It is reportedly in 1912 that psychoanalysis was first introduced into Japan. That introduction, however, did not go beyond the translation and abridgment of Freud's works and exerted no influence on clinical practice or medical treatment. One reason for this is that Freud's libido theory, introduced as it was in an unscientific way, created a lasting impression among the general public that psychoanalysis was a pseudoscience. Another reason was rooted in the Japanese culture of that time. Regulated by a patriarchal system of relations, the society expected emotional problems to be resolved within the family; they were not to be made the object of professional scrutiny. Moreover, psychiatry in Japan was then oriented primarily to German psychiatry and its emphasis on biology. Despite these initial difficulties, however, psychoanalysis in Japan has since made steady progress.
It was Seitai Marui, a professor at Tohoku University, who formally introduced psychoanalysis into Japanese academic psychiatry. While studying neurology under Adolf Meyer at Johns Hopkins in the years 1916–1919, he witnessed the early influence of the new science on American psychiatry. Upon returning to Japan, he delivered a lecture on psychoanalysis to his university colleagues. Unfortunately, however, since he had received no analytic training during his stay in America, he was not well versed in such technical aspects of the discipline as resistance, transference, and working through. Nonetheless, from among his pupils emerged such distinguished figures as Heisaku Kosawa, Michio Maruyama, and Katsumi Kaketa, who were to blaze the way for the development of psychoanalysis in Japan. Marui himself made a tour of Europe in 1933 and met both Freud and Ernest Jones. With their approval, he organized the Sendai Branch of the International Psychoanalytical Association.
Heisaku Kosawa (1897–1969) studied in Vienna in 1932–1933. There he underwent a training analysis with Richard Sterba and took supervision from Paul Federn under Freud's direction. Returning to Japan, he opened a psychoanalytic clinic in Tokyo, where he conducted treatments and continued his studies. It was a lonely battle, however, in part because it was carried out during World War II. It was only after the war that his efforts began to bear fruit. In the context of a new constitution and system of civil law, the social and familial structure of Japan underwent drastic change, creating new sources of neurotic conflict and bringing long-suppressed conflicts to public view for the first time. People found it difficult to deal with these neuroses in the family, and the number of patients visiting psychiatrists increased. Some of these psychiatrists, those who evinced a interest in the psychological dimension of mental illness, were able to supplement their German-inflected psychiatry with information from the American psychiatrists then working with the U.S. occupation forces. The general public also took an interest in such matters, and Karl Menninger's The Human Mind, Love against Hate, and Man against Himself were translated into Japanese and found a ready audience. The influence of these books on the Japanese understanding of psychoanalysis was immeasurable.
On the professional side, young psychiatrists and psychologists, avidly seeking analytic training, now flocked to the once-isolated Kosawa. Some of these clinicians would eventually become the leaders of Japanese psychoanalysis. They include Takeo Doi, Sigeharu Maeda, Masahisa Nisizono, Keigo Okonogi, Susumu Takahashi, and Makoto Takeda. Kosawa's brand of psychoanalysis, often said to be characteristically Japanese, attached great importance to “motherliness” in the therapeutic relation. This he emphasized in line with the similar importance he accorded the mother's positive engagement and the mother-child bond in child development. In “Two Kinds of Guilt: The Ajase Complex,” a paper he presented to Freud while studying in Vienna, Kosawa distinguished the guilt occasioned by being cared for and forgiven by the mother and that attendant on the oedipus complex. In 1955 Kosawa established the Japan Psychoanalytic Society, with the approval of the International Psychoanalytical Association. The Society's membership included Kosawa, those trained by him, and members of the Sendai Branch, which it absorbed. The same year, Kosawa set up the Japan Psychoanalytical Association for dynamic psychiatrists, in the hope that their discipline would grow and develop. Members of the Society were core members of this association.
The two organizations have since been expanded by Kosawa's pupils, with Tokyo and Fukuoka, where most of them live, the center of their activities. Yet another generation has appeared, analysts who have taken training in Europe and the U.S., in addition to having trained in Japan. This overseas training has been increasingly available as a result of Japan's unprecedented economic development over the last several decades.
