BAY ST. LOUIS, Miss. – Like the swirling images of a nascent hurricane on a radar screen, the emotional and psychological fallout from Katrina is gathering across the region. But just as weather forecasters have difficulty saying where a storm will land and how much damage it will do, therapists say the long-term mental-health effects of last year’s killer storm also are hard to predict.
“The fact is that we don’t know a lot about the actual incidence of Post Traumatic Stress Disorder (PTSD) and depression associated with Katrina,” says Dr. Raymond Crowel, vice president for Mental Health and Substance Abuse Services at the National Mental Health Association. “It’s probably useful to think of Katrina as a slow motion disaster that has continued to unfold for people.”
But eight months after Katrina inflicted a $100 billion hit on the Gulf Coast and killed more than 1,300 people, Crowel and others say some things are clear:
--Hundreds of thousands of hurricane survivors will have serious mental health issues and a large percentage of them want some kind of help dealing with psychological issues.
--Trauma from the storm and living conditions that followed have irritated and fractured relationships throughout the community.
--Substance abuse -- from cigarettes to hard drugs -- appears to be increasing.
--One set of numbers indicates a dramatic increase in suicide rates in the storm area.
--There is a special concern for the trauma suffered by children during the disaster.
Dr. Anthony Ng, who heads the American Psychiatric Association’s Committee on Psychiatric Dimensions of Disasters, spent a week in Waveland soon after the storm hit while serving on a federal team sent to assess mental health needs in the Katrina area.
Extent of trauma difficult to quantify
“We are seeing an increased rate of some of these psychiatric disorders, PTSD, depression, substance abuse,” Ng says eight months later, while agreeing with Crowel that the issues are hard to quantify. “There are no numbers because people are still scattered everywhere.”
Crowel says the federal Substance Abuse and Mental Health Services Administration has taken a stab at the big statistical picture and estimates that 300,000 to 500,000 people “are going to have some significant mental health problems from Katrina.”
He says that estimate is based on studies conducted after Hurricane Andrew hit south Florida in 1992 that found that up to 36 percent of adults met criteria for PTSD, 30 percent for depression and 11 percent for general anxiety. Up to 29 percent of children showed severe PTSD symptoms, a number that leaped to 56 percent in the hardest hit areas.
Andrew was the most destructive hurricane in U.S. history at that time, but it was far less deadly -- 23 lives -- and far less costly -- $27 billion -- than Katrina proved to be 13 years later. Initial assessments from the Centers for Disease Control are that nearly half of the people who experienced Katrina said they needed mental health care soon after the storm and 70 percent said they would make use of mental health services if they were available, Crowel says.
A spike in suicide
Most chilling, he adds, figures from the New Orleans area indicate that “suicides in the four months after Katrina were double the national average. Obviously, there’s some distress.”
Mental health practitioners in the hurricane zone say their work with Katrina survivors backs up the general views offered by Crowel and Ng, and they are beginning to see some delayed stress reactions. Whether or not there will be many cases of full-blown PTSD remains to be seen.
“It starts coming in through the back door, more or less,” counselor Lynn Holland says in her home-office on Webster Street in Bay St. Louis. Now that lives are settling down and people are back in more normal routines, they have time and space to be more affected by “the guilt … the trauma … that leads to this whole swirling inside.”
Bay St. Louis counselor Lynn Holland has seen a number of emotional and psychological reactions to Katrina. (Jim Seida / MSNBC.com)
“The symptoms of PTSD just make you feel like you’re crazy so you really don’t want to talk about it,” she says, adding that clients with whom she ends up talking about storm issues do not arrive saying they want to talk about Katrina.
“I don’t know that people know how to identify what the storm is doing, nor do I. I know that it depresses me to come down here,” from Jackson, where she spends a lot of time now. “It’s heavy when I come down here and I’m happy when I leave and I never thought I’d say that.
“A lot of people just drink, just use drugs, just use sex to try and soothe that pain. Some people run, do the socially appropriate thing of running marathons. If it’s not a peaceful place in here,” she says, sweeping the back of her hand across her chest, “you try to find it out there.”
Another Bay St. Louis therapist, Dr. Angel Carpenter, says the psychological issues she has seen since Katrina are touching but not surprising. She has been working with many clients on relationship problems, anger management and stress.
