On the Body
Authors: Tanaka Kathryn M. 
Published: October 2022

Introduction
Fashion and beauty work are a part of identity that is shaped around normative, idealised, and often gendered bodies, and this has been the subject of much academic and popular attention. While much research focusses on fashion and beauty work as a way to highlight socially desirable traits or trends, it is important to note that fashion is equally important as a tool for the concealment of a visibly stigmatised identity. For people diagnosed with a visibly disfiguring illness, fashion and makeup practices became a way to either reinforce or negotiate stigma. In particular, writing by people diagnosed with Hansen’s disease in 1930s Japan reveals the way in which fashion—in the form of clothing issued by the institution—could reinforce the stigma of their condition, whereas clothing from home, and the use of makeup, allowed for concealment of some of the visible markers of their condition.
So associated is the notion of stigma with the condition of Hansen’s disease that “leprosy” or “leper” are used as pejoratives in some languages, to indicate conditions or behaviour out of line with social norms. Yet, it is only relatively recently that stigma and Hansen’s disease have been the subject of academic attention. Since Zachary Gussow’s ground-breaking 1989 work, Leprosy, Racism, and Public Health, however, Hansen’s disease stigma has been extensively studied, with much of the recent scholarship focused on visible stigma and social reintegration. That is to say, much of the attention is focussed on stigma reduction, and creating policies and awareness to decrease stigma by third parties. Few studies have focussed on the way stigma, in the case of Hansen’s disease, has been either reinforced or resisted by the people suffering from Hansen’s disease.
Stigma, as “degrading marks that are affixed to particular bodies, people, conditions and places within humiliating social interactions”, serves to mark bodies as abnormal or inferior (Tyler, 8). In the words of Erving Goffman from his classic study on stigma, the term refers to a “spoiled identity,” and limited social participation (Goffman, Stigma 11-15). More recently, in her ground-breaking book Stigma: The Machinery of Inequality, Imogen Tyler argued that stigma is both socially produced and negotiated, and that just as stigma can be leveraged to control unruly bodies, so too can it be a mode of resistance for those who are living with a stigmatised condition such as Hansen’s disease, an illness that was feared because prior to the discovery of Promin in 1943 the disease was incurable.
The physical signs of illness, such as deformity of the limbs and loss of hair, made this stigma unmistakable. When sufferers were subject to quarantine, fashion was used to further mark their bodies: patients in public institutions were issued standard garments that identified them as belonging to an institution. At the same time, private clothing and makeup allowed sufferers to use fashion to conceal their stigmatised condition, to fashion liminal identities that in Goffman’s terms are not yet discredited, but “discreditable”, with their stigmatised condition hidden but social exclusion eminent should their diagnosis become clear to those around them (Goffman, Stigma 16).
In the works I discuss below, we can see how clothing and makeup function to both reinforce and resist stigma in the case of writers with Hansen’s disease in Japan. This article explores the way in which illness intersected with beauty, fashion, stigma, and identity in the early years of the public institutions. First, I examine how changes in beauty marked sufferers as ill, and how that marked the sufferer as excluded from society. Makeup becomes a way to mask the visible signs of illness and inhabit a liminal space between health and marked by illness.
Second, I discuss clothing as part of the process of institutionalisation to examine how clothing further demarcated sufferers. For many people admitted to a public institution, the issuance of standard clothing was another form of social death. The uniform clothing and marks of illness all reinforced patient bodies as abnormal. At the same time, even as their bodies were abject, I argue here that fashion, clothing and makeup could also allow them to inhabit a liminal space, separate from sufferers with advanced physical disfigurement, and allowed them to maintain an affective connection to society.
Beauty, Making Up, and Masking Stigma
While the study of physical, visible stigma and its intersections with issues of identity and social control have been the subject of renewed attention in recent years, few scholars have explored the way in which makeup is part of a masking, or resistance, of stigmatised conditions. While there is some scholarship that focusses on beauty work as biopolitics, such work often focusses on contemporary, voluntary beauty work, such as cosmetic surgery or makeup (Miller; Elfving-Hwang). At the same time, recently scholars have begun to examine the ways in which ableist standards of beauty and fashion mark physical difference as abnormal, or threatening (Davidson, 1-2).
In the case of Hansen’s disease sufferers, facial changes as a manifestation of a stigmatised illness were for many writers a powerful symbol of their isolation from society. Makeup and fashion within the institution became a way for sufferers to resist the stigma associated with their disease. The application of makeup was a performance that signified inclusion in society, and its neglect was symbolic of social exclusion. This is clear in writing by women diagnosed with Hansen’s disease.
For example, Hayashi Yukiko (1909-1993), in 1939, wrote that the disease first manifested on her face, in the form of a small red spot under her left eye. She wrote that she used powder to cover it, suspecting what it was. The use of makeup allowed her to continue her job at the post office until, despite her use of makeup, her co-worker noticed it (Hayashi, in Uchida, Seto no Akebono 143). After her subsequent diagnosis, she quit her job and went into isolation at home. Writing of her experience of this time, she again mentions makeup:

