Everything in life happens for a reason.

Internist and media personality, Dr. Fumie Otawa currently works as a prison doctor, treating inmates within correctional facilities. However, her journey to this path involved forty years of harrowing experiences with her drug-addicted mother. She now reflects on her tumultuous life, offering insight into her beliefs that define her as a physician.

——From what I understand, you are active in many fields, often appearing in the media and giving lectures. But you also work as an internist treating inmates, correct?

Dr. Otawa: Yes. Physicians who work to maintain the health of inmates in prisons, detention centers, and juvenile facilities are called prison doctors or correctional medical officers. As of 2022, there are only 291 such practitioners, representing just 0.086 percent of all physicians in Japan. Some work full-time, while others balance this duty with work in outpatient departments at other hospitals or research at university institutions.
　I have been involved in correctional medicine on a part-time basis since 2018 and currently see patients about ten days a month across two or three prisons in the Tokyo metropolitan area.

——What kind of medical care do you provide within prisons?

Dr. Otawa: My patients, the inmates, all have diverse criminal backgrounds, from those convicted of murder to rape to those with chronic drug addictions. My primary role is to provide ongoing treatment for those suffering from cancer, lifestyle-related diseases, mental illness, and other conditions. While correctional facilities have limited medical equipment, which restricts what kind of medical care we can provide, it is fundamentally no different from general medical practice. I have always made a conscious effort to adjust my approach and treatment methods based on each patient's personality and background.
　People often ask me if I’m afraid to work in a prison, but I have never felt afraid. Guards are always present during medical consultations, and by the time inmates enter prison, they don't have access to weapons of any kind.
　I fulfill my role as a physician hoping that they can complete their sentence safely until the day of their release, and that they have improved in at least one way since they entered the facility.

——If you do not mind, could you share with us the foundation of your medical career and the path that has led you here?

Dr. Otawa: I was born as the only daughter of a general practitioner in Katsushika Ward, Tokyo. I loved my easygoing father, and from an early age, those around me expected me to follow the same path as him. Before I knew it, I had accepted that becoming a doctor was my role in life.
　My mother, a former nurse, seemed especially desperate for me to become a physician. The shift began with my elementary school entrance exams, and she transformed into what you might call a tiger mom, one that is obsessed with every aspect of my life. I was scolded if I wasn't the best at piano, violin, and English. For my study session, she imposed a daily quota of math questions, standing over me with a stopwatch. If I was even a second over the time limit, anything within her reach would come flying my way. Once, a stone ashtray hit me directly in the forehead and drew blood.

——It sounds like you had an abusive upbringing.

Dr. Otawa: And yet, I never once thought of my mother's behavior as abuse. My mother suffered from headaches and stomach pain and was naturally prone to mood swings. Moreover, I had no other family to compare mine to, so I concluded this was how all mothers were.
　The gears in our household began to spin out of sync when I was in the tail end of elementary school. Every time my mother complained of stomach pain, my father would prescribe painkillers, but they soon stopped working. He then prescribed a newly released opioid injection, which worked extremely well.
　Just around this time, I had become more independent and began to study on my own without my mother's supervision, and I believe that left a void inside of her. As if to fill that emptiness, she gradually began to use more of the medicine. We saw that the medicine softened her expressions, but neither I nor my father, who was a physician, realized this relief came from the state of euphoria the drug induced.
　I learned the truth of our situation during my clinical training at Tokyo Women's Medical University. Among the drugs that are strictly controlled, I found my mother's. When I asked the supervising physician, he explained that while opioids are legal, they are compounds similar to narcotics that produce a powerful sense of euphoria in the user, leading many to become addicted. The realization was devastating and everything went dark. My mother was using a dangerous drug. This was the beginning of my family's long battle.

——What was it like at the start of this struggle?

