Medicine: The Whiplash Controversy

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Nobody really knows when the term "whiplash injury" originated, and U.S. insurance companies, which each year pay out substantial damages to supposed whiplash victims, undoubtedly wish it never had. The sudden backward snap of the head to which whiplash is ascribed generally happens in rear-end automobile collisions; these annually result in thousands of cases of alleged neck injury. Yet standard medical dictionaries do not even mention whiplash, and in the District of Columbia's Medical Annals, Washington Surgeon Francis D. Threadgill insists that it is usually only a synonym for "malingering and self-delusion."

Many people who complain of whiplash, reports Dr. Threadgill. "do not have anything more than a temporary indisposition. They have no real injury to muscle, nerve, tendon or bone." In examination of 88 supposed whiplash victims, Threadgill found only 14 cases in which patients' subjective complaints (e.g., neck pains, headaches, loss of sensation, restricted arm movements') could be medically confirmed. His sardonic conclusion: apart from clear-cut cases of bone or nerve in jury, 90% of "socalled whiplash injuries" will disappear within six weeks "if legal settlement can be quickly obtained."

What Hit Him? But whiplash should not be so lightly dismissed, insist Drs. Robert Leopold and Harold Dillon of the University of Pennsylvania's Department of Neurology and Psychiatry. In a study of 47 whiplash victims, Drs. Leopold and Dillon found a considerably higher incidence of actual physical injury (14 "severe" cases, 26 "moderate") than did Dr. Threadgill.

More important, they also concluded that the degree of a patient's emotional reaction to an accident usually bore little relation to the severity of his physical injury. One 52-year-old woman, bothered by persistent neck pains after a minor collision, twice attempted suicide although she had no previous record of neurosis or depression. A 37-year-old ex-Marine was so bewildered by the accident in which he suffered a mild whiplash injury that one month later "he did not know what had hit him, or why."

Threatened Control. The human personality is peculiarly vulnerable to the shock of a sudden assault from behind, argue Drs. Leopold and Dillon. This, they theorize, may trigger a "denial mechanism" that prevents the victim from coming to terms emotionally with the meaning and discomfort of his injury. They add: "The fact that the head and neck are the sites of injury adds to this distortion . . . almost as if the ego unconsciously perceives that the control (head) can be severed from the body. It is our thesis that the whiplash injury is psychologically unique in that both its suddenness and its unconscious meaning tend to mobilize greater anxiety in ordinarily stable and well-integrated individuals than do other diseases or injuries to other parts of the body."