COLUMN ONE : Mending Wounds of a Massacre : The Stockton shootings have shown that, in an ethnically diverse area, the traditional mental health system can’t always cope.

A mother, following the dictates of her religion, prepares food three times a day and places it on an altar in case the spirit of her dead child should grow hungry. A sister, once a sweet and gentle child, now swears at her family, dresses in men’s clothes and brandishes a toy machine gun.

A brother, constantly haunted by the memory of gunfire, jumps every time the tetherball chains clang outside his classroom window. His friend refuses to drink Coca-Cola; the color reminds him of blood-spattered dirt.

A father, unable to talk about his pain, sits in the corner of a room saying nothing, week after week, month after month. A teacher, crippled but determined, has left her nightmares behind and is on the road lobbying for gun control.

These--and many more--are the legacies of Patrick Edward Purdy, a young white drifter with a history of mental problems who shocked the nation last year when he slipped onto an elementary playground here, gunned down five Southeast Asian immigrant children and wounded 29 other students and a teacher. He then killed himself.

The victims left behind--the mothers, the sisters, the brothers, the fathers, the friends, the teachers--are still, one year later, struggling to cope with the trauma in ways that reflect their own separate cultures and private religious beliefs. By American standards, some of these reactions have been normal and predictable. Others are foreign and unsettling. A few may even portend a life of recurring mental illness.

Although it will be years before the full impact of the massacre is known, doctors and counselors here already have reached some startling conclusions about the limitations of the American mental health system to cope with violence in an ethnically diverse population.

“Many of us thought the American way of treating and preventing mental illness”--that is, taking drugs to alleviate symptoms and talking about underlying fears and conflicts with trained counselors and therapists--”was the only way to heal emotional wounds,” said Marci Massei, one of the many psychologists here studying the psychological needs of the survivors. “What I have learned and what I think many people here are learning,” Massei said, “is that we do not always have all the answers in a world where we are becoming even more desperately in need of answers.

“We have learned that folk medicine and religious rituals may be just as effective” as the best therapy a psychologist can offer or the best medicine a psychiatrist can prescribe.

“We have learned that talking about problems does not always solve them any more than ignoring problems makes them go away,” Massei said.

Outwardly, life in Stockton has gone on much as before. Businessmen still dash to and fro on the freeways. Farmers still get in their pickups at dawn and return home at dusk. Dockworkers continue to unload barges on the San Joaquin River.

But there is a certain fragility about the people’s perception of their community now. The Stockton Record described 1989 as “A Year of Killing.” Sixty-nine homicides in a town of 190,000, about one killing every five days, the newspaper reported. Not a record, but worthy of a lengthy two-part series.

People have been troubled by other events as well. In the fall there was an earthquake. Right before Christmas, a passenger train collided with a truck in Stockton’s seemingly ever-present fog, killing three people and injuring 64 others. And just after the new year--two weeks before the anniversary of the Cleveland School massacre--teachers throughout the city’s school district went on strike in a dispute with the school board over wages and health benefits.

Yet what has continued to preoccupy doctors, counselors and social workers are the long-term emotional consequences of the violence that struck Jan. 17, 1989. More than 500 of the students and an undetermined number of their relatives have been getting psychological care.

City, county, state and federal governments have spent several hundred thousand dollars on medication and psychotherapy for the victims and their families. Over the past 360 days, hundreds of state workers have focused most, if not all, of their attention on the psychiatric and psychological needs of the community. Private doctors and therapists have donated untold hours to the task as well.

A major scientific study, the first of its kind, is also under way to assess the long-term psychological effects of the massacre. Though they have had trouble locating some families who have moved away and difficulty persuading others to participate, researchers hope the study will be completed no later than next summer.

The results may one day help other communities cope with the shock of mass killings or natural disasters, said Dr. Elizabeth Gonggui, a UCLA psychiatrist who designed the study. “Because the study of violence and trauma is a relatively new field, these are questions to which we as professionals simply do not as yet have clear answers,” Gonggui said.

But for many in Stockton, healing will not come from medical interviews or psychological profiles, but from ancient religious rituals, explained Dr. Steven Shon, a psychiatrist with the state’s Mental Health Department who is overseeing the study and much of the counseling.

One little boy, for example, complained of seeing ghosts on the playground of the school. Although this might have been interpreted by psychotherapists as a potentially dangerous hallucination, his parents and other members of his community knew better. He did not need drugs or counseling, they insisted. It was the playground that needed exorcising.

With permission from school officials, the Venerable Dharmawara Mahathera, a 100-year-old Buddhist monk, came to the Cleveland School several weeks after the shooting to chant scripture and sprinkle holy water on the spots where the children were gunned down.

The ghosts disappeared.

“As I understand it,” explained one school therapist, “the problem was that the spirits of the children were somehow joined with the spirit of the evil gunman. They could not rest in peace or be reincarnated until they were separated from him.”

Similarly the mothers who provide food daily for their children’s spirits know their children will stop being hungry when they are reincarnated. And when the children find new lives, the mothers know they at last will be free of the terrible pain they are now feeling.

Sorting out what are simply foreign ways of dealing with tragedy from those that are truly pathological is a task that is not always easy, said Howard M. Gillis, a clinical psychologist at UC San Francisco who has been counseling children in Stockton since March.

