Behind the Paper Screen / Illness as cultural phenomenon
Sawa Kurotani Special to The Daily Yomiuri
A friend of mine, who is in his late 40s, woke up one morning and had a shooting pain in his right shoulder. First he thought he must have hurt it while playing tennis, although he couldn't remember anything specific that could have caused such a pain. He took it easy for a few days until, realizing he was not getting better, he went to see a doctor, who said it must be a pulled muscle. Prescribed pain killers and anti-inflammatory medicine seemed to ease the symptom briefly, but he continued to have pain on and off for six months or so. And suddenly, it got better.
In Japan, I would not need such a lengthy explanation for my friend's experience. I would just say, "He had gojukata," and everyone would know what I meant.
As many readers may know, many Japanese people in their late 40s and early 50s are known to have persistent pain in their shoulders and/or upper arms. It just happens one morning, with no apparent cause. It often goes away, sometimes after a few weeks, often after several months, just as suddenly as it began. Not everyone gets it, but it occurs frequently enough that it is broadly recognized as an age-related physical ailment. We call it katakori, and gojukata means "katakori of one's 50s."
It is also fairly well-known among the Japanese who live in the United States that Americans do not seem to suffer from katakori. This is often translated as "stiff shoulders," but that's not an accurate translation as far as I can tell.
"Stiff shoulders" and "stiff necks," as Americans tend to think of them, are different from Japanese katakori. They are more often than not caused by the overuse of muscles during athletic activities, or by twisting or pulling muscles.
Katakori as known in Japan is, by contrast, usually caused by rigidity and immobility, both physical and psychological. For instance, a long and complicated business meeting causes many katakori cases, because participants must sit still for many hours, and because their effort to focus for a long time becomes stressful.
As such, katakori is closely associated with the stagnation of blood circulation, and the remedies for katakori, from massaging, to pounding, to applying blood-sucking leeches, are intended to release the obstructed blood flow.
Perhaps, Americans do sometimes get katakori, as I have seen some of them walking out of a conference room stretching their necks, but they seem neither highly conscious of this physical symptom, nor do they recognize the combination of physical immobility and mental strain at its root as Japanese would.
Taishitsu is another Japanese medical concept that has no equivalence in American terminology. Taishitsu literally means bodily nature, and the best way to explain in English may be "the natural disposition of one's body."
It is known that one inherits one's taishitsu or certain components of it. Yet, each individual taishitsu is unique in that one can inherit different traits from parents and grandparents, which combine to make up a unique whole. These traits, though, are not directly connected to particular illnesses. Rather, each human body has a unique set of characteristics that may predispose some to related illnesses, while protecting them from others.
I recall a few instances in which I tried to explain to American physicians this notion of taishitsu, without much success.
They do, of course, recognize the import!ance of hereditary factors in certain illnesses. But unlike the generalized and holistic taishitsu, the American doctors' understanding of heredity is specific and concrete and there is a strong sense of correspondence between a specific cause and a specific effect.
Anthropologists have noted for many years that illness is a cultural phenomenon, and that our experience of our bodies is culturally framed. That is to say, although people from various places around the world may have exactly the same physical symptoms, we perceive, understand and respond to those physical symptoms through the categories, worldviews and explanations that we have been taught through our socialization.
In the 1920s, Margaret Mead tested the common assumption that difficulty of adolescence was "hormonal," and therefore unavoidable. In her famous study of Samoan youth, she argued that the relaxed and stress-free adolescence of Samoan teenagers demonstrates that it is the social environment that determines whether physical changes during adolescence are experienced as stressful.
More recently, anthropologist Margaret Lock compared symptoms of menopause typically reported by North American women and Japanese women. She, too, concluded that, while menopause is caused by hormonal changes, the ways in which individual subjects experience those changes varied greatly between the two groups, suggesting that the experience of illness is culturally mediated.
Compared to the typical American instinct to pinpoint the cause-effect relationship of illness, Japanese ideas are decidedly fuzzy. Not that one is better than the other; they are just different, and each has strength and weakness. The scientific knowledge of our bodies and illnesses would not have been possible without the Western positivist emphasis on causality. At the same time, this model does not accommodate well those symptoms that cannot be connected to specific causes.
Fuzzy concepts like taishitsu, when misused, can keep people from getting proper diagnosis and treatment, and thus may be dangerous. However, they also let us be kind and forgiving to ourselves. Cultural categories do not only influence our recognition of certain illnesses, but also affect our responses to them.
To me, having grown up in Japan and watched many middle-aged people around me go through gojukata, it was immediately clear what my friend was experiencing and why he was experiencing it at the particular moment in his life. As it is one of the possible outcomes of the natural aging process, I would first think of accommodating it, rather than curing it.
For him, having grown up in the United States, there was no such ready reference to categorize his own bodily experience. Therefore, he kept asking what caused the pain, and was frustrated when he could not make it better. Similarly, katakori allows us to recognize the presence of mental stress, which is otherwise invisible, by giving it a concrete physical shape. There may be no clearly established causal relationship between katakori and mental stress, but from our experience, we all know that a set of warm hands on our shoulders somehow makes it better.
@: Kurotani is an associate professor of anthropology and director of Asian studies at the University of Redlands in California.
