⚫︎Even After Treatment, New Patients Keep Coming
—You've made "preventing mental illness through the dissemination of information" your guiding vision. What was the origin of that mission?
Kabasawa: I started out as an ordinary psychiatrist working at a hospital in Hokkaido. Treating patients is of course important, but no matter how many I cured, new patients kept coming. Mental illness is sometimes described as "a cold of the mind," but once it takes hold it can last six months, a year, sometimes three or five years, and some people never fully recover. As I repeated this cycle, I came to feel that we needed to increase the number of people who never reach that point in the first place. That is how, more than twenty years ago, I began to focus on prevention.
—And you chose the dissemination of information as your means of prevention.
Kabasawa: It was right when the internet and blogs were first appearing, so I believed that reaching large numbers of people online would be essential in the years ahead. From 2004, I spent three years researching psychiatry at the University of Illinois in Chicago. At the time, research institutions around the world were shifting their focus from drug therapy toward prevention. For three years, I too studied the biological factors involved in mental crises every day—changes in proteins, genetic factors, and the like.
—How did you put that experience to use after returning to Japan?
Kabasawa: When I came back, I found that in Japan too, tens of thousands of people each year were reaching a serious crisis from mental illness. Measures have improved since then, but if you include those at risk, the number rises to several million or more. Helping patients inside the hospital matters, but there are also healthy people, people who are a little tired, and people wondering whether to see a doctor. To reach as many of them as possible, I began sharing information on social media and YouTube.
⚫︎It Is Impossible to Judge Your Own Mental State by Yourself
—For working people, how to notice mental health problems seems like a crucial issue.
Kabasawa: This is an extremely important question, and to put the conclusion first: it is almost impossible to accurately judge your own mental state by yourself. Ideally, the moment you feel "something's off" or "I don't want to go to work," you would adjust your lifestyle or see a doctor—but most people cannot do that.
—Why is it that people cannot notice?
Kabasawa: The ability to grasp your own condition is called "metacognition," or self-insight, and probably only about 10 to 20 percent of people have it. People with metacognition can adjust on their own when stress builds up—"I'll rest this weekend," "I'll cut back on work a little"—so they never reach a severe state. Those who cannot, on the other hand, try to "push through on willpower" even when they are utterly exhausted, and by the time they notice, they have developed a serious mental illness. In some cases, it can even lead to irreversible consequences.
—So the people who lack metacognition are by far the majority.
Kabasawa: What's more, the worse your mental condition becomes, the less you can tell what state you're in. There's a fascinating study: when people who answered "yes, more or less" to "Are you sleeping well?" were fitted with devices that actually measured their sleep, many turned out not to be sleeping at all. In other words, it's fine when a very healthy person knows "I'm healthy," but as mood declines, people become foggy and dazed, barely managing to get to work and back. For someone in that state, noticing "I'm exhausted right now" is extremely difficult.
⚫︎Sleeplessness, More Mistakes — These May Be the Mind's SOS
—Then are there clues that let someone other than the person themselves notice?
Kabasawa: There are several. First, sleep. As mental condition deteriorates, more than 90 percent of people develop sleep problems—they can't fall asleep, their sleep becomes shallow, they wake repeatedly during the night. A loss of appetite is also common. But what I pay the most attention to is "an increase in mistakes."
—Mistakes?
Kabasawa: As mental illness progresses, the brain chemicals serotonin and noradrenaline decline. Noradrenaline is deeply involved in attention and concentration, so when it drops, carelessness and mistakes inevitably increase. For example, forgetting an appointment you absolutely must not miss, or completely overlooking the submission of a document with a deadline. When such things start happening to someone who is normally diligent and meticulous, it's a sign that brain fatigue has advanced considerably.
—Is it something you can tell if you work alongside the person?
Kabasawa: Yes, you can. The quality of their documents drops noticeably, they get dates wrong, they start making obvious mistakes—or there are even stories of someone leaving a bag with their laptop on the bullet train. When things that would be unthinkable for that person normally begin to happen, it's a sign of considerable brain fatigue. These changes are signs that family members and workplace colleagues can both observe. The mind's SOS appears as changes in behavior. That is precisely why the people around them noticing is so important.
⚫︎Protecting Cognitive Resources, Preventing Mental Decline
Having walked the path of "prevention" as a psychiatrist for more than twenty years, Dr. Kabasawa states plainly that we can barely perceive the state of our own minds. Only one or two people in ten possess metacognition. The signs of decline appear in our behavior—as disrupted sleep and unexpected mistakes. In the next installment, we ask why people who are struggling end up saying "I'm fine"—the psychology behind it, and what those around them can do for early detection.
Profile
Shion Kabasawa (Psychiatrist, Author, Film Critic)
Born in Sapporo in 1965. Graduated from the School of Medicine at Sapporo Medical University in 1991 and joined the university's Department of Neuropsychiatry. From 2004, he studied for three years at the psychiatry department of the University of Illinois in Chicago. After returning to Japan, he founded the Kabasawa Psychology Institute in Tokyo. Under the vision of "preventing mental illness through the dissemination of information," he shares knowledge of psychiatry, psychology, and neuroscience in accessible terms through internet media. With more than twenty years of communication experience, he has built a combined following of over one million across multiple online platforms, including his email newsletter, X, Facebook, YouTube, and Instagram. Known as "Japan's most prolific output psychiatrist," he has written 55 books (as of 2026), including The Power of Output and The Power of Input (Sanctuary Publishing), a series that has sold more than 2.7 million copies in total.
