As Japan Remembers a National Tragedy, a Spotlight Falls on Mental Health

On Saturday, family members and coworkers gathered to remember the victims of a fire that ripped through Japan’s Kyoto Animation’s studio No. 1 on July 18, 2019, killing 36 people and injuring almost as many more.

Far from a tragic accident, the fire had been started by a 41-year-old man who told police that he believed the anime studio had stolen plot details from a novel he had submitted as part of a contest. He allegedly poured out gasoline at the scene, set it on fire, and ran into the flames screaming in an act made all the more shocking by Japan’s well-earned reputation for safety.

"Being one in heart with our friends, their family members and those who support us, we will go forward step by step, albeit slowly," company President Hideaki Hatta said at the memorial, according to Kyodo.

A bereaved family member, meanwhile, said the survivors “have no choice but to keep living with these feelings of sadness and loneliness.”

The alleged perpetrator—an ex-con named Shinji Aoba who had previously received care for unspecified mental health issues—was badly injured in the attack, and was only formally arraigned last month after recovering enough to be wheeled into a Kyoto court on a stretcher for an appearance. He is currently being held in custody while experts evaluate whether he is mentally fit to stand trial.

The Kyoto Animation, or KyoAni, arson attack was a national tragedy, and one of the worst mass killings on Japanese soil since the end of World War II. But it was also part of a trend in recent years that has seen overall crime fall to all-time lows, even as similar headline-grabbing attacks remain stubbornly persistent.

In 2016, a stabbing rampage at a care home for disabled people in Sagamihara killed 19, and was perpetrated by a former care home employee who had previously been institutionalized, and who had spoken of wanting to "start a revolution" by euthanizing the disabled.

In 2017, a man stabbed his wife and five children to death before setting his apartment on fire in Hitachi, northeast of Tokyo. In 2018 three people were stabbed, one fatally, on a bullet train by a man who had also allegedly previously been institutionalized, and who told investigators he had carried out the random attack because he was “frustrated and wanted to kill someone.”

Last year, in May, a group of schoolchildren were ambushed at a bus stop just outside of Tokyo by a suicidal knife-wielding man who killed two in the attack and injured 15 others. The attacker, who was described as belonging to a class of mostly young social recluses known as hikikomori, fatally stabbed himself after the incident.

A month later, a police officer was disarmed and stabbed in Osaka by a man suffering from a mental illness who told investigators he had committed the act because his “disease got worse and because the people around me became bitter.”

However, Japan has long been one of the safest countries in the world, and is apparently only getting safer, with a government report late last year showing that crime in Japan in 2018 had actually fallen to a post-War low. According to World Bank data, for instance, the homicide rate in 2017 was a mere 0.2 per 100,000 people, third of what it was in 1993.

Confoundingly, though, at around the same time, Japanese citizens’ perceptions of crime in their society appear to be worsening. One study found that mentions of “heinous” and “murder” in a prominent Japanese paper skyrocketed through the 1990s and early-to-mid 2000s, even as actual murders declined.

“As with most comparable nations, the Japanese public’s fear of crime is not in proportion to the likelihood of being victimized,” the study’s author noted. “What is different is the scale of this mismatch. While Japan has one of the lowest victimization rates, the International Crime Victim Surveys (ICVS) indicate that it has among the highest levels of fear of crime.”

It’s against this backdrop that incidents like the KyoAni attack have taken place, prompting conversations around mental health in Japan that often involve calls for more government intervention to protect public safety in the face of violent crimes at the hands of the mentally ill.

However, experts and observers caution against stigmatizing the mentally ill for the high-profile crimes. In a joint op-ed in the Japan Times published in the wake of KyoAni attack, writers Mark Bookman and Michael Gillan Peckitt argued that disclosing suspects’ mental health issues merely served to explain away violent crimes as an aberration in an orderly society—albeit at the risk of “tarnishing” an entire class of people.

“A mention of mental illness can eclipse all other aspects of an individual’s identity, especially when they do something antisocial,” they wrote. “They cease to be a person and instead become a symptom that needs to be treated, often via political reform. Such reforms almost always result in increased surveillance and public scrutiny of otherwise innocent persons with psychiatric disabilities.”

Japan’s record on mental health, meanwhile, is somewhat mixed. It has the highest number of psychiatric beds among all OECD countries, but despite transitioning toward community-based support, the mental health system relies heavily on institutionalization and symptom-based treatment.

But Andrew Grimes, a British psychotherapist at Tokyo Counselling Services who has been counseling patients in Japan for almost two decades, told VICE News he doesn't believe there are any critical flaws in Japan’s mental health care system, stressing that people suffering from mental illness are not inherently violent

“The bottom line is that there no way to tell whether someone is going to potentially be a threat on the scale of mass murder,” he said. “In fact, statistically, people with a mental health diagnosis such as schizophrenia are less violent than the general population.”

In the wake of the Kyoto Animation arson attack, new restrictions around the sale of gasoline were passed requiring, among other things, ID checks, though there were no calls to review the mental health care system as there had been with past cases.

Grimes, meanwhile, said Japan was moving in the right direction when it comes to better safeguarding the public’s mental health, particularly thanks to the introduction of national licensing for clinical psychologists in 2018.

“The public is much more on board with reaching out about being clinically depressed, having an anxiety disorder, or even PTSD,” he said. “It has become much more socially destigmatized, in part thanks to celebrities publicly sharing mental health struggles and greater public awareness and education programs”.

But that wasn’t always the case, said Taeko Yamada, a Tokyo-based social worker and psychotherapist with Tell, a nationwide counseling hotline. In the case of hikikomori, for instance, the recluses tend to be taken care of by their elderly parents who still hold onto traditional misconceptions that their child’s behavior is a symptom of laziness or weakness.

“There used to be a strong stigma that mental health issues were only for people who are ‘crazy’ or ‘weird,’’’ she told VICE News.

Yamada said that in the last 10 years Japan’s mental health network has come a long way, but there is still room for improvement. At a community level, information about local mental health services can be disjointed, as access to psychotherapy remains outside the national health insurance scheme.

“People don’t tend to know what's available at their local health center since it varies between municipalities,” she said. “It’s the responsibility of the patient or family to reach out, which is difficult if you are unwell, and in general Japanese clients still tend to wait longer before they ask for help.”