NORIKO YAMAMOTO-MITANI and MARGARET I.

WALLHAGEN

PURSUIT OF PSYCHOLOGICAL WELL-BEING (IKIGAI) AND

THE EVOLUTION OF SELF-UNDERSTANDING IN
THE CONTEXT OF CAREGIVING IN JAPAN

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.

KEY WORDS: family caregiving, ikigai, Japanese self, psychological well-being

Although a great deal of research has focused on caregivers of persons with

dementia, most has been accomplished using Western theoretical models
(e.g., Pearlin et al. 1990), even when the subjects of study are from non-
Western populations (e.g., Wake 1998). Yet different cultural contexts can
influence the experience of caregiving and the caregivers satisfaction and
well-being. In order to better assist caregiving families, explorations of
varying cultural patterns of caregiving may prove valuable. For example,
an exploration of family caregiving in Japan may expose features not
necessarily salient in the same experience in Western cultures, such as
distinctive coping styles and alternative ways of experiencing well-being.
Based on this premise, the current research aims to explore how
daughter or daughter-in-law caregivers for elderly with dementia in Japan
pursue their psychological well-being in the face of enormous difficulty.
The exploration was accomplished using the term ikigai. Ikigai denotes
well-being and is literally translated in English as the worth of living.
Exploring the construct of ikigai within the context of caregiving may
enhance our understanding of how caregivers derive, maintain, or lose
psychological well-being. The construct of ikigai is further examined in

Culture, Medicine and Psychiatry 26: 399417, 2002.

2002 Kluwer Academic Publishers. Printed in the Netherlands.
400 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN

relation to the construct of self-understanding, because the data suggest

ikigai experience influences how caregivers self-understanding changes
over time.

FAMILY CAREGIVING IN JAPAN

The traditional family in Japan (ie) is characterized by its patrilineal

genealogy; it is a vertically composite form of nuclear families, one from
each generation (Lebra 1984: 20). In this structural characteristic of the
Japanese family, care of the aged has been traditionally considered the
fixed responsibility of the succeeding couple, a tradition that was main-
tained through primogeniture. In addition, the care of the sick and elderly
has traditionally been a role expectation for women (Iwao 1993).
When a woman marries, she is considered to have left her maiden
family and entered the lineal family of her husband. She is expected to
fulfill her domestic responsibilities, one of which is caring for her parents-
in-law. This includes all the hands-on caregiving: assistance in eating,
bathing and changing diapers. Providing care to parents-in-law is one
of the major tasks expected by women at the time of marriage, espe-
cially when they are to marry the first son of a family (Yamamoto and
Wallhagen 1997). As a result of these cultural traditions, even in 1998,
32.5 percent of bedridden elderly persons who were not in institutions
were cared for by their daughters-in-law (JMHW 1999). Institutional-
ization of elderly parents has long been stigmatized as neglect by their
children and is therefore a shame to the family; care of the elderly was
largely considered a private matter. Even today, the influence of such tradi-
tional values connected to the ie remains a genuine factor affecting the
conceptualization of families in Japan, especially in the rural areas.
At the same time, the family in Japan and related values and norms have
been under constant change. The new Japanese constitution after World
War II established the legal independence of the new couple from their ie
lineage. Reflecting this change and the increased industrialization of the
country, the number of extended families has decreased while the number
of nuclear families has risen.1 In this combination of the continuing
influence of traditional values and the changing family configurations,
individuals mix traditional options with newer ones, . . . and struggle to
make sense of broader social trends and changes in terms of their own
personal circumstances (Elliott and Campbell 1993: 121).
Reflecting a rapid increase in the elderly population, the difficulties
around family caregiving began to gain public attention in the early 1980s.
A variety of services were introduced and/or intensified, including home
 CAREGIVING IN JAPAN 401

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).

