Poisoning the mind

first_imgRelated posts:No related photos. Comments are closed. Previous Article Next Article What are the psychological consequences following chemicalpoisoning or exposure? OH practitioners often acknowledge the problem, but findthere is no uniform judicial approach and little information available, by AlanCare There is clearly a difference between a chemical exposure causing physical(organic) chemical poisoning given a sufficient dose, and an exposure tochemicals that may only cause a short-lived acute adverse reaction withpsychological overlay. Chemical exposure inevitably causes psychological harm and injury for themajority of individuals who are exposed to toxic substances and in many cases,the psychological reaction may far outweigh the original physical chemicalreaction. For example, a chemical exposure causing only a headache may lead toa lifetime of psychological worry and anxiety. An example of a classic industrial disease of chemical poisoning causingchronic long-term damage would be a high-dose exposure to benzene, triggeringleukaemia. The condition will be physically life threatening, and obviously theindividual will also suffer a considerable amount of anxiety. However, in many cases, the individual may only be exposed to a chemical, ora combination of chemicals, that should not – according to toxicologicalunderstanding – result in an adverse chronic illness. But often we see thoseindividuals ‘fall apart’, unable to return to work or recover any normalsemblance of life prior to the exposure. Some individuals may become obsessed about their exposure and carry outextensive research into diseases and chemicals to the nth degree, which mayconsiderably add to their anxiety. With easy access to information via theinternet – where although there are some useful websites, there are many othersof dubious quality – this situation is becoming increasingly common. In the courts, the expectation as to a ‘normal’ reaction of the individualto a chemical poisoning or exposure seems to start from what would be thereaction of the reasonable man or woman. The older expression was, ‘is thatperson of average phlegm and fortitude?’ In theory, the judge always determines the individual’s reaction to a toxicevent or exposure with the help of expert opinion. But in reality, theirdecision is entirely subjective. Is this the best that can be achieved? How dothe majority of chemical poisoning victims react to their exposure to hazardousand toxic substances? The ‘right’ reaction The reaction to chemical exposure may vary – the victim may just shrug theirshoulders and move on. But from my 20 years experience in dealing with suchcases, the far more common reaction is moderate to severe anxiety. Some arefrightened witless. And for many, coming to terms with their exposure and anyacute injury or harm is more than they can cope with. So why do individuals often respond so profoundly to toxic exposure? TheATSDR1, the leading Disease Registry in Atlanta, states: “Unlike thedamage and injuries caused by a natural disaster, many toxic substances areinvisible to the senses. This invisibility results in feelings of uncertainty.People cannot be sure without instrumentation if they have been exposed to atoxin and how much they have been exposed. “Also, due to the time lag between exposure and the appearance of achronic disease [for example mesothelioma as a result of asbestos exposure] itis very difficult to relate past exposure to subsequent disease. “Health outcomes are therefore uncertain and leave individuals with aloss of control. Two areas where people have the most difficulty coping arewith uncertainty and loss of control”. Or is it all in their heads? In another study, a physical rather thanpsychological effect may be the sole cause, as was argued by one expert. Theyreported that a small scale study of Gulf War veterans who complained ofdizziness showed that some of them had brain damage similar to that found invictims of the 1995 Tokyo subway nerve gas attack. Or, as Dr Roland commented,”In other words, these people are not faking it and they are not stressedout”.2 Interestingly, a 1997 report following up the Sarin nerve agent attack byterrorists on the Tokyo subway on 20 March 1995 – two years earlier – statedthat post-incident, 60 per cent of 610 individuals were affected even three tosix months later by psychological sequelae and PTSD (Post Traumatic SyndromeDisorder) type problems. The disease centre in Atlanta has also stated: “A second significantpoint made was that the majority of the responses people have to exposure totoxic substances are normal, that is, normal people behaving normally in anabnormal situation.” It is this central issue, ‘normal people behaving normally in an abnormalsituation’ that has not yet been fully addressed, and at present is only subjectivelydetermined. What exactly is our understanding of acting normally in an abnormalsituation? Some will be less than sympathetic and say ‘get a grip’; ‘move on’; ‘thereis no connection between your present symptoms and the chemical exposure, it isall in your mind’. This is very much so when there is clear scientific andmedical evidence that the exposure could only result in trivial consequencesand the individual has in effect over reacted. But what is a ‘normal’ or reasonable overreaction to poisoning or exposure.Who defines susceptibility? As an example, a worker for a local council was exposed to 1 nml above theaction level for Lindane, an organo-chlorine pesticide. This was anextraordinarily small exposure. However, on his enquiry of the Health &Safety Executive (HSE) as to Lindane and its effects, he received reams ofinformation with which he frankly could not cope. Suffering sweats and hightemperatures, he took to his bed for years, only venturing out of his bed tolay on his couch, and rarely going outside. A toxicologist will say that 1 nml would only have a trivial effect. But apsychiatric condition was diagnosed and he received substantial damages in anout-of-court settlement. In the unreported case of Ashton v ICI High Court, Manchester 21 May 1992,Mr Justice Rose awarded damages of £10,000 for pain, suffering and loss ofamenity to Mr Ashton. He had suffered severe anxiety believing that he wouldcontract cancer having been exposed to Vinyl Chloride Monomer – a cause ofangiosarcoma cancer of the liver. The consultant psychiatrist Dr Cashman stated in the judgement in hisopinion: “The plaintiff has a chronic reactive anxiety depression causedby his apprehensive concern about developing the