Virtuous violence from the war room to death row.

How likely is it that someone would approve of using a nuclear weapon to kill millions of enemy civilians in the hope of ending a ground war that threatens thousands of American troops? Ask them how they feel about prosecuting immigrants, banning abortion, supporting the death penalty, and protecting gun rights and you will know. This is the finding from two national surveys of Democrats and Republicans that measured support for punitive regulations and policies across these four seemingly unrelated issues, and a fifth, using nuclear weapons against enemy civilians (in survey 1) or approving of disproportionate killing with conventional weapons (in survey 2). Those who support these various policies that threaten harm to many people tend to believe that the victims are blameworthy and it is ethical to take actions or policies that might harm them. This lends support to the provocative notion of "virtuous violence" put forth by Fiske and Rai [A. P. Fiske, T. S. Rai, Virtuous Violence: Hurting and Killing to Create, Sustain, End, and Honor Social Relationships (2014)], who assert that people commit violence because they believe it is the morally right thing to do. The common thread of punitiveness underlying and connecting these issues needs to be recognized, understood, and confronted by any society that professes to value fundamental human rights and wishes to prevent important decisions from being affected by irrelevant and harmful sociocultural and political biases.

Healing a Sick World: Psychiatric Medicine and the Atomic Age.

The onset of nuclear warfare in Hiroshima and Nagasaki had far-reaching implications for the world of medicine. The study of the A-bomb and its implications led to the launching of new fields and avenues of research, most notably in genetics and radiation studies. Far less understood and under-studied was the impact of nuclear research on psychiatric medicine. Psychological research, however, was a major focus of post-war military and civilian research into the bomb. This research and the perceived revolutionary impact of atomic energy and warfare on society, this paper argues, played an important role in the global development of post-war psychiatry. Focusing on psychiatrists in North America, Japan and the United Nations, this paper examines the reaction of the profession to the nuclear age from the early post-war period to the mid 1960s. The way psychiatric medicine related to atomic issues, I argue, shifted significantly between the immediate post-war period and the 1960s. While the early post-war psychiatrists sought to help society deal with and adjust to the new nuclear reality, later psychiatrists moved towards a more radical position that sought to resist the establishment's efforts to normalise the bomb and nuclear energy. This shift had important consequences for research into the psychological trauma suffered by victims of nuclear warfare, which, ultimately, together with other research into the impact of war and systematic violence, led to our current understanding of Post-Traumatic Stress Disorder (PTSD).

Psychological effects following the Iran nuclear deal: Iranian nuclear threat salience moderates the relationship between PTSD symptoms and sleep problems.

Following the July-14th, 2015 Iranian agreement, we examined if preoccupation with the threat of a nuclear Iran moderates the relationship between posttraumatic stress disorder (PTSD) symptoms and reported sleep problems in individuals exposed to the 2014 Israel-Gaza conflict. While sleep problems were evident in individuals suffering from PTSD symptoms, they were especially pronounced when PTSD symptoms were coupled with increased Iranian nuclear threat salience. Preoccupation with future national threats may increase PTSD-related sleep problems. Therefore, it may be useful if such threats are accounted for in interventions aiming to ameliorate trauma-related sleep problems arising in the context of security situation.

Transmitting the sum of all fears: Iranian nuclear threat salience among offspring of Holocaust survivors.

Many Israelis are preoccupied with the prospect of a nuclear-armed Iran, frequently associating it with the danger of annihilation that existed during the Holocaust. The current article examined whether offspring of Holocaust survivors (OHS) are especially preoccupied and sensitive to the Iranian threat, and whether this susceptibility is a part of their increased general image of actual and potential threats, defined as the hostile world scenario (HWS). Study 1 (N = 106) showed that relative to comparisons, OHS reported more preoccupation with the Iranian nuclear threat. Moreover, the positive relationship between the salience of the Iranian threat and symptoms of anxiety was stronger among OHS. Study 2 (N = 450) replicated these findings, while focusing on the Iranian nuclear threat salience and symptoms of psychological distress. It further showed that OHS reported more negative engagement with the HWS (i.e., feeling that surrounding threats decrease one's sense of competence), which in turn mediated their increased preoccupation with the Iranian threat. The results suggest that intergenerational transmission of the Holocaust trauma includes heightened preoccupation with and sensitivity to potential threats of annihilation, and that the specific preoccupation with threats of annihilation reflects a part of a more general preoccupation with surrounding threats.

Persistent distress after psychological exposure to the Nagasaki atomic bomb explosion.

