從「瘋」到「精神病」——臺灣精神病法律史 （1683-1945）

From Madness（Feng） to Mental Illness —A Legal History of Mental Illness in Taiwan（1683-1945）

本文研究台灣清治時期瘋病規範與日治時期精神病法律的發展。清治時期，官方尚未出現現代法體系下之行政與刑事之分，惟檢視官方的瘋病規範可發現，官方依照管制對象為「瘋病之人」與「瘋犯」，各有不同的管制措施。進一步檢視，清代瘋病規範一直在改變，對瘋病本人有「嚴厲化」、「刑名化」的走向。對於瘋病之人的家屬、地方官而言，可看到官方課予更多的義務與責任。
日治時期，在現代法體系的分野下，官方精神病法律可分成行政與刑事兩大控制體系。在行政體系方面，《精神病者監護法》與《精神病院法》此兩部內地法律依勅令施行於台。官方欲將此兩部法律施行於台，主要的考量是為因應台灣日益漸增的精神病人數所帶來的「非法拘禁」問題，同時替當時甫興建完畢，但在制度上仍無相對應措施的養神院建制而設。比較內外地版本，儘管台灣在權利救濟的保障上明顯較內地不足，然而在應用《精神病院法》的標準方面，實比日本內地更為嚴格。
刑事體系部分，在被告責任方面，由清治時期至日治時期的演進，可以看到從「情有可原」到「責任能力」的轉變。在清代，判官面對瘋犯時，常基於「憐憫」心態，以「情有可原」、「情法之平」作為論理，網開一面釋放瘋犯。然而，在日治時期，隨著西方罪責原則的引進，裁判實務上發展出一套相當不同於清代的論理模式。在罪責原則之下，當被告欠缺一定「責任能力」時，此時裁判官依照法律規定，就被告責任能力欠缺之程度，應做出不罰或減輕其刑的裁判。此處「責任能力」有無的判斷，由於涉及精神醫學專業，在日治時期可以看到，裁判官針對此類問題通常會命精神科醫生為被告施做精神鑑定。專業精神鑑定的出現，除了反映日治時期法學與精神醫學在制度上的相互合作外，另由裁判官藉由鑑定意見來作為裁判上的輔助此點來看，可見當時的執法者顯然已經將精神醫學作為一門有別於法學的專業知識來加以看待。
事實上，在清治時期與日治時期，都可見到「治療」瘋病或精神病的影子。清治方面，儘管官方規範中並未特別強調治療瘋犯的重要性，然而透過《淡新檔案》，我們可看到當時官方對於瘋病，已存在零星的醫療處置。由此可看出，自清代開始，「瘋病」已被官方認定是一種疾病。日治時期與清治時期對於瘋病與精神病的一個明顯的分野，即為西方精神醫學的引進。隨著西方精神醫學知識自日治引入台灣，「精神病」開始在醫學上被明確界定，可以看到官方利用科學方法將一切病理「精神病化」的現象。從「瘋」到「精神病」的轉化過程，官方法律用語的轉變背後所反映的，正是不同時期的政權對於精神異常狀態的理解與處置態度及方式。
儘管西方精神醫學在日治時期已成為一股重要的力量，但從當時本島人對於精神病的理解，甚至選擇治療精神病的方式，可以看到，童乩等民俗療法以及漢醫的影響，在民間仍普遍存在一定的作用。

This article studies the development of regulations and laws related to madness and mental illness during the Qing Dynasty and the Japanese colonial period in Taiwan. During the Qing Dynasty, there was no clear separation between administrative and criminal law in the modern sense. However, by examining the official regulations on madness, it is evident that different control measures were implemented depending on whether the target was a“mad person”(「瘋病之人」) or a“mad criminal”(「瘋犯」). Furthermore, it can be observed that the Qing Dynasty’s regulations on madness underwent continuous changes, with a tendency towards becoming more strict and criminalized. For the family members of mad person and local officials, these regulations also imposed more duties and responsibilities.
During the Japanese colonial period in Taiwan, the official laws related to mental illness were divided into two major control systems: administrative and criminal. In terms of the administrative system, two main laws, the“Home Custody Act of Mental Patients”(精神病者監護法) and the“Mental Hospital Act”(精神病院法) were enforced in Taiwan by edict. The main reason for enforcing these laws in Taiwan was to address the issue of“illegal detention”caused by the increasing number of mentally ill individuals in Taiwan, as well as to establish corresponding measures for the newly constructed mental hospital Yang-Shen-Yuan (養神院), which lacked a systemic framework. Although the Taiwan version of these laws lacked adequate safeguards for the protection of rights and remedies in comparison to the mainland version, Taiwan was more stringent than Japan in applying the standards set forth in the“Mental Hospital Act”.
In terms of the criminal justice system, the evolution from the Qing Dynasty to the Japanese colonial period reveals a shift in the concept of culpability from“excusable”(情有可原) to“responsibility.”In the Qing Dynasty, judges facing mad prisoner often released them with a sympathetic mindset, using“excusable”(情有可原) and“justice tempered with mercy”(情法之平) as reasoning. However, during the Japanese colonial period, with the introduction of Western principles of criminal responsibility, a quite different logical framework developed in judicial practice.
Under the principle of criminal responsibility, when the defendant lacks a certain“responsibility”, the judge should make a decision not to punish or reduce the sentence of the responsibility, according to the law. The determination of whether the defendant has the responsibility involves the field of psychiatry, and during the Japanese colonial period, judges often appointed psychiatrists to conduct mental appraisal for defendants in such cases. The emergence of mental appraisal not only reflects the institutional collaboration between legal law and psychiatry during the Japanese colonial period, but also demonstrates that judges relied on the evaluation opinions as an aid in their decision-making process. From this perspective, it is apparent that the law enforcers at that time had already regarded psychiatry as a specialized knowledge distinct from legal law.
During both the Qing and Japanese colonial periods, there were indications of“treatment”for mental illness and madness. Despite the fact that official regulations in the Qing dynasty did not particularly emphasize the importance of treating the madness, we can see through the“Tan-Hsin Archives”(淡新檔案)that there were sporadic medical treatments for madness at that time. Thus, in practice, madness had already been recognized as a disease by the authorities since the Qing dynasty.
A clear distinction between the Japanese colonial period and the Qing dynasty was the introduction of Western psychiatry. With the introduction of Western psychiatric knowledge during the Japanese colonial in Taiwan,“mental illness”began to be clearly defined in medicine, and it can be seen that the authorities used scientific methods to“psychiatrize”(精神病化) all pathological phenomena. The transformation of legal terminology from“madness”to“mental illness”reflects the different understandings of mental abnormality by different regimes in different periods.
Despite the fact that Western psychiatry had become an important force during the Japanese colonial period, the understanding of mental illness among the local people and the ways of treating it still showed the influence of folk remedies such as Tongji(童乩) and traditional Chinese medicine.