Lock M
West J Med. 1983 Dec;139(6):829-34.
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.
理解“连贯感”这一概念，有助于解释人们如何成功且健康地适应社会变革和移民情况。日本社会生活中的某些基本动态因素，促成了当今日本人生活中的连贯感。研究现代日本的分析人士指出，日本并未成为西方社会的翻版，因为主要社会群体优先于个人需求和自主性。此外，尽管日本人的性格可能具有多面性，但一个主要特点是倾向于压抑对亲密之人、家人和权威人士的负面情绪。这种倾向对医患关系产生影响，医患关系往往仪式化，以保护患者的内心感受。由于在日本思想中身心从未分离，所以不存在与身体健康相分离的心理健康概念；相反，患者和医生都欣然接受疾病是社会层面压力的一种表现。相应地，人们认为康复的责任在于患者及其家人，医生则扮演熟练且富有同情心的技术人员角色。归因文化身份的起源有刻板印象之嫌，但理解日本移民某些价值观得以延续的原因，将使医生能够利用这些价值观，也解释了这些移民能健康适应移民带来的扰乱。
