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February 2010
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Tue, Jan. 13th, 2009 03:29 am
Utsu: drugging the ordinary sadness of Japanese and children

"Utsu is the Japanese word for depression," proclaims a Helvetica caption in the elegant trailer for Mike Mills' 2007 documentary Does Your Soul Have A Cold? "Before 2000 utsu was seldom heard outside psychiatric circles. The concept of depression as a mental illness was virtually unknown in Japan... In 2000 the first Western pharmaceutical company began selling antidepressants in Japan. Utsu is now common knowledge."

I ran this "fact" past some Japanese friends. They all told me it wasn't true; that utsu was in fact a fairly commonly-used word long before 2000, and that anti-depressants had been advertised and sold in Japan since the 1960s.

Mike Mills repeats his thesis in this interview given when his film showed at SXSW in Austin, Texas: "Before 2000 they didn't really have a commonly-used word for depression, they didn't really know about depression, and they definitely didn't really know about it as, like, a mental illness that could be dealt with or cured or treated," Mills said. "And so companies like GlaxoSmithKline came in with these very large ad campaigns and website presence and symposiums and taught people about depression and their version of how to fix it."

But Mills adds a sort of disclaimer: "My film is more a portrait of five people who are taking anti-depressants than a heavy-duty reporting on GlaxoSmithKline or something like that." The story of a golden age before anti-depressants forms a kind of mythical backdrop to these five portraits. There are shades of the Garden of Eden and the Tree of Knowledge in his tale, but transposed to Japan; in Mills' telling, malaise is seen as a positive quality in Japanese folk stories, and Buddhism sees pain as an integral part of life. GlaxoSmithKline is the foreign snake suggesting the Japanese innocents bite into the apple.

Even if I'm a bit skeptical of the mythical backdrop to Mills' documentary, I think he's probably right about the lengths to which big drug companies are prepared to go to extend not just the definitions of mental illness into ever-more-normal areas of pain and anxiety, but also the categories of people they're prepared to prey upon. In a shocking article in the current New York Review of Books entitled Drug Companies and Doctors: A Story of Corruption, Marcia Angell exposes the kickbacks authoritative figures in US medical circles are receiving to whitewash new medications from major drug companies. She also shows how drug companies and professors of psychiatry like Dr. Joseph L. Biederman are encouraging doctors to diagnose children as young as two years old as "bipolar" and prescribe cocktails of powerful drugs.

"We are now in the midst of an apparent epidemic of bipolar disease in children (which seems to be replacing attention-deficit hyperactivity disorder as the most publicized condition in childhood)," Angell writes, "with a forty-fold increase in the diagnosis between 1994 and 2003. These children are often treated with multiple drugs off-label, many of which, whatever their other properties, are sedating, and nearly all of which have potentially serious side effects." Many of these drugs have never been approved by the FDA, and none of them have been approved for children below the age of ten.

There are parallels between the penetration of psychoactive drugs into new markets (Japan, children) and the mortgage crisis which triggered the great financial meltdown of 2008; in both cases sheer greed, aggressive marketing and spurious redefinitions have expanded markets in ways which delivered immediate new sources of profit, but also exposed everybody involved to new risks. Just as American banks were developing their ingeniously stupid No Income No Asset (NINA) mortgages, the mental health industry was developing criminally irresponsible No Illness No Effect (NINE, I guess) medications: drugs prescribed for perfectly normal types of sadness, and often no more effective than placebos. Angell describes how FDA reviews of the six most widely used antidepressant drugs approved between 1987 and 1999 -- Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor -- found that, on average, placebos were 80 percent as effective as the drugs.

This didn't stop GlaxoSmithKline from making $2.7 billion annually in sales of Paxil alone in 2004. Capitalism -- doesn't it make you sick?

The process by which drug companies expanded definitions of mental illness even to ordinary conditions of the human soul is covered well in Adam Curtis' BBC documentary series The Trap. Here are two excerpts from the series covering the invention of conditions like OCD, ADHD and PDSD:

Dr Robert Spitzer, the creator of a simple new diagnostic system based on yes / no responses to questions about surface symptoms, admits to Curtis that he may have over-diagnosed mental illness by between 20% and 30%. The computerised system, launched in 1979, came back with the startling "finding" that more than 50% of Americans suffered from some type of mental disorder: a "hidden epidemic".

Context was ignored; "we don't know the causes, but this is what these new conditions look like". The new conditions -- OCD, ADHD, PDSD, SAD -- were met, conveniently, by new drugs from the major drug companies, SSRIs like Prozac, which modified behaviour chemically. Spitzer's checklist became a powerful guide to what was considered normal and abnormal, and people came to doctors expecting prescriptions for chemicals which would take away perfectly normal, realistic and, in many cases, appropriate mental states like fear, grief, anxiety, disappointment and loneliness. Social problems were medicalised, political solutions tranquilised.

