Naoko’s mental illness

Naoko’s mental illness shapes her movement between a quiet, voluntary convalescent community and a hospital offering intensive treatment, but the novel does not present recovery as a simple or settled outcome. She can speak lucidly, make plans, and appear well, while also experiencing severe emotional instability and episodes in which she hears voices and withdraws. Her course is known largely through the people caring for her and through retrospective narration; its uncertainty remains part of the account.

Care at the Sanatorium

The community where Naoko lives is not described as an ordinary hospital. Its residents enter and leave voluntarily; doctors check on their condition, while the institution’s primary purpose is convalescence rather than the administration of conventional treatment. The scale is small relative to its open grounds: about seventy residents and just over twenty staff members. The quiet, spacious setting offers a different rhythm of life, but it is also sustained by particular conditions and cannot be mistaken for ordinary life outside.

The sanatorium’s approach includes daily communal activity and mutual accommodation. Residents play sports, grow vegetables, and live together with an awareness that each person has distinctive ways of thinking and feeling. A doctor explains that the aim is not simply to correct people’s differences, but to help them recognize and live with them. This account provides context for Naoko’s residence: care is not framed only as a cure imposed from outside, but as an effort to make room for suffering and reduce the risk that residents will hurt one another.

Reiko, Naoko’s roommate, has lived at the sanatorium for seven years. She teaches music as a form of therapy and helps with office work, making the boundary between patient and staff difficult to distinguish in daily life. She explains to Toru Watanabe that the community suits people able to participate in this voluntary kind of convalescence; those needing specialized therapy may be sent to a specialist hospital. The distinction later becomes central to Naoko’s care.

Fluctuation and Transfer for Treatment

Naoko’s condition is not continuously severe. Reiko reports that she is fine much of the time, but that her emotions can become extremely unstable. During intense episodes of hearing voices, Naoko shuts down and retreats inward. At those times, the staff cannot take their eyes off her because they do not know what she might do. Her care therefore reaches a limit: the community’s patient, shared routine cannot reliably provide the level of supervision and treatment she needs during a crisis.

After Naoko’s mother visits from Kobe, the four of them—Naoko, her mother, Reiko, and the doctor—talk and decide that Naoko should move to a hospital for a period of intensive treatment. Reiko supports the decision even though she expects to miss Naoko and worry about her. Naoko herself would prefer to remain at the sanatorium and become well there, but the worsening difficulty of keeping her safe and supervised makes a specialist setting necessary. Reiko describes the next step not as abandoning hope but as continuing patiently, working through the tangled parts of Naoko’s condition one at a time.

The hospital’s tests later show that Naoko is improving for the moment, yet the recommendation is for a longer stay so that intensive therapy can continue. Reiko conveys this news in a letter, adding that Naoko may eventually return to the sanatorium if her progress allows. A later letter reports unexpectedly rapid improvement: Reiko has spoken with Naoko by telephone and found her lucid, and a return seems possible. The account thus records improvement as real but provisional, not as proof that the illness has ended.

A Brief Return and Plans for the Future

On August 24, Naoko’s mother calls to ask whether Naoko may visit the sanatorium. Naoko wants to collect belongings she left behind, speak at length with Reiko, and perhaps spend the night in their shared flat. She arrives the next day with her mother. Reiko had feared that hospital testing and therapy would leave her exhausted and unwell, but instead finds her healthier-looking than expected: Naoko smiles, jokes, talks more normally, and shows off a new hairstyle. Her mother leaves after Naoko assures her that she will be fine.

Naoko says she intends to let the hospital doctors cure her once and for all. During a walk with Reiko, she speaks about a future in which the two women leave the sanatorium and live together somewhere. Reiko asks about Watanabe, and Naoko says she will sort things out with him. She appears to have settled on a plan, and Reiko understands this sense of direction as part of the energy and confidence Naoko displays that day. The scene makes her improvement consequential: she is not merely described as looking well, but as imagining a life beyond treatment and the sanatorium.

As part of leaving the past behind, Naoko burns her diary notebook and the letters she has received, including Watanabe’s letters, which she had formerly kept and reread. She explains the act as clearing away the past in order to be reborn in the future. The gesture sits beside her intention to pursue treatment and her plans with Reiko, giving her apparent renewal a concrete form. Yet the narrative does not treat this resolve as a guarantee of safety.

Crisis and the Limits of Explanation

That evening, Naoko speaks openly to Reiko about her sexual experience with Watanabe and about the distress associated with intimacy. Reiko listens as Naoko explains that she does not want anyone to enter her body again. Naoko then breaks down in tears and asks Reiko to hold her. Reiko comforts her, helps her settle for the night, and believes she can sleep without immediate concern. The account places this intimate disclosure within the last hours Reiko spends with her, but does not establish it as a complete explanation for what follows.

When Reiko wakes at six in the morning, Naoko is gone. Her nightdress remains, but she has taken her clothes, trainers, and the torch kept beside Reiko’s pillow; Reiko realizes that the torch means Naoko left in the dark. A note asks Reiko to give her clothes to her. The residents and staff search the buildings and surrounding woods, taking five hours to find her. Reiko says Naoko had brought a rope. An ambulance takes Naoko away, and police question Reiko; the note makes the death appear to them to be suicide. The narrative gives these circumstances plainly but does not turn them into a definitive causal diagnosis.

Reiko’s account also preserves the painful contrast between the hopeful visit and its outcome. Naoko had seemed healthier, spoken about treatment, and made plans to live with Reiko, yet she died after leaving in the night. Her mother, Watanabe, and the people at the sanatorium are left with the consequences; Reiko telegraphs Watanabe after the police depart. The sequence shows why apparent improvement cannot be treated as certainty, while leaving Naoko’s illness more complex than a single event or a simple recovery story.

Illness, Death, and Grief

The novel places Naoko’s illness within a broader meditation on living alongside death, but it does not make that meditation a cure for bereavement. Watanabe had come to understand that death exists as part of life, a realization he associates first with Kizuki’s death. After Naoko dies, he travels west along the coast, unable to absorb that she is gone. Memories return in waves, and in them he can imagine speaking with and holding her; when that imagined closeness recedes, grief leaves him alone again.

Watanabe concludes that no truth, sincerity, strength, or kindness can cure the sadness of losing someone loved. The distinction matters to the portrayal of Naoko’s illness: neither a philosophy about death nor the care given by the sanatorium and hospital can make loss intelligible or remove its pain. After returning to Tokyo, Watanabe shuts himself away for days, his memory fixed on the dead rather than the living. Naoko’s condition and death remain consequential not because the novel supplies a final medical explanation, but because her uncertain course continues to shape the lives and relationships of those who survive her.