The Importance of Developing Pastoral Care Services and Religious Education 

Rev. Mari Sengoku

Supervisor for the Naikan Center for Awakening Mind and Body 

Published in Buddhist Care for the Dying and Bereaved in the Modern World: Global Perspectives Edited by Jonathan Watts and Yoshiharu Tomatsu (Wisdom Publications – Boston & the Jodo Shu Research Institute – Tokyo, 2012)

Introduction

As a minister of the Jodo Shin Pure Land denomination, hospital chaplain, and psychotherapist in Japan and Hawaii, I like to reflect on the words of the founder of Jodo Shin, Shinran Shonin (1173-1262): “Know that the Primal Vow of Amida makes no distinction between people young and old, good and evil; only shinjin (entrusting faith) is essential.” (Shinran, 1997) This quote makes me think about all the terminally ill patients and elderly people whom I have met at hospices, viharas, and nursing homes. Unlike sects that emphasize strict practice to gain enlightenment, Jodo Shin Buddhism teaches that Amida Buddha will ultimately save everyone, including persons who are dying or suffering from dementia. Jodo Shin Buddhism has great potential to bring peace and comfort to such patients. As the death rate from cancer and numbers of elderly people in nursing homes increase in both Japan and America, it is the special challenge and responsibility of Jodo Shin ministers to address their spiritual needs.

From 1994 to 2007, I served as a hospital chaplain and psychotherapist, as a minister of the Jodo Shin (Nishi) Honpa Hongwanji Mission of Hawaii. Living in the United States, I learned that providing counseling for our congregations is one of the ministry’s most important services. Regardless of denomination, chaplains play a very important role wherein ministers can serve the spiritual needs of hospitals, nursing homes, prisons, the military, and the police. In Japan, however, Buddhist ministers rarely provide such services. Generally, Japanese people have the impression that Buddhist ministers only perform funeral rites and memorial services, having nothing to do with their daily lives. Although more than one million people suffer from depression, and more than thirty thousand Japanese commit suicide annually (NHK 2009), it is rare for a Japanese to seek out a Buddhist minister for spiritual guidance.

Upon my return from Hawaii to Japan, I was honored to serve for a year as the first Buddhist chaplain at the Vihara Hongwanji Nursing Home and the Asoka Vihara Clinic for terminal patients in Joyo City, Kyoto, established by my Jodo Shin Nishi Hongwanji denomination. It was a dream come true to introduce chaplaincy to Buddhist organizations in Japan dealing with patients’ spiritual pain and elders’ spiritual needs. Unfortunately, I soon discovered that chaplaincy rarely reaches the majority of Japanese who ignore Buddhist teachings while they are well. If patients are unfamiliar with the ideas and teachings of the Buddha, it may be too late to help them when they are confronting death or suffering from severe dementia. In this chapter, by presenting case studies and a survey comparing Hawaii with Japan, I would like to stress the importance of early religious education and urge the establishment of a systematized Japanese Buddhist chaplain program and services.

The Integration of Chaplaincy in Medical Care in Hawaii

Most large hospitals in Hawaii welcome chaplain services in sickrooms, hospices, ICUs, and Emergency Rooms, where their patients confront death and dying (Sengoku 2002). American chaplains are pastoral care counselors licensed by the Association of Professional Chaplains (APC) after completing all necessary curricula and training. Chaplains are required in emergency situations, and when patients or families request spiritual services. Chaplains are often asked to pray for patients’ recovery, to provide bedside services, and to comfort troubled patients or grieving families. Since Hawaii is a multicultural society, chaplains encounter a wide range of cultural customs and religious beliefs; the Christian-Buddhist encounter is especially noteworthy. Sometimes Buddhist chaplains conduct services for Christians and vice-versa.

The Queen’s Medical Center, where I served as a chaplain, was founded in 1859 by Hawaii’s King Kamehameha IV and Queen Emma. The Queen donated her property and solicited contributions for Hawaii’s first hospital, when foreign-bred plagues endangered the Hawaiians’ very existence. In the century and a half since its founding, the original hospital of 124 beds has expanded to 560 beds, employing over 1,000 doctors and 3,500 staff. The chapel that chaplains, patients, and their families use to fulfill their spiritual needs, such as prayers, services, and counseling sessions, shows the dynamics of multiculturalism and spirituality in Hawaii. When you open the Christian style stained glass doors, you find a statue of Amida Buddha inside. When I first entered this chapel, I felt that everyone was welcome, regardless of their religious or ethnic background. As a Japanese, I had never been exposed to multicultural and religious differences until I started to work in Hawaii. Through my activities as a chaplain, I learned the importance of empathetic listening, to show understanding towards patients and their families. Many feelings and emotions transcend ethnicity; hospitalized patients and their families particularly seek salvation and comfort as they confront death or tragedy.