BACKGROUND: Although there is speculation that individuals living in the vicinity of nuclear disasters have persistent mental health deterioration due to psychological stress, few attempts have been made to examine this issue. AIMS: To determine whether having been in the vicinity of the Nagasaki atomic bomb explosion in the absence of substantial exposure to radiation affected the mental health of local inhabitants more than half a century later. METHOD: Participants were randomly recruited from individuals who lived in the vicinity of the atomic bomb explosion in uncontaminated suburbs of Nagasaki. This sample (n = 347) was stratified by gender, age, perception of the explosion and current district of residence. Controls (n = 288) were recruited from among individuals who had moved into the area from outside Nagasaki 5-15 years after the bombing, matched for gender, age and district of residence. The primary outcome measure was the proportion of those at high risk of mental disorder based on the 28-item version of the General Health Questionnaire, with a cut-off point of 5/6. Other parameters related to individual perception of the explosion, health status, life events and habits were also assessed. RESULTS: Having been in the vicinity of the explosion was the most significant factor (OR = 5.26, 95% CI 2.56-11.11) contributing to poorer mental health; erroneous knowledge of radiological hazard showed a mild association. In the sample group, anxiety after learning of the potential radiological hazard was significantly correlated with poor mental health (P<0.05), whereas anxiety about the explosion, or the degree of perception of it, was not; 74.5% of the sample group believed erroneously that the flash of the explosion was synonymous with radiation. CONCLUSIONS: Having been in the vicinity of the atomic bomb explosion without radiological exposure continued to be associated with poorer mental health more than half a century after the event. Fear on learning about the potential radiological hazard and lack of knowledge about radiological risk are responsible for this association.

Vulnerability and vigilance: threat awareness and perceived adversary intent moderate the impact of mortality salience on intergroup violence.

Three studies examined whether perceived adversary intent and personal vulnerability moderate the effects of mortality salience (MS) on violent solutions to conflict. In Study 1, following MS, Israeli participants read a description of de-escalating or escalating Iranian rhetoric. In Study 2, following MS, Israeli participants read about tensions with Iran and reflected on the personal ramifications of the conflict or on the content of the passage. In Study 3, Israeli participants with direct war exposure were compared to participants with no war exposure, and following MS, read a description of escalating or de-escalating Hezbollah rhetoric. Results revealed that MS increased support of violence under escalating conditions and low perceived vulnerability. However, for persons with direct war exposure, MS induced support of violence contingent on adversary rhetoric. Thus, direct experience with war leads to a more nuanced contingent response to existential threat not present among those without direct war experience.

An integrated physical dispersion and behavioral response model for risk assessment of radiological dispersion device (RDD) events.

A radiological dispersion device (RDD) or "dirty" bomb is a conventional explosive wrapped in radiological material. Terrorists may use an RDD to disperse radioactive material across a populated area, causing casualties and/or economic damage. Nearly all risk assessment models for RDDs make unrealistic assumptions about public behavior in their health assessments, including assumptions that the public would stand outside in a single location indefinitely. In this article, we describe an approach for assessing the risks of RDD events incorporating both physical dispersion and behavioral response variables. The general approach is tested using the City of Pittsburgh, Pennsylvania as a case study. Atmospheric models simulate an RDD attack and its likely fallout, while radiation exposure models assess fatal cancer risk. We model different geographical distributions of the population based on time of day. We evaluate aggregate health impacts for different public responses (i.e., sheltering-in-place, evacuating). We find that current RDD models in use can be improved with the integration of behavioral components. Using the results from the model, we show how risk varies across several behavioral and physical variables. We show that the best policy to recommend to the public depends on many different variables, such as the amount of trauma at ground zero, the capability of emergency responders to get trauma victims to local hospitals quickly and efficiently, how quickly evacuations can take place in the city, and the amount of shielding available for shelterers. Using a parametric analysis, we develop behaviorally realistic risk assessments, we identify variables that can affect an optimal risk reduction policy, and we find that decision making can be improved by evaluating the tradeoff between trauma and cancer fatalities for various RDD scenarios before they occur.

Addressing the psychosocial and communication challenges posed by radiological/nuclear terrorism: key developments since NCRP Report No. 138.

