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From Neurasthenia to Morita Therapy: the development of psychiatric knowledge in modern Japan (1900s-1930s)

Sarah Terrail-Lormel
Translated by Karen Grimwade

Abstracts

The aim of this paper is to review and summarise recent historical research on neurasthenia in Japan and show how the concept of neurasthenia and its wide diffusion among the Japanese public in the early twentieth century constituted a watershed in the elaboration of psychiatric knowledge. Psychiatry became established in Japan as a medical discipline and a system of care for the mentally ill in the 1880s, but its views on mental illness and the treatments it espoused only gradually gained legitimacy among the public. The notion of neurasthenia – which was imported as a disease category by Japanese psychiatrists in the 1880s and assimilated by the general public after the end of the Russo-Japanese War (1905) – provided a new lens through which the Japanese could grasp everyday physical and mental complaints by placing them in the social and cultural context of the “process of civilisation” and the “struggle for existence”. In this way, the concept of neurasthenia brought a new sphere of individual experience into the realm of psychiatric expertise and contributed to the production of new psychiatric knowledge by generating a growing number of sufferers in search of a cure. Between the 1910s and 1930s, psychiatrist Morita Shōma (1874–1938) developed a novel theory and psychotherapy for neurasthenia that lay at the crossroads of Western psychiatric and psychological knowledge and popular Japanese therapies of the day.

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Original release: Sarah Terrail-Lormel, « De la neurasthénie à la thérapie Morita : la fabrique du savoir psychiatrique dans le Japon moderne (décennies 1900-1930) », Cipango, 22, 2015, p. 51-107.. URL : http://journals.openedition.org/cipango/2707 ; DOI : https://doi.org/​10.4000/​cipango.2707.

Introduction

  • 1 Miéko Macé, Médecins et médecine dans l’histoire du Japon [Doctors and Medicine in Japanese Histor (...)
  • 2 Serizawa Kazuya 芹沢一也, “Hō” kara kaihō sareru kenryoku: hanzai, kyōki, hinkon, soshite Taishō demok (...)
  • 3 Genshiro Hiruta, “Japanese Psychiatry in the Edo Period (1600–1868)”, History of Psychiatry, vol.  (...)
  • 4 See the distinction made by Ian Hacking between the classifications of objects produced by the nat (...)
  • 5 See, for example, Jan Goldstein’s discussion of the “boundary disputes” pitting French psychiatris (...)

1After the Meiji Restoration (1868), Western medicine came to play an important role in building the modern Japanese nation-state. While the central government was keen to ensure public health and fight epidemics in order to guarantee a nation of healthy soldiers and workers,1 the legal framework surrounding Japan’s fledgling psychiatric field meant that in its early days, the discipline was part of a system designed to deal with the “lunatics” threatening public order rather than a branch of medicine tasked with improving the health of the Japanese as a whole.2 As such, psychiatry perpetuated existing local practices for dealing with insanity. Yet this recently imported science also provided a new view of “mental illness” that contrasted with popular beliefs on madness and the conceptions held by the main Sino-Japanese schools of medicine.3 The first Japanese psychiatrists of the 1890s and 1900s thus found themselves restricted to treating a tiny section of the population and facing a need to prove the pertinence of their expertise and therapeutic treatments to both the country’s leaders (who saw psychiatry merely as an instrument for maintaining social order) and the general public (who were attached to native Japanese therapies). In fact, historical research has shown how the peculiar nature of psychiatric knowledge has meant that, wherever it was imported, the field consistently had to prove its usefulness to political leaders and win popular support for theories and practices of which patients were themselves the object4 and which had traditionally been the domain of other specialists.5

  • 6 Junko Kitanaka, Depression in Japan: Psychiatric Cures for a Society in Distress (Princeton: Princ (...)

2Psychiatry’s legitimisation within society and its expansion beyond the walls of the asylum were part of a bi-directional process that took place in Japan during the first decades of the twentieth century: On the one hand, psychiatry acted as a guarantor of social order and helped tackle the “social question” – meaning the various social problems linked to the industrialisation and urbanisation of Japan (alcoholism, juvenile delinquency, etc.). And on the other, it was able to position itself as a protector of public health by contributing to the discourse on the evils of modern life and imposing a psychiatric view of the disorders affecting normal people, in particular neurasthenia.6 This “disease of civilisation”, which in the 1900s–1930s was perceived as having reached epidemic proportions, gained immense importance on the cultural, clinical and scientific levels. As the concept of neurasthenia spread throughout society, it provided a new means of understanding not only individual suffering but also the profound transformations that had been affecting Japanese society for several decades, illustrating the public’s appropriation of psychiatric concepts and helping psychiatry to expand in the public sphere. In return, the neurasthenia “epidemic” created a fertile ground on which one particular psychological theory and an original form of psychotherapy could develop within Japanese psychiatry – Morita therapy (morita ryōhō 森田療法), which drew on Western science as it was developing almost in parallel in that time and adapted it to the clinical and sociocultural reality of Japan. Morita therapy was quickly recognised as an important national discovery; it founded the first psychotherapeutic school of thought in Japanese psychiatry and reached the peak of its development after World War II.

  • 7 Suzuki Akihito has examined the history of psychiatry in Japan from the angle of the social histor (...)
  • 8 Aside from some rather hagiographical works on Morita, the only studies to place his theories in t (...)

3Throughout this paper I will draw on recent historical research on Japanese psychiatry, which since the 2000s has breathed new life into a field previously dominated by historical studies written by psychiatrists mainly interested in the discipline’s institutionalisation “from above” and the treatments reserved for the “insane”. In recent years, researchers from the humanities and social sciences have turned their attention to the issue of psychiatric knowledge within society, focusing in particular on the dissemination of the concept of neurasthenia in Japan as a key moment in psychiatry’s penetration of Japanese society.7 Although a plethora of publications on Morita therapy has been written since its emergence – by practitioners and patients alike – it has only recently been the subject of a small number of historical studies, which have also informed this paper.8

4The first section of this paper provides a brief outline of the birth of psychiatry as a discipline in Japan; in the second section I will describe how neurasthenia emerged in Japan as a psychiatric concept, a social discourse and a clinical phenomenon. The final section explores how one local branch of psychiatric knowledge came to develop in the form of Morita therapy and his theory of neurasthenia.

The institutionalisation of psychiatry in Japan

5The four decades from 1890 onwards saw psychiatry become established as an academic discipline and a clinical speciality within Japan’s new official medicine. New legislation was adopted on the treatment of the mentally ill and a system of psychiatric care was implemented that relied heavily on private initiatives.

  • 9 The dissemination, through “Dutch learning”, of Western medical theories prior to the opening up o (...)
  • 10 Okada Yasuo 岡田靖雄, Nihon seishinka iryōshi 日本精神科医療史 [The History of Japanese Psychiatry] (Tokyo: Ig (...)
  • 11 The Japanese Society of Psychiatry and Neurology continues to be the main professional organisatio (...)
  • 12 Okada, Nihon seishinka, 186; Serizawa, “Hō” kara kaihō, 104–06.
  • 13 Okada, Nihon seishinka, 168–69.

6Psychiatry – known at the time as seishinbyō-gaku 精神病学 – began to take root in Japan in the 1870s and 1880s9 after Western medicine – of which it was one branch – was officially adopted by the Japanese government in 1874. It was occasionally taught during medical lectures given by European professors,10 and the first two Western-style public asylums opened in Japan in Kyoto (1875) and Tokyo (1879). However, it was not until 1886 that academic psychiatry was officially founded with the creation of the first chair in psychiatry at Tokyo Imperial University. The first person to assume this position was Sakaki Hajime 榊俶 (1857–1897), followed after his premature death by Kure Shūzō 呉秀三 (1865–1932), who took over the role in 1901 and occupied it for almost a quarter of a century, until 1925. It is notably for this reason that Kure is considered in psychiatric historiography to be the “founder” of Japanese psychiatry. Whether or not that is true, Kure was undeniably the main institutional figure in Japanese psychiatry during the first quarter of the twentieth century. He devoted a substantial part of his long career to establishing psychiatry as an academic discipline, developing and improving psychiatric care, and promoting mental hygiene. In 1902 he co-founded with his Imperial University colleague Miura Kinnosuke 三浦謹之助 (1864–1950) the Japanese Society of Neurology (Nihon shinkei gakkai 日本神経学会) – forerunner of what is now the Japanese Society of Psychiatry and Neurology (Nihon seishin shinkei gakkai 日本精神神経学会) – which he co-chaired almost continuously until his death.11 The society’s journal, Shinkeigaku zasshi 神経学会雑誌 (Journal of Neurology), was created that same year. Kure also made improving the teaching of psychiatry one of his priorities and successfully campaigned to have psychiatry classes made compulsory at medical schools in 1908.12 Kure’s students went on to found psychiatry departments at more than twenty universities and medical schools during the first two decades of the twentieth century.13

7Psychiatric theory as it was taught at Japanese universities largely followed the main tenets of German-language psychiatry, until the end of World War II at least. The vast majority of students undertook a period of study in a German-speaking country and early textbooks were usually a compilation of texts translated from German-language textbooks.

8At Tokyo University, Sakaki Hajime, who had studied in Berlin under Carl Westphal (1833–1890), one of the most illustrious representatives of a generation of psychiatrists devoted to conducting lab research on the anatomy of the brain and the nervous system, adopted the approach promoted by Wilhelm Griesinger (1817–1868) – whose textbook provided the framework for Sakaki’s early classes – summed up in his famous maxim as “mental diseases are brain diseases”.

  • 14 Okada Yasuo, “Meiji-ki no seishinka iryō — sono shoki jijō” 明治期の精神科医療—その初期事情 [Psychiatric Care in (...)
  • 15 Kure spent part of his study trip (1897–1901) in Heidelberg, studying under Kraepelin. A leading f (...)
  • 16 Engstrom, Clinical Psychiatry in Imperial Germany, 174–77, 194–98.

9Richard von Krafft-Ebing (1840–1902) was another key author for a Japanese psychiatry that was closely linked to forensic medicine in its early years.14 This orientation remained more or less unchanged under Kure, whose teaching emphasised influential German-speaking clinical psychiatrists from the next generation: Emil Kraepelin (1856–1926) and Theodor Ziehen (1862–1950).15 Other elements Kure brought back to Japan included Kraepelin’s disease classification system, a view of mental illness as hereditary, and an awareness of psychiatry’s role in social prophylaxis.16

  • 17 With the Kyoto asylum having closed in 1882, all that remained was Sugamo Hospital 東京府立巣鴨病院 (forme (...)
  • 18 The Custody Law for the Mentally Ill (Seishinbyōsha kango-hō 精神病者監護法), adopted in 1900, was design (...)
  • 19 Suzuki, “The State, The Family”, 199–201.
  • 20 Satō Masahiro 佐藤雅浩, Seishin shikkan gensetsu no rekishi shakaigaku: “kokoro no yamai” wa naze ryūk (...)
  • 21 Published in the Tokyo Journal of Medical Science under the title “Actual Conditions of Home Confi (...)
  • 22 Okada, Nihon seishinka, 174–75.
  • 23 Suzuki, “The State, the Family”, 202–03, 213.
  • 24 Ibid. 217.
  • 25 Satō, Seishin shikkan gensetsu, 200–30.

10From an institutional point of view, the period from 1880 to 1920 saw psychiatric care expand progressively, particularly in the private sector. The first psychiatrists condemned Japan’s treatment of the mentally ill as both insufficient and deplorable, regularly criticising it in the press and to political leaders. Indeed, at the turn of the century Japan boasted only one public asylum.17 The main method for dealing with the insane consisted of “home confinement” (shitaku kanchi 私宅監置), a practice employed since the Edo period and institutionalised by law in 1900.18 Psychiatry had no role to play in this system: the business of dealing with unruly lunatics (vagrants and criminals for example) fell principally to families and local authorities.19 For decades, psychiatrists at the imperial universities repeatedly stressed the need to build psychiatric hospitals, justifying their call by evoking the threat to public order (dangerous lunatics should be locked up), appealing to the country’s sense of national prestige (any civilised nation has a duty to show concern for the mentally ill) and using humanistic arguments (the insane deserve to receive the appropriate medical care).20 In 1918, Kure and several of his pupils at the University of Tokyo scored an important point by publishing a famous report documenting and denouncing the wretched conditions of patients in home custody.21 Their campaign was instrumental in bringing about the 1919 Mental Hospitals Act (Seishinbyōin-hō 精神病院法), which for the first time asserted the need to actually care for the mentally ill. This act ordered the creation of public asylums in every prefecture and assigned psychiatrists certain decision-making powers in committing and discharging patients.22 Nevertheless, it was a partial failure in its implementation: a lack of the funding necessary to achieve its objectives and the existence of a system of financing public beds in private facilities meant that the Mental Hospitals Act actually strengthened the private psychiatric sector, which had been experiencing a boom since the late nineteenth century. As an illustration, in 1918, just before the Mental Hospitals Act came into effect, 57 private hospitals with a capacity of 4,000 beds already existed, compared to just 450 beds in Japan’s single public asylum. Twenty years later, in 1940, 7 public hospitals existed versus 160 private institutions.23 Suzuki Akihito has stressed that this expansion of the commercial sector reflected a genuine demand for psychiatric care from private clients.24 This demand can be explained in part by the dissemination of psychiatric views on mental illness among the general public and the recognition achieved by psychiatric therapies. Indeed, Satō Masahiro has shown that psychiatry was a regular topic in the media at the turn of the century and a new discourse on mental illness had appeared, thereby familiarising readers with psychiatric concepts and mental hospitals.25 The concept of neurasthenia, which was a dominant feature of this new discourse, facilitated the assimilation of psychiatry by Japanese society.