As we will see in greater detail in later chapters in this volume, American hospitals treat chaplains as medical staff, who work with doctors, nurses, therapists, and social workers. For instance, when a family has to decide whether to remove a patient’s life support, the doctor and chaplain discuss the feelings and best interests of the patient and the family. Americans do not consider, body, mind and spirit divisible; illness is not only a physical problem. Since body, mind, and spirit influence each other, they must be treated simultaneously. The chaplain is crucial not only for providing spiritual guidance, but also for advising medical staff. Whereas Japanese associate priests with death and funerals, Americans see them as caregivers, sources of spirituality. As examples, let me present some cases of my patients in Hawaii.

Case 1: This case involves a 39-year-old Japanese male instructor at a Japanese medical school, conducting research while on vacation in Hawaii. He had had cardiac and kidney trouble for fourteen years, but things took an unexpected turn for the worse on this trip. He was admitted to an ICU unit in Queen’s Medical Center. When his doctor and nurses asked me to visit him, they told me that they had contacted his family in Japan, for he was expected to die in a few days. When I visited him, he was sitting in a chair, but it was painful to see so many tubes connecting him to machines. When I introduced myself as a chaplain, he did not understand the term. I explained the role of a chaplain as a spiritual caregiver, a part of his medical team. The patient was surprised but understood about chaplaincy and asked me if he could be cremated in Hawaii. Shocked at his request, I inquired why he so desired. He replied that he knew he would die soon, so he did not want to burden his family who were on their way from Japan. Contemplating his pain and feelings confronting death alone in a foreign country, I did not know how to comfort him. “We will take care of everything. Please do not worry, but trust yourself to the Buddha,” was all that I could respond.

When his family arrived in Hawaii, he was already unconscious. When I visited the family, his irate father berated me, “You came too soon! My son is still alive!”,  thinking that a priest should only be summoned after the decease. When I explained chaplain services in America, the family understood and was relieved that I had talked to the patient before he went unconscious. The father regretted not coming sooner, for he had never imagined that his son would die so suddenly.

Although they were not Jodo Shin Buddhists and planned to have a funeral at their family temple as soon as they returned to Japan, they requested my services at the bedside and cremation. At these services, I met the patient’s wife and two little boys. None of the family could accept the sudden death of this medical doctor. At the service, I preached, “Using his own body as an example, he has revealed the truth that everything is impermanent. Don’t take his death only as misfortune, but rather as an occasion to listen to the teaching of the Buddha.”

This happened many years ago when I had just started as a chaplain. Even now, I clearly recall that incident, and sometimes remember that patient and his family. This illustrates how Japanese in tragic situations avoid ministers. Since then, I have met countless families of Japanese tourists encountering traffic accidents or unexpected strokes or heart attacks in Hawaii. They do not understand chaplaincy at first, but some feel encouraged by meeting a Japanese minister concerned about them.

When I was young, I lost my own fiancé to a brain tumor. It was this spiritual crisis that led me to move to Hawaii, where I later learned about chaplaincy as a Jodo Shin Nishi Hongwanji minister. In Japan, few medical staff perform spiritual care for patients and their families. I wish I had been able to see a chaplain for my own spiritual comfort when I was grieving. Bereaved without spiritual support, I suffered depression for three years. However, I now appreciate the incident, because it gave me the opportunity to think about what I could do as a minister and spiritual caregiver.

Case 2: This case involves a 90-year-old female, second-generation Japanese-American from a Buddhist tradition. Doctors, nurses, and chaplains visited her home regularly, caring for her terminal cancer with Hospice Hawaii’s home care service. When I visited her for the first time, she delightedly reminisced about her family and departed husband. She related the rigors of laboring on the sugar plantations as she struggled to establish a better life.

