Susto and the career path of the victim of an industrial accident: A sociological case study

This is a case study of the processes involved in attaining the status of 'victim' after an industrial accident. In this case a migrant working in the manufacturing industry becomes increasingly 'disabled' and seeks legitimation as a 'victim' who is 'worthy' of financial compensation. The institutional processes involved are the industrial, medical and legal systems. Chronic pain is a condition that often defies an unambiguous diagnosis. Most chronic pain victims are therefore constantly seeking legitimation for their condition as physicians attempt to uncover the aetiology of the pain. Most chronic pain victims also fail to fulfil the expectation of getting well as soon as possible. Physicians can, at best, only give a prognosis that is little better than an 'educated guess'. The conditional nature of the legitimacy gives the chronic pain victims only limited legitimacy for their sick role and this often results in physicians seeking psychological or moral explanations for what began as a relatively simple physical problem. Psychological or psychiatric diagnoses are considerably weaker metaphorically than physiological diagnoses and tend to infer the strong possibility of the victim contributing to her/his condition as a result of hypochondriacal or psychosomatic 'tendencies' or, even worse, 'malingering'. The migrant client can exacerbate this situation through an earnest desire to (over)conform to norms by going along with whatever is recommended by people who hold superior status by virtue of their knowledge and power ('posicíon'). Among some Latin American countries 'over-compliance' has been recognised a socio-medical condition and is termed 'susto'. In the workers' compensation context the shift to overconformity ('susto') results from the uncertainty about receiving (legitimate) acknowledgement and compensation. The desire is to ensure, as far as possible, that a certainty of outcome is achieved (i.e. a return to work or adequate compensation). In other words, concurrent practises within the system (medical-social-legal) produces what it tries to eliminate-- the seemingly unjustifiable/illegitimate internalising of the role of victim intent on receiving compensation. 'Susto' is therefore an adaptive response to normative ambiguity and uncertainty about future outcomes. Under conditions of worsening health (physical and mental), and the pressure to continue treatment, the best 'solution' for the victim appears to be to 'pull the victim out of the medical system', to de-socialise her/him from semi-institutionalisation, and to use social and informal support structures to build up on the victim's independence, self-esteem, personal integrity and sense of control of her/his own life.