Healing psychological trauma

The destruction wrought by the disaster does not stop at the devastated buildings of affected towns. The terrible traces of its passing are scarred also onto the hearts and minds of those who lived there. Clinical psychology is the patient restoration of people’s traumatized hearts and minds. In other words, the renaissance of the heart.

Haruhiko Shimoyama
Professor, Graduate School of Education

We live each day on the premise of continuity, that what is here in one instant will also be here in the next. President Hamada expresses this in his opening message as “we have taken coexistence for granted, like the air we breathe.”

But the March 11 disaster destroyed that continuity in an instant. In that instant, what had been the very basis of our lives, our existence taken for granted, was taken from us. In that instant, the connections to loved ones, loved things, loved places, taken for granted in daily life, were taken from us. Faced with the extreme fear induced by that situation, people experience severe traumatic reactions and enter an abnormal psychological state (Table 2). But this is no more than a normal reaction to an abnormal situation. For example, a clinical psychologist who visited one area affected by the March disaster to give psychological support to victims reported “At the evacuation center, the laughs of children playing among the silent adults who had lost so many loved ones was the only salvation. But after I played with one of the children, he suddenly took on a sad expression and blurted out ‘My granny is missing.’ His mother confided that he would come to her in the night saying ‘I can’t sleep. I keep having nightmares.’ and expressed her concern for her child.”

Table 2. Trauma reactions (psychological reactions to experience of trauma)
Type Description Impact Results
PTSD symptoms Invasion, hyperarousal, and emotional numbing. Many recover naturally from the disorder in a short period of time, but the symptoms sometimes become chronic. In some cases symptoms manifest after an incubation period. ASD, PTSD.
Emotional changes Depression, grief, anger, frustration, and sense of helplessness (survivors’ guilt, John Wayne Syndrome, etc.) Physical reactions of anxiety include insomnia, lack of appetite, palpitations, shivering, sweating, breathing difficulties, and numbness. Inconsistent behavior, psychological projection, rejection of treatment and support, self-harming, anger against supporters, and searching for scapegoats. Chronic grief reactions, misidentification as (borderline) personality disorder, and problems with interpersonal relationships.
Changes in interpersonal relationships Loss of trust in oneself and society, difficulty in interpreting experiences, narrowed scope of activities due to the destruction of the infrastructure of daily life (partly due to emotional reactions). Interference with work, decrease in number of friends, increased economic difficulties, and increased conflict within the family. Social withdrawal and social maladjustment.
Source: Yoshiharu Kin (ed.) The Psychology and Care of Psychological Trauma (Second Edition), Jiho Inc. (2006). p. 5.

When people experience psychological trauma, they will usually experience symptoms including insomnia, depression, fatigue, anger, frustration, feelings of helplessness, emotional numbing, anxiety, and an inability to concentrate. In most cases, however, trauma recovery is possible through rest and recreational activities in an environment in which they feel supported and safe. However, in cases where people cannot recover naturally in this way, they develop a mental disorder called post-traumatic stress disorder (PTSD), in which they become unable to get rid of the fear they have experienced. The trauma experienced “invades” their minds against their will and is relived vividly in flashbacks and nightmares. They become excessively sensitive to sounds and other external stimuli and enter a state of “hyperarousal” in which they become very tense and frustrated and unable to sleep. They lose their sense of reality, begin to feel detached from the people around them, and enter a state where their everyday activities are “numbed” and they avoid facing reality, making it difficult to lead a normal life.

The March disaster was of such great scale that it has had extremely serious and complex psychological effects on victims, far beyond the normal framework of reactions to trauma. In addition, the tsunami is a very particular disaster. After an earthquake, what was destroyed remains there in place. But the tsunami sweeps away everything, taking not just lives but even the bodies of the dead. The sense of loss that people feel when their loved ones pass away begins to decrease after the funeral, which acts as a farewell ceremony for the deceased. But funerals cannot be held for the missing. Moreover, some victims of the disaster are now deprived of all the things that formed the backdrop to their daily lives, including their houses, mementoes, the neighborhood landscape — the things with which they had grown up and coexisted. They have lost even their jobs — the way they made their living. They have lost virtually everything related to their daily lives. As a result, they develop the kinds of grief reactions described in Table 3.

