Veterans affairs disability compensation: a case study in countertherapeutic
jurisprudence.
D. Mossman,
Bull. Amer. Acad. Psychiatry & the Law
24(1): 27-44, 1996.
This article examines the disability compensation programs and health care system of the
Department of Veterans Affairs (VA) from the perspective of therapeutic jurisprudence scholarship.
VA psychiatric patients have unambiguous financial incentives to endlessly litigate disability claims,
to seek lengthy hospitalization rather than outpatient treatment, and to be ill, disabled, and
unemployed. These countertherapeutic incentives reward incapacitation, encourage perceiving
one-self as sick, diminish personal responsibility, taint treatment relationships, and lead to
disparaging perceptions of VA patients. In addition, such perceptions produce moral dilemmas that
arise from mutual distrust and frustration when patients and caregivers have antagonistic goals for
the clinical encounter. Changes in disability determination procedures, compensation levels, and
patterns of payment for treatment could give VA patients and caregivers a "healthier" health care
system that encourages personal responsibility and promotes respectful attitudes toward patients. In
the absence of such changes, an awareness of countertherapeutic financial incentives can help
clinicians distinguish between psychopathological behavior and the pursuit of a rational income
strategy, and can help practitioners recognize that apparently deceitful or litigious behavior
represents a reasonable response to the economic contingencies that VA patients face. [References:
100]