ML20079F268
| ML20079F268 | |
| Person / Time | |
|---|---|
| Site: | 05000000, Crane |
| Issue date: | 03/02/1982 |
| From: | Dircks W NRC OFFICE OF THE EXECUTIVE DIRECTOR FOR OPERATIONS (EDO) |
| To: | |
| Shared Package | |
| ML20079F227 | List: |
| References | |
| FOIA-83-363, TASK-PII, TASK-SE SECY-82-092, SECY-82-92, NUDOCS 8203180400 | |
| Download: ML20079F268 (102) | |
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March 2. 1982 SECY-82-92 (Information)
For:
The Ccmissioners Frem:
William J. Dircks Executive Director for Cperations Subfect:
TMI-l RESTART - ENVIRONMENTAL ASSESSMENT OF PSYCHOLOGICAL STRESS purcose:
To inform the Cem. mission of the status of staff action and plans.
Di:cussion:
During its meeting en January 20, 1982, the Cc mission directed the staff to initiate an environmental assessment of psychological stress resulting from restart of TMI-1.
The staff was requested to determine its rescurce require-cents and advise the Cc= issicn of its plans; was authcri:ed to consider SPU efforts in its plan without placing primary reliance an GPU; and was requested to plan so that it could proceed with either an environmental assessment or an enviren= ental impact statement as appropriate.
The staff has ceveloped a plan for c nducting the enviren= ental assessmant. Staffing and major milestones for the plan are provideo as Encicsures 1 and 2 to this paper. Under this plan submissicg cf the environmental assessment and staff rece=endations to the Ccmission is scheduled for June 1, 1982. Althcugh our plan is directed toward preparation of an environmental assessment, mucn of the technical werk requirec would ce identical if an assessment or if a state ent were to be prepared. Thus, should it be decided t0 pre:are a statement at some later date, this :Ould be accceplished with cnly eccest percurbation of the major milestones excect that an additicnal three acnths would be required to circulate the draft statement for c:: ent and prepare a final s+=tement.
Inclementation of the plan has begun and the current '. 4tus cf activitics felicws.
A workshco en ;sychalcgical stress associated with the restart of TMI-1 was held at the MITRE Corporation en February 4-5, 1982. Eleven authorities on psychological stress and related issues served as panelists. The objective of the workshcp was to have the panelists (a) assess whe:her it is possible to extrapolate frcm -
existing information to predict stress respcnses from TMI-1 restart, (b) ciscuss the scientific basis for such predi:tiens, anc (c) identify what can be done in the sn:rt term to increase confidence in suen ;redictions. A final
.crksnco rescrt will :e issued in mid-March. A draft of this re: Ort is provicea as Enclosure 3.
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, In the stafft opinion the workshop fully met the objective.
The panelists generally agreed that:
- Reasonable estimates of stress can be developed based on knowledge of the community and extrapolation from other events, recognizing that it is not possible to predict with a high degree of certainty the stress resulting from TMI-1 restart;
- Additional short-term (3 month) studies would signif-icantly improve the estimates; and
- Stress levels can be moderated by appropriate public interaction strategies.
A seven person team has been established within NRR to prepare the assessment. This team possesses the expertise to deal with both the individual (psychological) and the cccmunity (sociological /econcaic) aspects of the stress issue.
Contractual support requirements have been identified and contractual arrangements are being developed (Enclosure 2).
Completion of the Environmental Assessment by June 1,1982, is dependent on the expediticus execution of required centracts and will likely require sole source procurements.
Close coordination has been initiated with the comenwealth of f nnsylvania. Discussions have also been initiated with GPU to determine what contributions they can bring tc the effort.
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William J. Dircks Executive Director for Operations
Enclosures:
1.
Staffing Plan 2.
Major Milestones and Resource Rec;uirements 3.
Draft Workshop Repcrt l
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,t El191R0il!1EllTAL ASSESSliENT TEAli - PSYCil0 LOGICAL STRESS ASSOCIATED e.
j WITil TMI-1 RESTART l
Mn.11. Regan, Jr., Chief Siting Analysis Branch i
Jan A. Norris, Project Manager Donald P. Cleary, Section Leader RIAS*, Siting Analysis Bianch Siting Analysis Branch Technical flonitor l
l illDIVIDllAL Illi' ACTS COMiililllTY IMPACTS I
Patriciapathbun,SeniorAnalyTt' Michael Kaltman, RIAS, Roberta Ingram, Licensing Assistant (detailed from RES)
Siting Analysis Branch
! Operating Reactors Branch #4 Senior Analyst f
Susan Frant RIAS, SAB
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a ARIAS - Regional Impact Analysis Section i
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ENVIRONMENTAL ASSESSMENT OF PSYCH 0t0GICAL STRESS ASSOCIATED WITH TMI-1 RESTART-MAJOR MILESTONES Milestone Comoletion Date Workshop on Psychological Stress February 4 & 5',
Draft Workshop Report February 19 Meeting with GPU to Define GPU's Rule in Assessment February 25 Oraft Contractual Scope of Work March 1 Action Plan for_ Involving the Public March 5 Contractual Arrangements Complete March 15 Annotated Outline - Psychological and Community Stress March 19 Draft of Psychological and Ccamunity Analysis Secti6n April 22 All Reports frcm Contract Research Due May 12 Draft EA Ccmpleted for Management Review May 24 Submit EA and Staff Recommendation on Need for EIS to the Commission June 1 RESOURCE RE0VIREMENTS FOR ADDITIOMAL RESEARCH Item SK,
- Analysis relevant to TMI-1 restart of data already collected 10 - 25
- Additional field studies and analysis 100 - 125 Individual (psychological) impacts 80 - 100 Community (socioeconomic) impacts 20 - 25
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NUREG MTRS2W00026 SLT'.ARY REPORT WORKSHOP CN PSYCHOLOGICAL STRESS DRAFT REPORT 19 February 1982 J.J. Gordon W.E. Fraize R.C. Johnson P. Walker The MITPJi: Corporation McIaan, Virginia Prepared for U.S. Nuclear Regulatory Cc=nission
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a A3STRACT on 4 and 5 February 1982, eleven experts in the field of psychological stress met for a two-day Workshop at The MITRE Corporation. De general purpose of the Workshop, sponsored by the Nuclear Regulatory Commission, was to assess the state-of-knowledge of psychological stress related to nuclear power. Of particular interest was the extent to which existing concepts and studies might be used to extrapolate or infer the range of stress responses likely to result from the proposed restart of the nuclear power plant DfI-1 at the Bree Mile Island site of the Metropolitan Edison Company.
This report summarizes the discussions of the Workshop participants.
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O TABLE OF CONTENTS P, age, 1.0 EXECUTIVE
SUMMARY
x1 1.1 Workshop Response to Objectives 21 1.1.1 Inference and Extrapolation to the Potential Psychological Stress of a TMI-1 Restart xii 1.1.2 The Scientific Basis for Predicting Psychological Stress xii 1.1.3 Near-Ter:n Efforts to Increase Confidence in Predictions xv 1.2 Additional Workshop Discussions xvi 2.0 3ACKGROUND 1
2.1 Sequence of Events 1
2.2 Workshop Objectives 4
2.3 Workshop Organization 5
2.4 Report Organization 6
3.0 SUMMARIES OF WORKSHOP DISCUSSIONS 9
3.1 Psychological Effects of Nuclear Power 10 3.1.1 Nature of the Psychological Effects 10 3.1.2 Characterization of Nuclear Power by the Public 11 3.1.3 Generic and Unique Aspects of Stress Associated with Nuclear Power 12 3.1.4 Perceived Risks of Nuclear Power 14 3.1.5 Summary 15 3.2 Studies of Psychological Stress in the Vicinity of TMI 17 3.2.1 Dr. Warheit 17 3.2.2 Dr. Kasi 18 3.2.3 Dr. Houts 20 3.2.4 Dr. Bromet 24 3.2.5 Dr. Baum 27 3.2.6 Dr. Mileti 29 l
i 3.2.7 Dr. Fongemie 29 3.2.8 Summary 30 V
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3.3 Concepts, causes and Consequences of Stress Which 31 May be Applicable to TMI-l Rascart 3.3.1 Differences Between a Natural Disaster and 31 the IMI-2 Accident 33 3.3.2 Group Efforts to Define the Problem 35 3.3.4 The Acute Stress Response 36 3.3.4 The Chronic Disabled Group 37 3.3.5 Summary 3.4 Evaluation of Methods Used in Identification and 38 Measurement of Stress and Stress Responses 3.4.1 Potential Goals of Identification and 38 Measurement 39 3.4.2 Consideration of Multiple Method Approaches 40 3.4.3 Comment on Specific Methods 44 3.4.4 Other Problems and Issues 44 3.4.5 Summary 3.5 Ability to Extrapolate from Existing Studies to 45 IdI-l Restart 45 3.5.1 Caveats Associated with Extrapolacian 3.5.2 Scope of Extrapolation 49 3.5.3 Assumptions and Approaches for Extrspolation 50 3.5.4 Summary 53 3.6 Technical Considerations for Predicting Psychological Stress Associated with a Restart of IMI-l 54 3.6.1 Approsches to Predicting Pscyhological Stress Ac.ociated with a Reetart of TMI-l 54 3.6.2 Factors Affecting Confidence in Predictions 59 3.6.3 Summary 60 3.7 Identification of Additional Near Term Efforts Needed to Fill Caps in Existing Concepts and Studies 61 3.7.1 Near Term Efforts 62 3.7.2 Potential Benefit 65 3.7.3 Summary 66 vi g
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P,,s,ge 3.8 Analiorative Actions 66 3.8.1 Purpose of Ameliorative Actions 67 3.8.2 Preconditiona for Applying Ameliorative Actions 69 3.8.3 Guidelines, Procedures and Approaches 70 3.8.4 Sur: mary 72 4.0 POST-WORKSHOP OPINION PA'ERS 75 APPENDIX A - U.S. COURT OF APPEALS JUDGMENT 77 APPENDII B - LIST OF ATTENDEES 81 Table D-1 Expert Participants Taole B-2 Expert Observers Table 3-3 Attendees on 4 February 1982 Table 3-4 Attendees on 5 February 1982 APPENDIX C - WORKSHOP AGENDA 37 APPENDIX D - BIBLIOGRAPHY 91 w
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$q$ = h wa ACKNOWLEDGMENT The authors of this sumanary report gratefully acknowledge the spirit with which the expert participants entered into discussions, the self discipline demonstrated by the expert observers in delivering their messages within the specified time constraints, and the restraint exhibited by the other Workshop observers in complying with the Workshop ground rules on participation. We also particularly would like to thank Donald Cleary, Patricia Rathbun and William Regan of the NRC for their guidance and involvement in designing the Workshop; Diane Pask for her attention to the logistic details; and Jan Kindrick, Diane Pask and Vicki Ziegenhagen for their considerable secretarial effort in producing this summary report in a timely manner.
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l.0 EXECUTIVE SI:MMARI Following the accident at the Three Mile Island Unic 2 (2(I-2) nuclear power plant, the decision to restart the undamaged IMI-l
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unit, located on the same site, was delayed pending Nuclear Regulatory Commission (NRC) review. During the IMI-l restart hearing process, the contention was raised by People Against Nuclear Energy (PANE) that psychological stress might occur within the ViI community as a result of the TMI-l restart, and this possibility should be considered in NRC's decision. A U.S. Court of Appeals decision on 7 January 1982 supported PANE's contention.
In response to the court decision, the NRC has begun the process of preparing an environmental assessment of the effects of a proposed IMI-l restart on the psychological health of the residents and on the well-being of the communities in the TMI neighborhood.
The first step in preparing such an environmental assessment is to ascerrain the state-of-knowledge of psychological stress to determine the extent to which psychological stress associated with a restart of IdI-l can be predicted.
Accordingly, the MITRE Corporation, at the request of the NRC, convened a two-day workshop on the 4th and 5th of February 1982, consisting of eleven nationally recognized experts in the field of psychological s tress. These Workshop participants shared professional judgments, hypotheses, research methods and study results to address the following questions, which constitute the 1
essence of the Workshop objectives:
e What can we infer or extrapolate from existing concepts and studies concerning the psychological responses that will be exhibited among the TMI population as a result of a TMI-l restart?
e What is the scientific basis for predicting the types and ranges of these psychological stress responses?
e What additional near term efforts are required to
- l increase the confidence in these predictions?
I 1.1 Workshop Response to Objectives j
i The. discussion below summarizes, in order, the response to each of the three Workshop objectives. This information is drawn primarily from Sections 3.5, 3.6, and 3.7 of the report and is supplemented by information drawn from the other sunnaries contained in Section 3.0.
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1.1.1 Inference and Extrapolation to the Potential Psychologics. Stress of a 211-1 Researc Many participants stated that generalized predictions of stress responses associated with a restart of THI-l can be made; however, the limitations of social science theory and methodology, as well as inadequate data, are likely to yield predictions in which they would not place a high degree of confidence. Responses to the TMI-2 accident and the venting of krypton gas are felt to bound the upper end of potential stress response. Stress responses to a IdI-l restart are expected to be lower in magnitude than those associated with the accident, possibly being more comparable to those associated with the venting.
(It was noted that responses to the krypton venting were mediated by agreement among officials, the nedia and authoritative scientific sources that the venting was necessary and would not be harmful to the TKI population.)
Specific items that are amenable to prediction with the greatest confidence are:
the incidence of the acute stress
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that which is short lived; the qualitative severity of the acute stress response; e
the character and effects over time of much of the e
acute s tress response; and subgroups at high risk for acute stress.
e Relevant items about which predictions cannot be made with nuch certainty are:
the incidence, duration, and effects of long-ters, e
low-level acute stress; e the incidence of a chronic disabled group; 1
the character and effects over time of the stress e
response in the chronic disabled group; and subgroups at high risk for chronic disability.
e 1.1.2 The Scientific Basis for Predicting Psychological Stress Existing theory regarding stress and stress responses, as well as data gathered following the THI-2 accident and in conjuaction
- Acute, in the context of the Workshop discussions, referred to rapidity of onset of synptoms rather than magnitude of the response.
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with the krypton venting constitute the primary scientific basis for i
prediction of the types and ranges of psychological stress responses l
associated with a restart of TMI-1.
Theory indicates that responses to e threat are biologically and psychologically the same, regardless of the source of the threat. Accordingly, responses to a TMI-l restart are not expected to be qualitatively different from responses to other situations involving fear. The results of studies of *he TMI population tend to support this premise.
The basis for quantification of the stress response, particularly with respect to severity and duration, is more complicated. Although a body of literature exists on responses to natural disasters and other transient stresses, the issue of its applicability to a THI-l restart remains unresolved. Some participants argued in favor of extrapolating from this literature, contending that the qualitative similarities between the TMI-2 accident and natural disasters make such extrapolation appropriate.
Others argued, in contrast, that the TMI-2 accident was too minor an event to define as a disaster; hence, extrapolation from the disaster literature will overestimate the stress of a TMI-l restart. Others agreed that extrapolation from the disaster literature is inappropriate, but based their position, instead, on the argument that having been subject to the TMI-2 accident and sensitized by the experience, the TMI population is unique.
Compensating for the ambiguity regarding use of the disaster and transient stress literature are the TMI data. These data provide extensive, if incomplete, knowledge of the incidence, severity, and duration of acute stress. The data collected to study the psychological effects of krypton venting offer same insigh~t into the response of a sensitized population to a new event that is related to a prior stressful event.
Inasmuch as stress is cumulative, the krypton venting, however, will have additionally transformed the TMI population, perhaps affecting its response to a restart of Unit 1.
