Along with everyone else, I have been watching with horror and heartbreak the news from Japan. The images grow increasingly startling: cars, trucks and buildings swept away by the powerful wave, people on roofs watching, stunned, as the water rises, an elderly woman being rescued after days trapped in a car.

But I am stopped by a photograph on the CNN website of a young woman wrapped in a pink blanket and standing amid rubble. (You can find it here, but will have to click around.)

The look on her face haunts me. I mean no disrespect, but her expression is profound, deeply felt, and existential WTF-ness. It is a face of someone surveying the end of life as she knew it, who faced death and finds herself alive but doesn’t know what to do next. Someone who has images, sounds, emotions churning around in her head, the likes of which most of us cannot even imagine.

What does this young woman need to recover from the trauma? How can psychologists help her heal and ensure that she doesn’t wake screaming in the night for the rest of her life? After food and shelter, what is the first thing this woman needs?

It seems nobody really knows.

Psychologists are pretty sure that parachuting in after a disaster and insisting people talk about their experiences—called debriefing—is a bad idea. It appears that if you make people relive traumatic experiences too soon, the memory becomes so deeply encoded that the risk of post-traumatic stress disorder is increased.

And it appears, said trauma researcher Richard Bryant, on the brilliant Australian radio show All In The Mind, that what people really need after a traumatic event is to be calmed.

“…one of the rather solid findings we’re coming up with is that people in those first hours, or the first day or two after a very traumatic event experience very high arousal. We know that that’s predictive of subsequent post-traumatic stress disorder, months and years later. …

People who get morphine in the hours after an event, which is a suppressant of arousal, that tends to be protective of later PTSD.”

(Morphine or maybe Tetris, which also appears to interfere with memory encoding.)

However, Bryant said, nobody knows for sure if that helps in the long term, or what else might. Most of what we “know” about helping people after traumatic events is intuitive, guesswork, hope, speculation, and pieced together from flawed research.

Even clinical psychologist Debbie Hawker, a consultant for humanitarian organizations, who was on the show to defend the use of debriefing for humanitarian aid workers (whose needs are different from primary victims) conceded that too much is unknown for any determination to be made about the best first response to trauma.

Conducting research on trauma is difficult, but from either side of the debate on debriefing, Bryant and Hawker agree that more research is necessary.

Unfortunately, they won’t have it figured out in time to help the girl in the pink blanket. And unfortunately, they have a lot of people to work with these days.

Photo by Dave_B via Flickr (Creative Commons).