Developing culture-specific ‘systemic-psychodynamic’ models instead of PTSD
Published on June 11, 2011 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0
My friend and colleague Naoto Kawabata is a Japanese psychologist doing relief work with families who have been traumatized by the disaster at Fukushima in Japan. Naoto is the Founder and President of the Kyoto Institute of Psychoanalysis and Psychotherapy (KIPP) and Professor of Psychology at Kyoto Bunkyo University.
I met Naoto when he came to New York City to study advanced psychotherapy and psychoanalysis at the William Alanson White Institute where I teach and supervise.
When I taught seminars in Interpersonal Psychoanalysis in Japan Naoto hosted my visit and I got to know his wife, Yoshiko, and his daughter, Shiho.
Naoto was a first responder at the earthquake in Kobe in 1995 and this experience affected him profoundly. As a result of his work in Kobe, Naoto, who is a brilliant thinker, questioned whether and how western theories of trauma treatment can be translatable for Japanese trauma victims.
I was not surprised to find out that Naoto is now at the front lines working with families traumatized by the Fukushima disaster. Naoto agreed to let me interview him (via email) about his experiences there.
Naoto, how were you called to the Fukushima disaster?
The Board of Education of Kyoto prefecture asked the Kyoto Association of Clinical Psychologists to recommend psychologists for a support team to travel to the Fukushima area and work with the teachers and children. Many of the children of Fukushima have been evacuated to the Aizu district which was saved from contamination because it is surrounded by high mountains.
I already had a fair amount of experience with disaster because I worked in Kobe after the earthquake 16 years ago. But this time we had more complex factors than in Kobe: in addition to the earthquake and tsunami we have the nuclear power plant accident of Fukushima. Despite the strong wish to help, I was frozen with fear of the radioactivity. However, I overcame my fear and volunteered to become a member of the first team.
What is the first thing that struck you about the disaster when you arrived?
The first thing that struck me was the normalcy of the town. I realized I had overestimated the immediate impact of the accident because there was no visible damage or abnormality in people’s lives. But in one of the towns I visited, the radiation level was 3 times higher than normal and in another town it was 10 times higher than in the first town. Then I realized that I had underestimated the risk of radiation.
I never imagined that Fukushima was such an attractive place. It is a beautiful pastoral landscape of mountains and villages with various kinds of farm animals and products raised with loving care. The spirit of these people cultivated through its long history, touched my heart deeply.
Now this wonderful place is feared and avoided for risk of radiation exposure. How can we understand the agony of the people who are forced to desert their ancestral homes?
What did you do there?
There were three towns where we mainly worked: Aizu-Wakamatsu, Aizu-Bange and Inawashiro. Many people from Fukushima were evacuated to these towns. Besides working in the schools we visited shelters and interviewed evacuees. We found that the stress level in the shelters was very high. The situation is very hard because grandparents, parents and children are living in one small room together. Old people who lost their routine work and chores just lie down the whole day and are very depressed. They have no idea bout how long they will have to stay there. We recommended organizing some recreation activity there the next team put that plan into place.
What is the biggest mental health challenge facing the people of Fukushima?
There are numerous challenges: Fear of exposure to radiation, Anger against TEPCO and the Japanese government, uncertainty about the future, sadness of having to desert their land, jobs and community.
What approach are you using to help?
I have strong opinions about what kind of psychological aid is helpful in this kind of catastrophic disasters. I have found that the Post Traumatic Stress Disorder (PTSD) model does not fit this situation– I am developing a different model, which call the “systemic-psychodynamic” model of disaster aid.
The PTSD model is too simplistic to help in a disaster situation like Fukushima. Of course, there are some people who survived the horrible earthquake or tsunami but most adults and children in the disaster zone did not necessarily go through this. The stress they suffer is more complicated. For example, after the disaster, parents are working so hard they cannot watch their children carefully. Some families are having strong conflicts between parents and grandparents, because they have to live together in the small space of the shelter. Each individual has his/her own circumstances, and it is different from person to person. In general, the problems arise in the same spot which had been a weak spot before the disaster. Thus, the problem after the disaster is an amplified condition of the systemic weakness. That is why the most effective aid is to try to recover the system, and support people from their own backyard.
