Overview
1. Mental illness
2. Deaf people
3. Blind people
4. Wheelchair users
5. Leprosy
6. HIV/AIDS
7. Minamata
1. Mental Illness
Changing attitudes
Traditional view: Crazy behavior caused by possession (toritsuke とりつけ)
Late 19th century: Introduction of Western (mainly German/Austrian) psychiatry.
Lacking funds, government encouraged private enterprise to open psychiatric hospitals, esp after WW2. Average size is c. 200 beds.
Hospitalization is common
Year Mental hospital population
1960 c. 85,000
1970 c. 250,000
1980 c. 360,000
2000 c. 340,000
… and 89% of psychiatric hospitals are privately run. (Lecount Report http://www.dinf.ne.jp/doc/english/resource/lecount/)
Japan is No. 1
With 2.9 psychiatric beds per 1000 head of population, Japan has the highest mental hospitalization rate in the world. (Cf. Germany 1.8, USA 0.6).
About 18% of all psychiatric beds in the World are in Japan (WHO stats).
About half of all in-patients (170,000 of 340,000) are in closed wards with 24-hour confinement.
Source: Mental Health Atlas 2005. World Health Organization,
Dept. of Mental Health and Substance Abuse.
Country Psychiatric
beds /
10,000 pop.
Of which,
in mental
hospitals
Psychiatrists
/ 100,000
pop.
Psychiatric
nurses /
100,000 pop.
Japan 28.4 20.6 9.4 59
Korea (ROK) 13.8 6.3 3.5 10.1
USA 7.7 3.1 13.7 6.5
Austria 6.5 4.5 11.8 37.8
UK 5.8 - 11 104
China (PRC) 1.06 0.87 1.29 1.99
What are the key characteristics of the
Japanese data compared internationally?
Some answers
1. A high number of psychiatric beds
2. A heavy concentration in specialized
institutions
3. Relatively low number of mental health
professionals to look after people in
those beds.
…so the image of people abandoned in
mental hospitals has some foundation.
Very easy to get put away…
2 kinds of admission to mental hospital:
1.Compulsory (sochi nyû’in 措置入院) [c. 10% State covers costs]
2. With consent (dôi nyû’in 同意入院) [c. 90% Family covers costs]
… but that doesn’t mean ‘consent of the patient’ – it means ‘consent of the person responsible for his/her care’ (hogo gimusha) 保護義務者
What is a ‘hogo gimusha’?
NOT a legally appointed guardian,
but “usually only a near relative”.
“For example, if a husband
considers his wife mentally
disturbed… and if the head of the
mental health facility shares this
opinion, the said wife may be
committed to the hospital.”
“It is not necessary to go through
any formal procedures.”
Exceptions: If nearest relative
refuses to sign papers, or 2 or more
relatives are eligible, the family
court will appoint a guardian.
(Ingrid Kargl, ‘Hospitalization of the
Mentally Ill in Japan’, 1988, p.127)
Poor conditions inside… Government rules allow mental hospitals
to employ about 1/3 the number of doctors and 2/3 the number of nurses per patient as other hospitals.
⇒Heavy use of tranquillizers and other medication rather than therapy.
Source: Japan National Group of Mentally
Disabled People, at www.geocities.jp/jngmdp And
Throwing Away the Key on the Mentally Ill
By Jens Wilkinson From The Japan Observer Vol.
7 No. 4 (Winter 2002)
Not so easy to get out
Average stay: 330 days.
US average stay: 8 days.
150,000 inmates of mental hospitals have
been there for 5 years of more.
(Cf About 1,500 people in prison for 5
years or more.)
Bad Publicity “Japan cures its mentally ill by putting
them under lock and key in hospital-prisons in isolated mountainsides… The wards are often locked 24 hours a day, and access to telephones and other forms of communication with the outside world are denied... the more agitated patients are put into isolation… crumbling buildings [ボロボロの設備]… exploitation of the patients by making them work, with the excuse of occupational therapy.”
Source: The Economist,
24 November 2001
“As almost all of these hospitals are run privately, the Ministry of Health has to negotiate any kind of intervention with their powerful sector Associations, whose policy is not to lose even a single bed. The rights of the patients should be guaranteed by a committee, which, as many say, is just a puppet in the hands of the owners.”
Zenkaren 全家連
National movement of families of mentally ill people. Note stress on family.
全国精神障害者家族会連合会 Zenkoku Seishin Shogaisha Kazoku-
kai Rengokai
National Federation of Families with the Mentally Ill
Zenkaren was founded in
1965. It has more than
1,600 affiliated local
groups with 120,000
members from all parts of
Japan.
The birth of Zenkaren
Zenkaren was established in 1965 in response
to a proposed amendment to Japan's Mental
Health Act. A young man with schizophrenia
had stabbed the U.S. ambassador, and the
national government wanted to subject
people with mental illness to police
supervision. Some 500 participants from
across the country called for the mentally ill
to be handled by local government and not
the police. The campaign succeeded.
Zenkaren activities
• Advocacy: Zenkaren lobbies for better social
welfare policies and rehabilitation programs
by national and local governments.
• Self-help: Zenkaren provides counseling and
information services for people suffering
from mental illness and their families.
• Rehabilitation: Zenkaren supports sheltered
workshops that serve as job-training and
social centers for the mentally ill.
Renaming schizophrenia
Schizophrenia is the most common
diagnosis of mental patients in Japan.
Zenkaren recently succeeded in having
the official Japanese term changed:
• WAS:精神分裂病 (seishin bunretsu-
byo): ‘split personality disorder.’
• IS NOW統合失調症 (togo-sochitcho-
sho): ‘disorder of the function of the
mind.’
