Traditional temple and shrine
therapies
In late eighteenth-century Western society, the rise of mental science was deeply intertwined with processes of industrialization and urbanization. Psychiatry as a discipline developed with the founding of a new type of asylum – therapeutic rather than custodial – that rapidly increased in number in the nineteenth century as an urbanizing society became more sensitive to the presence of psychotic individuals.1 In the case of Japan, the modernization, or Westernization,2 of society and the introduction of modern psychiatry from the West came together after the Meiji Restoration in 1868. The history of psychiatry in Japan, however, cannot be described simply as a developing process in which traditional therapies were replaced by Western medicine under the influence of ‘enlightened’ doctors.3 In the course of the modernization of psychiatry, leading psychiatrists generally criticized traditional therapies for the mentally ill, which were widely practised in the form of bathing, incantations, and prayers at religious institutions all over the country. Yet psychiatrists occasionally acknowledged a traditional therapy if it was consistent with Western medical theories, and in some cases they attempted to combine modern medicine with traditional therapies. Moreover, the shortage in Japan of psychiatric institutions, together with increasing demands from patients, succeeded in giving renewed life and potential to traditional therapies.
When we look at ordinary people’s theories on mental illness, traditional Japanese folk beliefs seem to be active still in modern society. Since ancient times people have attributed mental derangement to possession by an evil spirit of a living or dead person, or of an animal such as a fox, a tanuki (raccoon dog), a dog, a monkey, and so on. Among them the fox has a special meaning for the Japanese: it is believed to bewitch people, but at the same time it is worshipped as a messenger of the god of bumper crops.4 Probably such folklore led people to believe that the fox had supernatural power and could possess people. According to Hiruta Genshiro, who has analysed various representations of possession depicted in Japanese classical literature, possession by mononoke, or evil spirits, is often to be found in literature from ancient times through to the medieval period, while kitsune tsuki, or fox possession, becomes more dominant from the pre-modern Edo period (1603–1868) onwards.5
Hayami Yasutaka has suggested that the spread of kitsune tsuki in the seventeenth century can be linked to socioeconomic change: a money-based economy came to the villages, changing human relationships and promoting new sorts of conflict between the poor and the rich.6 After the Meiji Restoration people’s belief in kitsune tsuki lived on despite attempts at ‘enlightenment’ in the newspapers. While psychiatrists began to try to understand kitsune tsuki and other forms of possession in medical terms,7 traditional therapies continued to emphasize the exorcism of evil spirits. These latter therapies seem to have appeared more attractive and realistic to people suffering from mental illness than psychiatric treatments, at least in the early stages of modernization.
In this chapter I will explore the role of religion in the treatment of mental illness from the mid-nineteenth to the mid-twentieth century in Japan. I will look at conflict and harmony between traditional therapies and Western medicine in terms of therapeutic effectiveness and scientific rationale, and also at the historical and social context of religious therapists and institutions.
The first article by a Japanese scholar to refer to traditional therapies in Japan was an 1886 piece on Japanese psychiatry written in German by Sakaki Hajime, the first professor of psychiatry at the University of Tokyo. He wrote:
As far as the history of psychiatry [in Japan] is concerned, we know little about it. There have been no descriptions of it until now. (…) Treatment of the mentally ill was left in the hands of priests, fortune-tellers, or sometimes laymen. (…) Such treatments were practiced in a Buddhist temple or at home. This was the situation in the past, but even now some of it remains the same.8
In 1903 Sakaki’s pupil Kure Shūzō, who at the time was a professor of psychiatry at the University of Tokyo, published an article on the history of Japanese psychiatry in an Austrian medical journal.9 The article dealt with traditional therapies and ranged from ancient times to the early modern Edo period. There was little in these two articles, however, about traditional therapies practised from the beginning of the modern Meiji period onwards. Instead, an article written by Kure in 191210 described at length and for the first time the state of Japanese traditional therapies in his own day. He introduced twenty-one temples and shrines all over Japan where the mentally ill gathered and were treated by religious healers – Kure called them ‘non-medical institutions for the mentally ill’. A 1918 article by Kure and his colleague Kashida Gorō11 then reported the generally miserable situation of mental patients under home custody,12 and looked specifically at six locations associated with traditional healing. While not a broad survey, Kure and Kashida described each in detail and offered case studies of particular mental patients who were staying and being treated at these institutions.
The Japanese government too was, at this time, seeking knowledge about the state of non-medical institutions for the treatment of mental illness. Influenced by policy in European countries, the government in the early twentieth century was very much interested in the Japanese nation’s health and experience of disease: to this end, the Hoken’eisei Chōsakai (Health Inspection Committee) was established in 1916, as an advisory body to the Minister of Home Affairs.13 The aim of the committee was to investigate the condition of the nation’s health, including that of mental patients both at home and in various psychiatric institutions. The 1917 report of the committee (published by the Ministry of Home Affairs)14 listed eighteen non-medical institutions (‘temples and shrines, waterfalls, hot springs, and others’) for the mentally ill, albeit containing only basic information such as the names and addresses of institutions, and the number of patients at each institution. After that until the 1940s, the Ministry of Home Affairs (from 1938 onwards the Ministry of Health and Welfare) published a similar list of ‘temples and shrines, waterfalls, hot springs, and others’ several times. The number of institutions seems actually to have increased as years went by: from eighteen in the 1917 report (by the Health Inspection Committee),15 to twenty-nine in 1927,16 thirty-four in 1937,17 and fifty-five in 1940.18 These reports are useful in statistical terms, but they do not give any details about the practice of traditional therapies. Of greater help to historians is a 1937 article by Kan Osamu,19 a psychiatrist at Matsuzawa Mental Hospital in Tokyo, which lists forty-five non-medical institutions for the mentally ill and includes the name of the person in charge and the year of establishment for each institution, in addition to the basic information given above.
After the Second World War psychiatrists seemed to lose interest in monitoring traditional therapies for a while, until Kobayashi Yasuhiko, associate professor of psychiatry at Nagoya City University, published a monograph on the history of Japanese psychiatry in 1963.20 Whereas articles published before the war were inclined to criticize the backwardness of traditional therapies, Kobayashi depicted them as unique and attractive.
In the 1970s and 1980s, probably using information contained in the articles by Kure (1912), Kure and Kashida (1918), and Kan (1937), he inspected dozens of temples, shrines, and hot springs, gathering information and publishing several articles.21
Psychiatrist Omata Waichirō’s 1998 book on the history of mental hospitals in Japan,22 which greatly contributed to attracting public interest to this field, was heavily influenced by Kobayashi’s positive perspective on traditional therapies.
