Overnight, Tokyo transformed into the world's largest psychological laboratory.
Japan's now-rescinded warning yesterday that radioactive iodine in the city's drinking water exceeded standards set for infants' chronic radiation exposure was, above all, a public health threat. But it is likely that the warning's psychological effects on Tokyo could cause lasting stress to a group particularly at risk during nuclear crisis: young mothers.
The mental health legacies of nuclear power accidents like Chernobyl and Three Mile Island are not open-and-shut cases. Parts of the population exposed to the accidents appear to bounce back quickly. There is resilience. But several groups have proved to be especially vulnerable to the stress caused by the accidents, said Evelyn Bromet, a psychiatric epidemiologist at New York's Stony Brook University.
"[And] one of highest risk groups," she said, "are women with little kids."
A bustling metropolis of 13 million people, Tokyo is home to some 80,000 infants, according to state estimates. Until yesterday, the city's dense population had remained relatively unaffected by the ongoing health concerns from the Fukushima Daiichi power plant. Radiation levels remained low, and milk and spinach produced from the regions around the plant could be avoided.
But after the government detected at one treatment plant radioactive iodine at levels double the accepted rate for chronic infant exposure -- but below limits for adults -- bottled water began flying off the shelves. The government promised to distribute 240,000 bottles of water to households with infants in the area, adding to the city's -- and presumable mothers' -- anxiety.
Japanese officials today rescinded their warning about the city's water and infants, citing a drop in iodine-131 levels. Readings showed the water testing at 79 becquerels per kilogram -- becquerels measure the amount of radioactive decay -- well below the chronic exposure standards for children and adults. Iodine monitoring is ongoing, the officials said, while also reportedly thanking Tokyo's population for "staying cool" during the warning.
While Tokyo's drinking-water warnings could pass as a 24-hour blip in the news cycle for many in the United States, it is very possible -- but by no means confirmed -- that for young mothers in Tokyo, the warning could spur lasting distrust and emotional distress, scientists say.
Certainly, lasting scars of emotional distress -- which, at its worst, can manifest itself as serious depression or post-traumatic stress, among other symptoms -- are what researchers found in young mothers and others directly affected by past nuclear accidents at Three Mile Island in 1979 and seven years later at the much more serious Chernobyl meltdown in Ukraine.
"What's most striking," Bromet said, "both about Three Mile Island and Chernobyl, which are obviously completely different events with different environmental consequences, is that the emotional consequences just never end."
The Fukushima crisis is, of course, an incredibly difficult situation for Japan's authorities and residents. Caution is more than justifiable when it comes to radiation, and the fear and stress that could stem from radiation risk warnings would be difficult to prioritize over immediate health concerns, said Johan Havenaar, a Dutch psychiatrist who has worked with Chernobyl evacuees.
"It is an understandably frightening situation for [the Japanese]," he said, "even if the risk is small and the measure predominantly precautionary. ... It would be unfair to suggest that the psychological effects -- i.e. their fears -- are unjustified."
What authorities should do, and often fail to do, is treat mental and physical health problems with equal respect, understanding that the two go hand in hand, Bromet said. They must respect the persistent fears that will form about radiation exposure in Japan, no matter how low the exposure and how this can take a permanent toll on people's lives, she said.
'Distress and distrust'
Bromet is the most prominent scientist studying the mental health consequences of past nuclear accidents.
After Three Mile Island, which saw a negligible release of radiation to the public, she followed a group of young mothers for 10 years. And since Chernobyl, she has studied, with European colleagues, residents from the Chernobyl area who were subsequently evacuated to Kiev.
While it is difficult to make generalizations across the two events, the women in both studies felt continued health-related anxiety about their exposure, even if nonexistent, to radiation. Such fears are natural. Radiation, complex, mysterious and carcinogenic, is perhaps the ultimate source of dread in modern society, hitting all of humanity's primal buttons when we attempt assessments of risk (Greenwire, March 18).
At Three Mile Island, the distress felt by the population living in the plant's shadow was transient. As local researchers began questioning residents weeks after the crisis, they found very high levels of distress, nearing and times exceeding what might be found in patients treated in mental health centers, said Bruce Dohrenwend, the psychiatrist at Columbia University who ran the presidential commission investigating Three Mile Island's mental health effects.
"The stress varied with socially defined risk factors defined by the authorities," Dohrenwend said -- much like risk factors cited in Tokyo. "[They] were especially high for those living within five miles. Especially high in mothers with young children, because they were singled out in advisories."
For many living around Three Mile Island, stress fell back to normal levels soon after the partial meltdown. But Bromet, expecting such a result, instead focused her surveys on mothers with young children, expecting them, following previously established trends, to have persistent problems.
