Taiwan’s insurance trade began developing in the 1960s. Given the newness of the industry, insurance sales agents were often mistakenly thought to be selling a product that wished evil upon people. Due to such misunderstandings, some insurance companies failed to prosper and ceased operations, while others were acquired by multinational corporations.
The development of psychiatric care shares a similar history. After World War II, the Department of Psychiatry at National Taiwan University Hospital was the only institution deemed qualified to practice this new area of medicine. There were very few non-governmental practices, and those institutions were referred to as “madhouses.”
People with mental illnesses would be considered to be possessed by karma creditors, or shouldering the immorality of their ancestors. When a psychiatric institution was about to be established, residents in the surrounding area would try to block construction.
Tsao-Tun Psychiatric Center is one example. According to the Ministry of Health and Welfare’s initial plan, it was meant to be built in Taichung, but local opposition forced the hospital to the foothills of Chielao Mountain (茄荖山) in Nantou County.
Taiwanese are today more enlightened about psychiatry, and the government has helped it gain a more positive profile. Psychiatric institutions in Taiwan are also helping to remove stigma from mental health issues. For instance, the Taiwanese Society of Psychiatry encouraged the Ministry of Health and Welfare to change the term “schizophrenia” to “early psychosis,” and “mental deficiency” to “the loss of intellectual functioning” when referring to dementia.
Medical students in Taiwan no longer consider psychiatry a risky or unpromising career. When Chung-Ho Memorial Hospital announced two openings for resident doctors in psychiatry, it received more than 40 applications.
It is therefore most regrettable that insurance companies do not remember their own stigma when they screen their customers for mental illness. When people purchase health or life insurance products, the companies often search the purchasers’ medical records on the National Health Insurance Administration database.
If records of psychiatric care are found, the insurance provider often refuses the sale on the pretext of a “pre-existing condition.” This is ironic and disheartening, especially given that Taiwanese society has made such progress in acknowledging the significance of seeking and receiving care for mental health.
Setting aside the serious mental illnesses of psychosis, bipolar disorder and dementia, the pressures of working in modern businesses and dealing with highly developed and ever-changing industries have made mental health stress a large part of life. It is inevitable that many people would seek help from a psychiatrist for even a mild mental health condition, including emotional disorder, adjustment disorder or temporary sleep disorder, which can result from working in shifts.
When people look after their mental health by seeking medical assistance, it ultimately reduces the cost and burden to society. People should be encouraged to see a psychiatrist if needed.
Insurance companies, however, often reject potential clients who have a record of seeking such care. This violates a person’s rights and interests, while stigmatizing psychiatry and mental health professions.
The government must do its best to stop such discrimination in the insurance industry, which itself must make greater efforts to keep up with the times.
Wu Chao-tsong is a psychiatrist living in Changhua County.
Translated by Liu Yi-hung
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