New documentary explores taboo subject of mental illness in Japan

New documentary explores taboo subject of mental illness in Japan Courtesy of Kasuhiro Soda

TOKYO —

Widely regarded as one of Japan’s leading new documentary filmmakers, Kazuhiro Soda made a name for himself with his first full-length movie, “Campaign.” Released in 2007, the film depicted the adventures of an unlikely LDP candidate in his quest to win a city council seat in Kawasaki. While Soda’s shadowing of his subject with a handheld camera may not have created a flattering advertisement for the LDP, it did produce a triumph for the cinéma vérité style of filmmaking: it debuted at the Berlin International Film Festival, enjoyed a weeklong run at New York’s Museum of Modern Art, and was broadcast on TV in 20 countries.

In his latest offering, “Seishin” (Mental), Soda uses the same fly-on-the-wall filmmaking techniques to record life inside a small mental health clinic in Okayama Prefecture. Due for domestic release in June after generating a buzz on the international film-festival circuit, “Seishin” takes audiences into a world that many would prefer to keep hidden. Soda depicts consultations and therapy sessions, with interviews that delve into the patients’ personal histories and battles with mental illness. The result is a film that offers not just greater insight into the world inside the clinic, but into Japanese society as a whole.

From his home in New York City, where he has lived since 1993, Soda reveals that the film’s subject matter was, in part, determined by his own experiences as an editor of Tokyo University’s student paper.

“It’s only a student newspaper, but it has a long history that goes back to the Taisho era,” explains the 38-year-old Tochigi native. “I had to organize the finances as well as the editing, and we had to publish every week, so I was working day and night. One day I woke up and found myself unable to do anything. When I went to the computer, I couldn’t write.”

Soda sought help at Todai’s department of psychiatry, where he received a diagnosis of “burn-out.” He received medication, quit the newspaper and, after catching up on weeks of lost sleep, managed to recover. The experience, however, made him reconsider his ideas about mental illness.

“I thought I was immune to that sort of thing, but I wasn’t. It changed my view of mentally ill people too. We have this demonic image of them, that they are scary. But for a time, a very brief period, I was one of them, and I wasn’t a monster. So I was always interested in this subject.”

24% of Japanese suffer mental health problems

This director’s experience is far from unique. A study last year by the Ministry of Health, Welfare and Labor found that 24% of Japanese people had suffered from some kind of mental health problem. Another report found that one in five adults had considered killing themselves, with actual suicide rates at 51 per 100,000 people — twice as high as the U.S. and three times that of the UK. The figures have prompted a $222 million government campaign to raise awareness of the issue and to make counseling services more widely available.

Despite these numbers, mental health treatment in Japan is widely regarded as lagging behind that of many other developed countries. Until as recently as 1987, patients with more severe emotional problems could be institutionalized against their will under the “Mental Hygiene Law.”

Even today, a sense of shame prevents those who suffer less severe ailments from seeking treatment. Yuzo Kato, director of the Tokyo Suicide Prevention Centre, is critical of the government campaign to reduce the suicide rate, which focuses mainly on making counseling services available. “More should be done to end the cultural stigma attached to mental illness,” he says.

“Seishin” was filmed at Chorale Okayama, an outpatient clinic run by Dr Masatomo Yamamoto, who for decades has been involved in changing attitudes towards the treatment of the mentally ill in Japan. Yamamoto accords his patients a high degree of respect, listening to their opinions and involving them in decisions about treatment. The clinic features a patient-run restaurant and milk delivery service to help connect them with the outside world.

“Masatomo’s whole approach is related to an experience he had working in a large mental institution in 1969,” says Soda. “He wondered why the doors of the rooms and wards were locked, so he decided to have a discussion involving staff and patients. The discussion was about who was responsible for locking the doors of the rooms. The patients said it was the nurses, but the nurses said this was because the patients behaved badly — sometimes they would disappear or leave without permission.”

The dialogue between the two groups eventually led to greater understanding.

“The patients started to say, ‘Well maybe we should behave a little better,’ and the nurses started to say, ‘Maybe we’re locking the doors for the sake of our convenience.’ They began to work towards the same thing — having the doors unlocked. And I believe the most important thing was that the patients were included in this discussion. I don’t think many other mental institutions are like the one I filmed. Some are still like the one the doctor worked at in the ’60s.”

An invisible curtain

In the press material for “Seishin,” Soda talks about an invisible “curtain” that hides this world of the mentally ill from that of so-called “normal” society.

“My job as a filmmaker was to open this curtain and create a film where the viewer has a kind of virtual experience of being in this mental clinic,” he explains. “By doing this, maybe you get some kind of respect, understanding or insights into the issue. It’s up to each viewer what kind of experience they get, but I hope it will be a positive and insightful one.”

