Stigma in International Spotlight At WPA Congress in Japan

Better treatment of the mentally ill requires the universal realization that good mental health is the key to good physical health. And this will come not only with improvement of mental health care facilities, but also through elimination of mental illness stigma and partnership with the public to reach these goals through education and open discussion.

The XIIth World Congress of Psychiatry in Yokohama, Japan, in August brought these goals into sharp focus through the Citizens Forum at which the public, along with consumer groups and mental health organizations, discussed the evergreen topics of a better understanding of mental illness, reducing the stigma against psychiatric disorders, child and adolescent societal problems, the social and psychological consequences of disaster and stress, drug abuse and polypharmacy, and the prevention of alcohol-related problems.

One workshop issued an instruction manual on how to develop programs against stigmatization and discrimination at local and national levels. The Japanese Society of Psychiatry and Neurology (JSPN), one of the organizers of the congress, officially changed the Japanese term for schizophrenia to help rectify problems of stigmatization against the estimated 600,000 schizophrenia patients in Japan and their families. The government is expected to adopt the new definition and use it in official documents.

(In Chinese characters and kanji, which are used both in Chinese and Japanese, schizophrenia is translated as “split-minded disease.” The new term “togo shitcho sho,” roughly meaning “integration disorder syndrome,” was felt to be more suitable. The Japanese name for schizophrenia came from a translation in 1937 of the German name. The Japanese medical system is based on the German model. A Japanese representative said he also wants English-speaking countries to change the term “schizophrenia,” coined in 1911 by Swiss psychiatrist Emil Bleuler.)

Delegates from South Korea and China also reported patterns of stigmatization of people with schizophrenia related to language.

Japan lags behind other developed nations in helping mentally ill people lead normal lives outside of institutions, officials at JSPN acknowledged. Only about 55 percent of schizophrenia patients are told of their diagnosis, presumably because of stigma, according to JSPN President Yuki Nichimura, so physicians are failing to meet requirements of informed consent.

Some Progress Evident

On average, the 37 countries and areas in the western Pacific region devote less than 1 percent of their health budgets to the treatment and prevention of mental disorders, said Shigeru Omi, M.D., director of the Western Pacific Region of the World Health Organization in Manila, Philippines.

One out of five people in the western Pacific region who seek the help of a health care professional suffers from a mental disorder. Of this number, only a fraction are properly diagnosed, and of those who are, fewer ever get treatment or proper care, said Omi.

But some positive responses to mental health challenges were also reported. Adults in China are receiving treatment for epilepsy; children in Cambodia are being taught to deal with stress through play and games; more Australian and Malaysian nongovernmental and mental health professionals are working with their governments in areas that affect mental health. The Mongolian government is integrating mental health care into the primary medical health care system and training more workers in psychiatry, Omi noted.

To emphasize the enormity of the problem and the importance of governments devoting more resources for education and for training health care workers in mental health, the congress passed the “Yokohama Declaration,” which calls on all countries to provide the best possible treatment for those with mental illness and to promote awareness of good mental health.

Injustices Must Be Fought

In his opening address, WPA President Juan Lopez-Ibor, M.D., said that one of the prime aims of the congress, whose theme was “Partnership for Mental Health,” was to build bridges to overcome the barriers between patients and society.

“In order to do so, we have to fight many injustices that prevail in the world,” he said.

In another meeting at the congress, the WPA agreed to look into allegations that China is confining political dissidents, including members of the Falun Gong sect, in psychiatric wards and forcing detainees to undergo shock therapy and medication. Falun Gong was outlawed in China in 1999 for allegedly threatening national security. The WPA plans to send a fact-finding team to China, according to Lopez-Ibor.

Similar charges were leveled by UN High Commissioner for Human Rights Mary Robinson during her visit to China earlier this year. Human Rights Watch reported that Chinese psychiatric archives reveal “a longstanding misuse of psychiatry for politically repressive purposes, one that resembles that of the former Soviet Union.”

Chinese officials have denied the charges. Under WPA rules, if China refuses to accept the inspection team, Chinese psychiatrists might be expelled from the association.

In 1983 similar charges of psychiatric abuse led the then Soviet Union to withdraw from the WPA before it would have been expelled. In 1989 Russian psychiatrists were re-admitted after hundreds of confined dissidents were released.

The six-day congress, the first of its kind held in Asia, was opened by Crown Prince Naruhito and attracted more than 6,200 psychiatrists, mental health professionals, patients, and their families. Half of the attendees were from Japan, and the rest were from 111 other countries.

Among the representatives of APA in attendance was APA President-elect Marcia Goin. “The meeting in Yokohama was characterized by gracious hospitality, thoughtful outreach, and a panoply of excellent educational opportunities,” she commented after the congress. “The pageant of the opening ceremonies was heightened by the presence of the crown prince and princess, who gave forth a sense of cordial gentility. At the final banquet the Japanese dignitaries were at their fun-loving best, singing traditional chants and welcoming the assembled group to enjoy the pleasures of their wonderful country.”

Despite the gargantuan program—more than 300 symposia, 52 workshops (even one on organizing a successful congress), dozens of lectures, and hundreds of papers delivered in English, Japanese, Spanish, French, and Russian with simultaneous interpretations—attendees managed to get in some sightseeing, sip green tea, and munch on sushi and tempura. The program and abstracts filled three volumes of 300 pages each, weighing a hefty 3 kilos. So diehards who didn’t get their fill at the congress had plenty to read on the plane back home.

The next WCP meeting will be held in Cairo in September 2005. ▪