Mental Health Challenges Facing Contemporary Japanese Society – The ‘Lonely People’

By Yuko Kawanishi


Global Oriental, 2009, 175 pages including index and bibliography, ISBN 978-1-906876-00-5, £30

Review by Sir Hugh Cortazzi

One of the main problems for Japanese today is that they take themselves too seriously.  But is this not true of other peoples and does the diagnosis help?  Our personalities are all conditioned not only by our genes but also by our environment including family and the traditional values we absorb.

Dr Kawanishi, who attended universities in California, Boston and Kyoto and has specialized in social psychology, describes in this interesting book many of the stresses and strains of modern Japanese life and analyses the factors which have led to mental breakdowns and suicides.  It has taken a long time for Japanese generally to recognize that mental health needs to be treated with as much seriousness as physical health.  The Ministry of Health, Welfare and Labour (page 54) reports that “three quarters of those suffering from depression are not receiving any treatment.” Dr Kawanishi notes that “There is an old Japanese saying that emphasizes the importance of being resilient: one should keep going even though falling seven times by picking oneself up eight times.” In Britain also for far too long the stresses and strains of modern life were treated as flaws or weakness of character rather than problems of mental health. The answer was thought to lie in calling for the sufferer to show a stiff upper lip.  It was only towards the end of the First World War that shell-shock was recognized as a mental illness and did not amount to cowardice. We have moved on from such simple analyses and Dr Kawanishi shows that Japanese opinion has also progressed, although probably not as far as in some other developed societies.

Dr Kawanishi’s initial analysis of the Japanese psyche is not new. She notes (page 15) that “Japanese thinking patterns are dominated by an almost excessive stress on valuing social relationships over the individual as an independent entity.”   She emphasizes the bond developed between mother and child and notes that “too much love can kill you.”  She draws attention to the Japanese emphasis on ittaikan or “oneness in the group.” She points out that the image of Japan as number one boosted Japanese self–confidence but this was followed by years of stagnation and loss of self-confidence.

Her second Chapter on “Mental Health at Work” covers among other phenomena karoshi or death by over work which she describes as a form of suicide.  She notes that long hours for many employees were regarded by employers as normal. She quotes a woman as saying of her son who killed himself after overwork that “no matter how long he worked, his payroll would only record that he left work at 9 p.m.” Japanese employers, who insist on employees taking their holiday entitlements are very rare, although a few in the financial sector must surely have come round to recognizing that an employee, who never takes a holiday, could be disguising problems. She points out that the performance evaluations systems introduced in many Japanese companies instead of seniority based promotion structures have increased pressure to overwork.

Her third chapter devoted to the Japanese family, which is still influenced by the old pre-war Ie or household system under a male head, makes dismal reading. She describes “The contemporary family” as “an efficient arrangement for great economic growth.” She notes (page 70) that “husbands spend less and less time at home with their wives and children. Their contribution to household chores is notoriously low…Home became a place for many Japanese husbands simply to rest before going back to work again next morning…With the husband often a weak and peripheral figure, the risk of a mother-child bond becoming too close is rather high.”  She draws attention to the number of sexless marriages among young people in Japan today where the net reproduction rate is one of the lowest in the world. She asks: “Is Japanese marriage at a crossroads?” She thinks that (page 93) “many of the problems Japanese families face today come from a strange mixture of warped post-war political and economic development, the haunting influence of Confucian-based ie ideology on the surface, and a deeper cultural, psychological orientation.”

This sets the framework for her discussion in chapter 4 of Japanese youth and its various problems including refusal to go to school, bullying, violence by children against their parents and the hikkomori or withdrawal syndrome which has become such a prominent feature in foreign commentaries on Japanese life. She notes that hikkomori, with its implication that the person concerned, like monks in olden times, is withdrawing from the world, “sounds more benign and more like a temporary condition than ‘personality disorder’” and thus tends to gloss over the reality. She feels (page 133) that it “is ironic that, in an era of globalization in which communication with different kinds of people is crucial to the future and survival of Japan, many young Japanese suffer from an inability to relate to other human beings.”

Sadly Dr Kawanishi does not see any simple ways out of the psychological problems Japan confronts today. For her the Japanese need (page 158) “to re-establish a healthy sense of boundary between the individual and others… and to learn how to do this” or in other words (page 160) “to create a new sense of independence that can coexist alongside a traditional Japanese self.” If they cannot do so “the Japanese will continue to live a lonely and lightless existence.”

This is a thought-provoking if depressing book.

Review by Sandra Lawman

I first went to Japan because I thought it would be a schizophrenic society, with its emphasis on a maternal culture, its reserve and its mood swings.  I think I was proved largely right, and it suited me to experience a society I thought I had some kinship with.

This book examines the mental health challenges facing contemporary Japan, and frames them in terms of the national psyche, such as it exists, and the pressures on the traditional psychology with the decline as a superpower and all that comes with post industrialisation.  The author gives an incisive and coherent account of why there are now so many “lonely people” and why the country seems to be going through a depressive phase.  She posits that the traditional strengths of group loyalty, self effacement and concealment of emotions are now contributing to some of the bad aspects today.  She particularly emphasises people’s difficulty with expressing emotions and communicating generally on a personal level, which is increasing with the failings in the economy.

Japanese people rightly pride themselves on subtle non-verbal communication, but somewhere along the way the ability to articulate problems has been lost, and the author claims this leads to pent-up stress which may contribute to the high levels of suicide.  There is also an increasingly high incidence of clinical depression, which is often disguised as mental stress or mild depression to escape the stigma of something worse.

She looks at mental health at work, and the phenomenon of dying through hard work, and she investigates the current trend in family life, including sex, and the prevalence of hikikomori, where people withdraw completely from society and shut themselves up in their rooms.  This has attracted considerable international media interest in the last decade or so, and it is still unclear whether in itself it is a mental health problem per se, or has more of a social cause. Examination of this leads to a particular in depth look at youth, and the changes in society which are putting pressure not only on the young people but also on their families and workplaces.  A phenomenon almost unique to Japan is violence in the home by children towards parents, which is on the increase, and which is the result of an unarticulated frustration.

Most of the book concentrates on common mental stresses and strains, which are becoming more prevalent, but, interestingly, the incidence of major illnesses such as schizophrenia or manic depression seems to be decreasing, with better treatment.  These diseases are not so medicated yet as in other countries, and from my own research I know there is limited self-help, although there are groups out there.  I was always taught that, whilst the main thing in British society is to ‘stand on your own two feet,’ the main tenet of Japanese society is ‘not to stick out from the crowd.’ The book does point to some measures which are now being taken to help those who deviate from the norm, but there is still some way to go,

Sandra Lawman lived in Tokyo in the early 1980’s until she left with a diagnosis of paranoid schizophrenia,  Since then she has lectured on mental health in Japan, done a study of the Japanese  mental health service user movement, and written a paper on the added value of trust and foundation funding to the health and social care NGO sector in Japan.  She also worked at a major Japanese company in London throughout the 90’s.

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