Answerman

Why Don't Anime Characters Go To Therapy?

I've noticed that in a lot of anime, when characters have very deep, psychological problems, nobody ever considers going to therapy or telling someone to seek professional help. After watching anime such as A Silent Voice and Anthem of the Heart, where there are characters who would seriously benefit from receiving psychological help, it baffles me that they never consider it. I know Japan has a stigma against those with disabilities, mental illness, and other things of the like, but I'm curious to know how Japan views therapy and psychiatry.

This is a difficult question to answer, because Western concepts of psychiatry and the understanding of treatment of psychiatric issues have simply not taken root in Japan. Freud, the now-outdated-but-still-revered founder of Western psychology never had much influence over there. Common clinical diagnosis like depression and anxiety have similar, but not identical, equivalents. This makes it very difficult to talk about Japan's psychology in Western terms -- we're not just speaking different languages but using different manuals entirely.

That said, the vast majority of people in Japan that might benefit from mental health care do not get it. Mental illness often carries a heavy stigma in Japan. There's a strong tradition of keeping your problems to yourself, so as not to burden others or embarrass your family. Most people don't connect biological issues with mental health problems, and are quick to blame the person's weak character for their issues. Several violent incidents involving mentally ill people turned into media circuses over the years, which only made people shun the mentally ill even more. As a result, few people want to go in for help because a diagnosis could be horribly shameful. Only about one in three of people with severe mental health issues seeks treatment.

Even if an individual did decide to get help, the accessibility of care can make it even more daunting. The government does not regulate mental health professionals (they decided that they should in 2015, but the latest writings I can find indicate that they're still working on building some sort of certification), and virtually no government or private insurance covers psychological treatment, forcing the patient and/or their families to bear the costs. Most antidepressants and other medications for treating mental afflictions are simply not available there. Western mental health organizations exist there, but primarily treat non-Japanese people.

Japan does have mental health professionals and psychiatric care programs, but they are primarily inpatient programs -- institutions, in other words. As a substitute for Freud, much of Japanese mental health therapy is based in the Morita method, named after its inventor Shoma Morita (1874–1938). Inspired by Zen practices, the therapy aims to lessen the effects of anxiety disorders with a combination of bedrest and occupational therapies to quiet the brain's constant analysis and judgement, and reawaken a fascination with life and the natural world in the patient. In this way, the treatment hopes to ease the patient into an acceptance of their circumstances.

Does the Japanese way of dealing with mental health problems work? Even that doesn't have a clear answer. While suicide rates have been going down in recent years, Japan still has one of the highest suicide rates in the world. But that figure doesn't clearly point to a systemic failure, since centuries of ritual and honor-related suicides have left current attitudes much more accepting of the practice than the Christian-influenced West. (This isn't to say that people aren't concerned about it, but more that the choice is not condemned so harshly.) This has led to an odd subculture of suicidal individuals online, who discuss their plans on forums and sometimes enter into pacts with each other.

The high rates of suicide and perhaps other signs have successfully alarmed both government and the general public that something isn't working with the current system. The government and various institutional bodies all seem to agree that change is needed, but due to societal attitudes and stigmas, change has been very slow to come.

Sources:

• Depression in Japan: Psychiatric Cures for a Society in Distress
• American Psychological Association: International Mental Health Professionals in Japan
• Review of Mental Health-Related Stigma in Japan
• Wikipedia: Morita therapy

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Anime News Network founder Justin Sevakis wrote Answerman between July 2013 and August 2019, and had over 20 years of experience in the anime business at the time. These days, he's the owner of the video production company MediaOCD, where he produces many anime Blu-rays. You can follow him on Twitter at @worldofcrap.