1. History

The first case of karōshi was reported in 1969 with the stroke-related death of a 29-year-old male worker in the shipping department of Japan 's largest newspaper company.^[1] The term was invented in 1978 to refer to an increasing number of people suffering from fatal strokes and heart attacks attributed to overwork. A book on the issue in 1982 brought the term into public usage.

It was not until the mid to late 1980s, during the Bubble Economy, when several high-ranking business executives who were still in their prime years suddenly died without any previous sign of illness, that the term emerged into Japanese public life. This new phenomenon was immediately seen as a new and serious menace for people in the work force. In 1987, as public concern increased, the Japanese Ministry of Labour began to publish statistics on karōshi.

In 1988, the Labor Force Survey reported that almost one fourth of the male working employees worked over 60 hours per week, which is 50% longer than a typical 40-hour weekly working schedule. Realizing the seriousness and widespread nature of this emerging problem, a group of lawyers and doctors set up “karoshi hotlines” that are nationally available, dedicating to help those who seek consultation on karoshi related issues.^[2]

Japan's rise from the devastation of World War II to economic prominence and the huge war reparations they have paid in the post-war decades have been regarded as the trigger for what has been called a new epidemic. It was recognized that employees cannot work for 12 or more hours a day, 6–7 days a week, year after year, without suffering physically as well as mentally. It is common for the overtime to go unpaid.^[3][4]

In an International Labour Organization article about karōshi,^[5] the following four typical cases of karōshi were mentioned:

1. Mr. A worked at a major snack food processing company for as long as 110 hours a week (not a month) and died from a heart attack at the age of 34. His death was recognized as work-related by the Labour Standards Office.
2. Mr. B, a bus driver, whose death was also recognized as work-related, worked 3,000 hours a year. He did not have a day off in the 15 years before he had a stroke at the age of 37.
3. Mr. C worked in a large printing company in Tokyo for 4,320 hours a year including night work and died from a stroke at the age of 58. His widow received workers' compensation 14 years after her husband's death.
4. Ms. D, a 22-year-old nurse, died from a heart attack after 34 hours of continuous duty five times a month.

As well as physical pressure, mental stress from the workplace can cause karōshi. People who commit suicide due to mental stress are called "karōjisatsu (過労自殺)." The ILO also lists some causes of overwork or occupational stress that include the following:

1. All-night, late-night or holiday work, both long and excessive hours. During the long-term economic recession after the collapse of the bubble economy in the 1980s and 1990s, many companies reduced the number of employees. The total amount of work, however, did not decrease, forcing each employee to work harder.
2. Stress accumulated due to frustration at not being able to achieve the goals set by the company. Even in economic recession, companies tended to demand excessive sales efforts from their employees and require them to achieve better results. This increased the psychological burden placed on the employees at work.
3. Forced resignation, dismissal, and bullying. For example, employees who worked for a company for many years and saw themselves as loyal to the company were suddenly asked to resign because of the need for staff cutbacks.
4. Suffering of middle management. They were often in a position to lay off workers and torn between implementing a corporate restructuring policy and protecting their staff.

2. Karoshi Hotline

In a 1988 report published by the Karoshi Hotline Network, the majority of the clients who consulted were not workers, but the wives of the workers who either passed away because of karoshi or had a high potential of.^[6] This indicated that those who were stressed out by work either did not realize the cause was overworking or were under social pressure to not express it explicitly by seeking help.

The Karoshi Hotline received the highest number of calls when it was first established in 1988. From 1988 to 1998, there were a total number of 1806 calls received. From 1990 to 2007, the number of calls received per year decreased, but still maintained an average of 400 calls per year.^[7] Its availability is nationwide, ranging from Hokkaido(北海道) to Kanto(関東).^[8]

3. Effects on Society

Suicide can be induced by overwork-related stresses or when businessmen are laid off from their jobs.^[9] The deceased person's relatives demand compensation payments when such deaths occur. Life insurance companies started putting one-year exemption clauses in their contracts.^[9] They did this so that the person must wait one year to commit suicide in order to receive the money.^[9]

There is a new movement of Japanese workers, formed as a result of karōshi. Young Japanese are choosing part-time work, contrary to their elder counterparts who work overtime. This is a new style of career choice for the young Japanese people who want to try out different jobs in order to figure out their own potential. These individuals work for "hourly wages rather than regular salaries,"^[10] and are called "freeters." The number of freeters has increased throughout the years,^[10] from 200,000 in the 1980s to about 400,000 in 1997.^[10]

Freeters undergo a special kind of employment, defined by Atsuko Kanai as those who are currently employed and referred to as "part-time workers or arbeit (temporary workers), who are currently employed but wish to be employed as part time workers, or who are currently not in the labor force and neither doing housework nor attending school but wish to be employed as part-time workers."^[11] Freeters are not in school, are aged 15–34, and if they are women, are unmarried. The movement of the freeters has its problems, however. Most freeters fail to launch successful careers, based on a few factors.

