The Psychological Aftermath of Katrina

First Published 8 September 2005

Articles are starting to appear about how some Katrina refugees are being arrested for public intoxication and disorderly conduct in the Astrodome and in various shelters.  The articles mention this fact as if it were happening in a vacuum, as if the last horrible days were not an inextricable backdrop to this behavior.

Of course order needs to prevail to keep people safe.  And yes, there are a few folks who were no doubt engaged in disorderly conduct before the winds and the water of Katrina came.  But the vast majority of them were not.   And in the aftermath of Katrina, these folks might find themselves feeling things and thinking things and doing things that are ‘off.’  Things that they, themselves, do not understand.  When this happens, what they need is competent psychological understanding and, if need be, intervention.  Yes, such intervention can include caring, respectful containment when necessary.  But what it definitely does not include is a jail cell.

Imagine it.  You’ve weathered a huge, horrific hurricane in which your very life was threatened.   The residents of your beloved city were forced to flee in a dramatic mass exodus.  That, in and of itself, is traumatizing enough.  But then in the aftermath, if you were lucky enough to have a house or apartment left, you are now faced with no electricity or any running water and no prospect of any.  As you are scrounging for potable water, you watch in amazement as your home with all of your worldly possessions you can’t afford to replace, your precious memorabilia and your memories get swallowed up in a fast rising flood of water you are helpless to stop.  Many of you are elderly or sick or frail.  You watch as one by one you begin to succumb to the rising water, the heat, the lack of food or essential medicines.  If you haven’t watched your family die, perhaps you can’t find them.  Maybe they were whisked away by a helicopter to who knows where. 

As you sit grief-stricken at the loss of beloved pets and family members, you watch in horror as the bloated bodies of your friends and neighbors float down your street that is now a rubble-choked river. You feel ill and weak from little decent food and water for days upon days.  You are filthy.  Everything, including you, stinks. You feel betrayed and abandoned as the promised help never came, and never came, and never came.  You feel helpless, always helpless.  When you are finally rescued, you perhaps are separated from your six month old child, your husband or your grandmother with nothing but the clothes on your back, or a garbage bag filled with hastily gathered, soaking belongings. You are then transported tens, hundreds, or even thousands of miles away to a totally unfamiliar place.  If you are one of the few lucky ones, you are taken in by a family of strangers.  If not, you are either put in another huge warehouse-like situation or in a shelter where you are under armed, curfewed watch and told blithely that “you are not under arrest.”  But it sure feels like it.  You have been subject to such surreal and stupefying trauma upon trauma upon trauma that nobody could ever possibly understand but you and those who have also gone through it.  And then with your mind still reeling and your body in shock, you are expected to behave as if you are at a big tea party on the 50 yard line with thousands of others.  And if you “misbehave” because you are beyond your breaking point, you may be arrested. 

Tea party manners in the Astrodome and the shelters would be lovely, but our brains and our bodies just don’t work that way after such incredible trauma.  Sure, some folks may internalize the stress of it all and shut down and look somewhat worse for wear but ‘fine’ on the outside – at least for now.  But for most people, something is going to give.   

After a trauma, you first help people feel as safe as is humanly possible and then you educate them about their reaction and let them know it’s normal.  You help them tolerate their seemingly ‘crazy’ reactions and find ways to mitigate their impact.  If need be, you help them contain themselves.  In the long term, you help them integrate their experience so they can regain a semblance of normalcy in their lives.  But never, ever do you punish them.  It is a wrongheaded, uninformed response that will only add trauma to trauma and increase the very behaviors you are trying to stop.

“If they are safe now, what’s the problem?” you might be tempted to ask.  The problem is that now is when the psychological aftermath begins.  Once you are no longer in life or death, minute-to-minute survival mode,  your brain and your body now have room to begin processing, feeling, reliving, and remembering all that’s happened, whether you want to or not.  And try as folks might to keep it together, often times they can’t.  These are not people misbehaving – they are having a perfectly human response to a stress none of us should ever find ourselves pretending we can possibly imagine.