Suddenly serious, she queried, “Reverend, I have lived a long and satisfying life. I am happy to be surrounded by my beloved children and grandchildren. I have no regrets, but I have one concern. Will it hurt when I die?” Unprepared for her question, I leveled with her, “I am sorry; I cannot say whether you will feel pain or not when you pass. But you are embraced by Amida Buddha, here and now, and at the moment of your death. Your staff, including me, are always by your side. Please do not worry, but entrust yourself to the Buddha and to us.” Upon hearing this, the patient seemed relieved, and retold some other people’s experiences of meeting angels before they passed. A few days later, she passed away peacefully at home, surrounded by her children, grandchildren, and medical staff.

Case 3: This case involves a 65-year-old Caucasian male with lung cancer who was admitted to the medical center and requested a chaplain through a nurse. A Baptist but open to Buddhist teachings, he tearfully lamented, “Reverend, I am ready to die. I had a wonderful life. However, I have one regret. My daughter is pregnant, but I won’t be able to see my grandson. In fact, I won’t be able to do anything for him.” I suggested he might write or record a message to his grandson. Delighted with the idea, he recorded how much he wanted to see his grandson and promised to watch over him from heaven, exhorting him to live the best life that he could. He asked his daughter to play the message for his grandson when he became 10 years old. His nurses informed me that he passed peacefully a few weeks later.

Japanese professors, such as Kazuko Kikui of Kawasaki University of Medical Welfare, and Mieko Yamaguchi of Hiroshima State University College of Health Sciences, have visited Hawaii to observe hospice care and have highly evaluated chaplaincy as an integral part of the medical system. They report that patients’ spiritual pain is not fully considered by most Japanese terminal care services, but Hawaiian chaplains fill indispensable roles as spiritual caregivers transcending ethnicity, culture, and religious denomination. For terminally ill patients, pain is not only physical but psychological, social, and spiritual. To respond to patients’ total pain, caregivers should work as a team with doctors, nurses, social workers, chaplains, counselors, and volunteers. In Japan, although social workers and volunteers play important roles in terminal care, chaplains are rarely involved, except in Christian hospices and Buddhist viharas. This is despite the fact that spiritual pain is the most fundamental pain of all (Kikui and Yamaguchi 2004).

In a recent popular book entitled Healing through Words (Kotoba-de Chiryo-suru), Dr. Minoru Kamata, Professor of Clinical Studies at Tokyo Medical and Dental University, advocates improving doctors’ attitudes and communication skills with terminal patients. He advises Japanese medical doctors to be more considerate when they talk to terminally ill patients and their families. Kamata deplores the many doctors who are so busy that they forget their original reasons for becoming doctors. He urges that doctors and nurses learn communication skills, lest patients feel ignored or abandoned by their medical staff. These are all points strongly echoed by Rev. Yoshiharu Tomatsu in his chapter in this volume. Finally, Kamata also recognizes the importance of doctors’, nurses’, therapists’, and social workers’ hospital teamwork to deal with patients’ needs.

Dr. Kamata explains that in his use of narrative therapy with terminally ill patients, he acknowledges the difficulties of attending patients confronting death. However, he proposes that listening to patients’ stories and feelings may gradually help them to accept their deaths. Indeed, it is crucial to listen to patients non-judgmentally, and this can be a first step for patients dealing with life and death. However, Kamata discusses neither patients’ spiritual pain nor chaplaincy. For peace and comfort toward the end of their lives, some patients need more than Kamata’s narrative therapy. Patients need heartfelt satisfaction, a sense of gratitude, and acceptance or forgiveness. I admire Kamata’s wonderful work and compassion for his patients and hope that young Japanese doctors will follow his path. At the same time, the conspicuous absence of discussion of spiritual pain and its treatment indicates how far Japanese hospitals lag in terms of spiritual care.

“People Die as They Lived”: Experiences with Patient Religiosity in Japan

In April, 2008, the Jodo Shin Nishi Hongwanji denomination founded a terminal care clinic, the Asoka Vihara Clinic, and an adjacent nursing home, the Vihara Hongwanji, in Joyo City, Kyoto. Unlike regular clinics, hospitals, and nursing homes in Japan, both facilities have altars to Amida Buddha, where Hongwanji ministers and chaplains conduct morning and evening services, monthly dharma services, and special major Buddhist services for patients, residents, and their families. Until March, 2009, I served as one of the first Buddhist chaplains in these facilities. The chaplains who serve for the Asoka Vihara Clinic and the Vihara Honwanji are called “Vihara Ministers.” Vihara is a Sanskrit term meaning a Buddhist temple or a place for rest, similar to the term “hospice” in English. The Asoka Vihara Clinic has the capacity for nineteen terminal patients, while the Vihara Hongwanji accommodates one hundred permanent residents and eight persons for short stays. Surrounded by beautiful wooded hills, these facilities provide a quiet relaxed atmosphere for patients and residents.

