Talking in Taiwan (1) Taiwanese Society of Psychiatry

Risk of the Day Being electrocuted by the electric toilet

On arriving back at my hotel room, after only a moderate amount of fine red wine, I was disturbed to find the toilet glowing ghostly blue in the dark. On further exploration, it had numerous other electrical, plumbing and extremely personal features that were all controlled by a remote close by. However, I escaped unharmed.

Classification:     UE (unnatural end)

Control:                Full (4/4) turn it off!

Likelihood:          1

Impact:                 2

Score:                   2

Woke with that 'uh-oh - something's happening today' feeling, and finished polishing up the talk (after some more helpful comments from Lue about what his colleagues would and wouldn't like to hear). Here's the version that I presented, plus refs and links: http://prezi.com/fq0fv-d0bfcf/?utm_campaign=share&utm_medium=copy&rc=ex0share

We arrived at the conference venue - the military medical academy - in a blaze of bonhomie and lavishly-illuminated drug company stands.

Guess who's paying for this party!

The Prezi confused the technicians team, but we agreed it would be fine if shown from my own laptop, in the vast, plush, crimson auditorium. In fact it wasn't fine: the technicians took about five minutes to get me up and running, during which time my kindly and gracious introducer, Dr Ta-Jen Chang, extemporised about something in Chinese, and after the previous speaker had over-run by about 20 minutes. Keep Calm, and all that...

One of the uniformed conference assistants pinned a fragrant orchid arrangement to my top pocket and off I went. The talk went pretty much as planned, and I'm told it was fine. I nearly walked off the stage before they could do the ceremonial presentation - the level of corporate care and detail was extraordinary - plaques and gifts duly received and photographed, I could relax. Several people approached me later in the afternoon to thank and congratulate me - felt very warm and thankful to them all.

Some interesting conversations with people, one theme of which I need to think about and explore: "it would not work for us to have TCs in Taiwan. It would not work". And it seems to be both economic and structural: psychotherapy is too expensive to be included in the national health insurance scheme, and it is seen as separate to psychiatry (although most psychotherapists here are psychiatrists, they do it in their own time, with private patients).

If we can make the model work in Bangalore and Low and Middle Income Countries, Bouganville with Natural Nurturers, and possibly even Kabul - as part of the 'Enhanced Self-Help Groups' programme (see http://prezi.com/c2mszczmtnas/?utm_campaign=share&utm_medium=copy&rc=ex0share)  - why ever not in Taiwan? Is it the hegemony of westernised practice? Or just a manifestation of the enormous gap between 'expert help' and 'self-help'? Or a widespread lack of understanding about the principles of empowerment, personal agency, and groups taking responsibility for themselves? Only questions for now, but I will try to come back to this one.

Back to hotel and short rest before the formal conference dinner. And how formal it was! Lue rather ruefully pointed out to me, as we walked into the banqueting suite, that he would have to sit at the other end of the room because I was the special guest and had to sit with the important people, and he was not: it is very hierarchical. Not very TC, I said, as we parted company.

I ended up sitting between a hyperdynamic Chinese researcher (vast cluster RCTs on adolescent interventions in schools for BPD), and a laconic journal editor (who was very amused at the 'horse-trading' going on all around as preparation for tomorrow's elections to the governing committee of the Taiwanese Society of Psychiatry). My over-riding thought was that these people were all fiercely competitive, working in a globalised academic 'game', and very familiar with the trappings of hierarchical  formalities, manners and rituals. Although I expect this is true in all fields, I started to wonder whether its prominence here - in international psychiatric development - might be related to my earlier question, about empowerment. This system by which the experts maintain their power and status - may be the same system that keeps a substantial gap between 'expert' and 'self-help' treatment...

New Thing of the day

Wearing a bouquet of flowers on my lapel (involuntarily)