[3][2] Setouchi studied Japanese literature at Tokyo Woman's Christian University before her arranged marriage to scholar Yasushi Sakai in 1943.

[4][5] She began to shift her novel writing focus to historical female writers and activists,[5] eventually including Kanoko Okamoto, Toshiko Tamura, Sugako Kanno, Fumiko Kaneko,[4] and Itō Noe.

[6] In 1963, she was awarded The Women's Literature Prize (Joryu Bungaku Sho)[5] for her 1962 book Natsu no Owari ("The End of Summer"),[7] which became a best-seller.

[4] In 1973, Setouchi began training to become a Buddhist nun[3] within the Tendai school of Buddhism,[8] and received her name Jakuchō,[3] which means "silent, lonely listening.

[4][8] She received the Tanizaki Prize for her novel Hana ni Toe ("Ask the Flowers") in 1992,[9] and was named a Person of Cultural Merit in 1997.

[12][10] She considered Prince Genji to be a plot device for the stories of the women of the court and used a contemporary version of Japanese for her translation.