The psychological landscape of Chinese mainlanders

In the 1950s and 1960s, Taiwanese newspapers reported innumerable cases of suicides, mental illness, and crimes of passion, a significant portion of which involved individuals who had recently fled from China. Sun Moon Lake, a renowned tourist destination in central Taiwan, became a hotspot for suicides, drawing scores of desolate incomers.Footnote ²³ The prevalence of mental illness and disorderly vagrancy further heightened social and political instability.Footnote ²⁴ Additionally, crimes of passion, frequently linked to economic hardship and family discord, attracted extensive media coverage.Footnote ²⁵ In 1956, Dr. Hsu-chu Lee, Director of the Air Force Medical Corps, discussed the influence of Taiwan’s natural environment on mainlanders. They often experienced feelings of frustration, homesickness, excessive workloads, and susceptibility to illnesses. Additionally, abnormal mental states, including

Lee, originally from Beijing, urged his fellow incomers to familiarise themselves with the local environment, adjust their lifestyles, and maintain their mental well-being to ‘create a new living environment and return to the mainland happily and promptly’.Footnote ²⁶

As pointed out by historian Yu-Chuan Wu, psychiatric disorders during the 1950s and 1960s were not merely perceived as health issues but entailed considerations of social welfare and public security. The Taiwan Provincial Government issued the ‘Taiwan Province Measures for Suppressing Deserters and Vagrants’ in 1950 to police homeless deserters, unemployed vagrants, and beggars, as well as street vendors and individuals engaging in unlawful occupations that posed threats to social order.Footnote ²⁷ Wu notes that managing ‘mentally ill wanderers’ became ‘one of the most important factors shaping Taiwan’s psychiatric healthcare policies during the 1950s and 1960s’.Footnote ²⁸ The prevalence of social turmoil, coupled with the increasing number of psychiatric patients due to the influx of incomers, prompted both central and local governments to expand, or at least plan to expand, existing social relief and psychiatric facilities, as well as establish new mental health institutions.Footnote ²⁹ Given the limited number of psychiatric hospitals established by central or local governments during that period and the heavy reliance on private psychiatric clinics or asylums for mental health matters, the establishment of a few facilities mainly targeting the need of Chinese incomers – the psychiatric unit at Yuli Veteran Hospital in Hualien, for instance – highlights the severity of their psychological distress.

Apart from newspaper reports and government documents, the old case notes of the Department of Neurology and Psychiatry at the National Taiwan University Hospital (hereafter as NTUH), currently stored at the Institute of Modern History, Academia Sinica, provide another invaluable glimpse into the psychological landscape of post-war Taiwan, primarily through the psychiatric lens.

A brief discussion of the historical context precedes our analysis of the case notes. During the colonial period, Taiwanese psychiatry developed primarily under Japanese physicians.Footnote ³⁰ Following the war, these colonial psychiatrists were repatriated, and in 1946, Tsung-Yi Lin, a 26-year-old graduate of Tokyo Imperial University, was appointed Director of the Department of Neurology and Psychiatry at the newly restructured National Taiwan University (NTU). Over the subsequent two decades, amidst shifting East Asian geopolitics and increasing Western aid, the department transitioned from Japanese and German influences to European and North American psychiatric trends. For instance, the bachelor’s dissertations completed at NTU’s Medical College in the late 1940s demonstrate a predominant focus on the hereditary and biological foundations of mental disorders.Footnote ³¹ Topics of study encompassed pathobiography (e.g. Goethe, Rousseau, and Nietzsche), eugenics, and intelligence testing.Footnote ³² While biological and neurological research continued in the 1950s and 1960s, there was a discernible shift towards incorporating social, psychological, and cultural dimensions into psychiatric inquiry.Footnote ³³ International exposure further accelerated this epistemological transformation. More than two dozen Taiwanese psychiatrists, psychologists, nurses, and social workers pursued advanced studies abroad in the 1950s and 1960s through fellowships from the World Health Organization (WHO), the US Agency for International Development, and other aid organisations. Over two-thirds trained in the US, with others studying in the UK, Canada, and Europe.Footnote ³⁴ Consequently, Taiwan’s early psychiatrists acquired expertise in epidemiology, cultural and dynamic psychiatry, psychotherapy, mental hygiene, and neurophysiology.Footnote ³⁵ Despite some psychiatrists relocating from mainland China and the military establishing its own psychiatric care system in the early 1950s,Footnote ³⁶ NTUH’s Department of Neurology and Psychiatry remained the most research-intensive and well-resourced institution in post-war Taiwan.