Untouched since I got sickThe makeup case gathers dustOn the corner of the shelf病みてよりふれぬがままの化粧箱ほこり積りて棚隅にあり (Uchida, Hagi no satojima 61)

A second poet, Seto Senshū, expresses similar feelings of hopelessness through an evocation of makeup:

The powder that has not touchedMy hands for years Comes out of the jar with a dry rustle年久しく手にふれざりし白粉のかはきて瓶にかさと音立つ (Abe 72)

For both of these authors, being quarantined because of their illness meant being cut off from society, and the discontinuance of makeup application became symbolic of social exclusion, an acknowledgement of the fact that fashion as a mode of concealment is no longer necessary.
For many sufferers, an early sign of the illness was a loss of eyebrows. This was in part because Hansen's disease affects the nerve endings and the skin, the illness often manifested on the face of sufferers, and marked them as targets for discrimination or loss of social status. As eyebrows were an early sign of the illness, they were a point of concern for patients. Laura Miller and Higuchi Kiyoyuki have pointed to the importance of eyebrows in beauty work in Japan dating back to the Heian period (Miller, 141; Higuchi 81-84). Eyebrows, their shape, and the cosmetics used upon them, then, are important symbols of beauty. In Hansen’s disease literature, then, references to eyebrows and makeup are often indicators of the progress of the disease and how the illness specifically impacts the identity of women. Hayashi Yukiko wrote of her eyebrows:

Every morning, every morningThe cloth with which I wipe my faceComes away with my eyebrow hairMy heart sinks朝な朝な我が顔拭ふ手拭に眉毛つき来て心が沈む

Difficult to see my motherGaze anxiously at my faceI look down我が顔を気づかはしげに見る母のまみは見難く面ふせにけり (Uchida 61-62)

In these poems, Hayashi’s changing appearance is tied to what it means to fashion gendered beauty in Japanese society. To have eyebrows altered in a way that is recognisable as “diseased” is a significant, traumatic impairment. This trauma is made more acute by the fact that the gaze of people is now directed at her with anxiety or fear, a response to her visibly altered body. Imogen Tyler has referred to similar phenomenon as “the stigmatising gaze”, a recognition of “stigmata on the bodies” that can no longer be masked (Tyler 12).
This stigma of the illness and the gaze of those around them was particularly heavy on women. Even within the sanatorium, male patients sometimes remarked on the stigmatised beauty of the female patients. Ishikawa Kō (1906-1930), a poet who lived in Kyūshū Sanatorium, hints at the futility of makeup to hide the signs of the illness:

In the waiting room in the morningWith sadness, seeing the woman patient, eyes downcastEyebrows pencilled inうつむきし女患者の書き眉をかなしく見たり朝の控所に (Kawamura and Uchida 9)

