Eating disorders and Postpartum Depression in the Community: detection and treatment


Today’s society is often regarded as a “society of stress.” An increase in depression and other mental illnesses has become a major social problem in recent years. Professor Nishizono-Maher conducts research in psychiatry with a focus on eating disorders and postpartum mental health. Through the development of research methods for detecting and supporting people with problems at school or in the community, she aims at early detection and early treatment, as well as a more broad social understanding of mental illness.

Aya Nishizono-Maher Professor, Department of Psychology, Faculty of Psychology Received an M.D. from Kyushu University School of Medicine, and completed her Ph.D. in Internal Medicine (Psychiatry) at Keio University Graduate School of Medicine. She completed postgraduate studies in psychiatry in the Division of Psychiatry, University of Edinburgh, Scotland.She has worked as a psychiatrist at Keio University Hospital and served as project leader of research in the Children and Adolescents Project, Tokyo Institute of Psychiatry. She was affiliated with the Cullen Centre, a specialist unit for eating disorders, in the Royal Edinburgh Hospital. She was a visiting researcher at the Institute of Psychiatry, Kings College, London. She was a professor in the Faculty of Children’s Studies, Shiraume Gakuen University, before assuming her current position in April, 2019. She specializes in clinical and social psychiatry.

Women’s mental health is a growing social concern

As a psychiatrist and medical specialist, my research focus, over considerable time, has been the development of methods of detection, patient support as well as the development of treatment programs, with a focus on eating disorders and postpartum mental health. In particular, my research and clinical practice in the “peripheries” of hospitals and clinics, has focused on the detection of eating disorders in educational settings, how to detect postpartum depression in the community, how to convey knowledge of these disorders to related professions, and what kind of teams should be assembled to deal with them.

“Eating disorder” is a general term for problems related to eating behaviors and mental health, arising from various psychological factors. Representative diseases include anorexia and bulimia, which manifest themselves in various ways: not being able to eat sufficiently or, conversely, eating too much, or intentionally vomiting what has been eaten. Though these diseases are known to be more common among young women in their teens and twenties, the age range of patients has broadened in recent years, making this an increasingly problematic issue. The disorders are also observed in men.

Like eating disorders, postpartum mental health has attracted increased interest as a mental health issue primarily affecting women. There have been numerous cases of child abuse, typically due to the mother’s mental illness, and there are growing social concerns about how to prevent such tragedies.

Eating disorders and the influence of media and social networking

Eating disorders are often discussed in the context of dieting and an unreasonable desire to be thin. Also, there is a prevalent image of eating disorders as a modern-day disease. The reality, however, is that eating disorders have a long history, with apparent cases of anorexia nervosa in Japan recorded in medical literature published in 1788(the Edo period). Eating disorders partly arise due to physical factors, such lacking a constitution that can properly regulate appetite. Thus, it is likely that eating disorders have always existed to some extent, regardless of era and social circumstances.

Undoubtedly, modern social factors like women’s position in society, and media that actively promote thinness have contributed to the expansion of these diseases. The influence of social networking is a current focus of discussion: some sufferers upload images of themselves vomiting, which other people can watch and imitate.

Early detection and treatment of these disorders are important, but many sufferers consider overeating as a weakness of will, not something to warrant medical treatment. They will not, therefore, see a doctor until their condition has worsened. “Self-stigma,” shame and denial of having a mental problem, is another factor that makes people hesitant to visit a doctor or receive treatment.

Educational messages can be counterproductive

Awareness-raising activities about eating disorders are, needless to say, very important, but lack of care regarding the content - how the message is communicated - risks having the opposite effect. For example, to specifically state, “some people induce vomiting, which is dangerous” as an example of an eating disorder symptom, some trying to lose weight may in fact imitate that behavior, leading to an onset of the disorder. Also, overemphasizing the dangers of dieting, especially to teenagers, may prevent them from reporting symptoms, for fear of being scolded by teachers or parents.

