How the Disaster Has Affected Child Upbringing
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
Our country is a land of disasters, and there are many earthquakes and tsunamis in our memory.
The Tohoku region has experienced the Meiji Sanriku Earthquake (1896) and the Showa Sanriku
Earthquake (1933), and there are various “legends” and monuments to these occurrences. Despite
these warnings, these events leave behind huge scars, and everyone feels, “Was there anything
more I could have done?” There is a possibility that a disaster of the same scale will occur in areas
other than Tohoku in the future, and I feel that it is the responsibility of the professionals in thedisaster area to report the actual situation so that it may be a clue that enables prompt support inan emergency.
In response to this unprecedented disaster, many organizations began to support the affectedareas immediately after it occurred. In the special role of a child psychiatrist, I joined a mental
health care team early on, visiting evacuation centers, making individual visits, and paying
attention to family situations, including that of children. Approximately one year after theearthquake, the places I make rounds at have changed from evacuation shelters to temporary
housing, and I now visit schools and kindergartens. The acute and medium- to long-term mental
reactions observed in children have already been reported separately; please refer to them 1)-8).
The earthquake not only took away what was important to us but also changed our living
environment itself. Even today, chaotic emotions swirl around the disaster area, and even us
professionals are at the mercy of every new day. There is no doubt that this disaster has had andwill continue to have a great impact on the environment in which children grow up. This paper
reports on the current situation, focusing on the childrearing environment, which has changed
owing to the earthquake, and the ideal way of raising children as a family and community.

2. Regressing Children
Countless children experienced painful experiences during this earthquake, and various reactions were observed. Most of the cases I was assigned during patrol duty immediately after thedisaster 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. The mostbasic form of advice in this situation is careful explanation and normalization. To children who
have undergone an experience such as this, regression is a very natural response, and is merely
a transient return to a more child-like state. I often told mothers that this wasn’t a strange response
and that it wouldn’t last long, and I decided to simply observe and monitor the progress of thesecases. Afterward, I continued to visit these individuals in evacuation shelters or their own homes,
and nearly all cases resolved themselves over time.
On the contrary, among those who could not be sent to counseling, I began to become worried
about a particular group of children whom I observed at the evacuation shelter. They would
occupy an outlet in a corner and were absorbed in portable games all day long. After asking around,
I would often hear that their families were always out, cleaning up their tsunami-flooded house orbusy with official procedures such as documenting proof of damage. These children couldn’t even“regress” because they had nothing to cling to for protection, and they seemed to escape to thegame world and fight desperately against fictional monsters.
After considering both, I realized that the former was a case of children being in anenvironment in which they could display their symptoms early on. If the parents do not give them
the necessary time or attention, they will be unable to notice the changes in their children. Only
when parents have their antennae extended, so to speak, will they be able to connect their child tospecialized counseling at an early stage. The phenomenon of regression may be seen because thechild actually has something they can cling to with peace of mind. With this in mind, I focused on- 118 -

the positive aspects and gave feedback to these families, saying, “I think, in the long run, it’s
actually better that they’re having this reaction now.” In fact, in clinical practice, there are cases
where a child 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 managing to spare some time 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” is essential for children to develop the ability to regulate emotions and behaviors. In disaster areas, theechoes of fear remain strong, and both parents and children are in a situation where they cannot
be separated. Naturally, the range of children’s activities narrows, and exploratory behavior isrestricted. Children who have had a difficult experience regress and cling to their caregiver, while
the caregiver hesitates to allow their 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. In other words, if the debris is not cleared and housing
problems are not solved, parents cannot reach a situation where they can feel physically relieved,
and their children will not be able to develop the ability to regulate their emotions and behaviors.

3. Changes in Household Environments
The earthquake has had a great impact on children’s family environments. After being placedin a crisis situation, families have an opportunity to reconsider their own internal structure, andthey can become more cohesive. However, it takes time for children to adapt to changes in theirfamily environment, and it is also true that they tend to suppress their emotions after attuning
themselves to the fact that those around them already carry significant psychological burdens.
