On June 18th, I was able to receive the chance to meet with Professor Motoaki Sugiura of the Department of Human Brain Science at Tohoku University.

I learned about his research, which partially focuses on how to instill the eight characteristics associated with survival in disasters in people: leadership, problem solving, altruism, stubbornness, etiquette, emotional regulation, and self-transcendence. Currently, it seems his lab is focusing on leadership, problem solving, and emotional regulation.

Professor Sugiura, when discussing how these values can be taught in schools, commented that Japanese education tends to focus on finding a single correct answer, which is not very applicable to real life situations. As a result, he and his colleagues have been developing methods to try and teach children to think more creatively.

He also told me about some of the difficulties of his research. Finding the neural mechanisms behind the eight traits can be very challenging. While it would be ideal to simulate a disaster while a subject is in an MRI, this brings up questions of what a disaster is and how you can simulate one. Similarly, differentiating the traits from other, similar traits can be troublesome (i.e. what is stubbornness vs. what is grit?). Other measures should in theory be easy to study, but are difficult to operationalize (e.g. self-transcendence?how does one measure the degree to which someone is doing things they should?).

Of the eight traits, the one that is most well-known is leadership, which also contains social capital. Professor Sugiura is also currently looking at the differences between people who can spontaneously emotionally regulate and those who cannot. He is also looking at the relationship between exposure to negative stimuli and emotion regulation. So far, he has found that the sensory cortex seems to suppress sensing negative emotions. Because these skills are not by nature related to disasters, they are being studied separately in a wide variety of contexts.

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On June 24th, I was also able to meet with Professor Hiroaki Tomita of the Department of Disaster Psychiatry in IRIDeS. He informed me of his research projects surrounding mental health of survivors of the earthquake. Before we got into talking about the 3/11 disaster, we briefly discussed stigmas surrounding mental health.

Professor Tomita’s main location for disaster field research is Shichigahama, a coastal town in Miyagi Prefecture. He informs me that the main sources of disaster stress are loss (namely in the loss of relatives and other loved ones, but also including the loss of property and the destruction of natural sites), social changes (e.g. having to move to temporary or public housing, especially for those who have lived in a single location their entire lives), and economic changes (losing or changing jobs/schools). This disaster stress can have negative effects on one’s body and health whether they’re aware of it or not.

I learned that trauma, as defined clinically, has two requirements: the traumatic even must be sudden and life threatening. As opposed to normal daily stressors, which tend to be more frequent, but low-stress, trauma tends to be caused by a single high-stress event.

When in a life-or-death situation, the sympathetic nervous system (SNS) triggers the fight-or-flight response. This response facilitates the release of adrenaline and other chemicals such as cortisol. The practical results of this include feats such as 80 year olds being able to carry their families to safety. While normally, the stress response subsides, but for some people, it continues. If someone continues to remain in a state of high stress for four or more weeks, the acute stress response is termed as PTSD.

The main symptoms are: dissociation, avoidance, and a hyperactive SNS. Dissociation refers to blocking out or detaching oneself from traumatic memories and emotions; many who experience dissociation describe the memories of their trauma as if they were watching a movie of themselves. Avoidance refers to avoiding things that will trigger traumatic memories; this could include things such as not watching TV programs about the disaster or refusing to talk with others about it. The severity of avoidance can vary between people; there are some who were so traumatized by the tsunami that puddles, or for some, showers, could become triggers.

The characteristics of those who can recover, I was told, are: the ability to confront traumatic memories, and having a community of people to discuss their experiences with. Professor Tomita has found in Shichigahama that longitudinally, the best predictor of positive outcomes is resilience. While avoidance and withdrawal can be some people’s way of coping, physical and psychological isolation can make symptoms worse.

When I asked Professor Tomita about preventative measures one can take to avoid developing PTSD. It is known that there are genetic components to PTSD development from twin studies. From the 3/11 disaster specifically, some of those who did not develop PTSD were able to avoid certain experiences that would have put them at height risk.

I also asked more about the stigma behind mental health. Professor Tomita actually has done work on this, conducting a survey on 12,000 people who had been evaluated by cognitive psychologists for having PTSD. While initially fearing that their phone calls would not be returned, the subjects were actually much more cooperative than he had expected. He found that the root of the problems of mental health in Japan were more awareness than stigma. People do not really understand mental health disorders well, and thus are not able to tell when their thinking is disordered or unusual. They tend to think something is just wrong with themselves as an individual and develop coping mechanisms without realizing that they have a diagnosable condition.

He also indicated the problems of intimate partner violence (IPV) and child abuse. The lack of awareness around mental health impacts victims of both types of abuse, as they are not aware that their situation is abnormal. As a result, victims can tend to blame themselves for being in an abusive situation.

Professor Tomita, like Professor Sugiura, emphasized the importance of education in disaster preparedness. In the case of Professor Tomita, this means increasing mental health education in compulsory schooling. This, he believes, could eliminate the internal sense of shame that causes people to avoid seeking help. This sense of shame can make several mental health conditions worse. For example, if someone is suffering from depression, they may have low motivation. In order to get their work done, they may overwork themselves or sleep less, ruining their physical health, further impacting their mental health negatively. These kinds of situations can be come a vicious cycle. In addition, people have to be taught how to respond when others around them seem to be having mental health problems. If someone around them attempts to cheer them up, whether in a more sympathetic or more insensitive way, the person suffering may feel guilty about their inability to do so and feel worse. These feelings can also lead to the development of unhealthy coping mechanisms. Changing how people view mental health is important; if people were to treat their mental health like their physical health outcomes would be better.

Professor Tomita also informed me about psychological first aid (PSA), a technique designed to help prevent PTSD from occurring. This is a technique that can be taught to laypeople and used during and immediately after a disaster.

I also learned about the struggles of those who were suffering trauma from the disaster, but whose symptoms were not severe enough to be diagnosed with PTSD. Professor Tomita found that 30% of people living in Shichigahama had displayed symptoms of PTSD. Those who are being treated are those who have severe and recurring symptoms.

Interestingly and somewhat distressingly, between 2014 and 2017, mental health in Shichigahama went down, and insomnia increased. Professor Tomita explains that this was probably caused by the fact that between these years, may residents left temporary housing for new permanent housing. As temporary housing tended to be large groups, when moving into permanent housing, residents were separated from the communities they had formed. This isolation led to a decrease in mental health. However, since 2017, government workers and volunteers have been hosting events to try and reduce loneliness.

Prior to the earthquake and tsunami, the Shichigahama community was tightly-knit. Around 90% of residents talked with or greeted their neighbors regularly. In more rural areas such as Shichigahama, monthly newsletters are distributed throughout the town, giving more opportunities to regularly interact with others.

We also discussed gender differences in communication; it has been found that men in particular tend not to participate in their local communities. Professor Tomita hypothesized that this was the legacy of traditional gender attitudes. Women, through gendered expectations to stay at home, develop stronger people skills and connections in their communities, whereas men tended to be more isolated. These gender expectations are important to both disaster survival and general mental health problems; up to 80% of those in shelters would be women, and traditional gender expectations also contribute to IPV. Thus, changing these expectations would benefit both men and women and increase their likelihood for positive mental health outcomes after disasters. Men would be able to increase their bonds with their communities, and women would be able to more able to leave destructive relationships, both in disaster situations and everyday life.

Overall, through my discussions with these two professors, I was able to learn about how trauma from the 2011 earthquake and tsunami are being dealt with and how the lessons learn from that horrible experience are being transformed into something positive.