低。

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這次危機事件讓我明白如果決定要陪伴另一個生命，就不要帶著自己的害怕、自責去陪伴，不要帶著自己的匱乏去陪伴，要好好守護自己的心，守住想要陪伴照顧婆婆的初心，停下評論自己做的好不好的批判，以及之後無限衍生的念頭。

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合作

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在精神藥物治療和家人多回去陪伴之下，半年後，婆婆開始願意出門做例行的散步運動，再過兩個月，她已經願意參加進香團，跟公公參加銀髮團健行活動。由於婆婆的精神狀況反反覆覆，也提醒我和老公重新檢視事務的安排，多回家陪陪老人家。

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陪伴父母親變老是ㄧ條漫長的路，如今，婆婆邁入80歲，已有輕微失智現象及生理退化，光是如何安置住處、是否請看護及是否送入照護機構等都倚靠家人之間的溝通協調，彼此學習體諒合作，分擔照顧責任，也尋求社會資源的協助，讓彼此共好。

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如何健康老化是我們一生的課題，身體機能退化伴隨而來的各種慢性疾病，以及如何影響心理層面的變化也值得我們在生活中仔細去觀察。願我們都嘗試多與人連接，走出自己習慣性的生活小圈圈，創造新的生活經驗，然後帶著一份理解和接受的心去迎接這些可能的挑戰。

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文/劉玉文 諮商心理師

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