One day in November 2016, my depression has flared up. This forced me to retire from work. I was suffering from a serious sleep disorder. For example, I went to bed at 23: 00 and woke up at 24: 00. The very short sleep led to a serious sleep deprivation. Of course, I came in late and was absent too often. Finally I couldn’t go to work anymore.

Awareness of disability

The initial depression developed in April 2010. But soon, in early May, I rushed to a psychotherapist. As a result, this quick action prevented me from becoming seriously ill.

I was diagnosed with masked depression that doesn’t come with psychological symptoms: depressive mood, decreased motivation, and diminished ability to think. Therefore, until November 2016, I was working at a company with no problems as a healthy person. I’m sure that no one knew I was a depressed patient.

However, after six years (very long period), I had serious symptoms again. This made me aware of the persistence and the difficulty in preventing recurrence of depression.

• Steadily I was going into remission, but suddenly had gotten worse.
• I couldn’t find an obvious reason for this relapse.

I was thrown into the depths of disappointment all at once. That has made me consider myself as a handicapped person for the very first time.

You should have a disability certificate

In order to live as a handicapped person, you need a disability certificate. Without it, you are not recognized officially as a person with a disability and cannot receive official services.

Obtaining a disability certificate does not mean that you have to always disclose your disability certificate in private situations. There is no need or obligation to be open about your disability at all.

• As long as you don’t disclose it, your privacy is protected.
• You can also work as a normal person even if you have a disability certificate.

These flexibilities attracted me, so I immediately got a mental disability certificate. I was given the lightest grade 3.

No one knows much about disability pensions

On November 1, 2016, to know more about employment of persons with disabilities, I met seishinshogaisha-koyo-totaru-sapota (Total supporter of employment of the mentally disabled) .

By the way, why is there a specialized consultation service only for people with mental disorders? This graph tells the answer. The answer is only the employment rate of people with mental disabilities is extraordinarily low. There must be various reasons for companies. But it’s clearly discrimination; I totally lose my cool.

Let’s get back on the track. Here’s a summary of what I was told by the person in charge.

I was very shocked. Non-permanent and minimum wage. I would lose my home and die on the side of the street.

Ought to have received a disability pension

So I asked him, “HOW on earth do the mentally challenged live?”

For your information, people with the mildest symptoms fall into the 3rd grade in Japan.

I was a little relieved. But later I’ve found that the latter half of his remark was entirely false.

Just as I started making these actions, I went to the clinic, for regular visits. I asked my doctor for his opinions on my disability pension. He explained that these days, the review process for disability pensions has become much stricter, and in fact, cases that would have been OK in the past are no longer being approved. And he said that in my case, there was very little chance of passing the review.

“That’s different from what I was explained,” I said to myself. And I felt very anxious.

But it can’t be approved unless I apply for it. The doctor also said, “it’s up to you whether you apply it or not.”

Only the second page matters

Three weeks later, I went to the hospital to receive my medical certificate. When I checked the contents, I felt, “I really can’t receive a disability pension.”

No matter how severe your condition is, it is related to your previous pension contributions. Also, depending on the type of health insurance at the time of your first examination, you may not be able to apply for even grade 3 disability pension. Anyway, initial checks and consultations are very important.

The staff explained about the general criteria for certification by showing the table below. Based on that table, it seemed to me that my situation was well applicable to Grade 3. The staff personally agreed with that point. Officially, however, she did not dare to affirm it.

But at the same time, she gave me a piece of advice: “This table is just a rough guide, and the second page of your doctor’s medical certificate is what matters most.”

Same as the certification of needed long-term care, needed support?

“The second page of the medical certificate” is this below.

It consists of a assessment of 2 Score of Daily Living Skills (left) and 3 Level of Daily Living Skills (right). Simply put, it’s an assessment of how well you can live without the support or assistance from others.

“Daily living skills” are for example, the ability to “eat properly”, “keep yourself clean”, and “do your shopping by yourself.” I thought that was rather an assessment criterion for people with physical and intellectual disabilities. Not for the mentally disabled.

When I got home, I checked the medical report again. Questions about whether you can “eat properly”, “maintain personal cleanliness”, and “do your shopping by yourself.” without the support or assistance from others. These are almost identical to the certification of needed long-term care and needed support for nursing care insurance. In short, it’s quite beside the mark.