THI data also permit identification of some subgroups at high risk for acute stress. Further analysis of TMI data, supplemented by relevant theory, may yield the identity of additional high risk groups. In the absence of additional research on the TMI population and further development of identification techniques, some, but not necessarily all, high risk groups can be identified.
An unanticipated finding in several of 'the TMI studies was the longevity of a low level of acute stress in part of the population after both the TMI-2 accident and the krypton venting. There is a dearth of theory and data on the incidence and effects of long-term, low level acute stress, thereby leaving the scientific basis for assessment of this phenomenon incomplete.
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A group which participants felt it important to understand but also difficult to assess, given the limitations of existing theory and data, is the chronic disabled. This group is expected to emerge over the long term, after most people with acute stress responses have resolved their problema. Given the present knowledge base, a priori identification of those at high risk for being among the chronic disabled will be difficult and prediction of the incidence of chronic disabled onerous. The f airly limited time frame of existing studies, the type of sampling procedures employed and an insufficient understanding of this response are likely to preclude identification and analysis from existing TMI data of a chronic disabled group. Unlike prediction of acute stress, therefore, the disaster and transient stress literature was regarded by participants to be the principal source of information for assessing the chronic disabled. The literature on veterans exposed to Agent Orange during the Viet Nam War and to chlorine gas during World War I was cited as a potentially useful source of information.
Participants felt strongly that predictions be accompanied by the researchers' degree of confidence in the results. The possibility was raised that the uncertainty of the predictions could be so high that they would not be willing to make them at all.
Thus, data and methodological limitations that tend to reduce participants' confidence in predictions, and caveats that should be observed if predictive efforts are undertaken were discussed.
Limitations and caveats include:
Dissimilarities between a TMI-l restart and prior e
IMI-2 events and natural disasters will make predictions uncertain.
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The data base on the TMI population is limited. IMI-2 e
studies are descriptive, not designed for prediction.
Expressed attitudes toward restart will be an important e
source of information from which extrapolations would have to be made; yet the relationship between expressed attitudes and future stress is problematic.
An insufficient understanding of causal variables impedes e
interpretation of statistical data on TMI-2.
Techniques for identifying high risk subgroups may be e
inadequate.
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5 Existing theory and data preclude the satisfactcry e
assessment of the chronic disabled group and of the long term, low level acute stress response.
1.1.3 Near-Term Efforts to Increase Confidence in Predictions The expert participants recommended additional data gathering and analysis efforts in two areas: data specific to the TMI population and non-IMI data. The former was generally felt to be the more useful. Three recommendations regarding the TMI-specific data emerged:
Reanalyze existing TMI data with the objectives of e
identifying high risk groups, systematically correlating interstudy consistencies, and discerning additional associations that may help in predicting stress responses.
Analyze existing raw TMI data which focus on mothers and TMI workers ; data concerning attitudes of these subgroups towards a TMI-l restart are especially pertinent.
Cather additional data among the TMI population for the I
e purposes of establishing improved baselines (for evaluating stress responses to a TMI-l restart and developing interventions to ameliorate the stress), possibly identifying an emerging chronic disabled group, identifying and analyzing additional high risk groups, and assessing possible psychological impacts of a decision not to restart TMI-1.
The first reccamendation was developed under the assumption of a one-month time constraint, the latter two under the assumption of a six-month constraint.
In the area of non-TMI data, the Workshop participants suggested a focused review of literature concerning general crises, natural disasters and events leading to chronic psychological disability (e.g., exposure to Agent Orange). The purposes for examining the non-TMI data would include: defining bourds on the fraction of the population likely to be affected at various stress levels, characterizing chronic disabled groups and estimating races of chronic disability.
Participants identified guidelines to be enployed should additional efforts be considered:
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Any additional research should be designed to provide in-e formation qualitatively different from that already I
available.
Accepted theories of stress should be used to identify major e
causal variables and to predict types of responses; existing date should then be analyzed with reference to theory.
A multiple method approach should be used. People e
evidence stress in a variety of ways and no single method can capture all manifestations of stress. Ibrther, the techniques themselves are imperfect.
No new studies should be initiated unless it is determined e
that the existing data base is inadequate. Also considered should be the fact that postponement of a IMI-l restart may prolong conflict resolution.
Among the benefits to be expected from additional short term (i.e., one to six months) data gathering and analysis efforts, the participants highlighted: increased qualitative and potential statistical confidence in predicting stress response, more certain identification of high risk groups, and more effective targeting and development of, treatment programs and intervention techniques.
1.2 Additional Workshoo Discussions Stress is one of a number of psychological effects of nuclear Public perceptions of nuclear power affect the psychological power.
impacts of this technology. Studies referred to by one participant indicate that a common perception is that nuclear power is a risk or threat second in magnitude only to nuclear war.
Except in the early perceptual or cognitive phase, stress due to nuclear power leads to responses essentially identical to responses due to other events involving fear.
Participants presented the results of several studies conducted on the IMI population to assess the psychological effects of the T1I-2 accident and the krypton venting. Overall, stress responses appeared to be fairly mild. The studies, as analyzed to date, have shown that there was an increased incidence of somatization
- observed in the general IMI population immediately after the 211-2 accident. These symptoms were genere11y found more frequently and at higher levels among individuals closer to IMI. With the
- The expression of mental experiences or states in the form of physical symptoms.
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passage of time since the accident, stress response symptoms The studies have generally decreased in frequency and extent.
helped to identify certain high risk subgroups.
Perceptions of TMI as a threat and distrust of public officials persist.
Analogies from natural disasters and other transient stress events to the TMI-2 accident and to a restart of TMI-l were sought, but none were agreed upon by all the participants. The intangible nature of the conseqences to the consunity resulting from the accident is a major characteristic differentiating the a:cident from a natural disaster. The lack of visible damage prevented many residents from clearly defining what had occurred and from taking corrective measures. The f act that a possible restart of ITI-l involves anticipatory stress made analogies to natural disasters particularly difficult.
Participants elaborated on the acute and chronic stress Acute responses generally are relatively short lived and responses.
are considered normal reactions to stressful events. Participants were surprised that in the TMI consunity low level acute stress appears to have been maintained over an unusually long period of time. Illness due to chronic stress most often occurs in people who have concurrent life problems and who have a past history of personal difficulties which predisposes them to chronic disability.
Ameliorative actions that might lessen the psychological stress i= pact of a TMI-1 restart should focus on education, information access and counseling. Actions should be implemented only after the public is assured of the safety of TMI-l and the case for a restart of this unit convincingly presented.
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2.0 BACKGROUND
Ihis section provides a brief overview of the salient events leading up to the decision of the Nuclear Regulatory Commission to sponsor the Workshop on Psychological Stress. It also summarizes the chosen objectives for the Workshop, identifies the Workshop attendees and describes their roles and responsibilities. As a last item, the organization of the remainder of this summary report is explained.
2.1 Secuence of Events On 28 March 1979 'an accident danaged the Three Mila Island (TMI) nuclear power reactor Unit 2, known as TMI-2, at the electric generating station of the Metropolitan Edison Company near Harrisburg, Pennsylvania. Attendant to the accident was the need to inform the local population of: the potentially dangerous situation at the site, the possibility of release of radioactive material and the precautionary voluntary evacuation of people within a five mile radius of the plant.
Coincidentally, at the time of the accident, the other nearly identical nuclear power reactor, Dil-1, on the same Three Mile Island site was shut down for scheduled maintenance and refueling.
The Nuclear Regulatory Commission (NRC) ordered the DiI-l reactor, although undamaged by the accident, to remain shut down pending further NRC action.
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DRiiFT The NRC subsequently announced the formation of a Licensing Board charged with conducting public hearings and defining issues appropriate for NRC consideration prior to authorization of a TMI-l The issue of psychological stress among the people 117128 restart.
in the vicinity of the plant that might result from a IMI-1 restart was raised. Specifically, People Against Nuclear Energy (PANE) filed two contentions
- related to psychological stress for the Board's consideration:
- 1) Renewed operation of Three Mile Island, Unit 1 (Til-1) would cause severe psychological distress to PANE's members and other persons living in the vicinity of the reactor.
The accident at Unit 2 has already impaired the health and sense of well being of these individuals, as evidenced by their feelings of increased anxiety, tension and fear, a sense of_ helplessness and such physical disorders as skin
. rashes, aggravated ulcers, and skeletal and muscular problems.
Such manifestations of psychological distress have been seen in the af t.*rsath of. other disasters. The possibility that IMI Unit I will reopen severely aggravates these problems. As long as the possibility exists, PANE's sembers and other persons living in the communities around the plant vill be unable to resolve and recover from the trauma which they have suffered. Operation of Unit 1 would be a constant reminder of the terror which they felt during the accident, and of the possibility that it will happen again. The distress caused by this ever present spectre of disaster makes it inpassible for the NRC to operate TMI-l without endangering the public health and safety.
- 2) Renewed operation of IMI would cause 2evere harm to the stability, coh siveness and well-being of the communities in the vicinity of the reactor. Community institutions have already been weakened as a result of a loss of citizen confidence in the ability of these institutions to function
- These contentions are reproduced from the brief filed by William S.
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properly and in a helpful manner during a crisis. The potential for a reoccurrence (sic) of the accident will further stress the community infrastructure, causing 4
increased loss of confidence and a breakdown of the social and political order. Sociologists such as Kai Erikson have documented similar phenomena in other communities following disasters.
The perception, created by the accident, that the communities near Three Mile Island are undesirable locations for business and industry, or for the establishment of law or medical practice, or homes i
compounds the damage to the viability of the communities.
Community vitality depends upon the ability.to attract and keep persons, such as teachers, doctors, lawyers, and businesses critical to economic and social health. The potential for another accident, should TMI-1 be allowed to operate, would compound and make permanent the damage, trapping the residents in disintegrating and dying communities and discouraging the influx of essential growth.
The Licensing Board reviewed the question of the admissibility of psychological stress contentions in the IdI-l restart proceedings and concluded on 22 February 1980 that while not required to do so, che NRC "may and should consider psychological stress and community 1
fears under NEPA* for the purpose of mitigating the effects of its IMI-1 licensing activities." The Commissien, on a 2-to-2 vote, was divided on whether psychological strass is2ues should be considered. The tie vote, however, amounted to an effective denial of PANE's two contentions.
PANE appealed the NRC decision to the U.S. Court of Appeals for the District of Columbia Circuit. On 7 January 1982 the Appeals Court decided in PANE's favor and directed the NRC to prepare an i
- National Environmental Policy Act.
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" environmental impact assessment regarding the effects of the proposed restart of the nuclear facility at Three Mile Island Unit One (TMI-1) on the psychological health of the neighboring residents i
and on the well-being of the surrounding communities." The Court's decision noted that such an assessment had never previously been required or considered under the National Environmental Policy Act.
Thus, there are no precedents for the NRC to follow in developing such an assessment. The judgment as rendered on 7 January 1982 may be found in Appendix A.
2.2 Workshop Objectives While the NRC is considering what formal action to taka, it ias directed its staff to prepare an environmental assessment of the effects of the proposed re, start of TMI-1 on both the psychological health of neighboring residents and on the well being of the communities surrounding TMI. While the NRC staff has f amiliarity with psychological stress related to natural disaster,s and with the THI-2 accident, it felt the need for expert guidance on the ability to predict psychological stress responses for a future event, such as the TMI-1 restart. Hence, this Workshop was convened with the express purpose of obtaining expert opinion both on the extent to i
which existing concepts and data would permit reliable estimation of the psychologi' cal stress surrounding the proposed TMI-1 restart and on the possible need for additional studies before such an assessment could be made.
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i Specifically, the Workshop was charged with obtaining answers from the expert community to the following questions What can we infer or extrapolate, from existing concepts l
e and retrospective or longitudinal studies, concerning the i
range of stress responses that will be exhibited among the population in the vicinity of TMI to a restart of TNI-17 f
What is the scientific basis for prediction of the types and e
ranges of these responses to the psychological stress associated with a restart of TMI-17 i
e What, if any, gaps must be filled in order to increase your confidence, as an expert, in these predictions? How might these be filled?
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2.3 Workshoo Organization The two day Workshop on the 4th and 5th of February 1982 at The MITRE Corporation in McLean, Virginia, consisted primarily of a gathering of eleven of the nation's recognized active researchers and clinicians in the field of psychological stress associated with both natural and technology-related disasters (see Appendix 3 for a list of the expert participants). The eleven experts were guided in their efforts to address the Workshop objectives by an experienced but neutral facilitator for such group activities, Dr. Arthur l
Freedman of the National Training Laboratories.
Dr. Freedman's role was to keep the discussion focused on the topics outlined in the agenda (see Appendix C), with the intent that thorough discussion of these issues would provide answers to the three questions framed as I
the Workshop objectives.
In addition to the experts, two other groups were present:
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2 DRAFT expert observers, who were identified prior to the meeting
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e as likely to have substantive contributions to make to the workshop discussions and who were invited to address the expert panel at several specific pointe in the agenda for brief time intervals (see Appendix B for a list of the expert observers) and, i
non-participating observers from the NRC, MITRE, PANE and e
the affected utility among others (see Appendix B for a list of the attendees on each day).
The meeting was conducted as a workshop, not a hearing or an advisory board. The expert participants were encouraged to share professional judgments and hypotheses es well as research conclusions. The group was not instructed to strive for consensus or to avoid disagreement.
It was not the explicit purpose of the Workshop to provide specific recounsendations to the NRC. The Workshop discussions were recorded by a professional court reporter.
This report is a summaary of those discussions as they relate to the Workshop objectives.
2.4 Report Organization Sections 3.1 to 3.7 of this document follow the general outline of the agenda and suunnarize, within that framework, the major items of discussion, including different perspectives that were aired at the Workshop. Although Section 3.8, Ameliorative Actions, was not a major topic on the Workshop agenda, it was an issue of some interest during many of the Workshop discussions. It is, therefore, included with the sumanaries of the other Workshop discussions. Every attempt has been made to keep this su= unary report faithful to the transcript.
6
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The scanary report has been reviewed by each of the expert partici-pants.
In addition to this sumanary of the Workshop discussions, each expert was given an opportunity to respond to the Workshop discussions by means of a post-Workshop opinion paper. The papers of those who chose to submit them are presented in Section 4.0.
In Appendix A the U.S. Court of Appeals Judgement issued on 7 January 1982 is presented. Expert participants, expert observers and attendees lists are included in Appendix B.
The Workshop agenda is presented in Appendix C.
Citations are provided in Appendix D for bibliographic material mentioned during Workshop discussions.
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s-I 3.0 SUMMARIES OF WORKSHOP DISCUSSIONS As indicated previously, this section is organized according to the Workshop agenda (see Appendix C) with the exception of the last subsection, 3.8, Ameliorative Actions. Section 3.8 is included here because it was the subject of considerable discussion at several Points during the Workshop.
The introduction to each of the eight subsections (i.e., 3.1 through 3.8) indicates the general purpose of the session and the major topics discussed during the session. Thereafter, the subsections relate directly to Workshop discussions and present only material considered during the Workshop, with the exception of the asterisk-indicated notes in section 3.2.
Although the material in the notes was a topic of conversation during the session, the citations are not contained in the transcript and were not givec during the session. Each of the researchers noted provided the citations.
In the following sections a variety of terms are considered equivalent to or inclusive of the expert participant (s),
e.g.,
participant (s), panel, Workshop member (s). Unanimity of agreemant among the expert participants is not implicit in the use of any one of these terms. When there was apparent agreement (i.e., no dissent expressed) among the expert participants concerning an issue presented in this summary report, it is so noted.