The daily practice at the department was significantly structured by the socio-political situation in post-war Taiwan. As the island’s political and social centre, Taipei attracted a substantial influx of incomers. Consequently, taking the year 1951 for instance, approximately 63% of the outpatients seeking psychiatric and neurological assistance at NTUH, at least according to the existing medical records, were from Mainland China. Many had affiliations with the military, police, and civil service.Footnote ³⁷ Among the myriad psychiatric and neurological cases in the same year, psychoneuroses constituted 40%, with mainlanders comprising 75% of this category. Consisting of around 16% of all cases, schizophrenia emerged as the most predominant psychosis, with the Taiwanese being more affected. Nevertheless, the paranoid subtype of schizophrenia was notably conspicuous among mainlanders.

The content of some of these medical records taken in 1951 casts light on the social, economic, and psychological suffering experienced by mainlanders in more detail, as well as how the NTUH team framed and managed their conditions. Lang, a law student at NTU, struggled with adaptation issues and was diagnosed with the anxiety state of psychoneurosis. Considering Lang’s educational background, his psychiatrist recommended that Lang write an autobiography. The college student uncovered that both his strained relationship with his father and his flawed personality were at the root of his condition. His medical record revealed that, along with medication, Lang also underwent experimental treatments such as psychoanalytic therapy.Footnote ³⁸ Kan, originally from a wealthy family in Shanghai, faced financial hardship upon relocating to Taiwan, leading her husband to work as a rickshaw puller. She once endured a challenging childbirth due to malnutrition. Suffering from insomnia, anxiety, and hypochondria, this mother of two was diagnosed with psychoneurosis and treated with medications.Footnote ³⁹ Some patients exhibited more severe conditions. While in Shanghai, a young man surnamed Teng was so troubled by nocturnal emissions and headaches that he engaged in self-harm and entertained suicidal thoughts. Recently, the 25-year-old suffered from nervousness, anxiety, and pessimism. Convinced that military trucks passing by his school were targeting him, Teng felt under constant surveillance and attempted suicide by mutilating his genitals. His diagnosis was schizophrenia, paranoid type.Footnote ⁴⁰ Kung, the 40-year-old wife of a civil servant, suffered from religious and political delusions. She believed that she was being targeted by communists who subjected her to X-ray attacks, allegedly in retaliation for her physical confrontation with Stalin. She claimed that she was later rescued by divine intervention and would receive visits from President Chiang Kai-shek. Following her immediate hospitalisation, she underwent 17 sessions of insulin shock therapy and 11 sessions of electroconvulsive therapy. Eventually, the case note indicated she was ‘moderately improved’ and discharged.Footnote ⁴¹

A few points merit further consideration. First, as mentioned above, existing patient records show that the mass migration in late 1949 and 1950 significantly changed the ethnic composition of the patient population. The disproportionate presence of mainlanders in Taipei and its neighbouring areas created an opportunity for comparative studies among subethnic groups at NTUH. Furthermore, it very likely drew the NTUH team’s attention to migration-related issues, which will be examined in more detail in the following sections. Second, many patients exhibited symptoms before they arrived in Taiwan; some even stated that the origin of their disorders dated back a long time. For them, migration itself was a painful experience, though it exacerbated their existing social and personal suffering. On the other hand, an inclination to link current complaints with past experiences among several patients might probably result from the growing influence of a dynamic and socio-psychological style of thinking, which places particular emphasis on the critical life events that cause nervous and psychotic disorders. Third, the initial predominant usage of Japanese and German in the case notes in the mid- and late 1940s, followed by the gradual incorporation of English and Chinese, highlights the complexity of Taiwan’s medical and social history. Almost all psychiatrists who practised at the NTUH during the immediate post-war era were native Taiwanese. From affluent families with prestigious colonial educational backgrounds, they were compelled to shift their political allegiance following the island’s transfer to Chinese control, navigating profound social upheavals and linguistic shifts. These young psychiatrists had to adapt, mastering Mandarin Chinese or even the local Hokkien dialect to effectively communicate with their diverse patient population, many of whom spoke varying dialects and were from dissimilar cultural and social backgrounds. Tsung-Yi Lin and Wen-Shing Tseng aptly termed these challenges as ‘cultural shock’, reflecting the daily tribulations encountered during a transitional era.Footnote ⁴²

Epidemiological studies of migration and social change

Between the late 1940s and the 1970s, the NTUH psychiatric team conducted a series of studies on mass migration and its related social changes. They can be broadly categorised into four main themes: (1) epidemiology, (2) delusions and culturally distinctive psychiatric disorders, (3) institutionalised geriatric and pauper population, and (4) suicide and other social ills. Due to word limitations, the present study will focus on the first two themes.

