Japanese Citizens Becoming Masked Heroes to Serve Society

In a Tortoiseshell: In her R3, Nanako Shirai argues that surgical masks in Japan have transformed from individually-oriented devices meant to protect against the spread of the H1N1 virus into symbols of Japanese collective identity and social duty.  Her thesis extends from a clear research question and motive, as well as from a strong set of evidence, which help make it feel new and interesting.

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Excerpt / Nanako Shirai

The Ministry of Health, Labour and Welfare in Japan published guidelines that recommended infectious individuals and key public sector workers wear masks (Burgess and Horii 1187), and over time, many people who did not have the virus also began to wear face masks in public — “with the expectation that it helps prevent respiratory infections” (Wada et al. 1). By 2010, SteelFisher et al. found that “71% of responders in Japan…said they wore masks” (847). Curiously, masks are still worn today, seven years later. While the extensive usage of surgical masks in Japan initially appears to stem from a desire to contain the 2009 H1N1 pandemic, the continued use of the masks still in 2017 suggests otherwise. Studying why masks became such a popular non-pharmaceutical intervention in Japan helps us to understand how cultural characteristics influence the management of a disease outbreak. In Japan, the surgical mask, over time, transformed from a personal device used to stop infectious diseases to a social device that functions as the physical manifestation of Japanese society’s devotion to collective identity and desire to serve Japanese society.

The extensive usage of surgical masks in Japan initially rested on the assumption that masks protect one from getting a disease, but studies have proven that masks are actually not effective as protective gear. Inouye et al., a public health research unit at Otsuma Women’s University in Japan, writes that “from a public-health perspective, blocking viral spread with masks at a point of origin, that is, coughing patients, is more efficient than blocking virus particles that have been scattered in the air with masks worn by susceptible persons” (179). In other words, researchers such as Inouye et al. and Wada et al. have found that while masks may hinder the spread of viruses from an infected person, masks are not very efficient at protecting a healthy person (179, 1). While research has proved the inefficacy of masks for healthy individuals, according to a study conducted by Morishima et al. in Japan in 2009 during the flu pandemic, the most common intended use of the surgical masks was the “prevention of influenza and the common cold” (15). Since the study collected open answer responses, the use of the word “prevention” specifically by a large number of the respondents suggests that masks were erroneously viewed as a way to protect oneself from disease. In addition, the masks were used for “influenza and the common cold.” While the masks initially became popular due to the H1N1 pandemic, its use had expanded to common health concerns. Although the Ministry of Health, Labour and Welfare in Japan published guidelines that recommended only infectious individuals and key public sector workers wear masks, within the same year, surgical masks had become tools for healthy people to use for any type of contagious health concern. Thus the purpose of masks was no longer for stopping disease — they had become an all-purpose protection device.

The transition of the mask into an all-purpose protection device is revealed by studying how masks were used in the aftermath of the 2011 Great East Japan Earthquake and Tsunami. The 2011 Great East Japan Earthquake and Tsunami was the 4th largest earthquake in the world (Associated Press), and the resulting tsunami caused three nuclear reactors in Japan’s Fukushima Daiichi nuclear power plant to break down (Wakatsuki and Lah). In response to this natural disaster, the mask was newly employed for protection “against the threat of radiation from the Fukushima reactor” (Burgess and Horii 1184). According to Burgess and Horii, although masks were not proven or known to be effective against radiation, children throughout East Asia were asked to wear these masks as concerns about nuclear fallout grew (1184). The surgical face mask had become “Japan’s (all-purpose) ‘safety blanket’” (Burgess and Horii 1184). Theoretically, the surgical face mask now not only “protected” one from influenza and the common cold, but also from nuclear radiation; essentially, the mask’s actual function in stopping infectious diseases was irrelevant — the physical mask was now only worn to represent a barrier against undesirables from the outside world. The physical masks that the Japanese people were wearing were no longer expected to stop infectious diseases. The emphasis was now placed on the significance of the act of putting on a mask.

While it may appear on first glance that these masks are “personal protective devices,” they actually are “societal protective devices”; the purpose of the mask changed from a device that “prevents one from getting a disease” to a device that illustrates one’s consideration for society. Because the masks were now being used to protect oneself from afflictions other than infectious diseases, in SteelFisher et al.’s study in Japan, the use of a mask is classified as a “personal protective behavior” (847). While this classification appears valid at first glance, further research reveals that the use of the masks is not as individualistic, or “personal,” as originally assumed. The Health Promotion Act of 2002 in Japan “asserts that the active monitoring of health and engagement in health promotion are the duty of each citizen” (Burgess and Horii 1189). The usage of the word “duty” underlines the demanding commitment that needs to be made for Japanese society by “each citizen.” A survey done by Burgess and Horii found that there is some “perceived pressure” in wearing a mask (1191). If a citizen wants to do his “duty” for society, he needs to wear a mask while out in public; the “pressure” comes from the fact that a citizen should do his “duty” for society — otherwise he would be looked down upon by the other members of Japanese society. That is to say, demonstrating a concern for others by wearing a mask when one is sick became social etiquette. As Burgess and Horii observe, “in a shift of bodily perception, non-wearers [became] an object of attention” (1187). “Non-wearers” became “objects of attention” because the fact that they were not wearing a mask suggested that they did not have regard for Japanese society; namely, “non-wearers” were seen as being disrespectful to Japanese society (Burgess and Horii 1191). As mask wearing became perceived more and more as a “duty,” people who wore masks even when they were healthy were seen as having a respectful and especially commendable regard for society (Burgess and Horii 1191). Since people in Japan wanted to be perceived as being respectful of Japanese society, more people began to wear masks.

