In Living with Lost Time (4)(2025)

4. Dementia and Contemporary Society

Modernity, often criticized through the discourses of thinkers such as Philippe Ariès or Martin Heidegger, finds one object of such criticism in this: that, contrary to the history wherein people once accepted death as something natural from childhood onward, indeed grew familiar with it as part of daily life, in the present age death has been driven into the isolated place called the hospital, thus distanced from the daily life of the people, such that, as a result, fear toward death has been amplified, the very act of speaking of death becoming, in itself, an implicit taboo. Within the voices lamenting such change lies an aspect deserving of recognition within the modern reflections carried out in the domain of thanatology; however, many such assertions, even while standing upon the cognitive framework of modernity, follow a kind of formulaic method of criticizing that very framework, behind which lurks, so to speak, an anxiety of self-negation seeking ceaselessly to reconsider one’s own thought and sensation together with a gesture of aversion, while at once a complex feeling of relief that this very obsession brings.

The premodern community is, first of all, an age of communitarianism bearing the structure wherein the community itself exists prior, the individual being subsumed within it; in such an age, it is precisely the norm recognized by the community that comes to be shared among the inhabitants as a whole. By following such norms, by practicing a “good way of life,” individual happiness was thought to be attained; this, however, is never established through individual judgment alone, but rather through evaluation by the values that the community approves. Likewise, the phenomenon of death, too, comes to be understood within the framework of this norm, treated not as belonging to the individual but as an event for the community as a whole.

In fact, death in the premodern age is recognized not, as in the present age, as the consciousness of “my own death,” but rather in the form of “the death of another.” This death, rather than being shunned as something gruesome, is depicted as existing on the extension of an ideal way of life, a peaceful world without suffering. For instance, for the commoners of the Edo period, the greatest concern lay in whether, after death, one could reach the Pure Land taught by Buddhism; this was believed to be realized through the ideal way of life shown by the norm. Moreover, the understanding within the view of life and death differs, in many folk religions, from that of the world religions wherein this present world and the next are clearly divided, a place of judgment set between them; instead, this world and the other world continue as one, the dead returning to this present world on certain occasions as ancestors, then returning once more to the next world, thus forming a circular structure. Within such a view of life and death, death itself comes to be recognized not so much as an individual experience, but rather as something shared among individuals through the norm of the community. It is this very shared norm that fulfills the role of granting a certain meaning and stability toward the unavoidable event called death.

Modernity, on the other hand, bears, at its beginning, the memory of ferocious wars of religion, arriving, from this very painful experience, at the separation of religion and governance as its most fundamental principle. This principle symbolizes a shift whereby values come to be entrusted not to the norm of the community but to the individual; as a result, the event called death, too, comes to be reinterpreted, no longer shared within a communitarian framework, but bearing, instead, an individualistic meaning. However, such change, even while appearing at first glance to promise freedom, in fact loses the firm foundation once supported by a norm shared in common, the interpretation of the problem called death diversifying into something founded upon the values of each individual, giving rise to a myriad of differing forms.

Within such a circumstance, when an authoritarian state attempts to dominate the individual from within, manipulation arises in the form of forcing people to die for the cause of the nation, by making them deny the very fact of holding fear toward death. Such a structure robs the individual of freedom concerning death, harboring the danger of drawing in a fascistic perception — that is, a movement seeking to restore the moralism once belonging to the union of religion and governance.

Thus, the direction that contemporary thanatology ought to pursue lies not merely in reviving the premodern view of life and death, nor in reproducing, as it stands, the framework of community, but rather in questioning how the unavoidable phenomenon called death ought to be reconceived within the dignity of the individual. In doing so, the task confronting people of the present age is this: without denying the sense of unity and the element of consolation once held by the values of the community, but rather in a form surpassing these, death ought to be granted new meaning while bound to deep reflection within the individual’s own interior.

Indeed, even granting that there is some truth to the observation that modern people avoid death, that their understanding of it remains immature, in comparison with people of the premodern age, with regard to the phenomenon of aging, no age of humankind has ever felt it so close, nor had so many occasions of contact with it, as the present age. In the former age, aging too was grasped through the norm shared by the community; given the shortness of average lifespan, the very state of old age was grasped as a kind of good fortune. This is, in many communities, one reason the elderly come to be treated with respect, as the authority of the village elder shows. In the premodern age, given that innovation of various kinds remained limited, social change proceeded gradually; the experience accumulated within it came to be prized as wisdom of value to the community. For this reason, the elderly, having accumulated experience over a long span, generally receive special respect, regarded as more than a mere existence having lived long, but as one embodying wisdom itself.

In the present age, however, given the dramatic extension of average lifespan, the population of the elderly has increased, society as a whole arriving at a circumstance wherein it cannot but grasp the phenomenon of aging as part of daily life. This makes clear that, unlike the discussion concerning death, the understanding of aging in the present age surpasses that of the premodern age. This shows the necessity that aging be granted new significance — not as a static concept bound to the communitarian norm of a former age, but as a phenomenon that ought to be dynamically reinterpreted within the life of each individual human being. Within such a recognition, how the people of the present age ought to become aware of, and confront, the universal experience called aging, remains a question to be continually posed — this stands as a contemporary task.

