Ogasawara: April 2011

Environmental Stress ー　One Decade After Chernobyl　（１９８６）

An Exercise In Applied Ecopsychology

The following is excerpted from the proceedings of an international conference sponsored by the United Nations and other bodies held in Vienna during April 1996.

(The principal author of this part of the report is Professor Terrance Lee, School of Psychology, University of St. Andrew's, St. Andrew's, Fife, in the United Kingdom.

ABSTRACT
Environmental Stress Reactions Following the Chernobyl Accident.

The widespread Chris Drury

public anxiety and pessimism about the Chernobyl accident appears to be out of all proportion to the radiation-induced health effects. The concept of stress is invoked to explain the widespread damage to general health and well-being. Stress can be defined as the process by which adverse mental experiences have negative effects on bodily functions. The mechanism is physiological, mediated through the autonomic nervous system and the endocrinological s stem.
The International Chernobyl Project study was conducted by the International Advisory Committee in 1990 and published by the IAEA in 1991. The study found significant differences between "contaminated" and "clean" areas for symptoms attributable to stress. Forty-five percent (30 percent in "clean" areas) of the people believed that they had an illness due to radiation exposure. The level of general health was found to be low and almost all ailments were attributed by the population to radiation. These effects (confirmed by other studies) were compounded by poor public understanding of radiation, initial secrecy, subsequent lack of effective Chris Drury

communication, and the collapse of the centralized political and economic systems. Distrust of "authorities" is widespread. One important study using a regression method has shown that "economic situation" and "attitude to the future" are better predictors of stress symptoms than contamination level.
A large-scale survey has compared stress effects in "restricted," "non-restricted" (but geographically close), "resettlement" and control areas. Positive differences were found between the distant control sites (surveyed for comparative purposes) and other sites, but differences between "restricted" and "non-restricted" were small. "Resettlement" areas were no better and, on some criteria, worse. Many respondents believed that they had received a dangerous dose of radiation and that their personal health had been damaged. Other studies question the effectiveness of resettlement as a countermeasure. Neither women nor the elderly show any net benefit and only in Russia is there an overall reduction in stress.

An important study has measured "locus of control," i.e. the belief that one can control one's own destiny, versus "fatalism". This was used to predict the response to food controls, measured directly by dose uptake. As expected, "fatalism" is associated with higher stress levels and lower compliance with food controls. Other research has shown that social support is crucial to recovery from stress and the United Nations Educational, Scientific and Cultural Organization (UNESCO) has set up community centers to provide trustworthy information, individual and group therapy, and a variety of recreational/cultural activities. A range of other initiatives with similar aims are being developed.
The allocation of the prototypical public reaction to a correct diagnostic category is an obvious first step in planning future countermeasures. Chris Drury

False labelling such as "vegetative dystonia" and "radiophobia" is counterproductive. The same applies to the well-established category of "post-traumatic stress disorder," although this fits those exposed to the initial event. The alternative suggested is "chronic environmental stress disorder." The original stressor cannot be removed, but it is possible to change the way in which it is perceived and to enhance people's feelings of control over it. This means that beliefs and attitudes have to be changed. The problem is more one of communication than of medication.

I. ISSUES
The purpose of this paper is to review the nature and extent of damage to the psychosocial well-being of the populations exposed to the Chernobyl accident; to diagnose the public's reaction by placing it in context with similar events in the past; and to consider the effects of three main countermeasures. These are: food controls, resettlement, and community action.
A severe obstacle to the clarification of these issues lies in the difficulty of defining the "contaminated" or "affected" areas. These extend well beyond the territories officially designated as contaminated. This is because people are aware of the great irregularity in the pattern of deposition; of the arbitrary nature of the threshold values; of the fact that averages are computed from fairly sparse measurements; and that areas identified by different authorities do not precisely coincide. In any case, they deeply distrust the authorities, are Chris Drury

