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Workers Rehabilitation And Compensation Amendment (Presumption As To Cause Of Disease) Bill 2019


Rosalie Woodruff MP

Rosalie Woodruff MP  -  Tuesday, 9 April 2019

Tags: Post Traumatic Stress, Workers Rehabilitation and Compensation, Vietnam

Dr WOODRUFF - Madam Speaker, I rise on behalf of the Greens to strongly support this very important amendment to the Workers Rehabilitation and Compensation Act. This is a great step for Tasmania and a great step for all people who have suffered trauma and are going through the process of healing or learning to live with post-traumatic stress.

There are a number of comments I want to make about this bill. I understand we are going into Committee and there are a couple of questions I have in relation to exactly who will be included under the definition of 'worker' and 'volunteer', so I will ask those questions then. The Greens argued the case very strongly when the post-traumatic stress disorder legislation came before us previously to include firefighters. We are pleased the Government has undertaken the review and has, as we hoped, included a presumption that post-traumatic stress can be suffered by public sector workers. It shifts the onus of proof from the worker to the employer. In doing so, it continues our strong attempts as a community to destigmatise post-traumatic stress. We know so much more about post-traumatic stress and its impact on brain physiology than we did 70 years ago. Certainly, we know much more than after the end of the First World War in which people suffered extreme exposure to horrific experiences in that terribly brutal war. We called them a range of things when they returned. We had no way of understanding the impact on their brain physiology, on their emotions, on their responses, their volatility, their emotional reclusiveness, their anger and sometimes violence towards the people they loved the most. They were suffering from seeing things they could not comprehend and their brain could not leave behind.

We know a lot more about what healing involves and we know that some people do recover from post-traumatic stress. Other people have to learn how they can accommodate those experiences which, often unbidden, come into their life. Experiences they have had come back and overwhelm them and they have to do deal with their physical and emotional responses.

We strongly welcome this because for people not to have to argue that post-traumatic stress is something they could suffer from in the workplace is a very important shift.

I would like to spend some time talking about language. We have talked about wanting to remove stigma. That is a large part of honouring the reality of people with post-traumatic stress and their right to workers compensation if that stress was caused by a workplace event. It is also about understanding how we talk about that post-traumatic stress. We have moved from talking about post-traumatic stress as a disease and a disorder to a growing awareness that neither of those words are the way that people with post-traumatic stress want to be talked about, or consider themselves. The word 'injury' is being increasingly used. In the bill we talk about a worker suffering an injury that consists of a post-traumatic stress disorder. The title of the bill refers to parts of the underlying act, the Workers Rehabilitation and Compensation Act. We are muddling together three different terms. Do we need to have a more considered discussion with people in the medical and psychiatric communities, people in the first responders communities, people in the post-traumatic stress communities and mental health areas about what terms we use and whether we need to go through state legislation to achieve harmony in these terms?

Post-traumatic stress disorder was created in 1980 as a diagnosis by the American Psychiatric Association under the DSM. It followed a movement after the Vietnam War, the women's family violence movement, genocide survivors and the research that was done on natural disasters at the time. That is the genesis of the concept of post-traumatic stress disorder.

No-one then realised how deeply and widely this term would be used. It is a diagnosis which has helped millions of people around the world by giving name to something that was confusing, frightening and disabling. It allowed us to research causes and remedies. It allowed insurance coverage and disability payments where none existed previously. It meant fostered self-help for people with the condition and collaboration among people who wanted to study and treat post-traumatic stress disorder. At the time it was a good change and was brought about by people who care about trauma and its consequences.

Since then the term 'post-traumatic stress disorder' has also become a source of stigma. The term, indeed the disorder, has been reported as discouraging some people, particularly people from a military experience, from seeking help because they feel that there is a sense of honour from having a war injury. A disorder implies that there is some underlying inadequacy in the person, some weakness. They do not receive the same honour and status as a person who has had their arm blown off by a mine.

