Mass trauma lurks as Itaewon tragedy sears into our minds

Mourners wipe away tears at one of the makeshift memorials for the victims of the Itaewon crowd crush located at Seoul Plaza, Jung District, central Seoul on Tuesday. [YONHAP]

Images from Itaewon last Saturday are seared into the minds of so many, and that could take a serious toll on individuals and society as a whole.

Witnessing a horror like the deadly crush that took so many lives just a few days ago can cause a wide range of symptoms and create a whole host of problems. Headaches. Sleepless nights. Bad relationships.

"I haven't slept at all since Saturday," read a post on Twitter.

This could be mass trauma, which can become post-traumatic stress disorder (PTSD) for some.

In the case of the Itaewon crush, and for that matter any such tragedy these days, what is disturbing can be turbocharged and squared by aggressive algorithms and near unlimited bandwidth, taking a limited and localized disorder and making it globalized and far more severe.

"You didn't have to be there to experience trauma," said Chae Jeong-ho, professor of psychiatry at the Catholic University of Korea’s College of Medicine and president of the Korean Society for Traumatic Stress Studies.

The easy fix is just not to look at the images. Put the phone away. Don't Google the tragedy.

For many, bystanders, victims and first responders — and for some smartphone-addicted millennials — that's not an option. They have experienced the trauma already. The good news is that for 80 percent of these people, it will go away naturally. Some breathing exercises and a bit of time will help them heal.

For others, the road to recovery could take time, generations if they are not careful.

Mass trauma, or collective trauma, is defined as an entire group’s psychological reaction to a traumatic event that affects society at large, according to the Frontiers in Psychology journal. Academics have outlined that mass trauma leads to disruption of community life, work, normal networks, institutions and structures in the long term.

Such trauma concerns not only survivors who were at the scene of the crush and relatives of the deceased but also anyone affected by the disaster, according to mental health experts.

PTSD is a medical condition and psychiatric disorder that occurs in people who have experienced or witnessed a traumatic event and was previously known by names such as "shell shock" or "combat fatigue." Symptoms include trouble sleeping, irritability, overwhelming guilt or shame, nightmares, repetitive and distressing images or sensations and physical sensations such as pain, sweating, feeling sick or trembling.

“Many are already experiencing symptoms of PTSD,” said Chae. “It’s too early to determine PTSD yet since diagnoses are made at least a month after a traumatic event, but symptoms such as being unable to sleep, nausea, shaking and headaches are clear signs.”

As of Wednesday, searches for the National Center for Disaster and Trauma skyrocketed 10-fold on Google Korea compared to a week earlier, according to data from Google Trends. Searches for other related keywords also jumped, with “trauma center” increasing six-fold and “trauma symptoms” rising four-fold.

Although mass casualties have occurred in the past, such as the sinking of the Sewol ferry that took 304 lives in 2014, mass trauma has only recently become a focus. Before, mental illness of any kind was seen as sign of weakness, and still is in some ways.

“It was only after the Sewol ferry disaster that people started taking the concept of mental health support after a disaster seriously,” said Chae. “Before that, with disasters such as the Daejeon subway fire and the Sampoong Department Store collapse, there was no mental health care support at all.”

Technology could make the trauma deeper and far more broad this time around.

“The media environment has changed so dramatically in recent years that it’s a continuous loop of exposure to graphic videos and photos from the Itaewon crush, powered by algorithms, which is wholly different from how it was like after the Sewol disaster,” said Yu Hyun-jae, professor of communications and director of Sogang University’s Health Communication Center and Journalism. “This is a serious issue and it’s going to get worse.”

“Media-induced trauma has recently been introduced as an academic term,” said Lim Myung-ho, professor of psychiatry at Dankook University.

Studies have shown that survivors of disasters, families of the deceased, first responders and medical personnel at disaster scenes and others involved have a high likelihood to be affected by other similar disasters, being nearly four times as vulnerable to mental health problems than others, according to Lim.

The Korean government has set up counseling booths next to memorials at Itaewon and Seoul Plaza and a phone counseling service available at 1577-0199, which anyone can call to receive counseling. The Ministry of Health and Welfare has also promised to expand services in English and other languages.

But Korea still lacks systematic emergency medical care that covers mental health, and continuity in services and providing for those outside of the Seoul area could be a problem.

“The National Center for Disaster and Trauma has weak influence in areas outside Seoul,” said Lim. “And there is the problem of persistently providing mental health care to those suffering from traumatic disasters.”

An even bigger problem is that the mass trauma and mental health problems suffered by those affected in disasters such as the Itaewon crowd crush can last not only those individual’s lifetimes but also that of future generations, according to Chae. This decades-long aftereffect of trauma is called generational trauma.

“We almost never talk about generational trauma in Korea,” said Chae. “Disasters like these affect children of PTSD patients and even further, as seen in research done overseas on disaster and the families of war victims. There is one single center covering generational trauma in Korea, the 43 Trauma Healing Center that offers counseling to families of the Jeju April 3 incident. And that was established only two years ago.”

The idea that trauma can be passed on can be unfamiliar in a country like Korea, where discussions about mental health itself has only just escaped its status as taboo.

“For example, survivors of the Itaewon crowd crush could experience serious anxiety about their own children going out to celebrations or other events if they have children of their own later on,” said Lim. “This will end up affecting those children in turn.”

“We need to look at this as a very long-term issue and prepare what we’re going to do about it,” said Chae. “Trauma is all about how we’re going to respond in the aftermath of disasters.”

Regulation is being advocated by some.

“It’s only been a few years since illegal downloading has been regulated in Korea,” said Yu. “We also need to discuss – with the Itaewon disaster as a catalyst – how circulation of graphic content will be managed. Floods of footage and photos traumatizing people will become more serious in the future without it.”

The Korean Neuropsychiatric Association released a statement Sunday that warned against the spread of footage and photos of the scene at Itaewon on social media and urging the media to strictly adhere to guidelines on disaster reporting.

The National Center for Disaster and Trauma advises that people experiencing symptoms of trauma in the acute stage – three to seven days after a disaster – practice simple breathing exercises to calm themselves and to visit a counseling center as soon as possible if symptoms continue for more than a week.

BY LIM JEONG-WON [lim.jeongwon@joongang.co.kr]