THE HIDDEN SCARS THAT TAKE YEARS TO HEAL

Many survivors of the Wenchuan earthquake, which struck 10 years ago this week, are still experiencing psychological problems.

Chen Heqiong vividly remembers the absolute darkness that engulfed her when she was trapped for three days below the ruins of her high school after a magnitude 8 earthquake hit Yingxiu, Sichuan province, on May 12, 2008.

The temblor, known as the Wenchuan earthquake, claimed 69,226 lives and left another 17,923 people missing. It also left the main building of Xuankou High School in the mountain township severely warped and leaning precariously to one side. Buildings were destroyed almost immediately in the worst-affected areas of the quake zone, which covered about 130,000 square kilometers.

The twisted school building is now part of the local earthquake museum. Every year, on May 11, Chen visits the site on her own to "talk" to the 54 students and eight teachers who lost their lives. Most of the students and teachers were in classrooms and school offices when the quake struck at 2:28 pm on the first day of the school week.

"It's a form of therapy for me. I avoid going there at all costs, except for that one day. After all, it was a day the people of Yingxiu, including me, have been trying to forget," said Chen, 50.

She now works as a psychological counselor at a new school, named Qiyi, which was built after the quake. It stands near a huge boulder that rolled down the mountain during the disaster and has become a tourist attraction because it marks the epicenter of the quake.

Ten years on, all the schools in the province that were damaged or destroyed have been rebuilt and fitted with state-of-the-art teaching equipment. However, many of the students who survived the quake are still struggling with post-traumatic stress, and it may take decades for them to recover fully, according to Chen, the teacher-turned-counselor.

"The earthquake has left a giant boulder in everybody's heart. Some people are able to walk past it, while others remain stuck behind it," she said.

As a result, many teachers in the quake zone have retrained as psychological counselors to provide step-by-step assistance for troubled survivors, even those who have graduated and started their working lives.

"As someone who was trapped and then rescued, I can perfectly understand what students who had similar experiences went through. I can connect with them and they trust me," said Chen, who had gained a bachelor's in educational psychology a few months before the earthquake struck.

In 2009, when the new campus came into use, Chen, who once taught political education, became a full-time counselor at the school because she believed the students' psychological wounds should be treated as quickly as possible.

During the following year, she helped a student who began crying uncontrollably when the teacher asked the class to write letters to their relatives, because he had lost his father in the quake. She also held therapy sessions with a student who told her she saw no point in living after her mother and grandmother died in the disaster.

Feng Chengjie, a former student of Chen's, knows he was fortunate to survive.

"My left leg was stuck in the rubble and I was trapped for more than two days. But I consider myself lucky because a classmate who was right behind me as we tried to escape died when the ceiling fell in," said the 24-year-old, who started working in Chengdu, the capital of Sichuan, two years ago after graduating from a university in the city.

Although the muscles in his left leg were badly damaged below the knee, the doctors treating him were able to avoid amputation. However, the leg was permanently damaged and the scars are obvious.

In 2009, after completing his studies in junior high school at the temporary tent campus in Yingxiu, Feng began attending a senior high school in another township. That was when he first noticed his emotional scars.

"When my new classmates asked what was wrong with my leg, I immediately became very angry and refused to say another word," he recalled.

Eventually, he decided to consult Chen in an attempt to deal with his stress before it became worse.

"She told me it was perfectly normal to feel uncomfortable about people's questions about my injury, but I should understand that my new classmates only asked because they cared about me," he said.

"She also encouraged me to accept my injury as a part of the 'new me', and that there was nothing to be ashamed of. Now, I have no problem explaining about the earthquake and what happened, but I don't want to be treated differently because of what I went through 10 years ago."

Feng keeps in close contact with a student who was rescued from a high school in Yingxiu that was also severely damaged. The two shared a room in the hospital and quickly became friends.

"One of his legs was amputated, and he lost his father. The earthquake is still a forbidden topic for him. He gets very angry and swears at people if they mention the event, which he believes destroyed his life," Feng said.

Although Feng doesn't mind talking about the quake, he usually refuses to visit Yingxiu: "The old school is still there. I don't really want to see it."

However, he will make an exception this year, to attend a class reunion.

Hidden problems

Chen Xuemin, a teacher who provides psychological counseling at Ziyan Primary School in Mianzhu city, which was also hit by the quake, said some students displayed obvious and severe psychological trauma immediately after the event, but that didn't mean that those who showed no symptoms wouldn't experience problems later on.

She described treating a former student who began having a recurring nightmare about seven years after the quake. The girl dreamed she was walking to school with her friends along a road lined with graveyards. However, on the journey home she was always alone.

