With the successful control of many of the most serious occupational hazards to health, the focus of occupational medicine in developed countries has shifted to other work related disorders that are rarely fatal but cause substantial disability. This paper hypothesises that many of these disorders do not arise from detectable organic pathology, but rather are a psychologically mediated response to triggering exposures that is conditioned by individual characteristics and cultural circumstances. If correct, this has important implications for the way in which such illness should be managed and prevented. Proposals are made for ways in which the hypothesis could be tested.

Occupational medicine first emerged as a specialist discipline in response to chemical, physical, and biological hazards that caused serious and often fatal disease. A framework was developed for the management of such hazards that entailed assessment of the relation between exposure and risk; reduction of exposure (by elimination of the noxious agent, improved engineering, modified systems of work or the use of personal protective equipment); and monitoring to check that controls on exposure were effective. This approach has been notably successful, preventing much avoidable morbidity and mortality. For example, in Britain, occupational diseases such as bladder cancer in the rubber industry (from exposure to 2-naphthylamine)¹ and phossy jaw (caused by exposure to white phosphorus)² have now been eliminated.

As many of the most serious occupational hazards have been successfully addressed, attention has shifted increasingly to other work related disorders which are rarely fatal, but which nevertheless give rise to widespread illness and disability, and account for substantial loss of time from work and demand for healthcare. Thus, when Harrington and Calvert conducted a survey of managers and occupational physicians in 1996, both professional groups identified musculoskeletal disorders and occupational stress as the two …