The Gazette 1990

GAZETTE

SEPTEMBER 199 0

at any other time, or her capacity at any other time to form a normal marriage relationship with an y other person". He granted th e Decree. It seems to me that the situation in the ecclesiastical courts and the Civil courts in regard to the granting of nullity in cases where mental . . . th e s i tuat i on i n th e ecclesiastical courts an d th e Civil courts i n regard t o th e granting o f nullity when mental illness exists a t th e time o f marriage i s roughly similar." illness exists a t th e time o f marriage is roughly similar. My im- pression from experience, however, is that the ecclesiastical courts take a broader view in th e case of personality problems. Head injury & schizophrenia The last subject that I will touch upon is the relationship of trauma to the aetiology of schizophrenia. This arises most commonly when a person who has had a road traffic accident subsequently develops schizophrenia. The literature on this subject is very sparse. For example, I consulted two recently published books on the psychological affects of head injury an d found no re - ference to schizophrenia in their indexes. Th e major studies have been on war time head injuries. Lishman ha s summed up th e situation well in discussing the pos- sible relationship between head injury an d th e development of psychoses. H e says "Various possibilities exist. Organic brain dis- turbance ma y itself contribute directly to such developments; or it may act merely as a precipitant in someone already predisposed; or cerebral damage ma y create a proneness to psychotic disorder by altering th e subject's pattern of reaction to stresses and difficulties. Alternatively, organic factors may be unimportant in themselves: the injury or its psychological reper- cussions may have acted as a non- specific stress to precipitate the psychosis, or psychogenic causes may lie in the changes wrought in the patient's life or th e special difficulties he has to face. Finally, of course, the possibility of simple co- incidence must also be considered". The most extensive review of the literature wa s carried ou t by

Davison and Bagley (1969). Their conclusions were that th e inci- dence o f schizophrenia-like psy - chosis after head injury is certainly greater than chance expectation, and that the trauma may often be of direct aetiological significance rather than merely a precipitating factor. The influence of genetic or personality pre-disposition wa s found t o be less than in the naturally occurring disease. Th e early onset of the psychosis was related to th e severity of diffuse brain injury, and a possible special association with temporal lobe damage was suggested. These conclusions are not very helpful in dealing with th e indi- vidual case and it is probable that juries will be inclined to give th e plaintiff the benefit of the doubt. In an y individual case i t is essential to determine whether or not symptoms were evident before the accident. It should be deter- mined whether or not there was a family history of the disorder, al - though the evidence regarding its significance is conflicting. Points in favour of the injury being of aetio- logical significance would be if the brain damage has been extensive and diffuse with loss of conscious- ness of over twenty four hours, or if the damage particularly affects the temporal lobe, especially the left. In the latter case there is often a long latency period before the onset of the symptoms, whereas in the former the onset may be early. The illnesses ar e usually schizo- phreniform rather than true chronic deteriorating schizophrenia. Conclusion In this paper I have endeavoured to show that schizophrenia is a very serious disorder with many forms, and that i t ma y have serious medico-legal consequences both for the sufferer and for those deal- ing with them. S. Desmond McGrath is Medical Director at St. John of God Hospital, Stillorgan, Co. Dublin. Emeritus Consultant Psychiatrist, Beaumont Hospital, Dublin. * A lecture delivered t o th e

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Medico Legal Society o f Ireland o n 29th January, 1989. NOTES 1. [1974] I R 55 . 2. [1985] I R 517 .

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