Faltering Discipline and the Ailing Family
Faltering Discipline and the Ailing Family
Abstract and Keywords
The basic ingredients in the discussion of the modern Japanese family and its members are, nearly everyone agrees, limitations of space in the Japanese archipelago, urbanization and other demographic changes, post-war reform, loss of contact with nature, and an increasing acceptance of the Western value of individualism. Discussants sorted and grouped this potpourri in various ways to create competing discourses about the family, some positive about the current situation but many, and most particularly in official documents, critical. Human relationships in urban areas are increasingly described as thin, a state symbolized by the phenomenon of elderly people dying alone and unnoticed. The majority of women, although they had given some thought to kōnenki, were primarily interested in family vicissitudes and work; concern about kōnenki was usually confined to the fact that it signals the approach of old age and thus inevitably impinges on family matters.
The Fragile Family
An ark drifting along on a rough sea is an apt metaphor for the contemporary Japanese family.
(Higuchi Keiko 1980, 93)
Recent proposals for a new national holiday, Family Day, form part of the debate in Japan over the “health” of the country. Supporters of the proposal claim that the country's spiritual health is poor despite its economic soundness (Mochida 1980). Conservative social critics link the malaise to changes in the family system and most notably to a decline in the number of traditional households. They often explicitly contrast the strength of the ie to the fragility of the postwar nuclear family, home of the professional housewife, her husband, and children.
Although the ie was officially abolished at the end of the war, as Nakane and others point out, it is a “form of group consciousness” that survives (with much of the nationalism removed) as the structural basis for many contemporary Japanese institutions and organizations (Nakane 1983, 260; Murakami et al. 1979). It is this traditional household that people have in mind as the lost ideal when they talk about the spiritual malaise of the modern family.
The nuclear household exists, in contrast to the ie, as an urban residence, separated both in fact and in spirit from the seat of the ancestors. A nuclear household has undergone what is sometimes called “privatization” (Morioka 1983, 130) because it is no longer subject to either state or community surveillance as was the prewar household. Some social commentators consider the modern family, unlike the traditional one, to be a (p.108) brittle “pathological” system in which sexual equality, liberalization of parent-child relations, and egalitarian inheritance laws have disrupted the traditional forms of control, leading to an epidemic of social anomie (Eto 1979; Mochida 1980). Other analysts vehemently disagree with this position. Yuzawa, for example, a psychologist at the Tokyo Family Court, uses statistics to support his argument that no “pathological evolution of the family” has taken place in recent years (Yuzawa 1977; 1980, 77). He states that the mass media, by giving undue coverage to deviancy and divorce, have convinced the Japanese public that the family is an “ailing” system. He believes the reverse to be true: “The family has thrown off the shackles of the traditional … system, freed itself from poverty, and eliminated inhuman relationships” (Yuzawa 1980, 85). Higuchi Keiko, a well known social commentator, does not have such a rosy view. While she supports Yuzawa's position, she believes that too great a burden is being placed on the modern family and that critics should examine the goals of society at large (Higuchi 1980, 90).
The basic ingredients in the discussion of the modern Japanese family and its members are, nearly everyone agrees, limitations of space in the Japanese archipelago, urbanization and other demographic changes, postwar reform, loss of contact with nature, and an increasing acceptance of the Western value of individualism. Discussants sort and group this potpourri in various ways to create competing discourses about the family, some positive about the current situation but many, and most particularly in official documents, critical. Human relationships in urban areas are increasingly described as “thin,” a state “symbolized by the phenomenon of elderly people dying alone and unnoticed” (Imazu et al. 1979, 43). Excess emphasis on the achievement of personal desires rather than self-sacrifice for the state or family is also noted as a problem (Monbushō 1983); the “social underpinnings” of the family are said to be weak, permitting the isolation of family members, and the “natural” order of the traditional community and the extended family is said to be destroyed (Imazu et al. 1979, 47; Kokumin Seikatsu Hakusho 1983).
This deterioration leads in turn, it is claimed, to more cases of suicide and to a “sharply increased … incidence of neurotic disorders and affective psychoses, as well as that of senile psychotic conditions” (Munakata 1986, 166). The absence of the father because of demands of work also produces social problems including an “undue” strengthening of the mother-child bond so that the mother is inclined to overprotect and dote on her child (Kitahara 1989, 64). A letter to the editor of the Mainichi newspaper in November 1983 suggested the reasons for juvenile delinquency and crime: (p.109) people once lived in extended families where someone was always watching the children, but not now. In the nuclear family, communication has diminished, children have their own rooms, and so parents do not know what their children are doing, and parents just give their children money and aren't really interested in them (Mainichi shinbun 1983a). A psychiatrist writing in the same newspaper the day before (and probably triggering the letter) stated that the trend toward giving children private rooms was “merely copying the outward forms of Western individualism while sticking to traditional overly close (beta-beta shita) human relationships, leading to anxiety states in children when they find themselves alone in their own private rooms” (Mainichi shinbun 1983b).
Conservative social critics also lament the way in which the younger generations, through lack of close contact with their grandparents, no longer know how to act properly in household religious rituals, at weddings, funerals, and other formal gatherings. A series of videotapes on the correct way to conduct various rituals are now available as substitutes for the elders, a phenomenon that the film director Itami Jūzō parodied in his film Sōshiki (Funeral). In response to this rampant social malaise, the government suggested that it is important to “regain a consciousness of the special character of the family and its role and to create a family system and a system of human relationships suitable for our country” (Kokumin Seikatsu Hakusho 1983, 258).
Resort to metaphorical images of sickness and pathology to describe the state of the nation or family relationships in times of rapid social change is not new. Such images were widespread at the turn of the century for example, most particularly to characterize migration from rural to urban environments. The well-known folklorist Yanagita Kunio referred to the transformation of farmers into townsmen as shakai no yamai (an illness of society) and deplored the way in which their descendants would become vagabonds (Yanagita 1912, 46–48). People interested in “getting ahead” at that time were said to be infected with “enterprise fever,” “business fever,” and “get-rich-quick-market fever” (Gluck 1985, 161). Similar metaphors occur today, although, in keeping with changes in diagnostic fashion, people no longer suffer from social “fevers” but from “syndromes” and “neuroses.”