Neurasthenia: from psychiatric term to social disease

  • 26 Beard’s first paper on neurasthenia was published in 1869, but the two books that popularised the (...)
  • 27 Marijke Gijswift-Hofstra, “Cultures of Neurasthenia, from Beard to the First World War” in Culture (...)
  • 28 In his 1880 publication, Beard lists more than 70 symptoms, including: dilated pupils, headaches, (...)
  • 29 A modern civilisation characterised, according to Beard – in an oft-quoted phrase – by the followi (...)
  • 30 Brad Campbell, “The Making of ‘American’: Race and Nation in Neurasthenic Discourse”, History of P (...)

11The term neurasthenia, originally popularised by the American neurologist George Miller Beard (1839–1883) in 1869,26 referred to a state of nervous exhaustion brought about by the excessive demands imposed on the central nervous system by modern life.27 It covered a wide spectrum of symptoms, with the common denominators being emotional volatility and a heightened susceptibility to physical and mental fatigue.28 At its origins, neurasthenia was thus a physical and neurological illness that was distinctive for having a social cause: Beard saw it as a disease of modern civilisation29 affecting in particular those at the forefront of the process of civilisation. The neurasthenic was typically presented as a white, educated – or even sophisticated – and above all overworked male from the well-off urban classes.30

  • 31 The contributed volume by Marijke Gijswijt-Hofstra and Roy Porter (Cultures of Neurasthenia) clear (...)
  • 32 Tom Lutz, “Neurasthenia and Fatigue Syndromes – Social Section” in The History of Mental Symptoms, (...)

12Although Beard saw neurasthenia as essentially an American disorder, the diagnosis rapidly crossed the Atlantic and became extremely popular in Europe – in particular Germany – where it took various forms according to each country’s clinical, theoretical as well as social, political and cultural particularities.31 Epidemics of neurasthenia began to sweep through European countries in the 1880s, generating heated theoretical debate as to its causes, inspiring a plethora of essays, papers and novels, and making the fortunes of the sanatoriums and bathing establishments converted into treatment centres.32

  • 33 Shorter, A History of Psychiatry, 132; Volker Roelcke, “Electrified Nerves, Degenerated Bodies: Me (...)

13It is important to stress that the neurasthenia “epidemic” went hand in hand with psychiatry’s expansion as a private clinical practice and, in Germany in particular, with its establishment as an academic discipline. By turning psychiatrists’ attention towards disorders of the “nerves”, neurasthenia provided psychiatry with a new public consisting not of lunatics but of well-educated middle- and upper-class individuals seeking treatment on their own initiative. It also established psychiatrists as experts capable of proposing solutions to social problems.33

  • 34 Campbell, “The Making of ‘American’”, 165–68; Wessely, “Neurasthenia and Fatigue Syndromes”, 512–1 (...)

14Despite this, at the turn of the century neurasthenia gradually began to lose its social and scientific credibility due to a combination of factors. These included: accusations of improper diagnosis or overdiagnosis by incompetent, unscrupulous doctors and idle patients (as an excuse to avoid work); a questioning of the social cause of the disorder (since neurasthenia also existed among the working classes); a failure to prove the organic interpretation of neurasthenia (the neuropathological lesions supposed to exist proved impossible to identify); and the revelation that psychological processes played a role in the disease’s development and treatment. Neurasthenia came to be seen as a psychological disorder rather than a neurological disease and thus many doctors lost interest in it. The notion of neurasthenia ultimately gave way to new psychogenic concepts such as Freud’s anxiety neurosis and obsessional neurosis (1895–1896) and Pierre Janet’s psychasthenia (1903).34

15In Japan, the concept of neurasthenia began to spread within medical and intellectual circles in the 1880s; however, it was only after the Russo-Japanese War (1904-1905) that it became known to the general public through frequent debate in the media by doctors, essayists, educators, sexologists and novelists, and via the appearance of a plethora of treatments. The Japanese neurasthenia “epidemic” (meaning its prevalence in clinical settings and in discourse) lasted for around thirty years before waning in the 1930s and finally disappearing completely after World War II. Japan’s cultural and scientific environment in the early twentieth century was comparable to other neurasthenic nations, making it a fertile ground for “nervous exhaustion” to develop: on the one hand, rampant industrialisation and urbanisation were radically changing all aspects of Japanese social life, and on the other, the fledgling field of psychiatry was seeking academic and social legitimacy.

16In the following section I will attempt to describe the Japanese “epidemic” of neurasthenia from a medical perspective (although limited to psychiatric discourse), as a public discourse, and finally, as a therapeutic phenomenon.

A minor degeneration: the theory of neurasthenia in psychiatric literature

  • 35 Sexual neurasthenia was mentioned in an 1879 paper on “Nervous Illnesses Linked to the Male Reprod (...)
  • 36 Chikamori Takaaki 近森高明, “Futatsu no ‘jidaibyō’ – shinkei suijaku to noirōze no hayari ni miru ning (...)

17The concept of neurasthenia, or shinkei suijaku 神経衰弱, appeared in Japanese medical literature in the early 1880s thanks to the international circulation of ideas and experts.35 Numerous papers were published in medical journals up until the early twentieth century, demonstrating doctors’ interest in the disorder. Most of these papers consisted of presentations of the theory of neurasthenia, translations or summaries of articles published in foreign journals, or reports on local clinical studies (conducted, for example, at Tokyo Imperial University Hospital).36 The medical community in Japan closely monitored scientific developments overseas.

  • 37 See in particular Volker Roelcke, “Biologizing Social Facts: An Early 20th Century Debate on Kraep (...)
  • 38 Ishida Noboru 石田昇, Shinsen seishinbyō-gaku 新選精神病学 [New Anthology of Psychiatry], revised 4th ed. ( (...)
  • 39 So-called acquired neurasthenia was also known as “chronic nervous exhaustion” (mansei shinkeisei (...)
  • 40 Ishida, Shinsen seishinbyō-gaku, 261–62; Miyake Kōichi 三宅鑛一, Seishinbyō shindan oyobi chiryōgaku(...)
  • 41 As was the case in Germany (see Engstrom, Clinical Psychiatry, 194–98). Serizawa Kazuya and Hyōdō (...)

18The theory of neurasthenia adopted by the majority of Japanese academic psychiatrists was heavily influenced by German ideas, in particular those of Emil Kraepelin. The main characteristics of this conception were a belief in the essentially organic origin of mental illness, a focus on hereditarianism and an emphasis on the theory of degeneration.37 The process of civilisation highlighted by Beard was deemed at most a trigger, and neurasthenic symptoms were grouped into two separate diagnoses depending on the suspected cause. The first, known as “acquired neurasthenia” (kōtensei shinkei suijaku後天性神経衰弱), referred to a temporary state of exhaustion that might follow an illness or a state of overexertion. The most common symptoms were intense fatigue, memory problems, anxiety, headaches, difficulty sleeping, digestive complaints and genital problems.38 The second, known as “constitutional neurasthenia” (sentensei shinkei suijaku 先天性神経衰弱, in German konstitutionelle Neurasthenie) or “nervosity” (shinkeishitsu 神経質, in German Nervosität),39 covered the same symptoms but these were often accompanied by psychological disturbances such as hypochondria, obsessive ideas and “abnormal” sexual habits. However, this second form of neurasthenia was thought to stem from a congenital nervous disposition and to appear during childhood. In fact, constitutional neurasthenia was categorised as a form of “insanity of degeneration” (henshitsubyō 変質病 or henshitsusei seishinbyō 変質性精神病, in German Entartungsirresein). The term “mental degenerate” referred to a category of individuals who presented no obvious problems in their physical and mental development but who suffered from a “birth defect” visible in their “abnormal psychological personality” (particularly in emotional and volitional terms), which placed them on the “borderline between sanity and insanity”.40 Mental degenerates – along with the mentally retarded and a whole range of “abnormal personalities” (criminals, prostitutes, alcoholics, beggars and other marginals) – were considered to represent an “intermediate state” (chūkan jōtai 中間状態, in German Grennzustände), a concept that encompassed a vast range of individuals deemed by the booming field of psychiatry to fall between mental health and illness.41 The result was a morally ambiguous and less desirable view of neurasthenia than the one originally developed by Beard.

  • 42 Matsubara Saburō 松原三郎 (1877–1936), for example, one of Kure’s students who spent time in the Unite (...)
  • 43 Summaries of the presentations were published in Shinkeigaku zasshi, vol. 12, no. 6 (1913): 305–11
  • 44 Miyake Kōichi 三宅鑛一, “Shinkei suijaku to shinkeishitsu no kata” 神経衰弱と神経質の型 [Forms of Neurasthenia a (...)

19However, as Kitanaka Junko has pointed out, some psychiatrists did not support the German theory of neurasthenia and instead championed Beard’s version.42 Much research and theoretical debate was devoted to neurasthenia during the Taishō period. In 1913, for example, the twelfth annual conference of the Japanese Society of Neurology included a session on neurasthenia.43 In the 1920s, however, leading psychiatry professors began to speak out about what they saw as an excessive and improper use of the diagnosis by certain colleagues and within society. In a 1927 paper published in Shinkeigaku zasshi, for example, Miyake Kōichi 三宅鑛一 (1876–1954) – Kure’s successor to the psychiatry chair at Tokyo Imperial University – reminded doctors that cases of pure neurasthenia (meaning exclusively due to environmental causes) were extremely rare, that in most instances the problem was nervosity (i.e. constitutional neurasthenia) and that, in any event, an inherited morbid predisposition was almost always present.44

  • 45 Satō, Seishin shikkan gensetsu, 308–09.

20In the 1930s, neurasthenia’s loss of scientific legitimacy as a diagnosis – which was already complete in the West – and the development by Morita Shōma of a strong psychogenic theory of nervosity – echoing the establishment of a psychological cause for traumatic neurosis45 – ultimately killed off what little interest researchers at the prestigious universities had ever shown in neurasthenia.

  • 46 In several of his novels, Natsume Sōseki, an eminent neurasthenic himself, depicted characters con (...)

21Nonetheless, whatever degree of consensus was achieved by psychiatrists on the subject of neurasthenia, they were far from having the monopoly on disseminating and using the diagnosis within society, or even beyond the walls of the top universities. Not only had the concept not waited for psychiatry to be institutionalised before circulating around Japan, there was also a significant disparity between the recently imported European medical theories adopted by mainstream academics and the multifaceted discourse on neurasthenia to which the general public was exposed. The popularisation of the term by specialists thus interacted with local conceptions of the body and mind that blended vocabulary from modern Western medicine and traditional Sino-Japanese medicine, as well as with literary depictions of the disorder.46

A disease of civilisation: neurasthenia in the public discourse

  • 47 Kitanaka, Depression in Japan, 55–58; Satō, Seishin shikkan gensetsu, 166–84.

22Neurasthenia first entered the intellectual debate in the 1880s; however, it was only in the mid-1900s that it was disseminated to a wider public, notably through the daily press and via books popularising medical knowledge. A little over a decade later, it had not only displaced native Japanese concepts of everyday ills, it had become a “national disease” (kokumin byō 国民病) threatening the entire population, something from which people were encouraged to protect themselves.47

  • 48 Watarai, Meiji no seishin isetsu, 186–94.
  • 49 Satō, Seishin shikkan gensetsu, 144-59.

23Studies on the history of neurasthenia in Japan have noted that the concept spread throughout society precisely at the end of the Russo-Japanese War. Two researchers in particular have offered interpretations of why this was the case. Watarai Yoshiichi, whose work draws heavily on private sources, has suggested that neurasthenia spread throughout Japan as a metaphor for the exhaustion felt by the Japanese nation engaged in the 1904–1905 war. The vast number of soldiers deployed made this war an event with national repercussions, and the malleable concept of neurasthenia was able to express the difficulties and suffering experienced by people in a wide variety of milieus.48 Alongside this examination of the individual experience of neurasthenia, Satō Masahiro, who focused his analysis on the national press, revealed a geopolitical dimension to the condition. According to Satō, neurasthenia, as it was portrayed in war propaganda featuring Russian leaders and officers from the Imperial Russian Army, had a two-fold connotation as both a shameful illness suffered by a defeated enemy and as the privilege of great men in a great empire. Satō sees this duality as reflecting Japan’s ambivalence towards the Western powers. Having entered the concert of “civilised” nations following its 1905 victory against Russia, Japan could now suffer from the same ills and share the same fears of national degeneration. Satō describes the concept of neurasthenia at that time as “expressing the nationalist pride and fear of a now-civilised Japan capable of rivalling the Western powers, and symbolising the feeling of crisis caused by the various social changes brought about by international competition and affecting everyday life.”49

  • 50 The golden age of neurasthenia, in terms of discourse, spanned the four decades from 1900 to 1940. (...)
  • 51 Kanō Kengo 狩野謙吾, for example, director of the Kanō Hospital in Tokyo and inventor of a “visceral c (...)
  • 52 The Darwinian metaphor of the “struggle for existence”, first used in the context of war (as a “st (...)
  • 53 Satō, Seishin shikkan gensetsu, 169, 172.
  • 54 Sabine Frühstück has examined the sexual dimension of neurasthenic discourse, in particular the de (...)

