Prof Akira Hashimoto
History, Aichi Prefectural University, Japan
‘Freedom and control:The changing context of work and activity in mental hospitals in modern Japan’
(Introduced by: Dr Yolanda Eraso, Health and Life Sciences, Oxford Brookes University)
[19min; 16 slides]
Paper presented to the International Research Symposium:
Historical and Contemporary Perspectives on Labour and Occupational Therapy"
26–27 June 2013, St Anne’s College, Oxford
Abstract: The development of occupational therapy in pre-World War II Japan was associated with the reform of psychiatric institutions. In the early twentieth century, Kure Shuzō, professor of psychiatry at Tokyo University, led the reorganization of the treatment of mental patients shortly after his return from studying in Europe. As the medical director of Tokyo Prefectural Sugamo Mental Hospital, Kure prohibited the use of chains and introduced work and diversions for the inmates, although the prefectural government was displeased with these “liberty and license” practices in Sugamo. However, it was not until Kure’s reforms themselves improved before the hospital was moved from Sugamo to Matsuzawa village in the suburbs of Tokyo in 1919. In Matsuzawa Hospital, the psychiatrist Katō Fusajirō was in charge of occupational therapy. He himself constructed a mountain and a pond in the hospital grounds together with the patients. But, generally speaking, various work and activities practiced as occupational therapy in mental hospitals at the time seem to have been nothing more than labour.
After World War II, occupational therapy was exploited to control psychiatric patients in hospitals. From the 1950s onwards many mental hospitals were constructed, and more and more patients were hospitalized all over Japan. Meanwhile, psychiatrists introduced a new practice called seikatsu ryōhō (“life therapy”) to control the daily lives of long-stay chronic patients, although their initial intention was to liberate the patients from labour in the hospitals. Seikatsu ryōhō was a combination of habit training, recreational therapy, and work therapy, and was invented in 1956 by the psychiatrist Kobayashi Hachirō, who maintained that it was more comprehensive than the occupational therapy practiced before the war. His method was widely accepted among mental hospitals. On the other hand, seikatsu ryōhō was criticized for its control of patients’ lives and for violating the human rights of patients. Mainstream practices later shifted from seikatsu ryōhō to occupational therapy copied from the American model, and in 1965 the state qualification of “occupational therapist” was introduced. In 1974 occupational therapy began to be covered by medical insurance, but psychiatrists were opposed to it, stating that occupational therapy remained forced labour in closed mental hospitals. In recent years occupational therapists tend to emphasize the difference of philosophy and culture in terms of practising occupational therapy in Japan and America.
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