Date of Award

Spring 5-15-2021

Author's School

Graduate School of Arts and Sciences

Author's Department


Degree Name

Doctor of Philosophy (PhD)

Degree Type



This dissertation is an ethnography of elderly life in Japan. Aging populations present serious challenges to societies in the provision of care and support for the elderly. As household sizes shrink and kin disperses, networks of support and informal care premised on familial involvement may no longer suffice. States encounter budgetary strains as the proportion of workers to elderly skews toward the latter. In Japan, these problems are present and have been exacerbated by shortages of professional care workers and long-term facilities for the elderly. However, the elderly have proved strategic and adaptive in relation to population aging in other cultural settings. In this dissertation, I explore the ways that the elderly use and shape cooperative medical institutions affiliated with Min-Iren, a leftist medical federation, to address their social and medical needs in Japan’s aging society. Based on ideals of solidarity and democratic participation, Min-Iren provides the elderly with a potent outlet to shape their lives and neighborhoods. Participation in Min-Iren institutions is located in “friendship associations” (tomo no kai). In addition to serving as bodies for collective ownership and management of Min-Iren medical facilities, friendship associations also provide the institutional structure for elderly members to create and participate in a myriad of clubs and groups devoted to hobbies, study, volunteering, health promotion, and politics. Within friendship associations, elderly members often pursue activities where they can be of use to others. In the process, I argue, they fashion social utility as an ideal to animate the latter years of life, providing an alternative to the conventional notion of ikigai (“a pursuit that makes life worth living”). Elderly members also seek to maintain physical and cognitive health through friendship associations clubs. Underlying currents in these clubs, however, are an acceptance of declines and the need to accommodate limitations. Whereas state programs tend to emphasize individual responsibility, often through the vaunting of ikigai, the elderly foster an ethic of collective support in Min-Iren settings. On the level of formal care, friendship associations provide pathways to shape medical institutions, including the establishment of homecare services. A common purpose is to enable continued residence in accustomed neighborhoods until death. Finally, the scope of activity in Min-Iren institutions extends to neighborhoods. Elderly members use the machinery of friendship associations and expertise of employees to improve local conditions, pooling efforts to enhance the built environment, found new medical facilities, and establish transportation services. This dissertation is organized ethnographically along a trajectory of decline. Providing close depictions gathered from a long period of engagement in the field, I chronicle elderly life, endeavors, problems, and attempts at resolution as frailty heightens and death approaches. Analytically, I use social capital as a tool to examine the effects of friendship associations on health and wellbeing, highlighting social engagement, social support, and collective efficacy. A social capital lens also reveals how Min-Iren’s association with leftist politics inhibits efforts to enrich social connections and improve neighborhoods. Min-Iren institutions take on ambivalent qualities, encouraging health and wellbeing in some contexts while limiting the creation and potential benefits of social capital in others. The relationship between the elderly and Min-Iren, I argue, reveals the ways that a society’s eldest members can use cooperative organizations to craft meaning and adapt to an aged society.


English (en)

Chair and Committee

Geoff Childs

Committee Members

Peter Benson, John Bowen, Talia Dan-Cohen, Shanti Parikh,