Medical pluralism

By William Wetherall

A review of
Edward Norbeck and Margaret Lock (editors)
Health, Illness, and Medical Care in Japan:
Cultural and Social Dimensions

Honolulu: University of Hawaii Press, 1987

A version of this article appeared in
Far Eastern Economic Review, 140(23), 9 June 1988, page 88

A somewhat different version appeared as
"The Culturally Constituted Boy" in
Asahi Evening News, 13 May 1988, page 11

This collection of revised and edited papers, originally presented at the American Anthropological Association Meeting in Chicago in 1983, is a typical "conference book" in that it remains a mixed bag despite its comprehensive main title. The narrow sub-title should have included "political" since power and influence are important aspects of any health system that "medicalizes" culture and society.

Robert J. Smith sets the stage for this otherwise interesting book in his foreword. Japan has had a pluralistic medical system for over a century in which traditional medicine has fused with modern medicine.

"Over the years a degree of integration has taken place so that the recent boom in the use of herbal medicines is traceable in part to its promotion by Japan's great pharmaceutical houses," Smith writes. "Thus, the Japanese-ever concerned with health and given to equating illness with disorder-enjoy the benefits of medical pluralism and increasingly exploit its diversity.".

Margaret Lock (East Asian Medicine in Urban Japan, University of California Press, 1980) properly introduces the book with a discussion of Health and Medical Care as Cultural and Social Phenomena. This most general and interesting chapter raises the basic issues while looking at recent studies of health and illness in Japan.

Lock and her colleagues are particularly interested in how culture affects the body. "A recent flood of work in medical anthropology and sociology . . . has begun to question persistently the naive assumption that the body physical, because of its constitution from cells, molecules, and liquids, should be exempt from cultural analysis," Lock writes. "Contemporary research sets out to demonstrate that the body is socially and culturally produced and historically situated: it is both a part of nature and society but, at the same time, a representation of the way that nature and society are conceived."

"Medicalization" is another theme that runs throughout this book. Some critics believe that the medical profession "actively creates a market for its services principally by redefining certain behaviors and problems as diseases."

Lock observes that menopause, traditionally just a transition in life, has become highly medicalized in the west. One important cause of this has been "the aggressive marketing of estrogen replacement therapy and its adoption by gynecologists in their belief that it is an effective cure for symptomatology at menopause, which has been redefined in the medical literature as a 'deficiency disease'."

Lock herself has done a survey which "shows that Japanese women do not suffer to anything like the same degree from the symptoms that are commonly associated with menopause in the West." She wonders why: genetic, dietary, or climatic variation? cultural interpretation of symptoms? medicalization? She thinks all three.

William Steslicke describes Japan's medical care system in a chapter called "The Japanese State of Health: A Political-Economic Perspective". The eighteen tables, graphs, and charts reflect an uncritical dependence on official statistics, and there is little trend analysis.

A more detailed account of the powerful and controversial Japan Medical Association, which Steslicke mentions only in passing, is found in "Health Care Providers: Technology, Policy, and Professional Dominance" by Susan Long, who gives a closer look at the history of biomedicine in Japan, and how it has come to co-exist with traditional medicine. But she, too, sidesteps the problem of structural corruption in Japan's highly politicized medical world.

The next chapters jump to "Care of the Aged in Japan" by Christie Kiefer, a competent student of this subject, and to "Japanese Models of Psychotherapy" by David Reynolds, who has written extensively (and almost religiously) on "quiet therapies" like Morita and Naikan.

The final two chapters deal with women. Margaret Lock returns with "Protests of a Good Wife and Wise Mother: The Medicalization of Distress in Japan", and Nancy Rosenberger writes on "Productivity, Sexuality, and Ideologies of Menopausal Problems in Japan". But don't expect much about abortion or the pill.

Editor Lock notes that "it is unfortunate that no contributions to this volume have been made by Japanese researchers, an unavoidable result of the exigencies of current funding in the social sciences." She does not explain why money should have excluded Japanese papers. Nor does she suggest how Japanese views might have differed from those of American anthropologists using Japanese sources.