Two weeks after Hurricane Katrina forced people to abandon their homes, their belongings and their communities, the trauma and shock of the natural disaster may lead to a second wave of suffering.
As the water recedes, mental health experts believe that up to 20 percent of the 1 million evacuees will suffer psychological effects, and that doesn't count those already suffering from mental illness.
The loss of loved ones, property and safety, on top of dislocation, can cause great distress to children and adults alike. Normal reactions to trauma include shock, fear, sadness, anger, difficulty sleeping and even aggressive behavior, according to the National Institute of Mental Health, which has studied the reactions of people following the Sept. 11 terrorist attacks, the Oklahoma City bombing, wars in the Middle East and natural disasters.
"Most people after a period of adjustment will recover, but a small portion of people will have lasting effects," said Dr. Liza Suarez, clinical assistant professor at the Center for Anxiety and Related Disorders at Boston University. Ongoing difficulties can range from depression to post-traumatic stress disorder (characterized by re-experiencing the trauma) to violence. Suarez, along with many colleagues around the country, organized teams of mental health professionals to dispatch their services at base camps and shelters for evacuees.
The focus now should be comfort and stability, experts say, adding that more harm than good will come from forcing people to confront what they've seen and experienced.
"If you get in trauma and your nerves are on edge, reliving it is like adding fuel on a flame," said Dr. Gene Beresin, co-director of the Harvard Medical School Center for Mental Health. "You want to provide comfort, reassurance and calm people down before you help people take stock."
So far, the Red Cross has given more than 100,000 hurricane survivors a mental health screening to ascertain if they need psychiatric help and/or medication.
Increased Awareness About Trauma
Suarez believes that Sept. 11 raised everyone's awareness about mental health. The federal government has been more willing to provide psychiatric care following a disaster, she said. In addition, she said, seeking help after a major trauma doesn't carry as much of a stigma anymore.
Suarez and Beresin say they are primarily concerned with making sure evacuees get access to psychiatric help in the long term.
More than financial assistance, Beresin says the main goal right now should be to alleviate symptoms and help evacuees find some normalcy by keeping a routine and regaining a sense of control over their displaced lives. Then and only then will people be able to deal with the colossal loss involved.
Dr. Robert Trestman, professor of psychiatry at the University of Connecticut, believes that Katrina poses mental health challenges incomparable to other events because of the profound dislocation. "More people died during Sept. 11, but many more people had their lives disrupted by Katrina," he said.
Victims lost relatives but also their homes and their community -- a triple whammy with no quick fix in sight, especially for New Orleans natives.
Trestman said that people who already suffer from or are susceptible to mental illness are especially vulnerable.
"Under severe distress, the underlying vulnerabilities and depression become apparent," he said.
Considering that some 70,000 of the 1 million evacuees probably have bipolar disorder, schizophrenia or another disorder that requires medication, the hurricane has had drastic effects, Trestman said. Most evacuees found themselves stranded on rooftops with no time to grab their wallets, let alone their pill boxes.
Abruptly stopping use of these psychiatric drugs can have profound consequences.
"When you stop taking [psychiatric] medication, you change the brain's regulatory mechanism," Trestman said.
What Can You Do?
Beresin stressed the importance of screening everyone affected and paying attention not only to the people who vocalize their distress, but also those who don't. "Unfortunately, the ones who get immediate attention often are the ones who scream, while many others suffer in silence," he said.
Symptoms vary according to age, but counselors are looking for irritability, insomnia, withdrawal, aggression or regressive behavior. Another common fallback may be drugs and alcohol, which are more socially acceptable ways to cope but can often lead to dependency.
Beresin advised that parents take care of themselves first to avoid having kids suffer from a distressed caretaker who hasn't sufficiently recovered. Like in an airplane when the pressure drops, the parent should slip on the oxygen mask before they put one on their child, he said.
Kids of all ages need security, stability and a sense of safety so having a parent helping to process the events will greatly decrease psychological aftereffects, he said.
Safety in the Community
Aside from parent stability, establishing a sense of community can be a good preventive measure. Evacuees should seek to build a support network of school teachers, police, clergy and other victims to help them keep tabs on each other and reassure each other.
Beresin points out that people far away from the eye of the storm may have also suffered distress from the hurricane. Watching media reports or even overhearing parents' graphic descriptions of the devastation can have a profound impact on kids, he said.
He says parents should spend time with their kids and let them express their worries. Children can also get a sense of purpose by taking part in the relief efforts, such as starting a lemonade stand to raise money.
Most important, say experts, is to seek professional help immediately, because over time, mental health problems can get worse.