Bridging the Gap in Mental Health Approaches between East and West: The Psychosocial Consequences of Radiation Exposure

Environmental Health Perspectives 105, Supplement 6, December 1997

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Bridging the Gap in Mental Health Approaches between East and West: The Psychosocial Consequences of Radiation Exposure

Ilya I. Yevelson,¹ Anna Abdelgani,¹ Julie Cwikel,¹ and Igor S. Yevelson²

¹Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheba, Israel; ²Bryansk Regional Psychoneurological Hospital, Regional Psychiatric Expert Commission, Bryansk, Russia

Abstract
Mental health professionals in Western countries and the Confederation of Independent States ([CIS], the former Soviet Union) have been examining the social and psychological consequences of the 1986 Chernobyl nuclear accident on the people who lived or are living in the exposed areas. Based on reviews of the literature, papers from international conferences, and communication between researchers in various countries, different perspectives have emerged on classifying distress and disorders and designing treatment programs. The origins of these differences lie in philosophical, historical, and political developments in the West and the CIS. These different approaches often have made it difficult for mental health professionals from the CIS and the West to work together. The goal of this paper is 2-fold: to identify and recognize the main differences in these approaches and to propose specific solutions for bridging the gap. The basic approach of mental health professionals in the CIS is a physiological, nosological one--it focuses on the etiology of the illness. Although their main diagnostic tool is the International Classification of Diseases, 10th Revision, it has undergone adaptations that reflect the Soviet medical and physiological attitude toward psychiatry. These changes have resulted in the abrogation and addition of disorder categories. For example, in the CIS edition of the ICD-9, there is no mention of post traumatic stress disorder as a distinct disorder. In contrast, in the West, the dominant approach is a symptomatic, phenomenologic one. Emphasis is placed on a dynamic understanding of the disorder and treatment is conducted by mental health professionals (psychologists, social workers, psychiatrists). This contrasts with the approach used in the CIS, where psychological distress often is somaticized and treatment undertaken by physicians rather than mental health professionals. The authors of this paper call on researchers to come together and work jointly on the recognition and resolution of these differences. Then both groups will be able to offer concrete solutions and build tools that can benefit both sides. It is hoped that these new approaches will receive worldwide recognition and prove useful for other mental health professionals working with persons affected by the accident at Chernobyl. -- Environ Health Perspect 105(Suppl 6):1551-1556 (1997)

Key words: Russian, psychiatric approaches, PTSD, Chernobyl, technological disasters, mental health outcomes, liquidators, central nervous system, somatic complaints

This paper is based on a presentation at the International Conference on Radiation and Health held 3-7 November 1996 in Beer Sheva, Israel. Abstracts of these papers were previously published in Public Health Reviews 24(3-4):205-431 (1996). Manuscript received at EHP 18 April 1997; accepted 19 June 1997.
Address correspondence to Dr. J. Cwikel, Spitzer Department of Social Work, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheba, Israel 84105. Telephone: 972 7 6472321or 972 7 6472328. Fax: 972 7 6472933. E-mail: jcwikel@bgumail.bgu.ac.il
Abbreviations used: ARS, acute radiation sickness; CIS, Confederation of Independent States (former Soviet Union); CNS, central nervous system; DSM, Diagnostic and Statistical Manual; GHQ, General Health Questionnaire; ICD, International Classification of Diseases; IES, Impact of Events Scale; NTC, national traditional classification; PTSD, post traumatic stress disorder; SCL, Symptom Classification List.

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