02/28/2012

 

The Fukushima Psychiatrist

'It's Amazing How Traumatized They Are'

DPA

Since the Fukushima catastrophe almost one year ago, Jun Shigemura has been providing psychological care to workers from the stricken nuclear facility. In an interview with SPIEGEL ONLINE, he tells of the immense challenges facing TEPCO employees -- and why most of them have elected not to quit their jobs.

SPIEGEL ONLINE: Since May, you have been providing psychological assistance to workers in the stricken Fukushima nuclear power plant. How did you end up with such a job?

 

Shigemura: Actually it is a bit sad that I am in charge of the workers' mental health. But TEPCO had lots to take care of and didn't have enough capacity to provide mental health services. Before the quake, a part-time psychiatrist looked after the workers in Daiichi and Daini. But he is from Minamisoma and it takes him too long to get to work now because of the exclusion zone. A few nurses in the health center for the two plants read my publications and contacted me. Then TEPCO sent for me. I am there as a volunteer.

 

SPIEGEL ONLINE: You don't get paid for your work?

Shigemura: Not by TEPCO, but I wouldn't want that. It would hurt my position. I don't want to be involved in the profit-making nuclear industry, even more so because workers' wages have been cut by 20 percent. That's why I made a government project out of this. TEPCO has yet to find a psychiatrist who wants to take over the job. Most of them are probably worried about radiation and their image. Furthermore there are not enough psychiatrists in Japan. After the Kobe earthquake in 1995, more people began to understand how important psychological assistance is. But many still think that those who go to a psychiatrist must be crazy. I hope that things will improve further after this catastrophe.

SPIEGEL ONLINE: Aren't you worried about radioactivity yourself?

Shigemura: I am not afraid, but that doesn't mean I am not anxious. I haven't been in Fukushima Daiichi facility. The health center is at the Daini plant, about 10 kilometers away. Radioactivity levels are low there, but my wife isn't very happy about my new job. In the beginning she said: "Me or the nuclear plant." I have made several trips since then, so I hope my wife has accepted it to some extent.

SPIEGEL ONLINE: What have the workers gone through since the accident?

Shigemura: They thought that they would die when the reactors exploded in May. But they still had to continue their work, to save their country. Many come from the area around the plant, the tsunami washed away their homes, their families had to evacuate. The workers have lost their homes, their loved ones are far away and the public blames them, because they work for TEPCO. Many think that TEPCO is responsible for the catastrophe. The workers weren't seen as heroes as they were in Europe. One time, somebody donated fresh vegetables for the workers, because TEPCO at that point wasn't able to provide fresh food inside the evacuation zone. But the donation was made anonymously, because those who gave it didn't want to be caught helping TEPCO workers.

SPIEGEL ONLINE: How are the workers today?

Shigemura: It is amazing how traumatized they are. Two to three months after the quake, I carried out a survey among 1,800 TEPCO workers in Daiichi and Daini. When a catastrophe like the tsunami hits a community, about 1 to 5 percent of the general population suffers long-term traumatization. Among police, fire-fighters and other disaster workers, it is about 10 to 20 percent. Among TEPCO workers the percentage is much higher.

SPIEGEL ONLINE: What consequences does such a level of traumatization have?

Shigemura: I am currently treating a man in his early forties. He had a house on the coast close to Daiichi that was destroyed by the tsunami. That's when he lost his 7-year-old son. The man had to flee and he tried to rent an apartment somewhere else. But the landlord rejected him because he works for TEPCO. When he finally found a flat the neighbors posted a paper on his door: TEPCO workers get out. Because the man received quite a high dose of radiation, he had to change to another department. Now he's got a desk job that he doesn't enjoy and isn't trained for. He is afraid that he might get ill with cancer, he is in financial difficulties because his salary was cut and he lost his house. He also has problems with his family. His mother lost her husband to the tsunami and she feels guilty, because she couldn't save him and her grandson. She cries a lot. When my patient gets home after work, he doesn't feel comfortable there either.

SPIEGEL ONLINE: Why don't these people simply quit their jobs with TEPCO?

