The trauma doesn't seem to end for Japan: First earthquake, then tsunami, now a country with more than 4,000 known dead and nearly 10,000 more missing must cope with the threat of nuclear contamination.
Although officials are still struggling to meet the immediate, physical needs of survivors, the psychological wounds of this disaster, for those directly impacted and the nation as a whole, will leave their imprint for years, even decades, to come, psychologists say.
Beyond the practical aspects of rebuilding, how does a devastated nation restore the minds and hearts of its people and stave off long-term psychological distress? Even as relief efforts fight to get food, baby formula, water, and oil to the affected region, post-trauma mental health care has already begun.
Psychiatric teams have gone into the area, says Dr. Makiko Okuyama, head of the Department of Psychosocial Medicine at the National Center for Child Health Development, who is part of the relief effort now in Japan.
After Japan's Kobe earthquake in 1995, "it was chaos," he says, but that disaster birthed Japan's first consolidated system for psychological aid following a crisis. "But this disaster is much more than we expected; too wide [of an] area and too much damage," he says.
Meeting physical needs is the first priority for psychological aid, he adds.
Back in Tokyo, the Japanese Society of Neurology and Psychiatry, the equivalent to the American Psychological Association, is meeting Friday night to discuss how it will handle the situation, says Dr. Fumitaka Noda, co-chair of the World Psychiatric Association and chair of the Japanese Society of Transcultural Psychiatry at Taisho University in Japan.
It will take a long and concerted effort on the part of mental health care workers in Japan, and most likely those abroad as well, to meet the psychological needs of the survivors in the coming weeks, months and years, says Reiko True, a clinical psychologist who worked with Kobe earthquake victims and was in Tokyo's Narita airport at the time of last week's earthquake.
"Since Kobe [Japan] has done a lot of preparation for dealing with "not only the physical and structural needs of a community, but to care for the psychological wounds of the people, but I think the needs now are overwhelming," she says. "Eventually, they will want and welcome help from the outside. What I'm hearing is that they are not prepared to accept mental health help from the outside yet, though."
Although many survivors are no doubt in psychological distress, therapy is not actually what they need at this point, psychology experts say.
"We need to be careful, the urge for mental health care providers is to rush right in and do some kind of psychological help, but data suggests that getting people too involved in talking about trauma while it's still going on is not helpful," says Joseph Scotti, professor of psychology at Eberly College of Arts and Sciences.
"You cannot help people with therapy when they are living in radiated rubble. To work on psych stuff you have to first get them safe and sheltered and their family together."