在門診診間裡，我們每天都在與疼痛對決。檢測報告上的數據、復健的進度、藥物的劑量，都是我們衡量康復的標準。然而，行醫久了，有時會在某些病患的眼神裡，捕捉到一種令人困惑的寂靜。
那是一種在得知病情好轉時，非但沒有鬆一口氣，反而閃過一絲抗拒與迷茫的眼神。
後來我才明白，在某些病患的潛意識裡，其實有一部分是並不想好起來的。
很多時候，無法痊癒的痼疾、反覆發作的疼痛所承載的，是無法言說的委屈與不甘心。因為內心的傷痕是看不見的，只好轉化成身體上的病痛與殘缺。
In the consulting room, our daily work is a battle against pain. We measure recovery by the numbers on investigation reports, the progress in rehabilitation, and the dosages of medication. Yet, after years in practice, I occasionally catch something confounding in the eyes of certain patients.
It is a look that surfaces the moment they are told their condition is improving—not a sigh of relief, but a fleeting shadow of resistance and bewilderment.
Only later did I come to understand that, deep within the subconscious of some patients, a part of them simply does not wish to get better.
More often than not, chronic ailments that refuse to heal and recurrent pains carry a weight of unspoken resentment and grievance. Because the scars of the mind remain invisible, they have no choice but to manifest as physical suffering and infirmity.
因為身體的痛苦是具象的、是無法被忽視的。當他拖著病體、當他無法拿重物、當他在深夜痛得呻吟時，他其實是在用這份肉體的折磨，向周遭那些曾經傷害過他、忽視過他的人，發出無聲且嚴厲的控訴：
「你看，你們把我害得有多慘。」
「你看，就是因為你們，我才會變成今天這個樣子。」
身體的病痛，成了他對抗不公的武器，也是他拒絕原諒的堅持。對他而言，如果有一天身體完全康復了，就好像要他完全放下過去的傷害，當作什麼都沒發生過一樣；康復，彷彿就代表著加害者可以不用再感到愧疚，而那份巨大的不甘心，將再也沒有安放的理由。
For physical pain is tangible; it refuses to be ignored. As they drag their ailing frame about, struggle to lift a heavy parcel, or groan in agony in the dead of night, they are using this bodily torment to hurl a silent, yet searing indictment at those who once wronged or neglected them:
“Look at what you have reduced me to.”
“Look at what I have become, all because of you.”
The afflictions of the flesh become a weapon against injustice, a steadfast refusal to forgive. To them, complete recovery would feel as though they were being asked to simply brush aside past hurts—to act as if nothing had ever happened. To heal would mean absolving the wrongdoers of their guilt, leaving that immense, aggrieved sense of injustice with nowhere left to rest.
他寧可保留這份痛苦，以此作為向世界索要道歉與關注的憑證。
身為醫者，我們可以用藥物緩解發炎，可以用手術修補結構，但我們往往治不好那顆因為不甘心而把自己鎖在疾病裡的心。要解開這個結，或許需要的不是更先進的醫療，而是病患終於願意對自己說一聲：「我的康復，不是為了原諒他們，而是為了放過我自己。」
They would rather hold fast to this suffering, using it as proof with which to demand an apology and a shred of notice from the world.
As clinicians, we can alleviate inflammation with prescription drugs, and we can mend structures through surgery, but we cannot cure a heart that has locked itself away within illness out of sheer resentment. To untie this knot, perhaps what is required is not more advanced medicine, but the moment a patient is finally ready to tell themselves: “My recovery is not an act of forgiveness towards them, but a reconciliation with myself.”
在我的門診裡，有位 64 歲的婦人。高血壓、頭痛、胃酸逆流、喉嚨總像卡著一口痰，外加嚴重的失眠與噩夢。她的生活被綑綁在方圓幾公尺內，日夜照顧著一位 90 多歲、極度黏人的公公。每次看到她，她總是滿臉疲憊地坐在診間，像一盞快要燃盡的油燈。
為了幫她找回一點生活的主控權，我絞盡腦汁。考量到她沒體力、無法出門，我幫她設計了最簡單的處方：和先生下象棋，或是用一張紙、一支筆，在家就能寫心流筆記。我仔細地把方法寫在紙上遞給他們，那時刻，夫妻倆眼神裡是有光的，承諾回家一定試試。
In my consulting room sits a sixty-four-year-old lady. She presents with a cluster of chronic ailments—hypertension, headaches, acid reflux, a persistent sensation of phlegm caught in her throat, compounded by severe insomnia and nightmares. Her life is rigidly confined to a radius of just a few yards, bound night and day to the care of her ninety-something, deeply dependent father-in-law. Every time I see her, she sits in the clinic chair thoroughly exhausted, resembling a lamp whose oil is all but spent.
Wracking my brains to help her claw back some semblance of control over her life, and knowing she lacked both the stamina and freedom to leave the house, I devised the simplest of prescriptions. I suggested playing chess with her husband, or taking up 'flow journaling'—an exercise requiring nothing more than a sheet of paper and a pen, easily done at home. I meticulously jotted down the steps on a piece of paper and handed it over; at that moment, a spark caught in the couple's eyes, and they promised me they would give it a try.