convinced that they have reason to underplay the seriousness of the situation and, indeed, believe that there was a "cover up" during the early days.
Hence, people in many areas with essentially no radioactive contamination due to the accident are nonetheless affected, albeit to a lesser extent, by the fear of it.
The direct physical health effects on those living in "contaminated" areas are naturally disturbing when considered in absolute terms, but even the direct effects (i.e. thyroid cancers, which are mainly non-fatal), when seen relative to the overall health statistics of the three countries, can hardly justify the extremely high levels of public pessimism and anxiety. According to the Organization for Economic Co-operation and Development, "There has been no increase in leukaemia, congenital abnormalities, adverse pregnancy outcomes or any other radiation induced disease". The physical effects certainly pale into insignificance when compared, for example, with deaths from lung cancer arising from radon gas or diseases and deaths from industrial pollution.

It is one hundred years since the discovery of the phenomenon of radioactivity Chris Drury

(and, a few years later, of subatomic particles), and the consequent revolution in physics, chemistry and medicine has excited enormous and still growing scientific attention. Understandably, most of the interest in the Chernobyl accident on the part of the world community of scientists has been concentrated on radiation measurements, protection and therapy; whereas the main human legacy of the accident has been anxiety about health and a social disruption that has manifested in widespread health disorders not induced by radiation. These are attributable to the mechanisms now generally accepted by medical science as stress: the negative interaction of mental with bodily processes.
Chris Drury

        As for these secondary but widespread effects, it is known that stress can be alleviated in a number of ways. An obvious one is to remove the stressor, a second is to provide people with a sense of control over the stressor and, related to this, a third is to change the ways in which the source of stress is perceived. These are huge tasks. In the present case, the original stressor cannot be removed and uncertainty over its effects, i.e. the effects of the release of radioactive materials on physical health, will remain for a generation at least. Medicine may mitigate these effects by screening, diagnosis and treatment, but it will not remove them; they have happened.
         The second alternative is to increase people's sense of control. As already mentioned, three specific countermeasures offering this potential are briefly reviewed in this Background Paper. They are voluntary food controls, resettlement and community action. (Medical procedures to counter any direct health effects of radiation will also increase the sense of control, but their discussion is left to other delegates.) Thirdly, the most obvious means of providing perceived control over a stressor is by diffusion of knowledge that changes the way in which it is perceived. This issue is also discussed.
         One final issue to be considered is that of diagnosis, It should be helpful to compare the pattern of public reaction to the Chernobyl accident with those to similar stressful events in the past. If there are consistencies, this should help with prognosis and with the evaluation of alternative countermeasures.

II. CONCLUSIONS
1. Expert Consensus
Little disagreement has been evident in the various research studies reported in this paper; they tend to reinforce and supplement each other. There is a general consensus between psychiatrists, psychologists and sociologists that the physical and mental effects of stress are the main issue. This consensus extends to Chris Drury

the CIS researchers whose work has been quoted here, who have collaborated closely with those from the west, particularly through the Programme of the European Commission. A mild exception has been some conflict between the broadly psychological interpretation of events and that of a few senior radiation protection specialists from CIS countries, who have dismissed the public reactions as "radiophobia". Other problems have arisen because of differences in the ways in which mental illnesses are classified by psychiatrists from different countries.
2. Speculation and Myths
Outside the scientific community, there appears to have been almost no limit to the speculation and evocation of myths by the media. It has been argued elsewhere that there is a pervasive dread of nuclear energy, which originates from its close association with the atom bomb and nuclear warfare; also, by virtue of some of the general characteristics of the hazard, Chris Drury

i.e. "lack of familiarity", "lack of controllability" and "no directly perceivable benefit".
It is now widely accepted that the media do not generate these anxieties, but exploit them because they attract readership. There follows a process of "social amplification" as the public reacts to dramatic reporting with increased anxiety, which in turn stimulates further media promotion.
Apart from wild and unsubstantiated reports of "thousands of cancer deaths," the media has specialized in photographs of children suffering from leukaemia, with the distinctive baldness of chemotherapy; also of elderly people still living in the exclusion zone and apparently suffering from terminal illness. Another favorite media image is of the children of Chernobyl enjoying the benefits of summer camp type holidays in countries abroad in order to relieve the symptoms of illness which, it is implied, afflict them. The children selected by photographers are unlikely to be the most robust ones.

