Figure 6.1 Bob Baker surrounded by children (and his teddy bears) in a kindergarten on Awajii Island, where the earthquake began. In back row is Yoshiko Luscombe, Bob’s main interpreter. (Pesonal photo of author.)
The Great Hanshin-Awaji Earthquake: Adapted Strategies for Survival
Once upon a time, in San Francisco, California, there lived a teddy bear. He loved sleeping and didn’t like walking around. But, one morning, when he was in bed, he was awoken by a tremendous shaking. The bed shook, the house shook; books and glasses and plates fell all around him. There was a huge noise. He was so frightened. He got out of bed and rushed outside. He saw that trees had fallen down; houses and apartment buildings had collapsed and were burning; schools were broken up and there were cracks in the ground. The sky was gray with smoke and dust. There was a horrid smell. The teddy bear got scared and wanted to run away.
But he decided to stay in San Francisco and help rebuild the city. He rescued injured people, put out the fires, cleared up the rubble from broken buildings and mended the roads. He was so busy helping people. After the clearing up was finished, he built new houses and apartments, schools, and hospitals. He planted trees and flowers, and sunshine returned to San Francisco.
The teddy bear has many faces. He is a policeman, nurse, teacher, fireman, doctor, volunteer, builder, truck driver, psychologist, social worker, mother, grandmother, father, grandfather. As he worked, he helped peace return to the city. It became clean and beautiful again. People began to be happy again and the teddy bear smiled and went back to his favorite pastime—sleeping. He knew that children, grownups, and the elderly know how scary an earthquake is but it is not the end. After an earthquake can come a new future (Baker, 1995).
When an earthquake struck Kobe, Japan, a densely urban community of commercial establishments, residential facilities, and industry, in 1995, Dr. Robert Baker, a Vietnam veteran and former clinical consultant at the National Center for Post-Traumatic Stress Disorder in Palo Alto, California, wanted to do something to help the young victims. He and his wife collected 10,000 teddy bears to give to the children of Kobe. Two months after the disaster, Dr. Baker, his wife, son, and other concerned Americans were flown to Kobe by United Airlines. An adapted version of the children’s story related above was used by Yoshiko Luscombe and Andrew Luscombe, coordinators of the Mental Health Support Team, to accompany the bears when they were given to children at a sports club and other sites. The bears became a symbol of love, support, and hope for the Japanese children as well as for the adults who cared for them. Based on the San Francisco earthquake, the tale told children what happened, helped them focus on working together to rebuild what was broken or destroyed and look toward a happy future. Along with the stuffed bears came efforts at normalization and validation of the children’s behavior after their tragic experience in the quake. Mental health support team managers helped over 2,000 children, their parents, other family members, and teachers over a 2-week period. Dr. Baker returned to Kobe several times. The presentations of bears and the accompanying attempt at normalization and validation of children’s behavior after their tragic experience in the quake helped to train the Japanese about trauma response and disaster reactions (Baker, 1996).
On the morning of January 17, 1995, at 5:46 a.m., the city of Kobe, Japan, was sleeping. Suddenly, an earthquake hit the area. The epicenter was on the Northern part of Awaji Island (N 34.6, E 135.0) at a depth of 14 kilometers (8.7 miles), registering a force of 7.2 on the Richter scale and 6 or 7 on the Japanese scale (Japan Meterological Association, 1995). It struck the southern Hoygo Prefecture and lasted 22 seconds, creating both vertical and horizontal movement that liquefied the landfill sections of the Kobe harbor facilities and much of the city itself. The devastation extended through central Japan, traversing an area 69 kilometers long (42.9 miles) and 3–9 kilometers wide (1.9–5.6 miles; Great Hanshin Earthquake Statistics, 1996; “The Quakes,” 1995). Prior to the devastation, Kobe was considered one of the most earthquake-prepared cities in Japan (“Up From the Ashes,” 1995). That belief proved to be very wrong.
When the disaster statistics were gathered officially some 6 weeks later on March 9, 6,269 persons were reported dead, 1 missing, and 14,679 injured. Approximately 1,000 children lost one or both parents. Almost half of the deaths were among the elderly: older persons tended to sleep on the ground floors of the multiple-story family homes and therefore were killed when the buildings collapsed upon them [International Psycho-Oncology Society (IPOS), 1995]. The massive extent of destruction also meant that many thousands lost relatives and friends as well as their financial livelihood, community, and a feeling of belonging.
