Natural Disaster, Self-Neglect,
or Social Problem?

Heat Wave:
A Social Autopsy of Disaster in Chicago

By Eric Klinenberg
University of Chicago Press
2002

Most of us think that in terms of natural disasters, storms, earthquakes and tornados rack up the biggest toll. Not true. In the United States, “more people die in heat waves than in all other extreme meteorological events combined” (p. 17), says Eric Klinenberg, author of Heat Wave: A Social Autopsy of Disaster in Chicago.

Klinenberg’s book focuses on a July 1995 heat wave, one of the deadliest in American history, that killed between 485 and 740 Chicagoans. Seventy-three percent (73%) of the victims were older than 65, and the vast majority lived and died alone. Of the dead, about 170 bodies went unclaimed until the Public Administrator’s Office tracked down “relatives who had not noticed that a member of their family was missing” (p. 15). In a fourth to a third of those cases, no relative was ever found and the bodies were buried in a public, mass grave.

If those statistics about the dead sound familiar to people who work with self-neglecters and other adult protective services clients, it should. The descriptions of where these victims had lived should also sound familiar: about one victim, the author says, “Laczko apparently staved off loneliness by collecting his neighbors’ unwanted mail and filling his home with phone books, old newspapers, and shoddy furniture.” Other descriptions of victims’ environments similarly sound like the homes of hoarders. A large proportion of the victims lived in Single Room Occupancy (SRO) hotels.

Although the commissioner of the Department of Human Services stated publicly that “people...died because they neglected themselves,” (p. 32), Heat Wave argues that social conditions and institutions, not individual psychopathology, underpin the death toll, and that those conditions continue to put people at risk. It is this “social autopsy” approach of the book that is of most interest and, possibly, relevance to those of us who are concerned with preventing adult abuse and neglect, including self-neglect. Specifically, Klinenberg focuses on isolation, urban neighborhoods, city services’ structure, government public relations, and news media as components of the disaster.

The Social Production of Isolation

Klinenberg identified four trends that he feels contribute to older persons’ isolation:

• Well-known demographic shifts increasing the number of elders and the mobility of families;
• Crime, which contributes to elders’ reluctance to leave their homes or open their doors (in this case, even to government workers going door-to-door to check on people);
• “Spatial transformation, the degradation, fortification, or elimination of public spaces and supported housing clusters or SRO dwellings, especially in areas with concentrated poverty, violence, and illness”; and
• “[T]he tendency for older men, particularly single men without children and men with substance abuse problems, to lose crucial parts of their social networks and valuable sources of social support at they age.” (p. 48)

Klinenberg reports that in studies of “seniors living alone and below the poverty line, one out of three sees neither friends nor neighbors for as much as two weeks at a time, and one out of five has no phone conversations with friends” (p. 50). One woman Klinenberg met lives on a third-floor walk-up, refusing to move lower because “it is much safer than the first floor.” She leaves her apartment about six times a year (p. 51). In a 1986 study of residents of SROs, one researcher found that only about half of the residents had fans, and many lived in rooms with sealed windows they could not open (p. 71).

Urban Neighborhoods and the Ecology of Support

In his chapter on urban neighborhoods, Klinenberg begins explaining how social and economic structures weave into the social isolation factors to create neighborhood pockets where death rates were exceptionally high or low. By comparing “similar” neighborhoods, Klinenberg adds to previously-identified risk factors for heat wave mortality -- high poverty, concentrated elderly populations, poor housing, and low vegetation -- the “quality of public spaces, the vigor of street-level commercial activity, and the centralization of support networks and institutions” (p. 127). He concludes that,

[A] key reason that African-Americans had the highest death rates in the Chicago heat wave is that they are the only group in the city segregated and ghettoized in community areas with high levels of abandoned housing stock, empty lots, depleted commercial infrastructure, population decline, degraded sidewalks, parks, and streets, and impoverished institutions. Violent crime and active street-level drug markets, which are facilitated by these ecological conditions, exacerbate the difficulties of using public space and organizing effective support networks in such areas. (p. 127)

This chapter, with its vibrant descriptions of how some elders are “drawn into” the streets while others literally barricade themselves in, may be a particularly important one for those of us who are used to thinking about risk factors only in terms of individuals and families, not neighborhoods and social structures.

