Mental Health Worsening for Katrina Victims
ALISON STEWART, host:
You know, there are so many cliches about how to cope with loss: Time heals all wounds, seeking closure, moving on with your life. But no cliches, no matter how much truth they usually hold, seem to help the victims of Hurricane Katrina. Unlike in other post-disaster eras, a sampling of those who survived Katrina have seen an increase in mental illness. Now, that's according to findings on a new study conducted by Harvard Medical School.
Let's listen to one woman who is part of the study. She's trying to cope with what has happened to her and her family.
Unidentified Woman #1: I'm trying to keep my mind off of the loss…
Unidentified Woman #2: Mm-hmm.
Unidentified Woman #1: …but it's very, very difficult when it's that close to home. I mean, when I think of Katrina, I think of my mom still, the baby that died. I'm thinking about my brothers…
Unidentified Woman #2: All right. Hello. Go…
Unidentified Woman #1: …and he had tore the roof down. It just blew his rood completely off.
Unidentified Woman #2: Right.
Unidentified Woman #1: So it - that's it for right now. I don't think I can go any further with the interview.
STEWART: With us this morning is the director of that study, Professor Ronald Kessler of the Harvard Medical School.
Professor, thanks for being with us on THE BRYANT PARK PROJECT.
Professor RONALD KESSLER (Health Care Policy, Harvard Medical School): My pleasure.
STEWART: What was the original purpose of this study? What were you hoping to learn?
Prof. KESSLER: Well, we were hoping to essentially keep our fingers on the psychological pulse of this population as the recovery process evolved. This is a rather unique disaster in that so many people were spread to the far corners of the United States because of the big displacement. And it makes it more difficult to plan relief efforts when you don't know what's going on. So we wanted to create a representative panel of the people who were victims of the hurricane and just track them over time to see what happened.
STEWART: As you were tracking them over time, what were you looking for specifically in terms of mental illness?
Prof. KESSLER: Well, we've been looking at standard kind of things that you see after disasters - post-traumatic stress disorder, depression, anxiety, feelings of suicidality, hopelessness, alcohol and drug problems. And also, you find sometimes increases in violence among people, with the frustrations of not being able to recover being taken out on spouses and kids.
STEWART: So this long after a disaster, what would researchers normally find about the levels of mental illness among victims, as compared to those that you found who had survived Katrina?
Prof. KESSLER: Well, normally, what we find is that the majority of people who have emotional problems after a disaster recover after a year, the vast majority after a couple of years, and they get on with their lives. The difference here is that people haven't been able to get on with their lives because there's an enormous amount of infrastructure damage. Many people still don't have electricity. Many people are still displaced and at loose ends. And so, rather than finding that typical pattern of recovery, we're finding that people are actually getting worse, emotionally, over time.
STEWART: And is that because the uniqueness of Katrina?
Prof. KESSLER: Well, it's hard to say the reason why. We've looked at many other disaster situations, and typically, we find this recovery pattern. In really bad disasters, we find that recovery's quite slow, and that maybe after two years we find no change. But we've never found a dramatic increase at the sort we found here. We finding a doubling - of the number of people with post-traumatic stress disorder, a quadrupling of the number of people who feel like life isn't worth living and they're thinking about killing themselves. This is really unprecedented.
STEWART: Anecdotally, I mean, there's many of those conversations on your Web site - they're really interesting to listen to - between the researchers and the people that they're calling out to. But what kind of stories have you heard that really, really surprise you? I mean, you've been doing this for years.
Prof. KESSLER: Well, it's hard to be surprised at a certain point.
Prof. KESSLER: The first thing that you might be surprise by if, you know, when you first hear these kind of things is that it sounds like this is something from your story in Bangladesh or Pakistan or Indonesia. It's hard to imagine that this is actually happening in the United States, the kind of devastation and lack of ability to climb up again. It's just - it's staggering.
STEWART: Did you find that this broke down along economic lines or racial lines at all?
Prof. KESSLER: No. This is a rather unique hurricane in the sense that everybody's lives were affected, whether they were rich or poor, or black or white, or young or old, kind of an equal opportunity disaster, if you will. Rich people, obviously, were the only ones who lost million dollar houses. Poor people were more likely to lose loved ones.
And I think the thing that was distinctive about it was when you come up with a long list of terrible things that can happen in a disaster, the vast majority of people had something, and a very substantial number of people had many, many things happen to them. They lost a loved one and a job and a home and a community. And that pile up of multiple things, without having any one piece of your life that you can hold on to that's stable, that's the thing that really makes it tough for people to recover.
STEWART: And I can imagine, the situation was so dire immediately following it that perhaps some of the stress and some of the difficulties that you might have experienced for the first six months maybe were prolonged.
Prof. KESSLER: Well, you know, very often in disaster situations, you find that in the short run, people have this kind of psychological adrenalin that keeps them going.
Prof. KESSLER: And they don't fall apart right away. They just - the first reaction is, my God, I'm alive. I'm so happy.
Prof. KESSLER: And then when things, you know, in a few months afterwards is when you start seeing things kind of crash, and that that adrenalin drops. But then, people typically start picking themselves up, and as time goes on, time heals, and you find recovery. In this particular situation, though, much of the stress is still there with them. It's not post trauma. It's today's trauma. It's still there every day in their life. It just makes it very tough to recover when you don't have a job anymore and it goes on and on and on, and you just still don't have a house, and you still don't have electricity.
The stress associated with loss of a loved one dying or not seeing your old friends, those kind of things heal with time. But the active components, the part that you can't get your life going again, that's the stuff that just wear you down over time, and these people are wearing down.
STEWART: We're talking to Professor Ronald Kessler of Harvard Medical School about the study which found this increase in mental illness among people who had survived Katrina.
And, professor, from your research, you know, one of the things that everybody keeps asking, what lessons have we learned from Katrina? There will be another huge disaster of some kind, whether it's an earthquake, whether it's another hurricane like this. Is there anything - any preventative measures that could be taken so next time around, we won't have results like these?
Prof. KESSLER: Well, in the practical sense, I'm not an expert. I mean, you know, we know that there are people more moving to the coast than there was in the past or the baby boomer generation. Aging and people who want to live near the water, and there are more people building on areas that used to be seen as unbuildable, and we know that there's climate change. So these things are going to happen, and one would hope that the engineering experts are doing something to prepare themselves.
In a psychological scope, though, we know that there is an enormous amount of psychological distress associated with disasters, and we know that people need help. And we know that it's exactly when that need for help is greatest then the availability of help is least. In the case of Katrina, there were close to 300 psychiatrists, for example, in New Orleans before the storm. There's currently only 40 or 50. The number of people who need to see a psychiatrist has quadrupled. So what do you do in a situation of that sort? And we're starting to realize that the typical disaster response have experts go down there for two weeks, clean things up and go back to their life just doesn't work. People need long-term help. It's not practical to move in an army of mental health professionals.
So what we're starting to think of is the possibility of what's called telepsychiatry, which is having treatment - psychological therapy for people over the telephone by professionals around the country, by having primary care doctors be more involved in giving medications for emotional problems, but with the assistance, the backup, consultation of mental health professionals -again, it can be from around the country - but, in general, using modern technology to help focus the energies of people from a lot broader area on that small area of the country that needs the help.
STEWART: Ronald Kessler is the director of the study and a professor of health care policy at Harvard Medical School.
Thanks for explaining it all to us, professor.
Prof. KESSLER: My pleasure. Thanks for having me.