electronic journal of contemporary japanese studies (ejcjs)
Conference and Seminar Papers in 2002

KenkyuProceedings of a Postgraduate Research Seminar in Japanese Studiesth

Oxford Brookes University Research Centre, Oxford Brookes University, UK, Saturday 28 July, 2001
Post-Graduate Network in Japanese Studies (PGN)

Japanese Health Cosmology: a study of terminal cancer
patients in Japan
Ikumi Okamoto
D.Phil Candidate
Institute of Social and Cultural Anthropology, University of Oxford
ikumi.okamoto@wolfson.ox.ac.uk

Introduction
This paper is a short presentation of Japanese attitudes towards health and illness based on
empirical research on the experiences of dying patients receiving palliative care incontemporary Japan. It aims to show how the traditional Japanese holistic concept of healthand illness coexists with Western medicine, and the degree to which it is still highly
evaluated within the realm of palliative care. In so doing, I would like to introduce theconcepts of tairyoku and taichō and then to clarify how these concepts affect patients’ (andtheir families’) decision-making processes when they receive medical treatments.
Palliative care is the care given to patients whose disease is not responsive to curative
treatment. Pain and symptom control is mainly conducted at palliative care units (PCU),
instead of providing aggressive treatments such as chemo- and radiotherapy. Palliative careregards a patient humanely, and aims ‘to achieve the best possible quality of life for patientsand their families’ (WHO Expert Committee on Cancer Pain Relief and Active Supportive
Care 1990: 11).
Patients who enter PCU expect that they can receive the most advanced Western medical
technologies to relieve their pain. Interestingly, however, it was found that not all treatments
recommended by medical professionals were preferred by patients in Japan. This researchclarified the concept of health and disease specific to Japanese culture (i.e. tairyoku andtaichō), and helps explain why patents do not always agree with the suggestions of medical
professionals.

37

Methodology and background
I carried out fieldwork at the Palliative Care Unit (PCU) 1 in Higashi Sapporo Hospital(Sapporo, Japan) from November 1999 to October 2000. I also visited other hospices
including two Christian ones (Yodogawa Christian Hospital in Osaka and Rokko Hospital inKobe) and one Buddhist hospice called Vihara (Nagaoka-Nishi Hospital in Niigata) which
provide religious care by Christian chaplains and Buddhist monks respectively. One private
surgery, Tanaka Surgery in Miyazaki Prefecture, was also visited.
At the PCU in Higashi Sapporo Hospital, I spent most of my time in close contact withpatients, families and medical professionals in order to conduct direct interviews and longterm observation. I attended daily conferences for PCU staff, doctors’ meetings with patientsand families, and PCU outpatients’ consultations. I concentrated on recording the speech andactions of patients, families and medical professionals.
Most PCU patients suffered from cancer, and were at the terminal stage. In many cases,
entering the PCU was the patients’ own choice, or they decided to do so because they wererecommended by their family who had heard of the PCU, or by their previous doctors.
Palliative care units have not yet been fully accepted in Japanese society, mainly due to theirsmall number, and also because they normally exist in urban areas only. Therefore, it can besaid that those at PCUs and their families are generally people who are more familiar with
Western medical systems in urban areas.2
Illness - a part of healthy life
The Japanese concept of health and illness is holistic. It considers ‘all the parts of the body to
be interconnected and mutually affecting each other, and affected by, the environment, bothsocial and physical’ (Lock 1980: 217). This also assumes that there is no perfect health assuch, as health is not a static state. When everything is relatively in balance, a person isconsidered to be in a state of good health.
According to Ohnuki-Tierney (1984: 51), many Japanese regard themselves as somewhat
less than healthy, if not sickly. ‘The concept of jibyō clearly reflects this aspect of Japanese
attitudes toward health and illness. […] Jibyō means an illness that a person carries
throughout life, and suffers at some times more acutely than at others’ (Ohnuki-Tierney,
1984: 53). Examples of jibyō include shoulder stiffness, constipation, low blood pressure,headaches and dizziness. Common to all these jibyō is the fact that they are chronic andincurable.
Another concept, taishitsu, is closely linked with the notion of jibyō. Taishitu is ‘the nature of
the constitution with which one is born’ (Ohnuki-Tierney 1984: 54). The common taishitsu
are, for example, healthy, ordinary, weak and unenergetic, hypersensitive, and so on. In asense, as Ohnuki-Tierney suggests (ibid.: 72), in Japan,

