PTSD and Me

Evidently doctors hate it.  Our ability to self-diagnose and the like, all thanks to WebMD and more has them collectively annoyed.  "I think I have..." is at the top of their list of dislikes.  Do I do this, too?  Yes.  Watch me.  I'm going to right here.

I temper my self-diagnosis lest my doctor reads this.  Let's say I perhaps, I maybe show signs and symptoms.  I might be a candidate for treatment.  When insomnia lies next to me in bed poking me in the ribs just as I start to doze, the nights when I truly can't sleep are when I wonder.  Do I have PTSD?

I've been on vacation for a week.  I don't relax well, something to discuss and review on another day.  My husband and I have talked for the entire duration of my time off how we should go to Emma's Pizza.  We are the couple that always orders a half 16, half 17.  We've done so for years.  The servers know us by what we eat.  There's comfort in this routine.

Except I discovered the Canadian ham and carmelized onions concoction that has my name all over it, so there goes our routine.  In with the new.  It's delicious.

It took us a week to get here, to Emma's.  We made it tonight and shocked the server when we ordered a half five, half 19.  There was a bit of delight in this, the shocking of our server.  We smiled to ourselves as she walked away in amazement, quite the mysterious couple.  Alas.

My husband and I chat.  We look at the other customers.  I tell him why I didn't like the film we watched last night.  We remember what we had scheduled for Thursday.  Then I hear it.  My head jerks towards the big window.  My breath catches and only when I realize what just happened do I release.

A man on a Harley Davidson rides by.  The low rumble was his motorcycle.  I know that now.  Several seconds ago I knew that in some corner of my mind, the intellectual side of me realizing the low rumble was not the precursor announcing an earthquake, the warning many in northern Japan have gotten accustomed to.  Isn't it nice that the earth warns us when an earthquake is about to hit?  To be warned?  So we can prepare?

No.  There's nothing comforting knowing an earthquake is coming.  We can't stop it.  The rumbling, how loud it is or how long it lasts in no way determines how big the quake will be or how badly we will shake.  We sit, clutch the arms of our chairs and wait.

I've also found myself freezing as the walk-up apartment my husband now lives in shakes when our third floor neighbors begin their exercise routine.  Somewhere in the back of my mind I know this is not an earthquake.  My body, however, does not operate with the same speed.  I cringe.  I begin to shake.  I walk through airports with the same discomfort.  The floor of the terminal bounces only slightly with the passing of a jumbo jet and in my mind this is an earthquake.

Surely these symptoms do not reflect comfort with my surroundings.  The man on his Harley tonight did not bring warnings of an earthquake.  My mind, however, did not register safety.  Quite the opposite.  I braced myself for the impending earthquake.

Is this PTSD?  I'm in no position to diagnose but that doesn't stop me from wondering.  Three years of aftershocks, some mild and others severe has my response system on edge.  I'm a taut wire ready to snap or so it feels when I assume I might be facing danger.

I have no practical solution to appease myself, to tell my mind the rumblings in our favorite pizza restaurant will cause me no concern.  Is there a solution?  Will I grow out of this?  Move on?  Get over it?  I don't know.

I live with this ambiguity because I see no other alternative.  So it is.

I Am Not Depressed

I will never say or write any given culture is superior to another.  Elements of a culture may be beautiful.  More beautiful than others.  Elements of a culture may be cruel.  How I define this beauty and cruelty is mine.  Yours may differ.  Your definition and mine probably won't always intersect in a peaceful and harmonious way.  Some days this is just fine.  Other days it's anything but.

Robin Williams is dead.  According to news sources, he took his own life.  According to the same and other news sources, he was suffering from depression.  We probably won't know the truth for awhile, if ever.

What do differing definitions of cultural beauty and cruelty have to do with Robin Williams?  In order to explain this, I must first commit possibly a great faux pas.  I will now renege.  I won't actually say Japanese culture is inferior to others, but in one particular cultural norm I offer my harshest assessment and criticism:  Japan's attitudes towards mental health care as a whole are wrong, outdated, not helpful, and harmful.

I've now worked in the disaster region of Japan for over three years.  To say the tsunami of March 2011 messed people up is a stupid understatement.  I've lived and worked alongside people suffering from deep and profound pain.  Sadness is normal.  Grief is constant.  Getting help?  Seeing a therapist?  Openly discussing this pain and sadness and grief?  Not a chance.

