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The
Community
Psychologist

Volume 53   Number 2 Spring 2020

Self-Help and Mutual Support

Edited by Thomasina Borkman, George Mason University and Ronald Harvey, University in Bulgaria

Selective Use of Professional Services by Family Survivors of Suicide’s Self-Help Groups in Japan

Written by Tomofumi Oka, PhD, Sophia University, Japan

This paper is an excerpt from, and expansion of a presentation made at the Third International Social Development Conference in Malaysia (Oka, 2018). The purpose of the paper was to consider how self-help groups (SHGs) play a unique role in the field of human and social development. The presentation considered two case studies of the various knowledge bases of SHGs in Japan. This paper extracts one case study, the family survivors of suicide and their “liberating meaning perspective” based on their collective experiential knowledge which is related to the rejection of mental health bereavement professionals but welcomes and accepts legal professionals. This paper’s contribution to the SHG literature is to highlight the group’s differing relationships with professionals, a distinction rarely made in the literature.

The relationship between professionals and SHGs is a matter of much discussion and contention (see Shepherd et al., 1999): “Professional” implicitly means the professional legitimately trained to handle an issue, not all professionals; thus, a heart disease professional is a physician or health care professional, not an accountant, lawyer, or journalist.

The importance of “lived experience” or “experiential knowledge” as the source of authority and knowledge in SHGs is widely understood today. However, some professionals still lack understanding of the collective experiential knowledge of developed SHGs and some “professionals tend to trivialize the ‘experiential knowledge’… of self-help groups by identifying it as knowledge that individuals get from their idiosyncratic experience” (Oka, 2013a, p. 224).  However, as Munn-Giddings and her associates (2016) state:

“A critical feature of the way in which SH/MAGs [self-help groups] work is that members are learning together and building a collective knowledge base that remains in the group even after they leave it. The difference between an individual’s experience of a health or social condition and this collective knowledge tends to be much underestimated by professionals and policy-makers.” (p. 398)

Our interest is in this collective experiential knowledge which in mature SHGs results in a “liberating meaning perspective.’  Liberating meaning perspective (Borkman, 1999) is similar in meaning but an alternative term to Antze’s (1976) “ideology” which implies cult-like or politically motivated.  I like liberating meaning perspective because it considers social phenomena such as stigma. Borkman (1999) says:

  “People with stigmatized conditions need a liberating meaning perspective that can free them of self-hate, a negative self-identity and assumptions that they are inadequate. They need to redefine their humanity. Moreover, they need a constructive way of dealing with their problem.” (p.115)

Case Study of Family Survivors of Suicide

The social context in which the SHG developed is important to note. Japan is estimated to have about three million family survivors of suicide. The government adopted national suicide prevention measures through postintervention, support and treatment of family survivors of suicide. Thereafter, many professionally led support groups for family survivors of suicide were started throughout Japan (Oka & Borkman, 2011). They work within mental health agencies, so clients identify with the groups as a mental health intervention. Bereavement professionals who lead the groups use a mental health framework that focuses on stages of grief which the bereaved go through and then complete. According to that framework, clients can get stuck in various stages instead of finding closure and a state of resolution. Detachment from the deceased is the goal; clients who fail to detach are regarded as having a mental health problem. Chronic grief is viewed as a form of mental illness.

This supposedly scientific perspective on grieving however fails to take account of cultural differences. In Japan, part of the culture is belief in maintaining connection with the dead and the Japanese believe that the “spirits of the dead interact with the living” (Klass & Goss, 1999, p.550). Many family survivors of suicide tried the professionally led support groups but found their perspectives objectionable and felt more stigmatized; some worked to develop an alternative that they ran themselves.

Family survivors of suicide started their national organization, Zenkoku Jishi Izoku Renrakukai (usually abbreviated to Zenjiren), in 2008, and their membership is over 3,000. Their groups are entirely independent of mental health professionals and are critical of psychological intervention for family survivors. In this paper, family survivors of suicide means members of this national organization.

