Traumatic neurosis in Modern Japan
Medical history in Japan – by Masahiro Sato
My current work in progress aims to explore some of the social, political and cultural environments in which the concept of ‘traumatic neurosis’ – a psychoneurotic or psychological concept that received much attention in the late 19th century and the early 20th century in Europe and North America – spread and thrived in Japan before World War II. In recent decades, medical historians or history-orientated scholars have intensively researched the history of trauma in Western societies, and they have revealed many interesting relationships between the concept and the multitudinous social contexts of that time.
However, the history of traumatic neurosis in modern Japan has yet to be adequately clarified. The dearth of research is generally attributed to the delay in medical study of the disease itself. As is well known, medical research on the disease progressed dramatically in European countries through the study of soldiers who returned from World War I. By contrast, there was little motive to study the disease in Japanese medicine because Japan had little or no involvement in World War I, and Japan did not pay much attention to the concept of trauma until the Great Hanshin Earthquake of 1995.
Until the 1990s, there were few popular books or newspaper articles on the disease in Japan; therefore, it is reasonably safe to say that Japanese laypeople have only recently become familiar with the concept of trauma and the idea that the human psyche could be damaged by devastating events. However, it may be wrong to assume that Japanese medical professionals in the 20th century had little knowledge about the disease. In effect, the concept of traumatic neurosis was imported to Japanese medical circles by the late 1880s at the latest, and many medical scientists and physicians had extensively published papers on the disease up to the 1930s. More than 100 relevant academic papers and journal articles were written in pre-World War II Japan.
So who did pay attention to the disease? To my knowledge, it was the physicians working in railroad hospitals or for the Railroad Administration in pre-World War II Japan. They collected many clinical cases, most of whom were railroad workers suspected of traumatic neuroses, from railroad hospitals across the country to explore the pathogenesis and prognosis of the disease. They studied the cases of hundreds of railroad workers, maybe more.
Why, then, did physicians who treated railroad workers attach so much importance to researching the disease? In short, this was because political and/or socioeconomic pressures pushed them to carry out research. To be more specific, research was conducted because of the superiority of the workers’ compensation system in the factories of the Railroad Administration, and, as was the case with other Western countries in the 1920s, Japanese physicians at the time were of the opinion that workers in such a situation were prone to illnesses and difficulty in recovering because of their psychodynamic mechanism.
In addition, there is a possibility that personnel who suffered neurological symptoms were beginning to file claims for occupational damages against their companies owing to the then rapid industrialisation and general expansion of social security programmes across Japan. Furthermore, some communistic labour unions began to use the diagnosis to blame the patients’ plight on the tyranny of the capitalists, or employers, by representing the patients as victims of avaricious capitalism.
Consequently, politically conservative physicians and government officials were afraid of an increase in the number of patients with traumatic neurosis and the accompanying healthcare costs or anti-establishment movements. As a result, the term ‘traumatic neurosis’ was gradually stigmatised around the 1930s as a ‘disease of will’, or one caused by patients’ egotistic desires for compensation. It was also referred to as a ‘social disease’ because patients were cured via the verbal persuasion of physicians or a minimal compensation from companies. In other words, traumatic neurosis came to be considered a quasi-medical diagnosis after the 1930s and almost disappeared from the medical lexicon in Japan after World War II.
This is a brief history of traumatic neurosis in modern Japan; however, some questions about this history remain unanswered. For example, why did physicians and laypeople treat the mental trauma of the people affected by the Great Kanto Earthquake (which struck Tokyo in 1923) as a trivial issue at the time, despite the fact that the death toll in this earthquake was 20 times that of the Great Hanshin Earthquake of 1995? Furthermore, why did post-World War II Japanese society pay so little attention to traumatic neurosis in soldiers who had returned from World War II, even though the financial condition of the health insurance system after World War II was relatively stable? Only a handful of physicians or medical officers paid attention to the psychological problems of people who were victims of war and natural disasters and made the effort to document their case reports in medical journals. Some would say that the attitude of the Japanese in pre-World War II Japan was characterised by an utter disregard for the disease, which could be true. However, I am of the opinion that more complex sociopolitical and cultural circumstances were involved in the delay of research into the disease, and exploring the history of this disease will shed some light on important aspects of the disposition of the modern Japanese. This quest for the history behind traumatic neurosis and psychological injuries in Japan is still in its initial stages.
Masahiro Sato is a part-time lecturer at Keio University and a PhD candidate at the University of Tokyo, Japan.