Enter the Japanese spirit of gaman.  Children are told to "suck it up" and "be strong" and "behave" and "not complain".  Men drink away their frustration.  Women keep going.  These are perhaps gross generalizations, but that does not make them false.  In the Tohoku region where the disaster struck there is even a stronger, more stubborn sense of pride over the Japanese spirit of gaman.  Here, people really don't complain.  I am baffled, confused, bothered, and upset by this resolve.

On a good day gaman can mean strength.

"I will survive."
"I will persevere."
"I am strong."
"I am stoic."
"I am brave."

Yes.   All that.
Until none stay true.

To my friends who believe the spirit of gaman will carry them through forever, I offer you these words.

Isn't it possible that before you are Japanese and I, American, we are human?  As human beings, isn't it true that (unless there are underlying mental health issues already present) we like the same things?  Good food makes us happy.  Laughter is the best medicine.  We love sex.  Friendship, companionship, camaraderie all leave us feeling good.

We dislike the same things.  Betrayal hurts.  Death of a loved one causes pain.  Rotten food doesn't taste good.  Abandonment we fear.

If we are baseline the same, built on the same emotional foundation why then must we deny ourselves these natural feelings in the name of culture?  I get that quiet strength is noble and to be admired.  Not, however, at the expense of collective mourning that sweeps everyone into the vacuum of depression, collateral damage all around.

So, let me say this.  I am not depressed.

But, last week I had several moments that shook me up.  I was tired.  Incredibly tired.  Too tired.  Not-good tired.

Several times during the week I found myself wondering, "What would it be like to go to sleep and not ever wake up?  Wouldn't that feel good?"

Let me repeat:  I am not depressed.  I am not suicidal.  I am, however, deeply and monumentally tired.

Why am I writing this?  Because I don't believe suicide is the best solution for dealing with pain.  I don't know what happened with Robin Williams.  I remember crying he made me laugh so hard.  I will miss that.  I will miss what he offered in his comedy and acting.  But, if depression did indeed play a role in his choice to take his life (not confirmed as I write this) then I find myself angry as I am saddened.

Let's talk.
Let's talk about how we feel.
Let's talk about what troubles us.
Maybe, just maybe, gaman is not the right response to a massive disaster.  Maybe asking several hundred thousand children to "be strong because you're Japanese" is exactly the wrong way of going about mental health care.

Maybe Robin Williams didn't have to take his life.  Maybe we really need to change the way we deal with pain, grief, trauma, and sadness.  Maybe we put culture aside for a minute and focus on the fact before we belong to culture we are a species with just as many commonalities as differences.

And me?  I'm going on vacation.  I will do nothing productive other than rest.  For two weeks.  If after that I'm still tired, then I will look at resigning my job.  I don't ever again want to be attracted to the idea of not waking up in the morning.

Mary's Skunk and PTSD

Once upon a time, Mary may indeed have had a little lamb.  I'm sure it was a cute, fluffy thing.  Several months back, the animal belonging to Mary was a skunk.  Which she gave to me, she said, because it matched my outfit and because I reminded her of Liza Minnelli.  Okay.

Mary's skunk was about 50cm long, a cute and fluffy stuffed animal.  I said, "thank you" when she gave it to me because when people give you a skunk, or any other stuffed animal for that matter, it's just polite to express gratitude.

I named the skunk Liza.  Seemed fitting.

I took Liza to one of the preschools in Rikuzentakata where I decided to put it to good use.  To my knowledge, there are no skunks in Japan.  (Correct me if I'm wrong.)  Would the kids know what animal this is?  They did.  Cue my cloak-and-dagger way of introducing the topic of feelings.  Liza would help.

"Do you know what skunks do when they get scared or angry?"
Several hands shoot up and there is general consensus.
"It farts," the kids say, and we alternate between giggling and guffawing.
"Right," I say.  "When a skunk gets scared it farts.  What do you do when you get scared?"  Before anyone can answer, I add, "Do you fart?"
More giggles.
"Nooooo.  We don't fart," one girl says.
"I don't either," I say.  "What do you do then?"
Silence.
Slowly, hands go up.
"I go to my mommy," another girl says.  I nod.
More silence.
"What about when you get angry?  What do you do then?"
A boy says, "I hit.  Especially if it's my brother."  I want to laugh but don't.
This is good.  We're talking about feelings--a topic not usually discussed--today Liza's presence makes this seem normal.
"What about when you're sad?"  I say.  "Do you cry?"
Almost all of the children nod.
"It's okay to cry," I say.  "Did you know that?"  Some heads nod.