Volunteer musicians, dancers, and storytellers periodically provide entertainment. Besides my regular routine as a Vihara Minister, I played the harp and sang for patients in music therapy sessions. Harp music has been shown to ameliorate depressive disorders, cardiac and blood pressure problems, and other somatic and psychological problems. This is hardly new as the Book of Samuel relates that the Psalmist David played his harp to relieve King Saul’s manic depression 3,000 years ago (Hinohara and Yukawa 2004). Playing the harp for the patients, elderly people, and their families is a great method of communication. My patients often cried, “I never expected such beautiful harp music here.” Unlike America, however, Japanese patients and elderly do not comfortably express their feelings about their lives and deaths to chaplains.

“People die as they lived” is the motto of Haruhiko Dozono, physician for countless hospice patients in Kagoshima, Japan (Dozono 1998). He holds that patients who live their lives with appreciation end their lives with gratitude and satisfaction, while inappreciative or troubled patients have difficulty dying peacefully. Observing and communicating with patients and elderly in Hawaii and Kyoto, I would add, “People die as they lived, and they also grow old as they lived.” I have observed that it makes quite a difference in how one grows old and dies in comparing two groups of people: 1) those with religious practices regardless of religious denomination; and 2) those without religious practice. In the nursing home at the Vihara Hongwanji, about 80% of the residents have dementia or Alzheimer’s disease. The 10% of the residents who do join in the daily dharma services rarely complain about their lives, rather helping the ministers and staff as much as they can. They usually smile and put their palms together in gassho to show their appreciation. Some have dementia or Alzheimer’s so severe that they cannot even remember their own relatives, but they still show their appreciation to the staff.

On the other hand, residents lacking religious faith and practice tend to complain about their lives and blame the hospital staff. Some become violent, causing trouble for other residents; others suffer fits of anxiety, repeatedly summoning “Help! Help!” Although we have a beautiful altar where we hold services every day, people lacking childhood religious training never join our daily services. Conversely, those raised in a Buddhist tradition join the services even with dementia or Alzheimer’s. Observing them, I conclude that religious affiliation from a young age inculcates an appreciative and happy attitude even for people suffering illnesses. My observation coincides with the theory of Tom Kitwood (1937-1998) who established Person-Centered Care. He proposed: Person with Dementia = Personality × Biography × Physical Health × Neurological Impairment × Social Psychology (Nakazawa 2007). This formula indicates that what we think and how act here and now contributes to what we will become when we get older. Thus, “People grow old as they lived.”

In terms of “People die as they lived,” in America, the acceptance of chaplaincy allows chaplains to talk sincerely and deeply with patients concerning their lives and deaths. In Japan, most Japanese patients avoid serious conversations with chaplains. I have listened to some who said, “I hate my daughter-in-law who took my son;” “I hope my boyfriend never forgets me;” and “I have many concerns, but I do not want to mention them to anybody.” Their comments display reticence both to admitting their own mortality and to communicating heartfelt concerns before while there is still time.  In contrast to America, where people usually know of their impending deaths, many patients in Japan are uninformed of their brief life expectancies. This frustrates chaplains’ full spiritual support towards the end of their lives. Still, I was able to connect deeply with Japanese patients in a few cases.

Case 4: This case involves a 76-year-old female cancer patient. Raised in a Jodo Shin Buddhist family, she had grown up watching her mother reciting Amida Buddha’s name, Namu Amida Butsu, at their home altar. Encouraged by that memory of her mother, the patient joined our morning and evening services regularly, reciting the sutras along with the ministers and staff, and attentively heeding the minister’s sermons. As her condition worsened, she joined the services in her wheelchair or on her bed, accompanied by her family or a nurse. Visiting her bedside, I listened to her stories, especially about her grandchildren. She enjoyed my harp and voice when I played for her. I performed “Sakura Sakura” (“Cherry Blossoms”), “Kojo no Tsuki” (“Castle Ruins in the Moonlight”), “Furusato” (“My Old Home”), and other songs familiar to her from youth. She enjoyed my music and even sang with me saying, “These really take me back.” However, when a nurse asked her which song she liked best, she answered, “Sen no Kaze ni Natte” (“A Thousand Winds”), a hit song expressing that the deceased is not in a grave but always by your side, like sunlight on a ripened grain, a gentle autumn rain, or a thousand winds.