Sixteen years ago after the Kobe earthquake, American crisis response teams came to Japan and taught us various intervention techniques, such as letting victims talk, or letting children draw pictures about the trauma. Many volunteer groups were hastily made up and began to visit shelters and volunteers asked people to tell them their experiences. The groups were eager to look for “PTSD candidates” but the vast majority of people were fine. If they found a good “PTSD candidate” he/she was probably someone who had been anxious even before the earthquake. It was peculiar for the people in the shelters, as it was for me, to see these different groups, coming and going, each asking the same questions.
The situation in Fukushima is even more complex. Most children evacuated from their home town are now living in shelters in a different city. At the same time that they have been victimized by the electric companies, 70% of there parents are still working for Fukushima nuclear plant and many of them hope to continue to work for the plant even after the disaster. Of course, there are parents who are furious at TEPCO. How are the teachers supposed to explain the disaster to children? This is not a question we can easily answer.
We need psychologists who will think together with parents, teachers, and children in Fukushima from a systemic and psychodynamic point of view and to work with the community on a long-term basis. First we must establish a relationship with the community; then we have to find out from the victims what they need and offer help if it is available or come up with some other ideas to resolve their most urgent problems if immediate help is not available. By making contact with people in the community there is a chance to talk to people in depth and ask about their experience of the disaster. After establishing a relationship, we can propose interventions such as screening tests, individual counseling, group counseling or organizational consultation-whatever is needed. But we have to be careful not to be intrusive. Very often it works better to provide supervision and consultation for staff who are already working in the community. The goal is to help the system to recover and the raise the level of mindfulness.
Has your psychoanalytic training been useful in helping the victims of this disaster?
My psychoanalytic training has been very important in allowing me to put this type of intervention into action — we need very long-term perspective and must work together with the communities. This painstaking endeavor is similar to intensive psychotherapy. The psychodynamic way of thinking, particularly the interpersonal approach which includes the systemic point of view, is useful for seeing the ways problems manifest themselves among individuals and within communities and organizations. We face people’s transferences and our own countertransferences and these can become very powerful and complicated. My psychoanalytic training has been helpful in understanding these interactions
Describe some of your countertransference reactions.
Overestimation of immediate impact of the disaster and underestimation of risk is one of them. Fear of radiation, anger toward the electric companies and the Japanese government and scientists who just say on television and in the media “there is no danger”. I have fantasies to be a savior and to become an activist. I have competitive feelings toward other groups who are trying to help and I’ve developed a strong attachment to the land of Fukushima and the fantasy to become a resident of Fukushima. In addition to these, I think that the desire to know what is going on at the site of the disaster is my most characteristic countertransference.
What are you doing to protect yourself from radiation?
Almost nothing. I bought masks, but have hardly worn them.
What are you doing to protect yourself from the psychological/emotional stress of working in Fukushima?
I have a discussion group at my institute in Kyoto (KIPP). It has been very important for me to have a place where I can discuss my feelings with other clinicians. Spending time with my family is also very important. Gathering information from the internet is very helpful, but exhausting-I have mixed feelings about this.
How does your family feel about the work you are doing? Are they with you?
My wife, Yoshiko was very against the idea of going to the disaster zone first. My daughter, Shiho, was too. They called me stupid!!! But gradually they gave up, and finally became supportive. Yoshiko and Shiho did not go with me but I think a 50-year old man is old enough to be safe with radiation.
I hope you are right about that, Naoto!
Is there anything the people in the US, particularly psychologists can do to help the people of Fukushima?
Fukushima is very serious problem for everyone in the world. The contamination will affect the entire Pacific Ocean. The nuclear energy problem is really global issues. I hope psychologists in the US will think about this with us. I am in the process of setting up a blog site where US psychologists can contribute information. Economic aid is also very important.