November 17, 2011
OPINION
Article from The Sydney Morning Herald
The stand-off between the NSW government and the police union appears outwardly to be a plain vanilla industrial showdown, one that has failed to attract much media interest compared with the Qantas dispute.
But the cuts to disability payments the government is proposing are as much about redefining what constitutes trauma as about saving taxpayers' funds.
In recent years there has been a huge blowout in police disability claims relating to mental illness. NSW taxpayers have paid more than $100 million since 2005 to settle them. There has been a 300 per cent increase in mental health cases, exacerbated by a scheme that pays generous amounts to those claiming at younger ages.
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I assess many such claimants and the vast majority of cases relate to the legitimacy of post-traumatic stress disorder diagnoses. It can be an easy one to sell, given the job of a policeman is innately stressful and can involve considerable exposure to death, drama and destruction.
What might once have been defined as work angst, disappointment over failed aspirations or garden-variety performance management is now often considered workplace bullying or job-related trauma, which then gets transmitted through the lens of mental illness. The rise in disability claims is part of a broader societal change in the way we view the relationship between trauma, adversity and mental illness.
Before the Vietnam War, the idea that traumatic events alone could cause mental illness was not accepted. The prevailing view was that every man had his breaking point, but the real cause was either genetic inheritance or upbringing. The war was merely the trigger. This view held good for the first half of the century and began to be eroded by literature on concentration camp survivors, but was not fundamentally challenged until Vietnam.
Amid the swell of protest and public antipathy towards the war, the idea of post-traumatic stress disorder arose. The cause was deemed a simple one, that of adult trauma, exposure to life-threatening events in particular. By this notion trauma was no longer a trigger for mental illness, but a cause.
It was a great example of how mental health diagnoses are often more acts of politics than of biology or medicine. There was no new knowledge to confirm this change.
The boundaries of psychiatric injury have since widened. In its initial formulation PTSD could be diagnosed only after situations that had genuinely threatened life and limb. This has been broadened to include situations in which people felt in peril, even if they were not, and, finally, to any adverse experience, from viewing the World Trade Centre attacks on television, receiving a medical diagnosis or even normal experiences such as childbirth.
The diagnostic label of PTSD has become a shorthand for all distress, and shifted from its initial rigorous formulation in the military context to a much looser one for civilians. The police are a great indicator of societal concepts of trauma for they represent a middle ground between the military and civilians.
The seminal psychiatric study relating to police and mental health claims was published in the British Medical Journal in 2005. Dr Derek Summerfield reviewed 300 cases of officers retiring on mental health grounds during his time as psychiatrist to the Metropolitan Police. During Summerfield's time retirement on mental health grounds as a proportion of ill health retirement rose dramatically, just as it has in NSW.
Summerfield noted that long-term sickness absence was strongly associated with workplace disputes. He found little evidence of formal mental disorders in the officers he assessed and was often perceived as a barrier between them and the retirement to which they felt entitled.
Labels such as post-traumatic stress disorder were common, yet many officers were experiencing a range of stressors, including conflict with other staff, unresolved grievance procedures, marital discord and financial worries.
This does not mean the officers were feigning illness, but experience of adversity is as much shaped by societal notions of trauma as the trauma itself. Since Vietnam there has been a fundamental shift in the way we view people, from being fundamentally resilient to being innately fragile.
The state government's decision seems a long way from academic psychiatry, but it raises a small barrier in the unending loosening of our notions of trauma.
Dr Tanveer Ahmed is a psychiatrist and author of The Exotic Rissole.