"Japanese hesitate to use mental health support - not only mental health support, but support in general," said Tsuyoshi Akiyama, the chairman of the disaster support committee set up by the Japanese Society of Psychiatry and Neurology.
Most of the debris has been cleared in Rikuzentakata, leaving only an overgrown field where the town once stood. Dump trucks and bulldozers barrel down the town's few paved roads, sending clouds of yellow dust into the air.
After sunset, there is only silence. Some residents say they believe in ghosts and a few taxi drivers say they refuse to pick up passengers after dark after some claimed to have seen apparitions. The sound of the ocean is faint, and many survivors say they avoid the seaside at night.
Mental health professionals say resentment has also built among the survivors because some have managed to get their lives back on track faster than others.
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"In the first year, there is a collective feeling of working together, of overcoming this together," said Ayako Sato, a psychologist hired by the Rikuzentakata city board.
"In the second year, everyone wants to help each other because everyone suffered a loss in the disaster. But by the third year, you start to see a rift in living standards. People drift apart," Sato said.
Takeshi Kanno, 63, is a pillar of the Rikuzentakata village of Kesencho, which lost all of its homes to the disaster. While Kanno built a relief camp at the Buddhist temple above the town, his youngest son, a volunteer firefighter, searched for bodies in the debris below.