Reflections of Buddhist priests who started a dementia carers’ café in Japan

Introduction

Dementia care is expanding globally from a medical model focused on preventing behavioral symptoms to a social model that involves creating dementia-friendly communities (Alzheimer’s Disease International, 2016). Recently, new types of dementia care that focus on creating and maintaining a meaningful everyday life for people with dementia are emerging. Examples in both Western (Hassink et al., 2010) and Eastern (Ura et al., 2021) locations include: dementia villages, created for people with advanced dementia to provide them with safe and familiar surroundings and a where they can still feel part of a local community; and green care farms, which are a community-based, empowerment-oriented, strengths-based service within a farm setting. There is a need for unconventional ways of supporting people with dementia.

Support for carers has become an important issue because caring for people with dementia can be physically and emotionally challenging and can negatively impact carers’ health (Zhu et al., 2015). In Japan, moreover, social isolation of the carers of people with dementia continues to be a serious issue. According to one public report, 26% of family carers do not have any anyone with whom they can consult (Sendai Center for Dementia Care Research and Practices, 2018). Although psychosocial intervention for carers has reportedly decreased depression rates among them worldwide (Mittelman et al., 2008), research on carers’ support is lacking in Japan. A novel approach that is both culturally acceptable and feasible is essential. Previously, Shoji et al. (2021) reported on a project, launched by one of the seven Japanese mainstream Buddhist denominations, that supports carers’ cafés in their temples. This project is supported by an interdisciplinary team comprising social workers, psychologists, and psychiatrists.

The number of people with dementia is expected to double every 20 years, exceeding 100 million in 2050 globally (Prince et al., 2013). It is also estimated that majority of them are living in the low- and middle- income countries. There may be a lack of resources to support people with dementia and their carers.

Faith-based organizations may be a potential global resource. We adopted a definition used by the Faith-Based Organizations and Exclusion in European Cities (FACIT) project, funded by the European Commission: “any non-governmental organisation that refers directly or indirectly to religion or religious values and functions as a welfare provider or as a political actor” (European Commission, 2013). Historically, as Putnam (2000) reported, “faith communities are arguably the single most important repository of social capital in America,” that serve excluded people. Recently, faith-based organizations have had a greater social impact as a new type of welfare regime with a stronger focus on local policies and strategies and new interplays between local authorities and civil society organizations (European Commission, 2013).

The details of faith-based organizations’ activities have not been fully explored in the academic literature. The activities of Christian faith-based organizations and Muslim faith-based organizations in Europe manifest in particular ways. The former tend to work on secular funding by keeping a distance from their faith, while the latter tend to be less influenced by secular society (European Commission, 2013). However, little is known about delivering care in this faith-based setting in Japan. It is necessary to provide more details about this activity to create more dementia-friendly communities.

In addition, the impact of major natural disasters—particularly the 2011 Great East Japan Earthquake—is casting the shadow on the Japanese faith-based organizations’ activities. This earthquake was the largest ever recorded in Japan; the resulting tsunami killed more than 15,000 people. Nearly every Japanese citizen watched in terror as live television coverage showed the tsunami approaching and people being swallowed by the water in real time. The probability of a similar earthquake striking Tokyo in the next 30 years is now predicted to be 70% (Ministry of Land, Infrastructure, Transport and Tourism, 2021). In the Tohoku region, severely affected by the 2011 earthquake and tsunami, that religious people were allowed to enter hospital wards for the first time in a national university, and where they were able to gain the trust of the people by working in disaster areas. The Practical Religious Studies Department in National Tohoku University (Kusajima et al., 2009; Baffelli et al., 2021) is now training a new type of religious worker who, upon adopting the essential minimum of manners and learning how to provide care to people, goes on to operate not only at disaster sites, but in hospitals and welfare facilities. The function of religion in the reconstruction and development of existential meaning and psychosocial well-being after the 2011 Great East Japan earthquake and tsunami was previously studied in detail (Nahlbom, 2018). Many volunteer religious workers from various religious organizations believed that their work was a mission that they needed to be fulfilled as religious persons. Their faith motivated them to work for the survivors and the damaged area. They rediscovered, moreover, that being a religious person was an important resource they could use in their helping activities. Through the religious response, religious workers played significant roles in promoting the reconstruction of existential meaning and psychological meaning in the damaged areas.