Of the total 472,160 houses standing before the quake, 54,949 were fully destroyed and 31,783 were partially destroyed. Only 3% of the homes had earthquake insurance. Rebuilding would therefore mean large mortgage payments on limited land (“Up From the Ashes,” 1995). Many of these houses in Old Kobe were constructed with thin wooden supports and stucco. They collapsed as if they were houses of cards. The lower levels of many buildings pancaked as the quake caused vertical lifting and dropping.
“I can still hear my daughter cry for help,” murmurs an anguished father. The fifth grader was trapped when the roof of their home collapsed. She died in front of him. … Another resident … and his wife were sleeping side by side when their house fell on them. The old man managed to grab onto his wife’s hand, but, as they waited to be rescued, he felt it grow cold and still. (“Up From the Ashes,” 1995)
One physician reported treating 10 patients with crush injuries whom he eventually released. Nine of the 10 returned to the ruins of their homes and committed suicide. Property damage was over $8 billion. Port facilities were 90% destroyed.
One hundred seventy-six fires raged, and an area of 65.85 hectares (163 acres) burned to the ground. There were 7,046 fully burned and 331 partially burned buildings. Many of these fires were caused by knocked-over gas stoves; others, by sparks from damaged electrical wires. These fires continued for 3 days. Fighting them was difficult because broken water mains could not supply water to the hydrants. (Later, the head of the water department committed suicide.) The air became smoke-filled and the thick haze darkened the daylight hours. Survivors helped one another out of the rubble, gathering meager personal possessions if possible. Others tried to rescue trapped persons as the firestorms raged.
Elevated expressways collapsed in a way similar to the collapse of the 1–80 Cypress Street Expressway in Oakland, California, in the 1991 Loma Prieta/San Francisco earthquake. The quake twisted railroad tracks as if they were ribbons; it destroyed the monorail for the Bullet Train. Almost all of the 116 kilometers (72 miles) of waterfront was damaged; only 9 of the 239 berths escaped damage. One hundred six berths were restored by March 16, but the entire rehabilitation was expected to take 2 years.
Thirty-five schools were completely destroyed and 38 others were seriously damaged. Almost two thirds of all schools sustained some damage. Most were reopened by March 6. Two of three municipal hospitals were damaged. Three of the 112 total hospitals in Kobe were totally destroyed, 9 were half-destroyed, and 88 were slightly damaged. Of the 192 member companies of the Shoe Federation, 158 were seriously damaged. Twenty-one of 31 breweries were seriously damaged as well.
Four hundred forty-one temporary shelters housed those who survived. As of 1 week after the quake, 232,403 persons were residing in them; 6 weeks later, 114,679 people still remained.
The Stories of Kobe
The stories of Kobe are many. One story describes the agony of a gas service control point worker as he decided to turn off the gas supply to the city without proper authorization. His quick thinking saved many lives and averted immeasurable property damage. Cultural norms in Japan, as well as organizational procedures, required him to contact a supervisor before terminating natural gas services to millions of customers. If he made an independent, wrong decision, his act would cost millions of dollars to reestablish gas service to the entire area. The worker had seconds to decide to violate procedure, go against cultural tradition, and assume personal responsibility. However, through his action, he became known as the “hero of Kobe” although he was given no official recognition by the press.
Because many of the survivors were elderly, they had also survived the bombs and fires of World War II. They remembered March 14, 1945, when, at 2:20 a.m., American planes bombed Kobe, destroying 30% of the city and killing over 250,000 persons. One older woman, standing at the steps of her temporary housing unit, wondered out loud and asked “is this worse than the bombs and fires of WWII?” Thus, the history of the community was one of “planes from the sea, fire from the sky, … flames (leaping) more than 300 feet in the hot air, exploding gas tanks” that blew house apart, firestorms, and a quivering fireball sky (Thomas, 1994, p. ??).
Thomas (1994) continues that the devastation “looked like a no man’s land. Brick chimneys stood like stark tombstones over mounds of ashes and smoking rubble. The stench of death permeated the air… .” This quote was made by an American in Kobe in 1945. In this instance, though, the elderly seemed to universally agree that the 1995 earthquake was worse because of the lack of warning and the inability of citizens to seek shelter and to protect themselves, their loved ones, and their possessions.
