SUSAN K. TOMITA
T H E C O N S I D E R A T I O N OF C U L T U R A L F A C T O R S I N T H E R E S E A R C H OF E L D E R M I S T R E A T M E N T WITH AN IN-DEPTH LOOK AT THE JAPANESE
ABSTRACT. Within the context of elder mistreatment, little attention has been paid to ethnicity and cultural factors as independent or causal variables. Focusing on the Japanese as an example, this paper explores cultural factors that may be associated with family conflict and eider mistreatment, including the use of silence as an extreme form of punishment. Also explored are the interrelationships of dependency (amae), holding back (enryo), and being in the way (jama); of social obligation (giri), personal indebtedness (on), and natural feelings or desires (ninjo); and of filial piety and casting away the elder (obasute). Currently-used research and detection protocols will not identify elder mistreatment among the Japanese unless they are modified. This paper provides suggestions for these modifications, as well as suggestions for practitioners who may treat Asian victims of elder mistreatment. Key Words: cultural variables, elder abuse, elder mistreatment, ethnicity, Japanese,
silence INTRODUCTION Within the context of elder mistreatment, defined in this paper as other-inflicted suffering that interferes with the maintenance of the quality of life of the older person (T. Johnson 1986), little attention has been paid to ethnicity and cultural factors as independent or causal variables. So far, in the research literature, the majority of the victims have been reported to be Caucasian females, with little being said about ethnic group differences (Block and Sinott, 1979; Lau and Kosberg 1979; Phillips 1986; Pillemer 1986; Godkin, Wolf and Pillemer 1989). While some preliminary information is available (see for example, Stein 1991), not much is known about how elder mistreatment manifests itself among ethnic minority groups and if the prevalence of elder mistreatment is higher or lower in these groups. Even if we were to study elder mistreatment among certain groups, what would we be looking for? Do Asians mistreat their elders, and if they do, to what extent and in what fashion? What cultural variables seem to contribute to elder mistreatment? Are American-Western methods of elder mistreatment research, diagnosis, and treatment applicable t o Asian-Eastern groups? If not, how are these methods to be modified? What follows is a section that briefly introduces in general terms the Japanese in America, and the second section, using the Japanese as an example, focuses on cultural variables that may be associated with family conflict and elder mistreatment within one ethnic group. The subsequent sections provide practice considerations, research topics with regard to the Japanese and elder mistreatment, and research methodological considerations. The paper concludes with a discussion arising from some of these initial questions.
Journal of Cross-Cultural Gerontology 9: 39-52, 1994. 9 1994 KluwerAcademic Publishers. Printed in the Netherlands.
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SUSANK. TOMITA THE JAPANESE IN THE UNITED STATES
The Japanese have been in the United States for a relatively short time, first immigrating to Hawaii as contract laborers on plantations in 1885 (Mindel, Habenstein, and Wright, Jr. 1988). Immigration to the mainland began in the 1890s, with most doing domestic and unskilled labor on the railroads, in canneries, and in the logging, and mining industries. Initially, many of the Issei, or first generation Japanese, came as single men, who intended to return home after making their fortune. When it became clear that they would not be returning home, the unavailability of potential brides due to anti-miscegenation laws and cultural differences compelled many to marry women in Japan with help from their relatives and community, and through the "picture bride" practice of exchanging photos with women in Japan who subsequently joined their husbands in America. Immigration after the Gentleman's Agreement of 1907 involved relatives, and by 1920, more than 100,000 Japanese lived in Hawaii. Currently, based on the 1990 census, there are an estimated 850,000 Japanese in the United States (U.S. Bureau of the Census 1992). The Issei brought with them the structure, language, and values of Japan's Meiji Era (1868-1912), including the ie, or house or household as the primary unit within a larger "family" context, the community (Nakane 1970); a patriarchal system that gave more rights as well as responsibilities to first-born sons; and family rituals during holidays such as New Year's Day, and O-Bon, a summer festival honoring the dead. Hierarchically, loyalty and commitment to one's community was primary to one's devotion to family, and the needs and wants of any individual were always secondary to the former two (Kitano 1969). Heavy emphasis was placed on the education of the Nisei or second-generation Japanese, as the chief means of upward mobility. Currently, there are very few Issei still alive; the oldest Nisei are in their 80s and the youngest in their 50s. The Sansei, or third-generation Japanese have assumed caregiving roles, providing direct care either in the elder's home, or visiting them in facilities. Wide variation exists among the Nisei and the Sansei with regard to their integration of American values and attitudes with those learned from their Issei parents and grandparents. The extent to which Japanese values are maintained are dependent on age and degree of exposure to other ethnic groups, the makeup of the immediate community, socialization practices of the family, and degree of isolation from other Japanese families. While their families vary in the rate and extent of acculturation, it is believed that many Asians retain some distinctive values from their traditional cultures, and that currently, these values play a significant role in their interpersonal functioning (Sue and Sue 1990). F. Johnson (1993: xiv), studying interactional behavior among Japanese Americans in Hawaii, found certain behaviors of the Nisei and Sansei to be similar to those in Japan despite many years of separation from the Japanese culture. Some Asian-Americans are viewed as having a twolayered personality, a deeper core personality associated with the traditional culture that is sometimes not obvious to others, and an outer layer, associated
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with the acculturation to American and Western influences. Compared to the Issei and the Nisei, the Sansei seem completely "Americanized", but they still exhibit a certain amount of emotional and verbal restraint when compared to middle-class Caucasians (Kitano 1988; Roland 1988). Recognizing this distinctive cultural core, this paper concentrates on one Asian group, the Japanese, in a broad social milieu that includes their culture. It becomes possible then to explore in more detail several concepts that may be of interest to elder mistreatment researchers and practitioners, with the assumption that values from Japan have been transferred to America and may be observed among even the Sansei. JAPANESE CULTURAL VALUES
Interpersonal Concepts: Amae, Enryo, and Jama To know when to allow oneself to be indulged (amaeru) and when to hold back (enryo) is a core aspect of Japanese social relations. Within families, the finetuning of whose needs are indulged by whom and to what extent is often a primary source of conflict. Doi (1973) explains that a Japanese mother indulges her child (amayakasu), and in turn, a child grows up being passively dependent (amae) on her, and even when grown, may still expect indulgence. Even in adulthood, the Japanese seek fulfillment of this emotional dependence through intimate relationships although such behavior is not always recognized as amae (Befu 1971). Incidents of conflict in the Japanese family reveal the emotional extremes to which amae may be carried. Kumagai (1983), reporting on Japanese filial violence by male adolescents, explores the effects of over-indulgence or overamae. She explains that although indulgence by mothers exists in the American home, its degree differs significantly when compared to the Japanese home. The consequences of over-indulgence are that the adolescent frequently finds difficulty in adjusting to a larger social context outside the home environment, expects constant attention and assistance from others that he received from his parents, and has difficulty separating himself from his parents. The consequences of over-indulgence can be extrapolated into later life. If a son is grossly over-indulged as a boy, with his parents holding back (enryo) or failing to counter inappropriate behavior, he is likely to develop into a selfish, overbearing person (wagamama) with excessive demands (F. Johnson 1993: 169), who perceives others to be in the way (lama) of fulfilling his sense of entitlement to indulgence or amae (Roland 1988: 274). Such pathological amae or over-indulgence (amaya kashi sugiru) can be postulated to be at the root of later family conflict, particularly when the need to care for an elderly parent intensifies the competition for fulfillment of dependency needs among family members. For example, when a son with pathological amae has his mother move into
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his home to receive care, he may not check or hold back (enryo) his amae from asking for what he feels is his, perhaps money, favors, or attention, from his mother. He may become enraged when his wife tries to indulge his mother rather than him, or his anger may be directed at his frail mother, who is prevented by her physical, financial, or mental condition from indulging him to the extent to which he is accustomed. He now considers her to be in the way or jama, a hindrance to the fulfillment of his amae. In another potential dynamic, the wife may be annoyed by her husband's attempts to maintain an amae relationship with his mother. If she thwarts him from attempting to meet his dependency needs through his mother's indulgence, the wife may also be perceived by him as a hindrance orjama. Additionally, she may have always yearned for her husband's indulgence, and may have endured years of unfulfillment. At this juncture, she may be faced with strong feelings of herself being jama, and like her mother-in-law, believe that she is unworthy of amae. Members of the Japanese household (uchi), regardless of its composition, comprise an inner circle, in which delicate maneuverings take place (Kuwayama 1992; Lebra 1976). A good deal of time is spent maintaining good relationships, regardless of their inner feelings (Kondo 1990: 22). Each member tries to avoid being jama or in the way, while trying within prescribed boundaries to have their own amae fulfilled. They attempt to hold back or enryo from expressing their needs and criticize those who do not enryo sufficiently ("he doesn't have any enryo"). At the same time, in some situations, members feel that because they are part of an inner circle or family, they are not obliged to enryo at all. In such an environment, it is difficult for those who are soto, or outside, to detect conflict, mainly because of a general dislike of the Japanese for the overt expression of differing opinions, their liking for at least an appearance of consensus, and because of the enryo of the Japanese toward those outside their inner circle (Bachnik 1992). Despite the overt absence of conflict, a quiet competition for fulfillment might be taking place in some Japanese families. Doi identifies the sense of being hindered or interfered with by someone who is jama, of being victimized, as a general cultural theme resulting from the value placed on enryo, and from passively waiting for one's needs to be fulfilled (amae). Doi states, "it is precisely the dominance of the amae mentality in Japanese society that has given rise to such a strong awareness ofjama ... the victim mentality seems to be an extremely everyday underlying component of the Japanese mentality" (1973: 130). According to Doi, the phrase, higaisha ishiki, a sense of being the victim, has been specially coined to refer to this concept. We Versus I: On, Giri, and Ninjo
