Symposium on the medical implications of nuclear war/Summary and perspective: With some observations on informed consent

A Symposium on the Medical Implications of Nuclear War, organized under the auspices of the Institute of Medicine, was held at the National Academy of Sciences, Washington DC, on 20–22 September 1985. The proceedings have been published in book form: The Medical Implications of Nuclear War, © 1986 by the National Academy of Sciences. Permission has been given by the publishers, National Academy Press, and the author of the concluding remarks for this paper to be reprinted in Medicine and War. Dr Abrams is Professor of Radiology at Stanford University School of Medicine and a Member‐in‐Residence of the Stanford Center for International Security and Arms Control.

The book is available from the National Academy Press, 2101 Constitution Avenue, NW Washington, DC 20418, and is marketed and distributed in the UK, Europe and Africa by John Wiley & Sons Ltd of Chichester, UK. (Pp. 637, $43.50/£35.60 hbk, $33.50/£27.40 pbk, ISBN 0 309 03692 5/4.)     

Psychological effects of the nuclear arms race on children

In an Information Session of the Sixth IPPNW World Congress, DR TYTTI SOLANTAUS reviewed previous studies on children's anxiety or worry about nuclear war, and described new investigations on confidence in personal contributions to prevention of nuclear war. The speaker considered that social responsibility should be regarded as an integral part of mental health in the nuclear age.     

Nuclear winter: Uncertainties,scientific consensus,and the SCOPE‐ENUWAR report

This paper reviews recent findings on the long‐term environmental effects of nuclear war with particular reference to the findings of the SCOPE‐ENUWAR report.     

The psychology of anxiety

In a Discussion Session of the Sixth IPPNW World Congress the psychology of anxiety was considered conceptually and in relation to nuclear war.     

The nuclear imperative the Crookshank lecture,1984

The overwhelming destructiveness of thermonuclear weapons is illustrated by some simple comparisons with TNT—the ‘conventional’ military explosive. There is no theoretical upper limit to the size of an H‐bomb. It is recognized that nuclear war cannot be ‘won’ and must therefore be prevented; the current policy of ‘deterrence’ is examined and is seen to lead, not to a stable balance but, inexorably, to escalation. Richardson's mathematical analysis of conflict situations showed that automatic military responses to perceived threats generally lead to an escalating arms race. Human beings, however, need not behave like automata. Instead, they can try to see things from the standpoint of the adversary and seek ways of reducing instead of increasing tension. It is only if such saner responses are made that stability can be achieved. Scientists and technicians must not become so fascinated by the technological interest of weapons development that they ignore its ultimate purpose. Immanuel Kant summed up the conditions for peaceful and happy human society in his ‘categorical imperative’. His later essay On Permanent Peace showed that the same principle must apply between nations. Today this is the ‘nuclear imperative’ and we must throw off old habits of thought and resolve our conflicts in ways that do not include the threat of mutual extinction. Doctors should be in the forefront of this movement.     

IPPNW's Seventh world congress

The Seventh World Congress of IPPNW was held in Moscow. Many subjects relating to nuclear war and its prevention were considered. This unarticle reports on four of the topics: ‘star wars’, the impact of the arms race on health, nuclear power, and the psychological effects on children of the threat of nuclear war.     

The psychosocial impact and developmental implications of the threat of nuclear war on adolescents

The particular significance of the threat of nuclear war in relation to the lifeview of the 270 Midwestern adolescents in our study appears manifest in the high level of awareness and concern a majority show regarding the imminence of nuclear war — its unlimitability, unsurvivability, and probability in their lifetime — and in the significant correlations demonstrated: The most highly threatened are also the more pessimistic about the future — for both the world and themselves, the more sceptical of the efficacy of socio‐political activism, and the more critical of adult stewardship. The intensity of these youngsters' feelings about the threat of nuclear war, their uncertainty about the future, and the depth of their disappointment and disapproval of adults' management of these matters and world affairs may be testimony to a substantial compromising of trust and faith in the parental generation.     

International milestones 1985

In three studies we investigated denial and related concepts ('phenomena of make believe’, ‘psychic numbing’, ‘blotting out the idea’ and ‘veil of denial') as the predominant human psychological responses to the nuclear war threat. We found support for this assertion within the subjects’ emotional reactions of overwhelming fear and sadness. To reduce the paralyzing effect of the denial response, we suggest three steps: immersing ourselves in the negative affect, presenting moderate fear arousal messages, and promoting active involvement.     

MCANW annual conference 1988: The real costs of nuclear deterrence

The Annual Conference of the Medical Campaign Against Nuclear Weapons was held at Regent's College, London on 23–24 April 1988. Two sessions were devoted to the effects of nuclear deterrence.     

