Tuesday, May 27, 2014

Won't Miss #542 - simplistic and ineffective therapy

Recently, I watched a video lecture about a mental health issue in which an international audience was present. After the presentation, members of the audience were allowed to ask questions or make comments. When it was the turn for a Japanese audience member to speak, his comment about the fact that optimists suffered less degradation in their bodies than pessimists was, 'so you're saying we should just smile all of the time.' He said this without irony and it was clear that he felt this was a correct conclusion to reach. This overly simplistic conclusion coming from a Japanese person in mental health did not surprise me in the least.

While I was in Japan, I learned a bit about various mental health entities there and their methods of treatment. The national health system generally allows people to only have sessions that are 20 minutes in length which doesn't allow much time for treatment. Of course, they probably don't need much more than that because, in many cases, the first line of assistance for people who have contacted someone who is a qualified professional is to be told to take a walk, look at pretty flowers, and smile more. These things are not a bad idea, but "just cheer up and get out" is not the sort of advice that I would want to get if I was in a sufficiently bad state to make the effort of going to a psychologist or psychiatrist.

Considering the high suicide rate, you'd think Japan would have a large task force figuring out the best way to help people with their issues, but there are still no small number of people who think that it's just a matter of turning that frown upside down, taking the time to smell the roses, or pulling yourself up by your bootstraps. It's no shock to me that one of my coworkers was away from the office for an entire year with depression considering the shockingly ineffectual manner in which mental health is sometimes managed in Japan. I don't miss the stupidly simplistic (and potentially damaging) way in which "therapy" is carried out. 


  1. Treatment is important, but so is prevention. And to deal with prevention means to look at the root causes, which means taking a hard look at how society creates these mental-health issues... something that will absolutely not happen in a society that has learned to use mind control as effectively as Japan has.

    1. I agree that dealing with causes is important, and most countries, including Japan, don't do it very well.

  2. Wow, great post. The mental health system in Japan is simplistic, understaffed and wholly ineffective. In general, psychiatry and/or psychology of the individual is simply not a huge priority in Japan; the priority is placed on a well functioning social system. I guess I would put it this way: if Japanese students were 'forced' to choose a major of sociology vs. psychology, sociology would win hands down.

    Much of this can be attributed to the fact that there is so much racial and social homogeneity in Japan, whereas America has a very high degree of diversity and, as such, it doesn't surprise me that trying to figure out what is 'wrong' with someone who doesn't 'seem right' would be a much bigger emphasis in America rather than Japan.

    Actually, the # of psychologists in Japan is frighteningly low. There just isn't much of any emphasis on it, nor is there much attention paid to it. Some of the best American minds go into psychology as a profession. The same cannot be said for Japan and I just don't see that changing anytime soon.

    1. I have to disagree - because the pressure for uniformity in Japan is extremely strong and well-obeyed, people who don't want to conform or aren't able to, be it for mental health reasons, are treated like outcasts and cannot count on their peers' empathy.
      It's simply not socially acceptable to have mental health issues, so people will only go to seek help in the most extreme cases, if ever.
      Also, because in Japan there is a fatal societal phenomena in that people who come in contact with social outcasts or simply "unnormal folk" will be avoided as well. For example, when in Japan, a woman is sexually harassed on a train, she will be treated with the same (or even more) disdain as the harasser himself, because she "dared to stick out" by getting harassed.
      That's the reason why very few Japanese want to go into professions like psychotherapy where they have contact with "unnormal people" - there is a big social stigma attached to it, and it could make it impossible for them to get married, start a family, or get any other job afterwards.

  3. My personal experience is that what you wrote is true not only for therapy, but (to my shock), almost any area of life. After living in Japan, I am actually clueless how the Japanese were able to have the technologically advanced infrastructure and state of the art health care they now enjoy. I have not found a single person who was interested to get to the bottom of things in his field of work. I've never seen people so quickly satisfied with simplistic answers to their questions.
    This is an actual source of bewilderment for me - Japan is, at least technologically, an advanced country. But I have no idea how they've come to this level. Maybe in the boom years, the Japanese were more naturally curious, and have since become more complacent?

    1. I can only speculate based on my experience, but I will say that my sense mirrors yours. That is, that people are content with simple answers, or, at times, no answer at all. I think this is cultural and goes back to the feudal system. History shapes psychology so much.

      It is an interesting question about how they are so advanced despite this complacency, but, in my opinion, the answer is essentially related to the ability to acquire technology/culture from other countries and meticulously refine it.

      When I first started using the internet in Japan, it lagged greatly behind that of the US. It took forever for the to move to dial-up access of any sort and then sluggishly move to ISDN. Once they started putting things in place though, they raced ahead and got it all in place and surpassed overall infrastructure in America. There are multiple reasons for this and one is certainly logistical. Getting the physical infrastructure together is a lot easier when everyone lives in a smaller area. Also, I do believe the way in which the government supports business (including monopolies) played a part. The Japanese are slow to make a decision, but, once it is made, they are pretty efficiently about getting the job done. It's just the getting to it part that takes forever.

      If you look at a lot of Japanese culture, much of it is appropriated from other cultures and then refined. They got a lot of their food from China and Korea, and their writing system from China. Historically, they have not been inventive, but they have been innovative. I think that is how they manage their advancement despite the lack of those qualities which tend to stimulate invention. That's just my guess.

      Incidentally, I don't know how "state of the art" their health care system is compared to other countries. I can say that, when I had my gall bladder removed in Tokyo, they were lagging behind the U.S. in lapraoscopic surgical techniques. One of my coworkers had had such surgery 4 years before I had mine in Japan and the hospital I went to (a big one in Ogikubo) was using me as a "teaching" patient. An American doctor was coming in and teaching them at that time.

      I'm not saying their health care is in any way lacking. I think it's really good, but I don't know if they are at the top of the game relative to other countries (especially perhaps some European ones with really good socialized care). That's just another speculation though - it could be they are more on top of things now. That being said, a lot of doctors and dentists learn by going abroad. I think they go outside their own culture to keep on top of things. Both of my surgeons and my dentist trained in the U.S., but then they were treating me because they spoke English.

  4. It is mind blowing to me that despite all that humanity knows about attachment and the detrimental effects of institutionalization on children, orphanages are still the go-to solution for children who can't be raised by their parents in Japan. After spending eight years in an orphanage I can see the impact on my son, but the "professional advice" is so woeful. The psychiatrist appointed by the city welfare office to assess him told me, as if it were a nugget of deep wisdom, that I should "tell him what is expected and explain the rules instead of assuming he will know how to behave". Um, wouldn't one do that with any child?! Then when my son was scared of the old man in the white coat he had never met before and looked down at the ground, he was sent for an autism assessment. So much face-palming.


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