After the Dream of Medicine As a Versatile Solution, What Comes Next?

Since ancient times, Japan has had an unusual self-care culture. Following Japan’s nineteenth-century modernization, Western medicine has prevailed in the country, and the high health awareness of lay people forms the basis for promoting medicalization. Modern Western medicine is currently the national standard in Japan’s system of universal health insurance coverage. Unlike self-care movements closely connected with individual rights, such as in the United States, Japanese lay people’s high level of interest in health does not exert an influence at the institutional level. Thus, medical discourse still has prime influential power.

We have studied illnesses that lack objective abnormalities, especially the awareness of fibromyalgia, with respect to both patients and physicians. Although medicalization has prevailed in all fields in Japan, disseminating the concept of fibromyalgia and incorporating its treatment in the health-care system has lagged markedly compared with other countries.

This paper presents four phases of medicalization for descriptive purposes: cultural basis and prevailing healthism; explanation of specific conditions using medical terms; institutionalization and dissemination of medical categories; and demedicalization of untreatable conditions. We discuss the issues related to each phase using the data from our previous survey. We especially address the situation after medicalization has progressed with respect to fibromyalgia diagnosis: when fibromyalgia is being diagnosed but social awareness does not follow or effective remedies do not exist, how do patients and physicians interpret the diagnosis of fibromyalgia? We describe the process of demedicalization, whose characteristics in Japan may differ from those in Western countries. Namely, following the excessive expectations of biomedicine and distrust in medicine, it is possible that the Japanese are currently seeking greater faith in traditional forms of medicine, as a form of “regression.” This analysis presents a basis for rethinking the question of what comes after medicalization.