本文探討1945到1970年間臺灣的精神醫療，嘗試釐清當時就精神病問題，專業、國家、外援與民間社會各自不同的理解、立場與策略，並分析其背後的多重脈絡。精神病不僅是一個醫療問題，同時也是一個社會與國家治理問題，且其中又包含了衛生行政、社會救濟與治安維護等不同且時常相互衝突的面向。此外，民間社會對於自古即有的精神病及其患者，也自有其認知、風俗與對策。從戰後到1960年代，在國際冷戰架構、國內政治情勢、國家經濟與財政狀況、美國經濟援助、歐美精神醫學潮流以及工業化與都市化等因素的形塑下，臺灣的精神醫學專業、政府機關以及民間社會，各自以不同方式架構、理解與嘗試解決精神病問題。它們之間並非沒有對話與交集，但也有許多異見與衝突。這段時期的歷史留下許多有形與無形的遺產，最顯著的就是若干以收容而非治療為主旨的中型與大型養護機構。這些機構的醫療化與現代化，成為臺灣精神醫療在二十世紀剩下的時間中必須面對的主要問題之一。

This paper examines mental health provision in Taiwan in the period between 1945 and 1970, aiming to elucidate the different perspectives and strategies adopted by the nascent psychiatric profession, the state, the U.S. aid agencies, and civil society with regard to the management and care of mentally ill patients. The care of mentally ill patients was not only a medical issue but also a political, social, and security one. The psychiatric profession, the state, and civil society had each developed different ways of understanding, framing, and coping with the problems posed by mentally ill patients. There were consensus and cooperation, but it was differences and conflicts that were more common. This history left many tangible and intangible legacies, of which the most notable was those large custodial institutions built in the 1960s and 1970s. These institutions’ medicalization and modernization became a major task for the mental health care system in the remaining years of the twentieth century.

精神醫療;精神病;錫口療養院;高雄療養院;玉里療養院;散兵遊民;貧民施醫

mental health care; psychosis; Hsikou Mental Hospital; Kaohsiung Mental Hospital; Yuli Mental Hospital;“deserted soldiers and vagrants”; medical assistance for low-income families