In the Mind of Dementia: Neurobiological Empathy, Incommensurability, and the Dementia Tojisha Movement in Japan

Abstract

Living in the world's leading superaging society, Japanese are confronted with a tsunami of dementia that has generated fear of becoming mentally incommensurable to oneself and to others. Based on three years of fieldwork in various clinical settings, including a memory clinic in Tokyo, I show how people with dementia (dementia tojishas) and doctors have employed three approaches to overcoming incommensurability: psychotherapeutic, neurobiological, and ecological. With a primary focus on the neurobiological, I show how tojishas and doctors try to cultivate what I call "neurobiological empathy," asking people to imagine not just how to be together with those with dementia but also what it is to be (in the mind of someone) with dementia. Investigating both the effects and limits of the neurobiologization of dementia, I ask how the dementia tojisha movement can work toward diminishing the preexisting fear about dementia and supplementing incommensurability with understanding and empathy. [dementia, empathy, incommensurability, neurobiology, Japan]

Limits of empathy: The dementia tōjisha movement in Japan

“…What he needed was not to psychopharmaceutically silence tōjishas but rather ask them the reasons for their "problematic behaviors" in the first place. Citing a fundamental passage from Man's Search for Meaning by Victor Frankl (a famous book on the Holocaust that was translated in 1956 and became a longtime best-seller in Japan, particularly as it resonated with the existential questions that Japanese grappled within the postwar period and beyond), some of these doctors explained to me that they began to empathize with patients' predicaments when they realized that patients' seemingly "abnormal" behaviors were in fact "normal" responses to "abnormal" conditions (for this, some use what I call "neurobiological empathy": see Kitanaka, 2020; also on the danger of "empathy" achieved through neurobiological imagination; see Goldfarb, 2015). These changing currents in dementia medicine and care met with nationwide public campaigns for raising awareness about dementia involving multiple sectors from the early 2000s.…”

“…In the name of care, they are slowly smothered out of existence. Tōjishas instead ask for a different form of empathy, where to do less for them is actually to do so much more (Kitanaka, 2020). Dementia tōjishas' arguments are reminiscent of the Green Grass movement (Aoi Shiba no kai) of the 1960s and 1970s when a group of people with cerebral palsy demanded the right to live and be independent.…”

“…Moreover, tōjishas, with their memory loss and personality changes, are often portrayed as having a special power for enabling family members also to forget and reconcile with the painful memories of the past. These representations reiterate the theme of spiritual transcendence and depict tōjishas as healers of sorts, whose going beyond the mundane concerns and petty obsessions of the secular world becomes a source of spiritual power for those who care for them, and who begin to contemplate what really matters in life (Kitanaka, 2020).…”

“…In the name of care, they are slowly smothered out of existence. Tōjishas instead ask for a different form of empathy, where to do less for them is actually to do so much more (Kitanaka, 2020).…”

“…As psychiatrist Hideki Yamazaki (2020) and others have suggested, Japanese attitudes to dementia have evolved through four stages somewhat in parallel to legal and institutional changes. First was the phase of regarding people with dementia as senile, incommensurable beings living in another world, who understood nothing, who thus needed not to be engaged with (on the incommensurability of dementia; see Kitanaka, 2020). Second, after the enactment of universal health coverage in 1961, and the Elderly Welfare Law in 1963, people with dementia became much more frequently institutionalized nationwide, and treated as psychiatric patients, whose abnormal behaviors were still largely incomprehensible but who could now be medically understood and managed.…”