(Aug. 23, 2007)
Sawa Kurotani Special to The Daily Yomiuri
A friend of mine, who is in his late 40s, woke up one morning and had a shooting pain in his right shoulder. First he thought he must have hurt it while playing tennis, although he couldn't remember anything specific that could have caused such a pain. He took it easy for a few days until, realizing he was not getting better, he went to see a doctor, who said it must be a pulled muscle. Prescribed pain killers and anti-inflammatory medicine seemed to ease the symptom briefly, but he continued to have pain on and off for six months or so. And suddenly, it got better.
In Japan, I would not need such a lengthy explanation for my friend's experience. I would just say, "He had gojukata," and everyone would know what I meant.
As many readers may know, many Japanese people in their late 40s and early 50s are known to have persistent pain in their shoulders and/or upper arms. It just happens one morning, with no apparent cause. It often goes away, sometimes after a few weeks, often after several months, just as suddenly as it began. Not everyone gets it, but it occurs frequently enough that it is broadly recognized as an age-related physical ailment. We call it katakori, and gojukata means "katakori of one's 50s."
It is also fairly well-known among the Japanese who live in the United States that Americans do not seem to suffer from katakori. This is often translated as "stiff shoulders," but that's not an accurate translation as far as I can tell.
"Stiff shoulders" and "stiff necks," as Americans tend to think of them, are different from Japanese katakori. They are more often than not caused by the overuse of muscles during athletic activities, or by twisting or pulling muscles.
Katakori as known in Japan is, by contrast, usually caused by rigidity and immobility, both physical and psychological. For instance, a long and complicated business meeting causes many katakori cases, because participants must sit still for many hours, and because their effort to focus for a long time becomes stressful.
As such, katakori is closely associated with the stagnation of blood circulation, and the remedies for katakori, from massaging, to pounding, to applying blood-sucking leeches, are intended to release the obstructed blood flow.
Perhaps, Americans do sometimes get katakori, as I have seen some of them walking out of a conference room stretching their necks, but they seem neither highly conscious of this physical symptom, nor do they recognize the combination of physical immobility and mental strain at its root as Japanese would.
Taishitsu is another Japanese medical concept that has no equivalence in American terminology. Taishitsu literally means bodily nature, and the best way to explain in English may be "the natural disposition of one's body."
It is known that one inherits one's taishitsu or certain components of it. Yet, each individual taishitsu is unique in that one can inherit different traits from parents and grandparents, which combine to make up a unique whole. These traits, though, are not directly connected to particular illnesses. Rather, each human body has a unique set of characteristics that may predispose some to related illnesses, while protecting them from others.
I recall a few instances in which I tried to explain to American physicians this notion of taishitsu, without much success.
They do, of course, recognize the import!ance of hereditary factors in certain illnesses. But unlike the generalized and holistic taishitsu, the American doctors' understanding of heredity is specific and concrete and there is a strong sense of correspondence between a specific cause and a specific effect.
Anthropologists have noted for many years that illness is a cultural phenomenon, and that our experience of our bodies is culturally framed. That is to say, although people from various places around the world may have exactly the same physical symptoms, we perceive, understand and respond to those physical symptoms through the categories, worldviews and explanations that we have been taught through our socialization.
In the 1920s, Margaret Mead tested the common assumption that difficulty of adolescence was "hormonal," and therefore unavoidable. In her famous study of Samoan youth, she argued that the relaxed and stress-free adolescence of Samoan teenagers demonstrates that it is the social environment that determines whether physical changes during adolescence are experienced as stressful.
More recently, anthropologist Margaret Lock compared symptoms of menopause typically reported by North American women and Japanese women. She, too, concluded that, while menopause is caused by hormonal changes, the ways in which individual subjects experience those changes varied greatly between the two groups, suggesting that the experience of illness is culturally mediated.
Compared to the typical American instinct to pinpoint the cause-effect relationship of illness, Japanese ideas are decidedly fuzzy. Not that one is better than the other; they are just different, and each has strength and weakness. The scientific knowledge of our bodies and illnesses would not have been possible without the Western positivist emphasis on causality. At the same time, this model does not accommodate well those symptoms that cannot be connected to specific causes.
Fuzzy concepts like taishitsu, when misused, can keep people from getting proper diagnosis and treatment, and thus may be dangerous. However, they also let us be kind and forgiving to ourselves. Cultural categories do not only influence our recognition of certain illnesses, but also affect our responses to them.
To me, having grown up in Japan and watched many middle-aged people around me go through gojukata, it was immediately clear what my friend was experiencing and why he was experiencing it at the particular moment in his life. As it is one of the possible outcomes of the natural aging process, I would first think of accommodating it, rather than curing it.
For him, having grown up in the United States, there was no such ready reference to categorize his own bodily experience. Therefore, he kept asking what caused the pain, and was frustrated when he could not make it better. Similarly, katakori allows us to recognize the presence of mental stress, which is otherwise invisible, by giving it a concrete physical shape. There may be no clearly established causal relationship between katakori and mental stress, but from our experience, we all know that a set of warm hands on our shoulders somehow makes it better.
@: Kurotani is an associate professor of anthropology and director of Asian studies at the University of Redlands in California.
(Aug. 23, 2007)