BIRMINGHAM, Ala. (AP) - Wiping tears away at her Forestdale home, 56-year-old Shelia Hurd recently reflected on the loss of her mother. "It's the little things," she said.
Her mother's voice on the phone. Her laugh at Sunday dinner. Working side-by-side at church.
Grief can come upon Hurd any day of the week, but Wednesdays are especially hard. For it was on Wednesday, April 27, that a tornado ripped through Pratt City and killed her 72-year-old mother, Bessie Brewster.
"I wonder why she had to go the way she did," Hurd said. "It was not a peaceful way to go, what she went through the last few minutes."
The physical scars wrought by the 62 tornadoes on that day in Alabama are readily apparent -- toppled trees, broken bones, hollowed-out neighborhoods and freshly dug graves.
Less visible, yet painfully real to thousands of victims across the state, are the emotional wounds: nightmares, waves of sadness, edgy anger over things large and small, trembling apprehension when skies darken and thunder rumbles.
These emotions are normal, experts say. They're especially intense for people directly affected by the storms, but even those who didn't lose a shingle can be wrapped in mournful loss for their community or in fear that it may happen to them next time. A smaller group suffers more paralyzing torments, such as severe depression and post-traumatic stress disorder.
The anticipated psychological toll of the storms was such that the Federal Emergency Management Agency set aside more than $7.5 million to provide crisis counseling services through next June.
Using FEMA's grants, the Alabama Department of Mental Health's Project Rebound program contracted with local mental health centers to send 160 counselors to the 43 counties affected by the tornadoes.
Project Rebound's counselors have visited more than 36,000 people and conducted an additional 12,000 counseling sessions, said Zelia Baugh, the commissioner of the Alabama Department of Mental Health. Gaye Vance, president of the Alabama Psychological Association, said private psychologists are also seeing an uptick in tornado-related issues, many involving "mood issues" such as anger and frustration over housing and insurance.
A study in its early stages of emergency room visits at UAB Hospital is finding that the rate of post traumatic stress disorder (PTSD) among storm victims appeared to be 10 times the rate of the general population in the first three months after April 27, and the rate of depression among victims appeared to be double, said Dr. Cheryl McCullumsmith, director of hospital psychiatry.
McCullumsmith noted the study will continue for a year and numbers could change, and it's aimed at a select group -- emergency room patients.
PTSD, in contrast to normal grieving, is a prolonged impairment in functioning. It entails symptoms that keep a person from normal daily activities, she said. "For example, I don't want to go to church anymore because I don't want to talk about the tornadoes, or I am unable to go to work or take care of my family because of flashbacks or anxiety about the storms," she said.
People who have had past traumas or who suffered multiple losses in the April storms are more likely to experience such serious reactions. For most storm victims, the impact is less than that, but still very real.
Most victims need assurance that what they are experiencing is normal under the circumstances. "It doesn't mean you are going over the edge. It doesn't mean you're weak," Baugh said. "It's a normal reaction to an abnormal situation."
April 27 was the largest tornado outbreak in the history of Alabama, a state that leads the nation in tornado deaths since 1950.
While Alabamians braced for an onslaught amid all-day weather warnings, few people were prepared for the fateful instant when house and tornado meet.
"Imagine you're sitting there, and all of the sudden you hear the devil coming after you," said Kay Spanick of Concord, who lost her home on a street where four people were killed. "That's what it was to me. It was the most evil thing I've ever heard."
When it hit, said 63-year-old Melvin Love of Pratt City, he was shaking, holding his mother and looking skyward. "Lying there I could see the house go before my eyes like splinters."
Love found himself in his front yard with his mother. His next-door neighbor was screaming for help and from the pain of a broken leg. Across the street, the house of another neighbor, Shelia Hurd's mother, was wiped clean. Bessie Brewster was later found dead a half-block away.
The streets of Pratt City and dozens of neighborhoods across the state that evening were like darkened disaster movie sets with blaring sirens, flashing lights, and people in search of loved ones. Others covered in mud, blood and debris wandered around, trying to find something familiar.
"People were walking around like zombies -- in shock," said Russellville Police Department chaplain Bobby Brown, who came to the small northern Alabama town of Phil Campbell to help counsel victims shortly after the town was scrambled by a tornado's 200-mph-plus winds.
Brown recalled a young woman holding a baby in a blanket who walked up to him. She didn't know where she was. "She said she had to get to Hackleburg, but didn't know why."
Close to six months later, many storm victims are just now getting their lives in enough order to confront their feelings, mental health officials say. And in some ways, the passage of time can create new emotional burdens, as tornado victims begin to receive less support and concern from people who weren't directly affected by the storms.
"Everyone else carries on with their lives," said Dr. Timothy Stone, the medical director of the Department of Mental Health. "That can be very difficult to handle."
Even under the best of circumstances, disaster victims can expect to experience emotional turmoil. They may struggle with varying degrees of sadness, grief and anxiety, often "triggered" by events that serve as reminders -- anniversary dates, holidays, thunderstorms.
