Abstract
Keywords
When major disasters occur, the way in which individuals, organizations, and countries respond greatly depends on their own experience. Taiwan and South Korea’s effective containment of COVID-19 might be attributed to their more active stance in making preparations for an epidemic after both coped with SARS poorly. This unique failure experience proves crucial in driving home the ‘universal principle’ that daily preparation is important, although by itself it does not work well, for people tend to just shrug it off and never learn, as exemplified by the incompetent handling of COVID-19 almost everywhere else. Consequently, when we learn from others’ experience, it is of paramount importance to not only draw general lessons but also understand the contexts in which decisions and choices are made.
In terms of dealing with the various health needs of victims of the Great East Japan Earthquake and the subsequent nuclear accident, the present volume edited by Dr Tsujiuchi provides precisely that context. The collection of academic articles, which results from a comprehensive health care project carried out by a group of scholars, consists of depictions of rescue and support activities in Part I and findings through survey responses from victims in Part II.
The book starts strongly by raising empathy, at least from those who experienced the disaster of 11 March 2011 and its aftermath. Reading its first chapter after running through the foreword and introduction made me almost relive my tense five days from the earthquake to my family’s evacuation from Tokyo, myself left behind. The chapter adopts an anthropological approach to record how the project began, starting from the scene where Tsujiuchi and others headed to an evacuation site in Saitama Prefecture, to their encounter with ‘the Shinsai Shien Network Saitama,’ which later became an important collaborator in the project, to the preparation process of a questionnaire survey – the first activity of the project. Unfortunately, when it was almost ready the survey had to be suspended due to the circumstances within the local government, which had requested it in the first place. My experience was of course a far cry from these much tougher situations that Tsujiuchi and his colleagues had to deal with, but the events documented in Chapter 1 of Part I create a context that I can share – even if only partially, thus showing a promise of lessons to be learned.
The following three articles in Part I further enrich that context from several perspectives. Chapter 2 depicts how project members and other players with different expertise worked together to provide care for victims, and their diverse views are introduced. Chapter 3 brings in medical insights by outlining post-disaster activities supporting the local public health system. Chapter 4 explores ways in which children and their families can be supported through a series of case studies on ‘social gathering,’ thus adding the viewpoint of victims and their families. In contrast, the last two articles in Part I are somewhat elusive: Chapter 5 introduces an effort to provide support and consultation through radiation measurements conducted in Fukushima; Chapter 6 ventures to discuss the role of collaboration in the post-disaster society.
Now that the necessary context has been laid out, Part II of the book moves on to present the results of surveys conducted with victims of the disaster. Chapter 1 establishes the basis for discussion across the part by reviewing literature on mental health damage caused by the earthquake. Chapters 2 through 5 and 8 make use of data from the same set of questionnaires, which appears to be an updated version of the suspended survey mentioned early in Part I. In addition to this core set, Tsujiuchi in Chapter 2 looks into various other surveys in which he was involved. He focuses on psychological stress cases and traces changes in the levels of stress over time as well as possible factors triggering them. Notably, Tsujiuchi’s analysis makes use of Johan Galtung’s concept of ‘structural violence,’ whereby he points out that the psychological stress from which victims suffered was not only enhanced by individual factors and circumstances but also by social and structural problems. In Chapter 3, analyses of two surveys of evacuees from Fukushima reveal that ‘social capital’ has a strong impact on mental health in the population affected by the disaster. The author of Chapter 4 finds that ‘social ties’ have on average weakened among the victims after the accident, with those who had such experience likely to have higher levels of stress. In Chapter 5, multiple logistic regression analysis is performed in an attempt to uncover factors affecting levels of stress. Chapter 8 takes a different approach from these chapters and looks at the living conditions of people who were evacuated from Fukushima to other prefectures and their intentions to return.
Chapters 6 and 7 treat families that were evacuated from Fukushima as units of their analyses. Chapter 6 makes comparisons on the current status of these families, following how their living conditions and emotions change as well as highlighting the differences between each family’s situation. Chapter 7 interviews two families that participated in the activities described in Chapter 4 of Part I and shows in detail how crises and frictions unfold both within and outside the families. Chapter 9, which addresses the issue of compensation for the nuclear accident victims and evacuees, can be seen as largely independent of other chapters.
The diversity of approaches presented in both parts certainly substantiates the main claim of this book, which is well characterized by its subtitle, although I cannot help wondering if the publisher could have proposed a better term than ‘holistic health.’ Indeed, one of the most valuable lessons that we may draw from this book is that it is important that experts from various fields realize that health takes more than a singular approach and cooperate closely while working in parallel with each other. Only by doing so can the various health hazards, which may threaten disaster victims in all kinds of ways, be eliminated as much as possible.
That lesson is not just an abstract image. Chapter 1 of Part I, for example, depicts a specific field situation in evacuation centers that called for a comprehensive approach, which materialized in the form of a ‘revolutionary idea’ of labeling counseling service booths as ‘Anything Goes Consultations’ rather than ‘Mental Health Care.’ The rationale goes that the victims’ psychology is, by the nature of their horrifying experience, very complex, causing all sorts of exhaustion and anxiety, and it is too simplistic to bluntly attribute such feelings to mental illness (p. 15). Assuming the victims require ‘Mental Health Care’ interventions can thus feel insulting and alienate them. The complexity of the problems faced by disaster victims is further underlined by the survey results in Part II: structural violence (Chapter 2) turns out to be the dominant factor the stress victims suffer from, and some of the combined effects and confounding factors (Chapter 5) make matters worse.
While these discussions help us better appreciate the scope and complexity of the issue at hand, a closer look reveals flaws. The same Chapter 5 mentioned above happens to also contain extremely problematic statistical processing and interpretation. The multivariate analysis aimed at finding out what factors may affect levels of stress needs to statistically test many relationships. However, the strict significance threshold for individual tests that is generally required to avoid the multiple testing problem is nowhere to be found. Even more troubling, once the author figures out that no reliable correlation can be established between his hypothesized factors and subjects’ stress level in a particular group, he takes a rather unorthodox step and concludes by abruptly introducing some seemingly arbitrary new data, without even bothering to apply his chosen statistical tool to them (p. 177).
Other than occasional sloppy methodology, I also feel that the book overall could have benefitted from better editing. While one should not expect much continuity or consistency out of a collection of articles, the book is unnecessarily verbose yet fails to provide key information where necessary. For example, most chapters in Part II include a brief and similar description of the earthquake or the nuclear accident at the beginning, which can get old pretty quickly. Meanwhile, although the content of the core surveys in Part II is summarized in Chapter 2, their details are scattered around in each chapter, making it impossible to grasp the whole picture and leaving one wonder whether survey items are shown in their entirety at all.
Despite these problems, I believe important lessons with regard to supporting disaster victims can be drawn from the book. It also presents a great opportunity to confirm that these lessons and related concepts often need to be found in their contexts. The data, i.e., survey results, through which such conclusions are reached make it possible for anyone with good intentions to find the context they need. Hopefully that will prove helpful enough in generating useful insights for researchers and practitioners of immediate relief and long-term reconstruction after ongoing and future disasters.