The Japanese have a strong sense of a we-self and a familial-self, and what some might label a non-I-self, while Americans have an individualized or I-self with the familial self in the background (Roland 1988: 223; Smith 1983). This group
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sense of sell which derives from the symbiosis-reciprocity norm, contributes to situations in which the we-self is emotionally enmeshed with others. Roland notes that the Japanese have a "collective man" whereas Americans focus on individuals; Americans may be defined culturally as composed of a collection of individuals with social equality and permissive kinship arrangements, whereas the Japanese have mutual interdependent obligations governed by contextual norms (Kondo 1990: 29). This interdependency is expressed through the concepts of girl or social obligation, on or personal indebtedness, and ninjo or natural feelings or desires (Bachnik 1992; Befu 1971). Within the Japanese-American family, a push-pull relationship exists between girl and ninjo. As an example, the parent may want the child to participate in family or community activities to fulfill what they perceive to be the family's social debt (giri) for being supported by the community in ways that are not obvious to the child, or perhaps because the family has incurred a personal debt (on) from an incident that involved family members years ago. On the other hand, belonging to a younger generation that is less prone to be enmeshed in giri or family obligations and responsibilities (Kitano 1988), the child may feel that the parent is too restrictive and not cognizant of the child's personal feelings or desires (ninjo). In America, if the child is acculturated to a greater degree than the parent, and does not rely solely on the family for the meaning of existence, ninjo or personal interests may win over giri or caring for an elder parent who needs the child's help. The parent, on the other hand, might suppress his or her discomfort due to the desire to preserve the we-ness of the family and for fear of being ostracized. She is described as having no jibun or no-self. The group is the source of existence and to be removed from the family is to obliterate the self. Doi states, "If the rejection of the 'small self' in favor of the 'larger self' is extolled as a virtue, it becomes easier for him to act in concert with the group. In this way friction in human relations within the group is kept to a minimum, and the efficiency of group activity enhanced" (1973: 135). A very popular saying in the Japanese-American community is, kodomo no tame ni, or for the sake of the children, used to refer to the sacrifices that the Issei incurred so that the subsequent generations could have a better life in America. In conversations using this phrase, what generally follows is an analysis of whether the sacrifices have paid off, and whether the off-spring show gratitude by practicing filial piety, doing well in school, and being successful in a job. For some elderly, their sacrifices may seem to have been in vain if their children and grandchildren fail to adhere to the concepts of giri and on. In this context, to ask the elderly parent to think of his or her own needs would be counterproductive; it may be more productive for practitioners working with mistreated elders to focus on the family's we-needs or on the child's needs, and to engage the parent in seeking solutions that would benefit the children as well as themselves.
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A Suffering Culture? Some authors believe that the Japanese elderly are basically unhappy people (Befu 1971) who count melancholy, sadness, fatalism, and suffering as parts of an esthetic style and often appreciate them as such. Among the Japanese, a sick or a weak person is often encouraged to gaman or to endure in order to survive a difficult situation, and an apprentice of an art or craft is expected to work hard for long periods with little compensation, often enduring physical and verbal abuse by the master in return for a better future. This quiet suffering in a stoic manner is pervasive in the Japanese culture, also portrayed well in hahamono or motherhood movies, in which sadness is the key emotional ingredient and the suffering mother blames herself for the child's failure (Befu 1971; Kondo 1990: 148). Although the Confucian practice of filial piety and respect of elders is commonly attributed to the Japanese and other Asians, a lesser-known and contrasting tradition also exists, that is, the theme of obasute, or discarding grandmother, whereby persons over 70 were taken to the mountains and left to die (Donow 1990), usually in order to preserve the limited resources for those who were capable of participating in maintaining the family's survival or in inclusive fitness promotion, a sociobiological term that refers to promoting the reproductive success of kin (Daly and Wilson 1982). Generally, the elder is resigned to being cast away and does not protest the fatal action, because the elder already intuits that the family is waiting for him or her to die and that he or she is jama. Perhaps contemporary manifestations of obasute are the failure to provide the basic necessities of life, such as food and warm clothing, failure to obtain medical care for an ill elder, and the failure to socialize with the elder. It is not known how the struggle between filial piety and obasute plays itself out and how the elder reacts to being in the way. The elder may agree to sell her home and move to a more restrictive setting in order to please her children, whom she perceives to be fired of caring for her. One consequence of the younger generation's adaptation to a more AmericanWestern way of living may be the dilution of its awareness of amae, enryo, and jama. The elder may perceive herself as an interference in her children's busy lives and may move about very little in and out of the home to be less jama. She may make no requests of others, in spite of her discomforts and needs. If help is offered, the elder may be afraid that she will be accused of not having enough enryo if she accepts help the first time that it is offered. She may wait for the offer to be repeated to be convinced that the offer is sincere and in order not to appear greedy (Kondo 1990: 62). In the meantime, her Americanized children may be glad that she is not bothersome; conversely, they may miss out on her needs entirely, taking her first non-acceptance of help at face value. Under such circumstances, the effects of cultural dilution are tragic, especially when the younger family members would have been willing to be more helpful if only they had understood the subtle cues. A sense of fatalism is also common, conveyed by the term, shikata ga nai, or,
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"it cannot be helped". For example, when a Japanese elder finds himself or herself in an exploitive or abusive situation that to others is intolerable, and is unable to see a way out of it, he or she may state this term with a sigh. In such cases, a practitioner will need to use all of his or her skills to counter this very strong cultural mind set that is supported by the aforementioned concepts, and more so by the Buddhist notion of experiencing contentment in a less than perfect world, and by one of the Buddhist Four Noble Truths, that life is full of suffering. Within this suffering context, elder mistreatment may not be recognized as mistreatment, but as just another situation in life in which the elder must gaman because shikata ga nai. In addition to these cultural concepts, the communication style of the Japanese provides some clues to mistreatment behaviors that may be experienced by them. Verbal and Non- Verbal Communication
By studying a group's communication patterns, it is possible to understand how a culture's uniqueness is expressed. Among the Japanese, there is concern for minimizing differences, preserving harmony, and reinforcing group loyalty that the use of intuition is essential to understand and to respond to others. Among Americans, the emphasis is not on intuition, but on maximizing differences, confrontation, and compromise, as well as on verbal contact and on intellectual sparring. The Japanese cultural style of expressions are subtlety and indirection, a lack of obviousness, verbal restraint, and non-verbal communication of emotion (Lebra 1992:112). The indirectness of communication is practiced instead of the outright expression of feelings to preserve a highly private self and to prevent a disruption in the family functioning (Roland 1988: 83). Strong expectations of being given to as well as of giving to others are not stated, and hurt and anger may occur when actions are not reciprocated or when one's needs, which are not expressed openly due to self restraint, are not correctly identified and reciprocated. The anger, prohibited from being expressed in order to preserve the harmony or we-ness of the group, and because the source of anger is an elder or superior, is expressed indirectly or with silence (F. Johnson 1993: 253-254). This emphasis on non-verbal channels of communication may arise from the Japanese attitude toward conflict: it is extremely difficult or even impossible for the Japanese to restore a relationship once it is destroyed by words (Bachnik 1978: 40). Non-verbal forms of communication produce less explicit meanings, greater ambiguity, and a lower potential for provoking hostility. Family harmony is important, deference and yielding to others out of respect becomes submission, and yielding to others out of fear invites domination. In a selfdenying society, the potential for exploitation is great. So, although confrontation or tairitsu is to be avoided so that the family member will not lose face, in the same quiet situation it is also possible for the submissive elder to be abused (Barnlund 1975; 1989).
