Kokoro no kaze: A cold in the soul

Heart flu. A cold in the soul. ‘Adjustment disorder’… all terms used in Japan as ‘labels’ for depression—but the fact they’re used at all symbolises a revolution in Japanese culture. As recently as 10 years ago, the whole concept of depression carried a great stigma in Japan.

The ‘shame’ of depression

The usual reaction to the idea of consulting 
doctors and other healthcare professionals 
was one of great shame. There was very little 
understanding of what depression might be, 
and the Japanese cultural pressure to remain 
stoical and accepting, even in the face of 
great emotional suffering, meant many people 
with depression struggled on alone. 

A suicide rate of twice that in the USA 
appeared to be testimony to poor mental 
health services and little recognition of the 
need for greater openness.

Now, things are different – not everywhere, 
and not completely. Rural areas, such as the 
north east where the tsunami struck, have yet to catch up with more metropolitan areas, where a huge increase in people seeking the help of doctors and therapists has shown that attitudes have undergone a genuine shift. But concerns have been expressed that the psychological fall out from the tsunami will be hard to address, if the pressure remains to suffer in silence.

Big drug companies bring the change

What made the difference in urban Japan? Why do therapists and doctors report a greater willingness to recognise and treat depression? And is this change wholly without a downside?

In Crazy Like Us, researcher Ethan Watters describes how major pharmaceutical company GlaxoSmithKline became the leader in events that can only be called the ‘marketing’ of depression at the turn of the millennium. 

Drug companies – like Eli Lilly, makers of Prozac – had previously by-passed Japan, on the grounds that culturally, the Japanese people and their doctors would not be interested in pills for a disorder they either ignored or denied.

Glaxo thought differently—they believed with the right approach, they could ‘sell’ depression, along with treatment for it. It became the first western drug company to target doctors and the media with an extensive, and naturally enough, expensive, campaign of public relations and education, and giving financial and academic support to the Japanese medics whose views they favoured. 

The ‘buzzword’

According to the New York Times, depression—or rather ‘kokoro no kaze’, the soul catching a cold, as the new term had it—became a ‘buzzword’ in just a couple of years. Celebrities went on TV to talk openly about their experiences and how the medication had cured them. Magazines and newspapers carried articles about the phenomenon. Dozens of books were published, and doctors welcomed literally thousands of new patients.

Watters details the way in which Glaxo made the most of existing academic and political concerns, rumbling away for decades, that Japan was light years behind the USA in its grasp of mental health issues and needed to drag itself into the 21st century with new ideas.

Medicalised sadness

The downside of this, suggest critics, is that ‘ordinary’ sadness—grief and normal low mood in the face of life’s ups and downs—has become medicalised, and treated with drugs which we now know have unwelcome side effects in many, and which may only have a small chance of a cure.

Traditional community, family, and spiritual supports for emotional stress and depression have been undermined and marginalised, and opportunities for Japanese researchers to explore other means of treating depression, in a culturally sensitive way, are reduced.

As the New York Times reported, “rather than expanding options for care for those who suffer, the globalization of psychopharmacology may ultimately sow a monocrop of ideas about health and sickness.”

Image credit: Andy Gray