This post is part of the Kluge Center’s 25 for 25, in honor of the Kluge Center’s 25th anniversary, celebrating 25 books that were written thanks to the Kluge Center’s support. Read the introductory post to the series here.
During Japan’s Meiji period (1868-1912), there was little structural or governmental support for those with mental illnesses. Even by 1918, there was still only one public asylum for the entire country, and 57 private hospitals in urban areas, housing a total of approximately 4,450 patients. Consequently, only the severest cases of “madness”—the broad term historian H. Yumi Kim uses to avoid modern connotations of mental illness and reflect historical Japanese social and cultural understanding—were typically treated in asylums. Responsibility for care fell primarily on families, especially women, who were socially expected and legally required to care for those considered mentally and spiritually disturbed.
Most studies around madness in this era focus on psychiatry and formal institutions. In her groundbreaking book “Madness in the Family: Women, Care, and Illness in Japan (Oxford, 2022),” historian H. Yumi Kim instead centers the experiences of family, particularly female family members who disproportionately carried the burden of care.
Her book illuminates the hidden labor of women caring for those considered mad, as well as the creation of gendered understandings of madness. Each chapter explores a different physical or conceptual space, including “the rural village, farm household, urban marketplace, and courtroom.”
Kim recounts that Meiji lawmakers had envisioned reforming the country’s medical system to mirror those of Western cultures, with a wide-reaching system of hospitals and Western-trained physicians offering treatment to those with physical and mental ailments. However, because Japan lacked the resources to enact such dramatic and expensive institutional change, the government instead used law, ideology, and its bureaucracy to reinforce long-held practices of familial responsibility for the provision of care.
Unfortunately, this system often placed families in difficult situations. Families were sometimes required to provide care for mentally ill relatives who might pose a danger to themselves or others. This also had consequences for those being cared for. In rural areas, with limited access to institutional support, families sometimes confined relatives exhibiting violent or erratic behavior into wooden, cage-like structures within their homes, a practice that was state sanctioned and regulated.
When patients were confined, families were required to submit written requests to the local police and prefectural governor. The requests included information such as the reason for confinement, the dimensions of the cage-like rooms, and measures to ensure hygiene. The police were required by law to inspect these confinement rooms on a monthly basis.
It was primarily women, contends Kim, that carried the burden of labor, both emotional and physical, of looking after those who were confined in their homes. These same women also frequently navigated the bureaucratic process of obtaining legal permission for confinement.
As Kim notes, this system blurred the lines between care and neglect. Confinement was seemingly the best available option, but often was hard to distinguish from abandonment, and usually worsened a person’s mental and physical health.
Gender played a significant role in the understanding and diagnosis of madness in Meiji Japan. Men and women with similar symptoms, writes Kim, were often diagnosed with different ailments. In the town of Kita-Adachi in 1882, for example, madness was often attributed to “fox attachment.” This condition was believed to occur when a fox spirit attached itself to a human spirit and was linked to visiting shrines of Inari, a deity symbolized by the shape-shifting fox. Depending on religious and local cultural factors, attachment could also be attributed to a range of other animals, ghosts, or deities. State officials attempted to replace these beliefs with medical diagnoses.
Psychiatrist-ethnographers, sent to rural villages with high levels of fox attachment to conduct surveys, diagnosed those believed to be afflicted with specific diseases. However, when women and men presented the same symptoms, Kim explains, women were typically diagnosed with hysteria while men were assigned a wider variety of other possible ailments. Despite state officials’ efforts, the belief in fox attachment lasted long into the late nineteenth and early twentieth centuries, according to Kim.
Gender also played a role in the assessment of criminal cases. When a woman was found to be guilty of a crime like murder, her responsibility was deemed to be dependent on factors such as pregnancy or menstruation, which Japanese forensic psychiatrists, lawyers, and criminologists thought diminished a woman’s ability to reason, hence driving them toward violent crimes. While some women capitalized on this reasoning to their advantage in court, others resisted gendered assumptions, pointing instead to factors like class, labor, and family situations.
By focusing on the experiences of women, Kim offers a more complete view of how care, madness, and family functioned in Meiji Japan, and how legacies of gendered understanding continue to shape caregiving and mental health policies in the country today.
Kim completed the research for Madness in the Family as a David B. Larson Fellow in Health and Spirituality at the John W. Kluge Center. Among many accolades, Madness in the Family received the 2023 John K. Fairbank Prize in East Asian History from the American Historical Association and the First Book Subvention Award from the Association for Asian Studies.
This post, and others in this series, does not constitute the Library’s endorsement of the views of the individual scholar or an endorsement of the publisher.