24As we have seen, in the mid-1900s the concept of neurasthenia began to spread throughout Japanese society, thanks notably to the national press and medical books written for the general public.50 The most fervent promoters of this discourse were initially psychiatrists. However, as Satō has shown, the psychiatrists driving media coverage of neurasthenia were by no means the leading names in their field. They were not researchers from the prestigious imperial universities but rather upwardly mobile clinicians and private hospital directors, who made a living from their practice and needed to generate a clientele. These psychiatrists used several long series of articles published in national newspapers in 1905–1906, and later republished as bestselling books, to teach readers to recognise the insidious symptoms of this as-yet little-known illness while simultaneously promoting the treatments their institutions offered.51 They directly profited from the neurasthenia “epidemic” that quickly followed their tireless media campaign. In the articles they wrote, these clinicians attributed neurasthenia to three causes: hereditary causes, which were given more or less importance according to the author in question, environmental factors (illness, excessive behaviours, etc.) and sociological causes, in particular the evolutionary “struggle for existence” (seizon kyōsō 生存競争)52 thought to characterise the modern era.53 Furthermore, psychiatrists were not the only experts working in the field of neurasthenia: sexologists and paediatricians also fuelled the public discourse by highlighting problems that fell directly within their professional jurisdiction.54

  • 55 Satō, Seishin shikkan gensetsu, 230–39.

25Having initially been conceived as a problem affecting conscripts, neurasthenia became a student affliction after the war with Russia. The highly publicised suicide of Fujimura Misao 藤村操 (1903), a literary student at Tokyo Imperial University, provoked a concerned reaction in the media over a perceived wave of suicides among cultivated young people. These events were initially attributed, post-1905, to the political and cultural changes Japan had experienced since opening its doors, and the young men in question were presented as suffering from nervous or brain exhaustion caused by excessive academic competition (a symptom of the “struggle for existence”). However, in the mid-1910s, neurasthenia among overworked students came to be seen as merely the tip of an iceberg that was endangering the entire Japanese nation, a threat to brain health caused by the growing burden of the process of civilisation (bunmeika 文明化).55

26Although the three causes – hereditary, environmental and sociological – coexisted in the media, the dominant idea among the general public seems to have been that neurasthenia was a “disease of civilisation” (bunmeibyō 文明病), hence the repeated references to urbanisation, the increased demand for intellectual effort and the need to rapidly assimilate new knowledge in order to succeed in the age of the “struggle for existence”. The ideas expressed by Natsume Sōseki in his famous lecture on the modernisation of Japan in 1911 are typical of this phenomenon:

  • 56 Natsume Sōseki, “Gendai Nihon no kaika 1911”. Translation taken from “The Civilization of Modern-d (...)

Let us suppose that in forty-odd years of educational efforts that we have expended since the Meiji Restoration, we were able to arrive at the high degree of academic specialization that the Westerners realized after a hundred years and that we were able to do this entirely through internal motivation and without relying on any half-digested theories imported from the West, passing through a natural series of stages from theory A to B to C, entirely as a result of our own original research. If the Westerners, whose mental and physical powers far surpass ours, took a hundred years to get where they are now and we were able to reach that point in less than half that time (forgetting for the moment the difficulties they faced as pioneers), then we could certainly boast of an astounding intellectual accomplishment, but we would also succumb to an incurable nervous breakdown [neurasthenia]; we would fall by the wayside gasping for breath. And this is in no way farfetched. If you stop and think about it, a nervous breakdown [neurasthenia] is exactly what most university professors end up with after ten years of hard work.56

  • 57 Chikamori, “Futatsu no ‘jidaibyō’”, 200–01; Wu Yu-Chuan, “A Disorder of Ki: Alternative Treatments (...)
  • 58 For example, Nakamura Yuzuru 中村譲, a psychiatrist trained at the University of Tokyo, published in (...)
  • 59 Satō, Seishin shikkan gensetsu, 238; Frühstück, “Male Anxieties”, 43, 47–48.
  • 60 Satō, Seishin shikkan gensetsu, 310–12.

27Neurasthenia was thus frequently presented as a disease of mental exhaustion (or exhaustion of the brain) affecting the educated classes, people like politicians, senior government officials, doctors, lawyers and journalists – in other words, the intellectuals grappling with modernity.57 In some ways, then, although neurasthenia was a cause of suffering, it was also a desirable and positive cultural symbol – something contemporaries of the day were quick to ridicule.58 Yet as neurasthenia spread, fear crept in: namely, a fear of madness, with many patients concerned that neurasthenia might degenerate into true mental illness, and a fear of the nation’s decline, due to the danger of neurasthenia spreading among those expected to support or defend the country (such as students and soldiers).59 Note that media discourse was relatively impervious to the evolutions in academic psychiatric doctrine, changing little between the turn of the century and the 1930s.60

  • 61 Kitanaka, Depression in Japan, 57–59.
  • 62 For example, the disorders known in the late 19th century as ki-utsu 気鬱 (melancholia, sadness, anx (...)
  • 63 This change of focus to the brain was particularly visible in the names chosen for private psychia (...)
  • 64 Wu, A Disorder of Ki, 46.
  • 65 Satō, Seishin shikkan gensetsu, 200–30.

28As Kitanaka61 has pointed out, the dissemination of the concept of neurasthenia in Japanese society is remarkable in that just a few decades earlier – before the institutionalisation of modern Western medicine and its assimilation by the public – the Japanese had paid little attention to their brains and even less so to their nerves, since the latter did not exist in the “pure” tradition of Sino-Japanese medicine; instead, they were concerned with poorly flowing ki (energy, vital force).62 One of the cultural factors that enabled neurasthenia to resonate with the public was thus the establishment of a “language of nerves” and, perhaps even more importantly, of what Watarai calls a “culture of brain disease” in which the discourse on neurasthenia would make sense. Indeed, in the early Meiji period, terms like nōbyō 脳病 (brain disease) and shinkeibyō 神経病 (nervous disease, neurosis) were commonly used by the public to describe a range of somatic and psychological symptoms (headaches, insomnia, poor concentration, existential angst, etc.).63 In other words, the familiarity of the Japanese with this new perception of their organs meant that they could begin to suffer from a neurasthenia seen in Japan as “a disease of modern civilization. But rather than a disease of the nervous system, it was understood more as one of the brain, with the modern civilization regarded as a civilization of the ‘brain’ or the ‘head’.”64 One decisive structural factor in this cultural change was the high visibility of psychiatry (and of medicine in general) in the media since the turn of the century. Satō has shown how Kure Shūzō and his colleagues exploited the media as part of their campaign to improve psychiatric care, disseminating medical knowledge on mental illness and rallying the public to their cause by publishing summaries of lectures, articles on mental hygiene, statistics on mental illness and reports on psychiatric hospitals. The resulting media coverage created an intertextuality that facilitated the emergence of articles on neurasthenia.65

Treatments for neurasthenia

  • 66 Erwin Baelz taught medicine at Tokyo Imperial University as a guest lecturer from 1876 to 1902.
  • 67 Watarai, Meiji no seishin isetsu, 160.
  • 68 Okada Yasuo, Shisetsu Matsuzawa byōin-shi 私説松沢病院史 1879-1980 [A Personal History of Matsuzawa Hospi (...)
  • 69 Tōkyō daigaku seishin igaku kyōshitsu hyakunijūnen henshūiinkai 東京大学精神医学教室120年編集委員会 (ed.), Tōkyō d (...)
  • 70 Note that in contrast to contemporary representations of neurasthenics, a significant proportion o (...)

29Leaving aside discourse, how did neurasthenia evolve from a clinical point of view? The first known use of neurasthenia as a diagnosis was made by the famous German physician Erwin Baelz66 (1849–1913). Of the 1,534 outpatients he examined in 1890 at Tokyo Imperial University’s First Hospital, 107 individuals (in other words 6.9%) were diagnosed as neurasthenic. A similar proportion was observed four years later: 249 neurasthenics out of 3,914 patients (6.3%).67 It was not until immediately after the Russo-Japanese War, when public discourse on neurasthenia became increasingly pervasive, that the number of patients diagnosed with neurasthenia reached “epidemic” proportions. The annual percentage of new cases of neurasthenia diagnosed at the outpatient clinic of Sugamo Psychiatric Hospital increased regularly, from 10.6% in 1904 (12 patients), 16.5% in 1905 (37 patients), 18.9% in 1908 (60 patients) and 24.1% in 1911 (70 patients) to 21.8% in 1917 (51 patients).68 In contrast to these modest figures, between the creation in 1914 of an outpatient clinic in the psychiatry unit of Tokyo Imperial University’s hospital and 1921 at least, the percentage of neurasthenics was on average 32.5% of total patients, representing between 143 and 375 individuals per year.69 Over in the private sector, Gotō Shōgo 後藤省吾, head of the Tōkyō nōbyō-in 東京脳病院 (Tokyo Brain Clinic), claimed to have diagnosed no less than 789 cases of neurasthenia between 1899 and 1904, representing 30.8% of his clientele.70 Neurasthenia thus accounted for a large proportion of the diagnoses made at private and outpatient clinics, in other words, in institutional settings usually attended voluntarily by patients, suggesting that psychiatry had begun to be seen as a provider of treatments to “normal” people and not merely as a medical discipline dealing with the dangerously insane.

  • 71 This treatment, reported by Morita as having been administered by his colleague Ishida Noboru (187 (...)
  • 72 Miyake, Seishinbyō shindan, 597; Kure Shūzō, Seishinbyō-gaku shūyō 精神病學集要 [Compendium of Psychiatr (...)
  • 73 Kure Shūzō, “Bunmei to shinkei suijaku” 文明と神経衰弱 [Civilisation and Neurasthenia], Yomiuri Shimbun (...)
  • 74 Satō, Seishin shikkan gensetsu, 183.
  • 75 Presented by Kanō Kengo as a world first, this treatment consisted of injecting or orally administ (...)
  • 76 Tamura Kasaburō 田村化三郎 (a former army doctor converted to private practice), for example, claimed t (...)

30So what treatments did psychiatrists offer this growing number of patients? Academic literature indicates that the therapies commonly employed in Western countries were known in Japan and had been adopted. A patient suffering from neurasthenia might be treated using a combination of therapies, including waking suggestion, prolonged baths, the use of bromide, sleeping pills and lecithin, and finally, rest and large quantities of nutritious food.71 However, as of the 1910s, constitutional neurasthenia (i.e. nervosity) tended to be described as a particularly difficult-to-treat condition, both in the pages of Shinkeigaku zasshi and in psychiatry textbooks, and the only approach envisaged was prevention via hygiene measures and moderately eugenic policies: sobriety was recommended and “neurotics” were strongly advised against marrying one another.72 As for acquired neurasthenia – in other words, the chronic nervous exhaustion more familiar to the general public – scholars do not seem to have paid it much attention. Kure Shūzō, for example, writing in the Yomiuri Shimbun in 1913, explained briefly that a balanced diet and regular sleep were all that was needed to recover.73 This apparent disinterest from academics contrasted with the response of clinical psychiatrists, in particular private hospital directors (as both doctors and business managers), who actively developed treatments for what represented a considerable portion of their business.74 Adverts abounded in the press for the purportedly revolutionary treatments they offered. These included electrotherapy as well as more intriguingly named treatments like the “organic cure” (zōki ryōhō 臓器療法) developed by Kanō Kengo75 or the “injection cures” (chūsha ryōhō 注射療法) administered by various practitioners.76

  • 77 Kitanaka, “‘Shinkei suijaku’”, 160.
  • 78 This intellectual movement was linked to the defence of a Sino-Japanese medicine deprived of insti (...)
  • 79 Wu, A Disorder of Ki”, 31.

31Nevertheless, psychiatrists were far from the only professionals treating neurasthenics. Patient accounts and numerous guides attest to the existence of a wide variety of treatment options. In addition to GPs – often the first port-of-call for neurasthenics (and regularly described by disgruntled former patients as offering only pharmacological solutions)77 – a multitude of “alternative” therapies existed outside institutional medicine. Wu Yu-Chuan has studied these therapies, which owed their popularity to a broader movement of public opinion involving doctors practising traditional Sino-Japanese medicine, patients, intellectuals and clergymen, who all lamented the institutional monopoly of Western medicine since the Meiji Restoration. They highlighted its limits – notably its “materialism” and ignorance of the mind’s influence on the body – and called for the defence of native Japanese therapies and knowledge.78 This intellectual movement brought about multiple modern reinventions of traditional Edo-period methods for preserving health (yōjōhō 養生法) (such as Futaki Kenzō’s “abdominal breathing”, harashiki kokyūhō 腹式呼吸法), as well as various psychotherapies (seishin ryōhō 精神療法) and “spirit techniques” (reijutsu 霊術) that combined Buddhist-derived concepts of the spirit with hypnosis (such as Igarashi Kōryū’s “automatic cure”, jidō ryōhō 自動療法). According to Wu, these therapies, whose theories of neurasthenia incorporated ideas from Western psychology and neurophysiology as well as traditional Japanese medicine and Buddhism, constituted a cultural and social critique of “Western thought”, seen by some as invasive, materialistic, individualistic and damaging for the “Japanese body”. They also represented a call for a return to “traditional” Japanese values.79

  • 80 Mark Nichter, “Idioms of Distress: Alternatives in the Expression of Psychosocial Distress: A Case (...)