One Cambodian child who was wounded refused to talk for days after the shooting, therapists noted. Initially, according to Shon, doctors in the hospital where she was being treated thought she was having a severe psychological reaction to the trauma on the playground. In fact, therapists realized later, she was simply frightened by what was happening to her in the hospital. This was a young girl, Shon said, who had never seen an American hospital. She had not watched medical shows on American television. As far as she knew, she was being tortured by enemies.

“It is so easy,” Gillis said, “to misdiagnose . . . to fall back on ethnic stereotypes . . . to miss the subtleties and complexities of these problems. Even with behavior that is familiar and expected, it is sometimes hard to know what is normal and what is not.”

One father whose child was killed spends his days bundled in a heavy coat in his sparsely furnished apartment in a squalid complex that is home to hundreds of Cambodian refugees. People come and go, but he seems to take no notice. His only apparent interest in life is replaying a video of his daughter’s funeral.

Many people, particularly children, are especially sensitive to physical reminders of past traumas. Sounds that remind them of gunfire and colors that recall the color of blood can bring back a flood of memories.

And while children often use play to work out their anxieties, many Stockton youngsters have busied themselves over the last 12 months pretending to be dead, pretending to be the killers of small children.

“When does the response become pathological and warrant treatment and when is it a normal reaction that one can live with? These are the questions we ask ourselves again and again,” Gillis said.

In the professional literature, there are few answers. Although there is now an official psychiatric diagnosis for the pains many of the people at Stockton are suffering--post-traumatic stress disorder--doctors and counselors often disagree about who is most susceptible to it and how long it is likely to last.

In many ways, according to Shon of California’s Mental Health Department, Stockton was better equipped than most cities and certainly other rural communities to deal with the tragedy.

Nearly two years before, the county had set up a Transcultural Mental Health Clinic, staffed with translators and professional counselors sensitive to the needs of Stockton’s immigrant community. The staff had the nearly impossible task of providing mental-health services to people who thought mental illness a stigma, best to be ignored by friends and family and certainly not something to be treated by strangers.

A 1987 California study had found that Southeast Asians in the state were four times more likely than the general population to have severe mental-health needs because of the horrors they had endured before coming to the United States.

Indeed, many of the families whose children attended the Cleveland School last year had come to California’s Central Valley seeking sanctuary from the violence of their homelands. Parents were willing to toil in the tomato fields or the dry-cleaning establishments as long as their children got the protection and help that only an American education could provide.

When this, too, failed, they at least had a sense of acceptance, one that few Westerners have. It was, in the Buddhist and Hindu traditions, their karma. Their fate.

“The Eastern idea of how to cope with tragedy is to learn to accept it,” Massei said. “That’s very different from the Western notion of trying to overcome it.”

That Western notion has served Janet Geng well. She was the one teacher wounded at Cleveland School--shot in the leg as she was trying to help get children off the playground. Though she has only recently given up using a walker, she is on the road this week lobbying for stronger gun-control laws. A number of Stockton teachers have put their energies over the past year into getting gun-control legislation passed.

While some of the survivors of the Stockton massacre are trying to give meaning to what otherwise appears to be a senseless act of violence, others are seeking the root causes of the tragedy.

Some have turned to superstition as an explanation. After all, explained Diane Batres, who runs the victims’ assistance program in the district attorney’s office, the shooting occurred Jan. 17, the earthquake occurred Oct. 17 and one of last year’s most violent domestic murders--a Cambodian man who shot himself and his wife in front of their eight children--occurred April 17.

But for those who have neither a superstitious streak nor a sense of karma, there is a need to lay blame.

Teachers at Cleveland School have tried to reassure their students that the massacre was the work of a single man who was simply and tragically mentally ill.

Having conducted its own “psychological autopsy,” the state attorney general’s office has its own explanation. It was, the attorney general concluded, an act of racism by a man obsessed with hatred of Cambodians, Indians, Pakistanis and especially Vietnamese.

“The good side to the whole tragedy,” said John Klose, the bespectacled public information officer in the Stockton Unified School District, “is that I think we have learned something about each other. I think there is a greater understanding of Southeast Asians today than there was a year ago.”

Sokchea Thlang, a 13-year-old refugee from Cambodia, has an appreciation of both her old world and her new. The morning of Jan. 17, her best friend’s sister dreamed that her life meant nothing. “She knew,” Sokchea said. “She told all her family about it. She told everything but they could do nothing. Then at recess, she got shot. She got blood all over her. I saw the blood.”

The girl died.

With her own family, Sokchea does not talk about the premonition or the killings. Nor does she discuss the two sisters and one brother who died in Cambodia. “My parents don’t tell me their names. I never knew them,” she said. “Now, here in America, I have two brothers and one sister.”

But Sokchea does talk in school. Early every morning, she races off to the kindergarten class where she helps the American teacher translate into English what the children are saying in Cambodian. She likes it, she said, because the children tell her their fears and she can tell them her dreams.

“I dream we play and no one will come and shoot. I dream there is no mean men to do no good. I dream it’s going to get better.”

And when she grows up, does she want to become a teacher too?

With a grin big enough to span two cultures on one little face, Sokchea replied, “That, or a counselor.”