The Hall of Dragon Metamorphoses: Taiwan’s Last “Premodern” Asylum

Written by Yi-Cheng Wu and Harry Yi-Jui Wu.

In December 2017 an outbreak of amoeba dysentery in Long Fa Tang (龍發堂) in southern Taiwan saw the local government relocate approximately 500 inmates. The Buddhism-based mental asylum closed shortly thereafter, marking the last chapter in its controversial five decade-long history. Long Fa Tang, which literally means ‘The Hall of Dragon Metamorphoses’, was established in 1971 by the Buddhist Abbot Shi Kai Feng (釋開豐). He sought alternative ways to manage patients with chronic mental illness and his methods were long disputed by a range of psychiatric professionals.

Taiwan was a pioneer of modern mental health care in Asia because of its early participation in international organisations. Its geographic characteristics and colonial pasts also enabled early contact with ‘Western medicine’. After WWII, Taiwan (representing China) actively participated in the activities of the World Health Organisation, doing so until the early 1970s.

Long Fa Tang emerged when the global movement of community psychiatry began to consider mental patients as citizens and as the connections between mental health and social integration became better understood. In the 1990s the health care system in Taiwan experienced two breakthroughs enhancing mental patients’ access to treatment: the Mental Health Act and National Health Insurance System. During the past two decades, the legislature has amended the People with Disabilities Rights Protection Act and Mental Health Act to ensure that disadvantaged groups enjoy improved social inclusion and to provide medical professionals with concrete guidelines to avoid infringement of human rights. Long Fa Tang continued to operate in this climate of modernisation.

Shi Kai Feng created his own folk treatments, most notably with therapeutic functions such as using a rope to link the patients and stabilising their condition through the teaching of traditional aphoristic literature (sutras). The rope, which served as the ‘affection chain’ (ganqing lian in Mandarin), was later replaced with a metal chain, which prompted human rights concerns. However, Long Fa Tang still received support from those searching for alternative places to bring their ill family members, often because they feared admission to psychiatric hospitals. To some extent, Long Fa Tang’s Buddhist-informed care could satisfy these families’ need to compensate for feelings of loss and guilt arising from abandoning their beloved kin.

Despite the seemingly positive aspects for families seeking to care for ill members, Long Fa Tang received considerable criticism. In the 1980s several ‘inhumane’ measures inside the facility were observed by researchers and journalists. Although Long Fa Tang claimed that the ganqing lian was no longer used, an auditor from the local Department of Health still noticed the asylum’s insufficient condition of care, such as limited space and coercive styles of imprisonment. “We even saw an inmate being chained naked with excrement on the floor”, a health officer said after her snap check in December 2017. Long Fa Tang was corrected by the local government for its out-of-date treatment of its inmates and has been cited as an example of the poor type of patient care that a modern nation should abolish.

Disputes over Long Fa Tang’s treatment methods also existed among psychiatrists. In the 1980s, a psychiatrist with an anthropological background led a research team to investigate the asylum’s therapy model. He indicated that Long Fa Tang provides an alternative method of care in the folk sector and might even serve as a model for patients’ functional recovery. However, the high mortality rate of its inmates implied poor hygiene control. His ambivalent conclusion, which affirmed the cultural dimension of care, did not convince proponents of modern psychiatric medicine (who sought its closure).

In December 2017, cluster infections of tuberculosis and amoebiasis within Long Fa Tang accelerated moves to close the institution. In late February 2018, nearly 500 inmates were relocated to various types of hospitals or sent home for either institutional or out-patient care. However, the death of a former inmate after caregivers lost track of her in early March 2018 again stirred up an uproar among human rights organisations and some families regarding the inadequacy of care resources.

Recent debates over human rights for mental health in Taiwan have shown paradoxical and ambivalent narratives over modern psychiatric practice. Based on the critique of Freeman et al. over the idealised principle of the General Comment on Article 12 of the UN Convention on the Rights of Persons with Disabilities (CRPD), which may hamper patients’ right to adequate treatment, Taiwanese psychiatry professionals argue that they have been doing ‘sufficiently good’ on compulsory admission. On the contrary, human rights advocacy groups also noted that the CRPD condemned the current Mental Health Act in Taiwan, which fell short of protecting the liberty of individuals and had become a form of social control.

Long Fa Tang was founded in 1971, the year Taiwan left the United Nations; in debates over the legitimacy of psychiatric admission in Taiwan, health care professionals and human rights groups both believed that their practice and pleas benchmarked the highest international standard despite, the absence of UN membership. However, since then, Long Fa Tang continued to exist in a corner of society most groups were uninterested in. Before its eventual closure, it functioned in the narrow but niche area that responded to the need of families who distrusted pharmaceutical psychiatry.

