Gramps and the Gangster visit the memory clinic

“Are you free tomorrow?”

“Sure, what’s going on?”

“It’s a big day for Gramps! I’m taking him to the doctor. I guess someone from the ward office said he ought to be checked for dementia.”

I could tell Ken was trying to make a joke about this ‘big day,’ but as he started slowly walking past me, he leaned his head back and closed his eyes, sighing, “Aah, dementia!”

Ken, a former yakuza gang member now in his fifties, and Gramps had been living together for the last two months. Their housing was arranged by a non-profit organization, based in Tokyo, that assists with ex-offender resettlement and rehabilitation. Gramps got his nickname because at 73, he was the oldest ex-offender in the cohort receiving assistance. While most of the younger ex-offenders were trying to get jobs and build ‘ordinary’ social lives, Gramps spent most of his time alone, watching television while sitting on a rented hospital bed in his house.

Gramps had a stroke around the age of 60, not long after being released from his second short stint in prison. I sometimes wondered how much this damaged his cognitive functioning, but it was hard to tell because his speech had become so impaired I usually strained to make out the short bursts of words he struggled to produce. His last two arrests since the stroke were for common petty crimes. One time he left a restaurant without paying for his lunch. The month I arrived, he was caught stealing 20 yen (about $0.18) out of a donation box of a small shrine. The arrest immediately triggered a cancellation of his welfare benefits and consequently the loss of his apartment. When he was released after eight days in detention, he was not only broke, but homeless too. The non-profit helped him out again, but decided it was best for Gramps to share a house with someone else. Ken, who was released only two months prior, was chosen as the new housemate. Ken often stayed away from home because he couldn’t afford the long commute to his worksite, and he would often call me up saying “Gramps is lonely!” as soon as I answered the phone. I would head over to check on Gramps whenever I got the call (I don’t argue with gangsters).

A survey of older Japanese prisoners conducted in 2017 estimated that over 14% have some form of dementia. Many of these prisoners are in prison for shoplifting and other petty crimes like those Gramps committed. The other characteristic that linked these prisoners to Gramps was that they were typically estranged from their families. Even if this wasn’t the case before incarceration, the stigma associated with prison would be enough for most families to cut ties, and older people are particularly vulnerable. Without family members to offer support, a prison sentence, even for small crimes, is an almost inevitable outcome. The Japanese government has recently increased funding to hire more prison caregiver staff and to train more prison guards on how to interact with prisoners with dementia, but in current practice, it’s fellow prisoners who end up doing most of the daily care tasks like bathing and changing. For Gramps, this was still the case, even on the outside.

After Ken invited me to join him at the clinic, I wondered if the long lonely days were finally starting to take their toll on Gramps’ mental health. As we got into the car to see Gramps, Ken’s phone rang. Gramps had tried to go to the hospital earlier that day on his own. With his bad knees, it took Gramps almost seven hours to reach the hospital. When he arrived, he hadn’t brought his proof of insurance and other papers, so he was sent home again without seeing anyone.

When Ken and I got back to the house, Gramps was lying in bed, dozing with the TV still on. Ken roused him and Gramps told us the story again, adding that when they refused to see him, he got in a fight with the staff and a social worker was called to take him home. Ken was exasperated.

“You got to be careful with that Gramps! You’re on probation, so if something were to happen you’d be right back in prison!”

The next day at the neurology clinic, I sat in the examining room with Ken and Gramps as the doctor started asking questions: what does he eat? Is he taking medication? Does he forget to lock the door? At one point the doctor turned to Ken, asking, “Are you the eldest son then?”

“No, no, no, we just, he just lives with me right now. He’s looked after by this non-profit group”

“So he is in a facility?” (the word he uses could mean a nursing home or a prison)

“Um, no, not really. Sort of”

Later I joked with Ken, saying he and Gramps looked like they could be family. After all, who else would bring someone like Gramps to the clinic like this, wheeling him through the corridors, helping collect his urine sample? And wasn’t it Ken himself who insisted on calling him by a familial nickname? Sort of.

“What do you think of all this?” I asked Gramps as we waited for the results of the tests.

He looked me straight in the eyes and grinned, “I’m completely senile!”

“That’s nonsense!” I said reflexively.

He kept grinning but I wasn’t sure if I had said the right thing. I had wanted to resist the whole atmosphere of the clinic, the brain scan images, the waiting patients slumped on benches, the nurses asking him to repeat a list of vegetables, the doctor asking him who the President of the United States was. Even if Gramps had some symptoms associated with dementia, I didn’t want a dementia diagnosis to be the final say on who he was. But who was I to make that call?

Maybe Gramps’ ‘joke’ about being ‘completely senile’ was a comment about what his world had become: small, dark, lonely, yes, but also punctuated, at least, by moments of care and intimacy, moments almost like family. And that might be enough for him. What did memory matter when everyday was more or less the same? Perhaps, for Gramps, dementia wasn’t merely a death sentence. It could also be a means of embedding himself even more deeply within an unlikely group of carers like Ken. Maybe it held the hope of forgetting the things he lost or the regrets that wouldn’t leave. Ken told me that for the younger ex-offenders, looking after Gramps was a way to stay out of prison by cultivating an attitude of service and humility. Dementia had already changed Gramps’ social world, whatever diagnosis the doctor would give us when we were called back into the office.

The essays in this series, in different ways, dismantle the notion of dementia as pathology, a category of non-personhood, or a final and compelling form of address. They resist drawing the edges of dementia too sharply, leaving it open-ended— a possibility, a question unfinished, a work in progress— “Aah, dementia.” Strangers, spirits, memories move in and out of this life, “bubbling into each other,” as Pols so evocatively describes it, sharing a slippery fragility with each other. These social connections bear the weight of their own histories and the histories of places, like prisons, that were never made for old people living with dementia, but which become embodied by them. As I followed Ken and Gramps out of the clinic, the two of them joking with each other in prison slang, I found myself hanging on to this ordinary moment of care, of hope.

Jason Danely is Senior Lecturer of Anthropology at Oxford Brookes University. His books include Aging and Loss: Mourning and Maturity in Contemporary Japan (2014, RUP) and Transitions and Transformations: Cultural Perspectives on Aging and the Life Course (Editor, 2013, Berghahn). His current research examines elderly ex-offender resettlement in Japan and the UK.

This post is a contribution to ‘The Stories Continue’ in the Somatosphere series ‘Thinking with dementia.’