32Although neurasthenia began as a psychiatric concept, it was in the wider cultural sphere that it really took hold and became an ambivalent, flexible cultural symbol, an “idiom of distress”80 that gave meaning to individual suffering by linking it to the wider cultural context. The spread of neurasthenia in Japanese society during the first half of the twentieth century thus reflected the assimilation and incorporation of Western psychiatric knowledge into the cultural imagination and everyday lives of the Japanese, as evidenced by the proliferation of treatments for neurasthenia. In the next part of this paper I will attempt to illustrate the effect on Japanese psychiatry of the cultural support encountered by neurasthenia. Just as Freud’s invention of psychoanalysis is linked to the history of hysteria in Europe, what later became known as “Morita therapy” (morita ryōhō 森田療法) grew from a scientific and cultural context established by neurasthenia in Japan.

Morita’s therapy and theory of nervosity: the Japanese invention of psychotherapy

  • 81 Morita’s given name can be read either as Shōma or as Masatake. “Shōma” is the reading known to Mo (...)
  • 82 Hentai shinri 変態心理 [Abnormal Psychology] was a journal founded in 1917 by Nakamura Kokyō 中村古峡 (188 (...)
  • 83 Morita Shōma, “Shinkeishitsu no ryōhō” 神経質の療法 [Nervosity Treatment], Seiikai zasshi 成医会雑誌, no. 453 (...)
  • 84 In contrast to many other works on the history of Morita therapy, which retain the transcription s (...)
  • 85 The first, Shinkeishitsu oyobi shinkei suijaku-shō no ryōhō 神経質及神経衰弱の療法 [The Treatment of Nervosit (...)

33With the neurasthenia “epidemic” in full swing, Morita Shōma 森田正馬 (1874–1938),81 a psychiatrist from Kōchi, medical director of Negishi Hospital in Tokyo and a lecturer in psychiatry at Jikeikai University School of Medicine (Jikeikai iin igakkō 慈恵会医院医学校), published a series of papers in two medical journals and Hentai shinri82 in which he argued that nervosity was a psychological disorder that could be successfully treated with a psychotherapy he had devised.83 Morita spent the next twenty years working to increase awareness of his “special treatment for nervosity”,84 publishing numerous papers in general interest journals as well as several best-selling books written in an accessible style.85 It is possible that those hearing about Dr Morita’s therapy at the time saw it as yet another self-proclaimed miracle cure for neurasthenia. Nevertheless, despite the abundant range of treatments on offer, Morita therapy is the only one to have survived neurasthenia, so to speak, becoming a recognised and institutionalised psychotherapy in Japan after World War II and even being exported overseas.

  • 86 Morita Shōma 森田正馬, “Shinkei suijaku oyobi kyōhaku kannen no konjihō” 神経衰弱及強迫観念の根治法 [Completely Cur (...)
  • 87 Morita, “Shinkei suijaku oyobi kyōhaku”, 72.
  • 88 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 347.
  • 89 Wu, A Disorder of Ki, 128–39.
  • 90 Nomura Akichika 野村章恒, Morita Shōma hyōden 森田正馬評伝 [Critical Biography of Morita Shōma] (Tokyo: Haku (...)
  • 91 However, he was not the only person to take an interest in psychotherapy. One of his classmates at (...)
  • 92 This knowledge was derived from books. Morita never studied overseas.
  • 93 Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 395–406.
  • 94 Despite initially writing almost exclusively in medical publications, in the 1910s Morita wrote mo (...)

34As a founding member of Hentai shinri and a regular contributor, Morita Shōma often criticised modern (Western) medicine, believing like others that it tended “to consider only what is material and neglect psychological factors”.86 He held doctors partially responsible for the spread of neurasthenia, accusing them of “scaring” people by disseminating false information on neurasthenia in books aimed at the general public.87 However, Morita reserved his harshest words for popular psychotherapies, meditative practices and various other regimens, most of which he considered to be nothing more than “superstitious treatments” (meishin ryōhō 迷信療法) applied as a panacea88. Morita’s dual criticism of Western medicine and native therapies reflected his position at the intersection of these two fields: he represented both academic psychiatry and psychotherapy, a field occupied at the time by self-styled hypnotists seen as charlatans by scholars at the prestigious universities.89 Morita belonged to psychiatry’s elite. He graduated from the Fifth Higher School (Kumamoto) before studying medicine at Tokyo Imperial University (1898-1902), where he also attended classes in psychology at the Faculty of Letters. He then specialised in psychiatry during a residency under Kure Shūzō (1903-1906) and finally obtained the prestigious title of doctor (hakase) in 1924.90 It was Kure who recommended that Morita focus his research on psychotherapy. Among his contemporaries, Morita was undoubtedly the greatest specialist of psychotherapeutic techniques.91 He had knowledge of Western psychotherapies92 and was responsible for introducing occupational therapy at Sugamo Hospital during his studies. Morita was also well versed in popular Japanese treatments for neurasthenia. Having been a sickly, tormented child with a strong interest in philosophy, religion and magic, and then having suffered from neurasthenia as a student, Morita appears to have had considerable experience with these therapies, as either a patient or an observer.93 His writings attest to the fact that he gradually left behind a prestigious career in academic psychiatry to focus on treating neurasthenics.94

Morita’s theory of nervosity

  • 95 Morita was not the first Japanese psychiatrist to explore the psychological causes of nervosity. O (...)

35Morita’s theory of neurasthenia, or rather nervosity (shinkeishitsu 神経質), was fundamentally influenced by the epistemological framework of academic psychiatry at that time. What differed was the crucial role Morita attributed to psychological factors,95 his shift of focus away from the theory of degeneration and his relatively positive view of the “nervous” disposition.

  • 96 “Neurasthenia is said to increase with culture, as if it resulted from physical and nervous exhaus (...)
  • 97 Morita, “Shinkeishitsu oyobi shinkei suijaku”, 333.
  • 98 Morita, “Shinkei suijaku oyobi kyōhaku”, 81.
  • 99 “Nervosity is a constitution characterised by an excessively sensitive and weak physical and menta (...)

36Like his colleagues, Morita refuted the commonly held idea that neurasthenia was a “disease of civilisation” caused by “the increasingly complex nature of society and the intensification of the struggle for existence”,96 stating that “one does not become nervous (shinkeishitsu) from urban living or the competitiveness of student life, any more than one can avoid the condition by living in the country”. “Nervosity”, he continued, “is a hereditary disposition that is far from rare among farmers”.97 More specifically, Morita saw nervosity as a kind of physical, and above all mental, constitution. Yet he cautioned against viewing this “constitution” as an illness – an error committed by many doctors who focused naively on patients’ complaints and allowed themselves to be deceived by the symptoms they presented.98 Nervosity, he believed, was not a disease but rather a state which only differed from normality by degrees, not by nature.99 Its symptoms were not caused by a pathological change in the body but by a psychological mechanism:

  • 100 Ibid. 241.

Nervosity is characterised by a congenital state of irritable asthenia, yet close examination shows that the vital functions are not weakened: the problem is entirely psychological. The individual sees themselves as having weak stamina and it is this that causes the various symptoms and irritable asthenia to appear.100

  • 101 According to Morita, this hypochondriacal tendency was fuelled by the hygienist discourse of the d (...)
  • 102 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 240–41.

37Morita used the term nervosity to designate a group of disorders that fell under the category of neuroses, adding obsessional neurosis, anxiety neurosis and hypochondria to the symptoms traditionally associated with constitutional neurasthenia (see earlier in this paper). Morita classified nervosity into three subtypes: simple nervousness, obsessive ideas and paroxysmal neurosis. At its core, his psychopathological view of nervousness was based on two main concepts. The first was a “hypochondriacal base” (hipokondoriisei kichō ヒポコンドリー性基調), the indispensable congenital predisposition on which nervosity could develop. He described this predisposition as a “psychological tendency” – in this case an exaggerated tendency to be aware of and concerned with one’s own psychological and physical states.101 The other key element in Morita’s theory was a psychopathological mechanism he called “psychological interaction” (seishin kōgo sayō 精神交互作用): a vicious circle in which the attention paid to one’s physical sensations and ideas tends to exacerbate them, thereby increasing the attention paid to them and so on. It was this psychological interaction that generated the physical symptoms of nervosity (headaches, palpitations, etc.) rather than a truly organic cause.102

38But what caused this pathological self-awareness? As we saw, the dominant theory among psychiatrists at the imperial university was that those suffering from nervousness were degenerates, of a non-serious variety, but nonetheless incurable. Morita’s theory of nervosity approached the question of degeneration indirectly. While he subscribed to the principle of degeneration, he radically restricted its theoretical importance, and in doing so, its moral weight. The importance of heredity was also considerably reduced. Morita refuted any idea of nervosity being strictly determined by birth, stating that “nervous” parents did not necessarily have “nervous” children. Furthermore, he expressed doubts as to the very nature of what was commonly referred to as “congenital”:

  • 103 Ibid. 326–27; Morita Shōma, “Shinkeishitsu no hontai oyobi ryōhō” 神経質の本態及療法 [The True Nature of Ne (...)

Is it genetic material we inherit directly from our ancestors? Is it something that appears in-utero, that can affect us after birth, that arises during illness or is impacted by upbringing? I cannot yet tell.103

39Ultimately, in Morita’s theory of nervosity, degeneration lost its status as general cause. Though he never rejected the concept directly, Morita rendered it meaningless, replacing it with the idea of more or less innate “psychological tendencies”. This cautious scientific stance had a further consequence for Morita’s readers in that it removed the idea of a genetic defect and reassured the many sufferers who feared the condition might lead to actual insanity.

  • 104 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 244.
  • 105 Ibid. 248.
  • 106 Ibid. 244.
  • 107 Morita Shōma 森田正馬, “Henshitsusha no bunrui ni tsuite” 変質者の分類について [Classifying Degenerates], Shinke (...)

40It was these “psychological tendencies” (seishinteki keikō 精神的傾向) then, in Morita’s view, that were decisive in explaining why neuroses developed. To support his hypothesis, Morita refuted several Western psychological theories of neurasthenia. He rejected the “theories of long-lasting psychic trauma” for their inability to explain why only certain people became neurotic, despite the fact that all individuals experience “psychic trauma” – in his eyes, merely a normal part of life. “The cause”, he explained, “lies not outside the body but inside, in the form of predispositions”.104 Morita devoted slightly more space to discussing the “theories on the influence of unconscious complexes of ideas [geishiki kannengun 下意識観念群]”, no doubt because these theories were “supported by many scholars”, in particular Sigmund Freud. While Morita saw the unconscious inner life as vitally important and “recognise[d] that the influence of unconscious complexes of ideas causes various hysterical and neurasthenic symptoms”,105 he remained unsatisfied with what he saw as Freud’s “obscure and confused”106 application of these complexes. Although they could explain everyday mental disorders and symptoms of hysteria, in his opinion they could not account for the major psychological differences between, for example, a person suffering from hysteria and one suffering from nervosity. “We must consider other causes”, he said, and it was the idea of psychological predispositions that enabled Morita to resolve what he saw as the contradictions in existing psychogenic theories. Having become convinced of the fundamental importance of psychological predisposition – an intuition he claimed had been confirmed to him after discovering Ernst Kretschmer’s (1888–1964) theory of constitutional types – he established it as a general nosological principle in the late 1920s.107

  • 108 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 253; Morita, “Shinkeishitsu no hontai oyobi ryō (...)
  • 109 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 253, 334–340.
  • 110 According to Morita, nervosity was a pathological by-product of an essentially positive trait he c (...)
  • 111 Irie Hideo 入江英雄 speaking in Kōra Takehisa 高良武久 (ed.), Keigai sensei genkōroku – Morita Shōma no Om (...)

41This theory of psychological predispositions thus became the basis for Morita’s typology of neurotic personalities, which he categorised into three groups: nervous individuals, hysterics and “degenerates in the strict sense of the word”. There was a clear moral hierarchy to Morita’s description of these personality types and his classification of their symptoms. Nervous individuals were described by Morita as prone to “(psychological) introversion and intellectualisation” but without “the self-centredness and ostentatiousness of hysterics, the impulsiveness and shamelessness of immoral degenerates, or the lack of ambition and indolence of the weak-willed”.108 The reason for this is that, while the hypochondriacal tendency of nervous individuals was a clear sign of self-centredness, their behaviour was marked by emotional repression and excessive introspection: too bogged down in moral conflicts to fall into deviancy, their behaviour was subject to perpetual indecision.109 In Morita’s description, the symptoms of a nervous disposition were more akin to a disordered expression of essentially positive personal attributes. Indeed, although this “nervous” temperament was a source of suffering, it was also, according to Morita, the mark of a superior personality (an idea perhaps influenced by Morita’s own experience).110 This belief was particularly apparent in Morita’s discussions with patients, where he regularly mentioned venerable names from Japan’s spiritual pantheon. Former patients recall being told that “Shaka and Confucius had a nervous disposition. The personalities of truly great men are only found among the nervous”, and “One does not become nervous without having superior intelligence”.111 Such affirmations illustrate the vast difference between academic psychiatry’s description of nervosity and Morita’s depiction of the nervous individual: from an incurable degeneration of the nerves, nervosity became a personality type that more closely resembled a gift than a defect. Paradoxically, despite Morita’s refutation of neurasthenia’s media portrayal as a disease of civilisation, his diagnosis was equally attractive: nervosity, as he described it, once again became an eminently positive mark of distinction.

Dr Morita’s “special treatment for nervosity”: the invention of psychotherapy in Japanese psychiatry

  • 112 Sociologically speaking, to a certain extent Morita’s clientele reflected the stereotypes on neura (...)
  • 113 Based on Morita’s description of his therapy in his 1928 book (see the 1974 republication in Morit (...)
  • 114 In reality Morita also treated many sufferers as outpatients and by correspondence.
  • 115 Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 412–13.
  • 116 Morita claimed to have hospitalised “more than 260 patients” between 1919 and 1928. Given that he (...)

