Foros Temáticos - Crisis Mundial - The traumatic effect of mass comunnication in the México City earthquake: Crisis intervention and preventive measures

Crisis Mundial

The traumatic effect of mass comunnication in the México City earthquake: Crisis intervention and preventive measures

Agustín Palaciós, José Cuieli, José Camacho, Ramón Clériga, Pablo Cuevas, Jaime Ayala and Linda Cossoff

(1986) INT. R. PSYCHO-ANAL., 13:279 (IRP)

In the early morning of 19 September 1985 the greater part of western central Mexico was shaken by one of the stronger earthquakes in the recorded history of modern seismology, if not the strongest. The most affected area was the city of Mexico and its suburbs, an area that encompasses the largest human concentration in the world. Amazingly enough, the damage was extremely limited considering the intensity and duration of the earthquake. If this quake is compared with others such as the one in Japan in 1923 or the one in Managua in 1972, it is evident that the destructive impact in Mexico was minor (Ahearn, 1984); (Ahearn & Rizo Castellón, 1979). Although the total losses in terms of dwellings, housing, businesses, governmental offices, etc. have not yet been fully assessed, it is estimated that only 0.2 per cent of the edifices in the city suffered total collapse or were otherwise rendered unusable. Also relatively small was the loss of human life although the exact death toll will probably never be known. Many victims were buried under the debris of the fallen buildings and their remains were not recovered in time for identification. However, it is estimated that less than 20,000 persons perished as a direct result of the quake. When one adds to this figure the surviving victims who were in some way directly affected by the disaster-some 300,000-the sum total represents a relatively small percentage of the total population living in the Valley of Mexico, conservatively estimated at 18 million.

For purposes of this report, victims are considered to be those who suffered personal injuries and/or the loss of close family members or more distant relatives and who were either direct witnesses of their deaths or were separated from their families when the disaster struck. Also included in this category are those who suffered property losses and will be unable, due to their financial situation, to recuperate these losses.

Unfortunately, however, a number of events coincided to produce what we shall refer to as an enormous psychological impact that was experienced not only by the victims themselves but also by the large majority of the population. The number of people involved is so vast that it is possible to postulate that we are dealing with the largest psychological disaster in peace time, at least in recent history. The main traumatic agent was the mass communications media. It can be affirmed beyond doubt that such a psychological catastrophe could not have occurred in earlier centuries.

The major events setting the stage for this massive psychological trauma can be reduced to three. Other factors, such as the poorly understood pre-traumatic influence of overcrowding, high levels of noise, contaminated atmosphere, ecological destruction (Cesarman, 1974), etc,. acting upon the ego capacity to cope with the overflow of stimulation, could be considered as facilitating aetiological factors. These environmental circumstances are only applicable to the inhabitants of the metropolitan area of the Federal District of Mexico and its immediate surroundings.

The three principal factors to be considered are: (a) the weakening of the ego's synthetic capacity and/or ego disorganization due to persistent stress and frequent mourning processes in the large majority of the population resulting from of financial and social stability (Brenner, 1973). Here, the traumatic effect of current information on world affairs, especially the ever-present fear (usually denied) of apocalyptic destruction by atomic warfare should also be taken into account; (b) the regressive impact of the earthquake, together with the sudden resulting activation of primitive unconscious fantasies, reenactment of old mourning processes and, in many cases, the increment of feelings of guilt which, due to the relative strengthening of primitive superego remnants, contributed to ego disorganization and weakness; and (c) the overflow of traumatic stimuli through television and radio messages. Such stimulation is too rapid to be effectively neutralized and it found a permeable stimulus barrier in most members of the population involved (Godiman, 1971); the latter critical aetiological factor was even more damaging due to the direct effect of the first two factors.

Mexico, like many underdeveloped countries, concentrates not only a large portion of its population (about 24 per cent of the total) but also its Federal Government, main financial offices, industries, resource and communications centres in its capital city. Most of the government buildings, main bank offices and key communications installations are located in the oldest part of the city, the area that suffered the greatest damage. As such, the financial implications of this disaster, not just to the city itself but to the country as a whole, are enormous. Many vital services were affected, specifically important government departments, schools and hospital facilities. The Medical Centre of the Social Security System, the largest and most modern in Latin America, as well as many other smaller hospitals and clinics, became empty, useless shells.

Moreover, since the major communications installations were located in precisely this area, they too were severely crippled, with only partial intra-city communication remaining functional. The two main telephone stations suffered such extensive damage as to permit only minimal functioning. This situation, together with the massive overload of what remained of the telephone exchange system by anxious relatives and friends inquiring after the fate of loved ones or worried businessmen seeking news about their companies, etc., succeeded in provoking a near paralysis in the city-wide communications system. Communication with the rest of the world outside of the valley was virtually shut down. For a few days, there was no long-distance service at all and the telegraph system was overloaded. Initial reports of the damage were appalling, in the city itself but even more so in the country and the world at large. News captions worldwide read something to the effect of 'Mexico City Collapses in a Heap of Rubble'.

Amateur radio stations, the so-called 'ham radio operators', heroically provided a system of contacting people outside in an effort to soothe the anguish of families, friends and business relations.

