Human Responses to Disasters Predictable, but Preparedness Lags

Psychiatric Times

October 2005

Vol. XXII

Issue 11

There were many suicides. One particularly tragic incident occurred in a house on Jefferson Street. A man and wife stood at a second story window of their home Tuesday throughout the afternoon calling frantically for help. The street before the house had become a torrent and no one dared brave the current to get to the house in a boat. The water continued to crawl toward the two at the window.

'If the water reaches us, I shall kill my wife and end my own life!' the man shouted. He brandished a revolver. Darkness fell. Two shots were heard to ring out. In the morning the two figures were not at the window.

A reporter's vivid account of tragedy and death reads like New Orleans in the aftermath of Hurricane Katrina, but it is actually about Dayton, Ohio, in 1913. Days after a levee restraining the Miami River failed during March storms, water rose to a depth of 12 feet, and the city took on the appearance of "a vast inland lake," according to eyewitness accounts. With factories shut down and large numbers of people homeless and out of work, "in some places plundering wretches ... necessitated the calling out of troops to preserve order."

As local, state and federal officials rationalize the dire consequences that befell victims of Hurricane Katrina by emphasizing its unprecedented power and geographical reach, both historical and research data reveal that the human drama everyone saw unfold in the news media was largely predictable. Episodes of altruism and heroism--offset by allegations of rape, murder, assault and theft--commonly occur during times of distress. But if that is so, then why aren't the responses of emergency management teams more attuned to the likely psychological and sociological behaviors that emerge immediately after disasters?

"We should focus on people. We should take a mental health approach. And we should address people's fears, reactions, conflicts and most important their resiliency when confronted by danger," said Joseph C. Napoli, M.D., in an interview with Psychiatric Times. Napoli is assistant clinical professor of psychiatry at the Columbia College of Physicians and Surgeons and chair of the disaster preparedness committee of the New Jersey Psychiatric Association. He is also the co-author, along with V. Alex Kehayan, Ed.D., of Resiliency in the Face of Disaster and Terrorism: 10 Things To Do To Survive (Personhood Press), scheduled for publication this month. "There are people within the field that very much take into account those reactions; however, I think we can do better."

The academic literature is rife with studies that focus on the behavioral components of disasters, Napoli said, but the leap from research to practice is sometimes too great to result in immediate changes to response methods. Looking at disasters from a behavioral or mental health perspective is still relatively new for disaster relief, emergency management and first-response personnel, and so sometimes it can seem like there is a disconnect between what victims do and how government responds. "Obviously, more work has to be done to focus on the human behavior in the face of danger, at times of disaster and terrorism."

Stigma still plays a role, too, Napoli said. There is a broad array of responses to the dangers and challenges posed by disasters that are "normal" reactions to catastrophic events. These behaviors are not necessarily pathologic, or disordered or capable of being described as mental illness. Nevertheless, "there may be in some situations a reluctance to really look at the mental health piece."

A spokesperson for the Federal Emergency Management Agency (FEMA) declined to speak on the record regarding any efforts its officials undertake to anticipate behavioral responses in developing preparedness guidelines. She also said she did not know of anyone within the agency who could comment with any authority on the issue.

The Centers for Disease Control and Prevention in Atlanta also failed to return phone calls requesting an interview. It is among many federal and state agencies that have sponsored research in an effort to better understand community preparedness for disasters. For instance, one study published last year investigated "social factors such as social capital, social cohesion, and collective efficacy" in the aftermath of Hurricane Floyd, which struck eastern North Carolina in 1999 (Moore et al., 2004).

Investigators warned that socioeconomic disparities could predispose certain groups to disaster vulnerability. Similar to factors that affected hard-hit New Orleans, to acquire affordable housing in North Carolina, African-American, other minority groups and the poor had to settle in low-lying areas. As a result, they were disproportionately vulnerable to hurricane-induced flooding. "The historical disempowerment and marginalization of both minority groups and the poor did not, in the example of Hurricane Floyd, disappear with brief moments of unity and togetherness," Moore et al. reported. A spokesperson at the University of North Carolina in Chapel Hill, where the study was done, told PT that CDC officials requested a copy of the study shortly after Hurricane Katrina, but did not disclose what review was now underway.

Spencer Eth, M.D., the medical director of behavioral services at St. Vincent's Catholic Medical Center in New York City, and a professor of psychiatry at New York Medical College who specializes in disaster-related mental health, agreed that there is "an enormous literature" that has accumulated over the years relating to calamities and human behavioral responses. One 2002 study alone, he told PT, chronicled results obtained from 20 years' worth of investigations (Norris et al., 2002a, 2002b). In a review of some 250 articles, book chapters and books, the authors sought to summarize the disaster-related mental health implications derived from two decades' worth of investigations.