3. Open Questions
In summarizing briefly the prospects for different supposed countermeasures, it Chris Drury

should perhaps first be mentioned that there are no dependable research data on the usefulness of financial compensation or "special concessions". Anecdotal evidence suggests that the laudable aim of restoring social equity by this means has failed because the inevitably arbitrary allocations have created the opposite effect, i.e. feelings of inequity and jealousy.
By depleting the available financial resources for other countermeasures, the problem has been further compounded. The use of the supposed countermeasure of compensation, as with resettlement, has probably exacerbated the situation further by officially signalling to many people that their health is in serious danger when their risk is well within the normal range for radiation due to natural sources. As mentioned above, resettlement has failed so far to produce significant improvements in the sense of Chris Drury

well-being or reductions in anxiety, when compared with "restricted" areas. It is difficult to be sure of this, because the population may have been exposed to higher perceived or actual doses before their relocation, but it is more likely that any improvement in their lifestyle has been offset by the severe social stresses of resettlement, combined with similar anxiety and uncertainty about the future of their family's health experienced by those who remain behind in restricted" areas.
This anxiety may be justified, so far as the effects of prior exposure are concerned, but it does not apply to cumulative, lifetime exposure. A vigorous educational campaign addressed to the resettlement Chris Drury

population is obviously needed. There is also some evidence, referred to earlier, that the Russian resettlement program may have been more successful because of its greater retention of existing community links and a more carefully phased timing. Hence, it is extremely difficult to predict whether the ultimate health improvements achieved by a reduction in lifetime dose will be greater than the damage to health from stress induced disorders. We suspect not. The clearest evidence for this comes from research showing significantly increased illness and mortality rates among elderly people subjected to involuntary moves.
To resolve this, there is a clear need to monitor the health of a substantial sample of resettled peoples over, say, a five year period to assess the rate at which symptoms of stress subside and genuine rehabilitation occurs. This would provide a basis for extrapolation for comparison with radiation dose-response calculations. A strong case for community action has been made already in this paper and is re-emphasized here. Again, there is compelling evidence in the literature that social support from family, friends or community relieves stress. The best future prospects for this would appear to lie with UNESCO's "Centers of Trust". They appear to be tried and tested and the model is adaptable to local needs and circumstances. However, their importance is such that more systematic evidence of their effectiveness in relieving stress would be welcome. Arrangements are being made for peer review of the Centers and it is understood that some relevant survey evidence is currently being analyzed.

4. Stress and Post-Traumatic Stress Disorder
For a better model, the evidence presented here strongly indicates that we Chris Drury

must turn to the concept of stress, the unique nature of the stressor itself, and some contributory factors from the political and social turmoil and the generally fatalistic attitudes of the people.
The concept of stress is not a vague repository to which all ills that cannot be attributed to familiar diseases are consigned. Stress is directly measurable by a variety of physiological indices that have reliably been shown to be closely associated (in a dose-response relationship!) with adverse circumstances and events. The main agencies are the autonomic nervous system, which becomes dysfunctional under prolonged or intense emotional arousal, and the endocrinological system. Their engagement can be measured through changes at the cardiovascular level, by neural activity through the electroencephalograph; through skin conductance, through the sodium content of saliva and, perhaps most reliably, by chemical assays of the catecholamines of cortisol, epinephrine and norepinephrine. These can be taken from blood or urine samples; in the research studies following the Three Mile Island accident in the United States, it was found, when the Chris Drury

