Ask John: Why is Anemia so Common in Anime?

Question:
I’ve noticed in several anime there are characters that have a condition where they faint frequently, whether caused by a disease or a “weak body.” Mutsume from Love Hina, Hyatt from Excel Saga, and Kei from Onegai Teacher are all examples of this. To me, it seems very unbelievable that a person could faint so often for no apparent reason. Why is this so common in anime?

Answer:
Many common elements in anime seem foreign or unusual to Westerners, but are common in anime because they are familiar and meaningful to Japanese viewers. School uniforms, open school rooftops, referring to strangers with familial pronouns, heavy drinking, and even anemic characters all appear frequently in anime because these things are a reflection of Japanese society that Japanese viewers will be familiar with.

According the the Center for Disease Control, Japan has one of the world’s highest rates of Tuberculosis, a disease that can manifest itself through symptoms including fatigue and coughing blood. While the frequency of Tuberculosis is now much lower than it was in years past, Tuberculosis is sometimes associated with samurai who frequently cough up blood such as Takasugi of the Rurouni Kenshin Tsuioko-hen OAV series and Ukyo of Samurai Spirits. Tuberculosis was also rampant in Japan during the early half of the 20th century and appears as a plot and characterization device in Akira Kurosawa’s films Drunken Angel and Scandal.

Virtually any resource on cancer will also confirm that Japan, along with Eastern Europe, has the world’s highest rate of stomach cancer. According to the Comprehensive Cancer Information Website, stomach cancer is as much as 10 times more common in Japan than in America. Symptoms of stomach cancer include anemia and vomiting blood. Malignant gastric conditions are also the main cause of Pernicious Anemia, a disease statistically common in Japan. Furthermore, according to the Aplastic Anemia Central Facts & Statistics page, Aplastic Anemia is 7 times as common in Japan as in America.

Characters including Otohime Mutsumi of Love Hina, Hyatt of Excel Saga, Shiori Misaka of Kanon, Mio Kisaragi of Tokemeki Memorial, and girls from Sentimental Journey and Kokoro Toshokan whose names I’ve completely forgotten all exhibit weakness, ill health, and anemia because these conditions create the impression of a tragic, fragile princess around these characters. In fact, Mutusumi Otohime’s name even has the word for princess, “hime,” in it. Naturally anemic girls are not quite as common in Japan as anime would have you believe, but the frequency of clinical anemia in Japan is common enough to make the condition a legitimate option for anime characterizations.

(I did not include Kei Kusanagi of Onegai Teacher in my response because Kei’s condition is rooted in mental and emotional instability rather than physical anemia.)