During the first few years, Bromet's team found that rates of depression and anxiety in the mothers were double the rate of comparable groups. Then, 10 years later, they found depression and anxiety to be as high as it was shortly after the accident -- higher than would be expected in a typical community. Three-fourths of the mothers remained worried about the accident's health effects.
Dohrenwend is impressed by Bromet's work on Three Mile Island and finds it convincing. And while his surveys, which ultimately ranged over 2,500 people, did not identify persistent problems of distress in the general population, they did find a continued distrust of authority following the accident. Residents were baffled by the conflicting advice and warnings, he said, and began to disregard and distrust realities given by the government, like the limited scope of radiation.
"Distress and distrust, these are not small matters," he said. "Distrust can have tremendous ramifications. We have distrust issues in this nation in serious policy and human matters."
Preoccupation with 'physical symptoms'
After Three Mile Island, the government also gave short shrift to mental health, Dohrenwend added. In 1979, post-traumatic stress disorder had not been recognized as a clinical diagnosis in the medical community, and it was not until June that year -- nearly three months after the accident -- that the commission added a mental health component. The commissioners were engineers and physicists, not psychiatrists. Only thanks to the work of local academics did surveys begin early enough to document the stress peaks, Dohrenwend said.
Compared to Three Mile Island, the mental health consequences of Chernobyl are far more dire -- but also far more difficult to easily assess. Much like the Japanese crisis -- the earthquake and tsunami will also carry heavy mental health tolls -- Chernobyl can be seen as a series of disasters. There was a meltdown and explosion, but also traumatic evacuation and subsequent stigmatization, combined with the poverty and alcoholism pervasive in the region.
Bromet surveyed some 300 mothers in Kiev, Ukraine, 11 and 19 years after the disaster. Authorities had evacuated the mothers and their young children from the Chernobyl area, and in addition to possible radiation exposure, the families faced harsh treatment. Many pregnant women were encouraged to have abortions during the evacuation, Bromet said, and once in Kiev, doctors were hesitant to treat the women and often gave diagnoses that, in retrospect, had little grounding in reality.
Bromet found that these mothers, at 11 years after the meltdown, were more likely to face depression and chronic health worries than their similar peers in Kiev. Nearly 20 years after Chernobyl, nearly 20 percent of the women had post-traumatic stress disorder stemming from the disaster, compared to 7.5 percent of the control group. Nearly a third had faced major depression in the past year.
Many of these women remained fixated on Chernobyl, and for good reason. Several thousand children developed thyroid cancer from the radioactive iodine released by the disaster, and while nearly all of these children have survived this health problem, cancer is cancer. These worries are not limited to women, either, added Havenaar, the Dutch psychologist.
"People were preoccupied with physical symptoms," he said. "They worry a lot about what they might mean."
Studying Chernobyl cleanup workers
A particularly challenging group to study has been the "liquidators," the Soviet workers summoned from across the USSR to clean up after the disaster.
Bromet and Havenaar studied a group of 295 workers for a 2008 report, and they found slight but not statistically significant increases in depression and post-traumatic stress disorder compared to their peers. This is a troubled population, Bromet said, but their issues stem from many problems.
"Nutrition is bad, alcoholism is high and medical care is almost nonexistent," she said. Still, she added, anecdotally some of these men were truly disturbed. "We met liquidators who were almost nonfunctional," she said. "Expressionless. No energy. We met a lot of people like that in Ukraine and Latvia."
The problems plaguing the Chernobyl region led the World Health Organization to declare earlier this decade that mental health was the largest -- but not necessarily the most acute -- public health problem caused by the accident. The meltdown unleashed a cascade of disasters that resulted in "an increased sense of anomie and diminished sense of physical and emotional balance," it said.
Still, while the mental health challenges stemming from Chernobyl and Three Mile Island are real, they also require perspective. Most of these problems, especially in the latter, are considered subclinical issues, not rising to the level of post-traumatic stress disorder, let alone psychosis or phobia. But even such subclinical effects exact a price -- for example, persistent distrust can lead to disregard of safety guidelines.
It is far too early to know the ramifications of the Japanese crisis. Radiation threats could re-emerge, and the culture is different from that in the United States or Ukraine. Given only a day of panic, mothers in Tokyo could be wholly unaffected. It is unknown whether anyone is studying the response of the Japanese people. But Havenaar, the Dutch psychologist, hopes so.
"We could learn from that how Japanese mothers -- and fathers -- could react," he said.
Bromet held town hall-style meetings while she was in Kiev with her study subjects. Their questions were not just those of radiation victims, she said. They worried about their families' health, about asthma and their kids' behavior problems. Some had chronic fears, but they worked to overcome them.
"If you asked somebody [at that meeting] if they're worried about their health because of Chernobyl," she said, "they'd tell you, 'Yes. But life is bigger than just that.'"