There are clear methodological limits to many of these surveys, since traditional therapies were almost always documented through the eyes of medical doctors – it was very rare for ordinary people to keep a record of such therapies. For my purposes here, I combine these medical surveys with fieldwork conducted with my colleagues over the past few years, visiting many religious institutions and collecting testimony from all those concerned.23
In 1918 Kure Shūzō and Kashida Gorō published a report on treatments for mental patients that were rooted in Buddhism, Shintoism, and various folk beliefs.24 In general, they criticized these therapies as having no real effect, and as being rather harmful to patients from the viewpoint of modern medicine.
They referred to temples in various parts of Japan in which mental patients stayed with their family members while the patient underwent treatment. Bathing, incantations, and prayers were prevalent. Bathing under waterfalls was most popular, and is thought to have been influenced by the syncretistic belief known as Shugendō, or mountain asceticism, peculiar to Japan. Shugendō is derived from an early practice of worshipping the gods of a mountain, or the mountain itself as a god. Shugendō is said to have achieved the form of an organized religion by the twelfth century at the latest, under the influence of various imported religious systems, including shamanism, Taoism, and Buddhism. Practitioners of Shugendō stayed in the mountains and were trained in ascetic practices such as wandering, praying, or bathing under waterfalls. Through such training they were thought to gain healing powers. The most powerful trainees, who were called shugenja, were respected by the nobility at the time. In the early modern Edo period, however, the lifestyle of the shugenja – who were based in the mountains and were sometimes involved in espionage activities while freely wandering around the country, which might be detrimental to the shogunate25 – was regarded as dangerous by the Tokugawa government, which attempted to settle them permanently in communities. Satoshugenka, or the settlement of shugenja in the villages, was promoted, and here shugenja prayed for local people’s spiritual and material benefit in this world while conducting exorcisms and other treatments for the sick, including the mentally ill.26 At the same time, from the middle of the Edo period, pilgrimage to holy mountains such as Fujisan (Mount Fuji) and Kiso Ontake became popular. Sometimes people organized pilgrimage groups known as kō and regularly visited holy mountains together.
In this way the original ideas and practices of shugenja, including bathing under waterfalls to obtain healing powers and to recover from illness, spread through the mutual interaction of shugenja coming down from the mountains and into the villages, and through people visiting the mountains.27 Even when the Meiji government after 1868 sought to establish Shintoism as the national religion and put an end to Shugendō,28 these treatments survived and appear in fact to have become more popular.
As an example of bathing under waterfalls, Kure and Kashida described the practices at Nissekiji Temple located in the mountainous area of Ōiwa, Toyama Prefecture, in central Japan.29 Mount Tateyama in Toyama Prefecture was known as a centre of Shugendō. Tateyama is a general term for three peaks of c.3,000 metres above sea level. The cult of Tateyama probably began with the worship of the mountain itself, but its syncretistic character is obvious: Oyama Shrine, which stands on the summit of the mountain, is dedicated to the gods of Japanese mythology, while it is said that located at the top of Tateyama are a Buddhist paradise and Buddhist hell. In the Edo period from the seventeenth to the mid-nineteenth century, the cult of Tateyama became very popular among shugenja and ordinary people, with pilgrimages to Tateyama from across Japan. For the worship of this mountain a pilgrimage group, Tateyama kō, was organized nationally. A Tateyama kō from each region visited Tateyama, fostering the emergence of villages that specialized in supplying pilgrims’ lodgings (shukubō) along the route to Tateyama.30 At the foot of Mount Tateyama are sacred places connected to the cult of Tateyama,31 including Nissekiji Temple in the Ōiwa district, where many of the sick used to stay to undergo treatment. According to legend, Nissekiji Temple in Ōiwa was established in 725, when the famous Buddhist monk Gyōki visited and carved an image of Fudō Myō Ō (a Buddhist deity) on a rock, one of the most important cultic objects of Shugendō.32 But it was not until the mid-seventeenth century that the main buildings of the temple were fully developed. From around 1700, people came to the temple believing that holy water from the waterfalls around it were effective in healing eye diseases.33 The waterfalls were also thought to be effective for treating mental illness.34
In 1868 this esoteric Buddhist temple completed the construction of a waterfall consisting of six streams: tradition says that people who bathe under these falls will form a connection with Buddha and purify the six human kon (roots of living energy).35 At Nissekiji Temple, mental patients stayed with their families for a while in a small temple called a sanrōjo next to the main temple, or in inns run by the villagers in front of the temple.36
While accommodation in a sanrōjo was free of charge, the patient’s family had to do their own cooking and borrowed bedclothes from the inns (wealthier patients lodged at the inns).
According to families’ particular demands for incantations and prayers, a priest might burn goma (small pieces of wood, burned on an altar to invoke divine help) for the patients, but the falls were the most important aspect of the treatment. The temple did not force bathing on the patients and their families but let them do as they pleased. Patients generally bathed under the falls several times a day, five to ten minutes each time. At the family’s request, the bathing was sometimes assisted by a part-time helper called a gōriki who brought reluctant patients to the falls by force and restrained them for the duration of the bath.
Kure and Kashida (1918) wrote that an eighteen-year-old schizophrenic farmer, who was lodging with his father in one of the inns, had his hands and feet bound with towels and was taken to the falls by two gōriki, since he was acting violently. After five minutes he went back to the inn, but his condition deteriorated badly. He complained of a pain in his head and ears and continued to mumble to himself. Two other patients reportedly also took a turn for the worse after bathing. Seeing for himself how the patients bathed, the inspector (Kashida) told them that they had misunderstood the effect of the falls and should discontinue the bathing.