Society is classified according to the proportion occupied by the elderly among its members. The point at which the population aged sixty-five and above reaches seven percent of the total population is called an “aging society”; once this reaches fourteen percent, it is termed an “aged society”; once it exceeds twenty-one percent further still, it is termed a “super-aged society.” It was in 1970 that Japan made the transition into this “aging society”; thereafter, in 1994, it advances into an “aged society,” then, rapidly, in 2007, into a “super-aged society.” Amid such changes, it is Ariyoshi Sawako’s novel Kōkotsu no Hito (“The Twilight Years”) that first earnestly raises, within the field of literature, the problems borne by an aging society.

This work, focusing upon the elderly afflicted with dementia together with the family bearing the burden of care — in particular, the position of the daughter-in-law — depicts vividly the harsh reality of this very circumstance; upon its publication in 1972, it gives rise to social reverberation, becoming, in no time at all, a bestseller. The following year, 1973, it is also adapted into film, its narrative thereby received among an even broader stratum. Amid the advance of the aging society, many of those bearing the burden of care — the daughter-in-law, in particular — women suffering beneath such a burden, come to feel sympathy toward this novel, this being received as something speaking on behalf of their voiceless voice. At the same time, however, the reverberation this work brings to the literary world is, with the exception of a minority such as Inoue Hisashi, generally cold, giving rise even to a kind of rejection.

For instance, criticism comes at times in the form of comparison with Niwa Fumio’s Iyagarase no Nenrei (“The Age of Spite”); such reactions reveal nothing other than the fact that the literary world of that age, poisoned, needless to say, by paternalistic cognitive behavior, had scarcely understood the aging society itself. It is as though, closing their eyes to the change of the age, they prove, of themselves, an ignorance of the world, grasping with prejudice an event that was, indeed, certainly occurring within a corner of society.

The viewpoint of Kōkotsu no Hito rests not so much upon the elderly themselves, but rather upon the side bearing the burden of care — the position of women, in particular; in this sense, it overlaps as well with a feminist raising of the problem. Even granting that the elderly are increasing throughout society as a whole, the elderly remain still a minority; the problem of the aging society depends, rather, upon how the non-elderly side — the majority — comes to respond. At the time this work was published, in 1972, it was still before the “1.57 shock” of 1990; the influence of the declining birthrate remained limited, the population still tending toward increase, such that, for the people of that time, even when told of an “aging society,” this proved no concept accompanied by any real sense of feeling.

Nevertheless, the fact that Kōkotsu no Hito serves as the trigger giving rise to social debate, setting politics itself into motion, cannot be denied. The influence this novel brings exceeds the bounds of a mere literary work, becoming, indeed, a step that changes the age itself. It is much like an event that awakens something deep slumbering within the reader, lighting, as it were, a flame within the heart.

Just as it is said that medicalization bears the influence of social movements, the image of dementia depicted in Kōkotsu no Hito gives shock to the reader, becoming the occasion through which society as a whole at last turns its eyes toward this disease; nevertheless, viewed from the present day, it cannot be denied that this depiction simultaneously engraves deeply within the mind a certain stereotype concerning dementia — one capable of nothing, taking incomprehensible actions, endlessly troubling those nearby, exhausting the caregiver utterly. Implicated here is an essential characteristic belonging to the very form called the novel — a property whereby, in dealing with an abstract, general task, this task comes, almost without exception, to be represented through the mediation of a concrete, individual case. Within such a process of mediation, the reader, in many cases, generalizes this particular case, holding a tendency to expand the one individual world depicted within the work, within oneself, into a general truth covering the whole of reality.

Indeed, abstract description, were it to succeed, makes possible an understanding of greater universality; however, precisely because it is abstract, it remains an unavoidable fact that individual difference inevitably arises in the interpretation and understanding of each recipient. Properly speaking, in order to consider deeply a general, abstract task, criticism rather than the novel is what is required; given, however, that this very form tends to be shunned by people for being theoretical, moreover difficult, this too proves no easy matter. Whereas the novel takes a bottom-up approach — one evoking emotion and empathy from individual concrete examples, thereby inducing interest toward the problem from there — criticism takes a top-down approach — one organizing phenomena from abstract concepts and theory, situating them within a system. Between these two methodologies lies a gulf. Even granting that the novel proves useful, to the very last, as an occasion for arousing interest, as a means for understanding the problem at its essence, leading it toward resolution, it remains, inevitably, insufficient.

Within such a circumstance, the very problem inherent in placing the novel at the center of literature must not be overlooked. This carries the possibility of confining the understanding of the problem to something fragmentary, robbing one of the occasion to grasp the whole picture of the matter. Given that one is often drawn toward the captivating narrative that is the novel, the role that criticism ought to bear — that is, the task of organizing the whole, unraveling the essence of the problem — comes to be made light of. As a result, the understanding toward the task that society bears, far from evolving, rather increases in arbitrariness.

