 Hey good afternoon everybody in Hawaii. Good day to our viewers around the world. This is Steve Zercher. I'm the host of a webcast to run on ThinkTech Hawaii called Looking to the East. So we take a look at various issues related to Japan and Asia. A couple of weeks ago on our show we looked at baseball in Japan with a couple of journalists that are working on that and now we're going to address a much more serious issue having to do with the state of mental health in Japan. So that's the topic for our show today. And we're very fortunate to have a colleague and friend of mine Dr. Reggie Paul with us today. Reggie is a practicing clinical psychotherapist in private practice. He's also been a teacher and instructor of cross-cultural psychology over the years here in Japan. He even taught for three years in Thailand at Assumption University. If you have not heard of that school it's one of the best schools in Thailand. So Reggie has a very interesting background in psychotherapy both in private practice and also in instructing the topic as well. So Reggie, good morning to you here in Japan. Thank you so much for joining my show so early in the morning. I really appreciate it. Good morning. Yeah, so what prompted this show topic in my mind? It's part of it's my own personal experience and teaching over the last year. So my sense is and when I talk to my colleagues that are teaching is that the stress and anxiety levels of students at the Kansai Gaidae and other places I'm actually teaching of course at the University of Hawaii right now. And I kind of get a similar sense from the students that because of the pandemic the anxiety levels have been going up and the demand for mental health services are going up. So that's what prompted this in my mind. But let's start Reggie with looking at the state of mental health in Japan. I always I remember when I was a student at Kansai Gaidae there was a session, a hospital for mental people and it looked basically like a prison. I would ride my bike past it every day and I realized this is a while ago that Japanese people when they look at mental health issues they kind of tend to want to pretend like it doesn't exist. So I think Japan's come a long way from them. But Reggie, what would be your assessment of how mental health is perceived in this country and how it's addressed? Well the basic thing that I would start with is that mental health is something that's part of daily life. It is everywhere. But there's a there's a kind of a how do I say a split between daily mental health and mental health problems and with mental health problems they there's basically three ways that you deal with mental health problems. You talk with friends and or whatever family members however and you know the kind of normal ways that people do it everywhere. You go to a psychiatrist or you go to an institution and clinical psychotherapy the kind of work that I do is not popular and there's a big stigma with it. So there's an example of this is when I first started I was I didn't know about Japanese attitudes towards counseling, mental health. A client of mine told her boss that she was seeing me and after that her boss was just a steady stream of comments like oh you don't understand that? Well that's because you're mental that she had to deal with. And this is the attitude basically that this kind of in between ground that I work in is between people have problems but their regular social network is not enough but they're not they're people in daily life that are dealing with daily life problems like the pandemic. It doesn't mean that they need to be institutionalized or it doesn't mean that they need medication. So this is this is where the this is where the big stigma and the gap is in Japanese mental health. Have you thought as to why that is you know in many as Americans living in Japan we see some of our social trends echoed in this country along different lines and so forth but it seems like the the awareness or the acceptance of mental health is a part of your overall general well-being in the United States has not really translated into this country as of many other aspects of not just American culture but foreign culture that we see every day here. So why do you think there's been this resistance or reluctance on this particular topic? Well it's as in one of all kinds of things like this it has to do with cultural values and cultural attitudes. There's a lot of factors I mean one one factor I think is that the private self here inner self is is very much considered how do I say it's personal and it's private and people don't talk about it they don't share it even even in regular daily life and family life and so on. You notice that I look out the window at my neighbors and the windows are all this kind of frosted glass windows and this is very common that they have this kind of you know this division between the inner and the outer and this is this is just one attitude. I think another thing is that when you do have problems the way they deal with it is not in in Japanese society is not so much in terms of interpersonal dialogue is not the way that things work around here. Things get you are told what to do it works on a basis of this the function of the of society it works in a hierarchical basis rather than an equality basis as in the US and so people are told what to do the educational system is based on rote learning it's not based on a dialogue between the teacher and the student um so and if an example of this is the Japanese word honsei which means self-reflection but it's self-reflection but the way they do this kind of self-reflection honsei is a particular kind it's when you it's used when you've made a mistake you've done something bad you go off and you reflect by yourself and then you make a report back to the teacher or the boss as it happened to me one time um when I slept through uh I was sent to an appointment out somewhere and I slept through on the train I slept through my stop on the train and I woke up way down the line so I had to go back I was late for the appointment and afterwards the company asked me to write a honsei letter a honsei bun in Japanese which means a self-reflection letter on how I was going to improve my behavior and make sure that this didn't happen again in the future so it's it's individual it doesn't happen in dialogue that's the point I see doesn't happen and so you have this the culture is that when you a lot of the treatments that they have for people now that they developed they they've become very good in japan on dealing with emergencies in their own way you know suicide depression but but the kind of anxiety issues and stuff but the kind of ways that they deal with it are one thing is you might call it the rescuer and this is a traditional kind of therapy in japan but you stay like if you have depression the government has allowed companies to or mandated companies in some cases to give people time off when they have depression and you know three months six months is not uncommon right for a person to get leave from the job but what do they do during the six months they don't do counseling they just take a rest and then when they've recovered their feeling then they go back to the job and they're back into the same