Q: As mental health professionals dealing chiefly with native English-speakers in Tokyo, do you often have to deal with people who feel isolated and excluded in Japan, e.g. long-termers who have failed to "fit in" here, as in they lack Japanese friends, despite knowing the language, culture and so on?

A: Anyone who has been in Japan for a while has met other foreigners who have been in the country a long time. Some of these people do well socially and psychologically over the years and some do not. Some of these individuals may indeed come to our clinic, and while the people we see usually have either had a depression from before coming to Japan or experienced a worsening of their depression while here, there are certainly others who have a general social isolation but are not necessarily depressed. What might separate those who do well from those that do not?

First, we can look at psychiatric illnesses like anxiety or depression. Those with such conditions often have an inability to enjoy things, low energy and concentration, and their sleep and appetite may be disturbed. These problems often run in families. While social success may help mitigate them, they may still affect anyone regardless of their length of stay in Japan, number of friends, or other aspects of social success. People with these conditions require some kind of intensive psychiatric intervention.