Psychiatrist Rika Kayama is an outspoken doctor specializing in mental illness, a best-selling writer and a popular social commentator.
Her latest book, “Shigamitsukanai Ikikata” (“A Way of Life in Which You Don’t Cling to Anything”), has sold 422,000 copies since it was published in July.
In the book, Kayama, based on her clinical experience and research, suggests 10 rules by which stressed people can live happy lives. The rules recommend people not cling to money, love or children — and not pursue dreams through employment.
The book, with its realistic and laid-back take on life, has attracted much attention — in part because one rule stated, “Don’t try to be like Kazuyo Katsuma.”
Katsuma, an economic analyst and writer of self-improvement books, has become an icon as a successful businesswoman and has many fans.
Kayama, however, in her book, says not everybody should work hard to improve themselves in the way Katsuma does — because some people are at risk of developing mental illness due to stress.
The 49-year-old doctor has treated such people for 23 years, and in pondering how their problems relate to social issues, Kayama has concluded that the way patients suffering from stress-related illness think about their condition has changed.
Decades ago most of her patients blamed themselves, but an increasing number nowadays blame others, she said in her book “Waruinowa Watashijanai Shokogun” (“I-Am-Not-to-Blame Syndrome”). Kayama’s analysis was that the spread of neoliberalism (a mix of traditional liberal concerns for social justice and emphasis on economic growth) in Japan in the last decade caused intensified competition among people, which lead them to blame their illness on their colleagues, family members or others in order to shield themselves from the criticism that develops in a highly competitive atmosphere.
Kayama offers deep insights into the human condition and she seems to be a perfect fit for her role as a psychiatrist. But she says her job was not her first choice of career and she has never been carried away with her work.
Born in Sapporo in 1960, Kayama, the daughter of an obstetrician, entered high school in Tokyo at age 15 and hoped she would become a scientist. Upon failing the entrance exams for the universities she wanted to attend, she studied medicine at Tokyo Medical University, where, as a student, she started writing for a minor magazine under the pen name Rika Kayama. (She reserves use of her real name for her work with patients and her private life.)
She wrote her first book, “Rika-chan Complex,” while working as a psychiatrist in a hospital in Hokkaido in 1991. In it she analyzes various mental illnesses. Since then, she has written more than 90 books on this topic, as well as social issues and culture. She is outspoken about famous people who experience mental illness, including Crown Princess Masako, who she says suffers from being career-oriented but is at a professional impasse.
Kayama works at a Tokyo clinic and at the same time has columns in newspapers, appears on TV programs as a commentator and teaches at the College of Contemporary Psychology at Tokyo’s Rikkyo University.
On a mid-November day, Kayama spoke with The Japan Times at her office in Tokyo’s Harajuku district.
In your latest book, you said growing numbers of people don’t feel that they live in happiness or are satisfied. Do you see a lot of these people at the clinic where you work?
People say the gap between the rich and the poor is widening in Japanese society, and I see this gap reflected in patients who come to the clinic. The clinic is focused on psychiatry, so everyone who comes has problems such as depression, sleep deprivation or fatigue. Although people can develop depression for no reason, there are causes behind the cases of many people. So I listen to patients talk about their life and I have found two different tendencies. First, more and more people in Tokyo face difficulties because they cannot find jobs or are forced to move out of their homes (because they cannot pay the rent). Some are threatened by debt collectors or suffer domestic violence. The realities these people face are clearly tough, and they need to solve these problems before receiving medical treatment. Second, many other patients don’t have such problems at all. They are in a good environment. They have houses and dependable incomes. But they are not satisfied with themselves, feel empty and get depressed.
Why are people in the second group unhappy and unsatisfied?
Not in mental science but in social psychology, it is said that when people become rich, they seek fulfillment and want to think of themselves as different from others: They want something to live for. Such hope may be inevitable in a rich society. And it is good to seek something to live for. But, on the other hand, some people are blind to their existing happiness, and they think, “I don’t have anything” or “I am not privileged compared with others.” They are denying themselves, which is a significant problem. Because people have easy access to a lot of information nowadays, they can see themselves relative to others and lose their own way of evaluating themselves, saying, “Others make much more effort than I do” or “Other people are more successful than me, even though they are same age as me.”
You wrote 10 rules to achieve happiness in the book. One of the rules is, “Don’t try to be like Kazuyo Katsuma.” Why is that?
