Sometimes it's hard to remember why New Orleans was ever called "The Big Easy." When everyone's life has been disrupted and day-to-day living is a big logistical headache, New Orleans is worlds away from easy.
The recent experiences of local residents range from the most unimaginable trauma to a good hard shakeup. In the worst of circumstances, we have lost loved ones, homes and jobs; we're living in financial hell; and our "free time" is consumed by physical toil, endless paperwork, and butting heads with insurance companies and government agencies. Even the luckiest among us are frustrated by long waits in line, trash everywhere, on-and-off utilities, and drivers who don't know what to do at a four-way stop.
We're all saddened at the sight of once-vibrant urban swaths that now stand in ruins. We're anxious about our own futures and the future of New Orleans, which in our lifetime has never been less certain. Parents worry about how all this is affecting their kids -- while trying not to let their own raw emotions traumatize them. Family members are living too far apart or way too close, with multiple households crowded under one roof or together in trailers and tents. In a recent survey conducted by LSU's Manship School of Mass Communication, 53 percent of the respondents reported feeling depressed after the storm; 39 percent reported feeling angry.
In short, post-Katrina New Orleans is an urban pressure cooker, a city newly difficult to live in, inhabited by people who are more tightly wound than ever. It's the Big Opposite, and no one living here appears to be immune from the strain.
One of many ways that Hurricane Katrina has acted as a great equalizer is how it left everyone with a bad case of chronic stress -- with physical and mental symptoms that range from mild mood swings to severe depression. "Stress is a demand for more energy; it's a new burden on you," says French Quarter psychiatrist Douglas Greve. "Here, it's so disruptive to all of us; we're all experiencing stress, and I think in the next four to six months we're going to see a real increase in mental illness. I've already seen it."
Greve expects three main problems to emerge among New Orleanians: anxiety disorders, depression and substance abuse. "People can't concentrate; they're jumpy, irritable, they're very tense. I've also seen some very serious depressions. These vary from people who became depressed after what happened [to] patients who had previous episodes of depression but now they're much worse -- suicidal," Greve says. "The third thing I've seen is alcohol abuse -- everyone reports that [their drinking] has gone up significantly. Most people will get over it and go back to the way they used to drink, but some will develop a problem."
Addiction counselor Samantha-Hope Atkins, founder of the HopeNetworks and WeRecover support networks, says she has scrambled to get people into substance-abuse treatment since the storm. "In total, we have sent almost 100 people to treatment in various places across the country," Atkins says. "Many of the treatment centers paid for individuals to travel to and from their facilities.
"I wish we could have done more, as five hospitals are shut down in the city, and many returning are facing personal crises that too often they believe a bottle of booze or pills will heal." Atkins points out that the mental-health system was already overtaxed before Katrina, and she worries that people in need of drug or alcohol treatment will simply be thrown in jail. "I pray not," she says. "We do not have widely available help to both the insured and uninsured struggling with this."
Greve's appointment schedule has been booked solid lately. He's worried that mental-health resources in metro New Orleans are too limited now to serve such a needy population. "I understand that about 20 psychiatrists have left the area," he says. "Before Katrina, there were already waiting lists of people to get in to see a psychiatrist.
"So if you have 20 leaving or even 15, it's going to have an impact."
Cathleen Fleming left her job as a psychiatric nurse after Katrina. She says most of her former co-workers "are pretending everything is normal." As for herself, "I'm completely depressed, and then having states of euphoria since Katrina," Fleming says. "I've had the worst nightmares of my life since Katrina too."
In non-disaster situations, people generally list their jobs as one of their biggest sources of stress. In post-Katrina New Orleans, where residents across the board have major personal issues, job strain is just another problem on an already long list.
But it's a big one. Those who are employed here tend to be working long hours, with skeleton crews and more demands than normal. "The challenges being faced at work are exacerbated," says New Orleans therapist Michelle Longino. "People are just trying to hold on and get through the day. Their stress levels are so high they're spinning out. I hear that so many times in work places."
Even so, job performance is often the last thing to suffer after everything else falls apart. "What happens, particularly with men, is that they can go to work and make themselves do the work, but when they leave they can't function," Greve says. "Suicidal thoughts intrude, and they're tired of being depressed." About half of Greve's patients are doctors and other health-care workers. He says in some cases, the personal and professional burden of such demanding jobs has become unbearable. "Most people don't act on suicidal thoughts," he says, "but I've noticed a lot of suicides in the medical community ... and I'm seeing residents now, who were doing well prior to Katrina, [who] have developed significant depressions."
When it comes to discussing their state of mind these days, New Orleanians tend to get very honest very quickly.
Uptown resident Krista May ticks off recent issues, which she calls her "stress sandwich." "Loss of appetite. Nervousness. Took up smoking again. Periodic shaking of hands. Insomnia. Aversion to loud noises [and] quick movements. Very antsy when I'm a passenger, rather than the driver, in a car."
