In early January, I learned that Yuko, a friend of mine for several years, had been committed to a mental hospital in Japan, near her hometown, with a diagnosis of bipolar disorder. She was still committed several weeks after I learned of it, and our mutual friend, Patrick, asked me to come to Japan to help him as he tried to help arrange her release.

I have tried to provide here a brief summary of my experience while working towards this goal. For the sake of brevity, a great deal of information has been left out, but I hope that the account I’ve presented will provide an accurate general idea of what was happening during this time. If you have any questions, I’d be happy to hear them. You know how to contact me.

So, Yuko had been committed to the hospital by her parents around early November, which means that she had been there for about three months by early February, when I arrived in Japan. She was under heavy sedation, and was receiving four different varieties of anti-psychotic or mood stabilizing drugs. Patrick was allowed to visit her for several minutes once a week, but even this was sometimes denied. She had no access to the outdoors, and had been confined to a room alone for several days on different occasions. Most of these restrictions were performed at the request of her parents. We later found out that she had been physically restrained to her bed around this time, and would remain so for most of the next three weeks. (We would also learn that her wrist was injured during this period of restraint. She has still not recovered full use of it.) This was the situation when I agreed to come to Japan to offer my support.

When I arrived in Japan and first went to visit Yuko, her nurse told me that she was not interested in seeing me. I was not surprised to learn, later on, that Yuko had never been informed about my visit. I was allowed to write her a letter instead, which the nurses agreed to pass along to her (she did not receive it until weeks later). Unlike other patients, she was not allowed to write letters herself or place phone calls at this time.

The history and current state of the Japanese mental health system deserves a separate article of its own, but here are a few relevant points. As the persons responsible for her care, Yuko’s parents had the ability to release her at any time. Her doctor could also choose to release her if he desired. Any patient of a mental hospital also has the right to request a review for release from a prefectural review board. Yuko was not informed of this, and, even if she had known, she was not being allowed any way of contacting the world outside the hospital. The average length of stay in a Japanese mental hospital is over one year, and the recommitment rate is quite high compared to the United States.

During my first couple weeks there, I was helping research the Japanese mental health system and psychiatric drugs, writing letters to Yuko (which were initially being held from her), and supporting Patrick, who had already been committed to this endeavor for a month before I arrived and was slowly breaking from the ongoing stress and frustration. He met daily with the parents to try to convince them that the care Yuko was receiving was inappropriate. He met weekly with her doctor to get more information about the drugs she was given, her diagnosis, and her condition. He had already been calling lawyers and NGOs to try to obtain legal support, so far without success. He continued doing all this and more over the next several weeks.

Before I ever arrived, several other of Patrick’s and Yuko’s friends (both American and Japanese), including some of Patrick’s family, had also been there with Patrick, trying to help get Yuko out of the hospital. They had left by the time I arrived, but continued to help us out from their homes when possible.

Around late February, the head of a particular NGO returned to her office after working on another case. The goal of her organization is to help patients who are being wrongly held in mental institutions, and she was very sympathetic and supportive. She put us in touch with a lawyer who was willing to travel to the hospital and meet with Yuko, her parents and her doctor.

The impending arrival of the lawyer seemed to prompt a number of improvements in Yuko’s treatment. Suddenly, she was deemed well enough to write letters and place phone calls. On the day he arrived, her doctor determined that she could receive daily visitors (even from me, which was a first), take walks outdoors (with her parents as chaperone), and she was also taken off her restraints and allowed to interact again with other patients for the first time in weeks. The doctor’s outlook on her condition had abruptly changed for the better.

In the meantime, Mai, a Japanese friend of ours, had contacted a family she knew that also had experience with the nation’s mental health system. Unlike Yuko’s family, they quickly determined that their daughter’s treatment was not helpful, and actually seemed to be actively damaging to her mental health. The mother had agreed to come visit with Yuko’s mom in order to try to convince her that Yuko’s treatment was similarly harmful. She arrived shortly after the lawyer, and she and Mai’s mother spoke with Yuko’s parents for several hours over the course of a couple days. Yuko’s parents were evidently finally swayed by this time, and agreed to have her released into their care.

Yuko was released from the hospital in early March, about four months after first being committed.

When she was released, Yuko had just recently been taken off of her sedative and was lucid, rational and aware. She was still receiving four anti-psychotic and mood stabilizing drugs. For a few days following her release, Yuko, her parents, Patrick and (sometimes) I stayed together at her parents house or at their cabin in the nearby mountains. Yuko expressed a strong desire to distance herself from her parents for a while, so we left their house, against her mother’s wishes, to stay in the rented house where Patrick and I had been living, and then again to stay in a rented apartment in a Tokyo suburb.

Over the next few weeks, Yuko aggressively reduced the dosage of her medications until she was, ultimately, no longer taking any drugs. Thankfully she experienced no apparent withdrawal effects during this process. The public perception of psychiatric drugs, both in Japan and America, is also a topic that deserves an article of its own. In short, many people who have been diagnosed with bipolar disorder seem to live quite normal lives without medication, and she preferred to try an unmedicated approach for the time being.

As of this writing, Yuko is currently healthy and stable, living outside of the control of her parents, and is attempting to recover her life in the wake of this unexpected, four month absence from the world. My own thanks go to Patrick, Ana, Ben, Elena, Mai, Minako, Reiko and many others for all their help and support in getting her out of a highly destructive situation and back to a life of her own.

Unfortunately, Yuko’s case was not unusual in Japan, and a great deal of work needs to be done to change the public’s idea of appropriate mental health care and raise awareness about the existing, but largely ignored, rights of mental hospital patients. Thanks to the Tokyo Center for Mental Health and Human Rights and Ms Kobayashi for all their efforts on this front.