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

In this compelling and challenging work, Junko Kitanaka explores the rise of the diagnosis of depression in Japan in the 1990s. She argues that the popularization of depression was made possible by the formation of a new “psychiatric language” that departed not only from longstanding somatic conceptions of mental illness within Japanese psychiatry but also from the “brain chemistry” etiology promoted by the U.S. pharmaceutical manufacturers of antidepressants. The product of both psychiatric practice and legal discourse, this new “language” characterized depression as a social phenomenon rooted in the Japanese culture of work and its celebration of self-sacrifice, hard work, and devotion to one’s job that compelled male salaried workers in particular to work until their mental and physical health declined. Kitanaka argues that the term “Japanese-style fatigue induced depression,” a formulation favored by some Japanese psychiatrists, rendered depression a disorder that had a biological component but was also “collective, relational, and even historical” (p. 195).

The work is divided into three parts, each of which has its own theme and its own methodology. Part 1 examines the history of the concept of utsu byō, the Japanese term for depression, from the sixteenth century through the postwar era; part 2 draws upon Kitanaka’s ethnographic research in the psychiatric department of a Japanese medical school and focuses on the treatment of depression in a clinical setting; and part 3 examines how the concept of “overwork suicide” as a legal concept emerged and its social and cultural significance. Kitanaka’s multifaceted approach aims to explore depression in its local and global, juridical and clinical, historical and contemporary contexts, but the ambitious scope of this relatively brief work is both its strength and its weakness. Even while I appreciated the interdisciplinary nature of Kitanaka’s approach, I found myself frustrated by the book’s failure to adequately address some key questions, especially as it also contained a good deal of information that was tangential to its main argument.

The historical overview provided in part 1 is suggestive of the latter problem. Kitanaka devotes considerable space to exploring the varied meanings of utsubyō in premodern Japan. The term was introduced to Japan from China in the sixteenth century via Chinese medical texts but it soon came to be used in conflicting ways: while it initially referenced symptoms such as fatigue that resulted from the stagnation of vital energy (ki), by the seventeenth century it was being used to refer to the emotional upsets experienced by spoiled girls and dissipated men who lived lives of unhealthy excess. The introduction of Western medicine via the Dutch added yet another layer of meaning, as utsubyō came to be associated with melancholia, then understood as a humoral disorder. While interesting, the relevance of this information for the discussion that follows is not completely clear, since Kitanaka argues that these premodern conceptions of utsubyō were quickly eclipsed in the late nineteenth century as German neuropsychology was institutionalized within the Imperial University of Tokyo, where Japanese academic psychiatry took form. Depression was redefined as a “brain disease,” a form of psychosis that was degenerative and incurable.

What then of “everyday distress” that did not rise to the level of psychotic depression? It is well known that at the turn of the century the concept of neurasthenia (shinkeisuijaku), or overtaxed nerves, was widely deployed to explain a diverse set of symptoms such as fatigue, headaches, stomach upset, constipation, and sexual dysfunction. Kitanaka argues that Morita Masatake (who developed the so-called “Morita therapy”) played an influential role in transforming the understanding of neurasthenia in Japan. Morita, a self-identified neurasthenic, asserted that neurasthenia was not a “disease” but an inherent personality type characterized by “an excess of self-reflexivity” (p. 64). The aim of his therapy was not to cure a “disease” but to guide the patient toward understanding (and managing) his own...