The Gazette 1990

GAZETTE

nua

february

1990

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

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-

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

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:

-760780 Fax: 01 -764037.

.O.M. Office:

Telephone : 0624-822210

Telex : 628285.

Fax : 0624-823799

London Offica:

Telephone : 01-8317761

Telex : 297100 Fax : 01-8317485.