Tuesday, August 30, 2011

After Hurricane Katrina, Years of Post-Traumatic Stress #p2 #tcot

from http://www.theatlantic.com/national/archive/2011/08/after-hurricane-katrina-years-of-post-traumatic-stress/244029/

flood.jpg

Reuters

In 2003, I relocated to New Orleans from California, and two years later, I was living in a neighborhood called the Bywater on a street named for a saint who was flayed alive, six blocks west of the Industrial Canal that would flood the city's Lower 9th Ward. Two blocks from the Mississippi River, I rented half a shotgun -- an architectural style popular in New Orleans that gets its nickname from the fact that a person standing at the front door can fire a shotgun directly out the backdoor.

On August 26, 2005, Hurricane Katrina barreled into the Gulf of Mexico. By August 28, it had grown from a Category 3 hurricane to a Category 5 hurricane on the Saffir-Simpson Hurricane Scale with maximum sustained winds within its eyewall clocking in at 175 m.p.h. On the morning of August 29, the cyclone -- now a Category 3 with sustained winds of 125 m.p.h. -- made landfall near Buras, Louisiana, a small community located at the bottom of the toe of Louisiana's boot-like shape.

From there, the storm swept across St. Bernard Parish, St. Tammany Parish, and east of New Orleans. Continuing north, it slipped over the Louisiana-Mississippi border, and on August 30, it weakened to a tropical depression over the Tennessee Valley. The resultant storm surge produced massive destruction across multiple states, and New Orleans' levees were breached catastrophically, flooding an estimated 80-percent of the Crescent City. The hurricane left 1,836 dead and hundreds missing.

The day before Katrina made landfall, I fled the city, ending up in Lafayette, Louisiana, with a dozen other evacuees. Together, we looked on in paralyzed horror as the city flooded on the TV screen. The Louisiana Superdome became a refugee camp, New Orleans residents waited on rooftops bearing signs asking to be saved, and the dead lay uncollected in the streets. The storm's damage tally would exceed an estimated $80 billion. When it became clear none of us would be going home anytime soon, we left one by one, heading to points across the country.

When I did return to New Orleans, the city was ravaged, its great oak trees broken, its buildings crumbling, a refrigerator stranded on a dark sidewalk like a ghost. My neighborhood was deserted. A sign on the front of the house where I had lived indicated the roof shingles, which had come off during the storm, contained asbestos. I was in the 20 percent of the city that hadn't flooded, but portions of the roof had come off during the storm. 

Inside, the rain had spawned black, green, and yellow mold that crawled the walls. I could see the sky from the living room through the exposed wooden slats of the structure's bones. The ceiling was in the bed. In the backyard, a towering pecan tree that had stood for probably 100 years had been uprooted from the ground and tossed aside like a toothpick by a bored giant.

I took the boxes and my papers from the mostly undisturbed kitchen. From the rest of the house, I picked and chose from the things that didn't appear to have mold or asbestos on them. The following day, I drove out of the city. There was a boat in the middle of the street. The houses gaped, slack-jawed and empty-faced. I drove across the eastbound span of the Twin Span Bridge over Lake Pontchartrain, and parts of the westbound span of the bridge were simply gone. I drove an hour through a destroyed forest, and when I looked up in the sky, I tried to imagine a thing so big that it could destroy so much. 

*            *            *

Six months later, the shock had worn off, and I was numb, dead, like a plug disconnected from a socket. Somewhere along the way, my brain's neural circuitry had been overloaded. A fuse had blown, but I could not find the fuse box. I grew increasingly unable to think well, then to think at all. Broke, I took a job as a waitress, and life became something I witnessed through the wrong end of a kaleidoscope. I was disconnected, enraged, anxious. At night, I would fall asleep, then jerk awake moments later, my arms flailing as if warding off an oncoming attack.

In my dreams, the city was always flooding, even though I had missed the flood. I withdrew from the world. Sometimes I wondered if I was dead, suspended in a kind of posthumous existence in which everything appeared to be real but was a hallucination. It was hard to discern the root cause: Hurricane Katrina, the nervous breakdown I'd had in early 2005, the reporting I did as a journalist in the years prior covering the adult movie industry. Or, perhaps it was some inherent, unseen weakness in a malfunctioning brain that I could not see but that controlled me.

