遷移、挫折與現代性：蘭嶼達悟人精神失序受苦的社會根源

Migration, Mental Frustration, and Modernity: The Social Origins of the Mental Disorders of the Tao Aboriginal People on Taiwan's Orchid Island

本文目的，以社會受苦概念探討蘭嶼達悟人的遷移經驗與高比例精神失序的關係，並藉此反省九年代之後，基因研究取徑與原住民健康議題之間選擇性親近的關係之限制。主要分析的對象，為晚近達悟人精神失序發病所集中的25到60歲之間的青、壯世代。本文認為：要理解達悟人晚近廣泛而獨特的精神失序現象，不能簡單地訴諸單一因素，譬如生物醫學方面的基因解釋。因此本研究強調深入田野，接近達悟人的生活世界與日常經驗，同時輔以各種文獻資料，釐清長久的歷史處境與當代命運的關連。本文同時也指出：蘭嶼衛生所登記精神失序的個案中，半數以上首度出現不正常徵兆的地點，都是在台灣本島。達悟青、壯人口被迫來往遷移於蘭嶼與本島之間謀求生計，是這個離島少數族群某種集體的社會「脫序」(anomie)重要面向。這種原本與外界相當隔絕而孤立的少數族群的社會脫序，是無可選擇地被捲入現代社會的歷史發展結果。在平均年齡15、16歲隻身離開原鄉、沒有父母陪伴下來到以漢人為主的台灣社會求學工作的艱辛過程中，他們所遭受的種種困境與挫折，與流行於他們這個世代的高比例精神失序之間，有極密切的關係。這個世代由於遷移經驗而來的身心創傷，來自開始接受現代教育所必須面對的共同命運，超越了個別成員各自不同的個人遭遇。原鄉蘭嶼經歷快速的社會變遷，迫使達悟人離鄉背井以謀生計，而他們的特殊歷史經驗與文化傳統，則形塑、甚至加深青、壯世代在遷移台灣過程中的困境與創傷，因而誘發了高比例的精神失序現象。

From the perspective of social suffering, the paper explores the correlation between the migration experience of the Tao aboriginal people on Taiwan's Orchid Island and their mental disorders examines the limits of the genetic approach to aboriginal health based on the biomedical model of medicine after the 1990s. The focus of the study is on the cases of mental disorder of young and adult generations, ranging from 25- to 60-year-old population. I argue that the prevalence of mental disorders among the Taos cannot be explained by any single factor, such as a genetic disorder. My fieldwork and a variety of documentation and statistical data show that the Taos' mental health conditions are shaped by their particular historical experience of interacting with the outside world. In almost all cases, people with the experience of migrating to Taiwan and their symptoms of mental disorders began in Taiwan instead of in their isle community. I argue that the fact that the Tao members of the 25-60 age group have to migrate back and forth between Taiwan and Orchid Island to pursue education and find jobs creates a significant state of anomie in their aboriginal society, which, in turn, is a consequence of this society's involvement in the development of modernity. Migrating to Taiwan, a Han-dominated society, atthe age of about 15 or 16 with little support from their families, they are prone to experiencing frustration. There is a close connection between their common frustrating experience of migration and the mental disorders prevailing among them. The physical and psychological traumas caused by the particular migration experience are not just individual experience. They represent the common dilemmas that those Tao members who receive modern education in the postwar period encounter. Under the siege of dramatic social change in the aboriginal society, they have no alternative but to leave their isle to make a living. Tao cultural traditions and their historical experience of interacting with the outside world, however, have intensified the traumas from which the migrating members suffer and contributed to the prevalence of mental disorders among them.