On the streets of Grand Isle, La., Maryal Mewherter hands out hope.
Mewherter, who works with the Catholic Charities Diocese of Houma-Thibodaux, has been giving out $100 food vouchers for use at the local Sureway grocery store. The vouchers are from BP; they are for struggling families whose income was shut off or stunted by the oil spill, which began nearly two months ago with the explosion of the Deepwater Horizon oil-drilling platform.
Weeks ago, Mewherter said, the residents coming to her for help made up a slow trickle. Now, every day brings a steady stream of people.
"From what we heard, they were hoping that this would come and go in a week or two and things were going to go back to normal," she said. "But things didn't go back to normal yet. ... From what I can see I think people are still in denial about what's really happening or they really don't know."
As the reality of the spill sinks in, however, Mewherter fears that it may be difficult for many residents to adjust to the turmoil that the disaster has brought to the region, including loss of jobs and livelihood, a concern shared by psychologists who cite the possible mental health repercussions.
"This is where they grew up, this is where they lived all these years, this is their way of life," she said. "And they're not wanting to give that up."
Grand Isle BP spokesman Curtis Thomas said, "They are angry, they are mad."
His company, he said, has been a lightning rod for people's anger and frustration, as it now finds itself imposing beach and fishing restrictions and bringing in waves of outsiders for relief and other efforts.
Grand Isle Mayor David Camardelle said the local government is doing what it can to boost morale. "We take it one day at a time and tell people to stay strong," he said.
Still, he said, it is a challenge. Camardelle said he is trying to create summer jobs for teens to earn a bit of spending money and give them something to do, now that the accident has disrupted their lives. But as the oil continues to spill, opportunities, it seems, have dried up.
"There's really nothing to do" on the island, he said. "It puts a burden on the families."
Psychologists say the economic and psychological burdens of the spill could lead to mental health issues for some Gulf shore residents.
"Most people who are severely affected will experience some emotional distress," said Dr. Carol North, director of the Program in Trauma and Disaster at the Dallas VA Medical Center. "This may involve anger or denial ... as well as a range of emotions such as disbelief, sadness, or grief over losses. Also, ability to sleep and appetite may be affected for a period of time among people who are very upset."
Louisiana residents, of course, are no strangers to adversity. Many of the same residents affected by the spill today were also affected by Hurricane Katrina when it rolled through in 2005.
"In many respects, having gone through a prior trauma can cut two ways," said Dr. Craig Katz, supervising psychiatrist for the WTC Medical Monitoring Program in New York. "Prior traumas can be thought of as a way of building up 'tough hands.' Other people might be rendered more vulnerable by a prior trauma."
Separating these two groups of people, he said, is the challenge when it comes to getting mental health services to those who need them the most. He said that one good approach would be to find the people who had experienced psychological consequences from Katrina and monitor them for psychological problems with this disaster.
Another challenge, he said, will be to make the best use of community resources. In short, he said, this is not a problem that psychiatrists can solve with antidepressants alone.
"This is not going to be just, 'What symptoms do you have?'" he said. "As an economic disaster, we will really need to focus on [residents'] purpose and identity."
If there is a silver lining, some psychological experts said, it is that the vast majority of those affected by the BP disaster have not suffered the loss of loved ones and other traumatic events.
"The present oil spill differs from the other disasters such as Katrina or 9/11 in that this tragic event occurred far away from the population centers and has not caused death and destruction of the magnitude we are familiar with in the case of other disasters," said Dr. Arshad Husain, director of the International Center for Psychosocial Trauma at the University of Missouri-Columbia School of Medicine. "However, the threat is slowly creeping towards the coast like a slowly spreading cancer."
Husain said the psychological effects of those who did not witness or lose loved ones in the explosion of the oil rig will be much different from those who have been more indirectly affected by the spill , such as those who have lost their jobs and way of life.
"This group has not lost any loved one or received personal injuries," he said. "Their dwellings and personal properties are not destroyed. Their recovery will depend on how well they are compensated for the loss of their income and how quickly they re-establish their businesses. ... This group, in my opinion, is at lower risk than the first group of having serious emotional reactions."
North said a major determinant of longer lasting mental health effects in the area will be how quickly the issues surrounding the spill can be solved.
"Of course, the best safeguard is to prevent damages to people's lives and the environment," North said. "Rapid and full restoration of the damages and financial restitution of losses is very helpful for emotional recovery. Perceptions of unfairness and perceived lack of concern for the welfare of those highly affected may be linked to negative emotional responses to the situation."
In the meantime, she said, offering a helping hand may help some cope.
"It should not be forgotten ... that people tend to be resilient by nature, and people helping one another in the face of hardship and tragedy can help reduce the emotional toll."