Like a Surgeon: Japan’s Obsession with Surgical Masks

“Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth.”  ~ Oscar Wilde

“I got the bill for my surgery. Now I know what those doctors were wearing masks for.”  ~ James H. Boren

Who wants to ear an ugly, bulky mask when you can plug your nose??

Screen-shots from Bladerunner.  Look closely and you'll see today's streets of Tokyo.

Screen-shots from Bladerunner. Look closely and you’ll see today’s streets of Tokyo.

The movie Blade Runner contains sweeping street scenes that include scores of surgical face-masked pedestrians densely crowding the rainy, dark streets of a futuristic metropolis that appears to be a sleazy hybrid between Hong Kong and New York.  Although many of us probably didn’t pay it much attention, some way, somehow, Ridley Scott foresaw a future where “normal” street people would attempt to protect themselves from the effects of ever-increasing population density playing out in a dystopia:  the inevitability of zombies, uhm. I mean disease.


Now THAT is a mask!

Now THAT is a mask!

For those visiting Japan from the West, the shear proclivity of people in Japan to publicly wear surgical masks can be quite confusing and intimidating.  Jody and I, on our trip to Kyoto last week, saw hundreds of people wearing disposable face masks pouring out of train and subway stations each morning and afternoon, in a scene that is more reminiscent of 28 Days Later than real life.  An immediate thought:  what do they have, will I become a zombie, and holy crap!  Should I be wearing one too?!?  Okay, so maybe that’s a bit of exaggeration, but for those lacking flirtations with the Far East, the whole surgical masks being worn in public can be at best strange, and worst, scary.  The other only options are to club those suspicious of carrying disease, as we were all taught to do by Shaun of the Dead.

If the masks don't work, the clubs will.

If the masks don’t work, the clubs will.

bigAlthough I remember seeing the masks both times I lived in the Far East before (1999-2001, 2004-2005), the use has skyrocketed since those times.  It seems there were two turning points concerning wider mask use:  the 2009 swine flu (Kobe, Japan) and the 2011 tsunami and nuclear disaster (country-wide fear of nuclear fallout).  Both these events helped stimulate a degree of public panic and establish the masks’ role –rightly or wrongly – as the frontline protection of the public.  However, even before 2009, 72% of manufactured Japanese masks were sold for personal use, compared with just 16% in medical applications and 12% in industrial settings (Ohmura 2008).  Approximately 10-12% of Japanese use surgical masks in public and at work, of course adjusted for season and pandemic outbreaks.

Most are sold for personal use.

Most are sold for personal use.

While it does afford some measure of protection from others, a surgical mask is actually intended to be worn by health professionals to catch bacteria shed in liquid droplets and aerosols from the wearer’s mouth and nose.  Surgical masks, however, are also used by the general public in heavily populated countries in East Asia, primarily as an attempt to reduce the chance of spreading airborne diseases.  In Japan, it is common to wear a face mask when ill to avoid infecting others in public settings.  Surgical masks are also widely used in China, Hong Kong, and Vietnam, particularly during outbreaks of disease, like SARS or bird flu.

Nursing students in Taiwan!

Nursing students in Taiwan!

Bosozoku, the long-lived Japanese biker gang, are known for wearing masks (see my blog on this gang here:  bosozoku).  However, I’m sure that their surgical masks are not going to be what gives them away as members of a biker gang (wink).  These bikers wear masks simply to conceal their faces; they aren’t wearing them for allergies or disease prevention, unless, of course, they are from a kinder, gentler, more socially considerate bosozoku chapter!  Since they are known to carry clubs, they would, however and ironically, probably be the best first-line and frontline defense against zombies!!

Biker's evil eye, over a mask-covered face.

Biker’s evil eye, over a mask-covered face.

However, a much more common reason for mask-wearing (and in fact the leading reason) is that the wearers are sick, and wearing a mask is expected as consideration of those around them.  Likewise, many people wear masks to safeguard themselves from others.  Still others try to protect themselves from pollen, pollution, and even radiation!  And people don’t avoid others wearing masks like they are zombie-plague carry creatures; actually, the Japanese basically consider it an insult and will go out of their way to avoid you if you are coughing or sneezing and aren’t wearing one.

Mask-wearer in Hong Kong

Mask-wearer in Hong Kong

Given the vast increase in surgical mask use in public, I do believe that this has become Japan’s culture of fear.  I actually have been looking quietly and silently for where the Japanese obsess in some negative fashion.  For example, in America, we have a culture of fear centering on our own basic safety:  we are afraid of terrorists, afraid of criminals, and indeed, many of us are afraid of our neighbors that we no longer know….  Japan knows little fear in that regard.  But every culture has an Achilles’ heel.  And all this time I thought it was the depravity of their manga!

