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However, we should also entertain the more optimistic possibility that the ordeal of Katrina might have had strengthening effects. In response to the current “resilience” vogue in the psychology of trauma, the authors of the Harvard report asked respondents about the fiber of their families, their sense of inner purpose, and their faith in God. Overwhelmingly, survivors of the storm felt that since late August 2005 they had become closer to their families, to their religion, and felt stronger in their sense of capability and purpose. The authors linked the surge of strength and purpose to another major finding that, among those with serious mental illness, significantly fewer thought of suicide after the storm than before. Perhaps, in the new New Orleans, people with mental illness have drawn on a sense of purpose, stronger families, faith communities, and gratefulness for survival even in order to face instability, destruction of their homes and lives, and intensifying symptoms.  This is the story of mental health in New Orleans that the proponents of Louisiana Spirit find credible and hope that this and other “resilience-promoting”, “community-based” programs have played a role in making a reality.

People working on mental health and mental illness in New Orleans will favor one of the above explanations depending on their vantage point. Those who work in the emergency rooms and the hospitals will have witnessed repetitive despair and desperation, while those who have been able to go out into New Orleans, into homes and schools and churches (for example, Louisiana Spirit outreach workers) will have seen not only despair, but also strength and recovery.

The crisis in the mental health infrastructure in New Orleans will slowly, yet painfully, be resolved. By late January of 2007, the state government had announced the opening of new inpatient beds and a new “psychiatric emergency room.” The Metropolitan Human Services District, under new leadership, was putting new outpatient services in place. Perhaps by the time that the disaster psychiatry programs—Louisiana Spirit, and the international NGOs—have left the scene, the New Orleans psychiatric infrastructure will be back to its old troubled but functional form. If this is the case, it will be because the psychiatric system never reached beyond its traditional niche to address the deep well of untreated mental health problems. It will have done nothing to resolve the deep flaws of a system where care is given to the few who find their way to it, and only when they are dangerously sick. The presence of disaster psychiatry in New Orleans, and in America, was, and is, an opportunity to draw on an alternative version of psychiatry, grounded in prevention, resilience and outreach. So far, it has been an opportunity missed. International NGOs are accustomed to operating in countries where there is no psychiatric infrastructure to speak of, and in New Orleans, due to lack of coordination, they have functioned as if there were none. But time still remains to bridge this gap, to work to integrate psychiatric patients into the community through bolstering transitional housing and Assertive Community Treatment teams, and to reach into the community to address stigma and strengthen preventive support systems. This will mean transcending the uncertain boundaries of the discipline of psychiatry by asking the question that has faced every person on the Gulf Coast since the storm, “When and where does disorder and crisis fade into the troubles of the rest of life?”

Thomas Cannell is an alumnus of Yale College, Class of 2006. He is currently a graduate student at the University of KwaZulu-Natal in South Africa. The author would like to acknowledge the assistance of Chris Weaver, Elmore Rigamer, Heidi Nuss and Ryan Larrance.