Posted on January 28, 2010 - by David

Crazy Like Us, Part 4: Depression in Japan

part 1

part 2

part 3

Chapter 4 – The Mega-Marketing of Depression in Japan

One of the main ideas in Ethan Watters’ book, Crazy Like Us: The Globalization of the American Psyche is obviously that the active exportation of Western conceptions of mental illness has had a largely negative effect of the expression of these illnesses in other cultures. Nowhere is his criticism of this process more evident than in the final chapter on depression in Japan. Watters shows how drug companies went about actively creating a market for their products by both determining effective, culturally specific messages and ghostwriting research studies which would give credence to their claims of the need for, and efficacy of the SSRI anti-depressants. But what I’m most interested in looking at in this chapter is the evidence that depression as we know it is still missing from Japan.

At the end of the chapter, Watters concludes that the “mega-marketing” scheme seems to have worked in terms of profit. In its debut year in Japan , sales GlaxoSmithKline’s Paxil (the main drug discussed in the chapter) brought in over a hundred million dollars. By 2008, less than ten years after it was introduced, sales had grown to over a billion. This kind of gives the impression that depression, or at least its treatment, is now nearly the same in Japan as in the U.S. However the results of one small, impromptu survey I’ve been a part of twice suggest that the prevalence of depression in Japan is still nothing compared to America. Once a few years ago, and again this past November, I was present in Liah Greenfeld’s modernity seminar at Boston University when professor Chikako Takeishi of Chuo University in Tokyo brought a group of her students to class as part of larger U.S visit to cultural sites and institutions. Greenfeld asked her American students if they were friends with someone who had been depressed, and every hand went up. She then asked how many of us had been depressed ourselves, and I’d say a third, if not more of us, (including myself), raised our hands again. The responses of the Japanese students were strikingly different. Out of about 20 students, I believe no more than 3 said they had friends who had been depressed, and none of them had been depressed themselves. These were our Japanese counterparts  – university students from an industrialized and technologically advanced nation under as much, if not more, pressure to succeed than we were. Of course, a number of objections could be made regarding the methodology of our little study, but Watters book makes one thing clear: thanks in large part to the efforts of companies like GlaxoSmithKline, it was no longer possible for these students to be ignorant of what we were talking about when we used the word “depression.” They knew conceptually, but none of them knew intuitively, experientially, like we did, what it was to suffer from this illness.

One of the reasons depression might appear to be a problem in Japan is the cultural prominence of the melancholic personality type. While in the West, we associate melancholy with depression to such a degree that the two are almost synonymous, this is not so in Japan. The typus melancholicus was adapted into Japanese psychiatry in the 1960’s from a German professor named Hubert Tellenbach. It seems the idea caught on not as a result of any forceful marketing but because the description of this personality type corresponded to certain highly valued characteristics. As Watters writes, “its association with such prized Japanese traits as orderliness and high achievement meant that having such a sadness-prone personality was something not to be feared but aspired to” (208). Some have identified the importance of Buddhist beliefs about suffering as an explanation for the value placed on sadness in Japanese culture. So while on the outside, Japanese sadness may look like our depression, the difference seems to be that, for the most part, the Japanese experience is not maladaptive to the culture or a cause of dysfunction. Watters quotes professor Margaret Lock of McGill University, who believes that some experiences which we see as negative symptoms may actual serve to strengthen social ties among the Japanese:

Feeling sad and reacting sensitively to losses, particularly of loved ones, is an idea that has singular appeal in Japanese. The theater, a range of literature and indigenous popular songs, traditional and modern, positively wallow in nostalgia, sensation of grief and loss, and a sense of the impermanence of things. People cry freely (by North American and northern European standards) about separation and lost loved ones, but at the same time they seem to draw strength from these experiences, to tighten their bonds with those who remain living, and to reaffirm group solidarity (212)

While this tendency towards melancholy may account for some of the confusion, there is an even greater reason why many see the Japanese as a deeply depressed culture: the astounding suicide rate.  I agree with Watters, who writes that “most Americans would certainly assume that suicidal acts are nearly always caused by mental illness, most commonly depression” (218). The Japanese, though, have a long cultural history of suicide for reasons other than what we might expect. Watters references psychiatrist Masao Miyamoto, who has argued against the notion that the rise in suicide is related to depression. “A peculiarity of the Japanese is that they often die for the sake of the group,… They die for shame” (219)

In his classic study on suicide, sociologist Emile Durkheim identified altruistic suicide as one of three definitive types of suicide. In contrast to egoistic suicide, which results when society is not well-integrated and is unable to hold the individual members together, altruistic suicide occurs when the individual is so totally absorbed in the group that his own life loses value.  A suicide “for the sake of the group” falls into the altruistic category. We can see in the story of young Oshima Ichiro, (featured prominently in this chapter), how excessive social integration and lack of individual identity can lead to suicide. In 1990, Ichiro, 24, joined the Dentsu advertising agency, which Watters describes as “the largest company of its kind in the world” (214). The Japanese market was in the midst of a dramatic economic downturn, while only a few months earlier it had been the envy of the world. By Watters’ description, Ichiro pretty much handed his life over to the company. Apparently, he was working an average of 47 overtime hours a week, though interestingly, based on his time sheets he only averaged 12 to 20 hours overtime. This suggests to me that he saw it as his duty to put in the time necessary to help his company succeed without demanding excessive compensation. Also, it seems the treatment he received at work was by American standards far below acceptable. Watters writes:

At one late-night drinking binge at the office, Oshima’s boss poured beer into his own shoe and demaned that Oshima drink it down. When he momentarily refused the request, his boss beat him. (216)

Also striking is the fact that an hour before his family found him hanging in the bathroom, Ichiro called the office to tell them he was sick and wouldn’t be making it in. Obviously his identity had been completely absorbed by the Dentsu advertising agency. Even in the moments before his death he could not forgo his duty to at least notify the company that he would be absent that day. While many American identities are wrapped up in work, Oshima Ichiro’s identity belonged to the company that employed him, and I believe this is an important difference. Perhaps the most typical question asked when two Americans meet for the first time is ‘what do you do?’ , and we all understand that this means ‘what do you, as an individual, do for work?’ While our identities are linked to our individually chosen pursuits, it seems for the Japanese, identity is much more about who you are connected to. For Ichiro, failure would not be merely personal, it would mean letting all the other members of his company down, as well as his family and society as a whole.

While I’ve tried to show that suicide in Japan is not necessarily the result of depression, there are ways in which it may be related to modern societal changes. The third type of suicide which Durkheim mentions, anomic suicide, is caused by a lack of regulation in society. While this type is closely related to egoistic suicide, (and Greenfeld’s definition of anomie goes a long way towards reconciling the two into one), Durkheim focuses much of his discussion of anomic suicide specifically on lack of economic regulation.  It seems likely that the huge economic swings related to competition in the global marketplace introduced a new level of stress to the Japanese workforce, further augmenting the cultural tendency towards suicide.  For centuries, the Japanese have been dying for shame and the sake of the group, and their marriage to the modern economy seems to be a deadly union.

These two articles from the New York Times archives give some relevant background information on the topic of depression in Japan, as well as introduce what I see as one of the major problems with the whole discussion of depression in general. The first I believe is representative of the “depression is a serious brain disease” camp, while the second tends towards the “we have medicalized sadness” stance. For some reason, it seems that the implied middle view- the possibility that something is indeed seriously wrong, but the root causes of the problem are not simply biological or genetic- hardly even exists in the discussion. I guess I’m trying to do what little I can to change that.