1

The PCU was established in September 1993 with 28 beds within Higashi-Sapporo Hospital. There are two
full-time doctors, twenty registered nurses, five nursing assistants, one medical social worker, one dietitian, one
pharmacist, one music therapist and a team of voluntary staff.

2

In Higashi-Sapporo Hospital, some of the patients were from outside Sapporo. Although those patients were from morerural areas in Hokkaido Prefecture, they were often brought to the PCU by relatives or acquaintances living in Sapporo.

38

Individuals learn to live with weakness of the body, just as they live their daily lives
with the knowledge of ever-present danger and evil. […] In this context, it should bepointed out that in the Japanese Morita therapy, the indigenous so-called
psychotherapy developed for the treatment of neuroses, the basic premise is thathuman beings are weak. Therefore, the first step for recovery according to thismethod is to learn to acknowledge one’s weaknesses and live with them. (Miura and
Usa 1974; Reynolds 1976, cited in Ohnuki-Tierney)
Inherent characteristics are given, and the individual should adjust to rather than manipulate
them. Therefore, Japanese people who have a weak taishitsu, or some kind of jibyō, usuallyconsider themselves normal, and try to live harmoniously with what they are given, insteadof trying to change it.
Cancer is also sometimes seen as jibyō, especially when patients recognize that the disease is
no longer responsive to curative treatment, before the body has deteriorated badly. I heard
many cancer patients new to the PCU say to their doctors that they had to live with cancer
until they die, or that they wanted ‘to get along’ with cancer. Instead of manipulating a cancer
tumour itself, they mostly try to adjust themselves to their diseased body. They try to build up
more bodily energy, which is decreased due to cancer, and try to generate a more harmonious
condition with the cancer. The concepts of tairyoku and taichō are commonly employed by
PCU patients and their families to enhance the patients’ condition holistically.
The concepts of tairyoku and taichō
During my fieldwork at PCU and other hospices, words such as tairyoku (体力)2 and taichō(体調)3 were often heard. These words are also heard commonly in everyday conversation.
However, an environment where topics related to health and illness are more common, suchas PCU, these words are heard even more frequently than in other situations. The concepts oftairyoku and taicho also demonstrate Japanese people’s holistic view of health. These
concepts are generally used as a measurement of the total health condition, and tairyoku isthought to have a curative power. During my fieldwork in Japan, these words seemed like thekey words for patients to describe how they were.
Tairyoku literally means not only one’s physical power, but also vital bodily energy flowwhich is conceptually similar to the Japanese ki4 or Chinese qi5. For instance, the following
are typical statements made by patients at hospices:
Without tairyoku, human beings cannot survive.
(My husband said) his tairyoku has decreased since last summer (and since then his
cancer seems to have spread).
2

体 (tai or karada) and 力 (ryoku or chikara) mean ‘body’ and ‘power’ respectively.
体 (tai or karada) and 調 (chō) mean ‘body’ and ‘condition’ respectively.
4
According to Doi (1973: 96), the concept of ki is used particularly in expressions to do with emotion,
temperament and behaviour. It also indicates the movement of the mind from moment to moment (Doi, 1973:
109). Lock (85) noted that ki is considered dynamic, and is also closely related to the state of health. For
example, genki (‘good health’) literally means ‘original ki’ but also implies a steady flow of ki. The concept ofki explains that ‘health and ill health are both normal’, and ‘the body continually moves in and out of bothstates’ (ibid.).
5
Qi was the breath and substance of life, the vital force that maintained the health of an individual, the wellbeing of the family and the prosperity of the dynasty’ (Bray 1999: 191).
3

