Japan’s stigma towards mental health has been apparent since at least the 1900’s, when the Law of Confinement and Protection of the Mentally Ill was enacted. It more or less separated mental illness sufferers from the rest of the population, and prisoners with mental problems were first in line to be executed. Not to mention, Japan’s suicide rate is among the highest in the world, and probably the highest in a developed country. And it’s not just due to the notion of an honorable death; rather, the rate of depression in Japanese society is also very high.
Conversely, some Japanese have figured out the impact of mental illness on society. For instance, there has recently been an uptick in prescriptions for anxiety and insomnia drugs known as benzodiazepines (such as Xanax and Valium) in Japan, a phenomenon discussed in the Xinhuanet article above. These old drugs, while very effective in treating anxiety issues and sleep disorders, are also addictive, and this goes against the Western consensus that anxiety disorders should be treated with antidepressants on a long-term basis and, if benzodiazepines are used, it should be in the short term. Never mind that most Japanese doctors still have a limited understanding of how depression and anxiety work. Although mental health in Japan is better understood than before, the stigma attached to it is still great.
This week’s vocabulary:
うつ病 (うつびょう): depression
One of my patients with depression said he wanted to kill himself, and I’m worried.
不安 (ふあん): anxiety
Japanese doctors don’t often use medication for treating anxiety disorders.
不眠 (ふみん): insomnia
I have horrible insomnia before tests. What should I do?
精神科医 (せいしんかい): psychiatrist
When his mother died, he talked to a psychiatrist about it.
中毒 (ちゅうどく): addiction (suffix)
Why are you drinking so much coffee? Jeez, you’re such a caffeine addict!
The way Japan still stigmatizes mental illness is surprising, especially because of the country’s high suicide rate and development of phenomena such as hikikomori. It’s to the point where safe medications for mental illness are often overlooked. For example, Luvox/fluvoxamine, an extremely effective drug in the treatment of disorders like depression and OCD, was approved in Japan in 1999—over a decade after it had been introduced into clinical use. They still haven’t approved arguably the most well-known member of that drug class, Prozac/fluoxetine. Perhaps it is because of the treatment of mental illness, which is highly individual in nature, going against the one-size-fits-all collectivism present throughout Japanese society, that mental illness has been shut out of an otherwise advanced healthcare system. Next week, I plan to take another look at one mental health-related phenomenon unique to Japan: hikikomori.
Other sources on the subject: