Abstract
This chapter lays the book’s foundation by first examining the primary concept of tōjisha against the sociohistorical background of Japan’s tōjisha undō (movements by and for the tōjisha), which is compared with the madness movement in the West. The chapter then introduces related concepts, such as tōjisha shuken (tōjisha sovereignty), tōjisha-ness, and tōjisha mesen (tōjisha perspectives), from the perspective of disability studies. The chapter also provides theoretical arguments for the importance of tōjisha voices and describes Japan’s popular approach to mental health care, tōjisha kenkyū, initiated by the residents of a group home, Bethel House. The chapter advocates the importance of tōjisha mesen in understanding mental health challenges.
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Notes
- 1.
As exemplified by one of the case studies in this book, living closely with tōjisha can also lead to a serious health issue in the caregiver. Similar to other developed countries, the burden of caregiving is imposed on female family members—wives, mothers, and daughters—in Japan. Even if the caregiver is spared a serious health consequence, it can be a lonely, tough battle for wives to meet the constant demands of managing a mental health crisis as shown in two case studies in this book. A disability studies scholar, Michael Rembis, pointed out that such “relentless challenges that female caregivers face are brought on not only by the tōjisha but also by society’s expectations and how that society is structured both physically and culturally” (personal communication).
- 2.
The movement was brought up by disability rights activists after two key incidents occurred in the 1970s (Nakanishi & Ueno Nakanishi and Ueno 2003/2015: 25–7). The first incident involved a mother who killed her two-year-old daughter who had cerebral palsy, and the Blue Lawn Grass Club protested the public petition for reduced punishment. The second one was a conflict that took place in the Fuchu Care and Education Center where the residents protested against maltreatment and oppressive administration. Those who spearheaded the disability movement throughout the 1970s and 1980s were people with cerebral palsy in Japan who were against the government’s plan to allow the intentional abortion of disabled fetuses by amending the Eugenic Protection Act (see more about this history in Tateiwa and Sugita 2016). They also helped establish the first Center for Independent Living (CIL) in Tokyo in 1986, which spread throughout Japan in the 1980s and 1900s (Ishihara 2015: 27–28).
- 3.
In the history of tōjisha undō, 2006 is a year that marks significant developments. In the same year, Beteru-no-ie wa itsumo papipupepo, an illustrated essay about Bethel House, was published, and Ueno Chizuko’s writings about tōjisha were also in print.
- 4.
Mad Matters (Menzies et al. 2013) is a book published in Canada to assemble scholarly writings of the mad movement. Also recommended as further reading is Disability Incarcerated: Imprisonment and Disability in the United States and Canada (Ben-Moshe et al. 2014), a collection of papers written by Canadian and US scholars of mad studies. The essays in Disability Incarcerated will help the reader understand that people with disabilities have been “policed” in complex ways and that a disproportionate percentage of the disabled population has been institutionalized or incarcerated in North America.
- 5.
Put in a sociohistorical context, the term madness is evocative of Michel Foucault’s Madness and Civilization: History of Insanity in the Age of Reason (1961), and those involved in the Mad Pride movement followed in the footsteps of Black Pride and Gay Pride (Lewis 2009). The antipsychiatry movement is a movement of the 1960s, originally led by psychiatrists and intellectual scholars as a reform movement that challenged the legitimacy of standard psychiatric practice, asserting that psychiatric treatment is not helping but rather damaging patients (Gorman and LeFrançois 2019). In this view, psychiatry is an instrument of patient coercion and oppression via harmful treatments such as lobotomy and is demonstrative of an unequal power relationship between the doctor and patient. By contrast, the current mad movement, which is central to mad studies, is for and by psychiatric survivors; it is a patient-based consumer movement of mental health services that sprung out of the civil rights movements in the 1960s and 1970s. This movement advocates interventions by psychiatric survivors themselves, and its discourse centers around ex-patients’ personal histories of psychiatric abuse.
- 6.
Mad Pride events take place in North America as well as in Australia and England (Price 2011).
- 7.
