麻豆传媒

By George Wehrfritz

With Hideko Takayama and Kay Itoi in Tokyo and Deborah Hodgson in Akita

He blends with the salarymen who frequent the Imperial Hotel's lobby bar during cocktail hour in Tokyo. Three years ago he was one of them: a proud, confident corporate warrior who fancied himself a descendant of Japan's stoic samurai. Then the country's economic downturn slammed his company hard, and in late 1998 he became "spiritually weakened" by an anxiety he couldn't comprehend.

At first he couldn't sleep. Then he grew physically weak each time the train neared the station nearest his office. On several occasions he rode to the end of the line and called in sick. "At one point," the fiftyish company man told NEWSWEEK, speaking on condition that he not be identified, "I went to buy a rope, then put it in the trunk of my car to be prepared for the day when I would hang myself."

Fortunately, that day hasn't come. A doctor at the high-tech multinational where he works finally told him what he needed to hear--that his depression was curable--and over the next year provided him with counseling and anti-depressants. "Early one morning I felt like I didn't need the rope anymore," says the executive. "So I said goodbye to it, then threw it in a pond near my house."

In too many other cases in Japan, the rope in the trunk is strung over a tree limb, or the troubled soul in a three-piece suit simply jumps beneath a speeding commuter train. Last year alone, according to fresh statistics released in Tokyo this month, Japan's suicide tally topped 30,000 for the third year running. That's roughly triple the number of road deaths nationally and double the per capita suicide rate in the United States. Males make up 71 percent of the total, and since the late 1990s salarymen have constituted the bulk of the increase. Nearly one third of suicide notes recovered in 2000 cited economic hardship--the highest rate ever.

In other industrialized countries, alarm bells would have sounded. Not so in Japan, where depression is regarded as a sign of weakness and suicide is traditionally glamorized as part of the samurai tradition. The country lacks trained therapists. Most doctors either can't or won't treat mental illness, and denial prevents most patients from seeking help in the first place. Complex approval procedures have delayed the introduction of advanced antidepressants. (Prozac, launched in 1986 in Europe and a year later in the United States, still hasn't been approved.) And the government hasn't even undertaken studies to measure the prevalence of depression among its citizens. Says Susumu Oda, professor emeritus of psychiatry at Tsukuba University, "We're facing a mental-health crisis."

Depressed salarymen are the most at risk. "These people work hard, reach middle age and are restructured or laid off," says psychiatrist Toru Sekiya, author of several books on depression in corporate Japan. "Then, in the old samurai tradition, they think of suicide. Very few of them ever seek help." Those who do are generally relegated to company clinics, where barely a handful of the country's biggest corporations--let alone the thousands of small- and medium-sized enterprises that form the backbone of Japanese industry--offer even rudimentary mental-health care.

In its heyday, corporate Japan took care of its own in other ways. New recruits accepted an implicit social contract: they'd work tirelessly for their companies, and in return organizations would safeguard them for life. To honor their end of this bargain, Japanese workers clocked unpaid "service overtime," routinely forswore vacations and strove relentlessly to improve efficiency--all in the service of paternalistic companies. But by 1997, the year financial turmoil ravaged economies across Asia, Japan Inc. could no longer hold up its end of the deal. Debt-laden banks stopped extending survival loans to companies. Bankruptcies soared. Viable firms accepted the inevitability of downsizing and began doing what they pledged they never would--culling their work forces. The reforms pledged by Prime Minister Junichiro Koizumi promise more pain to come.

Unwanted workers "feel betrayed as if by a lover," says Hiromichi Yamazaki, a counselor at the Tokyo Managers' Union who himself was restructured out of a job a few years ago. Most have spent their entire lives conforming to the codes of one system, and know no other. Finding work seems next to impossible in the current economic slump. Typically, midcareer salarymen can't speak English or use a computer--serious barriers to entry in today's job market. Without their colleagues they are left with no social life. They face families they barely know, the shame of a society that valorizes hard work, and few prospects.

These lost souls are the heart of Japan's depression epidemic. Over the past year the number of working-age men who phoned the Tokyo Life Line doubled. "It seems to have a lot to do with recession and restructuring," says Wataru Suematsu, the hot line's executive director. "These middle-aged men were taught not to show their weakness and not to complain. They call us to express how lonely, isolated and depressed they feel."

Forensic pathologist Yoshihide Sorimachi has witnessed this epidemic from a grisly vantage point--Osaka's morgue. He confirms the alarming increase in suicides committed by middle-aged men, and says he has discovered that most victims had recently lost jobs. He's now studying this "strong positive correlation between suicide and unemployment" by comparing trends in Japan and Sweden--two countries with high income and low unemployment that hit the economic skids in the 1990s. Contrary to Japan's experience, Sweden's suicide rate is declining. Sorimachi attributes the disparity to Japan's comparatively strong work ethic and inferior social-security system, to life insurance policies that "reward" suicide by paying out if the policy is more than two years old and to insufficient psychiatric treatment offered depressed workers.

