Court Opinion

ID: 9685199
Source: CourtListenerOpinion
Date Created: 2023-08-24 14:25:54.90861+00
Date Added: 2024-06-11T18:18:03.228881
License: Public Domain

Coleman, J.
(dissenting). These three cases were remanded to the Workmen’s Compensation Appeal Board (WCAB) for further proceedings and a clear statement in each case of the underlying reasons for the subsequent findings, Deziel v Difco Laboratories, Inc, 394 Mich 466; 232 NW2d 146 (1975). The WCAB has returned the cases with findings as ordered.
Our focus is upon the standards or criteria to be used in determining whether the employer was statutorily responsible for the employees’ mental disorder. In each case the employee had "imagined/perceived/hallucinated”1 a disabling injury.
The Michigan worker’s disability act provides, in pertinent part, that a worker be compensated for "a personal injury arising out of and in the course *47of his employment”.2 The first majority opinion in these cases (Deziel, supra) directed the finder of fact to utilize the following three-pronged test to determine whether the requisite causal nexus exists:
"1. 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?”
Although the WCAB followed the order of the Court, the majority today has changed the rule and adopts a new test for the finder of fact to apply apparently instead of the critical third inquiry — the "honest perception” test:3
"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 *48employment '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.”
The Court again remands for compliance with the newest requirement. However, this standard is no standard at all in the reality of application. In cases where the "disability” and "personal injury” are established, the majority’s test for causal nexus 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. It is noted in passing that the majority opinion takes away the WCAB’s fact-finding role and substitutes the Court’s version prior to this second remand of the case.
We would affirm the WCAB’s findings pursuant to our prior remand. (Compensation was denied to Deziel and MacKenzie and awarded to Bahu.)
I
A brief summary of the facts and history of the cases follow:

Mary Deziel

Mary Deziel attributed headaches, tension, anxiety and dizziness to a splattering of iodine which occurred when she dropped a test tube. There was no physical damage and she was told to return to work the next morning. She testified that she had *49never had such problems, never had received medication, treatment or hospitalization for them and that her problems were caused by her accident at Difco. Because she had lived in Canada all of her life (and continues to live there) excepting the months here involved,4 inquiry was commenced in Canada, but after the referee’s hearing. Before the WCAB, it was learned for the first time that she had been treated, medicated and hospitalized in the past for these same complaints.
Upon remand for application of the three-pronged test, the WCAB found no causal nexus between her alleged disability and her employment with Difco. The WCAB members were previously unanimous in speaking of Dr. Brewer’s deposition:
"This deposition shows, with substantial weight, that plaintiff has been suffering from the same symptoms since 1962 [in Canada] and periodically thereafter which is most impressive to the point that her disability is not causally connected with her work.”
Because plaintiff had denied suffering such previous similar disability and hospitalization caused by it when she in fact had a long history, including hospitalization, before her short time in the United States, her credibility also was impaired.5
*50Despite this evidence, my brothers find "no conupetent evidence to support the appeal board’s finding of fact” based on our first order of remand. The WCAB order was vacated and the matter again is remanded but with the fact-finding already completed by the Court (including application of the "honest perception” test for causal nexus).

Yusuf Bahu

Plaintiff Bahu was hired by defendant in August 1967. He worked on a stamping machine and *51complained of back problems. He had a myelogram performed and returned to work after about three weeks on October 7, 1968. He quit on January 4, 1969. He seeks workmen’s compensation from Chrysler. He worked short periods of time at different places before and after this employment and completed a beautician’s course but did not pursue work in that field. Although no physical disability was found, expert testimony was to the effect that plaintiff experienced "cultural dissonance” upon coming to this country from the Near East. He married an ex-nun, a college graduate (he had no college education), and they "get along together because he assumes the position of a child and she assumes the position of the de facto parent”. Plaintiff’s failure to use his hairdressing training is indicative of his general disinclination to work. A psychiatrist explained that, instead of saying, "I made a wrong choice and I don’t like this,” he says, "I can’t lift my arms up to do it”. He "finds a reason not to do it, but not the true reason”.6
In the initial hearing, the WCAB found no causal connection, no aggravation of a pre-existing condition. Upon remand the WCAB found a causal connection to plaintiff’s employment and, therefore, that plaintiff had a compensable disability. The WCAB was affirmed by the majority, but again only after completing its own findings of fact.

