Suicide in Japan seems special. From ritual disembowelment to kamikaze fighter pilots, voluntary death in Japan has been romanticised as a tragic, yet honourable act that reflects ‘traditional’ values like altruism and loyalty. Japanese kill themselves, it is said, for the greater good of the nation, society or family. They possess a unique psychology that predisposes them to suicide. Their suicides follow distinctive patterns. But at least one historian has had enough of such cultural essentialism. In Suicide in Twentieth-Century Japan, Francesca Di Marco aims to loosen the tenacious grip of these stereotypes on the popular imagination by tracing changes in ideas about suicide in Japan from the 1880s to the 1980s. As a ‘counterweight’, to use her term, to the narrative about the uniqueness of Japanese suicide, Di Marco tells a lesser-known story about the efforts of psychiatrists to spread the notion that suicide was caused by biologically-based mental illnesses. Her book breaks new ground as the first full-length study in English that critically outlines the historical formation of medical and cultural ideas about suicide in Japan. It is a long-awaited addition to a growing body of work on the histories of Japanese medicine and psychiatry.

Di Marco frames the history of suicide in Japan as a battle between two narratives: a cultural narrative that declared suicide a voluntary act driven by so-called traditional values or nationalist pride and a medical narrative that treated suicide as the result of universal, biomedical diseases. The battle began in the 1890s with Western-trained Japanese psychiatrists claiming that suicide was triggered by mental diseases rooted in genetic inheritances and biological abnormalities. The psychiatrists viewed suicide as a product of pathology, not individual agency. In the 1920s, intellectuals and journalists began to attack the medical narrative for trampling on ‘traditional’ values and instead resurrected ‘a long-standing popular narrative in defense of individual sovereignty and in support of suicide as a free and romantic choice’ (28). Psychiatrists wavered. Some continued to promote a strictly biomedical explanation of suicide; others made exceptions to the rule, claiming that forms of ‘traditional’ suicide like Buddhist martyrdom and the ‘double suicide’ of lovers constituted normal behaviour. But in the late 1930s, the psychiatrists capitulated to the cultural narrative, integrating social factors and cultural features into their theories of suicide. By the beginning of the post-World War II era, they had reconceived suicide as socio-cultural – as opposed to biological – pathology. Although psychiatrists regained some ground in the early 1960s, aided by the growth of the pharmaceutical industry and the introduction of universal health care, they could not stop the spread in the 1980s of the idea that Japan was a ‘Suicide Nation’, a place where suicide was a timeless act that embodied uniquely Japanese cultural values. The cultural narrative had won.

But how? The answer, Di Marco suggests, is cultural nationalism. Nationalist propaganda and theories of distinctive Japanese identity (nihonjinron) in the 1930s and late 1960s, respectively, were mighty weapons in the battle against science and medicine. In the case of the post-war period, the process of economic recovery ignited a ‘rampant cultural nationalism’ characterised by an ‘ingrained ethnocentrism that then dominated every professional field [and] challenged the paradigms of biomedical science, rejecting biological reductionism and emphasizing sociocultural variables that tended to exalt national character’ (8). Yet to argue that the cultural narrative won because of the power of cultural nationalism is tautological. The tautology begs the question of what gave culture, or more specifically, the cultural notion of Japanese uniqueness in death, its power? To hear Di Marco tell it, the medical narrative hardly stood a chance in the face of the power of culture, but she does not satisfyingly explain the origins and nature of that power.

Another problem lies in the opposition constructed between medicine and culture, which undermines the subtlety and complexity of the sources that Di Marco has painstakingly researched. Medical science did not exist in a culture-free vacuum; nor was culture impervious to psychiatric ideas. Di Marco recognises the mutual constitution of medicine and culture to an extent, but makes normative judgements about the medical sciences. Consider her repeated use of the metaphor of contamination. She contends that the medical narrative was ‘contaminated’ by nationalistic discourse, making it ‘inconsistent’ and ‘lack[ing] scientific integrity’ (7). Psychiatric theories indirectly ‘reinvigorated’ the cultural narrative, Di Marco argues, because they were ‘fragmented’, ‘confused’ and ‘dissonant’ (123). She implies that psychiatry could have overpowered the cultural narrative of suicide if it had remained ‘purely’ scientific. To imagine that psychiatry was ever ‘uncontaminated’ by culture seems naïve at best, dangerous at worst.

Nor did all narratives of suicide in the twentieth century fit neatly into the categories of medicine or culture. Di Marco’s close analyses of sensationalised cases of suicide in the national press across the twentieth century suggest that individuals with experiences of suicide and attempted suicide crafted their own language and stories to make sense of their desire to die. Many left behind suicide letters, diaries and confessions that the popular press eagerly disseminated. Tracing the alternative narratives that appeared in such writings may have helped lessen the reductive quality found in the opposition of medicine and culture, a feature that mars this otherwise well-researched book.