Shigemura: There are many reasons for this. Those I have spoken to are loyal to their company and want to save it. Others do it for money. About 3,000 workers go to Daiichi every day. The complicated jobs are done by employees of TEPCO and other firms like Hitachi and Mitsubishi. The simple jobs are done by people hired by sub-subcontractors. My team of seven psychiatrists prioritizes workers with higher levels of responsibility, which alone amounts to more than 1,000 people. Within that group, we treat special risk cases, meaning people who have lost their colleagues, their families or who are in financial difficulties. Of course I would like to see all the workers, but that would be impossible. We had to make compromises.

SPIEGEL ONLINE: What do you say to those who can't go on?

Shigemura: The most important message is that of appreciation and support for what they have accomplished. Very rarely do we advise them to take a rest. It is better for the workers if they can stay at work. Otherwise their colleagues would think they are weak and they would be stigmatized as mentally ill. Also it motivates them to belong to a group. Staying away from work is a last resort.

SPIEGEL ONLINE: How afraid is the population of radioactivity?

Shigemura: People are confused and suspicious of the authorities. In such an environment, rumors and misinformation spread quickly. In a crisis, communication needs to be quick, transparent and accurate. If you want to prevent panic, you should release as much information as possible so the people can understand and assess the danger. But the government doesn't know much about this kind of risk communication. They kept silent about a meltdown, and people became even more anxious.

SPIEGEL ONLINE: What psychological consequences has the catastrophe had in the affected regions?

 

Shigemura: It will be years before all the psychological consequences become apparent. I am sure the suicide rate will increase in the northeast. Even before the catastrophe there were many suicides there: the winters are long and cold, there isn't much work and people are known for their perseverance, meaning they often don't speak about their problems. On top of this you have the fear of radiation, which cuts some communities in Fukushima in half. In Tamura one part wants to leave, one part wants to stay. This can also mean a crisis for families and friends. Maybe the wife wants to leave and the husband wants to stay. Social relationships can break apart over this question.

 

SPIEGEL ONLINE: How can such conflicts be overcome?

Shigemura: I don't have an answer for that. Of course I can't say: "It is okay for you to return to your village." In every case, people should be offered a broad choice on where and how they want to live. And jobs need to be created to give them a new perspective. Unemployment is a big problem among refugees. It is difficult for them to find permanent work, because nobody knows when they will return -- after a year, after 10 years. Or never.

Interview conducted by Heike Sonnberger Der Speigel

http://www.spiegel.de/international/world/0,1518,818054,00.html

 

PTSD

New technique to write off anxiety / PTSD sufferers encouraged to keep journals to help treat their disorders

Michio Watanabe / Yomiuri Shimbun Staff Writer

Sufferers of post-traumatic stress disorder are being encouraged to write about their trauma in a journal and then read their entries out loud, as part of a new treatment technique.

Masaru Horikoshi, a doctor at the National Center for Neurology and Psychiatry in Kodaira, Tokyo, says this fresh approach to mental health therapy can help PTSD sufferers recover from the disorder.

PTSD is an anxiety disorder that develops after someone experiences an incident that is beyond their ability to recover from, leading to severe psychological trauma.

"In some cases, the disorder can't be overcome by avoiding [dealing with the event]. By writing down what they feel about the incident, sufferers face painful experiences, put these into perspective and become strong enough to deal appropriately with them." Horikoshi said.

PTSD cases often involve those who have experienced a disaster, accident, sexual assault or another crime. Sufferers commonly develop sleeping difficulties and experience flashbacks of the traumatic incidents. These people tend to avoid things that remind them of the trauma and may erase part of the incident from their memory. PTSD is diagnosed when sufferers experience these symptoms for more than a month.

Mental health practitioners most commonly treat PTSD patients by asking them to recall the events, which caused the disorder and discuss these in detail. This dialogue is used to heal the patients' emotional scars.

Using writing to treat PTSD is a relatively new practice. In the United States it has produced almost identical results to the dialogue method.

"Sufferers can decide how much they want to write about their experiences. So this method of treatment could be an option for those who find it difficult to speak about their traumatic experiences," Horikoshi said.

Horikoshi is part of a group of people that is creating a nontechnical guide to use this writing technique to treat PTSD called "Kokoro o Iyasu Noto" (A notebook to heal your mind), which will be published in March.

This book has a section in which users can write down traumatic experiences and answer questions that are designed to help them deal with their problems.

Horikoshi explained how to maintain a journal that can be used to help in the treatment of PTSD.

