Social Victimization of
Leprosy Patients in the 2oth
century
by
Gerd Ferdinand Kirchhoff
Professor of Victimology
Doctor Course of
Graduate School of Victimology
Tokiwa University, Mito, Japan
Leprosy was perceived as a grave
threat for human health and for the
human community in general.
Leprosy control laws are not a standalone isolated phenomenon.
There are four different ideologies
which I want to look at when I try to
explain these control instruments.
Idelogies discussed in this
paper
1. an applied Darwinist evolutionary
orientation in the emerging social
sciences.
2. new theories in medicine about
diseases (mainly cell pathology and
immunology bit social medicine as well)
3. the ideology of eugenics and racial
health preservation
4. a growing insecurity in the law
community
These ideas greatly upset the traditional legal
justification of punishment and social control.
In the wake of the resulting policies, several ten
thousands of infected patients in Japan were
forcefully separated from their families. They
were arrested, and banned from their
communities. They were committed to leprosaria
where the were to stay until they died.
In this presentation, I will deal with some
underlying ideologies that led to mass
victimizations in the Japanese Leprosy Control
system.
Leprosy - later called Hansen’s Disease - was the curse of
mankind for centuries.
It was regarded a very dangerous disease that was spread
through contacts with lepers.
It is caused by a bacterium Mycobacterium leprae.
The infection causes damage to the skin and to the
peripheral nervous system.
The disease develops very slowly (from six months to 40
years).
It results in skin lesions and deformities.
It most often affects the cooler places of the body (e.g. nose,
eyes, earlobes, hands, feet, testicles).
Left untreated, it can cause disfiguring damages.
In 1873, the
Norwegian
physician Hansen
discovered bacteria
in leprosy lesions,
suggesting that the
disease spread by
infections.
It was not a hereditary disease, as Hansen’s
father-in-law, a famous Norwegian physician
and director of the central leprosy hospital in
Norway, believed and propagated.
Buddhist monks in Japan taught : it was a
punishment for sins committed in a previous
life.
The hereditary school drew from the
observation that often the disease occurred
among members of the same family.
There was no cure, no therapy.
For more than 5 000 year, humans reacted with
contact avoidance and prohibitions, with exclusion,
with enforced exiles and isolation. Lepers had to
live outside human settlements.
See the former leper “holes” in the old
Dubrovnik
Special clothes
Rattling acoustic warnings (rattles, bells)
Many infected became homeless - in Japan
often the shrines were the only places where
they lived as beggars until they died.
Victimology of Hansen’s
Disease Control
Definition of victimology
Social science of victims, victimizations and the
reactions to both Analysis approach from various sides
Individual side: victimizations as invasions into the
self of the victim, causing damages, distress, crisis
and crisis reactions, demanding crisis intervention
and assistance in coping when necessary.
Looking at the sufferings of the leprosy patients.
Can be originated by the invasion itself (infection?) or
by damaging reactions of the social environment.
We do no look at the damages produced by the
bacterium itself (victimology is not medicine). It is not
concerned with victims of bacteria or viruses.
The “fallacy” of General Victimology
Victimization by reactions towards the
patients
The families who disowned them
The neighbors who denunciated them and avoided
them
The village, the schools who expelled them
The agencies of health control who placed them into
closed institutions
Theoretical problem: do we have here a secondary
victimization without primary victimization?
That would not make sense.
Health politicians created the laws that prescribed
compulsory confinement in leprosaria. These laws created
an immediate danger of law enforcement that would
victimize.
Victimizations are
Imprisonment
Arrest
Forceful separation from home and family
Family members blowing the whistle denunciating their
children
Schools excluding infected people
Often compensation in these cases is denied with the
justification that “the law of the land” permitted these
measures.
Victimizations happen in a broader social climate. The patients
in Japan were treated in a horrifying way: they were forcefully
separated from their families, from all their resources, they had
to leave their property behind, they were forcefully transported,
injured, and were banned and exiled into closed institutions until
they died. This is what happened with patients of HD.
The first part in victimological analysis is to answer: “What did
did they suffer?” That is a shocking part. Victimologists try to
stand in the shoes of the victims, they try to do “victims
victimology” (SBD 2000). That is a scary and frustrating and
depressing stage. Victimology is a sad science if we stay and if
we remain here. Some do. We as scientists have to continue,
we cannot be content with compassion (sic) alone.
“Why did they suffer” is the next question. What are possible
explanations that make clear why this victimization happened to
them. There are different method of accessing the answer to
this question:
Historical access
Medical access
Sociological access
Psychological access
Social work access
The more accesses we activate the more chances do we have
to understand better what happened to the victims.
