About bullying in medico-legal examinations, workplace bullying, whistleblowing and much more

This excellent Queensland Government “ebook” is packed with interesting information and articles, cases, case studies and resources about all things bullying. It contains about 11 chapters and covers topics such as understanding stress, what workplace bullying is, bullying and psychiatry, whilsteblowing and even covers shocking bullying cases in medico-legal examinations! Definitely worth a read and  bookmarking!

About workplace bullying, bullying in medico-legal examinations and much more

Bullying in medico-legal examinations (Chapter 9)

Medico-legal examinations by psychiatrists, and less often psychologists, GPs, and other health personnel have caused problems in two particular areas. First when whistleblowing employees are forced to undergo medico-legal examinations as part of the typical process of victimisation and harassment.

The process is aimed at discrediting the whistleblowing employees while diverting attention from the issues which they have raised, issues which are usually corruption or danger to the public.

Second, within Workers Compensation cases, where the employer/insurance company are trying to avoid liability for stress-related illness.

This may happen in cases that are not related to whistleblowing, but often whistleblowers become Workers Compensation cases when they suffer stress breakdown as a result of victimisation at work.

The following are extracts from reports, legal judgements, and complaints by patients. Reports and doctors are from several States. Some doctors (Dr. X) appear more than once, most do not. Identifying data has been removed regarding patients, except where they have given permission. Extracts are grouped roughly as Behaviour, Reports, Results and International Implications.

BEHAVIOUR

WORKERS’ COMPENSATION/WHISTLEBLOWER: Dr. A.s’ complaint concerning behaviour of Dr. X:

“The psychiatrists refuse to allow relatives to go in, however in the case of Mrs G. I had warned her husband that he should go in with his wife. He did insist on going in and was so amazed at the performance that he has put in a complaint.

The usual performance involves yelling at the patient, accusing them of lying to get compensation, walking round behind the patient while firing questions, walking out of the room without warning and generally taking an aggressive and adversarial approach.

Mrs G. was so distressed that she had to be put into hospital for a while.

In fact it is not unusual for patients to be so distressed after these ‘interviews’ that they start seriously considering suicide.

Mr B. had suffered brain damage: The receptionist told the wife that usually after 30 minutes the doctor asked relatives to come in because by then the patient in medico-legal examinations was very distressed. It is not whether there is agreement on opinion, that is a matter for the Court alone. It is the manner in which this small number of psychiatrists treat patients during the examination that I strongly disapprove of.”

WORKERS’ COMPENSATION: A female patient whose own psychiatrist refused to allow her to attend any assessment by Dr X. He had himself witnessed X’s unethical treatment of one of his (Dr A’s) own patients when he had accompanied his patient to an X assessment. Dr A advised me he was willing to release the written complaint he had made regarding the man’s unacceptable behaviour.

WORKERS’ COMPENSATION: “As we entered Dr. X’s office he sat down behind his desk reclining back in his seat with his feet on the desk...just sat there pivoting in his chair and after quite some time he then proceeded to talk to my husband in a laughing and mocking manner.

He started becoming very rude in his tone of voice and said, ‘There is nothing wrong with you by the looks of you.’ I tried to explain [re her husband’s wounds] and he then

turned to me and said ‘Shut up, you fat bitch’.

On leaving his office I was quite upset and crying. His receptionist said, ‘O God, what has he done now?’ She asked if my husband was all right and we then left. I spoke to [insurance company] and told her what went on. She said ‘We did not send you there to be abused or upset. I am terribly sorry, do not worry, we will send your husband to someone else.’

About one week later my husband received a letter stating that we were not to receive any more compensation as we did not stay for the full length of the appointment with Dr. X.”

WORKERS’ COMPENSATION: “I felt that Dr. X’s behaviour at that initial interview was so crass and rude as to be dangerous…contrived so as to elicit the reactions the Insurer wanted. He conducted the whole interview with his feet on his desk, eating his lunch.”

WORKERS’ COMPENSATION: “I think Dr A. said that Dr. X. was not qualified to examine me and what’s more was dangerous, upsetting or harmful (something like that) to patients in my condition.”

WHISTLEBLOWER & WORKERS’ COMPENSATION: “I was approached in a manner that I felt was intimidating and questioned at length regarding issues that appear irrelevant. Certain questions also seemed to suggest impropriety between myself and other parties. Dr. Y further questioned me regarding a long list of symptoms. I was to answer yes or no irrespective of when and why I may have suffered these symptoms. The inference can be drawn that I suffer from ‘x’ rather than that I developed ‘x’. Dr. Y did not offer comment or reassurance regarding my visible distress. When I questioned the reason for a urine specimen I was not answered. I was given no indication that the consultation had finished. When I asked, I was shown the door in silence.

I was puzzled and alarmed by Dr. Y’s intimate familiarity with the details of my case. I have since been informed that Dr. Y is employed by the same company who effected my dismissal and has close communication with those instrumental in this dismissal.”