Over time, I would get better, but it would take several years, and, even then, there would be relapses. On October 13, 2009, four years after the storm made landfall, frustrated by a work-related problem, I walked from the living room of my apartment and into the kitchen. I stopped in front of a cabinet, rocked back on my heels, and slammed my head into the cupboard in front me as hard as I could. Immediately thereafter, I smashed my hand into the neighboring cupboard. In the wake of what had happened, I stood there, reeling.

In a paper called "Posttraumatic Stress Disorder and Memory," Dr. Bessel van der Kolk, a clinical psychiatrist who has studied PTSD for over three decades, explains how it works. "Ordinarily, memories of particular events are remembered as stories that change and deteriorate over time and that do not evoke intense emotions and sensations," van der Kolk writes. "In contrast, in PTSD the past is relived with an immediate sensory and emotional intensity that makes victims feel as if the event were occurring all over again." Simply put, one experiences a traumatic event but is unable to integrate it into the story of his or her life.

Why did I develop PTSD while some whose lives were more greatly devastated by Hurricane Katrina did not?

According to van der Kolk, it depends on whether or not one dissociates from the traumatic event. If the event is never fully experienced, it fails to be integrated into a "past-tense" narrative, leaving the survivor living in the shadow of a memory-in-limbo -- an experience playing over and over again on an internal JumboTron with no remote control. As a result, some disconnect emotionally; others fail to remember at all. "For example, traumatized people may know what has happened to them, but they may have no feelings about it," van der Kolk adds. "Conversely, people may act disturbed without knowing what makes them behave that way."

This past July, I was asked to appear on National Public Radio's "Talk of the Nation" to discuss the White House's decision to send condolence letters to families of servicemen and servicewomen who commit suicide while deployed in combat zones.

During the program, the conversation turned to post-traumatic stress disorder and some of its symptoms: hyper-vigilance, flashbacks, emotional numbness, night terrors, anger, depression, anxiety, and an exaggerated fight-or-flight response. The host, Neal Conan, asked me about my personal experience with PTSD, and I attempted to explain what it was like. I said that it was like looking at life through a pane of smoked glass. I told him that you become "emotionally dead."

After the show aired, I received an email from Brad Fleegle, 27, a Marine corporal and Iraq War veteran who lives in Portland, Oregon.

"I've often told people that I feel like there's a glass barrier between myself and everyone else," his email read, in part. "I can see them, but I can't connect and communicate with them. I am alone in a small glass box, seemingly within the world but actually removed from it."

Not every combat veteran emerges from war with this sense of dislocation. For some, an extreme life experience -- war, trauma, a natural disaster -- can give their lives new meaning. After the hurricane, I relocated to Virginia, where, working on a story for the local newspaper, I interviewed J.R. Martinez, a then-22-year-old Army corporal from Shreveport, Louisiana. Martinez had suffered burns over 40 percent of his body when he drove a Humvee over a landmine in Karbala, Iraq, and was trapped inside. 

At a fundraiser where he was helping raise money for other veterans injured in Iraq and Afghanistan, Martinez pulled off his knit cap to show me the breast implant that was embedded under the skin of his skull to expand the skin, which would be grafted onto other, scarred parts of his body. I suggested that when he was done with it, he donate the breast implant to a stripper who had only one breast implant, and we laughed. At the time, Martinez had undergone over two-dozen surgeries. For the most part, he was cheery and upbeat. It seemed through what had happened to him, he had found his purpose.

In 2010, I started interviewing combat veterans and launched The War Project. Some of the veterans I meet are struggling with their experiences; others are not. They have been to Iraq, Afghanistan, and sometimes both. On one end of the spectrum is Hart Viges, an Army mortarman-turned-conscientious objector who had a religious revelation during a post-deployment screening of "The Passion of the Christ" and now dresses up like Jesus, walking around town holding a sign that reads "JESUS AGAINST WAR." On the other is George Zubaty, who deployed to Afghanistan in 2002 and Iraq in 2003 and has the cool unflappability of a politician-to-be. Zubaty told me, "All the times when I shot at somebody in Iraq, it never really struck me as being something that I was gonna internalize as some kind of, like, great metaphysical wrong."

It's been six years since Hurricane Katrina made landfall and two years since I slammed my head into a cupboard on purpose. Over the years, I've come to understand those who witness stories bigger than themselves have a responsibility to tell their stories and keep telling them. It's through this process that we come to terms with what happened, and, in doing so, we are able to move on, even as we look at the past. It's a way to keep from dissociating, to weave our memories more firmly into the stories of our lives.

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