Insight and Psychosis by Xavier F. Amador & Anthony S. David

Author:Xavier F. Amador & Anthony S. David
Language: eng
Format: mobi
Tags: ISBN-13:, 9780198525684
ISBN: 9780198525684
Publisher: Oxford University Press
Published: 2004-09-14T21:00:00+00:00

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Chapter 11

Japanese attitudes towards

insight in schizophrenia

Yoshiharu Kim

Historical background

The development of modern Japanese psychiatry was inaugurated after the Meiji

Reformation in 1867. Pre-Meiji Japan had few asylums or hospitals to segregate the

mentally ill (such as as existed in Europe), and had only certain temples which offered

treatment through water bathing. Through Japan’s long history, officials had taken a

fairly generous attitude toward the mentally ill: records show few incidents of political

persecution against them, and in 701, it was already determined that the mentally ill

should be treated medically. During the Edo era (1604–1867) the criminal law admit-

ted insanity as a mitigating circumstance. Unlike the situation in Europe, where the

stigmatization of the mentally ill aroused moral protest by Pinel and Esquirol, there

had been only a weak social and political tendency to alienate them in Japan. Moreover,

the modern scientific urge to classify natural phenomena, promoted in Europe by

Linne and Darwin, had no basis in traditional Japanese culture, which consequently

experienced little systematic discussion of how to define and classify mental illness.

Little interest was paid to the subject of insight in the mentally disordered, a feature

whose lack was regarded in late nineteenth-century Europe as a kind of agnosia which

was sometimes claimed to be the definition of mental illness (Pick, 1882, Dagonet,

1881; see Berrios and Markova, Chapter 2).

During the late Edo period, with the development of industry, incidents of discrimi-

nation against the mentally disordered, including deportation from their villages and

the confinement to private prisons, increased. After the Meiji Reformation a number of

psychiatric asylums were founded in the naive belief that it was more humane to treat

the mentally disordered in hospitals than to leave them in their home or village. Since

then, Japanese psychiatric practice has been largely based upon such inpatient treat-

ment, borrowing its methodology mainly from German, and to a lesser degree French

and English psychiatry. The school of psychopathology that was methodologically

founded by Jaspers (1913), especially his assertion of the un-understandability of psy-

choses and the lack of insight in schizophrenia, became so influential in Japan as to

determine the view of the majority of psychiatrists.

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JAPANESE ATTITUDES TOWARDS INSIGHT IN SCHIZOPHRENIA

After the Second World War, the influence of American psychiatry reached Japan in

the form of a more flexible view of the possibility of recovery from schizophrenia.

Klerman (1991) stated that this American optimism was originally derived from experi-

ence with soldiers who suffered from reactive psychosis during wartime and recovered

afterwards. Despite the fact that reactive psychosis was not always included in a narrower

definition of schizophrenia used in Japan at that time, this new attitude stimulated the

interest of a number of Japanese psychiatrists in the social rehabilitation of schizo-

phrenics. After the introduction of anti-psychotic drugs in 1955, Japanese psychiatric

treatment started to change toward outpatient management, social rehabilitation and

day care treatment. In 1958, Utena and his colleagues at Gunma University instituted

the Seikatsu-rinshou, a long-term programme for the social rehabilitation of schizo-

phrenics that still continues today.

Under these circumstances, in 1963 a symposium on insight in schizophrenia was

held by the Japanese Conference of Psychopathology with the aim of

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