The Helpers: Initial Responses
The initial response from government and community agencies was to provide food, water, and shelter, to conduct search and rescue operations, and to prevent disease. Perhaps hundreds more could have been saved had rescue operations started immediately after the quake rather than 4 days later. It took the Self-Defense Force 4 days to send 30,000 men into the most devastated areas. The Kobe City Earthquake Relief Headquarters was established at 7:00 a.m. on January 17, 1995. The over 61,000 rescue personnel consisted of 16,000 police officers, 3,400 fire officials, 14,200 fire volunteers, 25,700 self-defense forces, 1,520 medical staff, and 1,000 maritime safety agency personnel. Dr. Shinfuku Naotaka, M.D., Ph.D., in charge of the mental and physical care aspects of the operation, loosely supervised the Hyogo Prefectural Mental Health Welfare Center.
Sixty-four organizations and governments from 22 countries sent relief supplies to Kobe by March 14, 1995. However, supplies were often kept in customs quarantine for weeks (T. Larson, personal communication with the head of the Hanshin Team, Tokyo, February 9, 1995). Six foreign rescue teams of 106 persons and eight foreign medical teams of 75 persons also assisted in the rescue efforts. Even the Yamaguchigumi, Japan’s largest crime syndicate, provided food, water, blankets, and umbrellas (“Japanese Gangsters,” 1995).
Electrical service was reestablished within a few weeks and drinking water became available at distribution sites in about a month. It took months longer for sewer and tap water as well as gas service to be reinstated. Gas was 90.5% restored by March 24, and water was 99.9% restored by March 25.
One week after the earthquake, Western mental health professionals living in or near Kobe and professional and paraprofessional Japanese volunteers formed the Mental Health Support Team (MHST). The objective of MHST was “to provide an organization which would bring together experts in the field of mental health, crisis intervention, and disaster psychology who would teach and train those who would be caring for the survivors and their care givers” (K. Lemmon-Kiski, personal communication with President of the Kansai International Association of Counselors and Psychotherapist, February 2, 1995). Professor Naotaka took this organization under his wing as well and invited a training team from the National Organization for Victim Assistance (NOVA) in Washington, DC to provide 2½ days of training and consultation to over 200 MHST volunteers and other mental health professionals (“Counselors Due,” 1995). Dr. Tom Williams (one of the coauthors of this chapter) was a member of the NOVA team. At the close of the team’s stay, he remained in Kobe as a consultant to volunteers working in the shelters.
The Hyogo Prefecture government, for the first time in Japanese history, put counselors in all usable public schools to offer psychological stress counseling (“Next Step Dealing,” 1995). In addition, elementary and special education teachers were taught to use the teddy bears provided by Dr. Robert Baker in a clinical approach dubbed “bearapy.” Kyoto University’s Research Center for Disaster Systems and Disaster Prevention Research Institute added a mental health component to disaster research and planning with the help of visiting professor, Dr. Glen Edwards.
Once the safety needs and immediate environmental needs had begun to be addressed, officials began to recognize the apparent need to deal with the emotional aftermath of the earthquake. What did volunteers and professionals see? Children sat in the shelters in near catatonic states; workers dropped dead from pushing themselves beyond their physical limits. The culture of Japan demands such worker dedication and devotion and, if that level of dedication cannot be met or if self- and cultural expectations fail to come up to what is expected, then seppuku (ritual suicide) may become an accepted act. There were reports, largely unconfirmed, of seppuku following the earthquake.
In spite of this initial awareness of emotional needs, there was no system in place to provide the needed emotional support. The Japanese government, furthermore, refused to accept foreign aide unless it was given by a nongovernmental agency (NGO), and then only if an official invitation was given. The U.S. Department of Veterans Affairs (VA) and the Australian Department of Veterans Affairs had to wait for invitations, even though teams were ready to assist immediately after the quake. Because of the cultural mores of not accepting help from other governments, the teams were not invited. Individuals, instead, came to help. One such individual was Australian certified trauma specialist Glen Edwards who trained, offered support and consultation, and coordinated the work by international trauma specialists with MHST. Edwards remained in Kobe about 4 months.
