As Haiti tries to recover from the disaster, one of the greatest challenges will be rebuilding infrastructure that includes good sanitation, clean water, and meals for the displaced. But the mental health of thousands of Haitians will be an issue long after international aid workers have left the country. Psychiatrists say it could be months before victims and their families feel the full effect of the earthquake, and that, they say, is when their work really begins.
It was a horrific disaster. Psychiatrists say people who react with shock, grief, and even anger, are responding normally to an abnormal event.
But later on, other equally strong emotions could surface, including the loss of a sense of structure, one of the most important things in a person's life.
If people lose that structure, without knowing what's coming next, it can be devastating, says Dr. Lorenzo Norris of George Washington University Hospital.
"Your mind will not really come to rest unless you have a secure environment. You know where your next meal is coming from, and you feel safe or someone is accounting for you."
Dr. Norris believes most Haitians will eventually recover from the trauma. But some will need treatment. An estimated eight to 10 percent of the population is likely to develop Post Traumatic Stress Disorder (PTSD), brought on by exposure to a terrifying event such as the earthquake.
Those most vulnerable have often experienced previous psychiatric illness or suffered overwhelming loss. They are most likely to suffer from PTSD, or what's called Major Depressive Disorder.
Dr. Norris says families and friends should watch out for symptoms of withdrawal, nightmares and flashbacks, which are memories of the tragic event. "Someone not moving forward and not being able to adapt, despite their sincere efforts to do so," he explained.
First responders are also likely to need mental health counseling. They are the rescue workers, police, doctors, nurses, even the journalists who tell the story to the world.
"It is those folks who are on the front line, the people that go there first, the folks that are digging through the rubble, that are finding the children. We as psychiatrists have a vested interest in making sure that their psychological health is really taken into account," Dr. Norris said.
Medication to relieve anxiety and pain, or to provide sleep can help human beings survive and acclimate. But mental health experts say recovery begins with recognition of the human resilience that provides hope of a better future.