Is a diagnosis of occupational post-traumatic schizophrenia possible?
We present the case of a man who became ill with schizophrenia at the age of 44 after he had been subjected to a series of investigations at his place of work. This case illustrates the issue of the development of schizophrenia as a result of trauma or stress. In our presentation we go into a detailed history of the case and the relevant legal and medical aspects, referring to the legal theory of microtrauma and the theory behind stress-vulnerability, in an attempt to contribute to the understanding of schizophrenia. We consider the legal definitions of 'occupational damage' and the 'common illness'. As to qualifying medical terms, medical science looks upon illnesses as resulting from the reciprocity between the organism and the environment. While the organism forever tends to maintain its equilibrium, environmental factors threaten to upset it. Considering mental illnesses in general and schizophrenia in particular, we discuss the theory of 'stress-vulnerability hypothesis'. We convey our opinion on how it is possible to bridge the gap between the law and medical science. Bringing together the two disciplines and their terms is not simple. The most significant question is whether vulnerability, or to be more precise, vulnerability or a genetic tendency, constitutes a natural morbidity process which is aggravated by the traumatic factor, or whether an individual who bears a 'vulnerability' is healthy until he comes into contact with the environmental factor. It is our opinion that one must not attach too much importance to this theory and must not consider it as fact, but rather confine one's judgment to cases where a latent 'vulnerability' has a clear-cut clinical expression. If we rely on a prevalent medical theory as if it were an evident reality we may miss the truth and may attach too much importance to a matter which is as yet solely theoretical. Our aim is to do justice to human beings. It is better to rely on facts than to trust the existence of latent factors which are within the bounds of theory. We also present a review of the literature about the connection between schizophrenia and trauma or unusual events of life.
Marchevsky
S
S
Netivim Institute of Psychotherapy and Supervision, Herzelia, Israel.
Baram
E
E
D000328:Adult; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008487:Medical History Taking; D009784:Occupational Diseases / Q000150:complications*; D016272:Occupational Health / Q000331:legislation & jurisprudence*; D012563:Schizophrenia, Paranoid / Q000175:diagnosis* / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*