RIKUZENTAKATA, Japan (Reuters) - Hatsuko Ishikawa never got a final look at her 36-year-old son, a firefighter, before he was swept away by the tsunami that devastated Japan's northeast coast three years ago.
Ishikawa only heard his voice, bellowing from his fire engine as he sped towards the sea to try to evacuate people before the wave struck. As the truck raced past, Ishikawa heard her son call out to her grandson, telling the boy to evacuate to higher ground. Then he was gone.
She is haunted by what happened and tormented by what might have been.
"I blame myself over and over again, asking myself why I didn't stop him," said Ishikawa, 65, as she sat in the spartan shelter where she has lived since that day.
Small towns across Japan's northeastern coast are rebuilding but far from healing three years since a massive earthquake set off a tsunami that killed nearly 20,000 people. In Rikuzentakata, where one in 10 residents died, nearly everyone lost a friend or family member on March 11, 2011.
The resilience of Rikuzentakata's tsunami survivors was embodied by a lone surviving tree, dubbed the "miracle pine". But the tree died last year and a replica stands in its place.
Around 5,000 people, a quarter of the town's population, are still in temporary shelters with their lives on hold. Many like Ishikawa have chosen to suffer alone rather than seek support.
Ishikawa's voice cracked as she described how her husband placed a scarf around their son's neck when they found him in a makeshift morgue. "He looked so cold," she said.
After finding him, she went back to the rubble to search for the bodies of her mother and younger brother.
There were days in the wake of the disaster when her mind was completely blank, Ishikawa said. Then her blood pressure spiked and she was taken to a hospital. Her doctor urged her to see a counselor but she declined.
"No stranger can understand what is in my heart. I must bear this alone," she said, tears running down her face.
Survivors can find it especially difficult to seek help in a country that still stigmatizes mental illness and prizes stoicism, experts say.
"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.
"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.
"He was young and reliable and everyone depended on him. This became a massive burden," said Kanno. "He didn't sleep and collapsed from exhaustion."
Kanno's son has since been hospitalized and has not spoken or left his room in nearly a year, he said.
A photo of his 28-year-old son hangs on the wall of the log cabin Kanno built after the disaster. The photo, taken in 2012, shows a young, slender man smiling as villagers line up before a drum performance. Some of that sense of community has disappeared, Kanno said.
There are no comprehensive statistics on the depth of the tsunami's psychological impact on survivors. Rikuzentakata's city hall so far counts three disaster-related suicides.
A study funded by Japan's health ministry found that more than a quarter of children aged between 3 and 5 in the disaster zone exhibited signs of distress that needed professional help.
Some daycare centers don't celebrate Mother's Day or Father's Day anymore because so many children lost at least one parent.
Rikuzentakata mayor Futoshi Toba lost his wife in the tsunami. He says the city must do what it can to help its residents heal as it rebuilds.
"There are people who feel better when they speak to someone, and then there are those who feel more traumatized when they remember the past," Toba said.
"What we have to do is to keep rebuilding and share the town's progress with the residents to keep up hope."
Additional reporting by Lisa Twaronite in TOKYO; Editing by Paul Tait