In the same report, Kure and Kashida also referred to the waterfall of Yakuōin Temple, an esoteric Buddhist temple, in Takao, Tokyo Prefecture. The system of bathing there was almost the same as at Nissekiji Temple. Kure and Kashida criticized Yakuoin Temple over eight patients who had died during the year as a result of bathing, and for its lack of medical control, for which the temple should have taken responsibility.37
In addition to bathing under waterfalls, Jōgi Onsen offered an example of bathing in onsen, or natural hot springs, as a therapy for the mentally ill.38 Although Kure and Kashida did not describe this as a religious therapy, onsen were originally associated with religion: from ancient times people had worshipped onsen themselves as gods. Until the Middle Ages, access to onsen was limited to the nobility, priests, and the ruling class, becoming popular amongst ordinary people only from the Edo period onwards. To attract visitors, in addition to the effects of the onsen themselves, the power of religious guardian figures was invoked: some onsen were dedicated to gods of Japanese mythology such as Ōnamuchi no mikoto and Sukunabikona no mikoto, heroes of the national foundation myth of Japan, while others were dedicated to Buddhist gods such as Yakushi nyorai and Jizō bosatsu.39
The custom of tōji, or onsen cure, is said to have been established in the Edo period, consisting of three elements: the hot spring itself, a bathhouse, and accommodation. People stayed at an inn for some time (mainly during an off-season for farmers) and walked to a nearby bathhouse, where water was drawn from the source of a hot spring.40 Jōgi Onsen, probably the most popular that we know of in the history of psychiatry in Japan, was located in the suburbs of Sendai in Miyagi Prefecture in northern Japan. When the inspector Shimoda Mitsuzō, a research assistant at the University of Tokyo, visited the onsen in the early twentieth century, there were about twenty patients there with their families. Most of them were suffering from schizophrenia, manic depression, neurasthenia, and similar conditions. Men and women would soak together in the 37°C bath almost all day long, believing that a shorter immersion would be ineffective. They were all staying at the only inn at Jōgi Onsen, run by the Ishigaki family.41
In terms of the origins and development of this onsen there are various views, but it seems certain that the Ishigaki family started the onsen business by the middle of the nineteenth century. The golden age of the hot spring was from the Taishō (1912–1926) to early Shōwa period before the start of the Pacific War. During this period 5,000 to 6,000 guests visited Jōgi Onsen every year.42 Even so it must have been very difficult for the Ishigaki family to run the inn solely on the basis of the accommodation charge, which was relatively modest – unless the Ishigakis were a large landowning family.43
Legend has it that Yunoyama Onsen, in Hiroshima Prefecture, dates back to the ninth century, while Yunoyama Myōjinsha shrine, which is connected with Yunoyama Onsen, is protected by six guardian gods of Japanese mythology including Ōnamuchi no mikoto and Sukunabikona no mikoto. In 1707 the hot springs started to flow stronger than ever, drawing more and more people – a feat repeated in 1748, when the hot spring again became active, following a brief hiatus. Hiroshima Han, the local government, appointed village headmen as onsen officials, supervising visitors and keeping the bathing areas in good condition. In 1797 Oka Minzan, a retainer of Hiroshima Han, visited Yunoyama, bathed in the bathhouse, and stayed at the Iwataya, one of several inns for onsen guests, which continued to be used until the second half of the twentieth century. He wrote in his diary, Tsushimi ōrai nikki, that some people made full recoveries from illness as a result of spa treatment.44 Yunoyama Onsen was especially well known as a spa for the treatment of mental illness,45 and at the time of a report published in 1940 by the Ministry of Health and Welfare it was still listed as a facility capable of accommodating the mentally ill.46
Why were these bathing places specified for the treatment of mental illness? In Europe during the Middle Ages pilgrimage sites attracted people hoping for recovery from illness, and each destination had a patron saint connected with a particular area of health. St. Dimpna in Geel, Belgium, was regarded as a patron saint of mental illness because madness was a feature of her own life story.47 However, as far as these places in Japan are concerned, the reason why mental patients in particular gathered there remains unclear.
Kure and Kashida reported on the saying of incantations and prayers at Nichirenshū (a sect of Buddhism) temples Hokekyōji and Myōgyōji in Chiba Prefecture, and at the (Shinto) Hozumi Shrine in Shizuoka Prefecture (originally linked to Shugendō).48
Established in 1260, Hokekyōji Temple in Nakayama is one of the head temples of the Nichirenshū sect. Within this temple was a sanrōjo in which twenty-five people, including fourteen mental patients, were boarding together when it was inspected in October 1917. The ritual of shuhō, a form of incantations and prayers, began at five o’clock every morning.
People moved from the sanrōjo through a corridor to another small temple, where they sat in front of the altar of Kishibojin (the goddess of childbirth and children) and loudly recited the phrase ‘Nammyō hōren gekyō’49 to the accompaniment of a drum, while the priest sat to the side overseeing the ritual. The prayers lasted for twenty minutes and started again after a break of thirty minutes. Aside from mealtimes, they continued to do this until nine o’clock in the evening. Kure and Kashida noted that four patients, whom they regarded as schizophrenic, did not recite the prayers and instead looked around and smiled blankly during the ritual. Another male patient, regarded as paretic, laid his breast and belly bare, hit himself around the navel, and smiled. Though the priest explained to the inspector Miyake Kōichi, a Tokyo University research assistant, that 70 per cent of the patients had been cured and that so far no scandals had occurred, the inspector heard from another person that quite a few mental patients had simply run away from the temple.
Myōgyōji Temple in Baraki was established in the sixteenth century and was restored at the end of the eighteenth century. The accommodation and practices were almost the same as those of Hokekyōji Temple. At the time of Miyake’s visit thirty-two people were gathered in front of the altar in the place where shuhō was performed: ten were patients who were about to be treated. When it came to the turn of one middle-aged woman, who was not a mental patient, she complained of a severe pain in her side. The priest made a noise by beating his wooden clapper and asked her, ‘How long have “you” hurt this woman, after “you” came into her body?’ The sound of the clapper was so ear-splitting that some of the other patients trembled. The woman answered, ‘For twenty-three years.’ After a few questions and answers were exchanged, the priest declared, ‘This woman will recover from her illness by tomorrow.’ This was shuhō as it was practised in Myōgyōji Temple at the time. Whether or not the woman recovered by the next day is unfortunately not recorded.
