Medicalization and Demedicalization of Mild Depression in Japanese Occupational Health

From 1999 to 2008 the number of patients with depression in Japan is thought to have increased by 2.4 times. Overdiagnosis of depression has attracted much attention both from the health professionals and the public. Previously, the concept of mild depression did not even exist until the 1990s in Japanese psychiatry. Some experts argue that the introduction of the DSM and ICD as a diagnostic tool is a possible factor of increasing depression in Japan. In this study I analyze the conflict between the medicalized and demedicalized views of mild depression in Japanese occupational health from the viewpoint of conflicting diagnostic contexts in Japanese psychiatry.

I conducted several interviews with physicians and psychiatrists active in the field of occupational health and attended various conferences and meetings of experts dealing with mild depression in occupational settings. Two findings are especially of significance to understand the current trend of depression epidemic. 1) There are double contexts in which depression diagnosis is made. Whereas the DSM or ICD is used as a tool to diagnose depression, they do not explain any etiology of the disease but just provide the criteria of the symptoms. Thus in those cases for which the explanation of the disease causes is needed, conventional Japanese psychiatry is referred, in which depression is modeled by major depression rather than by mild depression. 2) Major depression model in Japanese psychiatry includes a moralistic judgment about the “industrious” personality of the patient. As this aspect does not coincide with the mild depression patients, there is a strong tendency to demedicalize the mild depression on the side of psychiatry. The same tendency is also found in the media coverage of the disease. Thus the status of mild depression patients especially in occupational settings is unstable and vulnerable to the moral criticism on them.