WORKERS’ COMPENSATION: “I found Dr. X’s attitude from the start to be provocative and intimidating. He frequently smirked when I replied to his questions, and the whole interview with him was more in the nature of an interrogation. At a later stage of the interview Dr. X sat me in a chair and asked me to hunch up my shoulders. I indicated to him that I was in pain and that pushing down caused me pain. He asked me to hunch up my shoulders again and I refused. He pushed down on my shoulders hard.”

[Dr X’s report said”He was bristling with anger and hostility. Although diagnosed as suffering from major depression by Drs. A and B, I have reservations about this diagnosis and note he failed to respond satisfactorily to any treatment prescribed”. The patient subsequently suicided.]

WB/WORKERS’ COMPENSATION Report: “At first the patient showed signs of great anguish. He paced the floor and contorted his face with expressions of desperate anguish. He said that he was in such a desperate state he would do anything. It seemed so bad that I gained the impression he was crying, but when I gave him a Kleenex his expression changed and it was obvious he could not use it.” [Patient says Dr X threw the box of tissues at him and hit him on the head!]

WORKERS’ COMPENSATION cases: “Injured workers being sent to the X private hospital under the pretence of a Pain Management Clinic, and treated as psychiatric patients. When the patients have complained about the treatment, they have been given a signed medical certificate stating that they are fit to return to work.”
[Patients being abused and physically assaulted by doctors]

WORKERS’ COMPENSATION complaint by union representative: “In my view, Dr. X’s performance as a witness at the AAT hearing was unethical. The Tribunal itself noted that Dr. X was in the hearing room when S gave evidence. In fact I was sitting next to Dr. X at the back of the hearing room and saw what the Tribunal obviously did not, i.e. that Dr. X listening to S’s answers, was hurriedly scribbling notes and passing them to the Australia Post instructing solicitor to obviously assist their counsel in his cross-examination of S. It is noteworthy that Dr. Z was the specialist who, together with Dr. G for the Postal Commission, recommended S’s invalidity retirement in 1985. Dr. Z continued to treat S for some time. S then sought treatment from Dr. P. Dr. Z subsequently made a report to Australia Post which was contrary to his original invalidity recommendation and which contributed to the decision to terminate compensation payments.”

WHISTLEBLOWER: As a result, heavy pressure was placed on him to see a ‘management consultant.’ Eventually he agreed. The consultant proved to be a clinical psychologist who told him to complete [an MMPI]:”I saw they were trying to trap me, because you can interpret the results of these tests pretty much as you wish. I went back to him and told him I wouldn’t do it.

He told me his report would say I was obsessive and paranoid unless I agreed to fill out the questionnaire.

He said he had already made up his mind and my only chance to change it was to do the test.”

Urine Testing Used In Reports:

WHISTLEBLOWER/WORKERS’ COMPENSATION: “Ms H. asserted that she was taking Parnate 4 per day and Valium 5mg mane. It is noted that Parnate has been detected by Mass Spectrophotometry, no Valium has been detected. It is noted that the Valium asserted to be taken by Ms H was not taken by her. I do not think much can be made of this but it is simply noted that her assertion of medication ingestion is unreliable.”

WHISTLEBLOWER: “Mr P. stated that he had last taken Prothiaden, a tricyclic antidepressant some 3 days ago at a dose of 150mg nocte. It is noted that this was not detected on urine screening. He asserted he was taking Panadeine Forte between 6 to 9 on a daily basis, no evidence of this medication was detected and Mr Ps assertions in this regard are clearly untrue. The assertion that he is in significant pain and that he finds it necessary to take the medication, a statement clearly negated by the drug screening result must raise the possibility, that since Mr P. clearly lies in this regard, as to whether other aspects of his account could also be coloured by frank dishonesty.”
[Both patients were not in fact taking the disputed medication daily, and it is highly unlikely they would have said they were]

WHISTLEBLOWER: Under the WorkCover Act, the employer is supposed to have a locked area for employee medical records allowing specified officers limited access for the purpose of rehabilitation. This is almost impossible to police and relies almost entirely on standards of ethics not readily understood outside the medical profession.

Workers are unwittingly and unknowingly handing to their employer unseen psychiatric reports (obtained by the employer in the normal course of a workers compensation claim for stress) which are skewed against the worker. The employer can take action against the worker on the basis of a psychiatric report that, on the face of it, appears to be above the accusation of the employer using a ‘hired gun psychiatrist’.

REPORTS

Reports fall into two main groups. In whistleblowing cases the emphasis is on the patient’s abnormal personality as the cause of all the problems at work, with the usual diagnosis being paranoid personality disorder. In Workers Compensation cases the emphasis is on denying or dismissing the possibility of post-traumatic stress disorder.

Reports on Whistleblowers:

Donald Soeken: (US psychologist) “What I decided was that my loyalties, in terms of whatever loyalties l had, would lie with the individual who was coming in [whistleblowers forced to come for ‘fitness for duty’ examinations to be used as part of an adverse action]. I made a decision that it was unethical for a licensed professional to interview somebody and then destroy his or her life.”

