Depression in Japan: Psychiatric Cures for a Society in Distress (review)

Abstract

Kalman Applbaum University of Wisconsin-Milwaukee Junko Kitanaka, Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton: Princeton University Press, 2012. 264 pp. Over the past few decades, mainstream psychiatry has re-invented itself as part of modern scientific medicine. It regards mental illness as a brain dysfunction, classified into discrete diagnostic categories, and treatable by pharmaceuticals. Whether by professional design, administrative convenience, popular appeal, or commercial stratagem, this paradigm of practice has come to overshadow psychosocial models in much or most of the world. The history of psychiatry has been told mainly from the point of view of North America and Western Europe, from whence the biological paradigm and the major engines of its dissemination-the DSM (Diagnostic and Statistical Manual of Mental Disorders) and psychopharmaceuticals- originate. Diagnostic and therapeutic traditions that traveled earlier in the 20th century, such as Freudian or Lacanian psychoanalysis, were also Western in origin. With some notable exceptions, most of the attention paid to non-Western healthcare settings has focused on how these places have adapted western neuropsychiatric theories and technologies, often in combination with local ethnopsychiatric traditions. There is good reason to consider Japan over the course of the past roughly 120 years as a unique case in which the national psychiatry is simultaneously in dialogue with developments in the West and yet resolutely an agent and artifact of its own history. Just as economic theorists have delineated operatively familiar and yet distinctive features in Japanese capitalism, one might regard Japanese psychiatry as a fully realized version of the Western-originated discipline but with academic, institutional, and cultural contours of a very different cast. Until lately, anthropologists working in Japan have revealed aspects of Japanese psychiatry only indirectly, which is to say they have not taken professional psychiatry itself as their object of study.1 Junko Kitanaka's Depression in Japan is, in this respect and others I will reflect upon below, a pioneering study in the medical anthropology of Japan. The book takes as its joint objects Japanese psychiatry as an academic discipline and a field of clinical practice on the one hand, and the general footing for mental illness in Japanese society on the other. Although ambitious to the point of sometimes eliciting acrophobia, this double undertaking is essential. It is because the proper historiography and ethnography of modern mental illness demands recognition of its coconstruction at the interface between psychiatry and the public, including individual patients and their families, the courts, the Ministry of Health, Labor, and Welfare (or its equivalent), corporations, and vox populi. The reliable overview of the Japanese psy-complex also fills a missing piece in what might be conceived of as a series of interlocking regional puzzles. It would be false to only slowly unveil my enthusiasm for the result of Kitanaka's investigation. Depression in Japan will be a breakthrough book for cross-cultural psychiatry, medical anthropology, and Japanese studies. By apparent design the book answers many questions that have heretofore puzzled outside observers of mental illness and its treatment in Japan. These include the ambiguous psychiatric classification of suicide in a culture where it has oftbeen romanticized; the higher incidence of depression among men, when in most places the reverse is observed; the entrenchment of neurobiological and inheritance theories of mental illness in a society otherwise famous for its endless public debates on sociallyborne pathologies; the post-war trends of rising institutionalization and the stigmatization of the mentally ill while overlooking common mental disorders, when precisely the opposite was transpiring in the West; and the curious phenomenon of death from overwork. …