Psychosocial responses to environmental incidents: A review and a proposed typology Lisa A. Page a, 4 , Keith J. Petrie b , Simon C. Wessely a a Department of Psychological Medicine, Institute of Psychiatry, King’s College, London, UK b Health Psychology Department, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand Accepted 10 November 2005 Abstract Objective: The objective of this review was to propose a typology for understanding the diversity of psychosocial reactions to environmental incidents. Methodology: The first section provides an introduction and background to the topic; we then attempt to provide a typology of psychosocial responses to environmental incidents. Results: Response to an environ- mental incident can be usefully considered in terms of the expo- sure, the response of the individual, the action of professionals, the response of the community, and the influence of the society in which the incident occurs. We reviewed each of these factors. Conclusions: By examining incidents in an ordered frame- work, we suggest that a more comprehensive understanding is possible. We also suggest some basic ways in which the psycho- social management of such difficult and diverse incidents could be improved. D 2006 Elsevier Inc. All rights reserved. Keywords: Environment; Disaster; Psychosocial; Symptoms; Toxic; Radiation Introduction The past few decades have seen increased attention given to environmental incidents, including industrial accidents (e.g., Bhopal and Seveso), nuclear accidents (e.g., Three Mile Island and Chernobyl), and war (namely, the Gulf War). At the same time, and perhaps not unrelated, there has been an increase in general environmental health concerns by populations living near toxic waste sites and an increase in perceived environmental hazards such as cellular phone sites or radio transmitters [1]. Most public, professional, and media discourses on the aftermath of environmental accidents are preoccupied with direct toxicological and chemical hazards [2]. Less attention has been given to what many consider to be ultimately the most serious conse- quence of environmental accidents: their psychosocial consequences. In this article, we attempt to draw together some of the relevant literature and propose a psychosocial typology for environmental incidents (see Table 1). Psychosocial consequences result not only from the direct psychological effects of toxicological effects (anal- ogous to the psychological consequences of physical illness) but also increasingly from their perceived impact and risk to health. Indeed, the impact of episodes in which there is no actual environmental hazard at all but only the perception of such a threat can be as damaging as those in which there is at least some chemical exposure [3]. These episodes tend to be overlooked and are often reported under the label of mass psychogenic illness —referring to a dramatic increase in similar symptoms among affected individuals. It is an unsatisfactory term but preferable to mass hysteria [4]. No terminology exists for the long-term effects of perceived exposures. Changing labels The explanations people make for symptoms vary between time, place, and culture. Today, people in Western societies usually assume that symptoms represent bodily as 0022-3999/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2005.11.008 4 Corresponding reviewer. Department of Psychological Medicine, Room 3.14, 3rd Floor, Weston Education Center, Cutcombe Rd., SE5 9RJ London, UK. Tel.: +44 020 7848 5289; fax: +44 020 7848 5408. Journal of Psychosomatic Research 60 (2006) 413 – 422