Japan's National Health Service is itself an obstacle to effective mental-health care. It affords all citizens access to low-cost treatment, but in doing so forces them into local health clinics where physicians are either untrained or unwilling to diagnose depression. Under Japan's system, clinical psychologists can't examine patients or open clinics independently of doctors, so by law they're subordinate to M.D.s. Although a nongovernment organization, Japan's Certification Board for Clinical Psychologists has accredited nearly 8,000 clinicians since 1988, members have little practical autonomy. "Mental-health problems have not been considered as important as physical problems, so the status given to psychology professionals has accordingly been low," says Yoshitaka Otsuka, the board's executive director.

Asked to grade the level of mental-health care available at the average public-health clinic in Japan on an A to F scale, a prominent psychiatrist told NEWSWEEK: "I'd give it an 'E'." Even that may be generous. A World Health Organization study done in the mid-1990s found that doctors either missed or misdiagnosed mental illness 81 percent of the time. Too often, say experts, patients with symptoms of depression are either told, "Go home, there's nothing wrong with you," or simply given a mild tranquilizer. One depressive patient interviewed by NEWSWEEK encountered a doctor who asked what he'd been reading. Haruki Murakami, he answered. "You won't get better as long as you read Murakami," his physician chided without explanation. (In "Norwegian Wood," one of the author's most famous novels, the protagonist's girlfriend resides in a psychiatric hospital.)

Training doctors to treat depression is an urgent task, but thus far it's proved futile. Dr. Yoshibumi Nakane, director of a World Health Organization-affiliated research center in Nagasaki, has labored since the mid-1990s to raise awareness among physicians--and has little but frustration to show for it. For starters, he discovered early on that Japanese doctors somehow could not assimilate a standard WHO handbook on mental health, a publication that was successfully distributed in scores of countries. He subsequently had the material simplified. When he staged mental-health awareness trainings in a Nagasaki hospital, 20 of the 50 doctors who signed up quit before completing the 15-hour course. "Doctors are concerned that they not give the impression that they are treating mental illness, because it could get out in their communities and hurt their reputations," he says. "Maybe the people who have the strongest stigma and prejudice are doctors."

Even within Japan's psychiatric community, experts are reluctant to take on depression. Many distrust modern drug therapy and outpatient care, and prefer instead to focus on "serious" mental illnesses like schizophrenia. Most work in universities or within a sprawling network of mental hospitals, where patients are warehoused in numbers unseen in the United States and Europe since the 1970s. Japan, which did not follow the trend of deinstitutionalization as Western countries did, has four times the number of beds in mental hospitals per capita as does the United States. As one doctor specializing in adolescent psychiatry put it: "Japan is 20 to 30 years behind [the West]."

Those who do counsel outpatients see a huge unmet need. Dr. Takeshi Tsukishima, a psychiatrist at the Mental Health and Welfare Center in Sapporo, says the system on Japan's northern most island is swamped with "subclinical" patients for whom adequate counseling is simply unavailable. "In Japan," he says, "there is no concept that depression is a mental disorder."

Japan's economic woes, however, have made the problem too dire for companies to ignore. Labor lawyer Hiroshi Kawahito estimates that as many as a third of all suicides in Japan are "overwork-related." The government has a different figure: last year the Ministry of Labor recognized just 19 suicides as "occupational deaths," up from a single case in 1996. The discrepancy stems from complex legal ramifications. Under Japanese law, companies can be held liable for a phenomenon known as karoshi (death by overwork). Kawahito was among a group of doctors and lawyers who pushed Japan's courts to acknowledge karoshi in the 1980s, a time when marathon workdays caused strokes and heart attacks. "During the bubble, salarymen worked themselves to death for profit," he says. "Now, they do it to help their companies avoid bankruptcy, or to keep from being restructured. The stress is much greater than in the old days, and under these circumstances there are many more suicides."

Karoshi lawsuits may, in fact, be what forces companies to try to meet their workers' mental-health needs. In March 2000, Japan's Supreme Court found Dentsu Inc., the nation's largest public-opinion and advertising agency, liable for the death of a 24-year-old employee who committed suicide in 1991 after reportedly working for 17 months without a single day off. The landmark ruling censured Dentsu for failing to reduce the man's workload even though his superiors knew his health was deteriorating. Monetary settlements in such cases are modest by Western standards. (Dentsu was forced to pay $1.1 million.) But guilty verdicts are profoundly shameful in a corporate culture that prides itself on harmony between management and workers.

