"I'd rather die": Patients' will and decision-making practice in Japanese community psychiatry.

Authors

Yuto Kano

Published in

Medical anthropology quarterly. Pages e70021. Aug 25, 2025. Epub Aug 25, 2025.

Abstract

Recent mental health reforms have embraced patient autonomy and shared decision-making, where care unfolds through collaboration between clinicians and patients. However, how decision-making can improve in marginalized psychiatric clinics remains unclear. This paper examines how social psychiatrists at a Japanese community clinic engage with patients' will-especially when it appears resistant, ambivalent, or self-destructive. At Sakura Clinic in Kanagawa, the challenge lies in navigating "strong will" (tsuyoi ishi)-instances where patients reject treatment, defy medical logic, or say, simply, "I'd rather die." Here, decision-making stretches across time, shaped by evolving attunement between patients, clinicians, and their environments. When patients make risky choices, psychiatrists face an urgent ethical question: is this will an existential stance to be respected, or the mark of structural violence to be refused?

PMID:
40854159
Bibliographic data and abstract were imported from PubMed on 26 Aug 2025.

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