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Introduction

Research Question:

Japan’s Suicide Forest

Photo By Flickr User Wayne Hsieh

Show how Japanese history provides a valuable backdrop to understanding suicide-related attitudes
Address social risk factors among specific demographics
Examine how the following contribute to suicide in Japan:

socio-cultural values (e.g. seppuku, wa, collectivism)
social attitudes (e.g. stigmatization, suicide acceptability)
culture-specific phenomena (e.g., karo-jisatsu, netto shinjū,
inseki-jisatsu)

Aim: Examine the socio-cultural forces behind the high rates of suicide in modern Japan.

Are there socio-cultural forces behind the high rates of suicide in Japan? Why do culture-specific phenomenons like karo-jisatsu, or suicide by overwork, exist, and what is Japan doing to intervene?

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Background

Statistics

Japan has one of the highest suicide rates among developed, high-income countries (Kettenhofen, 2021).
Globally, Japan ranked 14th for suicide rates in 2018 (Dunghel, Sugai, Gilmore 2019).
While suicide rates has been declining over the past decade, they are still relatively high and there has a been a recent spike during the COVID-19 pandemic.

Other Variables: Outside of Socio-cultural Scope

During the 1997 Asian Financial Crisis, suicide rates spiked (Russel et al., 2017).
In 2008, The National Police Agency (NPA) identified that the causes of suicide for 15,000 out of 23,000 Japanese victims were health problems.

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Japanese History

Samurai Culture

From the 15th to 19th century Japan, seppuku, a form of ritualistic suicide by disembowlment, was practiced in samurai culture (Russel et al., 2017; Britannica, 2020).

Seppuku was considered the ultimate self-sacrifice and a demonstration of loyalty and honor (Russell et al., 2017).

Relevance Today

Traditional attitudes toward suicide are still portrayed in modern Japanese

media and literature.

Hagakure, a text about the Japanese Samurai spirit
Sonezaki-Shinju (Lovers’ Suicide at Sonezaki): a traditional puppet theater play

Junko Kitanaka (2008), PHd, claims that these portrayals contribute to the glamorization of suicide in Japan.

Japanese media often presents the suicide of political and public figures as an act of taking responsibility for mistakes (Kawashima et al., 2019).

Seppuku Depicted in Art

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Japanese Culture and Society

Collectivism

Wa (harmony) encourages individuals to suppress their personal

interests and freedoms in order to maintain harmony

(Genzberger, 1994).

Values on community are generally why Japanese people are

very conscious of themselves and others (Russell et al., 2017).

Differences in Emotional Expressivity

Uchida et al. (2009) studied emotional expression across American and Japanese people found a significant cultural variation in Japanese people in regards to their emotional expressivity.

Japanese people tended to experience emotions through social contexts and relationships, whereas Americans tended to experience emotion on an individual level. Aiming to avoid negative relationships, Japanese people tended to adjust to their environment.

Emotional Suppression -> Suicide Proneness

Joiner’s study (2005) on why people die by suicide found that those who suppress their emotions and are at higher risk for negative emotional outcomes are more prone to suicide ideation and attempts.

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Literature Review

Stigmatization

Mental-health-related stigma is still relatively high in Japan compared to other developed countries. (Griffiths et al., 2006, as cited in Kasahara-Kiritani et al., 2019).

In Ando et al.’s (2013) study on stigma surrounding mental illness (e.g. depression and schizophrenia), many reported that mental disorders are treatable, but only a handful of participants believed that recovery was possible.
Japanese people were more likely to consider factors like ‘weakness of character’ as the cause of mental illness rather than biological factors such as genetic predisposition (Nakane et al., 2005; Tanaka et al., 2005; Kurumatani et al, 2004, as cited in Ando et al., 2013).

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Demographics and Risk Factors

Male vs. Female

The NPA (2020) reported that 70% of suicide victims were male.

This large gap can be explained by suicide’s association with unemployment and economic recession (Desapriya, Iwase, 2003).

Elderly and Middle-Aged Men

“In 2020, the 50 to 59-year age group had the highest suicide rate in Japan with 20.6 suicides per 100,000 inhabitants” (Kettenhofen, 2021).

Suicides were often considered as “unpreventable, permissible, and a matter of self-choice” among the middle aged (Kageyama 2012).

Kageyama’s (2012) study of suicide-related attitudes amongst the elderly found that the Japanese senior citizens frequently experienced shame in seeking help and other demographic variables like health concerns and isolation.

Youth

Factors such as sexual orientation, drug abuse, bullying & harassment played a role in higher risks for suicide ideation.
These risk factors were also associated to promotive social factors in their environment (Hidaka et al. 2008).

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Karo-jisatsu

“Suicide by Overwork”

Inseki-jisatsu

“Responsibility-driven Suicide”

Netto Shinjū

“Internet Group Suicide”

Some Japanese workplaces implement “service overtime” (unpaid overtime labor that is not recorded).

implicit agreement between the employer and employee (Kawanishi, 2008).

