What are the psychological consequences following chemical
poisoning or exposure? OH practitioners often acknowledge the problem, but find
there is no uniform judicial approach and little information available, by Alan
Care
There is clearly a difference between a chemical exposure causing physical
(organic) chemical poisoning given a sufficient dose, and an exposure to
chemicals that may only cause a short-lived acute adverse reaction with
psychological overlay.
Chemical exposure inevitably causes psychological harm and injury for the
majority of individuals who are exposed to toxic substances and in many cases,
the psychological reaction may far outweigh the original physical chemical
reaction. For example, a chemical exposure causing only a headache may lead to
a lifetime of psychological worry and anxiety.
An example of a classic industrial disease of chemical poisoning causing
chronic long-term damage would be a high-dose exposure to benzene, triggering
leukaemia. The condition will be physically life threatening, and obviously the
individual will also suffer a considerable amount of anxiety.
However, in many cases, the individual may only be exposed to a chemical, or
a combination of chemicals, that should not – according to toxicological
understanding – result in an adverse chronic illness. But often we see those
individuals ‘fall apart’, unable to return to work or recover any normal
semblance of life prior to the exposure.
Some individuals may become obsessed about their exposure and carry out
extensive research into diseases and chemicals to the nth degree, which may
considerably add to their anxiety. With easy access to information via the
internet – where although there are some useful websites, there are many others
of dubious quality – this situation is becoming increasingly common.
In the courts, the expectation as to a ‘normal’ reaction of the individual
to a chemical poisoning or exposure seems to start from what would be the
reaction of the reasonable man or woman. The older expression was, ‘is that
person of average phlegm and fortitude?’
In theory, the judge always determines the individual’s reaction to a toxic
event or exposure with the help of expert opinion. But in reality, their
decision is entirely subjective. Is this the best that can be achieved? How do
the majority of chemical poisoning victims react to their exposure to hazardous
and toxic substances?
The ‘right’ reaction
The reaction to chemical exposure may vary – the victim may just shrug their
shoulders and move on. But from my 20 years experience in dealing with such
cases, the far more common reaction is moderate to severe anxiety. Some are
frightened witless. And for many, coming to terms with their exposure and any
acute injury or harm is more than they can cope with.
So why do individuals often respond so profoundly to toxic exposure? The
ATSDR1, the leading Disease Registry in Atlanta, states: "Unlike the
damage and injuries caused by a natural disaster, many toxic substances are
invisible to the senses. This invisibility results in feelings of uncertainty.
People cannot be sure without instrumentation if they have been exposed to a
toxin and how much they have been exposed.
"Also, due to the time lag between exposure and the appearance of a
chronic disease [for example mesothelioma as a result of asbestos exposure] it
is very difficult to relate past exposure to subsequent disease.
"Health outcomes are therefore uncertain and leave individuals with a
loss of control. Two areas where people have the most difficulty coping are
with uncertainty and loss of control".
Or is it all in their heads? In another study, a physical rather than
psychological effect may be the sole cause, as was argued by one expert. They
reported that a small scale study of Gulf War veterans who complained of
dizziness showed that some of them had brain damage similar to that found in
victims 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 stressed
out".2
Interestingly, a 1997 report following up the Sarin nerve agent attack by
terrorists on the Tokyo subway on 20 March 1995 – two years earlier – stated
that post-incident, 60 per cent of 610 individuals were affected even three to
six months later by psychological sequelae and PTSD (Post Traumatic Syndrome
Disorder) type problems.
The disease centre in Atlanta has also stated: "A second significant
point made was that the majority of the responses people have to exposure to
toxic substances are normal, that is, normal people behaving normally in an
abnormal situation."
It is this central issue, ‘normal people behaving normally in an abnormal
situation’ that has not yet been fully addressed, and at present is only subjectively
determined. What exactly is our understanding of acting normally in an abnormal
situation?
Some will be less than sympathetic and say ‘get a grip’; ‘move on’; ‘there
is no connection between your present symptoms and the chemical exposure, it is
all in your mind’. This is very much so when there is clear scientific and
medical evidence that the exposure could only result in trivial consequences
and 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 the
action level for Lindane, an organo-chlorine pesticide. This was an
extraordinarily small exposure. However, on his enquiry of the Health &
Safety Executive (HSE) as to Lindane and its effects, he received reams of
information with which he frankly could not cope. Suffering sweats and high
temperatures, he took to his bed for years, only venturing out of his bed to
lay on his couch, and rarely going outside.
A toxicologist will say that 1 nml would only have a trivial effect. But a
psychiatric condition was diagnosed and he received substantial damages in an
out-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 of
amenity to Mr Ashton. He had suffered severe anxiety believing that he would
contract cancer having been exposed to Vinyl Chloride Monomer – a cause of
angiosarcoma cancer of the liver.
The consultant psychiatrist Dr Cashman stated in the judgement in his
opinion: "The plaintiff has a chronic reactive anxiety depression caused
by his apprehensive concern about developing the fatal disease, namely ASL due
to VSM".
