|PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL
|Year : 2020 | Volume
| Issue : 2 | Page : 134-136
The COVID-19 Pandemic and Social Psychiatry: Lessons Shared, Lessons Learned – A Japanese Perspective
Masafumi Mizuno1, Chiyo Fujii2, Tsutomu Sakuta3
1 Department of Neuropsychiatry, Graduate School of Medicine, Toho University, Tokyo, Japan
2 Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
3 Japan University of Health Sciences, Satte, Japan
|Date of Submission||17-May-2020|
|Date of Decision||29-May-2020|
|Date of Acceptance||02-Jun-2020|
|Date of Web Publication||14-Aug-2020|
Prof. Masafumi Mizuno
6-11-1, Omorinishi, Ota-ku, Tokyo 143-8541
Source of Support: None, Conflict of Interest: None
It seems that Japan is succeeding in overcoming the COVID-19 pandemic, with the minimal sacrifice. The long-term confinement to one's home exposes the behavioral characteristics and mentality of each country. Authoritarianism, which depends on the government, and collectivism, in which groups take precedence over individuals, still remain in Japanese society. This creates synchronized pressure and mutual monitoring. We mental health professionals are needed to help people recover from injuries to their mental health, but this does not mean a simple return to the past values and styles.
Keywords: Authoritarianism, collectivism, Tokyo
|How to cite this article:|
Mizuno M, Fujii C, Sakuta T. The COVID-19 Pandemic and Social Psychiatry: Lessons Shared, Lessons Learned – A Japanese Perspective. World Soc Psychiatry 2020;2:134-6
The situation surrounding new corona infections in Japan is changing from moment to moment. To prevent the spread of infection in Japan, emphasis has been placed on tracking clusters, whereby the transmission route of a confirmed person is scrutinized through interviews, while polymerase chain reaction examination has not been emphasized. However, in Japan, it is difficult to collect the data on behavioral history of the last 14 days necessary for cluster analysis, perhaps because the restrictions on going out are much laxer than in Europe and the United States, and there is no obligation to disclose all personal information. According to the latest data, 112,816 individuals have been tested and 11,005 confirmed positive in Japan as of April 20, 2020. It is not easy to judge whether these numbers indicate an infection explosion in such a highly hygienic country as Japan.
Declaring a state of emergency will not lead to a lockdown like those seen in some American and European cities. Following the declaration, prefectural governors in the designated areas would be authorized to “request” residents to stay at home, except for essential tasks, such as grocery shopping. Governors would also be able to ask schools, childcare facilities, movie theaters, and other public facilities to temporarily close. The Japanese term typically translated as “request” is understood to be taken as a “demand” with the strong expectation that those asked will obey the directives, but there are no legal penalties if they are not followed. Authoritarianism, which depends on the government, and collectivism, in which groups take precedence over individuals, still remain in Japanese society. This creates synchronized pressure and mutual monitoring.
Based on the advice of epidemiological specialists regarding the prevention of the spread of COVID-19, the government insists on the importance of taking measures to avoid the “3 Cs” – Closed spaces with poor ventilation, Crowded conditions with many people, and Conversations in proximity. However, even in such situations, it is not easy to change people's behavior while observing the three Cs.
On March 29, Ken Shimura, one of the Japan's most celebrated comedians, passed away at the age of 70 from pneumonia caused by the novel coronavirus after testing positive for COVID-19. He was the first Japanese celebrity to die from COVID-19. The death of a popular person brought a slight but certain behavioral change in the population on the weekends. It is still evenly balanced at the time of writing whether the infection will spread over or go to convergence.
Initially, the new coronavirus disaster was a health problem, but it has gradually become an economic problem with the loss of jobs and homes. There is a sense of crisis as the risk of suicide has already begun to rise as a result of these economic hardships, causing the family environment and mental health to deteriorate, and showing associations with various problems. It has gradually spurred anxiety, fear, and distrust among people. In fact, there is a negative legacy in Japan: the number of suicides skyrocketed in 1998, when the country was experiencing a recession following the bursting of the bubble economy, and the number of suicides remained high for more than a decade after that.
