In this week’s photograph, we see a monk standing on a bustling Tokyo street, arms outstretched with a donation tray. He stands amid towering symbols of wealth. Before you feel sympathy for the monk, ask your Japanese friends to explain the privileged and complex role the priesthood holds, often amassing significant wealth. This begs the question: why the begging from the seemingly sympathetic?
But that’s beside the point for this week’s essay. Taking the scene in the photograph at face value, it invites reflection on this week’s quote.
The time has come to begin exploratory visits to assisted living facilities specializing in dementia care. Recently, the family attended a luncheon tour at one of the finer businesses in the area—and I choose that word deliberately. The sales manager mentioned how often she sees caregivers who have given so much that they end up needing a caregiver themselves.
“If you don’t mind me saying, it’s good to see some life in you after all that time I watched you die inside,” a neighbor remarked, referring to the two days off I now take each week from caregiving, thanks to the slowly increasing help that’s lightening the load.
“There’s no such thing as a good case of dementia, only worse ones,” is a phrase that etched itself into my mind—spoken by the special one. I carry a sense of gratitude that what could be a far heavier burden has remained manageable.
In 1960, Japan’s population aged 65 and older was just 5%. By 2022, that number had risen to 30%. Meanwhile, the family caregiver population (ages 15–64) as a percentage of the total population has plummeted—from 65% in 1960 to a high of 70% in 1990, and down to 58% in 2023. The situation becomes even more dire when you consider the rise of two-income households and the increasing number of unmarried individuals during this period, further shrinking the pool of family caregivers.
The real question is: with the Mayo Clinic now referring to some forms of dementia as “Type III Diabetes,” at what point do we need to forcefully prevent private profits from being subsidized by socialized losses?
Caregiving is often framed as an act of love or duty, but there’s an emotional cost that rarely gets discussed. You see it in the tired eyes of fellow caregivers waiting in silence, or in the quiet pauses during conversations where words can’t quite capture the weight they’re carrying. How long can society expect to run on the goodwill of its caregivers? It’s one thing when it’s family, but as the caregiver pool shrinks, society will have to confront uncomfortable questions. Will caregiving remain a personal duty, evolve into a community responsibility, or become something even larger—a task for governments or industries to shoulder? Maybe someday robots will take on the role. But should they? Until then, it’s real people, real lives, and real fatigue.
Standing here, my mind floods with questions: How unwell must a society become before those needing care outnumber—or outweigh—those who can provide it?
And now… know the photograph.