Rather than simply flagging dangers, early detection can be more effective when we ask, ‘Is the method of dieting which you invented causing you trouble?’ It is very difficult to choose the right words, and not being able to make a straightforward appeal can leave us feeling frustrated. Nevertheless, I hope to clarify through my research what approaches are effective, and how to best communicate such methods to society at large.

Infant checkups as a way to identify maternal depression

Since around the year 2000, we have used infant health checkups at local health centers as an opportunity to conduct screening for postpartum mental health issues. In this initiative, mothers coming for infant checkups are asked to complete a questionnaire on postpartum depression; those with high scores, or considered at risk, are interviewed and shown how to receive psychiatric treatment if needed.

When we interview women with postpartum depression, we often find they are one step away from child abuse. Speaking further with such patients, we discover that they experienced mental illness or psychological problems before their pregnancy. Some women say that they experienced depression in the past but overcame it after quitting their job or breaking up with a boyfriend. Childcare, however, cannot be so easily abandoned. Some women we meet in interviews have never received consultation or treatment We try to convey to them that there are problems experts can help them solve.

Though we must provide professional assistance to those with mental health problems, we cannot turn, “Let's all visit a psychiatrist!” into a slogan. The other day, I interviewed a non-Japanese patient for a postpartum mental health check-up. She asked me where in Japan she can find “adults she can trust,” stating that she had not yet met anyone like that. I was at a loss for an answer. Many people today have mental health problems, so there is a need for more “adults we can trust” in our communities. There is a need for various people to work together to address mental health issues. I will continue to proactively conduct psychiatry courses for psychologists, school nurses, public health nurses, midwives, dietitians, and others, in order to create an environment in which a wide range of professionals are involved in addressing mental health problems.

The significance of the fundamentals of medicine for students of humanities

As a faculty member of Meiji Gakuin University, I teach undergraduate courses and seminars in “Psychiatry” and in the “Structure and Function of the Human Body and Disease.”

I respect students’ desire to pursue their studies. Therefore, the research topics in my seminars are not limited to psychiatry. There are seminar students who, from personal or family experience of illness want to research the theme of mental illness or depression counseling. That is a wonderful proposition, but students with first-hand experience of such illnesses have the tendency to think that their own experience represents “all there is” to the disease. However, anyone hoping to become a psychological professional requires a comprehensive view of their own experience and an objective reassessment of that illness as manifested among a variety of people. Committed study in college courses and seminars is an enormous step forward to understand the individuality and peculiarities of our own experience.

The course “Structures, Functions, and Diseases of the Human Body” provides an overview of medical science. Many students seem to encounter difficulty with such technical subjects. For that reason, I design lectures to facilitate learning by humanities students that involve historical topics, such as: introducing Dr. James Curtis Hepburn, the physician and founder of Meiji Gakuin, or the beriberi controversy that arose in Japan during the Sino-Japanese and Russo-Japanese wars.

I would love students outside of the Faculty of Psychology to learn the basics of medicine as a “liberal arts” subject in order to prepare them for society and its workforce.

In society today, informed consent is fundamental to the practice of medicine. Informed consent means that patients themselves receive the necessary information about their treatment. Having understood that information, they are able to choose, agree to, or refuse that treatment. This requires careful explanations by medical providers. It requires also the patient’s ability to understand those explanations and choose an appropriate treatment. I hope that by learning the basics of medicine in college, students will acquire the ability to make better judgments when they are patients. Even if they do not wholly understand a medical explanation they should be able to select a more preferable treatment, distancing themselves from unscientific treatments that they now realize do not make sense.

The importance of more “adults we can trust”

Massive stigmas against mental illness have persisted in society. While attitudes have improved, the unfortunate truth is that prejudice still exists. Even many medical professionals consider eating disorders as a “special” disease. Through resolute research, we specialists are making efforts to ‘normalize’ eating disorders for which standard treatments are available at any hospital.

Neither postpartum mental health issues nor eating disorders will be solved by doctors and specialists alone. Discussion by society at large is essential. Through my research and teaching at Meiji Gakuin University, I am working toward a society and its communities that can better support those persons with mental health problems. I hope also that four years of study in the Faculty of Psychology will be constitute a first step for students to become “adults we can trust.”