Wednesday, July 10, 2013

Random Thoughts - Emotional Irregulars

Early in my time back in the U.S., I had a discussion with a relative about mental illness in America as compared to that in Japan. This stemmed from a comment I'd made on Facebook about how I was seeing so many adults standing on streets and corners holding up signs asking for money in which I said that that was unlikely to happen in Japan. There are multiple reasons for this. One is that Japanese people would be ashamed to ask strangers for money. Another is that families are expected to and generally do look after their relatives with problems. This is not always the case, but it is more often the case than in the U.S.

The situation is complex, and I'm sure even talking about it in a format as limited as a blog post will generate some trouble with those who are intent on not taking any caveats about that fact to heart, but I will talk about it nonetheless. It was my impression that this relative felt that I was being inherently unfair to Americans and portraying them as heartless and selfish. While I don't believe Americans are heartless (far from it), I do believe that from the Japanese perspective on some issues, they are quite selfish, particularly when it comes to matters of their homes.

One of the things I realized about Japanese families, in general, but certainly not specifically, is that they feel a strong sense of obligation to look after one another. A good example of this is the case of adult children with hikikomori, a mental disorder in which one seeks social isolation. In most cases, the family accommodates  a member's disease by finding a way to financially support and house them. They do not issue ultimatums to "get better" or "get out". They do not insist on treatment or expulsion from the home. The parents or other family tend to accept the burden and live with it. 

One might ask how I know this or if I'm basing my conclusions on anecdotal experience. Because those who suffer from hikikomori are in social isolation, it's not like I was going to run across them or have the experience of teaching them. My information comes from a broader source. I met a woman in Japan who was doing her PhD and as part of her dissertation was visiting and interviewing a large number of these young men (it's almost always men). I also saw her actual dissertation and part of what she said was that insisting that your mentally ill relative do whatever was in his or her power to get better or face having to leave simply "was not done". 

By contrast, in the U.S., and I worked for two years in a halfway house for people who had been institutionalized or hospitalized after having had a psychotic break, so I have first-hand experience with this as well, American families tell the people with such problems to get their crap together or get out of their homes. If they are too ill to actually do that, their families find a way to off-load them onto a social service system in not a small number of cases. I was part of a system onto which such people were off-loaded and some of the things I discovered about the families of people who couldn't get rid of their mentally ill were, at times, horrifying. In one of the worst cases, the sister of one woman who found her way to our facility routinely locked her in a closet or beat her when she didn't want to deal with her. 

My point in this post is not to paint Americans as evil people who do not care about their families, but rather to point out how we handle mental illness in the family differently. While Japanese people are far more likely to hide or obfuscate such illnesses because it brings shame to them, Americans are likely to try and push people out of their lives and insist on treatment at any cost. As I may have mentioned in a post before, this is because Americans are tolerant on a macro level (society at large), but intolerant on a micro level (within their own homes) whereas the Japanese are the opposite.

This is all an introduction to my larger topic and that is about how the manner in which we are treated when we have an emotional or mental problem greatly influences how that problem will manifest. As part of my discussion with the aforementioned relative, she offered an anecdote about the boyfriend of an acquaintance of hers who was narcissistic, selfish, lazy, and refused to take any work that was "beneath" him and was therefore utterly dependent on his girlfriend for support. She asserted that the only thing to be done with a person with such a personality disorder was to expel him or he would forever be a leech on whoever he was with. She tasked me with explaining how a Japanese family would deal differently with such a person. To this, I said that, whatever personality disorder he was biologically inclined to have would very likely manifest differently in Japanese culture. 

The seeds are the same in all of us, but the plant that grows sprouts differently depending on the soil, water, sunlight, and care that it is given. This is a fundamental notion that people who have lived within the perspective of a single culture have difficulty understanding. A man who is at risk of such a personality disorder in the U.S., with its culture of entitlement, consumerism, and emphasis on material gain, might see his tendencies manifest with a tendency to be parasitic on those around him even when he has skills and potential. In Japan, such a man would be unlikely to do so because his culture would teach him that it would be shameful to do so. He may end up being a tyrannical boss who foists work that he feels beneath him onto his subordinates. It is hard to predict precisely, but there are more or less likely outcomes for people with similar biochemical vulnerabilities to various mental illnesses based on the shaping of ones culture.