SENSE OF SELF AND PSYCHOLOGICAL WELL-BEING OF

THE JAPANESE

To describe the state of psychological well-being, the Japanese often use

the word ikigai. Therefore in this study the concept of ikigai was util-
ized to explore the psychological well-being of the caregivers. A review
of past literature suggests that the term ikigai is used to refer to 1) a
specific experience that creates a sense of worth and happiness, 2) the
resultant cognitive evaluation that finds ones life meaningful because of
the experience, and 3) the sense of fulfillment and joy that is derived from
the cognitive evaluation (e.g., Kamiya 1966; Mathews 1996). In Western
conceptualizations of psychological well-being, the idea of ikigai is readily
observable in such concepts as self-actualization (Maslow 1968; Rogers
1980) and meaning or purpose in life (Frankl 1984). Similar to the concept
of self-actualization and purpose in life, the concept of ikigai is character-
ized by vagueness, and the literature varies significantly regarding which of
the above three components (experience, cognitive evaluation, fulfillment)
is the primary characteristic of ikigai. Mathews (1996) argues that the
different conceptualizations of ikigai reflect individual values and world
views within Japan.
Frank Johnsons model of the self is used to highlight the influence of
ikigai on sense of self (Johnson 1985). Johnson proposes three dimensions
of the self: inner, interpersonal and social. The inner or subjective self
is involved with internal experiences consisting of solitary communica-
tion, such as introspection. The interpersonal and social selves are viewed
as presentational; they are experienced in reciprocal interactions within
small group encounters (interpersonal) or in nonreciprocal interactions
within larger groups (social). Although overlap and fluidity among the
three dimensions is assumed, Johnson suggests that these distinctions are
useful in acknowledging psychological sets of awareness inherent in an
operational, interactive self.
The Japanese self is characterized by its emphasis on situationality and
relativity. In order to maintain smooth operations and harmony in inter-
402 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN

personal relationships, the presentational self becomes situation-specific

and relational to the interactants (Lebra 1976; Kondo 1987), making the
presentational self infused with social cohesion (Johnson 1993: 233).
This situationality and relativity of the presentational self of the
Japanese also contributes to the formation of a dual structure of conscious-
ness (Doi 1985). Doi contends that in Japanese consciousness there is a
clear distinction between tatemae (an official stance), and honne (ones
real intention). Tatemae and honne, as described by Doi, correspond to a
general distinction between the group-oriented self and the individualistic
self, respectively. In most social transactions among the Japanese, only the
group (tatemae) self is fully expressed, whereas the individualistic (honne)
self tends to be expressed only when the situation allows.
A number of Eastern religions and philosophies maintain the primacy
of group (tatemae) self over individual (honne) self, and this greatly
influences how Japanese attain psychological well-being. For example,
complete happiness is thought to be hazardous because the gods (or
Ways of Heaven) will cause whatever is thriving to deteriorate or
disappear (Minami 1971). Confucianism teaches that people should know
their lot (Lebra 1976) and know how to be happy within any given situ-
ation. Buddhism also teaches that happiness in this world is ephemeral,
and therefore not to be trusted (Minami 1971). These moral constraints
on happiness3 further foster group-goal attainment and inhibit the pursuit
of individual satisfaction. As a result, psychological well-being is typi-
cally sought through belonging to a group in a harmonious manner and
achieving certain goals by means of group activity; it is not experienced as
an individually derived construct (DeVos 1985; Lebra 1976).
Whereas Dois dual structure highlights the features of the self that are
characteristic of Japanese within the presentational self, Johnsons model
is a depiction of universal awareness of self. In this paper, Dois dual
structure is used in examining the caregivers various pursuits of ikigai.
Johnsons model of self is utilized in the discussion of the formation of
self through ikigai, because it distinguishes subjective and presentational
selves for which ikigai works as a mediating force.
For Japanese women, traditional roles have occurred mainly within the
family: wife, mother, or daughter-in-law. Faithfully enacting such roles has
traditionally been considered to yield fulfillment (Iwao 1993). Endurance
is also valued among Japanese women and believed to be rewarded in the
future (Lebra 1984); therefore it is a cultural imperative for women in
Japan to work diligently for family harmony and peace as a way to achieve
ikigai.
 CAREGIVING IN JAPAN 403

These moral imperatives that underpin the lives of Japanese women

are undergoing significant modification. The number of married women
working outside the home is increasing,4 and womens roles are no longer
confined to the family. The introduction of more Western institutions
has also encouraged more individualistic views of self, family, and well-
being. However, like the norm of family caregiving, the traditional norms
of womens self-conception and well-being have not been completely
discarded, and Japanese women are endeavoring to come to terms with
the imposed juxtaposition of multiple values.
Given the fact that in todays Japan the number of older adults is
increasing rapidly and that the responsibility of family caregiving still falls
mainly on women, the traditional role of Japanese women as care providers
and their pursuit of ikigai need careful examination in the current social
environment. This research was designed to explore this issue.