42Morita’s “special treatment” was a psychotherapy he developed exclusively for patients corresponding to his definition of nervosity.112 Ideally,113 the treatment was to be administered in a full hospitalisation setting that in practice closely resembled a household (Morita called it a “familial treatment”, kateiteki ryōhō 家庭的療法).114 It was in fact the discovery of the benefits of hospitalising a patient in his own home that retrospectively marked the founding moment of Morita’s therapy.115 In the 1920s, Morita began to treat a small number of patients at his home in the Hongō neighbourhood of Tokyo, where patients came into daily contact with his family, his domestics and students from Jikeikai medical school under his wing.116 Treatment could last anywhere from around a dozen days to one or two months.

  • 117 Ibid. 348–52.
  • 118 Ibid. 353–56.
  • 119 Similarly, reading should not be either contemplative or forced in order to encourage the patient (...)

43The therapy comprised four precisely structured stages. The first stage consisted of “bed rest” (gajoku ryōhō 臥褥療法), during which the patient was placed in a room and required to stay in bed. During this period of complete isolation, no distractions (visits, reading or smoking, for example) were permitted. The main objectives of this stage were to confirm the diagnosis of nervosity and quell the patient’s anxiety. With no stimuli present, the patient was encouraged to confront his or her anxiety head-on and not seek to avoid it. Morita saw this constant attempt to avoid anxiety as perpetuating the symptoms: he believed that once anxiety had reached its peak it would naturally and rapidly disappear. With the crisis over, the patient would quickly begin to feel bored and desire some occupation. When they had sufficiently “experienced the torture of doing nothing”, the second stage of treatment could begin.117 During this period of “light occupational therapy” (karuki sagyō ryōhō 軽き作業療法) the patient continued to be kept away from fellow-patients, was forbidden distractions and required to accept any symptoms as they were. However, their days were spent outdoors in the garden and they were encouraged to take part in light work of their choice (sweeping up leaves, observing ants, etc.). The objective was essentially to encourage “spontaneous activity” and a desire for physical work. As they became absorbed in these tasks and took pleasure in doing them, patients gradually broke free of their usual ruminations. At this point, a new element was introduced: every day, the patient wrote down his or her thoughts and impressions in a diary (nikki) that was read and annotated by the therapist.118 It was mainly through this activity that Morita was able to monitor each patient individually. During the third stage, known as “heavy occupational therapy” (omoki sagyō ryōhō 重き作業療法), activities were imposed on the patient based on their physical condition rather than their personal preferences. These could include chopping wood, heating bath water or repairing geta sandals. During this stage of the treatment, the patient began to enjoy and become more accomplished at their tasks; in return, the pleasure of succeeding in their work boosted their self-confidence. The fourth and final stage consisted of a period of training in the “complexity of real life” (fukuzatsu naru jissai seikatsu-ki 複雑なる実際生活期) in which the patient was allowed to read and go outside the hospital, within certain limits. These excursions were not to be approached as attempts to face the outside world but instead should consist of specific tasks (such as posting a letter). In this way, the patient would tackle various everyday situations without being oppressed by “anticipated anxiety”.119

  • 120 Morita, “Shinkeishitsu no ryōhō”, 318.
  • 121 Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 348, 365–66.
  • 122 Ibid. 325.

44This “apparently banal, popular and far from medical” psychotherapy for nervosity, as Morita himself described it,120 was consistently presented as the result of a resolutely scientific approach and lengthy clinical experience. Indeed, Morita had more than fifteen years’ experience in the various treatments for neurasthenia, both as doctor and patient. His experience and legitimacy as an expert allowed him to dismiss popular native Japanese therapies (for example breathing exercises, introspective methods and ki circulation methods) as well as the treatments used by Western-trained doctors (like pharmacopoeia and electrotherapy). Native Japanese therapies, in his view, contravened a fundamental principle of medicine – the use of diagnosis –, whereas Western-trained doctors mistook the symptoms of neurasthenia for the illness itself. All of these treatments, Morita concluded, were at best “symptomatic” (shōkōteki ryōhō 症候的療法), meaning that they treated the symptoms without tackling the underlying cause. Any effectiveness was thus illusory and would only be temporary, since the results were simply based on a form of suggestion.121 In contrast, Morita saw his treatment as a “radical cure” (konpon ryōhō 根本療法) in the sense that it aimed to treat the root cause of nervosity by strengthening the individual’s character to resist their “hypochondriacal temperament” and breaking the vicious circle of “psychological interaction”.122 The means employed by Morita were based on his experience and criticism of reputed Western psychotherapeutic techniques.

  • 123 Ibid. 347.

Unlike Charcot, I see no value in suggestion therapy …. I do not currently use any mechanical method of regulated living, as employed by Binswanger and others. Neither do I try to persuade my patients with arguments, like Dubois. Finally, I see no use whatsoever in Freud’s method of searching for contingent events, which are only occasional causes.123

  • 124 For example, Morita abandoned hypnosis after practicing it for many years, discovered almost by ac (...)
  • 125 The famous Swiss neurologist and psychotherapist Paul Dubois developed a psychotherapy for nervous (...)
  • 126 This contradiction of ideas refers to the conflict between “objective” reality and the way it is p (...)
  • 127 Ibid. 348.
  • 128 The paper Morita sought to publish was translated into German by Shimoda Mitsuzō and refused on se (...)

45By negating the existing methods in this way, Morita set out his own scientific stance. He explained how his clinical experience and the understanding it had progressively given him of psychological mechanisms had led him to reject, adopt or modify the treatment methods of the day.124 He criticised, for example, the therapies developed by two renowned psychotherapists: Paul Dubois (1848–1918)125 and Sigmund Freud (1856–1939). Although he admitted to using a form of persuasion therapy, Morita asserted that the method employed by the Swiss psychotherapist had no effect on obsessional thinking because such thoughts were not a product of the intellect (obsessive ideas were not errors of logic) but of emotion. Morita believed that it was pointless trying to convince patients rationally of the absurdity of their obsessions (this much they already knew) – that would only reinforce the internal conflict experienced by the patient and needlessly exacerbate their mental torture. In Morita’s view, treating nervosity with psychotherapy involved helping the patient overcome what he called the “contradiction of ideas” (shisō no mujun 思想の矛盾). And since Morita viewed the human psyche as being dominated by emotion rather than reason, he believed that overcoming the “contradiction of ideas” could be done not through rational persuasion (settoku 説得) but through “experiential knowledge” (taitoku 体得).126 Although Freudian psychoanalysis could provide information on the patient’s psychology, Morita believed that such discoveries would be of no use to the neurasthenic, who was not submerged by an unconscious process – like the hysteric – but suffered from excessive self-awareness. Morita’s “experiential therapy” (taiken ryōhō 体験療法),127 as he sometimes called it, was a means of circumventing the neurotic’s tendency towards hyper-reflection, with the various components of the therapy designed to deflect the patient’s attention away from himself and towards the outside world, to make him feel (rather than understand) the illusory nature of his symptoms. In this way, Morita positioned his theory as a modern and scientific psychotherapy alongside the most eminent international representatives of the field. His belief that he had discovered something capable of advancing science and relieving a great number of patients drove Morita – unsuccessfully during his lifetime – to try to publish his work in Germany.128

  • 129 Matsubara Saburō 松原三郎 et al., “‘Shinkeishitsu oyobi shinkei suijaku-shō no ryōhō’ ni taisuru gakka (...)
  • 130 Ishikawa Teikichi 石川貞吉, Jitsuyō seishin ryōhō 実用精神療法 [Practical Psychotherapy] (Kyoto: Jinbun shoi (...)
  • 131 Ishikawa, Jitsuyō seishin ryōhō, 169.
  • 132 Shimoda Mitsuzō 下田光造 and Sugita Naoki 杉田直樹, Saishin seishinbyō-gaku 最新精神病學 [New Psychiatry] (Tokyo (...)
  • 133 These images regularly feature in accounts by Morita’s former patients, as reported in Kōra, Keiga (...)
  • 134 “Many people place too much emphasis on my conception of Zen Buddhism. Although I have practised s (...)
  • 135 An extreme version of this idea can be found in the work of Naka Shūzō 中修三 (1900-1988), a student (...)
  • 136 See Shimazono Susumu 島園進, “Iyasu chi no keifu: kagaku to shūkyō no hazama 癒す知の系譜 科学と宗教のはざま [The G (...)
  • 137 See Wu, A Disorder of Ki, 205–21, 228–33.
  • 138 Ibid. 191, 205.

46Although historical works on Morita tend to perpetuate the image of a misunderstood genius, and while he was not able to convert the majority of his colleagues to his cure for nervosity, Morita was nonetheless recognised by his peers as a highly talented clinician and his therapy hailed as an original Japanese creation. Fellow psychiatrist Matsubara Saburō 松原三郎, who largely disagreed with Morita’s theory of nervosity, nonetheless praised his 1921 work and called him “a world authority in the field of psychiatry”, notably for his psychotherapy, which was “absolutely original and should be extolled to the world”.129 Others compared Morita to eminent Western psychotherapists like Freud and Dubois.130 Indeed, Morita therapy was one of the first therapeutic innovations in Japanese psychiatry. Although Morita did not radically alter the media discourse on neurasthenia, he did make a name for himself (through his publications and a 1926 radio appearance), generating a group of supporters and disciples formed of intellectuals, medical students and devoted former patients. These included celebrities like Nakamura Kokyō and the writer Kurata Hyakuzō 倉田百三 (1891-1943), who helped popularise Morita therapy. Central to the reception of Morita’s work was its cultural dimension and the way his therapy was immediately perceived as a modern but also a Japanese scientific innovation – “a Far Eastern-style therapy”.131 Shimoda Mitsuzō 下田光造 (1885–1978), a highly influential professor of psychiatry at Kyūshū Imperial University from 1925 to 1945, described Morita therapy as “based on serious reflection and keen observation” but also “on Far Eastern philosophy”.132 The views expressed by Morita’s patients corroborate this perception. By their accounts, Morita’s therapeutic methods were far from resembling what a Japanese from the 1920s and 1930s might expect to find when consulting a doctor from the imperial university, and instead brought to mind a “Zen temple” where an “old monk” taught “the path to enlightenment”.133 Indeed, whether in his writings or his conversations with patients, Morita continually employed a sort of Buddhist rhetoric that included metaphors and Zen aphorisms to explain morbid processes and healing. What is more, the existential dimension of his theory made it possible to draw many parallels with spiritual practices, for example Zen meditation. Although he repeatedly insisted that he had based his theory on his study of Western psychotherapies and his own clinical experience, and that he only become aware of any potential similarities with Buddhism much later,134 Morita’s Buddhism-imbued style is no doubt largely responsible for the perception held by some of his contemporaries and future commentators that Morita therapy was “Far Eastern”, and even that nervosity (shinkeishitsu) was a specifically Japanese disorder.135 Furthermore, as Shimazono Susumu has suggested, certain elements in Morita’s practice and theory echoed concepts from Sino-Japanese medicine and Edo-period techniques for cultivating good health (yōjōhō 養生法).136 According to Wu, a common feature of “alternative” Japanese treatments for neurasthenia was the way they integrated “modern” Western techniques, “traditional” Japanese methods and social conservatism, something he also perceives in Morita’s work.137 Whether or not these elements were real or simply perceptions, whether or not they were intended by Morita, I too am tempted to see them as helping make Morita therapy, in the turbulent and rapidly shifting context of the 1920s and 1930s, a product of Japanese psychiatry that met the psychological, social, cultural and political expectations of certain patients.138

Conclusion

47Psychiatry came to Japan as part of the wide-scale importation of modern knowledge during the Meiji period, carried out in order to build a modern, powerful nation capable of defending itself against Western imperialism. Although academic institutions were rapidly created, early psychiatrists lamented their radically limited sphere of action and the minor role they had been assigned in a system designed above all to isolate the dangerously insane and not to allow psychiatrists to administer medical treatments. In fact, the science employed by those early psychiatrists differed radically from pre-existing Japanese practices and conceptions of mental illness, hence the necessity of legitimising their work in society. During the first decades of the twentieth century, Japanese psychiatrists strove to expand their practice: new legislation was adopted and a private market began to develop, indicating that psychiatry was gradually becoming a legitimate medical science and institution. During this same period, the concept of neurasthenia spread among the general public, having become fashionable in the West in the 1880s, when it also began to be employed by Japanese doctors and intellectuals. Like Kraepelin, academic psychiatrists in Japan conceptualised neurasthenia as a minor but more-or-less incurable form of degeneration and therefore did not make it a key research subject. Over in the media, however, the concept was actively promoted by clinical psychiatrists as a rampant disorder in a Japanese society engaged in the relentless “struggle for existence”.

48In Japan, where it echoed local preoccupations at a time of social, cultural and political upheaval (urbanisation, industrialisation, Westernisation of customs, overseas armed conflicts and political instability), neurasthenia became a means for individuals to understand, feel and legitimise their disorders by placing them in the wider social and cultural context of the “civilisation” and/or “Westernisation” of their country. While potentially substantial discrepancies exist between the way the public perceived neurasthenia and the way it was defined by psychiatrists at the imperial universities, it is nonetheless true that a radically new means of conceptualising everyday physical and mental complaints had appeared, sweeping aside pre-existing concepts and opening up this realm of individual experience to the expertise of psychiatrists.

