“To make a diamond shine, you need an even stronger diamond” says one of the patients of the Chorale Okayama Clinic, a Japanese centre for psychiatric care. He is referring to the actions and healing powers of a good doctor – of his doctor - on a suffering patient. The good doctor is Dr. Yamamoto Masatomo, not an ordinary professional or a typical psychiatrist; and the patient speaking, Sugano, with his poetry, his sensibility and his profound insights is no ordinary individual either.
That of Sugano is just one of the human stories narrated by the film "Seishin" ("Mental"), by Kazuhiro Soda, an unforgettable documentary (if often hard to watch) about mental health and mental suffering in the context of a small clinical community, with its efforts and hard work, its struggles with the bureaucracy and with budgeting, and its daily routine. It is also a documentary on what it means to offer care to patients who suffer mentally, and to be a doctor; most of all, it is a touching collection of scattered pieces of human life, seen through the lenses of a handful of particular individuals. Their stories and emotions, but also their bodies, faces, expressions and physical presence – talking, working, laughing, smoking - are the real centre of the account; their individual viewpoints represent more clearly than any theoretical discussion the infinite possible meanings of ‘mentally ill’ and ‘mentally sound’ across different situations and worlds, and from one individual to the other.
The words of Sugano, the extraordinarily patient I have mentioned, appear in the second half of the film; still, for their clarity they stand out as a guide into the subtleties of mental health and illness. Through his words one can rethink many of the stories and lives that populate the documentary, and place the suffering and therapeutics of Chorale Okayama under a different light – one that brings them much closer to universal human vulnerability.
In the clinic patients regularly receive a consultation with Dr. Yamamoto. During these meetings they are free to speak about their state and their struggles; the dialogue, however, does not resemble a psychoanalytical session by any means. Patients speak briefly and in a focused way, addressing only what is explicitly relevant, without digression; the respectful replies of the doctor, both succinct and gently prescriptive, are also different from an idea of conversational psychology. For example, he advises a patient who feels lonely to go and ‘ask the friends what is the problem they are having with you’; to another he assigns the task to ‘come up with a short-term objective’, something to be accomplished in a week; to a third he suggests a possible solution to find economic stability - to become a farmer. The advices, and their wording seem to be very carefully chosen in their apparent simplicity; and yet there is no emphasis, no pathos, and no visible dramatic empathy of the kind a Western viewer might instinctively expect in the face of such depth of suffering and misfortune. This blend of distance and true care makes the meetings extremely meaningful and charged, in an almost spiritual sense.
As a consequence, to be in the position of offering care to others is seen as an immense power and responsibility, that can have two sides. ‘When you are as great as mother Theresa’, explains Sugano, ‘some pretty evil thoughts surface in your head’. As written in the bible, ‘when I want to do what is good, evil is right there with me’; in order to fight evil ‘you need to be somewhat evil you too’. Psychiatric medicine is a double-edged activity; there is an ethical force to it, one that is not always entirely pure or innocent.
Sugano is the more philosophical voice in the group of patients: he writes beautiful poems, and speaks of his past with exceptional clarity and details. In his youth he was an extremely hardworking and diligent student – too hardworking, studying eighteen hours a day. Unable to handle pressure, he chained himself to an impossible routine of excruciating study until one day he finally collapsed. His breaking point showed on the occasion of his final school exams: after having prepared meticulously for months, once finally seated in front of the exam papers he did not answer a single one of the questions. Rather, he gave each teacher a grade and submitted it. Because of this, teachers began to think he was mad, and he began to receive psychiatric care.
