We can easily understand physical health and how to maintain it through exercise and diet control. We spend a good part of our biology classes in General Science at school learning about the intricacies of the human body, and how the various systems work. Mental health is something entirely different because of its unseen, intangible nature. A thought is not something that can be held or observed by another. In our intensely private inner worlds, much can be hidden from the view of others. We can appear to be balanced and grounded when in fact the internal reality is the complete opposite. We can see the effects of anxiety in another, so too depression – but by the time the physical symptoms start to make themselves known, the internal mechanisms that cause imbalance have long been churning away.
Big cities and modern life do not lend themselves well to the establishment of meaningfully deep relationships. There is a shallowness that exists simply because we have not had the experience of being deeply connected, or are even schooled in how to begin making networks of support. Look at the many apartment blocks around the central city and notice that the majority are pokey one-roomed spaces offering inhabitants 12 sqm of “room.” No more than a place to dump the body at the end of yet another 14 hour work day. Oddly amusing that these bolt holes have such palatial names as Grandia Lions Mansion, Parkside Place, Graceful Fields… and so on. There is nothing mansionesque about these grim testaments to the torturous Tokyo work day.
The quick and immediate are favoured above the slow and the long. Modern society is driven by the need to produce and consume at an ever increasing and frenetic pace. Technologically, if you do not update or renew your electronic devices on a regular three to six month basis, then you are missing out on possibly crucial developments. You will be left behind the throng of others competing in the thrill of the ever-new. God forbid you would find yourself with a model 3 phone in hand, when the rest of the populace is clamoring at the doors of the stores to get the model 10. Why the fuss? Doesn’t a 3 do the same as a 10?
Suicide rates in Japan are alarmingly high. There is a seasonal pattern evident that is linked to the end of the financial year and the contract renewal period at the end of March. The stress of losing a job and having to find another, without loss of face or a drop in income can lead salarymen at the end of their tethers to take their own lives by throwing themselves in front of a speeding express train. Even the well publicised “clean-up” costs that the remaining (possibly grieving) family are billed with and the massive backlog of commuters that result from each jump are not enough to dissuade the desperate from the final act. Some say that it is done to spite family and “work” in general. Work is such an important part of the modern urban identity that without it many feel valueless, lost and grow increasingly despondent.
Those that do work on a daily basis are on a seemingly endless treadmill leading nowhere except to bills, taxes, sickness and death. What a life! Any deviation from what is considered the norm is frowned upon, and any person with a gift or talent must fight to maintain their integrity in the face of the pressure to conform. There is very little opportunity to do things differently, simply because different implies “the unknown” – and that cannot be dealt with in a society in which trains run to schedule and everything starts and finishes on time.
I am thinking of a previous colleague of mine as I write. A well respected senior member of staff who was given a position of huge responsibility because of his obvious talents in administration. Not a permanent title, but one taken on rotation because of the stresses involved. All seemed to be going well. He displayed courage under fire. He maintained equanimity under duress. Until the time came for him to pass the baton to the next chosen person. The first signs that things were amiss occurred at the end of year party, when his sign-off speech lasted much longer than the normal five minutes. In fact, it became embarrassingly obvious twenty minutes later that he was not going to relinquish his hold on power willingly. There was hope that it was a momentary strain and all would be well at the start of the new year, however, when his outbursts in the staff room became a regular and embarrassing event, he was given a leave of absence that was protracted. No-one really mentioned him again. He was soon to be forgotten and only occasionally referred to, and then in quiet tones, as if he were dead.
Hush hush… seems to be the way to deal with mental ill health. It is a great unknown. The stories that abound of people being unendingly-incarcerated in privately run asylums in rural Japan are shocking because they are based on fact rather than popular myth. The science of psychiatry seems to be in the dark ages here, compared to the more enlightened practices in the West.
As a stranger living in a strange land, the prospect of dealing with emergencies usually occupies a background “what if” that is rarely considered fully. When the shit hits the fan though, it is important to take action. When it concerns not yourself, but a loved one, dear to many, it is even more crucial that the decisions made are life saving rather than the play-it as you go norms of daily life.
Last year the shit hit the fan for my wife.
