Lillie Sams, Pearlington, Hurricane Katrina and doing well

This piece comes from an interview I did earlier for a series of stories on Pearlington, Ms.,

I was fortunate enough to have met "Sister Sams," a.k.a. Lillie Sams thanks to the kind referral of Rev. Willie Rawls. Sams, who was a great story teller and overwhelmingly hospitable, sat down and gave a lengthy and thorough interview on her Katrina experience.
When I went home and listened to the tape, I was struck with an idea for this blog.
I've long wanted to attempt a "This American Life"-style radio piece, and here is my first go. I've always respected the work that Ira Glass's cohorts do, as well as other great long-form journalism radio shows like WNYC's Radiolab.
However, having now attempted it, I have a deeper respect for radio journalism. Writing journalism is incredibly hard, but truth be told newspaper journalists only really have to worry about words. I'm not going to say it's harder or easier, but radio journalists also worry about sound levels, music, mood, background noise, audio quality, in addition to words.
Anyway, Sams's story relates to post-Katrina mental health in that it is a positive one. She is doing fine, despite having lived through circumstances that have caused many to not be OK. As for why that might be, you'll just have to listen for yourself and let me know. I apologize for the sloppy look of the audio player below. I haven't figured out yet how to neaten it up.
If you cannot play the link because you use a different media player, here is a link directly to the archive that I stored the piece in. You can either download it yourself there or listen to it on their media player. It is about 14 minutes long.

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Equal at last? A beginning to the end of negative stigma?

Before I get to it, I gotta say that keeping up with a blog is a whole lot more work than I thought.
Alright, enough excuses.
Amazingly, the House of Representatives got around to passing a bill that would bring equal coverage to mental health treatment on insurance policies. Um, wow, basically.
Here's the AP story.
Here's the bill itself.
Since I first started talking to mental health professionals regularly, there were two things they all said made their job harder than it had to be:
First and foremost is the stigma. The best analogy I heard is this: When a 12-year-old breaks his leg playing with his friends, he gets cards, visits and special treatment. Mom gives him ice cream, props him up on the couch in front of the television. Family calls on him to see how he's healing.
When a 12-year-old unsuccessfully tries to kill himself, he becomes a pariah. Friends generally avoid him. The subject becomes taboo in conversations around the family. His healing is done in the same kind of isolation that may have driven him to desperation in the first place.
That is, of course, absurd. It is, however, the way we in this society treat it.

The second thing that all mental health professionals constantly talk about is the disparity in reimbursements from private insurance, Medicaid/Medicare and even Tricare, the military's post-service insurance plan. Simply put, a lot of people who need mental health treatment do not get it because they have to pay so much of the cost out of pocket. Mental health treatment providers cannot exactly provide discounts either, with soaring real estate, insurance and energy prices.
It has been a long time since there has been any debate over whether mental health affects physical health, yet it is only now that the government is starting to force insurers to own up to it.
I guess better late than never, no?

Psychological First Aid

The morning after the storm, I wandered west from the Biloxi/Gulfport border towards Long Beach and Pass Christian to do some reporting closer to where the eye of Katrina made landfall and therefore where the destruction was mostly shockingly brutal.
The largest of my (relatively minor) personal challenges post-Katrina was not knowing what to say to everyone else climbing through the ruins, like Kay Love of Pass Christian in the above picture. I knew how to get the information I needed for my stories from people, but I had absolutely no idea how I could help, if in fact I could help at all, those who were genuinely distressed.
When I found out the Red Cross was offering free classes in psychological first aid a few weeks ago, I leapt at it. (In retrospect, I think it is kind of amazing that reporters - and this is coming from someone who went to an alleged top-flight journalism school - are simply not trained in psychological first aid, especially considering how often we deal with people under extreme stress. And, sometimes, we find ourselves and our colleagues under extreme stress.)
I must admit here that until Katrina, I thought knowing how to deal with someone who is psychologically distressed was easy. You know, you think you just pat ‘em on the back, maybe hug them, and they’ll be better eventually.
By the way, this photo is of a former New York City Firefighter working with the Red Cross post-Katrina. He knew what he was doing. I did not at the time.
I think I first realized the depth of my naiveté in comforting those in dsitress when I was reporting the story on Katrina’s victims, namely, on who they all were. While I relied heavily on past reporting, I still spent more than a hundred hours on the phone and in person with grieving mothers, grandfathers, aunts, sons, cousins, and so on. Listening to their distress was more than humbling. It made me feel dumb. I felt dumb because I didn’t know what to say much beyond, “So, when was the last time you talked to him/her?” or “Did they originally plan on evacuating before the storm?”
The various folks who offer psychological first aid guides seem to have a basic common system that they all agree on, with the details and jargon differing. The following is what I think the bare basics are. Of course, I am a layperson and the following is just a basic overview. If you are genuinely interested in becoming proficient in psychological first aid, I strongly suggest getting trained by a professional or at the very least fully exploring the links I provide below. I hope this goes without saying: Someone in extreme emotional distress must be handled with the utmost care and professionalism.