Between 1946 and 1948, Tsung-Yi Lin, in collaboration with Japanese instructors such as Ryosuke Kurosawa and Taiwanese public health specialist Kung-Pei Chen, spearheaded a team from the NTUH in conducting a series of epidemiological investigations on mental disorders at Baksa, Simpo, and Ampeng. Lin aimed for their findings to lay the groundwork for mental health services in Taiwan. His research methodology closely followed the approach developed by his mentor, Japanese psychiatrist Yushi Uchimura, and his team in the 1930s and 40s, which focused on racial hygiene studies conducted in Hokkaido and the Izu archipelago.Footnote ⁴³ Given Lin’s previous tutelage under Uchimura and subsequent responsibility for devising a mental health plan upon his return to Taiwan, this methodology choice was a logical one. In addition to census registers, the NTUH team garnered support from local authorities, police force, community leaders, medical practitioners, and schoolteachers to conduct comprehensive surveys in three townships. The total population studied during this period numbered 19,931. Published in English in 1953, these findings gained international recognition and influenced the WHO’s research in social psychiatry.Footnote ⁴⁴ The team continued to employ the same methodology to investigate the incidence of mental disorders in subsequent decades. Interestingly, Lin’s article also very briefly addressed the phenomenon of mass migration, drawing on studies by Norwegian and American scholars that examined the prevalence of mental disorders among immigrants. He attributed the rise of mental disorders in Taiwan during the early 1950s to the disruptions caused by the repatriation of Japanese nationals and the influx of Chinese immigrants.Footnote ⁴⁵

The drastic social changes and their impact on Taiwanese society became recurrent themes in the following decades. In 1961, Ming-Tso Tsuang and Hsien Rin highlighted that Taipei City’s population had grown by 500,000 after the war, more than tripling its size; a substantial proportion of these new residents were of mainland Chinese origin.

Between 1947 and 1958, Tsuang and Rin continued, outpatient attendance at NTHU saw a more than tenfold increase, primarily driven by a surge in male patients with neurotic disorders of mainland Chinese ethnicity. This rise was attributed to changes in living conditions and economic circumstances among mainlanders, particularly those in military and public service roles seeking diagnostic certificates and social insurance. Ethnicity and gender also influenced illness prevalence, with male incomers experiencing greater social and psychological stress. Mainland female patients showed a greater tendency to delusional disorders, attributed by the authors to pre-existing issues in traditional Chinese family structures and the upheaval of migration. Referencing studies on European refugees in Canada and Australia, the authors highlighted the correlation between the rise in neurotic disorders, psychophysiological reactions, and delusional disorders with the psychological impacts of shifting societal demographics.Footnote ⁴⁷

The findings from Tsuang and Rin’s 1961 article recurred in subsequent epidemiological studies in various forms and with different emphases, reflecting the impact of forced political migration, economic struggles, and ensuing maladaptation on mainlanders. Mainlanders were reported to be more prone to a variety of mental disorders, including psychophysiological reactions, neurotic disorders, and delusional reactions. Notably, middle-aged individuals, females, and those with lower socio-economic status displayed a higher prevalence of adverse psychophysiological responses to stress. Mainlander females exhibited a significant prevalence of schizophrenia, while local males faced elevated rates of depression, attributed to the psychological strain stemming from societal and economic changes. Further studies indicated that immigrants living alone, belonging to lower social classes, and residing in dormitories had the highest rates of mental disorders. Other studies suggested that many mainlanders identified strongly with Western values, such as Christianity, yet their life experiences did not align with this Westernised identity, leading to psychological maladjustment.Footnote ⁴⁸ In a 1973 comparative study on Taiwan and Japan by Hsien Rin, Carmi Schooler, and William Caudill, it was noted that, unlike Japan, where symptoms tended to be introverted, the Chinese in Taiwan exhibited distinctive symptoms like hostility, detachment from reality, anxiety, and headaches.Footnote ⁴⁹