As a consequence of the telephone service breakdown, the television and radio stations, which, to a large extent, remained untouched and functional, took over a great deal of the communications function within the city, country and, in a relatively few hours, with the rest of the world. It was the radio stations and the government-operated television stations in particular that worked incessantly during several days in an attempt to substitute for the negligible telecommunications system. One task they performed was the transmission of information concerning the welfare of Mexico City dwellers to relatives living outside the city or country. In the latter instance this was possible due to the fact that some Mexican networks transmit signals to the southern portion of the U.S. Via satellite, television signals were transmitted to Europe and most of the North American continent.

The most vital service provided by the radio and television stations, however, was that of a relief network. In fact, it was mainly due to the relentless activity of their personnel that rescue efforts were able to be carried out with maximum speed and efficiency. The distribution of medication, water, clothing, food, etc. to the disaster victims, as well as the despatching of heavy construction equipment and rescue crews, were only some of the services they rendered. Calls for help were transmitted via visual and auditory signals to government and voluntary rescue groups that were organized almost miraculously. The youth of the city were amazingly fast in organizing assistance groups for their compatriots in need. As a result of the use of this system of communication, the largest television and radio audience in the history of the country was established.

To understand this discussion the reader hould be familiar with the fact that, in reality, the population of Mexico can be described as dual in terms of its socio-economic composition. The population is roughly composed of 40 per cent living in conditions comparable to those of the industrialized nations and 60 per cent who are confronted with the brutal impoverishment characteristic of the underdeveloped countries (Cordera & Tello, 1984). Nevertheless, during the 72 hours following the earthquake, almost all television sets and radio receivers, both stationary and the cheap portable ones commonly used by the rural population, were tuned in to the latest news broadcasts. Only the most isolated villages and marginal communities could be considered immune to the traumatic impact of the information transmitted by the mass media.

Although the exact size of the television audience is difficult to calculate, the various government-operated stations estimate that during the 'peak hours' of the three to four days immediately following the catastrophe, an average of 15 to 20 million people had their eyes glued to their TV sets. As far as the radio listening audience is concerned, marketing experts claim the totality of the Mexican population as recipients of these transmissions. This listening audience refers not only to those adults capable of fully understanding the content and meaning of the information being broadcasted but also to others, like the children, who were unable to do so. Moreover, in some of the more remote areas of this country, only a few and at times only a single privileged member of a given community may boast a portable radio among his possessions and it is his duty to transmit verbally the information to these less fortunate ones.

It should be noted that in so far as the adult and adolescent listening audience is concerned, persons in this age category tend to attach a visual imagery of their own production to the words and messages being spoken. This imagery is formulated in accordance with their own personal fantasies and experiences. Children, however, upon hearing or seeing this same information obviously attach to it the meaning of the fantasies that are prevalent and congruent with their developmental stages. Internal objects are therefore projected in rapid succession across the screen of the ego, juggled now, both normally as well as pathologically, into innumerable scenes and plots.

Thus, the chain of vital factors include the agglomeration of important edifices within a 13 kilometre radius, the isolation of this valley megalopolis due to the breakdown of the central telephone communications system, and characteristics directly related to earthquake phenomena such as suddenness of onset, their unpredictable nature1 and their enormous potential for wreaking havoc in minutes. Last but not least, it includes the bombardment of the postearthquake and by now highly vulnerable audience with heartrending scenes of mutilation, suffering and destruction-without the much needed compensatory visual projections and auditory information of the fact that 99.8 per cent of the city was left unscathed. All those factors, combined, set the stage for the massive psychological trauma of the largest population ever involved in a natural disaster in this era of instant communications. We witnessed the psychological penetration of television and radio signals and the magnitude of their influence, both beneficial and damaging. (The transcendental, ethical implications of this human experience go beyond the scope of this report.)

About 36 hours after the principal earthquake, a second one of 7.6 degrees on the Richter scale shook the stricken area yet again. The additional physical damage was minimal but the psychological response was panic; the egos, already disorganized, in severe regression and functioning at maximum hyper-alertness had to react to such a further traumatic stimulation. The permeability of the stimulus barrier was increased and the ego's disorganization worsened in a large percentage of the population. Needless to say people's urge to receive mass media communication was augmented as was the penetration of the messages. The unconscious fantasies, unfinished mourning processes, superego punishment (upon a now even weaker ego), etc. were stirred in a massive psychological whirlpool for the second time in 1It is a methodological mistake to use as analogy the human reactions during war and earthquakes. In war the population is prepared and organized even in air raids and blitzkrieg attacks. The possible exception is the atomic holocaust (Lifton, 1967) two nightmarish days. A number of smaller quakes occurred in the days following that unforgettable morning of 19 September, most of which were not consciously registered. Nevertheless, it is possible to affirm that, at a deeper psychological level, many of them were unconsciously perceived; the additional effect of such stimulation should be taken into account if a psychoanalytic hypothesis is to be constructed. A perceptual impact of such magnitude, sudden and unpredicted, must per se shatter the ego structures and evoke early traumatic events of great importance in the developmental history, such as the birth trauma, weaning, lack of adequate holding maternal behaviour, birth of siblings, death of significant adults and/or sibling rivals etc. (Bowlby, 1980). The sudden invasion of the ego by unneutralized impulses is, for the immature psychic apparatus, also traumatic; such common infantile experiences must also be relived in the face of natural disasters of this dimension.