Furthermore, the Japanese culture prescribes a stoic, private response to crisis situations. The mental health system in Japan, therefore, is not as formalized as it is in many western countries. There is no system of licensure for psychiatrists, psychologists, or social workers, and those professionals who have been trained in the United States, as is the case for Americans as well, have had little education in the fields of bereavement, disaster, and trauma. The Japanese caregivers had had almost no appropriate trauma-related training; in addition, many were exhausted; some were even living in shelters themselves; and many were vicariously traumatized as well.
The NOVA training team was among the first to teach the process of group debriefing. Sharing one’s emotional responses in a group format, as noted earlier, was not culturally acceptable. Yet the training provided was designed to give volunteers in shelters and professionals a road map of trauma responses of shock, impact, and resolution and intervention techniques. This training addressed the need to: (a) provide for or ensure safety and security; (b) provide a mechanism to allow survivors to ventilate feelings; (c) enable validations of feelings individually or with others, if possible; (d) predict general patterns of crisis reactions over time; (e) prepare survivors for future possible reactions; and (f) provide referral sources (NOVA, 1994).
Trained teams began their work at shelters on a twice-weekly basis only after receiving an invitation from a shelter manager. Ideally, the team consisted of a mental health professional, a university student, and two or three volunteers. Initially, the team helped at the food line or with individual needs (e.g., assisting a family to recover personal possessions from a destroyed home or arranging a visit by a public health nurse). After teams became known to and accepted by managers and refugees, they began to help survivors deal with emotional needs in the most acceptable manner possible. Team members played with children and provided lessons in knitting, music, art, and other areas while talking to parents about emotional aspects of survival. Soon, refugees were more than willing to start to discuss their emotional turmoil.
During the first 3 months after the earthquake, Dr. Shigeo Tatsuki organized the Kwansei Gakuin University Relief Volunteer Center and managed that Center’s crisis response activities. In June 1995, the Center, with help from the American Jewish World Service, organized a workshop on posttraumatic stress management for 24 helping professionals. The workshop featured Dr. Robert J. Lifton and others and taught critical incident stress debriefing, relaxation techniques, bibliotherapy, and other interventions. Dr. Tatsuki then participated in community-based debriefing group work projects between November 1995 and March 1996 with mothers of preschool children. The project’s team of social worker, clinical psychologist, and psychiatrist provided outreach services to local preschools under the auspices of the Kobe City Child Guidance Clinic. The Kobe Mother-Child Stress-Coping Research Project was conducted during the same period and looked at the impact of the earthquake on preschool children and their mothers as well as their coping styles. The project examined 438 questionnaires. Results of the questionnaires indicated that the majority of respondents had experienced major daily hardships after the earthquake (Tatsuki, 1997b).
A structural equation model of variables of postquake hardship, mothers’ stress, children’s stress, mothers’ preferred coping resources, and family cohesion and adaptability identified the following results:
1 Hardships caused by earthquake damage caused an increase in mothers’ psychological stress that, in turn, caused higher stress reactions among their children.
2 Mothers used internal and external resources to alleviate their children’s stress levels.
3 Family cohesion increased as a response to hardship stressors, but did not act as a coping resource to lessen stress levels in children or mothers.
4 Mothers who joined debriefing groups expressed their own emotions and lessened their own stress levels. They were taught that it was acceptable to express stress and that it was important that they, themselves, receive stress care.
The jichihai, or “neighborhood organizations,” with the assistance of the police, maintain records as to who lives at each residence and the location of distant family members. The government therefore knows where everyone in Kobe lives, and people also know their neighbors. In some instances, neighbors were assigned to shelters by neighborhoods. When this was possible, the relocation helped with natural recovery from loss and grief.
However, in many instances, it was not possible. The elderly and handicapped were given first priority for housing and were placed in temporary housing often far from their original neighborhoods. The death rate of these individuals, subsequently, was high. Over 70 of these “lonely deaths” due to alcoholism, dehydration, slips, falls, and natural causes had been reported by 1996 (Japanese Organization for Crisis Response, 1996). Many elderly have become isolated, discouraged, and hopeless. Neighbors who do not know them do not check on them because, culturally, they have been taught not to intrude. These elderly often say that they have lost everything. Meanwhile, those remaining in the shelters report that their bodies are getting weaker as they wait to return to their homes (IPOS, 1995).
