We may never know how many people hurricane Katrina killed. But we know this: The victims are going through double grief. They grieve for the family members and friends who have died (post-death grief), for missing loved ones, and countless losses to come, a process called anticipatory grief.

What is anticipatory grief? It's a feeling of loss before a death or dreaded event occurs. Katrina had both parts of this definition and was a dreaded event that killed thousands. As the victims' losses increase their anticipatory grief will also increase. If you had to summarize their lives with one word it would be uncertainty.

Everything is up for grabs.

John S. Rolland, author of "Living Beyond Loss: A Death in the Family," says the emotions associated with anticipatory grief are intense. What's more, these emotions can be total opposites, such as hope and despair. Katrina's victims are on emotional overload. No wonder they have most of the symptoms of anticipatory grief. Here are some of their symptoms.

DENIAL. You hear denial sentences on television and radio every day. "Gulf Coast residents are used to hurricanes." "We thought we could ride out the storm." "The [flood] water will go down soon." The problem with denial is that it can kill you.

EMOTIONAL NUMBNESS. Some victims are so traumatized they have a "flat affect" and display little emotion. Their faces are blank and their body language is minimal. It's as if Katrina wrung everything out of them.

NERVOUS BEHAVIOR. The hurricane victims are nervous because they've lost control of their lives. Who wouldn't be nervous? Kids are expressing their nervousness with hyper behavior, crying, or clinging.

ANXIETY AND DREAD. Katrina's victims ask themselves the same question every day: What will happen next? Kids may fear another disaster, according to The National Child Traumatic Stress Network. Unfortunately, weather forecasts may reinforce this fear.

CHOKED FEELING IN THE THROAT. Some hurricane victims cry easily, others hide their feelings because they must be strong for their families. So they live with a choked feeling in their throats. Besides, if they start crying they might not be able to stop.

CONSTANT SADNESS. Robert Veniga, MD, author of "A Gift of Hope: How We Survive Our Tragedies," says the victims of tragedy often believe things are going to get worse. "Their lives are governed by fears," he writes, "perhaps a fear that they can never again find happiness."

DEPRESSION. Suriving Katrina was hard enough, but now the victims have to face their losses and build new lives. Building a new life takes courage and physical stamina, two things that may be in short supply at the moment. The result is depression.

ANGER. Kids feel insecurity, anxiety, sadness, unfairness, anger and more, according to the National Child Traumatic Stress Network. For information on kids' reactions to disaster visit their Website at http://www.nimh.nih.gov/ and click on "Terrorism and Disaster."

POOR CONCENTRATION/RETENTION. "I can't even think," one victim told a CNN journalist. If you can't think it's hard to frame sentences and communicate ideas. Background noise makes things harder. Who could concentrate in a crowd of 10,000 people?

HEALTH CHANGES. Many victims were dehydrated when the relif workers found them, according to news reports. Some victims, those who swam or waded through toxic water, have developed skin problems. Kids may have stomach aches, headaches, loss of appetite, nightmares, and sleep problems. Adults and kids are just plain exhausted.

SLEEP PROBLEMS. The victims stranded on rooftops had to be constantly alert and got no sleep. Victims housed in shelters got no sleep, little sleep, or interrupted sleep. Sleep problems alter their perception, thinking, behavior, and the ability to solve problems.

FEELING DISCONNECTED AND ALONE. Trauma has caused hurricane victims and relief workers to feel disconnected. Some think they've been forgotten. But they're not forgotten. Americans and people around the globe are coming to their aid. You can help by:

* Learning about anticipatory grief. Once you know about it you'll understand its power over the hurricane victims.

* Contributing to AmeriCares, the American Red Cross, the Salvation Army, and religious groups that are providing relief. Every contribution is welcome.

* Donating new clothing - not used - to relief organizations. Make sure the size is listed on all items. Tie socks and shoes together.

* Donating blankets, sheets, pillow cases and pillows to relief organizations.

* Donating personal care items - toothbrushes, toothpaste, soap, shampoo, combs, makeup - to relief organizations.

* Asking your kids to give some of their gently used books and games to relief organizations.

* Donating art supplies. Young children have limited vocabularies, so they communicate through art. Instead of donating coloring books, donate blank paper, crayons and/or water color markers so kids can express their experiences and feelings.

* Sharing your expertise. The American Red Cross and the National Institute of Mental Health need health experts in a variety of fields. Visit their Websites for more information on volunteer needs.

* Sharing your home. Contact http://www.shareyourhome.org to work out details.

* Listening to victims' stories. If you share your home or if hurricane victims move to your community, take the time to listen to their stories. Your gift of listeing will ease their burdens and help them to see a brighter future.

Copyright 2005 by Harriet Hodgson. To learn more about her work go to www.harriethodgson.com.

Harriet Hodgson

Harriet Hodgson has been a nonfiction writer for 27 years. She is a member of the Association of Healh Care Journalists and the Association for Death Education and Counseling. A prolific writer, she is the author of 25 published books and hundreds of print and electronic articles.

Hodgson has written about parenting, recycling, sexual harassment, aging, Alzheimer's disease, caregiving, communication, nutrition, physical activity, weight management, anticipatory grief, and many other topics.

She started out as a teacher and earned a B.S. with honors from Wheelock College in Boston, MA. She went on to earn an M.A. in Art Education from the University of Minnesota and did additional graduate work. After spending a dozen years in the classroom Hodgson changed careers and turned to writing.

All of her writing comes from life experience. Hodgson has talked about her experienes on some 150 radio talk shows, including CBS Radio, Minnesota Public Radio, WCCO Radio and "Coping With Caregiving," an Internet-only radio program broadcast worldwide. In addition, she has appeared on dozens of television programs/stations including CNN.

Hodgson is a Past President of the Wing of the Aerospace Medical Association. A past president of the Minnesota Medical Association Alliance (MMAA), she represented MMAA members on the Minnesota Medical Association Health Care Reform Task Force. She is an active community volunteer and all of her volunteer efforts focus on health.

Hodgson is cited in "Something About the Author," "Who's Who of American Women," "Who's Who in America," "Who's Who in the World," "The Dictionary of International Biography," and "Contemporary Authors," published by Gale Research.

Hodgson lives in Rochester, Minnesota with her husband, C. John Hodgson. She enjoys learning, travel, antiques, singing, and spending time with her twin grandchildren.