Case Name: DEZIEL v. DIFCO LABORATORIES, INC (AFTER REMAND); BAHU v. CHRYSLER CORPORATION; MacKENZIE v. FISHER BODY DIVISION, GENERAL MOTORS CORPORATION
Court: Michigan Supreme Court
Jurisdiction: Michigan
Decision Date: 1975-08-19
Citations: 403 Mich. 1
Docket Number: Docket Nos. 54825, 54879, 55072
Parties: DEZIEL v DIFCO LABORATORIES, INC (AFTER REMAND) BAHU v CHRYSLER CORPORATION MACKENZIE v FISHER BODY DIVISION, GENERAL MOTORS CORPORATION
Judges: Kavanagh, C.J., and Williams and Levin, JJ., concurred with Blair Moody, Jr., J.
Reporter: Michigan Reports
Volume: 403
Pages: 1–62

Head Matter:
DEZIEL v DIFCO LABORATORIES, INC (AFTER REMAND) BAHU v CHRYSLER CORPORATION MACKENZIE v FISHER BODY DIVISION, GENERAL MOTORS CORPORATION
Docket Nos. 54825, 54879, 55072.
Argued June 4, 1974
(Calendar Nos. 1-3).
Decided August 19, 1975.
394 Mich 466.
Argued on resubmission after remand March 2, 1977
(Calendar Nos. 9-11).
Decided July 17, 1978.
Rehearing denied as to Deziel and MacKenzie post, p 955.
These cases concern the compensability of psychiatric injuries under the Worker’s Disability Compensation Act. In each case, there was no dispute that the claimant suffered a work-related personal injury and that the claimant was disabled, and no dispute that the claimant honestly, though perhaps mistakenly, perceived that the disability was caused by the personal injury. The Supreme Court remanded the cases to the Workmen’s Compensation Appeal Board for clarification of the decision of each case and retained jurisdiction. After clarification the Supreme Court ordered the appeals resubmitted.
Mary Deziel claimed workmen’s compensation against her employer, Difco Laboratories, Inc., asserting she cannot work because of pain in .the back of her eyes, anxiety, headaches, tiredness, and occasional dizziness, nausea and tightness in the chest. No physical cause for these symptoms has been found. The referee awarded compensation, finding that an accident at work aggravated a pre-existing latent mental disorder culminating in total occupational disablement. The appeal board reversed the referee. The Court of Appeals, Bronson, P.J., and Quinn and Danhof, JJ., denied leave to appeal (Docket No. 16185). Plaintiff appealed. On remand the appeal board held that it had not been shown that plaintiff Deziel’s disability had been aggravated by her work.
References for Points in Headnotes
[1, 3, 10] 82 Am Jur 2d, Workmen’s Compensation §§ 240 et. seq., 301, 302.
[2, 16] 82 Am Jur 2d, Workmen’s Compensation §§ 301, 302, 333, 337, 507, 516.
[4-8, 14, 15] 82 Am Jur 2d, Workmen’s Compensation § 301.
[9] 81 Am Jur 2d, Workmen’s Compensation § 29.
82 Am Jur 2d, Workmen’s Compensation § 296.
[11, 12] 82 Am Jur 2d, Workmen’s Compensation §§ 547, 635.
[13] 82 Am Jur 2d, Workmen’s Compensation §§ 568, 616, 642.
Yusuf Bahu claimed workmen’s compensation against his employer, Chrysler Corporation, alleging inability to work because of pain in his back, neck and arm. At the hearing, plaintiff’s psychiatrist said that Bahu’s physical pain was caused by preexisting personality factors and the precipitating events of a stressful job situation at Chrysler. Defendant’s psychiatrist said the pain was not caused by or aggravated by his work at Chrysler, but rather that Bahu’s personality makeup was fragile when he came to Chrysler and he subconsciously attached his life’s troubles to the event of the work-related injury. The referee awarded compensation. The appeal board reversed. The Court of Appeals, J. H. Gillis, P.J., and Bashara and O’Hara, JJ., denied leave to appeal (Docket No. 16600). Plaintiff appealed. On remand the appeal board adopted its former dissenting opinion finding that the injury was job-related because the job provided the plaintiff the “hook” on which he could hang his troubles and awarded benefits to the plaintiff.
Howard K. MacKenzie claimed workmen’s compensation against his employer, General Motors Corporation, Fisher Body Division. Plaintiff’s psychiatrist testified that MacKenzie suffered from a long-standing personality defect of compulsive perfectionism that centered on his job, and that eventually the job pressures disabled him. Defendant’s psychiatrist testified that it was MacKenzie’s perfectionistic need in conflict with the impairments of aging that produced his anxiety and that although MacKenzie perceived the stresses of the job as causing his anxiety those stresses were usual occurrences and did not cause his emotional problems. The referee awarded compensation finding that, although the stresses of the job were not great enough to cause ill effects in an average person, the stress did cause MacKenzie to become disabled. The appeal board reversed. The Court of Appeals, R. B. Burns and Van Valkenburg, JJ., affirmed (Bronson, P.J., dissenting) (Docket No. 14695.) 48 Mich App 175; 210 NW2d 357 (1973). Plaintiff appealed. On remand the appeal board adhered to its previous position: it found that MacKenzie’s illness arose from an imagined or hallucinated stimulus that had not been proven to exist except in his own mind. It found he had a predisposition to the mental condition and internal stimulus that eventually caused his disablement. Held:
1. An injury, whether physical or mental, must arise out of and in the course of employment to be compensable under the Worker’s Disability Compensation Act. The question of fact is whether the claimant’s employment aggravated, accelerated or combined with some internal weakness or disease to produce the physical or mental personal injury Which disabled him.
2. Workmen’s compensation law permits compensation for disabilities and injuries rooted in psychoses which are "causally” established as arising "out of and in the course of” the employment relationship. These cases involving mental conditions have generally been divided into three groups: a mental stimulus which has a physically disabling effect, a physical trauma or stimulus which results in a mental condition, and a mental stimulus which results in a mental condition. Althóugh other jurisdictions are split on the compensability of the third type of Case, in Michigan workmen’s compensation may be awarded for any of the three types of cases.
3. In the instant cases it is clear, after remand, that the three plaintiffs are "disabled” within the meaning of the statute and that they are disabled on account of some "personal injury”. The questions are whether the Workmen’s Compensation Appeal Board Used the correct standard in determining whether the plaintiffs’ employment aggravated, accelerated, or combined with some internal weakness or disease to produce the disability, and whether the appeal board correctly applied the standard.
4. In cases involving mental (including psychoneurotic or psychotic) injuries, once a plaintiff is found disabled and a personal injury is established, it is sufficient that a strictly subjective causal nexus be factually established, i.e., that the claimant honestly perceives some personal injury incurred during the ordinary work of his employment "caused” his disability. This standard applies where the claimant alleges a disability resulting from either a physical or mental stimulus and honestly, even though mistakenly, believes that he is disabled due to that work-related injury and therefore cannot resume his normal employment.
5. Any objective standard would not suffice; the inherent nature of psychoneuroses and psychoses is subjective, case law impliedly requires a subjective standard, and statutory construction requires that remedial legislation, such as workmen’s compensation acts, be construed liberally. The Workmen’s Compensation Appeal Board and its referees have the ability to detect malingerers at the fact-finding level. In fact, conscious simulation of a mental disorder by a claimant may be easier for the finder of fact to detect than certain feigned physical inju ries such as "whiplash” or back injury. Detection of falsified mental disability claims may be difficult if the testimony of expert witnesses is biased or perjured, but this difficulty may also exist in physical disability claims.
6. Almost all psychoneuroses and psychoses are, to some degree, latent in origin. The claimant’s predisposition to such disabilities usually can be traced to childhood. Therefore, a "but-for” or other objective proximate causation test would not be helpful in determining whether the claimant’s employment combined with some internal weakness or disease to produce the disability. In most cases multiple psychodynamic factors are involved; therefore, it is almost impossible to weigh the causal significance of any one factor. These mental conditions take on so many shades and forms that there is no logical pattern conforming to any objective test of legal causation.
7. These mental illnesses constitute, by definition, subjective injuries and disabilities. That is, they may only exist within the minds of the victims, as disorders which are rooted in unconscious mental causes. The victim’s disturbed perception of reality is not, however, imaginary to him. Therefore in most cases the question of whether there is an objective causation is unanswerable.
8. The primary goal of workmen’s compensation is to compensate a worker for his disability loss. When there is doubt as to the standard of causation which might lead a court to deny recovery under tort law, the notion of causation should be interpreted progressively or liberally. The Workmen’s Compensation Appeal Board and its referees, with the assistance of expert witnesses, will continue to be charged with the fact-finding function of detecting any falsified claims,
9. It is clear to the Court that in Deziel and MacKenzie, if the board had used the subjective standard it would have awarded the plaintiffs compensation. In these cases, there is no competent evidence to support the finding of the Workmen’s Compensation Appeal Board that the plaintiff’s employment did not aggravate, accelerate or combine with some internal weakness or disease to produce the disability. The undisputed evidence, testimony by the expert witnesses for each of the parties, was that the plaintiffs honestly perceived their work-related personal injuries to be the cause of the disability. The Workmen’s Compensation Appeal Board cannot draw inferences contrary to the undisputed evidence.