DEALING WITH DEATH: INTERRUPTION OF NORMAL RITUALS
Persons who have experienced the multiple deaths of family and friends are particularly vulnerable to “bereavement overload” in Western culture (Kastenbaum, 1969). However, the religious beliefs of the Japanese more frequently follow Buddhist and Shinto beliefs and practices. Shinto beliefs rule the lives of the Japanese while Buddhism focuses on the death and afterlife (Pikin, 1989). The apparent attitude toward life that accompanies these beliefs is shoganai: “It can’t be helped.” Thus, after the earthquake, some persons wept but were ignored by others out of respect and a desire to provide them with privacy. The general populace showed no hysteria, and grief was private and muted (“The Quakes,” 1995). Mourners exhibited self-control in following the cultural injunction that states “do not burden others with your sorrow,” an injunction that was in conflict with the process and goals of critical incident stress debriefing and emotional self-care (Haberstein, 1963).
In addition, it was not possible for families and friends of the dead to complete traditional religious practices before and after cremations of the mass casualties. These practices would have allowed a formal, culturally specific mourning process to occur. The lack of crematoriums and absence of natural gas necessitated nontraditional funeral practices. The otsuya, the all-night vigil with the body, was not generally possible. During this vigil, in the Buddhist, Shinto, and Christian customs, family and friends stayed up all night eating, drinking, praying, and discussing the deceased individual’s virtues. In the Buddhist tradition, a priest led the sutras and prayers, burned incense, and helped attendees express sorrow, pray for the salvation of the soul, and show respect to for the departed. The body would then be cremated the day following the death.
The kaiso, or funeral reception, also was not generally possible. This reception traditionally occurred after the body was cremated or placed in a coffin, and took place in the home of the deceased at the family altar. In Kobe, after the quake, there was generally no time for such a reception, no food, and often no home in which to hold it. Another practice which had to be modified was the “honorable bone gathering” of the cremains. In this ceremony, the family, in a stylized format, pick the bone shards from the cremains and pass them from person to person. Many of the dead were incinerated in firestorms or trapped under collapsed buildings, their bodies were not available for quick ceremony. In contrast, services had to be held in large auditoriums of mourners and lasted only a few minutes instead of the usual day and night time period (K. Lemmon-Kiski, personal communication with President of the Kansai International Association of Counselors and Psychotherapists, February 2, 1995).
On the 49th day following the Kobe earthquake, the shinjunichi ceremony was to occur. During this ceremony, the kami, or spirit of the deceased, was to be installed in the family’s home shrine and given a new posthumous name. While this day was officially recognized and celebrated by many families, thousands and thousands of others were still living in shelters and, thus, they were unable to observe this ceremony in a proper fashion.
The Obon festival (Bon festival), a Buddhist/Shinto ceremony, is held every summer to welcome back the souls of the deceased to their homes for 2 days (Pikin, 1989). This national celebration was recognized in Kobe but, as was the case with the other ceremonies, could not be conducted in the family homes by the many who, even by this time, were still living in temporary housing and shelters.
The circumstances of the earthquake and the direction of the government therefore led to the suspension of normal funeral practices. In many cultures, the people would have expressed hostility toward that government as well as anger because of the slow emergency response. In Kobe, too, anger was apparent 1 year postdisaster. Yet this anger was often hidden and indirectly expressed because displeasure and confrontation are not generally expressed directly in the Japanese culture.
Dr. Williams, as he walked through a destroyed part of town on his way to lecture on grief and recovery, met an elderly man in street clothes who wanted to know where he came from. The man and the woman accompanying him were Buddhist priests who invited Dr. Williams to their damaged temple. The priest told Dr. Williams that God was everywhere and anywhere and did not need a temple; God was in the air. This priest, Sato Nichirin of the Hokke Sect, Satosensei, explained to Dr. Williams, using sumi ink and calligraphy to supplement the translation provided by Dr. Williams’ translator, the cultural and religious aspects of dealing with refugees. He said:
• You must have heart and teach from the spirit. You can look through 10,000 pieces of metal before you can find one diamond, one real teacher.
• You must recognize bad spirit in everyone, not just see the good. You must accept the bad with the good. If you are wise you can see the bad side so you can be whole.
• You should have anger toward the injustice done to others; if you expect anger from others, you will get it.
