Though the Japanese may not discuss mental health as Westerners do, they are still concerned about it. “Urban policymakers in Japan often talk about the problem of stress and how to alleviate it,” McCay says. One example, karoshi, or “death from overwork,” often by stroke, heart attack, or suicide, is associated with high levels of stress. (Japan’s suicide rate is the fifth-highest in the world.) And hikkikomori are young people who withdraw from society and do not leave their homes for six months or more—a condition often triggered by high anxiety in response to pressure to succeed in school or work.

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Image: By Moyan Brenn from Anzio, Italy – Tokyo, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=40604084