In a culture where open displays of emotion are a no-no (especially of raw anger and deep sadness) even talking about how we express our feelings is not the norm.  There are exceptions, certainly.  Exceptions, by definition, are not the norm.  The foreign auntie is allowed to use tools to begin this dialogue.  I don't abuse this position, choosing carefully what to do when, what to talk about with whom.  For children living in an environment where the abnormal is now normal, I stand by my belief they need the vocabulary to talk about feelings.

If we don't talk about the collective trauma experienced by a disaster--any disaster--the simple fact is we internalize.  People of varying skills (some lacking altogether) have come up to Tohoku offering PTSD "counseling" over the past three years.  Aside from the fact few are qualified to counsel, the emphasis on PTSD--in particular, the "P"--is disturbing.

Post-Traumatic Stress Disorder contains the word "post".  As in, "in the past".  As in, "we're not traumatized now."  This is misleading.  It's wrong.  Never mind the qualifications (for now) of those who mean well.  The first fact that needs acknowledging is this:  it's not PTSD if you're still going through trauma.

Focus on the today's trauma.  Focus on the fact life is painful still today.  Let's not rush into telling anyone they're suffering from PTSD when in fact trauma is a part of daily life.  It's not past tense.  It's TSD.  Not PTSD.

Which is why Liza the skunk is necessary.  Not one to superimpose my beliefs on others, here I take exception.  I see no good coming out of maintaining the belief internalizing pain is good or brave.  At the very least, allow the kids to express.

Kick, hit, cry, laugh. 
It's time.

On Girls Day: An Apology To My Non-existent Daughter, and Wishes For My "Adopted" Daughter

I was cheated.  All I wanted for girls day in Japan was a set of hina ningyo.  Celebrated on March 3rd with a seven-tier stand of the most beautiful dolls any girl could hope for, I coveted this graceful doll set.  All my girl friends had them.  All of my girl friends had them.  Not me.  I am forever scared.  My parents did me a great disservice.  Send me a box of Band-Aids.

Why wouldn't they buy me these dolls?  Did they not love me?  Did I not deserve to be celebrated along with all the other girls in Japan?  Why not?  Why not?  Pretty please.

My parents answered with a very simple and powerful answer.  "We're not spending thousands of dollars on dolls."

Yes, these dolls really do cost thousands of dollars.  They're just dolls.  Dolls every girl wants, but in the end they're just dolls.  It wasn't about deserving these beauties.  It was simple math.  I get that now.  Many, many years later, I get that now.

I do not have a daughter.  I wanted one, not in place of our son, but in addition to him.  For many reasons we didn't.  I will take this regret to my grave.  Which is why I've placed a very special order with my son.  "Give me a grandbaby girl."  Specifically, a red head.  More specifically, a red haired girl with bouncing ringlets and gray eyes.  I've seen the one I want.  She walks hand-in-hand with her grandfather down the sidewalk in our city outside of Boston. 

"That one," I've said to my son seeing her again as we drive through town one day.  "I want that one."
"I'll see what I can do," he's promised, laughing.  "But, I doubt I can get you that specific girl.  She seems to belong to someone already.  Careful what you say.  You sound like a stalker."
"Please," I say.  "Don't be so dramatic."
I sighed loudly.  Whatever.  My son laughs, again.  I do, too.  Never mind the fact research shows both parents need red haired genes in order to produce a red-haired baby, and neither my side or my husband's family has anyone who matches this requirement.  A girl can dream.  I'm hoping for a miracle.

Had we been blessed with a daughter would I have bought her a set of hina dolls?  No.  I'm firmly in my parents camp.  I would never have spent thousands of dollars on dolls.  Why then do I chide my parents for depriving me?  No good reason, I suppose.  I wasn't then, and am not now very good at taking "NO" for an answer.  I wanted these dolls.  It was as simple as that.

Instead of the beautiful display of real hina dolls we made our own.  This was torture to the seven-year old me as they were in no way a replacement for the real thing.  My mother and I would drain two eggs, let them dry over night, and fold origami kimonos for the eggs that would become the prince and princess.  I would then proceed to paint faces on the eggs.  Every year I would crush one with an, "Oops.  I guess you'll have to buy me the real ones now" line which was never resulted in the purchase I desperately hoped for.  Oh well.  I tried.  I truly did.

While I do not have a daughter, I have informally adopted many.  We have no signed papers but just an understanding.  I had to send a rather terse e-mail to one of my daughters recently.  She botched something and it was my job to inform and guide her through the fix.

This daughter lost her real mother in the tsunami three years ago.  She was 17 at the time.  A nursing student now, she's trying to move on.

