Psychiatric Annals

Reflections on Traumatology

Howard P Rome, MD

Abstract

Dr. Walter Bromberg and his colleagues constitute an interdisciplinary team that explores the fascinating, comparatively new subspecialty of Psychiatric Traumatology. The subject limns the complex of societal processes in its efforts to apportion cause and effect relationships in objective assessments. One could begin to trace the lineage of this perspective to the industrialization era of the last century. However, the legitimacy of that arbitrary historic connection takes us too far away from the more recent legal events that specifically shape the interactions with which these surveys deal A more relevant consideration has to do with the derivative conflicts and their behavioral consequences incidental to the increased structuralization of today's society. In essence, the practice of Traumatology may be conceptualized as the least biased perspective in the assessment of personal damage resulting from traumatic experience.

Various systems of both medicine and organized society converge in the instance of an individual sustaining trauma. The federal and state governments are involved since they establish the legal framework incorporated in their statutes governing the settlement of tort actions and thus set the stage for the resolution of conflict. The data necessary for as impartial an assessment as possible requires the contribution of a variety of experts - emergency physicians, neurologists, neurosurgeons, neuropsychologists, psychiatrists, physiatrists, and the whole array of adjunctive personnel who participate in the continuing rehabilitation process. As a result of the investigations, their conclusions arrive at both a qualitative and a quantitative estimation of the impact of the traumatic experience on the function of the individual.

Their testimony is the evidence used in the legal process that purports to settle claims. The formal and/or the administrative quasi-judicial procedures determine the extent of compensable damage. A significant aspect of this legalistic weighing is determined by the credence given to the estimates of dysfunction. Inasmuch as this is not a cut-and-dried procedure, it depends in the largest measure on the outcome of an adversarial confrontation. The harder the data are, the more persuasive are the testaments.

It is unfortunate that the more subtle the dysfunctional elements, the more they tend to be suspect and consequently are less likely to be taken at face value. Even in jurisdictions where there are statutes establishing no-fault indemnification, the degree of residual dislocation rests on even less firm grounds. In recognition of these practicalities, Traumatology, as an interdisciplinary approach to the various facets of damage to the individual, has moved in the direction of ever-more quantitativeobjective data substantiating impairment. Thus, techniques that range from the more routine use of CAT scans that validate clinical examinations to batteries of standardized neuropsychological tests have come into use.

Each step in the sequence of events between the initial trauma and the ultimate adaptation to the irremediable consequences is attended by a quantum of stress. The gross as well as the subtle influence of this characteristically human contribution to the process of disruptive change has to be assayed. It is concerned with such peripheral untoward consequences as loss of conjugal services, diminished capacity to continue previous employment, and such other dysfunctions as are subsumed by the legal phrase "pain and suffering." Then too, even though the index traumatic experience is customarily judged as if it were an isolated happening, every realistic appraisal has to consider it as an occurrence influenced to a greater or lesser degree by prior life experiences. This consideration of the broader context brings into play yet another dimension. It is often expressed in the dubious dichotomization termed as "functional versus real." Nowadays, the weight given to each of these polar conclusions is substantiated or refuted by the adduced…

Dr. Walter Bromberg and his colleagues constitute an interdisciplinary team that explores the fascinating, comparatively new subspecialty of Psychiatric Traumatology. The subject limns the complex of societal processes in its efforts to apportion cause and effect relationships in objective assessments. One could begin to trace the lineage of this perspective to the industrialization era of the last century. However, the legitimacy of that arbitrary historic connection takes us too far away from the more recent legal events that specifically shape the interactions with which these surveys deal A more relevant consideration has to do with the derivative conflicts and their behavioral consequences incidental to the increased structuralization of today's society. In essence, the practice of Traumatology may be conceptualized as the least biased perspective in the assessment of personal damage resulting from traumatic experience.

Various systems of both medicine and organized society converge in the instance of an individual sustaining trauma. The federal and state governments are involved since they establish the legal framework incorporated in their statutes governing the settlement of tort actions and thus set the stage for the resolution of conflict. The data necessary for as impartial an assessment as possible requires the contribution of a variety of experts - emergency physicians, neurologists, neurosurgeons, neuropsychologists, psychiatrists, physiatrists, and the whole array of adjunctive personnel who participate in the continuing rehabilitation process. As a result of the investigations, their conclusions arrive at both a qualitative and a quantitative estimation of the impact of the traumatic experience on the function of the individual.

Their testimony is the evidence used in the legal process that purports to settle claims. The formal and/or the administrative quasi-judicial procedures determine the extent of compensable damage. A significant aspect of this legalistic weighing is determined by the credence given to the estimates of dysfunction. Inasmuch as this is not a cut-and-dried procedure, it depends in the largest measure on the outcome of an adversarial confrontation. The harder the data are, the more persuasive are the testaments.

It is unfortunate that the more subtle the dysfunctional elements, the more they tend to be suspect and consequently are less likely to be taken at face value. Even in jurisdictions where there are statutes establishing no-fault indemnification, the degree of residual dislocation rests on even less firm grounds. In recognition of these practicalities, Traumatology, as an interdisciplinary approach to the various facets of damage to the individual, has moved in the direction of ever-more quantitativeobjective data substantiating impairment. Thus, techniques that range from the more routine use of CAT scans that validate clinical examinations to batteries of standardized neuropsychological tests have come into use.

Each step in the sequence of events between the initial trauma and the ultimate adaptation to the irremediable consequences is attended by a quantum of stress. The gross as well as the subtle influence of this characteristically human contribution to the process of disruptive change has to be assayed. It is concerned with such peripheral untoward consequences as loss of conjugal services, diminished capacity to continue previous employment, and such other dysfunctions as are subsumed by the legal phrase "pain and suffering." Then too, even though the index traumatic experience is customarily judged as if it were an isolated happening, every realistic appraisal has to consider it as an occurrence influenced to a greater or lesser degree by prior life experiences. This consideration of the broader context brings into play yet another dimension. It is often expressed in the dubious dichotomization termed as "functional versus real." Nowadays, the weight given to each of these polar conclusions is substantiated or refuted by the adduced substantive data.

In our modern technological society in which the liability to injuries is a prevailing hazard, the contest that establishes rights is an integral part of the industrial process. Its development has become commensurately more subtle and consequently it demands more exacting quantitative and qualitative determination. The Editors take pleasure in devoting this issue to that subject.

10.3928/0048-5713-19840701-05

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