Tōjisha Manga: Japan’s Graphic Memoirs of Mental Disability

Yoshiko Okuyama explores the emerging genre of comics in Japan, tōjisha manga, and discusses how these comics illuminate and humanise the otherwise “faceless” people’s invisible tribulations caused by mental disability.

Manga, or Japanese comics, is not only popular but also influential. This essay introduces a type of manga, tōjisha manga, as an ever-growing subgenre of comic essay that narrates the author’s lived experience of mental health issues. Beginning in the early 2000s, this genre has taken up even more momentum during the pandemic. However, it is still an underappreciated and less internationally researched area of Japanese popular culture. I argue that tōjisha manga centralises mental health tōjisha’s voices and can be a useful resource for medical education and public education.

My personal connection with the topic of mental illness

Cover of Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health
Fig. 1. Cover of Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health (2020).

Growing up in Japan, I saw my mother suffering from Obsessive-Convulsive Disorder (OCD), one of the illnesses that have high family involvement. My family life was significantly impaired by her obsessions and compulsions, and I developed anorexia nervosa. That was probably my survival tactic, since the only thing that I could control in a seemingly uncontrollable family environment was my own body. Statistically, the mortality rate of anorexia nervosa is very high, second only to that of opioid overdose. Ironically, to “survive” my family’s mental illness, I almost killed myself. Therefore, I can personally attest that, when left untreated, a mental disability affects not only the individual but also people closely associated with the individual.

However, until recently, a public discourse on one’s lived experience of mental illness was almost non-existent in Japan. As I described in Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health (2020, 21-75), the importance of voices of those with lived experience of disabilities was only acknowledged for the first time in history during the tōjisha undō, Japan’s minority rights movements in the 1970s. A literary genre called tōbyōki (“illness memoirs”) then began to proliferate in Japan in the 1990s.

Tōjisha and “tōjisha manga”

Manga, or graphic novel, is a still, monochrome medium with images and texts. Recently, it has become an influential tool for educating the public about disability in Japan (Kodaira and Ito 2009; Masuda 2018). Researchers argue that those who have never met people with disabilities in real life are more likely to form their understanding of disability basing on the representation of disability in popular culture, including comics (Shakespeare 1999; Ellis and Goggin 2015). Therefore, accurate disability representation does matter.

In view of the importance of building a narrative “corpus” on mental illness in Japan, I started a research project in 2019 to document and study a cluster of graphic memoirs that narrate ordinary people’s lived experience of mental health problems in Japan. In the absence of a label specifically for this subgenre that has been rapidly growing in the past 20 years, I coined the term tōjisha manga, drawing from the Japanese sociohistorical underpinnings of the term tōjisha.

Originally, tōjisha means a “party or insider involved in litigation” in legal parlance. However, during Japan’s minority rights movements (tōjisha undo) in the 1970s, it started to take up the meaning of individuals with direct experiences of discrimination or oppression (Nakanishi and Ueno 2015).

Yoshiko standing in front of the original building of Bethel House, Urakawa, Hokkaido, Japan.
Fig. 2. Yoshiko standing in front of the original building of Bethel House, Urakawa, Hokkaido, Japan.

Among the tōjisha undō came the disability rights movement, spearheaded by the members of the Association of Green Grass, or Aoishiba no Kai in mid-1970. Although these disability rights activists were advocating tōjisha needs and sovereignty in the 1970s and 1980s, their aggressive style began to fall from favour in Japan. In the millennium, one of the most popular approaches to dealing with mental health issues in Japan is tōjisha kenkyū, which is a form of self-examination by the tōjisha themselves. This approach began at Bethel House, or Beteru no ie, a non-profit organisation that provides group homes and other support services to ex-patients of mental illness. This approach emphasises the importance of tōjisha’s connection with peers and the local community. When I was visiting Bethel House in the summer of 2022, the members were helping a strawberry farmer by providing labour, picking the strawberries, cleaning them, and packing them. Through this type of community ties, they gain not only some financial benefits but also a sense of belonging.

In Japanese, an umbrella term that refers to “people with mental disabilities” is seishin shōgai-sha (literally, “mentally disabled people”). In this compound word, shōgai literally means “obstacle or burden.” However, to rebuff the stigmatising label of shōgaisha branded by medical professionals and the government, the term tōjisha has been adopted by people with disabilities as a self-referent. Tōjisha has been used publicly in Japan in similar ways in which such expressions as “mental health consumers” and “psychiatric system survivors” are used in England and North America. Furthermore, by using the word tōjisha, we put an emphasis on the importance of an emic perspective (i.e., the viewpoint from within the identified group).

It is in this semantic connotation of tōjisha, as well as in the sociohistorical contexts of tōjisha undō and tōjisha kenkyū, that I coined the term tōjisha manga. To clarify, it is not my attempt to negate the more internationally known term graphic medicine, nor is it my focus to differentiate Japan’s graphic memoirs on disability and illness from it. I am aware that these two terms have a large overlap. Rather, it is in view of the many benefits of self-narratives, including stigma reduction (Sakae 2016; Kido 2007), that I coined the term (Okuyuma 2022). I believe that tōjisha voices must be put at central stage and that tōjisha manga is a more appropriate term, when evaluating this subgenre of comic essay.

Depression in tōjisha manga

In Tōjisha Manga (2022), I conducted interviews with five manga artists to gain more insights into each artist. I hope to use the background information to verify the interpretation of my semiotic analysis on their work. Basing on my respective interviews with Hosokawa Tenten and Tanaki Keiichi, I use the following two case studies to illustrate visual tropes used in their tōjisha manga and how they employed them to signify various mental health symptoms.

Cover of My SO Has Got Depression (2006-2013)
Fig.3. Cover of My SO Has Got Depression (2006-2013).

