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In my file of miscellaneous materials there is a color reproduction of a painting that epitomizes the common view of the relationship between modern biomedicine and the indigenous medical systems it has encoun­tered. Identified only as taken from a 1930s Soviet publication, Paint­ings by Yakut Artists, it shows an interior scene. On a platform bed, cov­ered by an animal skin throw, lies a woman with oriental features and long black hair. In a dark corner near the foot of the bed stand a small boy and an old man whose features register anxiety and resignation, respectively. At the back of the room, looking out sternly from under a fur-lined parka, is a man who seems to be the patient’s husband. For patient she is. Standing full center is the sturdy figure of a woman in the process of removing a heavy fur outercoat to reveal her gleaming white nurse’s uniform. She stands, obviously having been brought to the house by the husband, purposefully and powerfully delineated, looking toward the patient. Her features are Caucasian, her short hair, light brown. She is placed between the bed and a dark figure of a man whose posture sug­gests that he has been pushed aside. His features, like those of all the family members, are oriental, his long hair, jet black. Clad in full regalia and holding a skin drum and stick, he has been thrust into semidarkness. The painting, by one A. N. Ossipov, is entitled The Expulsion of the Shaman. It might well have been subtitled “Superstition Eclipsed by the Light of Reason.”

Readers of the contributions to this volume will soon discover that the allegory so carefully worked out by the Soviet artist could hardly be less appropriate to the contemporary Japanese medical scene. In one way or another every essay reveals how consistently and thoroughly interwoven xare the several systems by means of which the Japanese define health and the ways in which illness can be treated. Modern biomedical scientific practice was in fact built on the existing structure of the practice of what is loosely called “Chinese medicine.” The Meiji government, in the late nineteenth century, did indeed sponsor the establishment of Western biomedical science, as the Soviet government was to do in its turn, but in Japan no move was made to stamp out the indigenous system already in place. The authorities controlled its practice, to be sure, but a pluralistic system has flourished for over a century. 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. 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.

There is yet another major emphasis in these essays that greatly aids our understanding of how such systems work. In Japan, as in most—per­haps all—other societies today, the professionally given definitions of health, illness, and therapy are all in important ways shaped by social and cultural beliefs concerning the body, the concept of the self and identity, and the relationship of the individual to society. Folk or popular medical knowledge and assumptions are deeply implicated in the profes­sional biomedical definitions of proper health maintenance, symptoms of illness, and effective treatment of them. We would expect to find such cultural influences in, say, the psychotherapies, but the authors show similar interweaving of social and cultural factors in what are usually seen as purely technical medical decisions such as length of hospital stay, degree of intrusiveness of treatment, and analysis of the origins of the multiplying syndromes so widely reported in the Japanese press. That such decisions are strongly influenced by the notion that the primary responsibility for health and the successful treatment of illness rests squarely on the individual and members of the immediate social group—particularly the family—is only one of the many findings reported here that reveals how society and culture figure in the operation of seemingly autonomous technical domains.

What is true for Japan is equally true for other societies where indige­nous medical systems are fused with biomedicine. If these papers success­fully defend that proposition, as I believe they do, then we are in the authors’ debt for giving us one more example of the essential failure of the convergence model of modernization. That model holds that we are xiall tending in the same direction and says, in effect, that the expulsion of the shaman by the nurse is the inevitable outcome of the clash of medical systems in all societies. If the argument were valid, the Japanese medical scene by rights ought to be far less variegated and complex than it is after more than a century of full-scale adoption of alien biomedical teaching and practice. What has happened instead is the establishment of a plu­ralistic medical system strongly grounded in Japanese conceptions of the nature of men and women, the sources of their physical and psychologi­cal well-being, and the treatable causes of ill-health and disorder. Insofar as these considerations are socially and culturally specific, the resulting medical system is identifiably Japanese. To the degree that all medical systems are incorporative rather than exclusive, the contributions to this volume clearly signal the necessity to look more closely at our own.


Robert J. Smith

Cornell Universityxii

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