Locals report wild fluctuations between optimism and despair, patience and frustration, gratitude and rage. Relationships suffer as couples react to stress-inducing factors (or "stressors") in conflicting ways. "I've heard about a lot of relationships that are no longer -- no longer engaged, no longer dating," says Rebecca Hinojosa, who's living in the Garden District and planning her wedding next month. "It's like, if you can make it through this time in your relationship, you're gold." Several people call their emotional life a "roller coaster" and cite ways in which they're just not themselves. "I'm way more sensitive to things in the newspaper," Garden District resident Lesley Nash says. "I'll well up at the saddest little thing or the happiest little thing. I was actually crying at (Times-Picayune columnist) Sheila Stroup this morning."
Stories circulate about Valium and other anti-anxiety pills passed around at parties like after-dinner mints. Area pharmacists are filling prescription after prescription for sleep aids and anti-depression medications. "Ambien and Zoloft are really popular right now!" laughs Debbie Shatz, tending bar at a packed Parasol's on a Thursday afternoon. From behind the bar, Shatz encounters waves of customers moving back into town and she hears their stories. "I know when someone's in the one-week-back phase and who's in the two-week-back phase," she says. "It's not a coincidence that people are going through the same emotions in the same time frames."
For those living here, part of coming home includes the unsettling realization that New Orleans will take a long time to heal. "When we returned for the first time, I was very angry about the fact that the city had made very little progress, comparative to what was broadcast on the news," May says.
Wine retailer Youngblood opened the Sip wine store on Magazine Street along with Jennifer Powell after Katrina. Youngblood says the business became a rallying point for locals -- not just for wine purchases, but also for the shop's weekly tastings and events. "People are coming to those in droves," she says. "A lot of the community is gone, and they just want to be around other people."
Youngblood can also attest to the initial reaction to re-entry into the city: "In the beginning you were in shock. Now, not much is happening and I think the stress of that is getting worse. The unknown is worse than the known. It's the slowness of things that's getting to me the most."
New Orleanians who relocated have a different set of frustrations. They're homesick, living in unfamiliar areas, working at new jobs, hyper-sensitive to comments about New Orleans and Louisiana, worried the rest of the world has forgotten about Katrina, and cut off from their city, communities and culture.
Tracy Saunders, a Broadmoor resident, is living in Colorado while she waits to hear "something definitive" from insurance agents about her flooded home. She's been back to New Orleans twice. "I really can't decide which is worse: being there surrounded by sad, shell-shocked people trying to get their lives together under very difficult circumstances, or being in a distant state where Katrina is practically out of the news now, and no one understands the magnitude of what we have all gone through," she says. "I am worried about the prospect of rebuilding. When will the levees be fixed, and how can I possibly afford the new, undoubtedly higher insurance rates?
"Being relocated is also a challenge," Saunders continues. "I'm having to learn my way around town, I don't know where the simplest thing is, they don't sell liquor in the grocery stores here," Saunders jokes, "and at times it gets pretty damned cold! ... I try to remain positive and I know that others have it worse than me, but sadness and depression are still part of my daily existence."
"Survivor guilt" seems ubiquitous among those affected by Katrina, wherever they are. "I feel that most people are probably much worse off than me, and I shouldn't really complain at all," says Dan Eberhart, a recent Tulane Law School graduate who had been in the workforce only three weeks before Katrina hit. He's unemployed and living in Phoenix, studying for the Arizona bar exam. "I'm mostly OK," Eberhart says, "but one of my friends is a mental wreck. She's from Port Sulfur and her town is gone. She randomly starts crying all the time. We'll be at dinner and she'll start crying and go outside and sit in the car for two hours. If you ask her what's wrong she just shakes her head."
Others are getting the impression that people don't want to hear anything except stories about desperation and tragedy; anything less just isn't as interesting. "I sometimes feel like I don't have a right to talk about how I'm feeling, because on the outside I'm doing pretty well," says Morgan Kennedy Skilling, who moved away from New Orleans after her Mid-City home flooded out. "Perhaps we're not quite as dramatic as the poor people still living in shelters or motels or trailers."
Laura Drumm, living with her mother in San Antonio, is among the population of "part-time" New Orleans families -- her husband is here trying to restart their small business while she's in Texas with their two kids. "One day I feel hopeful and think that returning to the city is the right decision, the next I can't get out of bed," she says. "Some days I just play Scrabble on the computer. It's all I can manage."
With financial troubles looming, Drumm fears she's lost control of her life. "I think I often sleep because I feel so frustrated and just want the hours to pass," she says. "I am a go-getter and there isn't anything to 'go get' right now."
Though living in the aftermath of a massive catastrophe may be new to most of us, it's hardly unique on a global level. Large-scale disasters occur often enough that mental-health researchers have had plenty of opportunities to learn how people react after their city or region has been demolished by natural or man-made disasters.
It may help to know that all our "abnormality" appears to be pretty normal, at least according to research. One study of several "disaster populations" -- including flood and hurricane survivors, war-torn communities and the people living around Three Mile Island and the World Trade Center in New York -- found that the most common psychological effect on the people was post-traumatic stress disorder (PTSD). This was followed, in order of prevalence, by depression and then generalized anxiety disorder (GAD). Affected people also reported an increase in drinking, smoking and other drug usage. The study, "Range, Magnitude and Duration on the Effects of Disasters on Mental Health," was published in 2002 and updated this year after the Indian Ocean tsunami. "What these various events share in common," wrote psychologist and study author Fran Norris, "is their potential to affect many persons simultaneously and to engender an array of stressors, including threat to one's own life and physical integrity, exposure to the dead and dying, bereavement, profound loss, social and community disruption, and ongoing hardship."