Mr Justice Rose stated: "In my judgement, the plaintiff’s reaction was
of the same kind as that of other members of the workforce, although clearly
its extent was greater than that suffered by others. He was more susceptible
than some to psychiatric diseases. But this does not mean that psychiatric
diseases were not reasonably foreseeable".
Therefore in this case, even though Mr Ashton had not suffered any physical
injury 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 may
occur – they will become consumed by anxiety. Again, this is recognised by the
courts, and as long a recognisable psychiatric injury has occurred – for
example PTSD – damages may be awarded for the psychological sequelae as well as
for the physical acute injuries caused by the exposure.
In many cases, the strict PTSD criteria may not be met, but the individual
may be clearly affected by the severest form of anxiety. PTSD is strictly
defined according to a classification system. It can be argued that where
sudden chemical exposure occurs, those exposed only become aware of the
possible risk factors involved after the actual exposure has taken place.
Therefore although the chemical exposure will not give rise to traumatic
memories at the time, it is the post-incident anxiety caused by worrying about
future consequences that has the debilitating effect.
That individual may well have previously had an ‘ordinary’ lifestyle that is
now 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 media
attention. A poisoned individual may find it difficult to gain recognition and
a chemical poisoning diagnosis (some say it is impossible) and suffers all
alone, while a group may well discuss their collective problems at length, increasing
their anxiety.
Inevitably, there will be symptom comparisons. Thus normal occurrences such
as headaches and gastro-intestinal problems formerly accepted as a part of
life, suddenly develop sinister overtones as they become ‘proof’ of chemical
poisoning.
In one such unreported case, a bag containing a mercaptan – which is added
to North Sea gas to provide a warning smell for leaks – broke open in a
factory. This chemical has a low toxicity profile, but has an incredibly foul
smell. At that time, local children coincidentally suffered tummy upsets, which
the local physician described as probable summer diarrhoea. However, this led
to a multi-party action for damages by concerned parents. Again, fear of the
effects of the chemicals upon the long-term health of their children and
themselves clearly became the parents’ major concern, far outreaching any
physical reality of harm by the chemical.
But how far does one take this reaction and anxiety? To return to Mr Justice
Roses’ comments as to susceptibility, there are increasing numbers of
individuals and a growing body of medical literature3 highlighting Multiple
Chemical Sensitivity (MCS). MCS sufferers claim that often a single low-dose
chemical exposure event – particularly pesticides and petrochemicals – will
trigger their susceptibility ever more to even lower chemical exposures causing
disablement.
This aspect has been considered by Graveling and his colleagues4 (Health
& Safety Executive-funded research) who stated: "Éthe collated
evidence suggests that MCS does exist although its prevalence seems to be
exaggerated".
However, this view remains highly controversial and has been severely
criticised in certain quarters. It is perhaps fair to say that the battle lines
are drawn between those who support MCS, and those who don’t.
Conclusion
This article is not intended to understate or underplay the physical effects
upon human health of chemicals where clearly injuries, illness and even death
may occur. However, failure to recognise that individuals will react
differently – sometimes exceptionally and excessively – in the face of what is
proven both medically and scientifically to be a low toxicity chemical or low
dose of such a chemical, surely misses the point.
Again, the Atlanta Disease Registry discussions are prescient in stating
that individuals do not necessarily understand, agree with or work within the
parameters of scientists. The public have also lost considerable faith in most
‘experts’ – particularly government experts post BSE – and the old adage that
the ‘doctor knows best’ is no longer widely accepted.
To the affected individual the reality is simple: they have been poisoned or
exposed. They were previously healthy, and now they are not. What is the
court’s definitive approach to a reasonable reaction in such an abnormal
situation and how does the court decide causation in the absence of evidence
other than individual (or group) subjective symptoms. How is the court to judge
those individuals who genuinely cling on to their belief of illness, despite
scientific evidence to the contrary? Perhaps the judgment in Page v Smith House
of Lords provides some answers.
"Applying the principle that the defendant had to take his victim as he
found him…it was irrelevant that the defendant could not have foreseen that
the plaintiff had an ‘eggshell personality’ since (per Lord Browne-Wilkinson)
it was established by medical science that psychiatric illness could be
suffered as a consequence of an accident although not demonstrably attributable
directly to physical injury to the Plaintiff".5
Alan Care, of Thomson Snell & Passmore solicitors, specialises in
chemical poisoning personal injury claims and is co-ordinator of the
Association of Person Injury Lawyers (APIL) Environment Special Interest Group
References
1. ATSDR (Agency for Toxic Substances and Disease Registry) Executive
Summary Report on the Psychological Responses to Hazardous substances – website
last updated 22 9 2000 (workshop discussion and consideration of the effects on
local 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 MCS
Predecisional draft 1998/Ashford and Miller Chemical exposures – low levels and
high stakes 1991
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4. R A Graveling et al, Review of Multiple chemical sensitivity Occup.
Environ. Med. 1999
5. Page V Smith House of Lords 1995