The aims of this study are (1) to offer a detailed description of five carers’ cafés in Buddhist temples in Japan, and (2) to report the reflections of the Buddhist priests involved in the café’s creation and operation. Our study will expand the potential social support network for the people with dementia and their carers.

Materials and methods

We adapted a qualitative descriptive approach in this study (Neergaard et al., 2009). Qualitative description is useful in exploratory studies in which little is known about the topic in question. The aim of this approach is not theory development. Rather, because the interviewees (i.e., Buddhist priests who started the carers’ café) have their own unique perspectives on the experience, the researchers’ role was to analyze the interview data and identify themes in those data (Creswell, 2003). The resulting descriptions will facilitate similar activities in different settings (e.g., countries and regions) and contexts (e.g., cultures and religions).

Characteristics of the interviewees

The interviewees’ characteristics are shown in Table 1. Two of the pioneer priests were typical elite Buddhist priests in that each became the de facto leader of their temple just after they finished the training course. By contrast, the backgrounds of the other three interviewees were less conventional before becoming priests. This means that not only one type of priest fits this practice.

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Table 1.

Study participants and interview details.

Interview	Age, s	Sex	Brief description of the interviewee	Length of interview
Rev. R	40	Male	After receiving his B.A. (Buddhism) and Ph.D. (History) from Buddhist training college, he worked in an antique store for a few years. After that, he became a sub-leader in his temple and worked in a management section of the denomination. Now, he also works as a hospital chaplain and a prison chaplain.	122 min.
Rev. T	30	Male	When he was in the undergraduate course of the department of nursing science at Japan’s top-rated university, his grandfather, who was the lead priest in the temple, suddenly died. Because his father was not a priest, he decided to take the Buddhist course for business people in addition to studying at the above university. After a few years, he became the youngest leader priest.	116 min.
Rev. W	40	Male	When he graduated from Buddhism University, his father’s health was not good. So, he decided to be a sub-leader priest in his temple. As a young leader, he was interested in social activity. First, he started parent school.	115 min.
Rev. K	40	Male	He entered the undergraduate course of Buddhism University because his father was a priest. Because he was “a bad guy” he did not attend the Buddhism practice that was offered by the university. After trying various things, he attended the Buddhist course for business people where he met Re v. T and they became best friends.	130 min.
Rev. S	40	Male	When he graduated from Buddhism University, his father held a high position in the denomination and was living in Kyoto. So, he returned to the temple and became a young leader.	157 min.

Findings

Motivations to start a dementia carers’ café

The priests’ motivations for starting a carers’ café are described in Table 2. The essential factors originated from a wide range of sources: their own dementia care experiences (Rev. W and Rev. K), the Great East Japan Earthquake in 2011 (Rev. R), an encounter with a famous palliative physician (Rev. S), and curiosity about starting a new venture (Rev. T).

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Table 2.

Buddhist priests’ motivations for starting a dementia carers’ café.

When the Great East Japan Earthquake occurred in 2011, I went to the disaster site and met religious workers involved in social activities. I thought that I have to help! Then, I discovered this café project during the training course to become a Buddhist chaplain. (Rev. R)

Years after I became the representative of my temple and could do almost every ritual, I decided that I wanted to reassess myself. When the research project called “aging and Buddhism in the present” wanted to start a carers’ café, I was able to get involved because I had learned nursing science at university. (Rev T)

First, I took care of my mother. Before she was diagnosed, we fought each other. Second, I noticed that many mothers in my temple parenting salon are double caregivers who care for their children and their parents. Third, I am a Buddhist priest who prefers action rather than just thinking. (Rev. W)

My grandfather had severe dementia. (Rev. K)

When I was in the PhD course, my classmate’s wife became physically disabled and needed care. His friends helped take care of her in turns. One day, we met Dr. Okabe who is the father of Japanese end-of-life care. We became friends and he allowed us to use one room of his clinic for this care activity. He said that he is doing the work of a Buddhist priest in that when a dying patient asks him if there is an afterlife he answers yes. When I became a Buddhist priest, my high school classmate telephoned me and talked about their family worries. It was the first time I was consulted about such a heavy concern other than those regarding funerals. Then I went to an industrial counselors’ school for 6 months. (Rev. S)

Description of the carers’ café

Table 3 presents participants’ descriptions of the carers’ café that they supported. Because the priests communicate and learn from each other, their descriptions of the style of the café were very similar and the content of their narratives overlapped frequently. Thus, the speaker of each recorded section is not identified in the table. The priests wanted to engage with society and to make a contribution, particularly in relation to aging and dementia care, which is one of the biggest challenges in modern Japan. They wanted to contribute not only to their followers, but also to all members of society and to work in partnership with the government.

