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Culture, Medicine, and Psychiatry

, Volume 32, Issue 2, pp 152–176 | Cite as

Diagnosing Suicides of Resolve: Psychiatric Practice in Contemporary Japan

  • Junko KitanakaEmail author
Original Paper

Abstract

In Japan, suicide has long been depicted as an act of free will, even aestheticized in the cultural notion suicide of resolve. Amid the record-high Japanese suicide rates since the 1990s, however, Japanese psychiatrists have been working to medicalize suicide and, in the process, confronting this deeply ingrained cultural notion. Drawing on two years of fieldwork at psychiatric institutions around Tokyo, I examine how psychiatrists try to persuade patients of the pathological nature of their suicidal intentions and how patients respond to such medicalization. I also explore psychiatrists’ ambivalent attitudes toward pathologizing suicide and how they limit their biomedical jurisdiction by treating only what they regard as biological anomaly, while carefully avoiding the psychological realm. One ironic consequence of this medicalization may be that psychiatrists are reinforcing the dichotomy between normal and pathological, “pure” and “trivial,” suicides, despite their clinical knowledge of the tenuousness of such distinctions and the ephemerality of human intentionality. Thus, while the medicalization of suicide is cultivating a conceptual space for Japanese to debate how to bring the suicidal back onto the side of life, it scarcely seems poised to supplant the cultural discourse on suicide that has elevated suicide to a moral act of self-determination.

Keywords

Suicide Depression Medicalization Japan 

Notes

Acknowledgments

I would like to thank Professors Margaret Lock, Allan Young, Ellen Corin, Laurence Kirmayer, Kato Satoshi, Takahashi Yoshitomo, Eguchi Shigeyuki, Kobayashi Kayo, and Suzuki Akihito for their inspiring comments on earlier versions of this paper. Special thanks go to Chris Oliver and Dominique Béhague for wonderful dialogues over the years and for their many insights into my work. The dissertation research on which this paper is based was generously funded by McGill University, the Wenner-Gren Foundation for Anthropological Research (Grant 6682), and the Japan Foundation.