One of the most innovative aspects of NCRP Report No. 138 (Management of Terrorist Incidents Involving Radioactive Material) was the high priority it accorded to psychosocial and communication issues. While previous discussions of radiological and nuclear terrorism had occasionally referred to these topics, NCRP Report No. 138 was the first report of its kind to recognize the profound challenges posed by these issues and to place them at the heart of preparedness and response efforts. In the years since the report's release, a host of important developments have taken place in relation to psychosocial and communication issues. This paper reviews key changes and advances in five broad areas: (1) training exercises, (2) policy and guidance development, (3) findings on hospital and clinician needs, (4) survey research on public perceptions of radiological terrorism, and (5) risk communication for radiological and nuclear terrorism situations. The article concludes with a discussion of continuing psychosocial and communication challenges, including critical areas needing further attention as the nation moves to meet the threat of terrorism involving radioactive materials.

Fear of nuclear war increases the risk of common mental disorders among young adults: a five-year follow-up study.

BACKGROUND: Evidence on the relation between fear of war and mental health is insufficient. We carried out a prospective cohort study to find out whether fear of nuclear war is related to increased risk of common mental disorders. METHODS: Within two months preceding the outbreak of Persian Gulf War in January 1991, 1518 adolescents [mean age 16.8 years, SD 0.9] filled in a self-administered questionnaire. Of the 1493 respondents, 47% gave their written informed consent to participate in the follow-up study. There were no material differences between those who chose to respond anonymously and those who volunteered to give their name and address for the follow-up study. In 1995, the response to the follow-up questionnaire was 92%. Common mental disorders were assessed by 36-item version of the General Health Questionnaire [GHQ]. A score 5 or higher was considered to indicate caseness. We excluded 23 cases which had used mental health services in the year 1991 or earlier and two cases with deficient responses to GHQ. This left 626 subjects for analysis [400 women]. RESULTS: After adjusting for significant mental health risk factors in logistic regression analysis, the risk for common mental disorders was found to be significantly related to the increasing frequency of fear for nuclear war, high scores of trait anxiety and high scores of immature defense style. Elevated risk was confined to the group reporting fear of nuclear war once a week or more often [odds ratio 2.05; 95% confidence interval 1.29-3.27]. CONCLUSION: Frequent fear of nuclear war in adolescents seems to be an indicator for an increased risk for common mental disorders and deserves serious attention.

Mass violence and early mental health intervention: a proposed application of best practice guidelines to chemical, biological, and radiological attacks.

Based on past episodes, there will be psychological sequelae to chemical, biological, and radiological attacks. Some of the psychological morbidity should be able to be ameliorated through planning and appropriate early intervention. Key components of early intervention are illustrated following a hypothetical scenario of a bomb and anthrax threat near the Pentagon. Many of these components, such as monitoring clear, consistent messages about health risks, are provided by physicians or politicians, not mental health providers, but have a serious impact on the mental health of the population. We hope that this scenario and the principles of response will prove useful to planners of emergency preparedness and responders in the case of an actual attack.

The psychological dimension of chemical, biological, radiological and nuclear (CBRN) terrorism.

Terrorism is an increasing feature of the World Scene. In the UK, our perspective has changed from a largely Ireland focused one to a more international view. The United States of America are, for the first time, seen as major terrorist targets. We are now "at war with terrorism". The medical aspects of terrorism have been extensively discussed in this journal and elsewhere, this article specifically addresses the psychological consequences of the use of terror weapons.

Threat credibility and weapons of mass destruction.

Individual or collective preparedness for an attack involving weapons of mass destruction (WMD) must be based on an analysis of the threat. In threat assessment one takes many factors into account, including the physical and psychological parameters of the attacker. Although the potential devastation caused by WMD is significant, there are many limitations to the effective use of such weapons. Casualty rates will likely be measured in the thousands rather than millions because of factors that will be discussed. The psychological ramifications, it should be noted, the permutations of which have not yet been defined, will be much longer lasting. In this paper the author discusses these and other characteristics of the current threat.

Psychological effect of the Nagasaki atomic bombing on survivors after half a century.

In 1997 a mental health survey using a 30-item General Health Questionnaire (GHQ-30) and an interview survey of an atomic bombing experience were conducted in survivors of the Nagasaki atomic bombing. Overall psychological distress measured on the basis of the GHQ-30 was greater in the atomic bombing survivors than in the controls. As for the contents of psychological distress, those concerning emotion such as anxiety and depression were milder in survivors than in the controls, but those related to social activities such as apathy, disturbance of human relations, loss of enjoyment of living were more severe. Furthermore, recurring and distressing recollection of the experience of the atomic bombing, suspicion over the relationship between the atomic bombing and an unhealthy physical condition, and the experience of witnessing death or severe injury of close relatives due to the atomic bombing were significantly related to the degree of psychological distress of the survivors.