Panel Two Results:
Community and Social Science Perspectives
Composed of community and social psychologists, sociologists, anthropologists, political scientists, and community members affected by hazardous waste sites.
To review what is known about the psychosocial responses in communities located near hazardous waste sites and to make recommendations regarding ways of interacting with communities, outline problems in need of further investigation, and suggest possible psychosocial interventions to reduce stress. Panel members were not asked to evaluate community and psychosocial issues associated with specific sites. Instead they were asked to use their complementary backgrounds and areas of expertise to provide an overview of the following three areas: 1) the factors that might render some community members susceptible to the stress of living near a hazardous waste site, 2) the known psychosocial responses of community members living near hazardous waste sites, and 3) the psychological impact of experienced uncertainty of the consequences of toxic exposures.
With the discovery of toxic contamination, many affected communities will suffer social conflicts. The sources for social conflict are many. The invisibility of most toxic contaminants may make it difficult for community members to reach agreement on their effects. The uncertainty can heighten individual and family distress and may lead to disputes between neighbors, particularly when the contamination is spread unevenly throughout a community. Residents who live close to hazardous waste sites frequently have different views of their possible exposure and its health effects than residents of the same community who live farther away and do not believe themselves to be affected. For that reason, factions can develop in communities between those living inside and those living outside the affected area.
The chair of the panel, Dr. Stephen Couch, introduced this topic by comparing how communities respond to natural disasters with how they respond to technological (human-related) disasters.
Dr. Couch: (Dr. Couch's introduction is reported as transcribed from tapes of the meeting.)
I began my work on this topic in a town called Centralia, Pennsylvania, in 1981. This was a community affected by an underground mine fire. Rather than the pulling together of a community as described following a natural disaster, I observed a community breaking apart, neighbor fighting neighbor over what to do. Since then, I and my colleague Steve Kroll-Smith have studied social responses to human-mad disasters. We define location near a hazardous waste site as a chronic technological disaster-chronic because it's a long-lasting experience with potentially long-lasting or future health effects and technological because it is caused by the use of human technology. As Erikson so eloquently said, here is a "new species of trouble."
I see chronic technological disasters as the consequences of how we have set up our technological society. Charles Perrow's paper on normal accidents explains the inevitability of accidents occurring in complex, interdependent technical systems (29). The work of Ulrich Beck on the "risk society" is about how modern society organizes the distribution of risks (30).
With chronic technological disasters, the impact varies in different communities. At the worst, the impact can be severe, causing social conflict both within and between communities and other social entities. These conflicts are seen not only in our society but in other cultures. I traveled to Minamata, Japan, where methyl mercury contamination and resulting health sequelae occurred. There I found social conflict occurring more than 30 years after the contamination. The fact that all the community factions could sit face-to-face at a table and talk was viewed as great progress.
In chronic technological disasters, the social process exacerbates rather than ameliorates the primary stress of the exposure. There are two types of stressors: the stress of living near contamination and the stress that results from the social process that arises from contamination.
The members of the panel who are residents of communities living near hazardous waste sites asked that community members be fully accepted as experts on the problems in their community.
There are ethical issues associated with how a community effectively works through the stress from a technological rather than a natural disaster. For example, industry has suggested affecting public perceptions at a hazardous waste site by giving tours of the site and making therapy available at the site. This would be an unethical use of therapy to change people's minds in a pre-determined way.
This raises the question, should efforts be focused on helping people to cope with an unjust situation or helping them to change the situation. According to represented community members, this is the heart of the matter.
However, the community also feels that if the consequences for the public's health could be stopped as soon as detected, the high price of having to treat continuing stress, resulting from a continuing identified hazard entering the environment, could be avoided. If the causes of stress are curtailed or stopped completely, it won't have to be treated.
This discussion includes:
- Individual and community dynamics,
- Cultural factors affecting responses,
- Community (e.g., marginalized), and
- Factors involved in a community's response (i.e., duration of exposures, socioeconomic and demographic factors, and factors unique to a community).
