建国記念の日 Kenkoku Kinen no Hi. From 1872 to 1948, on February 11 the Japanese observed Kigen-setsu 紀元節, a holiday commemorating the day on which the legendary Emperor Jimmu is said by Nihon Shoki to have acceded the throne in 660 BCE. Due to such ultra-nationalistic associations, the modern form of the holiday was established in 1966 as a day to encourage a more contemporary sense of wholesome patriotism. Let’s celebrate by reading a nonfiction book about Japan.
Depression in Japan: Psychiatric Cures for a Society in Distress – Junko Kitanaka
In a world where young women catch Tourette’s Syndrome from TikTok influencers, it is not hard to accept the fact that elements in our culture shape our thinking about and experience of mental health and mental illness. Up to the 1990s, many Japanese people were unfamiliar with the word utsubyo, depression, and didn’t associate their “feeling down” with a clinical diagnosis of “depression” that might ever be applied to them. Medical anthropologist Kitanaka narrates how all that changed in Japan.
In the first part of this fascinating book, Dr. Kitanaka gives a history of the concept of utsubyo in Japan. In the 1700s, symptoms were explained away as caused by mental and physical laziness. Due to a young girl’s or dissipated man’s sluggish reluctance to do anything, their vital force of ki stagnated in the body. This condition was not seen in what us post-moderns could call medical terms. After all, the Buddha said life was full of suffering and what sane person would pathologize a fact? And poetry and prose were shot through with mono no aware, the sweet melancholy dwelling on the transience of all things. Furthermore, pre-modern Japanese didn’t see suicidal ideation as pathological either. Instead, in many cases they saw doing away with one’s self as a moral and social act of free will that preserved honor, atoned for wrong-doing, or cast blame on survivors to serve them right and fix their wagon but good.
Part 2 reports Kitanaka’s ethnographic research in the psychiatric department of a Japanese medical school circa the 2010’s. She observes the treatment of depression in a clinical setting and finds, oddly to my mind, that the psychiatrists resolutely avoid talking about “psychological” concepts with clients. Instead, the doctors prescribe meds and urge the patients to realize their blues and jitters come out of their sheer physical exhaustion brought on by overwork. If they just worked fewer hours, slept more, had better diets with less alcohol, and managed stress more effectively, they would feel more energetic and stronger and not feel so listless and not want to commit suicide anymore. Unbelievably, the docs saw between 30 and 60 patients a day. It boggles the mind.
Part 3 examines with the economic downturn of the 1990s and spreading knowledge about the symptoms of depression, by the year 2000, the Japanese were widely discussing depression and suicide as results of the stress and exhaustion of overwork. The web of course provided many listicles and quizzes so that people could self-diagnose.
The author discusses how depression in Japan became medicalized, shifting from being seen as a personal issue to a bio-social disease caused by work stress. The landmark Dentsū case in 2000, where an advertising agency admitted responsibility for an employee’s suicide due to overwork, marked a significant change in how such cases were viewed legally. The government and corporations became liable for workers’ suicides, prompting new policies to address mental health. Companies now monitor employees’ psychological well-being and offer resilience training, though taking sick leave remains stigmatized.
Pharmaceutical companies marketed SSRIs heavily, leading to a surge in diagnoses and prescriptions. However, the effectiveness of these medications was later questioned, and many patients did not improve, with some even experiencing worsened symptoms.
Despite the complex social science jargon, the book provides an intriguing exploration of cross-cultural psychiatry, medical anthropology, and Japanese studies. It has received multiple awards, including the American Anthropological Association’s Francis Hsu Prize in 2013.
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