The Armero tragedy: lessons for mental health professionals.

A U.S. mental health consultant worked closely with medical personnel soon after a volcanic eruption and mud avalanche killed about 22,000 persons and devastated the area around Armero, Colombia. The consultant conducted workshops and courses on crisis intervention for health personnel operating disaster relief units and for mental health professionals, pediatric nurses, and family workers; she also provided consultations to clinic and shelter directors and case consultation with hospitalized victims. Observations of early postdisaster responses of hospitalized victims showed recurring themes such as victims' ambivalence about learning the full extent of the disaster and their own losses, delayed mourning because many bodies could not be recovered, somatic expressions of anxiety and fear, and the use of primitive defenses, such as magical thinking.