Nightmares, Trauma Plague Quake Survivors

For Nilgun Ulgen, Turkey’s deadly earthquake never ends.

Night after night, the 20-year-old is trapped once again under the concrete chunks of her devastated five-story apartment building. People are screaming. Everything is pitch black. She cries desperately: “Help! Get me out!”

Then she wakes up. She is safe, in a makeshift wood-and-plastic tent, her worried mother at her side.

Like Ulgen, tens of thousands of survivors of the Aug. 17 earthquake in northwest Turkey are beginning to suffer psychological aftershocks such as fear, despair and nightmares. The massive scale of the loss produced an unusually high level of depression for a natural disaster, say Turkish psychologists. Some victims are expected to experience the kind of severe trauma suffered by Vietnam War veterans.

Turkish government hospitals, aid groups and psychologists are scrambling to set up counseling clinics and hotlines. But they are concerned that this developing country lacks the professionals and resources to cope with widespread psychological problems.

“Thousands will begin to experience the memories. They’ll have flashbacks, fear, depression. This is what’s coming,” warned Emre Konuk, president of the Istanbul chapter of the private Turkish Psychologists Assn.

In the days after the magnitude 7.4 quake, survivors were numb with shock and terrified of another temblor. But for many, the impact of the disaster--whose death toll as of Friday was at least 13,472--didn’t sink in. Victims threw themselves into digging out loved ones or finding shelter.

Now that most survivors have settled into tents, however, they are being hit with an emotional tidal wave as they come to grips with the sudden jolt that shattered their lives.

Ulgen and her three siblings try to block out the memories of the quake that destroyed their grandmother’s house, trapped them for hours and killed their 18-year-old sister and 11-year-old brother.

“When you ask them about the disaster, they don’t want to talk,” said their father, Hudaverdi Ulgen, who was in the Netherlands when the disaster occurred.

But at night, the four siblings lie awake on their mattresses, unable to sleep. When they finally nod off, the tent fills with murmurs. In their dreams, they are reliving the disaster and their fear as they waited to be rescued.

A medical doctor visits the family’s tent daily to examine the 80-year-old grandmother’s cuts and bruises. But there is no treatment for the family’s psychological wounds. Hudaverdi Ulgen snorted at the idea, insisting that the family will forget its pain and go on.

“A psychologist can’t bring back those we’ve lost,” he declared.

Thousands of survivors, however, are expected to seek psychological help. Government hospitals have set up a 24-hour hotline and are scrambling to establish psychological clinics in devastated cities. The psychologists association is appealing for funds to open a trauma center. An Israeli team specializing in wartime trauma is training counselors. Turkish media are featuring advice for parents on how to help child survivors: Hug them a lot, talk to them, assure them they’re not to blame for what happened.

“It’s worse for children,” said Dr. Resul Patan, the director of the government hospital here. “Both they and adults are affected. But adults are more mature; they can understand what happened.”

Patan plans to set up 10 clinics around the city that will use “play therapy,” in which children draw pictures or use modeling clay or games to express their feelings.

At a muddy tent city near his hospital, the psychological strain is evident among quake survivors. Children insist on sleeping nestled against their parents. Some people discuss over and over the moments after the quake. Others frequently burst into tears. Both children and adults fear the night, recalling the quake that struck at 3:02 a.m.

“Can you imagine the psychological state in a place where 50% of the population has been killed?” asks Sedat Aytuglu, a 56-year-old accountant who lost his youngest child, a 12-year-old boy.

Within minutes, his own tension flares. His adult daughter pops into his tent and asks if he can drive her to a nearby army relief operation.

“I can’t drive! My hands are shaking. My knees are too,” snaps Aytuglu, his face hardening into a frown.

His wife, Meliha, looks embarrassed.

“Everyone is nervous. Everyone is demoralized. Everyone is shouting,” she softly apologizes to a visitor.

Aytuglu’s head drops in shame. “OK, I’m coming,” he calls to his daughter, heading for the car he had rescued from outside his destroyed home.

Psychologists say they are seeing extremely high levels of depression because of the scale of the quake, which turned vast areas of cities into piles of rubble. Such destruction has been devastating for Turks, who often lived with relatives and friends in close-knit communities and now are separated from them.

“Hope is nil for the future. That’s a very important part of the fear,” said Dr. Nursel Telman, an Istanbul University psychologist who has been evaluating survivors.

Experts say some survivors mainly need to talk about their experience to overcome it. Others, who feel that their futures have been shattered, want concrete signs that they will be able to find housing, a job, some hope of a new life.

“Their main need is to know they haven’t been forgotten despite all these negative conditions,” psychologist Hakan Yuksek said.

Most victims overcome the psychological aftershocks in a few months. But others will need more intensive treatment. Konuk, of the psychologists association, said survivors can begin to have flashbacks months or years later. Such flashbacks, he explained, are more than just images of the experience replaying in survivors’ minds; victims are actually engulfed again in fear and panic.

“We expect in six months or a year there will be thousands of post-traumatic stress disorders” like those suffered by Vietnam War veterans, he said. “This will be the major problem for this population in the future.”

Unfortunately, Konuk said, Turkey has only a handful of psychologists who know how to treat such victims. The psychologists association is hoping to bring in training experts from the Pennsylvania-based EMDR Humanitarian Assistance Programs. The group’s experts aided victims of the 1992-95 war in Bosnia-Herzegovina and worked in Oklahoma City after the 1995 bombing that killed 168 people.

The association is appealing for funds to establish a special treatment center in Istanbul. Konuk is hoping that the center eventually will be able to serve victims of other kinds of trauma, such as torture.

“Turkey is a land of trauma,” Konuk said. “But we have no trauma experts.”