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Book Reviews   |    
Toxic Turmoil: Psychological and Societal Consequences of Ecological Disasters
Reviewed by Burton C. Einspruch, M.D., F.A.C.P.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.5.755
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edited by Johan M. Havenaar, Julie G. Cwikel, and Evelyn J. Bromet; New York, Kluwer Academic/Plenum Publishers, 2002, 279 pages, $65

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There is nothing new about apocalyptic events and typical human reactions to these unanticipated exposures. September 11, 2001, changed our thinking about the world and initiated studies and programs that will hopefully help us to understand and deal with potential massive public health demands, especially substantial psychological sequellae.

There is always room for a finely crafted work related to the psychological aspects of calamitous events. Exactly so, Toxic Turmoil: Psychological and Societal Consequences of Ecological Disasters is a collection of essays by authors who are obviously well qualified, although just as important is their ability to provide a remarkably clear presentation of their thoughts and the facts related to ecological catastrophes. This edition is part of an important series of publications on stress and coping and is presented in a highly informed fashion, resulting in an intriguing, important, and intellectually demanding text.

The book includes the works of some 20 authors and is divided into 14 chapters, each of which is worth reading. I suspect that I found the chapters about better-known events to be more intriguing because they are well within memory. Less well-known events, such as a plane crash in Amsterdam, are worthy of discussion but had less of an impact. The background in each chapter contains excellent introductory material so that each chapter stands alone. The authors not only present the material but also reach well-reasoned conclusions and, when appropriate, apply these conclusions to events that unquestionably will happen in the future, not only as a result of human malevolence but also because of ignorance and unpredictable accidents.

Toxic Turmoil, which covers terrorist-generated disasters as well as unanticipated calamities such as plane crashes and nuclear or chemical accidents, points out residual problems that are no different from those experienced in the United States after September 11 or those faced by civilians after the Chernobyl or Bhopal disasters. The persistence of psychological trauma documented throughout the book is essentially the same as that seen among those who survived the Oklahoma City bombing or the attacks on the World Trade Center. The authors point out the general recuperative powers of most individuals but acknowledge that some people will continue to have posttraumatic disorders.

The capacity for people to develop vague symptoms that become bonded to an event is extraordinarily difficult to evaluate, because many of these symptoms have elements of chronic fatigue or other somewhat fashionable, elusive symptoms and remain undeciphered or "shy." Fear of cancer and reproductive failure are especially vulnerable to exploitation by media hyperbole. The almost universal use of cell phones, pesticides, and computers arouses suspicion and antiscientific thinking that conveniently includes these items, in an irrational fashion, among potential sources of "toxic exposure."

It is also noted that the more involved the media becomes, the more biased and inaccurate is the information being disseminated to the public. Some believe that this distortion of information is due to manipulation by the authorities as a means of blurring the exact nature of casualties and their outcomes. As pointed out in Toxic Turmoil, some disasters never actually occurred but were simply outbreaks of hysteria that caught the media's attention and became self-perpetuated, although usually short-lived.

Despite the fact that much has been written about the impact of the trauma associated with the attacks on the World Trade Center, it is refreshing to read prescient and applicable works that were written before September 11 but that are no less poignant and clarifying, even preparatory, almost as if they had been written after the disaster.

Dr. Einspruch is clinical professor of psychiatry at the University of Texas at Dallas Southwestern Medical Center and clinical associate professor of psychiatry at New York University Medical Center in New York City.

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