49Many Japanese, having discovered themselves to be neurasthenic, became potential patients in search of a cure, leading to a proliferation of treatment options. Yet neurasthenia did more than just facilitate the assimilation of psychiatric concepts in Japanese society; it also benefited science by providing a fertile ground on which a specifically Japanese theory of psychology and an original form of psychotherapy could develop. Just as Western doctors and psychologists a few decades earlier had come to view “nervous” disorders as specifically psychological problems requiring psychological treatment, Morita used his knowledge of Western psychotherapies, his clinical experience of them, his knowledge of Japanese folk therapies and his first-hand experience as a neurasthenic to develop the first psychological theory of neurosis and the first psychotherapy in modern Japanese psychiatry. While Morita’s theory reflects the culture of neurasthenia that existed at the beginning of the Shōwa era, it nonetheless provided Japanese psychiatry and many patients with important resources for understanding neurosis until the end of that era.

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Notes

1 Miéko Macé, Médecins et médecine dans l’histoire du Japon [Doctors and Medicine in Japanese History] (Paris: Les Belles Lettres, 2013), 191–95.

2 Serizawa Kazuya 芹沢一也, “Hō” kara kaihō sareru kenryoku: hanzai, kyōki, hinkon, soshite Taishō demokurashii 〈法〉から解放される権力-犯罪、狂気、貧困、そして大正デモクラシー [Power Liberated from “Law” – crime, insanity, poverty and Taishō democracy] (Tokyo: Shin’yōsha 新陽社, 2001), 85–98.

3 Genshiro Hiruta, “Japanese Psychiatry in the Edo Period (1600–1868)”, History of Psychiatry, vol. 13, no. 50 (2002): 131–151.

4 See the distinction made by Ian Hacking between the classifications of objects produced by the natural sciences (where objects are “indifferent” to the classifications applied to them) and those produced by the social sciences, which deal with human beings and thus produce “interactive” classifications in the sense that they modify the behaviour and self-perceptions of the very people they designate. Ian Hacking, The Social Construction of What? (Cambridge, MA: Harvard University Press, 1999).

5 See, for example, Jan Goldstein’s discussion of the “boundary disputes” pitting French psychiatrists against lawyers and clerics: Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century (Cambridge: Cambridge University Press, 1987).

6 Junko Kitanaka, Depression in Japan: Psychiatric Cures for a Society in Distress (Princeton: Princeton University Press, 2012), 44–46; Eric J. Engstrom, Clinical Psychiatry in Imperial Germany: A History of Psychiatric Practice (Ithaca: Cornell University Press, 2003), 196–97.

7 Suzuki Akihito has examined the history of psychiatry in Japan from the angle of the social history of medicine, Kitanaka Junko from the angle of medical anthropology, Serizawa Kazuya using a Foucauldian analysis of discourse, and Satō Masahiro from the angle of historical sociology (see this paper’s bibliography for references).

8 Aside from some rather hagiographical works on Morita, the only studies to place his theories in their historical context are those by Shimazono Susumu and Wu Yu-Chuan.

9 The dissemination, through “Dutch learning”, of Western medical theories prior to the opening up of Japan falls outside the scope of this paper; however, note that in the late 18th century some Japanese doctors began to incorporate elements of European medicine (in particular the idea that the brain was the main site of mental activity) into the Sino-Japanese conception of madness. For more on the subject, see: Hiruta, “Japanese Psychiatry in the Edo Period”.

10 Okada Yasuo 岡田靖雄, Nihon seishinka iryōshi 日本精神科医療史 [The History of Japanese Psychiatry] (Tokyo: Igaku shoin, 2002), 122–29.

11 The Japanese Society of Psychiatry and Neurology continues to be the main professional organisation for Japanese psychiatrists and publishes the most prestigious Japanese journal in the field.

12 Okada, Nihon seishinka, 186; Serizawa, “Hō” kara kaihō, 104–06.

13 Okada, Nihon seishinka, 168–69.

14 Okada Yasuo, “Meiji-ki no seishinka iryō — sono shoki jijō” 明治期の精神科医療—その初期事情 [Psychiatric Care in Meiji Japan] in Seishin iryō no rekishi 精神医療の歴史 [The History of Psychiatric Care], ed. Matsushita Masaaki 松下正明 and Hiruta Genshirō 昼田源四郎 (Tokyo: Nakayama shoten 中山書店, 1999), 258–60. Okada, Nihon seishinka, 159–60, 168. Although he is best known for his controversial Psychopathia Sexualis, Krafft-Ebing also wrote two textbooks that were widely read in the 1870s, one on general psychiatry and one on forensic psychiatry.

15 Kure spent part of his study trip (1897–1901) in Heidelberg, studying under Kraepelin. A leading figure in German-language psychiatry in the 1890s to 1920s, Kraepelin wrote a psychiatry textbook whose successive republications (in particular those published during Kure’s time in Germany) radically changed the classification of mental illnesses by basing it on clinical observation. Okada, Nihon seishinka, 168; Engstrom, Clinical Psychiatry in Imperial Germany, 121–46.

16 Engstrom, Clinical Psychiatry in Imperial Germany, 174–77, 194–98.

17 With the Kyoto asylum having closed in 1882, all that remained was Sugamo Hospital 東京府立巣鴨病院 (formerly the Tokyo asylum), which since 1887 had been under the medical direction of the psychiatry chair at Tokyo Imperial University. It was there that students did their clinical practice and where psychiatry classes were taught until 1919.

18 The Custody Law for the Mentally Ill (Seishinbyōsha kango-hō 精神病者監護法), adopted in 1900, was designed to ensure the secure custody of mentally ill patients posing a threat to public order and prevent wrongful confinement. The aim was to regulate a centuries-old practice rather than to promote the expansion of psychiatric care. Akihito Suzuki, “The State, the Family, and the Insane in Japan, 1900-1945” in The Confinement of the Insane: International Perspectives, 1800-1965, ed. Roy Porter and David Wright (Cambridge: Cambridge University Press, 2003), 199–201. In 1905 the Ministry for Health reported a total of 12,000 patients confined to their homes, compared to 5,500 patients interned in hospitals. Akihito Suzuki, “A Brain Hospital in Tokyo and its Private and Public Patients, 1926–45”, History of Psychiatry, vol. 14, no. 3 (2003): 340.

19 Suzuki, “The State, The Family”, 199–201.

20 Satō Masahiro 佐藤雅浩, Seishin shikkan gensetsu no rekishi shakaigaku: “kokoro no yamai” wa naze ryūkō suru no ka? 精神疾患言説の歴史社会学 「心の病」はなぜ流行するのか [Historical Sociology of Discourses on Mental Illness: Why have “Disorders of the Mind” Become Prevalent?] (Tokyo: Shin’yōsha, 2013), 220–22.

21 Published in the Tokyo Journal of Medical Science under the title “Actual Conditions of Home Confinement and Statistical Observations of the Mentally Ill”, this lengthy report presented the results of a painstakingly in-depth national survey conducted between 1910 and 1916 on more than 350 confinement cells as well as on “popular” treatments for mental illness. Kure Shūzō 呉秀三, Kishida Gorō 樫田五郎, Seishinbyōsha shitaku kanchi no jikkyō: gendaigo yaku 精神病者私宅監置の実況 現代語訳 [Home Confinement Conditions of the Mentally Ill (modern translation)], trans. Kanekawa Hideo 金川英雄 (Tokyo: Igaku shoin 医学書院, 2012).

22 Okada, Nihon seishinka, 174–75.

23 Suzuki, “The State, the Family”, 202–03, 213.

24 Ibid. 217.

25 Satō, Seishin shikkan gensetsu, 200–30.

26 Beard’s first paper on neurasthenia was published in 1869, but the two books that popularised the concept overseas were A Practical Treatise on Nervous Exhaustion (Neurasthenia). Its Symptoms, Nature, Sequences, Treatment (1880) and American Nervousness: Its Causes and Consequences (1881).

27 Marijke Gijswift-Hofstra, “Cultures of Neurasthenia, from Beard to the First World War” in Cultures of Neurasthenia from Beard to the First World War, ed. Marijke Gijswijt-Hofstra and Roy Porter (Amsterdam and New York: Rodopi Bv Editions, 2001), 2; Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, (Hoboken: John Wiley & Sons, Inc., 1997), 129–30.

28 In his 1880 publication, Beard lists more than 70 symptoms, including: dilated pupils, headaches, mental irritability, morbid fears, frequent blushing, insomnia, localised muscle spasms, sensitivity to climate, a feeling of exhaustion, dry skin, tooth decay and impotence, etc. George M. Beard, A Practical Treatise on Nervous Exhaustion (Neurasthenia). Its Symptoms, Nature, Sequences, Treatment (New York: Rockwell, 1889), 36–117.

29 A modern civilisation characterised, according to Beard – in an oft-quoted phrase – by the following five elements: “wireless telegraphy, science, steam power, newspapers and the education of women” (quoted by Simon Wessely, “Neurasthenia and Fatigue Syndromes – Clinical Section” in The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth century, ed. German E. Berrios (London: Athlone, 1996), 512.

30 Brad Campbell, “The Making of ‘American’: Race and Nation in Neurasthenic Discourse”, History of Psychiatry, vol. 18, no. 2 (2007): 157–78.

31 The contributed volume by Marijke Gijswijt-Hofstra and Roy Porter (Cultures of Neurasthenia) clearly illustrates the differences between American, British, German, French and Dutch neurasthenia.

32 Tom Lutz, “Neurasthenia and Fatigue Syndromes – Social Section” in The History of Mental Symptoms, ed. German E. Berrios (London: Athlone, 1996), 533–45; Shorter, A History of Psychiatry, 119–28.

33 Shorter, A History of Psychiatry, 132; Volker Roelcke, “Electrified Nerves, Degenerated Bodies: Medical Discourses on Neurasthenia in Germany, circa 1880–1914” in Cultures of Neurasthenia, ed. Marijke Gijswijt-Hofstra and Roy Porter, 177–80.

34 Campbell, “The Making of ‘American’”, 165–68; Wessely, “Neurasthenia and Fatigue Syndromes”, 512–19. On the emergence of Freudian and Janetian concepts from the matrix of neurasthenia, see, in French, chapters V and VI of Pierre-Henri Castel, Âmes scrupuleuses, vies d’angoisse, tristes obsédés. Volume 1, Obsessions et contrainte intérieure de l’Antiquité à Freud [Scrupulous Souls, Anguished Lives, Sad Obsessed. Volume I, Obsessions and Internal Constraint from Antiquity to Freud] (Paris: Ithaque, 2011), 319–453.

35 Sexual neurasthenia was mentioned in an 1879 paper on “Nervous Illnesses Linked to the Male Reproductive Organs”, published in Tōkyō iji shinshi 東京医事新誌 [Tokyo New Medical Journal] one year before the publication of Beard’s Practical Treatise on Nervous Exhaustion. The term neurasthenia was translated in that paper as shinkei kyosui 神経虚衰. The first appearance of the term shinkei suijaku 神経衰弱 dates from 1884. Watarai Yoshiichi 度会好一, Meiji no seishin isetsu: shinkeibyō, shinkei suijaku, kamigakari 明治の精神異説:神経病・神経衰弱・神がかり [Diverse Theories on the Mind from the Meiji Period: neurosis, neurasthenia, possession] (Tokyo: Iwanami shoten 岩波書店, 2003), 159.

36 Chikamori Takaaki 近森高明, “Futatsu no ‘jidaibyō’ – shinkei suijaku to noirōze no hayari ni miru ningenkan no hen’yō” 二つの「時代病」—神経衰弱とノイローゼの流行にみる人間観の変容 [“Two ‘Illnesses of an Era’: the changes in human perspective visible in the prevalence of neurasthenia and neurosis”], Kyōto shakaigaku nenpō 京都社会学年報 [Kyoto Journal of Sociology], no. 7 (1999): 199; Satō, Seishin shikkan gensetsu, 161.

37 See in particular Volker Roelcke, “Biologizing Social Facts: An Early 20th Century Debate on Kraepelin’s Concepts of Culture, Neurasthenia, and Degeneration”, Culture, Medicine and Psychiatry, vol. 21, no. 4 (1997): 383–403. Degeneration theory, developed by Bénédict Augustin Morel (1809–1873) in 1857, was the first comprehensive theory of the cause of madness and occupied a prominent place in European psychiatric theory in the second half of the 19th century. Degeneration was conceived as a pathological transformation that predisposed individuals to madness. Morel believed that degeneration was inherited and had a cumulative effect, with each generation accumulating the defects of its predecessors until the extinction of the race. This process thus posed a threat to society and had to be tackled via social prophylaxis (measures to combat alcoholism, eugenic policies, etc.). Degeneration theory was highly influential in the European cultural sphere in the 1890s, where it fit in perfectly with the fin-de-siècle pessimism of the era and social Darwinism. Jean-Christophe Coffin, La Transmission de la folie 1850–1914 [The Transmission of Madness] (Paris: L’Harmattan, 2003), 21–64; Jacques Postel, Dictionnaire de la psychiatrie et de psychopathologie clinique [Dictionary of Psychiatry and Clinical Psychopathology] (Paris: Larousse, 2006), 120–22; Shorter, A History of Psychiatry, 93–99; Paul Weindling, Health, Race, and German Politics between National Unification and Nazism, 1870–1945 (Cambridge: Cambridge University Press, 1989), 80–89.

