Wednesday, June 21, 2006

These two pieces, published today in the New York Times, go hand in hand--one, about the rise in the rates of suicide and depression in New Orleans, and the other about a total lack of plan.

June 21, 2006
A Legacy of the Storm: Depression and Suicide

NEW ORLEANS, June 20 — Sgt. Ben Glaudi, the commander of the Police Department's Mobile Crisis Unit here, spends much of each workday on this city's flood-ravaged streets trying to persuade people not to kill themselves.

Last Tuesday in the French Quarter, Sergeant Glaudi's small staff was challenged by a man who strode straight into the roaring currents of the Mississippi River, hoping to drown. As the water threatened to suck him under, the man used the last of his strength to fight the rescuers, refusing to be saved.

"He said he'd lost everything and didn't want to live anymore," Sergeant Glaudi said.
The man was counseled by the crisis unit after being pulled from the river against his will. Others have not been so lucky.

"These things come at me fast and furious," Sergeant Glaudi said. "People are just not able to handle the situation here."

New Orleans is experiencing what appears to be a near epidemic of depression and post-traumatic stress disorders, one that mental health experts say is of an intensity rarely seen in this country. It is contributing to a suicide rate that state and local officials describe as close to triple what it was before Hurricane Katrina struck and the levees broke 10 months ago.

Compounding the challenge, the local mental health system has suffered a near total collapse, heaping a great deal of the work to be done with emotionally disturbed residents onto the Police Department and people like Sergeant Glaudi, who has sharp crisis management skills but no medical background. He says his unit handles 150 to 180 such distress calls a month.

Dr. Jeffrey Rouse, the deputy New Orleans coroner dealing with psychiatric cases, said the suicide rate in the city was less than nine a year per 100,000 residents before the storm and increased to an annualized rate of more than 26 per 100,000 in the four months afterward, to the end of 2005.

While there have been 12 deaths officially classified as suicides so far this year,
Dr. Rouse and Dr. Kathleen Crapanzano, director of the Louisiana Office of Mental Health, said the real number was almost certainly far higher, with many self-inflicted deaths remaining officially unclassified or wrongly described as accidents.

Charles G. Curie, the administrator of the federal Substance Abuse and Mental Health Services Administration, said the scope of the disaster that the hurricane inflicted had been "unprecedented," and added, "We've had great concerns about the level of substance abuse and mental health needs being at levels we had not seen before."

This is a city where thousands of people are living amid ruins that stretch for miles on end, where the vibrancy of life can be found only along the slivers of land next to the Mississippi. Garbage is piled up, the crime rate has soared, and as of Tuesday the National Guard and the state police were back in the city, patrolling streets that the Police Department has admitted it cannot handle on its own. The reminders of death are everywhere, and the emotional toll is now becoming clear.

Gina Barbe rode out the storm at her mother's house near Lake Pontchartrain, and says she has been crying almost every day since.

"I thought I could weather the storm, and I did — it's the aftermath that's killing me," said Ms. Barbe, who worked in tourism sales before the disaster. "When I'm driving through the city, I have to pull to the side of the street and sob. I can't drive around this city without crying."

Many people who are not at serious risk of suicide are nonetheless seeing their lives eroded by low-grade but persistent feelings of sadness, hopelessness and stress-related illnesses, doctors and researchers say. All this goes beyond the effects of 9/11 and the Oklahoma City bombing, Mr. Curie said. Beyond those of Hurricanes Andrew, Hugo and Ivan.

"We've been engaged much longer and with much more intensity in this disaster than in previous disasters," he said.

At the end of each day, Sergeant Glaudi returns to his own wrecked neighborhood and sleeps in a government-issued trailer outside what used to be home.

"You ride around and all you see is debris, debris, debris," he said.

And that is a major part of the problem, experts agree: the people of New Orleans are traumatized again every time they look around.

"This is a trauma that didn't last 24 hours, then go away," said Dr. Crapanzano, the Louisiana mental health official. "It goes on and on."

"If I could do anything," said Dr. Howard J. Osofsky, the chairman of the psychiatry department at Louisiana State University, "it would be to have a quicker pace of recovery for the community at large. The mental health needs are related to this."

