Psychic Trauma: Putting the Proposed Revisions to DSM-III in Perspective
Brown, Robert S., Developments in Mental Health Law
There is widespread disagreement within the legal community on the question of whether compensation should be paid to a person who suffers significant mental impairment after experiencing stress, or "psychic trauma," attributable to another's wrongdoing.
Traditionally courts have not permitted recovery for psychic trauma unless the plaintiff proved either that it was accompanied by physical trauma (the "impact rule"), or that some type of physical disorder (often nominal), resulted from the psychic trauma.
Recent advances in psychiatric theory and practice, however, have shown that serious mental disorder can occur just as surely as a result of the patient's having witnessed the physical injury of another, as having personally suffered the injury. And this psychic trauma and other kinds can lead to mental disorder that is unaccompanied by real physical illness. For this reason there has been some relaxation of the technical requirements necessary to prove compensable injury in a minority of American jurisdictions. (1)
The gap between psychiatric and legal views of mental impairment caused by psychic trauma, nonetheless, remains wide. This is partly due to fears of a flood of fraudulent claims and of a massive increase in societal costs as a result of greatly expanded defendant liability. These are at least the traditional judicial rationales for restricting recovery for psychic trauma. But it is also partly due to a longstanding disagreement among clinicians as to what constitutes a posttraumatic stress disorder (PTSD), a common mental impairment caused by severe psychic trauma. This lack of consensus among psychiatrists, psychologists, and others adds fuel to the skepticism of many lawyers about the usefulness of the behavioral sciences in general, and consequently has discouraged courts from allowing full recovery in psychic trauma cases.
The American Psychiatric Association is now considering a proposed revision of DSM-III, (2) which embodies several important alterations to the diagnostic category of post-traumatic stress disorder. An amended set of diagnostic criteria has been proposed with the aim of more precisely defining and clarifying both the causes and symptoms of the disorder. These changes, if adopted, will add to the credibility and usefulness of the PTSD diagnosis in legal settings.
To put the proposed revisions of the PTSD diagnosis in perspective, this article will give a brief account of the development of PTSD from its physiological beginnings in the Nineteenth Century to its present status as a clinically verifiable mental disorder. Some of the reasons for the proposed revisions to DSM-III, and the consequences of their adoption, should then be apparent.
An early case of psychic trauma was noted by a Dr. Maty in 1766. In 1761 a French officer, the Count de Lordat, overturned his carriage and received injuries to his neck, shoulder, arm, and head. Although he apparently escaped without serious harm at the time (he walked some miles for assistance), Dr. Maty described a series of dramatic changes that befell the Count in the next six months.
A more melancholy object I never beheld. The patient, naturally a handsome middle aged, sanguine man, of a cheerful disposition and active mind, appeared much emaciated, stooping, and dejected. He walked with a cane but with much difficulty and in a tottering manner. By this time it seemed his left hand and arm were paralyzed but also his right was somewhat benumbed and he could scarcely lift it to his head. (3)
This case is one of many reported from the mid-Eighteenth Century onwards. The pattern consisted of an accident causing varying degrees of physiological injury followed by neurological symptoms seemingly unconnected to the accident itself.
The spread of industrialization and the onset of the "Railway Age" were accompanied by an increase in the number of reported cases of this type. …