• You must have the power to endure. Teaching takes effort and patience.
• You must have life, have humanity, and be a natural person. If you live properly and be yourself, you are a natural person. A wise man knows he is stupid; a stupid man thinks he is smart. Don’t be afraid to be stupid. Life is difficult; deal with the hardships, do not hide from them. As with the drum, don’t hit life hard.
• You must study. Life is a study until you die. To understand takes time; this is very important.
• You can achieve peace by completing your mission.
Death is a release from the drudgery of human existence, he explained. The spirit continues through the cycle of life, death, and rebirth. Thus, Satosensei ventured the opinion that the quake was a result of humanity’s not respecting the earth.
One year after the quake, Dr. Williams again asked Satosensei about the affect on families of their inability to complete the traditional services in a proper manner. He and his lessor priest said that they were still finding kami that had not been properly dispatched and had been quite occupied in sending them off. He was more concerned with the spirits of the dead than the remaining families and had been finding spirits from the samurai days to assist with helping the kami to go beyond.
The Kyoto University Disaster Research Center is developing a national plan for crisis response that includes a mental health component. The program is also providing training and education and is creating a training manual that is more culturally appropriate than those available from western countries (Japanese Organization for Crisis Response, 1996).
When Tom Williams wrote the first draft of this chapter in 1996, Kobe had not yet been rebuilt. Buildings were still being torn down and new building had not yet commenced because the new master plan had not yet been approved. Government planners were seeking to recapture Kobe’s charm through a 10-year plan of rebuilding that intersperses residential areas, commercial enterprises, and nature.
The Japanese national and local governments, including emergency services, have publicly accepted that the disaster response to Kobe was poorly handled. Services that could have been offered were denied because they were not from NGOs or because formal capabilities were not available. Officials are now taking steps to have a response system in place prior to the next disaster.
As Tatsuki (1997a) noted, Kobe residents historically have been rather conservative in expectations about gender role performance. The dominant lifestyle for most urban females in Kobe is to remain in the home until children are in their teens. Mothers traditionally have used their own resources to lessen their children’s stress rather than to handle their own stress. The media also promoted the role of mother as “protector of children” after the quake, while companies expected fathers to return to the workplace almost immediately. Only through education and outreach did mothers learn to use their resources to lessen personal stress rather than to direct all their energies toward helping the children. This finding is extremely important for future policy planning in disaster management.
The need for mental health services is no longer seen as a Western phenomenon. This disaster has opened the gate for an awareness of the existence of emotional impacts and the need for healing. The Ago Shu Buddhist Association, for example, hosted an open forum for the citizens of Kobe on March 7, 1996. Over 450 people attended and participated in an educational debriefing on how to help neighbors and family members deal with earthquake-related emotional problems.
A new type of service provision in Japan has appeared—volunteers—to fill the gap between the needs of the devastated citizenry and the systemic governmental provision of services. Building upon the cultural concept of putting the needs of others first, persons are being trained in the techniques of listening skills, emotional responses to disaster, and provision of assistance to refugees. Prior to the use of volunteers in this disaster, there was no history of volunteerism or “volunteer culture” to guide the Japanese. No one had a sense of the status of a volunteer. It was the responsibility of teachers and master teachers to house and care for people in their neighborhood. They volunteered their services day and night.
Tatsuki and other Swansei Gakuin University professors created the Relief Volunteer Center to organize relief efforts for the first 3 months following the earthquake with 7,277 volunteers at 14 temporary shelters and other locations. Phases of emergency, development, and endings each lasted approximately 1 month. During the emergency phase, student relief volunteers mobilized in high numbers to move, sort, and store relief food and materials, prepare hot soup for victims, and build temporary toilets. Some volunteers patrolled shelters to ensure the safety of evacuees and increase external coping resources. The center encouraged volunteers to return to the same shelter and become acquainted with children, elderly, and handicapped individuals who were more vulnerable to stress.
During the development phase, the relief work began to empower individual citizens to form their own governance procedures. Asking for psychological help was seen as a sign of weakness and vulnerability; however, talking to a social worker or student volunteer (female) while the volunteer peeled an apple for the elderly individual was acceptable. Over time, the number of relief volunteers decreased. In certain centers, power struggles occurred as centers could not decide when to stop operation.