Carpenter and Holland agree that Katrina likely didn’t cause friendships, marriages and parent-child relationships to founder, but clearly compounded those issues where they existed. “They’ve lost their homes and they’re living in little tiny FEMA trailers,” Carpenter says, so it’s no wonder that tempers flare.
“All of a sudden, I think it just shakes the foundation,” says Holland. “If the problem’s not already there, I wouldn’t think this would cause it, but it would certainly exacerbate it.”
Carpenter has seen a fair number of clients “who weren’t really having any problems before.” Since the storm, they are experiencing “sleep disorders … not getting any joy out of anything … just feeling numb to it all … a lot of helplessness and a lot of hopelessness.” For many, the process is similar to grieving.
And, like Holland, she is seeing plenty of delayed stress. “Right after the storm, it was just a kind of survival mode kicking in” and emotions “got put on a back burner and people thought they were dealing with it really well.
'A point where they couldn't handle it'
“Suddenly, they reached a point where they couldn’t handle it. I’m seeing that probably in the last few weeks.”
Along with the emerging reactions to stress, Carpenter is seeing more “self-medicating” behavior. Some of her clients who were reformed smokers have started again and she sees “a lot more alcohol problems.”
While Carpenter and Holland don’t work directly with young children, they have seen and heard from other therapists that clinginess and fears about being alone or leaving the house have increased among kids.
In making a plea to pay special attention to the mental health needs of Katrina’s youngest survivors, the group Voices For America’s Children noted that “the impact this disaster has on children’s mental health is only beginning to surface and may linger for months and years to come. …Without adequately investing in the mental health of children affected by Katrina, we can never fully expect to rebuild the impacted Gulf States.”
Therapists say they’re finding that standard techniques of talk therapy and some cognitive-behavioral models, in which thoughts are connected to unwanted behaviors in an attempt to change them, are working best with Katrina clients. For some, anti-depressant medications and other drugs have helped.
“What I have seen in Bay St. Louis and Waveland is everyone talking about their experiences and I think that’s going to help a lot,” says Holland.
The passage of time also will help. “Human beings and children in particular are very resilient and will tend toward health over time,” says Crowel. “That will be true for the majority of people who were exposed to Katrina.”
Visible change, hidden pain
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Of course, having much of the country weigh in on how we are ripping them off in order to rebuild our mansions probably isn't helping...
Q., BSL (Sent Apr 30, 2006 11:47:27 PM)
as things get better people will too....some will never heal emotionly ...most will...what is expected after a disaster of this magnitude?....i'll bet school didn't train any therapist for this
andy,ms (Sent May 1, 2006 9:22:36 AM)
This past Saturday morning my 10 year old daughter became very distraught when she awoke in our FEMA trailer alone. I had just stepped outside to take the trash out! She was in a heap in the bed, tears streaming down her cheeks.
She berated me for not being in the trailer when she woke up. I listened, then crawled into the bed and hugged her. I tried to reassure her that I would not go off and leave her alone in the trailer, ever! While she did calm down, she also was adamant that I not EVER do that again.
Saturday night found her anxious about the storms that were pounding parts of Louisiana and headed our way. She was concerned, rightfully so, about our safety in the trailer. The wind had blown all day and continued into the night. Strong gusts rocked the trailer. Neither of us got much sleep that night. Every hour I was up checking the weather channel for updates to the storm.
The rain was certainly welcome. We could have done without the wind.
My daughter was brave throughout Hurricane Katrina. She kept her head and never panicked. She has taken everything in stride and kept a smile on her face. She is a survivor! But the ghosts of Katrina, that have haunted many of us, are now surfacing for her.
She needed a break from our usual weekend routine of working on our gutted home and going to the laundrymat. So, on Sunday we went out to lunch and came back to our trailer and played Monopoly.
For a few hours, we were real estate tycoons, wheeling and dealing our way all the way to the Boardwalk. In the end, she was the bigger tycoon.
It was a good game!
Sometimes, I forget that she is just ten. She is wise beyond her years, in so many ways. But she is still ten and while she has hidden it well until now, her heart was broken by Katrina.
