Social Victimization of Leprosy Patients in the 2oth century

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Social Victimization of Leprosy Patients in the 2oth century

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Title: Social Victimization of Leprosy Patients in the 2oth century

1
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 stand-alone
isolated phenomenon.
There are four different ideologies which I want
to look at when I try to explain these control
instruments.

3
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 Hansens 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.

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7

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 Hansens
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.

10
Victimology of Hansens 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 Ronnells
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 Husseins 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 ones own position (Miller
1973 p.2).Ideological positions are often
pre-conscious 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?

21
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 Kriminalwissenschaftl
iche 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.

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.

Rudolf Virchow 1821-1902

25
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.

26
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 Europes 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.

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33

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 ones 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 governments
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.

44
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.

45
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 Hansens Disease Museum in Tokyo keeps alive
the memory and collects all publications about
the Leprosy Control measures in the past.