然而，幾次回診後，先生無奈地說：「方法都知道，但她就是不做，沒用啦。」而婦人則低著頭、幽幽地抱怨：「我先生又不陪我下棋，一個人怎麼玩?」當我提醒她還有不需要別人也能做的心流筆記時，她沉默了，找了個「不知道這有什麼用」的理由推託。
那一刻，看著她依舊滿身的病痛與無精打采，我突然在挫折中看到了，她不是「做不到」，她是潛意識裡「不能做」。
Yet, upon her subsequent reviews in clinic, her husband remarked with an air of helplessness: “We know what to do now, doctor, but she just won't do it. It’s no bloody use.” The lady, keeping her head bowed, muttered a faint complaint: “My husband won't play chess with me anyway. How am I supposed to play on my own?” When I gently reminded her of the flow journal—an exercise that required no one else—she fell silent, dismissing it with the excuse that she "couldn't see what earthly use it would be.”
At that moment, looking at her ailing frame and profound listlessness, a sudden realisation pierced through my frustration. It was not that she could not do it; it was that, in her subconscious, she must not.
對這位長期被照顧責任壓得喘不過氣的婦人而言，滿身的痼疾其實是她身體最後的防線，而她在現實中被困住，噩夢只是白天的延伸。病痛，成了她在這個家裡唯一能夠正當罷工的理由。 只有當她是一個徹頭徹尾的病人、一個虛弱到無法起身的受害者時，她才能合理地對世界、對先生發出無聲的控訴：「你看，是你們把我折磨成這個樣子的。」
如果她真的照著醫生的話做了，如果她真的因為寫筆記、下象棋而有了笑容與活力，那麼在家庭的共病結構裡，大家就會預期她「好起來了」，她將失去所有示弱與索求關懷的權利，必須繼續毫無怨言地當那個完美的照顧者。
To this woman, suffocating under the endless yoke of her caregiving duties, her myriad of ailments served as her body’s final line of defence. Trapped in her waking reality, her nightmares were merely an extension of her days. Illness had become her only legitimate grounds for strike action within that household. Only by being a patient through and through—a victim too frail to rise—could she naturally hurl that silent accusation at her husband and the world: “Look at what you have reduced me to.”
If she were to do as the doctor advised, if she were to find a smile and a spark of vitality through journaling or chess, the codependent machinery of her family would immediately assume she was “cured.” She would lose all right to show vulnerability or to ask for comfort; she would be expected to return, without a murmur of complaint, to being the perfect carer.
身為醫生，我能開藥、針灸、為她量身設計心理練習，但我卻治不好一個必須用生病來換取喘息的靈魂。她的病與其說是不治之症，更像是她對這個困住她的一生，最無力也最沉重的抗議。
當內心的委屈、憤怒與不甘心無法用言語被聽見、被承認時，身體就成了最後的戰場。留著病痛，往往是病患潛意識裡對加害者或環境最嚴厲的懲罰。（用我的殘缺，來定你的罪。）
As a physician, I can prescribe medication, administer acupuncture, and tailor psychological exercises to her needs, yet I remain powerless to cure a soul that must rely on illness just to catch its breath. Her afflictions are not so much an incurable disease as they are a silent, crushing protest against the life that holds her captive.
When the inner weight of grievance, anger, and resentment cannot be voiced or acknowledged, the body becomes the final battleground. To cling to pain is often the subconscious mind’s most severe punishment inflicted upon one’s tormentors or surroundings. It is a silent decree: “I use my infirmity to condemn you.”
這種現象，即是疾病的次級獲益（Secondary Gain），和身體化障礙（Somatization）的體現。
無法言說的心理痛苦，轉化為真實的生理症狀。而雖然承受著痛苦，但病痛帶來了免除責任、獲得關懷或對他人的道德制約。
康復意味著「沒事了」，這在潛意識裡等於強迫他原諒那些傷害他的人或環境。為了不讓加害者脫罪，他選擇與疾病共存。
This phenomenon is a manifestation of what we call ‘secondary gain’ and ‘somatization.’ It is the process by which unspeakable psychological torment is transmuted into genuine physiological symptoms. Yet, despite the very real suffering it inflicts, the illness brings with it certain redemptive benefits: an exemption from duty, a claim on the care of others, or a powerful moral hold over those around them.
To recover would mean declaring that “all is well”—a concession that, in the subconscious, feels akin to being forced to forgive the very people or circumstances that broke them. To ensure the wrongdoers never escape their guilt, the patient chooses instead to co-exist with their disease.
該做的都做了，方法也都給了，或許這種時候，我能做的就只有陪著她，直到她真的準備好跨出那一步。
也或許，可以試著拆穿，但包容她的防衛。對她說：「我發現你其實好累好累了。你是不是覺得，如果你好起來了，大家就會覺得你沒事，然後你就得繼續這樣一直做下去，再也沒有人會心疼你？」
當她的痛苦終於被「看見」、甚至找到能共同承擔的人，就不需要再透過病痛來證明了。
When everything that can be done has been done, and every possible solution has been offered, perhaps all that remains for me to do is to walk alongside her, holding the space until she is truly ready to take that step forward.
Or perhaps, the way forward is to gently dismantle her defences—to name them, yet hold them with absolute compassion. To say to her: “I can see that you are just so incredibly weary. I wonder if you feel that if you get better, everyone will assume you are perfectly fine, and you will be left to carry this endless burden alone, with no one left to notice or care for your pain?”
The moment her suffering is finally “witnessed”, and perhaps even shared by someone willing to bear the weight with her, she will no longer need to rely on her body to prove that it exists.
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