Book Review: Depression in Japan: Psychiatric Cures for a Society in Distress.
Written By Zoya Gul
Global discourses surrounding depression have increasingly been construed through Western, ‘DSM-ized’ notions of the illness. The resultant ‘biologization’ of mental illness has depicted depression through a strictly pathological framework, shifting the onus of responsibility for the heightening prevalence of the condition away from social forces and towards individual biology. Japan is no exception to this pattern— localised understandings of depression struggle to compete with the prevailing biomedical model of the illness, and clinical dialogues surrounding the country’s ‘national disease’ have consequently undergone major transformation.
By drawing on extensive ethnographic fieldwork conducted in two mental hospitals and a psychiatric clinic in Tokyo, Junko Kitanaka’s Depression in Japan: Psychiatric Cures for a Society in Distress introduces readers to the key social, historical, political and economic actors that have contributed to fostering the nation’s unique psychiatric landscape. Kitanaka scrutinises psychiatry's history in Japan as an authoritative, often colonialist, purveyor of social order to catalogue the pivotal role the specialism has played in redefining Japanese understandings of the self. Whilst the dangerous tendency for pathological formulations of depression to medicalise human suffering is thoroughly discussed, Kitanaka also successfully illustrates the reductive, homogenising effect that social understandings of depression can exert on individualised experiences of the condition.
The first section of the book examines the history of depression in Japan. Kitanaka challenges the notion that historically, Japan did not recognise depression as a distinct concept, by discussing traditional understandings of ki, the life force. ‘Ki-stagnation’ emerged as a basis for interpreting elongated periods of pensiveness, but soon descended into obsolescence as Western, neurological explanations for depression percolated into the Japanese psychiatric sphere. This period of Japanese psychiatry was described as a process of ‘modernisation’, and rapidly transformed the field into an oppressive vessel for quelling social disorder. The concept of neurasthenia, which identified ‘nerve weakness’ as the pathology underlying what later came to be known as depression, evolved during this time. During the post-war era, the neurobiological hegemony of psychiatry was questioned by the proliferation of American psychoanalysis, and the anti-psychiatry movement surfaced as a force of resistance against the state weaponization of psychiatry. This era also saw the German psychopathological notion of Typus Melancholinus, which recognised endogenous personality traits of depressed individuals as the principle cause of their ailment, gain momentum. From the 1980s onwards, Japanese psychiatry has been defined by its transition from asylum-based to community-based care, alongside the re-Americanisation, and re-medicalisation, of Japanese psychiatric discourse via the international appeal of the DSM.
The second part explores the clinical consequences of localised Japanese perceptions of depression. Patients are coerced into internalising the biological nature of their ailment through a series of repetitive questioning which is designed to separate their regular selves from the disease, and thus distance their intentionality. This is especially apparent when psychiatrists encounter a ‘suicide of resolve’— a suicide which has philosophical, rather than biological, groundings. As existential ponderings are considered detrimental to both patient recovery and the existing psychiatric framework, patients are encouraged to ‘biologize’ their thoughts by reattributing their suicidal urges to psychopathology. Medicalisation is often the first mode of treatment; hospitalisation is reserved for rare ‘treatment-resistant’ cases, in which a psychotherapeutical model of treatment takes precedence. The historical backdrop of the anti-psychiatry movement serves as an explanation for this tentativeness with which Japanese psychiatrists approach psychotherapy. Kitanaka also examines the gendering of depression in Japan. Whilst portrayed as an overwhelmingly female malady in the West, depression in Japan is viewed as the product of the strenuous work ethic internalised by men. Men suffering from ‘overwork depression’ are met with empathy and understanding from physicians and families, whilst women afflicted with the condition are exempted from articulating structural inequalities as the origins of their distress.
The final section examines the wider societal impacts of this evolving framework of depression. Kitanaka draws on the Detsū, Inc. lawsuit amongst additional case studies to examine how Japanese psychiatry is being remobilised as a force of social change, but also considers its potential to be transformed into a surveillance method. The successful suing of major corporations by bereaving families of individuals deceased by ‘overwork suicide’ represents a monumental shift in Japanese conceptualisations of mental illness as the traditional notion of ‘endogenous’ or ‘genetic’ depression is increasingly abandoned. Despite this, the biomedical model still retains influence over Japanese psychiatric discourse, in turn facilitating the neoliberal productivity ideology by shifting the overwhelming burden of recovery and management from employer to employee. Moreover, whilst destigmatisation campaigns centring around ‘somatism’ have been successful, a new form of stigmatisation has arguably developed due to the homogeneity with which presentations of depression are approached.
Overall, Depression in Japan is a concise and compelling guide for readers interested in cross-cultural psychiatry. Kitanaka’s writing is absent of the flowery language often characteristic of anthropological writing, instead presenting its argument in a succinct, easy-to-digest format. This renders the text particularly informative for students or those who possess limited background knowledge of the subject area. Personal stories from patients are seamlessly woven into Kitanaka’s debate to highlight and strengthen key ideas, and a diverse collection of references are utilised to further formulate the overarching themes of the study. Repeated references to Western psychiatric understandings also adds a sense of comparative analysis to the writing. The text is, however, perhaps less representative of depression in Japan as it is of depression in Tokyo, where all of Kitanaka’s ethnographic fieldwork was conducted. Additionally, although Kitanaka explores how gender influences perceptions and experiences of depression, she fails to apply this level of investigation to factors such as age and socio-economic status. This is surprising given that Japan is notable for its high adolescent suicide rate, to which the Japanese work ethic that Kitanaka thoroughly dissects in her writing is thought to contribute towards. Despite these minor criticisms, Depression in Japan remains an enlightening addition to the anthropological literature of psychiatry, shedding an important light on the significance of understanding localised discourses surrounding mental illness.
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