Diseases of Civilization: Bunmeibyō
The plethora of syndromes and neuroses said to be of recent origin and thought to abound in the urban centers of modern Japan are a delight for the news-hungry world of the mass media. Described as “diseases of modernization” (p.110) (gendaibyō), or sometimes “diseases of civilization” (bunmeibyō) (Kyūtoku 1979, 19)—that is, of the postwar (un)civilization and loss of traditional values—these syndromes flourish in an environment that contrasts with “healthier” prewar times. This modern blight is ascribed in part to influences from the West, particularly the value placed on individualism and self-centered aspirations, but also to high-tech urban culture coupled with economic prosperity resulting in an excess of material comforts. In short, the blight stems from everything that the shōwa hitoketa and the generations who preceded them did not have.
People identified as at risk are usually members of the new middle class who live in urban nuclear families. Men, women, and children are all vulnerable to these diseases that, like their Meiji era forerunners, have arresting names: “apartment neurosis,” “moving day depression,” “child-rearing neurosis,” “kitchen syndrome,” “menopausal syndrome,” “school refusal syndrome,” “adolescent frustration syndrome,” “video generation lethargy,” “salaryman depression,” “maladjustment to the job syndrome,” “death from overwork,” “fear of going to work,” and so on. Accounting for these disorders is a moralistic rhetoric that postulates a close relation between health and well-being, physical as well as mental, and individual behavior. It often implicates rapid postwar changes, of both values and the structure of social relations, in the transformations of individual behavioral styles that undermine good health. But the problems it highlights and diagnoses as sicknesses are behavioral, disruptive of social relations at work, school, and home. Associated physical symptoms and individual suffering take second place, at least in public discourse. The middle-aged woman from a nuclear family who is vulnerable to the luxury-induced disease of menopausal symptoms is not, therefore, alone—other members of her family are equally at risk for various disagreeable problems.
The Absent Father
The shadow of Japanese fathers has become thin.
(Monbushō 1983, 26)
It is usual today for businessmen to be transferred at the whim of their employers to other parts of Japan or abroad for extended periods, often for several years or more, as was the case for Kuriyama-san's husband. This phenomenon is on the increase, and many believe that should an employee refuse to comply he will not achieve promotion in the usual way (Japan Times 1984a). If the children are small a man's family may also join him, (p.111) especially for a post abroad, but later in his career several factors mitigate against this. First, the company very rarely pays for the removal of a family or provides accommodation for them. Second, older children cannot be moved easily from one school to another. Most children study hard and many families struggle financially to have their children accepted into a specific high school to smooth their progress from there into a good university and hence to a rewarding career. Having attained temporary security in the highly competitive battle for educational success, the parents and usually the children are loath to relinquish this achievement. Furthermore, since formal education ends at junior high school, a high school has no obligation to accept transferred pupils, and refusals are not unusual. Moreover, new students are not always welcomed by their peers and may, as Hayase-san pointed out in her narrative, have to go through extensive hazing; bullying in schools is a major concern in Japan today. Finally, selling and buying houses in Japan is an extreme financial hazard, and renting houses (as opposed to tiny apartments) is not easy.
The result is that when salaried husbands with families are transferred on business for long stretches of time, they often live a single life, usually in dormitory accommodations, and return home two or three times a month, usually for fewer than forty-eight hours. Their families meantime become single-parent households. In 1984 a well-publicized case brought to public attention the suffering that these enforced absences may cause. A desperate wife left a suicide note for her husband, stating, “A woman has nothing good to live for. If you want to live just as a man, if you want to live with your job and not with me, then you should live alone. You don't need a family.” She murdered her three children aged eleven, ten, and nine and then tried but failed to take her own life (Mainichi shinbun 1984a).
Particularly since that incident the family with an absent father serves as a central theme in the rhetoric about the modern Japanese family, often epitomized by the phrase otōsan no kage wa usui (father's shadow is thin), implying that father is no longer able to discipline his family:
Are the fathers of Japan the men they ought to be? The government seems to be having doubts.
In a new guide for parents of three-year-olds, authorized by the Health and Welfare Ministry … fathers are urged to take a more independent role in the upbringing of their children to demonstrate their masculinity and to teach them to be brave and strong-minded.
The new guide apparently stems from anxiety about recent social changes within the Japanese family structure that have made (p.112) father only a fleeting figure, if not nonexistent, and where not father but mother “knows best.”
An overdominance [sic] of the mother in the child's upbringing, experts fear, is leading to the “feminization” of Japan, since many children are growing up without sufficient masculine influence to provide the balance they need.
(Mainichi shinbun 1985a)
Other articles feature the working life of Japanese men: a cross-cultural survey reveals that, comparatively speaking, Japanese are “worker bees” and that many put work before home. Training on the job produces “company-centered people” (Mainichi shinbun 1983d), particularly when employers can require all-night training sessions (1983e). Stress at work is thought to be severe because of the lifetime employment and seniority systems that advance the most devoted workers up the ladder to executive positions. According to one psychiatrist, “sober, diligent, but mediocre managers” who possess a “weak character and have few hobbies, [who] do not drink with colleagues after hours or play mah-jongg or golf at weekends” are particularly vulnerable to physical ailments (Japan Times 1984b). When surveyed, 73 percent of male workers reported that they suffered from “nervous tension” (1983f). Stress-related ailments include vomiting, heart attacks, loss of appetite, rheumatism, impotence, insomnia, and depression. The leading cause of these ailments is cited as overwork (1985b). Among middle-aged men inability to adapt to computer technology is cited as another major cause of stress (1985c). Several syndromes and neuroses particular to salaried workers are associated with stress; they include “fear of going to work,” “fear of returning home from work,” and “salaryman depression.”
The suicide rate is reported as high, particularly among men in their late forties and fifties who are in positions of responsibility, and illness is most often given as the reason for suicide. The salaryman more than anyone else in Japan today is regularly subjected to excessive demands, and in an effort to combat it, a few companies are trying to force employees to take all of their allotted vacation (Mainichi shinbun 1991a). In several recently reported cases men dropped dead on the job from what was diagnosed as “death from overwork” (karōshi) and family members sued, often successfully, for compensation (Karōshi Bengodan Zenkoku Renraku Kaigihen 1990). A recent poll revealed that among salaried men who have worked for fifteen years or more, 40 percent fear that they are on the path to an early death from overwork (Mainichi shinbun 1991b). People believed to be at greatest risk are those who regularly put in one hundred hours or more of overtime a month (1984b).