Author Commentary / Nanako Shirai

When my Writing Seminar professor first explained our prompt for the R3, I felt completely lost. As the deadline for the research proposal only kept getting closer and closer, at my wit’s end, I ended up submitting the first idea that came to my head. While getting ready to write my first draft, however, I realized that I wasn’t excited to do research on the topic I had chosen.

With this realization and a lot of reflection on my personal experience with “contagion” (the name of my Writing Seminar), I remembered an experience from several years ago, when I went back to Japan over the summer. That was the year of the 2009 H1N1 influenza, and everyone in Japan wore a surgical face mask to protect themselves and each other, even in the dense humidity and heat. While I thought that the mask wearing would only continue for a little while, as I went back to Japan during subsequent summers, I saw the surgical face mask transform into a popular fashion device. My first question and motivation to write this paper came from this phenomenon ⎯ why did surgical masks become so popular in Japan?

From there, I began my research. As a first year, I had no idea where to even start, so naturally, I started by going on Google Scholar to look up “japan face masks.” Looking back, a significant portion of my writing process was this initial research, and because the key words that I used in my search were very broad, I ended up getting a variety of sources. While I never thought that I would end up writing about Noh Theater, a type of traditional Japanese musical drama, in a paper about flu pandemics, it ended up being an integral part of my argument. Through reading different papers, I was able to craft my thesis ⎯ which I promptly emailed to my professor, asking for permission to change my research proposal.

My second motive was only realized after I finished writing my draft ⎯ after figuring out my thesis, I realized that my paper was significant also because “studying why masks became such a popular non-pharmaceutical intervention in Japan helps us to understand how cultural characteristics influence the management of a disease outbreak.”

While my initial research process was atypical, I was able to learn that personal motivation can be crucial when you’re trying to do in-depth research, and that this process really is the foundation for the rest of your paper ⎯ you can only enter the academic conversation if you know what everyone is talking about!

Editor Commentary / Leina Thurn

“Thesis” is a word that tends to scare budding and experienced writers alike, especially when it is accompanied by words like “new” and “interesting.” Whether an author is awaiting some divine inspiration for the perfect argument, or they lack the courage to argue something that may be controversial or inconsequential, the thesis can seem ever-elusive. However, it is important to realize that a “new” or “interesting” thesis does not spring from thin air; in fact, the best theses are those that extend naturally from strong motives and evidence.

An example of a successful thesis can be found in Nanako Shirai’s R3.  The excerpt above begins with the latter part of her introduction, where her motive comes to a head.  Prior to this, Nanako had oriented the reader to the 2009 H1N1 pandemic, which led many societies to adopt surgical masks as a protective measure against the spread of the virus.  After zooming in on the effects of the pandemic on Japanese society, she observes that “Curiously, masks are still worn today, seven years later.”  The slight shift in tone in evaluating her own observation as “curious” signals the beginning of a new line of inquisition.  The word tells readers to pay attention and ponder the matter – why are the surgical masks still worn in Japan, given what was said before?  She then goes on to state a broader motive concerning the importance of a situation like that in Japan: “Studying why masks became […] popular […] helps us to understand how cultural characteristics influence the management of a disease outbreak.”  Even before the reader knows what Nanako’s thesis statement itself is, they are already presented with several reasons why it is worth talking about. Thus, combining these motives, Nanako preps her thesis to be “new” and “interesting,” even before she has stated it at all.

After carefully prefacing her argument with several layers of motive, Nanako is then able to state her thesis itself: “In Japan, the surgical mask […] transformed […] to a social device that functions as the physical manifestation of Japanese society’s devotion to collective identity and desire to serve Japanese society.” As she shows throughout her paper, her argument uniquely posits that the surgical masks have abstracted into Japanese cultural symbols for social responsibility and duty. It is not an obvious answer to her implied question about the continuous use of these masks since the H1N1 pandemic, but as Nanako deftly goes on to show, it is a convincing one.

Within this short excerpt, she is able to concisely support her thesis with ample evidence from various studies on mask-wearing in Japan. The ease with which she moves through her argument makes it clear how she derived her thesis itself from these sources. That is, Nanako did not come up with an argument and seek sources which seemed to support it, but she read through sources and constructed an argument based on what she observed in them. As a result, her thesis is successful because it is derived not just from a clear motive, but also from a strong set of evidence.

