How cure was justified: rhetorical strategies for the treatment of colour vision deficiency in the 1970s and 1980s in Japan

Abstract

As colour vision deficiency (CVD) is hereditary and incurable, it is widely known that people with CVD do not need treatment, but rather appropriate social accommodation. Regardless, some practitioners of complementary and alternative medicine have attempted to treat CVD. By investigating the rhetorical strategies of these therapists who allegedly treated CVD in Japan in the 1970s and 1980s, this study analyses how they justified treating CVD despite the widespread prevalence of social accommodation. These therapists argued that treatment alone could remove the ‘dirty’ vision of people with CVD, even though it was clear that any trouble because of CVD can be mitigated through social accommodation. This finding has implications for understanding the history of the emancipation of people with CVD, enhancing the disability rights movement to refute the medical model that discounts the effects of social accommodation, and identifying how it demarcates itself from social accommodation.

Points of interest

• People with colour vision deficiency find it hard to recognise the difference between colours such as red and green. They have faced some restrictions in education and employment because of their different eyesight.

• They need appropriate social accommodation, including icons, symbols, and appropriate colour schemes, that decrease the difficulties from having colour vision deficiency without treatment.

• However, therapists of complementary and alternative medicine have tried to treat colour vision deficiency, especially in Japan, even when social accommodations were available.

• By analysing the discourse among the therapists, this study examines how this treatment was justified. The results show that the therapists argued that eyesight of people with colour vision deficiency was ‘dirty’ and can be improved, not by social accommodations, but by treatment.

• This study is important because the findings reveal how to refute cure-oriented discourse, which stigmatises impairments to justify treatment.

Keywords:

• Colour vision deficiency
• colour blindness
• treatment
• complementary and alternative medicine
• claim analysis

Introduction

What rhetoric was used to justify medical intervention to treat colour vision deficiency (CVD, also known as Daltonism and colour blindness) given the prevalence of the social model of disability? Was that rhetoric of justification something that could be refuted by the idea of a social model of disability?

People see colours in slightly different ways because there is a lot of diversity in the genes that can make up the cone cells in the retina. On this spectrum, people who find it difficult to distinguish between particular combinations of colours, such as red and green, are labelled as people with CVD. Since its existence was first reported by John Dalton (1794), people with CVD have long been detected through medical screening and have been excluded in modern society. They have been considered to be unsuitable for many occupations, especially in transportation, engineering, and medicine, because of their inability to distinguish traffic signals, electric cables, and chemical drugs, and have been restricted from these educational and occupational engagements based on vision standards (Vingrys and Cole 1988; Steward and Cole 1989; Cumberland, Rahi, and Peckham 2005; Chan, Goh, and Tan 2014; Goh, Chan, and Tan 2014; Barbur and Rodriguez-Carmona 2017).

However, along with the spread of the disability rights movement inspired by the social model of disability—which views disabilities not as individual/medical conditions, but as constructs of social environments—in the 1970s, attempts to eliminate the disadvantages faced by people with CVD through social accommodation have also emerged. Using appropriate colour schemes that are easily discerned by people with CVD is one of the most typical actions taken under the ambit of social accommodation. It is also useful to adopt icons and symbols that can be understood without having to rely on colours (Meeks et al. 2016). Eyeglass lenses that mitigate CVD have also been commercialised. In the United States, all of these are considered as reasonable accommodations for people with CVD under the Americans with Disability Act Amendments Act of 2008 (Job Accommodation Network 2021).

Some historical studies on CVD (Tokugawa 2016; Rossi 2019; Baba 2020) that have appeared over the last decade have delved into how the development of colour science and technology constructed our epistemology of colour from the 18th to the 20th centuries, made it possible to treat people with CVD as deviants, and built the industrial order of modern society on the back of national ideologies, for example, screening for military conscription and occupational vision standards for safety, especially in the medical, engineering, and transportation industries.

This order of modern society seems to have been dismantled, because widespread social accommodation for people with CVD has made educational and occupational restrictions via vision standards less necessary. Hacking (1999) coined the term ‘loop effect’, which applies here. This effect implies that there is a cycle, where a label that classifies people, also impacts their recognitions and practices; these recognitions and practices, in turn, transform the label. People’s practice of social accommodation seems to have transformed the label from one that once classified some people as deviants with CVD to another that considered them as part of a diverse spectrum. However, the actual looping process of the label of CVD was rather complex because, like other impairments, many societies have attempted to treat CVD even though social accommodation was available. In the middle of the 20th century, CVD was considered as untreatable by orthodox medicine, given the understanding that the biomedical mechanism of colour perception is determined by the gene located on the chromosome and, therefore, was unmodifiable (Brown and Wald 1964; Marks, Dobelle, and MacNichol 1964). Hence, appropriate social accommodation for CVD was developed as mentioned above. However, even after that, various devices were developed and unorthodox treatments were attempted to cure CVD. For example, a Japanese electronics manufacturer launched a colour vision training device called ‘Sambista’ in 1967. The British Optical Association Museum at London displays the Eric Bateman Visual Colour Training Series, which comprises cards that were developed in the 1960s to train colour vision. While earlier studies (Tokugawa 2016; Rossi 2019; Baba 2020) unravelled the birth of the order of colour in modern society, they did not discuss why this exclusive order against people with CVD was not broken down easily in the face of social accommodation. To fill this gap, it is necessary to investigate the politics between the practices around trying to expand social accommodation and those resisting them. This study makes an original contribution to the historical understanding of emancipation for people with CVD by revealing how people interacted when the CVD label was repainted from deviance to diversity.

