ML20028F927
| ML20028F927 | |
| Person / Time | |
|---|---|
| Site: | 05000000, Crane |
| Issue date: | 12/02/1982 |
| From: | NRC |
| To: | NRC |
| Shared Package | |
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| References | |
| FOIA-82-481 NUDOCS 8302070153 | |
| Download: ML20028F927 (11) | |
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MARCH 8, 1982 ASLB PANEL MEETING Psychological Stress.
A recently issued paper on Environmental Assessment of Psychological Stress at TMI-1 describes what staff has done to date.
In a workshop held on February 4-5, 1982, panelists concluded that reasonable estimates of stress can be developed based on knowledge of the community and extrapolation from other events, that an additional three months short term study would significantly improve the estimates, and stress levels can be moderated by appropriate public interaction strategies.
e 8302070153 821202
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MINUTES ATOMIC SAFETY AND LICENSING BOARD PANEL MEETING MONDAY, JULY 26, 1982 1
Psychological Stress On July 16, 1982, the Commission issued a Statement of Policy on Psycho-logical Stress Issues in order to provide guidance on the applicability of the Court's decision to NEPA issues raised in_ proceedings other than the The Commission interprets the Three Mile Island Unit I restart proceeding.
Court's opinion to say that psychological stress impacts under NEPA hinge (1) the impacts must consist of " post-traumatic anxie-on three elements:
ties"; (2) the impacts must be accompanied by physical effects; and (3) the
" post-traumatic anxietics" must have been caused by " fears of recurring catastrophe", meaning that some kind of nuclear accident must already have occurred at the site in question.
Accordingly, the Commission stated that only the Three Mile Island Unit 2 accident can currently serve as a basis for raising NEPA psychological stress issues.
Copies of this Policy State-ment were distributed to all full and part time Panel members last week.
MINUTES ATOMIC SAFETY AND LICENSING BOARD PANEL MEETING MONDAY, JUNE 28, 1982 TABLE S-3 AND PSYCHOLOGICAL STRESS The Commission will get something out within two or three weeks which will give us some kind of guidelines for dealing with these two issues.
Two recent D.C. Circuit Court decisions reversed established practice.
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ATOMIC SAFETY AND LICENSING BOAP.D PANEL MEETING 4
MONDa,Y, JUNE 14, 1982 Psychological Stress Contentions Judge Lazo reported that a policy statement. has not come out on this yet; j.
he expects something next week.
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MINUTES ATOMIC SAFETY AND LICENSING BOARD PANEL MEETING MONDAY, /PRIL 19, 1982 TMI-1 Psychological Impacts Case Mr. Prestemon reported that the United States Court of Appeals for the District of Columbia filed an Amended Judgment in the psychological stress case, PANE v.
NRC, on April 2, 1982.
The Court appears to have made several changes to its original judgment of January 7 as follows:
(1) the injunction barring a Com-mission decision to restart TMI-1 has been lifted; (2) the Commission is no longer required to prepare an environmental assessment regarding the effects of the proposed restart of TMI-1 on the psychological health of residents and the well being of surrounding communities; and (3) a positive determination by the Commission will not require the preparation of a full environmental impact statement but rather a supplemental environmental impact statement that consi-ders the psychological impacts at issue in this case.
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education for practicing physicians by I
ABBOTT LABORATORIES Vol. 8, No. 3. April,1981 l
Psychosomatic goDAY.lN
. vulvoyagimtis
>PSYCHlhTRY
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An interview with hielvin G. Dodson, hl.D.
ThreeMile h
Island: puzzling Dr. Dodson is Assistant Professorof Obstetrics and Gynecology,loyola University Stritch Schoolof 3,rdicine.
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aftermath Q. Dr. Dodson, textbook discussions of vaginitis rarely mention emotional factors, implying that the cause of vaginitis is always hiental stress,said by the organic. Can emotional problems cause vaginitis?
Pfeiident's Commission on the A. Yes, although severe and chronic forms of psychosomatic vul.
Accident at Three hiile Island to vovaginitis are not common, psychosomttic vulvovaginitis is a be the accident's only apparent 42p effect on the health of nearby very rea'. tlinical entity. Psychosomatic complaints can center i
ori the vagina just as they can on any other organ system. We residents, has not increased the have long recognized such things as hysterical blindness or pa.
caseloads of psychiatrists in ralysis, but we've been very slow to recognize that the vagina Central Pennsylvania.
can be an important focal point of emotional distress.
