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

A multitude of social, economic, and epistemic factors contribute to existing prognoses and treatments for depression (Horwitz and Wakefield 2007). Still, the processes by which depression takes form in different places remain unclear. While traditional Japanese wisdom recognizes the universality of suffering and the transience of happiness (Schulz 2009), the country’s recent struggle with rising rates of depression appears to be at odds with this important aspect of the national culture. Although one factor in the rise of depressive diagnoses may be the decision of Big Pharma to move heavily into the Japanese market (Applbaum 2006), Junko Kitanaka’s book Depression in Japan offers an analytic account from a different perspective.

Kitanaka looks into the reaction of the Japanese psychiatric profession to the significant transformations of society over the past few decades. Linking depression with the social changes that occurred during the “Lost Decade” that followed the bursting of economic bubbles in the 1990s, she portrays a psychiatric language that successfully “engages with—in fact reappropriates—cultural discourse about the social nature of depression” (5). Psychiatrists originally considered depression a constitutional illness that stems from the patient’s endogenous deficit, but recent psychiatric language has turned it into a morbid mental state resulting from interactions of the patient’s personality and a culture of overwork and repressive social norms. Thus, depression has been elevated to “a symbol of collective distress faced by many Japanese in terms of economic uncertainty” (5), but the diagnosis, when applied to overly diligent workers who burn out, also acts as leverage for compensation. In summary, the author considers depression as symptomatic not only of social ills but also of the resistance to social ills. This argument complicates the existing literature on depression in Japan.

This book’s three parts address depression in history, depression in clinical practice, and depression in society. In the first part, the author traces depression to utsushō, a morbid state caused by the stagnation of ki (life energy). Depression was gradually psychologized either as a manifestation of excessive agony or as a sign of idleness. When German neuropsychiatry arrived in Japan in the nineteenth century, a distinction was made between melancholia, translated as utsu-yū-byō, and depression, translated as utsushō. The former was considered a psychosis, whereas the latter was considered a milder illness resulting from depressed ki. Depression later replaced the much disputed diagnosis of neurasthenia. Gradually utsushō came to be viewed as a product of the personality of the patient (“typus melancholicus”) that interacted with societal changes, whether the ruthless forces of modernity of the 1970s or the nerve-wracking stress of globalization of the 2000s.

Part 2 focuses on the diagnosis and treatment of depression in clinical practice, providing rich ethnographic materials and provocative arguments. The author argues that the biologizing tendency of Japanese psychiatrists treating depression should not be considered simply as a sign of the dominance of biological psychiatry; it is, rather, a historically situated practice of psychiatrists to demarcate their purview, which is the biological, from their patients’ sense of self, which is the psychological. This practice is partly attributable to the antipsychiatry movement of the 1960s and 1970s, when neurobiological psychiatry survived fierce criticism.

This biologizing tendency has run up against problems as it tries to cope with suicide. Many people in Japan have been tempted to see suicide as an act of free will—what is known traditionally as the “suicide of resolve”—rather than a manifestation of mental pathology. This obliges psychiatrists to confront the boundary between pathological urges and existential angst. Consequently, they focus on treating clinical depression, which they believe is biologically based, with the hope that the suicidal ideation will vanish as soon as the patient’s mood improves. In the author’s words, patients eventually “reproduce narratives about suicide with surprising uniformity and consistency” (127), and the psychological issues too often remain unaddressed.

The unwillingness to intervene in...