Confucianism was an important influence on early Japanese culture and way of life. Confucianism, which originated in China, provided a code of ethics that emphasized the importance of family and social order. The following Japanese terms reflect the Meiji era values of traditional Japan.
The Japanese concept of filial piety (oyakoko) stems from Confucianism. Confucian philosophy arrived in Japan in the seventh century and has been passed from generation to generation. In Confucianism, filial piety was extremely important. Children were expected to obey and respect their parents, bring honor to their family by being successful in life, and support and care for their parents in old age. Additionally, for many Japanese immigrants, “kodomo no tame ni” or “for the sake of the children” became the motto by which parents sacrificed to provide a better standard of life for their children. Thus parents may expect, and children should feel obligated to support and care for their parents. For example, even though adult children may find it difficult to provide adequate care for their parents, guilt results if parents are placed in an institutional long-term care facility.
In the past, Japanese Americans were less likely to place their elders in nursing homes when compared to their non-Asian American counterparts. However, as the Confucian influence of filial piety fades with increasing cultural integration and assimilation, trends in nursing home statistics are expected to change. Japanese community organizations in three West Coast cities (Seattle, Sacramento, and Los Angeles) have built Japanese-specific long-term care facilities (assisted living and/or skilled nursing homes), although non-Japanese are also welcome. In Seattle, a study of over 1100 independent older Japanese Americans explored their preference for use of nursing homes. A little over half said they would use a nursing home if they had dementia, but that percentage was reduced by 60% if the Japanese nursing home, Keiro, were not available (McCormick, et al., 1995).
There is a general stigma associated with mental illnesses among Asian Americans in general. Thus, Japanese American patients or their families may not seek psychiatric care or psychological counseling. In traditional Japanese society, individual family members are taught to avoid bringing shame (haji) or embarrassment (hazukashii) upon the family name. For example, during the time of arranged marriages, having a family member with mental illness could easily have deterred the marriage.
For healthcare professionals conducting home visits, it would be important to be respectful, polite, and courteous and to gain the trust of the Japanese American client. For example, it may be necessary to remove the shoes at the door prior to entering the home. In some very traditional Japanese households, if food is offered in gratitude for services and chopsticks are placed on the table, it would be important to be aware of two faux pas. One is to not allow chopsticks anchored in food to stick straight up into the air when not holding them. This practice is associated with funerary custom in Japan, and traditional families will find it offensive. The other practice is to not pass food from chopstick to chopstick as this practice is also associated with funerary custom in Japan. If a questionable situation occurs, it is appropriate to ask the client/patient what the correct or most comfortable behavior/action should be.