10. In Bahu the Workmen’s Compensation Appeal Board correctly used the subjective standard in establishing the causal nexus. The expert witnesses for both parties agreed that the plaintiff actually believed that his disability was caused by the work-related personal injury.
The order of the Workmen’s Compensation Appeal Board on remand is affirmed as to plaintiff Bahu, and the orders are vacated and the cases remanded for further proceedings as to plaintiffs Deziel and MacKenzie.
Justice Coleman, joined by Justices Fitzgerald and Ryan, dissented on the ground that application of the Court’s "honest perception” test for causal nexus in cases where the disability and personal injury are established would result in an award of compensation for virtually all, if not all, claims based on mental disorders. If the claimant perceived that the job caused the problem, even if this were not true, the employer would be liable. The new formulation ignores both the fundamental nature of these mental disorders and the statutory requirement that causal nexus be factually established. The opinion of the Court also takes away the fact-finding role of the Workmen’s Compensation Appeal Board and substitutes the Court’s findings of fact prior to a second remand of these cases. A valid analysis of the causal nexus between mental disability and occupational trauma requires a basic understanding that most psychotic and neurotic states do not have a single cause in fact, but are emotional disorders with a pre-existing, extremely complex, etiology originating in childhood. Symptoms are usually preceded by some form of trauma, however minor; but the relationship between the trauma and symptoms is more chronological than causal. The claimant who suffers from a neurotic state is aware, on either a conscious or a subconscious level, of the inner conflicts and emotional weaknesses; but he is unable or unwilling to recognize and resolve these problems. The disorder is an unconscious attempt at resolution. The claimant may be consciously aware of only the work-related trauma, no matter how trivial, as the cause of his disorder and may incur a "secondary gain” by attributing causation to employment (e.g., a person who dislikes the work or who, because of the aging process, is no longer psychologically able to do it is given the opportunity to cease working, end fiscal responsibility, obtain financial compensation and create a socially acceptable excuse for not working). A neurotic personality, not recognizing reality, is predisposed to "honestly perceive” a causal connection between a work-related injury and the disability. Adoption of this test only invites confusion, difficulty for the finder of fact and increased arbitrariness in workmen’s compensation cases. The relevant inquiry should be whether the claimant’s employment did, in fact, aggravate, accelerate, or combine with some internal weakness pr disease in some substantial degree to produce the disability. The Court should not disturb the findings of fact made by the Workmen’s Compensation Appeal Board upon directions from the Court on remand.
Opinion op the Court
1. Workmen’s Compensation — Work-Related Injury.
Any injury, whether physical or mental, to be compensable under the Worker’s Disability Compensation Act, must arise out of and in the course of employment (MCL 418.301; MSA 17.237[3Q1]).
2. Workmen’s Compensation — ’Work-Related Injury — Mental Disorder — Pre-existing Condition.
A worker is entitled to workmen’s compensation benefits for a mental disorder or injury which disables him where his employment aggravated, accelerated or combined with some preexisting internal weakness or disease to produce the injury which disabled him (MCL 418.301; MSA 17.237[301]).
3. Workmen’s Compensation — Work-Related Injury — Mental Disorder.
The Worker’s Disability Compensation Act permits compensation for physical or mental disabilities and injuries rooted in psychoses which are causally established as arising out of and in the course of the employment relationship (MCL 418.301; MSA 17.237[301]).
4. Workmen’s Compensation — Work-Related Injury — Mental Disorder — Subjective Test.
A worker is entitled to workmen’s compensation benefits for a mental disorder where he is found to be disabled, the occurrence of a personal injury is established, and it is factually established, by a strictly subjective causal nexus, that the worker honestly, though perhaps mistakenly, perceives that a physical or mental personal injury incurred during the ordinary work of his employment caused his disability and that he therefore cannot resume his normal employment, (MCL 418.301; MSA 17.237[301]). '
5. Workmen’s Compensation — Work-Related Injury — Mental Disorder — Subjective Test.
Any objective causal standard for determining whether a worker’s mental disorder is work?related would not suffice for workmen’s compensation claims which allege psychoneurotic or psychotic disabilities and injuries because almost all psychoneu roses and psychoses are, to some degree, latent in origin and a claimant’s predisposition to such disabilities usually can be traced to childhood; these mental disorders take so many forms that they show no logical pattern vis-a-vis any objective test of legal causation (MCL 418.301; MSA 17.237[301]).
6. Workmen’s Compensation — Psychoses—Psychoneuroses—Words and Phrases — Mental Health.
Psychoses and psychoneuroses are mental disorders which are rooted in unconscious mental causes; persons suffering from these disorders develop personality problems which make it difficult for them to adapt to reality either because perception of reality is distorted or, in the worst psychotic cases, lost.
7. Workmen’s Compensation — Work-Related Injury — Mental Disorder — Subjective Test.
The disturbance which a psychoneurotic or psychotic workmen’s compensation claimant experiences is not imaginary to him, although his perception of reality may be unrealistic or mistaken; the subsequent incapacity is as real to the claimant as that resulting from a clearly discernible physical disability and must be examined under a strictly subjective standard in determining whether the claimant’s employment combined with some internal weakness or disease to produce the disability.
8. Workmen’s Compensation — Work-Related Injury — Mental Disorder — Subjective Test — Case Law.
Michigan case law impliedly requires the use of a subjective standard in determining workmen’s compensation claims arising out of mental injuries resulting from nervous or mental stimuli.
9. Workmen’s Compensation — Statutory Construction.
Remedial legislation, such as the Worker’s Disability Compensation Act, should be construed liberally (MCL 418.101 et seq.; MSA 17.237[101] etseq.).
10. Workmen’s Compensation — -Work-Related Injury — Causation —Torts.
The primary goal of workmen’s compensation legislation is to compensate a worker for his disability loss; therefore, only a very general theory of causation, that the injury and disability must arise "out of and in the course of’ employment, applies to such claims and workmen’s compensation is often awarded on facts which might lead a court to deny recovery under tort law (MCL 418.301; MSA 17.237[301]).
H. Workmen’s Compensation — Mental Disorder — Falsified Claims —Question of Fact.
Conscious simulation of a mental disorder by a workmen’s compensation claimant may be easier for the finder of fact to detect than certain feigned physical injuries such as "whiplash” or back injury.
12. Workmen’s Compensation — Mental Disorder — Falsified Claims —Question of Fact.
The detection of falsified workmen’s compensation claims for a mental disorder is a question of fact which must be left to the Workmen’s Compensation Appeal Board and its referees, with the assistance of expert witnesses.
13. Workmen’s Compensation — Appeal and Error — Finding of Fact.
An order of the Workmen’s Compensation Appeal Board is reversed where there is no competent evidence to support the appeal board’s finding of fact; the appeal board cannot draw inferences contrary to the undisputed evidence (Const 1963, art 6, § 28).
Dissenting Opinion by Coleman, J.
Fitzgerald and Ryan, JJ.
14. Workmen’s Compensation — Psychoses—Neuroses—Words and Phrases — Mental Health.
Most neurotic and psychotic states do not have a single cause-in-fact; they are emotional disorders with a complex etiology originating in childhood and although symptoms are usually preceded by some form of trauma, reality is not recognized and the relationship between the trauma and symptoms is more chronological than causal.
15. Workmen’s Compensation — Work-Related Injury — Mental Disorder — Subjective Test.
Adoption of a "honest perception” of the claimant standard for determining whether a mental disorder is, in fact, work-related only invites confusion, difficulty for the ñnder of fact and increased arbitrariness when determining employers’ responsibility for workmen’s compensation benefits (MCL 418.301; MSA 17.237[301]).
16. Workmen’s Compensation — Work-Related Injury — Mental Disorder — Causal Connection.
The inquiry in a claim for workmen’s compensation beneñts for a mental disorder should be whether the claimant’s employment did, in fact, aggravate, accelerate or combine with some internal weakness or disease in some substantial degree to produce the disability (MCL 418.301; MSA 17.237[301]).
Kelman, Loria, Downing, Schneider & Simpson for plaintiffs Deziel and Bahu.
Levine & Benjamin, P.C., for plaintiff MacKenzie.
LeVasseur, Werner, Mitseff & Brown (by Grahame G. Capp) for defendants Difco Laboratories, Inc., and Michigan Mutual Liability Company.
Lacey & Jones (by Francis L. Sylvester) for defendant Chrysler Corporation.
Plunkett, Cooney, Rutt, Watters, Stanczyk & Pedersen (by Edward K. Pedersen and Jeannette A. Paskin; Frazer F. Hilder, General Counsel, and Thomas W. Watkins and James A. Durkin, of counsel) for defendant General Motors Corporation.

Opinion:
After Remand
Blair Moody, Jr., J.
We originally granted leave in these three cases and directed that they be argued and submitted consecutively because they all concern aspects of the same problem: when and under what conditions alleged mental disorders (including psychoneuroses and psychoses) are compensable under the Worker's Disability Compensation Act of 1969 (the Act). 394 Mich 466; 232 NW2d 146 (1975).