RESEARCH PARTICIPANTS AND PROCEDURE

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

teaching, retirement), reflecting the geographic distribution of the sample.

At the time of the interviews, the elderly parents for whom these women
cared ranged from 63 to 99 years old (mean age = 80.2 years old), and
were living with the caregivers (n = 18), independently (n = 5), or in a
hospital for the elderly (n = 3). At the time of the interviews, caregivers
had varied histories of prior use of formal care services (e.g., home helper,
bath service, day care, short stay).
The process of research followed the constant comparative approach
as described by Strauss and Corbin (1990). A major strategy for data
collection in this approach is theoretical sampling, whereby interviewee
selection is guided by the ongoing analysis. Individual interviews were the
major source of data because exploration of the subjective experience of
care and pursuit of psychological well-being were the purposes of study.
All of the interviews were conducted by the first author, a Japanese native.
Interviews began with a general question: Would you tell me what
happened and what you and your family have done since you first noticed
there was something wrong with your parent(-in-law)? Follow-up probe
questions were added in such a way that the caregivers could give their
own view of the caregiving experience and their ikigai. Interviews lasted
one to four hours (mean = 2) and were audio tape-recorded and transcribed
word for word for data analysis.
The constant comparative analysis was conducted originally in
Japanese and gradually shifted to English as it progressed. Major
categories and concepts were developed first in Japanese and then
translated into English. Close communication was kept with American
researchers who are knowledgeable about Japan and Japanese people. The
staff who introduced the caregivers to the first author reviewed the progress
of analysis and gave comments as experts on family caregiving. Two
Japanese experts in the constant comparative approach also reviewed the
analysis. These procedures of cooperative interpretation between Amer-
ican and Japanese researchers/clinicians helped to insure valid analysis and
styles of presentation.

CAREGIVERS DEFINITION OF IKIGAI

In order to discuss how caregivers pursued ikigai within their caregiving

situations, it is necessary to first delineate how they defined ikigai for them-
selves. Despite the variety of interviewees descriptions of ikigai, a variety
that reflects the diversity of their values, ikigai emerged as having two
major components: certain life experiences (the source of ikigai) and the
positive emotion felt through those experiences (the sense of ikigai). These
 CAREGIVING IN JAPAN 405

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.

EVOLUTION OF IKIGAI FROM SUBCONSCIOUS TO

CONSCIOUS

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)

However, even when there is no crisis in life, caregivers sometimes

came to question what their ikigai was. This questioning often accom-
panied a feeling of vague discomfort or frustration. At times such as this,
one begins to take a close, conscious introspective look at ones self.
I feel anxious with hurry. I ask myself, Is it all right to get old and die in this way? For
what I have been living so far? . . . Because I have done nothing but work. . . . In our day,
when you came of age, your parents pressured you to marry. I married that way, too. . . .
After marriage, I got busy with work [laughs]. I worked day and night, and for the rest, I
just raised children. . . . I want to do something, but . . . I wonder what my life has been for.
(Hiroko, in-law, 53)

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.

PURSUIT OF IKIGAI WHILE CONTINUING CARE

As caregivers struggled to reconcile the difficulties of care and the values

derived from cultural norms and/or attachment to the elderly (Yamamoto
and Wallhagen 1997), they tried, through various means, to maintain or
regain their ikigai. Six major, non-mutually exclusive modes through
which caregivers attempted to maintain or restore their ikigai emerged
from the data: (a) maintaining ikigai in the family, (b) maintaining
ikigai in balancing, (c) maintaining ikigai in finding a substitute, (d)
maintaining ikigai in caregiving, (e) maintaining ikigai in imagination,
and (f) maintaining ikigai in philosophy.

(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)

Caregivers children, especially young children, can be sources of ikigai. In

this case, caregiving may not be included in their ikigai, and watching their
children grow gives them the encouragement needed to live the current
difficult life of caregiver.
Maintaining ikigai in the family tends not to be identified in clear
awareness. It is only when asked by the interviewer that these caregivers,
with much consideration, verbalized what was felt as their ikigai.