To address this question, we use as data the discourse of a complementary and alternative medicine (CAM) group, whose therapists allegedly treated CVD in the 1970s and 1980s in Japan. As will be discussed in detail later, this began when restrictions on employment and higher education for people with CVD were gradually relaxed, with the proliferation of social accommodation. The group attracted a lot of people with CVD and gained commercial success. Assuming that treatments for CVD were widely accepted, even though people knew social accommodation could mitigate the disadvantages caused by CVD, it seems that some persuasive rhetoric made people think that they should have their CVD treated, despite the prevalence of social accommodation. By investigating such rhetoric, this paper aims to understand the practices of exclusion against people with CVD.

The next section presents a theoretical overview of disability studies and the sociology of health and illness. It highlights the contributions of this study to the discussion on CVD and other broader contexts. The methodology used to analyse the discourse is described, after which the results are presented. Some conclusions are drawn in the final section.

Background

Treatment of disability

CVD has largely not been seen as a disability, except for some rare instances where it has been regarded as a learning disability (Espinda 1973; Litton 1979). However, how CVD has been categorised as deviance can be analysed from the perspective of disability studies. Davis (1995) argued that normalcy, or a standard of people, was constructed in the 19th century. People were often located in a hierarchy of ability based on the development of statistical measurements of their bodies and minds. This mechanism is closely intertwined with eugenics. Those who rank around average in this order are treated as normal and those who rank among the lower extreme are considered as deviants. In other words, majorities are outlined by such minorities and become ‘normal’ (Garland-Thomson 1997). Conditions that are seen as deviance have been targeted for treatment. Medicine focuses on cure and treatment as the only way to help people with disabilities and has tried to correct and bring them back to ‘normal’ through surgery and rehabilitation (Marks 1997; McRuer 2002). The same can be said for CVD. As seen in the last section, as medical screening was developed, CVD (and at the same time, ‘normal’ colour vision) was constructed socially and people with CVD became subjects for correction.

The social model of disability is one of the most important theoretical frameworks to resist this medical perspective. Oliver (1990), one of the earliest disability scholars, criticised medical screening that marked some people as deviants. In addition, many studies inspired by the social model have demonstrated that disadvantages faced by people with disabilities are caused by environmental, institutional, and attitudinal barriers, and that these disadvantages can/should be reduced not by surgery or rehabilitation, but by changing the social environment (UPIAS 1975; Marks 1997).

Following the social model, some aspects of the concept and practice of cure have been criticised. In many cases, the promises of cure posed by medicine are premature and offer excessive hope to people with disabilities, which are eventually destroyed (Shakespeare 2014 [2006]). Despite the inefficacy, the concept of cure prevents us from thinking about exclusive and inaccessible conditions that are normalised in society (McRuer 2002). Treatment is expensive and brings about physical, mental, and emotional pain, both during and after the process; in contrast, the same benefits can be gained through social accommodation, often painlessly (Tateiwa 2018 [2001]; Kim 2017). Even recent critical disability studies, which focus on the material reality of bodies and affirm the positive potential of technologies, do not regard impairments as a target of correction because that represents a return to re-essentialising impairments (Feely 2016).

On the contrary, some people hope to have their impairment cured. To attain the benefits of welfare in recession, these people emphasise the name of the impairment obtained through diagnosis and develop social movements based on their biological identity to endorse their right to be cured. They consider curing their impairment to be the most effective solution to their plight (Hughes 2009; Oliver 2013). This hope is fostered not only by those who need treatment to reduce their trouble, including the pain and fatigue caused by chronic illness (Wendell 1996; de Wolfe 2002; Bailey 2019), but also by those whose trouble can be reduced by social accommodation (Beauchamp-Pryor 2011). From the perspective of social model stalwarts, those who hope for treatment are considered to be irrational and unaware of the tenets of the social model, and therefore have been excluded from the scope of disability studies (Hughes 2009). However, as Petersen, Seear, and Munsie (2014) argued, even if seeking treatment seems unreasonable at first glance, the people involved often act under the impression that it is reasonable for them to pursue this course of action.

Considering this situation, the lack of discussion about discourses of medicine that promise a cure is strange because those who wish to have their impairment cured can be influenced by such discourse. To identify why people are persuaded to want treatment, it is necessary to examine the medical discourse that urges people to have their impairments treated despite social accommodation being available.