I have been thinking about this as of late because, even after a little over a year back home, I remain shocked and often distressed by the manner in which Americans will act out emotionally, often with strangers. I deeply miss the emotional regulation that Japanese people often displayed and a culture in which it was believed that only children acted out in such a fashion because only they had not yet learned to control their emotional impulses. 

I once read a study, and wish I could find it to link to, but have not relocated it on the web, which said that Japanese people experience a limited range of emotions relative to Westerners. If the saddest we can feel is a "1" and the happiest a "10", most Western folks will experience that full range from time to time. Most Japanese people will tend to operate in the 3-7 range, unless they live abroad for awhile.

This all links to what I was saying about how culture shapes our mental life. If you are raised in a culture in which emotional expression tends to be suppressed, your brain chemistry is shaped such that you are less vigorously emotionally activated less often. Acculturation in Japan leads to better emotional regulation both because emotional outbursts are not only discouraged, but can result in social censure, and because such control is heavily role-modeled. In America, no such acculturation occurs and role modeling of outbursts, particularly those meant to "teach" people a lesson about bad behavior by venting openly at them, is the norm. This emotional dysregulation which is a part of American life is at the root of the ugly American image as well as the tendency to be openly and vociferously opinionated. We are not taught to be in control, so our minds do not develop like those of people who are taught to be in control. 

I have been reading a book about the brains and bodies of criminals and how the development of certain areas of the brain are critical to whether someone behaves aggressively. People who behave violently have certain characteristics which are highly correlated with aggressive and often criminal behavior, but such characteristics are not deterministic. The "right" environment will prevent someone with a biology that is oriented toward aggression to act on those impulses in a less destructive manner. The "wrong" environment will have them engage in risk-taking or aggressive behavior. One thing that is evident as I read through this excellent book is that the support of the family when people have such biochemical risk factors is enormously important and can make the difference between someone who acts out and someone whose destructive behaviors remain relatively contained or re-routed in more productive ways.

I'm not offering any of this as a condemnation of Americans or as an elevation of the Japanese. As is the case with all things, there is a yin and a yang. The emotional suppression that happens in Japan, as I have said before, carries a heavy price to the people who have to exercise it and I personally believe that the high rates of suicide are a part of that. It is also one thing to say that the families supporting their mentally ill is a better thing than finding a way to outsource their care or leaving them on street corners holding signs asking for money and another to live that life. Having a mentally ill person live with you is very hard on everyone, and in Japan the burden for care-giving of the disabled of any sort disproportionately falls on the women of the family. Additionally, I often felt that the Japanese were denied the heights of passion as a result of the limited emotional ranges they tended to display. Not experiencing the lowest of the lows sounds good, but not experiencing the highest of the highs is a far less pleasing notion.

My point in talking about this is two-fold. One is that I'm fully aware that one of the benefits I had as a foreigner living in Japan was that I lived among people who were well-regulated emotionally in a manner in which I personally did not have to be regulated. I had the benefits without having to pay the same price. That being said, after years of being in that culture, I actually gained far better regulation and have much better emotional control than the average American. This has been a very hard experience for me upon returning to the U.S. I often feel as if I'm living in a nation of mentally unstable people, but that is part of the reverse culture shock I have been experiencing. I don't know if I'll ever feel comfortable with what I perceive as a great deal of instability around me, but it has been overwhelming and made me socially cautious in a manner I did not anticipate.

My other point is to open up my readers minds to the idea of how the common biochemical seeds of illness or aggression can grow different plants based on acculturation. There's a reason we don't see hikikomori in the U.S. or high levels of suicide and the Japanese don't see dissociative identity disorder or nearly as much crime and they are based on what we teach and raise our children. No country or culture is immune to the genetic tendencies to have certain problems, but what we do with the people with such issues shapes how they act out in each society. 


