Mental health matters: Expert advice for expats in despair in Japan

Most of us have lived through a disaster or crisis, so have some understanding of how to cope and stay resilient. But no one is immune to the effects of stress and pressure, and the coronavirus pandemic is a crisis like few in our lifetimes.

The disruption and devastation caused by the Great East Japan Earthquake and Tsunami of March 11, 2011, lingers in the minds of the country. But those terrible events and their impact were limited compared with the effects of Covid-19. What is happening now is causing mental health challenges on an enormous scale.

Japan’s suicide hotlines are reporting a surge in calls from people concerned about health and financial matters. According to Kyodo News on May 13, the Federation of Inochi no Denwa, comprised of some 50 suicide prevention organizations em­ploying some 6,000 counselors across Japan, said the number of incoming calls its members have received has soared since the government declared a state of emergency in April. Saitama Inochi no Denwa says 70–80 percent of the 70 or so calls it receives each day have been related to Covid-19.

For non-Japanese residents, such hotlines may be less acces­sible due to language barriers. Fortunately, the international community in Japan is supported by many experts who pro­vide counseling in English and other languages. Thanks to them, expats have a place to turn when they need help. The ACCJ Journal spoke with some to learn what they are hearing from those affected by the crisis and for tips on how to cope.

COVID IMPACT

Vickie Skorji, Lifeline director at TELL, explained that we have all been experiencing what is known as traumatic stress response, something that happens to everyone during a disaster. “As we adjust to all the changes and uncertainty that Covid-19 is placing on our lives, our stress response is in overdrive. And it is being stimulated by all the news reports and social media posts listing the number of cases, deaths, etc.,” she said. “It is important to recognize that everyone is stressed and pushed at the moment.

“On the Lifeline, people were initially worried about daycare, jobs, income, and why their workplace was still making them come into the office. We also heard from a lot of university students who were worried about whether they should stay in Japan or go home. Everyone was impacted,” Skorji said. “Now we are hearing from people who are stressed from working at home and trying to manage children and other matters. Relationships are strained, people are worried about finding work and paying bills, and those with mental health problems are feeling overwhelmed.”

MOUNTING PRESSURE

As the crisis stretches on, the stress of quarantine as well as the worries of job and income loss can send us on a downward course.

“If you notice that your relationships are becoming more strained—perhaps you are becoming more irritated with work colleagues or are fighting more with your spouse or children, this could mean that you are not taking enough breaks or setting boundaries on your working hours,” Skorji said. “You may also be feeling increasingly tired, not sleeping well, or having trouble switching off from news or social media. These are all signs that you are not coping well and are close to burnout.”

She explained that learning to understand how our body responds to physical and emotional stress is vital. “Putting in place healthy coping strategies is key to our ability to ride out this storm. Otherwise, we will burn out and our immune system will become more vulnerable—something we all want to avoid.”

Andrew Grimes, a clinical psychologist who is founder and director of Tokyo Counseling Services, warns of the stress that can be caused by the continuous stream of news reports. “Under any and all circumstances, do not watch or listen to constant news or podcasts about Covid-19. Spend up to 30 minutes each day checking on the situation of your folks and friends back home before you call them.

“Here in Japan, in the evenings, you can keep up with daily current developments by watching NHK news in English at 7 p.m. on NHK World. But, other than those times, keep your mind and heart on things that are more important to you. This will help you relax.”

COPING

Staying home all the time removes the framework that holds our days together and helps us move from task to task. That itself can cause stress, and Skorji emphasized the importance of maintaining structure.

“Keep a good routine of when you get up, start work, take breaks, and finish. Also, what time you go to bed at night. Getting at least eight hours of sleep is important, as is eating well and keeping active,” she said. “And for couples, it is important to sit down and figure out how to balance work and children’s schooling, and support each other.”

Skorji also recommends limiting the time you spend looking at news and social media. “Learning to switch off—perhaps meditating, doing deep breathing exercises, or yoga—are great way to decrease your stress levels,” she said, pointing us for more advice to telljp.com/covid-19-coping-tips

Michael Nevans, director of psychological services at Tokyo Mental Health, said that if we look at the changes we are facing as a systemic shift, the situation becomes less problem-saturated and more solution-oriented. “This is because systems organize themselves in a way that is sustainable. When people spend less time out of the house for work and more time in the home—working or otherwise—the rest of the system will shift to accommodate this.”

The issues they are seeing at Tokyo Mental Health are often related to families and individuals growing into these new systemic roles, Nevans said. “I think that, because this change was unexpected and thrust upon people, they are not well resourced to transition. They are getting stuck between old patterns and expectations and the new expectations and requirements of this ‘new normal’ that is taking shape. When you sprinkle this with poor communication and setting of boundaries, you wind up with dysfunction.”

Finding a way to accept these changes and shifting systems is a must, he explained, and offered some tips:

• Set boundaries: learn to say no and mean it
• Communicate effectively: listen more than you speak; be understanding and empathetic
• Segment: create transition times from one activity to the next, especially when changing roles

Role changes could be when you go from doing parenting tasks to having a moment with your partner, or from being in work mode to being in home mode.

Grimes encourages everyone living with family to continue taking an interest in what their children are doing. “Not only is it important to learn from your children—especially teenagers—what is important to them and what is worrying them, it can also keep you happy during this difficult time,” he said. “As much as possible, do things with them more than your previous business schedules allowed prior to Covid-19.”

