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ABSTRACT. Using the Japanese concept of ikigai, which describes a certain state of
psychological well-being, this study explores how Japanese family caregivers of elderly
parents with dementia pursue, maintain, or attempt to regain their psychological well-
being in the face of the hardship of caregiving. Using constant comparative methodology,
twenty-six Japanese women who were caring for an elderly demented parent or parent-in-
law were interviewed. Based on the analysis of interview data, we define ikigai as certain
life experiences and/or the positive emotion felt through those experiences that allow the
caregiver to judge her life as good and meaningful, and to feel that it is worthwhile to
continue living. Caregivers use various different means to pursue their ikigai depending on
the context of care. The types of their pursuit of ikigai are examined in varying contexts of
caregiving. Because the data suggest that ikigai experience influences how the caregivers
self-understanding changes over time, the notion of ikigai is further explored in relation to
the construct of self-understanding.
help, bathing, visiting nursing, and short institutional stays for respite
purposes. Until recently, the majority of services were provided as public
welfare.2 However, the services were often insufficient (Harris and Long
1993), and there was frequently a long waiting list at the municipal govern-
ment office. Available services varied greatly depending on the district.
The traditional value of family caregiving was also a barrier to service use
(Yamamoto and Wallhagen 1998).
Participants for the study were recruited through several senior service
organizations: (1) two senior service centers which offer various respite
services (i.e., day care, bath services, long-term institutionalization); (2)
a public health center in which a family caregiver support group is
sponsored; (3) two home care support centers through which home health
care services are provided; and (4) a private hospital for the elderly that
provides short- and long-term care. Caregivers were introduced to the first
author by staff members (nurses, social workers, or a psychiatrist). The
interviews were held between June and September of 1993.
The caregivers interviewed were all daughters or daughters-in-law of
an elderly person with dementia, and were living in several cities, towns,
and villages in Yamaguchi prefecture and Tokyo. Yamaguchi prefecture
is located in the west end of mainland Japan. Its economic base is made
up of refining and other heavy industries located in towns alongside the
Inland Sea, agriculture in villages located near the mountains, and fishing
in villages alongside the Japan Sea. Tokyo is the urban center of Japan, and
the interviewees were from suburban cities and downtown districts where
many small home industries are located.
After obtaining informed consent, interviews were conducted with 26
caregivers (13 daughters and 13 daughters-in-law), ranging from 32 to
63 years old (mean age = 52.8 years old). Two of the caregivers were
single, 23 were married, and one was widowed. Twenty-three of them
had dependent or adult children. The interviewees and their spouses were
involved in a variety of occupations (e.g., agriculture, banking, college
404 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN
experiences or emotions let the caregiver believe that her life was valuable,
meaningful, and satisfying, and that it was worthwhile to continue living.
The source of ikigai is described in such phrases as I think caregiving
for Grandma is my ikigai (Akemi, in-law, 495 ). The sense of ikigai was
described in statements like the following:
I think ikigai is ones own sense of fulfillment, . . . the accumulation of feeling that I had
a good day today, from wake up time to bedtime. (Tomoko, daughter, 53)
But more than mere happiness, ikigai assumes the presence of a value
judgment that a certain life experience is meaningful to the person. This
value was sometimes great enough for the caregiver to be willing to devote
her whole life to it: I think ikigai in general is something you can devote
your whole life to (Rumi, in-law, 50). As a consequence of the feeling
that ones life is meaningful, ikigai provides encouragement to the person
to live on; it is a springboard for tomorrow (Hideko, daughter, 45). I
guess ikigai means something to encourage you to live on (Kaoru, in-law,
43). Courage to live. . . . Reason to live. Something makes you happy to
live and keeps you going for many years to come (Yukiko, daughter, 51).
While there was a range of descriptions, the responses of these care-
givers support the three central dimensions of the concept of ikigai
described in the literature (experience, judgment, and fulfillment). The
responses also underline an inherent sense of commitment and dedica-
tion that emanates from the caregivers individual values; these individual
values were the basis of their various definitions of ikigai.
Although most caregivers were able to articulate their views of what ikigai
meant to them, some had to struggle. This emphasized another central
aspect of the phenomenon the taken-for-granted or contextual embedded-
ness of ikigai in ongoing daily life. This point is important to understanding
how these caregivers experience psychological well-being.