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One point of emphasis is that silence is not viewed as the absence of meaning but as a reflection of many meanings, one of which is anger. Within the context of elder mistreatment, not to speak to someone is an extreme form of punishment. In a report on i j i m e or bullying by daughters-in-law of their mothers-inlaw in Japan, Kaneko and Yamada (1990) report that the most common manifestation of mistreatment was 1) no conversation followed by making rude statements, and 2) ignoring the other person. This use of silence and avoidance may be as emotionally devastating as physical abuse; the abuser may stop talking suddenly, leave the room, refuse to sit with the elder, look right through the elder, and treat the elder as if he or she did not exist. Over time, the consequences of contained anger and non-verbal cruelty are unknown; ill feelings may fester or mount over time, or silence and avoidance may cause the elder to want to die. Such behaviors are not benign, and instead have been categorized by other researchers as aggressive (Foner 1984), as non-violent means of conflict management (Levinson 1989), and as forms of death-hastening or nonsupportive treatment of the elder (Glascock and Feinman 1981). The Japanese victim of elder mistreatment may reveal less of her private self than will a Western elder. If he or she suspects that revealing the abuse or neglect will result in betraying the group to which he or she belongs, the victim may never admit to the mistreatment. Instead, he or she will respond to threatening questions through the use of a passive rather than an active action, by remaining silent, or hinting verbally that he or she prefers not to discuss the mistreatment. The discussion of a tangential matter is also a way of refusing to discuss the pin-pointed issues without dismissing the inquirer. Outsiders must read between the lines, and attempt to interpret the word, s a . . . . or well .... because the Japanese have many ways of saying no, including not saying anything (Matsumoto 1988). As Japanese families assimilate more AmericanWestern modes and values of individualistic functioning, conflicts may occur between generations, with the more Western member being less tactful and verbally forthright, while the traditional member assumes that the other is still using the intuitive method to detect the more traditional member's unstated hurt or fearfulness. PRACTITIONER CONSIDERATIONS The cultural context provided in this paper reframes the elder mistreatment picture in a slightly different manner. The eider mistreatment literature already contains references to the victim's love of the grown child no matter how abusive or neglectful the child is, the victim's refusal to be separated from the abusive child, and the quiet suffering of the parent. The Japanese are not the only people to punish others through the use of aggressive and cruel silence. Those who are non-Japanese will recognize similar behaviors described here in their own circles. Also, extremes in behavior exist in different cultures: there are Japanese who are verbal and direct, and Americans who axe quiet and meditative. In comparing the literature on American versus Japanese attitudes, what
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stands out is the Japanese cultural support of suffering as a way of life and the non-emphasis on the self, which would make it difficult for practitioners and researchers to apply Western methods of investigation. In discussing methods for diagnosing child abuse and neglect within different cultures, Korbin (1980) suggests looking for idiosyncrasies of child rearing that are unacceptable within the context of the culture in question, or within the e m i c perspective. However, such efforts may mot prove fruitful in elder mistreatment situations if the use of silence, and the individual suffering and enduring for the sake of others in the collective are culturally syntonic. It is difficult to treat elders who are victims of mistreatment; generally speaking, they are not voluntary clients, but are reported to agencies by third parties such as neighbors and landlords, or come to the attention of health care providers. It is doubly difficult to detect and to treat elder mistreatment among elders who for cultural and communication reasons do not utilize community resources. Practitioners working with Asians cannot afford to stereotype them as belonging to supportive extended families. At all times, a high index of suspicion must exist to rule out elder mistreatment, and protocols that include ruling out obvious as well as subtle but harmful forms of mistreatment should be used, with language interpreters when necessary. Doi (1973) has reported that he found American psychiatrists to be insensitive to feelings of helplessness of their patients, and slow to detect their concealed a m a e . Tensions which cannot be voiced may go undetected unless there is an awareness of their existence and their potential to harm. Practitioners working with elders who are made to feel that they must share their resources may have difficulty convincing these elders that they are being deprived of the income which they should keep in order to maximize their independence, that giving away their resources may make them more, not less, of a burden. Some Asian victims who are recent immigrants may have been threatened with deportation to hinder the reporting of the mistreatment, and even if deportation is impossible, they may believe their abusers. Practitioners can anticipate this fear and discuss what is in fact possible and impossible. It may take more than one or a few sessions and a certain amount of self-disclosure to gain the trust of these victims. Practitioners must lower their expectations of themselves to solve these problems within a short period of time. Sue and Sue (1990), writing on counseling the culturally different, state that many Asian elders believe that thinking too much about something can perpetuate problems, that one way of diminishing negative feelings is to stop thinking about them. Asians are told to stop thinking about themselves, and instead to think of the family. Dependence on the family unit and an acceptance of the environment dictate differences in solving problems. The AmericanWestern culture advocates defining and attacking problems directly, while Asian cultures tend to accommodate or to deal with problems through indirection. To many, the best sources of problem-solving are the family and the community, and seeking help from Western professionals is non-productive and contrary to the dictates of the Asian philosophy. Given this, for some elderly Asians, it
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might be more fruitful to abandon insight-oriented therapy because it is an individual approach, and to replace it with a group or family approach, and with interventions by natural support systems within the community. Due to the indirectness of the Japanese, in counseling situations, productive methods may be the use of metaphors, as well as non-directive therapy that emphasizes empathy instead of problem-solving, goal-oriented discussions. Silence in an interview context may represent not anger but fear or respect, and the interviewer is reminded not to label the client as affectively flat, or unresponsive. Last, stress is manifested by somatic symptoms, which diverts one's attention from more critical issues in the family; it may be more acceptable to utilize a medical model for approaching intrafamilial problems. The next section considers variables of interest when conducting research on elder mistreatment with the Japanese and Asians. RESEARCH CONSIDERATIONS It is essential to consider cultural values and traditions in research design to better understand how the cultural environment may affect an ethnic minority person's use of services and agencies (Stein 1991). Discussing the cultural context in which family violence can be reviewed, Kumagal (1983) and Roland (1988) effectively point out some structural and personality factors which seem to account for the behavior of the Japanese. They include the structure of the ie or Japanese household, the degree of flexibility in the ethnic group, the normative structure of male supremacy, the extent of interdependence and parental overindulgence as explained by Doi's amae concept, the presence of a group orientation versus individual orientation, the degree of interpersonal sensitivity and interdependence among relatives, the extent to which the private self is preserved, and the presence of the cultural orientation for quiet and nonexpressiveness which Kumagai states might have been derived from the syntactical characteristics of the Japanese language. In view of the tendency to defer and to yield to others, perhaps research should focus on the feelings of helplessness and depression, and on deflected feelings in the form of somatizafion. Another area of research is the study of generational differences in the degree of commitment and involvement in caring for elders. Kalish and Yuen (1973) report that from an outsider's point of view, their research on first- and secondgeneration Japanese-Americans indicated second-generation (Nisei) appeared loyal to and supportive of their parents, but from the viewpoint of the parents, such loyalty and support were uncertain. At that time, they stated that they knew of no research reports that explored the effects of these factors upon the elderly Japanese-Americans. There are very few Issei or first-generation elderly still alive; with the Nisei now being the majority of the elderly, it would be interesting to study the extent to which those of the younger generation uphold the notions of filial piety versus obasute. Although it is a difficult endeavor, it will be necessary to describe and to
