AAS Annual Meeting

Japan Session 193

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Session 193: An Ethnographic Rethinking of Mental Health in Contemporary Japan

Organizer: Sachiko Horiguchi, Temple University Japan, Japan

Chair: Ellen Rubinstein, Yale University, USA

Discussant: Hideaki Matsuoka, Independent Scholar, Japan

Since the 1990s, English and Japanese media have reported on the demise of the once powerful Japanese nation, evidence of which could be found in high suicide rates, wayward youth, and social deviants. When the sensationalism died down, what emerged were new discourses intimately linking mental health and socioeconomics, articulated in mutually constitutive languages of society and psychiatry. Rather than arguing that such developments are indicative of the colonizing power of ‘biomedicalization,’ this panel takes a more nuanced approach in examining how conceptions of mental health arise within specific historical circumstances. Based on long-term ethnographic research, the papers in this panel engage the perspectives of the individuals on the ground – including tôjisha (the persons concerned), families, supporters, and mental health care professionals – to ask how they employ various socio-cultural resources to create new identities, communities, and lived realities. Panelists explore these issues through the categories of hattatsu shôgai (developmental disorders) and hikikomori (social withdrawal) and through the interactive spaces of the outpatient clinic and one remote, alternative community for those with psychiatric disability. These discursive sites of production exist at the nexus of the social and the medical, demonstrating how the two intertwine to determine what it is that makes someone a mentally fit and acceptable member of mainstream society.

What’s in a Name? Medical and Social Labeling of Psychiatric Disorders
Ellen Rubinstein, Yale University, USA

While contemporary Japanese psychiatry has adopted the standardized diagnostic criteria of Western classificatory systems, within the clinic unique socio-medical diagnostic labels arise from ongoing interactions between doctors and patients. Rather than communicating in terms of standardized criteria, psychiatrists speak in a contextualized language reflective of the characteristics and expectations of the patient’s social group. However, this diagnostic creativity is of arguable benefit, as it emerges from a history of psychiatric paternalism and secrecy, during which doctors made “disguised diagnoses” that concealed the truth about the severity of a patient’s condition. In one extreme case, a schizophrenic pilot who had been “diagnosed” with a range of nervous disorders crashed a plane at the command of his auditory hallucinations (Munakata 1989). Furthermore, parents of ill children want doctors to speak to them in the professional language of biomedicine, not in the misleading language of social norms. Using these communicative missteps as the point of departure, this paper explores diagnostic negotiations among doctors, patients, and family members to revisit key questions about the creation and adoption of psychiatric labels.

The Treatment of Hikikomori in Psychiatry: Perspectives from Tôjisha, Lay Supporters, and Psychiatrists
Sachiko Horiguchi, Temple University Japan, Japan

In Japan, the ‘problem’ of youth who isolate themselves from society and do not work or socialize with others emerged as a social issue in the late 1990s. Labeled hikikomori (referring to either the person or the condition), this is understood to be a uniquely Japanese phenomenon. The term hikikomori was defined in psychiatry as a condition that cannot be classified under the criteria of the American Diagnostic and Statistical Manual of Mental Disorders (DSM). In practice, the definition of hikikomori remains ambiguous, despite attempts to develop specific treatment or support programs, which include biomedical interventions, psychological counseling, and lay support systems. This paper draws on long-term ethnographic fieldwork at hikikomori support organizations, as well as ongoing in-depth interviews with psychiatrists, hikikomori tôjisha (those who call themselves hikikomori), and those who provide lay support to examine the following questions: To what extent is hikikomori seen as a mental disorder which requires biomedical intervention? What do tôjisha or families with hikikomori expect of psychiatric treatment or non-psychiatric support programs and what are the factors that influence their choice of treatment or support? What are the potential dilemmas that mental health professionals may have in treating ‘hikikomori patients’? By making sense of how the category of hikikomori is understood by various actors and realized in practice, this paper highlights the complexities of conceptualizing mental health in contemporary Japan.

Counting Disability: On the Question of Whether Hattatsu Shôgai is Increasing
Junko Teruyama, University of Michigan, Japan

It has been over a decade since hattatsu shôgai (developmental disorders including learning disabilities, ADD/ADHD and high-functioning autism) has begun to gain currency in Japan. The last few years in particular have seen significant governmental efforts and legislative changes to account for the needs of people with the aforementioned disability. Diagnosis, treatment and various educational and social services have become increasingly accessible, and public awareness has been raised significantly. However, alongside these changes there is a growing concern regarding what appears to be a sudden proliferation of people with hattatsu shôgai. Special education resources have been allocated for the estimated 6% of school-aged children who are seen to have the disability, while child consultation centers and child psychiatric clinics are booked for months in advance. Individuals within and outside the tôjisha (the persons concerned) community have voiced concerns regarding this situation. Where were these people and how were they coping prior to the emergence of the concept of hattatsu shôgai ? Does their sudden visibility owe entirely to the liberating process of giving a name for what was previously an unidentified difference among the members of the society? Or can this be viewed as a process of carving out a minority group where it didn’t exist? In this paper, I will draw on my long-term ethnographic fieldwork to discuss how the ever-increasing social presence of the hattatsu shôgai population has triggered a heated debate on the shifting boundaries of normalcy, raising critical questions regarding difference and diversity in Japan today.

A Disability of the Soul: Japan, Schizophrenia, Psychotourism, and Bethel House
Karen Nakamura, Yale University, USA

What does it mean to live with a severe psychiatric disability in Japan? A small collective of about 150 people in northern Japan is rethinking what a full life in the community means. In many ways, Bethel House represents a repudiation of mainstream Japanese society and its values. Some of the community leaders talk of going from a life of ascent to a life of descent – from upward mobility to living with less, both personally and psychologically. In addition, they reject the notion of a life of ease in an attempt to recover struggle and pain. Ironically, Bethel House has become a major site of what this author calls psychotourism – thousands of mainland Japanese visit Bethel each year to look at their social programs and operations. This paper explores the various threads of Christian belief and 12-step addiction recovery programs that underlie the philosophical structure of this unique community.