Overview of Occupation Neuroses

Overview of Occupation Neuroses (Table. 3)
In retrospect, those conditions originally included under the umbrella of Gowers' "Occupation Neuroses" comprised focal dystonias involving the upper limb (Sheehy and Marsden, 1982), the various upper limb entrapment neuropathies (Spaans, 1970), other neuritides (Mumenthaler and Schliack, 1991), and poorly understood local musculo-skeletal conditions (Bach, 1935; Travell, 1976; Yunus, 1983) as well as "hysterical" symptoms presenting in an occupational setting (Culpin, 1931).
Up until recently, occupational spasms, cramps and pains were described in the psychiatric literature as manifestations of conversion hysteria (Noyes, 1953; Kolb and Brodie, 1982). However opinions have changed significantly. For example, Lishman (1978) did not find that the existing psychodynamic, organic or learning theory models had great explanatory power. By 1987 it was generally acknowledged in the psychiatric literature that the aetiology of the adult-onset dystonias remained unknown and that there was "little current evidence that psychosocial factors are contributory" (Martin and Black, 1987). There has also been a realisation that chronic regional pain syndromes which had previously defied explanation in other than psychological terms may have an underlying neurophysiological basis (Merskey, 1990).
Although the 19th century construct of "neurosis" as an organic disturbance of central nervous system function has largely disappeared from medical thinking, that of "occupation neurosis" has remained in the medical literature to denote the various poorly understood occupational upper limb syndromes of diffuse pain, spasm and weakness, without demonstrable organic disease of the nervous system. As "neurosis" evolved into "psychoneurosis", it acquired a psychogenic connotation which has remained, despite the inherent untestability of the construct.

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