"For 1,500 years of Japanese history, Buddhism has encouraged the acceptance of sadness and discouraged the pursuit of happiness -- a fundamental distinction between Western and Eastern attitudes. The first of Buddhism's four central precepts is: suffering exists. Because sickness and death are inevitable, resisting them brings more misery, not less. ''Nature shows us that life is sadness, that everything dies or ends,'' Hayao Kawai, a clinical psychologist who is now Japan's commissioner of cultural affairs, said. ''Our mythology repeats that; we do not have stories where anyone lives happily ever after.'' Happiness is nearly always fleeting in Japanese art and literature. That bittersweet aesthetic, known as aware, prizes melancholy as a sign of sensitivity.
This traditional way of thinking about suffering helps to explain why mild depression was never considered a disease. ''Melancholia, sensitivity, fragility -- these are not negative things in a Japanese context,'' Tooru Takahashi, a psychiatrist who worked for Japan's National Institute of Mental Health for 30 years, explained. ''It never occurred to us that we should try to remove them, because it never occurred to us that they were bad.''
The medical model of depression, by contrast, sees suffering as pathological and prescribes a pill in response. That outlook is partly pragmatic: call depression a disease and health insurance covers its treatment.
Patient advocates also argue that reclassifying depression as a disease helps to diminish its stigma. But probably most important, the pharmaceutical industry has the financial incentive to recast moods as medical problems, creating what Kleinman calls ''a pharmacology of remorse and regret.'' It is, Kleinman said, ''one of the most powerful aspects of globalization, and Japan is at its leading edge.''
In the late 1980's, Eli Lilly decided against selling Prozac in Japan after market research there revealed virtually no demand for antidepressants. Throughout the 90's, when Prozac and other selective serotonin reuptake inhibitors, or S.S.R.I.'s, were traveling the strange road from chemical compound to cultural phenomenon in the West, the drugs and the disease alike remained virtually unknown in Japan.
Then, in 1999, a Japanese company, Meiji Seika Kaisha, began selling the S.S.R.I. Depromel. Meiji was among the first users of the phrase kokoro no kaze. The next year, GlaxoSmithKline -- maker of the antidepressant Paxil -- followed Meiji into the market. Koji Nakagawa, GlaxoSmithKline's product manager for Paxil, explained: ''When other pharmaceutical companies were giving up on developing antidepressants in Japan, we went ahead for a very simple reason: the successful marketing in the United States and Europe.''
Direct-to-consumer drug advertising is illegal in Japan, so the company relied on educational campaigns targeting mild depression. As Nakagawa put it: ''People didn't know they were suffering from a disease. We felt it was important to reach out to them.'' So the company formulated a tripartite message: ''Depression is a disease that anyone can get. It can be cured by medicine. Early detection is important.''
Like the Bush administration, GlaxoSmithKline has spent the last four years staying relentlessly on-message. Its 1,350 Paxil-promoting medical representatives visit selected doctors an average of twice a week. Awareness campaigns teach general practitioners and the public to recognize the following symptoms of depression (the translation is the company's): ''head feels heavy, cannot sleep, stiff shoulders, backache, tired and lazy, no appetite, not intrigued, feel depressed.'' "
Bob Fiddaman has dedicated some of his posts about the way Paxil/Seroxat is being sell in Japan. Read some of them here.
*Kathryn Schulz is a freelance writer and editor at large of Grist Magazine. She was a Spring 2004 Pew Fellow in international journalism.
*Kathryn Schulz is a freelance writer and editor at large of Grist Magazine. She was a Spring 2004 Pew Fellow in international journalism.
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