Business management systems uphold 3 core principles:

Lifetime employment
Pay scale based on seniority
Loyalty to the employer

There is high value placed on ability to cooperate, be positive, and willingness to assist other employees (Kawanishi, 2008).
Strict responsibilities and pressures result in long work hours and mental

& physical exhaustion.

Taking one’s life to take responsibility for poor actions, mistake, oversight, etc.

Pertains to individuals who have a high social standing (e.g. presidents, principals, CEOs)

Contemporary form of suicide where individuals assemble online and plan to commit suicide together (Shibui, 2004, as cited in Ikunaga, Nath, Skinner, 2013).

Common themes of netto shinjū:

Sought shared experiences and hoped for their suicide-related

wishes to be accepted by others

Seked for confirmation of seriousness of intent

(Kawano, 2004, as cited in Ikunaga, Nath, Skinner, 2013)

Culture-specific Phenomenon

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Netto Shinjū Cont.

Channel-2 Japanese Suicide Bulletin Board

Out of 201 discussants, 25 (12%) reported negative views of suicide, 16 (8%) reported positive views, and two reported neutral views.
However, positive views of suicide frequently regarded death as a relief or escape from pain (Ikunaga, Nath, Skinner, 2013).

Among both positive and negative views of suicide, dicussants hold tolerant attitudes toward death and suicide.

Societal Influences Behind Internet Group Suicide

Many discussants shared their interpersonal conflicts; they showed a need for belongingness and importance of affiliation.

“...suicide pacts seem to involve individuals giving up, or subordinating, their autonomy to a collective decision, a group choice” (Ozawa-de Silva, 2008).
Ozawa-de Silva (2008, 2010) also notes how this shared fear of being “left behind” and rejected by society indicates a clear “dependence upon a perceived acceptance by others.”

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Analysis of Sources

Sociological Influences

When looking closer at netto shinjū, it is clear that Japanese culture and society play a notable role in Japan’s cases of suicide.

The role of sociality and selfhood also play a key difference between group suicides and individual suicides (Ozawa de-Silva, 2008, 2010).

Group suicides seems to be linked to the shared mentalities of Japanese people and society.

There is a recurring pattern of need for belongingness, which operates on a “dual dimension.”

Dual dimension: Need for others to give meaning in their life and the need for others to be with them to end their life (Ozawa de-Silva, 2010).

Oversimplification in Suicide Discussion

Japanese suicide is often reduced to the dichotomy between Japanese collectivism and Western individualism when it is much more complex. (Ikunaga, Nath, Skinner, 2013)

Thus, other sociological factors like selfhood, belongingness, affiliation, and the “dual nature of being both individual and interdependent” should be taken into account when discussing suicide (Ozawa de-Silva, 2010).

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Argument

Glamorizing attitudes toward suicide that still linger today

Collectivist values and maintaining social harmony

Emotional suppression

And avoidance of negative relationships

Greater suicide acceptability

Stigma of mental illness and seeking support

Need for

belongingne-ss and asserting autonomy

There is a clear correlation between Japanese culture/society and suicide prominence in Japan that is worthy of close examination.

Suicide proneness and prominence in Japan

Main Argument:

Suicide in Japan must addressed using the biopsychosocial model and treated in a multi-faceted way.

When the complexities of the perspective are not neglected, the socio-cultural focus is vital to understanding and addressing suicide.

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Discussion

Central Question:

Should Japanese suicide be categorized as a biological, pathological, or social issue?

Counterargument:

The common psychiatric view of suicide emphasizes the biological nature of suicide and classifies it as a chemical balance.

But, there is still disagreement among psychiatrists about approaches to medicalization and classification.

“The cultural legitimacy of ‘suicide of resolve’ is being challenged today by some psychiatrists” (Kitanaka, 2008).

Suicide of resolve: notion that suicide is a rational decision and an act of free will

Response:

The psychiatric view of suicide is harmful to patients because it reduces patient’s suffering and ignores social conditions entirely.

“...psychiatrists retain their focus strictly on the internal, biological mechanisms. This has an effect of conceptually shifting the agency—the locus of control—away from the suicidal patient” (Kitanaka, 2008).

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Discussion Cont.

Suicide Intervention

There is not yet qualitative analysis and studies proving the effectiveness of mental health services on Japan’s suicide rates, but over the last decade, it is evident that Japan has treated suicide as matter of great concern.

The Japanese government enacted the Basic Act on Suicide Countermeasures in 2006 (Yutaro, 2012, as cited in Yamauchi et al., 2018).
Japan was the first country to pass a law aimed at promoting preventive measures against overwork-related disorders (Yamauchi et al., 2018).

Suicide prevention efforts in Japan should focus on the acutal implementation/practice of laws, polices, and programs rather than the establishment of these reforms themselves.

