Introducing the Japanese Imperial System – Part II

banner imperial system part 2Welcome to part two of my imperial blog post! Last time, we covered some of Japan’s oldest and newest emperors, today we will have a look at who’s in between. There truly is a lot to say about Japanese emperors (they are, one might argue, the backbone of the Japanese state), so I would like to give you a little bit more contextual information (the history of Japan in a nutshell) while simultaneously highlighting the accomplishments (and failures) of some of these rulers. Like I told you before, there have been 125 emperors thus far, allegedly all part of the same family since 600 BC. The first emperors and empresses are of rather legendary status and not much historical evidence can be found to verify their actions or even their existence.

At the end of the 7th century, a more reliable system of imperial era names (gengō 元号) was introduced, indicating a new era period in which a new emperor ascended the throne, or another historic event of great importance. Since the Meiji period, new era names could only change with every new emperor. Today, this system of periodization is still in use: the current year (2017 AD), for example, is Heisei 29 平成二十九年. Heisei indicates the period of emperor Akihito’s reign, and 29 is the 29th year of his ascension in 1989 (Heisei  1 = 1989). The name of the period refers to the posthumous name of the emperor. As such, the previous era, the Shōwa period (1926-1989), is named after Akihito’s father Hirohito, whose posthumous name is Emperor Shōwa. The names of emperors I mention in my blog posts, are always their posthumous names, with the exception of recent emperors. You might think this practice is outdated but nothing is less true. All official documents, newspapers, and other texts you will come across as a student of Japanese studies, use this era-naming system. Be prepared.


The Meiji emperor, aka Mutsuhito

Another link between emperor and era system is the place where the imperial family lived: the home city of the emperor was de facto the capital of Japan. Before the 7th century, assumed capitals are as legendary as their inhabiting emperors. It was customary to move the capital with every new emperor, since the demise of the previous one had “tainted” the palace. However, when Empress Genmei settled in Nara, then called “Heijo capital” (Heijō-kyō 平城京), it remained the capital for around 70 years (with one interruption of five years). Today, Nara is certainly worth visiting, with its historical palace Heijō-kyū 平城宮, many temples and shrines. The city itself was built in the middle of nowhere and was a smaller version of the Chinese capital Chang’an, structured in a grid pattern. Based on geomantic Feng Shui principles, the city is surrounded by mountains on three sides, a river that flows from North to South, and a palace facing South. It quickly urbanized and the population grew exponentially – yet it must be said that the inhabitants were mainly aristocrats (including the imperial family), civil servants and the clergy, the soldiers that protected them and the people who provided for their needs.

The Japanese Emperor had never been this powerful: he or she represented the central state (the old Japanese word for emperor, mikado, was even written in Chinese with the characters for state 国家), owned all of the land and the people on it and was above the law. The emperor ruled Japan by means of a centralized bureaucratic system. Under Empress Genmei’s reign, the discovery of Japanese copper was made and the Kojiki (“Records of Ancient matters” 古事記) was compiled. Succeeding her was Empress Genshō, the only female ruler that inherited her title from another empress regnant.


Emperor Shomu

The next Emperor, Shōmu, was the first to marry a “commoner”, someone outside the imperial family: a Fujiwara consort. If you know a little bit about Japanese history, you’ll probably recognize the name Fujiwara. The Fujiwaras were an aristocratic clan that basically monopolized all political power throughout the Heian period (794 – 1185). They maintained this power by marrying off their female family members to the emperor, hence securing a position as regent (sesshō 摂政or kanpaku 関白). As was often the case in history and still is in many countries today, the one with the highest position in theory does not hold as much power in practice as the one situated just one rank lower in hierarchy. You can compare it to a monarchy in which the prime minister is in charge and not the king. Emperor Shōmu also set the trend of retiring as a Buddhist priest.

Speaking of Buddhism, when the imperial family in Nara started to feel threatened by the power of the Buddhist clergy, Emperor Kanmu moved the capital to Kyoto (heian-kyō 平安京) in 794, where it would remain until mid-nineteenth century with the exception of a “pop-up” shogunate capital in Kamakura in the twelfth century.  Again, the city was modelled after Chang’an (and Nara). The palace, Daidairi 大内裏 or Heian-kyū 平安宮, lasted for five centuries until it burnt down to the ground – it doesn’t help that it was (re)constructed mainly out of wood. Besides arson, a lot of things happened during the Heian period. As I mentioned before, the court was practically kept under the Fujiwara’s thumb. The imperial family lost much of their “public” authority (my professor called this development a “privatization of the imperial power”) and had to compete with rivaling families by accumulating private properties and ruling the country through other, not so direct means.

The emperor was soon nothing more than a state symbol, tasked with the performance of religious ceremonies. Life at the Heian court was ridiculously luxurious and the gap between the aristocracy and the common people could not have been greater. As we know from writings dating back to the 10th century, court nobles cared a lot about their appearances, each others’ manners and spending their days in leisure (examples here). Peace at the Heian court was disrupted when the Genpei 源平 war (described in the Heike Monogatari) broke out. The war was fought between the samurai of the Fujiwara’s (Minamoto 源 clan) and the warrior of the Emperor (Taira 平 clan). Yoritomo Minamoto seized power and established the first shogunate government (bakufu 幕府) in Kamakura. This move created a diarchic situation in which the emperor had even less power than before.


Emperor Go-Toba

Here, the story becomes a little bit inception-like: the family that was really in charge of the shogunate was not the Minamoto’s, but the Hōjō 北条 clan. This family was related to the Taira, but betrayed them to the Minamoto clan, before betraying the latter as well. After Yoritomo’s death, they occupied the position of regent through intermarriage not only to the bakufu, but even to the emperor, hence reducing both players to puppets. Fujiwara 2.0, let’s say. Some emperors tried to reverse the situation, like the retired emperor Go-Toba, who sent an army to Kamakura. This attempt failed and the imperial family was severely punished. Emperor Go-Daigo was more succesful. Although his conspiracy against the Hōjō failed and he was sent into exile, other “underdogs” revolted and destroyed the Hōjō clan, including its Kamakura shogunate, in 1333.


shogun Yoshimitsu, sad because he couldn’t become emperor

Emperor Go-Daigo returned and established his own government, but managed to make himself so unpopular that he failed to consolidate imperial power, and soon a second shogunate was founded in Kyoto by Ashikaga Takauji. As the new shogun, Takauji put an emperor of his choice on the throne over which he ruled de facto. But ex-emperor Go-Daigo was not yet defeated and moved his own court to Nagano, close to Nara. As a result, there were two courts: one in the South, and one in the North, dominated by the bakufu. In 1392, the Southern court surrendered. Again, the Emperor was just a puppet with pretty clothes on, now closely watched by the bakufu residing in the same capital. And yet, someone was jelly. For shogun Ashikaga Yoshimitsu, ruling over Japan was not enough – he aspired to become emperor. His master plan was to have an imperial prince adopt his own son, make his son emperor and promote himself to “retired emperor”. He died too early to succeed. He did receive the title of “King of Japan” from China, though. And he lived in a fancy golden temple (kinkakuji 金閣寺).


The flower palace (Hana no gosho 花の御所), political and cultural center of the Muromachi shogunate

There was another big war, and things went from bad to worse. The emperor was now completely obsolete and had barely enough money to pay for his own coronation ceremony. Emperor Ōgimachi had to borrow money from powerful feudal lords (daimyō 大名) to be able to buy some sake. One ambitious daimyō in particular, Oda Nobunaga, conquered all other daimyō (I’m jumping to conclusions here) but remained emperor-friendly: he protected Ōgimachi, restored the palace and guaranteed his daily bread (or rather, rice). After he was murdered, Toyotomi Hideyoshi finished the job of unifying Japan. Hideyoshi was also keen to befriend the emperor. He had himself adopted into the Fujiwara family and eventually became regent to the emperor. Power relations were clear, though, as Hideyoshi built a palace exceeding the imperial palace by far in size and splendor and invited the Emperor to visit him there (it should be the other way around).

The seventeenth century and Hideyoshi’s death called for a new leader. Tokugawa Ieyasu became shogun in 1603 and moved the political center to Edo, nowadays Tokyo. The imperial family as well as aristocratic clans in Kyoto were granted some means, but their freedom was restricted to minimize the least chance of a rebellion. They had to act in accordance with a code (Kinchū narabi ni kuge shohatto 禁中並公家諸法度) that forbade them to be politically engaged or appoint members for the administration, and forced some princes to become monks, among other rules. When Emperor Go-Mizuno’o was so sneaky to appoint religious leaders behind the bakufu‘s back, the imperial family was completely stripped of their power. They even had to start teaching to earn a living (imagine!). Basically, the emperor was tolerated yet ignored throughout the Edo period.

edo castle attendance

The Edo castle


Emperor Kōmei

Two centuries later the situation turned around. The sonnō-jōi 尊王攘夷 (“revere the emperor, expel the barbarians”) movement wanted to kick the foreigners out of Japan who had been demanding trade relations from 1853 on, as well as teach the shogunate a lesson. Despite initially testing the water with some tentative proposals that were pro-bakufu, they couldn’t get over the fact that the bakufu signed treaties with the foreigners without consulting the emperor. They received support from Emperor Kōmei and in 1867, the bakufu was abolished and the shōgun surrendered his power to the emperor.

The Meiji restoration (meiji ishin 明治維新) was meant to restore imperial rule. As we have seen throughout this post, the emperor was in fact most of the time powerless, so they had to look back as far as the Nara period to imagine what prerogatives a ruling emperor should be given. The structure of Jinmu’s administration was also a source of inspiration. The imperial court was moved to Tokyo and replaced the shogunate there as the political center. Fans of the bakufu resisted but were defeated in the Boshin 戊辰 war. The Emperor became so important that the Meiji Constitution was practically written to solidify his divine sovereignty. He was also appointed supreme commander of the Japanese military force.

meiji moving to tokyo

Western drawing of the Meiji emperor moving from Kyoto to Tokyo.

During the Shōwa period (1926-1989), the extreme veneration of the Emperor was exploited as a war strategy: kamikaze pilots sacrified their life in name of the emperor. Today, the role of Hirohito in World War II is still a controversial topic: some see him as a war criminal who actively took part in plotting atrocities and expansionist policies, according to others he is a tragic hero who opposed the military’s decisions but was unable to keep the situation under control. Hirohito was never convicted.

The rest of the story you already know. After Hirohito’s death, Akihito ascended the throne, not as a divine sovereign, but as a human being and purely a symbol of the state. There occurred a couple of anti-emperor incidents, like the Toranomon incident (a communist attempted to assassinate prince Hirohito) in 1923 and an incident in 1959 in which a boy threw a stone at the wedding carriage of Akihito and his wife (he did not agree with the fact that they had spent tons of tax money on the ceremony). I described these incidents in my Japanese thesis about mental health stigma, since the perpetrators were often (falsely) declared “mad” and institutionalised because of the “Chrysanthemum taboo” 菊タブー Kiku tabū: a taboo on criticizing or even discussing the emperor and the imperial system. The underlying idea was that someone who was against the emperor could only be out of his mind.

wedding akihito 1

marriage parade of Emperor Akihito and “commoner” Michiko

And yet, I suspect there will remain a Japanese emperor on the throne for quite some time from now. A survey by NHK in 2009 revealed that only 8% wanted to have the imperial system abolished, while 82% stated that they were just fine with an emperor as symbol. Only 6% believed he should be given political power. I think the Japanese simply cannot do away with the imperial system because it is intrinsically linked to their country’s past and present – and you have to admit, it’s quite the family history.

Fun Facts

  • Somewhere from the Heian period on, the Emperor’s names appear to be dictated by a rule that they should be composed of two Chinese characters, the first one of choice and the second one hito 仁, meaning “perfect virtue”. The names of female members of the imperial family end in ko 子, meaning “noblewoman” traditionally. While hito 仁 is highly unlikely for “commoners”, ko 子 is a popular suffix for female names.
  • The Tokyo Imperial Palace was built on the ruins of the bakufu‘s Edo Castle.
  • Watch this cook prepare a fish for the emperor (be patient). You should keep in mind that this food was actually offered to the gods, after which the emperor could eat from it, hence the elaborate ceremony.


