Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan

By Mari Armstrong-Hough | Go to book overview

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 Japanese 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 life and maintaining health as other respondents. Or, rather, patients pointed 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 organize 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.

Finally, the majority of Japanese 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”

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