This has been pointed out to the American Psychiatric Association. In 2012 there was a move to make a shift in the Diagnostic and Statistical Manual to use the term 'post-traumatic stress injury'. Many people now believe that is the correct term from a physiological point of view as well as from a public perception point of view. People have made the case very strongly that 'disorder' is stigmatising where 'injury' is not.

A number of feminists have been very outspoken about this for many decades. Women who work in the family violence area have made the point that the term 'disorder' stigmatises psychological injuries and prevents people healing. Survivors from rape and domestic violence have many reasons to resent being stigmatised with the idea that they are disordered when their post-trauma reactions are absolutely consistent with injury and a normal response to the extreme violence they have had done to them.

I want mention a few comments that were made by two American psychiatrists, Frank Ochberg and Jonathan Shea in relation to changing this term from 'disorder' to 'injury', because they make some very good points from the medical point of view. They said that from the earliest conversations about creating a new diagnosis of PTSD back in the 1970s, they thought a concept would capture the experience with both survivors of catastrophic events such as war, fires, floods, killing and rape. They did not want the new syndrome only to apply to people with pre-existing conditions. They knew that in mass disasters, some people emerge with flashbacks and years of disabling symptoms while others emerge sadder and affected but not with the pattern of what we now call PTSD.

Some traumas are more traumatic than others. What we have come to understand through research, for example, is that surviving forcible rape, on average, has more intense and prolonged symptoms than surviving a car crash. They say, 'We also knew that one could have a clean bill of health prior to the trauma and then afterwards there was a profound difference'. That difference was not only about being nervous or inhibited. It featured an altered form of memory, a traumatic memory.

This is a core component of the term PTS, post-traumatic stress. It is more than about remembering something terrible. It is about a change in the brain's pattern of memory where people have episodes that are sometimes triggered, sometimes spontaneous; they can be triggered by smells or sensations, they can be garbled or clear pieces of information that come back, and it happens in different states of being awake or asleep. It is not an autobiographical memory or a dreadful event. It is a hot and traumatic memory.

For some survivors, but not all, exposure to a very extreme high signal of traumatic stress causes an actual change in brain physiology. The stimulus is so much that the capacity of an organ - and in the case of post-traumatic stress, the capacity of parts of the brain - to be able to take on that stimulus and to remain resilient as an organ exceeds the capability of the brain.

Post-traumatic stress clearly is not a weakness. It is definitely not, in its origin and manifestation, a disease. It has come from something that has happened, such as a traumatic amputation. No military surgeon would diagnose a soldier who has lost their foot in a mine incident as suffering from 'missing foot disorder'. That helps us to understand how for many people talking about post traumatic distress order just feels wrong. We also would not understand a GP or psychiatrist referring to a woman who has survived a rape or family violence as suffering from 'rape disorder' or 'family violence disorder'. It is the experience of those events or cumulative events which means that a person has post-traumatic stress.

The point is that it is not a disorder. The brain is injured, has been damaged and does not work the way it used to. There is a process of healing that needs to be undertaken. What we need to do as a community is consider whether we ought to be persisting with this term which was introduced to the DSM, the American Psychiatry Association which is responsible for bringing that change in. Should we consider changing that?

I am not standing here today proposing that there is a right way around this area but I encourage the minister, as part of the continuing work in this reform, to take up the opportunity to have formal conversations across the mental health, psychiatric and other medical areas, and especially with first responders to people with PTSI or PTSD - their own terms - and consider how we need to change this term. Should we shift to PTSI, which sounds as though is what is happening more broadly across Australia and around the world, and how do we make an adjustment to the legislation we have across all the different parts of government, such as emergency services, legislation and so on which this amendment bill refers?

I thank the Government for the work that has been done in this area. On behalf of all the people I have spoken to who are living with post-traumatic stress, I support this move. There is more we can do but it is a great start along this pathway.