The late actor Kiyoshi Atsumi, who played Tora-san in all of the movies with that title, was a compassionate man of the old Japanese school.

“When I was a kid, people in my neighborhood would look after each other,” he told me back in 1983 when extended families living together were still the norm, and many married eldest sons shared their parents’ home. “A neighbor would look after a bed-ridden elderly person while the wife in the family went out to work or shop. It was a nasakebukai (compassionate) society. Now that world is all gone.”

I recalled Atsumi’s words while watching a very moving program last month on NHK’s excellent evening news show, “Close Up Gendai,” hosted by bilingual announcer Hiroko Kuniya. The program was about what is called kaigojisatsu (suicide by elderly people in care). But it went further, discussing kaigoshinju (suicide by both cared-for and carer) and kaigosatsujin (murder of an elderly person under care, generally by a relative).

One tragic incident recounted on the show dealt with an attempted murder-suicide by a man in his fifties who had given up his job to care for his 86-year-old mother. Her dementia was causing her to act in unpredictable and sometimes violent ways, depriving her son of sleep. As the money ran out, the number of meals they could eat decreased and, eventually, they were unable to keep up their 30,000 yen monthly rent.

One day the son took his mother out in her wheelchair, but when they returned, he found himself unable to enter the house.

“Mo kaeraren noya (I can’t go back),” he said in his Kansai dialect. “Mo ikiraren noya (I can’t go on living).”

The son then took his mother’s life by strangling her, and afterward tried to kill himself. He survived, and has been indicted for murder.

Ultimate responsibility

Although the old ways are gradually breaking down, especially in the bigger cities, the more common story in Japan has the wife of the eldest son looking after her husband’s infirm parent or parents. It is often still considered one of her set duties, so much so that many women think twice before marrying a chonan (eldest son).

The responsibilities of the chonan are still taken seriously by many. A boy may have older sisters, but if he is the oldest male child he is still ultimately responsible for their parents’ welfare. After all, it is assumed that his sisters will marry and take on the responsibility of caring for their husband’s parents.

The entire problem of care for the elderly, particularly those with disabilities such as dementia, was thrust into the public eye more than 30 years ago by novelist Sawako Ariyoshi. Her brilliant novel “Kokotsu no Hito (The Twilight Years)” depicts a woman named Akiko who is obliged to look after Shigezo, her father-in-law. Published in 1972, it sold more than a million copies and was made into a powerful film by veteran director Shiro Toyoda. Toyoda shot the film in black and white, giving scenes such as one in which Shigezo defecates all over his futon a stark and pitiful reality.

Japan is by no means the only country where children find themselves caring for disabled parents; nor does Japan have a monopoly on suicide or killing of the elderly. But in this society, which government statistics show now has, at 21 percent, the world’s highest proportion of individuals aged 65 or over, there are peculiar problems not shared by other developed countries.

Japanese people may be the world’s longest lived, but do the aged enjoy a quality of life that makes those extra years truly worth living? If you are physically or mentally disabled, is being left virtually alone a viable lifestyle option?

The kind of society that Atsumi described to me has long vanished here. In addition, children often live far away from their parents and are unable to assume responsibilities for them. This leaves the aged parents isolated from family, and with no one to look after them. Of course, if they are well off, they can afford to hire home carers or even move into a nursing home, if necessary. But with the real value of pensions dwindling, and the prospects for old people to get paid employment almost nil, the vast majority are left to sink or swim by themselves.

Two essential differences

Their dilemma would be similar to that of contemporaries in northern Europe and the United States were it not for two essential differences in styles of life.

The highly developed welfare system in Scandinavian countries ensures that few elderly people are abandoned by society. Norway’s elderly suicide rate has decreased now to levels lower than in the 1980s and ’90s. Old people can rightfully feel that society continues to embrace them.

The United States, where only 13 percent of the population is 65 or older, is similar to Japan in that it lacks government-subsidized homes for the elderly. But the nature of American life, with its broad neighborhood- and church-based social networks, enables old people to stay connected with each other and with those who might help them in a pinch. In addition there are many people like my 93-year-old mother, who lives in a retirement village in southern California together with more than 20,000 elderly people. In fact, she has her own house there, but is able to avail herself of social clubs of every description, nursing care and the like. It’s not dissimilar in make-up and function to an old Japanese neighborhood.

This country still retains vestiges of the neo-Confucian tradition, according to which children must take care of their parents in old age. But the mobility of contemporary Japanese and the employment of women in full-time jobs have meant that the elderly are increasingly being left to their own meager devices. Japan chose not to adopt the Scandinavian system of welfare, and in fact has, of late, been winding down some of the social benefits that were instituted here. A recent law has put a cap on rehabilitation insurance payments for stroke victims, who can now receive money for only 180 days following the incident. After that they have to cease treatment or pay for it in full.

The compassion that existed in the old “neighborhood society” of Japan cannot now be relied upon. Nor can the government. What’s left for desperate old people and their carers? What good is a long life if its last years are a lonely living hell?

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