At the dawn of telemedicine in Japan, we are slipping into Galapagos syndrome. The main reason for this is that telemedicine remains considered an inferior substitute for in-person practice. As a result, the creative aspect of telemedicine is omitted and it is forcedly incorporated into the national health insurance system with heavy restrictions, making it useless. This occurred in 2018, and was coined "new telemedicine (bright side)" by the author, in contrast to "old telemedicine (shadow side)" , which existed beforehand. The remedy for this syndrome lies in the "shadow side" of telemedicine, which vividly retains the creative aspect of its art. The author presents several psychiatric case reports from the "shadow side", followed by analysis of the characteristics of videoconferencing as a media, and in conclusion, suggests that the "hybrid model" of telemedicine, which utilizes in-person practice and videoconferencing flexibly, will be the future of telepsychiatry.
 Author's abstract