National / Media | BIG IN JAPAN

As dementia cases rise, so a nation's character changes

by Michael Hoffman

Contributing Writer

“Your mother is senile, senile, senile!”

The family was dining at a restaurant. Mom had gone to the rest room and Dad, in anguish, faced his two grown children. Sawako Agawa — TV personality, journalist and author — recalls the scene for Bungei Shunju magazine (July).

It was fall, 2011. Shortly afterwards her mother was hospitalized for heart surgery. Talk at the hospital bedside turned to the catastrophic Great East Japan Earthquake six months before. Mom, listening, looked bewildered: “What earthquake?”

Some 6 million Japanese suffer from dementia. Their numbers rise as the overall population falls. By 2025 an estimated 7 million will be afflicted.

Is “affliction” the right word? Maybe our view of it is too bleak? That is the thrust of Bungei Shunju’s package of articles, whose overall title is “Dementia is not frightening.”

It is, of course. In 2013 an 82-year-old Osaka man set his house on fire. In Aichi Prefecture in 2007 a 91-year-old man was fatally struck by a train after wandering onto the track. The recent string of deaths caused by elderly drivers mistaking the accelerator for the brake is in the same vein. Not frightening? It’s terrifying.

Perhaps, though, extreme cases should not monopolize our view of the subject. “Bright, cute, senile Mom” is the title of Agawa’s article.

That flirts with the opposite extreme, equally distorting. On the other hand, maybe she’s earned the right to her high spirits — painfully acquired no doubt, after eight years of caregiving. Despair, a seemingly more becoming response, may be as destructive as the disease itself. “It’s better to laugh,” says Agawa.

In 2017, aged 63, she became engaged. The family prepared to celebrate. “Where are we going?” asked her mother. “Sawako’s getting married,” she was told. “Is she really?” she exclaimed. “To who?”

In the car on the way to the restaurant, “Where are we going?” she asked again.

“Sawako’s getting married.”

“Is she really? To who?”

And so on throughout the celebration, every three minutes or so.

You can cry, or you can laugh. Agawa chooses to laugh. Laughter, she says, is what “makes it possible for me to be kind to my mother.”

Dementia may, as of now, be preventable, and may someday be curable. For prevention, the magazine lists 15 “iron rules.” They are overwhelmingly dietetic: eat fish, beans, nuts; drink (in moderation) red wine and green tea; spurn cheap snacks and fried potatoes. Rule number 15 is, “be cheerful and positive every day.”

It can’t, surely, be that simple? If it were, we’d be wiping out dementia, not straining to look at its bright side. Dementia would be marginal. It’s not. Hope for a future cure rests on new developments in PET scan technology, making earlier detection possible. Meanwhile it must be lived with — on a scale without historical precedent, constituting a veritable, if temporary, revolution in human nature. Worldwide, an estimated 50 million people are living with minds that have strayed varying distances — often very far — from generally accepted notions of reality.

Caregiving experts who contribute to Bungei Shunju’s feature stress the individuality of dementia patients. It’s misleading to lump them together. Memory loss and impaired judgment are common symptoms, but experienced differently, the nuances as varied as those marking character traits of the unimpaired.

Other things aside, there are degrees of impairment. Forgetfulness of some things can generate sharpened memory of others. Disorientation in one sphere may heighten insight into others. Wandering, the source of such concern since the 2007 train accident, suggests the need for tracking — not necessarily for confinement.

Let them walk if at all possible, experts advise. Dementia doesn’t impair physical health; nor does it blunt exasperation at being cooped up against one’s will. Helpless exasperation is good for no one’s health — mental or physical.

A nation of soaring age and rising dementia becomes, increasingly, a nation of caregivers. The cares, responsibilities, anxieties and — just possibly — joys will transform us all, more or less directly. We will all have to learn new sensitivities. We’ll have to acquire degrees of patience, broadmindedness, tolerance, love and humor beyond anything our species’ million-odd years here have evolved us for. Two examples of what that might mean in practice are encapsulated in the following stories, both courtesy of Bungei Shunju.

Our first main character is famous, our second not. The first is Kazuo Hasegawa, a retired psychiatrist who specialized in dementia and authored a now-standard scale to measure its progress. Now, at 90, he lives with it himself, the most qualified and, it would seem, most good-humored of clinical self-observers. “I’m fine in the morning,” he says. “Toward evening I tire and grow forgetful.”

“I feel this very strongly,” he says. “Dementia or not, you’re still you. My bright morning self and my forgetful evening self are both me. Where does the one end and the other begin?”

He lives with his wife, and they relish forgetting things together. There is the diary he has kept all his life. Memory loss makes it harder. “What did we do yesterday?” he’ll ask, pen in hand. “The usual,” she says. “Which is what?” he demands. Trying to remember is a pleasant pastime. Shared forgetfulness can be to the elderly what shared memories are to the young.

The second character is a professional caregiver who asked a patient about to wander off, “Where are you going?” “Home,” she replied, having forgotten she was home. “Wait,” said the caregiver. “Before you go, could I trouble you to make me a plate of tasty scrambled eggs the way you always do?” “Oh,” said the woman, touched. “Certainly, with pleasure.” She set to work — and stayed.

Big in Japan is a weekly column that focuses on issues being discussed by domestic media organizations. Michael Hoffman’s latest book is the essay collection “Fuji, Sinai, Olympos.”

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