Shattered Lives
Victims of Katrina lost everything, especially their sense of security and well-being. Can they bounce back?
Long after some semblance of order is restored to the devastated neighborhoods and communities in the Gulf Coast, those who survived Katrina will still have to contend with the emotional effects of their shattered lives. It is not as if the nation hasn't heard it all before. The psychological lessons learned from other disasters--Oklahoma City, 9/11, plane crashes, and tsunamis--are clear.
After a disaster, about 25 percent of the affected population may experience clinically significant mental health needs, while an additional 10 to 20 percent suffer from more transient needs, says Charles Curie, administrator of the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services. With 1.2 million people affected by the disaster, a conservative estimate is that a quarter of a million people will have some serious mental health needs, such as depression, severe anxiety, or post-traumatic stress disorder.
But Katrina may provide new lessons in the grim textbook of disaster psychiatry. The almost complete eradication of neighborhoods and communities, the separation of families, the tragic destruction of an entire city, the continued danger for many victims for days after the winds died down, the loss of livelihoods, and the stuttering response of the government are hallmarks of this disaster. "The more of these factors that come into play, the greater the emotional impact of the disaster," says Robert Okin, chief of psychiatry at San Francisco General Hospital.
Mastery. The key for preventing, or at least mitigating, some of the long-term mental health consequences of the cataclysm is to limit these elements. "One of the really important factors in traumatic situations is the amount of control that one has during the event," says Steven Southwick, a psychiatrist with the National Center for Post-Traumatic Stress Disorder. "When people talk about stress-induced depression, they are talking about an uncontrollable situation, and one very important aspect for any kind of resilience and recovery for people in a stressful situation is to find some way to master some part of it."
But how can one find mastery in a force of nature so powerful? Henry Necaise of St. Martin, Miss., took refuge with his wife, two sons, a nephew and his son, and two Chihuahuas in the local school where he works as the maintenance man. Even though he figured the school was 60 feet above sea level, he had a plan if the water surged: Head for higher ground. When the water reached the floor of the school, he tied his sons to his body, picked up the dogs in a crate, and he and his family waded in waist-high water to a nearby hill.
Unlike countless others, Necaise was able to do something to improve his fate. But for those in the New Orleans Superdome and the convention center, mastery was impossible. There was no place else to go. In the city, rescue workers dodged bullets fired by the very victims they were trying to save. "People were enraged by their fate, they were enraged by the government's response, and they lashed out," says Jon Allen, a psychologist with the Menninger Clinic in Houston.
And images of the chaos were seen by millions of others, some of whom were grappling with their own reactions and agonies. Elizabeth Robison, a 37-year-old mother of two girls, grew up in New Orleans. Her house in Baton Rouge became a shelter for nine family members and friends. One evening, as they sat outside eating the red beans and rice her husband had prepared on a camp stove--there was no power--they all began to relax. Then came the news over the radio that a policeman had been shot in New Orleans and that there were looters and dead bodies in the Superdome. "No one wanted to go to sleep that night," she recalls. "Our world as we knew it was just melting away, and every day it seemed to get worse."
The dual horrors--one from nature and the other man made--conspired to deprive rescue workers and evacuees alike of that crucial component of resilience, what psychologists call "active coping." A number of studies have demonstrated that psychological outcomes are vastly improved when victims are able to do something involving their treatment, rather than being passive recipients of services.
Dwelling on circumstances while being treated like a commodity triggers another psychological mechanism known as "learned helplessness," in which negative, uncontrollable external events create a profound and debilitating sense of fatalism. Victims of child abuse and other traumas often suffer learned helplessness, which can in turn cause serious mental disorders, including anxiety and depression. "The problem is that what people most need is what they don't have," says Allen. "And that is a sense of security."
The sense of security so elusive in the chaos of New Orleans was offered in Houston. "We saw people with acute stress reactions, with anxiety and depression, even people who were psychotic," says Stuart Yudofsky, chair of the department of psychiatry at Baylor College of Medicine in Houston. "People had lost everything and had very little confidence that things could be well organized because of all their frustrations in New Orleans. They were under enormous stress and pressure."
Some victims received immediate counseling, as just having the opportunity to talk about what they had gone through was valuable. A number of the evacuees suffered from serious mental illnesses like schizophrenia or bipolar disorder and had run out of their medicines, so physicians could prescribe them and get them stabilized. Others were former addicts, deprived of methadone. Responding to the physical needs of those who were there "all served to help reduce the stress," says Yudofsky. "When they first came in, they were dazed and overwhelmed, then in four or five days of relative stability, they began to look a bit happier, more confident."
Among the most vulnerable victims, of course, are the children. Some were separated from their families, while others witnessed the ordeals and despair of their parents. John Krystal, professor of psychiatry at Yale University School of Medicine, says that studies of children who had been emotionally abused or who had faced traumatic situations revealed that the major differences in outcomes were dependent on how much support they received later on. "Even if faced with horrible maltreatment, those who were more resilient experienced at some point a supportive environment," says Krystal.
What the long-term effects of this catastrophe will be, no one can tell. And yet, as desperate as the images were, and as psychologically damaging as the disaster may prove to be, the capacity for resilience among those who have lost everything is one of the greatest psychological gifts and mysteries. Research has shown that one form of active coping that is deeply connected to resilience is altruism. Anthony Ng, chair of the American Psychiatric Association's Committee on Psychiatric Dimensions of Disasters, visited Pearlington, Miss., last week, one of the hardest-hit locations in the storm's wake. Only 600 of the town's 1,700 residents remain. "A lot of folks here are really dependent on each other to begin with," Ng says. "Are we tapping into helping people help each other? That is our job right now."
Coping. The maximized community involvement may result, experts hope, in long-term psychological well-being for Katrina's victims. Another aspect of active coping entails turning victims into partners as recovery efforts are being shaped. "If instead of active participation, people are treated as supplicants for whom the government is doing a favor, if their futures are simply handed down to them from the top, their sense of powerlessness will be intensified," says Okin. "And so will their long-term painful responses to the hurricane."
While there have been abundant images of loss, there have been similarly abundant images of generosity. When families are reunited, when perfect strangers become intimates, when communities mobilize to help, psychological damage is minimized. As Rita bears down, the still-fresh lessons of Katrina serve as a reminder both of what not to do and what must be done. "You have to do what you always do during times like this," says Robison. "People will get through this by helping each other." Within that neighborly statement resides a profound psychological truth.
The survivors. Photographs by Kevin Horan for USN&WR
Vivien Monus (from left) is staying at a community center shelter in Long Beach, Miss. "I hope they'll find me a trailer."
Lavone Lollar (with two of her children) is sheltered at a church in Ocean Springs, Miss. "I just want to get out of here."
Dale Kirk also took refuge at the Ocean Springs church. He lost his wife during the storm. "I cried 'til I couldn't cry no more."
Phil Armstrong, who experienced Hurricane Camille, is living in a tent at the Long Beach shelter. "We lost everything--again."
Adam Walter (left) and Chris Murphy, two teenagers from Baltimore, are helping Ocean Springs, Miss., residents (Murphy's father owns a construction company) clean up debris.
This story appears in the October 3, 2005 print edition of U.S. News & World Report.