There are people nicknamed “Katsuma” who aim to be like Ms. Katsuma. I have seen patients who are actually fans of Ms. Katsuma. They said they studied her methods vigorously but failed to achieve their goals. They blame themselves by thinking, “I am lazy,” or “I am one of society’s loser dogs (makeinu, a term used to describe single women aged over 30).” Even those who achieved their goals still think, “I am not as happy as Ms. Katsuma, and I don’t find life worth living everyday in the way she does.” Kazuyo Katsuma is a huge icon, especially for serious, hardworking women. I hope such women acknowledge and accept themselves, because they have worked hard enough and gained many things.
You debated Ms. Katsuma in the magazine “AERA.” How are your opinions different?
We have different models of the human precondition. Ms. Katsuma trusts human beings and believes everybody can achieve something if given opportunity and education. I think it is difficult to give everyone equal opportunity. And even if everyone is given equal opportunity, their personality can affect how hard they work. There might be freedom in not working hard. Some people, despite working hard, may have accidents befall them and fail as a result. Life holds uncertainty. I think it’s better to think that unexpected things will happen in life — extra bits, rather like the tabs used to glue together a cardboard box. Not everyone will be able to work hard and improve themselves. In that sense, I may not trust human beings. Ms. Katsuma doesn’t believe there are people who don’t want to make an effort. But I think it is human nature to be bad, lazy or dishonest.
In the book, you also included as a rule, “Don’t seek your dream in your job.” People often say, “Make your dream come true in your career,” or “Seek self-realization in your job.” Why do you think it is inadvisable to think this way?
I don’t mean that you must not seek your dream in your chosen profession. Because I also teach in a university, I see students who think, “I shouldn’t take a job I don’t really want.” Some students feel disappointed because they landed jobs in companies other than the ones they really like. They think they failed in their job hunting. But I think only a limited number of people get the jobs they actually want. And even those people later find the jobs are not that interesting. I think it is difficult to define what you think you like and what you think you don’t like. Of course, it is fortunate if you find you really love your job. But if not, you don’t need to be frustrated. Why do you work in the first place? I think you work to live. If you earn your livelihood, you succeed.
Was it your dream to be a doctor?
No. I thought I was not interested in human beings but rather nature and science, though I later found out that I had been mistaken. I wanted to be a scientist, so I tried to get into the relevant universities. But I failed for two years straight. Then my mother, who was more realistic, said to me, “Women have difficulty finding jobs in the scientific field. So you should go to universities where you can obtain certification that you know will help you land a job.” I followed her advice. Even then, I failed the exam for my first choice of university, and I ended up entering a private medical university. I was disappointed, and my parents were, too, because the school fees were expensive. Even after entering the university, I was not interested in medicine, and I felt glum. I decided to be a psychiatrist because I thought I couldn’t work in other medical fields, such as surgery. I was afraid that as a surgeon I might hurt patients.
You have worked as psychiatrist for 23 years and have written so many books based on your professional experience. What motivates you to write?
I write to escape. As a university student, I was not interested in medicine. I worked part time in a small company doing subcontract editorial work. I started to write for the company. When I graduated, I stopped writing. At that time I thought I had to become doctor and earn a living because my parents said they would not send me any money. But I started writing again as a form of escape when I was in doctor training and having a tough time.
What kind of changes have taken place in psychiatry in the last 23 years?
People’s understanding of psychiatry has improved a great deal. They don’t regard psychiatry as special anymore, and they are at ease to see a psychiatrist. That’s a good change. We see patients of all ages and backgrounds. Overall, the number of patients suffering serious mental illnesses has fallen and mild cases of illnesses have increased, though psychiatrists still don’t know why. Decades ago, the difference between people who do and don’t have mental illnesses appeared clear. It is now becoming less clear.
Are the number of patients who suffer from serious depression and schizophrenia decreasing?
Yes. Schizophrenia patients in particular are in decline. Meanwhile, more people are suffering from depression. I have also had many cases in which I found it difficult to diagnose the illness as either depression, adjustment disorder or personality disorder. But their symptoms are those of depression.
Since you became a psychiatrist, the economy has gone through great changes. The bubble economy burst, the IT revolution-induced boom occurred and ended. Then the financial crisis in the United States last autumn triggered recession in Japan. Does such economic change affect people’s mental health?