  1. Another thing you have to look at it how personality disorders, mental illness and other disabilities are defined. When it comes to things where a fully grown adult cannot take care of themselves because of paralysis, mental retardation, severe cases of autism and other such things most American families choose to take care of that person themselves and rarely result to confining a family member to a special needs clinic. In fact, in many cases it is under the recommendation of doctors, the court system, or social servers that most of these families voluntarily send patients to these places or have them permanently ripped from their families. Although I know many people abuse such family members, the same can be said of people in Japan who refuse to get their family members the help they need because of shame. Plus things are done not because they actually care but almost solely out of obligation which really says nothing good about heir character.
    As far as I'm concerned, the tough love approach to people with Hikikomori is the right way to go. I was an introvert with many social phobias and a severe case agoraphobia (with panic attacks). After Years of gingerly trying to get me to socialize more my family had enough and essentially forced me to address the issue and everyday I'm thankful for it because I literally had no friends and almost never left my house/room. However, my family never threatened to kick me out, then again I still go to school and made money online. Another thing you have to look at is the negative connotation attached to being a bum in American society. Moreover, many bums still live in their parent’s basements even at age 30 regardless of how often their parents threatened to kick them out.
    Thinking that a job position is too beneath you to take the offer but forcing your partner to support both of you is unacceptable as far as I’m concerned. I’ve seen to many men, women (mostly men) take care of their partners who refuse to work for one reason or another but aren’t stay at home parents, and it is a serious strain on any relationship. My cousin for example was going to school for her master’s degree, has a stay at home bf who was frequently intoxicated and partied all the time (he wasn’t always like this), and she supported both himself and herself. Yes she made a lot of money so it’s not like she need him to work but after a while you start wondering if they are with you because they love you or are they there for the free ride basically making you a sugar mama/sugar daddy.
    “By contrast, in the U.S., and I worked for two years in a halfway house for people who had been institutionalized or hospitalized after having had a psychotic break, so I have first-hand experience with this as well, we tell the people with such problems to get their crap together or get out.”
    Any halfway house that did this is violating current regulation and can be sued/permanently shut down. As for the families who just get rid the problem relative that’s a universal 1st world issue that needs to be addressed and is not solely an American thing. You also have to consider what a patients issue is, how long the family has had it, what led the family to finally give up, and whether or not a patient is exaggerating because the family y member is lying/aggravating, etc. In addition, Westerners as a whole define family very differently from Japan with each sub-culture having different priorities (i.e. abandoning a family member is almost unheard of in a truly Italian family).

    1. You make a good point about the mentally disabled or in some way congenitally disabled people being cared for at home. I think it points out that there is far less patience with mental disability than what is seen as unavoidable disability (such as Down's Syndrome). In the U.S., mental illness is seen as something you can just "get over".

      To that end, I have to ask if you were actually socially phobic or introverted and shy. There is a profound difference between feeling uncomfortable going out and being around people and being in such a state that you are diagnosed as socially phobic. Such people cannot be pressured by their families into getting off the stick and doing something. They are incapacitated by their illness and require structured treatment (often CBT or forms of graduated exposure).

      Also, the way I wrote about the halfway house must have been misleading. It wasn't the halfway house that told people to get their crap together, but the families of the people who stayed there.

    2. I was always a naturally shy and quite person but as I got older, my anxiety grew to the point that I was so afraid to be around people that I essentially began hearing and seeing people judging me even though most people never really noticed me because I was so naturally quiet. In fact, I was so quiet that more often than not my teachers actually had to put me up front, so that they’d remember I was in the room and others just sent around a sign in sheet to avoid missing any students. As I became older, I became less and less interested in associating with others and unconsciously began to justify my reason for not leaving my house to go anywhere other than school. I was my anxiety was so severe that I was uncomfortable leaving my home without an adult family member being present with me at all times; essentially making me the opposite of virtually all teenagers. Many of my former psychologists started noticing that I was developing the symptoms of agoraphobia, also while noting my anxiety disorders, and eventually started having panic attacks (at first believing it to be my past heart condition happening all over again). I kept making excuses for my lack of interest in interacting with people (my own age) but in reality outside my home the moment I saw other people my heart would begin to race and my vision would get blurry to the point of becoming dizzy and lightheaded. As for the take mental illness, I believe that you’re confusing personality disorders and psychotic breaks/meltdowns with mental disorders and the developmentally impaired. It is true that society in general does have a slight stigma against certain personality disorders, see below, but it’s not as harsh as you make it seem.
      The Personality Disorders:
      Cluster A (odd)
      Paranoid, Schizoid, Schizotypal
      Cluster B (dramatic)
      Antisocial (psychopathy/sociopathic), Borderline, Histrionic, Narcissistic
      Cluster C (anxious)
      Avoidant, Dependent, Obsessive–compulsive
      Not specified
      Depressive, Passive-aggressive, Sadistic, Self-defeating
      Alcoholism and drug related personality disorders are also look negatively upon but that is a case-by-case issue and celebrities who fit into this part are largely responsible from the public’s negative view of these people. Another thing I’d like to point out is that in many cases where Japanese parents actually get divorced I’ve heard/read numerous reports/first hand experiences of both parents essentially dumping their children on a relative (usually grandparents) and moving on with their lives. The little interaction the children receive is solely from supporting the children financially in most cases. I’ve met two of these types of people who came to my school in an exchange program and based on their experiences it’s common and most families almost always avoid the issue to keep up appearances.