One of the most popular venues for such training has been the Menninger School of Psychiatry in Topeka. The first Japanese analysts to go there were Takeo Doi and Kiyoshi Ogura, followed by Satoshi Fukui, Tetsuya Iwasaki, Rikihachiro Kano, and Satoshi Tsutsumi. In Japan the Kansas connection was maintained by frequent workshops supported by Roy Menninger, then president of the Menninger Foundation. These programs enabled many psychiatrists and psychologists to learn more about psychoanalysis. Other analysts to train in the U.S. are Kuninao Minakawa, who attended the University of Michigan, and Yutaka Ohno, who learned psychoanalysis at Cornell University Medical School–New York Hospital. Arnold Cooper, Otto and Paulina Kernberg, and other Cornell faculty have come to Japan at various times to hold workshops.
A British connection was also cultivated. In 1964 Masahisa Nisizono visited London and contacted John H. Padel, thus initiating an interchange between Japanese students and the British Society, particularly the Independent Group. Joji Kandabashi, Osamu Kitayama, Sadanobu Ushijima, and others have learned psychoanalysis under the guidance of this group and are at present active analytic leaders in Japan. Others, including Takayuki Kinugasa and Kunihero Matsuki, studied psychoanalysis under the tutelage of the Kleinians at the Tavistock Institute.
Initiation of a national health insurance system in 1961 rendered Japan's medical service internationally unique. Psychotherapy with patients not dependent on this insurance became almost impossible, a situation that continues to the present. Psychoanalysis is also covered by the system, but the frequency of treatment was initially limited to once a week, later increased to six times a month, and the hourly benefit was held too low. Naturally, under these conditions it was difficult for psychoanalysts to make a living except in big
cities, and as a result most Japanese analysts also worked in universities or hospitals. Nonetheless, psychiatrists and psychologists continue to take an increasing interest in psychoanalysis.
Against such a background, the Japan Psychoanalytic Society has made efforts to improve the training of analytic candidates. Even so, viewed from an international perspective, the system remains somewhat retrograde. In response to the IPA's formal adoption, in 1991, of the Minimum Criteria and Procedures for Becoming an Associate or Full Member of a Component or Provisional Society of the IPA, the Society decided to introduce them across the board and in 1994 amended its bylaws to reflect this. Included among the amendments is the specification that training analyses must be conducted at a frequency of no fewer than four sessions a week. In order to implement these changes, the Society plans to set up institutes in both Tokyo and Fukuoka. At present the Japan Psychoanalytic Society has twenty full members and fourteen associate members. They continue as the core members of the Japan Psychoanalytical Association, which currently boasts a membership of approximately 1,400 dynamic psychiatrists.
Perhaps the most notable achievement of Japanese psychoanalysis is the dependence theory of Takeo Doi. His The Anatomy of Dependence, published in 1973, earned him international fame. Initially he identified the Japanese concept amae (dependence) as central to effecting the psychoanalytic cure of a neurosis that was then understood as a culture-bound Japanese syndrome. Only later was amae understood as a basic and universal human desire. In another achievement of note, Keigo Okonogi elaborated Kosawa's concept of the ajase complex and attempted to propagate it internationally. Regarding the modal conditions in psychoanalysis, such as the setting of a negotiating scene between therapist and patient, he advocated a “therapeutic structure theory” from the viewpoint of regulating the substance of negotiations between the two.
In still another development, Masahisa Nisizono has developed what he calls anaclitic pharmcopsychotherapy, a combination of psychoanalysis and drug therapy, and has established a method by which, through the use of drugs, a more effective therapeutic regression can be induced. He has also stressed the mother-child relationship, further enriching a cultural soil that makes Japanese analysts particularly open to object relations theory. He has also clarified the father-child relationship, delineating its direct father-to-child form, as well as its indirect form, in which the mother, incorporating the father, relates to the child.
Today the generation represented by Doi, Okonogi, and Nisizono is being joined in the leadership by a new generation of analysts, many of whom received their training in Britain or the U.S. Those returning from abroad commonly assert themselves a bit sharply at first, but before long they come to pay greater attention to the Japanese milieu. Just as their older colleagues have striven to create a psychoanalysis common to the world, even while steeping themselves in the reality and cultural characteristics of their country, so the leaders of the new generation will come to adopt a compound eye-like viewpoint. Such a perspective will be necessary if psychoanalysis in Japan is to speak out to the world in an authentic voice.