And Now, Emotional Aftershocks

By Anastasia Toufexis

As the veterans of untold small tremors and countless mock drills, Californians have long been convinced they were psychologically ready for a big quake. Last week that comforting belief was demolished. "I'm scared," confesses Sarah Ford, 43, who with her three-year-old daughter found temporary shelter at an Oakland high school. "I need a stress pill. When I walk, I'm like tipping. I'm looking to see if anything moves."

The physical shocks may be waning, but the psychological reverberations are just beginning. In the next weeks and months, residents will have to cope with an array of symptoms that are increasingly recognized as the emotional legacy of mass disasters. Just like soldiers in combat and civilians in assaults, survivors of quakes -- as well as of floods, fires, plane crashes, even oil spills -- experience psychic upheavals so intense that their lives are shaken for years. In 1980 the American Psychiatric Association formally labeled such debilitating effects "post-traumatic stress disorder."

Some experts believe that Bay Area residents may be peculiarly vulnerable to the syndrome, precisely because they have been anticipating a cataclysm for years. "Chronic stress is very harmful," notes Dr. James Shore of the University of Colorado Health Sciences Center in Denver, who surveyed victims of the 1980 eruption of Mount St. Helens. "Preparedness can make people more susceptible."

Whether or not that proves true, the psychological buffeting Californians will endure will follow a characteristic pattern. Initial shock and fears will give way to a burst of elation. But that will quickly fade as the extent of the devastation sinks in. While few residents must confront the death of a loved one, many have lost their homes, which hold immense emotional as well as financial value. The destruction of family photographs can be tantamount to obliterating one's personal history.

Soon survivors will suffer a host of complaints, from headaches and stomach pains to flashbacks and suicidal thoughts. Victims of Hurricane Hugo, which lashed the Southeastern U.S. last month, are showing the expected strains. "About all of the people we talk to have sleep disturbances," says Dr. James Ballenger, head of the psychiatric institute at the Medical University of South Carolina in Charleston. "They are constantly fatigued. They leave briefcases at home. They forget appointments. They cannot concentrate."

There are other distress signals as well. Interest in food or sex often flags, while indulgence in alcohol or drugs deepens. People may be jumpy and their tempers short. In the first seven months after the Mount St. Helens blowup, reports of domestic violence in Othello, Wash., increased 45%, and criminal arrests went up 22%, according to one study. The most profound impact is a new sense of vulnerability. Victims wonder when disaster will strike again and conjure up fresh calamities. "Disasters like earthquakes challenge a fundamental fantasy that we live with: that we're immortal," explains psychiatrist David Spiegel of Stanford University's School of Medicine.

Most people recover their emotional equilibrium in about a year, though the trauma can easily last longer. In general, researchers have found that people cope with natural disasters better than man-made ones. And those who have suffered physical injuries often fare better ultimately than those who escape unhurt.

Rescuers, despite being trained to cope with disaster, may be particularly troubled by the grim sights and smells. "I don't care how professional your firemen and policemen are," says Jim Worlund, an Oakland emergency planner, referring to an amputation performed on a victim on the collapsed Nimitz Freeway, "that's hard to live with." Dr. Edward McCarroll of the Walter Reed Army Institute of Research in Washington last year conducted a survey of 150 military and civilian personnel who participated in rescue efforts at military disasters. He found that many were overwhelmed when they discovered a body that resembled them or when they handled victims' effects, like wedding rings. "All they can think of," he says, "is 'That could have been me.'

( Older people, once considered emotionally frail, are now regarded as exceptionally hardy. Their wealth of experience gives them a broader perspective to draw on. Children, on the other hand, appear to be very fragile. Psychologist Bill Locke of Texas Tech, who studied the aftereffects of a 1970 tornado in Lubbock, found that youngsters, even those as old as ten, regressed into clinging and infantile behavior and that some residual effects were felt in adolescence. Other high-risk groups: single parents, especially women, who usually carry the brunt of their family's emotional needs; and the poor, who are often already stressed to the limit.

The key to blunting mental trauma is counseling. Survivors need to be assured that their reactions are normal and expected. Talking to family and friends is encouraged, but often it is not enough. Says Susan Solomon, coordinator of the National Institute of Mental Health's emergency and disaster research program: "The thing that makes disasters particularly damaging is that the people you normally turn to for help are also victims." Many Alaskans affected by the Exxon Valdez oil spill last March are finding professional help useful. In the three months after the accident, the number of people seeking assistance at the Valdez Counseling Center was three times the number who came during the same period in the previous year.

The sooner help comes, the better. A study of 200 traumatic-stress cases by researchers at the Barrington Psychiatric Center in Los Angeles revealed that the costs of rehabilitation, disability, absence from work and litigation were six times as high for victims who received no or delayed therapy as for those who were treated quickly. That suggests that California health officials should offer as much counseling as possible now -- or face even more serious distress in the future.

With reporting by Andrea Dorfman/New York and Joseph J. Kane/Atlanta