CAUSES, CONSEQUENCES, AND POSSIBLE SOLUTIONS
BACKGROUND & WHY I CHOSE THIS TOPIC:
In Japan, the stigma on mental health is a large problem that obstructs access to and development of proper mental health care. When researching, I found that up to 50% of the individuals suffering from mental illness would rather stay silent about their sickness and more than 40% suffer from negative social impacts as a result of their illness. Almost two-thirds of those suffering refrain from seeking psychiatric help due to this stigmatization — a huge problem when considering how prevalent issues related to mental health are in Japan. Several other studies I found have confirmed that general stigmatization of mental illness is greater here than in other countries. I’d like to explore why widespread stigma still exists in such a highly developed and prosperous nation like that of Japan, the consequences that result from it, and possible solutions to the challenges my home country faces.
When given the option of what topic to choose for this catalyst conference, I knew I wanted to keep it close to home as my main purpose was to help those directly around me. Furthermore, one of the biggest motives for me joining “Abnormal Psychology” in the first place was my desire to learn more about the many unspoken issues (such as mental health) in Japan, so this conference was the perfect opportunity to explore that topic in depth. I recognized that mental illness was a big issue in my home country early on, long before taking this course, but didn’t know why so many were affected or why so few sought proper help. In the United States, for example, while stigma still exists surrounding mental health, there are so many different treatment options and places/people to go for help. In Japan, unfortunately, mental health care lags behind the US (and many other countries) and people have a more backward/negative view of the mentally ill. I wished to understand the underlying causes of stigma, the bleak consequences of it, and possible interventions to help reduce this mindset #ForAHealthierJapan.
In order to address stigma on mental illness in Japan, this paper will explore:
- The nature and characteristics of stigma (causes, consequences)
- Existing successful interventions aimed at reducing stigma
Firstly, both individual and community level causes of stigma will be assessed in more detail. Secondly, current successful interventions to reduce stigma will be explored and evaluated on their potential. Finally, based on the accumulated evidence, a conclusion will determine what needs to be done in order to change this stigmatization. This will then give insights in and provide suggestions for how stigmatization in Japan can best be addressed.
IDENTIFIED CAUSES OF MENTAL-HEALTH RELATED STIGMA:
In order to determine what causes mental health-related stigma in Japan, both individual and community level factors of stigma are explored in this section. I first researched the individual-level factors such as lack of education, negative attitudes, prejudice, and discrimination. Then, I addressed the community level factors of stigma in Japan and reviewed both separately.
Japanese society has various conceptions of mental illness that differ from other widely-held conceptions. For instance, common causes of mental illness are considered psychosocial factors including:
- Weakness of character
- Loss of willpower or being a generally nervous person
This also means Japanese society considers it shameful to have a mental illness since it is thought that the individual is responsible for developing it on their own. This shame is an important cause of stigma in Japan and leads to an increased social distance between the mentally ill and the general population.
Watch this video as a preview to better understand just how the Japanese deal with mental illness, specifically depression, which signals a cause of stigma and “backward” mindset regarding mental health.
1. Lack of Education Regarding Mental Illness
Particular conceptions of mental illness in Japan might be brought about by a lack of education on mental illness. Statistics show that:
- The Japanese consider recovery from mental illness unlikely (Only 5% believe that mentally ill people can recover from
- Japanese society doesn’t consider biomedical treatment as viable options helpful for the mentally ill (respectively only 30-41% and 54-67% regarded antipsychotics and psychotherapy as useful to patients)
There thus seems to be general mistrust in biomedical medicine, stemming from lack of knowledge and awareness.
In addition, Japanese society considers it the task of the family of the mentally ill to take care of these patients; studies show that the most commonly considered suitable help for mental illness are friends or family (70-72%). This contrasts with countries that have adopted a biomedical view on mental illness, where psychiatric treatment or other professional care is often considered the norm and best approach. In Japan, less than 50% of respondents regarded psychiatrists as suitable caretakers of the mentally ill, reducing the overall likelihood of them seeking professional help.
2. Prejudice and Negative Attitude towards Mental Illness
In addition to misconceptions being caused by lack of education, negative attitudes against mental illness are also often caused by ignorance among Japanese society. Negative attitudes can also emanate from misconceptions, and often lead to prejudice and increased social distance.
Consequences of negative attitudes and prejudice toward mentally ill:
- Loss of social opportunity
- Economic inequality
- Housing discrimination
- Low quality of life
One research article I read raised the statistic that 77% of mental health professionals believed that “it was dangerous for mentally ill people to live by themselves.” This clearly shows negative attitudes towards the mentally ill, even by professionals, who think of them as far less capable than a “normal” person.
3. Discrimination of the Mentally Ill
Discrimination occurs when stigma is acted upon in behavior, such as exclusion or rejection.