Indeed, investigating medical discourse would contribute to sophisticate the logic of the social model of disability. Today, even considering Shakespeare’s (2014 [2006]) warning as mentioned above, various disorders may become treatable through the development of medical science and technology (e.g. Mandai et al. 2017; Mercuri et al. 2018; Tsuji et al. 2019). Now that it is widely known, based on the social model, that the trouble with these disorders can be reduced not by treatment, but by social accommodation, medicine may develop a new logic to claim that treatment is still necessary even though social accommodation is available. As the medical model has been upgraded to compete with the social model, it is not enough, at present, to merely repeat that the social model is better. To refute the treatment-oriented logic, it is necessary to delve into the rhetoric of medicine, and the social model also has to be made more sophisticated.

Shedding light on historical rhetoric has contemporary significance. Discourses arguing in favour of the treatment of CVD in Japan in the 1970s and 1980s constitute one of the incipient cases of such rhetoric. The trouble with CVD can be reduced through social accommodation. This was recognised and carried out in Japan at the time. Nevertheless, CAM therapists who alleged that they could treat CVD became popular. What rhetoric did they use to attract people with CVD? By analysing the logic of enforcing normalcy (Davis 1995) that cannot be eliminated by simply repeating the social model, this study aims to empower the disability rights movement to refute the upgraded medical model and include people who yearn for treatment into the perspective of disability studies.

Demarcation by CAM practitioners

As the discourse we analyse later was provided by CAM practitioners, it is useful to locate this study in the context of sociological research on CAM to demonstrate what we add to this area.

Sociological studies focusing on the supply side of CAM have discussed how CAM practitioners have tried to demarcate themselves from orthodox medicine and other potential alternatives and to justify their legitimacy and authenticity in the medical market (Cant and Calnan 1991; Cant and Sharma 1996; Norris 2001; Fadlon 2004; Welsh et al. 2004). In these studies, it has been repeatedly pointed out that CAM practitioners’ demarcation is based on hybrid and/or ambivalent references to orthodox medicine. That is, they first vindicate their raison d’être by saying that they play a complementary role in treating what incapable orthodox medicine cannot deal with. At the same time, they claim their effectiveness and professionalism by trying to adopt scientific methods and terms, and to make self-regulated groups and educational standards seem like orthodox medicine.

While earlier studies have focused on the demarcation between CAM and orthodox medicine or among different kinds of CAMs, little is known on how CAMs demarcate themselves from social accommodation. How do they claim their significance when social accommodation, and not orthodox medicine, is a functional alternative for illness or disability? Japanese society in the 1970s and 1980s provides a suitable environment for the exploration of answers to this question. As restrictions against people with CVD were gradually relaxed, CAM therapists should have come under pressure to claim their necessity even though disadvantages owing to CVD were reduced without treatment. CAM gained popularity despite this, as therapists used rhetoric that successfully defended their necessity. By investigating this rhetoric, we can understand how CAM demarcated itself from both orthodox medicine and social accommodation. Considering that the social model of disability is prevalent, it is important to locate CAM in the relationship with social accommodation, which competes against it as a functional alternative for mitigating the trouble faced by people with CVD.

In brief, analysing the discourse of CAM therapists who were allegedly able to treat CVD will contribute to our knowledge by (1) enabling the understanding of the micro-level interactions that have been overlooked, but nevertheless took place under the macro-level norm of colour vision in modern societies, (2) providing a means to refute the medical model of disability, which is prepared to counter the social model, and (3) locating CAM strategies of demarcation in the relationship both with orthodox medicine and with social accommodation.

The situation in Japan

Before we proceed with our analysis, we outline the local context of the CAM groups in our study. We follow this with a discussion of the methods and data we used. In Japan, discrimination against people with CVD has traditionally been rampant. In 1916, Shinobu Ishihara, an ophthalmologist in the Japanese army, developed the Ishihara colour vision test for military recruitment. This test uses one of the most popular pseudo-isochromatic plates that makes it possible to screen people with CVD easily, and has since been used worldwide. Through medical screening, people with CVD were identified and considered as deviants in Japan. In 1920, the engagement between the then Crown Prince (future Emperor Hirohito) and a woman was almost broken off because she had relatives with CVD and there was speculation that any future children of the prince could be afflicted by CVD. Medical screening continued even after World War II because orthodox ophthalmologists, including the Japan Ophthalmologists Association, advocated medical screening. Although screenings in pre-employment medical examinations and at schools were abolished in 2001 and 2002, respectively, on the grounds that it could encourage discrimination, the Japan Ophthalmologists Association did not support the abolishment. Rather, they promoted the reintroduction of screening at schools, which was reinstated as an optional test in 2014. They believed that people with CVD should be aware of the nature of their eyesight as soon as possible (Ichikawa 2016). As seen later, the CAM group made use of this screening-oriented belief. Many people with CVD had trouble including educational and occupational restrictions. Worse still, people with severe CVD were potential subjects for forced sterilisation between 1940 and 1996 (Kawabata 2020). CVD was listed under the National Eugenic Act, which was adopted in 1940, as a basis for forced sterilisation, until the Eugenic Protection Act, which succeeded that law in 1948, was amended to the Maternal Health Act in 1996. It is unclear whether forced sterilisation of people with CVD was actually conducted. In 2019, the Japanese government apologised and began to compensate victims of forced sterilisation. In addition, the widespread belief was that curing impairments solved the problem faced by people with disabilities. Hayashi and Okuhira (2001) reported that surgeries to enable children with cerebral palsy to walk were conducted in vain without their permission. This is because, in Japan in 1970s, the idea of the social model of disability had not been imported fully, although grassroots movements for independent living by people with cerebral palsy had emerged. People with CVD neither organised themselves as disability activists nor collaborated with other disability rights movements.

