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Opinion
Japan's recovery will be a test of mind
The psychological impact of the triple disaster in 2011 is beginning to surface.
Last Modified: 11 Mar 2012 14:32

Sendai, Japan - In the past year, Mizue Yamamura has wished for nothing else but the news of her husband. The 71-year-old spends all her time in temporary accommodation in Onagawa worrying about the fate of still-missing Yoshio.

Mizue and Yoshio were in their third-floor apartment in Onagawa town on March 11, 2011, when the earthquake struck. As the tremors grew in intensity, the couple left their apartment for safety. "It was snowing outside and Yoshio came out wearing his sandals," recalls Mizue. "He went back to get properly dressed while I made my way up the hill."

That was the last time Mizue saw her 78-year-old husband. Within minutes, vast swathes of Onagawa disappeared under water, as huge tsunami waves swept through the town, washing away many lives in its wake. Later, when the water receded, Mizue returned to her home looking for Yoshio. "All I found was dead fish inside the house," she says.

Living alone, Mizue is going through an emotional upheaval. "I can move on if Yoshio's body is found," she says. Consumed with grief and uncertainty, Mizue cries every day in the privacy of her little room that has been fabricated from a shipping container. "I try to stay awake until late, as I don’t want to wake up in the middle of the night worrying about the future," she says.

In-depth coverage one year after triple disaster

Mizue is not the only one. Bereaved, displaced and dispossessed, tsunami survivors are facing harsh challenges as they pick up the pieces of their lives. The tsunami not only just washed away their homes and towns, but it also destroyed their communities. One year on, more than 340,000 people are still living in temporary accommodation, mostly among strangers, unsure when they will return to their homes.

Recovery efforts

Japan has launched a robust response and will spend 13 trillion yen ($167 billion) on recovery efforts during the next five years. The tsunami-ravaged coastline in the north-east is undergoing a clean-up never seen before in history for its sheer scale and speed. From Ishinomaki to Onagawa, Shichigahama to Kesennuma, the landscape has been drastically altered, as Japan presses on with the world's costliest disaster recovery to date.

Town after town has been razed to the ground. Houses, schools and busy markets have all disappeared. Almost everything that was damaged has been flattened and cleared. The horizon is now marked with towering stockpiles of scrapped cars, recovered metal and millions of tonnes of cleared debris. Some colossal industrial units will take longer to dismantle. The great fortresses of Japan's economic power - they stand like grim mausoleums - annihilated by the brute force of tsunami waves that tore through their steel ramparts as if they were made of paper.

Much like their resilient nation, Japan’s tsunami survivors are trying hard to put up a brave front to their immense loss and suffering. As the world watched the news of the aftermath of March 11 with disbelief, the people in tsunami-hit areas were making an orderly queue to receive emergency relief. Even in the face of catastrophic tragedy, there was little public display of emotion. One year on, the survivors still rarely speak about their feelings - and least of all complain about their circumstances. For them, to be seen needing help is a dent in their self respect, and seeking it is akin to a betrayal of those who might need it more.

"People in general are very afraid that others may think of them as psychologically weak or vulnerable if they seek help"

- Prof Machiko Kamiyama

Even with such overarching altruism and valiant attempts to live up to the embodied values of stoicism, tsunami survivors need help. Earthquake, tsunami and the fear of nuclear radiation has put a significant chunk of the population under stress. The worry for many psychologists and mental health experts is that many survivors could be going through serious emotional distress in silence without seeking any help.

"People in general are very afraid that others may think of them as psychologically weak or vulnerable if they seek help," says Machiko Kamiyama, a psychologist and professor at Yamagata University. In the first two months that she offered a free phone counselling service for survivors, fewer than ten people called up to share their problems. 

Growing needs

Mental health professionals readily furnish data to show how, years after the 1995 Kobe earthquake that killed more than 6,000 people, the number of psychological cases in Japan continued to rise. The 2011 tsunami dwarfs the Kobe disaster in its magnitude, geographical spread and death toll of about 16,000. The experts fear if emotional needs of affected people are not addressed immediately, last year's disasters could have long term ramifications on the general psychological wellbeing of those at risk, especially children.

"When we talk to children about the tsunami they have flashbacks and some start crying," says Choji Suzuki, principal of Shichigahama Junior High School.

"We asked school children to fill in a questionnaire six months after the tsunami. We found that more than 30 per cent of all children, including those not directly hit by the disaster, had been psychologically affected."

"We found that more than 30 per cent of all children, including those not directly hit by the disaster, had been psychologically affected."

- Choji Suzuki, principal at Shichigahama Junior High School

Nami still cannot get over the death of her close friend. In November, the 14-year-old participated in a musical based on the tsunami. It was about people who died in the disaster communicating with those who had been left behind. "The script mentioned the name of my deceased friend," says Nami. "As the practice went on I started to feel like my friend was actually speaking to me."

Even young children in nursery schools are showing psychological effects from the events of last year. Junko Kamada, principal of a preschool in Tagajo city was deeply unsettled when she found her school children playing "tsunami games" where they would run to escape the tsunami wave and pretend to drown. "It was hard for me when I saw children saying ‘the tsunami is coming, we have to run'. As some children in our school were killed by the tsunami, I was really worried," she says.