Here, women pencil in their eyebrows to become invisible to the stigmatising gaze, to escape notice as being disfigured even in the hospital. They use makeup to escape the gaze of others rather than attract it, as is clear in the downcast eyes.
While more women write about beauty work more than men, it was not only women applying makeup or aware of the gaze of those around them. The men also used makeup to disguise the disfigurement they suffered from their illness. Hōjō Tamio (1914-1937), one of the most famous authors of literature about his experience of illness and quarantine in the Tokyo district hospital, Tama Zenshō-en, writes of protagonist Oda’s process of institutionalisation in his most famous novella, Inochi no shoya (Life’s First Night). Describing Oda’s approach to the sanatorium, Hōjō writes:

One eyebrow had thinned because of his illness, and Oda had pencilled it in. When the [local village] men came up next to him, they suddenly ceased to chatter, and as they passed by, they looked with eyes full of curiosity at … Oda … . While Oda looked down silently, he keenly felt their gaze.

Similarly, in a haiku Kiyokawa Hachirō describes the act of making up his eyebrows. This poem picks up the seasonal word hatsukagami), referring to the first use of the mirror in the new year:

Drawing my eyebrows heavier than usualReflected in the mirror for the first time in the New Year常よりも眉濃くひけり初鏡 (Abe 72)

There is a disconnect between the poetic ideas of the first makeup application of the new year and the male author pencilling in thick eyebrows. Poems such as this make clear that eyebrow makeup was a means for both men and women to conceal the effects of their disease and conceal their illness through fashioning a discreditable but not yet discredited identity. At the same time, the poems also expose the futility of using makeup to fully conceal. The poems reveal a preoccupation with what Tyler calls the stigmatising gaze, and the scrutiny of others demonstrates the limits of makeup to conceal their stigmatised identity.
Clothing, Institutionalisation, Identity
After the 1931 Leprosy Prevention Law, hospitals were designed to be similar to what Erving Goffman calls “total institutions” (xiii). Total institutions such as prisons are characterised by physical boundaries separating residents from the outside world, restricting contact with that outside world, and by further boundaries within the institution separating residents from staff. Many of these elements were present in Japan’s Hansen’s Disease hospitals after 1931.
Entrance into the institution involved the creation, or acceptance, of a new identity and new social status. Institutionalisation for the treatment of Hansen’s disease in the 1930s included a disinfectant bath in the presence of medical professionals. As the newly admitted patient bathed, their possessions were taken for disinfection and inspection and their money was confiscated. After this, patients were then issued hospital standard kimonos: typically a plain, vertically striped (referred to as udon shima), cotton garment that marked them clearly as patients. Although the colours or patterns varied across institutions, the garment was the same for all residents, regardless of assigned sex or age (Kimono 3). This served several purposes: first, because patients themselves made and cared for all their clothing, purchasing the same fabric in bulk was economical. At the same time, wearing the same clothing also eliminated class distinctions between residents, and served to downplay the femininity of the female residents (ibid).
When working with patients, nurses and doctors dressed in head-to-toe white protective robes, complete with hats, gloves, and face masks. The seriously ill residents, confined to bed, were also issued thin, white cotton sick clothes (byōi). Thus, the boundaries between the sick and the healthy were inscribed on the clothing of individuals working and living in the hospital. The issuance of institutional clothing meant a clear severance with society, and some residents felt the clothing marked them, similar to the way prisoners in jail were identified by matching, stigmatised clothing (Kimono 3). Goffman’s notion of batch living is expressed through standardised kimono as Tamae, a poet at Seishō-en, the Shikoku area institution, expresses here:

At the hot water stationThe matching yukataAll hung out to dry湯の宿に揃いの浴衣干してあり (Moshiogusa 20).

Figs. 1 & 2: Examples of the standard-issue wear from the 1930s. Images courtesy of the National Hansen’s Disease Museum, Tokyo, Japan.
Hōjō Tamio, again in Inochi no shoya, describes the kimono. Oda first glimpses the clothing in a voyeuristic scene, as he peeps at two young women through the hedge demarcating the institution: “Looking in the direction of the sound, he saw two women on the inside of the hedge … . Out of the corner of his eye, he saw that both women were wearing short-sleeved kimonos with the same striped pattern” (Hōjō n.p.). This scene is recalled when Oda is in the bath:

a nurse showed him a new kimono as she said, “When you get out, put this on please”. The kimono was of the same striped pattern he had seen the two women wearing as he watched from outside the hedge. With its light sleeves, it looked like a kimono an elementary school student might wear, and when Oda got out of the bath and put it on, he felt he cut a shabby and ludicrous figure. He kept looking down at himself. (Hōjō n.p.)