Life histories are central in the movie because they are also so important in the therapeutic process – no cure is administered without personal attention and existential intensity, it seems, although biomedicine is also there and pills play an important role in the daily life, emotions and balance of these individuals. Many other patients have a voice in the film, if less eloquent than Sugano, and their stories and relationship with the world outside are equally prominent. Two men discuss the nerves needed to be part of an activity with people who are healthy, as ‘healthy people have no mercy sometimes’: the possibility to join a music band turn out to be a challenge that requires an extreme courage. ‘For healthy people, the world of mental illness is hidden behind a curtain’, one created by the ‘healthy’, but sometimes by the patients too’, explains another: shame and self-closure can cause even more pain than the illness itself. There is a woman who always felt ‘there was a balloon inside me, growing little by little’, until this feeling exploded into illness when someone commented that her legs were fat. Again, there is the sense of shame and taboo, a continuous background presence: the stigma for the mother whose child has refused to visit her for years because of her condition; the sense of rejection from one’s friends felt by the first patient, a woman who says that people around her ‘don’t want to have anything to do with her anymore’; the abused daughter grown into a helpless, depressed mother, finally responsible for the death of her own child.
Communication is a central element of therapy; this is made clear by Dr. Yamamoto in one of his lectures to students in psychiatric nursing, in which he explains that the pain of mental patients lies for a good part in their feeling of worthlessness, because ‘they are ignored by everybody’. To be asked and listened to not only brings dignity and warmth to patients, but also shapes the best response that has to come to each of them, as opposed to a fit-for-all, one-way communication. For instance, when a man tells Dr. Yamamoto about his experience of anxiety and loneliness, his sense of emptiness and fear, he suggests to him that ‘a destination to go and a place to be are a reason to live’: the patient needs to find a goal, a plan, however small at the beginning. Often he takes a piece of paper to sketch out the advice. In another case he draws two alternatives, two possible ways of thinking of life as ‘a destination to go’, made of stages from childhood to death, to choose from: a ‘Western’ one – an arrow pointing towards the upper right, as trail of progress and achievement – and a more ‘Eastern’ one – a circle, where beginning and end give sense to one another. The patient prefers the second, as it agrees with his own Buddhist beliefs: ‘I want to believe in this circular one’.
The telling and comforting that sometimes goes on between these patients does not, of course, erase the sadness of mental illness. Sharing, acknowledging and accepting pain, however, can bring relief. ‘My heart is like a broken glass’ - says Sugano pointing at a cracked glass door; and for this reason it emits a different light from the others. ‘It emits kindness. The Japanese character for kindness is a combination of man and grief. The more grief you have, the kinder you become’. Kindness to others is also a way to look after oneself, and by helping healing the wounds of others one looks after his own.
Many of the experiences presented in Seishin may sound familiar to a viewer who is accustomed to average Western care for the mentally ill, and with anecdotal experience with stories of mental suffering in this part of the world; many may strike personal chords. On the other hand, some aspects stand out more for a non-Japanese audience – especially, the weight of shame and the topic of social acceptance, and the presence of death as solution, or returning desire, so strongly and in so many of these voices.
It is impossible to say if these are more typical to the Japanese context than to Western societies. Although Japan is often described as a particularly traditional culture where dignity and shame play a far greater role than for many of us, the stereotypes should never be taken to the extreme; many European or American people who have suffered from mental illness might recognize these feelings too. What is clear, however, in the way these stories are presented (which perhaps reflects the characteristic style of the clinic as much as a cultural aspect) is that in the experience of illness and therapy a radical existential anguish comes to the foreground which is greater than the personal disappointments and problems. This is why to find an occupation, the possibility of entertainment and a chance to communicate with others is so important in this clinic which, as one of the operators explains, has much more staff than any other similar home, despite the costs: precisely to be able to afford that kind of help. This mission creates a moral and even philosophical level that gives the patients’ struggle a universal value, and casts Dr. Yamamoto as a figure of wisdom and an example of goodness before being a professional doctor – ‘he’s truly divine’, as Sugano says.
This is not a common note in films, documentaries or books dealing with medicalised mental disturbance, and makes this documentary so striking and precious. Despite the lack of indulgence in the way its stories are told (real tragedy and concrete dangers are not spared: the documentary is dedicated to three of the interviewed patients, who had died by the end of the film production) the overall sense of dignity and importance in each of these destinies remains, and brings their predicament very close to the ‘healthy people’ who hear their stories.