Due to their part-time work, their annual income is around 1 million yen, or around $8,500 USD. Also, economic growth in Japan is slow, making it difficult for freeters to switch to regular employment. Another problem is that freeters are given menial tasks, which makes it almost impossible to gain any real experience, which is necessary when converting to full-time employment. (Kanai, 2003) It may seem as if being a freeter is the answer to the overworked, near-karōshi individual suffering from long work hours. Those who are being non-regular employees or freeters who are supposedly wanting to only work part-time are finding themselves working 60 hours a week or more. Since non-regular employees' wages are so low, it is necessary for them to work longer hours, negating the desire to be a freeter. Freeters are now facing the risk of karōshi, just as regular workers have, due to their long hours.

There are other undesirable results, other than karōshi, that arise from working long hours. A psychological trait known as workaholism has been shown to lead one to work long hours. (Spence & Robbins, 1992) There are three defining factors of workaholism: high work involvement, being driven to or compelled to work by inner pressures, and low enjoyment of work. (Kanai, 1996). The last of these factors suggests a contradiction. However, Kanai argued that workaholism is not a psychological trait, but rather results from adaptation to that work demand overload. Individuals that overload on work are not doing so because they are workaholics, but that the demand of the workload brings out psychologically and behavioral characteristics similar to those with workaholism. Management welcomes hard work and rewards with promotions. Morioka (2005), suggests that in order to eliminate the harmful effects of workaholism, the workplace should be responsible for managing workload issues.

Overworking also has a negative effect on the family. Men who become too busy with their jobs think less about their family. High levels of family depression exist as a result. As the men focus on their jobs, they tend to develop negative feelings towards family. They take on less of a role in family life as they continue to overwork. The men see the family as something that is taking away from their work, which creates a resentment toward the family. As a result, avoidance of family time increases, even though it is their family that inspires them to work hard in the first place (Kanai, 2002). Kanai's findings suggest that excessive working hours are harmful to family life, not only in that are they spending less time with their families, but that they also develop hostility towards the family.

However, it could also be said that the men had taken on these jobs for the sake of providing for their family, but ultimately become less effective as a resource due to their exhaustion and complete focus on earning money. It is likely salarymen go into that lifestyle simply for the money, because the jobs pay well; if they work long hours, they can earn large sums of money and send it to their families to help provide for them, since in traditional Japanese families, the father is usually the main worker in the household. In an interview, a man had said that "the best thing about being born male was, 'having a family, and being able to support that family.' Conversely the worst thing was 'being unable to quit your job even if you want to' due to the same responsibility."^[12] The responsibility men have to provide for the family correlates with their masculinity, so if a man gets laid off he may think that "their own ability is really poor, and would get quite depressed."^[13] These pressures are ones that society puts on them, since it is expected that the men work and provide for the family.

The Cabinet Office analyzes the Household Survey on the Quality of Life to examine how large of an impact overwork has on health issues, including karoshi. The study finds that a long weekly working schedule, which is defined as over 60 hours for men and over 45 hours for women, significantly increased the anxiety of employees who believe they will be suffering from health issues. In other words, regardless of whether employees had health issues, merely working for longer hours created anxiety towards perceived health issues. The 15-hour gap between men and women does not mean that women are less capable of dealing with stress, but is because of the traditional Japanese value that puts the burden of taking care of children and other mundane household tasks on women. Women thus have much larger range of responsibilities to be concerned with, in addition to their everyday jobs.^[14]

The suicide prevention hotline in Japan is often so busy, callers occasionally have to try between 30 and 40 times until they can get an answer.^[15] Each year, roughly 30,000 people in Japan commit suicide.^[15] A potential reason why the number is so high could be the kind of camaraderie involved in the process of committing suicide, where people will spend time searching online to find other suicidal individuals and then "make plans to die together."^[15]

4. Government Policies

To provide a strategic plan on how to decreases the rate of karoshi, the National Institute of Health proposed the establishment of a comprehensive industrial health service program to reduce karoshi and other disease caused by work-related stress in its 2005 annual report. The program requires communal efforts from three different groups, the government, the labour unions and employers, and the employees. The government, as the policy maker, should promote shorter working hours, make health services readily accessible, encourage voluntary health examination and enhance the effectiveness of medical care. As the group that is more closely involved with the everyday health of employees, labour unions and employers should strive to implement and comply with government policies that focus on reducing work overtime and create a better work environment. The employees themselves should recognize their needs to take rests promptly and take preventative measures as needed.^[16]

