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

 

World Experts Urge UN to Take Up Mental Health

The UN General Assembly should devote a special session to the matter of MNS disorders, global health experts said (AFP/File, Don Emmert

World experts urge UN to take up mental health

(AFP) – 4 days ago  

WASHINGTON — Mental illness and drug abuse can wreak havoc in global societies and economies, and the UN General Assembly should devote a special session to the matter, global health experts said on Tuesday.

Every country in the world is affected by the burden of mental, neurological and substance use (MNS) disorders, but often sufferers face discrimination and human rights abuse, said the article in PLoS Medicine.

"The time has come for recognition at the highest levels of global development, namely the UN General Assembly, of the urgent need for a global strategy to address the global burden of MNS disorders," said the article.

Lead authors were Vikram Patel from the London School of Hygiene and Tropical Medicine and Judith Bass from Johns Hopkins School of Public Health in the United States.

Investment is needed in three key areas, they argued: expanding knowledge about mental health disorders, better access to evidence-based programs of care and treatment, and protection of human rights.

A list of key needs to be addressed and steps to take could be enshrined in a "People's Charter for Mental Health" accounting for input from policy makers, families, researchers and other advocates.

The article said neuropsychiatric disorders will account for the loss of some $16.1 trillion US dollars globally over the next two decades, with "dramatic impacts on productivity and quality of life," particularly as the population ages.

About 25 million people have dementia worldwide, a number set to skyrocket to 80 million by 2040, with close to three quarters of dementia patients concentrated in low and middle income countries.

Meanwhile, suicide claims at least one million lives per year and nearly four percent of all deaths around the world are attributable to alcohol.

Mental illness can also boost risky behaviors that result in disease.

"Depressive disorders markedly increase the risk for noncommunicable diseases such as diabetes, coronary artery disease, stroke, and dementia," said the article.

"Conflict, displacement, poverty, gender-based violence, and other social determinants of ill health increase the risk for MNS disorders," it added.

"MNS disorders are, in turn, associated with worsening of social and economic circumstances, setting up a vicious cycle of poverty and illness."

A majority of world governments would have to agree that the issue is important enough that it deserves a special session at the UN General Assembly.

"The fact that MNS disorders affect people in all countries should offer considerable incentive for investments by both public and private sectors in this initiative," the authors wrote.

Copyright © 2012 AFP. All rights reserved. More »

Futaba-Okuma Deadzone: Unsafe to Human Life for at least 50 years

2 towns at risk of disappearing / Okuma, Futaba face uncertain future due to nearby crippled N-plant

Yasushi Kaneko / Yomiuri Shimbun Staff Writer

How will the government help the estimated 25,000 people who lived in areas where residency likely will be prohibited for an extended period due to the crisis at the Fukushima No. 1 nuclear power plant?

In particular, Okuma and Futaba towns in Fukushima Prefecture will face extreme hardship because most of their residential areas fall in those areas. The crippled nuclear plant is located in the two towns.

It will be extremely difficult for the municipal governments to restore the towns to their conditions before the disaster. The central government will need to consider providing assistance to the evacuees so they can lead self-reliant lives.

The Education, Culture, Sports, Science and Technology Ministry detected many spots in the two towns where annual levels of exposure to radiation would be 100 millisieverts or higher. This is at least five times higher than the level deemed safe for human habitation.

The ministry measured radiation levels one meter above the ground and monitored the radioactive contamination of soil.

The ministry has regularly measured radiation levels using vehicles and planes in affected prefectures--mainly Fukushima Prefecture but also including Tokyo--with cooperation from local governments.

Air radiation levels were measured at about 3,000 spots in the no-entry zone around the nuclear plant and planned evacuation areas as of Dec. 11. Of them, annual radiation levels of 50 millisieverts or higher were estimated at about 700 spots. These sites likely will be designated as zones where residency is prohibited for an extended period.