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measure silence as a form of mistreatment. The diverse interpretation of silence makes it one of the greatest sources of misunderstanding, one of the most etusive of all communicative behaviors to measure, and most inaccessible to traditional forms of inquiry. One suggestion is to start with two basic and relatively non-provocative questions in the serious study of the role of silence: one, asking family members how frequently they experience silence when they are together; and two, how comfortable are they with silences of a specified duration. Focusing on the comfort and the frequency of silence may distinguish quietly unhappy elders from those who are so comfortable with others close to them that few words are necessary when they are together. With regard to research methodology, it may be difficult to be admitted into a Japanese group due to the sensitive nature of the topic, the firmer boundaries and the greater enmeshment of those in the group (Roland 1988: 224), and because of the differences in communication and interactional styles (Sue and Sue 1990). Since courtesy and tact are prized above spontaneous disclosure, the revealing of personal information by the researcher and a different method of field interviewing may be productive. Field methods combining qualitative and quantitative data gathering might include the use of cultural brokers, verbal instead of written consent, a relationship-oriented conversational approach in the participant's first language as opposed to a structured question-answer interview, and an unexpected honorarium as an in-kind exchange for the information obtained (Ishizuka 1978). Western measurement tools of domestic violence would not be adequate to measure elder mistreatment among Asians. These tools measure only physical and verbal aggression (Pillemer and Finkelhor 1988; Straus 1979). One suggestion is to modify the Conflict Tactics Scale or similar instruments to include methods that measure silence and more subtle yet injurious forms of mistreatment. Furthermore, in view of the emphasis on non-verbal interaction, telephone interviews may not be an appropriate method to measure family dynamics in the Japanese family. In-person interviews by culturally proficient interviewers may result in a different profile of elder mistreatment victims in this country. The last section contains some final thoughts and a few concluding remarks. CONCLUSION Due to the heterogeneity of the Asian group, and a lack of familiarity to the same degree of all groups, it is not possible to report on all of the Asian subgroups' cultural factors in one paper. Instead, this paper introduces a limited portion of the Japanese culture as an exercise that exemplifies the possibility of identifying some unique cultural variables in any group of interest that may be considered in the research of elder mistreatment. Aspects described in this paper may be criticized as being too general, stereotypic, or oversimplified; and viewing an ethnic group as uniquely separate or integrated is debated (Rosenberger 1992). The intent here is only to introduce a cultural context; it is
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impossible to explain something so complex as a communication style of a culture in a few paragraphs. Relatedly, Stein (1991) reminds researchers and practitioners that victims and abusers may or may not share in the cultural heritage of his or her ethnic group, and that generalizations do not reflect the total sum of knowledge of a cultural environment; they should be used as guiding principles and a beginning point. Some of the variables discussed here have a relationship to already-identified variables in the elder mistreatment literature. For example, it might be useful to explore the relationship of the abuser dependency and powerlessness and the concept of Japanese over-indulgence or amae gone haywire. Are the Caucasian abusers found in previous studies similarly overindulged children who have as much difficulty as the Japanese child with social adjustment? Future research may include studies that compare the caregiving behavior of the Nisei and the Sansei, and their attitudes toward the elderly. Testable hypotheses may include determining whether Sansei are less likely to condone elder mistreatment behavior than the Nisei; whether Sansei are more likely than the Nisei to report elder mistreatment to the regulatory agencies; whether among different ethnic groups, differences exist in the extent to which silence is used as a form of cruelty; and last, whether there are differences in the severity ratings of silence when compared to other forms of mistreatment, especially physical abuse. Conversely, some of the concepts diverge from what has been reported in the domestic violence literature so far. The bi-directional negative interdependency of the amae-seeking child and the over-indulgent parent is not equivalent to the causal relationship of abuser misconduct on elder victimization. The indulgent parent in this culturally syntonic process may not realize from an eric or outsider's perspective (Korbin 1980), that the child's behavior is considered abusive. When asked specific questions about elder mistreatment, this parent may not be able to recognize himself or herself as a victim of mistreatment, but when asked in Japanese if the family' s unhappiness and conflict are the result of over-amae, a good bet is that the same parent will readily recognize the role that he or she played in the relationship. The major task for researchers is to carefully review culturally-specific behaviors related to elders, and to decide whether and how to redefine some usually acceptable behaviors, when manifested in extreme forms, as elder mistreatment. If we are to accept the definition of elder mistreatment as inflicted suffering (T. Johnson 1986), with respect to the Japanese, one main difficulty for researchers lies in distinguishing normative suffering from unnecessary suffering. These statements are nothing more than conjectures and are a preface to hypothesis development. Obviously, the concepts introduced above by themselves are insufficient to explain elder mistreatment. Acknowledging the complementarity between the personality, social and cultural systems, another task at hand is to identify compounding and intervening variables from the anthropological, psychological, and sociological theories and to explore their relationships to cultural variables.
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ACKNOWLEDGMENTS Paper prepared for a National Institute on Aging workshop, Family Conflict and Elder Abuse, Bethesda, Maryland, May 2-3, 1991. The author is indebted to Misao Kaneko and Hiroko Tomita for their assistance with the Japanese terminology, and to Wendy Lustbader and Jill Korbin for their insightful contributions to an earlier version of this paper. REFERENCES Bachnik, J.M. 1978 Inside and Outside the Japanese Household (ie): A Contextual Approach to Japanese Social Organization. Ph.D. dissertation, Harvard University. Bachnik, J.M. 1992 Kejime: Defining a Shifting Self in Multiple Organizational Modes. In Japanese Sense of Self, N. Rosenberger, ed. Pp. 152-172. Cambridge: Cambridge University Press. Barnlund, D. 1975 Public and Private Self in Japan and the United States. Tokyo, Japan: The Simul Press, Inc. Barnlund, D. 1989 Communicative Styles of Japanese and Americans: Images and Realities. Belmont, CA: Wadsworth Publishing Co. Befu, H. 1971 Japan: An Anthropological Introduction. San Francisco, CA: Chandler Publishing Co. Block, M. and Sinott, J. 1979 The Battered Elder Syndrome: An Exploratory Study. College Park, MD: University of Maryland Center on Aging. Daly, M. and Wilson, M. 1982 Homicide and Kinship. American Anthropologist 84: 372-378. Doi, T. 1973 The Anatomy of Dependence, Translated by John Bester. Tokyo, Japan and New York: Kodansha International. Donow, H. 1990 Two Approaches to the Care of an Elder Parent: A Study of Robert Anderson's I Never Sang for My Father and Sawako Ariyoshi's Kokotsu no hito [The Twilight Years]. The Gerontologist 30(4):486-490. Foner, N. 1984 Ages in Conflict: A Cross-Cultural Perspective on Inequality Between Old and Young. New York: Columbia University Press. Glascock, A. and Feinman, S. 1981 Social Asset or Social Burden: Treatment of the Aged in Non-Industrial Societies. In Dimensions: Aging, Culture, and Health, C. Fry, ed. Pp. 13-31. New York: Praeger Publishers. Godkin, M., Wolf, R. and Pillemer, K. 1989 A Case Comparison Analysis of Elder Abuse and Neglect. International Journal of Aging and Human Development 28(3): 207-225. Ishizuka, K. 1978 The Elder Japanese. San Diego, CA: The Campanile Press, San Diego State University. Johnson, F. 1993 Dependency and Japanese Socialization: Psychoanalytic and Anthropological Investigations into Amae. New York: New York University Press. Johnson, T. 1986 Critical Issues in the Definition of Elder Mistreatment. In Elder Abuse: Conflict in the Family, K. Pillemer and R. Wolf, eds. Pp. 167-196. Dover, MA: Auburn House Publishing Co. Kalish, R. and Yuen, S. 1973 Americans of East Asian Ancestry: Aging and the Aged. In Asian-Americans: Psychological Perspectives, S. Sue and N. Wagner, eds. Pp. 236--251. Palo Alto, CA: Science and Behavior Books, Inc. Kaneko, Y. and Yamada, Y. 1990 Wives and Mothers-in-law: Potential for Family Conflict in Post-War Japan. Journal of Elder Abuse and Neglect 2( 1/2):87-99. Kitano, H. 1969 Japanese Americans: The Evolution of a Subculture. Englewood Cliffs, NJ: Prentice Hall. Kitano, H. 1988 The Japanese American Family. In Ethnic Families in America: Patterns
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and Variations, C. Mindel, R. Habenstein, and R. Wright, Jr., eds. Pp. 258-275. NY: Elsevier Science Publishing Co. Kondo, D.K. 1990 Crafting Selves: Power, Gender, and Discourses of Identity in a Japanese Workplace. Chicago: University of Chicago Press. Korbin, J. 1980 The Cultural Context of Child Abuse and Neglect. Child Abuse and Neglect 4:3-13. Kumagai, F. 1983 Filial Violence in Japan. Victimology: An International Journal 8: 173-194. Kuwayama, T. 1992 The Reference Other Orientation. In Japanese Sense of Self, N. Rosenberger, ed. Pp. 121-151. Cambridge: Cambridge University Press. Lau, E. and Kosberg, J. 1979 Abuse of the Elderly by Informal Care Providers. Aging, 299-300, September-October, 10-15. Lebra, T. 1976 Japanese Patterns of Behavior. Honolulu: University of Hawaii Press. Lebre, T. 1992 Self in Japanese Culture. In Japanese Sense of Self, N. Rosenberger, ed. Pp. 105-120. Cambridge: Cambridge University Press. Levinson, D. 1989 Family Violence in Cross-cultural Perspective. Newbury Park, CA: Sage Publications, Inc. Matsumoto, M. 1988 The Unspoken Way. Haragei: Silence in Japanese Business and Society. Tokyo, Japan and New York: Kodansha International. Mindel, C., Habenstein, R., and Wright, Jr., R. 1988 Family Lifestyles of America's Ethnic Minorities: An Introduction. In Ethnic Families in America: Patterns and Variations, C. Mindel, R. Habenstein, and R. Wright, Jr., eds. Pp. 1-14. New York: Elsevier Science Publishing Co. Nakane, C. 1970 Japanese Society. Berkeley and Los Angeles: University of California Press. Phillips, L. 1986 Theoretical Explanations of Elder Abuse: Competing Hypotheses and Unresolved Issues. In Elder Abuse: Conflict in the Family, K. Pillemer and R. Wolf, eds. Pp. 197-217. Dover, MA: Auburn House Publishing Co. Pillemer, K. 1986 Risk Factors in Elder Abuse: Results from a Case Control Study. In Elder Abuse: Conflict in the Family, K. Pillemer and R. Wolf, eds. Pp. 239-263. Dover, MA: Auburn House Publishing Co. Pillemer, K. and Finkelhor, D. 1988 The Prevalence of Elder Abuse: A Random Sample Survey. The Gerontologist 28:51-57. Roland, A. 1988 In Search of Self in India and Japan: Toward a Cross-cultural Psychology. Princeton, NJ: Princeton University Press. Rosenberger, N. 1992 Introduction. In Japanese Sense of Self, N. Rosenberger, ed. Pp. 1-20. Cambridge: Cambridge University Press. Smith, R.J. 1983 Japanese Society: Tradition, Self, and the Social Order. Cambridge: Cambridge University Press. Stein, K.F. 1991 Working with Abused and Neglected Elders in Minority Populations: A Synthesis of Research. Washington, D.C.: National Aging Resource Center on Elder Abuse (NARCEA). Straus, M. 1979 Measuring Intrafamily Conflict and Violence: The Conflict Tactic (CT) Scales. Journal of Marriage and the Family 41: 75-88. Sue, D.W. and Sue, S. 1990 Counseling the Culturally Different: Theory and Practice. NY: John Wiley and Sons. U.S. Bureau of the Census 1992 1990 Census of Population: General Population Characteristics, U.S. Washington, D.C.: Author.