Dr. Otawa: My father and I immediately contemplated our course of action and decided to take away the injections from my mother. However, this sent her into fits of rage like a child. Her dependency on the medicine had become severe, and her skin was scarred with keloids. My father would sometimes reluctantly give her the drugs, being worn down by her constant begging and tears.
　I desperately searched for a specialist who could help somehow, but the 1980s was a time when treatment for addicts was scarce. Even when we had her admitted to the isolation ward of a psychiatric hospital, we understood that keeping her away from the drugs was only a temporary measure, and her condition continued to worsen.
　Repetitively, I reasoned with her and there were moments when she would promise to quit; however, her promises were the sounds of a broken record. Her constant relapses left me completely exhausted. When I began my busy life as a resident physician, I left home as if to escape this ordeal, putting distance between us to minimize my involvement.

——How did you find hope from such a place?

Dr. Otawa: When I was in my thirties, after marrying at twenty-seven and as my media work began to grow alongside my medical practice, my father called to tell me, “Your mother has started becoming violent.” When I rushed to my parents’ home, I found used syringes scattered throughout the house. While I was gone, my mother's addiction had spiraled completely out of control, and she had become so violent that she would attack my father when he tried to stop her.
　The situation forced me to redouble my search for a specialist, which led me to the late Dr. Michio Takemura, an authority on addiction. This meeting became a major turning point. When I visited Dr. Takemura seeking salvation for my family, he made an unbelievable suggestion. He proposed that my father and I should first be hospitalized.

——He recommended that the family be hospitalized?

Dr. Otawa: Yes. At first, I was dumbfounded and asked for his rationale. He explained that after years of being entangled with her addiction, we too had already fallen into a pathological state. He persuaded us that it was essential for the family to first recover themselves. So, my father and I were hospitalized for two weeks at an addiction treatment facility in Akagikogen in Gunma Prefecture.
　At the facility, I participated in daily family meetings and had the opportunity to talk with the families of others struggling with various addictions, individuals dealing with drugs, alcohol, gambling, and many more. Connecting with these families not only deepened my understanding of addiction, but also brought comfort, knowing that we were not alone in our suffering. That was the greatest solace for my weary heart.

——What happened after your time at the facility?

Dr. Otawa: One thing I learned from our hospitalization was that while it was difficult to change my mother, we could change ourselves.
　Until then, the pity we felt for our mother made us complicit, trapping us in a cycle where we enabled her addiction by providing the very substance that harmed her. To break this chain, my father completely stopped procuring her medications. At first, my mother went from one pharmacy and hospital to another, but once she understood the drugs were beyond her reach, she gave up and stopped asking for them.
　Just as my mother was trying to break free from an addiction that lasted over twenty-five years, my father was diagnosed with liver cancer. He fought it for a year. However, he passed away in 2003 at the age of seventy-six.
　In his final moments, my father shed a single tear while unconscious. I felt his tear contained a world of emotion, the sorrow of parting and his regret for my mother.

——I am sorry for your loss.

Dr. Otawa: To me, my father was more than just a parent. He was a comrade-in-arms who had fought alongside me. With my emotional pillar gone, I was tormented by overwhelming loneliness, unsure of how to face the future.
　Meanwhile, my mother's addiction shifted from drugs to TV shopping, which was popular at the time. Moreover, she didn't even appear at my father's funeral. After his death, her abnormal behavior became increasingly erratic.
　She would call me dozens of times a day, and when I didn't answer, she would call an ambulance and cause a scene, or spread groundless lies about me to relatives and acquaintances. Here I was, fighting to protect my father's clinic after inheriting it, and she was relentlessly causing trouble. I was reaching my limit.
　“If this continues, I might kill my mother.” That thought flashed through my mind and I knew in that instant I had to sever my relationship with my mother. So, I did and became virtually alienated from her.

——So, you became estranged from your mother.

Dr. Otawa: I still wonder if there was a better path. But at that time, I saw no other choice. I entrusted her care to helpers, but after five years, in 2013, my mother died alone from a heart attack. Coincidentally, she lived to be seventy-six, the same as my father.
　In death, her visage was more peaceful than any other expression she had in my memory. In a way, she looked relieved. I am sure her life was deeply painful for her as well. She was tossed about by addiction, and in the process, she caused so much pain to her family.

——How did you come to be a prison doctor?