Manga Mathletes - like me - will appreciate the equations on the blackboard.

Manga Mathletes – like me – will appreciate the equations on the blackboard.

3742312738_931b81a789However, mask use in Japan goes much deeper than simply as a write it off to one-dimensional fear.  For example, there are those in Japan who wear surgical masks because they are self-conscious about the way they look or have something they want to hide.  Women admit wearing masks when they have no makeup on, particularly on public transport.  Women (mostly) also state protection from the sun as another reason.  In March 2011, News Post Seven surveyed 100 people wearing surgical masks in Shibuya, Tokyo’s most popular fashion district, and found that roughly 30% were wearing masks for reasons wholly unrelated to sickness or allergies.

Clearly a fashion statement.

Clearly a fashion statement.

masuku-yasu3Further, the Japanese news program ZIP! recently aired a special segment about young adults who choose to wear surgical masks as fashion accessories.  In a rather unscientific study, the staff counted the number of people wearing masks as they walked down a Tokyo street and found that the number has increased significantly from levels seen a decade ago.  ZIP! also surveyed the reasons why, with some surprising results:

1.  They’re not wearing any makeup/want to hide their face, emotions

2.  To keep their face warm

3.  To make their face look small

4.  It comforts them

Or perhaps to demonstrate just how secure you are with your masculinity.

Or perhaps to demonstrate just how secure you are with your masculinity.

So, in this sense, wearing masks for reasons other than for health considerations has become much more popular, especially with young people in the last 4-5 years, enough so that it actually has become a fashion trend, promulgated by the media, and pushed by commercial interests.

There really should be a black mask to go with those formal gowns....

There really should be a black mask to go with those formal gowns….

According to info-gathering site Naver Matome, some women see the mask as not only a way to cover up their face on a bad makeup  or acne outbreak day, but also as an accessory that can make them more attractive in some sort of strange nod to the veils of times past of the middle-east dancing concubines.  “It gives you a mysterious appearance since only your eyes are showing,” says one high-school girl.  “Wearing a mask makes me look cuter!”  It also identifies you as a potential zombie….



However, surgical mask use in Japan may go even psychologically deeper than self-image.  “I don’t want to show others my true self,” “Since my face is covered, people don’t know how I’m really feeling. It’s comforting,” and “I don’t like having to create facial expressions for people” are some of the reasons given by Japanese high school students who mask-up.  Author Yuzo Kikumoto, author of Date Mask Izonsho, claims that many Japanese students wear a mask to keep from standing out among the crowd.  “They have an abnormal fear of showing who they really are to their peers.”  Wearing masks in public offers some degree of anonymity in social settings, a comforting factor to many shy and introverted Japanese.  In many school settings, surgical masks give young people another way to blend in with the crowd.

School students in Japan all part of the crowd.

School students in Japan all part of the crowd.

And, with any good democracy, there are strong and powerful commercial interests seeking to capitalize on this new fashion trend.  Check out Picomask’s “Design Mask Collection” for a sample of their stylish and colorful surgical masks, sold since 2010.

Designer Masks

Designer Masks:  <$7USD!

Now we're talkin'!  Wash & Wear.

Now we’re talkin’! Wash & Wear.

So why is mask use not as prevalent in the West?  Well, it’s because we in the states (and much of Europe it seems), know that it is actually touch which is the more important factor in disease transmission.  It is more likely that simply washing hands is more effective in relation to reducing the threat of disease; a 2009 Japanese survey showed less than half wash their hands regularly).  And, in this sense, there is a distinct lack of disbursed and publicly available hand sanitizer in Japan.

>Tom the Tailor offered nose and mouth protectors for 35 cents to keep people safe from influenza. The ad ran on Nov 1, 1918.Either way – mask-wearing and/or hand-washing – such risk rituals are, in my opinion, more likely to embed anxiety centered on disease rather than resolve such worries.  We are told, East and West, and made to feel, at least rhetorically so, that we are individually responsible for disease transmission:  stay home when sick, wash your hands, sneeze into your sleeve, wear a mask, and get your shots!  But such health risks are, in some significant part, beyond our individual control, making the assumption of our inherent responsibility for sickness just about as useful as the risk rituals that accompany them.

We too dabbled with masks...almost 100 years ago.

We too dabbled with masks…almost 100 years ago.

myso3_mamBut who wants to end up stumbling through the narrow, dark Gion alleyways of Kyoto foaming at the mouth and with a taste for brains?  Although many Japanese would probably be quick to agree that surgical masks are not that effective, masks are still better than nothing.  Worse, coughing and sneezing on a crowded subway without wearing one indicates to other potential zombies that you really don’t care much for their welfare…or their brains, tasty as they might be.  So, it’s not hard to see how medical masks have become commonplace, at least as an expected standard of Japanese social etiquette.