The origin of the above-mentioned epistemological studies and how the research method was employed warrant additional examination. To begin with, as mentioned previously, the development of psychiatric medicine in Taiwan during this period was closely tied to the academic traditions of the Japanese imperial era. Uchimura’s team at Hokkaido and Tokyo Imperial Universities focused on racial hygiene and imperial medicine, conducting studies on hereditary mental illnesses and racial comparisons of mental disorders, including epidemiological research among the Ainu people in Hokkaido.Footnote ⁵⁰ Harry Wu uses the term ‘incomplete decolonisation’ to characterise this colonial legacy in post-war Taiwan.Footnote ⁵¹ Historian Akihito Suzuki has further noted the research methods of Uchimura’s team were influenced by Swiss psychiatrist Ernst Rüdin, who was involved in planning racial policies for Nazi Germany, and his Swiss disciple Brugger. In a similar vein, Hosanna Fukuzawa not only examine the close connection between Uchimura’s work on the Ainu people and the development of eugenics and racial science in Japan and Germany but also highlights the extensive influence of the research agenda within the Japanese Empire and its impact on post-war studies.Footnote ⁵² Therefore, Uchimura’s epidemiological and comparative psychiatric studies merged the attributes of ‘racial hygiene’ and ‘imperial medicine’.Footnote ⁵³ It is safe to say that, in terms of both research subjects and methodology, the epidemiological studies conducted by the NTUH team drew from German (including the comparativist psychiatric research with distinct colonial undertones led by Emil Kraepelin)Footnote ⁵⁴ and Japanese psychiatry. However, in the post-war international academic arena, particularly when publishing in international journals during the 1950s and 1960s, the concerns of Taiwanese psychiatrists no longer centred on racial hygiene. Even in European countries deeply influenced by German psychiatry before the war, the focus of attention had now shifted towards comparative psychiatric research focusing on cultural differences and social change.Footnote ⁵⁵ Taiwanese psychiatrists were similarly caught in this trend. This transition reflects a complex interplay between imperial Japanese, Fascist German, and Cold War West-led knowledge systems across pre- and post-Second World War eras, highlighting the complicated historical shifts in psychiatric knowledge production. It was in this academic and social milieu that the psychological impact of migration, as well as the ethnic differences in mental illness, were investigated in Taiwan.

Furthermore, the historical investigation into the link between migration and mental disorders, particularly within North American psychiatry, dates to the nineteenth century. Early studies, such as those conducted by the US Bureau of the Census, focused on immigrants’ races and their perceived impact on the native population’s mental health. Throughout the twentieth century, social scientists used statistical methods to examine how social and environmental factors affected immigrants’ susceptibility to mental disorders, with post-Second World War research focusing particularly on European refugees. Some studies indicated that immigrants had a lower proportion of mental disorders compared with the native population. Others advocated incorporating more variables (e.g. including age, gender, and education level) and delving deeper into cultural origins, migration conditions, and differences in disease types.Footnote ⁵⁶ Classic studies on foreign immigrants and migration patterns have frequently emerged in the NTUH team’s work. The team’s emphasis on the ‘distinctiveness’ or ‘breakthrough’ of its research merits further exploration. Unlike previous studies relying on hospital statistics, the NTUH team prioritised comprehensive data collection from community censuses and in-depth and sometimes intrusive interviews. The team also maintained consistency in its research methods and diagnostic systems. As they put it, this approach distinguished their research and could advance mental health efforts in developing countries.

Indeed, as Harry Wu has stated, mid-twentieth-century Taiwanese epidemiology has diverse academic origins.Footnote ⁵⁷ From the above analysis and on the foundation of studies by Hans Jakob Ritter and Volker Roelcke,Footnote ⁵⁸ Akihito Suzuki, and Hosanna Fukuzawa, it can be inferred that the early post-war Formosa Study incorporated elements from racial hygiene and imperial psychiatry from Japan and Germany, as well as the long-standing concern in North American society regarding immigrants as the ‘other’. Drastic changes in geopolitics and academic traditions prompted Taiwanese psychiatrists to make the most of an assemblage of knowledge systems they inherited and later picked up in daily practices and academic research. For instance, within the unique demographic context of Taiwan (with most residents being classified as ‘Han Chinese’ at that time), topics that might have been framed within the context of race or ethnicity in other studies were transmuted into discussions on cultural patterns and differences in stages of social change.

From another perspective, the epidemiological research conducted by the NTUH team from the mid-1940s onward addressed clinical imperatives. Tsung-Yi Lin recollected that upon returning to Taiwan after studying in Tokyo, he encountered significant challenges in communicating with patients from various ethnic groups to understand their life backgrounds, social environments, and even the normality or abnormality of their behaviours. This difficulty persisted even when interacting with local, Taiwanese-speaking farmers.Footnote ⁵⁹ On one occasion, when attempting to clarify the concept of ‘culture’ within psychiatry, Lin articulated more clearly the practical nature of cultural psychiatry research for him, stemming from the context of colonisation and the post-Second World War geopolitical landscape. He explained that such research had a tangible impact and was deeply rooted in personal life experiences.

The issues of cross-cultural exchange, migration, and social transformation were subjects of concern within the mainstream Western psychiatric, sociological, and anthropological circles. Naturally, they garnered the attention of Taiwan’s psychiatric elite. However, concurrently, post-war Taiwan was confronted with significant shifts in international politics, and the relevant conceptual frameworks originating from the West became essential sources of knowledge for these medical experts to understand their circumstances. Yet, delving deeper, it becomes evident that concepts such as cross-cultural experiences and migration, seemingly derived from the Western sphere, are rooted in the personal experiences of psychiatrists like Tsung-Yi Lin and Hsien Rin, who possessed colonial backgrounds and were compelled to adapt to post-colonial and Cold War political, social, and academic realities.

