Parenting and the Disaster
Miyagi Disaster Mental Health Care Center(Tohoku University Graduate School of Medicine, Department of Social Medicine, Department of Public Health)Community Support Department, Director – Naru Fukuchi
1. Introduction
Sumo is the national sport of Japan and an embodiment of the spirit of “bushido,” again uniqueto Japan. It is said that the sumo tradition, in which wrestlers literally collide with each other while
naked and fight each other openly with prescribed techniques, is pure. A few years ago, two strong
wrestlers with a fierce rivalry played a historic and heated championship match. After a long battle,
the winning sumo wrestler involuntarily made a “fist pump” gesture toward the audience. The
next day, the media criticized him harshly. They said that this fist pump in the ring wasdisrespectful to the opponent. It is a virtue to always maintain humility, not to reveal the feelings
hidden in the heart, and to carefully grasp the feelings of the other party. Such is the culture ofJapan.
Overseas media praised the Japanese response to the earthquake. Usually, when major disasters
have occurred overseas, disgruntled citizens have been known to riot, causing widespread security
concerns. This did not happen in Japan, thought to be a result of respect for etiquette and theemphasis on caring for and helping each other. Immediately after the earthquake, I continued tomake rounds at evacuation shelters as a member of a mental health care team. I cannot count how
many times I heard things like “There are people who are in worse condition than me, so tend tothem. I’m okay.” After a year, various ceremonies were held, but few people cried aloud or visibly
expressed their sadness. Clench your teeth, no matter how much you’re hurting, and realize theimpact your emotions will have on your surroundings: this is what we are told. Isn’t this culture a
detriment to overcoming historically unprecedented trauma? How will children grow up if they
are constantly imitating adults who simply endure?
The reactions of children in the acute and medium- to long-term after the earthquake aredescribed in various treatises; you can refer to them elsewhere 1) -8). In this article, I would liketo focus on some key words related to childrearing. Lastly, as a professional living in a disasterarea, I would like to make a proposal regarding future community development.

2. Status of Children in Disaster Areas(1) Children’s Experiences of Loss
We lost a lot in this earthquake. Important people, companions, and places. Those who havelost their jobs have lost their income, their social role, and their hopes for the future. Many victims
are missing, and many are experiencing vague losses that they cannot shake. The holes in my heart
are so big that I can’t even feel the pain of those chunks being scooped out. In Japan, grief careassociated with the bereavement of children is inadequate. In the future, we must inform adults
living in disaster areas about bereavement and loss to enable them to better support children as
they grow up.
Adults usually show a very strong grief reaction for several months after a loss, and it is said
that they gradually sort out their feelings while experiencing emotional fluctuations. On thecontrary, in the case of children, sadness always exists at the root of the growth process and isoften expressed in a different form. Children who cannot express grief in words have the power
to reproduce and heal through play and art. Understanding of death depends on the child’s
cognitive developmental stage, and they become aware of their situation as they grow up and talkabout their experiences of loss. A child wants to know the details about death, but when they see
adults around them endure sorrow, they sometimes hide their anguish. By telling them that talking
about bereavement is not taboo, children’s range of emotional expression is greatly expanded. It
should be noted that each individual has their own beliefs and ways, sometimes inappropriate toothers, of understanding death. We sometimes feel unnecessary remorse, such as “Maybe thismisfortune was my fault.” The essence of grief care is not to “heal” the wound but to “accompany”- 129 -