While some people are finding them­selves with lots of free time due to layoffs or restrictions on work hours, others are seeing exponential increases in work­­load as com­­panies try to main­tain the same level of output with fewer staff. In such cases, working on the week­end may seem unavoidable. Grimes says not to do it.

“As much as possible, do not use weekends to do work. Take this chance to share meals and build stronger family connections. Tell your children about your parents and grandparents to ensure that they have a good understanding of their family history and heritage. In time, they will pass this on to their children and grandchildren,” he said.

“If you are single and living alone, stay in touch with your friends and reach out to those you shared time with in your past. You’ll discover many happy memories and be reminded of all the fun times and love you received over the years. This can also help stave off feelings of stress and worry.”

PITFALLS

Nevans said a very important topic that he has not seen discussed much is excessive dissociation. “It is the cornerstone of all our toxic—and sometimes destructive—behaviors,” he said. “This is when people zone out. They can leave their body—meaning they do not feel the physical reaction of their emotions or thoughts—and they intentionally do things to avoid their feelings. Excessive dissociation is huge right now.”

Examples in daily life include:

• Excessive drinking
• Binge-watching TV
• Emotional eating
• Excessive online shopping
• Online gambling

To avoid dissociation, Nevans says to meditate and be mindful.

“Check your thoughts by adding an awareness moment throughout the day. Take a moment to breathe before your meals and check into your body. Ask yourself if you really want to do an activity or if you are just falling into routine behavior due to boredom or stress,” he explained

“Ask yourself, ‘Do I really want that drink?’ Maybe you decide to have it, but to have just one or two servings with dinner. Basically, align your mind and thoughts with your body and heart. You will find that you are much more present and deliberate in your actions.”

Grimes also pointed out how excessive use of technology and lack of work boundaries can be detrimental. He encourages people to set a schedule for when they will stop working each day and to rediscover their passions.

“On evenings during the week, decide what time you will stop looking at your computer and smartphone. Use the valuable time after that to enjoy your favorite authors and read books about your hobbies and interests,” he said. “Remember your passions and explore them more than before. Listen to your favorite inspiring music and watch your favorite comedy programs from the past, as well as ones you want to keep up with. If your family back home are also watching, it’s great for conversation.”

The bottom line, he said, is to avoid looking at your computer and smartphone screen at least two hours before you want and need to sleep. If you don’t, your brain will be unable to rest. And everyone agrees that getting proper sleep is important for managing stress during this crisis.

STRESSING THE STRESSED

While no one is immune to the pressures of this historic upheaval, Skorji said her biggest concern regarding mental health and the pandemic is the way it is putting additional pressure on those already struggling.

“I see the impact of Covid-19 as a long-running issue, and I worry that people will become exhausted and depressed. We may see an increase in suicides. Already, I am seeing an increase in people feeling suicidal on the Lifeline,” she explained.

“I am worried about the people who already have mental health problems, and the impact of the increased stressors and pressures in their lives. Also, about how long it will take the economy to recover and people to get their lives and jobs back.”

Nevans said that things get bad when people think they have no options or opportunities. “I think hopelessness and helplessness will become inevitable feelings and thoughts as we enter into the third month of this thing. When will we return to normal? What will the new normal look like for me? These questions will grow,” he explained.

“This is why I encourage psychological flexibility through acceptance whenever possible. It creates a resiliency to anxiety and depression. Like a palm tree bending in the storm, it stands strong and rooted, rising tall when the winds pass.”

STRONGER TOMORROW

While the coronavirus pandemic has brought great hardship to individuals and businesses, not everything about the disruption has to be bad. In some respects, it is the pause button that some people needed to assess the paths they’ve been traveling.

“This disaster has given us an opportunity to look at the way we conduct our work, schooling, how we eat out, how we get together,” said Skorji. “While it has created a lot of chaos and uncertainty, we have also seen people be very creative in finding new ways to connect, hold classes, operate businesses, and celebrate special occasions. Hopefully, we can implement many of these ideas going forward, providing people with more choices and opportunities.”

She believes it could also help us learn how to better deal with daily life. “We talk about stress and the stress response a lot, but most people don’t really pay that much attention to how they are coping with their day-to-day stressors and the impact these have on their bodies,” she said. “I hope that, going forward, we all have a better appreciation and understanding of this topic and how stressors impact our bodies, mental health, and relationships.”

Nevans agrees: “If we can see the situation from a place of strength and empowerment, we can find a way to make it a win. I tell a lot of people that this is the chance for new behavioral patterns to start, for new world views to emerge, and for people to really redefine themselves in their systems. All of this is possible when you see yourself as a powerful creator in your life, taking responsibility for your growth. For a lot of people, this growth will require new thinking and outlooks in addition to flexibility.”

He stressed that it won’t be easy, though.

“Change is always possible and always happening. But change—even good change—is hard. You need to be focused and keep control of yourself so that you can navigate the changing world to your benefit. Otherwise, you will fall victim to the change and get into that hopeless, helpless place.

“You will have moments of feeling defeated and run down. You will feel miserable, sometimes. But it is on the other side of that coin that you will find your indomitable spirit, the part of you that will live, survive, and thrive. Keep your hope alive—even if it is a flicker at times. Remember, you are the powerful creator of your world and you have the tools necessary to be successful.”

Need to talk?

TELL

telljp.com

Tokyo Counseling Service

tokyocounseling.com/english

Tokyo Mental Health

tokyomentalhealth.com

Custom Media publishes The ACCJ Journal for the American Chamber of Commerce in Japan.

• External Link
• https://journal.accj.or.jp/mental-health-matters/

© The ACCJ Journal