無言的抗議──兒童心身症

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1996 / 10月

文‧張瓊方



一位美國生物學家指稱,現代人的許多病並非來自感染或受傷等因素,而是由於人類本身和環境格格不入……。

「心身症」是一種由心理影響生理的疾病,一般出現在緊張、焦慮的成人身上,本該無憂無慮的孩子,如今卻也罹患了這種文明病。使人不禁要問:生病的究竟是社會還是人?錯的究竟是大人還是孩子?

一位官員念國中的兒子時常肚子痛,經過各大醫院各種高科技的檢查,都找不出原因。住院觀察期間醫生發現,每當媽媽來看他時病就發作,媽媽不在時不但不痛還興高采烈地跟醫生打乒乓球。醫師跟父母詳談後發現,孩子的功課從小名列前茅,但能力分班進入前段班後,名次一下子掉到三抴X名,媽媽說:「三抴X名要怎麼跟人家考高中!」於是開始肚子痛了。醫生建議父母將他調回普通班後,肚子痛不藥而癒。

一位小兒科醫生的兒子每天早上就不明原因頭痛,資深小兒科醫師後來找出孩子得的是心身症。原因是家長有移民的打算,於是把孩子送進美國學校,孩子進入一個語言不通的陌生環境後,開始排斥上學,每到上學時就頭痛。

無病呻吟?

在小兒科這樣的病例層出不窮,馬偕醫院副院長黃富源指出,有些孩子臉會莫名的抽搐、不斷的眨眼睛,有的會口吃,這些都是壓力的表現。

心身症常透過神經肌肉的症狀來表現,如:頭痛、肚子痛、關節痛、胸痛、語言障礙等等。也有以腸胃症狀表現,如:消化不良、消化性潰瘍等等。對孩子來說,以腹部疼痛狀況出現的居多。

此外,情緒障礙、行為障礙也是心身症的表現。長庚醫院兒童心智科醫師吳佑佑指出,有些孩子的情緒緊張、焦慮、憂鬱;有些會有偷竊、打人或蹺課等不良行為,有的甚至會自傷。

至於歐美國家較常見的暴食症、厭食症,近年我們也有增加的趨勢。吳佑佑指出,她曾見過最小的病例是小學五年級的孩子。「現在美的標準就是瘦,我自己的女兒才五歲,就跟我說她不要胖,胖起來很醜,她要減肥。」她指出,這就是孩子受大環境影響的結果。

心事無人知

有些孩子以疾病來對抗壓力;有些則以菸酒、藥物來逃避,或犯罪、飆車等行為來抗議。

根據董氏基金會民國八怳T年所做的調查,我國青少年的吸煙盛行率為百分之怳說E六,青少年喝酒的盛行率為百分之二怴E五。調查顯示,第一次吸煙的年齡最常在小學五、六年級時,孩子們最常在「心情不好」時吸煙。在台安醫院的戒煙班中,最小的戒煙案例年僅九歲。

台大副教授陳建煒表示,菸酒經常是藥物濫用的「入門」,孩子通常從容易取得的東西入門以後,然後才會進一步使用非法藥物。

台大兒童心理衛生中心醫師丘彥南指出,有些兒童心身症是「一過性」的,問題解決就好了,不必大費周章;但如果是持續性的困擾,就需要諮商協助了。

罹患心身症的孩子並非無病呻吟或為了不想上學而裝病,而是真的感到疼痛。丘彥南指出,壓力會影響神經、肌肉收縮、血管的反應,讓人真的痛起來。

然而,病毒、細菌感染引起的生理疾病,經過檢查都找得出病因,心理因素引起的心身症則檢查不出外來致病原因。因此,罹患心身症的兒童,往往在四處求醫未果後,才會到兒童心理科求診。

治療心身症的孩子通常先給予止痛藥等「症狀治療」,必要時給予孩子一些「抗憂鬱」、「抗焦慮」的藥物輔助降低他的焦慮,對病情都有幫助。但找出壓力來源,調整大人的期待、教導孩子應付壓力的方法等才是真正治本之道。

p.22

聯考時節的最後衝刺一景,儼然是

「家庭總動員」,是不是每個孩子都能

承受升學、出人頭地的壓力?

越來越多的兒童心身症患者,

也是台灣文明的成果之一?

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EN

When the Mental Turns Physical--Childrens Psychosomatic Disorders

Chang Chiung-fang /tr. by Jonathan Barnard


An American biologist points out that when people get sick these days, it isn't necessarily because they catch something contagious or have an accident, but it is often because humanity doesn't get along well with the environment. . . .