Here are the bare basics of psychological first aid:
Even though the first step might seem obvious, it is not easy: make contact with the person suffering quietly, compassionately and as unobtrusively as possible.
The Veterans Administration training guide actually offers a great line to memorize and use in these situations: “Hello. My name is ___________. I work with __________. I’m checking in with people to see how they are doing, and to see if I can help in any way. Is it okay if I talk to you for a few minutes? May I ask your name? Okay Mr./Mrs./Ms_______, before we talk, is there something right now that you need, like some water or juice?”
As the above introduction implies, the second most important thing is to make sure their most basic needs of safety, food, water and shelter are met. If they are not, do whatever you can to help them be met.
Next, if the person is not calm, help them become calm. If you cannot, find someone who can. Relatives and friends are often the best at doing this.
Now here is where things get tricky. After the person is fed, hydrated, safe and calm (hopefully), you need to know what is wrong.
There are many ways to go about this, but for the sake of brevity here’s the most important phrase to remember: “Would you mind if I ask a few questions?” Never, ever assume it’s okay.
If the answer is no, go find a professional immediately. If yes, proceed with caution and find out if they lost a loved one or a pet, if they were hurt physically, if they’re alone, if they need medication, if they’re feeling guilty or shameful, and finally if they are at all thinking about hurting themselves or others. If the answer to that last one is yes, find professionals immediately. Never ever take that lightly.
Okay, so once you have a basic idea of what is wrong, you better have your homework done and be prepared to offer some practical advice like where counselors or clergy can be sought out, how soon they can expect help from the authorities and government, what the overall situation is, and so on.
Taken as a whole, it seems that, short of being a trained counselor, one of the best things you can do for someone in serious distress is to know what is what. In general, the more knowledgeable you are, the more you can fill in the gaps of uncertainty, the more capable you are of helping.
After Katrina, reporters and editors from the Sun Herald carried stacks of newspapers in their cars to give out to anyone who wanted one. I and many others experienced people getting out of food lines to get a newspaper. So I guess I’m saying that you should basically be a newspaper when you want to help someone in psychological distress.
Finally, kids and adults are different. The previous guide was largely designed to deal with adults. Please seek out and learn the rules for dealing with kids before jumping into something that may be over your head.
There are a lot of resources online dealing with psychological first aid. Here’s three that are good to start with:
This set of guides is from the Veterans Administration. It’s quite thorough. It’s also a little dry, frankly and sometimes has too much jargon, but it is rather interesting.
Here’s a way to get a printable guide from the National Child Traumatic Stress Network. It’s very good and straightforward, but quite lengthy. (That’s not necessarily a bad thing.)
This is a great, short list of what to do and what not to do from the Substance Abuse and Mental Health Services Administration. It also contains some great phone numbers that could come in handy.

