Monday, March 21, 2011

19/03 Lessons for Japan’s Survivors: The Psychology of Recovery

March 19, 2011
By BENEDICT CAREY

JAPAN is in the middle of a catastrophe that transcends any talk of trauma and resilience, the easy language of armchair psychology. There is no reintegrating with friends and social networks now scattered or lost in the sea; there is no easy rebuilding of communities washed away, swallowed by the earth or bathed in radiation from ruptured nuclear plants.

Few can doubt that the country will eventually repair itself; that’s what people do, none more so than the Japanese. But some scientists say that recovering from this disaster will be even more complicated.

In dozens of studies around the world, researchers have tracked survivors’ behavior after disasters, including oil spills, civil wars, hurricanes and nuclear reactor meltdowns, as well as combined natural-technological crises, like what’s happening in Japan. One clear trend stands out: Mental distress tends to linger longer after man-made disasters, like an oil spill or radiation leak, than after purely natural ones, like a hurricane.

“Think about it,” said J. Steven Picou, a sociologist at the University of South Alabama. “The script for a purely natural disaster is: impact, then rescue, then inventory, then recovery. But with technical crises like these nuclear leaks it can go quickly from impact, to rescue — straight to blame, and often for good reason. But it means that the story line is contested, there’s no clear-cut resolution, you never have agreement on what exactly happened.”

He added: “To move past a catastrophe, people usually need to be able to tell themselves a clear story about what happened. And in this case the story is not so clear.”

One reason is that many people in Japan have begun to doubt the official version of events. “The mistrust of the government and Tepco was already there before the crisis,” said Susumu Hirakawa, a psychologist at Taisho University in Tokyo, referring to the Tokyo Electric Power Company, which owns the leaking nuclear plant. “Now people are even angrier because of the inaccurate information they’re getting.”

A similar reaction unfolded in the wake of the 1986 nuclear accident at Chernobyl in Ukraine. “Mismanagement of information creates consequences down the line,” Dr. Hirakawa said, “and in my estimation this tragedy is starting to look a lot like Chernobyl,” which forced the evacuation of thousands of people and contaminated millions of acres of forests and farmland.

The only country ever hit by a nuclear attack, Japan has a visceral appreciation of the uncertainties of radiation exposure, how it can spare some people in its wake and poison others silently, causing disease years later. It is caught in the middle: The story has a contested beginning and an uncertain ending.

Compounding the problem, Japanese psychologists say, is that many of their countrymen will attempt to manage their anger, grief and anxiety alone. In the older generations especially, people tend to be very reluctant to admit to mental and emotional problems, even to friends; they’re far more likely to describe physical symptoms, like headaches or fatigue, that arise from underlying depression or anxiety.

“It’s simply more socially acceptable to talk about these physical symptoms,” said Dr. Anthony Ng, a psychiatrist at the Uniformed Services University of the Health Sciences in Bethesda, Md., who consulted in the aftermath of the 1995 earthquake in Kobe.

Not that medicine can repair the deepest losses. The quake, tsunami and radiation have destroyed or defiled what may be the islands’ most precious commodity, land, dealing a psychological blow that for many will be existentially disorienting.

“In rural communities especially, there’s a very strong feeling that the land belongs to you and you belong to it,” said Kai Erikson, a sociologist at Yale who studied mining towns of the Buffalo Creek hollow in West Virginia, where more than a dozen towns were destroyed and at least 118 people killed when a dam burst in 1972, unleashing a wall of water as high as 30 feet that swept down the hollow. “And if you lose that, you’re not just dislocated physically, but you start to lose a sense of who you are.”

There are some reasons for optimism.

After purely natural disasters, about 95 percent of those directly affected typically shake off disabling feelings of sadness or grief in the first year, experts say; just eight months after Hurricane Ivan leveled Orange Beach, Ala., in 2004, about three-quarters of people thought the town was back on track, researchers found. And psychologists in Japan say they may get an unprecedented chance to reach out to survivors as many of them gather in schools, gyms and other places that have been set up as evacuation shelters.

Yet one-on-one therapy and crisis counseling efforts are not without their risks, either. “We have to be careful that we don’t create a whole class of victims, that we don’t put people into some diagnostic box that makes them permanently dependent,” said Joshua Breslau, a medical anthropologist and psychiatric epidemiologist at the University of California, Davis, who worked in Japan during the Kobe quake.

Once victimization becomes a part of a person’s identity, the disaster story may never end. Researchers led by Dr. Picou have regularly surveyed the residents of Cordova, Alaska, since the town was devastated by the Exxon Valdez oil spill in 1989. Even today, about half of those in the community report feeling angry, frustrated, or cheated by Exxon — and by the court system, after drawn-out litigation.

“More than 20 years later,” Dr. Picou said, “and many of those people still haven’t gotten over it.”



Mark McDonald contributed reporting from Tokyo.













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