Why is the Japanese rate of students with disability a fraction of that of the United States? Barring genetic differences between Americans and Japanese, the difference in disability rates must be what Durkheim called a “social fact,” a phenomenon explained by social differences between the two countries. In this paper we focus on the institutional and cultural factors that enter into the Japanese construction of disability of school-aged students. We argue that the lower incidence of disability in Japan is a result of Japan’s strong collectivist and paternalistic orientation and the requisite institutions promulgating those beliefs. The latter play a key role in the translation of general cultural dispositions into concrete policies and behavior on the ground.