Certification criteria means nothing

Again, let’s go back in time to the time when I first received my medical certificate: on November 26, 2016. The diagnosis made me wonder, “Maybe I really won’t be certified,” and it dumbfounded me. But again, I looked at the disability pension brochure.

I double-checked “the chart of certification criteria.”

The sentence: “Labor is severely restricted” in this “certification criteria” corresponded to my life situation at the time. In fact, I could come to work only 5 days a month because of a severe sleep disorder. I used to work full time, 5 days a week.

I thought “My living situation meets most of the certification criteria, so if I prepare the application documents well, my claim will be accepted.”

Two days later, on November 28, 2016, I submitted my application for a disability pension.

Just believe in good results. It takes 3-4 months to get the result (in Japan).

The mixture of anxiety and expectation sent me into a panic, my heart was beating fast. With trembling hands, I put the scissors in the envelope of my life.

Notice of non-payment decision

The survival instincts revived me.

I was slammed to the depths of hell. The force of the impact shattered my mind and body into pieces.

But even after such a huge blow, I was barely alive. The survival instincts issued a fierce warning and an extraordinary command to solve the greatest danger I was involved in that I was going to starve to death as quickly as possible.

Thus, driven by the instincts, I put together the fragments of my mind and body and began to take one action after another to survive.

From pillar to post

First, I went to seikatsu-jiritsu-shigoto-sodan-senta (Life Independence, Job Counseling Center). But they knew nothing about livelihood support for the disabled and nothing about the disability pensions. No advice was given.

However, they told me about the more specialized shogaisha-shugyo-seikatsu-shien-senta (Employment and Life Support Center for People with Disabilities) .

Immediately, I went to shogaisha-shugyo-seikatsu-shien-senta and asked for advice. They certainly gave me more professional and extensive advice, but it turned out that the only livelihood support I could receive was a disability pension. But I knew that I could request for examination of my disability pension.

So I asked the person in charge whether the decision could be overturned if I requested for examination. She said, “I don’t know, because I’m not a caseworker.” And she gave me an information about a caseworker in the city.

Surprisingly, the caseworker I was told about belonged to the clinic I was visiting. Being passed from pillar to post, finally I’m sent back to the starting point. Played on someone’s dice game; I felt infinitely helpless.

Later, I had a meeting at the clinic I always visited. The person who came into the room was the man who always worked at the reception desk. I smiled wryly saying, “what an unlucky guy I am.”

However, after meeting him, it became clear that all the reasons why my application for a disability pension was not approved and the backdrop behind it.

New guidelines have become effective

The very reason my application was not approved , was because certification under “the new grade determination guidelines for mental disorders” has started since September 1st, 2016.

The grade of disability pension is now determined “solely” based on the contents of the second page. That’s a heavy-handed approach.

Point rating system: state-sponsored violence

Under the new certification method, firstly, the patient’s “ability to perform activities of daily living” is rated on a 1 to 4 scale. Based solely on that score and the level, the grade is determined. It’s like a mark sheet scoring system. The following chart makes it easier to understand.

Level of “ability to perform activities of daily living”

(5) The patient needs constant assistance because he or she has little ability to perform personal activities of daily living.

(4) The patient needs a lot of assistance in daily life.

(3) The patient can perform simple daily activities in the home, but needs assistance occasionally.

(2) The patient can perform normal daily activities in the home, but needs assistance in social activities.

(1) The patient can lead a normal social life.

This section occupies the right half of the medical certificate. To save time, I translated only brief summaries.

Score of “ability to perform activities of daily living”

At the top, there is a cautionary note:

“Why?”

Anyway, the score of “ability to perform activities of daily living” is composed of each ratings (on a 4-point scale) in 7 categories.

As for rating, for example, 1 point is given, if you can do it by yourself. In the worst condition, 4 points are given: you are unable or unwilling to do it, even if advice or guidance is given. The breakdown of points is as follows:

Points gathered from 7 categories are averaged, thus the “overall average score” is calculated. And it finally becomes the Score of “ability to perform activities of daily living.”

The seven categories are as follows:

In my case, the level was (2), and the score was 1.28 (below 1.5).

In such a simple way, my application was   Rejected  .

