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Whiplash associated disorders have become an international medicolegal and social dilemma. Physicians are not sure what the best therapeutic approach should be, and the courts are finding the topic growing ever more controversial. There are many evident paradoxes in the development and presentation of such disorders. We will focus particularly on the remarkable epidemiological findings covering the “natural history” of this problem, and provide a biopsychosocial model to explain these observations.
A model that considers that chronic symptoms reflect some form of chronic, injury related damage cannot account for wide differences in the prevalence of such behaviours between different countries and even different regions of the same country.
SINGAPORE AND AUSTRALIA
The behaviour of reporting chronic symptoms, which once was so commonly observed in whiplash patients in Australia, does not occur in Singapore.1 This is despite there being at least as many collisions in Singapore. According to J L Balla, the late whiplash syndrome has thus been viewed as a culturally constructed illness behaviour based on indigenous categories and social structural determinants.1
Expanding on this observation W B Maguire2 notes that even in the absence of opportunity for financial gain in Singapore, if there were Singaporeans suffering from severe and long term “whiplash” symptoms, they should still present themselves at the quite sophisticated and free outpatients departments existing in most large Asian cities. Yet he cannot recall having seen one such case.
NEW ZEALAND AND AUSTRALIA
There is a very low incidence of whiplash cases in New Zealand, compared with the State of Victoria in Australia, even accounting for the number of vehicles and collisions. Mills and Horne explain that a significant difference between the two systems then was that in Australia the common law system readily offers a route to compensation.3 This is not to say that financial gain was necessarily the …
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