Literary Analysis Essay on A Disability of the Soul

Introduction

The book chosen for the report is called A Disability of the Soul: an ethnography of schizophrenia and mental illness in contemporary Japan by Karen Nakaruma. Schizophrenia is one of the most prevalent mental illnesses in the world. In the book, the author offers an ethnography of a small town in Japan called Bethel, which has people with severe mental illness. The literature provides a discussion of biopolitics, home confinement, financial incentives in the Japanese psychiatry field, and treatment or schizophrenic patients. The paper provides a report on key points of the book, personal reflection, and application of the points in the book.

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Key Points of the Book

One of the key aspects from the course illuminated from Nakaruma's book is community living. In class, we talked about community mental health and its significance. Besides, we discussed the way people with mental illness during historical times were categorized as lunatics and believed to be possessed by the devil. Due to that, they were often removed from society. In the book, Nakaruma (2013) indicates that during the old Japanese era, it was believed that people were possessed by supernatural spirits. The spirits and ghosts were called Mononoke, which was associated with the animated movie Princess Mononoke, who protects the spirits of the land. Besides, in the course, we learned about independent living, which Nakaruma discusses in her book. In class, we learned of the independent living philosophy, which is the movement of people living with disabilities working together towards self-determination, self-respect, and equal opportunity.

The second point from the course illuminated in the book is the concept of the model of medical disability. In the model, disability problems arise from the individual himself. In class, we talked about the way modern medicine began in the 19th century and physicians enhanced their role in society. Besides, we talked about the way people with disabilities have to benefit from medical professionals because their disabilities have different origins. Also, we talked about the way society has no role in making a place with people who have disabilities. In the book, Nakaruma (2013) discusses the de-institutionalization of psychiatric patients in Japan. As she explains, Patients in the psychiatric institutions were unhappy because of the harsh treatment they received in the wards while psychiatrists were happy because money kept flowing in the institutions. Also, she provides a story of Hayasaka, Bethel's town president, who was neglected by his family members and the society because of his schizophrenia. The book shows how society has still not embraced people living with disabilities.

The third point from the course illuminated in the book is that of exploring cultural assumptions. In class, we talked about socializing agents, cultural awareness, diversity, and competence. We learned that it is necessary to understand that culture plays a role in shaping our individual beliefs and values. We discussed that in turn, the individual beliefs and values shaped may impact people in their relationships with others who have a different set of cultural experiences, beliefs, and values from them. Besides, we learned that health and human service organizations are required to enhance services for culturally and linguistically diverse populations. In the book, Nakaruma (2013) indicates that in Japanese psychiatric hospitals, patients not considered mentally ill if their neighbors see them. They are described as having a weakness of the autonomous nervous system rather than being mentally ill. Also, the author talks about the way rules in the psychiatric facilities favored staff more than patients. In essence, the author paints a picture of the way society including community members and psychiatric doctors views people with mental illnesses.

The fourth point from the course illuminated in the book is that of stereotypes of people with mental illness. In class, we learned that stereotypes are over-generalized beliefs about a particular group of people. Stereotypes surrounding the mentally ill presume dangerousness, unpredictability, and unreliability. Mostly, patients who have schizophrenia are most affected by stereotypical behavior. In the book, Nakaruma (2013) discusses the way patients in the psychiatric wards are forced to take medications and are restrained. Although she says that during her stay she did not witness that, an interview with Dr. Kawaruma revealed that patients are always forced to take drugs and retrained because it is always the belief that mentally ill patients are violent and is likely to lash out at any time. The doctor indicates that staffs responsible for giving patients their anti-psychotic drugs believe that giving them a lot of those drugs would prevent the violent outbursts. According to the doctor, staffs at the facility believe that it is the most effective method of handling mentally ill patients. Also, Nakaruma (2013) asserts that during the interview, the doctor asserted that at Bethel, there is the stereotypical image that psychiatric patients are destructive and violent all the time.