(p.113) The Japanese salaryman is frequently depicted today in comics and on television as a sad figure, fit only for ridicule. Disciplined by his employers to the life of a worker bee, stereotyped as sodai gomi (gross garbage) around the home, and labeled incompetent as both father and husband largely because of his enforced absence from his family, this shadow of controlled samurai-style masculinity and model for future generations has certainly worn a little thin.
The Resistant Child
It is said that juvenile delinquency arises when there is no human kindness put into a mother's cooking.… A mother should season rice balls by hand, only then is her care properly expressed. Packaged rice balls that are bought at the market are not adequate.… It is important that mothers get up early in the morning for the children's sake in order to make them a meal.
(Commentary by an educator, Mainichi shinbun 1984b)
The rigors and competition associated with the Japanese school system are common knowledge today, but the continuing national debate about what has been described as the “desolation” of modern education is less well known. The media and government reports reflect growing concern over accelerated rates of delinquency, bullying, violence, vandalism, school absenteeism, and apathy. Although statistics are unreliable, they support the claim that these problems are on the increase even though the absolute numbers of children involved are much smaller than those that would lead to concern in North America (Lock 1986, 1988b). While some commentary on these problems focuses on excess in the demands and rigors of the Japanese school system, most of the government-sponsored documents and essays written by conservative social critics and some medical professionals ascribe the problems to loss of traditional values and urban life-styles leading to weakened family relationships and center their criticism on the poverty of child-rearing methods in the modern Japanese family.
Lack of contact with nature, and especially with the passing seasons, often figures as a crucial problem. One critic claims, for example, that urban children cannot associate their changing moods with the changing seasons and thus experience a sense of alienation; brought up away from a traditional community, they are “not good at playing in groups” (Hirata 1980, 36). The nuclear family is also a target. Mothers living in nuclear families are lonely and lack confidence in their ability to raise a child by themselves. They enter into a “symbiotic relationship” with their offspring that becomes the source of neuroses (Hirata 1980, 42; Monbushō 1983; (p.114) Suzuki 1983). Several writers accuse mothers of having lost their “natural” child-rearing instincts (Hirata 1980; Kyūtoku 1979). Other writers believe that many mothers have become selfish and unable to care sufficiently for their children. Specialists describe their personality types as anxious, worried, turned inward, unsociable, infantile, immature, un-motherly, overly methodical, unexpressive, dependent, and so on (Takuma and Inamura 1980). A psychiatrist of about fifty-five, herself a mother, told me that Japanese mothers had an easy time growing up surrounded by material abundance in the postwar years and consequently tend to treat their children “like pets” (Lock 1986, 104).
Absent fathers contribute to this breakdown: they do not project a “father image” (Monbushō 1983). The head of the section of the Japanese National Institute for Mental Health for research into family pathology states that a “hopeless” (dame) father stands “in the shadow” of every mother accused of causing illness in her children (Mainichi shinbun 1983g). Others characterize the personality types of fathers who are likely to produce “difficult” adolescents as lacking in confidence, poor at making decisions, turned inward, unsociable, verbose, and dependent (Takuma and Imamura 1980). Parents such as these, stereotyped linchpins of the nuclear family, produce deficient children, antisocial and nervous. A school administrator with whom I talked claims that children today have “expensive tastes,” many dislikes about food, and are unable to “stick at anything.” He says that they do not play in groups but live, instead, an isolated life looking at television and reading comics. Maeda-san believes that these children are poor at expressing themselves, which he attributes to the presence at home of an overprotective and bossy mother and the absence of a strong father figure. He also thinks that the usual image of a warm and harmonious Japanese family is a myth, and that these days people are “turned outward,” thinking about themselves rather than caring about other family members (Lock 1986, 90). Another child psychiatrist states that the “root cause” of problem children lies with mothers who have no purpose in life except their children. Mothers such as these, Dr. Yokoyama says, cannot allow their children to develop independence; on the contrary, they tend to lean on their adolescent children for support, particularly because their husbands are rarely at home (Lock 1986, 91).
Japanese physicians claim that in postwar years the incidence of psychosomatic complaints in children, including asthma, ulcers, and heart disease (Ikemi et al. 1980), has risen dramatically, along with “poor brain functioning” and a general weakening of the body, including a tendency for bones to break easily (Masaki 1979; Hirata 1980, 37). An oversensitivity (p.115)
As one response to the perceived pathology of youth, the government promotes the teaching of moral education throughout the school system; despite opposition, recent directives on education call for the instruction of students in both “love of country” (aikokushin) and more knowledge about the role of the emperor in state functions. Another response has been to medicalize the problem: in numerous magazine articles, books, television, and radio programs medical experts inform the public on the proper conduct of family life (Lock 1991). Regardless of such measures, (p.116) newspaper articles regularly intone something to the effect that “bullying is on the increase again and over half of the schoolchildren in Tokyo polled said they hate going to school” (Mainichi shinbun 1990c; Nihon keizai shinbun 1990).
The Selfish Housewife
Next time I want to be born a woman. Nowadays everyone wants to be born as a woman.
(Male consultant to a Tokyo Well Aging Club, cited in N. Matsumoto 1988, 42)
The media occasionally portray a middle-class housewife's daily life as san shoku hiru ne tsuki, implying an easy permanent job with three meals and a nap thrown in. The shared myth is that housewives today are selfish and idle, unsurpassed consumers with endless time to fill in who just play around, living a life of ease and luxury unknown in Japanese society until today. In addition, they often lack a real identity, have “no self,” and are deficient in the willpower and endurance characteristic of all the generations of Japanese women who preceded them. Alternatively, they may become excessively fastidious, withdrawn, and nervous, too concerned with tidiness and order. In both instances a middle-class housewife departs from the balanced and correctly controlled life of the good wife and wise mother and, whether selfish and empty-headed or withdrawn and neurotic, creates a poor family environment and produces ailing and deviant children. Like the other members of her family, the housewife is susceptible to disease, including apartment neurosis, child-rearing neurosis, and the “kitchen syndrome” (in which she experiences a variety of severe somatic symptoms the moment she enters the kitchen to prepare the evening meal [Katsura 1983]). Once she becomes middle-aged, kōnenki shōkōgun is her most likely disorder.
