Retrospecting the 15th EAACP Symposium Tainan (Bou-Yong Rhi, M.D., Ph.D.)

Retrospecting the 15th EAACP Symposium Tainan

Bou-Yong Rhi, M.D., Ph.D.
Professor emeritus Seoul National University
C.G. Jung Institute of Korea

Being utterly spoiled by the Taiwanese traditional hospitality we returned home.
I find no word how I express our gratitude to Taiwanese colleagues for their taking care for us, even for wives and husband of the Korean members.

The 15th Symposium has left not only a sentiment of human warmth in our heart, but also many unanswered questions on the subject of the mental health law and culture and the strong impressions elicited by the interesting presentations. I would describe some of my impressions on this symposium.

The memorial address on Professor Hsien Rin by Professor Hwu has awaken the aspects of Professor Rin’s personality as a poet and the thinker besides his brilliant contributions to the social and cultural psychiatry of the world. It was moving. I was for a while in the memory of this great man and in a silent prayer for his soul and for his bereaved family.
I enjoyed Professor Soong’s comprehensive review and in-depth analysis on the Mental Health and Culture in Taiwan. From the speech of both disciples of Professor Rin the words came across my mind: ” From Statistics to the Philosophy?” I had the impression that the senior professors of Taiwan are now integrating both epidemiological survey and the philosophical considerations. Regretably, we had no opportunity to discuss philosophical matters raised by Professor Soong.
Professor Wu’s emphasis upon the issues of the compulsive admission and compulsive community treatment of the mental health law in Taiwan is none of the trifling things. The compulsive admission of the mentally ill person was always the central issues triggering a hot debate in relation to the human right, and the problems of the aftercares of the discharged patients have been remained unresolved also in Korea.
Yesterday, I read in newspaper that the Court for the Constitution has pronounced the current article about the compulsive admission of the mental health law as a breach of the constitutional protection of citizen’s body. But, the lawyers seem to be less interested in patient’s ‘right’ to be treated and rehabilitated. For the continuing treatment and rehabilitation of the discharged patients some regulations should be made. From the speech of Professor Wu we could acknowledge his passion for the comprehensive approaches in mental health care and also for the improvement of the mental health legislation. Unfortunately, here again we had no intensive discussion and detailed comparisons between current mental health laws in three countries of East Asia. The insightful comment by Dr. Chung from Korea in regard to cultural viewpoint found no echo.

Luckily enough, we had Professor Shinfuku as our member, who was the former advisor for mental health, Western Pacific Regional Office, WHO. His lecture on the Japanese mental health law and culture was highly instructive. He made historical review and also demonstrated possible cultural factors. Historical changes of mental health legislation in Japan is similar to the Korean case, in the process from the way of the social defense, custodial care, the increase of the large mental hospital or institution to the deinstitutionalization and the community based mental health care. The last one – the community based mental health care – is not yet satisfactorily settled in Korea, although many community mental health centers have been established in Korea according to the mental health law. As Professor Shinfuku has mentioned mental health legislation is closely related with social events elicited by the mentally ill patient or mental institutions. That means, the mental health issues were the least concerns of the people and government. One carefully avoids this issues and when someone commits suicide or mentally ill person kills street walker, then people are suddenly ridden by panic, become defensive against the mentally ill patient. Cultural or social factors raised by Professor Shinfuku also could not be the subjects of full discussion.

Why do I feel that we had no sufficient time for discussion of the mental health law and culture, neither in comparison of the mental health laws, nor in discussion on the cultural factors? Naturally, one and a half days of the symposium is not sufficient to delve into such a vast and complex field. One can attribute it to the planning of symposium: the time allocation for general discussion, the uncertainty of the roles of chairperson etc. But, I found ultimately that the reason lies in myself. I was not fully prepared for, how to deal with the subject: mental health law from cultural context and how to approach the issues. Probably, many of my colleagues were the case. We also made neither objectives of the symposium nor the guideline of the description of the paper.
To investigate the cultural factors influencing upon the legislation and the cultural background of the mental health law we may need the following considerations:

A) Culture and law.
1. Is law a product of the culture? How different the content of the law according to different cultures. Cross-cultural comparisons of laws.
2. People’s attitude towards law.
Is there any cultural difference? Yes, probably. Judeo-Christian culture and the eastern culture. Industrial society versus agrarian society
B) Mental Health Law and Culture:
1. Legislation about mentally ill patient, when, how?
2. Changes of legislation in relation to the changes of the spirit of the time, change of type of society, political ideology
3. Concept of mental illness in the given cultures (People’s attitude toward mental illness and mentally ill patient)
4. Establishment of the real community as die Gemeinschaft. not Gesellschaft.

Even if we drafted ‘ideal type’ of the mental health law it may be not useful when it does not fit for the cultural niveau of the people. If any pioneer or a group drafts mental health law and requests the government to actualize it, it takes time until the members of the society, congress men and women, and governmental officials are ready for accepting it. From the 1ate 1960s the Korean Neuropsychiatric Association drafted the mental health law and asked the ministry of health to take it into consideration, but, the mental health law was proclaimed almost 30 years later.
But, a pioneer who has power and capacity can enhance the process of the legislation, for example, Professor Shuzo Kure’s investigations of the family care of the mentally ill person and his various efforts in Japan brought the first legislation of the mental care in Japan.
NGO such as the family association for mental health can exert influence on the legislation of the mental health law.
Religious community may have influence, in either positive or negative way, upon the mental health care and legislation. Mass execution of the mentally ill person in the name of witch hunting can only be seen in Christian Europe and North America. In Asia there was no such mass possession until recent past when western culture introduced into the East. On the other hand Catholic monasteries have been served as the place for the care of mentally ill patient in the Middle Ages of Europe. The Buddhist temple of Japan has also served as the place of custodial care for the mentally ill patients before legal arrangement of the family care in Meiji era.

Mental Health Law is, as we all admit, for the benefit of the patient.
It is not for the benefit of the mental health professionals and any other person. But, what means ‘the benefit for the patient’: what is the nature of his ‘illness’ and what is ‘healing’; what means the ‘mental health’ ultimately? The definitions are not self-evident. Every schools of psychotherapy claim the object of the therapy should be ‘whole person’. And yet the concept of the wholeness is diverse according to each school.

Enormous paradigm shift may occur in future in legislation of the mental health or mental health promotion law with the changing concepts of ‘mental health.’ Psychiatrists should be prepared for the holistic viewpoint, the total view of man and woman including cultural aspect.

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This is a kind of monologue, but I welcome any response from members of EAACP. (2016.10.1. Bou-Yong, Rhi)