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I’m not very confident about leaving the hospice, as I have no tairyoku at the
moment.
An examination of patients’ narratives suggests that tairyoku is constructed from four closely
related components, these being gentle but not extreme exercise, nutrition, rest, and state ofmind. The following are quotations from patients’ narratives:
Mrs. M exercises everyday. She also takes many kinds of foodstuffs in order toregain tairyoku and increase her immunity.
nurse
What he (a patient) calls treatments are yoga and health food. He also wants to eat tobuild up his tairyoku.
doctor
If I become able to eat, I think I will have more tairyoku.
patient
Patient: (Even when I lost my ability to taste due to radiotherapy), I ate and ate bysome means or other, although I was asked by other patients how I could manage todo that despite the fact that I could not taste anything.
Patient’s wife: I also told him to eat and eat, as nobody can live without tairyoku.
at a PCU outpatient consultation
My mother seems to strongly believe that rehabilitation will increase her tairyoku
and she will recover sooner or later.
patient’s daughter[…] I wonder if I would live longer (i.e. have more tairyoku) if I stay somewhere
warmer doing nothing in order to recuperate […]patient
Patient: When I first entered here, I really felt ill, and it was so hard for me to eat. I
also had a hard time mentally, but I’ve felt much better since the last few days,
thanks to you. I’ve become able to eat, you know, I have more power [tairyoku].
Doctor: The power to hang on.
Patient: Eating makes a big difference, doesn’t it?
on a doctor’s roundI won’t be able to walk any more if I don’t eat.
patient
My face is swollen so much and I’m depressed … I feel I’m loosing my tairyoku
now…
It is believed that tairyoku is built up on the basis of exercise, nutrition, rest, and state ofmind. In addition, if one of these is lacking, the whole balance is thought to be disturbed, andthis leads to a decrease in tairyoku. For instance, if one does not eat properly, one will lose
one’s mobility, become unable to have a proper rest and also to keep oneself in a good stateof mind. If, however, all four factors are well balanced, the body is filled with tairyoku,
which brings good health to a person. Therefore, this balance dominates a person’s general
well being, and when a person becomes ill, restoring the balance between the four factors is
considered important.

40

Taichō, on the other hand, refers to one’s bodily condition, and so can also mean the balanceof the four factors (i.e. eating, resting, exercise, and state of mind) needed to maintaintairyoku. It is therefore thought to be essential to have good taichō in the first place as aprecondition of good health. During my fieldwork, I heard many patients say to medical
professionals,
I came here to get my taichō into good shape.
Normally, patients had already tried many possible cancer treatments prior to entering a
PCU. Due to side effects caused by aggressive treatments, patients have suffered from an
imbalance between the four factors, and they may realize that they do not have good taichō.
Thus, it is considered important to restore the balance necessary for good taicho and so
rebuild their tairyoku.
Tairyoku – as a measurement of bodily condition
The word tairyoku is also often heard during the patients’ decision-making process regarding
medical treatments. The more tairyoku they have, the better and stronger they feel, and they
seemed to prefer having any kinds of treatment when they have more tairyoku.
I was told that I might not be able to have an operation next time, as I won’t haveenough tairyoku then.
(patient)
I heard radiotherapy has no effect on cancer, and it only takes tairyoku away, thenmakes my condition worse.
(patient)
Blood transfusion brought on a fever last time. I wonder what will happen to me thistime, as I have much less tairyoku now than before.
(patient)
I’d like to have more tairyoku, so I don’t want to take any medicine.
(patient)
The above statements show that even treatments recommended by medical professionals are
not always considered preferable, if there is a possibility that they will bring about a decreasein tairyoku, and that a certain amount of tairyoku is thought to be necessary to undergo an
operation. When discussing treatments, patients tend to consider the influence on tairyoku
rather than mere physical discomfort caused by side effects. In other words, it can be said
that Japanese patients tend to consider holistic consequences in the long run, rather than
immediate cause and effect on the body itself.
What will happen if tairyoku starts to decrease, and nothing can stop it? Two patients said thefollowing to their doctors:
My disease is taking my tairyoku away.
I sometimes think I’ll have more tumours one after another, then my tairyoku will
decrease until death.
It can be said that a decrease in tairyoku is thought to indicate that one is approaching death.
A disease undermines tairyoku until it runs out at death.

