Medical Practices in Vietnam
Several medical traditions co-existed in Vietnam. These include western medicine, traditional Chinese medicine (ong lang), and folk medicine and health concepts centering on the ill effects of phong (“wind”). As elsewhere in Southeast Asia, there were also religious views which linked illness to supernatural intervention.
Western Medicine and Psychiatry
Western medical services were first introduced in Vietnam prior to the 1800's by European and American missionaries and later expanded during the French colonial rule (1883-1946). During this period, the French established public health services, hospitals and clinics, and a school of medicine at the University of Hanoi. In South Vietnam, faculties of medicine were subsequently added to the University of Saigon and, in 1961, to the University of Hue (Smith 1967:129-131). By the fall of the Thieu government in 1975, South Vietnam reportedly had 2,000 registered physicians. For a population of 18 million, this theoretically meant a ratio of physicians to patients of 1 to 9,000. Because three-quarters of the physicians served in the army, there were probably even fewer available for the civilian population (Tung 1980:32-33). By contrast, there was a fairly large number of practitioners trained in traditional Chinese medicine. According to one estimate, there were 4,600 such practitioners in 1965, six hundred of whom resided in Saigon (Smith, pp.129,132). According to Rieu (n.d.), fifty percent of the rural and urban population continued to resort to these doctors of Chinese medicine.
The shortage of western-trained medical personnel also applied to the field of psychiatry. According to Tung (p.75), the medical personnel in this field included three clinical psychologists; three psychiatric social workers;
― 45 ―psychiatric nurses who were trained on the job; and eight full-time psychiatrists, who were responsible for two in-patient facilities and about 2,000 hospital beds. It was not unusual for patients to have tried some form of traditional treatment before entering a psychiatric facility or consulting a western-style physician (McKinley 1966:423; Tung, p.74). Often these physicians were the final choice, resorted to only after traditional cures proved ineffective and the patient was no longer manageable in the home or the community.
Traditional Medical Practices
Traditional avenues for the treatment of mental disorders can be categorized according to one of three disease models. Tung (1980) describes these as the “Am Duong Model,” the “Organic Model,” and a collection of beliefs centering on supernatural beings. The latter reflects a mixture of folk religion, Buddhism, Confuciansim, and Taoism.
The Vietnamese concepts of am and duong are based to a large extent on Chinese traditional medicine and the belief that illnesses are caused by im-balances in a complex system of correspondences. All phenomena in the universe (including the organs of the human body, the seasons and cardinal points, and the emotions) are incorporated into this classificatory system. The basic categories are yin (am) and yang (duong). Associated with yin are foods characterized by their sour or pungent taste; the seasons of winter and autumn; the hours between noon midnight; cold and coolness; and human organs such as the liver, heart, and spleen (Lock 1980:32; Porket 1974:23-29).
Illnesses, depending on their properties or symptoms, can also be classified in terms of a deficiency or excess of yin or yang. The system applies to both physiological and mental illnesses. For example, pimples are thought to come from an excessive amount of heat which erupts through the skin (Tung, p.13). Delirium and agitated psychoses are thought to be caused by a preponderance of yin (p.56). Physiological imbalances (i.e., excesses or deficiencies of yin or yang) can be caused by internal influences (e.g., one's emotional state) or external influences (e.g., sudden climatic or seasonal changes), which work within the body to obstruct the circulation of ch'i (vital energy) or one of
― 46 ―its variants (e.g., blood or hsüeh). One method of clearing obstructions is the application of acupuncture to strategic points of the body. Another way of remedying the imbalance is to prescribe herbs or aliments which can offset the imbalance by virtue of their yin or yang attributes (Lock, pp.35-37).
The Organic Model sees mental illness as a function of the nervous system. According to Tung (p.55), the Vietnamese, like the Chinese, describe neuroses as a “weakness of the nerves” (than kinh suy nhuoc) and psychoses as a “turmoil of the nerves” (than kinh thac loan). In practice, “weak nerves” seems to be a common complaint, signifying minor mental disorders ranging from anxiety to depression and sometimes including mental retardation and mental deterioration. Medicine (e.g., an appropriate nerve tonic or tranquilizer) is usually prescribed to treat such conditions.
According to Tung (p.74), supernatural intervention has been the most persistently held cause of mental illness as well as its most popular form of treatment, regardless of the patient's level of education and sophistication. In Vietnam, folk beliefs are similar to other Southeast Asian groups such as the Hmong and Mien in that they encompass a body of spirits with both harmful and protective tendencies. The malevolent spirits are capable of inflicting illness, insanity, or even death by taking one of the souls or “vital spirits” which the Vietnamese believe sustain and give life to the human body (Hickey 1964:76).
Two opposing types of supernatural beings, or spirits, are the tien, deities who are believed to have the power to protect individuals, and errant spirits. The latter are the spirits of individuals who have died without benefit of an ancestral cult in their honor (p.76). The importance of the cults resides in the belief that individuals can attain happiness in the after-life only if they are properly venerated by their descendants (p.88). Cult maintenance is the responsibility of members of the same patrilineage (toc) and involve appropriate ceremonies and offering in honor of deceased ancestors, usually up to three generations in ascent from the patrilineal head. Ma troi are a type of errant spirit, normally the ghosts of people who
― 47 ―have drowned but whose bodies have not been recovered. Like others who have died violent deaths or have no families to carry on observances in their behalf, ma troi are destined to wander the earth, causing harm to the living, until they can be restored to the family tomb or to the ancestral altar (p.78).
Vietnamese communities had several types of religious healers who were able to prevent or treat supernaturally caused illnesses. These include spirit mediums, “sorcerers,” and Buddhist priests and lay monks. Hickey describes two such healers in a small village located outside of Saigon. The ong thay phap (“Masters of Sorcery”) were healers who derived their special powers to invoke and exorcise evil spirits from patron deities who were the center of cult worship. According to Hickey (pp.78-80), one of the village ong thay phap specialized in curing mental disorders. The usual procedure was to obtain a sample of blood from the patient and use it to write a special formula which had the power to frighten away the afflicting spirit.
Hickey (pp.64-66) also describes two village lay monks (cu si) who served as healers. The elder cu si, who had learned his healing arts from monks in southern Cambodia, employed amulets and medicines for physical ailments and exorcism for cases of “insanity.” The younger cu si specialized in disorders associated with childbirth.
Ong dong and ba dong are spirit mediums associated with the popular cult, chu vi, which honors the spirits related to the goddess Lieu Hanh and the fourteenth century cultural hero, General Tran Hung Dao. Cult rituals focus on communication with either the spirits or with the souls of ancestors. Ong ho, usually associated with a particular pagoda, derive their powers to protect individuals against misfortunes and disease from the deity Quan De or by his acolytes, Quan Chau and Linh Hau (LeBar, p.170).