NEW YORK - The image of his brother trapped in a car with water rising to his neck, his eyes silently pleading for help, is part of a recurring nightmare that wakes Anthony Gatti up, screaming, at night.
Gatti hauled his brother out of the car just in time, saving his life at the height of Superstorm Sandy. The two men rode out the hurricane in their childhood Staten Island home and survived. But weeks afterward, Gatti still hasn't moved on.
Now he's living in a tent in the backyard, burning pieces of furniture as firewood, refusing to leave until the place is demolished. Day and night, he is haunted by memories of the storm.
"My mind don't let me get past the fact that I can't get him out of the car. And I know I did," Gatti said, squeezing his eyes tightly shut at the memory. "But my mind don't let me think that. My mind tells me I couldn't save him, he dies."
As communities battered by Sandy clear away the physical wreckage, a new crisis is emerging: the mental and emotional trauma that storm victims, including children, have endured. The extent of the problem is difficult to measure, as many people are too anxious to even leave their homes, wracked by fears of wind and water and parting from their loved ones. Others are too busy dealing with losses of property and livelihood to deal with their grief.
To tackle the problem, government officials are dispatching more than 1,000 crisis counselors to the worst-hit areas in New York and New Jersey, helping victims begin the long work of repairing Sandy's emotional damage.
Counselors are assuring people that anxiety and insomnia are natural after a disaster. But when the trauma starts to interfere with daily life, it's probably time to seek help. And in a pattern that played out in New Orleans and the Gulf Coast after Hurricane Katrina in 2005, symptoms may only get worse as victims transition from the initial shock to the disillusionment phase of the recovery.
"Folks are starting to realize that they may be in this for the long haul," said Eric Hierholzer, a commander in the U.S. Public Health Service. "And things aren't necessarily going to get better tomorrow or next week."
At St. John's Episcopal Hospital in Far Rockaway, the psychiatry department has recorded a 20 percent increase in walk-in patients since the storm hit, with residents reporting the whole gamut of stress-related symptoms. Anxiety. Insomnia. Panic attacks.
Local schools have referred 25 percent more children than usual to the hospital's outpatient mental health programs.
"The children are very, very traumatized," said Fern Zagor, who runs the Staten Island Mental Health Society. "They have a hard time making sense of this sudden change in their world. It's frightening to them."
A 5-year-old girl who was pulled from floodwaters clinging to her father hasn't been able to attend kindergarten since the storm, Zagor said, because she's too traumatized to be parted from him now. An 11-year-old boy is working with counselors after floating in water up to his neck on the second floor of his home for several hours before being rescued.
"This child has said he worries about rain," Zagor said. "He worries about whether he'll ever want to swim in a swimming pool again."
The society is among many mental health providers who are working with Project Hope, a New York crisis counseling program funded by an $8.2 million Federal Emergency Management Agency grant that has just begun sending counselors to local communities. New York Gov. Andrew Cuomo's office estimates the program will help more than 200,000 people.
Project Hope Counselor Yomira Natera has been seeking out storm victims who don't speak English as their first language.
"We've seen an increase in substance abuse with folks who may have language barriers," she said, "who may be frustrated with the system, who find it difficult to communicate."
At least 20,000 people have so far made contact with counselors from the New Jersey Hope and Healing Program, which has dispatched hundreds of state-trained disaster crisis response counselors into the storm zone. The state also launched a hotline for people to call and talk to a counselor.
In Union Beach, N.J., a working-class enclave on Raritan Bay, Kathy Parsells volunteered at a FEMA recovery center on a recent afternoon, helping to coordinate deliveries. Her daughter and grandchildren had to be rescued during the storm.
"I'm OK," she said, stifling tears. "My grandsons have nightmares. My grandson, the first night, was screaming: `It's coming up the stairs.'"
Jeannette Van Houten, who lost her home in Union Beach, said in a telephone interview that she feels like she's going through the same stages of grief that she endured when her niece was murdered in 2008.
"I have days that I can't put a thought together. Like you start talking and you forget what you're saying," said Van Houten, who sleeps just two or three hours on a good night nowadays. "And the numbness, like you look at things that are happening around you, but you're not part of it."
The Rev. Matthew Dowling, a pastor at the Monmouth Church of Christ in Tinton Falls, N.J., volunteered as a crisis counselor in the days after the storm and heard a lot of survivor's remorse from people who were more fortunate than their neighbors. But there was also a great deal of frustration.
"When FEMA arrives, they think everything is going to be fixed," Dowling said. "The reality is it's going to take months and months to get back to normal. Just like the steps of grief there's anger at the new normal."
Distress calls to LifeNet, New York City's local crisis hotline, doubled during the first few weeks after the storm hit, averaging more than 2,000 calls per week from people who were angry and worried that basic needs — food, clothing, shelter — had not been met.
Officials are now preparing for a new wave of calls from people struggling with depression and other mental health issues, said Christian Burgess, director of the Disaster Distress Helpline, a national crisis hotline run by the federal government that provides a network of trained counselors in the aftermath of a major disaster.
Coming to grips with the loss of everything she owned has been difficult for Carol Stenquist, who stood outside borough hall in Union Beach, nervously dragging on a cigarette and crying.
"I have anxiety over it. Even when I lay down at night I feel my heart palpitating with the loss of everything," said Stenquist, whose home was destroyed. "I was there for 20 years."
She thinks she needs to talk to a professional counselor, but hasn't sought one out yet.
"I'm kind of afraid that the emotional stuff I feel now is just part of what I'm going to feel when it's over," she said. "I've had my breakdowns, cries, feelings of depression. I've had all of that."
On Staten Island, volunteers have been quietly stopping by Anthony Gatti's tent to check in on him during his long vigil, dropping off boxes of cereal and cans of coffee. A volunteer therapist tried to talk him into leaving, but to no avail. He spends his days patrolling the property for looters and gazing at photos of the storm's destruction on his laptop.
"I keep trying to make him understand. It's a lot of wood and metal and pipes, that's all it is," said his mother, Marge Gatti. "You've got to get numb. You gotta get tough. If I'm not numb, I can't function."