In Ingram’s conceptualization, mad studies is “a space of social action and theorizing about oppression and psy-violence that centres the histories of psychiatrised bodies,” and its focus is on the “retrieving, documenting, understanding, revisiting and teaching of mad people’s history” (Gorman & LeFrançois Gorman and LeFrançois 2019: 107). Although Ingram admits having coined the term, he adds that it was already emerging as a discipline at the time of the 2008 conference at Syracuse University in which he gave that memorable talk.
- 8.
In this discipline’s framework, which is based on critical race and feminist theories as well as the histories of colonization, racism, and exploitation of human rights, being psychiatrized is seen as akin to being colonized because patients are seen to be helpless “others” who need to be helped by “superior” medical professionals. By connecting to colonialization, mad studies scholars allude to drapetomania, a discredited category of mental illness hypothesized to cause enslaved Africans to flee captivity, as an example of psychiatrization.
- 9.
The term Big Pharma that appeared in Ingram’s (2016) writing is a reference to the pharmaceutical industry on a global scale and implies a disparaging view of the industry.
- 10.
The group home was founded by a Japanese Christian group in 1984 (Nakamura 2013; Mukaiyachi 2013). The name Bethel derives from Beth El (“house of God”) in the Old Testament and is also a reference to the Bethel Foundation, a psychiatric hospital in Germany (Nakamura 2013; Ishihara 2015). The Bethel Foundation is known to have courageously resisted Hitler’s orders to euthanize its mentally ill patients in 1940 (Nakamura 2013: 105). Sasaki Minoru, who was discharged from the hospital after having his schizophrenia symptoms treated, moved into one of the rooms at an old church and became the head of the Acorn Society. Then, Hayasaka Kiyoshi moved in, and they renovated the church to make it more habitable in 1984. Reverend Miyajima christened an old church building as “Bethel House.” The residents of Bethel House began to package and sell Hidaka kombu (Hidaka Seaweed) in 1988 and then established the Welfare Shop Bethel in 1989, which began to sell paper diapers and other medical products for the elderly in the community and the patients at the hospital. They also formed a support group, nicknamed “the Acorn Society” (Donguri no Kai), for both psychiatric patients and alcoholics and offered meetings in the church once a month. In 1990, Bethel House was renovated yet again for the occupancy of six residents, and the church began to operate three activities: caring for residents at the Group Home Bethel House, packaging kombu, and running a diaper delivery service at the Welfare Shop Bethel.
- 11.
A devout Christian from northern Honshu, Mukaiyachi established a support group for those discharged from the psychiatric ward of the Red Cross Hospital, the region’s only general hospital in Urakawa, in the 1980s. He had majored in social work at Hokusei Gakuen University in Hokkaido and was hired as a social worker at the hospital. One of his mission assignments was to help improve the social conditions of Urakawa that had “severe problems with alcoholism and domestic violence” (Nakamura 2013: 102). Mukaiyachi worked hard to help address the problems of alcoholism and domestic violence that existed in the community and brought neighborhood children to the church for Sunday school. Many of these kids were from Ainu families “with histories of mental illness or alcoholism” (104). Mukaiyachi has “a unique charisma, especially within the Bethel community” (Nakamura 2013: 112) and writes books and papers on psychiatric treatment and social work as well as on Christian philosophy.
- 12.
Why seaweed? In the region of Hidaka where Urakawa is located, packaging seaweed was a side job taken by many housewives. The region provided 90% of the kombu in Japan at that time. Thus, it was a reliable business idea.
- 13.
It is important to point out here that because of the influential philosophy of tōjisha-gaku, scholars of disability studies in Japan do advocate the significance of tōjisha voices, similar to their Western counterpart of mad studies. However, the anti-psychiatry movement by mental service users/survivors developed in the 1970s in the West did not garner much enthusiasm among them in Japan (Ishihara 2015: 33).
- 14.
