Against all odds

Psychiatrist and disaster expert Carol North inspires patients, colleagues

Carol S. North was camping in rural Missouri with her two Great Danes on Sept. 11, 2001. Shortly after the hijacked planes crashed into the World Trade Center and the Pentagon, reporters started calling. Soon she had been tracked down and brought back to town.

Carol S. North, M.D., professor of psychiatry, prepares interview material for the World Trade Center survival study with Barry Hong, Ph.D., professor of psychology in psychiatry and associate professor of medicine.
Carol S. North, M.D., professor of psychiatry, prepares interview material for the World Trade Center survival study with Barry Hong, Ph.D., professor of psychology in psychiatry and associate professor of medicine.

To understand why the media immediately went looking for North on that terrible day, you have to understand how she makes a living.

North, M.D., is a professor of psychiatry in the School of Medicine and an expert on disasters.

“Disasters happen, and terrorism is growing,” she says. “So we need to be ready for the kinds of problems that survivors encounter. We had worked with survivors of the Oklahoma City bombing, and those results provided a kind of ‘road map’ for mental health professionals who worked with the survivors of 9-11.”

Although other researchers had previously worked with disaster survivors, Washington University investigators were the pioneers in disaster research methods. They began somewhat serendipitously after the flooding and the discovery of dioxin in Times Beach, Mo., in 1982.

Shortly before the flooding, several Times Beach residents had been interviewed for the landmark Epidemiologic Catchment Area (ECA) study that was designed to learn about the prevalence of mental health problems in the United States.

Because the ECA researchers from the University had already interviewed residents, a team of researchers — led by psychiatry faculty member and disaster research pioneer Elizabeth Smith, Ph.D. — was able to study the impact of the Times Beach disaster on mental health by interviewing those same people a second time.

North teamed with Smith in 1987, and in the years since, she has traveled to more than a dozen different disaster sites, interviewed more than 2,000 survivors and analyzed reams of data.

Her first trip was to Indiana to interview the survivors of a plane crash. A military jet hit a Ramada Inn, and although the pilot ejected safely, 10 people on the ground were killed.

Later there was a mass murder in Arkansas and a cafeteria shooting in Texas. There were earthquakes and firestorms in California and the disastrous Midwestern flood of 1993.

Through it all, she has learned a great deal about how disasters can affect psychiatric health.

Some survivors get depressed. But the most common psychiatric effect of a disaster is posttraumatic stress disorder (PTSD). Soldiers can develop PTSD from battlefield experiences; disasters can cause the same problems for civilians.

Most of North’s recent studies involve attacks on civilians. She studied survivors of the 1995 Oklahoma City bombing and found that 45 percent had psychiatric problems in the six months following, with 34 percent suffering from PTSD.

Carol North with her Great Danes in Tower Grove Park.
Carol North with her Great Danes in Tower Grove Park.

Much of North’s current research focuses on the effects of terrorism. She’s mulling over data she collected from survivors of terrorist bombings in Nairobi, Kenya.

North also worked with congressional staffers who were exposed to anthrax. She has also recently received a grant to study Sept. 11 survivors who worked at the World Trade Center.

“Carol is one of the true stars in psychiatric epidemiology,” says Charles F. Zorumski, M.D., the Samuel B. Guze Professor and head of the Department of Psychiatry. “Over the past 10 to 15 years, she has become a national leader in understanding the psychiatric effects of disasters. Unfortunately for all of us, it seems certain that her work will take on increasing importance in the post-9-11 era.”

A miraculous recovery

North says it’s a miracle that she’s even working today.

Late in high school, she became very ill. During her freshman year of college, she was hospitalized and diagnosed with schizophrenia. Medications helped with some of the symptoms, but the side effects were severe.

In spite of the illness, she finished college and even started medical school at the University of Iowa. But her illness worsened her first year and ended up in the hospital again. The University of Iowa didn’t think it was a good idea for North to continue her medical training.

She had been hearing voices. Sometimes the voices told her to kill herself, and she came close to taking her own life. Desperate for some sort of help, North and her family turned to an experimental therapy in which her blood was filtered in a process that might be compared to kidney dialysis.

She details the experience in her inspiring book, Welcome Silence.

“They never demonstrated that the treatment was generally effective,” North says. “There were problems with the research, which eventually was abandoned.”

She received the treatment for 20 weeks. During the second week, the voices suddenly stopped.

That was more than 20 years ago. North hasn’t required any medication or had any symptoms of schizophrenia since.

“I see myself as blessed with a sort of personal miracle,” she says. “It was just against all odds because we know from experience in the field that few people recover or do as well as I’ve done.

“It’s just an experience that is so atypical that I would classify it as fairly miraculous.”

A unique perspective

North’s next miracle came from the late Samuel Guze, M.D.

When she applied to Washington University’s medical school, the dean’s office asked Guze, the former head of psychiatry and vice chancellor for medical affairs, for his opinion. Years later, he talked about his decision with Barry Hong, Ph.D., professor of psychology in psychiatry and associate professor of medicine.

“Sam Guze had always been a champion of people who had mental health problems,” Hong says. “He said Carol’s case was one where as a department and a university, we had to practice what we preached.

“He really championed her cause. He had confidence she would succeed.”

North says it’s a tribute to the School of Medicine that she was allowed to continue her studies.

“It’s important that when patients get better they have the opportunity to pursue their dreams,” she stresses.

Early in her studies, North had considered becoming a small-town doctor or maybe an ophthalmologist. But then she worked as a research assistant doing psychiatric epidemiology and enjoyed it.

She also felt her own experiences gave her a unique perspective.

“One could make the argument that it doesn’t take somebody with a brain tumor to make a good brain surgeon,” she says. “But in some regards, I have a bit of an edge because I experienced the degree of human suffering that psychiatric illness can bring.”

North has devoted her career to the suffering — not only those who have survived disasters but also to the homeless. For a decade, she was the psychiatrist for Grace Hill Neighborhood Services, where she worked with indigent and homeless people.

She even had to dodge bullets on the job. She was at a Grace Hill clinic discussing patient cases with a social worker when a gunfight began outside. They slid out of their chairs and continued working on the floor.

She also made “house calls,” visiting homeless patients in shelters, and occasionally provided services slightly outside of her normal routine.

“I delivered a baby at one of those clinics,” she says. “The primary-care doctor was at lunch, and I was the only doctor there when a young woman decided it was time to have her baby boy.”

A lifelong love

When she’s not traveling around the world to talk with disaster survivors or working with the homeless in St. Louis, North likes to run. A movement disorder has limited her mileage in recent years, but she’s completed two marathons and finished first in an ultramarathon — a distance of about 37 miles.

North and her husband, Richard Olson, met when both were in seventh grade in the town of Clinton, Iowa. They later went to the prom together.

These days, they live with their Great Danes near Tower Grove Park. They own two old houses next door to each other and are slowly restoring them.

Judging by one of their anniversary celebrations, it’s quite a romance. North’s husband always had wanted a yellow Corvette, and after they had eaten their anniversary dinner, the valet pulled up in her husband’s present — the yellow Corvette she bought him.

She says in addition to a romantic heart, there might be something about her past experiences and about working with disaster survivors that makes her want to savor life.

“Disasters are sort of equal opportunity employers,” she says. “They select cross sections of the population. People from all walks of life typically are exposed to a single disaster event, and it’s very compelling to see how such diverse people will respond.

“Interestingly, it’s not all negative. Many people actually tell us about positive effects that have occurred in their lives after these events.”

That doesn’t surprise Carol North. But then again, she’s experienced her share of miracles.