The stars of “Seishin” are the doctors and patients, and much of the film’s power results from its strong cast. One patient is a former high-flying businessman who wound up burning out. Another is a woman who developed an eating disorder after being told that her legs were fat. Yet another is a manic depressive with dreams of starting a farm in the countryside. And then there’s a character named Sugano, who one moment is doing an impersonation of a steam train with a lit cigarette up each nostril, the next reciting poetry.

The more Soda filmed, the more he came to respect the patients and realize that their experiences were not all negative.

“Of course, they are suffering and they want to get rid of their illness,” he says, “but at the same time, for example in the case of Sugano-san, he couldn’t have written those poems if he hadn’t experienced illness. In a sense, his illness makes him a more interesting, attractive person. Sometimes being ill can be a strength, not a weakness.”

“Seishin” was filmed by both Soda and his wife, Kiyoko Kashiwagi. As an experienced director accustomed to being behind the camera, Soda was able to maintain a distance from his subject matter. For Kashiwagi, this was not so easy. After spending so much time at the clinic with the patients, she began to question her own mental state. Eventually, she herself made an appointment to see Yamamoto.

“I felt really sorry for her as a husband,” Soda recalls. “But at the same time, as a filmmaker, I thought, ‘Mmm, this is interesting!’ Actually, she refused to allow me to film her consultation, but the point is, I think the roles of healthy/unhealthy are very ambiguous, and it’s very easy to cross between the two.”

Given the film’s controversial subject matter, it’s difficult to predict how audiences will react when it’s released here in Japan. Soda realizes that he risks being accused of exploiting the patients, but his biggest fear is that controversy might negatively affect the lives of the people depicted. To make sure everyone involved in the film knew how they were being portrayed, the director organized a private screening for patients and staff. He confesses that despite gaining the patients’ permission to be filmed, he was worried about their reaction. At first, it seemed his fears might be realized.

“As soon as we announced the screening, some of the patients said they wouldn’t see the film. I was most worried about one patient in particular, whose baby had died. She hadn’t told many people about that, but she had confessed to me on camera about her role in the baby’s death, and I kept this confession in the finished version. I heard before the screening that she’d said that she wasn’t coming, so I was worried about what might happen if she heard things about the film from other people. I knew that she’d tried to kill herself six or seven times the previous year.”

The patient arrived at the screening after her scene had been shown, but in a discussion afterwards, she asked the director if he had included “that” scene.

“I told her that I had. At first, she was very disappointed and angry. She said, ‘So everybody knows about that… now I won’t be able to live.’

“I didn’t know what to say, but then another patient raised her hand and said, ‘Well, it was shocking to learn what happened, but I am glad I now know your suffering. I didn’t know you as a whole person before and now I do, and I’m not changing my mind about you. I’m a mother, and I know how hard it is to raise a kid.’ I think it was the first time that people had listened to her story, and I think she was surprised that anybody could possibly sympathize with her.”

With an increasing media focus on violent crime, often committed by people seen as mentally ill, Soda’s film offers a different view.

“In the case of the woman I talked about, in the news she would just be portrayed as an evil mother — it’s always black and white,” he says. “But if you listen to the stories of some of the people involved in these things, it’s not that simple… Demonizing people doesn’t solve anything. In a sense, I want to provide an antidote to that kind of attitude. It wasn’t my purpose when I started filming, but I am hoping this film will show that these people are human beings and they are vulnerable. We are all vulnerable and need support. If somebody was there to listen to these people, maybe some of the crimes wouldn’t happen.”

In a sad footnote, three of the patients who appear in the film have killed themselves since it was made.

“Seishin” has won the Best Documentary Award at both the Dubai and Pusan film festivals, and when it debuts in Tokyo, selected screenings will be with English subtitles. Whatever the reaction, it seems likely that the director will achieve at least one of his aims: bringing the topic of mental illness out into the open, at least for a little while.

For more information about “Seishin,” see www.laboratoryx.us/mental.

This story originally appeared in Metropolis magazine (www.metropolis.co.jp).

  • -1

    sharky1

    The status of mental health in Japan is still a sad state of affairs. Most hospitals use archaic forms of treatment for disorders, and as indicated in the article above, psychopharmacology is the preferred treatment instead of treatment through psychotherapy. Most psychotherapy treatments are provided for inpatients only. Although there have been some improvements over the last few years, Japan is still far,far behind the rest of the industrialized nation when it comes to treatment and public sentiment concerning mental disorders.

  • 1

    medievaltimes

    Mental health is an area Japan needs to better address. This documentary sounds interesting. Hopefully it will at least raise awareness.

  • -1

    Disillusioned

    Only 24%??? By whose standards? By Japanese standards maybe, but from where I come from the whole place is in need of a personality implant.

  • 0

    FryingMonkey

    Disillusioned – Obviously you have never been to Japan. To ignorantly place the whole population into a group needing a personality implant is just stupid. If you have been to Japan it must have been forced upon you because anyone who has such a poor outlook on a population’s mental state and still visits or lives in such a place is in itself a bit on the “not so right in the head” area of the mental health spectrum. Also, I could not agree more with medievaltimes.