However, after hearing extensive oral argu ments, examining the briefs and reviewing the record, and upon reading the opinions of both the referees'and Workers' Compensation Appeal Board (the WCAB), this Court determined that in each case certain vital factual findings had been omitted by the WCAB. Therefore, we had no choice but to remand each case to the WCAB for amplification of its factual findings (retaining jurisdiction).
Upon remand, we informed the WCAB that we were not convinced that it had properly construed the law as it applies to mental disabilities of the character involved in these cases. The Court stated that for any injury to be compensable it must arise "out of and in the course of' employment. MCLA 418.301; MSA 17.237(301). In cases such as these, which involve an alleged pre-existing mental condition, the question of whether a disability arose out of the employment should be resolved by establishing a work nexus.
Furthermore, the legal principle to be applied by the WCAB is set forth in Larson's treatise on Workmen's Compensation Law, § 12.20, p 3-231, whether
"the employment aggravated, accelerated, or combined with the disease or infirmity to produce the disability".
This Court then gave the WCAB a three-step test to apply in resolving the questions of fact and law relating to compensability in these cases:
"D Is the claimant disabled?
"2) If so, is the claimant disabled on account of some 'personal injury'?
"3) Did the claimant's employment aggravate, accelerate, or combine with some internal wéakness or disease to produce the personal injury?
"If those questions are answered in the affirmative and supported by the record, the decision maker must then find as a matter of law that the claimant had a personal injury, which arose out of the employment, and that compensation must be awarded.
"By the same token, if there is support for a negative answer to any of the questions, compensation may not be awarded." 394 Mich 476.
The WCAB has amplified the records and now these cases are once again before our Court. However, before we discuss the WCAB's decisions on remand, we will briefly restate:
1) the facts in each case;
2) the initial decisions of the referee, WCAB and Court of Appeals in each case;
3) this Court's specific remand order as it applied to each case; and
4) the pertinent part of the WCAB's majority opinion in each case upon remand.
Deziel
1. The Facts
"Mary Deziel, 39 at the time of suit, began working for Difco in 1968 handling test tubes, mixtures and various chemicals. On January 23, 1969 a test tube she was filling broke, causing glass to get into her eye. She was treated the next day and returned to work. On April 24, 1969 a test tube filled with iodine slipped from her hand and hit the table, splattering iodine around her eyes. She has not returned to work since. She made claim for compensation asserting she cannot work because of pain in the back of her eyes, anxiety, headaches, tiredness, and occasional dizziness, nausea and tightness in the chest. No physical cause for these symptoms has been found.
"In her testimony before the referee Deziel denied being treated for headaches and nervousness prior to working for Difco.
"However, prior to her employment with Difco, Deziel lived and worked in Ontario where she was treated by Dr. Brewer, who was deposed by Difco after the referee's decision. Brewer testified that he had treated Deziel for various ailments including headaches, anxiety, and tiredness but did not recall whether she had complained of eye problems." 394 Mich 470-471.
2. Initial Decisions
"The referee accepted and adopted the disease theory of Difco's psychiatrist, Dr. Forrer, namely that Deziel has always suffered from an obsessive-compulsive character which attached to the eye injury and developed into a psychosis, called a schizophrenic reaction. Coupled with that disease theory, the referee found that the iodine splashing 'aggravated the pre-existing latent mental disorder' culminating into a total occupational disablement. He awarded compensation.
"The Appeal Board in a unanimous opinion reversed the referee, holding that Deziel had not met the burden of proof to show her ailments were associated with her work, because with the exception of her eye ailments she had suffered the same symptoms since 1962." 394 Mich 471.
(The Court of Appeals denied leave to appeal.)
3. Remand Order
"In Deziel, the Appeal Board explained its holding in this manner:
" 'Mainly by her own testimony did the plaintiff prevail before the referee, proving a psychiatric, disability associated with her work. Since the decision, additional testimony in the nature of a deposition by Dr. Brewer has become a part of the record. This deposition shows, with substantial weight, that plaintiff had been suffering from the same symptoms since 1962 and periodically thereafter which is most impressive to the point that her disability was not causally connected with her work. Further, her credibility is impaired by the fact she denied suffering such disability prior to her employment with the defendant which is completely controverted by the doctor's deposition.
" '(11) The only discrepancy between her symptoms of 1962 and thereafter and her allegations of disability upon which she predicates her petition for benefits is pain behind the left eye. The plaintiff has not met the burden of proof to show her ailments are associated with her work or that her injury precipitated her present, allegedly disabled condition.
" 'The order of the referee is reversed.'
"From our reading of this, it is impossible for us to determine whether they addressed themselves to the appropriate question. If they did not, their holding as a matter of law would be erroneous.
"We remand for clarification, retaining jurisdiction.
"The phrase 'allegedly disabled condition' in the last full paragraph quoted indicates that the board may have concluded that the claimant was not disabled despite the testimony of both psychiatrists which seem to lead to the conclusion that she is disabled. The first paragraph, however, indicates that the board accepted the evidence of disability, but concluded the disability was not occasioned by her work.
"The applicable law is clear. If the claimant is disabled on account of her employment aggravating, accelerating or combining with some internal weakness or disease she is entitled to compensation.
"There is no need to seek any further connection between the work and disability." 394 Mich 476-477.
4. WCAB's Majority Opinion Upon Remand
"Plaintiff's testimony under oath is completely rebutted as to previous ailments by Dr. Brewer, a medical witness who treated her prior to her employment with the defendant and was called by the defendant for the purpose of impeachment. We have a situation where this Board has the prerogative of disregarding plaintiff's complete testimony unless her testimony is corroborated by other evidence.
"This not being the case we find that plaintiff has not met the burden of proof to show her employment aggravated, accelerated, or combined with some internal weakness to produce an injury.
"Plaintiffs medical problems of 1962 coincide with those now alleged to be disabling by the plaintiff. This fact negates a finding that plaintiffs disability is company-oriented in any way.
"The record calls for a finding of disability and personal injury. As to employment aggravating, accelerating or combining with some internal weakness or disease to produce the personal injury we find in the negative. Other than the fact plaintiff has not worked since the second test tube dropping incident we can find little evidence to promote the plaintiffs case, especially in the light of the obvious credibility gap." Opinion on remand, pp 2-3,
Bahu
1. The Facts
"Bahu, 35 at the time of suit, was hired by Chrysler in 1967. In 1968 he worked at a stamping machine lifting and moving 1500 seven-pound parts a day from an overhead conveyor to large tubs. From September 19, 1968 through October 7, 1968 he was off work with back pains and was voluntarily paid workmen's compensation benefits. Bahu returned to work and continued to complain of pain in his back, neck, and arms and of an inability to move one of his arms. He asked for lighter work but was refused. He quit on January 4, 1969. From January 29, 1969 through part of 1970 he worked at other jobs, but quit because of pain in his back and neck and arm.
"At the hearing before the referee on his claim for compensation, two psychiatrists testified. Plaintiff's psychiatrist, Dr. Dorsey, said that Bahu's physical pain was caused by pre-existing personality factors plus the precipitating events of a stressful job situation at Chrysler.
"Defendant's psychiatrist, Dr. Forrer, testified that Bahu was in pain. Forrer said that the pain was not caused by or aggravated by his work at Chrysler, but rather that Bahu's personality makeup was fragile when he came to Chrysler and he subconsciously attached his life's troubles to the event of the work-related injury. In the words of Dr. Forrer the work injury was 'a convenient hook on which he can attach causation for troubles of all kinds'." 394 Mich 472.
2. Initial Decisions
"The referee, without stating any reasons, found that Bahu received a compensable personal injury, and awarded compensation from January 5, 1969 until further order.
"The Appeal Board in a four to three opinion was not persuaded that Bahu's disability was causally related to his work for Chrysler. The dissenting members would have awarded compensation, finding that the requirement of job relationship was satisfied because the job provided the hook on which Bahu could hang his troubles." 394 Mich 472-473.
(The Court of Appeals denied leave to appeal.)
3. Remand Order
"In Bahu we have the same problem as Deziel. The board concluded that it was not persuaded 'that plain tiff has a disability causally related to his work for the defendant'.
"We are unable to discern from the board's opinion whether they found that Bahu was in fact disabled.
"We remand for the same fact finding ordered in Deziel and point out that a disabled plaintiff who has suffered a personal injury is not required to prove a 'causal' relationship between his injury and his work. A sufficient connection between the injury and the employment is established if the employment aggravated or accelerated or combined with some internal weakness to produce the injury." 394 Mich 477-478.
4. WCAB's Majority Opinion Upon Remand
(The WCAB in a unanimous decision upon remand reversed its previous decision and awarded compensation to Bahu. The board's analysis is excerpted in pertinent part.)
" 'In summary, plaintiff may have been an emotional "accident waiting to happen," but the accident did happen (injury stipulated) and per his unimpeached testimony the residuals thereof have continued and have disabled him. That is all the plaintiff knows or all he is capable of having insight regarding. The expert witnesses tell us there is no physical disability remaining except that in plaintiff's mind a real disability [remains]. This is a psychiatric disability "precipitated" by a sequence of events including the work injury (per Dr. Dorsey), which injury was a "hook on which he can attach causation" (per Dr. Forrer).
