1980s >> 1988 >> no-1004-april-1988

The business of madness

This is the title of an article in Open Mind, the mental health magazine, for December 1987/January 1988. It deals with mental health “care” in prosperous, go-ahead Japan. The author. Dr Thomas Fahy, works at the Maudsley Hospital and his article is grim reading, making mental health care here, for all its shortcomings, appear enlightened.

In Japan 85 per cent of mental hospitals are privately owned. Patients can be committed on the say-so of one relative and one doctor (usually the administrator of the hospital concerned; hardly a disinterested party), which results in almost 80 per cent of admissions being compulsory. Two thirds of patients are kept in locked wards; average patient stay is over six-and-and-half years.

The system is designed not only to make money for those running the hospitals but to give profitable spin-offs to friends and relations. At the Bunoshin hospital where investigations had to be made into allegations of patient beatings and even deaths in suspicious circumstances, occupational therapy consists of eight hours work daily in the deep freeze food factory owned by the director’s family. When, finally, the government enquiry was instituted, lawyers were refused access to patients and the slowness of police investigations was explained when it emerged that the Assistant Superintendent of the hospital was a member of the police group making the enquiry.

Privately owned mental health hospitals have, for a long time, been one of Japan’s business success stories. Overcrowded wards and compulsory detention of patients for long periods, without any right of review or appeal, are good business. After all, when patients are paid for it would be foolish not to ensure that they are around for as long as possible. Modern capitalism is a stressful society and many families feel the burden of caring for mentally ill or feeble relatives is too great. As Etsuno Totsuka, a Tokyo lawyer who has been involved in trying to review and improve conditions pointed out, the dumping of the mentally ill may well be the necessary price of economic success.

Opposition to even the most elementary reforms is strong from interested parties who have ensured that, for instance, appeal procedures against compulsory detention will not be introduced. Considerable publicity is, rightly, given to abuses of psychiatric practices in Russia but, although the World Health Organisation suggested as far back as 1985 that the Royal College of Psychiatry could play an important part in exposing conditions in Japan, of which they are well informed, little or nothing has been heard from them. Could it be that here, as in so many spheres, it seems more important not to upset a profitable trading partner than to protect the rights and well-being of an impotent minority who are considered useless for exploitation in the profit-making process?

Eva Goodman