A traumatic response has nothing to do with being poor or having no formal education.  It is not about skin color.   It is not about having a ‘weak character,’ as is the prevailing attitude in the military when men and women in combat zones get ‘shell shocked.’  Traumatized soldiers are expected to have a very brief respite, if they’re lucky, and then ‘suck it up’ and get back to the front lines.  That is as absurd and ignorant of how human beings are hardwired as it is adding insult to injury.  While people bring their own personal and family histories and cultures to every situation, so everyone’s response will be somewhat different, trauma affects everyone to one degree or another. 

The symptoms are many and won’t be fully delineated here.   But for example, some people may get depressed or suicidal when they’ve never remotely felt that way before.  People may start having serious panic attacks.  Some may become unable to go outside or come inside.  Others may be startled extremely easily.  They may have difficulty concentrating to the point of not being able to have a simple conversation.  Day to day life may seem superficial and intolerable. Sleep may be severely disturbed.  Nightmares are common.  Interpersonal interactions can become painfully difficult, and long standing relationships may suffer.   Kids often regress and show much younger behaviors than is usual for their age – thumb sucking, bedwetting, etc.  They may be very clingy, or attach to nobody, or both.  The ability to contain emotions, including anger, may be more pronounced. Fights might be more apt to break out, particularly when people are being forced to live in such close quarters with so many where autonomy and privacy is all but non-existent.  It’s more tolerable for many to feel angry than it is to feel sad or scared.  Children and adolescents, particularly, often act out their trauma through “behavioral problems.”

To cope with such intolerable feelings and thoughts, people often resort to alcohol and drugs, as we do when we try to numb ourselves in other situations we have difficulty wrapping our heads around.  Such numbing is common whether it is through substance abuse, children refusing to talk, or feeling like everything around you is a dream, to name but a few ways.

However the collective trauma manifests, I fear the response to these emerging and very predictable symptoms will cause people who don’t understand to heap appalling, unfair stereotypes on the refugees who are mostly poor and people of color – “they don’t know how to be behave” “they are ‘conduct problems,’” “they should be quiet and appreciate what has been done for them,” etc.  Such mislabeling and gross misinterpretation of the situation would be its own disaster.

Expecting refugees to take a small amount of financial assistance and ‘get on with’ it is extremely unrealistic.  It’s a set up for the refugees and it’s a set up for the people of our country.  Those who suffered through Katrina need to be educated about the effects of trauma, as do the loved ones and communities that are welcoming them, as does our government.  Dismiss this if you will.  But just like the socio-political subtext of this disaster, if we pay no heed to it, you can be assured we’ll all live with greater consequences later.

If we’re serious about helping the refugees of such a tragedy in the long term, we must make mental health care a priority.  Significant impairment in occupational functioning is very common in those who have suffered major trauma.  Looking at it from a stark dollars and cents standpoint, if we start helping folks deal with their trauma now and in the ensuing weeks and months (and, yes, maybe years) ahead, the likelihood that they can create productive, fulfilling lives for themselves will increase.  If not, some children may not be able to sustain their efforts in school and drop out.  Those same kids as well as the adult survivors of Katrina may show up in psychiatric hospitals, community mental health settings and the like.  Such reactive forms of treatment are vital but are much costlier interventions for tax payers than preventative care.  And they certainly are more psychologically and emotionally costly for those finding themselves with such severe symptoms that they need major interventions or inpatient stays.  This is true for mental health services in general.

If you are concerned that you or someone you know is suffering from trauma, regardless of the cause, talk to a mental health professional in your community, or go to http://www.sidran.org/survivor.html for some good resources.  But in general, remember a ‘crazy’ stress response is really a perfectly normal response to a ‘crazy’ situation. There is no shame in being human.  Our psyches can only take so much, no matter who we are.   In the very unlikely event they were ever to find themselves in the same situation, privileged white presidents and their cabinet members and their family members would manifest dramatic trauma symptoms, too.

_____________________________________________________

In the Wake of Katrina, Who Do We Want to Be Now, America?