But there's no doubt mental stress has plagued residents of the Q. Are the symptoms real?
area since h1 arch 28,1979. That's obvious in the vociferous local A. They're real. The patient does indeed experience the pain, opposition to each proposed step toward cleaning up the burning, itching, or general discomfort she describes. The differ-crippled nuclear reactor, marked by arguments that any release ence is in the cause of the symptoms, not in the symptoms of radiation, however small and gradual, poses dangers-dangers themselves.
perhaps not recognized by the scientists and nuclear engineers Q. I!ow common is psychosomatic vulvoyaginitis?
who so badly misjudged the seriousness of the original accident.
Stressisals apparent in questi n5 Put to primary-care phy si-A. nat depends on the types of patients making up one's prac-cians, reflecting doubt, uncertainty, and fear.
tice, the thoroughness of the evaluation, and, of course, the phy-Agam and again, patients ask whether their physical ills can sician's awareness that the patients' symptoms might have a psy-be the result of the nuclear accident, and whether children now chological rather than physical cause. In my own practice, I can living or yet to be born can expect to develop normally.
make the diagnosis in about two percent of those patients who Seldom, however, do those questions reach psychiatrists.The have persistent complaints despite a negative evaluation. But stress has not manifested itselfin an increase of anxiety neuroses, that estimate doesn't include the frequently seen milder forms of as might be expected,or m other recognized mentalillnesses.
& dh The situation poses many questions. Among them are:
Q. Ilow is it diagnosed? Are there any personality traits associ-Ilas the intensity of stress been overestimated by the Presi-sted with it?
dent's Commission and by the several other teams that have Contimacden pa ;2 Continued on page 3
s.
NUISOVAGINITIS Continuedfrom page J k
A.Well,manyof thepati ntsdoh vepsychol:gic11 difficulties 5
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which cre sometimes obvious evzn during th2 first office visit.
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You're led to suspect a psychological cause when the woman has
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a long history of many different unsuccessful treatments. She has usually been seen by several different physicians. This type of
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eI history, coupled with emotional labilitf or distress, should make N
the clinician very suspicious. To confirm the diagnosis, he must
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exclude infections, allergies, and other organic problems.
Q. Beginning with tests for the common vaginal pathogens?
I A. That's right. Wet smears and bactesial and viral cultures will usually help to identify most infections caused by Trichomonas, Candido, Hemophilus coginalis, herpes simplex, gonorrhea, or g
chlanydiae. These organisms are responsible for the great ma-j jority of vulvovaginal symptoms, and they must be ruled out.
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i Th; wet mount is particularly important. True infections cause q
an inflammatory response with an outpouring ofleukocytes into j L)t th2 vagina. I clearly distinguish microscopically between nor.
mal vaginal secretions, which consist only of vaginal epithelial J
cells, mucus, and normal vaginal bacteria, and an abnormal dis-charge loaded with inflammatory cells.
em tionalproblems.
Q. Should all tests be done again, even if they were done earlier?
Q. What symptoms alert you to the possibility of psychosomatic A. Yes. You should see the patient several times and reevaluate
""I'***d"III'I h:r cultures and wet mount;it's particularly important to spend A. They run a spectrum from mild and intermi: tent vulvovagi-time talking with her at each visit, so you can confirm the emo, n.1 discomtort to severe and persistent symptoms that may cause tional component before making the diagnosis, a complete loss of sexual function. Needless to say, the full.
Q. What other procedures are indicated?
blown syndrome is easiest to recognize. ne patient may report she can't have intercourse "because of the discomfort" and insist A. A careful physical examination and history will usually re-she would enjoy sex "ifI could only be cured of my disease." Her vect any foreign body or trauma, and one must aho rule out un-response to previous treatments may not only have not cured usmi dermatological disorders and allergies, including allergy to her, but also may have resulted in an " allergic" reaction that semen.
made her condition even worse. Many patients will report they Q. Isallergy to semen common?
had to stop using the medication and will often consult with an-A. It's apparently quite rare. Dr.Te-Wen Chang of the Tufts ther physician.
