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

In the past decade, Japan has been through a most extensive medicalization of depression, which is now a part of the landscape of Japan. In 1996, the number of patients was about four hundred thousand: in 2008, it exceeded one million. The public are now bombarded with campaigns to be aware of the disease in posters and PR videos. Patients suffering from the disease are now familiar characters in both real life and the world of fiction. During this process, depression has been transformed into a new sociocultural and medical entity. In Depression in Japan, Junko Kitanaka analyzes the remodeling of the disease and asks how, when, why, and by whom this metamorphosis has taken place.

Kitanaka combines two disciplines and two approaches: history and anthropology. The history shows that Japan has found depression in a medical sense quite recently. When Japan started to import and to employ Western medicine in the late nineteenth and early twentieth centuries, Japan had little idea of depression. Instead, it learned the disease category of Kraepelin’s manic-depressive disease, which was one of two major diseases along with dementia praecox. As a result of this historical trajectory, Japanese psychiatry focused on hereditary and neurological conceptualization of the bipolar disease, and did not find depression per se until the 1990s. The timing was important, because this was when Japan began to struggle with economic depression. At this time Japanese psychiatry was still old-fashioned asylum medicine, not only because it held vast inpatient populations but also because its doctors were apparently gatekeepers of the incurables. Hence, psychiatrists looked for a new role for them in medicine and society by explaining social diseases via psychiatric knowledge. In doing so, they highlighted the issue of male suicides that had started increasing in the age of economic depression. They tried to explain male suicide by linking it with overwork, thought to be a part of the “traditional” work culture in Japan. The culture of overwork stems from the discourse of neurasthenia around the turn of the twentieth century, when medical fringes and popular fronts argued that neurasthenia, imported from the United States, was caused by male overwork. In the 1990s, Japanese psychiatrists revived this notion, in order to make their discourse more convincing. Depression has been constructed with the male suicide originating from the old work ethic.

Kitanaka also argues that the medicalization of depression is rooted in daily clinical practices of psychiatry. Psychiatrists sought not only new legitimacy in constructing the depression discourse but also a clinical language to answer for the increasing anxieties and emotional problems in the 1990s. In the period that is called the “lost decade” in Japan, people long to have a convincing explanation for their symptoms, and biological pathology of (manic-)depressive disease did not stand for the task. Facing such patients, psychiatrists found a possible answer in male overwork under the unjust economic and social systems, and moreover linked it with increasing suicide. This turned out to be a convincing explanation for patients, who profit from it because it entitles them to compensation. Paradoxically, everybody has become happy through the new notion of depression: psychiatrists have won a new field of practice and can establish a doctor–patient relationship that works well in clinical settings, whereas patients have gained an explanation of which they could be convinced and which has given them a legitimate excuse for their ill health. A localized notion of depression, which has intersected the history and the present, has been created and established.

As shown above, Kitanaka’s book on depression in twentieth-century Japan shows a success story of Japanese psychiatry. It has won a jurisdiction of milder mental illness and social status. This is a familiar pattern for historians of psychiatry, for a rise and expansion of psychiatry happened in the United States, Britain, and other Western countries...