Psychiatry - July 2008 - (Page 35)

CASE 2—THE MENTAL HEALTH CHALLENGES OF MANY RETURNING NEW ORLEANS RESIDENTS “If we weren’t already the screwiest crowd in America, we sure are now.” Times-Picayune columnist James Gill wrote the quote above in describing the plight of many New Orleans residents as they returned to their homes in late 2005 and 2006.18 His sentiments have since been borne out by a number of studies examining the mental and emotional health of returning New Orleans residents— most without significant pre-existing psychiatric issues. These studies include the on-going door-to-door survey of over 1500 residents performed by the Kaiser Family Foundation that found 18 percent of returning residents facing serious mental health challenges.18 In another study—this time a telephone survey done in early 2006 of over 1,000 displaced residents of the Gulf Coast—Wang and colleagues19 found evidence of mood or anxiety disorders in 31 percent of those surveyed. Most distressing about Wang’s study results is that just a fraction of those with symptoms, whether serious or not, were receiving any form of treatment. It was in this environment in New Orleans that the plight of TimesPicayune photographer John McCusker occurred. On August 6, 2006, Mr. McCusker was seen driving erratically in New Orleans and was pulled over to a street corner by police.20 When officers approached his car, McCusker rolled his window down and repeatedly said, “Just kill me, get it over with, kill me!” When the police did not shoot him, McCusker put his car in reverse and pinned one of the officers between the rear bumper of his car and his police cruiser. Although lethal force was indicated, the responding officers instead shot at McCusker’s back tires. McCusker then drove off and sped down St. Charles Avenue, purposely knocking down a few of the ubiquitous roadside construction signs that appeared after Katrina. Police eventually pulled him over at another intersection several blocks away. McCusker then had to be pulled out of his car and subdued by a Taser device as McCusker continued to resist police and beg the police to kill him. When media outlets became aware that Mr. McCusker was a TimesPicayune photographer—and part of its 2006 Pulitzer Prize winning staff21—his arrest became widely reported.13,22,23 Even the manufacturer of the Taser, at that time under its own public assault by the American Civil Liberties Union for scores of deaths associated with its device,13 put out a press release that gave the Taser great credit in being able to subdue and arrest McCusker, rather than killing him.22 McCusker was very distraught at the scene, which alerted police to his mental health issues. Furthermore, McCusker was known to several police officers through his work as a photographer for the TimesPicayune. In fact, he had taken many of the highly publicized photographs of Katrina’s impact on New Orleans.23 McCusker was arrested and charged with battery of a police officer and aggravated flight from an officer.24 He also underwent psychiatric care through Orleans Parish Prison. In the days that followed his arrest, many of the stressors that McCusker had been experiencing became generally known. In an eerie coincidence, the current issue of the American Journalism Review featured McCusker and other TimesPicayune staffers in a tribute to their continuing efforts to cover Katrina’s effects on New Orleans.25 The article discussed that McCusker had wanted to be a photographer for the TimesPicayune for decades and could trace his own New Orleanian lineage back to the days of colonial Spain. McCusker had helped the TimesPicayune to document New Orleans’s darkest moments after Katrina and described his experience this way: “You have to understand the depth of the horror that the city was… Tens of thousands of people on the freeways stranded. The children begging for food and water. The looting at the Wal-Mart. It was of biblical proportions.”26 In the months after Katrina, McCusker had become increasingly depressed and irritable, and frequently broke into crying fits. He sought psychotherapy, eventually going three times a week. He also took a leave of absence from the newspaper to help him emotionally recover. Although his leave certainly helped him, McCusker had also just learned that his insurance was not going to pay to rebuild his destroyed home.27 Furthermore, McCusker reportedly had an adverse reaction to psychotropic medication he had been put on to help him deal with his stress during his absence from work.28 Following his arrest, there were declarations of support from people representing a wide swath of New Orleans. Mr. McCusker had no prior arrests and his family was well respected in the city. Furthermore, nearly all New Orleanians could easily identify with McCusker’s frustration with his insurance company and his symptoms of posttraumatic stress, now formally diagnosed by mental health experts assigned to evaluate him in prison. As Lt. Governor Mitch Landrieu told 8,000 members of the American Psychological Association gathering at that time in New Orleans for a convention, “You don’t need an expert—a psychologist or psychiatrist—to see that the people of Louisiana are hurting.”25 Boston Herald editorial columnist Rachelle Cohen best captured the zeitgeist of New Orleans by writing, “Everybody has a story, and many are weary of the daily battle just to exist.”29 In December, 2007, more than a year after the initial incident, McCusker reached an agreement with prosecutors that allowed him to receive probation and the possibility of charges being dismissed in the months to come. McCusker also sincerely apologized in court to the police officer who McCusker had pinned with his car. The presiding judge summarized the view of many when she stated at the end of the hearing, “I think it was a bad [JULY] Psychiatry 2008 35

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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