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‘Dementia 21’ review: And you thought American healthcare was bonkers

Shintaro Kago deftly combines realism and absurdity for a manga title that’s equal parts joyful, evocative, and jarring.

Maybe I’m just another spoiled, closed-minded Western reader, but I’ve never been able to get into manga. Yet my beloved girlfriend’s tween daughter is a manga maniac, and it seems as if these books/stories will inevitably become a part of my everyday language. Having rushed through some titles in the past, I recently jumped headlong into Dementia 21, the brainchild of illustrator Shintaro Kago. Across the 17-story collection, Kago delivers a blend of ideas and influences that demonstrates the pure power of this medium for devotees and the uninitiated alike. That, and plenty of graphic horror and chocolate.

Image credit: Fantagraphics Books

Dementia 21 follows the misadventures of Yukie Sakai, a home health nurse, as she goes about her job of healing the sick and soothing the elderly across an increasingly bizarre series of circumstances (featuring elderly lady monsters, self-replicating patients, exploding heads, giant aliens, and the disintegration of actual ideas/concepts, among other things). The weirdness alone would be enough to keep anyone interested. There’s a seemingly endless string of cosmic kerfuffles exploding in Yukie’s face, like a Fellini film starring the Three Stooges. Kago’s really playful in how he approaches the insanity, and that goes a long way to keeping things interesting without bombarding one’s sensibilities.

Still, there’s a draw far more effective than hyperspace wrinkles and zombie grandmas, and that’s Yukie herself. On the one hand, she’s a sweet and pleasant girl, trying to be a bastion of peace and good health to her clients. Yet she’s also trudging through all this malarkey as a means of ranking no. 1 within her agency (Green Net), which means better pay/bonuses. That creates this dichotomy that engages the reader in her journey. You almost want her to struggle, either to see if goodness can win out over all this insanity, or if the pursuit of excessive material goals only leads to ruin (or, in Yukie’s case, being devoured somehow). Either way, she’s an interesting character to subject to all this Lynchian madness: a perfect blend of desperation, heart, and a dash of self-delusion.

Yago’s artwork certainly helps bear a huge chunk of the emotional and narrative weight. For the uninitated (like me), a lot of the book has the same aesthetic feel as other manga, although Kago’s lines and attention to detail are top-notch. The best portions of the art may be the many “set pieces,” like the covers or huge one-panel pages. To some extent, they’re quite comparable to movie posters; there’s lots of exaggerated action and high drama in these extra lush pieces. Having this sudden uptick in theatricality, a sharp boom in the book’s greater aesthetic/artistic appeal, does a lot to keep the pace feeling fresh and to contextualize the sheer absurdity. That, and a lot of Yukie’s depth and charm comes via her specific movements and gestures.

Image credit: Fantagraphics Books

It’s not just internal movement–there’s a driving tension in the book. That’s all thanks to Ms. Ayase, another aide who’s come in second to Yukie in the rankings. Rather than work hard to improve, she uses her relationship with a manager to screw over her rival. Sure, she’s bad to the bone, but there’s still a certain honesty to her treachery and that makes a difference. It’s this nasty streak that keeps her in charge as Yukie bounds between increasingly dangerous jobs. In a way, you need something relatable about a protagonist. Not only because it gives you a reason to believe in their efforts, but also because it provides keen insights about the story and the hero. In this instance, that means a thread of near-comedic intensity that powers and contextualizes the barrage of otherworldly action.

In reading the book, I became deeply interested in this dynamic between Ms. Yakai and Ms. Ayase. It’s this rivalry of sorts that feels like a powerful commentary on a few key elements. Namely, the nature of competition, female relations in the workplace, the fruitless pursuit of rankings and status, and the chaos of modern medicine. Or it’s absolutely none of those things, and we can divine meaning by how we each interpret this parade of bizarreness.

Either way, I think Kago has at least stumbled upon this slightly meta commentary about storytelling. That if you set up the right circumstances, and give your characters something to fight for, you’ll be surprised how things turn out. The sheer insanity that is born, and the depths characters are willing to go to achieve their prime objectives. That idea pushes the book forward in a big way. With that said, the whole process can feel slightly repetitive (Yukie meets patient, nuclear weirdo bomb goes off, struggle for resolution, generally happy ending).

Image credit: Fantagraphics Books

As a reader, however, you’re right there with Yukie, wading through the muck to see just what happens, to cut through all the kooky vines and chance upon a resolution or just more crazy patients. The book’s described as a part of Kago’s own genre, “fashionable paranoia.” To me, that’s a great encapsulation of the book’s successful efforts in making this hungry pursuit for what’s next resonate with heart and depth (even when it’s totes weird). It’s a commentary about how insatiable we all are in moving through a chaotic world, and what that might show (or gift) us in the long run.

As deeply as I enjoyed this book, it doesn’t necessarily mean I’m a manga convert. Rather than taking away an intense sense of fandom, I now more fully understand just what makes this format so effective: the value of humor and general weirdness, the heightened sense of reality, an ownership of something so niche, and the freedom of creators to explore unique ideas. If nothing else, I now have something new to discuss with my little family unit.

Dementia 21
Is it good?
Shintaro Kago deftly combines realism and absurdity for a manga title that's equal parts joyful, evocative, and jarring.
Beautiful, deeply realistic art that's both engaging and traumatizing
Endless oddities balanced with a certain depth and sense of pacing
Zombies and chocolate showers
Some of these stories suffer from tedious repetition
The larger story structure may not be everyone's cup of tea

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