PORT-AU-PRINCE, Haiti – The battered bodies may be mending, but the minds still struggle.

As many as one in five Haiti earthquake victims have suffered trauma so great with the multiple shock of lost homes, jobs and loved ones that they won’t be able to cope without professional help, doctors say.

In a country where mental health services barely existed before the quake, building the required support is a huge challenge. The symptoms can’t be diagnosed by stethoscopes, blood tests and X-rays, and can take time to surface after the initial shock of the disaster.

“It’s not about immediate psychological counseling,” said Dr. Lynne Jones, a senior medical adviser for the International Medical Corps. “It’s about assisting mourning. People cannot recover if their social needs are not met.”

Jones, a veteran of natural disasters and wars from Bosnia to Indonesia, is teaching front-line doctors how to identify “disabling fear” and, quite literally, hold people’s hands and listen.

Hugo Emmanuel is one of the untold thousands who doctors say have lost the ability to cope.

“Stay away! I don’t want you to touch me,” he barks at an American nurse who only wants to wash his shattered lower leg.

Emmanuel, 49, is an educated man of spindly limbs but voluble spirit who lies on a mattress on the floor of the kitchenette in the Espoir Hospital in the capital’s eastern hills.

He tore the cast off his leg last week. For days after he arrived two weeks ago, he only let the hospital director feed him; he claimed everyone else was trying to poison him.

Emmanuel, who lies in his underwear beneath a white sheet and towel, is at least getting personal attention. Most of those diagnosed with severe trauma are treated as outpatients because there is no room for them in the country’s 91 functioning hospitals.

“The doctors in such situations tend only to hand out tranquilizers,” Jones said. “We don’t want them to do that.”

Tranquilizers are hardly sufficient for earthquake victims like Emmanuel, who lost his house, both of his parents and his job.

“I was in a coma-type situation,” Emmanuel says in graceful French that reflects his experience as a Quisqueya University researcher. “Every time I think about losing my family, I lose my mind.”

He quickly corrects himself. “I’m not crazy. I just think I’m suffering from psychological shock.”

The hospital’s director, Dr. Gusse Darline, said Emmanuel is sporadically amnesiac. But that’s only part of his problem.

“He didn’t want to come into the hospital for treatment. We had to drag him in,” she said.

Darline says she doesn’t know what to do with Emmanuel once his leg heals.

Port-au-Prince’s only psychiatric hospital is barely functioning. All but 11 of its more than 100 pre-quake patients were removed by relatives who feared the building would collapse in another quake, said Dr. Peter Hughes, an Irish psychiatrist who arrived late last week and is studying what to do.