Re: Re[2]: NIH Incident

[mozley@darius.pet.upenn.edu (P. David Mozley, M.D.)]

If you can not sleep, you can not eat, you can not think the things you
want to think or need to think in order to adapt and function, i.e., if you
suddenly can no longer live the kind of mental life you ordinarily do and
want to, then you have signs and symptoms of a brain disorder.  Period.
It does not matter whether there is a "good" reason or not.  It does not
matter if there has been a real trauma that would produce distress in any
healthy person.  When the distress takes on a life of its own that prevents
you from living yours, i.e., keeps you from coping effectively with the
distressor, it is appropriately classified as a disease state. The
individual in distress becomes deserving of treatment.  And people taking a
history from the distressed individual need to corroborate the facts they
are told by the victim of the disease.

Again, the original request was for facts that have been independently
verified by emotionally uninvolved investigators, as opposed to relying on
the testimony of a tearful person on TV with obvious manifestations of
brain dysfunction.  No specific diagnosis was ever suggested.  My free
advice would be to refrain from making a specific diagnosis unless you are
getting paid at least $300 an hour for it, but, my advice might in this
regard may also be worth what you paid for it.

The interest in the case is not purely purrulent.  The victim is not
actually the issue at all.  The policies that will be elaborated as a
result are the problem.  The regulations that the TV reporter implied are
needed to prevent an incident like this from occuring in the future were
horrifying.  Those I would almost be willing to diagnose as "hysterical" if
it were not for the archaism and political incorrectness of the label.

Mozley


>     The symptoms are consistent with "panic" or anxiety attacks. I am not
>     sure whether they can be construed to be "brain disease." They are
>     manifested in a person who has suffered trauma or extreme
>     psychological stress. I am also not sure whether a person who is
>     stressed out can be diagnosed as having "brain disease." We all suffer
>     some form of stress that is manifested in many different ways. This
>     person is stressed out for very good reason. Whether or not the
>     radiation exposure has the potential to affect her fetus is not the
>     important issue here. The important factor is that she "believes and
>     perceives " that to be the case and is understandably very stressed
>     out. I would suppose her husband might feel the same, and may even
>     demonstrate the same traits as she does. I would not consider him to
>     have a "brain disease" either.
>
>     Sandy Perle
>     Supervisor Health Physics
>     Florida Power and Light Company
>
>     (407) 694-4219  office
>     (407) 694-3706  fax
>
>     sandy_perle@email.fpl.com
>
>
>______________________________ Reply Separator
>_________________________________
>Subject: Re: NIH Incident
>Author:  radsafe@romulus.ehs.uiuc.edu at Internet-Mail
>Date:    10/13/95 8:29 AM
>
>
>The doctor does not have to be suffering from a case of venereal disease to
>diagnose and treat it.  The issue has not been why pathological anxiety and
>other symptoms of brain dysfunction were so palpable on the headline news
>(CNN).  The questions in this forum have been related to how much of the
>story this person has told have been verified.  If there were other
>questions to be asked regarding the affected individual, they would most
>appropriately address what to do about the brain dysfunction.  The surgeon
>does not ask why the bullet is in the chest.  It is only important which
>operation will be performed to deal with it.  Similarly, this person states
>she can not sleep, has no appetite, is weepy all the time, can't
>concentrate, can't stop obsessing over the incident, etc.  These are not
>problems unique to womanhood.  This is a constellation of symptoms
>manifesting brain disease, pure and (not so) simple.
>
>Mozley
>
>
>>I have been reading with interest the comments about the contamination
>>victim's anxiety. Let me point out that, while we may regard the quantity of
>>P-32 and its dose implications as medically insignificant and see the
>>'deliberate' nature of the incident and the loss of control of regulated
>>material as the salient features, none of us males in the discussion will
>>ever have any idea what it is like to be pregnant, let alone pregnant and
>>exposed to a potentially harmful substance, and are, therefore, uniquely
>>unqualified to judge whether she should be fearful in this situation. (It is
>>my personal obeservation that the majority of comments have been from male
>>Radsafers.) It is not difficult to understand how Dr. Ma might find reason
>>to be anxious about her health and that of her unborn child, even though our
>>profession's best estimate is that no observable harm should be expected.
>>The fact that she is an educated woman doesn't mean that her education
>>included health physics; she may have received most of education about
>>radiation from the same place as the rest of America: a popular press
>>educated in science by Beekman's World. Alternatively, her education may be
>>sufficient to understand how little we know about internal dosimetry for the
>>fetus. While we may see her fear as unnecessary, her fear is still very real
>>to her.
>>
>>It has been my experience that internal exposure incidents in the workplace
>>generally involve small amounts of radioactive material and inconsequential
>>doses, but the unusual nature of the contamination event triggers a strong
>>response from management and the radiation protection staff. The victim
>>usually doesn't understand that the staff's reaction is to the unusual
>>incident, not the magnitude of the doses involved. Thus, the HP staff
>>reaction can inadvertently create the anxiety in the victim concerning dose
>>that we see as unwarranted. My question is: has the hoopla (NIH
>>investigation, all the bioassay, NRC investigation, FBI investigation, press
>>attention) created a sense of alarm that didn't need to exist? How can we
>>deal effectively with investigating the events of the incident without
>>upsetting the participants in the incident?
>>
>>Bob Flood
>>Unless otherwise noted, all opinions are mine alone.
>>(415) 926-3793
>>bflood@slac.stanford.edu