This review of the public health impact of Hurricane Katrina tends to support de Goyet's generalizations about disasters,1
except for Myths #8 and 9, regarding the need for food aid and clothing, respectively. In fact, food aid was provided by FEMA to about 637,000 households for more than three weeks. Clothing was also needed on a massive scale due to the loss of, or evacuees' protracted separation from homes, possessions, and employment related to the hurricane. Indeed, the destructive power and extent of the damage caused by Hurricane Katrina was unprecedented in the U.S.
Regarding the issue of psychosocial responses to disaster, it was believed and hyped in the media that massive trauma led to the abandonment of social mores and relationships and even to violence, as people attempted to escape or to satisfy their own individual needs (Myth #4). To the contrary, studies of behavior in disaster show that the great majority of those directly affected tend to remain calm and behave in an orderly and considerate fashion.54,55
However, what has been lacking to date is a conceptual framework for understanding behavior in disaster.
Although de Goyet presented his generalizations without an overall conceptual framework, his observations related to psychosocial needs and behaviors can be usefully framed in the context of the Social Attachment Model of collective responses to threat and disaster.7,8
The central tenets of the model are that individuals develop attachments to other people (significant others), as well as pets, objects, and places; moreover, once these attachments are formed, individuals strive to maintain them by seeking proximity to the objects of attachment, particularly under conditions of threat or danger. Hence, the overriding tendency expected in disasters would be to seek the familiar and, in particular, the proximity of attachment objects rather than flight or passivity. Thus, increases in altruism, camaraderie, and social solidarity would tend to occur at the community level rather than social breakdown and individualism. Being in proximity to attachment figures also influences the perception of danger and reduces fear, so that in situations where individuals are physically close to their attachment figures and objects, as in community disasters, even severe environmental threats normally induce affiliation rather than flight. Indeed, separation from loved ones and familiars is generally a greater stressor than physical danger itself.
Against the view that disasters cause overwhelming self-interest and social breakdown, manifested in aggression, looting, or rioting (Myth #4), a large body of evidence indicates that the dominant response in community disasters is indeed to seek telephone and physical contact with loved ones and possessions as well as other familiar people and places (affiliative behavior). Contrary to the view that affected populations respond with shock, helplessness, and overall passivity (Myth #5), the tendency toward social affiliation also leads to a multicultural dedication to the common good, expressed in altruism, camaraderie, and social solidarity among victims, enabling many to find new strength and resiliency during the emergency and to respond positively and generously.7,56
With an increasing sense of shared plight, a desire to help predominates. The greater the danger sensed by people in their familiar environment, the more likely they are to strengthen their attachments with family, friends, and neighbors, and to develop new attachments with people sharing the same environment, overriding traditional differences and barriers among people such as race, age, and socioeconomic status. The Social Identity Model of crowd behavior57
also postulates that altruism and self-sacrifice occur when a common identity emerges among people in the same predicament, even when great risk is involved.27
These tendencies were all in evidence during Hurricane Katrina and its aftermath, yet sporadic rioting and acts of violence also erupted after the hurricane at the New Orleans Superdome and other areas in the city business district.16,25,58
These acts may have reflected separation from—or the loss of—family members and friends, devastation of homes, and disruption of community and social networks, caused by the unexpectedly sudden and intense flooding of many parts of the city.
Human beings under threat of death are not invariably motivated by a simple drive for physical safety. As noted, rather than fight or flight, the typical response to danger is to seek the proximity of familiar people and places, even if this involves remaining in or approaching danger. Official organizations often have difficulty in getting people to evacuate before disasters, partly because family ties and other attachments (home, possessions, and their safeguarding) keep individual members in the danger zone. While residents tend to remain in the disaster area, those who flee often lack attachments to the area. However, when residents are forced to evacuate, they strive strongly to do so as a group or in family units, thereby maintaining contact and proximity with familiars.
On the other hand, forcible separation and arbitrary evacuation of separated people to unknown destinations during the chaos following a major disaster would be expected to give rise to hostility and mistrust of intervening authority, as well as “officialdom” at all levels of government, from local to federal, even though the purpose of the intervention was to save lives. Evacuees also tend to orient themselves in the direction of relatives whose homes are outside the danger area, while those forced to go to official evacuation sites form clusters that partially duplicate their old neighborhoods. Affiliative behavior and interactions with family or community members often continue at a high level of intensity and frequency for years after disasters.7,8
Physical danger as a whole is generally far less disturbing or stressful than separation from familiar people and surroundings. During the London bombing raids in World War II, children showed few signs of distress, even if exposed to scenes of death and violence, if they were with a parent or with schoolmates and teachers; it was only if they were separated from parents or other attachment figures under these conditions that serious psychological disturbances occurred.59
More frequent symptoms of disturbance also occur among people who are forced to move because of damage to their homes than among those able to remain in their homes;60
likewise, non-returning evacuees experience significantly greater anxiety, injuries, and other problems than evacuees who are able to remain in the disaster area.61,62
Separation from or the loss of familiar people and surroundings also has profoundly adverse effects on mental and physical health; conversely, individuals of many species tend to remain calm and unafraid in danger situations if they are in the presence of attachment figures and objects.63
Maintaining social attachments is thus essential for preserving mental and physical health and overall well-being. Indeed, the literature on disaster suggests that the greater the loss of the familiar social and physical environment, the greater is the adverse impact on mental health and social adjustment.6,64
Following Hurricane Katrina, only about 50,000 people went to shelters. Consistent with the social attachment model,7
most of the nearly one million displaced people went to the homes of family and friends or stayed together in hotels.65
Evacuees in temporary housing reportedly moved 3.5 times on average after the storm,64
adding to the burden of stress and readjustment. A psychological needs assessment of Hurricane Katrina evacuees in Houston shelters (n
=124) from September 4 to 12, 2005, showed that moderate and severe symptoms of post-traumatic stress disorder were shown by 39% and 24% of evacuees, respectively.66
The suddenness and extent of post-hurricane flooding in New Orleans meant that many individuals and families were separated during the hurricane, and in the aftermath it was difficult for families to be reunited. Evacuees who had to rely on emergency transport out of the city were taken to totally unfamiliar locations, and some family members were taken to different locations.
The public health importance of individual and family registration systems and of communication between authorities and evacuees was shown by the fact that 10 days after the hurricane, more than 50% of the known dialysis patients in New Orleans could not be located. A tracking program was launched by the Centers for Medicare and Medicaid Services to remedy this situation.15
Large gathering places such as the Superdome and the New Orleans Convention Center were designated as initial staging points for registration and first aid and for contacting missing relatives and friends. However, these venues were suitable only for the briefest occupancy.19