在少了醫學背景知識的狀況下，一個人會如何主觀的「認為」（或不認為）自己生病了？我對此感到很好奇。一個人是如何「認出」自己進入了失序的狀態？
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前幾天剛讀完波蘭作家Stanislaw Lem的科幻小說《索拉力星》。萊姆有四本小說的主題是地球太空船接觸外星球，遇見外星「生物」，分別是《Eden》、《Fiasco》、《Invincible》與《Solaris》，可以說都是挫敗的故事，各有不同的方式與原因。如果在挫敗的原因中強調缺乏了解、無法溝通等等，那麼《索拉力星》把了解與溝通的問題帶到更深的核心，因為在索拉力星的海洋裡，一直蒙著一層無法以「理」破解的紗。人類要溝通的外星生物竟是深藏在人內心之自我的一部份。科學家們雖然拚命想以理性思維去解讀現象與生命型態，扯後腿的卻是每個人自己內心深處、理性之光無法找到的黑暗。
我們有多麼了解自己，我們如何與自己溝通？《索拉力星》給人類提出了一個問題：如果不能先了解自己的內在世界，我們能夠真正了解外在宇宙嗎？
𓍯𓂃 ֶָ˖ ࣪⊹
飲食失序（eating disorder）經常被視為是一種生活狀態（lifestyle）的選擇，事實上卻是多重成因且可能致命的疾病，這些疾病會導致個人受到飲食行為的高度困擾。對食物、體重、體型高度執迷也是飲食失序的警訊，常見的類型有厭食症、暴食症以及嗜食症。這些疾病可能造成患者低血壓、體溫過低、電解質失衡、心律不整、喉嚨受損、腸胃功能損壞、骨質疏鬆、牙齒腐蝕、脫水、腦部受損等，甚至可導致多重器官衰竭而死亡。
Eating disorders are often viewed as a lifestyle choice, but they are in fact multi-faceted and potentially fatal illnesses that cause significant distress in an individual's eating behaviour. An obsession with food, weight, and body shape is also a warning sign of an eating disorder. Common types include anorexia, bulimia, and binge eating disorder. These disorders can cause low blood pressure, hypothermia, electrolyte imbalance, arrhythmia, throat injury, gastrointestinal damage, osteoporosis, tooth decay, dehydration, brain damage, and can even lead to multiple organ failure and death.
台灣社會自1990年代末開始有一股新的趨勢，將追求健康視為全民的共同生活目標，追求良好體態的概念不再限於「女性追求美貌」，而是漸漸正當化為全民健康精神。這股以「健康」為號召的風潮，鼓勵個人透過運動、飲食控制、自我控管身體數值，加上將「肥胖病態化、醫療化」的相關論述來背書，增添了越來越多污名在「無法控制進食量」的情況及肥胖者身上。在這樣的社會風氣之下「連吃都不能控制，那你還能控制什麼」話中隱含的道德評價，成為許多人生活中持續存在的壓力。
Since the late 1990s, a new trend has emerged in Taiwanese society, making the pursuit of health a shared life goal for all citizens. The concept of pursuing a good physique is no longer limited to “women's pursuit of beauty” but has gradually been legitimised as a national health spirit. This trend, centred on “health,” encourages individuals to manage their bodies through exercise, diet control, and self-monitoring of body metrics. Coupled with the endorsement of discourses on “pathologicalizing and medicalising obesity,” this has added increasing stigma to those who “cannot control their food intake” and to overweight individuals. Under this social atmosphere, the implicit moral judgment in the statement, “If you can't even control what you eat, what can you control?” has become a persistent source of pressure for many people.
在醫療層面，1980-1990前後有些許變遷（有但不多）。1980年代前多在關注體質（即生物性因素如：內分泌）、心理（精神動力、人格特質）、家庭功能。而1990年代後，雖承認飲食失序為多重成因，以及社會文化對飲食失序可能造成影響（往往僅用「崇尚苗條身材的時尚潮流」帶過），但均非研究主軸，而是著重於描述患者的生理症狀和疾病成因，治療方式則持續以認知行為治療、家族治療、藥物治療為主要方向。
In the medical field, there were some changes around 1980-1990 (though not many). Before the 1980s, the focus was mainly on physical constitution (i.e., biological factors such as endocrine function), psychology (psychodynamics, personality traits), and family function. After the 1990s, although it was acknowledged that eating disorders have multiple causes and that socio-cultural factors may influence them (often only mentioned in the context of “fashion trends that idealise slender physiques”), these were not the main research focus. Instead, the emphasis was on describing patients' physiological symptoms and the causes of their diseases, and treatment continued to focus on cognitive behavioural therapy, family therapy, and pharmacological treatment.
