Title: Sick at Heart
Description: This dissertation traces the evolution of ideas and experiences of mental illness (seishinbyō) in Japan around the turn of the twentieth century, showing how it changed from a diagnostic category of biomedical disease into a dynamic but stigmatized pathology of the self in which the mental and emotional core of a person – who he or she was, essentially – was thought to have malfunctioned. In the course of this transformation, seishinbyō had multiple manifestations, its meanings shifting across time and in different social contexts. It originated in Japanese psychiatric discourse of the 1870s as an allegedly universal category of disease, but was soon modified to account for such existing phenomena as fox-spirit possession. In the family, one of the main sites for the management and treatment of madness in modern Japan, mental illness was associated less with medical etiology and more with violent and socially unacceptable behavior, as seen in cases of home confinement. As the concept of mental illness spread in popular culture and legal discourse, it evolved into a broader cultural idiom about the pathology of the self during a time of rapid social and cultural change.

From the gendering of hysteria as the feminine counterpart to male neurasthenia in the media to the menstrual psychosis defense invoked to absolve female defendants of criminal responsibility, gender played an especially prominent role in this evolution. By the 1930s, the idea that the self was the source of its own distress had taken root, shifting attention away from external and social factors, whether fox possession or the stresses of modernity, to inner causes of suffering. The driving forces behind this conceptual change were the social structures and relations of family, gender, and the urban-rural divide. In the context of these three overlapping social sites, changing ideas and practices concerning the mentally ill produced broader transformations in the understanding of the relationship between self and society, including conceptions of mind and body, gendered norms of thought and behavior, and the boundary between the inner self and social forces during a time of modernizing change.