According to Japan Atomic Energy Agency calculations, it would take more than 50 years for radiation levels at the sites to naturally fall below the safe limit of 20 millisieverts.

Environment Minister Goshi Hosono has said it will be "difficult to lower air radiation levels with conventional decontamination methods" in areas where annual levels are 50 millisieverts or higher. Residing in these areas will be forbidden for an extended period.

The government has only said "it will likely take at least five years" until residents can shift back to these areas. The government has not specified after how many years residents can return--or even if they actually will be able to live there again.

A survey by Fukushima University found that about 60 percent of residents of the two towns wish to return. Many of the evacuees said they cannot make any concrete plans for the future until it becomes clear whether they will be able to return to the towns.

The government needs to properly explain the current conditions in the towns--and the likely fate of the municipalities--to the evacuees.

Government assistance to evacuees mainly comprises measures that assume they will return home, such as construction of temporary housing units in which they can live for two years in principle.

From now, it will be necessary to consider helping evacuees resettle elsewhere by offering assistance in such fields as employment and education, and helping them fit in and form local communities.

The government should present such measures as soon as possible.

Meanwhile, Futaba Mayor Katsutaka Idogawa has suggested his town might need to move elsewhere.

"I'll have to ask for a temporary site to which our town will be relocated," he said to reporters.

Okuma and Futaba might have to consider merging with neighboring municipalities to which some residents will move, if the locals consent to such a tieup.

(Jan. 9, 2012)

 

http://www.yomiuri.co.jp/dy/national/T120108003576.htm

Suicide

Thursday, Jan. 12, 2012

Suicides top 30,000 for 14th straight year

2011 figure lowest since annual tally hit mark in 1998

By MIZUHO AOKI

Staff writer

2011 appears to be the 14th straight year for the annual suicide count to exceed 30,000, according to tentative statistics recently released by the National Police Agency.

 

The latest 2011 figure — 30,513 — however, was the lowest number since the annual suicide count topped the 30,000 mark in 1998, declining from 31,690 in 2010. Males accounted for 20,867 of the 2011 suicides, or 68 percent, the data show.

By prefecture, Tokyo had the most suicides, at 3,100, followed by Osaka with 1,899 and Kanagawa with 1,824.

An NPA official said a further statistical breakdown, including ages, occupations and other details of the victims, will be released sometime later this year.

"Although the total number declined, it is still a very serious situation to have over 30,000 people a year committing suicide," Yasuyuki Shimizu, director of the Tokyo-based nonprofit suicide prevention group Lifelink, told The Japan Times Wednesday.

The statistics show declines in annual suicide counts in Miyagi, Iwate and Fukushima prefectures, which were devastated in the March 11 disasters. But Shimizu said optimism about the results may be short-lived, because suicides tend to increase in devastated areas after a year or so, as was the case in the wake of the Great Hanshin Earthquake of 1995.

As reality sets in, people are forced to confront their losses, and some may suffer greatly to the extent that they commit suicide, Shimizu said.

According to a different survey by the Cabinet Office, as of November 49 people in the three prefectures committed suicide for reasons related to the March 11 disaster. Considering past studies, continuous support is crucial, Shimizu stressed.

The data also show that unlike the past three years in which the highest monthly suicide count was marked in March — which is the end of the business year for many corporations — last year saw the level peak in May.

Shimizu, who analyzed the unusual spike in May, said the jump may be related to the media's sensationalized reporting on the May 12 suicide of TV celebrity Miyu Uehara. Daily suicide tallies increased sharply for 10 days starting May 13, Shimizu said.

"Those who committed suicide in this period were mostly women in their 20s and 30s. . . . The media's excessive reporting may have triggered" this phenomenon, Shimizu said.

To prevent suicides, Shimizu said consultations to help people meet multiple needs, including debts and employment, are necessary.

"From our survey, we know that, on average, there are four reasons why people commit suicide," he said. "So by providing consultations to meet such multiple needs, I believe (we can) help people who feel cornered choose a path to live."