  • 0

    jonnyboy

    the problem with mental health in japan is dealing with it properly would require people to realise that there are certain people in society who can never "fit in" and have to be specially provisioned for

  • 0

    dennis0bauer

    FryingMonkey i agree with you, but the strain which japanese work under i also think 24% is a conservative estimate

  • 0

    PASHA_51

    24% figure seems very conservative and writer must re study and tell right figures . He nust advise latest remedies on the problems faced by Japnese people ranging from housewives, unmarried women and office employees etc .

  • 1

    Potsu

    This country is mental....right through from kindergartens to the royal family.

  • 0

    PaulieWalnuts

    a step in the right direction. sadly very few people in Japan will see it.

  • 0

    bennyb

    This is all well and good, but the film appears to barely scrape the surface of the vast array of mental illnesses that people turn a blind eye to. I understand the need to have it be an entertaining film and all, but what about someone with schizophrenia? Or bipolar disorder? Or any number of offending conditions which shock us down to the core, make us shudder and feel better about looking away than facing the issue? Sure, it wouldn't bring much commercial success but these are the kind of realities people ened to be forced to see.

    Anyways, I'm glad someone is saying something about the issue.

  • 0

    Good_Jorb

    The DSM 4 has 297 disorders, which does not included everything that falls under "not yet specified". It would take a ridiculously long time to document each and every one and make for a really long film.

  • 0

    gogogo

    Taboo? if 24% of Japanese suffer mental health problems then it's not taboo is it serious.

  • 0

    KaptainKichigai

    Every chick i have gone out with in this country needs to see this documentary.

  • 0

    sharky1

    The DSM-IV-TR is a tiered multi-axial diagnostic and statistical manual for mental disorders. It may have a large listing of disorders, but they fall within 16 primary categories, and only 5 levels of axis. Your flippant comment concerning the levity of Japan's mental health is not welcome, nor is your inadequate reference of the DSM IV, of which you seem to have very little knowledge.

  • 0

    rondh69

    I always thought that "Visitor Q" (2001) by Takashi Miike tackled this topic well...

  • -1

    memyselfI

    ***>>24% of Japanese suffer mental health problems ***

    It's more higher than that. You know what they say. Usually, a person with mental illiness denies they are mentally ill. They always say to themselves and others that they do not have a mental problem. But they seriously do !!!!

  • 1

    ZazoomZa

    Usually, a person with mental illiness denies they are mentally ill. They always say to themselves and others that they do not have a mental problem. But they seriously do

    Yes but until they admit it nothing can be done. Most are in denial and the internet is also a place where they come to vent their frustrations. But it's not the cure. I hope we see more movies/documentaries like this and raise awareness if only as a beginning.

  • -1

    lat

    Getting the Japanese to think outside of their bubble is a really good thing. Theyve lived in it so long that Im not surprised to hear about any hidden aspects of this society. If you live in Japan, you realize how much effort people put forth in protecting their image and avoiding open-minded conversations that discuss any ugly truths about their people or country. This pressure cooker society is boiling over more and more. How long till there is a severe meltdown?

  • 1

    kirakira25

    What we need is to make it fashionable and mainstream in Japan to have mental problems. A bit like the way re-hab is going back home.

    A smattering of pretty but vacant tarentos and a few sports heros going on J TV to talk gently about their new perspective on life (and forthcoming autobiography) since their diagnosis and treatment, and before you know it everyone will be beating a path to the clinic doors.

    I have just finished working with the sister of a friend to help get her through severe post-natal depression. Shes doing great now, but she had ZERO support - a doctor who basically said "get over it, you have a baby to feed" and a bunch of friends who responded to her pleas for help with "nice weather were having". She was told she "couldnt have medication beacuse it would stop her breastfeeding". The woman was virtually comatose - she couldnt even change a diaper.

    Therapy is almost always the answer in the long-term, but sometimes in the immediate term medication is necessary just to get the individual out of imminent danger - and right now Japan seems to be sadly lacking in both.

    This documentary and doctors like Yamamoto sensei are battling against the current and doing a fantastic job.

  • -1

    WMD

    Only 24% of the population it is claimed have mental problems?? I would have thought it was much much higher than that. Everyday having the to act the part of being a japanese, putting on your mask, always saying the right things and acting according to the strait-jacket imposed upon you. In the office having to do 12 to 14 hour days with no overtime pay and few holidays, kowtowing to the incompetent old gits kmown as the management. 24%?? Not 100%??

  • -1

    gooner

    they're so sad and lonely, no close friends or family, no one to talk to, not natural forms of expression, alcoholic, overworked, over concerned with outward appearances and list whatever other forms of social retardation you like, is it any surprise they're mad as hatters?

  • 1

    Betting

    Regardless of whether Japan's mental illness rate is higher than 24% or not, it's good to see that some people are trying to bring the problem out into the open where that is the only place it can be fixed. And this country certainly does need its mental welfare problems to be fixed.

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