  • Vande Walle, Willy. Een geschiedenis van Japan van samurai tot soft power. Leuven: Acco, 2011.
  • Encyclopedia Britannica
  • Wikipedia
  • All pictures are from Wikimedia Commons
  • 井上章一『狂気と王権』東京: 講談社, 2008

Introducing the Japanese Imperial System

japanese imperial system banner NippakuOn (long overdue) request of my good friend Seppe, I wanted to talk to you about the imperial system in Japan this time. And by “the imperial system”, I do not mean the confusing and ridiculous measurement units that some countries are still using today (metric system fan over here); no, in this post I attempt to make you aware of the amazing fact that almost the entire Japanese history is marked by the presence of an emperor (tennō 天皇, “heavenly sovereign”, introduced as a Japanese counterpart for the Chinese term). The Japanese emperor, occupying the Chrysanthemum Throne, fulfills a symbolic role as ceremonial head of the state and is “boss” of the Shintō religion (神道).

Today, Japan is the only country with an emperor in the world – and even more impressive, it has always been the same imperial family! The first Japanese emperor, Jinmu 神武, allegedly came to power in the 7th century BC, and although it is difficult to prove that the current emperor is related to this mythical figure, we know almost for sure that since 500 AD the same family has reigned. I keep finding it very difficult to wrap my head around this unbroken chain of hereditary monarchy, that unlike European royalty, did not lead to extreme cases of family illness, deformities and other royal genetic disorders due to intermarriage. Of course, the Japanese imperial family has its fair share of inherited diseases (e.g. “mad” emperors), but none are as far-going as the hemophilia in queen Victoria’s bloodline or the Habsburg jaw as exemplified by Charles II, among others. A possible explanation is that the Japanese imperial family is not an unbroken chain of blood relatives: indeed, the emperor’s wife was often supplied by a powerful family such as the Fujiwara’s in the Heian period, and was not necessarily related to the imperial family (not to mention the many concubines, with the system of concubinage only abolished in 1924).


The Meiji emperor and his family (not really looking all that human but let’s blame the painter and not genetics for that)


Emperor Akihito

Recently, the 125th Japanese emperor, Akihito明仁, has been receiving a lot of media attention because of his request to abdicate and to install his eldest son Naruhito徳仁 on the throne. Emperor Akihito, who is 83, fears that his advanced age and health problems will prevent him from performing his imperial duties in the future. This is quite a unique situation since the last time this happened was two centuries ago. It is also slightly problematic because in 1889 a law was passed that demands emperors to reign until their death. Hence, a legal change was made by the parliament last June: the new legislation, however, is only applicable to emperor Akihito and in case of more abdication plans from future emperors, the parliament will have to pass a new law.

But let’s start from the beginning. As I said before, Jinmu 神武 (real name: Kan’yamato Iwarebiko, born 711) is mentioned as Japan’s first emperor in the country’s oldest, 8th-century historical records “Records of Ancient Matters” (kojiki 古事記) and “the Chronicles of Japan” (nihonshoki 日本書紀). Jinmu came to power around 660 BC. According to legend, Jinmu is related to Amaterasu 天照, the sun goddess, born to the deities Izanagi 伊邪那岐 and Izanami 伊邪那美who created Japan. In short, Amaterasu’s grandson, Ninigi no mikoto, fathered Jinmu’s grandfather. Jinmu and his brother battled their way from Southern Kyūshū up to other domains, eventually reaching Yamato (an area located in nowadays Nara prefecture). There, Jinmu ascended the throne and became the ruler of the first united Japan – which he named the Dragonfly Islands (akitsushima 秋津島). The legend also claims that Jinmu died at the advanced age of 126. Other parts of the story that are difficult to believe are the date of Jinmu’s ascension, assumed by historians to have happened at least a couple of centuries later.

Emperor_Jimmu by Yoshitoshi

Emperor Jinmu

Jinmu is remarkably unremarkable when it comes to his veneration, save for the period in Japanese history between the Meiji period and the end of World War II. During its transformation into a modern nation-state, Japan restored imperial rule in order to maintain control over the country. The role of the emperor, for example, was central to the Meiji Constitution promulgated in 1889 (translation here).


Emperor Hirohito – A controversial figure: was he a war criminal?

In the year 1940, the 2600th anniversary of Jinmu’s ascension, and thus the founding of Japan, was celebrated all over the country. The Japanese often claimed during wartime that their superiority was due to this long-standing (yet probably fictitious) tradition. The renewed attention for emperor Jinmu and the extravagant festivities can be interpreted as a sign of “reactionary modernism”, similar to what had inspired the Meiji revolution. But after Hiroshima and Nagasaki were bombed, the imperial fun was over: emperor Hirohito 裕仁 declared on 1 January 1946 that he was not a “deity in human form” (akitsumikami 現つ御神) but a human being like everyone else. His son, Akihito, the current emperor, is the first to have fulfilled his imperial duty as a human being, not as a descendent of the Sun Goddess, Amaterasu.


Amaterasu, the Sun Goddess

Despite securing their divine status through a female ancestor, the list of female emperors in Japanese history is woefully short. The list of excuses for this fact, on the other hand, is unsurprisingly long. Apart from the good old patriarchical explanations, another reason is that becoming an emperor is actually a sexual thing, symbolizing the – heterosexual – intercourse between the emperor-to-be and Amaterasu in his ascension ritual (nothing beats a little incest).

The Imperial Household Law from 1947, drawing inspiration from the 1889 Meiji Constitution, clearly stipulates that only men can become emperor. When Prime Minister Koizumi proposed a change pro female succession a decade ago, more than 170 lawmakers opposed. When princess Nagako, Hirohito’s wife, gave birth to 4 girls in a row before delivering Akihito, there was a serious debate going on about whether or not to bring back the concubinage system instead of opting for a female heir to the throne (we’re talking about the 1920s). Moreover, when female members marry someone outside the family, they lose their status until this day. There are, however, rumors that the new legislation that will cover Akihito’s abdication, could also include a resolution to allow female members of the imperial family to retain their status after marrying a commoner. In short, even today, the Japanese still believe that the idea of a woman on the imperial throne is ludicrous.


Empress Jingu in Korea

This was, however, not always the case. Throughout history, there were 9 reigning empresses, two of them ruling twice. The first one, Empress Jingū 神功 (3rd century AD), is a legendary figure of whom not much is known, not even if she really was a reigning empress. In the picture above, she is depicted invading Korea, the invasion is itself being a controversial topic as well, although there is some historical proof of Japanese influence in Korea around the 4th century. It is also believed by some researchers that Western Japan during that time was characterized by a matriarchical society, as Korean and Chinese sources referred to the area as “Queen Country”. Others identify Jingū as Himiko 卑弥呼, the legendary shaman queen of Yamatai.


Empress Suiko

But let’s move on to one of the female rulers of whom we know for sure that they existed and fulfilled the role of Empress during their lifetime: Empress Suiko 推古, for example. At the end of the Kofun period (3rd to 6th century) and start of the Asuka period (538 – 710), Yamato was ruled by a handful of powerful clans like the Mononobe, Nakatomi and Soga. The Soga clan wanted to gain more power, started a feud over the imperial succession, destroyed the other two clans and installed their own man on the throne. The latter was, however, not as obedient as expected and they got him assassinated. He was replaced by Suiko, a remarkable choice in that time (Japan was no longer a “Queen Country”). The Soga were huge fans of Buddhism and everything else Chinese, and Suiko was the first to adopt Buddhism as the state religion instead of Shintō. Together with her nephew, (semi-legendary) regent Prince Shōtoku 聖徳太子, she also imported many cultural elements from oversees, for example the Chinese calender, the bureaucratic system and Chinese artistry. She reigned for 35 years.

I sense that the length of this post – like many of my previous posts – could already be testing the attention span of my dear readers, so I will leave it there for now. But since there is  so much more to say about Japan’s emperors in my opinion, please look out for a sequel to this post on Nippaku!

Fun Facts 

  • The emperor’s birthday is a national holiday. Yay!
  • Akihito is the first Emperor to have married a commoner. He met Empress Michiko on a tennis court, which lead to a boom in the popularity of tennis in Japan. Unfortunately, Michiko was bullied by the media and allegedly by her stepmother for lacking imperial ancestry. The stress that caused her resulted in health problems.
  • As a splendid example of a sunekajiri すねかじり (“sponger”), Naruhito lived with his parents until he was 30 years old.
  • The Japanese imperial family members do not have a surname. I once heard that someone related to the emperor (Prince Mikasa, I believe) got a job as a university professor, which posed a lot of difficulties regarding how students should address him (teachers are always addressed by their last name) and some administrative troubles as well, I guess.
  • There is a specific vocabulary to talk about the Emperor. There is a word for the Emperor’s face (ryūgan 龍顔) and voice (gyokuon玉音), his feelings (shinkin 宸襟), the trips he makes (= junkō 巡幸), and his death (= hōgyo 崩御) [Read more here]. Moreover, the Emperor is never called by his name like I do in this blog post (I’m so rude). While foreign newspaper report about “Emperor Akihito”, the Japanese call him very politely “His Imperial Majesty the Emperor” (tennō heika 天皇陛下) or, more objectively “The current emperor” (kinjō tennō 今上天皇).


  • New York Times 
  • Ruoff, Kenneth J. Imperial Japan at Its Zenith: The Wartime Celebration of the Empire’s 2,600th Anniversary. Studies of the Weatherhead East Asian Institute, Columbia University. Ithaca ; London: Cornell University Press, 2010.
  • Facts and Details 
  • Encyclopedia Britannica
  • Wikipedia
  • All pictures are from Wikimedia Commons

A History of Hansen’s Disease in Japan: the Isolation Policy as a Violation of Human Rights

leprosybannerSome months ago, I wrote a paper for Culture and Disability, an elective course in my Anthropology program. I took this course because, as you all know, I am very interested in the history of medicine (and in medical anthropology as a whole), in particular in the Japanese history of psychiatry and its relation to culture. One series that I publish here regularly is the history of mental health stigma in Japan (see part 1, 2, 3, 4, 5). While researching this topic, I noticed that it bears many similarities with how Hansen’s Disease (leprosy) patients were treated throughout Japanese history: some sources on mental health I read perceived both types of patients as similar victims of medical injustice. In this post, I will focus on the Isolation Policy, a law that prescribed the forced segregation of Hansen’s Disease patients in Japan and was only recently abolished. I selected the parts from my paper that I believe could be of interest to you and skipped my theoretical analysis, so this post is only a very general introduction to the topic of leprosy in Japan.

In May 2016, an extraordinary thing happened: the Japanese Supreme Court Chief Justice apologized for the discriminatory practices towards leprosy patients the court had engaged in (Japan Times, 2016). The apology was a reaction to the findings of an investigation, requested by former leprosy patients in 2014. Between 1948 and 1972, special courts were established at facilities for leprosy patients, based on the wrong assumption that Hansen’s disease is highly contagious. In trying leprosy patients outside of standard courtrooms, the Constitution’s principle of equality was violated and discrimination was fostered. The fact that news on leprosy in Japan is still featured on a regular basis, points toward the significant role played by policy stipulating the treatment of Hansen’s disease patients. But what exactly is Hansen’s disease or leprosy?


Leprosy is a chronic, infectious disease caused by the bacilli Mycobacterium leprae. Also named ‘Hansen’s disease’ after the Norwegian doctor Gerhard Armauer Hansen who discovered and identified this specific bacterium as the cause of leprosy in 1873, both the terms ‘leprosy’ (raibyō 癩病[1] ) and ‘Hansen’s disease’ (hansenbyō ハンセン病) have been used in Japan, although the latter is strongly preferred in today’s discourse because of its neutrality[2]. In the long term, Hansen’s disease results in the formation of granulomas, or collections of immune cells, called macrophages. This is manifested in the growth and expansion of nodules, or lumps, and patches, or macules, on the skin and eyes, and eventually weakness, deformities and paralysis. The bacterium further affects internal functions such as the respiratory tracts and peripheral nerves. Patients experience a loss of sensation due to the weakening of the nervous system, and may damage their limbs.

leprosy who

From World Health Organisation, Global Leprosy Strategy
2016–2020 (p. 3)

One of the misconceptions concerning leprosy is that the disease itself causes the loss of body parts, while it is actually the result of lacking the necessary motor functions and the sensation of pain, due to which the patient fails to notice injuries or infections (, 2014). Another, more serious common misunderstanding of the disease concerns the need for the isolation of the patient once he or she is diagnosed. Contrary to popular belief, a historical remain that was disproved by scientific discoveries in the twentieth century but is still prevalent today, leprosy is not highly contagious and relatively easy to cure with free multidrug therapy. Hence, isolation is in fact not necessary. Since the year 2000 globally, and in most countries from 2005, Hansen’s disease is no longer considered a public health problem. Yearly, thousands of patients have been treated back to health and over the past twenty years, this number has exceeded sixteen million around the world (WHO, 2016). Japan counts around 1,500 institutionalized patients and this figure continues to decrease (Ministry of Health, Labor and Welfare, 2016).


