The Sword of Damocles

Whiplash: Medicalization of a Minor Injury?

Why on earth would whiplash victims in Saskatchewan suddenly begin recovering from their injuries en masse at a faster rate? According to Dr. Nortin Hadler, it happened right after the Canadian province instituted a “no-fault” insurance system that eliminated court awards for pain and suffering.

Hadler, in his fascinating book “Stabbed in the Back: Confronting Back Pain in an Overtreated Society”, describes “Whiplash-Associated Disorders” (WAD) in this way:

“WAD hangs over the necks of drivers in the United States, Canada, Switzerland and many other resource-advantaged countries like the sword of Damocles.”

Damocles, for those who forgot their Greek history, was a citizen of the kingdom of Syracuse who professed a wish to live like his king for the day. While dining at a sumptuous feast, he looked up and noticed a sharpened sword hanging by a horse hair over his head, placed there by the king to instruct his subject about the constant threats faced by those in power.

Hadler, citing numerous studies in his densely-footnoted book, argues that the injury of whiplash, which often leads to long-term disability in countries with legal systems that enable large monetary awards, is a socially-constructed disease that results from “medicalization” of a minor injury.

He says its treatment often starts with a diagnosis intended to maximize an insurance settlement, detailing serious, ” irreparable harm” to the spine.

“Some learn to fear this outcome by virtue of being offered early, aggressive care, which correlates with delayed recovery,” Hadler writes. “…Furthermore, many have an unshakeable belief that WAD is their likely fate from the outset.”

If this story of diagnosis-driven symptoms and outc0mes seems familiar to you, it’s because I’ve written about it before, when reviewing the work of Dr. John Sarno (see Living a Lie, Excavating a Diagnosis, Back Pain Zombies, Getting my Mojo Back and It’s All in Your Head). Sarno believes that patients who are told they have debilitating “structural” spine problems that may lead to lifetime disability truly internalize their diagnoses, beginning long, torturous self-fulfilling prophesies encouraged by unnessessary treatment and coddling of minor injuries.

Hadler’s views on whiplash dovetail with Sarno’s, but Hadler takes it a step further to address the diagnosis of general back pain as well (a problem he’s also convinced is largely “treatment-induced”.)

“A remarkable number of these socially constructed diseases relate to the regional musculoskeletal disorders, regional back pain in particular,” Hadler says.

And it isn’t just the neurosurgeons and orthopedic surgeons who are driving this counterproductive process – Hadler also criticizes the “alternative” medical field for foisting untested, costly treatment on the public.

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3 responses to “The Sword of Damocles

  1. Chris, another great posting to your blog. The psychological side of back pain and surgery can also be seen in a study on knee surgury. Patients that received a placebo surgery for their knee pain showed the same level of improvement than patients that had costly arthroscopic procedures. http://www.medscape.com/viewarticle/438238

    • Matt, that’s a fascinating correlation, thanks for adding to the discussion! I think it makes sense that surgery delivers a powerful placebo effect – I think the problem with back surgery is not only cost, as you mentioned, but also the risks associated with any kind of surgery near your spine, including paralysis, infection or scar tissue.

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