N:w England Medical Center reported in 1976 that he found it in four women of the same family, a mother and three daughters, Q. So these patients don't really want to get well?
who were all p agued by a red, swollen vulva whenever they had A. In a manner of speaking, that's true. I think some of them int:rcourse. He allergy can be identified by a skin test.
may accept all their discomfort because it gives them a good rea-son not to have sex. neir aversion to sex is apparently not con-Q. Must every possible allergy be checked out?
scious, and they are reluctant to accept any treatment that might A. Since allergic reations to so many different things can occur, destroy their defense mechanism.
checking out everything isn't really possible. But a careful his-tory may make you suspect some agents that need further Q. Doyou find much support for that theory in the psychiatric literature?
'"*"E*d A.So little hasbeen written about vulvovaginitis that many phy.
Q. Do you start suspecting a psychcheial cause only after you sicians have never heard ofit. I find the paucity of articles surpris-fail 12 find a physicalone?
ing.since so much has been written about sex-related psycholog-A. Not at all. As I said earlier, many of thea vomen have ob.
feal problems. During a 1956 sym posiu m, Dr. Paul J. Poinsard, a vious psychological problems. But a prominent feature of this Psychiatrist. observed that the pathway between brain and vulvo-syndiome is the patient's strong resistance to any suggestion that vaginal tract goes in both directions. Dr. Rodney West, an obste-tha trouble might have a psychological basis. A thorough search trician and gynecologist, has also written on the subject.
for v:ginal pathogens also has the secondary value of preparing tha patient to accept a psychological etiology. Unless all the Q. Does the type of discharge help you make the diagnosis? And tests tre done, she'll flatly reject such a diagnosis.
sWd psychosomatic vulvovaginitis be suspected if there is no discharge?
Q. So you have to keep both physical and emotional factors in mind as the tests are done?
A. Every woman has some vaginal discharge as she sheds vagi-nal epithelial cells, which are then mixed with mucous from the A. Right. By spending some time simply talking to the patient cervix. He production of mucous.ecretions varies greatly from during several visits, the physician can often uncover a poor one woman to the next. A " heavy discharge" may be quite nor-body image, guilt feelings about sex, or other signs suggesting mal for some women. ne real issue, as I said earlier, is whether 2
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y A. Yes. You h.ve to *..!for the opportunity to suggest referral y
l when the patient is most receptive to it Some patients refuse ts 3
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take the advice.They may go elsewhere for additional treat-i 5
.q ment, but of course they are not "curod" by their new doctor ei-ther. If you have tried building a good rapport with the patient, d
and if you've been thorough in your evaluation and sympathetic to her problem, she will eventually return. IIaving repeatedly learned that vaginal cream and antibiotics have faih d or made o
e her worse, she is more willing to see a psychiatrist.
Q. Is there any kind of definitive test showing whether or not e
O the diseaseis psychosomatic?
A. It's not completely definitive, but infiltrating the genital area with an anesthetic, or doing a complete pudendal block while l
g the patient is having the pain, is useful. Pain that persists even O
during anesthesia probably has its origin between the ears rather than between the legs. Of course, referred pain and pain from preganglionic nerve roots would persist we. a pudendal block, but those kinds of pain are extremely rare. Explaining all this to the patient may also help convince her that psychiatric referral is the proper course.
the discharge is a true leukorrhea, indicating inflammation or in-Q. What can be done for the patient who refuses to accept psy.
fection, or merely a profuse but normal mucorrhea.
chiatric consultation?
Q. Y:u also said that psychosomatic vulvoyaginitis is more eas.
A. If the clinician continues to be supportive and sympathetic, ily recognized in pa tients whose symptoms are persistent a nd se.
eventually she may accept psychiatric referral. Remember, she's vire. Are there any clues to p y chogenesis in less severe, earlier even more frustrated with her problem than you are.
stiges of the disease?
Q. How do you try to convince her she needs p fchotherapy?
A. Yes, if you're alert for them. The patient whose symptoms are A. I suggest psychotherapy in an almost casual way, at first, mild and of relatively short duration may only be experiencing a gauging the reaction. Some patients who are very resistant then transient situational adjustment reaction. You may find she's had can be convinced in time that psychotherapy is at least " worth a some recent family problem, or problems with work or school.
try." I'll often suggest she might pay one or two visits :o a psy-Most of these patients willimprove as they adjust to the chiatrist while we continue to look for the cause of the "infee-situation.
tion." Enlisting the husband as an ally often helps.