Acknowledging that experience suggests that local, state and federal officials have yet to pay enough attention to anticipatable behavioral factors in disaster preparedness, Eth said that it is also difficult to generalize because of the many different types of emergencies that may arise. For instance, the New York City blackout in 1977 resulted in looting incidents, while the one in the summer of 2003 produced little in the way of civil disorder.

"So how would you prepare?" Eth asked PT. "If you thought about the first one, you'd say you'd have to give a lot of preparation for the possibility of looting and riotous behavior. But as it turned out, that didn't really happen even in a much larger scale power outage [the second time]."

Trying to determine what will cause opportunistic and criminal behaviors during catastrophes, rather than altruistic and even heroic responses, delves more into sociology than psychiatry or psychology, Eth said. In the case of the Hurricane Katrina aftermath, the breakdown of civility could have any number of causes, some of which raise issues that policy-makers often prefer to ignore.

"There are always the issues of poverty, minority status and [the lack of a] sense of ownership, all of those issues that lurk in the background of these kinds of analyses that people are hesitant to comment about, because that almost seems more political than sociological or psychological, but clearly were at play more so in this disaster than in others," Eth said. Demographics make a difference in group psychology and in national politics, he added. "Sadly, in this country there are fault lines and polarizations that have become more transparent as a result of this disaster."

Even so, Eth is uncertain that it is even possible to fully prepare for "rare" events. "How much preparation really is there, or is there an illusion of preparation? Having a disaster manual on a shelf somewhere isn't really preparation," he said. "After all the attention and money spent on homeland security, is there really homeland security? Is there even an illusion of homeland security? Do people look a whole lot more secure and comfy on airplanes these days? I don't think so."

Nevertheless, Eth said that even though disasters are infrequent in any one place, in the aggregate they are common. As a result, the current emphasis on initial local and state responses may need to be reassessed to include a quicker federal response depending on the situation. But he hesitated to favor one or the other, insisting that people need both, depending on the circumstances of any given situation. In any event, officials need to consider the behavioral factors that could cause a situation to escalate beyond control.

No disaster response is ever perfect, and experts agree that one of the most important ways to improve preparedness and response is to carefully evaluate the effectiveness of what was done previously. In the case of Hurricane Katrina, the first stage of that process touched off a round of finger-pointing that will not likely subside for a long time. The resignation of FEMA Director Michael Brown amid allegations that he achieved his position because of politics and an inflated resume rather than merit will not stanch that debate either.

But these early manifestations show how important leadership during times of crisis can be.

One of the most severe criticisms that could be levied against a person leading an organization would be that they were merely posing as a leader, falsely currying the favor and trust of followers by superficially self-promoting yet behaving in ways that betray insincerity of lack of character [Kolditz and Brazil, in press].

So wrote Col. Tom Kolditz, Ph.D., the head of the department of behavioral sciences and leadership at the U.S. Military Academy at West Point. His research into behavior of individuals exposed to in extremis situations, and their ability to function as "authentic" leaders, could offer a key to how others will react during dangerous situations.

Relying on principles espoused by Bruce J. Avolio, Ph.D., who developed the concept of "authentic leadership theory," Kolditz told PT that it plays a central role in his in extremis analysis because it affects the "the leaders' ability to maintain resilience, hope and optimism among followers." While he declined to comment directly on the implications of his research on Hurricane Katrina victims without further study, Kolditz said that public displays of blame and anger by leaders could cause followers to model these poor coping mechanisms as well, making the situation even worse.

"This disaster was a wakeup call and I think that people will now focus more on those kinds of behavioral issues because prior to this happening a lot of disaster preparedness particularly with respect to flooding down there was theoretical and modeling," Kolditz said. "Now, they understand the scope of the problem. There are people who have the ability to predict what's going to happen not only in terms of the weather, but in terms of people's reactions to it, but decision-makers have to be in a position to listen and to understand what's going to happen."

Whether leaders will begin to take notice and to make the appropriate changes is not at all clear yet, and may never be. Even the most obvious fixes often do not happen for one reason or another. According to one critic in Chicago, "The country is willing and anxious to spend money for the maintenance of an army and navy, yet it is almost impossible to gain an appropriation for the building of dikes and levees." He said that on March 30, 1913.

References

Kolditz TA, Brazil DM (in press), Authentic leadership in in extremis settings: a concept for extraordinary leaders in exceptional situations. In: Authentic Leadership Theory and Practice, 3, Gardner WL, Avolio BJ, Walumbwa FO, eds., Monographs in Leadership and Management Series. New York: Elsevier.

Moore S, Daniel M, Linnan L et al. (2004), After Hurricane Floyd passed: investigating the social determinants of disaster preparedness and recovery. Fam Community Health 27(3):204-217.

Norris FH, Friedman MJ, Watson PJ (2002a), 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry 65(3):240-260.

Norris FH, Friedman MJ, Waston PJ et al. (2002b), 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001. Psychiatry 65(3):207-239.