Then the shocking depressing phase is past.
This is the phase of understanding, a very rewarding phase.
The next phase is: what has to be done to alleviate the burden of
the victims? What kind of assistance is needed? How to get
restitution” compensation? How can we prevent that such
victimizations happen again? That is the richest phase of
victimological analysis - it looks into the future. Here is the place for
Natti Ronnell’s Positive Victimology.
That allows me to distinguish different elements in the
construction. E.g. Dubrovnik centuries of coexistence
between Serbs and Croats - reality was constructed to call
for coexistence. If this construction is given up in favor of
calls for ethnic cleansing, then sooner or later ethnic
cleansing become reality. Convictions either favor or they
impede victimizations.
e.g. power disequilibrium between men and women, support
of unequal power favors victimization.
If a disease is defined as consequences of sins in previous
lives, it shifts the burden to the patients. It is pretty irrational
and you have to believe a lot of things before you can
understand this construction of reality. But people construct
this way.
If an incurable disease is defined as extremely contagious,
then victimization of the patients is very likely. However, if
the disease is defined differently, victimization is less likely.
The definition of victimization is already framed and molded
by ideology.
That is obvious in case of victimization by weapons of mass
destruction in WW II in Germany and in Japan.
It is not only the damage, victimization needs social
recognition - otherwise it does not exist.
Child beating in family and in schools
Corporal punishment in schools
Victimizations during trainings in high performance sports
Silenced conditions in institutions of aging and dying (we
instantly and quasi religious hope that physicians do not
abuse their power)
Female genital mutilation,
Circumcision of boys.
Wife beating in India and Arab countries
Kurds as victims of mass persecutions (chemical weapons)
during Saddam Hussein’s regime (no compensation)
Victims of Human Trafficking - who is the victim? Who
deserves assistance, protection and treatment? Who is
target of repressive social control?
The social climate is molded and constructed by ideologies.
Ideologies are the set of general or abstract beliefs or
assumptions about he correct, proper and desirable state of
things, particular with respect to the morale and political
arrangements which serve to shape one’s own position
(Miller 1973 p.2).Ideological positions are often preconscious rather than explicit, and they serve - under most
conditions - as unexamined presumption that underlie
positions taken openly. They bear a strong emotional
charge. This charge becomes evident when the ideology is
challenged. Scientific positions are very often based on
ideologies.
Ideologies in law and politics , economics, psychology and
criminology. Miller: ”In crime and crime control, it is all about
ideology”.
Once established, ideologies become relatively impervious
to change since they serve to reject or receive new evidence
in terms of a self contained and self reinforcing system. They
support the ruling systems and the ruling institutions.
By this, they become part of the definitions that favor
victimizations and that impede victimizations.
When science deals with social problems, we see how
generally shared beliefs determine how facts are
constructed. What is accepted as fact? Scientific convictions
are nothing but a special construction of reality (Kuhn 1968).
If the constructions change, scientific convictions change as
well.
If society reconstructs a disease as deadly contagious, it will
develop different consequences than if science constructs
the disease as containable, curable and only mildly
contagious. Exactly that happened with the social responses
to leprosy worldwide and in Japan.
Examples:
Victimologists do not like to look at victimizations in prison conditions in Guantanamo must be brought to our attention
by hunger strikes.
Victimologists do not look at executions of death penalty they do not even comment on the new government of Abe
being responsible for 5 state sanctioned killings. For some
people, even death penalty is not enough - ritually the mass
media report about opinion polls that favor to 85% death
penalty, if not “something worse”.
Definitions of reality influence the perception of victimization.
Reality is not something that exists outside our definitions.
This thesis is grounded in the small and harmless looking
sentence of William I. Thomas and Dorothy Swaine Thomas,
The Child in America, 1928 p.573:
“If men define situations as real, they are real in their
consequences”.
It became the credo of the upcoming science sociology, and,
elaborated by many great sociologists, the term “Social
Construction of Reality” became an acknowledged technical
term.
This explains THAT definitions are so powerful. But how do
they become so powerful?
Lessons from the Sociology of
Social Movements
Social movements (Mauss 1975) start in a small circle of
concerned often dedicated and passionate people.
Growth of the movement. Research in Tokiwa has used this
approach to interpret the victim movement (Kirchhoff 1998,
Kirchhoff-Morosawa 2012, Okamura 2012).
Public 1: The Internationale Kriminalwissenschaftliche
Vereinigung
Consisted of concerned experts that saw that the predominant
ideology that justified punishment, was eroding. It was the
absolute guilt -theory in the wake of Kant and Hegel: Retribution
was seen as the only valid justification of punishment.
