Résumé
The family of a mentally ill patient was one of the most important agents in the general picture of insanity in society. Family members such as husband, wife, father, mother, and children played crucial roles in bringing the insane member to medical or religious practitioners. In Europe during the early modern period, family members in countries such as France, England, Germany and the Netherlands collaborated with medical or religious professionals or practitioners to care for, control, or even fabricate mentally ill patients. In such situations of domestic process, whether the problem was a real mental illness did not always matter: the domestic circumstances or social trouble were often major issues.
Japanese families had very similar power during the early modern period in the context of mental illness. The legal and social structure of the Tokugawa era (1603-1868) may have given the family more power than that of Western European countries. There were a few reasons for the domestic power. During the Tokugawa era, Japanese people were not allowed to move around in the country in a kind of feudalistic system and carrying them to distant mental hospitals or madhouses was illegal. The Confucian philosophy encouraged people to cultivate domestic emotions, dedication to familial virtue, and to take care of mentally ill family members. The family was regarded as responsible for its members' behaviour. When the members were regarded as suffering from severe mental illness, the family and the community usually asked the local authorities to confine the patient in a visible cage in both rural and urban areas.
The Meiji Restoration took place in 1868, and the Japanese government and people started quick westernisation. The care and treatment of mentally ill patients in mental hospitals or asylums was what many elite bureaucrats, who had visited European countries, wanted to introduce into Japan. Importing psychiatry from German universities was relatively easy, and the department of psychiatry of the Tokyo Imperial University was quickly established and flourished. Many young psychiatrists also attended German universities and trained in their medical skills and in the interesting use of the German language.
However, the relatively rapid psychiatric development was just one part of the development of modern care and treatment in Japanese society. Japan and many other East Asian countries or colonies did not have the concept of hospitals until the late nineteenth century. Japan was very quick to introduce the Western medicine from around 1750. During the same period, Tokyo (Edo) had already developed a consumer society for the sale of Chinese medicine, with some additional medicines imported through the Dutch merchant. Perhaps the most important was the development of a visible cage in the family long after the Meiji Restoration. Until the late 1920s, the number of domestic cages continued to grow, while the number of mental hospitals grew much more quickly.
The power of the family was more crucial in psychiatric hospitals. From around 1900, large cities, particularly Tokyo and Osaka, began building new psychiatric hospitals. The public psychiatric hospitals, which were usually medical schools’ teaching hospitals, were given academic priority and designated as centres to attract young students. The private hospitals led the situation in terms of psychiatric beds, and more than ninety per cent of the entire beds were and still are shared by the private mental hospitals. Many of the private mental hospitals received support from the local administration for the care of poor patients in the buildings, as well as payment from wealthy patients.
Ohji Psychiatric Hospital, hereafter OBH, was perhaps the most flourishing privately owned psychiatric hospital in Tokyo in the 1920s and the 1930s. Although its buildings were almost completely destroyed during the Tokyo air raids in 1945, its archives and thousands of patients’ case histories survived. The case histories of OBH represent several agents’ viewpoints and behaviour. The families of the patients almost always represented their interpretation of the hospitalisation, with different views expressed by the patients.
Another important subject is the societal and cultural environment in domestic relationships. Politics, economy, culture and other factors had a tremendous influence on the tension between family members. Especially the society of Tokyo from the 1920s to the end of the Second World War had enormous and drastic changes in the everyday life of the people in the city, and mentally ill patients and their family members. The case histories of the thousands of patients are almost a representation of the rapidly changing Tokyo in the second quarter of the twentieth century.
After presenting the situation of psychiatric hospitals in Tokyo, this paper will first discuss some interesting cases of domestic power and its tension with the patients. These cases allow historians to examine the similarities and differences between European and Japanese cases. This is followed by a detailed analysis of a case history of a young woman that shows the complex tensions between the patient and her family members during two hospitalisations in 1936 and 1939. This case highlights several complex aspects of psychiatric hospitals in Tokyo. From the patient’s perspective, the question of whether young women can be employed was the first major issue. The female outfit in clothes and hairstyle on the street was another. The right to enjoy the modern new dancing in the city centre was yet another. From the parents’ perspective, the patient's theft of the family’s money is a major concern. Her visiting the dancing halls, not just in Tokyo but also in Osaka and Kobe, is yet another large issue. Perhaps the largest fear of the family is that the daughter was almost caught by procurers for prostitution, due to her lifestyle of urban pleasure.
This paper will conclude with some considerations about the case and other similar cases. The patients were not suffering from severe and straightforward mental illness. Many people might not be able to decide whether such patients were experiencing neurosis or related mental symptoms. This paper will argue that the centrality of family members' power in the making of psychiatry in Tokyo was crucial.
