Some Japanese friends told us a story that is making the rounds through the grapevine about a Fukushima farmer who killed himself when he learned that he had to destroy his crop of radioactive cabbage. This grapevine story appeared in the Los Angeles Times today in a story titled "Japan fears post-quake rise in suicides."
The story addresses the concerns behind our attempts to get people to start thinking beyond urgent care toward emergent care. Last week, I took Fielding Graduate University Professor of Social Psychology Dr. David Willis to visit social workers, mental health professionals, and academics in the disaster areas to explore how we might bring in a team of international post-disaster trauma care experts to local communities that were traumatized by disaster. Trauma care and suicide prevention seem like increasingly urgent and obvious needs; but, as my Japanese friends might say when they recognize the impossibility of explaining to "gaijin" the intricacies of Japanese society and the hurdles of Japanese bureaucracy: "It is just difficult." Difficult or not, we can still consider what we might do to fill a life-sucking void that others don't seem to see.
The media and government tend to focus only on the quantifiable loss of life, property, and economy. However, we cannot comprehend the scope of disaster until we also consider the long-term impact on qualitative factors like culture, heritage, and psychology. Otherwise, the only quantifiable number the government may be able to comprehend is escalating suicide rates; by then, any response is too late.
Some seem to partially understand the importance of providing trauma care for survivors. For example, Aomori Prefecture established a trauma care program for elderly survivors in an area that had major damage to the local economic infrastructure (1). Three people lost their lives in the area, but thousands lost their livelihoods when tsunamis wiped out entire industries. The prefecture formed a small group of social workers into a trauma care task force. Daily, members of the task force visit at-risk survivors who have shuttered themselves from the world. Such a program would show forward thinking, except that the members of the small task force do not have training to provide such support, are also suffering trauma from losing loved ones in the initial stages of the disaster, are overwhelmed by the challenges of a task for which they have little qualification, and were given only one month to complete their project. The project is scheduled to end this week, just as the risk of post-disaster trauma starts to emerge. The program offers a nice sentiment, but the lack of experience, time, and resources demonstrate little concern at the government level for the emerging needs of survivors.
In Iwate Prefecture, an area that suffered major loss of life, property and heritage, dedicated mental health professionals have immersed themselves in caring for survivors. Dr. Otsuka, a suicide prevention specialist, told us that mental health professionals are continuously frustrated in their efforts because the locals don't trust outsiders, even if they are Japanese. In other words, even those experienced professionals who are willing to give their personal time and resources are being turned away by local country folk who distrust anyone who is not part of their community.
In short, the dilemma is this: on one hand we have governments that seem to lack the desire, ability, and resources to provide needed care; on the other hand, we have rustic locals who are not willing to accept help from anyone that they consider to be an outsider. The initial response to this dilemma seems to be "shikataganai", meaning: it's not my problem; even if it were, there is nothing we can do about it so let's leave it alone and go about our own business. This seems to be the response of most. However, working in these communities helps to illuminate a third option: Teach locals how to provide trauma support to one another--and do it quickly. This requires finding the embedded locals who are not only able to learn from outsiders but who also have the ability to teach locals the basic skill sets to treat one another.
Building a local, self-perpetuating trauma care program is particularly important because any program that is dependent on outside care givers will end the moment the outsiders leave. A locally-administered mutual support program would also help to reduce the damage do-gooders tend to do by showing up to help, administering care that makes them feel good, then leaving to find someone else to help--leaving things worse than they were before they arrived. Another key benefit of teaching locals how to provide mutual support is that alleviating the suffering of others can be therapeutic for one who is suffering. Those who are in the most need may be most effective at and helped by administering to others.
Although volunteerism seems to be a fundamental disaster response for Americans, it has not been part of traditional Japanese society. Akiko, a single office worker in her mid-30's expressed a common sentiment among many Japanese: "We always want to do something, but we don't know how; we don't have a way to volunteer." Though this is still mostly the case, it started to change when thousands of international volunteers arrived to help after the 1995 Kobe earthquake. In a society that had neither infrastructure nor precedence for accommodating volunteer activities, the global do-gooders taxed an already stressed system. Since then, the Japanese have borrowed Western models to form their own volunteer infrastructures, which are now organizing volunteers from around the nation to assist with recovery efforts.
The Kobe quake became the catalyst for establishing volunteer infrastures, and the victims and survivors of the Great Tohoku quake and Tsunami are becoming the benefactors of that change. Aiko, a 65 year old women wearing a yellow blazer stamped with "Volunteer" on the shoulder, explained to me why she volunteered to help her neighbors, even after she had lost her home, family members, and friends when tsunamis ravaged her neighborhood. "Without volunteering, I don't know what I would do." Volunteering to help others is the only way she can escape from the shelter and deal with her losses. Otherwise, there would be neither purpose nor hope.
Fueko Haduki, a professor of Environmental Chemistry at Hirosaki University explained to me how important volunteerism can be for people who are not directly affected by disaster. Although she lived in an area that was not directly affected by the disaster, she volunteered to help with a recovery project for herself because the disaster made her feel "uneasy, helpless, and guilt" to the point that she could not enjoy life. "I can donate some money and save some energy but that's all." As a volunteer, she said she could only do "small work like cleaning, but it had a large impact on my mental health." As a result she can "think positive" and dedicate herself to use her skills for conducting research on cesium pollution in Fukushima.
This emerging volunteer spirit could be an an important source of energy for developing locally-administered trauma support programs. As suggested by Professor Haduki, getting dirty to clean up can be therapuetic in the short-term, but developing long-term resilience may require that we help people channel existing or newly-acquired skills to provide higher-order support to one another for their own sakes. This means learning how transcend self through service to others.
Churches might be obvious starting points for building self-perpetuating trauma support in communities because they consist of locals who have a belief system rooted in self sacrifice for others, including strangers. Limitations of going through the churches is the tendency of some to exploit tragedy for their own gain (2), and that local congregations can be seen as isolated outsiders within the larger community. However, a congregation of people willing to selflessly administer sans preaching could be a strong starting point for forming a grassroots, self-perpetuating trauma care program. Schools seem to be another obvious outlet for a community-based program. They are well entrenched, trusted, and have established programs into which a trauma "first aid" program could fill a needed void. More importantly, schools could have opinion leaders who can bridge outside knowledge with inside culture. Of course, getting the sponsorship of local governments would also be a major boost to building a community-based trauma care program, especially since Japanese tend to expect their government to be a first line of support in times of disaster.
Of course, just meandering at this point with nothing solid, except for the emerging needs. But, if we are to influence change, I believe we must use existing practice and infrastructure within the established culture. That means teaching locals how to administer to one another, not imposing programs, practice, and morals as outsiders.
(1) I am not able to mention the name of this area here at this time.
(2) With apologies to the true believers. I understand that salvation may be the ultimate help we can offer; but, hope that true believers can recognize the value of preaching through works not words. Practicing belief by serving God by serving others without hope of gain for self or congregation is how to bring comfort and grace at this time. Save the pulpit for later. IMHO.