Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Japan DisasterOverview for American Military Leaders
The earthquake, tsunami and ongoing
and those with previous traumaticTheearthquake,tsunamiandradiation event at the nuclear power
exposure.
plant in Japan have resulted in significant■■ Even those not directly exposed
ongoing radiation event at thehuman tragedy and distress. Overmay be affected. Sometimes, it isnuclear power plant in Japan have
10,000 people have died, hundreds ofhelpful to think of concentric circles
thousands more have had to be relocatedresulted in significant humanof affected persons—those directly
and an entire nation has been gripped
affected at the center, then—moving
tragedy and distress.
by sadness and fear. Many Americans
outward—their family and friends,
who were living in Japan or working
their colleagues, the nation as ain the area have been relocated or have otherwise been
whole. Even those who are far away geographically may
directly affected by the events. The United States has offered
be greatly affected because of affected families, friends
assistance to the Japanese, and American military andor other strong identification with the affected.
civilian officials will be tasked with responding to a horrible■■ A nuclear event in particular can induce fear amongand still evolving disaster. This information sheet serves tolarge swaths of the population both near the reactors
provide some helpful approaches to confronting the many
and at some distance.
challenges that military personnel and their families may
confront in this disaster.
How Do People React to Disaster?
■■ Most people are able to function relatively well in theWho Has Been Affected?
wake of a disaster, rising to the occasion to ensure the■■ Those who were directly exposed to the event including
well-being of themselves and others. However, evenpeople who were injured or displaced or those who
those that function relatively well may experience somelost loved ones may be particularly affected. This groupdegree of distress. Some problems may not emerge until
includes American military personnel who were living
the initial phase of the disaster is over.
in Japan prior to the event as well as those who have
traveled to the area—working on the ground or on ships ■■ Leaders and responders should be aware of
psychological and behavioral responses to disaster.
nearby—since the event as part of the disaster response.
These include—but are not limited to—increased
Some personnel and families have had to be relocatedsmoking, drinking and drug use; avoidance, sadness,out of their home area, away from familiar surroundings
insomnia, anxiety; missed work and neglected family
and people and have had to alter or suspend important
obligations. Interpersonal relationships may be moredaily activities and cultural practices.
strained during this period as people may be more■■ Other personnel have been emergently deployed toshort-tempered, more irritable, and less available.
the area to assist in the disaster response and may be■■ For a majority of individuals, symptoms such as
vulnerable to significant stress given the nature of theirinsomnia, nightmares, anxiety and sadness will diminish
work, the intense and often continuous operational
over time without intervention. A smaller proportion
tempo, the frequently non-standard chain of command,
may need some short-term professional assistancethe unfamiliar setting and the distance from family andsuch as help with insomnia or someone with whom toother social support.
talk, but will do fine afterwards. An even smaller subset■■ Vulnerable populations may require special attention
may develop more significant conditions including
and include children, those with previous/present
clinical depression, anxiety or substance abuse. Thismental health problems, those who are physicallygroup may require more formalized treatment.
displaced and/or lost property, medically ill persons
Continued

