Katrina's Emotional Damage Lingers

For the professionals on the ground here, David's tale is all too familiar.

"New Orleans is a very special place where people exist on very thin circumstances," he said haltingly. "I was one of those people."

During the first week, from a relative's home in Texas, he watched televised images of his beloved New Orleans descend into a dark, violent wasteland. "I said, 'My God, who destroyed my city?' " he recalled. "I went into shock."

On a recent day, as David's wait to see a physician stretched past two hours, he paced in and out of the still-hot Louisiana sun, dragging on a Marlboro he bummed off another patient. He is both dapper and disheveled -- his wide-brimmed hat and polished shoes odd accoutrements to his soiled shirt and heavy wool trousers.

"I'm one of those people who just got hit real hard. I'm very scared," he said, his voice barely audible, his face hidden beneath the hat. "I'm scared because I don't have any identity anymore."

He drew sustenance -- financial, emotional, intellectual and spiritual support -- from all that this historic, jazz-loving, slightly down-and-out melting pot of a city had to offer. Everything familiar -- his favorite clubs, Charity Hospital, funky shops, fellow artists and paying customers -- is gone. A borderline alcoholic who took anti-anxiety medication, David, now nearing 60, fears that his landlord is about to evict him and that he has run out of family and friends to lean on. The combination of sadness, guilt and despair has prompted him to consider suicide.

"Being here right now, this exact moment, is one of the most painful moments of my life," he said.

David went to the tent complex inside the convention center because the MASH-style unit here is his only real option. Of the 534 psychiatric beds in the metropolitan area, the region is down to fewer than 80, said Charles Hart, manager of the behavior medicine center affiliated with West Jefferson Medical Center. And for those lucky enough to be placed inpatient, "discharge is a real problem because there's no place to send anyone" for ongoing outpatient care, he said.

Susan-Anne Henry, a psychiatric nurse practitioner at East Jefferson General Hospital, called 21 facilities in search of a bed for one severely ill patient. "The reason I stopped at 21 was I ran out of facilities to call," she said.

Yet keeping psychotic patients in the emergency department creates a backlog and often exacerbates her patients' condition. She was recently forced to keep one patient in the ER for 37 hours. "The next day, when I returned, he was worse," she said.

So deep and widespread is the emotional damage that Cheryll Bowers Stephens, head of the Louisiana Office of Mental Health, likens Katrina's impact to the trauma of war. The military presence -- tanks on city streets, soldiers in camouflage, the constant din of helicopters overhead and armed checkpoints -- over a prolonged period of time made Katrina "a different type of disaster than we have seen previously," she said.

Therapists are especially concerned about first responders and colleagues who witnessed so much suffering firsthand.

Many police officers report nightmares, family tensions and having "short fuses," said Howard J. Osofsky, chairman of the psychiatry department at the Louisiana State University School of Medicine. Riding in an elevator recently, someone asked what day of the week it was, prompting a response from one officer that Osofsky will never forget. "He said, 'I know what day it is. Every day is the same day; it's the day after the hurricane.' "

Osofsky's great fear is that as more residents return to nothing -- no home, no car, no job -- nothing except a life insurance policy, they will opt for a "rational suicide," he said. "In their minds, the question is whether they are better off dead or trying to take care of their families."

David asks himself similar questions every day.

"I'm tired. I'm so weak. I don't have any strength, and I don't have any will," he said. "Being here is kind of like being in prison."