The story of the pathological family does not end here, because two crucial members of the ie, the parents-in-law, have been eased out of the nuclear family. Perhaps the most troubling problem on the horizon for the planners of Japan are the elderly, lonely and abandoned by the nuclear family as so much garbage (kuzu). Plans and projections for care of the elderly occupy the officials who scrutinize the lives of the shōwa hitoketa and the generations of women who will follow them to become middle-aged in their turn. Will the good wives of urban middle-class Japan continue to fulfill that important function assigned to them by custom: care of the elderly? Or will they abandon the discipline of childhood and early married years and opt instead for onna tengoku, a women's heaven replete (p.117) with endless trips to exotic countries, a surfeit of money to spend on luxury items, and no assigned role in life other than preparation of the occasional meal for a husband? Such willful and selfish women, anomalies in a society that reveres hard work and dedication to family harmony, are clearly in people's minds when they describe kōnenki disorders as a “luxury disease.”
Welfare Service for the Silver Agers
The foundation of welfare for the aged is believed to be in the home.
(Nisen Nen no Nihon 1982, 143)
The Ōhira government characterized the 1980s as the “age of culture,” a time when the “freedom” and “abundance” produced by unprecedented economic prosperity were to be tempered by restoration of warm human relationships in the family, the workplace, and local regions (Ōhira Sōri no Seisaku Kenkyūkai Hōkokusho 1980). Driving this call for a return of “warmth” in the family appears to be an accelerating disquiet as the “aging” society and its nonproductive and dependent population rapidly proliferate.
In contrast to prewar days, an eighty-year life span (jinsei hachijūnen), rather than one of fifty years, is recognized as the average Japanese life (Hosoya 1987; Yamane 1979). Plath points out that this newly received “gift of mass longevity” is in some ways disquieting (Plath 1980, 1). While most individuals presumably look forward to a ripe old age, for planners, politicians, and bureaucrats an image of 16 percent or more of the population over sixty-five signals the approach of disaster. The graying of Japan is particularly disturbing because demographic changes that took eighty-five years in Sweden, one hundred thirty years in France, and seventy years in the United States have taken just twenty-five years in Japan (Kinoshita 1993). Some official estimates calculate that if present trends continue (that is, if fertility remains low and mortality continues to decline), by the year 2025 people of sixty-five and over will make up a remarkable 23.4 percent of the population. Among the elderly, more than 53 percent will be over seventy-five years old (Nisen Nen no Nihon 1982; Ogawa 1988; Kōseishō Jinkō Mondai Kenkyūsho 1987). Japanese life expectancy is the longest in the world, over seventy-six years for men and eighty-two for women, and already more than three thousand people are over one hundred years old (Mainichi shinbun 1990d).
The most dramatic demographic changes are projected for the first quarter of the next century, when the postwar baby boomers reach old age. As (p.118) they join the elderly, the economy will probably be declining as the labor force rapidly ages and all expenditures for the elderly mount (Nisen Nen no Nihon 1982, 101; Ogawa 1988). Ogawa Naohiro estimates that by the year 2020 almost 55 percent of medical expenditures will relate to the elderly, that actual costs will increase tenfold, and that almost all this money will come, if the health insurance system remains unmodified, from national, prefectural, and municipal government sources—that is, it will come largely from the pockets of the declining younger population of taxpayers.
Ogawa goes on to point out that, again, if present trends continue, more than two and one-quarter million Japanese will be suffering from senile dementia by 2025, of whom just over two-thirds will be women, and more than two million people will be bedridden, of whom slightly fewer than two-thirds will be women. Ogawa voices a major government concern when he questions where the “manpower” will come from to take care of this decrepit population (Ogawa 1988, 274), known euphemistically as the silver generation (Plath 1988). Construction of facilities for the elderly, much of it government sponsored, is going on in most parts of the country, but it is far from adequate to deal with the projected future needs and in any case occurs with a good deal of foot-dragging on the part of local and national officials. Even so, Article 25 of the constitution proclaims that “in all spheres of life, the State shall use its endeavors for the promotion and extension of social welfare and security, and of public health.”
Significantly, government documents on the graying of Japan usually point out that it is preferable for care of the elderly to take place in their homes and that the family should be the primary care giver (Nisen Nen no Nihon 1982, 121; Kōsei Hakusho 1989). Policymakers are clearly concerned by increasing public expectations that the government will assume a larger role in care of the aging population and have made several recent policy changes to try to reverse this trend. The elderly are no longer fully covered by the national health-care system but must shoulder some of the expense themselves, including part of the cost of hospitalization; at the same time, the government actively encourages all individuals to take responsibility for preservation of their own health (Kōsei Hakusho 1989).
Since the 1970s, when the aging society attracted the attention of policy makers, succeeding conservative governments in Japan have commented on the dangers of what they term the “English disease,” with reference to the pre-Thatcher social welfare system of the United Kingdom, which they consider excessive. The ruling Liberal Democratic party set out to create, instead, what has come to be known as the Japanese Welfare Society, which (p.119) assigns some responsibility to individuals and their families for care and financing of their needs. Hence, the long-term outlook committee of the Economic Planning Agency of the Suzuki government states:
Not even the most conservative policy makers resort to the term ie to describe the new-style extended family. Instead, the “new residence system” (atarashii jūtaku shisutemu) goes under the tag of “living together in three-generation households” (san sedai dōkyo). Income tax credits and loans are to be made available to allow the remodeling of homes so that elderly parents can join the household (Kōsei Hakusho 1989), and the latest devices to help with care of the elderly are to be installed in such houses (Ōhira Sōri no Seisaku Kenkyūkai Hōkokusho 1980).
The home is extremely important to the aged for a secure life of retirement, their health and welfare. In an attempt to form a social environment ideal for future living, it will be necessary to correctly position the home in society … the role of people caring for the aged at home will become more important.… Also, it will be necessary to promote a land policy aimed at pressing for three family generations to live in the same place or for family members to live within easy reach.
(Nisen Nen no Nihon 1982, 123)
A paragraph or two on the way in which middle-aged and older women should conduct their lives figure in the Ōhira government report on the proposed “enrichment” of the Japanese family. After pointing out the importance of hobbies, sports, cultural activities, and further education for women's psychological and physical welfare, the document states that women should take a positive attitude toward work, and that they should use their newfound freedom from family demands to take up suitable part-time employment or volunteer work (Ōhira Sōri no Seisaku Kenkyūkai Hōkokusho 1980). Perhaps in response to official encouragement of this kind, some women chose to go back to school in middle age to obtain nursing degrees (although occasionally husbands and other family members objected) and eagerly took the required entrance examinations in order to return to school. It was reported that these women, called “Nightingale mamas” and “angels in white,” rarely missed a class and that they wanted to seek out something to add more meaning to their lives, although they hastily added, when asked, that being a housewife was already a rewarding life-style. All the women apparently claimed that their studies made them feel young again (Mainichi shinbun 1983h). Nursing and related care-giving activities are exactly the kind of interim work that the government would like women to perform so that when their parents-in-law (p.120)
In recent years it has become accepted policy, as far as possible, not to place the elderly for any length of time in hospitals or even nursing homes, although more of these institutions are gradually becoming available. Local governments administer most care of the elderly under a policy of cooperation between government and families so that, if at all possible, old people stay at home in the bosom of their families.1 Funds have been set aside, in the Gold Plan for care of the elderly, to train home helpers, public health nurses, and nurses who do home visits, whose task is to assist middle-aged and older women caring for their spouses or parents-in-law. It is (p.121) stressed that “the quality of life” of the elderly will be best enhanced if they remain at home (Kōsei Hakusho 1989).