This ideology effectively blocked away any discussion about
alternative purposes of punishing (like resocialisation or general
and special prevention).
Two very disquieting trends were felt by the lawyers.
With the rise of natural sciences in chemistry, physics,
astronomy, medicine and with the invasion of natural science
methods into the upcoming social sciences, the absolute
theory became target of attack. Soon it was ridiculed and
branded as hopelessly antiquated.
The industrialization changed the focal concerns: masses of
uneducated workers concerned the ruling classes - their
health status was dangerous and their educational level
needed improvement. In Japan and in Germany, the general
draft systems and the obligatory school system were
introduced, and that made medical control of the whole
nation - in Japan and in Germany - necessary.
Medicine and social health politics became the dominant
topics.
In 1906, the IKV had 1347 personal members from 29
countries. 77% were lawyers. The next biggest group with
4% were physicians. Despite all programmatic references
to include anthropological, medical and sociological
research, the IKV was an almost pure association of
lawyers. The almost undisputed authority in this field was
Franz von Liszt.
The lawyers took notice of what happened in medicine
and especially in social medicine.
Maybe it is too polemic but the impression prevails that no
longer the lawyers as interpreters of the interests of the
powerful classes were most important for the wellbeing of
society. They were extremely impressed by the
progresses of medicine and they tried to integrate the
principles developed in medicine to social control via
criminal law.
Rudolf Virchow
1821-1902
An ardent democrat, Virchow was
not only founder of cell pathology
but founder of social medicine as
well. In a path breaking report on
the outbreak of typhus in Silesia (
an epidemic that closed the very
important coal mining facilities of
the region) he wrote 1848:
The outbreak could not have
been solved by treating individual
patients with drugs of with minor
changes in food, housing and
clothing laws but only though a
radical action to promote the
advancement of the entire
population which could only be
achieved through full and
unlimited democracy, education,
freedom and prosperity.
Virchow on social problems
“Medicine is a social science, and politics is nothing else than
medicine on a large scale. Medicine, as a social science, as the
science of human beings, has the obligation to point out
problems and attempt their theoretical solution: the politician,
the practical anthropologist, must find the means for their actual
solution. The physicians are the natural attorneys of the poor,
and social problems fall to a large extend within their
jurisdiction”.
1874-1884 he conducted the most elaborative comprehensive
anthropometric project in the German Empire, 6.8 million school
children were surveyed (anthropological measurements).
To create good health conditions for the masses of industrial
workers and good education to meet the demands of the army
and industry became a central topic, not only in Germany but in
Japan as well.
The social prestige of physicians grew immensely – they were a
living proof for the success of the new states – the new
Germany and the new Japan.
Robert Koch 1843 - 1910
The leading immunologist,
worked on anthrax and on
tuberculosis (Nobel Price in
1905).
His students found the
organisms responsible for
infectious diseases like
diphtheria, typhoid,
pneumonia, gonorrhea,
cerebrospinal meningitis,
leprosy, the bubonic plague
(this was done by his
important Japanese disciple
Shibasaburo Kitasato 1894),
tetanus and syphilis
(Wassermann).
Between 1896 and 1907, Koch spent 10 years worldwide
teaching and travelling, six in Africa and the remaining 4 in Asia
and India. A private trip brought him 1908 to USA and Japan
(visit to his disciple Kitasato - Director of the Japanese Institute
for Immunology, the nucleus of Kitasato University, and later
Dean of Medical School of Keio University, first president of the
Japanese Medical Association , member of the House of
Peers). Nobel Price in Medicine in 1905.
Cell pathology (Virchow) and immunology (Koch) are the two
medical schools that fascinate the thinking of the time. The
political task of medicine was obvious: The creation and
maintenance of a healthy population was decisive for a
successful industrialization and a blooming industry. Both
depend on a good school system and on the military strength of
a country.
Till the middle of the century, the lawyers had been the ones
who were directly useful for the ruling classes in the feudal
order - but that monopoly changed.
The new theories in medicine
Combined with the evolution theory of Darwin
These developments led to an insecurity of the law
professors and the leading figures in the political sphere.
This insecurity lead the traditionalists to a procrastinated
absolute guilt theory (following the Retribution Thesis that
was attributed to Kant). More progressive ones looked for an
alternative.
The leading figure in Europe’s criminal law was Franz Ritter
von Liszt (1851-1919).
