Depression in Japan: Psychiatric Cures for a Society in Distress

by Junko Kitanaka (Paper | 2011 | $29.95 / £19.95 | ISBN: 9780691142050Cloth | 2011 | $75.00 / £52.00 | ISBN: 9780691142043264 pp. | 6 x 9 |5 halftones. 1 line illus)

Review by Sandra Lawman

In this very scholarly book, Junko Kitanaka gives a clear view of the history of depression in Japan, its medicalization and its effects on society.

From my own work on mental health in Japan, I know that suicide rates are soaring and depression is now a kind of ‘national disease’, but how did it get to this?  It is deeply engrained into the Japanese psyche ‘not to stick out from the crowd’, but anyone with severe mental illness does, and this attitude makes it worse.  Even not at the severe end, there is a high incidence of low level depression which affects the economy and the general well -being of the population.  Kitanaka highlights ‘karoshi’ or death from overwork, which now seems to be an accepted phenomenon.

She writes from a historical, clinical and sociological perspective, which are all her areas of academic expertise.  Her account is fascinating and gripping, and she relates how historically, contra to previous opinion, there was a language for depression, and the talk of melancholia in the 19th century was very similar to the Western view.  She goes on to relate how psychiatry fits in with this, and how now it is accepted and part of society and the wider human condition. She says (p51) ‘I suggest that the antipsychiatry movement – and its dismantling of traditional Japanese psychiatry – was crucial for preparing the conditions for the later medicalization of depression’. This was in the 1980’s and a very prevalent force in the West, from where from a different angle strong mental health service user movements were founded.  Japan is now catching up with this.

She also spends some time both on the physiological effects of depression, which were the main concerns in medieval times, and then the 19th century somatisation of mental illness, when it was suggested it might have a biological basis.  This was a good basis for the acceptance of psychiatry later.

Kitkanaka concentrates some of her work on the treatment of suicide, which was very much the focus of psychiatry fifty years ago, and details how this has developed into a wider mental health treatment which is now accepted.  She is also very interesting on gender and depression, and points out that in Japan depression is seen as a male illness, whereas elsewhere it is very female. She says (p140) ‘In sharp contrast to the culturally evocative, sympathetic portrayal of overworked salarymen in the popular discourse, until recently no clear master narrative had existed for female depression.’ This is an interesting and new analysis of this issue and provides food for thought.

Overall the book adds greatly to the knowledge of the field, and is a jolly good read.  More is being published now on this subject, and there is interest from a lay audience outside Japan, which is growing.  Junko Kitanaka provides a scholarly insight into aspects of the issue, and a coherent overall view of the state of mental illness in Japanese society, and is to be commended for that.

Sandra J Lawman is an Associate for the Shaftesbury Partnership. She has recently co-edited with Dr Ruth  Taplin ‘Mental Health Care in Japan’ published by Routledge in June 2012.


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