Magazine article The Times Higher Education Supplement : THE

Hard Times Are Not Happy Times

Magazine article The Times Higher Education Supplement : THE

Hard Times Are Not Happy Times

Article excerpt

Japanese notions of mental health differ from ours but everyone suffers in recession, finds David Healy.

Depression in Japan: Psychiatric Cures for a Society in Distress

By Junko Kitanaka

Princeton University Press

264pp, Pounds 52.00 and Pounds 20.95

ISBN 9780691142043 and 2050

Published 24 October 2011

Japan is a mystery to many in the West. Japanese psychiatry has been particularly perplexing - and depression is its heart of darkness. The Japanese didn't do Freud or Prozac; and psychotropic drugs promoted institutionalisation there while they led to deinstitutionalisation here. And until very recently, in the face of one of the highest suicide rates in the world - three times that of the UK - the Japanese haven't had depression, either. "Suicides of resolve" have been an existential issue. Instead of depression, there has been an apparent aesthetic of melancholy (wabi-sabi), with men more affected than women.

For decades, Western authors have struggled to make sense of this difference, given that Japanese psychiatry has been ostensibly Western in form for more than a century. They have inserted accounts of Morita therapy to fill the Freud-shaped gap. They have outlined syndromes such as shinkeishitsu (anxiety disorder) and claimed these as the equivalents of Western disorders. They have suggested that amae (dependency) accounts for the different clinical trajectory of disorders in Japan. But rather than clarifying anything, these accounts have served only to deepen the mystery.

Medical anthropology, with its propensity to theoretise and problematise issues and refer endlessly to other work and concepts with which the reader will not be familiar, is for many outsiders almost as impenetrable as Japanese psychiatry. Putting the two together should be a recipe for disaster, but in Junko Kitanaka's hands, this book is instead a triumph, perhaps even a classic.

She begins with Oshima Ichiro, a young advertising executive whose family was awarded about Pounds 1 million in 2000 by Japan's Supreme Court after his death by suicide nine years earlier was blamed on overwork. Then, through a series of vignettes, Kitanaka handles issues of temperament and personality, neurosis and malingering, genetic determinism, somatism and biological reductionism. These are issues that both Western and Japanese medicine have had to grapple with, and Kitanaka's handling of them sheds light on both approaches. …

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