When the American adult market became saturated with these abnormality-defining conditions and the normalcy-bringing drugs associated with them, it was time to move on to new markets: children and -- apparently -- Japanese people.


Tue, Jan. 13th, 2009 04:23 pm (UTC)

It's important not to confuse sadness with clinical depression. I've known people who suffer from depression, and if it were a matter of just being sad, or down, it would have been a tremendous improvement for them. It's more a matter of mental anguish leaching into your physical pain receptors. You can't fucking move, and if you could move, you'd take the first opportunity to kill yourself. Read Dick Cavett on the subject. He's an articulate victim.
That said, sadness is one of the defining aspects of a person's character. It's frequently the shadow of creativity.
I can't remember the exact quotation, but Nabakov said something to the effect that our sadness is the thing that is most uniquely our own, and up until now, it was inviolable. The effort to monetize it is bound ultimately to result in a society of dipshits.

Tue, Jan. 13th, 2009 04:55 pm (UTC)

And these days some people get a different type of medication, often one that is cheaper to produce, which is worthless. If they have Parkinson's and get a medication that doesn't work it can go considerably wrong.

My grandmother, for example, got some new medication for Parkinson's and it gives her hallucinations among other things. Completely worthless!


(no subject) - (Anonymous)
Tue, Jan. 13th, 2009 05:03 pm (UTC)

the talk of depression instantly reminded me of this marvellous collection of pics of various derelict places in japan -like a sort of metaphor. faded glories and all that. here:http://home.f01.itscom.net/spiral/research.html

ReplyThread Parent
Tue, Jan. 13th, 2009 05:57 pm (UTC)
Heroes and villains

ooh momus on sociology of medicine, total win.

I'm always a bit dubious about any model in this area where individuals are the unwilling victims of a corporate conspiracy to rebrand subjective human experience. it seems to me that there's something very seductive about reframing our emotions and social problems in reductionist biomedical terms, we need to embrace ownership of that and examine it, also it's not just big pharma, but also quacks and the media, as i argue in this, er, extract from my book.


Ben Goldacre

Tue, Jan. 13th, 2009 07:18 pm (UTC)
Re: Heroes and villains

Thank you, Dr Ben, and I totally agree with the points you make in that extract. In fact, I'd like to quote one paragraph here, for anyone whose ADHD prevents them from reading the whole thing:

"The World Health Organisation’s Commission on the Social Determinants of Health reported this week, and it contained some chilling figures. Life expectancy in the poorest area of Glasgow - Calton - is 28 years less than in Lenzie, a middle-class area just eight miles away. That is a lot less life, and it isn’t just because the people in Lenzie are careful to eat goji berries for extra antioxidants, and a handful of brazil nuts every day, thus ensuring they’re not deficient in selenium, as per nutritionists’ advice."

ReplyThread Parent

(no subject) - (Anonymous) Expand

Tue, Jan. 13th, 2009 06:50 pm (UTC)

Severe depression runs in my family on both sides. Until SSRIs were made available, we had at least one suicide (or "hunting accident") per generation. I would not be here if not for medication.

I'm not taking "happy pills" - I doubt I'm any happier, or happy any more often, than anyone else. I have highs and lows like anybody else. I'm just not lying in bed all day figuring out what I have around the house to do myself in with.

Tue, Jan. 13th, 2009 07:35 pm (UTC)

By sheer coincidence, I just got asked today to interview Mike Mills for a magazine next month. So I'll get to ask him about utsu in person.

Tue, Jan. 13th, 2009 11:34 pm (UTC)

Is he in Berlin for the film festival?

ReplyThread Parent Expand

Tue, Jan. 13th, 2009 07:55 pm (UTC)

This is a subject close to my heart. Of course, recently we've had news that research suggests anti-depressants are no more effective, generally, than placebos. This is something I've believed for a long time, having taken many, many different kinds. The definition of depression is, well, a delicate and touchy thing. I certainly don't believe depression is all about 'chemicals in the brain', which is utterly facile. You might as well say that politics is all about 'chemicals in the brain', that the situation in Gaza is all about 'chemicals in the brain', and so on. If I have taken many, many kinds of anti-depressant, it's largely because I've been advised to do so, and it seems as if not to do so sends out the message that you don't want help, or don't want to change. And yet, again and again, the only thing that was ever offered me, was pills.

