Mental Health Care in Japan

Edited by Ruth Taplin and Sandra J. Lawman
Routledge: Contemporary Japan Series
June 2012, 148 pages 
ISBN: 978-0-415-69068-3

Review by Sean Curtin

This impressive multi-authored work comprehensively examines the current state of the mental health system in Japan. It furnishes an excellent overview of the present situation and the multifaceted issues facing the country. Despite having one of the world’s highest suicide rates, mental health issues are often underplayed or completely overlooked. Other major challenges confronting the country are widespread depression, institutionalisation, over sedation of patients and a relatively restrictive mental health care system. All these important topics are analysed in this work which meticulously explores the current challenges. It provides a helpful overview of the complex tapestry of the current system and discusses the latest legislation, approaches to treatment and problematic areas.

Although research indicates depression is relatively common in the country, with a significant increase since the devastating March 2011 triple catastrophe, according to Hiroto Ito, “awareness of depression is not high in Japan (page 45).” Psychiatric care is also problematic as Hajime Oketani and Hiromi Akiyama outline, “Massive doses of psychiatric drugs are administered in order to keep the patients under sedation; they are often over-sedated. Then, the treatment is considered as ‘going well.’…This is the background of megadose culture in psychiatric care in Japan, which is extremely unique; few countries in the world practise this type of mental care approach (page 83).”

To provide a comprehensive picture, there is analysis of key cultural aspects which impact on mental health. For example, the role of family structures in contributing to mental health problems is looked at as well as the wider social concepts of tatemae and honne. Ruth Taplin writes in the comprehensive introductory chapter, “Tatemae and honne are concepts essential to understanding the Japanese psyche as the former refers to how things should be and the latter refers to the reality and how things are in actuality…In Japan, the very attempt to separate the two states of mind so they do not come into conflict can cause tension, especially within the context of the family where it is more difficult to hide true feelings (page 2).”

There is analysis of various ideas and practices concerning a variety of aspects related to rehabilitation into the workforce and the community and service user groups that empower the mentally afflicted. Sandra Lawman believes, “The user movement in Japan is fragile and needs further nurturing (page 111), ” while Satoru Hashimoto observes, “At the present time, the way of creating new jobs for those with metal disorders is not generally accepted at Japanese enterprises (page 70).” The topic of the social stigma attached to mental health issues is explored by Shuntaro Ando and Graham Thornicroft (pages 113-142) with some illuminating international comparisons while a Japan-Britain analysis of the user movement is given by Sandra Lawman (pages 98-112).

On attitudes towards mental illness Shuntaro Ando and Graham Thornicroft conclude, “In Japan, knowledge about the causes of mental illness was found to be poor, and weakness of personality was preferred as the cause rather than heritability….The majority of the general public in Japan presented social distance from individuals with mental illness especially in closer relationships (page 132).” They also noted that “Japanese society’s values emphasising conformity may also be a deteriorating factor for stigma against mental illness, which deviates from the norm (page 129).”

This work is also packed with a variety of interesting case studies, I particular found the one by Yayoi Imamura on how people with mental illness can be integrated into a rural town enlightening (pages 79-82). The trial took place in the relatively remote town of Urakawa in Hokkaido and demonstrates that the countryside in Japan is not as conservative as it is generally portrayed.

It has only been in recent years that mental health issues have become a more prominent public issue of concern with demands for action. This momentum can be seen in the various laws and reforms that have been passed in the past decade. Dr Hiroto Ito, one of the book’s contributors who looks at this issue (pages 36-56), has also been closely involved with helping shape government policy. The issue of counselling those with post traumatic stress has also become a prominent issue since the devastating 11 March 2011 Tohoku Earthquake and it is hoped this should spur further improvements in the system.

While there are many challenges facing the mental health system in Japan, most contributors to this work believe the overall situation is improving. Shuntaro Ando and Graham Thornicroft recommend, “…educational programmes that focus on the adverse effect of institutionalism and offer direct social contact with people with mental illness are required in Japan, as they have been shown to be effective in the world (page 133).” Focusing on the positive Hajime Oketani and Hiromi Akiyama comment, “What we can do, from within the field of mental health, is to keep on nurturing good aspects of Japanese culture and society and contribute to build communities where people can happily live their lives (page 96).”

The book was launched on 26 June 2012 at a lively and well attended seminar entitled “Mental Health Care in Japan” which was held in the impressive surroundings of St. Dunstan’s Church, in Fleet Street, London. There were four speakers, three of the book’s contributors, Graham Thornicroft with editors Ruth Taplin and Sandra Lawman along with Yuriko Suzuki, a Japanese psychiatrist with first hand experience of treating and dealing with the victims of post traumatic shock in Japan. Koji Maruyama, First Secretary (Health and Welfare) at the Embassy of Japan in the UK also spoke about the importance of improving mental health care in Japan. All the speakers underlined the increased importance of the topic since the Great East Japan Earthquake and how this new book will help non-Japanese understand the current state of mental health care and the challenges facing Japan.

It is often difficult to find good quality analysis of these issues in English and this impressive new work fills an important void with first rate contributions and analysis from a wide range of Japanese and foreign professionals and practitioners. The editors and authors deserved to be commended for producing this insightful and cutting-edge work.

Notes

The book is divided into seven sections with a postscript. These are as follows: 1. Mental Health Care in Japan – An Introduction by Ruth Taplin (pages 1-35) 2. The Mental Health Policy and Services: Where We Stand by Hiroto Ito (pages 36-56) 3. Reintegrating the Mentally Ill into Society and Work by Satoru Hashimoto (pages 57-72) 4. How Mental Hospitals Treat their Patients, and Programmes for Rehabilitation into the Community by Yayoi Imamura (pages 73-82) 5. National Federation of Families for the Mentally Ill in Japan: Historical and Future Perspectives by Hajime Oketani and Hiromi Akiyama (pages 83-97) 6. An Overview of the User Movement in Britain and Japan by Sandra Lawman (pages 98-112) 7. Attitudes to Mental Illness in Japan and Britain by Shuntaro Ando and Graham Thornicroft (pages 113-142) and Postscript by Sandra Lawman (page 143).