The state estimates that the city has lost more than half its psychiatrists, social workers, psychologists and other mental health workers, many of whom relocated after the storm. And according to the Louisiana Hospital Association, there are little more than 60 hospital beds for psychiatric patients in the seven hospitals that remain open here.

Because of a lack of mental heath clinics and related services, severely disturbed patients end up in hospital emergency rooms, where they often languish. Many poorer patients were dependent on a large public institution, Charity Hospital, but it has been closed since the storm despite the protests of many medical professionals who say the building is in good condition. Big Charity, as the locals called it, had room for 100 psychiatric patients and could have used more capacity.

"When you don't have a place to send that wandering schizophrenic directing traffic, guess what? Law enforcement is going to wind up taking care of that," said Dr. Rouse, the deputy coroner. "When the Police Department is forced to do the job of the mental health system, it's a lose-lose situation for everyone."

"When the family comes to see me at the coroner's office," he added, "it's a defeat. The state has a moral obligation to reinstitute this care."

Sergeant Glaudi and others said some people struggling with emotional issues had no prior history of mental illness or depression.

The symptoms cut across economic and racial lines; life in New Orleans is difficult and inconvenient for everyone.

Susan Howell, a political scientist at the University of New Orleans, conducted a recent study with researchers from Louisiana State to see how people were coping with everyday life in the city and neighboring Jefferson Parish. Ms. Howell managed a similar survey in 2003.

"The symptoms of depression have, at minimum, doubled since Katrina," she said. "These are classic post-trauma symptoms. People can't sleep, they're irritable, feeling that everything's an effort and sad."

The new survey was conducted in March and April, and canvassed 470 respondents who were living in houses or apartments. Since they were not living in government-issued trailers, it is likely that they were among the more fortunate.

Jennifer Lindsley, a gallery owner, also feels the sting of missing her friends.

"When you can't get ahold of people you used to know, it leaves you feeling kind of empty," Ms. Lindsley said. "When you try to explain it to people in other cities, they say: 'The whole world is over it, so you've got to get over it. Sorry that happened, but too bad. Move on.' "

Some people have decided to leave solely because of the mood of the city.

"I'm really aware of the air of mild depression that pervades this entire area," said Gayle Falgoust, a retired teacher. "I'm leaving after this month. I worry about living with this level of depression all the time. I worry that it might affect my health. I know the move will improve my mood."

And now, one of the causes:

June 21, 2006

The New Orleans Muddle

It has been almost 10 months since Hurricane Katrina battered the Gulf Coast, and there is still no redevelopment plan for New Orleans. Congress has passed the emergency relief bill, and President Bush has signed it into law. Billions of dollars are headed the city's way. Leaders in New Orleans and in the state capital of Baton Rouge will have only one chance to get it right. There are no more excuses for local officials, no more pointing toward Washington. It is time for southeastern Louisiana to rebuild itself.

Yet Adam Nossiter reported this week in The Times that it will be six months before a "master planning document" answers the questions foremost in the minds of residents, like which neighborhoods will return, where rebuilding will be encouraged and where returning residents will have to make do without city services. That is totally unacceptable.

In large swaths of the city, houses still sit empty, block after block. In many places, trash and flood-ruined automobiles have yet to be cleared away. These wastelands provide hideouts for criminals, the perfect breeding ground for the kind of violence that erupted over the weekend when five teenagers were shot and killed.

If the city's open wounds are left to fester, it will begin to rot from the inside.
The city's police department is close to its prehurricane size, protecting a population that is less than half of what it was before the storm. Yet Mayor Ray Nagin has now felt compelled to request — and the governor has granted — a National Guard force to help keep the peace. This does not bolster our confidence that the city will be able to govern itself.

New Orleans has its own way of doing things and says it doesn't want to be told by outsiders in what size and shape it should be reborn. That is fair enough, but only if local officials are living up to their responsibilities. Right now, the people of the city are being held hostage to whims and foot-dragging, their lives on hold as they wait for their leaders to make decisions — decisions that should have been made months ago.

If there is one individual who needs to step up more than any other, it is Mayor Nagin. His city needs a leader more than a politician in this difficult time. Now that Mr. Nagin has been re-elected, it is time to start spending the political capital his victory earned him. His legacy will not rest on how many people like him, but on the effectiveness of the reconstruction and the safety and well-being of residents in the years to come.