situation they were in and nothing's changed so this is a kind of this is kind of the this is this is the cultural way of doing dealing with these kinds of things yeah wow you know we we both teach about culture each in our own domain and I even though I've been doing it for so many years it's just I'm always amazed how deep culture influences behavior what you what you just described to me if we had a mental health professional listening to this from the United States or some other Europe or South America they would go that's ridiculous how can someone fix himself or herself by just self-reflection just take a break and come back to these exact same conditions clearly the problem will repeat again but anyway within the Japanese context that's the solution that's been created and wow I'll say there are other there are other aspects too you know the idea of maturity in Japan the idea of maturity in Japan is based on the idea of being able to um how do I say deal with the situation gracefully without it's basically enduring without causing problems this is the idea of this is a the ideal of maturity so um there's a Japanese word race which means kind of cool hearted or cool headed you don't let your emotions get to you right and uh so this is so instead of like dialogue right you have these kinds of the you kind of deal with it on yourself and you try to you know you end up with these values of like acceptance of the problem acceptance of the situation not causing waves not causing the idea of not causing problems for other people these are all uh these kinds of attitudes are what's are inter it's all interwoven in these kinds of ways it's kind of ironic Reggie isn't it that uh this sense of community and not not placing a burden on others which Japanese people are taught from day one basically and it's built into the language as well um places this burden on the individual it is really really deep you know so it's a sense of community but really when it comes to this people are forced to kind of make do on their own one time a friend of mine was talking about how he was talking with a Japanese man a friend a Japanese friend of his and his friend said I think Japan is very proud of the fact that Japan is a harm harmonious culture and his response was it's not harmony it's coercion that's the that's the difference you know that's the difference between the when people on the way say go along with the established order there's very much a sense in Japan that you can't you can't change the established order is just a given you know sort of like an existential given in life you can't change it you just have to so this is one of the explanations for why Hiki Komori which is the the idea of being a shut-in you people retreat from the world when they have problems right yeah I didn't think to dress as as an issue but that's certainly an aspect of Japanese mental health which is a severe challenge and actually the government is trying to directly face that and we we have we have a colleague whose daughter went through this and eventually died of starvation it's quite sad well I know yeah I've heard anyway Richie let me let me has you've been here in Japan a long time as I have it sounds like things aren't changing all that much from when I was looking at the psychology hospital and the situation today but we do have Naomi Osaka just recently who is revered in this country as you know a very famous and successful tennis player who withdrew from a recent tennis tournament for mental health reasons and of course that was unbelievable news do you think that those types of things would maybe on the edges change the perception about how people deal with these problems because she to her credit was very open about it I'm sure there have been tennis players or other professionals in the past that have had similar issues but they didn't bring it up publicly and then recently there was an American athlete at the Olympics who also withdrew from events because of mental health so there's a Japanese-American and then an American that are doing this do you think that this will have a positive impact in terms of how people perceive mental health and then it'll become gradually gradually it's a slow process it's a slow process okay so all right so we have to be patient on that if we expect that to grow well as I said I said they're very good with the they have centers now for domestic violence they've all these governing initiatives to that's a big reason why part of the reason why the suicide rate has declined since 2003 in Japan until recently depression is being treated now there are ways that they're doing it but they're still kind of doing it in their own way which is only natural okay yeah that that brings up that's a nice segue to my next question Reggie and that's the recent rise in the suicide rate in Japan the government for many years has been attempting to try and bring that number down and they have been successful as you pointed out but unfortunately as we were talking before the show starting in July that number now is going up so the number for 2020 was a rise in the suicide rate of 3.7 percent as I mentioned earlier I teaching my students you can feel a sense of anxiety in them the things they write about the things they talk about and oftentimes they just disappear from my class and sometimes they'll tell me that they need to take this mental vacation that you were talking about they're they're actually doing the same thing have you noticed that in your practice are you more busy now than you were perhaps a year or two years ago I am definitely more busy it's definitely the the impact well it's part of the reason it's a lot of it's connected to the pandemic but part of the reason that I'm busier is because of the rise in mental health issues connected to the other part of the reason is because of the acceptance and the use of these kinds of things like zoom and internet technology it's much more common now and so people in it makes it more accessible and particularly in Japan where there might not be a therapist next door as they might easily defined in the US people are more spread out and so because of the the use of tele therapy that's which is also connected to the pandemic because it's been so much so many things have gone online so that's part of the reason to your as a practicing psychotherapist your reach is increased because patients can contact you through zoom and do you find that zoom sessions are as effective as normal face to face they're effective it's it's I still prefer in person you know there's there's the nonverbal and you know these the kind of the the visceral feeling of being in the same room together and and these kinds of things I think it's still preferable but I tele therapy is is effective there's and there's been plenty of research that demonstrates this okay and getting back to the suicide rates you had told me before we started the show that the biggest increase there is with young people you said under the age of 18 that has been the segment that has unfortunately grown the most do you also attribute that to the pandemic even for these younger people that's part of the part of it is the is the pandemic yes it's the the the pressures that have have increased on the students