Comparing Gaman

On Good Food and Endurance in a Japanese Collective of Diabetes Patients

Paper prepared for the East Asian Anthropological Association Conference, Hong Kong, July 6,
2012. Comments and suggestions welcome.

Mohcsi Gergely
Keio University

Email: mohacska@z3.keio.jp

KEYWORDS: diabetes, comparison, nutrition, embodiment, Japan

ABSTRACT: Explicitly or not, the comparison of differences constitutes the
epistemological backbone of most anthropological thinking. The comparative
method, however, is by no means a monopoly of our discipline. As I will try to
show in this paper, the act of comparing is also central to the innovation of
medical knowledge as well as the articulation of emotions. People living with
diabetes have many stories to tell about comparing their differences through the
social act of sharing and consuming food. Kuromatsu-no-kai, the focus of this
paper, is a self-help group that brings together people with diabetes and their
families in the Sunamachi area of Tokyo, Japan. Through their stories of
comparing food and the emotions that follow from eating (or not), my aim is to
work through the complex relations between anthropological, medical and
interpersonal modes of comparison and show how theoretical perspectives are
produced by as much as they are producing the world. The mundane routines
of counting, comparing and eating food suggest important ways of generating
creativity both in diabetes care and in the conceptual work of anthropology. I will
ask what kind of new understandings and emotions could arise from such
recursive relations and how they might travel between Japanese and other
contexts.
1 of 10

1 Comparison
Since its inception, much of the anthropological agenda has been revolving
around various forms of comparison. Whether viewed as a method (the
comparative method) or as an attitude, comparison turns out to be, to
paraphrase Marilyn Strathern, a heterogeneous spectrum of middle-range
strategies, mainstream and subaltern, that sustained the discipline along
numerous lifelines (Strathern 2002: xii). Its probably not too much to say that
the comparison of differences constitutes the epistemological backbone of
anthropological thinking and thus merit special attention, correction and
improvement. This is, so to say, the purpose of this paper.

Needless to say, the comparative method is by no means a monopoly of

anthropological thinking. From genetics to tourism, it is one of the most common

ways of learning about each other in our global world.1 What is more, methods
and issues of anthropological interest fold into each other in these comparative

acts.2

2 Gaman
It is hard to avoid such mundane comparative acts these days in Japan. Both
foreign and Japanese media is replete with the obvious parallels of coping with
natural disaster in post-tsunami Japan and other countries that suffered similar
catastrophes in the recent past. In these accounts the index of human effort is
the endurance of hardships and the control of human emotions.

As you might expect, Japanese people tend to be on the favorable side

in these comparisons: they endure, they work hard, and, against all odds, they
1

As well as it is to many of my informants: patients who ask me about diabetes treatment in

Hungary (where I come from) or molecular biologists who compare genetic defects of Japanese
populations in Brazil and Okayama. As I will try to show in this paper, the act of comparing is
central to the innovation of medical knowledge as well as the articulation of negative emotions.
2

For ethnographic examples of this kind of recursive relation between method and practice, see
(Choy 2011; Niewhner and Scheffer 2010); for a more interdisciplinary take on the comparative
method, see the special issue Comparative Relativism Symposium on an Impossibility, in
Common Knowledge (Jensen 2011).

2 of 10

rebuild their country in a time span that would be unthinkable in New Orleans or
Sumatra. This endurance is referred to as gaman. Yes, I can see the suspicious
doubt in your eyes, especially those of you from Japan. The primary
anthropological reaction to such kind of comparison is that Japanese
endurance is, at best, a social construction, or, worse, a sign of some kind of
reemerging nationalism.

What Id like to show in todays presentation, however, is that there may be

more to it. Gaman, I will argue, is both a hotbed and an outcome of cultural and
other seemingly incommensurable differences. In the following case study, it
lies between the comparative practices of diabetes patients and the
anthropologist.