9
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ea 3.1 Psychological Effects of Nuclear Power The Workshop opened on the topic of psychological effects of nuclear power in general, before getting into the more specific THI-related objectives of the workshop. This ordering was chosen to allow the assembled experts to begin the process of defining key terms and concepts. The discussion during this session included the nature of the psychological effects associated with nuclear power, the manner in which nuclear power is perceived by the public, the identification of generic and unique aspects of nuclear-related stress, and the public perception of the risk of nuclear power.
3.1.1 Nature of the Psychological Effects The participants suggested that stress is only one of many potential psychological effects of nuclear power and that psychological stress can have several sources. While a major cause of stress may be a fear of nuclear power, stress may also have secondary causes such as the various coping actions that residents in the vicinity of a nuclear plant may elect to take. Coping style and its resulting actions, such as moving one's residence or engsging in political action, may increase stress levels.
The manner in which public officials and technical experts characterize nuclear power can also affect psychological stress among the general public. It was suggested that stress can be increased by the very awareness of official concern over stress levels related to nuclear power. Decisions to delay or interrupt 10 l
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the operation of nuclear power plants for safety-related reasons may support the public's view that nuclear power is risky.
1 In assessing the effects of nuclear power on the psychological I
health of the community, it was felt important to recognize that stress and its responses are not necessarily harmful. While some in a nuclear plant community may be harmfully stressed, others may not be stressed at all or may use the stress as a catalyst for establishing a stress-relieving coping response. For example, political efforts may lead to community cohesiveness, promoting feelings of satisfaction among the community members. This is not to say that psychological stress as it may be associated with nuclear power was not felt to be of major concern, but, rather that it is a couplicated, multi-variable problem not amenable to simp 1'e solution.
3.1.2 Characterization of Nuclear Power by the Public The expert participants identified many of the ways in which nuclear power is characterized or perceived by the public.
Understanding the public's views of nuclear power was felt by some to be an essential first step in assessing psychological stress and possibilities for its mitigation.
Many of those who react negatively to nuclear power perceive it as a risk or a threat. The participants noted that this sense of risk results from many causes, some of the more important ones being:
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catastrophic accidents at a nuclear power facility; this may impart a certain dread quality to nuclear power, making it generally perceived by the public as riskier than anything but a nuclear war.
Nuclear power involves the use of very sophisticated techno-e logy which is unknown and largely incomprehensible to the general public; lack of knowledge of nuclear power can trans-late to fears of its potential consequences.
The public feels that nuclear power is involuntarily imposed e
i upon it by forces and institutions outside its control.
There is no way for an individual to know the extent, if any, e
of personal radiation exposure; and, once exposed, there is no way to escape its effects or to be immediately certain of the extent of those ef f ects.
The expert technical coemunity, when addressing such issues as nuclear plant safety and the dangers of radiation exposure, frequently displays disagreement among its members, a fact which reinforces public confusion and fear of nuclear power.
3.1.3 Generic and Unique Aspects of Stress Associated with Nuclear Power The participants identified many ways in which nuclear-power-related stress is analogous to the response to other technology-related or natural events. At the same time, the unique aspects of nuclear power as a cause of stress were discussed. While they generally agreed on the ways in which stress from nuclear power was either similar to or diff erent from other major sources of stress (such as living in an earthquake prone region), there was disagreement over the relative importance of the stress characteristics. This led some to assert that the unique aspects of nuclear-power-related stress were the more important, with others 12 l
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feeling that such stress could be well understood by analogy with other major stress-causing events.
The expert participants discussed at least three ways in which l
l stress and stress responses associated with nuclear power may be unique:
The early perceptive or cognitive phases of the threat e
associated with nuclear energy, including the manner in which the public is made aware of how the technology operates and is told what to anticipate, can make the stress response unique; the early perceptual or cognitive phase defines the initial stress response only; thereaf ter, stress responwas may not be unique.
The potential for nuclear accidents is more likely to cause e
anticipatory stress, a topic on which thera has been little research to date.
Whereas the types of stress response may be similar to those o
of non-nuclear. events, nuclear-related stress may be unique in terms of the levels of stimulus and str'ess response.
Among the ways in which nuclear-related stress may be generically similar to other external sources of stress, the expert participants identified the following:
Fear of nuclear power is an important stress agent; the e
resulting stress responses are likely to be similar to those for other situations which involve fear.
Stress resulting from nuclear power is related, at least e
in part, to the mutually reinforcing effects of a sense of fear and helplessness associated with 20th century technology in general.
I The effects of continuing stress on a specific population e
are cumulative over time.
While many aspects of initial stress responses to a nuclear event may be unique, the similarity to responses to other events is 13 l
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likely to increase over time. This may suggest that after the l
I initial response, effects of psychological stress can be understood by reference to experience with other fear-inducing events.
3.1.4 Perceived Risk of Nuclear Power Since psychological stress associated with nuclear power is closely tied to the perceived risk of the technology, the Workshop devoted some discussion time to understanding the nature of this perceived risk.
The first distinction made by the experts was in the area of objective versus subjective perception of risk. Although some members felt that a distinction between rational and irrational fears was not very helpful, some felt that both types of fear had to be dealt with. Irrational fears (i.e.,those "not based on data")
are not always easy to di~stinguish from rational (i.e., objectivi, data-based) fears; people perceiving an anticipated event to be dangerous will respond with fear whether objectively justified or not.
So-called rational fears may be based on an objective view of reality, but that view may include reality as it is perceived by the individual (e.g., as presented by the media). Thus, the distinction between objective and subjective reality can be indefinite and ambiguous, making it difficult to study only one or the other.
I It was noted that risk perception is affected by knowledge of the technology. Experts are likely to view risk in terms of l
mathematical probability and known consequences. Lay people, 14 l
AI:g< sw aan however, more likely will see risk in terms such as equity, transfer of risk to other generations, and uncertainty of short-and long-term consequences. While it may be less grounded in data, the typical lay person's view of risk is just as real in terms of the response and may in fact be, in the words of one expert, the " richer perception of risk."
In many discussions during the Workshop it was noted that nuclear power may be burdened with the fact that the stress symptoms observed in the environment of a nuclear power plant or af ter a nuclear accident may be falsely attributed to nuclear power.
Responses to nuclear power also can be influenced by the predisposition and mental health status of the individual, so that there is no simple cause-effect relationship.
Lastly, the panel observed that risk perception is colored by political and ideological interpretations. Vested interests and belief systems may be involved in stated concerns over the risk of nuclear power. As an example, one participant observed that a portion of the public in the vicinity of a nuclear accident will likely perceive they are under the influence of a cartel or conspiracy which may involve the nuclear industry, the utility, government agencies and the press.
3.1.5 Summa ry Stress is only one of a number of potential psychological effects of nuclear power. A nuclear accident may directly cause 15 l.
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BRMi reactions such as flight from the area or political action, which themselves may lead to more stresa than the original event. Stress can be caused or aggravated by official ccacerns or delaying actions related to nuclear plants. Stress is not necessarily harmful and in some cases can be constructive.
Public perceptions of nuclear power affect the psychological i
impact of a nuclear event. A common perception is that nuclear power is a risk or threat. This feeling stems from the facts that:
The possibility for calamitous accidents exists.
e Nuclear power is perceived as unknown and involuntarily e
imposed.
The expert community appears to be in disagreement on e
the health, safety and risk issues.
Stress due to nuclear power, except in the early cognitive phases, leads to types of stress responses similar to those resulting from other events involving fear. Levels of stress and stress response, however, may be higher with nuclear accidents.
Stress is closely tied to the perceived risk of nuclear technology.
Risk perception may be consistent with the technical risk of accident or may be greatly exaggerated; in either case, the stress response is equally real and needs to be taken seriously. The perceived risk of nuclear power is also affected by knowledge of the technology, political and ideological positions and the emotional health of the individual.
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_L Z-I 3.2 Studies of Psychological Stress in the Vicinity of TMI In order that all the expert participants have the same data base from which to approach the Workshop objectives, a brief chronological review of the studies concerning individuals in the THI vicinity that have been done was provided during this Workshop session by each of the expert participants that have been involved in this research. Due to constraints of time, presentations were limited and necessarily incomplete. For additional detail, not presented during the Workshop, review of the references noted by each researcher's name will provide more information.
In order, presentations of TMI studies were made by Dr. George Warheit, Dr.
Stanislav Kasl, Dr. Peter Houts, Dr. Evelyn 3romet. Dr. Andrew Baum, Dr. Dennis Mileti, and Dr. Victor Fongeaie. Summaries of these presentations follow.
3.2.1 Dr. Warheit Dr. Warbeit* discussed data that had been collected by Ray Goldsteen as assisted by Victor Fongemie and others in the Pennsylvania State Department of Mental Health. He noted that the methods used for collection and analysis were not uniformly rigorous. Data were obtained on some of the psychological states (e.g., anxiety, depression, phobia) that are associated with
- Dohrenwend, B.F., Dohrenwend B.S., Fabrikant, J.I., Kast, S.V.,
- Warheit, G.J., Bartlett, G.S., Chisholm, R.F., Goldsteen, R.L.,
Goldsteen, K., and Martin, J.L.:
Report of the Task Group on Behavioral Effects In: Staff Reocres to the President's Coa-mission on the Accident at the Three Mile Island. Washington, D.G.:
U.S. Government Printing of fice, 257-308, 1979.
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I RI h demoralization (i.e., a broad melange of symptoms and dysfunctions).
The study groups were: some large general population samples, a subgroup of mothers, and some rough probability samples obtained using telephone directories. There was one small comparison group consisting of patients being treated at one of the local community mental health centers. Over the course of data collection the individuals in this control group changed. Data were gathered for approximately four months beginning in April 1979.
In summary, the findings reported, based on analysis of the data collected, were:
Iroediately after the accident the rate of reporting e
of symptoms of demoralization in the TMI population was higher than that expected in a statistical probability sample in the general population. This rate did not equal but did approach the rate of reporting of l
demoralization symptoms in the patient control group.
Over the sampling time of this study the incidence of o
demoralization in the TMI population dissipated and returned to levels expected in the general population.
Indications of distrust of public officials were con-e sistently higher than expected among the sampled TMI population. This persisted throughout the study.
3.2.2 Dr. Kael Dr. Kas1* reported the results of a study conducted among nuclear power plant workers. He noted that the results of such a
- Ka s i, L. V., Chisholm, R.F. ; and Eskenazi, B. "The Imptet of the Accident at the Three Mile Island on the Behavior and Well Being of Nuclear Workers: Part I and Part II."
American Journal of Public Health, 71, (1981): 472-495.
18
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study might be less applicable r.o the general TMI population because workers might be expected to bias their responses in order to be protective of the industry and their jobs. Roughly 600 telephone interviews were conducted approximately six months post-accident, about one-half among TMI workers and the remainder among workers at Peach Bottom, a nuclear power plant 40 to 50 miles away in a sociodemographically similar area. For purposes of data analysis the workers' positions were distinguished as supervisory or noneuper-viso ry.
Targets of interest during data collection included:
perception of workplace hazards, e
residual feelings (i.e., Now, six months after the e
accident, how do you feel about
?)
role conflict difficulties ('e.g., remaining employed e
at TMI or moving f amily out of the ares),
behavioral changes (e.g., alcohol consumption, self-e medication),
effects on job satisfaction, and e
e incidence of demoralization.
The findings concerning workplace hazards and their resultant effects on health indicated that, of approximately 12 topic hazards, the only dif ference between the responses given by the TMI workers and those offered by the Peach Bottom employees concerned perceived exposure to radiation. At TMI roughly one half of the supervisory and nonsupervisory personnel felt they had been exposed to elevated icvels of radiation during the accident and about one half felt that their health was endangered by the TMI-2 accident. With respect to 19
BRAFT
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residual effects (e.g., concern about living proximate to TMI, concern for the health of their children), the responses given by I
the TMI workers indicated dissipation of these concerns at the time of the interview (i.e., six months after the accident). Ti responses of the TMI workers confirmed significant difficulty with i
role conflict (e.g., staying home or moving away with their family versus going to work at TMI) but no significant increase in alcohol consumption, self-medication, or seeking professional medical attention. In their employment attitudes the TMI workers suffered clearly reduced job satisfaction and increased concern about their employment and the future of the nuclear industry.
In addition, the supervisory individuals at TMI experienced decreased occupational self esteem and lessened identification with the company.
In general, an elevation in demoralization symptomatology remained among the TMI workers, primarily among nonsupervisory individuals, six months after the accident. Primarily among the supervisory personnel, the effect seemed to be increased if they had young children.
3.2.3 Dr. Houts_
Dr. Houts* reported the findings derived from data gathered during the following six random access dialing telephone surveys
- Houts, Peter, S., Goldhcber, Marilyn K.; " Psychological and Social Effects on the Population Surrounding Three Mile Island Af ter the Nuclear Accident on March 28, 1979." Energy, Environment.
and the Economy, Chapter 14, edited by Majumelar, S.,
Pennsylvania Academy of Sciences, 1981.
20 i
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conducted by a professional polling organization:
July 1979, interviewed about 700 people within 5 miles e
of TMI; January 1980, reinterviewed 400 of the 700 individuals from e
the July 1979 study; January 1980, interviewed a panel separating individuals into e
groups by distance from the plant; January 1980, interviewed people using the Langner scale *;
e October 1980, repeated interviews with a portion of those e
inuividuals separated into groups by distance from the plant; and October 1980, conducted a study on mobility in the area, e
in concert with the Pennsylvania Department of Health.
For all of the analyses, responses from a control group 40 to 55 miles away were used for comparison. It was noted that telephone interviews are hampered by th'e fact that it is not reasonable to ask long or complex questions over the phone. In addition, care was taken to emphasize that these studies were general population surveys and, as such, the natare of the effects of IMI on vulnerable or highly affected subgroups in the population would not be expected to be apparent.
The findings of all these studies evaluated together generally indicate that the psychological stress phenomena evidenced 18 months af ter the accident are probably quite different from those apparent
- The Langner Scale was designed to differentiate mental health patients from the general population and correlates strongly with the denoralization scale.
21
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=u a during and immediately after the accident. More specifically, a trend toward decreased concern is exhibited. When comparing the data gathered over time, it is apparent that, initially, people closer to TMI reported being more upset than those farther away. In January 1980 concern still varied inversely with distance from the plant but the significance of the difference had decreased. Responses obtained in October 1980 demonstrate no significant difference in level of concern associated with proximity to TMI. A similar trend was deduced when evaluating responses to the question of IMI being a serious threat. The people close to IMI revealed more concern than those farther away. The difference persisted over time, but the extent of the difference decreased over time.
With respect to behavioral (e.g., sleeplessness, irritability) and somatic (e.g., sweating spells, abdominal pain) symptom reporting, the group close to TMI retrospectively reported markedly higher incidences at the time of the accident. This effect persisted, although the differences decreased, through January 1980. In October 1980 no significant differences in symptom reporting were found, when, as in the previous comparisons, the analyses were statistically controlled for age, sex, education and marital status.
In addition, of the people reporting behavioral or
[
somatic symptoms, those living close to TMI more frequently l
l attributed them to the accident. This persisted even in October 1980 when the frequency of symptom reporting in the two groups was essentially the same.
22 l
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When the Langner scale was employed to collect data in January 1980, no differences were found between the group proximate to TMI and the group distant from the plant. Using the Langner Scale to compare, for instance, the incidence of headaches among two groups, people are counted as a positive only if they indicate that they have had headaches often (i.e., out of a choice of responses between never, sometimes and often). Therefore, using the Langner Scale only the individuals who report having had headaches often will be grouped for comparison,-while the groups compared in the other January 1980 analyses were composed of people who had had even one headache during the time period of interest.
