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Reliability Engineering and Systems Safety 60 (1998) 263-264 © 1998 Published by Elsevier Science Ltd. All rights reserved/

Printed in Great Britain 0951-8320/98/$19.00

Book review

Man-made Disasters, second edition. B. A. Turner and N. Pidgeon. Butterworth-Heinemann, Oxford, 1997

The first edition of this book, which was published by Barry Turner in 1978, was not widely recognized. Only more recently has it become fashionable to study the sociological causes of disaster.

Barry Turner died in February 1995, when a second edition, much like the first, was in preparation. Nick Pidgeon took over the various revisions planned by Turner, edited the first ten chapters, and added an eleventh chapter which looks at more recent developments, including culture, politics, and organizational learning.

The first edition of Man-made Disasters was truly a pioneering work and was based upon a detailed analysis of 84 official reports on accidents and disasters published by the British Government during the years 1965-1975. The data analysis was used by Turner to build up a vocabulary, a set of concepts, and ultimately, a theory of the novel topics under investigation.

Man-made Disasters was among the first studies to conceive of sudden-onset disasters in terms of process rather than as acts of God. The model developed is qualitative with a clear-cut statement of the factors that make for the incubation of disaster: perceptual rigidities (wrong interpretations of warning signals); information ambiguities; the disregard of rules and instructions; and overconfidence and organizational arrogance. It is of no small interest to note that the title of Turner's Ph.D. thesis, from which the first edition evolved, was 'Failure of foresight'. For Barry Turner, man-made disasters had preconditions with long incubation periods, during which early warning signs were ignored. Institutional, organiza- tional, and administrative structures contributed to the process with long gestation periods.

In looking for general principles that help understand the creation of disaster, rather than restricting one's attention to purely technical causes of disastrous accidents, it is better to think of the problem of understanding disasters as a socio-technical problem, with sociological, organizational, and technical processes interacting to produce the event. A better understanding of the nature of disasters requires realizing that disasters arise from an absence of one kind of knowledge at some point. A key point lies in discovering how knowledge and information were distributed before the disaster happened.

Chapter 2, entitled 'Attempts to understand disasters',

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reviews the ways different groups of specialists approach disasters and large-scale accidents. The point is made that each group has a limited perspective, whereas the study of the nature and origins of disasters is the kind of inquiry that is naturally a multidisciplinary one.

Chapter 3, 'Attempts to understand disasters', points out that, prior to the mid-1970s, the aim of studies to gain an understanding of the social process associated with disasters focused upon the impact of the disaster.

In Chapter 4, three disasters are analysed. The similarities include the following: (a) rigidities in percep- tion and beliefs in organizational setting; (b) the decoy problem in which attention on one safety issue distracts attention from the other, less-well-structured issue; (c) organizational exclusivity (disregard of non-members); (d) informational difficulties; (e) the involvement of strangers; (f) failure to comply with regulations; and x minimizing emergent danger.

The book then presents a list of factors that may combine to produce disaster, and some possible early lessons.

Chapter 5 discusses the incubation period of disasters, in which there is an accumulation of an unnoticed set of events that are at odds with the accepted beliefs about hazards and the norms for their avoidance. These events may be unknown, or are known but not fully understood by all concerned, especially as to their full implications. A precipitating event then leads to the onset of the disaster.

Chapter 6 deals with the role of errors and of communication difficulties. Highlighted are erroneous assumptions, difficulties in handling information in complex situations, violation of precautions passing unnoticed because of a cultural lag in existing precaution, and events misunderstood because of a reluctance to fear the worst outcome.

Chapters 7 and 8 present a fairly abstract discussion of rationality, order, and the role of information.

Chapter 9 extends the prior discussion of the limits of decision-making from an individual to an organizational level. An examination of five accidents is used to ascertain the level in the organization at which errors in decision making had occurred. Higher level errors were more likely to be more far-reaching.

Chapter 10 discusses the origins of disaster. It argues that all disasters may be regarded as the outcomes of misplaced or misdirected energy, and states a general principle, as follows: disaster equals energy plus misinformation. The chapter places a major focus on the ways misinformation may arise.

264 Book Review

Chapter 11 provides an excellent review of much of the significant literature dealing with sociological studies of man-made disasters published since release of the first edition. The first section of this chapter examines military intelligence failures; engineering safety in construction; organizational learning and the role of cultural readjust- ment following fires and explosions; the social construct of the 'truth' of disaster causation; and the influence of politics.

The second section considers defective group decisions; complexity and the normal accident; human error and resident pathogens; and warnings and the normalization of deviance.

The third section of Chapter 11 is entitled 'Promoting safety'. It discusses risk assessment or safety control; auditing safety; institutional design and safety culture; and high reliability organizations. Pidgeon then examines

Sagan's 'The limits of safety', and concludes with a re-visit to the subject of organizational learning, in which he focuses, in part, on the system used in civilian aviation.

All in all, the book is quite valuable for anyone interested in the sociological aspects of safety, which can have major importance. The case studies drawn from several public inquiries are very interesting as a source of insight into man-made disasters. Except for a few chapters, the book is very readable.

The pioneering work of Barry Turner deserves to become better known.

David Okrent School of Engineering and Applied Science

University of California Los Angeles, CA 90095-1597

USA