References

  1. Althusser, Louis 1971 Essays on Ideology. London and New York: Verso.Google Scholar
  2. Atkinson, Paul 1995 Medical Talk and Medical Work. London: Sage.Google Scholar
  3. Bakhtin, M. M., and Michael Holquist 1981 The Dialogic Imagination: Four Essays. Austin: University of Texas Press.Google Scholar
  4. Barrett, Robert J. 1996 The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness. Cambridge, UK: Cambridge University Press.Google Scholar
  5. Borovoy, Amy 2005 The Too-Good Wife: Alcohol, Codependency, and the Politics of Nurturance in Postwar Japan. Berkeley: University of California Press.Google Scholar
  6. Cohen, Lawrence 1998 No Aging in India: Alzheimer’s, the Bad Family, and Other Modern Things. Berkeley: University of California Press.Google Scholar
  7. Corin, Ellen 1998 The Thickness of Being: Intentional Worlds, Strategies of Identity and Experience among Schizophrenics. Psychiatry 61(2):133–146.Google Scholar
  8. Corin, Ellen, and Gilles Lauzon 1992 Positive Withdrawal and the Quest for Meaning: The Reconstruction of Experience among Schizophrenia. Psychiatry 55(3):266–278.Google Scholar
  9. Estroff, Sue E. 1981 Making It Crazy: An Ethnography of Psychiatric Clients in an American Community. Berkeley: University of California Press.Google Scholar
  10. Estroff, Sue E. 1993 Identity, Disability, and Schizophrenia: the Problem of Chronicity. In Knowledge, Power and Practice. Shirley Lindenbaum and Margaret Lock, eds. Berkeley: University of California Press.Google Scholar
  11. Foucault, Michel 1973 Madness and Civilization: A History of Insanity in the Age of Reason. New York: Vintage.Google Scholar
  12. Fukuoka Chihô Saibansho [Fukuoka District Court] 1982 Songai Baishô Seikyû Jiken [Appeal for Compensation for Damage] 27405686.Google Scholar
  13. Gaines, Atwood D., ed. 1992a From DSM I to III-R; Voices of Self, Mastery and the Other: A Cultural Constructivist Reading of U.S. Psychiatric Classification. Social Science and Medicine 35(1): 3–24.Google Scholar
  14. Gaines, Atwood D., ed. 1992b Ethnopsychiatry: The Cultural Construction of Professional and Folk Psychiatries. Albany: State University of New York Press.Google Scholar
  15. Gaines, Atwood D., ed. 1998 Religion and Culture in Psychiatry: Christian and Secular Psychiatric Theory and Practice in the United States. In Handbook of Religion and Mental Health. H. G. Koenig, ed., pp. 291–320. New York: Academic Press.Google Scholar
  16. Gates, Barbara T. 1988 Victorian Suicide: Mad Crimes and Sad Histories. Princeton, NJ: Princeton University Press.Google Scholar
  17. Goldstein, Jan 1987 Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Cambridge, UK: Cambridge University Press.Google Scholar
  18. Good, Byron J. 1994 Medicine, Rationality, and Experience: An Anthropological Perspective. Cambridge, UK: Cambridge University Press.Google Scholar
  19. Hendin, H., A. Lipschitz, J. T. Maltsberger, A. P. Haas, and S. Wynecoop 2000 Therapists’ Reactions to Patients’ Suicides. American Journal of Psychiatry 157(12):2022–2027.CrossRefGoogle Scholar
  20. Igarashi, Yoshio, and Kazuhiko Ishii 2000 Seishinka Byôin Deno Jisatsu no Jittai [Suicide in Psychiatric Hospitals]. Igaku no Ayumi [Journal of Clinical and Experimental Medicine] 194(6):529–533.Google Scholar
  21. Inamura, Hiroshi 1977 Jisatsugaku: Sono Chiryô to Yobô no Tameni [Suicidology: Treatment and Prevention]. Tokyo: Tokyo Daigaku Shuppan.Google Scholar
  22. Ishikawa, Kiyoshi 1962 Seishin Byôrigaku no Shotaikei to Ryôkai Seishin Byôrigaku Teki Hôhô [The Systems of Psychopathologies and “Versthehens”—Psychopathological Approach]. Seishin Shinkeigaku Zasshi [Journal of Psychiatry and Neurology] 64:953.Google Scholar
