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Secrecy and disclosure of diagnosis in a Japanese psychiatric apprenticeship

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Joshua Breslau

Discussions of disclosure of diagnosis have not examined the broader issues of secrecy that pervade medical practice. This paper examines the disclosure of psychiatric diagnoses in Japan, where non-disclosure of some diagnoses is widely supported by professional opinion. Ethnographic data is drawn from a study of an apprenticeship training program for novice psychiatrists on the psychiatric ward of a university hospital. The standard interpretation of secrecy as a symptom of excess power is challenged through an examination of strategies regarding diagnostic disclosure for different diagnoses and comparison with institutional secrecy in other ethnographic contexts, medical and otherwise. The relevance of close attention to such strategies for an understanding of global medical institutions is also explored.

Joshua Breslau is a lecturer in health care policy in the Department of Health Care Policy at Harvard Medical School. He has a Ph.D. in anthropology from Harvard University and has held a postdoctoral fellowship in epidemiology at the Harvard School of Public Health. His research interests are in studies of psychiatric institutions and mental health epidemiology.