3 Background
But before I start, let me tell you briefly about the background of this paper. It is
a part of my doctoral research, in which I tried to accomplish what I call an
ethnography of disease. I focused on diabetes in Japan by examining (1) how
medical technologies interact with cultural values and (2) how does living with
chronic illness rearrange human senses. Building my analysis around the
concept of metabolism, I described how daily encounters with medical
technologies and popular health practices introduce new ways of attending
bodies (of self and other). This is an ethnographic attempt to draw attention to
the important and often neglected dimension of the mediation between scientific
facts and cultural meanings at various sites of disease: a diabetes center in
northern Japan, a molecular biology lab, and a patient group in Shitamachi,
Tokyo. It is this latter place that Im going to focus on today.

4 Kuromatsu-no-kai
Kuromatsu-no-kai is a self-help group that brings together people with diabetes
and their families in the Sunamachi area of Koto-ward. It is a blue-collar

3 of 10

neighborhood in Eastern Tokyo, a fifteen minutes train ride from the centers of
the city, sitting on a land that has been mostly reclaimed from the sea since the
Edo period. Sunamachi shares most of its history of industrialization and
disasters with the surrounding neighborhoods that are collectively referred to as
Shitamachi (low city) by Tokyoites conjuring up nostalgic images of communal
harmony and bustling shopping streets.

Between 2006 and 2009, I participated in the monthly meetings of

Kuromatsu-no-kai, where I found, among others, friendly chats about the

newest kampo medications (and why physicians refuse to prescribe them) and
heated discussions over an official invitation to the national federation of
diabetes self-help groups, which some members rejected flat out. One
overwhelming concern was how to reach a common ground that was more than
the adoption of existing clichs about strict control, but less than a cacophony of
patient voices. Technocrats, doctors and community leaders connected the risk
of diabetes with lay expertise and state institutions in the activities of cooking,
walking and learning.

5 Learning
Murata-san, one of the founders, expressed his doubts about such a
collaboration and put the emphasis on the separation between governance and
activism. He was very explicit about such a distance from both technocratic
values and medical professionals when he recalled the early years of the
association:

I was always nervous in front of the doctor and the five minuteexamination at the clinic didnt help much to get rid of that tension. I felt
paralyzed And then I first attended this training program at the
hoken-jo and it just gave me a different sense of the disease in me.
We cooked together and enjoyed the meal that we prepared together.

4 of 10

We shared our food at the table and our stories of struggling with diet
restrictions. I kind of forgot that we were there for the disease. And
then we decided to gather again, and again to learn about diabetes.
We formed this little learning group. Well, I say learning, but, you see,
there are no doctors here, we dont need them; we are all patients, we

eat together, and we learn about diabetes in our own way.

6 Nutrition
Eating became a way of learning diabetes, an event of appreciating disease.
Food, drink, and the acts of preparing and consuming them extended to the
core of each patients being providing a way to express suffering and distress in
situations of knowing about the disease inside their bodies (Whats the time?
Oops! My insulin peaks soon Im going to go grab something for lunch. Will
you join me?). Daily stress was a condition that followed blood sugar levels.
The self-help group entered into this space of disease by crafting new
configurations of engagement with food from organizing cooking days around
particular themes (like bento, Chinese, soup, etc.) to inviting chefs from a
hotel or sales representatives of catering services specializing in diabetic food
delivery. These events connected them to things (food and else) they had never
seen or done before by prompting them to take the painful aspects of living with
diabetes as an access to knowledge.

7 Food
However, for many diabetes patients and their families sociability is not simply
a way of encouraging eating: it is also an end in itself for which eating and
drinking provide the means (Mol, Harbers, and Stollmeyer 2002:216). This
collective experience of disease was important for women like Takagi-san in
performing their public role as caregivers in the act of preparing and measuring
food. She wasnt sick herself, but attended the meetings on behalf of her
husband who couldnt actively participate in weekday activities because of his
5 of 10

work. As she put it: I do the cooking anyway! He could learn nothing here even

if he had the time to come.3 And while eating was indeed both a beginning and
an end of the collective, it had to get through some calculation before it could be
shared as a negative social experience of disease.4

8 Balance
Kuromatsu-no-kais spring meetings were held in a park close to the health
center where members were regularly gathering. It was scheduled for the first
week of April, which, if all went well, coincided with the flower-viewing season
providing an occasion for preparing and enjoying bento, or boxed-lunch,
together under the blossoming cherry trees a traditional activity of urban
Japanese called hanami and practiced by hundreds of thousands of Tokyoites
each year.