  23. Katô, Masaaki 1953 Kattô Hannô to Shite no Jisatsu no Kisei ni Tsuite [The Mechanism of Suicide as a Response to a Conflict]. Seishin Shinkeigaku Zasshi [Journal of Psychiatry and Neurology] 55(4).Google Scholar
  24. Katô, Masaaki 1976 Shakai to Seishin Byôri [Society and Psychopathology]. Tokyo: Kôbundô.Google Scholar
  25. Kayama, Rika 1999 Atogaki [Afterward]. In Jisatsu [Suicide]. Yu Miri, ed. Tokyo: Bungeishunju.Google Scholar
  26. Kirmayer, Laurence 1994 Improvisation and Authority in Illness Meaning. Culture, Medicine and Psychiatry 18(2):183–214.CrossRefGoogle Scholar
  27. Kirmayer, Laurence 2000 Broken Narratives: Clinical Encounters and the Poetics of Illness Experience. In Narrative and the Cultural Construction of Illness and Healing. Cheryl Mattingly and Linda C. Garro, eds. Berkeley: University of California Press.Google Scholar
  28. Kitanaka, Junko 2008 Questioning the Suicide of Resolve: Disputes Regarding ‘Overwork Suicide’ in 20th Century Japan. In A History of Suicide in the Modern World: International Perspectives. John Weaver and David Wright, eds. Toronto: University of Toronto Press.Google Scholar
  29. Kleinman, Arthur 1986 Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China. New Haven, CT: Yale University Press.Google Scholar
  30. Kleinman, Arthur 1995 Writing at the Margin: Discourse between Anthropology and Medicine. Berkeley: University of California Press.Google Scholar
  31. Kleinman, Arthur, Veena Das, and Margaret Lock, eds. 1997 Social Suffering. Berkeley: University of California Press.Google Scholar
  32. Kure, Shûzô 1900 Seishin Byôsha no Jisatsu oyobi Jisatu no Kishin [Suicide and Attempted Suicide among the Mentally Ill]. Chûgai Iji Shinpô 20.Google Scholar
  33. Lifton, Robert J. 1979 The Broken Connection: On Death and the Continuity of Life. New York: Simon and Schuster.Google Scholar
  34. Lock, Margaret 1980 East Asian Medicine in Urban Japan. Berkeley: University of California Press.Google Scholar
  35. Lock, Margaret 1982 Popular Conceptions of Mental Health in Japan. In Cultural Conceptions of Mental Health and Therapy. A. J. Marsella and G. M. White, eds. Boston, Dordrecht: D. Reidel.Google Scholar
  36. Lock, Margaret 1986 Plea for Acceptance: School Refusal Syndrome in Japan. Social Sciences and Medicine 23(2):99–112.CrossRefGoogle Scholar
  37. Lock, Margaret 1987 Protests of a Good Wife and Wise Mother: the Medicalization of Distress in Japan. In Health, Illness, and Medical Care in Japan. E. Norbeck and M. Lock, eds. Honolulu: University of Hawaii Press.Google Scholar
  38. Lock, Margaret 1988 A Nation at Risk: Interpretations of School Refusal in Japan. In Biomedicine Examined. Margaret Lock and Deborah R. Gordon, eds. Boston, Dordrecht: Kluwer Academic.Google Scholar
  39. Lock, Margaret 1991 Flawed Jewels and National Dis/order: Narratives on Adolescent Dissent in Japan. Journal of Psychohistory 18(4):509–531.Google Scholar
  40. Lock, Margaret 1993 Encounters with Aging: Mythologies of Menopause in Japan and North America. Berkeley: University of California Press.Google Scholar
  41. Lock, Margaret 2002 Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: University of California Press.Google Scholar
  42. Lock, Margaret, and Deborah Gordon, eds. 1988 Biomedicine Examined. Boston, Dordrecht: Kluwer Academic.Google Scholar
  43. MacDonald, Michael, and Terence R. Murphy 1990 Sleepless Souls: Suicide in Early Modern England. Oxford; New York: Oxford University Press.Google Scholar
  44. Marsella, Anthony 1980 Depressive Experience and Disorder Across Cultures. In Handbook of Cross-Cultural Psychology. Vol. 6. Psychopathology. J. Draguns and H. Triandis, eds., pp. 237–289. New York: Allyn & Bacon.Google Scholar
  45. Miyake, Shû 1903 Seishinbyôsha ni Taisuru Kokka no Senmu [The Nation’s Tasks with Regard to the Mentally Ill]. Taiyô 9.Google Scholar
