Healing Japan: Psychological Fallout Could Last Years

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That's especially true for a culture such as Japan's, which puts a lot of emphasis on community and family. The essential role that mental health care workers can play at this point is to help people locate family members and field immediate psychological breakdowns as necessary, not force people to talk about the trauma who may still be in shock.

"Restore physical safety, that's number one, but number two is reuniting families and communities wherever possible," says Dr. Joan Anzia, associate professor of Psychiatry at Northwestern Medicine. "This is actually a form of treatment."

In the coming weeks, however, more in depth counseling will be necessary to stem the tide of post-traumatic stress disorder that psychiatrists say is inevitable after a disaster of this magnitude.

"The literature is clear that the extent and severity of PTSD and other disaster-related reactions follows a 'dose of exposure' pattern," says Alan Steinberg, associate director of the UCLA/Duke University National Center for Child Traumatic Stress, meaning that the number of traumatic events and the extent of them is directly proportionate to the extent of the "disaster after the disaster," or the psychological fallout.

"Typically, we see rates of PTSD are about a third of those affected by the trauma, but with these three traumas, earthquake, tsunami, and radiation, the rates of PTSD are likely to be incredible," Scotti adds.

From Hiroshima to Fukushima: Japan and Nuclear Anxiety

And continual psychological aid for a long period of time will be essential in Japan. These disasters have a long afterlife in terms of psychological distress, says Dr. Besser van der Kolk, professor of Psychiatry, Boston University School of Medicine.

This can be seen among victims of Hurricane Katrina, a third of whom, three years later, still suffer from PTSD. There also tends to be a "rush of help" at the beginning of a crisis such as this one, with mental health aid petering out after initial interest. So it is important to emphasize continual aid.

Although the earthquake and tsunami were colossal disasters in their own right, the subsequent and increasing nuclear threat surrounding the damaged nuclear power plant at Fukushima brings with it a different order of anxiety, anger, and fear for the Japanese people; one that may be harder to cope with than the natural disaster that spurred it, psychiatrists say.

"The distress from the nuclear threat is very different; an 'act of God' like an earthquake is different from a man-made disaster," Northwestern's Anzia says. "With a man-made disaster, there's more of a feeling of betrayal by your government, and betrayal traumas have in some ways a heavier impact."

Nuclear threat will have a special impact on the Japanese people, many of whom have grown up in the shadow of the ravages of the atomic bomb at Hiroshima and Nagasaki post-WWII.

Survivors of Hiroshima and Nagasaki faced lifelong fear of "invisible contamination" with radiation, says Robert Lifton, a psychiatrist and Hiroshima expert.

Because radiation cannot be seen or smelled, and because its damaging effects can take months or years to manifest, anxiety surrounding contamination is more subversive and harder to address than the anxiety and stress surrounding other disasters.

"The fear of radiation effects [from this disaster] will linger indefinitely, even after some improvement in the situation," he says.

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