Analysis of East Asian Medicine in Urban Japan Written by Margaret M. Lock - Book Report/Review Example

Yu Zhou Stoner Medicine and Anthropology Critical Ethnography Review April. 17 2008 Book Review East Asian Medicine in Urban Japan Written by Margaret M. Lock Margaret M. Lock’s East Asian Medicine in Urban Japan studies the East Asian Medicine, during the 1970s in urban Japan, as a holistic medical system. Based on her fieldwork interviews during a sixteen months period in Kyoto, Japan from 1973 to1974, Lock attempted to analyze the practice of the East Asian medicine and compares it with the East Asian medicine in the pre-industrialized period in Japan. Cosmopolitan medicine refers to Western medicine or biomedicine in this book. These cross-cultural comparisons reveal the coexistence of holism and reductionism in the pluralistic medical systems in Japan and inspire the readers to borrow the holistic approach from the East Asian medicine and reevaluate the cultural biases of biomedicine. Although I highly appreciate Lock’s work, I will review this ethnography with a critical eye. There are two underlying assumptions concerning the study. Firstly, the book attempted to map a larger picture of the East Asian medicine in Japan from the eighth century to the late twentieth century, in which East Asian medicine was seen as Chinese medicine in Japan. The Japanese term Kanpo, literally, “Chinese method,” was thought to be a medical system learned from China, maintaining its Chinese flavor over 1300 years in Japan. Secondly, Lock assumed that the actual interviews that include only 50 Kyoto families, 2 schools, 8 herbal pharmacies, and dozens of patients and practitioners can represent the Japanese people’s thoughts concerning the practices of a pluralistic medicine in the 1970s in an urban setting in Japan. The samples are not considered large enough to draw up generalizations and to make assumption regarding a whole urban population. The ancient capital of Kyoto is also assumed to be representative as a model of a modern city in Japan. Based on these assumptions, Lock analyzed the East Asian medicine from three perspectives. Firstly, she uses a historical approach to analyze the classic Chinese medical works as the theories of East Asian medicine in a pre-industrialized Japan. The Japanese cultural ethos is analyzed as a less important force compared to the Chinese philosophies and Buddhist thoughts. Secondly, she uses a cultural anthropological approach to analyze her limited interviews and case studies in Kyoto to represente an issue of the adopting the East Asian medicine. Except for Tokyo and Osaka, other major Japanese cities other than Kyoto are barely mentioned. Thirdly, she used a critical anthropological approach to analyze the East Asian medicine in Japan as a foil to cosmopolitan medicine in the West. The weaknesses of the cosmopolitan medicine are criticized, but the weaknesses of the East Asian medicine are less critically examined. Three approaches of analyses are organized into five parts. The first two parts focused on the East Asian medicine in the pre-industrial East Asia; the third and fourth parts focused on East Asian medicine in modern Japan; and the fifth part is a comparative assessment and an open conclusion. Both macro and micro levels of social organizations are mentioned. From the macro level, Lock studied the political-social-economic forces that have shaped the East Asian medical system in Japan. From the micro level, Lock provided detailed personal experiences of the practice of the East Asian medicine, including Kanpo: acupuncture, moxibustion, and massage. Finally, Lock posited that the East Asian medical system contrasts the cosmopolitan medicine in a global setting and encouraged the Western readers to learn holism from the revival of the East Asian medicine in Japan. This structure suggests that the study contributes to the following topics: 1) the features of East Asian medicine in contrast to cosmopolitan medicine, 2) the beliefs of Japanese people in health and sickness in contrast to Americans, 3) the regulations, rules, and cultures of the practice of Kanpo medicine in the 1970s in Kyoto, 4) the regulations, rules, and cultures of the practices of acupuncture, moxibustion, and massage in the 1970s in Kyoto, and 5) the regulations, rules, and cultures of the practice of cosmopolitan medicine in the 1970s in Kyoto. Lock stressed the culture uniqueness of these topics. In the first topic, the features of East Asian medicine in contrast to cosmopolitan medicine, she found that East Asian medicine paid more attention to the social and environmental context of diseases and patients than biomedicine. Besides, unlike the ontological perspective of biomedicine, the East Asian