Q. Doa that mean some less severe cases can be left untreated' Q. Is a lengthy course of psychotherapy required?
A, No. The patient should, of course, be evaluated adequately.
A. That depends. Once the patient accepts the idea that the If the vulvovaginitis is a psychosomatb reaction to a temporary cause is psychological, her " vaginitis" improves fairly rapidiv. I situational adjustment problem, she will probably respond well have seen significant improvement in four months or less.
to reassurance and supportive therapy. Most of these patients Within that time, the patient's sexual relations have also im-won't greatly resist the idea of a psychological etiology. I've proved significantly. But a longer course of psychotherapy may even had some who suggested nerves were c<mtributing to their be necessarv-not to treat the vaginitis, but to treat long-stand-
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probhm. But again, these are mild and teniporary cases associ-ing emotional problems.
Sted with situational adjustment reactions.
Q. Do you insist on the complete search for pathogens even in these mild cases?
A. Yes. A complete examination is called for, because vaginitis TilREE MILE ISLAND Continuedfrom page 1 usually is caused by some of the pathogens Pve mentioned, studied behavioral sequelae of the accident?
Q. Ilow are the persistent, severe cases treated?
Does acceptance of reassurance provided by pediatricians, obstetricians, internists, and family physicians confirm medi-A. I'm sure some gynecologists and family physicians may have cine's stature as a profession that can still be bMes edS enough experience and skill to undertake the necessary psycho-Or are the stresses of the nuclear age an entirely new phe-therapy,but I prefer to convince patients with severe or incapaci-nomenon, affecting people in ways not understood? In particu-tating symptoms toaccept referral to a psychiatrist. " Shotgun" lar, do thev intensify over time, rather than dissipate?
medication and assurance that "nothing is wrong"in these pa-Unclear answers tients will only cat se frustration for both patient and doctor. We have to realize welre dealingwitly a true and often long-standing No clear answers are available so far. In the words of psychia-psychiatrie problem. The physician who is too busy. or who is un-trist Abram M. Hostetter, chairman of the state medical society's skilledin psychotherapy.should request psychiatnc eonsultation.
Council on Education and Science,"It's likely to be several years-unless some new development clarifies the picture-be-Q. Isn't that sometimes difficult, particularly since denying any fore we understand and can deal intelligently with the stresses psychological cause is part of the syndrome?
Continucd on page 4 3h
TXREE'h1ILE ISLAND Continuedfrom page 3 jus t bet
.nucMn commonA conhat Mantryn an arismg among people who live and work near nuclear reactors.,,
is subject to a great deal of physical discomfort; he,s in the midst Dr. Ilostet ter has been involved in the Three hfile Island inci-of gunfire and sees his comrades being killed and wounded. Ob- '
dent since the begm.mng m several ways, none of them tied t vrously the worker in a nuclear plant isn t under anythm.glike the specific interests of the utility companies, regulatory these overt stresses. The dangers of ionizing radiation-when agencies, or antinuclear blocs.
they exist at all-are unseen and unfelt."
Patients seen in his office in IIershey, just 11 miles from the But combat soldier and nuclear worker apparently do have i
accident site, almost all hve within 20 miles of the nuclear plant, one significant thing in common. Neither knows what his superi-as he does himself.
ors are planning. Each can easily start feeling that his own wel-The council he heads has the j. b of answering the many fare getslittle consideration.
o j
What do I tell my patients? questions raised by physicians af-
" Studies of nuclear workers show prettv clearly that levels of ter the accident.
stress are lower among superviscrs than ainong rank-and-file em-Dr. Ilostetter abo is aware of recently completed and contm.-
l ployees,,, Dr. IIostetter said..'The more you know what,s gom.g i
uing studies. An associate of his, Timothy Bennett, studied the on, the less disturbed you're likely to be."
TMI accident as Field Coordinatcr for hfentalIIealth Studies.