There are many contributing factors to a breakdown. Those mentioned above in passing related to work, the stress of ageing parents, the blunt reminders of our own mortality and that our time here is finite. Whatever the reasons, the simple fact is that loss of mental health requires the support of many, if recovery is to be successful. Support networks, friendships and relationships are put to the test.
Depression has variations in severity. Many of us can understand some of the darkness that it brings through having experienced brief bouts after a break-up in a relationship, a loss or a disappointment of some sort. We tend to bounce back generally speaking and add the episode to our list of life experiences. The good, the bad, the ugly and the beautiful that forms the collage of life. Deep depression is an entirely different fish and one that lurks in the abyss of the lesser known. It is shocking in its transformative intensity. It takes its victim into such terrifying depths of despair that it is difficult to ever imagine being able to return with mind intact.
We are so fragile.
Keiko had not yet fully recovered from hip replacement surgery in the summer before having to return to work. She felt unable to concentrate on the tasks before her, or to handle what she felt were normal expectations. There was a quick loss of confidence in herself and an inability to see a solution. Our first emergency occurred at a weekend when regular support services were closed. Darkness had descended so quickly that I felt I could not wait. The emergency department at the Adventist hospital indicated that we could go to see the duty doctor, which is exactly what we did. The doctor could not really do more than the usual “take two ….. and call me in the morning.” The “two” in this case were benzodiazepine of some form or another – and as I was about to find out, a very common prescription given to those in Japan suffering from anxiety.
Sleep patterns became interrupted, some times non-existent. The stress of the stress was beginning to feed on itself. Luckily, Keiko was able to see the surgeon who had treated her for breast cancer two years before. Dr. Mayuko mentioned that the hormone replacement therapy she was on as part of her five year recovery plan may be partly to blame for the sudden turn of events. She allowed Keiko to be admitted to hospital under her care and that of a psychiatrist who visited rarely. The benzos continued with some tranquilising effect, but no other treatment was offered. It seemed odd to me that the psychiatrist was in a sense keeping her distance and was not at all interested in linking Keiko to treatment in the hospital she was associated with. I learned later on, that was perhaps a very good thing indeed.
Keiko came home after a period of two weeks, however her condition continued to deteriorate. It was difficult having to go to work in the morning and leaving her trembling at the door. I really did not know what to do and felt a panic beginning to rise. Where could I turn? How can I get help here in Tokyo when my language skills are at the perpetual level of the beginner?
Friends rallied around. We tried to arrange for Keiko to be in contact with someone at all times so that she would not be by herself. But still there were times when she would be alone and we all feared that she was suicidal. We managed to get an appointment with an English qualified psychiatrist who has a clinic in downtown Tokyo. It was a breath of fresh air in that he offered a planned way out through a known route using a prescribed course of mirtazapine, whilst gradually weaning her off the benzodiazepines that we know now are so highly addictive and only a short term option outside of Japan. However, our hopes were soon dashed when Keiko reacted adversely to the medication and began to spiral down faster.
I began to think that admitting her to care was really the only option left open to me. To date, it has been the most difficult thing I have had to do in my life. We were both fearful as there was some truth to the horror stories we had heard. It certainly did not help at this tender time to have people in the medical field in Japan warn me sternly not to proceed. I seriously considered leaving the country and heading to New Zealand to get help for Keiko. In the end though, after speaking with a psychiatrist friend in Australia and emotional support from TEL in Tokyo, the next step became clear. There was no choice. With the help of a Japanese/English speaking friend and after a day of travelling by car from one hospital to the next we finally found the possibility of admittance at Tama Sogo Hospital.
Yes, it was a secure ward. Patients are closely supervised and monitored. There are rooms where patients that need to be strapped down to stop them from self-harming are isolated. Yes, the route to recovery is through medication, routine, rest, regulated diet and sleep. Yes, they do succeed.
Anyone who has ever had anything to do in a professional sense with psychiatric nurses and doctors knows of the tough love stance taken. From the outset, Keiko was treated with respect and given the space to find the ground again. She was listened to and nurtured back to health by a doctor who seemed freshly out of high-school, but who demonstrated a depth to his being beyond his years. I visited Keiko almost daily and saw the slow turn around happening. We spent time on a intricate colouring-in project that would later become one of our shared treasures. The patients on the ward became close friends and helped each other through conversations that seemed to take the place of counselling. We saw broken people getting well all around us. This was a place of healing. A sanctuary for the mind.