City Services in the Empowerment Era

In another provocative chapter, Klinenberg argues that recent trends to adopt a competitive market strategy for providing government goods and services ill serves many people. “[T]he entrepreneurial state demands aggressive behavior from everyone in the system, including top officials, administrators, employees, contracting firms, and even the citizens who receive services,” Klinenberg says (p. 139). Other features of the current governance structure that Klinenberg says helped lead to the catastrophe are:

• “The delegation of key health and support services to paramilitary organizations” that are ill-equipped to handle such “soft services” (such as police and emergency medical technicians);
• “The lack of an effective system for organizing and coordinating the services programs of different city, county, state, and federal agencies”;
• “The lack of political will and public commitment to provide basic resources necessary for the protection of city residents whose poverty or frailty renders them in need of support, but whose condition has become a normal, acceptable, and taken-for-granted feature of urban life”; and
• “The practice of governing by public relations,” which he goes into in more depth in a later chapter. (pp. 142-3)

This is the chapter in which Klinenberg points out that even if some of the elderly victims had had air conditioners in their homes, many would not have used them because of their more pressing fear that they could not pay their utility bills, which would result in complete loss of all of their power.

Governing by Public Relations

This chapter is Chicago-specific and incident-specific. Here the book details how the mayor and various government leaders tried to “spin” what was happening during and after the heat wave, including how they attempted to place the blame for deaths on the victims rather than on any failure of public health or social service systems.

Those who know their own governments’ responses to crises such as a highly-publicized abuse or neglect case might benefit from comparing their experiences to this analysis of Chicago’s crisis. Particularly poignant is the discussion of the “Final Report of the Mayor’s Commission on Extreme Weather Conditions,” and how it obscured pertinent facts by, for example, pointing out that “the numbers of African-American and white victims were almost identical,” without discussing the disparate death rates.

Policymakers and advocates may also find a useful tool in the partial list of the sociologist’s Stanley Cohen’s catalog of common forms of denial quoted in Heat Wave:

• Literal denial: “The fact or knowledge of the fact is denied.”
• Interpretive denial: “The raw facts are not being denied. Rather, they are given a different meaning from what seems apparent to others.... What is happening is really something else.”
• Implicatory denial, or denial of responsibility: “To attribute responsibility to forces -- named or unnamed -- that supposedly have nothing to do with the government and are beyond its control.”
• Denial of voice, or silencing: Using political authority to mute damaging reports.
• Denial of realist language, or renaming: “Using euphemisms to disguise meaning of the event.... These are everyday devices for masking, sanitizing, and conferring respectability by using palliative terms.”
• Denial of public record: Using the symbolic power of state to define the official version of the event.
• Denial of pattern: Claiming that the event is unique and aberrant, and historically isolated. (p. 180)

News Organizations and the Representation of Catastrophe

There have been many analyses in the past decades of how the media’s depiction of events shapes citizens’ responses and, ultimately, public policy. What was particularly interesting about Klinenberg’s analysis is how newspaper coverage of the heat wave differed significantly in various parts of Chicago, resulting in suburban readers -- who, in urban centers like Chicago, frequently have more political clout than inner-city residents -- not getting as many details about the conditions causing the heat wave deaths. Instead, in one example, the suburban edition of one paper ran a feature on a horse photographer instead of a story on problems with the city cooling centers.

As the elder abuse field increases its level of sophistication about influencing public policy matters, analysis of media’s role and strategies for influencing news coverage should be placed on our agenda. This chapter is a decent place to start thinking about what this might look like.

Conclusion

Sometimes the most useful insights to a problem come from a distinctly different field. Klinenberg did not set out to study self-neglecters or abused elders, but his “social autopsy” of a meteorological disaster nevertheless gives us important new tools for thinking about the risk factors for neglect and abuse. As he says, “the deeper question the disaster raises concerns the capacity of contemporary government agencies to protect an aging society of atomized and sometimes isolated citizens whose families, friends, and personal finances cannot provide for their social and medical needs” (p. 143). This deeper question is deeply relevant to those of us working in adult abuse, and Klinenberg’s approach may help us think about answering it in new ways.