When caregivers are not experiencing much difficulty, their situations
present no reason for them to question their lives in light of their values,
and thoughts of ikigai seem not to surface; ikigai is maintained subcon-
sciously. Some difficulties may exist in caregiving or other areas of their
lives, but these are minor, and the high value placed on caregiving and
other life experiences easily overpowers the difficulties: I feel I am having
a relatively good life. I feel my life is fruitful (Yoshiko, in-law, 55). Ikigai
is also maintained subconsciously when the caregivers belief in the value
406 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN
of caregiving is strongly held and they are not challenged in their daily
lives:
Because I am intent on living wholeheartedly, . . . I guess it is serving as my ikigai. Because
I devote myself to accomplish everything, I lose myself in them. . . . I have no time for
pondering about such a thing as ikigai. I have to give her [the care recipient] a bath every
other week, and on Tuesdays I distribute boxed lunches. . . . I never have time for thinking
about ikigai or something to live for. I dont even know how to answer such a question. . . .
I just do things because I live wholeheartedly. (Mayu, in-law, 56)
This gradual awakening to the meaning of ikigai often occurs as the diffi-
culties in the caregiving role increase. Rising tensions bring thoughts of
ikigai increasingly to the surface and into conscious awareness. In being
aware of ikigai, the caregivers struggle to maintain it while they continue
care that is increasingly difficult. The following section describes several
strategies used to maintain ikigai that were disclosed by the caregivers.
(a) Maintaining ikigai in the family. Given the societal norm that has
granted high value to womens role in the family, it is not surprising
that many caregivers cite maintenance of family harmony and health
including taking care of elderly parents as their primary ikigai.
CAREGIVING IN JAPAN 407
Caregiving and ikigai, after all, for me, . . . they are inseparable. They are myself, my
husband, children, and that I am able to do what I like. I feel all of these things together
make one ikigai for me. . . . It is like a set. (Kaoru, in-law, 43)
Each time when you have something you cannot do [because of caregiving] even if you
want to, you find something else you can do. . . . There is no point of holding on to what
you really want to do, so for the time being you go ahead with what you can do, and save
what you really want to do till you can. . . . What you want to do now, . . . the circumstance
does not allow you to do. . . . At the moment I do what I can, such as knitting or sewing. I
can do these things here and now. . . . I am happy about what I am doing now, . . . because
Im creating something by knitting and sewing. If my daughter goes to work wearing it,
that makes me happy in its own way. . . . I cannot dress up and go out now, but I can let my
daughter have some nice clothes. That is one ikigai. (Rie, in-law, 58)
Thus caregivers try to enjoy the replaced ikigai as much as possible within
the given circumstance. Because enjoying such activities still offers some
satisfaction and encouragement to caregivers, it helps them maintain their
psychological well-being.
The higher the value the caregiver assigns to caregiving, the less
it matters what she can do instead of the very thing she wants to do.
However, when a caregiver cannot assign a high value to her caregiver
role, giving up certain activities may be difficult, and finding a substitute
may not maintain the sense of ikigai. Also, when caregivers have to give
up activities that are very important for their sense of ikigai, finding a
replacement can be difficult.
Now I think taking care of Mother is something like my ikigai. . . . From time to time,
I wonder what my ikigai is. . . . I think my main ikigai is caregiving [for] my mother.
Sometimes I feel wretched if I dont think that way. . . . I have to believe that taking care
of Mother is my ikigai. I have to believe that, otherwise I feel empty. . . . I think that how
you do in caregiving depends on how your mind is set. My feeling swings, too. Sometimes
I feel if I tell myself that caregiving of my mother is my ikigai, my hope can be diverted.
But sometimes I still wonder what indeed my life is for. Because my health is not so good,
. . . my feelings swing all the more. (Emi, daughter, 51)
The imagined ikigai is a hope for the future that enables them to tolerate
todays difficulty. The hope for future luck may be encouraged by other
family members as well. Akemis (in-law, 49) husband wrote in his care-
giving photo journal, After this, there will surely be something good
waiting for us. So lets hold out, just for some more time.6
Imagined future ikigai may be related to current difficulties, and current
difficulties can have value in connection to future ikigai. Toshiko (in-law,
42) and Chieko (in-law, 32) are considering future careers in helping other
family caregivers in similar situations, thereby making good use of their
experiences. In order to make sense out of their current life, they cultivate
hopeful expectations of using the experience for their future ikigai.