First Published 6 September 2005

From Hiroshima and Nagasaki to Viet Nam to our inner cities, the United States has a long history of not wanting to know, of forgetting, of “moving on.”  But as most anyone in the psychology world will tell you, you can’t truly move on until you finally face the truth, whatever it may be.  You must explore it, fully grieve it, compassionately take responsibility for any part you might have played, and come to terms with it.  Then you move on.  If you don’t, try as you might to keep it out of your awareness, the thing you’ve pushed deep down will undoubtedly make its way back to the surface as a sign or a symptom begging to be heard – maybe a heart attack or depression, perhaps substance abuse.  What is ignored on a societal level also finds indirect expression, be it violence, unchecked consumerism or obsession with mind-numbing ‘reality shows.’

President Bush, too, I imagine has a long history of not wanting to know.   He said there were no real warnings about 9.11.   There were.  He said there were no real warnings about the possibility of levees breaking in New Orleans. Flatly untrue.  From his well-documented succession of business failings to his substance abuse to the fortuitous coattails he has ridden, I believe Bush has a history he is desperately trying to undo.

In his early days as president, even the highest office in the world wasn’t enough to erase his past.  He was faltering once again and his handlers were worried.   But then came 9.11.  And in the rubble and the horror and the shock of it all Bush at last found the shame-erasing persona he so desperately needed.  From that day forward he was no longer George Bush, Struggling Son, but was George Bush, Avenger of Terrorism, George Bush, Slayer of Evildoers.  (See article about Bush’s shame.)

Still, somewhere deep down he knew the truth.  And to this day he struggles to keep up the pretense like the all-too human man behind the curtain playing the grand Wizard of Oz.  The more Bush blusters and postures, the more vulnerable he sounds.  Those who are happy and secure with themselves and their world have no need to bluster, to discount, to ignore or to pass the buck.   People secure in their world are open.  They listen.

But Bush said he couldn’t listen to the grieving mother of a dead soldier camped outside his Texas ranch because he had to “get on with [his] life.”  Of course he couldn’t listen.  Listening to her would be a chink in his Avenger’s armor, a crack in his reality, and thus a threat to his very fragile sense of self.  We are all hardwired to hold on tenaciously to our sense of who we are - it’s part of our survival instinct.  But unlike most of us, Bush’s intractable hold on his reality is at the expense of countless lives the world over.

Bush’s handlers, I believe, understand his deep need to play the role he fears he’s not and so they’ve fostered the Avenger of Terrorism persona to manipulate his insecurities to then perpetuate their self-interested ends.

This tenuous reality needs to be carefully protected.  So since 9.11 Bush has been all but hermetically sealed in a mobile bubble of unreality, a roving movie set.  This was evident during the last presidential campaign at a fundraiser in Northern California where layers and layers of reality-proofing in the form of a line of riot-geared police in front of a long row of obscuring 18-wheelers in front of his huge bullet-proofed, tinted-window entourage were put between the president and the protestors – ostensibly to keep them from him, but equally to keep him from catching a glimpse of such non-scripted reality.  Also on the campaign trail, those that didn’t sign a promise to support Bush were not allowed into his stump speeches, lest a dissenting sign catch his or the media’s eye.  At town hall meetings, the audiences were checked and vetted and scripted.  White House press conferences are also scripted and those that don’t follow the script are shunned and no longer given access - a perfect metaphor for the overarching philosophy of the Bush administration. 

Such a choreographed presidential life, his rigid, fragile sense of self and his exceptionally privileged upbringing keep the horror of the happenings of the Gulf Coast from having real life resonance with Bush, just as he can’t fathom the struggles of the average worker who actually has to live within the limitations of his paycheck. 

It’s an administration disastrously disconnected from reality and the real life needs of its people.  As Bush said to Reverend Jim Wallis, “I’m a white Republican guy who doesn’t get it…I don’t understand how poor people think.”  I don’t pretend to speak for all of us non-wealthy folks, but I’ll tell you this – poor people and middle class people don’t think, “Gee, I’d be so happy if only our GNP was forever #1 in the world.”  We don’t think how great it would be to send our kids off to die to kick the butt of a terrible, but clearly impotent leader. What we’re thinking is that we need decent schools for our kids to help them succeed.  We need jobs to put food on the table and roofs over our families’ heads.  And we want health benefits and non-toxic air and water.  We want to be considered worthy enough to be helped in a disaster.  That’s what we’re thinking.