醫學上，總是會傾向於將處於飲食失序狀態的個人視為患者或輔導個案，治療者面對的是「疾病」，飲食失序者如何在每日面對飲食問題並維持個人的生活秩序，皆不是關注的重點。如此一來，當然不易理解為何飲食失序者這麼的「固執」、「不聽勸」，並持續實踐著這些病理化的飲食行為。
In medicine, individuals experiencing eating disorders are often viewed as patients or counselling cases. Therapists deal with the “disease,” how individuals with eating disorders cope with their daily eating problems and maintain their personalorder remains outside the focus. As a result, it is difficult for the health providers to understand why individuals with eating disorders are so “stubborn,” “poor compliance,” and continue to practice these pathological eating behaviours.
「飲食失序」指的是受苦於失序飲食（disordered eating）且因為飲食而影響到生活秩序與功能的生活狀態；曾經歷飲食失序者，是指那些曾以飲食為生活主軸，且因此造成身心損害及生活失序，並為此感到受苦長達半年以上的人。
此刻我們以「生活狀態」而非診斷病名切入，用意在於反映「飲食失序」邊界模糊、不易定義的特性，並接納經歷飲食失序的個人對此狀態各種可能的詮釋。
“Eating disorders” refers to a state of life where persistent disturbances in eating behaviours disrupt a person’s ability to function in daily life. Those who have experienced eating disorders have suffered physically and mentally from living a life that revolves around “eating” for more than six months.
Here we are using the term “state of life” rather than a diagnosis to reflect the ambiguous and difficult-to-define nature of eating disorders, and to allow for various possible interpretations of this state by individuals experiencing eating disorders.
飲食失序有三個主要特色：遵循特定飲食規則、飲食失控以及清除行為。這三個特色會隨著個人生命經驗所形塑的特質與時間遞嬗而變化，造成不同程度的限制，並影響當事人的生命軌跡。
在這些限制下，飲食失序者必須不斷面對飲食秩序與一般生活秩序間的衝突，因而必須持續投入心力將飲食失序組裝入社會秩序之中。
Eating disorder has three main characteristics: adherence to rigid eating rules, binge eating/compulsivity, and elimination/compensatory behaviours (purging). These three characteristics can change over time, shaping an individual's life experiences and causing varying degrees of limitation, thus affecting personal life trajectory.
Under these restrictions, people with eating disorders must constantly face the conflict between personal eating orders (or habits) and the general order of life; therefore must continuously devote their energy to integrating their eating disorder into the social order.
飲食失序不是突然就發生的，而是一段漫長且難以明確描述因果關係與時序的歷程。飲食失序者往往是在一段時間內，不斷感到有「異狀」，生活功能受到程度不一的影響；再平凡不過的飲食活動，卻逐漸導致原有的生活秩序崩解。一開始，飲食失序者會試圖依照新的既有條件，重新秩序化生活，直到飲食的秩序再也無法與生活秩序整合，飲食失序者才終於認定自己異常。
Eating disorder doesn't just suddenly appear; rather, it's a long process where the cause-and-effect and timeline are difficult to describe precisely. People with eating disorder often experience a persistent feeling of “abnormal” over a period of time, with varying degrees of impact on their daily functions. The most mundane activities, like eating, gradually lead to the collapse of their life order. Initially, they attempt to reorganise their lives according to the new existing conditions, until the order of eating can no longer be integrated into their overall life order, they finally recognise that there’s something wrong.
但也有些飲食失序者，則是對自己的飲食方式沒有懷疑，但某天驚覺自己早已滑過了正常與失序的邊際，再重新審視時才會意識到生活中的不對勁。
Some people with eating disorders do not question their eating habits until one day they realise that they have already crossed the line between normal and disordered, and only when they re-examine their lives will they realise something’s off.
不過，飲食失序者通常都是從四個重要現象指認出自己好像有點「異常」。「不成比例的密集投入心力、時間與注意力在關於進食、食物熱量的思緒」，就是第一個飲食失序者指認的重要現象。由於過度專注於記憶、理解、實踐這些飲食規則，以及感受身體與食物間的關係，以致於愈來愈難以專注在眼前的事情。這種情況會從頻繁發生，到直接影響了個人的日常活動，然後逐漸失去自主性。
Nevertheless, people with eating disorders usually can identify themselves as “abnormal” based on four key phenomena. The first key phenomenon is “a disproportionately high level of mental effort, time, and attention devoted to thoughts about eating and food calories.” Because of this excessive focus on memorising, understanding, and practising eating rules, and on the relationship between the body and food, it becomes increasingly difficult to concentrate on the present moment. This can progress from frequent occurrences to directly impacting daily activities, and eventually leading to a loss of autonomy.
