Slightly built and soft-spoken, at first glance, Dr. Suimei Morikawa does not appear a likely candidate to carry hope to a place that hasn’t much of it. Yet that’s exactly what he’s doing for Otsuchi, an Iwate Prefecture town among the most devastated places struck by the March 11 disasters.
Morikawa raced to Otsuchi within days of the 9.0 magnitude earthquake and 10-meter tsunami that wiped out 90% of the town and claimed the lives of more than 10% of its population of about 15,000, including every member of the local government ranked section chief or higher.
The doctor, who works at the disaster zone on a voluntary basis under the auspices of the humanitarian aid organization Medecins du Monde Japon (MDMJ), or Doctors of the World Japan, says that five months after the disasters, there are signs that the neediest of Otsuchi’s disaster victims are in danger of being left behind in the effort to recover.
“There is a big difference between the people I first met and the people I am treating now,” Morikawa said. “Initially, everybody was in the same situation. They had lost something, families, homes. People were in a severe state, and that created a bond and they supported each other.”
He added that some people who were better off materially or psychologically or who had lots of relatives, managed to break out of that tough situation and recover. At one point, everyone had been in the same situation, but now it has changed so that people are being left behind, and they feel deserted.
“People shouldn’t think there’s no need to provide support,” Morikawa said. “There are many people whose recovery could take 3, 5, 10 years.”
The doctor now splits his time between Tohoku and Tokyo. However, from March 29 until mid-May, he was in Otsuchi on a daily basis. Despite Japan having about 320,000 mental health hospital beds–more than any other country on earth–Morikawa said it is estimated that only 1 in 5 patients actually seeks treatment for mental illness.
Supporting the mental health of disaster victims
He pointed out that Japan has the world’s sixth highest suicide rate, with more than 30,000 taking their own lives annually over the past 12 years. If attitudes toward mental health are less than encouraging nationally, they are even worse in Otsuchi.
“Otsuchi didn’t even have a mental health clinic before the disasters,” Morikawa said, who is also an acupuncturist and occasionally uses that skill to open the hearts and minds of the disaster victims. “Initially, I could feel a strong sense of prejudice and ignorance regarding mental health care. That remains to a large extent, but the people have learned that mental health care is not frightening, but a place where they can talk when they’re feeling bad, and they’re not going to be treated like they’re crazy.”
He noted that everyone still talks about it that way, but those who have been treated have changed their tune. Some even encourage others to come and talk to him.
Nonetheless, the doctor and other medical professionals working in Otsuchi in the wake of the disasters continue facing a Herculean task. Mental health falls low on the list of priorities for Otsuchi’s disaster victims. Their prime priorities are food, clothing, shelter, and physical health: next things like jobs take precedence. It’s only then that mental health comes into play, according to Morikawa.
Demand for mental health care will increase from now on and Morikawa dismisses the widely held notion that people from the Tohoku region have a grin-and-bear-it attitude toward adversity.
“Uncomplaining only tells part of the story,” he said. “It’s more a matter of not being able to say what you think, or not knowing how to say it. People are fairly strict with each other, so it’s difficult to say some things to others, so thoughts have to be concealed. Tohoku originally had that kind of culture. Rather than perseverant, people were more scared.”
He says they are afraid to have things about them revealed and they fear being rejected. It has never been a wealthy area, so making something of oneself in one’s own strength has always been a difficult proposition, which means people are worried that their weaknesses will become troublesome for others.
“They are anxious because the moment they cause trouble for others they will be rejected,” Morikawa said. “I’ve seen many instances of this. Half the tiredness caused in the disaster area stems from relationships with others. There has been almost no example of perseverance being shown.”
According to Morikawa, being unable to say anything creates pain that either drives people to choose alcohol as a balm, or ultimately commit suicide. “And in Otsuchi, there was no clinic to rely on, so the only thing people could rely on was alcohol.”
Alcohol and isolation loom as major obstacles for the residents’ recovery. Special alcoholism treatment teams led by Dr. Susumu Higashi from Kurihama National Hospital, Japan’s foremost center for alcohol dependence rehabilitation, are working in Iwate prefecture. Reports indicate that alcohol abuse is on the rise in the disaster areas and the doctor fears this may happen in Otsuchi as well.
“There are absolutely no social controls on alcohol,” he said. “However, anyone doing something strange under the effects of alcohol, or those who show symptoms of alcohol dependence are strongly rejected by society.”
Morikawa said efforts are being made to help victims avoid becoming isolated. MDMJ aims to help those it aids to gain, or regain, their independence, and does so by supporting local organizations in the places where it works. It helps public health officials who patrol homes to check up on people and passes out information to those who look as though they will likely be left alone.
Morikawa said that maintaining a reason to live is crucial in treating disaster victims.
“There are some who have lost all their families and use this as motivation for living, saying that they’ve got to do so on behalf of those who were lost. They throw themselves into living. On the other hand, when people realize they’re alone, even if they have family members, there’s little you can do once they start to question the reason why they’re alive,” he said.
Confronted with death, disaster and devastation has not been easy for Morikawa, whose position is made even more difficult because empathy with patients is so vital in providing them with treatment. At times, it’s even been too much.
“I was there daily until the middle of May, and I didn’t realize it at the time, but I would remember something somebody had told me and suddenly burst into tears,” he says. “I didn’t realize myself that I was experiencing a psychogenic reaction at the time. As I’m a specialist, I realized that I needed to do something or I wouldn’t be able to listen to what people had to say, so I had to make sure I regularly got time away from the disaster zone. I totally stopped thinking and just listened to music.”
At his very worst, Morikawa just sat in his room and did nothing but listen to music for a day or two. Now, he spends half his time in the disaster zone and half his time in Tokyo. When he’s in Otsuchi he concentrates fully on what is happening, but back in Tokyo he tries to put the disaster zone out of his mind.
Morikawa is using some of what worked for him to try to alleviate the difficulties being felt by those recovering from the disaster in Otsuchi.
“People can’t get away from the devastation,” he said. “It’s there in front of them their every waking moment. This brings back memories of the disaster. I don’t know whether this is a symptom of Post-Traumatic Stress Disorder (PTSD) or because of the situation they’re in. Many of the people I am still treating now are showing the symptoms of PTSD.”
Morikawa noted that the problem with recovery is that people have to confront the disaster zone daily, so he and his team encourage people to get away if they can, which can help aid their recovery.