From the strong beginning presented in this excerpt, Nanako is able to delve into more complex and nuanced points that support her thesis, like how masks already have a long history in Japanese culture through Noh theater, and how surgical masks do not seem to inhibit face-to-face interactions between individuals in Japanese society. Altogether, it is hard to deny that the thesis in Nanako’s R3 achieves the seemingly unattainable status of both “new” and “interesting.”

Professor Commentary / Carolyn Ureña, Princeton Writing Program

We often think of masks as meant to hide or shield, but some masks show more than they conceal. In “Japanese Citizens Becoming Masked Heroes to Serve Society,” originally written for the writing seminar, “Contagion,” Nanako examines the use of surgical masks in the wake of the 2009 H1N1 flu pandemic in Japan to consider: how does the way we respond to disease reflect local culture? and how might we harness cultural values to help stop the spread of disease? Nanako’s interdisciplinary research distinguishes itself through its sophisticated engagement with a wide variety of sources from epidemiology and psychology, to drama studies and art criticism.

In this excerpt, Nanako does an excellent job of analyzing her sources to explain why the public use of surgical masks became so popular despite the fact that it does not protect the wearer from infectious disease — which is something most people don’t know! What had started as a motivating question for Nanako — why is this practice so popular? — led to this revelation, and she ultimately used this misunderstanding of medical technology as a way to better understand Japanese culture. In this way, Nanako builds a strong scholarly motive. That is, she illuminates the way that looking at a seemingly small but “curious” puzzle in human behavior actually sheds light on a broader cultural value.

First, Nanako establishes with evidence that surgical masks were recommended for “infectious individuals” — in other words, those who would transmit disease rather than those concerned with becoming infected. However, years after the flu pandemic, the uninfected continue to wear masks. Mask-wearing thus becomes Nanako’s object of study, and in the longer paper she skillfully contextualizes masks within Japanese culture through its centrality to theater. Having thus established masks as culturally significant, Nanako was able to “read” this practice within the broader Japanese cultural value of social responsibility. To wear a mask and to protect others from disease thus becomes an outwardly visible sign of a person’s membership in the community, of having internalized a sense of care and concern for another’s well-being.

Her paper exemplifies what is possible when you allow your curiosity to take the lead in research, and I am very proud of the way she was able to write such a nuanced exploration of the way culture influences behavior that we often think should be guided by so-called “reason.”

Works Cited

Associated Press. “New USGS Number Puts Japan Quake at 4th Largest.” CBS News, CBS Interactive, 14 Mar. 2011, www.cbsnews.com/news/new-usgs-number-puts-japan-quake-at-4th-largest/.

Burgess, Adam, and Mitsutoshi Horii. “Risk, Ritual and Health Responsibilisation: Japan’s ‘Safety Blanket’ of Surgical Face Mask‐wearing.” Sociology of Health & Illness, vol. 34, no. 8, 2012, pp. 1184-98. Wiley, doi: 10.1111/j.1467-9566.2012.01466.x.

Inouye, Sakae, et al. “Masks for Influenza Patients: Measurement of Airflow from the Mouth.” Japanese Journal of Infectious Diseases, vol. 59, no. 3, June 2006, pp. 179–181.

Morishima, Mika, et al. “Analysis of Problem Awareness in Hygiene Mask Wearers: A Cross-Sectional Survey.” International Journal of Affective Engineering, vol. 13, no. 1, 2014, pp. 11–18. doi:10.5057/ijae.13.11.

Steelfisher, Gillian K, et al. “Public Response to the 2009 Influenza A H1N1 Pandemic: A Polling Study in Five Countries.” The Lancet Infectious Diseases, vol. 12, no. 11, 2012, pp. 845–50. ScienceDirect, doi:10.1016/s1473-3099(12)70206-2.

Wada, Koji, et al. “Wearing Face Masks in Public during the Influenza Season May Reflect Other Positive Hygiene Practices in Japan.” BMC Public Health, vol. 12, no. 1, 2012, pp. 1065-70. doi:10.1186/1471-2458-12-1065.

Wakatsuki, Yoko, and Kyung Lah. “3 Nuclear Reactors Melted Down after Quake, Japan Confirms.” CNN, Cable News Network, 7 June 2011, www.cnn.com/2011/WORLD/asiapcf/06/06/japan.nuclear.meltdown/index.html.

The author


Nanako Shirai ’21 is a sophomore from Hanover, New Hampshire, majoring in Molecular Biology with a certificate in Linguistics. On campus, she works at the Writing Center and is involved in the Princeton University Orchestra and women’s club lacrosse team. In her free time, she dreams about Sweetgreen coming to Princeton, tries to do leg lifts in the Captain’s Chair machine at Stephens Fitness Center, and watches trailers for the next Spiderman movie on YouTube. Nanako wrote this essay as a first-year.

Leina Thurn ’20 is a native of Ashburn, VA, pursuing a concentration in Classics and certificates in Linguistics, Archaeology, and Hellenic Studies.  This year, she works as the Editor-in-Chief of Tortoise, a Writing Center Fellow, and a coin cataloger in Princeton’s Numismatics Collection. She wrote this as a junior.