Harold K. MacKenzie

Plaintiff was born in 1909 and, after an automobile accident (he had a leg wound which would not heal), treatment for high blood pressure and hospitalization (from August 23, 1965 to September 12, *521965) for gall stones, he asked for and received early retirement on September 30, 1965. During the course of his employment, he never was examined by a psychiatrist.
On January 17, 1968, plaintiff claimed a psychiatric disability caused by his employment. His job had been to place red tags on parts which were to be returned to vendors. He claimed to be upset because some tags were removed and because his partner was lazy and not doing his share of the work.
After the petition was filed, plaintiff was examined by two psychiatrists.
Dr. Fink found that plaintiff had had a neurosis for "all of his life” described as "severe psychoneurosis hypochondriacal”. He was "obsessed with the [inner] workings of his own basic body”. He was older than his years and "everything had to be perfect”. He was going through the "usual process of psychological and physical decompensation” and a realistic impairment due to the aging process. The diagnosis of Dr. Fink was that the cause of the neurotic condition was not plaintiff’s job and that "his disability is his own internal neurosis”.
Mr. MacKenzie’s psychiatrist, Dr. Dreyer, said that previously plaintiff had felt "no pressure at work but as the years went on and his compulsive defenses weren’t quite so readily adaptable as they were before, he found that what he used to do routinely was a pressure now”.
Dr. Dreyer said that plaintiff had a passive aggressive personality and probably had been neurotic since he was a teenager. It had been over three years since retirement before plaintiff had petitioned for workmen’s compensation, so defense counsel asked if the insomnia, etc., could be caused by something other than the job environment. Dr. *53Dreyer said that other things in the environment coiild be causing plaintiff’s troubles. "He is not working and that is troublesome for him, he is afraid, he wants to be a man and work and he is not working; that alone will cause further symptoms”. He acknowledged that to be a syndrome common to many people who have worked all their lives. However, Dr. Dreyer found Mr. MacKenzie was disabled through a work-connected personal injury.
The WCAB found no causal connection in its initial opinion. After remand and after application of the required test, it still found no causal nexus and denied compensation. The majority vacates the WCAB order, finds the "honest perception” test to be met and remands for an order consistent with that finding of fact.
II
A valid analysis of the causal nexus between mental disability and occupational trauma requires a basic understanding of the origins of the mental disorder. Most neurotic and psychotic states do not have a single cause-in-fact and are emotional disorders with a pre-existing, extremely complex etiology originating in childhood.7 Symp*54toms are usually preceded by some form of trauma, however minor.8 The relationship between such trauma and symptoms is more chronological than causal.
Placing the focal point of analysis upon the claimant’s perception of causation ignores the fundamental nature of these neuroses and of human nature. The claimant is aware of the inner conflicts and emotional weaknesses which comprise the etiology of the claimed disorder on either a conscious or a subconscious level. However, for a neurotic state to exist, such as is claimed by these plaintiffs, the person must be unable, or unwilling, to recognize and resolve these problems. The disorder is an unconscious attempt at resolution. The only possible causative factor of which the claimant is, or will allow himself to be, consciously aware is the work-related trauma. Reality is elusive. It is therefore, highly unlikely that the claimant’s perception of causation will be anything but his employment.
Furthermore, any valid analysis of psychiatric *55disability cannot disregard the secondary gain to the claimant, incurred as a result of attributing causation to employment. The term "gain” is used in its psychiatric sense — psychic rather than monetary gain. However, financial compensation can produce psychic gain. Psychiatry recognizes two types of gain, both of which accrue to the individual out of unconscious motivation. Primary gains are produced by primary symptoms acting upon the mind. These symptoms (repression, withdrawal, obsession, etc.) ensure a more secure internal (mental) environment for the person. Secondary gains relate to the external environment. Secondary symptons (e.g., depression, anxiety, impatience, fatigue, pain) act upon the outside world (e.g., home, job, friends) to produce a secure external environment. See 3 Lawyers’ Medical Cyclopedia (rev vol), §§ 20.6-20.7.9 In the case of a person who dislikes his work or whose aging process renders him psychologically unable to do even simple tasks, secondary gains might be not having to work, removal of fiscal responsibility, financial compensation and a socially acceptable excuse for not working.