The inspector of these two temples noted that their respective sanrōjo, where mental patients were housed, appeared to be pavilions styled after psychiatric wards in European countries. He further suggested that shuhō, where the cause of mental illness was thought to be possession or heresy, was in fact a form of psychotherapy or hypnotism. This was perhaps more than just a personal feeling for the similarities here between Japan and Europe: in general, Japanese psychiatrists at this time were inclined to look for elements of contemporary European therapies in Japanese traditional or religious ones (see below). The inspector had high hopes that Nakayama Ryōyōin (Nakayama Mental Hospital), established in 1917 by Hokekyōji Temple, would combine modern therapy with religious psychotherapy. Nakayama Ryōyōin is one of the oldest cases of a religious institution developing into a modern mental hospital.50
Kure and Kashida also reported on another type of prayer practised at this time at Hozumi Shrine in Shizuoka Prefecture, which had been converted from a Buddhist temple in the wake of Meiji religious policies that favoured Shintoism over Buddhism as a national religion. Hozumi Shrine had been known as a place where mental patients could find a cure in yukitō (hot water prayers). Every morning and evening the priest offered prayers to the patients, and at the same time sprayed hot water on their heads, which was boiled in a pot placed before the shrine. Patients and their families stayed and cooked in accommodation designed for pilgrims in the grounds of the shrine. When the inspector, Suizu Shinji, from Tokyo University, visited Hozumi Shrine in August 1911, there was only a single twenty-eight-year-old male patient staying there with his father.
Prior to coming to the shrine the patient had thrown an axe at his wife and injured her. Since then his health had deteriorated, and he had started yukitō from July of that year. His father took care of him, and in the daytime the patient tried to help his father do light work such as weeding or chopping wood, but he soon got bored. The inspector offered a generally negative account of the treatment at Hozumi, commenting on the relative lack of patients and the poor standard of the accommodation.51
The type of therapy used at temples and shrines differed from one religious sect to another: in general, bathing under waterfalls tended to be practised at Mikkyō (esoteric Buddhism) temples, which were deeply influenced by Shugendō, while incantations and prayers were used more in Nichirenshū temples.52 Shintō, Sōtōshū (a Zen sect), and Shinshū (True Pureland Buddhism) seem not to have offered a great deal of treatment for mental illness.53 In many cases the difference in religious sect does not seem to have been crucial; however, at a single institution, priests of different sects could be found practising a range of therapies, depending on their personal inclinations – including their reasons for offering treatment and care to mental patients in the first place. The particular ways in which these priests arranged and controlled the daily lives of patients during their stays is also crucial, and were linked in important ways to the religious therapies themselves.
The work of the shugenja Yamamoto Shūsen (1786–1870) offers an example of the centrality of the priest and his personal experience. Yamamoto established Yamamoto Kyūgosho (Yamamoto Relief House) in the grounds of Tenjōji Temple, in Miyashiro Village (now Tarui chō, Gifu Prefecture) in 1840 after he succeeded in healing a member of his own family who had been mentally ill. As a shugenja he himself bathed under waterfalls with mental patients and performed prayers and incantations for the treatment of mental illness. He invented a form of settoku, or persuasion therapy: according to his own experiences, he was convinced that the symptoms of mental illness could be improved by the positive attitudes of family members toward a patient, and so he persuaded family members to change their behaviour.54 Yamamoto died in 1870, apparently killed by a patient, and his son Yamamoto Shūdō (1827–1892) took over the family business.55 In the same year, Shūdō’s three-year-old daughter was carried off by a female patient, and neither were ever seen again. Regardless of these tragedies, the Yamamoto family continued to take care of the mentally ill, while Shūdō’s own eccentricities prompted a local newspaper to publish an article about ‘the mad cur[ing] the mad’.56
Shugendō, regarded as a syncretic blend of Shintoism and Buddhism, was abolished by government order in the Meiji period. As a result, in 1870 Yamamoto Shūdō had to change from a shugenja to a Shintoist and join Shintō Shūseiha, one of the new government-approved sects of Shintoism, which was established by Nitta Kunimitsu (1829–1902) in 1873. ‘Shūrikosei Kōkameisai’, the doctrine of Shintō Shūseiha, provided a system of ethics for daily living, and began to influence the treatment of patients looked after by the Yamamoto family. In keeping with the doctrine, patients engaged in daily activities such as light work and cleaning, which could be regarded in retrospect as a sort of occupational therapy.57
After Shūdō’s death his son Yamamoto Ichiji (1873–?) took care of the patients, and the Yamamoto family business extended into a third generation. However, not long after the end of the Second World War, Yamamoto Kyūgosho was finally closed, due either to food shortages58 or to the new Mental Hygiene Act of 1950.59 By this Act, two previous laws, the Mental Patients’ Custody Act (1900) and the Mental Hospital Act (1919), were repealed and replaced. The 1900 Act had been criticized for allowing the confinement of mental patients at home (home custody), while the latter had failed to promote the construction of public mental hospitals. The new law stipulated the medical treatment and protection of mental patients, and required that their accommodation be limited to mental hospitals. Non-medical institutions were thereby forced to give up receiving mental patients.
The work of the Nichirenshū Buddhist priest Hasegawa Kanzen in the town of Minobu, in Yamanashi Prefecture, shows us something of the links between mental healthcare and general philanthropy in modern Japan.60 Shocked to find, one winter’s day, that an old, homeless woman had died in the grounds of Kuonji Temple, Hasegawa established Minobusan Kudokukai (hereafter referred to as Kudokukai) in 1906 to provide accommodation for the homeless, a number of whom were mentally ill. Hasegawa’s Kudokukai was involved not so much in religious therapy per se as in Buddhist philanthropy, the nature of which gradually changed as the Japanese government sought to incorporate religious philanthropy into the strong nation-state that it was determined to build.61 According to Kan Osamu’s 1937 article, the number of mentally ill staying in Kudokukai was five.62 When the Kudokukai buildings were extended in 1940, some confinement rooms for the mentally ill were constructed, accommodating six patients.63 After the Second World War, Kudokukai was transformed into an institution for the aged. It seems that Kudokukai was unable to accommodate any more mental patients because accommodation was restricted to mental hospitals by the new Mental Hygiene Act in 1950.64
Meanwhile, religious therapies sometimes deteriorated into the abuse of mental patients. At a retreat centre called Ryōzen’an, which was built at the foot of Mount Ryōzen in Fukushima Prefecture in the 1920s, the founder and (probably Shugendō) trainee monk Ōe Ryōken recited a sutra as a remedy for mental patients. As his reputation grew, more and more patients visited Ryōzen’an. At its peak, thirty to forty patients lived at the retreat. In Kan’s article, Ryozen’an was described as a Seishinbyōsha hoyōjo, or a sanatorium for mental patients.65 In 1936, however, Ōe and his colleagues were arrested by the police, and the local authorities demanded the retreat be closed: a mental patient who had run away from Ryōzen’an had complained to the police about violent abuse in the name of therapy. A local newspaper reporting on Ryōzen’an wrote:
