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Home , Seppuku, Suicide, Suicide epidemic, Suicide in Japan

: A Unique Epidemic in

Magdalena Wilson College of Arts and Science, Vanderbilt University

Japan, a country with a long , strong economy and stable political system seems like an unlikely place to encounter a deadly global epidemic. Yet, the unique history and , including its , media, and economy, create a setting in which rates of suicide are reaching unprecedented levels. The culture of Japan combined with the peculiar nature of suicide, which allows it to evade clear classification as a disease, creates an intriguing public health challenge for Japan in tackling this epidemic.

A high GDP, a literacy rate of 99 percent, a performing a form of more appropriate for healthy life expectancy of 72-78 years, and a health times of peace, or “suicide to follow one‟s lord budget of 1660 international dollars per capita (World to the grave,” (59) as an outlet for expressing their Health Organization 2005) are not the features valor and dedication to their lord. Seppuku emerged typically associated with a country from one yet again in a slightly different form in the 17th of the worst outbreaks of a deadly global epidemic. century Japanese legal system as a somewhat more Then again, nothing is really typical about the suicide dignified alternative to the penalty. Throughout epidemic in Japan. In general, suicide is a growing the next two hundred years, seppuku remained central public health problem globally, with international to Japanese society in its various forms until Japan suicide rates increasing 60 percent in the last 45 years began to modernize during the period in the late (World Health Organization 2009). More specifically, 1800s and early 1900s. During this time, the Japanese Southeastern and the Western Pacific regions of Asia government attempted to adopt a more Western view are disproportionately affected, representing 60% of on suicide and banned seppuku as a form of death the world‟s ( International penalty (Fusé 1980, 59). Despite the ban on seppuku 2008). Within this region of Asia, the suicide in official and political contexts, it continued to be epidemic is particularly devastating in Japan, a used as a form of voluntary suicide into the mid country that has seen at least 30,000 from 1900s. One of the best examples of this is the suicide suicide annually since 1998 (Hidaka, et al. 2008, 752). of 350 military officers following Hirohito‟s In Japan, suicide is inextricably tied to nearly every announcement of surrender during World War II facet of society, including its history, religion, media, (Gordon 2009, 225). While incidences of seppuku and economy, creating an intriguing public health have since become rare, as Fusé states, “[seppuku] challenge for Japan in tackling this epidemic. remains as a „romantic‟ tradition deep in the Japanese psyche” (59). Historical Context Another manifestation of suicide in Japanese Suicide is a dark thread that weaves through history that may be more memorable to the Western centuries of Japanese history as an integral part of world is the pilots that were used by the culture and society, manifesting itself in various forms Japanese during World War II. While the images of over the years. Fusé (1980) investigated one of the suicide bombers flying into Allied armies strikes only primary manifestations of suicide in Japanese culture, chords of horror in American minds, the kamikaze seppuku, which is “a ritualized form of suicide by pilots are viewed very differently in Japan, shown in ” (57). This form of suicide first the words of Japanese Captain Okamura when he appeared in 716 AD in the story of Harima, a young referred to the kamikaze pilots as a swarm of bees goddess who slit her stomach after fighting with her which die after they have stung (Axell and Kase 2002, god-husband. After such appearances in literature and 35). This comparison between Kamikaze pilots and mythology, seppuku spread to the military bees shows that for the Japanese, being a Kamikaze aristocracy during their rise to power in the 12th pilot is a natural role in society, just as it is natural for century as a form preserving one‟s honor from the a bee to sting its enemy and die in the hopes that the indignity of capture by the enemy. Acts of seppuku sting will protect its fellow bees. Axell and Kase then peaked during the Mongol invasion in the 13th further this idea, explaining that the many Japanese century, when the military conflict gave the samurai recruited to be Kamikaze pilots were viewed as myriad opportunities to use seppuku as a show of their eirei, or guardian spirits, of the country, a position valor. After the war, the samurai switched to held in high honor (200235). The honor of the eirei position made it easy to recruit young Japanese and (Wiseman 2008). Understanding of this perspective is thus, as the war went on, additional suicide weapons necessary in order to control the