In this two-part series, Mad in Asia Pacific is in conversation with members of Taiwan Mad Alliance, namely, Shu Shu, Tien-Hsing Hao, Zhao Sheng Lin, Fyon.*
We explored some of the issues faced by queer and mad people with psychosocial disability in Taiwan today.
About Taiwan Mad Alliance
Taiwan Mad Alliance consists of four core members who are also survivors of the mental health system in Taiwan. They identify with the label ‘mad’ and named the group Taiwan Mad Alliance accordingly, in October 2019.
Even though TMA does not have an official social media page or website, it was definitely not formed in haste. All members have years of experience in user/survivor advocacy, mad art creation and facilitation of user/survivor groups. The group had started work on TMA long before its culmination with a name, and spent months of careful preparation.
They are now reviewing literature and news reports about being “crazy/mad” in premodern-modern Taiwan, focusing on the institutionalisation of the modern Western mental health, and the categorisation system during the Japanese colonial period, which has already become a governing tool of suffering today.
TMA also wants to reclaim the “mad history” of Taiwan, similar to what Roy Porter did in “Madness: A Brief History.” From a survivor point of view, this is one way to know their context, how they are situated, and where they are headed.
They are also gathering their narratives of ‘failures.’ First, they aim to understand and learn from the failures of previous involvement of resistance movements. They experienced a lot of frustration in their previous involvement in a very small scale user/survivor movement in Taiwan. Therefore, they have decided to come together and reflect on ‘why?’.
To answer this question, they are recording their own experiences, analysing the social conditions in Taiwan, understanding the ethics of peer relationships, and assessing the differences between users/survivors from different social backgrounds with unique personal life experiences. All these questions help them understand the contexts of their failures. More importantly, this is a way for them to start their journey of healing.
Secondly, they feel that they need to tell the stories of all the failures of “asking for help” from the professional mental health system, such as the iatrogenic effects caused and the power-asymmetries (for example, no proper reporting system for users to file complaints). They are therefore gathering the stories of traumatized users, including themselves.
Thirdly, they are looking at the ‘failure’ of living a liveable life. They are young people in their late twenties to early thirties, who often feel hopeless due to increasing house rents, low salaries, and a lack of decent employment opportunities, to name a few.
TMA members sometimes feel like the lucky few who have been able to obtain some cultural capital from higher education, but there are very few opportunities to transform these into the economic capital needed to give them a basic, stable, liveable life—as a group that is queer, domestic violence survivors, and lives alone without any stable social support.
They believe that the complexities of these traumas and the struggles of surviving have driven them ‘mad,’ but the modern mental health system has simply colonised their suffering by categorising them in “syndromes”, rather than understanding that our suffering comes from social oppression, trauma and lack of connection.
TMA does not speak for all users/survivors/mad persons in Taiwan, instead, they negotiate an alternative discourse of “being mad” in Taiwan, and hope that sharing their experiences will provide insight into the sufferings of their generation in Taiwanese society today.
Jhilmil Breckenridge: Using ‘mad’ in your name is a politically charged step. How do you think Taiwan will respond to it? What are you hoping to change by reclaiming the terms mad/crazy?
Since the 19th century, biomedical discourse started expanding and developing its methods of diagnosis as tools to not only to manage human suffering but also to govern the lunatic, insane and mad by categorising them into all kinds of “mental illnesses”.
In this era of biomedicalization and pathologisation, the internal factors— genes, brain and the human body’s chemicals — are often considered to be the crucial causes of “abnormal” emotions, thoughts and behaviour. The experts (mostly psychiatrists) are authorised and expected to take actions on the “deviants”— to diagnose and provide medical treatment.
People might ask us: “Do you mean that you’re ‘anti-psychiatry’ by saying this?” We just want to create the alternative. It concerns us that the dominant biomedical discourse leaves limited room to examine the social and political aspects of human suffering, and how one’s suffering is often caused by exclusion due to social norms. We reconsider the meaning of human suffering, the “abnormal” or deviant, and find they are negotiated and produced within social, cultural and historical contexts. For example, at one time, most Chinese intellectuals used to show their taste by smoking. Now smoking is a disease/addiction that needs to be “cured”.
In traditional Chinese, we call ourselves “失序者”. “者”, which means “those who are…”, and “失序” can be translated directly into “dis-order”. “序” means “norm” or “order”, “失” can be both “out of” or “lost”. In the Chinese world, “失序者” describes “those who are in chaos”.
Interestingly, “disorder” is already a highly medicalised term in the English world, and if we say someone is “in chaos” in English, it is usually interpreted as a “chaotic mental state”. But in the Chinese world, “失序者”, or “who are in chaos”, the “in chaos” can be both considered as “not fitting in certain social norms” or “feeling chaotic”. We choose the position “失序者” to challenge the personal versus social, and inner mental state versus outside social world dualism.
In the English world, we choose “mad” to describe ourselves. In the 14th century, “mad” described behaviours of animals with rabies. Now, after hundreds of years, it refers to rage, chaos, obsession, foolishness and frustration; these authentic emotions and experiences are what we’d like to reclaim from the categorisations done by the mental health system. And in doing so, we connect ourselves with the global mad movement, which always holds a radical position and emphasises the social and political aspect of mental distress.
To compete with the dominant biomedical discourse, we also need alternative narratives, which can be developed within the subculture of diverse user/survivor groups.