Against this background, Noriko Yamada, a dermatologist, and her spouse Taketoshi Yamada, with the pseudonym Ataru Yamada, formed a CAM group called Wado-kai (和同会) in the late 1970s. It alleged that by passing an electric current through patients’ foreheads, it could treat CVD and short-sightedness, pollinosis, nocturnal enuresis, autonomic imbalance, and allergenic nasal inflammation. While the Japanese Ophthalmological Society issued a statement that Wado-kai practised fraudulent medicine and a newspaper reported this in 1980, it sued the newspaper for libel and won the case in 1986 (although it lost in a High Court in 1990, which led to the decline of the group). According to its announcement, the group had treated approximately 120,000 people by 1991. Its therapy was not subsidised by the national insurance system and cost about JPY 160,000 per person at 1980 prices (Yamada 1980, 33), which is equivalent to GBP 1449.73 as of 1 May 2021. The prosperity of the group made it possible to open three clinics across Japan and display 179 advertisements in newspapers between 1981 and 1986 (counted on the database of Yomiuri Shimbun). This study does not aim to verify whether CAM by Wado-kai can actually treat CVD, although the author deeply doubts the effectiveness of CAM.

The prosperity of this CAM group and the relaxation of restrictions against people with CVD happened simultaneously in the late 1980s. Around 1970, Yoshie Takayanagi, an orthodox ophthalmologist, began working against discrimination. She pointed out that social accommodation such as using discernible colour schemes with appropriate brightness and chroma and designs that can be read without involving colour had to be developed (Takayanagi 1998, 2014 [1996]). As seen above, at that time, the social model of disability had not been introduced in Japan and people with CVD were not organised as disability activists; thus, she suggested these arrangements independently. This creates an unusual situation; cure, which is often sought by orthodox doctors, was supported by the CAM group, while orthodox ophthalmologists were only eager to screen for CVD. Social accommodations, which are often requested by disabled persons, were suggested by Takayanagi, which made her unique among orthodox ophthalmologist. As a result of her efforts, the absurdity of restrictions in higher education and employment began to be widely recognised, as seen in newspaper reports, and educational and occupational restrictions were gradually eased in the late 1980s (Takayanagi 2014 [1996], 58, 91; Kawabata 2020, 101). Thus, CAM by Wado-kai gained popularity when the trouble with CVD was mitigated without treatment. It seems that it used rhetoric that justified the (dubious) treatment of CVD despite the prevalence of social accommodation, which is the core focus of our analysis.

Method

The main source of data for this study was books written by therapists and advocates of Wado-kai. They reported the social situations of people with CVD, the methods of and necessity for treatment, and anecdotes of clients the group had allegedly treated. Newspaper articles from the time and books written by Takayanagi, both of which were against treatment and sought to adjust the social environment, were used as supplementary data. The author acquired these as second-hand books. Newspaper articles were obtained via databases. These materials, written in Japanese, were translated into English, and cited.

A claim analysis was adopted, as suggested by Best (2021). From the perspective of the sociology of social problems inspired by social constructionism, when people think of a prevailing condition as a problem, their claims that the problem should be solved construct the social problem. Based on this idea, when, how, and why a phenomenon becomes a social problem and attracts social attention has been discussed (Spector and Kitsuse 1977; Loseke 2003; Best 2021). Drawing on Toulmin’s (1958) model, Best (2021, 30–41) presented a method of examining claims by breaking them down into three components: grounds, warrants, and conclusions. Grounds are assertions that a problem exists as an objective fact. By sharing statistics with a shocking number and typical examples that attract audiences, claim makers can assert that a problem is real. They also provide a framework to understand a certain condition by attaching a name to it. Objectively incorrect statements can become grounds when claim makers treat them as facts. Warrants are values that explain why a condition should be solved. People share values such as equality, well-being, and human rights. Referring to these values, claim makers try to draw the sympathy of audiences to a prevailing condition as undesirable and justify that it is necessary to solve the problem. Led by grounds and warrants, conclusions are shaped. Conclusions are statements on how problems should be solved. When a particular claim is made, those who disagree with it try to refute its grounds and warrants and make counterclaims. In responding to the counterclaims, such claims are made sophisticated through the revision of grounds and warrants. Best (2021, 49–54) recommended studying the trends and developments in social problems by investigating how claims evolve through exchange and identifying the conclusions that gain priority.