(b) Maintaining ikigai in balancing. A number of caregivers find life

fulfilling when they are able to keep a balance between their responsi-
bilities as housewife and their needs for personal enjoyment or fulfillment.
Balancing multiple roles successfully becomes a source of ikigai.
Ikigai? It may be going to work. It may be handling various things, continuing my work
outside home, taking care of children . . . and seeing my old age. . . . If I am asked what
my ikigai is, Ill say it is to stay on my job, reconciling home duties and my job. (Hatsue,
daughter, 44)

Balancing also occurs between emotional demands. The societal norm

calls for Japanese women to be supportive to others. Being supportive thus
often constitutes one source of ikigai. However, doing things for others
only is not always sufficient for caregivers as individuals:
It is really sad if caregiving is my ikigai. . . . Because caregiving constantly requires
suppressing myself. After all, caregiving is putting yourself in a care recipients place,
thinking what is the best for that person. . . . When you think about it, there is very little
concern for myself. Therefore, it is hard to continue only caregiving. (Naoko, in-law, 42)

Naoko also said afterward that caregiving is one of her ikigai. It is a

juxtaposition of the tatemae (a group-oriented or official stance) and honne
(ones real, individualistic intention) of her self that needs to be balanced.
Another caregiver mentioned, Grandfather [the care recipient] is not all
of my ikigai (Rie, in-law, 58). This is the reason balancing can be a source
of ikigai.
When multiple roles are balanced successfully, they are mutually
enhancing, although it is often difficult to balance them. Naoko can
diligently enjoy her English classes because her time is limited due to
the demands within the family; concurrently, because of the contentment
she derives from these classes she is further motivated to fulfill her
responsibility as daughter-in-law.
408 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN

(c) Maintaining ikigai in finding a substitute. There are some occasions

when ikigai is maintained in finding a substitute for the activities that were
given up due to the increasing demand of care. Alternatives are sought to
meet individual needs for satisfaction.

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.

(d) Maintaining ikigai in caregiving. When internalization of the societal

norms regarding filial caregiving is strong and there is no way out of
caregiving for an extensive period of time, caregivers sometimes come to
perceive caregiving as the source of their ikigai. At times this is subcon-
scious. Akemi (49), a daughter-in-law caregiver whose family was once
the focus of a national TV program as a model family of home care, said
without hesitation that caregiving is her ikigai. For her, as a housewife,
caregiving is a source of great pride. Thus, once caregiving becomes a
source of ikigai, working as a caregiver can be a source of very positive
motivation.
On the other hand, when a caregiver cannot find a way out of caregiving,
she may force herself to consciously think that caregiving is the source of
her ikigai in order to maintain her sense of well-being. This intentional
perceptual modification is necessary in order to believe that ones life is
good and acceptable, thus avoiding a sense of despair.
 CAREGIVING IN JAPAN 409

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)

One danger of maintaining ikigai in caregiving is that the caregiver

may lose her sense of ikigai following the death of the care recipient.
Several caregivers spoke of neighbor family caregivers becoming severely
depressed after their care recipients passed away. This condition is referred
to as caregiving dementia (kaigo boke) by the caregivers.

(e) Maintaining ikigai in imagination. When caregiving becomes

demanding and there is no time to spend on other activities at all, some
caregivers turn to imagining or day-dreaming about their future freedom
from their caregiving responsibilities.
Recently I think there is no ikigai. But after I send Mother off, I shouldnt think about
that, but sooner or later she will depart from life, then I think I can have my ikigai. (Miho,
daughter, 61)

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

(f) Maintaining ikigai in philosophy. A caregiver may be able to maintain

ikigai because her daily life meets the requirements of her philosophy. For
Reiko (daughter, 57), living a Christian life serves as her ikigai, and for
her the specific activities in daily life do not matter. After describing how
she had to minimize her work as a successful career woman to care for her
mother, Reiko stated, I dont think it really matters to a person whether
one can or cannot do something.

