Published papers

In this paper, I examine the peer-reviewing process as an institutional setting and analyze how contributors should act to establish it. For this purpose, I use the record of a mock peer review hosted by The Japanese Society of Health and Medical Sociology, where my article was reviewed. In this article, I distinguish two aspects of the peer review: "communication" and "evaluation." Moreover, I emphasize that contributors must interpret every aspect of comments provided by reviewers as "evaluation"; contributors must divide reviewers' long comments into brief checklist points in their articles. In the peer-reviewing process, reviewers have more power than contributors do, and such a situation is sometimes considered "unequal." However, this inequality must be overcome by contributors' skills of interpreting comments, not through the abstract "equal dialogue" with reviewers.

Family caretakers of the elderly with dementia often claim that they "are the only people who know the real condition of these elderlies." In this paper, I examine such remarks as the "claims of privileged knowledge" (Gubrium & Holstein 1990), which appear to conflict with recent medical theories about dementia. In recent years, Japanese medical practitioners have argued that dementia patients sustain their ability to interact, and they demand that such ability be respected. Family caretakers, on the other hand, seem to ignore the elderlies abilities and impose upon them their "definition of reality" (Amada 2007). However, in this article, I emphasize that their claims are based on "dementia" as a medical concept and medical practitioners discourses that stress the dementia patients ability to interact. Many medical practitioners have pointed out that the environment and those concerned, such as doctors, social workers, and patients relatives, often dramatically change the dementia patients conditions because they sustain the patients interaction abilities. For that feature of "dementia," those concerned tend to make inconsistent judgments about the patients conditions (e.g., "You said that hes getting worse and worse, but he is fine because he talked to us a lot about our old times."). In such cases, family caretakers often insist on interpreting the patients reactions (such as "talking about old times to relatives") as symptoms of dementia and remain steadfast in their judgment. In brief, family caretakers make "claims of privileged knowledge" about how to apply the concept of "dementia" to the elderlies daily lives and presume the elderlies conditions. Such conflicts between the family caretakers and others reveal problems in the order of family care in "the new century of dementia care" (Iguchi 2007) in Japan.

In this paper, I examine "dementia" as the concept, which indicates "who" and "how to" remedy troubles about care. I analyze data collected through participant observations and interviews in self-help groups (SHGs) that family caregivers of the demented elderly attended. I emphasize the following four points. First, if elderlies are represented as " the demented, " they are exempted from the responsibility of remedying troubles. Second, assigning such responsibilities to "family caregivers" implies that they must provide care by considering that people with dementia "cannot think logically, while their emotional abilities are preserved." Third, people with dementia are regarded as "innocent" or "harmless" as a result of this categorization. Fourth, by participating in SHGs, family caregivers can develop a new frame of interpretation for "troubles to remedy" in dementia.

In this article, the subject of my analysis is "how does the category become relevant, initially, at different times, and in different ways, in the life of a person?" (See Lynch2001: 249 about "dementia".) Sociological studies on early dementia (Deguchi 1999; Amada 2007; Iguchi 2007) focus on conflicts among family members. The early symptoms of dementia are always vague (e.g., forgetfulness, character change). Therefore, family members may differ in regarding whether certain "troubles"（Emerson & Messinger1977）can be termed dementia symptoms; this will lead to conflicts among the family members. While considering the abovementioned studies, I examine how Ms. J and Ms.I define their mother, Ms. K, as being demented, despite the inconsistency in their early decisions. I emphasize the following two points. First, considering the accountability of family members regarding the "deviances" in the elderly, a family member's perception of "deviance" in the behavior of an elderly person does not necessarily imply that the elderly person is demented, because there are many possible interpretations of such behavior besides dementia; the behavior could result from non-dementia illnesses or factors such as family discord. So family members attribute the elderly person's "deviance" to dementia and disregard other possible causes for such behavior, only when the context of social interaction suggests it. Second, considering the importance of acknowledging social settings, the mere "deviances" noticed in behavior cannot be categorized as the symptoms of clinical disorders such as dementia. As suggested above, family members' decisions regarding the symptoms of dementia should always be based on an elderly person's pattern of everyday life and the context of any specific interaction. Therefore, they must consider the social settings that form the context of social interaction.

How do people react to and interpret the behaviors of an individual labeled a "dementia patient"? To answer this question, an in-depth analysis of one particular case of "the new century of dementia care" (Iguchi 2007) is presented in this paper. "The new century of dementia care" defines the current Japanese perspective on dementia care in which much importance is attached to communication between patients and their carers. This perspective recognizes that carers often try to "approach" patients in their current condition with the expectation that they may react. Moreover, carers regard such "approaching" as a "moral duty." What seems to be lacking is detailed analysis of the actual "approaching" or communication that occurs, the findings on which could lead to a reformation of present sociological frameworks on dementia care that emphasize the "self-fulfilling prophecy of impairment" (Lyman 1989). Data were gathered from participant observations within care settings, and this paper discusses in particular the interactions between Ms L (the patient) and her family. Data analysis revealed many elements of "the new century of dementia care," where Ms L's family was strongly oriented to "approach" (or communicate with) her with expectations of her reaction. Thus, their case was deemed a particular example of such care. Family carers almost always referred to Ms L's previous way of life before she was diagnosed with dementia. The study found a certain standard of "approaching" in dementia care, which I termed "life," after the geriatric psychiatrist Isao Ozawa's (2003) discussion. Further, a paradoxical conclusion was drawn: because carers respect the "life" of patients as a standard of care, carers must mobilize all their knowledge about patients in caring for them. While dementia care often centers on care settings, "what patients want/like/feel" and so on is highly dependent on interactions with carers.