Harborview Medical Center Seattle, Washington School of Social Work University of Washington
T H E C O N S I D E R A T I O N OF C U L T U R A L F A C T O R S I N T H E R E S E A R C H OF E L D E R M I S T R E A T M E N T WITH AN IN-DEPTH LOOK AT THE JAPANESE
ABSTRACT. Within the context of elder mistreatment, little attention has been paid to ethnicity and cultural factors as independent or causal variables. Focusing on the Japanese as an example, this paper explores cultural factors that may be associated with family conflict and eider mistreatment, including the use of silence as an extreme form of punishment. Also explored are the interrelationships of dependency (amae), holding back (enryo), and being in the way (jama); of social obligation (giri), personal indebtedness (on), and natural feelings or desires (ninjo); and of filial piety and casting away the elder (obasute). Currently-used research and detection protocols will not identify elder mistreatment among the Japanese unless they are modified. This paper provides suggestions for these modifications, as well as suggestions for practitioners who may treat Asian victims of elder mistreatment. Key Words: cultural variables, elder abuse, elder mistreatment, ethnicity, Japanese,
silence INTRODUCTION Within the context of elder mistreatment, defined in this paper as other-inflicted suffering that interferes with the maintenance of the quality of life of the older person (T. Johnson 1986), little attention has been paid to ethnicity and cultural factors as independent or causal variables. So far, in the research literature, the majority of the victims have been reported to be Caucasian females, with little being said about ethnic group differences (Block and Sinott, 1979; Lau and Kosberg 1979; Phillips 1986; Pillemer 1986; Godkin, Wolf and Pillemer 1989). While some preliminary information is available (see for example, Stein 1991), not much is known about how elder mistreatment manifests itself among ethnic minority groups and if the prevalence of elder mistreatment is higher or lower in these groups. Even if we were to study elder mistreatment among certain groups, what would we be looking for? Do Asians mistreat their elders, and if they do, to what extent and in what fashion? What cultural variables seem to contribute to elder mistreatment? Are American-Western methods of elder mistreatment research, diagnosis, and treatment applicable t o Asian-Eastern groups? If not, how are these methods to be modified? What follows is a section that briefly introduces in general terms the Japanese in America, and the second section, using the Japanese as an example, focuses on cultural variables that may be associated with family conflict and elder mistreatment within one ethnic group. The subsequent sections provide practice considerations, research topics with regard to the Japanese and elder mistreatment, and research methodological considerations. The paper concludes with a discussion arising from some of these initial questions.
Journal of Cross-Cultural Gerontology 9: 39-52, 1994. 9 1994 KluwerAcademic Publishers. Printed in the Netherlands.
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The Japanese have been in the United States for a relatively short time, first immigrating to Hawaii as contract laborers on plantations in 1885 (Mindel, Habenstein, and Wright, Jr. 1988). Immigration to the mainland began in the 1890s, with most doing domestic and unskilled labor on the railroads, in canneries, and in the logging, and mining industries. Initially, many of the Issei, or first generation Japanese, came as single men, who intended to return home after making their fortune. When it became clear that they would not be returning home, the unavailability of potential brides due to anti-miscegenation laws and cultural differences compelled many to marry women in Japan with help from their relatives and community, and through the "picture bride" practice of exchanging photos with women in Japan who subsequently joined their husbands in America. Immigration after the Gentleman's Agreement of 1907 involved relatives, and by 1920, more than 100,000 Japanese lived in Hawaii. Currently, based on the 1990 census, there are an estimated 850,000 Japanese in the United States (U.S. Bureau of the Census 1992). The Issei brought with them the structure, language, and values of Japan's Meiji Era (1868-1912), including the ie, or house or household as the primary unit within a larger "family" context, the community (Nakane 1970); a patriarchal system that gave more rights as well as responsibilities to first-born sons; and family rituals during holidays such as New Year's Day, and O-Bon, a summer festival honoring the dead. Hierarchically, loyalty and commitment to one's community was primary to one's devotion to family, and the needs and wants of any individual were always secondary to the former two (Kitano 1969). Heavy emphasis was placed on the education of the Nisei or second-generation Japanese, as the chief means of upward mobility. Currently, there are very few Issei still alive; the oldest Nisei are in their 80s and the youngest in their 50s. The Sansei, or third-generation Japanese have assumed caregiving roles, providing direct care either in the elder's home, or visiting them in facilities. Wide variation exists among the Nisei and the Sansei with regard to their integration of American values and attitudes with those learned from their Issei parents and grandparents. The extent to which Japanese values are maintained are dependent on age and degree of exposure to other ethnic groups, the makeup of the immediate community, socialization practices of the family, and degree of isolation from other Japanese families. While their families vary in the rate and extent of acculturation, it is believed that many Asians retain some distinctive values from their traditional cultures, and that currently, these values play a significant role in their interpersonal functioning (Sue and Sue 1990). F. Johnson (1993: xiv), studying interactional behavior among Japanese Americans in Hawaii, found certain behaviors of the Nisei and Sansei to be similar to those in Japan despite many years of separation from the Japanese culture. Some Asian-Americans are viewed as having a twolayered personality, a deeper core personality associated with the traditional culture that is sometimes not obvious to others, and an outer layer, associated
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with the acculturation to American and Western influences. Compared to the Issei and the Nisei, the Sansei seem completely "Americanized", but they still exhibit a certain amount of emotional and verbal restraint when compared to middle-class Caucasians (Kitano 1988; Roland 1988). Recognizing this distinctive cultural core, this paper concentrates on one Asian group, the Japanese, in a broad social milieu that includes their culture. It becomes possible then to explore in more detail several concepts that may be of interest to elder mistreatment researchers and practitioners, with the assumption that values from Japan have been transferred to America and may be observed among even the Sansei. JAPANESE CULTURAL VALUES
Interpersonal Concepts: Amae, Enryo, and Jama To know when to allow oneself to be indulged (amaeru) and when to hold back (enryo) is a core aspect of Japanese social relations. Within families, the finetuning of whose needs are indulged by whom and to what extent is often a primary source of conflict. Doi (1973) explains that a Japanese mother indulges her child (amayakasu), and in turn, a child grows up being passively dependent (amae) on her, and even when grown, may still expect indulgence. Even in adulthood, the Japanese seek fulfillment of this emotional dependence through intimate relationships although such behavior is not always recognized as amae (Befu 1971). Incidents of conflict in the Japanese family reveal the emotional extremes to which amae may be carried. Kumagai (1983), reporting on Japanese filial violence by male adolescents, explores the effects of over-indulgence or overamae. She explains that although indulgence by mothers exists in the American home, its degree differs significantly when compared to the Japanese home. The consequences of over-indulgence are that the adolescent frequently finds difficulty in adjusting to a larger social context outside the home environment, expects constant attention and assistance from others that he received from his parents, and has difficulty separating himself from his parents. The consequences of over-indulgence can be extrapolated into later life. If a son is grossly over-indulged as a boy, with his parents holding back (enryo) or failing to counter inappropriate behavior, he is likely to develop into a selfish, overbearing person (wagamama) with excessive demands (F. Johnson 1993: 169), who perceives others to be in the way (lama) of fulfilling his sense of entitlement to indulgence or amae (Roland 1988: 274). Such pathological amae or over-indulgence (amaya kashi sugiru) can be postulated to be at the root of later family conflict, particularly when the need to care for an elderly parent intensifies the competition for fulfillment of dependency needs among family members. For example, when a son with pathological amae has his mother move into
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his home to receive care, he may not check or hold back (enryo) his amae from asking for what he feels is his, perhaps money, favors, or attention, from his mother. He may become enraged when his wife tries to indulge his mother rather than him, or his anger may be directed at his frail mother, who is prevented by her physical, financial, or mental condition from indulging him to the extent to which he is accustomed. He now considers her to be in the way or jama, a hindrance to the fulfillment of his amae. In another potential dynamic, the wife may be annoyed by her husband's attempts to maintain an amae relationship with his mother. If she thwarts him from attempting to meet his dependency needs through his mother's indulgence, the wife may also be perceived by him as a hindrance orjama. Additionally, she may have always yearned for her husband's indulgence, and may have endured years of unfulfillment. At this juncture, she may be faced with strong feelings of herself being jama, and like her mother-in-law, believe that she is unworthy of amae. Members of the Japanese household (uchi), regardless of its composition, comprise an inner circle, in which delicate maneuverings take place (Kuwayama 1992; Lebra 1976). A good deal of time is spent maintaining good relationships, regardless of their inner feelings (Kondo 1990: 22). Each member tries to avoid being jama or in the way, while trying within prescribed boundaries to have their own amae fulfilled. They attempt to hold back or enryo from expressing their needs and criticize those who do not enryo sufficiently ("he doesn't have any enryo"). At the same time, in some situations, members feel that because they are part of an inner circle or family, they are not obliged to enryo at all. In such an environment, it is difficult for those who are soto, or outside, to detect conflict, mainly because of a general dislike of the Japanese for the overt expression of differing opinions, their liking for at least an appearance of consensus, and because of the enryo of the Japanese toward those outside their inner circle (Bachnik 1992). Despite the overt absence of conflict, a quiet competition for fulfillment might be taking place in some Japanese families. Doi identifies the sense of being hindered or interfered with by someone who is jama, of being victimized, as a general cultural theme resulting from the value placed on enryo, and from passively waiting for one's needs to be fulfilled (amae). Doi states, "it is precisely the dominance of the amae mentality in Japanese society that has given rise to such a strong awareness ofjama ... the victim mentality seems to be an extremely everyday underlying component of the Japanese mentality" (1973: 130). According to Doi, the phrase, higaisha ishiki, a sense of being the victim, has been specially coined to refer to this concept. We Versus I: On, Giri, and Ninjo