Even were one to take up a novel, immersing oneself deeply within its narrative, the reader could never come to understand the “institution,” in a figurative sense, that the world depicted there tacitly presupposes. Such an “institution,” without anything being spoken of it on the surface, flows through the narrative as though it were the very air. Suppose, for instance, that a caregiver of a dementia patient, drawing upon this very experience, writes an introspective novel. Behind this work lies a framework concerning how dementia is positioned within the society of the same age — therein lies the operation of laws implemented by the government, the provision of care as a public service, moreover the activities of private bodies addressing individual tasks, the latest trends reported by the mass media, even the immediate information circulated through social media and word of mouth. However, all of these remain nothing more than premises shared, so to speak, tacitly; scarcely anything of them comes to be made explicit within the novel. As a result, through reading the novel alone, coming to know the full picture of such a background, of such institutions, proves impossible.

The form called the novel is, in its very essence, a narrative dealing with concrete, individual cases; in order for such a narrative to be constituted, confining the world within a certain frame — an aorist bearing a beginning and an end — cannot be avoided. Within the closed narrative, the conduct and thought of the characters are depicted down to the smallest detail; even while this very minuteness captivates the reader, the structure of the broad “institution” lurking behind it, together with its complex interaction, comes to be overlooked. Were the reader to seek to know such a background, no means would remain save to investigate, to learn, on one’s own. In actuality, however, many readers spare themselves such trouble, coming to believe themselves to have understood the world to which the narrative belongs, through information given implicitly or through heuristic conjecture founded upon one’s own experience. This arbitrariness often becomes the very cause whereby the problem comes to be diminished, the complexity of the institution overlooked.

David Armstrong, known for surveillance medicine theory, points out that the advance of medicalization, through screening, detects in advance a reserve army from among risk factors, broadening the object of management even further beyond the patient, even while robbing the individual — one bearing body and mind together — of the very right to decide upon health management; nevertheless, the number of elderly with dementia in Japan in 2024 stands at approximately 4.43 million, behind which lies an astonishing prevalence rate of some 12.3 percent among the elderly aged sixty-five and above. This proportion is no mere figure; it seems, rather, to tell of how, amid the great current of the present age wherein the elderly population increases, the accumulation of each individual life inscribed beneath such a flow continues, even while touched by the wave of dementia, to keep its hand upon the shore that is the maintenance of health. Moreover, the number of elderly bearing mild cognitive impairment, that is, MCI, stands at approximately 5.61 million, accompanied likewise by a prevalence rate of some 15.5 percent, a figure no less astonishing, this too casting a question toward the very state of contemporary society. Even while it is said that one in eight bears dementia, one in seven MCI, the fact that this is held to a level lower than expected is analyzed by specialists as the fruit of preventive measures, the advance of medicine, moreover the taking root, within people’s awareness, of improved management of lifestyle disease. The former projection of the Ministry of Health, Labour and Welfare — an estimate that, by 2025, approximately one in five of the elderly, that is, some 7 million, would develop dementia — has, through the most recent data, been revised downward to 4.72 million. Even while facing the further circumstance to come with the passage of the age — the reality that, as the elderly population continues to increase, the number of those bearing dementia or MCI will increase ever further — if one considers the very background that made such a downward revision possible, then, even while recognizing this as a stern challenge, there can exist hope that, through improvement of lifestyle, the spread of health awareness, the advance of medical technology, the prediction may be betrayed in a good sense.

Given that such statistical figures suggest the possibility that anyone might develop dementia, or become its caregiver — even as, in my own case, bearing this very care, the anxiety at times crosses my mind that the present figure of my mother may be myself in the future — it seems that a social consensus arises whereby dementia is no longer a matter belonging to another. Even granting that the concern harboring the possibility that anyone might come to be placed beneath its influence proves certain, the reason dementia is no matter belonging to another lies not, in truth, in a fear resembling Russian roulette, but rather in this: that it is the inevitable outcome brought by a contemporary society advancing in age, an outcome invited by the very conduct of our daily life. Even while medicalization often attributes the cause of disease to the individual, bearing the danger of misunderstanding its treatment as the resolution of the problem, the influence of social structure cannot be ignored, its impact proving great. This is the fact that, accompanying our very way of life, has come to appear somewhere, quietly yet certainly. Precisely herein lies the reason the phenomenon called dementia surfaces not as a problem of the individual but as a task for society as a whole. When, through the increase of the elderly population invited by our own very activity, the change occurring within the body and mind of each individual comes, in time, to form a great current within society, in the fact that this process reflects itself self-reflexively, dementia can be unrelated to no one. Frankly speaking, to obtain such a recognition through a novel dealing with dementia proves difficult, even while one may come to feel empathy toward the drama unfolding within the interior of the characters.