Comments on “Causal Relation” in Workmen's Compensation Proceedings

Abstract

The lack of “fit” between legal and medical concepts is perhaps best shown in the psychiatric disability of injured workmen. In the particular case discussed in this article, the problem is illustrated (1) in the long-standing preexistence of organic brain disease over many years, (2) in the occurrence of a heart attack from which the claimant recovered in “physical” terms. The heart attack forced a break in his employment and made his previously subclinical disability obvious to employer, wife, and the claimant himself. The resulting disability featured depression, anhedonia, and loss of identity, thus becoming primarily psychiatric in nature. No one of these disorders is “causally related” as a single entity; the problem is the outcome of a cumulative stress in a person made highly vulnerable through prior deterioration. Of particular import is the demonstration of “context-dependence”: workers depend for their own sense of identity and responsibility upon their occupation, and the loss of work becomes itself a “causal” factor.