Adopting Best’s method, rhetorical strategies of the CAM group are analysed. This study investigates the grounds and warrants mobilised to arrive at the conclusion that CVD had to be treated. The development of its counterclaims against oppositional claims that trouble with CVD can be mitigated without treatment in the late 1980s, when restrictions against people with CVD were gradually relaxed, is also explored.

Results

In this section, the transition of the CAM group’s rhetorical strategies is examined in the periods before and after the progress of social accommodation.

Early 1980s

In this period, claims on the need for the treatment of CVD were provided by taking the then-prevailing state of restrictions as unchangeable. First, the CAM group presented an argument that people with CVD have ‘different eyesight’ by referring to biomedical knowledge:

Behind the retina of our eyes, there are three types of cone cells which sense colours, and when some of them decrease their function, various types of CVD occur. (Yamada 1980, 39)

Besides scientific knowledge, it also used clients’ anecdotes to describe the experience of people with CVD. It highlighted the details of the trouble it encountered daily, because of such different eyesight, as facts.

When I was in junior high school, I was red-green colour blind, and it was killing me. What was the most troublesome was painting. When a teacher asked me what I drew as motif, it was hard for me to get through the situation. So, when painting, I did not attend the class or intentionally left painting and had to do something else. (Yamada 1980, 93)

One of the most important reasons why I wanted to have my CVD treated is that I could not help my wife choose her clothes. Non-disabled persons may think it is trifle, but my wife seemed to feel very lonely. When she asked me which clothes I prefer, I could only tell her ‘I don’t know’. This kind of experience can be enough reason. (Think-tank Wado-kai 1981, 185)

The CAM group presented statistics on educational and occupational restrictions as grounds as well. Out of the 205 universities it surveyed in 1980, it found that 147 had a mild to severe regulation that prohibited people with CVD from enrolling. It also pointed out, albeit by quoting somewhat old data, that many companies, especially in the tertiary sector, prohibited people with CVD from joining them (Yamada 1980, 73–86, 220–229).

People who follow the social model would consider these grounds as undesirable. While the CAM group also considered the situation to be problematic, it brought another warrant: the meritocratic ideology that competent people should not be wasted. From the perspective of the CAM group, the situation with CVD was undesirable not because the restrictions amounted to unfair discrimination, but because they prevented the use of talented people.

Suffering due to CVD is shoved to the back of the society where the sun never shines. Many talented people have been buried and blocked by the wall of discrimination caused by the lack of understanding of people. (Yamada 1980, 5)

The problem for companies is that they can reject talented people just because they have CVD. If the companies know the treatment for CVD, they can hire them on condition that they have CVD treated. (Tsuchiya 1981, 248)

Mobilising this warrant meant that the group accepted the restrictions per se as legitimate. As people with CVD had minority vision, these restrictions were considered as inevitable. As a result, the solution the group offered aimed to help people with CVD, while taking the restrictions as unchangeable. That is, making people with CVD become people without CVD. The following quotations justify the educational and occupational restrictions and treatment using almost the same logic:

If people with CVD were to enrol there [faculty of medicine, pedagogy, dentistry, pharmacy engineering, agriculture and so on], it is obvious that some sort of accident would occur. That is why logic like ‘it is discrimination to prohibit people from enrolling because of being colour-blind’ or ‘in order to eliminate discrimination, take inclusive measures for people with CVD’ ignores the reality. So, should we just leave things as they are? Then, no matter how long we wait, there will be no help for people with CVD. There is only one answer. In the end, the only solution is to eliminate CVD, i.e. to return them to normalcy. (Tsuchiya 1981, 63)

The hardships and psychological burdens of finding a job for people with CVD are not comparable to those of normal people. However, it is natural that the logic that ‘companies should accept people with CVD unconditionally’ should not hold true. This is because a company is a profit-seeking organisation, not a place for charity. It has always been the case that companies are looking for talented people who can complete more work quickly and accurately. […] What can be done to help people with CVD get jobs and make their living? As long as the corporate structure remains unchanged and restrictions are essential for this purpose, there is only one way left for people with CVD: to change the constitution of CVD, that is, to cure it and return to normalcy. (Tsuchiya 1981, 73–74)

Second, it justified the need for treatment by demarcating CAM from orthodox medicine. It considered the ability to treat CVD as a fact. The group conveniently used the study of Ryo Seki (1975), an orthodox ophthalmologist who tried to measure the efficacy of CAMs to support and authorise its claims (Yamada 1980, 213). Although Seki said that he did not advocate Wado-kai in a newspaper article (Asahi Shimbun, December 14, 1980), his testimonial was repeatedly cited in Wado-kai’s books in the 1980s. Whether he changed his mind or Wado-kai fabricated the testimonial remains unclear. At the same time, however, the group disrespected scientific protocols and placed great value on personal anecdotes. Both selective reference to orthodox medicine and overwriting personal anecdotes resonate with the findings of earlier studies (Roichman 2020).