(1) Living Together During a Disaster
The houses in devastated areas were all washed away by the tsunami, and some families chose
not to move to evacuation shelters but into their relatives’ homes, which were less damaged. At
first glance, this may seem like an opportunity for the family to reunite, cooperate, and reaffirm
their bonds. However, many families inevitably started living together without sufficient mental
preparation. In the beginning, they were forced to tolerate each other’s existence. With the passageof time, however, discord within the family, which until now had been balanced by physicaldistance, sometimes emerged. For children, uncles and aunts, whom they had only occasionally
met during long vacations, suddenly started living with them, leading to a terrible family
atmosphere. These children became confused, tried to align themselves with the feelings of theadults around them, and eventually developed physical symptoms such as abdominal pain andheadaches. Ultimately, they were taken to emergency hospitals, and after much scrutiny, thesource of the symptoms was determined to be a “mental problem,” and some of them were referredto our specialized agency.
(2) A Double Life
Many families living in the southern part of Tohoku evacuated to other prefectures owing toconcerns about radiation from the nuclear accident. However, since stable work is not guaranteed
at evacuation shelters, it would inevitably be only the mother and child who would end up
evacuating. The father would remain in their place of residence and continue to work, and thefamily would reunite on the weekends. The financial burden of such a double life is heavy,
especially as the father continues to be exposed to radiation. This burden is particularly heavy formothers with infants and for pregnant women. In addition, if the mother and child evacuated toan area with a large influx of people, there could be conflicts between newcomers and locals, andthe mother and child could be forced to live in shame. The stress caused by the nuclear accident
simply has no parallel among the events investigated in various trauma studies in the past, and thefuture stress response is unpredictable. These families, uncertain of how long this situation will
last, experience unimaginable anxiety. It is difficult for children to accurately understand all thesecircumstances; they simply feel the anxiety of their parents, notice that they are being exposed tounpleasant prejudices similar to “pity” from their surroundings, and continue to live in temporary
housing where their future is ambiguous.
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(3) Reformation of the Family
Many orphaned children were taken in by relatives, who decided to build new families as
relative-foster parents. In their hyperaroused state immediately after the earthquake, these children
somehow managed to survive amidst confusion and excitement. In the medium to long term,
however, they began to react in various ways as they gradually became aware of their situation.
These processes have also been reported in various previous studies of foster parenting 9). The
feeling that they were betraying their deceased parents sometimes arose, and children sometimes
did not get along with their new caregivers, causing repeated rebellion. Foster parents found it
difficult to raise these children, which became a major obstacle to family reformation. Normally,
foster parents are certified after undergoing simple training and repeated confirmation of theirintentions, but it is undeniable that such preparations were inadequate in this earthquake. Foster
parents were at the mercy of their children’s trial-and-error behavior. Countless children havebecome orphans or been abandoned as a result of the disaster, and it is extremely difficult to follow
all cases at the local Child Guidance Center alone. It is necessary that we support childrearing
through the involvement of local community strengths, rather than through child welfare andadministrative support.
4. Changes in the Environment Outside the Home
In addition to the home, there are other factors that hinder the healthy growth of children. It
is difficult for each individual to resolve their own trauma; the community, including the family,
becomes indispensable in this regard. In order to unite and overcome the predicament, it is also
necessary to improve the physical environment outside the home.
(1) A Lack of Places to PlayIn places where the plains are widely flooded, the creation of residential areas is a top priority
and there is an absolute shortage of children’s playgrounds. When schools reopened in April,classrooms were used as shelters, and in some areas, temporary housing was built in theschoolyard. Even in areas where the damage was low, there was an influx of population due toevacuation, and some schools saw a significant increase in students. As a result, prefabricatedtemporary school buildings were built in schoolyards, further reducing play space. On the contrary,in the southern part of Tohoku, the number of children has decreased sharply because of anxiety
about radiation, and there are some areas where outdoor play is restricted in order to reduce theamount of radiation exposure. There is an urgent need to secure a “safe playground” for the healthy
growth and development of children. Under these circumstances, several children’s goods
manufacturers have cooperated to set up playgrounds and gatherings that are safe for children.
These are not only places for children to interact but also for parents to exchange information 10).