Yet we consider the massive overflow of televised and radio-transmitted information and not the immediate physical impact of the earthquake to be the main traumatic agent. As described above, the government-operated television stations, while rendering an invaluable service to their audience, presented frequent views of the disaster. The commercial television stations, while far less concerned with the rendering of a public service, flooded their audience with untold images of agony and death, the most poignant and gruesome often being transmitted several times over a short period. One such scene, for instance, was a close-up view of a mangled and twisted doll lying abandoned among the debris of what was once a housing complex. As can be imagined, the impact such scenes had upon the viewers was devastating. Such perceptual impacts are highly effective as traumatic agents because they can easily be linked to object representations of a similar nature, as well as to universal and individual unconscious fantasies of aggressive quality. The previously described non-verbal or visual overflow of stimuli is beyond the average ego's capacity of neutralization; it may find already-present self and object representations to attach itself to; but at first glance, it seems to pertain mainly to the economic factor in a metapsychological construct. The former impacts are, obviously, more easily detected in the initial psychoanalytic assessment of the psychic phenomenon that is being described.

Although children tend to hide their conflicts from the poorly trained eye of most adults, they were greatly affected. Schools were closed in the city until the buildings could be checked to ensure their safety; therefore, the youngsters were, more than ever, drawn for hours at a time to the television set as though hypnotized by the morbid scenes unfolding before their eyes.

It is true that the kids' favourite programmes depict gruesome events, yet the children, especially the older ones, know very well that they are contemplating productions of fantasy; most of these programmes are in fact quite a bit milder than are the children's own unconscious creations. Moreover, in both cartoons and adventure stories not only 'bad guys' are depicted but also heroes with whom the immature ego can identify, and on whom its ideal may be projected, thereby nurturing reparatory strivings. In this case, however, due to a large extent to the carelessness of the parents who were themselves over-attentive to the newscasts, the children were over-exposed to real life horror scenes while being deprived of the compensatory presence of readily identifiable heroes.

Worse still, their confrontation with the ugly face of death all to often occurred within the arena of their peer group. The sudden shadow of doubt thus cast upon their own omnipotence (projected and deposited into significant adults) shattered whatever had remained of their narcissistic invulnerability. It may be said, therefore, that for these children their basic security, the central pillar of their psychological development, was severely and perhaps irreparably undermined, not so much by the earthquake itself as by their favourite source of entertainment-the television screen. (Hopefully, this inadvertently imposed but nevertheless painfully traumatic experience will suffice to arouse serious concern about the psychological effect that this passivity-inducing modern replacement of play activity can have upon the ego structuring of present and future generations.)

Disaster report information had a similar although far more diluted effect upon the radio-listening public. This latter group having been absolved from a confrontation with a gruesome, visual imagery may likewise have been spared the pathogenic qualities of the television screen's direct impact although, as previously mentioned, the radio broadcasts stimulate the visual inner imagery of the listener. Those reading newspapers, both older children and their adult counterparts, were even better protected than were the radio listeners from the psychological trauma. The incorporation of written symbols occurs at a much slower pace, thus allowing for a far more effective use of the ego's neutralizing potential.

PSYCHOLOGICAL TRAUMA: VICTIMS 'PER SE' AND THOSE INDIRECTLY AFFECTED, GENERAL POPULATION

Despite the similarity in stages through which both groups may pass in the elaboration of the trauma, the psychological process of the victims must be clearly differentiated from that of those who were involuntary witnesses and thus indirectly affected by the disaster. In the preceding pages, reference has been made primarily to the latter process. The former process has already been well described in an abundance of scientific documents and literature on civil disaster published in the last three decades (Demerath & Wallace, 1957); (Drayer, 1957); (Fritz, 1961); (Furst, 1967); (Heally, 1969); (Horowitz, 1974); (Keiser, 1968); (Krystal, 1968); (Lucas, 1969); (Titchener & Kapp, 1976); (Titchener & Ross, 1974); (Tyhurst, 1951); (Warnes, 1972); and (Wolfestein, 1957).

As the days went by, we were able, in the privacy of our consulting rooms, to acquire a deeper and more detailed view of the psychodynamic after-effects of the disaster both as it concerns the general population and the victimsper se. This in turn allowed us a more meaningful understanding of the hierarchy and sequencing to the psychological processes involved. It became increasingly evident that with the gradual dwindling away of the initial shock, the major conflict confronting the ego was the reactivation of both normal and pathological mourning processes. Metaphorically speaking, what the combined force of the earthquake itself plus the lengthy exposure to sensationalist, biased reporting succeeded in doing was to pry open long-forgotten psychological graves. Consultation rooms were invaded by a march of sinister ghostlike figures whose corpses, long before buried in unconscious coffins, had now been released under the psychological impact.

Primitive superegos in persecution of the fantasized murderers seemed to clamour for revenge, wreaking havoc with already overburdened and guilt-ridden egos. Strong denial mechanisms formerly effective in sealing off these grave-sites had been rendered ineffective by the impact, thus freeing these seemingly vampire-like, persecutory objects further to sap the strength of what was, in many instances, only a precariously functioning ego. Some immediate and often lethal psychosomatic reactions could easily be traced to this sudden reactivation of unresolved mourning processes.

However, in those less severely affected by the impact, the almost immediate recollection of intense denial mechanisms served to put the lid back on these coffins. In most individuals, however, this defensive manoeuvre resulted in an outpouring of aggression, manic behaviours and impulsive, pseudo-reparatory acts. The mobilization and acting out of these defences is quite possibly what accounted for much of the personal suffering and family conflicts (some of which led to a permanent rupture in the marital relationship) that became increasingly evident in the aftermath of the earthquake.