41

Tairyoku - as a curative power
Tairyoku seems to be believed to have a power of healing. The following are all statementsby patients who knew their true diagnosis.
If I stay here (PCU), I’ll get better and have more tairyoku, I think.
I’d like to cure my cancer with my tairyoku.
I’m relying on my natural healing power. You (a doctor) told me I have nothing
wrong internally. I am fighting my cancer. I’m not about to let it beat me.
Its function is very similar to the immune system in Western medicine – the more tairyoku
patients have, the stronger they are, and they can fight a disease and kill it.
Additionally, as seen in the last statement above, patients seem to believe that their cancer is
not fatal when they have nothing abnormal internally. Another patient suffering from tongue
cancer also said, “I was told that nothing internal is affected.”, and showed his positive
attitude toward cure. It seems that if cancer does not affect internal organs, patients are still
able to eat, and therefore they can build tairyoku to fight their cancer. Tairyoku may beconsidered something internal, and thus if a cancer is developed on the surface of a body, thetumour will not affect tairyoku, which means that they can build tairyoku from within theirbody. One lung cancer patient said to his doctor:
I don’t mind having cancer all over, if I have no pain.
Here, having a cancer does not seem to be connected with bodily dysfunction that results indeath. Having no pain may simply mean that he is in enough comfort to be able to build up
his tairyoku again and so live longer. Even if cancer tumours spread all over the body, solong as there is no pain, this gives a patient a chance to regenerate tairyoku, which will seemto place them far from death.
It is thought that death approaches only when tairyoku runs out, and people are likely tobelieve that if patients have enough tairyoku, they can ‘throw off’ their cancer. The activities
to increase tairyoku, such as having nutrients, exercise, rest and a good state of mind are thus
significant for patients, although some of them may seem medically meaningless.
Tairyoku and eating
At the PCU it was observed that eating is one of the most meaningful of acts for many
patients. A prime example was a patient who would not give up eating, saying, “The day I
become unable to eat will be the day I die.” One patient cried and lamented, “Today is theworst day of my life”, when her doctor told the patient that she would not be able to eat
again. One patient who tried to eat said, “I won’t be able to walk any more if I don’t eat”.
However, in the course of cancer, patients usually suffer from anorexia. Both physical andsocio-emotional factors can be possible causes. For example, enlarged cancer tumours
putting pressure on the gullet, side effects of treatments, symptoms of cancer itself, such as
nausea and vomiting, fever, mouth ulcers, and depression (Yodogawa Christian Hospital
Hospice 1997; Kato 2000). Terminal Care Manual (1997), compiled by Yodogawa Christian
Hospital Hospice, noted that:42

