Society in distress : the psychiatric production of depression in contemporary Japan

This dissertation examines the rising medicalization of depression in Japan and asks how it has become possible that Japanese, who reportedly barely suffered from depression until recently, are now increasingly becoming "depressed." Drawing upon two years of fieldwork in psychiatric institutions in the Tokyo environs, I examine this change from three different angles---historical, clinical, and socio-legal. First, my historical analysis questions the assumption held by Japanese psychiatrists that depression did not exist in premodern Japan; I show that traditional Japanese medicine did indeed have a notion of depression (called utsusho), conceived as an illness of emotions in which psychological suffering was seen as intimately connected to both physiological and social distress. Though the premodern notion of depression was effectively obscured by the 19th-century adoption of German neuropsychiatry that located depression in individual brains, the current medicalization of depression is nevertheless deeply informed by an indigenous psychiatric theory emphasizing that depression is in part socially produced. Second, I examine how Japanese psychiatrists use this local language of depression in clinical practice in attempting to persuade patients that they are victims of both biological and social forces lying beyond their control. The lack of any psychiatric model of agency concerning depression, however, leads some patients---especially suicidal patients---to question psychiatry's jurisdiction over the meaning of their distress. Third, I analyze how the psychiatric language of depression has been adopted in legal discourse surrounding "overwork suicide," where corporations and the government have been found liable for workers' deaths on the grounds that excessive work stress can drive workers to depression and suicide. Furthermore, the psychiatric language is curiously limited in the sense that, in contrast to the West, in Japan it is men rather than women who have been represented as typical victims of depression. By examining patients' narratives, I demonstrate how psychiatry constructs a gendered discourse of depression, closely tied to local politics about whose distress is recognized as legitimate social suffering. The medicalization of depression in Japan thus suggests not a hegemonic, global standardization, but the emergence of psychiatry as a politically potent---though limited---force for social transformation