(2) Changes Inside the School
Schools that were heavily damaged by the tsunami are renting vacant classrooms at those that
suffered minimal damage. The number of children in these classes exceeds the capacity of therooms, which are not typically used as classrooms, and children are forced to learn in a shamefulenvironment. Owing to the differences in their experiences from the school’s original students,
the newcomers find it difficult to naturally blend in and play. Even though children of the sameage are studying in the same school building, events such as athletic meets and festivals are held
separately. Although it sounds harsh, it is unlikely that damaged schools will be restored, andeventual consolidation is natural. However, the power of the group is essential to overcome major
trauma, and being separated from peers who can share their experience can undermine thesechildren’s resilience. If it is predicted that a reaction will occur over time, I feel that somepreventive measures need to be taken in the field of education. In Fukushima Prefecture,
preventive psychoeducation for children is being conducted in educational institutions affiliatedwith Hamamatsu Medical University, and it could be a model for the future.
(3) Temporary Housing
Owing to the damage to many houses, temporary housing was built at a rapid pace in thedisaster area. The walls are thin, and even at normal volume, voices leak through. Under suchcircumstances, residents are constantly aware of the goings-on in one other’s lives. In the winter,
there are more things to worry about, such as measures against freezing of the water supply.
Further, there are those who are forced to live in unfamiliar areas because of the shortage of landto build temporary housing.
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Students in the disaster area had to work on learning at evacuation shelters and temporary
housing. The tsunami swept away study tools and it was difficult to secure a place to study.
Immediately after the disaster, many at evacuation shelters were annoyed because of hyperarousal,
and it was difficult for them to be conscientious, to calm down, and to concentrate on learning.
Confronted with unpleasant expressions like “Turn off those lights already” and “Don’t leaveeraser dust everywhere,” these children took their exams in fear. Under such circumstances, there
were many volunteers who secured a place for these children to study with peace of mind andprovided learning support free of charge. It seems to have been very helpful in alleviating theanxiety of the examinees.
(4) Becoming Used to Support
We are grateful for the goodwill people have shown in sending various relief supplies.
However, there were instances of relief supplies being wasted because of mismatches between
requirements and destinations. For example, a large number of soccer balls arrived at anelementary school without a playground, diapers arrived at an evacuation center where there wereno elderly people, and an air gun was included in children’s play equipment. In particular, foodrelief supplies became saturated early on, and warehouses were piled up with food that had passed
its expiration date. Even the author who visited as a supporter was able to share food relief supplies.
At school, on Christmas, relief supplies (mainly sweets) arrived from various groups. At one
elementary school, children said, “I don’t need it because there are so many at home” and gaveme sweets as a gift. Many celebrities also visited us, but it was not necessarily overwhelming, andsome children reacted coldly. What will remain in children’s mind after this “human tsunami” isover? I am afraid that they will become accustomed to being supported and become dependent.
5. 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. Adults usually show
a very strong grief reaction for several months after a loss, and it is said that they gradually sortout their feelings while experiencing emotional fluctuations. On the contrary, in the case of children, sadness always exists at the root of the growth process and is often expressed in a different
form.
Bereavement of a loved one is said to affect development in many ways 11). In Japan, there isan inadequate response to grief care associated with the bereavement of children. Children who
cannot express grief in words have the power to reproduce and heal in play and art. Understandingof death depends on children’s cognitive developmental stage, and they become aware of theirsituation as they grow up and talk about their experiences of loss. A child wants to know thedetails of death, but when they see adults around them endure sorrow, they sometimes hide theiranguish. 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 andways, sometimes inappropriate to others, with regard to understanding death. We sometimes feel
unnecessary remorse, such as “Maybe this misfortune was my fault.” The essence of grief care is
not to “heal” the wound, but to “accompany” 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 to mental illness. Thus, individuals should bereferred to specialized counseling agencies when necessary. Many adults will need to be aware ofthese basic responses to bereavement in children.
Providing opportunities for children to spend time with peers with similar bereavement experiences 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 experiences as them can understandtheir feelings. Adolescents, in particular, need to receive support from friends whom they feel
understand them. In the disaster area, multiple groups are working on grief care and holding groupmeetings 12). In such places, it is necessary to set ground rules because of the possibility of emotions running high, and the adults who support them must ensure safety.
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6. Advice for 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 way of approaching community and school mental health in
the wake of the earthquake.
No one would have expected a disaster of this magnitude. While it is important to be prepared,
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 that 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 recognize 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 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 such as childguidance and juvenile justice centers must effectively collaborate. Ideally, these multiple networks
would be organically connected with each other like a living being.
7. 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 this 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.

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