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Sunday, Dec. 13, 2009

COUNTERPOINT

Tragedy exposes need to care more for carers' mental well-being


Shortly after 1 p.m. on April 21, 2009, a worker at Fuji Reien cemetery in Gotenba City, Shizuoka Prefecture, discovered the body of a woman on its grounds. Nearby, a semi-conscious elderly lady sat shivering in a wheelchair.

The body was that of the singer and actress Yukiko Shimizu. She had taken her invalid mother to the gravesite of her father, who had died, age 39, when Yukiko was in third grade. In front of her father's grave, she put her head inside a plastic bag containing hydrogen sulfide. The highly toxic gas attacked her nervous system and killed her.

Shortly afterward, her sister Yoshiko, who had just turned 1 when their father died of complications caused by an enlarged heart, claimed the body. Death by suicide was officially declared at 5 p.m. that evening, and Yoshiko was obliged to take charge of her mother from that day on.

This incident was an undoubted tragedy, but one underscored by the fact that Yukiko Shimizu was once an idol who first shot to fame in 1977, age 17, with her innocent rendition of the song "Ogenki desu ka?" ("How are You?"), which begins: How are you / Are you happy? / Please answer me / I care about you . . . .

After her father died and she grew into adulthood, Yukiko became the breadwinner of the family. She sang and acted, and even played keyboard in the Kinchan Band of comedian Kinichi Hagimoto.

Once, when she appeared in 1992 in "Tetsuko's Room," a television program hosted by Tetsuko Kuroyanagi, she wore a lovely pale-pink, hand-embroidered kimono that her mother particularly loved. Clearly impressed, Tetsuko called her a "healthy and adorable actress."

What happened to drive such a popular and successful woman to take her own life?

Some answers are to be found in a book published last month by Bookmansha. "Kaigoutsu-Oneechan, nan de shinjatta no" ("Carer's Depression — Sis, why did you have to die?") is a poignant account of her sister's life and death by Yoshiko Shimizu. It brings into stark focus the onerous burden that carers carry with them every day of their and their loved one's life.

Their mother, who suffered from kidney disease and diabetes, was in and out of hospital for 30 years. Yet, when Yukiko spoke about this during a second appearance in "Tetsuko's Room" in 1996, she said her mother was still spry, despite her maladies.

As the years passed, though, it took up more and more of Yukiko's time to look after her — a burden complicated all the more by the punishing schedule that entertainers in Japan must maintain in a drastically competitive business.

Her mother underwent cataract surgery in her 70s, fell and broke a bone, yet insisted on staying for as short a time as possible in hospital, "which she hated with a passion." Yukiko tried to persuade her mother to give up her pack-a-day cigarette addiction, but to no avail.

In 2006, Yukiko quit the agency she had been with since her debut and retained only one regular TV spot. That was in "Five O'Clock at Tomochan's House" on the regional Yamanashi Broadcasting channel — which necessitated her commuting to the location every Saturday. In 2007 that show came to an end, and with it Shimizu's long and successful career.

As is the case with most houses in this country, the Shimizu home was small and not easily adapted to the needs of an invalid. It became an increasingly tiring chore to bathe her mother and change her nappies five or six times a day.

By the time of Yukiko's death, her mother was beginning to suffer seriously from dementia. "Yukiko, is that you?" she said to Yoshiko not long after Yukiko's death.

"It's not Yukiko. She's in heaven with daddy."

"Oh," said her mother blankly.

When Yukiko was 46, that is, about three years before she died, she confessed to her sister that she wanted to retire from the entertainment industry. Exhausted from work and looking after their mother, she was experiencing dizziness and insomnia. Yoshiko could see that her sister was in danger of collapsing and falling into depression herself, but Yukiko insisted on being their mother's primary carer.

Perhaps her extraordinary, self-sacrificing devotion stemmed in some way from the loss of her father when she was only 9. In the Feb. 6, 2005 issue of the Yomiuri Weekly magazine, she wrote:

"If my father were alive, I often think how much I'd like to go out drinking with him and how happy I'd be to be scolded by him. I was so lonely at primary school. I hated Father's Day more than anything.''

The Royal College of Psychiatrists in Britain has issued a pamphlet for carers titled "Partners in Care." It urges carers not to forget to take care of themselves, to ask for help and to share the worries, to eat well and exercise, and to see a doctor if necessary for sleep deprivation and depression. Yukiko made the mistake of shouldering the burden of care by herself and suffering in silence.

A 2007 study of 3,750 carers by the department of psychology at Deakin University in Melbourne, Australia, found that 56 percent of them could be classified as "moderately depressed" — compared with 6 percent of people in the general population.

There are 4.5 million people aged 65 or older requiring care in Japan, approximately 75 percent of whom are being looked after by a relative.

The Ministry of Health, Labor and Welfare in Japan estimates that 25 percent of home carers suffer from moderate depression; and that when those carers reach the age of 50, some 20 percent of them express the desire to die themselves.

There is considerable government assistance available for carers in Japan, and awareness of the needs of the elderly is high. But the issue of carers' depression has not had sufficient airing, especially in a country with a neo-Confucian ethic, according to which children (that is usually a daughter, or the wife of the eldest son) take care of a sick or dying parent.

When Yukiko Shimizu's effects were returned to Yoshiko by the police, she found an unsent mail dated April 21 on her sister's cell phone. It read: Yoshi Forgive me for taking Mum with me. / I will be watching over your happiness from heaven. / I left a letter in Mum's room. / Please look after everything for me. See you. Goodbye. Really sorry.



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