Consideration of Both Individual and Community Dynamics
The panel began by discussing the chronology of the Superfund process as presented by Dr. Michael Edelstein. It is important to realize that the environment of a Superfund site changes over time. At the beginning, there is the incubation phase. A hazard exists but is not recognized as such by the community. Then, there is the discovery stage. The public learns of the existence of a problem with a hazardous substance, usually by some type of announcement. After the discovery of a hazard, a long stage of environmental turbulence begins. First, there is short-term adjustment or initial coping on individual, family, social network, and institutional levels. If the initial coping fails, then a disabling and frustration of the community occurs with social turbulence. At this stage, efforts at collective coping are initiated. These efforts include mobilizing social support, seeking sources of trusted information, and utilizing community or individual power. If proactive coping works, then the community can successfully form a response to contamination. If efforts at collective coping fail, social turbulence occurs, dissension or community destruction ensues, and an environmental stigma is cast on that community.
All communities are susceptible to the stress of environmental contamination but in different ways. The following are some prevariables that affect susceptibility: age, length of residence, location or proximity to the site, socioeconomic status, specific cultural factors, and coping vulnerabilities (e.g., state of psychological health). Intrinsic factors are preexisting health status and the physiological impacts of hazardous substances. Extrinsic factors are the social context in which the contamination occurs and the social response to that contamination. To evaluate the community, the ecohistorical context in which the contamination occurs must be understood.
Environmental contamination or chronic technologic disasters take place over time. This changes the disaster cycle known from studies of natural disasters. In a natural disaster, such as a hurricane, there are distinct stages-warning, threat, impact, and so on-to recovery and rehabilitation. In environmental contamination, communities get stuck in certain stages; there is no linear progression through them. Environmental contamination leads to cycles of the warning, threat, and impact stages.
Another difficulty of these situations is the dependence of communities on external government agencies. Few communities have the resources to cope with or respond to environmental contamination. Another important factor is the trust relations between the parties involved. The decentralized structure of dealing with a hazardous waste site means that many government agencies participate but without a clear line of command. This results in differing information from various agencies, which leads to a loss of trust and a reason for dissension in the communities.
Also, what can these communities expect in the way of final outcome and resolution of chronic technologic disasters? The solutions range from a technical fix (which many people may have difficulty believing has solved the problem) to relocat on (which destroys the community because it disperses the individuals within it).
Cultural Factors Affecting Response
Dr. John Pettersen led the panel discussion on this topic. Culture plays a direct role in perception of threat and response to threat. People of certain cultural backgrounds are more sensitive to threat and have lower thresholds for suspicions. Some of these perceptions are based on historical events (e.g., Native Americans' history with U.S. government treaties), lack of political control, and impoverishment.
Additionally, traditional communities are often more tightly knit, have kinship groups, have religious ties to the land, and find it harder to leave an area impacted by environmental contamination. Different groups of people have different vested interests in the land (i.e., development versus subsistence) and even different belief systems in relation to the land.
After an environmental disaster, such as the Exxon Valdez accident or the discovery of a leaking hazardous waste site, the response may alter existing customs within a culture. For example, in Alaska after the Exxon Valdez accident, the high-wage clean-up jobs displaced employees from traditional subsistence hunting. When you alter existing customs within a culture, structures within a community, or even regulations within a large social structure like an industry, the rebound amplifications create social tensions and disruptions. These are secondary responses to contamination. The primary stress comes from exposure to the contamination; other parts of the psychosocial stress come from the secondary social response to the contamination.
Other secondary responses are related to mitigating suspected, potential, or actual exposure to contaminants within a community. For example, if a fish consumption health advisory is issued because of environmental contaminants present in fish, the stress for some community members worried about the contamination will decrease but may increase in other groups within the community, such as commercial or subsistence fishermen. Such an intervention could reduce or eliminate the income of the commercial fishers or the low-fat dietary source of protein for subsistence fishers. Either of these outcomes could ultimately have a negative effect on the health status of the members within these groups. The health benefits of any intervention within a community should be assessed in relation to the health risks they could potentially generate. All stakeholders should be identified and their concerns addressed before interventions are implemented to reduce the psychosocial effects and stress associated with the interventions.
It is important to remember that often health is stated as the central concern of communities affected by contamination; however, a health concern is also often the only issue that some community members feel they can cite to legitimize their concerns. Quality of life, social "toxic" stigma, and reduction in community resources (e.g., loss of equity and tax base resulting from property devaluation) are valid areas of concern. Frequently, however, those issues go unstated because residents believe they will not generate much response and support.