" 'This writer submits the referee's awarding of partial compensation during the brief periods of subsequent employment, and an open award of weekly benefits [have] record support. There are not proofs to justify reversal.'
"This fact-finding, I believe, answers affirmatively all of the Court's test questions:
" T) Is the claimant disabled?
" '2) If so, is the claimant disabled on account of some "personal injury"?
" '3) Did the claimant's employment aggravate, accelerate, or combine with some internal weakness or disease to produce the personal injury?' " Opinion on remand, p 3.
MacKenzie
1. The Facts
"MacKenzie, 65 at the time of suit, began working for General Motors in 1924 at the age of 15. In 1965 he took an early retirement at age 56. For about five years prior to his retirement he worked on the day shift in a General Motors Fisher Body salvage department. His job was to count, keep track of, and ship back to vendors red-tagged defective parts. During his last two or three years with General Motors he became irritable and nervous because the afternoon shift would take defective parts from his department and install them on cars in the assembly line. This caused him to worry about the safety of new cars and required him to recount the remaining parts and account to his supervisors for the missing parts. In addition, the poor work habits of his co-worker required MacKenzie to work harder, which added to his anxiety.
"He made claim for compensation. At the hearing before the referee, MacKenzie's psychiatrist, Dr. Dreyer, testified that MacKenzie suffered from a longstanding personality defect of compulsive perfectionism that centered on his job, and that eventually the job pressures disabled him. This was subjective analysis based on MacKenzie's view of his job.
"General Motor's psychiatrist, Dr. Fink, testified that it was MacKenzie's perfectionistic need in conflict with the impairments of aging that produced his anxiety and that although MacKenzie perceived the stresses of the job as causing his anxiety those stresses were usual occurrences and did not cause his emotional problems. This was an objective analysis based on the normal worker's view of MacKenzie's job." 394 Mich 473-474.
2. Initial decisions
"The referee awarded compensation finding that, although the stresses of the job were not great enough to cause ill effects in an average person, the stress did cause MacKenzie to become disabled.
"The Appeal Board in its five to two majority opinion reversed the referee and rejected the subjective analysis in favor of an objective analysis and ruled that an actual mental injury caused by a claimant's perception of his work environment is not compensable when that environment is not injurious to the average worker.
"Two members of the board dissented and would have awarded compensation by applying the subjective analysis and finding that the on-the-job stress aggravated MacKenzie's pre-existing personality disorder.
"The Court of Appeals majority did not speak to whether a subjective or objective test should be used. It affirmed, holding only that there was evidence to support the board's findings of fact.
"Judge Bronson dissented, stating that Carter v General Motors Corp, 361 Mich 577; 106 NW2d 105 (1960), requires that a subjective analysis must be employed in deciding the issue of causation. [48 Mich App 175; 210 NW2d 357 (1973).]" 394 Mich 474.
3. Remand Order
"In MacKenzie the board's majority impliedly found that plaintiff was disabled by a mental condition that amounted to a personal injury.
"It is not clear why the majority denied compensation. They may have found that the claimant's disability had no connection with his work. The majority said:
" 'In this case, plaintiff MacKenzie was disabled by something from within — that internal cause of his disability being a personality disorder dating back to his youth.'
"On the other hand they may have denied compensation because they believed that a work-related personal mental injury in order to be compensable must result from an actual stressful situation. In their next sentence the majority stated:
" 'We know of no case law that would permit compensation for plaintiffs perception of a work environment as injurious, when in fact that perception does not square with fact and the environment is shown not to be injurious.' (Emphasis in the original.)
"Such an objective standard (i.e., the effect Qf the actual work environment on the average worker) is not the standard to be employed. In workmen's compensation psychiatric disability cases a subjective standard (i.e., the effect of the perceived work environment on the claimant) is used when determining whether the injury arose out of the employment.
"In Carter v General Motors, 361 Mich 577; 106 NW2d 105 (1960), this Court affirmed an award of compensation to an employee whose disability resulted from his pre-existing mental disturbance and ordinary assembly line pressures.
"The Court in Carter applied a subjective test, saying at 585:
"' his disability was caused by emotional pressures produced by production line employment not shown by him to be unusual in any respect, — that is, not shown by him to be any different from the emotional pressures encountered by his fellow workers in similar employment.'
"The instant case is on all fours with Carter. The fact that MacKenzie's mental condition became acute because of the abnormal perception of his employment does not make the connection with that employment any less real for MacKenzie.
"We remand in this case for clarification. Did MacKenzie's employment aggravate, accelerate, or combine with his personality disorder to produce his injury or was his injury totally unrelated to his employment?" 394 Mich 478-479.
4. WCAB's Majority Opinion Upon Remand
"The first two of the three questions — whether plaintiff has disability and personal injury we again answer in the affirmative (See 1972 WCABO [1370]). To the third — aggravation, acceleration or combination — we again answer in the negative and deny compensation.
"Again in retrospect, perhaps the choice of the word 'perception' should have yielded to a more descriptive term — hallucination. We attempted then, and now, to accept the proposition that the most ordinary stimulus can be devastating and thus compensable when it causes disability in a predisposed individual. But we attempted then, and now, to exclude situations where the claimed compensable disability arose from an imagined/perceived/hallucinated stimulus that has not been proven existed or took place, even in the most normal form — except in the mind of the recipient.
"Applied to the facts of this case, we have pyschiatric testimony that paints plaintiff as a man whose adaptive mechanisms had begun to fail. His compulsions centered around his job. While his characterizations of specific work situations would normally be characterized as 'unrebutted,' we are forced by the medical description of plaintiffs personality to find that it is at least as likely an inference that these were imagined. There was no corroborating testimony. Compensation is not payable simply because an employee becomes unable to perform or cope with his job — it hinges on whether causal relationship can be proven between that physical or mental inability (disability) and the work that has gone before.
"In this case we believe and find that plaintiff brought to the workplace both his predisposition to the mental condition, and the internal stimulus that eventually led to his disablement. We are not convinced that this record demonstrates even the normal work duties of plaintiff as having aggravated, accelerated or combined with his personality disorder to produce disability." Opinion on remand, pp 2, 5.
Discussion
This Court views the real problem underlying these three cases to be whether the WCAB identified and correctly applied the legal standard for establishing legal causation in workers' compensation cases involving mental and nervous injuries. More succinctly, the Court must decide whether the WCAB properly states the causal nexus to be established by plaintiffs who allege that their disabilities and injuries are psychoneurotically or psychotically rooted , i.e., arose "out of and in the course of' their employment milieu.
However, before tackling this very complex question, we must analytically identify the types of cases in which psychoneuroses or psychoses are involved. This Court, of course, assumes that it is clear that Michigan law permits compensation for disabilities and injuries rooted in psychoses which are "causally" established as arising "out of and in the course of' the employment relationship. See Klein v Len H Darling Co, 217 Mich 485; 187 NW 400 (1922).
Generally, workers' compensation cases involving emotional, nervous, psychoneurotic or psychotic (i.e., mental) conditions have been divided into three groups:
1. a mental stimulus resulting in a physical injury;
2. a physical trauma or stimulus resulting in mental injury (emotional, nervous, psychoneurotic or psychotic); and
3. a mental stimulus resulting in a mental injury (again, emotional, nervous, psychoneurotic or psychotic).
Workers' compensation referees and boards have been most willing to grant awards in the first type of case: an employee suffers a work-connected mental blow or trauma which results in a psychoneurosis or psychosis that has a physically disabling effect. Klein v Len H Darling Co, supra, represents the archetypal Michigan case in this area.
In Klein, a 1922 case, this Court held that a mentally stimulated emotional shock to an employee was a compensable injury. Plaintiff Klein accidentally had allowed a piece of machinery to slip and strike another employee on the head. Klein became anxious and fearful that he had killed his co-worker. He remained in a highly anxious, nervous condition during the next four days at work. Klein eventually became delirious, went into shock and died seven days later. The Court awarded compensation to Klein's family, based on the theory that a mental stimulus or trauma which occurred during his employment had resulted in the physical injury.
Most jurisdictions have also been willing to award compensation for a mental injury (traumatic neurosis, conversion hysteria and hysterical paralysis are the most common injuries) when the plaintiffs disability results from a physical trauma or stimulus. The leading Michigan case is Johnson v Vibradamp Corp, 381 Mich 388; 162 NW2d 139 (1968). In that case, plaintiff Johnson suffered a compensable hernia in the course of his employment. He was eventually released by his physician to return to work. However, the employer corpora tion refused to reinstate him. The plaintiff then developed a functional overlay with regard to a back condition and could not return to work. This Court held that plaintiff's functional overlay was a compensable disability. Also see Redfern v SparksWithington Co, 353 Mich 286; 91 NW2d 516 (1958), and Harris v Castile Mining Co, 222 Mich 709; 193 NW 855 (1923).
