Junko Kitanaka was awarded the 2013 Frances LK Hsu Book Prize for her book Depression in Japan: Psychiatric Cures for a Society in Distress.
Heidi Lam: What drew you to the issue of how depression has been defined in Japan?
Junko Kitanaka: Since my undergraduate days, I have always been interested in how people placed in extreme situations can still find meaning in life. I was influenced by the works of Viktor Frankl, an Austrian psychiatrist who wrote of his own experience in concentration camps. As an undergraduate psychology major, I did volunteer work in a children’s unit at a cancer center in Tokyo, where death was real and imminent. Children there were the most considerate, kind and artistic people I’d ever met. At the same time, I was meeting people who seemed to have everything and yet were psychologically so distressed that they were even suicidal. So I became interested in the question of how people driven to the edge can recover meaning in life and how others like psychiatrists take part in this process of self-transformation. Depression seemed like a perfect entry point for exploring these issues.
HL: How did you decide on the three analytical frames of history, the clinic, and societal conceptions?
JK: The three frames were born out of the puzzles I faced in my fieldwork. Upon entering psychiatric institutions for fieldwork, I immediately encountered seemingly strange notions about depression that Japanese doctors and patients seemed to share, which I had never heard of when conducting fieldwork in Canadian psychiatric settings. I couldn’t find any books that would answer my questions—Japanese psychiatric textbooks on depression would explain its history by starting with melancholia in ancient Greece, shift to medieval Europe and then, modern Germany, and then tie it to the present scientific notion of depression. So I had to dig up archival materials to see how the local notions about depression had been shaped. The social section also grew out of fieldwork, as I began to follow the social course of depression, which was just then beginning to acquire economic and political currency as it became adopted by lawyers, activists, industrial leaders, and policy makers who almost seemed to be trying to lift Japan out of economic depression by treating individuals’ clinical depression.
HL: You examine how psychiatrists frame depression in tension with patient narratives about “suicide of resolve” and the overlooked depression of women. How do your interlocutors view your framework of the social and biological?
JK: My book first came out in English, then in French. I’m currently working on a Japanese version so it’s hard to say what the general reception will be. But a paper I wrote on overwork suicide in an influential magazine in Japan has been featured in the national Asahi Newspaper and the responses to it and to my book from experts in Japan so far have been all very favorable.
The most receptive audience in Japan for my work has been Japanese psychiatrists. From the mid-2000s, prominent psychiatrists began to invite me to conferences, to contribute to their journals and textbooks, and serve on a special committee of the Japanese Society of Depression. They would cite my paper on neurasthenia to discuss how they shouldn’t repeat the same mistakes of turning depression into another illness of personality. Doctors would often come up to me to tell me how my analysis of the gender relationship in psychiatry has made them more reflexive, for instance. I’m often surprised how much doctors seem to enjoy a critical anthropological perspective.
HL: What were the influences on your work?
JK: The biggest influences are, undoubtedly, Margaret Lock and Allan Young. My goal was to write a book like theirs. I’ve also been deeply influenced by those who established the anthropology of medicine as it is today, particularly Emily Martin, Jean Comaroff, Michael Taussig, Byron Good, Judith Farquhar, and Arthur Kleinman, as well as scholars like Anna Tsing and Elizabeth Povinelli. Because I began studying anthropology at the University of Chicago at the height of postmodernism and postcolonialism, my initial concern, as a native anthropologist, was how to incorporate reflexivity in my own work. As I began to do my fieldwork, however, I became more interested in the power relations between global science and local psychiatry, and started to work with historians of medicine and science. My current passion lies in helping more firmly establish the social studies of medicine in Asia.
HL: What ethical issues did you face in the field?
JK: Intruding into the most private aspects of people’s lives was a major concern for me at the time I did my fieldwork, but the patients I met were typically very explicit about wanting to help me as a way of reciprocating those who had helped them. They wanted me to not only write about how they’ve struggled but also about how they recovered, so that others who are suffering now can have hope. The ethics committees of the hospitals where I conducted fieldwork were also very helpful. They taught me that even a seemingly bureaucratic act like giving informed consent can be part of a therapeutic process for patients.
HL: In the conclusion, you discuss the alternate framings of depression through the concept “ground-up medicalization.” What narratives do you preview?
JK: Depression has been made a popular category in Japan through “medicalization through social movement,” in part by workers who see depression as emblematic of their social predicament. More recently, however, there has been potentially a reverse trend, as we see with the rise of new psychiatric regimens such as “Rework,” which is a crossover between medical treatment and occupational training designed to restore workers’ productivity. There is also a national move to introduce mental health mass screening for workers. As such local changes seem to resonate with the global rise of preemptive psychiatry and so-called “resilience” training, I’m keeping a close eye on how new treatments of depression may be indicative of new technologies of surveillance and self-governance.
Junko Kitanaka is a medical anthropologist and associate professor in the Department of Human Sciences at Keio University. Depression in Japan: Psychiatric Cures for a Society in Distress is based on her McGill University doctoral dissertation, which won multiple awards. Her current project explores the psychiatrization of the life cycle.