Until more is known about the specifics of stress reaction to Research so far confirms the October 1979 prediction of the the nuclear presence, Dr. Ilostetter believes education is the President's Commission that effects of the accident did not end best way to prevent stress. People must knowjust what radiation I
l with the mld shutdown, but will contima until the years-long l
cleanup of the nuclear plant is completed. Dr. Ilostetter agrees.
Rumor and fantasy l
"But more than a year had passed before we began seeing That belief dates back to the first few days after the accident, j
TMI workers who showed signs of long-term stress," he said.
when mary fears were based on rumor and fantasy.
Those signs remain subtle.
For the time being, Dr. Ilostetter refuses to theorize on the "We're seeing many more people with drinking and marital significance of stresses now showing up in the ThiI employees.
problems-things like that," he said. Only a few of the nuclear "We may find out that what we're seeing is little more than worhen have so far become psychiatric patients.
people worrying about future employment, about whether the Bottle fatigue?
TMI reactor will be abandoned or restored to operation."
The delayed reaction has led to suggestions, aired only in Dr. Ilostetter warns against underestimating the worry curbstone consultations, that nuclear power plant employees caused by lack of job security, which involves basic survival in-may gradually develop an anxiety neurosis that's similar to stincts. Tension increases greatly among truckers during fuel battle fatigue.
wiortages, among farmers during a drought, and even, he said, After lengthy exposure to danger, the soldier becomes tense, among workers in IIershey's chocolate factory each time there's easily startled. IIis judgment is affected, and he loses his ability a sugar shortage or the price of cocoa beans goes up.
to sustain offensive action. According to a frequently cited "We can't expect the atomic energy workers to behave dif-study, the average U.S. soldier reached that state after 85 days of ferently," he said,"and we can't hope to understand the psycho-combat. Even the bravest man has his " breaking point."
social problems of the nucles age until we can isolate fears Are TMI workers moving toward a breaking point several based on the action cf atoms from more familiar causes of fear.
years in the future? Dr. IIostetter said no. "The two situations Much of the stress w e're seeing doesn't seem to be specifically re-lated to nuclear energy. We need hard facts about whatever por-tion of it is related."
Psychiatrists from other parts of the country,who question Dr. IIostetter each time he attends a meeting, are surprised to find that psychiatric symptoms trave been so mild.
"But that's really not surprising,"he said,"when we realize nearly everyone in the region had and still has the option to leave.
Astongastheoptionsexist fewpsychiatricsymptomsdevelop.
Rather, they appear when a person feels there's no way to
- escape, There can be no doubt that the urge to flee was quite strong in some people. Ilowever, the estimated 144,000 who left included many who left only after the urging of relatives, or in response to Pennsylvania Govemor Thornburgh's advice, on M arch 30, 1979, that pregnant women and preschool children leave.
Studyresults Motivationsof theevacueeswereexploredininterviews that weren't held until weeks after the event. Dr. Ilostettersees tittle significancein the survey results,which provide no data at all about people who didn't return. It's those people who would most likely become mentally ill, but the survey didn't reach them.
Of greater research value, he feels, are studies that compare Continued on page 6
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TilREE hilLE ISLGD Continuedfrom page 4 people living ne.
4 fossil-fuel power plant, but financial con-sw -
straints ruled out that source of data.
the Thil population to other groups, preferably those with only To Dr. Ilostetter, the Bromet preliminary report confirms e single difference.
what he and other psychiatrist. in the area h" ave gathered from lie points to a study conducted for the National Institute of clinicalirpsions: that few people have psychiatric symptoms Mental ilealth by Evelyn Bromet, Ph.D., and 13 collaborators, attributable to the Th11 accident, although aimost every Thil based on protocols drawn up at Pennsylvania s Western Psy-subject was likely to check off feeling " worried" or " upset" or chictric Institute and Clinic in Pittsburgh.
even " demoralized."
Unlike most of a dozen other studies of the TMI psychosocial In hindsight, none of those words, appearing in question-aftermath, which concentr:.ted on subjective questioning, the naires designed when researchers expected to find majer mental disturbances, is adequate because none describes the subclinical degrees of stress eventually identified.
Andbecause there'sno generally accepted terminology for la-beting and measurir-the subtle effects oflong-term exposure to ill-defined risks, attempts to analyze the phenomenon-oieven to discuss it with scientifle accuracy-are severely hampered.
