It is not as easy as one might think to describe the mental trauma experienced by the survivors of the A-Bombs (Hibakusha).
For facilitating the understanding of what has actually happened to the minds or the psyches of A-Bomb survivors, it would be useful if the traumas could be broken down into different elements that could then be precisely identified, named, and classified in a list in a neat way, but this is impossible. The elements of their traumas are intricately intertwined and change over time. In addition, they experience symptoms that reflect or are the consequences of physical ailments and social relations. Therefore, in this section, I will first deal with the complaints Hibakusha often make about their conditions that are readily understandable. Then, I will go on with what they cannot express as complaints, their traumatic memories, and their mechanisms for the suppression and reproduction of memories. I will describe the processes through which psychic damage is exacerbated by the stigmas and hardships of life which the survivors have suffered after the atomic bombings. Finally, I will consider how the minds of survivors continue to be pained in their old age. This does not mean that I am trying to demonstrate that there are various types of harm incurred on the mind of Hibakusha. What I am trying to show is the three-dimensional structure of the psychic injury that Hibakusha continued to experience. I will do it by looking into their minds from different angles as well as at different levels, from the surfaces into the depths of their psyches, from the past to the present (and sometimes from the present to the past). However, one must admit that the sensibility or the vulnerability to psychic injury, how it is perceived or felt, is not identical for all: it differs considerably from one individual to another. Thus, describing the psychological consequences of the atomic bombings in a clear-cut manner will not bring us nearer to the truth but rather farther away from it. I will, therefore, try to outline the structures of psychic injury in such a way so as to make it as easy as possible for anyone to understand, while being well aware that I run the risk of departing from the truth.

From the Harm Knowable and Understandable to All to the Harm Unperceivable to the Victims Themselves
The tragic experiences of the Hibakusha after the atomic bombings are presented in this book. I think some readers have wanted to give up reading these stories before their endings because they weigh so heavily on our hearts. Habitations disappeared in an instant. Parents and friends died right before their eyes. They witnessed masses of deformed dead bodies and processions of ghost-like survivors. They found themselves unable to give any help to the agonizing victims, lacking even the water to moisten the lips of the dying people. These types of experience deeply hurt all who have gone through them. Anyone who hears or learns about such experiences can understand what they mean. No one could ever forget such experiences or such stories because they mark one's mind so deeply. An ordinary person with normal senses can understand these experiences by referring to his or her own experiences. As a matter of fact, people listening to Hibakusha tell their stories, reading what Hibakusha have written, and watching documentary films on the Hibakusha can understand their injuries and share their experiences. This is why many Hibakusha have spoken or written about their pains and sufferings even though they are the origins and the basis of the injuries they sustained in their minds. In the context of describing what actually happened, however, Hibakusha without exception admit that it is impossible to put their experiences fully into words. This shows that Hibakusha feel there is something that they are unable to communicate to others: they feel the limits of language as a means for communicating and sharing experiences. In fact, the psychic injury they incurred is so deep that it surpasses our imagination. The defective memories and apathetic attitudes often observed in Hibakusha are two of the symptomatic signs of their injuries.
When, all of a sudden, we are thrown into an unprecedented crisis or an extreme situation, we unconsciously freeze our memories and suppress our cognitive and/or emotional functions, instinctively trying to protect ourselves by restricting memory inputs. This is exactly what has happened to the individuals who experienced the atomic bombings. From carefully interviewing A-Bomb survivors, I realized that they all without exception had had episodes of defective memories at various periods and to different degrees.
Defective memory may take different forms depending on individuals. Some may have kept for a long time very vivid memories which confuse realities and fabricated realities, while others have gaps in their memories or very dim memories about a certain period of time. There are also individuals who do not clearly recall what they did after the bombings because they were too absorbed in searching for their relatives. It is generally believed that one must be at least seven or eight years old to be able to keep a solid memory. In the case of A-Bomb survivors, loss of memory or memory deficits have occurred in those who are over seven or eight years old. The written testimonies of Hibakusha must be seen as comprising fragmented psychic remembrances that remain in their memory because they cannot write of what they do not remember or of what they do remember but only vaguely. It would be wrong, however, to believe that they tell lies to fill the gaps in their memories, and we must acknowledge that they might have suffered much more severe circumstances than they remember having suffered during the period of time of which they cannot fully remember.
Most Hibakusha recall very well, more precisely than anything else, what they were doing and where they were when the atomic bombs exploded. This suggests that they were not suffering from any memory disorder before they were exposed to the atomic blasts, but they have problems in remembering things that happened after the bombings. What triggers memory freezes or rejections of inputs differs from one individual to another, and taking into account the fact that similar symptoms are observed in those who were not directly exposed to the atomic explosions but who entered the bombed cities after the bombings (entrant Hibakusha), there must be many types of causes.
Judging from particular cases, it seems that memory freezes or rejections of inputs are triggered when individuals are thrown into an unusual world and have undergone an instantaneous disintegration of their existence, such as being confronted with a large number of hideously disfigured dead bodies. Complaints such as "I cannot recall that moment" or "I can only remember it vaguely" do not mean that there is nothing left in the complainant's memory storage. They can recall things that are left in their memories when something prompts them, and when they do not remember, they re-memorize more solidly the experiences of fear that they remember. These types of memories will in future provide the basis for flashbacks of fear.
The same reasoning may apply to emotional paralysis or apathy. Hibakusha often tell their stories with remorse and self-reproach, "I was unable to respond to people asking for help," "I could not give water to those who badly needed water," "I dealt with dead bodies without any respect, as if they were objects," and "I cremated my relatives without shedding a tear." They tell of these things only retrospectively because when they were doing these acts their emotions and sensibilities were suppressed or contained by strong psychic barriers which served as self-defense mechanisms. They could not function in an extreme situation, such as an atomic disaster, without these mechanisms.
After having been in an extreme situation that did not allow them to behave with dignity as humans, Hibakusha were swayed by violent feelings of guilt and remorse, desperately looking for ways to atone for their sins. In addition, they put strict rules on their way of life, thinking that they owe their lives to those whom they left behind to die (feelings of guilt for being alive).