Franz Ritter von Liszt (1851 1919) was a German jurist,
criminologist and international
law reformer. As a legal
scholar, he was a proponent of
the modern sociological and
historical school of law. He
was President of the IKV. In
his Petersburg lecture 1902,he
proclaims:
Criminal law has to protect the weaker as long as possible
so that they do not loose in the fight for survival of the fittest.
Where such assistance is no longer possible, the legilator
has to take care, that those elements are eliminated that are
completely unsuited for coexistence in society.
While it is obvious that society itself performs this
elimination: the misfits will go down without fail, afetr one or
two generationstheir ability to reproduce is exhausted. But
this social selection process is very slow and it is connected
with severe victimizations for society. The wellbeing of the
whole and the care for the individual demands imperatively
the intervention of the state. Without any softness but without
unneccessary strictness the legislator has to perform the
elimination.
This speech reflects the predominant ideology. It reflects what was
taught and learned in university seminars. Ideas are somehow
connected with the concept of race.
A subfield of Eugenics that looked at the physiologically and
genetically determined differences of nations.
In the context of colonialism, the concept of race was used to
degrade groups like Indians and Jews.
“We take animals as they are and we treat them accordingly. In
the same way, unbiased and unprejudiced, we should treat
humans as well” (Moebius 1853 - 1907) Ueber Entartung 1900
p.120).
A great deal of teaching and publication was spent on efforts to
find ways to preserve the purity of the race and to find social
institutions that serve the purpose to avert deleterious
consequences for the “healthy body of the race”.
One of the lawyers, fascinated by the promise of medicine,
studied medicine in Paris and became later the founding
father of victimology. Hans von Hentig: Strafrecht und
Auslese 1914 p.85:
“We have to get used to the idea that some criminals are not
improvable. It would be irrational to help where any help is
futile. If we want to argue for real empathy with these
unfortunate individuals, then we cannot do a better thing
than bye and bye to let this class of humans gradually die
out.”
Social Darwinism at that time gained currency with scientists
around the world, so in Japan.
Eugenics - so the Japanese Hisomu Nagai - involves the
prevention of sexual reproduction through induced abortions or
sterilization among people deemed unfit . And unfit included
for him
Alcoholics
Lepers
Mentally ill
Physically disabled
Criminals
The Leprosy Control Law of 1909
Provided that all leprosy patients should be interned in
leprosaria.
Coupled with an extensive propaganda campaign “Our
Prefecture is leprosy-free”
The law was enforced:
Patients were collected in schools, at the workplace, from
waiting rooms of physicians clinic,
Married partners were forcefully separated, children
separated from their parents.
One women Onose-san interviewed had already three children and was
pregnant when diagnosed to suffer from leprosy. Her mother had forced
her to an abortion.
She secretly was brought at night to the leprosarium so that neighbors
did not realize that family was hit by the shameful disease.
Families were afraid of discriminating reactions of the neighborhood
Patients were hidden from sight of the neighbors as long as possible
Either neighbors blew the whistle and police arrested the patients or
the health officer informed police. Physicians had to inform the
authorities of cases of leprosy.
In another case Onose-san interviewed, a brother developed
leprosy while in the army - that led to discovery of a sister being
infected at home.
Patients were usually disowned by their family who feared the
social exclusion and ostracism of the community. They feared that
somehow patients would come back and bring dishonor to the
families.
Still today patients do not return to their place of birth since they
fear to bring shame and dishonor to the family members who
still reside there.
Onose-san interviewed a 83 year old patient. Her husband
divorced her 5 years after institutionalization. He never
mentioned her to anybody nor did he ever write to her. She
was silenced and did no longer exist She wanted to know about
the live of her three children, never dared to ask.
The leprosaria were closed institutions - no one could leave
them.
Upon commitment, patients had to sign a form consenting to
their autopsy - that caused considerable fear and confusion,
of course patients hoed to be cured.
Institutions were badly financed and had to be self
supporting, few physicians and nurses, untrained supervising
personnel.
Patients had to do all work, cook meals, provide farming,
provide wood for heating in winter, clean rooms, had to do all
construction works - that was dangerous since the disease
brought numbness of the limbs (severe wounds)
In institutions, strict separation of men and women.
Heavy punishment for those who violated this order:
Forced sterilizations, forced abortions.
“It is a lovely baby and it looks like you!”
The presentation of the fetus after abortion was routine,
anesthesia were believed to be a waste of money.
These stories were mentioned to Onose-san and that shows
how traumatic these events were.
Punishments made the regime even more unbearable.