What we needed was the conclusion that sensitivity of colours can improve, not the theory. […] To make superstition [that CVD is untreatable] disappear, what we needed was not the ‘reason why it was cured’ but ‘the facts that it was cured’. (Think-tank Wado-kai 1981, 35)

This ground of curability converged with the warrant of the Hippocratic Oath of medicine: doing what benefits patients. Based on the ethics of medicine, the group showed disdain and demarcated CAM from orthodox medicine, which it believed left out treatable diseases. The use of such ethics is also similar to the points noted in previous studies (Fadlon 2004).

As a doctor, we never tell patients that ‘Your disease will not be cured. Give up on it’. It is doctors’ mission to try to help them somehow. (Yamada 1980, 4)

It has to be said that it is doctors’ delinquency to leave patients alone who suffer from CVD. In the end, whether they are helped or not matters. Indeed, many patients have been helped. It is this fact that is the most important thing for doctors. (Think-tank Wado-kai 1981, 103)

While many ophthalmologists are eager to screen CVD, they lack compassion for patients’ desperate hope. (Think-tank Wado-kai 1981, 167)

It looks like they [ophthalmologists in orthodox medicine] consider ‘CVD is hereditary and incurable’ with obstinacy, stop thinking, and never think ‘is there possibility of treatment?’ (Think-tank Wado-kai 1981, 179)

In sum, before the relaxation of restrictions against people with CVD, the group justified the need for treatment on the following grounds: (1) different levels of colour sensitivity, (2) social disadvantages because of CVD, and (3) the effectiveness of therapy. However, the group never found these restrictions undesirable per se. Rather, it coupled these grounds with (1) meritocratic value and (2) the Hippocratic oath. The use of these warrants and the arbitrary reference to orthodox medicine correspond with previous studies in terms of their demarcation with orthodox medicine (Cant and Calnan 1991; Cant and Sharma 1996; Fadlon 2004; Welsh et al. 2004; Roichman 2020).

Late 1980s

From 1984, Takayanagi, an orthodox ophthalmologist, investigated the restrictions and began to campaign against them (Takayanagi 2014 [1996]). The grounds she used were that people with CVD had minority eyesight and that the restrictions were rampant, which had also been pointed out by Wado-kai. However, relying on the basic knowledge of orthodox ophthalmology, she did not affirm that CVD was treatable. She combined these grounds with the warrants of human rights including the freedom to choose an occupation and equal access to educational opportunities, both of which are stipulated in the Japanese Constitution and other laws. She criticised the restrictions as discrimination and argued that given the appropriate social accommodation, people with CVD are less likely to encounter challenges and are fully capable of studying and working. Although she did not use the term ‘social model of disability’ directly, her logic was remarkably similar to it.

Responding to Takayanagi’s campaign, concerns about the restrictions against people with CVD grew among the mass media and educators. Newspapers highlighted the restrictions imposed by universities and companies and called them unjustified.

Half of the national universities exclude people with CVD (so called colour blindness or colour weakness), even though it does not interfere with their studies or daily life. (Asahi Shimbun, February 17, 1986)

To eliminate the discrimination against people with CVD and promote appropriate measures, an interparty group of parliamentarians established the ‘Parliamentarians’ Association on Colour Vision’ on the 23rd. (Asahi Shimbun, April 24, 1986)

Restrictions were gradually eased. The number of universities that prohibited the enrolment of people with CVD decreased by more than 70% from 1986 to 1990. Companies also relaxed their restrictions. According to Takayanagi’s survey, 86.7% of companies did not have colour vision standards in 1986, although people with CVD were still considered to be ineligible for national qualifications (e.g. firefighters, defence force personnel, and equestrians) (Takayanagi 2014 [1996]; Kawabata 2020).

Under these circumstances, the group should have changed its rhetorical strategies, as the validity of both its grounds and its warrants had been weakened. The ground of incurability was now denied. In the face of the actual relaxation of restrictions, the grounds of invariability of restrictions and impossibility to study and work without treatment were doubted. The group’s counterclaims that appeared in this period were not observed in the early 1980s. With the new claims, the group tried to maintain its legitimacy. As a result, it survived for some time.

First, the group aimed to maintain its initial contentions. Citing personal anecdotes repeatedly and saying, ‘seeing is believing’ (‘proof is better than argument’ in Japanese), it tried to maintain its argument that CVD was curable. It also doubted that the restrictions were truly relaxed. It presented a counterclaim that insisted that the educational and occupational restrictions remain unchanged.

