Suicide, mental health, and the pandemic in Japan

Guest: Dr. Yuko Kawanishi
Dr. Yuko Kawanishi is a sociologist based in Tokyo, who specializes in mental health, gender relations, and contemporary Japanese social issues. When in 2020, nearly 7,000 women took their own lives and the country experienced one of the highest suicide rates in the world, Dr. Kawanishi took interest. She joins us to reflect on the professional expectations, the stoic culture, and the social shame that created a perfect storm of pressure on women during the pandemic. Dr. Kawanishi breaks down the gender equity dynamics in Japan at large, and makes a compelling case for every woman to connect with the mental health services they need.
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Dr. Yuko Kawanishi Transcript

Sabrina Merage Naim
From Evoke Media I'm Sabrina Mirage Naim. With me is Kassia Binkowski, and this is Breaking Glass, a series of conversations with women around the world who are shattering glass ceilings and challenging social norms. They are audacious, gutsy, and their stories are echoed across borders and generations in a rallying cry that is changing the narrative for women everywhere. We head to Tokyo today to have a timely discussion on the mental health of Japanese women during the pandemic, the New York Times headline that grabbed our attention and sparked our interest in this topic read "as pandemic took hold suicides rose among Japanese women". In 2020 alone, nearly 7000 women took their own lives, putting the country at one of the highest suicide rates in the world. So we went looking for a local expert to understand why. Dr. Yuko Kawanishi is a sociologist based in Tokyo who specializes in mental health, gender and family relations and contemporary Japanese social issues.

Kassia Binkowski
Sabrina, Dr. Yuko breaks down for us the unique expectations that Japanese culture places on women. And we explore how some of those dynamics were exacerbated by the pandemic. But perhaps more interesting than that our conversation actually shed light on the gender dynamics in Japan at large. I for one was shocked to learn how poorly the country ranks on global gender equity indices and how men's mental health has actually been impacted as women push for greater opportunity and representation.

Sabrina Merage Naim
Right and there's still so much work to be done. From de-stigmatizing mental health services to lifting the intense shame and victim blaming being put on women, there's a lot to learn from this conversation and quite a bit left to do. Take a listen. Okay, Dr. Yuko Kawanishi, thank you so much for joining us today on what we feel is a very timely issue about mental health in Japan.

Dr. Yuko Kawanishi
First of all, thank you very much for inviting me to this.

Sabrina Merage Naim
So you specialize in contemporary Japanese social issues. And I'd like to understand a little bit better how modern demands on women specifically, conflict with some of the traditional cultural expectations and frameworks in Japan.

Dr. Yuko Kawanishi
You know, talking about the status of Japanese women is pretty embarrassing. You know, I mean, Japan is the third largest economy, implying the third most sophisticated, industrialized, Western country. We do have a pretty nice level of education and hygiene and other kinds of things. But when it comes to the status of women, they take a bottom. There is this famous international organization, that was a really famous organization that comes up with the result of "International Gender Equality Index". And I think in the latest one they covered the almost 150 nations based on their own indicators and Japan is like 121st.

Sabrina Merage Naim
That's surprising.

Dr. Yuko Kawanishi
And I noticed this more than 20 years ago. So Japan started to take up this as an issue. In those days, Japan was still the second largest economy. But anyway, it's pretty embarrassing, hasn't changed even though we have a wonderful constitution, in which men and women's rights are absolutely equal. And, you know, I mean, it's the same in the United States and in many highly industrialized nations.

Sabrina Merage Naim
So you're saying that even though legally, and on paper men and women should be treated equally, of course, in society and culturally those things have not progressed. I want to dig into that a little bit more because traditionally, Japan is a pretty stoic culture. And there's a tremendous amount of pressure that's placed on both men and women to excel professionally. And women have become much more professionally focused than in decades before. No longer solely relying on men to be the breadwinners of the family. And the implication of this is that men and women are getting married later. Sometimes they're even reserving sexual relationships for later in life. How does this pressure for national performance impact mental health?