38 Ishida Noboru 石田昇, Shinsen seishinbyō-gaku 新選精神病学 [New Anthology of Psychiatry], revised 4th ed. (Tokyo: Nankōdō 南江堂, 1909), 237.

39 So-called acquired neurasthenia was also known as “chronic nervous exhaustion” (mansei shinkeisei hihai 慢性神経性疲憊, in German nervöse erschöpfung), while constitutional neurasthenia was also called “congenital neurasthenia” (shōraisei shinkei suijaku 生来性神経衰弱) or “physical neurasthenia” (taishitsusei shinkei suijaku 体質性神経衰弱).

40 Ishida, Shinsen seishinbyō-gaku, 261–62; Miyake Kōichi 三宅鑛一, Seishinbyō shindan oyobi chiryōgaku 精神病診断及治療学 [Diagnosis and Treatment of Mental Illness], vol. 1 (Tokyo: Nankōdō 南江堂, 1910), 594.

41 As was the case in Germany (see Engstrom, Clinical Psychiatry, 194–98). Serizawa Kazuya and Hyōdō Akiko have stressed that the Japanese concept of intermediate states reflects an attempt by psychiatrists to expand their professional jurisdiction from their established realm of insanity to a new area of competence – and responsibility – with regards behaviours previously seen as social or personal problems. They did this by highlighting the purported underlying medical issue. Serizawa, “Hō” kara kaihō, 138; Hyōdō Akiko 兵頭晶子, Seishinbyō no Nihon kindai: tsuku shinshin kara yamu shinshin e 精神病の日本近代 憑く心身から病む心身へ [Japanese Modernity and Mental Illness: from a possessed mind and body to a sick mind and body] (Tokyo: Seikyūsha青弓社, 2008), 136–37, 176–77.

42 Matsubara Saburō 松原三郎 (1877–1936), for example, one of Kure’s students who spent time in the United States (rather than Germany or Austria as was the norm at that time), saw neurasthenia as an illness of overwork suffered by people at the frontline of the process of civilisation. Kitanaka Junko 北中淳子, “’Shinkei suijaku’ seisuishi – ‘karō no yamai’ wa ika ni ‘jinkaku no yamai’ e sutigumaka saretaka” 「神経衰弱」盛衰史-「過労の病」はいかに「人格の病」へとスティグマ化されたか [The Rise and Fall of Neurasthenia: how it went from a “disease of overwork” to a “disease of personality”], Yuriika ユリイカ, vol. 36, no. 5 (2004): 156; Izumi Takateru 泉孝英 (ed.), Nihon kingendai igaku jinmei jiten 1868–2011 日本近現代医学人名事典 1868–2011 [A Biographical Dictionary of Modern and Contemporary Japanese Doctors 1868–2011] (Tokyo: Igaku shoin, 2012), 570.

43 Summaries of the presentations were published in Shinkeigaku zasshi, vol. 12, no. 6 (1913): 305–11.

44 Miyake Kōichi 三宅鑛一, “Shinkei suijaku to shinkeishitsu no kata” 神経衰弱と神経質の型 [Forms of Neurasthenia and Nervosity], Shinkeigaku zasshi 神経学雑誌, vol. 28, no. 1 (1927): 75–86.

45 Satō, Seishin shikkan gensetsu, 308–09.

46 In several of his novels, Natsume Sōseki, an eminent neurasthenic himself, depicted characters considered by friends and family to be neurasthenic (I Am a Cat, Kusamakura). Takahashi Masao 高橋正雄, “Sōseki bungaku ni okeru iyashi: ‘Shinkei suijaku’ sha no rikai to kyūsai” 漱石文学における癒し 「神経衰弱」者の理解と救済 [Healing in the Work of Sōseki – understanding and relieving “neurasthenics”], Nihon byōsekigaku zasshi 日本病跡学雑誌, no. 52 (1996): 30–36.

47 Kitanaka, Depression in Japan, 55–58; Satō, Seishin shikkan gensetsu, 166–84.

48 Watarai, Meiji no seishin isetsu, 186–94.

49 Satō, Seishin shikkan gensetsu, 144-59.

50 The golden age of neurasthenia, in terms of discourse, spanned the four decades from 1900 to 1940. Satō Masahiro has identified more than 550 articles on neurasthenia published between 1905 and 1939 in the Asahi alone, and 110 books on the subject published between 1906 and 1939 held at the National Diet Library (Satō, Seishin shikkan gensetsu, 148, 164.)

51 Kanō Kengo 狩野謙吾, for example, director of the Kanō Hospital in Tokyo and inventor of a “visceral cure” for neurasthenia, was just one of these “media psychiatrists”. He wrote a series of around 50 articles for the Asahi in 1905–1906, later published collectively in his book Shinkei suijaku yobōhō 神経衰弱予防法 [Preventative Methods for Neurasthenia], republished immediately upon its release (1906). Satō, Seishin shikkan gensetsu, 166–84.

52 The Darwinian metaphor of the “struggle for existence”, first used in the context of war (as a “struggle for existence” against the United States and the cause of neurasthenia among Russian soldiers) and later identified as the cause of the neurasthenia consuming society, is said by Satō to have helped establish an analogy between the military, political and economic “struggles” of Japan internationally, and the violence of the everyday “struggle for existence” experienced by individuals during times of peace. Satō, Seishin shikkan gensetsu, 158–59.

53 Satō, Seishin shikkan gensetsu, 169, 172.

54 Sabine Frühstück has examined the sexual dimension of neurasthenic discourse, in particular the debates over masturbation as a cause of neurasthenia and the promotion of sex education by the fledgling field of sexology. Sabine Frühstück, “Male Anxieties: Nerve Force, Nation, and the Power of Sexual Knowledge” in Building a Modern Japan: Science, Technology, and Medicine in the Meiji Era and Beyond, ed. Morris Low (New York: Palgrave Macmillan, 2005), 37–59.

55 Satō, Seishin shikkan gensetsu, 230–39.

56 Natsume Sōseki, “Gendai Nihon no kaika 1911”. Translation taken from “The Civilization of Modern-day Japan”, trans. Jay Rubin, in The Columbia Anthology of Modern Japanese Literature, ed. J. Thomas Rimer and Van C. Gessel (New York: Columbia University Press, 2011), 160. Note that although the translation uses the term “nervous breakdown”, the Japanese term employed by Sōseki was actually shinkei suijaku (neurasthenia). Bracketed elements added by the present author.

57 Chikamori, “Futatsu no ‘jidaibyō’”, 200–01; Wu Yu-Chuan, “A Disorder of Ki: Alternative Treatments for Neurasthenia in Japan, 1890–1945” (PhD thesis, University College London, 2012), 38. Available at http://discovery.ucl.ac.uk/1344102/1/1344102.pdf (accessed September 2018).

58 For example, Nakamura Yuzuru 中村譲, a psychiatrist trained at the University of Tokyo, published in 1912 a book aimed at the general public in which he ridiculed those who “took pride in suffering from modern civilisation and who, no sooner have they noticed one or two symptoms [of neurasthenia] in themselves, then they announce it to anyone who will listen, boasting that they embody civilisation” (quoted in Watarai, Meiji no seishin isetsu, 180).

59 Satō, Seishin shikkan gensetsu, 238; Frühstück, “Male Anxieties”, 43, 47–48.

60 Satō, Seishin shikkan gensetsu, 310–12.

61 Kitanaka, Depression in Japan, 57–59.

62 For example, the disorders known in the late 19th century as ki-utsu 気鬱 (melancholia, sadness, anxiety) and shaku 癪 (irritability), seen as resulting from an accumulation or stagnation of ki, were replaced during the Meiji period by the notion of nervous exhaustion. For more information, see : Shigehisa Kuriyama, “Translation and the History of Japanese Irritability” in Traduire, transposer, naturaliser: la formation d’une langue scientifique moderne hors des frontières de l’Europe au xixe siècle, ed. Pascal Crozet & Annick Horiuchi (Paris: L’Harmattan, 2004), 27–41; see also the chapter “Reading Emotions in the Body: the Premodern Language of Depression” in Kitanaka, Depression in Japan, 23–39; and Keiko Daidoji, “Treating Emotion-Related Disorders in Japanese Traditional Medicine: Language, Patients and Doctors”, Culture, Medicine and Psychiatry, no. 37 (2013): 59–80.

63 This change of focus to the brain was particularly visible in the names chosen for private psychiatric hospitals, which from 1899 ceased calling themselves tenkyōin 癲狂院 (in reference to traditional Japanese categories for madness) and instead became “brain clinics” (byōin 脳病院), and in the frequent publication of detailed guides on how to maintain a “healthy brain” (kennō 健脳). Watarai, Meiji no seishin isetsu, 20–24; Okada, Nihon seishinka iryōshi, 156–58; Chikamori, “Futatsu no ‘jidaibyō’”, 201.

64 Wu, A Disorder of Ki, 46.

65 Satō, Seishin shikkan gensetsu, 200–30.

66 Erwin Baelz taught medicine at Tokyo Imperial University as a guest lecturer from 1876 to 1902.

67 Watarai, Meiji no seishin isetsu, 160.

68 Okada Yasuo, Shisetsu Matsuzawa byōin-shi 私説松沢病院史 1879-1980 [A Personal History of Matsuzawa Hospital (1879-1980)] (Tokyo: Iwasaki gakujutsu shuppansha 岩崎学術出版社, 1981), 284, 291, 324, 374 and 400.

69 Tōkyō daigaku seishin igaku kyōshitsu hyakunijūnen henshūiinkai 東京大学精神医学教室120年編集委員会 (ed.), Tōkyō daigaku seishin igaku kyōshitsu hyakunijūnen 東京大学精神医学教室120年 [120 Years of the Psychiatry Department at the University of Tokyo] (Tokyo: Shinkō igaku shuppansha 新興医学出版社, 2007), 261, 286.

70 Note that in contrast to contemporary representations of neurasthenics, a significant proportion of Gotō’s patients were shopkeepers and farmers. Quoted by Watarai, Meiji no seishin isetsu, 163–64.

71 This treatment, reported by Morita as having been administered by his colleague Ishida Noboru (1875–1941) (Morita Shōma 森田正馬, “Shinkeishitsu oyobi shinkei suijaku-shō no ryōhō” 神経質及神経衰弱症の療法 [The Treatment of Nervosity and Neurasthenia] in Morita Shōma zenshū 森田正馬全集 [Collected Works of Morita Shōma], vol. 1 [Tokyo: Hakuyōsha 白揚社, 1974], 346) , is typical in that it aimed to both calm the nerves and strengthen the body (see Janet Oppenheim, Shattered Nerves: Doctors, Patients, and Depression in Victorian England (Oxford: Oxford University Press, 1991), 110–40); combining rest and abundant nutrition was the trademark of the highly popular “rest cure” devised by American physician Silas Weir Mitchell.

72 Miyake, Seishinbyō shindan, 597; Kure Shūzō, Seishinbyō-gaku shūyō 精神病學集要 [Compendium of Psychiatry], vol. 2 (Tokyo: Tohōdō 吐鳳堂, 1916), 90; Ishida Noboru 石田昇, Shinsen seishinbyō-gaku 新選精神病学 [New Anthology of Psychiatry] (Tokyo: Nankōdō 南江堂, 1922), 450.

73 Kure Shūzō, “Bunmei to shinkei suijaku” 文明と神経衰弱 [Civilisation and Neurasthenia], Yomiuri Shimbun 読売新聞, 20 May 1913, 5.

74 Satō, Seishin shikkan gensetsu, 183.

75 Presented by Kanō Kengo as a world first, this treatment consisted of injecting or orally administering a blend of mysterious animal-derived “products” which he claimed were good for the body and effective not only for treating neurasthenia but also ophthalmological and pulmonary diseases, genital disorders and anaemia. Kanō Kengo 狩野謙吾, “Shinkei suijakubyō no hanashi” 神経衰弱病の話 [Conversation on Neurasthenia], Asahi Shimbun 朝日新聞, 30 June 1903, 7.

76 Tamura Kasaburō 田村化三郎 (a former army doctor converted to private practice), for example, claimed that he injected patients with an “excellent fortifying medicine […] which acts on the brain and nerves to strengthen the brain and increase overall physical strength, thus completely relieving neurasthenia”. Quoted by Watarai, Meiji no seishin isetsu, 185.

77 Kitanaka, “‘Shinkei suijaku’”, 160.

78 This intellectual movement was linked to the defence of a Sino-Japanese medicine deprived of institutional legitimacy since 1874 – though still widely supported by the public – and of forbidden native Japanese therapeutic practices (religious and secular). It was also linked to a revival of Buddhism during the Meiji period and a “boom” in hypnosis and scientific spiritualism. Lastly, it reflected a certain hostility towards psychiatry, which worked hand-in-hand with the state to destroy these practices. Satō, Seishin shikkan gensetsu, 262–68.

79 Wu, A Disorder of Ki”, 31.

80 Mark Nichter, “Idioms of Distress: Alternatives in the Expression of Psychosocial Distress: A Case Study from South India”, Culture, Medicine and Psychiatry, vol. 5, no. 4 (1981): 379–408.

81 Morita’s given name can be read either as Shōma or as Masatake. “Shōma” is the reading known to Morita’s contemporaries, for example his student and successor Kōra Takehisa, who presented Morita by the name Shōma in foreign journals. “Masatake” is thought to be the true reading of Morita’s given name, as Morita himself was heard to confirm on one occasion. Although “Masatake” is becoming popular in contemporary academic literature (it was chosen by the Encyclopaedia of Psychiatry for example [Seishin igaku jiten 精神医学事典, Tokyo: Kyōbundō, 1993]), both readings coexist, as indicated in the Dictionary of Modern and Contemporary Japanese Physicians (Nihon kingendai igaku jinmei jiten 日本近現代医学人名事典, Tokyo: Igaku shoin, 2012). I have decided to retain the usual reading of “Shōma”.