A person afflicted with a mental disorder will, almost as a matter of course, claim precipitating trauma as a more palatable explanation of his or her symptoms. Responsibility for the inability to resolve mental and emotional conflicts may be shifted quite unconsciously to the employment. It makes for satisfactory results — a socially acceptable disability, freedom from responsibility, financial compensation, sympathy and understanding— and creates a secure external environment. The *56inability consciously to accept the fact that he or she is neurotic leads to the claimant’s search for a more psychically pleasing excuse for his problems. Or, as one commentator posits:
"Psychiatric claims seem only to arise when there is someone other than the claimant at fault or at least able to assume financial responsibility for the effects of injury. By contrast, the number of claims of psychiatric disability following trauma consequent to an athletic injury or to the plaintiff’s drunkenly driving his own car into a tree are infinitesimally small.
"What indeed may be occupationally related, however, is the neurotic secondary gain — the unconscious 'fringe benefits’ often consequent to disability — always a factor in claims of psychiatric disability. Though not causative (in that secondary gain arises as an issue following injury), such secondary gain factors as financial compensation, the solicitude of others, freedom from responsibility and/or restitution for real or imagined past exploitation may greatly prolong convalescence and prevent recovery.” Blinder, The Defense of Claims of Psychic Trauma and Psychiatric Disability, 12 Forum 934, 937 (1977).
Suppression of inner conflicts from consciousness, secondary gain and basic human nature dictate that a neurotic personality attribute symptoms to the last event in the chronological progression of his or her etiology. Trauma associated with employment is usually that last event, or it is the only etiological factor which the claimant will recognize. As one writer notes:
"Even when the extra straw causes a fracture, note should be made that there are many instances on record wherein the complainant, in all sincerity, attributed his symptoms to the straw, not realizing that certain coincidental factors were more relevantly re*57lated to the appearance of his symptoms. It is all too human for a person to attribute his anxieties and pains to external causes rather than to his own internal problems.” (Emphasis added.) Yochelson, Traumatic Neurosis, Readings in Law and Psychiatry (Allen, Ferster, Rubin, eds, Baltimore: The Johns Hopkins University Press, 1975), p 453.
The job becomes a convenient "hook” upon which to hang all one’s troubles. The psychiatric testimony in each of the cases before us supports this analysis. Deziel, Bahu and MacKenzie attributed all of their problems to work-related trauma. It was completely predictable that they would do so. Similarly, the suggestive effect of the legal emphasis upon the causative role of the job, necessary to recovery, will not often be lost on the worker who hangs his life’s problems on the "hook” of some trivial stimulus or trauma. Indeed, it is the common conclusion of psychiatrists that the compensation process promotes neuroses and has a debilitating effect upon claimants.10
Not only is a neurotic personality predisposed toward mental disorder prior to the perceived symptom-precipitating trauma, but such a person*58ality is predisposed to "honestly perceive some personal injury incurred during the ordinary work of his employment 'caused’ his disability”. Acceptance of this fact makes it clear that the majority’s "honest perception” standard is of little utility as an honest analytical tool.
A further objection to my colleagues’ test is its broad grasp. Clearly, a claimant may have a real mental injury and not be entitled to workers’ compensation because of a lack of nexus. This situation becomes particularly apparent when the mental disorder is extant prior to occupational trauma or prior to commencement of employment, as in Deziel.11 However, my brothers’ standard would provide compensation even in this situation. Such a result is beyond the ambit and purposes of workers’ disability legislation.
Ill