A wife and her leprose husband

Not much is known about how leprosy first came to Japan, but the disease appears to have been around since the eighth century. Already then, leprosy was regarded as “transmittable to those nearby (Kikuchi, 1997:629)” [3]. During the middle ages, ‘lepers’ were forced to live outside the community, sometimes creating their own leprosy colonies (Sato & Narita, 2003), and to beg for food at places of worship. This was morally justified by a common perception of hereditary ‘impurity (kegare穢れ)’ (Encyclopedia Nipponica, 2001). Leprosy was also regarded as a punishment in the next life for those who did not respect Buddhist sutras. Christian missionaries from Europe took an interest in leprosy patients, pitying their neglected and discriminated position as ‘discarded people’ in society, but were soon suppressed by the Edo government after it had banned Christianity in 1620. Hansen’s disease patients were even sentenced to death because of their religious affiliation with their benefactors (Yamamoto, 1993).

At the beginning of the Meiji period (1868-1912) there were more than 30,000 leprosy patients in Japan. Statistical surveys published numbers going between 23,660 leprosy patients in 1897 to 30,359 patients in 1900 (Goto, 2011: 99), although these numbers are probably underestimated since statistical methodology was still in its infancy at that time (Kikuchi, 1997). A 1898 report on the situation in Japan, written by the United States Consulate, further specifies: “We learn that it is almost universally recognized by the medical authorities that leprosy is a contagious disease, and that the terrible disease is most prevalent where fish is most freely used as an article of food (Gowey, 1898:211)”. Ascribing the overconsumption of fish as a cause, on the one hand, is related to the belief that eating too much would result in leprosy. According to Burns (2012), “[a]lmost every text on leprosy included a lengthy list of foods to be avoided (p. 302)”. The presumed contagiousness of leprosy, on the other hand, corresponded with the ‘resolutions’ of the First International Conference about Leprosy, held in Berlin in 1897 (Pandya, 2003). This encouraged the Japanese attendees to pursue a segregation policy.

First Steps towards an Institutionalization of Leprosy Patients

leprosy hannah riddell

Patients at the hospital established by Hannah Riddell. Picture from Anglican History

Around the end of the nineteenth century, European missionaries, motivated by the same Christian values as their predecessors, began to establish facilities for leprosy patients in Japan. Father Testevuide from France was the first to open a relief center for Hansen’s disease patients in 1889, which he transformed three years later into Japan’s first leprosarium. Significant for Japan’s leprosy history is Hannah Riddell, an English missionary who established a hospital for Hansen’s disease patients in 1895. Yet, the movement towards institutionalized treatment was not limited to the endeavors of foreign missionaries. Leprosy had become a topic of medical discussions in eighteenth and nineteenth-century Japan, informed by western medicine. Already in 1874, esteemed doctor Gotō Masafumi had petitioned for the public funding of future leprosaria (Burns, 2012). Gotō claimed that the water therapy he had discovered was the best cure for leprosy. He founded a private hospital in 1872 to perform his leprosy treatment, but inspired by European examples (he suggested that European states had eradicated leprosy by establishing public leprosaria), he aimed for a similar system on a national scale. Eventually, Gotō received funding and his hospital in Tokyo officially became a ‘leprosy ward’.

This is surprising, since the doctor could not show much evidence of the effectiveness of his treatment. It is, however, explicable with the Japanese political situation in mind: after more than two centuries of isolation from mainstream society, the Meiji revolution marked the beginning of a new era. Being forced to open up its borders by the western powerful states and to sign unequal treaties, Japan was desperate to present itself as a modern, strong and civilized nation and prove to the world that it had left its ‘barbarian’ past behind. To succeed in this, it promoted western knowledge, including medicine[4], and European policies, such as the establishment of leprosy hospitals[5]. Additionally, the Japanese press responded to the desire for progress and compassion by painting Gotō as a heroic Samaritan. Hence, to solve the problem of Hansen’s disease, ‘a national shame’ in comparison to an almost leprosy-free West, the government only became actively involved in the treatment, or rather containment, of the disease when it believed its future prospects were being threatened by leprosy patients and other ‘dangers’: “Public health and medical policy, it was argued, by linking individual health to the economic well-being and political security of the nation valorized the vitality and productivity of the citizenry and rendered the poor, the weak, and the sick as dangerous “others” who threatened the Japanese nation and empire (Burns, 2012: 298)”.

The Leprosy Prevention Law

In other words, the Japanese government at first did not show much interest in tackling leprosy between 1868, when Japan opened up its borders and underwent a process of modernization, and 1902. Due to a convergence of interests of both the Japanese government and certain physicians, the 1907 law concerning the prevention of leprosy (rai yobō ni kansuru ken癩予防ニ関スル件) was passed that ordered the creation of five publicly funded leprosaria to confine the ‘lepers’ starting from 1909. It must be noted, however, that it targeted especially leprosy patients roaming the streets and the poor, thus not those who were cared for at home, and whose supervision was the task of the police (Hirokawa in Wittner & Brown, 2015). Public safety was still prioritized over welfare: around the leprosaria were walls and gates, and two of the leprosaria were built on small islands. Pictures below show the leprosaria Tamazenshoen in Tokyo and Aiseien in Nagashima (many more interesting pictures of Hansen’s disease hospitals today on

From the 1930s on, scientists started to doubt the necessity of compulsory segregation, since the mortality rate, infectiousness and chance of a sudden outbreak turned out to be lower than estimated. Nevertheless, the Japanese government strengthened its approach of isolation in legal terms: the Leprosy Prevention Law (rai yobō hō 癩予防法) of 1931 stipulated the forced segregation of leprosy patients. Between 1929 and 1934, a movement called ‘No Leprosy in our Prefecture’ (muraiken undō無癩県運動) and funded by the government, aimed to collect money for the establishment of leprosaria in each prefecture. This movement had laid the foundations for the 1931 law. The Hygienic Bureau of the Ministry of Home Affairs wrote in 1930 in a pamphlet titled Measure for the Eradication of Leprosy that “Japanese citizens are exposed to the extreme danger of leprosy infection” to justify their policy of absolute segregation. This time, the law was applicable to all patients, regardless of their financial status (Goto, 2011). Consequently, people who had previously been nursed at home, were now forced to move into a designated leprosarium.

While abroad isolation policies quickly came to be questioned due to scientific developments such as chemotherapy in the 1940s and epidemiological studies, Japan maintained its policy of strict segregation for decades (Sato, 2002). During the occupation of the Korean peninsula (1910-1945), the Japanese also enforced this policy among the occupied population (Sase e.a., 2004). The Leprosy Prevention Law was revised in 1953, but maintained its policy on leprosy: mandatory segregation, prohibition to leave the institution and punishment – often imprisonment – for those who disturbed the peace (Yamamoto, 1997).

Maintaining Forced Segregation

Why did Japan persist in its policy of segregation, even when it became openly criticized during international conventions from the 1950s on? It has been suggested that since the number of leprosy patients in Japan and its colonies was relatively small (compared to the one million tuberculosis patients at that time), obligatory confinement was introduced simply because it was possible (Goto, 2011). It was maintained, then, to avoid policy changes. Since more than 90 percent of leprosy patients was hospitalized without the possibility for rehabilitation by the 1960s, the switch towards outpatient services was deemed too difficult and had low priority (Sato & Narita, 2003). The revision of the Leprosy Prevention Law in 1953 was based on the expert advice of three leprosarium directors, who – unsurprisingly, and despite patients’ protest – attested in favor of compulsory isolation (Sato, 2002).

leprosy promin

Promin medicine – Picture from Ehime Prefecture site

Moreover, segregation from healthy Japanese people was still prioritized over the well-being of the patients in question: mainly poor people such as farmers on the countryside suffered from Hansen’s disease, and they could not afford treatment at the few university hospitals located in the big cities (Goto, 2011). The spread of leprosy medicine, especially Promin at that time, was also lagging behind in Japan. Furthermore, patients who had been hospitalized for most of their lives ended up as depending on their institutionalization, since they had nowhere to go outside of the leprosarium: outpatient treatment or other services were very scarce to informal – not to mention the stigmatization patients would experience from the Japanese people they had been hidden from. In short, because Hansen’s disease patients had been rendered invisible for many years, there was no need and much reluctance to change or undo the established isolation policies.

The Abolition of the Isolation Policy

In the years after the revision of the Leprosy Prevention Law, the strict rules of the isolation policy were slightly loosened[6], but the law remained in force until its abolition in 1996. In the process towards an abolition of the law that had forcibly separated them for decades, leprosy patients, united in the Federation of National Leprosarium Patients (zenkoku kokuritsu rairyōyōjo kanja kyōgikai 全国国立ライ療養所患者協議会), played an important role. The federation requested a revision of the law, based on the scientific knowledge that Hansen’s disease did not require compulsory segregation, which was a violation of their human rights and fostered stigmatization in Japanese society.


A Hansen’s Disease patient reads braille with his tongue due to a lost sense of touch in the fingertips – Book with Pictures called “90 Years of Segregation” by Tada Junichi

Nevertheless, Sato (2002) points out that the patients’ voices were divided over the existence of the Leprosy Prevention Law: on the one hand they perceived themselves as victims of the law, on the other hand they did not want to lose the care and housing the government was legally bound to provide them with due to that same law. Hence, the federation decided to lobby in favor of an improvement, not an abolition. The leprosarium directors as well as the Ministry of Health and Welfare were reluctant to put an abrupt end to the law because of the reasons mentioned above: the directors feared for their hospitals, and the ministry saw the transformation of leprosaria into rehabilitation centers as financially unfeasible.

One central figure in the abolition of the Leprosy Prevention law was Fujio Ōtani, chairman of the Tofu Society (Tōfū  Kyōkai藤楓協会[7]). In 1990, he started the establishment of a National Hansen’s Disease Museum, which was completed by 1993  and organized public symposia that attracted media attention. With the abolition of the law in mind, Ōtani also created a study committee and started to meet patients. He took their wish to continue living at the leprosaria into consideration. Based on the committee’s report, it was publicly acknowledged in 1995 by the Japanese Leprosy Association, the Federation of National Leprosarium Patients and the Federation of Leprosarium Directors that leprosy did not request compulsory segregation and that the law fostered stigma. One year later, the law was terminated, without endangering the existing services leprosaria offered. Patients could stay as long as they wished[8]. The minister of Health, Labor and Welfare officially apologized for the delayed abolishment. The same year, the Federation of National Leprosarium Patients changed its name to the Federation of National Hansen Disease Sanatorium Patients, since it was argued that the term for leprosy (rai) triggered social stigma.

leprosy 5

“We won the lawsuit” – the isolation policy was abolished in 1996

After thirteen patients had sued the government for its unconstitutional policy in 1998, a law was introduced in 2001 that made it possible for Hansen’s disease patients to receive compensation for their suffering. In that same year, the prime minister apologized for the continued violation of leprosy patients’ human rights. The most recent legislation on Hansen’s disease dates back from 2008:  the Law for the Acceleration of a Solution of the Hansen’s Disease Problem (Hansenbyō mondai no kaiketsu no sokushin ni kansuru hōritsu ハンセン病問題の解決の促進に関する法律) stipulated that national leprosaria a) could not discharge patients against their will b) should provide the necessary treatment and facilities and c) should share the use of their land, buildings and services with the local community. Moreover, the state should take measures to restore the honor of leprosy patients, establish and maintain the national Hansen’s Disease Museum and historical buildings, and promote the spread of correct knowledge on Hansen’s disease and Japan’s policy history in order to honor deceased patients.