That's why the Pennsylvania hiedical Society hasn 4 made any formal statement on the hsue.
Yet last sp ring, when public hearings were held on the pro-l posal for venting krypton-85 gas as the firtt step toward cleaning up the reactor, organized medicine felt it should make its view-point known. But how andby whom?
After considerable debate, the state society's,Fifth Councillor District, comisting of the six county societies serving areas within 20 miles of the reactor, was chosen to spenk-and Dr.Jchn L Randall, of the Department of Family and Community hiedi-cine at Lancast er General llospital, was chosen as spokesman.
Dr. Randallis also chairman of the EnvironmentalIIealth Com-mittee of the Lancaster County Medical Society.
51isleading term Dr. Randall. testified that the term " psychological distress,"
which had been used by many, was misleading, implying a path-ological con lition. He said doctors had chosen the term "m-ntal t
Bromet protocol called for more objective evidence of mental anguish" as a better one to describe what were normal, rather health status, including the physical symptoms accompanying than pathological, reactiors to stress.
mental stress, such as poor appetite, sleep problems, and loss of lie said that mental anguish, sometiraes severe, might well interest in sex.
occur chiefly because of poor communication and particularly Asa control group, the Bromet team selected residents of Bea-because people don't believe explanations made by hietropoli-ver County, Pennsylvania,some 200 miles to the west,who live tan Edison. owner and operatur of the plant, and officials of the within 10 miles of nuclear plants that have neverhad an accident.
Nuclear Regulatory Commission.
Within each population,three groups thought to be exposed to He pointed out that htetropolitan Edison wasconsidered inca-high levels of stress were chosen: clients of nentalhealth eenters, pable of managing the crippled reactor, though it was able to mothers of preschool children, and workers in the plants.
manage a functioning one, and he asked,"Should health decisions Because of budgetary limitations, the groups were smaller regardingour environment be left up to engineers and health than the Bromet team would have liked; they decided on a two-physicists whose livelihord and existence tre dependent on the to-one ratio of Thil to Beaver County residents. The Th11 sub-presence of the industry onwhich they are makingjudgment?"
jects included 177 mental health center clients,328 mothers, and Dr. Randall was echoing questions raised ayear earlierby Dr.
189 workers. compared to 70 clients,133 mothers, and 143 Gordon K. hf acLeod,who became the state's Secretary of ficalth workers in Beaver County.
only 12 da;.t Vec the Thil accident. Dr. hiacLeod had found the Small differences IIealth Deputmeat entirely without jurisdiction or resources.
With minor exceptions, notably a greater incidence of pre 4 h1 ental IIealth was in the Department of Welfare, all airborne lems among children in the Thil area (as perceived by their and waterborne threats were in the Departm:nt of Environmen-mothers), the Bromet study found "very small differences"in tal Resources, and the Ilealth Department didn't even have a li-mental health status between Thil and Beaver County subjects.
brary that could be consulted for radiation dangers; it had been Al hough the Th11 residents' stress levels were slightly above eliminated as an economy measure by a prior administration.
t those of Beaver County's, they were well below those found No one paid any attention to Dr. htacLeod's pleas that the among mental health center clients.
IIealth Department take part in trying to answer questions raised A major defect in the analysis, which Dr. Bromet herself by the accident. Those pleas are believed to hsve been a big reason points out, is not having a second control group, one that didn't for his dismissalby GovemorThornburgh in October 1979.
live near a nuclear plant.The ideal study would have included And nobody believed the feds.The credibr.ity of the Nuclear 6
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Reg +atory Commission is so low in Central..nsylvania that.
the guise of the psychs.. erapist, he'll be faced with an array of President Carterhad the Environmental Protection Agency questions. *There's the question of how much of what he's doing J
monitor radiation levels near the Th1I plant.
is Psychotherapy and how much is the traditional role of tha The EPA stillhr ao authority to measure radiation in the plan
- physician. Both the specialist's role and the CP's require differ-itself. said Dr. Randall, so public dist rust has been only partly al-ent levels of skill."The APA is concerned about the wide differ-i layed.The basic failure of the scientific community to agree on ences in techniques called psychotherapy arW the widely differ-
" safe" exposures tolor!-vel radiation adds to mental anguish.
ent practitioners who apply them. It says that certain kinds of Dr. Hostetter singles out the "Who can I believe?" factor as problems should be treated by physicians. "But there's still a the principal cause of continuing mental stress.
range of problems the proposals raise rather than resolve."
