Asylum for Mr H
He fled from persecution in Japan, where a gargantuan madness industry
has been after him. Etsuro Totsuka tells the alarming story of an outcast.

In October last year I was in London and was suddenly asked to see a Japanese client. To my surprise, a 30-year-old ex-mental-hospital detainee, Mr H, had flown from Japan to visit MIND in London and to seek asylum in the UK.

He told us that he had been persecuted by his family, psychiatrists and a public mental hospital; that he was in imminent danger of being detained against his will in hospital in Japan; that escaping from Japan was the only way to secure his freedom; and that he wanted shelter and legal assistance under international refugee law.

Mr H's initiative in flying to London to claim asylum - an ironic concept for a mental patient - is highly unusual but unfortunately his desperate experience in Japan is not. Until quite recently mental illness was regarded in Japan as genetic, incurable, impossible to understand and dangerous. Mentally-ill people were thought to be a disgrace to the family. The Japanese did not want to talk about them, see them, hear about them, get married to them or employ them. Families hid their ill relatives in a cell at home or in a mental hospital.

Domestic confinement was prohibited for the first time in 1950. After the introduction of the National Health Insurance Act in 1958 the private sector expanded sharply to cover more than 80 per cent of Japanese medical services. Mental illness became a very profitable business indeed. The number of mental hospital beds trebled to over 300,000 in 20 years and has since risen to 340,000. As many as 250 people per 100,000 population are detained in mental hospitals without their consent, compared with only 2.5 people per 100,000 in Europe.

Mr H is typical of the kind of patient who is locked up in Japan but who would have retained his freedom elsewhere. He was the eldest child in his family. His mother encouraged him to study harder and harder so he could become a doctor, one of the most financially rewarding occupations in Japan.

He was 17 years old when he suddenly became generally exhausted and tired of studying. He simply could not go to school. He did not speak, stayed in his room and ate there, slept in the daytime and spent hours listening to the radio.

His mother took him to a district mental hospital. Mr H says the doctor did not speak to him and did not see him without his mother. She did not conduct any physical examination. After 10 to 20 minutes she said that Mr H was mentally ill and would become worse without the medicines she prescribed. He later found out the diagnosis was 'schizophrenia'.

A few years passed and he wanted to work. He found a good job. A company promised to employ him. But his mother did not give him permission to work. As he was under 20, he could not be employed without his parents' permission. He failed a university entrance exam.

One day, for the first time, he became violent with his mother. He was taken to the hospital by police, where he was given a great deal of medicine and became unconscious. About a week later he realized he was in a locked ward with iron bars. He had to stay there for a year. After being discharged and spending a year at home he was again hospitalized because he spent his time listening to the radio rather than studying.

All of his admissions were involuntary, probably 'consent admissions' authorized by a superintendent of the hospital and his parents. There was no freedom, no consent to treatment, no second opinion, no review, no lawyer, no notice of rights, no definite time limit to the detention - and no cure.

He thought that he was schizophrenic. The doctors had diagnosed it. He believed he needed a better hospital in order to be cured. Life in the hospital was miserable. He could not refuse strong medicines. He felt very weak and slept all the time. A doctor suggested brain surgery.

He finally got himself transferred to one of the best university hospitals. Here, for the first time, he was interviewed in depth by a psychiatrist without his mother. He could talk about his whole life. He was told that out-patient treatment was enough for him. There was no need for hospitalization. But his mother became angry at the new psychiatrist's opinion. She insisted that hospitalization was necessary and threatened to commit him to a private mental hospital unless the university hospital took him in. He decided to take asylum in the university hospital for two years with no treatment.

The doctor cut off all the drugs he was taking with no ill effects. Psychiatrists there, including the Professor of Psychiatry, certified that he was not mentally ill. He was frightened and trembled when he saw iron bars because of his earlier experience of detentions. There was no easy way to cure this. He was able to go out, however, to a school of English. Later he found a temporary job and a room.

It was not easy to find the room. To rent a room, a certificate of employment is required. To find a job he had to hide the fact that he had been in a mental hospital. After his successful discharge he had to change jobs several times. Not because of any failure, but because his employers wanted to promote him from temporary to permanent status and this required checking his background.

Then he had difficulty with his hearing and heard some noises. He should not have told his family. His mother once again took him to the district hospital, not to the university hospital. A psychiatrist there prescribed heavy medication without examining his ears. It was not long before he fainted from the drugs. He was admitted by ambulance to an ordinary hospital. He was found to have an ear disease and was given surgery for this.

