Nine years on, Fukushima’s mental health fallout lingers

Wired Magazine ignores the reality of radiation for Fukushima residents. It’s one thing to stigmatize the mental health of those living there, but it’s an entirely different to act as though radioactivity is not, in fact, a real threat!

Beneath the obligatory ‘subsiding’ spin, there are some heroic citizen scientists at the heart of this article…
& more than mental health ‘still’ at risk

Mizue Kanno, 67, a Fukushima evacuee and anti-nuclear activist, recalls Yamashita telling an audience in Japan just eight days after the accident, “Radiation does not affect people who smile. It affects people who worry.”

His comments caused furore. “My friend and I took a photo of us smiling at the evacuation centre when he said that. And we both still got cancer,” says Kanno, pulling down her turtleneck to show a neat scar across her neck. “They took half my thyroid.”

The road from Namie (pop. 1,238) to the Fukushima plant

If it were not illegal, Ayumi Iida would love to test a dead body. Recently, she tested a wild boar’s heart. She’s also tested the contents of her vacuum cleaner and the filter of her car’s air conditioner. Her children are so used to her scanning the material contents of their life that when she cuts the grass, her son asks, “Are you going to test that too?”

Iida, who is 35, forbids her children from entering the sea or into forests. She agonises over which foods to buy. But no matter what she does, she can’t completely protect her children from radiation. It even lurks in their urine.

“Maybe he’s being exposed through the school lunch,” she says, puzzling over why her nine-year-old son’s urine showed two-and-a-half times the concentration of caesium that hers did, when she takes such care shopping. “Or maybe it’s from the soil outside where he plays. Or is it because children have a faster metabolism, so he flushes more out? We don’t know.”

Iida is a public relations officer at Tarachine, a citizens’ lab in Fukushima, Japan, that tests for radioactive contamination released from the 2011 accident at the Fukushima Daiichi nuclear plant. Agricultural produce grown in the area is subject to government and supermarket testing, but Tarachine wants to provide people with an option to test anything, from foraged mushrooms to dust from their home. Iida tests anything unknown before feeding it to her four children. Recently, she threw out some rice she received as a present after finding its level of contamination – although 80 times lower than the government limit – unacceptably high. “My husband considered eating it ourselves, but it’s too much to cook two batches of rice for every meal. In the end we fed it to some seagulls.”

Tarachine is one of several citizen labs founded in the wake of the Tōhoku earthquake and tsunami on March 11, 2011, which obliterated a swathe of the country’s northwest coast and killed more than 18,000 people. The wave knocked out cooling systems at the Fukushima Daiichi nuclear plant, triggering a meltdown in three of the reactor cores and hydrogen explosions that sprayed radionuclides across the Fukushima prefecture. More than 160,000 people were forced to evacuate. A government decontamination programme has allowed evacuation orders to be lifted in many municipalities, but one zone is still off limits, with only short visits permitted.

Driven by a desire to find out precisely how much radiation there was in the environment and where, a group of volunteers launched Tarachine in Iwaki, a coastal city that escaped the worst of the radioactive plume and was not evacuated, through a crowdfunding campaign in November 2011. It is now registered as a non-profit organisation, and runs on donations.

In a windowless room controlled for temperature and humidity and dotted with screens showing graphs, two women sort and label samples, either collected by staff or sent in by the public: soil from back gardens, candied grasshoppers, seawater. In the beginning, mothers sent in litres of breastmilk. Tarachine initially charged a tenth of what a university lab would charge to make the testing accessible to as many people as possible; last year, they made it free.

To test for caesium-137, the main long-term contaminant released from the plant, staff finely chop samples and put them inside a gamma counter, a cylindrical grey machine that looks like a centrifuge. Tarachine’s machines are more accurate than the more commonly accessible measuring tools: at some public monitoring posts, shoppers can simply place their produce on top of a device to get a reading, but this can be heavily skewed by background radiation (waving a Geiger counter over food won’t give an accurate reading for the same reason). Tarachine tries to get as precise readings as possible; the lab’s machines give results to one decimal place, and they try to block out excess background radiation by placing bottles of water around the machines.