Kimberly L, Waveland,MS (Sent May 1, 2006 10:00:09 AM)
Thank God the system is trying to get a handle on the mental health angle of Katrina fallout. Espcially the children as they say, I have had PTSD since I was 12(gang rape),and my life has been much harder than need be. Hopefully, this will not be the case with these people, if they are able to recieve help.
bsue, Little Rock, Ark. (Sent May 1, 2006 10:48:47 AM)
The psyche fallout will be there for years, much like 9/11 has and will continue to be for the rest of us. It is yet another reminder that this nation can't forget our southerly brothers and sisters and must do whatever we can to support them.
Stephanie Umbro, Maine (Sent May 1, 2006 11:43:42 AM)
This is why I feel some people across the nation are heartless when they say they are tired of hearing about Katrina and related stories. You can't imagine how people are suffering until you walk in their shoes.
ann, covington, la (Sent May 1, 2006 1:56:31 PM)
I would have never guessed how much THIS storm has mentally affected all of us on the Coast. From the children (who have had very little time to mull over their situations - schools in Pascagoula, doubled up on their school hours to make up for lost days, have had no councelling to the kids) to the elderly (what can you say) and the people that are working/struggling to keep it all going from day to day. We have lost our possessions, family members, homes, and we are expected to "keep up" our chins in face of it all...it ain't easy, but I guess we'll somehow manage...I hope no one in this country ever has to experience this in my life time again...
SLoper, Pascagoula, MS (Sent May 1, 2006 2:36:45 PM)
When I evacuated to Dallas from New Orleans, I was incredibly depressed. I received counseling there for the sleepless nights and dreams of water. However, I've since moved back to New Orleans and my depression is worse. It has become difficult to find crisis counseling here, so I'm going back to Dallas where I can get the help I need.
Janice Brown, New Orleans (Sent May 1, 2006 3:03:18 PM)
I'm a Katrina evacuee living in the Tallahassee, Florida area. I have to commute almost 50 miles to work each way daily. I have a place to live and a job, and I thought I was ok, but the other day, I was playing a cd and heard a song by Frankie Beverly and Maze. I suddenly remembered dancing to that song at the Essence Festival a few years ago and thought about all the fun I had in New Orleans and I suddenly broke down in huge, heaving sobs. I hadn't cried much since Katrina, but that day, I had to pull over and I haven't cried so hard in ages. The crushing pain just was squeezing the breath out of me and I couldn't stop crying. I missed being in New Orleans, I missed my friends, I missed the good times I used to have and I knew that all that was gone forever. I can't describe the pain I felt. I feel isolated from mostly everyone and I hurt because sometimes I feel most people have forgotten us and all that we went through. I hate to go home to the house I live in now, I feel like my spouse is no longer my spouse, but just somebody I live with. I am out of place, out of time, out of everything. I went to a counselor, but he wanted to talk about my marriage which I already know is over. I wanted to talk about how I felt since Katrina and he kind of glossed over that, so I didn't go back, but I know I need to do some therapy cause I am in such pain now. I really hope the people in America don't forget us all and don't think we are all loafers and thieves or whatever. Most of us are just hard working people who lived in a great place that no longer exists. We are trying to live in this new life but we weren't ready for this and we are having a hard time now. Please understand how we feel - even though most of us don't understand it ourselves.
Brenda (Sent May 1, 2006 3:10:43 PM)
Thank you MSNBC, and NBC (Brian Williams) for continuing to cover this story. It is unfolding. This blog has helped me realize that my feelings too are validated. My children also melted down a couple of nights ago when we were surrounded by tornadic weather. We too do not know whether to stay or go. We have been a sort of an outpost for others, though most folks up and down our block flooded. (during Rita too.) We did not, but only by 1 inch. We still have 'Lakeview Folks" living with us. They were denied any kind of rental assistance. They are rebuilding, day by day. It is difficult to live down here as it is different. I have all of the repect in the world for the hardy souls who are going into the city eveyday, trying to bring it back. I naively thought that in 6 months or so that we would be betting more or less back to 'normal', but Pre-K is just that, a dream for many. The idea of another hurrican season looming is traumatizing. All of us, especially parents, will have to swallow our own fears to be strong for our kids.
Mary Kay,Madisonville, LA (Sent May 1, 2006 4:02:00 PM)
I have numerous times stated that some people who want to help can help by giving people here vacations. YES - we need them. I myself have done a few things and I actually hear myself laugh and am amazed at the sound. Please, any one out there that can assit a family in a get away, a vacation, please do so. It might be avoiding reality but laughing is good for the soul.