No more disability pensions for the mentally disabled

I was able to understand the caseworker’s explanation. But also, I was filled with a sense of helplessness and unfocused anger. Reading the brochure on disability pensions again, I hollowly asked him, “Why this certification criteria is still listed?”

Well, no idea either. I guess the officials are just leaving it for no particular reason.

Sadness, emptiness or disappointment. I had struggled believing in this humane “Certification criteria.” But, now it’s both abominable and confusing.

“MHLW, remove it right away !”

While being devastated, I asked him if I requested for examination, the decision could be overturned. That was the point I wanted to hear at the meeting.

It’s quite difficult. The grading system has totally changed just a few months ago.

He was right. Since the same medical certificate is used, the Level and Score of “ability to perform activities of daily living” won’t change at all. For only the mentally disabled, requesting for examination doesn’t make any sense at all.

MHLW, you are too cunning and heartless! But why on earth you target only the mentally disabled?

MHLW: Ministry of Health, Labour and Welfare.

Reduce the disability pension payments

Since September 1, 2016, seishin-no shogai-ni-kakaru-tokyu-hantei-gaidorain (the new grade determination guidelines for mental disorders) has come into force.

Its good cause, in brief, was to eliminate regional disparities in disability pension non-payment rates and equalize them. But obviously this is a blatant untruth.

Indeed, there used to be significant disparities in the rate of non-payment.

The number keeps rising

There is one distinctive difference between the mentally disabled and the others: the psychogenic origin. Let me explain it in the case of depression. Depressions are divided into three groups based on the origins of the disease.

Endogenous depression :

Inborn factors, such as genetics and constitution

Exogenous depression :

Due to the brain injury caused by a physical blow, other illnesses, or drug abuse.

Psychogenic depression :

Due to mental stresses

But recently, no convincing information has been disclosed on the number of the mentally disabled. Will unfavorable information continue to be withheld?

The majority of applicants will be the mentally disabled

As this graph clearly shows, the number of people with mental disabilities is already the highest among the three types of disabilities. Moreover, in this stressful society, the number of the mentally disabled, especially due to psychogenic depression, surely keeps increasing. It won’t be long that the number of the with mentally disabled becomes the twice as high as the number of the physically disabled, or about 7 million.

If that happens, officials will curb the issuance of disability certificates and reduce the number of people with mental disabilities. But even if they falsify the number of the disabled, they can’t fake the number of suicides. There will be more and more regrettable corpses in Japan. No HOPE for the future.

Meanwhile, the number of people with physical and intellectual disabilities will continue to level off. At present, there are no external factors that could increase these numbers.

Anyway, from now on, the majority of applicants will be the mentally disabled. And applications by the mentally disabled keep increasing. If the officials respond diligently to the ever-increasing number of applications and continue to provide disability pensions, Japan will be in dire straits.

Because both old-age pensions and disability pensions are administered by the same organization: Japan Pension Service.

The nation has great difficulties in funding even old-age pensions. So I guess the officials built a Trump Wall against the specific minority: the mentally disabled, who have difficulty in raising their voices out of fear of privacy, prejudice and lack of understanding, are becoming even-larger numbers of disability pension applicants.

No payments, as long as you live alone

Allaying my rage against unfairness, now I return the topic to “the new grade determination guidelines for mental disorders.” The adoption of this new grading system has created a pitiable group of people who will never receive disability pensions until the end of time.

The new grading system is, simply put, a way of assessing just how well the patient can live without the support or assistance from others.

In almost all of the seven situations, you can do it by yourself (i.e. 1 point).

It means your score of “ability to perform activities of daily living” will surely become below 1.5. At that moment, it is no use trying it. It definitely won’t be approved.

Patients living alone are urgently in need of help

However, if you compare the two:

• The mentally disabled living with family; They have a chance to receive disability pension benefits.
• The mentally disabled living alone; They are never allowed to receive them eternally.

Who is more in need of money?

They have to pay their house rent. Not only that, they have to pay for utilities, and also are charged for social insurance premiums. Cash spreads its wings and flies away without mercy.

Even if they don’t eat, they will force themselves to work again for securing a place to live. However, the overwork doesn’t last long, and the disease re-worsens. The tragedy repeats over and over again.

The mentally disabled living alone can hardly reintegrate into society without public financial support.

Also, they have to ease their sufferings all by themselves.

