SMA: Perspectives from Contemporary Japan

On Saturday, September 26, a group of younger Japanese researchers, joined by veteran Japan scholars Susan Orpett Long and discussant William Kelly, presented papers in a session titled “Emerging Alterities in Medicine: Perspectives from Contemporary Japan.” The session’s title distracted from a substantial unity surrounding the expanding personal and social experience of biotechnology in Japan as it stands on a continuum with experiences in other parts of the world—from one standpoint the session might have been better named, as Kelly pointed out in his comments, “dissolving alterities”. The analysis and questions raised in each of the case studies (including two not discussed here) is worthy of more recapitulation than I can offer here.

Long opened with “Bodies, Technologies, and Aging in Japan (Old People and their Things).” She concentrated on low-tech or everyday assistive devices used by the elderly in Japan, such as walkers, hearing aids and grab bars, to explore how even these humble technologies require acceptance and assimilation, technically and interpretively, by their users. Assistive devices are consumer goods, however, they differ from other consumer goods social scientists have variously analyzed in that they are undesired items that carry negative social significance. The usual link in consumer studies of goods to popular culture and identity construction, Long suggests, is not useful here; a new framework for making sense of a government-subsidized, needed-but-not-wanted, and yet an economically and commercially important set of technologies is called for. In Japan, “the aging society” has been regarded as a central social issue for some time, however, the social processes Long identifies will be useful to consider in these terms elsewhere.

Goro Yamazaki presented “Making the Gift Economy Work: The Case of Organ Trade in Japan.” Organ transplantation has been less common in Japan than elsewhere. Just this past June, not without opposition, the law was revised to permit greater exchange of organs. Yamazaki acknowledges the cultural explanations for reluctance over organ transplantation, but in his paper he reframes the issue in terms of gift vs. commodity discourses to try to identify a more embedded, transactional, and perhaps quotidian way of analyzing the opposition. The analysis of a publicized case in which a friend’s gift of an organ turned into a litany of requests for what amounted to remuneration demonstrates the utility of this approach. It also, Yamazaki points out, leads us to question the boundaries of anthropological definitions of the gift as it may be applied to organs. We might well ask: What manner of exchange item are organs? What manner of entanglements (to use Nicholas Thomas’ term, 1991) do they generate in any given locale and between them (since the organ trade is global)?.

Given the renewed attention to transplantation in Japan, it was not surprising to find another presenter on this topic. Aya Nakagoshi (“Beyond Blood: Organ Transplantation and the Rise of New Kinship”) likewise situates organ transfers into two familiar anthropological frames of analysis: communication/gift exchange and kinship. Her work is openly comparative with North America. She cited some cases from the US and Canada to illustrate the formation of a kind of kinship bond that forms between live donors and the recipients of their organs. In Japan, by contrast, where nearly all donors are alive (as compared to about 1/3 of total donors in the US), she found no stories in the media referring to positive organ donor kinship bonds. In Japan there are only, she observes, negative stories about kidney donation—“the dark side of the gift,” as she puts it. Like Yamazaki, Nakagoshi calls for a reconsideration of the gift/market distinction in regards the organ trade. Precisely because of the marked cultural differences in attitude about organ transplantation that Margaret Lock (2001) has analyzed in her work, we can expect to learn much about this subject by scrutinizing the Japanese scene in the finer details that Yamazaki and Nakagoshi are pursuing.

Gergely Mohacsi’s paper, “In Search of New Pharmaceutical Senses”, addresses the embodiment of pharmaceuticals in Japan, in this case as applied to the uptake of diabetes pills. The focus on how drugs are assimilated not just into local public health rhetoric of disease management but also into actual physical comprehension is constructive to questions raised in comparative subjectivity studies in pharmaceutical/medical anthropology. It is also a potential case in the global sociology of disease management, since the idea that early medical and lifestyle intervention for type-II diabetes is indispensable derives from epidemiological understandings developed first in the US, funded and promoted by the pharmaceutical industry already beginning in the 1960s. Japan is both more recent to the trend and, Mohacsi’s report seems to suggest, ostensibly more scientific in its outlook. The cultural differences between Japan and elsewhere are mediated by biological measurements (blood glucose, indicated by the diabetes marker, HbA1c) as they are incorporated into Japanese patient habits (lifestyle, attitudes, treatment-seeking behaviors) and bodies, as well as in the practice of Japanese medicine. As Mohacsi puts it, “When ‘lifestyle’ is expressed as HbA1c levels, it becomes a transportable fact.”

Kelly’s concluding remarks to this session could apply as well to others I attended, which marveled at the “heterogeneous ensemble of articulated discourses, institutions, structural forms [and] laws surrounding [for example] organ transplants. It seems to me that what each of you are calling attention to…are precisely the ensembles that articulate and dispose the practices that bind individuals to institutions, knowledge to practice, and, for that matter, the normal to the abnormal, and health to illness.”

References:

Lock, Margaret. 2001. Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: University of California Press.

Thomas, Nicholas. 1991. Entangled Objects: Exchange, Material Culture and Colonialism in the Pacific. Cambridge: Harvard University Press.