Constructing RSI: Belief and Desire
By Yolande Lucire
UNSW Press 2003, 216 pp.
"Into the 1920s, neither lack of therapeutic success nor weakness of theoretical
justification deterred reputable surgeons from removing the uterus as a treatment
for hysteria".
Our language belies our cultural history. It is no linguistic accident that
this particular surgical procedure is called a hysterectomy.
Plus ca change? Is the same true for the way the epidemic of repetitive strain
injury was medicalised a decade or so ago?
One should be quite clear that Dr Lucire, a Sydney forensic psychiatrist,
is not arguing that RSI is all in the mind. She is adamant that many victims
are suffering real and debilitating symptoms. What she is arguing is that on
the basis of the evidence (historical and case studies), she has meticulously
collected and analysed, these symptoms are seldom the result of physical injury
and that repetitive strain at work is a most inconsistent (and therefore unlikely)
cause.
Many readers will be confronted by her polemics.
In summary, Lucire posits that what is consistent and therefore more likely,
is that RSI is a physical manifestation of large and unresolved personal problems
and stress, at home or at work, or a conflict between the two. For this reason
she argues that it strikes women much more than men, and the weak more than
those in greater control of their situations.
Making RSI a 'compensatable' disease, provided a way out for the trapped and
a resolution for the conflicts in intolerable situations. She also argues that
the trade unions pursued a worthy aim for the wrong reasons, in that they successfully
exploited RSI as a lever for winning better physical conditions in the workplace.
Even a sociologist as gentle as ANU's Andrew Hopkins took umbrage at that
thought, and Lucire quotes him as saying in a learned journal; "her epistemology
is akin to that of a religious believer", and "anyone who could seriously
expect feminists to be persuaded by this argument needs to see a psychiatrist".
He was (and is) not alone in his vehement criticism of Lucire's thesis. I was
an inaugural member of the National Occupational Health and Safety Commission
in 1984, (later Worksafe Australia), representing the ACT on behalf of the Federal
Minister for Territories. I witnessed the enthusiasm for the medicalisation
of RSI.
A major bone of her contention is with the medical fraternity whose surgical
interventions to treat RSI, she reports as about as successful as those of the
earlier surgeons (with hysterectomy) for hysteria. At least for her, the medicos
have damaged only their own patients. The lawyers involved have damaged society.
Dr Lucire's major attack is on the continuing acceptance of 'junk' science
as expert evidence in the courtroom, in particular the High Court-room where
(RSI) cases like "Abalos" reign in infamy in forensic science circles
and are used to frighten their children. In the US jurisdictions, scientific
evidence must be in a form that is refutable, that is capable of being tested
as to its truth or falsehood. In Australia, truth is in the eye of the beholder
who happen to be judges and juries. Expert evidence can be judged by the demeanour
of the witness. Truth as a social construct is hard on physical scientists,
even if we accept that justice is so construed.
Both Dr Lucire and I are both members of the Australian Academy of Forensic
Science, which is a professional society of jurists, medicos and scientists
of widely spread persuasions, dedicated to a better understanding of each other.
This book is a solid read with a very useful glossary of terms and makes a very
significant contribution towards the Academy's aim.
emeritus Professor Ben Selinger FTSE, FRACI
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