Anti-suicide barriers at train station

Photo by Flickr user Pixeloflight

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Conclusion

All factors (e.g. biological, psychological, social) are

considered equally contributive to both normal and abnormal behavior

(King, 2020).

Many psychologists use this model to study and understand human brain and behavior.

An integrated approach that combines all perspectives

(e.g, socio-cultural, biological, psychological) is crucial to effectively understanding, recognizing, and combating suicide in Japan..

Suicide is a global issue!

“Globally, close to 800,000 people die from suicide every year. That’s one person every 40 seconds” (Ritchie, Roser, Ortiz-Ospina, 2015).

Preventative measures against suicide on a global scale should follow an integrated approach (i.e. biopsychosocial model) and should be a priority in the global public health agenda.

Biopsychosocial Model

Why This Matters

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Works Cited

Dhungel, B., Sugai, M. K., & Gilmour, S. (2019). Trends in Suicide Mortality by Method from 1979 to 2016 in Japan. International journal of environmental research and public health, 16(10), 1794. https://doi.org/10.3390/ijerph16101794

Russell, R., Metraux, D., & Tohen, M. (2017). Cultural influences on suicide in Japan. Psychiatry Clin Neurosci, 71(1):2-5. doi: 10.1111/pcn.12428. Epub 2016 Sep 13. PMID: 27487762.

Britannica, T. Editors of Encyclopaedia (2020, September 23). seppuku. Encyclopedia Britannica. https://www.britannica.com/topic/seppuku

Kettenhofen, L. (2021). Suicide in Japan - statistics & facts. Statista. Retrieved October 7, 2021, from https://www.statista.com/topics/5259/suicide-in-japan/#dossierKeyfigures.

Kettenhofen, L. (2021). Suicide rate in Japan 2020, by age. Statista. Retrieved October 7, 2021, from https://www.statista.com/topics/5259/suicide-in-japan/#dossierKeyfigures.

Kitanaka, J. (2008). Diagnosing Suicides of Resolve: Psychiatric Practice in Contemporary Japan. Culture, Medicine and Psychiatry, 32(2), 152-76. http://dx.doi.org.ezproxy.collegeofsanmateo.edu/10.1007/s11013-008-9087-1

Genzberger, C. (1994). Japan Business: The Portable Encyclopedia for Doing Business With Japan. World Trade Press. pp. 155. ISBN 978-0-9631864-2-3. Retrieved 5 October 2021.

Uchida, Y., Townsend, S., Markus, H., & Bergsieker, H. (2009). Emotions as Within or Between People? Cultural Variation in Lay Theories of Emotion Expression and Inference. Personality & social psychology bulletin, 35. 1427-39. 10.1177/0146167209347322.

Joiner, T. (2005) Why people die by suicide. Cambridge, MA: Harvard University Press.

Kawanishi, Y. (2008). On Karo-Jisatsu (Suicide by Overwork): Why Do Japanese Workers Work Themselves to Death? International Journal of Mental Health, 37(1), 61–74. doi: 10.2753/IMH0020-7411370104

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Works Cited Cont.

Ikunaga, A., Nath, S. R., & Skinner, K. A. (2013). Internet suicide in Japan: A qualitative content analysis of a suicide bulletin board. Transcultural Psychiatry, 50(2), 280–302. https://doi.org/10.1177/1363461513487308

"令和元年中における自殺の状況" (PDF). National Police Agency. 17 March 2020. Archived (PDF) from the original on 7 October 2021. Retrieved 7 October 2021.

Hidaka, Y., Operario, D., Takenaka, M., Sachiko, O., Ichikawa, S., & Shirasaka, T. (2008). Attempted Suicide and Associated Risk Factors among Youth in Urban Japan. Social psychiatry and psychiatric epidemiology, 43.9: 752-7. ProQuest. Web.

Ozawa-de Silva, C. (2008). Too Lonely to Die Alone: Internet Suicide Pacts and Existential Suffering in Japan. Culture, Medicine and Psychiatry, 32(4), 516-51. http://dx.doi.org.ezproxy.collegeofsanmateo.edu/10.1007/s11013-008-9108-0

Ozawa-De Silva C. (2010). Shared death: self, sociality and internet group suicide in Japan. Transcultural psychiatry, 47(3), 392–418. https://doi.org/10.1177/1363461510370239

Yamauchi, T., Sasaki, T., Yoshikawa, T., Matsumoto, S., & Takahashi, M. (2018). Incidence of overwork-related mental disorders and suicide in Japan. Occupational medicine (Oxford, England), 68(6), 370–377. https://doi.org/10.1093/occmed/kqy080

King, L. (2020). The Science of Psychology: The Appreciative View. (5th digital ed.) McGraw-Hill Education

Ritchie, H., Roser, M., & Ortiz-Ospina, E. (2015). "Suicide.” Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/suicide'