Through such policy the government hoped, of course, to avoid raising taxes to foot the bill for social services, although five years ago, after massive public opposition, it introduced a small consumer tax on goods and services, most of the tax in theory to be set aside for implementing plans for care of the elderly. Despite the government's apparent acknowledgment of some responsibility for care of the elderly, financing of all aspects of the Gold Plan falls seriously short of the projected implementation of home care and intermediate facilities.
Several surveys have revealed that people of childbearing age assume that they will not depend on their children for care when they grow old; nevertheless the majority of Japanese people at present aged sixty and over prefer to be looked after by their children. In one five-country study, 58 percent of older Japanese stated that they would like to live with their children while only 3 percent of older Americans responded positively (Sōmu cho Tōkei Kyoku 1987). Should they become physically ill, 95 percent of Japanese aged sixty and over would like family members to take care of them and designated as preferred care givers almost exclusively wives, daughters-in-law, or daughters. Policy makers (many of whom are aged sixty or more) are drawing on the image of the ie and a well-entrenched consciousness among older people that, after a life of hard work, they can expect to depend on their offspring for care. The government reminds the public in its official handouts of what the elders—the shōwa hitoketa and their seniors—have done in the way of nation building:
This document goes on to state that the Japanese sense of value of the home is fundamentally closer to that of Asia than it is to Europe and America, and that “it is possible to expect the home to act as a vital force” and function positively in supporting society in its care of the elderly (117).
The people who will retire from their active careers and join in the formation of the aged group toward the twenty-first century will be those who have lived in turbulent periods, supported the era of high economic growth in Japan and helped establish the country's present economic affluence. It is the duty of the succeeding generation to assist these people in building an affluent society in which they can live well.
(Nisen Nen no Nihon 1982, 116)
Although Confucianism formally endorses filial piety and respect for the elders, a tradition honored in theory in Respect for Elders Day (a (p.122) national holiday created in 1966), ambivalence about the elderly exists in numerous tales and legends from ancient times to present-day novels and films about the trials and tribulations of coping with old people (Ariyoshi 1972; Tahara 1980; Niwa 1947). Some of these tales refer to a mountain called obāsuteyama (the mountain for disposing of Granny), where the elderly (and perhaps especially women) might be abandoned and left to starve in times of food shortages. Imamura Shōhei's film Ballad of Narayama dramatized the family conflict that the plight of elderly parents created in feudal Japan, and a number of Japanese mountains still retain this name. That they were actually used for geronticide seems unlikely but does not preclude the possibility that such wishes existed “in the hearts and minds” of family members (Cornell 1991).
A shortage of food is rare today (although many elderly, even in prosperous Japan, live at or below the poverty level [Lock 1984]), but the conflict between filial piety and the interests of younger members of the family has become, if anything, even more acute in contemporary times. Not only are there more dependent elderly who live longer, but urban life is more complex and houses are small. Mixed feelings of duty and guilt, portrayed graphically in contemporary Japanese film (Ehrlich 1992), are very evident among middle-aged people; rather than place their aged relatives in a nursing home, which is often explicitly characterized as the modern obāsuteyama, many couples choose to adapt their own life-style so that they are joined by or, alternatively, join or rejoin their elderly parents (most usually those of the husband) in the family house. For the younger couple, one distinct advantage of such arrangements is inheriting the home—an arrangement that, given Japanese land prices, appeals to many people and more than compensates for burdens the elderly may impose. Because Japan is a highly mobile society, such arrangements do not always work out smoothly, however; many elderly parents today join the urban household of their children or take up residence nearby.
One other facet of traditional society acts in favor of the government in its effort to avoid “excessive” expenditures in care of the elderly. A Japanese home is a private place. Elderly individuals and those who care for them, as Atsuko-san's narrative indicated, are often exceedingly uncomfortable at the thought of having home helpers or nurses enter their houses and so choose to deal with the problem unaided. This attitude arises partly because it is “natural” that an extended family should take care of itself and not lean on others, and because embarrassment arises at having a stranger come into the house in any role other than that of an invited guest.
Until recently, the leading cause of death in Japan was cerebrovascular disease, and a large number of infirm elderly are people who have suffered from strokes and are therefore rather severely disabled. More than six hundred thousand people aged sixty-five and over are bedridden, and the majority of these people remain at home. In commenting on the large numbers of bedridden elderly, Kiefer (1987) notes the shortage of rehabilitation facilities in Japan. He points out, as do a good number of other researchers, that to be dependent on others is culturally “available” (particularly for the very young and the old); hence, in contrast to North America, in Japan there is indirect encouragement for individuals, once they become infirm, to stay dependent (see also Campbell 1984). The combination of a high incidence of stroke, a disease that renders people particularly helpless, and the cultural reinforcement for dependence as natural and highly acceptable, means that the care of in-laws may occupy many women from about the age of fifty or fifty-five: women make up 93 percent of those who look after senile or bedridden elderly individuals in Japan, and by far the majority of these women are wives, daughters-in-law, or daughters.
The original word for nursing in Japanese (mitori) incorporates the idea of caring for someone until death. If either partner of an elderly couple dies, then the survivor (usually mother-in-law) will most probably join the younger woman's household for the remainder of her life (assuming that she is not already in residence) and can expect to receive full care from her daughter-in-law. Should the daughter-in-law's husband later become dependent, she is expected to care for him and, once widowed herself, to lean in turn on her daughter-in-law. Hosoya Tsugiko, who works in a halfway house for the elderly in Tokyo, is very concerned about the burden that care of the elderly puts on middle-aged women. She describes Japan's current welfare system as a “private” one, based on the family, and points out that halfway houses and other interim-care facilities are too few in number (Hosoya 1987, 162). Recent studies show that care at home for the elderly with chronic diseases takes up on average four to five hours a day and that in addition a family incurs considerable expenses (Satō et al. 1988).