I never found them to work. Never, over a period of many, many years, except for a brief period in Japan. I took prescription drugs in Japan in the year 2002, not long after Mike Mills says Japanese depression was invented. I didn't have the impression that the doctor was unfamiliar with utsu-byo at all, though he asked if I minded medical students sitting in on the consultation - I said I didn't. I have a vague impression, from the Japanese people I spoke to, that 'depression' is not seen so much as a household medical term as it is in the west. People are ever so slightly unfamiliar with it, or were in 2002, and fumbled for a word they'd heard somewhere - utsu-byo.

Medicalising depression is, in my view, a way of not dealing with its implications. Others disagree with me. Many who have suffered depression have recommended pills to me. In the end, I have been baffled by such recommendations. But then, different people respond differently to different substances. Commerically available anti-depressants seem like a really, really bad one-size-fits-all treatment, and there lies behind them the philosophy, or the lie, that a substance can make everything all right. It can't.

By the way, enjoying Joemus.


Tue, Jan. 13th, 2009 09:38 pm (UTC)

Read up on Traditional Chinese Medicine: these "diseases", ADD/ADHD, Autism, Bipolarity, and Depression, all have the same root cause: Jing Deficiency.

wiki Jing (TCM)

And all of them can be addressed with diet, herbs, acupuncture, and lifestyle practices.

The drugs deplete more Jing to simply metabolize and thus entrench the issue further; like putting out fire with gasoline...burning down the house. It's a case of building up the belfry with the foundation stones. Pharmaceuticals deplete Jing by unnaturally sucking it out from the stores in the body and pipelining it to the brain which makes one feel..."more". It's this flatline of "more" that allows some to bootstrap their way back into normalcy...but for some it only amplifies the psychosomatic symptoms of the real problem thus suicide, mania, etc....but all are just doing irrevocable damage to their genetic makeup which...if you haven't noticed... has created a population rife with autistics, Riltalin-jockies, and social inepts. You'll also come to see that it creates a nation of people sterile-without-assitance and more short-lived. Jing is that thing in the body that is like the honey jar of life; once its gone, you are too.

The only thing that will turn this around is by implementing TCM concepts which so far only has analongs in the Green movement: local, in season, not too far, clean air, low stress, limited caffiene, meat only to tonify deficiency & sickness, processed foods no longer created thus imparting an economic/worldhunger/povertry coloration to some of these issues...and then even more so the further you study this paradigm of the body-in-the-world that TCM acts as lense. The most important element remedied from TCM practices as covered in your "capitalism/sick" piece: sustainable emotional palettes. Food creates emotional latitude directly. Low-efficiency nutrition, aka empty calories, creates the empty feelings, in short. One feeds into the other and creates a vicious cycle. And the Western medical paradigm of "unintended consequences" used to "fix minds" is as stated, a dangerous state of palliative abuse. Arsenic can make you sleep at night, too.


Tue, Jan. 13th, 2009 10:31 pm (UTC)
Depression Symptoms in terms of TCM


ReplyThread Parent Expand

Thomas Scott
Tue, Jan. 13th, 2009 09:49 pm (UTC)
In pills we trust

Good post, Momus does Ben Goldacre.
This CH4 doc, which I saw a number of years ago examined similar themes, only from the perspective of the U.S.

I have a friend, who after several years of battling depression, did with great reluctance agree to taking medication and did with find SSRIs helpful.
The problem is of course is that people like this are more the exception than the rule; antidepressants are prescribed for the monday-morning-blues and it makes sense, that with U.S. markets saturated, drug companies should seek to propagate the culture of pathologisation in Japan.


Thu, Jan. 15th, 2009 09:28 pm (UTC)
funny story

A friend of my dad back home in the Canary Islands (where locals have been traditionally more familiar with "opression" than "depression") recently gave me a really nice bycicle he hadn't used in 10 or 20 years.
He told me the story of the bike. At some point in his life, he started feeling depressed, and he didnt know why. He went to the psychiatrist, who told him to get a bike and ride a bit every day. To his amazement, the depression went away. He started cycling lots, with his friends, as far as the cliffs in the other side of the island, tho since he is middle aged he has ditched it for a motorbike.

I dont wanna say pills are useless tho. I have friend who obviously need them. But it makes me think of brave new world and all that. Especially when I see the lively but small and skinny wild cats that live by my dad's house and compare it to big fat and lazy house cats in the city.


Mon, Jun. 8th, 2009 07:37 am (UTC)
I was writing on the same topic just as I left LJ

I love how this turned out, and how you have continued your train of thought and consistantly write to your blog on a daily basis, I wish I could keep up with everything.. but its nice to see exactly why I read your blog to begin with. Oh you Mercury in Piscies :) you are always going to uncover something universally true.. something that is important for everyone to know. Thank you for giving my heart a smile! AlterEgoTrip /formerly known as Svenskasfinx