The emotional mending for many people touched by the Bay Area earthquake will take much longer than the structural rebuilding and outward return to normalcy. Psychological aftershocks will be felt for months and years--and far beyond the Bay Area itself.
"The most vulnerable are those people who were closest to the death and destruction, as well as the very old, the young, and the already stressed-out," said Dr. Spencer Eth, medical director of the Psychological Trauma Center, affiliated with Cedars-Sinai Medical Center in Los Angeles.
He estimated that 80% of those who survived the collapse of the Nimitz Freeway, the San Francisco-Oakland Bay Bridge or a building will experience symptoms of post-traumatic stress disorder. "But people who were not even in San Francisco will be affected--such as those who experienced the Whittier or Mexico City quakes."
Many will become anxious, hyper-alert, disturbed by nightmares or intrusive thoughts about quakes, fearful, or have guilt feelings or become numb to what is going on around them. For most, such symptoms may be fleeting. Others will become depressed, develop psychosomatic symptoms such as stomachaches, chest pains and labored breathing. Some will make a habit of avoiding certain situations--such as driving over bridges or visiting shopping malls.
Surprisingly, however, some seemingly "fragile individuals may cope better than those who consider themselves invulnerable and tough," Yale University sociologist Kai Erikson said. Hospitalized mental patients, for example, often deal calmly with fires, while "normal" people sometimes panic and stampede in similar situations.
Panic and looting--thought to be a result of lowered inhibitions and tempting opportunity during crises--were minimal after Tuesday's quake.
"There will be a spectrum of reaction," agreed Dr. Robert Pynoos, who directs UCLA's Prevention Program in Trauma, Violence and Sudden Bereavement, "not a global response."
Earthquakes usually elicit stronger reactions than other natural disasters. "Everyone feels the ground isn't solid," Pynoos said. "Our world view of the stability of the Earth is shaken. Some believe the myth that we are going to be swallowed by the ground. And our inner stability is disturbed." Studies by Pynoos and others have found that such traumatic experiences can actually alter brain chemistry, though how long-lasting such changes are is still unknown.
Still, unlike man-made catastrophes or violence, natural disasters often are easier to cope with psychologically because they appear to be acts of God. Fits of nature do not produce revenge fantasies and recriminations.
Disaster researchers also distinguish between "centrifugal" and "centripetal" disasters: plane crashes and boat sinkings fall in the first category, involving people from many places brought together accidentally; earthquakes, volcanoes, hurricanes and tornadoes fall into the second, because whole communities are disrupted.
In the first, survivors can return to normal environments and support systems, while in the second the damage and disruption are concentrated and inescapable--property damage, power outages, restrictions on movement, and loss of friends, relatives or belongings.
Erikson said many San Franciscans will be surprised at how long they grieve, not only for the dead and severely injured, but for the loss of material things, such as homes or cherished objects--things they had not realized are an extension of themselves.
Children are among those most traumatized by an earthquake. They take their cue as to how to react from their parents and their level of understanding of the phenomenon.
However, psychiatrist Eth said, "When parents have their act together, the kids do pretty well." Some, prepared in school drills, actually seem to enjoy the experience and feel secure in knowing what to do in such an emergency.
"The first thing parents have to do is stay calm themselves," Los Angeles child psychologist Robert Butterworth said. "If the earth is shaking and the parents are shaking, the child's world is in trouble." Very young children may attribute the shaking to monsters or ghosts.
One teacher in Prunedale, near the quake's epicenter, said she had to hold two frightened children in her arms on the classroom floor for about 90 minutes before they would move. The quake was especially hard on families who were separated and unable to contact each other.
In the days and weeks after a temblor, some children may refuse to sleep alone or go to school, wet the bed, have recurring nightmares, cry and cling, insist that the lights be left on, and jump at the slightest noise.
Experts say that discussing the quake does not increase fear, but helps the child feel more secure. Eth said youngsters need to know what happened and what may happen, noting that "the kids in Whittier were told there'd been an earthquake but nobody told them there would be aftershocks," which consequently were even more frightening.