While Ryōzen’an collected a lot of money from patients through charging for board, the patients were given meals poorer than those of beggars. So that the patients would sleep well at night, they were compelled to work, chained to one another like prisoners.66
The newspaper also reported that some patients seemed to have died under punishment, while others were raped. Ōe was eventually sentenced to eighteen months of penal servitude for the crime of illegal confinement and injury.67
Terayama Kōichi, a psychiatrist and local historian in Fukushima, analysed the case of Ryōzen’an in the following terms:
Since some psychogenic-psychotic patients can be cured by praying or a change of air, some patients in Ryōzen’an were cured. That must have made Ryōzen’an popular, so people began to leave patients in its care. Although at first the institution must have been faithful to its patients’ care, the increase in the number of patients changed its character, and it came to pursue profit and to treat troublesome patients badly.68
Nevertheless, because of the shortage of psychiatric beds in Fukushima Prefecture, where the first mental hospital was built with just thirty-nine beds in Kōriyama in 1933, people had little choice but to leave patients in the ‘questionable’ care of Ryōzen’an.69
Leading medical doctors generally criticized traditional therapies practised at religious institutions. Kure and Kashida primarily criticized the lack of medical supervision in the treatment of the mentally ill, hoping to transform unscientific remedies into ‘modern treatment’ in the Western sense. Although they conceded that bathing under waterfalls could be a kind of hydrotherapy,70 and that incantations and prayers could be a kind of psychotherapy, they worried about problems of hygiene and morality associated with these therapies: the degree of mental illness or the physical constitution of each patient was often ignored and patients were force-treated. Kure and Kashida also criticized local and central governments for failing to control traditional therapies, even though such therapies contravened the Mental Patients’ Custody Act (1900), which prohibited the accommodation of patients at non-psychiatric institutions.71
However, in spite of the criticisms levelled at traditional therapies, they still seem to have prospered, not least because of the poor state of psychiatry at that time. Japan suffered from a chronic shortage of beds for psychiatric patients, and most patients who needed to be treated had to choose either home custody, under police observation and without sufficient medical care, or traditional remedies at religious institutions.72
At the same time, people were highly doubtful of the treatment in mental hospitals. Kodama Sakae, psychiatrist and director at Aichi Prefectural Mental Hospital, reported in 1934 that most of the families who confined their patients at home under the Mental Patients’ Custody Act simply did not trust mental hospitals and did not want to leave their family members there. They responded (on questionnaires) that ‘Nobody knows how patients are treated in mental hospitals’, or ‘Since we are relatives, I would like to take care of the person at home, even if admission into a mental hospital would cost little or nothing’.73 Although religious institutions may also have gained some notoriety, the bad reputation of mental hospitals must have increased through the scandals reported regularly in the newspapers. From May 7 to June 20, 1903, the Yomiuri newspaper ran a series entitled ‘Mental hospitals: the darkest world of mankind’,74 which revealed lurid details of ill treatment in public and private mental hospitals.75
Despite their criticisms, Kure and Kashida did not argue that traditional therapies should be abolished. They thought that it would be useful and appropriate if medical doctors were to supervise traditional therapies, or if such religious institutions were to be transformed into mental hospitals. Moreover, they suggested to the central government and the public that traditional therapies could be reorganized according to modern psychiatric theories accepted in Western countries.76 In other words, traditional remedies were accepted and recommended only if they could be understood in terms of the methods or concepts of modern Western medicine. Traditional practices were reinterpreted and given the terminology of modern medicine, as seen in the examples of Nichirenshū temples in Chiba and other traditions described in Kure and Kashida’s report: shuhō, for example, would be religious psychotherapy,1 and bathing in the hot springs at Jōgi Onsen in Miyagi Prefecture would be duration bathing (Dauerbad),78 which was practised in Europe as physical therapy for mental patients at the beginning of the twentieth century.
Some doctors tried to combine modern medicine with traditional remedies – for example, Matsumura Masami in Takizawa, Gumma Prefecture. The mountainous Takizawa district was originally a holy place for shugenja, and Kure’s article of 1912 had reported the use of bathing under waterfalls for the treatment of mental illness in Takizawa. In 1930, Matsumura established a sanatorium for hydrotherapy near the waterfalls in Takizawa, because in his words ‘hydrotherapy is highly regarded in Western countries.’79 As a modernist doctor he introduced ‘Dampfdusche’, or steam showers, most likely from Germany, for which a special room and facilities were constructed. He also adopted traditional bathing under waterfalls, according to patients’ symptoms.
In this way he did not simply interpret bathing under waterfalls as hydrotherapy, but rather he tried to combine modern and traditional treatment, making use of the natural and historical environment in Takizawa. This all came to an end when Matsumura, serving as an army surgeon, died on the battlefield in 1943.80
Awai Shrine at Naruto in Tokushima Prefecture serves as another example and was written about by Kure in 1912.81 This Shinto shrine was known for its long tradition of suigyō, or bathing at the seaside. In 1927 Awaijima Mental Hospital was established beside the shrine by a Shinto priest and villagers. In planning the hospital, they had visited some modern institutions in Tokyo and Kyoto. Kure visited the hospital and evaluated its combination of modern Western hospitalization and Japanese tradition. The bathing of patients continued as part of the daily treatment until the postwar period. According to the daily schedule of the hospital, suigyō was conducted three times a day (at seven and at eleven in the morning each for thirty minutes, and at four in the afternoon for ninety minutes).82 The institution was criticized, however, for making the practice of suigyō compulsory.83 In 1948 a military official of the US occupation army, thought to have worked as a psychiatric social worker in a mental hospital in America, inspected Awaijima Mental Hospital and ordered that religious practice there should be abolished because it was inhumane.84
By the 1940s traditional therapies seem to have entered a new phase. Mental hospitals were now constructed not only in urban areas but in the countryside as well. Until 1899 almost all mental hospitals existed only in three out of forty-seven prefectures (Tokyo, Kyoto, and Osaka), but by 1918 at least one mental hospital had been built in each of fourteen further prefectures; by 1935 every prefecture except for Aomori and Okinawa Prefectures had at least one mental hospital (see Shiotsuki, this volume).85 With this emergence of institutionalism, the number of mental patients who were admitted into mental hospitals gradually increased, although sometimes it took many hours to convince their families that they should be hospitalized, since many people still attributed mental illness to possession by foxes or other beings and so relied on incantations and prayers.86 In addition, under the influence of the Regulation for Control of Hospitals and Clinics in 1933, each prefecture controlled medical and medicine-related institutions more and more strictly. It became more difficult than before for traditional therapies to survive: in 1933 Kanagawa Prefecture prohibited traditional treatment at Shōmyōji Temple in Kamakura. Since 1915 the temple had run a special house called Konsenzan Seiyōjo (Konsenzan Sanatorium) for mental patients who stayed there for incantations, prayers, and to bathe in the falls. A newspaper article at the time reported that the founder of the institution, a Buddhist by the name of Narumi Zuiō (1881–1954) planned to turn it into a mental hospital by hiring the necessary medical staff – he was apparently ready to apply to the local government office for the required permission.87
