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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amanda, is hysterical "good" or "bad"?....i never know...some people don't understand me....what a drag it is getting old....ta coin a old Stone's song!
andy,booneville ms. (Sent May 21, 2006 11:02:30 PM)
I want to write just to let you know that you are not forgotten. I think of you everyday and pray for you everyday. I watched in horror as the government dropped the ball at the time of the disaster and sat at this computer and wept for all the victims of katrina. I confess that in the beginning my horror was at the chaos in NO, but soon I saw that MS had been hard hit as well. I wanted to leave immediately and come and volunteer but just as quickly realized that in the aftermath I would have been more a liability than a help. I sometimes forget that I am in this wheelchair and am no longer able to cut trees, clean and haul debris, etc. But, I haven't forgotten and I continue to pray for you. I understand PTSD and have suffered from it for years and it can get better. Mine resulted from abuse and with time and talking it is better. I also understand in a VERY SMALL way the feelings of loss and devastation. When I was watching the news reports from Katrina I thought of the T-shirt I have put away that says "I survived the Flood of '93". My family and I were very lucky--our basement flooded and we lost the hot water heater and the furnace... We were in an evacuated area and had no gas to cook with and the whole area lost water because the water company flooded. Across the river from us, our neighbors (including my sister-in-law) lost everything...houses flooded with all their worldly possessions. My biggest disappointment was the loss of our garden--we were in our 3rd year of growing vegetables for sale, the flood took it all (just as we were becoming known and established)and the money from the AG dept. didn't even cover the cost of our seeds and plants much less our lost profit...it put us out of business. So, I say, in a small way I can understand how you feel. And I want you to know YOU ARE NOT FORGOTTEN!
Jean Burgess (Sent May 22, 2006 4:33:27 AM)
I was one of the lucky ones. Although I lived directly on the Beach in Gulfport and my entire apartment building along with 98% of my possessions was completely destroyed, I was able to relocate to Jackson, MS where the bulk of my family lives. Because I worked from my home, I never missed a paycheck. I signed a new lease two days after the Storm. Although I have been blessed, I will never be the same. I still have nightmares and not a day goes by without thinking of those less fortunate. I not only lost 'things', I lost connections to the past, a way of life, and friends I miss every day. The help and compassion so generously shared from the rest of the Nation inspires me to heal, but I shall never forget.
Walter Johnson, Ridgeland, MS (Sent May 23, 2006 1:31:59 PM)
Amanda,
Thank you for letting us know you care. My son is doing better now and we are rebuilding our home. I have thought about counseling and I know it is a good idea. Thanks to everyone for their prayers. I know time will make this better. Let's hope the 2006 season will be mild. Maybe we can all go to Connecticut and stat with Theodore.
Kelly, Mobile, AL (Sent May 23, 2006 3:00:19 PM)
I take great umbrage at those who think we who lost our homes, family, friends, and in my case my marraige are suffering mentally because we are lacking in our relationship with God. My relationship with God has never been stronger and I thank him for sending all the mental health assistance to help us deal with this crisis. I have learned over the years that God and most importantly the people God sends to us whether it be a minister, priest, therapist, family, friend, or one of the many outstanding individuals from across this great nation who come to help is what matters most.
Otto Knudsen, New Orleans, LA (Sent May 25, 2006 6:39:29 AM)
Good Idea Kelly,....Redneck Invasion on Theo...I know he'll be so proud to have us....i'll cook chittlin's in his house!!!....maybe a cabbage too
andy,ms (Sent May 25, 2006 9:47:51 AM)
Andy,
don't forget the grits.
I don't know about everyone else, but I appreciate your sense of humor. What part of Mississippi are you from?
Kelly, Mobile, AL (Sent May 25, 2006 10:28:25 AM)
Booneville, Kelly...north of Tupelo...south of Corinth.....you ever ate a chittlin'?....pretty good....but STINKY when cookin'......COMIN' ta get ya Theo.....dammit!....pickup trucks, beer cans, peeing in da yard....Theo will be SOOO proud he invited us
andy,booneville ms. (Sent May 25, 2006 11:30:46 PM)
GOD HELP US ALL!
I'm a civil servant and I'm finding it hard just thinking about the upcoming H season. I have planned an extended vacation to try to remove myself from what maybe.Our environment will never be the same.Co-workers, family and friends. Everyone has been effected no matter where you lay your head.the traffic,the lines,the trash,the construction,Oh GOD the cost to say the least.Everyone has been affected in one way or another.the humality that people have extended is indescribible.Every member of my family parents,bothers,sister, aunts,uncles,cousins friends have lost their homes and Life as we knew it.
jazzy j,Slidell La (Sent May 31, 2006 1:05:04 PM)
I just want to say that no one can truly appreciate what you all have been through. Your lives have both literally and figuratively been turned upside down. In early May this year our church group went down to help in New Orleans and while pictures in the news have depicted great devastation, I didn't fully appreciate until I saw it for myself. I truly could not believe what I was seeing 9 months after Katrina. I cannot ever imagine going through what you all did. When I came home, I looked at my family and home and tried to imagine what it would be like to endure the utter devastation and still could not wrap my mind around the magnitude. The one thing it did impress upon me is to appreciate what you have-family, friends and a home. While I did feel like we were helping those families whose homes we worked on, I knew from what I saw, our work was only a pin head sized effort compared to all the help and work that was still needed. Having had conversations with some of the families whose homes we worked on as well as neighbors we met who were working on their homes, I still wanted to really understand what happened and the impact to our fellow Americans. I am reading a book The Great Deluge by Douglas Brinkley which is very well written and includes first hand accounts from those directly affected as well as a tribute to those who really jumped in and helped during the catastrophe. I highly recommend this to anyone who is "tired" of hearing about Katrina. There should be no "tired" comments coming from anyone and while we are miles away up north, it is not acceptable to forget what happened and we really need to continue to do whatever we can to help. Our church group is hoping to go down again in the fall which is when we were advised to do so, but please know to all down south that you continue to be in our thoughts and prayers and you are not forgotten.
Beth, Pennsylvania (Sent May 31, 2006 6:01:14 PM)
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