In 1952, Hansen’s disease patient Matsuo Fujimoto was charged with murder and sentenced to death in a ‘special court’, since it was believed to be too dangerous to bring leprosy patients into a non-isolated court. Fujimoto’s arrest and trial was by many perceived as unfair and unconstitutional: it was one of the many forms of discrimination that patients experienced due to the long-standing isolation policy and social stigma. During the same period, leprosy patients held demonstrations against the revision of the Leprosy Prevention Law that still prescribed forced segregation. In July and August 1953, Hansen’s disease patients protested in every national leprosarium, in front of the Senate and in the corridors of the Ministry of Health, Labor and Welfare. Led by the Federation of National Leprosarium Patients, voices protested against compulsory isolation, the prohibition to leave the leprosarium, disciplinary restraint, eugenic surgery, the lack of privacy, the impossibility to start or maintain a family, and the continued use of the discriminatory term ‘leprosy’ (Inaba, 2011).

leprosy special court

A special court for Leprosy patients – picture from Mainichi Shimbun

Discrimination inside the leprosaria

During the 1940s, patients were forced to work due to a shortage of staff, food and other resources (Aoyama, 2010). Residents engaged in farming, agriculture and other forms of production to supply all leprosarium patients and were also actively involved in administrative matters[9]. Before the end of the war, male and female patients had to live apart, regardless of their marital status. Later, sexual intercourse was allowed, but couples experienced a complete lack of privacy on that account. The first houses for couples were built from the 1950s on (Kikuchi, 1997). Since children from leprosy patients were perceived as a ‘burden’ to the hospital[10], birth control was implemented. Male patients often underwent a vasectomy, and abortion was exceptionally allowed by the state in case of leprosy. No permission from the patient was needed.

leprosy nurse

staff treating a patients

Human right infringements also included a lack of medical treatment: not the employees of the leprosaria but the patients themselves had to take care of each other, despite the fact that the many blind and physically impaired residents were in high need of professional assistance. It was only in 1963 that leprosaria started to employ nurses. In 1954, the Federation of National Leprosarium Patients protested heavily against this problem, abandoning their tasks at the leprosarium, demonstrating on the streets and occupying the ministry of Health, Labor and Welfare for five days. This nationwide movement eventually led to the slow transition of replacing patients’ nursing tasks by duties for personnel. Taking the aspects of life at the leprosarium mentioned here into account, it is clear that Japan’s Leprosy Prevention Law resulted in a serious infringement of the patient’s human rights.


One of the discriminatory practices Hansen’s disease patients had to endure for decades, was the application of eugenic measure, most prominent in its form as institutionalized sterilization and abortions: not only in Japan, but worldwide, “[p]erceived and ascribed disabilities of body and mind were one of the core sets of eugenics traits that provided the basis for institutionalized sterilization on eugenic grounds for the first 75 years of the twentieth-century (Wilson & St. Pierre in Devlieger e.a., 2016: 93)”. As mentioned before, forced vasectomy for male patients and abortion for female patients was the standard procedure at leprosaria. In Japan, eugenic policies became popular in the twentieth century, especially from the 1930s on, an era characterized by imperialism and national pride (Otsubo & Bartholomew, 1998).

leprosy eugenics

Japan followed the example of Germany in pursuing a eugenic policy during WWII

At first, eugenic activity targeted the racially ‘impure’, but was soon redirected towards people with mental illness, hereditary and infectious diseases. In March 1940, the National Eugenics Law (kokumin yūsei hō 国民優生法) was passed. The law encompassed both positive eugenics (encouraging healthy citizens to procreate) and negative eugenics (preventing ‘unhealthy’ people to procreate). In 1948, the National Eugenics Law was replaced by the Eugenic Protection Law (yūsei hogo hō優生保護法), which allowed abortion in certain cases, such as leprosy. This law was eventually discontinued in 1996.

Right-based activism

leprosy protest

Protest march against the discriminatory medical treatment of Hansen’s Disease patients

These forms of institutionalized discrimination sparked right-based activism in 1970s Japan (Hayashi & Okuhiro in Addlakha, 2009). The lawsuits against the government filed as a direct result of the movement in the 1990s, was clearly inspired by the early campaigns in the 1950s. Arrington (2014) indicates that this activism for the rights of (ex-)leprosy patients in Japan inspired similar right-based movements in South-Korea and Taiwan. By 2001, the number of plaintiffs in Japan had risen to almost thousand, and a network of hundred lawyers represented them. Reminiscent of the patients’ stance in the process towards an abolishment of the Leprosy Prevention Law, some patients opposed the lawsuits since they were afraid to lose the care and housing benefits provided by the state. Nevertheless, until this day, (ex-)patients and their families, with the support of thousands of Japanese people, are fighting against the human rights infringement they suffered.

Today, most patients with Hansen Disease are over eighty years old and the number of newly diagnosed patients is negligible. It is most likely that leprosy will cease to occur in Japan in the near future. Yet, attempts in the past to eradicate the existence of leprosy patients has now been reversed: the law of 2008 clearly states that the history of leprosy patients and the discriminatory policies they were subjected to, should be remembered and passed onto future generations. The establishment of the National Hansen’s Disease Museum, for example, is an indication of this objective. Another way to honor the memory of mistreated Hansen’s Disease patients is through a revaluation of leprosy literature in Japan: many patients produced literature (mostly poetry) inside the leprosarium and, doing so, created a whole new genre. I wrote about leprosy literature in this post, feel free to check it out!


[1] Already described in Japan’s oldest history books, rai refers to a collection of skin diseases. (Weiner, 2009: 10) [2] Both terms will be used interchangeably here with no distinction between nuances. [3] Apparently, this was the first document worldwide to claim so. [4] It should be noted that western medicine was not simply copied but rather integrated into traditional Sino-Japanese medicine. Gotō, for example, subscribed to the ‘traditional’ school but his work and writings were informed by western discourse while he maintained a Sino-Japanese approach in therapy and etiology. [5] A similar case is the promulgation of institutionalization laws for mental health patients, which was based on the same impetus to show legal maturity towards the West (Suzuki, 2003: 199). [6] For example, patients were now more free to leave the institution. [7] Established in 1952, the Tofu Society was a reformation of the Leprosy Prevention Association, founded by Empress Teimei. [8] The importance of this decision is illustrated by the fact that only six patients left their leprosaria in the next two years after the abolition (Koh, 1999). [9] Aoyama (2010) argues that because patients were part of the organizational and administrative structure of the facility, they could strengthen their position in negotiations and slightly improve their living circumstances. [10] Children of leprosy patients also experienced stigmatization: In 1954, patient’s children, although not affected by Hansen’s disease, were denied schooling by the parent-teacher association.

Reference list here


wp-image-1575460682jpg.jpgAt this moment, my university (KU Leuven in Belgium) and other institutions are commemorating Thomas More’s Utopia. This work, written in Latin and edited by Erasmus, was published by Dirk Martens in Leuven, the city where I study, exactly 500 years ago. (Okay, I started working on this post in 2016, so it’s 501 years ago now.) Utopia is a frame story about a fictitious island. The title, a neologism invented by More’s good friend Erasmus but derived from the Greek language, means “no place”, not to be confused with eutopia, “good place”. Nevertheless, More gives the impression that Utopia really existed, providing the reader not only with a detailed description of the island, but also inserting several letters to his own friends such as Peter Giles, town clerk of Antwerp, who plays a role in the story too. Additionally, the book was furnished with a map of the island, the Utopian alphabet (designed by Peter Giles) and two poems in the Utopian language with translation.

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The work itself consists out of two books: the first book covers discussions and criticism on the “real” society while the second book goes into details about the unknown island of Utopia. A character called More (a surrogate for the author) is introduced by his friend Peter Giles to Raphael Hythloday, the Portuguese explorer that discovered Utopia. They discuss the current political situation in Europe, ethical issues in serving at court, social abuse that leads to theft and other topics. In the second book, Hythloday recounts his journey to Utopia. During his stay of 5 years, he familiarized himself with the remarkable Utopian customs. A description of these customs would take more than one post, so check out this summary if you are interested.

Utopia paved the way for a whole new genre of literature. The ideas the humanist and statesman More (1478-1535) put forward in his book, are still relevant and inspiring today (for example the 6-hour working day Sweden has been experimenting with), and some ideas have even come true. However, not all of the Utopian customs would be considered OK nowadays. Slavery, for example, was still a thing. Moreover, it is wrong to think that Utopia represents the perfect society because this was not More’s intention at all – the difference between “eutopia” and “utopia” is really important here. On the contrary, the author distances himself from some of the Utopian ideals and principles. Therefore, Utopia should be read as a criticism of the society More lived in. Not an easy task, by the way: the danger of critiquing society directly is illustrated by the fact that More was later beheaded because he did not go along with Henry VIII’s plan for the establishment of a Church of England.

Climbing the Utopia-themed stairs to the Japanese collection at the University Library

You are probably wondering what this has to do with Japan. Well, I was curious whether, traditionally speaking, Japanese literature also covers a genre of utopian writings. This has been a question often addressed by scholars, and the usual answer is: no, not in the Western sense of the word (not so strange because the genre was named after More’s Utopia), but yes, Japanese literature includes utopian-ish texts, especially works written during the Meiji period (1868-1912). Apparently, utopian works in the West are characterized by a constant shift in position between reality and the imaginary world. The difficulties the reader is faced with in trying to distinguish between what is fictional and what is real, is precisely the level of ambiguity utopian literature aims for.

It is argued that in Japanese works, this ambiguity is not very present. However, the differences between Western utopias and Japanese literature on a similar topic do not indicate that Japanese works are ‘underdeveloped’ or lacking what their western counterpart have: this would be measuring with a Western yardstick. Imagine if a pasta dish was critically evaluated based on its similarity to ramen, Japanese noodle soup (both are tasty in their own way, right?). Moreover, in the manga, anime and Japanese drama of today, a utopian setting is often used. This has certainly been influenced by the popularity of western science fiction from the postwar period on, but apparently utopian-ish genres date back to the Edo period or even earlier. The length of this post will convince you that comparing both literary traditions is more complex than is often assumed.


Example of a “kibyoshi” from 1809 –

Burton (2007) points out that in mid-Edo times, a genre of fantastic travel narratives existed that was also used to critique contemporary society: kibyōshi 黄表紙 “yellow cover books”, the first comic books for adults. Because Japan was isolated from the rest of the world due to a policy of seclusion (sakoku 鎖国) at that time, the Japanese became fascinated by these booklets with their yellow covers that illustrated in words and (lots of) pictures the (imaginative) travels to far, exotic countries and their curious inhabitants. Burton further argues that the Japanese travel narratives were highly influenced by much older Chinese sources, often rooted in Taoist and Buddhist iconography. Such fantastic tales were regularly set in a different time period, to completely mask the fact that they were actually criticism on contemporary society. By doing so, authors could address political or other “forbidden” themes in a satirical way that would be censored otherwise. Although kibyōshi did not stand the test of time and popular authors soon disappeared into oblivion, the idea of a hypothetical world inspired Japanese writers in the centuries afterwards. 


Japanese translation of More’s Utopia

More highbrow alternatives for  kibyōshi  are Ihara Saikaku’s  “Island of Women” (女護島 nyogonoshima) in which the author criticizes gender inequality, and Yoshitsune’s trip to fantastic islands with half-human, half-animals creatures  in the classic  The Tale of the Heike (平家物語 Heike monogatari). Once Japan’s borders opened up for foreign literature in the second half of the 19th century, the Japanese public became fascinated by Western utopias. For example, Jonathan Swift’s Gulliver’s Travels was translated and published in 1880, More’s Utopia the year after that. Moichi (1999) argues that the Japanese imported Western novels as a type of Western technology that had a political purpose. As a result, Japanese utopian-style texts inspired by this Western literature mainly promoted a modern ideology, which they hoped would result in political change in Japan’s near future. Coincidently, the Japanese public gained an enormous interest in writings on the future – eutopian or dystopian (the latter was slightly favored because it could shock the readers more).

I could devote an entire post to the well-established tradition of futurological literature in Japan, but at least an introduction is in order since both genres are often interlinked (stories about other, unfamiliar worlds regularly take place in the future). Drawing on the contents of an interesting class I took last year, I was able to trace the origins of futuristic narratives back to early Japanese history. The genre of miraiki (未来記 “record of the future”) is a literary tradition in Japanese history that has its roots in Chinese dynastic writings. At the start of every new dynasty in China (often established by means of a massacre), the new royal family had to justify why they deserved the “heavenly mandate”  (tenmei 天命) by discrediting the previous dynasty. Hence, they referred to a text that had “predicted” the rightful establishment of a new dynasty (the massacre part of the old dynasty was also slightly downplayed).