Dealing with the nuclear threat as a function of grieving

The psychological process of dealing with the threat of nuclear war may be considered as a process of accommodation to a major loss or threat of a loss. In effect, this represents a special case of the grieving process first delineated by Dr E. Kubler‐Ross when she studied accommodation to impending death. By considering where a person is in his or her grieving syndrome with respect to the nuclear issue, we may be more capable of improving our communication with that person and help to facilitate the process of coming fully to terms with this most important threat to our health.     

Children's fear of nuclear war: An empirical Danish study

This paper summarizes an investigation by questionnaire that was carried out in Denmark in 1985 on 1209 school pupils aged 13 to 17 years. The main finding was that fear of nuclear war was their foremost concern. It is concluded that the arms race and the threat of war are a risk for the mental health of children and teenagers.     

Civil defence against nuclear attack: An evaluation of one local plan

In order to assess the value of civil defence planning for a nuclear attack, this paper focuses on a specific local example—the official civil defence plan of Pitt County, North Carolina, USA. Pitt County has been designated a host area in which all of its 90 000 residents and 75 000 evacuees from neighbouring target areas are to be sheltered. After a brief review of this plan, three crucial questions are considered: (1) Will the evacuees designated for shelter in Pitt County arrive? (2) Will county officials be able to provide for the needs of the sheltered population? (3) If the population is sheltered as planned, will they survive a nuclear war? Doubts are expressed about whether each of these goals could be achieved. For example, it is estimated that 13.5 per cent of persons in shelters would be exposed to lethal doses of fallout radiation, but the plan makes no mention of the danger of acute radiation sickness. In view of the serious weaknesses identified in the plan, the paper concludes that efforts to protect populations against the overwhelming devastation of a nuclear war are futile, and that energies should be directed instead towards prevention of this catastrophic medical emergency.     

The child and nuclear war

We are now faced with the most brutal fact in human history, namely the capability to end the species that our sexual instincts continue by procreation. Children live in the shadow of possible, indeed some would say probable, nuclear weapon omnicide. Such an event would be the result of adult quarrelling and strife. In this article the natural right of children collectively not to be killed by adults is considered. They are seen as a helpless, international and neutral population who constitute our species’ future on earth, and therefore as the biological and spiritual responsibility of the world's adult population collectively.

The situation is one that urgently concerns medicine, philosophy, theology and related disciplines. It is suggested that efforts to safeguard the rights of the child in the nuclear age should be co‐ordinated under the auspices of the United Nations.     

Psychological defence mechanisms and the nuclear arms race: An interactive model

Concern about the risk of nuclear war has sparked interest in the psychology of the nuclear arms race. This paper reviews recent work in this area and develops a model linking the threat of nuclear weaponry, resultant anxiety, and psychological defence mechanisms employed by the managers of the arms race. The role of psychological defences implicit in military and political social systems is emphasized. Primitive or narcissistic defences found at both individual and group levels are maladaptive as they increase rather than decrease the risk of nuclear conflict. Psychological approaches to crisis management and conflict resolution require development and application to this problem.     

The threat of nuclear war: A study of some of the psychological effects on adults

The paper reports an enquiry into the worry that adults have about the threat of nuclear war. A random sample of 500 people on the electoral roll in Greater Manchester were sent a postal questionnaire. A 10% sample of non‐responders were followed up by interview and a stratified sample of 50 of the responders to the postal questionnaire were interviewed in depth. The findings suggest that most adults worry little or not at all about nuclear war, that this worry decreases with age, and that while more women than men worry about it, men are more affected by their worry. It also suggests that almost everyone believes that it is useless to make plans to protect people from the effects of nuclear war. Finally, the study considers the relationship between worry about nuclear war, attitudes to prevention and the peace movement.     

On population aspects of group disasters: An evolutionary view

Simple mathematical models were constructed (using a DEC PDP 11/40 computer) to evaluate the probable significance of differences between individuals in adaptive reserve—survival time (modelled as “failure rate")—for group survival and of basic population parameters (fertility and mortality) for the gradual compensation of group size/age distribution of a population after an acute group disaster. The results indicate that reversion to prehuman biological regulative mechanisms probably occurs, and that after short‐lasting group disasters the time‐course for compensation (normalization) of population size and age distribution (when probable values of fertility and mortality were considered) is prolonged.     

The radiologist as an attending physician: routine or special procedure?

The role of the interventional radiologist as an attending physician is discussed, and the disadvantages considered. It is the author's opinion that the disadvantages outweigh the advantages, and that a system in which interventional radiologists function as attending physicians will have limited applicability in most practices.