Hurricane Victims Cope With Trauma

Psychological Impact of Hurricane Katrina

Dr. Jerry Jacobs , director of the Disaster Mental Health Institute at the University of South Dakota and the American Psychological Association's consultant during Asia's tsunami, was online Thursday, Sept. 1, at noon ET to discuss the psychological impact of Hurricane Katrina and coping with trauma.

The transcript follows.

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washingtonpost.com: This discussion will begin momentarily. We apologize for the delay.

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Dr. Jerry Jacobs: Thank you for joining me today.

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Dallas, Tex.: I have some immediate family near Baton Rouge, LA and they are severely crippled from Katrina. They have no power right now and food supply is very low. I am halfway there right now in Shreveport, LA to deliver a truckful of supplies, food, etc. My question is should I be concerned about the reported carjackings and looting going on? I am fixing to travel South on I-10 through Baton Rouge and despite road conditions being okay I am worried about the situation I am entering. Have you heard about any criminal activity/road conditions in that area?

Dr. Jerry Jacobs: Please be certain to check with state police before attempting to enter the area. They can advise you about your plans.

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Dr. Jerry Jacobs: We have been having some technical problems, which appear to be resolved now. I have been trying to reply, and will work through your questions as quickly as I can.

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Seattle, Wash.: How do I accept not being able to contact all of my family members to find out if they are okay? As well as lifelong friends. I moved away a few years ago but I went to school with the same people from kindergarten through high school. I know my immediate family is fine, but this fear in my gut of not knowing or being able to help is really tough.

Dr. Jerry Jacobs: This is a realistic and common feeling after such an event. Even in the aftermath of the Olympic bombing in Atlanta - a fairly small event - more than 10,000 people called the Red Cross to ask about their loved ones. In this situation it may take longer for folks to contact their loved ones. Try not to focus on the event to much - put your energy into other activities. Another good strategy is to become involved in disaster relief effort. Volunteer with the American Red Cross. Chapters across the nation are providing immediate training for those prepared to help. Being involved can definitely help with those sorts of feelings.

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Washington, D.C.: Dr. Jacobs, I have a friend from New Orleans staying with me. She came on vacation and then wasn't able to return. She is, understandably, in shock but talks about returning to retrieve her things and I get the feeling she thinks it will be sooner than later. How realistic do I need to be with her at this point? She doesn't seem to understand that the city as she knew it is gone for what seems to be the next few months. I know it's easier for me to process this since it's not happening to me, so should I just let her work it out on her own or at some point do I have to be more firm with her regarding what's really going on? Thanks.

Dr. Jerry Jacobs: The most important support we can provide is a warm, caring presence. Be ready to listen when she is ready to talk. Note that I am not saying it is good to force her to talk about it, but just to be ready to listen when she is ready to talk, If she attempts to return to the area without checking with authorities - that would be a time to be more direct. You may want to encourage her not to watch too much television coverage. On the other hand, watching the coverage with her may provide an opportunity for some discussion.

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Boston, Mass.: For those of us with family members in Southern states like northern Ala., Ga. and S.C., how do we handle the guilt of feeling "thank God mine are ok".

Dr. Jerry Jacobs: First, it is important to recognize that these feelings are ordinary reactions. In the disaster field they are known as "survivor's guilt". Don't focus too much on the events, and try to maintain a fairly normal routine. On the other hand, it can help to become involved in the relief effort. American Red Cross chapters across the nation are conducting immediate training in various aspects of Disaster Response. It's just neighbors helping neighbors, and the people in the affected area are going to need a lot of help.

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Atlanta, Ga.: Hi and thank you for this discussion. My question is more of a general nature, with regards to coping with trauma. A friend of mine recently experienced the violent death of the mother of his two young children. She was gunned down in the middle of a cafe while having lunching with her kids. The gunman eventually killed himself. There was no relationship between the killer and the woman. My friend has only recently resumed part-time working and and takes medication to ease his bouts of weeping. He would prefer not to take the drug since one apparent side-effect is intense headaches and numbness The kids are being taken care of by their grandparents in the meantime. He is reluctant to tap his insurance for counseling, and has only seen a psychologist for 2 sessions because of the out-of-pocket costs.

Do you have any suggestions of any books or literature that I can obtain? Also, he tends to retreat into solitude when he is visibly upset and oftentimes is reluctant to "talk about" his grief. What role should family and friends play in such instances?

Dr. Jerry Jacobs: The grief process is a lengthy one whether caused by disaster or other traumatic events. Give the person time and space to grieve. Provide a warm caring presence, and as I've said in some other replies, be ready to listen when he is ready to talk. -- Don't push him to talk, just let him know you're there for him. -- Regarding medications, have him talk with his physician about them. There are too many variable to be able to begin to discuss such issues here.

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Washington, D.C.: Hello, I was just chatting with some co-workers about what to do to help with the destruction brought by Katrina. We had an idea, is there a way to "adopt" a family in need so to help them get back on their feet with clothing donations, money, food and such. A few of us would love to pool our money and resources together to help a family in need. We have already given to the Red Cross but feel we need to do more. Thanks.