The Japanese have a strong sense of a we-self and a familial-self, and what some might label a non-I-self, while Americans have an individualized or I-self with the familial self in the background (Roland 1988: 223; Smith 1983). This group
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sense of sell which derives from the symbiosis-reciprocity norm, contributes to situations in which the we-self is emotionally enmeshed with others. Roland notes that the Japanese have a "collective man" whereas Americans focus on individuals; Americans may be defined culturally as composed of a collection of individuals with social equality and permissive kinship arrangements, whereas the Japanese have mutual interdependent obligations governed by contextual norms (Kondo 1990: 29). This interdependency is expressed through the concepts of girl or social obligation, on or personal indebtedness, and ninjo or natural feelings or desires (Bachnik 1992; Befu 1971). Within the Japanese-American family, a push-pull relationship exists between girl and ninjo. As an example, the parent may want the child to participate in family or community activities to fulfill what they perceive to be the family's social debt (giri) for being supported by the community in ways that are not obvious to the child, or perhaps because the family has incurred a personal debt (on) from an incident that involved family members years ago. On the other hand, belonging to a younger generation that is less prone to be enmeshed in giri or family obligations and responsibilities (Kitano 1988), the child may feel that the parent is too restrictive and not cognizant of the child's personal feelings or desires (ninjo). In America, if the child is acculturated to a greater degree than the parent, and does not rely solely on the family for the meaning of existence, ninjo or personal interests may win over giri or caring for an elder parent who needs the child's help. The parent, on the other hand, might suppress his or her discomfort due to the desire to preserve the we-ness of the family and for fear of being ostracized. She is described as having no jibun or no-self. The group is the source of existence and to be removed from the family is to obliterate the self. Doi states, "If the rejection of the 'small self' in favor of the 'larger self' is extolled as a virtue, it becomes easier for him to act in concert with the group. In this way friction in human relations within the group is kept to a minimum, and the efficiency of group activity enhanced" (1973: 135). A very popular saying in the Japanese-American community is, kodomo no tame ni, or for the sake of the children, used to refer to the sacrifices that the Issei incurred so that the subsequent generations could have a better life in America. In conversations using this phrase, what generally follows is an analysis of whether the sacrifices have paid off, and whether the off-spring show gratitude by practicing filial piety, doing well in school, and being successful in a job. For some elderly, their sacrifices may seem to have been in vain if their children and grandchildren fail to adhere to the concepts of giri and on. In this context, to ask the elderly parent to think of his or her own needs would be counterproductive; it may be more productive for practitioners working with mistreated elders to focus on the family's we-needs or on the child's needs, and to engage the parent in seeking solutions that would benefit the children as well as themselves.
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A Suffering Culture? Some authors believe that the Japanese elderly are basically unhappy people (Befu 1971) who count melancholy, sadness, fatalism, and suffering as parts of an esthetic style and often appreciate them as such. Among the Japanese, a sick or a weak person is often encouraged to gaman or to endure in order to survive a difficult situation, and an apprentice of an art or craft is expected to work hard for long periods with little compensation, often enduring physical and verbal abuse by the master in return for a better future. This quiet suffering in a stoic manner is pervasive in the Japanese culture, also portrayed well in hahamono or motherhood movies, in which sadness is the key emotional ingredient and the suffering mother blames herself for the child's failure (Befu 1971; Kondo 1990: 148). Although the Confucian practice of filial piety and respect of elders is commonly attributed to the Japanese and other Asians, a lesser-known and contrasting tradition also exists, that is, the theme of obasute, or discarding grandmother, whereby persons over 70 were taken to the mountains and left to die (Donow 1990), usually in order to preserve the limited resources for those who were capable of participating in maintaining the family's survival or in inclusive fitness promotion, a sociobiological term that refers to promoting the reproductive success of kin (Daly and Wilson 1982). Generally, the elder is resigned to being cast away and does not protest the fatal action, because the elder already intuits that the family is waiting for him or her to die and that he or she is jama. Perhaps contemporary manifestations of obasute are the failure to provide the basic necessities of life, such as food and warm clothing, failure to obtain medical care for an ill elder, and the failure to socialize with the elder. It is not known how the struggle between filial piety and obasute plays itself out and how the elder reacts to being in the way. The elder may agree to sell her home and move to a more restrictive setting in order to please her children, whom she perceives to be fired of caring for her. One consequence of the younger generation's adaptation to a more AmericanWestern way of living may be the dilution of its awareness of amae, enryo, and jama. The elder may perceive herself as an interference in her children's busy lives and may move about very little in and out of the home to be less jama. She may make no requests of others, in spite of her discomforts and needs. If help is offered, the elder may be afraid that she will be accused of not having enough enryo if she accepts help the first time that it is offered. She may wait for the offer to be repeated to be convinced that the offer is sincere and in order not to appear greedy (Kondo 1990: 62). In the meantime, her Americanized children may be glad that she is not bothersome; conversely, they may miss out on her needs entirely, taking her first non-acceptance of help at face value. Under such circumstances, the effects of cultural dilution are tragic, especially when the younger family members would have been willing to be more helpful if only they had understood the subtle cues. A sense of fatalism is also common, conveyed by the term, shikata ga nai, or,
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"it cannot be helped". For example, when a Japanese elder finds himself or herself in an exploitive or abusive situation that to others is intolerable, and is unable to see a way out of it, he or she may state this term with a sigh. In such cases, a practitioner will need to use all of his or her skills to counter this very strong cultural mind set that is supported by the aforementioned concepts, and more so by the Buddhist notion of experiencing contentment in a less than perfect world, and by one of the Buddhist Four Noble Truths, that life is full of suffering. Within this suffering context, elder mistreatment may not be recognized as mistreatment, but as just another situation in life in which the elder must gaman because shikata ga nai. In addition to these cultural concepts, the communication style of the Japanese provides some clues to mistreatment behaviors that may be experienced by them. Verbal and Non- Verbal Communication
By studying a group's communication patterns, it is possible to understand how a culture's uniqueness is expressed. Among the Japanese, there is concern for minimizing differences, preserving harmony, and reinforcing group loyalty that the use of intuition is essential to understand and to respond to others. Among Americans, the emphasis is not on intuition, but on maximizing differences, confrontation, and compromise, as well as on verbal contact and on intellectual sparring. The Japanese cultural style of expressions are subtlety and indirection, a lack of obviousness, verbal restraint, and non-verbal communication of emotion (Lebra 1992:112). The indirectness of communication is practiced instead of the outright expression of feelings to preserve a highly private self and to prevent a disruption in the family functioning (Roland 1988: 83). Strong expectations of being given to as well as of giving to others are not stated, and hurt and anger may occur when actions are not reciprocated or when one's needs, which are not expressed openly due to self restraint, are not correctly identified and reciprocated. The anger, prohibited from being expressed in order to preserve the harmony or we-ness of the group, and because the source of anger is an elder or superior, is expressed indirectly or with silence (F. Johnson 1993: 253-254). This emphasis on non-verbal channels of communication may arise from the Japanese attitude toward conflict: it is extremely difficult or even impossible for the Japanese to restore a relationship once it is destroyed by words (Bachnik 1978: 40). Non-verbal forms of communication produce less explicit meanings, greater ambiguity, and a lower potential for provoking hostility. Family harmony is important, deference and yielding to others out of respect becomes submission, and yielding to others out of fear invites domination. In a selfdenying society, the potential for exploitation is great. So, although confrontation or tairitsu is to be avoided so that the family member will not lose face, in the same quiet situation it is also possible for the submissive elder to be abused (Barnlund 1975; 1989).