As a formal response to this proposal, the Industry Safety and Health Act was revised in 2006. The Act established various terms that focus on work-related health issues, including mandatory heath checks and consultations with professional medical personnel for employees who work long hours and have a higher possibility of having work related illness.^[17] It might seem to be an odd decision, speaking from an economic standpoint, to use government policy to force companies to reduce work hours. It seems to be counterproductive of the profit maximizing nature of market economy. This counterintuitive intervention, according to Yoshio Higuchi, is attributed to the several factors unique to the Japanese society. Traditionally, Japanese workers are very loyal employees.^[18]

It is very common for someone to work for the same company from a freshly out of school graduate to a nearly retired man. The society also views those who constantly change jobs with skeptical eyes. Such discouragement directly caused the difficulty in moving into new jobs. Thus, companies usually have a much higher bargaining power when it comes to “exploiting” their employees. In order to cut costs, companies would usually demand their employees work for longer hours instead of hiring someone to take over part of the workload. Therefore, if the government does not intervene and mandate companies to reduce working time, no orders would be taken seriously.^[18]

The current Labor Standards Act is not effective if the majority of the representative employees agree with working over 40 hours per week, despite clauses in the Act prohibits such overtime. A study by the Cabinet Office of the Economic and Social Research Institute of Japan (the Cabinet Office) pointed out that refusing to consent with the ILO's treaty on work time regulations could be a large contributing factor to the current state of the labor market.

5. Salaryman

A Japanese businessman, also known as a salaryman (サラリーマン, "sararīman"), is often a victim of karōshi due to the strenuous work hours their job requires, in addition to the mandatory after-hours socializing and drinking that their jobs require.^[19] Often these salarymen are invited to nomikai, or "drinking parties," to build better connections between coworkers in the company.^[19] According to an article on Gaijinpot, "A common saying in Japan is, 'if you want to work your way up the corporate ladder you have to drink.' This was how many older generation workers established relationships and considered this the normal way of doing business."^[19]

According to these values, a key to business success was a willingness to go out and participate in this mandatory socializing with coworkers. Since not everyone can keep up with the pace and immersion of salaryman life, stress-induced death became fairly common. Due to this high-stress nature of a salaryman's job, death by cardivascular diseases or mental disorders were some of the two biggest factors.^[20]

Since Japanese businessmen are under a lot of work-related pressures, karōshi suicides have increased, especially due to economic crises.^[21] Even those that were able to keep their jobs, after their company laid off multiple employees, experienced a large increase in work. "In 2000, 28% of regular Japanese employees worked 50 hours or more per week, compared to 16% to 21% in New Zealand, United States , Australia and the United Kingdom and less than 6% in 13 other industrialized nations."^[21]

Businessmen in Japan have been overworked, but physicians specifically have been feeling great pressures of being overworked, while still facing a moral obligation to continue. Physicians work an average of 65 hours a week or more.^[22] "They are reaching the limit in terms of the number of service hours they can provide without risking their own health.”^[23] The government used to have restrictions on the number of physicians that could attend medical school, but now they have increased medical school enrollment.^[23] It takes years for physicians to become qualified, so it is critical that alternative measures come into play before karōshi takes a toll on physicians in Japan.

6. Corporate Response

A number of companies have been making an effort to find a better work-life balance for their employees. Toyota, for example, now generally limits overtime to 360 hours a year (an average of 30 hours monthly), and, at some offices, issues public address announcements every hour after 7 p.m. pointing out the importance of rest and urging workers to go home. Nissan offers telecommuting for office workers to make it easier to care for children or elderly parents.^[4] Dozens of large corporations have also implemented "no overtime days", which require employees to leave the office promptly at 5:30 p.m. However, since their workload is too high, few workers can actually take advantage of this, and opt to stay in the office with the lights off or to simply take their work home, "cloaked overtime" called "furoshiki" (風呂敷) after the Japanese traditional wrapping cloth.

