Translator: 黃 韻潔 Reviewer: Gentian Pan
I'm a psychiatrist.
I wonder what pops in your mind of a psychiatrist?
The common impressions are that
they tie people up in mental houses to give a needle shot?
Or sitting on the opposite end of a desk
saying: " You are absolutely right!"
"I wonder what you're thinking?"
"Look on the bright side. Don’t kill yourself."
I wonder which one it is.
Being a psychiatrist,
we must return to basic principles.
A psychiatrist is dealing with mental issues
and aspects on physiology, psychology and society.
You might ask: "what does psychology have to do with physiology and society?"
Take an example of mental disease.
Schizophrenia, a mental disorder,
is known as split or multiple identities.
Some are paranoid with hallucination,
often saying things of nonsense
or behaving weirdly.
This kind of disease is unique.
Its prevalence around the world is one percent.
Yet we know that this disease is hereditary,
meaning that if one of your parents
or siblings is schizophrenic,
then your lifetime prevalence will rise to 10%.
If your identical twin is a schizophrenic,
then your lifetime prevalence will be 50%.
Besides it is hereditary,
basic and clinical research tells us that
schizophrenia is caused by mental problems,
and will also become severe physiological problems.
We know that the lack of neurotransmitters
in the brain, dopamine,
is the main cause for the disease.
It is just like Myocardial infarction, a heart disease;
and kidney failure, a kidney illness.
Some say that Schizophrenia is a brain disease.
Can this explain for all cases?
Here is an example. This is Lanyu.
Research suggests that schizophrenia prevalence
is 3 times the main island of Taiwan.
Quite strange!
Isn't schizophrenia roughly of the same prevalence around the world?
Why is Lanyu 3 times?
Remember that I said this disease is highly hereditary.
Is it possible that gene
was passed on between generations on the little island,
causing its high prevalence?
Here's another observation.
If we review the documentary,
the research conducted by anthropologists in the 1960s,
suggested none diagnosed as schizophrenia.
In the 1980s,
The doctors on site reported
only 2 to 4 patients.
However, starting from 1992,
the doctors from Mackay Memorial Hospital
found that the mental patients were on a rise,
climbing to 50 in 2004, reaching 58 in 2005, and 66 in 2009.
If you ask in detail how their disease progress,
you will find something peculiar -
over half of the patients started to show symptoms
when they were in Taiwan.
Strangely, how is such connection between Taiwan and Lanyu?
Actually, we know that in the 1970s Lanyu was a restricted mountain area.
There wasn't much interconnection in between.
After 1971 to 1973, there appeared regular flights between the two islands
and this lifted the restrictions.
The people of Lanyu could freely go to Taiwan and vice versa.
We found that among these 66 mental patients,
their demography is distributed between 25 to 60.
Very few were above 60.
If you push the axis back,
you will see these people approaching post-adolescence
have gone through major social shock to alter their own lives.
Over half of these people share the same story.
They grew up at the village in Lanyu.
After leaving school, they looked for jobs.
Becasue of no job locally,
they went to Taiwan for work or study.
Coming to a new environment with no acquaintances
led to the pressure of migration.
Furthermore, in their hometown
they could be a good fisherman,
capable of building canoes
but in main island, they are nothing.
Their social structure disappeared,
family function was deconstructed,
and self-recognition had collapsed.
This led to issues of alcoholism.
Some were suffering psychiatric symptoms
and then sent back to Lanyu.
Apart from Schizophrenia, the abuse of materials,
in particular, the alcohol
is a major domain in psychology.
According to anthropologists' survey,
there wasn't a alcohol culture in the tribe of Lanyu.
We don't know why their ancestors,
when migrating from Batan islands of Philippines,
did not bring wine-making culture to Lanyu.
So, there is no wine in their culture.
But starting from the yeat 1971,
the wine consumption,
soared, regardless of quantity or cost.
I have told two stories -
about schizophrenia,
and "abuse of material", respectively.
Both are linked to society.
But you might say
that it's special because it's psychiatric disorders.
Well, one disease unrelated to psychology is -
HIV, the AIDS disease.
AIDS basically is not psychiatry.
It's a infectious disease.
Before being a psychiatrist,
I had been to Africa twice for medical practice.
The first trip was Swaziland located in the Southern Africa.
The second one was Ghana in the Western Africa.
Swaziland has
the highest prevalence of AIDS in the world,
and the lowest average life expectancy.