Judging by the countless newspaper headlines, the rest of the world is horror-struck at how the logistically capable federal government of the wealthiest nation on the planet did not help its people in their dire hour of need.  They are flabbergasted at how it failed to step in, in the crucial hours and days after Katrina hit when so many lives could’ve been spared.  They are disgusted at how our federal government yet again tries to pass the buck.  Horror and disgust are appropriate responses to such seemingly perplexing behavior that had and will continue to have such dire consequences.  But given its disconnect from the reality of average folk, I wouldn’t have expected anything different from this administration. 

In the highly-controlled, distant world it has created for itself, it has gotten so used to doing what it wants when it wants with almost no criticism and thus no accountability, it has gotten lackadaisical and cocky to the extreme.  The goal of the Bush administration’s world is to perpetuate the Bush administration’s world.  Those charged with our care play seemingly infinite rounds of golf, pausing before a putt or jetting off to a disaster area between rounds to grab a quick photo op and offer an insulting sound bite about how well it’s all going while our country’s infrastructure and ideals crumble around us. 

In another disastrous disconnect, a global one this time, the Bush administration not only didn’t heed warnings about terrorists attacking high rises, it blew an unprecedented opportunity after 9.11 to unite a sympathetic world in cooperation, connection and compassion.  Instead it unabashedly exploited 9.11 for political and corporate gain while alienating the rest of the world.  And through the debacle in Iraq it helped spawn scores of new U.S.-loathing terrorists. 

In the days and weeks and months that followed 9.11, the patriotism of the people of the U.S. was manipulated and distorted, and our fear and reason were hijacked.  Feeling so shocked and unsafe and seeking security as we are hardwired to do, many of us very understandably went into survival mode and shut down.  We stopped listening and stopped thinking.  We disconnected and saw the world through our need to feel protected and to rally round the person charged to do that – the president, with the help of his staff.

Our disconnection found expression in things like the ‘reality’ shows that have become so ubiquitous.  They mask reality, yet at the same time belie a deeper one.  They distract us from the goings-on of our real life world as we absorb ourselves in a drama that is less threatening to look at because it’s not ours, it’s “out there.”   The plotting and the scheming and the pitting one person against another in a clawing, scratching climb to the top on those shows is a metaphor for the consumer-frenzied, kill or be killed world the Bush administration is helping to perpetuate at an unparalleled rate, intentionally or not.  “Get money!  Get fame.  Screw over your friends.  If you aren’t rich, you’re lazy.  Lie.  Grab whatever you can.  You need more stuff! There’s not enough.  Hurry!”

All the while these and the American Idol-type shows that are filled with real people give false hope to other real people who are not making ends meet.  People who are wrestling with difficult life circumstances often deal with it by holding on to the thought of “making it big” some day.  The truth is that Americans are less socio-economically mobile than any other industrialized country.  We use those shows and the like to keep our unrealistic dream alive.  Were the fictional American Dream not floating around in our current mythology, we would surely rebel in mass numbers as many exploited people have done before us.

But reality is peering its ugly head around every shuttered Mom and Pop store and every choking, toxic lake and river, proving too great a presence to ignore any longer.  Opinion polls show the Bush administration’s carefully constructed façade is cracking.  We still see the world through the need to be protected.  But it’s because of this very need that we are letting ourselves see what’s really in front of us. 

So the Bush administration can say what it will, but we know the truth in our hearts.  We feel it in our bones.  We see it in our neighborhoods and on our streets.   Our schools are disintegrating and along with them the promise of our children and our country’s future. Social programs are hamstringed or gutted to fund the debacle created in Iraq and the never-ending, opportunistically-defined ‘war on terror.’  Racial inequality is the elephant in the room (even among progressives), and class inequality is creating a gaping, unsustainable tear in the fabric of our society tax cut by tax cut.   

