2025 Theses Doctoral

Making Way for Uncertainty: Gender, Power, and the Epistemology of Illness in Japan, 1585–1953

Huang, Tianyuan

This dissertation explores the power dynamics of Japan’s enduring medical pluralism and the laywoman’s lived experience of illness therein between the late sixteenth and mid-twentieth centuries. Through the lens of agnotology, the study of ignorance, it traces the various epistemologies of illness that lent legitimacy, popularity, and power to a health diagnosis called the “way of blood” (chi no michi), which signified “women’s illness,” especially when symptoms appeared subjective and nonspecific in the eyes of the doctor. The study analyzes knowledge transmission across hegemonic and nonhegemonic therapeutic traditions, together with the epistemic labor of clinicians, patients, and the various communities of practice that rallied behind or against them. The inquiry reframes the mystification of women in healthcare as more than merely an unfortunate outcome of medical sexism.

Drawing on medical as well as nonmedical sources, the dissertation argues that clinical uncertainty has been leveraged historically to serve the purpose of leveling the playfield in illness management. Besides making way for lived experiences to rival academic expertise, the lack of certainty in determining the presence and nature of pathology may afford delegitimized epistemologies of illness the opportunity to renegotiate the criteria for knowing, knowledge, and the identity of the knower. The vernacular notion of the “way of blood” discouraged, evaded, and resisted the exposition of elite physicians of both Chinese-style medicine (kanpō) and Western scientific medicine, which reinforced its status as a health condition fraught with diagnostic ambiguity. The laywoman, meanwhile, welcomed the diagnosis over the centuries precisely because its lack of clarity afforded her a versatile tool to create her own meaning around unintended pregnancies, maternal griefs, and other ambivalent health implications of womanhood.

The dissertation illuminates the historical operations of ignorance by demonstrating the potential of clinical uncertainty to facilitate autonomy and defiance alike. It invites us to explore epistemic empowerment not only within the context of knowledge production but also by reimagining the distribution of authority among different forms of knowing.