The Gazette 1990

j A nua R y / february

1990

GAZETTE

net". Involvement of the General Practitioner and ancillary com- munity supports at an early stage is crucial and can be facilitated by case conferences in the primary care centres. With respect to medico-legal cases, unnecessary suffering could be prevented with a shorter time- span between injury and settle- ment. This could be facilitated if more thought was given to the easy access and availability of medical data, streamlining appointments between the various parties and a spirit of co-operation and goodwill. One of the most essential de- velopments, particularly where liability is not an issue, should be the immediate availability of monies to those who have lost their earning capacity. It is tragic to see indiv- iduals in needless financial hardship which not only compounds their "The costs of specific rehabilitation and vocational programmes should also be mat in order to facilitate early recovery and use time constructively." difficulties but creates new ones, where family and other commit- ments are involved. The costs of specific rehabilita- tion and vocational programmes should also be met in order to facilitate early recovery and use time constructively. In this crucial area, Insurance Companies could do a lot more and in the longterm cut their own costs. • ISLE OF MAN & TURKS & CAICOS ISLANDS MESSRS SAMUEL Mc CLEERY Solicitors. Attorneyvat-Law of the Turks and Caicos Islands, Registered Legal prac- tioners in the Isle of Man of 1 Castle Street.Castletown, Isle of Man. will be pleased to accept instructions by their senior resident partner, Mr. Samuel McCleery from Irish Solicitors in the forma- tion of resident and non-resident I.O.M. Companies and exempt Turks and Caicos Island Companies. Irish Office. 26 South Frederick Street. Dublin 2. Telephone: 01 -760780 Fax: 01 -764037. I .O.M. Office: Telephone : 0624-822210 Telex : 628285. Fax : 0624-823799 London Offica: Telephone : 01-8317761 Telex : 297100 Fax : 01-8317485.

dispositions to emotional or mental instability prior to the unfortunate accident. To assume that there is a "normally" constituted individual who is different from one of "neurotic or insecure" constitution may be necessary in legal work, but it does not conform to a wholistic framework of human behaviour. I feel it is easier, safer and indeed more acceptable to assume that psychopathology and normality are a matter of degree, not kind. That normality/sanity is a relative, rather than an absolute state and that the predisposition to an emotional or mental disorder is on a continuum that is extremely difficult to evalu- ate. To exclude vulnerability as a predisposing factor is erroneous as it introduces the notion of "super- man" living in an "ideal" world. Malingering is a conscious simu- lation of illness in order to achieve some gain or purpose. It was a term used to describe the behaviour of soldiers in the 18th centruy who concocted medical complaints to escape the misery and horrors of war. Abuses surely occur, malinger- ing and other types of fraudulent exaggeration and prolongation of symptoms are possible. However in psychiatry a diagnosis of malinger- ing is rare and it is usually more likely found if at all, in other branches of medicine. Given the negative connotations, stigma, and culture of silence associated with mental distress, it is more likely that Psychiatrists encounter not so infrequently individuals who sham health in an effort to deny its existence to both self and others. Few would dispute the necessity for new machinery to meet the needs of the multidisabled following personal injuries. Too many individuals are left floundering after they leave the hospital milieu with no adequate aftercare, continual assessment, compensationary educational pro- grammes, adequate rehabilitation and vocational training opportun- ities, remedial equipment, designed living environments for unique disabilities, financial support, counselling and easy access to specialist requirements. Coping and living with permanent disablement is a lifelong process and not a single event. Even within the existing struct- ures multi-disciplinary communica- tion, co-operation and demystifica- tion can ease frustrations, save time and prevent individuals from getting lost through the "safety

bars, walking frames, face a long rehabilitation and recovery phase. Many experience irritability, high levels of anxiety, frustration and depression. For the brain-damaged individual, absorbing and retaining new information, remembering names, faces, appointments and having to put the effort into making laborious lists, checking and re- checking, anticipating problems, rehearsing situations, can lead to an enormous strain, triggering off explosive reactions. The families and friends of those with personality changes as a result of frontal lobe damage may have to adapt and accept at best the coarsening of a previously sophisticated personality, at worst, extreme, gross and disabling alterations. It is now widely recognised that after minor head injuries, almost all patients complain for a time of headaches, dizziness and some reduction in mental capacity and that these symptoms are based on subtle microscopic changes in brain tissue. Concussion used to imply that there was no structural damage only transient functional disorders. Middle ear dysfunction is not uncommonly associated and explains more readily the phenomenon of dizziness, vertigo and where high frequency hearing loss is also established, undue sensitivity to noise. With respect to closed head injuries, as a result of the phenomenon of contre-coup, the brain is literally knocked about, twisted and stretched within the skull. Like a ship in a storm contained in a small harbour, the brain in pulled and dragged along the floor of the skull and knocked against various parts of its walls. What the various phenomena of post traumatic injury reveal is that the human being is an indivisible integrated coherent bio-psycho- social organisation which is intim- ately connected to and dependent on the organisation of the external environment in which it dwells. Having said that, in the context of medico-legal proceedings, there is a need for precise and to some ex- tent, absolute views. In this context the issue of "predisposition" amongst others is hotly contested. In this instance an individual is seen to have been, or not to have been, "a normally constituted individual," with or without various pre-

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