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Table 3.

Description of the carers’ café.

Preparation for introducing the carers’ café

✓ The priests attended the elderly support brunch of the local government and community support centers.

✓ Although some local governments department refused publicity because of their views about secular and religious separation, most of the public sectors were friendly and some staff visited the temple on the first day the café opened.

✓ The priests worried if people would come as events are not usually held at the temple for non-believers.

Operation of the café

✓ The priests announced the date of the café in the city paper, on social network services, in flyers, and via letters mailed to previous guests.

✓ The regular preparation takes only 20 minutes.

✓ The priests announce the café rules: 1) whatever is heard here is to be kept secret, 2) try to listen, 3) do not deny others.

✓ The visitors arrange themselves into a circle. If the number of the guests is large, tables are prepared for them to sit around.

✓ First, the facilitator introduces themselves. Then, every guest introduces themselves, explaining their present situation. This takes about 60 minutes.

✓ Guests comprise more non-believers than believers.

✓ The sweets are served, which were offerings to Buddha.

✓ No chanting and no prayers.

Interactions of carers’ who visit the temple café

✓ A person who could not reveal their suffering got angry and left. After a while, the person turned out to be the family of another denomination’s leader who was suffering from dementia care burden. The person returned to the café and is now a strong supporter of the café.

✓ After the café activities, the guests and community workers sometimes keep talking and thus form strong connections.

✓ The religious factor is usually veiled. However, when a regular guest died, the priests naturally prayed and chanted in the café.

✓ A priest met a person who is caring for their father, after being out of touch for a long time. He deserted his family long ago. The person is tired from providing care and running their own business. All the priest could do was just listen to the story.

✓ A person who had been withdrawn for a long time began to open up to others.

✓ A person who was aggressive toward the person they were caring for became calm.

Experiencing a carers’ café

On the basis of the thematic analyses, six prominent themes were identified, which are illustrated in Figure 1 and quotes are shown in Table 4.OPEN IN VIEWER

Figure 1.

Summary of themes.

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Table 4.

Narratives of the Buddhist priests.

A carers’ café aligns with Buddhist doctrine

A carers’ café makes the world more equal

Everyone might be a carer or a care receiver. Buddhist priests should not salvage people from the upper position, but connect people to help each other… Because nobody’s perfect, we have to respect each other. (Rev. T)

It helps suffering people

I’m afraid not many believers are willing to help poor people. (Rev. R)

It is important to help the poor people near you. (Rev. W)

It creates opportunities for reciprocity

In the carers’ café, those who listen to the visitors do not only help visitors but also learn. It’s reciprocity. (Rev, T)

It offers peace of mind for carers

In the café, the solitude is healing, and [the visitors] get relief about the fate of being and dying. (Rev. T)

A carers’ café can salve worries and suffering. (Rev. S)

It is the meaning of religion to share the anxiety of being. (Rev. R)

A carers’ café reveals the strengths of Buddhism and its temples

Has existing believers’ network

It strengthens the bonds among believers. (Rev. R)

Temple is an extraordinary space

The extraordinary space of the temples is effective. The view of the graves has a great effect. (Rev. R)

The temple setting stimulates all the (five) senses. (Rev. K)

Care provided after patient’s death

When the care receiver passes, secular support ends but we keep on offering support. (Rev. T)

Financial advantages

No venue fee is needed. We have plenty of sweets offerings. (Rev. K)

A carers’ café helps establish the role of a temple in the community

The visitors connect with community workers such as public health nurses, staff of community support centers, and staff of social welfare councils. (Rev. W)

It enables temples to get involved in the issues of the community. (Rev. S)

I realized that temples are social resources from the viewpoint of the local government. (Rev. K)

A carers’ café facilitates priests’ personal growth

It gave deeper understanding about suffering

I understood that many people are suffering like me in this aging society. (Rev. W)

I learned about various types of suffering. (Rev. K)

I learned more of the depth and diversity of human suffering. (Rev. S)

It changed the mindset about aging

I realized that I regarded aging as a negative phenomenon. (Rev. T)

It gave priests more self-confidence

I believe that my activity meets many needs of the society…I felt the raison d'être of the temples even for the non-believers. (Rev. R)