At the highest level were those more fortunate members of our society whose bereaved egos were not quite so haunted by ambivalence and murderous infantile impulses and fantasies. As such, instead of releasing mutilated corpses, the opening of inner graves was to release amicable ghosts whose temporary visit was in some instances even welcomed. Whereas in these cases and others the re-enactment of old mourning processes allowed the ego a further opportunity for resolution, in still others it heralded the onset of severe depressions, life-threatening psychosomatic conditions, automobile accidents, and suicidal behaviours. For most, however, this reshuffling of internal objects, defences and economic balances was of short duration. As the nightmarish activity of death and disaster recede into the past and a dawn-like stillness sets in, psychic gravestones are once again set into place as the psychic horror story draws to a close.

Psychological trauma, regardless of its source (internal or external), may be defined as any conscious or unconscious perception of a given stimulus whose intensity (once the stimulus barriers have been transgressed) is stronger than the ego's capacity for effective neutralization. What we are dealing with, therefore, is mainly a quantitative overflow as it pertains both to its ulterior symbolization as well as to the long-term after-effects. Needless to say, an ego with a weak synthetic capacity will readily disorganize under a relatively mild impact. In terms of the trauma experienced as a result of the Mexico City disaster, however, it is possible to state that the sudden and massive influx of stimulation was such that the neutralizing potential of the average ego structure was by far surpassed.

Ideally speaking, particularly as concerns the direct victims of this disaster, pre-trauma assessments of the psychological equilibrium of these individuals would have provided us with far more solid ground upon which to base our conclusions. This, however, is a rhetorical proposition, especially in the light of the magnitude of the event we are attempting to describe. The following elements are nevertheless pertinent to this report:

a. The traumatic impact; both in its real dimension as well as in its inverse proportion to the ego strength of the victims.

b. The resulting intrapsychic process; that is, the outcome of the psychodynamic phenomena derived from the permanent or transient structural changes in the psychic apparatus (due to the reactivation of unresolved, previous traumas and dependent on formal regression, character structure, pre-existing neurotic conflicts, etc.)

c. Types of discharge of the impact; that is, the functional attempts of the ego structures to attain some degree of reorganization following the devastating impact of the trauma. Such transitory functional organization may result in confusion, uncontrollable discharge of impulses and emotions or retraction of ego boundaries (affective freezing, stupor, etc.). Symptoms related to this fragile reorganization of the ego include hypersensitivity, intense anxiety, lack of sleep or hypersomnia, etc. Such reactions are to be found in approximately 60 per cent of the victims. Another 15 to 25 per cent are able to cope with the massive trauma with some degree of adaptive efficiency. When one sits back to take a good look at these figures, it is appalling to realize just how small the proportion of persons with evident ego strength really is. Regardless of the further implications of this fact, however, these fortunate individuals are the ones who are capable of providing immediate first aid to their fellow victims.

In the remaining 15s25 per cent of the victim population involved in any major disaster, psychological disorganization of major importance occurs due, to a large extent, to the previously existing psychopathological ego structures.

d. Varying degrees of long-lasting formal regression. Normal and pathological mourning processes occurring in those whose losses include immediate family members and/or properties heavily invested with affect.

e. Reconstruction of effective ego functioning in the majority of those directly involved in the disaster, although 10s15 per cent may suffer retarded psychopathological reactions (neurotic reactions, an increment in character pathology and psychosomatic diseases).
The intensity and pathology of the formal regression and retarded effects may, to a large extent, depend upon the ego's capacity for rapid neutralization of the stimuli as well as to the fast and effective intervention of the rescue crews. (This refers also to how quickly the 'buried alive' victims were rescued, how many hours or days elapsed before food, shelter and reunion with other surviving family members were provided, as well as how quickly these people received proper assistance to help them digest the trauma.) Our attempts at crisis intervention were of course aimed at the most crucial aspects of the victims' immediate psychological task, that is, the discharge of massive stimulation so as to allow the ego some degree of adequate functioning.

With regard to the psychological process characterizing the general population who, although spared the direct impact, nevertheless suffered significantly from the disaster, this has also been well described. (It should be noted that in transmitting this information to the general public, we referred to the psychological process in the simplest possible terminology so as to make it understandable to the average individual who, at least in our community, is highly unsophisticated in the use of psychological jargon.) The following steps of the process are those we consider most pertinent to this report:

a. The immediate reaction, described as theHeroic Stage. Although joyful at the realization of having been spared from the major brunt of the tragedy, the average individual, due to his unconscious, gregarious obligations, guilt feelings, and the awareness of his impotence to have in any way prevented the disaster or reduced the death toll and/or material losses, experiences the activation of manic defences to help the ego cope with its sudden disorganization. The most frequent immediate responses are elation and negation-these manic reactions forming the basis for the many attitudes of excessive solidarity, relentless assistance activities as well as irrational displays of generosity that prevail during this phase. Again, however, it is only 15s25 per cent of the non-affected population that is capable of responding with effective rescue actions and adaptive organization; 65 per cent of the non-affected population present abnormal reactions due to the onset of severe regression and invading guilt feelings (with a consequential setting into motion of manic defences). Severe psychopathology, including major and, not infrequently, lethal psychosomatic conditions as well as a lesser incidence of suicidal attempts, may be observed in approximately 10s15 per cent of the population (non-affected).