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One point of emphasis is that silence is not viewed as the absence of meaning but as a reflection of many meanings, one of which is anger. Within the context of elder mistreatment, not to speak to someone is an extreme form of punishment. In a report on i j i m e or bullying by daughters-in-law of their mothers-inlaw in Japan, Kaneko and Yamada (1990) report that the most common manifestation of mistreatment was 1) no conversation followed by making rude statements, and 2) ignoring the other person. This use of silence and avoidance may be as emotionally devastating as physical abuse; the abuser may stop talking suddenly, leave the room, refuse to sit with the elder, look right through the elder, and treat the elder as if he or she did not exist. Over time, the consequences of contained anger and non-verbal cruelty are unknown; ill feelings may fester or mount over time, or silence and avoidance may cause the elder to want to die. Such behaviors are not benign, and instead have been categorized by other researchers as aggressive (Foner 1984), as non-violent means of conflict management (Levinson 1989), and as forms of death-hastening or nonsupportive treatment of the elder (Glascock and Feinman 1981). The Japanese victim of elder mistreatment may reveal less of her private self than will a Western elder. If he or she suspects that revealing the abuse or neglect will result in betraying the group to which he or she belongs, the victim may never admit to the mistreatment. Instead, he or she will respond to threatening questions through the use of a passive rather than an active action, by remaining silent, or hinting verbally that he or she prefers not to discuss the mistreatment. The discussion of a tangential matter is also a way of refusing to discuss the pin-pointed issues without dismissing the inquirer. Outsiders must read between the lines, and attempt to interpret the word, s a . . . . or well .... because the Japanese have many ways of saying no, including not saying anything (Matsumoto 1988). As Japanese families assimilate more AmericanWestern modes and values of individualistic functioning, conflicts may occur between generations, with the more Western member being less tactful and verbally forthright, while the traditional member assumes that the other is still using the intuitive method to detect the more traditional member's unstated hurt or fearfulness. PRACTITIONER CONSIDERATIONS The cultural context provided in this paper reframes the elder mistreatment picture in a slightly different manner. The eider mistreatment literature already contains references to the victim's love of the grown child no matter how abusive or neglectful the child is, the victim's refusal to be separated from the abusive child, and the quiet suffering of the parent. The Japanese are not the only people to punish others through the use of aggressive and cruel silence. Those who are non-Japanese will recognize similar behaviors described here in their own circles. Also, extremes in behavior exist in different cultures: there are Japanese who are verbal and direct, and Americans who axe quiet and meditative. In comparing the literature on American versus Japanese attitudes, what
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stands out is the Japanese cultural support of suffering as a way of life and the non-emphasis on the self, which would make it difficult for practitioners and researchers to apply Western methods of investigation. In discussing methods for diagnosing child abuse and neglect within different cultures, Korbin (1980) suggests looking for idiosyncrasies of child rearing that are unacceptable within the context of the culture in question, or within the e m i c perspective. However, such efforts may mot prove fruitful in elder mistreatment situations if the use of silence, and the individual suffering and enduring for the sake of others in the collective are culturally syntonic. It is difficult to treat elders who are victims of mistreatment; generally speaking, they are not voluntary clients, but are reported to agencies by third parties such as neighbors and landlords, or come to the attention of health care providers. It is doubly difficult to detect and to treat elder mistreatment among elders who for cultural and communication reasons do not utilize community resources. Practitioners working with Asians cannot afford to stereotype them as belonging to supportive extended families. At all times, a high index of suspicion must exist to rule out elder mistreatment, and protocols that include ruling out obvious as well as subtle but harmful forms of mistreatment should be used, with language interpreters when necessary. Doi (1973) has reported that he found American psychiatrists to be insensitive to feelings of helplessness of their patients, and slow to detect their concealed a m a e . Tensions which cannot be voiced may go undetected unless there is an awareness of their existence and their potential to harm. Practitioners working with elders who are made to feel that they must share their resources may have difficulty convincing these elders that they are being deprived of the income which they should keep in order to maximize their independence, that giving away their resources may make them more, not less, of a burden. Some Asian victims who are recent immigrants may have been threatened with deportation to hinder the reporting of the mistreatment, and even if deportation is impossible, they may believe their abusers. Practitioners can anticipate this fear and discuss what is in fact possible and impossible. It may take more than one or a few sessions and a certain amount of self-disclosure to gain the trust of these victims. Practitioners must lower their expectations of themselves to solve these problems within a short period of time. Sue and Sue (1990), writing on counseling the culturally different, state that many Asian elders believe that thinking too much about something can perpetuate problems, that one way of diminishing negative feelings is to stop thinking about them. Asians are told to stop thinking about themselves, and instead to think of the family. Dependence on the family unit and an acceptance of the environment dictate differences in solving problems. The AmericanWestern culture advocates defining and attacking problems directly, while Asian cultures tend to accommodate or to deal with problems through indirection. To many, the best sources of problem-solving are the family and the community, and seeking help from Western professionals is non-productive and contrary to the dictates of the Asian philosophy. Given this, for some elderly Asians, it
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might be more fruitful to abandon insight-oriented therapy because it is an individual approach, and to replace it with a group or family approach, and with interventions by natural support systems within the community. Due to the indirectness of the Japanese, in counseling situations, productive methods may be the use of metaphors, as well as non-directive therapy that emphasizes empathy instead of problem-solving, goal-oriented discussions. Silence in an interview context may represent not anger but fear or respect, and the interviewer is reminded not to label the client as affectively flat, or unresponsive. Last, stress is manifested by somatic symptoms, which diverts one's attention from more critical issues in the family; it may be more acceptable to utilize a medical model for approaching intrafamilial problems. The next section considers variables of interest when conducting research on elder mistreatment with the Japanese and Asians. RESEARCH CONSIDERATIONS It is essential to consider cultural values and traditions in research design to better understand how the cultural environment may affect an ethnic minority person's use of services and agencies (Stein 1991). Discussing the cultural context in which family violence can be reviewed, Kumagal (1983) and Roland (1988) effectively point out some structural and personality factors which seem to account for the behavior of the Japanese. They include the structure of the ie or Japanese household, the degree of flexibility in the ethnic group, the normative structure of male supremacy, the extent of interdependence and parental overindulgence as explained by Doi's amae concept, the presence of a group orientation versus individual orientation, the degree of interpersonal sensitivity and interdependence among relatives, the extent to which the private self is preserved, and the presence of the cultural orientation for quiet and nonexpressiveness which Kumagai states might have been derived from the syntactical characteristics of the Japanese language. In view of the tendency to defer and to yield to others, perhaps research should focus on the feelings of helplessness and depression, and on deflected feelings in the form of somatizafion. Another area of research is the study of generational differences in the degree of commitment and involvement in caring for elders. Kalish and Yuen (1973) report that from an outsider's point of view, their research on first- and secondgeneration Japanese-Americans indicated second-generation (Nisei) appeared loyal to and supportive of their parents, but from the viewpoint of the parents, such loyalty and support were uncertain. At that time, they stated that they knew of no research reports that explored the effects of these factors upon the elderly Japanese-Americans. There are very few Issei or first-generation elderly still alive; with the Nisei now being the majority of the elderly, it would be interesting to study the extent to which those of the younger generation uphold the notions of filial piety versus obasute. Although it is a difficult endeavor, it will be necessary to describe and to
