Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

"Public Enemies"

If you are encumbered by resentment of patients with work related orthopedic injuries, seeing them as inappreciative, uncooperative, manipulative…you are likely a victim of their displacement. This process occurs when an individual is unable to express an emotion toward the targeted person and, instead, expresses it toward someone who is perceived as safe. Your boss frustrates you, and you come home and yell at your spouse. Your spouse angers you, and you are harsh toward your child.

Similarly, injured workers harbor a great deal of anger and resentment. While they can yell at their claims adjustor or attorney, it is not necessarily safe to do so because they can just as readily be abandoned by these individuals.

Your tests are not being authorized, your checks are not arriving on time and your prescriptions are not being filled. As a patient you can, and many do, express this frustration toward their claims adjustor, but is it safe to do so? Is there not a risk in expressing anger at someone you actually need?

For some injured workers, the only safe outlet is the person providing care and support. The nurse case manager and the doctor, after all, “should know” the pain, difficulty, frustration and emptiness of the post injury experience. Some patients hope that this acting out will evoke concern, warmth, compassion and support. Of course, it most often does just the opposite.

The response in such cases is a rather direct one: “Clearly you are angry, frustrated and disappointed. You are expressing these feelings toward me, but I believe that you know that I am doing all that I can. If you can tell me with whom you are truly angry, I may be able to offer some advice and direction. However, if you drive me away, then you are left even more alone.”

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