I am a Japanese psychiatrist who has worked in psychiatry for more than 30 years. In this series, I share some of what I have learned about medicine, mental health, life, and people through my experiences in Japan and the United States.
What Felt Strange to Me as a Japanese Psychiatrist Visiting American Addiction Treatment
When I visited an addiction treatment facility in the United States, I saw something that felt rather strange to me.
Perhaps "strange" is not quite the right word.
It was more like a small sense of discomfort.
I had been working as a psychiatrist in Japan, and I thought I understood, at least to some extent, how addiction was treated.
But what I saw in America was different from what I had expected.
The patients came to the facility regularly to receive their medication.
A medical professional would give them the medication and make sure that they actually took it.
The process was carefully controlled.
I understood the reason.
When someone is dependent on a drug, simply giving them medication and asking them to take it as prescribed may not always work.
There is always the possibility that the medication will be misused, shared with someone else, or taken in a different way.
So the medical staff needed to know exactly what was happening.
From a medical point of view, it made sense.
And yet, as I watched the process, I began to wonder about something.
If we replace one drug with another medication, are we really treating the addiction itself?
Of course, I understood that the purpose was not simply to replace one drug with another.
There were medical reasons for choosing a particular medication.
The goal was to stabilize the patient and gradually help them regain control of their lives.
Still, I could not completely get rid of the feeling that something was missing.
Addiction is not only a problem with a substance.
Behind the substance, there is a person.
There may be loneliness.
There may be anxiety.
There may be family problems.
There may be difficulties at work.
There may be a way of thinking that has developed over many years.
There may also be a deep sense of hopelessness.
Medication can help with some of these problems.
But medication alone cannot change a person's entire life.
That was the part that stayed in my mind.
I also noticed how carefully the medical staff watched the patients.
At first, this seemed rather strict to me.
In Japan, I had been accustomed to a somewhat different approach.
Patients were generally expected to take responsibility for their own medication.
But in addiction treatment, that assumption may not always be realistic.
If a person is struggling with dependence, asking them simply to control themselves may be asking too much.
Perhaps what looks strict from the outside is actually a form of support.
This made me reconsider my own assumptions.
I had initially thought,
"Why do they need to control the medication so carefully?"
But after seeing the patients and hearing their stories, I began to think,
"Perhaps they need this kind of structure precisely because they are struggling to control things on their own."
That was an important lesson for me.
At the same time, I still felt a certain contradiction.
The more carefully we control the medication, the more dependent the patient may become on the medical system.
But without that structure, some patients may not be able to remain stable.
So where is the right balance?
How much should we control?
How much should we leave to the patient?
When should we intervene?
And when should we step back?
These are not questions that can be answered simply by reading a textbook.
I had to see the patients and the treatment setting with my own eyes before I could begin to understand them.
Looking back, I think that was one of the most valuable experiences I had in America.
I did not simply learn a different way of treating addiction.
I learned that the same medical problem can look very different depending on the country, the medical system, and the assumptions we bring with us.
And I learned something else.
Sometimes, the things that feel strange to us are not necessarily wrong.
They may simply be based on a different way of understanding the problem.
But that does not mean that we should accept everything without question.
We can observe.
We can wonder.
We can question.
And perhaps, by doing so, we can find a better way.
That is what I remember most from my experience of visiting addiction treatment in America.
I went there expecting to learn about American psychiatry.
Instead, I also learned something about myself—and about the assumptions I had been carrying as a Japanese psychiatrist.