A few days before her departure, she complained of severe pain, beseeching the nurses “Please help me!” Although she had enjoyed the dharma so much, she showed how difficult it is to die peacefully in the face of physical pain. When I visited her bedside, I proposed, “Your cry for ‘help’ and ‘Namu Amida Butsu’ are the same. Why don’t you recite Amida Buddha’s name instead of screaming ‘help’?” Thereafter, the staff and I heard her continuously reciting Namu Amida Butsu. The next day, she passed away repeating, “I am saved! I am saved!” Although others could not see it, I believe that the path to the Pure Land was opened to her.

Case 5: This case involves a 71-year-old male with kidney cancer. Estranged from his daughter and ex-wife since his divorce, he was cared for by his two sisters who visited him frequently. Since the patient was informed of his diagnosis, I conferred directly about his life and death. He joined daily services with his deceased parents’ picture, and we enjoyed talking about the Pure Land. He loved singing “Furusato” to my harp. Once I averred, “The Pure Land is our wonderful furusato (home town). Whether I precede or follow you, we can rendezvous in the Pure Land.” Imagining that we might marry in the Pure Land, he often regaled his nurses, “I will marry Rev. Sengoku in the Pure Land.” I wondered about his notion of marriage, but since he believed he would go to the Pure Land, I did not worry about him. Before he passed, he reiterated, “Thank you. I am happy and satisfied to die here.” When he passed, I missed him, but I was gratified that he had died peacefully and gratefully, feeling rather relieved that he was reprieved from his severe physical pain. What disturbed me about this case was that, although the patient passed with gratitude and satisfaction, the doctor still lamented, “It’s too bad.” For that doctor, any patient’s death was a defeat, despite the fact that no one can avoid death.

In my understanding of chaplaincy, gentle but correct communication of diagnosis and prognosis is essential. Anyone would be shocked to learn that their condition is terminal. However, contemplating their own mortality, patients can reflect deeply and resolve unfinished business before their departure. Some may want to convey thanks or apologies, or to see long-lost friends or relations, in order to leave this life without regrets.

Some Japanese patients ostensibly prefer not to know the facts, but their feelings may be assuaged if they are assured of sufficient spiritual care. Even at hospices and viharas in Japan, many doctors and nurses lack an understanding of life and death. One doctor confided that he would conceal his patients’ diagnoses since he felt sorry for them. I reproved, “If someone else could die for them, they do not have to know. But it is they who will die, so they have to confront their own deaths.” The shocked doctor admitted that he had never thought about it in that way; in fact, he had never contemplated his own mortality.

I believe it is very important that medical staff develop their own understandings of life and death, and respect the spirituality of their patients. Otherwise, staff will suffer burnout, burdened by stress and harboring regret when all treatment proves futile. Regardless of personal religious differences, unless staff support patients’ spirituality collectively, no hospice or vihara can fulfill its mandate, but will reduce to simply performing like any other hospital that addresses patients’ physical problems alone.

Case 6: This case involves a 91-year-old male nursing home resident who was a retired high school principal. Confined to a wheelchair by a stroke, while fighting diabetes and minor dementia, he showed no problematic behavior. He voiced his concern, “Reverend, please do not think I am crazy, but I saw a host of ghosts marching from the entrance to the statue of Amida Buddha, where they disappeared. It made me fear that I may die soon. Then, last night in my dream, I heard the voice of Buddha saying “anjin-ritsumei” [literally: secure-mind-establishing-life]. What do you think of that?” I explained the significance of his nocturnal message. Anjin-ritsumei describes the Buddha’s state of mind, for anjin means “mentally peaceful and stable,” and ritsumei means “constantly guiding sentient beings.” (Murase 2009, 173-179) Hearing my explication, he rejoined, “Now I understand. The Buddha was instructing me, ‘Do not worry. I am here with you.’ I feel ashamed that, although I was born into a Jodo Shin family, I was not an earnest practitioner and have never joined the services here. Nevertheless, Amida Buddha shows me his compassion. Now I believe it is my great karma to live in this nursing home.” Starting that very day, he joined in the Buddhist services. I was happy that his anxiety transformed into gratitude to Buddha, because he had encountered Buddhism when he was a child.