Paranoid personality disorder is defined in the Diagnostic and Statistical Manual (DSM 3R) as follows:

Diagnostic criteria

A pervasive and unwarranted tendency, beginning by early adulthood and present in a variety of contexts, to interpret the actions of people as deliberately demeaning or threatening, as indicated by at least four of the following:

  1. expects, without sufficient basis, to be exploited or harmed by others
  2.  questions, without justification, the loyalty or trustworthiness of friends or associates
  3. reads hidden demeaning or threatening meanings into benign remarks or events, e.g. suspects that a neighbour put out trash early to annoy him or her
  4.  bears grudges or is unforgiving of insults or slights
  5.  is reluctant to confide in others because of unwarranted fear that the information will be used against him or her
  6.  is easily slighted and quick to react with anger or to counterattack
  7. questions, without justification, fidelity of spouse or sexual partner
  8. (Note that much of this description normally will fit whistleblowers’ behaviour at work once they are being victimised, and is of course then not ‘unwarranted’. Other key points which would need to be demonstrated are that the pattern was present by early adulthood, i.e. it long pre-dated the whistleblowing; and that they are equally paranoid in other contexts, not just at work).

WORKERS’ COMPENSATION, WHISTLEBLOWER: Treating psychiatrist:

“The question of whether or not Mr W. was ‘paranoid’ in his perception of his work environment in the past required my consideration at an early stage. While I of course do not have first hand information corroborating his story, I believe from the consistency of his story, his obvious intelligence, and the general intactness of his cognitive reasoning, that there are no persecutory delusions present in this man’s mental state. While during my treatment of him I have found him a tired, troubled individual, I have found him reasonable in his evaluation of the world around him, and to take a balanced view of his overall circumstances; something clearly not easy to do given this man’s history over the last 13 years.

Mr W impresses me as an honest, courageous man who has been prepared to pay a high price for the defence of his principles. It would seem highly unlikely that a scientist of Mr W’s qualifications would fabricate the story that he has related to me and others.”

Government-appointed physician:

“It is my opinion that Mr W. suffers from a severe personality disorder, which is manifesting itself with ideas of persecution and complaints of stress. There is little doubt that the present state of affairs could have been brought on if Mr W. was mistreated in his previous job. It is not my brief to make a judgement on the rights and wrongs of his treatment. Whatever the case, I am equally sure that Mr W’s personality would make it extremely difficult for anybody to deal with him in a work situation.”

Government-appointed psychologist’s report:

“Conclusion: Validity scales do not indicate malingering or exaggeration of symptoms. There are indications that the disturbances are sufficiently severe to warrant treatment. My opinion of the profile is that it is descriptive of personality conditions that pre-exist [current] pressures.”

Government-appointed psychiatrist:

“I am of the view that his job is essentially secondary in the development of his emotional and related physical symptoms, and that he would probably have developed these wherever he was or whatever he was doing. I think it likely there are strong paranoid traits in his personality which would result in problems in his relationship with others, and from this conflict would arise various emotional and perhaps physical symptoms. He is an ambitious and driving person and is likely to experience profound disappointment if he does not attain his ambitions.

After having interviewed Mr W. for almost 5 hours and reading the various documents about him forwarded by you [information from the people he was in dispute with], I am of the view that he suffers from a serious personality disorder. This is characterised by very marked suspicion of others, and an underlying belief that he’s always at risk of being persecuted by others teaming up against him. I believe this derives from very deep and intense feelings of insecurity which possibly derive from early childhood experience. The other side of his marked suspicion and tendency to feel persecuted is a grandiose view of himself. There is a marked preoccupation with physical health. To describe someone as suspicious, litigious, grandiose and hypochondriacal could be viewed as pejorative, and I want to make it clear that this is not my intent – my description is clinical and not moralistic.”

WHISTLEBLOWER case – Mr N. Psychiatrist:

“He presented as before, as a tense man, and there seems little doubt that in the last year what had been a highly valued idea by him, that is exposure of corruption in the SRA, has become an obsession in the sense that he both cannot and will not put it out of his mind [List of bodies approached – Auditor-General, Ombudsman, ICAC]. By this time everyone except Mr N. had had enough, apparently involved in a battle that he both cannot and will not give up and the cost is irrelevant apparently.” [Transport Appeals Board found against Mr N. in his action for wrongful dismissal. Judgement quoted:”Mr N. was certainly under significant situational stress and now appears to have become obsessed in the neurotic sense of the word by his fight so that he both cannot and will not give up the battle no matter what the cost” (extract from same report)].

Report by another government-appointed psychiatrist:

“All of this occurred on a background of work with a very good record. He does not at present suffer from a nervous disorder and is fit for work not involving the stresses mentioned. Further management depends on the outcome of the relevant matters. I would be interested in any other information available with respect to his work performance and the allegations he makes.”

WHISTLEBLOWER case Mr K: Psychologist:

“It is likely that he has a severe personality problem, and he may in fact have a personality disorder. His personality traits are such as to produce grandiose and obsessive behaviour, paranoid reactions and regular grievance procedures for insufficient cause.”

Treating psychiatrist:

“At all times Mr K. has presented as a coherent, relaxed and good informant. It would appear to me that his grievances were justified. As a consequence I regard the position he took as being appropriate to that of a dedicated scientist and not the behaviour of an emotionally disturbed person. I have not found any evidence to support the assertion that he is grandiose, obsessive, or paranoid.”