A good vacation trip will be something positive that a family can remember during these times. A picture of the family with Mickey Mouse hanging on the FEMA trailer wall will surely bring a smile.
BettySue, Waveland (Sent May 1, 2006 4:13:35 PM)
Dear Brenda,
My heart goes out to you! I understand how you feel about New Orleans. Probably the only people who really understand how special that area is, are the ones who were born and raised in South Louisiana like I was. I do understand how you feel out of place and out of time, like you are living in a time warp. From personal experience, I know what it is like to lose everything and feel totally lost. It takes a long time to get over it, if you ever do. The best thing that can help you is time, just take one step at a time and one day at a time. The stable things of life, job, every day routine, is what helps you get through it. And for myself, a very strong faith in God. God bless you and please know someone does care.
Ann, Greensboro, NC (Sent May 1, 2006 6:17:23 PM)
One thing that we on the coast are going to have to get accustomed to is that we will never be "normal" again. Normal disappeared on Aug. 29th 2005 and will never return. Someday we will have something else that we call "normal", but that is years away ... and there will be many of us that will never see "normal" again. After Camille we didn't "return to normal", we had to refigure and become something else down here, which took years. Now we face it again ... and so many things that were "normal" are now gone, never to return ... the old homes, the trees, the shops that will never be rebuilt ... those were "normal". We are rebuilding and going foward, but this will only be normal for our children and grandchildren. And that is a psychic blow that we down here will be receiving on a daily basis for a long time to come. Yes, most of us will "weather the storm", but each and every one of us will, at one time or another even years from now, will think of "what was" and shed tears over it.
Lanie, MS Gulf Coast (Sent May 1, 2006 6:35:09 PM)
BettySue ya'll are welcome at my house anytime...shoot we will go to the Tenn. river catch some fish and have a hoodah...get your vacation....ya'll come!
andy,booneville ms. (Sent May 1, 2006 8:44:09 PM)
I can't sleep. I'm always tired. And we're still on "the list" waiting for the carpenter to ever get to our house. Every day we have to wait, the cost of building materials goes up. Our insurance company says they have given us what our estimates have said we need to fix our roof, but when we add up the checks, they don't add up to that. So, it's back to the insurance office. Again. It's probably just as well the carpenter hasn't gotten to us, because we wouldn't be ready anyway. And hurricane season starts in a month.
Jane, Southern Mississippi (Sent May 2, 2006 2:07:44 AM)
My family and I lived in Metairie, LA prior to Katrina. We have been all around, from New Orleans/Metairie to Kentucky, back to LA (living in a hotel room for four months, trying to find permanent housing. There is no place to live unless you move away. I was born and raised in New Orleans, and my roots are in that city/state. I don't want to move to a different culture. I love my home, New Orleans. My daughter and grandson and I have been traveling together as my daughter is disabled. We had FEMA trailers in Covington, LA, but due to plumbing problems we had to vacate the trailers. I have been suffering from depression since the storm. For a long while I was afraid to leave the hotel/trailer/car, or whatever we were calling home since 8/28/05. I feel like a gypsy, having no roots. I feel sad and hopeless. After talking with FEMA representatives (who have been very kind) it appears they still can't financially help me. I had a good job prior to the storn, and now I can hardly maintain a job. I was unable to work for months after the storn because I was afraid to leave and drive anywhere, much less hold down a job. I could not think, I didn't really understand what was wrong with me. I felt like I was losing my mind. I am taking an anti-depressant now and a counselor, thank God for that.
When I hear people, who were not effected by the storm say "they need to get over this". It makes me very upset because it's not over for us. We still have no place to live. My 15 year old grandson has been to four schools this year. We are staying in a dirty old nasty trailer temporarily, in the woods outside of Hammond, LA.I don't know if this message will be put on the web, but it has made me feel a little better, just expressing myself. Please pray for our people from New Orleans and throughout the Gulf Coast. This devastating "Katrina" has ruined many lives.
