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Sunday, Sept. 20, 2009

COUNTERPOINT

Now suicide has become a political issue, how will Japan address it?


Without a doubt the grimmest statistic coming out of Japan today concerns the number of suicides, which have exceeded 30,000 annually for 11 years in a row — engendering indescribable tragedies for so many families.

But with this having spun into an issue in last month's Lower House elections — even Yukio Hatoyama, who is now prime minister, mentioned it in his speeches — it's clear the Japanese people have begun to take that awful statistic to heart and to treat suicide as a national problem.

So how should Japan deal with this? And would there be any lessons in a Japanese approach that might alleviate the problem worldwide?

The primary causes of suicide are universal: despair brought about by tragedy or a personal sense of failure; and clinical depression, caused by neurological factors or trauma.

The scale, too, is universally large. In Japan, as in much of the developed world, suicide is by far the leading cause of death among young people, amounting here to one-third of deaths in the 20-to-49 age group. In all, the number of suicides in Japan is five times that of total deaths from road traffic accidents.

The Japanese Society of Psychiatry and Neurology estimates that 20 to 30 percent of hospital outpatients and 30 to 40 percent of inpatients have a psychiatric disorder. There are 13,000 physicians in Japan practicing psychiatry, and yet the JSPN states, "We still feel that this is not enough to meet the demand generated by the vast number of mental health issues present in society today."

Japanese men and women may boast the best longevity records in the world, but chronic depression in the aged can severely mar the quality of their last years. In younger people, depression can lead to domestic violence, child abuse, alcohol or drug dependence and a host of other antisocial behaviors.

But why is it that suicides in Japan have topped 30,000 annually for each of the last 11 years? What has occurred in the society that could have prompted such an increase?

Economic stagnation has certainly been a factor. There have been such eras in the past, but this one followed the greatest and most widespread quarter century (1965-90) of economic boom in 100 years. The letdown factor, the dashed expectations and the wounded pride of household providers has surely fed despair — a despair often leading to alienation from society and isolation from family and friends. These are the very themes prominent in the works of the novelist Haruki Murakami; and I believe they resonate into his wild popularity.

Other factors contribute to the consequences of despair or mental instability in Japan: the traditional notion here that you should grin and bear your suffering, keep your sorrows inside and not make an issue of it; the lack of societal institutions where people can gather to pour their heart out to each other, particularly strangers, who are often more sympathetic than their "nearest and dearest"; and, perhaps most of all, the absence of moral stigma attached to suicide.

Suicide in Japan, throughout most of the nation's history, has been viewed, in certain circumstances, as an act associated with being noble and taking responsibility for life's setbacks.

There can even be a romantic element attached to it, one that others may tragically wish to follow in so-called suicides of emulation. Literature and drama, from ancient pages and stages to today's movies and TV screens, are replete with examples of romantic suicides, single and double, that somehow inspire emulation. In recent years, the death of Yukiko Okada comes to mind.

Okada was a famous young singer and actor. Born in 1967, she rocketed to stardom in the '80s thanks not only to her talent but to her sweet personality and infectious smile — a smile so famous that it had a name: the "Yukko smile." She was only 18 when, in 1986, she threw herself off the roof of the Sun Music Building in Tokyo's Yotsuya district. This led to a spate of suicides in Japan, in tragic emulation of her act.

The religious factor is also relevant. Buddhism, which forms one basis of Japanese philosophical and ethical belief, views all death as part of a cycle in lives, a passage from one realm of existence to another. It can be interpreted as an expression of karmic fate.

In the Judeo-Christian traditions, suicide is a major sin. "Despite yourself you were fashioned, and despite yourself you were born, and despite yourself you live, and despite yourself you die . . . " So goes a passage of Jewish rabbinic teaching in the "Chapters of the Fathers." Traditionally, Jews who committed suicide were not allowed burial in a cemetery. Christianity equally condemns suicide. Matters of life and death are in God's hands alone, not your own. To take you own life is to sin against God.

This allows us to regard the problem of suicide in Japan in a broader perspective.

Because there is virtually no stigma attached to suicide in Japan, the statistics may be considered fairly accurate. Statistics in countries of the West may not reflect the true picture. Families of the deceased and medical practitioners are prone to construe the cause of death as accidental. In the United States, for instance, if many "accidental firearm deaths" and some single-car accidents were added into the suicide statistics, the rate would soar.

Certainly, it was economic factors that drove my great aunt's husband to kill himself in 1931, after he lost his family's life savings and wanted his wife and children to receive money from his life insurance. My entire family grieved for him, wishing that he had not done it; and yet, it became a family secret, a "shameful" fact that had to be repressed for the sake of pride and face.

Yes, Japan can teach the rest of the world lessons in this grievous problem.

Confront the issue face on, without moral opprobrium, and determine the cause of death without resorting to the application of prejudicial religious tenets.

Treat depression with tolerance and care in public and private, and invest heavily in research on how to deal medically with mood disorders.

Train more physicians to recognize and treat psychiatric problems in their patients.

De-romanticize suicide without condemning people for attempting it.

Suicide is at once the most private and most public act. In Japan, the problem is now politically in the open. The way to deal with it is to realize that the life to be saved is not only your own.



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