臺灣自閉症的「初」現

The Initial Appearance of Autism in Taiwan

本研究以「知識流通」為分析工具，探討自閉症在臺灣「初」現的歷程，分析本土行動者從歐美社會引進自閉症知識過程中的實作與在地修飾，突顯自閉症知識在全球流通的豐富樣態。本文追溯1960年代之前，自閉症診斷尚未出現時的臺灣社會，如何看待「沉默孤僻」的問題學童；而後由不同單位推行心理衛生計畫，即便實踐效果有限，但仍提供發現自閉症的基礎，讓部分的問題行為學童進入醫療化。臺灣本土行動者引進自閉症診斷時，不僅考量到醫學實作與當地文化的適應性，也以文化差異解釋不同地方的兒童異常表現，讓自閉症在臺灣的「初」現與發展，有著不同於歐美社群討論的意涵。藉此可發現，兒童心理衛生工作推動了當代兒童精神醫學診斷、量表與治療實作，是臺灣兒童精神醫學發展的重要磚瓦。本研究最後結合知識流通與醫療化的過程，發現臺灣自閉症的初現，不僅是特定行為問題朝向醫療化的時機，也充分顯示本土行動者篩選與應用知識的能動性。

This paper explores the initial appearance of autism in Taiwan. Drawing on perspectives of knowledge in transit, I argue that the practice and local tailoring of native actors reflect the rich global ecology of autism knowledge in transit from Western society to Taiwan. Descriptions of ''problem children'' who were ''unsociable and eccentric'' were commonplace in Taiwan prior to the emergence of autism as a formal diagnosis in the 1960s. My analysis reveals that, despite its limited influence, the Mental Health Programme in Taiwan provided the basic infrastructure for medicalizing certain behavioral problems of children, and for the eventual formalization of autism as a diagnosis. Autism's emergence in Taiwan and its cultural ramifications differed from those in North America and Europe due to the practices of local medical practitioners and their understanding of the abnormal behavior of children from varied cultures. Therefore, the Mental Health Programme played a central role in shaping the field of child psychiatry by promoting the contemporary diagnosis, scale and practice of autism as a medical and social phenomenon. By looking at autism knowledge in transit, this paper deepens our understanding of medicalization and highlights the agency of the local practitioners as they filtered and applied autism knowledge.