The Environment and Mental Health

A Guide for Clinicians

Ante Lundberg

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134809134
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Environmental illness is a concept of growing concern to all health professionals. Patients with problems presumably caused by sick buildings, electromagnetic fields and hypersensitivity to chemicals--to name a few--are often referred to psychologists, psychiatrists, and other counselors. The battery worker with fatigue, headaches, abdominal pain and an elevated lead level...the assembly worker with pain and numbness in her hand and delayed median nerve conduction...the patient who develops typical contact dermatitis after working with epoxies..., these are straightforward cases. But they are in the minority. In many cases, needy, demanding, and difficult patients present complex and challenging psychological issues. Practitioners often lack the training or wisdom to handle these issues effectively. We know that exposure to lead, mercury, and PCBs affect psychological development and behavior; we know much less about the effects of thousands of other chemicals in the environment. In addition, global climate change, social disruption, and the spread of infections will--in the near future--expose people to novel environmental threats. Symptoms caused by toxins can overlap those caused by fear, stress, and depression, and the clinical picture can mimic a variety of other mental disorders. On the other hand, the natural environment can also be a healer. Research shows that hospital stays are shortened and the need for pain medication reduced for patients exposed to nature, even in images, or to the company of animals. Nursing home patients live longer if allowed to keep pets, and one controlled study shows that caring for animals reduces disruptive behavior in even the most difficult ADD children. This book offers the first overview of the many ways the environment can affect mental health and illness. It will prove to be an important and valuable resource for physicians in psychiatry, public health, and environmental medicine; for clinical and counseling psychologists and social workers; and for environmental researchers and advocates worldwide.

Chapter 1

Introduction

Ante Lundberg

Washington, DC Commission on Mental Health Services

 

 

 

By the term environment mental health professionals usually mean an individual's family and immediate social circle. Psychotherapy tends to focus on intrapsychic events and on interaction with the closest family and social group. In recent decades, the focus has shifted to biological determinants of individual experience and behavior, to the genetics of serious mental illness, and to pharmacotherapy for psychiatric disorders.

Genetics and family environment combine to mold a person (Eisenberg, 1995), but growing evidence shows that the nonsocial environment—biological and physical—is important as well, not only for health and psychological functioning, but also for psychiatric morbidity (Lundberg, 1996; Schottenfeld, 1992). Toxins and traumatic experiences such as natural disasters cause illness and vulnerability. Epidemiological data show a sharp rise in depression among adolescents and young adults (Kessler et al., 1994). On the other hand, interacting with the living world, even contemplating pictures of nature, can have therapeutic effects (Katcher & Wilkins, 1993; Ulrich, 1993).

Anecdotal evidence indicates that clinicians see more and more patients who have been exposed to environmental poisons or environmental stress, who worry about environmental threats, or who are preoccupied with the fate of the environment. Often such concerns are irrational and can be seen as representing cognitive dysfunction or neurotic defense such as displacement or rationalization. But in some cases the fears are well founded.

Psychiatric teaching and research has paid only sporadic attention to these often elusive but powerful influences. Searles (1960) explored the topic from a psychoanalytic perspective in The Nonhuman Environment in Normal Development and in Schizophrenia:

It is my conviction that there is within the human individual a sense, whether at a conscious or unconscious level, of relatedness to his nonhuman environment, that this relatedness is one of the transcendentally important facts of human living, that—as with other very important circumstances in human existence—it is a source of ambivalent feelings to him, and that, if he tries to ignore its importance to himself, he does so at peril to his psychological well-being. (p. 6)

An annotated bibliography, Environmental Pollution and Mental Health, was published by Williams, Leyman, Karp, and Wilson (1973). The editors pointed out that the “complex processes through which degraded aspects of the physical environment affect man's mental health are poorly understood. Aside from the literature on lead, there is little that can be said with confidence about the effects of pollution and a deteriorated physical environment on mental health” (pp. 2–3).

In 1979, a task force of the American Psychiatric Association produced a bibliography, Relating Environment to Mental Health and Illness: The Ecopsychia-tric Data Base (Shurley, 1979). It was organized around the concepts of General Systems Theory and contained a comprehensive listing of the relevant literature up to that year. Its emphasis was largely theoretical and conceptual. Freeman's Environment and Mental Health-was published in 1984 (a new edition is planned). It assembled experts from many fields including medicine, social sciences, architecture, zoology, and law who reviewed available information about the psychosocial effects of the man-made environment.

