One of the first things that becomes readily apparent in any review of the nation's worker's compensation laws, Michigan's included, is that they are crafted for and anticipate compensation for physical injuries. The whole focus on "injury" or "accident" and "arising out of employment" and "limitation" reflects a system designed to respond to physical disability, and indeed, until recent decades, that is exactly what the worker's compensation system in each state did address. Mental claims were rare and, when redressed, were usually tied to a claimant's simultaneous physical problems.

Although various diagnoses and descriptive terminology have developed, they are extremely flexible and imprecise in practical application.

This historical happenstance is important. There is a very significant difference between dealing with physical injuries and dealing with mental complaints. Physical problems are substantially more tangible than mental problems. Medical science is much better able to recognize physical problems, and so are lawyers and adjudicators. Objective tests can usually measure physical complaints and restrictions. Patient response to physical pain and physical limitations is much more readily identifiable by simple observation.

If a person is injured while lifting a heavy object, the consequences of such injury are usually quite quantifiable. X-rays, MRI's and other sophisticated medical tools can often show to the eye the consequences of the injury. Physicians have a battery of objective medical tests available to them for testing the practical impact of such injury upon a patient's ability to physically function. Doctors may debate the precise source of such injury, or the severity of the injury, or the proper mode of treatment, but such debate is engaged within fairly narrow confines. There is a common language among both medical experts and laymen in analyzing a back injury.

In sharp contrast, a mental problem is unquantifiable. It exists purely in the mind of the individual. It manifests itself entirely in modes of behavior. It is entirely dependent upon the subjective explanations of the patient. No tests exist which can provide any type of certainty for the measurement of the mental problem. Physicians simply have not yet achieved any kind of true understanding of the processes of the mind. Although various diagnoses and descriptive terminology have developed, they are extremely flexible and imprecise in practical application. Laymen, including the attorneys and adjudicators in the worker's compensation system, usually find themselves adrift in uncertainty, turning with something close to helplessness toward psychiatric/psychological experts.

It is this dramatic difference between physical and mental "injuries" which produces the most problems in the worker's compensation system. As certain states across the country have moved in the direction of compensating stress, the dilemmas posed by the uncertainty of the entire field of mental health has resulted in a more chaotic, ever-changing mix of compensation entitlement standards than has ever been witnessed in any other area of worker's compensation law. Difficult areas such as heart disease and occupational diseases (such as cancer, asbestosis, toxic syndromes, etc.) have produced their share of consternation, but no area of worker's compensation law has produced more debate and discomfort than the area of mental disability. Legislators crafting the statutes and judges interpreting the law have simply not been comfortable enough to address mental disability claims with any kind of certainty or full expression of confidence.