In the process of investigating the companies’ hiring restrictions, Wado-kai uncovered their real intentions and their pretensions. Many companies claim that they have no special restrictions on CVD, but in fact they reject them vigorously. Companies are concerned about their ‘corporate image’, do not want to be accused of unfairly discriminating against CVD, and do not want a boycott to happen. That is why they try to conceal their restrictions on CVD as much as possible. (Wado Doctors Group 1988 [1984], 138)

Universities, like companies, are often reluctant to reveal their true intentions due to fear of being accused of ‘discrimination’. There are many universities which state in their application forms that ‘no colour vision requirements’. However, the Wado Doctors’ group has come to the conclusion that it is impossible to know whether this is really the case unless you check them directly and relentlessly from every angle. (Wado Doctors Group 1989, 101)

There were some restrictions in place at the time (Kawabata 2020). As Best (2021) argued, it is often the case that extreme rather than typical examples are presented. According to a report by a national institute, CVD was thought to be used as an excuse to conceal the fact that a person had been rejected on the basis of the university from which they had graduated (The Japan Association for Employment of Persons with Disabilities 1995). Thus, outwardly, it looked as if CVD still posed a challenge in gaining employment. Consequently, the group tried to use this reason to refute its opponents’ contentions that the restrictions on employment had eased.

However, as the relaxation of restrictions was widely reported in newspapers, it became difficult for the group to continue refuting them. Second, the group presented another counterclaim that emphasised that the vision of people with CVD was hideous and that hideousness cannot be mitigated by social accommodation. In the books published by Wado-kai during this period, living with the anomalies of CVD was negatively referred to with various adjectives such as ‘dirty’, ‘horrible’, and ‘scary’.

They [Everyone who went through treatments] said that they do not want to go back to that damaged and bizarre world. (Wado Doctors Group 1989, 136)

That boy’s eyes are doubtlessly abnormal. On that day [of the diagnosis], I got a glimpse of the unknown world, abnormal world veiled in CVD. Even though he sees colours different from ours, I hope the world he sees is beautiful as well as the world we see. There is nothing for it but to pray to God. That is the only thing the mother hopes. I only hoped it wasn’t an insane world. (Wado Doctors Group 1985, 8–10)

I think it is a dismal life to live in a world where cucumbers look red, red tomatoes look green, mountains look black, and green leaves look brown. (Wado Doctors Group 1985, 3)

In early 1980, although it was noted that the vision of people with CVD did differ from that of people without it, the former was rarely represented as ‘dirty’ or ‘bad’. Although the group emphasised that life with CVD meant that one would face a lot of trouble in school and office, it was not believed that having a different kind of colour-specific vision was equal to leading a dismal life. However, in the late 1980s, it was repeatedly noted that their vision was not only different from that of those who did not have CVD, but was also considered to be ‘dirty’. This discourse existed in Japan even before the group began to use it. Baba (2020, 263) pointed out that the vision of people with CVD was considered to be ‘dirty’ by some doctors who tried to cure it in 1937. However, it was only in the late 1980s that the group began to call the vision of people with CVD ‘dirty’ in its own discourse, even though it had previously existed in Japanese vocabulary and epistemology.

Why did the group begin to use such language in the late 1980s? This can be answered by recognising that the representation was a counterclaim against the claims that called for social accommodation. The relaxation of educational and occupational restrictions with social accommodation made the group’s claims less persuasive, as its grounds and warrants had weakened. Unchangeable restrictions, which were once the group’s ground, had eased. As more and more people with CVD were allowed to study and work comfortably without treatment, the meritocratic criterion ceased to function as a basis for treatment. The Hippocratic Oath did not work as a basis either because the curability of CVD was negated. However, the claim that people with CVD had different vision remained unaffected, although by itself, it could not justify the need for treatment. Thus, the group had to make a new claim that was robust, despite the prevalence of social accommodation. This new claim was the stigmatisation of CVD. They started to find the wrongness of CVD not in the trouble it caused, which could be mitigated by accommodation, but in the eyesight of CVD itself, which could not. In stigmatising CVD, the difference in colour-specific vision was redefined as something that had to be cured independently of social change, along the lines of a cold or trauma.

With widespread social accommodation that weakened its claims, the CAM group tried to maintain the need for treatment for CVD by (1) doubting social change and suspecting the true intentions of universities and companies, and (2) stigmatising different vision to regard it as a problem that could not be removed through social accommodation. With these counterclaims, the group continued to position CVD as an object of treatment and to attract clients. Even during the widespread prevalence of social accommodation, the CAM group enjoyed prosperity—at least for a while.

Discussion

Despite the relaxation of educational and occupational restrictions with social accommodation, the group that allegedly treated CVD thrived in Japan in the 1980s. This study aimed to understand why/how the group was able to maintain the persuasiveness of its claim that CVD had to be treated, even though the trouble caused by CVD could be mitigated without treatment. Theoretically, this study was based on the framework of disability studies on the pros and cons of cure, and the sociology of health and illness on the legitimating work by CAM therapists. By focusing on social accommodation, this study tried to contribute to both fields of study. It built on the claim analysis suggested by Best (2021), which investigates the components and exchange of claims.

This study found that the CAM group remodelled its claims and developed fresh counterclaims when it faced social changes that weakened the persuasiveness of its original claims. The claims that advocated social accommodation for people with CVD refuted the grounds of incurability and actual restrictions, which also rendered both meritocratic value and the Hippocratic Oath irrelevant. To compete with these claims, the CAM group made the following counterclaims: (1) it doubted whether social change had taken place and argued that the restrictions remained, and (2) it considered the vision of people with CVD to be a deviance and something that had to be treated. It is both a paradox and an irony that the stigmatisation of CVD was invented as a response to the widespread prevalence of social accommodation.