𒂗
「談過了？」他問。
「嗯。」
「結果呢？」
「沒有結果。我問你，為什麼所有事情永遠都不對勁？」
「因為當事情對勁的時候，我們總是不知不覺。」
๋࣭𓈒𓂂 𓈒
飲食失序檢驗問卷EDE 17.0D中的「過度專注」和強迫症中的「強迫思考」是類似的現象，而且飲食障礙症與強迫症有高度共病性。EDE 17.0D 中對「過度專注」的定義是「出現注意力受損」，並特指「過度專注於食物、飲食或卡路里」。事實上，「一直想」未必會讓當事者感到有異，但是當它進一步影響到那段時間的記憶時，就經常是指認自己失序的契機。例如驚覺自己「生活就是由吃組成的」「只記得不斷思考要吃什麼，以及不能吃什麼。」對這之外的事情都沒興趣。
The “preoccupation” in the EDE 17.0D eating disorder questionnaire is similar to “compulsive thinking” in obsessive-compulsive disorder (OCD), and eating disorders and OCD share a high degree of comorbidity. EDE 17.0D defines “preoccupation” as “the presence of concentration impairment,” specifically referring to “excessive focus on food, eating, or calories.” In fact, “constantly thinking about” may not necessarily make the person feel anything unusual, but when it further affects their memory of that period, it often becomes the trigger for identifying their disorder. For example, they may suddenly realise that “life consists of eating,” or “they only remember constantly thinking about what they want to eat and what they can't eat,” and have no interest in anything else.
「安全食物」是飲食失序者認為「可以吃」，吃下去不會感到害怕或焦慮的食物。除了每個飲食失序者認定的安全食物有差異之外，對遵守規則嚴格的程度也經常不同。某些飲食失序者在突發或難以避免的情境，能對規則妥協；某些飲食失序者則幾乎不容許妥協的空間。他們會努力避免生活日程、環境發生變化，以確保自己隨時能取得安全食物。
“Safe food” refers to foods that individuals with eating disorders believe they “can eat,” foods that they will not feel fear or anxiety about. Besides the differences in what can be categorised as safe food among individuals with eating disorders, how strictly they adhere to rules also varies. Some individuals with eating disorders are willing to compromise on rules in unexpected or unavoidable situations; others, however, allow almost no room for compromise. They will strive to avoid changes in their daily routines and environment to ensure they can always access safe food.
這些飲食規則也會以具身的方式干擾飲食失序者的注意力，即第二個飲食失序者指認的重要現象：「特殊的身體感」。例如身體「很脹」，讓他無法忽視那種感受；有些人會稱某些食物「不乾淨」，一旦吃到「不乾淨」的食物，就會嚴重腹瀉。有些人一旦違背了飲食規則，就會一整天心神不寧，什麼事也做不了。某些飲食失序者會描述類似有「異物」在身體裡的感受，「像一塊東西黏在身體裡面，好想把它挖掉」、「像有噁心的東西在身體裡面。」
These eating rules can also embodiedly interfere with the attention of those with eating disorders, which is the second important phenomenon identified by those with eating disorders: “a creepy physical sensation”. For example, a feeling of "bloating" that they cannot ignore; some people claim certain foods are “unclean,” and experience severe diarrhea after eating them. Some people become restless and unable to do anything once they break their eating rules. Some people describe a feeling similar to having a “foreign object” in their body, “like something stuck inside, wanting to dig it out,” or “like something disgusting inside.”
違背規則時的罪惡感或者「奇怪」、「髒」、「脹」、「恐怖」、「噁心」的身體感受，可能引起數小時至數天的焦慮和不適。若是這種焦慮感、異物感持續存在，「清除」（purging）行為就會是十分合理的選擇（清除罪惡感、清除身體的不適、清除違反規則帶來的問題），其中包括催吐、吃瀉藥或其它幫助排泄或阻斷吸收的食品或藥物、禁食、嚴厲節食、大量運動等作法。如果不想，或沒有能力進行清除，那最好的作法就是只吃安全食物（或什麼也不吃），避免暴露於「非安全食物」帶來的威脅中。
The guilt associated with breaking the rules, along with physical sensations of “eerie,” “filth,” “bloating,” “horror,” and “disgusting” can cause anxiety and discomfort for hours or even days. If this anxiety and foreign body sensation persist, “ purging ” is a perfectly reasonable option (purging the guilt, the physical discomfort, and the problems arising from breaking the rules). This includes induced vomiting, taking laxatives or other foods or medications that help with excretion or block absorption, fasting, strict dieting, and vigorous exercise. If the person doesn't want to or is unable to purge, the best course of action is to eat only safe foods (or nothing at all) and avoid exposure to the threats posed by “ unsafe foods. ”
它能解釋在後續的歷程中，為什麼放棄飲食規則對飲食失序者而言萬分困難，也能說明為什麼在治療過程中，飲食失序者常會被視為「固執」、「不合作」，而難以有所治療進展。即使反覆對飲食失序者進行營養知識的教育，也未必會改變他們的飲食行為，因為只要這些身體經驗和焦慮沒有解除，就不太可能停下那些控制飲食的行為。
This explains why abandoning dietary rules is extremely difficult for those with eating disorders in the subsequent process, and why they are often seen as “stubborn” and “uncooperative” during treatment, making it difficult to make any progress. Even repeated nutritional education for those with eating disorders may not change their eating behaviours, because as long as these physical experiences and anxieties remain, it is unlikely that they will stop controlling their diet.