Dr. Yuko Kawanishi
I think the reality at the beginning, the general picture is that growing up, all Japanese students are getting a lot of pressure from parents to excel in anything. And most Japanese women are very highly educated, you know, and they also aim to get a job after they graduate and even graduate from college. But talking about excelling professionally, they stop at a certain level. And they have to make this measure, and you can't do this point of their life. Oftentimes, if they choose to follow the path of their mother, like having a family, they have to choose one of them. And it's still the case. And many of these women, they do get a job after getting the finishing education which is a big difference. Compared to 40 years ago, everybody now thinks that men and women both get a good job. But then having a family, marrying, and again, the marriage and becoming a mother, they just think that they just can't do both. So I have to choose was one of them. And so a lot of Japanese women who are working, they retreat from the job market for a while, once they realize that they get pregnant, or more and more of them continue to work until they have a baby. But then when the baby's born, they also feel they have to choose. And then after a while when the children are big enough, you know, they would like to go back to the labor market. And they started to work again, but the picture environment surrounding their work, and the choices are vastly different. And that really affecting but that means women's mental health.

Kassia Binkowski
What about the stigma around mental health? You did your training in the United States, and you now practice in Tokyo. How does that compare and contrast between these two radically different cultures?

Dr. Yuko Kawanishi
We do have a stronger sense of stigmatization and shame. And plus, I think that many people still lack the knowledge about professional health professionals and support systems which are increasing and increasing its visibility far more compared to 10 or 20 years ago. We're making progress, but people just don't quite think about, “I'm so distressed, so let's go to professional people”. I believe that comes much easier to people in America.

Sabrina Merage Naim
In the past few years, we've seen certain trends come out of Japan to try and abate loneliness. Places like hostess bars, where men predominantly pay hostesses to essentially act like they're interested in him and give him attention, or cuddle cafes where people pay to cuddle or hold hands with a stranger at a cafe. And these are largely non-sexual activities that have become accepted in Japan as ways, again, predominantly for men to feel less alone. Are these outlets aggravating the social expectation that men have to pretend like they are always okay?

Dr. Yuko Kawanishi
Yeah, I think so. But funny, you know, this culture has been a Japanese contemporary culture for many, many decades.

Sabrina Merage Naim
Through the geisha culture. Yes, right.

Dr. Yuko Kawanishi
And you were so right in pointing out that it's nothing sexual. It's about more like playing the role and it's definitely catering to the men. And for geishas, the world is a little bit different. I mean, they go through this training to become a fine performer. But when it comes to the contemporary hostess… I do give them a respect, some of them very expressive hostesses, they have to be very intelligent and well trained. But their role is to make men feel good and help them raise the feel, you know, help maintain their high self-esteem.

Kassia Binkowski
I'm curious how this compares for women. I know that one of your specialties is family and gender relations. I want to understand, does the same pressure to be stoic exist for women as it does for men in Japanese culture? And if so, do they have similar outlets? I mean, do these kind of social activities and social outlets exists to serve the women as well?

Dr. Yuko Kawanishi
I think that Japanese women have a lot of social outlets. They have their own women's circle friends, they have much richer, personal relationships with other people outside of home, unlike their own husband. And also their time with their children is so strong and intimate. Which, honestly, personally speaking, I think is a bit of a problem. But it's another issue… but so they are the ones who are actually more, well supported informally, even though socio-economically, they definitely have a disadvantaged position in Japan.

Sabrina Merage Naim
Yeah, it's interesting to hear you reflect on how the contemporary hostess culture in Japan is really just a reflection of cultural practice that has existed for many, many generations. And of course, the geisha women, like you said, are trained and go through a trauma. You know, they leave their families at a young age, they go through a tremendous amount of training to learn how to be conversationalists, dancers, they play instruments, you know how to host for the men. And I just think its kind of interesting to hear that it's really a straight line between the two. But maybe one of the differences, and I want to hear you reflect on this, one of the main differences today is that there's a much larger percentage of the female population that are in the workforce. And like we said, men and women are getting married later, even having sexual relations later. So how much does that impact men now seeking out that culture of the hostess, or the cuddle cafes, whereas otherwise, it was just a kind of general business, social business practice. How much of it is really that men and women are not getting together as much as they were previously?