For many hospital residents in the 1930s, these issued garments would be all the clothing they had. The uniform clothing of the institution served as another way to mark the illness of the wearer on the body—fashion becomes an additional mark of stigma. Indeed, in images from that time, sufferers of Hansen’s disease are immediately identifiable not only through the manifestations of the illness on their bodies but through their clothing as well. In the three images shown below, residents wearing institutionally issued kimono are immediately identifiable through their clothing, making a resident wearing what is likely a chequered, personal kimono in the final image stand out. Furthermore, the doctors are also clearly identifiable amongst them, dressed in white and covered from head to toe.

Fig. 3: Men sharing tea at a work station, wearing the standard issue kimono. Image courtesy of the National Hansen’s Disease Museum, Tokyo, Japan.

Fig. 4: A group of blind patients together with medical professionals. Image courtesy of the National Hansen’s Disease Museum, Tokyo, Japan.

Fig. 5: Promotional postcard from Zenshō-en in the early 1930s featuring patients, medical professionals, and an officer together on the veranda of a housing ward. Image from the author’s personal collection.  
Yet, as can also be seen above, there was still difference in clothing within the institution. First, because all work was performed by residents of the institution, patients would wear work-appropriate clothes, such as the aprons some women wear in fig. 4. Second, as can be seen in fig. 5 in the standing figure second from right, some patients did in fact have their own clothing within the hospital. This was, as I have discussed, fashion as resistance of a stigmatised identity, but for those within the institution personal kimono was also a performance of class and connection to home through their fashion. For example, Nogiku, a writer from Seishō-en, wrote:

In the package sent to meA yukata handwoven by my mother送り来し母の手織の浴衣かな (Moshiogusa, 20)

A second poem from Hayashi Michiko, also from Seishō-en, expressed similar sentiments years later:

This was sewn for meBy my motherWhen it was decided I would go to the leprosarium癩園に行くが決まりしわがために母縫ひくれし単衣ぞこれは (Seishō 18)

For many residents, institutionalisation meant a severing of ties with their families and communities. The stigma associated with the illness meant that a family would face discrimination in work and marriage prospects if it were widely known a relative had been diagnosed with Hansen’s disease. For many other patients, even if they were undeterred by the stigma, their families could not afford to send packages or visit. The receipt of a yukata, or Japanese summer garb, or special clothing handmade by the authors’ mothers are not only fashion; they also serve as a physical representation of a continued connection to family and society outside of the institution and of the social status of the poet. The privilege of wearing private clothes in the institution, then, was a marker of both class and continued connection to society beyond the hospital. In that sense, private fashion was also a way to resist the stigma of the disease through a clear association with the uniform of the institution.
Conclusion
Clothing and makeup are ephemeral objects, often things that are used every day and then discarded when they are worn out or used up. They are items that people often use as routine, without thinking. The fact that writers diagnosed with Hansen’s disease traced their experiences with illness and stigma through makeup and clothing indicates the deep, symbolic meaning these items were imbued with after a diagnosis. More than a way to express oneself, or play with identities, as other contributions in this issue discuss, for people diagnosed with Hansen’s disease, makeup, and clothing became a way to use fashion as concealment, as well as a physical connection to home and social status. Makeup and clothing were a way to resist stigma and fashion to a “not-yet-discredited” identity, to conceal the markers of illness and quarantine. The importance of makeup and fashion as a mode of concealment can be seen in writing by people who experienced illness and quarantine.
All translations in this article are the author’s own.
Acknowledgements
The research for this article was conducted with the support of Grant-in-Aid for Early-Career Scientists 20K12936.
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