강요가 정신장애인의 회복에 미치는 영향

다국어 초록 (Multilingual Abstract)

Self-determination, an important human rights, means the making decisions for one's own life. However, the mental illness often result in serious social maladjustment due to their chronic and cyclical prognoses and most persons with mental illness tend not to accept the need for treatment because they can't recognize the existence of illness. The paternalism group is socially accepted with its view that limits autonomy of the persons with mental illness on a need basis for symptomatic recovery through optimal treatment. On the contrary, there are many who claim that limiting autonomy even for optimal treatment would lower the quality of life and eventually affect negatively on the recovery of the persons with mental illness. Thus, there has been a long battle in the mental health field between paternalism(the view in which patients' autonomy can be limited for optimal treatment of the persons with mental illness with neurological and cognitive symptoms) and right-driven view(the view that autonomy should be guaranteed in all people and should be respected in any case). The battle led to the debate over the results of forced treatment and previous studies also showed opposing aspects of positive and negative results.
Nonetheless, it is difficult to confirm the results of forced treatment without considering how the persons with mental illness also feel about coercion and forced treatment. Since different treatment results can be brought about from actual objective and external environments due to the uniqueness of each individual patient so that it is very important to examine the mediating effects of the perceived coercion by the persons with mental illness in the relationship between coercion treatment and recovery.
Based on the debate between paternalism and right-driven view, this study was done i) to examine how coercions would affect perceived coercion in the process of treatment, ii) to determine how coercion would affect recovery, and iii) to verify the mediating effect of perceived coercion on the effects of forced treatment on recovery.
This study is conducted interviews with 391 persons with mental illness who were either hospitalized or resided in the community. Coercion was divided into family and experts, depending on coercer and was divided into positive and negative coercion, depending on types of coercion. And recovery was divided into four sub factors including the purpose of life-related recovery, coping with disease-related recovery, hope/optimism related recovery, and the perceived support system. The controlled variables included the level of education, type of residence, presence of spouse, severity of symptoms, and diagnosis. The analyses used were correlation analysis, t-test, analysis of variance, regression analysis and sobel test.
The results of this study are as follows :
1. Based on the type of residence, community group is higher positive coercion by family and experts and perceived coercion than hospital group. In the case of the diagnosis, mood disorder group is higher coping with disease-related recovery than schizophrenia group.
2. There is a significant correlation the coercion by family and experts, perceived coercion and the recovery. The higher positive coercion by family and experts is, the higher four sub factors of recovery is. And the higher negative coercion by family and experts is, the higher perceived coercion is.
3. In a model that controlled all demographic factors, severity of symptoms and the type of residence, positive and negative coercion by family, and negative coercion by experts showed a significant effect on perceived coercion.
4. The effects of positive coercion on recovery were analyzed by controlling demographic and disability factors of the person with mental illness. When the severity of symptoms and the level of education were controlled, positive coercion by family and experts affected significantly on the purpose of life-related recovery. When controlled he severity of symptoms, coercion by family and experts affect coping with disease-related recovery. The effects of positive coercion on hope/optimism related recovery were analyzed by controlling the severity of symptoms, the level of education and the presence of spouse; positive coercions by family and experts affect significantly on hope/optimism related recovery. In the case of the perceived support system, the severity of symptoms and the level of education were controlled, and positive coercion by family and experts affect significantly on the perceived support system.
5. The effects of negative coercion on the recovery of the persons with mental illness were analyzed by controlling the demographic and disability factors. Negative coercion don't have significant effect on all four sub factors of recovery.
6. When the mediating effects of perceived coercion were analyzed based on the four-step procedures by Baron and Kenny, no mediating effect of perceived coercion was seen with any types of coercion and recovery including the purpose of life-related recovery, cope with disease-related recovery, hope/optimism related recovery, and the perceived support system.
The following implications were concluded from the results of this study.
1. When autonomy needs to be limited for unavoidable the mental illness, it is necessary to use positive coercion such as persuasion or appeasement rather than negative coercion such as violence or threats.
2. The priority should be controlling mental symptoms in which monitoring of these symptoms is needed on continually by strengthening clinical treatments including drug therapy and individual counselling.
3. Family education needs to be systematized further and a program for treating persons with mental illness considering their human rights is needed. Furthermore, services and policy support are needed for families of the mental illness to reduce their subjective and objective burdens.
4. It should be strengthen human rights education for mental health professional.

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 문제 제기 1
• 2. 연구 목적 5
• Ⅱ. 문헌 연구 7
• 1. 강요 7
• 1) 개념 7
• 2) 유형 8
• 2. 정신보건영역에서 강요에 대한 관점 13
• 1) 권리존중 관점 14
• 2) 온정주의 관점 15
• 3) 정신보건영역에서의 강요의 정당성 18
• (1) 선행원칙 19
• (2) 무능력원칙 20
• (3) 위해회피원칙 22
• 3. 회복 23
• 4. 강요와 회복에 관한 선행 연구 27
• 1) 강요행위와 지각된 강요 27
• 2) 강요행위와 결과로서의 회복 31
• 3) 지각된 강요와 회복 34
• Ⅲ. 연구모형 및 연구가설 37
• 1. 연구 모형 37
• 2. 연구 가설 39
• Ⅳ. 연구 방법 42
• 1. 조사대상 및 표집방법 42
• 2. 변수정의 및 측정도구 45
• 1) 강요행위 45
• 2) 지각된 강요 46
• 3) 회복 46
• 4) 증상정도 48
• 5) 진단명 48
• 6) 거주유형 48
• 3. 자료분석 방법 49
• Ⅴ. 연구결과 51
• 1. 주요변수의 기술통계 51
• 2. 인구학적·장애특성에 따른 주요변수의 차이 52
• 3. 주요변수 간 상관관계 56
• 4. 회복에 영향을 미치는 강요 요인 57
• 5. 가설검증 61
• 1) 강요행위가 지각된 강요에 미치는 영향 61
• 2) 강요행위가 회복에 미치는 영향 64
• 3) 지각된 강요의 매개효과 68
• Ⅵ. 결론 77
• 1. 연구결과 요약 77
• 2. 함의 82
• 1) 이론적 함의 82
• 2) 실천적 함의 84
• 3. 향후 연구에 대한 제언 86
• 4. 연구의 한계 87
• 참고문헌 89
• 부록 1 : 각 척도의 요인분석 결과표 102
• 부록 2 : 설문지 106