It is important to clarify whose problem anorexia is and what is the nature of thatproblem. Sometimes a patient’s or a family’s idea that ‘the body will be weakened
without food’ is too heavy a burden for a patient.
(Yodogawa Christian Hospital Hospice 1997: 74)
One dietician has pointed out that it is important for patients’ families and carers to bear thefollowing things in mind:
1) to respect a patient’s will2) not to be alternately happy and miserable at a patient’s appetite
3) to accept that a patient will have less appetite in the course of a disease4) to think up various recipes which reduce the burden for carers (it issometimes essential for them to have a rest and make use of store-bought,
prepared foods for patients)
5) to keep a patient’s mouth hygienically clean6) to provide the best environment for a patient (for example, providing
ventilation, a clean room, maintaining a comfortable room temperature,music, and flowers on the table)(Kato 2000: 16)
Kato (ibid.) also claims that eating is important both to maintain life and to improve apatient’s quality of life. It is meaningful for patients to enjoy tasty seasonal meals together
with their families. Additionally, Kato (ibid.: 17) recommends recipes for patients who haveeating difficulties due to their symptoms, whether vomiting, diarrhea, dysphagia or oral
problems. This implies that it is important for patients and families to consume food orally
despite the difficulties.
This idea is supported by the fact that many hospices and PCUs in Japan organise events
offering seasonally themed meals. For instance, at PCU in Higashi Sapporo Hospital,
voluntary workers hold seasonal events, such as a summer festival in August and a moonviewing party in September, providing foods traditional to those events. Patients can enjoy
foods different from those usually provided by the hospital, and sometimes patients who
reject hospital meals can eat those seasonal ones, as a special treat for them. Additionally, as
medical professionals and other people working at PCU are all invited to these events, they
provide a great opportunity for patients and medical professionals to communicate informallywith one another. They eat the same food at the same table and talk about personal topics
other than their health. Both patients and doctors can be ‘themselves,’ escaping the roles ofpatient and carer. I heard some patients saying that they completely forgot to take medicines
after enjoying a meal of cooked salmon and vegetables from the communal pot (nabe),followed by a session of karaoke with other patients and all the people working at the PCU.
They had as good a time as they used to before becoming patients. Additionally, it should be
remembered that having meals with company can encourage the appetite.
A sixty-three year old breast cancer patient, Mrs. T lost her appetite while she was at PCU.
She said to her doctor:
I can eat if somebody else helps me. I don’t feel like eating at all when I’m alone, but
a nursing aid feeds me. Then I have more appetite. I become unable to eat when I’m
on my own, as I feel pain. People at the nurse station often come to my room.

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A nurse at Vihara 6 in Nagaoka Nishi Hospital said about a seventy-seven year old lungcancer patient that
She seems to have no particular pain, but her appetite has fallen off. She can’t really
eat breakfast. But she seems to be able to eat when her son is with her, so she eatslunch and dinner quite well.
In the former case, having company more or less affects the patient’s mental status, whicheven helps decrease the level of physical pain, and this enables her to eat. The latter caseshows that her son’s being together with the patient clearly encourages her appetite. A
Buddhist monk working voluntarily at Vihara told me that
There was a male patient who used to be at Vihara … I often went to his room tohave a chat. One day I found that he liked drinking. Then we had even more to talkabout. He told me there was a pub which served a very good mixed stew. I had neverbeen there, as it looked a bit dirty. However, I went to the pub at around four, and got
some stew for him. We drank together with it in his room. Then we became evencloser.
(Kiso: personal communication)
Having a good meal with others not only helps patients have a good appetite, but also builds
a good relationship with others, which may lead to a better mental state. Here is anotherexample which shows that having tasty food is considered important. A chief nurse at Tanaka
Surgery in Miyazaki Prefecture said:
I always ask all patients who come to this hospital what they want to eat, and what
they want to do. One old lady told me that she wanted to eat a flatfish. So I evendrove to Miyazaki City to buy a very good one for her. Once I had trouble with arequested food … We sent a patient with leukemia to the Miyazaki Prefectural
Hospital in December. When I visited him there with another nurse, he told us hewanted to eat some bamboo shoots. We didn’t know what to do, as it was not inseason, but someone who knew him well went to the mountains, and dug a few verysmall bamboo shoots for him. He ate only a little of them. It was his last meal. He
died three days after that. Later, I heard that he said it was so delicious.
(Tanaka: personal communication)
Eating is considered one of the biggest pleasures for patients, especially when they have lost
other faculties such as mobility. Therefore, carers usually try to help them eat even if they areat the very terminal stage, and patients themselves also try to eat as much as possible.
Feeding patients also seems to have a significant meaning for carers. Ohnuki-Tierney (1984)
points out that feeding patients their favourite foods is a non-verbalized method for dealing
with the psychological dimension of patients. Japanese people are more likely to feedpatients than to vocally express their concerns to patients. She attributes this to what Caudill(1976) pointed out, namely that ‘the Japanese are reluctant to verbalize their feelings,
although they can do so in writing’ (cited in Ohnuki-Tierney 1980: 221).

