In 2017, Matsuzawa Hospital was featured in an NHK television program. The purpose of the documentary was to find out why, despite an increasing rate of physical constraint of patients at other institutions throughout the country, the rate at Matsuzawa Hospital has been decreasing yearly to where it is now one-tenth of the national average. The occasion was extremely gratifying to all of us here at Matsuzawa because we felt that it vindicated our efforts over the years. The story is to be featured on “Close-Up Gendai Plus” for anyone interested in watching it.
It so happens that not long before the visit to our hospital by NHK, I was interviewed as the current Director of Matsuzawa Hospital for a documentary tracing the achievements of Dr. Shuzo Kure, the founding father of this institution. Just to avoid embarrassing myself through my ignorance, I boned up on Dr. Kure’s achievements as Director of Matsuzawa Hospital. Dr. Kure was the guiding light and driving force of psychiatry during its foundational period in Japan and is remembered not only for his academic achievements, but also for having improved the treatment of persons with mental illness from a humanitarian perspective. After returning in 1901 from his three-year period of study in Germany and Austria, Kure assumed a professorial post at Tokyo Imperial Medical College in October of the same year, then began his tenure as the Chief Hospital Administrator (the equivalent of today’s Director) at Sugamo Hospital, the forerunner to Tokyo Metropolitan Matsuzawa Hospital, at 36 years of age. No sooner had he assumed his new post than he began zealously to work on improving the treatment of the inmates there; straightway, upon beginning his work as the chief administrator, he bans the use of cuffs, shackles, straightjackets made of tough fabrics and other devices intended for the physical constraint of patients and places limits on recourse to isolation chambers. When he discovers that his new policy is not being followed in all quarters, he has all the devices used for the physical constraint of the patients collected and brought to him in January of the following year, and on the 28th of the next month, sees to it that they are incinerated. Meanwhile, he has the floor space of the isolation chambers enlarged and furnishes the rooms with windows; he provides the patients in the general wards with the opportunity to engage in various work activities; holds concerts for their benefit; and even adds excursions and other forms of entertainment to help improve their state of mind. Contrary to the fears that banning the use of physical constraints might increase violent incidents among the inmates, Kure’s policy had the effect of restoring peacefulness to their daily life. The physical constraint rate of 4.5% recorded for 1902 had declined to 1.2% by 1905.
Now, shortly after the filming of the documentary, I was overcome by an odd feeling as I explained our efforts of the past five years to minimize the physical constraint of patients at our hospital; I fell to wondering how our efforts were any different from Kure’s own endeavor of over one hundred years ago. Try as hard as I might, I could not discern any difference at all. During Kure’s time, there were no psychotropic drugs or electroshock therapy. Large numbers of patients at Sugamo Hospital were employed as staff, and professionally trained nurses were unknown. Today, by contrast, at Matsuzawa Hospital we have available drugs to calm patients, an mECT facility, and highly trained physicians, nurses, and other medical staff. So why, then, were we now still trying to achieve what Kure had accomplished single-handedly one hundred years ago?
1918 saw the publication of a report coauthored by Shuzo Kure and Goro Hamada entitled, “Conditions of home detention of psychiatric patients and relevant statistical observations,” which was a compilation of data on persons with mental illnesses who were confined at home in accordance with regular psychiatric practice throughout Japan. The report contained many photographs illustrating the miserable conditions under which numerous patients, stripped of any vestige of human dignity, were constrained to live during their home detention.
On December 26, 2017, on the very eve, as it were, of the new year, the news reported a shocking incident involving the discovery of the corpse of a 33-year-old woman found in a residence in the town of Neyagawa in Osaka. The woman’s parents had kept her confined for 17 years under lock and key until she succumbed to the abusive neglect and died. As I watched the images broadcast on the television detailing the horrors of the report, I remembered the photographs in Kure’s report. The stark reality was that social attitudes towards persons with debilitating mental illnesses remained unchanged from how they were a century ago during Kure’s time.
We confine persons with debilitating mental illnesses in closed facilities we call hospitals because at bottom, we are afraid of what we sense to be different from ourselves and are incapable of understanding. Modern Japanese society values individualism and is tolerant of even egregious examples of it as long as the general peace is not disturbed. In this respect, Japan today differs signally from Japan of one hundred years ago. However, once such individuals are suspected of harboring the potential to disrupt the lives of those around them, society does its utmost to remove the offending element. In this respect, Japanese society is the same as it was in Kure’s time. Some concerned individuals have pegged this behavior as a manifestation of discrimination against persons with mental illnesses and have asserted the importance of enlightening and educating the benighted public as means of overcoming this proclivity. However, I happen to be of the opinion that it is something much more complex, for if enlightenment and education were effective antidotes to this tendency, why is it that we are still witness to the same scenes as Kure was a century ago? I believe that our impulse to fear the different and to try to rid ourselves of its presence are an expression of biological instinct or the result of cultural evolution that has ingrained these attitudes in us universally; under certain conditions, these predispositions or instincts manifest in our prejudice against and exclusion of what embodies otherness. The problem is, of course, that quite often those who are earmarked as strange or ‘other’ are defenseless social minorities, and the ingrained fear of the other needs only the slightest of triggers to set in motion actions and events of a wholly wanton and irrational character. What is therefore important is for us to be cognizant of this ‘biological or cultural gene’ that predisposes us to this behavior and always to be on guard against its rearing its head. It isn’t easy to accept persons with disabilities into society, especially when the disability renders that person incapable of readily adapting to societal norms. The powerful human inclination to be rid of such individuals reasserts itself despite our best efforts to quell it. This is why our untiring vigilance—over ourselves—is called for.
One hundred years ago, Kure tried to improve the treatment of patients in his hospital and remove those who were confined under the deplorable conditions of home detention to place them in the ideal environment he created for them in his hospital. Today, our efforts are aimed at returning patients to the community. But if societal attitudes today are no different from what they were a century ago, what is crucial for the successful discharge and social rehabilitation of patients is not to criticize the psychiatric hospital for perceived failures but rather to establish a strategy to enable persons with mental disabilities to find acceptance in their community.
In the work which I mentioned earlier, Kure states, “The tens of thousands of psychiatric patients in Japan must endure not only the misery caused by their illness, but also the misfortune of having been born in this nation.” These words have long been a source of inspiration and beacon to those who have striven to improve psychiatry in Japan. Yet I have secretly harbored some doubts about the veracity of this observation today. Is there any nation now where, amid the clamor for efficiency and the pressure to conform to societal norms, a mentally disabled person can live without fear or anxiety? Kure’s Japan had bidden farewell to its policy of isolation, then enshrined as its mission the goal of achieving parity with the civilization of Western Europe. We in modern Japan, however, will never solve the societal issues that confront us if we allow ourselves to be lulled into some saccharine fantasy of chasing an elusive utopia. I believe that we can build a society that enables persons with mental and other types of disability, as well as those who are ‘different’ in some way from the rest of us, to live among us with peace of mind. For my part, I intend to continue my efforts to come even one step closer to achieving this aim in the coming new year.