My honest opinion is that very few things in one’s life can be as fulfilling as living abroad. The opportunity to break away from my comfort zone, brave new horizons, and immerse myself in new cultures has probably been the greatest joy I’ve found during my time on this Earth. Japan in particular holds a deeply special place in my heart, given my long-standing love for its culture and people, both of which have been part of my life since my childhood in Brazil.
Of course, that raises the question: “Well, how come you’re talking about having anxiety in Japan then?” The truth is, living abroad has brought me woes and wonders in equal measure.
Through this article, I aim to share some of my experiences dealing with severe anxiety and navigating Japan’s medical system, in the hopes that they can, in turn, be of help to someone else.
- How the anxiety began
- Finding help (for the wrong thing)
- Mental health in Japan
- Finding help—again
- Bringing medicine into Japan
- Helping yourself
- Final advice
- Resources
How the anxiety began
Japan was not my first experience living abroad. Before coming here, I lived in neighbouring Taiwan for around three years. Deciding I wanted to try living somewhere else, I settled on Japan, as it seemed to have a vibrant international developer community (through TokyoDev, of course).
Once the decision was made, it was time to prepare. All in all, it took me a year and a half to feel comfortable enough to make the move. However, everything did not go as smoothly as I’d hoped. There were quite a few bumps on the road, which almost made me give up on the move altogether, but in the end I decided to go through with it.
Instead of finding work before the move, I chose to study the language while searching for employment. This made failure a much riskier prospect, as I was now actively investing both time and money into my stay in the country. All of this is to say that I was already under quite a bit of pressure when I arrived.
Eventually something had to give, and that thing was my stomach: unexplained nausea, digestion troubles, lack of appetite, and so on. It was quite frustrating that just a few weeks after I arrived in Japan I already found myself having to deal with health issues.
Oh well, nothing to do but have it looked at, I thought to myself.
Finding help (for the wrong thing)
If you’re in Tokyo, you won’t have any trouble finding yourself a clinic for pretty much every specialization known to modern (and even ancient) medicine. Most of them have a listing on Google Maps, and you can usually find them just by typing the specialty in plain English.
At the time, as I thought my symptoms were physical, I searched for an internal medicine clinic (内科, naika), and actually ended up finding a gastroenterologist near where I lived. However, the doctor didn’t speak English, and while some doctors in Japan do, this is by no means the norm.
Finding clinics that actively cater to foreigners can be even more difficult. They certainly exist, but they also tend to have limited availability, and higher prices on average because they often don’t accept NHI.
Knowing the doctor didn’t speak English meant I had some homework to do before my appointment. I researched how to describe some of my symptoms in Japanese, noted them down on my phone, and translated the rest on the go during the visit.
All in all, everything went smoothly. The doctors and nurses were very kind and made sure we could fully understand each other every step of the way. After a battery of examinations, however, it was clear that there was nothing particularly wrong with my stomach, and that the problem lay elsewhere.
This is where my experience started to become frustrating. Once digestive issues were ruled out, I ended up with no guidance on what to do next, and was merely given more medicine for the immediate symptoms. Feeling sick on the train? Here’s some medication for that. Dizziness? Here’s another one.
When I finally connected the dots that the problem might be related to stress or anxiety, and brought it up with the doctor, I was told to “Drink some coffee every day to relax.”
Mental health in Japan
Historically, mental health has carried significant stigma in Japan. A 2013 study showed that “mental illness was considerably stigmatised, with schizophrenia being more stigmatised than depression” and that “the general public often lacked accurate knowledge about mental illness.”
Some of the effects of this stigma can be seen in the healthcare system itself. A 2015 OECD Review pointed out that “service provision for mild-to-moderate disorders, such as depression and anxiety is poor relative to the expected burden of disease,” and that the mental health needs of vulnerable groups, including children, adolescents, and the elderly, were not being adequately met at the time.
However, a more recent study from 2023 suggests that attitudes toward conditions such as depression have become more informed over time. Increased public discussion around mental health, alongside government efforts to improve awareness and access to mental healthcare, may have contributed to this shift.
Finding help—again
The old stigmas might, at least in part, explain the doctor’s response. Given the sensitive nature of the issue, he might have been reluctant to bring up the topic, or to address something outside his area of expertise.
Whatever the reason, I once again found myself searching for help on my own. Since my mental health was a far more complex issue than my stomach pains, I decided not to compromise this time and instead looked for a professional with whom I could discuss my problems without struggling to find the right words.
You might recognize this as a fairly common experience when seeing any doctor in Japan. While this approach might be fine when treating a rash or a cold, when it comes to people’s mental state, it leaves a lot to be desired.