"Psychosomatic disorders" are illnesses where the mind affects the body. Nervous and anxious adults are the most common sufferers, but even children, who are supposed to be so carefree, can fall victim to them. It makes you wonder: Who is ill, the patients or society? And is it a problem with the children or with their elders?

The son of a government bureaucrat who is in junior high school often had stomachaches. Although he went to various hospitals for all sorts of high-tech tests, no cause had been found. When he was in the hospital for observation, the doctors discovered that every time his mother came to visit, his illness flared up, and when his mother was away not only did he not feel any pain, but he happily played ping-pong with the doctors. When the doctors talked to the boy's parents, they discovered that he had always ranked among the top in his class, but when sections were divided according to ability and he entered the top class, his rank fell into the thirties, and his mother said, "If your rank is in the thirties, how are you going to test into a good high school?" That's when his stomachaches started. When the parents took the doctor's advice to put the boy into a regular section, the pain stopped.

The son of a pediatrician had a headache every morning for some unknown reason. One of his father's senior colleagues discovered that the child's problem was psychosomatic. Planning to emigrate, they had enrolled the boy in the Taipei American School, which was for him a strange environment where it was hard to communicate. As a result, he began to reject school, and got a headache whenever it came time for it.

Not faking it

There is no scarcity of such illnesses in pediatrics. Huang Fu-yuan, the vice superintendent of Mackay Memorial Hospital, points out that some children have inexplicable tics in their cheeks, blink constantly, or stutter. All are signs of pressure.

Psychosomatic disorders commonly come in the form of nervous or muscular problems, such as headaches, stomachaches, aching joints, linguistic blocks, etc. They can also manifest themselves as problems involving the digestive tract, such as poor digestion or stomach ulcers. For children, ailments like these with pain in the belly are most common.

Emotional and behavioral problems can also be manifestations of psychosomatic disorders. Wu Yu-yu of the children's psychiatry department at Chang Gung Memorial Children's Hospital explains that some children become nervous, anxious and depressed; others steal things, hit people or skip class; some even hurt themselves.

Bulimia and anorexia, which are common in America and Europe, have been on the rise here too in recent years. Wu Yu-yu says that the smallest sufferer she has seen was a fifth-grader. "Being thin is currently the standard for beauty. My own daughter is only five, and she has told me that she doesn't want to get fat, that being fat is ugly, that she wants to go on a diet." Wu notes that this is just the result of children being influenced by the greater environment.

No one knows my heart

Some children use illness to resist pressure; others escape by smoking, drinking and doing drugs; others protest by taking to crime or illegally racing motorbikes.

According to a study carried out by the John Tung Foundation in 1994, 16.6% of teenagers in the ROC smoke and 20.5% of them drink alcohol. The study revealed that the most common age to first smoke is in the fifth or sixth grade. Children most often smoke when they are "in a bad mood." The youngest-ever participant in Taiwan Adventist Hospital's smoke-out class was nine.

Chen Chien-wei, an associate professor at NTU, points out that tobacco and alcohol are the "entryway" to drug use. Children usually start with easily obtainable substances, and only then go a step further to illegal drugs.

The root of the problem

Chiu Yen-nan, a doctor at NTU's Child Psychology Support Center, points out that some children's psychosomatic disorders are "just a stage," and when the problem is resolved that will be the end of it. But if the problem lasts, it requires treatment.

The children who suffer from these psychosomatic disorders aren't feigning illness to get out of going to school. They are truly in pain. Chiu Yen-nan points out that mental pressure can affect the nerves and blood vessels and cause muscle contractions.

Physical examinations will reveal the causes of bacterial diseases or viruses, but they won't make sense of psychosomatic disorders. Hence, children who suffer from them will go from doctor to doctor before finally turning to child psychiatry.

Children diagnosed as having a psychosomatic disorder usually first take pain killers "to treat the symptoms." Often it is also necessary to give them some anti-depressants and anti-anxiety drugs. These help to calm their nerves, which is important when treating a psychosomatic disorder. But only by finding the source of the pressure and adjusting adults' expectations or by teaching children methods to cope with pressure can the problem be tackled at its roots.

p.22

A scene from the last leg of the joint-entrance exam marathon. The exams may involve a "general family mobilization" as here, but can every child bear the pressures to succeed academically? Are the growing number of pyschosomatic disorders among the children of Taiwan the downside of progress?

(photo by Hsueh Chi-kuang)

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