In August, a somewhat unusual Israeli delegation landed at Tokyo airport. Three Israelis got off the commercial flight: Dr. Flora Mor, a psychotherapist and head of curriculum development for the Joint Distribution Committee’s Ashalim program for at-risk children and youth; psychologist Dr. Shai Hen-Gal, a project director specializing in trauma at Ashalim and the Education Ministry; and Daniella Hadassi, an art therapist who works on behalf of the Foreign Ministry. They brought with them 180 stuffed animals in rustling plastic wrapping. These little plush puppies, with their sad faces, have a proven positive effect on traumatized souls.
The first breath of the chilly Tokyo air was unsettling given the high levels of radiation that had been measured in the city (though the stuffed animals didn’t bat an eyelash ), but the team of therapists didn’t have time for such worries. They were greeted by their hosts, members of the Japanese Puppet Therapy Association, and by their translator Yishai Hika, and were off to the hotel.
The tsunami that struck Japan’s northeastern coast on March 11 took more than 20,000 lives and left nearly a million homeless. The tsunami also damaged the nuclear reactor at Fukushima and radiation that escaped from there threatened Tokyo and parts of northern Japan. Since then the national mood has been in the doldrums. Planned power outages were paralyzing the economy, foreign tourism was wiped out. In the Fukushima area, residents were shutting themselves inside their homes, isolated in their distress.
Japan had begun to slowly recover from the disaster, but while the recycling plants were busy grinding up the rubble for use in new infrastructure projects, in another sensitive area they were struggling to find relief: The Japanese psyche remained trapped between the national code of restraint that requires that one to go one with “business as usual” and avoid public displays of emotion – and the terrible trauma it had undergone.
Many of the worst affected were children in the disaster zone: The world they knew had collapsed, some lost their homes as well as their loved ones. Doctors in the region were reporting symptoms that indicated serious emotional distress. Many children had stopped laughing or crying. Their facial expressions were frozen and they weren’t interested in playing.
The authorities have encountered great difficulty in trying to provide such children with psychological assistance. There are hundreds of thousands of affected children, spread over a vast area. Nor is there a very highly developed mental health system as one would expect to see in the West. There are not enough psychologists, psychiatrists and educational counselors to reach all the children and give them the attention they need. And direct mental health assistance from foreign countries isn’t available either. Foreigners don’t know the language, and Japanese law prohibits anyone who didn’t study medicine in Japan from providing medical aid to a local resident. The Israeli delegation was an exception, because of its experience in treating victims of mass trauma.
Five years before the tsunami in Japan, Israel endured a barrage of rockets in the Second Lebanon War. Thousands of residents of the north abandoned their homes and found temporary shelter in the tent city set up by Arcadi Gaydamak in Nitzanim. Thousands of children roamed the camp unsupervised. The psychological counseling service of the Education Ministry eventually sent a delegation there, including Hen-Gal.
“One of the challenges was to quickly diagnose thousands of children and offer them a suitable intervention plan,” he recalls. “Some were fine and others had suffered trauma of one degree or another.”
Children are just as vulnerable to trauma, caused by catastrophic events or shocking and painful incidents, as adults – perhaps more so. Children who have experienced stress and trauma are liable to direct destructive behavior at others and at themselves, and to suffer learning difficulties, dissociative problems, somatic problems and distortion in self-perception and their perception of others. They can even develop chronic behavior patterns that show minimal involvement in what is going on, plus an excessive preoccupation with the past.
“Traumatic conditions in children entail a terrible sense of loneliness that can include subjective feelings such as ‘I don’t want to be different than other children,’ or ‘I don’t want to burden everyone with my story,’” explains Hen-Gal, adding that often the adults around an affected child will avoid direct mention of his distress.
Back at Nitzanim, it wasn’t possible to offer standard therapy because the families left there after a short stay, so the team had limited time, and thus needed a quick and effective tool. Hen-Gal contacted his professor from Tel Aviv University, clinical psychologist Avi Sadeh.
“He invited me and we met at the camp,” Sadeh recounts. “I offered to volunteer but he explained that they had enough volunteers, but needed some sort of strategic solution. I suggested an approach that I use in treating children in a private clinic: I recommend that parents buy a stuffed animal and then I teach them how to use it.” And thus Hibuki (“Huggy” ) was born.
Truth be told, Hibuki – a soft, sad-eyed puppy, made in China – began life in Israel as a failure; the importer didn’t understand why parents weren’t buying it. Sadeh came across it by chance. “I was wandering the toy stores looking for a plush toy and finally I came to one place where I saw this one and knew right away that it was what we needed. I used the research money I had left over to buy the first 70 stuffed animals.”
The sad face that kept parents from embracing Hibuki turned out to be just right for Hen-Gal and Sadeh’s purposes.
“A traumatized child identifies more with a sad animal because it’s easier for him to project his own sadness onto it,” Hen-Gal explains. “One of the first questions we asked the children was why Hibuki was sad, and the child would say: ‘Because a Qassam fell on his doghouse.’ Or, ‘He doesn’t have any friends.’ Another advantage of this stuffed animal was its human expression, plus the long arms with Velcro at the ends that can hug the child and cling to him. The child hugs the puppet and the puppet hugs him. That’s where the name comes from.”
The two psychologists distributed the stuffed animals in the camp and asked parents and staff to encourage the kids to “take care” of them. The results were astounding. Making the child act like a caretaker prompted him to shift his focus from his own problems to those of the little animal, as it were, and thus indirectly helped the child take care of himself. The parents were also given a very valuable means for reconnecting with the child and understanding how he was doing, via indirect questions about his relationship with Hibuki.
Hen-Gal: “It was clear the parents were afraid to confront reality head-on. They didn’t know what to say to the children, and also felt guilty that the kids were paying such a heavy price. As a result, the children were exposed to vast loneliness, accompanied by anxiety. Our intervention made [parents] see that children are affected much worse when they aren’t able to speak about their anxiety, and we helped them to get the children talking and to answer their questions.”
In the past 15 years, mental health research has found that the healing powers of people who are in the children’s natural surroundings – parents, teachers, counselors, etc. – are greater than that of an outsider, no matter how skilled he or she may be. Rather than the magnitude of the disaster, it has been found that it is the ability of such adults to mediate the experience for the child that affects the extent of their psychological damage.
“Even children who are exposed to very severe trauma can heal efficiently if their parents and others around them are able to mediate the distress for them,” says Hen-Gal.
Sadeh and Hen-Gal show that treatment with the Hibuki toy is suitable for 95 percent of children exposed to stressful and traumatic events, and that within just a few days, incidents of stress-related behavior such as bedwetting, nightmares, anxiety and violence were reduced by 40 percent. Plus the therapeutic effect was apparently long-lasting.
As the rocket barrages continued, and with funding from the Israeli JDC and from Jewish communities in North America, Hen-Gal returned to the importer with an urgent request that he bring over as many stuffed animals as possible. The importer was able to find 250 in warehouses, but since there were thousands of children in need, other toys were tried, Hen-Gal recalls: “We tried to use a green frog but it didn’t work. We asked the kids, ‘Why is the frog sad?’ But it didn’t look sad to them and the kids didn’t understand what we wanted from them.”