Dr. Yuko Kawanishi
I think it's a very good, interesting point. That psychologically, I think there might be more need for men, including younger men, to be given an opportunity to feel on surface, so professionally, feel good. Another picture I would like to give you is there are more and more women who are young and college educated, and they definitely have a different generation. They’re more ambitious, even though they might end up facing big obstacles later on. They are ambitious, and they are also good at communicating their ideas. And a lot of times my impression, also teaching in college and observing the young people in Japan, many Japanese men are becoming less than less confident about themselves. And they are a little bit overwhelmed by I mean, girls do very well at school. Also there's, I think maybe culturally a lack of good father models. I mean, depends on the family again, but there's generally a father absent culture in this country. So yeah, Japanese younger women are more energetic and looking forward. And younger Japanese men do not necessarily match up with their energy level.

Sabrina Merage Naim
That’s kind of what I was trying to get out, which I think is really interesting, is that before the patriarchal society that existed kind of placed men on a pedestal and put them in a position of being the head of the family and the breadwinners, and now that women are much more ambitious and very active in the workforce, I don't know… culturally, it seems like contemporary men don't know how to deal with that dynamic anymore.

Kassia Binkowski
I think it's really interesting though, considering you're seeing the implications of that in men's mental health. And yet, Japan is near the bottom of the gender equity index, like you said earlier. There's still a tremendous amount of work to be done. And it'll be very interesting to see how the mental health fares of both genders and kind of what takes place as hopefully Japan continues to climb that ladder.

Sabrina Merage Naim
So let's turn to the pandemic now. While we know that women have been disproportionately impacted around the world, Japan has some of its own unique challenges and circumstances. For example, in Tokyo where you live, one in five women live alone. And during the pandemic and during lockdown, that's a really challenging position to be in. So, we'd like to hear a little bit about, in what ways did the pandemic exacerbate burdens that women already shoulder in Japanese culture?

Dr. Yuko Kawanishi
Yes. First of all in Japan, we haven't seen the same kind of explosion of infections as we are battling in America. Mask wearing is a part of our culture. And also, everybody is more or less conforming to what is expected as a social norm. So that helped in the bigger cities. The housing situation is… I kind of miss American housing. I mean, I used to live in LA, but the housing situation it's more crowded and limited. So, I mean, just simple. You can imagine that people in a cramped, much smaller area, they have children, stress level goes up. And then where many women have their own work to do from home. And anyway, it's just that this whole thing about where, you know, domestic stress levels went up so much, and everybody is more or less stuck in a hole at home. Physically home, and as an expectation on a woman to play this same domestic rogue continues. So I think it's very easy for you to imagine that there's a lot of tension, and tension and stress can bring a lot of bad things out of the family and out of you. It's been difficult for women.

Kassia Binkowski
What you're describing isn't dissimilar from what we're seeing here in the United States, and in a lot of places in the world where women are shouldering a domestic burden on top of their professional, now work from home responsibilities. I'm curious though, about something we read with regards to Japanese culture, and that's that women often have this expectation that they will be the ones managing their family's health. In the case of the pandemic, do you think that Japanese culture placed any shame on women who became infected or whose families became infected?

Dr. Yuko Kawanishi
Yes, it's a shame-oriented culture, and people try everything to avoid shame. This is such a negative aspect of Japanese mentality. And the pandemic, surprisingly, people who got sick, and everybody has a potential of getting sick, they are often blamed for getting sick. And it's considered to me the personal responsibility. And the personal responsibility is shared by oftentimes very good mentality is by the closest unit like a family. So, blaming the victim has been often seen. And that really added another pressure to the family and to the woman if she became sick. And you might have heard that there was a woman some weeks ago, a couple of months ago, who ended up killing herself believing that she was responsible for infecting her family.

Kassia Binkowski
Yeah, let's talk about that. Because the suicide rates in Japan are something absolutely worth noting. I mean, in the last year alone, nearly 7000 women took their own lives. And that was the first year over year increase. It's our understanding anyway, in suicides in the last 15 years in your country. These are some of the highest suicide rates in the world. Why is that? What is it about the experience of the Japanese woman during this pandemic that drove to such tragic numbers?

Dr. Yuko Kawanishi
First of all, Japanese people have been described to have this propensity for suicide as a last resort because we are not a Christian culture, and we have a traditional Japanese cultural view of death that is a bit of a different one. There is not such a sense of guilt attached to it.