During analysis of these data collected over time, Dr. Bouts found changes in the characteristics of the concerned group.
In his early surveys, the group most concerned could be characterized as primarily young, more highly educated and female rather than male.
During later surveys, women still emerged as more concerned than men but individuals with less formal education were more concerned than those with more.
The surveys examined people's attitudes to restart of TMI-1.
In January 1980 sixty percent of the people residing within five miles of TMI were opposed to restart, while in October of the same year opposition had decreased to 46 percent, a statistically significant reduction.
Dr. Routs indicated that although levels of concern seem to be decreasing among the general population, the levels have decreased at a faster race among those living nes: IMI.
23
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oc' J,g udP a When the group in opposition to TMI-l restart was analyzed for age, income, education and sex, the only significant finding was that the group had an unexpectedly high proportion of women.
l The final three findings reported by Dr. Houts concerned mobility, health care utilization and coping strategies. Although many people originally indicated an intention to move from the TMI area, no corroborative evidence was found for a strong mobility effect. Similarly, there was no significant increase in health care utilization rates even though people were reporting increased somatic and behavioral symptoms. The responses to questions concerning coping strategies provided curious results. Apparently, individuals who were active copers (i.e., did something about their concerns) were more anxious initially and tended to remain more anxious over time than non-copers.
3.2.4 Dr. Bromec Dr. Bromet* reported the findings of a study that focused on the following three research questions:
e Nine months after the accident, were there differences in the mental health of individuals living near TMI?
e Were there increased mental health problems at the time of the anniversary of the accident (i.e., March 1980)?
To what extent does social support serve as a moderating e
variable for stress responses to the accident?
- 1 1
- Bromet, Evelyn, et al.
"Three Mile Island: Mental Health Findings." Prepared through support of NIMH contract
- 278-79-0048 (SM) Department of Bealth and Human Services, National Institute of Mental Health Disaster Assistance and Emergency Mental Health Section, Oct. 1980.
24 i
. __.E D. f.M tJFiMTl The study concentrated on the following three groups of people:
mothers who had given birth during the 15 months prior o
to the accident and who also lived within 10 miles of TMI, nuclear workers who were members of one of the unions e
and working at the plant at the time of the accident, and patients who had been in the public mental health e
system within the six months prior to the accident who lived within ten miles of the plant.
These groups were compared with similarly structured groups from the area around the Shippingport-Beaver Valley nuclear facility in Beaver County. It was noted that since these comparison groups may have been stressed indirectly by the TMI accident, the results of the analyses may be considered conservative estimations of the impact of the accident among those living near TMI.
Face-to-face semi-structured diagnostic interviews were administered by mental health professionals, who were working at the time in the mental health field, had a relevant master's degree and at least five years of clinical experience in a mental health center. Interviews were conducted twice (i.e., nine to ten months af ter'the accident and 12 to 13 months post-accident) and focused on two aspects of mental health. These were: 1) depression and anxiety that met research diagnostic criteria and 2) subclinical manifestations of stress as identified using the 90-item symptom checklist developed at Johns Hopkins (SCL-90). The interviews also included life history for psychopathology.
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f w $'dh'$ s.A Analysis of the data provided by the interviews with the mothers indicated that there had been no differences in terms of clinical disorder rates between the two groups prior to the accident; however, in the year post-accident significant differences were observed in clinical depression and anxicty rates. The majority of the clinical episodes occurred during the two months immediately following the accident. Other than this difference in rates, no other single predictor. of clinical disorder was observed.
There was a significant difference in subclinical symptomatology between the two groups of mothers, but none of the predictors except for living proximate to TMI correlated with the difference. One other variable did relate directly, i.e., history of psychopa-thology. Mothers who had had prior clinical experiences more of ten experienced clinical disorders af ter the TMI accident. With respect to subclinical symptom reporting, those who perceived their social support systems to be positive reported fewer symptoms.
There were virtually no differences in mental health found
~
between the nuclear workers at TMI and those in Beaver County. In addition, no statistically significant differences in mental health were observed when comparing the two patient groups. There was a relationship between perception of risk associated with living near a r.uclear plant and symptom reporting by the patients. Those who I
perceived it as dangerous tended to be more symptomatie.
26 1
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u 3.2.5 Dr. Baum Dr. Baum* reported the results of studies concerned with the response of IMI area residents to the venting of krypton gas at THI-2.
A group of 44 people living within five miles of INI served as the study group and a socioeconomically similar group from the Frederick, Maryland area, 85 miles southwest of IMI, was used for comparisons. Interviews were conducted four times:
shortly before the venting, after the intention to vent e
had been announced; e two weeks later, during venting; within a few days of the end of the venting; and e
e six weeks after venting ceased.
As measurement methods, the SCL-90 was used to collect reported symptomatology, a proofreading task was administered to evaluate b'ehavioral effects and a 15-hour urine sample was assayed for catecholamine levels to evaluate physiologic effects.
Results gathered and analyzed from the first interviews suggest the IMI group was experiencing anticipatory stress (i.e., they vere reporting more symptoms, the intensity of some of those symptoms was greater, their proofreading performance was affected, and their urine catecholamine levels reflected greater stress than in the Frederick, Maryland group). Once the venting began and until
- Baum, Andrew; Gatchel, Robert J.; Fleming, Raymond; and Lake, C.R.,
Chronic and Acute Stress Associated with the Three Mile Island Accident and Decontamination: Preliminary Findings of a Longitudinal Study. Draf t Re po rt, submitted to NRC July 1981.
27
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i the last study, the differences reported initially began to decrease and continued to decrease for all but somatization, as measured by l
the SCL-90, and proofreading. For the most part, the differences observed between the TMI and control groups, with the two noted exceptions, were still significant at the last interview. However, the level of stress observed appeared to be mild (i.e., SCL-90 scores were considerably less than would be expected from a population of clinical patients, catecholamine levels were generally in the high normal range and proofreading abilities generally were equivalent to those expected from college students immediately after being subjected to one-half hour of noise). The consistency and duration of the stress response was considered surprising.
Perceptions of threat and mistrust were also, measured and, although the levels remained high, they correlated poorly with the other measures of stress. When queried concerning opposition to the venting, there seemed to be no real difference between the IMI and control groups (i.e., in both groups most people were moderately opposed, soms extremely opposed and some in favor).
During the last interview two additional control groups were added. The first group lived near a coal-fired power plant in Maryland about 100 miles frca TMI. The second group lived near an undamaged nuclear plant in New Jersey about 150 miles from TMI.
These groups did not differ significantly from the original control group on any of the measures used, suggesting that the TMI responses were unique to TM1.
28
k 3.2.6 Dr. Mileti Dr. Mileti* summarized a study of unobtrusive behavioral indications of stress (e.g., alcohol c.onsumption, automobile accidents, suicides, psychiatric admissions) among three groups (i.e., people living within 5 miles of IMI, people living 5 to 10 miles from TMI, and people in a demographically similar area of Pennsylvania).
The summarized findings were that the major indicators (e.g.,
suicide, psychiatric admissions) did not reflect a significant stress response, but that the minor indicators (e.g., alcohol consumption) did suggest a low level stress response. The response observed was of short duration and was considered similar to the stress associated with a major holiday.
~
3.2.7 Dr. Fongemie Dr. Fongezie* reported the findings of a study that had been done through Hahnemann Medical College. They were:
The people at TMI had a considerable lack of f aith e
in the information they received during the crisis.
- Mileti, Dennis S.,; Hartsough, Donald, and Madsen, Patti.
"The Three Mile Island Incident: A Study of Behavioral Incicators of Human Stress" draft report prepared for Shaw, Pittman, Potts and Trowbridge, Legal Counsel to General Public Utilities and Metroplican Edison, 1981.
- Morell, Jonathan A. ; Spivak, Geor2e.
" Review of Studies on the Psychological and Behavioral Impact of the TMI Nuclear Accident 1
with Specific Implications for Research and Planning, draf t report, Department of Mental Health Sciences. Hahnemann Medical College, 1980.
29
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N4 4 4 $
8=
Re i People at TMI acted reasonably well on the basis of e
what they believed to be true and how they felt about it.
There was a significant amount of stress and psychological e
discomfort among the people proximate to TMI.
People at TMI acted rationally.
e 3.2.8 Summary There was an increased incidence of somatization observed in the general TMI population immediately af ter the TMI-2 accident.
These symptoms were generally found more frequently and at greater levels among individuals living closer to TMI.
The groups exhibiting most concern of ten had a greater than expected proportion of women.
With the passage of time since the accident, symptomatology generally decreased in frequency and extent, although reporting was still elevated above expected levels in one study as much as seventeen
~
months after the accident. As long as 18 months post-accident people living near TMI were attributing reported behavioral and somatic symptoms to the accidant, although their rate of symptom reporting was essentially the same as a control group that did not attribute symptoms to TMI. The TMI population responded to another nuclear-related event (i.e., venting of krypton gas) with anticipatory stress and with low level but long lived stress after the venting ceased. Perceptions of IMI as a threat and distrust of public officials persist.
i 30 i
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3.3 Concepts, causes and Consequences of Stress Which May be Applicable to the TMI-1 Restart The purpose of this session was to provide the expert partici-pants an opportunity to discuss possibly conflicting concepts of stress and to identify causes and consequences of stress they have observed or have become acquainted with in the literature. The members of the Workshop identified and discussed the similarities and dissimilarities of the TMI situation with other stressful l
situations that have been studied. Blame behavior, coping style and political activism were discussed. The nature of the acute stress response at TMI was outlined and the probability of the emergence of a chronic disabed group suggested.
3.3.1 Differences Between a Natural Disaster and the TMI-2 Accident
. Considerable discussion centered around the dif ferences between natural disasters and the nuclear accident at TMI-2.
After a natural di,saster the cause is usually concrete and relatively clearly understood. The worst is over quickly, the process of definition of damage gets underway and the community unites and begins to allocate resources for recovery activities.
- 1 In contrast, the nuclear accident at TMI-2 was not bounded in I
space and time. At the time of the accident, the various experts and information sources disagreed on the extent and danger of i
exposure. Because of the intangible nature of radiation and radiacion danage, people did not know whether they had been harmed; a
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they were aware that the effects of radiation may be delayed many years and are uncertain. If people lef t the area, they might be taking personal damage with them rather than leaving it behind.
One participant in the Workshop described the difference in arrival at the site of a natural disaster and arrival at Harrisburg five days after the accident.
In the TMI area, there was no visible damage and no community consensus about damage or the options for recovery. The predominant response, if any, was flight, either actual or anticipated. Those persons living near the plant had been faced with the choice of joining the precautionary avacuation without solid information on which to base their choice. There was no option fr.' physical involvement in the process of recovery from the event, as there is af ter a natural disaster.
Additional observations concerning the similarities and dif ferences between TMI-2 and natural disasters were made including:
The person who lives in an earthquake zone and the
~
e person who lives near a nuclear power plant =ay both experience stress. This stress may be revived or increased on a continuing basis by the reports of earthquakes or nuclear incidents elsewhere.
An earthquake is not in the realm of human control e
and political activity is not effective in averting A power plant accident, in contrast, is a conse-one.
quence of human economic activity that can be affected by the political process.
The participants of the Workshop suggested that a critical aspect of the TMI-2 accident was the lack of problem definition and resolution. As noted, the extent and. implications of exposure'were 32 v
e
!! RAFT
\\
e undefined in the public mind, but dreaded. People who believed they had been exposed also fear that they carry the damage around within them and that the results of that damage may not become apparent for many years. Various analogous situations were suggested:
exposure to chlorine gas during World War I; e
post-World War II exposure of military personnel e
in atomic tests; exposure to Agent Orange during Viet Nam; e
exposure to toxic waste sites, such as the Love e
Canal; and the period af ter internal trauma, such as a e
heart attack.
While none of these analogies was seen as identical to TMI-2, they had in common an event or situation of uncertain future outcome that was considered potentially stressful to the individual.
3.3.2 Croup Ifforts to Define the Problem Af ter a natural disaster, the dominant mode of community response is the definition of damages and the allocation of resources for recovery. It was suggested that af ter a technological disaster, a protest group may be performing a similar function:
seeking to define the problem and providing a focus for com= unity organization.
1 The people at TMI who were most strongly opposed to nuclear power also tended to prefer that the nuclear dec,ision-making process be vested in the political arena rather than in the technical experts or agencies. Ihe genesis of a protest group af ter a f
e 33
-.... - -. ~. - - -.. ~
1 Al69' i macar technological disaster should probably be expected because of the
~
need to define the problem and propose a community course of Additionally, because the event provides a "cause" to rally action.
around, some individuals who do not acttsally have strong feelings, may be drawn inte the protest.
The 'Jorkshop also addressed differences in blame behavior and After a natural coping as related to psychological stress.
disaster, if any blame is to be allocated, it is more readily directed towards oneself. The problem is defined as having to deal with "my own emotional responses." Af ter a technological disaster there are man-made causes that can be identified and blamed. Some people. therefore, may focus blame outward and not co=e to terms
~
vith their own feelings.
People also vary with respect to coping style. Although it might be predicted that it should be easier to deal with an external source, evidence was presented to the contrary. Those who approached the TMI accident with a problem-solving orientation as contrasted with an emotion-resolving orientation showed higher levels of frustration and stress. It was noted that the resolution of a problem in the political arena is of ten difficult, frustrating and long-term. This approach may, in fact, perpetuate the lack of resolution of the stress. (Clinical practice has shown that people who try to deal, for example, with fear of flying by dealing with the external reality, e.g., FAA or air safety issues rather than i
34
~
DRAFT with their own emotions, will show continuing frustration and lack of conflict resolution.) Failure to gain attention and to achieve political objectives may lead to depression and a feeling of helplessness.
t 3.3.3 The Acute Stress Response Participants f elt that the acute stress response is a nor=al expected response to a stressful event and, therefore, is not necessarily an illness. The psychological and physiological indicators of anxiety and depression may be expected to peak initially and then taper back to baseline levels as resolution is achieved. This pattern was observed after 241-2 with two important qualifications. First, the measured levels of stress, even inicially, were relatively mild and have since fallen to levels that, although low, still appear to be above normal or expected levels. Secor.d, there are indications that this elevated but low level of stress has been maintained over a surprisingly long period of time.
The bulk of the stress literature deals with apparently acute stress that is resolved relatively quickly. The physiological and psychological effects of long term maintenance of low level stress are not known. One possible analogy mentioned at the Workshop is prisoner-of-war situations, in which victims are in an unresolved situation for years at a time. Assessment of the psychological inpacts of these situations is, however, usually additionally i
35 i
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6ur s 2 It was complicated by nutritional deprivation and physical torture.
suggested that the traditional stress model of depression / anxiety /
resolution that guides ;esearch projects may need to be modified to include indices of chronic degenerative processes.
Concern was also expressed that.high risk groups in the population be identified and studied. These may be groups that are apt to have been more highly stressed in the original event (e.g.,
mothers of young children) or are apt to maintain a long-term but mild 1evel of stress (e.g., political activists).
~
3.3.4 The Chronic Disabled Group Participants in the Workshop hypothesized that a chronic disabled group =ay be expected to emerge over time. Membership in
~
this group may be different from membership in the acute stress group. In fact, the emergence of a person as chronically disabled may not be related to severity of the initial exposure. For example, exposure to Agant Orange initially produced a dose-related skin response. The enronic disabled group that later emerged showed no clear correlation with the extent of initial exposure.
Members of the chronic disabled group may or may not be exposed to any more stressful life events chan the general population, but they have personalized interpretations of these events. They.
generally function in support groups that are unusual or impoverished. Sometimes they have a history of psychological problems and of ten have a number of other concurrent life problems.