For more information and some sources:

Death by Public Service Announcement: Commercials on AFN


“The only thing we have to fear is fear itself.” ~ Franklin D. Roosevelt

“To him who is in fear everything rustles.” ~ Sophocles

“We fear things in proportion to our ignorance of them.” ~ Christian Nestell Bovee


Okay, I’ve decided to finally try to capture the true nature and extent of the Commercially Induced Culture of Fear that the military has created and under which it seems to thrive overseas when they hold the monopoly on most, if not all things media.

I’m talking about the commercials on Armed Forces Network (AFN).  Well, actually they should be more appropriately called Public Service Announcements.

But then again, they are none of those things.

They are crafted not for the public, but for what I can only assume is us, the people our leadership considers wholly mindless, relatively incapable, and quite immature military servicemembers and dependents on the island.  Sorry contractors – you fall somewhere in that mix as well, although you are generally compensated much more appropriately to endure this pain and suffering..

The only “service” from these PSA’s is in a nostalgic, prison-influenced characterization of “time-served” once removed from Okinawa and it’s falsely created, media-limited bubble.  Any prudent, normalized American would and could only assume such attempts at brain-washing and behavioral control would be attempted on, say, designated political deviants in a gulag of the ex-USSR…or within Camp X-Ray of GTMO in 2003.


And finally, announcement is defined by Google as “a public and typically formal statement about a fact, occurrence, or intention.”  Okay, we’ve already talked about intentions (see brain-washing and behavioral control above, if you need reminded, which the military would assume given that you are mindless and incapable on your own), and while the barebones facts of the content making up this propaganda in many cases are sound, they are projected or extrapolated into occurrences which, in one way or another, will kill you….

So, I’ve taken notes on the commercials I heard yesterday.  Now, remember, this is for one day and one day only.  It does encompass scanning back and forth between the one AM and one FM station available here.  But it’s even better than that:  it’s for only that time in one day when I was in my car.  Which is, basically, a trip or two to a store and/or the commissary, a trip to the gym, perhaps a dive shop or two, and finally a relatively long detour to a different exit from the base due to an accident and massive traffic backup….  But still probably no more than 90 minutes.  Check this out and tell me I’m not over-reacting:

  • Vaccines.  Get your dang adult vaccines or HPV, Tetanus, Shingles and Whopping Cough will kill you, your family, and your friends.  Okay, I’ll give the military this:  Tetanus is a killer, and HPV can cause cancer…which is a killer.  BUT, being in or associated with the military here on Okinawa, we all are screen for and required to get vaccines (see Always Listen to your Momma)!  So what’s the point??
The Vaccine that we all really need....

The Vaccine that we all really need….

  • FDIC.  Yes, without the Federal Deposit Insurance Corporation, your money isn’t safe, and ultimately you will die.  Except this time poor and destitute.
IOUs are about as good as Cash

IOUs are about as good as Cash

  • Water Safety.  Swimming and/or water sports can result in drowning…which will kill you.  If you gave in to the warnings, you wouldn’t even look at the water with any sense of longing or excitement.


  • Finances.  If you don’t plan well, you run out of time to build a retirement and then you die.  Poor once again.  Imagine if you ignored financial planning AND blew off the FDIC.  Surely a sign of the End of Days.
A Typical Approach to Retirement Planning

A Typical Approach to Retirement Planning

  • Emergency Room.  The order cases are taken are based on triage (who doesn’t know this??), so don’t forget that unless you are dying, you’ll have to wait….
Don't use the ER as your Family Practice Clinic.  Or dentist....

Don’t use the ER as your Family Practice Clinic. Or dentist….

  • Tours.  Okay, there was something helpful about upcoming tours offered by the Air Force and Marine Corps.  But seriously, a 30 minute radio show?  The radio personalities on AFN barely know how to operate the former, and lack the latter.


  • Integrity.  Dirt-bag airmen will in some bizarre linkage of unintended consequences, you guessed it, kill you.  Something about “resilient airmen,” whatever that means, although it suspiciously seems connected with all the highly flexing yoga I see the Air Force doing at the base gym.
Real Integrity.  And Guts.

Real Integrity. And Guts.

  • Heroes.  An interesting snippet on General Marshall, of “Marshall Plan” fame.  I’ve tried, but I don’t see much chance of dying from this one.  Although the piece does tie him to setting the state for the European Union, which may in the coming hears lead to the deaths of a number of national economies.