b. The Honeymoon Stage, a short general reaction of mildly manic quality. It involves an unrealistic and excessively optimistic appraisal of the collective action. (Although poorly organized in the first crucial hours, the response, especially from the private sector including universities was, in reality, not only massive but impressive in its spontaneity and increasing effectiveness.) In the population at large the atmosphere that prevails is one of over-friendliness, solidarity and a courtesy that is rarely seen in the everyday social exchanges of a vast metropolis such as this one. Criminality is significantly reduced during this phase.

c. The Stage of Disillusionment that often lasts for weeks and even months. This sets in when a realistic appraisal of the damage, death toll and suffering gradually begins to cast a bitter shadow over the populace. As things slowly return to 'normal', it becomes increasingly evident that the disaster left far more than a human death toll in its wake. In the aftermath of the Mexico City disaster, people quickly became aware of the fact that the financial crisis plaguing the nation had been worsened by the material losses so recently incurred. Hostility prevails among members of the stricken community. Psychic, family, social and political cracks become evident.

d. The Stage of Reorganization. Both social and individual systems return to former operational pathways although the changes that have arisen out of the ashes of the disaster are easily recognizable. Those members of the population with pathological structures will show the retarded effects of the psychological impact.

CRISIS INTER VENTION THE METHOD

A number of favourable circumstances coincided to allow for the fast and effective intervention by psychoanalysts during this crisis, instigated by a number of aetiological factors. It can, in fact, be stated that it was precisely the unfortunate conditions that prevail in underdeveloped countries that this time worked in favour of our spontaneous response to the psychological needs of our fellow men. The centralization of governmental departments and massive information installations, as well as the web of relationships that professionals can enjoy in a country with limited resources worked to our advantage. The government-operated television and radio station were the first to invite psychoanalysts to appear before an audience very much in need of guidance; later, at our request, they were to place their broadcasting channels at our disposal and, finally, the order was given to the commercial stations to join in so as to serve as the main source of dissemination of our programme aimed at the prevention of severe psychopathological reactions. Both media announced in frequently repeated 'spots' the training courses that were being given in our locale and in other health institution auditoriums. The sensitivity of both the Government authorities and the management of the mass media stations can hardly receive sufficient praise. Provided our efforts prove fruitful, similar crisis intervention programmes could be implemented elsewhere, though with greater planning and prior organization. The senior analysts appeared on city-wide television screens less than 60 hours after the first major quake. One, in fact, was in the middle of underscoring the need for victims to ventilate their anguish, sorrow and fear as quickly as possible, and to voice their ghastly experiences, when the telesion studio was rocked by the second tremor. The audience was also informed of the inevitability of reliving early traumatic events as a result of the current psychological impact. The following evening another highly respected senior analyst appeared on one of the more popular television shows where he explained in everyday parlance the dynamics of traumatic neurosis and the expected immediate reactions. The need for emergency 'chimney-sweeping' was again stressed.

The witch's broom of metapsychology quickly began sweeping our battered brains (Freud, 1937, p. 225)and the leaders of the Psychoanalytic Association tentatively organized a plan of action to help one cope with the increasingly ominous after-effects looming before us. At first, only a small group participated but later, more or less 50 per cent of the membership was to become involved in one aspect or another of the programme.

The real starting point of the Crisis Intervention was a televised programme in which four of us appeared before an estimated audience of 20 million persons. The main topics of our presentation were communicated using non-technical, everyday language and, apparently, the message got through. Five main aspects were stressed, namely: (1) the need to allow the victims to abreact if necessary, placing the 'bottled-up' ones into small groups with others who were communicating their experiences and emotions in whatever way; (2) to use sedatives and tranquillizers only in limited dosage and mainly for the purpose of ensuring good nocturnal rest; (3) all personnel working directly with victims should, regardless of their profession, be involved in their highly charged rescue activity for only a few hours at a time; (4) personnel working in rescue units, hospitals or in the rapidly improvised shelters should, after every 6-hour work stretch, get together with a few of their companions in order to communicate their experiences in an attempt to discharge their emotions. They were encouraged to cry and even to share with these companions those early memories and experiences evoked by close contact with the victims; and (5) we alerted them against heroic performances and conveyed a few of the concepts concerning unconscious guilt in an attempt to prevent manic, disruptive behaviours among the many enthusiastic and generous citizens who ran to the help of their countrymen.

We also made an urgent plea for involvement by universities and professional organizations related to the Mental Health field. As we were to learn only later, the Departments of Psychology of the three largest universities of this city were already fomenting their own plan of action. Finally, we committed ourselves to initiate, as soon as possible, training programmes that would enable all those involved in the health professions to deal better with the emotional condition of the victims.

The response was impressive. Most of the Mental Health organizations participated in one way or another in the project and what is more, most of the activities were complementary to one another, including those of our own Association.

So, our first actions were directed towards the prevention of major psychological disorganization, both immediate and long-term in the victimsper se. We were also greatly concerned about the reaction of the general population and decided to use precisely those same communications media that had caused the massive critical reaction. We like to think of it as a kind of homeopathic mental health intervention.

Six days after the earthquake, the Secretariat of Education's powerful radio station transmitted a pre-recorded programme in which one of us attempted to instruct the general population as to the successive and overlapping stages of the psychological process that almost every citizen, according to individually-determined timing, would pass through. The rationale underlying such interventions has already widely proven its validity. It is generally accepted that the possibility of anticipating the possible reactions of a given population tends to help the large majority to regain ego control and, as such, affectively prevents a good number of undesirable, disruptive and
aggressive behaviours.