WHISTLEBLOWER case Mr T:

“He was a rather rigid, obsessional, paranoid personality. He held all his viewpoints very rigidly and was very grandiose regarding his abilities as a … He certainly does have a marked personality disturbance, which has seriously impaired his work performance to the point where he has now lost all reasonable perspective in the conduct of his duties. There is every reason to believe he will continue in his current litigious activities writing numerous letters to Parliamentarians, Ministers and the PM, etc. He is quite insightless into his mental condition. There are substantial grounds, on the basis of his mental state, to prevent him carrying out his duties now or in the foreseeable future.”

Psychiatrist’s report on the same case:

“Very detailed, several external checks, including the report of his medical boss. Refers to a conversation with Dr M. in which he said that, ‘He is not responsible for his actions. He needs treatment otherwise he could do harm to his family. He is in danger of becoming a paranoid schizophrenic.’ I have, with Mr T’s consent, asked Dr M. to confirm this report, and indicate whether he has ever held the view that Mr T. was mentally ill. Dr M. denied holding this opinion most emphatically.”

WHISTLEBLOWER Mr V:

“I spent over one and a half hours with Mr V. It became apparent during my questioning, which at times was necessarily provocative, that Mr V. has a very abnormal personality. He has developed compulsive behaviour based on his own set of high moral values. His compulsive neurotic behaviour showed itself in other forms. He constantly wrote down observations or comments that I made. He linked this [objecting to the Water Board underestimating contamination by a factor of 1,000] to his experiences with the Second World War. He felt he had been severely cheated and misled by the authorities under the Nazi regime. He determined that he would never unquestioningly accept those who are in power. Mr V. exhibits quite an extreme degree of compulsive-obsessional behaviour. This type of personality could qualify as a reason for retirement on medical grounds. If this did occur, it would have to be forced upon Mr V., as he can see nothing wrong with his personality and merely considers himself to be a person of great integrity.”

Same case, government psychiatrist:

“Mr V. does not suffer from any form of clinical nervous disorder. Given the accuracy of the information supplied, he has substantial reasons for his criticisms of the Water Board, and his disclosures to the media. It would not make him an abnormal personality, even if a somewhat unique one.”
The following two reports are in the ‘you can’t win’ category:

WHISTLEBLOWER Mr T:

“I found Mr T. to be very cooperative in the interviews and to have a cheerful and pleasant manner. This contrasted with accounts given to me by others, mentioned above, that he can at times be very belligerent and uncooperative. It was easy to see that he would be able to present his viewpoints in a very plausible manner to people who were in relatively brief contact with him, or who did not seriously challenge his statements.”
WHISTLEBLOWER Mr W:

“There is no past history of personality difficulties which I am aware of and from a psychiatric point of view I cannot establish the presence throughout his life of personality traits which significantly affected his work or social life. This is not surprising given Mr W’s defensiveness and projection of all his difficulties onto the Department.”

Workers Compensation Reports

Post-traumatic stress disorder – DSM 3R definition (abridged)
A. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.
B. The traumatic event is persistently re-experienced in at least one of the following ways: intrusive memories, distressing dreams, ‘flashbacks’, distress on exposure to reminders.
C. Persistent avoidance of stimuli associated with the trauma, or numbing of general responsiveness indicated by at least three of the following: avoiding feelings, activities associated, detachment, loss of interest, restricted affect, foreshortened future
D. Persistent symptoms of increased arousal, indicated by at least two of: difficulty falling/staying asleep, irritability, difficulty concentrating, hypervigilance, exaggerated startle response, physiological reactivity on exposure to reminders.
E. Duration of at least 1 month.

WORKERS’ COMPENSATION report by Dr X:

(who incidentally has published an article in which he expresses a very broad and different view of the causation and course of Post Traumatic Stress Disorder).

“In the last year or so I have been referred a number of compensation claims for service-related PTSD. In nearly every case, the external objective facts of the matter were so obviously inconsistent with a plausible diagnosis of service related PTSD, that I was left puzzled as to why such a claim and diagnosis was ever made.

I think Mr B’s presentation is yet another example of these cases [remarks concern 25-yr gap between trauma and major illness]. There is no history to suggest that he developed or showed any clinically significant reaction to the traumatic event. Whilst he was no doubt shaken by the experience I could find no evidence that Mr B was suffering from any manifest psychiatric disorder, despite his angry and somewhat hostile manner.

He accused me of calling him a ‘bludger’, which I certainly did not do. I simply tried to explain to him my difficulties of attributing his alleged complaints more recently on the Voyager incident for all the reasons detailed above. In my opinion, there is simply no plausible clinical basis for Mr B’s claim. This is not to deny that Mr B has been variably dysphoric for the last few years, for other reasons. Every astute observer of human nature recognises the common tendency in people to find a blameless explanation for their problems and failures in life. Possibly this applies in this case.”

Report from another psychiatrist on Mr B’s case:

“The worst experience of his life was when he was on board the Voyager on 10th Feb, 1964, when it collided with the bows of HMAS Melbourne and was cut in half. Mr B. was in the forward half of the ship which rapidly rolled over and sank within eight minutes of the collision. There was loss of life (eighty-four men, all in the forward half) and many injured.