精神分裂病
Seishin is translated in different ways, as mind, spirit, soul, heart, intention, motive – there are many connotations. Bunretsu is often translated as a “division”, a splitting, a break up・or a “fragmentation” – and the final kanji is Byo which is usually translated as disease. So Seishin Bunretsu Byo means a disease which is a fragmentation of the soul – which sounds pretty horrible really. (Jerome Young, schizophrenia researcher in Japan).
Zenkaren
celebrates 30th
anniversary
with a book
entitled “If we
all walk
together a
road will
result.”
2.Blind People: c. 250,000 in Japan
盲人 Môjin (Traditional term)
視覚障害者 Shikaku shôgaisha (Visually handicapped – more politically correct… includes blind and partially-sighted people.)
目が不自由 Me ga fujiyû (Eyes are not free – polite and vague)
Japan has
8 centers
breeding
guide dogs
(môdôken)
盲導犬
(Note also the braille tiles leading to
the entrance of this school for blind
people…)
… but there is still a severe
shortage of guide dogs. Only
948 blind people had guide
dogs (as of 31/3/04), and there
is a waiting list estimated at
4,000 to 7,000. Training centers
are underfunded, and depend
mainly on charitable donations.
A strictly fictional character…
A roaming blind masseur and gambler, who reveals incredible skills of swordsmanship when danger threatens. Also has a brilliant sense of humor and fantastically sensitive hearing to compensate for his blindness. The stories are set in the turbulent times of the late Tokugawa Era (early to mid-19th century).
25 movies
(1962-74) and
one more in
1989… played
by Shintaro
Katsu. Beat
Takeshi made
an inferior
copy a few
years ago.
The mystique of blindness
Cannot see – so hearing becomes very acute. Hence musicians, piano tuners etc.
Likewise sense of touch becomes acute. Hence massage is another traditional form of employment.
Cannot see physically – so develop psychic “vision”. Fortune-tellers, prophets, seers.
Shoko Asahara, guru of Aum
Shinrikyo
Partially-
sighted, he
exaggerated
his blindness
for image
purposes
3. Deaf People
See Deafness in Japan: A Preliminary Field Report, by Steve Fedorowicz (unpublished paper, 2000)
Resistance and Co-optation: the Japanese Federation of the Deaf and its Relations with State Power, by Karen Nakamura (Social Science Japan Journal #5.1, April 2002, pp. 17-35)
Deaf terminology
つんぼ(聾) Tsunbo Deaf (Traditional
term; kanji shows dragon over ear)
聴覚が不自由 Chôkaku ga fujiyû
(Hearing impaired)
耳が聞こえない Mimi ga kikoenai (Ears
can’t hear)
耳が遠い Mimi ga tôi (Ears are distant)
聾唖 Roa (Deaf and dumb)
Deaf Population
About 300,000 – more if you count partially deaf people too. As with blind people, there is a national network of schools for deaf people and support centers in every prefecture to provide sign-language interpreters, sub-titled videos etc.
全日本聾唖連盟 The Japanese Federation of the Deaf is
the main organization campaigning to support deaf people in Japan.
The JFD has 27,000 members, all of them deaf.
It is an NGO: legal status is zaidan hojin or incorporated foundation.
Gets contracts from government to run deaf services (itaku jigyo 委託事業).
Karen Nakamura’s paper
Describes the subtle balance struck by
the JFD in its dealings with government.
It needs the cash from the “itaku jigyo”,
but it also wants to avoid government
interference in its activities through
admistrative guidance, or ex-ministry
officials “parachuting” (amakudari) into
posts at the JFD.
Sign Language (Shuwa) 手話
Japan Sign Language (JSL) has some elements in common with international sign language (deaf people are often very good at international communication), and some Japan-specific elements.
Fedorowicz mentions variation between regions of Japan – sign language dialects.
4. Wheelchair users
Used to get a really bad deal…
access to public buildings,
stations, transportation etc was
terrible.
Now, after lengthy campaigning,
things are slowly improving.
Hirotada Ototake was born in 1976 with
tetra-amelia, a congenital condition that
left him with almost no arms or legs. His
parents decided that, as much as possible,
he would live a "normal" life. This means
that he was given no special treatment
either at home or at school, and ended up
participating in schooling and sports. He
played basketball, pulled himself around
on his behind for the 50-meter dash, and
had his friends take him up Mount Kobo.
Extract from a review of No-one’s
Perfect
“No matter how brave a face we may put on it, the hard fact is that people with disabilities do have a handicap in love.”
I think the important thing is not to turn your disability into an excuse. True, when your heart's just been broken, it may be the first thing you think of... but was that the real reason it didn't work out?
I don't suppose a disability is actually an asset in too many people's eyes, but don't let that stop you. In the end, it all comes down to what you, as a person, have to offer.
Oto turns out to be just a bit
too loveable. He's the
disabled kid that the non-
disabled love: always
smiling, always looking on
the bright side.
…the lack of agony in this book leaves
me on edge.* When at one point he is
being wheeled down the street and he
passes some kids shouting “What's
that?” and “Gross!”** --- are we to
suppose that Oto has no reaction at
all? Is such possible? Are we to believe
in all his twenty-five years he has never
had even one dark night of the soul ---
wondering, "Why me?"
* 違和感あり ** 何それ?気持ち悪い!
By L. W. Milam (a person with a disability)
in RALPH (The Review of Arts, Literature,
Philosophy and the Humanities #51, 2000)
• The Japanese, as the rest of the world,
want to be convinced that one who has
to crawl up stairs and scramble up into
chairs is always merry, never blue.
Thus his popularity. But if Oto is
completely happy, then he is either one
in a million, or he is a saint.