The following day another one of us repeated the message on a nationally televised programme broadcasted by all stations, commercial as well as governmental. In the following two weeks excerpts from this intervention were televised over 50 times. A number of radio and television interventions by other psychoanalysts were used to reinforce the effectiveness of this action.

All of the important Mexico City newspapers co-operated by publishing a number of editorials, interviews and featured articles by psychoanalysts and other Mental Health professionals, all of whom dealt with various topics related to the psychological reactions of victims and the general population.

The most effective method for crisis intervention, however, was the direct psychotherapeutic contact with groups. It is pertinent to mention that a large percentage of the members of the Mexican Psychoanalytic Association are trained in Group and Family Therapies. Therefore, techniques such as the one implemented by the Balints (1961) are used whenever it is deeemed advisable. Thirteen years ago a book was published by one of us (Cueli & Biro, 1975) describing a method devised to study and transform marginal communities through the guided activity of students. It was found that the emotional impact of close contact with a totally different subculture and the projective counter-identification of poorly neutralized impulses and primitive fantasies tends to be devastating. Therefore the group of field researchers met once a week with a psychoanalyst trained in the method referred to above. The main objectives of such encounters were first, to allow these observers to discharge the overload of stimulation to which their egos had been subjected and second, to help them reconnect these impacting and traumatic experiences with their own inner conflicts, unconscious fantasies and earlier traumas. This would, in turn, allow their egos to cope with the impact and help to neutralize both superego and id activity set into motion by the contact with the massive invasiveness of the slum-dwellers' poorly integrated psychic apparatus. By sending these groups of observers out into the marginal communities and subsequently bringing them together in a semi-supervisory setting, the psychocommunity researchers were able to gather a wealth of information on aspects observed by proxy in the aforementioned setting. Important data concerning interpersonal relations, collective unconscious fantasies, social organization, and cultural cues was thus made available for research. Finally, this method has proven invaluable as a teaching device in the training not only of psychology students, but also of medically and socially oriented professionals, serving as the basis for higher level training in psychoanalytic psychology, psychotherapy and other related mental health programmes. many members of our Association are acquainted with this method. Recently three of us implemented the method for research and educational purposes with freshman psychology students who were sent to two psychiatric hospitals with different theoretical orientations. The experience was not only enriching in terms of research data and training, but also resulted in a dramatic decline of the emotional disturbances, accident-proneness, etc. so frequently observed in unsophisticated students, especially in their first contacts with psychotic patients (Clériga et al., 1985).

As had been promised in the emergency television presentation, brief training courses were offered in the locale of the Psychoanalytic Association and in auditoriums of psychiatric hospitals. These free courses in crisis intervention were given to professionals in psychiatry, other branches of medicine, psychology, social work, nursing, and education as well as to volunteers working in relief centres. At one point the audience even included high ranking government and military personnel. We estimate that some 2,000 persons attended our courses in the first three weeks following the disaster.

The programme was organized as follows: three lectures of 30 minutes' duration, the first of which dealt with traumatic neurosis, psychological stress symptomatology and the common psychopathological reactions that follow the acute impact of catastrophes. The second imparted information on elementary psychoanalytic concepts of ego functioning, neutralization, discharge, defences and a summarized explanation of the stages that are the well-known psychological chain of events in both the direct victims and in the population at large. The third lecture dealt with psychotherapeutic techniques for coping with the immediate and long-term psychological effects of the massive trauma.

Subsequent to this informative phase, the audience was divided into groups (some with as many as 150 participants and others with as few as 20), each of which was assigned a member of the Psychoanalytic Association with some training in group therapy. The more experienced the professional, the larger the group of assignation and vice versa. The purpose of these groups was two-fold: (1) to help these persons to cope with the impact on themselves by opening their own denied feelings, helping them to understand that this recent traumatic experience was connected in their own psychic apparatus with early personal traumas and to transmit to them that, by understanding this sequence they could best neutralize the experience and thus be better able to function efficiently and effectively; (2) through such massive group discharge, in which the sharing of experiences was often accompanied by tears, loudly voiced feelings of shame, impotence and guilt, the members of the audience were able to regain ego organizational functioning and to return to their task of facing and receiving the brutal impact of their victim-patients. Some information was given as to the simple mental health measures to be taken, such as not to work too many hours, to undertake other activities, to share their experiences, to open themselves up and to avoid containing their tears and distress. Reassurance was also given them as to the willingness of the different professional organizations, university faculties and governmental health institutions to send personnel to work in situ with their groups as well as to provide supervision for them at these institutions and organizations. Our own members gave willingly of their time and a few were even directly involved in psychotherapeutic relief actions with direct victims in hospitals and rescue centres. This activity was and continues to be, free of charge.

Mental health professional organizations and the psychology departments of the largest universities were working intensely, sending their members and Master Degree graduate students into relief centres, hospitals, etc. to provide psychotherapeutic help on location or to receive individuals or groups working in the trenches of the relief efforts so that they could share their experiences and receive some sort of psychological support. Amazingly, in this highly complex and somewhat disorganized metropolis with its vast array of services, what slowly emerged was a spontaneous co-operation between the various institutions, in which they proved to be capable of overcoming natural rivalries, differences of conceptual frameworks and personal conflicts in favour of developing a common, informal unit of assistance. Catastrophes sometimes give birth to miracles.