Paranoia and culturally distinctive psychiatric disorders

Given their specific aims, the NTUH team’s epidemiological studies inherently offer a simplified examination of illness experiences among diverse ethnic subgroups. In comparison, their cultural and anthropological approach is evident in their more detailed analyses of the content of delusions and hallucinations and a range of culturally distinctive psychoneuroses.

The prevalence of delusional psychosis in Taiwanese society during the early post-war era captured the attention of Taiwanese psychiatrists. Simultaneously, from the 1930s to the 1960s, the enduring global interest in migration spurred the research pursuits of the NTUH team. In their collaborative article, ‘The Characteristics of Paranoid Reaction in Present Day Taiwan’, authored by Hsien Rin, Chen-Chin Hsu, and Sau-Lien Liu in 1958, they initially referenced North American studies indicating that forced immigrants often encountered mental disorders, including delusions, amidst profound cultural transitions.Footnote ⁶¹ Despite both Taiwanese and mainlanders sharing a common overarching culture, disparities in situational backgrounds arose due to the experience of migration, leading the authors to focus on exploring the correlation between paranoid psychosis and Taiwan’s current situation. Among the four groups classified by province of origin and gender, mainland-born women exhibit the highest incidence of paranoid reaction, primarily attributed to maladjustment following migration, alongside issues like marital discord and strained relationships between mothers- and daughters-in-law. Even though mainlanders experienced long-term turbulence, their paranoid breakdowns occurred a few years after migration. The article included six case studies spanning mainland-born women, a mainland-born male, and local-born male and female patients. Employing a dynamic psychiatric approach, including psychoanalysis, the authors delved into the cases’ life trajectories and etiological mechanisms. For instance, a Fujian-born Christian woman became delusional, believing her husband was unfaithful and President Chiang was her father, anticipating a visit from a ‘prince’. Similarly, a Jiangsu-born Air Force instructor, grieving his son’s death, developed delusions, accusing his wife of sexual frigidity and suspecting colleagues of ill intentions, envisioning surveillance by secret agents. Throughout, the article highlights how migration triggered family separation, economic turmoil, and hardships, fostering grief and hostility, which in turn manifest in mental disorders such as paranoid reactions, psychoneuroses, and suicides. The authors emphasised that while interpersonal issues might aggravate these fundamental factors, Chinese culture also shapes personality structures.

In 1962, Hsien Rin, Kwang-Chung Wu, and Ching-Ling Lin conducted a study involving 220 cases, revealing that local-born patients exhibited a higher prevalence of religious, superstitious, and supernatural elements in their delusions and hallucinations. Local-born males, particularly, displayed more grandiose ideas, linked with their lower socioeconomic status. Conversely, mainlanders often expressed delusions related to political concerns, espionage, and international affairs, indicating the significant impact of migratory phenomena driven by political factors on the manifestation of delusional and hallucinatory symptoms. The findings confirmed the close connection they observed between ‘social catastrophes and the subsequent development of paranoid disorders’. ‘The type and content of delusions and hallucinations’, as the authors continued, ‘will be coloured by one’s particular experiences, personality, and cultural milieu’.Footnote ⁶²

As previously discussed, Western studies have shaped the exploration of migration by Taiwanese psychiatrists. Early research in the 1930s on Norwegian immigrants to the United States and African Americans migrating to New York hinted at a higher prevalence of mental disorders among migrants. However, debate persisted over whether these conditions were pre-existing or a result of migration-related challenges.Footnote ⁶³ By the late 1940s and early 1950s, studies on Second World War refugees relocating to Canada and Australia provided more explicit evidence of the direct link between migration and mental health. For example, Libuse Tyhurst’s study in Montreal revealed how refugees often experienced delusions of being perceived as communist spies, with anxiety manifesting through physical symptoms rather than verbal communication.Footnote ⁶⁴ Ignacy A. Listwan’s research on European immigrant patients in Australian psychiatric hospitals found that migrants, particularly young single men from Eastern Europe, were more prone to delusional symptoms, often emerging after their arrival in Australia amidst challenges such as economic hardships and loneliness. Listwan also applied Freud’s theories to elucidate migrants’ personality traits and psychological states.Footnote ⁶⁵ Moreover, migrants experienced neuroses as a form of collective anxiety arising from the psychological conflict between prejudice and assimilation. Difficulty in adaptation often led to regression and delusions, serving as coping mechanisms to exaggerate their behaviours and customs.Footnote ⁶⁶

