You’re the entrepreneurial type, let’s say, ambitious but a little unsure of yourself. What field is ripe for your energy and enthusiasm?
Have you considered pharmaceuticals? You could do worse.
It’s a ¥9.3 trillion-a-year market in Japan. The Japanese have a long history as eager consumers of medicine. It goes back to ancient times, when kampō (Chinese medicine) boasted not only curative powers but the cachet of an admired civilization. Today of course it’s “Western” medicine, with perhaps something of the same cachet.
Why suffer needlessly? For every complaint there’s a cure — isn’t there? Certainly for every complaint there’s a physician willing to prescribe a cure. And if a physician prescribes it, it must be beneficial — mustn’t it?
Depression. These are depressing times. A long-stagnant economy has thwarted many a budding career. Personal finances are stripped to the bone, social life is thin, marriage and children are out of reach for many. That’s on the merely personal level. Regionally, Japan feels increasingly isolated among unfriendly neighbors. Globally, the threats and uncertainties posed by geopolitics and climate change seem to mock national, international, corporate and human efforts to check them.
So how surprised should we be if clinical depression seems rampant? In 1996, says Shukan Gendai magazine, Japan had 430,000 reported cases; in 2002, 711,000; in 2008, a peak year, 1.04 million; in 2011, 958,00. The conventional wisdom is that reported cases are a bare fraction of unreported ones, and grossly understate the scope of the problem.
Or maybe they overstate it? Are depressed people ill, or simply unhappy? Where is the fine line between pathological unhappiness and what we might call healthy unhappiness — a rational, natural, possibly creative response to unhappy surroundings, circumstances, or the world at large, with its wealth of evidence that humans were not meant for unalloyed happiness?
Depression is relatively new in Japan — not unhappiness, of course, but the perception of unhappiness as a curable illness. The question Shukan Gendai poses is this: Does that represent a change for the better, or a change manipulated by the profit motive of the massive global industry known colloquially, and none too affectionately, as “big pharma”?
“Pharma” is very big indeed. It has reach and it has clout. The Japanese public got a sense of that earlier this year when the health ministry filed criminal charges against Novartis Pharma KK, the Japanese subsidiary of Swiss pharmaceutical giant Novartis, alleging company tampering with research data.
On a more quotidian level, Shukan Gendai quotes an unnamed psychiatrist describing a typical sales pitch by manufacturers of antidepressant drugs. On the front lines are flirtatious young women who visit psychiatric clinics and seductively invite psychiatrists to conferences at which the results of clinical drug tests are to be announced. Transportation: paid. First-class hotel bills: paid. Would the doctor be so kind as to grace our conference with a little speech? That would be so nice! Our gratitude would take the form of ¥100,000, or thereabouts. And if the doctor is seeking publicity or a professorship or a research grant, the firm is not disinclined to help those whose help it has received.
“That’s how they hook you,” the psychiatrist tells Shukan Gendai. “You feel under a kind of obligation to prescribe that company’s drugs. That’s how it is that doctors, as it were, ‘pickle’ their patients in medication.”
Back in August 1983, the American newsweekly Time put out a special issue on “Japan: A Nation in Search of Itself.” An article on Japanese psychiatry, titled “Increasing Signs of Stress,” noted some key differences between Eastern and Western practices. Depression, a seemingly inevitable concomitant of modern economic growth, was on the rise of course, but Japanese society, and the sufferers themselves, regarded it as shameful, a mark of failure and inadequacy. Therapy, for those few desperate or courageous enough to seek it, “may seem (to Americans) like anti-therapies or brainwashing.” The therapist typically “focuses on (the patient’s) ingratitude toward the sacrifices of other persons” — of mother in particular, of society in general. “Many patients break down crying, and some want to commit suicide out of guilt and regret. … The final message from the therapist is that the only escape from mental anguish is to plunge into acts of service.”
“Anti-therapy” indeed. It has about it a touch of the Dark Ages. But the pendulum was soon to swing — very sharply. 1999 was the watershed year. A campaign gathered steam whose animating slogan was, “Utsu wa kokoro no kaze” — “Depression is a cold in the heart,” an emotional sniffle, no big deal, certainly nothing to be ashamed of; a little rest, a little medication, maybe a lot of medication, will soon have you back on your feet.
Who orchestrated the campaign? Conductor-in-chief, alleges Shukan Gendai, was “big pharma,” with psychiatrists lending eager support. Suddenly, the magazine says, it became fashionable to be seeing a psychiatrist. It was what later terminology would describe as a win-win situation. Japan turned into a “mega-market” for antidepressive medication. Drug company profits soared, psychiatrists had all the business they could cope with, and patients — from genuine depressives to the merely discontented — had their “heart colds” attended to, or “pickled,” depending on the point of view.
Real depression is much more than a “heart cold.” In 2011, the Health Ministry identified it as one of Japan’s most dangerous illnesses, along with cancer, brain hemorrhage, heart disease and diabetes. The ministry said, in addition, that 24 percent of Japanese are likely at some point in their lives to suffer from some form of mental illness, notably depression. The question is not whether depression is real or not, but how much of it is rooted in brain chemistry and how much in an environment increasingly at variance with true human needs. To what extent are drug companies and the doctors they woo treating the disease, and to what extent are they merely exploiting it?