Although similar and far better organized task forces have been designed for use in recent war situations, we believe that the peace-time action described above is the largest ever organized, thanks to the need for improvisation in a Third World society.

THE INITIAL CONCEPTUALIZATION OF OUR METHOD

As the days went by we were gradually able to comprehend and intuitively to formulate hypotheses about what had happened in this emergency situation. We came to realize that what we were doing was applying our common psychoanalytic knowledge and experience in a collage of techniques. Mental health preventive measures, critical intervention, group psychotherapies, emergency supervision of cases and elementary psychoanalytic information are only some of the methods we were forced to merge. We were fortunate to have at our disposal extensions of our egos that were precisely the same instruments that had acted as pathogenic agents. One of us directed the National Association of Radio Stations in the creation of 'spots' presently being broadcast on all 54 radio stations of the city. These are aimed at alerting audiences to the psychological phases of the digestive process of the impact. Another series of spots has also been prepared for the television audience. We are well aware of the fact that our intervention coincides with the political interests of the government and the maintenance of social order. But our rationale for action is solely directed at preserving, to the degree possible, the psychological integrity of our fellowmen. We firmly believe that science should be devoid of political
orientation.

Our effort could best be described as a series of ego auxiliary support systems arranged in the form of a pyramid. Another way of describing this activity is as a series of concentric sponges, at the epicentre of which are the direct earthquake victims. Moving outward from this central point, the next surrounding circle of sponges represents the trench-line circle or first line assistance, made up of the physicians, nurses, mental health professionals, social workers, rescue crew members, policemen and volunteers who were in direct contact with the victims and absorbed a tremendous amount of the emotional debris. These people were urged by us (and many other psychologists and psychiatrists, shortly afterwards) to help the victims to discharge, as rapidly as possible, the brutal flood of stimulation to which their egos had been subjected in just a few short hours (although some were trapped under the remains of the falling buildings for several days). The trench-workers were also advised to help the victims in planning for their immediate future. They were instructed to provide them not only with food, medication, medical assistance and cover for their bodies but also with a willing ear to receive their sorrow, grief, screams and sobs. In the case of the stuporous victims whose egos had become constricted and rigidified in a somewhat ineffective but desperate attempt to cope with the impact, the trench-line workers were advised, both directly and via the mass media, to organize them into small groups with other victims who were discharging vocally, even if in a confused and disorganized fashion. They were encouraged to do their best to 'open these bottled up victims'.

At the second level of the concentric circles were all those spontaneous and formal relief organizations set into action in this emergency situation. These were the hospitals, governmental institutions, army, navy, police force, communications media, social security systems, foreignaid personnel, etc. In our field were the members of the Mexican Psychoanalytic Association who, in conjunction with other Mental Health institutions, were providing both the ego support and the information and training necessary to establish this chain of ego systems, primarily in accord with the Psycho-community Model.

Since this enormous task force-the largest ever to be activated in a peace-time disaster-was created in such a rush, we anticipate that some of its members will be unable to function adequately, but we are hopeful that a large majority has provided and continues to give the best psychotherapeutic help available in our city. More importantly, they are acting as the best preventive agents to help avoid the effects that will inevitably follow the massive psychological impact, not only upon the victims but also on the population at large. We are well aware that our gigantic community will never be the same as it was before 19 September 1985 but we are trying our best to help put back on its feet what hopefully will not be too damaged a society. The limited resources of our country are, more than ever, needed for the construction of a better future.

Our applied psychoanalytical crisis intervention was consciously directed toward the young in the population. Although we were unsuccessful in our attempt to implement a preventive mental health programme involving the entire school system, we were able to stimulate in many schools and household groups the playing of earthquake games for the very young and group discussions of the disaster with the older ones. The participation of many members trained in child psychoanalysis as well as the collaboration of child and adolescent psychotherapists trained both in our own, extensive academic programme and elsewhere, was also rapid and effective. We are presently gathering a wealth of drawings and recordings of such preventive activities for future study and publication (see appendix).

In the near future we expect to learn the exact extent of the number of victims, the death toll directly derived from the earthquake as well as suicides, and a great deal of other pertinent data, such as psychiatric admissions, to study the type of patients and the comparative epidemiological figures. We will also be attentive to the publications of Public Health reports that may give us some idea of the results of our efforts, however inaccurate. We foresee that this initial attempt at conceptualization will yield greater intellectual harvests in the near future and we feel obliged to share it with other professionals in the mental health sciences throughout the world.

We trust that it can be improved by the expertise of those living in more highly developed societies. Our effort was partly influenced by our Latin background and the youthful remains of romanticism common to our people. The experience has united us despite our differences of age and training into a team of assistance. If nothing more, it has given us great satisfaction and a sense of purpose. Last but not least, we have developed the pride of belonging to the small professional universe that is best equipped to understand, intervene psychotherapeutically and conceptualize psychological events in the realms of both the individual and the group (Freud, 1921).

One final word about our sponge metaphor. The first circle 'sucks out' the discharge of the victims and, therefore, overflows in a few hours. The second circle of sponges, mostly the emergency psychotherapists, suck out the debris of the first circle while attempting to give some psychodynamic and genetic meaning to the action. The third circle, ourselves and others performing a similar activity, serves as a highly sophisticated ego auxiliary system located at the very top of the pyramid. We cannot estimate the figure representing the base of the pyramid with precision but we do calculate at least several tens of thousands.