Ultimately what we realize is that this administration is not, in fact, protecting us or making our survival one bit easier.  In fact, the promise of America is being stolen from us by a handful of people blinded by their own fears and rendered so out of touch with reality by their own insecurities.   Such abuses did not start with the Bush administration to be sure.  History is littered with stories of men (as it happens, almost exclusively men) doing similar things.  But this administration is literally running amok in a way other governments could only have dreamed about.   

And our congressional Democrats, succumbing to their own fear and insecurities, have disconnected from our needs, too, failing to speak up for us in the face of it all.  Many still remain hawkish despite the fact that the overwhelming majority of Democrats, and the majority of Americans, are against the occupation in Iraq.  The Democrats, then, are as culpable as the Bush administration.

Katrina and how it has been handled by our federal government was as fierce a wake up call for many in the U.S. as the hurricane itself.  It has forced us to look at our leaders’ blatant disconnection to us and our needs.  We watched in horror the images of the poor and the people of color being all but left to fend for themselves.  Along with the rest of the world, we waited for the massive government mobilization – this is America, after all, we thought.  But we shook our heads in disbelief and outrage when it was not immediate when we knew it very well could and should have been.  The scene has been a horrific one. But as excruciatingly difficult as the last days have been, how we choose to care for Katrina’s refugees and our country as a whole in the aftermath will prove to be the most difficult part of all.

If we choose to turn a blind eye and not do everything we can to ensure the engrained prejudices, the unmasked fear, the blatant self-interest and self-absorption of our government, the you name it – all the mechanisms that were in place to help create such an unspeakable nightmare - are not brought to the light of day and challenged, then we, too, are culpable. 

Ignoring or “moving on” before we’ve explored what needs to be explored is certainly a recipe for more disasters.  The way the United States manages itself is proving time and again to be unsustainable.  Like the levees in New Orleans, our economy is broken and soon something is going to give in a big way.  Our social structure is equally broken and is not holding what it was put in place to hold.   If we don’t take on these issues, the levees are going to break, and the issues are going to continue to take us on, whether we’re ready or not. 

The public outcry about the handling of Katrina lets me know we are ready.  It’s time for us to come together in all our remarkable diversity with a compassionate but starkly candid eye and take a reckoning.  It’s time very literally to decide in what direction we want our country go.

Do we want to be a country that pretends race and class are not issues, or do we want to start a real dialogue and listen? 

Do we want to be a country that allows money to be systematically taken from agencies like FEMA, our social programs, and the very safety nets that make America, America?  Do we allow monies that should’ve been spent rebuilding the levees in New Orleans and our schools to continue to be drained by tax cuts for the rich and appropriated to fund an appallingly unnecessary war in Iraq and beyond, or do we demand our government drop the barren rhetoric and make the quality of life of its people its priority via real actions and substantive policies?

Do we want to be a country that lets rampant consumerism and the drive to have stuff continue to mask a deeper need, or do we slow down and look at what’s missing in our communities and our lives?

Do we want to be a people that continue to feel despairing and victimized and immobilized by a government that seems too disconnected and omnipotent to contend with, or do we let ourselves feel powerful, recognizing that people all over the world and throughout history have triumphed over much more daunting odds?

Do we let this grand experiment in democracy, many generations old, become a failed one, or do we dare to look at what’s really going on in our government so we can turn around a country that we know in our hearts is going terribly, terribly wrong? 

Like 9.11, the Gulf Coast tragedy has potential to be one of those change moments.  It could be a catalyst to finding our way back to ourselves, our communities, our ideals and our world.  We can choose to forget all we’ve seen and know and stick our heads in the sand, squandering another opportunity. We can choose to “move on” and let our country continue on its hollow path of vacuous consumerism, inequity and unrepresentative government, or we can say enough is enough.  We can rise to the occasion and take responsibility for this messy, beautiful place we call the United States and help make it a place that truly practices what it preaches. 

The sociopolitical subtext of Katrina will make itself known.  Period. What that looks like and what direction our country takes now is entirely our choice, America. 

What’s it going to be?