Measuring for strontium, a type of less penetrative beta radiation, is even more complicated: the food has to first be roasted to ash before being mixed with an acid and sifted. The whole process takes two to three days. Tarachine received training and advice from university radiation labs around the country, but the volunteers had to experiment with everyday food items that scientists had never tested. “There was no recipe like ‘Roast the leaf for two hours at so-and-so Celsius’, you know?” says Iida. “If it’s too burnt it’s no good. We also had to experiment with types of acid and how much of the acid to add.”

Japanese government standards for radiation are some of the most stringent in the world: the upper limit of radioactive caesium in food such as meat and vegetables is 100 becquerels per kilogram, compared with 1,250 in the European Union and 1,200 in the US (the becquerel unit measures how much ionizing radiation is released due to radioactive decay). Many supermarkets adhere to a tighter limit, proudly advertising that their produce contains less than 40 becquerels, or as few as 10. Tarachine aims for just 1 becquerel.

“How I think about it is, how much radiation was there in local rice before the accident? It was about 0.01 becquerel. So that’s what I want the standard to be,” says Iida.

Ayumi Iida in the Tarachine radiation testing lab

Nine years on from a disaster known locally as Japan’s 9/11, victims continue to deal with the ongoing aftermath of the nuclear accident. Tsunami survivors in other prefectures are moving on. But few in Fukushima feel the crisis is anywhere close to resolved.

Some radiation experts would say women such as Iida are unduly worried about radiation – paranoid, even. Global agencies charged with creating radiation guidelines and advice – the International Commission on Radiological Protection (ICRP), the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the International Atomic Energy Agency (IAEA), and the World Health Organization (WHO) — have said that radiation levels in Fukushima have been much lower than in Chernobyl and predict no discernible increase in future cancer rates and hereditary diseases as a result of the accident. Estimated internal doses, based on reconstructions, are much lower than among those affected by the 1986 Chernobyl accident, which has been attributed to comprehensive food testing and lower consumption of wild or foraged food.

The secondary effects of the disaster seem more lethal than the radiation itself: although no one was killed by the initial explosion, the hurried evacuation of hospitals and nursing homes led to 50 deaths, due to hypothermia, dehydration, and lack of support for medical problems such as renal failure. Countless people trapped in the rubble after the quake and tsunami likely died as a result of the rescue effort being called off as the radioactive plume spread. And, in the years since, a prolonged evacuation – so long that some say evacuees have more in common with refugees than disaster survivors – has been linked to suicides, heart disease and other illnesses that have caused 2,286 deaths – more than those killed by the tsunami in the prefecture. Diabetes and other lifestyle diseases have spiked alarmingly. Overstretched medical staff and social workers are suffering from burnout, insomnia and other stress disorders.

Under current international guidelines, the radiation released meant that the initial evacuation was unavoidable. And while the Japanese government has tried to move people back to evacuated areas as soon as possible by hiking the legal annual exposure limit for ordinary citizens in Fukushima from 1 millisievert per year to 20, previously the limit for nuclear plant workers, the move has enraged the public. Not only does the new limit mean some re-opened areas would be classed as uninhabitable elsewhere in Japan and the rest of the world (the ICRP recommends a public dose limit of 1 millisievert per year on top of regular background radiation levels), the government also uses it as justification for cutting off financial aid to former residents once evacuation orders are lifted. A special rapporteur from the United Nations Office of the Higher Commissioner on Human Rights has urged Japan to stop its relocation policy to protect the rights of children and women of reproductive age.

The government also raised the limit for nuclear workers from 20 millisieverts per year to 250 millisieverts, a level permitted by the IAEA for emergency situations.

Michiko Sakai, whose husband worked at the Fukushima Daiichi plant

“It was this unthinkable level! My husband was so angry,” says Michiko Sakai, whose husband, Hiroaki Sakai, worked at the plant. He was summoned a week after the accident to go up in a crane to inspect the damage to the fourth reactor, and received a dose of radiation equivalent to half the new annual limit. He was later diagnosed with salivary gland cancer.

Some workers have been awarded compensation after Japan’s health and labour ministry recognised their leukaemia or cancer as a “work-related” health issue. The first was 41 years old, and had received an accumulated dose of 16 millisieverts — well under 100 millisieverts, the level beyond which international agencies say a statistically significant increase in cancers is observable.

“They say it’s nothing to do with the radiation. But it makes you think. My husband says we can’t know,” says Sakai. “People around him say, why don’t you sue? But he says, there’s no proof. We just can’t know.”