Escaped patients were retransferred
Kensuke Matsuda wrote that patients committed assault and
battery, theft, adultery and riots - directors had not been given
authority to police or to punish patients. Normalprisons would
not accept lepers. A special leprosy prison was built 1953 - but
since 1916 the government empowered directors to punish
disobedient patients. They could imprison patients up to one
month, reduce their food. Directors regarded this as a mild
form of house arrest.
These arrests would have rarely any effect on the “brutal one’s”
who would repeat crimes. Directors decided to build a special
facility. Praised by practitioners, the new institution was a cruel
place of disease and death - debilities, pneumonia, nephritis and
suicide - outside temperatures dropped to minus 16 degrees C,
there was no heating. The time of imprisonment exceeded
maximum permitted lengths - one prisoner survived for 500 days.
Forced sterilizations on absconders, patients who wanted to
cohabitate were given the permission provided they were sterilized.
This was seen as the milder and more effective way of controlling
behavior of the inmates (compared to punishment and gender
separation). It served peace and tranquility in the institutions since
no new children were born.
The leprosaria were not small institutions:
1900 30 000 patients were found in Japan.
1955 11 057 Inmates
1955 the directors of the institutions demanded from
parliament to maintain and enlarge the capacity - that
happened in spite of the fact that since 1943, with PROMIN
1943 there was a effective medicine.
But the effect was not perfect, relapses occurred, in addition
Promin was very painful to administer. Therefore the
involved physicians convinced parliament that the disease
was still very contagious and incurable.
In 1950 and 1951 the three directors led by Kensuke Mitsuda
stated that about 9 000 patients were institutionalized and 6
000 still were outside the institutions.
In 1951 already, one director explained to the parliament that
many deformed patients could not be released from the
institutions since they remained unaccepted in society and
therefore could not live outside.
The Leprosy Prevention Law from 1953 basically restates
the prohibition to live outside the institutions and the
prohibition to leave these places.
Counter Actions
With the new constitution providing for individual rights, the
Patients’ Federation became more and more active as a
public opposing official policy. They insisted that the
institutions lacked the scientific basis and that they violated
human rights. They claimed to be victims of enforced
segregation and of a social stigma that was created and
maintained by the law..
1973: the federation filed a petition for a revised law and sends 200
patients to pressure parliament and ministry.
Ministry argues: the existing law legitimizes compulsory isolation of
patients and it constitutes the legal base for government’s
responsibility to provide the inmates with care and comfortable
living environment. Revision of the law might abolish the leprosaria,
patients could no longer live on public support. In a survey after that
only 16% of the inmates voted for being discharged. The rest felt
they were unable to live without leprosaria.
That is no surprise: the leprosaria existed for more than fifty years,
patients were really dependent on them. They were afraid to be
forced to leave the institutions they were forced to get accustomed
to.
1976: the directors draft a law that incorporated specific discharge
conditions - rejected by the patients federation - this could end up in
enforced discharges. The Federation feared that budgetary
considerations would play the main role, not their welfare.
In 1998, the Kumamoto Court ordered several million Yen
compensation to 127 patients for their illegal internment. Prime
Minister Koizumi prohibited an appeal of the sentence.
2009:
2600 leprosy patients live in 13 national sanatoriums and in two
private hospitals. Their mean age is 80 years.
There are no newly diagnosed leprosy patients in 2005 in Japan, in
the following 2 years one per year.
Due to age, sterilization and abortion, the patients do not have
children. Many have diseases of advanced age, and help is
necessary. Some earnestly hope for social rehabilitation, but there
are very few who are active in society.
Those in sanatoriums, enjoy the help and he care of physicians,
nurses, health workers. Some families visit them in the sanatoria
and some visit their families.
a high
The literature I consulted, blames the government or keeping
the institutions even if there was medical help available.
The reason behind this delayed reaction is that many
persons are involved in maintaining such a system and these
people do not want to admit that their work over the last fifty
years was a mistake. These people had invested
considerable time and work. They simply did not want to give
up.
Shortly before the Kumamoto sentence, the physicians
working in the leprosaria were celebrated in a parliamentary
discussion and the leading director was awarded a high
decoration – with this the old generation was given the
chance for a honorable farewell.
The surviving patients were compensated. The institutions
were transformed into sanatoria or in homes for the aged.
Outlook
All in all, leprosy is no longer a problem in Japan.
The number of former inmates will decrease
drastically and finally no one will survive. But that
is no longer a problem of victimology.
The compensation measures have been reported
as generous and satisfactory.
The survivors can expect to end their lives in
security and being cared for.
Survivors are active in informing the public about
the history of their suffering.
A Hansen’s Disease Museum in Tokyo keeps alive
the memory and collects all publications about the
Leprosy Control measures in the past.