社區照顧的再省思：小型化？規格化？產業化？

Abstract

本文嘗試回顧社區照顧在過去二十年台灣社會福利發展中經歷的多次更迭，試圖從社區照顧的多元論述扣合到台灣近年社會福利的政治經濟演變脈絡中重新理解，希望提供社區照顧未來發展新的可能性。本文採用Fraser的需求詮釋政治為理論架構，以論述分析作為研究方法。文中將社區照顧分為「小型化」、「現格化」、「產業化」指稱三種分別以經營規模、行政管理、與市場經濟為基調所發展的論述型態，並以關鍵政策與事件為例，說明社區照顧在地演變的歷史軌跡。文末呈現被目前這三種主流社區照顧論述所排除的實踐經驗。相較於小型化論述，黃嬡齡在近三千床的玉里榮民醫院所嘗試推動的「治療性社區」，將台灣社會、玉里鎭、醫院分別視為精神病患的「社區」，視社區為對精神疾病有共同生活想像的人群。相較於規格化行政管理，張紅雅在台北內湖建立的「陽光廚房」，拒絕依照行政邏輯將社區民眾分隔為婦女、青少年、與老人的行政／專業類屬，建構彼此互助的生活圈。相較於產業化，黃盈豪在台中縣和平鄉秦雅部落推動的「共同廚房」，以恢複原住民互助共食傳統，透過傳統以物易物、換工的方式，將部落居民的照顧需求加以「去產業化」。這些案例的共通性在於凸顯目前社區照顧論述忽略了建構共同生活想像的社區化過程，回歸需求者的在地生活中重新思考專業的介入與國家政策，或許是社區照顧重新出發的起點。

This paper tries to review the discursive shifts of community care policy in Taiwan and examine the dialectic relationship between the discursive shifts and the political economy of social welfare in order to gain insight into why the current development of community care is the way it is now. This article adopts Nancy Fraser`s concept of the politics of needs interpretation as theoretical framework and discourse analysis as research method. Three major discourses, community care as down-sizing, as normalization, and, as marketization are identified, which define community care in terms of service organization, ways of understanding care that make care manageable by the state, and care as a profit-making market. Excluded discourses by these mainstream discourses on community care are identified to point out future possibilities for community care. Examples that illustrate such possibilities are presented, which include the therapeutic community project in Yu-Li Veteran Psychiatric Hospital, the community co-op kitchen in Ho-Ping aboriginal tribe, and the Sunshine Kitchen in Taipei City.