“Prince Shotoku’s secret writings “Miraiki” disclosed”

It is not difficult to guess that this text was written by the new dynasty and not by someone in the past. As a result, we can regard traditional “futuristic texts” more as writings about the past than about the future. Since Japan does not have a dynastic system, their take on futuristic texts was different: most miraiki were attributed to Prince Shōtoku (Shōtoku Taishi 聖徳太子, 574-622) who is said to be capable of predicting the future. Those texts emerged throughout the Heian period and the Japanese Middle Ages. Similar to the Chinese original, miraiki were used in political discourse for refiguring the past. So here as well, miraiki are part of a literary tradition that claims to be futurological in spirit but is actually historical. The reliance on Prince Shōtoku’s authority to introduce certain standpoints clearly indicates the political character of miraiki. 

Miraiki underwent a drastic transformation from the Edo period  (1603-1868) on: they were trivialized and appeared in the form of satiric kibyōshi for the general public (this should ring a bell for attentive readers!). In other words, the genre of kibyōshi is believed to emerge from the tradition of miraiki. Yet, these “new” miraiki differed considerably. Kibyōshi stories are not necessarily set in the future, but those that are, are seen as equally impossible as utopian-ish stories, which results in absurd and comical narratives. This changed, again, with the arrival of Western futuristic works at the beginning of the Meiji period (1868-1912). The future became more approachable, and speculation about it less absurd. According to Kurita (2000: 6), “Japanese during the formative years of Meiji, like the founders of the United States (…) had an unusually keen interest in proactively creating their own future.” Reminiscent of miraiki literature, it is remarkable that, once again, Japan wanted nothing more than to glorify and at the same time rewrite its past: the Meiji Restoration is characterized by a desire to go back to imperial rule and make an end to the power of the shogunate that had been overshadowing the emperor’s leadership from 1185 on. Hence, the future of Japan was envisioned with the past in mind.

anno-2065Kurita further argues that the reception of the Dutch novel Anno 2065; Een Blik in de Toekomst (“A Glimpse into the Future”, 1865) by Dr. Dioscorides aka Pieter Harting in Japan acted as the stimulus to another change in literary perception of the future. Anno 2065 appealed to the Japanese because of its “dream device”. The narrator falls asleep and wakes up in the future. According to Kurita, this inspired many Japanese authors to use  the same dream device in their miraiki. However, it should be noted that the “dream”, or rather, “the magical dream pillow” is a traditional element in Chinese, Korean and Japanese storytelling, and we should be careful to interpret the presence of it in Meiji period miraiki as a mere imitation of Western works that use a similar device. From the 1880s on, the refashioned miraiki integrated a Western notion of utopianism and futurology by not only focusing on the past, but also taking present understandings into consideration. Between 1885 and 1890, more than 100 miraiki were published.

One work in particular, Nijūsannen miraiki 二十三年未来記 (The Year 23: A Record of the Future, 1886) by Suehiro Tecchō 末広鉄腸 (writer’s name Suehiro Shigeyasu 末廣重恭), helped the miraiki genre gain a nation-wide but short-lived popularity (previously published texts, sometimes with the same title, were also influential but Suehiro’s novel was the first one able to break through successfully). The year 23 refers to Meiji 23, or 1890. Not really that far away in the future to count as futurological literature, you would think. Nevertheless, life in 1890 was imagined very differently due to a drastic change: the introduction of a Diet system. In 1881, an edict called into existence a constitution and a National Diet. Since the public was not familiar with these concepts, journalists such as Suehiro wanted to educate people about this new political system and promote it through means of the popular genre of miraiki.

The story in The Year 23 depicts a parliamentary debate in 1890. Again, miraiki mainly played a political role. Yet, they were innovative in combining a Japanese traditional genre with a futurological perspective as introduced through Western literature. They are set in the (near) future, but do also reflect contemporary society mixed with expectations and desires about how Japan should look like (hopefully to be fulfilled in the future). In that sense, these kind of miraiki have a flavor of eutopian utopias, albeit a different one than More’s work evoked in the West. After the second World War, Japanese readers became interested in American science fiction (often in a dystopian setting)  which also resulted in SF novels flooding the market. Today, utopianism is a recurring theme in modern Japanese literature. Haruki Murakami’s Hard-Boiled Wonderland and the End of the World, for example (check one of my first posts on this book here!), or manga such as Akira and  Nausicaä of the Valley of the Wind. Enough reading material to feel like you are living in a different world…


150 Years of Japan-Belgium Relations

150_fb_sharingAs some of you perhaps already know, this year we celebrate 150 years of friendship between Japan and Belgium (so 150 years Nippaku 日白, actually). In this post, I will give a short overview of the events leading to the signing of the treaty and some (early) history that both countries share.

It all started in 1866 when a Treaty of Amity, Commerce and Navigation was signed. Belgium was the ninth Western state the Japanese shogunate entered such a treaty with. The Japanese were particularly attracted by Belgium’s technology, e.g. the railroad industry and glass techniques, and institutional organisation, such as law and the central bank system (the Bank of Japan was actually founded in 1882 based on the Belgian model). It is also suggested that the Meiji constitution was indirectly influenced by the Belgian one. The visit from the younger brother of the shogun, Tokugawa Akitake (1867), Japanese students (1871) and the Iwakura mission (1873) are proof of that interest. Belgium, on the other hand, believed that Japan was a promising new market.


1866 Treaty –


Count de Mountblanc with a Japanese retainer.

Ironically, it was a French journalist that suggested in 1847 that Belgium should send a military expedition to Japan in order to pursue foreign trade (“gunboat diplomacy”). Although the project was firmly rejected and the interest in Japan was almost non-existing at that time, the appearance of American Commodore Matthew Perry in 1853 who forced the Japanese to sign a treaty, impressed the Western countries greatly. Thus, Belgium used the opportunity to sign a similar treaty on 1 August 1866. Count Charles Descantons de Mountblanc established the first official contacts and negotiations were undertaken by Auguste t’Kint de Roodenbeke. Despite the title “Treaty of Amity, Commerce and Navigation” 修好通商条約, it was clearly an unequal/semi-colonial one: it included extraterritoriality (foreigners in Japan were exempted from local jurisdiction) and denial of the right for Japan to determine the import tariffs. The foreign ministers in the following years would devote a big deal of their time on revising these unequal treaties.

The amount of export from Belgium to Japan was around ten times the amount of import, but trade between the two countries in general was limited for a long time. The policy Belgium adopted to encourage marine trade brought a change: now the shipping company Nippon Yūsen made a stop at the port of Antwerp on its way to London. The line was inaugurated in 1896.

map iapan nippaku

Old map of Japan. “Indiae Orientalis Insularumque Adiacientium Typus”. f. 63 of Abraham Ortelius. in Theatrum orbis terrarum […] Antwerp, 1575. Collection KU Leuven.

Informal connections between Belgium and Japan, however, go back much further in time and originally rooted in religion. The first “Belgian” avant la lettre to ever set foot in Japan was Jesuit missionary Theodoor Mantels in 1588. The arrival of the second Belgian, missionary Ludovicus Frarijn, in 1620 was rather short-lived since he was burnt alive two years later. A third unlucky missionary, Lambert Trouvez, befell the same fate. This was due to the ban on Christianity promulgated in 1587.


Float with Belgian tapestry at Gion festival –

Flemish art, mainly inspired by religious figures, reached Japan at an early stage. During the sixteenth century, copper engravings and such were sent to Japan and China as a visual means of spreading Christianity. For example, some Brussels tapestries dating from that period are still used today to decorate the floats at the Gion festival in Kyoto.

During the “splendid isolation” (sakoku 鎖国, ca. 1633-1853) period, the Low Countries (including The Netherlands and Belgium of today) was the sole Western country Japan maintained a relationship with. [Check out my post on Jacob de Zoet if you want to know more about this topic!] Via the VOC (East India Company) various books written in Dutch or Latin were imported and exerted considerable influence as new sources of knowledge on technology, medicines etc. In order to understand the members of the VOC residing on the island of Dejima, and read the books they brought along, the Japanese started to learn Dutch (the so-called rangaku 蘭学, “Dutch learning”).

13293122_10208766063484840_1783271670_nOne work that played a crucial role in the development of rangaku is the Cruydt-Boeck (“herbal book”, 1554) by Rembert Dodoens, a botanist and physician from Mechelen. Shogun Tokugawa Yoshimune (r. 1716-1853) was curious about its contents and ordered a translation. Problem: no one could read Dutch well enough. It took ten years to offer the shogun some sort of summary, and the complete translation in Japanese was ready only two hundred years after the original publication date. Nevertheless, its translation laid the groundwork for a flourishing study of Dutch in the first half of the nineteenth century. We know, for example, that Hiraga Gennai was an avid collector of Dutch works such as Dodoens’s.

201933Vice-versa, the enormous influence of Japan on Belgium during the late nineteenth century can not be overlooked. The treaty of 1866 set in motion the cultural exchange we now call “japonisme/Japonism”. The Belgian bourgeoisie and nouveaux riches became obsessed with Japanese fine arts and decorative arts, such as fans, kimono, paintings, woodcut prints, nature motifs, ceramics, textiles etc. The VOC had imported Japanese objects as curiosities before, but these objets d’art really became fashionable around the 1880s. International exhibitions played an important part in the diffusion of Japanese culture, as did  the magazine Le Japon Artistique by art dealer Siegfried Bing.

The impact of Japanese art is visible in neo-impressionism, decorative art, symbolism and Art Nouveau. Examples of Belgian artists influenced by Japonism are Théo Van Rysselberghe, Fernand Khnopff, James Ensor, Alfred Stevens (pictures below), Henri Van de Velde and Victor Horta. [A Dutch example is Vincent Van Gogh, post here.] They were attracted by elements such as simplicity, two-dimensionality and asymmetry. In short, a style completely different from traditional Western painting. Japanese elements are also present in fin de siècle literature for example the work of the Destrée brothers, Max Elskamp or Émile Verhaeren. Nevertheless, there is the critique that artists influenced by Japonism hardly made any distinction with chinoiserie and had a rather superficial idea of Japanese arts.

Inversely, there were also Japanese artists influenced by their visit to Belgium. The poet Kaneko Mitsuharu and European-style painter Kojima Torajirō, for example. The former read work of Flemish authors and interacted with the Belgian artistic society during his stay in Brussels. The latter’s work, as you can see below, is obviously influenced by pointillism or neo-impressionism (luminism in Belgium). Kojima studied in Ghent and was acquainted with Emile Claus. Furthermore, he brought many European works back home. Nowadays, these are displayed at the Ohara museum of art in Kurashiki, the oldest museum featuring Western art in Japan.


Japanese tower in Brussels. – picture by author

Other things that indicate a link between Japan and Belgium are 1) the Japanese tower in Brussels. King Leopold II had the plan to establish a district in North East Brussels full of majestic buildings from different cultures. Besides a Chinese pavilion, he required the building of a Japanese tower. Although the bottom part was a piece from the 1900 world exhibition in Paris, the rest of it was designed by Belgian and French architects. Hence, the tower is far from an accurate representation of a pagoda. The number of roofs, the structure and the interior design are way off the mark. It is more a reflection of how the West saw Japan than a real effort to understand Japanese culture. What is more, King Leopold lost all interest in the tower once it was completed. 2) there is a second Manneken Pis, the iconic statue of a urinating boy, in  Tokushima. The statue was a gift from the Belgian embassy. But that is not the only replica: apparently there is also a Manneken Pis in Itami, Hamamatsu and Tokyo.

Concerning diplomacy, bilateral relations intensified during the 1960s after a difficult start in the postwar period. Japanese companies sought access to the European market for investments. Nowadays, Belgium’s most important export product to Japan is pharmaceuticals, while Japan mainly exports cars to Belgium and Europe in general. It is also known that there are close ties between the imperial Japanese family and the Belgian royal family. Both families frequently make official or private visits, for example in the vintage photograph below.

1992 royal imperial family

1992. © Collection of queen Fabiola – more pictures on [in French]

Although I would love to go into more detail about this fascinating topic, I fear this post might become too long. In case you would like to know more, check out the referenced materials!