The problem was still his mother and the district doctors, who continued to believe that he was schizophrenic and should be hospitalized. He asked a lawyer well known for his work in medical affairs to protect his freedom but the lawyer refused to take on mental-health cases. So Mr H concluded there was no place for him to live in Japan except in a mental hospital. He made up his mind to flee to Britain.

Ironically, though Mr H did not know it, mental-health reformers in Japan were at last making some headway. In the 1980s a series of scandals received widespread publicity. The most notorious was in 1984 when it was reported that two detained patients had been beaten to death by staff of Hotokukai Utsunomiya Hospital. There had been 222 deaths at the 1,000-bed hospital in just three years. Very little was officially known about any of them. Under mounting local and international pressure, and after a long campaign, the Japanese government finally passed a new Mental Health Act in 1987. The process of establishing and protecting the rights of mentally-ill people in Japan had begun.

Mr H knew nothing about the new law when he arrived in the UK. I could honestly tell him that there had been improvements. They could lead to valuable advances in the whole attitude towards the care of mentally-ill people, including areas where the law cannot always enter. With the principle of voluntary hospitalization accepted, and safeguards now surrounding the standards of treatment, the chances are that a better, more professionally trained mental-health service will develop.

But the most important change of all needs to take place in public and government attitudes towards mental illness. And here there is still a very long way to go. Which is why Mr H is still frightened to return and continues his battle for asylum.

Etsuro Totsuka is a Japanese lawyer who has campaigned for the rights of mentally-ill people in Japan for many years.

The black death When Europeans arrived in Australia they had a disastrous effect on Aborigines' mental health. Andrew McKenna describes the impact of a neurotic society. Fifty years after the arrival of the First Fleet at Sydney Cove, JD Lang wrote of Australia's Aborigines: '(we have) despoiled them of their land, and given them in exchange European vice and European disease in' every foul and fatal form.' When Europeans invaded Australia, they couldn't recognize what they thought of as 'madness' amongst Aborigines. The reason for its absence, or at least its lack of recognition, lay in the very fabric of Aboriginal society itself, the integrating force of which was religion. Erratic behaviour, as well as physical illness, could usually be explained by the malignant magic of other tribes, of individuals, or of evil spirits, and could be cured by the observance of the correct social or spiritual mores of tribal life. A 'clever man' could be called in to effect a cure, and tribal medicine was usually seen as a specialized branch of religion. Pre-conquest black Australians understood themselves to be in a secure and meaningful cosmos, with an infinite past and an infinite future. The arrival of the Europeans spread fear and insecurity throughout black Australia. News travelled quickly of land seizures, massacres and savage reprisals against those who defended their homes. The future became filled with doubt. Death from unfamiliar diseases turned the world into a disjointed and meaningless place. Few Aboriginal languages had words for 'thank you'; reciprocity was a fundamental tenet of life. The system of sharing broke under the onslaught of Western individualism. Sharing is even more out of step with materialistic white Australia today than it was 200 years ago. Nor was there a word for 'suicide'. The phenomenon remains extremely rare today tn Arnhem Land and the Central Desert, where groups still live more or less traditional lifestyles. But with 'decultured' Aborigines it has become such a problem that it has been labelled the Black Death. The loss of land, for a people fundamentally dependent on it both physically and spiritually, has caused an acute crisis of identity. Many Aborigines become disorientated as tribal societies crumble and black independence erodes further - they have become a marginalized minority. Poor conditions, unemployment, bad housing and racism take their toll on black people's mental health. Lacking white skills, disproportionately large numbers are incarcerated in penal institutions, alcohol rehabilitation centres and psychiatric hospitals. Such signs of 'maladjustment' to Western society obscure its own neurotic nature. The neurotic is unable to face the strange, feels threatened and undermined by it, and can often only deal with it through violence. It may be that white Australians see Aborigines from a neurotic viewpoint. Certainly the solutions to the 'black problem' of the past 200 years have been of limited vision - hostile, intolerant and frequently brutal. Aboriginal life was once in balance with itself and with the world. In the words of Aboriginal novelist Colin Johnson: 'Life goes on within you and without you. It is like a mighty river, not like some sort of psychedelic light show.' The same can hardly be said of today's Australia. Perhaps we should be looking at the mental state not of individuals but of society as a whole. Andrew McKenna is a freelance journalist based in St Kilda, Victoria.