  2. I have been worrying recently about my plan to go back to North America in a year or so for the exact reasons you mention. At first I had the impression of Japanese people as being very good at false politeness - which is sometimes true - and not cultivating true close relationships with foreigners, sometimes not even with other Japanese people. However, over time my viewpoint has changed a lot. Now I dread going back to a place where the majority feel they are doing a service pressing their opinions on those around them, and everyone seems to live in their own world with their own rules in public. There are many things I love and miss about North America, but the emotional balance, careful politeness, and awareness of those around you are the things I appreciate here.
    I have a friend here who is a Japanese woman in her 60s. She has two children, a well-adjusted girl of about 30 and a son who is also an adult and a hikikomori. We got to talking about it one day and she told me that she thinks it is usually the boys because they are spoiled too much by their parents. She said (I am paraphrasing) "we women have it harder, so we're strong". She believes she also spoiled her son more than her daughter and allowed him to get to the state he is in. Perhaps that feeling of responsibility also factors into why she takes care of him, which she does as a natural thing. I don't think she would understand if someone suggested she stop. I'm presenting this information without any true analysis, because I have no proper experience to draw upon and make conclusions.

    1. Pratyeka: I believe your concerns about adjustment may be well placed based on my experiences. I'm right there with you on having things that one loves and misses, but also having problems with other things, particularly the apparent lack of any rough rules for social order in public. When I lived here before, I didn't know there could be such order. It's like never having tasted chocolate so you don't develop a taste for it. Once you try it, you want it in your life forever.

      I also lack information to analyze hikkokomori and its roots. My sense is that all such things develop in a complex stew that includes genetic inclination and family and social environment. It seems to me that hikkikomori is a uniquely Japanese manifestation of social phobia or other types of phobias rolled into a painful and crippling mess.

      I'd be inclined to some extent to agree with the woman you spoke with, but I think there's more to it than that. Yes, women have it tougher in Japan in some ways and they have to be stronger (and they often are), but men have it hard in a different way. Women in Japan have role flexibility and are allowed to be dependent or independent. I can't tell you how many women I spoke with who wanted to marry so they could have the freedom to quit their jobs should they desire to do so.

      Men, on the other hand, are relatively limited in their options. They have few choices but to be the breadwinner, often in soulless jobs and currently in an economic situation which is very harsh. I think that it's not so much indulgence that has created hikkikomori, because I think such indulgence (as well as a family structure which centralizes sons even above fathers in many cases and creates more intimate relationships between mothers and sons) existed long before the current spate of cases of hikkikomori. I think it's the fact that many young men are emotionally overwhelmed at the prospect of being men in the world they live in. They don't face it with hope, but with dread and fear. It's so overbearing and terrifying, that they turn inward and hide from it.

      So, I'd guess there are roughly three pieces to it - genetic inclination, a lack of toughness for whatever reason (including possibly upbringing and indulgence), and the current social situation which means thriving as a man in Japan is really hard at present.

      And what you said about his mother not understanding if someone suggested that she stop? That is exactly what my friends research said as well.

      Thank you for your thoughtful comment. I truly appreciate it.

    2. I've always wondered why mothers tend to be overprotective and nurturing with their sons while fathers tend to be over protective and strict with their daughters, and in the case with many western (mostly American societies) total pusher overs for their "little girls/princess" outside of relationship (and/or dangerous) related issues.


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