背景：思覺失調症患者深受烙印之苦，烙印不僅影響患者心理、社會層面，更造成疾病防治的困難，身為精神衛生專業人員除了治療疾病本身以外，更應協助患者減少烙印造成的影響，然而患者接受到的真的是協助亦或另一種烙印的創傷？國內外均有研究顯示精神衛生專業人員對精神疾病患者的社會距離與烙印態度與一般社會大眾並無顯著差異，這意味著精神衛生專業人員烙印精神疾病患者的狀況事實上是存在的，再者，大部分的研究多著墨於精神衛生專業人員對精神疾病患者的烙印看法與態度，但較少直接探究患者被精神衛生專業人員烙印的親身經驗與感受為何。
目的：瞭解思覺失調症患者接受精神衛生專業人員服務時之主觀烙印經驗與相關感受。
方法：本研究採質性研究方法，研究對象納入標準為(1)由精神科專科醫師診斷為思覺失調症；(2)曾有精神科住院經驗或正在精神科日間病房住院者；(3)能以國語或台語溝通，且有適當口語表達能力，並願意表達主觀感受者；(4)精神症狀不影響會談者。並排除有暴力風險與有其它精神疾病診斷者。本研究計劃經臺灣南部某醫學中心人體試驗委員會審核通過，在取得研究對象同意後，由第一作者擔任訪談者與觀察者，以半結構之訪談指引進行面對面深度訪談。本研究於臺灣南部某醫學中心精神科門診、日間病房與社區復健中心，以立意取樣選定思覺失調症患者共10位。最後利用紮根理論分析方法進行資料分析。
結果：研究結果顯示「規訓的雙重桎梏」為浮現於資料之中的核心範疇，由四個階段組成：(1)相遇(Encounter)；(2)感受規訓的存在(Perception of the existence of discipline)；(3)判斷工作態度(Evaluation of work attitude)；(4)絆與伴—形成經驗(Trammels and companion—Form experience)
結論：結果有助精神衛生專業人員重新檢視自我對精神疾病患者之烙印態度，並作為理論發展的基礎。

SUMMARY
The purpose of this study was to explore the experience of stigma perceived by persons with schizophrenia within the premises of mental health services. This qualitative study was based on interviews with 10 schizophrenic persons. Data was analyzed with the grounded theory methodology. The main idea that emerged from the data analysis was a “Double bind of discipline”. The “ Double bind of discipline” is a four-part process in which persons with schizophrenia identify whether mental health professionals stereotyped them as schizophrenics or regarded them as human individuals. The process was successively: (a) Encounter; (b) Perception of the existence of discipline; (c) Evaluation of work attitude; and (d) Trammels and companion-from experience. In this study, the participants revealed an experience of stigma inflicted by the mental health professionals who were bound by their professional discipline.
INTRODUCTION
Persons with schizophrenia suffer high levels of stigma and discrimination. Stigma negatively affects people since it decreases opportunities by reducing social contacts, housing options, and employment opportunities. Further, stigma causes affected individuals to underutilize health care in order to avoid being stigmatized. Eventually, stigma may create barriers to their successful reintegration into society (Corrigan, 2005；Link et al., 1999；Link & Phelan, 2001；Thornicroft, 2006；Thornicroft, Brohan, Rose, Sartorius, & Leese, 2009). While mental health professionals are considered to be advocacy leaders for anti-stigma issues, they may hold many of the same stigmatizing attitudes toward mental illness as does the general public (Corrigan, Thompson, Lambert, Sangster, Noel, & Campbell, 2003；Sadow & Ryder, 2008; Schulze, & Angermeyer, 2003； Henderson et al., 2012; Wahl, 1999). Mental health professionals may be aware that they should not perpetuate stigma, yet persons who seek help for mental health concerns report that some of the deeply felt stigma they experience arises from their interactions with mental health professionals. Although most mental health professionals know stigma can significantly hurt persons with mental illness, they may not realize that stigma has been extended to the treatment and care they provide to patients, especially within recovery-oriented services (Delaney, 2012). Most of the literature on this issue focuses on mental health professionals as the main object. However little is known about the first-person perspective on the experience stigma of persons with schizophrenia when receiving mental health services. As such, the overall aim of this study was to explore the experience of stigma perceived by persons with schizophrenia in mental health services.
