MIANYANG, CHINA — At a camp for earthquake survivors, a psychologist hands some plastic toys to a lonely girl named Wang Yue and encourages her to build a house. Why did you put a phone there? he asks her. To call my parents. What's the police car for? To find my grandfather. What's the ambulance for? So I don't get hurt.
This month's devastating quake in China destroyed the 9-year-old's house -- and her little world. Her parents, migrant workers, live far away. Her beloved grandfather, who raised her, has left in search of medical care, destroying her sense of security. The psychologist, Zhang Mingliang, says it's no wonder she's depressed and showing signs of post-traumatic stress.
But in the two days his team has been role-playing with her, the little dolls in her model house, which were placed far away in earlier games, are getting closer to home. Those are all good signs, he says, as the slight girl sits sullen, her memory temporarily gone, her shoulders bowed.
The death and destruction experienced by millions of people in Sichuan province will leave some with scars lasting a lifetime. And the reminders continue unabated, with a magnitude 6 aftershock striking Sunday afternoon, killing at least six people and damaging about 270,000 houses, according to the official New China News Agency.
Psychology, psychiatry and grief counseling are relatively new fields in a culture where formality, Confucian hierarchy and decorum are highly valued and many families customarily don't talk much about their feelings, particularly fathers and sons.
"Chinese traditionally don't like to articulate their emotions," says Helen Chiu, chairwoman of the psychology department at the Chinese University of Hong Kong.
In a major turnaround, the government has embraced mental health issues almost from the beginning of this disaster, sending more than 500 volunteers and experts to the affected area, with more on the way.
Although these efforts are sometimes amateur, on balance experts see this as a huge shift in society's view of trauma, stress and mental health.
"This is a big change from the past," Chiu adds. "The government is much more aware of psychological problems and has learned quickly from other recent disasters," including Sept. 11 and the 2004 Asian tsunami.
Generally, a significant percentage of the population suffers stress after a major disaster. This is normal, trauma experts say. Among those most vulnerable include those who have lost children or seen their loved ones disappear without a chance for closure. For most people, acute stress diminishes over time, generally within a year. A smaller percentage suffers problems for much longer, with a few succumbing to chronic mental illness.
Beneath the broad pattern, however, are issues specific to each crisis. One relatively unique issue in the current crisis is the effect of China's one-child policy. Schools were among the most badly damaged buildings, leaving many parents mourning the loss of an only child. Making matters worse, the next generation is expected to look after parents in old age, in a society where the safety net is disappearing.
"This is a huge burden for parents, especially those beyond childbearing age," says Francis Lu, clinical psychology professor at UC San Francisco.
Many Asian cultures also place a high value on maintaining a stiff upper lip, remaining strong, just getting over it. Under the banner "Earthquake Psychological Health Station," a tent at the camp housing 20,000 displaced offers counseling by students. Very few people come.
A 41-year-old farmer from a mountain village is brought in by his daughter. It's been over a week since the earthquake, but the ground won't stop shaking, he says. The student tells him he should conquer it. "You can't keep this up," she says. "If you keep doing this for the next month, how can you keep functioning?"
Denial and urging people to power through the pain can be a healthy coping mechanism, says Richard Mollica, director of a refugee trauma program at Harvard Medical School.
The problem comes when a small percentage of people who need professional help are stigmatized by a society that may condemn them as weak or crazy.
This often funnels people with justifiable stress to Western or traditional Chinese medicine doctors, a more socially acceptable place to go for help. Experts expect a sharp increase in psychosomatic illnesses in coming months.
China's 7.9 earthquake was centered in the mountainous area of northern Sichuan, which creates added social complexities. Many of those most affected are from small subsistence communities where the focus is on making ends meet. In this world, anything to do with your inner emotional needs may seem indulgent.
In addition, as in the case of Yue, the young girl, many parents have migrated to distant cities for work, leaving children with elderly grandparents who often have an even more traditional distrust of emotional expression.