Japan’s Suicide Epidemic

As pressure mounted from his job as an auto parts designer, Kazuhiro Kuroda encountered bouts of listlessness. Then the odd night of poor sleep turned into chronic insomnia and irritability. He had trouble breathing.

A perfectionist, he redoubled his efforts and tried to power through the problems. But as cost-cutting intensified and colleagues quit, leaving him with more work, the stress proved relentless.

He attempted suicide. Twice.

Kuroda, 45, a resident of central Japan, asked for mental health leave. He took the maximum allowed by regulation, 18 months, but still wasn’t back on his feet, so the company forced him to resign. A few weeks ago, he joined at least 3.5 million others on the unemployment line as the jobless rate here hit a record 5.4%.

Japan’s economic deterioration is damaging a lot more than balance sheets and bank statements. Extreme stress and mental instability are at record highs. About 425,000 people were treated for stress-related mental disorders last year. In 1998, when the economy started tanking, suicides jumped 25% to more than 30,000 and haven’t declined. Suicides directly attributed to employment, personal debt and the economy now number 8,500 annually, up fourfold from a decade ago. Because of population changes, the mortality rate per 100,000 people has eased slightly.

Mental health professionals say the actual number of stress-related illnesses may be much higher because psychological difficulties are often ignored or swept under the tatami mat in Japan, where depression is still viewed as a character flaw and treatment is inadequate.

“There’s a very dark cloud hanging over Japanese society as more and more people lose their psychological signposts,” said Dr. Yoshitomo Takahashi, a researcher with the Tokyo Institute of Psychiatry. “Mental illness still carries a lot of shame, so most people are referred only at the terminal stage. This makes our job very difficult.”

Countries around the world have for decades lived with high unemployment and the social, economic and political costs it engenders. But in Japan, workers saw a job as an entitlement, and for years that was the case until Japan’s economy faltered.

Companies began pruning payrolls, and the pain now is jolting the core of Japanese society: breadwinners in their 40s and 50s. This generation sacrificed almost everything for the company and now feels betrayed, isolated and worthless at being let go.

“Japan is suddenly waking up from a 56-year dream,” said Hirotake Araya, general manager of Tokyo Shoko Research, a private data-collection company. “The end of lifetime employment is very difficult to accept, particularly for middle-aged people.”

At the Aokigahara forest at the base of Mt. Fuji, where suicide by hanging or overdose is common, a large sign at the trail head entreats visitors to think twice before killing themselves. “Wait a Minute!” it says. “The world holds bitterness but also joy. You only have one life to live, so think it over.”

The forest has been a magnet for distraught Japanese since a popular 1970s television drama used it as a backdrop for the heroine’s suicide. The reality is far less romantic, but people keep coming, said Yoshiaki Watanabe, patrol leader of a volunteer cleanup and rescue crew that periodically combs the dense woods.

“With this economy, we’re bracing for a lot more,” he said. “Some bodies are found, but many others probably never will be. Sometimes there’s nothing left but bones, even though it’s obvious what happened because there are pills littered nearby.”

Souvenir stand worker Kouki Watanabe said he alerted the fire department in late October after a car went untouched for days. The owner’s body wasn’t found in the ensuing search, but five others were.

Drivers with the nearby Fujikyu Yamanashi taxi company use an informal profiling system. People who arrive on the last train from Tokyo without much money and ask to go to “the woods” despite the late hour and no camping equipment are immediately suspect.

“After a while, you can tell instinctively,” said Yukihiko Igari, a driver of 14 years. “We drag them into our office here and do absolutely anything but drive them up there. Often their problems--bad debt, a lost job--seem rather trivial to an outsider.”

Another spot long popular with suicidal Japanese is the Chuo Line in central Tokyo. Parent company East Japan Railway reported 196 people jumped from platforms into the paths of oncoming trains throughout its system last year. The railroad company charges family members up to $65,000 in cleanup fees as a disincentive in this responsibility-conscious society.

Last year, the company took a new approach by painting platforms bright colors, adding lights and installing talking sensors and large mirrors to cheer people up or prompt them to reconsider.

Japan’s medical system, meanwhile, reinforces social stigmas, critics charge, by funding giant, impersonal mental hospitals over community-based clinics. High-dose sedatives and physical restraints are preferred treatment methods, they say, with relatively little attention given to prevention or early outpatient treatment, the direction taken since the 1960s in the U.S. and Europe.

“Outside of a few places like Tokyo and Fukuoka, the approach is just to feed patients drugs, keep them in bed and leave them there,” said Dr. Rika Tanaka, a psychiatrist with Fukuoka’s Shiranui Psychiatric Hospital. “Many see Japanese hospitals as asylums using straitjackets, so nine out of 10 people stay away.”

Many patients also are deterred by social prejudice and a long-standing view that gaman, or perseverance, is the best approach.

“There’s great discrimination throughout society regarding depression,” said Dr. Toru Sekiya, president of the Hatsudai Sekiya Neuro-Psychiatric Clinic in Tokyo. “Some of this goes back to rural Japan when families traditionally kept sick relatives locked in small rooms. The stigma continues.”

After years of essentially ignoring most mental health issues, the Ministry of Health, Labor and Welfare this year initiated a $3-million suicide prevention program, with the distribution of brochures at companies and local communities a cornerstone. The goal is to reduce suicides 30% by 2010.

Although it’s a start, critics say it leaves a lot to be desired. The program’s first recommendation: Workers should treat themselves by relaxing and working less. But professionals say this is unrealistic when companies are looking for any excuse to hand out pink slips.

“Even if people read the government’s brochures and seek professional help, there’s no place they can go,” said Masaaki Noda, professor of psychopathology at Kyoto Women’s University. “There are so few psychiatrists in Japan that it’s meaningless. The government approach borders on criminal negligence.”

Japan has just one psychiatrist for every 10,000 people, about half the one per 5,300 people in the United States.

In a tiny warren of rooms on the fourth floor of the Japan Lutheran Church in Tokyo, Yukio Saito oversees the Tokyo Lifeline, part of a national network of 5,000 crisis hotlines for depressed and suicidal callers. Saito helped found the voluntary effort in 1971.

Three decades later, society is still wary of tackling suicide and depression issues head-on, he said. Architects of the nationwide anti-suicide campaign, for instance, refuse to use the word “suicide” on their posters, falling back instead on the slogan, “Support Life.”

The private sector has started introducing more mental health programs. All too often, however, they’re run by personnel departments, leaving workers fearful that participation will derail future promotions or that details of counseling sessions will be leaked.

Interest rose sharply after Japanese courts started ruling against companies in karoshi, or death-by-overwork, lawsuits.

Still, some of the greatest stress by all accounts is found at small and mid-size companies, many of which are barely hanging on, let alone willing to fund mental health programs.

“Even my company, which isn’t the smallest, didn’t have a very good program,” auto parts designer Kuroda said.

Now that he’s out of work, the father of three adolescent children is increasingly worried about finding a job, something he hasn’t had to do in three decades. Things are pretty bleak, he said. Few employers want middle-aged workers in a nation where age discrimination is widespread. And, even if they did, there are few jobs available that pay enough to support a family of five. Their savings will last a year at most if they live very frugally, he said.

Another big problem, even if he can somehow land a spot, is how to finesse his illness. If he tells prospective employers about it, he won’t be hired. If he doesn’t say anything, they’ll find out eventually and fire him for not being forthcoming about it.

“I wish society were more generous,” he said. “It’s all seems so hopeless.”

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Hisako Ueno in The Times’ Tokyo Bureau contributed to this report.