The Liberating Meaning Perspective (hereafter Perspective) of family survivors of suicide attracts many bereaved people who are not satisfied with professional medical or mental health service, which they sense are encouraging them to recover from grief. The SHG’s Perspective tells them they do not need to recover from grief but to live with it. “Grief is love” is their favorite motto, and this positive view of grief differentiates the group from professional opinion (Oka, 2013b). Because the Perspective contradicts that of many psychologists and psychiatrists, they do not use their professional knowledge. In fact, they loathe professional mental health terms such as “grief care.”  

 According to Oka’s interviews, the groups accept any stories that members tell of extreme reactions to overwhelming grief as normal. For example, a mother who was extremely angry at her deceased son’s wife made a straw doll to curse her. A pair of parents confessed that they were so sad that they had eaten their daughter’s ashes little by little (Oka & Borkman, 2011, English version, p. 9).  The group also counteracts the stigma families face from the community by providing round-the-clock support and friendship.

However, the groups have a network of supportive professionals, many of whom are legal professionals who are attractive for their advice on protecting the group’s legal rights. Supportive professionals are named “external reviewers”, not “advisors” which indicates the groups’ ethos of working independently of professionals. I am one of the external reviewers. I have been working with them since 2008, shortly after the establishment of the national organization; in Japan, a social scientist who is allowed to do research with a group incurs an obligation to work with the group, publicizing their research, assisting them with group issues, or other help (Oka & Chenhall, 2011).

Many family survivors need to seek legal help and thus find lawyers and other legal professionals helpful.  For example, an owner of an apartment house in which a woman killed herself demanded compensation from her family for the damage caused to the reputation of the house. Other families have sued schools for bullying their children and causing their suicide. A wife sued her husband’s company for having overworked him which had driven him to suicide. (Oka & Borkman, 2011, English version, pp. 15-16).

This brief case study shows that SHGs often react differentially to various kinds of professionals. Further research is needed on how the experiential knowledge and Liberating Meaning Perspective of a SHG is related to the professional tasked with dealing with that focal issue, but how SHGs might be receptive and welcoming to professionals outside their immediate sphere of experiential knowledge.

Tomofumi.oka@gmail.com

References

Antze, P. (1976). The role of ideologies in peer psychotherapy organizations: Some theoretical considerations & three case studies. Journal of Applied Behavioral Science, 12(3), 323-346.

Borkman, T. J. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press.

Klass, D., & Goss, R. (1999). Spiritual bonds to the dead in cross-cultural and historical perspective: Comparative religion and modern grief. Death Studies, 23(6), 547-567.

Munn-Giddings, C., Oka, T., Borkman, T., Mazat, J., & Montano, R. (2016). Self-help and mutual aid group volunteering. In D. H. Smith, C. Rochester & R. A. Stebbins (Eds.), Palgrave handbook on volunteering and nonprofit associations (pp. 393-416). Basingstoke, Hampshire, UK: Palgrave Macmillan.

Oka, T. (2013a). Self-help groups in Japan: Historical development and current issues. International Journal of Self Help and Self Care, 7(2), 217-232.

Oka, T. (2013b). “Grief is Love”: Understanding grief through self-help groups organised by the family survivors of suicide. In A. A. Drautzburg & J. Oldfield (Eds.), Making sense of suffering: A collective attempt (pp. 75-86). Oxford, UK: Inter-Disciplinary Press.

Oka, T. (2018, August). The knowledge base of self-help groups in Japan: Experience, popular psychology, and indigenous/religious knowledge. Paper presented at the Third International Social Development Conference, Sintok, Kedah Darul Aman, Malaysia. Retrieved from https://researchmap.jp/tomofumioka/presentations/5706246

Oka, T. & Borkman, T. (2011). Self-help groups, self-help supporters, and social work: A Theoretical discussion with some case illustrations of family survivors of suicide in Japan. Studies on Social Work, 37,3, 168-183. English version retrieved from        https://researchmap.jp/tomofumioka/published_papers/17538627

Oka, T., & Chenhall, R. D. (2011). Research on Self-Help Organizations in Japan: Working with a Sense of Duty (“Giri”). International Journal of Self Help and Self Care, 5(4), 371-392.

Shepherd, M.D., Schoenberg, M., Slavich, S., Wituk, S., Warren, M., & Meissen, G. (1999). Continuum of professional involvement in self-help groups. Journal of Community Psychology, 27,1, 39-53.