Taboos and traditions

By William Wetherall

A review of
Emiko Ohnuki-Tierney
Illness and Culture in Contemporary Japan:
An anthropological view

London: Cambridge University Press, 1984 xiv, 242 pages, hardcover

A version of this article appeared in
Far Eastern Economic Review, 127(4), 31 January 1985, pages 40-41

After studying the Ainu Japanese minority for sixteen years and living in the U.S. for two decades, University of Wisconsin anthropologist Emiko Ohnuki-Tierney decided to apply her training and experience to her own Yamato Japanese majority culture. She writes for both scholars and motivated general readers "to fill the gap in available publications by describing the medical systems of contemporary Japan, whose society is modernized in every sense of the word, and yet whose medical systems in many ways present striking contrasts to those of Western societies dominated by the biomedical tradition" -- her word for what others call cosmopolitan, Western, scientific, or simply "modern" medicine.

A chapter on "Japanese germs" concludes that things perceived and experienced "inside" or "above" are "pure" in contrast with the "impure" things that are "outside" or "below". Hence shoes which bear outside germs are removed in the entrance way, while hands and throats which may also bear germs are ritually washed and gargled. But even the most polluted outlander who has lived in Japan for more than a few days will frown at the author's tendency to exaggerate reality.

She states, for example, that "despite the rapid modernization that has brought about many drastic changes in contemporary Japanese life, the custom of taking off one's shoes before one enters 'the inside' has remained a cardinal rule, whether it is a private home, a public place, a private car, or a vehicle for public transportation." This reads like a 19th-century caricature: today Japanese wear street shoes in public places including most buildings and all trains and taxis, and even in their own family cars.

Ohnuki-Tierney also writes that "the Japanese still do not trust hands, even after washing . . . virtually no food is eaten with the fingers . . . Eating food and using chopsticks are inseparable." This incredible generalization entirely overlooks sushi, the very symbol of Japanese food, which is usually eaten with the fingers, especially in public places when it is presented on a lacquer bar or tray by a gloveless sushi maker. All kinds of rice balls are likewise eaten with the fingers, and one can cite other examples of "inter-finger skinship" (the reviewer's term) that tend to upset the author's overly contrived (and borrowed) theory of Japanese pollution and hygiene.

The author describes a number of "conflicting attitudes" among Japanese toward illness and death. On the one hand, Japanese exhibit a hypochondriacal tendency to worry about minor illnesses; they openly talk about colds and belly aches and other common ailments that may be exacerbated by popular conceptions about "inborn constitution" and seasonal influences. Japanese may also attribute sickness to physical traits like blood type, or body pH (acidity/alkalinity).

On the other hand, Japanese do not like to discuss "dreaded illnesses" like cancer; even doctors prefer not to disclose diagnoses to their patients (if even close relatives) except in special cases. Yet the author observes that kamikaze pilots bravely faced "other forms of death" during World War II; so why the reluctance to acknowledge death from a terminal illness in a culture which elevates suicide to the level of an esthetic experience?

Ohnuki-Tierney "speculates" (her word) that "the explanation for [such] conflicting attitudes . . . lies in the basic orientation of the Japanese toward the present life, rather than the life after death, and the fact that the present life is seen as a dualistic one in constant flux between health and illness, and between good and evil." By this she means that "the Japanese are pragmatically fatalistic in turning away from serious illnesses which are beyond their control, [while] culturally sanctioned modes of suicide constitute an act in which the individual is in control of his or her own life, rather than letting fate decide."

But the long list of references at the back of the book suggests that the author did not consult even the most basic sources on suicide in Japan, much less the numerous reports on elevated suicide risks among those who suffer from poor health. National Police Agency statistics, for example, indicate that "suffering from an illness" is an immediate "cause" or "motive" in 10,441 (41.4 percent) of the 25,202 suicides counted in 1983, followed by "alcohol problems and mental disorders" at 3,815 (15.1 percent).

Thus over half of all suicides in Japan are associated with real or perceived physical and/or mental incapacitation or disability. And most of these suicides are committed by people who are acutely or chronically depressed over the various (including economic) discomforts of poor health, rather than over thoughts of death per se. They may (as humans) be afraid of death, but their fear is ambivalent, for they choose suicide, and not because electing death when ill is considered an "esthetic" act by their neighbors.

One hardly needs an elaborate theory of "dualistic world view" to explain what for most Japanese (and other people) turns out to be a continuum of ultimate concerns about human existence from before the cradle to after the grave. Yet the author concludes that "Health to the Japanese is an ephemeral phenomenon, temporarily achieved in a constant struggle to keep the balance between, on the one hand, chronic illnesses and the inborn constitution, and on the other hand, the numerous methods of healing."

All told, there are too many unconvincing arguments and theories in the chapters on Japanese germs, world views, and physiomorphism. But the second half of the book is an interesting account of the author's first-hand tour of the major varieties of medical treatments and facilities and healers in Japan -- folk, religious, and super-scientific -- that make up what she appropriately calls Japan's medical pluralism.

These final chapters read better if the author's claim to have written them from "the perspective of the ordinary Japanese" is taken with a grain of salt. Ohnuki-Tierney can only have described what she saw as a U.S.-trained anthropologist -- which clearly disqualifies her as an "ordinary" person of whatever nationality.