The heat and the dust invading a café near the National Mental Hospital 2 in Bien Hoa were about to cut short our interview with Mrs. N.
Then the 52-year-old woman, battling depression, said something that hit us: “Every day around 6 p.m. I feel very sad and the doctor will come to make me take a pill that makes me forget I am sad.”
For an hour, she had been talking about what brought her to the top psychiatric hospital in the southern province of Dong Nai (35 kilometers to the northeast of Ho Chi Minh City), the fourth time in 16 years.
She had her first anxiety episodes in 2000, which soon turned into severe insomnia and chronic jaw clenching. Her father developed similar symptoms in his old age, so she was ready to accept the possibility of mental illness.
But the mother of two wanted to find a solution that could help her keep working. She then took her first trip from her home in Long An Province to the Bien Hoa hospital, which is the only regional facility for all 26 provinces in central and southern Vietnam.
After a short stay, she came home and managed to overcome two short episodes of depression. Then came two deaths in the family in 2014 and 2015, which hit her with waves of anxiety and worry. A visit to a fortune teller made things worse: she was told to expect more sorrow to come. The mother had to return to Bien Hoa.
This time, she has been here for 60 days and the medication is stronger. Even though the hospital is state-sponsored, her family still has to pay several hundreds of thousands of dong every day for her treatment.
A doctor’s story
Earlier that day, Mrs. N. was carefully selected for us as a potential interviewee by her doctor, one of the most senior at the hospital.
During a separate, long conversation, the doctor never tried to hide that his job has been overwhelming. A general physician who had to learn mostly on the job, he never had time for intensive continuous training on psychiatry.
The doctor was upfront about the difficulties that medical professionals in Vietnam face in this kind of public facility: the lack of government funding that prevents them from spending more time with their patients to understand the causes of mental illness, and from conducting statistics research.
In November 2016, the Ministry of Labor, Invalids and Social Affairs released alarming figures on the issue of mental health in Vietnam. According to its data, 13.5 million people suffer from mental disorders, a rough 15 percent of the country’s total population.
Among them, 2.8 percent live with depression and 2.6 with anxiety disorders. Dr. Pham Dung, speaking at a symposium held in Hai Phong in November, gave a more precise insight: 200,000 Vietnamese suffer from severe illnesses, but 37 percent of them are yet to receive a treatment.
From Lao Cai to Ca Mau, there are only 45 hospitals entitled to treat mental illness, including a department of the military hospital 103 in Hanoi specialized in post-traumatic stress disorder for war veterans.
Far the biggest of them all, the Bien Hoa hospital has 1,200 beds. The facility, whose sheer size strangely recalls that of the factories on the other edge of the industrial town, was initially built as an asylum by the French between 1915 and 1919. It soon saw a rapid growth in the number of patients. In 1937, it was euphemistically named Duong Tri Vien, or an institute for convalescence.
The hospital is the leading mental health facility in Vietnam with 1,200 beds. Photo by Nguyen Duc Tu
The ‘madness’ taboo
The taboo and the stigma surrounding “madness” and psychiatry in Vietnam, like most parts of the world, are still very strong.
Mrs. N.’s doctor said patients from remote areas often come to doctors as their very last resort. The word tam than (mental) scares them, mostly because of the discrimination they, as well as their families, may suffer in their community.
In a doctoral thesis she defended at Columbia University in 2013, Claire Edington has studied the history of psychiatry in Vietnam with a special focus on the Bien Hoa hospital. She demonstrates that, by quoting Henri Reboul, Director of Public Health in Indochina in 1913, the lack of reliable statistics was a big problem for French doctors.
It led the authorities to underestimate the number of Vietnamese people with mental disorders during the first three decades of the colonial period. One hundred years ago, unfortunately, society was already hiding the “mads.”
The new figures released by the social affairs ministry two months ago could be seen as a first step in the right direction. But more studies are needed to be done now to understand why these figures are so high and whether there is any connexion with the fast social, economic and cultural change and the feeling of anomy it produces. Because for now, the main victims of the current lack of understanding are the patients.
For individual cases, questions should also be asked about the prescribing of heavy medication, the use of institutionalization and the legal and psychological support for patients like Mrs. N.
Another step should be to open many more mental health facilities. Having to go to Bien Hoa from a central province is a challenge. And a massive hospital with 1,200 could be too big and intimidating.
Last but not least, better training for psychiatrists is vital. Doctors like the ones we met in Bien Hoa already have the goodwill. Now they need more support so that they could offer more rays of hope to the restless minds.
* Louis Raymond is a French writer interested in the social history of Vietnam. The article does not necessarily reflect the views of VnExpress International or VnExpress.