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Depression in Japan: Psychiatric Cures for a Society in Distress
Since the 1990s, suicide in recession-plagued Japan has soared, and rates of depression have both increased and received greater public attention. In a nation that has traditionally been uncomfortable addressing mental illness, what factors have allowed for the rising medicalization of depression and suicide? Investigating these profound changes from historical, clinical, and sociolegal perspectives, Depression in Japan explores how depression has become a national disease and entered the Japanese lexicon, how psychiatry has responded to the nation's ailing social order, and how, in a remarkable transformation, psychiatry has overcome the longstanding resistance to its intrusion in Japanese life.
Questioning claims made by Japanese psychiatrists that depression hardly existed in premodern Japan, Junko Kitanaka shows that Japanese medicine did indeed have a language for talking about depression which was conceived of as an illness where psychological suffering was intimately connected to physiological and social distress. The author looks at how Japanese psychiatrists now use the discourse of depression to persuade patients that they are victims of biological and social forces beyond their control; analyzes how this language has been adopted in legal discourse surrounding "overwork suicide"; and considers how, in contrast to the West, this language curiously emphasizes the suffering of men rather than women. Examining patients' narratives, Kitanaka demonstrates how psychiatry constructs a gendering of depression, one that is closely tied to local politics and questions of legitimate social suffering.
Drawing upon extensive research in psychiatric institutions in Tokyo and the surrounding region, Depression in Japan uncovers the emergence of psychiatry as a force for social transformation in Japan.
Questioning claims made by Japanese psychiatrists that depression hardly existed in premodern Japan, Junko Kitanaka shows that Japanese medicine did indeed have a language for talking about depression which was conceived of as an illness where psychological suffering was intimately connected to physiological and social distress. The author looks at how Japanese psychiatrists now use the discourse of depression to persuade patients that they are victims of biological and social forces beyond their control; analyzes how this language has been adopted in legal discourse surrounding "overwork suicide"; and considers how, in contrast to the West, this language curiously emphasizes the suffering of men rather than women. Examining patients' narratives, Kitanaka demonstrates how psychiatry constructs a gendering of depression, one that is closely tied to local politics and questions of legitimate social suffering.
Drawing upon extensive research in psychiatric institutions in Tokyo and the surrounding region, Depression in Japan uncovers the emergence of psychiatry as a force for social transformation in Japan.
240 pages, Paperback
First published September 26, 2011
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Displaying 1 - 4 of 4 reviews
August 4, 2024
My second visit to Japan was inspired by Junko Kitanaka’s book title - Depression In Japan.
In this brilliantly nuanced book, the Medical Anthropologist - Kitanaka - documents the evolution of depression from something rarely heard of into a ubiquitous illness that is not only popular but often used by lay Japanese to get “sick leave.” In the past, seeking mental help had several social and economic consequences. But things changed after the bubble burst. Since the 1990s, Japanese psychiatrists, the government and the labor market encouraged employees to seek medical help if they felt physically and mentally disturbed. This was one way of saving individuals from committing suicide and protecting companies/ corporations from litigation over “overwork suicide.” What I particularly found shocking and brutal at the same time how some psychiatrists and pharmaceutical industries capitalized by prescribing overdose of antidepressant to depressed patients.
Mind-blowing ethnography! This book revolutionized the medical field both in the East and West.
In this brilliantly nuanced book, the Medical Anthropologist - Kitanaka - documents the evolution of depression from something rarely heard of into a ubiquitous illness that is not only popular but often used by lay Japanese to get “sick leave.” In the past, seeking mental help had several social and economic consequences. But things changed after the bubble burst. Since the 1990s, Japanese psychiatrists, the government and the labor market encouraged employees to seek medical help if they felt physically and mentally disturbed. This was one way of saving individuals from committing suicide and protecting companies/ corporations from litigation over “overwork suicide.” What I particularly found shocking and brutal at the same time how some psychiatrists and pharmaceutical industries capitalized by prescribing overdose of antidepressant to depressed patients.
Mind-blowing ethnography! This book revolutionized the medical field both in the East and West.
