In Houston, a stressed-out mother sits on a cot in the middle of the Astrodome and says she has probably slept just four hours in the past three days.
In New Orleans, a policeman, apparently distraught over his inability to rescue people, sticks a gun in his mouth and pulls the trigger.
And in California, an 11-year-old boy turns to his father and asks if hurricanes can happen there.
Hurricane Katrina has wrenched the lives of its survivors, rescue workers and even a transfixed nation that watched the catastrophe unfold. Many survivors, especially, will suffer significant psychological trauma, some experts say. But they also stress that people are remarkably resilient, and that most who survived the storm and floodwaters won’t be permanently impaired.
“I would expect to see most people recover and be fine,” said psychologist Andrew Baum of the University of Pittsburgh, who studies reactions to disasters. “People do better than we expect them to.”
'It all happened so fast'
That would be a welcome change for Selika Thomas, whose home is currently the Astrodome.
“I’m depressed, I’m stressed out,” said the 30-year-old mother of two who worked as a hotel chef in New Orleans. “It all happened so fast. We see this every day, homeless people living in the streets, but I didn’t expect it to happen to our whole city.”
Even after they reach safety physically, the survivors of Katrina have plenty of psychological pressures to cope with. They may not know the fate of family members and friends. They may not know if they have houses to return to. The social fabric of their everyday lives, things as mundane as the stores they shopped at, has been disrupted. They have little control over their lives. And they’ve seen horrible things.
That will lead to “ordinary reactions to extraordinary events,” as Gerard Jacobs, director of the Disaster Mental Health Institute at the University of South Dakota, puts it.
Anxiety. Anger. Depression. Trouble concentrating and remembering things. Nightmares. Headaches. Withdrawal from other people and activities. Some survivors, and it’s not clear how many, could develop post-traumatic stress disorder, a long-term reaction that includes flashbacks and intrusive thoughts.
Jacobs, who expects little chronic PTSD to develop, said the other symptoms typically last for six to eight weeks after a catastrophic event ends. But he notes that it’s hard to tell when an event like Katrina really ends, with the long-term disruption in people’s lives.
“I think in each individual, it’s going to be a question of when they see the event as being over and when they see themselves as beginning the recovery process and moving forward,” Jacobs said.
Barry Hong, a psychiatry professor at Washington University School of Medicine in St. Louis, who has studied flood survivors, said he’d guess that maybe half the survivors might need counseling or other formal psychological treatment, while the other half may do fine on their own with help from family and friends.
Sense of normalcy, control is crucial
It will be crucial for survivors to regain a sense of normalcy and control over their lives by getting jobs and putting their kids in school, and to reconnect with their families and friends, he said.
Jacobs said that in his study of survivors of the Indonesian tsunami, “it strikes me how strong the people are and how they’re able to look forward. That’s more the norm than the exception... I think you’ll find that in the South, too.”
But Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University and president of the Children’s Health Fund, isn’t so sure that lessons of previous disasters can be applied to Katrina.
Speaking by telephone from hard-hit Biloxi, Miss., Redlener agrees that people are resilient. But the scope of destruction and dislocation caused by Katrina means all bets are off for assessing their psychological futures.
“I wouldn’t be too quick to predict how this is going to turn out,” Redlener said.
Hong agrees it’s hard to tell what will happen, but, “If I was going to bet, I’d bet on resilience. Most people bounce back.”
Rescue workers at risk
Rescue workers are at risk for psychological fallout too. Two New Orleans policemen killed themselves. One, Sgt. Paul Accardo, a department spokesman, was troubled because he couldn’t help stranded women who were pleading for water and food, his boss said. He even wanted to help animals lost in the disaster. Unable to stop the unfolding catastrophe, he sank into depression.
Baum said trained rescue workers tend to be very resilient, even in the face of grotesque experiences. Hong agreed but noted that in this case, police and other rescuers also lost homes and had family members to worry about.
And what of people who never set foot in the affected area, but simply soak up image after image of the destruction?
“We’ve seen a major United States metropolis turn into what appears to be a Third World country... That’s pretty frightening,” said Dr. Gary Small, a psychiatry professor at the University of California, Los Angeles.
His own son asked whether hurricanes could hit California. Children in particular might suffer nightmares, fears and anxiety from the news coverage, said Small, and he advised parents to speak reassuringly to their kids.
As for adults, the frightening news coverage is a reminder of the hazards of life and a “wake-up call that our government may not always be able to take care of us,” he said. In his neighborhood, many people are now taking better earthquake precautions, which he called a healthy reaction.
But Small said that like public concern following the Sept. 11 attacks, he expects the general public’s alarm over Katrina to gradually fade.
“We get into this crisis mode,” he said, and then “we go back to our usual ways and we adjust to it.”