There are a few clinics which can properly accommodate foreigners, usually offering support in multiple languages in addition to English. With that said, I ran into two problems. First, they were often fully booked for weeks on end. Second, many of them did not accept Japan’s National Health Insurance, meaning that I would have had to pay out of pocket. Things were much the same when I looked for a therapist, as psychotherapy sessions are not covered by the NHI at all.
While I did eventually find some very promising clinics by that point my symptoms threatened to overwhelm me. I was unable to ride a train, travel by car, or even sit through a 30-minute lesson without experiencing severe discomfort. My daily life had become so disrupted that even the smallest things took me a great deal of effort.
Faced with this, I decided to return to my home country during the semester break in order to seek help in a more familiar environment.
Bringing medicine into Japan
I initially planned a short, two-week stay, but once I saw the doctor it became clear that that wouldn’t be the case. I was immediately diagnosed with anxiety disorder and agoraphobia, and started on medication.
While I was relieved to finally have a proper diagnosis, I knew that the road to recovery would be a long one. It took almost two months for me to be healthy enough to face the 30-hour journey alone back to Japan. The medication also introduced a new challenge: once I left Brazil, I would have to find a way to obtain it in Japan.
The first point I needed to confirm was if I would be able to fill my prescription while in the country. Since I was prescribed escitalopram, an SSRI (Selective Serotonin Reuptake Inhibitor) that is very commonly used as a treatment for depression and anxiety, I learned it was readily available at most pharmacies as long as I had the prescription on hand.
This isn’t the case for all medicines, however. Some, like Bupropion, are not sold within the country, and need to be replaced by viable alternatives. Another option would be to bring them into the country by presenting an Import Confirmation Certificate (輸入確認書, yunyuu kakuninsho) upon arrival, but not every medication can be brought this way, and there are also strict limits on the amount imported per person. Many of the same restrictions apply if you plan on importing them after arrival. Depending on the medication, receiving additional supplies from a family member abroad may be difficult or even impossible.
With your prescription in hand, you can head to any pharmacy to obtain your medicine.
Helping yourself
Being given what was essentially a second chance to enjoy my life in Japan, I decided I would do things differently, if only to avoid falling into the same traps of the past. For me, that meant I started going to the gym, talking to a therapist, attending meetups with like-minded people, doing hikes, and etc.
These are generic things, sure, but they are surprisingly effective. By keeping both mind and body busy, you avoid ruminating about the past or worrying about the future. At the same time, the meetups and hikes provided something to look forward to, a reward of sorts for the week’s efforts.
Another very helpful thing was finding ways to practice my Japanese. Interacting with people, either in real life or online, can soothe the feelings of isolation so commonly felt by expats. Dating apps like Bumble are surprisingly good tools for casual conversation, even if you’re not interested in dating.
You will also find that the people you interact with might help you in ways you hadn’t even considered before. When I told the staff at my language school about what had happened, they were extremely helpful in finding me a clinic at which to continue my treatment. In much the same way, I later learned from an acquaintance that the Tokyo government offers a hotline specifically for introducing clinics.
This article itself is a coping strategy. Putting things into writing can be a cathartic experience, regardless of whether there will be an audience for it or not. Writing will take things out of the ephemeral and force you to structure them in a way that helps ease the usual catastrophic thinking that often accompanies anxiety.
And finally, even though it’s a cliché, remember you are not alone. Looking back, one of my biggest mistakes was trying to deal with everything on my own. Moving to a new country is never easy, and even the most cheerful people can be affected by it. Reach out to friends and family. There is no shame in sharing your problems and worries with those who care about you.
Final advice
Fighting anxiety is a long battle, and even after you believe you’ve defeated your enemy, it can return in unexpected ways. The medicine didn’t magically solve the problem, but made it considerably easier for me to tackle it on my own.
Life in Japan has become better than I ever could have hoped for, and I can truly say that I’m living it to the fullest. I’ll leave some of the resources I found along the way below, in the hopes that they can be of use.
Resources
- ABC Japan, a Brazilian NPO that offers free consultations with a therapist in various languages. I’ve used ABC Japan’s consultation services myself. While their schedules are very busy, the doctors are very patient and will listen to your troubles very carefully.
- A Reddit thread detailing foreigner-friendly mental health clinics in Japan
- Meetup.com, for finding communities with many different interests
- TELL Japan, a NPO which maintains a toll-free hotline in English. While I did not use TELL’s services, they’re often brought up when speaking with foreigners about mental health, and come very highly recommended.
Finally, feel free to reach out to me at ricardo@ramsa.dev with any questions you might have regarding anything in this article. I’ll be more than happy to help.