For some reason, however, the mental hospital idea was not realized – possibly Narumi’s plan was rejected by the local government. Instead the temple seems to have introduced regular consultations by a doctor in order to keep Konsenzan Seiyōjo going.88 As for the inn run by the Satō family located near the waterfall of Yakuōin Temple in Takao, Tokyo, it was unable to continue to accommodate mental patients as a result of control by Tokyo Prefecture. But it did, however, succeed in establishing a mental hospital, Takao Hoyōin, in 1936.89
The movements of the emperor of Japan had a powerful influence on the evolution of hospitalization amongst mental patients. As the Sino-Japanese war broke out in the 1930s, the emperor frequently visited places where army manoeuvres were held, and prior to his visits police strictly controlled mental patients who lived outside psychiatric institutions – if necessary confining them in mental hospitals, and even going so far as to construct new mental hospitals in areas in which there were none.90 Similarly, Ganryūji Temple in Hyōgo Prefecture, a Shingonshū (a sect of esoteric Buddhism) temple established in the ninth century, attracted the attention of the police just prior to the emperor’s visit to Kobe. The head of the police department and a policeman from a substation visited Ganryūji Temple and requested that the priest no longer accommodate any patients in the temple.91
After the Second World War, the accommodation of mental patients anywhere outside psychiatric institutions was prohibited by the Mental Hygiene Act of 1950, and the number of mental patients staying at religious institutions for treatment went into decisive decline. Even before the Act, however, religious treatment was already waning. As more and more patients were hospitalized in the 1930s and 1940s, people gradually came to think of treatment at temples and shrines as a kind of ‘occult’ practice. It is not easy to detect a clear moment of change in people’s view of traditional therapies, but probably by the 1930s the public began to keep a distance from traditional practices. Whereas from the 1950s onwards the numbers of psychiatric inpatients in Western countries decreased, against a background of deinstitutionalization policies, the promotion of community mental health, and the introduction of antipsychotics, in Japan the trend ran in the opposite direction. Numbers of mental hospitals and psychiatric beds continued to increase right through to the 1990s: in 1950 the number of the beds was just less than 18,000; in 1970, around 250,000; and in 1980, the number exceeded 300,000. The peak number of the beds was 363,010, in 1993.92
The following quote, from a sarcastic newspaper article of 1950, illustrates the lost prestige of religious treatments by this time:
In the time of penicillin and X-rays, rural customs persist. Several mental patients seem to be staying at Ryūfukuji Temple in Iwai, Chiba Prefecture, and bathing in the waterfalls there. When I visited in mid summer, I saw a naked woman bathing under the falls with a grin on her face. The sight sent chills down my spine.93
While bathing in the falls became an object of ridicule, the temple degenerated into a place of abuse. Mental patients accommodated at Ryūfukuji Temple were ill treated until the Mental Hygiene Act in 1950, according to an article by Satō Ichizō, a psychiatrist at Chiba University.94 Satō came to learn of traditional therapy for the first time through his experience with patients whose hands and feet were badly scarred by chains. They all came from Iwai. He visited Ryūfukuji Temple in May 1949 and found that a dozen patients were accommodated in some of the temple buildings, chained at the ankle and connected to pillars such that they could move only within a range of one metre. They were chained even when eating, relieving themselves, and bathing under the waterfall.95
In the course of the modernization of psychiatry in Japan, leading psychiatrists generally criticized traditional therapies. Occasionally, however, doctors acknowledged a traditional remedy if it was consistent with Western medical theories. The fact that people believed in the effectiveness of traditional therapy might, in itself, have given rise to cures in some cases. Crucially, people had a great suspicion that patients would not be cured in mental hospitals and, even worse, might be badly treated there. Nevertheless the 1930s saw the construction of mental hospitals even in rural areas and the hospitalization of mental patients increasing nationwide. Under Japan’s wartime regime more and more ‘dangerous’ patients in the community were confined in psychiatric institutions. The use of traditional therapies, long supported by public belief, began to decline. It was in this period in prewar Japan, when the hospitalization of mental patients was still behind that of Europe and North America, that the ground was laid for the drastic institutionalization seen in postwar Japan.
This institutional trend did not, however, reflect a general shift in public attitudes away from religious therapies and towards understanding mental illness entirely as a medical problem. As the philosopher Uchiyama Takashi has pointed out, the long-standing Japanese view that man belongs to – is a component of – nature helped to produce ideas such as Shugendō, in which mountains were worshipped as gods, and fox possession. This reflected a close relationship between people, gods, and nature, which lasted for hundreds of years until a period of unprecedented economic growth in the 1960s, when social and industrial structures drastically changed in Japan.96 Still today traditional understandings seem to be alive in places. A few years ago at a group meeting held to decide upon activities for mental health patients at a public health centre in Yamaguchi Prefecture, one patient proposed Taikodani Inari Shrine in Tsuwano, Shimane Prefecture, only for another patient to object that if they went they might be possessed by a fox.97
Let us return, finally, to Ōiwa in Toyama Prefecture, where Nissekiji Temple is located, a place blessed with beautiful natural surroundings. On the occasion of the Panama–Pacific International Exposition held in San Francisco in 1915 it was hailed as one of the most pleasant summer retreats in the province, where ‘even now bathing in the waterfalls is popularly believed to be efficacious for curing mental derangement and also eye diseases, and thus the place is visited by sick people all the year round.’98 Infrastructural conditions for accepting mentally ill people and their accompanying family members were also in place. As Ōiwa had been developed as a destination for pilgrimages, it had sufficient capacity to accommodate guests, as mentioned above, in a small temple next to the main building of Nissekiji Temple and in several inns across from the temple. The opening of a railway in 1913 made access to Ōiwa easier. The care of the mentally ill was supported not only by family members but also by the entire community, including priests, innkeepers, helpers for waterfall bathing, a resident police officer, and villagers. In the context of twenty-first-century psychiatry, this would be highly regarded as an example of community mental health – of a sort with a short record in Japan, only introduced in these terms in the 1960s, but a very long history.99
1 Shorter, A Historical Dictionary of Psychiatry, pp. 3–4.
2 For a critical discussion of the relationship between modernization and Westernization in Japan, see Suzuki, Nyūmon nihon kingendai bungeishi.