Toyota (1998) states that even the tōjisha themselves find it challenging to understand their circumstances completely. Similarly, Kumagaya (Kumagaya 2013) illustrates how unreliable so-called needs are. He quotes the original motto of the tōjisha movement led by people with cerebral palsy: “It is we who know about ourselves best. We decide who we are, what we will do” (218). However, he now questions it and wonders if we always know what we need and who we are. He then proposes to amend the original strong view to a new perspective: “We don’t know ourselves well. We ask ourselves who we are, what we will do together with peers” (219). Unless one has a clear, predictable condition, the tōjisha’s well-being can change abruptly as their condition may deteriorate due to some factors such as aging. Having experienced the sudden presence of painful symptoms that turned into his niji-shōgai (secondary disability), he now knows that physically disabled people, particularly those with cerebral palsy, may sustain a secondary disability as they age. Through this experience, Kumagaya argues that the so-called needs are not stable, nor are they always clear to tōjisha themselves, as he was forced to figure out what his new needs were when his condition suddenly changed.
- 15.
Nakanishi and Ueno (2003/2015) define “tōjisha” as the persons who know themselves well and aim the purpose of their tōjisha-gaku at enabling them to reclaim their agency. By contrast, Mukaiyachi (cited in Ogura’s paper in Ogura 2014) defines the tōjisha as “persons who least understand themselves,” as explained earlier.
- 16.
The growing popularity of tōjisha kenkyū does not mean there are no critics. In fact, Yoshii (2014) sorts out a few shortfalls of this approach. First, the goals of tōjisha kenkyū are somewhat unclear. Second, unlike the disability rights movement spearheaded by the Association of Green Grass, tōjisha kenkyū has no definitive “enemy” to fight against; thus, the tōjisha are not deemed powerful enough to carry the torch for the next generation of the tōjisha movement. Tōjisha share their similar experiences of ikizurasa (difficulty of living) through storytelling, but time will test how well such “sharedness” will unite people together. Third, even if their narrative takes the most polished form of storytelling, recipients may only be moved. Its influence falls short of overturning the system of discrimination. Thus, Yoshii criticizes that performers of tōjisha kenkyū are hardly aware that they need “weapons” to revolutionalize the status quo. In Yoshii’s opinion, unless tōjisha cultivate themselves as the resilient agent of the movement, they will not be able to measure up to the circumstances that discriminate against them.
- 17.
The methods of psychotherapy similar to the philosophy of tōjisha kenkyū exist in Japan and beyond. For instance, the method of participant-centric initiatives (PCI) emphasizes the importance of integrating patients’ presence, requiring both patients’ and their family members’ participation in the treatment (Kaneko 2019). Also, the Open Dialogue method in Finland is a method of intervention, an alternative approach to the treatment of psychosis that started in the 1980s at Keropudas Hospital in Finland (Sato et al. 2017). In this approach, patients have a say about their own treatment in therapeutic “family therapy” meetings and are placed equally to their healthcare providers. Similar to tōjisha kenkyū, Open Dialogue utilizes meetings among the patients and peer staff members who assist them. Both Keropudas Hospital and Bethel House are located in a remote area, away from the central cities of each country. In both approaches, the dialogue is structured so naturally that participants are not actually aware that it is a therapy; in fact, in both situations, the approach is considered a “nutrition” rather than a (medical) method. However, they differ in that the former emphasizes equality (equal distribution of decision-making power) and allow a strong teamwork relationship between participants and medical professionals including peer support members, while the latter emphasizes the sharing of participants’ self-study themes as well as their pains and suffering with those who are struggling with their own cases of mental illness.
- 18.
Similar to the term ableism used in disability studies, sanism is a term that refers to an attitude of shaming those deemed “insane,” attaching stigma to them, and discriminating and oppressing them just because they have a certain mental trait or condition. However, some may feel ableism is sufficient to critique prejudice against mental disability if we incorporate the view of “bodymind” as discussed in Price’s (2011) Mad at School. It is beyond this book’s capacity to debate whether we need a separate word in discussing stigma and mental disability.
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Okuyama, Y. (2022). Tōjisha. In: Tōjisha Manga. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-00840-5_2
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