Psychiatry in Southeast Asia: Where the West Meets the East
Not only is Southeast Asia one of the most culturally diverse regions in the world, but it is also well known for its many natural resources. The latter attracted Western colonialism, setting up a mixed scene of traditional values and Western modernization that is reflected in the psychiatry of many Southeast Asian countries.
Despite not being very large, Southeast Asia is particularly culturally diverse, with many languages, people, and religions. Therefore, it is no surprise that the history of psychiatry in this region is equally diverse, especially before the arrival of Western colonizers. However, parallels between Southeast Asia and closely related cultures do exist. Like most regions in the world, Southeast Asians also accounted for the unbalanced harmony between humans and the spiritual world to be the culprit for mental illness. The stigma surrounding these unbalanced harmonies, however, varied from culture to culture.
For example, in both Cambodia and Vietnam, supernatural forces were believed to have caused mental illness among their people. While the Cambodians saw the prevalence of mental illness as a sign to clear some miscommunications between humans and ancestral spirits, the Vietnamese saw this as a serious consequence of wrongdoings against the spirits. Thus, in Vietnamese culture, the entire family had to endure the punishment together. There was even an actual law in Vietnam dictating the responsibilities of the family when a member had mental disorders.
While the stigma varied, the overall approach to mental illness in pre-colonial Southeast Asia seemed family-centric, accompanied by religious guidance. In countries where Buddhism dominated, such as Vietnam and Thailand, people with mental illness were usually entrusted to temples. The monks would pray for them before returning home to family members with care instructions. Herbal remedies were also popular. In Thailand, these ancient remedies were found carved in wooden or stone structures in temples which were considered the first medical universities in Thailand. In other countries, such as Laos, Cambodia, and Malaysia, people called on shamans to deal with mental disorders.
The overview of psychiatry in Southeast Asia came together around the same time as the first colonizers arrived in the nineteenth century. The colonizers started building madhouses, not only for mentally ill patients but also for prisoners. As a result, institutionalization had inevitably arrived in Southeast Asia.
Thailand and Singapore fared quite well during this period. Both countries were heavily influenced by the West, but unlike most of their neighbors, Thailand and Singapore maintained autonomy over their lands. Both had an open policy with Westerner diplomats and seemed to encourage Western knowledge. In 1889, the first hospital for the insane was opened in Thailand and run by the Royal Family, starting with King Rama IV. The mental health provisions of Thailand were modeled after the U.S. with a combination of traditional treatments that were free for not only Thai citizens, but also for refugees from other countries who could not afford the Singaporean hospitals that were modeled after the British. The Royal Family of Thailand oversaw the mental hospital until the early twentieth century when the democratic government took over and psychiatry became an official subject of study at universities. The semi-independence of Thailand and Singapore allowed both countries to develop their own mental health provision systems, which until today, surpass that of many neighboring countries.
The same could not be said for other countries like Cambodia, Vietnam, the Philippines, and Malaysia. Each of these countries had undergone a long and bloody period of colonialism. The Philippines, in particular, was ruled by Spain for three hundred years. A generalized version of Western mental institutionalization was forced onto the colonies, whose mental treatments had been family and community-centric. The culture and history of these colonies were completely disregarded by supremacist ideologies and by the beginning of the twentieth century, psychiatric hospitals appeared in most Southeast Asian countries. Under the control of the Dutch, Indonesia had the largest number of psychiatry beds in the region.
The combination of European supremacist ideologies and the stark contrast between the attitudes of the East and the West regarding mental health created immense tension and hatred for the colonizers. It did not help that in some countries, like Cambodia for instance, mental institutions also doubled as prisons. In Vietnam, which France controlled, traditional medicines were even prohibited. As a result, refusing Western treatments became a form of silent protest against colonialism. Institutionalization was already heavily unpopular and stigmatized in these countries. Therefore whenever possible, many people would still seek out traditional remedies instead of Western ones.
As time progressed, each formal colony eventually fought off the shackles of colonialism. Due to the stigmatization of mental institutionalization, many countries returned to their traditions. However, their systems, under decades and centuries of colonialism, have become deeply flawed. Not only mental health provisions, but also their economies, governments, and history have been destroyed by invaders.
As a result, many Southeast Asian countries have had to choose which aspect of their country to improve first. No one can blame them for prioritizing their overall ruling systems and economies over mental health. With mental health provisions being pushed behind, these institutions carried on a mixture of the flawed Western and traditional values that prevent people from trusting psychiatric hospitals. The current scene of psychiatry in Southeast Asia, once again, is just as diverse as their cultures. While most formal colonies are now politically and financially stable enough to focus on mental health, it would still take them a lot of time and effort to undo the damage caused by centuries of stigmatization and colonialism.
Southeast Asia is culturally diverse and so is their attitude towards mental health.
The history of psychiatry in Southeast Asia could be summarized into three parts: pre, during, and after colonialism.
The impacts of colonialism are extremely negative on the attitude of Southeast Asian people regarding mental institutions and the mental health provisions of the region in general.