Book Review
Constructing RSI: Belief and Desire
Yolande Lucire
University of New South Wales Press, Sydney, 2003, softcover,
216 pp; ISBN 0 86840 778 X.
Dr. Lucire has an outstanding ability to recognise false beliefs and invalid
fashions early in their appearance. She acts, searching the literature to find
corresponding falsities in the most remarkable of places, assessing patients
in large numbers, refuting diagnoses fearlessly regardless of the authority
she faces and making known the rational conclusions in no uncertain terms in
the fora where they receive intense attention. The epidemic from 1982 to 1987
in Australia of the pseudo-illness known as repetitive strain injury (RSI) features
as just one, but the most intense, of her public crusades.
Her book comes well after events have proved her correct. Probably more
than any other single individual in Australia she helped to bring the epidemic
to a relatively speedy and well-deserved demise. Perhaps the massive, far
more prolonged and expensive epidemic in the United States at present persists
for lack of a similar personality there. She says very little about the threats
and indignities which she had to endure and the efforts to prevent her from
continuing her work. Other assessors who shared her convictions faced similar
attacks, but none as fierce as those which she fended off.
She relates much information about the unworthy intrigues and bumbling at
the level of government, the National Health and Medical Research Council,
the National Health and Occupational Commission, the Health Commission, trade
unions, professional organisations and last, but certainly not the least,
the legal tribunals up to the level of the High Court. Her loyalty to the
Labor party makes her observations, expressed with sorrow rather than anger,
about the self-defeating tactics of trade unions all the more telling. The
patients dictate the belief, the doctors legitimate it and the courts open
the gates by failing to differentiate invalid belief from reality. Many judgment
converted falsity to the law's version of the facts, convicted innocent people,
organisations and processes by attributing false cause to an event. "There
can be no justice based on falsehood."
Her story tells a tale of how a pseudo-illness established itself and spread.
Her research uncovers previous episodes over more than a century, the philosophical
probings of what actuates pseudo-illnesses and the part that the professions
play in their creation. Her historical analysis of illness and the ideas
about it provides a valuable resource. Therapists do not devise the precise
pattern of the iatrogenesis that they commit. They follow the lead of their
somatising patients, legitimate their aspirations to benefit and collect the
rent from invalid treatment pursued hopelessly for as long as the claimant
can make someone pay. And they do this in complete sincerity, led by their
belief in the pseudo-illness, which satisfies their patient's desire. She
names many who remain respected authorities.
Despite the sordid realities of her tale, Lucire maintains her faith in the
patients and institutions. She recognises the desperate predicaments of most
of the patients she assessed. They clutched at the assistance society offered.
But all in some way exploited the gullibility of society. Most failed to
reveal the real problems in their lives. At least 20% of her subjects practised
deliberate deception. So too did their doctors. One made a gynaecological
diagnosis requiring surgery and at the same time gave a certificate for RSI
so that the patient need not erode her sick leave. She took four years.
Some patients achieved double dipping, gaining compensation for whiplash after
a motor vehicle accident before advancing a claim for RSI. One learned to
play the violin while claiming to be unable to type. Almost all of a group
seen in the UK had an established history of somatisation.
The text does have weaknesses. Do not let the vagueness of the preface put
you off. The meat follows shortly after and continues throughout. Do not
cavil at recurrent failures to bring home an argument, which promotes ideology
rather than science. Like her subjects, Lucire also has her beliefs and desires,
not the least of which is her reluctance to stigmatise the patients whose
foibles she exposes. She subscribes to the faith that somatisers feel pain
just as fiercely as those who have real illness.
She reaches sounder ground with her clinical observations. We can recognise
pseudo-illness. The truly ill do not welcome a gloomy prognosis and cherish
it against all reason. In contrast, somatisers seek out the physician prepared
to diagnose a hopeless condition. They remain loyal while interminable treatment
provides no benefit. They continue as long as they need the authentication
which the profession endows on their claim.
David S. Bell
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