A recent study by the Ministry of Labor showed that out of nearly five hundred people who were nursing the elderly in their Tokyo homes over 81 percent were women whose average age was fifty-six years. More than 60 percent of these women had been looking after their relatives for three years or more, and over 16 percent of them had been doing so for over (p.124) ten years (Tōkyō shinbun 1990). Another study included one ninety-year-old woman who was singlehandedly taking care of her bedridden husband; over 57 percent of the care givers were daughters-in-law or daughters, and many of these women were seventy years old (Serizawa 1989). Lebra notes that some of the most disruptive quarrels among relatives in Japanese families are to do with the question of who will take care of ailing parents. The situation becomes particularly acute if the wife of the eldest son for one reason or another cannot or will not fulfill what everyone regards as her “natural” duty (Lebra 1984, 254–55). But, as the length of time devoted to care giving grows longer and longer, and the care givers themselves reach old age, the burden becomes intolerable. Even the most devoted daughters-in-law or wives presumably do not relish the idea of nursing bedridden, incontinent, and often senile elderly for thirty or more years, with little or no relief; and, for all their well-meaning efforts, the quality of care at home may be inferior to that of professional help (Kobayashi and Reich 1993).
A white paper on women points out the inadequacies of professional and even volunteer assistance for those who nurse elderly relatives (Nihon Fujindantai Rengōkai 1989). The number of home helpers (untrained volunteers who receive a small financial reward for their services), a total of 27, 105 in 1989, is inadequate (to augment this number the government now supports the training of female immigrant labor for home care). A half-day's help per week is the maximum time that most people receive, and they must pay for it. Short stays in nursing homes and other facilities are limited to seven days, and extensions are possible only under highly extenuating circumstances. In 1989 the total number of beds in the entire country for short stays was 2,374; more than 40,000 families requested this service, but the complicated procedures and questioning they were expected to go through on behalf of their elderly relatives overwhelmed many of these applicants. The government has written a great deal about Day Service Centers, but as yet fewer than 1,000 of these centers exist (although 10,000 more are promised by the year 2000). The white paper on women also reminds us, the government changed its policy on payments for hospital services, so that there is now little financial incentive, as was formerly the case, for hospitals to offer care for old people. Since there are few nursing homes and intermediate-care facilities are obviously insufficient, the elderly have only their families to turn to or return to (Nihon Fujindantai Rengōkai 1989; Kinoshita 1993) because, justifiably, first priority for institutional care goes to old people with no close relatives.
Recently the government acknowledged the existence of yet another disease of civilization, “fatigue from home care and nursing” (kaigo tsukare), and suggested that women diagnosed with this illness should be considered eligible for home help and respite care (Asahi shinbun 1991); (p.126) earlier, the well-known social critic Higuchi Keiko suggested that if a new national holiday is created it should be Welfare Service Day rather than Family Day (Higuchi 1980, 82). At present the government is considering the creation of a holiday to be called Nursing Day, not to honor overworked and underpaid hospital nurses—whose work is bitterly described as kitsui, kiken, and kitanai (grueling, dangerous, and dirty)—but to recognize home helpers, public health nurses, and nurses who do home visits; these are the future linchpins of the new welfare service directed at the home (zaitaku fukushi).
Among the many conversations I had with Japanese women about midlife, one of the most moving was with Inagaki-san, a married woman who farms in Nagano, mother of a young woman of twenty-one and a boy of fourteen. She underwent major breast surgery for cancer two and one-half years ago.
“My husband is employed in a company—an electrical company. Until I had my operation ojīchan2 [father-in-law] and I did all the farming, but now my husband has to help, although he's never done any real farming before.”
“How big is your farm?”
“It's medium-sized, less than one chō [about two acres].”
“What do you grow?”
“Rice, and enough vegetables for the family and friends. We don't sell the vegetables. What we get from selling the rice is only just enough to buy fertilizer for the next year. We actually live on my husband's income.”
“You must be very busy.”
“Yes, thereʼre always weeds to be pulled up somewhere, and you have to plant everything at the right time of course. We use machinery for the first plowing these days, but I do the rest, the hoeing and transplanting by hand.”
“Do your children help?”
“No, they're no help at all. My daughter hates farming.”
“Do you hope your son will take over from you later on?”
“Well, yes, but that's not very realistic. Young people are going to choose their own lives from now on. I think what we're really doing now is just taking care of the property until we die, it's been in the family for about a hundred years. Even so, it doesn't really seem necessary.”
“But do you take pride in your work?”
(p.127) “Well, that's a hard question. It's just that I am the yome [daughter-in-law] in this family, and if we sold the land people would criticize us; I just take care of it because we have it, but we don't make anything out of it.”
“Do you have relatives nearby who can give you a helping hand sometimes?”
“Yes, thank goodness. Actually my husband is the second son in his family, but his older brother was adopted into his wife's family because they had no sons, so we have the farm and are taking care of my husband's parents. About a year ago my mother-in-law became bedridden. She's eighty-six, and she needs a bedpan. My father-in-law is also eighty-six and he has several health problems, but he is still quite active and he helps take care of obāsan; she's had to have special soft food for the past three and a half years.”
“Does anyone come from the local hospital to help you?”
“No, the only help we get is from our relatives. They don't have enough nurses in the hospital; the only thing they've done is to come to give her shots. When she got worse, the doctor said we should put her in hospital, but she says she'd rather die than go there [shinu hodo iya]. Anyway, if she went into hospital, I'd have to take care of her there, and then the family would have trouble with meals.”
“Tell me about your daily routine, would you?”
“Well, I get up at 6:30 A.M. in summer, and around 7:00 A.M. in winter. Actually, I get up at 6:00 A.M. to turn on the rice cooker and then I go back to bed for a while! Then we have breakfast. Fortunately my husband doesn't need a boxed lunch, but my son does, so I make that first thing. I do the laundry every other day, while I'm getting breakfast ready. I have to serve breakfast four times, first to my son, then my husband, next ojīchan, and finally he and I feed obāsan together.”
“After breakfast I work in the fields until lunchtime. I eat lunch with ojīsan and then I spend some time with obāsan, I usually bathe her in the afternoon because there's no time in the evenings. I do the bedpan nearly all the time but sometimes ojīsan does it, although he doesn't really like to, but if I'm in the fields then he has to. Of course I can't go out much at all, except just to work in the fields. But obāsan isn't senile or anything so it's not too bad.”
