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Rikuzentakata, Japan (CNN) -- Since disaster struck the Japanese town of Rikuzentakata a month ago, Mayor Futoshi Toba has made hundreds of decisions.
But it's the one he made just before the tsunami that bothers him most.
When the wall of water was bearing down on his town, Toba faced an agonizing choice: Leave his post at city hall and race home to save his wife and children or stay to do what he could for the city.
Luckily, his two boys were in school and were able to get away to safety. But Toba's wife disappeared in the waves of water that devastated the town.
"She was missing and I wanted to go to find her," he says staring out over his town. "Maybe I should have gone to find her. I think about that but still think I would do my duty again."
Her body wasn't discovered until recently, and the 46-year-old mayor was only able to hold a ceremony and have her remains cremated a week ago.
In the meantime, he has been working 16- to 18-hour days, scrambling to help survivors packed into temporary shelters and cope with the cleanup.
The tsunami roared ashore, and one in 10 people in this town of 23,000 disappeared or died -- including his wife.
"I've told myself that this is the way it is meant to be," he says. "Now I've stopped struggling"
But amidst the devastation around them, many tsunami survivors are increasingly struggling with the emotional and psychological devastation within themselves.
The numbers are still being compiled, but health officials report suicides in Iwate prefecture, where Rikuzentakata lies, are on the rise.
Japan already has one of the highest rates of suicide in the world, and psychiatrists such as Dr. Fuminori Chida are worried that the kind of stoicism and sense of duty the mayor showed may be making things worse.
"In the four weeks since the quake, the initial acute stress has converted gradually to post traumatic stress disorder (PTSD)," says Chida who runs a private clinic trying to help survivors and first responders. "That's where the need for the psychiatrist comes in."
But psychiatrists are in short supply here.
Chida has been focusing on police officers and government workers, many of whom have worked non-stop doing the grim job of recovering the dead.
He says as many as half the ones he's met with show symptoms of PTSD.
This is Japan, however, a culture known for its stoicism. Psychiatric medicine is not widely accepted outside of major cities.
The idea of confessing your feelings to a stranger is almost unthinkable.
Instead, there is a message being sent to the people over airwaves, on signs in shelters, even lit up on the quake-damaged Tokyo Tower: Ganbatte.
It's a very Japanese term that roughly translates to "keep it up," or perservere through the worst with a stiff upper lip.
That talk may sound good but experts like Chida say it really doesn't help. Instead of holding feelings in, they say it would be better for survivors to let them out.
"This is the kind of thing we should publicize more." Chida says, "You are not alone. You're not the only person suffering so much fear and agony, and you can recover."
The doctor has led teams of his colleagues to the coastal towns over the past few weekends, hoping to bring some comfort and help to the survivors who feel they're too busy to see psychiatrists, or trying to work through the emotional agonies.
It's a challenge though. Chida told CNN that one police officer who was tumbled through the tsunami in his car with a colleague who died was berated by a superior when the officer began to cry one day.
Meanwhile, back in Rikuzentakata, the stress continues to grow on Mayor Futoshi Toba.
He wants to help more people find their lost loved ones.
"Losing someone with tsunami is different from losing someone from sickness," he says reflecting on finding his wife. "The way she (looked) is not what she was."
And he tells of facing one last difficult decision.
"I haven't told my kids that their mother is dead or the fact that her body was found," he says solemnly.
"So it is true that I do not need to cope with my feelings while I am at work, but when I am with kids I often think abut when to tell them the harsh fact."