In the three-volume series My SO Has Got Depression (2006-2013), manga artist Hosokawa Tenten chronicles her husband Tsure’s depression. Narrated in a humorous but highly personal way, this manga not only offers the wife’s perspective but also draws from Tsure’s own dairy to prioritise the tōjisha’s voice. Hosokawa mobilises a variety of visual strategies, one of which is a cute and comical drawing of a “turtle bed,” or kame futon. She uses it as a visual metaphor for Tsure’s initial stage of depression, during which he would crawl into bed with a blanket over himself, just sobbing and feeling miserable all day.

To describe Tsure’s mood swings, Hosokawa depicts him as being swallowed by a towering “depression wave. Hosokawa intentionally draws the characters cute and doll-like in datsuryokukei kyara, a style of character drawing known to have healing effects, to prevent traumatising the reader with sombre, depressing graphics. When her first memoir came out in 2006, it was earth-shuttering for a “formidable” salary-man to go public with his experience of depression in manga. With close to a million copies sold, the story from the first volume was adapted into a TV drama, first, and then later a popular film.

 Cover of Utsu nuke (2017)
Fig.4. Cover of Utsu nuke (2017).

Another example of tōjisha manga on depression is Utsu nuke (2017), written and illustrated by Tanaka Keiichi. The manga is based on Tanaka’s lived experience of depression, along with 16 other tōjisha who went through the depression tunnel, or “utsu tonneru.” His drawing style is noticeably similar to that of the legendary manga artist, Tezuka Osamu. Being a parody manga artist, Tanaka makes great use of humour, especially to lighten up this heavy topic of depression using a variety of visual and textual metaphors in his multicolour memoir.

For example, the manga’s title, utsu nuke, is a metaphor he invents to refer to the act of “coming through depression”, as he associates his experience as being stuck in a long, dark tunnel. Another example of his visual strategies is the personification of his feelings of sadness as “utsu-kun”, that is, innocuous and tamable minions (see the creatures he is holding in Fig. 4). Tanaka uses personification to create a healthy distance from his “miserable, excruciating experience” of depression (Okuyuma 2022, 184). With close to 400,000 copies sold, this popular manga was adapted into a television drama series.

To counteract cultural stereotypes of depression as the individual’s weakness, laziness, or personality flaw, both artists reframe their lived experience as a serious illness that deserves proper medical treatments and the public’s understanding and support. For example, Tanaka metaphorically calls his depression kokoro no kaze (“cancer of the mind”) to emphasise that it can be as lethal as a cancer of the body and that the afflicted should not be stigmatised or blamed for their condition. Their narratives offer detailed insights into the lived experience of depression with in-depth information including diagnosis criteria, specific symptoms and feelings associated with them, and bumpy recovery processes. They narrate with humour, empathy-evoking visual strategies, and reader-friendly storytelling. Therefore, these episodes are not only entertaining but also eye-opening and informative to readers who have no knowledge of this medical condition.

Due to the limit of text, my analysis of 46 drawings of five tōjisha manga stories featured in the book could not be presented in this essay. However, as my analysis on these two narratives shows, first-person narratives like tōjisha manga centralise mental health tōjisha’s voices. From the perspective of disability studies, this genre of tōjisha manga differentiates itself from stereotypical representations of disability, such as supercrip comics (Ellis and Goggin 2015) and “ableist” storytelling (Haller 2010). They can be a useful resource for medical education, countering sociocultural stigma and stereotypes, and raising public awareness.



My fieldwork in Japan for Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health was funded by the Association for Asian Studies and the University of Hawaiʻi’s faculty development grant. I also received a scholarship from the National Endowment for Humanities (NEH) to attend its summer institute on disability studies, which made a tremendous impact on the writing of this book. This essay is dedicated to the memory of Dr. Mark Bookman, a young scholar of Japanese disability studies who passed away unexpectedly in December 2022.


About the author

Yoshiko Okuyama is a professor of Japanese Studies at the University of Hawaiʻi at Hilo. She is currently a visiting scholar of disability studies at Cornell University’s East Asia Program and an affiliated scholar at Ritsumeikan University’s Institute of Ars Vivendi. Her recent publications include Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health (Palgrave Macmillan, 2022), Reframing Disability in Manga (University of Hawaii Press, 2020), and Japanese Mythology in Film: A Semiotic Approach to Reading Japanese Film and Anime (Lexington Books, 2015).



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Haller, Berth, A. 2010. Representing Disability in an Ableist World. Louisville, KY: Advocado Press.

Hosokawa, Tenten. 2006. Tsure ga utsu ni narimashite (My SO Has Got Depression). Tokyo: Gentosha.

—. 2009. Sonogo no tsure ga utsu ni narimashite (My SO Has Got Depression Afterwards). Tokyo: Gentosha.

—. 2013. Nananenme no tsure ga utsu ni narimashite (My SO Has Got Depression After Seven Years). Tokyo: Gentosha.

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Okuyuma, Yoshiko. 2022. Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health. New York: Palgrave Macmillan.

Sakae, Setsuko. 2016. “The possibility of social change by the public talk of people with mental disorders” (Seishin shōgai tōjisha no katari gamotarasu shakai henkaku no kanōsei)Core Ethics 12: 89-101.

Shakespeare, Tom. 1999. “Art and Lies? Representations of Disability on Film.” Disability Discourse, Marian Corker and Sally French (eds.), pp.164-172. Buckingham: Open University Press.

Tanaka, Keiichi. 2017. Utsu nuke: Utsu tonneru wo nuketa hitotachi (Depression Breakthrough: People Who Got Through the Depression Tunnel). Tokyo: KADOKAWA.


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