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Background Within the vague system of primary care and COVID‐19 infection control in Japan, we explored how primary care (PC) physicians exhibited adaptive performance in their institutions and communities to cope with the COVID‐19 pandemic from January to May 2020. Methods Narrative analysis conducted by a team of medical professionals and anthropologists. We purposefully selected 10 PC physicians in community‐based hospitals and clinics and conducted a total of 17 individual and group interviews. The verbatim transcript data were analyzed using the conceptual framework of adaptive performance. Results We identified three “phases” of the time period (January–May 2020). In Phase 1, PC physicians initially perceived the disease as a problem unrelated to them. In Phase 2, the Diamond Princess outbreak triggered adaptive performance of the physicians, who began to deal with medical issues related to COVID‐19 by using social networking services and applying the collected information to their organization and/or communities. Following this, in Phase 3, the PC physicians’ adaptive performance in their own communities and institutions emerged in the face of the pandemic. Reflecting their sensitivity to local context, the PC physicians were seen to exhibit adaptive performance through dealing with context‐dependent problems and relationships. Conclusions PC physicians exhibited adaptive performance in the course of coping with the realities of COVID‐19 in shifting phases and in differing localities in the early stages of the pandemic. The trajectories of adaptive performance in later stages of the pandemic remain to be seen.

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Labeling is a fundamental component of stigma, which allows the identification of features or behaviors that are then stereotyped and made into targets of discrimination. In Japan, the label applied to the condition known in the DSM and International Statistical Classification of Diseases and Related Health Conditions as "schizophrenia" was revised in 2002 from "mind-split disease" to "integration disorder," intending to alleviate stigma associated with this condition. However, there has been little research examining the effect of the label itself on stigmatizing attitudes, particularly in relation to other mental health conditions, such as depression, or nonclinical cultural idioms of distress, such as hikikomori (i.e., social withdrawal or, literally, "pulling inward"). In this vignette study, we examined the influence of labeling on mental illness stigma by randomizing the label attached to a set of diagnostically ambiguous cases and assessing attitudes regarding these cases among an Internet-based sample of Japanese adults (N ϭ 192). Using within-subjects analysis of variance, we found that both schizophrenia labels, "integration disorder" and "mind-split disease," were similarly associated with the greatest levels of stereotype awareness but not any other components of stigma. The schizophrenia-labeled cases were also viewed as being more biologically rather than socially caused, compared to depression and hikikomori. Compared to hikikomori, all 3 clinical label conditions (both schizophrenia labels, plus depression) were rated as having a greater need for clinical treatment. Overall, there were no significant differences between the 2 schizophrenia labels on any outcome measure, whereas the nonclinical label was associated with less perceived need for treatment, greater social causation, and less perceived unpredictability.