She called me 15 minutes after I sent the e-mail.  We talked about its content.  She explained.  I listened.
"I need to tell you something," she said towards the end of our phone call.
"What is it?"
"I've been," and she pauses, "I've been diagnosed with depression."
I don't speak.
"I'm getting treatment."
"I'm glad," I say.
"I'm not excusing what I did, but in hindsight, I realize I should never have done that project.  I wasn't in a good place.  I should have turned it down."

She talks some more, her voice cracking in some spots.  I try to keep mine steady.  I tell her to call me any time she needs to.  I tell her I will always be there for her.  I silently curse the Japanese mental health care system again, the one that keeps people shut up about their trauma lest they become stigmatized as "mentally ill".  I tell her I'm proud of her.  I tell her she's brave.  I ask if I can help.

As a child I prayed my parents would change their minds about purchasing hina dolls.  As an adult I pray for my daughter with depression.  Girls can survive being denied dolls.  I'm proof.  Don't pray for me that magically I'll see dolls on my front door step tomorrow.  I'll be fine living without.  If you do pray, if you believe in asking for help from whatever deity you work with, please pray for my daughter.  Light a candle.  Sing.  Dance.  Send good vibes.

My daughter and I ended our chat with a promise.
"If I'm still living in Japan when I'm old, I want you to take care of me," I say.
She laughs.  "You'll be a handful," she says.
"Of course I will," I say.
"I'll try."
"I don't like needles," I say to her, and laugh.
"We'll figure something out."
"Promise?"
"I promise."

On Resilience, Coping Mechanisms, and Differences of Opinion

To each their own.  Who am I to tell you the way you choose to cope is wrong?  I don't know your pain and your experiences are not mine.  Hard is just hard.  Your "my life is hard" is not a measurable event, and my version of "my life is hard" is just that.  Let's not compare.  Let's not one-up each other.

I spent time with Yuriko over the weekend, one of my favorite women in Tohoku.  She's strong, opinionated and honest.  She personifies "work hard play hard" which isn't a motto many think well of, especially coming from a woman, a wife, and a mother.  That I'm tired of this double-standard argument is not the point.  Not today, at least.  Yuriko told me of how Rio, her six-year old daughter got angry at her (and me) for the deed I meant as a good one which completely backfired.

"She was angry she didn't get to see you when you brought the Halloween candy," Yuriko tells me.
"I'm sorry.  I showed up without calling, I know.  I was on my way somewhere--I don't remember where now--and I saw your light on so I just popped in."
"When I took the candy back to Rio and the other two, Rio got really quiet, gave me one of her I'm-angry-now looks and said, 'You saw Amya-san today?'  So I said I had, and then Rio went off.  I got 'Why didn't she tell me?' and 'Why didn't you call me when she was there?' and then, 'Make sure you tell her I want candy next year, too.'  It was quite the tongue-lashing!"  Yuriko laughs.
"Oh, and then when I asked Rio, 'You wanted to see Amya-san?' she gave me one of these you're-so-dense-mom looks and said, 'Well yeah.  For awhile now.'"
Yuriko and I laugh but I realize my mistake and promise Yuriko I will stop by with more notice next time.

Rio is the girl who, at three years old, told (not asked) her mother to drive by the spot Yuriko's store used to be everyday for a month.  "Rio would put her hands up to the car's window and stare," Yuriko says.  "I have to assume that's how she was processing what happened.  I lost my store but so did she.  That place was just as much hers as it was mine."  This story ends with Rio announcing one day she didn't need Yuriko to drive past the store anymore. "She must have worked it out," Yuriko says.  "I don't understand it," Yuriko tells me, "but something clicked on that day.  She didn't need to see where the store was anymore."  It was on this day that Rio told Yuriko she would protect her mother if another tsunami were to hit.  "I'll beat it up," the three-year old Rio told Yuriko.  This was when I first fell in love with the girl.  I was then and still am today inspired by her resilience.

We cope with trauma and tragedy differently.  Here in Tohoku, a place still very much a disaster zone, there are multiple coping mechanisms:  some drink (sometimes to excess), some shut pain away, some cut themselves, some ignore it, some throw themselves into work to forget, others throw themselves into working towards progress, and a very select few try to work it out by talking it through.

I choose to read.  I need to escape into a world that is at times surreal, unreal, far-fetched, silly, and/or all of the above.  I won't take kindly to people saying this is not a legitimate way for me to process.  Nor can I support others who might think reading to escape is not a viable method of coping--not just for me but for anyone.