There is still not much empirical research devoted to environment and mental health in the behavioral and clinical sciences. Seasonal affective disorder has been studied since the 1980s (Oren & Rosenthal, 1992) and seasonal pattern has been added as a specifier to mood disorders in the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994). The DSM-TValso allows referring to environmental problems under Axis rV of the multi-axial assessment. Psychologists have shown more interest in the effects of the environment than psychiatrists. A two-volume Handbook of Environmental Psychology was published by Stokols and Airman (1987). Of particular interest is the work of Kaplan and Kaplan (1989) on the experience of nature, discussed in chapter 11. A review of many of these topics for the general reader can be found in The Power of Place (Gallagher, 1993).

Sociology, geography, and philosophy have contributed to the study of the interaction between man and his environment; a large body of essays and popular writing show the degree of public interest and concern. A movement among nonmedical therapists, ecopsychology, addresses grief for environmental destruction and our perceived alienation from the natural world. Its philosophical-spiritual premise assumes that human sanity requires an ongoing relationship, even identification with the wider world; its practitioners advocate an ecological definition of self (Conn, 1995). Their arguments are compelling, even if they are experiential and poetic rather than scientific.

There are scientific, economic, and clinical reasons to treat mental illness separately from mental health (Torrey, 1995). Biological etiology has been proven for some major psychoses, insurance coverage is more readily available, and treatment fits the “medical model.” But the distinction is not clear-cut; much psychological suffering and disability is not due to major mental illness but to psychological or physical stress and trauma (Mazure, 1995). Furthermore, health, not only disease, is the proper concern of physicians.

The interaction between environment and mental health and illness has many dimensions. Interaction with animals and nature has been shown to be beneficial, whereas environmental illness (EI) can be caused by toxins and other hazards in combination with unavoidable psychological stressors and individual vulnerability. An EI patient must be evaluated in physiological as well as psychological terms. Clinicians working with these patients must understand how stress affects physiology as well as mood and behavior, and be familiar with the behavioral manifestations of neurotoxins. EI patients have to contend with a particular set of secondary stressors: Their symptoms are often vague and nonspecific, defy diagnosis and invite a skeptical response, and the presumed cause is usually invisible and elusive. They worry that exposure to toxins or radiation may have delayed effects, perhaps affecting their future children. The same questions worry those who are not ill but fear that they were exposed. Inadequate and untrustworthy information from officials adds to feelings of helplessness and alienation. Exposed individuals can feel stigmatized. When groups and communities get involved, the debate (e.g., over the placement of a dangerous waste facility or who will get compensated) often becomes emotional and politicized. Controversy and lack of scientific data in many areas further increase the patient's uncertainty. The clinician also needs to know how social context, perception of risk, and coping style affect experience.

The stressors described here apply in varying degree to the whole range of conditions discussed in this book, but particularly to the sick veterans of Operation Desert Storm in the Persian Gulf War, who are still trying to find out what ails them.

Some of the chapters in this book are controversial; in most areas there is a shortage of scientific data. This book is designed to introduce the new field of environmental psychiatry, to illustrate its importance for clinical practice, and to serve as a practical guide.

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: Author.

Conn, S. (1995). When the earth hurts, who responds? In T.Roszak, M.E.Goves, & A.D.Kanner (Eds.), Ecopsychology: Restoring the earth, healing the mind (pp. 156–171). San Francisco: Sierra Club Books.

Eisenberg.L. (1995). The social construction of the human brain. American Journal ofPsychiatry, 152, 1563–1575.

Freeman, H. (Ed.). (1984). Mental health and the environment. New York: Churchill Livingstone.

Gallagher, W. (1993). The power of place: How our surroundings shape our thoughts, emotions and actions. New York: Poseidon Press.

Kaplan, R., & Kaplan, S. (1989). The experience of nature: A psychological perspective. Cambridge,England & New York: Cambridge University Press.

Katcher, A., & Wilkins, G. (1993). Dialogue with animals: Its nature and culture. In S.R.Kellert & E.O.Wilson (Eds.), Biophilia hypothesis (pp. 173–197). Washington, DC: Island Press.

Kessler, R.C McGonagle, K A., Nelson, C.B ., Hughes, M., Swartz, M., & Blazer, D.G. (1994). Sex and depression in the national comorbidity survey II: Cohort effects. Journal of Affective Disorders, 30, 15–26.

