Will Katrina survivors need brigades of grief counsellors?

Along with the National Guard, an army of grief and trauma counsellors is bearing down on the people uprooted by hurricane Katrina. But is that what they really need?

What does it feel like to lose your home, job, community and city, all in one hit? What if the same disaster that swept those things away also took the lives of family members or friends, perhaps as you looked on helplessly? What if you are living in emergency accommodation with thousands of other refugees and have no idea when or how you will have anything like a normal life again?

These are the questions that strain the imagination and tug at the heart as our television screens nightly confront us with the refugees and survivors of hurricane Katrina. Above all, what can be done to comfort these people—particularly those who, like a black family who spent days shut in their marooned house with their dead mother, have suffered the worst experiences?

While most of us ponder these questions with awe, others already have their answers and are marshalling psychological support for the victims. Trauma experts, death educators and grief counsellors are responding in force to a great tide of human need that will continue to rise even as the floods recede. Or so it seems. A Google search on "trauma counselling" linked with Katrina yielded 43,000 results. They included a downloadable journal "for processing and recording your trauma experience" and a podcast discussing how to respond to survivors.

These efforts and many others more substantial are, of course, well-intentioned. But how useful are they? Are the displaced and bereaved souls sheltering in superdomes at risk of prolonged trauma and lasting psychological damage if they do not have immediate, expert help to "release" their experiences?

Maybe not. A psychiatrist writing in the New England Journal of Medicine after the recent London bombings notes: "There have now been more than a dozen controlled trials in which people who have been involved in accidents and other traumatic events have been randomly assigned to receive or not to receive such counselling. The results have shown conclusively that such immediate psychological debriefing does not work. Those who received it were no better off emotionally than those who did not. Worse, the better studies with the longer follow-up periods showed that receiving such counselling actually increased the likelihood of later psychological problems."

In fact, says the writer, Professor Simon Wessely of Kings College London, "the people who seemed to be harmed by this intervention were those who had been especially upset at the time—precisely those who one might think ought to be treated. So whereas immediate post-trauma counselling may reassure the rest of us that something is being done, it does not actually help those who receive it."

This point of view is supported by what happened -- or didn't happen -- after 9/11. As the New York Times pointed out, " There were more psychotherapists and mental health agencies per square mile than anywhere else in the country" -- or in the world, for that matter. But few people went knocking on their doors after the disaster. New York Academy of Medicine researchers found only a very slight increase in the number of New Yorkers who had seen a mental health professional. "But the increase was not clinically significant," said researcher Joseph A. Boscarino. ''We expected higher use rates."

A few moments' reflection on our own experiences of emotional shock, or the experience of others, reveals why. The first thing we have to do when confronted with a sudden death, diagnosis of illness, financial disaster or the like, is "take it in", not spit it out. The harder the blow the longer it will take to recover from initial numbness and get the feel of it. It is natural, in the face of adversity, to suffer a bit in silence.

The idea that we need to talk about everything all the time seems to be dictated more by the theories of certain professionals and needs of the media ("Don't move the camera until you see the lip quiver and the tears start to roll!") than the needs of the traumatised.

Some of us may spill the beans quickly, but whenever we do talk it is unlikely that we will want to confide in a stranger, however expert. We naturally turn to family members, friends, colleagues, our priest or pastor—or, in the case of an event like Katrina, to those we have shared the disaster with and who are a bit stronger emotionally than ourselves.

What the people uprooted by Katrina need most from those outside their community, and what will boost their mental health, is the practical assistance that is now pouring into the region and that ranges from tents and stretchers to scholarships and "hurricane buddies" for students affected by Katrina who are enrolling at colleges.

Eventually they will return to their wrecked homes or settle in new communities and rebuild their lives. For most of them, the demands of daily life will push grief into the back ground, and healing will come with the help of factors like religious faith, or simply the passage of time.

Others, less resilient, may need expert help. In England, according to Wessely, those directly affected by the July bombings were to be followed up by mental health services after six weeks, screened for signs of stress disorders and offered therapy. This timing, he says, was found effective in the aftermath of the 1998 bombing in Omagh, Northern Ireland.

In a world that is never long without some kind of disaster, and where robustness of character, family support and faith all seem to be in decline, there is clearly a place for professional counsellors who can make up to some degree for these deficiencies. But their tendency to appear at the scene of every tragedy, even everyday ones like workplace accidents and the death of a schoolmate, suggests a confusion about their role and about human nature.

Like September 11 and July 7, Katrina is teaching us that people are generally more resilient than they are given credit for, and that families and ordinary support systems do work for them. This is evident as last week's stories of anger and desperation over the handling of the emergency give way to stories of bravery, generosity, ingenuity, humour, faith, stoicism or just plain resignation.

All these qualities are at least dormant in the average citizen, although it may take a disaster to drag them out of some of us. Indeed, there are signs that people even relish the opportunity to rise to the occasion. It would be too bad if that process was forestalled by someone bent on turning us into victims.

Carolyn Moynihan is deputy editor of MercatorNet