聽到「心理疾病」一詞，你會聯想到什麼？心理健康、精神衛生、心理諮商……這些話題在近幾年都是熱門的關鍵字，似乎決定著現代生活的快樂與否。但在台灣，心理疾病被污名化是個常態——它被認為是丟臉、貶低甚至危險的代名詞。無論是媒體的渲染、健保政策的失責，還是亞洲價值觀的偏見，讓飽受其害的患者們更不願意站出來，進而無法接受治療，造成惡性循環。

那麼，這和《小熊維尼》又有什麼關係？

《小熊維尼》從1926年出版到現在，一路從繪本、卡通、動畫、錄影帶到大銀幕至今已經九十五歲。Winnie the Pooh不僅走進了我們的童年，對於我們的父母、我們父母的父母應該都不陌生呢。英國作家A. A. Milne 筆下的每個角色：貪吃的維尼、緊張的小豬、活蹦亂跳的跳跳虎、愁眉苦臉的伊耳、愛打掃的瑞比、老智者貓頭鷹……各個生動可愛，令人印象深刻。

利用這個穿越時代、國界的共同童年回憶，美國的心理學家分析了每個角色分別可能象徵的心理疾病。編者整理了兩個不同團隊分別在2000年和2015年對《小熊維尼》的研究，一起重新認識心理疾病吧！

科普心理疾病：DSM-5和心理健康

但在重溫百畝森林之前，先科普一下關於心理健康的知識。

DSM-5，中文譯為《精神疾病診斷與統計手冊》，是The Diagnostic and Statistical Manual of Mental Disorders的簡稱。手冊由美國精神醫學學會出版，提供心理疾病定義、種類分辨、症狀診斷，以及建議藥物治療。DSM-5的數字5則是指手冊版本；第一版於1952年出版，現今最新的第五版發佈於2013年。隨著醫療研究、科技和社會觀念的進步，DSM持續更新版本，提供最有助於患者治療的內容。

但必須記得的是，手冊也只是參考依據。臨床心理學有各種理論和方法，目前沒有唯一正確解答，也絕對不要替自己診斷，尋求專業協助才是解決之道。

《小熊維尼》中的心理疾病象徵

說回《小熊維尼》，早在2000年，戴爾豪斯大學的Sarah E. Shea教授和她的團隊分析了《小熊維尼》故事裡的主角們，用DSM-4的視角來解釋維尼、小豬、伊耳、瑞比、貓頭鷹、跳跳虎、袋鼠媽媽、小荳和克里斯多福。在2015年時，波爾州大學的Rachel C. Smith使用最新版的DSM-5再次打開童話故事書，重新詮釋這些受到大家喜愛的角色們。

以下節錄了幾個有趣的說法，一起來看看吧！

小豬Piglet – 焦慮症（General Anxiety Disorder）

對於許多事件或活動有預期性的過度焦慮或擔憂、經常處在高度緊張狀態、難以控制焦躁不安

“Piglet shows a lot of the symptoms of this disorder based on how he is in the stories. He is uncomfortable in all situations. He is always the one to express his worries. He stutters when he talks because he is so scared. He is always looking at the negative outcomes and bringing them up to everyone. He is always expressing that bad things could happen. He is constantly anxious and flustered. He is constantly shaking and has an unrealistic fear of everything. He does a lot of thinking and he really is just unsettled from everything around him. In the story “Piglet Is Entirely Surrounded by Water,” Piglet was stuck in a tree and the ground was flooding around him. He mentioned how anxious he was, and he kept worrying about things like when the water would reach his own bed.”

跳跳虎 Tigger – 注意力不足過動症（ADHD）

持續性注意力不集中、容易快速分心、組織計劃能力不佳、對於日常生活事項、對話、記憶力、時效期限感到困難、社交場合不適當的衝動：坐不住、動作控制失調等

Tigger shows a lot of the qualities of a character who has ADHD. He is always bouncing, and when he talks, he switches from topic to topic. He gets overly excited about activities. He can’t sit still, and he is always doing something. He can’t pay attention to one thing for too long. He is unable to focus. In the story “Tigger Is Unbounced,” the characters get together and try to get Tigger to stop bouncing all the time, because they get annoyed that he is always doing it and can’t stop moving.

伊耳 Eeyore – 持續性憂鬱症（Dysthymia）

持續兩年（自認或者觀察者認為）憂鬱、同時出現兩種或更多：食慾低落或暴食、失眠或嗜睡、絕望感、無精打采或疲勞、專注力差、自卑感、無望感

“Eeyore definitely shows a lot of symptoms of dysthymia. He is always upset. He expects bad things to happen, and he never has a positive outlook. He doesn’t try to be cheerful, and he accepts his state the way he is. He always looks at the negative side of things. In the story “Eeyore Has a Birthday and Gets Two Presents,” the story began with Eeyore looking at himself in the river and mentioning how pathetic he is. Throughout the stories, the characters mention how gloomy Eeyore always is.“

貓頭鷹 Owl – 失讀症（Dyslexia）

常人的智商、但識字和書寫困難、拼字和閱讀困難

“He misspells things, and he often reads things wrong. During one of the stories, he read that the word “school” was “skull” instead. In the story “Eeyore Has a Birthday and Gets Two Presents,” Owl writes “HIPY PAPY BTHUTHDTH THUTHDA BTHUTHDY.” It could be a play on the fact that owls are supposed to be wise. He might be wise, but he also might not be able to read that well.”