“At night I have to feed my son first again, because he's always hungry, then ojīchan and obāsan, and finally my husband and I eat together. It means a lot of time in the kitchen. I have two books checked out of the library now, but I'll never find time to read them.”
“My daughter is away most of the time these days but when she's here she helps sometimes, if she feels like it. My son's job is to put things away in the refrigerator at night, after we've finished eating.”
“What kind of education did you have?”
“I finished high school. I came from a farm family, so I'd done this kind of work even when I was a girl.”
“Does your husband help around the house?”
“He didn't do anything before my operation but he does a lot now. I was in hospital for a month and he and ojīchan managed OK, feeding my son and so on—I was surprised at how well they did!”
“Would you mind telling me a little more about the operation?”
“Well, I discovered I had a problem in August two summers ago. I was sleeping in a T-shirt, and I happened to brush my hand against my breast and all of sudden I felt a lump about the size of a soybean. I'd heard some lectures about breast cancer, and so right away I went to the hospital. They did a special test, and the doctor cut a little piece out. He said he thought it looked all right, but ten days later I got a call telling me to come to the surgical department right away. At first they said it wasn't really cancer but that it would be best to operate anyway. My daughter was with me, and she looked as though she'd had a concussion and went terribly pale when they talked to us, so I knew right away what was up.”
“Japanese doctors don't usually tell people they have cancer, do they?”
“I think they do with breast cancer, because they can't really disguise it. But with stomach cancer they tell you it's an ulcer.”
“You were in hospital for a month?”
“Yes, but I didn't have any radiation treatment. They put obāsan in hospital too because there was no one to take care of her properly at home, but she was sent home the same day as I was.”
“How did you feel when you went home?”
“I didn't feel at all well, and I had to take some black medicine that didn't agree with me. I got an infection all around my mouth. When I told the doctor about it he scolded me. He said only one person in a hundred has that kind of reaction, but finally they changed the medicine. Now I'm pretty well, though I can't raise my arm very far. But I can carry heavy things again.”
“Do you still go for examinations?”
“Yes, once a week. And I'm still taking medicine—they say I'll have to take it for six or seven years. I worry that it will reoccur, but because I'm afraid, I don't ask the doctor anything, and he never offers any information. (p.129) If I think about it too much, I won't have the energy to go on living.”
“Your experience must have affected the whole family.”
“Yes, I feel very apologetic [moshiwake nai] to my husband. Cancer is a very frightening thing, and it would be hard for him if I died, especially while there are still the old folks to look after.”
“Has your daily life changed?”
“Since I had the operation I haven't felt like having ‘that’ [sex] at all. I always liked it a lot, but I've lost that feeling. Actually, my husband never wanted it much after he was forty; I was the one who was interested. He comes home at 8 oʼclock, and he's really tired every night.”
“I've never showed him where I had the operation. At first I used to hang a towel over the mirror when I took a bath. Now I'm used to it, but when my husband comes in to wash my back, I always cover up with a towel. He says, ‘What's wrong with showing it to me?’ But I tell him he can see it when I'm dead. If he sees how ugly it is he won't be able to forget it, I know. I don't intend to let anyone see it while I'm still alive.”
“You know, I've done some reading about cancer recently, and I found out that women with strong personalities are more prone to cancer—that's why so many foreign women get it. I may seem to be weak, but actually I'm strong; that's the reason I got it. Also, hormones have something to do with it, and once, when I was having some unusual bleeding, the doctor gave me some hormone shots; that was another cause, I think.”
“What about kōnenki?”
“I stopped menstruating seven months after the operation. I'm forty-nine now so it was early, but I barely noticed the difference with all the other things in my life.”
“How would you compare your life with your mother's?”
“Oh, mine is much easier. My mother married a man who was the second of eight children, and she always had to worry about his siblings' feelings. She told me she used to think about running away, but she decided if she went back to her parents' home it would cause her mother too much worry, so she just stuck it out. Working in the rice fields was tough for her too, and she had seven children, one after another. She had to put the baby down to sleep beside the rice paddy, and she said one time she found one of her babies covered with ants. We don't have to go through that kind of thing anymore—things are easier now.”
“Are your own parents still alive?”
“My father is eighty-one and my mother is seventy-nine, but I can't see them very often although they don't live far away because I can't leave obāsan. Anyway that's life, one has to ‘stick things out’—there are a lot of people less fortunate than me.”
(p.130) Obviously, contrary to official urgings that women take up hobbies, more education, volunteer services, and so on, individuals such as Inagaki-san are in no position to create their own lives apart from family obligations except by disrupting what is considered normal behavior and aspirations. Although she has put the family's well-being above her own health, she nevertheless feels apologetic about letting the family down; despite some dents and scratches, the good wife, wise mother, and dutiful daughter-in-law survives. In Higuchi Keiko's words, “Hidden behind the superficial glamour … the prewar family system lives grimly on” (1985, 53).
Of course, Higuchi-san and other outspoken Japanese women have not sat quietly on the sidelines while the government pushes them deeper into servitude. Among other things, they have organized a series of annual symposia by women on the aging society, in which dominant themes have been “to live and die in a society that supports independence in old age” and to create “as soon as possible a situation where old people can live satisfactorily on their own” (Asahi shinbun 1990a). Aspirations such as these call for nothing short of a complete revamping of both the pension system and all social support systems for the elderly—in which so far the government shows little interest.
A recent incident, involving a man of forty-two who nursed his prematurely senile wife of fifty-nine until he found a place for her in an institution, whereupon he divorced her, brought forth a flurry of responses from feminists. While many commentators showed sympathy for the man, they went on to state that if the incident had involved a demented husband with a younger wife, she would have been expected to deal with the burden of nursing him by herself at home. Although the case is a very unusual one, feminists have taken the opportunity of the publicity to demand consideration for the rights of people who nurse the elderly, in addition to the rights of the elderly themselves. In other words, they ask for radical modification in the Japanese-style welfare society to allow recognition of the “hidden assets” (fukumi shisan) that it draws on, namely free nursing services carried out almost exclusively by women in their homes, and the transfer of most of the burden to society at large. Nursing the elderly at home, feminists claim, should not be based on the “sacrifice and devotion of families” (Mainichi shinbun 1990e).
