joshua thaisen

Sprawling in volcanic darkness along the northwestern slopes of Mt. Fuji lies Aokigahara Forest. Very little light filters through the dense canopy of Japanese cedar and fir trees, however iridescent brushstrokes of green moss cover the forest floor and vibrant bursts of orange fungi catch the eye from afar. In spite of it’s enchanted beauty, Aokigahara has a horrific history of suicide, and on a sullen and steamy morning deep inside a restricted area of the forest, Suki Tamura collapsed into a pile of decomposing leaves, unresponsive and shivering, as her body began to shut down from a self administered drug overdose.

 

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According to the World Health Organization roughly 30,000 people commit suicide in Japan each year, that is one person every 20 minutes. Suicide has become the number one cause of death in men aged 20-44, and overall suicide rates in Japan are 60% higher than the global average. These tragic statistics compound a public health crisis stemming from mental illness, and though the Japanese government has vowed to bring the total down, these numbers continue reflect an archaic, unregulated and overstretched mental healthcare system where social withdrawal issues effect millions of people.

 

There are many cultural aspects to understanding the behavior of suicide in Japan. Within Christian nations suicide has been historically refracted through a religious lens, and viewed as a sin, however in Japan this association does not exist. In WWII Kamikaze pilots were celebrated as national heroes, and in an older era the Samurai ended their own lives as a way of taking responsibility and maintaining their honor. However in modern day Japan majority of suicides are associated with depression and prolonged isolation.

 

Vickie Skorji is the director of Lifeline services at TELL—a Tokyo based non-profit suicide prevention hotline. Skorji understands that people who want to commit suicide “have stopped having productive problem solving capabilities. Most people have isolated themselves and are feeling like they’re a failure, hopeless, and worthless. It sort of closes in all their choices. So talking to someone to help them to think about problem solving and connecting again is really important.”

 

“Suicide isn’t wanting to die, it’s trying to find a solution to a problem. When someone is really depressed they feel like suicide is a solution, but it’s just one option out of a number surrounding a problem of depression.” Skorji explained.

 

There is a significant difference between the onset of suicidal thoughts and someone developing a plan to commit the act. TELL’s lifeline phone operators are trained in risk assessment to evaluate peoples state of depression and listen to the reasons why someone may want to die. This conversation is a pivotal point in suicide prevention because it creates an opportunity for counselors to discuss the reasons why the caller might want to live.

 

TELL field over 6000 calls per year, however due to a lack of volunteers they only have one phone line in operation from 9am to 11pm. Because TELL aren’t a 24 hour service, the calls they receive in the middle of the night are passed onto other international call centers outside of Japan. TELL is a member of the Federation of Inochi No Denwa, which was founded by Japan’s Lifeline Service that has dozens of branches throughout the country. However due to a high call volume conversations are limited to a maximum of 20 minutes and it can take over 50 attempts to get connected to their in-undated lifeline.

 

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An emergency response team from the Yamanishi Prefecture Fire Department was first on the scene, charging through the perilous volcanic terrain they were determined that they still had time to save Tamura’s life. An hour had passed since Tamura was last seen alive, and in that time lapse she had gone into shock, and was shaking uncontrollably in the fetal position on the wet forest floor. A young paramedic quickly went to work on Tamura, securing her airways and stabilizing her body onto the stretcher. Once they got oxygen flowing into her lungs the shaking eased and the paramedics became more confident that they could save her life. 

 

Frequent and decisive radio chatter took over from the soundtrack of the song birds that pervaded the forest beforehand, and whilst emergency services hurried into the forest, getting Tamura out safely required a well coordinated team effort as the conditions were extremely slippery and unpredictable.The well drilled emergency services from Yamanishi Prefecture were instrumental in saving her life, and less than three hours after ingesting the drugs she was in the back of an ambulance on her way to hospital. However, even if Tamura is lucky enough to make a full recovery she will be re-injected into a landscape of mental healthcare that is more focused on repressing emotional illness rather than confronting it head on.