Importance of Religious Education for Youth

Through such encounters with patients and elderly as I have described above, I have concluded that it is too late to develop a spiritual life when you start to suffer from dementia or just before you die. Each of our days alive affects how we grow old and how we die. No matter how beautiful the buildings at the Asoka Vihara, this beauty cannot function fully unless people desire to learn and appreciate the dharma. Buddhist education from an early age is crucial in guiding people towards a meaningful life and a peaceful death.

According to world-famous professor of psychosomatic medicine Dr. Yujiro Ikemi, the human neo-cortex completes its development by the age of fifteen to sixteen, so personal character formation is very difficult to change thereafter. The paleo-cortex is even more fragile and sensitive to stress than the neo-cortex. Infants’ interpersonal emotional stresses greatly influence the formation of their pale-ocortices and hence their personalities (Ikemi 1986). Ikemi’s perspective suggests the importance of providing a warm spiritual environment for children from infancy. Many mental patients do successfully complete long-term psychological therapy and transform themselves from negative to positive and appreciative ways of thinking. However, unless they continually repeat the therapy by themselves, they are drawn back to their previous habits and perspectives (Sengoku 2010).

In the 1990’s, I conducted a survey entitled, “Evaluating Jodo Shin Buddhism as a Potential Tool for Coping with Spiritual Decline in Modern Japan” (Sengoku 1999), to discover how Shin Buddhists educate children in their homes and how Buddhist teachings affect the relationships and understandings of parents and children. Using questionnaires given to Hawaiian Americans of Japanese Ancestry (HAJA) and to Japanese nationals, including parents and children (14 to 18 years old), I surveyed three types of families: 1) “religious” families who highly respect Buddhist teachings in their daily lives; 2) “cultural” families who visit temples periodically for cultural association; and 3) “secular” families disinterested in Buddhist teachings. 60 families (ten from each group in each country) completed my questionnaires.

The questionnaires included the questions: “How important is religion in your life?”, and “How often, and on what occasions, do you go to temple or church?” The survey concluded that regardless of religious or cultural background, children were strongly influenced by their parents’ attitudes. For example, one question asked: “Do you know the meaning of the Japanese word itadakimasu, said before meals? If so, explain.” Itadakimasu is a very important term expressing gratitude for the sacrifice of plants and animals and respect for the labor that raised and prepared the food. When the parents knew the meaning of the term, so did the children; and when they did not, the children did not either. This question revealed that parents’ attitudes—and indeed Buddhist spirituality—affect children in their daily lives.

Today, Japanese temples rarely hold Sunday services, camping and sports activities for children, or volunteer activities and conferences for adults and seniors, which are so common in America. My survey confirmed that regardless of the strength of their religious orientation, Japanese people seldom visit their family temples. On the average, they attend temple only two or three times a year, on special occasions such as the Obon summer festival for the dead, memorial services, or funerals. By contrast, religious HAJA families regularly attend Sunday as well as annual Buddhist services. For many Japanese, religion provides no spiritual guidance for daily life, but only a connection to their deceased. Many HAJAs rely on their religion for spiritual guidance. Admittedly, some HAJAs enjoy the temple as a venue to socialize with other HAJAs, yet many admirably plumb their ministers’ sermons for spiritual guidance. HAJAs typically answered that Buddhism teaches respect for individual differences, the preciousness of life, and appreciation of the environment sustaining all people and animals.

Generally, American Buddhist ministers communicate with their parishioners at Sunday services, at other Buddhist and interfaith services, at individual pastoral counseling sessions, and as chaplains at hospitals or nursing homes. This variety of religious outreach is conspicuously lacking in current Japanese society. Nuclear families constitute the norm in both countries, but in Hawaii, parents, grandparents, and children gather at Sunday services and other temple activities. The lack of such opportunities for Japanese families may be a factor in the weakening of their intergenerational relations. Rev. Tatsuya Konishi, Director of the Spiritual Care Department at Higashi Sapporo Hospital in Hokkaido, stresses the importance of introducing chaplaincy to Japan with an eye to cultural sensitivity (Konishi 2006). However, unless patients themselves seek the benefits of chaplaincy, it will not fully function.

