Note: I wrote the following for a class I took in Gerontology. I have not been to Japan, nor have I had a broad exposure to Japanese culture. The following paper is a product of reading about 15 journal articles relating to nursing and women's issues in Japan. So the following (with the exception of the population demographics) is probably biased towards the feelings of the authors whose works I read. Any comments or suggestions for changes would be greatly appreciated.
Japan is a place of tradition and ancient ethical guidelines. In order to understand how Japan treats its older population currently, and how it is changing into the future, you need to understand three things: What social effect did Confucianism have on Japan, and how is it currently interpreted? How has modernity and the women’s rights movement changed the social balance? Finally, how has Japan’s current demographic shift influenced the way services are administered and the nature of the family unit?
Confucianism, an ethical system founded in the sixth century BC by Confucius, made its way into Japan through China. Confucianism taught proper etiquette and defined person-to-person contact. Confucianism’s core tenets included, “harmony, reciprocity, dependency and privacy.” Importantly, it has also spread the idea of “filial piety” or “ancestor worship (Hashizume 2000, p. 26).” This idea holds the elderly in high esteem because of their knowledge and their understanding of tradition. Additionally, the elderly and the children in Japanese society were seen as interlinked creatures that were closer to the gods (Takaya 1994, p.454).
The elderly and the children of this society were given this special status for two reasons. The most important was the idea that the elderly are reborn again as children. “Thirty-three years after the death of an old person, the soul was thought to be reborn as a soul of a child (Takaya 1994, p.454).” The other reason these two groups are related is by their life style. Japan’s society is based on the ability to work and be monetarily productive, but children and the elderly fall outside of this idea. Since children and the elderly were, “outside… and peripheral to this existence meant that they were free from the restrictions of society. A Japanese proverb states, ‘Until 7 the child is of the gods (Takaya 1994, p.454).’” This freedom of time, as well as moving into a new stage of development where rapid changes occur, further link the two groups in Japanese eyes.
Even though the elderly hold a special position outside of the normal society of Japan, the power of the society’s devotion to production and creation sometimes the elderly are not as valued as Confucianism requires. In response in the Japanese folk tradition there is a story the elderly pass on to prove that everyone will be in their situation one day (Takaya 1994, p.454).
This is the story of “Oyasute”, or “Discarding Mother.” In the story, a father takes his son and his mother into the mountains carrying them on his back in a basket called a mokko. The father turns to leave his infirm mother behind and notices that his son has picked up the mokko and is taking it with him back down the mountain. The father asks his son why he picked up the basket. The son replies that he would need the basket when it came time to leave him on the mountain. Horrified at this prospect and at his own cruelty, the father carries his mother back home with them (Takaya 1994, p.454).
Who takes care of the Japanese elderly? Since Confucianism demands, “harmony, reciprocity, dependency and privacy,” the task is usually met by the family, in their home and in private. The idea of caring for your elderly parents or in-laws comes particularly from the idea of reciprocity. Caring for a parent is, “a way of meeting debt and obligation… which arises from a sense of gratitude for childhood nurturing (Hashizume 2000, p. 26).”
Traditionally, Japan has been a male dominated society. In fact, one writer discussing the changing social climate in Japan, wrote that, “Before World War II, women were very oppressed in Japan,” and that in 1950 only “one out of every three girls…received a high school education (Hashizume 2000, p. 26).”
However, changing demographics and exposure to western society after World War II has radically changed the social structure of Japanese society. Women began taking advantage of educational opportunities that were becoming available to them. In contrast to the 1950 statistic above, “since the mid 1970s almost all Japanese children have attended high school, and two out of five high school graduates have gone on to higher education (Hashizume 2000, p. 26).” Partially, because of this new freedom, women have been having fewer children; in fact, in 1991 the rate was 1.53 children per woman (Hashizume 2000, p.26).
As a result of this, the population of Japan has being “graying” very quickly. In fact, over the past thirty years Japan has gotten older than any other country. Additionally, Japan’s life expectancy in 1990 was the highest in the world at 81 years for both men and women. (Morley 1999) These two interlinked phenomenon, Japan getting older and its lower birth rate, have created a health care crisis (Hashziume 2000).
In Japan there is a social construct called “ie-seido,” which defines family roles. This structure “demands that women obey men, that the young obey the old, and that daughters-in-law obey their mothers-in-law. This structure used to be legally binding, but after World War II it was disbanded, but is still in practical effect (Hashizume 2000, p.27). In fact, the tax structure in Japan puts women’s work and wages at a disadvantage in order to keep them from having a career full time (Morley 1999, p.90). This structure would provide people to take care of the old, however, middle-aged women the traditional caregivers in society who in the past quit their jobs when nursing care was needed, are in large part not following tradition. With the greater educational opportunities over the past thirty years, women have come into their own in business and other career fields and do not want to quit (Hashizume 2000, p.28).
How is the Japanese government and society in general responding to the crisis? They are somewhat handicapped in providing services because of another Confucianist tenet, the extreme privacy and autonomy of the family unit in society. This inhibits any in-home outside care, as it would be seen as an intrusion and a violation of privacy. As a result, the number of women caring for their older family members remains rather high: 34.8% (Hashizume 2000, p. 27-28).
In those situations where a female family member remains in the work force, hospitalization is the most common alternative. In most cases, the elderly family members are otherwise healthy, but they are put into the hospital when their ability to care for themselves breaks down (Hashizume 2000, p. 27). As a result, hospital stays in Japan are ten times as long as in the United States. Japan has a universal health care system so the costs are spread across society, however policy makers are slowly finding that the current situation is not ideal and makes treating those with real disease or other health care problems more difficult (Hashizume 2000).
Japan’s department of health and welfare has devised a “Gold Plan,” which set aside 61 billion dollars to increase the number of long term care facilities for the elderly. However, to date not much of that money has been put to use, and the number of spots in long term care facilities is still lagging behind the population that needs them (Hashizume 2000, p.26).
One of the unique ways that elder care is being tested in Japan is through child daycare. Since the birthrate is going down, there are many child daycare facilities that are being underutilized. As a result, in some cities there are programs that are retraining workers and combining child and adult daycare (Yamazaki, p.459). It is beneficial for Japanese society, because as noted above, tradition links the young and the old. Additionally, the centers are using their older patients as ad-hoc teachers for the young. In this way, they are passing down traditional stories, crafts and other culture. This is an interesting approach, and one that seems to be working in small-scale trials (Yamazaki, p. 459).
Overall, the Japanese revere their elder citizens. The problem they are facing however, is how to live up to that reverence. As noted above there are some new and interesting programs, but society and governance seems to be moving very slowly. Hopefully, this structural lag will dissipate and the burden will be less on a female population that is coming into its own.
Hashizume, Yumi. (January/February 2000). Gender Issues and Japanese Family Centered Caregiving for Frail Elderly Patients or Parents-in-Law in Modern Japan: From the Sociocultural and Historical Perspectives. Public Health Nursing, Vol.17 No.1, pp. 25-31
Morley, Patricia. (1999). Facing Two Ways and The Twilight Years: Caring for the Elderly. In The Mountain is Moving: Japanese Women’s Lives (p. 70 and p. 89-103)
Yamazaki, Takaya. (July/August 1994). Intergenerational Interaction outside the Family. Educational Gerontology, Vol. 20, No. 5, pp. 453-463.