「一旦開始吃，就停不下來」這種狀況聽起來與一般人一時嘴饞、吃了消夜、點心，或多吃了一些自己愛吃的食物有些相似，許多飲食失序者在最初面對自己違背意願進食的舉動，也會以一時嘴饞、貪吃、意志力不足自我解釋。區別嘴饞與飲食失序的關鍵，是意識到進食「失去了自主性」。
The feeling of “you can't stop once you start eating” sounds similar to a normal person having a momentary craving, eating a late-night snack, dessert, or overeating their favourite foods. Many people with eating disorders initially explain their involuntary eating as a momentary craving, overeating, or a lack of willpower. The key to distinguishing between cravings and eating disorders is a loss of autonomy over eating.
一個特徵是「恍惚狀態」，在過度進食的當下，某些飲食失序者會進入一種有些恍惚的狀態，並不是失去意識，而是過度放鬆，只對飲食過度投入，因而呈現既極度專注，又相當恍神的狀態。許多飲食失序者認為失控與先前嚴格的規則與控制是相關的，尤其是那些對於違背飲食規則會高度焦慮的人，更容易產生這種「厭轉暴」（厭食症轉為暴食症）的現象，或可稱之為「反撲」。
One characteristic is a “trance state.” During overeating, some people with eating disorders enter a somewhat trance-like state. It's not a loss of consciousness, but rather an excessive relaxation, an over-involvement in eating, extremely focused and quite absent-minded at the same time. Many people with eating disorders believe that the loss of control is related to previously strict rules and control, especially those who experience severe anxiety when breaking their eating rules. They are more prone to this phenomenon of “anorexia turning into bulimia,” or what could be called a “rebound.”
飲食失序者往往會失去「吃飽」的感覺，要吃到「痛」、「想吐」、「噁心」、「累」才會忽然「醒來」。這點與許多理論主張，身體在這種情況下是「缺席的」（absent presence）不謀而合，也就是身體不在主體意識之內。吃到身體痛了才停止，在此之前，失控的過程是「感受不到餓，也不知道飽，只知道一直吃」；心理學中稱此現象為「壞損現身」（dys-appearance）。
People with eating disorders often lose the feeling of being “full,” only suddenly “wake up” when they experience pain, nausea, vomiting, or exhaustion. This aligns with many theories that suggest the body is “absent-presence” in such a state, meaning the body is not within the subject's consciousness. They only stop eating when their body hurts; before that, the process involves “not feeling hungry or full, only knowing to keep eating.” In psychology, it’s called “dys-appearance.”
與「健康時身體無感」的狀態不同，「壞損現身」反映了慢性病患者在生病過程中，身體帶來的痛苦體驗，導致自我不再將身體視為「存在於世界」的工具（vanishing-body），而是變成了「必須去負擔與處理」的對象，身體作為一個「問題」出現在主體意識中。壞損現身常與「過度呈現」（hyper-appearance）並存或動態轉換，前者強調功能失調的痛苦，後者則是患者為了管理自身疾病而過度關注身體的狀態。
Unlike the state of “not having any special physical sensation when healthy,” “dys-appearance” reflects the painful experience of chronic illness, causing the self to no longer see the body as a “vanishing body” but as an object “that must be borne and dealt with.” The body appears as a “problem” in the person's consciousness. Dys-appearance often coexists with or dynamically intertransforms with “hyper-appearance.” The former emphasises the pain of functional disorder, while the latter is the patient’s overfocusing on the body in order to manage their illness.