The precise relationship between doses of ionising radiation and their effect are the subject of fierce debate. Some scientists believe the dangers have been exaggerated, while others believe that even low doses over time may induce cancer.

After the accident, Fukushima Medical University set up the Health Management Survey, a study consisting of four parts to track the physical and mental health of the two million people who had been in Fukushima at the time of the disaster. One part is a screening for thyroid cancers among those who were children at the time of the accident, as a higher incidence of these cancers was the biggest physical health impact observed after the Chernobyl disaster. From the outset, Dr. Shunichi Yamashita, a government-appointed radiation risk management adviser who led the screening, emphasised that the survey was primarily being conducted to assuage anxiety about radiation.

To date, 186 cases of thyroid cancer among children have been found. Doctors at FMU contend that these are likely due to the “screening effect”, in which widespread testing of a population – 300,000 children, in this case – turns up diseases that would otherwise have remained undetected. They add that thyroid cancers only appeared to increase four years after the Chernobyl accident, and in Fukushima most were found in the first round of screening, with fewer diagnoses each round. The age pattern of children with tumours in Fukushima is also different to that in Chernobyl, where incidence was higher amongst younger children.

But some activists and doctors reject these explanations, arguing that doctors in the USSR missed tumours in the early years because they were diagnosed by hand rather than ultrasound. They also note that thyroid doses have only been estimated based on reconstructions, rather than actual measurements taken immediately after the accident.

Mizue Kanno, 67, a Fukushima evacuee and anti-nuclear activist, recalls Yamashita telling an audience in Japan just eight days after the accident, “Radiation does not affect people who smile. It affects people who worry.”

His comments caused furore. “My friend and I took a photo of us smiling at the evacuation centre when he said that. And we both still got cancer,” says Kanno, pulling down her turtleneck to show a neat scar across her neck. “They took half my thyroid.”

Data from Chernobyl shows that the incidence of thyroid cancers rose only in people who were exposed to high doses of radiation as children, making it unlikely that Kanno’s tumour was caused by the release at the Fukushima plant. Nonetheless, to Kanno and others, Yamashita’s remarks have become a symbol of what they perceive as the medical establishment’s callous arrogance.

In response to parents’ concerns, Tarachine opened a clinic in 2013 where anyone – even adults – could have their thyroid checked, or get a second opinion. “In Japan, everyone has a lot of respect for doctors and sees them as kind of superior, so people don’t find them very approachable and they find it hard to ask questions,” says Iida. Since radioactive iodine, which causes the thyroid tumours, has a half-life of just eight days and was fully decayed within a few months of the accident, the government screening only covers children born before the accident. Iida has had her three children born since the accident tested anyway.

“I think we just can’t know for sure,” she says. “You often hear, ‘Statistically, this number of people in Fukushima will get sick’. But mothers can’t relate to that. I have a child right in front of me, that’s who I’m concerned about.”

Masaharu Tsubokura, a radiation specialist at the Soma Central Hospital in Fukushima

Sakai and her husband’s home in Namie was swept away in the tsunami. “Completely obliterated. There was nothing left. Only the concrete foundations,” she recalls. Because of radiation levels, it was three years before she was allowed to go back to see the devastation for herself.

By then, her family had been broken up: her husband was working at the plant and living in a company dormitory nearby, while her mother-in-law moved into temporary government housing to be close to her former neighbours. With her son at university, Sakai and her daughter moved inland to Fukushima City.

“If we had been pulled apart by a natural disaster, I think we would have been able to knit the family back together. But because of the radiation, we were separated,” Sakai says. She lost friends after her village community was scattered during the evacuation. “I had no sense of who was dead and who was alive. Even if I heard they had died [in the tsunami], I had this feeling that they’d just evacuated elsewhere. The realisation that they were dead didn’t hit.”

Some of the few community ties that remained have been aggravated by enmity over compensation money. Evacuees have even been bullied for receiving compensation – to the extent that Sakai didn’t tell her new neighbours where she was from, not wanting to invite resentment.

“What the radiation broke was my heart,” she says. “It’s not about my body being exposed. You can measure that. But the emotional pain it causes – you can’t see that.”

Indeed, the impact of the nuclear accident goes well beyond worries about the physical impact of radiation: in 2017, fewer than two per cent of callers to a mental health helpline for Fukushima evacuees touched on radiation-related concerns, in contrast to other health issues, which were discussed in 80 per cent of calls, and family issues, which came up in a third.