Lundberg, A. (1996). Psychiatric aspects of air pollution. Otolaryngology Head and Neck Surgery, 114,227–231.

Mazure, C.M. (Ed.). (1995). Does stress cause psychiatric illness? Washington, DC: American Psychiatric Press, Inc.

Oren, D.A , & Rosenthal, N.E (1992). Seasonal affective disorders. In E.S.Paykel (Ed.),Handbook of affective disorders (pp. 551–556). New York: Guilford Press.

Schottenfeld, R.S (1992). Psychologic sequelae of chemical and hazardous materials exposures. In J.B.Sullivan & G.R.Krieger (Eds.), Hazardous materials toxicology (pp.463–470). Baltimore: Williams & Wilkins.

Searles, H. (1960). The nonhuman environment in normal devehpment and in schizophrenia. New York: International Universities Press.

Shurley, J.T. (1979). Relating environment to mental health and illness: The eafysychiatric data hose (Rep. No. 16). Washington, DC: American Psychiatric Association Task Force.

Stokols, D., & Altman, I. (Eds.). (1987). Handbook of environmental psychology. New York: Wiley.

Torrey, E.F F. (1995, October). The marriage of mental illness and mental health: Isn't it time for a divorce? Lecture presented at the American Psychiatric Association's Institute on Psychiatric Services, Boston, MA.

Ulrich, R.S. (1993). Biophilia, biophobia, and natural landscapes. In S.R.Kellert & E.O.Wilson (Eds.), The biophilia hypothesis (pp. 73–137). Washington, DC: Island Press.

Williams, J.S.,Leyman, E., Karp, S.A., & Wilson, P.T. (1973). Environmental pollution and mental health. Washington, DC: Information Resources Press.

Chapter 2

Environmental Change
and Human Health

Ante Lundberg

Washington, DC Commission on Mental Health Services

Changes in the world around us test our ability to adapt and may threaten health and well-being. In industrialized societies most people lead lives very different from their grandparents, who were often directly dependent on the natural world. The electronic revolution continues to change how we live and work. Elsewhere, political and economic conditions force vast numbers of people to leave their homes. We are all exposed to the consequences of pollution, climate change, and loss of stratospheric ozone: real but insidious new threats from toxic substances, infections, and ultraviolet (UV) radiation.

In the community, environmental threats such as a hazardous waste site, a polluting factory, or a nuclear power plant can be seen and confronted, even if the danger they represent is invisible and technically complicated. Acid rain due to industrial activity in a remote area is a more abstract notion, even though its consequences, for example, dying trees and fish, are starkly visible. Global issues such as climate change, ozone depletion, and loss of biodiversity have potentially catastrophic consequences, yet to most people they seem distant and theoretical, obscured by a debate that is technical and driven by ideology, special interests, and emotion. But pressures on the environment will continue to build: Population and consumption are growing, and we can expect greater environmental health problems.

Mental health is inseparable from physical health. Both depend to a large extent on socioeconomic and environmental conditions. A report on world mental health (Desjarlais, Eisenberg, Good, & Kleinman, 1995) points out that the remarkable improvement in health care and life expectancy in some developing countries has been accompanied by “an increase in depression, schizophrenia, dementia, and...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgments
• Chapter 1 Introduction
• Chapter 2 Environmental Change and Human Health
• Chapter 3 Behavioral Manifestations of Neurotoxicity
• Chapter 4 The Psychiatric Evaluation of Patients With Suspected Toxic Exposure
• Chapter 5 Psychiatric Aspects of Technological Disasters
• Chapter 6 Environmental Influences on Illness in Persian Gulf War Veterans
• Chapter 7 Psychological Aftermath of Participation in the Persian Gulf War
• Chapter 8 Risk Perception and Coping
• Chapter 9 Environmental Illness: Multiple Chemical Sensitivity, Sick Building Syndrome, Electric and Magnetic Field Disease
• Chapter 10 Psychosocial Effects of Urban Environments, Noise, and Crowding
• Chapter 11 Nature and Mental Health: Biophilia and Biophobia
• Chapter 12 Animal-Assisted Therapy in the Treatment of Disruptive Behavior Disorders in Children
• Chapter 13 Psychiatry and Ecopsychology
• Appendix Environmental Information Resources for the Clinician
• Author Index
• Subject Index