Many more people could benefit from treatment

ONAGAWA, Japan - The forbearance shown by survivors of Japan's earthquake and tsunami has been lauded in the West, but psychologists worry not talking about the hurt could be doing long-term damage.

Commentators have heaped praise on the emotional resilience of people who have lost everything, but, say some, the surface calm masks deep undercurrents of emotion.

"To be honest I really feel like breaking down and crying - because I'm sad," said evacuee Kenichi Endo, 45, briefly screwing up his eyes.

"I've lost my father, my pet, my car, my savings. I've lost everything. But, everyone here is the same. If I cry, everyone else will, so I can't," he said in a shelter in Onagawa, clenching his fists into tight balls.

Unbearable tragedy was heaped on Japan on March 11 when a magnitude-9.0 quake unleashed a gigantic wave on the country's northeast, killing more than 13,700 people and leaving more than 14,000 missing.

More than five weeks on and tens of thousands of evacuees are still living in school gymnasiums and other public buildings, sharing their sleeping space with dozens - sometimes hundreds - of other people.

Under these conditions, emotion remains tightly regulated.

Instead, grief appears at unexpected times - while sleeping, listening to music or even while eating.

"The one thing I really want now is privacy," said Ken Hiraaki, an evacuee in another shelter. "At night I hear people groaning in their dreams. But sometimes my wife wakes me up because I am groaning too."

The unwillingness of many survivors to openly discuss their sadness is worrying health professionals, who say it makes them vulnerable to depression and long-term problems.

"Many people now are in a phase of acute stress disorder, which is a totally natural response to this level of trauma," said Ritsuko Nishimae, a clinical psychologist working with international aid group Doctors Without Borders in Minamisanriku.

"If they are not able to get proper support psychologically, there is an increased possibility that they could develop post-traumatic stress disorder," she said.

In Japan depression continues to carry a stigma it has long shed in much of the West. This is especially marked in rural areas such as the disaster-struck northeast, where community and family ties are strong.

It is only in the past decade that metropolitan Japan has begun to tackle taboos on mental illness, with around 900,000 people a year treated for depression, a condition referred to euphemistically as "heart flu".

Psychiatrists, who are known as "heart carers", say many more people could benefit from treatment.

"When you say psychiatry, people become extremely sensitive. They think it is embarrassing," said Naoki Hayashi, a psychiatrist from Tokyo working in an evacuation center in Rikuzentakata.

"They look at me quizzically, as if they're saying, 'Who are you?' So instead of telling them I'm a psychiatrist I just tell them I am a doctor," he added.

Agence France-Presse