The third and most difficult type of cases involves those where a plaintiff seeks compensation for mental injuries resulting from nervous or mental stimuli. There appears to be a jurisdictional split in authority on compensability in these cases. However, Michigan clearly adopts the progressive view which allows for compensation. Carter v General Motors Corp, 361 Mich 577; 106 NW2d 105 (1960). In Carter, plaintiff's paranoid schizophrenia was found to have resulted from the emotional pressures encountered by him in the daily performance of his work. The Court held that plaintiff developed a compensable psychosis due to his worry over his inability to maintain the established production rate of the assembly line.
Turning to the instant cases, we should categorize the disabilities and injuries alleged by plaintiffs Deziel, Bahu and MacKenzie.
Plaintiffs Deziel and Bahu's alleged disabilities and injuries clearly fall within the second classification. They posit that certain physical traumas or stimuli led to their mental/psychotic injuries. In Deziel, it is claimed that plaintiff's test tube accidents, especially the one involving the splattering of iodine, resulted. in a mental injury and subsequent disability. In Bahu, it is claimed that plaintiffs back injury resulted in a mental injury (functional overlay) and subsequent disability.
Plaintiff MacKenzie's alleged injury and disability falls into our third classification. He posits that certain nervous/mental stimuli led to a mental injury and disability. In MacKenzie, it is claimed that the pressures of plaintiffs work situation resulted in mental injury and subsequent disability.
In all these cases, it is now clear, after remand, that (1) the three plaintiffs are "disabled" and that (2) the plaintiffs are disabled "on account of some 'personal injury' ". The respective referees and appeal boards have unanimously answered these two questions in the affirmative.
Our Court is thus confronted by this difficult question: did the WCAB utilize the correct standard in determining whether the plaintiffs' employment aggravated, accelerated, or combined with some internal weakness or disease to produce the disability. This court must decide whether the WCAB correctly applied Michigan's standard for legal causation in cases involving alleged mental injuries and disabilities.
The initial consideration, then, is what is the causal nexus to be established by a plaintiff (psychoneurotic or psychotic) who is admittedly "disabled" "on account of some 'personal injury' " and claims that his employment "combine[d] with some internal weakness or disease to produce the disability".
We hold, as a matter of law, that in cases involving mental (including psychoneurotic or psychotic) injuries, once a plaintiff is found disabled and a personal injury is established, it is sufficient that a strictly subjective causal nexus be utilized by referees and the WCAB to determine compensability. Under a "strictly subjective causal nexus" standard, a claimant is entitled to compensation if it is factually established that claimant honestly perceives some personal injury incurred during the ordinary work of his employment "caused" his disability. This standard applies where the plaintiff alleges a disability resulting from either a physical or mental stimulus and honestly, even though mistakenly, believes that he is disabled due to that work-related injury and therefore cannot resume his normal employment. See Anno: Workmen's compensation: neurasthenia as compensable, 44 ALR 500.
The focal point of this standard is the plaintiff's own perception of reality.
This standard is not adopted haphazardly. This Court is fully cognizant that the area of workers' compensation relating to alleged mental injuries is fraught with the dangers of malingering, shamming and even fraud. However, upon careful consideration of the complex nature of the psychoneurosis-psychosis problem, we feel compelled to adopt the aforementioned standard. We do so for basically five reasons:
1) any objective causal nexus standard would not suffice;
2) the inherent nature of psychoneuroses and psychoses is subjective;
3) stare decisis impliedly requires a subjective standard;
4) a subjective standard is mandated by the requirement that remedial legislation be construed liberally; and
5) the workers' compensation referees, with the assistance of the WCAB, have the ability to detect malingerers in mental injury cases at the fact-finding level.
1.
Any objective causal nexus standard would not suffice when examining compensation cases alleging psychoneurotic or psychotic disabilities and injuries. This is true because almost all psychoneuroses and psychoses are, to some degree, latent in origin. The claimant's predisposition for such disabilities usually can be traced back to childhood. Therefore, a "but-for" or other objective proximate causation test will not be helpful in determining whether the claimant's employment "combined with some internal weakness or disease to produce the disability".
"Unfortunately, the complex etiology of psychoneurosis and the demands of time for examination are such that in a substantial number of cases a psychiatrist will be unable to estimate with any degree of accuracy the probabilities of the injury occurring in the absence of employment. All major schools of psychoanalytic thought agree that although immediate factors of reality may serve as precipitating or exciting causes, the adult's predisposition towards a psychoneurotic reaction lies in the childhood. The existence within the unconscious of unresolved conflicts, aggression, unrecognized motivations, and repressed hostilities from childhood onward may creáte conflicts with which the ego is incapable of coping. The individual is then particularly susceptible to the production of a psychoneurotic reaction as a way of relieving any additional tension. Whether a given experience or combination of experiences will trigger the psychoneurotic potential into a psychoneurosis will depend on the vulnerability of the individual and the nature and duration of the stresses bearing upon him. (Footnotes omitted.)" Cohen, Comment: Workmen's Compensation Awards For Psycho-neurotic Reactions, 70 Yale L J 1129, 1142-1143 (1961).
Any objective causation standard, whether it be in the form of the "but-for" or the "aggravation-acceleration" rule, will be of little assistance in deciding whether to award compensation in cases involving psychoneuroses or psychoses. Perhaps some direct causal nexus with an employment event can be established in a few cases. But in most cases a constellation of psychodynamic factors is involved; therefore, it is almost impossible to weigh the causal significance of any one factor. Indeed, it has been posited that the utilization of an objective legal causal analysis in these psychoses cases would be analogous to entering a maze without a map. Psychoneuroses and psychoses take on so many shades and forms as to show no logical pattern vis-á-vis any notion of objective legal causation.
The result to date of this fundamental misunderstanding of the causation problem is that referees and the WCAB often are forced to manipulate the causal nexus in order to grant or deny compensation on an ad hoc basis.
2.
The only conceptually sound method for analyzing psychoses or psychoneuroses is to recognize that these illnesses constitute, by definition, subjective injuries and disabilities. As such, they only exist within the minds of their unfortunate victims.
Simply stated, psychoses and psychoneuroses are mental disorders which are rooted in unconscious mental causes. In finding solutions to their unconscious problems, psychoneurotics and psychotics develop personality problems which make it difficult for them to adapt to reality as it is encountered by so-called "average" or "normal" individuals. This failure of the psychoneurotic or psychotic's reactions and adjustment mechanisms can either distort his perception of reality or, in the worst psychotic cases, cause the individual to lose contact with reality and suffer severe disturbances in all areas of his life.
Although laymen and logicians may view the psychoneurotic or psychotic's perception of reality as unrealistic, the disturbance which the individual experiences is not imaginary to him. The subsequent incapacity is as real to the claimant as that resulting from a clearly discernible "physical" disability.
Professor Arthur Larson, in his article on Mental and Nervous Injury in Workmen's Compensation, explores why the layman misunderstands the nature of mental injury:
" '[H]ow could it be real when it was purely mental?'
"This poignant judicial cry out of the past, which I occasionally quote to put down my psychiatrist friends, contains the clue to almost all of the trouble that has attended the development of workmen's compensation law related to mental and nervous injuries. This equation of 'mental' with 'unreal,' or imaginary, or phoney, is so ingrained that it has achieved a firm place in our idiomatic language. Who has not at some time, in dismissing a physical complaint of some suffering friend or relative, airily waved the complaint aside by saying, 'Oh, it's all in his head?' " 23 Vanderbilt L Rev 1243 (1970).
This "poignant judicial cry" can only be explained if it is understood that all people manufacture their own concepts of reality. "Normal" persons are those who manufacture a reality which most closely parallels that which the vast majority of "average" people encounter. Psychoneurotics and psychotics fail to manufacture or encounter the same reality because their reactions and adjustment mechanisms either distort, warp or completely fail.
However, their distorted concept of reality is just as "real" for them as the average person's concept of reality is for him. This is the critical insight.
Once it is determined that (1) a psychoneurotic or psychotic is disabled and (2) a personal injury is established, it is only logical that we employ a subjective standard in determining whether the claimant's employment combined with some internal weakness or disease to produce the disability. A subjective standard acknowledges that the claimant is "mis-manufacturing" or misperceiving reality, otherwise the person would not be a psychoneurotic or psychotic by definition.
What the referee and WCAB must factually determine, with the aid of competent psychiatric evidence, is whether the claimant is honestly misperceiving reality. It , is always a psychological "given'' that the claimant is distorting reality or the claimant would not be classified as a psycho-neurotic or psychotic.
Thus it becomes incumbent on the finder-of-fact to determine whether the claimant honestly, even though mistakenly, believes that he is disabled on account of some work-related personal injury, physical or mental, and therefore cannot resume his normal employment. Any attempt to take the inquiry to an objective level, i.e., "did claimant's employment really combine with some internal weakness or disease to produce the disability?", is bound to lead to frustration and eventually ad hoc manipulation. This is true because in most cases the question is unanswerable.
3.
Our reading of stare decisis in Michigan impliedly requires the use of a subjective standard in compensation cases involving psychoneuroses and psychoses. Carter v General Motors Corp, supra, has long been recognized not only as the leading Michigan case, but probably as the landmark case in the nation in this area of workers' compensation law. See Malone, Plant & Little, Cases and Materials on the Employment Relation, pp 276-290.