Discussions among Taiwanese psychiatrists concerning Western research on migration from the 1930s to the 1950s reveal significant disparities in research methodologies and theoretical underpinnings. Two key characteristics emerge. First, whereas international studies primarily focused on migrants as their central analysis subjects, the NTUH team, while singling out the psychological states of Chinese incomers, directed their attention also toward major ethnic subgroups within Taiwan, conducting comparative analyses of their mental health conditions. Second, investigations into European refugees delved more deeply into migrants’ psychological states and psychodynamic mechanisms through psychoanalytic and psychodynamic lenses. In comparison, Taiwanese migration-related studies predominantly unfolded within the epidemiological framework. While these studies mirrored crucial observations by Western scholars, the depth of analysis of migrants’ psychological mechanisms in Taiwanese studies did not match that of Western ones. This disparity, however, does not stem from a lack of familiarity with psychodynamic psychiatry among Taiwanese researchers; rather, the framework of cultural psychiatry compelled figures like Hsien Rin to prioritise the interplay between traditional culture, contemporary circumstances, and individual experiences. Conversely, scholars such as Tyhurst and Listwan discussed migrants’ cultural traditions and personality traits to a limited extent, focusing primarily on migrants’ psychological responses in extreme real-world situations. Furthermore, geo-political realities or ‘the present-day situation’ loomed larger in Taiwanese psychiatric studies, so much so that the experience of migration and adaptation emerged as, at least for Taiwanese psychiatrists, the distinctive feature separating Taiwanese from mainlanders. The previously-mentioned 1958 paper on ‘The Characteristics of Paranoid Reaction in Present Day Taiwan’, for instance, underscored the contextual significance of the country’s ‘present day situation’. While emphasising the role of migration-related issues in generating paranoid symptoms among mainland patients, the authors adhered to a more traditional analytical framework when tracing the origins of conditions in Taiwanese cases to childhood family dynamics, their impact on personality development, and their longstanding supernatural beliefs. In other words, despite that the 1949 mass migration affected all ethnic groups in Taiwan, the NTUH team’s comparative psychiatric studies adopted a more sociological approach in highlighting the connection between specific forms of disease presentation, geo-political realities, and major life events among incomers, while the cases involving native Taiwanese were framed within a more cultural and, as it were, static context.

The interpretation of the entanglement between socio-political realities and disease representation took an interesting twist several decades later. Reflecting on the NTUH team’s early studies on paranoia, Hsien Rin noted in 2009 that, at least during the 1960s, compared with Taiwan, Japan exhibited a slower pace of paranoidisation among people with schizophrenia and a lower paranoid patient count. The greater prevalence of paranoia in Taiwan can be attributed to the island state’s status as a ‘modern nation formed by the coexistence of multiple ethnic groups’. At the same time, Japan has been a ‘nation with a single ethnic group and a consistent historical background’.Footnote ⁶⁷ Through this observation, Rin underscores again the role of social change, particularly modernisation (in the form of the formation of the modern state), in shaping shifts in the typology of mental illnesses. More importantly, the portrayal of ethnic diversity and turbulent historical occurrences aptly captures the erratic geopolitical, social, and psychological transformations the country has experienced.

In comparison with their earlier focus on paranoia, Taiwanese psychiatrists garnered increased international recognition through their cross-cultural examinations of culture-bound syndromes. Their investigations delved into alcoholism among aboriginal tribes, as well as phenomena such as koro, frigophobia, and neurasthenia. The latter trio, deeply rooted in Chinese cultural contexts, epitomised traditional medical and bodily conceptions.Footnote ⁶⁸ Within these discussions, issues involving migration and ethnicity surfaced subtly. The study by one of the current authors on the psychiatric discourse surrounding neurasthenia in post-war Taiwan illuminates the NTUH team’s profound engagement with the topic. This interest was intricately intertwined with several critical factors, including the surge of Chinese mainlanders into Taiwan, the burgeoning impact of traditional Chinese medicine, and the Taiwanese psychiatrists’ scholarly pursuits into Chinese cultural and character structures, coinciding with the rise of cultural psychiatry on the international stage.Footnote ⁶⁹ Taking Koro as another example, the two patients discussed in Hsien Rin’s 1963 and 1965 papers were originally from mainland China. Both were firstborn sons in conventional Chinese households, lacked maternal nurturing, and experienced a limited connection with their fathers. Economic strife and familial discord intensified anxiety and heightened sexual urges. Rin attributed their breakdowns to ‘a threat on personal and family security through employment and financial difficulties subsequent to their migration to Taiwan’.Footnote ⁷⁰ Essentially, migration exacerbated or activated existing pathological personality traits within cultural frameworks, underscoring how migration could catalyse latent pathological tendencies. Rin’s approach primarily focused on dissecting mental illness characteristics in Taiwan through cultural and comparative psychiatric lenses, thus positioning him as a cultural psychiatrist and underscoring NTUH’s stature as a prominent hub for international cultural psychiatric inquiry during that era.