30 to 40% of the population
are infected with the HIV virus.
It was a common scene in the medical wards where
a young patient was lying on a hospital bed
feeling weak from the fever.
We supposed the black spots on his face
are probably the Kaposi's sarcoma.
He must be an AIDS patient in terminal stage .
I asked his family,
"What happened to him, how did he end up this way?"
They replied,
"This young man originally grew up in our village.
When he attained adulthood,
he couldn't find a job in the village.
So, he went to the city for jobs.
After four to five years,
he returned looking like this.
As for infectious diseases, there are two elements:
one is source of infection, the other is a route of transmission.
Now we know that AIDS is unlike SARS
which is easy to spread.
AIDS is infected through contact with body fluids.
Swaziland is a country with many hills.
their residential housing is scattered communities.
It is far away between each of housing unit or village.
Under these geographical circumstances,
how did AIDS spread so quickly through the country?
How did it become one of the major problems in Swaziland?
One day I asked the driver that drove us around town,
"How much does our medical team pay you per month?"
"About 5000 NTD," he replied.
The commodity prices in Swaziland aren't low.
A 300 mL Coke costs about 20 NTD,
which is almost the same in Taiwan.
You can hardly feed yourself with 5000 NTD,
let alone a whole family.
A salary of 5000 NTD
could be enough in a traditional or agricultural society.
He may live by self-contained produce from the land.
However in a society of monetary economy, or economies of scale
all goods put on shelves in stores are
labeled with a price.
The only way to acquire these commodities
is to buy it with earned money.
But can they earn enough?
It's very difficult to be enough.
So it prompts him to leave their own village,
move to the big city
and find part time jobs there.
After leaving his own social bonds,
leaving his own family,
they are not integrated into the big city,
and become the marginal man.
Marginal men bunch up in cities.
Whether it is drugs, alcohol, or sexually transmitted disease,
it all originates here.
So they return to their village with these evil habits,
and evil habits spread out.
Afterwards, I went to Ghana.
It was a completely different scene.
The shopping mall in the picture, as big as Carrefour,
is hardly seen in Ghana.
The most common scene in Ghana
is like this picture - their second biggest city.
Their most bustling area is full of shopping stalls,
which you can't find in Swaziland.
You might find a fancy restaurant in Swaziland,
but in Ghana, all you can see is stalls.
Besides, you might see superior cars, Alpha Romeo
But in Ghana, you see a Nissan
or a Hyundai,
even used as a pick-up truck.
You can see it carrying a bunch of bananas.
Ghana gives the feeling that every family seems to have a farm,
and run a small business.
It may not generate a huge amount of GDP,
or exports on a large economic scale,
but at least, it is enough to feed themselves.
Look at comparison of AIDS prevalence.
Ghana is 3%.
Swaziland is 10 times their rate, ranging between 25~30.
Their Human Development Index is approximately the same.
A contrast exists in the wealth gaps.
Ghana is at 61st place, Swaziland comes in 19th place.
The top three countries are
Lesotho, South Africa, and Botswana.
If you are unfamiliar with these countries,
check this map.
It just happens that these countries
are the highest HIV prevalence in the world.
The UN reported on the wealth gap
that even in developed countries
such as Europe, America, Japan,
the higher the wealth gap,
the severer the problems.
Other than the criminal rate and literacy rate,
social problem related to the medical is life expectancy.
and the the ratio of psychiatric patients.
I've seen this often.
This picture intrigues me,
because our medical station in Ghana
was in a remote village
without tap water.
You would see this scene
that lots of children, after school time, retrieve water at the river,
carry the buckets on the head and walk in a line back home.
What I saw were smiles on their faces.
The smiles were seldom seen in Swaziland,
You can hardly see the young in rural areas of Swaziland.
You can see them drinking on the roadside,
or sometimes drinking in bars.
This is just my observations,
not a sample from statistics.
but I sure see big difference between two countries.
If you hop on a subway,
you will hear, ”Mind The Gap.“
Be careful of the gap on the platform.
Actually there are lots of little things that we don't even notice.
You can't see the gaps.
You could say that
these gaps make people across this gap feel like strangers.
These AIDS patients
these drug addicts, alcoholics
deserve it!
They don't keep their nose clean.
If you bravely step away from the gap,
putting these problems in the same vein of society,
their meanings will emerge.
Once you cross this gap,
diseases are no longer just diseases.
It's big social problems behind the scene.
So I leave you with this -
"Mind the gap." Thank you!