Extraordinary Care for Extraordinary Conditions: Constructing Parental Care for Serious Mental Illness in Japan
This article presents an account of how Japanese parents in a family support group for mental illness constructed understandings of care for adult children with serious mental illness, primarily schizophrenia. I build from Janis H. Jenkins’s research on the “extraordinary condition” of schizophrenia to discuss “extraordinary care,” which parents practiced as a way to refute cultural and clinical beliefs about pathogenic families and degenerative diseases. Parents’ accounts of extraordinary care revealed a reliance on biomedical knowledge to treat the symptoms of mental illness coupled with an ongoing determination to improve children’s lives beyond what psychiatry could offer. Extraordinary care thus points to the therapeutic limits of biomedical psychiatry while also reinforcing the significance of social relations as families work toward recovery.
KeywordsCare Families Schizophrenia Psychiatry Recovery Japan
Portions of this manuscript have appeared in different guises at American Anthropological Association (2016, 2017) and Society for Psychological Anthropology (2017) meetings, and I am grateful for comments I have received from discussants Janis H. Jenkins, Lenore Manderson, and Narelle Warren (and panel organization wizardry from Emily Hammad Mrig, Merav Shohet, and Narelle Warren). I would like to thank William W. Kelly, with whom I began this project, and Daniel M. Goldstein, who enabled me to finish it. I have also benefited from thoughtful feedback from two anonymous peer reviewers. I would like to thank Etsuko Kosuge, Ai Ohtani, Toko Shiiki, Ellen Tilton-Cantrell, Hiromi Yamashita, and the amazing Rae Sakakibara for transcription and translation assistance. My deepest thanks are due to the members of Tomodachi, who allowed me to participate in their group and become part of their lives.
This study was funded by the Japan-U.S. Educational Commission (Fulbright IIE) Dissertation Research Fellowship, Yale University’s Whitney and Betty MacMillan Center for International and Area Studies Dissertation Grant, and Yale University’s Council on East Asian Studies Dissertation Research Grant.
Compliance with Ethical Standards
Conflict of interest
Ellen B. Rubinstein declares that she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of Yale University’s Institutional Review Board (IRB Protocol #: 0909005658).
- Bernard, H. Russell, and Clarence C. Gravlee, eds. 2014 Handbook of Methods in Cultural Anthropology. Lanham, Md: Rowland & LIttlefield.Google Scholar
- Fromm-Reichmann, Frieda 1948 Notes on the Development of Treatment of Schizophrenics by Psychoanalytic Therapy. Psychiatry: Journal for the Study of Interpersonal Processes 11:263–273.Google Scholar
- Hashimoto, Akiko 2007 Chiryô no ba o meguru seishin iryôshi: ‘iyashi no ba’ kara ‘futsûka sareta ba’ e. (The history of psychiatric treatment surrounding curative places: from ‘healing places’ to ‘universalized places.’). In Jidai ga tsukuru “kyôki.” Seishiniryô to shakai. (Madness created by the ages: psychiatric treatment and society.). K. Serizawa, ed., pp. 50–84. Tokyo: Asahi Shimbun.Google Scholar
- Ishihara, Kohji 2015 Learning from Tôjisha Kenkyu: Mental Health “Patients” Studying their Difficulties with their Peers. In Disability Research Today: International Perspectives. T. Shakespeare, ed. Pp. 27-42. New York: Routledge.Google Scholar
- Ishihara, Kohji, Tetsuya Kono, and Ikuyoshi Mukaiyachi, eds. 2016 Seishin igaku to tôjisha (Psychiatry and affected individuals). Tokyo: Tokyo University Press.Google Scholar
- Jenkins, Janis H. 2015 Extraordinary Conditions: Culture and Experience in Mental Illness. Oakland: University of California Press.Google Scholar
- Jenkins, Janis H., and Robert J. Barrett 2004 Schizophrenia, Culture, and Subjectivity: The Edge of Experience. West Nyack, N.Y.: Cambridge University Press.Google Scholar
- Kelly, William W., and Merry I. White 2006 Students, Slackers, Singles, Seniors, and Strangers: Transforming a Family-Nation. In Beyond Japan: The dynamics of East Asian regionalism. P.J. Katzenstein and T. Shiraishi, eds. Pp. 63-82. Ithaca: Cornell University Press.Google Scholar
- Kitanaka, Junko 2012 Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton, NJ: Princeton University Press.Google Scholar
- Kleinman, Arthur 2006 What Really Matters: Living a Moral Life amidst Uncertainty and Danger. Oxford: Oxford University Press.Google Scholar
- Kôseirôdôshô (Ministry of Health, Labour and Welfare) 2004 Seishin hoken iryô fukushi no kaikaku bijon (Visions in the reform of mental health and medical welfare). www.mhlw.go.jp/topics/2004/09/dl/tp0902-1a.pdf, published September 2004; accessed December 7, 2008.