were developed such as the ohka (human bombs), and because consideration of the uniquely Japanese view kaiten (manned torpedoes) (Axell and Kase 2002). In towards suicide will undoubtedly need to be a central stark contrast to the American view of a suicide part of any public health measures targeting suicide mission as unfathomable, the Japanese see the use of rates in Japan. Also, one must recognize the other suicide weapons as strategic and the many men who cultural factors that do not necessarily affect died piloting these weapons as respectable soldiers perspective on suicide, but rather directly affect the who chose a commendable method of serving their rates of suicide. Two such factors are the media and country (Axell and Kase 2002). the . While seppuku and the Kamikaze soldiers represent the historical and militaristic traditions of The Media and the Economy , there are other cultural factors that In 2000 Malcolm Gladwell shook up popular have added to the current Japanese perspective notions about the spread of ideas when he introduced towards suicide. Religion is one such factor. As the concept of the tipping point, the small event that discussed in the World Health Organization‟s report serves as the pathogen in social epidemics. One on suicide in Asia, Vijayakumar (2002) has shown example he used to explain this concept was that that “religion may be protective against suicide, both highly publicized suicides could serve as the tipping at the individual and societal level, and this effect may point in suicide epidemics, citing one study that found be mediated by the degree to which a given religion that media coverage of suicides predicts higher rates sanctions suicide” (Hendin, et al. 2008, 24). This may of traffic fatalities, which are often indirect and less be particularly true in Japan, which has a unique mix public forms of suicide (Gladwell 2000, 224). This of , where 83.9% of the population is Shinto idea that media coverage of suicides increases suicide and 71.4% of the population is Buddhist, with many rates, something called the effect, has been people in both categories (CIA World reported in numerous studies, many of which also add Factbook 2005). Buddhism views suicide as “an the idea that the effect of the media depends upon how empty, act, which will lead to unpleasant receptive the audience is (Chiu, Ko and Wu 2007, consequences such as the loss of a child in the next 585). Stack looked at the effect of media coverage of rebirth” (Hendin, et al. 2008, 25). While this view suicides on suicide rates in Japan in particular from does not promote suicide, it also does not condemn 1955-1985 and found similar results to previous suicide as strongly as many other religions. Possibly studies done Western cultures. That is, only stories of more important, then, is the Shinto view of suicide, state citizens have an imitation effect; news stories of which “has little or no concept of the sanctity of foreigners‟ suicides have no imitation effect on the human life as this idea is understood in Western Japanese (Stack 1996, 139). Additionally, he found Christianity… and [permits] withdrawal from this life that the imitation effect was not greater in Japan than through suicide for a wide variety of reasons,” it was in the United States (1996140). Though Stack including both religious and purely personal reasons had predicted a greater effect in Japan due to ranging from patriotism to romance to philosophy to increased receptiveness to suicide in Japanese society, despair (Barry 1994, 57-58). The combination of the he instead found that the factors affecting the extent of Buddhist and Shinto view of suicide does little to the imitation effect are unclear. In general, there sanction suicide and thus, according to Vijayakumar‟s appears to be a substantial effect of media coverage findings, likely has little protective effect against on suicide rates in general and in Japanese society, suicide. In this way religion plays a role in the suicide something that should be considered when epidemic in Japan. constructing public health prevention measures for The historical traditions of ritual or militaristic suicide. suicide and the religious views towards suicide are While the link between the media and suicide vitally important to the present day study of suicide in rates is a recent discovery, Morselli drew a link Japan because they give indispensible insight into the between poor economic conditions and a rise in Japanese perspective on suicide. The historical and suicide rates as early as 1882 (as cited in Chang, religious context helps to explain why the Japanese Gunnell, Sterne, Lu & Cheng, 2009, p. 1323). Chang view suicide not as a sin, but almost as a virtue et al showed this link again in 2009 in a study of the effects of the economic crisis of 1997 and1998 on traditional epidemiological concept of communicable suicide rates in a number of countries in East and and noncommunicable disease. The classification of , including Japan. They found that the an epidemic as communicable or noncommunicable is economic crisis “was associated with an excess of significant because it determines how the epidemic is around 10,000 suicides in Japan, Hong Kong and treated and which prevention measures are employed. Korea” (1330). Moreover, of the socio-economic If suicide were classified as a communicable disease, variables studied, “changes in rates each outbreak could be treated as a uniform event were most closely associated with rises in suicide after with one common cause and thus one common the Asian economic crisis” (1330). As a result, prevention measure. If, on the other hand, suicide working-age men were the group that was most were considered more like a noncommunicable affected (p. 1330). Such information shows that the disease, prevention would focus more on encouraging economy is an important risk factor for public health lifestyle changes. officials to watch when monitoring suicide rates; and, In some ways suicide resembles a should economic turmoil occur, the working-age men communicable disease, which is defined as: are the target risk group to watch. An illness due to a specific infection agent or The above discussion serves to explain its toxic products that arises through through cultural influences why the suicide epidemic transmission of that agent or its products from in Japan is different from the epidemic in other an infected person animal or reservoir to a countries. The discussion also attempts to tease out susceptible host, either directly or indirectly the extent to which global risk factors such as the through an intermediate plan or animal host, media and the economy affect Japan in particular. As vector, or the inanimate environment. (Porta Bertolote & Fleishmann explain: 2008, 46-47) Global figures and statistics are very suitable Suicide fits this definition because it can be for giving a broad view of a problem, raising transmitted between people, as seen in the effects of awareness about it and providing a means of the media on suicide rates. However, there is no clear comparison with other problems. However, infection agent or toxic product that causes the they hide important regional and local infection, placing suicide outside the previously stated characteristics and cannot replace a sound definition of a communicable disease. In other ways, local system of monitoring suicide trends, suicide resembles the non-communicable diseases, including sociodemographic, psychiatric and which are defined as, “chronic conditions that do not psychological variables. (2002, 8) result from an acute infection process…[They] cause Analyzing the differences in the effect of global risk death, dysfunction, or impairment in the quality of life factors between countries is one step towards finding and the usually develop over relatively long periods - the local characteristics that are hidden within broad at first without causing symptoms” international data. Japan in unique because, unlike (Noncommunicable Disease Control 2002). Also, many other Asian countries, local data is available due according to Breslow &Cengage, are included to the country‟s strict system of reporting detailed as a form of noncommunicable disease (2002). information about all suicides (Hendin, et al. 2008, 8). Suicide fits in the given context of a Because the infrastructure is already in place, Japan noncommunicable disease in a couple of ways. In a currently has a better chance than many of its Asian majority of cases, suicide fits in the context of mental neighbors to discover the sociodemographic, illness, a traditionally recognized noncommunicable psychiatric, and psychological variables that Bertolote disease (Noncommunicable Disease Control 2002). & Fleishmann emphasize. In fact, “90% of people who commit suicide have one or more diagnosable mental illness” (Conwell and An Epidemiological Perspective Brent 1995). The other 10% of suicides that are not Understanding all of these variables requires preceded by mental illness can also be in the category the consideration of suicide from an epidemiological of noncommunicable diseases, but in the context of perspective. Unfortunately, viewing suicide from an instead of mental illness. However, because epidemiological perspective is a lot like wearing suicide itself is neither a mental illness nor an injury, sunglasses indoors; nothing is as clear as it could be. per sé, it once again falls outside traditional Suicide fits somewhere in the grey areas between the epidemiological definitions. Because suicide cannot be clearly categorized, prevention measures, at least in Zealand‟s journalists dismissed the guidelines soon Asia, resemble those from both categories. after their implementation. However, the journalists were not against the guidelines as a whole, but rather Prevention Measures only against the original format of the guidelines, Recently, Japan has employed a particularly demonstrated by the recent efforts