MINAMI-SOMA, JapanJapan's radiation nightmare has turned the lively home that truck driver Takahiro Ishitani once shared with his wife and three sons into a cluttered bachelor pad.
A coffee mug full of cigarette butts, a towel and other odds and ends sit on a low table in the apartment's small living room. He offers a visitor a takeout box lunch, his main source of sustenance these days. Laundry hangs inside so it won't absorb the radiation that remains in the ground, two years after an earthquake and tsunami caused meltdowns and explosions at the Fukushima Dai-ichi nuclear power plant, about 30 kilometers (18 miles) to the south.
To escape this lonely weekday existence, the 42-year-old Ishitani drives three hours up winding roads every weekend to see his family, which has moved away because of fears that radiation could harm the children.
"If it really is safe, I want them to come back," says Ishitani, a stocky man with a small beard on the tip of his chin. "But it's hard to know. Different people say different things, and that adds to my stress. I don't know whom to trust."
Just as with Three Mile Island and Chernobyl, mental distress could be one of the biggest health issues to emerge from this disaster, experts say. While attention has focused on the potential cancer risks, they remain unclear. What is clear is that the uncertainty and the upheaval it's caused in people's lives is already exacting a very real and pervasive psychological toll.
"It's one of the biggest problems," said Seiji Yasumura, a professor of public health at Fukushima Medical University.
Ishitani collapsed on the street with an ulcer nine months into the disaster. He was hospitalized for three days and still takes stomach medicine. The slightest tremor wakes him at night, and then he can't back to sleep as he worries about the future.
Will his youngest son, 8-year-old Ryusei, ever be able to play in the woods and catch crawfish in the river as Ishitani did as a child? How long can his family continue this divided life? Will his now half-deserted hometown of Minami-Soma even survive - or shrivel and die?
More than a decade after the 1986 Chernobyl accident, mothers of young children who were evacuated had twice the rate of post-traumatic disorders than the general population, according to Evelyn Bromet, a psychiatrist at the State University of New York, Stony Brook.
A health questionnaire sent to Fukushima residents by Fukushima Medical University showed that about 15 percent of 67,500 respondents indicated high levels of stress on the Kessler Psychological Distress Scale, a commonly used test to gauge stress, much higher than the 3 percent among the general population.
The survey results, compiled through June, the most recent available, also showed 21 percent scored high on a checklist used to screen for post-traumatic stress disorder.
As Ishitani runs errands around Minami-Soma in his four-ton truck, he wonders out loud whether his family should return to a place where hardly any children ride bikes anymore for fear of touching the contaminated ground.
"Look around. There aren't many kids playing outside," he says as he points to an empty playground. "A lot of people say that 5 to 10 years down the road, this town isn't going to survive. When I think about that, too, I wonder if it's right to bring my son back to a town that's shrinking."
Later, outside his apartment, Ishitani holds a beeping Ukrainian-made Geiger counter near the ground next to his parked minivan: 3 microsieverts per hour. A regular chest X-ray gives a dose of about 50 microsieverts. He used to check radiation levels regularly, but has stopped doing it much because "it just got to be silly."
Hardly any progress has been made in decontaminating the area, and many doubt the cleanup - hosing down walls, carting away topsoil -is effective.
"I don't care about how much radiation I absorb," Ishitani says. "But when I think about the impact it might have on my child, I can't let him come back."
Ishitani and his family fled abruptly in the middle of the night three days after the tsunami hit. A friend called to warn them that a second reactor might explode and that their lives were in danger.
Terrified, they hurriedly packed a couple of bags and jumped in their car. Ishitani drove madly into the mountains of neighboring Yamagata prefecture, figuring they would be safe there. After two months in an evacuation center, Ishitani returned to Minami-Soma to work. The rest of the family - including his wife's two older sons from a previous marriage - later moved to a house whose rent is covered by the government for three years.
Many families are similarly split - fathers sticking it out with their jobs while mothers and children live in temporary shelters or government-sponsored housing. Sometimes, the stress of separation has gotten to be too much, leading to what the media has dubbed "nuclear divorces." Ishitani says his marriage remains strong, though his wife Yuko is lonely. His parents still live in Minami-Soma, and his 67-year-old mother, wiping away a tear, says she misses her eight grandchildren, most of whom have moved away.
All told, some 160,000 people in Fukushima prefecture remain displaced by the disaster.
Japanese authorities have sought to address the psychological strain on residents by bringing in psychiatrists and counselors to help staff mental health clinics and organize support groups at temporary housing settlements, but experts acknowledge that many psychological needs are not being met.
A huge barrier is a strong cultural resistance to visiting a psychiatrist or "heart care clinics," as counseling centers are called to reduce the stigma. That's particularly true in the northern region of Tohoku, where people are generally stoic and private matters stay private. Ishitani and others here say such clinics are for the seriously ill, not for stress that everyone is experiencing.
"No one around me ever goes to those places," he says. "Even if you go to them, it isn't really going to help the situation."
There's little to do to relieve stress. Before the disaster, Ishitani would go out with friends on a fishing boat once a month and bring home flounder and greenling that his wife would broil to perfection. But he's stopped doing that after authorities said the fish are contaminated.
He frequently talks with friends, some of whom have moved away, but the conversations often end up becoming gripe sessions about the authorities.
There's anger at the government and the utility that owns the Fukushima plant, Tokyo Electric Power Co., or TEPCO. Ishitani doesn't know where to direct his rage. It makes him feel powerless.
He has called the utility's head office in Tokyo numerous times to complain, but feels helpless unloading on a low-level public relations staffer who can't take any action.
"It's the deception of the politicians, bureaucrats and TEPCO that makes me the maddest," he says, his voice rising slightly. "The feeling is that if we just compensate people with money, that's enough. That just drives me crazy."
His family received 500,000 yen ($5,200) per month from TEPCO as compensation until last August, he says, but he wants something different.
"Rather than stay in their big offices, I'd like to see them come out and help clean up," he says. "They are in Tokyo getting their big salaries. They aren't living here."
Hours later, Ishitani is much calmer as he sits with his wife and youngest son in the family's rented house in Yamagata prefecture. There's two meters (six feet) of snow outside, but he's warm and content eating a supper of broiled fish and hot soup, his legs tucked under the traditional "kotatsu" table, which has a blanket and built-in heater to keep warm.
It feels like home, even if it isn't.