(4 of 4)
The placid postwar history of japan has little in common with the devastation Cambodia has endured. In Japan the streets are neat, and the government coffers are full despite more than a decade of economic stagnation. And yet there is a melancholy in the country that has caused more than 30,000 Japanese to commit suicide every year since 1998, compared with fewer than 15,000 a year in the 1970s. That's the highest suicide rate in East Asia, and one of the highest in the world. In part, the malaise that is gripping Japan seems to be a product of a hyper-commercial society where so many feel the need to competeand so many fall apart when they slip behind. "We are very developed economically, but Japanese are still intent on getting ahead," says Yukio Saito, who runs a suicide-prevention hot line headquartered in Tokyo. "That pressure makes it very hard to sustain a healthy life."
To its credit, Japan has tried to heal its perennially depressed populace. Already, the nation has the most inpatient psychiatric beds in the world, and recent regulations have raised standards at private hospitals where care was often substandard. Government bureaucrats have also loosened stringent regulations on imports of Prozac and other badly needed medication. There has been a push to allocate more money for outpatient care and community-based education through posters. And on the Chuo train line, a well-known final destination for the terminally depressed, local authorities have installed mirrors in the train tunnel because studies show that looking at one's own reflection helps check suicidal impulses.
Yet, for all its efforts, Japan's suicide statistics remain desperately high. The phenomenon strikes most frequently among middle-aged men, precisely the same group most affected by Japan's long economic downturn and ensuing corporate restructuring. Among government bureaucrats, for instance, suicide is the second leading cause of death. "These people, who were used to lifetime employment, have seen a huge shift in the social system," says Saito. "But they can't admit to themselves that they're depressed, and they don't see any other noble way out." Even suicide itself is a shameful topicironic for a nation weaned on tales of kamikaze pilots and hara-kiri samurai. Saito remembers talking to a widow who couldn't admit to her family and friends that her husband had committed suicide. "She told everyone he died of a heart attack," he recalls. "That was the best way not to embarrass the family and his company."
In Japan, as in many other East Asian nations, such avoidance of social humiliation guides people's lives. "In America, people talk about going to the psychiatrist like going to the grocery store," says Tokyo-based psychiatrist Osamu Tajima. "But here, it's still quite taboo." Even after several nationwide education campaigns, mental illness is still widely seen in Japan as largely incurable. And though mental-health spending is higher in Japan than in other Asian nations, the country's legislation allows mental hospitals to have up to 48 patients per doctor, while regular hospitals are limited to just 16 patients per physician.
In tackling Asia's mental-health crisis, perhaps the most important task is to make smart spending a priority. Eight years ago, South Korean government officials tried just that, shifting resources from full-fledged mental institutions to community mental-health centers. The majority of patients who visit the 40 nationwide centers suffer from severe mental illnesses such as schizophrenia and bipolar disorder. But with rehabilitation courses and occupational training, many can reintegrate into a society that once shunned them. "Helping patients realize that they can manage their illness without being institutionalized is my duty," says Hong Joo Eun, who heads the Sungdong district community mental-health center in Seoul. Still, Hong notes that staff at such centers are paid half of what those in general hospitals earn, and the turnover rate among center workers is high.
The weight of battling on the front line of Asia's mental-health epidemic seems to hang heavy on psychiatrist Tajima. Sitting in his claustrophobic, fluorescent-lit consulting room in Tokyo, he rubs his eyes and cups his head in his hands. He has a bad headache that simply will not go away. Then, Tajima looks up and smiles a peculiarly Japanese smilehalf apology, half wistfulness, without a hint of humor in it. "You know, I fit the profile of a high-risk suicide candidate in Japan," he says, massaging his temples. "I am a middle-aged man who is overworked and can't see that situation changing anytime soon." And with that thought, Tajima bows his head ever so politely and walks slowly out of the room.