it in the process of organizing it. In addition, although the loss experience itself is not an illness,
it should be noted that various factors may overlap and grief may be complicated, leading tomental illness. Thus, individuals should be referred to specialized counseling agencies whennecessary. Professionals should be placed into support teams so that they can connect these
individuals to professional counseling agencies when needed.
Providing opportunities for children to spend time with peers’ children who have the same
bereavement experience as them can be of great help in getting them to express their emotions
and understand death. Children themselves may feel that only those who have the same experienceas them can understand their feelings. Adolescents, in particular, need to receive support fromfriends whom they feel understand them. In the disaster area, multiple groups are working on griefcare and holding group meetings 10), 11). In such places, it is necessary to set ground rules becauseof the possibility of emotions running high, and the adults who support them must ensure safety.
(2) Loss of a Safe Zone
I patrolled evacuation centers during the acute phase, began to work with elementary andjunior high schools for the medium to long term, and continued to observe the situation of many
children. Through all this, I deeply realize that all of children’s primitive reactions are in “regression.” Children observe the responses of adults, and instinctively do not cling to those whom they
feel do not have time or energy for them. It is thought that adults’ emotional reactions occur aftermaterial problems are solved, and children’s emotional reactions come to the surface after thoseof adults. Although there are regional differences, the current situation is that the removal of rubble has not progressed at all, and in areas where housing and employment are not stable, children’s
mental arrangement is delayed.
Most of the cases I was assigned during patrol duty immediately after the disaster involved
regression: symptoms such as being unable to leave their mother’s side, being unable to sleep
alone, being afraid of darkness, and urinating at night were observed. For children who have had
an unimaginable experience, it is no wonder that these reactions occur, and the matter of clinicalrelevance is determining when exactly this regression occurs. As mentioned above, children do
not “regress” if the adults around them do not have the time or energy to care for them. In situations wherein a child’s reaction occurs immediately after the earthquake and leads to counselingwith a specialized agency, part of the credit also goes to the parents, who had to have been unwavering, firm, and sensitive to the needs of their child. On the contrary, a group of children who
could not even “regress” was observed. They occupied an outlet in a corner and were absorbed in
portable games all day long. Their games were largely battle-based, and strangely, even if multiple
children gathered, they rarely played with each other competitively. When I talked to these children, they seemed to ignore me. After asking around, I would often hear that their families werealways out, cleaning up their tsunami-flooded house or busy with official procedures such as documenting proof of damage. These children couldn’t regress because they had nothing to cling tofor protection, and they seemed to escape to the game world and fight desperately against fictional
monsters. In other words, the regression of these children may appear late. In fact, in clinicalpractice, there are cases where children who did not respond immediately after the earthquake
suddenly regressed after about a year. While death anniversary reactions may be a factor, these
episodes can be regarded as latency phenomena caused by parents finally finding some time tospare for their kids.
The earthquake destroyed an absolute “safe zone” for children. According to Bowlby’s theoryof attachment, the ability to come and go between a “safe zone” and “exploratory behavior” isessential for children to develop the ability to regulate emotions and behaviors. Even though one
year has now passed, in disaster areas, the echoes of fear remain strong, and both parents andchildren are in a situation where they cannot be separated. Naturally, children’s range of activities
becomes narrowed, and exploratory behavior is restricted. Children who have had a difficult experience regress and cling to their caregiver, while the caregiver hesitates to allow the child to“search” because of their anxiety about letting go. Conversely, as we saw in the cases of children
who immersed themselves in games, if the parent has no time to spare for their child, the family
no longer functions as a “safe zone” and the child will not be able to perform either behavior.