They don’t have any family or roommates to talk to about their hardships and pains. Which type of the two are suffering more, and facing more obstacles in their lives? Who of them should be aided first?

Procedural memory and the survival instinct

Adult people, but not all of them, might have had this kind of experience: drinking to the point of oblivion, but somehow came home safely and slept in their pajamas.

The reason why we can do such magical thing is because the actions of coming home and going to bed are remembered as a single procedure: procedural memory.

Unlike semantic and episodic memory, procedural memory is said to be formed through the cycle of physical activities.

There are many familiar examples, such as learning to ride a bicycle, to play the piano, to master touch typing and so on.

In all cases, it’s very important to keep practicing physically and to never give up. In other words, the more experiences you gain, the more your procedural memories and skills will grow.

Less experienced, more advantaged

Whether they are handicapped or not, people living with family have much less experience of cooking, cleaning, managing money, shopping, etc. all by themselves.

Less experience means that they have poorer procedural memories and skills “to perform activities of daily living.”

On the other hand, the mentally disabled living alone already have gained much more “experiences for daily activities.”

Ironically, under the current grading system, the higher their abilities are, the lower they are graded. So their applications will be   Rejected  .

Persistence of procedural memory

Procedural memory has another unique feature: long-term persistence. Once acquired, it will last for a lifetime.

Thanks to the persistence of procedural memories, people with depression living alone can “perform activities of daily livings” without much difficulty.

Of course, depression causes a decrease in motivation and interferes with daily life. But when you are in the high risk of starving, the survival instincts will at least force you to get something to eat. Such instinctive behavior corresponds to an Appropriate diet?

For those reasons, I can tell you the new grading guidelines, which rely solely on the “ability to perform activities of daily living,” is completely unsuitable for evaluating the pathological conditions of the mentally disabled and their difficulties in daily and social life.

The highest percentage of living alone

Now, the mentally disabled living alone can no longer receive disability pensions due to bullying by the Ministry of Health and Welfare. Ironically, of the three types of disabilities: physically, intellectually, and mentally; the mentally disabled have the highest percentage of living alone.

Among the mentally disabled, the psychogenic depressed sufferers, in particular, had been normal healthy people before they encountered an excessively stressful event.

Because they had been healthy, they of course did the same work as their colleagues and earned comparable salaries. Some of them had earned much more.

Such a peaceful life is unexpectedly overwhelmed by excessive stress, which will suddenly turn you from a healthy person to the mentally disabled halfway through life. The life of the mentally disabled due to psychogenic origins is generally like this.

I think the sudden onset of psychogenic origins is the reason why the mentally disabled have the highest percentage of living alone.

Application after recovery

As I mentioned before, the number of the mentally disabled keeps rising. I think the main factor for this is definitely the increase of patients with psychogenic depression.

Psychogenic depression has a peculiar feature that is very different from other mental illnesses: very fast recovery.

As the above figure shows, with proper rest and medication, Psychogenic depression temporarily can be recovered in about 2-3 months. That’s a V-shaped recovery.

But when you’re at the bottom of the V-shaped valley, you can’t even think about disability pensions. In those times, you should rather take an adequate rest.

The most efficient way to apply for a disability pension is to have a family member represent you when your symptoms are most severe. But the mentally disabled living alone have no family member or roommate to whom they can delegate the application process.

Too much pity for the mentally disabled living alone. They can’t be cured under those circumstances. Naturally, their reintegration into society is hardly possible.

Concerning their privacy and prejudice

Lastly, I would like to share this with you all. Patients with mental disabilities are not willing to have disability certificates for fear of privacy and prejudice. As a patient, I thought just the same way.

This means that the actual number of the mentally disabled is higher than the figure below.

In other words, there are so many patients working in offices for healthy people, disguised as healthy people, while suffering from mental diseases.

Such difficulties peculiar to the mentally disabled are due to prejudice and lack of understanding of mental illness itself. And because mental disability is the most prejudiced and uncomprehended of all disabilities, we continue to be discriminated against in the employment of people with disabilities.

There are two types of minorities: those easily exposed to public attention and those generally ignored (dark minorities). The mentally disabled are the dark minority who are always left out in the cold.

Without any support from my family and the government, I am still living alone. To be honest, I’m so starving that I’m afraid I’ll die alone.

I’ve wanted to change this unfair society.
But almost no energy, I can’t let out a howl any more.

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