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Care Providers

Disaster’s Scope Impeded Psychiatrists’

Best-Laid Plans

Aaron Levin

Japanese psychiatrists recount the multilayered story of challenges facing mental health care providers following last spring’s devastating earthquake and tsunami.

The Great Eastern Japan Earthquake on March 11, 2011, along with the ensuing tsunami and the subsequent explosions at three nuclear power reactors at Fukushima, left much physical and human damage in their wake, reported Japanese psychiatrists at the annual meeting of the International Society for Traumatic Stress Studies in Baltimore last November.

More than 15,000 people died, nearly 6,000 were injured, and 3,700 remain missing.

Jun Shigemura, M.D.

 

The disaster workers who responded to the scene, and who continued working in the area for many months afterward, were among the hardest-hit groups, said Jun Shigemura, M.D., Ph.D., of the National Defense Medical College in Tokorozawa, Japan.

“Disaster workers were not only exposed to traumatic events but had heavy workloads and bore high expectations from the rest of Japanese society,” said Shigemura, listing a number of affected groups: police, military forces, firefighters, coast-guard personnel, nuclear-plant employees, civilian government officials, construction workers, and-medical and dental professionals.

Many recovered bodies were held pending identification in temporary morgues. Shigemura described meetings with mortuary workers responsible for 500 unidentified bodies in a single warehouse. He sought to destigmatize the workers’ acute responses to the tragedy and to handling the resulting bodies, and he helped supervisors understand the stresses borne by these workers.

Nuclear-plant workers were under particular stress, he said. They worked six days on and three days off and often slept in the plants wearing their protective clothing. Many had already come close to death, having survived the tsunami, the explosion, and the release of radiation. Some had lost coworkers, family members, and homes and were additionally burdened by public criticism and guilt for being among the perpetrators of the nuclear part of the disaster.

Radiation Complicated Response

National health authorities will need to allocate additional resources to counteract this increased stress and higher prevalence of mental health disorders among the disaster responders, said Shigemura.

The radiological dimension of the disaster added to the complexity of the response, said Yoshiharu Kim, M.D., Ph.D., of the National Center for Neurology and Psychiatry in Tokyo.

“Anxiety about radiation can develop independently of actual pollution,” he said. “So the scientific idea of ‘safety’ is different from the psychological sense of ‘security.’ ”

As a result, it is important for health authorities to integrate psychosocial support with provision of information about radiation well beyond the known geographic limits of increased radioactivity, he pointed out.

Lessons Learned From Prior Disaster

As bad as the disaster was, the mental health response might have been worse had it not been for the lessons learned from a previous massive earthquake that struck the city of Kobe in January 1995, said Hiroshi Kato, M.D., Ph.D., of the Hyogo Institute for Traumatic Stress in Kobe.

Workers in protective suits and masks wait to enter the emergency operation center at the crippled Fukushima Dai-ichi nuclear power station in Okuma, Japan, last November.

Credit: AP Photo/David Guttenfelder, Pool

“Before the Kobe quake, the suffering of survivors was overlooked because people were habituated to disasters and bore them with silence, avoidance, and patience,” said Kato. “ ‘Gaman’—endurance—is a very important attitude in Japan.”

The nation was better prepared to offer mental health support for survivors after the March earthquake, but was handicapped by the sheer scope of the damage, said Kato. “Many survivors lost family members, and people couldn’t put their lives back together because the loss of infrastructure destroyed their livelihoods as well.”

The mental health response system developed after Kobe depended on public-health nurses providing outreach, since they were already close to local people and thus were able to reduce the stigma some people felt about seeing higher-level mental health professionals.

After the 2011 disaster, however, regional health centers were evacuated or severely damaged, said Kato. In addition, many health workers were among the disaster’s victims. Thus, increasing the mental health workforce on such short notice was difficult. Long-term funding was allocated for more mental health workers, but there were not enough professionals available for the short term.