Silenced Controversies: The Professionalization of Psychiatry and the Biomedicalization of ADHD in Taiwan

ADHD (Attention Deficit/Hyperactivity Disorder), the most common mental disorder among children and adolescents in Taiwan, does not seem to be as controversial in terms of its entity, diagnosis and medical safety among local professional groups as it is in some Western countries such as the United States. This is not to say that Taiwanese psychiatrists uniformly embrace the biomedical model of ADHD. However, alternative paradigms and practices of psychiatry are excluded from the public sphere and discouraged by the National Health Insurance. Besides, the strategic alliance among psychiatrists, teachers and parents for dealing with various learning difficulties effectively justifies the medical framework of children’s deviant behaviors. By analyzing the archives of the professionalization of Taiwanese psychiatry, and by conducting interviews with psychiatrists, relevant medical professionals, teachers, and the main parents organization, I unravel the interrelated processes of the development of the medical subspecialty, the publicization of health services and the medicalization of education, in order to elaborate that the biomedicalization of ADHD in Taiwan is not a necessary achievement of advancement in psychiatry, but a co-production with various social and political conditions. In particular, the “biomedical evidences” and “gearing to the international norms” constitute the driving rationality and emotion of the professionalization of Taiwanese psychiatry in a latecomer context; moreover, as a late-developing medical specialty, Taiwanese psychiatry lacks a sufficiently powerful legacy of the psycho-dynamic approach, which dominated Euro-American psychiatry before the 1980s and has thus far provided competition for the biomedical approach. Furthermore, Taiwanese child and adolescent psychiatrists are too few in number to encourage multi-paradigms. Therefore, although controversies and alternative practices concerning ADHD exist, they do not originate from the psychiatric in-group and thus find it difficult to shake the mainstream practices. Consequently, the biomedical discourses and treatment of ADHD have been stabilized and reproduced in Taiwanese psychiatry.