Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Medication Access

Early childhood abuse is, of course, not related to their injury, but it may determine the compliance with treatment, the effort put forth in rehabilitation and ultimately their use of narcotics and willingness to ever return to work.

Abuse occurs when we are vulnerable. Arguably there is nothing more horrible than the concept and reality of child abuse. Only second to that is spousal abuse.

In both situations, the individual is left powerless, helpless and often hopeless. They rapidly lose the capacity to trust, feel betrayed by authority and feel alone and abandoned by their world. There is shame, embarrassment and unresolved rage.

This formerly (or sometimes currently) abused individual is injured at work. Indeed, sometimes they are only working because the abusive individual in their life insists that they do. They become injured and are fearful of the response at home when they are no longer financially productive. The workers’ comp system does not probe this area, and the patient is shuttled between clinic, providers and treatment regimen. Someone may note that they are depressed, withdrawn and “not putting forth full effort.” Yet no one will ask if they have been, or are currently being, abused.

If the abuse is current, the patient may need to enter a shelter along with dependent children. If the abuse is part of a distant past, the patient’s fear of mistreatment and abandonment by treating physicians, there needs to be very specific and targeted reassurances and demonstration that the fears are unfounded.

These factors are, unfortunately, not rare when treating industrially injured workers. Individuals from such a background often quit school and marry to flee abuse. Or if the abuse has occurred during adulthood, they will desperately seek any, even high risk, employment just to escape an oppressive situation.

Thus, you need to determine if the patient selected this particular job largely because of abuse, has poor relationship with you and others because of abuse and fully expects (and will create) failure since this has so much been a part of life.

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