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01 October 2023
An Alternative Story of Mental Health

Which approaches can be taken to improve mental health? One is to try “curing” the disease just like a physical ailment. It focuses on the individual’s inner self to identify and address the root cause. While this is the current paradigm, there is another school of psychological science.

In contrast to the mainstream, which assumes a linear relationship of cause and effect, the alternative attempts to examine the patient’s interrelationships. It focuses on the interaction between individuals and the people around them, and is grounded in the belief that a problematic state can be formed by a chain of such interactions. Rather than looking for specific causes within the individual, attempts are made to resolve the problem by targeting relationships as a whole.

“Since the premise is different, it’s viewed as a wrong path,” says Satoru Yoshikawa, Dean of the Faculty of Psychology at Ryukoku University, one of those who has himself adopted the “wrong path”. Despite this, it’s an alternative story of mental health which is opening new horizons. The current state of this path is explored here.

Rather than looking for specific causes within the individual, attempts are made to resolve the problem by targeting relationships as a whole.


The case of a truant who had withdrawn from school and had difficulty coming to the clinic, but turned things around simply by interacting with their family and neighbors, clearly demonstrates the power of the “wrong path.” However, even with a proven track record, it’s not easy to disseminate a new way of looking at things. Professor Yoshikawa asserts that the scientific understanding medical professionals gain through their education is based on the cause and effect relationship, and that the Japanese medical system acts as a brake on the adoption of this new way of thinking. In the United States, penetration of the “wrong path” is relatively high, but this is due to the division of medical work into specialties. In Japan, diagnosis and prescription are combined into a single procedure, so the flow from discovering the pathology to prescribing the corresponding drug is fixed, making it difficult to look at other approaches.

Professor Yoshikawa hopes to create a virtuous cycle which increases the number of those with flexible perspectives, in which the approach focusing on the “wrong path” is widely and effectively utilized, and in which patients whose lives are turned around by the approach also contribute to improving the well-being of those around them. In fact, he says, when he has tried establishing specialized psychologists in general hospitals, practitioners in the field were amazed at their effectiveness. The alternative story depicts a future in which a variety of supporters, not just doctors, treat patients by chatting with them outside the doctor’s office, and in which this scene becomes the norm.

Another View What is the Current Status of the “Wrong Path” in the Mental Health Care Field?

Expectations for a Non-idealistic Approach based on Mental Health Care Realities

I believe that the approach of viewing patients as social beings is the “main path” rather than the “wrong path.”
In fact, it has been said for more than 30 years in the field that treatment should be conducted in the context of interpersonal relationships. The problem is that this remains as an ideal. If we continuously communicate (including with those in the patients’ surroundings), medical service fees will not go up and clinics will be unable to operate.
To begin with, there are very few among those who aspire to become doctors and their university educators who are interested in interpersonal relationships. The framework of medical care itself is based on the concept that a doctor’s main duty is to cure patients with drugs or surgery, and I feel the reality is that mental health care has been unable to break free from this core belief.
This is why I feel that Dr. Yoshikawa’s practice in the field, and the proactive attitude of the Professors of the Ryukoku University Department of Psychology, are extremely rare and sincere. If students are nurtured there and enter the field, they will surely become a great force. I believe they will be the ones who will seriously start to improve the state of mental health care, in which to date only fine-sounding talks have been heard.

Yasufumi Nakoshi / Visiting Professor, Department of Psychology, Ryukoku University
/ Psychiatrist with Specialty in Adolescent Psychiatry, Mental Health Therapy

After establishing and taking charge of the Psychiatric Emergency Ward at the Osaka Psychiatric Medical Center, Professor Nakoshi continues to be involved in clinical practice and is active in various fields such as commentary, film criticism, and manga analysis.

Alternatives to Mental Health

We introduce six researchers affiliated with the Faculty of Psychology at Ryukoku University, whose “Mental Health Alternatives” view relationships within various frameworks (such as company, family, and community).

  • Applying Psychological Insights to the Business Arena
    Opinion. 01

    Professor Minakuchi’s research in coaching psychology covers business relationships based on “psychological safety,” which affects both organizations and individuals. He is committed to psychology as a discipline which transcends the boundaries of disease and disability and is reducible to all people.

    Masato Minakuchi (Professor, Department of Psychology, Ryukoku University)
  • Developing Problem-solving Methods through Dialogue
    Opinion. 02

    Based on the premise of Social Constructivism, which considers reality as reconstructed through dialogue, Professor Higashi’s research includes analysis of communication in which problems are created, and the development of communication methods in which solutions are formed.

    Yutaka Higashi (Professor, Department of Psychology, Ryukoku University)
  • An Approach Possible even Without the Person Concerned
    Opinion. 03

    Specializing in family and other forms of therapy, Professor Akatsu proposes an approach which is possible, even in the absence of the person concerned, through the support of those around them. She also focuses on the analysis of non-verbal communication to understand relationships from a variety of perspectives.

    Reiko Akatsu (Professor, Department of Psychology, Ryukoku University)
  • Abuse Prevention not Viewing Individual Parents for Problems
    Opinion. 04

    Professor Takabayashi works from the perspective of viewing child abuse not as a problem in individual parents, but as a problem of relationships among the entire family, community, and society, and develops methods to prevent abuse by intervening in relationships without creating a conflict structure.

    Manabu Takabayashi (Professor, Department of Psychology, Ryukoku University)
  • Understanding Medical and School Settings from a Relational Perspective
    Opinion. 05

    Focusing on communication in clinical and school settings, Professor Ito’s analysis is conducted through simulated psychological interviews. He looks not only at one-on-one relationships, but also at formats in which multiple people, including family members and other concerned parties, are clients.

    Hideaki Ito (Associate Professor, Department of Psychology, Ryukoku University)
  • Promoting Employment Support through Collaboration and Cooperation
    Opinion. 06

    Mr. Shida focuses on employment support for adults with developmental disabilities and multidisciplinary collaboration. He pursues methods to promote employment and retention support by building positive relationships with families, communities, workplaces, and others.

    Nozomu Shida (Lecturer, Department of Psychology, Ryukoku University)

Learn More Below is a collection of resources
selected by researchers
to assist in updating your perspectives.

As long as we live in this society, we cannot escape being part of a “net of interactions.” Alternative perspectives are now a necessity for all of us to think about ourselves and the organizations we belong to. Below are seven sources which you do not have to be a professional psychotherapist to read, and which will improve your way of viewing mental health.

General Editorial Supervision

Dr. Satoru Yoshikawa
/ Professor, Department of Psychology, Ryukoku University

Dr. Yoshikawa is a licensed clinical psychologist who works daily on a large number of cases, advocating the usefulness of the “systems approach” at relevant conferences, clinical workshops, and lectures. He is also a university teacher and an active golfer.

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