Table 3. Understanding and treating grief reactions
Typical grief reactions Clues to understanding grief reactions Initial care to be given
Strong grief and sense of bereavement Denial of death, emotional withdrawal and turbulence Physical reactions Degree of loss Present family/living environment Approach and building connection
Intense grief, strong affection, longing, loneliness
Searching for the deceased, desiring to meet the deceased again, dreaming of the deceased
Stunned, shocked, unable to accept, denying and refuting death
Inability to weep, lack/paucity of emotional expression, breaking off interpersonal relations, withdrawal from society
Anxiety, inability to concentrate, easily angered, aggressive, increased uneasiness
Depression, become tearful, self-blame
Problems related to physiological rhythms (sleeping, eating, excretion)
Stomachache/headache, feeling sluggish, feeling constriction in the throat and chest, excessive sensitivity to noise
Depth of affection for and relationship with the deceased
Other additional losses (family members, friends, pets, house, school) or similar experience in the past
Presence of support network
Existence of daily routine
Family’s attitude and response to death (attitude of spouse, siblings, or parents)
Changes in family roles (having to do housework or take extra responsibility in place of the deceased)
To help the person maintain interpersonal relationships, and build a good relationship with supporter (so that they feel secure enough to express their emotions)
Do not put pressure on bereaved individuals to speak as they may be suffering from dissociation as a result of shock. Stay with the person and wait until they calm down.
Source: Prepared by the author based on Masaya Ito, Satomi Nakajima, “Understanding and Treating Adult Reactions to Grief after Disaster,” Department of Adult Mental Health, National Institute of Mental Health, National Center for Neurology and Psychiatry.

To avoid prolonged trauma and grief, it is first necessary to ensure that the victims feel secure by providing shelter and medical services. It is necessary to communicate the fact that it is natural to feel anxious after a disaster and that it will take some time for that anxiety to subside. It is also important to help them to relax, including for example teaching breathing exercises and relaxation methods and suggesting recreational activities, as these things will help them to unwind mentally.

Experts and volunteers have been working for more than six months since the disaster to give psychological support to the victims, who now face new problems that emerge after they get over the initial stage. Refugees helped each other at the evacuation centers, but after moving to temporary accommodation increased independence can lead to strengthened feelings of isolation, depression and grief. Alcoholism increasingly becomes a problem as some turn to drink to suppress emotions. The tsunami devastated some districts while leaving others within the same area intact, which can manifest itself through the unraveling of community cooperation. In some areas residents live with the additional invisible fear of radiation and a sense of stagnation with no visible escape. Under these circumstances the symptoms of PTSD emerge in chronic forms that are extremely difficult to discern. We are at a stage where it is increasingly important that psychological support is provided to the victims of this disaster.

It has been proven that the exposure method is effective in the treatment of PTSD. In this treatment a sufferer of PTSD faces up to and then overcomes the cause of their fear step by step with the support of a professional therapist. Yet the victims of the disaster are generally not willing to receive this kind of support. This attitude might be difficult to understand for experts who have come in from outside Japan. For the people of the Tohoku region, which has a tradition of pulling together to overcome challenges and enduring troubles in silence, such an attitude is perfectly natural. One clinical psychologist, who stayed for a month providing support at an evacuation center and earned the trust of refugees there, reported that an elderly woman said to him “How on earth are we supposed to be able to talk about our difficulties to outsiders who come here uninvited and push aid on us?” Not a few victims have been hurt by the attitude of the mass media, researchers, and supporters who visit the affected areas to take photos, conduct surveys, hold interviews, and provide support for only brief periods.

If we truly want to help people in the disaster area to recover from their psychological trauma, we need to become involved in local communities long-term, with a commitment to coexistence in a recovery process that will continue for several decades. The Ministry of Education, Culture, Sports, Science and Technology has announced a special program to send that qualified clinical psychologists to schools in the affected areas as school counselors to provide mental health support to children. It is vital to give support through schools and other institutions rooted in local communities, just as it is vital to give careful and dependable support to local people. Members of the Japanese Self-Defense Forces, in addition to clearing debris, are making efforts to recover photos and other personal effects and return them to their owners. This kind of considered and careful support is necessary to help individuals reconnect with each other and with the local communities in which they grew up and coexisted.

Building on the traditional solidarity of the people of Tohoku, we are persisting with our steady efforts to encourage local people and their supporters to work together to restore the hope and confidence required for the long task of regenerating local communities.