Finally, communities and scientists have different cultural assumptions. The scientists look for material proof of physical health problems. Community members rely on feelings (i.e., symptoms) as cues for problems. These differing assumptions make communications between the groups difficult.
Dr. Mildred McClain led this discussion. (Dr. McClain's comments are reported verbatim from the tapes of the workshop.)
In marginalized communities, disenfranchised communities, uncertainty is an everyday way of life. People are not recognized as full citizens. There is a loss of control over community life. There are multiple layers of stress: violence, poverty, poor health, lack of knowledge about environmental problems, and lack of understanding of the science.
There is a lack of understanding of the problems of a marginalized community in the mainstream culture. African-American communities are a non-homogeneous population.There is a diversity of political persuasions. We suffer from poor health services. There are economic deprivations. We are dependent on jobs with the polluting industry. Racism. Acceptance of what is. Fear of speaking out. Programmed belief in Cain vs. Abel. The curse of Cain rooted in Biblical validation. Lack of any services or systems to help deal with any stress. Internal violence within these communities coupled with substance abuse and lack of respect. There is a high level of mistrust in government agencies-history of not addressing the problems. Add to that a lack of resources to empower people to participate and a perceived lack of power. Add to this stress the extra stress of living near a hazardous waste site as well as the recurrence of pollution and accidents in an industrialized zone.
What is the impact of the stress and impact of environmental toxins? What was the effect of industrial intrusions in our communities? "Walking poison time bombs." How does poor nutrition affect our response to environmental contamination? We believe the environment is everything. Environment encompasses everything. If the land is injured, then the people are too. The general society believes "we are in control." In marginalized communities there is no separation. The Superfund assumption is that you can isolate one source of contamination. This assumption ignores the multiple sources of contamination.
What Factors to Consider When Assessing a Community's Response
As stated before, communities are not homogeneous. When you consider the various coping mechanisms of different groups within a community, group culture plays a large part in shaping responses to situations. Groups provide alternatives, different strengths, as well as resilience and capacities to respond.
The following is a list of factors to consider when assessing a community's response to an exposure to a hazardous substance:
- Other stressors affecting the community,
- Community values,
- Sex roles,
- Percentage of renters versus homeowners,
- Primary language (may not be English),
- Odors from the hazardous waste site,
- Visibility of toxins such as fires and smoke, and
- Physical factors (e.g., cancer incidence and outcome, low-term birth weights, stillbirths, birth defects).
Data Gaps and Recommendations
- There is a need for more work on explicating the following gaps in the data:
- Sources of stress in conversations about environmental hazards,
- Amount of stress inherent in learning of contamination,
- Nature of known or believed exposures,
- Fear of the unknown regarding hazardous exposures, and
- Stages of where a community is in the Superfund process.
- There is a need to explore and compare responses of mainstream culture to hazardous substances with that of traditional and marginalized communities.
- There is a need for greater understanding of how culture shapes response to the threat of environmental contamination.
To meet these needs, the following recommendations must be considered:
- Treat communities with dignity and respect.
- Don't try to solve the communities' problems for them; rather, assist them in solving their own problems.
- Be thoughtful of race/ethnicity.
- Realize that scientists may not have all the answers for a community near a Superfund site.
- Give communities practical actions to take.
- Identify the different sectors of a community. Take into account that communities are diverse, and identify centers of respect between diverse groups.
- Don't use technical language or jargon when communicating with communities.
- Two-way communication between government agencies and communities is critical.
What are some of the psychosocial responses that communities have given to the stress of living near a hazardous waste site, and what have the results of those responses been?
A survey of the literature shows that living near a hazardous waste site can cause great stress within a community and within the individuals living in that community. Some of the psychosocial responses of community members living near a hazardous waste site are:
- Fear and uncertainty over the possible health effects of exposure,
- Feeling a loss of control over the present situation and the future,
- Anger over loss of security and safety within the community,
- Confusion brought on by trying to understand various government documents,
- Community conflict over who is to blame and what actions to take,
- Frustration over the lengthy clean-up process,
- Increased family conflict,
- Concerns over economic losses (e.g., property devaluation, doctor bills, and business losses),
- Feelings of being stigmatized and isolated because of living near a hazardous waste site,
- Frustration of dealing with bureaucratic agencies, and
- Frustration of being accused of "overreacting."