36
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O f, W W
The expert participants suggested that stress is multi-factoral; many events contribute to the level of stress an individual experiences at any one time. Many of these stressful events are family-and job-related. When a person appears in the chronic disabled group, it is difficult to say what particular causes of stress pushed them beyond their ability to cope with stress. W e participants in the Workshop were not able to predict whether the chronic disabled group that may emerge in the mI population will be any larger than it would have been in the absence o f the D11-2 accident.
Although stress related to the NI-2 accident, or to the possible restart of NI-1, is but one of the factors or life stresses that might have contributed to the emergence of chronic disabled individuals, there is likely to be fairly high level of attribution of that condition to the mI-2 accident or to the restart, should it occur. People who are chronically disabled characteristically identify an event to explain their condition.
The attribution of chronic disabilty to the 211-2 accident or to the restart of 21-1 was suggested by one of the participants as a L
potential future legal problem.
3.3.5 Summary The N I-2 accident was characterized by uncertainty of the L
damage and lack of resolution. The resulting stress was compounded I
by the fear of nuclear accidents and the long-ter= but hidden effects of radiation dosage.
37 m
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- _ _ _ _.i _ ~ ~
Acute stress responses have been observed at 'LMI. -These normal responses to a stressful situation were initially relatively mild and have since declined to low, but slightly elevated, levels.
The implications of these mild but long term stress levels are not known.
A chronic disabled group may be expected to emerge over time.
This group, probably different in membership from the groups originally manifesting stress, is characterized by many life pro-blems and is likely to attribute disability to the TMI-2 accident.
3.4 Evaluation of Methods Used in Identification and Measurement of Stress and Stress Responses The purpose of this Workshop session was to provide the experts with an opportunity to evaluate critically and systematically the various stress identification and measurement methods employed, particularly those they have used. It was noted by one of the participants that the National Academy of Science has recently completed and published a comprehensive evaluation of methods used in the identification and measurement of stress responses.
Therefore, the discussions during this session focused on the goals f or identification and measurement, an assessment of the various research approaches and methods, and problems and issues encountered in identification and measurement of stress responses.
3.4.1 Potential Goals of Identification and Measurement j
The expert participants identified five major goals for f
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identification and measurement:
38 1
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Determine the proportion of stressed individuals e
in the target population as compared to baseline and control populations.
e Measure or infer the level of stress.
- Measure the outcomes of stress. It was suggested that typically these have been anxiety, depression, or psychophysiological symptoms but may have to be broadened to include chronic degenerative states and perhaps some quality of life measures.
Identify specific high risk subgroups within the target e
population.
Describe the evolution of stress-related impacts and gain e
some insight into process dynamics.
3.4.2 Consideration of Multiple Method Approaches The members of the Workshop agreed that the use of multiple measures and methods by a variety of investigators is the most desirable approach to analyzing stress responses. Stress research
~
is a demanding discipline with complex varied responses and without precise measures. Each method used has its own shortcomings; but, when used together, methods may provide a convergence or a consensus in the major findings. It was felt that when a trend is found by a number of research approaches, the research community can be far note certain of the validity of the finding. To a certain extent, such has been the case in the TMI-2 studies. For instance, the persistence of the stress response was noted as surprising to the 241-2 researchers, but the finding was verified by several studies.
A When a consensus is not found, the results of each approach are judged on their own merits rather than discounted. Where results i
6 39 h
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i confliet, attention may be focused on what is being measured and what intervening variables may be affecting the findings. Lack of consensus or appearance of conflict does not suggest necessarily that one or both findings are in error, but careful interpretation of the result is essential.
The participants noted that agreement between the various measures of stress should not generally be expected, especially when evaluating relatively low levels of stress. Different people respond to stress in different ways. One measure will pick up one typa of response, another neasure another type of response. Only when the level of stress is quite high might several of the various indicators of stress be manifest concurrently. In fact, it was
' suggested that agreement between the results of various measures may be an indication of severity of stress.
3.4.3 Comment on Specific Methods The participants discussed a variety of research designs and measures and indicated some of the strengths and weaknesses of each. Specific discussion concerned probability samples, subgroup studies and longitudinal studies. Self-report measures, physiological measures and quality of life measures were also discussed.
The probability sample may be the sampling technique of choice if adequate funds are available. Statistical sampling of the affected population allows the findings to be generalized to the 40 l
i
Wm Y, E t 4 C.* G population as a whole. The participants noted that a large sample will be required, particularly if multiple measures are to be used and if the level of stress is relatively mild. This method is appropriate to answer questions such as "What are the impacts on people living within the five mile radius as compared with another group?" Large scale sampling also may be used as a screening tool in an effort to identify subgroups that may be at particularly high risk. This method, however, is not useful for describing the high risk groups themselves and will not necessarily permit all high risk subgroups to be identified. Rather, generalizations can be made j
only to the overall population.
l Detailed study over time of a high risk subgroup may allow observation of the evolution of;the stress response or impacts in those particularly affected. To identify high risk subgroups for further study an a priori judgment of which groups are particularly vulnerable must be made or some clustering method must be employed based on data from larger scale studies. It was suggested that when funds are constrained, the best strategy may be to focus attention on those groups that are believed to be most susceptible to the effects of stress.
Longitudinal studies are needed for tracking changes over time and describing the process of resolution of acute stress and the possible emergence of a chronic disabled group. The problem pointed out by the participants is that these studies usually lack adequate 41
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,1 Mm f b* f A %) f baseline data. In general, a population studied af ter a disaster has been inadequately characterized before the disaster. As a result, there may be a tendency to attribute stress to those individuals in the population whose stress indicators do not return to baseline. Whether these individuals are stressed or simply have a high normal vslue for a particular measure cannot be determined without the baseline data.
Self-report studies and field intsrviews are co=monly used methods for obtaining prevalence and $1cidence data. However, l
1 caution was recommended when relying on findings based on l
i self-report data, because of the following biases that are diff1 cult to control:
The people being interviewed may respond with answers e
believed to be desired, rather than with answers that j
I reveal what they really think.
j The people being interviewed may falsify their responses e
for manipulative purposes (e.g., political or ideological motivations).
Recollection of past events may be unconsciously biased by e
more recent events or attituden.
- People may attribute causality that ir not warranted.
Well-conducted interviews and well-constructed field instru-ments usually have built-in checks to counteract some of these biasing effects. 7,ome participants in the Workshop suggested that it would be appropriate to supplement the self-report data with the use of non -self-report measures.
42
dhri.5 g
t A number of interview instruments are widely used. The diagnostic interview schedule (DIS)*, for instance, is being used by the National Institute of Mental Health in a number of large-scale studies. The common use of instruments like DlS among studies may allow comparisons with other populations.
Physiological measures were felt to be useful in avoiding the bias problems of self-report measures. Sowever, some of the expert participants noted that the high degree of individual variation often renders these measures as inadequate as psychological measures of stress. Covariation between physiological and psychological measures is greater when used to describe impacts of higher levels of stress. At higher levels of stress these physiological measures nay be useful for assessing magnitude of the stress impact.
The members of the Workshop considered quality of life measures but found it difficult to tie these measures into the traditional concepts of stress. It was noted that a sense of well being is certainly part of the quality of life, but that stress measures should go beyond opinions, feelings and political objectives, factors which quality of life indices tend to reflect. It was also
~
noted that quality of life measures should have some correlation with physiological measures if they are to be considered measures of health. It was suggested that support groups and networking be
- A structured interview, focusing on historical and current psychological states, that can be administered by a lay person.
43 l
5 6 8 g BRAFT studica to determine their role as stress-related indicators of quality of life.
3.4.4 Other Problems and Issues The identification of high risk groups generally has been done on an informed but a priori basis. The identification of individuals within that group who may be particularly vulnerable is difficult. Some of the reasons for this difficulty are:
Individual differences exist in psychological and e
physiological makeup. People exhibiting a high level of stress on any 2iven stress measurement, in fact, may be highly stressed or may be exhibiting a high, but for them normal, level.
e Differences in coping behavior affect the extent and rate to which stress is expressed and/or resolved.
e Differences exist in the number of variables that lie between the stressor and the stress responses or impacts.
This includes differences in perception, differences in support groups and,-for children, differences in develop-mental stage.
An individual may be experiencing other stresses con-e currently, of which the investigator is not aware. Stress is cumulative and the individual response observed may be affected by stresses other than those the researcher has defined.
3.4.5 Summarv The members of the Workshop agreed that multiple measures and methods are needed to evaluate stress responses. Each of the major 4
measurement approaches, including probability samples, subgroup j
studies, longitudinal studies, self-report measures and physio-f logical measures, was found to have advantages and imperfections.
44
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Although each approach has its own problems, when a consensus is found among various studies using multiple measures, confidence in the finding is increased. The members of the Workshop also agreed that they do not expect the various psychological and physiological measures of stress all to agree with each other. In fact, when they do, that is generally taken as an indication of severity of the stress.
Goals for measurement include information on the incidence and severity of stress within the population, identification of high risk subgroups and insight into the process dynamics of stress. The traditional measures of stress impacts may need to be broadened to include chronic degenerative states and some appropriate quality of life indicators.
3.5 Ability to Extrapolate From Existing Studies To TMI-l Restart The purpose of this session was to evaluate the extent to which existing knowledge and data on psychological stress provide a basis for predicting stress in the event of a restart of TfI-1.
Three major topics were discussed: caveats associated with extrapolation,the scope of extrapolation, and assumptions and approaches for extrapolation.
3.5.1 Caveats Associated with Extrapolation Many participants stated that generalized predictions can be made; however, the limitations of social science theory and methodology, as well as inadequate data, are likely to yield 45
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L predictions in which they would not place a high degree of confidence. Indeed, the fact that several unanticipated results were found in the stress studies on the TMI-2 accident was discussed. Reference was made to findings such as the unexpected longevity of the stress after the accident, followed by a decline to normal or nearly normal levels. Elevated rates of somatization as much as six weeks af ter the venting of krypton gas also was pointed out as an unexpected finding. Given their expectation of a lov level of confidence in extrapolations, participants prefaced their comments with the following caveats.
First, predicting f:sture behavior is very difficult. The degree of difficulty rises as the dissimilarity between k,nown events from which extrapolations are to be made and the potential event increases. A restart of 241-1 may have no real parallels since people living in the vicinity of TMI already have experienced a nuclear accident and thus constitute a population sensitized to s tres s.
Post-accident stress following the TMI-2 incident or a natural disaster may be quite different from anticipatory stress which may accompany a restart of IMI-1.
(Stress associated with the krypton venting may be more analogous to a THI-l restart.)
Second, knowledge about the TMI population, while more complete than that available for most populations, is not sufficient. There 6
are no baseline, pre-accident data on this population, and the post-accident data are incomplete. Moreover, few data have been 46
collected specific to the potential restart of TMI-1.
For example, f
it would be useful to understand the perceptions of residents regarding the competence of THI-l managers and operators and residents' evaluation of the possibility of future accidents. The data that do exist on the TMI population come primarily from descriptive studies of responses to the TMI-2 accident. These studies were not designed for predicton.
Third, even if data on the potential restart of TMI-l were collected, inferences from them would be problematic. Many of these data would be obtained from survey instruments which require people to anticipate their feelings should TMI-1 reopen. Responses may be biased both by the inability of people to predict accurately their future feelings and behavior and by deliberate misrepresentation designed to influence the restart decision. The participants referred to classic studies of the inability to relate intentions to behavior, as illustrated by the work of Lapier and Lefler on the topics of racial prejudice and integration. These studies suggest that while people may state their opposition to a situation and indicate a refusal to participate, many in fact do participate.
Similarly, studies of toxic waste dumps and nuclear reactor siting have shown that the hostility of residents declines significantly within a year af ter installation of the facility. Thus, asking people about their potential reaction to the reopening of IMI-1 may provide data too unreliable for prediction.
47 i
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ny a Fourth, social science theory currently does not permit a complete enough understanding of psychological stress phenomena associated with past and potential TMI events. A consequence of this is that statistical analy:cs are difficult to carry out aad interpret. A multiplief',y of fact. ors affect stress at IMI, conf ounding identification of the most important causal variables.
In addition, statistical artifacts may be complicating the interpretation of existing data specific to the TMI-2 accident.
Another consequence is the inability to adequately characterize or fully anticipate certain stress responses. A particular concern is the physiological effects of long-ters, low-levels of acute stress on the TMI population. This type of stress may have unique aspects, distinguishing IMI from transient stressors (e.g., earthquakes);
yet existing literature on this issue focuses instead on the physiological effects of short-term stress. It was pointed out that it veuld be logical to look for degenerative processes such as increased blood pressure that result from being in an unresolved state for a prolonged period of time. Similarly, a chronic disabled group may well emerge but is not well documented. Suggested analogies of low-level, long-term stress may be found in soldiers exposed to chlorine gas in World War.I and to Agent Orange in the Viet Nam War. Ihe literature on these events may be an important source of information.
48
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3.5.2 scope of Extrapolation In light of these reservations, participants made a series of comments on the possibility and scope of extrapolation. It was commonly agreed that plausible guesses or general predictions can be made, albeit with large errors and variances expected. Participants also agreed generally that responses to TMI-2 bound the range of responses expected to a restart of IMI-1, with the latter probably being less stressful than the 23I-2 accident. It was argued that it should be possible to identify the most important variables fo'r predicting psychological stress. Participants were not in agreement, however, regarding what the most important variables Data collected on responses to the TMI-2 accident and the a re.
venting of krypton gas were identified as the basis hrom which any extrapolation should proceed.
It was argued that responsea to a threat are biologically and psychologically the same regardless of the sourco of the threat and that responses will not be different for the IMI population. The I
incidence of acute stress can be measured and predicted with much i
greater confidence than that of chronic stress. Moderate responses l
are more difficult to predict chan extreme responses. Most groups particularly vulnerable to acute stress can be identified, and the temporal character of that stress predicted. Predictions of the time pattern of acute stress will be more accurate if no problems or disturbances accompany a TMI-l restart.
49 i
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Participants emphasized the value of using existing data specific to the IMI population in making extrapolations. Opinions differed regarding the validity s f extrapolating from the general body of disaster and transient stress literature. Three trguments emerged. One was that IMI events are not qualitatively different from natural disasters; thus, extrapolation from the disaster literature is appropriate. A second argument was that the TMI-2 accident is too minor to define as a disaster; hence, extrapolation from the disaster literature will overestimate the stress of a IMI-l A third argument was that as a sensitized population restart.
exhibiting a number of unanticipated, if not unique stress I
r.esponses, IMI residents' stress associated with a restart of Unit cannot be analyzed appropriately via extrapolation from natural disaster or transient stress literature.
3.5.3 Assumptions and Aporoaches for Extrapolation Participants pointed out that extrapolations to a IMI-1 restart should be grounded in several specific assumptions. These assumptions, in turn, help define approaches to extrapolation, and in some cases, indicate further uncertainties. Assumptions and approaches discussed included statistical distribution of the stress response, the effect of past stress on the IMI population, parameters that identify high risk populations, assessment of the I
chronic disabled and the role of intervention to mitigate stress.
50
-.~ l ne stress response is assumed to be nor: sally distributed.
Some participants maintained that the proptreions of response types (i.e., those severely affected as opposed to those mildly affected or unaffected) would be similar to proportions found in the disaster literature. Others disagreed strongly with statements about proportions. We mean of the distribution or average stress level is assumed to be a function of the competence with which a possible M 1-1 restart is effected: technical problems or vocal opposition will tend to increase the mean. It was noted, however, that even the occurrence of a subsequent accident does not necessarily mean that the process of accommodation will cease.