He has tried to forget this experience and is amazed that his memories are so vivid despite his attempts to push them out of his mind.

Just prior to this event, both ships were in darkness as part of the exercise, and the Voyager could not be seen from the Melbourne [and vice versa].

Mr B. was in the lower mess when suddenly there was an explosion and all the inside lights went out. The ship began rolling over and there were injured men screaming all around him.

Mr B. was not physically injured to any extent, although a piece of steel thumped him in the chest as he rapidly made his way to a staircase. The most horrifying aspect for him was knowing that he could do nothing to help anybody else in the darkness while his survival instinct took over as he attempted to escape from the sinking ship. Water was coming in and he had to make his way up a staircase (now listing to one side) and towards a light which turned out to be the escape hatch opening and closing. He estimates that it took him about six minutes to get out of the ship and dive into the oily water.

He had to swim past men who were apparently never saved, found a life raft, climbed in and promptly vomited. As the life raft progressively filled with injured men, he climbed out and held on to the edge. They were evacuated by helicopter. To this day he feels extremely guilty that he may have contributed to the deaths of others by simply struggling through the darkness inside the ship to get out before it sank.

Many of his colleagues were trapped within the ship, and those who were still alive at the time of the sinking were singing Waltzing Matilda to comfort themselves knowing they were trapped and would die. Mr B. can no longer hear this song without it bringing back strong experiences of his situation at that time.”

WORKERS’ COMPENSATION/WHISTLEBLOWER – Ms. H.:

“She asserts that as a result of her dismissal she has developed a psychiatric disorder namely a disease of the mind. To assert that as a result of a dismissal a disease of the mind can be produced is as close to psychiatric nonsense as it is possible to get.

It is well recognised that external environmental circumstances may cause a mental illness [PTSD and Adjustment Disorder]. It is not tenable that Ms H. suffers from PTSD since the external stressors are not significant. The assertion that she suffers from an Adjustment Reaction is also negated by the fact that by definition an Adjustment reaction is limited to 6 months dismissal itself is distressing.
Summary dismissal is even more distressing and undoubtedly is for the person being dismissed an unpleasant humiliating anxiety provoking situation. This description however constitutes a normal human response to a situation that is decidedly unpleasant. It does not constitute an illness, nor does it constitute a disease of the mind which would in any manner prevent work.”

WHISTLEBLOWER/WORKERS’ COMPENSATION

– the ‘colour TV case’, which occurred towards the end of the years of the Fraser government. The patient, who remains in a very emotionally disabled state, says that his treatment by this psychiatrist was the most traumatic aspect of the whole very traumatic affair.

“The prominent feature at this interview was what I consider to be over-acting. The appearance of great anguish was so excessive that I can only regard it as histrionic. It is my impression that [his complaints] are manufactured for the purposes of elaborating upon what may have been a genuine disorder in the past. The PTSD follows a predictable course. Gradually it improves and the change follows a consistent pattern. Only in certain circumstances would it be expected to become worse, namely, a succession of significant stresses producing a cumulative effect. The patient has not had this succession of stresses. [Comparison with Vietnam Veteran claimants who had never been to Vietnam] In my opinion the state of the patient at present no longer meets the criteria of PTSD, but rather impresses me more as malingering hysteria. Clearly he has not cooperated with the treatment program and from the beginning I pointed out the existence of a personality disorder in his case there is always the outside possibility of schizophrenia in a circumstance such as these.”
[Result – immediate withdrawal of benefits; patient had to appeal]

Treating psychiatrist:

“It is important to look at the upbringing and the past history of this patient to be able to understand his reactions to a stressful event in his life; only child, close family, stable, played sport, friends, 8-year engagement, lack of ambition, refused promotion, steady, effective work 20 years, calming influence on upset passengers. Dr. X mentions a character disorder in his report yet he does not name what sort of disorder this is. I cannot find any character disorder in this man except that he is a particular personality, namely a man who is rather retiring and unambitious with limited interests. There is no doubt that there is an intimate connection between the trauma he suffered while on duty and his present condition. As far as malingering is concerned or exaggeration of symptoms which Dr. X mentioned, I cannot find any evidence of it and one has only got to witness the distress of the patient to see that this is genuine.”

Miscellaneous

WHISTLEBLOWER Mr G:

Report by police/forensic psychiatrist which probably saved his life: “Mr G. was referred because of anxiety and suicidal ideation arising from his belief that he was being persecuted by the police. He described a complex system of ideas/concerns involving the SA police/Star Force holding them up at night with guns, threatening/harassing. Dr A. was unsure, as was Dr B, whether or not Mr G’s complaints of persecution were reality based or delusional. Faced with the same problem, I spoke to Mr G’s girlfriend. [Outline of Mr G’s complaints].
I contacted Commodore M. I have the greatest respect for Commodore M. and was therefore somewhat disappointed that Commodore M. had dismissed Mr G’s complaints. He believed the use of the Star Squad, as described above, was justified because Mr G. is a violent man. I pointed out that Mr G. had no history of violence. Commodore M felt, it seemed, that police assurances that G. was violent were sufficient justification. Commodore M. had not checked to ascertain whether Mr G. had in fact reported police officers to Operation Hygiene.
I cannot judge the legality of Mr G’s actions, nor the validity of all his allegations, but as a result of my examination, I am of the opinion that:

  1.  Mr G. is not delusional
  2. he has become depressed and anxious as a result of at least some of the above events
  3. his hypertensive state has been aggravated by the above
  4. the enforced three times weekly attendances are aggravating Mr G’s mental health problems.”