Many persons who survived the Kobe earthquake exhibited no symptoms of acute or posttraumatic stress (11% had no symptoms). What symptoms did appear? The primary symptom was one of reexperiencing through flashbacks and arousal (muscle tension, irritability, sleep disturbance). Second were symptoms of burn-out. Survivors tended to express their pain more physiologically than psychologically, through somatization that enabled them to ask nurses and other healthcare workers for help.
Dr. Robert Baker, coauthor of this chapter, provided the following commentary about the impact of the quake on him, personally.
As I walked through one neighborhood on my first day in Kobe, there were cars flattened and homes crushed. I saw children’s toys smashed by heavy timbers that were once main supports of their homes, now gone. It looked and smelled much like a combat zone. Visions of a war from my adolescent past intruded into the disaster area where children played, just weeks ago. I looked at one large apartment building from a distance of two blocks and wasn’t sure at first why it looked surreal to me. … Closer, I could see why. The third floor had collapsed into the second floor and the first floor had collapsed into the underground garage.
I also remember the Sports Club where all 10,000 teddy bears were housed for us at no charge. Outside the large building was the sports field (on which) the rubble of the City was being dumped about 15–20 feet high. … There were skyscrapers tilted to one side or … just a little shorter than before the quake.
I remember the horrible smell and sights of the neighborhood that lost 2,500 of its residents to the quake: the fire that burned so hot that only gnarled steel girders remained, as well as the smell of fire-burned ground, wood, plastic, and people. … I could not believe the smell was so strong after 2 months…. (Yet) the primary school in the same area had … new flowers and some greenery and … fresh paint… to help the children in the postearthquake environment to remember that a new day was unveiling itself to them…. The smell of fresh paint and the smell of smoke and dust mixed in the air to present a battlefield smell and feel. (Baker, 1996)
The Great Hanshin Earthquake was devastating in the loss of human life, the loss of property, and the dislocation incurred by many after its occurrence. Many survivors experienced acute stress disorder symptoms of shock and trauma. Persons who had lost loved ones suffered more intensely than those who had lost property alone. Speakers at a presentation at the 13th Annual Meeting of the International Society for Traumatic Stress Studies noted that the long-term effects of the earthquake were many. Among them were a decrease in population, reduction of industrial production due to closed and/or damaged factories; unemployment; change in physical community and dislocations of residents from their home neighborhoods; increase in school phobia and divorce; and increase in alcohol consumption.
A major problem area was that of temporary housing. By November 1997, 50,000 persons still remained in temporary housing. Frequently these units, assigned by lottery, are far from the original community of the inhabitants. Thus these individuals, many of them aged and/or sick, are now located far from their relatives, their communities, hospitals, stores, and resources. Their new neighborhoods have become concentrations of urban poverty. Cultural practices that reinforce the sanctity of the neighborhood and provide care for elderly who remained in their home now undermine adjustment of individuals who had been torn from their original locales.
This chapter began with a story, a story of a teddy bear. The chapter ends with a story, the story of the creator of “Teddycare,” when he met the children of Kobe.
In his reflections of his experiences in Kobe, Dr. Baker describes the following to the senior chapter author (March, 1998):
The children I met on my first visit were hollow-eyed but cleanly dressed. When entertained by the teddy-bear story, they seemed to brighten up, smile, and laugh as they learned that teddy bears of all types (fire fighters, police officers) worked together to rebuild their city. During the story of the teddy bear that saved San Francisco, as I presented bears to individual children, that child thought of the bear as his or her gift.
No country is immune from disaster and no country that experiences a disaster is immune from its short-term acute impacts and long-term traumatic responses. The extent and nature of those responses vary with the number of stressors, community support, and cultural factors. As we have seen, cultural factors influenced the response to the quake and the responses of community after the quake, particularly, as noted here, in treatment of the dead. Response to community disasters varies. In the case of Kobe, individuals stepped in to serve as focal points for community interventions. Whether delivering teddy bears, leading workshops, or organizing volunteers, these individuals fostered community grief resolution and healing. Perhaps the lesson learned most from Kobe is that no government or city can function totally alone or in isolation when faced with a crisis of this magnitude. If the occurrence of this earthquake has taught countries of the world that they must work together to protect the populace either prior to a disaster or postdisaster, then some meaning has been found in an otherwise horrific event.
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