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Diane St. Denis, RN, of the American Red Cross’s Disaster Health Services, counsels New Orleans evacuee Alice Teeter at the Santa Clara Valley Chapter office in San Jose, Calif..
PHOTO BY YOUNG KIM
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The Storm
from Within
Meeting the mental health needs of Hurricane Katrina’s survivors.
by Carrie Farella, RN, MA
“It haunts me like a ghost,” says Nancy Johnson, a lifetime Louisiana native recalling the wrath of Hurricane Betsy, a Category 3 storm that pounded New Orleans in September of 1965. “These folks who survived Katrina? Even a breeze won’t sound the same to them ever again.”
And so people are learning.
While Katrina’s howling winds and torrential rain have passed, and water has drained out of the city like a clogged bathtub, those who struggled to stay alive are learning to cope with their own swirling emotions in the storm’s muddy aftermath.
The Katrina survivors “have experienced a superhuman amount of trauma, and they’re suffering a host of emotional problems,” says Carson Easley, RN, MS, director of nursing for the Mental Health and Mental Retardation Authority (MHMRA) of Texas’ Harris County. Her agency has waded through the mental anguish of some of the 225,000 evacuees forced to take refuge in the Lone Star State. Some came directly from the crippled Superdome and were placed into emergency shelters, hospitals, or alternative housing.
“Many truly believed they were sent to the Superdome to die,” Easley says. “And with dead bodies piling up around them, their fears were justified. We’re seeing the fallout of so much emotional pain.”
Easley describes two phases of trauma the Katrina evacuees are encountering. First, immediately after the hurricane, survivors showed an acute response. Feelings of shock, anger, and frustration are common as the evacuees try to assess their losses and search for loved ones. Their focus becomes survival, finding food, shelter, and clothing.
But just when people feel like they’re getting back to normal, they are likely to be flooded with strong emotions that affect their outlook and undermine their hope for the future.
Easley’s staff has seen countless cases of acute stress disorder, anxiety, and the beginnings of posttraumatic stress disorder. “They don’t have the same confidence and security they once had,” she says of the hurricane survivors. “And it begins to eat at them from the inside. Every time a storm hits, they’ll remember.”
The second stage surfaces after the shock has melted away and survivors must endure a storm of the mind. “They begin to truly comprehend the magnitude of their loss,” says Easley. “Their lives have been permanently changed, routines disrupted, and the rhythm of their old lives is gone.”
So many over the edge
“They’ll also be overwhelmed by loss of control,” predicts Marc Brown, RN, an MHMRA staff nurse who spent two and a half weeks at Houston’s Astrodome, triaging and counseling thousands of shattered souls. “There were mothers crying for their missing babies, wives and husbands learning their spouses were dead, someone always seemed to know someone who drowned. One poor man put his wife in a rescue boat ahead of himself only to watch the boat collide with debris and flip. His wife drowned.
“So many people were over the edge.”
For some, the trauma was just too much to bear. One middle-aged man lost his wife, child, and sister, and attempted suicide by choking himself with a belt. Brown counseled two teen boys who had both lost their families and were despondent and suicidal. “I’ll always remember those kids. The looks on their faces. The deep, deep pain,” says Brown. He got all three evacuees transferred to hospital-based psychiatric facilities for evaluation and treatment.
“I tried to talk a little, listen a lot, and just offer advice,” says Brown. “I couldn’t say, ‘Everything’s gonna be fine.’ I
couldn’t promise things I couldn’t deliver. And I don’t know who I missed.”
Like Easley and Brown, others worry about those who slipped through without being assessed. So many Katrina survivors were suffering silently. Others had underlying psychiatric diagnoses needing treatment but couldn’t advocate for themselves. To help, the Louisiana Department of Health and Hospitals (DHH) set up teams of nurses and mental health professionals in two key areas: one at the causeway, the other at the airport. Anyone identified by staff or who came forward about their unique needs was taken to one of several special-needs shelters, staffed with professionals and stocked with prescription medications. If necessary, patients were transferred to a hospital-based psychiatric facility for treatment. Besides the medical necessities, the shelters offered the patients a haven of safety and routine that’s essential to
their well-being.
“To those patients who are already dealing with existing problems like mood disorders [or] schizophrenia, the trauma of the hurricane and subsequent life-altering incidents push them to their limits,” says Easley. “These are people who are fragile on a good day. We did all we could to get them care once we knew they needed our help.”
But many people who needed help were just invisible. “We did our best, but I know really traumatized victims were not being identified who should have been,” says Tom Washington, MD, head of mental health at the DHH. “Unless they were seriously involved psychologically or came forward on their own, there was just no way to tell. We couldn’t read their minds.”
