Tom Gill

Meiji Gakuin Course No. 3505

Minority and Marginal

Groups of

Contemporary Japan

People with

Disabilities

障害者

Lecture No. 13

Images

from

Challenged

A photo

collection by

Kiyoshi

Makita

牧田 清

Key term

五体満足

Gotai manzoku

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

A Zenkaren Demonstration

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)

Japanese Braille: Tenji 点字

Widely used in public places…

A traditional

braille

punchboard

… don’t

forget each

character is

back to

front!

The high-tech approach…

Bulk Braille printing… no problem.

Braille Money

1 embossed ring = ¥1,000

So is this also a ¥1,000 note?

No… a ¥5,000 with one worn ring.

．．．quite clearly.

¥10,000… 2 horizontal rings

Ll

The system is not perfect. Blind

people often complain that the

ridges soon get worn down.

The ¥2,000 note…

Spots instead of

rings… 3

vertical…

blacked in for

partially-sighted

people…

progressive!

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.

Blind glamour: Zatoichi

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.

The “Chairmate”

Wheelchair ramp

(Sapporo station)

Wheelchair-accessible bus (rare)

Post Office Access

Hirotada

Ototake 乙武

洋匡

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.

His book,

‘Gotai

Fumanzoku’

(1998), has sold

4.5 million

copies…

Japan’s No.2

best-seller

since WW2

The English-

language

version of

Ototake’s

book also

sold very well

Several editions and translations…

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.