6

Vihara is the term advocated by Hitoshi Tamiya in 1985. This is the name for terminal care facilities with a
Buddhist background, and is used instead of the name ‘Buddhist hospice’ (Nagaoka Nishi Hospital home page,2001).

44

Increasing tairyoku with medical assistance
When a decrease in tairyoku becomes apparent, it threatens patients and families, as it
implies that death is approaching. Interestingly, many patients and families who still believein the fighting power of tairyoku start to seek medical assistance to increase their level oftairyoku.
Case study - Mr. H
Mr. H (aged eighty-five) who suffered from parotid gland cancer asked for TPN (total
parenteral nutrition7) in order to put on weight, although he was still able to take foods orally.
Doctor: A drip infusion on the back of your hand has the equivalent calories of one
rice ball.
Mr. H: If I have it on there, it will hurt, so I want to have it on here (points on his
chest).
Doctor: Would you like to have one, then?
Mr. H: I would like to, as I have never lost this much weight before …
Mr. H was practicing Yoga and taking health food regularly to build up his tairyoku.
Therefore, it was very shocking for him that he suddenly became unable to eat much andstarted to lose weight.
Case study - Mrs. K
Mrs. K was a fifty-four year old housewife who suffered from lung cancer. When her cancer
was diagnosed, it was already incurable. She tried many different alternative medicines, suchas Chinese medicine and health foods. Incidentally, her two sons were particularly keen on
Chinese herbal medicine prescribed by a Chinese medical doctor in Tokyo.
When I met her at the PCU, she was almost unconscious. Although it was hard for her toswallow, her family was still keen on Chinese herbal medicine, which was liquid. They werestill asking a doctor to insert a tube from her nose to throat, so that she could take the Chinese
medicine as she could not swallow. They were also constantly preoccupied with her
nutrition.
Toward the end of the patent’s life, the family even asked a doctor to try to manipulate herelectrolytes, and to improve her nutritional blood condition by using TPN, although a doctor
explained to the family that giving her treatments at this stage would be a burden for her.
They also asked a doctor to photocopy the blood test result for them to keep. The
conversation between the patient’s husband, son and a doctor suggests that the family werethinking that her cancer had affected her tairyoku rather than her organs themselves.
Husband: What is happening to her leukocytes?
Doctor: At the terminal stage they are always like this.
Son: Why does she have a fever?

7

Nutrition maintained entirely by intravenous injection or other nongastrointestinal route (Stedman’s Medical
Dictionary 1995).