Turning to the elderly themselves, the 1989 white paper on women released by the Japanese Coalition of Women's Groups points out that four times as many elderly women as men live alone, a total of 1,286,000. Over 70 percent of people in old-age homes with special nursing care are (p.131) women, 93 percent of people in ordinary homes for the elderly are women, and over 93 percent of bedridden people being nursed at home by younger female family members are women. Of those elderly who have Alzheimer's disease, 80 percent are women. Clearly, this paper concludes, the aging society is a woman's problem, and with poor social welfare policies the burden of care for the elderly simply drops into the laps of younger women (Nihon Fujindantai Rengōkai 1989).
As with so many other problems of national import in Japan, in grass-roots activism we observe the first signs of change. In 1985 eight housewives and several social workers living in Takamatsu city on the island of Shikoku formed a group to provide nursing care for needy elderly and their families. Since that time the size of the group has risen to four hundred sixty members, most of whom are full-time housewives, but it also includes twenty men. Volunteers, after instruction in treating bedsores, bathing the elderly, and so on, do simple nursing, prepare meals, shop, and chauffeur senile and bedridden old people. There is a small fee, but instead of receiving money most of the volunteers prefer to chalk up points that will ensure similar services for them once they become old (Mainichi shinbun 1991c). The movement has spread to Osaka and Tokyo and will shortly become a nationwide network. Although grass-roots activity such as this puts no direct pressure on the government, nevertheless it both solves individual problems and fans public and media consciousness into a ground swell that may eventually produce political change, particularly at the level of local government. However, one acquaintance who is a schoolteacher observed with a note of bitterness that only those who are not fully employed can hope to take part in such activities.
In Seven Hundred Years, Only Four Hundred Japanese
The graying of society does not come entirely, of course, from the numerous old people. The birthrate also contributes. The former minister of finance Hashimoto Ryūtaro suggests that the trend for Japanese women to obtain higher education is responsible for the “nation's sagging birthrate” (Mainichi shinbun 1990g). A government white paper recently reported that the 1989 birthrate hit an all-time low of 1.57 children per woman, a big drop from the 1988 rate of 1.66. It also advanced the date at which senior citizens would outnumber children from the previous estimate of the year 2004. At a news conference officials stressed the government's concern at the low birthrate because the welfare burden of Japan's aging society will be difficult to manage. When asked if the government intended to return to the prewar policy of encouraging women “to give (p.132) birth and multiply” for the sake of the nation, the officials replied: “It isn't such an easy matter to get Japanese women to bear children” (1990g).
A national meeting for women in the Liberal Democratic party was told that if women do not bear 2.1–2.2 children “for us,” then the population will decrease, “disrupting the pension system for retirees” (1990f). This recent statistic on the birthrate has been dubbed the “1.57 crisis” (the estimate has recently been revised to 1.32), and feminists and other commentators are very concerned because it threatens to invoke the specter of the government's involvement in family matters, especially childbearing, as occurred before the war. Unidentified experts apparently estimate that if the current Japanese birthrate remains unchanged, in another seven hundred years' time only four hundred Japanese will remain. Although some of the women at the conference were highly amused by this inanity, one delegate commented that she thinks every married couple should have at least four children because, she claims, larger families are essential for children to learn how to deal with traditional relations between superiors and inferiors.
The drop in birthrate reflects in part a smaller number of infants born to married women, a trend that more than one analyst links to the high price of land and inordinate cost of housing (Mainichi shinbun 1990h). It also relates to a dramatic increase in the number of single people in Japan. In 1985, 61 percent of men and 31 percent of women in their late twenties were not married. More recently, in Setagaya-ku, one of the wealthier sections of Tokyo, 68 percent of women between the ages of twenty-five and thirty were unmarried (Asahi Evening News 1991). Over 80 percent of both men and women between eighteen and thirty-four responded in a poll that there are “advantages to being single” (Arioka 1991). The government is worried about these trends; perhaps soon there will be not only proportionately fewer young to old people but also more elderly who never married and who therefore have no spouse or child to lean on in old age (Figure 5). Yet what the government fails to remind people is that the incidence of stroke is declining because of carefully implemented public health measures involving changes in dietary practices. If this trend continues, then the numbers of decrepit and bedridden elderly may not be nearly as high as projected. Furthermore, although young people are not rushing into marriage, so far they usually merely postpone rather than abandon the institution.
Public gatherings of all kinds organized by local governments, women's groups, and similar organizations again and again take up the theme of the aging society (kōrei shakai) and the state of the modern Japanese family (p.133)
Some women have started to discuss alternatives. Hayase-san, the bar owner, although still in her forties, stated that she will live with three friends of long standing, probably outside Tokyo, where she now lives and works. A Nagano farmer insisted that by the time she is old, children will not expect to look after their elders. She has talked quite a bit with her friends about the future, and they have decided that since so many of the younger people are leaving, the best hope for the future is for the old women who are left behind (themselves, that is) to band together and move into one of their homes (which will probably remain unsold because of the present taxation system). “We all think that some kind of co-op would be better than a senior citizens' home,” this woman stated vehemently. “Although there are some round here, none of us want to end up in that (p.134) kind of place.” The shōwa hitoketa are indeed a “sandwich generation” as Plath suggests, caught between a life of hard work and dedication to others characteristic of prewar Japanese but facing a future in which they must exert their independence in order to survive.
During the interviews, when the discussion turned to changing family relationships and the aging society, most women participated actively. Indeed, at this juncture they usually took charge of the conversation. Many people were also reasonably animated over discussions about their general health, particularly if they had experienced episodes of difficult illness. But, aside from those very few women whose lives had been seriously disrupted by kōnenki symptoms, or the one or two who associated kōnenki with an unhappy life, most were not so interested in this part of the interview and volunteered much less information. The majority of women, although they had given some thought to kōnenki, were primarily interested in family vicissitudes and work; concern about kōnenki was usually confined to the fact that it signals the approach of old age and thus inevitably impinges on family matters.
(1.) Until recently, the health insurance plan in Japan did not restrict long stays in hospital but created strong economic incentives that discouraged (p.395) physicians and hospitals from developing home-care programs (Kobayashi and Reich 1993).
(2.) The familiar suffix -chan is often added to the terms grandfather or grandmother to denote one's elderly in-laws, in place of the more formal -san that is usually placed after family names in Japanese. As with the term obāsan (old lady, grandmother, mother-in-law, or mother, depending on the context), so too ojīsan can mean old man, grandfather, father-in-law, or one's own father.