physical symptoms; pre-existing psychiatric problems; disability or symptoms which appear out of proportion to the injury; additional stressful events; persistent severe pain; non specialist psychiatric opinions.

68 Introduction

68.1 The psychological impact of whiplash injury should be understood in the context of what is known about the impact of all physical disorders, and particularly of trauma. It is also useful to consider it in an even wider context as a particular form of stressful life event. These are well known to precipitate psychological and psychiatric problems in the absence of physical injury. An informed opinion on legal issues relating to psychological factors in whiplash cases requires knowledge and experience in psychiatry as a whole and of a number of general points.

68.2 Severity of suffering It is frequently asserted that assessment of mental aspects of personal injury is less satisfactory, and much more suspect, than the assessment of the physical problems. Whilst it is undoubted that some psychiatric reports (like some medical reports) are unconvincing and of poor quality, there is a very substantial body of expertise which enables rigorous and quantitative assessment of distress and disability. The assessment of the effects of psychiatric disorders on everyday life is, in fact, no different to the assessment of the impact of physical symptoms and limitations.¹

68.3 Reliability of psychiatric assessment There is also a widespread tendency to assume that psychiatric consequences of physical illness are less significant than more immediately conspicuous physical limitations and handicaps. This view is erroneous. There is consistent and compelling evidence that psychiatric disorders have effects on quality of life which are often greater than those of disabling chronic physical problems.² The anguish and hopelessness of severe depression is said by those who have experienced it to be greater than could be imagined for most physical conditions.

68.4 Outcome: a comprehensive view Psychologically determined