The findings of this study have both theoretical and practical implications. Theoretically, this study contributes to knowledge on the demarcation of CAM. Earlier studies have investigated how CAM demarcated itself from orthodox medicine (Cant and Calnan 1991; Cant and Sharma 1996; Norris 2001; Fadlon 2004; Welsh et al. 2004). The group on which this study focused also used the strategies that these studies found (e.g. emphasising personal anecdotes and using orthodox knowledge selectively). However, this study also found that the social context has an important effect, especially when CAM therapists try to legitimise their raison d’être. In the early 1980s, they justified the need for treatment on the grounds that there were restrictions against people with CVD, and in the late 1980s, they did so by doubting whether these restrictions had been relaxed at all. While they changed their strategy, they also referred to and dealt with the social context consistently. Thus, the study of the CAM group’s self-demarcation must be carried out not only in the relationship with orthodox medicine, but also within the social context. Locating demarcation in a broader context, we can understand the CAM group’s approach better. In doing so, we can also specify the strategy that the CAM group used only when it tried to demarcate itself from orthodox medicine.

Practically, this study’s findings can enhance the logic of disability rights movements. Disability studies have taken for granted the idea that social accommodation should be a priority over treatments as the cost/benefit performance of the latter is inferior to that of the former. Troublingly, this logic of the social model can be vulnerable when the need for treatment is justified persuasively with a full understanding of social accommodation. If somebody, such as the CAM group in question, argued persuasively that some problems can be solved not by social accommodation but by treatment, it will be difficult to position the former over the latter using the social model of disability alone. As a result, the persuasiveness of the social model of disability may decrease. However, by following the origin and change in claims, it was found that such logic was a deception that the group somehow developed when it was driven into a corner by widespread social accommodation. This finding makes it easier to refute cure-oriented logics from a different angle. It also signifies the importance of critiquing logics that stigmatise impairment, by placing an extra emphasis on problems that cannot be solved through social and environmental adjustments.

This study has remarkable characteristics, which are as follows. First, it considered CVD to be a physical impairment and successfully located it in the context of disability studies. While there is little research on CVD in disability studies, this study indicated that existing issues in disability studies, such as the translation of physical differences into deviations and the need to counter it based on the social model, are also relevant to CVD. It also clarified that disability studies on CVD can and should be conducted. Second, it performed a complementary role by augmenting the existing research on CVD. While existing studies (Tokugawa 2016; Rossi 2019; Baba 2020) have been limited to how restrictions on people with CVD were interwoven with the establishment of the order of modern society through the development of colour science, this study shed light on how people dealt with CVD under such an order, by focusing on the (ex)changes of discourse on treatment. Third, it built a bridge between disability studies and the sociology of health and illness based on existing research on both sides. Thomas (2007) suggested that the sociology of health and illness should incorporate the idea of disability studies as inspired by the social model, which does not see disability (and chronic illness) as deviance, and integrate both disciplines. Driven by the idea of the social model of disability, this study contributed to the discussion on demarcation by CAM.

This study also has certain limitations. First, generalisation is an inevitable problem in qualitative case studies. It is difficult to generalise our findings to other CAM groups across time and space. Other CAM therapies may use other strategies to demarcate themselves from social accommodation in different contexts. However, we found some strategies that CAM therapists may use. This is the first step, in collaboration with other studies, towards presenting a fuller picture of the CAM group’s strategy. Second, the limited source of data cannot be ignored. We used books written by therapists and did not interview the clients of the CAM group. As a result, the agency of clients was not considered. Although the rhetoric of the clinic was persuasive, clients must have been free to decide to be treated. We cannot verify why/how clients decided to have their CVD treated when social accommodations were available.

To conclude, further research is necessary. Some of the directions for future research are as follows. First, we can focus on the demand side of CAM, that is, the clients of the group. Although their personal anecdotes were provided in the books, the group may have been selective in telling the story. Hearing their experiences directly, we can investigate how they interpreted the group’s discourse and why they tried to have their CVD treated, despite the relaxation of restrictions. This will complement this study. Second, international comparisons can be conducted. There have been many attempts to treat CVD world over. However, they were all in vain. The comparison of these attempts will clarify the similarity and uniqueness of the logic to justify the treatment of CVD across time and space. Finally, comparisons can be made not only with CVD, but also with orthodox medicine. Contemporary developments in biomedical science and technology have been able to treat some impairments that were once considered to be incurable. As it is now common knowledge that trouble because of these impairments can be mitigated by social accommodation, orthodox medicine will have to justify that treatment is necessary, even though the idea of social accommodation prevails. Whether it uses the rhetorical strategies this study found, or develops other strategies because of its orthodoxy, must be studied in the future.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This work was supported by JSPS KAKENHI Grant Numbers JP18K12943, JP20K20782.