When it is difficult for caregivers to estimate how long caregiving will
last and they cannot visualize their goals, imagination may be a fantasy of
a better life that is almost unrealistic. Here ikigai is equated to hope. Rie
(in-law, 58) dreams about going to Tokyo Disneyland, knowing that it is
impossible in the near future. Akiyo (in-law, 51) can continue caregiving
by fantasizing about being alone. In fact, she actually purchased an
apartment room to be alone, and she occasionally enjoys solitude there.
This partial realization of her fantasy is a symbol of her hope, and it is her
safety valve when extreme difficulty ensues.
410 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN
For some caregivers, attempts to pursue ikigai are unsuccessful, and there
comes a point when they cannot identify the source of their ikigai: Ikigai
. . . I guess for me ikigai means to live on without committing suicide
(Sachie, daughter, 44). Some caregivers described conditions that included
physical problems (e.g., angina pectoris, occasional fainting, backaches),
excessive alcohol consumption, and various negative thoughts, such as
hurting the care recipient. Such situations can be explained as final failure
in maintaining ikigai.
SUMMARY
DISCUSSION
This research explored how the Japanese family caregivers of the elderly
pursue and maintain their ikigai, and how the experience of ikigai accom-
panies a change in self-understanding. The fact that the purpose of the
pursuit of ikigai is to live a life true to ones values suggests that the
pursuit of ikigai by the Japanese and the Western way of seeking happi-
ness share common ground. However, these two approaches emphasize
CAREGIVING IN JAPAN 413
different points. The various strategies used to pursue ikigai reveal the
struggles these caregivers experience. In spite of the visible incorporation
of a more Westernized, independent view of self and family, the caregivers
lives were essentially embedded in traditional norms and beliefs. As long
as they live under these societal norms, their ikigai cannot be maintained
in a form that threatens their social identity. As a result, these caregivers
attempt to pursue their ikigai in finding a compromise between societal
norms and their own fulfillment, although this is not easy.
The resultant modes of ikigai maintenance are mostly perceptual modi-
fications that also entail a gradual perceptual change in self, with a few
exceptions where there is a reduction in the commitment and work as a
caregiver. This process may be criticized as resulting from oppression by
the societal values of Japan. However, it can also be adaptive, given the
fact that caregiving is valued by the caregivers themselves as well as by
society; giving up a caregiver role also means a loss of one source of ikigai.
Yet many of these women could not continue caregiving without main-
taining their own fulfillment in various ways, and the multiple strategies
elucidated here were the result. The above modes of ikigai maintenance
offer effective means for the caregivers to maintain their psychological
well-being without disturbing family harmony and health.
The current findings of various modes of ikigai pursuit may be appli-
cable to Japanese men as well, though to a lesser extent. The precedence of
group harmony over individual satisfaction in Japan is not gender specific.
The fact that Japanese men are expected to endure and akirame (give in
and accept) with the feeling of shikatanai (no way out, unable to be
helped) in their workplaces has been documented (e.g., Hamada 1992),
although this is also changing. Further study may clarify the applicability
of the findings across gender.
Also, the perceptual modifications observed in this research are
comparable to cognitive coping discussed by Western researchers such as
Lazarus and Folkman (1984). In fact, some research suggests that similar
cognitive coping is employed with success among American caregivers
who are in situations where there is no effective way to solve problems
(e.g., Pruchno and Kleban 1993). However, maintaining psychological
well-being through perceptual modification may be particularly common
for Japanese who have learned to regard certain situations as shikatanai
and to akirame throughout their lives.7 Additional study of this area in light
of ikigai may further our understanding of the mechanism of how people
in difficult life situations maintain psychological well-being, regardless of
culture.
414 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN
ACKNOWLEDGMENTS
This research was supported under contract with the Toyota Foundation
Grant, and the Fumiko Yamaji Trust for Academic Nursing Education and
Research, Tokyo, Japan. The authors would like to thank Drs. Laura Reif,
Shizuko Fagerhaugh, Frank Johnson, Juliet Corbin, and the late Anselm
Strauss for their advice and assistance throughout the research process.
Also, we would like to thank all the participants in the research, staff
members of the organizations who kindly introduced the research partici-
pants to the first author, and the directors of the related organizations.
NOTES
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NORIKO YAMAMOTO-MITANI
School of Nursing
University of California
Los Angeles
Box 951702
Los Angeles, CA 90095-1702
USA
MARGARET I. WALLHAGEN
University of California
San Fransisco
USA