T O K Y O, Sept. 4, 2001 -- Mostly it's the men who do it, quietly and almost always alone.
And being Japanese, they don't allow themselves to talk about it. They'd rather die.
Last year, more than 31,957 people killed themselves in Japan, one of the most affluent and advanced societies in the world.
They didn't die of plague, or starvation or natural catastrophe; they died because they just couldn't stand to live any longer, and following the stern rules of their culture they didn't ask for help.
The figures for 2000 reflect a slight decrease of 1,091 from the previous year but still, an average of almost 100 people kill themselves every day. There are higher rates in other countries, but none with such a high level of economic and industrial development.
The United States has about the same number of suicides as Japan annually, but Japan has a total population of 126 million compared to the United States' 275 million.
Almost three-quarters (71 percent) of the suicides last year were Japanese men.
This doesn't surprise Dr. Tia Powell, an American psychiatrist trained at Harvard, Yale and Columbia, who now lives and works in Tokyo. She told ABCNEWS.com that in her experience in Japan, suicide is almost always the result of depression, which may or may not be linked to outside events, like losing a job.
Ironically, with new advances in medicine, depression is now relatively treatable.
But there is a tricky aspect to getting a depressed person in Japan the help that he or she needs. In Japan, mental illness is still commonly defined not in terms of "chemical imbalance" or "illness" … but in the much more shameful terms of "weakness."
And for Japan's men, admitting such a "weakness" is generally unthinkable. Rather than ask for help, they hang themselves, or jump in front of trains … this century's lonely versions of ritual suicide.
Japanese women who want to die sometimes choose death by drowning, or they overdose on medication.
Looking for Lifelines
Another factor is Japan's health system and its prevention of the sale of anti-depressants, which for years have been routinely prescribed in the West.
Prozac, which is widely used throughout the world, has not been approved for use in Japan. Neither has the popular Zoloft. Paxil was only recently allowed.
Japan's health system provides low-cost treatment to all, but local clinics used by most people are staffed by doctors lacking training in, or unwilling to diagnose, depression.
Clinical psychologists are not allowed to examine patients independently of of general practitioners.
"Mental-health problems have not been considered as important as physical problems, so the status given to psychology professionals has accordingly been low," Yoshitaka Otsuka of Japan's Certification Board for Clinical Psychologists recently told Newsweek magazine.
Powell says the Japanese government could do a lot more to educate the public about depression and these new and available treatments. She believes the old days of doctors telling troubled and miserable Japanese patients that they should just go home and "forget" about their problems are, if not completely over, at least coming to an end.
There are several telephone "life lines" now available to help the desperate.
And Powell says something new, and considered locally as almost revolutionary, is now gaining ground; Japanese companies offering counseling at work, for employees who want help.
This simple step may not sound like much to Americans, who see no stigma in seeking professional help if they feel they need it.
But in Japan, where "face" is everything and "losing face" is shameful, getting help is a major undertaking only a handful of Japanese are pursuing.