Yes. Many people suffer from depression caused by recession. Not only recession but also a lack of trust, I think, can cause depression. The public lost trust in goods and people, because of mislabeling of food products, faked earthquake-resistance building data, and bureaucratic scandals. People don’t trust each other. The introduction of performance-based salary systems, too, create an atmosphere in which employees think only of themselves and regard colleagues as rivals. People’s wariness and tension has increased and that causes stress, I think.
What do you make of the fact that more than 30,000 people have committed suicide annually in Japan in each of the past 11 years?
It is very serious. The number of people who killed themselves exceeded 30,000 in 1997, when the economy hit the bottom and the number of unemployed and bankrupt people increased. After that, the economy seemed to recover due to structural reform. However, 2003 saw a record number of suicides. Even though the economy recovered, more people killed themselves. This is rich in irony. Since then, we’ve realized that not just economic problems but also uneasiness and lack of trust among people drive them into isolation and lead them tocommit suicide. Recently, public sentiment has shifted to the view that measures to prevent suicide should involve not only creating employment but also fostering in people a healthy mentality. This has been reflected in the government’s enacting of the Basic Suicide Prevention Law in 2006.
I wonder whether it is quite difficult for people to renew their trust in society.
That’s true. I am involved in measures companies are taking with regard to the mental health of employees. Officials at these companies say employees taking sick leave due to depression have risen following the introduction of performance-based salary systems. Development of information technology has brought less direct communication between employees as they communicate by e-mail. Flexible working hours also reduces the opportunities employees have for seeing each other. Nowadays many companies try to increase direct communication among employees by having meetings and organizing such events as company excursions and sports days.
While some people suffer from depression and commit suicide, you observe in your book, “Watashiwa Utsuto Iitagaru Hitotachi” (“People Who Want to Say I Am a Depression Patient”), that there are people who want to be diagnosed as depressed. When did such people appear?
Around the year 2000, I guess.
Do they feel relieved if they are diagnosed as having depression?
Yes. As the atmosphere in society becomes less generous toward people, there are people who cannot achieve the goals their bosses set them. So they have to take full responsibility for their failure. The situation is well expressed through the popular use of the word “jikosekinin” (personal responsibility). Because it is hard for them to take full responsibility, they want to be diagnosed as having depression so, they believe, they can be exempt from their responsibility. They think, “I am not to blame; depression is to blame.”
The stigma attached to depression used to be strong. Employees suffering depression were often fired just because of their illness. Is there less of a stigma surrounding the disease now?
Yes. It is because depression has been promoted as a topic of education, which I welcome as psychiatrist. However, there is a tendency for people who are not actually suffering from depression to declare themselves victims of the disease.
More and more celebrities have gone public about their mental illnesses in recent years. Among them is the Crown Princess, who has suffered from adjustment disorder since 2004. What do you think about her case?
How to improve the work-life balance, including for women who work and raise children, is starting to be discussed in Japan. Princess Masako is among the first generation of women to get jobs on par with those of men after the Equal Employment Opportunity Law was enacted (in 1986). I believe she has a strong desire to achieve fulfillment through work, as she was probably taught that “if women study hard, they can attain equality with men in the workplace.” She sought independence through work. Although she married Crown Prince Naruhito, she didn’t want to be a Cinderellalike princess. I think she strongly hoped to use her talent and her role to engage in Imperial diplomacy. But the Imperial system didn’t allow for it. Because she is strong willed, she wouldn’t change her mind and has experienced stress for years.
Do you think pressure to bear a “future prince” also put stress on the Crown Princess?
I think so. It is not possible to guarantee a baby will be a boy. Princess Masako, who is probably good at clearing goals she sets herself, must have been at a loss at being expected to do something she cannot control. The public know it is not good to put pressure on her but they still expect her to bear a future prince because that has been the way in the Imperial family through the generations.
Not only the Crown Princess but also regular women feel pressure about marriage, bearing children and self-fulfillment. Have you experienced such stress?
