Japan’s mental health, still not much improved

The following article was published by Japan Times contributor Roger Pulvers on Feb 12, 2012. Nearly five years later, the situation has not improved by much. Here’s the article in full:

The greatest public health issue facing the people of Japan today is not cancer. It is not vascular diseases than can cause heart attacks and strokes. It is not the prevalence of Alzheimer’s disease in the ever-rising number of the elderly.

It is depression in its many forms and guises.

Depression is the big gorilla on the basketball court, the one that’s stealing the ball but isn’t seen because everyone is willfully looking the other way.

The causes of depression can be biological, psychological, social or a combination of these. It affects young people to a much greater degree than they or their elders imagine. The elderly are particularly vulnerable. In fact, according to the Health and Consumer Protection Directorate-General of the European Commission, “depressive illness is the most frequent mental disorder among older people.”

Name any significant social problem — alcoholism and other drug-related illnesses, homelessness, teenage pregnancies, self-harm, domestic violence, child abuse, suicide — and you are more than likely to find some form of depression or serious mood disorder as a cause.

According to the World Health Organization, the international health burden brought on by clinical depression is enormous when measured by “cause of death, disability, incapacity to work and the use of medical resources.” And this does not take into account the hidden costs, such as those borne by unpaid caregivers, nor the heartrending toll on sufferers’ families.

Here in Japan, where a conservative estimate is that 1 in 5 people will experience one or another form of depression in their lifetime, the abiding societal postulate is: Keep it to yourself (KITY). In fact, this principle is applicable to the appearance of many social ills. If you don’t ask and you don’t tell, then it’s as if through such deceptions the problem will somehow slip below the tatami and disappear from
sight.

Whether you analyze this national trait as coming from an ancient Buddhist notion according to which victims and their family are “responsible” for a blight, or simply as a factor of garden-variety prejudice against anything smacking of “abnormality,” this society has long stigmatized anyone who might put a blot on the veneer of decorous harmony.

So, in actual fact, the working precept here is stigmatization. If you stigmatize someone in their milieu, they generally go away and hide (or die). Once they stigmatize themselves, you don’t need to bother anymore. You can even pretend to be tolerant. It works like a charm.

Kenzo Denda, of the Department of Psychiatry at Hokkaido University Graduate School of Medicine, has reported that 1 in 12 elementary school pupils suffers from depression, while at the middle-school level the figure may be as high as 1 in 4. Studies show that at least one-third of the prison population is made up of the clinically depressed.

Statistics on depression for Japan are very similar to those in the developed West. Statistics published by the Japan Committee for Prevention and Treatment of Depression (JCPTD) show that 6.6 percent of Japanese have depression, while every year the reported incidence is 2.1 percent. The breakdown by gender is also similar to that in the West: Women with depression outnumber male sufferers by about 3 to 1. In the West, the incidence of depression is particularly high in the young, while in Japan, says the JCPTD, it is spread among young and old.

But these comparative statistics can be misleading. A joint Japan-Australia survey on mental health conducted in 2003 and 2004 indicated that, in the case of Japan, a great many actual cases of depression were put in the category of “psychological problems and stress.”

Recognition is the crux of the problem. While big strides have been made in the treatment of depression in Japan over recent years, thanks in part to effective new drugs, the recognition of depression at the primary-care level is inadequate. General practitioners are not sufficiently trained to recognize depression. They too often attribute symptoms to other illnesses. The KITY meme exacerbates this. Japanese tend to be too reticent to divulge their true anxieties to anyone.

There has been an overemphasis in this country on male problems based on the stresses and strains of employment. Japanese women are traditionally told to grin and bear their suffering and not overburden others with their personal problems. Don’t nag. Don’t whine. Just pull yourself together, sigh a big sigh and get on with your tasks.

Active for the last 40 years, JCPTD has held countless conferences, meetings and forums for health professionals and the public. The organization is proactive in trying to train doctors to recognize depression when they see it. National broadcaster NHK’s educational channel has also had some amazingly frank shows about depression — including one in which female sufferers admitted to having sex with a great number of men in order to bolster their self-esteem. The courage of these women, who appeared under their own names, would be astounding in any country — let alone in Japan, where appearances count for so much. But Japanese society will not come to terms with depression until very high-profile sufferers — whether royalty, movie stars or politicians — come out from behind the folding screen and openly talk about their illness. (Some people in show business have done this; and this has had a beneficial effect on public awareness.)