Psychosomatic Technological Risk & Its Assessment and Management. J. Pop-Jordanov, Macedonian Academy of Sciences and Art; and N. Pop-Jordanova, University of Skopje, Faculty of Medicine, Skopje, Macedonia
1. INTRODUCTION
The need of improving the existing risk concepts and methodologies, going beyond the National Academy of Sciences (NAS) paradigm [1], has been fully recognized [2, 3]. Among others, the importance of perception, trust and adversity, as well as of the interaction between risk assessment and risk management have been pointed out [4, 5]. However, in considerations toward refinements, the psychosomatic health effects (i.e. the somatic diseases induced or enhanced by psychological stress exposure) were not mentioned. Our paper is an attempt to extend the NAS paradigm, introducing a psychosomatic risk concept. Simultaneously, it assigns new meaning to the role of psychological risk factors as well as to the risk assessment-risk management interaction.
2. NAS PARADIGM
The NAS conceptual scheme defines four risk assessment steps (hazard identification, dose response assessment, exposure assessment, risk characterization), together with a partially overlapped but operationally independent risk management pattern.
The NAS paradigm implies the following definition of the term risk assessment: "... We use risk assessment to mean the characterization of the potential adverse health effects of human exposures to environmental hazards... Broader uses of the term than ours also embrace analysis of perceived risks, comparisons of risks associated with different regulatory strategies, and occasionally analysis of the economic and social implications of regulatory decisions -- functions that we assign to risk management." [1, p. 18]
The current models and guidelines for risk assessment and risk management of any technological system (in industry, medicine, agriculture etc.) are based on the above NAS definition. In the corresponding standard environmental transfer pathways and structures of risk management systems the risk assessment is restricted to physical/chemical emissions and interactions, while the perceptive elements (emotional, cognitive) are assigned exclusively to risk management. The practical consequence is that current procedures for assessing and managing of health risks from technological systems consider only somatic diseases (respiratory, malignant etc.), induced by physical/chemical pollution ( radiation, toxins etc.). Our point is that the psychosomatic diseases (peptic ulcer, hypertension etc.) provoked by "psychological pollution" from technological systems should also be taken into account.
3. PSYCHOSOMATIC (PS) EXTENSION
Referring to the cited NAS definition, we postulate the following statement: The somatic and synergetic effects of technology-related psychological stress represent non-negligible "potential adverse health effects of human exposures to environmental hazards," and should be included in the risk assessment concept. This further means that the "analysis of perceived risks" should be assigned not only to risk management, but to the risk assessment as well.
The examination of the formulated psychosomatic extension will be performed considering all components from the NAS risk assessment paradigm in the light of the above proposition.
4. PS RISK ASSESSMENT
4.1 Hazard identification
According to NAS scheme, the hazard identification step should show whether a certain agent causes the adverse effects, demonstrating a relationship between an agent and an injury. In the standard procedures, based on NAS paradigm, the following causality sequence is implied: material (physical, chemical) agent-->tissue harm-->functional disorder.
However, technological hazards may also induce other kinds of agents, identified as emotional stresses (fear, anxiety etc.). As it is known from psychosomatic medicine, they lead to chronic activation of the nervous and endocrine-imunological systems and consequently to functional disturbance, resulting in somatic (organic) damage, i.e. disease. Therefore, we have proposed an inverse causality model in risk assessment: immaterial (psychological) agent-->functional disorder-->tissue harm [6].
4.2. Dose-response assessment
In order to answer how "toxic" a certain "stuff' is, the relationship between dose and response should be investigated, from human epidemiological studies as well as extrapolating from laboratory animal studies.
The PS risk concept is concerned with chronic stress doses, characteristic for many modem technologies. The stress agents are being refracted through the individual history of a person as through a prism, leading to a spectrum of possible reactions. The personality prism [7] comprises heredity, early childhood experience and actual conflict, while the resulting disorders, as a response of the human being, have the form of disturbed behaviors from one side, and psychosomatic diseases and amplifying synergism, from the other. The probability of each outcome depends primarily on the individual personality prism, as well as on the characteristics of the stressors.
Consequently, the chronic stress due to technological hazards appears as an individual experience in a specific culture, becoming psychosomatic pathogen after the refraction through the particular prism. Nevertheless, irrespective of the different individual stress reactions and ambiguities, certain statistical (group) regularities do exist, demonstrating the PS dose-response relationship.
4.3. Exposure assessment
By the definition, the exposure assessment step deals with analysis of exposures, currently experienced or anticipated, under different conditions. A number of sensitive measurement techniques and accurate statistical procedures for characterizing exposures to contaminants have been developed.
Analogous to the case of physical/chemical exposure, the specification of the psychological exposure due to technological hazards can be executed using various psychometric instruments and probabilistic schemes. As examples, we have diagnosed and analyzed the psychological pollution for the cases of nuclear radiation and coal power plants, exploring and comparing the opinions and facts concerning the incidence of relevant somatic diseases [8]. In addition, the cognitive structure related to stress level and underlying the attitude has been studied [9].
4.4. Risk characterization
At this step, the qualitative and quantitative information on the estimated incidence of the adverse effect in a given population should be provided.
To characterize the psychosomatic technological risk, we have
investigated the incidence of the primary psychosomatic diseases
in the staff at three hazardous technologies and compared with
presumably non-exposed (control) groups, using epidemiological
data from the related medical care institutions (Table I).
As can be seen from Table I, in most cases a considerable increase in the incidence of primary psychosomatic diseases compared to control groups is evidenced, justifying the introduction of the psychosomatic risk assessment concept.
The inclusion of PS risk assessment components supplements the standard risk transfer pathway with a parallel "psychosomatic" branch, comprising stressor dispersion, personality prism and a holistic synergetic amplifier.
5. PS RISK MANAGEMENT
Following the psychosomatic risk concept, an additional branch in the standard structure of risk management system has to be introduced, connecting by feedback the risk perception and risk assessment levels.
Finally, we have started to apply computer aided techniques for psychosomatic risk mitigation, including workplace assessment, real-time presentation of psycho-physiological response and interactive stress management.
6. SUMMARY
A comparison between the standard risk concept, based on NAS
risk assessment/risk management paradigm, and the proposed
psychosomatic extension is summarized in Table II.
References
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[6] Pop-Jordanov, J., Pop-Jordanova, N., "Inverse causality model in social and health risk assessment," First SRA-Europe Conference "The Utility of Risk Analysis in Decision Making," Nov. 10-11, IIASA, Laxenburg, Austria (1988) 49.
[7] Lader, M., "Psychophysiological research and psychosomatic medicine," Physiology, Emotion and Psychosomatic Illness (Elsevier, Amsterdam-London-New York, 1972).
[8] Pop-Jordanov, J., Pop-Jordanova, N., "Stress consequences of technological emissions," in: Developments in Environmental Modeling, 15, Environmental Models: Emissions and Consequences (Elsevier, Amsterdam-Oxford-New York-Tokyo, 1990) 163-168.
[9] Pop-Jordanov, J., Pop-Jordanova, N., "Risks of
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