3 For a discussion of the limitations of the modernization paradigm, see Geyer, ‘Deutschland und Japan im Zeitalter der Globalisierung’.
4 Komatsu, Hyōrei shinkō ron, p. 22.
5 Hiruta, ‘Nihon no seishin iryōshi’.
6 Hayami, Tsukimono mochi meishin. The prominent folklorist Yanagita Kunio wrote an introduction for this book (the first edition in 1953), but he criticized Hayami’s socioeconomic analysis of fox possession. cf. Itoh, Yanagita Kunio to Umesao Tadao, pp. 38–41.
7 Okada, Nihon seishinka iryōshi, pp. 113–122.
8 Sakaki, ‘Ueber das Irrenwesen in Japan’.
9 Kure, ‘Geschichte der Psychiatrie in Japan’.
10 Kure, Wagakuni ni okeru seishinbyō ni kansuru saikin no shisetsu.
11 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu. This article was also published in the medical journal Tokyo igakukai zasshi, vol. 32 (no. 10–13) in 1918. It dealt not only with mental patients under home custody, but also folk therapies, folk medicine, and transportation of mental patients (from home to mental hospitals). Field research for the article was undertaken between 1910 and 1916, by twelve assistants at the University of Tokyo.
12 ‘Home custody’ was a form of confinement of mental patients at home under the control of the police, which was regulated by the Mental Patients’ Custody Act in 1900. Most of the home custody patients were confined in a small cage built inside or outside their own house.
13 Hoken’eisei chōsakai [Health Inspection Committee], Hoken’eisei chōsakai dai ikkai hōkokusho.
14 Naimushō [Ministry of Home Affairs], Seishinbyōsha chihōbetsuhyō.
15 Ibid.
16 Naimushō [Ministry of Home Affairs], Seishinbyōsha shūyōshisetsu chōsa.
17 Naimushō [Ministry of Home Affairs], Seishinbyōsha shūyōshisetsu chōsa (at 1 January 1937).
18 Kōseishō [Ministry of Health and Welfare], Seishinbyōsha shūyōshisetsu chōsa (as 1 January 1940).
19 Kan, ‘Honpō ni okeru seishinbyōsha narabini koreni kinsetsu seru seishin’ijōsha ni kansuru chōsa’.
20 Kobayashi, Nihon seishin’igaku shōshi.
21 For a typical article of his from this period, see Kobayashi, ‘Nihon seishin’igaku no rekishi’.
22 Omata, Seishinbyōin no kigen.
23 For more on this fieldwork, see Hashimoto (ed.), Chiryō no basho to seishin’iryōshi.
24 Kure and Kashida , Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu.
25 Japan’s political system of the time, incorporating a ruling elite of regional leaders (daimyō) with a shōgun at the top.
26 Miyake, Shugendō.
27 Sakurai, Kō shūdan seiritsukatei no kenkyū, pp. 572–582.
28 Miyake, Shugendō, pp. 120–121.
29 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, pp. 97–99.
30 Toyama dai hyakkajiten gekan, pp. 120–123.
31 Tanego (ed.), Shugenja no michi, p. 4.
32 The story that tells of Gyōki carving the image in the eighth century must be an invention. Based on the style of the carving, it seems instead to have been completed in the late Heian period (794–1185/1192). cf. Toyama dai hyakkajiten gekan, p. 122.
33 Nojima (ed.), Ōiwasan Nissekiji, pp. 25–26.
34 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, pp. 97–99.
35 According to the tradition of Nissekiji Temple, the six roots are: eye, ear, nose, tongue, body, and will.
36 After the Second World War the sanrōjo at Nissekiji Temple was destroyed. However, some of the inns continue to be used today. According to Takigawa Iwao, the innkeeper of Dangoya Inn, whom we interviewed in September 2005, the former main building of Nissekiji Temple burned down in 1967. But before that time the sanrōjo, which had adjoined the main building, had already disappeared. It seems that Nissekiji Temple stopped accommodating the mentally ill in the sanrōjo after the Mental Hygiene Act of 1950.
37 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, pp. 89–91. According to Kure and Kashida, the internal rules of Yakuōin Temple stipulated that a person planning to bathe in the falls should first consult a doctor and obtain medical permission. However, the inspector Ishikawa Teikichi, a research assistant at the University of Tokyo, heard that many patients came to the temple without having had any medical consultation, and that some other patients went to the temple after undergoing ineffective medical treatment.
38 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, p. 99.
39 Onsen bunka kenkyūkai, Onsen wo yomu.
40 Ibid.
41 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, p. 99.
42 Hiruta, ‘ “Kichigai no yu”: Jōgi Onsen no rekishi kikigaki’.
43 Kondō, ‘Tōjiba ni okeru seishinbyō chiryō: Miyagiken Jōgi no “sanchū no tenkyō’in” ’.
44 Hiroshimaken kyōiku iinkai, Hiroshimaken bunkazai chōsahōkoku dai ni shū.
45 Asada, ‘Nihon seishin’igaku fudoki Hiroshimaken’.
46 Kōseishō, Seishinbyōsha shūyōshisetsu chōsa.
47 Hashimoto, ‘Geel no seishin’iryōshi: denshō to junrei ni tsuite’.
48 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, pp. 91–93.
49 The phrase comes originally from Sanskrit: ‘I embrace the teachings of the Hokekyō (the Lotus Sutra).’
50 The number of modern mental hospitals originating from a religious institution is limited. Honda Byōin (Osaka Prefecture) is thought to be the oldest, originating from Jōkenji Temple, which was established in the sixteenth century and became a hospital in 1882. See Tokyo seishinbyōin kyōkai, Tokyo no shiritsu seishinbyōinshi; Okada, Nihon seishinka iryōshi, pp. 46–48.
51 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, p. 97.
52 Omata, Seishinbyōin no kigen.
53 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, p. 87.