The context of Hsien Rin and his colleagues’ 1975 study on frigophobia was also intertwined with the issue of migration. Among the five cases examined, four originated from various provinces of China. The authors analysed the patients’ persistent and unfounded fear of coldness through the lens of traditional medical beliefs, bodily perceptions, and Chinese familial dynamics.Footnote ⁷¹ Although the work on frigophobia did not mention the patients’ life experiences specifically, the link between this culture-bound syndrome and significant historical events was evident to some observers. During a visit to the psychiatric wards of NTUH in the 1980s, Japanese cultural psychiatrist Koichi Ogino used his concept of ‘homelandlessness’ to understand a Chinese frigophobia patient with a history of migration.Footnote ⁷²

Taiwanese studies on the above-mentioned culture-bound syndromes attracted extensive international scholarly attention. Through their works, Tsung-Yi Lin, Hsien Rin, and Wen-Shing Tseng eventually became renowned researchers in cultural psychiatry. Considering that Communist China was primarily shut off from the Western world in the heat of the Cold War, as the present study has shown, Taiwanese psychiatrists capitalised on Taiwan’s status as a laboratory for Chinese studies. Their systematic inquiries into the psychological dynamics of Chinese immigrants contributed to their professional visibility at a time when global collaboration on cultural matters was actively promoted. It is also noteworthy that, during the Cold War, while many American scholars conducted fieldwork in traditional Taiwanese villages as proxies for understanding the so-called Chinese culture and history,Footnote ⁷³ native-born Taiwanese psychiatrists contributed to the construction of ‘Chinese Culture’ and ‘Chineseness’ through their work in comparative psychiatry, which substantially incorporated the life experiences of displaced Chinese under extraordinary historical circumstances.

‘ … this restriction of expression’

Five years after the lifting of Taiwan’s Martial Law in 1987, Tsung-Yi Lin commented in a speech to his fellow Taiwanese psychiatrists on the lack of comprehensive research into the psychological factors contributing to the divergence in psychiatric manifestations between Taiwanese and Mainlanders during the 1960s and 1970s. Alongside the scarcity of personnel, Lin singled out the constraints imposed by ‘a political atmosphere sensitive to enquiry into Taiwanese-Mainlander relationships’.Footnote ⁷⁴ Authoritarianism and tense ethical relationships in Cold War Taiwan were not merely the backdrop against which the NTUH team conducted their clinical work and research but constituted their everyday reality. The disappearance of Bosei Lim (or Mao-Sheng Lin) – Lin’s father and then the acting dean of the College of Humanities at NTU – during the February 28 Incident in 1947 has been considered one of the most notorious atrocities perpetrated by the Kuomintang against native Taiwanese. Eng-Kung Yeh’s father-in-law, a prominent native businessman who had been charged with seditious conspiracy, was sentenced to imprisonment for ten years. Sheng-Ji Yeh, a leftist medical student of NTU and a close friend of Hsien Rin and Eng-Kung Yeh during the immediate post-war era, noted on several occasions in his diary his disdain for mainlanders, including the authoritarian demeanour of one of his Chinese professors.Footnote ⁷⁵ Sheng-Ji Yeh ultimately faced execution due to his affiliation with an underground communist cell. A pathology professor originally from the mainland attributed the strained relationship between professors and students at NTU at the time to the undue colonial influence exerted on native students.Footnote ⁷⁶ The fact that several fellow students, professors, and even their family members perished or were significantly affected amidst the February 28 Incident and the White Terror had a substantial impact on Taiwanese psychiatrists.Footnote ⁷⁷ One of the main reasons that Tsung-Yi Lin left the country to work for the United Nations (UN) and later in Canada was the death of his father and the oppressive political environment. Eng-Kung Yeh, Tsu-Pei Hung, and Chu-Chang Chen mentioned their experiences of the White Terror in their biographies, and the former championed native consciousness vocally later in his life.Footnote ⁷⁸ American psychiatrist and anthropologist Arthur Kleinman gives a vivid description of the ‘political tensions and historical resentments’ he and his wife witnessed when they visited Taiwan in the 1970s. Due to the dominance of the ‘authoritarian mainland governing elite’, the young native psychiatrists and nurses with whom Kleinman collaborated at NTUH harboured clandestine support for political independence.Footnote ⁷⁹ This sentiment was also observed by several American scholars who conducted research in Taiwan during the Cold War era.Footnote ⁸⁰