Underlying issues

There are fears that the psychological impact may run much deeper, something the recovery package may have failed to take account of. In the rapid reconstruction and rebuilding underway in tsunami-affected areas, the desperate attempt to return to "business as usual" is evident. The core priorities of recovery have been set around economic revival and benefits. Missing, however, from the equation is any discussion to comprehensively address the emotional and psychological needs of survivors.

"In Japan, we do not have a precise idea of disaster psychiatry; it has not yet been systematised," says Dr Hiroaki Homma, Director of Miyagi Comprehensive Children’s Centre. "We know we should do something, but we don’t really know how." The fact that a provincial health centre with a small team of just eight staff, including four doctors, is one of the largest facilities for child psychiatry in the country reflects the status of mental health service provision in Japan.

"It is hard to imagine the situation in Fukushima, where no such facility exists. The number of children who have developed psychological issues is likely to be much higher, due to the additional impact caused by ongoing radiation concerns," says Dr Homma. Regardless, his team is relentlessly monitoring the psychological situation of children in Miyagi Prefecture.

"In Japan, we do not have a precise idea of disaster psychiatry; it has not yet been systematised ... We know we should do something, but we don’t really know how."

- Dr Hiroaki Homma, director at Miyagi Comprehensive Children's Centre

More and more cases of children are now being dealt with at the Miyagi Centre, with the figure reaching somewhere close to 300. Given that most cases requiring psychological care don’t ever get reported - due to a supposed stigma attached to mental health, this figure is alarming for doctors, as they fear this could just be the tip of the iceberg.

"According to a screening done by a different healthcare team in a big city, out of 13,000 children from 300 primary and secondary schools, 40 per cent showed signs of Post-traumatic Stress Disorder," says Dr Homma.

Prof Misako Hatayama, president of Care Miyagi - a group of psychologists who came together after the tsunami to provide emotional care to survivors - says the behaviour of children has worsened after the disaster, with increasing violence in school and children refusing to go to school. "It seems the need for individual intervention has increased with time," she says.

Rebranding mental health care
 
The experiences of child rights organisation Plan in reaching thousands of tsunami survivors in the worst affected areas of Miyagi prefecture in the past year confirm the grim situation on the ground. From children to parents, teachers, government officials, doctors and even aid workers; the disaster has had an impact on all. The organisation has come across deeply disturbing stories of children affected by the disaster, with some, for example, scared to flush toilets - as the sound reminds them of tsunami waves. Psychologists working with Plan have reported cases of older children showing anxiety, such as wetting beds, and adults going through depression - with some developing alcohol and gambling addictions. 

The accepted social norm to be resilient and the common confusion in Japan of psychosocial care with mental illness means those in real need may never seek any help. Plan Japan staff had to evolve ways to reach their own, very private people. "We rebranded psychosocial care as child support to make it more amenable to people," says Mie Kashiwade who leads the organisation’s emergency response unit in Sendai, capital of Miyagi prefecture. "Tea parties were used as an excuse to bring people together so they could talk and share their feelings."

Emotional support or psychosocial care is often neglected in disaster response, yet it is among the most basic needs of survivors. It is vital for affected people to be able to relate to and deal with their circumstances. Simple things, such as group activities, games or getting people to talk to each other can play a significant role in the healing process. Best still, expressing emotions and sharing feelings can prevent people at a high risk of developing psychological problems from advancing into stages where they require specialised mental health care involving psychiatrists or clinical psychologists.

"We rebranded psychosocial care as child support to make it more amenable ... Tea parties were used as an excuse to bring people together."

- Mie Kashiwade, Plan Japan

It is becoming increasingly evident that the aftermath of tsunami has inadvertently exposed a worrying neglect of emotional well-being in Japanese society, a sentiment echoed by mental health experts who fear that things could get worse. Regardless of a nation's advancement and resources, disasters affect everyone. There is a growing concern that the emotional impact of the tsunami on its survivors cannot be addressed by Japan’s reconstruction and physical recovery alone.

As time passes, tsunami survivors face an increasing risk of being forgotten - just when the real scale of the tsunami’s psychological impact is gradually beginning to surface. In the first few months after the disaster, the survivors received an overwhelming amount of support from within and outside Japan.

"It was like a festival. Famous people visited affected areas, they were singing, dancing, doing performances to cheer up everyone. The baseball team’s hero visited and played with the children," recalls Prof Kamiyama. "But the period passed away very quickly," she adds.

Survivors such as Mizue provide a glimpse of how thousands are battling extreme loneliness and an overwhelming sense of isolation. "During the day I go to the community centre in the temporary housing complex and have tea with other people. We sit together and talk, but we don't talk about our bad experiences," she says.

For its prided stoicism and economic realities, the pressure is intense on Japan and its tsunami survivors to get back in business. As the world’s third largest economy races ahead to rebuild and reconstruct everything that was lost to the tsunami, it faces its biggest test yet to mitigate the impact of nation’s worst crisis since the Second World War on survivors’ minds. It is a challenge and a humanitarian need that must be met. For Japan’s recovery to be successful, it will have to be matched in mind.

Davinder Kumar is an award-winning development journalist and global press officer for child rights organisation Plan International. He is also a Chevening Human Rights Scholar. The article is based on his visit to tsunami-affected areas in February 2012. You can follow him on Twitter: @davtox

The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera's editorial policy.

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