[Causal relations of occupational psychiatric disability]

This article discusses a problem that is relatively common in psychiatric practice, but almost non existent in the literature i.e., an occupational disability arising from a psychological trauma. This inquiry focuses on an area in which millions of dollars a year are at stake. Legislative and administrative authorities are increasingly demand that psychiatrists define objective criteria on which legislators can base decisions in contentious cases. What is the connection between the trauma and the current disability, and what is the risk of reoccurrence? Will the employee be able to resume his or her former duties? It quickly becomes clear that clinical, administrative and legislative realities are often incompatible. This article will therefore provide an overview of the subject in a historical perspective, and to orient the reader, will briefly describe the legislative context in the US and Quebec, as well as the role of the expert in assessing causality. We will attempt, by means of an overall conceptual model, to provide a synopsis of the usual procedure in this type of expert assessment.