Despite the NTUH team’s exploration of narcoanalysis in forensic investigations and the involvement of certain members in overseeing mentally ill political prisoners under intelligence agencies,Footnote ⁸¹ their academic trajectories suggest a degree of autonomy or agency. In the immediate postwar period, when the Kuomintang regime began implementing a series of decolonisation policies, the Japanese influence in psychiatry remained significant. Furthermore, from the early 1950s onward, their research topics displayed both diversity and continuity, with a number of studies addressing politically sensitive issues such as ethnic relations and social maladaptation. In this sense, the present study corroborates the findings of Harry Yi-Jui Wu on the professional agency of Taiwanese psychiatrists during the Cold War period.Footnote ⁸² This partial ‘autonomy’, at least from the authoritarian Kuomintang regime, was nevertheless also a product of Cold War geopolitics. A substantial part of the funding for training psychiatric professionals and establishing mental health services in early post-war Taiwan was provided by international aid agencies such as the WHO, the American Bureau of Medical Aid to China, and the United States Agency for International Development.Footnote ⁸³ Nevertheless, exploring the psychological landscape of the Cold War-era Taiwan and the impacts of social catastrophes still posed a significant challenge for Taiwanese psychiatrists. Some of the NTUH team members managed to navigate the limitations imposed on them. Sharing the result of their cultural and psychological investigations, sometimes coupled with social critique, through international journals was one of the options, and the following two examples illustrate the point.

One of the major studies conducted by the NTUH team in the 1940s and 1950s was the socio-psychomatic study of hypertension.Footnote ⁸⁴ As Tsung-Yi Lin explained, the project was closely linked with the experience of mass migration: ‘The rapid social change after the influx of mainland Chinese since 1948 led to the postulation of a possible association between the apparent increase of hypertensives and socio-environmental factors’.Footnote ⁸⁵ Data from around 10,000 hypertensives in Taipei, comprising both Taiwanese and Mainlanders, were gathered to determine the frequency and distribution of hypertension among ethnic Chinese and the relationships between biological and socio-psychological factors and hypertension. Published in Chinese in the Journal of the Formosan Medical Association in 1956, the first report of the study only provided preliminary statistics.Footnote ⁸⁶ No following report can be found in the Taiwanese journal, and another report published in Clinical Science several years later reiterated the initial study’s statistical findings.Footnote ⁸⁷ Tsu-Pei Hung, one of the co-authors of these two reports, published a follow-up study in Japanese in the Japanese Circulation Journal in 1961.Footnote ⁸⁸ Contrary to the widespread belief that mainlanders, due to migration and adaptation pressure, might experience higher blood pressure, the findings of Hung and the NTUH team revealed otherwise. Across gender and social class, hypertension incidence was predominantly higher among the local population. Drawing upon psychodynamic and psychosomatic studies by Franz Alexander, Leon J. Saul, and Stewart Wolf, he concluded that mainlanders often channelled their hostility and aggression through projection. This discovery aligned with the NTUH team’s earlier findings, indicating that mainlanders, compared with Taiwanese, were more prone to paranoid psychosis. Moreover, Hung continued, the escalating instances of suicides, forced suicides, and antisocial crimes among mainlanders were also linked to this outward expression of hostility. While highlighting the aggression of the mainlanders, the Taiwanese neurologist intimated a more subdued way by which the Taiwanese faced social changes and political oppression. Interestingly, Saul’s study was grounded in seven psychoanalytic cases, placing primary emphasis on the dynamics between patients and their parents alongside personality development traits.Footnote ⁸⁹ Conversely, Hung, resonating with Alexander’s work on the psychological distress of African Americans, redirected focus from individual analysis to exploring collective psychology within subcultures or ethnic subgroups.

Another instance of Taiwanese psychiatrists utilising international platforms to voice their discontent is related to their research on child mental health. Eng-Kung Yeh characterised the post-war political regime transition as ‘a state of social confusion’, highlighting that the significant social change since 1948 had led to ‘social tension and conflicts in the traditional ways of life and security system’. In addressing the problem of so-called ‘low intelligence’ and ‘poor school records’ among some schoolchildren, he reframed the issue. He attributed its origin to overpopulation, the implementation of compulsory education, and the lack of sufficient schools.Footnote ⁹⁰ Referring to a similar issue, Tsung-Yi Lin recounted in 1961 the experience of one of his colleagues who endeavoured to develop a standardised intelligence test in the late 1940s. With the implementation of government policy on the limited use of the Japanese language, the psychologist discovered that schoolchildren participating in the experiment faced difficulties in articulation, describing concrete objects, and engaging in abstract thinking.

The research project was then temporarily suspended ‘until new patterns of communication and culture in general had established themselves in the community’.Footnote ⁹¹ As evidenced by the present study, for these Taiwanese elites, this ‘restriction of experience’ was a ‘cultural’ phenomenon affecting a considerable portion of the population, including themselves, and was not confined to the native schoolchildren who were compelled to undergo speedy decolonisation.