瑞比Rabbit – 強迫症（Obsessive Compulsive Disorder）

受某種強迫思維的推使，進行無意義的重複性行為、症狀分為：強迫思考、強迫行為，會造成患者極大壓力

Rabbit definitely has a lot of symptoms that could show him to have Obsessive Compulsive Disorder. He has a garden that always has to be in perfect order. He said that everything has a place, and he gets mad when anyone messes with that order. His house is super organized, and he is constantly cleaning it. He always has to keep everything in order. It almost seems methodical what he does. He doesn’t like things to lose their order or get out of place. In the story “Rabbit Has a Busy Day, and We Learn What Christopher Robin Does in the Mornings,” Rabbit woke up feeling the need to organize something, and he thought that everything depended on him.

克里斯多福Christopher Robin – 多重人格（Dissociative Identity Disorder）

多於一個人格、身分混淆無法連結、精神狀態複雜：記憶、情緒、感知混亂

“I think Christopher Robin has this because he has alterations in his memory, consciousness, and perception. He creates this entire world that he lives in, and it is almost as if he has one personality in the real world and one personality in the Hundred Acre Woods. He could have created this world and each of the characters in it. In this reality, he could have the personality of each of the characters. He isn’t entirely who he says he is, and he could have created these stories entirely in his mind because he plays the part of each of the characters. This is a way that he brings all the characters to life, because each of them is a different personality of his.”

維尼Winnie the Pooh – 暴食症（Binge Eating Disorder）

沒有飢餓感時，依然過量和快速的暴食、暴食後感到羞愧或不悅、通常在類似狀況下引發、無法控制或停止、甚至感到身體不適

“For Winnie the Pooh, he always is eating honey, and he always wants more. He is often seen doing anything to get it, even if it is dangerous. He is always talking about honey and carrying it, and he very often overeats when he is not hungry. After he eats a lot, he feels distress, like he just did something wrong. However, he wants to keep eating at the next opportunity.”

心理疾病是個光譜：正常看待

你有沒有過一種經驗，時隔好幾年再回頭看一本小時候看過的書、或一部電影，赫然發現它隱藏的意義？《玩具總動員》是給小孩看的，電影院裡的父母們卻感動得熱淚盈眶；從小看到大的宮崎駿，在十年前看到的是精采的冒險故事，十年後看到人類和大自然共生的議題。許多創造給兒童的作品背後常常藏著一些寓意，小時候看、長大後看的感受截然不同。

當然，創作者當初是否有這些深層意涵，可能已經無從考究，但或許世界上有人需要聽這些話。

Rachel C. Smith在報告的結尾寫到，心理疾病本就是個「光譜」，如果一個人表現出一些符合病徵描述的行為，並不代表他就一定是個患者。這也告訴我們：無論是自己、抑或是生活周遭的人，都可能表現一些心理疾病的病徵，但這並不是件壞事——也許它和童書一樣無害。

「我們小時候覺得《小熊維尼》中的角色可愛又無害；長大之後也發現，他們的確就是如此。雖然這些角色有許多明顯的病徵，但他們就跟你和我一樣。我們生活中一定有像跳跳虎、伊爾和袋鼠媽媽的人，而他們一點也不危險。」

「這給了心理疾病一個更實際的觀點。心理疾病不該背著社會汙名，而應該是相反的；如果我們能不帶任何負面想法的看一本童書，那我們應該也能用一樣的方式對待有心理疾病的人。」

預防勝過於治療：心理諮商

心理健康（Mental Health）是我們現代社會遇到的一大課題。2015年的一項研究預估，世界上14.3%的死亡跟心理疾病（Mental Illnesses）有關——這意味著一年大約有8百萬人的死亡與精神健康相關。根據衛生福利部最新的資料，台灣在2019年因為精神疾患就醫的人數較 2018 年增加了約 10 萬人。

預防永遠勝過於治療，因此在文章的最後，編者想聊聊「諮商」這件事。

你如何處理你的負面情緒？一個人在生活裡所扮演的角色有千百種，是學生、是同事、是主管、是朋友、是手足、是父母、是另一半……有時候實在讓人喘不過氣來。面對日積月累的壓力，突如其來的低潮，光是承認自己撐不下去了已經很困難，尋求幫忙更是難以啟齒。

如果沒有能夠傾訴的對象，或許可以考慮心理諮商。意識到自己需要幫助，並且採取行動並不簡單，Netflix影集《馬男波傑克Bojack Horseman 》裡有段話我一直記得：「Sometimes, you need to take responsibility for your own happiness. It takes a long time to realize how truly miserable you are, even longer to see it doesn’t have to be that way. 」

尋求幫助一點也不丟臉。心理疾病、心理健康的迷思破除的同時，心理諮商也應該被正常化。就跟定期的健康檢查和培養運動習慣一樣，心理諮商更能夠作為我們「維持」自己健康的方式，而不是等到重病才就醫的最後通牒。

雖然尚未被納入台灣的健保體制，但若預算容許，心理諮商或許是個很棒的投資。每個月我們會定期「進廠維修」：做指甲、接睫毛，有些人每週上健身房，固定補染髮根、不時換個新髮色——目的不外乎是維持自己最漂亮、最喜歡的樣子。絕世美女奧黛麗 · 赫本說過一句名言，Happy girls are the prettiest，獻給讀到這邊的你：在光彩絢麗的生活之餘，也別忘了關心自己的心理健康哦！