In Carter, the Court did not address the precise problem of what causal nexus is sufficient to find compensation in cases where the claimant is disabled as a result of a personal injury, and honestly, though perhaps mistakenly, perceives his disability as work-related.
However, a careful reading of Carter leads to the inescapable conclusion that the Court employed the subjective standard in determining whether plaintiff's claimed disability and injury involving psychosis was compensable. A brief sampling of the expert testimony quoted by the Court in that case so demonstrates:
" 'The patient saw himself as in an impossible situation in which he couldn't win. He couldn't please the foreman operating the machine in his job the way he was. If he attempted to do it the foreman's way he would fall behind in his work and the men on the line would complain and the foreman would get after him for this. So he really felt himself caught in an impossible situation which had no solution.
" 'Now, I feel that here we had an unhappy combination of circumstances, that after a period of a layoff the man comes into a new job which for somebody, I think with the relative inflexibility of personality that this man had, required some adaptation. So that already he was working in a new position with which he was not familiar and he found himself in a — as I believe I described it before, in what to him was an impossible situation. Namely, that he could not meet the foreman's demands and stay on the work and doing it the way the foreman wanted him to do, and on the other hand, if he did keep up, then his job was threatened in that fashion. So that he actually felt that the job which he had described to his wife as liking very much was threatened in either way. We frequently see a situation of this type where the person feels himself trapped in a situation that has no solution, at least to them, precipitating a schizophrenic breakdown. And I think the indications are that this is what occurred here. '" (Emphasis added.) 361 Mich 583-584.
The Court, in quoting the proffered psychiatric testimony, clearly employed a strictly subjective causal nexus. The Court and the psychiatrist were concerned with how the "patient saw himself', how "he really felt himself', etc.
The Court, without precisely stating so, analyzed how this particular injured and disabled claimant perceived reality, even though it is very probable that, due to latent psychoses, he misperceived his employment situation.
Judge Bronson of the Court of Appeals astutely commented on the implicit Carter analysis in his dissent in the instant MacKenzie case:
"It is inconceivable that the inquiry should be shifted by such analytical [sleight] of hand from the disabled employee's ability to withstand the alleged injurious working conditions to an abstract evaluation of the injurious nature of the work environment. Plaintiff's perception of his work environment is indispensable to an attempt to establish a causal relationship between his employment and disability. The Court in Carter recognized this interrelationship by quoting the physician's testimony describing Carter's distorted view of his job in detail. The inquiry in Carter was not whether the job created pressures or difficulties for any other employee, but whether they created an impossible situation for Carter given his pre-existing mental condition or infirmity. The employee's ability to cope with his job is indispensable to the issue of causation and should not be lost in analytical diversions." (Emphasis added) 48 Mich App 180.
Judge Bronson recognized the critical causal nexus is ultimately dependent upon how Carter himself, a psychotic, perceived or misperceived the relationship between his disability/injury and his work environment. The analysis employed comports with our strictly subjective standard.
4.
There exists a frequently quoted maxim or "rule of construction" to be applied by courts in interpreting remedial legislation such as workers' compensation acts: remedial legislation should be construed liberally. See, inter alia, Van Dorpel v Haven-Busch Co, 350 Mich 135, 154; 85 NW2d 97 (1957).
Rules of construction are often rotely cited and thus their underlying rationales are lost. However, we ought not lose track of the rationale for such a rule of construction in workers' compensation cases.
Workers' compensation laws were originally enacted in order to remove work-related injuries from the realm of tort law. Regardless of fault, liability was imposed on employers for any worker's loss of earning capacity due to disability. Most vestiges of tort law have been erased. Complicated legal theories of duty, breach of duty, negligence, contributory negligence, causation, proximate causation, etc., have been abolished.
The social and economic reasons for the abolition of the previous system are too well known to require further explication here.
In the area under examination only a very general notion of causation was carried over into compensation law. Namely, the injury and the subsequent disability must arise "out of and in the course of" employment. But this very general notion of causation was and should always be read progressively or liberally. The primary goal of workers' compensation is to compensate a worker for his disability loss. When there is doubt which might lead a court to deny recovery under the tort law system, récovery under workers' compensation law is often allowed. Compensation for disability takes preference over any subsidiary doubts about the existence of an objective causal nexus.
The spirit in which compensation laws were enacted should not be lost in legalistic tort niceties.
It is with these equitable concepts in mind that this Court adopts the subjective standard in cases involving mental disabilities and injuries. When theré is agreement that the worker is disabled and a work-related personal injury is established, a liberal construction of the causal héxus should be applied in deciding whether to award benefits. If it can be satisfactorily established that the worker honestly, though mistakenly* perceives that his employment-related injury is responsible for his disability, benefits are to be awarded.
5.
Employers are concerned that the utilization of a strictly subjective causal nexus standard in Cases involving mental disabilities may encourage malingering, shamming and outright fraud. This Court understands and shares the employers' concern, even though that apprehension may be slightly exaggerated. Employers seem to operate under the assumption that mental injuries by their very nature are more difficult to substantiate and, therefore, less genuine than physical injuries.
First, modern legal and medical theory does not lend credence to that assumption:
"The separate category reserved for 'physical' injuries has little support in psychiatric theory, which regards man as an integrated being. The rule is sometimes rationalized, however, by appeal to administrative considerations. It is contended, for example, that the 'physical' injury requirement will guarantee the genuineness of the claim. But use of this rule as a protective device places a heavier burden of proof on those suffering from mental disturbances without any basis for such a distinction. In fact, conscious simulation of the often complex patterns of psychoneurotic reactions may be easier to detect than certain feigned 'physical' injuries such as whiplash or back injury. While detection of falsified claims may be made difficult if the testimony of medical witnesses is partial or perjured, this danger seems no less present in cases where there has been a physical impact or injury." (Footnotes omitted.) See Cohen, supra, 1137.
Second, the referees, with the assistance of expert psychiatric testimony and under the watchful eye of the WCAB, are skilled in detecting malingerers at the fact-finding level:
"In the last analysis, the problem of malingering is one of fact, which must be left to the skill and experience of medical and psychiatric experts, and of compen sation administrators, who usually manage in time to develop considerable facility in detecting malingerers at the factfinding level." See Larson, 23 Vanderbilt L Rev 1259.
Furthermore, in positing a strictly subjective standard for the causal nexus in mental injury cases, this Court is not infringing on the historic fact-finding function of the referees or the WCAB. Const 1963, art 6, § 28. The referees, in conjunction with the WCAB, remain charged with determining (1) whether the worker/claimant is disabled and (2) whether a personal injury (a precipitating, work-related event) occurred. This Court is only requiring that the subjective causal nexus standard be utilized in deciding (3) whether the claimant's employment combined with some internal weakness or disease to produce the disability. All three questions must be answered in the affirmative and supported by the record for compensation to be awarded. The referees and the WCAB have the competence to detect malingerers at one of these three levels of inquiry.
Deziel
Upon remand, the WCAB held (1) that plaintiff Deziel was disabled and (2) that a work-related personal injury had occurred. However, the board denied compensation on the grounds that Deziel's employment did not aggravate, accelerate or combine with some internal weakness or disease to produce the disability.
We reverse. We conclude that there is no competent evidence to support the appeal board's finding of fact. White v Revere Copper & Brass, Inc, 383 Mich 457, 462-463; 175 NW2d 774 (1970).
It is clear to this Court that if the board had utilized the strictly subjective standard for establishing the causal nexus, it would have awarded compensation. The undisputed evidence- demonstrates that plaintiff Deziel honestly, though perhaps mistakenly, perceived the "cause" of her disability to be the work-related personal injury. It makes no difference under the aforementioned standard whether the injury really caused the disability or whether, due to some latent psychoneurosis or psychosis, the plaintiff misperceived the cause of her disability.
The WCAB cannot draw inferences contrary to the undisputed evidence. White, supra.
In the instant case, both plaintiff Deziel's and defendant Difco's expert psychiatric witnesses testified that she honestly perceived the work-related personal injury to be the cause of her disability.
Plaintiff DezieTs expert psychiatric witness, Dr. Herbert A. Raskin, testified thus:
"The diagnosis established is that of psychoneurotic reaction, conversion reaction type. It would appear that the accident incurred in April, 1969, served as the precipitating focus of psychodynamic changes, which produced the psychopathology observed and reported.
"It is quite doubtful that Mrs. Deziel would be able to return to her former type of employment, It would be advisable for her to seek psychiatric consultation in order to aid in meeting with the emotional disturbance diagnosed above. It cannot be estimated at this time how long duration of psychotherapy would be prior to her being able to resume wprk.
"Q. One last question, Doctor, Does this woman have a conscious understanding of what mechanism is gping on in her, pr is this unconscious?
"A. The psyehpneurotic reactipn is repeatedly uncenscieus. I do not feel that she had any significant degree of conscious understanding or insight, awareness, and knowledge of what she was experiencing.
"Consciously, she is convinced that something is organically wrong with her eye, that something is organically wrong with her as a total person." (Emphasis added.)