medical system, diseases are approached from a physiological perspective. In the second topic, the beliefs of Japanese people in health and sickness in contrast to Americans, Lock found that the Japanese view of health and sickness was influenced by Shinto, Chinese, and cosmopolitan medical theories. Japanese people consider ki or energy as the key to health, hara or abdomen as the center of the body, and sickness as a chance in which people can show their nonverbal emotions to their sick relatives, friends, and people in other social relationships. Lock also emphasized how different people view their sicknesses differently. For example, housewives do not dare to get sick because their families heavily rely on them; employees work during sickness because they want to reinforce their responsible images in the workplace. Lock also pointed out that her informants used the East Asian medicine for their chronic sicknesses and biomedicine for their acute sicknesses. In the third topic, the regulations, rules, and cultures of the practice of Kanpo medicine in the 1970s in Kyoto, Lock found that the training procedures, the vocabulary, and the general approach of the East Asian medical system had been updated since the 1970s in Kyoto. Kanpo physicians have Doctor of Medicine degrees and distain the classical East Asian medical texts. The holistic conceptions of the East Asian medicine are maintained in the practice, but the larger part of the traditional Kanpo medicine has been given up. In the fourth topic, the regulations, rules, and cultures of the practices of acupuncture, moxibustion, and massage in the 1970s in Kyoto, Lock found that the practices of acupuncture, moxibustion, and massage retained most ancient beliefs, rituals, and cultures. The practitioners of acupuncture, moxibustion, and massage are less educated than Kanpo Doctors of Medicine and licensed Kanpo pharmacists. The practices of acupuncture, moxibustion, and massage are more popular in the rural areas than they are in the cities. Urban patients are more likely to visit the clinics of Kanpo medicine and less likely to visit the clinics of acupuncture, moxibustion, and massage. In the fifth topic, the regulations, rules, and cultures of the practice of cosmopolitan medicine in the 1970s in Kyoto, Lock found the resurgence of the East Asian medicine in urban Japan. The clinics that provide the East Asian medicine have more patients than they had the 1940s. The prices of Kanpo medicines have increased. The services related to the East Asian medicine are more popular as well. The Japanese people realize that their culture-bound-syndromes can only be treated by East Asian medicine rather than biomedicine. And on a world-wide basis, the interpersonal, psychological, and symbolic dynamics of sickness and therapy of the East Asian medicine are more appreciated than ever before. I do not agree entirely with the ways Lock interpreted her findings. Firstly, Lock tends to blur the boundary between the Chinese medicine and Kanpo medicine in viewing the history of East Asian medicine in Japan. Although Lock pointed out the role of the Shinto medical theory in Japan, she overlooked, that the Shinto medical theory as well as many other traditional concepts that are popular in Japan have “Japanized” Chinese medicine. The Chinese medical theories Lock analyzed in the first chapter may not have as much an influence as Lock may have believed. For example, “the mutual productive order” Lock introduced in Chapter 3 has been questioned and denied ever since the Tokugawa period (1600-1868) when Japan had not yet been significantly urbanized. To what extend this order has impacted the East Asian medicine in the 1970s urban Japan is questionable. Secondly, the topics Lock covered were too large to be represented by her actual fieldwork sample. What she observed was the practice of the East Asian medicine in the 1970s in Kyoto, Japan. The 1970s was a special decade for Japan in terms of its economy. Japan transformed from a defeated country during World War II to become the second most economically important country in the 1970s. Not only in East Asian medicine but the entire country was booming. The resurgence of the East Asian medicine is not an everlasting phenomenon. Firstly, in the 1990s’ novels and cartoons, Kanpo medicine was usually portrayed used by elderly and making it less popular. Secondly, the use of Kyoto as a representative city in Japan is problematic. Kyoto is famous for its ancient architecture and cultural conservation. Traditional concepts and products are more welcomed in Kyoto than many other cities in Japan. East Asian medicine, too, may be less acceptable in the entire urban Japan. Thirdly, the sample of the interviews was not a representative