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18 January 1999

Compensation syndrome

Dr Michael Fitzpatrick on the origins of Gulf War syndrome and other similar conditions

The conclusion of a survey of 3000 veterans of the 1991 Gulf War, published in The Lancet last week, was that Gulf War syndrome does not exist. This is unlikely to curtail the wave of claims from those who say they are victims of this syndrome and their legal advocates whose cause is driven by a powerful culture of compensation, which seeks redress for people who believe that their misfortunes can be blamed on something or somebody, irrespective of the weight of objective evidence to the contrary.

Many Gulf War veterans claim that a wide range of symptoms (including chronic fatigue, insomnia, headaches, joint and muscle pains, skin conditions, even cancers and congenital abnormalities in veterans' children) are attributable to particular hazards of the war - vaccinations against biological weapons, exposure to pesticides, chemicals, toxic gases from burning oil-wells and wearing nuclear-biological-chemical protection suits. Last week's report confirmed that servicemen returning from the Gulf suffered more illnesses than those who came home from Bosnia, but could not identify a specific illness or cause.

Gulf War syndrome is one of a number of conditions, which, though they lack a clear medical definition, are driven by victims' claims for compensation. These include conditions attributed to some immunisations, repetitive strain injury supposedly caused by keyboard working, respiratory diseases blamed on passive smoking, post-traumatic stress disorder and other 'stress' disorders, some cases of chronic fatigue syndrome/ME. As a growing number of cases arising from such claims come to court, and victims are encouraged by specialist solicitors to join 'class' actions with fellow victims, the numbers suffering from these conditions is growing rapidly.

The culture of compensation is driven by a number of factors.

* a high prevalence of unexplained physical symptoms

Numerous surveys confirm that many people who consult doctors present symptoms which cannot be explained according to recognised disease categories. It appears that such complaints are especially common in public services - the armed forces and the police, health, education and local government. The common features of these occupational groups are low morale and a widespread sense of being overworked, underpaid and undervalued.

* an enhanced sense of individual vulnerability

It is striking that soldiers and policemen, whose job has always involved some exposure to the grisly side of life, now appear to experience emotional trauma in the course of their work on an unprecedented scale. A common feature of the compensation syndromes is a perception of damage to the immune system, resulting from vaccinations, toxins, radiation, etc. The immune system - more a physiological concept than an anatomical entity - has become a metaphor for a sense of individual vulnerability.

* a breakdown of trust

Another common theme of the compensation syndromes is the conviction that established sources of authority - government, doctors, scientists - cannot be trusted. Indeed it is widely believed that such agencies are withholding information or otherwise misleading the public in the pursuit of their own or other vested interests (though this does not prevent claimants from putting their faith in rival experts, so long as they confirm the claims of victimhood). Healthy scepticism has been corrupted into a denial of even the possibility of objectivity; the result is the elevation of subjectivity and a descent into irrationalism. 'We strongly believe that the cocktail of vaccinations has broken down the immune system and the neurological system', says Tony Flint of the National Gulf War Veterans and Families Association, indicating that this is for him an article of faith, beyond any influence by the results of objective scientific inquiry.

* blaming and claiming

The belief that one's own misfortune is somebody else's fault is a familiar infantile reaction. In parallel with wider trends towards the infantilisation of modern society, it now drives the culture of compensation. Claims for compensation from society for the misfortune of illness are encouraged by lawyers and also by the inadequacy of welfare provision for those suffering from chronic debilitating disease.

The origins of Gulf War syndrome - and other similar conditions - are not likely to be found through studying the effects of diverse alleged toxins on the immune system. A study of the relationship between the individual and modern society might provide more valuable insights into the contemporary malaise and the symptoms of distress to which it gives rise.

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