Defendant Difco's expert psychiatric witness, Dr. Gordon R. Forrer, confirmed plaintiff's perception of her disability but labeled it psychotic:
"Q. Isn't it true that the eye seems to be the source of the problem to her because that is the place where she suffered the trauma?
"A. No. It is not because it is the place where she suffered the trauma; it is because her life would be more comfortable if she were blind to all of the unhappinesses which have happened to her life and, as a matter of fact, she is in a sense blind, because she can't tell you much about herself. She has closed her eyes to herself.
"Q. The excuse to do that, though, was an eye injury, isn't that right?
"A. Not the excuse, but a hook which was a happenstance that came along which fit right in chance-wise.
"Q. Something to hang her hat on, you might say?
'A. Yes. In fact, it is very likely that if it had happened at some other time in her life she wouldn't have latched on to it. This kind of thing happens frequently. A person gets repeated injuries of the same kind, and they only respond psychotically to one because it happens to her at such a time in life when all the factors, when the combination has been made that it just takes that one thing that they latch onto.
"Q. Doctor, when Mr. Kelman asked you if the plaintiff might hang her hat onto something, this is not an opinion you share with the plaintiff, is it?
"A. Well, the plaintiff doesn't look upon this as something to hang her hat on. This is an explanation of what she is doing but she doesn't think this. She thinks that what she experiences and what she feels is all related to the splash of iodine, and this has produced what she alleges to be an incapacity to work. That is her theory.
"Q. And why does, in your opinion, she feel this way? Is this a valid feeling?
"A. Well, she has this conviction, but it is psychotic. It is because her logic is incorrect. She ascribes to a superñcial injury enormous catastrophic consequences which don't make sense. It is psychotic." (Emphasis added.)
The evidence is undisputed. The plaintiff, either a psychoneurotic or psychotic (depending on which theory is adopted), honestly, though mistakenly, perceives the work-related personal injury to be the cause of her disability. This evidence satisfies this Court's subjective standard.
We vacate the order of the WCAB and remand the case for proceedings not inconsistent with this opinion. Jurisdiction is not retained. No costs.
Bahu
Upon remand, the WCAB held (1) that plaintiff Bahu was disabled; (2) that a work-related personal injury did occur; and (3) that Bahu's employment did aggravate, accelerate or combine with some internal weakness or disease to produce the disability. Compensation was awarded.
We affirm. We conclude that the board's finding of fact is supported by competent evidence. White, supra. The board correctly utilized the strictly subjective standard in establishing the causal nexus:
" 'In summary, plaintiff may have been an emotional "accident waiting to happen," but the accident did happen (injury stipulated) and per his unimpeached testimony the residuals thereof have continued and have disabled him. That is all the plaintiff knows or all he is capable of having insight regarding. The expert witnesses tell us there is no physical disability remaining except that in plaintiff's mind a real disability [remains]. This is a psychiatric disability "precipitated" by a sequence of events including the work injury (per Dr. Dorsey), which injury was a "hook on which he can attach causation" (per Dr. Forrer).
" 'This writer submits the referee's awarding of partial compensation during the brief periods of subsequent employment, and an open award of weekly benefits has record support. There are not proofs to justify reversal.' " (Emphasis added.)
The appeal board correctly states that plaintiff Bahu honestly, though perhaps mistakenly, perceived the "cause" of his disability to be the work-related personal injury. The board astutely implies that it makes no difference under this standard whether the injury really caused the disability. It is enough that, due to some latent psychoneurosis or psychosis, the plaintiff perceives the stipulated injury to be the cause of his stipulated disability.
Both plaintiff Bahu's psychiatrist, Dr. Dorsey, and defendant Chrysler's psychiatrist, Dr. Forrer, concurred in their analysis of Bahu's condition. Dr. Forrer's testimony was particularly illuminating:
"Q. [D]id you find any evidence whatsoever of a possible psychiatric problem or disability related to his injury which he did actually sustain at Chrysler during his employment there?
"A. Well, there is a relationship, but the relationship is not cause and effect, and the relationship is not aggravation. The relationship is this, that an event happens in such an individual's life and he has a background he is all set up to attach to some dramatic event in his life 'causations' which do not in reality belong there. But this performs the function of a convenient hook on which he can attach causation for troubles of all kinds and once this is set up, this traumatic event becomes the assigned cause by the patient. Then, he very quickly forms a way of looking at life — 'Before this event everything was all right and after this event nothing was all right.'
"Q. [T]his process that you've described of a convenient hook to attach his troubles to and so on is an unconscious process?
"A. Yes.
"Q. He actually does believe that he has the pain?
"A. Not only that, he does have pain." (Emphasis added.)
We affirm the order of the WCAB. No costs.
Mackenzie
Upon remand, the WCAB held (1) that plaintiff MacKenzie was disabled and (2) that a work-related personal injury had occurred. However, the board denied compensation on the grounds that MacKenzie's employment did not aggravate, accelerate or combine with some internal weakness or disease to produce the disability.
We reverse. We conclude that there exists no competent evidence to support the appeal board's finding of fact. White v Revere Copper & Brass, Inc, supra.
It is once again apparent to this Court that had the board utilized the strictly subjective standard for establishing the causal nexus, cqmpensation would have been awarded. The undisputed evidence demonstrates that plaintiff MacKenzie honestly, though perhaps mistakenly, perceived the cause of his stipulated disability to be the undisputed work-related personal injury. The WCAB cannot draw inferences contrary to the undisputed evidence. White, supra.
Both plaintiff MacKenzie's and defendant General Motor's expert psychiatric witnesses testified that he honestly, though perhaps mistakenly, perceived the work-related personal injury to be the cause of his disability.
Plaintiff MacKenzie's psychiatrist, Dr, Joel Dreyer, testified thus:
"Q. Doctor, do you have an opinion based upon the history which you took and the examination which you performed as to whether or not at the time this man stopped working he was disabled from working?
"A. Yes, I have an opinion.
"Q. What is that opinion?
"A. He was disabled.
"Q. What was the cause of his disability?
"A. I feel work was the cause of his disability.
"Q. Doctor, do you have an opinion as to whether or not this man still is disabled?
"A. Yes, I do. I feel that at least when I saw him at the time in January and without any intervention I feel he is still disabled.
"Q. Doctor, this role that the stress of his employment played, if this man were engaged in any stressful situation would this have occurred?
'A. Well, certainly he had the potential to get into trouble in any stressful situation, but this man would be more likely to get in trouble at something he did ritualistically by fighting his compulsive pattern rather than an individual stress. This kind of guy would be more likely to break from daily stress rather than an incident.
"Q. So what you are saying then is the constant stress of the work from day to day was the thing that apparently caused this man's problems?
"A. Yes.
"Q. Doctor, if this man had previously been given a job where there were no stressful obligations, no responsibilities as such, would he have then been able to continue to function or be more able to continue to function?
'A. His interpretation of what stress is — for instance I don't know how heavy or difficult his work was per se, I only know it from how he tells it to me, and. again it could be a distortion of some of the facts, but it is how he perceives it and not how stressful it is and he certainly perceived it was stressful for him to handle. I have seen people decompensate who felt sweeping was too stressful, so if it is his perception it is stressful then that is his stress. " (Emphasis added.)
Defendant General Motors' psychiatrist, Dr. Jerome Fink, confirmed plaintiffs perception of his disability:
"Q. I see. Doctor, you also indicated to Mr. Poppe that this man was unable to — you were unable to ascertain any realistic pressures that this man was subjected to?
"A. That is correct.
"Q. He did indicate to you that he felt he was subjected to pressure, didn't he?
"A. He indicated to me that he felt he was pressured, but that this was a subjective pressure because at no time was he able to give me specific examples of pressure situations, in my opinion, and I have been around long and made enough trips through Pontiac, Fisher Body Division, and other plants to get some idea what the usual run of expectation is in the industrial employ[ment], and he gave me nothing which would indicate stress outside the usual run, the customary expectation of a man earning his living from a large corporation.
"Q. What you are saying then, Doctor, is you didn't feel he was subject to any unusual stresses?
"A. No, I'm not saying that.
"Q. Oh?
"A. I'm saying that I did not find in his history anything which to my satisfaction indicates unusual stresses.
"Q. The stresses which he relates to you are real to him, are they not, Doctor?
"A. They are as real to him as the voice of the schizophrenic is to himself.
"Q. When he tells you that he was feeling subjected to pressure, he believed that he was being subjected to pressures, does he not, Doctor?
"A. Right or wrong, he believed it.
"Q. Whether he is right or not is — as a matter of fact, that is part of his disease?
"A. That's very important; this is the very basis of a mental illness.
"Q. Doctor, this man told you why he retired from General Motors, didn't he?
"A. I believe so.
"Q. He told you that the job was getting too much for him, didn't he?
'A. He told me he felt the job was getting too much for him.
"Q. When he told you that, did he believe it?
"A. Did who believe it?
"Q. Mr. MacKenzie.
"A. Oh, he believes it, yes.
"Q. To him this problem was very real, was it not?
"A. To him, he believed it. " (Emphasis added.)