For example, TMA members seldom talk about “symptoms;” instead, we use our dark humour, laughing at how absurd it is when we’re tied up in psychiatric wards and still sometimes find a way to untie ourselves. We talk about several topics: the detrimental effects of being treated by sexual orientation conversion therapy; the fear of the law after committing petty crimes like responsible (but illegal) drug use (for e.g., using marijuana); how anxiety and shame worsens one’s mental health more than the drugs themselves; and the feeling of despair of being ‘working poor’, we say our diagnosis should be “working poor disorder.” Our generation is facing a situation of low wages and high house rents and costs, and we can’t afford to have a home of our own to start up a family (no matter what form of the family). So we call our depression and anxiety, the “mental diseases” which may be all cyclical, and in fact be caused by these inequities: the “working poor disorder.”
It is only when we share our experiences openly without fearing intervention of mental health or law systems, that we can open up a space to explore alternative meanings of being “in chaos” or “mad”.
Jhilmil Breckenridge: Tell us more about the situation in Taiwan? How supportive are families, schools and workplaces? Are there other modes of ‘treatment’ that people use that are more culturally appropriate?
In Taiwan, the resources allocated for mental health have remained insufficient for a long time. Although the annual expense account in 2018 made up over 6.6 billion, the budget for medical treatments for depression was less than 1 per cent.
Most importantly, there was a great shortage of funds for community-based services like home-visit counsellors. Because the employment of counsellors is determined annually and is contractual, it is not stable. It is therefore quite difficult for them to keep a consistent and permanent connection with the target family.
Due to the lack of support for persons with mental distress, whether in medical institutions or the community, family members have to take the responsibility of accompanying them and monitoring their health. Furthermore, these responsibilities had been legalised under the Mental Health Law of 1990, which means, for a person diagnosed as a “serious case,” someone among their parents, spouse or relatives are chosen as a “guardian,” with the obligation to take the person being treated to institutions and to give updates about their condition after they are discharged. Due to the lack of care resources, the main caretakers often want to send their loved ones back to the hospital, as it becomes emotionally draining for them.
One of TMA’s partners with meth use experience has also been undertaking caretaking jobs for his friends who are without family and are living with organic schizophrenia caused by meth. He finds it very exhausting, and although he doesn’t trust the institutional inpatient services, sometimes those seem like the only means through which he can save himself from endless caretaking responsibilities.
In many cases, when people with mental distress leave home, they could be evaluated by the university campus counsellors’ office or a mental health centre, and they could be referred to a social worker or any psychologist/therapist employed by the local Administration of Education.
The Ministry of Labour has an “Employee Assistance Program,” a part of which is a workplace consultant that could be sent to assist the affected person. But it is not common for workplaces in Taiwan to provide mental health resources, not to mention making reasonable accommodation for mental health disorders in employment settings.
In governance, there is a “risk management logic” instead of authentic care for one’s rights or wellbeing. So when it comes to a conflict between these two – holistic development for an individual, or the smooth operation of a company – professionals often sacrifice the former. Therefore, individuals have to ‘adjust’ in the workplaces instead of being accommodated. In some cases, a teacher’s career might be threatened if they don’t take the ‘responsibility’ to report students with suicide ideation, even though reporting may not be in the student’s best interest.
Jhilmil Breckenridge: I like your idea of learning from failure. What are you hoping to find and what is your method of researching what did not work? Are you relying on literature or interviews or some other method?
Once, in a TMA meeting, one of our partners, ‘L’, casually said that partner ‘T’ would be perfect to manage TMA’s paperwork because she’s good at it. Suddenly, T became very upset and said: “Don’t make me the one who only does the paperwork!”
For a while, T couldn’t explain what happened, she kept crying and shaking and pulling her hair vigorously. Many mental health practitioners might see T’s behaviour as “showing symptoms of mental illness,” but we tried to focus on why she felt this way. Finally, T spoke, and it turns out that:
- T always wanted to be a scholar, but she couldn’t afford a PhD program. She had also been afraid to apply for one because of her lack of confidence. She then ended up settling for other jobs she didn’t really have a passion for, most of them being administrative support tasks (paperwork). She even thought about taking the civil service exams, although she knew it wasn’t for her. It’s the common experience of being a working poor generation— the broken dreams, and the loss of aspiration.
- She can’t hide her self-injury scars forever and she doesn’t want to hide them either. So being perfectly in control of her emotions becomes one of her stigma management strategies. She hopes that maybe that will make people forget about her scars. But she sometimes breaks down in front of work partners, and she hates it, including this time. She couldn’t put her shame into words so she just kept scratching herself.
- She was embarrassed by her own behaviour. She felt bad for creating a scene and bothering her friends.
The narratives above, which emerge from our daily interactions, are all about suffering and failures. These are about the suffering of the working poor generation, the haunting neoliberal subjectivity and the pressure of social stigma.
For us at TMA, we didn’t see this breakdown as a burden, instead, it was an opportunity for us to think about how influential these success and failure discourses can be. L said she also resonates with the loss of aspiration, and we talked about the failed pursuit of a cosy, stable, middle-class lifestyle. We believe that every narrative reflects not only the individual’s realities but also social realities. We are learning how to speak and hear the voice of suffering, and that voice needs us to reflect on our everyday realities.
Join us in a few weeks for Part 2 of this exciting interview!
*With special thanks to Richard K. F. Liu and Tzeng Sean for their help with English translation.