During one of his annual trips to the Kashmir region of northern Pakistan, Samoon Ahmad, MD, interviews a man to determine whether he's suffering from post-traumatic stress disorder.

Aftershocks of the Mind

A Cataclysmic Event Inspires a Humanitarian Homecoming

Samoon Ahmad, MD, clinical associate professor of psychiatry, was at Bellevue Hospital one day when a colleague asked him if he had heard the news. At 8:50 a.m. on October 8, 2005, an earthquake measuring 7.6 on the Richter scale—similar in magnitude to the San Francisco catastrophe of 1906—had struck one of the earth’s great collision zones. With its epicenter located about 65 miles northeast of Islamabad, the capital, the quake convulsed the mountainous Kashmir region of northern Pakistan, Dr. Ahmad’s homeland. The quake rattled more than 7,500 square miles, exploding mountains, shattering lives, and taking an unprecedented toll on this country of 160 million that is nearly twice the size of Texas.

In less than a minute, an estimated 250,000 people perished (though the official toll remains 80,000), 70,000 were injured, and 3.5 million became homeless. As Saturday is a school day in the region, most children were in class, so up to 40 percent of the fatalities were youngsters buried beneath collapsed buildings. No foreshocks provided merciful warning, but nearly 1,000 major aftershocks rattled the land and its people.

Having grown up and been educated in Lahore from elementary school through four residencies (he later did his general psychiatry residency at Bellevue), Dr. Ahmad quickly called his family to make sure they were safe. But then he became the one who was called. “I must go there,” he thought to himself. Only now can he laugh when describing the reaction of his wife, Kim, as he shared his plan to trek home “to grasp the human suffering” of it all. “‘You want to travel 7,000 miles to an earthquake zone in the land of the Taliban?’” he recalls her asking.

Long interested in post-traumatic stress disorder (PTSD), Dr. Ahmad was drawn not only by a desire to treat victims, but also by a need to understand the psychic aftershocks, which made the aftermath a kind of disaster within a disaster. “I wondered how these people were surviving emotionally,” he says.

In April 2006—the earliest he could reach the forbidding mountainous terrain—Dr. Ahmad arrived in Pakistan. Accompanied by a childhood friend who is an internist, he spent two weeks interviewing and videotaping survivors in Urdu and English. Every year since, he has done the same, traversing some 1,500 miles and chronicling the plight of nearly 400 people thus far.

Their tales are horrific. One man describes how he watched helplessly as the earth suddenly parted, swallowed his daughter from a field, and then closed up again. Another explains that he lost 300 members of his extended family. A woman addresses Dr. Ahmad as “Son,” perhaps because it comforts her as she mourns the loss of one or more of her own. When word that "the doctor is coming" spread throughout one village, Dr. Ahmad found himself treating 200 patients within six hours. He is now developing a teleconferencing system that will enable him and other specialists to help survivors from afar.

Dr. Ahmad edited hundreds of hours of heartbreaking footage into an 18-minute documentary. In so doing, he gathered data for the first study (soon to be published in the Journal of Traumatic Stress) to measure the severity of PTSD among earthquake survivors living in remote communities with no access to mental
health services.

“PTSD has always been viewed as a Western phenomenon because it was first identified among Vietnam vets,” explains Dr. Ahmad. “I went in with the hypothesis that these people have endured so many hardships and disasters, that they’re resilient enough to overcome any tragedy. But I was blown away. About 80 percent of the people I evaluated during my first trip met the key criteria: sadness, tearfulness, jitteriness, hopelessness, nightmares, flashbacks. This verifies the universality of the biology of PTSD.”

Dr. Ahmad titled his award-winning film The Wrath of God because he found that faith played a vital role in how survivors coped and why most saw themselves not as victims but as sinners who brought retribution upon themselves. “Their lives belonged to Allah,” says one survivor. “We got what we deserved.”

Dr. Ahmad finds both irony and insight in the fact that the calamity, occurring as it did during Ramadan, the Muslim holy month of sacrifice, actually reinforced the faith of many. “An earthquake is the ultimate lack and loss of human control,” he notes. “It means that some almighty power is in control—and if he can do it, then he can undo it. The undoing is in repentance.”