  46. Nishizono, Masahisa 1986 Seishin Ryôhô [Psychotherapy]. Seishiknka Mook [Psychiatry] 13:189–198.Google Scholar
  47. Ôhara, Kenshirô, ed. 1975 Jisatsu to Bunka [Suicide and Culture]. Tokyo: Shihôdô.Google Scholar
  48. Ohnuki-Tierney, Emiko 1984 Health and Illness in Contemporary Japan. Cambridge, UK: Cambridge University Press.Google Scholar
  49. Okada, Yasuo 1989 Seishinka Kanja no Jisatsu Jiken: I no Tachiba kara [Suicide Cases of Mentally Ill Patients: From a Medical Point of View]. Jurist Bessatsu: Iryô Kago Hanrei 100 Sen [Jurist Supplement: 100 Cases of Medical Malpractice]: 90–91.Google Scholar
  50. Okajima, Yoshirô 2005 Shi o Nozomu Kanja ni Seishinkai wa Nani ga Dekiruka? [What Can Psychiatrists Do for Patients Who Want to Die?] Seishin Shinkeigaku Zasshi [Psychiatria et Neurologia Japonica] 107(9):936–946.Google Scholar
  51. Osborne, Thomas 1994 Power and Persons: On Ethical Stylisation and Person-Centered Medicine. Sociology of Health and Illness 16(4):515–535.CrossRefGoogle Scholar
  52. Ozawa-de Shilva, Chikako 2002 Beyond the Body/Mind? Japanese Contemporary Thinkers on Alternative Sociologies of the Body. Body and Society 8(2):21–38.CrossRefGoogle Scholar
  53. Ozawa-de Shilva, Chikako 2006 Psychotherapy and Religion in Japan. London: Routledge.Google Scholar
  54. Pinguet, Maurice 1993 Voluntary Death in Japan. Rosemary Morris, trans. Cambridge, UK: Polity Press.Google Scholar
  55. Sakurai, Hirono, Kunihiko Tsutsumi, Yuko Tomita, and Mitsukuni Murasaki 1998 Sanji Kyûkyû Senta ni Hansô Sareta Seishinka Tsûinchû no Jisatsu Kito Kanja no Haikei [Research into Suicide Attempters Under Psychiatric Treatment at a Critical and Emergency Center]. Rinshô Seishinigaku [Japanese Journal of Clinical Psychiatry] 27(11):1363–1370.Google Scholar
  56. Saris, A. Jamie 1995 Telling Stories: Life Histories, Illness Narratives, and Institutional Landscapes. Culture, Medicine and Psychiatry 19:39–72.CrossRefGoogle Scholar
  57. Suzuki, Hiroko 2000 Daigaku Byôin Seishinka no Jikangai Shinryô ni Okeru Jisatsukitosha no Jittai [The Realities of Attempted Suicides in a University Hospital’s Emergency Unit]. Igaku no Ayumi [Journal of Clinical and Experimental Medicine] 194(6):541–544.Google Scholar
  58. Takahashi, Takao 2003 Anrakushi ni Tsuite: Nihonteki Seishikan Kara Toinaosu [On Euthanesia: Reexamining It in Light of Japanese Views on Death and Life]. In Yoki Shi no Sahô [Manners of Good Death]. Takao Takahashi and Hiroaki Taguchi, eds. Fukuoka: Syûshû Daigaku Shuppan.Google Scholar
  59. Takahashi, Yoshitomo 1994 Jisatsu Keikô [Suicidal Tendencies]. Rinshô Seishin Igaku [Journal of Clinical Psychiatry] 23(1):55–63.Google Scholar
  60. Takemura, Kenji, and Hiroshi Shimura 1977 Kaihô Ryôhô no Jissen no Moto De Okita Jisatsu no Keiken [Experience of Suicide Cases That Occurred Under the Open-Ward Therapy]. In Seishin Byôin ni Okeru Jisatsu [Suicides in Mental Hospitals]. Seishin Byôin Kyôkai [Association of Mental Hospitals]. Tokyo: Makino Shuppan.Google Scholar
  61. Takemura, Kenji, and Hiroshi Shimura 1987 Jisatsu no Sain [Signs of Suicide]. Osaka: Shinryô Shinsha.Google Scholar
  62. Taussig, Michael 1980 Reification and the Consciousness of the Patient. Social Science and Medicine 14B:3–13.Google Scholar
  63. Young, Allan 1982a The Anthropologies of Illness and Sickness. Annual Review of Anthropology 11:257–285.CrossRefGoogle Scholar
  64. Young, Allan 1982b Rational Men and the Explanatory Model Approach. Culture, Medicine and Psychiatry 6:21–34.CrossRefGoogle Scholar
  65. Young, Allan 1995 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Human Sciences, Faculty of LettersKeio UniversityTokyoJapan

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