Mental Disability in Japan: Norm or Nusance?

By: Erin Putnam

14 September 2010

     Japanese culture is one in which the ability to form into the mold of society is desired by its citizens. While “advancement” of therapy is beginning to utilize more Western styles of therapy, the underlying culture of Japan will severely stunt any development in the Japanese psychiatric field.

     The presence of mental illness within Japanese culture is a topic of great controversy and instability. While recognized within the Japanese community, psychiatric care in Japan is in direct violation of the Japanese concept of "wa", or harmony (Rosen). The disruption of wa by the mentally ill in Japan has brought a negative aura to the very subject, and has caused a severe decrease in the progression of mental health care in Japan. However, despite the mindset of Japanese citizens against mental health care, research has shown that approximately 24% of all Japanese have some form of mental illness (Priestley).

Above: Wa- Harmony

www.google.com  

Japanese Mindset and Culture

     In her Washington University Article, Erica Rosen claims that Japanese citizens have a concious recognition of status, society, and abnormality. Rosen describes the Japanese mindsets of "uchi" (native behaviors within a group), "soto" (foreign behaviors within a group), "honne" (true feelings), and "tatemae" (public face) in order to explain the apparent and accepted separation of ones individual self from the unit of society. Rosen explains how a family's "Koseki", or "family registration" may be tainted by the institution of a family member, and with it the family's reputation as a whole.

Japanese Psychiatric Infastructure 

• Prior to the 1920’s:  Japanese citizens suspected of having mental disorders were kept under the care of their families and were rarely allowed into Japanese society.
• 1919-1949: The "Mental Hospital Law" called for Districts to instate official mental health facilities.
• 1950-Present: The "Mental Health Hygiene Law" granted rights to mentally ill citizens

                                *Under this clause a citizen may be institutionalized by a family member against

                                  his or her will.

[ Above: Rosen]

     Despite the progression of the psychological field and the laws it produced throughout the first half of the century, psychological treatment itself is controversial within the Japanese community. It has been argued that this may be due to the Japanese cultural trait of “haji”, or shame.  After the South East Asian economic crash in 1992, psychological services were re-emphasized within society (Mental Health). However the wa and haji culture in Japan described above produced two rather passive forms of therapy, Naikan and Morita.

     Naikan, being the more passive of the two, is based in Buddhist principles and stresses the healing of oneself through self-enlightenment through personal retreats. Morita on the other hand is still relatively passive however unlike Naikan, Morita therapy encourages patients to stay in a mental health facility after their retreat to better assimilate to everyday life. (Rosen)

There are three types of processes which can be undergone to institutionalize a Japanese citizen.

• Voluntary: Institutionalism is the patients choice (paid for by the individual)
• Compulsory: A group of psychiatrists deem the need for institutionalization (paid for by the state)
• Family Instated: Funded by the family member or town leader who chooses to institutionalize the patient

[Above: Bleak] 

Taijin Kyofusho

                                                                                                   www.ac.wwu.edu/~knecht/homeres.html

     Taijin Kyofusho is a form of mental illness that has been debated by scholars as being solely prominent in South East Asia. The illness, which is divided into four subcategories (sekimen-kyofu, shubo-kyofu, jukoshisen-kyofu, and jikoshu-kyofu), describes people who are so rooted in their sense of wa and haji that they develop a phobia of themselves. (Suzuki…)

Sekimen-kyofu: Fear of blushing

Shubo-kyofu: Fear of “deformed body”

Jukoshisen-kyofu: Fear of eye to eye contact

Jikoshu-kyofu: Fear of body odor

(Suzuki…)

*2009 the Japanese suicide rate: 26/100,000 people (9/100,000 UK; 11/100,000 US) [Chambers]

Moving Forward?      

     In his film, “Seishin” (Mental), film-maker Kazuhiro Soda gave his audience insight into a more western style of therapy. This therapy included open conversation between patient and therapist and directly countered the more traditional Japanese style of therapy. (*Note: Post production of “Seishin”, three of the cast members portrayed in the film committed suicide. (Priestly)

http://www.laboratoryx.us/mental/                      

Above: (Left) Tomohiro Kato of Tokyo, mentally ill- convicted of murder in 2008                                                                                                   

Above: (Right) Mentally ill Japanese artist Yayoi Kusama

Above:(Lower Left) The artwork of Yayoi Kusama http://www.joeymaalouf.com/2010/07/mental-illness-meet-art-art-mental.html     

                                                                                                                         http://www.blacktokyo.com/?p=3207 

Sources:

Bleak, Jennifer M.D. "Psychiatric Hospitals in the Tokyo area." Emergency Psychiatric Admissions in Japan. Embassy of the United States: Japan. 13 September 2010.  

     http://tokyo.usembassy.gov/e/acs/tacs-psychadmissions.html

Chambers, Andrew. "Japan: ending the culture of the 'honourable suicide." guardian.co.uk. 3 August 2010. 13 September 2010.

     http://www.guardian.co.uk/commentisfree/2010/aug/03/japan-honourable-suicide-rate

"Haji." Japanese Language. About.com. 7 July 1997. 13 September 2010. http://japanese.about.com/library/weekly/aa070797.htm

Koizumi, Kiyoka Ph.D.; Harris, Paul M.D. "Mental Health Care in Japan." Psychiatric Services. American Psychiatric Association. November 1992. 13 September 2010. 

     http://psychservices.psychiatryonline.org/cgi/content/abstract/43/11/1100

"Mental health and counseling in Japan: a path toward societal transformation." Journal of Mental Health Counseling. 1 April 2005. 13 September 2010. 

     http://goliath.ecnext.com/coms2/gi_0199-4170298/Mental-health-and-counseling-in.html

Priestley, Ian. "New documentart explores taboo subject of mental illness in Japan." Japan Today. 13 July 2010. 

     http://www.japantoday.com/category/entertainment-arts/view/new-documentary-explores-taboo-subject-of-mental-illness-in-japan

Rosen, Erica. "The Influence of Culture on Mental Health and Psychopathology in Japan." Washington Univerity in St. Louis: Arts and Sciences. 29 November 2001. 13 September

      2010. http://artsci.wustl.edu/~copeland/rosen.html

Suzuki, Katsuaki M.D. Ph.D.; Takei Nori, M.D. Ph.D. M.Sc; Kawai Madayoshi, M.D.; Minabe, Yoshio, M.D. Ph.D.; and Mori, Norio, M.D. Ph.D. "Is Taijan Kyofusho a Culture-Bound

      Syndrome?" The American Journal of Psychiatry. July 2003. 12 September 2010. http://ajp.psychiatryonline.org/cgi/content/full/160/7/1358