Cultural Competence in Japan Aids Recovery After Tsunami

NYAPRS Note: Below is an excerpt from an article relaying the challenges of overcoming widespread trauma in Northeast Japan after a tsunami claimed thousands of lives there in 2011. The article highlights how culturally competent treatments-including comfortable settings where peers could communicate in groups—have been the most effective for protecting the mental health of individuals and communities. The response has not ended, however; the article notes that a 25-year study of Chernobyl, where a radioactive blast devastated the Ukraine city in 1986, implicated protracted mental health challenges as more significant than the physical health calamities associated with nuclear radiation. Mental health professionals in Japan continue to seek culturally appropriate innovations to alleviate  the suffering of survivors.


Getting on With Life in Japan After Tsunami’s Mental Challenges

The Vancouver Sun; Erin Ellis, 12/21/2013


The nascent field of disaster psychology is looking at the aftermath of such catastrophes and debating the best action for preventing mental illness among victims. The message from Japan is that culture matters in recovery, and Western notions about what victims need - beyond immediate shelter, clean water and food - may be far off the mark.

Dr. Tsuyoshi Akiyama is the head of neuropsychiatry at NTT Medical Centre Tokyo and has served on professional committees focused on disaster response, both immediately after the earthquake and in the event of future emergencies. He’s also passionate about the uneasy situation of residents living in the Fukushima area, his hometown.

He says Japan turned down offers of psychological assistance teams after the 2011 earthquake and tsunami because it learned from the 1995 Kobe earthquake that it wasn’t a useful addition.

“When there is a disaster, what people need first are basic comforts. Ordinary counselling - let’s talk about the experience - is not helpful... When you ask people to try to remember the trauma, it may consolidate the symptoms rather than relieve them.”

Instead, psychological relief teams that have visited the tsunami zone found the best approach was to hold coffee houses where evacuees could talk to each other, and professionals if they wished. One-on-one counselling was a non-starter. Why? Because Japanese people don’t want to tell strangers they are suffering.

“In general, the Japanese people hate, hate, to be seen as complainers,” says Akiyama. “In Western culture, if you can’t explain your thoughts, that is not good. You are not contributing to society. But traditionally in Japan, people have to be careful about expressing an opinion.”

While Japan felt confident in mobilizing only its own mental health professionals, he says Indonesia let in foreign teams after the 2004 tsunami smashed into the Banda Aceh region, bringing with them culturally inappropriate techniques - like hugging. His colleagues there have told him there was no huge surge in the number of cases of post-traumatic stress disorder because most victims are Muslims who believe they must accept the will of God.

In Japan, Akiyama says there is also a tradition of accepting one’s destiny, perhaps because of the strong Buddhist influence. And there is a high social value placed on quietly and privately coping with stressful situations.

“I cannot imagine that the impact of a life-threatening experience is so different between Japanese and non-Japanese. However, PTSD arises from a psychological interpretation of the situation. My hypothesis is that through trust in other people, the stress after a disaster may be lessened in the Japanese. Or, when Japanese don’t feel much anger about the disaster, it may help them to avoid additional stress.”

While hard numbers on mental illness following the earthquake-tsunami aren’t available due to chaotic record keeping in the immediate aftermath, experts say it’s generally accepted that 20 per cent of survivors and about 15 per cent of caregivers developed post-traumatic stress disorder.

Dr. Norio Narita is a neurosurgeon in Kesennuma who oversaw the city hospital’s emergency services after the tsunami. He says PTSD and other mental conditions have been a real problem in the community and among his staff, but treating them is like aiming at a moving target.

Disaster psychology research suggests that PTSD peaks about six to eight weeks after the event and waves of Japanese teams were fanning out to evacuation centres to treat victims by then, Narita said. But living in overcrowded emergency centres in schools and community halls had already taken its toll, particularly on the elderly, who often withdrew and become immobilized.

Today, unemployment and displacement continue to plague the area.

Most of the workers who are clearing the land and hauling away debris have come from outside.

Locals formerly employed in fish-processing plants — the main industry on this stretch of coastline — have no place to work.

Alcoholism is reported to be on the rise among those with no jobs or homes and who are living on government assistance.

“We still need mental health treatment,” says Narita. “But the needs are different than earlier on.”

That includes ongoing uncertainty for about three million people living in the area of Fukushima.

Akiyama is collaborating with other psychiatrists - including several from the U.S. - and local health workers to encourage residents to stop hiding in their homes and start living again.

Little is known about the long-term effects of low-level radiation exposure, he says, except that anxiety about it has strong psychological effects.

“The tsunami was one day... We cannot bring back the lives lost, we can only rebuild,” he says. “Radiation is a much different case.”

Long-term research on the effects of a nuclear accident and widespread release of radioactive material in Chernobyl, Ukraine, in 1986 has shown an increase in thyroid cancers and also a significant increase in suicide, depression and alcoholism among cleanup workers and residents.

A 25-year study published last year concluded that mental rather than physical ill effects have been the main health problem.

“That is the case in Fukushima, too,” said Akiyama. “Naturally the anxiety level is higher and you cannot fight against it.”