Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


Patients can become frustrated with their symptoms or delays in their care. They can become irritable. They can become aggrieved. Such patients most often calm rapidly when reassured, their needs are understood and attempts are made to meet those needs.

Belligerent patients, however, cannot be soothed. Just when you think that you have made headway, and they are about to be reasonable, they become abusive. They have no boundaries and will abuse you, your staff and even those upon whom they are knowingly dependent.

Such individuals will not display this in merely one setting although they will try to pit individuals against each other. They will tell you that they disliked their last surgeon and document the reasons. They are never at fault in their stories.

They fire their lawyers, and they change providers, and even those whom they say they trust and respect you will find have been treated poorly.

This becomes a characterological pattern quite early in life. You will find it in the patient_s employment history. You will find it within their family relationships. You will find it in their tenuously held social relationships.

Belligerent individuals are so impressive in their lack of diplomacy that we often create television and movie characters from this mold, and then have them punished in the story line. The only individuals who are comfortable around belligerent patients are those who naively feel they are immune

from the attacks and/or that the attacks will serve some greater good. In reality, these _supportive/encouraging_ individuals ultimately wind up being denigrated by the belligerent patient at some point.

Remember, in their minds, these patients are never wrong. You are. And you cannot sympathize or empathize sufficiently to halt their belligerence. The only option is to deal with the most concrete aspects of their demands and minimize the contact time you have with them. The more time you attempt to invest, the more contempt you will evoke.

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