Modern medicine ultimately triumphed over Taiwan’s last “premodern” mental asylum. It was reported that the symptoms of 80% of former inmates who received additional psychiatric care after release were ameliorated following a year-long treatment. The tragedy of the recently deceased former inmate, however, reveals that mental patients are still unwanted by a society as yet unconvinced by modern psychiatry. Whilst modern medicine in East Asia has always developed as a self-fashioned rational and scientific discipline under the notions of progressiveness and modernisation, structural quandaries still exist and can only be overcome by advocacy work. Such work should be continuously carried out by focusing on patients’ needs under the dynamic relationships between the individual and society, rather than by merely proposing to liberate the inmates from their chains (metaphorical chains but, in the case of Long Fa Tang’s past, sometimes physical too).

The existence of Long Fa Tang reflects the incongruence of people who sit in-between local societies and the modern standardised diagnostic system. Furthermore, the difficulties in closing Long Fa Tang reveal certain hesitations among clients and families to accept modern medicine. The kind of psychiatric care we now enjoy remains a sensitive topic, especially when such a paternalistic style can impinge patients’ subjectivities. However, these discussions would at least lead to an opportunity to make an inventory of the conditions that encompass a ‘sufficiently good’ infrastructure of psychiatric care with structural sensitivity. This should not only include medical resources and the condition of patient’s well-being, but, most importantly, the logic of care of patients and their families.

Yi-Cheng Wu is Attending Psychiatrist at the Hsinchu Mackay Memorial Hospital and a PhD Candidate, Anthropology Department, Durham University, yi-cheng.wu@durham.ac.uk

Harry Yi-Jui Wu is Assistant Professor and Director at the Medical Ethics and Humanities Unit, The University of Hong Kong, hyjw@hku.hk. Image credit: CC by GDJ/Pixabay

2 comments

  1. “The tragedy of the recently deceased former inmate, however, reveals that mental patients are still unwanted by a society as yet unconvinced by modern psychiatry.”

    There are several issues with this statement.

    1. It implies that all mental patients are at all times still unwanted by all members of a society of whom all are yet unconvinced by modern psychiatry. Obviously, those are a lot of crude generalisations.

    2. But even for the specific, recently deceased former inmate the article provides no evidence that she was unwanted. It just reports that there was “an uproar among human rights organisations and some families regarding the inadequacy of care resources”. One bad outcome and the subjective judgement on resource inadequacy do not make a whole group of persons unwanted.

    3. There is no such thing as a homogeneous society. Some groups are oblivious to all psychiatry, others embrace modern psychiatry, others again are doubtful of modern psychiatry and still others completely reject it.

    4. There is no such thing as modern psychiatry. There are many different schools with a holistic approach to therapy, there are psychiatrists who rely mainly on psychopharmacology and there are many groups who try different approaches of scientific understanding of mental illnesses. Most of those groups are critical, one way or another, of each of the other groups’ approaches.

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  2. “In the 1980s, a psychiatrist with an anthropological background led a research team to investigate the asylum’s therapy model. He indicated that Long Fa Tang provides an alternative method of care in the folk sector and might even serve as a model for patients’ functional recovery.”

    At that time the asylum was still operational and its therapy model was neither proved harmful nor proved ineffectual. So, what’s the base for triumphalism shown today after it was closed down and no direct comparison is possible any more as expressed in the following conclusion from the article.

    “Modern medicine ultimately triumphed over Taiwan’s last ‘premodern’ mental asylum. It was reported that the symptoms of 80% of former inmates who received additional psychiatric care after release were ameliorated following a year-long treatment.”

    There are two ways to ameliorate symptoms. First, the mental illness gets cured and the symptoms go away. Second, the mental illness gets contained and the symptoms became less bad, often by medication that dampens the patient’s emotional life and such throws them into a dull existence. Therapy by medication usually is of the second type in cases of mental illness. So, I am suspicious of the above claim on amelioration.

    Furthermore, the asylum was closed because of poor hygiene and not because of poor psychiatric care as stated in the following excerpt from the article.

    “In December 2017, cluster infections of tuberculosis and amoebiasis within Long Fa Tang accelerated moves to close the institution. In late February 2018, nearly 500 inmates were relocated to various types of hospitals or sent home for either institutional or out-patient care.”

    And care seems to have been imperfect outside the asylum, too, as was reported before.

    “The death of a former inmate after caregivers lost track of her in early March 2018 again stirred up an uproar …”

    The results of psychiatric care have always been, and are still, patchy and often unsatisfactory. Therefore, replacing traditional asylums by modern psychiatric care is no suitable marker for the transformation of a ‘backward’ nation into a ‘modern’ nation. I suggest to be less damning of backwardness and less enthusiastic about modernity. Instances of both warrant critical evaluation.

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