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(3) Issue of Self-Perception
This overlaps to some degree with the loss experience mentioned above, but once again I
would like to imagine how the children themselves perceive their experiences. The tsunami took
away everything in an instant, so quickly that people didn’t have the time to feel “terrified” or“sad.” There is a time lag between the actual experience and the raw emotions, and when you
remember and reconfirm, these emotions swell. Naturally, children who do not want to remember
try desperately to protect themselves in the form of denial. The degree of understanding may differ
depending on the stage of growth and development, and the appearance of symptoms may differ
accordingly. Children after junior high school and children with high intellectual abilities
recognize everything, and some children actively try to play a role by themselves. However, it ishard to say that children in the lower grades of elementary school are aware of the current situation.
It was thought that the temporary increase in infants’ physical symptoms during the hyperacuteperiod was not a psychological reaction based on understanding the current situation but a panic
response to a strongly impactful experience.
Even months after the earthquake, the number of children who come to medical institutions
has by no means increased. Strangely enough, the number of children who come from coastal
areas with severe damage is quite low, and the ones who get checked up are almost always those
who moved to safe inland areas. Indeed, if one were to take a look at them, these children did not,in fact, look to be carrying any serious worries: they would speak loudly and play energetically.
However, when I look back, I think this state may have been greatly influenced by post-disaster“hyperarousal.”
Behind this unusual phenomenon is likely an issue with these children’s “self-perception.”
Almost without exception, children who did not move out of areas with severe damage went
through the same experiences. They all saw the tsunami and their neighbors being washed away.
Many of them even lost a family member. These children just assume that “everyone else has gone
through the same thing too.” On the contrary, children who move or transfer schools to areas withless damage come face-to-face with the gap between their experiences and the experiences of
those around them. They are essentially forced into the realization that, “Wow, I really went
through something horrible.” They become unable to share their experiences with others and end
up feeling lonely or isolated. As a result, they begin to present with a variety of physical symptoms,
can fall into depression, and may end up not going to school. When, then, will the mental reactionsof children who are still in the coastal areas occur? Although this may be a bit of a harsh expression,in reality it is unlikely that damaged schools will be restored, and will eventually be consolidated.
At that time, when faced with reality, these children may react in various ways. However, thepower of the group is essential in overcoming major trauma, and being separated from peers who
can share their experience can undermine these children’s resilience. If it is predicted that areaction will occur over time, I feel some preventive measures need to be taken in the field of
education.
(4) Prevention of Trauma Responses
In an emergency, it will be necessary to provide psychoeducation that gives a person accurate
information about what has happened, prepares one for future mental reactions, and teaches
relaxation that reduces anxiety. Immediately after the earthquake, in a Child and Adolescent
Psychiatry ward where the author was working, impromptu psychoeducation was provided tohospitalized children 12). The results were generally good: there were no children whose anxiety
worsened, and they were able to respond to the situation without becoming overly perturbed. In
principle, such educational content must be taught by adults who are familiar with the children, ina place where they can feel at ease. In reality, it would be effective for teachers to do it in schoolwith the support of professionals such as doctors and psychologists.
This happened but a few months after the earthquake. A girl in the second grade whocomplained of anxiety symptoms visited the clinic. According to her mother, she was incredibly
afraid of rain. When it rained and there was thunder, she got angry if her mother didn’t close thewindow in a hurry, and could even become violent. Yet the area where this girl lived was among
the least damaged in the prefecture, and lifelines there were restored quickly. Therefore, I wasquite puzzled by the severity of her anxiety symptoms. While playing and communicating with- 131 -

