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110 chapter six Diabetes at Home Explanatory Models in Everyday Practice In chapter 3, I argued that the diabetes epidemic in Japan is cast as a morality tale about the nature of Japa­ nese identity, emphasizing the particularity of diabetes risk to the Japa­nese body in con­temporary Japan. But this narrative emerged when respondents ­were asked about the diabetes epidemic, not their personal experience with type 2 diabetes. When asked instead about daily preventative practices, personal worries, and causal theories to explain their own illness or the illness of someone close to them, participants instead articulated explanatory models centered on the disruption of healthy, ordered rhythms. When the level is shifted from the population to the personal, explanations shift as well. When discussing personal health philosophies and explanations of their own health and illness, Japa­nese interview participants first associated health with having an order or rhythm to one’s life. Observing regular, unchanging hours for core activities like waking, eating, and bathing ­were identified as key to a healthy life. Type 2 diabetes patients in the sample articulated a similar causal understanding of the relationship between living an ordered lifeandmaintaininghealthasotherrespondents.Or,rather,patientspointed to a relationship between living or having lived an “unordered” life and the onset of their illness. But the responsibility for this temporal maintenance falls largely on­ women: ­ women work to or­ ga­ nize loved ones’ time into a healthy, regular rhythm. Gender played an even clearer role in the illness experiences of type 2 diabetes patients and their families. Male patients described worry over their condition but offered few causal narratives. The wives, ­daughters, and­ sisters of male patients, however, often offered explanatory models on behalf of their loved one. ­ Women worked not only to manage diabetes on behalf of loved ones but to give it meaning. Fi­ nally, the majority of Japa­ nese physicians I interviewed said that they personally worried about developing type 2 diabetes. This stands in sharp contrast to the American providers, only one of whom expressed concern. Most of the Japa­nese physicians reported a sense of inadequacy at reducing their personal risk of diabetes and other types of illness by living an “ordered” Diabetes at Home 111 life, which they felt was out of the question given their professional obligations . The American providers, on the other hand, felt invulnerable to diabetes ­because of their privilege and access to healthful ­things. Private Experiences of Health and Illness in Japan Illness narratives draw our attention to the interface between agency and social structure. ­ These narratives are si­ mul­ ta­ neously strategic tools with which patients restructure social roles and articulations of how their lives are ­ shaped by political-­ economic forces beyond their control (Mendenhall et al. 2010). Narrative is an autonomous act to make sense of and to renegotiate one’s social roles. Yet illness narratives often implicate the social, po­ liti­cal, and economic forces outside the patient’s power. Moreover, narratives are built, at least in part, from local materials. Cancer patients, for example ,constructcausalstoriesabouttheirillnessesusing“localmoralconstructs framed within distinct cultural and social perspectives” (Hunt 1998, 2000, cited in Mendenhall et al. 2010). When asked to talk about the nature of health, laypeople and providers alike emphasized imposing order and regulation on the body as a general route to wellness. Patients with a diagnosis, members of the general public who worried about getting diabetes, and ­ people who expressed no worry about facing chronic disease themselves mostly agreed on one ­ thing: the ordered life can maintain health, while the disordered life leads to illness. This section ­ will first discuss the model of the ordered life that respondents associated with health and then the narratives about disorder type 2 diabetes patients offered when asked why they thought they developed type 2 diabetes. Fi­ nally, the discussion ­ will turn to the par­ tic­ u­ lar private experiences of Japa­ nese physicians, who experience higher rates of type 2 diabetes than their American counter­parts and ­were more likely to report personal worries about the disease. The Ordered Life and Classification of Time When asked, “In general, what is the best way to stay healthy?” most lay respondents described an “ordered” life, or a life according to rules. ­ These respondents described the ordered life in one of two ways. The most common responses ­ were “kisoku tadashii seikatsu” or “kisokutekina seikatsu,” phraseswithonlyminordifferencesinmeaning.Theformer,literally“rule—­ correct—­lifestyle,” suggests orderly or clocklike. The latter, literally “rule-­like 112 Chapter Six lifestyle,” is closer to...


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