January 4, 2026
Kitanaka skillfully employed her training as a medical anthropologist in a number of ways in Depression in Japan. First, a 29 page bibliography meant that she reviewed and assimilated a very wide array of information gleaned from both English and Japanese language sources. Furthermore, extensive field work consisting of interviews with many psychiatrists and patients and observing numerous case conferences and patient interviews in mental health settings allowed her to supplement the theoretical knowledge she shared with practical, specific data. Footnotes were liberally utilized to explain her methodology and/or to elaborate more thoroughly on a point she had made in the narrative text.
Second, the book is extremely well organized. Four sections addressed how depression has been medicalized, how it has been viewed historically by psychiatry, how it has been treated in Japan since the late 19th century, and how the perspective of Japanese society in general on this issue has evolved. Each section opens with some introductory comments and each chapter ends with some concluding observations. These latter features ensure that readers will grasp the main points being made.
I am retired psychologist who used to write clinical reports. Thus, I can heartily endorse that Kitanaka did a credible job of summarizing complex cases concisely and yet with enough detail to allow the general reader to understand and to empathize with what a depressed person seeking treatment might be struggling with. However, her descriptions of psychiatric concepts and theories about depression were sometimes so succinct as to make me wonder if the general reader would grasp what she was trying to communicate. As the narrative text of DiJ is only about 200 pages long, a few more sentences here and there to elaborate more on some of these issues would not have made it burdensome to read.
Third, the author enhanced the book’s readability by dividing each chapter into sections. Timely quotations from psychiatrists and patients very effectively underscored the points she made. Unfortunately, one aspect of this book detracted from its readability: as is often the case with academic treatises her frequent reliance on complex, compound sentences made it slower going than it could have ideally been. IMHO, her prose style made the complicated topics presented more difficult rather than easier to grasp.
Kitanaka’s chapter on the longstanding failure of Japanese psychiatry to recognize and to treat depression in women was noteworthy. However, she failed to articulate why that might be the case. As the vast majority of psychiatrists and government officials trying to address this issue are men who have been imbued with the culture’s longstanding patriarchal values it is not surprising that women’s struggles with depression have have been minimized.
There were two other issues which the author did not address as fully as I would have wished. First, she hardly mentioned the extent to which drinking is a contributing factor in depression. Frequent and heavy after hours ingestion of alcohol is endemic to corporate Japan. Alcohol is a central nervous system depressant. At the very least it exacerbates an individual’s developing depression. In some instances frequent, intense drinking might actually cause depression. As is the case with the vast majority of American psychiatrists Japanese doctors do not seem to be aware of the need to address this issue both for those who are drinking problematically as well as for their family members who are suffering because of it.
Second, Kitanaka opined that a law passed in 2006 highlighting the risk of people working 80 hours of overtime per month was a sign of progress. That translates into almost 20 hours of overtime a week. That amount of extra work on an ongoing basis is still going to create intense fatigue which can lead to depression. So does the fact that women are disproportionately working as so called part time, temporary employees. This means they earn less money and do not have much job security. Don’t Japanese government officials and psychiatrists realize that these factors continue to fuel the crisis of depression there?!?
As DiJ was published in 2012, I wondered if any progress had been made in dealing with this issue. A study published in April 2024 found that ‘Standardized suicide mortality rates per 100,000 population in Japan consistently decreased from 2009–2019, but these decreasing trends were reversed to increase in 2020.’ The study found that the reversal was caused by two factors. First, the COVID pandemic meant that many male and female workers became unemployed. As they lost their income not surprisingly their stress levels, depression, and suicidality worsened. Second, the Worker Reform Act of 2018 set even stronger limits on overtime allowed. Fewer hours for part time, temporary workers, which were more women than men, also meant less income. Thus, working women’s rates of suicidality worsened more than working men’s.
https://pmc.ncbi.nlm.nih.gov/articles...
For those readers who are interested the book noted below provides a more general review of mental health issues in Japan. It discusses death and suicide from overwork but does not describe the efforts made by the government and psychiatrists to address these issues. Problematic marital and family dynamics which fuel women’s depression are described. Brief mention of alcohol abuse is also included. Although it was published in 2009, the book is still relevant today. Sadly, this is because little has changed in Japan.
https://www.goodreads.com/book/show/8...