1 "ht:t Ed and the NiiC argue there is no danger, that restoring Basic questions the reactor is the only feasible thing to do, and that it will also A basic question, "What is psychotherapy?" leads to the mak electricity cheaper,"he s : "Others say cleanup poses questions, "What is mental illness?" and "What are the risks, and both sides cite what they call ' scientific' evidence to clinicalindications for psychotherapy?" According to Dr.
support their arguments." He added that until hard facts are Richman, "The current general impression of mental illners marshaled to resolve that debate, public uncertainties and stress as having a long duration and needing pershtent psychiatric will continue.
care will be supplemented by a recognition that many Dr. Hostetter recognized soon after the accident that hard acute, short-term illnesses do not require prolonged care."
facts were needed both by physicians and the public. But no text-His survey showed that short-term treatment v as more prev-books devoted to the psychological aspects of the nuclear age alent than long-term treatment. Although mental disorders over existed.
a six-year period rose from six to 10 percent of tl.e population, They still don't. The Department of Health supplies doctors only a small portion of those were diagnosed as requiring long-with a paperback on nuclear radiation, including the best avail-term treatment.
able estimates of safe exposure levels, but no book devoted spe-Psychiatric services by cps exceeded the.mmber of psychia-cifically to mental aspects hasyet been written.
trists in 1G75 and have continued to climb. (A sizable portion of "And it's unlikely that one vill be written for quite a while "
psychiatric services are also performed by mental health clinics.)
Dr. Hostetter said. "We just don't have the facts yet."
Nonetheless, only a minority of cps do psychotherapy. How do David Af. Cleary they manage the large patient-load? "'Ihere's an extensive use of tranquilizers," said Dr. Richman.
He told Afind 6 Afedicine, "What seems to be happening is that the general public is getting more mulical services called psychotherapy, that the long-wanding differences in access to it
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betwee rural and urban areas is decreasing, but that it is not GP64psychiatri*stsn wideiy used _a,ieas,ne,in H ova Sco,ia.,
htore Canadians than ever before are getting psychotherapy, thanks largely to National Health Insurance (NHI). But most of them are not going to psychiatnsts and psychologists. hiore than half are being treated by general practitioners.This same situ-ation will come about in American psychiatry with, or possibly even without, government medical insurarice. So a Canadian psychiatrist predicted at the APA wmual meeting last hiay.
{lN l
[ A serviceof He's Dr. Alex Richman, from Dalhousie University's depart-LLil I
C ABBOTTLABORATORIES ment of psychiay. With two colleagues in the Training and Re-search Unit in Psychiatric Epidemiology, he surveyed mental health care in Canada, particularly in Saskatchewan and Nova h1ind & Afedicine is published monthly by Scotia. "We found that 10.5 to 12 percent of the medical dallars Borland-Coogan Associates, Inc.for Abbott lehoratories, paid by Nill go for treating mental disorders, and the treatment North Chicago, Illinois. Editorial content is independently was mainly by cps, he said.
selected by the consultants and stof and does not necessarily "WMt do you think of the nonspecialist practicing psy-reflect the opinions of the sponsor.
chiatry? Afind63fedicme a kedhim.
Afedical ConsultantsJoseph V. Fisher, AfD, "I think th famdy physician has much to offer his patients in Fidney Werkman, SiD, CarrollL. Witten,3fD.
the way of psychotherapy,, he said.
EditorJoseph P. Coogan.
Thit's also ine opinion, he pointed out, of the President's Comminon on hiental Health, which has recommended that All correspondence should be addressed to:
mdd to moderate emotional distress should be largely a responsi-A1ind & Afedicine bility of the primary practitioner. If that recommendation is 1500 facust Street r cted on, along with recommended changes in health insurance 3,,,,39g3 coverage, a large share of Americans' mental and emotional ills Philadelphia would be treated by the CP. "After all," Dr. Richman said, "the Pennsytrania 19102.
traditional picture of the family physician was of a wise peison who supported, interpreted, remembered, and helped."
If the family doctor in that idealized picture comes back in 7