Recurrent Reproduction and Alteration of the Memory of That Day
When a person has gone through a painful experience, he or she is obliged to bury deep the memory of that experience to carry on day to day. It is not possible to live constantly overwhelmed by painful remembrances. Psychic injury usually tends to heal with time. Once something happens and reminds that person of the painful experience, however, the buried memory immediately revives, which is a terrifying experience for the person. This is why the person in question often chooses to live a life that does not remind him or her of the painful experience. Even living in that way, however, he or she is tormented by nightmares and insomnia for some time. This process as a whole is called PTSD (Post Traumatic Stress Disorder).
Most Hibakusha are going through a similar process. The first symptom is silence or not speaking. They do not respond to questions and refrain from talking to others except for a few words.
Nevertheless, all the symptoms observed in Hibakusha do not fit in the concept of PTSD as it is currently defined. It would be more correct to say that the symptoms of Hibakusha go beyond the defined PTSD concept. It is necessary, therefore, to redefine PTSD, taking into account the characteristics discussed below.
The first is that the traumatic memories of Hibakusha are so strong that, even suspended, they come back with any minor stimulus (such as a flash or rumbling of thunder), taking Hibakusha instantly back to the days of the atomic bombings. The Hibakusha have been suffering from this for more than sixty years. According to a survey made sixty years after the atomic bombings, at least thirty percent of A-Bomb survivors are likely to have these types of flashbacks. For the survivors who were under sixteen years of age in 1945 and who were exposed to the bomb blasts near ground zero, the proportion exceeds forty percent.
The second is that Hibakusha in different periods during the course of their lives are assaulted successively by stimuli that oblige them to remember that day, even if they have chosen to live in retreat from society. The first assault comes from discrimination and prejudice. During their school years, many Hibakusha were excluded by their classmates as children of Pikadon (the atomic bomb). Among other moments, they also faced discriminated when attempting to marry. The second assault is seeing other Hibakusha die of A-Bomb Disease (mostly leukemia and other cancers). Every time they learn of the death of another Hibakusha they cannot help but feel themselves taken back to that day against their will. When they themselves fall ill (whether of A-Bomb Disease or not), they think their turn to die has come. This is probably the most typical flashback commonly seen in Hibakusha. In each flashback, the wounds in the minds of Hibakusha lose their scabs that have formed and the wounds grow deeper. This is the most significant characteristic of the psychic damage Hibakusha have sustained. The harm was not greatest when they originally experienced the atomic bombings, and the harm does not lessen with time. On the contrary, that day was only the beginning of this particular trauma. It grows more and more severe. Why?
This is because the harmful effects of the A-Bombs are essentially from radiation exposure, and these harmful effects are long-term. Along with the physical shock waves, blasts and heat rays, the radiation of the atomic bombs killed or injured a massive number of people on those days. The blasts and heat rays, however intense they were, only have transitory effects. In contrast, radiation has pernicious, delayed effects that reveal their diabolic nature only after many years, and these effects grow stronger with time. Those who barely survived the atomic bombings have been haunted by the late effects of radiation. The fear of these effects follows the survivors everywhere and at all times, threatening them and not giving them time to heal the wounds in their minds.
In addition, the contents of the flashbacks change subtly as they recur many times. In the beginning, they mainly include memories of the cities that disappeared in a flash, of ghost-like victims, of a massive number of deformed bodies, and of more personal episodes of being unable to rescue others. Then, personal episodes of not being able to save others and of letting them die take more weight in the flashbacks as they repeat because the feelings of guilt for being alive to the detriment of those who died becomes stronger due to emotional paralysis or apathy. At this stage, Hibakusha feel that their life exists on the basis of that of the dead, but the dead here most often means specified individuals whom they came across by chance, not necessarily their closest relatives or unspecified individuals they could not save. One possible explanation for this is that, for the sake of atonement for their sins, they need concrete individuals to convince themselves. Another explanation is that this is a manifestation of human loftiness.

