The unfolding crisis in Japan is marked by uncertainty, but seasoned emergency responders have a clear mission: to promote resilience in survivors. Resilience, in this sense, is a metaphor for the quality of an elastic object that springs back into shape after being deformed. Resilient people and communities are those that recover readily from trauma.
In the acute phase of a disaster, fostering resilience has more to do with social than psychological assistance. Not long ago, it was common to find therapists rushing to a disaster zone, engaging survivors in a discussion about the trauma they had just experienced, and sometimes indiscriminately dispensing sedatives. So-called "critical incident stress debriefing," which still has its adherents, has fallen out of vogue. It's "been found to be ineffective," says Dr. Leslie Snider, a psychiatrist and senior technical adviser for the War Trauma Foundation in the Netherlands.
Research and experience have led experts to focus instead on promoting social interventions that decrease stress and restore a sense of control, safety and normality whenever possible. That includes ensuring that survivors have social support and access to information about the emergency. It also means arming people with practical knowledge about how to help themselves and those around them, a sort of emotional first aid that anyone can offer to a neighbor, friend or loved one. Helping others "is good for the people being helped as well as the people providing that help," says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health. "The more people know what they're supposed to do and what they can expect, the more capable they will be in responding to a disaster."
By the measure of self-help, the Japanese have already shown great signs of resilience, which benefits from good disaster preparedness. The government is working with private companies such as supermarkets to increase food aid to disaster survivors. Hundreds of disaster medical teams have been deployed, and many localities are drawing upon pre-existing agreements to aid each other in times of need. Many regular citizens have also stepped forward to assist, including offering private buildings to shelter the displaced.
With an estimated 15,000 people still missing, reuniting family members with surviving relatives as quickly as possible, and bringing those without families into social networks, is also important for recovery, particularly among children. "Having a buffering adult who's protective, who's reassuring and is confident, can help children get through the most traumatic situations relatively unscathed," Redlener says.
The United Nations estimates that about half a million people have moved to evacuation centers in Japan, almost half of them from areas around nuclear plants. Aid workers from the nonprofit organization Save the Children USA have set up a play area in one center in Sendai and are planning for more. "The most simple interventions really change lives," says Deb Barry, global director for child protection at the organization.
Save the Children trains disaster-affected volunteers to staff these "child friendly spaces" in emergencies. The idea is to give children a safe place to be kids. Barry says she has seen "children who just literally don't speak, who are really afraid of things, even the sound of a truck going by because it reminds them of an earthquake. All the sudden, [they] get this confidence back where they can really express themselves."
Quickly restarting school may be an even stronger way to promote resilience in children. "In Japan, children's lives are very structured," Barry says. "We're already getting a sense children want to be back in school."
Cultural insights like that are important for responders from overseas. The Japanese government has officially accepted assistance from 14 countries, and hundreds of international relief and search and rescue workers have already arrived. In particular, acts of mourning and recovery often draw on specific religious and spiritual practices and beliefs; in Japan, naming and identifying those who have died will be particularly important. When it comes to offering counseling, Japanese nationals are the best ones to provide it, says Yukie Osa, a professor of sociology at Rikkyo University in Tokyo and board chair of the Association for Aid and Relief, Japan. "It will be difficult for foreigners," she says. "The culture will be very different."
Osa, whose organization is assisting survivors in Japan after having provided emergency relief around the world, including in war-ravaged Afghanistan and after the 2004 tsunami in Indonesia, says Japanese people are used to giving overseas disaster aid, not getting it. "It's our first time to be helped," she says, but with such a vast area of devastation, ongoing displacement, harsh weather, and some places yet to be reached, the help is welcome. "I think people are ready to receive foreign assistance." She adds: "It's not only the goods, but also the people that are a help."
A recent newscast showed Pakistani residents of Japan cooking boiled rice for displaced people in a school. "The Pakistani person interviewed said, 'Since we were helped by Japanese people five years ago when the earthquake hit [Pakistan], now it is our turn to help Japanese people,'" Osa says. A child eating food in the gymnasium said that the curry was spicy, but delicious. "She was smiling," Osa says. "It was a very touching scene."
Psychiatrist Snider says that profound events lead not only to losses, but also to unexpected gains, including new knowledge and skills. "Our lives are all about how we make meaning of events," she says. "How we pull the thread of our life's story through a very tragic or significant event is particularly important, because [the event] becomes a part of that life story." Promoting resilience, she said, is about helping survivors search for and find their own meaning.
Dr. Fink is a Pulitzer Prize-winning investigative journalist, author of War Hospital: A True Story of Surgery and Survival, and a Senior Fellow at the New America Foundation and at the Harvard Humanitarian Initiative. She has worked with humanitarian aid organizations in more than a half dozen emergencies in the U.S. and overseas.