Japan and Mental Health

In English class we've been reading Hamlet. For those of you unfamiliar with the work, please take a brief primer on Western culture, and then return to this post. The rest of you will know that one of the major in themes in Hamlet is that of sanity. What constitutes insanity? How do we tell whether someone is insane or not? Where is the line? Is Hamlet sane? What about Ophelia?

As part of studying these issues, our class has talked a lot about whether and how being crazy or mentally unhealthy is culture-dependent. Western culture has defined sanity based on everything from balances in the four humors (fluids inside the body) to an individual's ability to maximize his or her happiness. Across time insanity has always been outside the norm. Sanity is normal, the insane are not. This leads to shifting definitions and treatments of insanity not only from time to time, but also from culture to culture in the same time period. One of the cultures that coexists with the American culture is that of Japan.

There are many who would tell you that Japanese culture as a whole is just plain insane. In writing this post I'll take a leap of faith in assuming that the Japanese do not see their culture the same way. The more interesting question is whether differing culture norms translate into different visions of insanity.

Rather than finding other cultures' models of mental illness harder to understand, it seems as if the opposite is coming true. In an excellent blog post summarizing a book, Christopher Lane, a professor at Northwestern, contends that America is essentially exporting it's ideas of insanity to other countries, including Japan. I encourage the reader to read that whole post, as it eloquently summarizes ideas I can only hope to re-summarize here.

The most interesting anecdote in the post is about Japan, so I'll expound on it. It's about drugs that treat depression. Conditions that could be labeled depression exist in most people in most societies. It's usually a matter of how an individual deals with inevitable sadness, and what society has to say about how much we should pity ourselves for how sad we feel. I would even postulate that depression symptoms fall under a type of negative Barnum Effect (things like horoscopes can apply to everyone because they're so vague), as anyone reading symptoms of depression can in some way connect. GlaxoSmithKline took advantage of depression's marketability in exporting the illness to Japan. Lane relates the story of how an aggressive marketing push corresponding with Paxil becoming available in Japan essentially created a mental health epidemic. The company made people sick to sell drugs to them.

This example is one of many related to Westerners' propensities to use their labels where they don't apply, leading to explosions in diagnoses of illnesses like PTSD in other countries. The question isn't whether symptoms that could constitute illness in a Western sense exist, but rather whether medicalization of these diseases according to an American model is the best solution. Telling people they're sick is a great way to get them to buy treatment, but probably not the best way to get them healthy.