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Japanese responses to social change--making the strange familiar.

Understanding the concept of a "sense of coherence" can be useful in trying to account for successful and healthy adaptations to situations of social change and migration. Certain fundamental dynamics of social life in Japan contribute to a sense of coherence in the lives of Japanese today. Analysts of modern Japan have noted that it has not become a replica of western societies in that primary social groups take precedence over individual needs and autonomy. Moreover, although the Japanese personality may be characterized as multilayered, one dominant aspect is the tendency to suppress negative feelings-towards intimates, family and those in authority. This tendency has implications for the patient-physician relationship, which tends to be ritualized to protect a patient's innermost feelings. Because there has never been a split between mind and body in Japanese thinking there is no concept of mental health that is separate from physical health; rather, patients and physicians readily accept that illness is an expression of stress on the social level. As a corollary, the responsibility for healing is felt to be in the hands of patients and their families, with physicians playing the part of skilled and sympathetic technicians. Ascribing the origins of a cultural identity risks stereotyping, but understanding the reasons for the continuity of certain values in Japanese immigrants will enable physicians to use these values to advantage, and explains the healthy adaptation of these immigrants to the disruption of migration.