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Review of Yoshiko Okuyama’s Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health

By Victoria Rahbar, The University of British Columbia

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

Graphic memoirs and essay manga are undergoing increased popularity amongst readers, but a question remains about authority when identifying which works are autobiographical and which are simply observant. In Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health, Yoshiko Okuyama does a deep dive into who is writing what she terms tōjisha manga, why authors and those who live besides them can speak on their experiences, and how manga can serve as a vehicle for readers to understand the lived experience of “invisible” mental and neurological conditions. Okuyama builds on her past work Reframing Disability in Manga, which convincingly argued that manga can amend ableist ways of thinking (Reframing Disability in Manga xiv), while also shifting her focus to more “invisible” mental disabilities and contending once more for manga’s place in the classroom (Tōjisha Manga 284). Tōjisha manga, she defines, “are real-life stories that narrate the tōjisha experience of mental health problems” (43). Readers may be familiar with tōjisha as reference to “any minority, including people with a mental or neurological disability, whose voice has been suppressed in mainstream discourse” (22). One of Okuyama’s strengths is her ability to break down complex culturally nuanced terms. Her newest monograph opens with an explanation on word choice reflecting her semiotic approach to manga and on-going conversations on self-identifying language and health terminology. She avoids terms like “mental illness” and “mental disorder” in favor of words which depathologize neurological differences (vii). Like any good interviewer, she does retain the terms used by the manga creators interviewed for her study, so readers should expect some words of discomfort.

Tōjisha manga are a sub-genre of essay manga focusing on stigmatized conditions often categorized as developmental disabilities, intellectual disabilities, and mental disabilities with particular reference to works published over the last twenty years (2). Okuyama argues that manga creators humanize and visualize their daily lives through humor, self-reflection, and manga symbols which make readers understand something which may have been hidden in other mediums. For example, a static photograph of someone silently experiencing sensory overload while sitting in a crowded café becomes “loud” when handwritten thought bubbles and sound effects are included. Okuyama describes her methodology as follows. First, she uses semiotics to read not just the words of the series, but also manga’s visual language of speech bubbles, special effects, and sound effects (8). Next, at a macro level, she compiles an author biography and origin story for the series gained from interviews with manga creators before analyzing their comments against sociocultural factors around mental disability in Japan (8). Finally, she places the series in the world of reader’s reception by noting any accolades a series received (9). In total, ninety series fit Okuyama’s criteria for tōjisha manga with the five best-of series ultimately chosen for this monograph. These five series make up the second part titled “Case Studies” while the context needed to understand these series is addressed in the first part titled Foundations.

In “Foundations,” Okuyama articulates the merit behind the term “tōjisha.” Who is a “tōjisha?” While the term can be applied to any marginalized person (22), Okuyama convincingly argues that tōjisha can and should be expanded to include those who have firsthand experience as family/caregivers and not just limited to those who have a diagnosis or other signifier of neurological differences. While Okuyama uses the term “caregivers” extensively, there is no implication that tōjisha cannot live independent lives. Rather, Okuyama posits that “caregivers” refer to all those directly involved with this active engagement allowing them to also become tōjisha. Scholars should listen to Okuyama’s push to replace stigmatizing words with tōjisha (i.e., seishin shōgaisha includes the character for “obstacle” which suggests disabilities are harmful hindrances) (43). The third chapter highlights the history of first-person narratives as stories of social change and empowerment, both in Japan and North America. Here Okuyama speaks directly to the reader by presenting complete objectivity as an impossibility because researchers will unavoidably insert bias into their work as a result of their own lived experiences (53). This is central to the allotment of tōjisha manga as legitimate works to conduct research on, and similarly allows tōjisha manga to exist as works which can enact social change when placed in the classroom as informative accounts. There is a fault in tōjisha manga which Okuyama is key to acknowledge – inauthentic representation (56). Okuyama sees that collaboration between tōjisha manga creators and those who live beside them is essential in crafting a more authentic story, and thus has chosen works which reached this standard as much as possible (56). The last chapter of “Foundations” describes essay manga. These are narratives of the creator’s own life explained by the author in the form of a simply drawn protagonist in a world full of humor (85) carefully curated to protect their own identity and of those close to them (88). Tōjisha manga creators also engage in above-mentioned self-censorship (92), but their works differ in that creators are often writing in the aftermath of difficult periods and in doing so can laugh at themselves more easily (93). Conclusively, Okuyama says this ability to live with mental disability, rather than treat it solely as an obstacle, is what allows tōjisha manga to be particularly appealing to non-tōjisha readers who also experience the turbulence of daily life (103). 