Resilience could be relative

I spent two years in Togo, West Africa, with the Peace Corps in a village of about three hundred people on a dusty dirt road about 12 miles from the nearest paved road. There was no electricity or running water in my village, Kollo. Everyone in town survived on subsistence farming and the nearest decent hospital was hundreds of miles away. That is to say that life was often hard for the people of Kollo. Death, crop failure and other traumas came often and unexpectedly. Adding to the general air of unease, one of the area's most powerful witchdoctors was the village chief (who was a really nice guy to me at least) and my little village was famous throughout the country for "curing" severely mentally ill people. That is to say, there were literally mentally unhinged individuals walking around the village in chains (to make them less mobile) at all times.
Shortly after I got back to America, I was having dinner at a friend's parent's house in the Washington, D.C., suburbs, when one of the neighbors asked, "Well, were people happy there?"
While I was there, my memories of the Kollo villagers were not filled with tears, domestic violence, severe alcohol abuse, crippling depressions, and so on. To be sure, sometimes someone couldn't handle the trauma anymore and flipped out. Actually, that probably happened to my fellow Peace Corps volunteers more often than it did Africans.
In general, the Togolese took bad news in stride, and sometimes even found the capacity to joke about it. So I retorted to the questioner: "Well, how many people on this block are happy?"
He laughed, and replied, "Probably not enough."
In my article (FYI, this link will expire in two weeks) in today's SunHerald I try to figure out why most folks in Pearlington say they're doing OK mentally.
Here's a little background on why that does not seem totally plausible, from yesterday's article on Pearlington:
All of Pearlington was submerged during Hurricane Katrina, a circumstance created by its close proximity to the Gulf and the river while sitting directly underneath the eye of the storm. Every building flooded and the community had an estimated average storm surge height of about 19 feet, not counting the wave action.
Before Katrina, Pearlington was isolated, a little lonely, and many locals preferred it that way. After Katrina, that made recovery difficult, to put it mildly.
Yet most folks say they are doing fine, despite the fact that some other areas less destroyed by the storm are generally having a mental health crisis of sorts.
Are they kidding themselves? Is it impossible to see the problem when you are in the middle of it? How could it be that Pearlingtonians (that's not official, FYI) do so much better than so many other Coastians?
Welp, of the many plausible explanations I heard, longtime Pearlingtonian Kevin Hill gave the best one I heard. Again, from today's story:
"Folks are just used to hard times," Hill said. "We're so used to not having, it didn't really strike us that hard."
To bring things back around, I think that Africans deal with hard times so well because they are so used to hard times. For better or worse (probably worse) the thing that amazed me most about Africans was their capacity to absorb suffering. In a related way, so were the people of Pearlington following Katrina. They just went on with their lives, picked up the pieces and moved on. Many have called the ability to deal well with the storm's aftermath resilience. In places like Pearlington, I think it's probably just relative hard times.

Under the eye, is it the stigma?

For those who don't know, little Pearlington, Ms. was literally submerged during Hurricane Katrina. Sitting on the banks of the Pearl River, which divides Mississippi and Louisiana on the Gulf Coast, it had no chance when the eye passed directly over head. The water reached more than 20 feet in some parts, not including the wave action. Amazingly, not that many people died and stories of heroism and miracle saves abound. Pearlington was an isolated community before the storm, on the outskirts of Hancock County and equally close to Slidell, La., as Waveland, Ms. To say the storm increased that sense of isolation is to be generous.
Last week, some folks from the University of Minnesota came down to offer free mental health screenings in Pearlington, Ms. Attendance was sparse.
It got me thinking about the time Memorial Behavioral Health offered free health screenings at their Orange Grove center in Gulfport last fall and four people showed up. It also got me thinking about the time the Resiliency Center in Biloxi offered free Resiliency Training, $250,000 worth, to first responders and two showed up.
Despite the evidence, I'm still not convinced that those things were a result of a negative mental health stigma.
The University of Pennsylvania held a health fair at the Pearlington Recovery Center at which allegedly 300 people showed up. It was a more general health fair, with free medical and dental screenings in addition to mental health stuff.
I will be exploring Pearlington's recovery, both physically and mentally in an upcoming series in the Sun Herald.
To the point of this post: Do you think stigma still prevents folks from getting help, even if its free? In all fairness, those three poorly attended events I mentioned above were not well advertised, and the UPenn one was. Is that all it takes, advertising? Is advertising enough to convince folks to at least talk through their problems? Could the lack of attendance be indicative of a healthy mental health recovery?

What is a Katrina victim?