The al community is assumed to be sensitized as a result of the m I-2 accident. Consequently, incidents in the nuclear power industry outside the M I vicinity are expected to affect the level of stress and, therefore, nuclear power should be included as an independent variable in a stress assessment. As a sensitized population, the mI community is assumed to have had its ability to cope with additional stress affected. De participants disagreed as to whether coping ability was enhanced or impaired as a result of the accident.
Certain subgroups are expected to be mest vulnerable to acute stress, but there was not general agreement about the character-istica of these groups.
It was suggested that some high risk groups could be identified by social and demographic characteristics and 4
51
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I might include those living closest to the power plant, pregnant women, and women and men with small children. It also was suggested that attitudes toward authority, nuclear power and the reopening of THI-1 may be correlated with stress should THI-l reopen. Because much of the data on TMI is based on general population surveys, which may mask a significant effect distributed among a small segment of the population, none of the participants was confident that all high risk subgroups can be identified.
A group that will be particularly difficult to analyze but important to understand is the chronic disabled. This group is expected to energe over the longer term, af ter most people with acute stress responses have resolved their problems. Given the present knowledge base; a priori identification of those at high risk for the chronic disabled group will be difficult using demographic data and prediction of the incidence of chronic disabled onerous. How chronicity may alter symptomatology is not clear.
Agent Orange studies suggest that chronic stress response tends not to be proportional to the extent of exposure to the stress agent.
The chronic disabled are usually people who have concurrent life problems and whose past history of personal difficulties predisposes them to this response to cumulative stress. A particular problem with regard to the chronic disabled is establishing whether a link actually exists between their later disability and the IdI-2 accident or the restart of TMI-1.
52 i
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$ 5 A 4,g Some participants suggested that extrapolation be conditional upon intervention. That is, it could be assumed that interventions to mitigate the stress of restart will be helpful. Extrapolations I
and predictions of stress response then would be made based on the l
assunption that specific interventions will be used.
3.5.4 Su= mary Generalized predictions about stress associated with a THI-l restart can be made, but possibly without a high degree of confidence. Several caveats should be observed if predictive 4
efforts are undertaken. Caveats include:
e Dissimilarities between a DdI-l restart on the one hand and prior TMI-2 events and natural disasters on the other will nake predictions uncertain.
The data base on the IMI population is limited, especially e
with respect to attitudes toward TMI-l restart.
The relationship between expressed attitudes toward restart e
and future stress responses is problematic.
-Social science knowledge of the effects of long-term, e
low level acute st ess is limited.
An insufficient understanding of causal variables impedes e
interpretation of statistical data.
Responses to the 241-2 accident and krypton venting are believed to bound the upper range of responses to a restart of IMI-1.
The incidence of acute stress can be neasured and predicted with some confidence, most groups particularly vulnerable to acute i
stress can be identified and the temporal pattern of that stress can
)
be predicted. Generally, the qualitative severity of the acute stress response can be predicted. The theoretical and empirical 53 l
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s sP Ft, body of knowledge on the chronic disabled group is much less developed, and prediction of chronic stress is highly uncertain.
Data specific to TMI will be more important for extrapolation than vill be the disaster literature.
The following assumptions will f acilitate extrapolations:
The stress response to a TMI-restart will be normally e
dis tributed.
he population's coping ability has been affected by the e
accident.
Specific subgroups will be more vulnerable to stress.
e A chronic disabled group will emerge over the e
longer term.
3.6 Technical Censiderations for Predicting Psychological Stress Associated With a Restart o f TMI-1 In this session participants were asked to discuss the f actors they would consider in conducting an assessment of the psychological impacts of reopening TMI-1.
They were instructed to assume that the assessnent would begin today and that predictions of stress could be based only on existing data and information. Topics addressed in this session, then, were approaches to predicting, with the existing data base, the psychological stress associated with a restart of 241-1 and factors affecting the confidence with which such predictions can be made.
3.6.1 Approaches to Predicting Psychological Stress Associated i
with a Restart of IMI-l It was noted previously that participants felt that responses to the 211-2 accident and the venting of krypton gas bound the upper 54
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range of stress responses expected to a restart of TMI-1.
S tress responses to a THI-l restart are expected to be lower in magnitude than those associated with the accident. As such, the approaches suggested in this session emphasized the use of the most recent data and literature available, particularly data specific to THI-2, including the data on the venting of krypton gas. Participants noted that in addition to the results of TMI studies presented by researchers in the second session of the Workshop, a body of unanalyzed TMI data exists, which should be applied to an assessment of a 211-1 restart. Participants also referred to on-going studies of the TMI population which would be relevant to an assessment.
Participants observed that important data in assessing a TMI-l restart are the attitudes of the TMI population to this potential event. Although research has not focused on the issue thus far, a number of questions about restart have been asked in the various TMI studies. Responses to these questions represent the best informa-tion available about attitudes toward restart. It was suggested that data on opposition to restart be exasited to distinguish between activist opponents and those whose opposition is evidenced primarily in their responses to surveys. Additional data believed to illuminate the issue are the feelings of the TMI population about il nuclear power in general. Such information also is contained in the g
existing data base. Another important use of the TMI data base is for identification of the characteristics of people who were most 55
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highly stressed from the TMI-2 accident, on the assumption that similar types of people are more likely to be highly stressed should TMI-1 be restarted.
One suggested focus for analysis, insofar as TMI-2 data permit, is to determine whatever meaningful correlations exist between feelings of distress due to the TMI-2 accident and opposition to reopening TMI-1.
Ralated to this is whether there is a correlation between opposition to nuclear power and stress from the IMI-2 accident. It was pointed out, however, that correlations of this nature may derive in part from false attribution -- unconscious or deliberate -- of symptoms of stress to the THI-2 accident. Results l
l of analysis of IMI data to date are mixed concerning the strength of I
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these correlations.
Another area requiring emphasis is subgroup analysis. It was l
l suggested that groups shown to be vulnerable to stress from the j-)
2d1-2 accident be examined in more detail to help explain the characteristics and dynamics of their stress. It also was suggested that the existing data be analyzed to identify clusters of problems and then to link these problems to subgroups. Participants agreed I
that the existing data base may not permit complete identification l
1 of vulnerable subgroups.
Participants indicated that in analyzing the existing TdI-2 data, they would seek to identify consistent results across studies as well as t a identify similar ambiguities or inconsistencies across studies.
56
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-s It was pointed out further that in analyzing IMI-2 data, attention should be given to the time trend of behavior, primarily to provide an understanding of the changes in acute stress response over time. The time trend optimally also would indicate whether a chronic disabled group is emerging. However, the fairly limited time frame of existing studies, types of sampling procedures employed, and a less comprehensive understanding of this stress response are likely to preclude identification of a chronic disabled group from existing TMI data.
Although focus on the TMI data generally was agreed to be the best approach for predicting the stress of restarting IdI-1, three additional suggestions were made. The first two concerned ways of supplementing the data base and filling in gaps, and the third recommended a specific starting point.
First, indirect data, such as that collected by Dr. Mileti, =ay be used to assess the stress of 24I-2.
This includes data on alcohol consumption, absences from work, automobile accidents, and political action. While some participants felt that this information would be useful for predicting stress, it also was argued that it can be used only for monitoring purposes.
Second, the disaster literature was viewed as secondary in importance to specific TMI-2 data but nevertheless useful for general information and filling gaps. The area in which it would have to be the principal source of information is for assessing the 57 l
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chronic disabled. Participants concluded that neither the liter-ature nor the data vill permit a satisfactory assessment of the chronic disabled group.
Third, it was suggested that contrary to the majority's emphasis on data, the process of prediction should begin by studying existing theory to determine the most important causal factors.
From this, researchers will be better prepared to evaluate the relevance of existing data and literature.
Several participants observed that the stress of not reopening TMI-1 is as important to assess as the stress of reopening the unit, since that, too, is an action with associated stresses. A i
psychological consequence of not restarting 23I-1 may be to confir=
that nuclear power is very dangerous: the idle plant will remain in the community and be a source of stress, perhaps even more severe a stress than a reopening. It was noted that the phobia literature suggests that people who do not confront their fears suffer greater
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distress. In contrast, it was argued that persoss with a real i
phobia to restart could be desensitized by a restart; but, if their a
fear is radiation, they cannot be desensitized, and restart may sustain the f ear.
Not reopening TMI-l will have economic consequences, which have potential for leading to psychological stress. Parties at risk for economic and related psychological stress should 231-1 not be reopened include utility employees, utility stockholders and 58 "1-.
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ratepayers. An analogous situation may be industrial f ailures, e.g., Studebaker. Studies of psychological stress of unemployed vorkers tere suggested as a data source. It was pointed out, however, that the electric utility industry may be unique in ter=s
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Finally, it was argued that any assessment of psychological s
stress associated with a restart of 21-1 be conducted and presented i
in the context of other stresses. If this is not done, the likelihood is high that the ' potential for. stress of this event will l
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be exaEgerated and that the studies themselves possibly could I
exicerbate the stress.
ia 3.6.2 Factors Affecting Confidence in Predictions
- participducs felt strongly that predictions be accompanied by
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the researchers' degree of confidence in the results. The possi-w bility was raised that the uncertainty of the predictions could be i
so high that they would not be villing to make them at all and that law-confidence predictions could be harmful. Data and methodological limitations that tend to reduce participants' confidence in predic-s tions carried out without the benefit of further research were 3
i discussed.
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signilitance and confidence for many results important for predicting the stress of, restart.
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Second, while THI-2 data are helpful, the reopening of TMI-1 and the TMI-2 accident and krypton venting are different events.
Moreover, the accident has transformed the TMI population. Yet extrapolation from existing data requires the assumption that the response to e. restart will be similar to the response to the accident and to the venting of krypton gas, implying a close similarity of events and populations.
Third, techniques for identifying people at high risk are not satisfacecrily developed. The emergence of a chronic disablad group certainly cannot be treated adequately due to the paucity of both theory and data. Techniques for identifying other high risk groups also say be inadequate. It was argued, for example, that men and women of ten evidence stress in different ways and that existing stress evaluation instruments tend to detect stress in women more frequently than in men. Methodological weaknesses of this type may cause underestimation of the stress experienced by the population as a whole and by specific groups.
3.6.3 Summary According to the participants existing data specific to 241-2 offer the best basis for predicting the psychological effects of a TMI-l restart. Analysis of these data should focus on the following i
factors:
e attitudes toward a 241-1 restart, e identification of subgroups highly stressed from the i
TMI-2 accident, 60
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possible correlation between opposition to nuclear a
power and IMI-1 restart and stress, and e changes in stress over time.
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Examination of the theory of stress will permit a bettsr evaluation of the data.
Indirect data (e.g., alcohol consumption, absenteeism) and relevant disaster literature are of secondary importance to EdI-specific data but are useful for general information and filling gaps. The exception is for assessing the incidence and nature of the chronic disabled. Here the literature appears to be the best source of information in terms of both theory and data. The stress of not restarting TMI-l should also be considered.
It is important that predictions be made with adequate confidence. The following data problems and methodological weaknesses tend to reduce confidence in predictions:
TMI-2 studies are descriptive, not designed for prediction.
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Predictions require assumptions that events and populations associated with the TMI-1 restart are similar to those associated with the TMI-2 accident and krypton venting.
Techniques for identifying high risk subgroups may be e
inadequate.
- Existing theory and data preclude satisfactory assessment of the chronic disabled group.
3.7 Identification of Additional Near Term Efforts Needed to Fill Gaps in Existing Concepts and Studies l
One of the outcomes of many discussions during the Workshop was an indication concerning the need for additional research and j
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analysis in order to increase confidence in any predictions of psychological stress that may be associated with a restart of MI-1.
The expert participants were asked during this Workshop I
uession to focus on needs that might be fulfilled in the near ters (i.e., within the next 6 months). In addition, they were asked to indicate what benefit (s) might be gained, in terms of increased confidence in their predictions concerning the stresa associated with a 21-1 restart, by performing the additional research and/or analysis.
3.7.1 Near Ters Efforts In responding to the question of additional near term research needs, the thoughts of the expert participants and expert observers generally fell into two areas. The first concerned specific research and analysis to be done:
reanaly:e existing MI data, evaluate sone as yet unanalyzed o
NI data, and gather new TMI data; and conduct a focused review of the existing non NI literature.
e The second area concerned other parspectives from which to view the situation and included:
- Perform additional work only if the outcome vill provide information that is qualitatively different (e.g. not another attitudinal survey) from that already available.
Use accepted theories of stress and review the data with e
the objective of supporting the theories.
o Conduct no new studies because the available information is sufficient to suggest that conducting new studies and postponing restart may only prolong the time to conflict l
j resolution among the individuals in the con:munity.
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i For those comments pertinent to the first group, the specific i
suggestions for data gathering and analysis were varied and included reanalysis of data already analyzed, analysis of data collected but not examined, and collection and analysis of raw data. In the realm I
of reanalysis, the essential idea was to evaluate collectively all of the mI data now available to all of the investigators and organizations that have been studying the population in the 21 environs, with the objectives of attempting to:
identify clusters of vulnerable individuals (e.g., those who e
exhibited high stress levels) for the purpose of further followup study; systematically correlate interstudy consf stencies and incon-e sistencies; and discern any as yet unsubstantiated associations (e.g., level e
of distrust or suspicion of authorities with extent of stress response).
It was generally felt that with sufficient resources, this reanalysis could be completed within one month.
Civen a longer period of time (i.e., up to 6 menths) there were several suggested activities that essentially involved evaluation of as yet unanalyzed MI data and gathering of new 21 data. The unanalyzed data focus on the MI workers and on mothers in the SI area and, as such, will be useful only for making observations about these groups and not for comparing them with other unassessed groups (e.g., f athers in the EI area). However, there was an attempt made in the interviewing of these people to determine their response to 4
e restart of 31-1.
Bis information clearly would be most pertinent i
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to the question of psychological stress associated with restart of MI-l and would add considerably to the data available on this issue.
We suggestions concerning new data collection were directed towards collecting baseline data for future comparison with data e
collected during and after restart for use in evaluating the psyc.hological stress effects of restart, collecting baseline data to identify the most appropriate e
methods of intervention and to assess any intervention me thods ultimately employed, e continued monitoring of existing study and control popula-tions in an attempt to identify those individuals who may be just now emerging as chronic disabled, l
attempting to establish psychological / physiological e
correlates for use in identifying and analyzing high risk groups (e.g., further study of self-selected individuals),
and collecting data useful in analyzing the psychological stress e
impacts associated with a decision not to restart 21-1 (e.g., loss of employment, increased electric rates).
Although it was generally felt that recent MI-specific data were the most useful in making predictions of restart stress and caution was expressed in assuming the UI population was analogous to any other, interest was expressed in conducting a focused review of the non 21 literature concerning general crises, natural l
disasters and the chronic psychologically disabled (e.g. Viet Nam veterans, individuals exposed to Agent Orange, victims of the l
Coconut Grove fire, people who have experienced earthquakes and hurricanes). We objectives of the review would be to:
e discern characteristics of those individuals most vulnerable to chronic disabled stress responses, 64
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Asesus 3 I
'es obtain estimates concerning the rates of chronic disabled, e
and identify outer limits in terms of percentages within which e
a prediction concerning the stress effects expected in the TMI population post-restart should fall.