Before the main event, seven members of the group got together in

Murata-sans house, which stood behind an old abandoned brick factory and a
danchi (apartment complex) on the other side of the road. All participants
arrived with the Food Exchange List in their hands and Murata-sans wife
arranged tiny scales for everyone to measure the weight of the foodstuffs.
Another woman bought three different kinds of bento at a nearby department
store, and now she was busy with emptying their various contents upon a long
3

Such a view of food may seem akin to what anthropologist Anne Allison has observed as the
effect of education motherhood. In her study of mothers who prepare lunch-boxes for their
children at Japanese daycare centers Allison found that food practices embedded family bonds
in a web of power relations from the collectivity of pupils to institutions of the state by blend(ing)
personal discipline and collective life (shdan seikatsu) so that everyone was expected not only
to eat correctly but also to eat correctly as a member of the group (Allison 1991).
4 Food figured as an important event of patient advocacy in the act of counting calories. The
move, then, was away from food and toward nutrition. Nutrition was not a premise of health
advocacy dancing in the heads of epidemiologists and bureaucrats; it was coming into being in
the enactment of blood sugar levels that changed according to the amount and types of food
consumed and the daily management of their balance. Such calculations had been the work of
professional nutritionists and nurses until recently, but thanks to a simple printed catalog of
foodstuffs, now it was changing into a means of estimation done by diabetes patients
themselves. The daily practice of calculation that was made possible by this so-called Food
Exchange List and other tools of measuring reconfigured the simple routine of eating as and
act of knowing and articulating nutrition levels.

6 of 10

table on the tatami mat surrounded by group members. They put each food item
on the scale and wrote down their weight on a piece of paper. Next, these
numbers were transcribed to the blank columns of a printed list prepared by
Murata-sans son a couple of days earlier. It was this Calorie Counting
Chart (karor keisan hy) that made nutrition and food speak about the same
object through measuring, estimating and comparing. Such a process of
translation, however, was far from being smooth; it was a demanding and
stressful task.

After they looked up ingredients one by one in the official Food Exchange

List, they entered them into the pre-structured tables on their homemade sheets
that mapped the items of the lunch-box against their nutritional values.
Calculating, classifying and converting the content of the three different bento in
this way, radish and tofu put on the character of nutrition even for those
members who never in their life prepared a meal themselves and were mostly
ignorant of the content of foodstuffs. The following day, the final version of this
handmade list was printed and handed out along with the lunch-box to all
members of the hanami outing.

In this way, nutrition allowed participants to compare the three lunch boxes

along some meaningful dimension: (1) tasty, but calorie-laden; (2) low calorie,
but expensive; (3) a good balance between the two. The whole idea of
calculating and comparing the contents of three different kinds of bento was
about choosing the most adequate one for the hanami, to begin with. Eating
tasty food is a pleasure, but their calorie density is a source of stress. Lowcalorie bento may be a solution, if you dont have to worry about your wallet.
Good balance means then, for members of the patient group, a
commensuration between calories and prices that align the multiple sources of
distress. But how?

At first, participants agreed that the third with its good balance was the

best option if they decided to buy the same bento for everyone. However, at this
point, Suzuki-san cautioned the group that for some members even this amount

7 of 10

of food is too much, so they may go for the one with the lowest calorie. To
counter this argument, Shimazaki-san, an energetic woman in her early
seventies, answered: Well, it may require some endurance (dakara, gaman
sureba ii dehs) from those whose recommendation is lower. I hate to tell this,
but couldnt they just leave the extra food in the box? But Suzuki-san was far
from convinced: We go all the way to flower-viewing and then we end up
worrying about [calories]! (Sekkaku no hanami na no ni, ki wo tsukatte bakari),
she muttered.