of these same notable community-based suicide prevention program journalists to work with suicide prevention researchers in six communities around the city of Akita (Hendin, and collaboratively establish new guidelines for the et al. 2008). This program takes a multi-faceted country (Hendin, et al. 2008, 42). The stories of approach, including “raising public awareness, Australia and New Zealand leave hope that through …specialist training in suicide prevention, screening collaboration between the media and for , counselling (sic) for those who needed groups guidelines can and will be established in many it, and communal activities for senior citizens to more Asian countries. Additionally, there is hope that decrease isolation” (Hendin, et al. 2008, 32). One of these guidelines will, in fact, decrease suicide rates in the most unique aspects of this project is that it is “the the respective countries; but, to date none of the only one of its kind to have demonstrable measures to studies that aim to determine the effectiveness of evaluate its success” (200832). Using these media guidelines have been completed (Hendin, et al. evaluative measures the Japanese government found 2008, 44). that the program was highly successful, and it is now Both the broad public awareness campaigns planning to create similar programs in other and the specific media guidelines are advantageous in communities (Hendin, et al. 2008, 32). Other Asian their own way, one because it reaches a larger countries have not employed such holistic programs, population and the other because it more thoroughly but they are still taking action. Korea, New Zealand, addresses one of the risk factors for suicide. When China, Singapore, Pakistan, and Malaysia have all combined, as is occurring currently in many Asian established strong public education and awareness countries, they may be very effective in curbing the campaigns to inform the population about suicide and increasing rate of suicides in many of these countries. depression (Hendin, et al. 2008, 32-34). Both these Such combined efforts should be lauded because they general awareness campaigns and the multi-faceted require each country‟s public health officials to keep community approaches to preventing suicide resemble in mind the unique epidemiological nature of suicide a non-communicable disease prevention approach as and employ creativity and flexibility when crafting they aim to make broad lifestyle changes in the public health interventions. Additionally, however, population, a technique often used when fighting these public health professionals must remember that, obesity or cardiovascular disease (U. S. Department of as stated by the World Health Organization, “while Health and Human Services n.d., World Health the risk factors for suicide are universal, their Organization 2010). importance and nature differ across countries and In addition to the previously described broad cultures” (Suicide prevention in different cultures public health measures, some countries are also 2009). That is, while risk factors may be shared acknowledging the communicable characteristics of across countries, epidemics still have unique the suicide epidemic and thus taking more directed, manifestations in each country. For this reason public specific approaches to preventing single risk factors, health interventions need to be individually designed such as the media‟s influence on suicide rates. to fit into each country‟s cultural and epidemiological Australia, Malaysia, the Republic of Korea, and New setting. Zealand have all created national guidelines for media coverage of suicides, which have been met with Conclusions mixed success. Australia implemented a set of While this essay began by discussing the guidelines for media coverage in the country called unique characteristics of suicide in Japan, it also Reporting Suicide and Mental Illness, which “have reveals important lessons for dealing with non- been relatively well received by the media traditional epidemics in a larger context, notably the professionals” (Hendin, et al. 2008, 41). In contrast, immense necessity of considering the cultural context New Zealand tried to issue media guidelines in 1998, of a country and the unique characteristics of an but did not consult enough media personnel during the epidemic when forming public health interventions. construction of the guidelines and, consequently, New While globalization may be blurring the distinct cultural lines between societies, notable differences Conwell, Yeates, and David Brent. “Suicide and still exist between various cultures‟ views on suicide. Aging I: Patterns of Psychiatric Diagnosis.” For example, at least to date, globalization has not yet International Psychogeriatrics (Springer erased the thousands of years of unique history in Publishign Company) 7, no. 2 (June 1995): Japan that are shaping how the suicide epidemic 149-164. develops in Japan. 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