The motorway exit for the site of the Fukushima Daiichi plant

The accident forced tens of thousands out of their homes, shattering communities, wrenching apart families, and robbing them of their jobs. Evacuees have lived in limbo for years, not knowing when they will be allowed to move home, or even whether they want to, given the shrunken and now inconvenient towns that await them.

“The consequences of the radiation accident is not purely about exposure to radiation. It’s also not purely psychological. It’s changes in lifestyle, family issues, changes in society, hospitals closing, stigma, bullying, money,” says Masaharu Tsubokura, a radiation specialist at Soma Central Hospital in Fukushima. “Hardly anyone here talks about radiation. Those people don’t come back.”

Those most concerned about radiation fled as far as they could, and stayed away; some even moved to Okinawa, the island prefecture south of the Japanese mainland. Some 30,000 evacuees still live outside Fukushima prefecture.

Over the past nine years, as background radiation levels fall and evacuation orders have gradually been lifted, the government has encouraged — or pressured, through the withdrawal of financial aid — people to return. But the longer it took for the evacuation orders to be lifted, the fewer people came back. Towns have been left frozen in time, and still lack supermarkets, schools, hospitals and clinics — not to mention citizens.

In Okuma, once a picturesque town of 11,500 people, curtains are blowing through broken windows. Huge, grand houses nestled into golden hillsides have been ruined with mildew, and are too contaminated to live in. There is a small patch where decontamination has beaten background radiation back enough to meet the government standard. Here, a tight cluster of grey identikit prefabs have been built for former residents. Across the road are similar units for those who work at the nuclear plant or in decontamination.

In an airy, high-ceilinged cafeteria, bearing the faintly plasticky smell of fresh construction, men in work clothes queue up with trays. “I never usually come here. There’s nowhere to meet friends,” says Masumi Kohata, a local council representative. “They’ve built a bar, but that’s only for workers — the residents are all elderly and don’t go out drinking.”

Only between around 10 to 15 per cent of former residents of towns close to the plant, like Okuma, express a desire to return, and actual returnee rates are even lower. Shrinking and ageing populations are a problem all over rural Japan, but in the towns affected by radiation, the effect is particularly acute. The nuclear accident functioned like a second, ageist tsunami: the plume dragged everyone out, but the riptide of government policy deposited only the elderly back. Those over 60 feel more intensely a traditional obligation to be close to their ancestors’ graves. Younger people tend not to come back due to a lack of work opportunities, schools for their children, or because they have settled elsewhere.

Kazuma Yonekura, a psychiatric nurse who works at a clinic in Minamisōma

In many cases, men stayed behind for work in Fukushima while their wives and children moved elsewhere in Japan. Such stresses led to the break-up of so many marriages that a new word was coined: genpatsu-rikon, or nuclear divorce. Other families were split along generational lines as younger members moved away. Even those who evacuated inside Fukushima were often separated from their communities, leading to the disintegration of the social fabric. On average, evacuees have moved four to five times; eight moves is not unusual.

“The extended evacuation meant people couldn’t settle down and come to terms with what had happened. They didn’t know whether to make a decision to move back, or to put it off. They were – some still are – living in limbo,” says Kazuma Yonekura, a psychiatric nurse at Nagomi, a clinic in Minamisōma that is part of Kokoro No Care, a mental health organisation that has been set up in the wake of disasters since the Kobe earthquake in 1995.

Compensation money and the loss of work meant people smoked more, gambled more, and drank more; in 2014, one in five male evacuees and one in ten female evacuees in Fukushima were considered problem drinkers. Those who had lived active lives were suddenly cooped up in cramped temporary housing units; the change in lifestyle and diet, compounded by stress and inactivity, has triggered a massive rise in diabetes among the middle-aged and elderly. Some 10,000 people are considered at risk of depression.

Yonekura recalls one nuclear plant worker in his 40s who took sleeping pills with alcohol, knocking himself out for such long periods that he got bedsores. “We realised that medical treatment could only go so far,” says Yonekura, who brought the man to soup kitchens and fetched hot water from a local bathhouse when he couldn’t pay his gas bill. “Doctors can give out prescriptions, but then it’s left to people to change their lives.”

