Recently I have read the following book. A book summary and my comments are:
Book title: Junko Kitanaka. 2012. Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton and Oxford: Princeton University press.
In 2000 Japan’s Supreme Court ordered Dentsu, the biggest advertising agency, to compensate a very large amount of money to the family of an employee who was died of depression through work. Alarmed by this and similar legal disputes, the government implemented new mental health measures and policy changes to tackle stress-induced mental illness as a national problem, and signaled the beginning of broad-scale medicalization of suicide and depression in Japan (p.1-2).
The goal of this book was to examine how depression had suddenly become a ‘national disease’ and how psychiatry had emerged as a new vehicle for curing the social ailment. This change was remarkable because Japan so far had resisted psychiatric intrusion into everyday life as psychiatry was reserved only for the severely ill. Because its stigmatizing effect, psychiatry’s expansion into the realm of everyday distress had been limited (p.2). Built upon recent anthropological analyses of medicaliztion and medical practices, this book investigates how psychiatry had come to provide Japan with a new understanding of ‘depression’.
In contrast to the view of medicalization as a tool of top-down biomedical domination and homogenization, anthropologist had of late come to articulate competing views on the nature of the stress. Based on this approach, the book investigates how these views had generated new subjects via new or altered norms, knowledge, and concepts. The book argues that psychiatry had largely overcome Japans resistance by creating a new language of depression that closely engaged with cultural discourse about the social nature of depression (p.5). Focusing on what some they had called ‘Japanese-style’ fatigue-induced depression, psychiatrists demonstrated how depression was not only a pathology of the individual brain but was also rooted in the Japan’s culture itself (p.5). This book explores how the different forms of medicalization in Japan had come about, and what consequences it brought (p.6). Psychiatrists popularized depression by disseminating two contrasting yet complementary languages of depression: one is grounded on the biology which depicted depression as a disease in the brain. The other was the social language of depression which asserted depression was a socially caused pathology, suggesting that it was time to think of depression in social terms (p.9).
Throughout this book the author investigates whether medicalization had resulted in more diversified articulation of individual suffering and served to counter the effects of medicalization. (p.18).
Psychiatrists had begun to have public voice in the political sphere. The author has demonstrated the conceptual and institutional linkage that psychiatrists had made between depression, work stress, and recession in order to demonstrate how the difference in medicalizaiton was stemmed in part from particular political and economic concern. (18)
The book has three parts. In part 1 (ch. 2-5) the author shows that the notion of utsubyo (or its predecessor utsusho) had a long historical root in Japan’s traditional medicine. Utsubyo was a category that indicated pathological stagnation leading to symptoms such as lack of energy dejection, and social withdrawal. In 1880s, Japanese psychiatrists began to discard this traditional medical idea by arguing that psychopathology including utsebyo was a matter of individual neurological defects existed independent of social environment (p.21). The book shows how psychiatrists’ reinterpretations of the ‘biological’ had been essential for redefining depression as social pathology warranting legal, economic and political intervention. The book also shows how Japanese psychiatrists had successfully transformed depression into one of the most talked about illness today, suggesting that depressed people were victims of biological and social forces. (p.22).
The focus of part 2 (ch.6 -8) of the book was to examines how depression was actually talked about by psychiatrists and patients in local clinical practices (p.85). While psychiatrist had made fatigue from work stress an evocative theme, they did not think that this was the single cause of depression and neither was it the only object of their concern. At the beginning of part 2, the book tries to demonstrate how psychiatrists successfully persuaded patients about the pathological nature of depression. The author shows how psychiatrists tried to contain patients’ reflectivity and avoid intruding into the realm of the psychology in order to protect patients’ already fragile sense of shelf (p.85). Part 2 then explored where psychiatrists failed to persuade patients of the biological nature of the ‘depression’. This limitation became a focal point in psychiatrist’s confrontations with suicidal patients. In the end of part 2, the book examines how psychiatric persuasion actually worked in structuring patient’s own understanding and experience of depression by calling attention to the peculiars ‘gendering’ of depression in Japan. In Japan men had been represented as likely to suffer from depression then women. Women rarely seemed to link the cause of their suffering to depression (p.86).
The focus of part 3 (chapters 9-11) was to look at the effect of medicalization beyond the walls of clinics and examine how lay people and other professionals drew upon psychiatry as a framework for expressing social ills. It also examines the changes brought on by medicalization in the realms of legal debates over overwork depression and suicide etc. (p.153). In the beginning of part 3, it demonstrates how claims of the social origins of depression had gained force through a series of worker’s legal victories. In the middle of part 3, it analyzes the overall effects of the medicalization in three realms – legal/political changes, public debates on antidepressants, and industrial management. At the end of part 3, it reconsiders the local forces of medicaliztion in light of global political movements (p.153).
This book shows that the Japanese often create new words and terms, for example karoushi (death due to overwork) and ‘suicide of resolve’ to describe their society. This book also shows how Japanese male and female are treated differently in the society. It can be noted that in many the case of karoushi, the victims were male employees. Junko Iitanaka quotes what Dorinne Kondo has said in Crafting Selves that “in the larger context of Japanese culture, women’s narrative productions of identity in work are not part of the central storey. . .” (p.140) in order to support her observation that “in sharp contrast to the culturally evocative, sympathetic portrays of overworked salarymen in the popular discourse, until recently no clear master narrative had existed for female depression”. While she attributes the lack of master narrative on women due to the ‘three lacks’, I think this is also a reflection that Japan is still primarily a male dominated society. Overall this is a good book for understanding how depression has suddenly become a ‘national disease’ and how psychiatry has emerged as a new vehicle for curing the social ailment.