Wow. Many thanks to those of you taking an interest in this blog. It is already shaping up to be the conversation I thought it would be. Please give me some time to sort through those messages and comments the readers of this blog have sent before I start posting and commenting on them here.
In the meantime, the one thing that really stood out to me from all the initial responses to this blog is all the amazing personal stories. For a split second after Katrina, I thought my storm story was a really compelling one. It took only a little bit of listening after finally making it deep into the profound destruction of Pass Christian and Long Beach on August 30, 2005, before I realized how minor my tale was.
There are certain story lines that many people seem to have followed, with only the details differing. One story I keep hearing over and over again is this one: "My (parent, grandparent, elderly relative, etc.) was doing fine before Katrina. They survived the storm. However, upon returning to their home in (the Pass, the Lower 9, the Kiln, Gentilly, etc.) afterwards, their health started to deteriorate. They stopped (eating, sleeping, smiling, communicating, etc.) Eventually, they died."
I am not a doctor. My understanding of how moods and emotions affect one's physical well being does not go beyond that which seems obvious. (In other words, if you're happy, you're healthy, and vice versa.) However, it seems to me that the subjects of those stories are Katrina victims. Yet their names will never appear on any monument. Perhaps we should call them "non-intuitive storm victims," because they are rarely thought of or even properly remembered in the aftermath by the public at large.
I think non-intuitive storm victims are relevant to this blog because it is usually poor mental health that does them in. I have been able to write about them before, largely because at least one person, John Mutter of Columbia University, is actually trying to figure out who all of Katrina's non-intuitive storm victims are.
Here is his website that is the gathering point for his effort if you think you know a non-intuitive storm victim and want to submit their name. There is also a toll free number you can call: 1-866-511-0436. Leave a message and someone will get back to you.
Here is a short excerpt from the last story I wrote, in September of last year: John Mutter said there are two main concerns that arise when (non-intuitive storm victims) are not considered an "official" Katrina victim. First, there are the lessons to be learned from the storm and only a complete account Katrina's death toll will provide appropriate, accurate lessons for health professionals, first responders and emergency operations personnel. Second, there are the memorials which are sure to spring up, some with names.
Is it fair to leave (non-intuitive storm victims) off those memorials?

To add one more thing: I fear the list of Katrina's non-intuitive storm victims grows all the time. I only hope its growth rate is slowing.

Post-Traumatic Growth (i.e. that which does not kill you...)

In Sunday's Sun Herald the first of a two-part series should appear on a thing called Post-Traumatic Growth. (I say should because I am assuming there will not be a major news event between now and then that will deserve more attention than my stories. It happens sometimes.)
Post-Traumatic Growth is a psychologist's fancy way of saying, "That which does not kill you makes you stronger."
One of the originators of the term is a psychologist from the University of North Carolina at Charlotte called Richard Tedeschi.
Here is one of the more important published works on the subject of Post-Traumatic Growth that he wrote with a colleague for the Psychiatric Times in 2004.
I got the idea to write about this thanks to Ray Scurfield, a PTSD expert based at the University of Southern Mississippi. Scurfield and I met by coincidence at the International Society for Traumatic Stress Studies annual conference. He suggested I attend a lecture on the subject, and it was a fascinating new way to think about trauma.
In more human terms, I am tired of hearing and being told just how bad things are down here mental health-wise, and how difficult it is for folks to handle post-Katrina stress.
In many ways the stories are a response to some of the issues I raised in my last blog post. There have been a barrage of post-Katrina mental health studies released this winter, all of them saying that to some degree or another things are horrible. Very few of the academies and institutions producing those studies have reached out to local treatment provides to help them actually DO something about the problem. Additionally, none have reached out to me, the only full-time mental health writer on the Gulf Coast, to offer possible solutions to the problems they say are bad. (Or even let me know they were going to say in national publications things are bad, but I digress.)
So a story on Post-Traumatic Growth was a start, I thought, at looking past the crisis and into a brighter future for sufferers of Katrina-related stress and disorders. It follows on the heels of another story I wrote for the same reasons about attempts at combining primary care and mental health care in Harrison County, Miss. (More later on that subject.)
Do you know of any others?