RESULTS

WORKERS’ COMPENSATION/WHISTLEBLOWER

(Appeal Court decision): “For the defendant it was contended that the plaintiff suffered from a prior personality disorder, which would not, in the early stages from 1977 onwards, have been reasonably apparent to the defendant and which by late 1979 and thereafter would have caused the plaintiff to suffer in any event a breakdown similar to the one which he in fact suffered”.
…..derived most help from the reports of Dr X. He concluded that by the end of 1990 the plaintiff’s personality problems did indeed ‘constitute a severe affliction’ and his feelings of persecution and frustration, often manifested in signs of physical illness, had become so strong that they rendered him unfit for employment…..
…..agreed with the following description by Dr Y. of the plaintiff’s personality: …..displayed personality traits which would have made it difficult for his employee (sic) to deal with. In particular;

  1. a tendency to be easily slighted and quick to take offence
  2. the emphasis on always being correct and moral
  3. a readiness to counter-attack when any threat is perceived
  4. the expectation of trickery or harm from his co-workers
  5. the blaming of all his problems onto others
  6.  a tendency to distortion and over-reaction

…..once the process had begun there was really no turning back. Mr W. [interpreted most of what happened to him in a persecutory fashion, and became increasingly obsessed with the injustice of his treatment] “The proposition that a man susceptible to nervous shock is not entitled to damages is said to be reconcilable with [the egg-shell rule] because it is said that there is no duty of care for unknown abnormal persons who suffer harm because of their abnormality: only if a defendant knew or ought to have known of the existence of the plaintiff’s infirmity had he a duty to avoid harm to him which a normal man would not suffer”

Much the same opinion was expressed by Dr X. in his report of 24 Feb 1991, that the patient’s emotional symptoms were not a result of what happened to him in his department, but rather the result of gradually developing processes in his life which would have taken place regardless of the circumstances at work. The trial judge found Dr X’s reports ‘most helpful’.
WORKERS’ COMPENSATION/WHISTLEBLOWER: – found plaintiff suffered from ‘an underlying personality disorder prior to 1979.’ Supreme Court ACT judgement 11.3.92/ Federal Court on appeal 22.9.93 – Gallop Spender and Ryan – appeal dismissed; cross-appeal allowed, and judgement set aside. Plaintiff to pay costs of action and appeal.

[Catchword ‘ abnormal psychiatric state’ – duty of care only arises if abnormal state known by employer. Record of medical examination prior to employment disappeared. Plaintiff would not have had access to this report; the Court did not comment on its absence.

On 12.10.94 Mr W was denied leave to appeal to the High Court. The case is a significant precedent for people who have been injured at work. It is also a typical case of re-victimising the victim/restigmatising the stigmatised.

Mr W was illegitimate, and spent much of his childhood in an orphanage. The government-appointed psychiatrists made much of this in their reports, the implication being that someone from such a stigmatised background, however well he might have performed in the past, was a breakdown waiting to happen. A similar line is often taken with people who have suffered abuse as children.]

W. to Senate Select Committee on Public Interest Whistleblowing:

“The fundamental error in the approach to psychiatrists in the first instance is the erroneous reliance they put on false and misleading copious data they are sent by the Commonwealth, in order to assist them in their demolition task.

One psychiatrist in his very biased reports on myself relied entirely on slabs of unbalanced and untrue information provided by people with whom I was in conflict, which he literally transcribed into his own reports.
If you cannot discredit the report or you cannot discredit what a man writes, then you have only one avenue, which is to try to discredit him personally. In fact the first psychiatrist they sent me to was honest enough to tell me what the brief was from the Department of Defence. It was to write a report that said I was paranoid. But the man was honest enough to tell me, after half an hour’s conversation with him, that his ethic would not allow him to go that far. But others do not care what kind of ethics they have at all.”

INTERNATIONAL IMPLICATIONS

Recent contact with a police whistleblower from Hong Kong.

Forced to attend a police psychiatrist, who had been in the job (from UK) only 3 months. Psychiatrist reported there was nothing wrong with him. Psychiatrist was ejected from job and back to UK shortly afterwards. Replacement psychiatrist a few months later certified a junior police whistleblower insane, who spent 12 months in a psychiatric hospital and was then repatriated to UK.

Medicine Betrayed – The Participation of Doctors in Human Rights Abuses (BMA).