82 Hentai shinri 変態心理 [Abnormal Psychology] was a journal founded in 1917 by Nakamura Kokyō 中村古峡 (1881-1952), a literary graduate from the Imperial University, and other intellectuals. It criticised the materialism of modern psychiatry, advocated the scientific study of all “abnormal” psychic phenomena (including psychopathology, hypnosis and psychotherapies, deviance and supernatural phenomena) and published papers in a range of fields, for example psychology, literature, sociology, medicine, education, anthropology, criminology and sexology. Kanno Satomi 菅野聡美, “Hentai” no jidai 〈変態〉の時代 [The Age of “Abnormality”] (Tokyo: Kōdansha 講談社, 2005), 16–20.

83 Morita Shōma, “Shinkeishitsu no ryōhō” 神経質の療法 [Nervosity Treatment], Seiikai zasshi 成医会雑誌, no. 453 (1919): 315–27; Morita Shōma, “Shinkeishitsu no hanashi” 神経質の話 [Talking about Nervosity], Hentai shinri 変態心理, vol. 3, no. 6 (1919): 510-26; Morita Shōma, “Shinkei suijaku no tokushu ryōhō” 神経衰弱の特殊療法 [Special Treatment for Neurasthenia], Hentai shinri 変態心理, vol. 7, no. 4 (1919): 420; Morita Shōma, “Shinkei suijaku no hontai, shinkeishitsu no ryōhō” 神経衰弱の本態・神経質の療法 [The True Nature of Neurasthenia: Treating Nervosity], Shinkeigaku zasshi 神経学雑誌, vol. 20, no. 7 (1921): 361–67.

84 In contrast to many other works on the history of Morita therapy, which retain the transcription shinkeishitsu, in this paper the term has been translated as “nervosity”. As we saw earlier, the term shinkeishitsu was adopted by Japanese psychiatrists in the early twentieth century as a translation of the Western terms Nervosität and nervosity/nervousness. Retaining the Japanese word in Western texts gives this concept an artificially exotic feel, when it was actually derived from a shared intellectual context. Although later connotations of the term (post-World War II) may justify such a decision, when talking about Morita himself, it seems anachronistic.

85 The first, Shinkeishitsu oyobi shinkei suijaku-shō no ryōhō 神経質及神経衰弱の療法 [The Treatment of Nervosity and Neurasthenia], published in 1921, was republished annually; Shinkei suijaku oyobi kyōhaku kannen no konjihō 神経衰弱及強迫観念の根治法 [Completely Curing Neurasthenia and Obsessive Thoughts], published in 1926, was republished no less than thirty times in ten years; finally, Shinkeishitsu no hontai oyobi ryōhō 神経質の本態及療法 [The True Nature and Treatment of Nervosity] was published in 1928.

86 Morita Shōma 森田正馬, “Shinkei suijaku oyobi kyōhaku kannen no konjihō” 神経衰弱及強迫観念の根治法 [Completely Curing Neurasthenia and Obsessive Thoughts], in Morita Shōma zenshū森田正馬全集 [Collected Works of Morita Shōma], vol. 2 (Tokyo: Hakuyōsha 白揚社, 1974), 73.

87 Morita, “Shinkei suijaku oyobi kyōhaku”, 72.

88 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 347.

89 Wu, A Disorder of Ki, 128–39.

90 Nomura Akichika 野村章恒, Morita Shōma hyōden 森田正馬評伝 [Critical Biography of Morita Shōma] (Tokyo: Hakuyōsha 白揚社, 1974), 158. Morita belonged to the first cohort of Kure’s students.

91 However, he was not the only person to take an interest in psychotherapy. One of his classmates at university, Ishikawa Teikichi 石川貞吉 (1869–1940), published a fairly comprehensive review of psychotherapies in 1910: Seishinryōhō-gaku 精神療法学 [Psychotherapy].

92 This knowledge was derived from books. Morita never studied overseas.

93 Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 395–406.

94 Despite initially writing almost exclusively in medical publications, in the 1910s Morita wrote most frequently for the general public (Hentai shinri, women’s magazines and medical journals aimed at the layman).

95 Morita was not the first Japanese psychiatrist to explore the psychological causes of nervosity. One of his university classmates, Nakamura Yuzuru 中村譲 (b. 1877, death unknown), wrote a book for the general public in 1912 in which he argued that neurasthenic symptoms were caused by the mind (Shinkeishitsu to sono ryōhō 神経質とその療法 [Nervosity and its Treatment]).

96 “Neurasthenia is said to increase with culture, as if it resulted from physical and nervous exhaustion caused by the struggle for existence. But the struggle for existence is above all about getting enough food to live. Are there many neurasthenics among those who struggle to feed themselves? No. Neurasthenia is actually more frequent among the affluent.” Morita, “Shinkei suijaku oyobi kyōhaku”, 71.

97 Morita, “Shinkeishitsu oyobi shinkei suijaku”, 333.

98 Morita, “Shinkei suijaku oyobi kyōhaku”, 81.

99 “Nervosity is a constitution characterised by an excessively sensitive and weak physical and mental stamina; in other words, it is not a disease. For the sake of convenience, since its symptoms can be significant and disabling in everyday life, I will refer to it as if it were a disease. However, just like the feeble-minded and degenerates, nervous individuals represent an intermediate state with regards mental illness.” Morita, “Shinkeishitsu oyobi shinkei suijaku”, 252.

100 Ibid. 241.

101 According to Morita, this hypochondriacal tendency was fuelled by the hygienist discourse of the day and it was only in this sense that neurasthenia could be considered a “disease of civilisation”.

102 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 240–41.

103 Ibid. 326–27; Morita Shōma, “Shinkeishitsu no hontai oyobi ryōhō” 神経質の本態及療法 [The True Nature of Nervosity and its Cure], in Morita Shōma zenshū 森田正馬全集, vol. 2 (Tokyo: Hakuyōsha 白揚社, 1974), 281–442.

104 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 244.

105 Ibid. 248.

106 Ibid. 244.

107 Morita Shōma 森田正馬, “Henshitsusha no bunrui ni tsuite” 変質者の分類について [Classifying Degenerates], Shinkeigaku zasshi 神経学雑誌, vol. 27, no. 9 (1927): 556–62.

108 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 253; Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 315–16.

109 Morita, “Shinkeishitsu oyobi shinkei suijaku-shō”, 253, 334–340.

110 According to Morita, nervosity was a pathological by-product of an essentially positive trait he called the “desire for life” (sei no yokubō 生の欲望), which he contrasted with the “fear of death” (shi no kyōfu 死の恐怖). Since these two characteristics were directly proportional, intense anxiety was seen as signalling an equally strong desire for life.

111 Irie Hideo 入江英雄 speaking in Kōra Takehisa 高良武久 (ed.), Keigai sensei genkōroku – Morita Shōma no Omoide 形外先生言行録-森田正馬の思い出 [The Words and Deeds of Professor Keigai — Recollections of Morita Shōma] (Tokyo: Morita Shōma Seitanhyakunen kinen jigyōkai 森田正馬生誕百年記念事業会, 1975), 85. Comments like this abound in the accounts given by Morita’s patients.

112 Sociologically speaking, to a certain extent Morita’s clientele reflected the stereotypes on neurasthenia: the overwhelming majority were men and a third were students; however, there were also many shopkeepers, office workers, farmers, bureaucrats, soldiers and teachers. Morita refuted the cliché of the overworked neurasthenic student, which he saw as a statistical bias caused by the fact that nervosity usually appeared at an age when people were still in education (which by then had been extended to the general public). Morita Shōma, “Shinkeishitsu ni taisuru yo no tokushu ryōhō seiseki” 神経質に対する余の特殊療法成績 [The Results of my Special Treatment for Nervosity] in Morita Shōma zenshū 森田正馬全集 [Collected Works of Morita Shōma], vol. 2 (Tokyo: Hakuyōsha 白揚社, 1974), 34–43; Morita, “Shinkei suijaku oyobi kyōhaku”, 116–17.

113 Based on Morita’s description of his therapy in his 1928 book (see the 1974 republication in Morita, “Shinkeishitsu no hontai oyobi ryōhō”). He had been administering it for around ten years at the time of writing and it had acquired a more or less stable form.

114 In reality Morita also treated many sufferers as outpatients and by correspondence.

115 Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 412–13.

116 Morita claimed to have hospitalised “more than 260 patients” between 1919 and 1928. Given that he treated 86 in 1925, this puts the average yearly number at between 14 and 28. Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 361.

117 Ibid. 348–52.

118 Ibid. 353–56.

119 Similarly, reading should not be either contemplative or forced in order to encourage the patient to let go of their perfectionistic and inhibiting desire to read efficiently (a phobia of reading was common among student neurasthenics). Ibid. 358–60.

120 Morita, “Shinkeishitsu no ryōhō”, 318.

121 Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 348, 365–66.

122 Ibid. 325.

123 Ibid. 347.

124 For example, Morita abandoned hypnosis after practicing it for many years, discovered almost by accident the benefits of occupational therapy on psychotic patients at Sugamo Hospital, and relaxed the method of regulated living developed by Swiss psychiatrist Otto Binswanger (1852–1929) after deciding that too much structuration impeded the spontaneous activity of patients and was only effective during hospitalisation. Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 348 and 408.

125 The famous Swiss neurologist and psychotherapist Paul Dubois developed a psychotherapy for nervous disorders that aimed to “make the patient master of himself” through “the education of the will, or, more exactly, of the reason.Dubois, The Psychic Treatment of Nervous Disorders: The Psychoneuroses and Their Moral Treatment, trans. Smith Ely Jelliffe and William A. White (New York: Cornell University Library, 2009), 35. The original text was translated into several languages and abundantly republished.

126 This contradiction of ideas refers to the conflict between “objective” reality and the way it is perceived or desired to be. Such a conflict can be resolved by adopting an existential attitude of “obedience to nature” (shizen fukujū 自然服従) and by accepting things “as they are” (arugamama あるがまま). Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 326.

127 Ibid. 348.

128 The paper Morita sought to publish was translated into German by Shimoda Mitsuzō and refused on several occasions in Germany. It was finally rewritten by one of Shimoda’s students and published in 1940, under the title “Der Begriff der Nervosität”, in the journal Zentralblatt für Psychotherapie und ihre Grenzgebiete.

129 Matsubara Saburō 松原三郎 et al., “‘Shinkeishitsu oyobi shinkei suijaku-shō no ryōhō’ ni taisuru gakkai no hankyō” 「神経質及神経衰弱症の療法」に対する学界の反響 [Reactions of the Academic World to the Treatment of Nervosity and Neurasthenia], Hentai shinri 変態心理, vol. 8, no. 6 (1921): 650–58.

130 Ishikawa Teikichi 石川貞吉, Jitsuyō seishin ryōhō 実用精神療法 [Practical Psychotherapy] (Kyoto: Jinbun shoin, 1928), 169; Wu, A Disorder of Ki, 188.

131 Ishikawa, Jitsuyō seishin ryōhō, 169.

132 Shimoda Mitsuzō 下田光造 and Sugita Naoki 杉田直樹, Saishin seishinbyō-gaku 最新精神病學 [New Psychiatry] (Tokyo: Kokuseidō 克誠堂, 1930), 2. Shimoda was an unfailing supporter of Morita’s and notably presented Morita’s therapy in his own psychiatry textbook; he was also one of the few academics practising it at the time (based on Wu, A Disorder of Ki, 237).

133 These images regularly feature in accounts by Morita’s former patients, as reported in Kōra, Keigai sensei genkōroku, 71–72, 92, 106.

134 “Many people place too much emphasis on my conception of Zen Buddhism. Although I have practised sitting meditation (zazen) and carried out Zen training – for study purposes and out of curiosity – I did not even manage to resolve the kōan …. My knowledge of nervosity does not come from Zen. I simply use interesting Zen expressions to explain things.” Morita, “Shinkeishitsu no hontai oyobi ryōhō”, 231.

135 An extreme version of this idea can be found in the work of Naka Shūzō 中修三 (1900-1988), a student of Shimoda’s, who saw Morita’s nervosity as an exact portrait of the Japanese psyche and applied it to colonists in Taiwan (where he worked from 1934 to 1945) as the Japanese version of the “tropical neurasthenia” afflicting Westerners (Wu, A Disorder of Ki, 233–42).

136 See Shimazono Susumu 島園進, “Iyasu chi no keifu: kagaku to shūkyō no hazama <癒す知>の系譜 科学と宗教のはざま [The Genealogy of “Healing Knowledge”: between science and religion] (Tokyo: Yoshikawa kōbunkan 吉川弘文館, 2003), 110–78.

137 See Wu, A Disorder of Ki, 205–21, 228–33.

138 Ibid. 191, 205.

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Electronic reference

Sarah Terrail-Lormel, “From Neurasthenia to Morita Therapy: the development of psychiatric knowledge in modern Japan (1900s-1930s)”Cipango - French Journal of Japanese Studies [Online], 6 | 2021, Online since 14 January 2022, connection on 19 August 2022. URL: http://journals.openedition.org/cjs/1489; DOI: https://doi.org/10.4000/cjs.1489

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