The Medical Treatment and Supervision Act (2005): Forensic Mental Health in Japan Today – PART 2

In the previous post, I wrote about the historical events that prompted the implementation of the Medical Treatment and Supervision Act of 2005. In this second and last part, we will see what changes the most recent Act on forensic mental health brings about, and what problems it has already met.

banner MTSA 2


The revised Mental Health and Welfare act of 1999 scheduled a reform in 2004, including a new legislation for mentally ill offenders (Kunihiko, 1999). This reform should address the lack of security in mental hospitals. Indeed, no special provisions existed concerning the hospitalization of mentally diseased offenders. Moreover, the concept of “forensic health” originated in Europe and was never discussed before in Japan (Satsumi & Oda, 1995). This issue received public attention after a janitor, suffering from personality disorders[1], stabbed 8 children to death in the Osaka school massacre in 2001. When it became known that the offender had a criminal record, the public opinion called for a legislation concerning the treatment of the mentally ill and recidivists in particular (Fujii, Fukuda, Ando, Kikuchi, Okada et al., 2014). The Ministry of Justice issued a briefing report, aiming at the integration of forensic inpatient and outpatient services, provided they were strictly controlled. The report also included the necessity of a mentality change towards the mentally ill (Weisstub & Carney, 2005).

Osaka School Massacre -

Osaka school massacre: offender convicted to death penalty, deemed  criminal responsible despite mentally ill –

In 2002, a new Bill for the Medical Treatment and Supervision Act was introduced to the Diet (Nakayama, 2005). The bill was proposed by the government and supported by the Japanese Association of Psychiatric Hospitals. The emphasis on the prevention of re-offending (再犯の恐れ), however, triggered criticism from the parties involved (Moriya & Ujiie, 2008). The bill stipulated that only those deemed prone to recidivism were suited for hospital treatment. More than 20 organizations[2] objected that future criminal intentions could not be predicted (Nakatani, Kojimoto, Matsubara & Takayanagi, 2010). The Japan Federation of Bar Associations warned that it could “bring about violation of human rights”[3]. The Bill was passed in 2003 and implemented on 15 July 2005 as The Medical Treatment and Supervision Act, short for the Act for the Medical Treatment and Supervision of Persons with Mental Disorders Who Caused Serious Harm[4]. This time, the word for ‘fear for re-offending’, was left out and replaced by euphemisms in the Act, because it echoed the traditional emphasis on maintaining public order (Fujii et al., 2014).

Q&A manual about the MTSA by the Japanese Federation of Bar Associations.

Q&A manual about the MTSA by the Japanese Federation of Bar Associations.

The purpose of the Act is threefold: stimulating rehabilitation, improving accurate treatment and preventing recidivism (Nakatani, 2012). Whether a mentally ill offender will be treated or not, depends on three criteria (Guidelines for Psychiatric Evaluation). Firstly, the nature and severity of the mental disorder and its link with the crime; Secondly, the treatability; thirdly, the existence of factors that could interfere with the rehabilitation. If all three criteria are met, the mentally ill offender is designated a treatment order. The Medical Treatment and Supervision Act, however, only applies to mentally ill offenders who committed a serious crime: homicide, robbery, bodily injury, arson, or a sexual crime (Nakatani & Kuroda, 2013). Other crimes are regulated by the Inmates and Detainees Act or the Mental Health and Welfare Act.

Between 2005 and 2012, there were 2,750  requests for treatment according to the Medical Treatment and Supervision Ac of which 63.1% received an inpatient treatment order (Fujii et al., 2014). Inpatient treatment[5] includes three stages: acute, recovery and rehabilitation (Nakatani et al., 2010). The expected length of stay is 18 months but can be prolonged, which happened in more than 33% of the cases in 2011[6] (Nakatani & Kuroda, 2013). By December 2007, 14 designated[7] inpatient facilities were attached to public psychiatry hospitals in Japan (Matsubara, 2008), by 2013 there were 30 facilities, or 791 beds available in the whole country (Fujii et al., 2014). Two of the four medical prisons in Japan are specialized in psychiatry (Nomura, 2009). The director of the designated facility confirms the continuity of hospitalization every six months (Ministry of Justice, 2012). He or she also asks permission to the District Court in order to discharge the mentally ill offender (Nakatani, 2012). Through a hearing, the Court decides whether a patient can be released or not.

Outpatient treatment[8] requires a collaboration of various institutions such as designated[9] outpatient facilities and local health and welfare agencies (Nakatani et al., 2010). When the Court orders an outpatient order, the patient is placed under the probation office’s mental health supervision. The director of the probation office defines a plan for every mentally ill offender and assigns rehabilitation coordinators. The expected length of the treatment is three years but can be prolonged with an additional two years.  The director of the probation office asks permission to the District Court in order to conclude the outpatient treatment, or to hospitalize the mentally ill offender in case his condition worsens (Nakatani, 2012). The court decides after conducting a hearing (Ministry of Justice, 2012). In March 2008, there were no less than 260 designated outpatient facilities (Matsubara, 2008). By 2014, this number  rose to 452 facilities (Fujii et al., 2014).

Although the Medical Treatment and Supervision Act was successfully enacted, the implementation is still in its infancy. In today’s forensic health literature, scholars recognize serious problems that hinder an adequate treatment of mentally ill offenders.

Firstly, it appears that personality disordered offenders are hardly appointed a treatment order[10]. The same applies to offenders whose treatability is doubtful. As a result, the number of treatment orders for insane offenders in Japan is remarkably low compared to other countries (Nakatani, 2012). This number remains stable, although more inmates have been diagnosed with mental disorders (e.g. schizophrenia) in recent years (Nakatani & Kuroda, 2013; Nomura, 2009).

Secondly, human and financial resources for outpatient treatment prove to be insufficient. Next to that, rehabilitation coordinators are not given enough authority in crisis situations (Nakatani, 2012). Furthermore, a regional gap in inpatient as well outpatient designated facilities can be observed[11] (Fujii et al., 2014). Thirdly, the foreseen length of stay for inpatient treatment is too short in most cases, which leads to overpopulation of mental health facilities (ibid.). Fourth, when an offender – suspected to be ill – stands trial according to a jury system, it could be difficult for lay judges to grasp the psychiatric context of the offense (Moriya & Ujiie, 2008).

Fifth, it is observed that thirty percent of mentally ill offenders are addicted to methamphetamines or to other kind of drugs (Imamura, Matsumoto, Kobayashi, Hirabayashi & Wada, 2010). This extends the length of recovery (Nakatani & Kuroda, 2013). Sixth, psychiatric personnel appear to be understaffed. In April 2007, only 26 full-time psychiatrists were employed in Japanese forensic institutions[12] (Nakane, 2007; Kuroda, 2008). As a result, refractory patients, frequent among mentally disordered, are not treated properly. Psychiatric personnel are also rather unwilling and reluctant to work in forensic hospitals (Nakatani & Kuroda, 2013). Seventh, once incarcerated, it remains very difficult for offenders whose mental condition worsens, to be transferred to a specialist institution. Similarly, mentally ill offenders are rarely released on parole, because they have difficulty expressing the motivation necessary for such release (ibid.).

Eighth, not enough attention is paid to death row inmates, who tend to develop mental disorders (ibid.). Ninth, no significant change in attitude towards forensic mental health is noticed (Shiina, Okita, Fujisaki, Igarashi & Iyo, 2013) after the enactment of the Medical Treatment and Supervision Act. Mentally ill offenders appear to be stigmatized twice in society. Tenth, there exists no formal framework for psychiatric practice. Therefore, psychiatrists develop their own way of dealing with mentally ill offenders (Weisstub & Carney, 2005). Eleventh, the treatment of mentally disordered offenders is often cut off when they are released after having served their sentence (Nomura, 2009). When this implies a risk of recidivism, the director of a designated facility notifies the prefectural governor and asks for an involuntary hospitalization order. Local authorities, however, seldom carry out this order (ibid.). Twelfth, offenders of less serious crimes are not covered by the Medical Treatment and Supervision Act and are often incarcerated with minimal psychiatric assistance (Odagaki & Toyoshima, 2010).

MTSA flow chart

Some scholars believe the advantages of the Medical Treatment and Supervision Act do not equal its advantages and call for an abolishment of the act (Nakajima, 2011). Others are less radical but still emphasize the need for a thorough revision of the Act (Odagaki & Toyoshima, 2010). Although the Act was slightly adapted in 2006, the scheduled revision for 2010 did not take place. The fact that the Act is not yet widely known could also be an explanation for the lack of international criticism (ibid.).

The new system is a unique but limited combination of forensic and general psychiatry. This way of dealing with the mentally ill already faces many challenges, and it will not take long before the Medical Treatment and Supervision Act is revised.


Thanks for reading!

citation of this article: Van Enis, Ann-Sofie. “The Medical Treatment and Supervision Act (2005): Forensic Mental Health in Japan Today.” Nippaku, January 20, 2015.


[1] The offender, however, was attributed full responsibility and was sentenced to death.
[2] Including the Japan Association of Psychiatry and Neurology, the National Federation of Families with Mentally Ill in Japan and the Japan Federation of Bar Associations (Japan Times, 8 June 2002).
[3]「許容しがたい人権侵害をもたらす」said president Kazumasu Kuboi (Asahi Shimbun, 16 March 2002).
[4]心神喪失等の状態で重大な他害行為を行った者の医療及び観察等に関する法律 (略:医療 観察法)in Japanese (Moriya & Ujiie, 2008).
[5]入院処遇 in Japanese (Moriya & Ujiie, 2008).
[6] The stay of 144 (33.2%) mentally ill offenders was prolonged. In general, forensic patients stay longer than non-forensic patients in mental health facilities.
[7] Designated by the Minister of Health, Labour and Welfare.
[8] 通院処遇 in Japanese (Moriya & Ujiie, 2008).
[9] Designated by the Minister of Health, Labour and Welfare.
[10] Only 1,1% of mentally ill offenders treated according to the Medical Health and Supervision Act is diagnosed with a personality disorder. The reason is that most of them are found guilty and fully responsible, eliminating the possibility of being referred to the Act (cf. supra: Osaka school massacre) (Fujii et al., 2014).
[11] At the end of 2013, no designated inpatient facility existed in Hokkaidō and Shikoku (Fujii et al., 2014).
[12] Compare this to Belgium, where 32 full-time psychiatrists and 147 full-time psychologists were employed in June 2006 (Salize, Dreßing & Kief, 2007).


bibliography MTSA

The Medical Treatment and Supervision Act (2005): Forensic Mental Health in Japan Today – PART 1

For the course “Politics, Law and Society in Japan: A Global Perspective” I wrote a paper about Japanese forensic mental health, focusing on the Medical Treatment and Supervision Act, implemented 10 years ago. I will post this paper in two parts. The first part deals with the historical background and how and why this Act was established. The second part gives a short overview of the functioning of the Act and summarizes the challenges the Act already has been faced with.

banner MTSA 1


How mentally ill offenders are treated has always been a difficult issue to deal with, for the reason that they are situated in a double paradigm: on the one hand they have committed a crime and are therefore offenders; on the other hand they are deemed to be ill and should receive treatment. According to article 39 of the Japanese Penal Code, enacted in 1907, “an act of insanity is not punishable and an act of diminished capacity shall lead to the punishment being reduced” (心神喪失者の行為は、罰しない。心神耗弱者の行為は、その刑を減軽する). The Penal Code, however, does not provide any measurements to treat mentally ill offenders acquitted due to their disorder. Only until recently, forensic mental health was covered by general health treatment. In fact, no special system existed for such offenders, making Japan unique in that way. As a result, mentally ill offenders were treated either in prison when convicted or in general psychiatric hospitals.

In July 2005, the Act for the Medical Treatment and Supervision of Persons with Mental Disorders Who Caused Serious Harm (shortened to “Medical Treatment and Supervision Act”) (心神喪失等の状態で重大な他害行為を行った者の医療及び観察等に関する法律 (略:医療 観察法)) was enforced and brought about radical changes. For the first time, the act aimed at the rehabilitation and the right medical treatment of mentally ill offenders. The system established two different types of treatment: inpatient and outpatient treatment. Where previous acts were mostly highlighting the fear of recidivism, the act of 2005 specifically encourages reintegration of mentally ill offenders in society. While the enactment and transition went smoothly, Japan is still struggling with optimizing outpatient treatment.


