Study: 40% of Battle of Okinawa survivors show signs of PTSD

June 13, 2013


Hiroko Henzan started experiencing sudden heart pounding, eating problems and nightmares about a decade ago.

Around that time, she also suffered from an increase in flashbacks of an event that has haunted her throughout her life: being covered in blood and leaving behind her dying younger sister.

That occurred 68 years ago, when Henzan was 9 years old.

Henzan, 77, who lives on Iejima island in Okinawa Prefecture, is believed to be one of the many survivors of the 1945 Battle of Okinawa who are now suffering from post-traumatic stress disorder (PTSD).

Six psychiatrists and other specialists in Okinawa studied about 400 elderly Okinawa residents and found that about 40 percent likely had PTSD.

Those involved in the study believe that the horrors of the Battle of Okinawa experienced by the elderly when they were young and the continued presence of U.S. military bases in the prefecture contributed to the high percentage.

“When we look at how much time has passed, 40 percent was an unexpectedly high number,” said Fujiko Toyama, a former professor of mental health and psychiatric nursing at the Okinawa Prefectural College of Nursing, who headed the study group. “After suffering huge trauma from the fighting that also spread to civilians, they were faced with the issue of U.S. bases in Okinawa, meaning the situation continued in which their scars could not heal.”

The study is believed to be the first on the psychological damage from the Battle of Okinawa involving such a large number of subjects.

Henzan began waking up from nightmares of being attacked by U.S. planes about 10 years ago. On some days, her condition was so bad she could not get out of bed. She was examined by doctors specializing in internal medicine, but they could not pinpoint the cause.

Six years ago, the psychiatric department of a university hospital determined that Henzan was suffering from a psychiatric disorder and gave her anti-depressants and sleeping pills. That helped her to get more sleep and improve her appetite.

Although she rarely leaves her home because of difficulties in getting up in the morning, she cooks, does laundry and continues to visit the hospital once a month.

She still cannot get over the events on April 17, 1945, a day after U.S. troops landed on Iejima. Henzan and her family had fled to a bomb shelter, but it was attacked, forcing Henzan to run away while piggybacking her younger sister.

The sister suddenly fell off. Henzan called out to her sister and tried to carry her again, but the girl did not respond. She had been shot.

Henzan had to leave her there to flee the approaching U.S. soldiers. After finally being reunited with her mother, Henzan realized that she was covered in red. She herself had been shot in the back.

After six days of fighting and instances of mass suicides, U.S. troops occupied Iejima. In all, about 1,500 islanders died and the 2,000 or so who survived were forcibly evacuated to another island.

According to statistics compiled by the Okinawa prefectural government, about 120,000 of the 450,000 or so residents at the time of the battle died. In total, more than 200,000 people died in the Battle of Okinawa, including Japanese and U.S. soldiers.

One aim of the researchers involved in the PTSD study was to provide psychological care for the senior citizens.

Between April 2012 and February 2013, 431 Okinawans 75 years and older who used day service care were randomly selected through the cooperation of local governments and social welfare associations.

Public health workers and graduate students interviewed the subjects, and valid responses were received from 359 individuals. Their average age was 82.

The Impact of Event Scale-Revised, which is widely used both in Japan and abroad as a measure of distress caused by traumatic events, was incorporated as an indicator of PTSD.

The subjects were questioned on 22 topics, such as the degree in which “the event suddenly enters my mind” and “strong emotions well up within me.” They were also asked about their personal experiences in the Battle of Okinawa.

Of the 359 subjects, 141, or 39 percent, showed a high possibility of PTSD, and many of them had painful experiences of the battle.

Seventy-eight percent in this group lost a family member during the period from the battle until one year after the fighting ended. Among the group that did not have a high possibility of PTSD, 66 percent said they lost a family member in the same period.

Those in the first group also more frequently recalled the fighting.

When asked about the possible triggers for their flashbacks of the battle, 82 percent said “when watching news about the war,” while 60 percent said “when I look at or hear noise pollution from U.S. bases or military planes.”

During the study, one woman in her 80s with a high possibility of PTSD recalled seeing local residents killed in the fighting and wetting herself as a result. She fled to a bomb shelter, but it collapsed, and she was trapped unconscious for a week.

She said her recollections of the war have increased in frequency since last autumn, when the U.S. Osprey transport aircraft were deployed to the U.S. Marine Corps Air Station Futenma.

“When I see the planes flying at low altitude, I am screaming in my mind, ‘Go home, go home,’” she said in her interview.

Ryoji Aritsuka, 66, a psychiatrist who now resides in Sendai, said he joined the study group because he saw many senior citizens suffering from insomnia for no apparent reason. He worked for nine years until this spring at the psychosomatic medicine department of a hospital in Okinawa.

Aritsuka also believes the presence of U.S. military bases in Okinawa Prefecture is a major reason PTSD symptoms remain in senior citizens who experienced the Battle of Okinawa.

“Ordinarily, the passage of time will leave a scab on psychological scars, but the scab for those with scars from the Battle of Okinawa peels off whenever they come in contact with incidents involving U.S. military personnel or the daily flights of U.S. military planes,” he said.

When Aritsuka was trying to determine the cause of the insomnia, he came across a foreign document about Holocaust survivors who had similar psychological symptoms. When he asked his patients about their war experiences, they all replied that they had seen a family member killed in front of them.

While many of them likely had little time to think about the war when they were younger and busy at work, the death of a family member or their own retirement triggered the insomnia and other worries, he said.

According to health ministry statistics, PTSD occurs in 30 to 40 percent of people who experience a major natural disaster or a crime spree over a wide area within six months of the event.

About half of them eventually overcome the condition naturally. The incidence after one year is between 10 and 20 percent, and the condition becomes chronic for those who still show symptoms.

“In addition to the tragedy of the Battle of Okinawa, the special circumstances of the U.S. base burden that continues today in Okinawa led to the occurrence of what can be called ‘late-onset’ PTSD,” Aritsuka said.

For Henzan, her living environment contains many triggers for her PTSD symptoms.

Iejima is one of the sites for training exercises involving the U.S. Osprey aircraft. Henzan said she recalls the Battle of Okinawa whenever she sees news reports about the Osprey.

She also suffers from guilt, wondering why she survived and if she had the “heart of the devil.”

Sitting in front of the Buddhist altar for her younger sister, Henzan could only say: “I am sorry. I am sorry.”

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Hiroko Henzan continues to hold feelings of guilt over the death of younger sister in 1945. (Tsukasa Kimura)

Hiroko Henzan continues to hold feelings of guilt over the death of younger sister in 1945. (Tsukasa Kimura)

  • Hiroko Henzan continues to hold feelings of guilt over the death of younger sister in 1945. (Tsukasa Kimura)

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