Gayle Ellis, Springfield, LA (Sent May 2, 2006 11:25:41 AM)
I have family in the Ocean Springs area. I am deeply and sincerely sorrowful about all that the coast has had to endure since last August 29. My heartfelt respect and concern go out to all survivors of this horrible hurricane, be they current residents of the Gulf Coast or folks who've moved on. Nothing has been easy. My prayers go with all of you.
Janelle Meehan, Brooklyn, New York (Sent May 2, 2006 12:10:02 PM)
Gayle please keep the chin up. Myself, I am better now but stories like yours' bring back the pain (I do thank God I do not carry it at every moment now.) That is another example of how we will be affected forever. The pain of knowing how you feel carries among us all.
What you feel is very very "normal" for the situation. Know that you are normal, that is important. Be thankful you are normal. All I can say to you (because I know hard to believe anything) is that things will fall in place for you. For some reason we all have to do the freaken dance from hell to get to a good spot. Your good spot is waiting, know that, know you will get there!
God bless you - keep talking, keep venting, so many don't understand and won't listen. We here who know will listen and we will support you. Remember that too!!!
To the rest of you, don't this woman sound like she needs a trip to Disney World, or the mountains, to find a smile for herself, her family? Even for a day? A moment?
BettySue, Waveland (Sent May 2, 2006 12:31:17 PM)
I also thought I was going to have a nervous breakdown Sat night when the weather blew through Bay ST Louis. My Mother and I stayed for Katrina and wound up on the roof of our house for 5 hours in 150+ winds...Give you any idea about how I felt on Sat pm and into Sun am. No sleep til 3 am when weather finally settled down. I had no idea how badly I have been affected by staying through Katrina. My Mother would not leave and as I have told people I may need therapy for staying in a storm but I don't need it for not leaving my Mother who would not have gotten out of the house by herself... I still have her and that is the most improtant. Next time we have another gully washer or Hurricane I think I am heading out. Stay Strong folks, and get aid and assistance where you can.
Maddog45 (Sent May 2, 2006 1:39:22 PM)
I wonder about how those volunteering in the area have been affected also. We have friends who have given up their apartments and jobs and are there working "for the duration". We also know volunteers who have been there to work, came back home, and are deeply upset that people back home seem to have forgotten what still needs to be done along the Gulf Coast. We keep all the people living and working there in the Deep South in our prayers every day. Y'all are such incredible people!
Hoosiers who care (Sent May 2, 2006 3:05:47 PM)
When you are down, and oh your soul so weary. When trouble comes, and your heart burden be. Still He is strong, and waiting in the shadows for you to come and sit away while with He. He'll raise you up so you can climb the mountains. He'll raise you up to walk on stormy seas. He'll raise you up to more than you thought you'd be.
Lynn, Kansas City, MO (Sent May 2, 2006 4:41:50 PM)
Gayle Ellis, express yourself more....and we will listen...cry...and pray for you and yours....it'll get better{can't get no damn worse}
andy,ms (Sent May 2, 2006 6:16:16 PM)
We all know that we are going to have friends move on, we will have changes in jobs and homes. But what we didn't expect is how much and how quickly things would change in just a few hours time. Not only were many homes and businesses completely gone that we had come to love and depend on but the people ---- in a matter of three weeks six of my long time good friends had to move as they were hit worse than me. Now I find myself not wanting to replace anything I lost and what is scaring me so badly, I don't want to make new friends because I know I'll just lose them too.
shena, pass christian (Sent May 2, 2006 6:43:28 PM)
I am a former resident of New Orleans. I left 10 years ago, but my heart is still there. I want to share something that would make a huge difference to people surviving Katrina's aftermath. I recently learned a technique that is very effective for trauma, stress, anxiety, PTSD, physical pain, etc. It is very quick and easy to learn. I consider myself a newbie to it, and have already successfully healed 47 people including myself. It is called Emotional Freedom Techniques (EFT). If you go to the website www.emofree.com, you can download the manual for free. You will be amazed at the results!
David Shear (Sent May 3, 2006 10:49:59 AM)
Unfortunately, my job requires travel. This was good for evac purposes, but that's about it. I have two little kids, and I find it harder and harder to hop on that plane and go away from them. I also find that I am not as outgoing as I used to be. I have people asking me all the time, you ok? Well...no, I'm not.
B. Francis, New Orleans, LA (Sent May 3, 2006 11:46:15 AM)
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