The “Case Studies” section focuses on the following five series: the Gaki-tame series by Okita Bakka, the Akira-san series by Nonami Tsuna, Utsunuke by Tanaka Keiichi, the Tsure utsu series by Hosokawa Tenten, and Uchi no OCD by Shiramizu Sadako. The first two chapters focus on manga which addresses neurological differences, namely the Gaki-tame and Akira-san series. The next two turn to accounts of living with depression by means of the Utsunuke and the Tsure utsu series. This section’s final chapter examines tales of obsessive-compulsive disorder with Uchi no OCD. Okuyama’s analysis of the Gaki-tame series establishes how tōjisha manga makes the “invisible” visible by noting the dyspraxia, selective mutism, and hypersensitivity experienced by the author and figured in her illustrations (133). The Akira-san series is written from the perspective of a self-identified non-autistic woman married to an autistic man. Nonami locates herself in the genre of tōjisha manga by illustrating her own experiences with Cassandra Syndrome. At the same time, she understands “that her experience is not generalizable to every neurotypical and neuro-atypical partnership” (172). The argument that manga illustratively communicates life with a mental disability to readers is present in Utsunuke which draws on the idea of the depression tunnel (193) and the Tsure utsu series’ use of motif style depression waves (237). With her analysis of Uchi no OCD, Okuyama returns to her argument that collaboration is what provides creators with the authoritative information to develop a tōjisha work as was the case for Shiramizu and her spouse’s life with obsessive-compulsive disorder (251 – 253). The monograph concludes with a notable “Afterword” given that much of Okuyama’s work was conducted during the COVID-19 public health crisis and the co-occurring second manga boom in the United States. Readers interested in research during crisis may find “Afterword” quite valuable.

Manga scholarship is most convincing when making use of both image and text. Okuyama uses Japanese-language manga pages with English-language descriptions to support why the author chose a motif or other visual elements. While her interviews with creators may be seen as more evident, without these images the voice of the creator would also be muffled. These images are high quality and in full color, showing how even the black-and-white page features more than two stark colors. While I would be curious to see a listing of all ninety series which Okuyama deemed as tōjisha manga, she does reassure us of upcoming projects which feature series excluded from this monograph (12). Textually, Okuyama’s monograph is very accessible as each chapter opens with the key questions under consideration which then allows the reader an experience akin to a classroom lecture where questions and clarifications are welcomed. 

To close, I would like to return to the idea of who has the authority to create these stories and the use of tōjisha manga in the classroom. In “Foundations,” Okuyama admits that to include the caregiver, family, and others who are involved as also tōjisha can be difficult for some to accept (27 – 28). And yet by the end of the monograph, Okuyama’s intervention is particularly convincing. The expanded notion of Tōjisha manga provides multiple viewpoints of a phenomenon, encouraging manga creators to break with self-censorship. Okuyama makes these viewpoints known by interviewing creators and contextualizing their work within the larger world of manga and public discussions on mental health. For instance, her interview with Hosokawa Tenten, author of Tsure utsu, exemplifies how scholars can use information about manga to understand this wider discourse. Rather than simply focusing on high readership and sales, Okuyama highlights authority and authenticity when writing: “In addition to the value of the family’s perspective, Tsure utsu offered a bona fide story about lived experience of depression, for which the public was hungry” (245). This need from the public can be served by tōjisha manga, allowing a close-up of life with mental disability for those who experience it, as self and as caretaker. For that reason, Okuyama argues that tōjisha manga should have a place in health and wellness education (283 – 284).

Yoshiko Okuyama’s Tōjisha Manga: Japan’s Graphic Memoirs of Brain and Mental Health is a welcomed addition to any university library or classroom addressing disability and the genre of the graphic memoir. While Okuyama imagines her target audience as Asian popular culture scholars (5), I would expand the readership to those working in graphic medicine. For those interested in Okuyama’s process in researching and writing Tōjisha Manga, see her article in The Polyphony (“Tōjisha Manga: Japan’s Graphic Memoirs of Mental Disability”). I look forward to Okuyama’s next publication on informative manga that challenges the norm of misrepresenting disability in comics. 


Works Cited

Okuyama, Yoshiko. “Tōjisha Manga: Japan’s Graphic Memoirs of Mental Disability.” The Polyphony, 3 May 2023,

———. Reframing Disability in Manga. University of Hawai’i Press, 2020.

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