MATERIALS AND METHODS
The study was conducted in southern Taiwan. Qualitative interviews were used with the intention of capturing the personal experience of stigma of our participants. Before data collection the research plan was approved by the institutional board of the National Cheng Kung University Hospital. A purposive sample was non-randomly selected amongst prospective participants solicited from a medical center and a community rehabilitation centre from May 2015 to October 2015. The including criteria were persons who: (a) were diagnosed as schizophrenic based on the Diagnostic and Statistical Manual of Mental Disorder-Fourth Edition (DSM-IV); (b) had received inpatient psychiatric care or were being treated in a psychiatric daycare ward; (c) could communicate in Chinese or Taiwanese, had adequate oral communication skills and were willing to express subjective feelings; and (d) whose psychiatric symptoms did not interfere the interviews. Persons with schizophrenia who have a tendency for violence or acts of violence and have had other mental illness diagnoses were excluded. In-depth interviews were conducted with a semi-structured interview method. All interviews were taped with informed consent and ranged from 60 to 90 minutes. Data from the interview were transcribed soon after the interview. Finally, a total of 23 interview transcripts data were analyzed through the grounded theory methodology of Strauss and Corbin (1998).
RESULTS AND DISCUSSION
There were ten research participants including three who had been treated in a daycare ward, three in an outpatient department, and four in a community rehabilitation centre. Participants in this study shared numerous positive and negative experiences. A typology was constructed using a comparative analysis of self-descriptions from participants’ personal accounts. The main idea that emerged from the data analysis was a “Double bind of discipline”. The “Double bind of discipline” is a four-part process in which persons with schizophrenia identify whether mental health professionals stereotyped them as schizophrenics or regard them as human individuals. The process was successively: (a) Encounter; (b) Perception of the existence of discipline; (c) Evaluation of work attitude; and (d) Trammels and companion—from experience. In the first part, called Encounter, participants seek for mental health services because of the problems caused by their mental illness, therefore participants and mental health professionals encountered in psychiatric care related fields. In the second part, Perception of the existence of discipline, because of the power and status of mental health professionals, participants perceived the existence of discipline in mental health services. The third part, Evaluation of work attitude, is the way in which participants evaluated that mental health professionals treat patients in accordance with their professional discipline or their emotional investment. The results of Evaluation of work attitude provide the basis for the final part of the process, called Trammels and companion—from experience. The mental health professionals that participants classified as treating patients in accordance with their professional discipline seemed to define patients by their mental illness rather than regarding them as individuals. Therefore the study participants experienced stigma. On the other hand, the mental health professionals which participants classified as “Emotionally invested” validated them as individual human beings. Descriptions in the literature on the experience of stigma of persons with mental illness inflicted by mental health professionals support the findings of this study.
CONCLUSION
This study provided a perspective on the perceptions of persons with schizophrenia concerning their experience of stigma in mental health services. Data were analyzed through the grounded theory methodology. The main idea that emerged from the data analysis was a “Double bind of discipline”. The “Double bind of discipline” is a four-part process in which persons with schizophrenia identify whether mental health professionals stereotype them as schizophrenics or regard them as unique human beings. The process was successively: (a) Encounter; (b) Perception of the existence of discipline; (c) Evaluation of work attitude; and (d) Trammels and companion—from experience. “Double bind of discipline” means that it appears that mental health professionals have the power to impose a discipline to persons with schizophrenia, but they are also themselves bound by their professional discipline. Mental health professionals can’t go beyond their own professional discipline, which therefore also made the study participants feel bound by the caregivers’ professional discipline. As a result the participants experienced stigma. The results of this study can help mental health professionals to reflect on themselves in order to avoid an attitude that creates stigma and therefore improve the patient-healthcare professional relationship.

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