The point then is not that patients have necessarily left this meeting with a

nuanced understanding of nutritional values; neither that such activities had a

profound effect on their daily management of diabetes (although it might have
for some). What I rather suggest is that in this technosocial commensuration of
numbers, types of nutrients and the daily pleasure or anxiety of eating personal
and social distress of diabetes fuse into each other.

9 Hanami
The next day, I went to the hanami, which, thanks to the fine weather, was
attended by almost all active members of the group making it a successful
learning experience. Shimazaki-san took the lead before handing out the lunch
boxes by explaining the pros and cons of leaving some food in the box:

Dear friends, please check the Calorie Counting Chart we prepared
for you yesterday. You will find all the ingredients of the bento and the
energy content of it in [food exchange] units. Im sure that it will be too
much for some of you, so please check your daily calorie prescriptions
before you start to eat and adjust the content of your lunch to it. Its
okay to leave food in your box, so start with your favorite ones. I admit
that its not easy, but think of it as some kind of stress relief game.

8 of 10

That is to say, food provoked intense concern and worry when it became
nutrition because, and so far as, stress and diabetes extended each other in
their effects of calculating caloric intake collectively.

Distress may not be the direct cause of high sugar levels (biologically

speaking, its actually the other way around), but local understandings of what
actually can be sensed as stress and how may follow the daily practices of
diabetes management.

10 Comparison, reloaded
The notion of incommensurability may be useful for underscoring the limitations
of the vast array of scholarly work on the relationship between chronic disease
and stress. From a methodological point of view, the a priori dependence on
interpretive frameworks of comparison such as the social or the cultural
in ethnographic fieldwork bypasses some important links that medical practice
creates between incommensurable realms of doctors and patients, biology and
suffering, or diabetes and stress. These two distant worlds, which medical
anthropologists used to call disease and illness, include each other in multiple
ways that are nonetheless fundamental, although less easy to account for in the
language of pluralism.

The activities of the Kuromatsu-no-kai suggest that patients advocacy can

articulate new modes of comparison that tolerate the diversion of distinct

entities. As we have seen, disease and stress emerge (again) as separate
entities when unique experiences clash with one another and singularities are
shared at the meetings of the self-help group. It is through this never ending
battle of glucose control that individual trajectories of distress open up a new
field of knowledge about diabetes. Considered in this way, anthropological
inquiry can be depicted as a theoretical device that promises to reveal the
implicit links between multiple levels of suffering and negative emotions.
Comparison, we may say, is a form of anthropology as well as its content, both
an explanatory resource and an achievement to be explained.

9 of 10

References
Allison, Anne
1991

Japanese Mothers and Obentos: The Lunch-Box as Ideological State Apparatus.

Anthropological Quarterly 64(4):195-208.

Choy, Timothy K.
2011

Ecologies of comparison : an ethnography of endangerment in Hong Kong. Durham

NC: Duke University Press.

Jensen, Casper Bruun

2011

Comparative Relativism Symposium on an Impossibility. Common Knowledge 17(1):

1-12.

Mol, Annemarie, Hans Harbers, and Alice Stollmeyer

2002

Food Matters: Arguments for an Ethnography of Daily Care. Theory Culture Society
19(5-6):207-226.

Niewhner, Jrg, and Thomas Scheffer

2010

Thick comparison : reviving the ethnographic aspiration. International studies in

sociology and social anthropology. Pp. 223 p. Leiden ; Boston: Brill.

Strathern, Marilyn
2002

Not Giving the Game Away (Foreword). In Anthropology by Comparison. A. Gingrich

and R. G. Fox, eds. Pp. xiii-xix. London: Routledge.

10 of 10