particularly in Japan and the people that have had the hardest time with the pandemic are the people that are on the how do we say the edges of society like children you know students are not part of the I mean they're part of the society it's not like they're on the edges of society but in terms of the power structure of society they're on the edge and the so the rates that have gone up in Japan have been with the difficulties have been the percentage of people who've had the most difficulties are with young people women both in terms of housewives because they're at home or their husbands are at home so the domestic violence rates have gone up because they're spending more time together and with frustration with greater frustrations and the social isolation factors are not being able to meet with people as easily as before and and also the other part of of women that is affected is the women who are single mothers or single adults and they tend to have a higher percentage of part-time workers women who are workers same with the young the the younger people people under 40 have had a hard time there's been what I read like 40 percent of people under 40 haven't been able to find a full-time job and so they end up with these hard-time jobs and they're the first person to get laid off and their difficulties so this is affected single mothers and single women adults and also in general the younger people and then the students so those are the people the groups of people that have been affected by the pandemic the most and also the of course the elderly people because of the social isolation factor wow it's a complex and challenging issue I think yeah it makes sense to me as a management professor coming from the kind of the business or econ side of things that if you put pressure on single working women or other families that are not getting by or students who have graduated as you said who cannot find full-time jobs most of my students at concai guide they lost all of their part-time jobs because basically the restaurants closed that's majority of them work in some kind of food service so that put economic pressure on them in addition to the social pressure and isolation it's it's a tough situation it is a tough situation yeah so Reggie one other thing I wanted to address you were focused on cross-cultural psychology as I recall your your thesis was on that right that's right and you practice that yourself have you also this growth in your activity is it coming from uh mixed marriages are they those couples also experiencing greater stress they are experiencing greater stress so they're not they're not outside of this then there I guess everybody's experiencing greater stress that's right that's right I don't I don't think it's a particular it's just it's the same kind of basically as I mentioned before with the domestic violence rates going up because of couples different reasons having stress either financial in terms of losing the job or being at home together more because the one person is working at at home now on the internet instead of going into the office um those are the those are the two of the main situations that have affected couples so yeah I think historically the divorce rate for mixed ethnic or mixed nationality couples in Japan is higher although that may be influenced by the military because lots of marriages occur out of that and the the divorce rate there is quite high but I don't know is that correct Reggie that's my my perception you agree with that what I was told by once by the people at the American Embassy when I had a meeting in Osaka at the American Embassy they said the divorce rate in Japan with with mixed marriages it's it's higher than the Japanese rate but lower than the American race okay so it kind of meets right in the middle okay but that when when you have that situation in your private practice as you were talking about earlier the psychological approach to mental health is so different across the Japanese culture and foreign cultures I guess we're both familiar with American cultures how do you navigate that when you recognize it you can say one thing and it will be understood this way by the American partner and a different way by the Japanese partner or this way for the Italian partner and this way for the Korean partner if you have those kinds of mixed couples as well I mean psychotherapy is so difficult to do I just can't imagine how you do that when you have two different cultures in the mix it's like it's like adding a whole another variable into the mix of things that you have just because you've got two people yeah interacting so it adds a whole another level of complexity to an already complex situation and part of what happens with cultural stuff is that people aren't aware of it people don't think about it so much I mean some things are obvious and people pick up on it but a lot of other things so one of the things that I do when I'm working with couples is when I hear something it has a cultural connection I point it out and so it's basically the phrase that I use with people is that the basic approach to cross-cultural understanding and cross-cultural difficulties is the first thing you need to do is to separate observation and interpretation people tend to observe and interpret things together that's the normal way of functioning and but when you have a cross-cultural situation the possibility of cultural things going on that you don't understand you first need to observe what's going on get information and then decide what to do with it just interpret it and so on so it's basically education but it affects things like communication styles are one way that it definitely cultural influence that people are tend to be unaware of affection how to communicate affection to other people is very is very cultural problem solving is also has cultural influences when there are problems that happen how do you deal with the problems and stress just general stress how you deal with stress is very cultural for so for example as I mentioned before the Japanese tend to deal with stress by enduring and trying to this this is the value but that's not the way that a lot of people deal with stress and so so these are these are kind of things that I work with when I'm you know working not an easy job Reggie that's what makes it on I see yeah and you can do so much good I think as well hey we're running out of time Reggie the time flew by so quickly if anybody is interested in contacting you regarding your practice or some of the research that you're doing on cross-cultural psychology what would be the best way to do that you just go to my website which is www.regiepaul.net sorry so it's uh and my name is Pete my Reggie my first name and my last name PAWLE and on the website there's a contact information uh button and they can contact me through that okay Reggie thank you so much for sharing your knowledge and your insight into this very very interesting issue so yeah so the viewers I'll see you again down the road we'll address another issue relating to Japan or Asia so thank you so much for tuning in appreciate it if you have comments about the show uh please provide them to think tech kawaii really appreciate it so we'll see you again thanks thanks again Reggie bye bye