𓈒𓂂𓏸
我覺得，人類就是一種喜歡控制的生物，一旦事情總是無法如願，前方無法預測，對此毫無辦法，什麼也掌握不住，就會感到痛苦。
人就是得感覺到掌握了什麼才行。醫學也是，也是人類假裝自己懂了這些生命現象，得做點什麼，不這樣不行。反正隔幾十年再以另一種言論推翻早期的，或在早期理論上加以演繹、添加細節，或是舊的又被翻出來當成新的，這樣就可以好好消磨掉好幾代人類壽命的時間了。
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疾病不一定會造成痛苦，造成痛苦的是那份「失序感」，因此，去了解這個「失序感」如何造成他的痛苦蠻重要的。畢竟這就是病人持續求醫（或嘗試各種自我治療的方法）的根本動機，以及病人的期望與醫生認定的治療出現落差的地方。
◬ ⟁ ⧋ ◬ ⟁
面對失控行為擾亂既有生活秩序時，他們為了恪守自己設立的飲食規定，可能會透過調整睡眠時間（例如感到飢餓時就去睡覺，以免醒著時不斷想吃）、吃少量的沙拉等方法，維持原有生活秩序與遵守飲食規則間的平衡，重新將失序的生活秩序化。
When faced with uncontrolled behaviour disrupting their existing life order, individuals with eating disorders may try to maintain a balance between their existing life order and adherence to dietary rules by adjusting their sleep schedule (e.g., go to sleep when they feel hungry to avoid constant cravings while awake) or eating small amounts of salad.
但隨著失控行為的頻率與強度持續增加，飲食失序者所能調整的方法及程度愈來愈有限，終至無計可施，不知還能如何調整。在生活秩序持續被破壞的情況下，飲食失序者終於確認自己幾乎無法掌握失控發生的頻率與失控時的狀態，只能在失控行為出現時，運用既有策略勉力掩飾失序帶來的影響，並且努力維持生活功能。
However, as the frequency and intensity of these uncontrolled behaviours increase, the measures and extent to which they can adjust become increasingly limited, eventually leading to a state of exhaustion and uncertainty about how to adjust. With their life order continuously disrupted, individuals with eating disorders finally realise that they have almost no control over the frequency and state of their eating behaviour. They can only try to hide the impact of the disorder using existing strategies when it occurs and strive to maintain their daily functioning.
飲食規則對飲食失序者的日常生活愈來愈重要，食物的意義與食物對身體帶來的影響，對飲食失序者而言也會隨之轉變，而這種轉變可能會讓飲食失序者做出失控或帶有污名性質的行為。飲食失序者在經歷失控時，往往產生自責、自我厭惡，並且擔心被他人發現，因此嘗試掩飾（covering）。因為在自我管控成為當代公民重要道德責任的背景下，與「管控失敗」連結的是個人的缺陷、道德上的瑕疵；這種自我厭惡及「污名行為」，是第四個飲食失序者指認失序的重要契機。
Dietary rules are becoming increasingly important in the daily lives of people with eating disorders. The meaning of food and its effects on the body are changing for them, and this change may lead them to engage in uncontrolled or stigma behaviours. When experiencing a loss of control, people with eating disorders often feel self-blame and self-loathing, and fear being discovered by others, thus attempting to cover it up. Because self-control has become an important moral responsibility for contemporary citizens, “fails to control” is linked to personal defects and moral flaws; this self-loathing and stigma behaviours is the fourth important trigger for persons to identify their disorder.
「污名行為」是在一般狀況下看似與進食沒有直接的關聯，也不是一般人會做的事情，需要放在飲食失序者對飲食/食物賦予的意義及個人感受下去理解。常見的是催吐、避食、因恐懼失控而丟棄食物、或者為了取得食物而不擇手段，如說謊、偷竊。這些行為往往是為了取回生活秩序才相應出現，是在經歷失序以前未曾發生過的行為。
“Stigma behaviours” are those that, under normal circumstances, seem unrelated to eating and are not things that ordinary people would do. They need to be understood within the context of the meaning that the person with the eating disorder attaches to food and their personal feelings. Common examples include purging, avoiding food, discarding food out of fear of losing control, or resorting to any means to obtain food, such as lying or stealing. These behaviours often arise in response to the need to regain order in life and are behaviours that did not occur before the onset of the disorder.
催吐是 DSM、EDE 17.0D 認定的診斷指標，也是許多飲食失序者判定自己失序的關鍵，但並不是每個飲食失序者都有能力催吐，或因其他原因無法催吐（找不到可以催吐的地點、沒有處理催吐的時間）。
Induced vomiting is a diagnostic indicator recognized by DSM and EDE 17.0D, and it is also a key factor for many people with eating disorders to determine themselves “disordered.” However, not every person with an eating disorder is able to induce vomiting, or may be unable to do so for other reasons (such as not being able to find a place to induce vomiting or not having time to do so).