First, it is necessary to prevent financial problems associated with the sudden increases in suicide by implementing proper measures to compensate individuals for losses of livelihood and to promote comprehensive measures that link mental health problems and support for the family environment. Tokyo Governor Yuriko Koike requested that the residents of the capital – with a population of more than 13 million – isolate themselves until May 6, starting at midnight March 25, as a measure against the ongoing COVID-19 pandemic. She announced that residents should refrain from any nonessential and nonurgent outings. Worry is merited regarding the poverty of women in nonregular jobs, such as the service industry. According to the 2019 Ministry of Internal Affairs and Communications Labor Force Survey, half of all working women are nonregular.
Even if they have a job, some families are facing new problems due to the recommendation to work from home. Tweets posted on “#Corona Divorce” in Japanese:
- I have been with my wife for the past month, but I am almost out of breath
- Before you had a child, how did you live together?
- My husband's stay-at-home on weekdays started with corona, and the number of people who have endured emotional abuse (“moral harassment” in Japanese) has increased. A husband who just eats three meals without doing anything
- My wife hates me to have hives if I am in the same space as she, so I am eating noodle alone on the kitchen floor. I hear the children's happy voices and I feel like dying
- In my home, the time for two people to prepare lunch and talk increased.
The greater the desire to live, the greater the fear of death. An extremely strong desire to live represents a flourishing desire to live. This is the basic position of Morita Therapy, which was founded by the Japanese psychiatrist Shoma Morita (1874–1938). Morita theory explains basic human desires and fears and the mechanism of feelings in a scientific fashion. It then proceeds to provide a means to overcome anxiety by educating the mind to “take things as they are” (Arugamama). Human beings cannot keep their minds calm without working, regardless of whether they are experiencing anxiety. People who can be cheerful without working are exceptional in the conventional Japanese culture, which respects diligence and honesty. Ordinary Japanese people fall into unhappiness if they do not work, and ordinary people always lead a disordered life if they do not work, lapsing into an unhappy mental state. If they do not work because of fear, they will feel their fear more terribly.
Japan might be regarded as a country with rich resources of information and communication. This is, in fact, largely true only of the commercial and industrial sectors, and the development of information and communication technology (ICT) in community life has been relatively slow. However, these days, people must suddenly change their working style with the use of remote communication to work at home. The request for people to work at home enforces isolation on them. Nevertheless, the younger generation, which has had the Internet since birth, appears to be adapting relatively quickly to these changes in communication styles. They use social networking sites and other tools as if they were breathing! However, Japan is a renowned super-aged society. It is feared that the elderly, who have difficulty even using their smartphones, may not be able to keep up with these changes in communication, leading to further isolation. Appropriate support will be needed for those who have difficulty in using ICT.
As the new coronavirus continues to spread in Japan, recovered patients and their families, coworkers, and neighbors face stigma and discriminatory treatment, a recurrent theme seen in society when people face new health threats, such as leprosy and the effects of nuclear accidents. A man who had been aboard the Diamond Princess, a cruise ship quarantined in February near Tokyo, stated in an interview on TV that he heard rumors that he was “spreading the virus by walking around the neighborhood” when returning home. Although the man has tested negative several times after disembarking in February, his family members were told to consult a healthcare center before visiting their family doctor.
Given the increasing number of reports of such social bias associated with the virus, the Education Ministry advised schools late last month to take measures to prevent discrimination among their students and teaching staff when they reopened after the government-requested closures. Unknown objects are objects of fear. It is hard to rid oneself of the fear of something that people cannot see or understand. Historically, there was discrimination against people with leprosy and HIV as people tried to stay away from the causes of infection. It is similar to people's fear of radiation following the Fukushima Daiichi nuclear power station disaster in 2011. People should imagine how they would feel if they themselves were to be discriminated against.
In such a limited space, it is difficult to discuss the psychiatric problems that are occurring in Japanese society in light of the ever-changing situation of the coronavirus pandemic. Let us hope that a vaccine against coronavirus or other fundamental remedy will be developed as soon as possible to restore the original state of well-being. Values, communication, and ways of life are rapidly changing through this experience and probably will not return to the way they were before the COVID-19 disaster. We mental health professionals are needed to help people recover from injuries to their mental health, but this does not mean a simple return to the past values and styles. Can we accept this fact and change our concerns to reflect changes in life?
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Conflicts of interest
There are no conflicts of interest.