45

Doctor: It is normal to have a fever just before death. In a sense, this is a naturalprocess.
[…]
Doctor: Normally, when weakened, patients suffer from lower sodium, but in hercase, the level has risen. It could be due to the Chinese medicine you have given her.
At an intensive care unit, the sodium level will be urgently corrected, but it ismeaningless to do that at the terminal stage of life.
Son: Is it really impossible, even if you try intentionally?
Doctor: Yes, if sodium is low, it could be supplied though …
Son: Are there any other problems with her blood test result?
Doctor: The level of one of her enzymes has gone up too, but this is partly caused byher cancer.
In this conversation, scientific and medical terms, such as sodium, leukocytes, and enzymes
are frequently used. Despite that, the family’s central concern was not very scientific.
Reference to the patient’s tumour itself and affected parts of the body were absent from theirconversation. The family’s main concern was at the molecular level, which is invisible
without advanced technology. However, this invisibility is similar to the concept of tairyoku.
In a sense, it seems that they consider the patient’s blood as a flow of tairyoku. The fact thatthey still tried to make her take the Chinese medicine, and asked the doctor to manipulate thesodium level in the blood, may not be very different from the perspectives of other patients
who try to rebuild tairyoku to fight their cancer. It can be said that this family also tried to put
the patient’s tairyoku back in balance by regulating her blood components, and to make itflow smoothly and harmoniously throughout her body. Although the word tairyoku wasbarely used here, Mrs. K’s family’s perspective demonstrates a similar concept in that they
tried to get something invisible back in balance for a better state of health. Additionally, italso seems that the family may have thought the patient would be cured if her blood
components were in balance, or if she had better nutrition. It was thought that the patient’s
symptoms were caused by a decrease in tairyoku due to her inability to eat, rather than bymalfunctioning organs due to her cancer. The subject of her cancer seems to be absent fromthe conversation.
Conclusion
The collection of patients’ and families’ narratives demonstrates that the traditional attitudes
towards health and illness coexist with Western medicine at PCUs in Japan. The concept oftairyoku appeared to be especially key. In sum, it functions as a measurement of bodily
condition, and it is thought to have a power to cure disease. Therefore, the activities toincrease tairyoku are considered important, and eating is the prime example of this. Whenpatients realize their disease is incurable, they exert themselves to increase their tairyoku tobeat the disease. Patients often believe that some medical treatments will result in thedecrease in tairyoku, and thus reject them. They prefer eating foods or taking alternative
medicine to undergoing Western medical treatments or taking drugs. However, when thedecrease in tairyoku becomes apparent despite their best efforts, they suddenly turn toWestern medicine in order to maintain the level of tairyoku.
Interestingly, when alternative medicine fails to meet patients’ expectations, they tend toreturn to biomedical treatment. Ohnuki-Tierney (1984) also explains that in Japan,
biomedicine is most effective in acute cases, and alternative medicine is most effective forhealth maintenance and in cases where biomedicine has failed. This may be because patients,

46

who are progressing to a more severe situation, need more immediate and specific treatment.
Biomedicine, which has the fragmentary tendencies that distinguish between body and mind,
physical and mental, rational and emotional, as independently constituted entities, can offer
treatments specifically to meet patients’ requests. It may also have more immediate andclearer effect than alternative medicine. (For example, it was explained to Mr. H by his
doctor that a drip infusion had calories equivalent to one rice ball.) Japanese patients may
believe that more specific and quick treatments on affected parts of body (including blood
components in Mrs. K’s case) will immediately result in returning the whole body to balance.
This may explain why the Japanese holistic view of health and disease coexists with Western
medicine.
In her book East Asian Medicine in Urban Japan, Lock (1980: 249) argues that ‘this type of
attitude reinforces reductionistic rather than holistic thinking and appears to have long
historical roots, since a similar attitude can be seen in traditional medical thinking: that thesocial order is given and the individual should adjust to it’. Lock illustrates that doctors andpatients do not usually attempt to manipulate dimensions other than physical ones, even if
other dimensions are seen as partially causal in illness. Instead, ‘they focus on building up
the patients’ physical states so that they can cope once again with the demands of daily life’(ibid.: 249). In the case of terminal cancer patients, Western medicine seems to be used toreinforce the balance to regenerate tairyoku. The things happening to patients’ bodies cannot
be changed and should be accepted, as they know their disease is incurable. In order to adjust
themselves to the situation, they want to build up the patients’ physical states at least at their
tairyoku level, instead of manipulating the cancer itself. Aspects similar to the concepts ofjibyō and taishitsu can be observed here.
The attitude of Mr. H and Mrs. K’s family may seem absurd and meaningless from the pointof view of Western medicine but can be explained in the context of Japanese concepts ofhealth and illness.
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