對許多飲食失序者（特別是嚴格恪守飲食規則的人）而言，與食物共處是壓力極大的事，只要一有食物在身上，就會急著想要丟棄，尤其是非預期得到的食物（身邊的人請客、贈送的小點心），會急著丟棄或送人。
For many people with eating disorders (especially those who strictly adhere to eating rules), being around food is extremely stressful. They are eager to throw away any food they have on them, especially unexpected food (such as snacks given to them by others).
部分的飲食失序者（特別是受苦於過度進食衝動的人）則是會囤積食物以獲得安全感。
Some people with eating disorders (especially those suffering from impulsive overeating) hoard food in order to feel safe.
值得注意的是，行為本身並非讓他們感受到異常的主因，而是對「行為具有污名性」的認知（不想被人看見）。例如會因為「不想嚇到其他人」而避免被看見過量進食或嘔吐，但對於嘔吐一事卻未曾感到異常，因為當事者覺得這是「可控制的」。
It's worth noting that the behaviour itself is not the main reason they considered themselves abnormal; rather, it's the perception that the behaviour is stigmatised (they don't want to be seen). For example, they may avoid being witnessed overeating or vomiting because they “don't want to scare others,” but they don't feel abnormal about vomiting because they feel it’s “under control.”
相較於投入大量心思與精力在管理吃和體重、注意力不集中、失控或種種讓當事者覺得丟臉的污名行為，能夠被醫學診斷的器質性損傷或可以量化的身體數值異常，看似是最為明確的指標，但對於生理指標的重視程度，以及要重視哪些生理指標，往往與當事人如何詮釋自己的飲食行為的影響有關。若進一步詢問他們，某某指數不合標準與他飲食行為之間有何關係？他們也說不清楚。
Compared to investing significant time and energy in managing eating and weight, attention deficit, loss of control, or other stigma behaviours, medically diagnosable organic damage or quantifiable abnormal physical metrics seem to be the most definitive cues. However, the importance placed on these physiological metrics, and which ones to prioritise, often depends on how a person interprets the impact of their eating behaviours. If further questioned about the relationship between a certain abnormal index and their eating habits, they often cannot provide a clear answer.
例如「血壓過低」並不是每個人都會重視的事情，掉髮量的正常與異常也難以判斷，嘴唇發炎與吃得太少之間的因果關係也不明確。有些人在節食一段時間後發生停經、掉髮、容易瘀青和疲勞等生理症狀，會認為與自己吃得太少有關，是因為他們曾搜尋關於「過瘦」的資料。而這些生理症狀顯然不足以促使他們改變飲食行為，通常是直到發生「真的嚇到」的事件，才覺得「沒辦法這樣過一輩子。」例如有些人過度進食並且會刻意催吐，但從未察覺這是異常的行為，直到因催吐導致食道灼傷，有一段時間幾乎完全無法說話，吞嚥功能也出現障礙，才意識到自己出了問題。
For example, low blood pressure is not something everyone pays attention to, and it's difficult to determine whether the amount of hair loss is normal or abnormal. The causal relationship between lip cracks and eating too little is also unclear. Some people experience amenorrhea, hair loss, easy bruising, and fatigue after restricting their diet for a period of time. They may think these physiological changes are related to eating too little because they have searched for information about being “underweight.” Nevertheless, these concerns about physiological symptoms obviously do not seem serious enough to make them change their eating behaviour. Usually, it is not until a truly frightening event occurs that they realise, “I can't live like this forever.”
以上四種現象可能於失序歷程中同時存在，可能在某些時間點或重大事件後才被當事者認知為異常，也可能持續、中斷而又出現，有時是潛伏的隱憂，有時是生活的主軸。
The above four phenomena may coexist in the process of disorder, and may only be recognised as abnormal by the person at certain points in time or after major events. They may also continue, be interrupted and reappear. Sometimes they are latent worries, and sometimes they are the major theme of life.
對於進入飲食失序狀態的個人而言，解決飲食規則與既有生活秩序的扞挌，是他們生命歷程中需要持續進行的任務。飲食失序者根據其失序狀態不同，有不同程度的能力和經濟能力進行過度飲食、催吐，和遵守特定攝食原則。而在失序狀態下維持社會身分，以及與他人互動時的策略，就會是主要的挑戰。例如，經常需要為自己的飲食選擇另外想說詞、或考慮坦承自己失序的狀況；需要耗費大量心力在互動策略上。
For individuals experiencing eating disorders, resolving the conflict between eating rules and established life order is an ongoing task throughout their lives. Depending on the degree of their disorder, individuals with eating disorders possess varying abilities and financial resources to overeat, induce vomiting, or adhere to specific eating principles. Maintaining social identity and developing strategies for interacting with others during this disordered state becomes a major challenge. For example, they often need to choose alternative explanations for their eating habits or consider honestly acknowledging their disorder; they also need to expend considerable effort on interaction strategies.