You begin by writing the things that have and have not changed following the traumatic event. This could be something to do with your personality, relationships, everyday life, philosophy and perspective of the world. This will help you think about the incident's significance to you. It's OK to stop if you are unable to write all of this information in one go. You may continue once more when you feel relaxed and have peace of mind.

"When writing about a traumatic experience, you might find it hard to continue writing if your emotions take over, and you begin experiencing anxious thoughts such as 'I can't trust anyone' or 'Nothing good will happen even if I keep going.' Draw a line on the page after your last word if you feel this way. This will help you understand what is bothering you and learn about things that you aren't sure how to feel about," Horikoshi said.

"One of the purposes of this treatment is to understand what you are mentally unable to deal with. So it's important to write down your thoughts honestly, even if this is done gradually," he added.

After an entry in your journal is completed, read it out loud. This will enable you to think again about the meaning of what you have written down, while gradually getting used to the uncomfortable feelings and emotions that you normally want to avoid.

Once you are able to read the entry out loud without skipping any lines, try to write down the details of the event itself. This process pushes you to review your traumatic experience, develop a better understanding of what happened and deal with the feelings and emotions that may be bothering you. Again, read all the entries out loud after they are written.

In the United States, sufferers take 12 weekly writing therapy sessions where they are assisted by doctors and mental health practitioners. Japan's National Center for Neurology and Psychiatry is preparing a training course for medical staff so that the same program can be introduced nationally.

Horikoshi hopes his book will help sufferers escape the shackles of PTSD and achieve a well-balanced way of thinking.

 

Grief Professionals

Kaleidoscope of the Heart: Saying yes to grief is a step to recovery

http://mdn.mainichi.jp/perspectives/news/20120205p2a00m0na002000c.html

Rika Kayama

Separation from family, being diagnosed with a serious disease, a sudden natural calamity -- life is full of bitter experiences.

But, quite surprisingly, "mental" specialists in the past didn't think very deeply of ways to help people pushed to the verge of a mental collapse by a devastating life experience.

The job of mental health specialists such as psychiatrists is to cure a disease. Therefore, when a patient comes and says, "I've been suffering so much since my mother passed away," specialists have become used to telling them that this is part of life and everyone goes through it, and we say things like, "You have to endure that."

However, especially in cases when people have lost their loved ones suddenly to a natural disaster, a crime, or a suicide, or when parents have lost their children, for example, they should be treated with special care.

Such special treatment, known as "grief care," is finally gaining real traction in the mental health community.

In fact, a number of grief care advocates in Japan have for many years made vocal appeals for its importance. Yoshiko Takaki, head of the Sophia University Grief Care Research Institute, is one of them.

During her life as a Catholic nun who has helped many to overcome grief, Takaki became aware that such people need special professional care to help them deal with the pain they have built up from the shock they have experienced. Based on rich practical experience, research, and training of specialists, Takaki has become a leading grief care expert.

When I met Takaki recently, she kindly gave me four books she wrote starting last year. After the enormous losses the Japanese people endured in the March 11, 2011 triple disasters, a number of publishing companies have asked her to write books on overcoming grief.

What struck me right away was that among the four books, three had titles that included the word "grief" -- "It's OK to be grieving" (Kanashindeii) and "On how to overcome grief" (Kanashimi no Norikoekata), for example.

Takaki, dressed in the simple outfit of her order and her eyes always sparkling like a little girl's, told me:

"See, I told the publisher that I doubt people would buy a book titled 'It's OK to be grieving.' But he told me, 'That's fine. This is exactly what people need right now.'"

It seems to me that until now, we have all forced ourselves into some kind of faux stoicism.

However, when we face a shock or unbearable pain, there is no need to pretend that everything is fine. We should openly admit that we are having problems, and people should respond by saying, "We know, it must be really hard for you right now." People should help others and stick with them until their tears are dry.

If I think about it that's exactly what we have done naturally in the past.

It's not bad to encourage a grieving person by saying things like "Chin up!" However, at times we can also say, "It's OK to feel down."

We should also all acknowledge our own feelings and honestly say that we are not happy when we aren't. I believe this is the first step in grief care. (By Rika Kayama, psychiatrist)

Click here for the original Japanese story

(Mainichi Japan) February 5, 2012