災難精神醫學：從阪神淡路大地震所學到的經驗

Disaster Psychiatry: Lessons Learned from the Great Hanshin Awaji Earthquake

背景：1995年1月17日早上，日本神戶（人口150萬人）及其週圍市區地區遭受到阪神淡路大災難。地震發生瞬間約5,500人死亡，與35萬人以上無家可歸。但是日本人從這次災難悲劇經驗中，學到了很多教訓。方法：在災難發生的時候，我親自在場體驗到這個地震的威力及傷害；在過去15年來，我也同時目睹了神戶地區之重建復原過程。我又以精神科醫師專業者的眼光，長期觀察了有些災民精神科問題的變化。結果：地震災難後，災民產生各式各樣身體上及心理上的問題，及其歷年來經歷了精神疾病及症狀變化。災民一開始有恐慌發作，然後慢慢被下列症狀取代－－憂鬱症狀、酒精濫用及其有關的問題、及所謂「單獨死亡」。但在日本地震災民中，壓力後創傷疾患並不普遍。一年後，這些精神病理學上的問題，慢慢地轉變成社會的問題。這些災民恢復過程的經驗，及神戶人們努力幫忙救災，已經把這些經驗，遠傳教導了亞洲及世界各地有同樣問題的災民。結論：災民從阪神淡路大地震悲劇後，所學到的經驗，已經與亞洲及世界各地精神科醫師及心理健康專家分享。這些種經驗的傳承，已經是地震災民繼續恢復的重要過程。我們可以這樣說：「是由災難中恢復過來，分享是重要的原動力」。

Background: In the early morning of January 17, 1995, the Kobe city (1.5 million inhabitants) and surrounding urban areas were devastated by the Great Hanshin Awaji Earthquake. This Earthquate killed more than 5,500 people immediately and made more than 350,000 people homeless. But the Japanese have learned many lessons through experiencing this tragic event. Methods: I personally experienced the Earthquake on spot at that time. I have also been witnessing the recovery process in the Kobe area over 15 years. As a psychiatrist, I have also been observing the changes of psychiatric problems of the Earthquate victims over the time. Results: Inhabitants in the Kobe area started to experience various physical and psychological problems after the disaster. These problems have been changing over the time. The fi rst victims’ symptoms were panic attacks, which were gradually replaced with depressive symptoms, alcohol abuse and alcoholrelated problems as well as so-called “solitary death.” But posttraumatic stress disorder was not common among those victims. In one year, those psychopathologic problems had quickly become social problems in Japan. The recovery process was accompanied with the efforts of the Kobe people to transfer their experiences to the victims of similar disasters in Asia and in the world. Conclusion: The Hanshin Awaji Earthquake was tragic. But, the lessons learned in Kobe is being shared by psychiatrists and mental health experts in Asia and in other developing countries. This transfer of experiences has constituted a continuous process in Japanese recovery from the Great Hanshin Awaji Earthquake. One could say, “sharing is the main source of our recovery from the disaster.”