At this juncture, reflection upon the concern for the problem of simulation or malingering is in order. The aforementioned discussion of the neurotic claimant’s predisposition to perceive his occupation as the sole cause of his symptoms is not predicated upon viewing the claimant as a malingerer. The same conclusion follows if one assumes that the claimant is being totally honest. Neurotic and psychotic personalities are predisposed to honestly perceive that some psychically satisfying trauma caused their disability.
*59While we agree that mental injuries are no less genuine than physical injuries, the line between conscious and unconscious simulation is fine. For instance, simulation can start as a conscious and comfortable effort to free one’s conscience or to appear in a better light to specific persons or the populace in general. It eventually can become a reality to the simulator. We suspect that such "honest perception” is not peculiar only to neurotics and psychotics. It is a not uncommon defense mechanism for many. Whether it is consciously or unconsciously willed, it is a diagnostic factor to be recognized and psychiatrists disagree as to the ability of the profession to detect the difference.12
However, we fail to see how the diagnostic techniques used to detect simulation can aid in determining whether a claimant’s self-serving statement of perception is "honest”. Our colleagues’ discussion of malingering relates to whether the person is truly disabled — but their "subjective”, "honest perception” standard relates only to causal nexus.
No concern has been shown for the problem of weighing the credibility of a mentally disturbed *60person. Indeed, it is unlikely that a referee or the WCAB can ascertain with any degree of certainty whether a neurotic person (to say nothing’of a psychotic) is telling the truth. By adoption of the "honest perception” standard for determining an employer’s responsibility, we only invite confusion, difficulty for the finder of fact and increased arbitrariness.
Conclusion
Finding the "honest perception” or "imaginary” standard untenable necessitates formulation of an acceptable means for determining causal nexus. Our efforts are constrained by the legislative requirement that an award of compensation be factually supported by some medical evidence connecting the injury and the employment.13 It is this factual predicate which the majority’s standard disregards.
The question in these appeals is whether the injury "arose out of’ the occupation. Given that mental disorders have many elements comprising *61their etiology, we find Professor Larson’s formulation of the factual issue more probative than the "honest perception” approach. The relevant inquiry is whether claimant’s employment did, in fact, "aggravate, accelerate or combine with some internal weakness or disease to produce the disability”.14 1 Larson, Workmen’s Compensation Law, § 12.20.
We would add the caveat that the fact finder will have to find more than a "de minimis” relationship between the mental disorder and the occupation before awarding compensation. In other words, in light of the acknowledged relationship between symptoms and non-occupational events, the causal connection must be established in some substantial degree.15 It is not enough to say that if a plaintiff thinks he is totally disabled by his employment, he is — regardless of whether the disability occurred before employment or was caused by the natural process of aging or disinclination to work.
There is no doubt that the decision today will be a costly burden to Michigan employers, small and large, who compete with out-of-state business and to the consumers who absorb those costs. The concern here expressed, however, is not only for employers and consumers but for employees. We have engaged in a seemingly inexorable march towards limiting the hiring of workers to only *62those persons in the top echelon of physical and mental condition.
While workmen’s compensation costs are burgeoning, the benefits must be spread ever more thinly among the workers to accommodate new categories of disorders (and ever more remote accidents) which cannot be guarded against or controlled by an employer. Moreover, when businesses close of move to another state, jobs and tax revenues are lost. When expansions of existing businesses are taken to other states, Michigan residents lose opportunities for employment. These economic facts of life should not be overlooked when we expand legislation by judicial fiat.
We do no service to the people of Michigan with this open-door opinion, especially when the new majority standard is considered in tandem with Anna Redfern and the other so-called "incurable insanity or imbecility” cases also released today.16
The WCAB found a causal nexus between employment and injury in Bahu and reached the opposite result in MacKenzie and Deziel. We would not disturb these findings of fact which were made upon directions from this Court on remand.
We would affirm.
Fitzgerald and Ryan, JJ., concurred with Coleman, J.