FAILURE TO MAINTAIN IKIGAI

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

The various modes of ikigai maintenance occur at different stages of the

caregiving experience and suggest that there is a hierarchy of strategies.
When caregiving demands are not very burdensome and the caregiver
role can be easily accommodated within the persons former roles, ikigai
may remain subconscious or be derived from family. However, the time
comes when the increasing demands of providing care make it difficult to
continue other roles in combination with the caregiver role. Then a care-
giver may pursue her ikigai by finding a substitute, using imagination, or
focusing on caregiving itself. Sometimes a caregiver may accept the limits
of her ability to care and reduce her involvement in caregiving activities.
On such occasions, ikigai may be maintained by balancing multiple roles.
The mode of ikigai maintenance in philosophy can occur throughout the
caregiving experience.
 CAREGIVING IN JAPAN 411

PROPOSED MODEL OF THE CONSTRUCTION OF

THE SELF THROUGH IKIGAI

The changes in ikigai maintenance modes during the course of caregiving

discussed above were intricately related to a concurrent evolution in the
caregivers self-understanding. This section proposes a preliminary model
to explain this relationship.
Along with the change in ikigai maintenance modes, the caregivers self
is constantly evolving during the process of caregiving. This is particularly
apparent in situations where the caregiver is beginning to reach or strug-
gling with her tolerance limit, or the point at which she feels she can no
longer continue giving care under the current arrangements. At this point,
the deteriorating condition of the care recipient demands a gradual increase
of the caregivers involvement. In such a situation preexisting roles in the
caregivers presentational self are gradually lost, one after another. Even
the role of mother is reduced, as was evidenced by caregivers reduced
opportunities to go out for activities like PTA meetings. Some caregivers
completely lose all other aspects of the presentational self besides that of
caregiver in this process. In contrast, when a caregiver reaches her toler-
ance limit and must reduce her level of involvement with care, the caregiver
aspect of the presentational self retreats and is replaced by other roles, such
as dancer, tennis player, or person who enjoys solitude.
The evolution of self-understanding described above seems to be
reflected in the experience of ikigai. That is, in assessing the actions of
the presentational self, the subjective self reaches the awareness of self
with a certain value, and this is the sense of ikigai. Having the sense of
ikigai means that some experiences in the presentational self (the sources
of ikigai) create general feelings of satisfaction in light of the values held
by the subjective self. Thus, the sense of ikigai is experienced in the realm
of the subjective self, while the source of ikigai is experienced in the roles
and actions of the presentational self.
Based upon the appraisal of ikigai, the subjective self may command a
change in the presentational self. The performance of the new presenta-
tional self brings more appraisal material back to the subjective self.
When the caregiver role is fulfilling, the subjective self senses ikigai, and
the caregiver role in the presentational self is recognized as a source of
ikigai. The role may be extended to enhance the sense of ikigai at the
cost of reducing other roles in presentational self (maintaining ikigai in
caregiving). Alternatively, the enlargement of the caregiver role can be
accepted as long as it brings some sense of ikigai, and as long as other
sources of ikigai help to maintain a certain level of overall ikigai (in the
412 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN

family, in finding a substitute, in imagination, in philosophy). If the care-

giver role is so consuming as to leave no other roles in the presentational
self, caregiving dementia may be experienced when the elderly person dies
and there are no sources of ikigai left for the caregiver.
On the other hand, if the caregiving role is not worthwhile enough,
the subjective self senses less ikigai and the role is less recognized as
the source of ikigai. The subjective self may then initiate change in the
presentational self to reduce the caregiver role. This is seen among care-
givers who have reached their tolerance limit and have to reduce their
care-involvement level (that is, in order to maintain ikigai in balancing and
in philosophy). If a caregiver cannot reduce the enlarged caregiver role
despite the lack of a sense of overall ikigai, she may experience despair (a
failure to maintain ikigai).
Through this process, changes in the presentational self gradually effect
changes in the subjective self, and the changed subjective self will appraise
its ikigai in a different way, which may again initiate change in the
presentational self. Thus the presentational and subjective selves interact
via ikigai, and they each evolve as the individual grows in life experience.
This is the interactional relationship between the self and ikigai. In this
process, as demonstrated above, an overarching purpose of various pursuits
of ikigai is to live a life true to ones values. At the same time, personal
values may change over time based on changes in the self.
This proposed theoretical model may help to explain the range of
experiences or emotions identified as ikigai and the range of strategies
utilized to pursue it identified in this study. Many of the caregivers did
not identify their ikigai as caregiving at the start of their experiences,
but with time some of them came to do so, while others decisively gave
up home caregiving. Some even came to think of becoming a helper for
other caregivers after their own caregiving ended. The evolution depends
on what the presentational self, as caregiver and as other roles, brings to the
subjective self in terms of ikigai, while the subjective self in turn influences
the performance of the presentational self.