 

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On a community level the biggest challenge facing suicide prevention is the cultural stigmatization of mental illness. Wataru Nishida —a senior psychotherapist, professor and counseling manager at Temple University Japan— believes that in Japanese society “there is a lot of stigma around the concept of counseling or psychotherapy. As if to say this is a foreign concept, but it is not. In Native American culture there is a healer, a medicine man, in many different cultures in different parts of the world there is always a designated person to create peace and positive energy to counter balance negativity. This is in the history of our human experience. The term counseling or therapy creates some unknown mysterious profession, when actually it’s about connection. Its about making connections from soul to soul, which we have been doing historically for a long time.”

“In Japan negative life experiences are taught to be hidden, and it becomes the individuals responsibility to deal with it somehow. Whereas perhaps in Western culture you might have a best friend you can talk to, even parents in some cases. In Japan— in some cases— its hard to seek out that deep level of help even within the family.” Nishida suggested.

 

Depression can be associated with 95% of people who commit suicide. In Japan one of the major issues surrounding depression is the continuous feeling of isolation created by a lack of resources to seek out effective help. The conditions of mental health that bring someone to commit suicide are universal but “what brings a person to be depressed is a variety of situations. From the elderly who have been isolated in rural areas, to men with economic situations, to women and their position in Japanese society, to the issues of bullying and stress in the school system for youth.” Skorji explained.

 

The direct opposite of isolation is life experience. Within the context of psychotherapy Nishida aims to cultivate a human to human connection that can act a template for future social interactions and emotional challenges. However more importantly, this relationship relieves the symptoms of isolation and develops self confidence in a way that the client can begin to explore themselves and other human relationships in a healthy way.

 

“I would start out by understanding where he or she is at because there is a reason for the human heart to feel that suicide is their only option. I would empathize with them, and validate that feeling. For them to feel understood when they’ve already decided that no one else could possibility understand them can provide hope. To get into that isolated place I would use our experience to give some hope, to give some light in their future.” Nishida explained.

 

However psychotherapists, counselors and psychiatrists in Japan are not held accountable by any regulatory body and there is no systemized education in place to ensure any consistency across mental health practices. This lack of oversight has created a climate of short term fixes and no long term accountability for the well being of Japans most vulnerable.

 

“One of the clear distinctive differences between Japan and the US, is that there is no standardized way of providing systemized education, meaning that when it comes to training and educating new therapists in the US, there is an American Counseling Association that oversees the quality of education in graduate schools. Meaning if you’re not credentialed by ACA—even if you go to grad school— you can’t claim to be a therapist. Here in Japan there is no such thing, so anyone can claim themselves to be a psychological counselor. In fact there are fortune tellers that can charge up to $400 US dollars an hour!” Nishida contended.

 

Furthermore the unfettered administration of psychotropic medication is adding to the community’s resistant posture towards talk-based therapy. This is creating a greater divide between psychological counselors and the larger mental healthcare system— to which psychotherapists are not included. The administration of psychotropic medication entails the prescription of drugs to treat an array of clinically defined mental illnesses including depression, anxiety, panic attacks and delusions.

 

Nishida has encountered many cases where the prolonged use of psychotropic medication has further exaggerated the symptoms of mental illness. “I do think we’re in a medication driven society, even for cold’s and minor illnesses. This is not a research based option— but I think that a lot of Japanese people think that mental illnesses can be cured with medication, rather than in conjunction with the necessity of psychotherapy.” Nishida argued.

 

“In the US when I have a client that I refer to a psychiatrist, the first thing I would do is get a consent form signed by my client so that I can talk to the referring psychiatrist about this client. That way I can freely exchange information between me and the psychiatrist because I will be continuing the care of this person during counseling. But here in Japan when I refer it’s not common practice for psychiatrists to recommend clients to continue therapy, especially if the person prescribing the medication is just a family doctor. Ethically speaking only a trained

psychiatrist would prescribe them. But here in Japan the lack of psychiatrists mean any psychical doctor can prescribe psychotropic medication without sufficient knowledge.”