fatal disease, namely ASL dueto VSM”. Mr Justice Rose stated: “In my judgement, the plaintiff’s reaction wasof the same kind as that of other members of the workforce, although clearlyits extent was greater than that suffered by others. He was more susceptiblethan some to psychiatric diseases. But this does not mean that psychiatricdiseases were not reasonably foreseeable”. Therefore in this case, even though Mr Ashton had not suffered any physicalinjury at all, his fear of cancer was enough to result in an award of damages. Group exposure In group or multi-party chemical exposure cases, a similar situation mayoccur – they will become consumed by anxiety. Again, this is recognised by thecourts, and as long a recognisable psychiatric injury has occurred – forexample PTSD – damages may be awarded for the psychological sequelae as well asfor the physical acute injuries caused by the exposure. In many cases, the strict PTSD criteria may not be met, but the individualmay be clearly affected by the severest form of anxiety. PTSD is strictlydefined according to a classification system. It can be argued that wheresudden chemical exposure occurs, those exposed only become aware of thepossible risk factors involved after the actual exposure has taken place.Therefore although the chemical exposure will not give rise to traumaticmemories at the time, it is the post-incident anxiety caused by worrying aboutfuture consequences that has the debilitating effect. That individual may well have previously had an ‘ordinary’ lifestyle that isnow completely in tatters, so it is surely the case that other ‘post-traumatic’type psychological illnesses do come into play. Group dynamics may well play a part in increasing anxiety among the group,particularly if it is large and the chemical concerned becomes a focus of mediaattention. A poisoned individual may find it difficult to gain recognition anda chemical poisoning diagnosis (some say it is impossible) and suffers allalone, while a group may well discuss their collective problems at length, increasingtheir anxiety. Inevitably, there will be symptom comparisons. Thus normal occurrences suchas headaches and gastro-intestinal problems formerly accepted as a part oflife, suddenly develop sinister overtones as they become ‘proof’ of chemicalpoisoning. In one such unreported case, a bag containing a mercaptan – which is addedto North Sea gas to provide a warning smell for leaks – broke open in afactory. This chemical has a low toxicity profile, but has an incredibly foulsmell. At that time, local children coincidentally suffered tummy upsets, whichthe local physician described as probable summer diarrhoea. However, this ledto a multi-party action for damages by concerned parents. Again, fear of theeffects of the chemicals upon the long-term health of their children andthemselves clearly became the parents’ major concern, far outreaching anyphysical reality of harm by the chemical. But how far does one take this reaction and anxiety? To return to Mr JusticeRoses’ comments as to susceptibility, there are increasing numbers ofindividuals and a growing body of medical literature3 highlighting MultipleChemical Sensitivity (MCS). MCS sufferers claim that often a single low-dosechemical exposure event – particularly pesticides and petrochemicals – willtrigger their susceptibility ever more to even lower chemical exposures causingdisablement. This aspect has been considered by Graveling and his colleagues4 (Health& Safety Executive-funded research) who stated: “Éthe collatedevidence suggests that MCS does exist although its prevalence seems to beexaggerated”. However, this view remains highly controversial and has been severelycriticised in certain quarters. It is perhaps fair to say that the battle linesare drawn between those who support MCS, and those who don’t. Conclusion This article is not intended to understate or underplay the physical effectsupon human health of chemicals where clearly injuries, illness and even deathmay occur. However, failure to recognise that individuals will reactdifferently – sometimes exceptionally and excessively – in the face of what isproven both medically and scientifically to be a low toxicity chemical or lowdose of such a chemical, surely misses the point. Again, the Atlanta Disease Registry discussions are prescient in statingthat individuals do not necessarily understand, agree with or work within theparameters of scientists. The public have also lost considerable faith in most‘experts’ – particularly government experts post BSE – and the old adage thatthe ‘doctor knows best’ is no longer widely accepted. To the affected individual the reality is simple: they have been poisoned orexposed. They were previously healthy, and now they are not. What is thecourt’s definitive approach to a reasonable reaction in such an abnormalsituation and how does the court decide causation in the absence of evidenceother than individual (or group) subjective symptoms. How is the court to judgethose individuals who genuinely cling on to their belief of illness, despitescientific evidence to the contrary? Perhaps the judgment in Page v Smith Houseof Lords provides some answers. “Applying the principle that the defendant had to take his victim as hefound him…it was irrelevant that the defendant could not have foreseen thatthe plaintiff had an ‘eggshell personality’ since (per Lord Browne-Wilkinson)it was established by medical science that psychiatric illness could besuffered as a consequence of an accident although not demonstrably attributabledirectly to physical injury to the Plaintiff”.5 Alan Care, of Thomson Snell & Passmore solicitors, specialises inchemical poisoning personal injury claims and is co-ordinator of theAssociation of Person Injury Lawyers (APIL) Environment Special Interest Group References 1. ATSDR (Agency for Toxic Substances and Disease Registry) ExecutiveSummary Report on the Psychological Responses to Hazardous substances – websitelast updated 22 9 2000 (workshop discussion and consideration of the effects onlocal community living near waste sites). 2. The National Gulf War Resources Centre Inc website as at 14 02 2002 3. A Report on chemical sensitivity (MCS) US Interagency Workshop on MCSPredecisional draft 1998/Ashford and Miller Chemical exposures – low levels andhigh stakes 1991 4. R A Graveling et al, Review of Multiple chemical sensitivity Occup.Environ. Med. 1999 5. Page V Smith House of Lords 1995 Poisoning the mindOn 2 Jan 2003 in Personnel Todaylast_img

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