Mrs. Mary Minor led a participatory discussion between the audience and the panel on this topic. A list of responses to the experience of living near a hazardous waste site was compiled from letters from her community. The letters indicate that the community members are experiencing the following: outrage, anger, depression, stigmatization of affected community members, distrust, fear, guilt, redlining of properties, violence inside the community, threats of violence because of social discord, intimidation, disenfranchisement, activism, and loss of community members through illness, burnout (i.e., exhaustion), or death.
There is a gap between the government agencies that deal with environmental contamination and the communities that experience it. The agencies have the power and authority to deal with the problem. The scientists know the problem better than community members, so agency representatives have a tendency to talk rather than listen to community members. Often, agency control over a situation produces little communication about the process. On the other hand, the community members are often fearful, lack true knowledge of the consequences of environmental contamination, can't or don't express their feelings about the situation, have no control over the situation, and need more communication with agency representatives. The situation must change so that agencies and communities work together to find solutions for environmental contamination.
Joint Audience and Panel Recommendation
- There is a need for a training handbook for state and local public health officials on how to work with communities in these situations.
Discuss how the human response to uncertainty may lead to different understandings of a possible exposure to a hazardous substance and its relationship to psychological responses such as learned helplessness.
Dr. Heather Tosteson presented her work on this question. (Dr. Tosteson's presentation is transcribed from tapes of the workshop. It is not printed verbatim.)
To get us started, I'm going to present some ideas about uncertainty and environmental health. First, I'll run through some of the effects uncertainty can have at the individual, social, and political levels, then discuss the distinctive content of our uncertainty in situations of environmental exposure. I'll conclude with some suggestions about how this content might affect our choice of a social response as a government agency to the distress we are seeing.
Disaster: I'd like to begin by making three distinctions to help us better define the specific situations we are looking at. Although we are discussing a disaster paradigm here, the situation at most of the sites we see is very different from the disasters-even technologic disasters-that have been studied because of the pervasiveness of the uncertainty involved. The Three Mile Island, Bhopal (India), and Exxon Valdez incidents were all socially defined as threats or disasters. The situation at National Priorities List (NPL) sites is often not that clear. Although listing on the NPL means the site is an environmental threat, whether it is a human disaster is often not as clearly defined. The disaster here is the undefinedness of the situation.
Siting/Exposure: The uncertainty posed by a siting decision and that posed by possible current or past exposure are quite different because the types of threat are different. It is not uncertainty alone that is stressful. For example, we can be uncertain if the sun will shine next weekend but not lose any sleep about it. What bothers us is uncertainty associated with possible danger to ourselves or those close to us combined-as is the case with technologic disasters-with some sense of responsibility for determining and avoiding the danger. When people fear they have suffered toxic exposures, they feel personally implicated in a more immediate and inescapable way than if they are contemplating the acceptability of a future risk. In other words, the situation we have here is one that is deeply undefined, but also one where the personal stakes are perceived as very high.
Normal/Abnormal: All the responses here are normal responses to chronic and pervasive uncertainty in general and to the range of uncertainty common to these specific situations of environmental exposure.
Uncertainty in these situations accentuates an already threatening and divisive situation. Its effect is to polarize views and to freeze the natural sequence of our responses so that we find it difficult to reach psychological or social closure and to integrate the experiences either individually or as a society. We cannot fight or flee. We can't resolve and move on. At a personal level, uncertainty interferes with the first step of coping, which is our ability to appraise the level of threat a situation poses for us. If we can't decide how dangerous a situation is, we can't decide how to cope with it. Further, if other people can't decide how dangerous a situation is or come to radically different interpretations from us, it is difficult for us to act in concert. And environmental threats are communal threats, so the role of community consensus is central.