  • Terror.  Yes, terrorists will kill you.  Even though Okinawa is, factually, the safest place I’ve live and will ever live, we are led to believe that just about everyone and everything should be considered suspicious.  No doubt we should be hugging our pillows tight and sleeping with one eye open.


  • DUI.  Drinking and driving will kill you, your friends, and someone else’s family.  True enough.  This is an issue here on Okinawa, but not because of the Japanese; the vast majority of tickets, arrests, and related issues are initiated by Americans on and to Americans.
Drunk Uncle to the Easter Bunny

Drunk Uncle to the Easter Bunny

  • Sports Pads.  Without them, you’ll die….  Don’t forget that mouth-guard!  Even knocked-out teeth can die.
Not to mention bike helmets....

Not to mention bike helmets….

  • Seatbelts.  Adult seatbelts will kill your kids.  Oh, so will airbags…when using adult seatbelts.  The piece doesn’t say anything about bouncing around the back of a station wagon like we all did growing up.
But what about our pets??

But what about our pets??

  • Etiquette.  You would not believe how often I hear this particular commercial:  “The Senior Member Enters a Car Last so that they may Exit the Car First.”  Really?  And who the heck requires this timely piece of military etiquette?  I can only imagine that an overly irate senior-ranking member of the AFN establishment might be so frustrated over the insult of leaving the car second (or god forbid, last) that they would resort to murder.
The Etiquette surrounding an office love-affair with a Jeanie is a bit more involved.

The Etiquette surrounding an office love-affair with a Jeanie is a bit more involved.

  • Spice & Salvia.  Taking drugs will kill you.  Oh, so will supplements.
Probably not the Spice in question.

Probably not the Spice in question.

  • Typhoons.  Even in Tropical Typhoon Condition of Readiness 4 – the lowest, base level of concern during the entire season, a typhoon can kill you within 72 hours.
Typhoons are Asian umbrellas!

Typhoons are deadly…to Asian umbrellas!

  • CAC Cards.  If you lose your ID card, a terrorist will get it and ultimately kill you.  See “Terror” above.
Some IDs ARE a license to kill.

Some IDs ARE a license to kill.

  • VA.  A playful take of VA benefits and services using a “greatest hits” approach.  But not playful enough to be entertaining the 2nd through 23rd times heard.
This Culture of Fear is not helping those with PTSD

This Culture of Fear is not helping PTSD

And finally, I saved my favorite for last.  Against all this other fearful chatter, there is the most odd and misplaced radio ditty concerning breast-feeding called “Every Ounce Counts;” you can listen to song Healthy Baby Healthy Mama here.  Now, don’t get me wrong.  I’m a full-time supporter of breastfeeding, and understand pretty well all the benefits to baby and Mom that come from this wholly natural and nature’s intended way of feeding babies.  But seriously, is this radio spot really necessary?  I cringe every time I hear this song and can’t help but think about the continual castration of the warrior class of the military long past….

Oops.  This pint-sized glass if for another type of drink....

Oops. This pint-sized glass if for another type of drink….

But, more critically, I would love to see a serious medical research study done on the effects and efficacy of such attempts at mind and behavioral control.  Two things strike me – a non-medically trained observer, but one with quite a bit of graduate education.

First, creating a culture of fear and imposing this culture on people 24/7 is counter-productive.  You can only cry “Wolf!” or that the “Sky is falling!” so many times before someone simply stops listening, and more dangerously, they stop caring.  The military reaches this point after a week on-island.  A persuasive and over-stated culture of fear benefits no one.

Radio does have its place.

Radio does have its place.

Second, there could be consequences, potentially serious, for subjecting the force to this type of indoctrination.  If you tell a young, moldable minded individual that everyone and everything, everywhere and anywhere, is dangerous, what results?  There is where a formalized study would not only be interesting but is one I believe long overdue and ultimately necessary.


I’ve written about the failures of military leadership in this blog before (see Epic Fail), and about AFN too (see Team America).  The commercials or PSAs or whatever you want to call them are the source of a lot of consternation online, the source of a whole slew of jokes on-island, and worst, is responsible for creating an overall lack of respect for the governmental-military-industrial complex…which includes leadership, large and small.  The fact that the collective “we” of the military community on Okinawa are continually subjected to be treated like children who don’t know any better so that we must be constantly reminded about the dangers around every corner and in every person, action, place or thing actually results in a backlash against the establishment.  And why leadership can’t see this, why they are not more aware of just how bad AFN is in this regard and how badly it is perceived, to me means they aren’t listening.

To AFN.  Or to those they wish to lead.  Now that’s something that truly should be feared.

Fear is a prison for your mind