BRIDGING THE GAP IN MENTAL-HEALTH APPROACHES BETWEEN EAST AND WEST - THE PSYCHOSOCIAL CONSEQUENCES OF RADIATION EXPOSURE

Mental health professionals in Western countries and the Confederation of Independent States ([CIS], the former Soviet Union) have been exam ining the social and psychological consequences of the 1986 Chernobyl nuclear accident on the people who lived or are living in the exposed areas. Based on reviews of the literature, papers from international c onferences; and communication between researchers in various countries , different perspectives have emerged on classifying distress and diso rders and designing treatment programs. The origins of these differenc es lie in philosophical, historical, and political developments in the West and the CIS. These different approaches often have made it diffi cult for mental health professionals from the CIS and the West to work together. The goal of this paper is 2-fold: to identify and recognize the main differences in these approaches and to propose specific solu tions for bridging the gap. The basic approach of mental health profes sionals in the CIS is a physiological, nosological one-it focuses on t he etiology of the illness. Although their main diagnostic tool is the International Classification oi Diseases, 10th Revision, it has under gone adaptations that reflect the Soviet medical and physiological att itude toward psychiatry. These changes have resulted in the abrogation and addition of disorder categories. For example, in the CIS edition di the ICD-9, there is no mention of post traumatic stress disorder as a distinct disorder, in contrast, in the West, the dominant approach is a symptomatic, phenomenologic one. Emphasis is placed on a dynamic understanding of the disorder and treatment is conducted by mental hea lth professionals (psychologists, social workers, psychiatrists). This contrasts with the approach used in the CIS, where psychological dist ress often is somaticized and treatment undertaken by physicians rathe r than mental health professionals. The authors of this paper call on researchers to come together and work jointly on the recognition and r esolution of these differences. Then both groups will be able to offer concrete solutions and build tools that can benefit both sides. It is hoped that these new approaches will receive worldwide recognition an d prove useful for other mental health professionals working with pers ons affected by the accident at Chernobyl.