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

The model of self by Johnson (1985) worked to explain the relation-

ship between ikigai and self, although the model was originally used for a
Western conceptualization of self. The current findings and the proposed
model of self-construction through ikigai will add the dynamic nature of
the self to the model, that is, how subjective and presentational selves
correspond via ikigai and how the self evolves over time based upon
daily experiences. The dual structure of tatemae (an official stance) and
honne (ones real intention) described by Doi was seen in the caregivers
conflict between respecting the traditional caregiver role (tatemae) and
enjoying individual fulfillment (honne). Maintaining both was considered
vitally important for the pursuit of ikigai. This finding corresponds to
Dois argument that the two elements of the dual structure are important in
maintaining psychological well-being (Doi 1985).
Lastly, it should be noted that the Japanese womens flexibility and
resilience sustained through the various ikigai pursuits has allowed the
society to remain heavily dependent on family members for the care of
the elderly. Lock (1993) argued that Japanese governments have made
continuous attempts to place a major responsibility for elderly caregiving
on family, emphasizing the tradition of family caregiving. Even the newly
developed caregiving insurance system (kaigo hoken) focuses on home
care, where the majority of family caregivers are women, rather than on
an extension of institutional care (JMHW 2000).
However, the cultural values and norms are changing rapidly, and the
assumption that family care is always the best may need reconsideration
in the near future. For example, in a 1997 national survey of those who
were 60 years old or older, as many as 42.7 percent of the people answered
that they would like to live in some kind of institution if they become
demented and need assistance (Shokuhin Ryutsu Joho Center 1998). A
variety of caregiving arrangements, including institutional as well as home
care, may become necessary in coming years.
A significant limitation of this research is sampling bias: only those
who are already using certain services were recruited, and only those who
had a relatively positive view of their caregiving may have agreed to be
interviewed. As a result, the findings may have unduly emphasized the
embeddedness of the caregivers lives in cultural norms and expectations.
Another limitation is that the examination of change in ikigai and self is
based on the retrospective account provided by the caregivers rather than
on an examination of their experience longitudinally. Despite these limita-
tions, this research uniquely explored these caregivers efforts to maintain
their psychological well-being from their own perspective. These data
will add to the current knowledge base in the caregiving and psychology
 CAREGIVING IN JAPAN 415

literature on how people in difficult situations struggle to maintain their

psychological well-being.

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

1. In 1920, the percentage of stem family (predominantly three-generation) households

was about 31 percent (Long 1987: 40). In 1999, the percentage of three-generation
families decreased to 10.6 percent (JMHW 1999).
2. In April 2000, the caregiving insurance system (kaigo hoken) was implemented in
Japan, and caregiving services are now provided under the insurance system rather
than the welfare system.
3. Group fulfillment always takes precedence over individual satisfaction; therefore, the
moral invalidation of happiness is particularly applicable to individual satisfaction
even if these notions of moral constraint on happiness do not explicitly distinguish
individual and group happiness.
4. The percentage of married women among all employed women increased from 32.7
percent in 1962 to 57.0 percent in 1999 (Japan Association for Advancement of
Working Women 1999).
5. All names used here are fictitious; daughter indicates a daughter caregiver, and in-
law a daughter-in-law caregiver. The number after kin relationship is the caregivers
age.
6. Akemi talked about this photo album in the interview and afterwards she loaned it
to the interviewer (N.Y.). The depth of her husbands appreciation and gratitude was
vividly shown in the way he prepared the album and added his comments in it. It is
likely that this appreciation also helps to make caregiving Akemis ikigai.
7. Cultural difference may lie in the appraisal of a situation regarding whether a specific
coping style is applicable in the situation, rather than the wholesale difference of
coping styles used. The use of perceptual modification may be more frequently
seen among Japanese caregivers because of their emphasis on group harmony and
situationality.
416 NORIKO YAMAMOTO-MITANI AND MARGARET I. WALLHAGEN

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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