2010 年 54 巻 3 号 p. 37-54,176
The point of departure of this thesis lies in the “fact” that the management principles of S. nursing home, the first in Japan to specialize in patients suffering from dementia, aim to maintain the norms and values of daily life, which, together with the caregivers’ pattern-making practices, have led its residents to form ways of being, doing, and living similar to people without dementia. This thesis attempts to pursue and envisage a concrete pathway in the system of “mutual” recognition in S. nursing home between caregivers and residents in the broader socio-political context in Japan. Notwithstanding the transformations of the new method in the regimes of care-giving and being cared for in modern industrial societies regarding people with dementia, notably in its shift from medicalization (the “disease model”) to person-centered care (the “relational model”), we find in S. nursing home in addition that there are cognitive adjustments relative to both models and also relative to the “common” elements in the conduct of daily life that help caregivers to change their interpretations of people with dementia and to recognise them as being similar to themselves, tied to “common sense” and narrative unity in age, yet also as being “communicable” partners. In the conduct of daily life: getting up in the morning, cooking, eating, and sleeping at night - caregivers (people without dementia) are no different from people with dementia. While the “disease model” underlies caregivers’ acceptance of patients, cognitive adjustments relative to these “common” elements endorse caregivers’ sympathy for residents (patients), which, although one-sided, complete the “relational model” as the caregivers’ primary mode of operation at S. nursing home. Three key concerns may greatly enrich not only academic studies of people with dementia, but also the various regimes of care-giving and being cared for in modern industrial societies. They constitute the conditions necessary to realise a “mutual” cognition between nursing home caregivers and residents with dementia. First, the malleable qualities of a public location (the nursing home): conditions similar to a home-like atmosphere enable nursing home caregivers to forge ties through situational cognition. Second, caregivers’ pattern-making practices under the conditions of the first mode make it possible to refer to a “common” element in both people with dementia and those without: the most basic determination of people struggling to cope with their own life events, such as dementia, and improving their circumstances through their own intention and will. Lastly, the requirement that the “relational model” affiliate with the “disease model” allows nursing home caregivers to take advantage of chances of communication with people with dementia, resulting in depathologisation. Although both are one-sided, the cognitive adjustments relative to both the “disease model,” as caregivers’ full acceptance of people with dementia, and the “relational model,” as caregivers’ primary mode of operation, are necessary for “mutual” recognition between caregivers and people with dementia to take place.