Changing Cultures

Changing Cultures: The Evolution of Psychology and Depression in Sweden and Japan

Introduction

Psychology and psychiatry have always been outliers in relation to other medical specialties. Beginning in the twentieth century, professionals from various places took different approaches to the development of psychology in their countries. In Sweden, modern psychology developed as a response to the socialist movement and the creation of a public healthcare system. In Japan, modern psychiatry and psychology continue to be integrated with traditional Japanese cultural and health practices. In each country, culture and values have shaped the outcome of what psychology is today.

Japan and Sweden have also seen the development of emotion-related disorders as a result of conflicting cultures. For parts of each country, the development of depression, or a similar ailment known as neurasthenia in Japan, was related to a clash of cultural values. Japan was modernized and encouraged to adopt Western values in the era between the world wars. The Sami reindeer herding people in Sweden are currently undergoing a similar struggle as their traditional way of life is being threatened by a Sweden that values social participation. This paper will explore the similarities and differences between the development of the field of psychology in Japan and Sweden, and how each country has been affected by emotion-related disorders precipitated by a changing culture.

A Brief History of Psychology in Sweden and Japan

Development of Psychology in Sweden

Utilitarian Beginnings. The evolution of psychology in Sweden is closely tied to the economic and political changes caused by the implementation of a socialistic healthcare system (Skagius & Münger, 2016, p. 277). Initially, psychology in Sweden was a purely academic venture based in universities upon a culture of experimentation and research; psychology’s initial application value was in the world of testing Swedish citizens to determine their appropriate places in organizations and schools (Skagius & Münger, 2016, p. 277).

In a post-World War II Sweden, social harmony was highly valued, and the welfare state of the Democratic Socialist welfare state was in full production. The utility of psychology revolved around psychotechnics, which allowed students and employees to be placed in the appropriate setting based upon aptitude and personality tests (Skagius & Münger, 2016, p. 277). Psychology was therefore funded by the government, and had the overall goal of improving the quality of life for all Swedish citizens.

Economia Nervosa. The field of psychology had been allowed to flourish in the beginning of the era of socialism because of the perceived benefit by the public and economic prosperity. However, in the 1990s, Sweden endured and economic crisis. Before this crisis, almost all psychologists worked in positions funded by the government and it was not believed that they could work anywhere else. However, the government was pressured to reduce public spending, and some psychologists left the public sector.

Those who stayed in the public sector were the subjects of a systematic restructuring by economists who were obsessed with saving money and were therefore labelled as having “economia nervosa,” (Skagius & Münger, 2016, p. 280). Towards the end of 1992, the prevailing crisis amongst Swedish psychologists changed to a demand for higher wages and increased autonomy within the public sector; the public sector was obligated to conform with these demands because of the fear of losing psychologists to the private sector. Some psychologists also remained members of the public welfare system and did so because of their professional obligation to protect the disadvantaged and disabled (Skagius & Münger, 2016, p. 280).

Psychodynamic vs. Cognitive Behavioral Therapy. In the post-economia nervosa phase of Swedish psychology, psychologists were able to turn their attention back to the development of the profession. The conflict in this era was between psychoanalysis and cognitive behavioral therapy (CBT), or, as some saw it, between the unscientific and the scientific, the obsolete and the modern (Skagius & Münger, 2016, p. 281). Psychoanalysis fell out of favor, and CBT was seen as being superior due to empirical research that had proven its efficacy. However, some psychologists believed that their subjective clinical experience supported psychodynamic therapy.

During this time, psychological education in Sweden was being transformed. Previously, there had been a disconnect between the study of psychology and the practice of psychology. These two applications of psychology were brought together within Swedish universities. Psychoanalysis and CBT were still surely pitted against each other, as supporters of psychoanalysis fought against the simplification of humans as merely biological beings (Skagius & Münger, 2016, p. 283). Additionally, public funding for practitioners of psychodynamic therapy was waning, and students of psychology had to determine if they were going to be researchers and/or practitioners of CBT in the public field or devotees of psychoanalysis in the private sector.