 The quoted phrase is taken from the WCAB’s opinion, upon remand, in MacKenzie.

 The statute in full reads:
"An employee, who receives a personal injury arising out of and in the course of his employment by an employer who is subject to the provisions of this act, at the time of such injury, shall be paid compensation in the manner and to the extent provided in this act, or in case of his death resulting from such injuries the compensation shall be paid to his dependents as defined in this act. Time of injury or date of injury as used in this act in the case of a disease or in the case of an injury not attributable to a single event shall be the last day of work in the employment in which the employee was last subjected to the conditions resulting in disability or death.” MCL 418.301(1); MSA 17.237(301X1).

 The language chosen to set forth the majority’s standard is particularly disturbing because of its ambiguity. If a claimant "honestly perceives” that "some” work-related "personal injury” "caused” his mental disability, then causal nexus is established, regardless of prior psychiatric history. For instance, if a worker "honestly perceives” that a broken finger "caused” his mental disorder, is nexus to be established? What if the injury is a scraped elbow? Surely the statute minimally requires some medical evidence connecting the injury and subsequent mental disorder before nexus is established.

 Mary Deziel came to live in the United States (Detroit) shortly before commencing employment with Difco Laboratories in September of 1968. She returned to Canada shortly after her accident on April 24, 1969.

 The record clearly reflects the extensive and prolonged history of medical and psychiatric problems suffered by Mary Deziel before coming to the United States. To summarize:
—She went to see Dr. Lloyd Brewer on June 2, 1962, complaining of dizziness, headaches, stomach problems and inability to breathe;
—Dr. Brewer treated her until September 15, 1962, when he hospitalized her for severe headaches and anxiety. She remained five days and was then referred to a psychiatrist and a neurologist. Tranquilizers were prescribed;
*50—In January 1963, she returned to Dr. Brewer complaining of dizziness;
—On March 16, 1963, Dr. Brewer saw her for a sore throat;
—On April 29, 1963, he saw her for mild anemia;
—On or about July 3, 1964, plaintiff was seen by Dr. Brewer for rhinitis;
—On September 20, 1965, plaintiff fell at work and struck her head and arm. She missed three days of work and saw Dr. Line, complaining of headaches and dizziness;
—Visits to Dr. Brewer on September 20, 1965 and October 1, 1965 resulted in improvement;
—On March 12, 1966, she was seen for acute sinusitis;
—On March 12, 1966, her medical complaint was lower back pain;
—In April 1966, she had a twisted knee;
—On April 29, 1966, she had yiral bronchitis;
—In May 1966, plaintiff was seen twice, once for a facial rash and once for bronchitis;
■ — During September 1966, Dr. Brewer diagnosed her various ailments as resulting from nervous tension. He prescribed a tranquilizer —Librium;
—In November 1966, plaintiff suffered from cystitis, acute pyelonephritis and a bladder infection;
—In May 1967, she was still on Librium and complaining of headaches;
—Plaintiff was seen on June 6, 1967 for a tension anxiety state;
—She was seen on June 20 for pain in her face and given more tranquilizer prescriptions;
—On December 4, 1967 she had some stomach trouble;
—On January 31, 1968, plaintiff had another fall at work and hit her head and back. She received six weeks of compensation;
—On February 8, 1968, she was seen for a sore spot on her spine;
—From May 18-25, 1968, plaintiff was hospitalized for a kidney infection;
—Dr. Brewer last treated Mary Deziel on May 31, 1968 and diagnosed her psychiatric problem as a tension anxiety state.

 The quoted language is taken from the testimony of Dr. Gordon R. Forrer.

 This is true of most mental disorders. One explanation is:
"To a large degree, the causes of mental illness, the factors that eventuate in the psychically or emotionally sick personality, are presumably the familiar difficulties of human existence. The so-called abnormal is but an exaggerated or unbalanced expression of the normal. For the present, therefore, it seems most fruitful to look upon most mental disorders not as the result or expression of some 'disease’ but as a mode of behavior or of living that is the logical, although socially maladjusted, outcome of the particular individual’s original endowment, of the molding influence of the home, of traumatic experiences that modified personality development, of the stresses and problems springing perhaps from deep within his emotional and instinctive life, of his inability to meet these strains, of the type of self-defensive reactions habitually utilized for minimizing anxiety, *54and of any bodily ailments that may impair the integrity or efficiency of his biological organism. Mental disorders should therefore be regarded as patterns of human reaction set in motion by stress. The tendency to look on those who manifest nervous or mental symptoms as being different in their organization from the so-called normal is therefore erroneous.” Noyes & Kolb, Modern Clinical Psychiatry: Psychiatry for Lawyers (Ann Arbor: Institute of Continuing Legal Education 1961), pp 83-84. See, also, Comment, Workmen’s Compensation Awards for Psychoneurotic Reactions, 70 Yale L J 1129, 1142-1143 (1961).

 Symptoms are the manifestations of the mental disorder. They represent an attempt by the neurotic personality to resolve inner problems and create psychic gain. Sometimes symptoms do not appear until one’s predisposition toward the mental disorder is "triggered” by some form of trauma, hence the appellation "triggered neurosis”. Sometimes the neurosis has been full blown or "triggered” before employment from which compensation is sought. "Trauma” encompasses both physical and psychological impact. Although trauma traditionally includes physical impact only, emotional shock, fright or extraordinary stress may be equally traumatic.

 See, also, Usdin, Neurosis Following Trauma, in Law, Medicine, Science — and Justice (Bear, ed, Springfield, 111: Charles C Thomas, 1964), pp 237-239; Blinder, The Defense of Claims of Psychic Trauma and Psychiatric Disability, 12 Forum 934, 937 (1977).