I can see that the role of priests and the temple have value…On the other hand, I was surprised that an elite Buddhist priest in the head temple said that he is not self-convinced. (Rev. T)

It gave opportunities for understanding themselves

We are afraid of death, and I am afraid of death, this is why religion emerged. (Rev. R)

I realized that I am in a privileged environment. (Rev. K)

I began to think about aging and death as my own problem. (Rev. S)

A carers’ café deepens one’s faith

I found the reality of dogma after I saw suffering...I found the tenderness of Buddhism. (Rev. R)

I found the Buddha’s mercy is everywhere…Even though I don’t force everyone to become Buddhist, I myself realized the tenderness of Buddha. (Rev. S)

A carers’ café introduces viewpoints from outside of Buddhism

It gives priests a chance to see themselves from the outside of Buddhism. (Rev. T)

Temples should care not only about believers but also about the community…The origin of Buddhism is “cloud funding” in that people invest money in priests to gain benefits…In the present day, we receive annual fees. However, if they end, we are not sustainable. (Rev. K)

Because diverse people come with questions concerning business, sex, age, and social class, we can learn many things….Some leaders in our denomination resist adapting to society, but this would lead to isolation. (Rev. S)

Discussion

This study showed that Buddhist priests’ experiences of starting a carers’ café were positive for them as religious workers because the activity aligns with Buddhist doctrine, reveals the strengths of Buddhism, and therefore could deepen their Buddhist faith. These experiences were also positive for them as individuals or community residents because it facilitated personal growth, a wider perspective, and a role in the community. Starting the carers’ café in the temple had many practical positive impacts.

Although a given denomination in Japan may offer the encouragement to start this type of activity, it is the individuals who are acting, free from the denomination’s control. One reason for this freedom is that each temple in Japan is registered (i.e., legally) as one independent religious corporation; the associated denominations are umbrella religious corporations. Therefore, both the encouragement of a denomination and personal motivation are necessary for the promotion of carers’ café in Buddhist temples.

Participants referred reservedly to the strengths of the Buddhist temples. Although the priests did not emphasize it, the factor, “extraordinary space,” meant more than concrete temple structures. Their temples were built in the 16th and 17th centuries, which means that the temples have had centuries-old relationships with their communities. Furthermore, family graves are typically on the temple grounds. We suggest that the temple environment offers the visitors a sense of connection with those who have passed away, encourages the visitors to think long-term, and ultimately relieves the anxiety about dying in a weakened state.

The impact of major natural disasters was suggested at various points in this study. One priest went to the disaster site and met religious workers involved in social activities. According to the priest, this experience was the driving force for him to step forward from inside the temple to help with social activities in the wider community. According to another priest, it was Dr. Okabe who encouraged him to work for the suffering people in the community. Dr. Okabe was the leading palliative care physician in Japan who later became the founder of the Practical Religious Studies Department in National Tohoku University (Kusajima et al., 2009; Baffelli et al., 2021), which is described in the introduction section. Dr. Okabe was apparently wishing for Buddhist priests’ engagement in society. Our limited data suggest that destructive disasters beyond human capacity may have motivated religious people to act (which resulted in activities such as the carers’ café) and may have renewed people’s perceptions of religion (which resulted in practical religious studies being introduced in the national university, for example).

According to Shoji (2021), faith-based organizations have great potential even in modern or post-modern societies. In the United States, for example, they serve excluded people and act as the backbone of the emergency homeless shelter system (Cnaan & Boddie, 2002). The states involve faith-based organizations in providing federally funded welfare services (National alliance to end homelessness, 2007). According to a government report (Japan Cabinet Office, 2017), the estimated number of people with dementia in Japan is 10 million, which exceeds 10% of the total population in 2050. Supporting people with dementia and their carers is an ideal way for faith-based organizations to be moderately engaged in secular society because those activities are not political.

On the one hand, secular domains expect Buddhism to play a more important role in society (Kawanami, 2013). Conversely, according to one participating priest, “some leaders in our denomination resist adapting to society,” a sentiment the speaker was afraid “would lead to isolation.” There are two directions for faith-based organizations: 1) to continue changing along with the changing world, or 2) keep everything unchanged. Delving into this argument is beyond the scope of this article. However, the findings from the present study clearly indicate that dementia care activities in the temples can have a positive impact on people with dementia, on their carers, and even on the Buddhist priests. To create a more inclusive society, it is necessary for secular entities to support this new movement in Buddhism while also being careful to avoid impeding the autonomy of denominations.