Traditionally in Japan, a mental disease was not regarded as a medical problem but as the possession of an individual by evil spirits, which could therefore only be treated by exorcist rituals like purification, incantation or shamanist treatment[1] (Mandiberg, 1996; Russell, 1988). The construction of a confined room at the family home to lock up lunatics (zashikirō 座敷牢 (Mandiberg, 1996), nyūkan 入監 (Salzberg, 1991)) was a common tradition until the 20th century.

shinto ritual to heal madness: standing under a waterfall for hours - kenkyukaiblog-jugem-jp

shinto ritual to heal madness: standing under a waterfall for hours –

The mad could also resort to Buddhist or Shintoist temples and shrines, sometimes resulting in rural communities around these places of refuge for the mentally diseased, and stimulating the reintegration in society. The Iwakura village near Kyoto was one of these pilgrimage and refuge places[2]. Later in 1884, it transformed itself from a community of boarding houses where farm families cared for mentally diseased, into a successful private mental hospital until its closure in 1945 (Nakamura, 2006).

Iwakura Hospital

Iwakura Hospital –

During the Edo period (1603-1868), the family head became heavily responsible for the conduct of his family members, and could end up being severely punished for the criminal acts of mentally ill diseased[3]. As a result, mad people were ostracized by removing their name from the family register or confined, whether it was at home, at a temple or in a public prison (nyūrō 入牢) (Russell, 1988). When the proper supervision of mentally ill individuals became impossible, they were often confined with medical care under supervision of eta[4] (tameazuke 溜預) (Yamazaki, 1931). Nevertheless, home confinement was still the primary way of dealing with lunatics.

zashikiro -

zashikiro –

On the one hand, it should be noted that these provisions were not established for the good of the mentally ill, but rather seen as a necessary measure to maintain social order. On the other hand, the traditional perception of mental diseases altered under the influence of Western medicine and philosophy, brought to the isolated isle by Dutch physicians during the 19th century. Compared to the inhumane imprisonment and traumatizing rituals, they introduced new concepts of psychiatric therapy, which were later put into practice by Japanese students of Western medicine.

influence of rangaku, the studie of the Netherlands, on medicine and mental health - mayanagi-hum-ibaraki-ac-jp

Influence of rangaku, the studie of the Netherlands, on medicine –

Both perspectives were developed further during the Meiji Period (1868-1912). Rapid social change compelled the Japanese government to issue laws concerning the attitude towards the insane. A circular in 1878 established certain rules for confinement of the mentally ill: imprisonment at home required a report of a physician and an official request of the family. Those disowned by their family were confined to detention centers (Salzberg, 1991). Because mentally ill individuals were considered as possibly dangerous subjects for society, a series of police orders stipulating the control and punishment of the insane followed (Kuwabara & True, 1976). A law in 1884 stated that mentally ill could only receive treatment if a doctor appointed by the police had examined them. When successfully confined, police authorities checked the patients once in a month. At the same time, however, a critical stance towards confinement and incarceration urged the demand for proper treatment centers. The first mental hospital in Kyoto was established in 1875 (Nakamura, 2006).

A "hospital" for the mentally diseased in Tokyo - kenkyu

A “hospital” for the mentally diseased in Tokyo in 1881-

One specific case drew particular attention to the necessity of a mental health law.  The daimyō of Sōma prefecture, Sōma Tomotane, at the time involved in a family dispute, was declared to be schizophrenic and thus confined to a zashikirō. Loyal retainers believed this was a conspiracy of the other family members against their lord. They kidnapped the daimyō from the psychiatric hospital he had been transferred to and made the details about his confinement public. This was largely covered in the media, including international newspapers. As it became clear that formal mental health regulations were yet to be established, the Meiji government feared the Sōma affair would undermine their long-fought efforts to develop Japan as a modern state (Russell, 1988). As a result, The Law for the Custody and Care of the Mentally Ill[5] was enacted in 1900. With this law, families were officially permitted to build zashikirō and were kept legally and financially responsible for their supervision and the actions of mad family members. The law was presented as a protection against illegal and arbitrary confinement, but in fact encouraged traditional and outdated practice. Again, the government’s main concern was public safety and order (Mandiberg, 1996).

Loyal retainer Nishigori rescues Soma from the asylum -

Loyal retainer Nishigori rescues Soma from the asylum –

Up till now, I have only discussed the attitude towards the mentally ill in general. This is simply because there were no special measurements separating mentally ill offenders from normal offenders. Insane individuals were prevented from committing crimes by incarceration or confinement (‘punitive treatment’) and did not receive medical assistance. Moreover, physicians were rarely involved in mental health treatment. The responsible family members were still forced to rely on shaman rituals, combined with familial care. We can see this as a type of community psychiatry, though very primitive and non-therapeutic (Kuwabara & True, 1976).

A survey, conducted by the government in 1915, indicated that 82% of mentally ill individuals were untreated[6]. Hence, the Law for the Custody and Care of the Mentally Ill was supplemented with the Mental Hospital Act[7] of 1919. This act, again for the sake of public safety, regulated compulsory confinement in a psychiatric hospital, under permission of the state or responsible family members. Nevertheless, most mental patients were still confined at home, taken into account that by World War II, only six public insane asylums had been built in Japan. The government had decided to fund mainly private mental hospitals, whose treatment only rich families could afford (ibid.). The limited number of beds dropped during World War II[8], when the mentally ill were neglected and died of starvation due to the National Eugenics Act[9] of 1940.

In 1950, opposition groups expressed concern for the proactive detention mentally ill people were subjected to. The Mental Hygiene Law[10] was enacted, abolishing home confinement and demanding the establishment of prefectural psychiatric hospitals. Mental diseases were acknowledged as medical problems that required appropriate treatment. However, households remained legally and financially responsible for the acts of mentally ill family members. The law defined three types of hospitalization when a certain degree of danger for the insane himself and his environment could be observed: compulsory or provisional compulsory admission ordered by the prefectural governor, and compulsory admission requested by the legal guardian. Still, the fact that no consent from the patient was needed was seen as a contradiction to the Constitution (Kunihiko, 1991). Once admitted to a mental hospital, there were no provisions to review the decision for another type of hospitalization, and few people were ever discharged. At the same time, options for community placement were very scarce (Mandiberg, 1996). During the 1950s and 1960s, the number of psychiatric beds rose significantly.

Ohio Insane Asylum in the 1950s -

Ohio Insane Asylum in the 1950s –

Criminal offenders deemed mentally ill were now often hospitalized instead of incarcerated. Consequently, more facilities were needed. This became clear in 1964 when a schizophrenic young man assaulted Edwin Reischauer, the American ambassador to Japan. On that account, the Japanese police authorities requested more powerful action against the mentally ill (Koizumi & Harris, 1992). This request was turned down, and instead more outpatient and community services were stipulated in the Revised Mental Hygiene Law[11] of 1965 (Nakatani, 2012; Kunihiko, 1991).  It has to be noted, however, that forensic health still did not differ from general mental health. Again, the 1965 law was implemented to maintain social order, and not to effectively help the mentally ill.

Reischauer incident

Reischauer incident

In the 1980s, scandals[12] lead to the establishment of the Mental Health Law[13] (1988) that emphasized the importance of human rights and rehabilitation (Nakatani, 2012). For the first time, the legal rights of the mentally ill were acknowledged and a Psychiatric Review Board reviewed their hospitalization (Cohen, 1995). Although this model was implemented, it appeared impossible to be carried out accordingly[14] (Mandiberg, 1996). The Mental Health and Welfare Act replaced the Mental Health Law[15] in 1995. This law mainly stipulated the increase of outpatient facilities, welfare services and participation in community (Kunihiko, 1999). As these amendments were hardly applicable to mentally ill offenders, only few psychiatrists were inclined to work in forensic health treatment (Nakatani, 2012).

In 1999, a White Paper of the Ministry of Justice pointed out these problems. Public prosecutors, who were more likely to file a report to the prefectural governor in case they assumed criminal responsibility, only indicted a small number of mentally ill offenders. A medical examination was subsequently carried out. If the assumption was verified, the prefectural governor commanded an involuntary admission. Although this procedure assured quick treatment for acquitted mentally ill offenders, the chance to stand trial was minimalized. Furthermore, general mental health hospitals often did not have the required security to receive criminals. In addition, psychiatrists carried a heavy responsibility, as they had to decide about the discharge or continued confinement of the patient, considering the possibility of recidivism (Nakatani, 2000).

protest against psychiatric hospital Utsunomiya -

protest against psychiatric hospital Utsunomiya –


The second part will give a short overview of the functioning of the Act and will summarize the challenges the Act already has been faced with.

citation of this article: Van Enis, Ann-Sofie. “The Medical Treatment and Supervision Act (2005): Forensic Mental Health in Japan Today.” Nippaku, January 20, 2015.


[1] The treatment by shamans or monks was often very expensive. Hence, rejection of the mad family member became a common practice (Official Order of the Kyoto local government, No. 325, July 25, p. 187, cited in Kuwabara & True, 1976).
[2] Mandiberg (1996) compares this to the city of Gheel in Belgium, whose concept of ‘family care’ inspired the Iwakura hospital, an ambition that never came true (Hashimoto, 2014).
[3] Because of the institutional gonin-gumi system (五人組), a group of five households shared collective responsibility.
[4] The eta穢多, burakumin部落民 or hinin非人 was an outcast group because of their impure or death-associated occupation. Together with the mad, underage and extremely ill offenders were supervised as well in these special detention centers (Salzberg, 1991).
[5] 精神病者監護法 in Japanese (Moriya & Ujiie, 2008).
[6] Department of Welfare, Bureau of Medical Administration (1955), cited in Kuwabara & True, 1976.
[7] 及び精神病院法 in Japanese (Moriya & Ujiie, 2008).
[8] In 1941 there was place for 24,000 mental patients all over Japan. By 1945, only 4,000 beds were left (Russell, 1988). The Iwakura Mental Hospital was forced by the Japanese army to close his doors (Nakamura, 2006).
[9]国民優生法In Japanese. Available at, accessed on 29 November 2014.
[10] 精神衛生法 in Japanese (Encyclopedia Nipponica online, accessed on 29 November 2014).
[11] 精神衛生法改正 in Japanese (Moriya & Ujiie, 2008).
[12] In 1984, two patients died by abuse in The Mental Hospital of Utsunomiya. Further research disclosed that over three years, 222 of the 1,000 patients hospitalized there had died in suspicious conditions (Jakopac & Patel, 2009). The United Nations Commission on Human Rights criticized Japan’s mental health system (Gostin & Gable, 2004).
[13] 精神保健法 in Japanese (Moriya & Ujiie, 2008).
[14] “Few patient-initiated PRB review applications are filed, and the few of those that are filed result in recommendations for discharge or change in treatment” (Mandiberg, 1996).
[15] 精神保健福祉法精神保健および精神障害者福祉に関する法 in Japanese (Moriya & Ujiie, 2008).


bibliography MTSA

Human Rights and The Media: Two Cases

Last Monday during newspaper class (yes, there is such a course), we learned about the clash between human rights of victim and assailant, and freedom of speech for journalists. I thought the cases that illustrated the protection of human rights quite interesting.

1. The Kobe Child Murders (神戸連続児童殺傷事件)

On 16 March 1997, a girl was murdered with a hammer, and three other girls attacked and wounded by a knife. On 27 May, a 11-year old boy was strangled, beheaded with a handsaw and further mutilated in the face with a knife. The head was left in front of a junior high school gate. A confession note written by “Sakakibara Seito” was stuffed in the victim’s mouth. In June, the Kobe newspaper company received a confession letter signed with the same pseudonym, and containing threatenings of more killings. On the 28th of June, a 14-year old boy was arrested.

These murders were beyond atrocity and evoked strong reactions among vengeful inhabitants all over Japan. According to the Japanese law, minor assailants are protected from having their personal information like name, address and description of looks, published. However, in this case, a photograph of the young criminal was released in the magazine Focus. The Ministry of Justice protested against this due to “violation of human rights” and requested the magazine to withdraw their article. As a result, journalists accused the government of having violated “freedom of speech”.