 See, e.g., Miller & Fellner, Compensable Injuries and Accompanying Neurosis: The Problem of Continuing Incapacity Despite Medical Recovery, 1968 Wis L Rev 184; Usdin, fn 9, supra; Hanna, Neurosis in Workmen’s Compensation Cases, 11 Defense L J 189 (1962). Indeed, one article notes:
"An able neuro-psychiatrist of our acquaintance went so far as to say it would be a signal service if courts could be induced to deny compensation in all cases of traumatic neurosis, as this would do more than any medical means to banish the disorder. We would not go so far as to espouse universal denial of compensation, but certainly this viewpoint has much in its favor in regard to neuroses which appear following trivial stimuli.” (Emphasis added.) Smith & Solomon, Traumatic Neuroses in Court, 30 Va L Rev 87, 107 fn 26 (1943).
The related problem of "compensation neurosis” is further indication of the often counter-productive nature of the compensation process, at least with regard to mental disorders. E.g., 1A Larson, Workmen’s Compensation Law, § 42.24.

 See fn 4-5 and accompanying text supra. An even more revealing fact situation is provided by Bedfern v Sparks-Withington Co, 403 Mich 63; 268 NW2d 28 (1978), also released today. Joseph Pastaleniec, making a claim for incurable insanity, was described by his expert witness as an obsessive-compulsive who was depressed and intermittently psychotic before his occupational "accident”. The trivial accident was said to be an excuse for him not to work. Yet the record reflects that the claimant "honestly perceives” that his disability was work-related.

 Usdin, in Neurosis Following Trauma, supra, fn 9, pp 242-244, says:
"It is a difficult task in a personal injury case [or compensation case] to differentiate malingering from psychoneurosis. Actually, malingering and hysteria may be considered to differ from each other only in the degree in which the conscious mind is a participant. Malingerers consciously fabricate while neurotics unconsciously use feigned illness to satisfy neurotic needs. Some may disagree, but the author does not believe that psychiatry has developed to the point that psychiatrists can, all the time, or even nearly all the time, detect malingerers, * * * . The diagnosis of malingering can be made in some cases only after a confession of malingering by the patient.” (Emphasis added.)
There are, however, others who believe malingering can be detected by a competent psychiatrist, excepting the extremely experienced or well-trained simulator. See, e.g., Keschner, Simulation of Nervous and Mental Disease, 44 Mich L Rev 715 (1946).

 Although the occupation need not be the proximate cause of the injuries, Whetro v Awkerman, 383 Mich 235; 174 NW2d 783 (1970), Vanderbee v Knape & Vogt Manufacturing Co, 48 Mich App 488; 210 NW2d 801 (1973), it is clear that the statute minimally requires some medical evidence causally connecting the injury and the occupation. MCL 418.301; MSA 17.237(301). We adhere to the previous position, in dissent, that the analytical knife need not be honed sharper than the statutory language. Deziel v Difco Laboratories, Inc, 394 Mich 466; 232 NW2d 146 (1975) (Coleman, J., dissenting). However, if we are to provide further guidance to the finder of fact, we must still be cognizant of the minimal nexus requirements set by the Legislature.
My colleagues would remove even this weak factual link between injury and occupation and replace it with a standard which requires no factual basis for awarding compensation. The implicit, if not explicit, justification for "repealing” the Legislature’s factual prerequisite is the assumption that modern medicine lacks the expertise to determine nexus with any degree of certainty and consistency. Although psychiatry is not an exact science, it is still the best source of expertise available to the finder of fact.

 The majority rejects this query as too "objective” in nature. We cannot agree with this characterization. If one focuses upon the individual, as distinct from the "average” employee, the "aggravate-accelerate-combine” language is inherently subjective.

 This is particularly true because the statute provides compensation for the full extent of the injury. For an argument that awarding compensation in proportion to the extent of the causative role of the job is possible and proper in workmen’s compensation, see Smith & Solomon, Traumatic Neuroses in Court, 30 Va L Rev 87, 138-148 (1943). See, also, 2 Larson, Workmen’s Compensation Law, § 59.20.

 Redfern v Sparks-Withingtoh Co, 403 Mich 63; 268 NW2d 28 (1978).