The evidence is undisputed. The plaintiff, either a psychoneurotic or psychotic, honestly, though perhaps mistakenly, perceived the work-related personal injury (stipulated) to be the "cause" of his disability (also stipulated). This evidence satisfies this Court's subjective causal nexus standard.
We vacate the order of the WCAB and remand this case for proceedings not inconsistent with this opinion. Jurisdiction is not retained. No costs.
Kavanagh, C.J., and Williams and Levin, JJ., concurred with Blair Moody, Jr., J.
It must be understood at the outset that the use of such descriptive terms as mental, nervous, psychoneurotic, psychotic, is not intended to convey precise medical meanings. Rather, they are employed to differentiate an almost infinite number of subtle psychological conditions and relationships for compensation law purposes.
The minority opinion upon remand would have found for compensation:
"Plaintiffs work history of several years stands unrebutted in the record before us. It was stipulated that this employee suffered injury on April 24, 1969, while employed by defendant. The testimony of both plaintiff and defendant's medical authorities who had examined plaintiff since the injury occurred establishes beyond doubt that this employee is truly disabled. Even if we assume that plaintiff was aware of the nature of her illness in 1962, and had deliberately lied about same, the fact remains that she had performed work satisfactorily for many years in the interim and has been unable to do so since the injury here involved occurred. Compensation is paid upon a showing of an injury and resulting disablement. There is no prohibition within the statute against the grant of an award for ensuing disablement even though the claimant may have testified untruthfully about other matters.
"My associates' holding that the credibility of this employee's testimony refutes all the proofs of disablemept which has continued since the date of injury in April, 1969, and defeats her claim, is nothing more than an erroneous factual crutch created to defeat her claim and avoid an award for the injury received. The referee's order being in compliance with the proofs before us should here be affirmed," Opinion on remand, p 10.
The WCAB reversed its previous decision unanimously; member Storie concurred to the extent that the opinion reaffirmed his previous dissenting opinion.
The minority opinion upon remand found for compensation:
"The unrebutted lay evidence submitted in this case shows plaintiff was employed 35 years by defendant without any indication of difficulty. Plaintiff was then assigned to employment for another six years which was beyond his mental capacity to properly assimilate. This last work resulted in a break with reality and disablement which all medical evidence before us agree prevents his reemployment. There was no evidence which showed that plaintiff was unable to cope with the realities of life in general outside the course of his employment during the six years which he had difficulty at work. Neither were there any proofs presented from which it would be reasonable to conclude that plaintiff was subjected to conditions outside the course of his employment during the last six years thereof which he was unable to assimilate within his mental capacity.
"The only medical evidence before us which accepted the above factual premise was the testimony of Dr. Dreyer. It was pointed out in the prior dissent filed by Mr. Jarrett that Dr. Fink's opinion, ' was based upon his impression that real work pressures were nonexistent' and that this doctor's opinion had origin in the fact that the history which he had received disclosed, ' no real examples of work pressure based upon his (the doctor's) experience in viewing "expectation in industrial employ[ment]" through many years of walking through industrial plants.' It was further noted in the dissent filed that Dr. Fink admitted that the plaintiff felt real pressures in his work but it was Dr. Fink's impression that such pressures were purely subjective. If the acceptance of this doctor's testimony as is here done in the majority decision is not contrary to the rule that 'the perceived work environment' be used in determining the effect the employment had upon the claimant then it would seem that it would be impossible for the Supreme Court to enforce this rule if such conclusions are accepted as findings of ordinary facts which are beyond the scope of review by the Court." Opinion on remand, p 6.
Psychoses and psychoneuroses are generic terms describing certain types of mental and nervous disorders.
Psychoses involve more serious personality disruptions than do psychoneuroses. Psychotic individuals usually suffer severe disturbances in all areas of their lives and may lose contact with reality.
Psychoneurotic individuals suffer milder disturbances in their lives and usually maintain some contact with reality. See English & Finch, Introduction to Psychiatry (New York: W W Norton & Co, Inc, 3d ed, 1964), p 44.
This decision deals with both phenomena in their generic senses. It is realized that both psychoneurotic and psychotic reactions can take on various forms such as anxiety reactions, phobic reactions, obsessive-compulsive reactions, conversion reactions, dissociative reactions, depressive reactions, and the like. See generally, English & Finch, supra.
1A Larson, Workmen's Compensation Law, § 42.20-42.24.
Larson discusses a fourth group of mental injuries which he denotes as "compensation neurosis":
"The most controversial mental-injury question is that of the compensability of 'compensation neurosis.' 'Compensation neurosis,' which must be distinguished from conscious malingering, may take the form of an unconscious desire to obtain or prolong compensation, or perhaps of sheer anxiety over the outcome of compensation litigation — in either case producing a genuine neurosis disabling the claimant."
Since none of the three instant cases involves such a claim, we need not address the problem. Larson, supra, § 42.24.
Again, it is incumbent upon us to caution the reader that this Court cannot attempt to categorize and discuss in this opinion every conceivable kind of neurotic, psychoneurotic, psychotic, depressive; or functional overlay, hysterical symptom, personality disorder. This Court attempts to be all-inclusive by using the general term "mental", while focusing on psychoneurotic or psychotic phenomena. However, the Court does not intend to exclude other associative phenomena.
In lay terminology, a functional overlay describes a "psychogenic overlay". It is an "emotionally determined increment to an existing symptom or disability which has been of organic or physically traumatic origin". See 17A Words and Phrases, Functional Overlay, p 539.
See Larson, supra, § 42.23, fns 81 and 82, for a state-by-state analysis.
The focus is on whether plaintiffs' employment "combined with some internal weakness or disease to produce the disability". In most cases involving alleged mental injuries, the condition is usually latent to some degree and only becomes patent upon a "triggering" or precipitating event, i.e., a personal injury. See infra, 27.
It is also a "given" that the employer accepts the employee at the gate with all his latent foibles and weaknesses, including latent pSychoneuroses and psychoses. See, inter alia, Zaremba v Chrysler Corp, 377 Mich 226; 139 NW2d 745 (1966).
Briefly, it was recognized that under the tort law system:
"a) large portions of all fatal and non-fatal injuries remained uncompensated, b) the sums actually paid were frequently inadequate token compensation, c) recoveries were obtained only after protracted litigation, d) the attorneys of the injured workmen retained a large share of the sum actually obtained, [and] e) an undue portion of the premiums paid by industry went to the insurance companies for profits, administrative costs and profits and was thus socially wasted." See Riesenfeld & Marshall, Modern Social Legislation (Brooklyn: The Foundation Press, Inc, 1950), p 137.
On the other hand, the goals of the workers' compensation laws are:
"1) to compensate the worker, his dependents, or survivors for at least part of the wage loss and medical expenses incurred as a result of industrial injury, 2) to rehabilitate the employee so that he can reenter the labor force and again become a productive member of the community, and 3) to provide a monetary incentive to the employer to minimize occupational injury." Cohen, svpra, 1130.
By progressively or liberally, this Court means "for compensation". If a disabling injury is incurred and the general circumstances lead to the conclusion that it was work-related, compensation should be awarded.
Malingering should be distinguished from "compensation neurosis". See fn 7, supra.
"The borderline between neurosis and malingering is tenuous and uncertain. For empirical purposes, psychiatric literature differentiates by saying malingering involves the conscious counterfeiting of physical signs for the purpose of secondary gain, whereas, conversion hysteria involves the subconscious counterfeiting of physical signs for the purpose of secondary gain. Simply stated, traumatic neurosis supposedly is predicated upon subconscious deception for the purpose of obtaining money, whereas malingering is conscious deception of others for the purpose of obtaining money." Turner, The Anatomy of Psychiatric Cross Examination, 34 Kan State Bar Ass'n J 93, 96 (1965), reprinted in Selzer, Psychiatry for Lawyers Handbook (Ann Arbor: Institute of Continuing Legal Education, 1966), pp 89, 95-96. Cited by appellee General Motors Corporation's brief, pp 19-20.
Defendant Difco and the board attach significance to the testimony of Dr. Brewer. Dr. Brewer, a physician, evidently treated Deziel years earlier for some, but not all, symptoms which she experienced after the iodine accident.
The record reflects that Deziel denied she had been previously treated for the same symptoms which resulted from her injury. Difco and the board believed that Dr. Brewer's testimony served to impeach Deziel's testimony.
The record, however, indicates that Dr. Brewer never disclosed to Deziel any of the conditions which he suspected or diagnosed. He only noted them for his own records. Furthermore, those latent conditions only became totally patent after the work-related injury occurred and Deziel became disabled. (Also, Dr. Brewer could not recall treating her for any eye pain.)
Both psychiatric experts gave evidence which established that plaintiff Deziel, either a psychoneurotic or a psychotic, misperceived the cause of her disability. Neither expert witness accused Deziel of malingering; in fact, defendant's expert witness testified she was not malingering. Therefore, Dr. Brewer's testimony is neither enlightening nor relevant to a subjective analysis. It serves to buttress the fact that Deziel misperceived the cause of her disability. It does not establish malingering or fraud. Furthermore, we note that Dr. Brewer did not suggest that Deziel was malingering, nor does the record reflect that he would be qualified to testify as an expert in this area.