It's often the fear of embarrassing litigation that compels companies to improve conditions in the workplace, say activists. Take Toshiba. The electronics giant was a typical Japanese pressure cooker until it began to get serious about mental health in 1999. By then the company was losing several of its 190,000 employees to suicide each year (Toshiba declined to name an exact figure). Toshiba now educates employees about stress and depression and administers routine stress tests to thousands of workers annually. The company's 24 doctors treat hundreds of depression cases in-house; about one employee a week is referred to outside psychiatrists. "I explain that depression comes from fatigue of the brain, and that it can be cured," says Dr. Katsutoshi Tanaka, the firm's mental-health coordinator. "When they hear that there are biological reasons for it, they are convinced."

Other large firms have imported an American program for promoting mental wellness at the workplace. It utilizes trained experts, many of them psychiatrists, who attempt to resolve personal issues that contribute to a decline in performance. That's a novel concept in a country where performance-based evaluations are seen as an example of "excess competition" anathema to Japan's hierarchical, age-based corporate structure. The program also trains managers to keep their staffs in good shape by lightening workloads and evaluating performance rather than the amount of midnight oil burned. "It's relatively easy for a company to contract counselors or psychiatrists to handle all their problems," says Kaoru Ichikawa, a mental-health counselor at Motorola Japan. "But at some point the management side must change its behavior."

Changing minds grows more difficult the smaller a company gets, however. Unlike Japan's corporate giants, the vast majority of small and medium businesses can't afford on-site clinics or tailored mental-health programs. Management is old-fashioned, and employees cling to the gambaru tradition of long hours, unflinching dedication to the firm and limited social lives beyond work. Typically these companies carry more debt and earn less profit than Japan's export-oriented multinationals. Thousands file for bankruptcy each year. "Generally, managers at medium and small enterprises don't care about mental health because it is not directly related to company performance," says Yoshiyuki Fukuzawa, an occupational health specialist at Japan's Ministry of Health, Labor and Welfare.

The ministry has launched two initiatives to improve awareness in average companies. In November it will send psychiatrists and occupational-health professionals to conduct pilot studies inside 60 medium-size firms with 300 to 1,000 workers. It will select "companies that want help but lack resources," says Fukuzawa, then dispatch experts to assist in creating mental-wellness plans free of charge. Next year the ministry plans to publish these case studies in a handbook on mental-health promotion in the workplace.

Still, it seems improbable that these measures will alleviate depression any time soon. The economic forecast remains so gloomy that unemployment, now officially at 4.9 percent, could rise far higher, dragging up the suicide tally in its wake. And in a nation that is aging faster than most others in the world, the number of suicides among the elderly is growing increasingly worrisome. Akita prefecture, a mountainous rice-farming region on the Sea of Japan, has topped the nation's suicide tally for six years running, with a rate 40 percent higher than Japan's national average. Most victims are elderly residents, who often complain of loneliness in the remote area, known for its forested peaks and deep winter snows.

The first step to combating the problem may be for the country as a whole simply to acknowledge it. Just ask Kazumi Kanaya, a widow who honors the memory of her husband, Ryoichi, at a cupboard-size altar in the Kobe-area home they once shared. His troubles began when his bosses at the Kaneka Corp., a large chemical company, offered him a promotion and transfer to a subsidiary on Kyushu, Japan's southernmost main island. They pressed him to take the job on short notice, and intimated that he would be forced to resign if he refused the assignment. Four months later, on Dec. 15, 1999, he hanged himself in the factory on his daughter's 19th birthday.

Kanaya, 48, was a corporate warrior stretched beyond his limits. After 29 years at the company, he'd been named the sole maintenance manager at a foam-insulation plant that operated 24 hours a day. According to his wife, in the weeks before his death he routinely clocked 14-, 15-, even 16-hour days. Near the end, he developed a fear of the telephone so profound that he screamed at her to stop calling. "I get no rest, no weekends off, and I don't want to hear the phone ring," he'd bark. "When I called on Dec. 11 he said: 'I'm tired. I'd like to sleep,' then hung up on me," she says. "That was the last time we spoke."

After his death, the company acknowledged that Kanaya had informed the subsidiary's president that he was cracking under his heavy workload. In a conversation with Kanaya's widow, the president explained that he had brushed aside his call for help by attributing it to "a case of homesickness." Over drinks he had delivered Japan Inc.'s traditional admonishment. He told his troubled maintenance manager to gambatte--hunker down and do his best. That was the last thing he needed to hear.

From Newsweek, August 20, 2001 and © 2001 Newsweek, Inc.
All rights reserved. Reprinted by permission.