注意到「不被看見失序行為」與「不被察覺失序」兩者並不相同，前者指的是不讓他人看見失序行為，後者指的是不讓他人意識到當事者處於失序的狀態。在難以避免與人共同進食，以及難以預料何時會發生失序行為的狀況下，大部分的飲食失序者都曾在他人面前表現過失序行為，例如避餐不吃、過度飲食、購買大量食物、丟掉吃到一半的食物等，但只要能找到適當的說詞，這些行為通常不會被與「疾病」或「失序」聯想在一起。
Notice the difference between “not being witnessed disordered behavior” and “not being perceived as disordered”; the former refers to preventing others from seeing the disordered behaviour, while the latter refers to preventing others from realising that the person is in a state of disorder. Given the challenges of avoiding eating with others and the unpredictability of when disordered behaviour will occur, most people with eating disorders have exhibited disordered behaviour in front of others, such as skipping meals, overeating, buying large amounts of food, or throwing away half-eaten food. However, as long as a suitable explanation can be found, these behaviours are usually not associated with “illness” or “disorder.”
嚴格地編織生活日程是很常見的做法，雖然有助於飲食失序者遵守嚴格的飲食規則，但有時過度飲食衝動突發的時間不易掌握，隨著發生的時間與情境、當時的主要身分與任務、經濟能力等限制，飲食失序者會需要以不同的方式取得食物，以及處理催吐的需求。最後，主要身分任務的優先性經常需要與飲食失序帶來的限制競逐，例如在課業表現上達成一定的成就，是作為學生的主要身分任務，但在飲食失序者的生活安排中，卻會隨著飲食規則帶來的限制與變化，優先順序會排在實行飲食規則之後。
Strictly planning one's daily routine is a common option. While this helps those with eating disorders adhere to strict eating rules, the timing of sudden overeating urges is sometimes difficult to predict. Depending on the time and context, their primary role and tasks at the time, and financial constraints, individuals with eating disorders may need to obtain food in different ways and manage the urge to vomit. Finally, the priority of primary role and tasks often competes with the limitations imposed by the eating disorder. For example, achieving academic success is a primary role and task for a student, but in the daily life of someone with an eating disorder, this priority may fall behind adhering to eating rules due to the limitations and changes in their eating habits.
這或許是飲食失序最難以被他人同理之處，大多數的人無法想像嚴格遵循特定飲食規則、過度飲食與清除行為，對於社會身分、人際關係、親密關係會有何影響？
This is perhaps the most difficult aspect for sufferers from eating disorder to be understood by ordinary people. Most people cannot imagine what impact strict adherence to specific dietary rules, overeating, and elimination behaviour would have on social identity, interpersonal relationships, and intimate relationships.
許多飲食失序者會以吸菸、毒癮這兩個他們認為帶有污名性質的惡習或癮頭為比喻，說明自己無法抗拒特定飲食行為的無助感，同時他們也會進行比較，表示菸、毒這樣的物質還有可能完全從生活中去除，或特意將自己隔離於某個環境以避免接觸。但每個人每天都必須面對食物，幾乎不可能將自己隔離於完全沒有食物的環境中。正是因為食物是人人必須攝取的物質，旁人（甚至連當事人自己都）不易辨認單次的飲食行為究竟有沒有問題？可不可以長久進行下去？這次的行為算不算是失序的一部分？
Many people with eating disorders use the stigma of smoking or drug addiction as a metaphor to explain their helplessness in resisting certain eating behaviours. They also make comparisons, pointing out that substances like tobacco and drugs can be completely eliminated from life, or that they can deliberately isolate themselves to avoid them. However, everyone must consume food every day, therefore, it's almost impossible to isolate oneself from food. Precisely because food is a necessity for everyone, it's difficult for others (and even the person experiencing the disorder) to discern whether a single eating behaviour is problematic, whether they can keep doing so, or whether this behaviour constitutes part of a disorder.
藉由「飲食失序」作為例子，希望能為追求健康的潮流與當今醫療產線化、商品化的缺陷帶來一些反思。個人認知的健康抑或失序，以及個人秩序與社會秩序的交織互動，究竟對個人與群體造成哪些影響？我們是否有可能調和出有效且可行的醫療或照護方式，減少浪費醫療資源，改變當前醫病雙輸的現況呢？
Using "eating disorder" as an example, this article aims to prompt reflection on the pursuit of health and the shortcomings of today's medical productisation and commodification. What impact does personal perception of “health” and “disorder”, and the interplay between personal and social order, ultimately have on individuals and society? Is it possible to reconcile these into effective and feasible medical care or management, reducing the waste of medical resources and changing the current lose-lose situation where both doctors and patients suffer losses?
