"I've been thinking the last couple days the best thing to do is die."
The man, speaking on a dull monotone, was slumped in a chair inside the steamy convention center here, waiting to see a doctor. He didn't want to come to the makeshift hospital, but a friend insisted.
"I'd hardly had a drink in years," said the man. "Right after the hurricane hit, I just started drinking. If I stop drinking, the pain becomes so great it's unbearable."
In these months after Hurricane Katrina, it is not hard to find people like David, a quirky, debonair, fragile artiste who asked that his last name not be published. They can be seen walking on deserted streets with glazed eyes. In grocery stores and offices, they inexplicably break into tears. Police officers confess to counselors that they are fighting more with spouses and yelling at their kids. Many turn up at local hospitals searching for a neat explanation for pain the likes of which they have never felt before.
Every disaster has its second wave, the emotional scars that linger after the initial blow. But the impact from Katrina -- which displaced nearly 2 million people, eradicated entire neighborhoods, separated families and reopened racial wounds -- is far beyond what mental health experts in this country have ever confronted, they say.
In the extreme cases -- and there have been many -- they have hanged themselves, overdosed and put guns to their heads. The number of suicides in neighboring Jefferson Parish is more than double what it was in the fall of 2004. In the first days of the crisis, coroner Robert Treuting saw five suicides in three days. In the two months since, there have been 11, compared with five a year ago. Two New Orleans police officers have taken their lives, and at least one more has attempted suicide.
"It's like living in the Twilight Zone," said Candace Cutrone, who as assistant coroner for mental health in Orleans Parish has the overwhelming task of evaluating psychiatric cases for local hospitals. "The whole world changed overnight."
Orleans Parish coroner Frank Minyard said he does not have statistics for the city, because many deaths -- including nine by gunshot -- remain a mystery. He knows of at least one woman who killed herself recently. New Orleans emergency personnel have responded to at least six suicides and nearly two dozen suicide attempts since Katrina. The tightly knit community of Academy of the Sacred Heart, the Rosary, is coping with two suicides, headmaster Timothy M. Burns said. Shortly before Thanksgiving, a woman with young children took her life. Last week, the father of a Sacred Heart student was buried.
And with so few medical services available in the region and the slow pace of rebuilding, experts expect the psychological toll to grow far worse.
"I think the whole city's grieving," said Alvin M. Rouchell, chairman of the psychiatry department at the Oschner Clinic Foundation in neighboring Jefferson Parish. "I've seen a lot of post-traumatic stress disorder. People who had emotional disorders before the hurricane have a worsening of conditions, and some people for the first time are having panic attacks, depression, PTSD."
Calls to a national suicide-prevention hotline skyrocketed from the typical 100 to 150 a day to more than 900 in the immediate aftermath of Katrina before leveling off to about 210 a day now, said Charles G. Curie, administrator of the federal Substance Abuse and Mental Health Services Administration.
In a clinical survey of Orleans and Jefferson parishes, the Centers for Disease Control and Prevention found that 45 percent of the residents were experiencing "significant distress or dysfunction" and 25 percent had an even "higher degree of dysfunction," said Dori Reissman of the CDC. Nearly half of those interviewed reported feeling isolated, and a quarter believe at least one family member needs counseling. On Wednesday, the Bush administration plans to distribute public service announcements to 11,000 media outlets advertising a confidential toll-free number for individuals or family members who may have been psychologically impacted by the storm and its aftermath.
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."