A number of panelists-in particular Drs. Couch and Edelstein-have studied the damaging social effects of differing appraisals of threat, differences that cannot be resolved because the science is not there to "prove" who has been exposed and what will happen to them. Dr. Edelstein wrote in his book on Legler that there may be no psychologically healthy way to respond to the uncertainty of toxic exposures-there was only obsession and denial. At a social level, fragmentation and stigmatization are ways of trying to limit uncertainty-obsession and denial on a larger scale. Different groups may be frozen at different stages in the disaster process-some still at the appraisal stage, while others are convinced that impacts have already occurred and that concerted communal action is required. Uncertainty also pervades public policy and politics because science cannot be used in its conventional role as an "objective" basis for decisions. Litigation and protest are evidence of the broad social and philosophical conflict these uncertain but highly resonant situations provoke.
Because science as we now know it is insufficient to resolve the questions people have about the safety of their environment, what uncertainty does in these situations is put up a blank screen on which some of our greatest fears flash continuously. This is a situation that as human beings we try to protect ourselves from constantly. It is the resonance and the unboundedness of the content of our fears about environmental hazards that we need to talk about because we can't get away from them. It's not just that we are uncertain, but that we are uncertain about things that are deeply-I would suggest primally-frightening. This is what gives these situations their particular emotional force. And it is the broad symbolic power, the philosophical and emotional validity of these issues, that ensures that we cannot wish them away. Environmental exposures can come to challenge our faith in ourselves, our physical and social worlds, and in our future.
Here are some of the issues that come up when considering environmental exposures:
Disease and mortality
Usually people begin to get actively involved in issues of toxic exposure because they have seen some evidence of harm, usually diseases in their family or community. Often these diseases are poorly explained by existing paradigms. Disease itself is frightening, particularly certain kinds of diseases, for example cancers and especially childhood cancers. Cancers frighten us because they are evidence that the body can turn on itself, that normal processes can suddenly twist back on themselves and become deadly.
Environmental exposures also provoke our fear of contamination, which is a fear about the boundaries between ourselves and our environment dissolving. How can we protect ourselves from something we can't see or touch, something we can't measure, something whose effects we can't predict? Horror movies often play on this basic fear of a threat we can't see, control, or escape-one that can invade our homes and threaten everyone we hold dear.
An extension of the fear of contamination is the fear of the consequences of social contamination, or stigma. Even if scientists think there is no threat, the world may see the situation differently. People can find their property values falling and their future economic security jeopardized by social processes over which they have no control.
Environmental exposure can challenge our trust in the justice of our social system because we realize that environmental exposures are not evenly distributed in society, that the people who suffer most from the fallout of our highly technologic society are not usually those who benefit most from the fruits of our way of life.
Our trust in our whole social structure can be challenged. We can begin to distrust industry, and more devastating, our scientists, who are meant to know what dangers they are creating with their technologies. We can begin to distrust our medical and health systems, which we have counted on to be able to identify and treat our illnesses, and we can begin to distrust our government, which is charged with protecting us.
Environmental exposures can pose even more immediate, thus more devastating, threats to our sense of community. We can find that our sense of the reality of threat and our neighbor's sense of the reality of threat are so different that it is as if we live in completely different worlds. We can begin to wonder if anything holds us together.
Our relationship with our physical world can be changed dramatically. What seemed beautiful and benign can now seem filled with invisible and thus unlimited threat.
Most devastating, environmental exposures, particularly our uncertainty about them, lead us to questions of ultimate concern. One of the most frightening of these is the issue of irreparable harm-that the way we are living now may end up destroying us and our children without our willing it. When we find out the true level of danger, it may be too late to change it. This fear is especially triggered by past exposures-things that have happened to us without our knowing it but which may pose threats to us and our families for generations to come.
Because of the resonances of these ideas and because of the sheer number of shocks to our belief system that can be associated with these environmental issues, people can come to see both their physical and their social worlds as profoundly unsafe. There is no place they can escape to and there is no one they can trust to help them. This, finally, is an unbearable way to live. The social distrust may well be the most damaging consequence, particularly when we are talking about past exposures. In siting decisions, people require fair choice-an equal voice in deciding on the acceptability of exposure to risks. Illness speaks more specifically to our dependency on each other. Here the relationship people need with their society is one of care. Part of that care is acknowledging the psychological and social stress caused by these situations of ineradicable uncertainty and potentially disastrous personal threat.
