MULTIMEDIA: See, hear survivors' storiesPART 1: Life bleak or hopefulPART 2: The struggle to find loved onesPART 3: Spirit of community wiped outPART 4: Daily obstructions bog down lifePART 5: Rebuild or demolish?HOUSTON: 100,000 displaced survivorsNEIGHBORHOODS: Some areas irreparable?HEALTH: Mental health problems aboundMore Katrina anniversary coverage
NEW ORLEANS — Billy Bob Hopson finds his therapy in collecting and tinkering with the rusted lawn mowers, mangled wall clocks and other debris that his neighbors toss on the curbs as they clear wreckage from Hurricane Katrina.
"I'm trying to keep my mind busy," he said, hefting junk into his battered trailer. "I've got a hurting thing. ... I lost more than I can handle. It's like someone cut off your arm. You keep looking for your arm, and you can't find it."
The "hurting thing" is a mental health epidemic afflicting hundreds of thousands a year after Katrina struck the Gulf Coast. Suicide rates in New Orleans have nearly tripled, a mental health hot line in Mississippi is swamped and the region's few remaining psychiatrists are overwhelmed with cases of depression, post-traumatic stress disorder and related problems.
By several estimates, half a million residents need mental health care.
"We really have a mental health crisis, and we've had it for months," said Dr. Janet Johnson, a psychiatrist at Tulane University in New Orleans. Most psychiatrists have left, she said, and major hospitals with mental health beds have closed, as have wards for substance abusers.
A few cases have hit the headlines in New Orleans: Two police officers shot themselves last September, a prominent pediatrician hanged himself in November, a news photographer snapped earlier this month and taunted police to kill him.
Those are only the most visible signals of massive and often hidden trauma.
In response, officials in Louisiana and Mississippi are revamping health-care systems, including mental health services. Private help is stepping in too.
A project funded by the W.K. Kellogg Foundation, for example, aims to train parents, clergy and counselors to ease anxiety. Regional officials have asked Congress for clearance to use crisis-counseling money for long-term treatment.
Most people along the Gulf Coast are handling the "hurting thing" the way Hopson does, treating themselves as best they can.
Hopson's strategy is to call forth pre-Katrina memories in hopes they can overpower flashbacks of a hellish scene at Charity Hospital in New Orleans. A year ago he'd sat at the hospital with his wife, who had colon cancer. After Katrina hit, they and others were trapped for days with no power and little food while looters attacked and snipers fired on the hospital.
When boats evacuated patients, Hopson begged to go with his wife. Instead, he was sidetracked to a plane that landed in San Antonio. Eventually, they found each other before she died earlier this year.
Hopson tried talking to a doctor about his fear and grief, "but sometime it can't come out," he said.
"I just got to keep busy," he concluded.
Keeping busy worked initially for most people, said the Rev. Bill Terry at St. Anna's Episcopal Church in New Orleans, where scores of survivors have come for counseling.
"You could be heroic in the face of the crisis," Terry said. "There were many things to do that seemed to be good."
Later, though, the rush of the rescue gave way to the grind of life in a wrecked region where corpses were uncovered as recently as last month, 50 million cubic yards of debris remain to be removed, rows of houses stand vacant and the list of the missing sticks stubbornly above 100.
"We started to wake up and realize that this is the way it's going to be for a long, long time," Terry said. "There is not one person living in this city who isn't impacted and experiencing some chronic fatigue, some depression. ... There are many, many children who become very clingy when it rains."
Experts estimate that 44 percent of the children who were relocated to trailers and hotels throughout the region experienced anxiety, depression and sleeping problems, according to a recent report in the Journal of the American Medical Association by psychiatrists at Louisiana State and Duke universities. Two-thirds of the women who cared for the kids had symptoms of psychiatric disorders.
It took months for the full extent of the problems to surface, the report said. A crisis center in Mississippi that deals with depression and anxiety saw a spurt in calls after March 1, the report noted.
Hospitals that would have been best equipped to meet the crisis - Charity in New Orleans and Veterans Administration facilities in Mississippi - had been destroyed.
As of June 14, only two psychiatry beds were available within 25 miles of New Orleans. Despite unprecedented substance abuse, there were no inpatient detoxification beds closer than Baton Rouge, 75 miles away.
Throughout the region, the report noted, "mental health services are lacking ... when they are most needed."
In New Orleans' battered neighborhoods, residents have their own terms for their mental states: "Katrina Mind" and "The New Normal."
Dawn Robinson's version of the New Normal explains why trauma is deepening for many in the city.
Few residents have returned to Robinson's shattered Eighth Ward neighborhood. She wants to leave, but her parents have too much invested in their brick home. While they stay in Atlanta, Robinson, 35, is fighting government and insurance bureaucracies for money to repair a home she hopes to sell. She's also battling insomnia and depression.
"What is this fight for?' she asked wearily. "There is nothing left in this neighborhood. Yet we can't leave. We're trapped."
She slept in her 1990 Acura for weeks, then in the moldy house, using candles for light. She couldn't get a FEMA trailer until May because she needed permission to move it across a neighbor's property and it took months to find the neighbor, who's in Mississippi.
Robinson rings the trailer with rat poison. Animal lovers keep leaving food for dogs that may have been stranded, she said, and she can't convince them that they're feeding only rats.
A Humvee with two National Guard soldiers rolled along Robinson's street one recent afternoon. By night, though, looters move in. So Robinson sleeps with a handgun tucked into her waistband.
Her experience, repeated throughout hard-hit areas, forces a twisted question: What's a normal response to an insane situation?
"It's not normal to have a city broken this long," said Johnson, of Tulane. "You have to say a lot of the mental health problems we are seeing are normal."
PART ONE: Life can be bleak or hopeful PART TWO: Survivors struggle to learn fates of loved ones PART THREE: Spirit of community wiped out PART FOUR: Daily obstructions bog down residents PART FIVE: Citizens pressured to rebuild or demolish HOUSTON: Home for 10,000 displaced survivors NEIGHBORHOODS: Some areas seem irreparable HEALTH: Mental health epidemic afflicts thousands MORE: Full Katrina anniversary coverage