Treating Post-quake Trauma

The third anniversary of the Wenchuan earthquake, which killed more than 80,000 people, injured tens of thousands of others and caused a direct economic loss of about 845.1 billion yuan (US$130.16 billion), is a time to mourn the dead and sympathize with the survivors. But May 12 is also a time to celebrate the resilience of the people and the building of a new Wenchuan from rubble.

In 2008, the Chinese government planned to rebuild Wenchuan in three years. But the task was completed before schedule, as Premier Wen Jiabao announced at the Fourth Session of the 11th National People's Congress in March.

In fact, Wenchuan's material reconstruction had basically been completed by the second anniversary of the quake, says Zhang Jianxin, deputy director of the Institute of Psychology, affiliated to the Chinese Academy of Sciences. "People are trickling into the 'new' county and their daily life is returning to normal," says Zhang, who visited Wenchuan recently.

But despite the material reconstruction, many people are still haunted by the devastation. These people need proper psychological counseling to overcome their grief. "And psychological reconstruction is an enduring task," says Zhang, who has been in charge of the psychological reconstruction program of the Institute of Psychology for the past three years. He heads the five workstations that the institute runs in the quake-hit areas.

Zhang and his colleagues began drafting their long-term counseling plan for the millions of quake survivors just after the quake. Some people are mentally strong and can absorb the loss of their dear ones, Zhang says. But others are not and suffer from mental setbacks to different degrees.

The strong ones can recover but those who cannot need psychological counseling and a long time to get back to normal life. Getting their life back on tracks is especially difficult for people who have lost their spouses and/or children. And occasions for family reunions like Spring Festival can be particularly torturous for them, for they bring back memories of their loved ones and heighten their pain.

Three years on some of them have remarried and/or become parents again, which should have helped relieve their pain. But that is not necessarily the case with all of them, for many are still wary of the future and lament their loss.

Many studies have been conducted after the quake to determine the rate of post-traumatic stress disorder (PTSD) among the survivors, and they show that 10 to 45.5 percent of them are suffering from the disorder.

The material reconstruction is complete and people are being relocated. But instead of bringing comfort, it has become a source of anguish for many. It's human nature to lament the past, irrespective of how troublesome it might have been. The relocation of surviving residents has made many compare their new dwellings with the old and with what others have got now, upsetting them further.

Zhang says the institute's workstations were first set up near temporary shelters built for the survivors. But instead of providing counseling immediately, his institute's staff members first surveyed the area to understand the survivors' needs. Only after that did they concentrate on their main task.

Many experts have suggested China learn from the experiences of countries like Japan and the United States, which have treated many PTSD cases. But the problem is that programs followed by Japan and the US may not succeed in China.

In the US, for example, governments usually offer a framework and play the instructors' role, while social organizations and non-governmental organizations (NGOs) take up the rebuilding task. Things in China are different. In China, governments at all levels have to coordinate and combine their efforts for post-disaster reconstruction. The administration thus has to lead the rescue and relief operations and reconstruction activities.

That's why the Institute of Psychology's personnel had to enlist the support of grassroots officials to make their task a success. In Wenchuan, for instance, the quake shattered the lives of grassroots officials, too. But many of them had to ignore their personal losses to perform their duty and help others. They knew pretty well what the survivors needed. So by counseling them and easing their pressure, the institute's staff members could win their support to spread their network of help.

The Institute of Psychology can boast of many successes but the greatest, as Zhang says, was to make the survivors realize the need for mental reconstruction along with material and physical reconstruction.

The treatment of PTSD patients on such a large scale is unprecedented in Chinese history. And though the central government attaches great importance to treatment of mental trauma, the subject is still not recognized as an important part of emergency relief, Zhang says.

Without a proper mechanism, survivors cannot get easy access to PTSD treatment. The ministries of Health, Civil Affairs and Education did organize rescue and relief operations which included psychological counseling, but their budgets don't make allocations exclusively for treating PTSD cases.

It is because of lack of such a mechanism that not enough professionals are trained to meet the demand in quake-ravaged areas. After the Wenchuan quake, medical teams which included psychologists were sent to the affected areas. But those psychologists were gathered from hospitals across the country and stayed there for only a short time.

Some educational institutions, especially universities, sent experts in mental therapy to the areas but they, too, stayed there only for brief periods. Besides, NGOs that can send such therapists to disaster-hit areas face budgetary problems, which is a disadvantage they cannot easily overcome.

But even if educational institutions and NGOs manage to send enough experts, they would treat survivors according to different standards for lack of an official mechanism, which may not fulfill the needs of the survivors.

So Zhang advocates setting up a national mechanism for PTSD treatment that would combine administrative and social efforts. Since the 12th Five-Year Plan (2011-2015) pays special attention to mental health of the people, Zhang also suggests making it a part of the legislation agenda.