New Orleans needs its mayor to speak difficult truths — like telling the residents of a vulnerable block that they will have to rebuild on safer ground. Right now, people don't know if or where to build their new walls. They deserve answers. They have waited long enough.


My own brand of depression has come in the form of intense spells of rage that are not warranted by the situations that bring them about. Yesterday I had a bad one, and I spent most of the dinner hour crying into my Indonesian fried rice, wanting badly to be comforted by my husband, who had just been the focus of my rage. Who could blame him for eating his own food, ignoring my grief, and then leaving the room to organize his office? (He seems to focus his own anxieties into spells of organization and miscellaneous projects.)

Because Simon lost his job after the storm, we have been living on extremely limited funds. Lucky for us, our landlord has not raised the rent, and so we made the decision last week to purchase a second car (mine was totalled by a drunk driver as it sat parked in front of our house... another long and depressing tale). We applied for financing through the UNO federal credit union and were told that if we purchased a car five years young or less (our 2001 Civic made the cut), we would get 5.99% financing. All seemed well.

But yesterday, when Simon returned from taking the car's purchase order to the bank, he told me that in fact the rate was 12.99%. We needed to purchase a 2002 or younger, he said. We would need to contact the car dealer to try to get a better rate.

I was angry. Really angry. But I contained my anger and argued (quite logically, I might add) that the credit union KNEW we were applying for a loan for a 2001 Civic (this is true,) and now that we had f-ing agreed to BUY the car they were telling us no?!

I called customer service for my credit card. They are offering 3.99% for the life of the balance on major purchases. Sounds great, but it means that the initial balance--at 15.99%--sits on the card longer and longer (you pay off the balance at the lowest rate first, of course.) So really we are simply lengthening the term of a 15.99% rate loan (sorry if I am boring you). No way out yet.

But it was the next news that got me. After taking a shower, Simon announced calmly that his account--the one whose plans were meant to be deposited in our new account--was overdrawn, which means, well, that he's running on empty. We recently opened a joint account and had agreed to spend our money responsibly. I think we've both been making an effort, too. But I was so angry that he had overdrawn his account that I just HAD to say some mean-spirited crap about the irresponsibility of it. (I mean, Christ, does ANYONE really need to be told this? No! So why did I have to say anything?)

Well, Simon reacted as anyone would--defensively. Did I want to talk blame, he asked (referring to my small mountain of debt--which I have been gradually chipping away at and NOT adding to, thank you very much!) I didn't.

No--but what I did want to do was scream at the top of my bloody lungs at him. I'm talking crazy, gutteral scream. Not just a yell; an all-out, blood-curdling SCREAM. It feels good when it happens, really. A kind of release--like a tiny hole in a big old dam and so that water comes f-ing SHOOTING out. A release like when you're angry and you scream into a pillow. Only I thought, screw the pillow, and subbed my husband.

I don't even remember what I said--or screamed--but I do remember how I felt: I wanted to hurl my plate of hot food at him. I wanted to break shit. I wanted to physically hurt something or someone. Preferably something that would make a noise as it went. Maybe his skull.

This is bad. This is the kind of behavior one gets asked about at one's shrink. ("Have you felt like hurting others or yourself?") For the first time I can recall, I would answer, "F--k YES!"

What is this rage all about?

It is the buildup of anxiety. It is trying to be and feel okay in an environment that is entirely broken. It is dealing with a very VERY uncertain future--and being newly married and afraid. It is resenting Simon for not having a job--and the city for not being able to provide a good one. It is stress and worry and now it is driving a car that we will pay for, yes, but which will end up costing us at least two grand more than we budgeted. It is knowing that no matter the outcome, it will, for a very long time, NOT be okay.

As I cried over dinner, I told Simon that I was sorry for my misdirected anger, but that I couldn't seem to channel mine like he does. Cleaning and organizing don't do it for me. What does it for me is comfort. It's being told we will be okay. It's BELIEVING we will be okay because there is an OKAY in sight.

But right now, here, in New Orleans, there isn't an okay in sight. There is no okay on the horizon, either. There is endurance and these occasional spells of rage, punctuated, occasionally, by hopeful (or is it really hopeless?) celebration of An End--The End (and we hope, a happy one)--that we cannot see.

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