Sabrina Merage Naim
And no fear of hell, the way that religion often puts into people's heads probably.

Dr. Yuko Kawanishi
Yeah. But it's quite shocking that as you pointed out, under this pandemic, we do see a lot more women killing themselves than before. Because Japanese society was known for a high, high suicide rate among the industrial societies, but it was typically about men, right? You know, workaholic men who lost everything when they lost the job. Women are considered to be stronger and have more support, like I mentioned earlier, and they are probably more resilient, they have other outlets and stuff. But now it's a crazy abnormal situation everywhere, but definitely in Japan to get a sense of excessive, a little bit pathological, responsibility and guilt of infecting others.

Sabrina Merage Naim
I just want to go back to the underlying shame. I think that's the word that I'm taking away from this conversation, underline, highlight, exclamation point, which is that this shame oriented culture is the thing that is putting so much extra pressure, so much guilt, and really affecting the mental health of women specifically during this pandemic. Because something that they otherwise would not be able to control, i.e. contracting COVID, is being blamed on them. And that is a shame that cannot be tolerated.

Kassia Binkowski
Yes. Wow. That's unbelievable.

Dr. Yuko Kawanishi
But, you know, this blaming the victim kind of mentality has been particularly around for the last 20 years or so. I mean, Japan used to have a sense of community and trying to support each other and family time was stronger. So, something happened from 21st century and on.

Kassia Binkowski
What happened? That's so much more novel than I would have expected.

Dr. Yuko Kawanishi
Yeah, I wonder. Policy change?

Kassia Binkowski
Yeah, I mean, it's just an interesting thing. You were talking about this sense of shame that's deeply embedded in Japanese culture, but it's actually relatively new.

Dr. Yuko Kawanishi
And also, I would like to point out again since we're talking about culture, I’d like to point this out. When many Japanese children are growing up, we get a lot of messages from parents, good and sometimes bad, but I don't really hear this from America in any other countries. But many Japanese girls, boys, grow up by hearing their parents say, among many other good things that are supposed to be instilled, grow up to be somebody who does not cause trouble to others. It used to be my generation, but even today, it's like a sense of morality. You grow up to be a fine, grown adult, somebody who does not cause any trouble.

Kassia Binkowski
Don't be burdensome.

Dr. Yuko Kawanishi
Yes. And I was hoping that it just used to be my generation, but no, it's so strong. Maybe even stronger among young people somehow. So we should not cause trouble to others. So…

Sabrina Merage Naim
So then let me end it and I won't cause trouble for anyone. So let's double click on that, because high school girls specifically saw twice the number of suicides than in previous years. Do you believe that what you're saying around the don't cause trouble for anyone, kind of be on the sidelines? Do you think that that's the underlying reason?

Dr. Yuko Kawanishi
Yes. And also, they just don't know how to seek help. And also, unfortunately, there’s a family tie. I mean, there is increasing divorce, and definitely an increase of single mother families. And you know how single mothers can struggle. I really believe should address how to express your sorrow.

Sabrina Merage Naim
So Yuko, if I told you that the women of Japan were listening, and I give you the microphone, and I say what do you want to say? What is the one takeaway, the one message that you hope that women in Japan or even around the world to take away from this conversation? What do you want it to be?

Dr. Yuko Kawanishi
I would say it's perfectly okay to recognize and admit that you are distressed and feeling weak and sad. And it's actually a courageous thing to seek help. Actually, I say this to a lot of first time clients, because I understand if they are Japanese, it must have been one big step to overcome to come and see me. So I would even commend their courage. And also getting a little bit from ideas from Japanese culture, I believe that nothing lasts forever. And what you are experiencing, you might think is near the bottom of everything, but it's just a temporary thing and nothing lasts forever. You change, circumstances change. So no reason to be hopeless. And you'll be surprised also, once you're willing to seek help actually there are a lot of people who would like to help you - public and private. I don’t know, I might be too optimistic, but I believe human nature is such that we want to help each other.

Sabrina Merage Naim
Breaking Glass is a production of Evoke Media. Evoke is a nonprofit organization that exists in order to elevate the people and stories that are working to make the world a more unified and equitable place. Learn more at weareevokemedia.com

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