At present the effort of the Mexican Psychoanalytic Association is being directed towards the training of mental health professionals to deal with the acute reaction to the loss of immediate relatives. The courses are primarily theoretical although some technical guidelines are also given. The wealth of pertinent literature is reviewed in an elementary fashion. Together with the classic psychoanalytic concepts on the subject, some more comprehensible information is suggested as a reading list (Beverley, 1977); (Bowlby, 1980); (Furnam, 1974) and (Pincus, 1976).

In due time, both public and private Mental Health facilities will carry the load of the psychopathological reactions resulting from the physical and the psychological disasters, i.e. relapses of chronic psychotic processes, new psychotic reactions, worsening of character disorders, neurotic reactions, psychosomatic diseases, etc. Most of these patients will be beyond our immediate reach. At present, diverse programmes are being implemented by the Secretariat of Health as well as by the hospitals and universities serving this enormous metropolis to help them better meet the needs of those directly and indirectly affected by the quake.

The ghastly disaster left some positive sediment in its wake. The potential for research themes is limitless. It is reasonable to predict studies on every aspect of traumatic neurosis, dreams, the psychological process observed in survivors who were rescued from the rubble of the fallen edifices, etc. Although the abundant harvest of such a catastrophe alleviates our sorrow, it can never compensate for the loss of lives nor for the suffering that our countrymen were forced to endure.

APPENDIX

CONCLUSIONS AND SUMMARY OF ASSISTANCE ORGANIZATION AND CIVIL DISASTER PLANNING

Operative Groups in Schools

The training course given at our headquarters in the days immediately following the disaster had two main objectives: to compile a register of interested volunteer workers (psychologists, teachers, sociologists, etc.) and to train these people in operative-group techniques (theory and self-practice, experiential) so they could act as 'multipliers' in their own immediate work environment (including schools) of this programme. Subsequent to their participation in the training programme, they were expected to go out into the field, returning periodically to report on their experiences and results, to discuss their problems and to take advantage of the supervision that was being offered free of charge.

Four major areas of assistance were outlined as part of a total organization programme, each headed by a senior psychoanalyst:

1. Schools s group work with:

children

adolescents

teachers

school psychologists

parents

2. Shelters s group work with:

authorities

inhabitants

adults

children

3. Victims s short-term group therapy and clinical investigation with:

the 'buried alive'

victims

('trapped syndrome')

4. High-Rish Groups: group work (Balint) volunteers involved in rescue activities

5. Communications s TV, radio and press spot-design and social communication

The programme especially designed for use in schools had as its main objective the amortization of the psychological impact resulting from the disaster experience. The topic was to be broached in one of the following three ways depending on the population involved: the use of a group format for directed open discussions (for adults, including teachers, parents, etc.); directed closed discussion groups when dealing with adolescents (high school and college students); and finally, the use of play techniques with the younger children.

Based on the psychoanalytic assumptions mentioned elsewhere in this paper, the main clinical objective of the group activity was that of emotional discharge via cathartic expression of affects overwhelming ego functioning. These expressions derived not only from actual experiences (children and teachers arriving at school at the precise moment when the earthquake struck and as a result having witnessed the collapse of these buildings), from having been bombarded by the information from the TV newscasts transmitted live from the disaster sites on a continuous 24-hour-a-day basis during the first three days after the initial quake, and lastly, from fear-laden fantasy productions, both conscious and unconscious, concerning real, potential and projected dangers.

Our findings include the following: teachers and parents: anxiety reactions, depression (reactive), emotional outbursts, anger and disgust at the many sinister jokes already in circulation, confusion as to how to discuss the disaster theme with their pupils. Behavioural manifestations indicative of severe regression (several senior college students absented themselves from any verbal communication, playing instead with charcoal and paper and producing drawings that were both primitive and infantile). Some of the emotional responses were far more reality-oriented, such as those expressions of sadness and guilt linked to disillusionment over the anticipated ineffectiveness of the rescue efforts.

Among adolescents both anxiety and apathetic mood were found in conjunction with hostility and pseudo-hedonistic behaviours. Many of them seemed to deny the whole situation despite expressions of sadness and sulkiness. Still others hesitated to air their feelings out of fear of peer ridicule. Frustration was common among young adolescents who felt themselves unable to help in any way. Others opted for excessive rationalization.

Findings derived from the direct observation of children and teachers' reports include increased incidents of enuresis, separation-attachment anxiety, skin rashes, insomnia and poor social and academic adjustment.

Each of the discussion groups was leader-directed and was aimed at the reorganization of ego functioning. The participants were invited to think about and to outlive some feasible and concrete plans and actions for helping their families as well as their fellow citizens. It was not long before favourable, spontaneous responses began to appear as groups started planning organized activities.

SUMMARY

The mental health professionals response to the population psychological needs and civil disaster planning after the quake on 19 September 1985 is outlined and discussed. The effect of the mass media's sensationalist reporting and massive overflow of transmitted information upon the by then battered ego functioning of the general population, is regarded as a traumatic agent due to its passive link with personal aggressive and destructive fantasies, triggered off by and related to subjective visual imagery, past experiences and internal object projections. Sequenced phases of psychological impact in victim and non-victim populations are described in terms of emotional first impact reactions, intrapsychic processes derived from it, types of discharge, regressive behaviour and reorganization. A crisis intervention method based upon previous experiences in the application of psychoanalytic theory in field work with large populations was instrumented. Description of the method and preliminary findings are reported.

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