Compensitis: The Psychological Claims Crisis as a Substitute for Real Life in Australia

Australia follows the rest of the world where the intervention of law in the practice of medicine is concerned, notably with the epidemic of compensation claims arising from work.

A fascinating, albeit depressing, tussle is taking place in the New South Wales State parliament, involving politicians, lawyers, insurance, unions and the working public—this no different from the other states. What the dispute represents is an existential condition for which the neologism compensitis is a suitable term. It represents the pervasive belief that any difficulties in life—in this case, at work—must have an external cause, someone else is to blame and the recipient is duly entitled to recognized victim status and financial compensation.

The NSW Workers’ Compensation scheme is effectively bankrupt, and the cause can be directly attributed to the state of postmodern life where having a psychiatric diagnosis provides validity, entitlement and status, rather than being a source of dismay. As President Macron found out, depriving people of their benefits from the state is akin to getting the sun to rotate around the earth again.

The despairing State treasurer Daniel Mookey is looking for ways to claw back the many millions that pour out for successful claimants of psychiatric injuries in the workplace. In response to his plans to limit the scheme, it takes little imagination to see all the vested interests coming out of the woodwork, claiming the end of civilization as we know it, the start of totalitarian state, and so on.

Showing that the universal truth of PJ O’Rourke’s “parliament of whores,” the NSW Liberal Party (her Majesty’s Official Opposition in formal terms), who in some prelapsarian universe used to proclaim their support for a rational business environment, has joined with the usual malcontents of good governance in blocking the attempts to control the claims, leaving little in their wake but the contempt that they deserve.

The problem starts with the legal definition of bullying. What a great idea it was to legally define unpleasant things that can happen to one at work. To litigators and social manipulators this sounds just fine; protect hapless workers from horrendous abuse in the workplace—the implication that this can be blamed on evil capitalist bosses is never far away. In practice, it is the equivalent of giving a greedy child free access to the sweet shop. Anything—and that means anything that is unacceptable to a worker—is now seen as a lucrative way of solving problems at work, not to forget a means of exacting revenge against an employer by submitting a claim for a psychiatric injury due to bullying. Performance review? Unwanted transfer? Disciplinary steps? Failure to get promotion? Anything occurring at work that is not satisfactory or desired is now up for grabs—it takes the concept of how long is a piece of string to undreamed-of lengths.

The paradox is that this is coeval with a vast industry intended to solve just such problems in the workplace. Unionists, human resources, occupational therapists and wall-to-wall counsellors exist just for this purpose. Has anyone asked why they are there in view of the epidemic of claims that they are supposed to prevent?

What claimants do not realize is that there are consequences for resorting to litigation that in most cases is woefully misapplied. It is highly unlikely (assuming they recover) that they will ever be reemployed. What company is keen to take back someone who has sued them, is just waiting for an opportunity to repeat it and has pushed up their yearly premiums to unsustainable levels?

Then look for another job? The first question a prospective employer asks is whether there have been any previous claims. Tick the box and the interview ends there.

Where does the misplaced psychiatric diagnosis come in? In order to qualify for an injury, there are legions of doctors, psychologists and social workers waiting to tick off the boxes and list the new queen of psychiatric conditions, namely adjustment disorder (AD).

What is this strange beast that had no existence before 1980? What psychiatric jungle were people left to flounder in before it was invented—and by such an ingenious sleight of hand? AD was cooked up by the well-intentioned but nefarious American DSM in 1980 as a compromise for statisticians and lobbyists in their fabled diagnostic manual. It can arguably be considered the worst diagnostic misstep in psychiatric history. It was based on Gerald Caplan’s concept of situational stress response which arose in response to disturbing or uncontrolled events in people’s lives. A sequence of emotional, behavioral and cognitive changes would follow before the person’s usual adaptation and coping responses reasserted, followed by settlement. This, it must be stressed, was regarded as normal behaviour—not a psychiatric disorder.

AD was, from the start, poorly defined and, despite numerous efforts, has never achieved scientific validity or reliability. It was a condition initially intended to last for 3 to 6 months before the ominous decision was made to add the criteria of chronic AD, which could persist indefinitely and now it certainly does.

To no surprise, AD is now the most frequent psychiatric diagnosis in the world. There is an obdurate refusal by those employing it to acknowledge that upset, distress, anxiety, sadness, anger, withdrawal and resentment are normal responses to stress—not psychiatric disorders—and, in the vast majority of individuals, will settle in relatively short time once their usual resilience reasserts itself. This is entirely consistent with the work of Gerald Caplan and many others.

In short, the epistemological danger, frequently realized, is that the current system is medicalizing workplace problems and creating an occupational epidemic.

Once off work and diagnosed with AD, the claimant will devolve into what can only be called a litigation neurosis. Preoccupied with the exigencies of their case, they perceive themselves as victimized by insurance companies and independent assessors who do not support their claim. At interviews emotional distress is focused on the issues surrounding the pursuit of the claim, not the events that led to leaving work. Each negative report (ie, not supporting their claim) is followed by a contradictory report to support their claim and on and on the adversarial ping pong goes, each encounter reinforcing illness behavior. It comes as no surprise that facilitators (unions, lawyers, counsellors) will funnel claimants to well-known practices who invariably support their claim and ensure that they are only treated by their own people who naturally perpetuate the claim support.

Medical specialist colleges have taken a low profile in response to these problems. Think that the Royal Australian and New Zealand College of Psychiatrists, ever preoccupied with gender and diversity issues, could issue guidelines to curb the promiscuous diagnosis of AD? Think again and keep waiting...

Examining these claimants is a depressingly repetitive process. A lengthy litany along the lines of “he said, she said” at work is followed by a dreary rhodomontade about the iniquities of an insurance company not paying for (seemingly endless and failing to lead to recovery) treatment and—even worse—forcing them back to work!

This sequence explains the epidemic of chronic AD claimants who remain unwell and can never return to work. What is making these people sick is their claim, not the purported workplace injury, and they assume a passive hostile attitude where any attempt to return to work is done under duress and sure to fail on the basis that this will invalidate their credibility.

German psychiatrist Michael Linden, who examined police and military officers’ claimants, wrote an insightful paper entitled “Querulant delusion and post-traumatic embitterment disorder”—the key word here is embitterment with querulant up close. Time and time again it was evident that the persisting pathology in the cases was not the perceived traumatic event (admittedly, another issue of dispute) but their anger towards their employers, leading to a chronic state of resentment, embitterment, and desuetude which was extremely difficult to dislodge. The issue came down to their very identity and self-image, regardless of how this clashed with the actual facts of the situation; in short, it was their truth that was at stake, perfectly epitomizing the postmodern antagonism to actual facts.

So, in the words of VI Lenin: what is to be done? It is not possible to continue this discussion without bringing in Franz Kafka, a lawyer who worked for the world’s second insurance company in Prague and saw just how insidious the legal process of a claim worked to subvert a claimant’s personality into one of chronic invalidity.

Practical solutions are aplenty, but each one will come up against an obdurate vested interest determined to fight to the death to block its institution. The real issue is postmodern society, and steps to take against this are probably hopeless. Compensitis is not a pretty picture, and the future cannot be said to be one that can work. In the end all we can do is go back to reading Kafka.

Dr Kaplan is a clinical associate professor in the School of Medicine at Western Sydney University, in Sydney, Australia.