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「我活得很痛苦」憂鬱症女跳山崖自殺

才女林奕含驟逝！夫證實上吊自殺…留手寫遺書：對不起

疑似壓力過大 清大女學生在家自殺

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一般來說，民眾對於心理疾病如憂鬱症、恐慌症等的瞭解，大多來自新聞等傳播媒體中，被做為新聞點的消息，像是：自殺、傷害他人、無辜民眾等， 近期因為憂鬱症而選擇自殺的韓星雪莉，經常淪為新聞媒體爭相報導的話題。

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媒體在這些社會事件爆發後，報導時往往希望簡單的找到一個歸因，簡化許多行動背後的原因。 心理疾病，就成為常見的替罪羔羊，更甚者，基於讓新聞更有爆點，媒體會以較聳動、吸引觀眾眼球的方式，選擇性地述說整件事，這些都可能汙名化許多心理疾病，如：憂鬱症 、思覺失調症 等。不但對患者造成困擾；也讓民眾無法釐清事件的全貌，甚至讓民眾失去去理解、幫助這些心理疾病患者的機會。先前的文章著重在說明憂鬱症本身，接下來我們將與大家分享與憂鬱症相關連的行為與病症，請大家暫時地放下對於「自殺」的批判或現有看法，先一起跟著認識一些存在於我們周遭，但卻深受疾病所苦的人們的生命故事。

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憂鬱症與自殺

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 談及憂鬱症，我們就不得不提及自殺這個嚴肅的議題。研究指出，多達90%企圖自殺的人患有精神疾病，而近70%以上自殺身亡的人在執行自殺企圖時深受憂鬱症所苦，其中罹患憂鬱症自殺身亡的占比約為15%。由此可知，一個企圖自殺的人在邁向死亡前，憂鬱症似乎是自殺企圖者間其中一個共通的因素。但我仍需強調，並非所有企圖自殺的人，必定罹患憂鬱症，因此，面對身旁罹患憂鬱症的朋友，不需要草木皆兵，以免徒增患者的壓力，也造成自己的恐慌。

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那麼先退一步來說，你可能會想知道，為什麼罹患憂鬱症會讓人想不開呢？先前的系列文章中，我曾經提到，當一個人反覆的想到死亡，或是對於邁向死亡一事有所規畫，是憂鬱症其中一個典型的症狀以及判斷標準之一。不過，有些人可能會接著問，憂鬱症患者在情緒如此低落的情況下，幾乎已經了無生氣，哪會有那麼大的動力、那麼強烈的決心想要去做出這般致命性的決策與行動呢？用常理來想的話應該比較少見吧？

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是的！所以注意了，當憂鬱症的症狀逐漸減輕，決策力以及行動力開始攀升的時候，才更是我們需要關注憂鬱症患者自殺風險的關鍵時刻，因此，憂鬱症患者邁向康復的過程中，患者周遭的家人、朋友，對於此時此刻患者的言行要更加敏感，觀察是否有自殺意圖，才能有效地防止遺憾發生。

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再者，除了罹患憂鬱症所帶來的「無望感」很可能會產生傷害自己的想法之外；若是患者本身性格上較為衝動；或是經驗負向事件時刻意透過飲酒、物質使用等方式麻痺自我控制的能力，讓自己較容易執行危險的行動等；上述這些都可能預測一個人自殺的可能性。

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以心理學的觀點來看，一個人企圖自殺通常也具有某些「目的（功能）」，像是想要透過死亡引發他人的罪惡感、要脅周遭他人聽命於自己、逃避當前的壓力等。因此，若無法達到這些目的，也不會無故採取這樣激烈的手段，缺乏問題解決的能力，也很可能將一個人推往死亡的懸崖。

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 \t而以「社會文化模式」來了解自殺的話，像是：孤獨、缺乏社會連結與歸屬感，亦能預測一個人是否可能邁向自殺一途，所以我們也不難想像獨居老人、親密伴侶突然死亡、經歷職場或校園霸凌的朋友們會萌生輕生的念頭，甚至像現在人常見低頭猛滑手機，對周遭事物漠不關心，都有可能讓自己與這個社會、他人越來越疏離。

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若想有效預防自殺的發生，直接對於自殺進行處理，或是治療與自殺有關的心理疾病，如憂鬱症，就是一個好方法。當中，「認知行為治療」是被多數醫療人員所採納的方式，因為「對於未來的無望感」是自殺企圖者最常見的核心信念，他們在經驗到負向事件時，會覺得對自己現階段的問題與困擾無能為力、認定自己沒有價值，同時也不認為自己能夠持續忍受得了這樣的痛苦，因此才走向自殺一途。

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然而，透過治療過程，去同理當事人的情緒，並在長期的陪伴過程中，協助這些陷入負面情緒、無能為力感的人：指認、鬆動、重組該人的信念系統，就可能削弱其實際執行自殺行為的可能性。

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此外，很多人可能會有一個迷思，會覺得跟想要自殺的人談論自殺這件事，會讓這個人真的去做出些傷害自己的行為，因此經常對於自殺話題避而不談，其實並不見得，因為若一個人願意嘗試開始跟你談論自殺，意味著他可能足夠信任眼前的你、覺得某部分而言你可以幫得上忙。此時，我們能夠做的，其實是陪伴當事人「討論」自殺的想法與感受，這並不會讓當事人更想執行死亡計畫，反而因你的陪伴，他「孤單」的感受少了，反而內心多了份溫暖與支持。

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Reference

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湯華盛(2007)。精神疾病與自殺防治。臺北市：行政院衛生署 自殺防治中心

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李錦虹、劉同雪、陳坤虎(譯)(2011)。自殺防治：有效的短期治療取向(原作者：M. David Rudd, Thomas Joiner, M. Hasan Rajab)。臺北市：心理出版社。

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Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L., & Steer, R. A. (2006). Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. Focus, 147(2), 190-296.

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Greene, S. M. (1989). The relationship between depression and hopelessness: Implications for current theories of depression. The British Journal of Psychiatry, 154(5), 650-659.

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Minkoff, K., Bergman, E., Beck, A. T., & Beck, R. (1973). Hopelessness, depression, and attempted suicide. American Journal of Psychiatry, 130(4), 455-459.

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Rudd, M. D. (2006). The assessment and management of suicidality. Professional Resource Press/Professional Resource Exchange.

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作者：臨床心理師 董仲薇

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