3.7.2 Potential Benefit When queried concerning the benefits to be gained from engaging in these additional activities, the participants suggested that 4
1 confidence in their predictions would definitely increase both in statistical terms and in the broader, nonstatistical sense. The j
extent of this gain in confidence is difficult to esti= ate until it is known what new infornation emerges or what existing correlations are strengthened or weakened. To the extent that these activities assist in any way in more clearly identifying high risk groups, s
developing or targeting treatment programs and designing interven-tion techniques, the benefit to the community is considerable (e.g.,
health effects prevention professionals have an opportunity to be proactive rather than reactive, individuals have an opportunity to participate in mitigation of potentially adverse health responses).
It was also noted that, although additional efforts would likely contribute to a general understanding of the problem and ways to l
approach it, there would still be many questions unanswered and issues not addressed (e.g., is the measurement of distress in an individual an indication of succersful adaptation and coping or is it an indication of psychological ill health?).
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BRAFT 3.7.3 Summa ry When queried concerning needed additional research and i
I analysis, the suggestions from the Workshop members for efforts to be undertaken included:
Collectively reanalyze existing TMI data.
o Analyze recently collected TMI data that have not yet e
been evaluated.
Gather and analyze new TMI data.
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- Conduct a focused review of the existing non TMI literature concerning general crises, natural disasters and chronic psychological disability.
It was generally felt that, although the extent of the benefit to be gained from these additional efforts was difficult to estimate, general understanding of the TMI population clearly would be enhanced. This understanding is critical to predictions of the impact on this population of any event and could be most important in selecting and monitoring any ameliorative measures employed should IMI-l be restarted. In addition, it was felt that the ability of the expert community to predict, and/or suggest mitigating measures for, the effects in other populations of other similar events would be increased.
3.8 Ameliorative Actions Although not specifically an agenda topic for this Workshop, the identification of actions for ameliorating potential psycho-logical stress associated with a 24I-1 restart was felt by the participants to be useful and consistent with the prior discussions 66 l
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nt of ways to predict psychological stress responses. Stress responses may be linked to whatever measures might be put in place to ameliorate those responses.
1 The panel insisted on having the record show that although the i
listing of potential ameliorative actions presumed that TMI-1 would restart, the panel is not thereby implying an endorsement of the restart of TMI-1.
At the same time, the panel noted that the preparation of this list of possible actions does not imply that TMI-l restart could not proceed without some or all of them.
l 3.8.1 Purpose of Ameliorative Actions The identification of ameliorative actions proceeds from the premise that such actions will, indeed, help the situation. One participant cautioned that some data suggest that educational activities of this sort can actually exacerbate stress levels for some people. With this qualifier in mind, the expert participants observed that the principal purpose of ameliorative actions would be to reduce stress through a combination of education, information access, and counseling. Treatment of stress requires redefinition af the stress and its causes in terms with which the stressed individual can deal; education serves this function well.
I Suggested actions focused on lessening the psychological impact of a TM1-1 restart on the local community. The Workshop consciously avoided designing another study to impose on the TMI population although, as noted below, the participants did suggest that the 67 s
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ameliorative actions and their impact be monitored so that they can be evaluated for future use.
It was noted that ameliorative actions should be employed only to lessen psychological stress during a restart and not to deflect opposition to a restart, which may come from many legitimate sources. ':he selected actions should be those that the population itself might ask for.
Consistent with their principal purpose of stress reduction, acellorative actions can also be integrated with plans for gathering data f or analysis of the effectiveness of the various measures.
Opportunity to monitor the comunity and individual stress levels during any restart process should be planned for. However, there was a difference of opinion within the panel as to how this data gathering should proceed. One view held that applying different ameliorative actions to different communities within the 'IMI population would enable the relative effectiveness of alternative actions to be reliably measured. Others argued that such a controlled experiment would be unacceptable since it might lead to certain com= unities being deprived of the more effective ameliorative actions, assuming the more effective actions could be identified in advance of any measurement. It was generally agreed 2
that ameliorative measures with proven effectiveness must be offered to all if offered to any; actions of doubtful worth may properly be restricted and differential results measured.
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The monitoring and analysis of the responses 'to various ameliorative actions could lead to recommendations of the more effective actions for similar events should they occur in the future. The greater use of the media as a means for stress reduction should be a typical activity for monitoring.
Prior to a restart, data gathering and analysis should be l
directed toward identifying appropriate ameliorative actions to implement and toward determining the current level of distrust among the TMI population, a factor the experts agreed was of great importance.
3.8.2 Preconditions for Applying Ameliorative Actions The participants observed that prior to the selection and implementation of ameliorative actions, attempts should be made to satisfy at least the following preconditions:
The safety of EdI-l should be convincingly' assured; to do e
this may require the involvement of a broad spectrum of official expert opinion on the safety issue.
e The credibility of expert and/or public officials should be improved.
I e A believable and concise case for the restart of TMI-l should be made. Public officials should be forthright 4
and direct regarding the reality of a startup, clearly informing the public of the institutional, economic, and technical considerations affecting a startup decision as well as the projected timing and procedures.
I e The absence of any legal or procedural connection between the TMI-l restart and any future operation of TMI-2 should be made unequivocally clear.
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3.8.3 Guidelines, Procedures, and Approaches Ameliorative actions suggested by the participants were presented in varying levels of detail. Suggestions ranged from f
broad guidelines for conducting an ameliorative action plan to 1
specific mechanisms for interaction with the public.
Members of the Workshop suggested guidelines for an ameliorative action plan which included the following:
e To command public respect, a 511-1 restart plan, at the time it is announced, should offer a definitive and prompt schedule of events, including all ameliorative activities.
e Ameliorative actions will be most effective if focused on educating the public as to what is to happen both technically and procedurally, including the real risks of accident and the potential consequences. One expert suggested that this educational thrust be modeled af ter the successful efforts to reduce stress associated with impending surgery in which pre-surgery familiarity with the operating room and pro-cedures has been found to lessen the psy'chological impact and improve the recovery process. Another participant cautioned that such educational efforts have the effect of exacerbating stress for some people (e.g., those highly stressed groups for whom education can undermine a " denial" coping mechanism).
The psychological aspects of what is likely to happen should e
be directly confronted. The public's fear should be openly addressed, recognized as understandable, and mitigated by credible information flow.
Every attempt should be made to ensure credibility in e
the pre-startup education process. For example, the condescending tone perceived by some when the nuclear engineering community is addressing the public should be i
avoided. Instead, a broad spectrum of expert opinion should be enlisted. (An effective example of the latter occurred during the krypton venting at 241-2 where the NRC and utility officials, the media and authoritative scientific sources all supported the view that venting was needed and would not harm the population.)
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-i 3A Going beyond the general guidelines listed above, the expert participants' suggestions included a number of procedural recommen-dations, of which the major ones are summarized below:
Public meetings are more likely to succeed if authorities o
work with many small, selected groups rather than one or two large community forums. Large forums are seen from experience to aggravate rather than ultigate stress.
e Information on the restart should emanate from a single authoritative source as opposed to the use of groups of community professionals (e.g., teachers, clergy, physicians) with ad hoc training to educate the rest of the community on the TMI-l restart issue. In this way, it was felt that the interjection of personal views in the public education process could be minimized. On the other hand, some felt that community professional groups should be involved in the information dissemination process since they have well established and accepted contact with the community and may be called upon by the public to deal with the TMI issue.
Attempts should be made to enlist the help of credible e
authoritative agencies such as the U.S. Public Health Service and the National Academy of Sciences, which to date have not played a significant role in educating the public on the issues of nuclear power acd which do not have a vested interest in the restart.
e Educational efforts should concentrate on the more vulner-able or highly stressed subgroups, of which the major ones identified so far are:
women, particularly those who are pregnant r are mothers of young children; and people who feel the greatest distrust for authorities in the nuclear power arena.
e An effective action program will have to be scheduled to accommodate the fact that stress is most likely to be the greatest during the week prior to restart and can be expected to decline steadily after a successful startup. In this con-nection, the participants observed that although a nuclear plant restart is several weeks in duration, the " event" will be marked by the beginning of the process. Educational 71 l
Y effort and other ameliorative actions should continue after i
the restart event for as long as there is an apparent need for them (i.e., the public continues to particpate).
I The Workshop sought to avoid suggesting specific tasks or c.c approaches to be considered as part of an ameliorative action plan.
Nevertheless, a few detailed suggestions did emerge from the discussion:
e As a vehicle for providing a single authoritative infor-mation source, several participants supported the concept of a continuous, interactive, television broadcast involving credible experts in the field. Interaction would be pro-vided by a continuous phone-in, open-line format.
Provision should be made for plant visits, specially tailored e
to the concerns of the N I community, for interested citizens.
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3.8,4 Summary Assuming, but not necessarily recommending, a 21-1 restart, the expert participants suggested ameliorative actions for
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minimizing any psychological stress response. It was noted that the central focus of such actions should be on a combination of educa-1 I
tion, inf ormation access and counseling. They should not serve to deflect legitimate opposition.
Prior to implementing ameliorative actions, the safety of 3 1-1 should be convincingly assured, the case for MI-l restart should be i
soundly presented and attempts at restoring official credibility w
should be made. Successful ameliorative actions would then be y
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guided by an emphasis on objectin information exchange and on open confrontation of the soueces of fear.
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gr.- y Js.4 Further, the participants suggested that:
large community forums be avoided; e
e information flow from a single authoritative source, with community professional groups involved to the extent practical; e other authoritative agencies such as the U.S. Public Health Service and the National Academy of Sciences be involved to help restore credibility; e efforts be focused on vulnerable subgroups, such as mothers of young children; and, e the scheduling of actions accommodate the peaking of stress approximately one week before the event and continue af ter the event for as long as needed.
Specifically, an effective implementing vehicle for ameliorating stress may be a continuous interactive t21evision broadcast providing the people with access to credible nuclear experts.
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n 4.0 POST-WORKSHOP OPINION PAPERS To be provided by expert participants on or before 8 March 1982.
73
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I APPENDIX A U.S. COURT OF APPEALS JUDGMENT I
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S FoR THE DISTMicT or Cot.Uwe. A CtROUlT Ssptember Term,1981 '.
No. 81-nn PEOPLE AGAINST NUCLEAR EXERGY, Petitioner UDil0d $[2l!S COUTt Of4pphi389
(
for tia D:stri:t cf C&=P.a Cirent UNITED STATES NUCLEAR REGULATORY COM:!ISSION g y,g 9
i and UNITED STATES OF AMERICA, Respondents -
1!ETROPOLITAN EDISON CCMPANY, et al.
. GEORGE A. FISHtR (PUBLIC UTILITIES). Intervenors C' ZRK l
Petition for Review of an order of.the-United States Nuclear Regulatory CocIniss'io'n.
~.
,.,Before: URIGHT, Circuit Judge, McG0WAN, Senior Circuit Judge, and WILKEY, Circuit
. Judge.
'JUDCMENT l
i This cause ca_e on to be heard on a petition for review of an order of the Uni {ed States Nuclear Regulatory Comzission and was briefed and argued by counsel. -
on ' consideration thereof, it is ORDERED and ADJUDGED by this ' court that the order of the Nuclear Reguistory Commission under review in this cause is hereby vacated. :'
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It is TUETHER ORDERED and ADJUDGED by this court that the Comission shall prepare an environ = ental assess =ent regarding the effects of the proposed restart of the nuclecr facility at Three Mile Island Unit one (D11-1) on the psychological health of neighbor-l ing residents and on the well-being of the surrounding communities. The Co=f ssion shall then determine, on the' basis of this environmental assessment, whether the Nation-al Environmental Policy Act requires pr'eparation of a full environmental i= pact state-ment.
It is TURTHE5L ORDERED and ADJUDGED by this court that, until the C = mission has !
4 complied with the requirements of the National Inviron= ental Policy Act as described in the preceding paragraph, it shall not make a decision to restart VII-1.
It is TURTHER ORDERED and ADJUDGED by this court that the Comission shall preparh a statement of the reasons for its determination that psychological health is. not cog-I
. nizable under the Atomic Energy Act.
t Opinions to follow.
Per Curiam 2
For the Court b 3ca A i
Cecrgd/ A. Fisher
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Clark Circuit Judge WILKEY dissents. Whether designedly so or not, this order vill bar; the resumption of furnishing nuclear power from TMI-1, at which there has never been an accident, until such time as the Nuclear Regulatory Commission satisfies this co,urt,
. first by an " environmental assessment," snd then, most likely, later by a required -
" full environmental impset statement," as to its consideration of certain new environ '
mental factors. This delay is imposed because of the asserted impset "on the psycho-
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.1 logical health of neighboring residents," an " impact" which has never before been-considered as covered by the National Inviron= ental Policy Ac4 This is yet another exa ple of a court inventing new procedural requirenants
's for an administrative agency in a manner which has enomous substantive consegeences.
see Ver=ent Yankee Nuclear Power Corn.
v.* NRDC, 435 U.S. 519 (1978). The court is e
concerned that "the vall-being of the surrounding cc = unities" be assessed, yet while this is taking place, for the co== unities near n!I-1 it vill be a colder vinter than predicted.
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$ h. y :.4f.,3]3' APPENDIX B LIST OF ATTENDEES O
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-1 TABLE B-1 EXPERT PARTICIPANTS Andrew Baum, Ph.D.
Evelyn Bromet, Ph.D.
Robert Dupont, M.D.
Kai Erikson, Ph.D.
Peter Houts, Ph.D.
Stanislav Kas1 Ph.D.
Ronald Perry, Ph.D.
Captain Richard Rahe, M.D.
Jon Rolf, Ph.D.
Paul Slovic, Ph.D.
George Warheit, Ph.D.
4 4
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TABLE 3-2 EXPERT OBSERVERS Victor Fongeaie, Ph.D.
Don Hartsough, Ph.D.
Robert Holtz, Ph.D.
Dennis Mileti, Ph.D.
Henry Vyner, M.D.