Second, the book is extremely well organized. Four sections addressed how depression has been medicalized, how it has been viewed historically by psychiatry, how it has been treated in Japan since the late 19th century, and how the perspective of Japanese society in general on this issue has evolved. Each section opens with some introductory comments and each chapter ends with some concluding observations. These latter features ensure that readers will grasp the main points being made.
I am retired psychologist who used to write clinical reports. Thus, I can heartily endorse that Kitanaka did a credible job of summarizing complex cases concisely and yet with enough detail to allow the general reader to understand and to empathize with what a depressed person seeking treatment might be struggling with. However, her descriptions of psychiatric concepts and theories about depression were sometimes so succinct as to make me wonder if the general reader would grasp what she was trying to communicate. As the narrative text of DiJ is only about 200 pages long, a few more sentences here and there to elaborate more on some of these issues would not have made it burdensome to read.
Third, the author enhanced the book’s readability by dividing each chapter into sections. Timely quotations from psychiatrists and patients very effectively underscored the points she made. Unfortunately, one aspect of this book detracted from its readability: as is often the case with academic treatises her frequent reliance on complex, compound sentences made it slower going than it could have ideally been. IMHO, her prose style made the complicated topics presented more difficult rather than easier to grasp.
Kitanaka’s chapter on the longstanding failure of Japanese psychiatry to recognize and to treat depression in women was noteworthy. However, she failed to articulate why that might be the case. As the vast majority of psychiatrists and government officials trying to address this issue are men who have been imbued with the culture’s longstanding patriarchal values it is not surprising that women’s struggles with depression have have been minimized.
There were two other issues which the author did not address as fully as I would have wished. First, she hardly mentioned the extent to which drinking is a contributing factor in depression. Frequent and heavy after hours ingestion of alcohol is endemic to corporate Japan. Alcohol is a central nervous system depressant. At the very least it exacerbates an individual’s developing depression. In some instances frequent, intense drinking might actually cause depression. As is the case with the vast majority of American psychiatrists Japanese doctors do not seem to be aware of the need to address this issue both for those who are drinking problematically as well as for their family members who are suffering because of it.
Second, Kitanaka opined that a law passed in 2006 highlighting the risk of people working 80 hours of overtime per month was a sign of progress. That translates into almost 20 hours of overtime a week. That amount of extra work on an ongoing basis is still going to create intense fatigue which can lead to depression. So does the fact that women are disproportionately working as so called part time, temporary employees. This means they earn less money and do not have much job security. Don’t Japanese government officials and psychiatrists realize that these factors continue to fuel the crisis of depression there?!?
As DiJ was published in 2012, I wondered if any progress had been made in dealing with this issue. A study published in April 2024 found that ‘Standardized suicide mortality rates per 100,000 population in Japan consistently decreased from 2009–2019, but these decreasing trends were reversed to increase in 2020.’ The study found that the reversal was caused by two factors. First, the COVID pandemic meant that many male and female workers became unemployed. As they lost their income not surprisingly their stress levels, depression, and suicidality worsened. Second, the Worker Reform Act of 2018 set even stronger limits on overtime allowed. Fewer hours for part time, temporary workers, which were more women than men, also meant less income. Thus, working women’s rates of suicidality worsened more than working men’s.
https://pmc.ncbi.nlm.nih.gov/articles...
For those readers who are interested the book noted below provides a more general review of mental health issues in Japan. It discusses death and suicide from overwork but does not describe the efforts made by the government and psychiatrists to address these issues. Problematic marital and family dynamics which fuel women’s depression are described. Brief mention of alcohol abuse is also included. Although it was published in 2009, the book is still relevant today. Sadly, this is because little has changed in Japan.
https://www.goodreads.com/book/show/8...
April 12, 2015
As someone in class pointed out, this book is more aptly titled "Depression as understood by a small subset of people in Tokyo"
April 12, 2014
very effective in provicianlizing europe ... I can borrow tons of ideas from her book to talk about chinese modernity! love love love this book.
Displaying 1 - 4 of 4 reviews