54 Umemura, ‘Yamamoto Kyūgosho no rekishi’.
55 Kure, Wagakuni ni okeru seishinbyō ni kansuru saikin no shisetsu, pp. 125–126.
56 Umemura, ‘Yamamoto Kyūgosho no rekishi’.
57 Ibid.
58 Ibid.
59 Kobayashi, Nihon seishin’igaku shōshi, p. 51.
60 Hashimoto, ‘Yamanashiken Minobu no seishinbyōsha’.
61 See Yoshida and Hasegawa, Nihon bukkyō fukushi shisōshi, pp. 147–195. National control of psychiatric institutions in the run-up to, and during, wartime included a fixed distribution system for rice and other food, which led to many patients’ deaths from malnutrition across Japan. See Okada, Shisetsu Matsuzawa Byōin shi, pp. 529–559; and Okada, Nihon seishinka iryōshi, pp. 198–199.
62 Kan, ‘Honpō ni okeru seishinbyōsha narabini koreni kinsetsu seru seishin’ijōsha ni kansuru chōsa’.
63 The Minobu Kyōhō, on September 3rd, 1940.
64 Hashimoto, Chiryō no basho to seishin’iryōshi.
65 Kan, ‘Honpō ni okeru seishinbyōsha narabini koreni kinsetsu seru seishin’ijōsha ni kansuru chōsa’.
66 The Fukushima Mimpo, on 10 December 1936.
67 The Fukushima Mimpo, on 20 December 1936.
68 Terayama, ‘Ryōzen’an oboegaki’.
69 Terayama, ‘Nihon seishin’igaku fudoki Fukushimaken’.
70 In his 1916 textbook Kure introduced contemporary hydrotherapy as it was being practised in Europe: warm and cold baths aimed at refreshing the mind and body. See Kure, Seishinbyōgaku shūyō dai 2 han zenpen, pp. 885–894.
71 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, pp. 136–137.
72 According to Ministry of Health and Welfare statistics, at least until 1928 the number of patients who were cared for in non-medical institutions (mostly home custody) was larger than that in mental hospitals. As for the patients who stayed at religious institutions, there are no accurate statistics. See Kōseisho (Ministry of Health and Welfare), Isei 80 nenshi, pp. 802–803.
73 Kodama, ‘Aichiken ni okeru seishinbyōsha, seishinhakujakusha chōsahōkoku’.
74 See Minami, Okada, and Sakai, Kindai shomin seikatsushi 20: Byōki eisei, pp. 183–223.
75 The predominance of private mental hospitals over public ones was (and remains) a notable feature in Japan. According to Kure and Kashida, around the year 1918 public mental hospitals (including university and medical school psychiatric wards, public general hospitals, military and naval hospitals, etc.) offered around 1,000 beds between them, whereas a total of thirty-seven private mental hospitals together provided about 4,000 beds. The Japanese government enacted the Mental Hospital Act in 1919 with the aim of establishing a public mental hospital in all forty-seven prefectures, with poorer patients to be admitted at public expense. However, only eight prefectural mental hospitals (Tokyo, Kanagawa, Aichi, Kyoto, Osaka, Hyōgo, Fukuoka, and Kagoshima Prefecture) were actually built under the auspices of this law (1919–1950). On the other hand, private mental hospitals continued to increase right up to the beginning of the Second World War. The leading private mental hospitals were recognized by the local government as a substitute for public mental hospitals (daiyō seishinbyōin) and received poor mental patients at public expense. See Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, pp. 4–5, and Okada, Nihon seishinka iryōshi, pp. 180–181.
76 Kure and Kashida, Seishinbyōsha shitakukanchi no jikkyō oyobi sono tōkeiteki kansatsu, p. 137.
77 Ibid, p. 94.
78 Ibid, p. 99.
79 Matsumura, ‘Suichi ryōhō ni tsuite’, p. 117.
80 Kasukawa mura hyakunenshi.
81 Kure, Wagakuni ni okeru seishinbyō ni kansuru saikin no shisetsu, pp. 127–128.
82 Tokushimaken seisin’eisei kyōkai, Tokushimaken seishin’eiseishi, p. 18.
83 Ibid, p. 22.
84 Ibid, p. 26.
85 Okada, ‘Senzen no nihon ni okeru seishinkabyōin seishinkabyōshō no hattatsu’.
86 For an example in Yamanashi Prefecture, see Matsuno, ‘Nihon seishin’igaku fudoki Yamanashiken’.
87 The Chugai Nippō, on 17 March 1934.
88 Nakanishi, Bukkyō to iryōfukushi no kindaishi, pp. 179–180.
89 Hiruta, ‘Takaosan takichiryō: Kikigaki’.
90 For instance Miyazaki Nōbyōin (Miyazaki Mental Hospital) was established as the first mental hospital in Miyazaki Prefecture in 1935 shortly before the emperor visited this area. cf. Miyazaki kenritsu Fuyōen, 50 shūnen kinenshi 1952–2002, p. 103.
91 Sakata et al., ‘Ganryūji ni okeru “sanrō” ni tsuite: Seishinbyōin seiritsu zengo no minkanryōho no ichi jirei’, pp. 110–117.
92 See Okada, Nihon seishinka iryōshi, pp. 198–205; and Wagakunino seishinhokenfukushi heisei 22 nendo ban, p. 789.
93 The Chiba Shimbun, 31 July 1950.
94 Satō, ‘’Iwai no taki’ kenbunki.
95 In 2007 the current chief priest, whose father was Hijikawa Kampō, the former chief priest, was interviewed about former conditions there. He said:
In the temple patients were chained at the ankle and connected to pillars, whose corners were rounded off from the chains. They had infected wounds on their ankles, which were sometimes infested with maggots. Patients in good health were not chained and worked in the garden. Local people were hired as helpers and took patients to the falls, prodding them with bamboo sticks as they went. After my father was demobilized in 1946 following the war, a newspaper criticized the treatment of patients here. We then tried to have the patients go back to their homes.
cf. Kindai nihon seishin iryōshi kenkyūkai tsūshin: 15–20
96 Uchiyama, Nihonjin wa naze kitsune ni damasarenaku nattanoka; Uchiyama, ‘Nihon no dentōtekina shizenkan ni tsuite’, pp. 20–40.
97 Account given by public health nurse to the author. Shrines in this area are famous for being at the centre of the Inari faith, which worships the fox as a messenger of the god of good harvests. See Hyōdō, Seishinbyō no Nihon Kindai: Tsuku Shinshin kara Yamu Shinshin e.
98 Ishizu, The Mineral Springs of Japan, p. III–47.
99 The revised Mental Hygiene Law of 1965 provided for the first time the promotion of community mental health services through public health centres.
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