Dr. Otawa: For most of my life, I lived believing my purpose was to fulfill my mother's expectations and to succeed my father. But after both my father and mother passed away, the anchors that held me in place were gone. I was uncertain whether I should continue being a doctor.
　I agonized over the decision, but I felt as if my father was giving me permission to let go. In 2017, I decided to close the clinic I had inherited from him. I then took the certification exam to become a specialist in general internal medicine that can provide comprehensive care. The exam was known as the most challenging test for internists, and I told myself that if I failed, I would leave the medical profession for good. With that ultimatum, I cut off any escape routes, studied intensely for six months, and passed.
　Just as I was considering whether to continue my medical career, an acquaintance asked me if I ever considered working as a correctional medical officer. The idea of such work never crossed my mind, but after I visited a prison, I had an intuition that it might suit me. When I heard stories about drug crimes, I knew I could understand due to my experience with my mother.
　There, within the prison walls, I might be able to finally utilize my unique experience of living with a mother who was a drug addict. I had found the answer I had been searching for all along: perhaps this was the very reason I had become a doctor. With that sense of purpose, I stepped into the examination room inside the prison.

——So, after days filled with struggles and pain, you found your true calling.

Dr. Otawa: Indeed. They had limited medications and equipment; however, I was not intimidated by the situation, as my prior experience providing medical care atop the Northern Alps in the summer had prepared me for such struggles. When I think about it that way, I see how even our most painful experiences ultimately serve some purpose. I truly feel that nothing in life is ever wasted.

——What is your guiding philosophy when treating inmates?

Dr. Otawa: As I mentioned earlier, it's basically no different from general medical care, but I do strive to guide them toward living a stable, dignified life. I try to impart to them the importance of the simple and ordinary, such as getting up in the morning, working during the day, and eating meals regularly.
　With that goal in mind, I introduced the Laughter Exercise Program, the first of its kind in Japan in 2019, as part of our efforts to support inmate rehabilitation. These exercises are based on laughter yoga devised by Dr. Madan Kataria of India, and have been proven to have various benefits such as pain relief and increased mental stability.
　Many inmates have lived without knowing how to laugh. I myself originally disliked laughing. During the years I spent fighting with my mother, I couldn't laugh at all. But when I was laughing through the exercises, I felt foolish for dwelling on unpleasant thoughts. I came to see that laughter wasn't so bad after all. That is why I personally appealed to the warden until they approved it.

——How did the inmates respond?

Dr. Otawa: After years of life behind bars, they found it very difficult to laugh at first. Still, as they exercised, while making sounds, their expressions softened. After thirty minutes had passed, everyone was laughing with a newfound complexion that was brighter.
　Fortunately, post-session surveys have yielded many positive comments. One inmate wrote, “I had forgotten how to laugh, but that felt good.” When they return to the outside world, they'll inevitably face an assortment of encounters and situations that might make them angry or unpleasant. But if they can laugh during difficult times, their mood might calm down and help prevent them from reentering the system. My hope is that they carry this exercise in the back of their minds and that it sparks some positive change in their lives.

——You've traversed a painful path unknown to most, carving out your own path as a doctor.

Dr. Otawa: Thank you. In my youth, it was just so painful. I lost count of the days I cried. People would often tell me how they envied my life, seeing me on television and assuming it was a wonderful one. Inside I would cry out, “If you are envious of my life, trade places with me.”
　But humans are strange creatures, and there always comes a day when we realize that none of our sorrows were insurmountable. Now, I feel that my life has not been a terrible one. In fact, I can say I am happy. When the sky is clear, or when I smell flowers blooming by the roadside, I feel grateful for small, daily blessings. It is precisely because I had endured years with my mother that I can appreciate the simple things and feel happy from the bottom of my heart.
　Indeed, no experience in life is ever wasted. And I believe that there are no hardships from which we cannot ultimately rise above.

——That is a wonderful life philosophy.

Dr. Otawa: As a doctor, I don't harbor grand ambitions of achieving something monumental or changing society or other such lofty goals. After all, I couldn't even change my own mother. But what I can do is apply myself wholeheartedly to what's in front of me. I walk this path as a doctor in a prison holding onto the belief that even if ninety-nine individuals cannot be reached, the hundredth might just find a way to change.