her, I came to a sudden realization, and asked, “Do you think tsunamis happen when it rains a lot?”“Huh? Is that not true?” she asked. In our next session, I used a whiteboard to give her a shortscience lesson. I explained the origins of earthquakes and tsunamis and taught her that rain andthunder have nothing to do with tsunamis. “Thank you, teacher. I’ll go to school and teacheveryone,” she said, and the examination ended. After that, she did not return to the clinic.
Accurate knowledge protects children from anxiety. According to the prescribed elementary
school curriculum, children learn about typhoons and floods in Grade 5 and earthquakes in Grade
6. It seems that some schools did not hold these classes because teachers were hesitant to remindchildren of their painful experiences. Even if it leads to an uneasy class atmosphere, I feel it isvery important to provide accurate knowledge in a safe environment and without the teachers
becoming upset. In order to prevent children from developing unnecessary anxiety, it is necessary
to devise ways to have children acquire a “knowledge defense.”

3. Advice on Community Building
As a professional living in the disaster area, every day I ask myself what “mental care” really
is. Psychiatric care in Japan is a hospital-centered system, one in which professionals wait forpeople to come in for consultations of their own volition. Therefore, psychiatry as public healthtool that supports community mental health has not been fully developed as an academic discipline.
However, after the earthquake, professionals went to the affected areas to raise awareness andpick up high-risk local residents. In other words, there was rapid progress in encouraging people
to boost the power of existing regions. My role as a child psychiatrist has shifted to visiting largekindergartens and schools and giving advice to professionals who are closely associated with children. If you think about it carefully, all these activities are natural. It is not a special initiative that
we are taking because of the earthquake but one that should be continued even in peacetime. I
think the creation of a community where “noisy” is the norm will be the basis for raising children.
It is necessary to reconsider the ideal approach to community and school mental health in the wakeof the earthquake.
No one would have expected a disaster of this magnitude. It is important to be prepared, but
not all events can be dealt with. It is important to take concrete measures, but the focus should beon ensuring that people and communities can respond to any eventuality. In the event of a disasterof this scale, the organization that manages the community itself will be destroyed, and it will benecessary to play a role of “connecting” before regaining normal functions. I feel that what acommunity should work together to nurture is not a charismatic leader but an individual who can
act as a “hub” that connects various related organizations. People in these “hub” roles would havea greater degree of freedom; they would go out to various areas and build relationships withvarious institutions. Even if given a flexible role in your first job after graduating from university,
it can be difficult to move with such freedom. I feel it is necessary to spread these ideas in theprescribed school education and allow them to take root to form a culture that creates “free people.”
Although clichéd, I think it is necessary to thoroughly nurture the ability to recognizing diverse
values. I believe that developing such human resources from an early stage and allocating multiple
personnel to the region will lead to increased resilience. In the area of children’s mental health, itwould be good to give school social workers a more flexible role and allow them to become
familiar with the characteristics of the children in the area. If you suddenly say “Let’s work
together” to someone you don’t normally work together with, it won’t happen. For children’s
mental health, medical organizations such as those related to pediatrics and child psychiatry,educational institutions such as schools and boards of education, and welfare organizations suchas child guidance and juvenile justice centers must effectively collaborate. Ideally, these multiple
networks would be organically connected with each other like a living being.

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4. Conclusion
I feel the Tohoku region has a deep-rooted spirit, a resolve to endure without complaint, nomatter what the circumstances. Although each area has its own characteristics, it cannot be denied
that there is a tendency to dislike “mental care” here, often making it difficult for supporters to dotheir work. Generally, in trauma care, we try to get patients to express and organize their memory
and emotions in some way, but in this disaster, we will ensure that activities are adapted to the
local climate and that residents are patiently dealt with. I feel that it is necessary to carry out
trauma care.
The road to reconstruction is long, and our strength alone is not enough to protect the mindsof our local children. Through this passage, I humbly ask all of you for your long-lasting support.

<References>
1. Naru Fukuchi, Mizuho Hayashi (2011). Current Status of Children in Disaster-Affected Areas.
Pediatric Psychology and Neurology 51. 126–132.
2. Naru Fukuchi: Trauma Care for Children After a Disaster. Miyagi Pediatrician Bulletin, 245;
43–45, 2011.
3. Naru Fukuchi, Asako Murai: The Actual Situation of Disaster Area Support for Children.
Japanese Hospital and Community Psychiatry, 54; 5–7, 2012. (In press)
4. Naru Fukuchi: How the Disaster Has Affected the Mind of a Child. Tokyo Pediatrician Bulletin, 30; 1–4, 2012. (In press)
5. Naru Fukuchi: The Disaster and the Mind of a Child. Journal of the Japanese Society of Pediatricians, 43, 2012. (In press)
6. Naru Fukuchi (2011). The Reality of Psychiatric Support in Disaster-Affected Areas. Monthly
Minna Net. 54; 7–11.
7. Naru Fukuchi: The Mind of a Child Recovers in Play. Child Health, 15; 53–55, 2012.
8. Medical Tribune: 2011.11.3 Report of the 29th Japanese Society of Pediatric Psychosomatic
Medicine.
9. Noriko Seto, Kayoko Kurokawa, Chikako Ishii: Assistance for Children Who Have
Experienced Bereavement. Oncology, 8; 51-56, 2011.
10. Sendai Grief Care Study Group http://www.sendai-griefcare.org/
11. Ai No Kai http://ainokaisendai.web.fc2.com/
12. Child
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http://kokoro.ncchd.go.jp/saigai_senmonka.html

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(Naru Fukuchi: Parenting and the Disaster. Published in Parenting Science. Vol. 18 Nippon
Hyoron sha. 2012: 74–78.)- 133 -