Adaptation pathologised: ‘Adjustment Disorder’ and its consequences

Dr Eric Ratcliff1

1Private Practice, Launceston, Australia

Among the many unintended consequences of the DSM system of psychiatric nosology are those that have resulted from the conceptual shift from ‘situational reactions’ to ‘Adjustment Disorders’. This has resulted in the reification of a diverse range of responses to adversity. Common-sense clinical assessments of the causes and features of such responses have been overtaken by the demand of administrators for a statistical category, and that has had consequences in the forensic realm. Concepts such as ‘pain and suffering’ used in common law have been replaced by statutory requirements for a recognised illness diagnosis in legislation and regulation concerning accident and workers’ compensation. This has fostered the medicalisation of many normal and expectable reactions, and has arguably increased and prolonged the resulting disability in many cases. The clinical respectability and relevance of such ‘diagnoses’ needs questioning.

The paper traces the emergence of the concept of Adjustment Disorder, and examines a sample of workers’ compensation cases seen in recent civil forensic practice. A  number of feature are sufficiently prevalent to suggest the emergence of a  syndrome that looks at least as consistent as the many manifestations of PTSD, but there is reason to suspect that these are currently and culturally conditioned, and in part a consequence of medicalisation.


Biography:

MANZCP 1976, FRANZCP 1981, Member College Council 1983-1991,  1993-1999, 2012-2013, Chair Clinical Practice Advisory Committee/Ethical Practice Committee 1988-2007. College Medal of Honour 2006. OAM 2004. Senior Regional Psychiatrist Northern Tasmania 1976-1985, Private Consultant Practice General Adult Psychiatry, Forensic Psychiatry 1985-2018. Foundation Member RANZCP Faculty of Forensic Psychiatry.