Shinran Shonin wrote, “Although we bonbu (ordinary fools) cannot live without accumulating karmic evils, encountering the nenbutsu (Namu Amida Butsu) allows us to live our lives fully, accepting death and being embraced by the light of Amida Buddha.” Shinran’s master Honen Shonin taught, “Since the world we live in is the dojo (practice hall) of nenbutsu practice, we can cultivate ourselves by reciting the nenbutsu. When we die, the door to the Pure Land opens up for us by eliminating our bodies of earthy desires.” (Kakehashi)

I believe that conveying the words of these masters is the greatest mission of Jodo Shin Buddhist ministers. The Asoka Vihara in Kyoto provides a wonderful spiritual environment conducive to peace of mind. To facilitate this, the effort of ministers to develop religious education and pastoral care services is especially urgent in Japan.

Conclusion

Comparison of Hawaii and Japan demonstrates the importance of introducing religious education at an early age and of spreading pastoral care services. Grounded in the customs of Sunday services and pastoral care, many Americans have their own religious practices. When they confront spiritual crises, they welcome pastoral care or chaplaincy for spiritual guidance. Since few Japanese consciously embrace Buddhist teachings, even when hospitalized in clinics or nursing homes with a Buddhist chaplaincy, they are uninterested in pastoral services. Many pass away with unresolved problems, anger, anxieties, and fears.

In Vihara activities, including the Asoka Vihara, medical staff should reflect on their own lives and deaths before dealing with dying patients. Even for those uninterested in Buddhism, Buddhist teachings foster spiritual development and comfort. Buddhist ministers must hasten to develop religious education, a systematized Buddhist chaplaincy program, and services responding to Japanese patients’ spiritual pain, aiding people through the Buddha dharma to achieve meaningful lives and peaceful departures.

References

Dozono, H. (1998) Sorezore-no Fukei: Hito-wa Ikitayoni Shinde-iku (To Each His Own [Various Outlooks]: People Die as They Lived.) Nihonkyobunsha: Tokyo.

Hinohara, S. and Yukawa, R. (2004). Ongakuriki (The Power of Music). Kairyusha: Tokyo.

Ikemi, Y. (1986). Shinryo-Naika: The Department of Psychosomatic Medicine. Chuo Kuronsha: Tokyo.

Kakehashi, J. (ND) Seitoshi ni Omou (Contemplating Life and Death). Compact Disc. Ichihara Eikodo: Kyoto.

Kamata, M. (2009). Kotoba-de Chiryo-suru (Healing with Words.) Asahi Shimbun Shuppan: Tokyo.

Kikui, K. and Yamaguchi, M. (June 2004). “Hospice Kea no Choryu (Current Hospice Care: Visiting a Hospice in Hawaii.)” Journal of Kango Kyoiku. Vol. 45, No. 6. pp. 496-500.

Konishi, T. (2006). The Chaplain and Spiritual Care. Kanwairyogaku. Vol. 8, No. 2. pp. 59 (167)- 64 (172).

Murase, D. (2009). “Lecture for Enmei Jyuku Kannon-kyo.” Daihorin. Daihorinkaku: Tokyo, Japan. 2009. pp.173-179.

Nakazawa, J. (2007). What is Person-Centered Care? Ninchisho kaigo-no kihon (Basic Book for Dementia Treatment). Chuohoki Shuppan: Tokyo.

New Perspectives for Depressive Disorder Treatment. (Feb. 22, 2009). NHK Special Program.

Shinran. (1997). “Tannisho: A Record in Lament of Divergences.” In The Collected Works of Shinran. Volume 1. Jodo Shinshu Hongwanji-ha, Kyoto.

Sengoku, M. (Feb. 1999). “Religious Education in Family: Hawaii and Japan.” Daihorin. Daihorinkaku: Tokyo. pp.178-184.

Sengoku, M. (Dec. 2002). “Social Application of Shin Buddhism in Counseling.” The Pure Land. Nos. 18-19. pp. 207-214.

Sengoku, M. (2010). “Does Daily Naikan Therapy Maintain the Efficacy of Intensive Naikan Therapy against Depression?” Psychiatry and Clinical Neurosciences. Vol. 64, pp. 44-51.