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measure silence as a form of mistreatment. The diverse interpretation of silence makes it one of the greatest sources of misunderstanding, one of the most etusive of all communicative behaviors to measure, and most inaccessible to traditional forms of inquiry. One suggestion is to start with two basic and relatively non-provocative questions in the serious study of the role of silence: one, asking family members how frequently they experience silence when they are together; and two, how comfortable are they with silences of a specified duration. Focusing on the comfort and the frequency of silence may distinguish quietly unhappy elders from those who are so comfortable with others close to them that few words are necessary when they are together. With regard to research methodology, it may be difficult to be admitted into a Japanese group due to the sensitive nature of the topic, the firmer boundaries and the greater enmeshment of those in the group (Roland 1988: 224), and because of the differences in communication and interactional styles (Sue and Sue 1990). Since courtesy and tact are prized above spontaneous disclosure, the revealing of personal information by the researcher and a different method of field interviewing may be productive. Field methods combining qualitative and quantitative data gathering might include the use of cultural brokers, verbal instead of written consent, a relationship-oriented conversational approach in the participant's first language as opposed to a structured question-answer interview, and an unexpected honorarium as an in-kind exchange for the information obtained (Ishizuka 1978). Western measurement tools of domestic violence would not be adequate to measure elder mistreatment among Asians. These tools measure only physical and verbal aggression (Pillemer and Finkelhor 1988; Straus 1979). One suggestion is to modify the Conflict Tactics Scale or similar instruments to include methods that measure silence and more subtle yet injurious forms of mistreatment. Furthermore, in view of the emphasis on non-verbal interaction, telephone interviews may not be an appropriate method to measure family dynamics in the Japanese family. In-person interviews by culturally proficient interviewers may result in a different profile of elder mistreatment victims in this country. The last section contains some final thoughts and a few concluding remarks. CONCLUSION Due to the heterogeneity of the Asian group, and a lack of familiarity to the same degree of all groups, it is not possible to report on all of the Asian subgroups' cultural factors in one paper. Instead, this paper introduces a limited portion of the Japanese culture as an exercise that exemplifies the possibility of identifying some unique cultural variables in any group of interest that may be considered in the research of elder mistreatment. Aspects described in this paper may be criticized as being too general, stereotypic, or oversimplified; and viewing an ethnic group as uniquely separate or integrated is debated (Rosenberger 1992). The intent here is only to introduce a cultural context; it is
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impossible to explain something so complex as a communication style of a culture in a few paragraphs. Relatedly, Stein (1991) reminds researchers and practitioners that victims and abusers may or may not share in the cultural heritage of his or her ethnic group, and that generalizations do not reflect the total sum of knowledge of a cultural environment; they should be used as guiding principles and a beginning point. Some of the variables discussed here have a relationship to already-identified variables in the elder mistreatment literature. For example, it might be useful to explore the relationship of the abuser dependency and powerlessness and the concept of Japanese over-indulgence or amae gone haywire. Are the Caucasian abusers found in previous studies similarly overindulged children who have as much difficulty as the Japanese child with social adjustment? Future research may include studies that compare the caregiving behavior of the Nisei and the Sansei, and their attitudes toward the elderly. Testable hypotheses may include determining whether Sansei are less likely to condone elder mistreatment behavior than the Nisei; whether Sansei are more likely than the Nisei to report elder mistreatment to the regulatory agencies; whether among different ethnic groups, differences exist in the extent to which silence is used as a form of cruelty; and last, whether there are differences in the severity ratings of silence when compared to other forms of mistreatment, especially physical abuse. Conversely, some of the concepts diverge from what has been reported in the domestic violence literature so far. The bi-directional negative interdependency of the amae-seeking child and the over-indulgent parent is not equivalent to the causal relationship of abuser misconduct on elder victimization. The indulgent parent in this culturally syntonic process may not realize from an eric or outsider's perspective (Korbin 1980), that the child's behavior is considered abusive. When asked specific questions about elder mistreatment, this parent may not be able to recognize himself or herself as a victim of mistreatment, but when asked in Japanese if the family' s unhappiness and conflict are the result of over-amae, a good bet is that the same parent will readily recognize the role that he or she played in the relationship. The major task for researchers is to carefully review culturally-specific behaviors related to elders, and to decide whether and how to redefine some usually acceptable behaviors, when manifested in extreme forms, as elder mistreatment. If we are to accept the definition of elder mistreatment as inflicted suffering (T. Johnson 1986), with respect to the Japanese, one main difficulty for researchers lies in distinguishing normative suffering from unnecessary suffering. These statements are nothing more than conjectures and are a preface to hypothesis development. Obviously, the concepts introduced above by themselves are insufficient to explain elder mistreatment. Acknowledging the complementarity between the personality, social and cultural systems, another task at hand is to identify compounding and intervening variables from the anthropological, psychological, and sociological theories and to explore their relationships to cultural variables.
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ACKNOWLEDGMENTS Paper prepared for a National Institute on Aging workshop, Family Conflict and Elder Abuse, Bethesda, Maryland, May 2-3, 1991. The author is indebted to Misao Kaneko and Hiroko Tomita for their assistance with the Japanese terminology, and to Wendy Lustbader and Jill Korbin for their insightful contributions to an earlier version of this paper. REFERENCES Bachnik, J.M. 1978 Inside and Outside the Japanese Household (ie): A Contextual Approach to Japanese Social Organization. Ph.D. dissertation, Harvard University. Bachnik, J.M. 1992 Kejime: Defining a Shifting Self in Multiple Organizational Modes. In Japanese Sense of Self, N. Rosenberger, ed. Pp. 152-172. Cambridge: Cambridge University Press. Barnlund, D. 1975 Public and Private Self in Japan and the United States. Tokyo, Japan: The Simul Press, Inc. Barnlund, D. 1989 Communicative Styles of Japanese and Americans: Images and Realities. Belmont, CA: Wadsworth Publishing Co. Befu, H. 1971 Japan: An Anthropological Introduction. San Francisco, CA: Chandler Publishing Co. Block, M. and Sinott, J. 1979 The Battered Elder Syndrome: An Exploratory Study. College Park, MD: University of Maryland Center on Aging. Daly, M. and Wilson, M. 1982 Homicide and Kinship. American Anthropologist 84: 372-378. Doi, T. 1973 The Anatomy of Dependence, Translated by John Bester. Tokyo, Japan and New York: Kodansha International. Donow, H. 1990 Two Approaches to the Care of an Elder Parent: A Study of Robert Anderson's I Never Sang for My Father and Sawako Ariyoshi's Kokotsu no hito [The Twilight Years]. The Gerontologist 30(4):486-490. Foner, N. 1984 Ages in Conflict: A Cross-Cultural Perspective on Inequality Between Old and Young. New York: Columbia University Press. Glascock, A. and Feinman, S. 1981 Social Asset or Social Burden: Treatment of the Aged in Non-Industrial Societies. In Dimensions: Aging, Culture, and Health, C. Fry, ed. Pp. 13-31. New York: Praeger Publishers. Godkin, M., Wolf, R. and Pillemer, K. 1989 A Case Comparison Analysis of Elder Abuse and Neglect. International Journal of Aging and Human Development 28(3): 207-225. Ishizuka, K. 1978 The Elder Japanese. San Diego, CA: The Campanile Press, San Diego State University. Johnson, F. 1993 Dependency and Japanese Socialization: Psychoanalytic and Anthropological Investigations into Amae. New York: New York University Press. Johnson, T. 1986 Critical Issues in the Definition of Elder Mistreatment. In Elder Abuse: Conflict in the Family, K. Pillemer and R. Wolf, eds. Pp. 167-196. Dover, MA: Auburn House Publishing Co. Kalish, R. and Yuen, S. 1973 Americans of East Asian Ancestry: Aging and the Aged. In Asian-Americans: Psychological Perspectives, S. Sue and N. Wagner, eds. Pp. 236--251. Palo Alto, CA: Science and Behavior Books, Inc. Kaneko, Y. and Yamada, Y. 1990 Wives and Mothers-in-law: Potential for Family Conflict in Post-War Japan. Journal of Elder Abuse and Neglect 2( 1/2):87-99. Kitano, H. 1969 Japanese Americans: The Evolution of a Subculture. Englewood Cliffs, NJ: Prentice Hall. Kitano, H. 1988 The Japanese American Family. In Ethnic Families in America: Patterns
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Harborview Medical Center Seattle, Washington School of Social Work University of Washington