Statistics of discrimination:
- 62.6% of Japanese respondents indicated they agreed that an individual suffering from chronic schizophrenia would be discriminated against by their community
- 27.2% of Japanese said people who have depression would be discriminated against
- 72% indicated they felt the need to conceal their diagnosis (this can be seen as a consequence of anticipated discrimination)
- Only 20% of mental health professionals believed that people with mental illness should live in a community without being hospitalized
- 61% of people said they would never employ someone with a mental illness
Both anticipated and negative discrimination of individuals with a mental illness can additionally lead to low rates of help-seeking, diminished access to care, treatment gap, poverty and social marginalization.
Community Level Factors that Influence Stigma on Mental Health:
Along with individual factors, stigma is often influenced by community-level factors such as the norms of asocial unit or society. An example of stigmatization on a community level is the shared belief that an individual must act as is deemed socially appropriate by their social community. Japanese culture is generally known for its high value of conformity within society. Having a mental illness is considered deviation from the norm and is therefore not publicly accepted. Moreover, Japanese culture knows a distinction between “Honne,” which refers to someone’s real opinions or feelings, and “Tatemae,” which refers to feelings that are publicly expressed. The Japanese have always been known to keep these different types of feelings separate, which sometimes leads to portraying the opinions that are publically accepted as opposed to opinions of their own. This is the reason for Japan’s preference of conformity which leads to increased stigmatization of mental illness.
My topic is challenging because while Japan clearly is in dire need of a solution concerning reduced stigma on mental illness, the “culture of shame” is embedded within society and directly challenging historically built ideas and customs is hard. Furthermore, I found that mental illness stigma is stronger amongst older people rather than younger people, but since Japan is ruled by the old, their opinions count more and perception never changes. Additionally, since the Japanese value conformity and Japan itself is a collectivist country, each person is expected to be functional members of society and anybody who needs additional help or makes others uncomfortable is automatically stigmatized. The mentally ill in Japan, unlike other countries, are discriminated against to the highest degree as they aren’t seen as socially valuable. Opportunities for them to get help, get a job or do anything meaningful with their lives don’t arise easily and they are left feeling alone and isolated in a society that doesn’t accept them.
Listen to this Brian Lehrer talk about 30 Issues If You Needed Mental Healthcare in Japan to get a better sense of the challenges in addressing this problem.
Based on the evaluated causes and consequences of stigma on mental health in Japan, it seems that interventions targeting education, attitudes, prejudice, discrimination, and contact between the mentally ill and general population would be most fruitful. More specifically, awareness campaigns, specifically within schools, to improve knowledge about mental illness seems to be missing in Japanese society. The government should work to make mental health a mandatory class within Japanese public schools so kids can start learning about and build empathy from a young age. Public awareness programs and campaigns to promote knowledge of mental illness seem also successful in addressing the lack of education, removing misconceptions, and decreasing negative attitudes towards mental illness. TELL, with a mission statement of “dedicated to providing effective support and counseling services to Japan’s international community and its increasing mental health needs,” does a good job spreading awareness and acting as care providers. More organizations like this should go and visit schools to spread awareness and promote active participation in shattering the stigma surrounding mental health.
WHAT CAN YOU DO?
Here are 9 simple steps that you can take to reduce stigma around mental health:
- Talk openly about mental health
- Educate yourself and others
- Be conscious of language
- Encourage equality between physical and mental illness
- Show compassion for those with mental illness
- Choose empowerment over shame
- Be honest about treatment
- Let the media know when they’re being stigmatizing
- Don’t harbor self-stigma
On top of these actions, you can try to push for a club at your school dedicating to mental health. At my school, I am a part of mental health awareness club called Piece of Mind, dedicated “to spread awareness about different mental illnesses in order to build compassion for those who go through it.” Our efforts include trying to create a safe space for students who are going through mental health struggles and provide stress-relief activities for high schoolers. During our meetings, we talk about different mental illnesses and what we can do as a club to reduce the stigma around them. We also fundraise through bake sales and events to donate to mental health organizations like TELL mentioned above. Be the change you want to see and create a club for yourself and others! #EndTheStigma
In Japan, there is a great need to reduce stigma on mental illness and increase awareness among the population since individuals with mental illness greatly suffer from the consequences. Increasing education, reducing negative attitudes and discrimination, as well as better facilitating contact through the implementation of deinstitutionalization should be achieved in order to reduce stigmatization in Japanese society.
Bauer, Dennis. “New Documentary Explores Taboo Subject of Mental Illness in Japan.” Japan Today, © Japan Today, 22 Mar. 2009, japantoday.com/category/features/new-documentary-explores-taboo-subject-of-mental-illness-in-japan.
“Mental Health.” Japan Healthcare Info, japanhealthinfo.com/mental-health/.
Taplin, Ruth, and Sandra J Lawman. “Mental Health Care in Japan.” Japan Society of the UK, 26 Apr. 2013, www.japansociety.org.uk/29943/mental-health-care-in-japan/.