Integration of Psychology with Traditional Japanese Medicine

The introduction of Western medicine in Japan led to a unique blending with traditional Japanese medicine, kampo, which in turn has led to a variety of psychological treatments combining with two ideologies (Daidoji, 2013, p. 60). During the Meiji period, neurasthenia became the most common emotional disorder in Japan, so most psychologists were focused on the treatment of this disorder (Daidoji, 2013, p. 59). It was during this period that Western medicine began to be practiced in Japan. The main implication of this phenomenon was a need for psychological treatments to be seen as scientifically supported (Wu, 2016, p. 457).

Integration. An example of the integration of Western medicine with Japanese kampo can be found in Wada Tōkaku. As court physician for the Japanese emperor, he focused on the liver as the cause of all diseases in the human body; constraint of the liver ki; agitation of liver fire; or liver poison (Daidoji, 2013, p. 63). When the liver is constrained due to a failure to be hardworking and industrious, ki cannot flow through the body and provide adequate circulation- leading to the disease known as constraint or neurasthenia (Daidoji, 2013, p. 64). Much like Western psychologists today, Wada suggested talk therapy and inpatient treatment for neurasthenia, and a return to traditional Japanese values.

The West is the Problem. Some Japanese wholeheartedly rejected Westernization and Western medicine and decided to embrace total reintegration with traditional Japanese culture as a cure for neurasthenia or other emotion-related disorders. Ishikawa Hanzan, a journalist, attributed his neurasthenic breakdown beginning in 1907 with a relentless pursuit of modernization and Western values (Wu, 2016, p. 459). His treatment for the affliction was to focus on the study of traditional theatre and music, and an attempt to be closer to nature through barefoot gardening (Wu, 2016, p. 460). He spread his healing practices with others and eventually became a leader for those who believed that pursuit a Western ideals was the culprit behind their discontent.

Cultural Conflict and Depression

The Swedish Sami Population

The indigenous Sami population of northern Sweden has been using their land, called Sápmi, to herd reindeer since 800 A.D, although evidence of their existence in Sápmi dates back over 6,000 years (Land is Life, p. 21-23). The history and traditions of this nomadic group were passed through their native language, which exists only in an oral form. A traditional way of life for the Sami became threatened at the end of the 19th century due to a Swedish policy of assimilation, when Sami children were forced to use exclusively Swedish at school (Land is Life, p. 22). Sami life has traditionally revolved around the patterns of reindeer migration, and a culture of self-sufficiency prevails.

Modern technology has altered the family-based herding system amongst the Sami, and now cooperatives usually form between herders to purchase equipment. The increased cost of reindeer herding has led to many Sami taking non-traditional jobs in order to provide sufficient income for their families (Land is Life, p. 23). Uncertainty in the future of reindeer herding, caused by conflicts between the Swedish government and the Sami, has led to Sami parents discouraging their children from pursuing a traditional way of life.

Colonization of Sápmi by Sweden introduced the concept of land ownership to a group which had previously looked after land that was divided based upon the needs of different families and herds (Land is Life, p. 30). Sweden took over rivers that had previously been used to allow reindeer to migrate on their own in order to harvest hydropower; these rivers became unusable for reindeer herding due to a decrease in the thickness of ice. The Swedish government has also encouraged farmers to settle on Sápmi to enhance the country’s claim to the land in the face of a changing Europe, impeding the Sami’s ability to use their native land effectively (Land is Life, p. 33).

Threats to their traditional way of life and living a life of discrimination has led to an increased prevalence in depression and anxiety in the Sami population (Kaiser, Sjölander, Liljegren, Jacobsson, & Renberg, 2010, p. 388). The increase in these psychopathologies is attributed to higher rates of substance abuse, poorer physical health, occupational stress, low levels of perceived control over one’s present and future, and limited social support (Kaiser et al., 2010, p. 384). This phenomenon is almost inescapable for the Sami population, as reindeer herding is seen as a way of life rather than a job. The unique culture and mental health needs of the Sami population are not considered by the Swedish mental health care system (Kaiser et al., 2010, p. 390).