- Kôseirôdôshô (Ministry of Health, Labour and Welfare) 2011 Iryô hôgô nyûin seido ni tsuite (Regarding the medical protection hospitalization system). http://www.mhlw.go.jp/stf/shingi/2r9852000001veej-att/2r9852000001vemy.pdf, published November 15, 2011; accessed February 26, 2018.
- Lock, Margaret M. 1980 East Asian Medicine in Urban Japan: Varieties of Medical Experience. Berkeley: University of California Press.Google Scholar
- Ma, Zhiying 2012 Psychiatric Subjectivity and Cultural Resistance: Experience and Explanations of Schizophrenia in Contemporary China. In Chinese Modernity and the Individual Psyche. A.B. Kipnis, ed. New York: Palgrave Macmillan.Google Scholar
- Maeda, Kei 2005 Sôsharu sukiruzu torêningu (SST) no riron to jisai. (Theory and practice in Social skills training [SST].). Sôgô rihabiritêshon (Comprehensive rehabilitation) 33(6):519–523.Google Scholar
- Mattingly, Cheryl 2010 The Paradox of Hope: Journeys through a Clinical Borderland. Berkeley: University of California Press.Google Scholar
- Mol, Annemarie, Ingunn Moser, and Jeannette Pols 2010 Care: Putting Practice into Theory. In Care in Practice: On Tinkering in Clinics, Homes and Farms. A. Mol, I. Moser, and J. Pols, eds., pp. 7–25. New Brunswick, NJ: Transaction Publishers (transcript Verlag, Bielefeld).Google Scholar
- Myers, Neely Laurenzo 2015 Recovery’s Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville, Tennessee: Vanderbilt University Press.Google Scholar
- Nakamura, Karen 2013 A Disability of the Soul: An Ethnography of Schizophrenia and Mental Illness in Contemporary Japan. Ithaca: Cornell University Press.Google Scholar
- Noguchi, Masayuki, Hisateru Tachimori, Yoichi Naganuma, Xianghua Zhao, Toshiaki Kono, Shigeo Horii, and Tadashi Takeshima 2016 Families’ Opinions about Caring for Patients with Psychiatric Disorders after Involuntary Hospitalization in Japan. International Journal of Social Psychiatry 62(2):167–175.CrossRefGoogle Scholar
- Oketani, Hajime, and Hiromi Akiyama 2012 National Federation of Families for the Mentally Ill in Japan. In Mental Health Care in Japan. R. Taplin and S. Lawman, eds. Pp. 83-97. London: Routledge.Google Scholar
- Rohlen, Thomas P. 1974 For Harmony and Strength: Japanese White-Collar Organization in Anthropological Perspective. Berkeley: University of California Press.Google Scholar
- Rubinstein, Ellen Beth 2012 Diagnosing Deviance: Schizophrenia and Social Withdrawal in Contemporary Japan. Ph.D. dissertation, Department of Anthropology, Yale University.Google Scholar
- Sato, Masahiro 2007 “Kokoro no yamai” no sengoshi. (The history of [the term] “kokoro no yamai” after the war.). In Jidai ga tsukuru “kyôki.” Seishiniryô to shakai. (Madness created by the ages: psychiatric treatment and society.). K. Serizawa, ed., pp. 173–211. Tokyo: Asahi Shimbun.Google Scholar
- Silverman, Chloe 2013 Understanding Autism: Parents, Doctors, and the History of a Disorder. Princeton: Princeton University Press.Google Scholar
- Sismondo, Sergio, and Jeremy A. Greene, eds. 2015 The Pharmaceutical Studies Reader. New York: Wiley-Blackwell.Google Scholar
- Stevenson, Lisa 2014 Life Beside Itself: Imagining Care in the Canadian Arctic. Berkeley: University of California Press.Google Scholar
- Takizawa, Takehisa 1989 Seishin shôgaisha kazokukai no soshiki to katsudô (Activities and organizations of families of the mentally disabled in Japan). Rihabiritêshon kenkyû (Rehabilitation studies) 58(59):79-82.Google Scholar
- Whyte, Susan Reynolds, Sjaak Van der Geest, and Anita Hardon 2002 The Social Lives of Medicines. Cambridge: Cambridge University Press.Google Scholar
- Yamada, Rie 2016 Seishin iryô shisutemu to kazoku (The psychiatric treatment system and the family). In Seishin igaku to tôjisha (Psychiatry and affected parties). K. Ishihara, T. Kono, and I. Mukaiyachi, eds. Pp. 154-176. Tokyo: Tokyo University Press.Google Scholar
- Yoshimura, Yuri 2008 Seishin shôgaisha o meguru soshiki ryoku — Zenkoku seishinshôgaisha kazokukai rengôkai o jirei to shite (Organizational capability surrounding individuals with psychiatric disabilities — the National Federation of Families for the Mentally Ill as an example). Gendai shisō (Contemporary thought) 36(3):138-155.Google Scholar