Reporting on this publication, Goodlee (1992) notes that by withdrawing cooperation, doctors could prevent institutionalised torture. Doctors certify prisoners fit for torture, revive after collapse, monitor during, give false or inadequate medical care, falsify death certificates.
The international medical community was ‘negatively struck by the number of examples of false, inadequate and absent forensic statements’ regarding torture-related incidents.
If governments choose to carry out life-threatening punishments, they must not look to the medical profession to alleviate or contain the suffering so imposed.
No distinction between torture and judicial corporal punishment. The participation of doctors in inflicting pain and suffering is regarded in the same way: as a breach of the doctor’s ethical obligations to the patient.
Refusal of doctors in Pakistan to perform judicial amputations has meant none performed since 1979. No new cases of Soviet psychiatric abuse since 1991.
To contribute to the preservation of democratic freedom doctors need to keep an ever watchful eye on the state.

South Africa – Steve Biko:
Three doctors examining him during his terminal illness diagnosed malingering in spite of overwhelming evidence suggesting that he had suffered extensive traumatic brain injury. Dr Silove (1990) suggests the doctors’ failure was due to complex influences:

  • their own social conditioning
  • habituation to degrading prison conditions
  • apartheid’s influence on medical practice
  • possible reprisal from Security Police
  • doctors’ obedience and passivity exploited by the Security Police
  • failure of major medical organisations in South Africa to provide clear guidance and leadership to state-employed doctors, with increased risk of individual doctors succumbing to pressures to condone acts of state-sanctioned violence against detainees…..

Soviet misuse of psychiatry
– Adler and Gluzman, in a recent review of the subject (1993) state: “The misuse of psychiatric hospitals, techniques and medications with the aim of repressing political dissidents was widely practised in the USSR. By claiming to ‘treat’ political adversaries in psychiatric institutions, the failures of the political system were relocated from the institutions of state to the psyche of the individual so that the Soviet Union could deny its own structural failings. A mature system of government typically tolerates its dissidents. Just as conformists support the stability of a system, dissidents provide the self -corrective feedback to alert the governors to remedy sources of discontent and destabilisation. When the arguments put forward by dissenters in any organisation are ignored, the system itself may be weakened.
The messenger who brings bad news can be shot, tortured into recanting, or declared insane, but that will not make the bad news any better.
The Soviet special psychiatric hospital system …was at worst criminal, and at best had lost contact with scientific reality. Its dissident inmates were neither criminal nor insane, but were treated as if they were both. Many mentally healthy individuals entered special psychiatric hospitals only to be eventually released from them as patients – with nightmares, symptoms of depression, and difficulty in communicating.”
As Bloch et al noted (1977), criticism of the Communist Party and recommendations for social change reflect ‘poor adaptation to the environment’. A dissenter’s advocacy of
change can only indicate that he is suffering from ‘reformist delusions’. Dissent is a symptom of schizophrenia, and constitutes a sufficient basis for the diagnosis in the absence of other symptoms: “Dissent is a different way of thinking…a way of thinking which is in disagreement with that of other people. It can be of various origins. It may also be determined by a disease of the brain in which the morbid process develops very slowly (sluggish form of schizophrenia) so that its other manifestations remain imperceptible. Diagnostic difficulties increase if the subject relates in a formally correct way to the environment.” (Prof. N. Timofeyev).
In sluggish schizophrenia, the onset of the illness is often ‘insidious’, with the patient retaining full ability to function socially. The syndromes may include paranoid ideas in which the patient overvalues his own importance and exhibits grandiose ideas of reforming the world.
Demands that patients give up political convictions, via ECT, neuroleptics and sulfazin, led to some reciting the Party line, recorded as ‘fading away of delirious conceptions.’
Diagnostic reports on dissenters:
paranoid delusions of reforming society or re-organising the state apparatus; overestimation of his own personality; opinions have a moralising character; and poor adaptation to the social environment; paranoid development of the personality. ‘He expresses with enthusiasm and great feeling reformist ideas concerning the teaching of Marxist classics, revealing in the process a clear overestimation of himself and an unshakeable conviction of his own rightness.’
The presence of this form of schizophrenia does not presuppose changes in the personality noticeable to others the absence of symptoms of an illness can not prove the absence of the illness itself.
“Much evidence points to the conclusion that the core group of psychiatrists are indeed acting unethically and prostituting the medical profession. They have twisted psychiatric concepts and terms to fit the requirements of the state. Among the factors which help to explain their collaboration is their allegiance to the Communist Party to which most, if not all, belong. The party can rely on their total obedience; in return, the psychiatrists are given important jobs and reap the benefits of the good life: access to privileges not available to ordinary Soviet citizens such as foreign travel, a country cottage, high salaries, shopping in special stores selling luxury goods, and the like.” (Bloch et al, l977).

SUGGESTED GROUND RULES FOR AUSTRALIA:

  • Normal good manners and considerate treatment of someone who must be presumed to be ill. Avoid tactics that will prevent the development of rapport and ‘dehumanise’ the patient.
  • Recognition that mental battering of patient ‘to get the truth’ is a form of torture, and the ones that crack will be those who are most ill.
  • Obligation to get independent evidence on premorbid personality and functioning; descriptions of personality should be just that, and must relate to lifelong patterns.
  • Obligation to spend adequate time (one independent psychiatrist for 6-8 hours would be infinitely preferable to 3 on each side, and cheaper).
  • Obligation to obtain written statement from patient of information that is to be contested.
  • ‘Obsessional’ personality should be expected in most whistleblowers.
  • ‘Paranoid’ attitude should be accepted as normal (at work) once whistleblowers are being victimised.
  • Anger is a normal human emotion in response to adverse events, and should be accepted as such.