Some of the symptoms of depression in Western cultures include depressed mood, diminished pleasure in activities, fatigue, insomnia, thoughts of death, and psychomotor agitation or retardation (DSM-V). These symptoms lead to an impairment in occupational, educational, or social functioning. Symptoms of depression are seen at a greater rate in Sami men than in other Swedish men (Kaiser et al., 2010, p. 390), and men in Sweden are at a greater risk of suicide than women (Reutfors et al., 2009, p. 61). The increased prevalence of depression may be attributed to forced assimilation by the Swedish government and the imperative to modernize herding practices in a Western, capitalistic economy.

Westernization of Japan

The beginning of the twentieth century, from 1912-1941, was known as the Taishô period in Japan (Columbia University, 2009). This period was defined by a booming economy and Western-inspired industrialization. Traditionally, Japan had been a collectivistic society that was largely agrarian. During this time, an illness called neurasthenia appeared in Japan (Suzuki, 1989, p. 187). Some of the symptoms of this disease, believed by the Japanese to be a physical disorder of the nervous system, included headaches, hypersensitivity, fatigue, mental distraction, and weakness- similar to the DSM-V symptoms of depression (Suzuki, 1989, p. 188). The use of the term neurasthenia was phased out en masse after World War II, and it was replaced by shinkeishitsu, a concept popularized by Japanese psychologist S. Morita (Suzuki, 1989, p. 189). Morita used this term to describe a depression-like condition caused by a “morbid disposition” related to an increase in individualism due to modernization of Japan (Suzuki, 1989, p. 188).

The modernization and westernization of Japan was believed to have ill effects on the physical and mental health of the Japanese people for a variety of reasons. Traditionally, Japanese health beliefs focused on the centrality of the belly, or hara (Wu, 2016, p. 453). A strong lower belly allowed for the adequate circulation of qi throughout the body, and therefore increased health. The belly was seen not only as the center of physical wellness, but also of mental wellness. The centrality of the belly was damaged by modern clothing, which restricted the movement of the belly and and forced shoulders outward when breathing. Instead of sitting on the ground with good posture, Japanese people began to sit in office chairs; all of this led to a top-heavy position, which contributed directly to neurasthenia (Wu, 2016, p. 454).

Westernization of Japan also introduced other practices that damaged the posture and psyche of the Japanese people. Entertainment, idle time for thinking, and military-style posture drills for school children fundamentally altered the culture of Japan (Wu, 2016, p. 455). Western sports also had a tendency to only focus on the development of certain body parts rather than the entire body, which led to a stagnation of qi and a congestion of the brain.

Currently, Japan is suffering from another disease of modernization. Modern-type depression is associated with young people in Japan who were raised in the presence of the internet (Misra, Hancock, Meeran, Dornhorst, & Oliver, 2010). The symptoms of modern-type depression include avoidance of strenuous work, a focus on individualism rather than collectivism, and a rejection of social norms; interestingly, these symptoms are only felt when at work.

Young people who are believed to be suffering from modern-type depression only derive joy from participating in internet-based games or other self-focused hobbies. They are unable to effectively contribute to the economy (Kato et al., 2016, p. 9). Modern-type depression, along with neurasthenia and shinkeishitsu, may all be maladjustment disorders related to the adoption of Western values in the predominantly collectivistic Japan.

Conclusion & Relevance

In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published, the first revision since 1994 (Bredström, 2017, p. 347). The American Psychiatric Association (ASA), which produces the manual, claims that the latest edition would be more culturally sensitive than the previous. However, some psychologists maintain that the DSM-5 is ethnocentric and focused solely on Western psychiatry, and that it emphasizes neurobiology as the basis of psychiatric disorders and fails to fully acknowledge the role that context and culture can play in the development of psychiatric disorders (Bredström, 2017, p. 351).

The field of cultural psychiatry formed after the publication of the DSM-IV in 1994, and has found that symptoms of mental disorders vary across cultures and affects how the individual comprehends and copes with the illness (Bredström, 2017, p. 351-352). Exploring the different manifestations of depression throughout cultures, and how these disorders developed in response to culture changes, is an important application of cultural psychiatry. Japan in the first half of the twentieth century is obviously quite different from modern-day Sápmi, Sweden, but each group experienced a clash of cultures that led to mental distress.

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