I am a few years older than Princess Masako. My generation was also raised to expect a rosy future for women that would include equal job opportunities. I believed it and chose to work. Fortunately or unfortunately, when I was in my 30s, people didn’t speak negatively about unmarried women who chose to follow their careers. So I was comfortable with working and felt no stress. But when I entered my 40s, people began discussing the low birth rate and started to call unmarried women “makeinu” (loser dogs). I asked myself whether it was in my interests to marry, but I decided it was too late. If I was now 37 or 38, I would be anxious about not getting married because words like “konkatsu” (marriage hunting) are thrown about so often. Many women of my generation who don’t have children feel inadequate because they contribute to the low birth rate. They feel they haven’t done their duty. Many of my friends lost self esteem because they didn’t have children. But I don’t think they should have to feel that way.
You wrote the books “Kireruotonawa Nazefueta” (“Why is There an Increase in Adults Who Crack Up?”) and “Waruinowa Watashijanai Shokogun” (“I-Am-Not- to-Blame Syndrome”). In recent years there seem to have been more rampages against people in public, such as the June 2008 massacre of four pedestrians in Akihabara. Do you think the criminals blame their crimes on other people or society, not on themselves?
I think they were unsatisfied because they weren’t able to attain the dreams they had for their careers. The alleged murderer in the Akihabara case was a temporary worker, so he might have been anxious about the expiration of his contract. In that sense, society has a problem. But perhaps he wasn’t thinking logically about the flaws in his way of thinking and the problems in society, so he directed his anger at people who had nothing to do with the cause of his troubles. While there have been a few cases in recent years where groups of young people have demonstrated against authorities in Japan, most youths nowadays don’t protest society’s shortcomings. They are obedient to authority even though our political and social systems are failing them. Some young people, however, build up a lot of frustration, and their anger suddenly erupts. They go into a negative spiral.
In your book “I-Am-Not-to-Blame Syndrome,” you wrote that some of your patients nominate a “former life” as the cause of their mental illness. Why do you think such people turn to spiritualism?
People want their lives to be special and want to live differently to others. But not everybody can achieve that. More and more people seem unsatisfied and think, “My life should not be like this.” Although they tell themselves “I have not tried enough” or “It’s society’s fault,” they usually don’t act to protest society’s flaws or to improve their situation. Then they look for reasons for why they are unhappy. I think they want a reason that has nothing to do with themselves but provides answers. If the reason is a “former life,” “guardian spirit,” or something separate from themselves, then there’s nothing they can do about it. Spiritualism seems to offer a convenient way for such people to think about their unsatisfied state of mind.
How is such spiritualism different to established religion?
I have considered the question of why people choose spiritualism over religion. Probably because religions such as Buddhism and Christianity teach that not just you but all people should be saved; those who pursue spiritualism have a strong desire to be saved but don’t pay particular attention to other people.
Why do believers in spiritualism, which you write about in your book “Supirichuaru ni Hamaruhito, Hamaranaihito” (“Those Who Believe in Spiritualism and Those Who Don’t”), believe things that have no basis in science?
I think it is because when something is unscientific and impossible to verify, it is easier to accept. If spiritualism had to be grounded in scientific fact, believers would have to approach it logically.
You wrote in that book that the psychology of seeking something easy to accept is the psychology that was at the forefront of public thinking when former Prime Minister Junichiro Koizumi was in power. Why?
Koizumi put a simple question to voters that they could not test. It was a choice between two options: “Go for postal reform. Yes or No?” The question gave voters nothing to test; they had to either go with his opinion or not. This is similar to the case of spiritualism; if people believe it and follow it, they feel as if they are saved.
The Democratic Party of Japan won the August general election, ushering in a change of government. Prime Minister Yukio Hatoyama said he would seek to improve people’s lives with a philosophy of “fraternity” and ensure that the perspectives of the disadvantaged in society and minority groups are respected in politics. Do you think government can change society?
Realistically, government will find it hard to change society. But we don’t have any choice but to resolve to entrust the task to government. Neoliberalism expanded in this decade, and during that time a limited number of powerful and hardworking people led society and succeeded. They were considered celebrities and gave little regard to weaker members of society. The gap between rich and poor expanded. So neoliberalism didn’t work very well. We have to create a society in which the disadvantaged and minorities have a sense of security in their life.
You are active as a psychiatrist, writer and university professor. Do you have any goal you seek to achieve in future?
I have no vision for my future at all. But if I must say something, I hope I am always on the side of those in society who are depressed at having failed at something. I hope there are fewer people in this situation in the future, but there will always be those who suffer in any good society.