Psychiatrists on standby as last shreds of hope turn to despair

The bereaved

As Kathy Schatz burst into sobs of anguish outside New York's Bellevue Hospital, a St Bernard with the words "Pet me! I'm friendly" on its collar nuzzled comfortingly against her leg. The shaggy "therapy dog" is just one way in which the emergency services are dealing with grief.

Ms Schatz, along with hundreds of other friends and relatives, came to the hospital with a dual purpose: to establish whether her brother had been found, and to put a flier with his details on the growing "mural of hope" along the hospital concourse.

Also there, with chaplains, Baptist ministers, rabbis and other religious figures, are the elite of the hospital's psychiatric unit. They are trained to identify all the stages of grief, and are bracing themselves for scenes of hope to turn to despair. The therapists are predicting an "emotional meltdown" as the unthinkable truth dawns on relatives and friends of the missing.

"My team is ready to take on this tragic task," said chief psychiatrist Paula James. "At the moment, you are seeing all the signs of hope. People are using these fliers [with loved ones' names] to express their fears in a constructive way and make themselves feel part of a community. Unfortunately, with every hour that passes, we are going to have to deal with that hope hanging by a thinner and thinner thread."

She went on to explain that many will contemplate suicide, and that the problem will be made far worse if, as many experts now expect, families will not even have bodies to bury. It is possible that religion may not be enough to comfort the bereaved. Also weighing on people's frayed emotions is the fact that many families of the missing have not been able to get to New York.

"When transport gets back to normal, the problem will explode," continued Ms James. "People have been driving hundreds and even thousands of miles across country to get here, and although they are filled with optimism, they could simply be arriving to receive the worst news imaginable."

For Ms James and her team of experts, the work is only just beginning. She and the New York Psychoanalytical Institute are also predicting a vast surge in cases of post- traumatic stress syndrome. The condition is frequently associated with war zone veterans, but the terrorist attacks may have sparked the biggest civilian example since the Second World War.

But the cellphone age has given the psychiatrists a glimmer of hope. "Many of the relatives and friends we are interviewing here received a call just minutes before the buildings collapsed," said Ms James. "It was the good old-fashioned instinct to call Mom that just took over. People who were at the top of the towers when the planes hit must have known they were going to die, but managed to get a message of love through to their homes."

Psychiatrists say it is impossible to overstate the importance of such messages. One of the single biggest contributing factors to grief is the feeling that one's last words to a loved one might have been angry or rushed.