The fifth point from the course illuminated in the book is cross-cultural competence. In class, we learned about a different principle of cultural competency. For instance, we discussed on the way to come up with culturally responsive knowledge, skills, and attitudes that can be applied to specific relationships in the workplace and in society. This final step integrates the previous steps of self-knowledge, general cultural knowledge, culturally responsive attitudes, and communication skills allowing providers to ask, listen, and react to patients' social needs in a way that boosts quality medicinal services for patients of every single social foundation. In the book, Nakaruma (2013) talks about this principle by discussing the way society and psychiatric doctors treat patients who are mentally ill. The author talks about the stereotypes that mentally ill patients go through on a daily basis. Also, we discussed the principle of coming up with attitudes that are culturally responsive to the groups served. We learned that while understanding other people's cultural perspectives is important, attitudes of trust, respect, and accommodation are essential to quality cross-cultural health care. In the book, Nakaruma (2013) talks about the emergence of psychiatry in Japan and the way many Japanese citizens who had graduated from medical school ventured into the field of psychiatry to get a better understanding of mental illnesses that their community members face. More so, we learned of the principle of self-awareness where it is essential that providers find out the cultural influences that shape their views of the world, health, illness, and treatment, as these will influence how they respond to other people's cultural worldviews about health and illness. During the second phase of mass institutionalism in Japan Nakaruma (2013) talks about the way psychiatrists worked to discover anti-psychotic drugs to treat patients who are mentally ill to remove the society's perception that mentally ill patients were possessed by evil spirits.

Personal Reflection

The aspect I found most moving was Kiyoshi Hayasaka's story. He is the president of Bethel. In the book, he talks about the way he grew up with his parents who were saw-millers and his younger brother. He talks of a tough childhood where his parent's constantly fought because of his father's drinking and infidelity. He says that when he was in 8th grade he knew that his mother had cancer. According to him, that was when he began to hallucinations. After his teacher realized his condition and took him to a psychiatrist, he told him that he was schizophrenic. He always had seizure attacks and his body would freeze. He says that he had a lot of episodes of lashing out, fights, and anxiety. Through this time, he was in and out of the hospital. He says that today, he receives a disability pension and social security from the government on top of his earning in Bethel. He talks about the way he attended church and participated in their activities but still has seizures, lack of sleep and temperate behavior. He says that his family used to make fun of him to an extent of calling him an idiot. That kind of treatment made him feel helpless. The reason I find his story moving is by the manner in which people treated him, but he still managed to live a positive life. It is clear that many people do not understand the severity of mental illness in society.

One aspect that I found compelling was psychiatry in Japan. Nakaruma (2013) indicates that in Japan, the history of psychiatry and mental illness can be divided into three parts. The first was the dominant form of care, which was the home confinement of those with mental illnesses. It occurred in the 1800s to 1950s. The second occurred from the 1950s onwards where many psychiatric hospitals existed and there was mass institutionalization of mentally ill patients. The third was in the 1980s onwards where patient's rights expanded and independent living facilities emerged. In phase 1, home confinement took place because it was thought that people were mad because supernatural spirits possessed them (Nakaruma, 2013). The author indicates that the perceived spirits were called Mononoke. In phase 2, first-generation antipsychotics led to the increased demand for psychiatric hospitals (Nakaruma, 2013). Also, the author indicates that government loans were easily accessible for families of people with mental illness to get to seek medical help. In phase 3, second-generation antipsychotics made people live out of the psychiatric hospitals (Nakaruma, 2013). The author indicates that cultural differences in Japan led to the realization of people to express the symptoms of mental illness differently. I find this part of the story compelling because it provides details of the shift of the treatment for mental health in Japan in three phases.

The aspect I found most challenging was the section that discusses Christianity and Japan. According to Nakaruma (2013), less than 1% of Japan's population identifies itself as being Christian as most of them are Buddhists and believe in Shinto. The author indicates that Shogunate enforced strict rules that pushed Christians out of Japan in 1939, which saw after 200 years, Christianity was non-existent in the country. She adds that after the end of World War 11, Christians were once again allowed to roam the streets of Japan and participate in their activities. The reason I find this part of the book is challenging is because of the worry of the way Christian culture and medical anthropologists can maneuver through the communities in Japan to find more information on the dynamics of mental illnesses.

I think the author framed issues like this because she wanted readers to get a clear picture of Japan in the past and in the modern times. Anne and Myers (2014) talk on the way the author was successful in accomplishing the mission of ensuring that readers get an intimate look of people living well with schizophrenia. The authors add that detailing the everyday life of a community was useful. Even so, in an interview with Frenkel (2013), Nakaruma affirms, "I wanted my project to approach Bethel from the ground up, from the perspective of the members rather than the staff." Notably, Nakaruma frames her issues to fit in different perspectives to give readers an understanding of the Japan community in the contemporary world.

Application

After reading the book, the reader hopes to achieve a better understanding of mental illnes...