Psychiatry has played a manifold role in the making of the modern world. The discipline offers care to patients who are often stigmatized; it also supplies ideas and values that shape understandings of the human mind and mental well-being. Yet the proliferation of diagnosable conditions and the infiltration of expert knowledge into culture and everyday life provoke suspicions about it being an agent of social control. This edited volume, with “modernity” and “governance” as the central themes, sets out to investigate contemporary phenomena that pertain to these issues in the context of Taiwan, a de facto country that has pioneered the development of psychiatry in Asia. The contributors come from backgrounds as diverse as STS, sociology, anthropology, public health, and forensic psychiatry. This disciplinary diversity is further enriched by the fact that several have clinical backgrounds. As the editors Yu-Yueh Tsai and Jia-Shin Chen proclaim in the introduction, this project is an attempt to instigate cooperation and dialogue between medicine and different humanities and social science disciplines.
The book is divided into five parts. The first section deals with the demarcation of the abnormal from the normal—a central act in psychiatry that its practitioners perform on a daily basis. Both articles demonstrate the constant presence of ambiguities and negotiations in actual clinical practice, which departs substantially from the ideal of an objective science grounded in definable brain pathologies. Fan-Tzu Tseng’s chapter examines how psychiatrists themselves reflect on their practices concerning attention-deficit hyperactivity disorder (ADHD). Highlighting the heterogeneity in these experiences, she challenges the grand theory of medicalization, arguing for a more finely tuned and microscopic approach. This sociological intervention is timely, since ADHD has become a focus of debate in Taiwanese society, partly due to the local incarnation of Scientology’s transnational war on psychiatry. Chen-Shuo Hong combines interviews with families and a review of the relevant medical literature to scrutinize the care practices of dementia. As he points out, dementia in Taiwan did not fall under the purview of psychiatry until around 2000, and this delay has contributed to a pluralistic landscape of care marked by collaboration and competition among different fields.
The second section moves from professionals and families to patients. The two chapters here adopt the perspective of cultural phenomenology to explore the subjectivity of those diagnosed with schizophrenia, the “quintessential” mental illness, which disrupts the workings of the mind at a fundamental level. Both are based on clinical ethnography, which places an emphasis on specific individuals. Shu-Jung Lin’s chapter offers three detailed case studies that involve a wide range of psychotic experiences. Delving into the lifeworlds of the patients, she renders these strange perceptions, thoughts, and senses of self comprehensible by situating them in interpersonal and cultural contexts. Shu-Chung Li focuses on the archetypal psychotic symptom of delusion. Like Lin, he employs a fine-grain analysis based on a thick description of illness experiences and a sophisticated understanding of local culture. Elements of folk religion loom large in both articles, demonstrating the continued relevance of supernatural explanations for severe mental illness in Taiwan, a supposedly “modern” society.
Psychiatry is known to constitute an indispensable component in the modern project of governance and policing. The third and lengthiest section of the volume comprises three chapters that examine this aspect of the discipline by probing into its intersection with the state. Yu-Yueh Tsai begins with the question of why mental patients on outlying Orchid Island—home to the Tao ethnic group—do not comply with medical treatments under the state-sponsored Integrated Delivery System. She deciphers the “chaos narratives” of these patients and recovers the meanings of their suffering, which has run through generations in this highly marginalized society. Jia-Shin Chen’s chapter examines the formation of a harm reduction policy in the mid-2000s, when drug injection suddenly became the leading route of transmission for HIV/AIDS in Taiwan. While analyzing the impromptu process of policy making, he conceptualizes the hodgepodge of experts and officials involved as the “office”—an assemblage that stands in contrast to the “street,” which is more frequently the target of ethnographic studies on addiction. Finally, Guei-Hui Lin tackles the similarly recent policy of suicide prevention. She discovers that, while the project seems rational and well supported by research, in its implementation, practitioners need to bring together whatever strategies and methods are useful and available, making the medicalization entailed by this policy another example of assemblage.
The fourth section extends the inquiry into the subdiscipline of forensic psychiatry, an area where psychiatry meets with law, the embodiment of state power. This is probably the most clinical part of the book, as both authors are preeminent forensic psychiatrists in Taiwan. Through subjects such as the legal definitions of mental illness, mental health legislation, the forays of psychiatry into domestic violence, and the rehabilitation of sexual offenders and addicts, Tien-Wei Yang examines the ongoing tensions between forensic psychiatry and the criminal justice system. He draws attention to an intriguing phenomenon: in Taiwan, civil commitment, covered by National Health Insurance, is absorbed into ordinary medical care—mostly custodial care in public hospitals—rather than forming the basis of specialized services. Chien-Chang Wu’s article builds on a survey on the use of neuroimaging when assessing the capacity of people with dementia. He concludes that this advanced technology is rarely put to use and that a folk psychology model, or in Sheila Jasanoff’s words, “civic epistemology,” still dominates actual practice.
The last section shifts to two institutions that are commonly considered “anomalies” in Taiwan’s history of psychiatry: Long Fa Tang, a self-styled asylum that offers long-term custodial and folk religion–inspired treatments; and Yuli Veterans Hospital, a huge psychiatric hospital that has long served as the “final destination” of the chronic mentally ill. Chia-Shuo Tang conducts a historical reevaluation of Long Fa Tang’s role during the 1980s, the formative decade of Taiwan’s mental health system. He revisits the ethnopsychiatric study of Dr. Jung-Kwang Wen, an aborted attempt to understand this alternative system and to inject elements of modern medicine into it. The study’s relevance to the forced evacuation and closure of the institution, which occurred in early 2018 due to the outbreak of infectious diseases, is also discussed. Ai-Ling Huang’s chapter describes how a group of progressive-thinking professionals have transformed the once notorious public asylum into the center of a three-layer “therapeutic community,” a new home for patients who have almost no hope of returning to their own homes. Her perspective is unique as she is deeply involved in this reform as a senior social worker in the hospital.
Supplementing these captivating chapters is Yu-Yueh Tsai and Jia-Shin Chen’s introduction, which does an excellent job of articulating their shared concerns and putting them into conversation with one another. As the editors indicate, all the contributors employ an interpretative approach and qualitative methods that question the biological determinism embraced by mainstream psychiatry. Two lines of inquiry run through the book: first, a more nuanced understanding of medicalization as grounded in local processes and producing uneven effects; and second, a deeper look into the entangled relationships among modernity (especially its mode of governance), psychiatry (itself a discipline undergoing modernization), and the vagaries of lived experiences and subjectivity too often eclipsed by biomedicine. At the end, the editors put forward a series of important topics that are yet to be explored; these will become an invaluable road map for aspiring researchers interested in historical and social studies of psychiatry in Taiwan.
This edited volume addresses a rich selection of topics and offers many insightful analyses. It will be of interest to humanities and social science scholars studying the development of psychiatry and mental health in various transnational, regional, and national settings, as well as mental health professionals and policy makers. One minor problem I have is that, with their focus on contemporary times, most of these chapters do not venture into Taiwan’s colonial or authoritarian pasts, nor do they attempt an analysis from a postcolonial or postauthoritarian perspective. However, this does not prevent the book from being another landmark work produced by Taiwan’s vibrant and highly interdisciplinary community of broadly defined STS scholars; most of the contributors have spent a decade or two building their scholarship. It has set very high standards for future research, and I believe scholars will follow their leads as the relevant fields continue to advance.