What about the other options then?  Rio needed to stare at the plot of land where she had memories.  Many around me drink.  Many who drink don't stop with just a few.  Medical professionals would very likely offer up facts on why drinking-to-forget is not a healthy way to deal with those parts of our lives we struggle through.  I am not one who drinks away my anxiety.  I read instead. It's not my business to be critical of those who choose a different way to cope.  Drink through your pain, deny it, work yourself through it.  I don't agree with the idea of suppressing feelings, drinking to excess, or overworking to forget, but I am constantly reminded of the fact this is not my country.  Who am I to say keeping things bottled up is wrong?  If drinking helps you process is it my place to say you shouldn't?  It's wrong for me, but maybe it's not for you.

I bring this up to say these are ideas I'm trying on.  I'm anything but comfortable with the idea excessive drinking and eating and gambling and the like as a legitimate and healthy way to process grief or trauma or pain.  That said, I'm not fond of those who easily right off my method of coping.  Indeed, I find myself surprised at how defensive I get when what is so important and necessary for me is easily dismissed or criticized.

Tolerance and patience:  the former I'm pretty good at, the latter I'm not.  Today's random musings are brought to you by kids whose resilience and strength I marvel at over and over.  Read away, dear child.  Talk back to your mother, Rio.  I hope it brings you peace.

Parents Who Snap At Their Kids: What Post-disaster Recovery Looks Like Today

I am in no position to diagnose.  With no training in medicine, psychology, or psychiatry it's not up to me to identify who's suffering from what.  What I can say is this:  I don't need a degree to see and understand there's still pain in post-diaster Tohoku.  Two and a half years after Japan's biggest earthquake triggered giant tsunamis, ambiguity and confusion are still the norm.  Leaving the question of why recovery is slow aside, those of us involved in disaster recovery focus on what we can do here and now.

Kazu is drunk.  The more alcohol he consumes the more honest he becomes.  Tonight he let out his pent-up inner most demons.  His main concern, he states over and over, is the kids.

"They're just too well behaved," he says.  "They don't ask for things, they don't say, 'Daddy can we go to so and so,' because they know what will happen if they do."
My job tonight is to listen and prod.  "What do you mean?"
"Well, it's primarily the adults who are the problem.  We snap at the kids.  We're all tense.  We've got short fuses.  We're tired, I know I'm tired, and when we get this way we take it out on the kids.  It's not right but we do it anyway."  He sips his drink.  How many has he had?  I've lost count.
"So, the kids, because they know we'll get pissy, they don't act out.  They're the ones trying to make sure the parents, that's us, don't have a reason to get angry.  Or, maybe I should say angrier."
We're silent for awhile.  When he speaks again Kazu runs his hand over his buzz-cut hair.  "I did it, too," he says.  "I snapped at Yuuki."
I think of Yuuki, Kazu's son, a boy who has I swear grown at least 20 cm in the two plus years I've known him.  "What happened?" I ask.
"It was dumb.  It's true I was mad.  Yuuki wouldn't stop playing those video games," and Kazu mimics Yuuki's fingers pressing buttons on a remote control device.  "I hate those things," he says.  "I had told Yuuki to go to bed.  He didn't, of course."  Kazu laughs but it's an uncomfortable laugh.  "So I yelled at him.  Normally, I would have said something about taking him up to his room and helping him get to bed, but that night I snapped and told him to get to bed.  We're all like that, us parents.  We're all stressed."

It's neither fair nor accurate to say all parents in Tohoku snap at their kids out of post-disaster anxiety.  Do some?  Yes.  Do many?  Perhaps.  Probably.  The take away tonight from Kazu's alcohol-induced honesty is that he is tired, and that many parents around him are, too.   Why wouldn't he be?  Earlier in the day, another one of my brothers from Tohoku told me how the spirit of gaman, usually a beautiful combination of strength, determination, and perseverance has turned into apathy.  "People are giving up," he tells me.  "Not in the 'I'm suicidal' way, but they're all tired of waiting.  Change and improvement, it's so slow.  It's taking so long.  Too long."  He's now talking to himself more than me, and because I don't have the words to fix what's wrong I stay silent.

In some communities rebuilding has been going on for a good year.  Prefabricated homes and stores and businesses have long since been available.  It's the newly rebuilt homes and stores and businesses that are marking how well reconstruction is going.  In cities like Rikuzentakata where nothing can be rebuilt in what was downtown, the city is far behind its neighbors.  The lack of speed in visible progress turns into disaster-fatigue which then turns into snapping parents.  Or so Kazu says.

Clearly I don't have the solution.  I listen.  I let them vent. I nod my head when they need agreement and shake it in disgust when they need an additional soul to commiserate with them.  I left Kazu wondering just how useful his venting was for him.  I tell myself I listened, and hope that was enough.