Leo Sher, M.D.

Today, we publish an interview with an eminent psychiatrist, Dr. Masahito Fushimi.

Masahito Fushimi, M.D., Ph.D. is the Director of the Akita University Health Center in Akita, Japan, where he is also a Professor. Dr. Fushimi is also a Member of the Japanese Society of Psychiatry and Neurology and a Member of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Men’s Mental Health.

Leo Sher: What is the most important issue in contemporary psychiatry?

Masahito Fushimi: I sense a change in psychiatric patients. Specifically, I am experiencing a decrease in consultations for schizophrenia and acute psychotic states and a trend towards milder conditions(a decrease in the number of cases that require hospitalization). This decline is likely to have been affected by the increasing number of consultations for mood disorders, anxiety disorders, developmental disorders, and dementia. Diagnoses for each psychiatric patient need to be categorized in order to resolve ambiguity between (i) a sufferer (requiring treatment), (ii) a disabled person (requiring support), or (iii) personality or characteristic(s) of the individual. Furthermore, this categorization should not excessively come to the conclusion that the mental state of the patient is abnormal (unbalanced) as in an illness (such as issues relating to gender identity disorder and bereavement reactions). It is also necessary to clarify if the patient requires psychiatric treatment, such as with issues related to treatment for criminal psychiatry(this is also related to being criminally responsible for actions). For other cases which are extremely mild (e.g. mild depressed state), determining the boundary between what falls under the category of psychiatry and what does not is ambiguous, and the scope differs according to each doctor. The root cause of this ambiguity could be the difficulty in confirming conditions through objective tests. Psychiatry needs to make efforts so it is better understood by the community (non-experts). Japan also has a unique problem where mentally disabled people are regarded to a sufficient extent to be subjects of welfare and employment support, since their support is mainly centered around medical measures, leading to the world’s longest hospitalization periods and a large number of psychiatric hospital beds.

Leo Sher: How do you see the future of psychiatry?

Masahito Fushimi: Two fields broadly speaking may develop in future psychiatry, although they belong outside what is considered treatment for mental illnesses. One field is the enhancement of preventive psychiatry at the stage before treatment, and the other is improved working efficiency and developed performance capabilities through mental enhancement targeting healthy individuals rather than just patients. Collaboration with various fields other than psychiatric is also believed to progress in proportion with the development of these fields, such as with somatic medicine, psychology,hygiene, relaxation, stress management, and stress sciences. It is extremely doubtful whether the same form of psychiatry will continue to exist in the future. Now may be the appropriate time to reconsider psychiatry in a fundamental way. In other words, the field of study known as psychiatry may be seeking a fundamentally new paradigm.

Leo Sher: What needs to be done to reduce suicide rates around the world?

Masahito Fushimi: Suffering from sickness and financial hardship in daily life are said to account for a large percentage of causes/motives for suicide in Japan. Physical and mental illnesses such as depression are examples of suffering. Regarding depression, it is presumed that there are many cases where the patient experienced everyday financial hardship or the like and entered a depressed state immediately before attempting suicide, in addition to cases where the patient had already been depressed.Suicide should not simply be considered a problem of the individual, and efforts should be made so the problem involves the community surrounding the individual. Therefore, it is crucial to build a secure society such as by enhancing welfare. Comprehensive efforts that require not only a psychiatric perspective, but social and economic perspectives as well are considered necessary in order to support individuals who are contemplating suicide, and to prevent suicide.