"After a number of therapy sessions I discovered that she had walked to school with her friends on the day of the earthquake, but she was the only one in the group who survived. The nightmares were triggered by anxiety as she prepared for the national college entrance exam," Chen Xuemin said, adding that the deeper the problems are hidden, the more difficult they are to treat.

Unexpected trigger

According to Du Li, a counselor at Dingxin Xinjian Primary School in Dujiangyan city, many teachers who survived the quake are still experiencing psychological problems, but as a result of unusual circumstances.

"Many parents who lost children in the earthquake decided to have another baby, and now some of the teachers are teaching the younger brothers or sisters of children they knew who died. Trust me, it's not easy for them," she said.

The 50-year-old is fully aware of the importance of psychological counseling because she has also experienced post-traumatic stress disorder, marked by extreme irritability and hallucinations. Professional assistance helped Du overcome her difficulties, and later she trained as a counselor.

Although many aspects of her life have changed in the past 10 years, one thing has remained constant - her cellphone number. "I want all the students who consulted me before to be able to reach me whenever they need to. Recovering psychologically from an earthquake can be a lifelong process," she said.

In the aftermath of the disaster, almost every school in the area affected by the quake established psychological consultation facilities, and many teachers received professional training.

"Psychological consultation was used like a first aid service in the first few years after the quake, and now it's part of the students' healthcare routine," Du said.

Established in 2006, the AIDS Prevention Education Project for Chinese Youth was one of first nonprofit organizations to provide psychological counseling after the quake.

"At the time, psychological problems didn't receive a lot of attention, because most resources were targeted at medical aid, food and water supplies, along with temporary housing," said Zhang Yinjun, the project's director.

A few days after the earthquake, the project organized teams of psychologists to help resolve conflicts between the education department and parents who had either lost children or whose children had been severely injured.

"Nothing can relieve the anguish of losing a child. Some parents had no way of expressing their grief, except by directing their anger at the education department," Zhang said.

However, when the experts arrived in the areas devastated by the quake, they realized that many students and teachers were experiencing severe post-traumatic stress.

In Dujiangyan, safety concerns meant 349 high school students and 329 teachers had to gather at one school, and classes had to resume almost immediately because many of the students were set to take the most important test of their young lives - the gaokao, or national college entrance examination - about a month later.

"Some students and teachers had post-traumatic stress disorders, such as insomnia and depression," Zhang said. "The experts lived with them for about two weeks, and offered assistance whenever they could, which helped many of those affected."

Long-term support

Zhang stressed the importance of long-term psychological support. "People often need a long time to recover from mental wounds. For example, take the magnitude 7.8 earthquake in Tangshan (Hebei province) - even now, many people are still influenced by what they experienced then, even though the quake occurred in 1976," she said.

In November 2008, the AIDS prevention project arranged for 34 teachers from Sichuan to visit Beijing and spend two weeks attending psychology classes and lectures delivered by experts. In the following three years, the project was extended, with the result that many of the teachers became licensed psychologists.

"The Wenchuan earthquake is a milestone in post-traumatic psychological support in China. In the past, people were reluctant to visit psychologists, even during a crisis, because they felt ashamed to be labeled as having a 'mental illness'," said Liu Zhengkui, a researcher with the Institute of Psychology at the Chinese Academy of Sciences.

According to Liu, before the Wenchuan quake, no psychologists in China specialized in post-traumatic assistance, so the inadequate counseling provided by untrained volunteers in the immediate aftermath resulted in many victims shunning psychological assistance, and some inappropriate advice even made the victims' conditions worse.

In the first three years after the quake, the institute sent professionals to many badly affected areas to provide treatment and training.

"Foreign experts who provided experience of post-trauma assistance were very helpful, but we discovered that some of their techniques, such as exposure therapy (which is often used to treat anxiety disorders), were not practiced efficiently in China," Liu said.

"By learning from both practice and overseas experience, our experts discovered some unique and effective treatments - for example, practicing calligraphy - which proved to be useful methods of tackling stress and nervous disorders for many patients."

According to the institute, more than 1 million people have benefited from crisis counseling in the past 10 years, with more than 50 percent of them age 18 or younger.

Moreover, some survivors have learned to overcome their initial trauma and now regard the disaster as a moment of revelation.

"I don't see the earthquake as a bad thing. Somehow, I have to appreciate it because it made me see the best in people. For me, the rescuers who used their bare hands to dig me out, the volunteers who cared for me 24/7 at the hospital and teacher Chen are all superheroes," said Feng, the former student.

Chen Heqiong, the teacher who spent three days buried in the rubble of Xuankou High School, was so deeply affected by the disaster that in 2009 she changed her birthday to May 12, the date the earthquake struck.

"For me and students such as Feng, it was the day we were reborn - we have to make sure we live our new lives to the full," she said.

Contact the writers at cuijia@chinadaily.com.cn