After waiting for so long, returnees often become depressed upon encountering the reality of their unrecognisable hometowns: suicides spike in towns after the evacuation orders are lifted.

The stress of seeing one’s old life wiped off the map can be equally distressing. “My friend decided to move back here and build a new house to make a fresh start,” says a waitress named Aiko Watanabe in a cafe in Tomioka. “But when she watched her old house being demolished, she had a heart attack, and died.”

Not all such deaths are included in the official count of “disaster-related deaths”, which now stands at 2,286 — compared to 469 in Iwate and 928 in Miyagi, the other two prefectures also affected by the tsunami. The nuclear accident has drastically complicated Fukushima’s recovery. Due to the scale and complexity of issues that victims still face, Kokoro No Care will continue to operate in Fukushima for 20 years in total, even though it was wound down after five years in Miyagi and Iwate.

But staff at Kokoro No Care and other relief workers, such as civil servants and medical staff, are overstretched. Three years after the disaster, nine per cent were considered at risk of suicide, and 18 per cent had symptoms of depression. “People working in support roles have too much work but they feel they can’t quit. Citizens are depending on them, but they feel stuck and can’t cope,” Yonekura says.

“That’s what the radiation accident caused. A loss of purpose. The loss of feeling at home, the feeling of being connected. There’s many people who suffered from that. And a lot of people suffered from the perception that they or their products were contaminated.”

Masahura Maeda, a professor at Fukushima Medical University’s department of disaster psychiatry

Stigmatization is one of the reasons doctors want to quell concerns around radiation. Children and adults from Fukushima have been bullied because of where they are from; some evacuees were initially refused entry to friends or relatives’ homes because they were perceived as being a danger.

“Some friends said we were still contaminated. I wasn’t offended, I think they were right,” says Kanno. “In Osaka, I felt like a mouldy orange. You know when an orange rots in a cardboard box, it spreads the mould around? That was me… I thought a mouldy orange should stay put and not spread the contamination around.”

Some 30 per cent of people in Fukushima believe the effects of radiation exposure are hereditary, with 15 per cent of people thinking it is “very likely” – in spite of the Life Span Study tracking 86,000 survivors of the atomic bombs dropped on Hiroshima and Nagasaki finding no evidence of this.

“Many people believe that these women should not get married or reproduce. That’s really worrying,” says Masaharu Maeda, a professor at Fukushima Medical University’s (FMU) Department of Disaster Psychiatry who has led the mental health response for evacuees. The stigma is even worse outside Fukushima: in one survey of 1,000 people in Tokyo in 2019, 40 per cent thought the effects would be transmitted to the next generation.

Maeda says that concern has fallen in Fukushima due to public education campaigns, pointing to a survey showing that just under a third of respondents in Fukushima now believe that effects are hereditary, down from half in 2012. But he and other doctors are worried about the small group of people – the 15 per cent – who still believe that they or their peers are genetically contaminated, despite official reassurances. In a survey of evacuees, Maeda and his colleagues were shocked to find that the biggest risk factor for “severe distress” was increased perception of risk from radiation exposure and the belief that it would affect one’s children or grandchildren.

“That’s the tricky thing about radiation,” says Koichi Tanigawa, vice president of the FMU and senior director of the Radiation Medical Science Center. “Someone’s way of thinking or what they believed [before the accident] has quite a big influence on their understanding of the issue. Scientific figures or research isn’t going to do much to change their mind.”

The full impact of the accident will take years to emerge – and even then, assessments will differ. Deaths caused by radiation-induced cancers may well be under- or overestimated, due to the difficulty of isolating radiation as a cause amidst a tangle of other lifestyle factors. Deaths from diabetes as a result of the evacuation may never be counted.

“A manmade disaster is much harder than a natural disaster,” says Maeda. He notes that after natural disasters, such as the earthquake in Kobe, it usually takes around five years for people to “recover”. One marker of this is the construction of a memorial, which allows people to begin mourning. Another is when the majority of those affected no longer consider themselves victims. “If you look at Fukushima,” Maeda says, “it’s nowhere near. The disaster is still ongoing.”

https://www.wired.co.uk/article/fukushima-evacuation-mental-health

July 10, 2020 Posted by dunrenard | Fukushima 2020 | Fukushima Disaster, radiation, Spin | Leave a comment