Dr. Jerry Jacobs: I don't know of any such process for adopting a family. Giving contributions to the American Red Cross is a wonderful way of helping. This will be an incredibly expensive disaster relief operation, and American Red Cross Disaster Response is 100% a gift of the American people. It is not a government funded process. It's neighbors helping neighbors. If you feel a need to do more, consider getting trained in disaster response at your local Red Cross chapter. Your employer may be willing to release one or more of you to participate in the disaster relief operation. More and more companies are doing just that.

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New York, N.Y.: Hasn't there been a lot of controversy regarding the optimal response for work with those who've experienced a trauma? Don't people disagree over whether it's helpful to have people go over or "process" the experience?

Dr. Jerry Jacobs: There has, indeed, been a lot of controversy. I think it is the result of some bad practices by people without appropriate training for this work, and a lack of understanding about what disaster psychology is. It is NOT appropriate to try to force someone to talk about their experience, or to process their feelings on some fixed time schedule. Rather, the key is to be prepared to provide psychological support when the person decides that they are ready to receive it. That's true for the professionals as well as the public.

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London, U.K.: How does an individual cope with the accumulated emotional baggage from experiencing numerous disasters and tragedies over a period of years? Each seem to compound one another ...

Dr. Jerry Jacobs: Indeed, stress is cumulative, like the proverbial straw that broke the camel's back. It is important to process accumulated stress. This can often be done in discussions with friends and family. But working with a good mental health professional that understands traumatic stress is also a valuable choice.

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Florida: I am curious about the outbreak of gun-related violence in New Orleans. I can understand the mounting frustration with the situation, but I can't quite grasp what the reasons are for people to shoot at the personnel who have been deployed to help evacuate and feed those who are stranded. It seems strange to me, but I can't even imagine what it must be like to be trapped in those conditions.

Dr. Jerry Jacobs: In situations in which people feel that their own lives or the lives of their families are threatened, sometimes societal boundaries break down. The reports you are describing probably include a combination of opportunistic behavior - people that would have done the same thing if a blackout occurred - and people who are feeling a sense of desperation to protect their families. In other situations in which such behavior has occurred, order was restored as soon as people became convinced that food, water, and shelter would be provided and would continue to be available.

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Washington, D.C.: What advice would you offer to help college students deal with the fact that they may not be able to return to their universities? My brother attends Tulane University and I don't think it has sunk in yet that he may not be returning. Even if he does return, the town and the university that he loves will be forever changed. Any thoughts? Thank you.

Dr. Jerry Jacobs: Give him time to process what is taking place. People are amazingly resilient - most people possess enormous amounts of psychological strength. But it does take time to understand the impact of events in our lives. Again, I would urge you to be warm, caring, and supportive, ready to listen when he is ready to talk. There are other universities, if that does prove necessary, and new futures to work out. But it takes time to accept the "new normal".

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Arnold, Md.: Is there a need or means for non-mental health professionals to get trained and help with counseling, etc.? In other words, what are some things that Average Joe/Jane can do to help affected people deal with their grief, trauma, and so forth?

Dr. Jerry Jacobs: There is definitely a role in psychological support for non-professionals. Research shows, in fact, that most people derive their psychological support from friends and family. The American Red Cross is just discussing the implementation of a national program of "psychological first aid". This basically involves teaching the general public how to provide psychological support for one another, and how to know when a person would benefit more from a mental health professional. Some parts of the country, including parts of Minnesota and Nebraska, have already started to implement these ideas. Hopefully, psychological first aid will become at least as common as physical first aid and CPR.

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Peterborough, Ontario: What physical, psychological and spiritual changes need to take place to re-build devastated areas?

Dr. Jerry Jacobs: The scope of that question is certainly beyond my expertise and this format. The rebuilding of these affected regions, and the healing of the people will require a tremendous will and tremendous financial and interpersonal resources. We have seen communities in other parts of the world with similar devastation that have rebuilt. There are many areas that can serve as inspiration.

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Falls Church, Va.: I have old friends who are okay but have nothing to go back to. Are there going to be predictable stages to this trauma - kind of like accepting a death. As we deal with friends who have survived the horrible loss of everything, can we expect them to go through different things?

Dr. Jerry Jacobs: There are stages of reactions, but they describe overall processes much better than individual ones. The comparison to grieving over a death is a fair one. But people move through those stages in a variable way. Everyone has some days that are more difficult than others. It is important to understand that this is a long process. Just because someone seems fine one day, don't be surprised if they are struggling the next. Being present to them is the best advice I can give. Let them know you are genuinely there for them when they need someone to lean on.

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Charlotte, N.C.: I have no relatives or friends in the affected region. But I am trying as best I can to handle the stress and anxiety I am feeling. I think it is caused by the relative uncertainty that this event has caused especially now as the ripple effects are hitting close to home i.e. gas prices, etc. I know I am fortunate that this is all I have to deal with but it certainly affects how I go about my "routine" as it were. I went through the same thing post 9-11 and have adjusted to the new "normal". Any suggestions you can offer?