size. The ethnography mentioned less than 500 informants; however, the population in Japan in 1973 was about 104,000,000, which is more than 200,000 times larger than the sample size. Thirdly, Lock ignored the role of the Japanese government and the political context in shaping the East Asian medicine in urban Japan. The events of the translation of Western anatomy and the elimination of Chinese doctors in Tokugawa Japan have signified the Japanese modernization. The governmental support is one of the determinants of the dominant role of the cosmopolitan medicine in Japan in the Meiji period (1868-1912). Kanpo medicine, no matter how popular it may be, has been appropriated to biomedicine. Legally, Kanpo doctors must be trained in medical schools where they learn both biomedical and the “Japanized” East Asian medical knowledge; Kanpo medicines must be approved by the governmental administration using biomedical methods. These signs suggest that the East Asian medical system in Japan is officially restructured by biomedicine and the resurgence does not necessarily mean a resurgence of an ethno-medicine. Fourthly, Lock may have misunderstood the role of Confucianism in East Asian medicine. She believed, partially due to the heritage of Confucianism, that the physicians and patients in the pre-industrialized Japan barely questioned the social order in the East Asian medical system. In fact, many pre-industrialized Japanese physicians view Confucian thoughts as the inspiration for them to question the whole East Asian medical system. One example is Sugita Genpaku (1773-1817), the Japanese physician who translated the New Book of Anatomy from Dutch to Japanese. His work denied that physical inner organs such as the lung and the heart are associated with psychological activities, which followed the collapse of the social order in the East Asian medical system in Japan. Sugita Genpaku admitted that it was Confucianism that encouraged him to question the Kanpo medical knowledge he learned and encouraged his disciples to study Confucianism.1 In addition, Lock’s descriptions of the Chinese medical system before the century may not be true. In chapter 2, Lock introduced the medical practitioners in 200 B.C. China were shamans and diseases were seen as the curse of unsatisfied ancestors. However, in Classic of Songs, a poetry collection complied no later than 600 B.C. showed herbal medicine and how physicians used them, were recorded. Besides, in the Qin government (221 B.C.-206 B.C.), imperial doctors who provided medicine were granted official levels whereas imperial shamans who conducted rituals were not. I think the functions of doctors and shamans have been clearly divided before the 200 B.C. era, and the way of thinking that the curse from unsatisfied ancestors are the cause of a disease could not have become a mainstream concept because it is contrary to both Confucianism and Taoism, which Lock as well as other medical anthropologists in the field of East Asian medicine consider as the philosophical foundation of Chinese medicine. My alternative approach based on Lock’s findings is a less ambitious analytical work focusing on East Asian medicine in the 1970s in Kyoto. I would refer to the traditional East Asian medical system as one of the reasons why my informants would view health and sickness differently from Americans, rather than use my informants’ point of view to support the conceptual framework of the East Asian medical system. I would also use a linguistic approach to clarify the ideas of “Kanpo,” “East Asian medicine,” “oriental medicine”, and “Chinese medicine” before I applied these terms in analyzing the East Asian medicine in Japan, because these terms have cultural differences that matter to the Japanese people. Japanese people usually prefer the word literally meaning “oriental” to that of “East Asian” because European invaders once called East Asian people “East Asian sick men.” Japanese people may also reject the word “Chinese” because at public high schools Japanese students are taught that Japanese are culturally superior to Chinese. In conclusion, Lock insightfully points out the merits of the East Asian medical system in Japan, but her ethnography covers an issue too large and heterogenic to be clearly analyzed in one book based on a sixteen month fieldwork. She could have done a better job if she had focused on the Westernized East Asian medical system during the 1970s in Kyoto Japan. To have evaluated the East Asian medicine fairly, she needed to assess the values of the East Asian medicine as critically as she did with biomedicine. There are many weaknesses left unstudied in East Asian medicine, which may help us better understand the strengths and weaknesses of biomedicine. Read More