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TABLE B-3 ATTENDEES ON 4 FE3RUARY 1982 Elaine Baer Jessica Laverty Lake Barrett Oliver Lynch Andrew Baum Al Manik Deborah Bauser John Menke Tom Brennan Dennis Mileti William Clements Daniel Muller Dan Collins Raymond Olney Peter Crane David Osterhout Jeanne Crumley Mike Parsont Donald Cleary Diane Pask Enrico Conti Ronald Perry Enrold Denton Gail Phelps Robert Dupont Richard Rahe Kai Erikson Ann Ramey-Smith Art Freedman Pat Rathbun Victor Fongemie William Regan Willard Fraize Jon Rolfe I
Susan Frant Yale Schiffman Sue Gagner Martin Scholl Judy Gordon Paul Slovic Vicki Harding B. J. Snyder Don Eartsough Ted Sullivan Robert Holtz Joan Tahami Peter Bouts Gordon Trowbridge James Hurst Richard Vollmer William Jordan Henry Vyner Channing Johnson Pamela Walker Stanislav Kasl George Warheit Kfiki Kehoe A. H. Wilcox t
Glenn Kinney Isabella Wood Rodney Lay Dorothy Zinberg Vicki Ziegenhagen 4
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TABLE B-4 ATTENDEES ON 5 FEBRUARY 1982 Elaine Baer Dennis Mileti Lake Barret Lois Miller Andrew Baum Daniel Muller Deborah Bauser Diane Pask Evelyn Bromet Ronald Perry Donald Cleary Gail Phelps Enrico Conti David Osterhout Don Collins Richard Rahe Laurie Davidson Ann Ramey-Smith Robert Dupont Patricia Rathbun Kai Erikson William Regan Victor Fongemie Jon Rolfe Ray Fleming Miller Spangler Art Freedman Paul Slovic Justin Frat March Schaeffer Willard 'fraize Yale Schiffman J. Gray Ted Sullivan Judy Gordon B. Snyder Don Hartsough Joe Scinto Robert Holtz Joan Tahami Peter Bouts Gerry Tomlin Channing Johnson Gordon Trowbridge Stanislav Kast Henry Vyner Glenn Kinney Richard Vollmer Rodney Lay Pamela Walker Oliver Lynch George Warheit John Menke Vicki Ziegenhagen John Montgomery 1
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- j P4 APPENDIX C WORKSEOP AGENDA
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3 Workshop on Psychological Stress Aaenda Thursday, 4 February 1982 9:00 - 9:30 Opening Remarks NRC MITRE 9:30 - 10:30 Psychological Effects of Nuclear Power nature and causes of stress associated with nuclear power distinction from stress associated with other causes observed stress responses associated with nuclear power 10:30 - 10:45 Break 10:45 - 12:00 Studies of Psychological Stress in the Vicinity of TML objectives sample methods findings conclusions O
12:00 - 1:00 Lunch m
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1:00 - 2:45 concepts, causes and consequences of Stress Which May Be Applicable to TMI-l Restart general definitions of stress which may be related to the TMI-1 restart specification and clarification of l
differences iu terminology and concepts identification of stimulus conditions from non-TMI studies which may be' applicable to the TMI-1 restart context. What studies?
identification of consequences of stress from non-TMI situations which may be appli-cable to the TMI-1 restart context. What studies?
moderating or intervening factors 2:45 - 3:00 Break 3:00 - 3:45 Evaluation of Methods Used in Identification and Measurement of Stress and Stress Responses techniques for measurement (surveys,
interviews, medical records, etc.) of stressors, intervening variables and outcomes validity, reliability and relevance of methods used 3:45 - 4:30 Ability to Extrapolate from Existing Studies to TMI-1 Restart similarities / dissimilarities in stressor events, populations, etc.
other confounding f actors to be considered 4:30 - 5:00 Focus for Tomorrow's Session i
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Friday, 5 February 1982 9:00 - 10:30 continue and conclude Discussion of Issues Identified at Close of Thursday Session 10:30 - 10:45 Break 10:45 - 12:15 Technical Considerations for Predicting Psychological Stress Associated with a Restarr of TMI-l 12:15 - 1:15 Lunch 1:15 - 2:00 Identification of Additional Near Term Efforts Needed to Fill Gaps in Existing Concepts and Studies benefit gained in terms of increased confidence in predictions 2:00 - 3:00 Summation of Workshop in Terms of Objectives r
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l APPENDIX D BIBLIOGRAPHY i
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1 l BIBLIOGRAPHY Bates, Fred, Fogelman, Charles, Parentin, Vern, Pittman, R. H., and Tracy, G.S.
The Social and Psychological Consequences of Disaster.
Washington, D.C. : National Academy of Sciences - National Research Co uncil, 1963.
Baum, Andrew, et al.
Psychological Stress for Alternatives of Decon-tamination of Three Mile Island-2 Reactor Building Atmosphere. USNRC Repo rt, NUREG/CR-1584, Washington, D.C.,1980.
Baum, Andrew, et al.
Chronic and Acute Stress Associated with Three Mile Island Accident and Decontamination. Prel1=inary Findings of g Longitudinal Study. Draf t report submitted to U.S. Nuclear Reguletory Co ission July 1981.
Baum, Andrew, Gatchel, R. J.
" Cognitive Determinants of Response to Uncontrollable Events: Development of Reactance and Learned Help-lessness." Journal of Personality and Social Psychology, 40, (1981) 1078-1089.
Bennett, Timothy F.
Final Report: Millirems, Mind Sets, Me=oranda, and Meanderings. Department of Public Welfare, Office of Mental Health, State of Pennsylvania, June 1980.
- Bromet, E.,
et al.
Three Mile Island: Mental Health Findings. Prepared through support of NIMH Contract #278-79-0048 (SM), Department of Health and Hu=an Services, National Institute of Mental Health, Disaster Assistance and Emergency Mental Health Section, October 1980.
B rome t,
E.,
et al.
Preliminarv Reoort on the Fhntal Health of the Three Mile Island Residents. Prepared through support of NIMH Contract
- 278-79-0045 (SM), Department of Health and Hu=an Services, National Institute of Mental Health, Disaster Assistance and Emergency Mental Health Section, May 1980.
Bromet, E. and Dunn, L. O.
" Mental Health of Mothers Nine Months After s
the Three Mile Island Accident." Urban and Social Change Review,14
'I (1981) 12-14.
Bromet, E., Parkinson, D., Schulberg, H. C., Dunn, L., and Gondek, P. C.
Three Mile Island: Mental Health Findings. Government Monographs through N1DH Contract #278-79-0048 (SM), in press.
- Bromet, E., Schulberg, H.
C., and Dunn, L. O.
" Reactions of Psychiatric Patients to the Three Mile Island Nuclear Accident." Archives of General Psychiatrv, in p ress.
92
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e F7 3 3
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}il f
~5 LW Chisholm, R. F., and Kasl, S. V.
"The Effects of Work Site, Supervisory Status, and Job Function on Nuclear Workers' Responses to the TNI Accident." Journal of Occupational Behavior, in press.
Chisholm, R. F., Kasl, S. V., Dohrenwend, B. P., Dohrenwend, B. S.,
Warheit, G. J., Goldsteac, R. L., Goldsteen, K., and Martin, J. L.
" Behavioral and Mental Health Effects of the TMI Accident on Nuclear Workers : A Preliminary Report." Annals of the New York Academy of Sciences, 365 (1981) 134-145.
Dohrenwend, B. P., Dohrenwend, B. S., Fabrikand, J. I., Kasl, S. V.,
Warheit, G. J., Bartlett, G. S., Chisholm, R. F., Goldsteen, R. L.,
Goldsteen, K., and Martin, J. L.
" Report of the Task Group on Behavioral Effects," Staff Reports to the President's Co= mission on the Accident at the Three Mile Island. Washington, D.C.: U.S.
Government Printing Office, (1979) 257-308.
DuPont, R. L.
" Nuclear Phobia: Phobic Thinking About Nuclear Power,"
Nuclear Power in American Thought, Decisionmakers, Vol. 8, Edison Electric Institute, (1981) 23-41.
DuPont, R. L.
"Fif ty Million Frenchmen Have Few Nuclear Fears,"
Electric Perspectives. Edison Electric Institute,'Su=mer 1981.
1 DuPont, R. L.
" Phobic Fear as a Nuclear Health Hazard," The Washington Star. July 20, 1980.
Erikson, Kai.
Evervthing in Its Path: Destruction of Community in j
the Buf f alo Creek Flood. New ferk: Simon and Schuster,19 76.
1 Erikson, Kai. " Loss of Communality on Buffalo Creek," American Journal of Psychiatry. 133 (1976) 302-306.
Flynn, C.
Three Mile Island Telephone Survey, Preliminary Report on Procedures and Findings, U.S. Nuclear Regulatory Commission, Washington, D.C., 1979.
Gamble. H. and Downing, R.
Effects of the Accident at Three Mile Island on Residential Property Values -and Sales, U.S. Nuclear Regulatory Commission, Washington, D.C., 1979.
Goldhaber, M., Houts, P., and DiSabella, R.
Mobility of the Population Within 5 Miles of Three Mile Island During the Period from August 1979 Through July 1980. Report submitted to the TMI Advisory Panel on Health Research Studies of the Pennsylvania Department of Health,1981.
Governor's Of fice of Policy Planning. The Socio-Econo =ic I= pacts o f the Three Mile Island Acc.ident: Final Report, Harrisburg, Pa., 19 80.
j; 93 Q:
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>e s Houts, Peter S., and Goldhaber, Marilyn K., " Psychological and Social Effects on the Population Surrounding TMI After the Nuclear Accident on March 28, 1979," Energy, Environ =ent and the Eceno=y, Chapter 14, S. Majumdar, editor. Pennsylvania Acade=y of Sciences,1981.
Houts, P., Mille r, R., Tokutata, G., Ham, K.
Health-Related Behavioral I= pact of the Three Mile Ieland Nuclear Incident Parts I and II.
Report sub=itted to the THI Advisory Panel on Health Research Studies of the Pennsylvania Department of Health,1980.
Houts, P., Miller, R., Ham, i'., and Tokuhata, G. " Extent and Duration of Psychological Distress of Persons in the Vicinity of Three Mile Island," Proceedings of the Pennsylvania Acade=ri of Science, 54, (1980) 22-28.
Houts, P., DiSabella, R., and Goldhaber, M.
Health-Related Behavioral I= pact of the Three Mile Island Nuclear Incident Part III.
Repo rt submitted to the TMI Advisory Panel on Health Research Studies of the Pennsylvania Department of Health, 1981.
Hu, T., Slays =an, K., Ram, K., and Yoder, M.
Health-Related Econo =ic Costs of the Three Mile Island Accident. Report sub=1tted to the TF1 Advisory Panel on Health Research Studies of the Pennsylvania Department o f Health, 19 81.
Hudgens, Richard. " Personal Catastrophe and Depression," Stressful Life Events, Dohrenwend, 3. and Dohrenwend, B.
New York: Wiley, 19 74 Kasl, S. V., Chishol=, R. F., and Eskenazi, 3. "The I= pact of the Accident at the Three Mile Island on the Behavior and Well-Being of Nuclear Workers: Part I.
Perceptions and Evaluations, Behavioral Responses, and Work-related Attitudes and Feelings," American Journal of Public Health, 71, (1981) 472-483.
- Kasl, S.V., Chisholm, R.F., and Eskenazi, B.
"The I= pact of the Accident at the Three Mile Island on the Behavior and Well-Being of Nuclear Workers: Part II.
Job Tension, Psychophysiological Sy=pto=s, and Indices of Distress." A=erican Journal of Public Health, 71, (1981) 484-495.
Mileti, Dennis S., Hartsough, Donald, and Madsen Patti. The Three Mile Island Incident: A Study of Behavioral Indicators of H" man Stress.
A report prepared for Shaw, Pitt=an, Potts and Trewbridge, Legal Counsel to General Public Utilities and Metropolitan Edison, final report fo rthcomin g.
94
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1 Morell, Jonathan A., and Spivak, George. Review of Studies en the Psychological and Behavioral Impact of the TMI Nuclear Accident, with Scecific Implications for Research and Planning, (unpublishe d),
Department of Mental Health Sciences, Hahnesann Medical College, Philadelphia, Pa., Oct. 1980.
Perry, Ronald, Greene, Marjorie, and Lindell, Fdchael. Human Response to Volcanic Eruption: Mt. St. Helens, May 1980. Report to the National Science Foundation.
Perry, Ronald, Lindell, Michael, and Greene Marjorie. " Threat Per-caption and Public Response to Volcano Hazard." Journal of Social Psycho lo gy, in press.
Perry, Ronald and Greene, Marjorie. " Population Evacuatica in Resonse to Volcanic Eruption," Disasters, in press.
Perry, Ronald, Lindell, Michael, and Greene, Marjorie. " Flood Warning:
How People React Af ter the Warning," The Hazard Monthly 1, 11 (1981) 1-6.
Perry, Ronald, Lindell, Michael and Greene, Marjorie.
"Mt. St. Helens:
Washingtonians View Their Volcano," The Hazard Monthlv, 1, No. 2 (1980) 1-3, Perry, Ronald. " Detecting Psychopathological Reactions to Disaster,"
Social Behavior and Personality, 7, No. 2 (1979) 173-177.
Perry, Ronald and Lindell, Michael. "The Psychological Consequences of Natural Disasters," Mass Emergencies, 3, No. 4 (1978) 194-204 Quarantelli, Enrico. " Images of Withdrawal Behavior in Disasters,"
Social Problems, 9, No. 1 (1960) 68-79.
Quarantelli, Enrico, and Dynes, Russell. " Response to Social Crisis and Disaster," Annual Review of Sociology, 3, (1977) 23-49.
Quarantelli, Enrice and Dynes, Russell. "When Disaster Strikes,"
Psychology Today, 4 (1972) 67-70.
Rahe, R. H.
Center History and Future Course for the Center for Prisoner of War Studies, San Diego, Calif. In: H. P. Wetzler (ed),
Proceedings, 5th Annual Joint Medical Meeting Concerning POW /MIA Matters, 19-20 Sept. 1978, USAF School of Aerospace Medicine, Brooks AFB, Te xas. Brooks AFB: Clinical Sciences Division, Dece=ber 1979, pp. 4-8.
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Y l
Richlin, M., Shale, J. H., and Rahe, R. H.
"Five Year Medical Follow-up of Navy POWS Repa*:riated from Vietnam: Preliminary Results,"
U.S.
Navy Medicine, 71 (August 1980) 19-26.
Scranton, W.
Report to the Governor's Coctnission on Three Mile Island, Harrisburg, Pa., 1980.
Shearer, D.
Ar,ee Mile Island Nuclear Accident Co== unity Impact Study on Real Estate. Harrisburg, Pa. : Greater Harrisbitrg Board of Realtors, 1980.
Slovic, P., Kunreuther, H., and White, G. F.
"Decisien Processes, Rationality, and Adjustment to Natural Hazards." In G. F. 'Inite (Ed.),
Natural Hazards, beal, Mational, and Global. New York: Oxford University Press, 1974 Pp. 187-205.
Slovic, P., " Psychological Determinants of Perceived and Acceptable Risk: Implications for Nuclear Waste Management." Proceedings of the Conference on Public Poliev Issues in Nuclear Waste Management.
- Chicago, Illinois, Oct. 1976. Edited by Harrison Associates, Washington, D.C.,
NTIS #PB 268181/AS(A17).
Slovic, P., Fischhoff, 3., and Lichtenstein, S.
" Risk Assessment:
3asic Issues."
In R. W. Kates (Ed.), Manating Technological Hazard:
2 Research Needs and Opportunities. University of Colorado, Institute of Behavioral Science, Monograph series on Technology, Government and Man, 1978.
Pp.81-108.
l Slovic, P., Lichtenstein, S., and Fischhoff, B.
" Images of Disaster:
Perception and Acceptance of Risks from Nuclear Power."
In G. Good =an and W. Rowe (Eds.), Energy Risk Management. London: Academic Press,
t 1979.
Pp. 223-245 Slovic, P., Fischhof f, B., and Lichtenstein, S.
" Facts vs. Fears :
l Perceived Risk and Opposition to Nuclear Energy." Proceedings of the Colloquium on the Risks of Different Energv Sources, sponsored by the Franch Nuclear Energy Society. Saint-Etienne: Gedis, 19 80, pp. 112-136.
Slovic, P., Fischhoff, B., and Lichtenstein, S. " Perceived Risk and Quantitative Safety Goals for Fuclear Power." Transactions of the A=erican Nuclear Society, 35, (1980) 400-401 Slovic, P., Fischhoff, B., and Lichtenstein, S.
" Characterizing Perceived Risk."
In R. W. Kates and C. Hohene=ser (Eds.), Tech-nological Hazard Management. Oelgeschlager, Gunn, & Hain, in press.
Slovic, P., Fischhof f, B., and Lichtenstein, S.
" Perception and Acceptance of Risk from Nuclear and Alternative Inergy Syste=s."
In Risks and Impacts of Alternative Energy Syste=s.
Report to 96
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the Risk and Impact Panel of the Committee on Nuclear and Alternative Energy Systems, National Acade::rf of Sciences, Washington, D.C, in press Slovic, P., Fischhof f, B., and Lichtenstein, S. "Public Perceptions of Nuclear Energy: Psychological Aspects of Risk Perception." In D. Sills, C. P. Wolf, and V. Shelanski (Edr..), The Accident ct Three Mile Island: The Human Disensions. Boulder, Colorado: Westview, in press.
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