最後以Mol（2008）提出「照護的邏輯」（the logic of care）作結：什麼是優質醫療？安妮瑪麗・莫爾在這本創新且引人入勝的著作中指出，優質醫療與「病患選擇」關係不大，因此，創造更多病患選擇的機會並不會改善醫療保健。
We end up here with Mol's (2008) concept of “the logic of care”: What is good care? In this innovative and compelling book, Annemarie Mol argues that good care has little to do with ‘patient choice’ and, therefore, creating more opportunities for patient to choose from will not improve health care.
儘管可以將尋求專業醫療協助的人視為顧客或公民，但莫爾認為，這種做法會削弱對醫療保健至關重要的思維和行動方式。良好的照護並非僅僅是做出經過深思熟慮的個人選擇，而是源於持續不斷的協作，旨在使「知識和技術」與「患病的身體」和「複雜的生活」互相適應。
Although it is possible to treat people who seek professional help as customers or citizens, Mol argues that this undermines ways of thinking and acting crucial to health care. Good care is not a matter of making well-argued individual choices but is something that grows out of collaborative and continuing attempts to attune knowledge and technologies to diseased bodies and complex lives.
莫爾並沒有批評她在田野調查中遇到的醫療實踐為「混亂」、「臨場應變」或「權宜之計」，而是明確指出背後的驅動力：一種巧妙的適應性和堅持不懈的結合。
Mol does not criticise the practices she encountered in her field work as messy or ad hoc, but makes explicit what it is that motivates them: an intriguing combination of adaptability and perseverance.
療癒應是療癒者與接受療癒的人一同合作，就既有的處境及資源考量，嘗試可能的生活方式，也尊重個人與疾病相處的狀態。在這個觀點下，「治癒」不再是唯一目標。
在許多人必須與慢性疾病共存的現代社會，個人的生活需求與隨時間變化的狀態，需要不斷調整與嘗試，在療癒者與患者的合作關係中持續前進。
Healing should be a collaborative effort between healers and those being cared for, considering existing circumstances and resources, exploring possible lifestyles, and respecting the person's coexistence with the illness. From this perspective, “cure” is no longer the sole purpose.
In modern society, where many must coexist with chronic diseases, personal needs and changing conditions over time require continuous adjustment and experimentation, moving forward through a collaborative relationship between healers and patients.
𓈒𓐍𓂃𓈒𓂂 ฅ^•ﻌ•^ฅ 𓂃◌𓈒𓐍𓂃𓈒𓂂
「你覺得為什麼你也經歷過那種事，你沒有發生飲食失序但是我有？」。
「我沒有想過這個問題。」他思索良久後說。
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這次的系列文章是從我看完《To The Bone》開始的。隔了這麼久，我終於敢看這個題材的故事。劇中的好多場景和對話，也實際發生在我人生過。也因為經歷了不同的社會角色，結果現在，我發現我可以同理那位厭食症女孩、可以同理那位女孩的母親、可以同理想要幫助女孩卻同樣無助的少年、也可以同理那位醫生。雖然同理也無法解決事情就是了。
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我猜我大概是一個，喜歡把生活中的大小事當作任務清單解決的人，那個事情「結案」、待辦事項清單上的東西減少的感覺非常重要。因為我必須藉此確保不會再有人向我追討。也許我安頓好那些事情後，我就能心無罣礙的做自己的事了。因此我發現，在工作中，我也總是在尋找一個......終點？......終點這個詞也不太對，總之我想要有完成的感覺，而且必須以某種正確的方式進行。但是在進入職場幾年後，我發現我找不到。這種感覺很恐怖，讓我想要逃跑。
好幾度我懷疑我能繼續做這個工作嗎？同時那種類似「鋼琴家再也無法彈鋼琴」的感受又是另一種恐怖。
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最近我終於比較能釋懷了，也意識到自己這樣也是一種想要「控制」，控制實際上無法控制的東西，那就是人與無常。
完全平衡的事情是不存在的，因為完全平衡就會完全靜止了。世界本來就沒有所謂合理或不合理可言，我們只是在混亂中或力挽狂瀾、或自我欺騙的爭取轉瞬的平衡而已。
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也許這就是我要的答案吧？
從「失序」中找到秩序
從不平衡中找到平衡
𓈒𓍼
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