One recent Wednesday morning, as Kay and David Spanick sat at their kitchen table recounting the horrors of April 27, the sudden wail of a siren stopped them cold. They looked at each other, both seeming to freeze in fear.
Then, Kay Spanick exhaled. "First Wednesday morning of the month. Tornado siren test," she said quietly. "There is no storm coming."
For children who went through the storms, anxiety is a common problem, reflected in fear of bad weather, nightmares and worry whether it will happen again.
Pam Burrell of Tuscaloosa said her 9-year-old daughter, Sha'Kayla Stallworth, has had trouble going to sleep since the tornado and is easily frightened. After one particular thunderclap, Sha'Kayla buried her head in her mother's chest "and just went to screaming and hollering," Burrell said.
"It really affected her," she said of the tornado, which destroyed their home as they huddled in the hallway. "She's really traumatized."
Don Collier in Hackleburg recalled how his 8-year-old grandson, Gage Anglin, wouldn't take off his shoes when he went to bed because he wanted to be ready "if the house blows away." The boy had survived April 27 in a safe room with his family as a tornado destroyed their house in Marion County.
Project Rebound says one way to help children is to empower them, by giving them information about what to do in emergencies. The program's counselors offer a "disaster preparedness" coloring book that tells children what to do in various weather situations and encourages them to prepare emergency kits.
For children and adults alike, knowing when a reaction is normal and when to seek professional help is crucial. Talking to friends, family or trained therapists is beneficial.
Project Rebound counselors provide information about resources and services available to storm victims, but they say listening is probably the most important part of their jobs. But even now, some people are "not ready to talk," said Martell Hall, a Project Rebound team leader in Concord.
Hurd understands. "I haven't come to the place where we can talk about the happy times we had with her," Hurd said of her mother, Bessie Brewster.
Love, who will rebuild his house across from Brewster's lot, notices that many residents in the Pratt City neighborhood don't want to talk about what happened.
"It's in their minds but they don't know what to do or say right now," said Love, the vice president of the Pratt City neighborhood association.
Some people are reluctant to talk about their problems in coping because they see a stigma to mental illness or even because they feel guilty.
Mental health officials say some are ashamed to grieve the loss of material things when others lost loved ones. Some have voiced such sentiments in calls to the Project Rebound call center.
"They'll say, 'I can't believe I feel this way. I should be grateful,'" said Lisa Turley, the program's director.
Indeed, Kay Spanick is overwhelmingly thankful that she survived the tornado along with her husband and 86-year-old father, Nathaniel Cremer. But when Project Rebound counselors knocked on her door out of the blue earlier this month, they found her tearful and eager to talk.
Some of her grief, admittedly, is about "just things." Then again, many of the belongings she lost -- such as family photos, Christmas ornaments and her grandmother's cooking gadgets -- can't be replaced.
Her sense of loss goes far beyond that, though. Because neither the Spanicks nor many of their neighbors are rebuilding, she lost a community she adored. And as the family was uprooted and making its way through temporary living arrangements before buying a new home, her father's health declined. He suffered a stroke in early June.
"I want my daddy back the way he was," she said.
Talking about it helps, but Spanick said she sometimes feels she shouldn't continue to burden those closest to her. "I know our friends are tired of hearing about it, and our family is, too," she said. "I'm tired of it."
Helen Jackson, 74, of Shoal Creek Valley, puts her faith in God to help in healing, but also believes in counseling. She is a retired pastor's wife and active volunteer in the small St. Clair County community, which lost 15 people to the tornadoes. "Some don't want to talk about it," said Jackson. "But I'm a firm believer that you should talk about it."
Counseling helped her get through several tragedies, including the death of her grandson, A.J. Jackson, one of nine people killed when a tornado hit Enterprise High School in 2007.
She advises victims to make something positive out of a disaster by volunteering to help other victims. "One of the best ways of overcoming devastation in your life, you give yourself away to help others," Jackson said.
Vance, the president of the Alabama Psychological Association, said one therapist working in a chronic pain clinic noticed positive therapeutic results for patients who became active in tornado relief efforts.
For Hurd, time has been the best healer, along with strong support from family and church, and she's finding positive ways to look at the world. She's starting to realize that her community as a whole is suffering and not just her.
She and her sister, Stephanie Anderson, now talk to each more often, rather than keeping up with each other's lives through their mother.
"We re-linked the chain, I guess, without the other person in it. It's the little things, the simple things" that they now appreciate even more.
It's from the little things, though, that grief can erupt. Little things such as a fistful of daffodils.
Driving recently near her former homeplace, Kay Spanick remembered a patch of daffodils the family discovered soon after they moved in -- a plentiful patch that grew every January, brightening the winter landscape. She remembered her young son bringing her a fistful of them 25 years ago, and she was struck by what she had lost because of the move.
"It just hit me right in the head: I wasn't going to have my daffodils," she said.
She wept so hard she had to pull over.
Experts say tears are part of healing process, and so does Polly Hilton, a 94-year-old tornado victim from McDonald Chapel. "You take your time to cry," she said. "That's the reason God gave us tears, to cleanse us up."