At A Piece of Pie, we firmly believe that Anthropology has the potential to revolutionize the healthcare system globally.

Over the next few weeks, we'll be sharing impactful examples of its positive influence. Anthropology is  a game-changer in enhancing patient outcomes, promoting cultural competence, and increasing patient satisfaction. It's a crucial puzzle piece in creating a healthier world. After all, "a little knowledge can go a long way," and Anthropology has plenty to offer in the quest for better healthcare.

We all know that the COVID-19 pandemic has been a global crisis that has affected not only physical health, but also mental health. According to the World Health Organization (WHO), the prevalence of anxiety and depression increased by 25% worldwide in the first year of the pandemic, with young people and women being the most affected groups. The pandemic has also caused stress, fear, loneliness, grief and financial worries for many people, as well as disrupted mental health services, increasing the risk of suicidal thoughts and behaviors.

However, in some healthcare systems, COVID-19 is just the straw that broke the camel’s back. We have all heard about the rampant suicide and depression rates ravaging Japan since the burst of the country’s economic bubble in the early 1990s. We might even be familiar with the image of an extremely overworked salaryman, dutifully devoted to his company at the expense of his own mental health.

Today, we will share one fascinating example of Anthropology's impact on Japan's healthcare system: the work of Junko Kitanaka on mental illness.

Unpacking Japan's cultural narrative of depression and its impact on clinical practice

The narrative of the burnt out (predominantly male) worker who develops a depression due to exhausting and stressful work conditions has penetrated Japan. Nowadays, those who are depressed are considered to be ideal Japanese: model employees that continue to follow the old Showa values of devotion to work and to one’s company, putting the group (the corporation, and even the Nation), before the self. But this narrative is recent. Only a few decades ago, depression was mainly seen as a result of a character flaw, and suicide was frequently considered as an act of free will.

The medical anthropologist Junko Kitanaka has studied this shift, and the implications it has on psychiatric clinical practice and patient outcomes still to this day. Through participant observation in clinical encounters and in depth-interviews with psychiatrists and depressed patients, Junko Kitanaka has found two distinct groups of patients, with different patient journeys with different diagnosis, treatment and health outcomes.

The first group of patients is constituted by depressed (mostly male) workers who tend to present the symptoms of their depression as resulting from the work conditions that they experience, marked by burnout and stress. Due to the cultural narrative presented above, psychiatrists, who are themselves all too familiar with these working conditions, empathize and recognize the patients’ symptoms as ‘a biological depression’. In other words, they consider that stress has caused a chemical imbalance in the patient’s brain, for which the patient is not at fault. In these cases, diagnosis is straightforward and unproblematic, and treatment follows promptly: antidepressants and a rest from work. In turn, most patients recover quickly.

The second group is constituted by female depressed patients. These patients, many of them housewives, do not present the symptoms of their distress as resulting from the work conditions they are experiencing; instead, their explanations are less linear and more complex, drawing from several causes. Psychiatrists have a harder time recognizing their symptoms as ‘a depression’, and when they do, they label them a depression with a psychological origin. In contrast to the biological causality of depression associated with the first group of patients, a depression with a psychological origin is more related to character flaws, and thus puts the blame on individual women. Furthermore, Japanese psychiatrists tend to treat it more dismissively. This lack of recognition leads women to not trust their doctors, embarking on a quest to find the right diagnosis and the right treatment. These female patients incur the risk of being labeled ‘problem patients’, might experience misdiagnosis, and might have poorer treatment and health outcomes.

Creating positive change: Kitanaka's legacy in improving mental health treatment in Japan

This ‘selective recognition of pain’, as Kitanaka calls it, and the diagnosis and treatment outcomes that follow, have important and distinct implications for the patient experience and the quality of life of depressed men and women in Japan. Kitanaka has spread her findings in medical conferences, reaching Japanese psychiatrists, who have been surprised and grateful to learn about her insights, and have in turn applied them to improve their medical practice.

Building on Kitanaka's legacy

Of course, the selective recognition of pain and its implications are not an exclusively Japanese issue, nor are they restricted to the arena of mental health. On the contrary, we encounter it frequently in the Ethnographic Observational Studies carried out at A Piece of Pie. Too many times I have listened to women with several chronic diseases torture themselves wondering why their doctors did not reach a diagnosis sooner; ‘if they had taken me seriously, maybe they would have caugth it (the disease) earlier.’ One of the aims of our Ethnographic Observational Studies, presented at medical conferences and published in international journals, is to unveil the selective recognition of pain and the need for treatment, building better healthcare systems by improving patient experiences and their quality of life, together with improved outcomes.

All in all, by tackling cultural narratives and assumptions, rigorous anthropological studies can have a huge impact on the healthcare system, ultimately improving patient outcomes.

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References:

Kitanaka, J. (2012) ‘The Gendering of Depression and the Selective Recognition of Pain, in Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton: Princeton University Press.

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