[SELECTION FROM CHAPTER 2]

Itō Takaaki 伊藤高晃 was thrilled. He hurried to tell his friend Kubotera Toshiyuki 窪寺俊之 about a newspaper article he had just seen. Both Japanese men, at different times, ordained in their respective Christian traditions (Anglican and Methodist, respectively), graduated from Masters of Divinity programs in the United States, and completed their Clinical Pastoral Education (CPE) in the US as well. It was 1998. They had both been back in Japan for years and were looking for opportunities to build a chaplaincy program similar to what they had experienced abroad. “Have you seen this?!? Our time is coming!,” Itō exclaimed as he opened up a short newspaper article.1 He was excited for two reasons. First, it was the first time he noticed the katakana word “spiritual” (supirichuaru) written in a main stream newspaper. Moreover, the contents of the article itself grabbed him. The World Health Organization (WHO) was debating a change to their official definition of health and for the first time, the Japanese heathcare establishment was forced into serious discussions about the meaning of “spiritual health.” Itō realized this could be a critical moment for opening the doors to chaplaincy in Japan.[2]

By the latter part of the twentieth century, socio-cultural factors combined with several critical events and the initiative of a few key individuals and groups to synthesize a more formal type of Buddhist chaplaincy in Japan. This chapter introduces those factors, individuals, and events in three sections. The first section outlines the impact of the above-mentioned WHO discussions within Japan along with social issues faced by Buddhists and broader Japanese society to show how the time and conditions became ripe for chaplaincy to take on a stronger role in Japan; it also outlines some of the challenges such a movement would face. The second section introduces four key chaplaincy movements that began to set roots during the late twentieth and early twenty-first centuries. Finally, the chapter summarizes the impact of the 2011 Great East Japan Disaster and the activities that followed in establishing chaplaincy programs.

In Need of Care: Contemporary Socio-Historical Context

In the 1990s, the WHO Constitution stated that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[3] Several nations wanted to add “spiritual health” as part of the equation in forming an overall concept of well-being. The regional office for the Mediterranean proposed a change to WHO’s Executive Board which gained serious consideration: “Health is a dynamic state of complete physical, mental, spiritual, and social well-being and not merely the absence of disease or infirmity.” Health would be defined as a dynamic state and spiritual would be an added component to convey an expanded notion of health. The proposal was accepted as part of the agenda of the 52nd World Health Assembly in May, 1999 with a vote of 22 yays, 0 nays, and 8 abstentions.[4] Ultimately, the issue was tabled for further discussion and eventually failed to pass.

However, just as Itō Takaaki had hoped, the debate itself sent a subtle shock-wave through the Japanese healthcare system. The lack of appropriate words in Japanese to account for the changes, as well as some of the dualistic and Christian notions associated with the word “spiritual” were part of the complications. Japanese officials deliberated about what the most appropriate terms would be for their own documents, but finally decided to adapt a katakana word to reference the spiritual side to medical care (スピリチュアルケア).[5]

There was a subsequent sharp increase in mentions of spirituality within academic publications in Japanese medical fields.[6] Various associations and networks also took their own initiative in examining how to deal with the new terminology and consider ways to better serve the  populace. For example, the Japanese Association for Clinical Research on Death  (nihonshinorinshōkenkyūkai 日本死の臨床研究会) was founded in 1977, made up of about 500 doctors, nurses, pharmacists, and psychologists who meet annually for a conference on the pressing issues of the time. Their 27th meeting in 2003 marked a very different direction for the organization as it was led by a Shingon Buddhist priest named Takamatsu Tetsuyū 高松哲雄 while conference participants tried to account for the adaptations by WHO and Japanese healthcare leaders. Though clergy made up only about 1% of the attendees, participation was larger than usual for the two-day conference, with 6,000 participants from all over the country discussing Buddhism’s participation in care for terminal illness.[7]

Despite the rise in discussions of spirituality and spiritual care, this does not mean such topics became dominant or common within Japanese medical care. As Masako Nagase asserted, “To date, there only exists a tacit acceptance of the notion of spiritual well-being within the conceptual dimensions of ‘health’ in the field of nursing and welfare in Japan.”[8] However, the WHO-related deliberations in Japan opened up the doors to religious engagement with medical personnel in ways that had not occurred since the Meiji Period (1868-1912). It also at least created the inroads for chaplaincy in modern Japanese public hospitals. However, one other topic that rose with discussions on overall well-being was the quality of interpersonal relationships during patient care—especially with the dying, a topic of increasing relevance in a “super-aging society.”

Populations in Need of Care

An aging rate is the percentage of a population sixty-five or older. WHO defines societies with 7% aging rates as  “aging societies,” 14% is referred to as “aged,” and 21% is “super-aged.” By March, 2018, Japan reached 27%, and its population of those over 75 years old outnumbered those between ages 65-74.[9] Japan will soon have a third of its population exceeding the average lifespan of the world. By 2050, 40% of the population is expected to be over the age of sixty-five years old.[10] “Never before in the history of humankind,” states Carl Becker, “have 127 million people, the present population of Japan, lived in such a small land area, nor have so many people ever died in such a short time with so few people to care for them.”[11] …