Illness, Mental Problems on Rise After Kobe Quake

After a week of unrelenting stress, Takashi Nakanishi, the official faced with the monstrous problem of restoring Kobe’s water-supply system shattered by the earthquake, decided to end it. He jumped out the fourth-floor window of his office building in an apparent suicide this week.

In the crammed and chilly relief centers around this devastated city, cracks are beginning to show in the remarkable stoicism and endurance of the Japanese people. Many of them, coughing and sniffling with colds or flu, which have begun to sweep through the centers, bitterly complain about official inaction and their grim living conditions.

“We can’t take a bath, the food is unsatisfactory, and there’s no privacy,” complained Yoshiaki Saito, 45, an evacuee stuffed into a small classroom with his family of five at the Uozaki Elementary School. “Japanese people are known for their endurance, but if this keeps up . . . there is going to be an explosion.”

As the aftermath of Japan’s worst earthquake disaster in more than 70 years entered its second week, officials have managed to get through the initial trauma of mass death and injury, widespread shortages of medical staff and supplies, and hospitals disabled by the quake damage.

The severely wounded are now being transported by helicopter or ambulance to hospitals in Osaka and other nearby undamaged areas. Supplies and medical volunteers are pouring into Kobe from around the world, although distributing goods evenly remains a problem and some camps still report shortages.

But now the health problems have begun to enter a new phase. Officials worry that a health crisis may break out.

Perhaps more ominous in the long term, however, are the mounting mental health problems. Victims are beginning to show anger, depression and other signs of mental trauma common to disaster victims around the world--but Japan is virtually unprepared to deal with them, experts here say.

“After the first phase, the issues shift to mental. But in Japan, there is hardly any psychiatric training aimed at disaster victims,” said Masaaki Noda, a psychiatrist at Kyoto Creative Arts College who worked with victims in calamities including the Hokkaido earthquake last year, which was followed by a deadly tsunami, or tidal wave.

There is deep social resistance to the very idea of therapy. “In Japan, people who see psychologists are viewed as crazy,” said Takayoshi Miyazaki, a psychiatrist who has begun working with Kobe quake victims in the heavily hit Nagata section of town.

A report to the World Health Organization this week on the Kobe disaster identified only four people in Japan with the skills for trauma counseling--all of them foreigners, said David Tharp, a mental-health consultant and medical journalist who has lived in Japan for 15 years and worked with Vietnam veterans and trauma victims.

Tharp said the importance the Japanese ascribe to social homogeneity has helped stunt the development of counseling services.

“When a Japanese goes to a psychologist or psychiatrist, members of the group see that person as different, defective or weak, and this weakness is not acceptable,” he said. “It is an embarrassment or shame not to be perfect like everyone else.”

Tharp said officials should consider setting up counseling centers in the relief camps, or at storefronts around the city to make the services readily available. Such walk-in services were extensively used to aid Vietnam veterans, he said.

Experts say that the Kobe victims are struggling with acute shock that goes beyond the calamity of losing their homes and being thrown into lives of grim subsistence at relief centers with no running water or heat, where the day’s biggest activity is to line up for meager meals of rice or bread.

They are also reeling from the shock of seeing two deep-rooted beliefs shattered: that an earthquake would never occur in the Kobe area and that the government authorities Japanese tend to heavily depend upon would take care of them.

Resentment toward authorities is on the verge of boiling over in many areas. As reporters crouch on blankets in a shelter to talk to one family about their plans, Hirokazu Matsushita impatiently breaks into the circle.

“What I want to say is that the Japanese government is fifth-rate!” he fumes. “Tell that to everyone!”

If the experiences of quake victims in Northridge, Hokkaido and other areas are any guide, the Kobe victims face a long road to recovery that is likely to include bouts of depression. Unless treated, the trauma and stress could lead to divorce, alcoholism, job problems and other destructive behavior, said psychiatrist Noda.

Yet Japanese relief efforts tend to focus on meeting only the material needs of victims, he said.

“The evacuation sites are like concentration camps, with victims in a powerless position,” he said. “It is necessary to have relief actions that will not take away the independence or individuality of victims. Otherwise they will become people who are simply dependent on others to give them things.”

For now, however, health officials say they have no time to plan such services because they are overwhelmed by more immediate problems: overflowing toilets, rotting corpses and fears that colds and flu could progress to pneumonia.

Many of the evacuees are also losing strength from lack of sleep in the cold centers, where lights stay on all night, and from the meager fare, health officials say.

At one medical center set up on the playground of a Kobe elementary school in the Nagata district, Kensei Yamaguchi, a Self-Defense Forces doctor, said most of his patients have come in with colds and flu.

Although the center now has running water, easing a major fear of contamination from filthy toilets, he said the inability to separate flu patients from others in the mass facility could spark bigger problems.

“Pneumonia is a worry, but so far we haven’t seen too much of it,” he said.

Kensuke Morimoto, Kobe’s harried health division chief, said centers are particularly short of medicines for diabetes and other diseases.

Researcher Chiaki Kitada of The Times’ Tokyo Bureau contributed to this report.

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