A study last year by the Ministry of Health, Welfare and Labor found that 24% of Japanese people had suffered from some kind of mental health problem. Another report found that one in five adults had considered killing themselves, with actual suicide rates at 51 per 100,000 people — twice as high as the U.S. and three times that of the UK. 

Widely regarded as one of Japan’s leading new documentary filmmakers, Kazuhiro Soda made a name for himself with his first full-length movie, “Campaign.” Released in 2007, the film depicted the adventures of an unlikely LDP candidate in his quest to win a city council seat in Kawasaki. While Soda’s shadowing of his subject with a handheld camera may not have created a flattering advertisement for the LDP, it did produce a triumph for the cinéma vérité style of filmmaking: it debuted at the Berlin International Film Festival, enjoyed a weeklong run at New York’s Museum of Modern Art, and was broadcast on TV in 20 countries.In his latest offering, “Seishin” (Mental), Soda uses the same fly-on-the-wall filmmaking techniques to record life inside a small mental health clinic in Okayama Prefecture. Due for domestic release in June after generating a buzz on the international film-festival circuit, “Seishin” takes audiences into a world that many would prefer to keep hidden. Soda depicts consultations and therapy sessions, with interviews that delve into the patients’ personal histories and battles with mental illness. The result is a film that offers not just greater insight into the world inside the clinic, but into Japanese society as a whole. From his home in New York City, where he has lived since 1993, Soda reveals that the film’s subject matter was, in part, determined by his own experiences as an editor of Tokyo University’s student paper. “It’s only a student newspaper, but it has a long history that goes back to the Taisho era,” explains the 38-year-old Tochigi native. “I had to organize the finances as well as the editing, and we had to publish every week, so I was working day and night. One day I woke up and found myself unable to do anything. When I went to the computer, I couldn’t write.”Soda sought help at Todai’s department of psychiatry, where he received a diagnosis of “burn-out.” He received medication, quit the newspaper and, after catching up on weeks of lost sleep, managed to recover. The experience, however, made him reconsider his ideas about mental illness. “I thought I was immune to that sort of thing, but I wasn’t. It changed my view of mentally ill people too. We have this demonic image of them, that they are scary. But for a time, a very brief period, I was one of them, and I wasn’t a monster. So I was always interested in this subject.”24% of Japanese suffer mental health problemsThis director’s experience is far from unique. A study last year by the Ministry of Health, Welfare and Labor found that 24% of Japanese people had suffered from some kind of mental health problem. Another report found that one in five adults had considered killing themselves, with actual suicide rates at 51 per 100,000 people — twice as high as the U.S. and three times that of the UK. The figures have prompted a $222 million government campaign to raise awareness of the issue and to make counseling services more widely available.Despite these numbers, mental health treatment in Japan is widely regarded as lagging behind that of many other developed countries. Until as recently as 1987, patients with more severe emotional problems could be institutionalized against their will under the “Mental Hygiene Law.”Even today, a sense of shame prevents those who suffer less severe ailments from seeking treatment. Yuzo Kato, director of the Tokyo Suicide Prevention Centre, is critical of the government campaign to reduce the suicide rate, which focuses mainly on making counseling services available. “More should be done to end the cultural stigma attached to mental illness,” he says.“Seishin” was filmed at Chorale Okayama, an outpatient clinic run by Dr Masatomo Yamamoto, who for decades has been involved in changing attitudes towards the treatment of the mentally ill in Japan. Yamamoto accords his patients a high degree of respect, listening to their opinions and involving them in decisions about treatment. The clinic features a patient-run restaurant and milk delivery service to help connect them with the outside world.“Masatomo’s whole approach is related to an experience he had working in a large mental institution in 1969,” says Soda. “He wondered why the doors of the rooms and wards were locked, so he decided to have a discussion involving staff and patients. The discussion was about who was responsible for locking the doors of the rooms. The patients said it was the nurses, but the nurses said this was because the patients behaved badly — sometimes they would disappear or leave without permission.”The dialogue between the two groups eventually led to greater understanding. “The patients started to say, ‘Well maybe we should behave a little better,’ and the nurses started to say, ‘Maybe we’re locking the doors for the sake of our convenience.’ They began to work towards the same thing — having the doors unlocked. And I believe the most important thing was that the patients were included in this discussion. I don’t think many other mental institutions are like the one I filmed. Some are still like the one the doctor worked at in the ’60s.”An invisible curtain In the press material for “Seishin,” Soda talks about an invisible “curtain” that hides this world of the mentally ill from that of so-called “normal” society. “My job as a filmmaker was to open this curtain and create a film where the viewer has a kind of virtual experience of being in this mental clinic,” he explains. “By doing this, maybe you get some kind of respect, understanding or insights into the issue. It’s up to each viewer what kind of experience they get, but I hope it will be a positive and insightful one.”The stars of “Seishin” are the doctors and patients, and much of the film’s power results from its strong cast. One patient is a former high-flying businessman who wound up burning out. Another is a woman who developed an eating disorder after being told that her legs were fat. Yet another is a manic depressive with dreams of starting a farm in the countryside. And then there’s a character named Sugano, who one moment is doing an impersonation of a steam train with a lit cigarette up each nostril, the next reciting poetry.The more Soda filmed, the more he came to respect the patients and realize that their experiences were not all negative. “Of course, they are suffering and they want to get rid of their illness,” he says, “but at the same time, for example in the case of Sugano-san, he couldn’t have written those poems if he hadn’t experienced illness. In a sense, his illness makes him a more interesting, attractive person. Sometimes being ill can be a strength, not a weakness.”“Seishin” was filmed by both Soda and his wife, Kiyoko Kashiwagi. As an experienced director accustomed to being behind the camera, Soda was able to maintain a distance from his subject matter. For Kashiwagi, this was not so easy. After spending so much time at the clinic with the patients, she began to question her own mental state. Eventually, she herself made an appointment to see Yamamoto. “I felt really sorry for her as a husband,” Soda recalls. “But at the same time, as a filmmaker, I thought, ‘Mmm, this is interesting!’ Actually, she refused to allow me to film her consultation, but the point is, I think the roles of healthy/unhealthy are very ambiguous, and it’s very easy to cross between the two.”Given the film’s controversial subject matter, it’s difficult to predict how audiences will react when it’s released here in Japan. Soda realizes that he risks being accused of exploiting the patients, but his biggest fear is that controversy might negatively affect the lives of the people depicted. To make sure everyone involved in the film knew how they were being portrayed, the director organized a private screening for patients and staff. He confesses that despite gaining the patients’ permission to be filmed, he was worried about their reaction. At first, it seemed his fears might be realized.“As soon as we announced the screening, some of the patients said they wouldn’t see the film. I was most worried about one patient in particular, whose baby had died. She hadn’t told many people about that, but she had confessed to me on camera about her role in the baby’s death, and I kept this confession in the finished version. I heard before the screening that she’d said that she wasn’t coming, so I was worried about what might happen if she heard things about the film from other people. I knew that she’d tried to kill herself six or seven times the previous year.”The patient arrived at the screening after her scene had been shown, but in a discussion afterwards, she asked the director if he had included “that” scene. “I told her that I had. At first, she was very disappointed and angry. She said, ‘So everybody knows about that… now I won’t be able to live.’ “I didn’t know what to say, but then another patient raised her hand and said, ‘Well, it was shocking to learn what happened, but I am glad I now know your suffering. I didn’t know you as a whole person before and now I do, and I’m not changing my mind about you. I’m a mother, and I know how hard it is to raise a kid.’ I think it was the first time that people had listened to her story, and I think she was surprised that anybody could possibly sympathize with her.”With an increasing media focus on violent crime, often committed by people seen as mentally ill, Soda’s film offers a different view. “In the case of the woman I talked about, in the news she would just be portrayed as an evil mother — it’s always black and white,” he says. “But if you listen to the stories of some of the people involved in these things, it’s not that simple… Demonizing people doesn’t solve anything. In a sense, I want to provide an antidote to that kind of attitude. It wasn’t my purpose when I started filming, but I am hoping this film will show that these people are human beings and they are vulnerable. We are all vulnerable and need support. If somebody was there to listen to these people, maybe some of the crimes wouldn’t happen.”In a sad footnote, three of the patients who appear in the film have killed themselves since it was made. “Seishin” has won the Best Documentary Award at both the Dubai and Pusan film festivals, and when it debuts in Tokyo, selected screenings will be with English subtitles. Whatever the reaction, it seems likely that the director will achieve at least one of his aims: bringing the topic of mental illness out into the open, at least for a little while.For more information about “Seishin,” see www.laboratoryx.us/mental.This story by  Ian Priestley originally appeared in Metropolis magazine (www.metropolis.co.jp).