When the culprit was released from the health institution on a provisional basis 6 years later, the media had lined up in front of the hospital en masse. On the Internet thousand of threads discussed his future address, shared photos, and gave away his real name. Again, the Ministry of Justice took action for the sake of a peaceful rehabilitation of the culprit in society, and requested the threads to be removed.

Because of the Kobe child murders, the age of criminal responsibility was lowered from 16 to 14 years. The discussion revived after the Sasebo slashing (also called Nevada Tan Case). In this case, a 11-year old girl slit the throat and arms of her classmate with a utility knife. Here as well, photos, information and real name circulated on bulletin boards on the Internet.

2. Murder of Yasuko Watanabe (東電OL殺人事件)

On 8 March 1997, Yasuko Watanabe, an elite economic researcher at TEPCO, was strangled to death in Shibuya. As soon as the media found out she was working as a prostitute after work, journalists eagerly started to collect information about the nightly activities of the victim. More than the murder case itself, the victim’s personal life was sensationalized and reported to great lengths. After all, people believed the victim was a “bad woman”, so violating her rights of privacy would no problem. At the trial, the victim’s mother said: “犯人ではなく、マスコミを死刑にしてほしい”. (Not the culprit, but the mass media I would like to see executed.)

Books about the victim's life

Books about the victim’s life –

Facts For Fun

– According to the Press Freedom Index 2013 of Reporters Without Borders:

In Asia, Japan (53rd, -31) has been affected by a lack of transparency and almost zero respect for access to information on subjects directly or indirectly related to Fukushima. This sharp fall should sound an alarm.

Belgium is on the 21st place.


Online text-book of Japanese Studies, KU Leuven

– Wikipedia

Five Facts about Japanese Politics and Economics to Fill Awkward Silent Moments Spent in Company of Japan-Ignorant People

Today’s topic is, well, like the title tells you. Just five facts I think worth mentioning. I often start monologues on random Japanese topics, or add the suitable amount of information about Japan during small talk conversations with my friends. They are used to it. And most people even ask about it when they find out what kind of special/weird/extraordinary thing I’m studying. If you sympathize with my quirky behaviour, or you took the trouble to read this far and don’t want to give up now, here we go:

Fact number 1

The Emperor of Japan is the only monarch left in the world who is still called Emperor. Moreover, current Emperor Akihito is a descendent of Japan’s first Emperor Jinmu (660 BC). Akihito is the 125th Emperor. I mean, it all stayed in the same family! China for example, had several dynasties, which means that there were different ruling families. It is amazing the Japanese succeeded in maintaining the position of the Emperor for around 25 centuries (although that was no plain sailing). Controversy about the function of the Emperor reached a peak at the end of World War II, when Hirohito declared himself to be a human being and not an incarnate God. In the Kojiki 古事記 and Nihonshoki 日本書紀, Japan’s two oldest writings, is described how the Imperial family descended from Amaterasu, the Sun Goddess.

First Emperor Jinmu and current Emperor Akihito

First Emperor Jinmu and current Emperor Akihito

Fact number 2

The Constitution of Japan (1947) was originally written in English, and afterwards translated into Japanese. That’s because it was written by American people during the occupation. MacArthur’s SCAP team managed to fabricate the most fundamental law in less than a week. Special thanks go to Beate Sirota Gordon, who made gender equality legal. Today, it’s still the same Constitution. Especially article 9 is a “popular” topic for discussion. Additional fact: Japan has no army, but “Self-Defense Forces”.

Constitution_of_Japan_original_copyFact number 3

Japanese prime ministers are not boring. We think immediately of “Lion Heart” Koizumi Junichirō (aka the Japanese Richard Gere). But who I want to introduce is Asō Tarō, prime minister from 2008 to 2009. He profiled himself as a passionate manga fan (which gave him the nickname Rozen Asō, from the manga Rozen Maiden)  and wanted to use Japanese pop culture to improve international relationships. He received a lot of criticism because he mispronounced or read kanji incorrectly during his speeches. As result, he gained another nickname (how studying Japanese politics can be a lot of fun!): KY Asō. Here is some explanation needed. KY is the abbreviation of Kūki Yomenai 空気読めない or “someone who can’t read te air”, meaning someone who cannot understand the situation. In Asō’s case, KY stands for Kanji Yomenai 漢字読めない, or someone who can’t read kanji (Chinese characters). So dearest reader, if you do have some issues studying kanji, don’t worry, at least you can make it as a prime minister. Extra fact: Aso has made a comeback this year as Minister of Finance in Abe’s cabinet. As no reading mistakes are reported this far, I assume furigana (the pronunciation in phonetic writing system next to the kanji) was successfully added.

Barack_Obama_&_Taro_Aso_in_the_Oval_Office_2-24-09Fact number 4

– And I tell you this because of the huge difference with Belgium, it’s more like taking some extra day off here – to go on strike in Japan is not really to go on strike. May following quote makes it all clear to you.

”In Japan,” he said, ”we have what I suppose you Americans would call ‘job inactions.’ When we strike, we put on armbands to show we are unhappy and we go into the plant and work twice as hard as usual to prove to the bosses how valuable we are.” – New York Times 

Why? Because labor unions are integrated in the company. Apart from the wages, they do not have many things to protect, because the Japanese company structure is famous for its “lifetime employment”. Nevertheless, every spring there’s a kind of traditional labor union festival held, oh wait no, it’s a strike! Shuntō 春闘, the Spring Offensive for a higher wage originated in the 1940 and  concerned negotiations  between the enterprise unions and employers. However, it lost most of its initial meaning and has become more or less a tradition.

Fact number 5

In 1980, the land price of Japan used to be around 1600 trillion yen or 4 times that of the USA  (and Japan fit 25 times in the USA). Especially Tokyo was a little bit expensive. In the late ’80, only the inside area of the Japan Railway Yamanote Line in Tokyo was worth 400 trillion, what made up for… the whole area of USA. Sony bought Columbia Pictures of Hollywood, Mitsubishi owned the Rockefeller Center for 80 percent and the Japanese Royal Palace was as much worth as California. Needless to say the American felt slightly intimidated. Why the high prices? Until 1990, Japan had created a bubble economy. That means that real estate stock prices skyrocketed due to speculation.

Aum Shinrikyō’s Legacy and Japanese Pop Culture

On 20 March 1995, The Aum cult released self-made Sarin gas in the metro of Tokyo. 13 people died, and more than 5000 people got injured. Till then, those “new religions” (shinshūkyō 新宗教) had not been causing such serious accidents, and were left undisturbed in their activities. The reason for that, is that the Japanese were afraid to break the law of “freedom of religion” and to create a precedent that would be similar to the institution of shintō as a state-religion in WWII. Therefor, new religions were tolerated and could spread their popularity across all layers of the Japanese – and sometimes foreign – population. These newly formed religious movements gathered a considerable number of followers, what made scientists think of this after-war period as “the rush hour of the gods”. Aum was supported by ten thousand members in Japan. Most striking is the fact that many highly qualified, young graduates from top universities joined Aum, what gave them the label of “The Elite Sect”.

In the aftermath of the 1995 terrorist action, or so-called “post-aum period”, the New Religious Movements faced strong opposition by the public opinion. The government did well in solely focussing on the severe punishment of Aum members. If they had been carried along with the public rage, there would have been the risk of endangering article 20 of Japan’s Constitution.

Anti-Aum protest

Anti-Aum protest

Some New Religious Movements share following two characteristics (only what’s in bold letters), which I adopt to Aum Shinrikyō (given explanation). I have no knowledge of all New Religous Movements, so I do not at all claim that each of them engages in terrorist actions, nor do I believe their members to be treated in the way as Aum members were. On the contrary, except for a few ones like Aum, New Religious Movements are peacefully pursuing and developing their spiritual life.

  • A central, spiritual leader: The almost blind Shōkō Asahara formed Aum Shinrikyō in 1984 and was granted legal recognition 5 years later. The doctrine he promoted, contains several elements of Buddhism and Shintoism, as well as Christianity and Hinduism. He proved his born leadership i.a. by performances of self-levitation. He also declared himself “Christ”. Asahara was condemned to capital punishment, but is still in death row.
  • The Apocalypse Scenario: Aum-followers strongly believed Nostradamus’ prediction of a millennium-ending apocalypse. This subscribed to a utopian view on a perfect world (“shambhala”, paradise) they could help to establish. By ending the sinful world a bit earlier, for example. Many members in search of a spiritual way had joined because they felt a decline of society due to too much focus on materialism. There was a possibility of salvation for human beings, be it evidently limited to members of Aum. These people underwent ‘survival training’. Methods like brain washing and feeding chemicals and drugs were used to remove anxiety. Some died because of too much intensive training (i.e. lack of sleep and food) and were secretly cremated and buried with the remains of murdered opponents.

Nowadays, Aum’s legacy still wanders around in Japanese people’s mind, as is visible in following products of pop culture.

Bloody Monday

(ブラッディ・モンデイ) drama, 11 episodes, 2008, adaptation of the same-titled manga

A terrorist group threatens to murder Tokyo’s population by spreading a deadly virus, called Bloody X. The story revolves around a school boy who succeeds to stop the organisation’s evil moves by hacking into their computers and system. If you are fond of thrilling, sensational drama, then I can recommend you this one. Maybe the story turns highly unlikely after nine episodes and the hacking skills of our young hero are far from belief as well, but that doesn’t make it not worth watching.

Now, back to reality. While watching, I immediately felt the resemblance with the gas attack of 1995. Leader of the terrorist cult group is “High Priest” Kamishima Shimon, who possesses the unearthly powers to kill people while being imprisoned (the magic is later on revealed; compare with photos of Asahara’s levitation, as they turned out to be taken while he ‘hopped’ in Lotus position). What’s so attractive about the massacre, is that the terrorists can become God, being in possession of both the virus and anti-virus. So, as the end of the world is absolutely necessary, fortunately they can choose who stays free of bloody noses. Their justification for murdering Tokyo’s population goes as follows:

This country is rotten. In order to regenerate the world, everything needs to be reset.

Sounds a lot like Asahara and his followers, isn’t it? Another resemblance has to do with Aum’s foreign business. In 1992, Asahara traveled to Moscow on a “Russian Salvation Tour”. A central office in the capital and three branch offices were opened, and 30,000 Russian joined the cult organization (at least that is the number Aum claims). The reason for many young Russian to devote themselves to Asahara and his theories, was the same as the Japanese youth: they were looking for spiritual nourishment. After the Cold War, they had lost the relationship with traditional christianity and turned towards more mystical beliefs. In Bloody Monday, Russia plays an important role as the location for the first experiments with the virus.

20th Century Boys

(二十世紀少年) manga by Naoki Urusawa, 1999, 22 volumes

20thCentury Boys- UrusawaLeader and Savior of the World “Friend” takes care of the end of the world, according to a plan he made with his school comrades a long time ago. Again, a virus with bloody results is featured, as well as the divine talent of “Friend” himself to fly and raise from the dead. He gains enormous popularity among the Japanese youth, and even starts his own political party (which is not without any foundation in real life: see the Facts for more on Sōka gakkai and Kōmeito).

Urusawa always does a great job, and this SF-manga contains again a thrilling story. That such things could happen in real life seems absurd, but you never know… One psycho and his ideology can cause a lot of harm. If people are discontent with their present society, who stops them from believing in a better world? In their conviction of helping mankind for their own good by slightly accelerating world’s end, they would go smiling around to spread gas and viruses. And there lies the hidden fear of all: no exposed violence and display of power, but how the fragility of people like you and me, can be used so easily.

Facts for Fun

– The internationally known cult movement Sōka gakkai formed in 1964 its own political party, Kōmeito. Scarcely 5 years later, it was Japan’s third largest political party. Nowadays, they represent 10% of national voters. Although the band with Sōka Gakkai has been officially broken, meetings behind the scenes still happen.

– Aum Shinrikyō still exists: it changed its name to Aleph. The members abandoned terroristic plans, but are not yet quite accepted by Japanese society.


– The inspiration and some info I gathered during the lessons of Japanese religions.

– Metraux, Daniel Alfred. Aum Shinrikyo’s Impact on Japanese Society. Lewiston, N.Y.: Edwin Mellen Press, 2000.

– First picture is from Wiki Commons. On the site where I found the photo of Asahara on the cover, a lot of information about Aum can be found.

– watch Bloody Monday and Bloody Monday 2 online