People who have been profoundly affected by these situations are different people when the situation is over. They see the world differently and may well need to have this shift in their world view expressed in social terms. Psychologically, it is the impact of this crisis of faith that needs to be addressed because it won't go away. Even if you label people as anxious or demoralized, any intervention will require that you return in the end to the content of that demoralization-the issues and ideas involved. Only by respecting both the rational source of the distress, its specific symbolic/philosophical/emotional power, and the need for us as a society to provide a social fabric that can contain these questions-that can discuss and debate them consciously rather than be driven by them-will we be able to find social, if not scientific, resolution. And I think social resolution is crucial in these situations. Uncertainty is a fact of life. It is also a dreadful mystery and one that we all find difficult to look at too long and too directly. It is a function of culture and of social structure to help us find ways to make the uncertainty of life bearable, and it is this role that I think we are not successfully fulfilling at this time. I think one of the questions we are being asked to answer here is who will care for us when we have looked too long and too directly into the abyss. How, when our faith in our way of life has been so severely challenged in so many ways, can we find a way to make life meaningful and trustworthy again?
Here it might be important to point out that the uncertainty of these situations has strong emotional impact on scientists as well. The level of scientific uncertainty can bring scientists to question the adequacy of the scientific method, to question the biomedical paradigm, to question the rightness of the professional control of the discipline, to challenge their belief that science is a value-free activity and that science plays a benign role in social conflicts. These challenges to their way of life are as pervasive and threatening as the challenges toxic exposures have been to communities. Thus, they resist any suggestion that they enlarge their definition of the problem to include the psychological and social effects of exposure, for to include them, to acknowledge the emotional force and philosophical resonance of the experiences of the communities, will expose them to a crisis of faith.
Data Gaps and Recommendations
- There needs to be open, honest discussion of the victims' concerns. They need to be treated with respect and compassion as real people, not just as scientific or clinical cases.
- Part of a community assessment for a Superfund site should include an overview of a community's options for action and the constraints to action.
- The process needs to openly confront the issue of values involved in environmental contamination. No amount of data will resolve fundamental differences in world views or belief systems.
What are the psychosocial effects of relocating a community when environmental contamination cannot be safely remediated?
At the request of Dr. Gershon Bergeisen, from the EPA, a special presentation of a relocated community member's perspective was given by Mrs. Cindy Babich, a community member from the Del Amo site in Torrance, California. The following is a summary of Mrs. Babich's presentation.
Mrs. Babich: To address the question of relocation, you must consider the effects of no relocation on a community affected by hazardous substances, the effects of relocation, as well as the psychosocial reasons to relocate a community.
Effects of no relocation: To the Superfund community, no relocation represents a lack of caring from the wider community. "Condemned" and "trapped" are terms frequently used to describe community perceptions. Real or perceived continuing exposure to the contamination occurs as well, and this may lead to continued stress.
Effects of permanent relocation: Government agencies could take steps to keep costs of relocation down by preplanning. There is a need for a set of permanent environmental relocation criteria. There also needs to be policies to address differing needs of homeowners versus renters. Home owners will wish to be bought out at fair market price. Renters will need help in finding similar housing. Agencies will need to consider whether or not the whole community wishes to move together. There will be a need for special outreach to inform community members and help them deal with relocation. There are the needs of special populations. Elderly can't deal with relocation. On the basis of our experience, there is a need for those undergoing relocation to have help and guidance in solving problems of daily life-mail forwarding, change of address, address expenses of increased travel to and from work, and possible change in schools for children.
Effects of temporary relocation: These effects are different from permanent relocation.
There is separation from the rest of the community by "being privileged" to be relocated. Coordination is needed with schools regarding the effects of environmental contamination and temporary relocation on children's performance at school. In our experience, children in our neighborhood who have been relocated have shown improved opportunities for learning, decreased rage, and less problems with concentration and attention.
Data Gaps and Recommendations
- There is a need to look at the effect of environmental contamination and relocation on children in these communities.
- There may exist a need to consider such actions as retraining for new jobs (if relocation involves loss of old jobs) and how relocation affects job performance.
- Early interventions to prevent physical and psychological stress need to be implemented in these communities. Maybe they could be based on the Federal Emergency Management Agency (FEMA) emergency response model.
- We recommend providing a list of government agencies involved in the Superfund process to the communities so they can sort out the players.
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