Some banged their heads against the hospital wall. Some, wide-eyed, just stared vacantly. Others mumbled "the sea is coming," reliving the horrors of the massive tsunami (search) that took their families and homes.
They were among the first people to be treated in Sri Lanka's southern port city of Galle for post-traumatic stress disorder (search). Doctors worry the debilitating condition will engulf many survivors of last week's massive waves.
The helplessness and agony are reflections of the loss of some 140,000 lives in 11 countries from Indonesia's 9.0-magnitude earthquake and the resulting tsunami. Sri Lanka accounted for more than 30,000 deaths.
Gamini Liyanage, 35, repeatedly pounded his head on the wall above his bed's iron headboard at Karapitiya hospital's main psychiatric ward. He then bounced out of bed and tried to jump out a window. Men in white hospital suits dragged him back to his bed, where he sobbed.
When the tsunami hit, Liyanage's 3-year-old daughter was yanked from his arms when he tripped while trying to escape his flooding home. His wife, Champika, escaped with their son but found her daughter's body hours later in what used to be their home.
"Even though I knew she was dead I carried her in my arms and ran about two kilometers (about a mile) to the hospital," Champika said, her eyes filled with tears. "We had so many expectations for her."
Dr. R. Reuban, a psychiatrist at the hospital, said he had dealt with several dozen patients after the tsunami whose symptoms include aggressiveness, incoherent speech, anxiety and suicidal tendencies.
"There are many people whose level of grief has reached abnormal proportions," he said. "It's important that these people get as much support from their remaining family members and are able to indulge in funeral and religious rituals" to help the healing process.
Post-traumatic stress disorder, or PTSD, is a psychiatric condition triggered by extremely upsetting experiences such as rape, war and natural disasters.
While nearly everyone exposed to such trauma suffers emotional distress, only a fraction develop PTSD. Unable to cope with the trauma, they become crippled by an extreme sense of helpless or fear, which can interfere with their ability to look after themselves.
"Survivors are ridden by guilt, recurring images of the tsunami and many have expressed fears about going back to the high seas," said Dr. I. Meenakshi, a psychiatrist from the Institute of Mental Health in Madras, India.
Meenakshi, part of a team of psychiatrists working in relief camps, said that while government departments and aid agencies have ensured emergency medical care, food and shelter, the emotional and psychological fallout of the tsunami (search) could take years to heal.
"We met fishermen who have been in the trade for 20 to 30 years, who expressed fear about taking a boat back to sea. Their confidence has been shaken and there are feelings of insecurity," she said.
Wivina Belmonte, Geneva spokeswoman for the U.N. Children's Fund, UNICEF, said the trauma for some is "unimaginable."
"It's horrific for us sitting in comfortable living rooms watching these horrendous pictures," Belmonte said. "For kids to have lived this, to have hung on to a parent, maybe to have lost the parent's grasp ... this is something they have to deal with for the next years."
Western tour operators have sent counselors to help returning tourists. The British, Finnish and American Red Cross (search) societies also have dispatched psychological support teams either to help tourists or to train local Red Cross workers, said Janet Rodenburg, who heads the Reference Center for Psychological Support of the international Red Cross.
"What the delegates are trying to do now is to inform the public about the very normal reactions to these things that have happened," Rodenburg said. "It's very normal to have problems sleeping and it's very normal that you are irritated."
A one-day workshop was to be held in Galle on Wednesday to train 60 medical students in disaster and trauma counseling, said Professor Susarith Mendis, head of the medical faculty. They will be then be dispatched to southern Sri Lanka to try to help.
It's that help that Champika clings to as she turns to Reuban with a question: "Can my husband be cured?"
He gives a hopeful nod.