For some developmentally disabled patients, the message was clear. “You’d see an unidentified person slumped in a wheelchair and around their neck or on their lap was a sign that read, ‘mentally retarded/needs help,’ ” recounts Easley. “We assessed them, listed them as John/Jane Doe and got them to a special-needs shelter.” She’s praying they all will be identified through the Red Cross People Finder system. Many have already been reunited with family.
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A vital question in Katrina’s wake: How will children who survived the storm fare psychologically?
PHOTO BY DANIEL CIMA/
AMERICAN RED CROSS
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‘They’ve seen too much tragedy’
One problem for survivors is that a hurricane has no face and no identity, so a victim has no target for his or her anger. “When that anger turns inward, that’s when we worry,” says Easley. “If it’s not resolved through therapy, these folks can develop depression and posttraumatic stress disorder.”
Easley, Brown, and Washington agree that three common scenarios will play out among survivors — the scarred, the separated, and the unscathed. How they weave Katrina into their lives and react to the devastation may depend heavily on how they perceived the experience from the beginning.
“A great number of people will be emotionally crippled by Katrina,” says Washington. “These are people who have been deeply and personally sliced open through personal loss. Whole families died. Babies separated from their mothers may never be reunited. The pain is searing and prolonged. They’ve seen too much tragedy.”
Johnson, the Hurricane Betsy survivor, knows, and she can’t forget. After the storm hit, the levees were topped, flooding her town and sending water surging up to the roof of her childhood home. “I saw a corpse in the water, a black snake on its back just floating with the tide. It was hideous,” she says. “And it’s with me forever.”
A second group of victims may have experienced the trauma of being separated from their families for a time but were reunited. Other families were together but displaced from their homes and neighborhoods — many permanently. “Remember, these people come from tightly knit circles, and those bonds have been disrupted,” says Washington.
Easley agrees. “These patients will likely develop attachment disorders. They’ll be withdrawn, shy, and reluctant to leave even questionable relationships in the future. They’ll need to talk out their experiences with a professional, maybe get some medication. They’ll limp through life but they’ll get through.”
Children are likely to be emotionally hobbled as well.
“We know kids are busy establishing trust before the age of 3. We’ve got [small] kids staying with strangers, some who wandered the streets, some are orphans. Trust is out the window,” says Easley. “Many will need a lot of proactive intervention. Yes, it was horrific, but we can only hope they’re adaptable.”
And children will also suffer when their parents are unable to cope.
“It’s sad to think about, but there are parents who just won’t look for their kids because they couldn’t take care of them to begin with,” says Brown. “It’s not a huge number of parents, but they’re out there, I’ve seen them. What happens to those kids?”
Hope for bouncing back
“I am one of those resilient kids,” says Janis Nihat, a Betsy survivor and an example of someone who made it through relatively unscathed. She and her family lived on Grand Isle, La., but evacuated when Betsy made landfall. She was a third-grader.
“”Everything changed. Our neighborhood was destroyed. People died. Our lives changed, too. But, we bounced back. We put our house up on pilings and returned,” says Nihat.
For a third group of survivors, like Nihat, Katrina will largely be something to tell their grandchildren about. They’ll recall sitting on a rooftop or being rescued by a helicopter, “but will look upon this as a natural life experience, something that just ‘happened,’ ” says Washington. “It has to do with what they saw, experienced, and their frame of mind at the time of disaster. We really don’t know why some folks bounce back.”
But Nihat worries about the ones who won’t. “Obviously, after Katrina, a lot of folks won’t be coming back, and that’s what’s different — and worse,” she says.
For those who can’t or won’t return to New Orleans, a whole new dimension of stress emerges. “They’re not unlike refugees,” says Easley. “If they’ve been displaced to another part of the country or even another state, they’ll have some culture shock.”
Research agrees. According to an April 2000 report published in Psychiatric Times, often refugees are deeply saddened by the loss of their familiar cultural landmarks, anxious about integrating into a new culture, and will continue to adjust to a new life for years or even decades.
For those who are able to return to a flood-ravaged community, rebuilding carries with it its own evils. “How will these survivors feel in a ‘new’ New Orleans? And, what if it is rebuilt as a parody of itself, [something] like Disneyland?” asks Washington. “Let’s face it, it can never be the same. These people get their identity by the neighborhood they came from. Now those neighborhoods are gone.”
Johnson agrees. “People from New Orleans don’t say, ‘I live in the suburbs.’ They say, ‘I’m in Bywater or Seventh Ward or Ninth Ward,’ ” she says. “Now what will they say? They’ve lost their identity and character.”
Easley is hopeful. “Let’s remember, crisis doesn’t build character, it reveals it,” she says. “We’ll have to wait and see.”
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