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New safety net for the mind provided by psychology

Shin-ichi Suzuki
Professor, Faculty of Social Sciences, Waseda University

Stress and mental health in modern society

Now "stress", originally a technical term, is a common word that even elementary school children often use. Over the last some decades, studies on stress have dramatically advanced, and produced a number of findings of how stress experience affects immune system, endocrine system, autonomic nervous system, and other organic systems for physical conditioning as well as activity of the brain controlling these systems.

Here is one question. Do our considerable interest in stress and a lot of study results on stress enable us to succeed in overcoming stress? The answer would be probably "No." Actually in Japan, during the last ten years, more than 30 thousand people committed suicide every year, and an increasing number of people have taken sick leave from companies because of depression or other mental problems. In view of this fact, it should be recognized that there was a big gap between approach to stress for the purpose of "research" and approach to stress for the purpose of "health administration."

Considering the current situation in Japan, however, we need to take "serious" measures against stress involved with modern society without any further delay. (I emphasize "serious" because of the fact that measures against stress has not been fully taken in actual circumstances though it first appeared in the guideline created by Former Department of Labor 20 years ago.) This paper discusses key points in stress issues to be tackled and shows the direction.

Preventative measures against depression and suicide

In Japan, more than 30 thousand people have committed suicide every year since 1998. When compared to seven to eight thousand people that were killed by car accident every year, this is a very alarming figure. According to the report by World Health Organization (WHO), it is expected that 95% or more of those who committed suicide (an estimated value because accurate investigation is not available for those who completed suicide) may have suffered from mental illnesses just before their suicide, especially with depression one of the most common causes. Also the number of people who do not attempt suicide, but take sick leave from companies for a long period due to mental problems has drastically increased. Recommendation of National Personnel Authority 2007 (analysis regarding national government employees) reports that 63% of the employees on sick leave for a long period claim depression or other mental illnesses.

Under such current circumstances, Health, Labor, and Welfare Ministry and other organizations are promoting mental health measures especially intended for people in their prime in companies and local communities. However, we cannot say our measures are more sophisticated than other countries. For accomplishment of more comprehensive and detailed measures in future, there are key points including:

  1. Preventive approach: Provides educational activities regarding depression, suicide, and stress management (self control of stress) in office and local community, and establishes system for supporting suffering people as well as those around them (implementation of facility where surrounding people can consult about what to do).
  2. Early detection, rapid cure: Detects those who chronically experience stress and suffer from mental and/or physical disorder early, and leads them to proper care (such as visit to clinic and counseling)
  3. Cooperation between general physicians and psychiatrists: A person suffering from depression very often consults his or her local general physician at first. This is partly because of resistance to visit to psychiatrist, but more particularly because of lassitude and malaise typical to depression. Thus it is urgently required to improve the ability of general physicians for treatment of mental illnesses as well as to establish network through which they can get assistance from psychiatrists as necessary during treatment.
  4. Enhancement of psychosocial rehabilitation: Since drug therapy for depression has been dramatically advanced, proper treatment leads to rather favorable progress and even enables a patient to maintain a stable condition. A stable condition, however, does not always mean return to work. To successfully re-adapt to social life while coping with stress, "mental rehabilitation (psychosocial rehabilitation)" is necessary. For example, it is recommended that a person toward recovery should make a plan for return to work while adjusting daily rhythm, gain confidence by taking actions according to that plan, and develop positive mental state and confidence. Also it is effective to learn how to cope with stress as well as to get practice in thinking flexibly rather than negatively. (These support strategies are called "cognitive behavior therapy".)

Establishing mental care system in the medical field

Depression and stress are deep problems not only for workers, but for those who suffer from serious illnesses such as cancer and heart disease, chronic disorder such as diabetes and nephropathy, or refractory diseases including refractory neuropathy. For example, National Cancer Center reports 20 to 40% of the cancer patients are in a protracted depressive state. Further the investigation of around 2500 heart disease patients conducted by a certain medical institution shows a prevalence of depression among heart disease patients is estimated at 14%. Though everyone knows "All illness comes from the mind", Japan is now far behind European countries in care system for the mind of both patients and their supporting family.

Of course, the current medical system provides mental treatment in addition to physical treatment if a serious mental problem appears. However, daily problems including stress associated with physical treatment and anxiety about prognosis are not fully cared for. Though psychotherapists are expected to care for the mind of physical disorder patients, they feel difficulty in contributing to the medical field because there is no national qualification concerning psychotherapy in the current health insurance system. This is a big problem.

Psychology contributing to establishment of "mental safety net

In today's society, there is surely increasing need for "mental support". Then, where should we go? As described earlier, system establishment is urgently required in local communities, companies, and medical institutions. Once system is established, however, it will not be effectively utilized until its "intermediary" or "guide" is available. Since such system is often regarded as "a place where a person in trouble goes, a person in mental health trouble has some internal hurdles (in other words, resistance he or she personally feels) so that he or she will not utilize the system because, for example, "I'm not at such a serious stage", "I'll get better after a little rest", and "I don't want to go such a place". That is, what is now required is "daily care" as well as "professional care", and further establishment of "mental safety net" for effective use of "professional care." I believe "psychology" does most contribute to establishment of this safety net.

Shin-ichi Suzuki
Associate Professor, Faculty of Human Sciences, Waseda University

Site URL:http://www.f.waseda.jp/ssuzuki/

The author was born in Tokyo, and took the current post in April 2007 after experiencing some posts including a psychotherapist in Tokyo Women's Medical University, psychotherapist in department of psychosomatic medicine in Ayase station clinic, full-time lecturer in Faculty of Health and Welfare Science, Okayama Prefectural University, and a manager of Training and research center for clinical psychology (associate professor) in Graduate school of Education, Hiroshima University. He joins the Japanese Association of Behavior Therapy (board member), the Japanese Association of Behavior Therapists (director-general), Japanese Society of Behavior Medicine (chairman of education and training committee), the Japanese Association of Cognitive Therapy (board member), Japanese Society of Psychosomatic Cardiology (board member), the Japanese Association of Anxiety Disorders (board member), the Japanese Association of Stress Science (board member), Society for Adult Disease Cognitive Behavior Therapy (secretary), Medical Psychological Network (chief facilitator), and Tokyo Cognitive Behavior Therapy Academy (board of member) .
He specializes in clinical psychology (cognitive behavior therapy), clinical stress science, and behavior medicine and devotes his professional life to establishment of mental care system by psychotherapists based on team medicine.

Main works:
"Stress management practice manual in school, office, and local community" Kitaoji- Shobo (2004), "Cognitive behavior therapy technique guide for practitioners" Kitaoji- Shobo (2005), translation of "Treatment for Chronic Depression - Cognitive Behavioral Analysis System of Psychotherapy (Jr., James P. McCullough)" Igaku-Shoin, and many others