Asking Themselves Why They Are Alive
Whether they are conscious of it or not, whether they are ill or not, Hibakusha seem to question today the significance of their survival, rather than facing the feeling of guilt for being alive. To put it more frankly, they are asking themselves why they are alive.
My personal impression is that, since the Chernobyl nuclear plant disaster in 1986, more and more Hibakusha have begun to tell their stories, to write, or to publish their memoirs. Today, increasing numbers of Hibakusha file lawsuits for obtaining A-Bomb Disease Recognition. Hibakusha more readily tell about their experiences. They are joining Hibakusha's movements and some of them have become leading figures of those movements. I guess their subconscious is telling them that they should do something. The same thing may be happening to the silent majority. If Hibakusha do not find that something to do, it will be the last psychic damage they will have to suffer. Since the end of war, Hibakusha have gone through a succession of events that they are unable to control. This life itself is a hotbed for hypochondria and depression. In the event that they do not find anything to do, they will suffer from hypochondria and other psychic diseases until they die. I am sure I am not the only one who would not like to see the Hibakusha die merely as victims because they, as A-Bomb survivors, can make their own contributions to society. I want to see them give meaning to their lives and to be proud of their lives.

Conclusion
The root cause of the psychic damage is the trauma Hibakusha sustained on that day; however, the psychic damage they are suffering today is from PTSD caused by the memory of one of the worst traumas in history. Moreover, they are constantly threatened by the recurrence of flashbacks. It is recurrent because the long-term harmful effects of the A-Bombs are from radiation. Late radiation disorders and their threat cause successively new psychic traumas to Hibakusha. Hibakusha are haunted by radiation all through their lives. This is the very diabolic nature of the atomic bombs.

Observations and Remarks
Researchers who preceded us have shed light on psychic injury as a problem linked to the ways Hibakusha feel, think, and live, but most of the work on this question has been done by Hibakusha themselves by telling, writing, or studying the harm they have suffered. Hibakusha often speak about their feelings of guilt and self-reproach generated by emotional paralysis or the experiences of leaving behind dying individuals. They also speak of gratuitous discrimination and prejudice and of feelings of sin or guilt for being alive. Robert Jay Lifton has systematically classified these feelings into different categories: spell of death, concentric circle of sin, and mental paralysis. Tadashi Ishida suggests that Hibakusha have developed an anti-A-Bomb philosophy by sublimating two conflicting ways of life, namely drifting and resisting. In this book, the term psychic injury, originally used in contexts that are totally different from ours, is used as a natural premise. We, therefore, have not found many new types of psychic injury. Rather, we have tried to explain the three-dimensional structure of that injury so that everyone can understand it. On that basis, we have looked at how that structure changes with time. I would be happy if this helps the general public to understand the psychic damage experienced by Hibakusha, psychic damage that does not heal even after sixty-two years. Hibakusha continue to suffer.
In recent years, in the event not only of large-scale natural disaster but also of crimes committed by psychopaths, the need for providing mental care for victims is vociferously emphasized by the media, and caregivers are rushed to the sites of disaster or crime. When I watch these reports, I cannot help but think of the difference in the treatment of Hibakusha. In my view, the harm Hibakusha have suffered should be subject to medical treatment and compensation. Hibakusha must demand this and the state must endeavor to provide medical care and compensation for the psychic damage incurred by Hibakusha. It is the duty of the Japanese people to support the Hibakusha.
(Extract from the book Hibakusha no Kokorono Kizu wo Otte (Following the Mental Injury in Hibakusha) published by Iwanami Shoten in July 2007.)