Though post-traumatic stress disorder can develop
following a disaster and has been the focus of muchrecent attention and study, mood disturbances such as
depression or traumatic grief are more common.
■■ Many disaster victims will be grieving—they will havelost loved ones, their property, their sense of security
and sometimes, their sense of identity. Grief can arrive
at differet times, and take on many different forms
depending on the person; possible experiences include
sadness, numbness, longing, anger and others.
■■ Fear, especially of the unknown (as is common in
nuclear events), can predominate and lead to changes inbehavior. Worries about children and their safety can beespecially prevalent and lead to significant distress andalterations in behavior. Fear often drives behavior that
may seem odd or excessive and may conflict with theadvice of authorities.
xx For example, people who have been advised not
to give potentially contaminated water to children
under 4 years old, may not give water to their older
children, themselves or even use it for bathing orother purposes.
xx Personnel who believe they may have been exposed
to radiation may be fearful of contact with theirfamilies for fear of endangering their spouse orchildren.
■■ Worries about exposure and beliefs about
contamination can be quite common following a
nuclear or biological weapon event. Many people willdevelop medically unexplained physical symptoms(MUPS) and present to care providers seeking
explanations and treatment. Health concerns canpersist for many years, especially given concerns
about increased cancer risk associated with radiation
exposure.
What Can Be Done?
■■ Interventions that are guided by principles of
Psychological First Aid should be employed. The
principles of first aid include (1) safety (e.g. getting
people out of harm’s way); (2) connection (e.g. helping
people get in contact with loved ones); (3) calming (e.g.
providing quiet, clean space and clear instructions); (4)self-efficacy (e.g. allowing autonomy and opportunities
for participation in recovery); and (5) hope.
■■ Providing support and listening to victims/survivors isimportant, but do not require that they tell their story—
this can lead to even more distress.
■■ Maintaining a registry of the evacuated/displaced
or exposed can help track a vulnerable population.
Maintaining a voluntary (e.g., agree to be contactedlater) registry of those individuals/families who soughtcare/evaluation after the disaster can also be helpful.

Good risk communication is vital. The information
source should be a well-regarded and competentauthority (e.g., doctor) who delivers regular updates,
shares what is known and unknown, avoids speculation,and provides information on what actions individuals/
families can do in order to provide for their safety. Clear
instruction on self- protection is also vital. For example,
instructions on proper safety and decontamination
measures can allay worries about health risks.
■■ Leaders, responders and primary providers shouldbe equipped with information about risks or be able
to direct individuals on how they can receive more
information. Questions about the degree of exposure,risk, and worry will most likely continue. Anticipatedquestions might include, “Am I at risk?”, “How do I
know if I’m affected?” “Can I go back to my home?” or,conversely, “Do I have to go back?”, “Are my belongings
safe?” Restoring a sense of normality, as much as
appropriate or possible, is important, especially forchildren. Providing an environment in which children
can continue with schooling, people can continue
to engage in social gatherings, and celebrate special
occasions is important. Ensuring that important
religious, spiritual, and/or cultural practices areavailable to people can be helpful.
■■ Limit exposure to stressful stimuli (e.g. TV/media
coverage of disaster coverage) can help reduce stress,
though this needs to be balanced with the need for
information dissemination and people’s interest in
learning about the disaster. Special care should be takenwith children. If children watch media coverage, it
should be with parents or other trusted adults who canwitness their reactions and discuss what the children
are seeing.
■■ Leaders may be called upon to provide “griefleadership.” Recognizing that grief is a natural partof loss and takes on various forms, normalizing thedifficult emotional experience, being aware of andrecognizing the sense of loss that communities andindividuals may feel (“I’m so sorry for your loss),
resisting any urge to offer false reassurance (“everythingwill be alright”) and assisting the grieving individuals
in identifying proper resources (e.g. funeral, spiritualleaders) are all tenets of grief leadership. Leadership
messages that focus on compassion, commitment, andoptimism can be especially helpful.
■■ Responders and leaders need to take care of themselves
as well, and mission effectiveness depends on it. Getting
appropriate rest, encouraging regular sleep patterns,
meals and daily routines, maintaining communication
with loved ones, and guarding against overdedication(i.e., doing too much and sacrificing their own healthand well-being) are all helpful guiding principles.
Leaders/supervisors are vitally important in monitoringthe function and health of their troops/workers —making an active effort to know them, walking around,and modeling a proper example of self-care (withappropriate rest, eating and hydration) are essential.
■■ Leaders and care providers should be aware that manypatients will present with medically unexplained
physical symptoms (MUPS) and/or concerns about

long-term health risks of exposure. Providing
potentially exposed individuals with accurate
information about what symptoms are and are notcause for concern is a good public health intervention.
Offering appropriate reassurance and limiting
iatrogenic injury to patients who present with MUPS is
an important skill for care providers.

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org