In 2007, Mitsubishi UFJ Trust & Banking, a division of Japan's largest banking group, started to allow employees to go home up to 3 hours early to care for children or elderly relatives. As of January 5, 2009, just 34 of the company's 7,000 employees had signed up for the plan.^[4]

In February 2017, Japanese Government launched a campaign called "Premium Friday" asking companies to allow their workers to leave at 3pm on the last Friday of the month. The initiative is part of an attempt to address the punishingly long hours many Japanese are expected to work, prompted by the suicide of a 24-year-old employee at the advertising firm Dentsu who was doing more than 100 hours' overtime in the months before her death. While some major companies, such as Honda, the drinks maker Suntory and the confectioner Morinaga, have adopted the optional scheme, others are less enthusiastic about the prospect of a mid-afternoon staff exodus. A survey of 155 big companies by the Nikkei business newspaper showed that 45% had no immediate plans to implement the scheme, with 37% saying they had either decided to enter into the spirit of Premium Friday or had plans to do so.^[24]

The problem with unpaid overtime in companies is that the overtime is simply not recorded in many cases. The amount of overtime is regulated by labor regulations, so, in order to not contradict labor regulations, workers are told not to record the overtime, since it would be considered an illegal action from the side of the company. The workers themselves often rationalize this by attributing the overwork to lacking skills from their side, describing a lack of familiarity with the work, "not being trained enough" as the cause for not being able to finish in a more timely manner. In general, overtime is something that is accepted as part of work, and protest against it is rare, due to concern for the reaction of colleagues, superiors and even family and friends.

"Seken" (世間), or the "public gaze" (others' opinions about one's behavior) is a strong cultural factor in this. It is safe to assume that most statistics of overtime in Japanese companies are not accurate, since overtime is not recorded in many occasions. It is not uncommon for many Japanese employees to work late hours until 2-3am, and being expected to be in the office again at 9am. In some cases (especially in subsidiaries of big listed companies that have to cope with the pressure of parent companies, who generate margins through exploitation of daughter companies) employees have been reported to have worked 300 hours of overtime in a single month. These statistics are in almost all cases not official, and most employees would always refrain from making such statements to authorities or the press, nor would they agree to be named.

7. China

In China, the analogous "death by overwork" concept is guolaosi (Traditional:過勞死 Simplified:过劳死), which in 2014 was reported to be a problem in the country.^[25] In Eastern Asian countries, like China, many businessmen work long hours and then feel the pressures of expanding and pleasing their networks. Making these connections is called building guanxi. Connections are a big part of the Chinese business world, and throughout different parts of China, businessmen would meet up in teahouses to take their job outside of the work atmosphere. It was important for businessmen to broaden their guanxi relationships, especially with powerful officials or bosses.^[26]

There is a lot of pressure to go to these nightclubs almost every night to drink heavily to move up in the business world.^[27] It has been shown that this kind of work could lead to health related problems down the line. For example, a businessman named Mr. Pan discussed with John Osburg, an anthropologist who wrote “Anxious Wealth: Money and Morality Among China's New Rich,” about his health and the need to continue working. Mr. Pan, the 'biggest boss in Chengdu,' was in the hospital for 'excessive drinking.' This has happened to him before. Mr. Pan said, “I can't stop or slow down. I have many people whose livelihoods depend on me (literally 'depend on me to eat.'). I've got about fifty employees and even more brothers. Their livelihoods depend on my success. I have to keep going.”^[28]

8. South Korea

In South Korea, the term gwarosa (과로사) is also used to refer to death by overworking. South Korea has some of the longest working hours in the world, even more so than Japan with the average being 68.^[29] This has caused many workers to feel the pressure of their jobs which has taken a toll on both their physical and mental health. Many have died from being overworked and the issue has only begun to gain more national attention due to many government workers having died from gwarosa.^[30] In order to reduce many problems caused from overworking, the government enacted a law cutting the working hours from 68 to 52.^[31]

9. Media Attention

The French-German TV channel Arte showed a documentary called "Alt in Japan" (Old in Japan) on 6 November 2006 dealing with older workers in Japan. In 2008, karōshi again made headlines: a death back in 2006 of a key Toyota engineer who averaged over 80 hours overtime each month was ruled the result of overwork. His family was awarded benefits after his case was reviewed.^[32]

Taiwanese media have reported a case of karōshi.^[33] An engineer had worked for Nanya Technology for 3 years from 2006 to 2009. It was found that he died in front of his computer which was surrounded by company documents. The prosecution found that the engineer had died of cardiogenic shock. The engineer's parents said that he had usually worked for 16–19 hours a day. CNN shows another reported case of karōshi in Taiwan.^[34] This short clip called "The Dangers of Overwork" shows a man who suffered a stroke and was left for three hours until taken to the hospital.^[34] It was made known that physicians are starting to make people more aware of these health deficits due to overworking. More people have been visiting their doctor, recognizing these signs and symptoms.^[34]