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COVID-19 Psychopathology: Normal or Mental Injury?

    It’s no secret that vast numbers of people are getting anxious, depressed and experiencing a variety of psychologically produced physical symptoms as a result of the coronavirus pandemic. One cause of these symptoms is the fear of illness to themselves, relatives and friends. Another cause is the disruption of their lives caused by occupational events such as fellow employees coming down with the illness and the potential of becoming infected as a result. Yet, another cause is the potential of their employer either temporarily or permanently closing their doors resulting in unemployment and an inability to provide for loved ones. 

    In the area of workers’ compensation, one has to be concerned with whether or not the above-described circumstances constitute a mental health injury as defined by the Labor Code and/or legal regulations. The key here is the definition of a Mental Disorder. In this regard, the DSM-IV-TR is very clear in stating that in order to be a disorder the condition “must not be merely an expectable and culturally sanctioned response to a particular event.” According, if the person who has anxiety, depression or psychosomatic symptoms is found to have a normal, expectable, reasonable and understandable reaction to their environmental circumstances at work they have not had a compensable psychiatric disorder regardless of how much anxiety, depression and psychosomatic symptoms they may be having. 

    Now, the most important question is: How is what is “normal, expectable, reasonable and understandable” defined? The answer is this is a matter of clinical judgment. It is up to the doctor to decide what is normal. Is it normal to get fearful, worry, get depressed and have a variety of physical symptoms such as heart palpitations, diarrhea and cold sweats or are these normal reactions to the environment? 

    That’s where a competent complete examination will help the doctor, the attorneys and the court come to a reasonable conclusion. 

    Specifically, the doctor must take a complete history of the patient’s symptoms, including information about their frequency, intensity, duration, onset and course over time. The doctor must also take a complete history of what occurred in the workplace that could have produced those symptoms. Then, they must decide if the work occurrences have, in all reasonable medical probability, caused those symptoms. Without that history the doctor’s report is deficient and neither the attorneys nor the court can decide if there has been a psychiatric injury. 

    Additionally, just for completeness, I should point out that the doctor should also give a battery of psychological tests that are headed by an instrument such as the Minnesota Multiphasic Personality Inventory (MMPI) capable of determining if the claimant is providing credible historical data and has the symptoms described during the interview. There must also be Mental Status Examination observational data backing up those symptoms. In addition, it would be helpful to have some medical and/or employment records to back up the patient’s history. 

    In short, in order to conclude that a claimant has had an industrially produced psychiatric injury in the form of a reaction to the coronavirus pandemic the doctor’s report must include: 

1. A history demonstrating the existence of aversive symptoms or complaints. 

2. A history of occupational events that could cause those symptoms. 

3. The doctor’s conclusion, backed up by clear logical reasoning, indicating whether the patient’s reactions were normal, understandable, reasonable and expectable for what occurred, or not. 

4. Psychological testing data demonstrating the patient is a credible historian. 

5. Mental Status Examination data support the patient’s complaints. 

6. Lastly, any available medical and/or occupational data supporting the patient’s history. 

    In summary, in situations where you suspect the doctor has not provided sufficient evidence in their report to support their conclusions you should come up with a series of questions to use in exposing the report’s flaws on cross-examination. That’s where my expertise in reviewing and critiquing psych reports and providing cross-examination questions exposing the flaws in psych reports will be useful to you! Call my office (844) 444-8898 or email us at drleckartwetc@gmail.com for more information.

Location: Los Angeles, CA, USA

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