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Rural regions struggle to stem elderly suicides
By: Hiroko Nakata
The Japan Times, March 8, 2002
Akita provides community-based efforts, get-togethers to prevent cases from escalating
AKITA -- An elderly couple hang themselves in the middle of a cold, snowy winter.
Villagers offer a sympathetic explanation -- they killed themselves to ease the physical and financial burden on their son and his wife, who are exhausted from taking care of their ailing son.
By prefecture, Akita, known as a rice bowl with an annual crop of 550,000 tons, holds the dubious distinction of having the highest suicide rate for six years in a row. Particularly prominent are suicides involving senior citizens, who had contributed to the area's farming legacy but later had a hard time coping with becoming less productive family members.
"Particularly in the Tohoku region, there is an old sense of value, which honors self-sacrifice, when an elderly person commits suicide," said Naoki Watanabe, an associate professor at the Center for Psychotherapy Research, Saint Marianna University School of Medicine in Tokyo.
It is not uncommon in Akita for people to have known several friends or neighbors who had committed suicide.
Heavy snow in northern Tohoku often shuts down communications and forces people to stay home. This could leave them introverted and it sometimes leads to depression, Watanabe said.
One conspicuous characteristic of suicides in Japan is the disproportionate number of senior citizens taking their lives, he said.
In 2000, the national suicide rate for people aged 90 and over was 47.8 per 100,000, according to the Ministry of Health, Labor and Welfare. The figure was 47.1 for those aged 85 to 89, and 40.7 for those between 80 and 84. Meanwhile, the corresponding figure for people in their 20s and 30s is around 20.
Akita went on the offensive last year, compiling a package to prevent suicides from soaring further.
The plan aims to reinforce various local networks to provide moral support for the aged.
A series of symposiums has also been held to raise awareness of the issue. The prefecture has held three forums in the year that ends on March 31, and will increase such events to five in the following year.
To provide better medical services, Akita is planning training programs for local physicians to deal with depression.
The prefecture aims to reduce the annual number of suicides to 330 by the end of fiscal 2010 from the 457 in 2000.
"It has been a big problem not being able to touch directly on the issue of suicides, because we can't step into the private affairs of each family and they don't want us to bother," said Kinya Shimizu, an Akita official in charge of suicide prevention programs.
"But we've decided not to make it taboo anymore. We are now urging people to squarely face the reality as much as possible."
Shimizu admitted that the current situation is unlikely to change anytime soon, but he added that he hopes it will improve in the long term.
If the 69 villages, towns and cities in this prefecture could each prevent one suicide a year, it would help stem the disturbing trend, he said.
Community projects
One of Akita's major projects has been to provide a 1 million yen subsidy to each of two model municipalities to boost mental health care for senior citizens.
Two more municipalities will be added to the project in fiscal 2002, which begins in April.
In Aikawa, a town of 8,000 in the north of the prefecture, old people are encouraged to get together on a regular basis as part of the plan.
The district of Kidoishi, for example, holds regular gatherings for those aged 75 and older and has planned additional events during the winter, when villagers rest from farming, to enjoy traditional flower arrangement, cooking buckwheat "soba" noodles or even English classes.
"We used to have close bonds with neighbors, helping them with rice-planting and harvesting. But now that we do it with machines, we have fewer opportunities to get together," said Shojiro Sato, 72, the representative of the Kidoishi district.
"I hope the gatherings will become bigger and help bring people together again."
Ikuo Takahashi, a deputy head of Akita Inochi No Denwa, a nonprofit telephone counseling hotline in the prefecture, pointed out that such unity in old farming communities was affected not only by the advent of farm machines but also the outflow of people to big cities during past economic booms.
Steep rises in Akita's suicide rate coincided with periods of rapid economic growth, such as in the late 1960s and late 1980s, Takahashi said.
"It was the time that the younger people started to drift away from the countryside, leaving old people alone and destroying local communities and family unity," he said.
In tandem with early treatment of depression, opportunities to provide moral support to senior citizens have become more important as a pre-emptive measure against suicides, said Yutaka Motohashi, professor of public health at Akita University School of Medicine.
Motohashi, who is conducting a survey on the mental health of residents in municipalities in Akita, including Aikawa, said one important approach to prevent suicides is to create a better social environment by providing useful information that helps strengthen people's abilities and minds.
To this end, Aikawa's efforts could be a good model for other districts with high suicide rates, Motohashi said.
Such moral support is vital for people living in the rural community, but doesn't promise to solve every problem.
"People here still depend on bonds with others. But because of this, when the relationship does not work well, people are more likely to be forced into a corner, resulting in the possibility of suicide," said Ko Sato, a veteran public health nurse working for Aikawa.
The legacy of suicide
People tend to lose meaning in their lives when they become physically weak and cannot work anymore. Under such conditions, they think their existence itself troubles other family members, according to experts.
That way of thinking, they explained, has its roots in times when the nation was extremely poor and a large number of farming families were on the verge of starvation. There were cases in the past when people abandoned elderly parents in the mountains and killed their babies in order to reduce the number of mouths to feed.
In addition, Japan has a unique history of considering suicide a noble act under certain conditions. In the feudal period, samurai often killed themselves as a way to maintain their honor. And in the final stages of World War II, the kamikaze pilots dove into enemy ships.
Honor aside, when rural elderly people commit suicide, loneliness may not be the main factor.
A greater number of senior citizens who live with their families commit suicide than those who live alone, said Watanabe of Saint Marianna University, adding that many of them lived with two younger generations in Akita and Niigata prefectures. Niigata has the second-highest suicide rate by prefecture.
"It is contrary to the situation in Europe and the United States, where people who commit suicide often live alone in big cities," he said.
Local efforts, such as those in Aikawa, however, still face many hurdles.
"It is difficult to find out which people suffer from problems because they don't usually attend gatherings," said Sato, the public health nurse in Aikawa.
"We can only help them by visiting their homes," she said, adding that a dearth of public nurses in rural areas makes it hard to do this with any regularity.
Takahashi, at Inochi No Denwa, said the anonymity of its telephone counseling protects the privacy of people with problems, unlike individual visits by nurses.
But the service also has its drawbacks, he admitted, because old people tend to feel guilty for talking on the telephone for long periods of time.
"If they just called us, we would do whatever we can to support them," Takahashi said.
Statistics show that only 1 percent of all people who called the lifeline in Akita in 2000 were in their 70s or older. Those in their 60s accounted for only 3 percent.
Experts said no single step will bring a perfect solution.
'What we can do is to take various measures and strive for a positive effect," Motohashi at Akita University said. "We should try to address every risk factor that results in suicides."
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© 2002 Global Action on Aging
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