Howard Frumkin Emory University
Those of us who practice environmental and occupational medicine are grateful for the simple cases -- the battery worker with fatigue, headaches, abdominal pain, and an elevated lead level; the assembly worker with pain and numbness in her hand and delayed median nerve conduction; the patient who develops typical contact dermatitis after working with epoxies. But few of our cases are straightforward. We often recognize complex and challenging psychological issues, and we often lack the training or wisdom to handle them well.
Environmental and occupational medicine intersects mental health in at least five ways. First, some chemicals have direct toxic effects. Mercury causes irritability and paranoia, a syndrome known as erethism. Manganese causes psychosis, dubbed locura manganica by Chilean miners. Carbon disulfide causes depression so striking that, according to legend, early British viscose rayon factories had to install bars on upper floor windows to prevent suicidal jumps by workers. And these are only the obvious syndromes that occur at high-dose exposures; milder neurotoxicity is seen with a range of toxins, including solvents, metals, and pesticides, at currently permissible levels.
Second, patients with occupational or environmental illnesses or injuries, like any other sick patients, may suffer from stress or