 

“I think that either the psychiatrist or the psychotherapist, when introducing psychotropic medication need a consistency in releasing information. That in deciding for medicated treatment it is necessary that you have to continue psychotherapy until both parties agree this can be terminated. So again if our mental healthcare system was systemized in a such a way— this could be possible.” Nishida rationalized.

 

In Japan there is no rebate on their National Healthcare Card for counseling, so people suffering from mental illnesses can only get financial support for psychiatrists and medication. Skorji offered a more sympathetic argument for Japanese psychiatrists.

 

“At the moment most people will see a psychiatrist, often times for not more than five minutes if they’re lucky, and they will get medication. People may get more support on their first session, but after that it gets very short and very limited. Thats not because the psychiatrist can’t do the work, or don’t want to do the work, but they have a queue of people that they just can’t get through.”

 

Skorji believes that in order to improve the landscape of mental healthcare in Japan there needs to be a collective effort to de-stigmatize mental illness between the government, the media, mental healthcare services and the wider community. She also suggested that people need to have broad “access to psychotherapy and counselors in additional to psychiatric support. You need campaigns about that, you need to have a government that is behind that, you need to have open discussions about that, and we need accurate reporting.”

 

“There are clear guidelines that have been developed by the World Health Organization on how to safely report suicides and talk about it. We need to talk about it, but we need to talk about it responsibly following those guidelines, ensuring people know how to get support, ensuring that we don’t glamorize it, or sensationalize it, and that we don’t encourage clusters or copy-cat effects that we know occur. These are all really important, but talking about it sensibly and talking about it openly is really important. Maybe thats part of de-stigmatizing it as well.” Skorji insisted.

 

Both sources— who have dedicated their lives to the treatment of mental illness— criticized the Japanese media for appearing largely unaware of the thought patterns and perceptions their reporting inculcates in the community’s understanding of mental health.

 

“One thing I wish the media would do more of is to normalize our collective human experiences. Depression is something we all experience and I think talking about it will allow people to find a solution. I think if people are trying to hide or portray this human condition as abnormal of course people won’t want to talk or seek out help.” Nishida explained.

 

Police reports indicated that thousands of people have committed suicide in Aokigahara forest since the 60’s, and growing trends from the early 2000’s estimated that over 100 people per year end their life in the forest. The most recent information on Aokigahara dates back to 2010, where the National Police Association (NPA) said that 257 people had attempted suicide in the forest, however the total number of deaths is almost impossible to qualify due to the size of the forest. The NPA claim that 71% of suicides in Japan are committed by men due to economic

reasons, and as Japan falls on harder economic times the government has made a conscious decision to refrain from releasing further information regarding suicide rates in the forest in order to deter copy-cat effects. However this lack of transparency appears to be more consistent with the Japanese government’s desire to veil it’s national crisis in secrecy, rather than embracing the opportunity to re-sculpt, revise and improve it’s mental healthcare system in open discourse.

Suicide is a complex issue and a stigmatized behavior that is often met with equal scorn and confusion in both public and private conversation. This reality— however tragic— becomes easier to understand when refracted through an honest and compassionate view of human nature.

 

Nishida simplified the reasons for this confusion and disparity of opinion, explaining that,“We all like to understand phenomenon by categorizing things into our way of understanding so we can make sense out of it. But when you think about human emotional experiences, we can’t, it just is, it just is, I think for us to put that behavior into a box... it’s not fair.”

 

Skorji—who regularly collaborates with the World Health Organization and the International Association of Suicide Prevention— wants the public to know that “Mental illness is just like any illness, and there is support out there, there’s no need to feel ashamed about reaching out and getting connected. There is life after mental illness, and even a life with mental illness. It does not need to define everything about an individual and there is support and help out there. You don't need to suffer alone, there are plenty of options and we can connect you with those. You don't have to be alone.”

 

People in Japan who’re looking for quality assistance and someone to talk to about their feelings can contact the English and Japanese speaking lifeline at TELL on 03-5774-0992. If you would like to donate to TELL please go to www.telljp.com/help/donate