The past and future of psychiatry and mental treatment in Japan from the standpoint of clinical psychiatry]

In the early 1950s, there was a serious shortage of hospital beds for mentally ill subjects in Japan, i.e., 30,000 in number as compared to 570,000 in the USA. Plans to supply sufficient beds achieved the goal of providing 280,000 beds in 1975. There were, however, a number of hospitals that fell short of medical and ethical standards, and invited severe criticism. To reconcile the situation, new laws and regulations were introduced to promote many projects for treating patients in the community through social welfare service. Day care institutions and outpatient mental clinics have increased markedly in recent years. Therapeutic measures for mental patients have changed dramatically in the last half of the 20th century, since the discovery of the anti-psychotic effect of chlorpromazine. A great number of psychotropic drugs, some produced in Japan, have been used routinely in psychiatric practice. In the same period of time, many kinds of psychotherapies, some originating in Japan such as the Morita and naikan therapies, have been developed for the relief of various psychological distresses. The diagnosis and classification of mental illnesses have long suffered from uncertainty and discrepancy, even among eminent psychiatrists. The publication of DSM-III in 1980, followed by DSM-III-R and IV and ICD-10, provided professional staff with practical manuals for making diagnoses of mental disorders, and for classifying them using common technical terms. These diagnostic criteria contributed greatly to the development of clinical and basic research in psychiatry. However, it should be noted that no manuals can replace textbooks and writings made available by elaborate studies.