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Social Exclusion and Care in Underclass Japan: Attunement as Techniques of Belonging

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Abstract

While Japan boasts a universal healthcare system and state-of-the-art medical technology, healthcare has often been denied to those who do not conform to moral ideals of a deserving patient. In underclass enclaves known as yoseba (day laborers’ quarter), patients have been frequently turned away or blacklisted on grounds of their abnormality and non-compliance. As much as healthcare was enmeshed in the normative bonds of family and community sanctioned by the state, yoseba men were considered as outsiders who neglected their duties of care, thus, undeserving of any form of care themselves. Focusing on the struggle for healthcare in a yoseba enclave in Yokohama over the past three decades, this paper explores how various practices of care have been improvised in this last refuge for the underclass men. The relentless endeavor pursued by local medical activists reveals how attending to yoseba patients required creative techniques of spatio-temporal attunement to make healthcare a communal project. Here, a form of “embodied belonging” was sought through bodily care coordinated among various agents and things, rather than through claims for membership in a bounded entity.

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Notes

  1. All names, including that of the clinic, are pseudonyms. Publications from the clinic are anonymized accordingly.

  2. For ethnographies of yoseba enclaves, see Fowler (1996), Gill (2001), and Stevens (1997).

  3. Although it is hard to find official health statistics of yoseba districts, memoirs and reports written by doctors, public health practitioners, and activists give us a glimpse of the patterns of disease and mortality shared by day laborers in these districts in the decades leading up to the bubble economy (Fujii 1990; Honda 1966; Koyanagi 1990; Nomoto 2003; Saeki 1982; Takayanagi 1987; Watanabe 1977). Since the collapse of the financial bubbles in the early 1990s, yoseba activists shifted their agenda from the right to labor to the right to survival, and yoseba enclaves have become rather exceptional protective refuge where impoverished and sick elderly men can spend the last years of their lives receiving welfare and social support (Gill 2015; Kim 2018).

  4. In understanding the current day meanings of en, it is important to distinguish its usage as a suffix from that as a standalone noun. When used alone, en maintains some of its Buddhist connotations, as shown in the idiomatic expression “we have en!” (en ga aru!) calling attention to the mysterious fate that brings strangers together (Goldfarb 2016; Nozawa 2015). As Kathryn Goldfarb decisively notes, these two different usages of en, nonetheless, converge in their emphasis on the prescribed and predetermined nature of human relations, which downplays the human agency in cultivating new relationships (Goldfarb 2016). For the purpose of this paper, I limit my discussion to the institutionalized relations of “-en” used as a suffix, as it is these –en that are put in question when people are categorized as being muen.

  5. According to the 2017 survey by the Cabinet Office, 31.4% of the 1758 homeless respondents reported to have been harassed by passengers-by and local residents, while 34.2% reported to have been physically abused. https://survey.gov-online.go.jp/h29/h29-jinken/zh/z24.html accessed on February 19, 2019.

  6. According to the nationwide complete enumeration survey of the homeless in Japan that continued since 2003, the majority has been identified as men, with women consistently counting around 3% of the total homeless population (https://www.mhlw.go.jp/toukei/list/63-15b.html accessed on August 30, 2019). The gender gap is understood to result from a combination of factors including the narrow definition of the homeless (as those sleeping outdoors) adopted in these surveys and the gendered social policy that uniquely excludes single able-bodied men from welfare schemes, compared to families, women, and children.

  7. MCN (1996:7).

  8. Among the middle class in Japan at the same time, a parallel case of medicalization took place around depression and suicide, which allowed psychiatry to become a powerful tool for a social movement against overwork, as well captured in Junko Kitanaka’s ethnography (Kitanaka 2012).

  9. By the time I started my fieldwork, Narita had already passed away, yet the story of his miraculous recovery from alcoholism was frequently recounted by the medical activists in Kotobuki district, as well as in the publications by Minnano Clinic. Narita’s story presented here is reconstructed from these imprints of his life circulated in and around the clinic.

  10. For an ethnographic account on this grave and its making, see Marr (2019).

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Acknowledgements

I deeply appreciate the anonymous reviewers and the special editors Dominik Mattes and Claudia Lang for their thoughtful feedback on earlier versions of this text. I would also like to express my sincere gratitude to all those who shared their stories and lives with me in Kotobuki.

Funding

This study was partially funded by Wenner-Gren Foundation (Grant Number 8130), the Ilju Academic and Cultural Research Foundation, and the Graduate School of East Asian Studies at the Freie Universität Berlin.

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  1. School of Languages, Cultures and Societies, University of Leeds, 14 Cromer Terrace, Room 1.16, Leeds, LS2 9JR, UK

    Jieun Kim

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Kim, J. Social Exclusion and Care in Underclass Japan: Attunement as Techniques of Belonging. Cult Med Psychiatry 45, 42–63 (2021). https://doi.org/10.1007/s11013-020-09678-2

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