"affected" population was compared with controls, that these biochemical effects had persisted for several years after the accident. There is emerging evidence that the immune system may also be affected by chronic stress.
Nonetheless, it is more usual to diagnose and measure stress in a clinical setting from reported symptoms such as anxiety, depression, disturbed sleep patterns, psychosomatic illness, aggression, suicide or attempted suicide, apathy ("learned helplessness"), family discord and, of course, by the recourse to such palliatives as drugs and alcohol.
Post-traumatic stress disorder (PTSD) is the existing formal categorization which, at first sight, most closely appears to fit the Chernobyl case. This category has become widely recognized and formally classified as an illness by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM-Ill-R). PTSD is a syndrome that originates from situations where people are closely involved in a specific catastrophe, for example fire, explosion, earthquake or battle situations, which are so far from normal human experience that they provoke an extreme emotional response. The effects on the memory of this experience, combined with the secondary reactions mediated through the body systems, vary in severity and duration according to the closeness to the accident and the passage of time. Hence, those who were working at the Chernobyl plant or nearby at the time, and who witnessed the fire and explosion, would certainly fit the now classical PTSD pattern.

However, away from the plant, most did not directly experience the event, but only received rumors of it from a variety of sources. They found it hard to come up with its true meaning until, perhaps, they Stephen Turner

were subjected to food restrictions or evacuated. Even in the latter case, realization must have dawned slowly because many expected that they would be returning to their homes and a normal diet when the problem had been cleared up. No evidence of the accident would have been received directly via their senses. Radiation cannot be seen, felt or smelled. Insofar as there was trauma, it was not caused by direct experience of the event. It must have been the haphazard but growing conviction that things were going very seriously wrong with their lives and the lives of their children. Over the course of many, many months as information leaked out, this realization became more and more somber but was surrounded by ever increasing uncertainty. The nature of radiation was not understood, the limits of contamination were not clearly defined and constantly changing, the health effects were disputed and the many countermeasures proposed were most unevenly applied.
Insofar as intrusive recollections of the accident itself and avoidance symptoms are dominant features of the classic PTSD syndrome, this diagnostic category is clearly inappropriate for the large majority of those exposed to Chernobyl. The typical chronic Chernobyl reaction includes only relatively few of the other Christopher Castle

symptoms. The sense of "learned helplessness" - of apathy and listlessness (asthenia) that is probably the principal characteristic of the post-Chernobyl reaction, is featured as "diminished interest" and as "feelings of detachment", but otherwise the overlap is slight.
Given that there have been a number of similar, if much less serious environmental threats or accidents, a new categorization would seem appropriate to resolve this dilemma. Some researchers have already recognized the need to identify a category that is similar to but distinguishable from PTSD. "Informed of Radioactive Contamination Syndrome" has been suggested. However, this would seem unnecessarily restrictive. Accidents involving a continuing awareness of chemical pollution of the soil, contamination of water supplies, seepage from a landfill site, the threat of flooding, radon gas, the discovery that roads had been sprayed with dioxin tar, even the belief that electromagnetic fields due to power lines or substations are damaging to health -- all present similar chronic threats with diffuse origins that Christopher Castle

may result in stress. Several authors have reported evidence of physical stress effects (e.g. headaches, nausea) and attitudinal changes (e.g. demoralization, upset, perceived threat, declining quality of life and distrust of authorities) associated with toxic waste disposal sites would propose Chronic Environmental Stress Disorder (CESD) as a more useful formulation for the general population affected by the Chernobyl accident. PTSD would then be reserved for those victims who had experienced the initiating, traumatic event.

ACKNOWLEDGEMENTS
The following colleagues, from each of the three affected countries, provided helpful support and information for this paper but are not responsible for the opinions expressed or the conclusions reached. G.M. Rumyantseva, Serbsky Scientific Research Institute for General and Forensic Psychiatry, Moscow; A. Nyagu, Ukrainian Centre of Radiation Medicine, Ukrainian Academy of Science, Kiev, Ukraine; L.A. Ageeva, Academy of Sciences of Belarus, Institute of Sociology, Minsk, Belarus.