NSW Branch AMA Guidelines adopted April 1993;

It is unethical for a psychiatrist chosen by the employer to see an employee who has been forced to attend. In cases where there is a genuine need for employees to be treated, they must have the right to choose their own doctor, and the only communication from doctor to employer should be a statement on whether or not they are fit for work. Psychiatrists’ reports should be confidential to the patient and the patient’s GP. These guidelines are currently under attack from the Royal Australian and New Zealand College of Psychiatrists, who have described them as ‘unnecessary and offensive’. They particularly object to any parallel being drawn with the Soviet misuse of psychiatry – readers can decide for themselves whether such comparisons are justified.

More great chapters in the ebook – must read, must bookmark or download

  • Understanding the behaviour of victimised people:Every normal human being will experience a major nervous system malfunction given sufficient stress. This is because the brain has circuit breaker cells which shut down parts of the cerebral cortex when overloaded and overstimulated…
  • Bullying: A Whole School Response: In recent years concern about bullying in school has found expression in many countries throughout the world, and each in its way has set about devising approaches to reduce the extent of the problem. In Australia, parliament has taken a national lead with its publication of ‘Sticks and Stones: A Report on Violence in Australian Schools’ (March 1994).
    In New Zealand there has been a number of initiatives, none more significant and influential than the video and resource pack produced by the New Zealand Police (August 1992). It is called Kia Kaha, which means Stand Strong. The video uses role play to show students how to cope with bullies by either being more assertive or by using conflict resolution strategies.
    Many other countries also have valuable and successful initiatives, among them several European countries such as Norway, Sweden and Holland; whilst in the United Kingdom a number of programmes operate in England, Scotland and Northern Ireland…
  • What is bullying: It is important at this point we clarify what we mean by bullying because as indicated earlier the problem is frequently misunderstood by adults, whilst others hold too narrow or simplistic a view. The following definition by Roland (1988) is comprehensive:
    “Bullying is long-standing violence, physical or psychological conducted by an individual or a group and directed against an individual who is not able to defend himself in the actual situation.”…
  • Workplace violence towards whislteblowers: People of conscience who navigate through the workplace to compass bearings marked ‘integrity’, ‘public interest’, ‘fairness’ and ‘justice’, are not safe in Queensland.
    This paper reports on 102 whistleblowers in the Queensland Public Sector whose public interest disclosures transformed their workplaces from sites of occupational diligence and enterprise into chambers of horror…
  • When the mask slips: inappropriate coercion in organisations undergoing restructuring: This chapter outlines the conceptual approach to a study of inappropriately coercive behaviours by managers in organisations undergoing restructuring and their effects on employees health and well-being (McCarthy, Sheehan, and Kearns, 1995). This chapter also sets the scene for Michael Sheehan’s reporting of experiences of bullying managerial behaviours by interviewees in the chapter immediately following…
  • When the mask slips: case studies in organisational restructuring: In the previous chapter Paul McCarthy discussed the theoretical framework of our ongoing research into inappropriately coercive behaviour in organisations undergoing restructuring. (McCarthy, Sheehan, and Kearns, 1995). This chapter describes some of the results of the study so far.
    Forty interviews of approximately one hour’s duration were conducted with a sample of participants from several public and private sector organisations undergoing restructuring programs in the past three to five years…
  • Psychological abuse in the workplace: When are actions, dismissed in the workplace as ‘culturally acceptable behaviour’, ‘office politics’, ‘adjustment to culture’, ‘initiation to regime’, and ‘mentoring’, really abuse of power in the workplace?
  • Bullying and psychiatry: As a preface to Jean Lennane’s chapter on bullying in medico-legal examinations, I’d like to make a few comments about bullying and psychiatry. Psychiatry has an element of bullying to it more than most other medical specialties but bullying is also present in the professions of teaching and law…
  • Where have all the bullies gone? I stand before you in a mild state of identity confusion, a little unsure whether to speak to you as a psychiatrist or a journalist, or as a victim or a bully…
  • Domestic violence, bulling at home: I will be focusing on domestic violence which is obviously a form of bullying. It is often taken to mean violence between men and women living in heterosexual relationships but it also includes violence in other close relationships and shared households such as homosexual couples, dating violence, and violence towards relatives other than the spouse or partner…

 

 

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Sourced by our very busy co-author Trinny (who’s on a RTW plan and studying) with great thanks 🙂

 

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One Response to “About bullying in medico-legal examinations, workplace bullying, whistleblowing and much more”

  1. Thanks Trinny

    I appreciate the evidence based approach to these issues.  Its sad that politicians rarely take this evidence into account.  My intention all along in completing a degree is applied social science has been to promote a more scientific and evidence based approach.  It is only when these facts are incorporated into policy formulation and management that systems will ever improve.    As it stands outdated biases and faulty assumptions continue to dominate – we only have to look at the failures of anti-bullying legislation and workers compensation systems to see that policy doesn’t reflect reality and are therefore doomed to ongoing failure.