But PTSD probably won't be the most common after-effect of Katrina, according to local mental-health experts. That psychiatric disorder generally occurs among people who survived life-threatening conditions or were exposed to intense life-and-death situations. During and after Katrina, most local residents weren't here and didn't suffer trauma of that magnitude.
"There are the people who went through what most of us did -- evacuation and displacement, and then returning to chaos and no sense of normalcy," says St. Charles Parish Hospital psychiatrist Erik Whitfield, who works with war veterans and other PTSD sufferers. "Then you have the Ninth Ward folks and the people who stayed through the storm and had to get out as everything crumbled -- and the cops and the firefighters and the health-care workers -- and their experience is different. They had all the problems we had, because they all got displaced, but they also went through something else on top of it. That's very important."
PTSD is marked by flashbacks and nightmares of the trauma; sufferers have trouble sleeping and tend to isolate or withdraw from friends, family and society. The disorder often occurs in tandem with other physical and mental-health problems, especially anxiety and depression. Those suffering from PTSD often find it hard to function in a family or a relationship or at their jobs. "With PTSD, you're dealing with severe impairment," Whitfield says.
Mental-health professionals in New Orleans have generally done a good job targeting those most at risk for PTSD; after the storm, hundreds of psychiatrists, psychologists and social workers came to Katrina-ravaged areas to provide emergency treatment to those who had seen the worst of the worst. These days, it's those who are suffering less acute symptoms that are flying under the radar. "As psychologists, we expect everybody to feel unsettled and out of sorts and to be grieving," Whitfield says. "Our city basically nearly died, and there's a whole grieving process going on with that, even for the people who made it out very well and who are living in New Orleans relatively unscathed.
"People are still under distress," Whitfield continues. "Their friends are gone, their jobs are different, the fabric of their lives has fundamentally changed. Even people who were more or less normal before the storm can adapt in an unhealthy way post-Katrina."
Research does point to some encouraging signs. In most cases, according to the Norris report, "symptoms declined, at least predominantly, over time." Local mental-health professionals agree that most New Orleanians will indeed recover from the effects of chronic stress, many without intervention. Natural stress relievers such as exercise, socializing, or participating in favorite hobbies and interests are enough of a cure to help the majority.
For others, improvement will require outside help -- mainly in the form of medication, therapy or both. Generally, people are urged to contact their doctors if they experience problems so disruptive they're interfering with basic living. "Some people have the perception that asking for help is a sign of weakness or craziness," Longino says. "While some of us are feeling crazy, I think that's a typical reaction to the abnormal situations that we've faced. What's really courageous is to ask for help. If you're not sleeping, get something from the doctor to help you sleep."
Since moving here, Longino has been active with the 3-year-old New Orleans Bayou Steppers Social Aid & Pleasure Club. She is currently reaching out to members of New Orleans' traditional social aid and pleasure clubs and affiliated groups, trying to get them to return. Reviving cultural traditions, she says, will be crucial for the city's recovery. "I'm trying to bring attention to the importance of bringing those tradition-bearers back home."
When city officials announced that Mardi Gras 2006 would indeed roll, residents viewed it with mixed emotions. Krista May says she considers the plan a waste of money. But, she adds, "It may be one step toward healing for many."
Small business owner Laura Drumm, in San Antonio, says it helps her to think about others who have survived worse than Katrina. "It's been said, and I believe this has some truth to it, that we're a spoiled society always taking our mental temperatures," she says. "People of other times, and current folks in certain countries don't have this luxury."
One thing that appears to help is the fact that everyone here has experienced Katrina in his or her own way, and we're talking about it -- to friends, family, strangers. "When people start to share their experience, there's a sense of community around it and it can be helpful to the healing process," Longino says. "You see it here, in the grocery line or in the bank line, in bars and restaurants. People are talking.
"People from other places don't necessarily understand what we are going through here in New Orleans," she says. "Finding people to talk to is really important."
So we've got that going for us. It also makes stress easier to take if we can blame a memory lapse on "Katrina brain" or a major weight gain/loss on the new "Katrina diet."
At least everyone around here gets it.
Where to Turn Here's a list of phone numbers for counseling and mental-health resources:
Algiers Child and Adolescent Behavioral Health Services: 432-8965
New Orleans Adolescent Hospital, Central City: 897-4741
Associated Catholic Charities: 835-5007
Family Services of Greater New Orleans: 361-0926 (West Jefferson); 733-4032 (East Jefferson): 985-893-1025 (Covington)
Jefferson Parish Mental Health Clinic: 349-8833
LSU New Orleans Clinic: 897-8558
River Oaks Hospital: 733-CARE
Jewish Family Services: 831-8475
Covenant House: 584-1111 or (800) 999-9999)
Or, dial 211 for mental-health referrals