Dr. Jerry Jacobs: It sounds like you understand the process. It is unsettling to see devastation of such magnitude, and to realize that even with the wealth and resources of the United States it can be difficult to get aid to everyone in need. Try to keep a familiar routine. Try not to focus too much on the events associated with Katrina. (I'm not saying to ignore it, just to limit how much coverage you watch.) -- And a new "normal" will emerge with time, just as after the terrorist attacks of September 11.

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Annapolis, Md.: Hello, Doctor, I've been living in New Orleans for the past five years, and last year I was accepted into a Masters program at Tulane. I had a job and a nice apartment. I evacuated on Saturday with just a couple changes of clothing. Now I'm living back with my parents, I have no money, no car, no photos or books or the family jewelry that had been entrusted to me. I'm having a really hard time coming to terms with the fact that I may have lost everything, and that it will be at least two months before I can even begin to think about going home. What can I do? I feel like my life has completely gone out the window.

Dr. Jerry Jacobs: These situations can shake us to our very foundations. I am glad you evacuated safely, and that you have a family to turn to at this point. The stress of such losses can be overwhelming. Try to be gentle with yourself. Allow yourself to grieve. You can find some handouts to help you understand the response at http://www.usd.edu/dmhi/publications.cfm. This is clearly a heavy setback, but a new path will emerge with time.

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Donating to the Red Cross: Thank you for taking questions. I am reluctant to donate to the Red Cross as I hear many people complaining that the money they give to the ARC doesn't make it's way to their intended recipients. Your thoughts?

Dr. Jerry Jacobs: Every charity in the United States is audited by an independent agency every year. I think it has been 14 years in a row now that the American Red Cross has been judged by those independent audits as the single most effective charity in the United States. The last one I saw said that 92 cents of every dollar donated went directly to disaster victims, a much higher ratio that any other organization. There were similar accusations by the NY Times after the September 11 attacks. Again, independent auditors concluded that not a single dime was misdirected. It is not the only effective charity in the nation, but it is the most effective, and the only one mandated by the United States Congress (an unfunded mandate) to respond to disasters in our nation.

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Ames, Iowa: I saw a report on CNN that most of the people desperate for help are the poor people (it said those with money mostly got out). I also saw in Lt. Stone's chat that someone safe in Wyoming was already criticizing the victims. Does racism and class enter into this?

Dr. Jerry Jacobs: Racism and class do enter into the political discussion. It is true that a greater percentage of impoverished people require assistance after disasters, but the trauma of a loss of these dimensions cuts across race, gender, and SES. It is an unfortunate waste of energy for people to focus on the racism. No reasonable person can deny the magnitude of what has taken place, or the enormity of the recovery effort facing the nation.

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Greensboro, N.C.: I know that there is no "right way" to handle these types of things, but I've tried to take the approach that this too shall pass and that given time, things will return to some semblance of normalcy. Am I just completely delusional or might I be on the right track?

Dr. Jerry Jacobs: Time does allow the opportunity to process one's reactions to these events. For those who are directly affected, however, who have had a loved one die, or lost a home, or perhaps even a city, in addition to time there is an enormous amount of psychological work that needs to occur to reach a new normal.

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Fort Myers, Florida: As someone who endured Charley last year, I can identify with the frustrations being exhibited by otherwise civil people. These became particularly acute when we realized that FEMA was sending aid to counties that weren't even hit, and some local officials seemed ill-equipped to handle the situation.

What's going to happen when over a million people find out that levees broke in part because of budgetary neglect, and that the President was at a vacation photo-op at the time this disaster struck?

Dr. Jerry Jacobs: Hopefully, we as a nation learn that we need to invest in our future through effective disaster preparedness, including maintenance of dikes, levees, pumps, evacuation routes, etc. We can be much better prepared, but such preparation is not as exciting as having a newer car in the driveway or a bigger television. In all fairness, however, it is important to realize the scope of this event. Some events can be overwhelming no matter how much preparation one makes. -- With regard to the president being on vacation when it struck, where should he be. The president has communications equipment and administrative staff with him or her to be able to respond to any situation that arises wherever they are.

Let's hope there is a good, honest review of the response to this situation, and effective steps taken to improve our ability to respond in the future.

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Washington, D.C.: How does one "get over" a situation. I have serious post-traumatic stress over a near death experience and sometime out of the blue my mind starts to relive the whole experience. It starts with hearing waves crash - even in my office - and my brain just goes on auto-pilot and relives the whole experience. I am fine. I am alive. How do I stop my mind from reliving this horrible event?

Dr. Jerry Jacobs: I would encourage you to consult with a mental health professional that is familiar with traumatic stress. There are very effective and fairly straightforward therapeutic techniques that are quite effective for post-traumatic stress disorder. Check with the American Psychological Association if you don't have another source that can refer you. They will be able to tell you someone in your area that provide you with the best therapy.

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Dr. Jerry Jacobs: Thanks for the involvement in the discussion today. Sorry for the technological glitches at the beginning. Please remember to be a part of the solution...

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