The recent earthquake and tsunami in Japan reminds one of the chronic pain that will invariably be suffered by the survivors long after the rebuilding of residences and infrastructure will have been completed. Survivors are at high risk for behavioral and emotional pathology. Psychiatrists report high rates of "nervous reactions" and "reactive depression" as common afflictions in the aftermath of major disasters. Post traumatic stress disorder has been estimated to occur in 32% to 60% of adult survivors and 26% to 95% of the children of survivors who have been evaluated after earthquakes.

It would thus appear that the aftershocks of an earthquake are not just the aftershocks of an earthquake.

Persistent or recurring disruptions from an earthquake contribute to the continued mental health woes of survivors. While the general psychological stress after an earthquake may stabilize after 12 months, the post traumatic stress reaction may not stabilize until 18 months after the temblor.

And there is a high probability significant numbers of survivors will suffer some form of permanent psychological symptoms, most likely proportional to the degree of personal loss suffered.

It will be interesting to see whether this latest earthquake in Asia will produce the same post-disaster psychopathology documented following other Asian earthquakes:

A study following the Yunnan, China earthquake of 1988 found that in the most severely affected regions, the psychiatric morbidity rates doubled. More telling was the fact that those rates were documented 6 months after the disaster, indicating that the researchers were capturing more chronic psychiatric morbidity, and not simply the acute distress one would expect to encounter following a major disaster. Much of this morbidity expressed itself as somatic symptoms, such as muscular tension, fatigue, sleep disturbance, panic/anxiety attacks, bodily aches and pains, to name but a few.

Most of the victims of the quake in Kobe, Japan of 15 years ago experienced emotional numbness. During the first week after the disaster there existed the expected fear and anxiety vis-à-vis possible aftershocks and grief for the loss of loved ones. Years later, many victims reported continued chronic pain and depressive symptoms.

It is generally considered that Japan treats mental illness with the attitude found in the old Japanese adage, "Put a lid on anything smelly", thereby ignoring the psychological suffering, and avoiding the treatment of this suffering for fear of bringing shame to the family.

As we meditate upon the current suffering in Japan, let us also be hopeful that the tsunami that resulted from that huge earthquake will bring a sea change in the deployment of mental health care to the victims. The psychological analyses that will surely follow will tell us whether that change has occurred.

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