JOHN STANMEYER/VII FOR TIME

Children at the Edhi Foundation mental hospital outside of Karachi, Pakistan, live in squalor behind bars

Hidden Away
	Stigmatized, abandoned, often locked up, Asia's mentally ill are left to inhabit a living hell. A TIME special report By Hannah Beech

Posted Monday, November 3, 2003; 21:00 HKT
If a boy disappears and nobody notices, is he really gone? Hisaki Fujishiro's withdrawal had been almost imperceptible, as hard to gauge as the ebb of a high tide. Even his mother failed to see the signposts, Fujishiro recalls: the elementary-school bullying that broke one of his fingers, the obsession with computer games, the increasing hours spent cloistered in his cluttered bedroom. These were, it seemed, the normal teethings of a preteen in postindustrial Tokyo, just another geeky kid wandering awkwardly through childhood. But gradually Fujishiro retreated completely.

The first tangible danger sign was an obsessive-compulsive disorder that manifested in Fujishiro when he entered junior high. He would write a character, erase it and rewrite it hundreds of times. Or he would frenetically wash his textbooks, as if the act of scrubbing them would somehow cleanse his troubled mind. Despite his eccentricities, Fujishiro managed to enter Tokyo's Chuo University in the mid-1990s. But soon he had withdrawn almost completely into the safety of his little room in student housing. Most days he would go to bed early and sleep through the morning, only venturing outside for exams or to buy a stash of junk food at the local 7-Eleven. He had no friends, preferring to spend his time with car magazines, which were stacked to the ceiling. "My curtains were always closed," recalls Fujishiro, now 29. "I didn't feel like I had a place where I belonged."

Fujishiro was hardly alone in his terrifying isolation. A generation of Japanese youngsters has dropped out of society entirely, unable to cope, it seems, with the rapid syncopation of life in Asia's most developed nation. The phenomenon has been dubbed hikikomori, or social withdrawal, by psychiatrist Tamaki Saito, who estimates that one in every 40 Japanese households has such a loner. That's an astounding 1 million social dropouts, most of whom are male. For Fujishiro, a support group at his university coaxed him out of his room, and he has now started reintegrating into society after eight years of seclusion. Today, he runs an online outreach program for other hikikomori slowly emerging from their shells. So far the disease has been diagnosed only in Japan, except for a handful of cases in South Korea. But these alienated youngsters might be a harbinger of what's to come for the rest of Asia, emblems of a continent hurtling so quickly into the future that its citizens have few tools to cope with the dizzying speeds.

Asia's mental health is, more than ever, in a perilous state. The Global Burden of Disease study commissioned jointly by the World Bank, the World Health Organization (WHO) and Harvard University predicts that by 2020 depression will be the leading cause of disability in Asia, measured by the number of years a person lives with a debilitating health condition. Already, mental illnesses account for five of the 10 leading causes of disability in Asia, including disorders such as depression and schizophrenia. That's a bigger health burden to the continent than cancer. A WHO study found that as many as one-quarter of all Indians currently suffer from some sort of mental illness. The region also boasts some of the highest suicide rates in the world. In China, for instance, suicide is the No. 1 cause of death among those aged 18-34, according to the Beijing Suicide Research and Prevention Center. At least 250,000 Chinese have killed themselves each year since the mid-1990s.

Yet only a small percentage of these troubled individuals ever seek help—or even possess the opportunity to do so. In Asia's most developed countries, ordered, Confucian cultures are loath to confront mental illness. Its victims commonly endure workplace discrimination, receive scant family support and feel obliged to hide their symptoms for fear of unsettling the people around them. Du Yasong, a psychiatrist at the Huashan Hospital in Shanghai, estimates that as many as one-third of all people who go to general practitioners in China are actually suffering from mental-health problems expressed psychosomatically through symptoms such as headaches or insomnia. Yet 95% of those with depression in China are untreated, according to Ji Jianlin, a medical professor at Shanghai's Fudan University who advises the central government on mental-health policy. Japan has the highest number of hospitalized, mentally ill patients in the world, yet psychiatry is still considered a crackpot discipline by many doctors there. "There is so much stigma when it comes to mental health," says Osamu Tajima, a leading psychiatrist in Tokyo. "The perception that it's a personality weakness prevails not just among 'normal' people. I've heard many doctors tell patients to stop complaining and tough it out."

Even when the severity of the problem is acknowledged, treatment is hampered by a disastrous lack of resources. This is especially true in Asia's poorer countries, where conditions for the mentally ill are often horrific. Many patients are locked up in hospitals no better than prisons. At the Panti Bina Laras Cipayung mental-health center in east Jakarta, just 10 minutes off a modern expressway, the air is thick with flies and the stench of feces. Originally intended for 200 patients, the government-run facility is crammed with 305 inmates. Most are naked, some are shackled or chained to window bars. Others, emaciated or showing oozing lesions, curl up on the soiled floor of the latrines. A doctor stops by the center only once a week for two to three hours; he has numerous other similar institutions to attend to. Though the center's number of patients has nearly doubled since 1996, its funding has not increased because of the weak economy—less than $1 is spent on each patient per day.

Indeed, most Asian nations spend tragically small amounts on mental-health care. In Cambodia, for instance, the country's entire mental-health budget is far less than what it would take to fund one topflight mental hospital in the U.S. In Pakistan, the government has all but given up on caring for the mentally ill and private donors have had to pick up the slack. More than 1,000 mentally ill patients live jammed together in the privately funded Karachi commune called Edhi Village, run by the prominent social worker Abdus Sattar Edhi. Iron gates lock the inmates in, some of whom, stark naked, slam their heads against the walls of their dark cells. "Our center is becoming a dumping ground for people who consider mentally ill people as the dirt of society," says Ghazanfar Karim, the complex's overburdened supervisor.

The grim irony of Asia's mental-health crisis is that it seems to be escalating even while much of the region is getting richer. Some experts see the continent's transformation as a profoundly mixed blessing, carrying with it dreams of cell phones and cable for all but also exacting an immense psychological toll on those who are struggling to keep up with the manic pace of change. Tradition and a sense of security have given way to upheaval and uncertainty. A farmer born of farmers, the father of future farmers, would work from dawn to dusk like everyone else he knew. Because he entertained no hope of an alternative lifestyle, he didn't agonize over one. But today the characteristics of a modern existence—the potential to get ahead, the rat race, even the crushing traffic—mean that Asians feel more psychological pressure than ever before. Psychiatrists in China, for instance, estimate that the rate of anxiety disorders is higher now than it was during the chaotic years of the Cultural Revolution. This, then, is the dark side of Asia's economic miracle.

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